In the twenty-first century, as in the first, we do not wage war against flesh and blood, but against “powers and principalities in the heavens” who increasingly would have us believe we are merely flesh and blood and therefore must cling to this life alone as the only one we will ever have, infected by fear of death and all the other associated afflictive passions that cripple the heart’s capacity for goodness and love and the mind’s recognition of Truth. Yet it is precisely our attachment to these illusions which is the real sickness in our lives.
An increasing interest in spirituality has arisen in American culture in recent years, and in particular, the relationship between spirituality and health. “Spiritual” has become a lucrative word that adds thousands of dollars in sales if included in a book’s title or on a conference’s agenda. Perhaps it is because it reminds us of a great need that is going unmet in our wildly affluent (for some), indulgent, and increasingly materialistic time.
By stark contrast, the Cappadocian fathers of the 4th century articulated a spiritual anthropology of personhood rooted in the Orthodox Christian understanding of the Incarnation and the Holy Trinity. It was an unprecedented historical advance, yet some 1,700 years later, the twentieth-first century marks a rapidly deteriorating trajectory that is depersonalizing and is undoing what was achieved in those early centuries and protected in subsequent ones by those few who gave blood in order to receive Spirit.
In the twentieth century, with advances in technology that can often bring immediate and dramatic results, healing has become increasingly the province of physicians. In this context persons first became patients, but as both healers and those seeking relief have been increasingly managed and defined by forces that regulate our lives not according to wholeness, ecological harmony, depth and meaning in the light of Christ, but rather according to numerical efficiency and cost, the idea of a “patient” has given way to a “customer,” or someone who is merely a consumer. This is certainly not spiritual progress, whatever face may be put upon it.
Orthodox Christianity provides an important counterweight to these culturally defining forces that threaten to inundate us through increasingly sophisticated advertising and market pressures that shape—and in some ways, distort and defame—human value. These forces do so by inflaming appetites that support an economic machine, whose success in some ways appears to be dependent on accepting a lower view of human potential than the one proclaimed by the reality of the Christian Gospel. Orthodox Christianity, by contrast, provides an integral context for healing, which involves a synergy between human and Divine that has been a hallmark of Christian faith from its inception.
Orthodox Christians do not see ourselves as citizens of this world only, but of a greater Kingdom than Caesar’s whose bounds are not time and space, but rather the infinite pure body and precious blood of Jesus Christ, in whom we place our hope to one day live in the fullness and eternal joy of the Holy Trinity. As Orthodox Christians, life is primarily an arena of struggle together to respond with body, heart, and mind to the uncreated grace of God which is “in all places and fills all things—the treasury of blessings,” which transfigures us so that we are born, “not of the flesh or of the will of man, but of God.”1 This is true whatever our calling, whether to medicine, psychology, or the priesthood, for all are called to personhood. And all who seek to alleviate the ills of humankind are in need of this deep healing of body, mind, and soul.
Though simply put and gratefully acknowledged, the synergy among religion and science is not easily embraced in practice, for it involves not merely (or necessarily) a technical or academic education, but, more importantly, an intentional and lifelong vigilance and spiritual warfare with forces that impede the aim of coming to full repentance and free obedient response to God in and through the Passion of Christ, on behalf of all life. This is the great medicine Christianity offers the world. Apart from continual repentance, which renders us responsive to the outpouring of the divine energies of grace, humankind, though made in the image of God, cannot achieve God’s likeness and, in so doing, in the words of St. Anthony, become ourselves. Orthodox Christianity is not a religion but a love relationship. If God is not a person, then we cannot be either.
In a time when Superman seems to be preferred over Christ, and the self-divinizing Promethean path to God re-emerges in the form of technological advances often masking the ancient impulse to understand and usurp the power of God apart from humble relationship with the Creator, it is not surprising that the production of alpha waves, acquisition of supernormal powers, physical vitality, beauty, and material prosperity are held to be the signs of Divine blessing in contrast to the more invisible fruits of the Spirit, which remain the same as always: charity, faithfulness, humility, poverty of spirit, and so on.
Apart from the fullness of the Divine life, there will always be something incomplete in us: a kind of longing that cannot be satisfied in this world, but only in the next, and never alone, but only in relationship with all others. Therefore we desperately need healers who treat us not only for ills in this world, but who offer guidance and care for achieving health and citizenship in the Other; healers who rely not on technology alone, but who themselves are struggling to enter into the fullness of relationship with God and with the beloved community and so bring to the healing partnership humility, a loving awareness of the presence of God, and the sanctity and mystery of each life.
The following case study is an example of one person’s attempt to bring the insights of modern psychology in the context of Orthodox Christian faith to the healing of a wounded soul, my client, Bonnie. I invite you, the readers, to consider with me how our approaches to illness and health exist within a much larger context than the one we generally respond from—a pastoral context that includes both medical and psychological but also points to something beyond them. If the aim of life and the standard of spiritual well-being is to become Passion-bearers along with Christ, who is the “Way” and the “Truth and the “Life” of God’s unfathomable love for all creation, then achieving physical or psychological comfort and well-being, in and of themselves, may be neither a necessary or vital condition.
By grasping at physical comforts or psychological stability without setting our compass to the plumb line of Jesus Christ who is “Way” to true fullness of life, we can inadvertently employ another idol and with it, a way of avoiding the path to personhood that is found in Passion-bearing rather than in passion-avoiding. Behind the post traumatic stress disorder of the DSM-IV is a larger and more critical post traumatic spiritual disorder.2 I believe that whatever the diagnosis, it remains true that whoever is content to remain in denial and seeks to save the smaller life of comfort as of primary importance, will lose the greater life of personhood; but whoever finds the secret of sacrificing the smaller life of possession by the fragmentary movements of individual egoistic self-preservation for the sake of serving the greater Love, who is Christ, shall be given all the rest as well.3
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“For a Christian there are no answers to be found in looking for who is responsible for evil: it lives in every human heart. There will always be evil on the earth. Christ said, In the world ye shall have tribulation, but be of good cheer, I have overcome the world (John 16:33). The question to ask ourselves in times of peril or sorrow is whether in the suffering that comes upon us we draw closer to God, strengthened in faith.” 4
Good psychotherapy, like good religion, helps people suffer for the right reasons and stop suffering for the wrong reasons. When psychotherapy occurs in the context of shared Christian faith between client and therapist, all other things being equal, I believe the conditions are ripe for the highest quality therapeutic alliance. Nevertheless, whatever the therapist may say or do, it is essentially the grace of God working through the client’s growing faith that is at work so that one may echo the words of our Lord Jesus Christ to the woman with the twelve year hemorrhage who touched his garment and was made well. “Go in peace,your faith has made your well.”
Put another way, we can say that the therapeutic alliance is a temporary relationship designed to clear away obstacles to a person’s permanent therapeutic journey in faith. Good pastoral psychotherapy occurs to the extent that we are least intrusive in peoples lives while at the same time being most interested, caring, and careful as we help them recognize the conscious and unconscious obstacles to the grace of God working in them through the presence of our Lord Jesus Christ and the power of the Holy Spirit.
Good psychotherapy requires a kind of informed, intentional naiveté and a continuing openness on the therapist’s part to being surprised by the dissonance between his or her expectations and perceptions of the client and the actual reality of the other person’s unfolding inner life and world. Navigating the bumps and twists and turns that occur from this requires a solid and trustworthy therapeutic alliance built up over time. At the end of his life, the late psychoanalyst Dr. C.G. Jung is said to have remarked that he starts over with each of his patients, “as if I knew nothing.”
