On this episode, we have discussed some of the most common challenges of Middle Eastern clients in psychotherapy. Our guest-Nawar Sourij-is a psychotherapist with vast experience working in many countries in the Middle East and beyond with people from various backgrounds.
Leila and Nawar explored:
– What repetitive patterns, issues, and challenges are observed mainly in Nawar’s practice among her Middle Eastern clients?
– What are the potential root causes behind those challenges?
– What can be done to change those patterns moving forward?
About the Guest:
Nawar Sourij is an integrative psychotherapist and a member of the United Kingdom Council of psychotherapy. Nawar holds many years of experience in working with clients from this region and beyond, with a vast area of expertise including : anxiety & depression, trauma & PTSD, couples counselling, sexual abuse, single parenting and weight management. In addition to these areas of expertise, Nawar is particularly passionate about working with clients on matters related to identity, and cultural issues as she recognizes the profound impact that societal influences can have on an individual’s mental well-being.
Episode’s Transcript:
Leila: Hi and welcome to another episode of the Bright Shift Podcast. After a very long pause, I’m very happy to be here. I’m Leila, Founder of Bright Shift and your host on this podcast. Bright Shift is a digital platform where you can find online therapy, meditation and healing sessions. You can find us at Brightshift.co.
Today my guest is Nawar Sourij, one of our team members at Bright Shift who many of you already know. Nawar is an integrative psychotherapist and a member of United Kingdom Council of Psychotherapy. Nawar holds many years of experience in working with clients from this region and beyond with the vast areas of expertise including anxiety and depression, trauma and PTSD, couples counselling, sexual abuse, single parenting and weight management.
In addition to these areas of expertise, Nawar is particularly passionate about working with clients on matters related to identity and cultural issues as she recognizes the profound impact that societal influences can have on an individual’s mental well-being. Nawar, welcome back to the Bright Shift Podcast. It’s great to have you back.
NS: Thank you for having me again.
L: Sure. So Nawar, a while ago, you discussed something with me that it stayed with me and you said even though you see so many different clients from different backgrounds from this region but it feels like you’re seeing the same person over and over again and that is mainly because they have very similar challenges and issues. So, I would like to know what repetitive patterns, issues and challenges do you observe in your therapy practice among your Middle Eastern clients.
NS: Yes, you’re absolutely right. I have definitely observed myself the reoccurrence and the repetition of some patterns clients come with and I would say the main one Leila is rooted in relational traumas. So, they come with relationship difficulties whether it’s with family members, romantic relationships, friendships, et cetera.
L: So, it’s mostly about relationships and for those who may not be so familiar with your work, I would like to mention that you have experience working in most of the countries in this region. Isn’t that right? You have worked in Egypt, Saudi Arabia, Tunisia. You have many clients from the UAE, Kuwait, Bahrain, everywhere in the GCC and beyond.
NS: That’s right. In addition to my Europe and Canada and America-based clients as well.
L: Yes, yes. So, you have a really good idea of the main challenges of the people of this region. So can you tell us a little bit more what do you observe? What symptoms do you see? Can you elaborate a little bit more about it please?
NS: Yes. So normally, Leila, clients don’t come saying, “I have relational traumas.” They always present certain issues. For example, nutrition, anxiety, not being able to engage with friends, lack of self-esteem. Some of them also report being stuck in a marriage or in a relationship that’s not satisfying to their needs. They also report feeling some unexplained physical illness. So, they go and do all the checks. They say everything is fine. But actually, they continue suppressing the physical symptoms.
L: Yeah, that’s really interesting.
NS: It is, yes.
L: And is there any specific age group or gender that you would say are challenged with these issues more?
NS: I have noticed that the majority of my clients are between 25 to 45 years of age and 90 percent are women.
L: OK, OK.
NS: I’m definitely starting getting more male clients but majority are women.
L: Yes. And so do you think throughout the years now more than ever people are open to therapy from this region?
NS: A hundred percent, yes. I’m actually very impressed by the willingness of these clients or this client group in particular, their interest in therapy. They’re very willing to explore and engage in different types of therapies, not just the traditional psychotherapy. So yeah, and I’ve also noticed how the number of men who are reaching out has also increased.
