Welcome to the Society for Christian Psychology

1
Welcome to theSociety for Christian Psychology
2
The Five DomainsA Christian Psychology Model
for Counseling

• Timothy A. Sisemore, PhD
• Psychological Studies Institute
• Chattanooga, TN

3
The Five Domains ModelOverview

• Elements of a counseling model
• A Christian Psychology Model
• Practical Applications
• Spiritual Change Processes
• Behavioral Change Processes
• Cognitive Change Processes
• Emotional Change Processes
• Interpersonal Change Processes
• Case Formulation and Treatment Planning
• Illustrative Case Study

4
1- Elements of a Counseling Model

• Epistemology
• Nature of persons
• Nature of health
• Nature of pathology
• Nature of treatment of that pathology

5
From Elements to a Model

• I propose that these elements are fairly
  universal in ALL counseling models
• Yet, parts are often implicit or not carefully
  worked out
• Ill use these to develop a Christian Psychology
  Model
• And try to point out how this may differ from an
  integration model

6
2- A Christian Psychology Modelfor Counseling
7
2a-EpistemologyWhat is Epistemology?

• The study of the origin, or source, of knowledge.

8
Why is Epistemology Important?

• How do you KNOW about the nature of persons?
• How do you KNOW about what problems really are?
• How do you KNOW what the goals of counseling are?
• How do you KNOW what techniques might help?
• How do you KNOW if these techniques are effective
  or appropriate for Christians?

9
A Brief History of Epistemology

• Premodern knowing mostly considered as
  spiritual
• Plato, e.g., thought true forms supernatural, we
  see shadows
• Christian epistemology pointed to revelation
• Modern scientific knowing
• Postmodern no objective knowledge
• Well use premodern views to look at the latter
  two

10
How do we knowAbout God?

• What He has SAID about himself
• Special Revelation
• What He has DONE in history and creation
• General Revelation

11
1. REVELATION

• 2 Timothy 316 tells us Scripture is profitable
• Tells us about God, human nature, and the human
  condition. This is AUTHORITATIVE.
• Yet, because we are sinful, we are fallible in
  interpreting this Truth.
• How complete is the Bible as a counseling manual?
• Biblical counseling says completely
• Christian psychology says it provides structure
  and some interventions, though general rev helps,
  too

12
How do we know about nature?2. RESEARCH

• Nature reveals God (general revelation)
• Yet, our sinfulness affects how we understand
  nature
• Science attempts to transcend our subjectivity
• EMPIRICAL science only that which is observable
  and measurable can be known

13
RESEARCH, continued

• Research is DESCRIPTIVE, not PRESCRIPTIVE
• It is imprecise .05 confidence level
• We need to judge good from poor science
• Something many Christian counselors dont do well!

14
How do we know other things?3. REASON

• Reason is rooted in the imago Dei which well
  discuss later
• It is how empirical science makes sense
• Seen in laws of logic, e.g. noncontradiction
• Still, our reasoning perverted by the Fall
• Especially these days when logic not taught much
• Logic uses the Bible (theology) and research data
  to formulate theory

15
Epistemology in OurChristian Psychology Model

• Knowledge from special AND general revelation
  helpful
• Biblical counselors may disagree with general
• Special revelation holds priority and trumps
  knowledge from general revelation
• Integrationists largely agree to this point
• But info from secular psychology cannot address
  vital issues like the nature of persons
• Thus, the language and theories of psychology are
  inadequate as the basis for a counseling model
• Here we may leave many integrationists behind

16
Issues in Counseling

• ONLY theology can tell us about human nature and
  the plight of persons.
• Psychology can tell some specifics about
  personsbut misses things like SIN
• Psychology can tell NORMAL, but not RIGHT, or
  even HEALTHY
• Technologies of psychology must be critiqued by
  our Christian worldview

