Christian Principles for the Practice of Counseling and Psychotherapy: A Neuro-Psycho-Spiritual Approach

By Carlos Fayard PhD

All approaches to counseling and psychotherapy rest on assumptions about human nature. Current theories are primarily derived from Buddhist, humanistic, and evolutionary perspectives where there is no God or faith. This book mines the riches of scripture to identify the dimensions of human nature as understood in the Christian faith that can illuminate the work of the practicing clinician. These dimensions of human nature serve as a scaffolding that organize the scientific findings from psychology and neuroscience while remaining attentive to the spirituality of the client. A neuro-psycho-spiritual approach takes a whole-person perspective, delving into the psychological, neurobiological, and spiritual layers of human experience that are relevant to clinical practice. The counselor and psychotherapist will learn how to utilize the dimensions of human nature found in the Bible and apply them to their clinical work through the treatment of Joe, a priest struggling with a sex addiction. Joe will serve as a guide to illustrate how Christian principles can serve as a roadmap to better understand how emotional healing can be facilitated.

• Language: English
• Publisher: WestBow Press
• Release date: Jul 24, 2017
• ISBN: 9781512796766

Carlos Fayard PhD

Carlos Fayard, Ph.D. is a practicing clinical psychologist, Associate Professor of Psychiatry, Chair of the Psychiatry & Religion Program, Director, World Health Organization Collaborating Center for Training and Community Mental Health and Director, Clinical Psychology Internship at Loma Linda University School of Medicine, in Loma Linda, California. He is also an Associate Director for Mental Health Affairs, Health Ministry Department, Global Headquarters of the Seventh-day Adventist Church in Silver Springs, Maryland. Dr. Fayard has been the recipient of the Guadalupe Award and the Amar Es Entregarse Award from the Catholic Diocese of San Bernardino, California and the Editor of “A Christian Worldview and Mental Health” and “Vida Abudante: La Psicologia Positiva desde la Cosmovision Biblica”.

Book preview

Christian Principles

for the Practice of

Counseling

and Psychotherapy

A Neuro-Psycho-Spiritual Approach

Carlos Fayard, PhD

Department of Psychiatry

Loma Linda University School of Medicine

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Copyright © 2017 Carlos Fayard, PhD.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

This book is a work of non-fiction. Unless otherwise noted, the author and the publisher make no explicit guarantees as to the accuracy of the information contained in this book and in some cases, names of people and places have been altered to protect their privacy.

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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.

ISBN: 978-1-5127-9677-3 (sc)

ISBN: 978-1-5127-9676-6 (e)

Library of Congress Control Number: 2017911170

WestBow Press rev. date: 7/24/2017

Contents

1   Introduction to a Neuro-Psycho-Spiritual Approach to Psychotherapy and Counseling

Meet Joe: The Failure of a Spiritual Marriage

Joe’s Story

Neuroscience, Psychology, and Spirituality in Counseling and Psychotherapy

Neuroscience, Counseling, and Psychotherapy

Psychology in Counseling and Psychotherapy

Spirituality in Counseling and Psychotherapy

The Philosophical Foundations of Counseling and Psychotherapy

The Value of a Good Clinical Theory Set on a Firm Foundation

Philosophical Anthropology as an Implicit Clinical Frame of Reference

Back to Joe: The Impact of Philosophical (Worldview) Assumptions in the Consulting Room

Thinking Christianly in the Consulting Room

Thinking Christianly About Joe

Including God in Psychotherapy—Beyond Cultural Congruence

General Outline of the Book

Conclusion

2   The Impact of Philosophical Assumptions on Clinical Practice: Theories of Human Nature in Counseling and Psychotherapy

Assumptions in Counseling and Psychotherapy

Basic Definitions: Worldview, Metaphysics, Epistemology, Ethical Assumptions, Philosophical Anthropology

Worldview: What Organizes the Understanding of the World?

Metaphysics: What Is Real?

Epistemology: How Do We Know What We Know and What We Do Not Know?

Ethical Assumptions: How Right and Wrong Can Be Recognized

Philosophical Anthropology: The Essentials of Human Nature

Philosophical Anthropology as the Latent Content in Counseling and Psychotherapy Theories

A Brief (and Incomplete) History of Psychotherapeutic Theory as a Philosophical Anthropology and Worldview

A Contemporary Example

Philosophical Assumptions Regarding Religion and Spirituality in Counseling and Psychotherapy

Three Friendly Approaches to Spirituality in the Consulting Room

The Integration of Christianity in Counseling and Psychotherapy

Models of Integration in Counseling and Psychotherapy

Christian Anthropology from the Roman Catholic Tradition and Psychotherapy

Joe’s Religion and Spirituality: Which Worldview?

The Relevance of a Biblical Anthropology for Counseling and Psychotherapy

Sorting Out the Issues

Concluding Thoughts

3   A Brief Overview of Existing Christian Models of Counseling and Psychotherapy and Spirituality in Dialogue with a Biblical Worldview

The Narrative Models

A Psychodynamic Approach (Rizzuto and Shafranske)

Clinical Vignette: If Joe Had Laid on Dr. Rizzuto’s Couch

Meditative Practices (Thomas Plante)

Clinical Vignette: If Joe Had Meditated with Dr. Plante

Psychotherapy and the Sacred (Kenneth Pargament)

Clinical Vignette: Joe in Dr. Pargament’s Office

The Integration Models

A Theistic Approach (Bergin and Richards)

Clinical Vignette: If Joe Had Visited Dr. Richards’s Office

Integrative Psychotherapy (Mark McMinn)

Clinical Vignette: Joe in Dr. McMinn’s Consulting Room

Christian Cognitive-Behavioral Therapy (Siang Yang Tan)

Clinical Vignette: Joe in Dr. Tan’s Office

The Power of Forgiveness (Worthington and Enright)

Clinical Vignette: If Joe Had Sought Consultation from Dr. Worthington

Faith-Based Acceptance and Commitment Therapy

Clinical Vignette: If Joe Had Worked with a Faith-Based ACT Therapist

Explicitly Christian Models

The Transformational Psychology Approach (Coe and Hall)

Clinical Vignette: If Joe Visited with Drs. Coe and Hall

The Project for a Christian Psychology (Eric Johnson)

Clinical Vignette: If Joe Was Under Dr. Johnson’s Soul Care

Concluding Thoughts

4   The Assessment of Religion and Spirituality in Clinical Practice

A Rationale for the Inclusion of Religion and Spirituality in the Assessment Process

Before Proceeding: Transference and Countertransference in the Assessment of Religion and Spirituality

Exploring Countertransferential Reactions

An Activity to Increase Clinicians’ Self-Awareness

Management of the Countertransference

The Contours of the Assessment: Definitions of Religion and Spirituality

Spirituality Defined from the Perspective of a Biblical Worldview

From Definitions to Clinical Practice

Conducting a Spiritual Assessment

Brief Initial Assessment

Comprehensive Assessment

Joe’s Spiritual Assessment

Countertransference and the Preparation of the Therapist

The Assessment Process

Case Conceptualization

Joe’s Initial Treatment Plan

From Assessment to Intervention: A Sample of Therapeutic Interventions Consistent with a Neuro-Psycho-Spiritual Approach

5   A Neuro-Psychosocial-Spiritual Approach to Religion and Spiritual Experience: Spirituality as a Core and Inseparable Component of Being

Wired for God

Biblical Anthropology and Spiritual Experience

A Christian Spirituality

Spiritual Thirst: The Seeking System

The Neuroscience of the Seeking System

Psychological Views on Spiritual Thirst

Clinical Vignette: The War Is Not Over

Love God with All Your Heart: The Attachment System

The Developmental Psychology of Attachment to God

The Neuroscience of the Attachment System

Clinical Vignette: Is Anybody Out There?

