Category Archives: christian psychology

March 5, 2008 · 5:35 am

Integrative Psychotherapy VIII: Symptom reduction of anxiety


If you recall from prior chapters, McMinn and Campbell propose a 3 tiered model (IP) to address symptom, schema, and relationship issues. In chapter 7, they explore symptom focused interventions for anxiety (while not denying or addressing relational or schema matters of anxiety disorders). The authors provide a description of 5 types of anxiety problems (panic, phobias, OCD, PTSD, and GAD) and typical Cognitive Therapy interventions for each. For example, they describe panic as a “fear of fear” and explore interventions designed to interrupt the cycle of “internal physiological events” and “fearful appraisal of physiological sensations.” Such interventions include cognitive challenges or reframes, breathing and relaxation, and exposure (in vivo or imaginal) coupled with relaxation training. 

After providing this review of anxiety and common interventions, they move to a very brief discussion of fear from a spiritual perspective. The opposite of fear is love (not courage). They conclude that fear is, “a great spiritual problem” (p. 236). But, they quickly say, “we should not attribute anxiety problems to spiritual weakness.” They argue that doing that sets up an inappropriate simplistic model (you are anxious because you are immature) and ignores the complexities of fear. They fear it may also send the message that only people with anxiety cause their problems, when in fact we all live “outside of Eden.” So, our bodies, our communities, our wills are all tainted with sin. But, they say, “it is damaging and unrealistic to assume direct and immediate connections between a particular problem and spiritual maturity.” What should we do? “Our best response is to recognize our own brokenness so that we can, in humility, become people of compassion and understanding, willing to walk alongside others through the difficult passages of life.” (p. 236)

My thoughts? This is a classic CT review of anxiety. I’m not sure I saw much of their theological model of persons in this chapter. However, I have to remember this is a chapter designed only to address the symptom reduction aspects of therapy. The authors did not intend to look at relationships and schemas. In the real world, we can’t separate out schema and symptoms and deal with only one and not the other. I understand why they do highlight interventions in each domain in the book, but it comes at a cost (realism). I do wish they would have included a chapter on putting it all together by following a particular case. I also wish they would keep following anxiety problems through the other 2 domains of the model, but they didn’t.

My bigger concern is the thin discussion on spiritual aspects of fear symptoms. Now, maybe they will pick up more when we get to schemas since schemas look at worldview and beliefs. But, while I agree completely with the last quote above, I think they make an all-or-nothing proposal. They are right that judgmentalism and simplistic understandings of fear are inappropriate. However, avoidance tactics found with panic symptoms do reveal implicit demands for control beyond what God intends. Symptoms both happen and are chosen. These demands that we make may be unconscious and may be completely understandable. And yet, I believe we can explore symptom maintenance and reduction AND talk about spiritual matters without equating spiritual maturity with the elimination of all problems.   For example, OCD symptoms such as worry that one has caused harm to another (e.g., hit someone while driving to work) can be best treated by cognitive challenges, imaginal exposure and response prevention. But as one attempts these interventions it is likely that conversations arise about the desire to avoid causing anyone harm. Now that is a deeply spiritual conversation–and I suspect the authors agree. Hopefully we’ll see some discussion of this in the next two chapters as they look at schema issues.  

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February 28, 2008 · 5:23 am

Integrative Psychotherapy VII: Functional Domain Interventions


McMinn and Campbell start out chapter six (a deeper review of the 1st domain of interventions, that of addressing symptoms) with this helpful insight: “Many of our graduate students select psychology as a profession after deciding against one of two alternative career paths.” Some are tempted to pastoral ministry and so see psychology as a way to care for human souls. Others are tempted to medical practice and so see psychology as a way to, “help people find relief from their troubles” (p. 177). This distinction is helpful in explaining why some of us hang out in one type of intervention over another.

But whatever one’s interests, everyone must address presenting problems and not bypass symptoms as these are what bring people in to therapy in the first place. So, the authors use this chapter to outline, in general, symptom-focused interventions, The next chapter will apply these interventions specifically to anxiety.

