Is the Christian concept of love relevant to evidence based therapy?

In my fourth blog, The Nature of Christian Love, I explained my understanding of love in Christianity.  Talk of the meaning of love led to talk of forgiveness as Christian or not, we all fall short of showing this love in our lives, love that may be given by all people, not a monopoly of Christians but a basic human attribute.  Many, most, will chose or only be able to give this gift to a selected few family and maybe, friends.  But what if a therapist is able to extend the circle of love to include their clients?

As you know, Cognitive Behaviour Therapy is a leading evidence based therapy.  In her book Cognitive Behavior Therapy:Basics and Beyond,  Judith Beck states as the second principle of CBT that it requires a sound therapeutic alliance.  She lists the basic ingredients necessary in a counselling situation as warmth, empathy, caring, genuine regard and competence.  All of these attributes except possibly the last may be considered as aspects of love.  Not all clients are interesting, attractive, pleasant, intelligent, good to be with, appreciative, friendly, sympathetic.  If we can love them, see past the initial front they present, accept whatever darkness lies underneath and be prepared to try to understand why they are as they are, we may be able to show warmth, to be empathetic and caring and hold them with genuine positive regard.

Love is patient so with love we may see past initial or continuing difficulties in the relationship between client and therapist.   Love is kind so the therapist will want to work with the client to reduce their distress.  Love is not envious or boastful or arrogant or rude.  It does not insist on its own way so the therapist will try to work collaboratively with the client and try not to be concerned with their own ego.  Love will enable the therapist to forgive and continue to work with clients who miss appointments, turn up, late change arrangements or fail to do their homework or bring their papers to therapy and not  be irritable or resentful.  Love will not rejoice in wrongdoing, in client's mistakes in life or misdeeds but rejoices in the truths the client discovers about life and how to be better selves and no longer need a therapist.  A therapist who loves their clients enough will bear all things, believe all things, hopes all things, endures all things for their client.

If we look for an example of love in action one example is Jesus.  When people heard that he had healing powers, they came to him in large numbers bringing their friends and relatives.  He had not asked for this and it does not appear to have been the type of work that he had wanted.  Seeing their need and because of the love which he felt for all, he could not refuse the healing they asked for even though it exhausted him and absorbed his time distracting him from his original mission.  He had to take drastic measures from time to time to get a break and he does appear to have recognised the need for self care going to places where he could be away from the crowds and also spending time with people accepting their invitations to eat and drink with them.  We are not Jesus and we may need to take even more care of ourselves and learn to say "no" but his example of love in action remains whether or not we are Christians.  Indeed there are many examples of doctors, healthcare and charity workers of faith and no faith who show this love.  Their feeling of a need to relieve suffering carries them through times of exhaustion and despair.  Most of us do not have these qualities of mega compassion but whatever level we do have, love may give us the energy and will to carry on with our work to relieve suffering when our conscious mind is telling us to stop.

Being aware of being loved and cared for increases the possibility that a client may be able themselves to love others and themselves.  We love because we were first loved.  A child loved and nurtured in a loving family is more likely to grow up as an adult able to share love than one deprived and mistreated.  Even then a healing relationship perhaps through therapy, may restore that wounded person's ability to love.

That is the theory, the ideal, but therapists are human and flawed.  We do resent missed appointments, absent homework and find client criticism sometimes hard to accept but if we begin and try to maintain an attitude of love, we will be better able to approach the qualities that Judith Beck describes.  We will fail often so we will find ourselves in need of the next concept, forgiveness. Any one who believes that they do not may be deceiving themselves. I will look at forgiveness in the next blog.  It is another thing that is hard for many of us to achieve.

