 But I was the accidental psychiatrist who was supposed to become an OB. And to the point that all of my training and all my advanced rotations were actually in the field of obstetrics and gynecology. To the point that when I came to apply for residency, my letters of recommendation still set on them obstetrics. So I'm interviewing at psychiatry residency programs at the Stanford's and the Harvard's and the Mayo Clinic and such. And they're telling me, so do you want to become a psychiatrist or an obstetrician? And I'm in these very awkward moments trying to explain what all happened that changed the course of direction. But Subhanallah, that's a long story and I won't go into all the details on how that happened. But in the short version of the story, here is where I have to thank my husband because at the time both of us had been trained. Our primary training is actually in Islamic law and theology. And had been teaching in the community. And in the process of teaching, it became very clear to us that there were so many things happening in the community that we didn't have words to explain despite our Islamic training. We didn't understand pathology, for example. We didn't understand what was normal typical behavior and what was pathological behavior that needed help. But as people who are religious leaders in the community are often given everything to work with, even if you don't have that specific training. And so he said to me, any trained person can deliver a baby. But only somebody who's really grounded in Islamic training could actually help the course of psychiatric and mental illness and really be able to integrate both from our tradition. And hence, my course of training changed. Full circle in that today's discussion is actually going to integrate the things that I care very deeply about all of them, all three things. And my advanced training actually happens to be in my fellowship training post residency, is actually in women's health and wellness. And so even till today, I'm still embedded once a week in an OBGYN clinic where there's five OBGYNs and I'm the one psychiatrist that's working with perinatal, maternal, and female health. So Subhanallah, and I'll do my best in today's discussion to bring in some of those themes, but because I'm primarily speaking as a psychiatrist, the lens will be primarily mental health. But the full circle. So thank you for that invitation, Washa'Allah. And you know, here I think we should start the discussion in really understanding the work that's happening right now for us in the field of mental health, you mentioned the Khalil Center, and the work that we're trying to do to really integrate Islamic fundamental teachings and understandings into what seems to be for many a very secularized field. Particularly when we think about this schism that seems to exist in the field of the sciences where there seems to be this division between science and religion. And there always seems to be this tension, should these two worlds integrate or not? And as a Muslim, this is always hard for me and for folks like you who know that in our Islamic teachings there is no division between these lines. Our scholars have always integrated and worked within the sciences and the faith all as one package. It wasn't this tension that exists in the modern, particularly medical world, but in the modern other domains and fields as well. So here, you know, I really want to talk about some concepts in which there are ethical dilemmas that show up when you train in the modern fields of psychology and psychiatry. Let's start there. But there are things that don't jive with the Islamic understanding. So what happens? What do you do? So the first story in case that I'll share with you actually highlights two terms that are very important to our field of mental health and specifically in counseling that often cause some ethical dilemma. These are the terms called transference and counter-transference. And I'll explain those momentarily. But first, to explain what I mean, I'll share with you the story of my very first day. I told you that I wasn't planning on going into psychiatry to begin with, and so I kept my psychiatry rotation in medical school until towards the end of my training. And my very first day, and my very first experience in a psychiatric institution with my very first formal interview of a psychiatric patient, so I was sent to a patient who was on an inpatient locked unit. She was at the very end of the hallway, and I went there. We were each assigned a patient, and I went there to do my interview skills. I emerged maybe an hour later and took my notes, copious notes, as a very green medical student I do to the attendings and the rest of the medical students, and each one is presenting the case that they had worked on. When it came my turn, I got up and I presented, you know, this so-and-so is a 20-some-year-old patient with A, B, and C history that presents for XYZ and on with the rest of the discussion. The two attendings, the two supervising attendings in the room, kept looking at each other the whole time I'm presenting, and I couldn't figure out what was I saying that was problematic or why were they looking at each other. And then after they let me give my whole spiel, the first attending says to me, did Mrs. So-and-So really say all of that? I was like a deer caught in the headlights, like, oh no. What did I say? What did I do? Did I mess this up? All those thoughts are going through my head. It's my first psychiatric interview. And the other attending jumps in and says, actually what he means to say is, Mrs. So-and-So