A Transcendent Therapy Intervention
Another way in which Christian psychotherapy differs from modern versions is the Christian assumption that God is an actual being who transcends this creation and can make a difference in human life. The majority of world religions have similar assumptions (except Buddhism, which is one reason why theorists and researchers may be more accepting of Buddhist psychology in current psychotherapy models). Most human beings sense a need for a source of goodness and help outside this visible world and beyond one’s own resources (Adams, 1999), and psychological wellbeing has been found to be enhanced with a focus on the transcendent (Muller, Creed, & Francis, 2004; Piedmont & Leach, 2002; Tomcsanyi, Martos, Ittzes, Horvath-Szabo, Szabo, & Nagy, 2013). More specifically, belief in the reality of God, in contrast to God as an abstraction, has been found to be correlated with positive psychological outcomes (Testoni, Visintin, Capozza, Carlucci, & Shams, 2016).
Christian psychology, in particular, suggests that the triune God has made himself available as a transcendent resource for psychospiritual transformation: omniscient, omnipresent, and omnipotent, righteous, as well as loving and compassionate (omnibenevolent). He has provided a transcendent remedy in Christ’s life, death, and resurrection for humanity’s greatest hindrance to flourishing: the shame and guilt that comes from sin,4 keeping us from reconciliation with God, our truly greatest Good. As a result, this God can become a meaningful and impactful part of one’s social system, a loving, wise father-figure and friend who provides assistance and support for all other aspects of the psychotherapeutic process.
Attachment to God
According to Christianity, humans can form a close personal relationship with God through faith in Christ. Such an ideal is made even more meaningful with the knowledge that the Christian God is triune and seeking the ultimate wellbeing of humans by drawing them into their Trinitarian communion (Ephesians 3:16-19; 1 John 1:3).
Based on attachment theory, many researchers have begun to consider human relations with God as a kind of attachment. “There is considerable evidence to support the notion that believers view God as a kind of exalted attachment figure” (Granqvist & Kirkpatrick, 2008, p. 908). Believers seek closeness to God and derive from him a sense of safety and security, both features of a healthy human attachment. Many studies now have investigated the relationship between early human attachments and God attachment, recognizing that the affectively loaded mental representation of self-and-other that is formed in childhood—which Bowlby (1969) called an internal working model (IWM)—provides the psychological basis for close relationships in adulthood, including one’s relationship with God. Evidence has been found of both compensation and correspondence explanations for why people form an attachment to God (Granqvist & Kirkpatrick, 2008). With the former, individuals turn to God as an attachment figure to make up for the insecure attachment in earlier human relationships, finding in God the perfect relational safety and security that is especially needed because of a deficient IWM; whereas the latter characterizes individuals whose relationship with God matches the secure attachment of their family of origin due to the adult transfer of the relatively well-formed IWM to God (McDonald, Beck, Allison, & Norsworthy, 2005).
At the same time, because of deficiencies in their IWM, Christians who were insecurely attached in childhood will generally experience greater internal and relational conflict than securely attached individuals, leading to potentially more turmoil in their relational experiences with God (more on that below). For some, it is hypothesized that this insecure attachment can be remediated in some degree in adulthood in a relationship with an omnipresent and perfectly loving caregiver (Granqvist 8c Kirkpatrick, 2008).
Over time, it seems possible that the emergence of “earned secure attachment status” could result for those who have had repeated, significant experiences of God’s love and care, similar to the mechanism of change in psychotherapeutic relationships (Hesse, 2008). However, such a process will likely be uneven and involve a gradual restructuring of one’s IWM through the experiences of life, an engagement with biblical revelation, and an encounter with God in affective and contemplative prayer, meditation, and worship. Though earned secure attachment with God has been repeatedly anecdotally confirmed, research is needed to document more rigorously this pathway of healing. By contrast, Christians who grew up with secure attachment will likely more readily obtain a safe and secure relationship with God, one who stabilizes them through the inevitable stresses and challenges of adulthood. In principle, such “continuously secure” individuals (Hesse, 2008) would seem primed to be able to enter into an increasingly intimate relationship with God throughout adulthood. Thus far, there has been ver}' little discussion in the psychological literature on attachment specifically with the Trinity (for an exception, see Miner, 2007) and how that might differ from attachment with a merely monotheistic God.
God Concept and God Image
A distinction has been made in recent years between a person’s God concept (one’s conscious, mental beliefs about God, shaped more by religious teaching) and one’s God image (a deeper, affect-laden, often unconscious representation of God shaped more by one’s early attachment history; Grimes, 2008), and this distinction may help illuminate troubled Christian experience. (A God image is generally interpreted as the application of one’s IWM to God; see Granqvist & Kirkpatrick, 2008; Noffke & Hall, 2007.) These contrasting perspectives on God can be discussed in therapy with Christian clients, since most Christians are unaware of the possibility that their implicit experience of God may differ from their explicit understanding of God due to impoverished relational histories (Davis, Moriarty, & Mauch, 2013).
