Handbook of Counseling and Psychotherapy in an International Context

Roy Moodley, Uwe P. Gielen, Rosa Wu, Roy Moodley, Uwe P. Gielen, Rosa Wu

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9780415872539
• eBook ISBN:
  9781135262723
• Topic: Psychology
• Subtopic: Education in Psychology
• Index: Psychology

Many factors in the world today, such as globalization and a rise in immigration, are increasing the need for mental health practitioners to acquire the ability to interact effectively with people of different cultures. This text will be the most comprehensive volume to address this need to date, exploring the history, philosophy, processes, and trends in counseling and psychotherapy in countries from all regions of the globe. Organized by continent and country, each chapter is written by esteemed scholars drawing on intimate knowledge of their homelands. They explore such topics as their countries' demographics, counselor education programs, current counseling theories and trends, and significant traditional and indigenous treatment and healing methods. This consistent structure facilitates quick and easy comparisons and contrasts across cultures, offering an enhanced understanding of diversity and multicultural competencies. Overall, this text is an invaluable resource for practitioners, researchers, students, and faculty, showing them how to look beyond their own borders and cultures to enhance their counseling practices.

Part I
Counseling and psychotherapy
in Africa

1
Counseling and
Psychotherapy in Egypt

Ambiguous identity of a regional leader

Mona M. Amer

Introduction

For over 4,000 years Egypt has been a land of intercultural exchanges of which was knowledge, facilitated by its location at the juncture of three continents: Africa, Europe, and Asia. Cultural diversity continues to be evident with a significant population of tourists and non-native residents. Despite this diversity, more than 99% of the population is of Egyptian ethnicity (Central Intelligence Agency [CIA], 2009). Among Egyptians, 90% are Muslim and 10% are Christian (CIA, 2009). The primary language is Arabic, with longstanding geographical, cultural, and socio-political ties with the rest of the Arab world.

In recent decades Egypt has seen the costly impacts of war, rural to urban migration, a flawed educational system, and political upheaval following the January 25, 2011 popular uprising. While the richest continue to gain in wealth, about 9% remain unemployed and about 16 million live in squatter and informal settlements (Rodenbeck, 2010). Egypt leads the world in hepatitis C infection (Rodenbeck, 2010) and its mega-city Cairo lays claim to the highest air pollution levels across the globe (The World Bank, 2007). However, despite such struggles associated with being a developing country, signs of stability and progress are clearly visible. These include the recent growth of extravagant housing and shopping complexes, private schools and universities, and communication technologies. With respect to health, the government has made significant strides in health indicators such as slashing infant mortality rates (Okasha, 2004). On the other hand, the positive health indicators of reduced infant mortality and increased life expectancy have contributed to the chronic challenge of overpopulation; Egypt is the sixteenth most populate country worldwide, totaling nearly 80.5 million people (CIA, 2009).

These complex socio-economic conditions form the backdrop to the mental health practitioner professions, which have similarly been characterized by juxtaposition between growth and stagnation. On the one hand Egypt has been a frontrunner in the Middle East in numbers of psychiatry and psychology educational programs. On the other hand, it is difficult to ascertain a coherent identity or vision for mental health service in Egypt. This chapter discusses this and many other issues that typify the ambiguous identity of present-day Egyptian counseling and psychotherapy. The review begins by tracing the development of the healing professions from ancient Egypt to contemporary times, highlighting the impacts of intercultural exchange and religious healing. Strengths and shortcomings of present-day education, practice, and research are discussed with an eye to future progress and more rigorous regulation of the field.