Who Shall We Believe?: The Theory-of-Mind System and Christian Spirituality

The Cognitive Psychology of Belief in God

The Neuroscience of the Theory-of-Mind System

Clinical Vignette: An Empty Spiritual Marriage

Clinical Implications for the Practice of Counseling and Psychotherapy

A Neuro-Psycho-Spiritual Approach

Joe’s Spiritual Journey in Psychotherapy

Conclusion and Future Directions

6   Love as an Organizer of Psychological Experience— Part 1: Love of God in Counseling and Psychotherapy

The Experience of Love in a Biblical Worldview

Love’s Ontological Significance

The Bible Is More Concerned with the Experience of Love than with Its Clear Definition

Love in Context: The Centrality of Trust and Safety

Jesus: The Embodiment of Divine Love

The Human Response to the Love of God

Basic and Applied Research and Theory

Godly Love

The Psychological Impact of the Love of God

The Developmental Psychology of Attachment to God

The Neuroscience of the Attachment to God

The Psychological Benefits of a Secure Attachment to God

Attachment to God and Psychological Maladjustment

When God Is Felt to Be Distant: Spiritual Struggles and Emotional Conflict

Love of God, Intrinsic Religiosity, and Depression

Clinical Applications

Interventions to Address Attachment-to-God Issues

Addressing Spiritual Struggles

Focusing the Mind on the Love of God

A Neuro-Psycho-Spiritual Approach to Attachment and Intersubjective Issues

Joe and the Vicissitudes of Love and Attachment

Concluding Thoughts

7  Love as an Organizer of Psychological Experience— Part 2: Intrinsic Relational Motivation in Counseling and Psychotherapy

The Human Experience of Love: Motivational, Interpersonal and Ethical Dimensions from a Biblical Worldview

Love in Context: The Centrality of Trust and Safety

Agape: Love’s Highest Expression

Relationality: Horizontal Dimensions

Relationality and Healing

The Dark Side of Relationships

Basic and Applied Research and Theory

Theoretical Perspectives

Types of Love

Agape, Altruism, Compassion, Empathy

Love: The Core of Healthy Relationality

The Psychological Impact of Feeling Loved

The Neuroscience of Love

The Neurobiological Impact of Not Feeling Loved

Intrinsic Relational Motivation, Spirituality, and the Family

The Powerfully Negative Impact of Mistrust and Social Isolation

The Global Impact of Social Isolation

Social Pain

Perceived Social Threat and the Interpersonal Legacy of Trauma

Clinical Implications: The Therapeutic Alliance

The Role of Religion in the Therapeutic Alliance

Trust: The Heart of the Therapeutic Alliance

The Neuroscience of the Therapeutic Relationship

Clinical Interventions: Facilitating the Therapeutic Alliance

Relational Processes, Forgiveness, and Spirituality in Counseling and Psychotherapy

Cultivating Compassion

Spiritual Resources to Address Trauma

The Ethical Context of Love as an Intervention

A Neuro-Psycho-Spiritual Approach to Attachment and Intersubjective Issues

The Vicissitudes of the Experience of Love in Joe’s Psychotherapy: The Development of Trust and the Therapeutic Alliance

8   Love as an Organizer of Psychological Experience— Part 3: Love of Self

Love of Self in a Biblical Worldview

Love of God, Love of Neighbor, and Love of Self

Love of Self and Caring for the Self

Self-Appraisal and Love of Self

Love of Self Requires a Well-Integrated Identity

Love of Self and Living Meaningfully

Applying Love of Neighbor to Love of Self

Loving Self Well: Moral Considerations

Self-Acceptance and Self-Forgiveness in a Biblical Worldview

The Disorders of Love of Self in Scripture: Pride and Selfishness

The Disorders of Love of Self in Scripture: Shame and Guilt

Humility: The Proper Measure of Love of Self

Theory and Research on Love of Self

Self-Acceptance and Self-Esteem

Self-Acceptance, Self-Esteem, and Religion/Spirituality

Self-Compassion and Self-Forgiveness

Self-Acceptance, Self-Forgiveness, Self-Compassion, and Religion/Spirituality

Humility

Humility, Religion, and Spirituality

Disordered Love of Self

An Inflated Love of Self: Self-Enhancement and Narcissism

Disorders of the Love of Self: Religion and Spirituality

Disorders of the Love of Self: Guilt and Shame

Disorders of Love of Self: Guilt, Shame, Religion, and Spirituality

Neuroscience and Love of Self: Self-Processing

The Neuroscience of Self-Appraisal

Self-Evaluation: Self-Esteem, Self-Enhancement, and Narcissism

Self-Evaluation: Guilt and Shame

Clinical Applications

Promoting Love of Self: Surrendering Leads to Self-Acceptance and Self-Compassion, Resulting in Positive Self-Worth

A Christian Appraisal of Mindfulness-Based Self-Compassion Interventions

Acceptance and Grace: The Road to Nurturing the Love of Self

Cultivating Self-Forgiveness

Nurturing Self-Worth

A Neuro-Psycho-Spiritual Approach to the Love of Self

Joe’s Fragile Narcissism

9   Embodied Counseling and Psychotherapy: A Whole-Person Approach in a Biblical Worldview

A Holistic View on Human Nature

A Biblical (Holistic) View of Embodied Experience

The Body in Scripture

The Mind in Scripture

The Spirit in Scripture

Theory and Research Findings

The Psychology of Embodied Experience

The Neuroscience of Embodied Experience

The Polyvagal Theory of Embodied Experience (Porges)

The Self Is an Embodied Self (Damasio)

Embodied Simulation and Social Interaction (Gallese)

Embodied Spirituality

Clinical Applications

Embodied Experience in Counseling and Psychotherapy

A Neuro-Psycho-Spiritual Approach to Embodied Experience in Counseling and Psychotherapy

Joe’s Body in the Clinical Process

Concluding Thoughts

10   Values and Imago Dei: Moral Issues in Counseling and Psychotherapy

Values and Moral Principles in a Biblical Worldview

The Decalogue: Boundary Values

The Fruit of the Spirit and the Beatitudes: Core Values in the Imago Dei

Christian Virtues: The Content and Nature of Human Potentiality

Character Matters

Values and Moral Understanding: Basic and Applied Theory and Research

The Values of Positive Psychology

The Values of Moral Psychology

The Neuroscience of Moral Emotions and Values

Values, Moral Emotions, and Religion

Values and Morality: Clinical Applications in Counseling and Psychotherapy

The Psychotherapy of Character Development

Structured Approaches for Character Change

The Virtuous Counselor

A Neuro-Psycho-Spiritual Approach to Values and Moral Issues in Counseling and Psychotherapy

