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  #1  
Unread September 13th, 2006, 09:39 AM
Janet Doron Janet Doron is offline
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Default CBT, religious faith, current events....

Greetings everyone,

I am working with an exceptionally intelligent and well-read individual who has been regularly researching philosophical, theological and political ideas for years. A victim of anxiety (also for years), he has successfully built a cognitive system that supports anxious thoughts and beliefs with religious premises, philosophical concepts or 'proof' from current political events.

To demonstrate: feeling unworthy, humble and submissive is a premise of being a good Christian, and is the essence of being human - hence a worthy goal to strive for in self development. Being a victim and sacrificing is the ultimate path to eternal life.
Competition and pride in achievements and in self are viewed negatively for the same reason.
Feeling insecure, unsure, and always judged is the (proper) human condition (though in this case it is clearly a result of childhood abuse). It is, for this individual, a moral goal.
Dread from 'the government' is easily supported with daily refernces in the press about threats to individual freedoms brought about by the current wave of 'the war on terrorism'. There is much more.

I am confronted with a well reasoned, well-supported system of beliefs that makes my task very hard because confronting religious premises seems unethical as well as useless to me. I find it hard to create doubts in this person's prevalent (and 'proven') political assesments, as well as his premises of faith, yet his anxiety feeds on those freely.
There have been some success as far as personal and family issues are concerned, but I am really hesitant how to approach basic attitudes which are anxiety driven but so well justified by deep religious faith and political insight.

I'd appreciate suggestions for approach, and/or recommended references about the topic.
Thanks.
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  #2  
Unread September 18th, 2006, 08:34 PM
Neil Levitsky Neil Levitsky is offline
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Default Re: CBT, religious faith, current events....

Hi,
An interesting dilemna. Here's my thoughts, FWIW, given I know very little besides the few paragraphs in your post.
I would tend to want to go "back to basics", in the sense of the very beginning of therapy. Since therapy can't proceed unless someone wants it, and wants to change, and has realistic goals, I would wonder what this person's goals are. Why does he want CBT; what would he like to see different if it helps? Perhaps you are thinking the goal needs to be to change what you view as illogical thinking. However, this client may not share that goal. Can the two of you find a realistic goal that you can both agree on? I think some people are just not good candidates for therapy, as they have unrealistic goals, such as "I want to be happier in a messed up world, but I don't want to change my belief system" Then again, if that is the problem, perhaps the initial work needs to be on identifying his main beliefs, and having him look at the advantages and disadvantages of holding the beliefs.

Not sure it this is of help, but these are my initial thoughts.

Neil Levitsky
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  #3  
Unread September 19th, 2006, 04:45 AM
Janet Doron Janet Doron is offline
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Default Re: CBT, religious faith, current events....

Neil, first of all thank you for answering me.

I believe you put your finger on the essence of the problem - the goals.

Anxiety has made life intolarable for decades for this person (as far as his personal life is concerned), and this he wishes to change. There was the question of consistent fear (for 12 years) that the woman he lives with (and has 3 children with) will surely eventually be unfaithful to him - we made good progress there - in fact he eventually married her and family life has become significantly improved with CBT through his own efforts. Not that the thoughts went away, they are just better dealt with on a continual, ad-hoc basis. There was the question of anxious thoughts concerning his young daughter - to a point of keeping her at home (protected by him from schooling, vaccinations, and all else deemed dangerous). In this, also, his understanding and genuine efforts were the main determinants of changes and progress. Not that his fears for her are gone - he just deals with them more practically. There is the question of his work: he is a very talented artist and writer, but perception of himself as a total failure and an incompetent, unworthy and lost person have made him withdraw from threatening challenges and commitments, to become a recluse whose fear of failure and criticism prevented him from taking up formal education to develop his talents, exposing his work to professional (and inevitable)critique, etc. Here, also, his own goals and efforts brought about significant progress - he is now a student (usually an A student) and his determination keeps him at it, though this is still rather an uphill, painful battle, with many setbacks. There is a history of panic attacks, and he made good progress there also - it is rarely an issue now.