has been in our unit for three weeks now and has not been willing to speak to a single one of us, not any of the doctors, not any of the nurses, not any of the techs, nobody. How did she say all of those things to you? So now that pit in your stomach, that's like, am I being accused here of falsifying this interview? And then one of them, they saw it was just sort of like stuck, and someone of them said, did she say anything to you that indicated why she would speak to you and not to anyone else? And I said, I don't know. But I remember her saying that she, in the point where we got to her educational history, she said that as a girl she attended a Catholic school in which there were all nuns, and that she, that period of her life was the most helpful and positive period of her life, and that she had this very positive affiliation with her, the nuns who were her teachers. And she said to me, you remind me of them. So the one attending raised his hands up and said, positive transference. And the other attending raised his hand and said, the nun effect. And I just said, what are those? I was terrified really. And all I could stammer was, but I'm not a nun. And they just laughed, and they kind of went through this whole discussion of explaining what transference was. And here is an example of a positive transference because what transference is in our counseling world is a term we use when the patient or the client is having a good connection or a vibe basically with the therapist or doctor who is in the room who is trying to help them. Now as you can imagine, there's also a negative transference that can happen the other way around where they are something about me as a practitioner is actually triggering to them and they are not willing to talk and they're not willing to actually open up. Now that's transference, but there's also counter-transference. And counter-transference is when I, as a clinician, there is something about the patient in the room that is bothering me or triggering me or not allowing me to be as objective as I should be in working with that patient. And so we are taught in our field to be very careful of these concepts of transference and counter-transference because as one of my mentors would say, Dr. Harold Koening is a very prolific author and the field and researcher in the field of spirituality and health and particularly in mental health, he's at Duke University and he has several books, many, many books. One of them is a book called The Patient Care and in there, he talks about how the mental health provider compared to all the other medical providers are held to a much more narrow and restrictive ability in what they can and cannot say to the patient or client in front of them. The reasoning he gives is because if we're not careful about crossing boundaries and not just our own crossing boundaries into the patient care or allowing also not stopping the patient when they cross boundaries into our space, then we lose the ability to actually give them the best care possible. And while especially for us psychiatrists who are trained as MDs in medicine, we are trained to be very decisive in what we say, Dr. do I have cancer or not? What antibiotics works well? What are the side effects? So you're trained to be able to say, you know, and there's, of course, our shades of grade. You're trained on how to say that as well. But they're expecting very specific answers from you. But in the field of psychiatry and specifically counseling psychology, you cannot speak that freely. That's one layer of difficulty. Now add to that the next layer of what happens if in addition to that you are working with a Muslim patient, you are a Muslim psychiatrist or psychologist. And because of that shared faith background, they are also expecting you to, in addition to have answers to the medical or illness kind of questions they're asking, of also having Islamic answers. Now comes another layer of complexity of what can you say that does not actually interfere with the therapeutic process that is happening in that therapy room. And that can also aid it and help it not the other way around. Now that I've prefaced the discussion, let's talk about some more specific cases of when this starts to show up and how exactly you, we have been struggling really to work on this. Like where is the role of bioethics, right? What is the role of ethics in these situations? Where is the role of the Muslim scholars in this situation? And then the role of those who are being trained. So here's an example. Let's start with this first example. You know, for those who are trained in Islamic law here in the room, there are certain maxims in our faith which we know very well, but may not be as obvious right away to the person who's in the room with us. For example, in therapy, this has happened a number of times now, where a patient may say to me, either she's saying it's something in passing, or that is the actual crux of the issue for which she's presenting, and each one differs. So here's the case. The patient comes in and says, she's talking about something totally different and saying, you know, maybe let's say the issue is really her work situation. My boss is giving me trouble with this. I'm having trouble with my coworkers here. I'm thinking of changing jobs. I need your support and help. That is the context with which she's speaking. And that's what she's seeking therapy for. And that's one of all of that. Comes this one liner, where in the middle of her describing how difficult life has been lately, she says something like, and then I've decided to go on birth control