Category Archives: Psychology

May 20, 2008 · 5:19 am

APA says sexual orientation isn’t biological but from yet to be determined factors


Last week I commented on sexual identity formation in little kids. It spawned a large number of comments, both on and off topic. Hesitantly, I will make another post on the topic of sexual identity–this time from a brochure published by my own clinical association.

The American Psychological Association (APA) has a pamphlet on sexual orientation and homosexuality designed to aid understanding and reduce prejudice. My friend, John Freeman, gave me this to me and pointed out an interesting line which we’ll look at in a moment. But first, let me summarize the pamphlet

Sexual orientation, according to the APA is

“an enduring pattern of emotional, romantic, and/or sexual attractions to men, women, or both sexes. Sexual orientation also refers to a person’s sense of identity based on those attractions, related behaviors, and membership in a community of others who share those attractions.”

Right away it is clear they don’t really distinguish between attraction and identity and orientation and identity. You see the simple equation: attraction=orientation/identity. This is where Yarhouse’s studies with individuals within a gay affirming church give ample concrete evidence that such an equation is simplistic and mischaracterizes a set of complex issues. The reality is that one may recognize an attractional pull without it forming a private or public identity.

The APA document continues with the following,

“According to current scientific and professional understanding, the core attractions that form the basis for adult sexual orientation typically emerge between middle childhood and early adolescence.”

Again we see the attractions = orientation. This fits with the popular identity development theory that one moves from discomfort with to pride in attractions and accepts orientation as a given. Interpretive assumptions are given short shrift here.

Now to the good stuff. The brochure asks the question: What causes a person to have a particular sexual orientation? And here is their answer,

There is no consensus among scientists about the exact reasons that an individual develops a heterosexual, bisexual, gay, or lesbian orientation. Although much research has examined the possible genetic, hormonal, developmental, social, and cultural influences on sexual orientation, no findings have emerged that permit scientist to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles; most people experience little or no sense of choice about their sexual orientation.

This is an interesting paragraph. The APA rightly recognizes that no one factor is likely to determine later orientation. In fact, we’re not really at a point where we can say one factor is X% of the equation. There is no equation yet. It doesn’t mean we won’t have a better sense of it in the future, but as of yet, the problem is not merely a biological process. So, this opens the door to choice and manipulation of one’s orientation unless one subscribes to behavioral naturalism–something most of us would not accept in other areas of life. Obviously no one is suggesting that sexual orientation is as transitory as a passing fancy. And yet the APA recognizes that even when folks don’t experience themselves choosing orientation, there is an interpretative and choice element however subtle and slow the process.

At this point the brochure turns to the problem of discrimination and its impact on gay and lesbian people. No matter your beliefs about homosexuality, you ought to recognize that there is great stigma and mistreatment for those so identified (and also for those who may not fit stereotyped roles but do not have a gay identity). Then the brochure covers the question of mental disorder. 

Is homosexuality a mental health disorder? No says the APA and I agree based on the definition of mental illness where it has to cause distress. Not all with a gay identity are distressed, period. This really isn’t the issue.

The brochure goes on but I will mention only one last section. They discuss the validity of therapy intended to change orientation. They state there is, “no scientifically adequate research to show that therapy aimed at changing sexual orientation is safe or effective.” First, this sentence is full of highly charged words whose meaning can be debated: adequate…safe…effective. What constitutes adequate? Safe? Effective? There is some data that is not merely anecdotal suggesting that change is possible and not unsafe (see Yarhouse and Jones’ Ex-Gays(IVP). Now, their data isn’t as strong as it could be, isn’t overwhelmingly positive, but neither can it be denied as an anecdote. On the flip side, there isn’t any adequately scientific data suggestive that change therapies are unsafe and ineffective. Both sides of the research agenda have the same set of weaknesses that one would expect in researching this particular population (i.e., convenience samples).

I agree with the APA that we therapist must respect and person’s right to self-determination. But the APA violates this very principle by disrespecting those who have carefully thought about change. It is a paternalistic stretch to say that every person who wishes to change orientation only does so because of biases or because of a fundamentalist upbringing. The APA wants to be sensitive to a client’s “race, culture, ethnicity, age, gender, gender identity, sexual orientation, religion…” as long as their religion doesn’t guide them to see sexuality in a different light.

