CBT for Personality Part 2: From a Christian Perspective

After reflecting further on my original post on CBT for personality, the New Paradigm for CBT I noticed some interesting parallels between my Christian faith and this therapy that may be relevant for both therapists and people seeking help for personality disorders that are also Christian.

In her new paradigm what I noted is that she explains old behaviour and beliefs that were held/used for “good reasons”.  Instead of challenging the old system she introduced a “new paradigm” in a very experiential manner.

It made me think of how Jesus taught about being born again to Nicodemus and how he offers the gift of eternal life to the woman at Jacob’s well.  He does not challenge the old system of sin, but acknowledged it openly and assumed that a person is already understood how the old system did not work and instead they are looking and seeking a new paradigm, this living water, or spirit life that is not based in place or a set of laws but “in spirit and in truth ” (John 4: 24).  Jesus is continuously offering images, and stories to activate the imagination of people to create a “new paradigm” to enter the kingdom of God that is “here but not yet” (common term from Kingdom theology).

Some of the people Jesus encounters, like those with personality disorders have been suffering for many years, like the woman with continuous bleeding.  Those with these physical ailments were also consequently excluded from relationships and the acceptance of society which is similar to the interpersonal difficulties and invalidation that those who have personality disorders experience.

However, unlike CBT personality that reconceptualizes  the world Jesus challenges us to imagine a new kingdom of God that is loving, beautiful, and a place for the broken.  This kingdom of God is not the world- the world is fallen- whereas the kingdom of God is good and allows people to live fully in love.  Paul for example would likely not approve of imagining the world as a good and loving place, but challenges followers to “not conform any longer to the pattern of this world, but be transformed by the renewing of your mind.”.(Romans 12:2).

Jesus does not want us to idealize ourselves in positive terms but to hold a dialectic together of both sinner and a new creation in Christ.  Loved deeply by God, though rejected by others.

We have an initial belief or experience as followers of Christ but that does not always mean that our old beliefs and habits die completely.  We struggle between paradigms slowly through steps of faith and in acting out our faith in obedience (behavioural experiments of sorts) we learn to walk in this new way. 

Ultimately what anchors us in this new life are not just the word and promises of the bible on a page (the challenging of our old system of belief through words and reason) but the discipline of living out faithfully this new life.

In this new system- or more accurately through a God that is who loves us, who is greater than ourselves – we gain the strength and new resources to cope in a new way with the struggles we face in this world.  Our old ways are no longer necessary as we live more deeply into the new way of Christ.

So if I was to use the new paradigm for CBT for personality from a Christian perspective I might initially focus the old as she does on the view of self, others and the world but conceptualize the new through replacing a focus on the world to the Kingdom of God as the new realm to live in.  This new kingdom paradigm could also be anchored through visualization, and experiential elements- encouraging one to actively enter God’s presence using imagery.

Then introducing interpersonal difficulties into this new kingdom/paradigm makes total sense because you are inviting someone to little by little start living in the kingdom of God (“let your kingdom come on earth as it is in Heaven”). For example you could say “If you are living in this new kingdom of God where God loves you, you are forgiven, you have joy, and are special…what happens when someone insults you…?” .

This new Christian interpretation of Padesky’s paradigm doesn’t just apply to those with personality disorders but I can see how it would be useful for each one of us to conceptualize in our imagination what it is like to live more fully in the kingdom of God.  It might also be helpful for those who struggle with deep shame, despite intellectually accepting that “God loves me” or “I am deeply loved”.

Kind of exciting!

Questions? Comments?

Prayers for helping professionals: St. Theresa of Avila’s “Let Nothing Disturb Thee”

Many years ago I came across this prayer by St. Theresa of Avila, a mystic and nun of the 16th century.

Let nothing disturb thee

Nothing affright thee

All things are passing

God never changeth

Patient endurance

Attaineth to all things

Who God possesseth

In nothing is wanting

Alone God sufficeth

I have recited this prayer in times of stress and anxiety during my life. Let nothing disturb thee herald’s back to countless biblical passages where God’s people are exhorted to fear God, not men ( eg Psalm 56:4: God, whose word I praise, in God I trust; I will not be afraid. What can mortal man do to me?). 

As a social worker working with people experiencing profound mental confusion, crises, and chaos in their lives it is essential to have a firm anchor in God.  Especially when it seems like even the best therapies fail, medications only provide minimal relief, and support is refused.  Ultimately, God is present and I will trust and pray for him to be with this client and myself in this mess we call life.  

It seems so simple, just trust in God, He never changes He’s always there. But we are afraid, we are disturbed by what we see. That is why we get into the work we do- because the state of the world disturbs us and we want to do something about it. 

And it seems at first glance that this prayer provides no recourse, no action to take about that which disturbs us.  Are we left retreat to our personal prayer with God away from these disturbances or claim that these disturbances are perceptions of reality that create suffering (a more Buddhist viewpoint)?