Right off the bat, the authors bring up emotions. They want to dispel the myth that cognitive therapist care little for feelings. They want to define negative emotions as either a sign of cognitive distortions and/or a warning sign that something is off in one’s life. [Hopefully, they do not fully believe that negative emotions means that something is wrong in one’s life. It may be something is wrong in the world…]. To achieve successful interventions in this domain, one must have good relational skills to listen well to both explicit and implicit feelings.

It comes as no surprise that domain 1 interventions include behavioral skills. The authors summarize classical and operant conditioning in a few short paragraphs and suggest that these techniques may help clients have dominion (through reinforcement strategies?) over their own behaviors and responses to life. Their lack of attention to behavioral mod. sends a message.

The bulk of the chapter then focuses on the basic of cognitive restructuring. They divide this task into two parts: sorting an experience into its component parts AND challenging distorted thinking. The authors describe the technique of the thought record and walk through several vignettes to show how it might be used. The record separates situations, thoughts, and feelings (and rates intensity of feelings/experiences on 1 to 10 scale). As the client gains insight, then the work is to counter the automatic thoughts with a rational response. The authors want to remind the counselor to avoid a disputing mindset when countering a client’s distorted thought patterns. Instead, they suggest a more collaborative approach or “Socratic method” using questions and reflections to lead the client to insight rather than drag them to it. 

Beyond the thought record, they describe other methods of changing one’s thinking: scaling (moving away from all/nothing thinking to put stressors in proper perspective), probability estimates (used when someone is worried about an unlikely event), decatastrophizing (helping to move away from “extremist thinking”), humorous counters (identifying silly thinking without making fun of), role-playing (reversing roles and having the client become the counselor), paradox (overstating the client’s fears to see the logical outcome), and cognitive rehearsal (repeated challenge to automatic thoughts).

Finally, they attempt to provide a Christian appraisal of these interventions. First, they tackle the problem of relativism that may underly CT by the biblical concept of testing and trying every “truth.” Instead of rejecting all client automatic thoughts by some sort of Stuart Smalley self-talk mantra, test their thoughts with Scripture, tradition, experience, and reason—aka Wesleyan quadrilateral. Then they give some examples of how a Christian collaborative response to a client with a difficult marriage might look different from a relativistic (be happy) response. The client and the counselor work together to explore what Scripture, tradition, experience and reason might bring to the table (these are not considered equally weighted of course) in discerning the truth about our selves and our thoughts about ourselves.

My thoughts? This chapter is solidly within the CT frame with the recognition that truth has a capital T. Our job as counselors isn’t to tell the clients the truth but to walk with them in a collaborative manner. It is good to see lots of humility in the chapter. We can abuse Scripture, overplay tradition or reason, become disputational, etc. What is missing from this chapter (maybe in comes later) is that while it is helpful to recognize logical errors, it is also true that logic does not always (often?) lead to better thinking. We have some pretty embedded views of ourselves that continue even in the face of our logic. How will they deal with this issue?

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February 20, 2008 · 12:32 pm

Integrative Psychotherapy VI: Assessment and Conceptualization


In chapter 6 of Integrative Psychotherapy: Toward a Comprehensive Christian Approach, McMinn and Campbell take up the matter of case conceptualization. Thus far they have been discussing the foundations and features of their therapy model. Just before going into deeper looks and clinical applications of their 3 domains, they stop to look at the concept of assessment and case planning. Why does case planning matter?

“Assessment is the task of systematically observing what signs and symptoms a client experiences. These signs and symptoms are then understood through a particular theoretical grid, resulting in a case conceptualization (a framework for understanding the symptoms). Case conceptualization is an effort to understand the cause of the symptoms, the role the symptoms play in the person’s experience and treatment strategies to help the person improve.” (p. 145)  The authors acknowledge that this task of assessment and conceptualization are neither linear nor without bias. As they say, the very questions one asks determines to some degree the data one gets and how one interprets that data.

They pose 3 questions for the Christian counselor. Is evaluation acceptable for Christians? Isn’t Christian assessment mostly a matter of identifying sin? How is Christian evaluation unique? I’ll dispense with the first two assuming we agree the answers are in order: yes. no, not only. How is Christian evaluation unique? It doesn’t settle for simplistic biological, behavioral, or volitional explanations of symptom manifestations. That probably isn’t unique. What is unique then? The starting point about human nature.