This is the attitude and wisdom of one who has come to understand how daunting a task it is to really appreciate the uniqueness of another person, to be able to call them by name while at the same time to refrain from tampering with their freedom or abusing the power and privilege of having access to their most intimate parts and the treasure house of their souls. This means that the therapist must always avoid shrinking persons to fit psychological diagnoses or developmental ideals that are far more narrow and less life-affirming than those which are part of being created in the Divine image and likeness of God, a member of the Body of Christ, and one who is destined for theosis! For this reason, pastoral psychotherapy is also a spiritual discipline. It occurs on holy ground. The encounter changes both therapist and client.
In presenting a portion of the therapeutic journey that Bonnie—my client of this case-study—and I have taken together, I would invite the reader to keep in mind that you are seeing only a kind of skeleton or X-ray of a living human document. The person and the relationship is being reduced to a set of actions and words that are removed from the here and now context of voice tones, gestures, and the quality of human presence that gives them their life. This is inevitable and reminds me of the distinction that Eric Fromm made in his classic little book The Art of Loving,5 in which he compares the knowing that comes from examining a dead butterfly pinned to a page to watching the butterfly flitter and flutter among the flowers as a means of getting to know what the essence of the butterfly is.
The trustworthy quality of the therapeutic alliance—my interest in Bonnie and respect for her freedom—are essential elements of the relationship upon which everything else is built. Beyond simply stating this as a proviso, due to the limitations of space, I have not made any literary attempts to try to convey this to the reader. That it exists can, I believe, be surmised on the basis of what follows and I would simply remind the reader that the quality of the therapeutic alliance, existing as it does in the larger context of shared Christian faith, is the cookie dough in which the chocolate chips of any so-called psychological and/or religious interventions adhere.
Secondly, whatever we may say about diagnosis and the use of psychological labels to describe persons and events—and I will be using these terms because they are the lingua franca of the profession—it must be remembered that the larger context and most applicable diagnosis is that of being created in the very image and growing likeness of our common Creator. This fundamental starting point guides what I do in psychotherapy and how I utilize psychological understanding and techniques in my attempts to assist persons in identifying—and, where possible—dissolving the obstacles that block their appreciation of their full human life in Christ.
Furthermore, regardless of what I may think is happening or why, causation in the field of human relations remains a very nebulous idea, more difficult to pin down than the butterfly. There are simply too many interactive variables. When we add the element of prayer and God’s grace to the equation, it is almost impossible to know what really has made the difference in alleviating symptoms. I may identify interventions that I think were helpful, but I may be off the mark. Even Bonnie herself may not realize how all the variables stack up. Nevertheless, with these caveats in mind, let me offer my few loaves and fish knowing that by God’s grace and blessing they may prove valuable for the readers in stimulating further conversation about the integration of psychotherapy and Orthodox Christian faith.
There are three Greek words used in the Gospels to describe our Lord Jesus Christ’s healing encounters with others: iaomai, therapeuw, and swdzo. Iaomaiis used when Jesus heals someone’s body-part in a similar way as might a physician. Therapeuw describes healing of their whole body, while swdzo is used when the healing is in a salvational context.6 These three words with their respective contexts remind me that God is present wherever any sort of healing occurs. However, healing has many aspects involving body, soul, and spirit, and these are all distinct though interwoven, just as the persons of the Holy Trinity are distinct yet one.
The domain of pastoral psychotherapy as a matter of definition involves overlapping but somewhat discrete dimensions of the healing ministry to persons. Sometimes there is healing which does not directly involve salvational elements pertaining to the spirit. Frequently the client is not an Orthodox Christian, as is the case with Bonnie, and yet I hope and believe that they still benefit from the fact that I am, even though I may not mention Christ at all in what I say. This is true for the field of medicine as well as psychotherapy; however, I believe that it is less problematic for the neurosurgeon who works on my brain—whether or not he or she is an Orthodox Christian—than if my pastoral psychotherapist is not a Christian. For neurosurgery, I want a knowledgeable and skilled practitioner. I am not particularly concerned about his or her faith stance. For pastoral psychotherapy I want a knowledgeable and skilled practitioner who also shares my deepest religious belief and understanding wherever possible because we are talking about my soul. The following diagram is offered as a heuristic tool to orient the reader to the endeavor of pastoral psychotherapy as I have come to view it.
The lines of the diagram are of necessity elastic, so that the inner circle of overlap that constitutes the field of pastoral psychotherapy can be wider or more narrow at times, depending on the skill and training of the therapist as well as the circumstances, needs, and particular problems of the person(s) who is seeking help.
Also, the activity of healers working in the domains of body, psyche, and spirit identified in the diagram as separate and distinct are not nearly so distinct in practice as they appear. Human beings are essentially a psychosomatic and spiritual unity, except to the degree that we are divided by sin and unnecessary suffering. For example, a good physician will establish a caring relationship with a patient through appropriate dialogue just as much as a good pastor will utilize referral of a person to a physician to address physical problems while at the same time utilizing the Sacraments, anointing them with Holy oil, and praying for their healing. Likewise, the priest may hear a confession, suggest a particular penance or rule of prayer, and depending on the factors involved, suggest that a person spend some time in pastoral psychotherapy in order to address related emotional issues that he is not trained to address and/or does not have the time to go into.
All three fields of medicine, psychology, and religion work together. Another way of representing this is with the symbol of three interlocking circles as the OCAMPR (Orthodox Christian Association of Medicine, Psychology, and Religion) logo signifies. The dialogue between these three domains is one which neither the Church nor medicine nor psychotherapy can afford to neglect if we are to minister to persons in the most effective ways in the twenty-first century.
Each domain has developed and continues to develop a body of knowledge and understanding of the forces of life that constitute the human being that have something unique to share. We gain most when all three perspectives are being considered in partnership and to the extent that the aims and methods of medicine and psychotherapy are applied within the larger context of the Orthodox faith and life. In any case, human beings are a psychosomatic, and spiritual unity and the treasury of blessings and Giver of life in all three domains is the same God from whom all good gifts come.
For the reader’s information, the modern field of pastoral psychotherapy developed under the auspices of the American Association of Pastoral Counseling in the early nineteen-sixties. Practitioners were all, at that time, ordained clergy who had advanced degrees in counseling and/or psychology along with having extensive personal therapy and supervision in order to lessen the chances of intrusion of one’s own problems and prejudices into the lives of those we work so intimately with. The focus was very clearly and intentionally on integration of psychotherapeutic principles in the context of religious faith and in the personal and professional identity of the pastoral psychotherapist. Thus the line that divides spiritual direction and counseling per se, may be seen as even more elastic for pastoral counselors so trained, than for secular clinicians without a pastoral identity, background, and/or experience in theological reflection and pastoral care.
This is certainly true for me, having served as an ordained protestant parish minister for eleven years prior to my conversion to Orthodoxy. I am comfortable with both my roles as pastor and as psychotherapist. For me they are seamlessly wed. Thus the more psychologically oriented reader may view my description of the therapy process as me relating to Bonnie as a pastor, while the clergy may notice I am using many psychotherapeutic tools. Medicines also are part of the healing picture, but they are not the focus of this article other than to note which ones have been used and have contributed to her well-being. (It should also be noted that Bonnie had been using medicines for many years without any real change occurring for her in the area of her grief, dissociation, and self-destructive patterns.)
