Category Archives: Psychology

April 14, 2008 · 10:01 am

Practicum Monday: Basic Competencies


Today starts our 3rd trimester of the 2007-8 school year and Cohort 3 begins their Practicum and Professional Orientation course and first fieldwork experiences of the program. Last year I ran across an article (see reference at end) trying to articulate the domains and levels of competence in focus in a psychology practicum experience. Though the article is directed to doctoral level practicums, I think the domains fit for any level of trainee and are a good reminder for both practicum students and their professors. The authors summarize the “Practicum Competencies Outline” and in turn I will quote/summarize/highlight them below. Click here for the whole document.

  • Baseline Competencies (for entry to practicum)
    • Personality Characteristics
      • interpersonal skills (verbal and nonverbal forms of communication, open to feedback, empathic, respectful)
      • cognitive skills (intellectual curiosity, flexibility, problem-solving, critical thinking, organizing)
      • affective skills (ability to tolerate affect and conflict and ambiguity)
      • personality/attitudes (desire to help, openness to new ideas, honesty, courage, valuing ethics)
      • expressive skills (ability to communicate ideas, feelings, ideas in multiple forms)
      • reflective skills (ability to examine and consider own motives, attitudes and behaviors and recognize one impact on others)
      • personal skills (ability to present oneself in a professional manner)
    • Knowledge from the classroom
      • assessment and interviewing
      • intervention
      • ethics and legal issues
      • diversity
  • Skills to Develop during Practicum
    • Relationship/interpersonal skills
    • Applying research (less so for MA level)
    • Psych assessment (not for MA level)
    • Intervention
    • Consultation/interprofessional collaboration
    • Diversity
    • Ethics
    • Leadership
    • Supervisory skills (not for MA level)
    • Metaknowledge/metacompetencies

This second major bullet point (competencies built during practicum) is fleshed out further by listing levels of competencies. The article illustrates relationship/interpersonal skill competencies by listing how it will show up with clients (e.g., ability to form working alliances), colleagues (e.g., ability to accept feedback nondefensively from peers), supervisors (ability to self-reflect), support staff (respectful of support staff roles), clinical teams (participates fully in team work), community professionals (ability to further the work and mission of the site).

Hatcher, R.L, & Lassiter, K.D. (2007). Initial Training in Professional Psychology: The Practicum Competencies Outline. Training and Education in Professional Psychology, 1, 49-63.

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April 11, 2008 · 5:10 am

Assuming the best or the worst?


Consider for a moment that person you tend to assume the worst when you think about their motivation for doing/not doing something. Now, consider your best friend and consider how you would react if they did the exact same thing as the first person. Would you assumption be different?

We like to believe that that our feelings and actions are based in facts and knowledge when in fact they are much more based on prior experiences (not necessarily facts) and interpretations we made about those experiences. What I find interesting is that we tend to either assume the best or the worst and find it difficult to remain neutral. We tend to perceive that people are for us or against us. Once someone crosses the divde from “for” to “against” we tend to go back and reinterpret our history with them to read their behavior toward us in an completely new light. Some times this is warranted. Other times it is not.

Can we live without making assumptions? No. But, our challenge is being humble about those assumptions and willing to be flexible (assuming the best) as much as possible as 1 Corinthians 13 calls us to. Such a move should not be naive but merely recognizing that we ought to be equally suspicious about our own assumptions.

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April 7, 2008 · 10:33 am

Integrative Psychotherapy XII: Soul Care Via Relationships


In the last substantive chapter of Integrative Psychotherapy, McMinn and Campbell explore relationship-focused interventions. As we have seen in previous chapters, their therapy model begins by addressing problems at the level of symptoms and ends with considering transformation of the person via soul care. Before describing soul care interventions the authors want to set out a few of their beliefs:

  • “One does not have a soul but is a soul” (p. 349)
  • The soul is not another word for personality or self or even person. Rather it is bigger because it encompasses meaning and relationship 
  • Soul care is based on the life AND work of Christ. Some use Jesus as an example for healthy relationships but stopping with Jesus’ behaviors misses out on Christ’s atoning work in redeeming us. His work is based on both grace and truth–both necessary in any human to human soul care work
  • There are multiple forms of soul care but one should not confuse or integrate spiritual direction and psychotherapy. “Christ is central to all soul care” (p. 356) but each version has differing goals and methods. They suggest these as some of the differences between the two:
    Spiritual Direction                         Therapy
    spiritual functioning                          psychological functioning
    lifelong spiritual transformation        transforming a specific problem area
    spiritual advising                               guided discovery
    spirit centered                                   problem centered
    God focused                                      client/counselor collaboration
    under church authority                     accountable to professional standards

Relationship interventions, per the authors, must be founded on therapeutic alliance (a safe trusting and collaborative relationship between counselor and client), therapeutic frame (“a setting conducive to change”–predictable, with clear expectations, roles, etc.), and relational dynamics (the inevitable “dance that occurs in any close relationship” (p. 363)).