L: And how about couples?
NS: Yes, I have more couples than men. So, most of the men I work with are actually in couples therapy rather than individual therapy.
L: OK. I would like to know what are the challenges that you notice in terms of the relationships. You said it can involve any kind of relationship, not just romantic relationship. So it can be the relationship with the parents, with friends, with coworkers. What are the challenges?
NS: I think mainly they don’t feel satisfied, meaning their relational needs are not being met in these relationships, Leila. For example, they don’t feel heard. They don’t feel seen. They don’t feel understood. They don’t feel validated and I think that lack of validation is actually a common one because it’s rooted in some cultural misconceptions that if you complain or suppress your needs, that makes you ungrateful.
So, clients feel a lot of shame when they talk about their struggle and they always say like, “I am not grateful to my blessings. Like I have health. I have money. I have healthy kids. Why am I not happy?” And there’s a lot of guilt I would say and when we explore this, Leila, it is always rooted in the idea that – especially what they grew up hearing, an Arabic phrase. You should say, “Alhamdulillah.”
So whenever they start expressing their needs, they are faced by this particular response that makes them suppress and internalized their feelings and it also reinforces the belief that “I am not important. My needs are not important. I should only focus on the good stuff I have, not what I’m lacking,” and obviously you can see how problematic this can be because they end up ignoring and neglecting their needs and problems just get worse and worse.
L: OK. So you mentioned so many different things and I took note of some of that and I would like to discuss them with you. For example, one of the things that you mentioned was a lack of expression and how culturally we sometimes …
NS: Suppress.
L: Yes. It’s actually sometimes a virtue to suppress our opinions and not be so vocal about our ideas or what we’re not happy with. All of that can have certain consequences whereas, you know, it’s totally fine to express yourself as far as you’re respectful and kind. It’s our right.
NS: Absolutely. But you can understand then why this is a problem Leila because it has been reinforced again and again that you should not talk about these issues until it became a belief. So they actually don’t believe that they should talk about their issues and then that takes a while in therapy to actually validate their feelings and tell them it’s OK and actually having money or having health doesn’t mean you shouldn’t talk about your problems in your relationships.
For example, I try to tell them that they’re all valid needs and one doesn’t substitute the other one. For example if you are hungry, you cannot drink. That wouldn’t satisfy your hunger. If you’re hungry, you should eat. If you’re thirsty, you should drink. If your emotional needs are not met, you should find ways to meet your emotional needs rather than saying, “Alhamdulillah! I have money and I have kids.”
L: Yes, yes. Obviously yes, we have so many different needs and so …
NS: And they’re all valid and important and if we don’t need them, then that ends or results in psychological dysfunction.
L: Yes. So, what other cultural issues have you noticed that you think they are causing more challenges for us in the Middle East? Because I know that you also have a lot of clients who are not Middle Eastern. So, it’s very easy for you to make that comparison and observe it in your therapy practice.
NS: Yes. I think one of the main ones that marriage is a one-way situation. Like I can only enter it but I cannot exit it and that causes the clients to feel stuck.
L: Yes, I have to agree with you. I have noticed that divorce is such a big taboo in our culture.
NS: It is, it is.
L: Yes, it is difficult to deal with in any culture understandably but yes, there’s a lot of work that needs to be done to remove that taboo.
NS: Normalize it. Although the rate of divorce is very high nowadays, so this belief actually didn’t make it better. But I’m saying if we feel and rewire our brain and change this perception that actually it’s a choice, then hopefully it can be done in a way that’s less damaging actually to ourselves, to the children. If we were just ready to accept it, then it won’t be as bad as – because it’s happening anyway. So, we might as well just do it in a better way.
L: Yes, yes and, you know, as difficult as it is, if a marriage is not a healthy one, a happy one, at least relatively – there’s not a perfect marriage – it is perhaps better to somehow end it and maybe start a new life than to live the entire life with being totally unhappy.
NS: Absolutely and not only that because as human beings, we need to have our relational needs met. So, when that doesn’t happen and we feel we’re stuck in a relationship, that leads clients to engage in relationships outside marriage and that’s one of the major issues I deal with in my practice daily, these affairs, if you don’t. The guilt it causes, it does. They come with a lot of shame and guilt and obviously they found that as a way that is maybe more acceptable for them than divorce itself.