Needless to say, given the constraints of a piece of paper to render a living relationship, and depending on the reader’s own theoretical orientation and understanding, numerous questions will arise about why something was or was not done. This is part of the reason for offering the material to public domain in order to stimulate dialogue. Bonnie herself has agreed to this and has read all the material prior to publication. Had she any objections to making it public, it would not have been published. I would only ask the reader to keep in mind that the following description of almost three years of therapy, condensed into what it must be for purposes of brevity, opens it up to a great deal of distortion. The reader will simply have to take on faith that the relationship is a solid one in which Bonnie has been in charge of her process and any interventions on my part have been suggestions that she was free to reject or receive and which I would respect and modify accordingly.
Also, as the narrative flows, it appears much more orderly and linear than such a relationship actually is. Of necessity, most of the give and take that evidences the growth and development of the therapeutic alliance is omitted for brevity’s sake. What remains is the skeleton of events that occurred, pointing to various aspects of psychological and religious integration, which is the subject of our inquiry. For the reader’s benefit I have placed in bold the interventions which were more explicitly religious while offering brief details of the course of content and progress of the therapy so as to offer some sense of the context in which these occur. The reader is instructed not to forget that the interventions noted, in and of themselves, must be assumed to be occurring as suggestions at the appropriate moment in the relationship, otherwise they might not have been received in the same way. They are specific for Bonnie and not to be seen as applying cookie-cutter style to others in apparently similar situations. Bonnie’s faith is the key ingredient which makes much possible in this arena that otherwise would not be, and I believe it is in fact her faith that is making her well.
Finally, there are some counselors who are such excellent writers that they can convey a better feel for this than myself, but even so, as some of the best material shows7 the actual encounter between persons in the presence of God is far more of a mystery than we generally appreciate. I hope the reader will not lose sight of this as he/she peruses the X-ray photographs of the following relationship frozen in time. It is offered as a means of furthering the dialogue about the relationship between Orthodox Christian faith and the practice of pastoral psychotherapy in the modern context.
Introduction of the Person
Bonnie is a thirty-eight year old Caucasian female married for fifteen years. She and her husband have two children ages seven and five. The oldest is adopted. Bonnie has a masters degree and is currently assisting in a multi staff pastorate while getting further graduate education. She and her husband explicitly seek out counseling at the Pastoral Institute because of their desire to have a Christian faith-based counselor.
When I first saw her and her husband for the marital consult, Bonnie was feeling overwhelmed by responsibilities working in the social services field in a supervisory capacity. She reported increasing depressive mood swings, panic attacks, binging, and purging in the midst of interpersonal tensions with her husband.
Bonnie’s face is very expressive of changes in her state of mind. She ranges from relaxed, warm, and open (at least outwardly) to frozen, sullen, frightened, and like the cat that swallowed the mouse. She yearns for love, affection, and affirmation and is tormented by a very controlling, task-oriented, critical, guilt-ridden, internal aggressor. Bonnie reported at the time of our first meeting, that for nineteen straight years she had suffered binging and purging episodes, beginning since she was raped in her first year of college by an older man who had been a kind of father figure for her.
Though controlling the extent of binging and vomiting for short periods of time—weeks and months at best—she had never been able to stop. In addition, she tends to be hospitalized on a regular basis for respiratory illnesses which recur in association with the stressors. Later it came out “that this is how I get some attention from my husband.”
Bonnie’s experience of life in her family of origin she describes as part of a family system that drew her close and then shunned her whenever she “didn’t behave as the status quo.” Her mother is a compulsive-eater weighing over 300 lbs. who married her father at age fifteen; her father frequently used to say that he had raised her mother along with the children. She described her father as harsh, critical, and controlling. He shamed Bonnie into not feeling and she, “grew numb in order not to be abandoned by him.” At age eleven she heard him say he “had not wanted any girls.” She felt not good enough and sometimes would turn the water in the shower on scalding hot in order to punish herself for being seen as “bad” by her daddy, or for not being trusted by him, or “just to feel something.”
Bonnie reports that just as she was starting to get to know her father later as an adult, he died following severe burns received in a fire. ”All the family got to say goodbye to him except for me. By the time I was standing by his bedside, he would not (could not?) respond.”
At the time of our first meeting Bonnie had gained fifty pounds in the previous year and had been binging and purging several times a day for the past four months. She said “The more weight I gain the more I despise myself.”
Bonnie has a history of panic attacks which she has controlled to some extent by Xanax. At the time of our initial consult, these had been occurring almost daily for the past eighteen months.
Because of the multiple problems accumulating for Bonnie, after a few conjoint sessions we agreed to work individually and to save marital work until she was more stable. Her husband, by the way, was more than willing, as he denies his own extensive problems in the area of compulsivity, preferring to keep her the identified patient. The following case notes provide my chronological summary of significant therapeutic instances in our individual sessions together. I have numbered the notes by session, summarizing the theme and focus as well as my intervention strategies and Bonnie’s responses.
Initial Diagnostic Impressions
Axis I 307.51 Bulemia Nervosa; 300.01 Panic Disorder w/o agoraphobia; 296.22 Major Depression, moderate, recurrent, (partial remission); r/o 309.81 PTSD
Axis II 799.9 Deferred (note possible Borderline Personality Disorder traits – may be better explained by PTSD)
Axis III Periodic Migraine Headaches; Recurring pneumonia (currently clear); herniated disk
Axis IV Stressors: Dual Income Career couple with two young children; multiple unresolved grief issues (death of 4 children in childbirth or premature labor; father burned in fire), job stresses; (husband’s involvement in pornography and his request to wife to seduce another man for him came out later, as did Bonnie’s multiple sexual encounters with mentor figures including a rape by the father of a girl-friend whose family she lived with in college – age 19)
Axis V CGAF: 50 HGAFPY tentatively 60
Rx: Prozac (This was changed to Paxil by psychiatrist I referred her to following intake. Later this was changed to Serzone + Xanax + Ambiens, H.S. – PRN)
Course of Therapy
Sessions #1-4 Conjoint with spouse: Assessment & establishing boundaries for out patient therapy; referral to psychiatrist for Rx evaluation and management; discussion of her work responsibilities and personal limits that balance self-care and care for others.
FOCUS: on job stress; personal limits in terms of energy and keeping healthy boundaries; husband’s “guilt” for not being able to save her from her depression; Bonnie’s increasing suicidal ideation.
#5-6 Grief over deaths of four children in childbirth and/or premature labor. Bonnie feels “Daddy took them.” She reports she is collecting pills to take in case it “becomes too much for me. “Suicide is something I can control. That’s why it’s attractive.” She agrees to turn the pills over to me to keep. (She refused to allow anyone else to have them.)
Religious intervention: Bonnie says she feels close to Jesus who was “abandoned by God” but not to the Father “who caused my children to die.” I gave her icon of Christ being taken down from the cross. (She wept as she held it in her hands.)
FOCUS: “Discussion of God’s humanity and compassion – suffering with us. Bonnie says, “For the first time since coming here I can say that I want to feel better.”
