Writing a Journal Article

Philosophia Reformata began in 1936 in The Netherlands by scholars interested in Christian Scholarship and particularly related to the outstanding achievement of Herman Dooyeweerd (1894-1977) whose magnum opus, De Wijsbegeerte der Wetsidee (A Philosophy of the Law-Idea) in 3 volumes had been published in Dutch (1935-1936). This work was later translated, edited, and elaborated further by Dooyeweerd and others, appearing in English as, A New Critique of Theoretical Thought (1953-1958).

I have just finished writing a journal article for Philosophia Reformata entitled, Out of the Abundance of the Heart: Implications for Christian Psychotherapy. In the article I have first outlined Dooyeweerd's views relating to the supratemporal heart or soul. The second part of the article deals with the implications of Dooyeweerd's Ideas for psychotherapy. One major implication I would like to emphasise is Dooyeweerd's belief that the realisation of an appreciation for God's sovereign reign over all of life required daily conversion of the heart, the supratemporal core of our being.

Depression as emotional and social disconnection

Many models are used to try to understand depressive mood disorder (DMD). A productive model is to understand DMD as caused by family levels of emotional and social disconnection. For example, if parents are unable/don't give appropriate amounts of emotional nurturance then the infant/child does not learn how to connect emotionally to them and then to others. Psychotherapies tend to work because all involve relationship with a therapist who actively but often implicitly offers a relation. And, much of what therapists do encourages greater contact through behavioural or 'action' assignments or directly through 'interpersonal therapy'. In these assignments, it should not be forgotten that all aspects of the person are involved, not just cognitive, emotional or 'behavioural' facets. At another level, families can sometimes be isolated and cut off from the mainstream culture because of their religious or ethnic allegiances. These links also imply disconnects with school and work situations where the differentness of the family may not be tolerated or understood. The latter raises the question of the character of the culture in which widespread DMD arises. Present western societies are dominated by the clash between a drive to subdue the natural world through science and technology on the one hand, and the equally urgent desire to promote the autonomy of the human personality on the other. My present thesis is that each of these idolatries -- for each idolatrises some relative part of temporal reality -- promotes societal disconnection: each does this by not only suppressing a fair estimation of its opponent's claims but also by wholesale distortion a range of other normative considerations. Such action has culture-wide grievous effects, which are also found in the psychological area of mood disorders.

Using rational therapy sceptically

I have viewed the family of rational therapies with some scepticism after unsuccessfully using such therapies in my own life. Yet, I know numbers of people find such procedures helpful.

I even know of those who have been helped by me using rational-cognitive methods even though I do not believe the theory that what we believe/think creates disabling moods! Yet, some clients are helped by this approach but not all.

Interestingly, even Albert Ellis at 90 years of age disagreed with the adage that one could use any technique as long as it was consistent with his rational-emotive behaviour therapy (REBT). In fact, he contended that one could use any technique even if it was inconsistent with REBT because the client's well-being had to come before any theory!! (See Ellis' Foreword to The Rational Emotive Behavior Therapist's Pocket Companion at http://xrl.in/85u.)

Others may put these puzzling effects down to the placebo effect (http://xrl.in/85u). However, I am more impressed with the 40-30-15-15 therapy component rule (see http://www.brieftherapysolutions.com.au/BSFTWhatWorks.html). According to this rule, 40% of therapeutic effectiveness is apportioned to extra-therapeutic factors such the strengths of clients and 30% to the therapeutic alliance. Techniques are said to contribute 15% with the placebo effect also contributing another 15%.

Hence, when we revisit the above apparent anomaly, it makes sense that REBT may fail to help me in my own life but still work with one of my clients. With a client, she is getting the benefit of the therapeutic alliance, which doubtless enhances the effects of the other three sets of factors.

Web of Affluenza

Oliver James symbolised affluenza as a "virus" with its symptoms being the "placing of a high value on money, possessions, appearances (physical and social) and fame" (http://www.mercatornet.com/articles/affluenza/).