Joe’s Values in the Clinical Process

Concluding Thoughts

11   Disordered Love: Moral Conflict and the Dark Side of Human Nature in Counseling and Psychotherapy

Internal Moral Conflict in a Biblical Anthropology

Basic and Applied Research on Internal Moral Conflict and Evil Behavior

Bad Is Stronger than Good

The Psychology of Moral Evil

The Neuroscience of Moral Conflict and Evil

Clinical Implications

A Neuro-Psycho-Spiritual Approach to the Human Dark Side in the Consulting Room

Divided Self, Dual Life, and Disordered Love: Joe’s Journey from Moral Apathy to Shame, Guilt, and Integrity in Psychotherapy

12   The Role of the Will in Counseling and Psychotherapy: Agency and the Power of Temperance (Self-Regulation)

A Biblical Worldview on Human Freedom, Agency, and Self-Regulation

Basic and Applied Research: Agency—The Capacity and Power to Choose

The Social Cognitive Psychology of Agency

Agency, Willpower, and Moral Decisions

Temperance and Self-Regulation

Self-Regulation, Moral Decisions, and Religion

The Developmental Emergence of Self-Regulation

The Contributions of Religious Behaviors and Practices to Self-Regulation

The Neuroscience of Agency and Self-Regulation

The Neuroscience of Agency

The Neuroscience of Self-Regulation

Clinical Applications of Agency and Temperance

Agency and Willpower

The Therapeutic Value of Religious Self-Regulation

Self-Regulation and the Spiritual Disciplines

Meditative Activity and Self-Regulation

Self-Regulation and the Therapeutic Relationship

Self-Regulation and Prudence: Mentalization-Based Strategies

A Neuro-Psycho-Spiritual Approach to Agency and Self-Regulation

Joe’s Choices: The Power of Temptation versus Increased Sense of Freedom through Temperance

13   Temporal Consciousness: The Importance of the Present Time, Hope, and Rest for Emotional Health

Time Consciousness in a Biblical Worldview

The Sabbath as Sacred Time: A Glimpse of Eternity in the Present

The Future Is Never Closed: Hope in a Biblical Worldview

Your Time Is Now: The Power of the Resurrection

Basic and Applied Research

Time Consciousness

Hope

The Psychological Power of the Resurrection

The Future Is Here: Sacred Time and the Spiritual Practices of Prayer and Meditation

Sacred Time

Prayer

Meditation

Clinical Implications

A Neuro-Psycho-Spiritual Approach to Time Consciousness

We Are Running Out of Time—Joe’s Last Hours

14   Designed to Reflect the Glory of God: Transformation in Counseling and Psychotherapy

Human Change in a Biblical Worldview

Basic and Applied Research

The Neuroscience of Change and Transformation: Neuroplasticity, Neurogenesis, Epigenetics, and Transformation

Clinical Implications

A Neuro-Psycho-Spiritual Approach to Transformation in Counseling and Psychotherapy

Joe’s Progression to a Fullness of Life

15 Conclusion

References

To Elba, unconditional love, unwavering support

To Daniel & Lisa, inspiration, patience, interest, encouragement

To Aime & Maria Esther, humbly following in your footsteps

I am grateful for the contributions and feedback from Antonia

Ciovica, Ph.D. and Mary Varghese, Ph.D.

1

Introduction to a Neuro-Psycho-Spiritual Approach

to Psychotherapy and Counseling

For in Him we live, we move, and have our being.

—Acts 17:28

It is perhaps ironic that a book connecting the areas of counseling and psychotherapy, neuroscience, and religion begins by making reference to Sigmund Freud, the founder of psychoanalysis. Freud was a trained neuroscientist, a physician with a specialty in neurology, and he had an interest in working with patients who presented with unexplained and difficult-to-treat symptoms. As an outgrowth of his work, he developed expansive theories about the etiology of these disorders and created psychoanalysis as a method to treat them. Although he is best known for his study of psychopathology, Freud also delved into the realms of developmental psychology, cultural anthropology, neuroscience, and the psychology of religion. An example is his ambitious Project for a Scientific Psychology (1895), in which he postulated a neuropsychology that could ground the work of the psychoanalyst.

Freud had a deep interest in the subject of religion, and this was demonstrated in the various books and articles he wrote on the subject (1913, 1927, 1930, 1933). He relied on theories of cultural anthropology to interpret religion through the lens of psychoanalysis. Although those theories were severely questioned at the time, he remained a formidable force in framing the debate between faith and psychotherapy for many years. In some ways, the terms of the debate initiated by Freud have not changed substantially. Psychotherapy and religion continue to experience a degree of tension, primarily because they subscribe to very different worldviews: the worldview of naturalism and the worldview of faith, respectively (Entwistle 2010).

In the current era, in which neuroscience has pervaded the foundation of most areas of psychology, comprehensive and creative efforts have been made to articulate models of counseling and psychotherapy that affirm a Christian worldview (for instance, see Coe and Hall 2010; Johnson 2007; McMinn and Campbell 2007). But the field has yet to see a systematic integration of the neurobiological processes involved that can firmly ground these approaches. There appears to be a paucity of cross-disciplinary, integrative theory building that connects these three broad fields, even when mindfulness (which many describe as a spiritual intervention that is widely applied in the field of counseling and psychotherapy) is the focus of the inquiry (Holzel, Lazar, Gard, Schuman-Olivier, Vago, and Ott 2011).

This book seeks to establish a trifecta connection between the fields of counseling and psychotherapy, clinically relevant Christian spirituality and religious beliefs, and the contributions from neuroscience and the behavioral sciences as organized by ideas from biblical anthropology. I suggest that the work of the counselor can be meaningfully guided by the Bible, specifically by dimensions of human nature found in scripture that are relevant to the tasks of the clinician. In this book, I present biblical anthropology as the scaffolding that frames and organizes dimensions of human experience encountered in psychotherapeutic practice, thus illuminating fundamental aspects of the clinical encounter. Furthermore, being firmly anchored in a Christian worldview, these pages will affirm that emotional healing proceeds from the infinite grace of God, who is deeply invested in our living life abundant (John 10:10); they will also affirm that the Bible, as God’s revealed Word, contains the fundamental principles required to understand human nature. These general ideas will be illustrated throughout the book with a clinical case of a former client who is now deceased. All demographic information and a substantial amount of the details in the case have been altered or omitted to protect his privacy.