#7-11 Bonnie makes the decision to resign her job. There is a fear of opening up old wounds: “I’m afraid I will hurt so bad that I want to die and I don’t want to die!” Her husband “has other things to do.” Bonnie says, “You see, when I get better he abandons me!” She tells me “You have helped me look at my relationship with God the Father, but what you don’t realize is that the closer I get to this the more I want to die to be with God and be away from the hurt.
I responded “Murder is not the way to God.”
Religious intervention: I reframe her pain in terms of “dying before you die” suggesting that she is holding on to her pain as if it were God – defining herself in terms of her suffering.” This clicks with her. I suggest that she pray the Lord’s prayer and Psalm 23 on the way home (more than hour’s drive) asking God to help her where she cannot help herself. This begins to prepare the ground, psychologically, for her Christian faith as the primary arena of her healing with her faith as a “transitional object.”
#12-14 “Pain has been my God. I am less suicidal now, but my arms ache (as they had when she lost her children).” I placed a teddy bear on the sofa beside her. She did some grief work and we reviewed a picture album of her children. During this time her best friend dies suddenly, leaving two children.
Religious Intervention: I gave her an article I had written on the death of our six year old entitled, “Dear Jesus Why Did our Child Have to Die?7. It was originally delivered as a sermon, dealing with anger with God and reconciliation in a personal, autobiographical way.
#15-17 Bonnie identifies the relational pattern in her marriage: “He loves me when I’m sick and when I’m better he eats and plays with our son and works.” The focus is on Bonnie developing her own life. Suicidal thoughts reoccur after receiving a Christmas card from the man that raped her. She talks more about the rape.
Religious intervention: Self assigned – Listening to Christian music – “Praise tapes” after the session on the way home.
#18-19 Began EMDR work:8 Bonnie relives age nine with her father: hyperventilation, nausea, feeling rejected, arms hurting as when losing her children. Her positive cognition is “I am a worthwhile person” and she utilizes holding the bear and talking to the bear as her nine year old self, from her adult part. Laughter is interspersed with pain. She felt much better during the week. Focus is on her attitude: “I don’t care if you don’t love me, just hold me.” She returns to the death of her babies – “My daddy is killing my babies.”
Religious Intervention: Ended EMDR with intentional awareness of Jesus present with her as a means of recontextualizing her pain and memory with her faith as well as trusting safe relationship in therapy in the here an now.
#20 Bonnie had contact with her mother who told her ‘You turned on your father and I guess I’m next.” She experiences binging and purging five times during the week. “I can’t blame my parents so I have to blame myself.” She feels abandoned by her husband. There is more dissociation, binging.
Religious Intervention: I suggest “Every sin is against the Lord and hurts all of us.” “Checkmate” she replies. This interaction had to do with Bonnie assuming responsibility for herself and her actions now, even though earlier in life she had not been able to because of the power differential and developmental stages inherent to her childhood relationship with parents. She was then indeed a victim.
Introduction of the idea of a “prayer bear” and keeping a log of her binges and “eating only enough to have some pleasure but stopping in order “to protect the bear” from any further self-hatred or abuse. This draws on the executive functions of Bonnie’s adult ego to help her re-parent her wounded child and be responsible for providing healthy nurture and boundaries for herself.
#21 Bonnie tells me “I have to be honest with you I have counted out all my pills. I can’t take it anymore.”
This is a reaction to perceived abandonment by her husband and not being able to control the binging; fear of therapy being cut off because of managed care pressure and consequent anger with me as potentially another abandonment in her life. Bonnie dissociates in the room. I ask her about it. “I’m leaving you.” I process her anger with her and tell her “I can’t work with you in out patient therapy if you need inpatient care because you are unstable and actively suicidal.” She agrees to bring the pills she’s collected and give them to Dr. Brende. I ask for her husband to accompany her next time to enlist his support.
#22 “collateral consult with spouse for support
#23-25 More EMDR work – scene of infants death –hyperventilation, nausea, despair. She reports her husband is more supportive now. She visits scene of her father’s death and her anger: weeping, gritting teeth, hyperventilation.
Religious intervention: Ended session with Jesus present with her in the room with her father. Theologically, she wrestled with “God the Father who could have saved my babies” and Jesus who suffers with her. Again this is an attempt to draw on the ego strength associated with her faith and to recontextualize her pain.
#26 Bonnie reports she got an “A” in her first counseling class. She identifies the sequence of acting out: “I feel empty. I eat. I purge. I cry. I feel better.” She has memories of her father spanking her so hard up and down her back that he left handprints all over her. He also shamed and bullied her into not expressing feelings.
#27 She reports four days without sleeping medication. There are fears of being alone and her arms are hurting.
Religious intervention: I suggested she receive the Lord’s supper daily through Easter and use Psalms and prayers to replace thoughts and impulses to fill emptiness with food. Emptiness is to be filled only by Eucharist. I gave her some incense to burn and remind her that she is taking nourishment by way of her breath from God’s spirit and in her mind feeding on God’s word and she is to accept this as sufficient for her no matter what for the duration of one week. (Tears, “I want this so very much!”)
#28 Bonnie is tearful most of the session. She reports having a panic attack in a traffic jam preventing her from reaching her school on time. Then she came home to a dark house (abandonment, uncared-for) with husband already asleep. She brought pictures of her dead child but was afraid to show me “because no one takes it seriously.”
Religious Intervention: She had not waited for Easter week to receive the Eucharist as I’d instructed, but immediately began receiving it when she went home. “I was looking for magic and it didn’t work.” I suggested by way of a story and reframe that Bonnie was trying to do things herself rather than trust in God to help her. I called this making “sorcery” of religion in which the self was still attempting to be in control (which is central to addiction.) This was aimed to interrupt her intense perfectionistic, self-blaming side that punishes her for not being able to control her victimization or her father’s rejection of her.
#29 We make a review of Bonnie’s progress to date: decrease in suicidality and interpersonal manipulation while being able to bear greater emotional intensity. I affirmed my willingness to continue with her even if insurance denies further sessions.
#30 EMDR session targets the rape. Bonnie hyperventilates, experiences rage, resignation at penetration which she feels as the same experience as resignation at gaining thirty pounds. She relives the sensory details. She reports sexuality with spouse occurs through the lenses “either of rape or of my father taking my babies out of me.” There is always an undercurrent of anger and/or victimization. Bonnie’s biological-feeling-memory is a conflation of three images: “father spanking me for a mushroom I didn’t eat and not believing me, the man who raped me not believing I was a virgin, and the man (who spouse asked her to seduce) not believing that my husband asked me to do it.” There is intense anger, powerlessness and grief over her father’s death.
Religious intervention: I pray the Jesus prayer out loud for Bonnie during her EMDR session. (She is weeping.)
#31 Bonnie informs me “When you were praying the Jesus Prayer out loud for me it was nothing short of miraculous (tears).” She reports she felt release of shame and a sense of God’s presence. She reports growth in her prayer life and recognition of Christianity as her primary therapy. “You have been my pastor for the past 8 months and that is what I have needed.”
#32 Four days go by without binging-purging and then with the news of the doctor being unable to help her back pain unless she loses weight she “knew I was going to binge when I got home.”
Religious Intervention: I give her material on “formation of passions” from a synthesis of the teachings of the Philokalia9 regarding stages of linking of attention with suggestions. I suggest she is “going to vomiting as to her lover (and god), for the release of tenderness involved.”
