Group Therapy on Reducing Shame

A couple of weeks ago we finished a ten-week therapy group focused on reducing shame. The group was for Christians who experience same-sex attraction, struggle with shame, and were looking for practical resources to help them in this area. I was co-leading it with a doctoral student who had developed a curriculum on reducing shame among Christian sexual minorities (she did this for her dissertation), and we used that curriculum and collected pre- and post-group data to see the impact of the group therapy experience on participants’ experience of shame.

What I like about co-leading groups is that the very act of coming together with people who share similar struggles has a way of reducing shame. I’ve run several other groups over the years that were not focused specifically on reducing shame, and my sense what that the group experience itself helped reduce shame.

As I learned from my student’s background research on the concept of shame, shame is very isolating. Shame wants to keep a person from others and from the truth about themselves. Group therapy, by definition, takes a person outside of themselves and places them in relationships with others, and it normalizes their experience and their struggle. On the idea of how shame keeps people from the truth about themselves, I think a Christian perspective says that people are valuable because they are made in the image of God. However, shame tells a person that if others really knew them, they would reject them. This often leads people to put on a mask and to relate to people out of an appearance that they believe others will like or approve of. Shame can also lead people to make choices that end up isolating them further (and confirming in their minds that others would not really like them or care to be in a relationship with them). This only increases the pressure on the person who struggles with shame to keep others from knowing them.  Talk about pressure – that is a difficult way to live and relate to others. It doesn’t meet basic needs for connection and relationship, in part because there is no sense of affirmation or acceptance for who a person is.

Christianity actually offers a helpful starting point that affirms that all people are made in the image of God and are to be valued for that apart from any acts or behavior as such. With this as a starting point (a more stable and accurate sense of identity as valued by God), a person can eventually reflect on how they wish to live, on habits that they might wish to cultivate, and they can benefit from a healthy sense of guilt about things that they do (or do not do), but that is a very different experience than shame, which centers again on who a person is (rather than what a person does).

In any case, the group therapy experience was a very positive way to explore the topic of shame, its impact on a group of people who shared many commonalities, and how to respond in practical ways to reduce the impact of shame on Christians who experience same-sex attraction.

On Sources of Spiritual Authority

Our church had a guest speaker this week who shared on 1 Cor. 4:14-21, an interesting passage for Christians to consider. What is particularly relevant today is the idea that we live in a culture in which there are so many voices speaking to us each day, we can get the message we want to receive. We can listen to “what works” for us. Although there is obviously more to the context, the guest speaker was developing some of what this can mean in the life of the believer.

Paul offers a warning – not to shame or scold the church in Corinth – but to speak to them as their spiritual father. What he is saying essentially is that these other, competing voices were not their spiritual fathers; they were not legitimate, not apostolic. Paul urges the church in Corinth to imitate him, to replicate how he lives. (Which is a rather remarkable thing to be able to say to a group of people if you think about it.) Paul’s lifestyle, the lifestyle of the Christian, is both taught and modeled, and he is saying they should essentially replicate the ways he followed Jesus. A Christian leader, then, draws people not to him/herself but to Christ.

In the area I study – the intersection of sexual identity and religious identity – this idea of listening to spiritual fathers and mothers is increasingly important as we as a church are going to have more people teaching more diverse things about topics where there has been greater consensus. It is in this context that I have been thinking about Jennifer Knapp’s recent interview on Larry King in which she told a pastor that he was not her pastor and that she had spiritual authorities who spoke into her life and apparently essentially blessed her decision to be in a same-sex relationship. Knapp said that the pastor could share his opinions about what Scripture teaches to his congregation but not to her.

There is a lot that can be said about this exchange, and I am unable to unpack all of it or even most of it. (For a thoughtful discussion of this, see Karen K’s blog here and here.) Certainly it is a very difficult thing to navigate sexual and religious identity, particularly for Christians who take their faith to be a central, guiding, and organizing aspect of who they are. We’ve had the chance to document some of those challenges in a series of studies over the years. I have no idea what that process has been like for Knapp or really anybody who is navigating that terrain, except for the people I have known personally or professionally (through research or clinical practice).

