Christianity and Developmental Psychopathology
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Christianity and Developmental Psychopathology

Foundations and Approaches

Kelly S. Flanagan, Sarah E. Hall, Kelly S. Flanagan, Sarah E. Hall

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eBook - ePub

Christianity and Developmental Psychopathology

Foundations and Approaches

Kelly S. Flanagan, Sarah E. Hall, Kelly S. Flanagan, Sarah E. Hall

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About This Book

Midwest Publishing Association Award of ExcellenceSince its origin in the early 1980s, the field of developmental psychopathology has become a highly influential framework for approaching the clinical treatment of children. Until now there has been no effort to integrate this framework with a Christian understanding of psychopathology.The essays in this volume break new ground by providing Christian mental health professionals with a theoretically and empirically sound basis for working with children, adolescents and families. Throughout the book, the authors explore three integrative themes, looking at children as divine gifts, as persons and as agents in their own development.Given the deep biblical and theological interest in children and the "least of these, " there is great potential in this integrative work for mutual enrichment. Christian insights help to prevent the scientific study of the developmental process from being reductive. At the same time, research into the biological, sociocultural and psychological dimensions of human development can serve to inform and guide Christian practices of care and hospitality toward children and families. Christianity and Developmental Psychopathology makes an important contribution to a conversation that is still in its infancy.Christian Association for Psychological Studies (CAPS) Books explore how Christianity relates to mental health and behavioral sciences including psychology, counseling, social work, and marriage and family therapy in order to equip Christian clinicians to support the well-being of their clients.

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Publisher
IVP Academic
Year
2014
ISBN
9780830895878
1