Meet Joe: The Failure of a Spiritual Marriage

I met Joe on a Tuesday afternoon, right after lunch. He came dressed in his clergy attire, and as he sat down, occupying most of the couch with his rotund presence, he looked straight into my eyes and warned me that he had been there, done that with the therapy route. He went on to claim that I should not fool myself into believing that this would be any different from previous therapists’ failed attempts—he elaborated with a slight mix of sarcasm and disdain. My initial reaction was a mix of mild irritation and competitiveness. Others might have failed, but I think I can do better than that, I told myself. Joe went on to describe my dilemma as a therapist. I have been referred to you by my bishop. It seems that everyone knows you at the office and thinks highly of you, but I don’t want you to communicate with him or anyone else. In other words, Joe was telling me, I don’t want to be here, although I have to. Your reputation is at stake, and don’t even think of asking for a release to hold me accountable. Joe quickly and deftly cornered me psychologically, and he positioned the therapeutic relationship on a hopeless, if subtly confrontational, course. After explicitly acknowledging the nature of his situation, he began to describe his predicament.

Joe’s Story

Joe was a single Caucasian male in his early sixties who had been an ordained clergy member for approximately half his life. Most of his life before ordination had been dedicated to serving in the church. From the name selected by his mother, to parochial schooling and serving as an altar boy, Joe’s life was very much immersed in the church. Joe came to me after a six-month stay at a residential treatment facility dedicated to assisting members of the clergy with a variety of mental health and addiction issues. The written summary of his treatment depicted a rather bleak picture and implied that Joe had made virtually no progress since his admission—that he had not motivated therapeutic engagement, in fact avoiding it altogether. After an extensive diagnostic workup, he had been deemed free of anxiety, depression, or psychotic symptoms. There were features of a mixed personality disorder with predominantly narcissistic and passive-aggressive components. Joe’s life of self-indulgence had left him with a number of medical problems, most importantly HIV and the long-term consequences of alcohol abuse on his liver.

From the first week of ordination, Joe had been sexually active in spite of a vow to celibacy. In the years prior to his admission to the residential facility, Joe had increased the frequency of his sexual contact, which had escalated to anonymous sex at adult bookstores and bathhouses. No faces, no names—just plain sex. On one occasion, Joe was recognized by one of his parishioners, and word reached his bishop. The bishop confronted Joe with the need to initiate a rehabilitation process, which subsequently led to residential treatment. This pattern of sexual acting out with adult males had become the main focus of his treatment, which involved individual and group psychotherapy, antidepressant medication, participation in a 12-step group, and spiritual direction. He received approximately six months of intensive residential treatment.

Joe had been in psychotherapy before, had attended 12-step groups before, and had participated in spiritual direction before. Our initial encounter, and the report from those who had worked with him at the residential facility where he had spent the best part of a year, left a rather pessimistic feel. The only reason Joe had stopped binge-drinking was that he had developed serious medical complications. The only reason Joe had participated in any form of treatment before was because he had been mandated to. Joe had descended into a spiral of self-destruction that had left him with significant medical problems, a jaded sense of his spiritual vocation, and an ample dose of cynicism about what any therapy could do for him.

As a priest, he had been in a spiritual marriage that had failed almost from day one.

As stated previously, Joe’s story will serve as a clinical example to illustrate the relevant topics discussed throughout this book. I will now turn to an overview of those relevant topics.

Neuroscience, Psychology, and Spirituality in Counseling and Psychotherapy

The recent decade has witnessed an explosion of highly productive research and applications in the fields of counseling and psychotherapy, the affective and cognitive neurosciences, and the field of religion and spirituality. Significant and comprehensive volumes have been written connecting some of these areas of knowledge to each other, or to their application to mental health (Cozzolino 2002; Ecker, Ticic, and Hulley 2012; Grawe 2006; McNamara 2006; Panksepp and Bevin 2012; Pargament 2007, 2013), but not discussing all three domains considered together.

The practice of counseling and psychotherapy has increasingly become a multidisciplinary endeavor, not just because many professions claim them as integral to their identity, but, rather, because clinicians are trained to understand subjective and interpersonal experiences, brain activity, and social determinants of behavior. Clinicians are also trained to be sensitive to different components of human diversity, including religion and spirituality. A comprehensive review of all these theories and research is beyond the scope of this book. I will instead share just a glimpse of where the professions that practice counseling and psychotherapy find themselves regarding the central concerns of this book, which are neurobiological, psychological, and spiritual considerations in clinical practice.

Neuroscience, Counseling, and Psychotherapy

Few developments in counseling and psychotherapy have been as dramatic as the emergence of neuroscience. As a presenter at a recent international gathering of therapists remarked, there is virtually no respectable theory at this time that is not seeking to frame itself in neuroscientific terms. With this in mind, it is possible to summarize the state of the field by organizing it in two domains: first, documentation of changes in brain activity as a result of therapeutic interventions, and second, the utilization of brain-based knowledge to guide interventions. The neuroscience of psychiatric conditions is now leading to potentially significant changes in the classification and diagnosis of mental disorders (Insel, 2013), and in some cases, their treatment (Van der Kolk 2014).

In establishing a neuroscience foundation for counseling, emerging research supports that psychotherapeutic approaches influence neural mechanisms. For instance, brain imaging studies have shown that cognitive-behavioral therapy (CBT), eye-movement desensitization and reprocessing (EMDR), interpersonal therapy, cognitive rehabilitation, mindfulness interventions, and psychodynamic psychotherapy all cause neural changes as the result of successful interventions (Barsaglini, et al., 2014). Oftentimes, these changes are comparable to those achieved through the use of medications, although the improvement from psychotherapy is seen in distinct regions of the brain from those obtained through pharmaceuticals (Abbas, Nowoweiski, Tarzwell, and Beutel, 2014; Roffman, Marci, Glick, Dougherty, and Rauch, 2005; Zeidan, Martucci, Kraft, McHaffie, and Coghill, 2014).

The impact on the brain from specific psychotherapeutic interventions has yet to be properly studied (with the exception of mindfulness meditation), but evidence thus far suggests the possibility of the dawning of an era of transtheoretical approaches in counseling and psychotherapy, given the potential explanatory power of neurobiological processes (Melchert, 2016). For instance, the therapeutic alliance is a fundamental process in counseling and psychotherapy with the corresponding neural mechanisms described by Daniel Siegel (2012), Allan Schore (2014), and Steven Porges (Geller and Porges, 2014). The modification of negative memories (Ecker, Ticic, and Hulley, 2012; Shapiro, 2013) and the role of bodily awareness in the treatment of trauma (van der Kolk, 2014) have also received significant attention. Although the mechanisms suggested may very well be accurate, the authors draw inferences from research in the fields of cognitive and affective neuroscience that await proper empirical verification. Thus, more work is needed in the quest to establish a truly sound neuroscientific foundation for counseling and psychotherapy.

For the Christian counselor, these developments are important but can potentially present some challenges, as neuroscience tends to rely heavily on philosophical assumptions that run counter to his or her faith. Neuroscience rests on naturalistic ideas about reality, excluding the notion of God or supernatural beings, and emphasizes evolutionary adaptations and processes to explain behaviors. Thus, when integrating advances in neuroscience with a Christian framework, it is necessary to examine the worldviews that underlie these approaches as well as identify interventions that are derived from this understanding.

