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- Herausgeber: IVP Academic
- Kategorie: Fachliteratur
- Sprache: Englisch
- Veröffentlichungsjahr: 2009
Mark McMinn and Clark Campbell present an integrative model of psychotherapy that is grounded in Christian biblical and theological teaching and in a critical and constructive engagement with contemporary psychology. This foundational work integrates behavioral, cognitive, and interpersonal models of therapy within a Christian theological framework. Not only do the authors integrate Christian faith and spirituality with the latest thinking in behavioral science at a theoretical level, they also integrate the theoretical and academic with the pastoral and clinical, offering a practical guide for the practitioner. Christian Association for Psychological Studies (CAPS) Books explore how Christianity relates to mental health and behavioral sciences including psychology, counseling, social work, and marriage and family therapy in order to equip Christian clinicians to support the well-being of their clients.
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To our doctoral students—courageous women and menwho make enormous sacrificesto become Christian psychologists.
And to Lisa and Donell, always.
Contents
Acknowledgments
THE JOURNEY OF LIFE HAS TWISTS AND TURNS, some of which are reflected in our friendship and in this book. Our paths first crossed when our young families settled in a small, rural community in northwest Oregon. We both taught on the faculty at George Fox College and worked in the clinical practice Clark established—Valley Psychological Associates (at the time, we were the only psychologists in Yamhill County). Collegiality grew into a warm and secure friendship that is now entering its third decade. At some point Mark left for a thirteen-year stint at Wheaton College in Illinois, but will be returning to Oregon shortly before this book appears in print. George Fox College is now George Fox University, Valley Psychological Associates is now a thriving practice involving many psychologists, and the small rural community of Newberg is feeling more and more like a suburb of Portland. Our friendship has stood the tests of time and change.
Our colleagues have helped shape our thinking about integration and psychotherapy. While at Wheaton College, Mark had opportunity to work alongside many gifted scholars and clinicians: Stanton Jones, Richard Butman, Robert Gregory, Francis White, Robert Roberts, Barrett McRay, James Wilhoit, Katheryn Meek, Amy Dominguez, Helen DeVries, Natalia Yangarber-Hicks, Michael Mangis, Elizabeth Hillstrom, Robert Vautin, Joan Laidig Brady, J. Derek McNeil, Sally Schwer Canning, Terri Watson, Robert Watson, Carlos Pozzi, Donald Preussler, Cynthia Neal Kimball, Kelly Flanagan, Trey Buchanan, William Struthers, Darlene Hannah, John Vessey, Raymond Phinney, James Rogers and others. Clark has benefited from numerous interactions with his colleagues as well: Wayne Adams, Rodger Bufford, Nancy Thurston, Mary Peterson, Kathleen Gathercoal, Bob Buckler, Brad Johnson, Carol Dell Oliver, Katherine Ecklund, Leo Marmol, Sally Hopkins, Jim Foster and Claire Russunen to name a few.
This book is an effort to bring psychology and Christian doctrine together into a coherent psychotherapy model. Such an endeavor is only possible because of the role that biblical scholars and theologians have played in our lives. Though we do not wish to implicate any of these individuals in whatever theological blunders may appear in the following pages, we are grateful for the friendship, teaching, writing and tutelage of Timothy Phillips, Walter Elwell, Gary Burge, Dennis Okholm, Paul Anderson, Tim Tsohantaridis, Gerald Wilson, Daniel Treier, Mark Husbands, Larry Shelton, Robert Webber, Carl Laney, Robert Hughes, Ronald Allen and Robert Cook. It is a male-dominated list, which says something disappointing about evangelical theological scholarship as well as the homogeneity of the company we keep. But still, we are grateful for the wisdom and preparation of these fine men. They have helped us think beyond what our psychology training provided.
Ask a college educator what the best thing about his or her work is, and you will probably hear something about students. It is an incredible honor and privilege to work with tomorrow’s leaders. Many of our students have read drafts of this book in various stages and offered both words of encouragement and suggestions for improvement. We are grateful for them and their ideas.
We have met with many psychotherapy clients over the past twenty-five years—enough to fill numerous file cabinets with aging clinical records. Many of these clients have been people with remarkable courage, wisdom, insight, resilience and tenacity. Whatever useful clinical advice is found in this book is due in large part to what we have learned from the people we have been privileged to serve in our role as clinical psychologists.
Like us, the Christian Association for Psychological Studies (CAPS) is about to turn fifty years old. Paul Regan, executive director of CAPS, and Jeffrey Terrell, current chair of the board, have encouraged us with their friendship and willingness to pursue a marketing partnership between CAPS and InterVarsity Press (IVP). CAPS is a steady organization—more solid than flashy, and more rooted than faddish. We commend the organization to those involved in psychology and Christianity as a good professional home. It is a privilege and honor to lead off the IVP/CAPS book series with this book.
IVP Academic has its reputation as an excellent evangelical press for good reason. We found out through back channels that our editor, Gary Deddo, has a Ph.D. in systematic theology. At first that was a bit daunting, but we learned quickly that Gary balances his knowledge with patience and kindness. He has been a joy to work with. Jeff Crosby, Mark’s good friend and director of marketing at IVP, has been both a personal encourager and a major reason that the IVP/CAPS book series has come to fruition. It is hard to understand how someone who gets three hundred e-mails a day, as Jeff does, can respond so promptly to our questions, which have been plentiful. We are also grateful for the two anonymous reviewers who read an early draft of this manuscript and made helpful recommendations.
Finally, our friends and families have been a tremendous source of satisfaction and support for us. We are two blessed men, grateful every day for the relationships God has brought into our lives. Mark is enlivened and supported by Lisa, his wife of twenty-eight years and an author in her own right (most recently, The Contented Soul, InterVarsity Press, 2006). Their grown children—Rae, Sarah and Megan—are a great joy. Over the years Clark has benefited from discussing several integrative ideas with his brother, Mark, who is a chaplain in the Air Force. He also appreciates the prayer group that has supported him through this project—Joe and Jamie O’Halloran, Steve and Glenda Gilroy, Tom and Dorie Byrd, and Hugh and Sue Anderson. Clark is encouraged, challenged and stretched by the love of his life, Donell. She has been a true partner in their journey of married life for twenty-eight years. Their children—Erin, Bryce and Alex—have enriched their lives and are further evidence of God’s blessing.
