Among Muslim mental health practitioners, there is a conflict between the positive approach of professional ethics with regard to LGBTQ+ clients and Muslim values. The positive approach of professional ethics toward LGBTQ+ clients is sometimes in conflict with the positive approach of Muslim values among mental health practitioners. In Muslim majority nations, the situation is no different, as same-sex relations are legally punished and socially disapproved, especially in Malaysia. This review sought to sum up the qualitative evidence around the ethical, religious, and professional dilemmas faced by Muslim counsellors/therapists working with LGBTQ+ clients, and the ways in which they handle these conflicts. Methods: A thematic synthesis was performed on 17 records published between 2013 and 2025, including journal articles, conference papers, book chapters, and repository papers. The data were extracted from the abstracts, findings, conclusions, and challenges. Line-by-line coding was performed, and subsequently, descriptive and analytical themes were constructed. Agreement/disagreement across studies was also chronologically analysed and examined. The collected data was analysed using four analytical themes: First, value conflict, as an integral experience, in all the empirical studies reported conflicting goals, roles, and interests. Second, navigational strategies were giving attention to religious values over professional values, balancing personal values with professional values, and information-seeking. A few counsellors used passive listening and/or secret solidarity. Third, there were systemic and individual barriers such as the lack of reference models, limitations of expertise, stigma, and a lack of culturally safe professionals in the field. Fourth, culturally safe care, intersectional strengths-based approaches, and co-created belonging are recommended for practice. A review made in the chronological order indicated that there was a shift from the psychological conflicts (2013-2014) to intersectionality and relational authenticity (2025). The results showed that there was a high level of consensus regarding the presence of value conflicts, but there were some differences in the approaches used to deal with the conflict, depending on the circumstances. Summary: Muslim practitioners use a variety of coping strategies, some of which can negatively affect the welfare of the client. Immediate culturally embedded ethical guidelines, training, and institutional support are needed that respect Islamic values and provide positive care for LGBTQ+ people. There is a need for further research in the study of large scale mixed-methods, and the establishment of culturally specific ethical guidelines for Malaysia.
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