All in all, the APA takes a complex set of factors and ends up with, “It just is, so be nice!” I’m all for reducing mistreatment and violations of constitutional rights. But, I expect my scientific organization to spend my dues in a more balanced manner–faithfully representing what is true, whether attractive or not.  

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May 19, 2008 · 10:05 am

Practicum Monday: Premature Termination in Counseling


Today in Practicum class we discuss matters around ending treatment or counseling relationships with our counselees. The one that causes interns most consternation is the premature termination by clients after only one session. The trainee is left to wonder why. “Did I fail to connect? Did I say something to offend them? What did I do wrong? Did they figure out I don’t know what I’m doing?” Usually, they report feeling like a failure. Here’s a secret: even experienced therapists feel this at times as well.

Well, let’s start with the murky data. Brogan, Prochaska & Prochaska (v. 36 (1999) of Psychotherapy: Theory, Research, Practice & Training, 105-113) report that various studies reveal a premature termination after just one session stands somewhere between 20 and 57%. Some 30-60% drop out before the counselor thinks they should. And a meta-analytic study (of 125 studies) reports a premature dropout rate of 47%. Even though our research in this area is still weak (we don’t really know what factors to use to report premature dropout), the numbers are pretty high.

So, why do people stop counseling before they should? Why do our clients not return? We really don’t know as much as we would like. We do know that individuals in certain demographics are more likely (lower SES, lower education, minority status) to drop out. But even here, we don’t really know why. Is it client-counselor mismatch? Lack of understanding of the process of counseling? Lack of hope?

We do know that several factors do NOT seem to relate to premature termination (therapy mode, setting, and ages of clients).

While our research is still cloudy, it makes sense to consider the combination of client factors (motivation for personal growth, ability to have insight), environmental factors (financial status, family support or detraction, cultural support), and counselor factors (capacity to empathize and connect with the client’s perceptions, diagnostic and listening skills).

Trainees can ask these questions in their postmortems:

1. Did we share an understanding of the type and severity of the problems?
2. Did I give evidence that I understand their experience (beyond saying so)?
3. Did I give some evidence of the path forward and hope for the future without overselling it?
4. Did I acknowledge potential pit-falls, hopelessness, fear?
5. Was my client the “customer” or was someone else demanding it (e.g. parent)?   

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May 15, 2008 · 5:54 am

When a good label loses its value, or, should we rethink labels altogether?


Ever found a word, term, idea that had great meaning for you become useless or degraded because it became popular? Well, maybe that only happens to academic and clinical types. As a counselor terms like idols of the heart, Biblical counselor, integration, christian psychology all are meant to help individuals identify themselves and shape a conversation. At Biblical Seminary, we are attempting to train students to think “missionally.” When we started down this path, not many were using the word. But now it seems everywhere and used in so many ways that make you question whether the word really has any meaning.

So, I’ve had these thoughts from time to time but last night I was reading Paul Wachtel’s (professor at CUNY) “Relational Theory and the Practice of Psychotherapy” and he had this to say about one of his terms, relational. You could easily replace all the relational words with your own favorite term.

[The relational movement] is a loose coalition that is encouraging a diversity in viewpoint rather than seeking to impose a new orthodoxy. But this diversity of meanings also introduces confusion. Students in particular often are unclear about just what it means to be relational, both theoretically and clinically. Some, for example, (mis)understand being relational as being almost relentlessly self-referentially interpreting everything that transpires as being about the therapist.

In part, the problem lies with the very success of the relational movement. As the term “relational” has come into broader and broader use in recent years, there has been a corresponding decrease in the degree to which it communicates a clear and unambiguous meaning. This is perhaps an inevitable cost of success; relational perspectives have become increasingly prominent in the field of psychotherapy, and we have reached a point where many people want to jump onto the bandwagon. As more and more people use the term, sometimes more as a token of membership in a movement to which they wish to belong than as a substantive reference to a clearly specified set of theoretical premises and practices, the ripple of meanings makes a phrase like relational psychotherapy less than ideally precise.

