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Integrative Psychotherapy III

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

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

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

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

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

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

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

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

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

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

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Integrative Psychotherapy II

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

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

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

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

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

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

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


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