A Cross-Cultural Redefinition of Rational Emotive and Cognitive Behavior Therapy

From the West to the Middle East

Murat Artiran

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781000650921
• Edition: 1
• Topic: Psychology
• Subtopic: Cognitive Behavioral Therapy (CBT)
• Index: Psychology

This unique volume integrates history, mythology/folklore, and theory and research to bridge the gap between Western and Middle Eastern approaches to and understanding of psychotherapy, particularly Cognitive Behavior Therapy (CBT) and Rational Emotive Behavior Therapy (REBT).

Part I lays the foundation with an overview of the theoretical essentials of REBT and CBT in the West, the goals and assumptions of REBT and CBT in the Middle East, and what Middle Eastern clients understand about cognitive distortions, irrational beliefs, and emotions. In Part II, chapters delve more deeply into how psychology is placed in the context of Middle Eastern folklore. The author provides a summary of the history of psychology in the Middle East; an analysis of the relevance of Sufism to self-acceptance, acceptance of others, and life acceptance; and an evaluation of the use of metaphor in psychotherapy from the Middle Eastern perspective. Finally, the author provides case studies that show how these concepts are applied in practice.

This text is ideal reading for researchers and clinicians who study Middle Eastern psychology and who work with Middle Eastern clients, as well as for Middle Eastern psychologists and clients.

Part I
Western Theory

1
What is this Book for?

There is a life-force within your soul, seek that life. There is a gem in the mountain of your body, seek that mine. O traveller, if you are in search of that, don’t look outside, look inside yourself and seek that.

— Rumi

Trying to apply a Western-based psychotherapy model with an ‘appropriate’ and ‘effective’ method of psychology techniques is more difficult than merely reading about the rhetoric of theoretical information in books. It also requires the understanding of a professional as to the needs of his or her client and then empathizing with the client, planning treatment, and providing ‘examples,’ within a treatment plan.

Think, if you will, that a client is like a hero in a novel, with a unique, personal story. To achieve a better outcome in any treatment, it is necessary for a sensitive psychologist to understand the client’s story well. Therefore, to assess the culture from which she springs become necessary. A practitioner needs to conceptualize a client’s problems based on theoretical essentials as well as cultural facts. A culturally redefined theory helps us to figure out the cultural backdrop, in a scientific way. Psychotherapy is a reflection of the science of psychology in practice. It is a blend of ‘science, art, literature, and life experience.’ It is a tool that progresses in the light of scientific data. On the other hand, the results may depend on a discovery of the client’s own story, using her own skill and life experience.

Therapist: What bothers you mostly?

Client: I question our existence, religion and life. Why do people have children? I worry when I think about what I really want to do with my life. I am sometimes depressed when thinking about whether I should live in this country or move abroad. I want you to give me some ideas and suggestions about these questions. And there are uncertainties in my life. I am seeking answers… meanings…

If a client is originally from Iraq, Saudi Arabia, Egypt, the United States, the United Kingdom, Ireland, Australia, Germany, Italy, China, Thailand, Cuba, or Brazil, how can one type of therapy deal with such questions? Helping a client is not only about applying a single psychotherapy theory but also about unique cultural aspects, history, values, definitions, expectations, and social rules.

Famous psychologist Carl Rogers declared that empathy is the first and foremost issue in therapy.1 If we do not touch on the culture, how can we apply ‘empathy’ in any therapy? Albert Ellis pointed out that the future of psychotherapy will be in the school system,2 based on more ‘teaching and learning’ rather than classical ‘talk therapy.’ Careful consideration—of cultural and subcultural differences, in learning appropriation and behavior—needs to be made before applying any therapy.

East and West

‘East-West’ distinctions in the articles of scientific journals and magazines are frequently discussed. Cultural and subcultural differences in learning behavior fail to address the diversity of their learners.3,4,5 It is argued that ‘Eastern’ culture and ‘Western’ culture are separate, or claimed that they are opposite, in terms of cultural structure. Is this true or not? We don’t have an exact answer. Nevertheless, a theoretical approach, principally, cannot make such distinctions; a theory can only reveal its own rules and principles. Cultural differences, meanwhile, can be applied only by a therapist in practice.

Although science may be a universal concept, any theory needs to be provable and display a certain flexibility so that, at times, it is also culturally adaptable. Due to its nature this is truer for psychotherapy theories. In this book, a ‘constructive’ and ‘processed-based’ perspective is put forward, with a culturally redefined approach. In psychotherapeutic interventions a therapist has a responsibility to understand and communicate with clients by conceptualizing their problems, not only using theoretical points of view but also by considering certain cultural aspects. George Kelly’s work6 helped the birth of cognitive psychotherapists (e.g., REBT and CT). Kelly’s use of constructs is what modern theorists explain as ‘schemas.’7 An individual’s way of conceptualizing life, from her own particular constructs, must be appreciated. Hopefully, this book will lead to a continuation of this ‘constructive’ route, culturally speaking.

It is assumed that the theory of psychotherapy is applicable anywhere in the world. In order to utilize Western psychotherapy to empathize with Middle Eastern people, to reveal a different and more ‘culturally compatible’ mental health treatment approach, this book hopes to address some concerns of practitioners. In order to understand clients better, more than just an awareness of culturally embedded issues should be included in therapy sessions. However, as mentioned, when it comes to the psychological counseling process in general, the issue becomes more complicated than ‘just applying the essentials of a psychotherapy theory.’