Spilka and other early researchers found positive relationships between positive views of self and images of God as loving and forgiving, as well as negative views of self and images of God as primarily wrathful and vindictive (Benson & Spilka, 1973; Spilka, Addison, & Rosensohn, 1975). This finding partly supports the contention mentioned above that one’s views of God, self, and others are fundamentally interrelated.
Research has also found that depressive and anxiety-related symptoms tend to be correlated with insecure God attachment and negative God images (Braam et al., 2008; Exline, Yah, & Sanderson, 2000; Knabb & Pelletier, 2014), whereas positive psychological and physical benefits are associated with a positive God image (Krause, Emmons, & Ironson, 2015; Bradshaw, Ellison, & Marcum, 2010). In addition, some have found that Christians’
God attachment and God image can change in positive directions with cognitive, affective, and relational psychotherapeutic strategies (Cheston, Piedmont, Eanes, & Lavin, 2003; Thomas, Moriarty, Davis, & Anderson, 2011; Tisdale, Key, Edwards, Brokaw, Kemperman, & Cloud, 1997). However, again, research is needed on how the revelation and experience of the triune God (Father, Son, and Spirit) might impact one’s God concept and God image.
One concern ought to be raised about the God image literature. Some authors have argued that humans only have access to their perceptions of God (congruent with much modern thought about God since Kant) and are, therefore, agnostic about whether those perceptions can count as knowledge that corresponds to their (noumenal) object (e.g., Jones, 2007; McDargh, 1983; Rizzuto, 1979). However, the classic Christian tradition has generally affirmed a realist epistemology regarding biblical revelation by means of the Holy Spirit and the Christian’s consequent knowledge and experience of God (Plantinga, 2000). In a similar vein, some authors within the indigenous psychology movement have critiqued secular clinical psychology because of its emphasis on reductionism, scientism, and materialism (Marsella, 2009). In the present context, a therapeutic orientation rooted in the classic Christian tradition would suggest that, while one’s God concept and God image can certainly be distorted by sin (e.g., alienation from God, broken communion with God) and poor socialization with malformed imagebearers, an important goal of Christian psychotherapy is the healing of such distortions so that one may know and experience God with increasing validity.'
Because of God’s transcendence and infinitude, every human’s perception and knowledge of God are more or less limited by finitude and more or less distorted by sin (Boyer & Hall, 2012; Frame, 2002). We perceive and know God only analogically. From a classical Christian standpoint, one’s psychological representations of God—both one’s God concept and God image—are the means by which one perceives and experiences the true and living God. Because one’s God concept is easier to change, more accurate perception and knowledge begin there, as Christians come to conform their conscious beliefs of God to the divine self-revelation recorded in the Bible. Second, they can use their more accurate God concept to guide the restoration of their God image so that it, too, increasingly conforms to God’s self-revelation in Scripture through multiple relational experiences with God via lectio divina, worship, and Christian meditation (e.g., contemplative prayer), profoundly reinforced by close personal relationships with humans who resemble God more than their early caregivers did (e.g., in therapy relationships).
Providence, Religious Coping, and Surrender
We saw in the previous chapter that, according to Christianity, God’s omnipotence means he is mysteriously overseeing all that happens in the created order and has control over all that occurs. “God control” has been studied as a theistic attribution style (Welton, Adkins, Ingle, & Dixon, 1996), has been linked to wellbeing, and appears to serve as an active form of coping in the midst of Christian challenges (Krause, 2005). Rather than lead to passive resignation, studies have found God control is positively correlated with internal locus of control among believers (Jackson & Coursey, 1988; Silvestri, 1979). In fact, the collaborative religious coping style, in which believers assume an active role in resolving problems while relying on God’s activity, is associated with numerous indeces of wellbeing (Pargament, 1997).
However, there are also times when wisdom dictates that direct human action is not warranted (e.g., dealing with the slow death of a loved one, accepting psychological symptoms that will not go away). In such cases, knowing that God is providentially guiding all that occurs for good is important (Romans 8:28), leading to another religious coping style: surrendering to God. Within the last few decades, surrender has been operationalized, and its psychological benefits for believers have been examined (Cole & Pargament, 1999; Wong-McDonald & Gorsuch, 2000). Drawing from a 350-year-old Jesuit writing called Trustful Surrender to Divine Providence, a recent study has empirically confirmed that deeply held, positive beliefs about God’s providence are linked to the ability to surrender to him as a form of religious coping (Knabb, Frederick, & Cumming, 2017). Also in the Knabb et al. study, surrender was negatively associated with worry, mediated by the ability to tolerate uncertainty. In Knabb et al.’s theoretical model—which was confirmed with path analyses in separate college and church samples—surrendering to God’s providence was related to less worry, with the surrender-worry link explained by the ability to accept the uncertainties and ambiguities in life.
