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Foundations for a psychotherapy of virtue: an integrated Catholic perspective.

Recent efforts have explicated Catholic anthropological foundations for clinical psychology (Brugger & the faculty of the Institute for the Psychological Sciences, 2008), incorporating a positive developmental and therapeutic psychology paradigm in terms of three levels: basic virtues, character strengths, and practices (Titus & Moncher, in press). In this article, we consider a psychology of virtue, which draws from a virtue-tradition with its achievements in philosophical and theoretical psychology (see, e.g., Aristotle, trans 1941; Aquinas, 1270/trans 1981; Hauerwas, 1981; John Paul II, 1998; McIntyre, 1981; Pinckaers, trns 1995, 2005; Titus, 2006). From within this tradition, we have identified certain anthropological principles relevant to the task of psychotherapy that spring from theological and philosophical sources (Moncher, 2001).

Inasmuch as we take an explicitly CatholicChristian perspective, we differ from other recent efforts to re-appropriate virtue in psychology, both those that assert a non-normative framework and those that take a relativistic approach to moral norms. On the one hand, the positive psychology paradigm of character strengths and virtues has attempted to abstract itself not only from particular religious traditions, but also from moral norms as such (e.g., Seligman, 2002; Peterson & Seligman, 2004; Joseph & Linley 2006; Snyder & Lopez, 2007). For example, Peterson and Seligman (2004) claim their "richer psychological content and greater explanatory power" (p. 88) is descriptive of character strengths, but without normative reference. While seeking moral references for good character in a pre-empirical moral anthropology (through the construal of the nature of virtue and the notion of positive human nature), they distance the inner motivation of the virtues from moral considerations (laws and principles) and from the normativeness of human nature. Such a separation of virtue and ethical sources (moral inclinations, sentiments, law, and principle) renders both psychological guidance and moral agency indecisive. While this approach may give some clues for positive growth, we find that it has not yet succeeded in understanding the role of virtue in psychotherapy (Titus & Moncher, in press; Titus, 2008). On the other hand, others see psychotherapy as moral discourse (e.g., Cushman 1990, 1993) and affirm the necessity of moral borders. Cushman (1993) sees the psychotherapist as a resource in the patient's discernment of moral issues (see also Tjeltveit, 1999), and claims that "It is the job of a psychotherapist to demonstrate the existence of a world constituted by different rules and to encourage patients to be aware of available moral traditions that oppose the moral frame by which they presently shape their lives" (p. 109). Moreover, he postulates an empty self, which is filled by ambient historical, cultural, and moral contexts, but only with relativistic references.

What the Catholic anthropology of this essay expresses, on the contrary, is a humble confidence in a moral framework that is sure enough to offer clear guidance and large enough to include room for faithful creativity and cultural differences. First, as part of a philosophical effort, an understanding of the human person is reached through the use of reasoned observation about human nature as embedded in culture and particular communities but also in a world that instantiates a deeper orderliness that underlies the relative disorders and the particularities of history. This work of theoretical psychology (or a philosophical anthropology) identifies the human person as embodied, relational, rational, and volitional. Second, the theological aspects draw upon the faith-based understanding of the human person, rooted in revelation as expressed in Judeo-Christian Scripture and tradition, particularly in a Roman Catholic perspective. This revelation of the origin and finality of human persons aids in distinguishing the numerous well-ordered means of pursuing ultimate human ends from various disordered similitudes.

It is not insignificant when Catholic and secular psychology texts differ in the content, categorization, and hierarchy of virtuous qualities. However, secular and such religious formulations are not necessarily at complete odds concerning issues of justice, respect, basic dignity, and so on; and in various psychosocial domains there is a possibility for cross-fertilization and mutual understanding. The content of the virtues get played out in various ways across cultures with different accents. Although the basic virtue areas are operative across cultures, the associated virtue strengths and practices are necessarily expressed with marked personal and cultural variations.

