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Nondirective counseling in Islamic

culture in the Middle East explored
through the work of one Muslim
person-centered counselor in the State
of Qatar
a

Aisha Al-Thani & Judy Moore

a

Qatar University , Doha , Qatar

University of East Anglia , Norwich , UK

Published online: 14 Aug 2012.

To cite this article: Aisha Al-Thani & Judy Moore (2012) Nondirective counseling in Islamic
culture in the Middle East explored through the work of one Muslim person-centered counselor
in the State of Qatar, Person-Centered & Experiential Psychotherapies, 11:3, 190-204, DOI:
10.1080/14779757.2012.686888
To link to this article: http://dx.doi.org/10.1080/14779757.2012.686888

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Person-Centered & Experiential Psychotherapies

Vol. 11, No. 3, September 2012, 190204

Nondirective counseling in Islamic culture in the Middle East explored

through the work of one Muslim person-centered counselor in the State
of Qatar
Aisha Al-Thania and Judy Mooreb*
a

Qatar University, Doha, Qatar; bUniversity of East Anglia, Norwich, UK

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(Received 30 December 2011; nal version received 16 April 2012)

Between 2006 and 2010 Aisha Al-Thani, under the academic supervision of Judy
Moore, studied the eects of introducing a form of nondirective counseling with a
selection of depressed clients at the Hamad Medical Corporation (HMC) in the
Islamic State of Qatar. The Middle Eastern perspective on counseling and the
need for cultural sensitivity to Islamic teaching in introducing nondirective
counseling in this society is discussed. Counseling sessions were recorded and
transcribed in Arabic and then translated into English; clients were also scored on
the Beck Depression Inventory. The outcomes of nine cases are given here and
issues around directivity/nondirectivity briey discussed; a fuller discussion is
made of one case example, Faimah, a devout Muslim woman, who responded
particularly well to nondirective counseling. It is clear that a shared Islamic
framework is critical to the success of the counseling and that nondirective
counseling can work in Islamic culture when it is introduced with insider
sensitivity.
Keywords: Islamic counseling; nondirectivity; depression; religion

Nicht-direktive Beratung in der islamischen Kultur im Mittleren Osten

anhandder Arbeit einer muslimischen personzentrierten Beraterin in Qatar
Zwischen 2006 und 2010 untersuchte Aisha Al-Thani, unter Supervision von Judy
Moore, die Wirkung einer Form von nicht-direktiver Beratung bei einer Gruppe
von depressiven Klienten am Hamad Medical Corporation (HMC) im
Islamischen Staat von Qatar. Der Beitrag diskutiert die mittelostliche Perspektive
auf Beratung und die Notwendigkeit fur kulturelle Sensibilitat fur die islamische
Lehre, wenn man nicht-direktive Beratung in dieser Gesellschaft einfuhrt.
Beratungssitzungen wurden aufgezeichnet, ins Arabische transkribiert und dann
ins Englische ubersetzt; die Klienten wurden auch mit der Beck DepressionsSkala geratet. Der Outcome von neun Fallen wird vorgestellt und die Fragen zu
Direktivitat/Nicht-Direktivitat kurz diskutiert; ausfuhrlicher wird ein Fallbeispiel: einer uberzeugt muslimische Frau erortert, die besonders gut auf die nichtdirektiver Beratung ansprach. Ein islamischer Bezugsrahmen ist entscheidend ist
fur den Erfolg der Beratung ; sie kann in der islamischen Kultur funktionieren
kann, wenn sie mit Insider Gespur eingefuhrt wird.

*Corresponding author. Email: judith.moore@uea.ac.uk

ISSN 1477-9757 print/ISSN 1752-9182 online
2012 World Association for Person-Centered & Experiential Psychotherapy & Counseling
http://dx.doi.org/10.1080/14779757.2012.686888
http://www.tandfonline.com

Person-Centered & Experiential Psychotherapies

191

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Counseling no directivo en la cultura islamica en Medio Oriente explorado a

traves del trabajo de un counselor musulman centrado en la persona del
Estado de Qatar
Entre 2006 y 2010 Aisha Al-Thani, bajo la supervision academica de Judy Moore,
estudio los efectos de introducir una forma de counseling no directivo con una
seleccion de clientes deprimidos en la Corporacion Medica Hamad (HMC en
ingles) en el Estado Islamico de Qatar. Se discute la perspectiva de Medio Oriente
sobre el counseling y la necesidad de sensibilidad cultural a la ensenanza islamica
si se quiere introducir el counseling no directivo en esta sociedad. Las sesiones de
counseling fueron grabadas y transcriptas en arabe y luego traducidas al ingles;
los clientes tambien fueron evaluados en el inventario de depresion de Beck.
Presentamos aqu los resultados de nueve casos y examinamos brevemente
cuestiones en torno a directividad/no directividad; tambien hacemos una
discusion mas profunda sobre un caso ejemplo, Faimah, una mujer musulmana
devota, que respondio muy bien al counseling no directivo. Esta claro que un
marco islamico compartido es fundamental para el exito del proceso de
counseling; y que el counseling no directivo puede funcionar en la cultura
islamica cuando es introducido con la sensibilidad de alguien de esa cultura.