I thought we could make better progress by addressing deeper issues, but
you are right. When we try to descend deeper into schemas and basic belief systems is where I consistently encounter resistence to change and to CBT. He consciously clings to some powerful, anxiety-related perceptions, and though they originate in childhood abandonment and severe physical and emotional abuse, he seems not to want to define a goal of being rid of them.
In fact he views many of them as goals in themselves.

I have a lot of respect for his achievements so far, as well as his talents and creativity. I believe this is one time where it's me who needs to change... I should probably confine my efforts to the practical circumstances of coping with daily life, and not try (as I have been doing) to ease things further by descending deeper into regions of the self where he doesn't _want_ CBT to touch. In fact, I can't help seeing a good side: much of his creative work (art and writing) is fuelled by his being what he is. I identify (in myself) a conflict between the wish to help further, and a deep reverence of the creativity that his suffering has fuelled.

I could not help feeling that I wouldn't be doing a good job of helping if I didn't try going deeper, but you have reminded me to come to terms with the limits of the help that we can or should offer. I will continue to do my best on his own terms, and since I feel genuine respect for his strengths, I don't think it'll be too hard for me to embrace that approach. I think there's a good chance he'll even make a name for himself, though I doubt he'll ever believe he is worthy of it.... Perhaps our world will benefit from his work, and if he just manages to 'keep his life together' then so be it.

Thank you for your input

Janet.
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  #4  
Unread September 20th, 2006, 08:08 PM
John Simon John Simon is offline
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Default Re: CBT, religious faith, current events....

Janet,

I believe that you may have hit upon a major revelation regarding this client’s suffering and his ability to use it in a creative fashion. Maybe instead of focusing on the negative aspects of his schemas, you could use the positive aspects of his belief system to help him fertilize his own self concept. Milton Erickson once said “look forward to the days when you can look back knowing that you left a trail of happiness.” Maybe you can help him look forward to the future days when God has allowed him to help so many people through his writing as they also suffer through life. After all, writers are a self sacrificing bunch as most do not get their due until they are dead. However, many of these writers are a great source of comfort to other people. Maybe after you get him focused on all of the ways that God allowed him to help other people then he will feel better. I suggest using God here since he will not want the focus on himself. Really build up the resources here about how comfortable he will feel in the next life having left behind such comfortable writings. Maybe after a couple of sessions working on his resources, you can begin to ask him how he might suggest that others find peace in this world. After all, if he is going to be a comfort to others by sacrificing his current life so that others can feel better in the future then maybe someone also did that for him already. Is there a writer or story that resonates with him now that can make him feel better? Just a thought.

John
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  #5  
Unread September 21st, 2006, 12:55 PM
Janet Doron Janet Doron is offline
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Default Re: CBT, religious faith, current events....

John,

Thank you for your ideas, support, and (if I may) inspiration.

I am travelling uncharted territory in this case, and I find myself continually challenged professionally, intellectually, philosophically and emotionally. I therefore feel responsibility lying more heavily on my shoulders, precisely because this is also an experience of growth to my own self. An erroneous approach due to insufficient knowledge or experience could cause harm, yet at times I have little but my own instinct to rely on. I tend to agree with the way you are seeing things, and I have at times instinctively approached similarly. I did need validation, reassurance and ideas from other professionals, or alternately, correction and guidance in choosing a better direction.

I will develop your specific ideas further. Sessions occasionally touch on the literary and philosophical, so that won't be difficult to do. I will also feel better about this approach (not challenging the negative schemas at all, but rather drawing on the positive forces) having received input from other, more experienced professionals.

Thank you for the Milton Erickson quote as well

Janet.
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  #6  
Unread September 23rd, 2006, 09:49 PM
James Pretzer James Pretzer is offline
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Default Re: CBT, religious faith, current events....

Excellent discussion!

