Association of Christian Psychologists – Poland 2009

INTEGRATIVE PSYCHOTHERAPY: A CHRISTIAN APPROACH
METHOD OF THERAPY

In the Integrative Psychotherapy from a Christian Perspective we distinguish three integration contexts:
1. Integration at the level of the concept of a person (anthropological assumptions)
2. Integration at the level of therapeutic practice (the method of therapy)
3. The inner integration of the therapist (including spirituality).
On the first level, that is of the idea of a person, the integrative role is played by Christian anthropology and the concept of a person; on the second level, that is, of the techniques applied, the core consists of psycho-dynamic and cognitive-behavioral methods.
The origin of disorders and the promotion of change.

Change may consist of:
1. revealing of past experiences (through insight),
2. experiencing feelings “unbearable” in the past (thanks to the safe therapeutic relation)
3. guiding the emotions in the right direction (getting out of transference),
4. experiencing emotions earlier repressed,
5. modifying beliefs towards being more constructive, true, connected with energy, strength for living,
6. modifying behavior towards being more constructive, effective (having their intended outcome),
7. strengthening the person as a whole,
8. enhancing the ability to perform conscious decisions,
9. integrating the healing processes and development with spirituality.

Strengthening a person.
Symptoms are treated as means of carrying information about deeper attitudes, usually originating from experiences in childhood, when the identity of a person was created in close relationship with the mother, father or other significant people. When someone does not act fully, he is somehow being ``killed”: the body sends signals – produces so called symptoms – calling for a change of something very important for the benefit of the whole person. The achievement of such a change should remove the symptoms.
“Strengthening a person” denotes all the activities aiming at the performance up to one's full emotional, cognitive, volitional and behavioral potential. We assume that everyone, in spite of being ill, has some sanity in himself and this is the tendency to be a person (everyone is a person and is becoming such). It is expected that during the care of therapy, thanks to the corrective experience in the therapeutic relation and the appropriate choice of techniques, a strengthening of the person will occur so that the patient will be able to take advantage of the full range of his possibilities (gifts), freely, in personal dialogue with others, respecting his own humanity, that is, what he feels, thinks, wants and does.
Strengthening a person usually involves bringing into consciousness excessively difficult experiences from the past, in which the child did not get support from significant people, and his experiences and feelings were ignored by people with whom the child was in relationship, even if those experiences were not caused by those people (consider Bowlby's attachment theory). In such situations the child experiences very strong emotions, hard to tolerate and for this reason repressed or dissociated – the child activates defense mechanisms. On the basis of his experience, the child draws conclusions about himself, others and the world. Those generalized conclusions form convictions, which in cognitive-behavioral therapy are called core beliefs. The behavior is suitably adapted, as a result of positive or negative reinforcements administered by significant people.
The therapy is to reveal the reasons for those attitudes (insight, understanding), to help in regaining the ability to feel and the right to experience in full one's emotions, regaining trust in one's good “equipment” (that is, in one's own emotional reactions, one's capability of correct judgment of a situation) and correct convictions and behavior. As a result, the self-image is corrected in the direction of the healthier action of the person. One desired change in beliefs may consist of a change in one’s God-image.

A necessary element of change in the self-image is the relationship with the therapist, who above all should not repeat the hurting behavior of significant people in the person’s past, but should provide positive corrective experiences.
Very important aspects of the healing process are the recovery by the patient of the sense of influence and the strengthening of the person, that is:
– taking advantage of all the information from the body and from the emotions
– taking advantage of the possibility of learning and judging, including spiritual learning
– making conscious decisions and following through in action
– conscious behavior appropriate to the internal and external situation and to the intended purpose.

We distinguish the healing process and the development process, though they coexist and are often interrelated. The development processes also involve relational abilities.

The relation to other psychotherapeutic approaches.
We apply elements of psychodynamic, cognitive-behavioral, humanistic-existential and systemic approaches.
In the psychodynamic approach, the following are acknowledged: the importance of experiences in childhood, the existence of unconscious processes, their influence on other experiences, the influence of emotions on cognition, decisions and action, the significance of defense mechanisms, transference and counter-transference.
In cognitive-behavioral therapy, the following are acknowledged: the significance of the learning process, positive and negative reinforcements, core beliefs, and automatic thoughts.
In humanistic-existential therapy, the following are acknowledged – the significance of a person in all aspects (including body, feelings and emotions), the potential of the person, the significance of a relationship for development and correction of attitudes, and also the significance of the sense of suffering and death.
In systemic family therapy – the significance of the family system and the social system for the development of a person and his relational schemata.
The influence of biological factors and physiological processes on the development of attitudes and current reactions is also acknowledged. The significance of the therapeutic relationship for the therapy process is always assumed, as well as the significance of the self-awareness of the therapist.
The following differences with respect to other therapeutic approaches can be observed:
1. We assume the influence of past experiences but not determinism.
2. We acknowledge the existence of free will understood as the area where someone wants or does not want something and makes decisions.
3. We acknowledge the existence of objective truth understood as internal and external facts and Biblical truths.
4. Therapists need to distinguish between psychological, spiritual and pseudo-spiritual experiences.