Is direction about how to live something that will be different for different people? Well…yes and no. Certainly people may be guided to different paths when they face similar circumstances. I think of the options facing couples struggling with infertility. Some may choose to go far along in their efforts to have biological children, and there are many medical interventions that can be taken to increase the possibilities there. Others will pursue adoption. Still others will decide not to pursue either of those directions. Each couple prayerfully considers what it best in light of a number of factors.

In the area of sexual identity, people also face a range of options. Some integrate their experiences of same-sex attraction into a gay identity and pursue same-sex relationships, while others neither integrate their attractions into a gay identity nor do they pursue same-sex relationships. Still others transform the meaning of the word gay; they may choose to live in keeping with the traditional Christian sexual ethic but the do not reject the word gay as a way of acknowledging their experiences of same-sex attraction. There are many, many ways in which Christians sort this out actually. (A student I’ve worked with just defended her dissertation and identified some nine different identity outcomes among Christians who experience same-sex attraction.) As people prayerfully consider the options that are before them, is it like decisions about family life, adoption, infertility treatment, and so on?

As difficult as it may be, it seems that Christians are given greater clarity about God’s revealed will for sexual behavior and expression, which is one reason why it is so important that Christians reflect on the sources of authority they listen to (this also points to the idea that sexual identity/behavior is a topic in which theological reflection rather than scientific evidence is going to be particularly crucial). I think this also points to a need for careful reflection on pastoral responses to enduring struggles in the life of the believer.

At the same time, it is going to be hard to speak into the life of someone who is sorting these issues out if a person doesn’t have a relationship with them. Simply relying on disputation or quoting Scripture will rarely (if ever) work; it tends to polarize and create a defensiveness in the other in an area in which the Christian wants to foster a climate for deeper and more careful reflection and consideration. It is in this context that it is important to note that Paul appeals to his prior relationship with the people in the church in Corinth.

It reminds me of when my kids are playing soccer: they hear a lot of parents yelling from the sidelines, but they can almost always hear their coach yell instructions and words of encouragement to them. They can pick out their coach’s voice because of the relationship the coach has established with them. And I think a good coach works hard  to have a relationship with each of player on the team so that they can trust what they have to say to them, so that they will be attuned to them.

This issue of listening to sources of spiritual authority is not new, and it is not limited solely to the topic of sexual identity/behavior. We are dealing with the issue of authority in all areas of our lives, and the church will continue to deal with this issue of authority in the future. (Protestant or Reformed churches face challenges here in terms of the vast number of denominations that exist, and Catholic churches face their own unique challenges.) In any case, thankfully, Paul was dealing with the issue of spiritual authority in his day, and he offered suggestions for how to respond when facing a cacophony of voices.

Update: Transgender Christians’ Experiences

The paper presentation on “Transgender Christians’ Experiences: A Qualitative Study” was earlier today. It went well. Trista and I went back and forth and discussed the various responses we received to questions about personal faith, relationship with God, religious coping activities, issues that arise in marriage, employment, etc. The day before the session, we were able to arrange to have a person in as a discussant who is transgender and Christian. She shared some of her own story and the challenges she has faced and choices she has made in response to gender dysphoria. Of course, these choices are not without consequences, and she was also able to share how some of her decisions had an impact on family members, local church experiences, and so on.

Although the audience was not large, those in attendance showed a genuine interest in the topic, and some had provided clinical services to this population. Most of the questions actually went to our discussant, which made a lot of sense, as she was quite open and transparent in sharing from her experience, and many in attendance probably have had few opportunities to interact with and ask questions of someone who has been sorting out gender identity questions and conflicts.

I also appreciated the opportunity to present at the Virginia Psychological Association. I have tended to gravitate toward the national organization, and this was my first foray into the state association. The audience was great, and the people there were quite receptive to the presentation and seemed quite appreciative that the topic was covered the way it was.

