Islamic psychology and Islamically integrated psychotherapy

1. Introduction

Version followed: Traditional Islamically Integrated Psychotherapy (TIIP) as published by Hooman Keshavarzi, Fahad Khan and colleagues at Khalil Center (Keshavarzi & Haque 2013; Keshavarzi, Khan, Ali & Awaad, eds., 2020; Khan et al. 2023). Two other versions are named where they differ: Carrie York Al-Karam's "Islamically integrated psychotherapy" (IIP, edited volume 2018), and Abdallah Rothman and Adrian Coyle's Islamic model of the soul and grounded-theory "Islamic psychotherapy" (2018, 2020).

Sources include: the chapter list and authors of Keshavarzi et al. (2020) (Routledge contents page), TIIP's history and three-level training structure (HBKU abstract of Khan, Aycan & Keshavarzi 2023), TIIP's non-manualised, two-track approach (TCSPP CE course KC 3), documented meditation adverse effects (Lindahl et al. 2017 and case reports, via Brown University and Meditating in Safety summaries), and reported harms from exorcism-type healing (press reports, section 5). Not verified from a primary text, because the sources used give only titles, abstracts or summaries: the content of TIIP's five assessment principles, the RIDA model, Prophetic empathy, the Waswasa Workbook, and TIIP's procedures for contemplative murāqabah, tawbah and dream interpretation. These stay marked [uncertain] and are not reconstructed.

What it is. "Islamic psychology" is a field, not a single therapy. Al-Karam describes it as "primarily a domain" that develops theoretical and applied psychology rooted in Islam, with overlapping strands: Islamic accounts of the self (fitrah, nafs, qalb), Islamically integrated therapy, early Muslim scholarship, tazkiyah/taṣawwuf, and the "diseases of the heart" [source: Al-Karam, JIFP 3(1), pp. 111–113]. "Islamically integrated psychotherapy" (IIP) is Al-Karam's umbrella term, not a protocol. Her 2018 volume collects nine clinician-authored approaches that combine Islamic teachings, principles and interventions with Western therapies. Examples include an Islamic theoretical orientation (Rothman), marital counselling (Asamarai), the HEART method using the Prophet as exemplar in cognitive therapy (Lodi), family therapy with Qur'anic stories (Malik), psychodynamic integration (Rüschoff & Kaplick), work with youth (Sheikh), Shiite teachings such as Duaa Arafa (Fatemi), and a TIIP case (Keshavarzi & Khan) [source: UBC Press/Templeton table of contents; Wisconsin Muslim Journal review]. TIIP is the most fully specified clinical model in this family, so it forms the backbone of this guide. The individual chapters of the IIP volume are cited from the contents list only [uncertain].

Core idea of change (TIIP, as its authors hold it). TIIP is a "bottom-up" model built on Islamic epistemology and ontology rather than an adapted secular therapy. It integrates established empirical findings and filters non-empirical claims through Islamic theology [source: Sikander 2025 review of Keshavarzi et al. 2020, pp. 13–16]. In TIIP's view, the psyche has interacting components: ʿaql (intellect/cognition), nafs (behavioural inclinations), rūḥ (spirit), iḥsās (emotion), and the qalb (spiritual heart) as the seat of health or pathology. Distress is understood as imbalance among these components. Healing means restoring balance (iʿtidāl) and integration (ittiḥād) through a guided relationship plus cognitive, behavioural, emotional and spiritual interventions, moving towards what the tradition calls the "qalb salīm" (sound heart) [source: Khan et al. 2023; Sikander 2025]. These are the tradition's own theological-psychological constructs, not empirically established entities. Rothman & Coyle's version holds that the soul's original nature (fitrah) becomes "covered over", and that therapy releases "blockages or imbalances" at the levels of nafs, ʿaql, qalb and rūḥ so the client can realign with fitrah [source: Rothman & Coyle 2020 AAM, pp. 3, 6].

Who it is for. Muslim clients who want an Islamically oriented approach. In the outcome study, the Khalil Center accepted clients aged over 13 with mild-to-moderate distress and excluded those with severe distress [source: Khan et al. 2023]. Its use with non-Muslims is an open question for its authors [source: Sikander 2025; Al-Karam JIFP p. 116].

Status. Evidence is preliminary: one uncontrolled practice-based study (107 clients, 5 therapists) [source: Khan et al. 2023]. Khalil Center, an Islamically oriented outpatient centre near Chicago, uses TIIP as its dominant modality for trauma, depression, anxiety, OCD and marital discord. Training is a three-level curriculum: Level I (foundations), Level II (advanced application) and Level III (clinical supervision), followed by certification; Levels I and II have been delivered in the United States, Canada, Türkiye and Pakistan [source: Khan, Aycan & Keshavarzi 2023, HBKU abstract; Khalil Center TIIP course schedule]. The model was first set out by Keshavarzi & Haque (2013), named TIIP by Keshavarzi & Khan (2018), with "traditional" signalling its grounding in traditional Sunni theology, and given its fullest account in Keshavarzi et al. (2020) [source: Khan, Aycan & Keshavarzi 2023 abstract]. TIIP is not strictly manualised and offers general theoretical directions. Its applications are of two kinds: inherently Islamic approaches drawn from the Qur'an, the Prophetic tradition and the spiritual sciences (such as contemplation and supplication), and established mainstream interventions adapted where they fit TIIP's principles [source: TCSPP CE course KC 3]. In practice therapists combine it flexibly with CBT, ACT and other approaches [source: Khan et al. 2023].

2. Framework

TIIP describes four parallel patient phases and three therapist mechanisms. The patient's process is the target; the therapist mechanisms produce it [source: Khan et al. 2023; Sikander 2025 citing Keshavarzi et al. 2020 pp. 31–36].