The Nature of Christian Love

This is my fourth blog on the use of Christian concepts in evidence based therapy.  The assumption that I am making is that Christian concepts may be used in evidence based therapy outside their religious context.  In my first blog, I asked whether Christian concepts can have any relevance in evidence based therapy and in the second I began to explore clients' objectives in evidence based therapy.  In my third blog, I discussed love as the fundamental concept of Christianity which Christians often fail to honour.  Now I wish to begin to explore the nature of Christian love.  As I wrote previously, love is the basis of Christianity and is the solution to the world's many ills. But what is love (agape) in Christianity?

There are many references to love in scripture and in Christian hymns, songs and writings but, as you might expect, no definition.  This is in the same way as we cannot limit God by a definition, love being the nature of God (and our ultimate nature too).  We are told to love our neighbour as ourself (please note, not instead of our self but as our self).  So self-love to the extent that we love our fellow humans is allowed.  Here neighbour includes enemies and those who hate us.  No wonder Christians fail to follow this commandment in their lives, it can be hard enough to love your family and friends, but the important thing is to keep trying and despite failure, not to give up.  

Jesus defines and shows us love through his life, teaching and death. St Paul gets close to a written definition in one of his letters.  It is worth quoting.  You may well have heard this passage read at a church wedding but its application is not limited to a couple about to share their lives together.  It is universal:

'And I will show you a still more excellent way.

If I speak in the tongues of mortals and of angels but do not have love, I am a noisy gong or clanging cymbal.  And if I have prophetic powers and understand all mysteries and all knowledge and if I have all faith so as to remove mountains but do not have love, I am nothing.  If I give away all my possessions and if I hand over my body so that I may boast but do not have love, I gain nothing.

Love is patient; love is kind; love is not envious or boastful or arrogant or rude.  It does not insist on its own way; it is not irritable or resentful; it does not rejoice in wrongdoing, but rejoices in the truth.  It bears all things, believes all things, hopes all things, endures all things.

Love never ends.  .................................  And now faith, hope and love abide, these three; and the greatest of these is love.'  (1Cor:13)

Paul also tells us that 'knowledge puffs up but love builds up.'  When we fail in love, it is love that forgives us so that we can carry on.  Love can also result from forgiveness received and love covers a multitude of sins (errors).

I only have to read those words to know how far short I fall with regard to love but closely aligned with love is forgiveness and that is a second Christian concept that I will need to consider later in these blogs.

We are told and shown by Jesus that the greatest love is to lay down one's life for another.  Loving our neighbour as our self may mean that we take actions that are in their interest but that are not apparently in our own .  Normally for most of us, this only leads us to a small sacrifice of our possessions or time or minor inconvenience but for a few it is their life.

 In this blog, I have tried to provide some insight into the Christian concept of love and introduced the importance of forgiveness. In my next, I will begin to examine how this concept can aid evidence based therapy both for the client and the therapist even when taken out of its Christian context.

I welcome any comments and the dialogue they may bring.

Love - the fundamental Christian concept

The objective of this blog is to discuss whether Christian concepts have any relevance to evidence based therapy when they are taken out of their religious context.  Love is the fundamental Christian concept about the nature of God and to love God and to love one's neighbour as one's-self are the first and second great commandments.  For anyone unfamiliar with Christianity, this second commandment, to love your neighbour as yourself, may seem somewhat surprising.  They may recall some examples of Christians who seem to love other people, there was Mother Teresa in India and the Salvation Army do some good work with the homeless.  But the people they know who go to Church, don't seem any more full of love than most other people they know.  That young family that disappear every Sunday morning are quite friendly but so are lots of other people.  They are never sure what to make of the older couple they see walking to that stone church a couple of streets away.  Do they love their neighbour as themselves?  How much do they love themselves anyway?  They look a bit grim faced.  All Christians fall a long way short of perfection and what do we really know about each other anyway.  Within Christian belief, Christians are told to do good in such a way that their left hand does not know what their right hand does so any acts that show their love of neighbour may in any case be hidden.