The rest of the chapter describes key assessment and conceptualization practices. Collect data from multiple sources. Make a diagnosis (they describe the benefits and drawbacks of making a DSM diagnosis and how it is the start of assessment, not the end). Consider etiology (predisposing, precipitating, and perpetuating factors). Consider client factors (client perceptions, expectations, ability to work with a therapist, additional strengths and resources). The authors also want IP counselors to assess the specific areas of maladaptive thoughts, schemas, and interpersonal relationships. They provide sample lines of questions to explore each area. Finally, they suggest that the counselor consider whether the data they collect in each of the above assessment areas is likely to facilitate or inhibit therapy. This action may guide clinicians as to where to start (if at all) and what kinds of goals might remove a specific therapy interfering behavior

My thoughts? I like this chapter. It provides a concise reminder to the beginning counselor regarding the basic data they should collect. It does remind us that our interpretive grids impact the data we get and the interpretations we make. We are not so objective. In light of that, I do wonder whether the DSM diagnosis is a good place to start. By starting there does not the clinician tempt herself to think only in light of classic psychiatric models. I would rather see the diagnosis happen at the end. In this way, the clinician can report to the client whether it is helpful to consider the diagnosis. For example, a child may look ADHD, but by collecting the other data, it may be clear that the child has a primary trauma or anxiety type problem.

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February 13, 2008 · 12:35 pm

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.

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February 6, 2008 · 1:15 pm

Integrative Psychotherapy IV


In chapter 3 of Integrative Psychotherapy, McMinn and Campbell provide a nice overview of a significant portion of their theoretical foundation–Cognitive therapy. They begin by discussing the so-called cognitive revolution in the 1960s (over against mechanistic behaviorism and the prior king, psychoanalysis). They remind us how this revolution continues to shape the landscape of mental health (empirically-validated treatments, short-term therapy, self-help books, etc.).

Going into more detail, McMinn and Campbell divide Cognitive therapies into 2 broad categories: Semantic Cognitive Therapy (SCT) and Constructivist Cognitive Therapy (CCT). What is the main difference between the two? SCT’s premise is that people attribute feelings to the events/circumstances in their life, but only simplistically–overlooking their interpretive thoughts about the situation. The authors provide this common diagram: Events -> Thoughts -> Feelings. SCT is designed to help folks critique their thought patterns and evaluate their rationality. Once this happens, it is supposed that individuals will then have more control over their feelings. They mention Albert Ellis’ REBT model: Activiating event -> Belief -> Consequential emotion. This leads to his treatment: Disputing irrational beliefs -> revised cognitive Effect. They also mention Aaron Beck’s additions to SCT in his description of Core Beliefs that color one’s view of the world and self and are highly resistant to change. While there are some benefits to SCT (revealing our tendencies to assume the worst, making mountains out of molehills) McMinn and Campbell find this model to oversimplify “the complexities of human change.” (p. 85).

CCT began to develop in the later 80s and 90s, per the authors, to address the problem of linearity in SCT. Instead of merely assuming that we react to events, CCT recognizes that how we shape events and feelings can also shape interpretations. “Our beliefs do not simply reflect a passive understanding or misunderstanding of reality; they actually change reality…” (p. 86). From this point, the authors go into a sidebar apology on constructivist philosophy, but not radical constructionism. “One can still believe in external authority and truth while acknowledging that human processes influence the actual events of everyday life.” Also, “Christians can and should accept the premise that personal values and perceptions of reality end up changing reality itself.” (p. 87) Unfortunately, CCT sputters and fades because of a new focus on Empirically Validated Therapies which are based on SCT models.

