- 01. Introduction
- 02. Five Views/Five Factors
- 03. A Nuanced Transformational Approach
- 04. Priorities & Initial Impressions
- 05. Assessment
- 06. Conceptualization
- 07. Treatment Plan and Techniques
- 08. Table 1: Biblio-therapeutic Resources
- 09. Blending of Counseling and Christian Spiritual Formation
- 10. Evaluation and Follow-up Care
- 11. Conclusions and Recommendations
- 12. References
The task in this chapter is to present a “behind closed doors” view of one of the five major counseling perspectives at the interface of Christianity and psychology—Transformational Psychology. This will be accomplished by displaying its distinctives when applied to the case of Jake as presented earlier. While this sounds fascinating, I need to ask the reader to be patient with my attempts to make Transformational Psychology more concrete. There are numerous reasons for this request. I will highlight the three most obvious. (1) Transformational Psychology is the most recent invitee to this multi-view discussion; (2) In fact, this “approach” to the relationship between the social sciences and Christianity that I will be attempting to represent was not formally recognized until the authors—and my friends—John Coe and Todd Hall labeled it in Psychology & Christianity: Five Views;John H. Coe and Todd W. Hall. “A Transformational Psychology View.” In Eric L. Johnson, ed. Psychology and Christianity: Five Views. Downers Grove, IL: InterVarsity Press, 2010, 199–244. (3) While my own approach to relating Christian spiritual formation with the professional practice of counseling and psychotherapy shares much in common with that of Coe and Hall, the reader will observe many dissimilarities—and a few occasions of outright disagreement. Indeed, I would be more comfortable simply presenting an approach that views matters of soul and spirit as integral or essential to working with the person. With those confessions on the table, we will begin.
For more than twenty years I have taught in two seminaries and two “integration” programs. My primary teaching has been in the area of merging professional practice with a Christian world view. In addition, I have been somewhat obsessed with looking for professionally appropriate ways to incorporate insights from the long history of spiritual direction literature into a counseling setting.Gary W. Moon, and John W. Fantuzzo. “An Integration: Christian Maturity and Positive Mental Health.” Journal of Psychology and Christianity, 2(1) (1982), 29–38; Gary W. Moon, “Christian Counseling: You Can Go Home Again,” The Christian Journal of Psychology and Counseling, 7(3) (1993), 12–16; Spiritual Directors and Christian Counselors: Where Do They Overlap? Christian Counseling Today, Winter (1994), 29–33; Homesick for Eden: Confessions about the Journey of a Soul (Franklin Springs, GA: LifeSprings, 1996); Spiritual Direction: “Meaning, Purpose, and Implications for Mental Health Professionals.” Journal of Psychology and Theology, 30(4) (2003), 264–265; “Which is More Important in Psychotherapy, the Manual or the Therapist?” Christian Counseling Today. 14.4 (2007), 51; Apprenticeship with Jesus: Learning to Live Like the Master (Grand Rapids, MI: Baker Books, 2009); “Moving Out of the Slums of Academia.” Christian Counseling Today, 17.1 (2010), 62–63; Gary W. Moon, Dale E. Willis, Judy W. Bailey and John C. Kwasny. “Self-Reported Use of Christian Guidance Techniques by Christian Psychotherapists, Pastoral Counselors, and Spiritual Directors.” Journal of Psychology and Christianity, 12(1) (1993), 24–37; Gary W. Moon, Judy W. Bailey, John C. Kwasny and Dale E. Willis. “Training in the Use of Christian Disciplines as Counseling Techniques within Christian Graduate Training Programs” in Everett L. Worthington, Jr., ed., Psychotherapy and Religious Values, 191–203. Grand Rapids, MI: Baker House, 1993; McMinn, Mark R., Gary W. Moon, and A. G. McCormick. “Integration in the Classroom: Ten Teaching Strategies.” Journal of Psychology and Theology, 37(1) (2009), 39–47.
I read the wonderful book, Psychology & Christianity: Five ViewsEric L. Johnson and Stanton L. Jones, ed., Psychology & Christianity: Five Views (Downers Grove, IL: InterVarsity Press, 2010)., with much pride in this new “discipline” of relating psychology and Christianity. I was greatly impressed by the wisdom and professionalism expressed by the contributors and by how far the “movement” has traveled in such a short time. But I also read the book with a tinge of sadness over what sometimes continues to appear as silo construction, which, I believe, must eventually come down if significant advancement is to be made in this important endeavor. So be forewarned, I am riveted to the possibilities of attempting to see almost everything in terms of both/and as opposed to either/or; and for me this even applies to the notion of assimilating both modern and post/pre-modern views.
As you recall from the first chapter of this book and Warren Brown’s “Resonance Model,”Warren S. Brown, “Resonance: A Model for Relating Science, Psychology, and Faith.” Journal of Psychology and Theology, 23(2) (2004), 110–120. John Wesley talked about the church deriving its stability from a dynamic interplay of four forces: (1) Scripture, (2) tradition, (3) reason, and (4) spiritual experience. I was delighted to see these references—and for the “integration” (a fifth force) implied. I also think Wesley was on to something quite profound. I am certainly very glad he did not pit one member of that quartet against the others. Indeed, I believe that it is only through such a “dynamic interplay” that eventually a “sixth view”—an “integral” view, an integration of radical inclusivism—can be discovered. But in the mean time I will try to describe an approach to counseling that lives somewhere between explicit integration and “transformational psychology.”
02. Five Views/Five Factors
I learned something from my mentor and expert in the area of factor analysis, Richard Gorsuch. Most things that psychologists examine are far too complex to be explained by a single variable or even a single cluster of variables, a factor. His book, Factor AnalysisRichard L. Gorsuch, Factor Analysis, 2nd ed. (Hillsdale, NJ: Laurence Erlbaum Associates, Inc. Publishers, 1983). was very well received—and may be the only serious tome on that topic to examine the Pentateuch using a factor analytic approach for investigating the sources of the text. But what has stuck with me from spending time with both text and author is the need for multiple factors to account for the maximum variance among variables.