Psychology in Counseling and Psychotherapy

Psychological processes broadly understood have been the foundation for counseling and psychotherapy for at least a hundred years. The field has moved in the last decades from a purely speculative position more closely aligned with philosophy, to a more empirical position with emphases on documenting the efficacy of interventions and identifying the mechanisms that contribute to change. To some extent, its scientific identity is still being defined, as indicated by the fact that numerous approaches to counseling and psychotherapy are being published, and the assumptions about the causes for dysfunction as well as the processes that contribute to change and healing vary greatly.

Although there is much disagreement over many of the active ingredients in counseling and psychotherapy, one component that is almost universally agreed upon as essential for therapeutic success is the centrality of the therapeutic alliance. Beyond that, there is still significant debate as to which approach can be reliably utilized for what condition. For instance, cognitive-behavioral therapy CBT has been identified by the World Health Organization as having substantial evidence for the treatment of the effects of trauma, but psychiatrist Bessel van der Kolk (2014) argues forcefully against this finding for a number of reasons. One of van der Kolk’s arguments that I found very compelling is reflected in the neuroimaging study of a couple who suffered an auto accident together and experienced significant trauma. The brain of one showed the overactivation often found in posttraumatic stress disorder (PTSD), and the other showed the underactivation associated with dissociative states. Even though both individuals may qualify for a diagnosis of PTSD, should both receive CBT? Psychodynamic therapy approaches would instead highlight the role of unconscious processes, sensorimotor therapy would point to the role of bodily experience, while Action and Commitment Therapy (ACT) would highlight the reification of the meaning derived from the accident.

For years, researchers have found that competing interventions have not proved to be substantially superior when compared to each other in clinical trials (Luborsky, Rosenthal, Diguer, Andrusyna, Berman, Levitt, Seligman, and Krause, 2006), resulting in the questioning of a need for clinical theories (Miller, Hubble, Chow, and Seidel, 2013).

In any case, whether clinicians adhere to specific theoretical orientations or ground their craft in evidence-based practices, all therapists are guided by a set of (often) implicit assumptions about human nature. The Christian clinician, who believes that God has created humanity and that He has set forth principles about human nature as revealed in scripture, may also be guided in clinical work but by a biblical anthropology. Additionally, the Christian clinician can also find benefit in the work of pioneers, such as Everett Worthington and others (e.g., Worthington, Johnson, Hook, and Aten, 2013), who have conducted studies to establish the empirical evidence for the efficacy of Christian-based interventions but may still be unclear as to the guiding role of assumptions on human nature found in these interventions. For instance, what are the implications of using mindfulness as a technique derived from Buddhism or psychodynamic interventions that interpret God as a derivative of relationships formed during the developmental years? Such examples are abundant across virtually every school of counseling and psychotherapy, and each one of them is guided by notions of human nature. Assumptions on human nature matter because they guide therapeutic goals and interventions. One of the objectives of this book is to make explicit the assumptions of human nature as found in the scriptures and to discuss their clinical applications.

Spirituality in Counseling and Psychotherapy

One of the most remarkable cultural shifts I have witnessed in the field of counseling and psychotherapy during my time has been the qualified welcoming of spirituality into the field. The use of the word spiritual appears to be as ubiquitous as the word brain in the professional literature. Although mental health clinicians tend to be significantly less spiritual or religious than the general population (Hathaway, 2016), it is now far more likely to come across articles and books on the topic than in times past. The Buddhist practice of mindfulness has found a way to permeate the culture in general and the practice of mental health clinicians in particular. As I wrote this text, I received an email from the American Psychological Association Division for the Psychology of Religion and Spirituality with a link to a discussion on just such an issue; namely, should mindfulness be used independent of its spiritual assumptions, and if so, what ethical issues would be involved? Buddhism is probably appealing to clinicians because it contains principles for living and techniques to ameliorate emotional discomfort—and very likely, because there is no God to contend with.

By and large, Christians seem to have embraced counseling and psychotherapy in various forms. The international meeting of the American Association of Christian Counselors, which convenes every other year, rivals the numbers drawn by the Evolution of Psychotherapy Conference that meets every five years. Explicitly Christian programs in clinical psychology and counseling can be found across the planet, particularly in the United States. But just as clinicians have a difficult time agreeing on the fundamental ideas of their trade, so do their Christian counterparts have yet to develop a significant agreement on the same. While some fully adopt the secular versions of counseling and psychotherapy, others try to develop a distinct perspective. Although most Christian clinicians would accept that God is active and present in the lives of the client and therapist alike, some are more comfortable explicitly addressing these factors, while others value more implicit ways to connect faith and practice.

In further exploring the intersection of Christianity and psychotherapy, chapter 2 will address in more detail the philosophical assumptions that make the Christian enterprise distinct from their secular counterparts, with a particular focus on the clinical impact that flows from assumptions about human nature. Chapter 3 will review the various forms in which Christians engage in counseling and psychotherapy.

The Philosophical Foundations of Counseling and Psychotherapy

The science of counseling and psychotherapy relies on philosophical assumptions about the nature of reality (metaphysics), the nature of knowledge (epistemology), what it means to be human (philosophical anthropology), the nature of morality (ethics in a broad sense), the cause and meaning of suffering and how suffering is overcome. More specifically, science tends to emphasize a naturalistic type of metaphysics, with the practical implication that in it, there is no room for God, spiritual beings, or life eternal. The scientific enterprise is now virtually in agreement in regard to the origin of life and humans, as it has embraced evolutionary theory. The field of counseling and psychotherapy is no exemption. It is now common to hear psychological dysfunction explained as a mismatch between current demands for adaptation and behaviors driven by the vestiges of evolutionary adaptations to the Pleistocene.

Psychology in general, and clinical theories in particular, rest on assumptions about the essence of what it means to be human. For instance, psychoanalytic theories have emphasized the power of biological forces in conflict with culture, while humanistic psychologies posit that human beings have a disposition for good derailed by negative events and an oppressive culture. Cognitive approaches claim that humans are essentially thinking beings whose suffering is the result of faulty understanding. Emotion-focused approaches, by contrast, believe that humans are more profoundly understood when their feelings find a natural expression. Relational and systemic theories feel that one-person psychologies miss the forest for the tree. What matters, they claim, is that humans live in relationships and cannot be understood separate from them. Acceptance and commitment therapies incorporate Buddhist beliefs about the nature of suffering—namely, fusion with destructive ideas or objects—and promote moderate detachment to resolve problems.

Although clinical approaches claim to take a nonjudgmental, objective perspective on the subject matter, they make implicit (and sometimes explicit) pronouncements on what is considered morally acceptable and spiritual. Clinical theories, instead, frequently utilize the language of illness and health to refer to these topics. For instance, self-sacrifice, obedience to God, formalized understanding of sexual boundaries, and the like, are typically judged as unhealthy. Finally, notions of suffering and healing flow from assumptions about the nature of reality (metaphysics), how knowledge is acquired and validated (epistemology), what is deemed acceptable (ethics), and what makes humans thrive or fail (philosophical anthropology). Chapter 2 will examine these assumptions in more detail.