Une etude de counseling non-directif dans la culture islamique au Moyen

Orient a` travers le travail dun counselor musulman centre sur la personne
dans letat du Qatar
Entre 2006 et 2010, Aisha Al-Thani a etudie, avec la supervision academique
de JudyMoore, les eets de lintroduction dune forme de counseling nondirectif aupre`s dune selection de clients depressifs au Hamad Medical
Corporation (HMC) dans letat islamique du Qatar. Cet article comprend une
discussion sur la vision moyenne-orientale du counseling et sur limportance
dune sensibilite culturelle en lien avec lenseignement de lIslam, lors de
lintroduction de la pratique du counseling non-directif dans cette societe. Les
seances de counseling sont enregistrees, transcrites en arabe et traduites en
anglais et les clients sont classes selon linventaire de depression de Beck. Les
resultats de neuf cas sont presentes ainsi quune bre`ve discussion autour de
questions de directivite/non-directivite. Un cas est presente de manie`re plus
approfondie en tant quexemple : il sagit de Faimah, une femme pieuse
musulmane pour qui le counseling non-directif est particulie`rement beneque. Il
est clair quun cadre de reference islamique partage est un facteur critique pour
la reussite du counseling et que le counseling non-directif peut etre ecace dans
la culture islamique quand il est utilise avec la sensibilite dun praticien qui la
connait de linterieur.

Counselling nao-diretivo na cultura islamica do Medio Oriente explorado a

partir do trabalho de um counsellor centrado na pessoa no Estado do Qatar
Entre 2006 e 2010, Aisha Al-Thani estudou, sob supervisao academica de Judy
Moore, os efeitos da introducao de uma abordagem de counselling nao-diretivo
num grupo de clientes deprimidos, na Hamad Medical Corporation (HMC), no
Estado Islamico do Qatar. Este artigo debate a perspetiva do Medio Oriente
sobre o counselling e a necessidade de uma sensibilidade cultural aos
ensinamentos islamicos aquando da introducao do counselling nao-diretivo
nestas sociedade. As sessoes de counselling foram gravadas e transcritas em
arabe e posteriormente traduzidas para ingles. Os clientes foram tambem
avaliados pelo Inventario de Depressao de Beck. Sao aqui apresentados os
resultados de nove casos e sao discutidos brevemente temas em torno da questao
da diretividade/nao-diretividade. E apresentada uma descricao mais exaustiva
de um dos casos, o de Faimah, uma muculmana devota, que respondeu
particularmente bem ao counselling nao-diretivo. E evidente que um quadro de

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A. Al-Thani and J. Moore

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referencia islamico compartilhadoe um fator cr tico para o sucesso do counselling

e que o counselling nao-diretivo pode ser bem-sucedido numa cultura islamica,
quando introduzido com a sensibilidade de alguem que pertence a` cultura.

Introduction
Over the past decade three postgraduate students from the Centre for Counselling
Studies at the University of East Anglia, England, have explored the viability of
introducing nondirective counseling in the Middle East: Dekheel Al-Bahadel in the
Kingdom of Saudi Arabia; Aisha Al-Thani in the State of Qatar and Justin Hett in
Syria. For the past decade Dekheel Al-Bahadel has sought to introduce counseling
for women and for families as well as to promote counseling in educational contexts
in Saudi Arabia. Justin Hett has more recently oered person-centered counseling in
Syria and his work will be published in due course. Some common themes emerge in
the work of all three, but this article will focus specically on the work of Aisha AlThani, herself a Sunni Muslim, who oered person-centered counseling to an
exclusively Muslim client group in a state where Islam is the ocial religion and
Sharia (Islamic law) the main source of legislation. The recordings of her counseling
sessions have been translated from Arabic to English and oer clear evidence of how
a form of nondirective counseling was oered in a particular Muslim culture and
what kind of modications were needed to make the counseling acceptable and
therefore successful with some clients.
The need for psychological support in the Middle East has accelerated in
recent years with many societal changes having taken place following the
discovery of vast oil reserves in the area in the 1940s. In Qatar, as elsewhere in
the region, increased wealth has meant that family structures have changed: more
women are now likely to work outside the home; there has been an inux of
foreign workers and Western, particularly U.S., inuences have permeated the
culture. Another change, partly in response to the increased stress and confusion
brought about by rapid societal change, is that psychological services have
been established, including the Psychiatric Hospital of the Hamad Medical

Person-Centered & Experiential Psychotherapies

193

Corporation (HMC), founded in 1979. It is here that Aisha Al-Thanis study took
place.