Patient phase	Therapist mechanism	Goal
1. Inqiyād (compliance/motivation)	Murābaṭah (alliance, therapeutic bond)	Trust and commitment strong enough to carry demanding work
2. Inkishāf (introspective self-awareness)	Mukāshafah (unveiling), mainly through "empathic following and deepening"	Client sees their cognitive, emotional, behavioural and spiritual tendencies
3. Iʿtidāl (psychospiritual equilibrium)	Muʿālajah (targeted intervention by domain)	Balance among ʿaql, nafs, iḥsās and rūḥ
4. Muwāṣalah (continuity) leading to Ittiḥād (integrative unity)	Continued muʿālajah and consolidation	Parts of the psyche aligned towards higher-order goals; resilience and growth beyond symptom relief

Assessment and case conceptualisation. Assessment is the subject of Ch. 5 of the TIIP text, Fahad Khan's "Quantitative and Qualitative Assessment of the Ontological Domains of the Psyche in TIIP" [source: Routledge contents page]. It presents case-conceptualisation models covering the cognitive, emotional, behavioural, spiritual and social aspects of the psyche, with quantitative and qualitative methods [source: Sikander 2025 on Ch. 5]. TIIP trainings also teach "5 assessment principles", "Prophetic empathy" and stages-of-change readiness in the session on assessment and the early stages of counselling [source: Khalil Center TIIP course schedule]. The five principles are named but not listed in the sources used; their content is [uncertain] and is not reconstructed here. The Khalil Center study measured outcomes session by session on the CAMOS, which covers concerns about therapy, relationship, psychological, spiritual and physical-health distress, and screened with the Brief Symptom Inventory. Do not reproduce items; obtain the instruments from their authors [source: Khan et al. 2023]. TIIP also has a Traditional Islamic Inventory of Virtues (TIIV), covering wisdom, temperance, valour, justice and spirituality. Its scoring and use are not described in the sources used [uncertain] [source: course schedule].

Session count and format. TIIP is individual outpatient therapy (couples, family and child work appear in the wider IIP literature). In the Khalil Center sample, clients attended 1–24 sessions, mean 4.4, and only 10% exceeded 10 sessions. No fixed course length is published [source: Khan et al. 2023]. Weekly 50-minute sessions are a reasonable default [synthesis].

Moving between phases. The authors publish no explicit criteria or timelines [source: Khan et al. 2023]. Working markers [synthesis]:

Phase 1→2: the client attends reliably, accepts the integrated frame, and agrees to look inward.
Phase 2→3: you and the client can jointly name which domain(s) are out of balance (for example, "catastrophic beliefs about sin (ʿaql) driving avoidance (nafs) with chronic guilt (iḥsās)") and agree goals.
Phase 3→4: symptom measures have improved, the client is using the practices independently, and the conversation shifts to values, character and relapse prevention.

Phases overlap. Expect to return to alliance work (phase 1) after any rupture.

3. Guiding principles

Bottom-up Islamic grounding. Start from the Islamic view of the person and add empirical methods that fit it, rather than decorating secular therapy with verses. Practical meaning: conceptualise the case in the five-domain language first, then choose techniques [source: Sikander 2025, p. 13; Rothman & Coyle 2020, p. 5 on avoiding "Islamicizing"].
Science and revelation are not set against each other. TIIP distinguishes definitive (qaṭʿī) from probabilistic (ẓannī) knowledge and does not dispute established empirical findings. Practical meaning: use evidence-based procedures such as exposure and response prevention (ERP) without apology, and do not present religious frames as replacing medical care [source: Sikander 2025, pp. 14–16].
Holism and balance. The aim is equilibrium across domains, not only symptom removal. Practical meaning: track which domain each intervention targets, and expect change in one to spill into the others [source: Khan et al. 2023].
Emotions are signals. In TIIP, iḥsās are alarm signals of underlying needs, healthy in moderation and unhealthy at extremes. Practical meaning: explore the source (belief, unmet need or spiritual experience) before trying to reduce the feeling [source: Khan et al. 2023].
The nafs is trained, not condemned. Rothman & Coyle's participants said the nafs is "not necessarily 'bad' or 'evil'". TIIP's principle of mukhālafah means opposing maladaptive primitive drives to build habits aligned with ʿaql. Practical meaning: frame behaviour change as training with compassion, not moral punishment [source: Rothman & Coyle 2020, pp. 18–19; Keshavarzi & Nsour 2020 abstract].
The therapist as guide and companion. TIIP draws on the tradition that self-knowledge needs a wise mentor (citing al-Ghazālī), and it describes therapists as khalīl or rafīq (close confidant, gentle companion). Practical meaning: be warm, credible and directive enough to guide, while remaining collaborative [source: Khan et al. 2023; Sikander 2025, p. 49].
Therapist's own development and modelling. Listed competencies include strong foundational knowledge, moral and ethical grounding, seeking supervision and collaboration, and "aspiring to model perfection in character". Practical meaning: arrange supervision, including access to an Islamic scholar for religious questions, and attend to your own conduct [source: Khan et al. 2023].
Know the limits of your role. TIIP training distinguishes several roles: murabbī, shaykh, muṣliḥ, ṭabīb, psychologist and faqīh (jurist). Rothman & Coyle's participants were cautious about "venturing into deep religious guidance" and referred to shaykhs or imams. Practical meaning: do not issue religious rulings (fatwā); refer legal-religious questions and consult scholars [source: Khalil Center course schedule; Rothman & Coyle 2020, p. 32].
Client choice. Khalil Center study participants were Muslims who wanted an Islamically oriented approach and gave informed consent [source: Khan et al. 2023]. Rothman & Coyle stress "radically respecting and honoring clients' religious beliefs" [source: Rothman & Coyle 2020, p. 5]. Practical meaning: ask at intake whether and how the client wants faith brought in, and check again before each explicitly religious intervention [synthesis].
Readiness and pacing. Some clients "have to begin on the outside" (behaviour and cognition) before moving to the heart [source: Rothman & Coyle 2020, p. 23]. Practical meaning: begin with the presenting behaviour and thoughts, and move to qalb and rūḥ work only when the client is ready.
The rūḥ is approached with humility. Most of Rothman & Coyle's participants treated the spirit as largely beyond clinical reach, citing Qur'an 17:85. TIIP does prescribe spiritual acts (dhikr) [source: Rothman & Coyle 2020, pp. 30–31; Khan et al. 2023]. Practical meaning: offer spiritual practices as supports the client already values; do not claim to treat the soul.
Severity and fit. Religious interventions may not suit serious psychiatric or neurological conditions [source: Khan et al. 2023, citing Razali et al. 1998]. Practical meaning: treat severe disorders with standard care first, adding faith-integrated elements only as adjuncts.

