‘It’s odd to take one to work, but you need a compass’

Previous 'Careers' interviewees have mentioned the challenge of delivering psychological services in an increasingly diverse society. Trends in first languages, beliefs about a range of issues from religion to the status of mental disease, cultural practices and attitudes to psychology, all challenge practitioners who themselves take a widening range of approaches to their profession. In searching for 'Muslim psychologist' online I though I might begin to investigate the effect of religious beliefs on psychological applications. Dawn Reeves, a Chartered Member of the Society and an HCPC-registered clinical psychologist, who I contacted at her web site www.muslimpsychologist4U.com, gave me a compelling and thoughtful interview that addressed this question but touched on a wider range of topics.

The trouble with careers advisers

Dawn spoke to me on Skype from Riyadh and it took a while to get the sound right. 'The rooms are quite high here and the floors are marble so sound bounces around.' Dawn grew up in Southend, Essex. 'My mum worked as a sorter in the post office and my dad was a self-employed carpenter. My elder sister had a friend who was taking psychology at college and she gave me a personality test. I was hooked. I went to a local college and did A-level Psychology, then took my degree at Brunel University.' Was the subject what you expected? 'It was more scientific and statistical, but my major feeling was intense shock that I'd got to university at all. I was the first person from my family to go and I hadn't expected it.' 

Dawn didn't have much luck talking to careers advisers ('at school I was told I would never get to university, and at university that becoming a clinical psychologist was going to be too difficult for me'), but her course gave her a lot of experience of different sorts of psychology. 'It was a "thin sandwich" course alternating six months work experience and six months learning. So I worked at a museum, a prison and an educational psychology service, among other things. I had wanted to do educational psychology at first but didn't have enough stats to do a PGCE. Despite the careers advice, I wanted to go into clinical psychology, and I had an assistant post within six months of completing my degree because of the work experience during my degree. I did my postgraduate work at the Salomons Centre, Canterbury Christ Church University and received a doctorate in 2000.' 

I want to go back to your first degree, which was a joint one in psychology and social anthropology. Tell me a bit about the latter. 'It was my bigger interest to begin with. But the two subjects fit very well together. Social anthropology looks at how culture is embodied in living groups and we looked at topics that seemed very psychological to me: the anthropology of cognition and linguistics, for instance. I think this influenced my use of systemic approaches and my interest in family therapy later on. It also interested me in issues such as the psychology of race, culture and gender. I suppose other courses were more technical, scientific and statistical, but this approach interested me.'

In retrospect Dawn feels she was quite young when she took her clinical course – 'it was tough and I had a lot to learn' – but her early assistant roles and placements during the course helped her get experience. 'In my first assistant's post I worked in a West Sussex Community Physical Disability Team with clients of very varied ages and backgrounds. Then during clinical training my placements got me interested in older people. My final large piece of work was on coping strategies of amputees.' Dawn then worked in older adult services at South London and Maudsley Trust and for eight years in older adult services in Leicester. 'I moved to Sudan for a while and when returning went into private practice.'

The Muslim psychologist

Dawn had initially been slightly reluctant, as others have been, to be interviewed. I wondered if she was uncertain of my motives in seeking to investigate Muslim psychology or whether there were issues around being interviewed as a woman psychologist based, at the moment, in Saudi Arabia. She explained her actual reasons: 'When you start talking about religion some people assume you're telling them what to do or believe. And I'm not doing that at all.'

When did you get involved in Islam? 'I don't come from a religious background, but I got interested at Brunel. There was an Islamic week and I went to a couple of events, bought an English translation of the Koran and it started from there. I converted fully a few years later.' And your move to Sudan? 'My husband is Sudanese. We lived there for a while and have also visited the country. It's a tough place to live when you have children, and we came back to the UK. I had a job offer in Saudi Arabia but it fell through, and that's where Muslim Psychologist 4U came from.'

Dawn's website describes itself as an 'e-mail, messenger or chat service across the internet for women who would like to access professional psychological help'. It suggests the service will suit women who want to access a female or Muslim psychologist. Clients don't have to be a Muslim but must be over 18. 'Creating an internet service reflects a number of factors. Many Muslim families move quite a bit. There is also some sensitivity about accessing psychological services within a community, and some women, whatever their beliefs, will prefer to talk to other women. In addition some Muslim women want to talk to someone who does have a basic understanding of the faith. Apart from anything else that saves time and prevents misunderstandings. So, I set it up the service.' Who created the website? 'I had a tight budget so I found out how to build and design a website, and how to get it hosted. I did everything myself.'

The site offers help on areas such as phobias, depression, low confidence, relationship difficulties and anxiety, 'but you have to be very careful that you make it clear what you won't and can't address, such as medical problems or suicidal feelings, and refer people on if they do present with such problems'. Dawn's approach is largely cognitive behavioural, but is also influenced by ideas from systemic, acceptance and commitment therapies, mindfulness and psychodynamic approaches. 'My Islamic beliefs don't affect what I do as a psychologist. Put simply, I trained in psychology and I practise my profession. On the other hand psychological interventions can include Islamic principles and practices. CBT's emphasis on thought and behaviour is very similar to an Islamic approach to mental well-being, though Islam includes an extra dimension, that of intention. The fact is that I'm not an Islamic scholar, and if anyone wanted help solely informed by that sort of knowledge I can refer them on.' 

Is there such a thing as Islamic psychology? 'Yes and a humane approach to issues of mental illness appears very early on in Islamic cultural history – in what's known as the Islamic Golden Age between the eighth and 15th centuries, when Islamic scholars were pioneering the recovery and application of Greek ideas to their religious beliefs. There has also been some recent work in the area including, I believe, a couple of books on Islamic psychology. As I put on my website, the term tazkiyat al nafs, which means self-purification, is the closest equivalent to psychotherapy and the actual study of psychology is ilm al nafs.'