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Islamic counseling
Since the 1970s a limited amount of counseling has been introduced into Arabic
Islamic cultures, based on the Holy Quran and the teaching of the Prophet
Mohammed (Peace Be Upon Him PBUH). Khalili, Murken, Reich, Shah and
Vahabzadeh (2001) state that:
The Islamic psychotherapeutic approach emphasizes the biological, social and spiritual
aspect of individuals . . . Islamic psychotherapy is reective, directive and critically
supportive. It emphasizes religious and cultural values . . . [it] emphasizes the importance
and benecial eects of the family and social bonds against all-out individualism and
selsh concerns. (p. 226)

Inayat (2001) emphasized the importance of applying Islamic values and traditions
in conjunction with the Holy Quran and the Prophets (PBUH) teachings. Badri
(2007) pointed out how closely cognitive psychology and other modern psychotherapeutic interventions recall early Islamic teaching and, in eect, that Western
therapies oer little that is new for the Muslim. Abdullah (2008), however, argued
that Islamic counseling needs to be developed to fulll individuals needs for
religious and spiritual support.
The general view of mental health professionals in Qatar prior to Aisha AlThanis study (Al-Thani, 2010) was that most clients seek help in the expectation of
getting a directive approach to their problems. One interviewee in the study
expressed this in the following terms:
The client wants . . . the counselor to give him an idea for solving his problem . . . He
wants you to help him nd the words that help him think and reach a solution
or a specic idea. The client wants everything quickly. Reaching the solution makes him
feel relaxed and he feels hes had the counselors help to solve his problems. (p. 36)

A psychologist interviewed as part of the study explained his own experience of

working with people with psychological diculties:
From my many years of observation I found it dicult to convince people to take a
more reciprocal and driving role in therapy. This is because people think that doctors
[and professionals working in the health care service] have a solution and that they
know everything in their eld. So clients expect to get advice from them. (p. 37)

The authority with which doctors and health care professionals are endowed is a
reection of the authority that is held by the Muslim cleric, the Imam, whose role is to
guide and direct Muslims by teaching them the Quran and showing them how to apply
it in their daily lives. Moracco, an early commentator on counseling in the Middle
East, is very clear about the inappropriateness of nondirectivity in this context:
Recognizing that the Middle Easterner is a product of an authoritarian society,
approaches to counseling which depend on counseling initiatives such as a strictly nondirective approach may not be appropriate. (1978, p. 207)

Unsurprisingly, given this view, Cognitive Behavioral Therapy (CBT) is the most
popular form of therapy in the Middle East and is widely regarded as being the

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A. Al-Thani and J. Moore

therapeutic intervention that is most compatible with Islam. Islamic counseling is

characterized by the introduction of Islamic teaching into the counseling session and,
because of the perceived compatibility of CBT, has traditionally had a cognitive bias.
Al-Bahadels original (2004) study favored CBT as the therapy of choice for Saudi
Arabia and, while he has more recently come to appreciate the potential of other, more
nondirective therapeutic approaches, particularly for counseling in an educational
context, the widespread popularity of CBT makes sense in Islamic terms. In addressing
a combination of cognitions and behaviors it is helpful in supporting Muslim clients
whose faith encourages them to change unwanted thoughts and behaviors. It does not
focus on changing the clients belief system or their intrinsic sense of self. The role of
the counselor is based on directivity and guidance, with homework as part of the
treatment, and an Islamic CBT counselor would ask a client to pray and do physical or
mental exercises at home related to his or her problems.
The dilemma facing Aisha Al-Thani in her endeavor to bring nondirective
person-centered counseling to her native Qatar was how to work to empower her
clients without challenging her culture, a culture in which the expert is
generally seen as being outside the self. In this respect her insider status was
vital in giving her the cultural understanding to discover a form of nondirective
counseling that would be appropriate both to her clients and to herself. Her
counseling work needed to incorporate Islamic teaching, but in such a way that
the client could also access inner experiencing in order to nd their own best way
forward.
Nondirective Islamic counseling
Verily never will Allah change the condition of a people until they change it themselves.
(Holy Quran, 13:11. www.Al-Islam.com)

Aisha Al-Thani completed her training in the person-centered approach at the

University of Durham in 2002. Through this training, she developed an
understanding and appreciation of the potential of the person-centered approach
to help clients beyond the Western culture in which she trained. Her aim as a
voluntary counselor at the psychiatric hospital of the Hamad Medical
Corporation (HMC) in Qatar, where she worked for several years, was, through
person-centered counseling, to help those clients who wanted to be listened to and
understood and were capable of learning to take more responsibility for their
lives. She knew that this kind of counseling would work when clients were able to
move beyond depending on the counselor to change them. Between 2006 and
2010 she engaged in a comprehensive study to investigate what her particular
kind of nondirective counseling looked like. A full version of this study appears
in her Ph.D. thesis, which she successfully completed at the University of East
Anglia in 2010.
Deeply versed in Islamic teaching, Aisha Al-Thani was able to move beyond an
authoritarian conception of the role of the helper, without losing her sense of what is
required by her religion. She believed that there is evidence enough in the Holy
Quran to support her in working towards enabling clients to become more aware of
themselves and more self-directing in their lives. She followed the Prophet
Mohammeds (PBUH) methods of working with individuals and integrated his
teaching into her oering of the therapeutic conditions of the person-centered