The remaining 20 pages of the chapter provide the authors’ critique of the the CT foundations and model. On the plus side, they see how CT has a lot of commonsense to it, has clear goals/objectives in focus, is time-limited, and supported by scientific research. As a model it does not have a deterministic mindset. Rather, CT believes in at least partial human agency–you can change how you think, see, feel, etc. You are not merely robotically determined by your past. On the negative side, they acknowledge that CT is rather disconnected from well thought out foundations. They call it a practical response to the frustration of analytic models. CT is, in their words, free-floating interventions without the foundation of a good theory. Further, they point out several false premises within CT and support with examples to the contrary: healthy people think rationally, cognitive errors are usually negative, healthy, rational people eliminate negative emotion, thoughts come before feelings, and we are motivated to be more rational. Finally, they charge CT with being “pragmatic rationalism” (I’d call it pragmatic modernistic rationalism) and point out the problem that it doesn’t deal well (at least as originally designed) with the importance of feelings, relationships, culture, fallen human condition, values, etc. in the process of change. They also point out that some of the Christian versions of CT fall into some of these false premises as well. “The Christian narrative is not primarily about correcting sloppy or ineffectual thinking. We are not taught in Scripture that the path to wholeness is found in better thinking. The bible is a narrative about humans being created for relationship with God and one another, struggling because those relationships are now tainted by the devastating effects of sin, and living with the hope of creation restored.” (p. 109).

My thoughts: I’m glad to see they critiqued the problems in CT. In fact, they did it so well, I’m surprised they didn’t do much more to defend why they keep it rather than looking for an entirely new model. Maybe that will get explained in the next chapters. They avoid the simplistic view that CT is similar to the put off/put on message of the bible. I’m glad they presented the material in the SCT vs. CCT description. I did wonder why CCT didn’t take off given its affinity with postmodern philosophies of science. I would quibble with their bible passages used to defend a chastened constructivism. I have no problems defending a form of social constructionism. But, the passages picked from 1 Peter have more to do about the fact that we influence others than about whether our assumptions about the world construct a portion of reality. I would have liked to see them build a more christian or theological model for CCT and relating it to emotions and narratival therapies. I understand the chapter was already getting long but I would have also like to see them connect the dots in other therapies that have cognitive features (e.g., emotion-focused therapy, Mindfulness, etc.).  

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January 30, 2008 · 11:09 am

Integrative Psychotherapy III


In chapter two of Integrative Psychotherapy, McMinn and Campbell attempt to set our their foundation for psychotherapy. You’ll remember that in the last chapter they articulated their theological foundation. This chapter nicely divides into two parts: (a) A defense of the science of psychotherapy, and (b) a summary of what is “known” about the what works, when, and why.

They begin the chapter by admitting that there are many competing and dispirit theories/models of psychotherapy–many which have never been tested through empirical means despite lofty claims. They also acknowledge that many Conservative Christians have cherry picked certain studies that show that psychotherapy is ineffective and ignored many others that say the opposite. In other words, anyone can find a stat to prove whatever they want.

McMinn and Campbell remind their readers that they intend to build a Christian Psychotherapy model built on a robust Christian worldview and fleshed out with scientific methods to tell us, “what works, whey, and why” (p. 56). They lament that since both scientists and theologians aren’t known for their humility, a robust Christian psychotherapy model has not really been built. Collective wisdom is needed to accomplish the goal.

Then the authors turn to some of the details about the science of psychotherapy? Is it really effective? They summarize some of the effectiveness and efficacy studies (these are different: effectiveness: client survey; efficacy: lab studies of very specific interventions on one particular problem). Back in the 1950s Hans Eysenck published a number of studies reporting, “there was no research evidence to support the effectiveness of psychotherapy compared to no-treatment control groups” (p. 57). By 1980, however, there was ample evidence to the contrary. In fact, McMinn and Campbell report, “that the average effect size for psychotherapy is .82 indicating that the average treated is less symptomatic than 80% of untreated persons” (p. 58). They then compare that number with the effect size of certain medications on psychiatric problems (stimulants for ADHD: .91, SSRIs for Depression: .50, Atypical Antipsychotics for Schizophrenia: .25).    

Does any one model work better than another? The authors report the oft-heard conclusion: no one model seems more effective than another. And yet, at the end of this chapter they state their preference for Cognitive theory models (due to the research published about cognitive techniques) joined to aspects of client-centered models and other aspects of psychotherapy research. In olden days, we called this eclectic. They do not call it that, most likely due to the negative connotations associated with the word (it has often been used to cover up the lack of theoretical awareness of the clinician using the term).

