A working theory merging Cognitive Behavioral Therapy (CPT), Attachment Theory (AT), and Christian psychology will be described along with an integration model based on the Christianity integrates psychology approach (Tan, 2011). The eclectic theory developed merges the importance of cognitions with an evaluation of the past when it has been perceived to be a cause of distress along with an assessment of attachment styles. It is fully dependent upon Yeshua the Messiah, Scripture, and the Spirit of Truth as the primary counselor for the client. A description integrating the different theories along with a Scriptural perspective will be used to determine what may create distress and what is considered psychological health in a client. Substantial empirical evidence in challenging maladaptive cognitions and supporting the establishing of secure attachments is presented along with a merging of the two in a way that accounts for the missing concepts in each of the theories. Finally, a Christian evaluation of the theories along with integration of Scriptural principles is presented.
Over the course of graduate study, exposure to fundamental theories provide the substructure on which to develop a preferred working theory. For the Christian counselor, there is an additional responsibility of choosing a model of integration of Christian beliefs. This is an important concept, considering that Yeshua the Messiah is to be the chief cornerstone in any endeavor (Mattithyahu (Matthew) 21:42, The Scriptures). Throughout this paper a working theory merging Cognitive Behavioral Therapy (CPT), Attachment Theory (AT), and Christian psychology will be described along with an integration model based on the Christianity integrates psychology approach (Tan, 2011).In developing an eclectic theory of counseling, consideration of the way different theories may be integrated with each other is necessary. Although there may be some concepts of a theory that may be discarded, the most useful eclectic theory will harmonize the different aspects in a way that causes the final product to be more efficient for the particular counselor than the original theories would be on their own. Due to my interest in trauma and neuroscience, the eclectic theory I have developed merges the importance of cognitions with an evaluation of the past when it has been perceived to be a cause of distress along with an assessment of attachment styles. The working theory developed is fully dependent upon Yeshua the Messiah, Scripture, and the Spirit of Truth as the primary counselor for the client. He (Spirit of Truth) and only He has the power to transform hearts, produce His fruit, and bring the peace of Messiah to a client. The counselor in this working theory is considered a vessel used for the purposes of glorifying YHVH (Yahweh, the God of Abraham, Yitshaq, and Ya’aqob) by providing comfort, understanding, support, and caring confrontation in a discipling therapeutic relationship (Tan, 2011).
Client Demographics
A basic understanding of what constitutes distress is needed as a benchmark for the evaluation of the circumstances a client may present with. Throughout this section, a description integrating the different theories along with a Scriptural perspective will be used to determine what may create distress and what is considered psychological health in a client.
Client Background
According to theory underlying CBT, distress that causes difficulties in behavior, thoughts, and emotions are partly a result of experience and learning (Craske, 2017). Therefore, wisdom in understanding client background through open and honest dialogue would be conducive to healing as experiential information is used to develop a treatment plan. Although outside of therapist control, genetic components and inherent character also interact with experience and learning to affect behavior (Scott, 2015). When treating children, it is additionally important to consider the way parent and child behaviors influence each other (Scott, 2015). Therefore, from a CBT perspective, although multiple factors are believed to contribute to distress, the major role in distress are cognitive distortions (Kress et al., 2021). These cognitive distortions shape the underlying beliefs a client has from childhood and increase vulnerability to problems (Kress et al., 2021). It is at this junction that AT can fill in gaps in traditional CBT and can be integrated in theory and practice.
AT contends that attachment styles in a client are developed as a result of the child-caregiver attachment experienced during infanthood (Hall & Maltby, 2014). Research performed by Mary Ainsworth and Mary Main expanded on John Bowlby’s AT to develop empirically supported categories for attachment styles falling into the two broad areas of secure and insecure attachment (Hall & Maltby, 2014). A client’s background related to childhood is valuable information towards developing a holistic approach to counseling in considering how attachment styles could be influencing current distress. Further information of relationships can further the understanding of the client since attachment styles are now known to be adaptable and therefore not as stable as previously considered by Bowlby and Ainsworth (Dansby Olufowote et al., 2020; Bosmans, 2016). This understanding has great therapeutic implications, as therapists develop a relationship that serves as a secure base for the client to explore their thoughts, emotions, and behaviors (Hall & Maltby, 2014).