One additional idea... When dealing with issues where the client has strong religious, philosophical, or political views it may be more productive to work within the client's belief system rather than trying to change it. For example, if the client believes that it is important for a good Christian to see himself as unworthy (as a number of Christian denominations believe) I'd want to find out what they/he believe(s) is the appropriate way for one to deal with one's unworthiness. Many denominations believe that one should accept one's unworthiness, repent, rejoice in God's grace, and then go forth and try to live a good life. This boils down to "I'm unworthy but God loves me anyway so it's OK to accept myself with all my flaws. I need not be miserable about being a flawed human being."

Likewise, one can accept that we live in a world that presents many dangers and then choose whether to shelter our children, to try to equip them to make good choices and cope effectively with the demands of the real world, or to strike a developmentally appropriate balance between the two strategies. One can accept that we have a government that pursues some highly questionable policies and choose whether to respond with fear and vigilance, to endeavor to live a moral life despite the government's questionable activities, or to engage in some degree of political activism.

Both mindfulness-based interventions and Acceptance and Committment Therapy may be relevant.
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  #7  
Unread September 25th, 2006, 02:56 AM
Janet Doron Janet Doron is offline
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Default Re: CBT, religious faith, current events....

Thank you, Dr. Pretzer, for responding.

I tried to phrase my concerns in general terms throughout the discussion, and received very valuable input. I do still feel the need to hear specific ideas for dealing with some aspects I will elaborate on now, with your permission.

Before I proceed, allow me to point out that I am working with an individual who is extremely intelligent and honest (also about himself), who has been actively involved (for decades) in a process of 'making sense out of life and its greater issues'. While doing this, he is trying to reconcile three forces: a deep faith (which he acknowledges as a deep, personal need that derives from his early life experiences), a pursuit of hard logic (he is not content with faith alone, but wishes to support it with reason), and a merciless honesty. The conflicts that such a combination can create, should be obvious to anyone who has ever tried to cope with issues of this nature. To him, if the premises of his faith are untrue, life is not worth living (i.e. if there is no God; if there is no ultimate Good and ultimate Love; if all we have is this world and its evils - namely force and violence - he may as well give it up). So the faith is what he hangs on to for dear life and its meaning, and a source of strength. This he acknowledges. Yet it must reconcile with a reasoned system of thought and logic, scrutinized very honestly. He built up a very sophisticated system that tries to accomplish this.

I am having an easier time working within his belief system regarding Christian faith, then I am regarding his perceptions of current affairs - a major source of anxiety for him at the moment. Here are his views:

1) The events of 9/11 were orchestrated by an administration who seeks to frighten Americans into relinquishing democracy, basic human rights and the Constitution itself, in favour of strict centralized control, which is progressively becoming fascist in nature. I am presented with endless historical examples of similar processes, and a barrage of current events supporting this view.
2)Conspiracy theories are, at best, very hard to debunk, but in this case there are distinguished scholars such as Dr. James Fetzer (a professor of Philosophy and Logic), Dr. Steven Jones (Physicist), and other respectable individuals who present compelling arguments. The "Truth for 911" and "Scholres for Truth" movements cannot be brushed off easily by political amateurs such as myself.
2)Another event similar, yet bigger than 911 is definitely approaching.
The current administration is feeling weakened and threatened by the awakening of the public, and will need to use more fear to coerce Americans into accepting their policies. The nuking of a city is a probable event (not possible, but probable), and this will result in a dramatic further decrease of democracy.
3)The fear these thoughts are generating is immense. It manifests in sleeplessness, endless and obsessive information searches, and physical symptoms of anxiety. Cost-benefit approaches are not working well.
4)There is a personal significance:
He will be personally persecuted for his political views, and 'they' will try to silence him by threatening him or his family with harm. Again, abundant historical examples are used. He does express his views publically in writing and art (including his own website, and activities in his community), and when he does, they do not sound like conspiracy theories (he knows better than that) but like well reasoned political and philosophical treatises. I cannot debunk any of his fears or the anxiety symptoms associated.
5)This ties in with the faith:
A day will come when he will have to make a choice between his life and the lives of his loved ones, and between his soul. He will have to choose between submitting to 'them' or seeing 'them' hurt his loved ones. Having a firm belief in eternal life and the need to preserve the soul above all else, he truly believes his choice MUST be to sacrifice his loved ones. This is a test of his faith, because if he is a true believer, he should TRUST that God will look after him and his loved ones, and should NOT put the concerns of this life above the concerns of the eternal one. He feels he SHOULD sacrifice himself and his loved ones, or else his faith is not strong enough.
6)This is a scenario he is terribly afraid of. He accepts himself as a human who may 'fail' such a test and therefore will require grace, but this he perceives as utter failure and a faith that is not strong enough - an even bigger failure.
7)God's love is the only true love (it manifests in the sacrifice of Christ), and we are ordered to be as Gods and to emulate that in our own sacrifices of life and family when we are called upon. This is the ultimate test for us, and he fears it but very much wants to pass it.