Techniques.
The techniques applied should be adapted to the patient's problem, the stage of therapy and the patient's abilities. We consider the life experiences, emotions, beliefs, and behavior of the patient. In our work with past experiences we pay much attention to emotions and work with emotions – especially using psychodynamic techniques (this can be called “work from the beginning” – from the past to the present). In the work “from the end” (focused on the present) there is a larger contribution of cognitive and behavioral techniques.
The therapist may give homework, which should serve to build new habits in the treatment of oneself and others, and greater self-awareness.
The therapist helps the patient reveal the truth about his life and to integrate those areas of his life that up to now he could not admit as his own. We believe that truth sets free – if someone knows the truth about himself, is in touch with his emotions, reaches deeper motivations for his behavior, understands facts from his life and the deeper context of his behavior which up to now was out of his control – he may find a constructive solution even in a difficult situation.
We emphasize the significance of the personalistic treatment of the patient, we use open-ended questions. We address not only conscious content (for instance declaration of intentions), we promote the disclosure of content that was unconscious, paying attention to mixed signals, feedback (understood as non verbal reaction to the therapist's intervention), indeed to all non-verbal information.
We pay attention to the passive and active voice in the patient's speech. If an adult person often uses the passive voice this suggest a passive-demanding attitude (the attitude of a “victim”) – we attempt to reinforce the “personalistic” attitude, involving self-awareness and taking responsibility for one’s decisions and actions (this is connected with energy for living).
This is a “directive-nondirective” therapy: in a directive way it acknowledges the person, his dignity and freedom; the therapy – especially in the work with difficult experiences and emotions – is conducted in a nondirective way, the therapist gives room to the patient, does not limit his autonomy, accompanies him in interpreting reality.
Spiritual dimension.
A Christian approach to Integrative Psychotherapy takes into account the view of a person from a transcendental perspective. The explicit anthropological assumptions provide a reference system for the evaluation of the results of therapy. Spirituality is treated as reality, not as a defense. We acknowledge that contact with God may be real, but also may be illusory – the therapist should be able to distinguish this knowing the criteria of healthy and ill spirituality.
In relation with the patient we try to see the spiritual process coexisting with the psychological process. In therapeutic practice this implies skills in the areas of:
1. Help in integrating healing and psychological development with spiritual development.
2. Understanding the patient's spirituality and distinguishing between healthy and ill religiousness (healthy, based on freedom and personal relation with God; ill – based on rigid schemata and defenses).
3. Applying – apart from typical therapeutic techniques – Biblical arguments enhancing the process of change, and showing that change is profitable also in spiritual terms (for many people the spiritual motivation is more important than the psychological one).

The stages of the therapeutic process:
1. Revealing the causes of current attitudes (how did I learn this? experiences in childhood,
especially in relationships with significant people, insight).
2. Revealing repressed emotions.
3. Corrective experience in the therapeutic relationship.
a. Experiencing previously unbearable emotions thanks to a safe therapeutic relation.
b. Experiencing acceptance and respect towards the experienced emotions.
c. Regaining the right to feel what one feels (support on the therapist's part).
d. Building trust in one's own personal resources, including emotions, thinking, constructive action and personal relation with God.
4. Work on beliefs concerning oneself, others, the world and God.
5. Work on behavior.
a. What do I do, especially in situations which are difficult for me?
b. How is it received, experienced by others? (the possibility of using the therapeutic relation).
c. Looking for alternative behavior and testing it.
d. Distinguishing between profitable and dangerous (destructive) influences of the environment – making use of constructive elements and eliminating as far as possible the dangerous, destructive elements.
6. Work on the integration of new attitudes with one’s new self image and new understanding of the
world.
a. Analysis of situations which cause anxiety and provoke the previous form of behavior, diagnosis of ``weak points”.
b. Therapeutic help in resolving those concrete problems.
c. Between-session exercises.
Translation: Zofia Adamowicz, ACP