The application of Islamically integrated chair-work techniques for unfinished business in patients with prolonged grief

This study aims to develop the Traditional Islamically Integrated Psychotherapy (TIIP) Grief Protocol, designed to reduce unfinished business tensions emerging in the bereavement process, and to evaluate its effectiveness among Muslim adults experiencing prolonged grief. The protocol's theoretical foundations and clinical applicability were examined experimentally. The study was structured as a process–outcome, using a nonconcurrent multiple-baseline experimental design across participants, comprising five phases: (1) baseline, (2) Empathic attunement (1st & 2nd sessions), (3) Chair-work intervention (3rd – 5th sessions), and (4) Cognitive consolidation and spiritual behavioral plan (6th & 7th sessions), and (5) follow-up phase (one-month post-intervention). The study was completed with nine participants (n = 9). Participants were randomly assigned to 2-, 4-, or 6-week baseline phases, followed by 50-minute face-to-face individual psychotherapy totaling seven sessions. TIIP Grief Protocol integrating insights from early Islamic scholars Al-Kindi, Al-Razi, and Ibn Sina with emotion-focused techniques to facilitate holistic and healthier bereavement. Analyses included visual inspection, Tau-U effect size estimation, Wilcoxon signed-rank tests, and the Jacobson–Truax Reliable Change Index. Visual analyses revealed stable baseline patterns across all participants and clear, consistent reductions in unfinished business tension beginning in Session 3. Tau-U analyses revealed significant effects, with 7 of 9 participants showing clinically meaningful improvement. Wilcoxon tests indicated significant and robust reductions in unfinished business from pre- to post-treatment and from pre-treatment to follow-up. Regarding unfinished business tension, RCI analysis showed reliable improvement for two participants. Follow-up assessments indicated significant reductions in grief cognitions, suggesting beneficial cognitive restructuring processes. Although decreases in prolonged grief symptoms did not reach statistical significance, they reflected moderate improvement. Taken together, the findings indicate that the TIIP Grief Protocol is a practical, sustainable, and clinically meaningful intervention for reducing unfinished business tension among bereaved Muslims.