17
Areas Where Theology Must Have Priority

• What are persons like BEFORE GOD?
• What is health?
• Goals of life
• Proper behavior (vs. norms)
• Spiritual dimension of problems
• How do persons change?
• Therapists boundaries (e.g. challenging v.
  passively accepting sin)
• Here our model is more dependent on theology than
  many (most?) integration models

18
2b- The Nature of Persons
19
Problems with Persons in Psychology

• Psychological research is built on a-theism
• Psychological theory may concede spirituality,
  but not a true God who acts
• Persons more often evolutions climax, not
  related to God
• Thus, a Christian Psychology model makes biblical
  anthropology as foundational

20
Humans the Climax of Creation

• Creation of man the climax of creation
• Not let there be but let us make
• Made in Gods image
• Made vice-regent over creation

• Has life breathed into him by God
• (Gen 27)
• Can comprehend God and His Law
• Possesses a conscience
• Has rational speech
• God covenants with us

21
The Imago Dei

• Seen in Gen. 126
• The reason we treat each other well
• Gen. 96
• Jas. 39

• What exactly is it?
• Many theories
• I prefer the restoration hermeneutic
• Eph. 421-24
• Col. 310
• Yields knowledge and righteousness as key
• One is toward God, the other toward man
• Thus fits the Great Commandment

22
Relevance of the Imago to Counseling

• The image of God is why we value others
• Our drives explained spiritually (cp.
  Augustines comment)
• Relatedness to others is vital to health
• Loss of these relationships key to problems
• Loss leads to defenses as in the Garden
• We are moral creatures
• Counseling to direct us toward relationship with
  God and others
• BUT SIN ENTERED THE WORLD!!!

23
Sin and Its Relation to Counseling
24
Sin Enters Paradise

• We assume if no sin, no psychological problems
• But Adam and Eve DO sin
• The world is changed dramatically until the Lord
  returns

25
Seven Effects of the Fall

• Loss of innocence
• Enter TRUE guilt
• And FALSE guilt
• Image of God distorted
• Self-focus replaces pure community
• Fellowship lost
• Lonely, restless hearts result

• Environment cursed
• Romans 820-22
• Man and woman punished
• Now Adam and Eve bring forth after their OWN kind
• Genesis 53
• We now need divine grace

26
Original Sin

• Three moral choices for persons
• Born good (Carl Rogers, etc.)
• Born neutral (behaviorists, etc.)
• Born sinful (the historic Christian belief)
• Yet many Christians today disagree, so this is
  more controversial than it used to be.

27
Not that sin is so popular
28
Original Sin

• Definition The inborn sinful nature that
  underlies all particular sins, inclining us to
  wrong so that none is righteous.
• We are NOT free NOT to sin
• Particular sins emerge from the sinful nature
• And we live in a sinful world (recall McMinn)

29
Scriptural Basis for Original Sin

• Genesis 65-6 821
• Psalm 141-3
• Psalm 515
• Psalm 583
• Psalm 1303
• Ecclesiastes 720
• Ecclesiastes 923

• Jeremiah 179
• John 542
• Romans 129-32
• Ephesians 21-3
• Matthew 718
• John 644,65
• 1 Corinthians 214

30
Implications for Christian Counselors

• People have a propensity toward sin
• Inherently self-seeking
• Want their own way, yet want relationship
• Psychological theories which claiming we are
  morally good or neutral dont stand the test of
  Scripture
• Fallen persons can twist the reason of the image
  of God to defend their sin
• Mental illness and psychological distress enter
  the world

31
Sin causes, or leads to, pain

• Idiopathic
• Inflicted
• Inherited
• Polypathic
• Including relationship pain, conflict, and
  longing
• We need a Savior!

32
Our Model Views Persons

• As important given they bear Gods image, albeit
  distorted
• Made to be in relation to God and each other
• Inherently sinful
• In need of a Savior
• Experience pain
• These, not psychological theory, best explain the
  human condition
• Integration models may agree, but in practice
  draw too heavily from psychological descriptions
  of humans

33
A Brief Commercial

• This theological anthropology ideally would form
  the basis of a Christian personality theory
• This is the most conspicuous missing piece in my
  model and in Christian psychology and integration
  in general
• What follows offers some possible pieces
• But a thorough one needed
• Are you game????