Before they end the chapter, they consider whether length of treatment matters. They do not really do much with this question other than to point out that most therapeutic courses are much shorter these days. They also consider the question whether therapy benefits last. Again, they don’t cite the literature but state the that certain factors will make it more or less likely for the benefits to last.

They speak briefly about two more important matters in the consideration of the effectiveness of psychotherapy: (a) recognizing that common threads of the change process (insight, affective experience, stages of change, behavioral change, etc.) and point to the works of Prochaska and DiClemente, and (b) common factors in all models of therapy that seem to account for success. They cite date regarding these factors (and the percentages the factor accounts for for therapy outcome) as

  1. Client and extratherapeutic factors (40%). Such as intelligence, motivation for change, persistence, social support, resiliency, etc.
  2. Relationship between client and therapist (30%). This is why program emphasize relational skills over techniques or models
  3. Hope/expectancy (15%). How much hope does the client have in the possibility of change?
  4. Model/Technique (15%). Notice that the learning of special therapeutic techniques only account for a small portion of the outcomes in psychotherapy.

My thoughts on this chapter. Nothing out of the ordinary here. The chapter follows conventional wisdom about the science of therapy. The reader who wants to go deeper can look look at their bibliography and dig pretty deep. The reality is that though we think we know a number of things, the research on psychotherapy is complex and sometimes controversial. This is not to say that we know nothing. But we do have a long way to go. I might have liked to see some more discussion on what we as yet do not know but really want to. Further, I would have also liked a short discussion of philosophy of science. Why? Just as we need to be tentative about some of our theological underpinnings, so we ought to be a bit tentative about the modernist underpinnings of psychological research. I don’t think they are overstating their case yet, but the reader may view these two disciplines (theology and psychology) as one having only theory and the other only fact.

I do hope that they will take a look at the presuppositions of cognitive theory in the next chapter. How does that model influence what they see? 

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January 23, 2008 · 5:06 am

Integrative Psychotherapy II


Chapter one of McMinn’s and Campbell’s Integrative Psychotherapy begins with Christian foundations. Interestingly, chapter 2 (next week) is entitled Scientific Foundations. We may not want to make those distinctions. This chapter lays out their theological anthropology. They begin by asserting that a responsible Christian psychology is founded on the “bedrock” of a Christian worldview. “Christianity–informed by Scripture and responsible theological appraisal–is trump” (p. 25). This is a significant change from older integrative models that often describe their task as weighted equally on the pillars of psychology and theology.

The remaining portions of the chapter discuss what it means to be made in God’s image. They employ 3 ways of looking at imago dei: functional, structural, and relational. Functional: God’s image is revealed in human behavior (especially in our managing and stewarding behaviors). Structural: God’s image is revealed in our moral and rational capacities. Relational: God’s image is revealed in relationality and communicative activities. Psychology also addresses these areas (adaptive behavior, cognitive behavior, effective relationships).  These form the 3 domains of Integrative Psychotherapy.

Then they tackle the Fall. They acknowledge that many psychotherapists live in denial about sin. Taking sin seriously, they say, doesn’t have to mean forgoing empathy. Instead the view it through the lens of Augustine. Sin, they assert is both a state of being (therefore “free will and personal resolve are not enough” to change behavior) and an act. We sin and are sinned against. Why does this matter to counselors? Because we have a tendency to deny and distort due to the effects of the Fall. Sin mars and colors everything one and everything. A robust doctrine of sin enables counselors to recognize the brokenness in the world.

The authors conclude the chapter looking at the theme of redemption. “A doctrine of sin, viewed in the context of a God who loves humanity, is the Christian’s great hope because it opens the possibility of redemption–God buying us back from the bondage of sin through the atoning work of Jesus Christ, restoring a right relationship with those who were lost in their sin” (p. 44). Long sentence, but sums of their view of redemption.  This matters to the Christian counselor because it means there is hope for change, hope for healing, hope for redeeming broken things. This hope is not a general hope of change but founded, for them, in the revelation and incarnation of Christ. “And so a Christian approach to psychotherapy calls us to consider more than general revelation….In short, [it] involves an awareness of sanctification as we all seek to be transformed by the divine life revealed in and mediated to us by Christ” (p. 49).