#33 Bonnie tells me “I was angry with you last session over something you said that really struck home and I haven’t vomited for seventeen days. (“She has gone to vomiting as to tenderness, etc.”) She says she has found tenderness and trust in God the Father again and a sense of spaciousness in her life, interrupting the drivenness of the “gospel of perfection” that had been terrorizing her.
Religious intervention: She is ready now to follow up on suggestion that she get spiritual direction and she will make arrangements to begin seeing Fr. B. for this.
#34 Still no vomiting. She is using the Jesus prayer to cut off thoughts and as prevention of “abandonment” fears.
#35 Bonnies’s face is shining and her affect is bright as in the previous session. She had her first contact with Fr. B for her spiritual direction and she reports it went well.
Religious intervention: She is reading books appropriate for her; experimenting with fasting in the context of spiritual discipline and growing in her appreciation for the “mystery” of the faith. She is viewing herself more as ”defined by God” in contrast to others around her or clinging to past. Used EMDR to lay down positive track of a new sense of trust in God over primary traumas.
#36-38 Bonnie brought pictures of her dead children with her and we went through her photograph album. She worked with EMDR. Still no vomiting.
Religious intervention: She is reading a book on fasting and the Jesus prayer. I loaned her Youth of the Apocalypse10 and Beloved Sufferer11
#39 I asked for a collateral consult with Bonnie’s spouse in order to make a referral to begin marital therapy. Bonnie’s fears of abandonment resurface. Her face is visibly changed in the session to an expression I haven’t seen since she first came.
#40 Her abandonment feelings have returned. “I’m trapped and just want out of the marriage.” She has a fear of decompensation and relapse if she begins to confront the marriage problems. She is still feeling punitive toward herself for having reached out to touch me in a previous session as she was leaving. (I had brought this up to process with her the following session.) This connects with not forgiving herself for having become sexual in relationships with men she had been seeking fathering from in the past. She fears I will blame her and reject her.” I offer reassurance of care and professional boundaries, etc.
We again assess the supports in place in her life now: her growing prayer life; spiritual direction relationship; church work, her successful school work and new career direction, love for her children, regular exercise. She agreed, these were true, “now that you point them out,” but felt paralyzed by the thought of losing our relationship. I was going on vacation for a week and there were no appointment vacancies the week after except for 5PM. I told her she could have that or a morning in three weeks. The session was ten minutes over already which was unusual. She was upset and would not choose, so I said “I will choose for you then and I choose three weeks because I believe in your strength and ability to care for yourself.”
#41 Bonnie reports that she binged on the way home from the previous session, but no vomiting. She says she hasn’t dealt with her sexuality yet and is not ready to terminate. She reported other sexual relationships she hadn’t talked about and said touching my hand and her subsequent feelings had elicited a flood of memories of her father blaming her for wearing make-up and she felt I was rejecting her for her “bad” desire for closeness and the guilt she feels for her sexualized relationships. “As long as I can count on you not abandoning me I think bi-weekly sessions will work.”
#42-45 Stable mood. Still no vomiting. Good developing contact with spiritual director who is also helping her with the Eucharist and fasting in the context of God’s leading gently rather than a compulsive desire for perfection. EMDR focus is on sexual encounters – self-blame vs. victimization. Her mood is more stable.
Religious intervention: Letting go of rule conscious urgency and enjoying more freedom. I recommend Beginning to Pray12
#46 Bonnie reports that one of her church mentors, the chairman of the pastor search committee that was considering her husband for a position, “kissed me on the lips after stopping by the church.” Her husband saw it and said nothing. I asked about this in context of husband earlier asking her to seduce one of his friends “who needed comfort”. She responds, “I had always blamed myself for that until you brought it up when he was here. He was angry about it.”
Religious intervention: I suggest that Bonnie pray the Jesus prayer from the place in her where she “cannot love my fat 10 year old self.”
#47 She had a panic attack and sleep disturbance. She relates this to praying the Jesus prayer at the point of her rejection of the inner “fat” child, but she feels good she was able to do this without falling into old self-destructive habits. We worked with EMDR around the scalding shower scene which she connected with binging and purging.
Religious intervention: I suggested that she let all physical pain convert to emotional and feel it in her heart so Jesus can help her. Deep attentive breathing begins while she is saying the Jesus prayer. She wept while I prayed Psalm 23 out loud during EMDR. Bonnie inhales sweet Jerusalem incense during EMDR and laughs as she reports that “The scalding water turned into a bubble bath and Jesus was present.” We both laughed as she relates this. The session ended with her “inner little girl” feeling loved.
At the end of this session I broke off a piece of my African milk plant and suggested that it was prickly outside but full of life within, and that if given the right conditions it would grow. It would shrivel a little at first because of being in new environment, etc. (This transitional object is alive and represents her growth and acceptance of her “prickly” parts. It is also an extension of the feeling and reality of the therapeutic relationship that Bonnie is internalizing and carries with it the implication of her responsibility to care for her own life by drawing on her desire to care for others.)
#48 Bonnie reports she stopped at church on way home from last session and prayed and felt Jesus healing parts of her she had not let in before. “Then I received phone call from (spouse’s) father being sexually inappropriate as he has been in the past.” She hadn’t talked about this before. She reports he has touched her before inappropriately. Husband doesn’t know. “What do I do to cause this kind of thing to happen?” She reports her mother lost 150 pounds after her father’s death and then gained it back after a man at work came on to her. She later told Bonnie the weight was for “protection”.
#49 Bonnie reports a terrible binge. She was curled up in the fetal position with the urge to vomit. She began the Jesus prayer and it went away. “When I have sex with husband I say the Jesus prayer, but I am somewhere else. Is this right?”
Religious Intervention: I tell her I do not know the answer about her use of the Jesus prayer in the sexual context with her husband. We talk about it and I give her Mother Alexandria’s commentary on the Jesus prayer13 to read and suggest that she discuss this with her spiritual father.
#50-52 Bonnie begins to work more definitely around sexuality: “I have never had a loving, non-anxious sexual encounter. My sister at fourteen had sex with the youth pastor in our house. My father found out. I began to try to be in control of men (by tempting them) the way they had been in control of me. I married to avoid being alone.” She reports her husband is not present in the sexual act and neither is she.
Religious Intervention: I gave her Thomas Hopko’s article on forgiveness and feelings when trauma is involved.14
CRITICAL INCIDENT
Bonnie calls in tears to report she has been sexually assaulted in her home by a former student
#53 Bonnie is numb, “I shut everything off.” She brought a drawing with her of the man – faulting herself for letting him in the door. Later that same week she had to see husband’s father at an event and he sexually came on to her. She vomited (not deliberate purging but because of nausea).
She reports she left for a couple days with a bottle of pills and prayed and wept. “I took the icon of Christ you gave me. It was a spiritual battle inside between life and death. I chose life.” She threw me the bottle of pills. “You can have these. I had just decided to address how messed up I am in the area of sexuality and then this happened. Now I just want to run away and not have to deal with sex.”
#54-56 Bonnie reports, “I haven’t binged or purged, but now for the first time in my life I want to cut myself. We debrief the sexual assault. Her face has the flicker of a sardonic smile that hasn’t been present in months. She is dissociated, removed from her pain, not sleeping well. Her arms are hurting again. Police investigation stirs up her emotions. EMDR – safety with the Jesus prayer. Husband is asking for all the details; she is disgusted thinking of his pornography addiction. Bonnie’s legs are jumping, hyperventilation, flashbacks to previous sexual assaults, suicidal darkness. Panic. I tell her “It is not God’s will for you to die.” As in previous sessions when she is upset, we use guided relaxation, movement or other technique to help her shift her awareness from the painful places before she leaves the session.