The failure of Christians to live up to their own standards points up the fundamental dichotomy between Christianity and people who are Christians.  Gandhi, the father of modern India is reported as saying that he was very attracted by Christianity and indeed he might have become a Christian if he had ever met one.  Christians fall very far short of perfection in following the teachings of their founder.  Some are aware of their failure but human nature means that many will not be.  This individual and corporate failure is recognised by the prominence given to confession in corporate and private prayer.  Acknowledgement of failings is followed by asking for and receiving forgiveness (another Christian concept).

I am not trying to justify Christianity let alone Christians in this blog but want to suggest that because the practitioners of an idea do not make a perfect job of following it, it does not mean that the idea itself is not valuable.  It has been said that there has only been one perfect Christian since Jesus and that was Francis of Assisi who lived in the twelfth century, not a very high percentage. Do you always live up to your own highest ideals and if not does that invalidate everything you believe in?

In subsequent blogs, I will look at the nature of love in Christianity and how this concept may be relevant to evidence based therap.

The Purposes of Psychotherapy and the use of Christian Concepts - a Personal View

In this blog item, I am trying to set out what I see as the purposes of psychotherapy into which Christian concepts taken out of their religious context may be integrated or may already be present.  I see the purpose of psychotherapy as the relief of suffering leading to an increased potential for happiness and human fulfilment and achievement both individually and as a society.  Probably that sounds a bit grand when related to the individual imperfect therapist such as myself and his/her client (for 'client' read 'patient' in other settings).  I also get paid which is nice.  It enables me to support myself and my family and makes therapy a job so I cannot feel too virtuous working in a helping profession.

Client's objectives

The purposes suggested above will be modified in the context of the client's own objectives which may alter over time but change must always be a factor or what is the point of therapy if the client is to remain the same.  The therapist will also be changed by this encounter with another human being at a level deeper than through a normal interaction between strangers.  So part of the process of therapy will be working with the client in clarifying the change they wish to achieve and how this will be recognised (often by having SMART goals).

Evidence based therapy

• If the therapist's aim is to help the client achieve their goals why would they not wish to do this in what they believe is the best way possible hence I try to follow ways of therapy for which there is evidence of utility.  Currently my understanding is that the modality of therapy for which there is the best evidence overall is Cognitive Behavioural Therapy (CBT). In this context, I understand that Aaron Beck the founder of CBT, is reported nas saying that CBT is anything that works so that CBT utilises some techniques developed in other modes of therapy such as imagery work while retaining its basic model.  This model proposes mechanisms explaining how a person develops unhelpful ways of being and how these are maintained but does not propose an ontological model of personal fulfilment or what it means to be a human person unlike Person-centred therapy or as a religion or certain philosophical or political systems might do.  It exists to help clients with the issues the client brings to therapy. It is confidential subject to a limited number of exceptions such as potential harm to the client or another person.  It is non-judgemental and does not have a defined objective in mind for the client, they define their own.  The therapist will work with the client in recognising conflicts between their objectives and their current and ongoing thoughts, beliefs and behaviours.  In their book, Cognitive Behavioral  Therapy for Anxiety Disorders: Mastering Clinical Challenges, Butler, Fennell and Hackmann  set out five recurring themes of CBT.  The five recurring themes are as follows: 

• The style of CBT - explicitness
                                - collaboration
                                - Socratic method
                                - openness of mind to allow exploration, questioning and testing                                                     of cognitions.
  
• Therapeutic relationship
  
•  Thinking about meaning
  
• Aiming for "whole system change" through full emotional processing.
  

• Three general principle, namely - curiosity rather than control
  
                                                          - reduced rigidity and increased flexibility
  
                                                          - facing anxiety rather avoidance or safety
                                                                           behaviors.
                             

       

So if CBT is what works, there may be approaches that originated in a religion, system of thought, belief or other source that will help a client to realise their goals or help a therapist in their practice.  Why should they not be used taken out of their original religious or other context if necessary when the client is not a subscriber to that particular belief system?

