British Muslims are underrepresented in UK secular mental health services, compared to other religious groups (NHS Digital, 2020; Office for National Statistics, 2022), are less likely to seek professional help (Hamid & Furnham, 2013), and may experience poorer treatment outcomes than individuals from other religious backgrounds (Baker & Kirk-Wade, 2024; Mir et al., 2019). Many are concerned that therapists may approach religion insensitively (Mayers et al., 2007), highlighting the need to improve accessibility of mental health services for religious clients (Ayub & Macaulay, 2023).
Proposed strategies include therapist–client religiosity matching and therapist respect for religious beliefs (Mayers et al., 2007, cited in Post & Wade, 2009), though practical guidance remains unclear. This study explored British Muslims’ preconceptions of therapy with non-Muslim therapists to identify anticipated barriers and facilitators to engagement (Hassan et al, 2025).
What are British Muslims’ perceived barriers and facilitators to engaging in therapy with non-Muslim therapists?
Methods
A qualitative online questionnaire study was conducted, recruiting British Muslims (aged 18+ with no prior experience of receiving or delivering therapy) via Twitter, LinkedIn, and WhatsApp (June–August 2022). After online consent, participants viewed a CBT vignette and a therapist video discussing the importance of acknowledging either general client values or religion in therapy (Hassan et al., 2024). Participants then provided a written response to a prompt, which asked about their views on therapy with a non-Muslim therapist.
Reflexive thematic analysis was conducted following Braun and Clarke (2006, 2019) and Robinson’s (2022) approach to organising large qualitative datasets in Excel. Responses were iteratively coded to identify recurring themes and contradictory perspectives. Data from both experimental conditions were combined due to substantial thematic overlap. Reflexive discussions were used to examine researcher positionality and potential biases, including those of the lead researcher, a British-Pakistani Muslim woman.
Results
Of 136 responses, 56 were excluded for not answering the question, leaving 80 for analysis. Most participants were female, Sunni, aged 18–50, and Asian or Asian British. Smaller numbers identified as African/Black British, Arab or Arab-mixed heritage, White British, or Other.
Themes
1. Belief differences as a barrier
Some participants felt fundamental belief differences would hinder therapeutic connection and depth of support. One noted a Muslim therapist has:
a better understanding of my position as we are situated within the same framework.
Others felt non-Muslim therapists could address only surface-level issues:
a non-Muslim therapist might help me fix the problem at the surface level but I’m not confident they will be able to get to the root of the problem.
Some described religious coping as alternatives to therapy, including…
trust in Allah, salah, dua, strong family and community ties.
2. Fear of judgement
Participants expressed concern they might not feel understood or respected in therapy…
Non-Muslim people tend to just not understand what it really means to be religious… patronising attitudes.
I would be worried that a non-Muslim therapist would be judgemental about my faith.
…Concerns of systemic surveillance…
worry about being referred to Prevent… this would affect my ability to safely access therapy.
And of conflict about beliefs…
I would be worried that a non-Muslim therapist would be judgemental about my faith, I’m a very conservative Muslim and believe that sharia [Islamic law] should be adhered to strictly.
3. Most felt therapy could be effective with respectful, informed therapists
Most participants noted therapy could be effective if therapists were acknowledging and respectful towards individual’s beliefs. Related to this, an “Islamic application” of CBT was suggested, perhaps indicating that individuals felt that CBT should be sympathetic and complimentary to belief systems. Some also felt therapists should have some form of spiritual understanding, or understand Muslim faith and culture. Other valued characteristics included gender matching and professional competence, with a minority prioritising therapist skill over religiosity and some noting differing perspectives might even be beneficial, provided therapy was sympathetic to their values: “getting a varied viewpoint is helpful’’.
Among 80 Muslim respondents, belief differences and fears of judgment hindered the work with non-Muslim therapists, though respect and cultural competence rendered therapy effective.