Labels like relational, object relational, classical, or contemporary Freudian (to use examples from the psychoanalytic realm) often serve less as a medium of illuminating discourse than as a functional activity of boundary making, akin to the way our animal cousins leave their  scent to mark off the boundaries of their territory. “I belong here, you belong there,” may be a sentence; but it is a sentence whose message is not very different from what is conveyed by the glands of our mammalian kin. (pp 7-8)

He goes on to say that words should not merely make boundaries but to “alter and complicate” them through the act of conversation. While there are boundaries, they do move and change and no one human created word will adequately separate the sheep and goats, to mix my metaphors.  

So, what do we do with labels if they lose explanatory power when others find them helpful? Get rid of them? Or, do we use them with greater and greater humility. I like Wachtel’s description of the problem with another set of labels, 1person and 2 person approaches to counseling (1 person refers to analysis where the client monologues and interacts with their own psyche and 2 person approaches tend toward a relational, experiential interaction). Wachtel holds a 2 person theory. But here’s what he says,

To begin with, it is worth noting that the distinction [between the two labels] is almost always employed by putative two-person thinkers, as a critique of one-person modes of thought. There are rather few writers who defiantly proclaim, “I am a one-person theorist and proud of it,” although there are, of course, many writers who declare themselves to be proponents of the models that are called one-person models by two-person theorists. Writing as someone who, if the dichotomy is usable at all, would without question fall on the “two-person” side of the divide, I must say I find it disquieting to be characterizing competing theorists in a way they do not acknowledge as the basis of their own thinking.

This lack of acknowledgment on the part of “one-person” theorists, of course, does not in itself invalidate the critiques. It is certainly possible that critics of one-person models are recognizing something about the theories they are criticizing that their advocates do not. Indeed, in certain respects I myself believe this to be the case. It does, however, raise a question as to whether there might be a way to frame the critique that would be more illuminating and experienced as less of a straw man by more traditional theorists.” (p. 11)

I think Wachtel is helpful here and I have said similar ideas in the past. We need to be willing to come at a situation with differing dividing markers than we may have used in the past. For us Christian counselors, this is especially true. Mark McMinn considers himself to be an integrationist. But, his recent book, reviewed here, shows willingness to describe his model in ways that might make older integrative folks uncomfortable (i.e., giving Scripture trump power). So, we need new ways of looking at the data and less focus on division and more focus on description. Maybe we take a little longer look to see what is shared in our venn diagrams… 

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Filed under book reviews, christian psychology, Communication, Cultural Anthropology, Doctrine/Theology, Great Quotes, missional, Missional Church, Psychology

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May 12, 2008 · 5:29 am

Practicum Monday: Scott Stanley on Couple Conflicts


Last week in our staff meeting we listened to the end of Scott Stanley’s conference presentation on couples communication. You may remember I blogged previously on his funny but too-true analogy of dogs and marriage (We fall in love with the front end of the puppy/marriage, but they both have backs ends that need to be managed).

In this section of the presentation he makes this statement: events trigger issues. Couples tend to fight about events but really most conflicts are about issues that are deeper (e.g., Who gets the say around here, Do I have influence, Do you care, and other expectation clashes). The challenge is to get couples to see past events to the issues.

Problem: most couples only talk about issues during emotionally charged events. Why? It would be easy to say avoidance. But take that a step further. If the couple is no longer in conflict, why bring up something that is likely to trigger it? As Stanley says, “We’re really getting along right now, so I don’t want to screw it up by talking about a problem.” Seems good in the moment, but bad over time.

Stanley’s point is to deal with this problem by (a) handling events well (time out, staying in the moment, etc.), and (b) being proactive by maintaining safe, open communication about issues. This takes sacrifice, he says. Healthy sacrifice (not martyrdom) is pretty powerful and helpful in moving toward the desires of the other.