I will now turn to argue for the importance of being aware of these assumptions.

The Value of a Good Clinical Theory Set on a Firm Foundation

Kurt Lewin, the founder of Gestalt Psychology, offered the somewhat enigmatic phrase there is nothing more practical than a good theory. A good clinical theory provides the counselor with a road map to reach the desired destination. There are many ways to reach New York from California, but some roads may be costly, others may make the trip longer, and still others may entail the risk of the driver getting lost. If the map is outdated or wrong, the chances of reaching New York may be seriously compromised. A good clinical theory rests on a set of philosophical ideas organized by an overarching perspective or worldview. A worldview is like the map for the trip to New York. Its accuracy is of the highest importance. The counsel given by an experienced sleuth to a younger colleague may be good for the clinician as well: Once you assume the wrong beginning, you’ll not only give the wrong answer, but ask the wrong question (cited by Entwistle, 2010, from a short story by A. K. Chesterton). For clinical theory, a wrong beginning means having an incomplete set of assumptions about human nature (philosophical anthropology), the nature of reality (the cause of suffering and the healing process), and the methodology to determine whether it is correct (epistemology). Embedded in any clinical theory are assumptions about human nature, values, and morality, and even what constitutes reality (including whether belief in God is real or a delusion), all of which will guide the process of counseling and psychotherapy.

What would constitute a good theory in counseling and psychotherapy for the Christian clinician? I suggest that a biblically based understanding of reality that welcomes the active presence of God and articulates ideas about human nature in a manner that is close to the experiential level of clinical practice can provide a strong foundation. A biblical account of human nature (biblical anthropology) can serve as a template or scaffolding that provides meaningful parameters for the understanding of emotional health and the ways through which emotional pain can be remedied. The dimensions of biblical anthropology to be discussed in subsequent chapters organize the neurobiological, psychological, and social data around concepts that can be fruitfully harvested by the Christian clinician in his or her work. This template or scaffolding becomes a broad road map for understanding human experience, emotional pain, and the processes that can contribute to healing.

I will now turn to the philosophical foundations of counseling and psychotherapy.

Philosophical Anthropology as an Implicit Clinical Frame of Reference

There are different worldviews, different approaches to psychological science, and different ideas about how to help people, in all therapeutic approaches, including Christian ones (Johnson, Worthington, Hook, and Aten, 2013, p. 300). There is now an emergence of empirical work confirming that worldview assumptions, particularly what clinicians believe about religion and spirituality, have a direct impact on how clinicians practice (Peteet, Rodriguez, Herschkopf, McCarthy, Betts, Romo, and Murphy, 2016).

To illustrate this point, I will again turn to Joe’s case.

Back to Joe: The Impact of Philosophical (Worldview) Assumptions in the Consulting Room

Many clinicians would see Joe’s case as sex addiction and therefore encourage a 12-step philosophy. The 12-step approach was originally grounded in Christian ideas and principles (Mee-Lee and Anderson, 2011) and wisely combines spiritual principles, group processes, peer counseling, and an experiential curriculum to manage the lifelong illness of addiction. Part of the genius of the 12-step approach is its ambiguity about the notions of illness and personal responsibility, which in most other contexts would be seen as oxymoronic (Dunnington, 2011). Currently, the 12-step process uses a language about spirituality that encourages inclusiveness. Participants are told to surrender to a Higher Power, whatever each participant conceives that Higher Power to be. Given that many clinicians do not espouse a theistic spirituality, they find it comfortable to see that their clients conceive a Higher Power as energy, for instance. One of the practical implications from a biblical worldview is that a Higher Power thought of as energy is incapable of loving the client back, granting him or her serenity or forgiveness, or even providing a moral frame of reference. Furthermore, such an approach operates from the metaphysical assumption that reality excludes a personal God.

Other clinicians may see Joe’s problems as associated with his faulty basic beliefs about himself, the world, and his future, and thus consider a CBT approach. Indeed, Joe had numerous cognitive distortions, but there was no distortion in regard to his addiction. He knew exactly what he was doing and how he was going about doing it, but he did not care to change much about it. Although there is much to be gained by the Christian clinician from a CBT approach (for a discussion, see Tan, 2010), to think Christianly in Joe’s case, one would have to set Joe’s cognitions, distorted and otherwise, against Christian values and morality and his own perception of God. Thinking Christianly would provide a ready scaffolding for notions drawn from a CBT approach, without having to be bound by some of its fundamental assumptions about reality and the process of psychological change. In other words, the technical aspects of CBT—for instance, keeping a thought record to track and correct cognitive distortions—can be helpful to the Christian clinician, who, in addition to addressing accurate cognitions, will place emphasis on the importance of being forgiven.

Yet, other clinicians might consider the vicissitudes of Joe’s developmental years and family-of-origin dynamics, leading them to think psychodynamically or systemically about Joe. Psychodynamic clinicians would zero in on early relational patterns reenacted in the nameless, faceless sexual transactions and see his acting out as failed attempts to experience emotional closeness. Expanding the view to systemic considerations would lead the clinician to ascertain what family roles were assumed early on, and which ones continued to act as unspoken narratives prescribing current behavior. In contrast, thinking Christianly would allow a clinician to understand the organizing role of feeling loved in Joe’s psychology, along with the inherent motivational power of relational dynamics. The Christian clinician would not leave out God as the source and giver of love, or fail to see that, for Joe, his relationship with God was as real and central as the relationships he had with his own family of origin.

Some Christian clinicians may in fact see Joe’s behavior as representing a clear violation of spiritual and moral expectations. Joe would have certainly agreed with their perspective, but he did not find it compelling enough to make the needed changes. Thinking Christianly allows the clinician to have a broad notion of biblical anthropology that then serves as the template organizing various strands of human experience, but without causing him or her to feel constrained by solely focusing on religious ideas and practices. Consequently, the clinician can seamlessly incorporate values and moral perspectives in a context of grace, all as components of therapeutic practice.

As may be gathered from the preceding paragraph, a psychotherapist or counselor will be proceeding on the basis of fundamental assumptions about what contributes to human flourishing, what the basic human processes and motivations are, and how the derailment of human experience may be helped, even when all may start at the same place (Joe’s sexual acting out). I agree with those who affirm that the clinical endeavor will be framed by the worldview of the therapist (e.g., Hodge, 2013; Slife, 2013). What that means in real and fundamental terms is that the therapeutic approach, Christian or not, will be shaped and guided by a philosophical anthropology (i.e., a set of assumptions about what it means to be human) that will answer questions about the nature of the problem and provide guidance for intervention. In other words, are Joe’s problems primarily spiritual in nature, biological at their core, the result of environmental and childhood experiences, or a combination of all of the above?

Furthermore, the therapist will also operate from assumptions about what is deemed to be real or not; that is, there will be as yet not operationalized metaphysics and notions of ultimate reality at work. For example, is God real? If so, what type of God is He? Would God be involved in the therapeutic process? How relevant is God to understanding Joe’s life and experience? Does believing and invoking God in the life of the counselor make a difference in the manner in which he or she works? If so, how?