Another key integrative aspect of CBT and AT is the merging of what constitutes psychopathology. Bowlby believed that past experiences and current events link to frame psychopathology, which would result from many maladaptive choices caused by problems in affect regulation (Hall & Maltby, 2014). As a result, internal working models are developed which inform behavior. CBT maintains that maladaptive cognitions are signposts of maladaptive cognitive schemas which function as governing bodies in information processing and thereby affect behavior (Kress et al., 2021). Therefore, the internal working models children create based on their experience with early caregivers in AT is congruent with the idea of a cognitive script developed based on experience in CBT leading to the concept of a secure base script, and in this merge attachment can be understood from a cognitive schema perspective (Bosmans, 2016).
It is also in evaluating background information that a Christian therapist evaluates whether the client has a secure base script with YHVH. With full dependence on the Spirit of Truth, therapists seek to understand the image of YHVH the client has. Moriarity (2007) considers the separation-individuation stage in Erickson’s developmental stages to have the primary influence on the YHVH image. Was the client able to trust and separate from their caregiver? If not, they may see YHVH through a lens of fear with corresponding cognitions that if they do become independent, He will abandon them (Moriarity, 2007). Careful information gathering, along with wisdom from the Spirit of Truth can reveal YHVH image problems that may have formed early in life through insecure attachment with caregivers (Moriarty, 2007).
Client Emotions/Sensations
According to CBT, maladaptive cognitions are evaluated in order to change emotions (Kress et al., 2021). When therapists understand how emotional responses are related to those faulty cognitions, then positive outcomes in therapy are more likely (Kress et al., 2021). Therefore, client emotions serve as guideposts for therapists. According to Kim-Van Daalen & Johnson (2013), one of the features of emotions is that they are based on cognitive interpretations that can be the cause of cognitive processes, such as the evaluation of value or worth of situations based on the interpretations.
In AT, the ability to experience the full range of emotions is a marker of psychological health (Hall & Maltby, 2014). The availability of a secure base provides for a child the ability to explore without the worry that their caregiver will not reliably intervene when needed to aid in regulation (Hall & Maltby, 2014). Cozolino (2017, p.24) states that “early attachment relationships establish the experiences that shape the neural networks (that regulate emotions, impulses, and behaviors) and allow us to regulate our emotional experience”. Without reliable intervention in making sense of emotions, defense mechanisms are put in place to distort reality and reduce anxiety (Cozolino, 2017). In counseling, a client can be evaluated for the lack of expression of any emotion or inability to use meaningful relationships to bridle emotional experiences, signaling some form of distress (Hall & Maltby, 2014).
From a Scriptural perspective, the expression of emotions is supported all throughout Scripture in the worship of YHVH, the fruit of the Spirit of Truth, and YHVH’s love (Kim-Van Daalen & Johnson, 2013). Christians are encouraged to view emotional maturation as a two-stage approach, in which the first stage includes moving beyond the self and towards YHVH and his Word and the second stage involves looking inwards towards the heart for the purposes of growing deeper in Him (Kim-Van Daalen & Johnson, 2013). In other words, the first stage represents emotional growth in acceptable feelings and the second stage represents emotional growth through the negative emotions most people repress (Kim-Van Daalen & Johnson, 2013).
Client Thoughts and Actions
In CBT, distress is made accessible and eligible for modification through the identification of automatic thoughts understood to cause distressing emotions (Kress et al., 2021). From this perspective, situation themselves do not cause the distress, but rather the maladaptive automatic thought does (Kress et al., 2021). Therefore, the perception of an experience is what influences the thoughts and actions of the client under distress (Scott, 2015). With regards to depression, Scott (2015) states that Beck’s cross-sectional model of cognitive processes stresses that a selective focus on the negative aspect of an experience is the fundamental reason for depressive symptoms. Further, CBT emphasizes that automatic thoughts can be examined to reveal intermediate beliefs, core beliefs, and cognitive schemas (Kress et al., 2021). Some cognitive distortions include making a conclusion without enough evidence to support it, focusing on specific information taken out of context, overgeneralizing, magnification or minimization, personalization, and dichotomous thinking (Tan, 2011). Maladaptive cognitive schemas are important to identify since clients are likely to focus on information that confirms the belief and deny information that contradicts it (Kress et al., 2021). Interestingly, Tan (2011) states that some maladaptive schemas are developed early in childhood, providing a perfect entry for integration with AT.
