Cognitive Behavioral Therapy for Christians with Depression

A Practical Tool-Based Primer

Michelle Pearce

• Publisher: Templeton Press
• Year: 2016
• Print ISBN: 9781599474915
• eBook ISBN: 9781599474922
• Topic: Psicología
• Subtopic: Psicología anormal

Does religion belong in psychotherapy?
 
For anyone in the helping profession, whether as mental health professional or religious leader, this question is bound to arise. Many mental health professionals feel uncomfortable discussing religion. In contrast, many religious leaders feel uncomfortable referring their congregants to professionals who do not know their faith or intent to engage with it.
 
And yet Michelle Pearce, PhD, assistant professor and clinical psychologist at the Center for Integrative Medicine at the University of Maryland, argues that if religion is essential to a client, religion will be a part of psychotherapy, whether it is discussed or not. Clients cannot check their values at the door more than the professionals who treat them.
 
To Pearce, the question isn't really, "does religion belong?" but rather, "how can mental health professionals help their religious clients engage with and use their faith as a healing resource in psychotherapy?"
 
Cognitive Behavioral Therapy for Christian Clientswith Depression is the answer to that question, as the book's purpose is to educate mental health professionals and pastoral counselors about religion's role in therapy, as well as equip them to discuss religious issues and use evidence-based, religiously-integrated tools with Christian clients experiencing depression.
 
In this book, readers will find the following resources in an easy-to-use format: 

• An overview of the scientific benefits of integrating clients' religious  beliefs and practices in psychotherapy
• An organizing therapeutic approach for doing Christian CBT
• Seven tools specific to Christian CBT to treat depression
• Suggested dialogue for therapists to introduce concepts and tools
• Skill-building activity worksheets for clients
• Clinical examples of Christian CBT and the seven tools in action

Practitioners will learn the helpful (and sometimes not so beneficial) role a person's Christian faith can play in psychotherapy. They will be equipped to discuss religious issues and use religiously-integrated tools in their work. At the same time, clergy will learn how Christianity can be integrated into an evidence-based secular mental health treatment for depression, which is sure to increase their comfort level for making referrals to mental health practitioners who provide this form of treatment.
 
Cognitive Behavioral Therapy for Christian Clients with Depression is a practical guide for mental health professionals and pastoral counselors who want to learn how to use Christian-specific CBT tools to treat depression in their Christian clients.
 

PART ONE

Overview of Christian Cognitive Behavioral Therapy

CHAPTER 1

Why Integrate Religion into Therapy?

CLIENTS BRING a powerful healing resource into our offices every day, yet few of us know it, let alone use it to help them recover. Most of us don’t realize that this valuable resource has the potential to create a strong therapeutic alliance early on, promote engagement with treatment, and increase our clients’ likelihood of experiencing positive change. For those of us who do know about this resource, few have received training on how to integrate it into treatment. It’s time for a change.

You’ve probably gathered from the title of this book that I’m going to say that this healing resource is religion. If so, you’re correct, but you don’t need to take my word for it. An accumulating body of scientific research shows that our clients’ religious beliefs, practices, and resources can have the positive and powerful impact described above when integrated into psychotherapy.

DOES RELIGION BELONG IN PSYCHOTHERAPY?

I hear this question a lot from mental health practitioners. Here’s my short answer: If religion is important to our clients, religion will be part of psychotherapy whether we discuss it or not.

I say this because clients can’t check their worldview, spirituality, or values at our door any more than we can choose to leave our hands and feet behind when we go to work. A religious identity and worldview are integral aspects of how religious clients think about, experience, respond to, and take action upon their world, which makes for a good chance that their religious faith is a lens through which they view their experience of depression and recovery. If we don’t discuss their religious beliefs and worldview, we may be missing vital information and a significant way of improving their psychological well-being.

So, to me, the question isn’t really, “Does religion belong?” but rather, “How can we help our religious clients engage with and use their faith as a healing resource in psychotherapy?” This book is my attempt to answer this important question.

Research shows that the majority of our religious clients want us to discuss their religious beliefs and practices with them. In a national poll of one thousand Americans, 83 percent said their religious beliefs and emotional health were closely related, and 72 percent preferred to see a therapist who respected and integrated their religious beliefs into therapy.¹ Other researchers have found that between 53 percent and 77 percent of clients want to have a discussion about religious and spiritual issues with their therapist.² In fact, the more religious a client is, the more likely she or he will want religion to play a role in therapy.³ Other research shows that clients think that therapists who integrate religion and spirituality are more competent than those who do not.⁴

You might have noticed that there is a long history of antagonism between psychology and religion, despite both being healing traditions. Fortunately, things are starting to shift, as practitioners of each tradition see that together they might provide an even more powerful healing force for those in need. For example, of 153 American marital and family therapists surveyed, 72 percent believed that spirituality is relevant to clinical practice, and 54 percent wanted to learn ways to assess for and integrate spirituality into treatment.⁵ Similarly, in a recent survey completed by 262 members of the Association of Behavioral and Cognitive Therapists, 96 percent reported that religious and spiritual issues are “sometimes” to “always” relevant to mental health, and 64 percent were “mostly” to “very much” interested in receiving further training in this area.⁶ However, another survey found that only 30 percent of psychologists discussed religion and spirituality with their clients.⁷

What we see from the literature is that the majority of therapists and clients are answering the question, “Does religion belong in psychotherapy?” with a resounding “Yes!” But many mental health professionals aren’t taught how to engage with religious issues in therapy, meaning that this resource for our clients often goes unnoticed and untapped. That’s one of the reasons I think we really should be examining the question, “How can we help our religious clients engage with and use their faith as a healing resource?”