4. Intervention inventory

The inventory is grouped by TIIP's therapist mechanisms and target domains. TIIP is not manualised. Its procedures are set out in Keshavarzi et al. (2020): Ch. 5 assessment (Khan); Ch. 6 dreams (Elzamzamy & Salem); Ch. 7 emotionally oriented psychotherapy (H. Keshavarzi & S. Keshavarzi); Ch. 8 the intellect (ʿaql) as a cognitive restructuring tool (Yusuf & Elhaddad); Ch. 9 behavioural (nafsānī) psychotherapy (Keshavarzi & Nsour); Ch. 10 spiritually (rūḥānī) focused psychotherapy (Keshavarzi, Yusuf, Kaplick, Ahmadi & Loucif) [source: Routledge contents page]. The chapter texts are cited through the contents page, abstracts and a published review, not the full text [uncertain]. Named interventions come from those sources. Step-by-step instructions are therefore largely my operationalisation and are marked [synthesis] unless a source gives the step. Example language is illustrative throughout.

A. Engagement and alliance (murābaṭah → inqiyād)

A1. Faith-integration intake and consent

Purpose: confirm the client wants an Islamically oriented approach and establish how explicit it should be. Khalil Center study inclusion required this preference [source: Khan et al. 2023]. Use at the first session.
Steps [synthesis]:
1. Ask what role faith plays in the client's life and in the problem. Religion can be a resource or part of the distress; 30.2% of Khalil Center clients said religion had contributed to their challenges [source: Khan et al. 2023].
2. Explain the TIIP frame briefly (see A3).
3. Agree which religious elements are welcome (concepts, Qur'anic or prophetic references, practices, prayer in session) and which are not.
4. Clarify your role: therapist, not mufti or shaykh. Explain how religious-legal questions will be referred.
5. Document consent. Revisit it before any new explicitly religious intervention.
Example language (illustrative): "Some people want their faith right at the centre of our work, some want it in the background, and some would rather keep it out. What would feel right for you?"
Watch for: deference to you as a religious authority; fear of being judged as a "bad Muslim"; family or community pressure to attend. It is working when the client states their own preferences and can disagree with you.

A2. Building the alliance (murābaṭah), including "Prophetic empathy"

Purpose: produce inqiyād, the trust and motivation needed for demanding work. This is the first mechanism of change in TIIP [source: Khan et al. 2023]. The TIIP curriculum teaches "Prophetic Empathy" and "Empathy Response Styles" alongside its assessment principles [source: Khalil Center course schedule]. No published description of either was found in the publisher, Khalil Center, CE-course or review pages searched, so their content is [uncertain] and the steps below are generic alliance practice, not TIIP's protocol.
Steps [synthesis]:
1. Listen to the client's account and reflect both content and feeling.
2. Validate religious and cultural meanings without correcting them early.
3. Address stigma about therapy and fears that therapy will weaken faith; the authors note many religious people avoid therapy for this reason [source: Khan et al. 2023].
4. Assess readiness (stages of change, which appear in the TIIP curriculum) and set an initial shared goal.
Example language (illustrative): "It took courage to come. Many people worry that a therapist will try to pull them away from their faith. That isn't my aim here."
Watch for: premature advice-giving, or over-identification when you share the client's faith. It is working when attendance is reliable and the client brings difficult material.

A3. Psychoeducation on the holistic model

Purpose: give a shared map. Rothman & Coyle report that practitioners generally begin with psychoeducation introducing a holistic view of mental health that includes the heart [source: Rothman & Coyle 2020, p. 27].
Steps [synthesis]:
1. Describe the five TIIP domains in plain words: thinking (ʿaql), urges and habits (nafs), feelings (iḥsās), spirit (rūḥ), and the heart (qalb) where they meet.
2. Map the presenting problem onto them together.
3. Note that change in one domain affects the others.
Example language (illustrative): "In this tradition the heart is where thoughts, urges and feelings meet. Let's look at which part feels most out of balance for you right now."
Watch for: clients hearing a spiritual frame as blame ("my iman is weak"). Reframe imbalance as human, not as a moral verdict.

A4. Case conceptualisation and outcome tracking

Purpose: identify which domain(s) to target and monitor progress. TIIP teaches its own case-conceptualisation format across cognitive, emotional, behavioural, spiritual and social domains [source: Sikander 2025 on Ch. 5; course schedule]. The specific TIIP format is not described in the sources used [uncertain].
Steps [synthesis]: (1) list symptoms and behaviours; (2) for each domain, note the excess, deficit or distortion; (3) hypothesise the dominant imbalance; (4) set goals per domain; (5) track a standard distress measure each session (Khalil Center used the CAMOS and BSI; obtain them properly and do not reproduce items) [source: Khan et al. 2023].
Watch for: over-spiritualising medical or psychiatric conditions. Complete standard risk and diagnostic assessment first.

B. Unveiling (mukāshafah → inkishāf)

B1. Empathic following and deepening

Purpose: raise introspective self-awareness so the client can see their inner world. TIIP says this is achieved "mostly through empathic following and deepening". The traditional rationale is that people struggle to see their own deficiencies without a guide [source: Khan et al. 2023].
Steps [synthesis; the specific TIIP technique is not described in the sources, uncertain]:
1. Follow the client's leading edge of feeling rather than the storyline.
2. Slow down at moments of affect.
3. Ask for felt detail ("what happens inside as you say that?").
4. Reflect the implicit belief, need or longing.
5. Invite the client to stay with it.
Example language (illustrative): "When you said 'Allah must be tired of me', your voice dropped. Can we stay there a moment? What is that like inside?"
Watch for: flooding (see section 5). It is working when the client starts naming patterns themselves.

B2. Nafs watchfulness ("is this coming from the ego?")

Purpose: build observing awareness of impulses. One practitioner in Rothman & Coyle helped clients ask whether a statement was coming from the "ego" (nafs) [source: Rothman & Coyle 2020, p. 20].
Steps [synthesis]: (1) when the client voices a demand or urge, pause; (2) ask which part of them is speaking; (3) distinguish the urge from the client's considered values (ʿaql); (4) note it without condemning it.
Example language (illustrative): "Is that the part of you that wants comfort right now, or the part of you that knows what you value?"
Watch for: self-attack. Reframe "evil" or "bad" terms using the Arabic concept, as practitioners did: the nafs as a drive to be guided [source: Rothman & Coyle 2020, p. 19].

