Family Therapies 2nd Edition

Family Therapy 2ndHere is the cover design for the second edition of Family Therapies: A Comprehensive Christian Appraisal. This was a fun book to revisit and update.

We looked at the various schools of family therapy and updated the research that has been conducted in support of the different approaches.

Our main focus was recognizing and reflecting the changing cultural landscape regarding family. The reader will pick this up throughout the book but especially in two new chapters. The first one is on cohabitation and how trends in living together before marriage (or just living together) affect relationship and family dynamics.

The other new chapter deals with LGBT+ couples and families and really expands how we interacted with sexual and gender identity experiences in the first edition of the book.

In any case, here is an overview of the book from the revised preface:

The book is divided into four parts. In part one (chaps. 1-2), we set the stage for the discussion of the first-generation models of family therapy. Chapter one is a discussion of a distinctively Christian perspective on the family. Chapter two is a discussion of the field of family therapy, how it developed and some key terms that will help the reader better understand the field.

Part two of the book (chaps. 3-12) devotes one chapter apiece to the major models of family therapy developed in what is sometimes referred to as the first generation of family therapists (e.g., structural family therapy). If each approach to family therapy is a “map” for getting families from a place of some kind of dysfunction to a place of better functioning, each chapter in this section contains an explanation of the map, followed by a discussion of the theoretical and philosophical assumptions and practical implications. We then focus on Christian critique and engagement of the theoretical and philosophical underpinnings and the practical issues involved in using specific techniques associated with that theory. We also provide brief reflections that tie back to the three foundational themes introduced in chapter one: family identity, family functioning and family relationships. In the closing chapter of this section of the book (chap. 12) we introduce a framework for integrative Christian family therapy.

Part three (chaps. 13-20) extends the discussion by taking topics that are commonly addressed in family therapy and inviting Christians to interact with the relevant materials. We introduce the reader to the issues (e.g., crisis and trauma, marital conflicts) and then review the literature in that area, followed by Christian engagement in light of what we see as particularly valuable from the first-generation models of family therapy and in light of what we propose for an integrative Christian family therapy. In the second edition we added a chapter on cohabitation and significantly revised the chapter on LGBT+ couples and families. We see cohabitation as an increasingly popular entryway into marriage as a a relationship status in and of itself. We want to help the reader grapple with that reality. An additional reality is the success of the marriage equality movement and the likelihood that Christian clinicians will work with LGBT+ couples and families in the years to come. We also want the reader to be familiar with those cultural shifts and to think deeply and well about some of the concerns that arise.  

Part four (chap. 21) reflects our desire to cast a vision for integrative Christian family therapy/counseling/ministry. In particular, we see the need for local family therapy to be influenced by a shrinking, global world in which family therapists will need to expand their understanding of family structure and relationships. Societal and cultural changes will have an impact on our work and the ways in which we think about and engage the families in ministry and service.

What is Gender Dysphoria?

Here is a talk I gave at Q Denver titled, What is Gender Dysphoria?  It is being featured on Q Ideas. I try to explain the phenomenon, as well as provide a little background information on theories of etiology, prevalence, and management strategies. Also, check out the talk by Melinda Selmys, who shares about her own experiences with gender dyshporia.

After we both spoke, Gabe Lyons invited us to join him for a time to Q & A from the audience. This was a helpful opportunity to reflect further on gender dysphoria:

To give you a little background on Q Ideas, here is a description from their website:

Q was birthed out of Gabe Lyons’ vision to see Christians, especially leaders, recover a vision for their historic responsibility to renew and restore cultures. Inspired by Chuck Colson’s statement, “Christians are called to redeem entire cultures, not just individuals,” Gabe set out to reintroduce Christians to what had seemed missing in recent decades from an American expression of Christian faithfulness; valuing both personal and cultural renewal, not one over the other. Re-educating Christians to this orthodox and unifying concept has become central to the vision of Q.

Together, we explore topics that fall into four broad themes: culture, future, church, and gospel. Q facilitates the investigation of deeper engagement and responsibility in each of these areas. As we continue to work through these ideas on a deeper level, so grows our commitment to equipping innovators, social entrepreneurs, entertainers, artists, church-shapers, futurists, scientists, educators, historians, environmentalists, and everyday people to do extraordinary things. At Q Ideas, you’ll see a broad spectrum of content represented in our small group curriculum, essays, videos, blog articles, and podcasts. These are all contributed and commissioned to shed light on unique areas of culture and the church.

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.

 

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.

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:

 

On Care for Those on the Margins

marginalizedA question I’m asked from time to time is some variation on the following: “Given that this is such a relatively small population, why do we allocate so much time and attention to it?”

I’ve had this question around sexual identity concerns, where roughly 6-8% of the population has at one time experienced same-sex attraction and 2-3% report a homosexual orientation. The question comes up a little more often when discussing gender dysphoria, which is quite rare, or even transgender persons, which is a broader umbrella, but still a smaller percentage than what is represented by gay and lesbian persons.