Conclusions
This study identifies perceived barriers to therapy engagement among British Muslims, including belief differences, fear of judgement, and systemic distrust. Participants indicated therapy could be acceptable if clinicians demonstrated respect for Islamic beliefs and cultural and religious knowledge and understanding. Some suggested adapting CBT to align with religious values, although specific adaptations were unclear.
However, participant views in this study reflect preconceptions rather than therapy experiences, and it is important to keep in mind that actual challenges with non-Muslim therapists may differ to those anticipated. Findings also highlight that Muslim communities may feel quite uncertain towards therapy prior to treatment, and could benefit from initiatives to promote therapy and mental health services in the community.
For non-Muslim therapists there may be a need to build trust in therapy and develop religiously affirming practices in clinical care.
Strengths and limitations
This study offers insight into British Muslims’ anticipatory fears and expectations of therapy with non-Muslim clinicians, highlighting the importance of therapist cultural and religious sensitivity. However, arguably, beyond therapist training around religious and cultural competency, it contributes little to clinical practice, as respect and acceptance for religious differences are already core therapeutic values.
Relying on a single open-ended question also limits understanding of why participants held particular preconceptions and investigation of what a religiously affirming CBT might involve, restricting implications for practice.
Examining preconceptions rather than lived experiences makes findings more informative about barriers to help-seeking than therapy challenges. This limits the implications for therapist training beyond trust-building and cultural and religious competence for Muslim clients, because participants’ limited therapy experience meant they could offer little insight into what improves comfort during therapy. In this way, findings may be more reflective of broader community attitudes, highlighting a need for proactive promotion of therapy/mental health services within Muslim communities.
Selection bias is also likely in this study, as older adults were underrepresented and participants were recruited via social media. This may limit the extent to which findings relate to the wider Muslim community, and their overall usefulness in informing religious and cultural adaptations to therapy.
Within this context, participants mentioned fears of being referred to ‘Prevent’ (CONTEST counter-terrorism strategy). In consideration of the recent literature on the impact of ‘Prevent’ among the British Muslim community, the development of a surveillance culture and the racialisation of Islam (Bruchhaus & Abbas, 2022; Zempi & Tripli, 2022), it would have had added value to meaningfully assess this in relation to psychological therapy access and collaboration with non-Muslim clinicians (Younis et al., 2019).
Participants’ reported worries of Prevent referrals highlight the role of surveillance stigma in therapy barriers, warranting future research on countering it to enhance access.
Implications for practice
This study suggests that enhancing therapist cultural and religious competence, rather than matching clients and therapists by faith, may be a feasible way to increase engagement with therapy services. It also highlights that demonstrating religious and cultural competence could help to build trust, and suggests a need to promote therapy-acceptance and address negative preconceptions towards therapy within Muslim communities.
As the study examined only preconceptions, future research should explore whether British Muslims with therapy experience report the same barriers and facilitators, to see how anticipated challenges manifest in practice.
Findings could clarify what constitutes truly affirmative therapy, guiding therapist training to strengthen client–therapist relationships, adapt CBT for cultural and religious sensitivity, and navigate situations where clinical advice may conflict with religious beliefs.
Research could also examine community-based strategies to improve therapy acceptance and accessibility—for example, evaluating the impact of posters, websites, and leaflets—and explore why some Muslims feel less in need of therapy due to religious or community resources/religion, which may offer insights for non-Muslim individuals seeking alternatives to formal mental health support.
More research is needed to define religiously affirming therapy and address negative attitudes that may impede help-seeking.
Statement of interests
Ellie Davis – No conflict of interests.
Edited by
Dr Dafni Katsampa.
Links
Primary paper
Hassan H, Lack S, Salkovskis PM, Thew GR (2025). British Muslims’ perceptions of therapy with non-Muslim therapists: A qualitative analysis of survey responses. Psychol Psychother. 2025 Nov 14. doi: 10.1111/papt.70023.
Other references
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