pills, but I'm not telling my husband because it's too much. I can't handle all this that's happening. And on goes the rest of the conversation. For the trained ear, in Islamic law, you hear this line and go, oh, this cringe that happens, of you know something was just said necessarily in accordance to the teachings of Islam, and she may be very oblivious to that it may not be purposeful. But she also hasn't asked for help with it, nor asked anything related to that particular topic. Unlike the other patient who comes in specifically to say, life has been really difficult lately. I have, I don't know, let's say five children under the age of six, you know, and I am tired. I am anemic. I can't sleep at night. I have no help. My hair is falling out and the list goes on and on and on. And in the midst of all that, she says, and I feel really guilty because I decided to go back on birth control pills, but I'm not telling my husband or I don't want to tell my husband because he would say no, but I just can't right now, but I feel so guilty over it. Doctor, what do I do? Now, each woman's story is different because the one who went on was just talking about her work and she says that one liner and then goes right into my boss and my coworkers and my job and wants help with that. What is the role of the person who is duly trained, who is there in the room as a therapist? That's the point of coming in. She's not catching me after my Friday night holoca saying to me, hey, Doctor Rania, what is the ruling on? And what she's seeking help for is what? All my issues happening at work. Do I pull that conversation back and say, hey, by the way, which our field would say, no. That would be egregious. That would be crossing boundaries. Unlike the other woman over here who's saying what? This is the crux of my problem and I need to untangle it because that's why I feel so guilty. They'll help me through the situation. That's the ruling. And she knows she's doing something that is not and for anybody in the room who's wondering what is this ruling? So let me clarify just in case. The ruling in Islam is that neither spouse should prevent purposefully, prevent the other spouse from having access or having a child. And just like the man cannot do something that either permanently or even temporarily prevents the woman from having children, especially if it's permanent for either one of them, but even temporary without a discussion back and forth and a decision between them. Now, this is the ideal case. This is what Islamic law teaches and here comes the situation where but that's too complicated. They're not seeing eye to eye in the first place. So what are we talking about here? Here we're talking about issues of ethical dilemma that start to show up in the context of therapy. And like I said, there's many layers to this story because either you have a practitioner, a patient who comes in, a client or patient who comes in who's not seeking out any, they're not coming to you because of anything related to the Muslim faith. In fact, they may not be necessarily, that's not really what they're interested in. That's not what they're seeking you out for. Unlike the patient who may come out to you, like we see in the Kharil center, the vast majority of people who seek out the Kharil center is a spiritually integrated professional counseling service. So these are clinics that are now in Mashallah throughout the country. They started off here in Chicago and we have branches in the Bay Area and LA in New York and Toronto and inshallah growing. So this concept of seeking out specifically mental Muslim, mental health providers who are not just Muslim, but they're actually also doing what if requested. What if requested? We'll also do a form of therapy that's called Islamically integrated psychotherapy. So if somebody seeks that form of therapy out, they are also asking for Islam to be integrated into the therapy ruling. So the patient is saying, help me figure out both Islamically, but also emotionally how to deal with this case. Now you start to see where the fields start to have a little bit of attention with each other. Do I put on my hat or hijab being a psychiatrist only in this case? Or do I also lend expertise towards the Islamic sciences in this case? Well the first thing I'll say to you is the patient or the client has to be the one to lead the discussion. What is it that they want and that's where we go? But in the meantime, there may be something that they said in the process of therapy that in my personal religious practice might be very difficult to stomach or hear. If you have that level of counter-transference, that level of difficulty working with somebody who may be doing something that for whatever reason it's triggering to you as a clinician, you are taught ethically to transfer them to another provider. Because then you cannot give objective good care if your lens is too cloudy in that way. So now let's keep going in this discussion and I want to tell you, and for those of you in the room who are trained in Islamic sciences, you may be hearing this and going, but wait, wait, how could somebody who is trained in Islamic law allow some of this to keep going? Because that's just one example and we have many, many. But just one example, because you know let's talk about the framework of Islamic law. For example, I'm going to use some Arabic words and I'll translate them. But in the framework of Islamic law, once you are trained there has to be for example a series of several things that happen. The first, to beyan al-hukm right? So basically giving clarification to the