L: So, the weight of the divorce is too heavy that they prefer to continue somehow.
NS: Yes.
L: But not get the divorce. And how would you think if we – if I asked you about the parenting, how much do you think the parenting styles – I know that this is like such an overgeneralization. But I would like to know what patterns have you noticed in parents that you think have somehow caused such issues?
NS: Are you referring Leila to the upbringing of these individuals and how it may have contributed to these patterns?
L: Yes.
NS: Yeah. Yeah, definitely. So, I think that’s the major cause actually, the root cause of relational trauma is insecure attachment. I would say that’s the number one cause. Childhood neglect is the second one. So basically, as children, when our developmental, emotional needs are not met, we incorporate these difficulties that we got through as “I am not worthy of love. I am not important,” and then as children, we try to find creative ways to deal with these painful emotions, including dissociation, daydreaming and all these things, avoidance in order to – because we were not taught how to process these emotions in a very young age.
So, when we grow up with these wounds, then obviously that will result in our choice in these unsatisfying relationships.
L: And can you please a little bit talk more about insecure attachment?
NS: Yes.
L: How does it feel? What do you mean by that?
NS: Sure. In the first few months of our contact with our primary caregiver, most of the time it’s the parent. If the parent was available emotionally, predictable, dependable, attentive to our needs, nonverbal needs, then we develop what we call a secure attachment style, which is the ability to trust others OK?
If our parents, the majority of these clients, they obviously – their attachment style is insecure because their parents were depressed, traumatized themselves, unavailable emotionally. So that results in two major types of attachments. One is anxious attachment, when the mother was unpredictable and inconsistent. So sometimes she would be able to meet our needs and in other times she won’t and that results in a lot of confusion and in adult relationships we become very clingy, very needy. We want constant connection and reassurance from our partner.
The last type of insecure attachment is the avoidant and this is when the mother was predictably inconsistent or predictably absent. So, the child learns to be self-sufficient and meet their own needs. So that results in obviously forming adult relationships where it’s very hard for them to trust or to show them vulnerability and obviously that hinders their relationships.
L: OK. And when you talk about childhood, I know it can start from even when the child is not born yet, and the woman is pregnant. So attachment can start forming from then. But up until which age?
NS: I think the secure attachment styles, these are – they develop very early on in infancy. However, some other family members, we can form different attachment styles with them. For example, if I had a loving grandma living in the house, my relating to that grandma might be secure whereas my attachment to my mother might be insecure. So, we develop different types of attachments if you like or relating to others depending on the surrounding people in our life. Yes.
L: All we need is like a really good one, right? Because some people, they may have not developed that secure attachment with their mother but there may have been like a mother figure in their life.
NS: Exactly. So, we need one dependable adult and I mean dependable and reliable emotionally. Yes.
L: And so how can that change if we come to know that? Which is probably the majority of us because not certainly because we have that parent but also the knowledge of attachment. It’s something relatively new, right? The past generations were not so familiar with it.
NS: Absolutely. I think the knowledge maybe is not as old. However, the relating to others, some people just – actually there are more, I would like to say more securely attached individuals than insecure. However, more stuff that I would say the majority of people in therapy obviously don’t have or they didn’t have secure attachments with their primary caregiver.
So, when they come to therapy and then they realize how their insecure attachments and childhood traumas is the cause for their dysfunctional relationships now, then they ask the question which you just asked. What do I do and how do I heal? We’re going to talk maybe towards the end of the podcast Leila about how to heal.
L: Yes.
NS: But I just want to mention here that it’s possible to heal through relationships that we develop in our adulthood. So, it could be friendships. It could be a loving relationship with our partner, with our children and with the therapist. So, the therapeutic relationship is where we rewire our brain and earn this security.
L: OK. I want to emphasize a little bit about that word “therapeutic relationship”. You must have heard of the AI and how there are some programs that can provide like psychotherapy and counselling for people. That’s just because they’re programmed. They’ve been given some information already and they can reply back to you, but they don’t have the ability to provide a therapeutic relationship. That therapeutic relationship, it’s the main element in the therapy process.