To answer this question, we as mental health practitioners first need to know the benefits of addressing our clients’ faith in psychotherapy. Then we need an organizing therapeutic approach and a set of practical tools to enable us to integrate religion effectively into treatment, and that’s what this book is designed to provide. Below, I’ve tried to anticipate the questions you might have about integrating religion in psychotherapy. As I attempt to provide answers, I’ll say more about the benefits of incorporating our clients’ religious beliefs and practices in therapy, and will introduce a therapeutic approach that helps us do just that.

IF I’M TREATING DEPRESSION, WHY DO I NEED TO KNOW ABOUT RELIGION?

Let’s take a look at some statistics to help answer this question. First, a little about depression, which is a serious public health problem. It’s the leading cause of disability worldwide, and national surveys reveal an alarming prevalence of depression in the United States. Every year, 25 million Americans experience symptoms severe enough to warrant a diagnosis of depression. That’s almost equivalent to the entire population of Texas! Twenty-five percent of women and 10 percent of men will experience an episode of depression in their lifetime. Sadly, more than half of these individuals will go on to experience at least one more episode of depression. If you’re in clinical practice, no doubt you have worked with many individuals experiencing depression.

National polls also reveal that America is a religious nation. Seventy-nine percent of Americans consider themselves affiliated with a religion, 93 percent believe in God or a higher power, and 77 percent consider themselves to be religious.⁸ Although the United States is a religiously diverse nation, and is becoming more so each year, the majority of Americans—77 percent—consider themselves Christian.⁹ Put these two sets of statistics together, and the chances are excellent that we will treat, and have already treated, Christian clients who are depressed.

At one time we might have considered religion to be just another descriptive fact about our clients, such as “buys Apple products” or “votes liberal”—a descriptive fact that we considered interesting, but not necessarily relevant to therapy. However, research shows that religious involvement is more than demographic information; it is related to our clients’ treatment of and recovery from depression. A large body of scientific work conducted by researchers worldwide has revealed a relationship between religion and depression. Between 1962 and 2011, at least 444 studies examined this relationship.¹⁰ Of these studies, 60 percent reported that the more religious individuals are, the less likely they are to be depressed, and if they do become depressed, they tend to recover more quickly. Among the 178 highest-quality studies, the number reporting this inverse relationship goes up to 67 percent. Only 6 percent of the studies reported greater depression among the more religious.

Greater religiousness may be associated with less depression for many reasons. Religion can help people cope with stress, buffer the effects of challenging life events, and offer a framework for meaning and purpose, particularly for circumstances that seem senseless and beyond our control.¹¹ Religious individuals are also often part of a religious community, and the social support received may help prevent the development of depression or speed its recovery.

We also need to acknowledge that religion is not always a source of healing and positive feelings. Christians can experience struggles in their relationship with God and members of their religious community and have other faith-related struggles, all of which can result in sadness, distress, doubt, fear, and guilt. Spiritual struggles, such as feeling punished or abandoned by God, can cause and worsen psychiatric symptoms,¹² just as psychiatric symptoms can cause and exacerbate spiritual struggles. In one survey of 2,754 clients across the United States, 20 percent endorsed clinically significant levels of religious or spiritual distress.¹³ As such, it is important for therapists to know how to assess for and engage with clients regarding spiritual struggles.

We look in more detail in the following chapters at the scientific literature demonstrating the relationship between religious beliefs and practices and depression. What we see from this brief overview is that religious beliefs, practices, values, and coping styles matter in the development and treatment of depression.

One more important reason to know about religion if we are treating depression is that our ethical practice codes mandate it. For example, the ethical codes of both the American Psychological Association (APA) and the American Counseling Association (ACA) state that religion is a domain of diversity that requires clinical competence.¹⁴ The APA’s Board of Ethnic and Minority Affairs state their guideline as follows: “Psychologists respect clients’ religious and/or spiritual beliefs and values, including attributions and taboos, since they affect worldview, psychosocial functioning, and expressions of distress.”¹⁵ Social workers are also mandated to demonstrate cultural competence, which includes using interventions that are relevant and sensitive to their clients’ worldview.¹⁶

These ethical codes suggest that respecting our clients’ religion requires more than just being aware that they are religious. We need to be intentional about knowing how our clients’ religion impacts how they view their world and function in it, as well as how it impacts their experience of and recovery from depression. Just like other domains of diversity, such as gender, ethnicity, or race, to achieve competency we need knowledge, understanding, and ongoing training. Learning how to integrate religion into psychotherapy is one way of working toward this required competency. In sum, as these statistics and practice guidelines demonstrate, we cannot ignore religion when we think about ...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Foreword
• Preface
• Acknowledgments
• Part One: Overview of Christian Cognitive Behavioral Therapy
• Part Two: Seven Practical CCBT Treatment Tools
• Appendix A: For Clergy
• Appendix B: CBT and Christian CBT Resources
• Appendix C: Reproducible Resources
• Notes
• References
• About the Author
• Index