My thoughts? McMinn and Campbell make a significant break with prior integrative models by acknowledging that the Christian worldview does provide a trump to all other competing reality claims. This does not need to set up an unnecessary sacred/secular divide but does remind us that the biblical data isn’t a sidebar to Christian care, but front and center. I’m glad to see them emphasize this without reservation. Too often folks talk about psychological truth as what is found in general revelation. This is problematic for two reasons. First it denies the rich psychological data in the bible. Second, general revelation has been misused to mean neutral data outside of Scripture. But, general revelation really is natural that points to the existence of the triune God.  

Its clear this text isn’t trying to be an advanced text in biblical anthropology. But what it summarizes is in keeping with classical theology. We’ll have to see how this works out in their model and practice. They write for the professional counseling student. To keep them interested they have little sidebar vignettes and practical tips. Some may like that but I find it a bit annoying because it breaks the flow of their argument. But, I suppose it does tell the student that what they talk about is not all pie in the sky.

Next week, I’ll summarize their scientific foundations in chapter 2.

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January 16, 2008 · 5:35 pm

Integrative Psychotherapy: A Review 1


Consider this your forwarning that I am about to start weekly chapter reviews of Mark McMinn and Clark Campbell’s book Integrative Psychotherapy: Toward a Comprehensive Approach(IVP, 2007). I believe this book is important because it marks an important step forward in developing a substantial theoretical model for integrationist psychotherapy. Most of what has gone on in the last several decades has been primarily theoretical and not practice oriented. Both men are professors at George Fox University in Oregon. I know Mark personally as he taught several of my classes at Wheaton and helped me publish my first book chapters in a book he edited. Mark is a gentleman, prolific writer, and pretty good basketball player (he has/had one of the quickest releases around, making it hard to block his shot).

I’m not likely to fully agree with this book, but I expect that it will provoke some thoughts among my student readers.

Introduction: What is a Christian psychotherapy? Good question. the authors say that Christian psychotherapy must be based on “a model of psychotherapy that is faithful to both Christianity and psychology.” (p. 15).

They acknowledge some problems with prior attempts. They define integration in 2 dimensions: (a) integrating a Christian view of persons with psychological literature, and (b) integrating various approaches to therapy (they do not believe in any one pure approach to therapy).

They are not trying to propose the ONE christian model for psychotherapy.

What is to come? the first 4 chapters establish their theoretical framework. For example, they use the concept of the imago dei and its functional, structural, and relational aspects to build their model of persons and therapy). The next 7 chapters consider the practice of their model referred to as IP.

Well, strap on your seatbelts and come along for the ride each Wednesday. 

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January 11, 2008 · 5:23 am

Mirroring yourself and why you can’t


We all believe we have a decent grasp on reality. We can read the emotions and motivations of others and accurately evaluate our self. But in point of fact, we operate mostly through assumptions and perceptions of others and our self. Some of us more closely approximate the truth, others less so. Those who have a better grasp of reality tend to be folks willing to test out their perceptions. Without becoming too dependent on the opinions of others, they ask what others are thinking and feeling without preemptive assumptions. When they hear these experiences, they spend more time trying to understand and less time defending their own opinion. They ask for feedback and consider what they hear without denial or acquiescence.

Why is it hard for some to avoid preemptive assumptions about self and the world? Why is it that some use repetitive relational scripts where they accept and play a role in most of their relationships? As children, our sense of self and other builds from our interactions with important figures in our lives. If we are exposed to relentless criticism (we are bad) or neglect (we don’t matter), we are likely to try to conjure up our own sense of self.  Some personality theorists call this a lack of appropriate mirroring.

Most then fall into one of two response types: I must be right all the time or not responsible for my failings (though I fear I will be found out to be a failure), or I am never right and am only worthy of shame (so I fear and avoid people at all costs or allow others to use and destroy me since that is all I am good for). Of course some vacillate between the two.   