In AT, the importance of the child-caregiver relationship during infancy and throughout life cannot be overstated. Cozolino (2017) expertly explains how neural networks in the brain are organized and integrated as a result of a secure attachment between mother and infant resulting in the ability of self-regulation of emotions in the child. Neural networks in the brain are plastic and therefore able to be changed (Cozolino, 2017). This provides the link between the emphasis on thoughts from CBT and emotions in AT. Ultimately, thoughts and emotions guide behavior in a complex and dynamic web.
From a Scriptural perspective, thoughts have an important place in consideration of the Word in counseling. Many passages refer to the renewing of the mind, thinking about worthy things, keeping the mind on Messiah for peace, taking thoughts captive to obey Messiah, and having His peace guard the mind (Romiyim (Romans) 12:2, Pilipiyim (Philippians) 4:4-9, Yeshayahu (Isaiah) 26:3, Qorintiyim Bet (2 Corinthians) 10:3-6, The Scriptures, 2018). Clients that are not able to submit their thoughts to Messiah have a greater chance of experiencing distress.
Client Family and Cultural Systems
Addressing distress from a CBT perspective with regards to family and cultural systems is similar to any other type of distress in that thoughts, emotions, and behaviors related to either family members or cultural issues are examined (Kress et al., 2021). Cognitive distortions and schemas as they relate to family members or the client’s culture are evaluated on a personal basis, keeping in mind the concept of CBT which regards perceptions of situations as the cause for distress (Kress et al., 2021). Therefore, a client presenting with distress related to cultural systems can acknowledge the issues that are present while still working on the perception and consequent emotions and behaviors that result. In treatments such as trauma-focused cognitive behavioral therapy (TF-CBT), AT is integrated in the emphasis placed on a safe caregiver for the child (Pleines, 2019). In this way, TF-CBT holistically addresses distress in the child related to trauma, incorporating the family into treatment.
Additional sources of distress may come from interpersonal relationships such as seeking parental approval, lack of appropriate boundaries, and forgiving past issues (Dansby Olufowote et al., 2020). Object relations theory, from which AT branched, states that satisfying relationships with people (the objects) is a basic need of life (Tan, 2011). Therefore, it stands to reason from this perspective that a client will often present with distress in interpersonal relationships. Since attachment styles are sustained unless a new experience brings about new ways of relating and therefore moves attachment along the continuum towards more secure or more insecure (Dansby Olufowote et al., 2020), the assessment of the impact of new experiences on emotions and relationships is paramount. From an AT perspective, experiencing the full range of emotions within meaningful relationships is the key to psychological health (Hall & Maltby, 2014), therefore care must be taken by therapists with clients from cultures in which demonstration of emotions are usually withheld.
Scripture has ample descriptions of both functional and dysfunctional families. Rueger et al. (2020) in providing a Christian evaluation of attachment-based family therapy (ABFT), also give an excellent review of Scripture with regards to families. Working from the foundation of Balswick’s model of healthy family functioning, they provide an overview of a model for health in the family. A client presenting with distress related to family systems may be lacking in established covenant love within the family, grace and the willingness to forgive, empowerment through encouragement or guidance, true intimacy, a healthy family hierarchy, mutual honor and respect, and hope in YHVH’s faithfulness (Rueger et al., 2020). From a cultural system perspective, a Christian client may have difficulties embracing the Truth of the Scriptures while also attempting to be a part of this world’s culture. Yohanan (John) 15:19 states “If you were of the world, the world would love its own. But because you are not of the world, but I chose you out of the world, for that reason the world hates you” (The Scriptures, 2018).
Overall, all of these previously addressed sources of distress are exacerbated by the presence of sin. While on this earth, sin cannot be fully disposed of as it is a pervasive nuance inherent in the very nature of being human. However, sin can be abated by dying daily to self, and committing the self to obedience to Yeshua Messiah. This includes thoughts, emotions, and actions. The competent Christian counselor must interweave the speaking of truth in Love with the experience of grace to clients who may be living in sin.