Brief history of counseling and psychotherapy

Purposive healing of mental and emotional ailments has a long history in Egypt, dating as far back as the Pharaohs. Insight into ancient mental health concepts and treatments can be gleaned from the Ebers, Edwin Smith Surgical, and Kahun papyri (Nasser, 1987; Okasha & Okasha, 2000). These documents, dating from at least 1,600–1,900 BCE, contain physical descriptions of the brain, as well as references to the mind and consciousness. Descriptions of mental illnesses such as hysteria, psychosomatic conditions, melancholia, thought disorder, dementia, and alcohol intoxication were captured in papyri and on temple walls (Nasser, 1987; Okasha, 2005). There is no record of a professional specialized in mental illness; however, the sorcerer, or temple priest, most likely offered mental health care. Treatment methods included temple sleep (“incubation”), dream interpretation, hypnotic methods, and religious methods integrating magic (Nasser, 1987; Okasha & Okasha, 2000).

It is not clear to what extent ancient Egyptian knowledge was transmitted to Europe through Greek visitors (Laver, 1972). However, centuries later, Greco-Roman theories on mental illness and psychotherapy/healing were conveyed to the Arab world, influencing the healing fields (Ahmed, 1992; Ibrahim, 2012). During the Islamic era, especially the ninth to twelfth centuries, great strides in understanding and treating mental illness occurred (Abou-Hatab, 2004). These were spearheaded by eminent scholars such as Najab ud-din Unhammad, Al-Razi (Razhes), Ibn Sina (Avicenna) and others, who catalogued medical and mental illnesses including etiology, differential diagnoses, symptoms, and preferred treatments (Ahmed, 1992; Ibrahim, 2012; Okasha, 2005). The healer was typically the hakim, a medical doctor (Mohit, 2001a).

Modern day mental health practice in Egypt was also influenced by Europe, and can be traced to the time period after the French occupation: during Mohammed Ali’s Ottoman rule from 1805 to 1848. One of Ali’s policy priorities was education, and as such several colleges were initiated in association with mosques, including a college of medicine in 1827 that subsequently offered psychiatry teachings (Abou-Hatab, 2004). The late 1880s saw the earliest noteworthy psychiatry textbook penned by Ismail Najaty (Abou-Hatab, 2004), and the first free-standing psychiatry hospital located in Abbassia (Okasha, 1993). Other trends included state-sponsored postgraduate studies in Europe and translations of textbooks from other countries into Arabic (Abou-Hatab, 2004). A diploma in neuropsychiatry was established over 65 years ago, and for over a quarter of a century medical schools have offered master’s and doctoral degrees (Okasha, 2004).

Parallel to the development of psychiatry was the budding profession of psychology. In 1908 the first secular university—The Egyptian University, now Cairo University—opened its gates. Two decades later it established a department of philosophical studies, under which material related to psychology was taught by mostly French professors. Other universities were subsequently founded, and the concepts and methods of psychological assessment were introduced. This stimulated interest in educational psychology, and a significant number of Egyptian students pursued this and other psychology disciplines in England, France, and the USA (Soueif & Ahmed, 2001).

The first Western-trained Egyptian psychologists returned to Egypt in the 1930s and 1940s to lay the foundations for diverse psychology disciplines including clinical psychology. British-trained educational expert Abdel-Aziz El-Koussy established a psychological clinic for school-aged youth in 1934 at the Higher Institute of Education (now the College of Education at Ain Shams University) (Abou-Hatab, 1992, 2004). Freudian psychoanalytic techniques were introduced to Egypt by French-trained Mostapha Zewar (Farag, 1987), and clinical psychology gained a presence with Somaya A. Fahmy, who studied in France, Switzerland, and the USA (Abou-Hatab, 2004). Other key pioneers were Marcus Gregory, who in 1939 became the first psychologist to practice psychotherapy, and Mohammed Fathy, who was the second (Abou-Hatab, 1992).

The second half of the 20th century saw dramatic developments in the field of modern psychology, including the establishment of independent psychology departments (Abou-Hatab, 1992; Soueif & Ahmed, 2001) and postgraduate diploma, master’s, and doctoral degrees (Ahmed, 1992). The psychologist’s identity as a clinician (rather than as a researcher or educator) evolved as Egypt imported psychotherapy models; for example, S. H. Mekhaimer promoted psychoanalysis and A. Abdel-Ghaffar endorsed humanistic psychology (Abou-Hatab, 1992). Moustafa Soueif, who was trained in the UK, shared his expertise in behavior therapy (Abou-Hatab, 1992) and took leadership in defining the role of the clinical psychologist (Ahmed, 2004).