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Person-Centered & Experiential Psychotherapies

195

approach. Her fundamental belief is that the counseling relationship has to be based
on both Islamic values and nondirective principles.
Central to her work is the understanding that Al-Thani brought to her Muslim
clients that the Quran is the only truth (Johansen, 2005, p. 182) and that the
principles and practices of Sharia law must be followed. This inevitably places some
constraints on what can be freely explored in the counseling relationship.
Homosexuality, for example, is haram (forbidden) by Sharia law and so cannot be
discussed without the counselor being obliged to point out that indulging this
tendency in the self through active engagement in homosexual behavior is haram. A
similar constraint is evident in terms of the Islamic requirement of respect for
parents, which means that negative feelings towards parents should not be
encouraged, however badly the parent might have treated the child. While the
client might introduce certain topics, the counselor reminds the client of Islamic
teaching where a course of action they are taking or planning to take is either haram
or simply against their religion.
Nondirectivity in Islamic culture, such as that of the State of Qatar, needs to
operate within a fabric of societal rules and conventions that are beyond challenge.
They are clear givens within a framework of shared understanding. The terms
self-actualization and self-awareness can be misunderstood when individuals
needs and decisions are based on the needs of the whole society (Badri, 2007).
Nevertheless, the development of the self through three stages (Nafs) is central to
Islamic teaching. The word self is mentioned in 259 verses in the Quran and refers
to the conscious part of ourselves that we need to develop in the best way we can over
a lifetime and encompasses the following: soul, the part of us that gives us life,
which is mentioned in 22 verses; mind (our thinking function) in 49 verses; and
heart in 132 verses (Mansour & Abo Abah, 1996, cited in Al-Malki, 2002, p.18).
The Islamic counselor will accompany their client in awareness of the three stages of
the self, conscious that the third stage (the satised soul, Nafs al Mutmainnah) is the
desirable point of development for all Muslims. The struggle with the self is regarded
as the greatest jihad (struggle) because individuals have to ght with their own desires
to reach the highest state. While no writer on counseling in an Islamic context prior to
Al-Thani advocates person-centered counseling as a therapy of choice, the value of
empathy is acknowledged by such writers as Chaleby and Racy (1999, p. 135) and the
need for warmth in the counselor towards the client, following the teaching style of
the Prophet Mohammed (PBUH), is widely accepted (e.g., Badri, 2007).
Within the powerful and clear framework of Islam is a shared understanding of
the potential of all human beings and a strong sense of the all-encompassing love of
Allah (Subhanahu Wa Taala the most gloried, the most high SWT). Moreover,
it is possible for the counselor to adapt some aspects of the Prophets (PBUH)
methods of teaching: clear communication with the other person, smiling to put the
other person at ease, and attention to both verbal and nonverbal communication.
Even as a nondirective Muslim counselor, Al-Thani would follow other, more
directive, Islamic counselors example in providing clients with verses from the Holy
Quran whenever it felt appropriate, for example:
On no soul doth Allah place a burden greater than it can bear. It gets every good that it
earns, and suers every ill that it earns. (Holy Quran, 2: 286)
If ye did well, ye did well for yourselves; if ye did evil [ye did it] against yourselves. (Holy
Quran, 17:7)

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A. Al-Thani and J. Moore

Part of her method also involved the introduction of formal Islamic prayer, salat,
and the remembering of the names of Allah (SWT), the aim of which she describes as
to maintain the relationship with Allah (SWT) . . . it is a method used to reduce
stress, worries and fears (Al-Thani, 2010, p. 52). The Muslim is also advised to
develop forgiveness (for both self and other) and to control anger:
The strong is not the one who overcomes people by use of his strength; rather he is the
one who controls himself while in anger. (Al-Jumuah, 2006)

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Beware of anger, for it is a live coal on the heart of the son of Adam. (Al-Jumuah, 2006)