#57 Collateral consultation with spouse to enlist his support. He wants to help. I tell him he can help by throwing out all his pornography to help his wife see she is not a mere object to him. He agrees.
#58 Bonnie is doing much better. Lots of rage emerged, but she went to a Church music workshop with “two-hundred people who love God” and she says she was “bathed by God’s forgiveness.”
#59 The perpetrator’s mother, a member of the church is questioning Bonnie about the assault and validating her. Her husband is not following through with his promise to discard the pornography. All the men have made excuses, like the perpetrator who told her “I saw the outline of your breast” and thus his attack was “her fault” for being a woman.
#60-61 Bonnie gives me copy of H. Nouwen’s Here and Now.15 She is finding new source of strength in her Christian faith.
#62 We resume EMDR targeting the binging and the conflict between “good and bad.” Bonnie experiences a sensation of nausea at men not listening to her –beginning with her father and the men who raped her or coerced sex from her. She wanted relationships, not sex. There is a sense of emptiness. “I eat to fill the emptiness created by the lack of relationships.”
#63-64 Bonnie fears “If I am truly forgiven by Christ and my faith grows, I will no longer love my husband.” I respond “Christ loves the world through us and if you feel loved by Christ you will have more capacity for love.” EMDR focus is on grief – dead babies and rapes.
#65 Bonnie is afraid of relapsing into major depression. “I fear if I have another major depression I wont have the strength to get out.” Her panic attacks return “out of nowhere.”
Religious intervention: I ask her to describe the inner territory where she deals with suggestions coming into her mind and she has a moment of relief when she realizes that the Jesus prayer “is not like an ember, but a little flame now in my life and that is the major difference from how I was before. I trust the love of the Father and I couldn’t before.”
#66-69 Bonnie’s spouse still hasn’t kept his promise to give up the pornography. I recommend that she read An Affair of the Mind.16 Bonnie struggles over the book and initial anger “that I have to be responsible for his problem!” She works through this and struggles for clarity about the difference between self-blame and self-responsibility and setting appropriate limits in relationship with husband’s pornography addiction as it parallels her relationship in the rapes. “Who is responsible?” She wants to “put my head in the sand and ignore it. Why do I have to be responsible for him?” Work on distinguishing responsibility from need to honor and protect her own boundaries.
#70 Her perpetrator is leaving phone messages on her phone. Her car hydroplaned into a ditch along with a truck and sank. She said she was “collecting pills again.” “I hoped it would go away. I didn’t want to disappoint you. I didn’t want to admit I was going backwards.” There is a sense of having no control in her life.
#71-75 More EMDR: working through sexual assault and related themes
Religious intervention: I remind her that Christ refused medication on the cross – suggesting that opening her eyes and being present to her pain without loss of faith in God is a metaphor for continuing grief work until she is finished.
#76 Bonnie is aware of her deepened capacity to experience pain and can acknowledge that as true without falling prey to binging/purging. Her weight is slowly coming off. Panic attacks are under control. Major depression is no longer in evidence. Transferential elements of Borderline Personality spectrum related to abandonment themes emerge briefly from time to time and the therapeutic alliance is such that these are confronted and discussed. I tell her “I’m the junior therapist. God is your primary therapist.”
Current diagnostic Picture:
Axis I 307.51 Bulemia Nervosa (binging in partial remission; no purging x 2 years); 300.01 Panic Disorder w/o agoraphobia,(in remission); 296.22 Major Depression, moderate recurrent, (in remission); 309.81 PTSD (partial remission)
Axis II (Borderline Personality Disorder organization) – mood is more stable with increased capacity for direct experience and articulation of feeling w/o acting out
Axis III Hx of migraine Headaches & frequent pneumonia (clear x 2 years)
Axis IV Stressors: multiple grief issues from FOO to current as noted plus sexual assault by former student 8 months ago in her own house, marital problems (husband’s involvement in pornography and poor boundaries;
Axis V CGAF: 68 HGAFPY 60
Current Rx: Zoloft and Serzone concurrently + Xanax ½ tid
Bonnie continues in Therapy at the time of this writing and continues to improve. We have used her reading of this material as part of her therapy process, examining feelings elicited as she has read about herself, seeing everything “condensed into black and white.” Because of her training as a therapist she is able to use it both from a personal standpoint as well as with some professional interest in the process that helps her understand and grow. It has helped her weave together with greater understanding some of the “compartmentalized” aspects of her history. We agreed beforehand that none of the material would be used if there was any doubt either of us had about its usefulness to her therapeutically.
Issues for Reflection
I have presented this sketch of a working pastoral psychotherapy relationship as a means of stimulating dialogue about the integration of psychotherapy and Orthodox Christian faith. As I read it, several areas stand out for me as places for further discussion with regard to the larger issues of discernment, diagnosis, timing and so forth, that inform the interventions. I am only going to comment briefly on some of the themes that emerge.
Physical Setting and Context of Therapy
It is not without significance that the counseling relationship occurs at the Pastoral Institute, an interdenominational Counseling Center and training institute that is explicitly Judaeo-Christian in orientation, although we work with persons of all faiths, including Hindu, Moslem, Jewish, Atheist, and Wiccan.
A large icon of Christ Pantokrator hangs on the wall of my office. St. Joseph, St. Seraphim of Sarov, the Holy Theotokos, the Stoning of St. Stephen, Sts. Cosmos & Damian, The Last Supper, and the Holy Transfiguration are some of the other icons participating in therapy silently from various points in my office. Projections are made on to them from time to time and these are part of the discussion of the therapy. Frequently there is the smell of incense in the air from each morning when I am preparing for the day, prior to seeing my clients. As in the Divine Liturgy, the witness of the saints and the ambience of the setting are conducive to responding with attention to the presence of oneself with others in the presence of God. This same context I believe is the most appropriate one of psychotherapeutic healing because it points to the larger web of relationships in which the therapeutic alliance exists. In some ways this is even more potent for persons, such as Bonnie, who have not grown up with such symbols and so they are a fresh and vivid witness.
Bibliotherapy
Books provide an ongoing contact in the form of a transitional object linking the client’s reading of the material with the therapeutic relationship that is gradually internalized, adding stability to the sense of self. This material offers valuable reframes and instruction beyond what is given in the session, particularly related to assisting in the client’s faith journey and broadening the cloud of witnesses who may offer sustenance for the continuing journey.
These are selected specifically for the person and her circumstances in light of where she appears to be in the journey. To the degree that they are timely and received by the person as a further extension of the care and specificity of her therapy process, they provide important follow-up to the work done in therapy as well as a means of self-soothing and additional support during post session periods. This also encourages the person to reflect and integrate material that is surfacing in therapy through the perspectives offered in the books which frequently point to the faith journey as the primary arena for healing.
Prayer
This occurs in many ways. The therapist prays for clients prior to the sessions and sometimes afterward. In addition there may be prayer during sessions. With Bonnie, prayer sometimes occurred during her EMDR sequences. Initially, praying the Jesus prayer out loud for her was a spontaneous action but was later requested by Bonnie. Sometimes Psalm 23 was used. Occasionally I invite persons to pray a selected Psalm out loud in a session in order to elicit feelings in the relational context with God. Tears and remembrance of injury in the presence of God and the witness of the saints who have also felt such pain is more healing than tears that are cried alone.