Treatment Strategies
At face value, it would seem CBT and AT are contrasting with respects to underlying mechanisms that lead to meaningful change and treatment strategies, however research provides interesting insight into the way these two theories have been integrated across various treatments.
Key Underlying Mechanisms
Key underlying mechanisms that bring change to clients when relying on CBT are based on identifying and changing cognitive distortions (Kress et al., 2021). More specifically cognitive restructuring involves identifying, evaluating, and modifying automatic thoughts, intermediate beliefs, core beliefs, and cognitive schemas (Kress et al., 2021). As thoughts are changed, emotions are changed (Kress et al., 2021). AT holds that only within the expression of the full range of emotions amongst important relationships, can true change towards a more secure attachment style be achieved (Hall & Maltby, 2014). The more secure of an attachment style the client can achieve through relationship with the therapist, the better the client will be able to regulate emotions in other circumstances and relationships (Hall & Maltby, 2014).
Empirical research not only supports each individual theory but also the integration of the theories. CBT possibly has the most empirical support of any other psychological theory (Kress et al., 2021). CBT has been found to help clients with depression, anxiety, adjustment disorders, obsessive compulsive disorders, anger, low self-esteem, hopelessness, substance abuse disorders, and posttraumatic stress disorder (PTSD) (Kress et al., 2021). Empirical evidence for spiritually oriented CBT (SO-CBT) approaches has deemed them efficacious, possibly efficacious, generally more effective than no treatment, and better than alternative psychotherapies (Tan, 2013). Also, Ohlschlager (2016) describes an integrative inner healing/cognitive behavioral/social systems counseling model that is client-centered and focused on client factors, therapeutic alliance, and the revelatory power of Scripture.
Although AT began as a majorly philosophical theory proposed by Bowlby, studies such as Mary Ainsworth’s “strange situation” and Mary Main’s development and testing of the adult attachment interview (AAI) which monitors adult thinking have provided solid empirical evidence for the identification of attachment styles (Hall & Maltby, 2014). Studies have found that mother’s prenatal AAI’s correspond with their infants strange situation classification when one year of age (Hall & Maltby, 2014). Recently, neuroscience has supported the importance of early infant-caregiver relationships with research in rats (Cozolino, 2017). Experience programs the genes that will be expressed by changing the structure of deoxyribonucleic acid (DNA). Glucocorticoid receptor (GR) methylation of DNA, caused by lack of mothering attention, decreased expression of GR and increased the stress response in pups. However, this was shown to be reversible, in that increased mothering affection decreased GR methylation of DNA and therefore increased GR expression and decreased the pup’s stress response (Cozolino, 2017). These pups were also found to be more resilient, nurturing of others, and experienced increased memory and learning (Cozolino, 2017). A study that compared the brain of suicide victims that had endured child abuse versus those that had not demonstrated that abused victims had lower levels of GR messenger ribonucleic acid (mRNA) (Cozolino, 2017). Therefore, animal and human studies demonstrate a correlation between stress or abuse with decreased GR methylation of nucleic acids possibly leading to a decreased ability to handle stressors (Cozolino, 2017). Other studies add to these in asserting that maternal attention affects the brain as well as in the brain’s capability of adapting to both positive and negative experiences (Cozolino, 2017).
These studies provide the implication that an empathic, secure therapeutic relationship has the ability to create a more secure internal working model in the client (Hall & Maltby, 2014). One major concept supported by research mostly for bipolar disorder is mentalization (Bateman & Fonegy, 2010). Mentalization is applicable in AT as a way to achieve secure attachment though the modeling of a secure therapeutic relationship (Hall & Maltby, 2014; Bateman & Fonegy, 2010). Insecure attachment has been correlated in numerous studies to bipolar disorder (Bateman & Fonegy, 2010), emotional and behavioral problems, depression, dissociation, eating disorders, non-suicidal self-injury, schizophrenia, and reduced distress coping skills (Bosmans, 2016). Another study found a relationship between decreased telomere length (a marker for cellular age) and childhood trauma histories for study participants found to have an insecure dismissing style (Pleines, 2019). Pleines (2019) cites this and several more studies to argue for the proper integration of a secure attachment relationship in TF-CBT between the parent and child throughout the course of treatment. ABFT is another attachment-based model with empirical support demonstrating efficacy through randomized clinical trials in treating adolescents with depression (Rueger et al., 2020). Social anxiety disorder (SAD) has also been shown to be related to insecure attachment styles in that clients with SAD report more attachment anxiety and avoidance than the control group (Straub et al., 2018).