Transgender Christians’ Experiences

This Thursday I’ll be co-presenting an interesting study I conducted with Trista Carr, a student in the Doctoral Program in Clinical Psychology at Regent. The study is interesting to me in part because it is the first one we’ve undertaken that has addressed the relationship between gender identity and religious identity. Specifically, it is a study of 32 self-identified Christians who also self-identified as biologically male but transgender. They provided information on their experiences with local churches, their relationship with God, their spouses, employers, and so on. They also shared ways in which religion was a coping resource. Some even shared how their struggle with gender identity concerns led to a strengthening of their personal faith as Christians.

Here is the abstract from the paper we’ll be presenting:

Though the experiences of transgender persons have been explored to some extent, very few scholars have delved into the relationship between gender identity as a trangender person and religious identity as a Christian. Therefore, the qualitative data described herein reflects the narratives of 32 transgender individuals who are biological males and identify as Christians. The study sought to bring some understanding of the events and processes that occur for this specific population. Although some participants indicated that their gender identity conflict led to a strengthening of their personal faith, others reported a past struggle – often with specific persons or church leadership – and some indicated that they moved away from organized religion in light of their conflict. Many participants in this study still identified religious coping activities tied to their faith tradition as sources of support during present difficulties. Participants also shared experiences with conflicts in their marriages and places of employment.

The study came about through a number of developments over the past several years. Some of those developments included providing consultations to families who were worried that their child might be gay. The children were often presenting with symptoms of Gender Identity Disorder, and some met criteria, while others had symptoms but were sub-threshold for the diagnosis. I’ve also worked with older adolescents and adults who identified as transgender and Christian and were asking for assistance with possible ways to manage their dysphoria and/or conflict with their religious beliefs and values. If you know someone who is transgender or if you’ve worked with this population, you may have a sense for how challenging it can be to fully understand the issues that are involved.

A few years ago I was also introduced by someone who identified as transgender and Christian to an online group of people with similar experiences. This led to the idea of possibly furthering my own understanding of their experiences (and the experiences of adults I’d worked with) by conducting an initial study of some of what they had been dealing with. I brought this idea to the Institute for the Study of Sexual Identity (ISSI), the research institute I work with at Regent, and Trista expressed interest in working on it, as did some of our other team members. So we got to work on developing a questionnaire, and we ran it by various members of the community for help with wording, etc. We announced the study through various avenues, and people were able to access it online and provide us with some of their experience with gender and religious identity issues. So the study is a first step, and I hope we are able to follow it up with additional studies that delve into other related areas, but it is a start.

The paper we’ll be presenting is titled, “Transgender Christians’ Experiences: A Qualitative Study.” It will be presented at the Virginia Psychological Association’s (VPA’s) spring convention this Thursday, April 22, from 4-5pm at the Norfolk Waterside Marriott.

CAPS Panel on Ethical Conflicts in Marital Therapy

Yesterday at the CAPS national conference I participated in a panel chaired by my colleague at Regent, Dr. Jennifer Ripley, on Ethics in Couples Interventions. The other panelists were Ev Worthington (Virginia Commonwealth University), Toddy Holeman (Asbury Seminary), and Bill Berman (Christian Family Institute). We had several interesting discussions on a range of topics in marriage therapy. The topics included use of forgiveness protocols, dealing with violence in relationships, confidentiality when working with couples, managed care and billing, and working with same-sex couples.

Ev Worthington discussed his work on forgiveness, and all of the panelists shared how they might introduce the concept of forgiveness, challenges when people come at forgiveness with different assumptions, distinguishing forgiveness from other concepts, such as reconciliation or exoneration, and so on. We also discussed a number of clinical issues, such as timing, the misuse of Scripture, etc.

On dealing with violence in relationships, we discussed again the potential misuse of Scripture to rationalize violence (as justified by some abusers to establish authority or maintain order), issues with the use of separation, what it means for the offender to repent, and so on.