The counselor or therapist will operate from an assumption about the degree to which Joe is responsible for his behavior. Is he ill, or is he an addict? If either, does he have diminished capacity? If his behavior is deemed as sinful, how can the clinician operate in a therapeutic expectation of positive regard and nonjudgmental empathy? The counselor will operate from a given set of values and a moral frame of reference, whether explicitly recognized or not. In other words, there will be assumptions about moral behavior and what constitutes morality or philosophical ethical considerations, and these assumptions will likely guide the selection of interventions used for Joe. (See Browning, 2007, for an excellent discussion on the topic of values embedded in clinical theory.)

If counselors adopt a Christian worldview, what does it mean to think Christianly in a clinical context? Will these therapists work in a manner radically different from the way their secular colleagues would? Would they keep faith and belief to themselves as much as possible so as to not to impose their values on the client? Should these counselors content themselves with mixing and adapting evidence-based approaches with a sprinkle of holy water in the form of scriptural references?

Thinking Christianly in the Consulting Room

To think Christianly in the consulting room means that one can take a transtheoretical perspective because the theoretical glue, the clinical road map, comes from the basic notions of what it means to be human from a biblical perspective. That is, the organizing and guiding principles emerge from a biblical worldview about the human condition. In this book, the findings from neuroscience and the broad field of psychology are organized by the fundamental assumptions of a biblical worldview, which in turn, informs a psychotherapeutic position and technique. The result may or may not be similar to those utilized by the various schools of counseling and psychotherapy. The goal is not to develop a fundamentally alternative approach or to take the position of an apologist, but, rather, to organize the knowledge coming from philosophical, neuroscientific, social, and psychological sources all cohesively around the nodal points offered by a biblical perspective on the human experience.

For the Christian clinician, the basic worldview assumptions are likely to rest in the belief that all healing proceeds from God, and that the Trinity is deeply invested and involved in the business of bringing about healing. The work of the counselor, then, is to find useful ways of articulating in every clinical encounter what God has revealed through His Word, and to be a humble servant guided by His Spirit (Appleby and Ohlschlager, 2013).

I believe the following dimensions in philosophical anthropology are grounded in the Bible (biblical anthropology) and can be helpful to the counselor and psychotherapist:

• Persons are whole—body, mind, and spirit—and do not experience themselves as separate compartments.

• Human experience is fundamentally relational and organized by love: love of God, love of neighbor, and love of self. We have been created with an intrinsic motivation to relate to others and to God.

• Spirituality is to be found in all humans, regardless of whether they overtly profess a religion or belong to a spiritual tradition.

• We are created in the image of God and function optimally when we are attentive to the moral imperatives that protect us from each other and from our negative tendencies.

• Sin has entered all of human experience. Our hearts and minds are not free from either temptation or the propensity to behave in destructive ways.

• In reflecting God’s image, humans are endowed with the capacity to choose, and also to strengthen our moral and psychological fiber in healthy directions.

• Although created for eternity, humans have to deal with death itself and all its reminders: sickness, disability, aging, and all forms of loss. The subjective experience of time is always present in the background; it is part of how we live. The Lord has given us beliefs and practices that help us connect to eternity, providing glimpses of boundless time and giving us hope that this can be our experience as well.

• Humans are created to reflect God’s glory. While we await the fullness of the restoration to come with His kingdom, we strive for more than just healthy coping or a less miserable experience. Through God’s grace, we seek the renewal of our minds and the transformation of our beings. Empowered by His promises, we trust His healing to lead to a transformed heart.

Bringing attention back Joe, I will now provide an overview to explain how these dimensions from biblical anthropology may inform the ways in which a clinician can understand his dilemma.

Thinking Christianly About Joe

I believe the Bible teaches that human beings cannot be compartmentalized; thus, what Joe does with his body cannot be divorced from his thoughts, feelings, or spirituality. His addiction involves his body, from the subjective experience of craving, to the objective experience of his acting out, which then betrays his faith and leaves him psychologically trapped. The Bible also teaches that humans are spiritual beings. Humans do not possess a spirituality or choose to be spiritual. Spirituality is an inescapable condition of being human. Joe worshipped sexual contact. His mind, energy, and resources were substantially dedicated to obtaining his next sexual fix. He was willing to risk everything for the sake of ensuring his sexual gratification. Jesus taught that wherever our treasures are, our hearts will be (Matthew 6:21). For Joe, this was in his compulsive drive for faceless sexual encounters. What Joe had come to love consequently organized his psychological experience: it alienated him from experiencing God’s love, seriously isolated him from the love of neighbor, and gutted any prospects for love of self properly understood.

Joe’s addiction was more than an illness. His addiction also pointed to the human struggle with sin in his life, the role of the will, and the moral issues that are inextricably present at every turn of human experience. The Bible also articulates the values and moral indicators that operationalize what is optimal for human life, and the psychological consequences when those are ignored. Joe knew what was right, healthy, and congruent with his values and identity, yet he felt compelled to frequently act to his own detriment.

Joe’s struggles also reflected a lack of existential awareness. The scriptures remind us that we are not meant for this world. Humans are meant for eternity, but in the meantime, we have to deal with our own mortality while retaining a sense of hope in regard to the future. We have to go on day to day while simultaneously savoring the flavor of our ultimate destination. We are created with a consciousness of time, together with the manner in which we live and experience time frames for so much of our lives. Do we live in fear of getting sick and dying? Do we live stuck in the past or constantly fretting about the future? Do we live like Joe, constantly devoured by the present? What if Joe had a clearer sense that death is not the end of it all? What if he had a way to see glimpses of the eternal kingdom to come? Could that have made a difference?

Joe’s journey would not have been complete if he only had been able to manage his addiction, or if he only had developed better coping strategies. Joe would not reach a sense of wholeness if he only had developed insight about the dynamics that contributed to his self-defeating tendencies. Joe would not have healed if he only had more adaptive cognitions or addressed family-of-origin configurations. Although likely providing some value, these strategies could never result in a full healing and transformation.

Joe healed when he knew that he was loved by God and accepted by his community. He healed when he was able to confront the moral bankruptcy of his predicament and yet still see that grace was available to him in abundance. Joe felt complete when his spiritual stirrings satisfied him more fully than the cravings of his body. In the end, Joe confronted his own death with the confidence that nothing could separate him from the love of Christ (Romans 8:38).

The Bible provides the foundation for how human nature can be properly understood and illuminates how the healing presence of God is attuned to bring about our healing. But the Bible is not a treatment manual for specific emotional disorders. In the Bible, we can find the true principles of psychology, but not its detailed description. The Bible does not ignore the importance of the mind, but it does not spell out the neurobiological mechanisms associated with its teachings. Scriptures guide the counselor to consider transtheoretical dimensions framed in a manner that is deeply relevant, given that it relies on the intent of the Creator of each human being and therefore can be easily and profitably recognized in the clinical dialogue. The foundation and the framing of a house are essential, but they do not make it into a habitable abode. Social, psychological, and neurobiological findings serve as the building blocks of the walls constituted by a biblical anthropology.