Introduction
GOOD COUNSELORS LISTEN MORE THAN THEY SPEAK. Believing writers should do the same, we have been listening for many years, trying to understand the opportunities and challenges of an integrative approach to psychotherapy.
We have listened to our colleagues. An ambitious book such as this may have two author names on the front cover, but it reflects the wisdom and work of numerous others who have taught, mentored, encouraged, critiqued and inspired us over the years. The contemporary movement to integrate psychology and Christianity has been championed by various godly men and women; we have been influenced by them and are privileged to call many our friends. Scholars have been doing important integration work over the past several decades, credible graduate programs have been developed, thoughtful Christian clinicians provide therapy that is sensitive to both psychology and faith, church communities have been helped by psychological principles, useful books have been written and scientific journals established, and the Christian Association for Psychological Studies has grown in depth and number. Indeed, psychology as a discipline has done well in considering integration, perhaps better than other academic disciplines. It is upon this foundation—formed by the insights and hard work of many dedicated scholars, clinicians, pastors, authors and educators—that we have developed Integrative Psychotherapy.
We have listened to our students. The integration of psychology and Christianity has become an important force in higher education—Christian colleges educate undergraduates in models of integration and theories of personality, most seminaries offer counseling courses and degree programs, countless masters programs offer degrees in Christian counseling or psychology, and various integration-based doctoral programs prepare students to become licensed psychologists. Students often make enormous sacrifices to study integration. They come to their training with a passion to learn an integrative approach to psychotherapy—one built on a Christian worldview—and too often they are offered only a variety of psychological models derived from nonreligious worldviews, a smattering of theology courses, and a charge to go out into the world and do good integration with what we have taught them. It need not surprise us that most students do very little integrative work after graduating. They have learned important information about psychology and Christianity, but they have not been taught what they came to study: the integration of psychology and Christianity as it relates to counseling and psychotherapy.
We have listened to pastors and others committed to church ministries. From storefront churches in crowded urban areas to sprawling suburban megachurch campuses to rural community chapels, pastors and church leaders face the same challenge of finding help for hurting parishioners. Everywhere Christian leaders are asking the same question: “Who can I trust to help care for the souls in my congregation?” Too often the Christian psychologist or Christian counselor across town turns out to be untrustworthy—a wolf in sheep’s clothing, someone who has bought into a nonreligious psychological worldview and yet attempts to build a practice by soliciting referrals from pastors. Perhaps the problem is not malice on the part of the therapists; often these are graduates of our integration-based graduate programs and seminaries just doing what they have been trained to do.
We have listened to our clients. People in pain take enormous risks to overcome inhibitions and admit their problems to a stranger. Some potential clients may still let their fingers do the walking through the Yellow Pages, or their mouse do the clicking through superpages.com, but most clients choose more carefully. They talk to a friend, a pastor, a physician, asking particular questions so they can find a trustworthy helper in a time of need: “I’m looking for a good counselor—do you know of any?” Often they add a coda, “It needs to be a Christian,” because the general public is more attuned to religious matters than the psychological community (Shafranske, 1996). When clients come for help they are sometimes surprised by how little faith is considered in therapy, even by therapists who promote themselves as Christian therapists.
We have listened to our critics. Biblical counselors argue that integrationists do not take Scripture and Christian doctrine seriously enough. Most of us in the integration movement respond by calling biblical counselors naive and uninformed, and sadly, we often do it without even reading their books or articles or developing relationships with biblical counselors. One might question who is really naive and uninformed under these circumstances. We Christian psychologists have too often maligned these critics without hearing their arguments, and so we have forgone the possibility of transformation and growth.
We have both spent many years in church-related service, clinical practice, reading and studying psychology and theology, and teaching doctoral students in clinical psychology. Integrative Psychotherapy represents our effort to articulate a model of psychotherapy that is faithful to both Christianity and psychology. It took almost three years to write, and the ideas behind it took almost three decades of listening, study and experience to develop.
An Integrative Model
Integration is a controversial notion. Some prefer to reject psychology altogether and look for a Christian model of helping that is completely scriptural. This is an ambitious endeavor, and one that we admire, but it seems to overlook the possibility of finding truth through created order as well as in Scripture. By looking only to Scripture, these counselors foreclose the possibility of learning through contemporary science. As a result, stunning scientific advances in treating many conditions are overlooked in deference to approaches deemed to be more consistent with Scripture (for a fascinating discussion on this, see Jones, 2001, and Powlison, 2001). Others reject integration by minimizing the importance of faith. Indeed, it seems that some come dangerously close to deeming their Christian faith irrelevant as they acculturate into their roles as mental health professionals. Preliminary evidence suggests graduates of Christian doctoral programs are less likely to use spiritual interventions in their clinical work than Christian graduates of secular programs (Sorenson & Hales, 2002). This could be good news—if graduates of Christian programs are more aware of the subtle ways spiritual interventions can be misused with vulnerable clients. But it could also be bad news if graduates of Christian programs are somehow abandoning the spiritual worldview that drew them to graduate school in the first place. Much of today’s Christian psychology is imbalanced in its integrative focus (Beck, 2003), failing to draw on both psychology and Christian thought.
Integrative Psychotherapy (IP) is integrative in two dimensions: theologically and theoretically. By theological integration we mean that a Christian psychotherapy must begin with a Christian view of persons. Christianity is the starting point—the fundamental worldview on which a Christian psychotherapy is based. Psychology provides a great deal of help once an adequate Christian foundation is established. By theoretical integration we refer to the general trend in the psychotherapy literature to find value in various theoretical approaches. Rarely does one find a purist cognitive therapist, for example. It is much more common to find a cognitive therapist who also values attachment theory, or a psychodynamic therapist who draws on various cognitive and behavior techniques for initial symptom relief. Integrative models are becoming increasingly popular among professionals as they realize the limitations of any single theory. In IP we integrate behavioral, cognitive and relational models of therapy.
It would be grossly overstated to say that ours is the first integrative understanding of psychotherapy in either of these two dimensions. Many have developed models of theoretical integration (Norcross & Goldfried, 2005). Others have developed models for Christian counseling and psychotherapy, and some with distinction. Counselors and pastors and scholars have developed helpful and innovative approaches to healing prayer and Christian counseling, or offered Christian appraisals of secular models, or provided models of biblical counseling that include occasional insights from psychology. But none of these models has gained prominence in integrative training programs, sometimes because they skim the surface of Christian doctrine—sprinkling Bible verses atop secular theories—or because they overlook advances of contemporary psychological theory and science. IP is unique in that it provides both a theoretical and a theological dimension of integration.
