This title will cause some eyebrow lifting. To many people it is nonsense to put “Christian” before “psychotherapy” as a modifier. It is like saying “Christian surgery” or “Christian dermatology” or like prefixing the term “Christian” to any other branch of science, medical or not. It implies that there can also be a non-Christian variety, like a Mohammedan or Atheist psychotherapy. It might further be inferred that psychotherapy can be differentiated along even finer sectarian lines such as Protestant or Roman Catholic. And this is reducing science to an absurdity.
Psychotherapy is generally thought of as a scientific discipline practiced by an adequately trained person with the proper professional degrees and credentials, and it makes no difference whether he is a Christian, Mohammedan, or Atheist. It is a healing technique for mental illness. When a surgical operation is needed the patient or his family do not look first for a doctor of their own faith but for one with skill in surgery, a specialist in the type of operation needed. Other things being equal they might prefer the surgeon of their own faith, but they would be fools to insist on it. Similarly it is thought that the person who needs a psychotherapist should look for the one with the best scientific skill rather than one with a particular religion, philosophy, or Weltanschauung. It is enough that he be “Christian” in the broad sense of being a decent, responsible, and honest person, but his specific religious beliefs are irrelevant. “Christian” is understood to refer to a set of beliefs, ethical values, moral goals, which in their nature lie outside the field of scientific enquiry.
It is conceded by this common view that the adjective “Christian” can be a proper modifier in some areas related to psychotherapy, such as Christian guidance and Christian (pastoral) counseling. In such context “Christian” refers to the facts and values of the Christian tradition. Guidance is thought to be educational or informational, giving facts as a basis for decision. Counseling is thought to be psychological, dealing with “normal” mental processes, to help a person to make decisions and pursue values agreeable to the Christian tradition. In distinction from these, it is thought that psychotherapy is psychiatric, a healing discipline to correct “abnormal” mental processes and patterns of behavior.
AN OVER-SIMPLIFICATION
While there is some validity to the distinctions given, it is wrong to suppose that they can be completely separated in actual practice. They overlap and may even merge. In a genuine person-to-person encounter something occurs which cannot be fitted into one particular mold. Insofar as an “abnormality” is functional (not due to known physical causes), ethical and moral concepts, religious and cultural values are involved. For example, a washing compulsion may be a feeling of being “dirty” arising out of early sexual behavior. But the “dirty” feeling can also have deeper reference in the person’s feeling about God. The biologically oriented therapist might try to encounter this patient in terms of the libido and Oedipus concept, the sociologically oriented therapist in terms of the interpersonal situation, the existentialist in terms of his concept of finitude and the threat of non-being, but the Christian would be concerned with the God concept and God relationship of the patient. The orientation or the presuppositions of the therapist and patient are determinants in the therapy.
It seems an over-simplification to say that counseling is psychological while psychotherapy is psychiatric. The very words used indicate that they deal with a common area. What is “Psyche”? Call it “mind” or “soul” or whatever you like, it refers to the unifying and integrating faculty, and judgmental values, the goals and moral aspects of life. The difference in suffix is hardly a distinction. Is psychology then a theoretical science, the “Logia,” the word-knowledge about the psyche, and is psychiatry then applied science, the therapeia (service, treatment) and iasis (healing) of the psyche, and is counseling then not an applied science and therapeutic? Is counseling really so different from psychotherapy? Does the psychiatrist’s M.D. give him skills which a properly trained counselor cannot have? The psychiatrist has to deal with goals, values, beliefs, yes, religion, and he has no exclusive claim on this field. The trained nonmedical person can be helpful in treating the psyche as well as an M.D. Indeed, a prominent psychoanalyst told the writer recently that his M.D. was a “pure luxury.” Of course, this is not to deny that much mental illness has a physical cause or may be associated with an organic trouble. A physical and neurological examination is essential in most cases, and the diagnosis should be done by the medical profession, and the physical symptoms must be medically treated. But the psychical aspects of the illness, whether somatic symptoms are present or not, are outside the field of empirical medicine because they involve value judgments, moral standards, religious and philosophical concepts.