I think this prayer could be interpreted this way but one line challenges me toward engagement: “Patient endurance attaineth all things”.  Patient endurance is an active choice, not a passive observer stance.  It’s like seeing a rushing river that you need to cross and instead of sitting on one side and fretting about it to instead decide to get in up to your waist in rushing water, hold on to whatever you can to get you across and endure the cold water as long as you have to until you reach the other side. 

This is what our life is like, but to patiently endure we must be “possessed” by God.  When we think of the word possessed we often have images of demon possession and exorcism by Catholic priests.  Very rarely do we hear of being possessed by God. Being possessed implies being owned or filled in its entirety. In being possessed by God Saint Theresa rightly says that nothing is wanting.  There is no need if God lives fully in us and through us.

As a social worker this is not easily done.  My place of work, like many of you, does not have its sole purpose in serving and loving God but is there to control and fix situations.  Very rarely can we offer people God’s solace and grace as a salve to their problems.  Mostly we can offer the accepted wisdom of our profession. 

This makes it difficult to be wholly possessed by God.  Maybe St. Theresa had it right in setting up convents and encouraging people to pray and seek God after all. 

How do you manage to keep centred and “possessed” by God as you engage in a secular helping system?

Healing from God and Healing from Therapy

The most visible part of Jesus’ ministry was healing people.  Jesus healed people of long-lasting illnesses, defects from birth, demon possession, raised the dead, but most of all he healed people from their sins.  His physical healing always had the ultimate message that pointed to the redemption of the whole person: body, soul and spirit.  I similarly believe that God has the power to heal today into our broken world- that this is his way of showing signs of his Kingdom for the lost and weary travellers of this earth.

There is a statistic from the World Health Organization that in 2030 depression will be the world’s largest health burden affecting more people than any other disease.

http://news.bbc.co.uk/2/hi/8230549.stm

If this will be the biggest disease burden of this world, where is Jesus and how is he working in the world for the healing of this condition?

We have often looked to Jesus to only heal physical symptoms, and are hesitant to ask God to heal mental health conditions, like depression.  This is in part because the church has viewed mental illness with stigma and often blames the individual, or family.  It is also because people, like myself, have prayed for the healing of people’s minds and addictions to no avail.  It is hard to find many stories of God’s miraculous healing of depression or schizophrenia.  Perhaps we lack faith, perhaps we do not fully understand the spiritual-socio-biological interactions of depression.

In fact, this is probably one of the main reasons that I decided to get training in social work and counselling.  I wanted more skills and tools to support, love, and promote the healing of people around me who struggled with trauma, addiction, and mental illness.  In our little church of about 20 or so people on any given Sunday I would guess that about 50% of people in the room have a diagnosed mental health condition (including substance abuse).  Some are on the paths to healing by slowly regaining independence and faith in God, while others feel like they haven’t received much relief from God or from therapy or medications.

I wish God would simply heal people, that we wouldn’t need psychotherapy or pharmaceuticals for mental health issues. I also wish that we did not need anti-retrovirals or chemotherapy for HIV/AIDS and cancer, but we do.

As a Christian therapist I have read the scientific research on mental illness.  Most medications address symptoms, rarely do they provide a cure and its’ success varies widely depending on the condition and the medication.  Similarly, psychotherapy fails many people and is not the cure-all for mental health issues although some forms of psychotherapy can provide lasting and improving relief from symptoms.  Interestingly enough, some people do not develop long-term symptoms and may have spontaneous remission or “natural” recovery with limited or no pharmaceutical or psychological interventions.

Prayer does not always cure.  The church regularly fails to care and love those struggling in their midst.  We fail to be a family of faith that treats each person as an equally beloved child of God.

Although the role of the therapist is not explicitly a biblical one, it will become increasingly important as the mental illness becomes more prevalent and recognized in our world.  Being a Christian therapist allows one to offer the most effective treatment available, while also believing in God’s ability to take care of a person in a way that reaches beyond what our limited understanding has discovered. Being intentionally open to the Holy Spirit, while using sound therapeutic judgement and evidence-based practices are ways of operating ethically and faithfully as a servant of Christ working within a secular medical system.

What are your experiences with mental illness and Christian faith/the church?

If you are a Christian therapist, how have you seen God work or what success have you seen within therapy?  What has surprised you?

What tension do you see between healing from God and healing from therapy?

Through the eyes of a Friend

I want to tell you about the most interesting thing that happened in therapy with a client. I was working with a man who has experienced significant trauma in his life and we were doing a safe place visualization where he imagines a safe place and I ask him questions to enrich the visualization.

One of the questions I asked was “who is there with you”. He answered a friend, a childhood friend. This man reports having no friends and no close family, and no social support in his life but was able to go back to his childhood and find a loving and kind friend. When I asked him about this friend after the visualization I found out that he and his childhood friend both had a similar name.

