The Social Context of Psychotherapy

Posted on February 25, 2008

This is my last installment of the SCP blog for February. We are continuing our discussion of Tjeltveit’s book, Ethics and Values in Psychotherapy. Although I will not be able to finish the discussion of Tjeltveit’s book on the SCP blog, I will continue a discussion of it on my blog, and readers are welcome to follow along there (www.psychologyandchristianity.wordpress.com).

In Chapter 7 Tjeltveit discusses the “social context of psychotherapy.” That is, he locates the practice of psychotherapy in the context of how it functions within society. He discusses psychotherapy’s medical heritage including bioethics and medical ethics and the two emphases of “the idea of the professional and a focus on the individual client” (p. 132). Other influences from medicine include reductionism in the form of limiting psychotherapy’s focus to a medical focus of symptom reduction. He seems to suggest that there is much more to biopsychosocial problems than merely what is understood in terms of a “medical issue”.

The other major social context in which psychotherapy occurs is business. Psychotherapy has become a “business relationship” (p. 139) in which there is an exchange of services that occurs in the context of economics (in which resources either contribute or impeded goals being met) and limited financial resources (of third-party payors, including government, insurance companies, employers, and so on). Tjeltveit observes that there is a risk of a kind of “ethical reductionism” (p. 141) to the extent that businesses “consider economic considerations alone” (p. 141).

I agree with Tjeltveit that psychotherapy occurs in the social contexts of its medical heritage and business. The challenge for Christian psychology is to reflect upon these social contexts and make intentional decisions about how Christian psychology ought to function within culture and society – to cast a vision for such innovative practice. I dare say that most Christians practicing clinical psychology and related mental health disciplines – most Christians providing psychotherapy – do so out of these social contexts but do not reflect upon the heritage or consider the implications.

Let’s think about this: How do you see these social contexts shaping the field and the practice of Christian practice for good or for ill? For example, the use of the “50-minute hour,” the fee for service model, and billing services to insurance or employers. What would a distinctively Christian psychology have looked like had it not been shaped as much as it has been by these social contexts? Are there places in our culture where this is occuring? How might we develop innovative practice in this area?

Approaches to “Values”

Posted on February 18, 2008

We have been learning about ethics from Alan Tjeltveit’s book, Ethics and Values in Psychotherapy. Last week we discussed the distinction between being an ethicist and being a moralist. In Chapter 5 Tjeltveit takes on the issues related to ways people understand “values.” He says, “We need to move beyond recognizing that ‘Therapy is not value-free’ to a well-developed understanding of the ways in which it is value-laden.” (p. 83).He then unpacks a few approaches to values (from pp. 84-85):

• values as psychological (e.g., when Skinner defines something as good based on how much reinforcement it provides; it simply describes what is valued)
• values as ethical (e.g., what ought to be valued rather than merely an account of what is desired)
• values as a means by which the powerful impose their will on the weak (an assertion, really, by those in power)
• values as choices (to be a genuine, authentic value is to have been chosen freely)
• values as authentic expressions of an individual’s nature (self-actualization)
• values as cultural and historical (context-specific)

When I first read the various approaches to values, I was struck by the variety, of course, but also what is often implicit in psychotherapy today. There are a lot of implicit assumptions about values based upon what is a genuinely free choice, what is authentic (because of our field’s emphasis on self-actualization), and, more recently, perhaps due to the influence of post-modernism, what is valued within a culture and what is imposed (by the majority, the privileged) on others (the marginalized). It isn’t always consistent, either. Nor is it taught explicitly. But these approaches to values exist in the field today and enjoy their status without having been argued for explicitly.

So what do you think? What is your definition of values? What definition of values best reflects a distinctively Christian psychology? How might one’s definition influence one’s clinical practice? Can definitions (of values) be matched with specific purposes in psychotherapy?

On Being an Ethicist

Posted on February 10, 2008

[Editor's note: Mark Yarhouse is blogging for us during the month of February.]

Let’s continue our discussion of a couple of specific and relevant concepts from Alan Tjeltveit’s book, Ethics and Values in Psychotherapy, In chapter three Tjeltveit defines an ethicist, and he makes the distinction between psychotherapist as ethicist and moralist. An ethicist is someone who has knowledge and perhaps training, who shows discernment, careful evaluation, and good judgment, and who is recognized for these qualities within a community. Ethicists hold ethical convictions and influence others either directly or indirectly. According to Tjeltveit, a psychotherapist/ethicist can function in many ways, such as teaching, consulting, coaching, and advocacy, to name a few.

Tjeltveit contrasts being an ethicist with being a moralist. While an ethicist creates space for others to reason, draw their own conclusions, and make their own decisions, a moralist is one who attempts to impose his or her beliefs upon others.