In contemporary thought, the related classical notions of the developmental originality and normative constancy of virtue are often misrepresented. Virtue theory is commonly perceived in the light of one or another of two common extremes. On the one hand, each virtue is perceived as an "ideal" norm that must be instantiated in the same way or not be considered virtue at all. On the other hand, there is the notion that virtue theory charts a developmental path that is absolutely unique to each person, therefore, lacking an ultimate normative grounding or goal. On the contrary, in Aquinas' Christian virtue perspective both elements (normativeness and development) are held in a mutually dependent unity, which offers a stable yet dynamic basis for psychotherapy.

An important characteristic of the Catholic virtue tradition is that it recognizes human potential and natural development which are central to the process of psychotherapy. In particular, we suggest that psychotherapy might seek not only the reduction of symptoms, but also growth in the positive human capacities at three levels (major virtues, associated virtues and character strengths, particular practices)--in fact, we assert that there is a concomitant movement in symptom reduction and in virtuous practices and development. With due consideration of its neuro-biological bases, psychological health ultimately is related to being able to choose "goods" that are objectively adequate for human flourishing and acting in a consequent manner; at this level, there is a convergence between psychology and what has classically been called natural acquired virtue. As patients become increasingly free to act and make choices in their lives, encouraging the exercise of related virtues and practices can have a dramatic impact on their mental health in terms of self-knowledge and self-mastery, but also of self-acceptance and trusting that they are worthy of love (Moncher, 2001). Furthermore, in order for the therapist to provide this encouragement coherently and effectively, it is also important that he or she be focused on living and learning the developmental pathways of the different groups of virtues in his or her own life.

Within this understanding of virtue, we will now focus on specific clinical applications utilizing a focus on emotions in psychotherapy. Many clients seeking psychological help are suffering in ways that require immediate and compassionate attention at preliminary levels of emotional, relational, and motivational well-being. These issues must be resolved in order to best prepare the person to pursue a fuller growth in virtue and related practices. Moreover, on a clearly spiritual level, we will consider briefly how the theological virtues of charity (i.e., love), faith, and hope, can be operative in the therapy process and provide a framework for understanding suffering and recovery.

The Case of Sister Lydia: Brief Family History and Background (1)

In order to make concrete the clinical application of this theory, we will present an overview of a case study that we will re-visit throughout the article.
 Lydia, a consecrated member of a
 Catholic religious congregation, is
 the oldest female of several children
 born in an intact family. She came
 from a middle class, Mid-western
 background, with a traditional family
 arrangement of father working
 outside the home and mother staying
 with the children. The family was
 raised in the Catholic Church but
 was not active outside of the Sunday
 obligation. Lydia often took on the
 role of protector and guide for her
 younger siblings who were at times
 physically abused by her father. Her
 mother would disappear when the
 father erupted in rage, and would
 even at times tell the father things
 that would predictably cause violence
 to her children. One remarkable
 aspect of the environment of her
 family life is that her parents were
 kind and gentle with people in the
 world, but angry and critical within
 the family. Sister Lydia learned that
 it was dangerous to relax, to trust in
 other's goodwill, and so developed an
 independent style and an assertive
 self-reliance, stuffing her feelings as
 a habitual response that kept her
 emotionally safe. Within her current
 'family' of the convent, however, she
 is surrounded by others who are not
 dangerous to her physically or emotionally,
 but still she has difficulty
 shifting her stance in these relationships
 to allow for more intimate
 relating appropriate to the circumstances.
 In the living of community
 life, Sister and her superiors realized
 that there was something amiss in
 how she was pursuing holiness.
 Somehow, the human virtues she was
 trying to enact were not bearing the
 expected fruit.