Based on this theoretical model from the Christian tradition, Knabb et al. conducted a pilot study on an eight-week group therapy for chronic worry— primarily utilizing contemplative prayer (e.g., the Jesus Prayer and centering prayer based on the Cloud of Unknowing) as a way to help practitioners surrender to God during instances of worry, uncertainty, and anxiety. Results elucidated medium to large effects pre- to post-treatment when examining changes in views of God’s providence (conceptualized as a type of God image), surrender as a form of religious coping, worry, intolerance of uncertainty, and depression, anxiety, and stress.
Surrender is also related to higher intrinsic religiosity, religious and existential wellbeing, and belief in God control (Wong-McDonald & Gorsuch, 2000), lower stress levels (Clements & Ermakova, 2012), less depression, better quality of life, and stress-related growth (Koenig, Pargament, & Nielsen, 1998), and lower depressed mood among childhood sexual abuse survivors (Gall, 2006). Surrender to God is also distinguishable from a deferring religious coping style, which cedes to God complete control over one’s problems, promotes passivity, and has been found to reduce the qualityof life of cancer patients (Pargament, 1997; McLaughlin, Yoo, D’Angelo, Tsang, Shaw, Shah, Baker, & Gustafson, 2013).
In what appears to be the first published randomized trial on contemplative prayer for psychological problems, researchers recently found that the daily practice of the Jesus Prayer—“Lord Jesus Christ, Son of God, have mercy on me”—decreased perceived stress among a sample of Christian college students, as well as increased their ability to surrender to God as a form of religious coping (Knabb & Vazquez, 2018). In a two-week time period, the authors also found a dose-response effect, suggesting that increasing the frequency of practice was linked to a higher score on a measure of surrender as a form of religious coping at the conclusion of the study.
It seems likely that having a strong view of providence, when combined with a benevolent view of God, helps believers negotiate difficult life circumstances, as well as address depressive and anxiety-related symptoms. Christians in therapy may also benefit from understanding the difference between the deferring and surrender religious coping styles and learning how to surrender themselves and troubling aspects of their lives to God, based on God’s perceived support and care in light of his omnipotence.
As revealed in the aforementioned studies, Christian meditation (e.g., apophatic prayer without words and images, such as centering prayer; kata-phatic prayer with words and images, such as meditating on Scripture [Davis, 2012] and Ignatius’ “prayer of the senses”) can help practitioners learn to surrender to God as a form of religious coping. This Christian-sensitive practice stands in contrast to the Buddhist-informed mindfulness and loving-kindness meditations that are currently popular in the clinical psychology literature (Germer, 2009; Kristeller & Johnson, 2005). With mindfulness meditation (referred to by Germer  as “nonattached awareness”), practitioners typically focus on one thing at a time in the present moment (e.g., the breath, one of the five senses), relating to their thoughts and feelings with non-judgment. Loving-kindness, on the other hand, helps practitioners to cultivate compassion for themselves and others by repeating a mantra (e.g., “May I be free from suffering”). Both practices have been empirically investigated in the clinical literature, based on the operationalization of these Buddhist-influenced practices.
A meta-analysis of 24 studies on loving-kindness found it to be effective in improving positive emotions (Zeng, Chiu, Wang, Oei, & Leung, 2015). Moreover, among 39 studies, Hofmann, Sawyer, Witt, and Oh (2010) uncovered a medium effect pre- to post-treatment when exploring mindfulness as an intervention for mood symptoms and a large effect across four studies for depressive disorders. Although there is certainly some overlap between Buddhist-informed and Christian meditative practices (e.g., both tend to emphasize a single point of focus; cultivate focused, sustained attention; and help practitioners to relate differently to distressing inner experience), Christian clients may prefer to draw from their own religious heritage for meditative practices (e.g., the Jesus Prayer, scriptural meditation within the Puritan tradition, the Cloud of Unknowing, or the Practice of the Presence of God) that can help them change the way they relate to difficult inner experiences, with the added benefit of cultivating a deeper relationship with God along the way. In other words, in the clinical psychology literature, Buddhist-informed (or secularized) meditation is utilized for pragmatic purposes (e.g., to ameliorate suffering), whereas Christian meditative practices are about surrendering to God—via the virtue of Christian detachment, exemplified by Jesus in Gethsemane—so as to pivot from earthly preoccupations to an awareness of God’s active, loving presence. Along the way, preliminary research suggests that Christians’ God image can change (Knabb, Frederick, & Cumming, 2017).