Counselor education programs, accreditation, licensure, and certification

Mental health practitioners in Egypt are typically specialized in either psychiatry or psychology, although some social workers also provide supportive family counseling. Psychiatry students complete 6 years of medical school, followed by a 1-year general internship and 3 years of psychiatry residency. Students can pursue further psychiatry specialization at the diploma, master’s, and doctoral levels (Okasha, 2004; Okasha & Karam, 1998). Residency and postgraduate training years are typically spent at psychiatric hospitals, where junior psychiatrists develop competencies in medication management, and, depending on the focus and expertise of their supervisors, learn counseling and psychotherapy skills.

At Egyptian universities, practice-oriented psychology degrees are usually housed in the colleges of arts. The bachelor’s degree takes 4 years to complete (Abou-Hatab, 2004; Ahmed, 1992). Postgraduate applied practice diplomas can be completed over 1 year at Cairo University or 2 years at Ain Shams University (Farag, 1987). These diplomas emphasize psychological assessment, although theories of psychotherapy are taught. Most universities require 1–2 years of qualifying coursework to gain admission to master’s or doctoral programs (Ahmed, 2004). The master’s thesis can take 2–4 years to complete and the doctoral thesis another 3–4 years (Farag, 1987). Theoretical coursework in counseling and psychotherapy is taught, but practical skills will depend on onsite training.

Egypt also has over 25 private universities. The oldest private university to offer a bachelor’s degree in psychology is the American University in Cairo (AUC). In 2009 AUC launched a master’s degree in counseling that aims to be the first practitioner program in Egypt to integrate systematic hands-on training. Other private universities offer psychology courses, and the October 6 University has an undergraduate psychology department with a comprehensive curriculum that includes coursework in clinical and counseling psychologies.

In response to the absence of systematic counseling and psychotherapy skills training at educational institutions, many universities, private clinics, and professional associations arrange for workshops and training courses by visiting psychotherapy “masters” from other countries, particularly from the USA and UK. Workshops also often highlight the expertise of local psychotherapists. Topics are varied depending on the interest of those organizing the events, such as cognitive-behavioral therapy, eye movement desensitization and reprocessing, sex therapy, and substance abuse counseling.

In terms of accreditation and certification processes, at the present time there are no formal mechanisms in Egypt for accrediting mental health practitioner training programs. Efforts particularly in the private sector are currently underway to certify participants who complete some of the lengthier workshops or training courses. Such certification or accreditation would be obtained from international organizations, particularly from the UK. Most of the courses are presently in the evaluation phase required for application for certification, in which data are collected to evaluate the first administration of the course.

As for licensure, the Law No. 198 was passed in 1956 as a response to the tense debate between psychiatrists and psychologists regarding their respective roles (Soueif, 2001) and the abusive practices undertaken by charlatan and unqualified persons. The law stipulated that in order to be eligible for licensure as a psychotherapist, a person must have completed training such as a diploma in psychiatry or neurology from a national or foreign medical school, certification and specialized training from a local or international psychotherapy organization, or a psychology postgraduate degree plus minimum 2 years of clinical practice at an authorized clinic. Therefore, by default psychiatrists with a diploma from Egypt have permission to practice psychotherapy and open private clinics. Persons who completed training abroad, as well as psychologists, must pass an exam offered by the Ministry of Health (Abou-Hatab, 1992; Farag, 1987).

In the past, psychologists have faced challenges obtaining licensure through the Ministry of Health. For example, in the late 1980s Farag (1987) documented only seven clinical psychologists who had a license and operated a clinic, and Ahmed (2004) observed that from psychologists without Egyptian university affiliation, none had been granted the license. To circumvent these challenges, some psychologists have instead opted to work under the license of a psychiatrist or open private practices as “educational training centers” under the regulation of other government ministries.