Here’s a couple of my thoughts:

Stanley has some great techniques and seems to have a good handle on what goes wrong in conflict. I think many couples can benefit from better care of the “back end” and making sure to remember and reinforce the front end as well. He rightly points out that we can easily miss the good sacrifices others do daily and then only recognize the good when it stops for some reason. If we’re not careful we take for granted the sacrifices of others and come to expect and even demand them as rights.

Stanley’s techniques seem not to work with couples where insight is low, trauma or violence has been a part of it, when folks have personality disorders, or when the couple are deeply entrenched in their bitterness towards each other. All events have meaning. The couple that is not willing to reconsider the meanings they apply to events (she is evil, that is why she leaves the kitchen that way), little couple work is possible. In fact, maybe even contraindicated. Techniques that should help become

weapons to hurt and destroy. Couple counseling is based on the capacity to observe self and other and to withhold judgment to see life from another perspective. Without this, it is hard to make much progress outside of painstaking experiential work.

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May 9, 2008 · 5:00 am

children, sexual identity, and counseling


“All Things Considered” on NPR ran a two day story on children and gender identity. Two days ago, they ran a story on two families with toddler to preschool boys who are attracted to girl-oriented toys, colors–one of whom sees himself as a girl, changing his name from Jonah to Jona as he entered school. His parents now refer to him as their daughter. Yesterday, they ran a story about a prepubescent boy wanting to take hormones to delay or stop puberty. You can click here to read or hear the stories and additional content on their site.

What makes this fascinating is the two psychologists interviewed. The first, Dr. Ken Zucker, sees the problem as gender identity confusion, something to be modified. The second psychologist, Dr. Diane Ehrensaft, sees it as something biological and fixed and then the job is to help the child and parents transition to transgender. Dr. Zucker rejects that idea and likens the acceptance/transition approach to that of accepting that a Black child wants to be thought of as white (I wonder if he would also liken it to accepting a psychotic child’s hallucinations were real). His response sounds behavioral in that the boy has his dolls and dresses removed and play with boy type toys is reinforced. Dr. Ehrensaft opposes this as controlling and suggests the best treatment is to go with the flow and allow the child to express him/her self as they see fit:

Ehrensaft, however, does not use that label [gender identity]. She describes children like Bradley and Jonah as transgender. And, unlike Zucker, she does not think parents should try to modify their child’s behavior. In fact, when Pam and Joel came to see her, she discouraged them from putting Jonah into any kind of therapy at all. Pam says because Ehrensaft does not see transgenderism itself as a dysfunction, the therapist didn’t think Pam and Joel should try to cure Jonah.

“She made it really clear that, you know, if Jonah’s not depressed, or anxious, or having anything go on that she would need to really be in therapy for, then don’t put a kid in therapy until they need it,” Pam says.

Ehrensaft did eventually encourage Joel and Pam to allow Jonah to live as a little girl. By the time he was 5, Jonah had made it very clear to his parents that he wanted to wear girl clothes full time — that he wanted to be known as a girl.

While I disagree with his approach, I would humbly suggest that Zucker’s diagnostic view is more accurate. Children may go through fixations and personality response types that do not carry into adulthood. To treat even an entrenched viewpoint of a small child as fixed is unethical. A child simply does not fully understand themselves and the world yet. We do not accept our children’s fears of monsters as normal, we do not accept our children’s hitting to get their way. Why? We know they are not old enough to understand. We empathize but correct.

This is not like trying to make a left handed child be right-handed, to force feed peas when the child gags. Our identities may be rooted in biology, they are not fixed. Zucker rightly accuses some of being essentialists–a form of biological reductionism. Even the APA does not do that when it comes to personality. A child cannot be given a personality disorder until 18 because we know that personality is flexible even when shaped and rooted in early years.

However, Zucker seems harsh in that his treatment is to remove all girl playtoys. While I would not want a child of one gender to accept and believe they are the opposite gender, I would want they and the parents to expand their view of gender. If a boy likes pink, silky things, dolls, etc. so what? There is nothing essentially male about trucks. My wife as a child was a cowboy. She’d be more likely to have six shooters than a doll. Thankfully, her family didn’t make it an issue (which may be the cause of some folks’ gender identity confusion). 