ruling when someone asks you about that ruling. And if you don't what happens is something called kitman al-alm that you are doing what, you are actually covering up knowledge, concealing knowledge which is considered to be impermissible to the person who has been trained in this field. And there causes the dilemma for that person. And then there's other aspects. For example, this concept of the obligation of advising which is what? Which correspond with the rules or khakam al-hisbah. Khakam al-hisbah is basically the rules where you enjoying good and forbid evil. So again, if someone's asking you this very, very directive question and you are actually trained in this and you have the answers and you purposefully do not answer, here comes an issue for the person who has actually been trained in Islamic law or theology. So, and conveying the deen in general, this obligation of conveying the deen, you know, the saying or Bismillah right? So convey even if it's just about me, even if it's just one verse. So here this concept of this framework looks very different than the framework over here. If I give you the framework of psychiatry, for example, or of the mental health and the counseling fields, which basically says we are not here to give you directive answers to anything that you bring up in therapy. We are here to do something called, and these are psych terms called hold and contain. Hold and contain is whatever you bring into the room, I am meant to hold it with you to help you with this thing, however heavy it is. And to help you walk along the path and guide you when needed and as needed by the questions that I might ask and by the exercises that I may teach you and techniques that I may teach you to help guide you on the path, but it's ever a directive you should do this or you shouldn't do that. So very different than the other framework that I just spoke about. So here when you really the idea here is to inspire people to make the best choices for themselves, that you can't make decisions for them as a therapist in the room. So here you are having this discussion and by the way I just have to say this is where I really love I didn't name the Khalil center, Dr. Humaan who will be here later came up with the term Khalil center, but it comes from the word Khalil in Arabic, which is basically the friend and it has other translations too, but the Khalil you know like the hadith that says al-mar'u ala dini Khalili A person is on the path of their good friend and therapists are not meant to be friends by the way. What I meant to explain here is somebody who walks along the path with you is your Khalil right. So that's how we see Islamically how we see a therapist in this modern kind of discussion of Islamic psychotherapy is what we determine the Khalil to be. Someone who's walking along the path and as needed kind of help guide you towards the questions, but it's ever very directive. So all of that being said now we have this kind of issue of what happens in this case I just discussed you with you because I'll tell you something very important. There are so many people coming through the pipeline of mental health so just like I had no plan to be a psychiatrist and I'll be the first one to say I had my own internalized stigma towards mental health. I didn't take a single psychology course in college because what good Muslim girl does such a thing remember I trained in Islamic sciences before I trained in medicine. So for me that was different and I'll be very honest with you. So when people have all this stigma against mental health I know exactly where you're coming from I was once there and Allah has a way of humbling you and so you know finding that path and understanding and this is a whole other discussion we don't have time for today but the discussion of how so much of mental health is part of our legacy as Muslims the heritage of Muslims that's usually what I'm always talking on and on and on about which Shala will have that discussion on another time and day but when I realized how much it was part of our heritage then it made sense to me and then came the question well how did our predecessors deal with these questions because every time you pick up a biography of any of the early Islamic scholars that wrote on what today we call mental health and you read their biography it always starts off with and so and so had studied Islamic sciences and memorized the Quran and then he studied medicine and then he wrote it and then he studied this and he studied that and the other thing encyclopedic scholars so clearly they had grounding in the Dean before they had grounding or along with the grounding they had in medicine and the sciences too so clearly these are not new ethical kadundra right this is something that we think is new but it's not actually so I actually urge us to go back to our tradition and figure out exactly how to have this all work out properly but let me give you another example because the examples like I said they're endless they're endless whether we talk about the example of you know you're the therapist in the room and the person this actually happened to me just recently I had a patient she's talking to me on and on about the difficulties of there was financial difficulties in the family and there were issues related to her and her husband weren't getting along there's a young child and you know just that's kind of the what's happening and then the next session I see her which was two weeks later she's coming in and she's an emotional wreck I mean crying nonstop what's wrong what happened when she could finally get the word she