Christian concepts relevant to psychotherapy

I am a Christian so this the religion I wish to explore in the context of evidence based therapy.  I have tried in this blog to set out a basis for an approach to therapy involving helping clients to achieve their goals using methods that are evidence based. In later blogs, I will begin 

• to explore the background in relation to evidence based therapy and CBT in particular and Christianity including how it is viewed by non Christians;
• to identify Christian concepts that may be relevant to therapy;
• look for evidence that these concepts may assist client change in practice;
• examine whether some of the concepts already in use in therapy are equivalent or similar to Christian concepts identified.

To recap, the aim is not to present these concepts to non-Christian clients as Christianity but as apparently universl truths and to explore their use for the benefit they offer in psychotherapy practice.  If a therapist is a Christian (some are) this may seem more natural to them but they should respect their clients' autonomy and not treat their use as any attempt at conversion. If a client is a Christian, the therapist should be aware that Christians vary greatly in their understanding of Christianity and the therapist should not advocate a particular religious approach though they may help a client recognise there are alternative interpretations of their faith that they can consider.  

Do Christian insights have any relevance to evidence based psychotherapy?

Through this blog, I would like to explore Christian insights that may benefit psychotherapy whilst recognising that most of my clients are not religious. It would not be appropriate or ethically acceptable to use Christian teaching as such with a client who was not a Christian but does that mean that there are no relevant and helpful insights that can be derived from the Christian traditions?  Many Western therapists use methods such as Mindfulness that have their origins in Buddhism but with the present receding tide of Christianity, some therapists and clients may be unaware of the rich and ancient traditions of Christianity. Despite all the many failings of the followers of this religion, in countries in which it is the majority faith with some exceptions, it has eventually led to the liberal, tolerant and to some extent, reason and evidence based societies we are now privileged to live in in the West.  (In a later blog, I will try to defend Christianity from some of the criticisms made of it which are more rightly directed at individual Christians and institutions.)

It appears at present that this exploration will fall into two parts, namely identification of relevant Christian insights and secondly, a search for evidence that the insights identified can be beneficial in therapy.  With regard to Christianity, I am not referring to a biblical literalist form of Christianity that is prepared while teaching love and forgiveness to condemn a large part of humanity to at worst, hell and eternal damnation and at best, extinction.  That does not seem how a loving parent  would treat  any of his children or consistent with how Jesus is portrayed in the New Testament despite the harsh words occasionally ascribed to him.

A practising Christian may see these Christian insights as helpful or mandatory even though he/she may fail to follow them consistently in their life. A non-Christian whether client or therapist will be more likely to subject them to critical consideration and rightly so.  I try to follow evidence-based practice, principally cognitive behavioural therapy, CBT.  I have written a lot more on this in a later post.  Although I am a Christian, I would want evidence that these insights are themselves beneficial in therapy.  Some of this evidence may already exist.  For instance, to the extent that there is evidence that compassion derived from the Buddhist tradition is a helpful quality in therapy, the Christian concept of love for self and neighbour (agape)may not be too far removed for it not be of use in therapy.

I am not a researcher but I can read the work of others and draw conclusions from it.  Nor am I a theologian but I have read quite a lot of theology.  But what would really help to move this project on will be the comments, criticisms and insights that any readers of this blog can offer based on their own expertise.  Of course it will be more helpful if these comments are constructive but an interest in improving therapeutic outcomes is more important in this context than having a religious faith.

Notes

1. '.......The premise for this 'evidence-based' practice is twofold: first, it is ethically appropriate that clients should be protected from harm, and should reasonably expect that the practitioner has justifiable grounds to believe that the intervention will effect remediation or improvement; second, all stakeholders (e.g. client, employer, service delivery setting, regulator) may reasonably assume that the psychological intervention or therapy will be delivered in an optimally effective and efficient way.' Atkinson, C. and Woods, K. (2017) Establishing Theoretical Stability Treatment Integrity For Motivational Interviewing Behavioural and Cognitive Psychotherapy, Vol 45, Issue 04, p.337.