However, I'm not sure I accept the idea of a virus because a virus implies the sufferer had little control over getting the disorder; contrariwise, I believe affluenza is more like a web that we get caught in because we imagine we can see something good there for us. Yet, what it finally gives us is overwork, stress, self-imposed pressures, high blood pressure, financial problems and fixations, marital and family pressures, many of which are self-induced.

Affluenza does not only have individual implications but has global ecological implications too for the inordinate desire for more and more has had, and continues to have, a disastrous effect on the planet.

In the face of the environment catastrophe we seem to have engendered, "we recycle our garbage. We vote greener. We buy sleek, new hybrid cars and fill our houses with energy-efficient light bulbs. And we put our money and faith in the brave and ingenious technologies that will rescue us from the whirlwind.

But it won't be enough" (http://www.affluenza.org/).

A fairly shocking conclusion reached given that even doing all these things won't be enough to save our planet! The author goes on to say that, it won't be enough because the problems we face are not ultimately technological or political. He says they are to do with "appetites, . . . narcissism, and . . . self-deceit" and advocates individual reform.

One wonders what might be the motivation for such 'reform'. Will our fear of extinction force us to change our selfish desires of more? Probably, governments will gradually force citizens to be more 'green' conscious, to be more conserving of fuel, to scale back our inflated wishes for more at the expense of everyone and everything else.

However, although the problems we face are not ultimately technological or political, they are more than "personal moral" issues. They lodge in the root of man, in the heart, out of which come all the issues of life. Hence, they are primarily "religious" because the questions lie with to do with the 'god(s)' we are committed to and the direction that what we take to be divine is urging us towards.

Many people entering therapy today, are caught within the affluenza web. Many of the symptoms seen by counsellors, psychologists, psychiatrists, and psychotherapists are directly related to affluenza. People may be orthodox Christians and still be in the web. Being extricated from the web requires repentance working with divine grace in the heart so that greater conversion to the image of Christ takes place.

Back in 1936

In Lewis Carrol's famous book, Alice's Adventures in Wonderland (1865), a race is suggested by the Dodo bird after various characters get wet from Alice's tears. The race is conducted in an irrational way with no fixed starting point or finishing line but the Dodo is called upon to judge who had won and who would get the winner's prize. His adjudication was that 'everyone has won and all must have prizes'.

This famous Dodo bird verdict was applied to the field of psychotherapy in 1936 by Saul Rosenzweig who believed that all psychotherapies worked about the same because of shared common factors. Rosenzweig died in 2004 at 97 still committed to teaching even though he had formally retired at 1975.

His conclusions have been supported by a number of researchers (Frank; Luborsky et al.; Weinberger) but strongly affirmed by Duncan (2002) who interviewed Rosenzweig at 93 having believed him to have died! Duncan sorted the common factors into the categories of client, relationship, placebo and technique believing that the contribution that each of these makes to psychotherapy's effectiveness is 40%, 30%, 15% and 15% respectively. Duncan opined that psychotherapy ought to take much more notice of the qualities and potential of clients to play a large role in their healing rather than be fixated on client techniques.

However, the common factor tradition has been strongly opposed by those who believe that research should continue to identify specific therapies for specific disorders under specific conditions. Such endeavour is the hallmark of so-called empirically-supported therapies (EST).

It seems to me that these two traditions will never quite meet because the latter is wedded to the idea that scientific research is the only pathway to truth; the earlier, common factors movement, while it esteems science also believes that the scientific study of technique alone cannot sum up all that psychotherapy is.

My sympathies lie with the common factors approach while allowing that certain, specific conditions (eg phobias) may be better helped by a specific therapy (eg behaviour therapy).

Over-generalising about depression

In dealing with clients struggling with depression over the years and also having my own struggles, I remain humbled by the fact that as a therapist, I cannot make generalisations as to how I will help this or that client.

