Modern Psychopathologies 2nd ed

mp2It’s been exciting to see Modern Psychopathologies: A Comprehensive Christian Appraisal published in its second edition. We realized with the change to DSM-5 a couple of years ago that we had to update the book, but it took awhile to pull that off. The second edition, like the first edition, is for counselors, psychologists and other mental health professionals, as well as for students in training. I have also known pastors who have benefited from reading the first edition. In any case, it is intended as a guide for readers interested in sorting out contemporary discussions about psychopathology and how those discussions relate to a Christian worldview. We introduce the various disorders and go over current findings on etiology, prevention, and treatment. We then engage that material from a Christian perspective. It is updated to DSM=5 and ICD-10.

In the opening section of the book, we also discuss current issues and debates related to classification of mental health concerns, the relationship between sin and psychopathology, and how pastoral care has related to mental health concerns over time.

Here is an endorsement from David Cimbora, professor and associate dean of doctoral programs, Rosemead School of Psychology:

Integrating faith with science is a significant undertaking in Christian higher education. As one who teaches Introduction to Psychopathology to beginning clinical psychology doctoral students in a faith-based program, I am consistently searching for tools to assist in the process of integration. I was summarily impressed with the first edition of this book, having used it for several years. I am excited to endorse this second edition, which brings the text up to date with current diagnostic organization and nomenclature in the DSM-5. The authors make integration explicit, sharing connections between historical faith traditions, current faith practices and understanding, and the latest scientific evidence from psychopathology. They outline general frameworks for understanding psychopathology from scriptural, pastoral, and scientific lenses. They then move to nuanced exploration of specific groupings of disorders, maintaining this multiple-lens approach. This allows for the reader to consider pathology from various perspectives and begin the process of integration. I have not found a better tool for assisting students with integration around issues of psychopathology. I highly recommend this text.”

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Posted by on October 21, 2016 in Uncategorized


Gender Dysphoria

Here is a chapel address I gave at Covenant College on the topic if Gender Dysphoria. I am usually asked to speak on sexual and religious identity (the intersection of gay, lesbian, bisexual identity and Christian faith); or I am asked to speak on sexuality more broadly (how to be a good steward of one’s sexuality or sexual impulses). So this is different.

We discussed having the chapel on the topic of Gender Dysphoria, which in recent months I’ve been asked to speak on a lot. Christian audiences have been really interested in the topic, but they often have little experience with it apart from media and entertainment. In any case, I hadn’t given a chapel address on the topic, so I thought this could be helpful.

The feedback from students was encouraging. Several came up to me throughout the day, and I received a few emails from students who experience Gender Dysphoria. It is a topic that students are discussing on Christian college campuses, but they often have little opportunity to explore different approaches to it. I don’t know that a chapel address changes that dramatically, but it does provide a venue for awareness of the experience and further discussion.

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Posted by on October 17, 2016 in Gender Identity, Transgender


Celibate Gay Christian Study: A Thank You and an Update

In January of this past year, the Institute for the Study of Sexual Identity (ISSI), under the leadership of Dr. Olya Zaporozhets and Dr. Mark Yarhouse, conducted a study concerning psychological factors and the spirituality of celibate gay Christians that relate to the wellbeing of “Side” B gay Christians. One of the student members of ISSI, Christine Baker, recently completed the analysis and write-up of the collected data in her dissertation, which is entitled, “Attachment, Well-Being, Distress, and Spirituality in Celibate Gay Christians”. We would like to first begin by expressing our gratitude to everyone who participated in the study. We are thankful for your time as it is very valuable, especially in such a busy world. We, therefore, truly want to thank you all for taking the time to complete the survey. We would also like to provide you all with a short summary of the results, as part of the debriefing process and in appreciation for the contribution to the research you all provided through your participation. cropped-identity.jpg

As seen in the title of (the now) Dr. Baker’s dissertation, the four factors being studied in the celibate gay Christian population were attachment style, well-being, distress, and spirituality. When reviewing the results from the clinical questionnaires along with a demographic survey of the 118 participants, the research team found some surprising and some expected results. To begin with the surprising results, this group of participants was moderately to highly content with life. This was a surprise due to previous research suggesting that social support was the strongest predictor of well-being in LGB persons (Lyons, Pitts, & Grierson, 2013). With “Side B” gay Christians not fitting clearly into one group by either being “too gay” for conservative Christians or “not gay enough” for “Side A” (Urquhart, 2014), the researchers hypothesized that this group would have low well-being scores as they often do not have a strong support system. However, in this sample, well-being questions were answered with an average of 80% satisfaction or above in regards six out of nine aspects of life (specifically: “your standard of living”, “your health”, “how safe you feel”, “feeling part of your community”, “your spirituality or religion”, and “your life as a whole”). We found that some of this variance was accounted by extrinsic religiosity levels: the higher scores on organized and non-organized religious activity correlating with higher well-being scores.