said as soon as I left the day after I left the session I found out I was pregnant my husband and I both decided we couldn't have this child I went to Planned Parenthood I had an abortion and I'm a wreck these are practicing Muslims I mean that's not the issue here the issue is this is someone's real life scenario so she's talking in the room about guilt written about what had happened and wanting to needing to talk through that space I'm not there to judge I'm not there to say haram I'm not there to say shame on you I'm there to help her through this process because the reality is it didn't come up in our earlier sessions for us to even have a discussion about it now had it maybe we could have had a discussion maybe the result would have still been the same and maybe that was the proper result for her I don't know but what I do know is that if it's something that a person has had it happens depending on your comfort because if for me that's too much for me to handle then I need to transfer her out to somebody else that can help her right now these cases whether they're on abortion maybe it's adultery for that matter maybe it's anything that may be considered problematic with the Islamic faith it's going to do what require us to really think how do we bring in the ethics into this discussion so here's another example for all of us in the room I know we have many health providers in the room but you know it's really important to understand that in the therapy space it's a very unique space different than other fields of medicine because we cannot and we are not allowed to give unsolicited advice so she's in the middle of saying all that and I can't just unsolicitously say oh you know you shouldn't have done that right like no that's not the space for that even if that is actually the ruling so imposing kind of these religious values especially on someone especially someone who didn't even ask you about it because the same person could have come in and didn't feel guilty felt that that was the right decision for her and now she wants to talk about something totally different I want to talk about you know the difficulty I'm having like the person who had difficulty at work let's say right so you cannot just like intervene and say something else in the middle of but it's difficult because here in the context of this therapeutic alliance that deforms it's it's hard for those who are kind of trained in multiple fields if you will especially if they're also trained in the Islamic field and all these people coming through the pipeline we want them to be grounded in the faith so that when Muslim patients come through and say I need guidance on I'm coming to you specifically because you're Muslim like me therefore we speak the same language right I don't mean actual language I mean lived experience language okay and that's why I'm seeking you out we have to be very careful in how we say what we say so here's another example and the here you know and this has happened also a number of times myself and other people I supervise at the real center you know we do a lot of marriage family counseling a lot of it and I can't tell you now the number of times this has happened either to me or someone I supervise where they're in the middle of talking about you know let's say it's a context of a 20 year marriage or even a 5 year marriage for that matter but it's like this very disjointed like timeline and then this happened and she said this and he did this and then they came here and this one happened and this kid was happening this one and it's just like and you're trying really hard to follow this timeline of this person's life basically and when you finally get it all down it becomes really clear again to the trained ear that these two people Islamically are no longer married but they're living together and they're working through in fact what they came for was marriage therapy to help them and now you're in this dilemma of do I say something about how that was the final Talaq or divorce you're way past three or maybe it was a non-araja I don't want to get into too many legal terminology here but it was a non-returning you know into the marriage do I say or do I not say and then ethically as a therapist do I continue counseling them in marriage when Islamically they're no longer married what a total ethical dilemma so here you are in the space of therapy and what we figured out is the level of training differs so if you are somebody who's actually been trained and I'll tell you some of the ways you might kind of very very sensitively ask these questions to see where again you are walking along the path with them but when there's an ethical conundrum you are not what meant to have to sit in a very difficult situation if you can't handle that situation nevertheless you might want to very well be able to help your clients your patients so at the Khalil center we developed something called religious consultants so now because what we realize is some of our therapists are trained they've actually gone through their legal studies they've gone through different kinds of studies and they have within themselves with the same body they have the professional therapy training and the Islamic law training but for many of our therapists they're in the process of training or they don't have this so this is where we have our in-house religious consultants where we basically have said when an issue like this comes up to the therapist when an issue like this comes up do not attempt to answer to have the correct and requisite knowledge to say anything Islamically about whether or not this