Avoiding Extremes
Whoever wrote that “every road has two ditches” must have lived before modern highway and drainage systems. Updating the adage to “every street has two curbs” would never work. But even in the suburbs and cities, where we have no ditches, the metaphor has lasting value. Much of life involves navigating between the boundaries on the right and the left, avoiding the extremes that render us irrelevant, fanatical or irresponsible. The task of this book—constructing a model of Christian psychotherapy—is, among other things, a task of avoiding two ditches.
At one extreme is the risk of implying that we have developed the only correct model for Christian counseling, psychotherapy and pastoral counseling. Though we believe the approach to therapy presented in this book to be theologically—and psychologically—sound and effective, we have no aspirations of joining the ranks of those who claim to have discovered the one true approach to Christian counseling. There is no single system of Christian psychology or psychotherapy and, it seems to us, there never will be. The Bible does not teach a single, unifying theory of personality that accounts for individual differences; that is simply not the purpose of Scripture (Jones & Butman, 1991). And any authority other than Scripture cannot possibly provide a foundation for counseling that will be agreeable to all Christians. History has proven how difficult it is for Christians to agree with one another. A parallel argument can be made on the basis of science: there are many psychotherapeutic paradigms available, but research evidence to date does not support claims of vast superiority for any one approach (Nathan, Stuart & Dolan, 2000). Thus, one of our navigational challenges in crafting this book is to avoid communicating that IP is the Christian approach to psychotherapy. It is not. IP is simply one approach to psychotherapy, informed by Christian theology and spirituality as well as contemporary psychology.
We have already mentioned the other extreme—one that ultimately disappoints our students, churches, clients and critics. Some Christian therapists and biblical counselors seem content to abandon the possibility of a truly integrative psychotherapy. They may wonder how such a task could ever be accomplished when there are so many incompatible theories and ideas swirling about us in both the realms of psychology and Christian thought. They become segregationists rather than integrationists.
We have tried to avoid these two extremes—the one that tickles our grandiosity by suggesting we are unveiling the long-awaited answer to how all Christians should do psychotherapy, and the one that segregates faith from psychology—and in the midst of these extremes to construct a responsible and helpful approach to psychotherapy. This, of course, is no easy task. We advocate IP because it is built on two foundations we value: Christian faith and science. Christian doctrine provides the ideological structure for IP while the methods of psychotherapy, with their weighty scientific support, provide a means for identifying and modifying emotions, cognitions, behaviors and relational patterns.
Responding to the Challenge
Adages abound, so we conclude this introduction by plundering two more for our purposes. The first likens a good book to a good friend. If so, Modern Psychotherapies: A Comprehensive Christian Appraisal (Jones & Butman, 1991) has become a good friend to many Christian psychologists and their students. Stanton L. Jones and Richard E. Butman provide an incisive Christian evaluation of the contemporary psychotherapies. Near the beginning of their book they describe two stages of constructive integration. The first, accomplished admirably with their volume, is critical appraisal—looking intently at various psychotherapies from a Christian vantage point. The second is to build a new theory of psychotherapy based on a Christian foundation. The authors issue a challenge of sorts:
We anticipate that a thoughtful reader will find this book inadequate, in that we will end with finding none of the approaches adequate for understanding human nature, while pointing out many benefits of most of the approaches. We challenge such a thoughtful reader to join in the dialog of developing the comprehensive Christian approach that we all so need! (p. 23)
Here is where the second adage comes to mind: it is about fools rushing in where angels (and other wise creatures) fear to tread. Our combined forty-five years of teaching psychology and fifty years of clinical practice have either rendered us fools or given us enough confidence to enter the dialogue that Jones and Butman suggest, or perhaps it is some of both. This book is an effort to articulate a Christian psychotherapy—one that takes both Christianity and psychology seriously, and that helps to serve hurting people through the ministries of Christian counselors, psychologists, social workers and pastors.
The first four chapters establish a theoretical frame for IP. chapter one provides an overview of Christian doctrine, viewed from an evangelical Protestant perspective, with special attention given to three theological views of what it means to be made in the image of God (imago Dei). These three views of the imago Dei correspond with the three domains of IP: functional, structural and relational. chapter two gives an overview of scientific findings regarding psychotherapy. This chapter will humble theoretical purists because it demonstrates that no single therapeutic approach can claim vast superiority over any other. The so-called cognitive revolution is described in chapter three, along with an overview and Christian critique of cognitive therapy—an important task because the first two domains of IP are closely related to contemporary cognitive therapy. chapter four is where we provide a theoretical overview of IP, drawing on the doctrinal, scientific and theoretical perspectives developed in the first three chapters.
Once a theoretical foundation is established, we consider the practice of IP in the next seven chapters. chapter five is a brief survey of assessment and case conceptualization. Chapters six and seven describe symptom-focused interventions, known as the functional domain. We pay special attention to treating anxiety disorders because they are well suited for functional-domain interventions. The structural, or schema-focused, domain of IP is the focus of chapters eight and nine. We discuss the treatment of depression in the context of describing schema-focused interventions. In chapters ten and eleven, we look at the relational domain of IP, concentrating on the importance of the therapeutic relationship in promoting change. Although relationship-focused interventions have many applications, we devote special attention to the treatment of personality disorders.
The final chapter summarizes and reiterates the integrative focus that we emphasize throughout the book while identifying various challenges and limitations to our integrative approach to psychotherapy. We intend this book to reflect both ambition and modesty, so we pr opose an integrative model of psychotherapy with confidence and hopefulness even as we acknowledge that there is more work to do.
References
Beck, J. R. (2003). The integration of psychology and theology: An enterprise out of balance. Journal of Psychology & Christianity, 22, 20-29.
Jones, S. L. (2001). An apologetic apologia for the integration of psychology and theology. In M. R. McMinn & T. R. Phillips (Eds.), Care for the soul: Exploring the intersection of psychology and theology (pp. 62-77). Downers Grove, IL: InterVarsity Press.