One of the main fears secular psychologists appear to have about Christian psychologists is that Christian psychologists will function as moralists in therapy. My question is whether that is a legitimate concern? What influences exist that would lead a Christian psychotherapist toward being either an ethicist or a moralist? Do these same concerns exist for other psychotherapists? In other words, we do not want to treat Christian psychotherapists as different from other psychotherapists, if the same concerns exist for others who provide therapy out of central, organizing convictions about significant aspects of reality.

Values in Psychotherapy

Posted on February 4, 2008

[Editor's Note: This entry marks our first for February from guest blogger, Mark A. Yarhouse, PsyD. Mark is Professor of Psychology at Regent University in Virginia Beach, Virginia, where he is the integration coordinator and directs the Institute for the Study of Sexual Identity. Consider joining him on his blog, Psychology and Christianity, as he discusses integration in his spring courses (Ethics and Family Therapy).]

I teach in the Doctoral Program in Clinical Psychology at Regent University. In our Ethics course this spring we are reading Ethics and Values in Psychotherapy by Alan Tjeltveit. Although we read another book by Celia Fisher on the ethics code, we read Tjeltveit to think more rigorously about values in psychotherapy. In any case, we recently discussed the first couple of chapters. Here’s a brief summary.

Tjeltveit’s thesis is that psychotherapy is value-laden – that it is invariably value-laden. In the opening two chapters he lays this out and in chapter one, especially, identifies competing views. Here they are:
• Psychotherapy is inconsequentially value-laden
• Psychotherapy involves only mental health values
• Clients alone should choose therapy values
• Psychotherapy ought to be based on science, not values
• It is meaningless to claim that values or ethical assertions in psychotherapy can be true or correct
• Psychotherapy is not value-free. So what?

He unpacks the meaning of each competing claim and then points out the difficulties inherent in that claim. For instance, the claim that Psychotherapy is inconsequentially value-laden makes the assertion that, yes, the psychotherapist could say to a client, “You should honor your marriage vow and return to your spouse and fulfill your responsibilities to your children” (p. 3). But what do most psychotherapists actually do? They say something like, “Sounds like you’re really feeling sad. How long has this been going on?” (p. 4). Tjeltveit’s response is to say is such a response really neutral? Or are their implicit values in responses we commonly identify as neutral?

His thesis is that psychotherapy is value-laden and that therapy – all therapy – necessarily involves goals that are value-laden. Goals reflect commitments to values and an ethical theory (at least an implicit one), and Tjeltveit reasons that it can be helpful to reflect on ethical convictions and theories.

This may not sound groundbreakig depending upon your starting point. However, you may have come across professionals who make the competing assertions noted above.

Let’s get into it: What do you make of Tjeltveit’s thesis? What are your thougths about the competing views? What are the implications of the various approaches to values for a Christian psychology?

Empirical Research

Posted on July 23, 2007

[Editor's note: This is the last entry from our July blogger, Mark Yarhouse. Thanks Mark for raising some good questions here and in your previous posts.]

Is there a place for empirical research in Christian psychology? This may seem like a strange question, but I have noticed that much of what I read about a distinctively Christian psychology is theoretical. It is often tied to philosophical and theological perspectives on psychology. This has been valuable to me and, I think, to many others.

Empirical research is the currency of modern psychology, at least academic psychology. Some would say it ought to be the currency of clinical psychology, both academic and in actual practice, particularly with recent efforts to identify “best practices” and empirically supported treatments.

Will Christian psychology use a similar currency? What are the benefits to relying upon empirical research and what are the limitations? I do not think of myself as a hard core researcher, but I do see its value, and I hope Christians will not shy away from conducting good research on various elements of a Christian psychology. As I think back to my first blog, I had quoted Alvin Plantinga in his inaugural address as he began at Notre Dame. He spoke of integration for philosophers, and I applied it to psychologists. What I want to point out this week is that he also included that we would have our own research program. We should think about this as psychologists. What is the research program for a Christian psychology? More accurately, what are some of the research programs for a distinctively Christian psychology? What would we benefit from studying?

Also, will a distinctively Christian psychology value both quantitative and qualitative methods? I would say it would depend upon the research being conducted, but I can certainly see the value in both approaches. What has kept research from having more of a prominent role in the early stages of Christian psychology?

Psychopathology

Posted on July 16, 2007

[Ed. note: This is the 3rd blog entry by our July blogger, Mark Yarhouse of Regent University. Mark and two other colleagues at Wheaton College have authored a text, Modern Psychopathologies: A Comprehensive Christian Appraisal, published by IVP in 2005.]