IDOLATRY OF TECHNIQUES
In the early days of psychoanalysis there was considerable debate about who could be an analyst. Freud himself felt strongly that it was not the exclusive domain of the medical profession. In fact, one of his most ardent disciples was a Swiss pastor, Oskar Pfister. The American analysts disagreed with him, and the reason may be that Americans are generally not so alert as the Europeans to philosophical implications and ultimate goals. We seem to be more preoccupied with techniques. However, this attitude has been changing. The growth of counseling—pastoral, vocational, marital, and so on, is indicative of this change. Lewis R. Wolberg, in his book, The Technique of Psychotherapy, includes in psychotherapy guidance and counseling as well as psychoanalysis. He recognizes their overlapping and that the lines of separation can become so thin that they are practically imperceptible. So long as a psychiatrist only dispenses tranquilizers and administers electro-shock treatments he is much like his colleague who treats kidney disease. But when he seeks out the dynamics of his patient, when he studies the mental life in its development from infancy on and considers the social and cultural forces, including the religious beliefs that have shaped his patient, then he is entering the field of values, of religio-philosophical concepts. Furthermore, as he helps his patient to understand himself, to uncover his deep motivations and achieve a meaningful and satisfying life, he cannot avoid questions of right and wrong, true and false, with respect to a person’s drives and behavior and the mores of his cultural, social, and religious milieu.
ILLUSION OF NEUTRALITY
Psychiatrists, especially the psychoanalysts, usually insist that they are “neutral” with respect to a patient’s moral and religious values. Their technique is designed to create a free and nonjudgmental atmosphere in which a patient can “open up.” The doctor tries to “understand” the patient not for the purpose of then telling him what he must do to be cured, but rather with the purpose of helping the patient to understand himself and to make the necessary changes in the direction of health. This is also the technique of counseling, whether it be the nondirective method of Carl Rogers or the more active method of the existentialists. The therapist tries to “experience with” the patient, to empathize so completely that both patient and therapist have what Rogers describes as a sort of trance-like experience. In an article in the American Psychologist, reprinted in Pastoral Psychology (March and April 1959), Rogers describes a conflict within himself between the therapist and scientist. He is troubled lest the scientist thwart the therapist by depersonalizing the patient. He is aware of his subjectivism as a therapist, while at the same time he wants to be objective as a scientist. He finds a modus operandi in suggesting that the scientist cannot be completely objective after all, that he “experiences,” lives “organismically” in his field in somewhat the same way that a therapist “experiences” his client. He concludes: “For science too, at its inception, is an ‘I-Thou’ relationship with the world of perceived objects, just as therapy at its deepest is an ‘I-Thou’ relationship with a person or persons. And only as a subjective person can I enter either of these relationships.” Thus if the therapist is a Christian (not merely a nominal one) his commitment comes with him into the therapeutic situation, and likewise the scientist who is a Christian cannot lock God out of his laboratory. Some analysts are frank to admit that they are not neutral, that their goals are religio-philosophical (for example, Erich Fromm, Psychoanalysis and Religion; Viktor Frankl, The Doctor and the Soul).
VALUES AND HEALTH
These considerations would suggest then that “Christian” is a proper adjective for psychotherapy. Values, moral standards, ethical goals, religious beliefs, a world-and-life view are involved in personality health or wholeness. If health be narrowly defined within a particular cultural situation, then the therapist is only concerned with adjustment, conformity, or the massman. But this is precisely what many modern psychotherapists fear and shun. “The courage to be,” the acceptance of personal “freedom” and “responsibility,” the willingness to be ourselves—these qualities are our uniqueness, and are what make us genuinely whole. But they confront us with the fundamental religious problem of the meaning of human existence. What is man and why is he here? What makes his life worth living, and what is the use of his three score and ten or four score years of which the strength is labor and sorrow?
Jacob J. Vellenga served on the National Board of Administration of the United Presbyterian Church from 1948–54. Since 1958 he has served the United Presbyterian Church in the U.S.A. as Associate Executive. He holds the A.B. degree from Monmouth College, the B.D. from Pittsburgh-Xenia Seminary, Th.D. from Southern Baptist Theological Seminary, and D.D. from Monmouth College, Illinois.