Overview of Developmental Psychopathology and Integrative Themes


Kelly S. Flanagan and Sarah E. Hall
For you created my inmost being;you knit me together in my mother’s womb.I praise you because I am fearfully and wonderfully made;your works are wonderful,I know that full well.
Psalm 139:13-14
[A] developmental perspective invites [us] to see each human life as a unique person emerging through common aspects that can be observed, measured, and evaluated, yet in essence a human soul, a soul with spiritual reality at core, alive through God’s redemptive grace.
Ward, 1995, p. 16
Start children off on the way they should go,and even when they are old they will not turn from it.
Proverbs 22:6
Advances over the past few decades within child clinical psychology and Christian theology reflect complex views of children and the need to attend to the multifaceted nature of their cognitive, emotional, social, moral and spiritual development. We contend that the parallel process within these two disciplines that has resulted in greater recognition of the complex and dynamic nature of children and their growth leads us to a nexus of integration. We also contend that child clinical psychology and theology have the potential to inform each other. For example, our understanding of child development (e.g., attachment relationships, prevention, child effects on parenting) can impact theological themes, such as the nature of faith, spiritual development, the human condition and church practice (Bunge, 2001a). In turn, theological understandings of children also affect how we understand their psychological well-being and conceptualize psychopathology.
Both developmental psychopathology and contemporary theological views of children challenge us to respect children and treat them with esteem and concern. Advocacy and care for the least of these is apparent throughout both disciplines (e.g., Couture, 2007; Tseng, 2012). Yet it is not always easy to be in relationship with children, a fact that we encounter in our clinical work and perhaps also our personal lives. In writing about her experience raising three children, Miller-McLemore (2007) describes parenting as a spiritual practice of “contemplation in the midst of chaos”; interactions with children cause us to face our own inner chaos (e.g., anger, fear, joy, love, humility and frustration) as well as learn to be with them in the external chaos that their personalities, activity level, desires and needs may instigate. We have a significant role when in relationship with children and thus must have an informed understanding of their world and their unique paths, which include both struggles and growth. Our relationships with children affect their understanding and perceptions of God (Yust, 2004), and likewise, the therapeutic alliance is crucial to work with children and their families (Shirk, Karver & Brown, 2011).
The need to recognize and accept the complexity of children and their world has been identified within Christianity (Miller-McLemore, 2003; Mercer, 2005). There are deep theological roots for attending to children. The care of children is founded on Jesus’ call to love one’s neighbor, to serve others and to heal the sick (Mk 10:23-25; Acts 4:30; Jas 5:16), and on his example to welcome children and not neglect them or cause them to stumble (Mt 18:1-6). Gundry-Volf (2001) explains that welcoming children necessitates the practice of service and hospitality and the recognition that children are paradoxically blessed in their powerlessness in the kingdom of God (Lk 9:46-48; Mt 18:3-4). Though a call to action to serve children was espoused by some theologians in the past (e.g., Wesley, Francke), within the past decade, numerous theologians have called their colleagues to attend to children so that children do not remain marginalized within contemporary theology (e.g., Bunge, 2001a, 2008; Couture, 2007; Jensen, 2005; Mercer, 2005; Miller-McLemore, 2003). Theologians who emphasize care for the young reflect on children in consideration of who the child is (personhood) within her context (Bunge, 2001b). The complexity of children is represented in the Bible, with contradictory portrayals of children throughout Scripture, including children as signs of God’s blessing and as sources of joy (Gen 17) but also foolish, impulsive (Prov 22:15) and in need of discipline (Prov 29:15); as occupying low social status but privileged by Christ (Mk 10:13-16); as models of faith in their vulnerability and dependency but also needing guidance and discipline (Deut 6:6-9; Mt 18:1-6) (Gundry-Volf, 2001). Further, the moral and religious complexity of children is acknowledged through honest appraisals of the multifaceted and multilayered representations of children and their nurture in the Bible (Bunge, 2008).
Within the discipline of psychology, the field of developmental psychopathology has helped clinicians and researchers to view children in a more complex light and to better understand their needs and the interface between development and psychopathology. Scientific insights from the field of developmental psychopathology can shape our clinical work via an informed view of the role of the development process and its impact on later functioning. Yet, we also do not want to reduce our science to merely identification of the right tools and prevention or intervention efforts for “optimal” development. Therefore, our scientific and clinical efforts must be continually grounded in a biblical and theological view of children.
The interface of psychology and Christianity regarding children has a sometimes difficult history, as described by Miller-McLemore (2003), and yet it is crucial in determining how we view children and interact with them. Certain religious practices or theological views might portray mental illness in less than helpful ways, and religion/spirituality has often been ignored within psychology (Yarhouse, Butman & McRay, 2005). Sometimes the nature of how we view psychology and theology may lead us to rely on psychology to the neglect of spiritual values, or likewise, certain views may lead us to distrust psychology as self-focused and spiritually bereft. For example, if we place decreasing importance on the role of sin, parents might turn primarily to secular experts for the difficult task of ensuring their children’s well-being and “improved functioning” (Miller-McLemore, 2003; Yarhouse et al., 2005). Yet our work with children inherently involves soul care as much as external reinforcement of desirable behavior, cognitive reappraisals, systems changes or the provision of insight. We must consider the multifaceted processes that shape the well-being of the whole child as a spiritual and bodily being. Parents should be guided by their moral values and, in the case of Christian parents, be informed by their faith in Christ and by the Holy Spirit’s leading. Likewise, spiritual and moral development should be a major focus for children’s growth and should not be pushed aside for a focus on achievement, self-fulfillment and happiness as an end in itself. In addition, an understanding of development can help us understand children’s capacities and how to walk with them in our mutual spiritual journey (e.g., Stonehouse & May, 2010; Yust, 2004) just as an informed perspective on abnormal development can help us to understand how to serve children and families who are suffering and ameliorate difficulties.
We need to wrestle with how our theology may affect our clinical work and our interactions with children (as well as how we may mistakenly set it aside when we work in what we see as a separate arena). Likewise, we need to wrestle with how our experiences with children in our clinical work and our scientific knowledge may affect our theological views. The purpose of this book is to integrate complex theological and clinical views of children and childhood to inform mental health research and practice. In general, the integrative approach the chapters will take is that of theology and psychology informing each other—theological doctrines influencing our views of children’s health and pathology, and psychological truths about child development and psychopathology influencing our theological views of childhood. Given historical influences on theological approaches to childhood, we do not believe that theology has a complete understanding of child development and psychopathology (see Bunge, 2001a); in fact, it has been noted that theologians have most often written about children only in relation to another issue, such as the doctrine of salvation and the baptism of infants (Mercer, 2005), rather than attending to children and childhood in its own right. Neither do we think that developmental and child clinical psychology have a holistic view of the child that considers her a spiritual being created in God’s image and placed in his world to be in relationship with him. Both disciplines must inform each other in order to present a more nuanced and complex understanding of the child and his or her development, which we believe children deserve. This book seeks to provide guidance to more appropriately understand and support children by examining how developmental psychopathology and Christian theology can complement each other to promote a respectful and open stance toward children.