NS: It is. It’s actually where the healing occurs and they did all the studies they did on the therapeutic relationship. They found that regardless of the modality of therapy, and there are over 400 modalities of psychotherapy, the common factor is the therapeutic relationship regardless of the modality your therapist is using.
Obviously for relational traumas and this is why – this is my area, if you like, of expertise because I am a relational therapist and the way I work is long term, is open-ended because as I believe, in developing this trusting, dependable, consistent relationship that rewires our brain with all the relational needs that were not met for us as children.
L: Absolutely. I would like to hear a little bit more about the cultural aspect of the repetitive patterns that you notice in your practice before we move on to the next questions. Are there any other points that you think we can hear?
NS: Yes. So, in addition to obviously the invalidation and how we shouldn’t suppress and feeling stuck and I can’t exit, there is also – we always handle this issue which is the anger. Anger towards the parents specifically when we realize that we are struggling now because of our insecure attachment that is caused by the traumas. It’s natural, Leila, to feel angry.
Yes, it’s not their fault. Our parents did the best they can, provided their circumstances and awareness. However, it did impact us greatly and it’s normal to feel angry but the problem is processing that anger can be an issue because of how parents have been idealized in our culture. So, you find people either extremely rejecting to this anger and defending the parent and in doing so, they are invalidating their own angry, wounded child or they go to the other end of the spectrum, the extreme end, and becoming extremely angry and cutting ties completely and not talking to the parents.
So, our task is to safely navigate through this anger and help the client release it and obviously we have to undo some of the shame and the guilt in doing so until we get to a place of compassion towards our parents and willing to repair the relationship and letting go of some of the unrealistic expectations we have and yeah, I think that’s a better way of healing rather than dismissing completely the anger.
L: It’s great to hear your viewpoint considering that you work with so many different clients from this region and beyond because I think all of these conversations, they can help us to become aware of these patterns in ourselves, in our relationships and perhaps do differently for the future generations.
NS: Absolutely and I see when people actually engage in therapy and heal these relationships and repair some of them. They are able to actually break the generational trauma and they make different choices in parenting their own children and I have seen that with my clients.
L: Yes, that’s beautiful. Yes.
NS: It’s very rewarding.
L: I know, I know. What do you think can be done to change those patterns moving forward? I know it’s a very big question but we can cover as much as we can.
NS: Yes. It is a very big one. I would share with you Leila the challenges that I faced when I started doing this work, this relational work with clients who have or who hold the belief that this is a problem and I need to fix it. I need a solution. So, we spend a lot of time trying to – I try to make them understand that this is not a problem that needs fixing and to treat it as an intimate, transformational, subjective experience. There isn’t right or wrong. There isn’t, “I realize the problem. Let me fix it.”
So it’s not like that. I mean it’s a different way of relating to ourselves and to the world and therefore there isn’t a book or an Instagram page or anything that would give us a formula of if you do one, two, three, you will heal. I guess a lot of people talk about healing and they say, “You should do the work,” as if we have figured out what the work is and therefore we should do it.
L: Yes, that formula, that word. It’s so important to talk about it because there are a lot of people in the psychology and wellness world where they are talking about the formula because they want to make things easy for people and it’s an attractive word, formula. Come here.
NS: It is, yeah, and I will tell you if you do this and this and this, this would happen. Yeah, exactly and I think selling this healing journey that way, it’s actually exhausting and is disappointing as well because clients come to me scarred actually with such promises, unfulfilled promises. So, I think understanding how this healing journey works is – and how to engage in it is actually the healing.
L: Yes, absolutely. So, the first dangerous word is “formula” and I think the second one is “fast”.
NS: Absolutely.
L: very fast results.
NS: Yes, they’re telling me, “So, how long does it take?” and I see the frustration and the disappointment when I tell them, “Well, there isn’t a timeframe. This is open-ended.” I’ve worked with my clients for years. Yes, we don’t necessarily see each other every single week but clients come back when they want to – when life changes. Let’s say they got married or they had a child. They come back and they discuss it. So, it’s a relationship and the relationship doesn’t end but they treat it as maybe a transaction. I come, I pay, you tell me what to do, good-bye. So I always emphasize to my clients this is not how I work and if you have such an issue that you want to resolve, then maybe another type of therapy might be suitable for you.