Given the enormous complexity of the present “y” in question in our discussion—improved functioning of a human being—I (along with several of my colleagues in this text) believe that a far better approach than “picking a winner” among the five approaches we are studying, would be to work toward a deeper understanding for how each of these five approaches might represent a different factor of predictability and help. To consider this analogy, what if accounting for our desired changes in “y” might best be served examining the additive role that each of our approaches can play? That is, given the following equation: (y) = a + b1x1 + b2x2 = b3x3 = b4x4 = b5x5 + e; positive changes in “y” may be associated with each of our five approaches (x1 through x5) but with different weights/magnitudes (b1 through b5) across a variety of different circumstances (e.g., presenting problems, client openness to explicit integration, etc.).
As suggested above, one of the reasons I struggle with the notion of forming a clear allegiance with any one of the approaches—including “Transformational Psychology”—is that I have found over time it is the circumstances of the client situation that suggest when the strengths of a particular approach, or multiple approaches should be brought in to serve the client. With a nod to Wesley, it is a variety of variables which determine when approaches leaning on Scripture (Biblical counseling), tradition (Christian psychology), reason (levels of explanation), spiritual experience (Transformational psychology), or synthesis (Integration approach) receive the most weight of emphasis.
However, even with my own leanings toward inclusivism, I have long felt that explicit models for incorporating insights from spiritual direction into treatment models (e.g., a transformational approach) have been somewhat neglected from the discussion. So, I read John Coe and Todd Hall’s chapter on Transformational Psychology in Christianity and Psychology: Five ViewsJohn H. Coe and Todd W. Hall. “A Transformational Psychology View.” with great interest. For almost twenty years I’ve felt like something of a voice in the wilderness.Gary W. Moon, “Training Tomorrow’s Integrators in Today’s Busy Intersection: Better Look Four Ways before Crossing.” Journal of Psychology and Theology, 25(2) (1997), 284–293; “Psychotherapy and Spiritual Direction: Reflections and Cautions on the Integrative path.” Christian Counseling Today, 11.4 (2003), 32–38; Falling for God: Saying Yes to His Extravagant Proposal (Colorado Springs, CO: Shaw/WaterBrook, 2004); Spiritual Direction and the Care of Souls: A Guide to Christian Approaches and Practices (Downer Grove, IL: InterVarsity Press, 2004); Apprenticeship with Jesus: Learning to Live Like the Master. (Grand Rapids, MI: Baker Books, 2009); “Moving Out of the Slums of Academia.” Christian Counseling Today, 17.1 (2010), 62–63; Gary W. Moon, Judy W. Bailey, John C. Kwasny and Dale E. Willis. “Training in the Use of Christian Disciplines as Counseling Techniques within Christian Graduate Training Programs” in Everett L. Worthington, Jr., ed., Psychotherapy and Religious Values (1993), 191–203. Grand Rapids, MI: Baker House, 1993. I applaud John Coe and Todd Hall for boldly making a case for: (1) the importance of the spiritual development of the counselor, (2) the potential benefits of learning to live more and more moments of one’s life “in Christ,” (3) a biblical view of the person, and (4) underscoring the importance of letting the realities of the object being studied (in this case the person) dictate the method of study.
However, as presently stated, I find their agenda a bit too ambitious, optimistic and somewhat exclusive of the other four positions. Specifically I am concerned with: (1) the claim to rethink the very nature of science itself, (2) apparent leanings toward elitism in the way it applies the concept of the need for the psychologist to be transformed, and (3) the lack of articulation concerning how it offers a clear, distinctive and practical application to the process of Christian counseling.
03. A Nuanced Transformational Approach
You may be thinking, is this the Transformational Psychology chapter or not? That is a fair question. As you have likely discerned, I would feel very comfortable writing from an “Integration” perspective which had a primary focus on the potential interplay between modern applied psychology and spiritual formation in working with certain client populations and certain presenting problems. David G. BennerDavid G. Benner, Care of Souls (Grand Rapids, MI: Baker, 1998). might call such a model a spiritually sensitive approach to psychotherapy. I would also be comfortable writing from an “Integral” perspective which would present the soul and spirit as essential to the functioning as a human being.
With that said, let me provide a few nuances to the Transformational Psychology approach as it relates to how I would work with a client and then I will actually get down to the intended business of this chapter.
Six streams as an example of inclusivism
I have been deeply impacted by the organization Renovaré in general and the writings of Richard J. Foster and Dallas Willard in particular. The mission of Renovaré is “to provide individual churches and their members with a ‘balanced, practical, effective small-group strategy for spiritual growth.’” Part of this “balanced” approach includes the study and celebration of six of the great traditions of Christian faith: Contemplative—the prayer filled life; Holiness—the virtuous life; Charismatic—the spirit-empowered life; Social Justice—the compassionate life; Evangelical—the word-centered life; and Incarnational—the sacramental life. Far from pitting one tradition against another, the aim is to draw from each in a similar way that a nutritionist would encourage a person to eat a balanced diet that takes from each of the major food groups.
For me, in a similar vein of inclusivism, a nuanced Transformational Psychology approach will maintain a primary focus on personal spiritual transformation—for both the counselor and counselee—while looking for ways to incorporate insights and techniques from each of the five approaches presented in this text: levels of explanation, biblical counseling, Christian psychology, transformational psychology, and integration.
Willard’s model of the person
In a recent article,Gary W. Moon, “A Tribute to Dallas Willard: My Favorite Psychologist.” The Journal of Spiritual Formation and Soul Care, 3(2) (2010), 267–282. I made the case for Dallas Willard—a philosopher by training and practice—being my favorite psychologist. One of the reasons for my praise of this sage of spiritual formation as a “psychologist” was for the help I have received from his writings for understanding in bringing the entire “person” into sharper focus. In Renovation of the Heart: Putting on the Character of Christ, Willard proposes there are six basic aspects of a human being, which together and in interplay make up “human nature.”Dallas Willard, Renovation of the Heart: Putting on the Character of Christ (Colorado Springs, CO: NavPress, 2002), 30. You may find it helpful to think of this model as a “BASIC-ID”Arnold A. Lazarus, The Practice of Multimodal Therapy: Systematic, Comprehensive and Effective Psychotherapy (Baltimore, MD: Johns Hopkins University Press, 1989).—but with a soul.