Is there any hope for us who find ourselves trapped in these scripts? Some personality theorists would say no. But, they are wrong. There is hope for us, but it is not a hope in safety. What do I mean? There is some safety in playing out the script as we always have. We know we will be rejected, we know that we will be mistreated or misunderstood, and we know how we will respond. There is comfort in the known (even if we hate it at the same time). What is unsafe is to put down our repetitive thoughts about self, fears about what others think, and just begin to observe the other in our relationships. What is it that they think? Feel? Desire? Believe? I liken this to having conversations with another where we no longer talk to them with a mirror in the middle. When the mirror is present, we are relating to them but constantly assessing ourselves, noticing our feelings, etc. When we remove the mirror, we have the opportunity to only see them and have our self go to the background. This, of course, causes us to feel small and vulnerable. Hence why I said that it does not feel safe. And yet, the very act of connecting to another without the mirror positions us to potentially receive more accurate feedback about ourselves.

I’m reminded of the biblical text in James about the man who looks in the mirror and then promptly forgets what he has seen (1:23). We forget when we listen to things but “forget” because other things are speak more powerfully to us–seem to be more true. The text goes on to say that we remember what we have seen and heard when we are open to the the perfect truth. So, we will have God’s power to change from building our own mirror to that of a more truthful image when we keep ourselves close to God, his Word, AND when we connect to others who also reflect God’s true character.  Misappropriating CS Lewis, its not a safe option, but it is good. 

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December 19, 2007 · 5:48 am

Should you listen to your clients?


In chapter one of Workmen of God, Oswald Chambers has this to say about the work of curing souls (bold emphases mine):

Keep these three things in mind—reliance on the Holy Spirit of God, keeping in contact with people, and above all, keeping in contact with the revelation facts in God’s Book; live amongst them, and ask God how to apply them.

Another thing I want to mention—never believe what people tell you about themselves. There is only one person in a thousand who can actually tell you his or her symptoms; and beware of the people who can tell you where they are spiritually. I mean by that, never be guided by what people tell you; rely on the Spirit of God all the time you are probing them.

Let me read you this in regard to medical treatment—

Recent evidence in the law courts has pointed to a fact which the medical profession holds of great value—the necessity, not only of personal and private interview with a patient, but of the penetrative ability to get at the real facts and symptoms. In other words, successful diagnosis depends on the doctor’s acumen in cross-examination. “Cross-examination of a patient is almost always necessary,” says an eminent medical man. “They will give me causes, or rather what they think are causes, instead of symptoms. The rich patient is more troublesome in this respect than the poor, for he has had leisure in which to evolve a sort of scheme of his illness, based on ‘popular’ medical knowledge.

“Patients always colour facts, speaking absolutely instead of relatively. They never tell the truth about the amount of sleep they have had or as to appetite. They frequently say they have had nothing to eat. Casually you find there were two eggs at least for breakfast. A minute or two later they remember stewed steak for dinner. Perhaps the greatest need for cross-examination is that it gives an extended opportunity to the medical man to examine the patient objectively. The most important symptoms are generally those the patient never notices.”

If that is true in the medical profession which deals with men’s bodies, it is a thousandfold more true about spiritual symptoms when it comes to dealing with a man’s soul. Do beware, then, of paying too much attention to the talk of the one that is in trouble, keep your own heart and mind alert on what God is saying to you; get to the place where you will know when the Holy Spirit brings the word of God to your remembrance for that one.

If you are unacquainted with Chambers, you might think him rather harsh and condescending to those he ministers. To the contrary, he very much cares for the souls he serves. In fact, his next lines are some of my favorite. He confronts those who love to hurl bible texts at others without listening to the Spirit.

So, how might these thoughts from Chambers inform the counselor?

Listen to what is being said, even if not the actual words. It is not hard to hear the heart cry despite being dressed up in words that accuse the self or other for causing the misery presently experienced. Then, consider what the Spirit and the Word have to say to that heart cry (Chambers alludes here to John 14:25).  It is a delicate balancing act to listen to our clients describe their dream of a solution to their problems, validate that dream, and yet bring reality into that dream. Sometimes, we are called to help them see how their dream leaves themselves out of the solution? Sometimes, we are called to help them work where they have the power to make changes and let go of those areas where they do not.

So, listen, validate, and yet point to those areas where God is leading the client. Of course, this assumes that the counselor is in touch with the Spirit and not just in touch with their own mind.  

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