Tuesday, November 06, 2007

Powlison Responds

David Powlison writes:

I appreciate Elliot Ravenwood’s questions (the 3rd comment in response to my post). I can see how my post can be taken as a “straw man” argument. Perhaps the difficulty comes in my attempt to combine humor with seriousness. I intended the video to be purely humorous and enjoyable. Of course Bob Newhart does not give an adequate representation of any real therapy. It’s only a takeoff.

But like all good humor, it has a point. And that point was only my starting point for making positive points about biblical ministry. (And high-level criticisms of Dr. Phil and even the most sophisticated CBT. They have essential commonalities at the level of worldview and change dynamic, though they have many secondary differences.)

I do question several things in the second half of Elliot’s post. He raises points that many people raise, and I hope a careful answer can be helpful in clarifying some very important matters:
CBT has been proven to be decidedly successful in treating symptoms of anxiety and clinical depression, something for which Biblical counseling alone is unfortunately not very effective. However, I do think Biblical counseling can play a great role in addressing the causes of those disorders, an area that CBT specifically chooses not to enter into.
First, it’s important to recognize that any number of things can treat symptoms successfully. Give your life to some cause (any cause). Get better exercise. Cut out the caffeine. Hang out with more constructive friends. Volunteer to help needy people. Take a vacation in a beautiful place. Become a Hindu or Buddhist, and learn calming meditation techniques. Take psychoactive medications. Become schooled in ANY therapy. Any organized worldview and constructively purposeful lifestyle “works” better than a disorganized worldview that has no sense of bigger meaning and purpose. If I had to choose from that list of options for managing a fallen world in a psychologically-successful way, I’d pick Buddhism combined with finding a good cause. But God wants us to become part of his redemption of a fallen world, not simply to manage our reactions. And God calls us to give ourselves to the best cause. So wise biblical counseling will “treat symptoms” effectively, but on a more substantial foundation.

Second, symptom alleviation, per se, is never proof that something is right and true. For example, any and all therapies can teach you to manage your emotions and make better choices. They all tend to be "ascetic" -- calling you to step back from the morass of experience and instinctive reactions. They teach you categories to reinterpret your life and experience. In other words, all therapies are theological and ministerial. CBT’s particular practical theology alleviates symptoms by teaching people Stoic philosophy. (Martha Nussbaum’s The Therapy of Desire gives a wonderful scholarly treatment of the "discipleship" processes of the Stoics and other Greek philosophers.) The Stoic world view disciples you to be less upset by what’s happening to you. How? You become more internally centered on self-reliance, and retain a certain detachment from what happens to you. You become more "philosophical," rather than becoming swallowed up in the disappointment, angst, anger, and fear caused by disappointed desires. That’s one kind of discipleship.

Christianity disciples you a different way. Christ teaches us to be more engaged with what’s going on, and with what’s wrong, but to view it and engage it through the eyes of redemptive love in Christ. We don’t quell our desires (the apatheia of Stoicism); we turn from the rule of our desires to the rule of God. Thus we redeem and retune our desires to function as they are meant to function. Wise biblical counseling also “successfully treats symptoms of anxiety and clinical depression,” but via a dynamic that generates faith and love, not a dynamic of self-reliance.

Third, CBT is certainly one option in the supermarket of ways to feel somewhat better and be less upset by life. It happens to be the option of choice currently, but if history is any guide (and it is!), that hegemony will eventually fade as the flaws in CBT become widely obvious to the culture, and something else appears more compelling. But, sticking with our cultural moment, what is the cash-value of a form of symptom-alleviation whose essential process is to inculcate a more psychologically-successful form of “leaning on your own understanding”? It does not teach a person to “trust in the Lord with all your heart,” to live in relationship to Him-with-whom-we-have-to-do. So it calms people down, but at the cost of becoming anesthetized to fundamental realities. By contrast, the psalms can be very upset – filled with anguish, anxiety, apprehension, pain – but it is an upset qualified and shaped by faith and love. So the psalms also know the peace-in-relationship of psalms 23 and 131, and the relational joys of the royal psalms and the hallulujah psalms. Psalms are far more “psychologically healthy” than a successful CBT patient, whose equanimity is successfully self-referential. And of course they are far more “psychologically healthy” than a prospective CBT client who is a nervous wreck, whose upset is unsuccessfully self-referential.

Fourth, I think it’s a mistake to think we can detach symptom alleviation from what any therapy/cure is doing at the level of the human heart. CBT in fact does “enter into the causes,” but in a way pointedly contrary to Christian faith. Any professed cure has implications for the heart’s loyalties and trusts. But a biblical gaze helps us see how Stoicism misdisciples the human heart into a false trust. False trust in a false message is why CBT "works." No therapist of any kind can escape being an evangelist for what he or she believes is true. In CBT you feel better because you trust yourself more, and affirm your basic OKness more consistently. That’s entering into causes (unwittingly, while pretending that your answer is "objective/realistic," and that you are theologically neutral). CBT carefully rewrites the inner script by making autonomy from God more successful and less frustrating.

Finally, I’m not sure what Elliot means by “biblical counseling alone.” I suspect he means citing Bible verses, doing Bible study, practicing the means of grace (prayer, preaching, sacrament, worship, small groups, accountability). (???) But to reduce wisdom to religious activities and theological words is exactly what actual biblical counseling aims to blow up and rebuild. Such spiritualizing is why the church usually lacks a vision for real counseling ministry, and thus is so vulnerable to things like CBT that pretend to operate in a different sphere (“symptoms,” not “causes”). If biblical counseling is a comprehensive wisdom, just as CBT is a comprehensive wisdom (founded on a different faith), then why can’t wise biblical counseling accomplish everything CBT accomplishes – and far more? It will do so on a sound rather than faulty basis, creating reliance on Christ rather than reliance on self. If something really deals with causes, it will also deal with symptoms, by definition. Morphine eases the pain of cancer; removing the tumor also eases the pain of cancer. If our worst cancers are operable by the means of mere words communicated in a relationship of trust, then why not skillfully employ the words of Christian faith rather than the words of Stoic faith?