Another unexpected result from the data was found around distress levels in this “Side B” group. Previous research on the LGB community suggests that this group of participants has higher levels of distress than their heterosexual counterparts (Bolton & Sareen, 2011; Bostwick, Boyd, Hughes, & McCabe, 2010). However, our sample of 118 celibate gay Christians experienced sub-clinical amounts of depression, anxiety, and stress, with 70% or more of the group of participants scoring in the normal range on all three subscales. What was not so surprising was the connection between attachment style and distress. Depression, anxiety, and stress scores were significantly affected by attachment style, with secure attachment styles correlating with significantly lower levels of depression, anxiety, and stress than preoccupied or fearful-avoidant attachment styles. This result supports the personal testimony of those who say that community and social support are necessary for this group (Hill, 2015; Nouwen, 1996).

Also in line what has been written by these celibate gay Christian authors, our study found that many of our participants (48.3%) were high in attachment anxiety and low in attachment avoidance, which correlates to a preoccupied attachment style. This was followed by 24.6% of our participants being low in both attachment anxiety and attachment avoidance, which correlates with a secure attachment style. Fearful-avoidant was the third highest score with 21.2% of our participants experiencing high levels of both attachment anxiety and attachment avoidance. Finally, only 5.9% of our participants scored in the dismissing-avoidant category, which represents those who scored low in attachment anxiety and high in attachment avoidance. To clarify these results for those who are not a part of the mental health community, attachment anxiety is defined as the fear of relational rejection or abandonment. This can lead to a strong need for approval and a high level of distress when one’s partner is unavailable. Attachment avoidance is defined as the fear of interpersonal dependence or intimacy. Individuals with high attachment avoidance have an excessive need for self-reliance and experience a reluctance to self-disclose (Wei, Russell, Mallinckrodt, & Vogel, 2007). This high level of preoccupied individuals makes sense in light of the high levels of loneliness and anxiety over rejection described experientially by celibate gay Christian (Norris, 1996; Nouwen, 1996; Sipe, 2011). The relationship between attachment and distress found in this study is important to consider when creating resources for celibate gay Christians. Suggestions include resources around healing attachment wounds, providing opportunities to connect with safe attachment figures, and commitment in friendships (Hill, 2015).

Finally, another expected result was the high levels of intrinsic and extrinsic spirituality in this group. This is not surprising since the LGB population (Pew Research Center, 2015) and the celibate population (Abbott, 2000; Olivera, 2004) tend to have a high desire for a spiritual life. According to the present study, a combination of healthy attachments and spiritual intrinsic and extrinsic meaning is the combination needed to bring about psychosocial spiritual health through lowered distress scores and higher well-being scores.

So, now what? While significant attachment wounding and/or concerning levels of depression or anxiety may need to be dealt with within the mental health community, there is much that the church and those who support Side B persons can do. Church education is vitally important in supporting the celibate gay Christian population considering that many in this population will seek direction primarily from their church leadership. If, as this study suggests, attachments are key to lowering depression, anxiety, and stress, the church must respond with receptive hearts and consistent friendships. Andrew Marin (2014), in the mission statement of The Marin Foundation, a nonprofit purposed to build bridges between the LGBTQ community and conservatives, suggests the importance of biblical and social education and diverse community gatherings. Biblical education to church staffs and congregations is vital as the church community needs to stand in unity and find comfort in their beliefs, while they exist in the tension. Social education is just as important as so many are uneducated about the myths surrounding homosexuality (i.e. that the population is all HIV-infected, that they are anti-traditional family, etc.). Church congregations also need training about the population in order to approach them more effectively (i.e. not call them “a homosexual”, not begin dialogue by discussing sin, etc.). Finally, once the church is educated and unified, the church must actually go out and engage with the LGB population. The hope behind this bridge-building effort is to support the change in the culture of so many conservative groups that see the gay community as the opposition. This change in culture is crucial if the church is going to serve this population in any kind of successful way.