Jones, S. L., & Butman, R. E. (1991). Modern psychotherapies: A comprehensive Christian appraisal. Downers Grove, IL: InterVarsity Press.
Nathan, P. E., Stuart, S. P., & Dolan, S. L. (2000). Research on psychotherapy efficacy and effectiveness: Between Scylla and Charybdis? Psychological Bulletin, 126, 964-81.
Norcross, J. C., & Goldfried, M. R. (2005). Handbook of psychotherapy integration (2nd ed.). New York: Oxford University Press.
Powlison, D. (2001). Questions at the crossroads: The care of souls and modern psychotherapies. In M. R. McMinn & T. R. Phillips (Eds.), Care for the soul: Exploring the intersection of psychology & theology (pp. 23-61). Downers Grove, IL: InterVarsity Press.
Shafranske, E. P. (1996). Religious beliefs, affiliations, and practices of clinical psychologists. In E. P. Shafranske (Ed.), Religion and the clinical practice of psychology (pp. 149-62). Washington, DC: American Psychological Association.
Sorenson, R. L., & Hales, S. (2002). Comparing evangelical Protestant psychologists trained at secular versus religiously affiliated programs. Psychotherapy: Theory, Research, Practice, Training, 39, 163-70.
1
Christian Foundations
PSYCHOLOGY AND COUNSELING HAVE ATTRACTED ENORMOUS attention in recent decades. Graduate programs in psychology and counseling have proliferated, both in mainstream universities and in distinctively Christian settings. In 1973 the American Psychological Association (APA) accredited 118 doctoral programs; by 2001 the number swelled to 346 programs (Peterson, 2003). Today’s membership in the APA is approximately one thousand times greater than its membership in the early twentieth century. Both the APA and the National Association of Social Workers now have more than 100,000 members, and the American Counseling Association’s membership exceeds 50,000. Numerous books authored by psychologists and counselors have caught the public’s attention, psychologists’ opinions ride radio and television waves into our living rooms, and we can even purchase Freudian slippers on the Internet to keep our feet warm at night.
Of course these changes have affected Christianity. Many churches have psychological counseling centers or extensive referral networks of mental health professionals in the community. Models of pastoral care have changed dramatically; most seminaries now teach courses in pastoral care that are heavily steeped in psychological theories and practices. Teaching within the church has been affected too—we hear more about personal stories, emotions, developmental processes and childhood experiences than in the past. Lay counseling ministries and support groups are being established in many churches, and small groups do more than study the Bible these days. Some have lamented psychology’s influence on the church (Bulkley, 1994) while others have embraced it cautiously (Collins, 1988; McMinn & Dominguez, 2005).
At least to some small degree, Christianity has also influenced psychology. There are now seven doctoral programs in clinical psychology at distinctively Christian institutions, most of them accredited by the APA. The APA has published various books on spirituality in recent years, many of them with chapters by Christian psychologists (Miller, 1999; Miller & Delaney, 2005; Richards & Bergin, 2000, 2004, 2005; Shafranske, 1996; Sperry & Shafranske, 2005), and the APA has even published a psychotherapy video demonstrating the Christian approach to psychotherapy that we describe in this book (McMinn, 2006). Religion is now considered an important form of diversity within APA, and a number of committed Christian psychologists have served in key leadership roles in the APA’s Psychology of Religion division and in related organizations, such as the National Council of Schools and Programs of Professional Psychology (NCSPP).
With all the interplay between psychology and religion, it seems regrettable that prevailing personality and counseling theories have not been influenced much by the Christian faith. Ask a new Christian psychologist about his or her theoretical orientation, and you will probably hear something about cognitive-behavioral therapy, object-relations theory or family systems, and it is likely that these theoretical viewpoints will be quite pristine—relatively untouched by the influence of Christian doctrine.
Some have responded by developing distinctly Christian alternatives to counseling. We respect these alternatives, but they can easily move to the other extreme—relying so heavily on Christian resources for counseling that they overlook the scientific and theoretical advances of contemporary psychology.
We write this book on integrative psychotherapy because we believe it is possible to provide therapy that is informed by both Christian theology and psychological science. Rather than viewing these two realms of knowledge as competitors, we begin with the assumption that both have important perspectives to offer.
Integration as Reciprocal Interaction
Though the integration of psychology and Christianity has deep historical roots that go back many centuries, contemporary integration began in the mid-1800s in reaction to those trying to extricate psychology from its theological and philosophical roots. By the late 1900s the movement had “coalesced into a distinct psychological and interdisciplinary specialty” (Vande Kemp, 1996, p. 77). Today’s proliferation of integrative writings and training programs is truly phenomenal—influencing the academy, the church, and the practice of clinical and counseling psychology.
But not everyone who works in counseling or psychology is interested in doing integration. There are various ways to construe the relationship between faith and psychology, some of them integrative and some not. The litmus test is the extent to which reciprocal interaction is perceived as desirable and possible—what Jones (1994) refers to as a “constructive relationship” between psychology and religion. To what extent should counseling and our view of persons be influenced by both the Christian faith and contemporary psychology? Some believe that faith is enough, that psychology is irrelevant and perhaps dangerous. Others believe that psychology is enough, that faith ought to be left outside the counseling office. Integrationists believe that some sort of reciprocal interaction between faith and psychology is the best way to gain a comprehensive understanding of personality and counseling. This is not to say that psychology carries the same authority as the Christian faith, but that understanding and wisdom can be discovered in both.
By way of analogy, consider the temperature system in an automobile (see figure 1.1). On one end of the continuum is hot air and on the other end is cool air. Often a person selects a temperature in the middle, mixing the hot and cool air for the desired effect. The climate is more desirable and adaptable by combining both sources of air than it could be if only one source of air were available. Though some Christians would be quick to say that psychology is a bunch of hot air, and some scientists would say the same about religion, this is not the point of the analogy. In this analogy we are considering two sources of information: psychology and Christian faith. To what extent do we let the “air” from both systems mix in order to achieve an optimal balance? Or should we trust only one source of information and not the other? Reciprocal interaction involves the assumption that caring for people’s souls is best done by bringing together truth from both sources.