The Human Person and the Virtue Perspective

Any psychotherapy that seeks to have a stable anthropological footing must answer some crucial questions: How does a general notion (such as virtue) accommodate diverse times and cultures, different ages of life, and the distinct biological sexes? Moreover, how do we explain human capacities for excellence, continuity, and creativity, along with the contrary human expressions of mediocrity, instability, and rote repetition? Virtue-based anthropology attempts such an account by recognizing the human person has an origin and a goal, as well as a need for personal development in the process, without denying a certain diversity in defining associated virtues. First, although not uncontroversial, it accepts from philosophical argument (e.g., D. McInerny, 2006) and empirical findings (e.g., Ekman, 1992, 2003) that human persons have a nature, a given structure that specifies the species by not only physiological traits but also natural inclinations toward fitting human lifegoals broadly-speaking. Second, it recognizes a developmental perspective that distinguishes various large areas in which human beings need to grow, in order, third, to approach the goal of mature flourishing, becoming free and responsible agents. That is, the anthropological vision identifies a structure of human origins, pathways for development, and fitting expressions of maturity (Schmitz, 2009).
 In psychotherapy, Lydia's difficulty
 was conceptualized as a result of the
 virtues not being interiorly formed,
 but instead being performed primarily
 out of duty to the exterior law;
 thus, she was seen to express an emotional
 and virtue profile blocked at
 the stage of a beginner (dependent on
 duty and external rules), with the
 incumbent difficulties, dryness, and
 lack of spontaneity. This conceptualization
 was put forth by the therapist
 in the context of their shared faith
 background, along with minor yet
 significant self-disclosure of his own
 experiences of this process. This intervention
 normalized her experiences
 and also enabled Sister to understand
 why she is exhausted when
 going about her daily routine in the
 convent trying to do the right things;
 she has reflexively and habitually
 stuffed her emotional reactions as
 they arise in order to not become
 overwhelmed by them and possibly
 behave inappropriately. As a result,
 she has tended to resist all emotions
 even if consequent to the goods that
 she seeks to pursue.


The Person on the Natural Level: Embodied, Relational, Rational, and Volitional

We would argue that the determinant qualities of human life, of the whole person, can be specified in terms of four philosophical anthropological areas: embodiment, relationality, rationality, and volition, expressed in a unified, developmental manner (Brugger & the faculty of the Institute for the Psychological Sciences, 2008).

First, 'embodiment' involves not only the motoric, perceptual, and biological sex of persons, but also the neuro-biological substrate for human life that is expressed in malleable sense cognition and emotion (see Lakoff & Johnson, 1999). At the level of embodied cognition, we have not only external, but internal senses; for we engender preconscious thoughts (such as judgments of attraction or repulsion) and conscious thoughts (such as memories and imaginings). At the level of embodied affectivity, we have emotions that relate to attraction proper: love, desire, pleasure, and joy, as well as hatred, repulsion, pain, and sorrow; moreover there are emotions related to goods that are difficult to attain, namely, fear, daring, despair, hope, and anger (Titus, 2006; on diverse classifications of emotion, see Ekman, 1992, 2003; Evans & Cruse, 2004; Griffiths, 1997).

Second, 'relationality' involves the socio-cultural dimensions that are necessary for healthy human development and flourishing, but that also can be at the source of some disorders and pathology. The human person has a species-specific nature, which needs to be interpersonally nurtured in order not only to merely survive, but also to attain capacities and to thrive in different forms of excellence. Such nurturance begins in the family and involves socio-cultural practices and interaction with others. The web of relations affects the person for better or worse, from the beginnings already in the mother's womb, until one's death bed.

Next, two other cognitive and affective capacities are proper to human 'intelligence;' namely reason and will. They pertain to the intuitive and discursive qualities that develop throughout a person's life. Intelligence--in its various reasoned and willed forms--is the realm of wisdom, understanding, and commitment, the deepest form of love and self-giving. Quite often, distinctively human intelligence is identified by expressions of conceptual analysis and linguistic expression, tool making and use, complex laws and social relationships, etc. While the capacity for intelligence is shared by the species, its reasoned and freely willed applications are also individual, since the pathways for constructive work and problem-solving are manifold, often marked by cultural propensities and personal limitations. The intellectual affect (will) can be distinguished from sense affects (emotions) inasmuch as the will collaborates with reason in a more direct manner; I can directly will my left hand to rise. The type of collaboration between reason, will, and the emotions is more indirect though nonetheless real; while I cannot will myself so easily to feel anger (although actors have ways of doing so), when I do feel anger there are reasons for it and also reasoned ways to deal with it.