This change in culture is not just surrounding biblical and social beliefs, but also the ideas around Christian friendship. Wesley Hill (2015) speaks of how the church does not value platonic friendships as it used to: “However our society might pay lip service to friendship, the fact remains that the only love it considers important – important enough to merit a huge public celebration – is romantic love” (p. 33). Hill (2015) suggests that the church offers the same kind of ceremony and commitment to platonic friendships as we do romantic ones. Hill’s suggestion answers the problems found in this paper: loneliness, fear of a solitary life, fear of people leaving, etc.

So, what are practical ways to move towards this kind of culture-shift? Specific suggestions from Eve Tushnet (2014), a celibate gay Catholic writer, include affirming the real power of friendships, leaving behind the idea that depending on friendships is “clingy”, and remembering that the church is meant to be the “family of God”, in which we make lives together whether you are single, married, gay, straight, or any other identity. This kind of movement offers an environment that is more of a “safe haven” for the celibate gay Christian to go to in times of need.

My hope is threefold in the publishing of this data. First, and foremost, my hope is to normalize the experience of celibate gay Christians. The personal testimonies of “Side B” individuals I read as a part of the literature review for my dissertation always spoke of the loneliness, confusion, and the “feeling crazy” part of this. I hope that through this study, this population is validated in their pain and provided hope for a different future. That leads to my second goal, which is to provide hope for the celibate gay Christian population. This population has been so forgotten in the psychological research, and my hope is that this study will be among the first of many that will be done in order to effectively walk alongside this group. Finally, I pray that this study is a call to the church to step up to the plate. We are called to carry each other’s burdens, and this is a burden that has been ignored for too long. If you have any further questions about this research, please feel free to contact me (, or I would love to direct you to the ISSI website. (Also posted a Spiritual Friendship)

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Posted by on October 11, 2016 in Uncategorized


Ukraine Reflections – Part 1

book in RussianI just returned from a trip to Ukraine. I was part of a larger team that was there to train pastors in basic skills of counseling and more advanced skills associated with trauma care and sexual issues. The team I took taught all morning for the week we were there and then did several activities in the afternoon to get better acquainted with the city. We taught on sexual issues in counseling based on a textbook I had co-authored with Erica S. N. Tan. That book was actually sponsored by several organizations to be translated into Russian before our trip, so that students could get the most out of it. That was exciting to see.

We also participated in a conference on sexuality at one of the prestigious universities in Kiev on Saturday and Sunday. I offered a plenary address on some of the changes in approaches to sexual minorities over the years (kind of updating a 2002 publication that created a typology of sorts around this topic) and the convergence of the APA’s position on client-affirmative care and Sexual Identity Therapy. I also conducted a workshop on SIT in individual and in group therapy contexts. The co-director of the institute gave another plenary address and students led workshops on body image and female sexual addiction, as well as poster sessions on recent empirical work we have been doing. It was an extraordinary 11 days to be honest with you.

kievI thought I might offer a few reflections on my time there. My thoughts are a bit scattered today, however, so this may be of little use to anyone. I’ve never taught using a translator. That was an extraordinary experience. I’ve taught while someone signed my class to a deaf student, but I had not taught in another language and had to work out the pace of teaching and allowing for translation. You get roughly 1/2 of the time to move through the material. I learned quite a bit about my lack of patience.

It was also striking to me how hungry people are in Ukraine for training. You can forget that they are at war right now, and that any training that helps them, any training that is practical and skills-based can be immediately of help to them. We tried to keep things very practical. In fact, I turned more toward clinical demonstrations of skills toward the end of the week (whereas I had been more lecture-based and theory oriented toward the beginning of the week).


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A High View of Scripture

As Christians have considered the best way to care for people with mental health concerns, there has been a divide between those who believe that Scripture is sufficient for the purposes of counseling those with these concerns and those who integrate a Christian worldview with the contemporary fields of psychology and counseling. These two positions (and many others along a continuum of sorts) have been discussed now for many, many years. Not too many people in my day to day world really debate this, so I was surprised to be invited into a discussion about all of this recently.

