Beyond cultural competence: a qualitative analysis of psychologists’ experiences with Muslim clients in South Africa

The intersection of mental healthcare, religious identity, and historical trauma has long presented complex challenges for clinical practitioners operating in diverse societies. A new qualitative study conducted in the Western Cape province of South Africa sheds critical light on these dynamics, examining how psychologists navigate explanatory models of mental health conditions among Muslim clients. Published in Frontiers in Psychology, the research explores the lived realities of therapists working in a post-Apartheid landscape where religious worldviews, historical marginalization, and cultural expectations heavily influence psychological well-being and help-seeking behaviors.

The study, led by researchers Mariam Salie and Dawid A. Kagee, addresses an emerging field of inquiry within the global South. While global mental health discourse frequently relies on Western biomedical paradigms, this research emphasizes the necessity of culturally responsive psychological care that accounts for indigenous frameworks, religious beliefs, and collective historical narratives.

Background and Sociopolitical Context

The Western Cape was intentionally chosen as the focal point of the research due to its unique demographic and historical profile. Muslims constitute approximately 2% of South Africa’s total population, but their concentration is notably higher in the Western Cape, standing at around 5.2%, according to Statistics South Africa data.

The historical makeup of this community is deeply layered, tracing back to three primary migration streams: enslaved individuals, political exiles, and laborers brought from Southeast Asia and East Africa during colonial rule; Indian merchants and traders; and post-Apartheid migrants from African nations with significant Muslim populations. Furthermore, the community has seen a steady rise in indigenous African converts since the mid-20th century.

Compounding these migration histories is the enduring legacy of Apartheid. During the Apartheid era, formal psychology was frequently utilized as an instrument of social engineering, perpetuating racist ideologies and reinforcing systemic inequality. Consequently, institutional skepticism toward psychological services persists among many historically marginalized communities in South Africa. This backdrop of socioeconomic deprivation, migration trauma, and institutional mistrust forms an essential foundation for understanding how contemporary Muslim clients conceptualize psychological distress.

Methodology and Qualitative Findings

To explore these phenomena, the researchers conducted semi-structured interviews with 15 clinical and counseling psychologists practicing across public and private healthcare settings in the Western Cape. Utilizing Reflexive Thematic Analysis (RTA), the study constructed three core themes reflecting the complexities of therapeutic encounters: the community context, the experiences of the Muslim client, and the practice of the culturally informed psychologist.

1. The Community Context and Historical Trauma

Participating psychologists emphasized that mental health discourses within the Western Cape Muslim community cannot be separated from historical and cultural realities. Intergenerational trauma stemming from Apartheid, racial discrimination, and socioeconomic hardship frequently manifests in how families communicate—or fail to communicate—about emotional well-being. Historically, emotional distress was rarely discussed openly within families, fostering a culture of endurance and silence. However, practitioners noted an encouraging shift in recent years, particularly following the COVID-19 pandemic and increased public discourse around mental health, leading to higher rates of formal help-seeking across diverse age groups.

2. Explanatory Models and Moral Dilemmas

The study revealed that Muslim clients frequently rely on diverse explanatory models to interpret mental health conditions. Rather than adhering strictly to biomedical definitions, clients often attribute psychological distress to a perceived lack of religiosity or supernatural influences, such as spirit possession (jinn), black magic, or the evil eye (ayn).

These explanatory frameworks frequently evoke profound emotional responses, including fear, guilt, and shame. Psychologists reported that clients often feared social stigmatization or rejection from family and community networks if their psychological struggles were made public. Consequently, many individuals initially sought alternative pathways to care, such as spiritual cleansing by religious clerics or intensive non-obligatory religious practices, sometimes delaying necessary professional intervention.

Furthermore, practitioners highlighted a frequent conflation between religious doctrine and specific cultural practices—such as certain regional traditions unique to the Cape Malay cultural landscape. While Islam was widely viewed by clients as a powerful source of resilience, meaning-making, and psychological anchoring, it was occasionally weaponized through misinterpretations to justify emotional suppression or avoidance of professional treatment under the guise of exercising patience (sabr).

3. Culturally Informed Practice and Humility

The majority of the psychologists interviewed identified as Muslim, allowing them to draw upon personal familiarity with Islamic terminology, cultural nuances, and religious rhetoric to build therapeutic rapport. However, participants cautioned against assuming homogeneity within the Muslim population. They stressed the importance of adopting a stance of curiosity and cultural humility rather than relying on generalized assumptions.

To deliver effective care, participating psychologists utilized various professional resources. Many engaged in peer consultation with Muslim colleagues, sought guidance from Islamic religious scholars and clerics, and pursued self-directed education regarding prophetic traditions and theological frameworks. Psychoeducation emerged as a vital tool in the therapeutic process, enabling clinicians to reframe mental health care as fully compatible with Islamic values of self-care and holistic well-being.

Broader Implications and Expert Analysis

The findings of this research extend classical medical anthropological theories, such as Arthur Kleinman’s explanatory model framework. While Kleinman emphasized how patients subjectively interpret illness, the South African study demonstrates that explanatory models are inextricably linked to collective institutional relationships, historical racialization, and socio-political histories.

Public health analysts and clinical educators point out that these insights carry profound implications for the decolonization of mental healthcare in the global South. By recognizing indigenous and religious explanatory frameworks not as barriers to be dismissed, but as meaningful components of a patient’s lived reality, mental health systems can bridge the gap between formal psychological services and marginalized communities.

Moreover, the study underscores the potential value of structured interdisciplinary collaboration between mental health professionals and religious leaders. Because clerics are frequently the first point of contact for individuals experiencing psychological distress, establishing ethical referral pathways and open dialogue could drastically reduce stigma, encourage early intervention, and foster integrated community support systems.

Conclusion and Future Directions

The research concludes that culturally responsive psychological practice requires moving far beyond basic cultural competence. Clinicians must actively engage with the intricate intersections of religious worldviews, cultural norms, and historical trauma. While the study provides valuable qualitative depth, its authors note certain limitations, including the predominance of Muslim participants and the specific regional focus of the Western Cape. Future research expanding upon multi-stakeholder perspectives—including community members, service users, and religious scholars—will be vital in continuing to refine mental health delivery for diverse populations across South Africa and the broader global South.