Any ideas?

Please remember that this is not the kind of person who responds to the basic approaches of CBT (he's pretty much thought of everything himself...). We've already agreed we need to work within his belief system, though his fears of authority, violence, coercion etc. are derived from extreme childhood abuse (as is his idea of perfect love - an ideal non-existent on earth). We also agreed not to descend vertically to deal with schemas that he doesn't want CBT to touch.

This has put to the test my philosophy schooling, my political understanding (not very extensive anyway), and my professional tools. Your input will be most appreciated.

Janet.
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  #8  
Unread September 25th, 2006, 11:08 AM
John Simon John Simon is offline
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Default Re: CBT, religious faith, current events....

If you don't mind, I am going to throw out a couple more things. First, I wonder what will happen when you join him where he is as though his beliefs were truth. Let me give you an example. I recently saw an interview with Warren Buffett who is the 2nd richest man in the world. Many people do not realize that he owns several re-insurance companies that bascially insure the insurance companies in case their losses are too large to cover. In the interview, he estimated the probability of a nuke going off in a major city in the next 30 years as 60%. Obviously Buffett is not some fanatic so your client's beliefs may not be so crazy. If we assume that all of this is true then I would want to know the following:

1. Are there ways that he can give himself comfort? Does writing about the problems of the world help him? What does he want to tell his family about his love from them, knowing what will happen? Does he want to spend time thinking about the outcome since he already knows the end of the story or is there another way that he would like to spend his remaining time on earth? Knowing all of this, can he really do anything about it? I mean - many Christians believe that the world is in the end times as evidenced by several preachers going on TV and saying as much. To many, the signs of this are peaceful as an indication that God is in control despite the bad situations.

2. An even more basic question is what does he want to do now that he knows this stuff. Can he make the world a better place in the meantime.

3. I might also explore his beliefs about how God helps people in difficult situations. I mean does he think that God would allow him to be in that situation without giving him strength? There are several examples in the Bible that show how God helped people in difficult times. For instance, God parting the Red Sea and Jesus sending the Holy Spirit to the disciples after he left earth. Could he pray about his situation to get strength etc.

4. Does he have friends that have the same belief but have more comfort in the situation? How do they do it etc?

5. Would he be more likely to make it through the tough situations ahead if he was well rested and clear minded or if he is tired from all of his anxiety?

I might ask him if he has a pastor or priest that he really trusts. If he does then I might ask to bring him into the sessions for a couple of visits. Maybe a pastor would be on more solid ground to give him some advice about his beliefs as this is a largely spiritual issue.

One other thing. Jay Haley used to say that when things are not working, it helps to come up with another hypothesis. Janet, I would really encourage you to drop the hypothesis that he belief system came from his childhood. Just really focus in on the truth of his argument. At minimum, you will just build on your alliance with the client which is a strong element of change. In other words, OK you are right so now what do we do?

Just my 2 cents worth.

John
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  #9  
Unread September 25th, 2006, 07:11 PM
Janet Doron Janet Doron is offline
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Default Re: CBT, religious faith, current events....

John, thank you so much for responding.