I usually acknowledge that more people in a given setting are navigating other concerns. For example, at a Christian college, far more students will be finding ways to respond to depression or anxiety or pornography than same-sex sexuality or gender dysphoria.

But the question seems to come out of a place of either inexperience or privilege. It’s typically asked by people who have no known connection to the topic or to persons represented by the topic.

I’ve never been asked that question by a Christian parent whose daughter has just come out. I’ve not been asked the question by a gay student who doesn’t know how to talk about his same-sex sexuality with anyone at his Christian college. Or a wife whose husband has announced he is a woman trapped in the body of a man.

For my point of view, we have to look at two things (at least). One thing to consider is that debates about sexuality and gender are imbued with significance both in the church and the broader culture. They have been front-and-center in the cultural wars and there have been mistakes made by many people who represent a range of stakeholders. We can all do better.

We can also consider whether it is simply the hallmark of the Christian to care about those at the margins. By definition, those at the margins will be underrepresented and a smaller overall number. But how we respond to them, how we find ways to identify their concerns and respond in a Christ-like manner is the stuff of Christianity. Whether we talk about the stranger in a strange land or the lost coin or the lost sheep or the lost son, it is part of what makes Christians Christ-like. It is in our DNA.

If these concerns are not your concerns, I can appreciate where you might raise this question. But can I invite you to get to know people for whom this is their concern? Would you consider spending some time with these folks and see if other questions come to mind?

Perhaps rather than ask why we spend time on a topic that represents a relatively small percent of people, you may find yourself asking why we haven’t spent time on this in the past, and why, when we have spent time on it, our efforts have not been nearly as constructive as perhaps they could have been.

 

Sexual Identity & The Question of Vocation

Vocation is an interesting word. It isn’t a word you hear tossed around that much today, outside of religious settings. Even there, the word has fallen out of common usage. If you google it, you get the idea that people have a resolve toward a career or activity of some kind: “a summons or strong inclination to a particular state or course of action; especially: a divine call to the religious life.”

I suppose dissertations could be written on the meaning and place of vocation in the life of the believer. I’m unable to get into all of those nuances, but I am intrigued by the word and its place in the life of the Christian. It certainly seems to entail purpose and meaning in ways that are often overlooked in many cultural discussions and debates about sexuality and sexual behavior.

In any case, I was invited to give a lecture series at Southeastern Baptist Seminary in the fall of last year. A part of that time together was giving a chapel address to the seminary students. I organized the chapel message around a letter that C.S. Lewis wrote to Sheldon and Davy VanAuken that raises the question of vocation.

The Cultural Salience of Gender Dysphoria

thAs we come to the close of 2015, let me take a moment to reflect on what has been a rather remarkable year with respect to gender dyshporia. For about 16 years now, I have seen individuals, couples, and families where a person was navigating gender dysphoria. It is not my primary area of research and clinical practice; that would be sexual identity. Gender dysphoria is thought to be a rare phenomenon, but conservative estimates have frequently come from the number of people seeking out specialty clinics in Europe. More recent approaches have been through national studies and the inclusion of “transgender” as a category option. Neither of these is a particularly accurate measure of prevalence. “Transgender” is itself an umbrella term for any number of experiences of gender identity that do not match those that align with one’s biological or birth sex. Those who experience gender dysphoria would be a subset of people who identify as transgender.

Earlier this year I was asked by the editor of Christianity Today (CT) to write a featured article on gender dysphoria for their magazine. The editor had watched a talk I gave at Calvin College in February and was looking for an article that would help the CT readership come to a better understanding of the topic. I had also just completed a book that was scheduled for publication by InterVarsity Press Academic in June/July, so that timing was actually pretty good. I agreed to write the article.

The CT article on gender dysphoria was recently listed as one of the most-read CT articles of 2015. The article has not been without its critics, however. One theologian wrote a critical response to it in First Things. The editors allowed me to write a reply, which you can read here. (The most insightful review I’ve read is here.)

As I have been thinking through the nature of the critiques, one acquaintance approached me with a typology that he thought might be helpful. He said it was not original to him, but he was sharing that there may be different callings and audiences in the mix. He offered a taxonomy of purposes and corresponding audiences:

  1. to instruct morally and to strengthen ethical resolve;
  2. to instruct for the purposes of pastoral response and engagement;
  3. to engage pastorally with individuals, that person in need, and families who are affected;
  4. to respond to the gay/gender activists, sometimes within the liberal church, and often those outside the church.

The thought that was being shared is that perhaps my article and primary area of work has been in #2 and #3, whereas conservative Christians who have raised concerns have as their primary role #1 and/or #4.

Gender Dysphoria coverIt’s an interesting thought, and one I will leave to the reader to discern. Part of where I think Christians who have raised concerns and I are potentially speaking past one another is that I am focusing on gender dysphoria and the management of the distress experienced by the person navigating gender identity conflicts. Some of my critics are tackling the entire transgender umbrella with many or all of its presentations. We are at times simply not discussing the same thing.

