April 8, 2008 · 5:37 am

Musings from Isaiah 40-45: Our only hope for egocentrism and self-sufficiency


I’ve been sitting in a SS class on Isaiah for the last 8 weeks. This week, we looked at Is. 44-45. One of the beauties of Isaiah is that he doesn’t mince words. In the same book, in the same chapter he points out our sin, God’s judgment and yet also points to God’s saving power. We’d prefer to focus on grace but Isaiah tells us we need both. Thus far in the book we get the truth: God is holy, we are not. Our trust in ourselves, in our leaders, in our ability to capture God have utterly failed. We are blind, dumb and no better (maybe worse) than the enemies of God.

And then we get to chapter 40. Here, we begin to get very clear images of God’s gracious acts along with more doses of the truth:

40:1-2: Comfort, comfort my people, says your God. Speak tenderly to Jerusalem and proclaim to her that her hard service has been completed, that her sin has been pain for, that she has received from the Lord’s hand double for all her sins

40:6f …All men are like grass…the grass withers…but the word of our God stands for ever.

And what is that word? Vs. 10f tells us that he comes in power, he tends his flock, carries them, and gently leads them. he will not grow tired or weary. Even though we grow weary, thosw who hope in him will walk and not faint.

In chapter 41 we again see God’s power. The islands see his power and tremble. What has he done with that power? He has chosen and not rejected a people. What are we to do? Not fear even though a war rages around. Can we not fear? Not really. But the Lord himself (v. 14) will help us.

In chapter 42, God will no longer stand idly by but will, like a woman in childbirth, cry out as he makes them trust only in Him. Yes, he handed deaf and dumb over to be plundered. But why? Chapter 43 gives the answer: because there is only one savior who redeems, only one who can be trusted to save. Though we pass through the waters, this savior is with us. Even in our punishment we are not abandoned. The whole Gospel is summed up in 43:11:

I, even I, am the Lord, and apart from me there is no savior.

So, for our sakes, we are sent to Babylon. Why? So we forget our former glories and recognize that only God provides the water and the food. While we would consider this punishment a sign of rejection and hatred, chapter 44 shows us God’s heart for holiness includes grace–even for foolish folk who try to find their comfort and safety in human things. He says, “Remember…I have made you, you are my servant; O Israel, I will not forget you. I have swept away your offenses like a cloud, your sins like the morning mist. Return to me, for I have redeemed you” (v. 21-22).

Chapter 45 shows an amazing picture. God’s victory over sin is sure. He even uses pagans (Cyrus) for the sake of his people (notice even in the temple, they can take no pride in having been the one’s to build it). And at the end of the day our hope comes not from our ability to be righteous but in the Lord’s power to save: “They will say to me, ‘In the Lord alone are righteousness and strength.'” 

I encourage you to read these chapters (especially 44:8; 24-28; 45:1-25) to see where our redemption and hope come from. Avoid trying to apply each little verse but read it as it is: poetry. Look at the description of God’s people, of THE Servant, and of God himself. You will walk away with the overwhelming sense that God is holy, that he keeps his word, and that he is delivering us from ourselves for his own namesake. A good thing to read if you are downcast and worried about yourself. 

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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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April 4, 2008 · 9:02 am

Pastors dealing with infatuated parishioners


Yesterday I was interviewed by a local newspaper reporter regarding the problem of pastors dealing with parishioners who become infatuated with them. She was interested in what seminaries do to help train divinity students to handle such a problem. The impetus is a situation where a woman was killed in her church allegedly by another woman who thought that the murder victim was trying to steal the pastor away. All allegations thus far. **Update 4/8/08: Here’s the reporter’s article. You’ll see that I’m not the most eloquent interviewee.**

I’m not the clearest or most formal speaker when it comes to interviews (I talked about warm fuzzies instead of attraction).  But, I tried to convey this.

1. Lots of folks feel warm and attracted to their pastors because their pastors listen, care, pray for, and encourage them. That’s pretty normal.

2. Some people (a small minority I believe) mistake these “warm fuzzies” for romantic feelings based on prior history.

3. An even smaller subset are willing to act on their sexual attractions.

4. Finally, the smallest subset become or were already delusional about the reciprocity.

What do pastors need to do? Build solid, clear boundaries. When boundaries are violated, they need to address those violations and involve other leaders or appropriate people–including the legal system should the person persist (stalk?) the pastor.

In reality, we spend far more time making sure that pastors understand their power and do not abuse it. We don’t spend a whole lot of time helping them protect themselves. But, we do try to help them normalize #1-2 above without freaking out or assuming the parishioner will move to #3-4. 

