David Powlison received his A.B. from Harvard College and worked four years in psychiatric hospitals before attending seminary. He graduated with a M.Div. from Westminster Theological Seminary and began a 30 year career in biblical counseling. Along the way he received his Ph.D. from the University of Pennsylvania in the history of science and medicine with a focus in the history of psychiatry. He has written numerous articles and books on counseling and on the relationship between faith and psychology including Speaking Truth in Love, Seeing with New Eyes, and The Biblical Counseling Movement: History and Context. David edits and writes for the Journal of Biblical Counseling which is scheduled to launch in an on-line format next year. He teaches as a faculty member for the Christian Counseling and Educational Foundation (CCEF) in Glenside, PA and also serves as a visiting professor at Westminster Theological Seminary.
Dr. Powlison generously adds his response to the VRT series. As a bonus, I've linked to pages on his website where he gives more detailed responses on video.
What is the role of religion or spirituality in your clinical practice?
Religion or spirituality is not a sector of some people's lives, but a dimension in every human life. It's a dimension in the same way that, in the four-dimensional space-time continuum, you can't go anywhere outside of time. Similarly no one escapes dealing with God, wittingly or unwittingly-in every thought, word, action, desire and life experience. Each of us faces essentially the same existential questions.
This has many implications. For example, I am more like the people I counsel than different. We will have significant differences in life experience, in personality, in the complexity or straightforwardness of our struggles, but we are like in kind. The notion of a common "human nature" puts us all on the same level. "No temptation overtakes you that is not common to all," as 1 Corinthians 10:13 puts it. This fundamental commonality means that as a counselor I never make the "us-them" move of reifying diagnostic categories. Yes, I pay close attention to the severity of what a person struggles with, but it's never as though "You are the sick, and I am the well; you are the patient, I am the doctor." Both of us suffer in various ways; both of us sin by our own version of obsessive self-absorption. [See Dr. Powlison responding to this question on video here]
How does your technique or theory differ from mainstream psychotherapy?
There are hundreds of variants in mainstream psychotherapy. Since cognitive behavioral therapy (CBT) is so well known, I'll offer a broad strokes comparison with the core of CBT's theory and technique.
There are apparent similarities. Many elements of constructive human conversation look similar at first glance. I care about people, psychotherapists care about people. I ask questions; they ask questions. I aim to facilitate changes (in perception, belief, values, choices, feelings); they do the same. Such similarities are like the similarities between different religions.
But the closer you look at what actually happens, the more radical the differences appear. Perhaps the biggest difference is this: CBT seeks to change your self-talk. It's essentially self-referential, not relational. It's about changing how you talk to yourself. But I don't want you to spend so much time either talking to or listening to yourself. My goals are essentially other-referential and relational. I want to overthrow self-obsession. I want both of us to learn to listen to God and talk with God. That's what all the Psalms are doing. This Copernican revolution of putting God at the center also changes how we view and treat others. We learn to relate in the same ways and in the same terms as we are being related to. And, along the way, how we talk to ourselves also changes. [Video response here]
A new client comes to therapy reporting his main problem is feeling detached from God. How would you proceed?
First, I want to know, "Who is the ‘God' that you feel far from?" As a Christian, I believe that God is a self-defining, self-revealing, active Person. He is not whatever we imagine him to be. God shows and tells who he is, but often people feel far away from a ‘God' that does not exist, a fabrication rather than the true God.
A second question is equally important: "What is happening in your life?" We face two kinds of evils as broken people in a broken world. Evils arise from within us (our sinfulness). Evils beset us from outside (the hardships of being sinned against, bereavement, pain, disability, etc.). Often, a person who feels detached from God is going through some traumatic suffering, or is experiencing some moral failure, or is living within a false frame of reference and chasing rainbows. The real God's mercies reach into our elemental human struggles and troubles: "He forgives all my iniquity; he redeems my life from the pit" (Psalm 103).
My third question is, "When you feel detached from God, what else are you attached to? To feel far from God doesn't mean that you now live in a vacuum or that God is far off. The human soul never lives in a vacuum; we always attach to something. What is the something that you are preoccupied with that is not the one true God? Answering that question opens a wide door to significant self knowledge and to grasping the real mercies of God in Christ.
What is the relationship between sin and psychopathology?
Sin is the ultimate ‘psychopathology.' Sin in the biblical view is not simply the high-handed actions we do-e.g., committing adultery, abusing a child, nursing a grievance, or complaining and gossiping. Sin includes high-handed things, but runs far deeper into who we are. It is the perverse inner bentness that erases God from his universe and skews all our perceptions, purposes and choices.
But sin is not the only factor at work in people's deep struggles and troubles. Our bodies undermine us (e.g., dementias, some depressions). Our social situation besets us (e.g., cultural lies, being abused). These things matter, yet the person never reduces to the interplay of physiological and social factors. For example, take the classic "nature-nurture" reductionism as applied to the etiology of eating disorders: "The body loads the gun, and the environment pulls the trigger." In other words, if an underlying obsessive-compulsive disorder meets a culture that idolizes a certain vision of beauty then, voilà, you have an eating disorder. Instead, I believe that body and culture may be significant factors, but you pull the trigger. Something about who you are-the sin-distortion in a person's values, desires, fears, aspirations-is decisive.
Who or what is the primary change agent in therapy?
Let me use a pictorial image to capture the interplay of five change agents that work in concert. Imagine a child's simple drawing of a house: floor, two walls, roof, the room inside. The floor (and foundation) is God's personal hands-on mercy and power. God is the underlying agent of true change. The roof is what God says. Scripture is his word to us, and we change when we listen and take to heart his message. One of the two walls represents the influence of wise, constructive people. We can be change agents with each other, hence friendship and counseling. The other wall is difficult life experience. People grow (either better or worse!) when pressed to realize limitations, to face mortality, to endure suffering, to recognize that career, money, power, and pleasure are not what they're advertised to be. Finally, the person himself or herself is the room inside the house. People are always responsible agents in the change process. A person awakens, turns, changes: "repentance and faith working out into love" is the classic formulation. All five elements of the house matter. [See Dr. Powlison respond to this question on video here]
What is the most difficult part of practicing psychotherapy while maintaining your beliefs?
Let me reframe the question slightly. The word ‘psychotherapy' is borrowed from the Christian phrase ‘cure of souls.' It describes the entire purpose of Christian ministry. That said, I would reword the question, "What is the most difficult part of practicing cure of souls in a way that is faithful to your beliefs?"
God has given us such a rich, comprehensive, and active truth in the person and work of Jesus Christ. It is very difficult to handle such life-searching depth and life-renewing breadth. I tend to get stuck on some piece of the whole, seeing half-truths or quarter-truths. I tend to grind an ax, focusing on what's familiar, or what has been personally significant, or what was helpful to the last person I talked with. May God be merciful to us all. [Video response here]
What is the most rewarding part of your counseling practice?
I get the privilege of watching another human being grow wiser, more trusting, more loving, more courageous. A mind owned by confusion, fear, hostility, immorality or despair (or all of the above) becomes increasingly organized and oriented. I am grateful for this privilege, that my interaction, by God's mercy, played a small part in another person's flourishing-and was part of my flourishing. It is a great delight to see relationships sweeten, to see movement in the direction of what is good, true, beautiful and imperishable.
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