B3. Body-based inquiry and body-noticing homework

Purpose: reach emotional material held in the body and in the qalb. One practitioner tracked emotions stored in the body back to their source. Another asked clients to notice bodily states between sessions, starting with positive experiences [source: Rothman & Coyle 2020, pp. 24–25, 28].
Steps [synthesis around these descriptions]: (1) ask where the feeling sits in the body; (2) describe its quality; (3) ask what memory, belief or need it connects to; (4) for homework, note a pleasant bodily state daily before progressing to difficult ones.
Example language (illustrative): "As you talk about your father, what do you notice in your chest or stomach?"
Watch for: dissociation or trauma activation. Ground the client and titrate exposure to the material.

C. Cognitive (ʿaql) interventions (muʿālajah)

C1. Religiously oriented (ʿaqlānī) cognitive restructuring

Purpose: change beliefs and give new perspectives using Islamic sources the client accepts. This was the most frequently recorded Islamic intervention at Khalil Center (42.4% of sessions) [source: Khan et al. 2023]. Haque & Keshavarzi describe cognitive restructuring using the Qur'an and hadith [source: Haque & Keshavarzi abstract]. TIIP's cognitive chapter is Ch. 8, "The Use of the Intellect (ʿaql) as a Cognitive Restructuring Tool in an Islamic Psychotherapy" (Yusuf & Elhaddad), which explores how Islamic thought conceives the intellect and its role in restructuring [source: Routledge contents page; Sikander 2025]. The curriculum introduces a "RIDA model" of cognitive psychotherapy with case illustrations, but no source opened expands the acronym or gives its steps [uncertain] [source: Khalil Center course schedule]. In TIIP, ʿaql, when developed, regulates emotion [source: Khan et al. 2023].
Steps [synthesis, standard CBT structure]:
1. Identify the automatic thought and the emotion it produces.
2. Examine the evidence.
3. Ask what the client's own tradition teaches about the theme (mercy, hope, decree, forgiveness), letting the client supply references they know.
4. Build a balanced alternative thought consistent with both the evidence and the client's faith.
5. Test it behaviourally.
Example language (illustrative): "You're concluding that one missed prayer means you're beyond forgiveness. What does your own understanding of God's mercy say about that?"
Watch for: you quoting texts as rulings, or the client using texts to argue for harsher conclusions. Refer contested points to a scholar. It is working when the alternative belief reduces distress and is the client's own.

C2. Positive reframing and ḥusn al-ẓann (good opinion)

Purpose: counter negative attribution bias. Ḥusn al-ẓann was recorded in 39% of Khalil Center sessions [source: Khan et al. 2023]. "Islamic positive cognitive reframing" is part of the TIIP waswasa protocol [source: TCSPP CE course KC 4]. The IIP volume review names reframing hardship as spiritual elevation (ibtilāʾ), trust in God (tawakkul) and contentment with decree (riḍā bil-qaḍāʾ) [source: Wisconsin Muslim Journal review].
Steps [synthesis]: (1) elicit the negative interpretation; (2) ask what other meanings are possible, including those the client's faith offers; (3) choose one the client finds credible; (4) rehearse it when the trigger recurs.
Example language (illustrative): "If a friend you admired went through this, how might you understand what it means for them?"
Watch for: "toxic positivity" or use of decree (qadar) to silence grief or legitimise abuse. Reframing should never be used to keep someone in danger [synthesis].

C3. Psychoeducation that corrects faulty religious beliefs

Purpose: replace mistaken religious beliefs that drive symptoms, for example scrupulous beliefs about purity or blasphemy, using accurate teaching [source: TCSPP CE course KC 4].
Steps [synthesis]: (1) identify the belief and where the client learned it; (2) check the mainstream position with a qualified scholar (TIIP supervision included an Islamic scholar [source: Khan et al. 2023]); (3) present it as information, not a ruling from you; (4) let the client consult their own scholar if preferred.
Watch for: "reassurance" that feeds OCD (see D3). Give the information once, then stop repeating it.

C4. The Prophetic exemplar

Purpose: model emotional and behavioural responses on the Prophet's example, drawing on the client's reverence. "Using the prophetic example" was recorded in 14% of Khalil Center sessions [source: Khan et al. 2023]. Farah Lodi's HEART method ("Healthy Emotions Anchored in RasoolAllah's Teachings") uses the Prophet as a psycho-spiritual exemplar in cognitive therapy; the chapter's method is not described in the sources used [uncertain] [source: UBC Press TOC].
Steps [synthesis]: (1) ask which accounts of the Prophet's conduct the client knows that bear on the situation (grief, anger, rejection); (2) explore what they show about responding; (3) translate them into a concrete coping plan.
Watch for: perfectionistic comparison ("I can never be like him"). Emphasise the example as guidance, not a standard to fail.

C5. Spiritually integrated themes (hope, mercy, gratitude, decree, forgiveness, doubts)

Purpose: address spiritual distress directly. Khalil Center therapists recorded discussing hope (36.7%), compassion (28.6%), acceptance of Allah's decree (23.6%), embracing Allah's mercy (19.5%), gratitude (17.1%), identifying pathways to God (15.5%) and exploring religious doubts (11.9%). They also discussed forgiveness and affirmed the client's divine worth [source: Khan et al. 2023].
Steps [synthesis]: open the theme with a question; explore the client's experience and belief; link it to the presenting problem; agree one practical expression (for example, a gratitude log).
Example language (illustrative): "You've said you have doubts. This is a safe place to say them out loud, without me judging you for them."
Watch for: doubts handled as pathology. Normalise them, and refer theological questions on request.

