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Understanding Orthodoxy for Mental Health Practitioners + Part 9

[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).]

by Fr. George Morelli

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 this online course, I presented a Case Study integrating scientific evidenced based Cognitive Behavior Therapy within an ethos of spiritual healing that makes up the Eastern Orthodox healing tradition. In the Orthodox Church, healing of the soul ranks higher than the healing of the body and mind. The primacy of spiritual to physical healing is derived from the Epistle of James. St. James tells us:

Is there any one among you suffering? Let him pray ... Is any among you sick? Let him call for the presbyters of the Church, and let them pray over him, anointing him with oil in the name of the Lord; and the prayer of faith will save the sick man, and the Lord will raise him up; and if he has committed sins, he will be forgiven (James 4.13 - 15).

However physical-mental healing is not to be ignored. As mentioned earlier in the course it behooves us to use God's gift to mankind of reasoning, (Gen 1:26) to understand His creation and use it to heal disease. This is in emulation of Christ Himself, who as St. Luke (5: 15) informs us that as He preached: "great multitudes came together to hear, and to be healed by Him of their infirmities." We are morally and ethically required to use the most advanced reasoning currently known to mankind in our current age. In the present day evidence based clinical psychotherapeutic science indicates that the Cognitive Behavior Therapy (CBT) and its related models (e.g. Rational Emotive Behavior Therapy (REBT), Dialectical Cognitive Behavior Therapy (DCBT), Interpersonal Cognitive Therapy (ICT) etc.) have been shown to be most efficacious in the psychotherapeutic treatment of various mental disorders. Recently questions have arisen about publication bias in favor of CBT. This is to say that scientific journal editors may have chosen to publish articles that promote favorable CBT findings. Researchers such as Cuijpers, Berking, Andersson, Quigley, Kleiboer, & Dobson. (2013) have addressed this issue doing a meta-analysis of studies derived from a comprehensive database including: PubMed, PsycINFO, Embase, and the Cochrane library. A summary of their findings indicate that while the effects of CBT "may have been overestimated until now," it nevertheless "has the greatest weight of evidence."

Thus this next segment of the course gives a brief outline of the CBT model.

Cognitive Distortions

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 automatic 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). 

A theoretical 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.


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.J. (2014) The Cognitive Behavioral Workbook for Anxiety (2nd edition).

In the therapeutic sessions, 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 (homework) is encouraged to facilitate the patient's integration of these concepts.
Three guiding questions are used in the restructuring process:

  1. Where is the evidence?
  2. Is there any other way of looking at it?
  3. Is it as bad as it seems?

With repetition, the new functional undistorted belief system becomes habitual (automatic) and credible.

 


ENDNOTES

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:

Apolytikion in Tone 1

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.


REFERENCES

(These references are for the entire course, only a portion are for Part 9)

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Beck, A.T. (1988). Love is Never Enough: how couples can overcome misunderstandings, resolve conflicts and solve relationship problems through cognitive therapy. NY: Harper-Collins

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