Book review of Cognitive Behavioral Therapy for Christians with Depression: A Practical Tool-based Primer by Michelle Pearce. Templeton Foundation Press, 2016, 231 pp. ISBN: 978-1599474915.
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Cognitive Behavioral Therapy for Christians with Depression by Michelle Pearce, PhD is a phenomenal guide to treating religious clients suffering from a depressive episode. It not only provides an evidence based treatment model, but exemplifies the importance of compassion and respect for the client and their values and beliefs that they bring to therapy. Although this book targets mental health professionals, Dr. Pearce includes resources for clergy and spiritual leaders who may be counseling a member of their church suffering from depression; these resources and the treatment modality are well articulated and easy to follow for both clergy and mental health professionals alike.
Dr. Pearce explains that while cultural and religious diversity are necessary ethical and clinical competencies, few clinicians utilize the healing properties religion has to offer our clients either because we are too hesitant to integrate religion into therapy and/or because we have not received adequate training in how to do so. Importantly, Dr. Pearce posits that religion will (and should) be a part of our therapy if religion is important to our clients, whether or not the therapist explicitly discusses it. She provides compelling evidence that religion helps clients to cope with depressive symptoms, instill hope, and buffer against stressful events and, therefore, should be incorporated into psychotherapy when possible. Additionally, she emphasizes the importance of conducting in-depth assessment of each individual client’s religious beliefs, values, and level of religiosity and avoiding assumptions. As therapists, we cannot assume that each Catholic or Baptist or Protestant are alike; we must first understand how religion plays into our client’s life before integrating religion into treatment. She provides helpful questions and examples on how to gather this religious history, which is extremely useful particularly because religious diversity and considerations are infrequently taught during our training as mental health professionals. Another important topic that she raised was how to incorporate religion into treatment when religious beliefs are part of the problem. This was particularly interesting because so often clients may be experiencing shame, guilt, despair, and conflict because their religious affiliation disapproves of a certain behavior or character trait. For example, she explains the negative psychosocial experience of Christians in relation todivorce, spanking, faith in healing. This understanding can be applied to Christian clients struggling with sexual orientation, abortion, or use of contraceptives as these are highly contentious issues within the Christian faith.
Dr. Pearce provided an excellent brief introduction of the Cognitive Behavioral Therapy (CBT) model and how CBT works. Impressively, she included biblical references that speak to the relationship between thoughts and feelings; this interesting additional resource can aid in psychoeducation for the client and provide biblical reassurance that CBT may in fact work in dealing with their depression. A clear, concise explanation of Christian Cognitive Behavioral Therapy (CCBT) was provided to the clinician and practical examples of how to introduce CCBT to the client were discussed. CCBT differs from typical CBT only in that it harnessed the client’s religious teachings, values, and practices to change dysfunctional thought patterns and, thereby, reduce depression.
The second part of the book focuses on seven practical CCBT tools to use throughout therapy. These include: renewing your mind (planting truth), changing your mind (metanoia), finding God and blessing in suffering (redemptive reframing), reaching out and connecting, letting go and letting God (acceptance and forgiveness), gratitude, and giving back (service). These chapters were filled with adequate scientific evidence supporting these tools, case examples, biblical passages to reference and suggest to clients, example dialogues and questions to facilitate client reflection. As a clinician, this portion of the book was extremely pragmatic and informative. Additionally, the plethora of examples may aid in reducing the clinician’s anxiety about bringing up religion during session or anxiety relating to not having enough knowledge about passages or values. I was particularly impressed with Figure 5.1 in which she delineates the 10 common cognitive distortions and provides theological reflections for each one. This is a useful tool not only for psychoeducation, but for reflection and metanoia. The only criticism, or rather an observation,, was the missed opportunity to elaborate and explicitly discuss Jesus’ doubt and questioning of God during His crucifixion as the most impactful example of redemptive reframing; “My God, my God, why have you forsaken me” (Matthew 27:46). An elaboration may have helped clinicians who are unfamiliar with the Bible or the Passion of Christ to understand and convey to their clients that even Jesus – the perfect son of God, whose entire life purpose was to die for the sins of His followers – questioned his suffering and pain during His torture and death. This example, in my opinion, would have been more impactful and validating to clients who feel guilty over questioning God, being angry with God, or blaming God for their suffering because it exemplifies that everyone, including Jesus, has questioned suffering and that it does not make you a bad person or a bad Christian. In fact, it is quite liberating to realize that questioning is expected and helps to restore the client’s relationship to God in finding new meaning and purpose in their trials.
Overall, I enjoyed Michelle Pearce’s Cognitive Behavioral Therapy for Christians with Depression. It was well articulated, easy and interesting to read, and provided many practical examples as well as biblical passages. These positive features of the book allowed for the therapist to refer to and to integrate them into treatment, regardless of the therapist’s faith or level of understanding of Christianity as a whole.