- Thought (images, concepts, judgments, inferences)
- Feeling (sensations, emotions)
- Body (action, interaction with the physical world)
- Social Context (personal and structural relations with others)
- Spirit (choice, will, heart, decision, CEO of the person)
- Soul (the factor that integrates all the above into one life)
In this model (please see Figure 1), we are presented with not only the components of the person but also the only five things a human being can do. Humans can think, feel, behave, interact with others, and choose. Spirit/will/heart is the center or core of a person’s life and may be called the “ego”—especially when functioning separately and apart from God as the source of life.I hope I am not being confusing here; I believe that we both need a healthy ego and that as part of a Christian’s journey of experiencing a greater sense of union with God, we need to lay it down. In this sense I am using “ego” to represent what is being called the “false self,” or that aspect of the person which is holding on to the notion that a life separate from God is good and desirable. I am not using ego in a technical sense. “Choice” is perhaps the best one-word encapsulation for the activity of this spirit/will/heart dimension. It underscores the most fundamental decision faced by humanity. Like their fore-parents, Christians, I believe, awaken each day to the choice of living in an intimate, conversational, and communal relationship with God, or of initiating and maintaining a separate existence. The spirit/CEO’s critical decision is between willingness, surrender, and obedience versus willfulness, autonomy, and separation from the Source of life.
According to Willard, the soul, as distinguished from the spirit/CEO, can be viewed as the invisible computer that keeps everything running and integrated into one person. The soul is the aspect that integrates all of the components of the person to form one life. The soul, Willard pens, “is that aspect of your whole being that correlates, integrates, and enlivens everything going on in the various dimensions of the self. It is the life center of the human being.”Dallas Willard, Renovation of the Heart: Putting on the Character of Christ (Colorado Springs, CO: NavPress, 2002), 199.
Willard’s model of human functioning provides a holistic way of conceptualizing and working with individuals that easily embraces abnormal psychology, positive psychology, and the soul/spirit. That is to say, each component (think “cognitive” aspect as one illustration) can be focused on for the purpose of (1) improving maladaptive functioning (e.g., reframing and restructuring thought patterns that lead to negative outcomes); (2) increasing positive outcome (e.g., strengthening and enhancing existing thought patterns that support positive functioning); and (3) enhancing Christian spiritual formation (e.g., examining an individual’s views and concepts of God for the purpose of facilitating the process of learning to live more moments “with” God). Now, that is a psychology that excites me and it is certainly one that informs my application of a Transformational psychology.
Jesus is very smart.
For most of my professional career I created a hierarchy of value for the various “schools” of psychology based on how closely they resembled the natural sciences. Neuropsychology and the biological explanations of behavior were at the top, closely followed by behavioral and cognitive approaches. I gave some credence to person-centered approaches as a safe way to spend time with clients before the “real psychology” could be brought in, and I tolerated the existence of Freudian approaches in a manner similar to the way I would tolerate a beloved, senile grandparent.
At the same time, I came to accept the Western view that the term “knowledge” should be reserved for subjects like math and the natural sciences. Religion—even Christianity—dealt in matters of faith, belief, and profession, but not knowledge. Indeed, how could one make a “leap of faith” if one’s faith were grounded in actual knowledge?
Recently, however, a slow change in my way of thinking has percolated to the surface and now causes me to believe that I have been dramatically short-changing what Jesus has to offer. I believe it is time for me—and perhaps others who are attempting to relate psychology and theology—to reposition faith in Jesus Christ and the ability to live interactively with him back within the category of knowledge. I am confessing that before encountering Willard’s line of thinking, I had not given Christianity its rightful place at the table as a source of not merely belief and practice, but knowledge.
As just one example, consider afresh for a moment the following table, which presents the four most fundamental worldview questions in the universe: (1) What is real? (2) Who is well off? (3) Who is a good person? and (4) How do I become one?Dallas Willard, Knowing Christ Today: Why We Can Trust Spiritual Knowledge. New York, NY: HarperCollins, 2009.
|(1) The Reality Question:
The foundational part of a worldview is always what it considers to be real—what is reality?
|God and his Kingdom; that is what you can count on and what you have to come to terms with.
|The measurable physical universe.
|The physical universe—including the unseen subconscious mind.
|(2) Who has it made?
The reality question is joined at the worldview level with the question of well-being. Who is well off?
|Anyone who is alive in the kingdom: that is, anyone who is interactively engaged with God and the various dynamic dimensions of his reigning. Such engagement with God is an eternal living, an eternal life.
|Anyone who is able to live with as many pleasant events as possible while living free from physical pain
|The person who is maximally in touch with his or her unconscious and able to live an examined life
|(3) The Character Question:
Who is a really good person?
|Anyone who is pervaded with love
|Anyone who on a personal and corporate level seeks to minimize pain and maximize pleasure for self and others
|A person who seeks to understand the self and help others do the same
|(4) The Development Question:
How does one become a genuinely good person?
|You place your confidence in Jesus Christ and become his student or apprentice in kingdom living. That amounts to progressively entering into the abundance of life he brings to us.
|You learn to shape your environment in such a way that you minimize the cause of pain in others.
I have become convinced that Jesus offers a source of exquisite knowledge to life’s most important questions and that his answers deserve—at minimum—equal attention to that received by psychology’s pioneers. I also believe that profound psychological good could be accomplished by moving this knowledge from the academic slums to the ivory towers. The mental health benefits of becoming a person pervaded with love are simply too enormous to ignore, as is the possibility of living more and more moments of each day in firsthand interaction (knowing by acquaintance) with Jesus and his kingdom.
