1
Introduction

Topics in Chapter 1

• A historical view of spirituality, religion and psychotherapy
• The development and dominance of cognitive therapy as a psychotherapy
• The importance of Christianity in the West
• The appreciation of the role of non-specific factors in psychotherapy
• Interest in the Buddhist technique of 'mindfulness'
• Findings relating religious adherence to positive mental and physical health
• The growing respect for cultural and individual differences
• The decline of logical positivism and the rise of postmodernism and social constructionist theory
• The question of a logical connection between cognitive therapy and the teachings of Jesus
• A general outline of the book

A historical view of spirituality, religion and psychotherapy

Psychotherapy, a form of treatment for people suffering from emotional and behavioural disorders such as anxiety disorders, had its major period of development during the twentieth century. With rare exceptions, for most of this time there was seen to be little connection between the conduct of psychotherapy on the one hand, and spirituality and the practice of religion on the other. Two very significant figures in the development of psychotherapy, Sigmund Freud and Albert Ellis, have taken an essentially negative view of religion. Freud saw it as an illusion and the result of wish fulfilment in terms of longing for the father (Wulff, 1996). Ellis (1980) contended that all forms of religious belief were pathological and lead to neurosis. For much of the twentieth century the view prevailed that values, including religious values, could be kept out of psychological theory, research and practice (Patterson, 1958, cited in Bergin, Payne & Richards, 1996).

Developments in general psychology for most of the twentieth century were also antagonistic to the exploration of the relevance of religion to psychotherapy. In the economic crisis after World War I the United States of America shifted to a preoccupation with scientific progress and economic success. Within psychology this was parallelled by the 'spectacular success of behaviourism and its ideal of an objective and mechanistic science' (Wulff, 1996, p. 45).

At the beginning of the twenty-first century it is appropriate to reconsider the issue. The divorce of psychotherapy from religion may never have been logical nor appropriate, and there have been developments that make it timely to consider the potential for integration of religion and psychotherapy. Some of these developments are: the development and dominance of cognitive therapy as a psychotherapy; the appreciation of the role of non-specific factors in psychotherapy, including the role of values; the interest in the Buddhist technique of 'mindfulness' by a number of respected authors within the cognitive therapy tradition; the finding that 'intrinsic' religiousness is positively related to mental health; the growing respect for cultural and individual differences; the decline of logical positivism and the scientific worldview and the rise of postmodernism and social constructionist theory; and cultural changes in Western society.

The development and dominance of cognitive therapy as a psychotherapy

Cognitive therapy is a psychotherapy that aims to assist people with emotional disorders such as the anxiety disorders, and depression. It has also been used with a wide variety of other disorders, including chronic pain, eating disorders and personality disorders. Cognitive therapy considers that emotional disorders, such as depression, are caused and/or maintained by faulty thinking. It works by the therapist using a variety of verbal and intellectual techniques to assist the patient to identify and change the dysfunctional beliefs and thought processes. Cognitive therapy (CT) was developed by Aaron T. (Tim) Beck in a series of books and papers in the 1960s and 70s, most notably Beck (1976) and Beck, Rush, Shaw and Emery (1979). CT continues to be refined by Beck and others (e.g. J. S. Beck, 1995). It is aligned with other therapies with a similar view of psychopathology and focus of treatment, including cognitive behaviour therapy (e.g. O'Donohue & Fisher, 2012); cognitive restructuring therapy (e.g. McMullin, 2000); rational emotive therapy/rational emotive behavior therapy (e.g. Ellis & Harper 1975; Ellis & Grieger 1977); acceptance and commitment therapy (e.g. Hayes, Strosahl & Wilson, 1999); and mindfulness based cognitive therapy (e.g. Segal, Williams & Teasdale, 2002).

Cognitive therapy is accepted by the American Psychological Association as a 'well-established' treatment for depression, a very common mental health problem, and is a component in about half of the psychological therapies considered to be well-established treatments by the clinical psychology division of the American Psychological Association (Chambless, et al., 1996, 1998; Task Force on promotion and dissemination of empirically validated psychological treatments, 1995), The relationship between cognitive therapy and cognitive behaviour therapy is complex and has been subject to misunderstandings and, in some cases, mislabelling of a particular therapy. Cognitive behavioural therapy was originally the integration of cognitive phenomena into traditional behaviour therapy, but in popular understanding it has come to mean the reverse. The following is a representative definition:

Cognitive therapy is a psychosocial (both psychological and social) therapy that assumes that faulty thought patterns (called cognitive patterns) cause maladaptive behavior and emotional responses. The treatment focuses on changing thoughts in order to solve psychological and personality problems. Behavior therapy is also a goal-oriented, therapeutic approach, and it treats emotional and behavioral disorders as maladaptive learned responses that can be replaced by healthier ones with appropriate training. Cognitive-behavioral therapy (CBT) integrates features of behavior modification into the traditional cognitive restructuring approach.

(Encyclopedia of Mental Disorders, n.d.)

Arden and Linford (2009, p. 55) define 'Pure CBT' as follows:

Pure CBT - as opposed to the elements of it many of us employ in our practices - has five components

1. Psychoeducation
2. Breathing retraining
3. Cognitive restructuring
4. Exposure
5. Relapse prevention

The situation is further complicated in that Beck's original 'Cognitive Therapy of Depression' (Beck et al., 1979) included a large behavioural assignment component. Thus both 'cognitive therapy' and 'cognitive behaviour therapy' include attempts to change both thoughts and behaviour directly.

It is this set of components that has been very successful in achieving outcomes for people with emotional and behavioural disorders by assisting people to change their thinking and their behaviour without recourse to attempts to change anatomy or physiology. The CT-CBT approach has outperformed other non-physiological/non anatomical approaches. It has also largely been a 'Western' phenomenon. It is therefore appropriate to consider the relationship of CT-CBT with the dominant religion of the West: Christianity.

The importance of Christianity in the West

The teachings of Jesus, a first-century Palestinian Jew from Nazareth, a small town in the north of Israel, are important to a very large number of people. Christianity, the religion based on those teachings, is unarguably the world's most popular religion with two billion adherents. The point prevalence for depression in adults ranges from 2-3 per cent for men and 5-9 per cent for women (American Psychiatric Association, 2000). Therefore between 40 and 180 million people with an adherence to Christianity are likely to be suffering from depression at any point in time, not to mention at least the same number who suffer from one of the many other disorders, including anxiety disorders, that benefit from cognitive therapy.

Many people with depression and other emotional disorders will (or should) receive CT as a component in their treatment. Many of these people, particularly in the West, will be practising Christians. If there are connections between the teachings of Jesus and CT, and if the teachings of Jesus can then be integrated positively with CT, clearly it could be very beneficial for people receiving CT who have Christian beliefs.

The appreciation of the role of non-specific factors in psychotherapy

Since the discovery in the mid 1980s that all psychological theories appear to have about the same positive effect on symptoms of disorders such as depression, interest has developed in the so-called non-specific effects of therapy. These are factors that are not necessarily derived from the theory the therapy is based on, but which affect therapy, or occur in the context of therapy. They have included the therapeutic alliance, and client factors such as motivation for therapy and expectancy of success in therapy. A non-specific factor explored explicitly in the context of psychotherapy is the role of both the therapist's and...