In the Field: Cognitive Therapy in Malaysia

Abstract

In Malaysia cognitive therapy (CT) has begun to be incorporated in the treatment armamentarium of the therapist not long ago. The first trained cognitive behavior therapist, Prof. Azhar Md. Zain, was trained in the U.K. in the year 1994 at the Warneford Hospital, Oxford. Since then he has been practicing CT in Malaysia. He is also making CT popular by holding several workshops all over Malaysia. He is also trying hard to disseminate the art to all levels of experts, such as psychiatrists, medical officers, psychologists, nurses, occupational therapists, etc. He is in the process of developing the first independent unit of behavioral therapy in Malaysia. The mode and duration of psychotherapy has been the subject of discussion for a long time. Andrews and Harvey (1981) found that the behavioral psychotherapies were superior to verbal psychotherapy and both were more effective than counseling. Andrews (1991) found that cognitive behavior therapy was a powerful specific treatment in neurosis. Here we are going to describe our experience in Malaysia. Our experience essentially indicates that the sociocultural issues when taken into account in psychotherapy can bring about remarkable results. Our patients, being more religious,responded faster to religious-oriented psychotherapy, something they are familiar with and can identify with. Even the families encourage them to continue the treatment. Csordas (1990) provides an illuminating description of the role of supernatural forces in causation and treatment by psychotherapy in Catholic charismatic healers. The distinguishing features of their method was that they recognized the role of evil spirits that, as components of a therapeutic system, manifest themselves as normal humans' mental and emotional states that are out of control. The therapeutic effect of the religious teachings and beliefs and the tendency of most people to fall back on religion for mental peace is also well known. It is a very important treatment method in psychiatry and, despite having been severely criticized for its theories which cannot be proven scientifically, it has been found to be effective. In another study, Andrews (1991) demonstrated that dynamic psychotherapy, although popular with patients and therapists, is not shown to be superior to placebo. In the same study, he also found that cognitive behavior therapy is a powerful specific treatment of neuroses. Based on these findings we attempted to see how our patients would respond to the various modes of psychotherapy. With our patients we practiced religious healing in psychotherapy but with a different concept. We operate more on a cognitive approach of religious healing rather than dynamic (Azhar & Varma, 1995; Azhar, Varma, & Dharap, 1994). The hypothesis is that an individual will experience dissonance with resultant guilt, anxiety or alienation if the individual acts are contrary to personal values. If unresolved, these feelings may manifest as mental illness. Values are ideals that we have learned from childhood through parents and later on become more defined as we pick up ideals from other sources, and in our culture the religious teachers are preachers. Clear values are relevant to mental health because if the intentions and actions are in accordance with the personal value system, there is no conflict. But if the actions are contrary to personal values there is dissonance, self-esteem is lowered and there may be feelings of shame, guilt, or anxiety. In this hypothesis the personal values need to be reassessed, analyzed and ultimately modified or changed to suit the environment, social situation and personal ideals. …