Training implications of a three-legged stool
In a similar fashion as McMinn,Mark R. McMinn, Psychology, Theology, and Spirituality in Christian Counseling (Carol Stream, IL: Tyndale House, 1996). I have come to believe that the best training program for producing “transformational psychologists/counselors” would resemble a three-legged stool. That is, I have envisioned the training to be composed of three primary domains with each receiving about one third of the curriculum space. The three areas would be: (1) Professionally sound and respected training in a mental health discipline; (2) classic models of spiritual direction (Orthodox, Benedictine, Ignatian, etc.); and (3) the best from a body of modern evangelical thought which presents a high and explicit Christology.
Please understand, I am not saying that the boundaries between these domains should disappear and spiritual directors should start asking questions about a directee’s defense mechanisms, prescribing medication and giving personality tests. God forbid. And God forbid a psychiatrist should start assuming that all major depressions are dark nights of the soul or writing prescriptions to pray. However, I have come to believe that a tri-lingual and tri-cultural (a person fluent in the language and culture of counseling, classic models of spiritual direction, and Christ centered approaches to spiritual transformation) could do a stellar job of working with one individual in ways that respect the ethical boundaries of each of those professions while also realizing the holistic nature of the individual. I have come to believe that it is time for new training programs that are no longer artificially hamstrung by the somewhat artificial confines imposed by the reductionisms of modernism.
All the roulette wheels must be considered.
In addition to the four nuances for a transformational psychology that I have discussed above, I will offer one final distinction before addressing our case study. The extent to which concepts and techniques from spiritual formation will be integrated into my work with a particular client will be dependent on where at least six “roulette wheels” stop spinning.
- It begins with me—training: The “spiritual interventions” I provide are first and foremost informed by my own level of training in this area of practice.
- It begins with me—formation: I will not attempt to lead a client down roads I have not walked.
- Client and setting: I will only consider “spiritual approaches” for clients who have given informed consent and who are requesting such interventions. Secondly, I will not go beyond the boundaries appropriate to the setting in which I am practicing.
- Presenting problem: The client’s presenting problem will have a huge impact on the decision to offer a spiritual insight or intervention. The diagnosis of enuresis might eliminate—pun intended—such an intervention.
- Stage of the relationship: While I will say more about this, I am inclined to draw from the discipline of spiritual direction in the latter—as opposed to earlier stage of the therapeutic process.
- Empirical “permission” for using techniques from formation field: I am more inclined toward such explicit integration if I can find supportive evidence in the psychological literature.
Against this backdrop, let’s now turn our attention to the case study.
The Case of Jake
04. Priorities & Initial Impressions
Consultation with the counselor
In consulting with the new counselor I would affirm that this is not a “simple case of adjustment to college life ‘blues,’” nor does it appear to be primarily “a rather severe case of ‘academic anxiety.’” I would also let her know that it may “take a village” of mental, medical and spiritual health professionals to appropriately attend to all the needs the Jake presents.
While I’m uncertain as to whether Jake will need a very intensive outpatient intervention—and possibly a brief in-patient stay for safety and evaluation—we will assume for now that Jake is being seen in a private practice setting in close proximity to his college. We will also assume that in addition to appropriate release of information documentation there will be informed consent concerning the fact that Jake will be seen by a licensed mental health professional who is also a Christian and, if the client so chooses, is willing to explore Christian resources as part of the counseling process.
Essential presuppositions and priorities
An immediate priority surpasses all presuppositions: Is it safe for Jake to leave the counselor’s office? Records indicate that he has made several references to self-harm. While, according to the records, these were “loose and without threatening details such as driving a car into a wall at a high speed.” He has stated that “he has a recurring desire to no longer live the life he is living,” and has made the additional statement, “If I can’t make it here I might as well get blown into oblivion.” Given these statements, his lack of social engagement, potential indicators of depression and “signs of impulsive tendencies and decisions,” my initial recommendation is to do some brief screening measures (a standard suicide assessment checklist, and Beck Depression Inventory II,Aaron T. Beck, Robert A. Steer, and Gregory K. Brown. Beck Depression Inventory, Second Edition (San Antonio, TX: Harcourt Brace, 1996). to get a better handle on Jake’s level of depression and suicide risk. It is not comforting to note the possibility of suicide in the death of Jake’s father.
From a more global perspective, my primary presuppositions are captured in Willard’s model of the person that has been presented. I am assuming that Jake is a non-ceasing spiritual being who will likely benefit greatly from aligning himself with the creator of the universe in an ongoing and transforming friendship. However, it is likely that such discussion will not be the primary focal point of the initial evaluation process. Jake is also a decaying earthen vessel and appears to have many prominent areas of maladaptive functioning in the other, less ephemeral, aspects of his person.
Definition of health and pathology
In the ultimate sense I believe a person is most healthy when s/he is living in as close an alignment as possible to God; and I think that Jesus’ use of the imagery of living in the Kingdom of God, the Apostle Paul’s repeated use of the phrase “Christ in you” and the early church’s view of salvationKallistos Ware, The Orthodox Way (Crestwood, NY: St. Vladimir’s Seminary Press, 1995). as being on a path toward union with God are three helpful ways to describe this process toward ultimate soul health. In fact, I believe Jesus summarizes this ideal state in John 15:5 (NIVAll Scripture quotations are taken from the Holy Bible, New International Version®, NIV®. Copyright ©1973, 1978, 1984, 2011 by Biblica, Inc.™ Used by permission of Zondervan. All rights reserved worldwide. www.zondervan.com The “NIV” and “New International Version” are trademarks registered in the United States Patent and Trademark Office by Biblica, Inc.™): “I am the vine; you are the branches. If you remain in me and I in you, you will bear much fruit; apart from me you can do nothing.”