In summary, Islamic nondirective counseling may be regarded as a combination

of teaching and reiteration of shared Islamic understanding within the context of
an acceptant and empathic person-centered relationship. In this relationship trust
is placed not only in Allah (SWT) and in the counselor, but also in the clients
intrinsic ability to self-reect and take greater responsibility for their lives and
choices. Both counselor and client are held by their faith and the counseling
can proceed within this shared and safe space, with both aware of the Islamic
teaching of needing to care for the self by loving and respecting it, putting Allah
(SWT) rst and then others, and learning from experience (Al-Qarnee, 2002: AlRashidi, 1995). At the same time, both counselor and client know that certain
behaviors are forbidden, that parents must be respected, that forgiveness must be
developed, and anger controlled. It is within this context that the client is
accepted as the authority on his or her own experiencing and encouraged to nd
their own way forward.
Outline of the research project
Both phases of the research (a pilot study in 2006 and a further study in 2007) took
place at the Psychiatric Hospital of the Hamad Medical Corporation (HMC), which
also gave ethical clearance for the project. The client group of choice for the project
comprised individuals who had been diagnosed as suering from depression and
who were regarded as suciently educated to be able to benet from a
psychotherapeutic intervention. All clients were initially referred by a psychologist
at the hospital. In the pilot study two male and two female clients completed eight
sessions of person-centered counseling; the 2007 study yielded data from three
female and two male clients who were oered as many counseling sessions as both
counselor and client considered necessary, though in practice no more than 14
sessions were completed by any one client. All clients, for both phases of the
research, were aged between 25 and 51.
It was made clear to participating clients that they were being oered a new type
of therapeutic intervention, nondirective counseling, by a qualied practitioner who
was also engaged in a research project. As part of the consent process, clients agreed
to the video recording and transcription of their counseling sessions. It was made
clear to participants that they could withdraw from the research project at any time
without their counseling being aected.
Some signicant changes were made between the pilot study and the 2007 study.
In 2006 the counseling did not take place in a dedicated space and counselor and
client frequently did not know which room they would be in or had to change rooms
at the last minute. In 2007 the counselor asked for and was given a dedicated room in
the hospital, which she was able to personalize with plants and cushions and create a

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Person-Centered & Experiential Psychotherapies

197

pleasant counseling space. In 2006 the counselor/researcher herself conducted postsession interviews, but in 2007 the psychologist responsible for making the original
referrals conducted the interviews so that clients did not feel obliged to give positive
feedback to their counselor. It was decided that more open-ended counseling should
be oered for the second phase of the study as it was clear from the pilot study that
some clients could have made good use of more sessions.
All counselling sessions were recorded, transcribed in Arabic, and then translated
into English. The majority of participating clients lled out the Beck Depression
Inventory (BDI-II) (Beck, Steer, & Brown, 1996) at the beginning and at the end of
the counseling. BDI-II is commonly used to measure levels of depression at HMC
and was therefore regarded as the most suitable quantitative measure. BDI-II
contains 21 questions, each being scored on a value 03. The scores are regarded as
indicating the following: 013: minimal depression; 1419: mild depression; 2018:
moderate depression and 2963: severe depression.
Both the BDI scores and the self-report scoring sheets for the pilot study show
little change for each client, though qualitative analysis of the counseling sessions, in
particular for Yassir, Maha and Amer, show signicant progression in terms of selfunderstanding and insight. Amers high score at the end of the counseling was
directly related to being very upset by problems at work, reporting at his post-session
interview that when you saw me at the last session I was really worried, I was not
totally with you. It was clear that he would have continued with further sessions
had they been on oer.
Clinically signicant change can be seen in two of the ve clients from the 2007
study, Maha and Faimah. Faha had chosen more than one answer for each question
on his pre-counseling form so a score for the beginning of his counseling could not be
calculated. Hassan had only three counseling sessions and did not complete any
forms. Very little change was seen in Hasnah. The case of Faimah, whose BDI scores
represent the greatest positive change, will be considered in more detail in the Case
Example section.
Brief comments on four of the cases
Maha had nine counseling sessions in all, which she attended regularly. She had
suered from depression for over 20 years. Her main concern was the relationship
Table 1.

Beck Depression Inventory Scores

Age

Before
counseling

Yassir
Kawther
Maha
Amer

51
50
34
33

8
7
33
37

Minimal
Minimal
Severe
Severe

2
6
29
38

Minimal
Minimal
Severe
Severe

8
8
8
8

Maha
Faha
Faimah
Hasnah
Hassan

50
42
42
25
34

25

39
56

Moderate

Severe
Severe

11
4
19
52

Minimal
Minimal
Mild
Severe

9
11
14
9
3

Participant

Level of
depression

After
counseling

Level of
depression

N
sessions

Pilot study

2007 study

198

A. Al-Thani and J. Moore

with her husbands second wife with whom she had to share the house where both
families lived. Through the counseling Maha managed to bring about improvements
in her relationship with her husband and to feel better about herself, although the
situation in itself remained fundamentally unchanged. Very movingly, in her
feedback interview, Maha summarized the benets of counseling in the following
terms:

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[Aisha] helped me to express what I feel, to express what is hidden in my heart. There
was a tremendous change between our rst meeting and the last one. (Feedback
Interview 1)