Of course, a family will want to draw some lines, such as saying no to referring to oneself as the opposite sex. “No, God made you a boy, but he gave you interests in soft things…” Instead of wearing dresses which in our culture isn’t the norm, the boy might be able to enjoy softer materials.

It would seem that some, in the interest of helping everyone self-actualize, lose their ability to think critically about child development. This is not unlike the misguided notion that all bad behaviors are about low self esteem and so we should only praise. In fact, many have too much esteem of self and so abuse others.

ADDED: Check out this link for a local Philly news article on the subject of a transgendered 9 year old and see that they spoke to the ever controversial Paul McHugh from Johns Hopkins.

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Filed under Cultural Anthropology, Identity, News and politics, parenting, Psychology

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May 6, 2008 · 5:44 am

Context and our perceptions


It shouldn’t be a surprise that context is everything when it comes to perception. Win the the 10 million dollar lotto and then have your car run over by a Mack truck (assuming no one was in it) and you probably laugh it off and go buy your dream car. Context changes how you perceive the event.

I had two reminders of the effect of context last Friday. First, I was on my way to a meeting and listening to an NPR show. The host of the show was interviewing Gary Marcus, NYU psychology prof and author of Kluge (a book on the mind). Though parts of his interview annoyed me greatly, he talked about contextual perceptions by pointing out this research tidbit (my words not a quote).

If researchers ask individuals (a) if they are happy, and (b) how many dates they have had lately they get one set of results. If they reverse these questions, the answer to the happiness question is clearly influenced by the answer to the dates question. I may in fact be happy until you remind me that I haven’t had any dates lately.

Second, at my meeting we were discussing perception of change in clients. Imagine this scenario:

You are working for 6 months with a man helping him to accept responsibility for his addictive behavior (you can substitute addictive with just about anything that needs change). The change has been painstaking but he has indeed begun to see his self-deception and begun to stop blaming his past for his present behavior. About this same time you hear that his wife would like to come in to a session. You invite her and when she comes with her husband you ask him to tell his wife what he has been learning. As he does you see her roll her eyes and smirk. You check in with her and she is absolutely livid. From her vantage point he hasn’t changed a bit. Sure, he’s not drinking anymore, he’s not beating her up, but did you know that he’s become rather obsessed with work, he still doesn’t call to tell her that he’ll be late and he won’t stop overspending each month. And worse for her, now he wants to have sex (in the past he avoided her) all the time. You acknowledge he has lots of work to do but you also realize she feels threatened to admit he has begun to change. If she does, maybe he’ll stop…

Notice how context influences our perceptions. If you think someone has come miles and miles in personal growth you likely get pretty excited. If, however, you focus on how far they have to go, your perceptions will be a bit more pessimistic.

Now here’s the challenge. How do we stop believing that our context is the only context for viewing experiences? It takes openness and empowerment and ability to see two things at once without demanding that one view overpower another. As Christians we must live in this bifurcated life. We are sinners…saved by grace. We are maturing…but never arriving. We are mistreated…and protected by God.

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Filed under Abuse, christian psychology, Cognitive biases, Insight, Psychology, Relationships

May 2, 2008 · 5:41 am

Sexual Harassment vs. Bullying: Which is worse?


In my latest edition of the Monitor on Psychology magazine (39:5/2008) I read an article about worker well-being. In it the writer describes a recent conference on the topic and some of the data discussed. One piece of research suggests that workplace bullying, “such as belittling employees and persistently criticizing their work, harms employees more than sexual harassment.” (p. 26)

Aparently a review of 110 studies reveals that people who are bullied and have interpersonal conflict are more likely to quit, be less satisfied and have lower sense of wellbeing. Both sexual and emotional harassment are bad, but this researcher suggests that aggression has more severe consequences.

Is it that bullying is worse or that it is more prevalent and harder to detect and so it lasts longer?

Which do you think is worse to experience? No matter your answer if you have ever experienced either, you know that your voice and your personhood have been assaulted.

