Arab and Muslim Americans have faced increased stressors since 9/11, but many who could benefit from counseling are reluctant to try it because of cultural and other barriers, according to Yale University postdoctoral fellow Mona Amer, PhD.

Amer, who studies Arab- and Muslim-American mental health, spoke at a Board of Professional Affairs-sponsored panel on working with Arab and Muslim Americans, at APA's 2006 Annual Convention.

Other presenters on the panel included Sameera Ahmed, PhD, of Muslim Family Services in Detroit, who offered advice for psychologists working with Muslim youth; Saba R. Ali, PhD, of the University of Iowa, who spoke about workplace issues faced by Muslim women who wear the traditional head covering; Ibrahim Kira, PhD, of the Access Community Health and Research Center in Dearborn, Mich., who shared his experiences working with Arab and Muslim victims of political oppression; and Julie Hakim-Larson, PhD, of the University of Windsor in Ontario, who spoke about issues of identity conflict and resolution among Arab Americans.

The terms Arab and Muslim cannot be used interchangeably, many of the presenters emphasized, because not all Arabs are Muslim and not all Muslims are Arab. However, both Arab and Muslim Americans, Amer said, are at increased risk for anxiety, depression and other ailments. They're particularly at risk because of the discrimination and anger they've perceived against their communities in the past five years, as well as the stress that many ethnic minorities feel when trying to acculturate to mainstream American culture.

Young people may feel the dichotomy between mainstream American culture and their traditional culture particularly acutely, Ahmed said, even developing "two identities"-one at home with their families, the other in the wider world-that they find difficult to reconcile.

And, Hakim-Larson added, "Arab Americans of all ages are caught in the crossfire of the sociopolitical tensions between the U.S. and the Arab world."

Kira offered particular advice for psychologists working with refugees from Iraq and other war-torn Middle Eastern nations. Kira, who works with Iraqi torture victims, said that it is not always best to try to teach those victims to forgive their torturers. "Positive anger can be constructive," he said. Instead, he said, psychologists should work with the strengths and resources that allowed their patients to survive the torture in the first place, whether that be religious faith or family and social support. "Torture survivors are more resilient than survivors of other trauma," he said.

Muslim women may face par-ticular stressors because their traditional dress makes them so identifiable, Ali pointed out. The media often portray Muslim women as being oppressed, she said, but in fact many Muslim-American women choose to wear a veil, and find it empowering, she said. Still, because of their identifiable dress they may become particular targets for discrimination and harassment. Employers, Ali said, can help by hiring more Muslim women to increase their visibility and acceptance, and by developing and posting accepting policies on head coverings in the workplace.

Despite these pressures and their accompanying need for mental health help, the negative attitudes that many traditional Arab Americans and Muslims hold toward formal psychological services, and the shame and stigma associated with seeking help, may keep some members of the community from visiting psychologists, said Amer.

So psychologists who want to help them must concentrate on reaching out to the Muslim-American community, she advised.

"We need to step away from the idea that people will come to us," she said.

Instead, she suggested, psychologists can offer their expertise through other routes. For example, they might give presentations at mosques and community center health fairs. Psychologists who do this, she advised, should stay away from the "psychological jargon" and begin by talking about nonthreatening subjects that interest everyone, such as parenting and family peace.

Psychologists might also consider offering consultations and advice to Imams, the Muslim religious leaders who are often the first people that Muslim Americans turn to for support, Amer said.

Amer also offered advice to psychologists and community service agencies that are already working with Muslim and Arab clients. Among her suggestions were:

  • Offer Arabic language translators. Also, be willing to tell your clients the name of the translator before the session. Especially in small communities, people may want to make sure that they don't know the translator socially before agreeing to the session.

  • Offer home services if possible. Many people might feel more comfortable talking to service providers in a private setting.

  • Provide the option of a same-sex practitioner. Many Muslims prefer not to meet in a closed room with a person of the opposite sex. Also, allow opposite-sex clients to decide whether to shake your hand.

  • Consider your terminology. Include "Middle Eastern" or "Arab" under ethnicity on intake forms, and include "Muslim" or "Islam" under religion.

  • Establish rapport. Refrain from asking sensitive questions, such as about sex or alcohol use, during the first session. Those questions can wait until you have established a solid relationship.

  • Hire familiar faces. Try to increase the number of Arab and Muslim staff in the office, through such means as advertising in Arabic-language press and offering training for Arab and Muslim graduate students.

  • Ask for help. If you think a better understanding of your clients' religious or cultural background would help you to help them, ask their permission to consult with an Imam or other community leader for advice.