I was invited, I suppose, because I represent what some people would refer to as an “integration” or “integrationist” position because I pursue the integration of Christian theology and worldview with the field of psychology. As I shared in a recent colloquium of biblical counselors, this is not a position I have argued for or defended, as others have. I have written textbooks from that perspective, but I don’t really spend a great deal of time justifying the position itself to critics. I think our worlds are sufficiently different and our approaches are sufficiently different that I have not engaged in that debate. My sense is that we would likely speak past one another. In any case, I think others have done a good job explaining the rationale for an integration perspective on this and there are other things I have been led to focus on in my work.

In any case, I was recently interviewed by a leading figure in the biblical counseling movement about all of this. He asked me what biblical counselors get wrong about integrationists. What I said was that I think biblical counselors view someone like me as having a low view of Scripture. The contrast, as I see it, is that biblical counselors often see themselves as having a high view of Scripture because they assert that the sufficiency of Scripture entails deriving treatment protocols from Scripture for various mental health concerns. In contrast to that position, I would think they would assume I then have a low view of Scripture. The opposite is actually true from my perspective. That is, I would say I have  high view of Scripture, and that it is precisely because I have a high view of Scripture that I do not derive treatment protocols from the Bible for panic disorder, eating disorders, sexual dysfunctions, and so on.

In that same venue I also discussed role integration, which is another distinction between the groups. In the work I’ve done with a colleague at Regent University, Bill Hathaway, we have discussed different types of integration (i.e., worldview, theoretical, applied, personal, and role integration). Role integration refers to times when a Christian serves in a role that entails serving the public good in some capacity. This might be simply being licensed to practice as a psychologist or counselor, as it involves being under the board of psychology or board of counseling in a given state. It could entail serving on a task force with the American Psychological Association or being a consultant to the National Institute of Corrections. That is, you are serving the public and not just providing services to the church or to a Christian.

It was interesting to me that many of the biblical counselors I was speaking to were pastors. I also serve the Body of Christ in a related capacity. I am an elder in my church. In that capacity, I have a different role in the lives of people who are members of our church, as they place themselves under the spiritual oversight of the pastoral staff and elders. But when I function as a licensed clinical psychologist, I enter into a role as I enter into the fiduciary space of public trust that is broader than what one might take on when providing spiritual direction to a congregant. I consult with the National Institute of Corrections, for instance, to serve all incarcerated people, not just Christians.

Are there tensions in role integration? Absolutely. There are potentially many tensions as a Christian psychologist considers his or her responsibilities in serving the public and in bringing honor to God. I won’t elaborate on those tensions here, but you see me write about them or speak about them often. But I think these tensions have been good for me in some ways. They have certainly kept me in prayer!

As I mentioned above, these exchanges with biblical counselors are not common experiences for me. I think our sense of calling and purpose are pretty far apart. I don’t see our worlds overlapping all that much. I suspect that all of us in that room (and in the broader movements represented by biblical counselors, integrationists, and others) may have good, honorable goals for the work we are doing, for the sense of calling we have, but we are likely to speak past one another because of where and how we serve.



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Homosexuality: A Christian View

The CBN News program titled, Homosexuality: A Christian View, was launched over Easter weekend. You’ll recall that there was a slow roll out of several interviews over the past couple of weeks. Well, the entire program is now available.

What I appreciate about the program is that the producer brought together a Christian theologian, pastor, and psychologist, as well as a parent of a gay man and a celibate gay Christian. So there are elements that address what we know/do not know from Scripture and from research on sexual orientation. There is also the experience of a compassionate pastor who holds in a tension the traditional Christian sexual ethic with a remarkable degree of compassion. I also appreciated hearing the personal stories of a mother of a gay son and the story of a celibate gay Christian. It accomplishes a lot in just 30 minutes.


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CBN News Interview on Sexual Identity

CBN News put together a program on sexual identity titled, Homosexuality: A Christian View. I think many Christians will find this to be a helpful program. There are perspectives from theology, psychology, pastoral care, and Christian persons navigating sexual identity in their lives or the lives of a loved one.

The program itself is only 30 minutes, but each interview was closer to an hour. CBN News is now making some of those interviews available in advance of the program debut.

In the program itself, you will see excerpts from the following interview. The only clarification I would offer is that my discussion of change ministries precedes a brief mention of a therapy group that I offer. The therapy group focuses on navigating and coping with sexual and religious identity conflicts and is not a change therapy, which is not as clear as I would have liked in the way the interview is edited.

In any case, some readers of the blog may find this helpful:


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Posted by on March 11, 2016 in Interview, Sexuality & Gender


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