A Scientific ‘Middle Eastern Mind’

The opinion that the ‘rational’ or ‘scientific mind’ originates in the West and that the world of the Middle East is light years away from having a scientific perspective is not correct. It is certainly not completely true, as history has shown. Harezmi in mathematics,8 Al-Ghazali in philosophy,9 Ibn-i-Sina (Avicenna) in medicine,10 and Ibn Rushd (Averroes) in philosophy11 all put forward rational and scientific theories, and they have been transferred to, and utilized by, the West. It is true, however, that Islamic countries have not followed their own theoreticians, nor have they embellished recent scientific knowledge (some caveats to this sentence are dealt with in later chapters). As a consequence, it is observed that rational and/or scientific knowledge is frequently exported from the West to the Middle East. The following chapters will discuss and provide some suggestions and examples about this topic.

Taboo

Generally speaking (there are exceptions) in the Middle Eastern population, psychological ill health is a taboo, or an unmentionable subject. When asked, many clients report that mental illness is not understood in their families/cultures at all and dismissed. They verbally or nonverbally link psychological problems to stigmas, such as being miserable, lazy, guilty, or crazy, and psychopathology is something which is forbidden. Additionally, according to some people, unfortunately, it is frequently seen that anyone who admits to seeing a mental health professional may be viewed as a lunatic, weak, shameful, unreliable, or/and fragile. Some Middle Easterners believe that mental illness may be seen as a lack of religious practice, or ‘disbelief’ in Islam.

In Middle Eastern countries many people still seek support from hodjas (Islamic teachers) for their mental health problems.10 In larger Turkish cities this is less true, though the practice continues, and the rise in the amount of practicing psychologists is proof that Western ideas are desired. The efficacy of some of these counselling centers is discussed in later chapters.

Middle Eastern societies tend to be collectivist and patriarchal. Western psychotherapy may offer an individual an approach based on an individualistic society from which it is generated, but psychotherapy, and even cures, transferred from Western to other cultures may differ during that transmission.12

Cultural Sensitivity

Culture-sensitive approaches to psychotherapy would seem to be a necessity in our digitalized global world. For mental health professionals, it is very easy to copy-paste a theory to their own culture; however, it is very complicated to ‘adapt’ a foreign theory to a different culture and then adopt it, in situ, in practice. For instance, when we use the terms self-actualization (in humanistic psychotherapy) or cognitive distortions (in cognitive psychotherapy), some clients may understand these thoughts are related to ‘anti-religious’ or ‘anti-traditional’ ideas in the Middle East, and clients usually give curious looks at the therapist, as if their spiritual values are being attacked. A borderline personality disorder client reported that when she was doing her ‘therapeutic’ homework, her mind went off in a different direction, sometimes, to that which was focused on during a session, and she started to pray to God for a release from her problems. Practitioners feel under pressure to apply the concepts of RE & CBT when transferring the aforementioned conceptualizations to the client, and need well-explained, clearly defined statements, and a clearly defined approach. Another client asked whether religious beliefs are irrational. According to Taskin, Muslim people often seek a cure for their psychological problems through the power of prayer.10 This may also be true for practicing Christians. It is desired that some of the chapters of this book (e.g., Chapter 7) will help many clients understand how we can use religious figures, such as Rumi (and Sufism), in psychotherapy, without direct use of religious concepts, in order to introduce scientific principles to bring about psychological well-being.

Another issue crops up with the ‘self.’ Many psychotherapies based on personality theories are interested in the conceptualization of the ‘self.’ The ‘Self’ has been taken as a social-cognitive framework and a constellation of cognitive schemas.13 According to cross-cultural researchers, the self is culturally constructed.14 For instance, Western societies create an individualistic model of personality theories.15 Nevertheless, cross-cultural research points out that members of many collectivistic cultures (e.g., Turkey, Syria, Egypt, and Iraq) see a person as part of a social network, rather than as a unique individual.16

Hofstede’s Theory

According to Hofstede’s theory of cultural differences, people in collectivist societies tend to emphasize the obligations they have towards their in-group members, and are willing to sacrifice their individual needs and desires for the benefits of the group.17 Hofstede developed a 100-item measurement and scale for people from different cultures.18 Hofstede’s work clearly shows that we cannot consider any theory without the cultural aspects. Aspects of cultural differences may vary in many fields of psychology too.

This book focuses on psychotherapy and the psychological counseling side of the cultural differences that are frequently encountered outside the West, and suggests some applications and interventions. The weight of the cultural dimensions of learned values, beliefs, and attitudes that shape cognitions, perceptions, emotions, and behavior cannot be stressed enough. To sum up, this book is for clients, practitioners, and academics who wonder what happens when Western psychotherapy is ‘transplanted’ or redefined to work in the (Middle) East and how to apply it in an appropriate way.

What Is in This Book?

Throughout the book readers will find:

• The essentials of rational emotive & cognitive behavior therapy
• Qualitative discussions about an ‘Eastern’ and ‘Western’ understanding of RE & CBT theory (cognitions, emotions, and behaviors)
• An introduction to cultural aspects of therapy
• An attempt at new, Middle Eastern-based ‘goals’ of treatment
• Some information about the history of Middle Eastern psychology
• Culturally redefined example sessions, protocols, and interventions
• Some materials for activities and homework

Conclusion

The practice of psychotherapy and psychiatric treatments has historically been provided by Western clinicians. Most of them are trained to address mental health problems and their hidden components directly. The question arises as to whether such an approach is completely true. Cultural competence is the capability to engage in performance, or produce conditions, so as to maximize the best possible progress of the client.19 In order that Middle Easterners can become less fearful of Western methods, psychotherapists who have a culturally redefined framework and outlook will help academics, clinicians, practitioners, and students to gain a greater understanding of the work involved. It is a truism to say that psychological treatment is too frequently misunderstood in the Middle East and often muddled with medical treatment, which is dealt with in later chapters in more detail. It is good news that some of the young generation do not hesitate to talk about depression or anxiety and psychosomatic symptoms with their friends and relatives. Psychol...