The Dubai Health Authority (DHA) introduced Dubai’s first comprehensive mental health strategy, “Happy Lives, Healthy Communities,” in May, 2018 as part of the general Dubai Health Strategy 2016-2021. The strategy aims to make mental health services more accessible through legislation and improved service delivery, as well as by empowering patients and combating the social and cultural stigma surrounding mental illness.
As of July, the Emirates’ Ministry of Community Development now offers free family counseling online and by phone through its new Taalouf (Harmony) initiative. Traditional, in-person family counseling is also offered through this initiative at seven centers across the UAE.
These measures signal a new focus on mental health care in the UAE, where psychology is still an emerging field. This new focus presents an opportunity to shape public perception of mental health care as it becomes more mainstream. Given the stigma associated throughout much of the Arab world with seeking psychological treatment and counseling, the efforts to expand mental health care in the Emirates could serve as an example of how to adapt psychotherapy to a cultural context distinct from the European context in which it originally developed.
Addressing the deeply entrenched stigma surrounding mental illness will be as integral to fulfilling the Dubai Health Authority’s plan as addressing the practical barriers to mental health care. Negative beliefs about mental illness in the UAE include the perception that it is a symptom of insufficient faith, spending time with friends who are a bad influence, or not relying enough on one’s family. This stigma also extends to the family of someone with a mental illness, the members of which may believe they have failed in adequately supporting their family member.
Even acknowledging that there is a mental health issue in the family is sometimes impossible due to the strong sense of “shame” traditionally associated with mental illness in Arab culture. If patients are able to get past the “shame” for purposes of acknowledging the problem, they may feel they have to seek help outside their communities, either in different emirates or abroad. Mental health initiatives in the UAE will be more successful in reaching patients if they can raise awareness of the fact that mental illness is not the patients’ or their families’ fault and is not something to which the notion of “shame” should be attached.
Even beyond the cultural impediments, the logistical obstacles to obtaining mental health care in the UAE are formidable. Until the unification of the seven emirates as one nation in 1971, the only form of care for people suffering from mental illness came in the form of religious healers, who used a combination of Qur’anic recitation and traditional medicine to drive out the malevolent spirits that were widely believed to be responsible for mental illness. This practice remains common in the Emirates today. Since the Emirates’ were unified, however, there have been steps toward providing psychiatric care and embracing psychotherapy.
One obstacle is the lack of training programs for psychotherapists, a result of the lack of qualified psychology professors. Currently, the highest available qualification in psychology in Emirati universities is a bachelor’s degree, and this specialization focuses only on school counseling.
The absence of qualified mental health professionals trained in the UAE has led to a significant proportion of practicing psychotherapists coming from outside the Emirates. The challenge for these therapists—and, to a lesser extent, for Emirati therapists as well—is that psychotherapy as a discipline was shaped by the European context in which it evolved. The fact that psychotherapy is helpful to patients within this cultural context does not mean that all of its techniques are universally applicable. In order to thrive in the UAE, psychotherapy will need to adapt to a different cultural context.
One point of disconnect between traditional models of psychotherapy and the potential for implementing them in the UAE is the disparity between different cultures’ expectations regarding independence and self-assertion. In the UAE, unlike in countries like the US, seeking help for mental health problems is almost always a family affair. The capacity of women in particular to seek out this help is contingent on their families’ support.
Psychotherapists in the UAE consequently have less latitude to be openly critical of a family dynamic or to encourage a patient to stand up for herself at the risk of alienating her family. Emirati patients are generally not receptive to individualist narratives in which their identity and growth are distinct from those of their family. Psychotherapists working in the UAE need to recognize that therapy based on this premise may be culturally incompatible and ineffective and learn to work with patients whose place in their family is integral to their sense of identity.
Research on psychotherapy with Arab patients, and Muslim patients more generally, may shed some light on how to adapt models of psychotherapy for Emirati patients. One review of research on Islamic psychotherapy found that some American therapists working with Muslim clients used verses from the Qur’an to justify their therapeutic techniques. The authors of this review are critical of this method, suggesting that it places a veneer of religion on practices that, while they may be compatible with Islam, are not rooted in it.
Amber Haque, a psychology professor in Malaysia, advocates for a more thorough Islamization of psychology. He asserts that Islam should be at the foundation of both the therapist’s and the patient’s understanding and treatment of the problems. To this end, he recommends further scholarly attention to Arabic texts on psychology (pre-dating the modern practice of psychotherapy) that have not been integrated into Western psychology because they were never translated from Arabic.
Psychologist Marwan Dwairy proposes a therapeutic technique for use with Arab-Muslim patients in collectivist cultures, for whom straightforward discussion of their family dynamics—both in the therapist-client relationship and within the family unit itself—may not be culturally acceptable. He outlines the potential use of symbolism and indirect communication about family issues as a medium for working through the patient’s inner conflicts in a way that does not threaten his or her loyalty to his family and sense of identity as part of the family unit.
In one implementation of this technique, he and a patient explored the patient’s relationship with his parents through a metaphor the patient introduced—that of a wall. Because the patient framed his family relationship within this metaphor, explaining that communicating with his parents felt like talking to a wall, Dwairy extended the metaphor as a vehicle for talking about potential solutions. The patient was then able to come up with symbolic solutions to his problem such as decorating the wall or attempting to climb over it.
In another case, a father’s gift to a patient was a manifestation of their troubled relationship. Rather than ask the client to discuss this relationship in more explicit terms, Dwairy expanded on the way the client had chosen to bring up the issue, asking what he could do with the gift. After working through various options, the client decided to return the gift. In this way, he was able to reflect on and express his feelings toward his father’s action. Exploring family conflict indirectly, using symbols as a medium, enabled these patients to process and express their feelings in a way that did not violate their strong family values.
Techniques like these are examples of how to address Emirati patients within their cultural context, rather than imposing a therapeutic framework that evolved in a very different context. This approach will be crucial if the DHA is to deconstruct the barriers to the expansion of psychotherapy and facilitate Emiratis’ openness to it.