Different approaches to soul care can be viewed along the continuum of figure 1.1. At one end of the continuum are those who trust Christian faith exclusively for the care of souls. Many biblical counselors would position themselves near this end of the continuum, and indeed they provide an important corrective for those who have embraced the naturalistic worldview assumptions offered by many contemporary psychologists. At the other end of the continuum are the secularists who view religion as unimportant and irrelevant to the psychological services they provide. Though some secularists and biblical counselors may find parts of this book on IP interesting, most will find our desire to mix Christianity and psychology frustrating. It is for the people in the middle of the continuum that we write this book.
Figure 1.1. Integrative psychotherapy in relation to psychology and Christianity
Squarely in the middle of figure 1.1 is an integration perspective, which we hold as the most tenable position. Integrationists attempt to find truth from both sources—Christian faith and psychology. Christian psychology is a relatively new movement that views psychology through the lens of historic Christianity (Johnson, 2007). Though advocates of Christian psychology may question our affinity for psychological theory and science, they are likely to find IP interesting and useful in various ways as well. The remaining category in figure 1.1 is religiously sensitive counseling. Many counselors and psychotherapists today are trained primarily in the mainstream theories and methods of counseling, but have become attuned to the religious issues of their clients and want to consider these issues in the process of counseling. Religiously sensitive counselors may find some of our assumptions about Christianity and the authority of Scripture troubling, but will probably find the principles of IP useful in working with Christian clients.
Beginning with a Christian Worldview
An integrative endeavor such as this—constructing a Christian approach to psychotherapy—must have a beginning point. Some integrationists would argue that we should build this model atop two equally authoritative pillars: special revelation and general revelation. (Special revelation is God’s truth revealed through Scripture and seen in the life of Jesus, and general revelation is God’s truth revealed throughout creation.) After all, we are told, all truth is God’s truth. This adage has caused a good deal of mischief and misunderstanding.
Whereas it is undoubtedly true that God ordained all truth that exists—and that truth can be discovered in creation as well as Scripture—it does not necessarily follow that both sources of truth are equally authoritative throughout all of life. General revelation is more authoritative on issues left unaddressed in the Bible. For example, when it comes to constructing microprocessors or treating bacterial pneumonia, general revelation is the place to look. But many issues in life, including matters of great importance, are addressed in the Bible. Here the wise Christian places more confidence in special revelation than general revelation. Thus, when it comes to matters of understanding human nature—motivation, spiritual yearnings, relational needs, repentance, forgiveness and so on—the truths of the Christian faith form the foundation of our understanding. General revelation may also be useful, but should not be deemed an equivalent form of truth because all of creation, including all the data of general revelation, is fallen and is tainted by the effects of sin. Jones and Butman (1991) write: “The claims of Christian truth should fundamentally transform, at a basic and profound level, the ways we conceptualize and understand our human subject matter, as well as our problems, our goals and the processes of change” (p. 403).
As the contemporary integration movement was being established several decades ago, it was not uncommon to read that psychology and theology should both have an equal footing for true integration to occur. If this is meant to say that both fields should be open to the influence of the other then we agree, but if it is meant to be an assertion of equal authority we cannot agree. For responsible Christian psychotherapy to occur, a Christian worldview must provide the foundational bedrock upon which an integrative system is built. There may be great benefit to understanding family systems and psychodynamics and information processing, but none of these will provide the necessary anthropological foundation for a responsible Christian psychology. For matters of understanding the human condition, Christianity—informed by Scripture and responsible theological appraisal—is trump.
An influential article in the psychology literature was titled “In the final analysis, it’s the data that count” (Nathan, 1997). Such an assertion is simplistic and potentially misleading. In the final analysis, no data can be viewed apart from underlying presuppositions and worldview assumptions. The final analyses are often not much different than the beginning assumptions because both are founded on particular beliefs about how the world works. If we are to construct a Christian psychotherapy, it behooves us to pay close attention to the beginning assumptions because those presuppositions will have a profound impact on whatever final analyses we may produce.
This first chapter provides a brief overview of a Christian anthropology based on three core Christian themes: creation, fall and redemption. Here we establish a foundation on which we will build our model of integrative psychotherapy. It is no perfunctory task to begin this book with a discussion of Christian doctrine. Indeed, it would be difficult for us to imagine any understanding of human nature or psychology apart from the Christian foundations that we outline here. J. I. Packer (1973) puts it well:
Knowing about God is crucially important for the living of our lives. As it would be cruel to an Amazonian tribesman to fly him to London, put him down without explanation in Trafalgar Square and leave him, as one who knew nothing of English or England, to fend for himself, so we are cruel to ourselves if we try to live in this world without knowing about the God whose world it is and who runs it. The world becomes a strange, mad, painful place, and life in it a disappointing and unpleasant business, for those who do not know about God. Disregard the study of God, and you sentence yourself to stumble and blunder through life blindfolded, as it were, with no sense of direction and no understanding of what surrounds you. (p. 19)
Creation
Discussions of creation sometimes lead to squabbles about how old the earth is, whether or not the creation occurred in seven literal days, and to what extent creation has adapted to earth’s changing environment since the beginning of time. But if we back up a few steps to look at the majesty of material creation, the significance of these questions fades. God, the eternal one, made something from nothing (Sproul, 1992). Notice the grass and sky, crocodiles and cocker spaniels, the wind and the sea, cardinals and cockroaches, the soil and everything produced in the soil. Everything we see, touch, smell, hear and taste exists because of what we read in the Bible’s first verse: “God created the heavens and the earth” (Gen 1:1).
Creation has profound implications. It means we are the creatures and God the Creator. We are not offshoots of God’s spiritual essence, as pantheists might assert, but finite material creatures crafted by God, on whom we are utterly dependent: “The human person does not exist autonomously or independently, but as a creature of God” (Hoekema, 1986, p. 5). A theology of creation means there is goodness and order around us. We can learn something about God by studying general revelation because everything around us has a sacred beginning: the periodic table, harmonics, art, vision, trigonometry, photosynthesis, food, light and so on. Creation means we reject the gnosticism that has fueled various heresies throughout many centuries. God, a spiritual being, created materiality and called it good. Our bodies and the physical world around us cannot be inherently bad because they were created by One who is purely good. The doctrine of creation also reveals that God is surely glorious. The stunning magnificence of nature, including human nature, reflects God’s majesty and splendor: “He is to be the object of worship, praise, and obedience” (Erickson, 1985, p. 378).