I further believe that learning to live a life of trusting submission to the will of God on a moment-by-moment basis, alive with the energy, power and presence of God, is a picture of healthy functioning. A life lived in transforming friendship with the Trinity (John 17:3) should have a positive impact on all other aspects of the person—thinking, feeling, behaving, relating, choosing. By contrast, spiritual pathology is living life separate and apart from God. Pathology thus defined—so common, I believe, even among Christians as to be considered “normal” functioning—is living life out of our false or “ego” self. Pathology is living unplugged from the “Tree of Life.”
Having said that, I am doubtful that such lofty language will be very helpful to Jake during the initial sessions. Other pathologies are practically defined by the DSM-IV-TRAmerican Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised, Text Revision. Washington, DC: American Psychiatric Association, 2000. as maladaptive functioning resulting in a disruption of social, vocational or emotional functioning. The first priority for Jake’s counselor will be the examination of his health and pathology from this reference point while also considering ways of introducing additional and alternative approaches to healthy functioning.
When do problems need counseling?
Problems need counseling whenever there is maladaptive functioning with any or all aspects of the person help is needed and may be requested. It is the presenting problem, the scope and nature of the counselor’s training, and a variety of client factors—including genuine motivation for change—which will help determine if the counselor is equipped to handle working with the client in the domains of maladaptive cognitions, behaviors, emotions, relationship, and also in the domains of spirit (e.g., will, heart, choice), and soul.
How are problems for counseling categorized?
With this case study I am concerned with the following questions: (1) Is it safe for Jake to leave the office? (2) What is the diagnosis (conceptualized first in DSM categories)? (3) Is the counselor (and am I) the right person to be working with Jake and what appropriate referrals may be needed? (4) Does the client have sufficient motivation to enter into counseling in a meaningful way? (5) What are the indications that a “spiritual” intervention (from discussion about Jake’s “God view” to more explicit discussion of where Jake is concerning entering into a transforming friendship with God) may be important to working with Jake?
How do you distinguish counseling and spiritual direction?
It is tempting to offer the succinct answer that: (1) Spiritual direction has an emphasis on enhancing one’s awareness of God’s presence and facilitating a journey toward spiritual health through increasing discernment and the practice of a variety of classic spiritual disciplines toward the end of experiencing union with God; and (2) Counseling has an emphasis on enhancing one’s awareness of self and facilitating a journey toward psychological health through the use of classic counseling techniques toward the end of seeing improvements in patterns of thought, behavior, and relationship. However, I have come to view the spiritual aspects of the person as far too integral (essential) to other domains of functioning to continue making that distinction—which now feels artificial. I now believe that distinctions between counseling and spiritual direction are more about training and turf than about the person.
What makes a person change?
According to one version of the old joke, “how many counselors does it take to change a light bulb?” the answer is: “Only one, if the bulb really wants to be changed.” I’m afraid there is much truth in that quip. Client motivation to change may be the single most important predictor of positive outcome. I would place that variable just ahead of the counselor’s ability to embody key non-specific therapeutic factors of a warm, genuine, and empathetic relationship.
However, if pressed to answer the question, “what makes a person change?,” I would have to say that the two primary “motivators” are pain—when it leads to a willingness to abandon maladaptive and self-defeating patterns of behavior—and love—when a client truly believes that another (God, the counselor, a significant person) truly desires for him or her what is good. Jake’s pain will hopefully increase his motivation to do the hard work of counseling and I hope that the counselor will be able to model some small measure of the type of love the Trinity feels among Its members. I would also hope to encourage Jake’s counselor to help him wrestle with the following questions: (1) what can I learn from my pain? (2) am I at a place of possible metanoia—am I ready to start rethinking my thinking: and (3) can I imagine a God who truly desires for me what is good?
What are the goals of counseling?
At the risk of sounding grandiose, the goal of a nuanced transformational psychology model is for the client to re-connect with God in a deep and profound way. The ultimate goal is perhaps captured best by the verse we would have explored, the only place in Scripture where Jesus defines eternal life (John 17:3). The goal is for the client to enter into a transforming friendship with the members of the Trinity, to deeply “know” God, Jesus and the Holy Spirit. To state the obvious, such an explicit spiritual goal does mean that the client must be both informed and desirous of such an intention.
The ultimate hope for Jake is vividly portrayed in the dynamic, pre-fall relationship of Adam, Eve and God in the Garden of Eden—to be in love with God and others, alive in a community of self-forgetful love. The ultimate goal is nothing short of the experience of union with God, as defined by the client’s ability to have an experiential awareness of more and more moments living life with God while experiencing love for God and others. Prominent among my goals/hopes for Jake will be for him to be able to experience theology in a way that makes a difference in how he begins to live his life.
07. Treatment Plan and Techniques
Intake and evaluation
While the intake process should be very standard (with a focus on presenting problems, history of presenting problems [e.g. onset, impairment to functioning, recent interventions, explanation of causation], psychiatric/counseling history, family history, social history, medical history, and a mental status exam), I would encourage the counselor to ask a number of additional questions (e.g., those of a spiritual nature) if Jake has consented to a method of counseling that would be a blend of professional counseling—with the focus on the client’s emotions, thoughts, behaviors, relationships—and spiritual formation/direction—with a sensitivity to matters of the spirit and insights from spiritual theology. For example, I would want to know more about the positive and negative roles religion has played in Jake’s life, and how he has viewed God at various points in his life. I would also want him to feel free to encourage or to veto any “God talk” during the counseling process.
Jake’s situation is very complex. As the counselor works through the intake and evaluation and consider additional testing, I would encourage her to be very aware that in addition to a potpourri of maladaptive dynamics within Jake’s social and family history, there are a number of concerns and diagnoses that will need to be ruled in or out. Among these are: (1) possible suicidal ideation, (2) impulsive actions and decisions, (3) social isolation (4) possible mood disturbance, (5) substance use/abuse, (6) possible Post-Traumatic Stress Disorder, (7) neurological impairment from a significant head injury, (8) mixed personality disorder which seems to include prominent antisocial traits, and (9) malingering—“need to keep disability funds flowing.” Each will need to be ruled in or out.