What a discovery! Inside of himself was not just a friend, but a kinder, gentler, more accepting part of himself an alter ego of sorts, a companion to the blaming, negative “self” that has crept in to dominate his vision of himself accusing  of failure day in and day out. It is incredible what an experience with a good friend can do for a person, even if the friendship is no longer present. It is similar to the experience of the therapeutic relationship; it gives a person a chance to build an alternate reality than they are accustomed one that is trustworthy, and stable that can disrupt older patterns of thinking that have gotten a person or family stuck.

It reminds me of my and my friends personal journey with people in our neighborhood who struggle with addiction and have had abusive childhoods.  For many years we plod along, not perfectly, but trying our best to be loving friends to those who are not always easily befriended, and who need a lot more than we can give.  It can be easy to dismiss these relationships as of such a small value in their overall healing journey.

Afterall, our love for one another pales in comparison to the amazing love and forgiveness that God offers to each of us.  But for some reason or another God chose us to live in relationship with one another and be the bearers of His love for the world to each other.  It would seem a lot more effective that he could appear in visions with bright light and angels announcing his love to each person, but instead he works in mysterious, gentle, and sometimes quiet ways through our broken selves.

Let us find encouragement that through the loving gaze of a friend this man could feel love and acceptance that he would not otherwise feel toward himself, and that our commitment to love can go a long way.

Jesus and Judgement (DBT musings part II)

Today I was in the DBT group that I observe as a student therapist and found scripture coming to mind as we covered mindfulness basics.

Nonjudgement is a key aspect of of Dialectical Behavioral Therapy. In DBT Mindfulness participants are encouraged to refrain from judgmnt and instead to observe, describe, then fully participate.  Many people who come to the group are plagued with judgement of themselves. 

Jesus says “Do not judge or you too will be judged. For in the same way you judge others, you will be judged, and with the measure you use, it will be measured to you.” (Matthew 7 1-2)

It is interesting that Jesus makes this link.  I previously interpreted this verse to mean that God will judge me as I have judged others.  However, I see now that it is also possible to interpret this scripture in the present tense- the more judgement I pass on others, the more I will also pass on myself. 

However, as in the parable about the log and speck (Matthew 7) just as we judge others incorrectly we also judge ourselves (I’m no good, I’m unloveable) inaccurately, often overjudge, and miss the parts of ourselves that hurt others (pride, arrogance). 

Throughout the Bible we are told that the only true judge is God alone- he is the ultimate judge- then why do we so often take on that role? 

Even Jesus’ disciples were notorious judgers- how many times did Jesus’ disciples want to turn away people because they innacurately judged Jesus’ love and desire to meet them?  For example, the little children (Matthew 19:13-15), and the Caananite woman (Matthew 15: 21-27). 

Is part of faith in Jesus refraining from judgement?  Not only to others, but to ourselves, and in judging what God can do and how He loves the world?

At first when I heard about non-judgement  I thought that th idea was ridiculous and not Christian as we want God to change our lives and free us from sin.  Isn’t judging the way we recognize sin in our lives?

Maybe, maybe not.

First of all we ask God to identify sin in our lives (Psalm 139: 22-24). 

Secondly we can examine ourselves with compassion and kindness- without judgement as God affirms us that he has saved us through his son and there is no condemnation (Romans 8: 1).  Why would we condemn ourselves when God has freed us?

How then do we identify sin in our lives?  We can examine our lives and observe the times and ways in which we have been far and near from God.  This can take the from of the daily examen – an ancient practice develop by St. Ignatius of Loyola.  Through observation of ourselves the discrepency between what is Godly and good, and what are the desires of flesh we can understand our actions, and seek forgiveness, repent, and recieve new life.

Many who have been saved by God continue to condemn and judge themselves.  Especially people we see in our neighborhood who have mental illness and drug addiction, are estranged from their family, and see their life as a string of failure. 

“It doesn’t make sense why God would love a person like me…”

“It’s hard to see anything but sin and regret in my life…”

Can Jesus free us from self-judgement? Yes, he must.  But he also fills us with the Holy Spirit which groans within us to rebuke us kindly and gently and as we experience the father’s love he slowly shows us our sin as we’re ready in a gentle way through scripture and his spirit.

In that way observing and describing and refrain judgeing can be a good start to accepting the love of Christ, rather than pushing it away or reinforcing the lies of the world (that we are unloveable, no good, constantly failing…). 

What do you think?  Comments?? Ideas?

What is this blog about?

This blog is an attempt to synthesize all the thoughts that I’ve been collecting in my head around social work, faith, therapy, psychology, and the like.

I’m at the tail end of a masters in social work in Canada.  I have had two placements in the area of mental health and addictions.  I also live in a poor neighborhood in our city, and am part of a network of Christians who are wanting to support people around here, creating a new kind of family, and a renewed expression of church.