Overview of Developmental Psychopathology

Developmental psychopathology has been identified as a scientific discipline with distinct theoretical tenets and components that differentiate it from other disciplines (Cicchetti, 1989). In 1984, a special issue of the journal Child Development was published that gave voice to this emerging field. The following definition provided in this publication continues to direct the field: “the study of the origins and course of individual patterns of behavioral maladaptations, whatever the age of onset, whatever the causes, whatever the transformations in behavioral manifestation, and however complex the course of the developmental pattern may be” (Sroufe & Rutter, 1984, p. 18). More recently, developmental psychopathology has succinctly been described as “an evolving scientific discipline whose predominant focus is elucidating the interplay among the biological, psychological, and social-contextual aspects of normal and abnormal development” (Cicchetti, 2006, p. 1).
The view of psychopathology within this framework emphasizes its malleable and context-based nature; that is, psychopathology is “probabilistic rather than predetermined,” with the interaction between the individual and the environment over time resulting in multiple pathways of development. This perspective underscores the integrated nature of development. We are reminded that “our patterns of adaptation and maladaptation, our particular liabilities and strengths, whether and how we are vulnerable or resilient—all are complex products of a lengthy developmental process” (Sroufe, 2009, p. 179). Thus, a lifespan perspective on development is crucial for researchers and clinicians who work from within this framework. Cicchetti (1989) reviewed the theoretical principles of differentiation, organization and hierarchical integration that govern development as crucial influences on the emergence of this discipline. For example, theories regarding the successive integration of stages of development into later growth in a hierarchical, cumulative fashion lead to the perspective that early development and experience remain a part of a person as she continues to develop. Given the intrapersonal, interpersonal and environmental influences on development, simplistic, linear thinking regarding causality is abandoned. Similarly, treatment and intervention approaches within this framework seek to understand and address the distinct developmental processes that have led to a unique individual’s current functioning.
As such, developmental psychopathology is an inherently multidisciplinary approach that combines principles from the study of development with understandings of health and maladaptation (Cicchetti, 2006). This creates a unique perspective on both development and disorder by combining research and perspectives from developmental and clinical psychology as well as an increasing breadth of other fields (e.g., cultural psychology, cognitive psychology, biology, epigenetics and sociology). Further, rather than merely drawing from multiple disciplines, developmental psychopathology aims to integrate information across disciplines to create a unique, complex, truly multisystemic perspective for understanding functioning. The multidisciplinary nature of developmental psychopathology is also highlighted in the view that multiple levels of analysis are necessary to understand any developmental process (Cicchetti, 2008). A child’s functioning at any point in time can be explored on several different levels, including biological (e.g., genetic, biochemical, physiological), psychological (cognitive, affective, experiential), social (e.g., intrafamilial, interpersonal), and cultural (e.g., socioeconomic, ethnic/racial, gendered). Developmental psychopathologists argue that multilevel analysis is not only beneficial but required to fully understand the development and adaptation of complex human beings. Practically speaking, then, developmental psychopathology is neither a theory of development nor a therapeutic orientation (such as psychodynamic and behavioral approaches are) but is rather a broad approach to understanding the complexities of human development that can inform theory and research within a variety of therapeutic approaches.
Several terms and concepts are central to a developmental psychopathology–based approach to the study of disorder. These include the ideas of normalcy and abnormality, the importance of context, a focus on pathways (including equifinality, multifinality, continuity and discontinuity), risk, protection, resilience, and prevention and intervention.
Normalcy and Abnormality
A central tenet of developmental psychopathology is that understandings of normal and abnormal development inform one another and are both necessary in the study of disorder (Cicchetti, 2006). On a basic level, how can we know what is abnormal if we do not know what is normal? How can we understand and identify autism, for example, without a good understanding of normal socioemotional development? Might we mislabel anxiety as pathological if we do not understand the typical development of children’s fears or separation anxiety? Therefore, developmental psychopathologists find value in the study of the mechanisms and processes that produce normal or typical developmental outcomes as well as those that produce pathology. In addition, health and disorder are viewed as existing along a continuum, with individuals ranging from more to less healthy in a particular realm rather than in the clearly distinguishable categories of “disordered” or “nondisordered.” All points along the continuum are significant, not merely cut-off points or the end points, as (1) the line between adaptation and maladaptation is often unclear, and (2) all degrees of competence offer value to researchers exploring the interplay of development and (mal)adaptation. Thus, developmental psychopathologists are interested in nondisordered populations, pathological populations, at-risk populations and high-risk nondisordered (resilient) populations.