It is likely that I will strongly suggest a referral to a neuropsychologist to better understand the severity of Jake’s head injury. This referral may also provide information concerning Jake’s preferred learning style and potential learning disability. A referral should be made to a psychiatrist both for diagnostic clarity and medication management in the areas of a possible mood disorder and post traumatic stress, and Jake should continue meeting with a psychiatrist during his counseling. Also Jake will be encouraged to reestablish involvement with an Alcoholics Anonymous (AA) program.
Jake’s therapist might follow a classic pattern for counseling developed by Gerald Egan,Gerard Egan, The Skilled Helper: A Model for Systematic Helping and Interpersonal Relating. (Monterey, CA: Brooks/Cole, 1975); The Skilled Helper: A Problem Management and Opportunity Development Approach to Helping (Belmont, CA: Brooks/Cole, 2009). moving through various stages which could be labeled, exploration, understanding/ insight, and change. I would likely add a fourth stage which may look to some more like traditional spiritual direction than professional counseling. Each of these stages would focus on the aspects of Jake’s life/personhood which include his patterns of emotion, thought, behavior, relationships and volition—including how these aspects of his life include God and the spiritual aspects of his life. In sum, the work with Jake will primarily be concerned with journeying with Jake through the numerous individual, community, academic and family issues he is facing while looking for possibilities for enhancing his relationship with God.
Phase I: Exploration
Against the backdrop of a solid initial evaluation, and assuming Jake’s agreement to and active participation in referral suggestions (a very big assumption), he would settle into an ongoing counseling relationship. During the initial work with Jake, the overarching goal will be to develop a therapeutic relationship and an environment where Jake will feel safe, cared for, and free to share openly and transparently. Stress will be placed on the counselor’s ability to feel and express the crucial non-specific factors—warmth, genuineness, acceptance, hope-instilling—of a good therapeutic relationship. Spiritual factors are important, but, at least initially, these will primarily center upon nurturing her own relationship with God, and hopefully, becoming a better conduit for grace to Jake.
During the time of exploration I will encourage the counselor to be with Jake and gently foster discussions about the key relationships in his life. She will be encouraged to walk with him as he relives many events from the highlight reel of past times with his father, mother, sister, significant peers, teachers and others who have molded his life. To facilitate this process—by extending the exploration to outside the counseling hour—a memory exercise may be useful. This exercise involves asking Jake if he is willing to do some work outside of our sessions.
If agreeable, the counselor would ask Jake to visit one of his favorite places for being alone (library, park, McDonald’s etc.) at least two times between sessions. She would ask him to take a note pad (or laptop) and simply sit in silence and allow memories to come to him from various time periods of his life. In subsequent weeks she would systematically walk through Jake’s life, allowing him to progress at a pace that feels comfortable. A portion of these early sessions would be devoted to Jake leading her through the significant memories of his life with the counselor simply facilitating a “Rogerian” exploration. The primary “God Views” (the ways that he has come to view the Divine) that have colored his spiritual life would also be explored.
The exploration together would also extend beyond key family and peer relationships in Jake’s life to critical themes raised during the intake and evaluation sessions. In addition to monitoring his progress and following through with neuropsychological testing, sessions with his psychiatrist, and attendance at AA meetings, a variety of themes would be explored. These would include but not be limited to: (1) Suicidal ideation—including the exploration of the spiritual implications of making a decision to end one’s life, (2) mood monitoring, (3) any apparent patterns of impulsive behaviors and decisions, (4) social isolation, and (5) possibilities of secondary gain.
As Jake feels comfortable with the counseling relationship, I would encourage him and his counselor to explore key religious and spiritual themes that would include his statements about: (1) being “hungry to grow in his faith,” (2) how he feels toward a God who is not readily “fixing” all his problems, (3) how his mother’s “holly roller” faith may have colored his own, (4) the positive relationship he had with the Army Chaplain, (5) any anger he may be feeling toward God, (6) his feelings for his former girlfriend and young daughter, and (7) his view of God during what Jake would consider to be the key events of his life.
Concerning key questions, such as those listed above, the use of the “empty chair technique” can be helpful to the process of exploration. While Jake may be invited to put any of a number of primary characters in the chair, it may prove particularly helpful for him to have many conversations with God. Particularly whenever Jake makes an emotional reference to God, I would encourage his counselor to have Jake place Him in an empty chair and enter into an in-the-present-moment conversation. The counselor will need to avoid putting words in God’s mouth and simply facilitate the dialogue. With this simple technique much can be learned about Jake’s perceived I-Thou relationship with God—especially as this relates to whether Jake has a healthy or unhealthy view of his Maker.
Phase II: Understanding
Sometimes a climate of exploration is all that a client needs, though this may not be true for Jake. As is often the case, many clients need help in “unpeeling the onion” of maladaptive patterns of thought, emotion, behavior and relationship. For this reason, as a counselor, I often add dimensions of interacting to my Rogerian core—for the purpose of facilitating insight/deeper understanding of the persistent patterns in one’s life. During the “middle” phase of working with a particular client the emphasis will often shift to the counselor’s use of self-disclosure, immediacy, probing questions, and some gentle challenges to maladaptive patterns.
In the understanding phase of working with Jake—and assuming a strong therapeutic relationship has been established—I will encourage the counselor to bring a prominent theme into play. Most succinctly stated, I will want her to examine how his current and past patterns of thought, behavior, relationship, and choice are working for him. That is, she will try to help him examine just how well his “self-protective-ego-self” is doing in running his life. We will also be looking to see if he has picked up any patterns from his past—ways of protecting himself from pain that are often present in his life now but causing more harm than good. In short, it is important here for Jake to understand the narratives he is using to run his life and compare them to the suggested narratives found in Scripture and the life of Jesus.
