Considerations, flexibility and supervision

Client Considerations

This therapy has been developed to be appropriate for Muslim clients who meet criteria for depression. It is also suitable for clients with other clinical depressive disorders and those who have significant depressed mood along with another diagnosis. It is not designed to be used with clients who (a) have bipolar depression, (b) are psychotic, (c) have a primary disorder for which empirically supported treatments exist (e.g., PTSD, other anxiety disorders, and borderline personality disorder) unless it is felt that depression should be the immediate focus of treatment, or (d) have primary substance abuse or dependence. Once BA-M has begun or been completed, therapists should follow their normal practice for stepping clients up to higher intensity interventions if this is appropriate, bearing in mind that BA has been found to be effective for severe depression (Dimidjian et al., 2006) and is used for addressing relationship problems (Kanter, 2010).

The manual is intended for use with all Muslim clients including: those who would benefit from BA with a strong intertwining of Muslim faith teachings, those for whom faith is not a major consideration in terms of their values and those who have an ambivalent or unsettled view on the role they want faith to play in their treatment.

Manual Flexibility

The flexibility of the manual is demonstrated in the picture on the left. The BA approach will remain constant in therapy no matter what the religious inclination of the client. The focus on Islamic teachings within this manual, however, will vary for different people from Muslim backgrounds. For some clients the focus on Islamic teachings will not be very relevant as this is not an important part of their identity or value framework. For others, these teachings will be somewhat relevant or they may feel ambivalent about their relationship with God. For some clients, religious teachings will be central to their identity and the most important aspect of their value framework.

Therapist Considerations/Supervision

To use this adapted therapy, therapists must:

• have graduate-level training in psychology, psychiatry, psychiatric social work or nursing, or counselling;
• have access to clinical backup and supervision and/or consultation from licensed mental health professionals (Kanter, 2010);
• be open to approaches outlined in the section of this manual entitled Treating Muslim Clients with Depression in order to work with Muslim clients effectively.

Supervision

As with integrating any new techniques into one’s therapeutic repertoire, it is recommended that those wishing to become proficient in the practice of BA-M receive feedback and guidance from a supervisor. The necessary qualifications of the supervisor will depend on the attributes of the therapist. Therapists who have practiced BA, but are unfamiliar with Islam or Muslim communities should enlist supervision from someone sensitive to Islamic teachings. Therapists who have experience of treating Muslim clients should seek out supervision from an experienced BA therapist.

Our pilot study highlighted the value of a group of people delivering the intervention at the same site to facilitate helpful discussion and peer supervision. It was also helpful for therapists to have access to a range of colleagues with expertise in BA and/or Islam to whom they could refer for advice on either area when necessary.

A list of questions that could be used for self-reflection and by supervisors with therapists is provided at Appendix 9.