It is important to clarify the meaning of the terms normal and abnormal. These are loaded terms, and the assumptions of a developmental psychopathology approach are better captured by the concepts of adaptation and maladaptation. Behaviors or outcomes that are adaptive are those that promote positive functioning in one’s various contexts (e.g., relationships, work, school); maladaptation, in contrast, occurs when an individual’s behavior interferes with optimal functioning. For example, the ability to sit quietly at one’s desk during a test even when one is anxious or distressed would be considered adaptive, whereas disrupting one’s classmates by storming out of the room or complaining angrily about the test is generally maladaptive. Clinical psychology’s focus on identifying the line between normal and abnormal is reinforced by its diagnostic system as outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (APA, 2013). There have been some positive changes in the most recent edition of the DSM, including an attempt to incorporate dimensional approaches into the categorical system, and to account for the course of illness over development with specific symptom considerations for different age groups and a developmental organization of disorders within categories; however, complaints about this diagnostic system abound, several of which are particularly relevant for child psychopathology. For example, with regard to questions of normalcy versus abnormality, the diagnostic criteria in the current categorization system (DSM-5) do not include an etiological component for understanding or diagnostic decision making. Disorders are defined by their symptoms, with little regard for the interaction between symptom and environment. In this approach, there is no opportunity to understand behavior as an adaptation to the demands of the environment. Along similar lines, the individualistic focus of the DSM-5 is inappropriate for children (and perhaps even adults). Symptoms are identified based on the client’s emotions and behaviors without accounting for the role of context. A teenager whose depression develops in the absence of any clear situational risk factors and one who displays symptoms of depression after years of abuse would be indistinguishable by current diagnostic criteria, even though their different developmental pathways are crucial to understand in conceptualizing the case.
It is important to note that all behaviors are, in some way, adaptations to the demands of the environment. A teenager who is aggressive toward his peers because the effectiveness of aggression has been modeled by his parents is attempting to function in his environment by soliciting attention from others and fulfill his need for interaction in the only way he has observed to be effective. A young child who dissociates as a reaction to sexual abuse is adapting to the demands of a situation that overwhelm her ability to consciously cope with severe danger and trauma. However, when we consider whether a behavior is truly adaptive or maladaptive, normal or abnormal, we must consider both its short- and long-term consequences. If the child who dissociates during a traumatic incident experiences a dissociative episode in class, her academic performance is likely to suffer. If dissociation becomes an automatic defense mechanism for coping with stress, her behavior will be maladaptive over the course of her development because such psychological distancing and withdrawal inhibits the ability to fully engage with a situation and make adaptive behavioral choices. For example, an adolescent who dissociates during an intense argument with a friend will likely not be capable of behaving in ways that resolve the conflict and preserve the relationship.
We must also recognize the role of societal factors in defining normalcy. The idea of normal is suspended within time and context; without placing a behavior in a particular setting at a particular point in history, we cannot determine whether it is normal (Trommsdorff & Cole, 2011). For example, in some cultures, striving hard for individual achievement and success is highly valued; in others, the effect of an individual’s behavior on others is more strongly emphasized than individual success. There is also wide cultural variation in views of masculinity and its defining characteristics (Gilmore, 1990). In a culture in which aggression is considered an important part of masculinity, a young man who displays violent behavior toward peers might be viewed as healthy, whereas in a setting in which violence is viewed negatively, such aggression would represent problematic behavior and maladaptive functioning. Furthermore, cultures are not homogenous; views of masculinity among men of the same national and cultural background show a fair amount of variation (Torres, Solberg & Carlstrom, 2002). Therefore, we must be deliberate in our assessment of the broader cultural influences on judgments of behavior while leaving room for the unique context of each individual.
Importance of Context
Context is a crucial component in our understanding of behavior for multiple reasons (Cicchetti & Aber, 1998). As addressed in the previous section, we cannot determine whether a behavior is adaptive or normative outside of its context. Jumping up and down and yelling is appropriate at a football game but not in the classroom, for instance. Furthermore, the context in which a child develops—including family, neighborhood, school, peers and culture—is an extremely important influence on development, an idea first popularized in ecological theory (Bronfenbrenner, 1979). Consistent with a multiple-levels-of-analysis approach, developmental psychopathology embraces the idea that each of these levels of contextual influence must be considered in developmental and clinical applications (e.g., Mian, Wainwright, Briggs-Gowan & Carter, 2011). As discussed throughout the chapters in this book, research consistently highlights the role of parental, sibling, peer, classroom, neighborhood, and cultural influences on children’s health and well-being,
Building on the idea of reciprocal determinism, in which the environment affects and is affected by an individual (Bandura, 1986), developmental psychology takes a transactional view of the development of children that occurs within multiple systems (Sameroff, 1975; Sameroff & Chandler, 1975; Lerner, 2002). A transactional view of development assumes that individuals are not only affected by their environments but also change and select their environments in both incidental and purposeful ways. A child is not a passive recipient of the influences of her classroom; rather, her behavior shapes the classroom environment itself, potentially impacting elements such as the emotional tone of the class, peer interactions, and even t...

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