I Confess: Cognitive Behavioral Therapy and the Gospel
“But just as we have the same spirit of faith that is in accordance with scripture—"I believed, and so I spoke"—we also believe, and so we speak” (2 Cor. 4:13).
“For with your heart you believe and are justified, and with your mouth you confess and are saved” (Rom. 10:10).
“Because I am, I suppose...worthy or whatever, of love and value, or something, to my loved ones,” I sputtered.
“Dan, you need to say it as we talked about it. You need to say it like you believe it,” responded my psychiatrist with a fair amount of exasperation.
And so, quietly and with feigned confidence, I repeated, “Because I am worthy of love and value to my loved ones.”
“Good,” she responded, “Keep doing that. Say it many times a day and whenever you feel the darkness start to overcome you and when your conscience starts to tell you otherwise.”
Imagine how silly I felt, sitting there repeating this self-help mantra over and over. As silly as it felt, and still feels, I have followed my psychiatrist's instructions and again learned the power of speaking truth. And I know that when it starts to feel like the life is being sucked from me, I can confess all the truths. I am worthy of basic dignity. I am baptized. I am not worthless or a burden. I am forgiven. I know, and so I speak even if these things don’t feel true and sometimes especially when they don’t feel true. Of course, the positive confession of a thoroughly modern style is ripe for criticism as psycho-babble, pandering to snowflakes, and feeding the narcissists. I understand this, and perhaps this will be written off in the same way we moderns dismiss Luther’s understanding of the demonic or melancholic. Nevertheless, let me suggest a parallel between the modern psychiatric practice of Cognitive Behavioral Therapy and the good news of the Christian faith, so often a salve for those of us who tend to fight lonely battles of solitude and doubt.
I said these words of basic truth and extraordinary grace (“I am not worthless, I am a child of God..”) aloud, sheepishly, even though I didn’t believe they were true. Merely speaking them didn’t make them true. I of all people recognized the wild inconsistencies between the internal situation I was feeling and the external confession I was making. But in saying these things aloud, I was able to fight back some of the lesser demons instinctively. It works, call it what you will. I tend to be a radical empiricist when it comes to my mental health.
Happily, instead of “should?” the question surrounding Christians and mental health professionals seems now to surround the question: “what kind?” In my case, I have found some of the profoundly helpful techniques practiced in Cognitive Behavioral Therapy to not only help alleviate the dark nights of doubt and fear but also to illuminate enough truth about the human condition to offer parallel analogies to the Gospel. Thus, using this type of therapy is not an issue of the Gospel being subsumed by a philosophy, science or pseudoscience, but rather another means for explaining and exploring the wonders of the reality of the Gospel of Jesus Christ.
Affirmation without Absolution?
Much of the criticism I have found against some types of therapy claims that by simply probing, asking, and affirming one is embracing a modern philosophy of “you do you,” what some may call hedonism. By affirming, I mean to treat the person with the rights and respect they have as a fellow child of God,made in the image of God, and for whom Christ died. I believe all people should be affirmed, and seen, and heard regardless of any situation which you, or I, might find personally disturbing. For those who suggest that our culture is one of “too much” affirmation, I might suggest it is possibly not enough, at least in the right place. Our first job is to affirm the divine image, not to judge. This is not to deny the reality of judgment, but to put it in its proper place. Many in the minority tend to need the most affirmation but instead receive judgment too quickly. In Christ, rather than simply giving affirmation, however, we can go a step further and proclaim absolution.
Can’t We Trust Our Pastors to Be Counselors?
If absolution is what is ultimately necessary, why don’t we turn to pastors and leaders in the church instead of psychologists in secular institutions? Or perhaps one should only meet with a therapist that shares the same Christian worldview? While this is a reasonable sounding argument, it starts to break down when you apply the need for a sanctified replacement for all of the world’s institutions. I believe our understanding of the priesthood of all believers and our doctrine of vocation similarly help us to not only safeguard the Gospel but also explore the gifts of common grace in the form of doctors and medicines.
A truth that flowered out of the Protestant Reformation was the doctrine of vocation as an engine for social change and development. No longer were the priests or pastors above the factory workers, farmers or mothers. The doctrine of vocation sees the entire world infused with meaning, even if hidden as under a veil. Whether you are getting a pulley to work, a lung valve replaced, or feeding a hungry table, all of those hands are the hands of God. The doctrine of vocation places value on specialization and training and seeks to uphold professionals by not confusing roles. Pastors and friends can and should listen and absolve, but needn’t be burdened with the vocation of another.
Maybe it’s Just Plain Silly
I’ll admit one last possible complaint against the practices of Cognitive Behavioral Therapy, might be the simplest and most embarrassingly persuasive: saying things does not make them so. It reminds me of an episode of “The Office,” when the superbly naive Michael Scott walks in the front door of the office after a particularly damaging financial decision, and shouts, “I declare bankruptcy!” At this point, one of the men in accounting takes him aside and asks him, “Do you know, Michael, you don’t just declare bankruptcy, but you actually have to fill out paperwork,” to which Michael responds, “Nope, that’s not how it works, that is why it's called declaring bankruptcy.” We all see the foolishness in Scott’s belief in the power of declaration. But a core tenet of Cognitive Behavioral Therapy is in speaking things, almost declaring things, to be so. The researchers point to the creation of neural pathways that can retrain the mind to stop thinking negative thoughts automatically. Of course, those of us who suffer from most kinds of mental illness understand the harsh nature of these accusations and doubts. These things are rarely “cured” by words, but it is (personally) encouraging to see the benefits of research that point to the healing power of words.
I’m reminded of one of the most oft-asked about lines in the translation of Martin Luther’s “A Mighty Fortress” (Eine Feste Berg): what is the “One little word [that] shall fell him”? The next stanza suggests that this word is above all earthly powers. Luther is playing with St. John’s Gospel (In the beginning was the Word) and also the Word of absolution. In his own throws of depression and bouts of demoralizing and demonic self-doubt, Luther is said to have proclaimed to his accuser:
“You should tell the devil,...For if you can tell me that I am a poor sinner, I, on the other hand, can tell you that Christ died for sinners, and is their Intercessor...You remind me of the boundless, great faithfulness and benefaction of my Lord and Savior Jesus Christ...to Him I direct you. You may accuse and condemn Him. Let me rest in peace; for on His shoulders, not on mine, lie all my sins.’”
Therapy with words might sound silly. But the heavenly doctor has not only given us the skilled hands and minds of those we entrust our physical bodies to, but also the antidote for that which ails both our physical and spiritual maladies. Cognitive Behavioral Therapy works for me, not because it substitutes a temporal and flimsy antidote to my problems but because it points me to the God who has adopted and baptized me. “In the beginning was the Word,” and this Word goes out to the ends of the earth and does what it set out to do. We are a people of the Word, an efficacious Word that not only speaks but effects through what He speaks. Our God utters to us the Word of life with both absolution and affirmation: you, and I, are forgiven and baptized into Jesus, in whom God is well pleased. Amen.