Lastly, a study conducted to develop a theory of earning secure attachment found the three categories needed for change are meta-conditions for positive attachment change, interpersonal and intrapsychic changes (Dansby Olufowote et al., 2019). Therefore, there is substantial empirical evidence not only in challenging maladaptive cognitions, or only in support of establishing secure attachments, but also in working the two together in a way that accounts for the missing concepts in each of the theories. All of this empirical research is important and necessary for accountability, yet the Christian counselor has the Spirit of Truth in them who is capable of bringing change even in unexpected circumstances. Therefore, for the Christian counselor, all though the research is worthy of evaluating, there is always the knowledge that the Spirit of Truth in is control and He may use the counselor as He pleases for the good of the client in the name of Yeshua the Messiah (Ma’asei (Acts) 4: 8-12, The Scriptures, 2018).
Treatment Strategies
CBT has in its repertoire a variety of treatment strategies, especially since it very often borrows from other theories as long as they fit the cognitive framework (Beck, 2020). AT is somewhat more obscure in its clinical applicability in that there is not a variety of techniques since the main focus is on the therapeutic relationship (Hall & Maltby, 2014). It is important to note that both types of therapies strongly emphasize the therapeutic relationship as the foundational aspect of treatment (Beck, 2020; Hall & Maltby, 2014). Assessments are integral to both CBT and AT, providing a groundwork understanding of where the client is at the present moment. It was found that assessment for a secure base script joins CBT and AT for a more effective treatment model (Bosmans, 2016). Recommendations include repairing attachment ruptures before initiating CBT treatment within families (Bosmans, 2016). Although there are many techniques and interventions that may be applied, I will focus on the key ones that are consistent with Scriptural truth (Tan, 2011) working towards the goal of the client developing a true relationship/covenant with Yeshua Messiah that glorifies the Father through the manifestation of the Spirit of Truth in the disciple’s emotions, thoughts, and actions.
CBT Treatment Strategies
With CBT’s emphasis on cognitive distortions, interventions fall within the realm of cognitive restructuring, skills training, and problem solving (Tan, 2011). Additionally, Beck (2020) states that treatment principles in CBT include continuously refining the case conceptualization based on new data, developing a strong therapeutic relationship, continuous feedback for clients and therapist, carefully tailoring treatment to the individual client, inspiring hope by attending to the positive, stressing collaboration, focusing on goals based on client values, focusing on the present except when circumstances call for a past focus, emphasizing psychoeducation, aims for short term structured therapy, uses guided discovery, and includes homework.
Cognitive strategies include exploring or identifying the personal meaning of words, questioning the evidence to support thoughts (emphasizing the need to focus on Scriptural truth), exploring alternative causes, rational responding, examining options and alternatives, decatastrophizing, fantasizing consequences, looking at pros and cons, turning adversity to advantage, guided discovery, scaling, externalization of voices, thought stopping, direct disputation (especially when needed based on the Spirit of Truth’s leading), labeling of distortions, and bibliotherapy (Tan, 2011).
Behavioral strategies include activity scheduling, social skills training, role-playing, exposure, homework, and relaxation training (Tan, 2011). Some strategies in CBT need to be modified to align with Scripture. For example, rather than employing self-instruction as a way to cope (Tan, 2011), the Christian counselor and client can explore Scripture to meditate on when dealing with a difficult situation. Garzon (2013) describes Christian meditation based on the Truth of Scripture. Additionally, the distraction technique used to refocus attention temporarily (Tan, 2011) can be reworked to guide the client in learning to focus on the Word.
