Integrative Psychotherapy V

Now here in chapter 4 of Integrative Psychotherapy, McMinn and Campbell are starting to map out their 3 domained model of persons and psychotherapy. As an aside, the next chapter will cover how to do assessment and case conceptualization within this model and the remaining 6 chapters (excluding the conclusion) will be spent exploring each domain and how to apply the concepts into practice (2 chapters per domain). Should be a fun ride.

If you will recall from their chapter 1, they imagine the imago dei as a good rubric of the nature of persons and as best described by its functional, structural, and relational aspects (i.e., behavior, cognitive/moral, and relational aspects). They note that most therapy models tend to address one of these 3 domains problems: cognitions and challenging distorted thinking/acting, schema or insight-oriented work, and relational/experiential work. Instead of separating these domains, McMinn and Campbell define them as necessary and interconnected. “A person engages in functional behavior because of certain structural capacities, and similarly, relationships influence a person’s [behaviors and schemas].” (p. 115)

I think the best way to understand the interconnected parts of their model is to see it. Page 136 offers a nice illustration (Thanks Mark for making this available.). Note how behaviors, thoughts and feelings are influenced by situations but also arise out of core beliefs/schema and relational experiences. Note also the dark arrows depict the common path of influence but that feed-back loops are in play as well. Though I wish they gave more detail here how the domains interrelate (that would be a very fat personality text!), they do a fine job illustrating what they mean by discussing the case of “James,” a man who suffers with anxiety and things his value comes from meeting others’ expectations.

Domain 1 (Functional/behavioral) lends itself to symptom reduction and skill-building activities (the heart of cognitive-behavioral therapy). A counselor might address how James might learn so anxiety reduction techniques. But stopping here leaves James and the counselor wanting more. Why does James view himself and the world this way? Where do these distorted views come from? McMinn and Campbell recognize that these views are very hard to disrupt because they are so well-engrained through experiences. Domain 2 (Structural) then looks deeper to settled core beliefs using insight-oriented techniques to expose unconscious schemas that might uncover how these schemas got started (we learn, among other things, that James’ father was harsh and that he made some understandable but problematic choices/interpretations that now lock him in a pattern of perceiving himself as a failure–even though this view violates his own Christian belief).

Domain 3 (Relational). IP recognizes that formative relationships shape our schemas AND that the formative relationship between client and counselor provides experiences to shape and reshape our experience of self, other, and God, mirroring the incarnation of Christ.

Throughout this chapter the authors show how the IP 3 domain model is similar and different from standard CT. Yes CT is interested in reducing distorted thinking and building life skills. But IP also values insight and experiential aspects to therapy and provide additional opportunities to expose settled core beliefs (See p. 132 for a great chart illustrating how IP stands as a bridge between CT and insight-oriented models). IP attempts to show how the interconnections of situations, past experiences, developed core beliefs, habits, etc. illustrate both determinism (stuff outside us shapes us significantly) AND human agency (our choices also shape us). They also explain that classic CT has not done a good job explaining how relationships, motivation, emotions and culture play in person development. Further IP is not merely CT with some additions because it is built on a Christian view of persons (creation, fall, redemption, imago dei, etc.)

MY THOUGHTS AND ONE QUESTION: Now, we are getting into the meat of their model. It is good to hear their theoretical foundations in previous chapters but now McMinn and Campbell show us how they see how humans develop. While acknowledging the Fall, here’s what I see about their view:

1. Humans are intrinsically motivated to move toward God and long for a proper relationship to God, others, and creation.
2. The fall brings misery, brokenness, and difficulty (our fundamental problem is broken relationships)
3. Fallen humans are ripe for cognitive distortion.
4. When good longings (see pt. 2) are not met, we make bad but understandable choices (even adaptive at the time) and interpretations which lead to formative experiences that we interpret in distorted ways which in turn lead to more cognitive, moral/schema, and relational problems.

Classic Reformed theology suggests we NOT ONLY inherit a broken world, we also inherit Adam and Eve’s desire to be on par with God. We have an intrinsic motivation to be God and our denial of God comes out of this motivation (Rom 1). So here’s my question (in 2 parts):

1. Do we begin with good longings that we attempt to meet in naive and foolish ways (a la James in chapter 4), OR do we begin at birth to read things in distorted ways because we are looking to be our own God? Or both
2. Does this distinction matter? How would it impact our therapy model or application?

Calvin seems to support both ideas. He says our heart are idol factories AND he says our problem is not so much what we want/desire, but how much we want it. Notice that if you emphasize the “bad response to a bad situation” then it might end up dismissing personal culpability. However, if you emphasize the “bad heart seeks self promotion” then it might end up missing the all important influence passed on from a broken world and thereby blaming people for being sinned against.