The therapeutic alliance was strong and it is clear that the counselors shared
knowledge of the culture was extremely important in enabling the client to feel
accepted in the stuckness of her domestic situation. Being free to express how she
felt about her husbands behavior in a nonjudgmental environment including one
in which the possibility of her leaving her domestic situation was simply not an
option enabled her to move to greater self-acceptance and from moderate to
mild depression.
Faha had 11 sessions. He had been widowed and subsequently married again,
but was unhappy in his marriage. He often felt taken advantage of by others, but
through counseling he came to consider his own needs as well as those of others.
Strikingly, like Maha, he had been depressed for over 20 years, and, again,
having the space simply to give expression to what was really going on for him
was hugely signicant: What I was in need of was to talk over my problem
which I have concealed for 25 years (Feedback Interview 1). He speaks of the
importance of the security he nds in the counseling relationship, a security
which lets him understand [himself] better (session 2) and, later, of the
counselors understanding: I feel if I talk she understands me exactly
(session 11). By the end of the sessions it was clear from the video recordings
that he was not tense and felt relaxed expressing his feelings (Al-Thani, 2010,
p. 137).
Conversely, Hasnah wore her nekhab (veil) throughout her counseling sessions
and the counselor could only see her unhappy eyes, full of sadness and pain. She was
25 at the time of the sessions. Her problems were overwhelming and she attended
counseling only erratically, although she had nine sessions in all. She lived with her
uncles family, and her uncle, who should have been her protector, had sexually
abused her between the ages of 9 and 24. She could not talk about this outside of the
counseling sessions because she was afraid no one would believe her. Moreover, she
was still dependent on her uncle and lived in his home. She was attracted to other
girls and women and this was deeply problematic because of the fact that lesbianism
is forbidden in her culture. Although she was able to speak of these issues in the
counseling relationship her level of hopelessness and despair remained fundamentally unchanged, unsurprisingly given her long history of abuse, the absence of love
for her in her home environment, and the cultural unacceptability of her sexual
orientation. In her feedback interviews she spoke of wanting more direction from her
counselor:
[Aishas] way is between you and yourself. It means that if you want to do the thing, do
it; if not dont. She doesnt tell you, but sometimes a person can be tired and doesnt
think: she must show him the way. (Feedback session 1)

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Hassan is a particularly interesting case with regard to nondirectivity. He came for

only three sessions and at rst regarded the counseling as unsuccessful. He wanted to
solve issues with his ex-wife and her family and also revealed that he missed the
support of his father who had recently returned to his native country. His fathers
support, however, had been ultimately disempowering to him: If I had a problem he
did not give me a chance to think how to solve it (session 2). Although Hassan was
able to share his thoughts and feelings with the counselor, he was critical of her way
of working: I feel she talks indirectly. She could give you hints, but I have to talk
continually (Feedback session 1). Paradoxically, however, in his second feedback
session (some months after the original counseling), he gives what could well be
regarded as a tting tribute to nondirective counseling:
I worked hard on myself. I observed within myself that somebody had helped me to
make things clear in my life, so I tried to work on myself, then I found myself at
last.(Feedback session 2)

Case example: Faimah

This case example demonstrates more of the nuances of nondirective Islamic
counseling within the context of a strong therapeutic alliance.
At her rst counseling session Faimah, a married woman in her late thirties with
ve children, was confused and overwhelmed and did not know where to begin. Like
Faha and Maha in the previous section, she had been depressed for many years and,
indeed, would have taken her own life had it not been against her religion.
She saw herself as a religious person who wanted to live in peace with herself
and others. She wanted to nd a way to improve her relationship with her husband
who was always busy and never expressed his feelings for her. She blamed him for
the disability of her brother, who had been seriously injured in a car accident when
her husband was driving. She missed her deceased father, a deeply religious man,
who had loved her very much, and she idealized her childhood when her family
had been happy. Since her fathers death, when she was in her late teens, her
mother and younger sisters had come to depend on her and they made
considerable demands on her. Her depression had grown worse since the car
accident and the loss of her brother as someone on whom the rest of the family
could depend. She felt guilty about her inability to respond to her children, but
could not help herself:
I feel Im not being fair to them . . . Ive totally left them . . . The only thing I do for them
is cook . . . They come to me seeking my love, but I dont have this feeling for them . . .
Ive lost my feelings about everything . . . I feel that there is a stone inside me. (Session 1)

The counselor listened attentively to the many strands of her story and encouraged
Faimah to look at what was happening inside her.
At the second session Faimah explained that she had spent the whole week since
the rst session searching for herself:
Where is Faimah in all of this? The whole week I sat thinking . . . Where am I? I
discovered that I forget myself. (Session 2)

Faimah wanted her husband to help her nd herself, but he wanted her to focus on
her religious duties and ask Allah (SWT) for help directly instead of asking him for

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help or even seeking professional help. Gradually, Faimah came to accept the
helping role of the counselor, and here it is important that the counselor shares her
religious perspective:
Faimah: . . . I feel that without help I will be in a loop of negativity . . . I need someone to
enlighten and help me.