D. Behavioural (nafsānī) interventions

D1. The Six M's model of behaviour change

Purpose: reach behavioural goals set jointly by practitioner and client by training the nafs to delay gratification and move towards tranquillity (iṭmʾīnān). The six stages adapt a classical Islamic self-discipline sequence [source: Keshavarzi & Nsour 2020 abstract; Sikander 2025, p. 256]. That sequence is al-Ghazali's (Revival of the Religious Sciences, book 38), which a traditional Islamic teaching institute presents as goal-setting, watching over oneself, taking oneself to account at a set time (daily, weekly or monthly), self-penalty as positive self-discipline, striving, and self-reproach that guards against self-satisfaction [source: SeekersGuidance 2019]. Use the model for habits, avoidance, compulsions and impulse problems. The names and glosses below are the authors'. The chapter's step-by-step procedures are not given in the sources used, so the operational steps are [synthesis].
Steps:
1. Mushāraṭah (goal-setting / commitment). Agree one specific, observable target behaviour and a commitment to it. "Commitment to behavior change (musharatah)" was recorded in 22.1% of Khalil Center sessions [source: Khan et al. 2023].
2. Murāqabah (self-monitoring / behavioural self-regulation). The client watches for the trigger and the urge in real time, logging when it occurs and what they did (18.8% of sessions) [source: Khan et al. 2023]. In TIIP's behavioural model, murāqabah means self-monitoring, distinct from the contemplative sense in E2 and F3.
3. Muḥāsabah (self-evaluation / behavioural retrospection). At a set time, review the log against the goal (16% of sessions) [source: Khan et al. 2023]. Haque & Keshavarzi describe "reflecting on a behavioral log of daily actions" [source: abstract]. Rothman & Coyle report a practitioner prescribing a five-to-seven-minute end-of-day review with journaling for anxiety and sleep [source: Rothman & Coyle 2020, p. 21].
4. Muʿāqabah (consequences). The client applies a pre-agreed, proportionate consequence or contingency to lapses, and you plan reinforcement for successes [synthesis on how; consequence-setting per source]. The classical sequence frames self-penalty as positive self-discipline, not punishment for its own sake [source: SeekersGuidance 2019].
5. Muʿātabah (self-reprimand). The client briefly holds themselves to account. Practise this as a short, kind, corrective statement rather than self-attack [synthesis; caution added].
6. Mujahādah (striving / exertion). Sustained effort against the urge over time (25% of sessions as "goal striving/self-struggle") [source: Khan et al. 2023].
Example language (illustrative): "This week, let's choose one habit. You'll notice each time the urge comes, jot it down, and each night take five minutes to look back. If you slip, what's a fair, kind way to set it right tomorrow?"
Watch for: risk flag. Muʿāqabah and muʿātabah can feed self-punishment, guilt or scrupulosity in depressed, perfectionistic or OCD clients. Keep consequences mild and corrective, and drop self-reprimand if it raises shame [synthesis]. It is working when logs show fewer lapses and the client reports more self-control without rising guilt.

D2. Mukhālafah: opposing maladaptive drives (response restriction and exposure)

Purpose: TIIP's central behavioural principle of opposing the nafs's "maladaptive primitive drives" [source: Keshavarzi & Nsour 2020 abstract]. In practice this means restricting safety- and pleasure-seeking behaviours and exposing clients to feared stimuli [source: Khan et al. 2023]. Related recorded interventions: going against unhealthy impulses (24%), self-control (24.5%), and dishabituation and extinction of unhealthy behaviours (16.9%) [source: Khan et al. 2023].
Steps [synthesis, standard exposure procedure]:
1. Obtain consent after explaining the rationale and the temporary rise in anxiety.
2. Build a graded hierarchy.
3. Agree which safety behaviours will be dropped.
4. Do exposures in and between sessions until anxiety reduces or expectancies change.
5. Frame this as the client's chosen striving, not a test of faith.
Example language (illustrative): "Going against the urge to check is hard by design. Each time you resist, you're training that part of yourself. We'll start with something rated about 3 out of 10."
Watch for: exposure safety. Screen for unstabilised trauma, active psychosis, suicidality and medical conditions aggravated by acute anxiety (for example cardiac conditions or pregnancy), and seek medical clearance where relevant [synthesis]. Never design exposures that require the client to act against their own religious obligations; choose exposures to doubt and uncertainty instead [synthesis].

D3. TIIP treatment of scrupulosity (waswasa)

Purpose: treat OCD with religious content [source: TCSPP CE course KC 4, Keshavarzi & Khan 2020; Keshavarzi & Nsour 2020 case; Keshavarzi, Khan & Syed 2020 chapter, title only]. TIIP has a Waswasa Workbook, whose content is not described in the sources used [uncertain] [source: course schedule].
Steps (components per the course description; sequencing is [synthesis]):
1. Assess symptoms across the four thematic clusters TIIP uses: ritual purity and prayer; marriage and divorce; blasphemy and apostasy; intrusive thoughts of sin. Distinguish OCD from ordinary religious conscientiousness.
2. Psychoeducation grounding waswasa in the Qur'an, prophetic traditions and scholarship, and identifying it as clinical, treatable pathology.
3. Religious dispensations. Review dispensations in Islamic ritual law, framed as disability accommodations. A scholar should confirm what applies to this client [synthesis on scholar role].
4. Cognitive work: challenge the evidence; correct faulty Islamic beliefs; accept intrusive thoughts and their inconsequentiality; "acting as if"; Islamic positive cognitive reframing.
5. ERP to reduce the anxiety linked to the intrusive thoughts that drive compulsions (repeating ablutions, repeating prayers, seeking reassurance).
6. Counterbalance negative attribution bias with "a more self-compassionate cognitive orientation".
Example language (illustrative): "Your scholars have discussed this kind of doubt for centuries and treated it as something not to follow. So the task isn't to become certain. It's to act as if the prayer counts and let the doubt be there."
Watch for: reassurance-seeking from you or imams; repeated fatwā-seeking as a compulsion; fear that ERP is sinful. It is working when compulsions and time spent decrease and the client completes worship within ordinary bounds.