In any case, I do provide clinical services in this area and continue to work closely with individuals, couples, and families navigating gender identity concerns. I typically recommend people go to more comprehensive clinics with larger, multidisciplinary teams, but in many cases people prefer to see a Christian, and so I am willing to meet with those individuals/families. So #3 is certainly a part of my professional work. Also, the CT article itself was geared toward helping Christians have a more compassionate response to a complex phenomenon, so in that sense #2 seems quite relevant.

About two years ago I thought that gender dysphoria would represent a wave that would crest on evangelical Christians and that the church was not prepared for it. This dawned on my through a series of talks to youth ministers who increasingly faced complex ministry challenges associated with gender identity questions. These encounters were why I approached IVP Academic about the book. However, it would have been difficult to predict just how culturally salient gender dyshporia and the transgender experience would become (with multiple reality TV shows, prominent award-recipients, and so on).

As we head into 2016 it will be interesting to track just how salient these topics will become, what they will symbolize in our culture, and how the Christian community will respond. There are no easy answers. What I recommend is a thoughtful, prayerful approach, one characterized by humility about what we know and do not know, and a response that embodies conviction, civility, and compassion in all our exchanges within the Body of Christ and beyond.

 

 

Establishing Boundaries

I returned recently from the American Association of Christian Counselors World Conference in Nashville. I was able to do a pre-conference workshop on different lenses for “seeing” sexual and gender identity concerns. I also conducted a regular workshop on counseling Christian parents whose children have come out. At the end of both sessions I received a lot of positive feedback. Many professionals and actual parents came up after the second session to say what they had gained from the workshop for counseling Christian parents.

boundariesIn addition to these positive responses, I also had a couple of people challenge the posture I took toward Christian parents around topics like whether to open their homes to a gay son or daughter, whether to attend important events (e.g., graduations, weddings), and so on. I think of this as establishing boundaries, which is a common challenge most Christian parents face as they respond to a child who has come out. Generally speaking, I work with parents to identify options for responding and setting boundaries and help them think through the potential benefits and drawbacks (to them, their child, and their relationship) of each option.

The main concern expressed to me by those critical of what I shared was the idea that in Scripture the apostle Paul writes about not even associating with someone who is engaged in immoral activity while professing to be a Christian. The admonition occurs in 1 Corinthians 5:11: “But now I am writing to you that you must not associate with anyone who claims to be a brother or sister but is sexually immoral or greedy, an idolater or slanderer, a drunkard or swindler. Do not even eat with such people.” One person quoted this passage; another quoted the passage in which Jesus says, “But he replied to the man who told him, ‘Who is my mother, and who are my brothers?And stretching out his hand toward his disciples, he said, ‘Here are my mother and my brothers! For whoever does the will of my Father in heaven is my brother and sister and mother.’” (Matthew 12:48-50). The person said, “Whoever does the will of my Father is the person I am to associate with; not someone who does not do the will of the Father.”

I wanted to take a few minutes to ‘think out loud’ about some of the feedback from those critical of the posture I took. My position in response to invitations to dinner, hosting meals, special occasions, and so on was to acknowledge that Christian parents have not reached consensus on what to do; they do not all do one thing. Indeed, there is great diversity in how Christian parents respond, and the posture I take is to create an environment for parents to weigh options and decide on boundaries in light of that thoughtful reflection. Among the one or two people who voiced a concern seemed to be the wish that I would tell the parents what they had to do as Christians. This is simply not the posture I take in counseling. The parent-child relationship is one of the most important relationships for the well-being of the child, and I want to help parents weight options and land on strategies after due consideration and prayerful reflection. In response to a wedding invitation, which I see as a little different than some of the other examples, I also discussed helping the parents think through what their concerns are, which usually has to do with having a Christian witness to their son/daughter, and which course of action best helps them communicate what they hope to communicate.

Part of what I was sharing was that there are essentially two tasks Christian parents have shared with us in different studies we have conducted: (1) seeking help/information/resources and (2) maintaining a relationship with their loved one. It is in the context of these two tasks that parents face questions about whether to participate in various activities and whether to host an adult child and his or her partner or spouse.

I do not know anyone who views Jesus’ comments as reflecting a posture you are to take toward family members–as though it was meant as detailed instruction for how to talk with an adult child about the decisions they face or have made. The passage from 1 Corinthians is perhaps more relevant at first glance, but I still do not see it as intending to provide instruction for how parents are to respond to a loved one. It may be that a family is part of a church that provides church discipline and that some behavior may warrant such oversight. But it seems to me that under those conditions any church discipline is carried out not by parents but by leadership in the church. Also, I hope that such church discipline occurs consistently across multiple areas of concern (and not exclusively associated with same-sex behavior) and with appropriate humility and with an eye for restoration of the person. I think it is a misreading of Paul to cut/paste verse 11 and apply it to parents who are responding to a child who has identifies as gay.

I also think it is an unhelpful posture to take toward counseling to simply tell parents how to relate to a loved one. These are very difficulty, weighty, and sometimes quite painful decisions, and such decisions warrant ample time, attention, and respectful engagement as parents consider which boundaries to draw.