I recently had an interview at a local counseling center for my graduate-level internship, and the topic came up about my theoretical approach. My graduate program is psychodynamic and family systems in orientation, and these are approaches I have grown to appreciate over the years. But several years ago, I would have quickly claimed allegiance to cognitive behavioral therapy. And so the director of the counseling center was trying to assess if she would assign me to herself, who practices CBT; or to another therapist at the practice who specializes in psychodynamic therapy. After my years of experience in lay counseling and studying, I can see the merits in both, and I honestly hate how the two schools of thought appear to always be at odds. And yet, theoretically, I must admit that they are quite opposed. So how do I reconcile my affinity for both styles?
I can only answer that the appropriateness of one approach over another depends on where the client is at. Precisely, I’m most interested in where the client is at developmentally. Ideally, people should be able to face the challenges of life with some social support, as they develop certain necessary skills attained by successfully meeting previous challenges. Such is the basis of Erikson’s theory of psychosocial development (Erikson, 1980). By God’s design and the necessity inherent with living in a fallen creation, people really need relationships and environmental support to fulfill their needs at each stage of life. (One might argue that relationships themselves are the very needs we have to fulfill.) And so if we look at the goal of counseling to make the client more self-sufficient (so far as our theology permits) and socially competent, then I would reason that the most appropriate theoretical approach depends on the client’s current developmental stage.
According to the psychosocial model, each stage of development is characterized by a certain crisis (usually interpersonal in nature) and the resolution of which will yield a particular strength needed in order to adequately deal with the next stage’s crisis. Of course, the resulting strength lands on a continuum, making the degrees on the lower or higher ends possible liabilities, if not at least unique personality traits that contribute to a variety of interesting challenges in life.
- Infancy – Trust vs. Mistrust. The target strength is hope, with too much causing gullibility and too little causing withdrawal from life.
- Early childhood – Autonomy vs. Shame. The target strength is will, with too much causing impulsivity and too little causing compulsivity.
- Play age – Initiative vs. Guilt. The target strength is purpose, with too much causing ruthlessness and too little causing inhibition.
- School age – Industry vs. Inferiority. The target strength is competence, with too much causing virtuosity and too little causing inertia.
- Adolescence – Identity vs. Role Confusion. The target strength is fidelity, with too much causing fanaticism and too little causing repudiation.
- Young adulthood – Intimacy vs. Isolation. The target strength is love, with too much causing promiscuity (if that can even be called “love”) and too little causing exclusivity.
- Middle adulthood – Generativity vs. Stagnation. The target strength is care (for the world and one’s legacy), with too much causing overextension and too little causing rejectivity and self-absorption.
- Old age – Integrity vs. Despair. The target strength is wisdom, with “too much” causing presumption (which ceases to be wisdom) and too little causing disdain.
Obviously, this model (and especially this brief representation of it) is not exhaustive. It omits or does not expound as much as it should on other areas of development, such as social skills, conflict resolution, cognitive, and moral development (we have Piaget and Kohlberg for some of those topics). Although Erikson was a major proponent of self-definition (his very name was one he created himself in order to proudly say “Erik son of Erik”), he developed this model during an era in Western society that still had very clear social and occupational life roles, and even his proposed “strengths” betray a bias toward a life of industry and production.
Nevertheless, as a Christian, I find Erikson’s conclusions to be very significant, as they parallel guidance in Scripture and practices in Hebrew culture (Hegstrom, 2006).
- Birth to 13 – Age of Directives. The immediate family teaches the child the foundations of their faith, responsibility, accountability, and respect.
- Adolescence – Age of Decision. The young person is now responsible for the consequences of his/her own choices.
- Adolescence to 30 – Age of Parental Management. The extended family mentors the young person in preparation for a trade and marriage. Only until a man reaches age 30 is he considered “full stature.” I find it fascinating how modern-day theorists continue to extend the age of adolescence and have introduced the idea of “emerging adulthood” (fueled by the discovery that the brain does not finish developing until about age 25, with the areas most involved in self-control and higher reasoning completing formation last) when all along God had a system in place to provide the necessary instruction and guidance in these difficult years.
If we understand that development is lifelong, then I argue that most psychological and relational problems are rooted in development. Therefore, meeting people where they are means to meet them at their developmental level and to assess which strengths they need reinforced or tempered or acquired for the first time. And depending on the task at hand, and the individuality of the client, either a cognitive-behavioral or psychodynamic approach may be most appropriate (or some other approach, like family systems, reality, gestalt, etc.). Perhaps the individual never gained a sense of competence and self-efficacy. I would reason that some form of skills training in an emotionally supportive relationship would best meet that developmental milestone that is long overdue. Or maybe as a result of early childhood neglect or abuse the client has an unstable sense of trust in others and self. No amount of cognitive restructuring could make up for the attachment loss the client suffers. Instead, through a long-term, consistent, nurturing therapeutic relationship the client may finally gain a new object of trust to internalize and integrate into his/her sense of self and relationship patterns.
But even in my own conclusions, as rational and aligned with Scripture as they may be, I need to remind myself to be flexible.