Made in God’s image. Perhaps the most exceptional thing about creation is the biblical assertion that humans are created in the image of God (or, imago Dei). This means that humans reflect something about God that is not revealed in the rest of creation, and that we represent God and are called to be ambassadors of God’s interests for the world (Hoekema, 1986). This has profound implications for psychotherapists. Any competent therapist is likely to treat a client as a person of dignity. The therapist will listen to the client’s story, validate emotions and genuinely care about the client’s losses. We do this because we believe humans have intrinsic dignity and are worthy of respect and care. But why? What gives our clients dignity and makes it important for us to respect them? What makes each of us valuable? In a Christian worldview, the basis for human dignity comes from being created in God’s image. Every human being is more than a survivor-of-the-fittest, more than a complex system of neurons evolved through natural selection. Each person is a created one, made in the image of a loving God. And Christian therapists are called a step beyond recognizing God’s dignity in other humans; we are to be ambassadors of God’s character in our dealings with others.
The image of God has captured the attention of theologians throughout the centuries. Erickson (1985) divides the various views of God’s image into three categories: functional, structural and relational views. It is striking to see the parallel between these views of the image of God and major systems within the history of psychology. Psychology also has functional, structural and relational perspectives, and although these terms do not mean exactly the same thing to psychologists as they do to theologians, there is substantial overlap. It seems reasonable that psychologists and theologians—both of whom engage in systematic efforts to understand the human person—have created similar categories.
Functional. Functional views consider God’s image as revealed in human behavior, specifically behaviors related to managing creation. We see this in the creation story and again in Psalm 8:
So God created people in his own image;
God patterned them after himself;
male and female he created them.
God blessed them and told them, “Multiply and fill the earth and subdue it. Be masters over the fish and birds and all the animals. (Gen 1:27-28)
For you made us only a little lower than God,
and you crowned us with glory and honor.
You put us in charge of everything you made,
giving us authority over all things—
the sheep and the cattle
and all the wild animals,
the birds in the sky, the fish in the sea,
and everything that swims the ocean currents. (Ps 8:5-8)
IN THE OFFICE 1.1: God’s Image and a Stance of Acceptance
If we want to know about being made in God’s image, the best place to look is the life of Christ. Jesus is the perfect image of God, revealed in human form (Col 1:15).
In Romans 15:7, the apostle Paul instructs believers to “accept each other just as Christ has accepted you; then God will be glorified.” Christ, the flawless image of God, accepts us in the midst of our greatest weaknesses and struggles, and so we are called to accept others in the same spirit of love and compassion.
James:
I feel so ashamed. Online gambling has taken over my life, and I couldn’t even see it until a few weeks ago when I got an $18,000 Visa bill. And the worst part is that I had kept it a secret from Cheryl. She has always trusted me with our finances, and now she doesn’t know what to do. We have hit bottom. We’re arguing and crying and struggling every day. I have never felt so empty and broken and lost.
Mark:
It sounds like a crisis for both of you; a time of facing painful emotions and some difficult realities.
James:
I just can’t believe I got involved in this. It started out just being fun—just sort of online recreation. But somehow I kept getting in deeper and deeper, then it wasn’t fun any more but I had to keep going to make up for all I had lost. I keep asking myself how this could have happened.
Mark:
It’s like the person you have been is not the person you truly are.
James:
Definitely. I desperately want to change. I need to change. And I want to earn back Cheryl’s trust and love. I can’t imagine how awful this must be for her.
Mark:
Yes, I’m sure this is a huge shock for Cheryl. It must hurt so much to see the pain in her eyes.
James:
Oh, that’s the worst part of all, to see how deeply I have wounded her.
This is not a time to confront James about his selfishness and impulsiveness; he is already broken by the weight of his transgressions. James needs care and acceptance, someone who will try to understand the depth of his pain. Notice that I can accept and care for James without condoning or excusing his behavior.
Functional views emphasize that we are to behave as stewards or managers, functioning as God’s representatives in watching over a good creation. Some emphasize dominion—that humans are to exert mastery over creation—and we certainly see human capacity for dominion in magnificent architectural feats that defy gravity and withstand nature’s elements, in cultivating the soil to produce the foods we desire, and in subduing wild animals that might otherwise lower us several notches in the food chain. Others emphasize stewardship—that we are to manage the earth well on God’s behalf—which we see in efforts to preserve and conserve the environment, in rotating crops so as to keep the soil vibrant and productive, in loving and caring for animals, and so on. Whether we think of dominion or stewardship, being managers of creation requires self-control. If a dog is left alone with a freshly baked pie, it is unlikely the pie will survive. But given sufficient rationale, a human will be able to leave the pie alone because humans have a capacity to control and discipline their own behaviors. Managing creation involves controlling personal urges and creating social structures that help others control their urges too. And so we till the soil, sow the crop, reap the harvest, feast on the earth’s bounty, create social mores and governments to keep one person from feasting at another person’s expense, and care for the land so that it will continue to produce. In all these ways we function in God’s image.
Psychology also has a functional emphasis, including (but not limited to) the functionalist school of thought that was popularized at the turn of the twentieth century with the work of William James and his contemporaries. (The philosophical foundations of functionalism go back much further, at least to Aristotle.) Functionalists in psychology were interested in looking at mental activities in relation to how they help humans function and adapt. This stood in contrast to the structuralism practiced in early psychology laboratories where psychologists attempted to break down complex experiences into smaller elements that could be studied systematically. One might imagine a structuralist such as Wilhelm Wundt stubbing his toe and then sitting down to contemplate exactly what the pain was like. What sensations were occurring in his toe, his stomach, his head? In contrast, W illiam James would have looked at the function of pain after stubbing his toe. What sort of perceptions, motivations, emotions and behaviors were associated with the pain? Did the pain make him want to scream and hit something, or to curl up in a corner and cry? To a functionalist, an internal state is always viewed in relation to human functioning. Functionalism is pragmatic, always considering the experiential “cash value” of one’s ideas or beliefs. Psychology’s functionalist school and behaviorist school gradually merged over the twentieth century, and today both are being incorporated into the rapidly growing area of evolutionary psychology.
At first glance these theological and psychological views of functionalism may appear to be quite different, but they share important similarities. Both are more interested in how humans function than in exploring the substance or structure of being human; both consider how humans relate and adapt to their environment; and both look closely at human behavior.