The discussion about confidentiality recognized different models for handling it with couples: (1) not keeping secrets, (2) keeping secrets said in an individual session/phone, and (3) using clinical judgment about whether specific information is kept secret (but not promising to hold secrets). Emphasis was placed on working with the disclosing spouse to share information that the other spouse should know (that they themselves would want to know if their roles were reversed), as well as discerning when disclosing a secret is for the good of the marriage or to get a weight off of the disclosing spouse’s shoulders.

The managed care discussion centered on how to treat individual psychopathology in a marital context. One panelist discussed providing services individually with the other spouse present, while others discussed treating individual psychopathology systemically by improving the marital relationship. Still others discussed having couples pay out of pocket if there is no identifiable disorder that can be diagnosed.

In the discussion about Christian mental health professionals working with same-sex couples, the panelists reflected on the challenges some Christians have faced in whether or not to provide services, issues related to professional competence, and value conflicts. A few current cases were mentioned, including the Ward case at Eastern Michigan University. There was some disagreement among panelists on how Christians can (or should) respond to these issues, with one voice emphasizing more of the issue of religious rights and competence, while another voice emphasized value conflicts being normal and occasionally rising to the level of a referral. The panelists discussed different options for Christians in practice, as well as relevant training concerns and what is in the best interest of the client seeking services.

CAPS 2010

The Christian Association for Psychological Studies (CAPS) national conference gets started Thursday and runs through Saturday. The meeting is being held at the Sheraton Overland Park Hotel in Overland Park, Kansas. Plenary speakers include Richard Beck, Scott Stanley, Shane Lopez, and Liz Gulliford. In addition to these presentations, I am looking forward to sessions by folks like Ev Worthington, Jamie Aten, Mark McMinn, and Randolph Sanders.

I am going to be involved in three panels/symposia. The one I am co-chairing with Jim Sells is on accreditation issues for Christian mental health training programs. It will feature Jim Beck and Clark Campbell discussing their experiences working toward (and receiving) CACREP and APA accreditation, and discussants will include representatives from CACREP and APA. The other two panels I am participating in are a discussion about ethical issues for Christians providing marital therapy chaired by Jen Ripley and a session on “integration journeys” chaired by Glen Moriarty in which participants will share some of their personal story as it relates to being a Christian and a psychologist.

The Man Who Was Thursday

It is nearly time for book club, and we are discussing The Man Who Was Thursday by G. K. Chesterton. I actually just finished it today. What with a number of other commitments, I’ve just had a difficult time getting through it. Thankfully, it is only 145 pages or so. It is not a quick read, however. There is a fair amount to digest, and it’s the kind of book you might read through quickly, because it’s a compelling read, but then you might want to read it again to catch the details and symbolism. I appreciated the Christian allegory and the overall look at anarchy in terms of humanity’s relationship to God (as rebellious). I wonder to what extent some of the meaning of the book hinges on the quote, “…no man should leave in the universe anything of which he is afraid” -Gabriel Syme.

In any case, here is what Kate Christensen from Time Magazine had to say about it (from the back cover):

I started reading G. K. Chesterton’s The Man Who Was Thursday on a subway ride, almost missed my stop and walked hom thumbing pages. It’s a wacky, nightmarish, deliriously well-written adventure story for grownups in which nothing is what it seems and everyone wears a mask, whether figurative or literal. Thursday, real name Gabriel Syme, is a poet turned detective gone undercover in an anarchists’ society, determined to foil its bomb plot and dismantle the forces of modern pessimism, atheism and chaos. The characters and landscapes he encounters are so vividly depicted, they crackle on the page. It’s hard to think of a more thrilling book.

It is a quick read in a sense, although I didn’t risk missing a subway stop over it. But the reader does want to understand the different plot twists as the various masks come off throughout the book. I had to read the ending a couple of times, too, to pull it together. It will be an interesting discussion. We’ll see how others in the book club experienced it.