34
(No Transcript)
35
2c- The Nature of Health
36
The Nature of Health

• Must understand the basic drives of humans and
  how they are designed to function
• Found in relationship with the Creator
• Spiritual health escapes the unbeliever
• Yet may find relative health in more successful
  coping
• Community part of health
• Problems are not surprising

37
What Motivates Us? The Pursuit of Pleasure

• Basic motivation To maximize pleasure
  pleasure (properly defined) and to minimize
  (not avoid) pain.
• Yet needs biblical, theological, and
  psychological support

38
(1) Biblical Support

• Joy in our faith Ps 374 Delight yourself in
  the Lord, and he will give you the desires of
  your heart.
• Also Ps 368 421-2 631

39
Joy in the work of being Christian

• Acts of mercy Rom. 128
• Loving mercy Micah 68
• Suffering loss with joy Heb. 1034
• Giving 2 Cor. 97

• Joying in the joy of others 2 Cor. 23
• Serving others eagerly 1 Peter 52
• Watching over our own souls Heb. 1317

40
(2) Theological Support

• Augustines restless heart
• Pascal All men seek happiness
• CS Lewis We are far too easily pleased
• Edwards Joy in God the key to religious
  affections
• Piper glorify God by enjoying Him forever
• Moon Homesick for Eden

41
(3) Psychological SupportSeligmans Authentic
Happiness

• Mistakes in modern understanding of happiness
• Gratifications over pleasures
• Using strengths to rise to occasion and meet
  challenge

42
Gratification

• Uses six core virtues
• Wisdom
• Courage
• Love and intimacy
• Justice
• Temperance
• Spirituality
• See authentichappiness.org

• Attachmentto God
• Rich social life
• Positive feelings over negative, or aversive,
  feelings

43
Gratifications are broadly defined
44
So, for our purposes

• Assume people seek things they believe will make
  them happy
• This partly instinctual, largely learned
• From parents
• Culture
• Those around us
• Frustrations or hindrances lead to pain
• As do false ideas of happiness
• These all stem from sin in the world

45
This Raises a Vital Question

• Is all pain a problem? Pathological?
• Secular theories give little place to suffering
• Yet, Scripture sees it as integral and beneficial
  to the Christian life

46
The Place of Suffering in Life

• Types persecution, sickness, accident
• Key using them to show our faith in God, not
  letting Satan use them to destroy faith
• This is in contrast to the idea the being a
  Christian means no suffering!
• And the frequent counseling mistake of trying to
  eliminate suffering at all costs

47
The Place of Suffering in Life - 2

• Were called to lead a life of sacrifice and loss
  that looks silly if there is no resurrection (e.g
  1 Cor 1529-31)
• If Christlikeness is the ultimate joy, then
  suffering has meaning in pursuit of the goal and
  thus is healthy
• We share in His sufferings
• Are changed into His likeness
• Suffering is thus meaningful and healthy
• Just like the pain of working out promotes
  physical health

48
Suffering Can Yield Benefits
49
Suffering in Counseling

• Dont be too quick to try to stop all suffering
• May need the counselee to see false ideas of the
  Christian life in this area
• Consider if it can be alleviated and what that
  would mean
• If not, show how can develop character and hope
  (Rom 53-5)
• Happiness is integrating suffering into the
  meaning of our lives, not simply avoiding it
  because we are into instant gratification

50
2d- Nature of Pathology

• Idiopathic pain
• Inflicted pain
• Inherited pain
• Polypathic pain
• But not all pain is pathological

51
Pathology in Christian Counseling

• Some psychological problems are more clearly
  diseases than others - part of life in a fallen
  world
• Many are the results of sin, or the fallout of
  the sins of others
• Many stem from misunderstanding
• the nature of the Christian life
• Ways of God leading to improper pursuits of
  pleasure.
• This is not necessarily pathology
• DSM-IV is useful, but may
• Pathologize or normalize sin
• Miss problems Christians encounter

