Psychotherapy from an Afghan Cultural Lens

By Nazo Shamal, PsyD, LCSW

Psychotherapy from an Afghan cultural lens involves considering unique cultural factors. It also considers social and religious influences that shape mental health practices within Afghan communities. Afghanistan’s rich history, deeply rooted traditions, and the challenges faced by its people can significantly influence how mental health is understood. Decades of war, displacement, and social upheaval also affect how it is expressed and treated. To provide effective psychotherapy in an Afghan context, it’s important to integrate both culturally sensitivity and awareness of the local worldview.

Afghanistan is a predominantly Muslim country, and Islam plays a central role in shaping people’s worldview, behaviors, and understanding of mental health. Religious beliefs and practices may significantly influence how Afghan people view mental illness. For instance, mental health challenges may be understood through a spiritual lens, where individuals may view problems as tests from God or the result of spiritual imbalances. Psychotherapists must be respectful of Islamic teachings, which often encourage patience, endurance, and reliance on prayer or seeking help from religious leaders.

Afghan clients may turn to prayer, seeking guidance from religious texts like the Quran, or consulting with local religious leaders (mullahs) as forms of coping. Including or respecting these practices in therapy could enhance trust and make therapy more culturally relevant. It is crucial to acknowledge and incorporate these spiritual practices where appropriate, as they may be central to the clients healing process.

Afghan culture tends to be highly collectivist, meaning that family and community are prioritized over the individual. This contrasts with the more individualistic approach common in western therapies. Problems may be seen as affecting the family or community as a whole, rather than just the individual. Therefore, family involvement in therapy may be essential, and therapists should consider engaging family members to support the individual’s mental health.

Afghan society places high value on respect for elders, and their opinions are often sought in decision-making. Psychotherapists may need to work with extended family, including parents or elders, to address client issues. This is especially important when working with younger clients who might not feel empowered to challenge family norms or who face familial pressure regarding mental health treatment.

There may be significant stigma around mental health within Afghan culture, and seeking psychotherapy could be viewed as a sign of weakness or something to hide. Many Afghans may feel ashamed or embarrassed to admit to having psychological struggles due to the social importance placed on personal strength and family honor. Therefore, therapy might be perceived with suspicion, creating a safe, nonjudgmental environment is essential for the therapeutic process to succeed.

Afghanistan has faced decades of conflict, including wars, insurgencies, and political instability, which have deeply affected mental health of its population. Many Afghans, especially refugees and those who have experienced direct conflict, may suffer from trauma-related conditions like post traumatic stress disorder, anxiety and depression. The impact of such historical and ongoing trauma needs to be understood within the cultural context. Trauma is often not seen in isolation but as something that affects entire communities.

Afghan culture also places a high value on resilience and endurance, particularly in the face of adversity. Many Afghans may view their ability to endure hardship as a sign of strength. This cultural resilience can be a powerful resource in therapy, but therapists must ensure that their approach does not undermine the clients sense of personal strength and coping. Rather than focusing solely on pathology, psychotherapy may need to highlight ways to build on this resilience and strength.

Afghan society often adheres to traditional gender roles, where men are expected to be primary breadwinners and protectors, while women may be expected to prioritize family and home life. These gender norms can affect mental health, particularly for women, who face challenges related to domestic violence, forced marriage, limited access to education, or restricted mobility. For men, social expectations around masculinity may lead to difficulties expressing vulnerability or seeking help for emotional distress.

A therapist working with Afghan clients must be sensitive to these gender norms. Female clients, for instance, may be uncomfortable or constrained in therapy if the therapist is male or if family dynamics place a strong emphasis on privacy or shame. In such cases, it might be helpful to involve female family members or therapists when appropriate, or to encourage a more gradual approach to opening up.

In Afghan culture, communication can often be indirect, especially in sensitive matters. People might avoid direct confrontation, and disagreements are often handled in a manner that preserves social harmony. Clients may be reluctant to openly discuss personal struggles in a direct manner. A therapist should recognize this subtlety and avoid pressuring the client for explicit details if they are not yet ready to open up. Building rapport and trust is crucial, and a culturally sensitive therapist should be patient with the pace at which client opens up.

Non verbal communication, such as body language and tone of voice, is also significant in Afghan culture. The therapist should be attentive to these cues, as clients may express discomfort, distress, or reluctance to discuss certain topics non-verbally.

Psychotherapy through an Afghan cultural lens requires a deep understanding of the cultural, religious, and social factors that shape the mental health experiences of Afghan individuals. By considering factors such as family dynamics, religious beliefs, gender roles, and the impact of trauma, therapists can build a culturally competent approach to therapy that respects Afghan traditions while also providing effective mental health support. Integrating Afghan cultural values into the therapeutic process can foster trust, enhance treatment outcomes, and ensure the psychotherapy is seen as a valid and helpful form of care.

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References

Nasim, M., & Shirzad, H. (2021). Mental health care in Afghanistan: Challenges and opportunities. Journal of Global Health, 11(1), 12001.

Ryder, A. G., Chentsova-Dutton, Y. E., & Hong, Y. (2018). Cultural influences on mental health and psychotherapy: Addressing cultural diversity in treatment. International Journal of Intercultural Relations, 62, 95-107.

Baggerly, J., & Osborn, D. (2016). Understanding the impact of war trauma on Afghan refugees and culturally sensitive approaches to psychotherapy. Traumatology, 22(4), 268-277.

Hadi, R., & Sistani, A. (2020). The influence of religious beliefs on mental health among Afghan refugees. Psychology of Religion and Spirituality, 12(3), 276-284.

Walden, J., & Sadat, L. (2017). Exploring gender roles in Afghan mental health: Barriers to seeking therapy for women. Mental Health, Religion & Culture, 20(5), 427-441.

Qaderi, M., & Panahi, S. (2019). Psychological aspects of Afghan culture: Implications for therapy. International Journal of Interpersonal Relations, 14(2), 112-123.