Understanding Orthodoxy for Mental Health Practitioners + Part 8
[This is a follow up course to Orthodox Christian Spirituality and Cognitive Psychotherapy: An Online Course, that appeared in four parts over the years 2012-2013. This second course is specifically oriented to explain Orthodoxy to mental health practitioners,and serve as a useful resource for Orthodox Clergy and laity as well. Ethically, mental health practitioners should incorporate the spiritual values of their patients in the therapeutic process. The course would serve as an introduction of the Eastern Orthodox ethos and cultural traditions to these professionals.
One of the most frequently questions I am asked as Chairman of the Chaplain and Pastoral Counseling Department of the Antiochian Archdiocese is for a referral to an Orthodox mental health practitioner. Sadly Orthodoxy is not a majority spiritual tradition in North America and Orthodox practitioners are few. So careful questioning by potential patients, family and clergy of a potential practitioner regarding the practitioner's understanding and respect for the spiritual values of their patients is very important. This course is meant to aid in this inquiry.
It also should be noted that this course is an updating and reworking of a recently published chapter: Psychotherapy with members of Eastern Orthodox Churches, (Morelli, 2014).]
You doctors, must take good care of your patients in order to avoid unpleasant situations. You should have a practical mind. Generally speaking, every one of us must take advantage of his mind which is a gift from God.
(Saint Paisios of the Holy Mountain)1
In the last segment of the course I presented a Case Study of integrating Orthodox spirituality with Cognitive Behavior Therapy. I do want to emphasize the importance of basing clinical psychological interventions on scientifically based evidential research. From the viewpoint of professional ethics, this is what is demanded by ethical principles. This is to say that mental health treatment sessions that do not have significant components of evidence based procedures are unethical. As Orthodox Christians, knowing God made us with the gift of reason, and knowing the command He gave to mankind, passed down to us by our ancestral parents to have dominion over creation (Gn 1: 28), we are impelled to use the fruits of reason, science to fulfill God's command to care for nature (Morelli, 2010).2
In the continuation of the course a nutshell, that is to say, an essential summary of the major principles of the solid evidence based Cognitive-Behavior Therapy principles are presented. These points are meant to aid the reader in interpreting and understanding the case study and to evaluate any mental health treatment programs.
Keeping in mind the caveats above, and as noted in the Case Study, the cognitive-behavioral model of emotional dysfunction (Beck, Rush, Shaw and Emery, 1979; Ellis, 1962) has been shown to be effective in dealing with dysfunctional emotions, decreasing inappropriate behavior and increasing appropriate behavior. According to this model, basic dysfunctional emotions such as anger, anxiety, depression and mania, as well as more complex emotions such as anticipation, awe, jealousy and remorse (Plutchik, 2002) are produced by distorted or irrational appraisals, attitudes, beliefs and/or cognitions.
Situations (something that someone has said or done or events that have happened) do not produce or cause the emotional reaction. Rather, we upset ourselves over people and events by our cognitive processing of these situations. If our thinking is clear, rational and non-distorted we have normal feelings like annoyance, concern and disappointment. Even opening this model to a less strict position, (allowing for subcortical activation of emotion) it would be maintained that some control over emotions initiated by these subcortical centers could be had by cognitive (cortical) methods.
In Beck's model, individuals have automatic thoughts (similar to primed cognitions investigated by Loftus, 1980) about activating events, including: selective abstraction (drawing conclusions unwarranted by the facts), personalization (attributing neutral events as referred to oneself), polarization (viewing events in all-or-nothing terms), generalization (the tendency to conclude events will never change or always remain the same), demanding expectations (Ellis, 1962) (the belief that there are laws or rules that must or should be obeyed) and catastrophizing (Ellis, 1962), (the perception that something is more than 100% bad, awful or terrible). In the diagram below the automatic thoughts that accompany dysfunctional emotions and behaviors are located in the middle or 'biased' section.
Another cognitive model with clinical-pastoral utility from an Orthodox perspective is attribution theory (Weiner, 1974; Abramson, Seligman & Teasdale, 1978). In this model, explanations of events as due to combinations of internal or external and unstable (temporary) or stable (permanent) factors influence felt emotion and subsequent behavior. After rapport and diagnosis and treatment goals have been established, the Cognitive-behavioral treatment strategies usually involve some form of didactic presentation of the cognitive model. Seemingly uncontrollable and stable attributions can be cognitively challenged and restructured and facilitate functional emotions and behaviors.
Bibliotherapy is often used adjunctively. Some recommended books include: Beck, A.T. (1988), Love is Never Enough; Burns, D. (1980), Feeling Good; Ellis, A. (Ellis and Harper, 1975) A Guide to Rational Living; Knaus, W, (2014) The Cognitive Behavioral Workbook for Anxiety.
The patient is then helped to recognize, pinpoint and identify his/her cognitive distortions and learns to challenge and restructure the irrational distorted cognitions that are initiating or sustaining the dysfunctional emotions and to change to more accurate non-distorted cognitions. Use of notes and charts in the treatment session and outside the office is encouraged to facilitate the patient's integration of these concepts.
1 Former Elder, now Saint Paisios of the Holy Mountain was officially canonized a saint by Patriarch Bartholomew of Constantinople and the Holy Synod on 13 January 2015. (www.omhksea.org/2015/01/ecumenical-patriarchate-officially-entered-elder-paisios-among-the-list-of-saints/) Among the Orthodox, the pathway to sainthood is usually started by the popular acclamation that someone is worthy (Axios!) of sainthood. This was the certainly the case of saintly Elder Paisios. His Feast Day will be on 12 July. My readers may want to pray the Apolytikion and Kontakion of the new saint:
The offspring of Farasa, and the adornment of Athos, and the imitator of the former righteous, equal in honor, O Paisios let us honor O faithful, the vessel full of graces, who hastens speedily to those who cry out: glory to Him Who gave you strength, glory to Him Who crowned you, glory to Him Who grants through you healings for all.
Kontakion in Plagal Tone 4
The most-famed ascetic of the Holy Mountain, and the newly-enlightened light of the Church, let us praise him with hymns with all our heart, for he leads the faithful towards a perfect life, filling them with rivers of gifts, therefore we cry out: Hail, O Father Paisios.
(These references are for the entire course, only a portion are for Part 8)
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