52
2e -The Nature of Treatment

• Pain, or frustrated pleasure seeking, can
  manifest itself in 5 different domains
• Movement is toward holiness (not necessarily
  comfort)
• God is seen as active agent in the process of
  change
• Utilizes biblical truth for living
• And empirically and/or theoretically sound
  techniques from psychology
• Choice of technique rests on understanding of
  pathology

53
ITS TIME FOR A BREAK WHEN
54
(No Transcript)
55
3 Practical Application

• Counseling works from the conceptualization we
  have examined
• Problems are viewed from Christian personality
  theory more than DSM-IV
• Seen as symptoms within 5 domains more than
  syndromes
• Formulation driven, not diagnosis driven

56
Choosing Interventions

• Starts with biblical teachings that address
  problems (contra much integration)
• E.g. much in Scripture on anxiety
• Biblical stories offer examples
• Sometimes psychoeducational uses helping client
  better understand faith and God
• Supplements with psychological techniques
• Particularly those with empirical support that
  are theologically sound
• Though theoretically sound approaches also as
  needed

57
Role of EVTs

• What is an empirically validated treatment?
• Advantages?
• Disadvantages?
• Our model takes components more than
  manualsbased on

58
Borrowing from Recent Medication Trends

• Finding meds cross diagnostic categories and
  address symptoms
• So with this modellook at pieces of the problem
  and apply techniques
• A COMPONENT or MODULAR model

59
Our Model Compared to Some Theories

• Psychodynamic
• Strength appreciates depth and dynamics
• Weakness theory misses Godward nature and terms
  alien to Christian vocabulary
• Client-Centered
• Strength Caring for those in Gods image
• Weakness Misjudges sinfulness

• Cognitive
• Strength Fits with biblical theme of thinking
  affecting feeling
• Weakness Doesnt consider motives
• Narrative
• Strength Theme of story fits with our meaning
  in Gods plan
• Weakness Little empirical evidence postmodern
  values

60
Formulating Treatment

• Think through the case in terms of the five
  domains
• Identify key problems
• Think through explanations of why they exist
  (formulation)
• Draws from personality theory, so admitted weak
  development here
• Identify appropriate interventions based on the
  explanations
• Prioritize timing

61
Questions to Consider in Formulating

• As you review the 5 domains, consider
• What is clients view of what happiness would be?
• Does this need to be changed?
• Theological misconception?
• Theological inconsistency?
• If not, what frustrations are contributing to the
  problem?
• Can these be overcome, or should coping be focus?

• If there is pain or suffering, what is source?
• If others, how to cope or find meaning?
• If self, how to master?
• Need for resources for coping?
• Family?
• Community?
• Are there needs for skills?
• Social?
• Cognitive?
• Emotional intelligence?

62
Surveying the Five Domains
63
Spiritual Change Processes
64
Spiritual Change Processes

• Assessment and informed consent
• The person of the counselor
• Correcting misunderstandings of the faith
• Spiritual life of clients family
• Clients role
• Conversion?
• Other strategies such as bibliotherapy, use of
  stories
• Prayer by, with, and for the client
• Promoting involvement in community
• Spiritual disciplines

65
Behavioral Change Processes
66
Behavioral Change Processes

• Serves to inhibit sinful inclinations
• Rooted in biblical blessings and cursings
• Assessment
• Moral reasoning
• Empathy training
• Behavior management techniques keep simple
• Behavioral assignments
• Including acts leading to gratifications

67
Interpersonal Change Processes
68
Interpersonal Change Processes

• Relationships key to healthy Christian life
• Treatment relationship necessary but not
  sufficient
• Biblical value of relationships
• Assessing relational functioning

69
Relationship as

• Support
• Scaffolding
• Relationship strengthens client to change
• Alliance
• Working together on the problem
• Technique
• Here and now lessons from the therapy relationship