The relationship oriented therapist pays attention to the alliance, the frame, and the dance because they do not merely talk about the client’s life but client and therapist experience life in the session and this experience enlightens, informs, and recreates patterns in the client’s life. These dynamics are commonly referred to as transference and countertransference.

While discussing alliance, frame, and dynamics are indeed therapeutic interventions (my view), McMinn and Campbell go on to discuss 4 relational interventions designed to, “provide simultaneous support and confrontation (grace and truth) designed to promote psychological growth” (p. 372).

  • Empathy. Having the capacity to experience the client’s world “as if” it were one’s own–and so communicate understanding. Why is this important? M & C say it provides, “safety necessary to keep the client’s defenses down” (p. 374).
  • Confrontation. “Gently pointing out inconsistencies or discrepancies to the client” (ibid). The authors remind the reader that individuals do not do well when they feel their whole person is being confronted. One suggestion is given to focus on the impact of one’s words or behavior more than intent (folks are much more likely to emphasize their intent and defend against impact).
  • Interpretation. “…Connecting current behavior, feelings, and images to previous ones in the client’s life….Whne clients re-create their interpersonal problems in therapy through reenactment, testing or transference, they are not aware usually of the connection between their current reactions and the coping strategies learned in childhood” (p. 376).These interpretations are not merely made to correct thinking but to be used in the counseling relationship.
  • Role behavior changes. We learn to play certain roles in life. While these roles may be adaptive or understood as part of a larger family system, they may become maladaptive later. When clients experience and understand their role rigidity, they then have the opportunity to try on new roles within the safety of therapy.

My thoughts? Notice the difference in details and concrete interventions between the treatment of automatic thought problems in domain 1 and relationship interventions here in domain 3. It’s no wonder some counselors are more attracted to “doing something” with cognitive therapy and so avoiding the vagaries of interpesonal processes. And yet, McMinn and Campbell are correct that the therapeutic relationship between therapist and client allows both to move beyond talking about problems to experiencing stuckness and healing–and so to have the opportunity to experience a different response to the self and the world. Boundary setting is an intervention and provides wonderful fodder for healing conversations. Far too many students see boundary setting as something to be done to avoid trouble rather than a primary tool for change. Second, these 4 interventions for a good start but we need much more exploration of relational healing interventions than is possible in this introductory work. One such deepening would be Marsha Linehan’s work in validation and irreverence as means to allow the “here and now” to provide feedback to the oft invalidated client.

While I am very supportive of their primary goal in this chapter I do have a couple of questions:

  • Can we really separate psychological growth and spiritual growth from each other? I think not. This makes it messy when trying to define the roles of a spiritual director and professional therapist. But, I think any role differences are somewhat artificial, based on “turf” wars. Wise and careful directors and therapists use the same frame, neither gets too far with exhorting (McMinn and Campbell call this advising), and Christians in both fields ought to submit themselves to God as well as government.
  • How does Jesus transform the world? By example? By love? By the cross? While I am thankful for their strong Christological focus for their soul care, they aren’t quite consistent in their description of Jesus’ work. They do recognize that merely looking at Jesus’ loving examples is not enough. We must see him as God in the flesh. But they also suggest on p. 351 that Jesus transforms, “the world through the power of relationship.” It seems they suggest that he transforms the world because he so moved and influenced the disciples to establish the church. Why? They consider the relationship with the apostles to be the primary reason. While we are designed for relationship, we are not healed through relationships because Jesus so influences us. No, we heal through relationships because we have been reconciled through the cross of Christ. 2 Cor. 5 16f make this very clear. So also does Romans 5. There is little mention of the cross of Christ throughout this book. Funny, the one place in this chapter where the cross appears is on p. 354 when they quote Alan Tjeltveit, “We stand in need of grace. Through the cross, grace is available to us, always.” It would be interesting to hear McMinn and Campbell discuss why they place more emphasis on Christ’s relationships and so little on the cross.