An important integrative treatment strategy is the inclusion of praying the Scriptures (Ohlshlager, 2016). The client is asked to recollect a favorite Scripture and as the counselor reads the Scripture, the client is guided into a relaxed mode and asked to visualize whatever the Scripture being read brings up (Ohlshlager, 2016). The intended outcome is to help the client have an experience with YHVH that transcends the natural world and enters into spiritual awareness of who He is. This is a place where the Spirit of Truth can work unencumbered (Ohlshlager, 2016).
AT Treatment Strategies
The emphasis in AT is in the therapeutic relationship (Hall & Maltby, 2014). In Emotion-Focused Therapy (closely related to AT) therapeutic change is only deemed possible when the emotional system is accessed (Kim-Van Daalen & Johnson, 2013). This emotional system is accessible through the therapist emphasizing the experience of the client with regards to the therapist, a place where mentalization treatment is well received (Hall & Maltby, 2014). Therefore, mentalization is an important strategy for the purpose of achieving a securely attached client-therapist relationship (Hall & Maltby, 2014).
Additionally, self-disclosure as it pertains to the client can be very useful in helping clients understand relationships better when mentalizing the transference (Bateman & Fonagy, 2010). The therapeutic stance for proper mentalizing includes engaging the client in a collaborative non-expert role, slowing the client down, identifying and legitimizing the client’s different viewpoints, asking for detailed descriptions instead of explanations, and honestly stating when something is not clear (Bateman & Fonegy, 2010).
In evaluating ABFT, Rueger et al. (2020) recommend focusing treatment on the client’s relationship with YHVH and on His faithfulness as the foundation for building up trust in relationships, as well as aiding in the repair work of forgiveness as additions to the values implicit in ABFT. Also, searching for a way adults with insecure attachment can earn security, Dansby Olufowote et al. (2019), in a qualitative study, were able to determine three main categories for change. It was found that when clients made intrapsychic changes, such as redefining their identity and worth, they were better able to make interpersonal changes, such as making peace with the past and taking small risks with trust (Dansby Olufowote et al., 2019). Virtually all participants in the study stated that the main avenue for change and earning security was due to intentional effort and a secure role-model (Dansby Olufowote et al., 2019). Therefore, strategies include achieving a high level of commitment to change from the client and establishing a secure base from which the client can then explore feelings, emotions, and actions (Dansby Olufowote et al., 2019).
Emotion-focused therapy, an AT approach, can be embraced from a Christian perspective by following the Christian emotion-focused therapy (CEBT) model (Kim-Van Daalen & Johnson, 2013). Several strategies are highlighted including any empathy-based and relational interventions such as presence of the counselor as a disciple of Messiah, empathic attunement, and equality in collaboration (Kim-Van Daalen & Johnson, 2013). Additionally, they include meditating on Scripture, visualizing Yeshua in control of their issues, empty chair or two-chair technique, inviting Yeshua into traumatic memories, and guided imagery (Kim-Van Daalen & Johnson, 2013). With such a variety of treatment strategies, the Christian counselor is equipped to offer empirically validated and spiritually sound therapy grounded on the truth of Scripture for the goal of establishing a secure relationship between the client and therapist, but more importantly the client and YHVH.
Christian Worldview
A Christian worldview informs perspective on all the above aspects. Tan (2013) describes a SO-CBT approach consistent with the working model I have described so far. I will summarize the approach and elaborate on one aspect of it. Tan’s (2013) SO-CBT approach consists of eight portions. First, although CBT emphasizes the need for a collaborative and supportive therapeutic relationship, SO-CBT emphasizes agape love in the therapeutic relationship, making it a more meaningful expression of YHVH (Tan, 2013). Second, although CBT rarely spends time in the past, SO-CBT is more cognizant of the past (Tan, 2013). My working model integrates AT for the improvement of therapy in dealing with past relationships and working towards secure attachment. Third, while CBT heavily emphasizes the rational and cognitive perspectives, SO-CBT continues to emphasize it as well, but in a more balanced way and from a Scriptural perspective (Tan, 2013). SO-CBT also considers demonic oppression as a possibility and hinges on the spiritual aspect of existence (Tan, 2013). Fourth, SO-CBT engages the client in cognitive restructuring, but based on the Truth of Scripture, not values based on relativism (Tan, 2013). Fifth, SO-CBT depends on prayer, the Spirit of Truth’s ministry in the life of both client and therapist, and Scripture more than on self-reliance (Tan, 2013). Sixth, a greater emphasis on the community of disciples as a resource also differentiates SO-CBT (Tan, 2013). Seventh, CBT’s emphasis on emotional positivity contrasts the concept of joy including a theology of suffering. Tan (2013) states that happiness is not necessarily a goal of counseling from a Christian perspective and a Scriptural worldview; instead, therapists proclaim a very different perspective of suffering from a Scriptural worldview. Lastly, SO-CBT relies on research to inform methods.