D4. Character development and virtue cultivation

Purpose: replace negative behaviours with positive ones and cultivate virtues. "Character development" was recorded in 21% of sessions and "positive behaviors to replace negative ones" in 20.2% [source: Khan et al. 2023]. TIIP's Traditional Islamic Inventory of Virtues covers wisdom, temperance, valour, justice and spirituality [source: course schedule]. Rothman & Coyle list the tradition's muhlikāt (vices such as anger, envy, greed and lust) and munjiyāt (virtues) [source: Rothman & Coyle 2020, p. 6].
Steps [synthesis]: (1) identify a vice-pattern linked to the problem (for example, anger in a marriage); (2) name the opposing virtue the client values; (3) define one behavioural expression of it; (4) track it with D1.
Example language (illustrative): "If patience were showing up in that argument, what would it actually look like?"
Watch for: labelling the client by vices. Rothman & Coyle warn against labelling clients and treat a muhlikāt-based diagnosis as unvalidated [source: Rothman & Coyle 2020, p. 37].

E. Emotion-focused (iḥsās) interventions

E1. Bottom-up emotional processing and regulation

Purpose: TIIP treats emotions as signals of underlying needs. It explores whether their source is beliefs, unmet needs or spiritual experience, and regulates extremes [source: Khan et al. 2023]. The relevant chapter is Ch. 7, "Emotionally Oriented Psychotherapy" (H. Keshavarzi & S. Keshavarzi), which covers emotions and their role in mental health from an Islamic perspective [source: Routledge contents page; Sikander 2025]. Its techniques and the curriculum's "emotional signature interventions" are not described in the sources used [uncertain] [source: course schedule].
Steps [synthesis, emotion-focused practice]:
1. Help the client attend to the emotion and name it.
2. Locate it in the body.
3. Explore the need or belief it signals.
4. If the emotion is maladaptive, access an adaptive emotion (for example self-compassion or assertive anger).
5. Teach regulation skills for extremes (slowed breathing, grounding, opposite action).
Example language (illustrative): "If this sadness could speak, what would it say it needs?"
Watch for: overwhelm (see section 5). It is working when emotions become nameable, tolerable and informative.

E2. Heart-focused attention and presence (ḥuḍūr)

Purpose: "activate" or "connect" with the qalb once heart and mind are in balance. Practitioners cultivated present-moment awareness (ḥuḍūr), and had clients close their eyes, focus on the chest and quiet their thoughts [source: Rothman & Coyle 2020, pp. 27–28].
Steps [synthesis around these descriptions]: (1) offer it as optional; (2) eyes closed or a lowered gaze; (3) settle the breath; (4) rest attention on the centre of the chest; (5) notice without pushing; (6) after a few minutes, reflect on what was noticed.
Example language (illustrative): "Let your attention settle in the centre of your chest. Just notice what is there, without needing to change it."
Watch for: meditation risks. Lindahl et al. (2017) interviewed nearly 100 Western Buddhist meditators and teachers and documented 59 kinds of challenging experience across cognitive, perceptual, affective, somatic, conative, sense-of-self and social domains. These included fear, anxiety, panic, loss of emotion, hypersensitivity to light or sound, insomnia, involuntary movements and disorienting changes in the sense of self. Effects lasted from days to months, occasionally over a decade; teachers often cited practice intensity, psychiatric or trauma history and quality of supervision as factors [source: Lindahl et al. 2017, via Brown University news release]. Case reports describe psychotic episodes (Kuijpers et al. 2007) and mania (Yorston 2001) after meditation, in people with and without prior psychiatric history [source: Meditating in Safety research summaries]. These studies concern Buddhist, Zen, yoga and TM practice, not Islamic heart-focused practice, and no TIIP or IIP source opened reports adverse effects, so applying them here is [synthesis]. Response [synthesis]: screen for psychosis or bipolar history and unstabilised trauma; keep the practice brief, optional and eyes-open-capable at first; ask afterwards what came up; stop and ground the client if fear, panic, depersonalisation or unusual perceptions appear; and say that such reactions are known and are not a spiritual failing (following Lindahl et al.'s call to reduce stigma).

F. Spiritual (rūḥānī) interventions

TIIP treats these practices as part of the client's own religion. The therapist encourages or prescribes practices the client already accepts. The therapist does not lead ritual, define its correct form or claim authority over it. Correct form and any further guidance belong to the client's scholars and teachers [synthesis, consistent with Rothman & Coyle 2020, p. 32].

F1. Prescribing dhikr and other spiritual acts

Purpose: strengthen the spiritual domain. TIIP's spiritual chapter discusses how motivated behaviours ("Islamic mechanisms") using dhikr, remembrance of the Divine, might positively modulate the spiritual domain, and how these can become psychotherapeutic interventions [source: Keshavarzi, Yusuf, Kaplick, Ahmadi & Loucif 2020 abstract]. In TIIP, muʿālajah for the rūḥ includes prescribing spiritual acts such as dhikr; prayer, charity and contemplation are named as practices that strengthen the spiritual connection [source: Khan et al. 2023]. Haque & Keshavarzi mention repeating prescribed prayers and invoking blessings on the Prophet [source: abstract]. Other practitioners prescribed listening to Qur'an recitation, or a particular sūrah before sleep, for poor sleep, and described worship assignments as "feeding" the rūḥ [source: Rothman & Coyle 2020, p. 32].
Steps [synthesis]:
1. Ask which practices already bring the client peace or connection.
2. Link one to the formulation (for example, remembrance at a known anxiety trigger, or recitation as part of a sleep routine).
3. Agree a manageable, client-chosen routine; content and wording are the client's choice or their teacher's, not yours.
4. Review the effect next session.
Example language (illustrative): "You said remembrance calms you. Would it help to build a few minutes of it into the moment you usually start worrying at night?"
Watch for: practices becoming compulsive (counting, repeating until it "feels right"). In waswasa, check that the practice is not a neutralising ritual. Also watch for guilt when the routine is missed. It is working when the practice brings calm or meaning and is done willingly.

F2. Tawbah (repentance) as a therapeutic process

Purpose: address guilt and the wish to change after wrongdoing. Ch. 10 of the TIIP text, "Spiritually (Rūḥānī) Focused Psychotherapy" (Keshavarzi, Yusuf, Kaplick, Ahmadi & Loucif), presents dhikr and tawbah (repentance) as therapeutic interventions [source: Sikander 2025; Routledge contents page]. Its procedure for tawbah is not described in the sources used, so the steps below are generic [uncertain].
Steps [synthesis]:
1. Distinguish adaptive guilt (a specific act, reparable) from pathological guilt (global, scrupulous).
2. For adaptive guilt, explore acknowledgement, regret, repair and recommitment in the client's own religious terms.
3. Connect it to behaviour change (D1).
4. Refer detailed religious questions about expiation to a scholar.
Example language (illustrative): "In your tradition, what does turning back after a mistake involve, and which part of that feels within reach for you now?"
Watch for: repeated repentance rituals as an OCD compulsion. In that case, treat it with D3 rather than encouraging more repentance.