With the exception of the 1956 law, there is minimal regulation of psychotherapists and counselors in Egypt. As a result of the laxness in regulations, it is possible to find bachelor’s-level graduates who call themselves “psychologists” and claim to offer psychotherapy and cou...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• EDITORS
• CONTRIBUTORS
• Foreword
• Acknowledgments
• Introduction
• PART I Counseling and psychotherapy in Africa
• 1 Counseling and Psychotherapy in Egypt Ambiguous identity of a regional leader
• 2 Counseling and Psychotherapy in Francophone West Africa (Focus on Senegal) Creating a future vision
• 3 Counseling and Psychotherapy in Nigeria Horizons for the future
• 4 Counseling and Psychotherapy in Morocco Renewal of an ancient tradition
• 5 Counseling and Psychotherapy in South Africa Responding to post-apartheid counseling needs
• 6 Counseling and Psychotherapy in Sub-Saharan Africa Brewed in an African pot with Western seasoning
• PART II Counseling and psychotherapy in the Americas
• 7 Counseling and Psychotherapy in Argentina A tango from psychoanalysis to integrative psychotherapies
• 8 Counseling and Psychotherapy in Brazil From private practice to community services
• 9 Counseling and Psychotherapy in Canada Diversity and growth
• 10 Counseling and Psychotherapy in the (English-Speaking) Caribbean Fidelity, fit or a cause for concern?
• 11 Counseling and Psychotherapy in Cuba Interdisciplinarity, community-driven research and education
• 12 Counseling and Psychotherapy in Mexico Moving towards a Latin American perspective
• 13 Counseling and Psychotherapy in The United States Multicultural competence, evidence-based, and measurable outcomes
• PART III Counseling and psychotherapy in Asia
• 14 Counseling and Psychotherapy in Australia Championing the egalitarian society?
• 15 Counseling and Psychotherapy in China Building capacity to serve 1.3 billion
• 16 Counseling and Psychotherapy in India Professionalism amidst changing times
• 17 Counseling and Psychotherapy in Japan Integrating Japanese traditions and contemporary values
• 18 Counseling and Psychotherapy in Malaysia The joy and pain of (continuous) pioneering work
• 19 Counseling and Psychotherapy in Pakistan Colonial legacies and Islamic influences
• 20 Counseling and Psychotherapy in the Philippines A discipline in transition
• 21 Counseling and Psychotherapy in South Korea Disciplines flourishing in a dynamic and challenging era
• PART IV Counseling and psychotherapy in Europe
• 22 Counseling and Psychotherapy in Belgium Towards accessible and evidence-based mental healthcare
• 23 Counseling and Psychotherapy in Denmark Counseling the "happiest people on Earth"
• 24 Counseling and Psychotherapy in France An evolving heterogeneous field
• 25 Counseling and Psychotherapy in Germany Common past, different present
• 26 Counseling and Psychotherapy in Italy Historical, cultural, and indigenous perspectives
• 27 Psychotherapy and Clinical Psychology in the Netherlands Settlement of five distinctive psy-professions
• 28 Psychotherapy in Spain Rapid growth and the vicissitudes of clinical psychology
• 29 Counseling and Psychotherapy in Russia Reunion with the international science community
• 30 Counseling and Psychotherapy in the United Kingdom Future of talk therapy
• PART V Counseling and psychotherapy in the Middle East
• 31 Counseling and Psychotherapy in Iran Flourishing perspectives
• 32 Counseling and Psychotherapy in Israel Milestones, disputes, and challenges
• 33 Counseling and Psychotherapy in Lebanon Towards a Lebanese framework of psychology
• 34 Counseling and Psychotherapy in Palestine Between occupation and cultural colonialism
• 35 Counseling and Psychotherapy in Turkey Western theories and culturally inclusive methods
• PART VI Conclusion
• 36 Counseling and Psychotherapy Around the World Current state and future prospects
• Index