L: Yes. Wherever I see that word “fast” in anyone’s practice, I know that’s the warning to not get called to this because it just sounds – it doesn’t work that way. There are fast ways to eliminate the symptoms. Please talk about that because that is possible. There are so many techniques that they can remove the symptoms but then elimination of the symptom does not mean healing. So, I would like to hear a little bit about this.
NS: Sure, sure. Yeah. There are different ingredients in this journey, Leila. Firstly, yes, the symptoms. So, we obviously want to help clients to manage the symptoms. If they’re overwhelmed, hyper-aroused, constantly anxious and dysregulated, so we give them tools to regulate themselves and I guess the most important thing that I offer my clients because of this background I have in neuroscience, I integrate neurobiology and the knowledge of the brain.
So, if we are hyper-aroused because we are triggered, then it’s our emotional brain that takes charge of the body. So, we become physiologically dysregulated and therefore, we obviously learn together techniques to help them manage and regulate their body and if these techniques like yoga, meditation, walking, journaling, all these things didn’t help them to regulate their bodies so that they can access their logical brain and process therapy, then I recommend medication.
So if we failed through these tools to regulate the body naturally, then we resort to medications which are absolutely a good option and then we continue working together and through trust, validation, presence, boundaries, consistency, the clients feel validated, feel heard and internalize these feelings. So, this therapeutic safe relationship becomes the reference for them for future relationships, how to develop healthy relationships because they’ve lived it now. They’ve experienced it. So, they know how it feels.
L: And what other solutions come to your mind?
NS: To help them understand? I think one of the very important points and I faced a lot of challenges is to learn to grieve because when we realize that actually I didn’t have the parents I wish I had, I didn’t have the childhood that I wish I had, then we have to grieve these losses Leila and also the loss of the identity as well.
So, we don’t know how to breathe. So, in our work together we also support clients to learn how to grieve and grief is attending to the wounded parts. This is what grief is and that requires a skill because it’s not an easy process, especially that we live in a world that tells you to distract yourself, do this and that and that and not actually specify time to attend to yourself.
L: Yes, I think living in this fast-paced world, it doesn’t help because most of us, we have so much to do. We need to make money. We need to attend to our families. We need to exercise, eat healthy, have some sort of a social life and then we need time for our mental well-being and these kinds of things. So, it does make it really complicated.
NS: It does actually, yes, and therefore if we understand that healing, the journey that requires patience and learning how to stay with the grief, how to understand that we have choices in life to make and that yes, what happened was – isn’t our fault but is our responsibility to heal and to take responsibility and to proactively actually challenge ourselves and what is my contribution in my relationship and how did I co-create it and all of them. Yes.
L: That’s right. Would you like to add something else about the solutions or anything else that comes to your mind?
NS: Yes. I would like to, yes, add two things. Number one, the power of choice, Leila. We always have choices as adults and when you say that to a client in a very stuck situation, it feels like they don’t have a choice, but we have to challenge that and say, “Yes. I’m not saying you have an easy choice but the choice by nature is something that has consequences.”
So am I choosing to stay in this dysfunctional relationship that does not meet my needs because of the financial comfort or do I want to exit and having to deal with the consequences of struggling financially. Do you get me? So, we need to help them navigate that they have options and yeah, finally that, as I said, responsibility because sometimes it’s easy to fall into this victim mindset and that – well, there’s nothing I can do about it. There is.
L: Yes. Imagine that, very important things. Absolutely. Something that we can struggle with often and I love that. I love what you said. We always have a choice. It’s just about the consequences.
NS: Yes.
L: And, you know, to come out of that victim mindset also takes a lot of work.
NS: It does and that’s what therapy empowers you to do.
L: Absolutely, absolutely. Thank you so much Nawar. It has been really wonderful having you here again and I really enjoyed having this conversation with you.
NS: Thank you, Leila. It’s always good talking to you and yeah, I look forward to more discussions.
L: Me too, absolutely.