F3. Contemplative practice (murāqabah), guided imagery and breathing

Purpose: the TIIP curriculum lists "Sufi practices" including murāqabah and dhikr integrated into psychotherapy, plus guided imagery and breathing exercises, as spiritually oriented interventions [source: Khalil Center TIIP course schedule]. Rothman & Coyle report that murāqabah and tafakkur (contemplation) were seen as adaptable, but most practitioners had not trained in them [source: Rothman & Coyle 2020, p. 28]. Note the two senses: in Ch. 9's Six M's model murāqabah means behavioural self-monitoring (see D1) [source: Sikander 2025, p. 256]; no published TIIP procedure for contemplative murāqabah is available in the sources used [uncertain].
Steps: none are given here, so as not to invent a TIIP protocol. If you use a contemplative exercise, keep to a generic, brief, eyes-open-optional attention exercise as in E2. Leave traditional Sufi murāqabah instruction to qualified teachers within the client's own tradition [synthesis].
Watch for: the meditation adverse effects documented in E2 [source: Lindahl et al. 2017; case reports via Meditating in Safety], applied here by extrapolation [synthesis].

F4. Prayer (duʿāʾ) or ṣalāh with the client in session

Purpose: some practitioners pray with clients in session. One practitioner prayed with female clients [source: Rothman & Coyle 2020, p. 32]. Duʿāʾ and istikhārah (prayer for guidance) are presented in the IIP volume as tools to share with Muslim clients [source: Wisconsin Muslim Journal review].
Steps [synthesis]: (1) do this only at the client's request or with explicit consent; (2) keep it brief and in the client's words where possible; (3) process its meaning afterwards; (4) consider gender norms, boundaries and dual-role issues, and document it.
Watch for: role confusion (therapist as imam), pressure on the client to pray, and transference effects. Avoid it entirely if the client is ambivalent about religion.

F5. Dream interpretation (ʿilm taʿbīr al-ruʾ yā)

Purpose: Ch. 6 of the TIIP text, "Dreams and Their Role in Islamically Integrated Mental Health Practice" (Khalid Elzamzamy & Mohamed Omar Salem), reviews classical Islamic dream interpretation (ʿilm taʿbīr al-ruʾyā), its significance in psychotherapy and clinical uses of dream analysis [source: Routledge contents page; Sikander 2025]. The chapter's method (any classification of dreams or steps) is not described in the sources used [uncertain].
Steps: none are given. Explore the dream's personal meaning and emotion as in standard dream work, without making predictive or religious pronouncements [synthesis].
Watch for: clients treating a dream as a divine command for a risky action. Assess safety.

G. Other IIP approaches (Al-Karam's volume, 2018)

These chapters are known from the table of contents only, and their procedures are not described here [uncertain]: an Islamic theoretical orientation to psychotherapy (Rothman); Islamic principles in marital counselling (Asamarai); the HEART method (Lodi; see C4); culturally responsive spiritually integrated family therapy (A. Haque); Islamic spirituality in psychodynamic therapy (Rüschoff & Kaplick); family therapy using Qur'anic stories (Malik); work with children and adolescents (Sheikh); and Duaa Arafa and other Shiite teachings in psychotherapy (Fatemi) [source: UBC Press TOC]. Note that a Shiite-informed approach (Fatemi) and the predominantly Sunni TIIP sample (93.4% Sunni [source: Khan et al. 2023]) differ: match sources to the client's school and denomination [synthesis].

5. Handling problems

The opened TIIP and IIP sources say little about problem management. Unless a source is tagged, the guidance below is [synthesis].