Virtue: A Disposition, Act, or Norm?

The notion of virtue has often been reduced by modern thinkers to a static concept that simply refers either to an act (a single choice or deed) or a moral norm for action. However, the basis of the classic Aristotelian-Thomist approach is the conception of virtue understood as developmental, as an acquired disposition to act (at emotional, cognitive, and volitional levels) in a way that contributes long-term to human flourishing.

Aristotle (trans., 1941) says that virtue involves a firm "state of character which makes a man good and which makes him do his own work well" (n. 1106a23). Aquinas (1270/1981, I-II 55.4) employs an Augustinian definition that includes not only acquired but also infused virtues; it says: "virtue is a good quality of the mind, by which we live righteously, of which no one can make bad use." Concerning the internal potency and causes of virtue that exist in the moral agent, Aquinas (I-II 63.3) moreover argues that all acquired virtues (intellectual and moral) "arise from certain natural principles pre-existing in us." This vision of virtue, as a disposition, resists identification with a tendency for static, rote repetition. It involves rather the life-long training of capacities that tend toward general types of good acts. Through the work of practical reason, people shape their inclinations. In time, wellordered acts create emotional, relational, rational, and volitional dispositions which find harmony when exhibiting a twofold order: the dispositions ordered among themselves, and ordered to the person's ultimate end (D. McInerny, 2006). Thus, through the virtuous dispositions the person seeks to employ his whole array of strengths for the sake of personal flourishing, the good of the community, and the glory of God (a three-fold love). Such a developmental view of virtue is consistent with psychological models that are sensitive to a patient's human potential for change both for better, in the case of positive growth, and for worse, in the case of psychological disorders, as well as consistent with CatholicChristian training models for psychologists (Sweeney, Titus, & Nordling, in press).

It should be noted that a practical approach to the virtues involves working on their particular matters (namely emotions, relationships, willing, and reasoning--and the interaction thereof) as well as their formal contents. Talking about virtue, however, is mostly a practical language involved in describing the course of strength or difficulty: growth or decay in the life of emotions like fear and love; the demands and potential in interpersonal relationships; and in the types of choices and reasons that we pursue or avoid. Each type of matter has multiple types of directionality and consequences, as well as correlations with the other matters. For example, the emotions embody diverse manifestations: from exaggerated moments, to timid expressions, to well-managed dispositions. However, each expression of emotion involves some past or present interaction with reasons, choices, and interpersonal relationships.

The timing with which a therapist introduces the language of virtue is important and must consider several factors. First, the patient's level of stress and general emotional health should be assessed. While a discussion of the matter of virtue will be needed, an explicitly normative language of virtue is most often not advised during times of crisis as it would be difficult for the patient to process the information discussed. Second, a patient's ability to successfully enact their intentions must be assessed, because some measure of self-control (volitional health) is necessary so that early success can be achieved to build upon in therapy. Third, account should be taken of the cultural expectations that have influenced the patient's understanding of fitting expressions of care, affection, anger, fear, masculinity, femininity, and so on. Finally, the patient's history of spiritual guidance and experiences should be assessed, as some people have been problematically (though perhaps inadvertently) shamed by others intending to encourage their religious and moral growth by challenging them to overcome weakness through spiritual means, when a privation at the natural or social level was a barrier to being able to do so.