This past week I have been thinking about what it means for something to be a psychopathology. There is a committee currently working on revisions that will eventually become DSM-V, with publication probably around 2011 or so. This is always an interesting time when various symptom clusters are given consideration and some current psychopathologies may end up being removed.

It is interesting to me to explore the question of psychopathology in a Christian psychology. As an intellectual exercise, it may be telling to consider what a diagnostic manual would look like if it were developed out of a distinctively Christian psychology. If there were no DSM and a group of thoughtful Christian psychologists, philosophers, and theologians were to have come up with a manual of some kind. In what ways would it have been different than the DSM? In what ways would it have been similar?

One of the many challenges in psychopathology is how to determine if a cluster of symptoms represent a condition that is pathological. The DSM tries to draw upon atypicality to some extent, but also maladjustment and distress are obviously considered. What we are left with is no real consensus on psychopathology today, and we see that the DSM has some disorders that are more clearly tied to sociocultural variables (e.g., eating disorders) while others (e.g., schizophrenia) are not.

It should also be pointed out that sociocultural variables are but one of several considerations in contemporary understandings of psychopathology. David Barlow is one of many authors who would also consider biological, emotional, learning, and cognitive factors.

So we are talking about more than what is in and what is out of a manual. We are talking about criteria for what constitutes psychopathology, as well as the many factors that are given consideration when determining what contributes to psychological problems.

Clinical Integration

Posted on July 9, 2007

I think of integration as the bringing together into a meaningful dialogue the fields of psychology and theology or religion (specifically, Christianity). By meaningful dialogue I am referring to a discourse in which both psychology and Christianity bring something substantive to the exchange. Integration ought to hold both psychology and Christianity in high regard.

In clinical practice, integration means the practical application of this meaningful dialogue. Take, for instance, a couple I saw not too long ago. Let’s call them “George” and “Laura.” They are both Christians. They are struggling with whether to remain married. George struggled with pornography and eventually sexual liaisons for about 3-4 years and stopped viewing pornography and meeting other women about 4 months prior to seeing me. Laura is struggling with what it means to trust George.

How does the Christian who is also a psychologist approach this case? My pastor was mentioning recently that the Bible often tells us what but does not always address the how. We know, for example, that husbands are to love their wives as Christ loved the church, and husbands are to be faithful to their wives (faithful in behavior and in their thoughts). There are broad principles for addressing issues in the family and in areas of human sexuality. But we do not always get the how from Scripture. We have little by way of instruction as to how to restore trust and covenantal faithfulness in the wake of these behaviors. I draw upon the best of what we know from psychology and the broad principles from Scripture to provide clinical services.

What interests me in the SCP is the development of a Christian psychology that would approach clinical services in a distinctively Christian manner. But I know from experience and training that I do not hesitate to draw upon psychology to inform clinical practice. It would be interesting to learn from others how they draw upon existing findings in the field of psychology, etc. while practicing as Christians. What do they believe a distinctively Christian psychology will bring to the table? How will that be expressed in clinical practice?

Integration and Christian Psychology

Posted on July 2, 2007

It is exciting to see the development of the Society, and I look forward to many meaningful discussions that move us in the direction of a Christian psychology. Let me say that I have many questions about the development of a Christian psychology, but I am intrigued by the idea. Much of my interest really came from my training at Wheaton College, where I first works that either directly or indirectly suggested the possibility of a Christian psychology, such as Alvin Plantinga’s “Advice to Christian Philosophers”, Bob Roberts’ Taking the Word to Heart and Steve Evans’ Soren Kierkegaard’s Christian Psychology. I suppose that I was also primed in some ways to enter into an integration discussion from my undergraduate days at Calvin College. Probably one of the more influential books I read there was Wolterstorff’s Reason Within the Bounds of Religion.

It should be noted that these authors are philosophers and not psychologists, so we may want to return to that at some point. I will say that each has shaped my thinking about the relationship between psychology and theology and have challenged me to think as a Christian about the field, and they have raised in my mind the possibility of a truly Christian psychology.

What struck me most about Plantinga (1983) was the idea that Christians in the field of psychology – if we make the jump from philosophy to psychology – have their own questions to ask, their own topics to address:

Christian [psychologists] … are the [psychologists] of the Christian community; and it is part of their task as Christian [psychologists] to serve the Christian community. But the Christian community has its own questions, its own concerns, its own topics for investigation, its own agenda and its own research programs. (p. 6)

We cannot expect non-Christian psychologists to ask about or care about the questions, topics, and research agendas that Christian care about. So we have to be in the field doing the work.

The question that comes up is how should we be in the field of psychology? What is the best way to position Christians so that we can do the work that is important to the broader Christian community? And is this the only work we are to do?