I assure you, if I thought his way of thinking was so crazy and out of line, I wouldn't bother addressing this forum, and I would probably have accessible tools to cope with this.... My problem is precisely the fact that the entire system of thought is so well grounded, supported and convincing on one hand, yet a source of anxious thoughts that generate severe symptoms on the other. I have not confronted his belief system to date due to my instinct, my ethical views, my perception that he is extremely unwilling to do so, and my inability to cope with such a well grounded system anyway. I have also been aware of the creativity it fuells - I feel deep respect for his art and writing talents.
I believe we established mutual respect and trust in each other's honesty, and I have no intention of forfeiting that.

I cannot, however, drop my working hypothesis as you suggested...
One thing I have no doubt about is the degree to which his childhood history has contributed to his anxiety. Please accept my evaluation; I assure you it is well grounded. This person is very verbal and has a writer's ability to describe vividly many specific events and situations from his childhood, which I am now very familiar with in detail. I marvel at his will and strength to cope with his past as well he has, anxiety notwithstanding.

I have taken it upon myself to do precisely as you and the other colleagues recommend, in other words to work within this person's belief system. I addressed this forum precisely because this has been my own instinctive approach, yet I felt unsure about not descending deeper into schemas and causes of anxiety. This person's entire philosophical system is a system which has served to support him through an otherwise unbearable history (severe physical and emotional abuse, violence and abandonment, no love, support or security at all). On the other hand, it is this well reasoned system that presently generates and feeds anxious thoughts, which manifest as severe symptoms.

I addressed this forum because I was unsure how to deal with this interwoven mesh where anxiety is so intimately associated with a personal history, yet so well supported with logic and reason, faith and political insight that turn upon themselves to feed the anxiety yet further.
Will I be neglecting something by working only within his belief system? Do I need to come to terms with the fact that there is only so much I can or should do, and not attempt to deal with deeper schemas? These are the questions I tried to find answers for in this forum, and I find the support, answers and ideas I receive here very helpful.

Far be it from me to underestimate this person. Far be it from me to belittle such a well thought out and supported system that is so nourishing to him.
It is myself I am doubting here. When I stay within his belief system we cannot deal with the roots of the anxiety. I asked myself if I am still providing adequate counselling.

By the way, there can be no priest, or pastor, or other representative of any institutionalized religion in his life, because churches and doctrines are viewed as power structures that corrupt the true faith. He disagrees with doctrines, and I can't blame him: I can't honestly refute these views (again).

Some of your ideas, John, are good for me to develop further and work on, and I will certainly do that. I especially like #1-3.

Thanks for all your help !

Janet.
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  #10  
Unread September 25th, 2006, 07:58 PM
John Simon John Simon is offline
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Default Re: CBT, religious faith, current events....

Janet,

I think that I have done a bad job of explaining my position and I hope it did not come across as atttacking you. It seems that you have done a great job with a difficult client. I know this because difficult clients tend to not stay in therapy if they are not satisfied. I can also tell that you really respect this client. What I also hear is that you feel stuck with this client. My intent on suggesting a different frame regarding the source of his anxiety was to try to free you from your current mindset. You know your client well and I am sure his anxiety stems from his childhood. However, it appears that he does not want to pursue this issue right now. One way that I overcome this issue is to develop a new hypothesis or pretend that there is some other reason for the anxiety and then this often leads to a new solution. However, even if you know that his childhood created the problem, can you just work on it in the here and now, giving him the resources he never got as a kid but needs now. That way you do not have to discuss his past when he does not want to go in that direction. Here are a few things that I am sure he missed given that he is anxious:
1. A sense of love
2. A sense of well being
3. A sense of comfort
4. A sense that he can handle difficult situations
5. A sense that he does not need to put himself down before others do
6. A sense of joy of living
7. A sense that he can look into the future and see himself
accomplishing his goals.

Can you give him these resources in the current context of his life so that a discussion of the past is not necessary. If you are able to do this then he might become less anxious in the moment. Just a thought and thanks for bringing such an interesting case to the forum.

John
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