Sister Lydia's Virtue: Inclined to, Pursued, but Imperfect
 Because Lydia had not acquired a
 disposition towards virtue in the
 complete sense, she was unable to
 function easily (that is, with promptness,
 ease, and joy) in her religious
 community. Still, as a youth, despite
 lacking formation, Lydia possessed a
 proclivity towards virtuous choices
 as an act or norm. Her natural
 inclinations are manifest in an
 example from her adolescence:
 Lydia had arisen early one morning
 to clean house before going to basketball
 practice, attended a full day
 of classes, and did homework during
 study hall when most peers were
 non-productive. Following her
 game, she helped clean the bus,
 accidentally leaving her books in the
 process. Upon arriving home, she
 called the bus depot, learned she
 could not get her books until the end
 of the following school day, and so
 was unable to finish her homework.
 She put her younger siblings to bed,
 and did further chores in the home.
 The next day, her teacher berated
 her in front of the class for not having
 her homework, being irresponsible,
 an example of "what's wrong
 with youth these days." She calmly
 but firmly told him that it was inappropriate
 to talk to her in that manner
 and left class, reflecting on how
 she had not actually been irresponsible
 the day before, but had simply
 made a mistake. Because of the violence
 and chaos in her home, she
 had adapted a style of not attending
 to her emotional state, instead stuffing
 her feelings and focusing on
 actions. So here she knew, intellectually,
 that she had not committed the
 error of which she was accused, and
 took reasonable actions to escape
 from the unjust accusation. She then
 did not process the event emotionally
 and obtain full satisfaction, but
 rather remained bewildered at best,
 and grew in cynicism about adults
 at worst.


Catholic Theological Anthropology and the Virtue Perspective

A Catholic-Christian theological foundation for a psychotherapy of virtue identifies a particular content within the general, philosophical form of the virtues as embodied, relational, rational, and agentive. That is, the difference that Christianity makes for understanding the origin, goals, and developmental pathways of a psychotherapy of virtue is found in the content of the related virtues that constitute the authentic character of the human person seen in the perspective of Christ, who "fully reveals humanity to itself and makes our supreme calling clear," as recalled by the Second Vatican Council (Baum, 1965, Gaudium et Spes, n.22). This perspective is neither a kind of modernism, nor essentialism, nor individualism; if anything, it demands a dialogue with contemporary sciences and culture. Although some Christian thinkers have preferred to mark a complete break between Biblical and non-biblical sources (Tertullian, Luther, Kierkegaard), others have noted the commonalities in the distinct traditions and the potential that humanist (non-Biblical) sources have in aiding Christian understanding of the human person and society (Justin Martyr, Aquinas). Our position is that different sources (scientific and sapiential) should be integrated into an anthropology according to their proper competencies, distinguishing human expressions, scientific descriptions, philosophical norms, and religious authority (Ashley 2006; John Paul II, 1998).

The Person at the Transcendent Level: Created, Fallen, Redeemed

A Catholic variant to and fulfillment of a virtue-based anthropology considers properly theological doctrines which conceive the human person as: (1) created in God's image, (2) marked by the effects of sin, and (3) redeemed by God's initiative in Jesus Christ. First, a key basis for understanding Catholic theological anthropology is the doctrine of the human person being created in the image and after the likeness of God (Gn 1:26-27; 1 Cor 11:7; Eph 4:24; Col 3:10). Human persons, being of human nature, are an imperfect image, or even created "toward" the image of God. Nonetheless, this type of image dynamically tends towards perfection, who is God (Mt 5:48). This tendency is not automatically self-fulfilling or imposed by God; in cooperation with God's grace and in imitation of God's goodness, it demands that as intelligent creatures we move and grow into God's image, by exercising our intelligence, free-will, and self-movement in aiming toward personal and social maturity in Christ (cf. Aquinas, ST I 35.2, ST II-II 23.1).

Next, from the first sin on, human beings have disfigured themselves and the above-mentioned image. The resulting structures of sin are many different kinds of personal and relational disorder. But in the human person these nonetheless remain secondary to the goodness of God's creation. For through God's good pleasure, His dynamic image and basic human dignity still remain after sin. To understand this potential for good and evil, for health and illness, for virtue or vice, we need to understand the whole human person in the light of how the Good News of Christ influences our practices relating to our embodiment, relationality, reason, and will.