70
Emotional Change Processes
71
Emotional Change Processes

• Galatians 522 first three fruit arguably
  emotions
• Overcontrolled emotions key in the past
• Undercontrolled gaining interest
• Designed to regulate internal states, moving us
  to action or calling us back to stasis (like a
  good cry)
• If not regulated, problems arise
• Affect modulation
• Emotional constriction
• Not understanding contextual cues
• Inability to control emotional impulses

72
Emotional Change ProcessesFour Important Aspects

• How well does client recognize feelings?
• May have to teach this as skill
• How well does client understand feelings?
• E.g. alexithymia
• How well does client grasp the meaning of
  emotions?
• How well can client regulate her emotions?

73
Cognitive Change Processes
74
(No Transcript)
75
Cognitive Change Processes

• Thinking is behind actions (e.g. Ps. 11911)
• Areas of cognitive function
• Structures
• Deficits
• Processes
• Learning disorders affect other areas
• Language problems in particular (play a role in
  many emotional problems)
• Traditional cognitive techniques among strongest
  in empirical research

76
4- Steps in Treatment Planning

• Identify personal/environmental strengths
• Try to use these in treatment
• Survey domains to define problems clearly
• List problems
• Develop formulations for each
• Identify interventions for each
• Biblical/theological
• Empirically validated
• Theoretically acceptable
• Prioritize order of treatment introduction

77
Case Studies
Hyacinth is a thirty-one year old divorcee who
comes to you for counseling as she feels her life
is meaningless and empty. A dedicated Christian,
she had always believed that God would honor her
faith with a faithful husband and kids. Her
husband had an affair and left her two years ago,
and her seven-year old son is exhausting her with
his behavior problems. Embarrassed by the
divorce, she left her church and has only
occasionally been attending different churches.
She works as a school teacher which adds stress
to her life, though she has a few friends among
the teachers there. Yet, she does little outside
of school with these friends because they drink
together and she doesnt think a Christian should
be around that type of activity. Hyacinth tells
you that she has little energy after work, so she
doesnt do a good job of taking care of the house
or managing her son. She simply plops in front
of the TV most nights. She feels she has
offended God for Him to let this happen to her,
though at times shell concede shes a bit angry
with God. She sees little hope for things
improving in the future, and says at times she
wishes she were deadthough she denies shed
commit suicide because her son needs her.
Hyacinth often sobs late at night after her son
is in bed, and has begun consoling herself with
ice cream. She has, of course, gained weight.
Hyacinth believes she can do nothing right and is
a failure as wife, mother, Christian, and, to a
lesser degree, teacher. Five Domains
Treatment Plan Adult.doc
78
Case Studies
Rudolph is a 16 year old boy who is brought by
his parents (mother and step-father) due to his
deteriorating performance in school. Rudolph
admits that he has changed over the past year,
taking up with kids who are low achievers. He
explains that this is due to his feeling his
mother and step-father dont appreciate his
efforts anyway, and around these friends he finds
acceptance that escapes him at home. Rudolph
thinks that his folks are making too big of a
deal of it anyway and that his grades havent
really changed nor is he getting in more trouble.
He denies doing drugs, saying his friends
respect him if he says no. His tastes in music
have changed to dark heavy metal, but he sees
this as merely his maturing. Rudolph considers
himself to be a Christian, but has been irritated
since his mother remarried and the parents
decided to change churches, so he blames this for
his not wanting to go to church any more. He
says he occasionally prays, though he wonders why
God doesnt change his parents when he asks Him
to. Rudolph sees his step-father as a hypocrite,
spouting off Bible verses but yelling at him and
his mother, calling them rather unchristian
names. Since he came on board, Rudolphs mom has
tried to get him to call him dad and to cut off
contact with his father. Rudolph admits his
father is lazy, but still loves him and Rudolph
wants to encourage his dad. Now he is punished
by not being allowed to see his father. Rudolph
thinks the solution would be to get his step-dad
to back off.
79
Thank you for comingTsisemore_at_psy.edu