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March 24, 2008 · 11:03 am

Science Monday: Easing the suffering in schizophrenia


While few outpatient, private practice therapists deal much with those diagnosed with schizophrenia, there are things therapists can do to ease the suffering of both client and family. Kim Mueser, a professor at Dartmouth Medical School has published a number of helpful research and popular writings designed to increase social and cognitive functioning and decrease family distress in people with schizophrenia. Click here for an Amazon.com list of his writings. His Complete Family Guide (#1 on the list) is probably the best though several other texts may be just as useful depending on the reader’s focus. And while medications are important in the treatment of schizophrenia, it is quite clear that when families and client learn to minimize family distress and conflict, they also reduce active psychotic episodes

—–

There are a number of interesting research angles on the pathways of Schizophrenia. One such hypothesis is that the croticostriatal loops do not work correctly in such patients. In lay terms this means that information doesn’t flow normally from the frontal lobe of the brain to some of the mid-brain structures and then back again. This seems to be part of the cause of apathy and lack of volition and/or planning. One wonders whether the longer time it takes for information to flow properly in order to make a decision or interpretation increases the likelihood of making random assumptions about the world. I know that when my children get stuck in a math problem, they are more likely to begin wild guessing to complete the task.  

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March 12, 2008 · 1:39 pm

Integrative Psychotherpay IX: Schema Focused Interventions


McMinn and Campbell go into detail regarding the 2nd domain of their 3 tiered model of persons/change in chapter 8 of Integrative Psychotherapy. While the first domain addresses symptoms, this domain (schema) looks beneath to deeper roots than habit and thought. “Schema-based interventions dig deeper than symptom-based interventions, looking to general core beliefs rather than specific automatic thoughts” (p. 243). Schema interventions address the heart of soul and deeply held beliefs (perceptions) about the self and the world that persist beyond specific situations.

So, they open their chapter with this assertion: “…it is often the currents beneath the surface of consciousness that have the most power and bring the most troubles in personal adjustment and interpersonal relationship.” (p. 240). They point to perceived parallels in Romans 7 (Sin causing me to do what I do not want to do) and Freudian theory regarding unmet needs to be both talking about underlying–yet controlling–currents in our lives. A wide view of sin (both active choice and result of living in a fallen world) incorporates both views without making one attack the other.

On page 242 they revisit a vignette of a unhappily married, 24 year old woman. She was afraid she didn’t love her husband and was afraid of being “doomed to misery if they stayed together.” In the vignette, “Denise” is told by her elder that she was facing a spiritual problem that required more prayer and bible reading. The authors fault the elder for having bad psychology (premature advice, no rapport) AND bad theology (that spiritual disciplines can always solve the problem of sin). They faulted the elder for not recommending a fuller orbed treatment of therapy or meds and for not considering a wider variety of underlying issues (her family of origin, communication issues, interpersonal anxiety, hidden secrets, biological predisposition, etc.)

So, is a better answer to Denise’s problem to trace her automatic thoughts back to her core belief? Not so fast say McMinn and Campbell. Linearity is nice but too simple. So, they turn to a discussion of schema.

Schema is not synonymous with core belief despite the fact that it is used that way (mea culpa in this post). Defined by the authors, “a schema is simply a structure that contains a representation of reality” (p. 247). They remind us that since we are actively interpreting our world, we shape our schemas and we shape our lives to fit our schemas. They further describe schemas with these statements (fleshed out in the book)
1. Schemas affect how we interpret and construct the world
2. Schemas are adaptive and maladaptive
3. Schemas can be activated and deactivated
4. Schemas are connect to modes (while schemas are cognitive they lead to a way of being, a personality, a motivational bent, an emotional and physiological bent)
5. Schemas can be categorized in how they interpret self, world, and future (p. 260 has a list of 18 schemas with accompanying core beliefs)
6. Schemas have a historical dimension (they point to literature describing 4 different early life experiences as key historical causes: toxic frustration, trauma, overindulged, and identifying with the pathology of a parent)
7. Schemas have an interpersonal dimension (they are not developed in a vacuum)
8. Schemas are influenced by original sin (faulty thinking doesn’t just come from bad environments. Those raised in great homes also struggle with faulty thinking because they are tainted from the Fall.)
9. Schemas have a cultural dimension (some schemas are culture-based and the authors warn against trying to change these)
10. Schemas have a faith dimension (schemas may shape perception of God; One’s theology shapes schemas)

To make this real, they refer back to “Denise.” Since Denise’s schema contains distrust of the world, she quickly interprets her husband’s cooking her favorite meal as an attempt to make up for his dis-trustfulness and so is defensive and irritable. Of course, this schema “predicts” distrust and then finds evidence of it when Don is hurt and doesn’t try to be nice after her attack of him.