Finally, we understand that through redemption in Christ, human beings are restored to a right relationship with God. Instead of annulling human nature, Christ

"restores the divine likeness which had been disfigured from the first sin onward ... He Who is 'the image of the invisible God' (Col 1:15; cf. 2 Cor 4:4), is Himself the perfect man.... Since human nature as He assumed it was not annulled, by that very fact it has been raised up to a divine dignity in our respect too." (Baum, 1965, Gaudium et Spes, n. 22).

Christ offers a way of adoptive sonship, holiness in the Spirit, and a promise of blessedness. In this last regard as attested to by poets and philosophers, humans seek flourishing, especially ultimate beatitude, as the primary goal of their lives. Although understandings of what makes us happy differ, the Catholic Christian vision revolves around the blessedness that is engendered by faith, hope, and love, and that is founded in Christ's teaching on the Beatitudes (Mt 5; Lk 6).

In summary, when Catholic theological anthropology speaks of development, it can deny neither human nature nor divine grace nor human differences in development thereof. Rather it construes a potential growth in natural capacities that is assured by grace, which builds upon, instead of destroying or replacing, human natural capacities and developmental processes (Baum, 1965, Gaudium et Spes, n. 22). With a willing Christian client, a conscious appeal to their faith, hope, and charity can aid the therapy 28 FOUNDATIONS FOR A PSYCHOTHERAPY OF VIRTUE process through cognitive and motivational supports. A therapist's understanding of and ability to utilize these resources will depend to some extent on their own formation, and the willingness and eagerness to reflect on virtue in their own life course. These virtues serve to provide a framework for understanding suffering, hoping for recovery, and a motivation for a better life, even as a primary emphasis is placed on an eternal perspective that does not offer ready-made solutions for problems and pathologies.

Sister Lydia: Theological Virtues
 Why would this young woman, not
 formed to be virtuously inclined either
 by parent or by her peer group, be of a
 mind to stand on principles? We know
 that even before feeling the call to her
 religious vocation, Lydia did not
 ascribe to the family pattern of mistreating
 each other. She instead spent
 her days and nights trying to order the
 house. This might be the result of not
 only a natural inclination to goodness,
 but also the supernatural,
 infused virtue of hope. She certainly
 shows charity in the sense that she
 makes a selfless gift to others [e.g.,
 making sure younger siblings are
 cared for when mother is "too busy" to
 do so]. When she reports praying to
 God that her life and death would be
 used for the conversion of her family
 [prior to knowing exactly what this
 might mean], she shows the virtue of
 faith. If these supernatural virtues are
 operative, we could conjecture about
 the influence of her attending Mass,
 for there she was exposed to scripture,
 the prayers of the liturgy, and in a
 real sense catechized by Christ's model
 of self-giving and hope. Theologically
 we can also speak of the effects of baptism
 with its graces that come in seedform
 and develop over time under
 divine guidance.


Psychotherapeutic Processes, Emotions, and a Christian Virtue Anthropology

Emotions and Virtue

Some philosophers and theologians have a great deal of suspicion concerning the emotions, as sometimes accommodating but unreliable at best (Bonaventure, Kant), or as consistently disruptive or evil at worst (Stoics). However, Aristotle and Aquinas and the Catholic tradition (Catechism of the Catholic Church, 2003, n. 1767) affirm that the emotions are potentially positive energies, which are subject to developmental processes. On the one hand, they express prerational or instinctive judgments that come through sense knowledge of various sorts. The emotions thus provide signs of intelligibility (within beings, interactions, and events) through attractions and repulsions, fears and hopes, angers and loves, and so on. On the other hand, the Aristotelian-Thomist approach to the emotions--which is a foundation for the Catholic tradition--also correlates emotional expression and development with reasoning, willing, and interpersonal relationships.