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Counselor: By the will of Allah (SWT) . . . we will be together by Allahs (SWT) will . . . I
believe that one should start with oneself rst. (Session 4)

In this respect, the counselor is not only listening to what is being said, but is actively
reinforcing the Islamic teaching that one should take care of oneself rst and then
care for others. Faimah began to explore the reason for some of her fears and her
depression. Her psychological mindedness undoubtedly helped her to look at herself
with greater objectivity and clarity and the main focus of the counselor was to
encourage the client to self-reect. Faimah expressed guilt at not looking after her
rst newborn baby very well, but explained that she was now trying to give her
daughter (by this time a young teenager) more attention. The counselor listens
nonjudgmentally and simply reects back this change in her.
Faimah came to her seventh session immediately from leaving the hospital after a
miscarriage. She noticed that she could now cry easily and is more compassionate
towards herself:
I feel that I have changed in my sessions with you . . . I have started to feel that Im
Faimah again . . . Im the old Faimah who Ive missed for a long time . . . I know what I
need and what I dont need. Ive started to feel that Faimah is overloaded . . . Im more
sympathetic with her now. Ive started to realize her needs. (Session 7)

The following session Faimahs mood had sunk again and she had become more
confused and here, interestingly, the counselor both listens empathically to what is
being said and reinforces Islamic teaching, encouraging the client to be more positive:
Client: I fear if I get happy then Ill have to get unhappy soon . . . I started to adjust, get
better. I became good and I improved . . . I started to laugh . . . I noticed myself laughing
with my children and talking to my husband. I started to laugh with him. . . . Allah
(SWT) is to be gloried. . . I know everything happens by the will of Allah (SWT) so why
am I unable to accept the situation? (sighs)
Counselor: I can imagine that all your previous experiences caused such pain for you
and let you live with unhappy thoughts, but I notice a dierence this time . . . between
this session and the rst one . . . you know that there are many things that are not in
Faimahs hands . . . Allah (SWT) is to be gloried . . . it is good that you surrender before
Allah (SWT). (Session 8)

In session 10, while acknowledging that she has to accept her past and be ready to
move on, Faimah suddenly asks for direction. The counselor points out that our
aim in this counseling is that Faimah tries to nd the solutions herself, although she
also says that I will be beside you, watching you, trying to help. To this Faimah
asks: Please do it more directly. The counselor replies:
By the will of Allah (SWT) I will try to use the nondirective method and Faimah herself
will nd the solution . . . and if I feel that you really need a directive way of treatment I
will refer you to another expert.

This is a very interesting moment in the therapy and the client has no doubt
whatsoever that she wants to continue with this particular form of help, even if

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she is not told directly what to do. The therapeutic alliance is very strong by this
point.
In terms of the clients expression of her thoughts and feelings there is no doubt
that the counselor listens and responds empathically and acceptantly. However, the
counselor will frequently remind the client of Islamic teaching where there is a
conict between her own desires and what is required by Islam, for example, between
her wish to be better supported by her husband and her duty to obey him or between
her wish for her mother to make fewer demands on her and her sense of duty as a
daughter. As Faimah expressed this:

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The framework of religion should determine my relationship with my mother . . . what is

required from me? Islam will determine my relation with my brother and sister and even
my husband. (Session 11)

To the non-Islamic reader of the counseling transcripts, the counselor seems at times
to be expressing excessive understanding of the husband at the expense of showing
empathy to the client. However, seen within the broader framework of Islamic
teaching, it is clear that her empathy is both for Faimah as a person and as a
Muslim. In this respect empathy is extended to the whole marital relationship and it
is accepted that within that relationship and the overall family structure there are
certain constraints. For example, Faimah is prepared to accept that her husband
might take a second wife if their relationship does not improve and if she cannot
meet his needs:
I wish he would accept me as I am, as I do him [smiles]. I told him, You can marry
someone else, but the condition is that my life should not be aected. (Session 13)

Nevertheless, it is possible for Faimah to nd herself within this framework and

within the diculties of some of her family relationships. She discovers her
softer nature that has got lost through all the years of being the strong
person who cares for her mother and sisters and, more recently, her disabled
brother. She rediscovers her love of reading and poetry and her relationship
with her children. She nds herself when she is alone or with two of her
children to whom she is particularly close. In a very signicant statement about
her eldest daughter (the daughter she could not respond to as a newborn baby)
she shows that she found in her daughter the love that she did not get from her
mother:
She compensates for . . . the love I miss from my mother [falls silent] who is the kind of
woman who doesnt care to truly and deeply know her daughter. (Session 13)

In the same session she also acknowledges that she has found a level of
listening and understanding in her counselor that she had longed to nd in her
husband.
In the nal counseling session (session 14) Faimah acknowledges that her
depression has lifted and that the counseling has helped her to dierentiate between
and deal with some of the many issues that have been weighing her down for a
long time:
I used to live in darkness . . . While I was in the crisis I didnt know where I was or where
I was going or what I was feeling, I was puzzled; I was feeling that there were many
things that came and pressed on my chest . . . I had to take myself out of this vicious
circle and, Allah bless you, for you have helped me. (Session 14)

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There then follows a very interesting exchange between counselor and client where
the love of Allah (SWT) is acknowledged as a signicant part of the framework of
the life and support of the client:
Client: Allah will comfort me . . . He creates us, He is the most merciful, and He is more
merciful than our mothers.
Counselor: Allah is perfect: there is nothing like Him . . . Maybe the love we dont nd in
our relationships with people, Allah provides it to us by loving and taking care of us.