Further insight into suffering reveals that although suffering is the result of sin entering the world, “suffering is bent to the purposes of the stronger will and higher purposes of a benevolent God” as it provides a correction, character formation, and shifting perspective to YHVH (Langer et al., 2017, p. 49). Therefore, Scriptural education on this perspective of suffering puts sin in its proper place while instilling hope in a God who cares for His creation. A thorough working model of Christian counseling that properly addresses suffering in this manner has the potential to answer basic concerns many Christians often have with regards to their faith.
Hall and Maltby (2014) list areas of resonance and dissonance between evangelical theology and AT. One area of resonance is the emphasis on relationships. AT, at its very core is a theory that emphasizes the importance of relationships. Our Trinitarian view of YHVH teaches a paradigm based on relations between the members of the Trinity which brings into focus part of what it means to be created in the image of YHVH (Hall & Maltby, 2014). As the image bearers of a relational God, who throughout His Word emphasizes His desire to extend His relational paradigm beyond the Trinity and towards His created people, it would be honoring unto Him to provide a secure base relationship to the clients He chooses to bring. As Hall & Maltby (2014, p.203) state “attachment theorists may have put their finger on the most profound aspect of what it means to be made in God’s image – being-in-relation”. A second area of resonance is the way these relationships are internalized through internal working models. The pattern in which models of the self in relation are stored in the mind is synonymous with relational patterns in Scripture such as, the body of Messiah, marriage, relationship with Messiah, and the dwelling of the Spirit of Truth in the believer (Hall & Maltby, 2014). Lastly, the image of sanctification as growth and healing in relationship to YHVH and others merges a Scriptural truth with AT (Hall & Maltby, 2014). As a believer’s faith is deepened in the heart through the process of experientially knowing YHVH as a personal God, a believer begins to experience the most secure attachment humans have access to. As a result, every other relationship is affected and “we are loved into loving” (Hall & Maltby, 2014, p. 204)
Two areas of dissonance between AT and Scripture are the emphasis on the environment for development and distress without taking sin into account and a naturalistic and evolutionary view of relations (Hall & Maltby, 2014). The Christian counselor must be careful to stress that even in a perfect environment in which a child has highly secure attachments, psychopathology is still possible due to sin and its effects on people (Hall & Maltby, 2014). Insecure attachments are due to a sinful nature, whether perceived or not. Therefore, if we are to properly address insecure attachments for the purposes of bringing awareness of the possibility of a more secure attachment style, then admitting and surrendering sin to Yeshua the Messiah is an important step. Lastly, from a Scriptural worldview, relationality is not developed as a means of survival but as an innate characteristic inherent in being made in the image of YHVH (Hall & Maltby, 2014).
Essentially, both SO-CBT and AT can be adapted to fit into a Scripturally consistent integrative Christian counseling approach, as long as the Christian counselor is devoted to listening to the Spirit of Truth at all times and staying true to Scripture. If at any point the counselor is not competent to perform these duties, a referral is recommended.
Conclusion
The working theory presented in this paper represents a responsible faith-based eclectic working theory. Scriptural principles inform theory and empirical evidence informs practice. SO-CBT and AT build on each other’s weaknesses and enhance each other’s strengths. In summary, distress was defined as the adoption of cognitive distortions, based on insecure attachment styles, and the sinful nature. Empirically demonstrated treatment strategies consistent with each theories’ core principles, and compatible with the Truth of Scripture are available for implementation. Lastly, the Christian evaluation of the theories along with integration of Scriptural principles presented demonstrated a proper example of the Christianity integrates psychology approach.
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