Sometimes prayer occurs before an EMDR session. Frequently I am praying the Jesus prayer silently and generally am using the prayer rope during therapy sessions, dividing my attention at times between the person’s words and my prayer for them as well as to my own presence in engaging them.
Bonnie also uses the Jesus prayer continuously following her sessions on her drive home. Bonnie got herself a “prayer bear” for holding in bed when she feels alone at night while she prays, remembering the inner child who needs God’s love and her good parenting. It is a tangible means of expression which allows the senses and feeling to connect with the remembrance of suffering, while allowing the adult mind to care for the wounded part of the self in ways that she did not have at the time of the injury.
Eucharist
I suggested that Bonnie receive the Eucharist (Lord’s Supper in her context) daily during the week of her Easter. I tried to help her frame the feelings of physical emptiness in the context of the fullness of God’s gifts in the place of other food. Framing this in the context of emptiness as preparation for fullness and connection rather than reiteration of loss and abandonment was designed to draw on her strong faith orientation which is heightened during the celebration of Easter week to help her heal a dismembered part of herself and begin to recover from her bulimia. I wanted her to recontextualize the feeling of emptiness that was a trigger for self-abuse.
The cycle of the church year—its feast and fast days and the activities of fasting, almsgiving, confession, and so forth—are extremely important means of healing. They are further vivified when entered into in conjunction with one’s psychotherapy process. There is a cross-fertilization that occurs between spiritual direction, worship, and pastoral psychotherapy journey that persons take. I believe Bonnie’s journey is strong testimony of this. Even though she is not Orthodox, she benefits from the Orthodox context, which still has much to offer her.
Incense
The sense of smell is powerfully connected to our feeling life and early memories. This was utilized intentionally on one occasion during an EMDR sequence related to Bonnie’s memory of taking the hot scalding shower as punishment. She said the scene “turned into a bubble bath” at the moment she smelled the incense. I subsequently gave her a piece of incense to light during a difficult time, which again served as transitional object to help stretch therapy beyond the session as preparation for “referral to God” for on-going care and healing. I hoped she would receive a palpable sense of the presence of God during prayer and that would fill her inner emptiness with a sense of God’s presence through the tangible inhaling of the sweet incense.
Re-membering in context of Biblical narratives
When persons are traumatized, a dismemberment occurs in the psyche. We are cut off from parts of ourselves, particularly between mind, body, and feelings, and from the community at large. This is frequently accompanied by a sense of not being loved by God as was the case with Bonnie. Re-membering is the work of therapy and it occurs within the body in the context of a beloved relationship through encountering missing links between sensations, feelings, and thoughts that are painful and were forced into the unconscious in order to allow the person to survive. From that wilderness place split off from consciousness, these feelings and conflicts create moods and compulsive acting out which in turn continue the person’s victimization with increasing anger, grief, and hopelessness and a host of PTSD symptoms including depression and compulsive addictive self-medicating to achieve psychic numbing.
In working through memories, Biblical stories prove useful as narrative therapeutic interventions. Jacob wrestling with an angel and walking away a new person with a limp as evidence of his struggle; the renewal motif in Joseph’s painful initial journey; the woman at the well’s renewal; the woman caught in adultery; the woman with the hemorrhage; all at one point or another in our work together offered valuable healing lenses to make new meaning out of Bonnie’s suffering.
Bonnie re-members her pain in the presence of a trusting relationship with a man, where the boundaries are increasingly experienced as safe for her to feel, in contrast to her previous history with her father. When this occurs explicitly in the larger context of her Christian faith (and mine) with hope in God’s eternal love, it re-contextualizes those past events so that the emotions can be named and discharged through her body without fear of being overwhelmed. They can be re-membered and the meaning extracted from them enhances the sense of control in her life as well as confirms a sense of her belovedness. God’s presence is made more tangible via the therapist (as is the case with the priest in confession). Her faith in God is strengthened simultaneously.
Confession
Existentially (in contrast to Sacramentally) this occurs within many of the sessions. Bonnie is explicit at times in asking for this. Sometimes this occurs as the therapist prays “May God forgive you” or with the Jesus prayer during an EMDR session as Bonnie confesses by way of her own internal memory without speaking outwardly. This also occurs in a more formal way in the context of her relationship with the priest who is her spiritual director. (For example, her responsibility as an adult for not telling her husband “No.” when he invited her to have sex with his friend.)
Spiritual Direction
This is a frequent and important adjunct to therapy (or vice versa). Pastoral Psychotherapy and Spiritual Direction frequently overlap, but they are different functions. In Bonnie’s case, the referral is to an older priest with experience in contemplative methods and spiritual direction. It serves to expand her support network and to prepare for our eventual termination of formal psychotherapy. She will then continue in her Christian faith as her “primary psychotherapy for the rest of her life.” Ultimately this is the task of pastoral psychotherapy as I understand it: to help others become able to enter freely with intention, responsibility, and joy into their respective faith journeys which are in essence designed to heal the human soul and to complete our development.
Spiritual Retreat
This is an area that provides needed boosts at important times. Bonnie gained a great deal from attending a short retreat on Church music. I have at times suggested that clients pray at the tombs of saints in locations that they have visited which has been very beneficial or to go to a monastery for several days’ retreat. Later the experiences are discussed and further suggestions are offered.
Discernment
Discernment comes from the Latin word cernere, meaning to sift apart or select. It refers to the theological arena having to do with human responsibility in light of the presence of God, the condition of the nous, and the inclinations of the will toward good and evil. In the context of pastoral psychotherapy, discernment has an important role along with diagnosis, as part of the progress of distinguishing or “sifting apart” the symptomatic characteristics of trauma and psychological illness from the effects of actively participating in the evil of continuing to choose self destructive patterns to the extent that one becomes capable of doing otherwise. The former is a sickness while the latter can involve sin and they are frequently, as in Bonnie’s case, woven together like the tares and wheat.
For example, fornication, despondency, and rancor are words drawn from the language of discernment and spiritual warfare. Drawing on the Patristic experience regarding suggestions and the movement of attention and the will, Bonnie was offered a valuable means of beginning to train herself in self-observation of her inner world in order to discern the intent of various motivations. She begins to distinguish what she is responsible for and what she is not, what is a healthy direction and what is not.
Bonnie first developed her habit of purging after her friend’s father sexualized his relationship with her while she was in college. She had dissociated when he first fondled her, confused, and feared abandonment if she protested. Immediately after the experience she vomited spontaneously. Subsequently, she developed a bulimic pattern which became a means of acting out the dissociated split-off feelings of fear, anger, repulsion, and shame—in effect continuing the re-victimization of herself at the psychological level.
This was all hidden behind the mask of tenderness and surrender that began to collect around the act of vomiting, which soothed her by releasing a flood of endorphins and keeping the underlying feelings hidden. I used the metaphor of the serpent in Genesis offering to the soul that which is already given by God: “It seems you believe the lie that you can only have tenderness and surrender and comfort by making yourself vomit. This lie hides the ugly nature of the acting out of self-hatred, guilt and anguish.” There was also the parallel in her eating and vomiting, of the pre-mature births/deaths of her children. She said, “I don’t deserve to have live baby’s. I can’t finish anything. That which is given is always taken away.” So she continued to punish herself inappropriately and to blame God for it. Even after much previous therapy, Bonnie stopped vomiting for the first time in nineteen years only after she recognized the lie that was involved in this. It was a major step in reclaiming responsibility for her actions as well as an act of trust and faith in God to care for her even when she felt bad.