is actually but if you have doubts what you heard and you're like this is there's no way these two people Islamically are still married and you have doubts on that then you say to them would it be permissible would it be okay for me to refer you to our religious consultants why because I'm wondering if we need to sort out some of the religious aspects the fiqi aspects the legal aspects of whether the two of you are actually married or not I don't know enough this is what a therapist might say but the religious consultant can help you sort this out so here in Chicago we have California we have in each of our we have people some of whom are separate religious consultants and there are some of us who are duly trained myself for example in the Bay office or who's in the LA office to be able to help discern what's happening now most of our clients actually I would say I haven't seen a case yet in which they weren't very thankful for that because again the reason they're seeking out this specific type of care is because they want the Islamic understanding and framework mostly now we have by the way just to be very very very clear we have non-Muslims in our office all the time and we cater to everybody and we have lots of Muslims in our office who don't want the Islamic paradigm they just want regular standard therapy but know that you have the same cultural background as them and everybody is welcome I'm talking about the subset of people who what who specifically are asking for both together Islamic understanding plus the therapy so we try to help ameliorate some of this with our Islamic with our religious consultants right but I also want to say and this is what we do with our training with regular therapy training and we always tell people be careful not to speak on what you do not know because you can make the situation 10 times exponentially worse do you know what I mean and so in the process of all this the back and forth and back and forth either because now as a therapist in this case I just mentioned if they are married now your role as a marriage family therapist is to do what is to actually help them get on good footing in that marriage and if they are actually divorced maybe the therapy has to take a different path where it actually helps them each figure out how to get on their feet as a divorced person and how to figure out co-parenting and all the rest that comes with that and if they wish to remarry that has a different type of therapy that needs to happen so you see one simple thing either and this is a process too where someone could just say it and passing and that's not even the reason they came to the first place or that may be the very reason they came and so this is where I want to show you the different layers of ethical conundrum that happens sometimes in our field of mental health that still kind of have I'm touching a little bit on the reproductive and sexual health discussion as well here but I really want to share with you these are difficult cases and I really want you to think about how that really affects both the people in the room who are trying to help but also affects us as the people trying to do the help and how important it is to really be as grounded and as trained as possible and to have the kind of supervision that is required because you see in the field of mental health I'll just speak of that field anybody, even a masters level trainee is going to go through not just two years of a masters program but they typically have about 3,000 hours or more of supervised clinical care that's about three more years give or take of actual supervision over the therapy they're doing meaning somebody else has to sign off in every case that they have until they're really well grounded and trained to then be able to do this solo so I'm going to take a small segue here and say for all of us who are on all of our dear Islamic studies and Islamic and imams and Islamic studies and religious teachers these things that we call counseling kind of informal counseling is also somewhat problematic when just like all those people that have had years and years and years of training to be careful of how they say things and how to frame things and what to do but they may not have the Islamic knowledge but the imams and religious and scholarly leaders might on this side have the requisite knowledge but don't have the training and the nuance of what you say and how you say and when you say it preferably there's cross training cross training that happens where there's training for imams on the mental health field which we have and we've developed specific imam training on how to actually speak other organizations have as well but this is written by people who have both the scholarly lens so that when they do the training the scholars are actually listening because it's speaking their language to be able to really fully understand what's happening and likewise our mental health providers and professionals have to have some requisite trainings that explain the Islamic side of things too so they're not mis-stepping and crossing boundaries they shouldn't be crossing either we often talk about this issue of staying in your own lane and people don't like this very much but the reality is if you try to drive and not stay in your own lane what's going to happen well this is what happens this is what happens here too and I could share some other cases and maybe we'll have time for that as well later but just think about all the different cases in which there really is and I just very briefly mentioned abortion but certainly it is a case that causes quite a bit