The Christian psychotherapist and counselor may benefit from biblical ideas, but the so-called clinical house only becomes Christian when God lives in it.

Including God in Psychotherapy—Beyond Cultural Congruence

God, as the Creator of humanity, provides unique insights into what it means to be human, thus helping us identify dimensions of human nature that matter to psychological health. The scriptures also teach that God remains engaged and present in the human realm; therefore, any human activity needs to be considered in the context of this interaction.

Let me give you an example. My client was a female in her midthirties who presented with symptoms of PTSD that could be clearly linked to childhood sexual abuse. At that time, I thought that using some of the grounding techniques outlined by Marsha Linehan’s dialectical behavioral therapy (1993) would be helpful in offering her relief from her symptoms. Faithfully following the directions provided in the client handbook, I asked her to reflect on the image of herself as a lotus flower gently reaching the ground. My client complied but was clearly going through the motions without any noticeable decrease in her level of anxiety. During her next appointment, she told me that she had felt grounded when she imagined herself embracing Jesus on the cross rather than seeing herself as a lotus flower. Upon discussion, she said she found the image of Jesus far more meaningful than the image of the drooping lotus flower, as the former was compatible with her own Christian beliefs. In this case, a supposedly neutral definition of spirituality (i.e., the lotus) and its associated clinical applications were meaningless to the client, but when the technique was adapted in a spiritually congruent manner, it was quite helpful. It was only when she connected the image of the suffering Christ to a cross firmly planted on the ground that she finally felt the power, relieving her of her symptoms. What helped her was not just that she had been able to come up with a culturally congruent symbol. Her connection to Christ was real. When all had fallen apart during her early experience of abuse, holding on to the Lord was the only source of stability and strength left to her. Her experience was beyond cultural congruence.

An ethical therapist will remain attentive to what the client believes and respect the client’s worldview. Current social trends make it more likely that clinicians may serve clients who would not include God in the consulting room. The Christian clinician may still be guided by the dimensions of a biblical anthropology while recognizing that God’s mercy and healing are not impeded by the client’s beliefs. The Lord sends his blessings on all. (See Matthew 5:45.) How is the Christian clinician, then, to remain ethical, biblically grounded, and able to relate to the client? Kenneth Pargament’s approach may be helpful here. He considers the sacred to be a very crucial component in psychotherapy, sometimes expressed in nonreligious terms (Pargament, Lomax, McGhee, and Fang, 2014). From a secular perspective, the sacred is all that is set apart and deserving of veneration and respect as defined by an individual or group. This concept may facilitate the connection to cultural parameters important to the client and decrease a therapist’s temptation to bring his or her own definition to the session, thus helping the therapist to remain ethical. It may also help to capture the contours of spiritual experiences that may not be as clearly defined by the client, thereby creating spiritual attunement. Sometimes language can have an evocative power that exceeds its semiotic intent. A stirring that is felt by the client as resonating psychologically may point to something more, something rooted in emotional experience that beckons in a deeper, if ill-defined, direction. These types of experiences I call integrative themes, as they have an evocative impact (see Appelbaum, 2000) on the therapeutic dialogue that reverberates in psychological as well as spiritual levels of experience. The client may not understand this stirring as something that is sacred, and yet may still recognize it as such if it is tactfully pointed out to him or her. The biblical grounding is given by the conceptual anchoring in the dimensions of human nature, which do not necessitate an explicit reference to its sources to be relevant.

Including God in psychotherapy can have a meaningful clinical impact, as illustrated above. There is emerging support for the fact that believing in God makes a difference in the outcome of psychiatric treatment, as shown in a study with 159 clients at a day hospital. Believers had a better response to treatment and greater reductions in depression and self-harm levels, after controlling for demographic and clinical variables (Rosmarin, Bigda-Peyton, Kertz, Smith, Rauch, and Bjorgvinsson, 2013). But it is also an epistemological statement that carries significant consequences in regard to the manner in which psychotherapy and counseling are conceived and practiced.

The Christian counselor may wonder what type of God is then invited to the consulting room when following the client’s religious inclinations. Cultural anthropologist of religion Ilkka Phyysianen (2009), a nonbeliever himself, affirms that beliefs about souls, spirits, ghosts, gods and demons can be found everywhere and seem to form a recurrent pattern within and across cultures, quite irrespective of what philosophers and theologians [and I would add psychotherapists] happen to consider important (p. 9). Naturally, the significance and meanings of religion and spirituality for individuals differ widely. Given the salience of religion and spirituality in most of the world’s population, it behooves clinicians to become conversant in the ways in which the sacred makes a psychological impact on the human psyche for good and for ill. Several books have recently addressed the issue of religion and spirituality in psychotherapy. For instance, Tan (1996) suggested a combined explicit and implicit manner of working in psychotherapy as a Christian in which the therapist continuously functions within an implicit spiritual frame of reference, while introducing clear religious language and practices when appropriate. Therefore, the psychotherapist and counselor must remain centered on the narratives that are germane to the case and the life of the client.

In articulating a neuro-psycho-spiritual approach to counseling and psychotherapy, the biblical anthropology espoused does not see human spirituality as a mere epiphenomenon of the brain, but, rather, affirms that brain activity is inseparable from religious experience, and as one of God’s most amazing creations, its understanding can expand and inform clinical practice. However, the kind of God believed in can make a significant difference. Recent research has documented the protective role of religion and spirituality for those who are at risk for major depressive disorder but find their faith personally meaningful. While brain imaging shows a thinning of critical cortical areas in the offspring of individuals diagnosed with major depression, the same brain regions are thicker (more complexity and connectivity) in those who espouse a personal religiosity (Miller, Bansal, Wickramaratne, Hao, Tenke, Weissman, and Peterson, 2014). Could it be that if Christian therapists were able to assist their clients in developing a deeper spiritual journey that the results would show significant differences in brain functioning? The counselor might then also be able to identify the religious and spiritual practices that could be associated with negative cerebral health (Crescntini, C., Aglioti, S., Fabbro, F. and Urgesi, C., 2014; Owen, Hayward, Koenig, Steffens, and Payne, 2011).

Perhaps a clinical example may better illustrate this point. Several years ago, I met several times with a Caucasian female in her fifties who had grown up in my own Seventh-Day Adventist faith tradition but who, over time, became an active Wiccan. At the time I met her, she was seriously ill. She had unremitting severe depression, experienced frequent suicidal ideation, and had endured multiple hospitalizations. The next-to-last time we met, she was very agitated and actively suicidal, leading to a prolonged admission followed by a course of electroconvulsive therapy treatment (ECT). On this meeting, she shared with me that she had led in a séance with a group of young Wiccans at a mountain cabin. During the séance, her mother showed up as a spiritual being. Her mother had committed suicide in front of her when she was about ten years old and seriously contributed to a lifelong history of mental illness. This experience completely destroyed the meager gains made up to this point, resulting in a long admission and course of ECT. The last time I met her, she was very sedated by her