Do Muslim clients have specific issues they present with? 'I've noticed that shame is a common theme, and it seems to have a big impact on self-evaluation and control of behaviour, family relationships and sense of identity or reputation in the wider community. There are also issues about how to discuss problems with parents or family. In Islam you must respect your parents at all times, most especially your mother, and ideally you should not talk about other people's faults. I think that this can lead to a lot of psychological conflict, because the nature of assessment and therapeutic conversation involves discussion about relationships and any problems that there might be. So sometimes when problems stem from a mother's or parents' behaviour in the past or present it can be a delicate balance having a conversation that maintains some sense of respect towards them.

'Another issue is the shame attached to having a mental health problem and the pressure from family to hide it. Related to this is the belief by some – not all – of the community that having a mental health problem is a sign of being possessed by "jinn". From my experience this belief seems to be associated with more severe forms of mental health problems. It's a very difficult area because within Islam there is advice on how to treat illness – including mental illness – for yourself or others by reciting verses from Quran and making du'a (prayers), it's called ruqya. This is not supposed to be at the exclusion of other known available medicines. However, some people take this further, and in my opinion are leaving the religion behind, when they practise a much harsher approach, which at its extreme can include physical assault, poisoning and torture. This can happen in the UK and also when families travel to other countries.' 

The difficulties of disappearing 

Has being a Muslim convert caused problems or opened up opportunities at work? 'A major set of issues relates to the five daily prayers, the times of which change throughout the year according to the position of the sun. During a full day at work during the winter you need to find somewhere to pray at least three times. I can usually find an empty consulting room within an office building, but it is more difficult if you are travelling around on back-to-back appointments. Even if you pass a mosque there may not be a women's section. Hospitals often have prayer rooms. In the beginning I felt embarrassed having to ask people at the different places where I could go to pray, but I always found the response was positive and as helpful as possible. It takes time to find a prayer room and to do wudu – the washing required before you perform salah (prayers). Being in a long meeting or attending workshops can be tricky because I am mindful of the clock ticking. On all these occasions some people wonder why you disappear at odd times – the variation in prayer times means that they can't all be done during the lunch break. Times will vary during the year and are slightly different depending where you are in the country. Maghrib, the fourth prayer prayed just after sunset, is the most important one to pray on time.

'It's an odd thing to take to work, but if you travel around you also need a compass because you must pray in the direction of the Kabba in Mecca. I used to carry around a small prayer mat as well because you must pray on a clean surface. I'm guessing Muslim men have to arrange some kind of extended lunch break on Fridays, because if they are practising it is obligatory for them to go the mosque every Friday for the congregational midday prayer. It is not obligatory for women to do this.'

'There also the issue of fasting between dawn and dusk during the month of Ramadan. Food and drink is such a central part of meetings and lunchtimes. I worry about offending people if I'm on a home visit and they offer me a hot drink. During winter time you may break your fast during a typical nine-to-five working day, probably around 3.45 at the earliest. It is recommended that you shouldn't continue fasting past sunset. So at the least you will need to drink some water or eat a date at that time. I sometimes find concentrating difficult when fasting, especially at the beginning and the end of the day, so writing up a complicated neuropsychological assessment can be a bit challenging!

'The other practical issues I've had are around drinking alcohol. There can be a culture of conference evening drinks that I can't attend. Social gatherings with work colleagues can be difficult making you feel like the odd one out. In my experience, colleagues try to be flexible.

'I've been very lucky I think, in that I've never experienced any obvious problems from clients because of the way I dress. I do get asked a lot about where I come from and when I explain that I am English I am always asked the follow-up question "Yes, but where do your parents come from?".'

Do you see religion as an important factor in the issues clients present with? 

I sometimes feel it's dismissed by some psychologists or seen as part of the problem they're addressing. 'I think most psychologists who are providing therapy will consider how, if a person is presenting themselves as religious, the religion forms part of a person's belief system and understanding of themselves and the world around them. It would be difficult to develop a therapeutic alliance and provide therapy if it was obvious that the therapist was dismissive of such a central part of a person's sense of self. 

It can, however, sometimes be dismissed when it is written about in research and reflective articles – to the extent that I find it quite insulting when I read someone write about religion and comparing it to delusional thinking or folk beliefs. That would suggest that the majority of the world's population and some of the world's greatest thinkers and figures from the past and present were all suffering from some kind of delusional thought processes.'

The travels of a psychologist and The Psychologist

How has your service worked out? 'Well, the anonymity it offers seems to be very important. Even if people use Skype, for instance, they often prefer not to use the video camera. This of course brings its own issues. For me it's given huge flexibility. I can work whether I'm in the UK or in Saudi Arabia.' Presumably CPD is difficult for you since you travel a lot. 'Well there are sites which offer really good online courses, including the Society's. And in fact I get The Psychologist here as I did in Sudan. It arrives in rather a battered condition but it keeps me up to date on thinking and gives me some entry points for online study. Since I'm both a provider and a recipient of online services I'm very aware that you have to be honest and think carefully about what works and what doesn't work over the internet. I'm trying to develop my supervisory service, and I'll have to think of that in terms of what needs to be done in person and what can be done at a distance.'

At the end of our interview Dawn summed up one of its key themes. 'I have children who I want to give a great upbringing. I've travelled and I'm now living in a different country from the one I trained in. But I wanted to keep up my career even if I can't work to conventional nine-to-five hours. I'm sure I'm not alone in this, and the internet suggests one avenue you can use to make this happen. It can also help you reach different groups of clients who may not like traditional in person therapy.'