God works with each person in different ways. I’m reminded of this every now and then when I don’t get the response I was expecting when I reveal truths that were instrumental for my own breakthroughs from low self-esteem, depression, and compulsive behaviors. As we adopt or integrate our favorite theories, it becomes very easy to deceive ourselves into thinking every person can fit a certain theory or treatment plan. People are individuals and their goals (including the implicit ones we don’t discuss) and treatment techniques need to be individualized. But that can be a lot of work. And I’ll bet that it’s not just a dogmatic commitment to a theory that locks us into a certain model but also an unwillingness to be creative. (And perhaps not even an unwillingness per se, but just a lack of creativity probably resulting from stress and burnout.)
Jesus certainly used variety when he touched people’s lives and healed them. Sure, he had his staples (like healing people by touching them, and he did feed the 5000 and 4000 in similar ways), but he was not afraid to mix it up sometimes. If he healed some blind people he might command them to see, spit in their faces, or put mud in the eyes. Need to understand what the Kingdom of God is? Jesus did not endlessly repeat the same analogy until people got the message; he used multiple parables for the same topic. Jesus simply would not allow us to put him in a box.
Ian Jones (2014) makes the case that from the beginning, in his interactions and interventions with us, God has always met us where we are (rather than where we should be). Precisely, God’s concern is our location in our relationship to him and then to others. Even in dealing with Adam and Eve after they sinned for the first time (Gen. 3:9-11), God asks “Where are you?” Why ask if he already knows? God says he knows our needs before we even pray (Matt. 6:8) . . . but that doesn’t mean that we are not supposed to still pray for them. Maybe he wants us to be able to articulate what we believe is our problem. And for us human counselors who do not have the luxury of omniscience, he models to us the necessity of joining with the client and understanding (as first-hand as possible) the client’s perspective and subjective experience.
However, the appreciation of subjective experience is not denial of objective reality. God does not ask where we are because he does not already know, nor does he ask us in an attempt to empower us to create our own truth. God knows the reality of where the client is, even if the client does not, and of course even if the therapist doesn’t know. Even more importantly, God knows where the client needs to go next. And I do not believe God desires to keep the client’s location a mystery (in so far as it helps us know where to go next with the client). The client may be on the right track already, or the client may need a serious detour. In his encounter with the Samaritan woman at the well (John 4:1-26), Jesus revealed exactly where she was in life. And he knew exactly what she needed, though she did not appear to know it yet herself. She thought she was going to get help to deal with thirst–and that issue certainly got resolved first–but the encounter did not end there. Jesus knew that her deeper need was for his living water.
So, yes, we sincerely and respectfully ask clients where they are and where they are going. We may even ask others in the client’s life these questions about the client (either directly or by asking the client what others say about them in these regards). But we should never neglect our need to depend on God for the whole truth. We trust that God will reveal what we (counselor and client, but most importantly the client) need to know and in his time. We need divine wisdom to guide our treatment plan and implementation. Wisdom is not just a trait of the elderly, for even Erikson admitted (Hoare, 2002) what Proverbs makes very clear: we need wisdom in order to successfully meet each developmental crisis!
And even when we know where we need to go, I need to remind myself that there is more than one way to get there. There is no cookie-cutter counseling. I wouldn’t want there to be. That would be boring! My appreciation for this reality has evolved over my years of leading a support and recovery group for men at my old college. At its incarnation, I designed the group to be very instructional, as I created psycho-spiritual-educational lessons for each topic I expected to address and I taught cognitive restructuring, behavioral, and social skills. Today, I only occasionally use lessons. I now savor the adventure of not knowing in advance exactly how each session will go. Some of the best discussions have arisen out of me leaving it up to the group to choose the night’s topic. And through our banter, God always weaves in a lesson. As we just recently reflected on this past school year, one of the members commented how he most valued those sessions. Now, am I discounting a structural, educational group model? Of course not (I still incorporate that), for if I were, I would be contradicting my very premise! Each client needs a different approach! In each school year, the group needs something different, and even at different points in the school year what the group needs may change. Perhaps this Spring, the group most needed freedom and the time to build cohesion over more open discussion, especially after doing so much hard work leading up to and including the sharing of their life timelines.
Where we are going with the client should be toward greater levels of maturity in relationship to self, others, and God. What a disappointment I would consider the counseling if all I did was help meet a temporary need but not help the client attain or identify a strength needed for the next inevitable challenge! Above all, I would hope that the client comes to a revelation of God as their greatest source of strength, for I measure true maturity by one’s acknowledgement of dependence on God.
Perseverance must finish its work so that you may be mature and complete, not lacking anything.
Erikson, E.H. (1980). Identity and the life cycle. New York, NY: Norton.
Hegstrom, P. (2006). Broken children, grown-up pain: Understanding the effects of your wounded past (2nd ed.). Kansas City, MO: Beacon Hill.
Hoare, C.H. (2002). Erikson on development in adulthood: New insights from the unpublished papers. New York, NY: Oxford.
Jones, I.F. (2014). A theology of Christian counseling 2.0. Forest, VA: American Association of Christian Counselors.