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April 28, 2008 · 10:53 am

Practicum Monday: Potentially Harmful Therapies


I was perusing the Journal of Psychology and Christianity (27:1, 2008; pp. 61-65) this morning and saw Siang-Yang Tan’s mini article entitled, “Potentially Harmful Therapies: Psychological Treatments That Can Cause Harm.” He was working of a similarly titled article by the so-called Ralph Nader of Psychology, Scott Lilienfeld of Emory U. (in Perspectives on Psychological Science, v. 2:1, 2007, pp. 53-70).

Some therapies on the PHT list would not surprise you. For example, Tan lists re-birthing techniques where you wrap up your client in blankets put them between the therapist’s legs so they can be healed from their birth trauma. Sadly, a teenager suffocated not that long ago here in PA when an unlicensed person attempted this with her client. Also, Tan lists the use of hypnosis with those with Dissociative Identity Disorder (DID).

But, you may be surprised to find that Critical Incident Stress Debriefing (CISD) also makes the list of PHTs. CISD (aka CISM) has been used for years with police and fire fighters to help them debrief from traumatic experiences and the thinking is that this prophylactic intervention helps exposed individuals avoid problems such as PTSD.  But there is evidence that such care may not only not help some individuals, it might actually harm others by increasing their arousal and those inclined to be hyperaroused appear to do better with no debriefing. For more of a critique of debreifing see DeVilly, Gist, & Cotton’s 2006 article in the Review of General Psychology (10:4) entitled, “Ready! Fire! Aim! …”

While CISD is not without merit and not always harmful, its popularity and widespread use without careful analysis should give us pause.

What widely accepted methods of Christian counseling also have the potential for harm?

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April 21, 2008 · 5:43 am

Practicum Monday: Is conflict necessary in therapy?


In the latest edition of the Journal of Counseling Psychology (55:2, 172-184), Nelson, Barnes, Evans, and Triggiano have published an article on the inevitable conflict between supervisor and supervisee–what leads to it, how supervisors react to it as well as supervisor strategies for managing it.

But, these lines about therapy caught my eye:

It is likely that conflict is as difficult to manage in supervision as it is in psychotherapy. Yet addressing conflicts successfully can be a healing and educational venture. The work of “tear and repair” in therapeutic relationships suggested by Safran (1993) and Safran and Murran (1996, 2000) is thought to be critical to optimal outcome in psychotherapy. The capacity of therapeutic relationships to recover from relationship breaches is thought to enhance client trust that relationships can survive misunderstandings and disagreements as well as client confidence that he or she can successfully resolve them. A skillful therapist can guide a client through the process of accepting the therapist’s inevitable fallibility, thus enhancing client capacity to accept his or her own… (172)

What do you think? Is conflict necessary for healing? I think yes. Otherwise, the client and the therapist idealize each other and so become blind to reality.

However, not all relationship breaches are good and we don’t always respond well to them, making matters worse.

How do you feel about conflict with your clients? With your counselor?

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April 16, 2008 · 5:41 am

Integrative Psychotherapy XIII: Concluding Thoughts


We come to the concluding chapter of Mark McMinn’s and Clark Campbell’s Integrative Psychotherapybook. They remind us that it was their endeavor to detail their model of integration, psychotherapy, and Christian approach. By integration they meant that they wanted to thoughtfully integrate a variety of psychological theories (as opposed to mindless or even pragmatic eclecticism) as well as their theological views of persons. Their version of integration is best defined, so they say, by the term theoretical integrationism (TI). “[TI] occurs when a person begins with a particular theoretical starting point and then extends the theoretical base by incorporating one or more additional theories” (p. 386). What is the heart of the IP model found in this book? McMinn started with CBT and CT and has incorporated relational approaches more likely found in dynamic models of therapy. Campbell is reported to have begun with interpersonal and family models and incorporated and practiced CT. I would suggest that CT is the heart of the IP model with relational and interpersonal understandings of persons included. I would suggest that there is little evidence of family models in this book.

The authors make brief mention of their theological integration in this chapter. They admit that they take a rather narrow view of Imago Dei and apply that to personhood and psychotherapy by looking at the image of God through the lens of functionality, structure, and relationship.