My problem with over-generalising came with my own experience with psychotropic medications that were supposed to fix me up but from which I got the most nasty side-effects. I wasn't supposed to get these side-effects or so it seemed. No one else apparently did or it seemed to be suggested got them like I did. The doctor had generalised that since many patients did get relief that if I didn't get relief there almost had to be something wrong with me!! Something was wrong with me but it was surprising to find that other patients also had similar problems with medications as well.

I used to find that the common SSRIs (Prozac, Zoloft, Aropax [awful], Cipramil) would wind me up so much that my whole being was constantly agitated. A wikipedia article describes this terrible state as akathisia (See http://en.wikipedia.org/wiki/Akathisia.)

Actually, it was only receiving help from a psychiatrist, who himself had depression and treated himself with medication, that started me on a path of having more self-confidence in my experience. He knew that patients did not always respond well to medications and that further, some of them had horrendous side-effects with some patients. (See http://xrl.in/2vm.) However, this doctor gave me hope even though he was not the one who finally helped me more definitively. He moved interstate and I had to find another specialist

Yet, even with the new specialist, I had to fight against being given the usual dose of a known 'benign' medication. Fortunately, providentially, I started off on a very low dosage and am still on this medication to this day although on a much higher dosage.


Another issue that sometimes patients have to fight with experts about are the generics that are 'just the same' as the original brands. Well not everyone finds it so. With other categories of medications that may be so but with psychotropic medications it is very unwise to change if one is doing reasonably well on a particular brand. Differences in responses to different generics can also be felt even though pharmacists will tell you that it cannot happen.

Therapy in Practice

A stimulating paper by Slife, Harris, Wiggins & Zenger (Brigham Young University) entitled Radical Relational Therapy in Practice (APA Presentation - 2005) at http://xrl.in/2km criticises the abstraction-into-practice tradition in psychotherapy.

And, while I agree that therapy is never just abstractions applied, it seems that Slife et al. do precisely what they claim to be protesting about. Let me explain.

They 'conscientiously used a relational ontology to orient all our year’s work together, with clients of all kinds' (p. 1). Now, what is this 'relational ontology' but an abstraction? Any ontology is some kind of philosophical science of being. Relations, as soon as we focus on them, become abstractions because we have abstracted them from experience. 'Relational' describes the type of ontology that one adheres to but using this contemporary buzz word does not mean one is not involved in abstraction.

Abstraction is unavoidable in therapy and can be observed in the given 'Ann' case study. The approach 'foregrounds the immediate, the richly contextual, and the authenticity of relationships' (p. 1), which states upfront that the therapy will emphasise three abstracted qualities from pretheoretical human experience.

I am not arguing against the importance or otherwise of these three qualities but rather arguing that in naming them we are necessarily involved in abstraction and thereby theory. It is a certain theory about human relationship that governs the way the therapy is conducted. For example, an unhappily married Ann says that she doesn't like herself in her marriage, to which the therapist responds with, 'Do you like yourself with me?' When she says that she does the she is asked to indicate what she is doing that allows that to happen. (Not we notice, what the therapist is doing but what she is doing.)

The therapist does not turn to either intrapsychic issues with internal objects or to disordered cognitions but focuses on what is going on in this therapeutic relationship that may lead to benefits in her other relationship.

The authors then present a 'tiny snippet of an actual therapy encounter' to demonstrate 'some important features of the relational approach'. The four summary points they draw from the case study are: '1) interpersonal connectedness is more important than individual depth; 2) a real relationship is more healing than an abstracted one; 3) being apart from community – individual autonomy – is less meaningful than being a part of it; and 4) living into, rather than abstracting from, contextual possibilities is more helpful' (p. 2-3).

To contend that these points and their terms are not 'theory-laden' is to ignore their abstracted character. However, on the other hand, nothing is wrong with abstraction as long as we don't imagine that abstractions are any substitute for mankind's fully given experience of reality.