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In this respect it is clear that trust in Allah (SWT) and the holding framework of the
counseling has enabled Faimah to begin to soften inside, to cry again and to feel love
for herself as well as those around her. She has even begun to borrow something of
the nondirective method in her dealings with her husband:
When we opened an issue, and he argued with me, I felt uneasy; but now I calm down,
and I let him have his say and leave him to answer himself [laughs] . . . this is his nature,
and I accept it. (Session 14)

The session draws to a close with a brief exchange that summarizes how the
counseling has worked in this context:
Client: You said it is not necessary to change what is around us, but we must change
ourselves.
Counselor: The change in Faimah has been positively eective. (Session 14)

In the post-session interviews with a colleague from HMC Faimah spoke about the
empowering eect of the counseling she had received:
I think that Madam Aisha succeeded, by the grace of Allah, in her method, which suited
my nature. Her method is not to give direct instructions . . . she let me make my own
suggestions . . . she gave me the chance to nd the solution myself. I worked hard to nd
the solution . . . I did it and I feel that it is my discovery. She let me feel that I can do it
. . . I can nd the solution. (Feedback session 1)

When the interviewer asked what was her role in the sessions Faimah replied, laughing,
that she did all the roles, but she also makes it clear that her counselor was not a mere
listener (as suggested by the interviewer), replying that the counselor understood and
interacted with every word I said. The counselors own view is that, regardless of their
respective roles and the fact that the counseling was part of a research project, she and
Faimah met as two women who shared a culture and a religion, but who were, above all,
engaged in a warm human relationship in which the core conditions enabled signicant
therapeutic movement to take place in the client.
Some responses to nondirective Islamic counseling
The modication to the person-centered approach introduced by Aisha Al-Thani
was that of adding to a basically nondirective method Islamic religious support
with references to the Holy Quran and the Prophets (PBUH) teachings whenever the
case needed it (Al-Thani, 2010, p. 271). To the Western person-centered eye these
interventions may not look entirely nondirective, but in the context in which this
work took place the counseling is revolutionary.
Perhaps the most signicant tribute to Aisha Al-Thanis work comes from Dr.
Elnour Dafeeah, a clinical psychologist from HMC, who helped her to set up her

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203

project and conducted the post-session interviews for the 2007 study. He is, like the
vast majority of his colleagues, a CBT-trained practitioner, and was initially
skeptical about the potential of the person-centered approach in the Middle East.
However, after completing the post-session interviews this is what he had to say:

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In the long run I am sure [that the nondirective approach] is very eective . . . and if the
bond that has been created between the client and counselor is right from the beginning,
the outcome will be very eective . . . I use CBT . . . but I have started to reconsider
because I have seen the feedback and have seen the remarkable feedback from some
clients, and the eectiveness of the way the counselor has addressed their problems.
They were so happy because they thought her particular way was good for them . . . we
need to consider that at least we need to train some people in the importance of the
theory, because we have not got any people here in this particular area.
I only read about the PCA and Carl Rogers in university and have a very supercial idea
about it, but I have not used it myself. But now that we are having a very close
encounter with the therapy itself I have seen the impact of [Aishas] way, and the
eectiveness of the outcomes were very positive and in some clients were excellent. This
is very important and needs to be addressed. (Interview with Dr. Dafeeah)

Aisha Al-Thanis work in the State of Qatar is just one instance of endeavors to
introduce nondirective counseling in the Middle East. The Kingdom of Saudi Arabia
has been trying to develop counseling services in schools throughout the country
over the past 10 years but these services have been slow to develop. According to a
recent survey by Al-Bahadel (2011), various factors, including lack of professional
counselors and lack of counseling interviewing techniques, have contributed to a
general lack of progress in terms of introducing counseling more widely. This same
survey explored the use of various nondirective therapeutic techniques amongst
counselors in Saudi Arabia and positive views regarding the potential helpfulness of
this way of working are evident from the responses of 85 female and 122 male
counselors.
Conclusion
Nondirective counseling in the Middle East is as yet in its early stages, and the
work of Aisha Al-Thani makes a small but signicant contribution in terms of
demonstrating that this kind of counseling can succeed for some clients in Islamic
culture. For the counseling to work it is important that there is a strong
therapeutic alliance, that the client is capable of self-reection and open to the
possibility of change, that they are willing (and contextually able) to take more
responsibility for their lives, make choices that will enhance their developing sense
of self, bringing them closer to the satised soul, the desirable point of
development for all Muslims. In addition, both counselor and client need to
understand and accept without question what is required of them by their
religion.
It is striking how long some of the clients discussed in this article had been in a
state of depression before beginning counseling. Yet therapeutic movement began to
occur fairly rapidly, initially simply as a result of their feeling heard. The
nondirective listening of the counselor in the longer term enabled these clients to
learn to listen with greater acceptance to themselves. In so doing they began to nd
their own sense of direction within both the constraints and the support of the
Islamic culture in which they live.

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