Intentionally letting go of old defenses that were once partially protective, but which later become a burden, is an important act of responsibility which the adult victim of trauma must eventually come to. Bonnie was not responsible for her original victimization, but at some point, she, as each of us—however we may have been wounded in the past through no fault of our own—is responsible for stopping her re-victimization at the psychological level. This involves identifying the moods and underlying feelings that generate the acting out or that activate the defenses that protect the psyche like an anesthesia, but which do not empower the executive ego to act in ways that protect the whole person from danger.
This is the arena of spiritual warfare with the passions that tend to develop around such injuries and block access to God and to the larger community. Getting at this requires both diagnosis and discernment, because the “wheat and the tares” of victimization and responsibility for one’s actions are mixed together. The grace of God working in concert with human attentiveness and recognition must heal the nous. It is critical not to blame the victim, yet it is equally important not to miss the task of empowering the adult survivor who gradually grows into a position to begin reclaiming her life from the powers that have held her back for so long. She should be empowered to become responsible for her own protection in effective ways that are now possible for her, and to trust God in the rest.
This is a very important aspect of the pastoral psychotherapy process because beguilement or “prelest” often is part of the process that keeps persons enslaved to self-destructive actions. Bonnie’s mentors sexualized their relationships with her out of their own needs. Her fear of abandonment left her vulnerable to this. Dissociation protected her from being overwhelmed at the time, but dissociation is essentially an unconscious automatic protective mechanism of trance that divides the nous. As she becomes aware of how this functions in her life, she sees that it leaves her vulnerable to further exploitation. Thus she gradually becomes responsible for protecting herself in more effective ways. This means confronting her abandonment fears and identifying how dissociation works and what motivations she is conscious of that collaborate with it—such as anger with self, despair, and so forth. As faith in God’s love increases, Bonnie’s fear of abandonment decreases and assertiveness becomes possible because she begins to trust that God will not abandon her. The therapeutic alliance helps to offer a concrete here and now representation of this along the way until she has internalized this in a way that makes it her own.
Bonnie is able to claim for herself that she never wanted sex from the men, only their genuine interest in her as a person, but her fear of losing them and her previous history left her too afraid of abandonment to assert her needed limits strongly enough to be heard and respected. This has lessened the degree of self-hatred she has experienced. Nevertheless, the process of disentangling the symptoms of the initial victimization and subsequent responsibility for allowing victimization to continue is a delicate one. The emotions this stirs have reoccurred over time as Bonnie began to identify her boundaries and became better able to actively protect them.
She blamed herself inappropriately for things she as a child was not responsible for and took into herself the disappointment and anger associated with her relationship with an emotionally abusive father and unavailable mother. These conditions of her family of origin distorted her sense of her own value and responsibility for protecting that value as an adult. On the other hand, it is also the material which God has allowed in her life that becomes the “Joseph journey” we all take in one way or another, and by the grace of God, either are reborn through the process of abiding in faith along the way, or are lost to fate in the jaws of faithlessness.
For years, Bonnie had trouble allowing herself to be responsible as an adult for some actions that are self-abusive and continue her victimization, like her bulemia. In fact she hated herself more for not being able to control it consciously, while unconsciously it was partly protective and partly a confirmation of her lack of value. Diagnosis and discernment around these issues that occurs in the context of sensitive on-going caring dialogue, allowing her freedom to express her confusion, anger, self-doubt, rage, grief, and fear, are vitally important in mid-wifing the birth of a new being in Christ. This is the birth of one whose identity is no longer defined by previous victimization, but by trust in the reality of her self who is hidden with Christ in God.
Finally, the question of whether in suffering Bonnie has drawn closer in faith to Christ during the almost three years of her psychotherapy, can be answered with a most definite, “Yes!” This is, I believe, the fundamental reason for the good direction of her healing journey. Christian faith has been the primary context for both Bonnie and myself as we have engaged in this Emmaus walk together and whatever interventions, quality of presence, personal faith, and so forth, have contributed to the process, we both acknowledge are testimony to the one thing we can be certain of: It is by the grace of God that good has prevailed and it is Bonnie’s faith that is making her well. In sharing this Emmaus journey together we both encounter a sense of the Holy God emerging with fresh visage in the midst of hearts that burn with a new sense of the mystery of God’s love for a fragile and sometimes bitter creation.17
Notes
1. The Gospel of John
2. Stephen Muse. ‘Post Traumatic Spiritual Disorder and the False History Syndrome” at the Orthodox peace Fellowship at http://incommunion.org/articles/essays/post-traumatic-spiritual-disorder-and-the-false-history-syndrome (2007)
3. This into is adapted from Raising Lazurus, edited by Stephen D. Muse, (Boston: Holy Cross Orthodox Press, 2004)
4. Abbess Michaela. ”Hope in the Fields of Kosovo” The Orthodox Word No. 205 (1999): 57.
5. Eric Fromm. (1956) The Art of Loving. (New York: Harper & Row Publishers, Inc., 1956)
6. Rev. John Sanford pointed this out in a lecture given at Loyola College Pastoral Counseling Department in Maryland, October 1990.
7. Irvin Yalom. Love’s Executioner: And Other Tales of Psychotherapy (New York: HarperCollins, 1989)
8. Stephen Muse. “Dear Jesus Why Did Our Child Have to Die?” The Pastoral Forum. Vol 13, No.2 (1995): 4-6.
9. F. Shapiro. Eye Movement Desensitization and Reprocessing. (New York: Guilford Press, 1995). This is a powerful method of rapidly processing trauma and grief that proved very useful with Bonnie. It is highly person-centered and relatively free of interpretive overlays. The person re-experiences their pain and conflicts in a safe environment with a high degree of inner attention to the links between sensation, feelings and thoughts.
10. E. Kadloubovsky and G.E.H. Palmer. Writings from the Philokalia on Prayer of the Heart. (London: Faber & Faber, 1975).
11. J. Marler and A. Wermuth. (1995) Youth of the Apocalypse (Alaska: St. Herman of Alaska Brotherhood, 1995): 168-188.
12. G. Durasov. Beloved Sufferer: The Life and Mystical Revelations of a Russian Eldress: Schemanun Macaria. (Alaska: St. Herman Brotherhood Press, 1997).
13. A. Bloom. Beginning to Pray. (New York: Paulist Press, 1970).
14. M. Alexandra. “Conference of Mother Alexandra” in Bolshakoff, S. & Pennington, B. In Search of True Wisdom. (New York: Alba House, 1991): 164-169.
15. T. Hopko. “Living in Communion: An interview with Father Thomas Hopko.” In Parabola 11.3 (1987): 50-59.
16. J.M. Nouwen. Here and Now: Living in the Spirit. (New York: Crossroad Publishing Company, 1997)
17. L. Hall. An Affair of the Mind: One Woman’s Courageous Battle to Salvage her Family From the Devastation of Pornography. (New York: Tyndale House Publishers, 1996)
18. This article was adapted from From Sickness or Sin: Differential Diagnosis and Discernment, John Chirban, ed. (Boston: Holy Cross Press, 2001)