Clinical psychologists and other mental health therapists often help people gain dominion over their lives and their environment. A young businesswoman finds that she gets intensely anxious and stammers over her words when presenting reports in staff meetings. A therapist helps her overcome her anxiety disorder through a combination of breathing and relaxation training, interoceptive exposure, and in vivo exposure (see chap. 7). Even for psychologists who do not think of this as a theological task, it bears similarity to functional views of the imago Dei.
COUNSELING TIP 1.1: Remember the Practical Concerns
Functional views of human behavior are important to remember when dealing with a person in pain. For adults coming to therapy to get help with a stifling depression or a debilitating anxiety problem, they may not want to start by talking about their childhood memories or peer relationships in elementary school. They want help functioning now! It is usually best to address these functional concerns early in therapy. This helps build rapport, eases the immediate crisis and gives the client a sense of competency. If the client chooses, there will be time later to explore underlying personality and developmental factors.
Structural. Structural perspectives on the image of God have a long and important theological history, and many contemporary evangelical theologians continue to hold to a structural view of the imago Dei (e.g., Erickson, 1985). The idea is that human nature reflects something of the nature of God. There is something majestic and noble built into our character. We see it every time we cry out for justice, when we think reasonably, when we feel deeply, when we extend mercy, when we long for relationship.
The swift and versatile movements of the soul in glancing from heaven to earth, connecting the future with the past, retaining the remembrance of former years, nay, forming creations of its own—its skill, moreover, in making astonishing discoveries, and inventing so many wonderful arts, are sure indications of the agency of God in man…. What shall we say but that man [sic] bears about with him a stamp of immortality which can never be effaced? (Calvin, 1559/1997, p. 54)
Structural views of the imago Dei typically emphasize the moral or rational capacity of humans. One’s ability to study, analyze, ponder, choose, speak, value and discern reflect many qualities of our omniscient God. Look at creation and marvel at the regulated harmony. Notice the order of physics, the predictability of astronomy, the precision of chemistry, the interconnections of biology. The rational and moral genius of God is evident all around. And we humans are made in the image of this mastermind creator. Think of our capacity to learn, how we move from helpless infants to language-bearing toddlers to literate grade-schoolers all in a period of a few years. We are wondrously made!
The rational capacities of humans as a reflection of God’s image have been both overstated and hotly debated throughout history. In the second century Irenaeus distinguished between the image and likeness of God (see Gen 1:26-27), describing the image as humans’ natural capacity to reason and choose and the likeness as a supernatural maturity into which Adam and Eve could have grown. When Adam and Eve sinned, they lost the likeness and retained the image. Thus, the only way to see the likeness of God is to look at Christ, who possessed both the image (being fully human) and the likeness (being fully divine). This notion of Irenaeus’s, which is quite appealing in its Christology, was exaggerated by medieval scholastic theologians to suggest that human reasoning (the image of God) remains relatively untainted by sin, whereas our innate capacity for goodness was damaged by original sin. The problem with this view is its optimism regarding human reason. It suggests that we may struggle in various ways because we have lost the likeness—the moral capacity that Christ had—but at least we have a reasoning capacity similar to Adam, Eve and Christ. Do we really?
Things changed with the Reformation. Luther, Calvin and other Reformers helped dismantle the distinction between God’s image and likeness, arguing that these are simply parallel words describing the same notion. Various facets of God’s image—rational, moral, volitional, social and so on—were built into Adam’s and Eve’s character, and every aspect was damaged by sin. Now only a remnant remains. Thus the Reformers provided a more sobering look at human rationality. It is not so close to divine reason as their predecessors thought.
Psychologists have also developed structural views of human nature, ranging from the late-nineteenth-century school of thought known as structuralism to today’s fascination with cognitive science, information processing and cognitive therapy. Just as some theologians have attempted to dissect the human psyche in order to isolate the substance of God’s image, so some psychologists have attempted to investigate particular structures of human experience. And just as theologians settled on rationality as an important area of study, so also psychologists have honed in on the topic of human rationality.
Contemporary cognitive therapy, which is based largely on information processing models coming out of cognitive science (Safran & Segal, 1990), assumes that people become healthier as they learn to think more rationally. In the grip of depression or anxiety or relational conflicts, thinking becomes compromised.
COUNSELING TIP 1.2: Rationality in the Therapy Office
Helping people think more rationally is an important goal of therapy. Psychological troubles get worse as people are swept away by extreme and irrational thinking. A depressed client may see herself as worthless and unlovable. An addicted client may say that he can stop any time he wants. A husband and wife in crisis may each believe it is the other person’s fault. Therapists help clients see things more rationally.
But just as medieval theologians may have overestimated human rationality, so also some therapists seem to elevate rationality too high and fail to give enough attention to relational, emotional and cultural issues. And sometimes therapists forget that they themselves are prone to faulty thinking. What seems rational to one therapist may seem quite irrational to another. One famous cognitive therapist once promoted adultery, arguing that it helps bring sexual energy into the marriage relationship. His advice seemed rational to him at the time, but to most other therapists—and virtually all Christian therapists—it seems irrational.
The depressed person looks at the world through a dark rain cloud. The anxious person evaluates the future based on feelings of dread or apprehension. The couple in distress sees the negative in one another but has misplaced the positive. Effective cognitive therapy—whether it is considered Christian or not—frequently involves helping people salvage their rational abilities and think more clearly about the circumstances they face.
Mirroring the historical arguments about the image of God, we see that contemporary cognitive therapy began with a very optimistic view of human rationality. Indeed, when reading the earliest books on cognitive therapy one gets the sense that learning to think correctly is the solution to all mental health problems. But time has eroded this sort of optimism, at least for many cognitive therapists. Rationality is still considered important, but it is not the only factor to consider for providing effective therapy.
Relational. Many contemporary theologians have shifted away from structural views of the imago Dei toward relational views. Emil Brunner, Karl Barth, Stanley Grenz and others have emphasized the relational nature of humans as reflective of God’s relational character. The imago Dei is verb rather than noun; it is not so much that each individual human contains the image of God—as is postulated in structural views—but that we collectively image God as we engage in loving relationships with God and one another. “As is evident throughout Scripture, the divine image is not primarily individual, but is shared or relational” (Grenz, 2000, p. 213).