In part because I train students in the context of a Christian doctoral program, I end up asking myself questions like, How might a Christian psychology develop? Does it occur in the context of existing secular training programs? Can it develop in the context of religiously-affiliated training programs? In explicitly Christian training programs? Does it develop best outside of the context of training programs altogether? Is it an independent endeavor, or is it to be done in collaboration with many Christians working on facets of it (e.g., clinical, developmental, social)?

References

Evans, C. S. (1990). Soren Kierkegaard’s Christian psychology. Grand Rapids, MI: Zondervan.

Plantinga, A. (1983). Advice to Christian philosophers. Faith and Philosophy, 1, 253-271.

Roberts, R. C. (1993). Taking the word to heart. Grand Rapids, MI: Eerdmans.

Wolterstorff, N. (1984). Reason within the bounds of religion (2nd ed.). Grand Rapids, MI: Eerdmans.

Blogger for July: Mark Yarhouse, PsyD

Posted on July 2, 2007

By way of introductions, Mark Yarhouse, Psy.D., is a licensed clinical psychologist and Professor of Psychology in the Doctoral Program in Clinical Psychology at Regent University. Mark teaches courses in psychopathology, ethics, family therapy, and human sexuality. He has also taught courses in community psychology, traditions in Christian healing, and geropsychology. Mark directs the Institute for the Study of Sexual Identity (www.sexualidentityinstitute.org) at Regent. He has published in mainstream psychology journals, such as Psychotherapy, Professional Psychology: Research and Practice, and American Journal of Family Therapy. He has also published in integration journals such as Christian Scholars’ Review, Journal of Psychology and Theology, and Journal of Psychology and Christianity. Mark is the co-author of several books including Modern Psychopathologies: A Comprehensive Christian Appraisal (2005) and Homosexuality: The Use of Scientific Research in the Church’s Moral Debate (2000).

It was mentioned last month that one of the exiting things about the Society is the diversity among its membership. Last month Ed Welch, a biblical counselor, shared his approach to counseling and some of the topics of interest to him. This month Mark, an integrationist, will share some of his interests. Again the Society is a place for psychologists (researchers, professors, and clinicians) and counselors, pastors and theologians, philosophers and public policy theorists, any Christians who are interested in human beings and whose faith seriously impacts their thinking and soul care practice, regardless of the label they use to describe themselves (e.g., integrationists and biblical counselors, as well as those who identify themselves as Christian psychologists).

About this blog

Posted on April 25, 2007

Welcome to the occasional blog of the Society for Christian Psychology. A few key Society members have agreed to share their ideas about the task and future of Christian Psychology. Each month we’ll feature one author who will blog on some their new ideas. The beauty of the Society is that its members range from practicing counselors to academics; from theologians and philosophers to clinical psychologists and biblical counselors. Though we may approach the task of a Christian Psychology from different starting points, we remain united in our quest to understand how the Christian story and faith shape our work with the people God has placed in our lives. Feel free to submit comments or questions to the bloggers as you have interest.

New blog entries and short bios for each blogger will appear shortly.

johnsoneric.jpg

Eric L. Johnson (Ph.D., Michigan State University) is an Associate Professor for Pastoral Theology at Southern Baptist Theological Seminary and the director of the Society for Christian Psychology. He has a book coming out in September entitled, Foundations for Soul Care: A Christian Psychology Proposal.

welch_ed.jpg

Edward T. Welch (M.Div., Biblical Seminary; Ph.D., University of Utah), is a counselor, faculty member and Director of the School of Biblical Counseling at CCEF and Professor of Practical Theology at Westminster Theological Seminary. He is the author of Depression: A Stubborn Darkness, Addictions: A Banquet in the Grave, Blame It On The Brain, When People Are Big and God is Small and numerous articles. Ed and his wife, Sheri, have two daughters.
yar-headshot.BMP
Mark Yarhouse (PsyD, Wheaton College) is Professor of Psychology at Regent University and director of the Institute for the Study of Sexual Identity. He has authored numerous articles as well as co-authored Modern Psychopathologies (2005) and Homosexuality: The Use of Scientific Research in the Church’s Moral Debate (2000).

halder.JPG
Kathrin Halder is Dean of IGNIS, a Christian Psychology institute in Germany. She is author of numerous correspondance courses and teachs introduction to Christian Psychology as well as courses that explore and critique the theological and psychological views of the nature of persons, problems, and healing.

mmcguire.jpgWilliam Michael (Mike) McGuire (Ph.D., Texas Women’s University; Th.M. Dallas Theological Seminary) is Associate Professor of Psychology and Counseling at Southwestern Baptist Theological Seminary (www.swbts.edu) in Fort Worth, TX.

Designed by Business Broker