of ethical conundrum as well and somebody who's in the counseling space may have a really difficult time if they feel very strongly that this is not or maybe they don't have the full requisite knowledge because the ruling is known but there's all this nuance in the fiqh that may or may not allow for somebody to actually undergo abortion Islamically I'm talking requisite knowledge Islamically so you really have to think about all the different layers that comes up in this discussion and how important all this cross training needs to happen and I also want to say that sometimes in therapy we have to be very careful in sitting with and working on cases that actually may somebody may say something in the context of therapy that very much to again to the trained religious ear may sound like Rida somebody has just exited the fold of Islam by what they just said but you are not there to be the judge or jury or executioner right you are there to actually help and if they were to turn around and say what I said there is that problematic with Islam that's a different discussion than the person who's saying that and sometimes I'll actually say to some of my patients who say things that you might even consider as blasphemous you know Islamically but I'll say to them it sounds like your depression is talking and they'll say what and I say you know when we're depressed sometimes we say things we have such a despondent state and we say things that later when we're out of that state we may actually not identify with and they may ask what do I mean and we might go back and forth and actually have a discussion on the importance of understanding that there's no judgment you say right now but if we're trying to help you through that case then either I am going to refer to some of our spiritual leaders to help in that or if I and I have permission to help as well walk along the path with you if that person is asking for help along that path will actually do so to help you know in those in this you know therapy that they're seeking so in closing I think what I want to say here is I really feel that one of the main places where that our ethicists can really help us and I'll tell you again because of that so many providers that are coming through the pipeline I think I started by saying at the time I went through training there are very few of us very very few to the point that when I finished my training so here I am a newly minted psychiatrist and I finished the training I only knew one maybe two people in the entire Bay Area region who were also Muslim and in mental health and I said to them let's just meet and see what happens so we sent out a message into cyberspace and said you know if any of you are Muslim and mental health providers we're going to have a monthly meeting at Stanford come join us the very first meeting there were 10 people nobody knew anybody else but for the most part literally we're all looking at everyone I was going who are you and where did you come from and you're down the street I had no idea you're in this field too and it was like you know talk about a real process group everyone felt that they were an island all by themselves and as the months went on this became a monthly meeting and now we're called the Bay Area Muslim Mental Health Professionals Network and every month that met that we met the numbers kept growing and growing doubling and then tripling and quadrupling washallah until it became an actual you know steady group of people and what's really wonderful out of those initiatives is that it became really clear to me how many more people were coming through the pipeline but once they came to the other end and they really wanted to work with the Muslim community but they didn't have a lot of training and had to actually engage the community either right and what they were trained in was a very very western secular lens and they knew that too and they wanted that help and kind of get coming through and for those who are reaching out for that kind of help hence the trainings that we're doing for example with the Khalil Center of what of integrating Islam with professional therapy for those who wish to have that and there is a very strong substance of our community who does so in closing here I'll just say here that just like our ethicists have worked and especially our bio ethicists have worked quite a bit on the fatawa relating to things like abortion or relating to fertility based questions you know sperm bank or not you know things like this I also think that here there are very important fatawa and Islamic discussions that need to happen especially for all of our trainees that are coming through the pipeline who are one day going to be psychologists and psychiatrists and social workers and professional licensed therapy therapists they're going to need some really developed manuals and developed guidelines and how to answer and work with our patients this particular patient population of the Muslim segment of the population and I really encourage our ethicists to help us and our Islamic scholars to help us and likewise know that even though it's a we're talking about being in your own lane know that the lane is bi-directional there are two you know it's a two way road or maybe three or four for that matter and so we need people to really be cross collaborating to come up and be able to answer some of the best in the best way give the best practices for what will be continue to be ethical dilemmas from the beginning till the end here inshallah I'll close and if we have time for questions I'll take them Peace be upon you Peace be upon you