So how does Integrative Psychotherapyaddress maladaptive schemas? They suggest “Recursive Schema Activation” (p. 270) over against class CT tactics that challenge core beliefs with logic. Merely engaging in logic battles minimizes, in their view, that core beliefs, “are embedded in a complex array of motivations, behaviors, emotions, and physiological responses” (p. 217). By “recursive” they mean to emphasize that we change through experience, dialog, repetitive activation and deactivation of the schema.

This means the client’s troubling schemas are activated and deactivated in the context of the therapeutic relationship, over and over again, all the time helping to foster the client’s ability to stand apart from the core beliefs and reconstruct a new, healthier identity–an outcome know as decentering. In decentering the clients begins to understand the nature, power and origins of the maladaptive core beliefs while simultaneously developing more conscious control over the schema deactivation process. (p. 272)

What is really different here from classic CT? McMinn and Campbell don’t want to talk only about a client’s schema, but to activate and experience the schema, and then decenter from it in order to understand and control it. They do not believe they can eliminate a damaged schema. Classic CT wants to correct maladaptive thoughts. IP wants attempts to recognize the impossibility of that and yet gain control and reduce the power of these maladaptive thoughts via therapeutic relationships.

My thoughts? Okay, lots to munch on here. I like how they recognize the limitations and arrogance of classic CT in correcting our struggle with deception and sin. Just as we don’t try to stop sexual temptation but fight to kill those things that lead us further along, we can’t stop initial fearful thoughts but work to stop our acting on them. What we do with our thoughts (take them captive) matters. And the authors here recognize that such efforts are not merely logical but experiential. I generally agree with their thoughts regarding how schemas color our world. We are active in shaping our interpretations of self and other and our world is active in shaping us. We are neither completely responsible for the content of our perceptions or completely victim of our perceptions. However, we are responsible for our actions and attitudes per the Scriptures. The Scriptures do not excuse us because we were mistreated. But there is grace.

I have two pet peeves. First, the example of bad pastoral care is not followed by bad example of stereotyped christian psychological care. Both are problems. I wish they did more to call out their own kind. Second, they continue to see sin primarily as only original sin. This, I think, does much to minimize active will, motivation and choices in everyday living. By listing the faith dimension of schemas last, they may unintentionally give it only a small slice of the pie when in fact it is a part of every other part of a schema. Each of the other 9 statements about schemas are clearly shaped by our spiritual beliefs and actions.  

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March 10, 2008 · 10:06 am

Science Monday: Child PTSD


Today’s psychopathology class focuses on child related problems. Given the societal focus on ADHD and Asperger’s, our class will hang out there. However, I want to bring to your attention some work in the area of family violence and childhood trauma reactions. Gayla Margolin and Katrina Vickerman (of USC) published 2 articles in a 2007 (38:6) issue of Professional Psychology: Research and Practiceon the topic of PTSD in children exposed to family violence.

Article one (pp 613-619) provides an overview. First, they recognize that some kids have PTSD without a single discrete precipitating and/or life-threatening event. It appears that prolonged exposure to violence (e.g., domestic violence, physical abuse, sexual abuse, community violence) likely has a deleterious impact on children. Some 30% of kids living with both parents experience domestic violence. Some 5-10% of kids experience severe physical abuse. One article summarizing a number of studies suggested that somewhere between 13 and 50% of kids exposed to family violence qualify for a PTSD diagnosis. In foster home and clinic studies, the number with PTSD seems higher, especially in girls. Not every child who experiences violence shows signs of PTSD. Severity and frequency of exposure to violence probably matters most. What makes family violence so troubling is that the child is faced with the constant threat of additional episodes.

What are the common domains of impairment related to complex trauma exposure? Affect regulation (inability to modulate anger, chronic flooding of negative affect), information processing (concentration, learning difficulties, missing subtle environmental nuances, overestimation of danger, preoccupied with worry about safety), self-concept (shame, guilt), behavioral control (aggression, proactive defenses, and substance abuse), interpersonal relationships (trust), and biological processes(delayed sensorimotor development (p. 615).