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April 3, 2008 · 2:03 pm

Marriage and falling in love with the front end of the puppy


Today in staff meeting, we listened to a CD by Scott Stanley, a researcher and co-author of “Fighting for your Marriage.” I came in late and so missed the full context but he was talking about the fact that we fall in love with the “front end of the puppy” but never the back end. But, every puppy has a back end. Dealing with the back end, he says, isn’t rocket science, but if it isn’t regulated, it will be a problem.

Like every dog, every marriage has a back end. Our challenge is to accept this fact and not try to make our marriages not have a back end. Communication skills are the primary way, for Stanley, to manage the back end of the puppy. If you don’t take turns talking and listening and validating, pretty soon, there’s a lot of poop all over the place and no one feels responsible to clean it up.

Like the image?

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April 2, 2008 · 2:34 pm

World Autism Day


Note: For those looking for the next installment of Integrative Psychotherapy, my apologies. Will be up soon.

Today is World Autism Awareness day. You should check out www.autismspeaks.org. If you register on the site you can see short videos that show the early signs of autism in children (along with those who do not have it).

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April 1, 2008 · 4:30 pm

Facial change recognition speed and personality problems


Read a study recently where the researchers discovered that folks with a diagnosis of Borderline Personality Disorder are markedly faster in their ability to discern subtle affective change in facial expressions than the general population. This data from the study also suggests that this population of people DO NOT make more mistakes in assessing mood than the general population.

Why would some folks be more sensitive to very subtle affect changes in others? The study didn’t attempt to answer that but I suspect it is because they (a) needed to be vigilant to potential danger, (b) they themselves are highly emotional, and (c) they have been “schooled” to believe that others are more right in their assessments and so they should accept other people’s feelings as more true. 

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March 31, 2008 · 2:20 pm

Science Monday: The end of Psychopathology


No, we haven’t found the cure for psychological problems. We’ve just come to the end of the course today. We’ll be looking at the problem of Borderline Personality Disorder. In order to understand personality disorders, we need to have an adequate understanding of both biblical anthropology (who does God say we are) AND the self (how we experience ourself and the world and so develop a consistent identity). Given that we live in a fallen world where deception rules the day, it is helpful to see how we tend to develop our self identity.  One such theory is called Constructivist Self-Development Theory. In short, the authors suggest the self is made up of

1. Frame of Reference: (one’s identity, worldview, beliefs, etc.)
2. Self-capacity: (inner capabilities that allow the individual to maintain a consistent coherent sense of self and to manage emotions)
3. Ego resources: (ability to conceive consequences, set boundaries, and self protect–ability to develop interpersonal strategies)
4. Sense of safety: (self-perception, trust, control, and connection to others)

This theory (and I haven’t done justice to it in this small space) suggests that these 4 areas work to help people form cognitive schemas that enable them to interpret events and memories from past events).

I like the theory’s attempt to address matters of safety and internal resources. Some people seem to have an innate sense of organization, boundaries, and ability to manage emotions. Others struggle more. In both cases, we develop a coherent sense of self as we construct our sense of ourselves in the world. Those who grow up in more chaotic and destructive environments have a much tougher time getting a bead on themselves and others. The world just doesn’t make as much sense.

The problem is what is not said or explored. Frame of reference, in my opinion, comes not only from experiences but also from God himself (Romans 1). We construct our perceptions of self but not in a vacuum.

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March 28, 2008 · 3:12 pm

Radio Disney?


My soon to be 10 year old found Radio Disney on the AM dial and now each morning I am greeted with vocals from Miley Cyrus and other teeny-bopper music. I think they have about 10 songs they play over and over and over…

So, now I have to start that habit that Paul Tripp used to talk about: listening to the music my son listens to and engaging him in dicussion about the lyrics. I’d prefer to ban it because it seems to be all about romance and never forgetting someone who makes you swoon. But, better to engage and not try to control. Right?

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March 27, 2008 · 5:33 am

The problem of embellishment: Not just the work of fishermen and politicians


Many people, myself included, had a little chuckle when yet another politician is caught by good ole videotape. Senator Clinton turns her trip to Bosnia in 1996 into something designed to play up her experiences with foreign diplomacy. She made it seem that she had to dodge sniper fire on her way from the plane to a waiting car. Now, the country wasn’t a picnic at that time, but neither did she have to dodge bullets. After first defending her account she now admits mis-speaking (notice she didn’t say she mis-represented the fact). 