IP attempts to address life both at the level of symptom reduction AND transformation. The authors recognize that many things lead to transformation–not just therapy. However,

“Psychotherapy is only one means of transformation, but in today’s society it has become an important and ubiquitous one. Even within the church there appears to be a strong and growing interest in counseling and psychotherapeutic ministries, though suspicions about psychology persist in many congregations and denominations. Church-based counseling ministries are now commonplace, most pastors and church leaders have a referral network of therapists in their community, seminaries offer courses and degrees in counseling, and support groups and peer-counseling ministries are being established in many churches. This trend is encouraging insofar as it helps the church care for whole persons as Jesus ministered to the spiritual, physical, relational and emotional needs he saw in others” (p. 388).  

Notice the word, “insofar” in the previous sentence. The authors see increased chance for harm if we “conflate” psychotherapy and the church. They are concerned about two problems: (a) making the gospel about us (self-actualization) instead of Jesus work, and (b) having untrained and undertrained individuals offering therapeutic help and so causing harm to vulnerable people. They do not want to see the Church compromised by becoming therapeutic nor do they want to see the profession of counseling dumbed down by removing the professional, academic, and scientific groundings.

Finally, they end the book by listing 6 ways their IP model is comprehensive: (a) includes both psychology and christianity, (b) consider multiple domains of persons, (c) multiple dimensions of therapy, (d) includes both scientific and relational approaches, (e) christocentric, and (f) usable with both christian and nonchristian clients.

So, now that we have concluded their book, what do you think? Did it make you more interested in viewing therapy through the symptom, schema, and relationship lenses? Did their model seem usable in your context? Were their Christian foundations necessary, or said differently, how did their Christian beliefs change how they function with clients? Would a Christian therapist who loves Jesus but sees their work as being a relational cognitive therapist act any differently? I’m curious if you have a reaction.

Some of my reactions:

1. This is probably the best Christian integrative book I have read. They work harder in this book to make sure that they acknowledge the all-too-common superficial use of Christian beliefs in building a model of care. They also display much humility and do not want the church to water down the Gospel. Therapy isn’t everything for them. Christianity is trump, in their eyes.
2. There is almost no negativity directed at any other model. Most of us use other models as foils for why what we do is better. I congratulate them on being able to map out a model without attacking others. When they do point out weaknesses, it is in their perception of the limits of cognitive therapy.
3. The book is now in need of a follow-up that more deeply illustrates case material. What does IP look like in an extended case study. I would love to see that as a follow-up text. What they did provide were little snippets that had a lot of realism to them. I just want more. Here’s one little question. Does Scripture only come into play at the symptom level of change? It seems to by the way they write and don’t write about Scripture. Does Scripture have anything to do with transformation and experience? Scripture is not merely a cognitive or intellectual enterprise (though we often use it this way).
4. I might quibble with them on their Christology, though I found their positions not quite clear and so may not differ as much as I think. Christ’s death and resurrection IS the power for change (2 Cor. 5:16f). His life does inspire us but we cannot love others merely because of his life. I think they might agree with this, but I’m left with confusion as to where they stand here.
5. As expected, this is a text for therapy trainees. It sets out boundaries for the profession. Lay and church leaders can learn from this model, say the authors, but ought to be careful not to function as a professional. Even though I am a professional and I have found in teaching counselors that it takes character, the Holy Spirit, skill acquisition, and much practice to be a wise counselor, I am always a bit troubled by the boundary setting. It seems we are trying to protect our own domain. I do think there are wise counselors who never had any academic psychological training. It may not be common, but let’s remember that pastoral care has been helping people long before clinical psychology developed into a discipline. I would have liked to see a bit more work in informing the reader (a psychology trainee) about the dangers in trying to function like a spiritual shepherd.
6. I’m in concert with their model as it functions in session. We are conduit for reconciliation. Therefor our working relationships matter almost as much as our words and interventions. When we can reduce symptoms of suffering, we should. But, we also recognize the insidious nature of sin in our lives and must seek transformation of our minds and experiences in submitting them to reality as seen through God’s eyes.

For those interested in Mark McMinn’s further work, you might check out his new book on sin, Sin and Grace in Christian Counseling (IVP, 2008). It is also written for the counseling practitioner.

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