Low engagement and early dropout. The Khalil Center mean was 4.4 sessions, and only 10% of clients attended more than 10 [source: Khan et al. 2023]. Response: front-load a formulation and one concrete win in sessions 1–3. Return to murābaṭah (A2) and ask directly what would make therapy worth continuing. Address fear that therapy threatens faith (A1).
Stuck in phase 2 (insight without change). Move from mukāshafah to a specific muʿālajah target. Pick the domain driving the cycle and set one Six M's goal (D1).
Stuck in phase 3 (change without integration). Link gains to the client's values and spiritual goals. Plan relapse prevention around lapses as part of mujahādah, not as failure.
Resistance to the religious frame. Some clients want a Muslim therapist but not explicit religion. Others feel judged by religious language. Response: scale integration down to implicit respect, and use standard evidence-based therapy. TIIP itself was delivered alongside CBT and ACT and is not manualised [source: Khan et al. 2023].
Religion as part of the distress. 30.2% of Khalil Center clients said religion had contributed to their challenges [source: Khan et al. 2023]. Examples include religious trauma, coercive family religiosity, guilt over doubts, and identity conflicts. Response: do not push religious interventions. Explore the client's own relationship to faith neutrally. Refer to a scholar only if the client wants it. Never steer the client towards or away from belief.
Overwhelm during deepening or heart-focused work. Stop the exercise and ground the client: eyes open, feet on the floor, orient to the room. Return to cognitive or behavioural work. Re-titrate. Review trauma history and stabilise before resuming.
Non-adherence to homework (logs, muḥāsabah, practices). Shrink the task and check whether it triggers guilt. Separate therapeutic homework from religious obligation so a missed log is not experienced as sin.
Scrupulosity spreading into the Six M's or spiritual practices. Watch for perfectionistic logging, harsh muʿātabah, repetitive dhikr or tawbah done to neutralise anxiety. Response: switch to the waswasa protocol (D3), with ERP, accepting intrusive thoughts and their inconsequentiality, and self-compassionate reframing [source: TCSPP CE course KC 4]. Stop reassurance, including from you.
The client asks for a religious ruling. Do not give one. TIIP training distinguishes therapist roles from the faqīh and shaykh [source: course schedule], and Rothman & Coyle's practitioners referred clients to shaykhs or imams [source: Rothman & Coyle 2020, p. 32]. Build a referral list of scholars familiar with mental health. In OCD, agree in advance that a ruling is sought once, then not re-asked.
Ruptures. These include feeling judged by a co-religionist therapist, gender or sect mismatch, or disagreement over an interpretation. Response: name the rupture, take your share, and invite correction. Offer a referral if a mismatch of school, sect or gender is central. Supervision should include someone able to advise on religious questions; the Khalil Center team included an Islamic scholar [source: Khan et al. 2023].
Spiritual or supernatural attributions (jinn, evil eye, sorcery, whispering). Rothman & Coyle's practitioners considered waswasa, shayṭān and jinn influences relevant in some cases, including psychosis [source: Rothman & Coyle 2020, pp. 22–23]. Response: respect the belief as the client's own frame. Complete standard psychiatric assessment regardless; psychotic, manic, neurological and medical causes must be assessed and treated. Ask whether the client is also receiving traditional healing (for example ruqyah) and from whom. Screen that healing for physical harm, restraint, coercion, sexual contact, financial exploitation, withdrawal from medication or isolation, and safeguard where needed [synthesis; documented harms are in the next item].
Harms reported from exorcism-type healing. Press reports describe serious harm where practitioners framed distress as jinn possession. In Marsa Matrouh, Egypt, two men claiming to be spiritual healers tied up a 54-year-old woman and beat her with ropes, wires and a stick for about an hour; her husband said she had hallucinations and had not been helped by psychiatrists. She died in hospital, and the men were referred for prosecution [source: Gulf News, updated June 2021]. In the Maldives in 2020, police sought charges against a 24-year-old ruqyah practitioner and the woman's husband after a woman and her children were confined, beaten and deprived of food and sleep to "punish" a jinn; the report also describes sexual abuse of a child. Police said that many people seeking sihr and ruqyah services had reported harassment and sexual abuse [source: Edition.mv, 25 December 2020]. A BBC investigation gathered 85 testimonies from women in Morocco and Sudan accusing 65 "Quranic healers" of sexual abuse ranging from harassment to rape, often in one-to-one sessions framed as exorcism; women stayed silent for fear of being blamed or of jinn retaliation [source: The New Arab, 9 August 2023, and Hespress, August 2023, both reporting the BBC investigation; figures as reported, secondary]. These are individual cases; the sources do not say how common such harms are, and the TIIP and IIP sources used do not discuss them. Response [synthesis]: ask non-judgementally about any healer and what happened in sessions (restraint, beating, enforced fasting or sleep deprivation, isolation, touching or sexual contact, payments, advice to stop medication); apply standard safeguarding and mandatory-reporting duties for children and adults at risk; support the client in reporting crimes to police; treat sequelae (trauma, shame, fear of retaliation by jinn) with standard trauma-informed care; and if the client values ruqyah, help them think through seeking it from a reputable source in an accompanied setting without physical contact, alongside medical and psychiatric care.
Severe illness and risk. The TIIP outcome study excluded severe distress, and its authors note religious interventions may not suit serious psychiatric or neurological conditions [source: Khan et al. 2023]. Response: for suicidality, psychosis, bipolar disorder, severe eating disorders or substance dependence, follow standard care, including medical and psychiatric treatment, crisis planning and lethal-means counselling (safe storage and removal). Add faith-integrated elements only as adjuncts. Assess religious beliefs about suicide as a possible protective factor, but do not rely on them. Make sure clients at risk know where to get help between sessions: in the US, call or text 988 (Suicide and Crisis Lifeline); in the UK and Ireland, Samaritans on 116 123. For eating-disorder support, point clients to the National Alliance for Eating Disorders.
Concerns reported about faith-integrated counselling. These are reported neutrally. The model's authors and reviewers flag preliminary, uncontrolled evidence and uncertain generalisability [source: Khan et al. 2023; Sikander 2025]. Rothman & Coyle's practitioners worried about "over-stepping their knowledge" [source: Rothman & Coyle 2020, p. 32]. Further risks [synthesis]: clinicians without Islamic training giving inaccurate teaching; unlicensed "Islamic counsellors" discouraging psychiatric care; disclosures of abuse or domestic violence handled through reconciliation framings rather than safeguarding. Response: keep standard mandatory-reporting and safeguarding duties, which are not altered by religious context, and never use religious concepts (patience, decree, family unity) to keep a client in danger.
Non-Muslim or differently-Muslim clients. TIIP's applicability to non-Muslims is an open question for its authors [source: Sikander 2025]. Do not import Islamic practices into work with clients who have not chosen them. Within Islam, adapt to Sunni, Shi'a, Sufi, Salafi, convert and culturally Muslim identities rather than assuming one normative practice.

Sources

Pages consulted:

Further pages consulted:

Books and papers cited [uncertain where relied on for chapter-level detail]:

Keshavarzi, H., Khan, F., Ali, B., & Awaad, R. (Eds.) (2020). Applying Islamic Principles to Clinical Mental Health Care: Introducing Traditional Islamically Integrated Psychotherapy. Routledge.
York Al-Karam, C. (Ed.) (2018). Islamically Integrated Psychotherapy: Uniting Faith and Professional Practice. Templeton Press.
Keshavarzi, H., & Haque, A. (2013). Outlining a psychotherapy model for enhancing Muslim mental health within an Islamic context. International Journal for the Psychology of Religion.
Haque, A., & Keshavarzi, H. (2014). Integrating indigenous healing methods in therapy: Muslim beliefs and practices. International Journal of Culture and Mental Health, 7(3), 297–314.
Rothman, A., & Coyle, A. (2018). Toward a framework for Islamic psychology and psychotherapy: An Islamic model of the soul. Journal of Religion and Health.
Keshavarzi, H., Khan, F., & Syed, A. (2020). Islamically integrated treatment of waswasa. In Tinaz et al. (Eds.), Spiritual Counseling and Care. Ensar.
Khan, F., & Keshavarzi, H. (2023). TIIP chapter in Richards, Allen & Judd (Eds.), Handbook of Spiritually Integrated Psychotherapies. APA.

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