As a way of facilitating the comparison of narratives, his counselor has hopefully earned enough trust from Jake for him to be willing to explore themes from “spiritual” theology. Specifically, I will want Jake to reflect on whether he sees the Trinity as a creative and compassionate community, who is inviting him to join their dance of self-forgetful love—or as something much less than the prodigal’s father (a picture of grace and love). The intent is that Jake will come to understand more about the good, the bad, and the ugly about himself—that is, the fact he has been created in the very image of God (the good), but is now separated from God (the bad) and that within him there is a great tug-of-war between his false self (that part that still believes autonomy from God is good and desirable) and true self (that part that believes the best thing that he can possibly do is give up, embrace willingness and surrender and begin a journey back home to the embrace of his prodigal—e.g., “lavish loving”—Father).
I also hope to help the counselor facilitate Jake’s view of Jesus as the most intelligent Being who ever walked the planet and to experience His invitation to live life a whole different way—alive to the realities of the Kingdom of God and the experience of Christ within. Finally, from the perspective of spiritual theology, I anticipate that part of the counseling work will involve Jake embracing the classic movements of transformation—purgation (rejecting God substitutes), illumination (embracing the ideal of union with God and the desire to move toward willingness and surrender) and union (an experiential awareness of that ideal).
I suspect that few if any of those ideals from spiritual theology are true for Jake. So, the most important thing that may happen during this phase of understanding will be to examine his current narratives concerning spiritual theology and to discuss the aspects of his life that caused them to be written in such a harmful manner.
James Bryan SmithJames Bryan Smith, The Good and Beautiful God: Falling in Love with the God Jesus Knows (Downers Grove, IL: InterVarsity Press, 2009). does a remarkable job of contrasting common core narratives used to navigate life and those of Jesus. To use but one example of this the counselor might help Jake understand whether he has developed a core narrative of distrust for God because of the negative events in his life. Is he sure that he can trust God? Has his own earthly father colored his perception of God? She might then move toward Jake beginning to understand that when Jesus describes God as “Father,” it is important to let Jesus define what this means—not Jake’s earthly father. I would hope that this insight would cause enough motivation in Jake for him to be willing to explore—through bibliotherapy—how Jesus rightly defines diving fatherhood and demonstrated trust under extraordinary circumstances.
Phase III: Change Strategies
In the best of worlds, careful attention to evaluation, assessment, case management, creating an environment conducive to exploration and the facilitation of deeper understanding and insight would be enough. And sometimes it is. However, for most clients, insights are the necessary but insufficient condition for change. For this reason a third phase in working with Jake would involve a shift of focus to the development of change strategies.
Some of these change strategies might look a lot like what my “levels of explanation” and “integrationist” friends might prescribe. It is likely that I would assist Jake’s counselor in working with Jake both in session and via homework in developing plans for monitoring and modifying maladaptive patterns of thought, behavior, choice and relationship. These could be targeted to any one of a number of areas such as: (1) impulsive actions and decisions, (2) social isolation, (3) mood disturbance, (4) substance use/abuse, (5) anxiety associated with post-traumatic stress, (6) antisocial traits, etc. In addition to these, any number of other issues may have come to the forefront over the course of our working together. But for the sake of brevity, I will only focus here on those “change strategies” that might be categorized as matters of spirit and soul.
As previously stated, I believe that the possibility of authentic spiritual formation which can result in an increasing experience of “Christ in you” or progressive “union with God” is built on the foundation of our view of God. Jake’s counselor will work to help him develop a warm, loving and healthy view of God. There are a number of resources that may be helpful to this process. (Please see table 1).
08. Table 1: Biblio-therapeutic Resources
|Renovation of the Heart: Putting on the Character of Christ (Colorado Springs, CO: NavPress, 2002)
Hearing God: Developing a Conversational Relationship with God (Downers Grove, IL: InterVarsity Press, 1999)
|Richard J. Foster
|Celebration of Discipline: The Path to Spiritual Growth (San Francisco, CA: HarperSanFrancisco, 1998)
Streams of Living Water: Celebrating the Great Traditions of Christian Faith (San Francisco, CA: HarperSanFrancisco, 1998)
|David G. Benner
|Surrender to Love: Discovering the heart of Christian Spirituality (Downers Grove, IL: InterVarsity Press, 2003)
|66 Love Letters: A conversation with God that Invites you into His Presence (Nashville, TN: Thomas Nelson, 2009)
|Spiritual Disciplines Handbook: Practices that Transform Us (Downers Grove, IL: InterVarsity Press, 2005)
|Invitation to the Jesus Life: Experiments in Christlikeness (Colorado Springs, CO: NavPress, 2008)
|Ruth Haley Barton
|Invitation to Solitude and Silence: Experiencing God’s Transforming Presence (Downers Grove, IL: InterVarsity Press, 2010)
|Conversations: A Forum for Authentic Transformation (currently being made available through Renovaré).
|DVD small group resources for Hearing God, Renovation of the Heart, Celebration of Discipline, Streams of Living Water,, and Hearing God are available through Renovaré.
The therapeutic ground already covered should provide a solid foundation for this work. Jake’s God views have been explored through the memory exercise above. There will have been an element of the incarnation in the person of the counselor and the environment that has been created. Along the way we will have sought to understand how any negative views of God may be part of maladaptive patterns in his life. But at this point, I would seek to work even more intentionally to provide Jake with a scripturally-accurate view of God and of himself, while providing some tools for increasing awareness of Divine presence—and hopefully creating a desire for spending more and more moments “with” God. Toward these ends, there are a variety of exercises Jake’s counselor might use with him. The following four are among those I use most frequently.
The counselor could ask Jake to experiment with a modified version of the Daily Examen which is part of the Spiritual Exercises of Saint Ignatius.George E. Ganss, The Spiritual Exercises of St. Ignatius: A Translation and Commentary (Chicago, IL: Loyola Press, 1992). In this modified examen, Jake would find a convenient time each day—preferably at or near the end of the day—to sit down, relax and review the previous 24 hours of his life. He would allow the times which had been the most life-giving to enter his mind. Following this, he would also allow himself to re-live the most life-taking moments of the previous day, ideally capturing these on paper to discuss in session. The theory is that the most “life-giving” moments of Jake’s day—those characterized by experiences of love, joy, peace, etc.—would be those in which he was moving with and toward God. The opposite entries, would most often involve times of moving separately and away from God. Over time the goal is for Jake to begin to pray that each new day would contain more and more moments in which he was aware of God’s presence and love.