The relational view of the imago Dei is argued by emphasizing communication within the Trinity as evidence of God’s relational character (Balswick, King & Reimer, 2005; Barth, 1945/1958; Grenz, 2000). “Then God said, ‘Let us make people in our image, to be like ourselves’” (Gen 1:26). Barth (1945/1958) refers to this as a “divine conversation” (p. 183) that illustrates a prototype within the Godhead that will be reflected in the creation of humans. As God is three persons in one, so humans are created male and female and are whole by being together in relationship. “God patterned them after himself; male and female he created them” (Gen 1:27). The very nature of God is seen in what Barth considered an I-Thou relationship; neither the male nor the female contain the image in themselves, but rather in their relating to one another. In the same way, humans are created to be in a covenant relationship with God. Further and foremost, the relational view of the imago Dei is argued by looking at Christ. If we want to understand the image of God in humanity, the best way is to look at Jesus, who is the only human image of God that has not been tainted by sin. “Christ is the visible image of the invisible God” (Col 1: 15). In Jesus we see one who loves his neighbor and God perfectly, even to the point of sacrificing his own life on a cross (see Rom 5:6-8). Jesus revealed God’s relational image in human form.
Relational (interpersonal) views have also been prominent in psychology, especially in the psychodynamic tradition (Sullivan, 1953). Recent adaptations of psychodynamic theory, including object-relations theory, are almost purely relational in their understanding of human pathology and treatment (Kernberg, 1976; Benjamin, 1996). Relational views of human nature are also evident in theories of human development, such as attachment theory (Bowlby, 1990). Some psychologists have introduced interpersonal dimensions into cognitive therapy (e.g., Safran, 1998; Safran & Segal, 1990). We applaud this trend toward relational forms of cognitive therapy; IP is a Christian adaptation and further development of ideas that have been emerging over the past two decades.
Whereas psychotherapists of various persuasions emphasize the importance of therapeutic relationships (e.g., Norcross, 2002), Christian psychotherapists take this a step further, recognizing our God-given call to relationships. We are made to relate, and so we look to Christ as our exemplar—the One who loves perfectly. Christian psychotherapy is motivated by and centered in an amazing and magnificent truth claim: God loves us more than we can imagine and created us to be relational. We experience some semblance of God’s image in relating to one another—love that forgives and endures and persists through the clamor of life (Tjeltveit, 2006). A yearning to connect is knitted into our souls.
COUNSELING TIP 1.3: The Rate-Limiting Step
Chemists speak of the “rate-limiting step”—the slowest chemical reaction in a series of cascading reactions. The entire chemical process can never go any faster than the rate-limiting step.
Establishing a good therapeutic relationship is like a rate-limiting step. No matter how technically expert a therapist may be, he or she also needs to relate well with others. Once trust and rapport are established in a warm and accepting therapeutic relationship, then the client is more likely to progress in therapy. Some would argue that the relationship itself is the healing ingredient in therapy.
Functional, structural and relational. The image of God is complex, defying simple explanation or categorization. Rather than choosing one of the three views just described, perhaps value can be found in all three. Jones and Butman (1991) suggest the same: “it seems judicious at this time to not fight for an exclusive meaning of the image, but rather to conclude that being created in the image of God means all this and more” (p. 44). The thoughtful Christian theologian is likely to have a primary allegiance to one view of the imago Dei, just as the thoughtful therapist will have a primary allegiance to one particular theoretical orientation in psychology, but still it is reasonable to find value in all three perspectives.
Hoekema’s (1986) helpful treatise on the imago Dei lends credence to each of the major views. Hoekema demonstrates that function and structur e are closely related:
Must we think of the image of God in man [sic] as involving only what man is and not what he does, or only what he does and not what he is, or both what he is and what he does?… It is my conviction that we need to maintain both aspects. Since the image of God includes the whole person, it must include both man’s structure and man’s functioning. One cannot function without a certain structure. An eagle, for example, propels itself through the air by flying—this is one of its functions. The eagle would be unable to fly, however, unless it had wings—one of its structures. (p. 69)
Similarly, one need not reject the functional or structural aspects of human character in favor of relational aspects. Hoekema points out that Christ was directed toward God and neighbor while also demonstrating his mastery over creation. The one who rose early in the morning to pray (relationship with God) was also the one who befriended the needy and downtrodden (relationship with neighbor) and healed the sick and walked on water and fed the masses and calmed the storm (mastery over creation). Here Hoekema connects relational and functional aspects of the imago Dei.
IP draws on all three perspectives, shown as concentric circles in figure 1.2. The outer circle, and the first domain of intervention in IP, pertains to how a person functions in relation to a complex environment. In a sense, every person is faced with the managerial challenge posed to Adam and Eve—we are all called to function properly in relation to the creation around us. A person who experiences extreme terror when speaking in public is not functioning well in relation to the demands of the environment and may come to a psychotherapist for help. The therapist will focus on thoughts and behaviors, and rightly so because this is a functional problem.
But human thoughts and behaviors always exist in the context of structural capacities—the second circle in figure 1.2 and the second domain of intervention in IP. Functioning well requires rational and moral abilities that reflect the ontological nature of God’s image. For example, the client who feels terror about speaking in public still has the rational and moral sensibility not to run out of the room. This demonstrates something unique about humans not seen in the rest of the animal kingdom. Humans have the cognitive capacity to see a bigger story, to transcend impulses of seeking pleasure and avoiding pain, to find meaning in life circumstances even when it involves tolerating discomfort. Some people come for therapy when their efforts to find meaning in life are falling short.
Figure 1.2. Integrative psychotherapy and three views of the imago Dei
The inner circle in figure 1.2, and the third domain of intervention in IP, is relational. The moral and rational structures of life—how we find meaning—are always embedded in the context of relationships with God and others. Brunner, Barth, Grenz and others argue this theologically, but social science brings us to the same conclusion (Andersen & Chen, 2002). Even the human capacity to think rationally—which is viewed as paramount in structural views of the imago Dei—is shaped by relationships. Culture, social mores, family background and close friendships all influence what we deem to be rational and irrational. One person considers it rational to eat dog for dinner while another person takes a dog to be groomed and bathed each week, or even to a pet therapist if the dog seems particularly subdued. These widely disparate views of rationality are shaped by a complex network of present and past relationships that we call culture.
The human capacities for functional behavior, cognitive appraisal and relationality are evident throughout IP—not just because this makes for effective therapy, but because these qualities reflect important realities about how we are