But Senator Clinton isn’t the only one who does this. In fact, I would suggest that we ALL embellish every day. We just don’t have video to catch us in the act. Here’s some possible examples for you to consider:

You leave for an appointment late and the “traffic was bad.” It may have been heavy traffic but the emphasis on the traffic deftly misdirects to a different (and wrong) cause and effect.  You were late because you didn’t plan well.

You tell someone that you are friends with _____ (someone you look up to and met once or twice but only on a superficial basis). You do this in order to sound more important.

You tell someone you spent all day cleaning. In actuality, you cleaned at several times during the day but you also watched a movie and surfed the web for an hour. You play up your work in order to make your point. Sadly, when we do it enough, we actually believe what we are saying.

Sometimes, embellishment just helps us make a point or tell a story. I’m not sure it is sinful. It may be that some of the OT numbers are there for story and point-making more than an exact headcount. But, of course embellishment is a problem when we do it to avoid the reality of the truth or to gain something that does not rightfully belong to us. So, let us endeavor to tell the truth and worry less about what others think of us.

Oh, did I tell you that Sen. Barack Obama sent me an email yesterday. Really, he did. 😉 

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March 26, 2008 · 3:15 pm

Integrative Psychotherapy XI: Relationship focused interventions


We’ve been following the development of the theory and application of McMinn and Campbell’s 3 tiered Integrative model of persons and change. Now, in chapter 10, we arrive at the deepest and least objective level of change that takes place in counseling: therapeutic relationships. While some problems can be dealt with through skills and behavior change and other problems can be dealt with by exploring core beliefs and schemas, there are some core or “soul” problems that are best handled by being in a healing relationship. We’ll get to what that means in a moment…

The authors begin to tackle the problem of personality disorders. They describe how we all have personality styles, how some of those styles turn into problems (unthoughtful engagements with others), and how some turn into full-blown disorders (“defined as consistent patterns of behavior, evident since childhood or adolescence, which impair social functioning and cause significant distress to self or others.” (320)).

Functionally, some people are unable to step back from their assumptions and schemas and consider alternative perspectives. Such a person experiences their life but has a hard time observing their life without being sucked into negative experiences (see inset on p. 322). The therapist’s job is to try to maintain a relationship, focusing on the here and now (the relating that is going on between the counselor and counselee) in order for the counselee to gain new experiences and thereby develop a greater capacity to step back and see self.  “The working assumption of relationship-focused IP is that relationships change people” (p. 324).

Then the authors give a little summary of key personality theory by reviewing Freud, Horney, Stack Sullivan, and family systems models regarding how interpersonal patterns develop. They conclude by saying that our interpersonal patterns, “are formed early in life as a means of reducing interpersonal anxiety, maintaining a consistent perception of self in relationship to others, and as a means of stabilizing family life” p. 331). 

McMinn and Campbell dig deeper to ask the question: how is it that these developing styles become rigidly used? How is that an early experience get “re-enacted” in adult life? They turn to 3 theories:

1. Interpersonal Process Approach. Unmet needs leads to anxiety which leads to internalizing negative feelings about the self which lead to treating others the same (ad nauseam). These interactions continue because they are familiar and they “work” for us by reducing anxiety (we can make sense of the world and they work to some degree).

2. Cyclical Maladaptive Patterns. A cycle develop that is played out in every relationship. These cycles are organized into 4 parts: acts of the self, expectations of others’ reactions, acts of others toward the self, and acts of the self toward the self (p. 335).

3. Reciprocal Role Procedures. As a person grows, they “develop more sophisticated ideas of where self ends and other begins. The growing child learns ways of relating with the other so as to maintain attachment between the I and the Thou….But each of these roles is reciprocal; that is, they are met with a response on the part of the other.”

Is there a Christian perspective on personality problems? The authors explain their take on the creation (that we are created to be in relationship) and fall (that because of our tendencies to use relationships for our own pleasures, self-deception, sins against us) we form patterns of how we see ourselves (usually victims). And finally, they briefly explore how redemption means experiencing safety and grace now in a manner to “reform faulty interpersonal patterns.”

My thoughts.Here the authors inject dynamic models of relating into the development of a mostly cognitive model–up to this point. They rightly recognize that we develop much of our sense of self in early stages of life and then cement those views in an on-going way–even when we hurt ourselves with those views. And true, we often see ourselves as victims. What is hard is to see that we are both victim AND victimizing at the same time. Unfortunately, they used up their space in the chapter in talking about how interpersonal processes can be broken without much theorizing about how and why present, positive interpersonal experiences change us and shape our constructs of self and why they change so slowly. It is somewhat easy to point out that our acting on and being acted on shapes us when we are vulnerable. But what happens in the now that enables us to open up and reconsider our identity without feeling like we lose ourselves?

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