The authors repeat a previous suggestion of a new diagnosis: Developmental Trauma Disorder(DTD) to adequately capture the picture of youth trauma reactions to family violence. Criteria include: repeated exposure to adverse interpersonal trauma, triggered pattern of repeated dysregulation of affect, persistently altered attributions and expectancies about self and other, and evidence of functional impairment.

In their second article (pp. 620-628), the authors summarize typical treatments for children: reexposure interventions(to help the child understand and gain mastery over their past experiences that intrude. This is done primarily by a trauma interview where therapists work directively to bring fragments of the story together into a coherent whole and meaning and safety are explored), cognitive restructuring and education about violence exposure (goal to undo lessons learned, practice thought stopping, and to normalize reactions), emotional recognition and expression (to attend to and understand connections between emotions, thoughts, and behaviors), social problems solving, safety planning for those not able to be out of potentially violent environments, and parenting interventions.

Do any of these treatments work? It appears several do. I’ll mention just one here:Trauma-focused CBT for child abuse victims (by Cohen, Mannarino, and Deblinger. That intervention is published in their 2006 Guilford Press book, Treating trauma and traumatic grief in child and adolescents.   

We should not underestimate the impact of family and community violence on children. There are many kids labeled bi-polar, ADHD, personality disordered, oppositional (and worse) who carry within their body the impact of violence. They might look like a gang-banger or a thug who’d kill you because you scuffed his shoes, but they likely are hypervigilant and only read part of the environmental cues to determine if they are in danger.

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March 7, 2008 · 11:44 am

On-line Models of Counseling Course


Biblical Seminary offers several completely on-line courses these days. Check out our homepage for short videos on each course: www.biblical.edu. Let me highlight one in particular. My colleague Bryan Maier is offering one this Spring entitled, Models of Counseling. Here’s his syllabus: http://www.biblical.edu/pages/equip/classes-course-syllabi-spring.htm

If you ever wanted to explore the key secular and Christian models of counseling from a Christian/biblical perspective, this course is for you. The good part is you don’t have to travel to Biblical to take it. Bryan is a great teacher with a good sense of humor. I think you would enjoy it.

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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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March 3, 2008 · 11:58 am

Science Monday: The Epidemic of Insomnia


Americans appear to be quite sleep deprived, so says the latest National Sleep Foundation Survey of working adults (2008). Sleep deprivation seems to be linked to obesity as well as driving and work accidents. We’re insomniacs for many reasons. One key reason is our electronic appetite. With 24/7 electronics we stay up later and then stay up longer when we do get up in the night because of insomnia.

Sadly, once we retire and have the freedom to sleep longer, we can’t. Some 30-60% of older persons have sleep complaints. Does anything help? Commonly, doctors prescribe sleep aids, exercise, Cognitive Behavioral Therapy, and sleep hygiene education. While sleep aids are quite attractive they often have significant side effects and tend to be less effective if used regularly. Susan McCurry and her colleagues at University of Washington reviewed 20 key studies published between 1990 and 2006 to determine if any psychological treatments (they eliminated drugs, massage, etc.) would meet standards for evidenced-based treatment. They determined that two treatments have strong evidence of success among the older population:

1. Sleep Restriction/Sleep Compression. This treatment “is based on the principle that curtailing time spent in bed helps solidify sleep.” (p. 20). So, if you are in bed for 8 hours but only sleep 5, then restrict your time in bed to only 5 hours. The idea is that if you do so, you will sleep more soundly for those 5 hours and likely begin to sleep longer until you read your optimal (not necessarily desired) sleep time.

2. Mulitcomponent CBT. This interventions combines sleep hygiene education (information about how to schedule sleep, dietary matters, activity recommendations, etc.), stimulus control(strengthening the association that bed is for sleep and avoiding napping and lying down awake), sleep restriction, and relaxation training (relaxation to induce drowsiness).

Stimulus control may in fact be beneficial by itself but more study is necessary.

It has been generally accepted that most individuals with secondary sleep problems need sleep hygiene education. In other words, they make matters worse by how they deal with their insomnia (staying in bed awake too long, napping, drinking alcohol, not enough exercise or too late in the evening, etc.). As of yet, we do not have actual research (meeting evidenced-based criteria) to prove that education helps in the elderly population–though some exists for the 40-50s crowd. There also may be some benefit to bright light exposure, exercise, and massage but these authors didn’t explore these nonpsychological interventions.

Bibliography: McCurry, Logsdon, Teri, & Vitiello (2007). Evidence-Based Psychological Treatments for Insomnia in Older Adults. Psychology and Aging, 22, 18-27.

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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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