Lectio Divina and Scripture Memorization
In class, I often have students do an exercise where they take 10 minutes to eat a raisin. The purpose is to see what can be learned about that raisin that would have been missed if eaten in 10 nanoseconds. I will want the counselor to show Jake, in session, how to slow down his reading of selected passages of scripture through using a form of devotional reading known as lectio Divina. There are many ways to approach this, but we will use a pattern of meditative reading that will provide time to approach through four movements: attending—reading as listening and silence; pondering—paying attention to the thoughts and images that arise; responding to the thoughts and images that occur; and contemplation—time in silence with God. It is possible that the counselor would ask Jake to memorize a passage of scripture—such as Colossians 3:1–17. The purposes of both the lectio and the memorization are to allow for the creation of alternative, positive views of God and the invitation to transformation.
Experiments in Solitude
It is likely that the counselor would ask Jake to experiment with the spiritual discipline of solitude. This practice could take the form of anything ranging from taking advantage of the little solitudes in the day (e.g., early morning moments in bed, slowly drinking a cup of coffee with a focus of attention on God) to spending a day or two at a retreat center.
Dallas Willard says in solitude “we purposefully abstain from interaction with other human beings, denying ourselves companionship and all that comes from our conscious interactions with others” and calls solitude: “the most fundamental of the disciplines.”Dallas Willard, The Spirit of the Disciplines (San Francisco, CA: Harper, 1988). 160. Why would he say such a thing? Maybe the answer is found in reflections by Teresa of Avila who wrote: “Settle yourself in solitude and you will come upon Him in yourself” and Richard J. Foster: “God takes this ‘useless’ Discipline, this ‘wasted time’ to make us His friend.” My hope for Jake in his practice of solitude would be that he finds within himself, Jesus, as a new friend.
Imagery Restructuring. It is also very likely that we would use the cognitive technique of guided imagery—toward the end of imagery restructuring. Tan (1996) refers to this technique as inner healing prayer and finds it particularly relevant in “situations where the client has suffered past hurts or childhood traumas,”Siang-Yang Tan, “Religion in Clinical Practice: Implicit and Explicit Integration,” in Edward P. Shafranske, ed. Religion and the Clinical Practice of Psychology (Washington, DC: American Psychological Association, 1996), 371. and goes on to describe the procedure.Tan, Siang-Yang, 372–374. Given Jake’s history with his parents—which has included rejection, abandonment and harsh criticism—and his traumatic memories from the military, he would seem to be a good candidate for this type of intervention. This particular form of prayer can be helpful in facilitating a feeling of spiritual reconciliation with God.
09. Blending of Counseling and Christian Spiritual Formation
With a nuanced transformational psychology approach, there is a blending of counseling and spiritual formation from the first encounter with the client. However, even with this approach there may come a time in the process where focus of the work has shifted to where the majority of the work would be categorized by most as spiritual direction. I have come to such a holistic view of the person—which includes spirit and soul as essential to optimal functioning—that I now believe such categorizations (e.g., this is “counseling,” this is “spiritual direction”) are far too reductionistic. Having said that, there have been times when I was working with clients where I have had to say, “What we are doing now no longer seems directly tied to the presenting issues we began with—or anything for which your insurance company would be willing to pay. I would be happy to continue working with you, if that is what you’d like to do. But it would be better if we re-defined the relationship, our goals, and how fees would be handled.”
In this hypothetical case with Jake, hopefully he would want to continue meeting with the counselor for a period of time where the entire focus was on living more and more moments of his life “with” God and the continuing journey toward union with God.
10. Evaluation and Follow-up Care
How do you know when it is time to terminate?
At the risk of sounding simplistic, I think counseling should terminate whenever the client believes that his or her goals—which will likely change and evolve over the course of the working relationship—have been reached. The goals in working with Jake have been myriad and some of them were more from a case management perspective—coordinating referrals for testing, AA/NA groups, and psychiatric care. In the latter phases of working with Jake, I would want to monitor where he felt he was concerning each of his presenting problems and the goals established for each—mood, suicidal ideation, impulsivity, social isolation, post-traumatic stress, and other patterns of maladaptive behavior. I would also want the counselor to monitor where he was in his journey toward viewing God in a manner more consistent with Scripture and his journey toward spending more and more moments “with” God. It is very possible that the counselor would offer to continue to meet with Jake on a less frequent basis—perhaps once per month—and with a more explicit focus on personal spiritual formation.
11. Conclusions and Recommendations
Eric Johnson offers a poignant quote from MacIntyre, who considers that “the person best equipped to contribute to the debate between two rival traditions [would] be trained in the discourse of both. . . . such individuals ‘are inhabitants of boundary situations, generally incurring the suspicion and misunderstanding of members of both of the contending parties.’”Eric L. Johnson, ed., Psychology and Christianity: Five Views (Downers Grove, IL: InterVarsity Press, 2010), 24. A primary consideration of my presentation concerning an approach to a nuanced version of transformational psychology is that the “boundaries” both within the “components” of the individual and across related mental/spiritual health disciplines have more to do with training than turf. I believe that a person, dually trained in a professional mental-health discipline and spiritual formation is not only capable of helping a person in a holistic manner, may well be in the best position to do so.
While the complexity of the case made it difficult to focus more exclusively on the spiritual formation elements of a transformational approach to psychology, I believe that the present case study, while purposefully broad and expansive, did help to demonstrate the possibility of working with a person in a manner that, at times, blurred traditional boundaries. I also believe the case showed the possibility that working in the area of soul and spirit would have implications for other “aspects” of that person as well.
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