Aquinas considers emotions to be good in two ways (cf. Aquinas, 1981; I-II, qs. 58-60 and q. 24, art. 3). First, as virtuously shaped emotive capacities, particular emotions express the reasons behind themselves and can point us toward acting in ways that are consistent with goals we have chosen in the past. They express intelligibility at a pre-rational or instinctive level. That is, emotions are good when, as reactions antecedent to reasoning, they tend towards a properlyfocused response; for example, when we have a fitting reaction of pity for those who suffer. Second, emotions are good as felt reactions consequent to an intellectual evaluation of a situation, where emotions can build upon rational decisions, or at least be kept from going to the extremes that blind and disable action. For example, the emotions consequent to a choice to rectify an injustice, can emotionally incline us to anger (1) which is restrained, lest it lead us to commit an additional wrong or (2) which is righteous, that can motivate us to act decisively. This conscious type of emotion exemplifies the significance of being able to read the intelligibility of emotions and to control the focus of one's emotional energy, even if emotions are only under a type of indirect and dialogical influence of reason, will, and social influences.

In contemporary psychological studies, emotion is construed as part of a rapid-action meaning system that informs individuals of the significance of events to their well-being. The functionality of an emotion is impacted by multiple factors associated both with the appraisal that gives rise to the emotion (e.g., its accuracy) and the response it generates (e.g., how modulated it is). Although emotions are not always functional, their benefits on average exceed their costs (Parrott, 2001). The anthropology presented here is consistent with theories of emotion that incorporate reason and will (see, e.g., Frijda, 1986; Lazarus, 1991; Levenson, 1999), since emotion depends upon perception and appraisal in an integrated view of the person capable of responsible action.

Case of Lydia: Regarding Justice
 The challenge of recognizing the reasons
 within emotions and of integrating
 emotions with reasoned judgment
 occurred when Lydia began her first
 job after college. She happened upon
 an irate customer yelling at a fellow
 employee who was overwhelmed and
 apparently frightened. Lydia confronted
 the customer calmly, stating that
 "we don't allow anyone to speak in
 that tone here" followed by "perhaps I
 can escort you out of the building".
 This in her mind being a statement of
 justice or "how people should treat
 each other." In the crisis, Lydia performs
 reasonably, making behavioral
 choices based upon her logical discernment
 of the circumstance. However,
 she neither reports feeling the
 natural accompanying emotions, nor
 recognizes that underlying the customer's
 expressed anger may be an
 even more pressing issue of justice.
 Lydia appears to miss the cues both of
 her own emotions and those of others,
 likely because she has learned not to
 attend to these sensations and sentiments;
 for in her family experience,
 emotions would not be explored, cared
 for, or understood, but instead might
 be seized upon as a vulnerability and
 ridiculed at minimum, if not used
 against her.


Emotions in Psychotherapy

Recent psychological literature provides a basis for our thesis that a priority on emotional, embodied healing is at times critical to the success of a therapy of virtue. Certain factors have been put forth as important elements in treatment outcome: the working alliance, the depth of experiencing, differences in individuals' capacity for engaging in treatment, and emotional processing, which includes both emotional experiencing and working with the emotional significance of things in therapy (Pos, Greenberg, Goldman & Korman, 2003). This last factor has gained attention as researchers of basic emotion processes appear to be moving toward a consensus that emotions are adaptive, emphasizing the utility of emotions in terms of responding to events and circumstances. Emotions are viewed as informing people about their cares and concerns; they prepare the body for action, as directing cognition into modes of operation likely to be optimal for the conditions at hand; and they signal and manipulate others in ways that suit the emotional person's needs (Parrott, 2001). Being disconnected from emotional experience, therefore, means being cut off from adaptive information (Pos et al., 2003).

Furthermore, virtually all theories of psychotherapy give central importance to dealing with clients' emotions in some manner: on the one hand, cognitive and behavioral approaches focus on control or elimination of anxiety or other unwanted emotion; alternatively, psychodynamic, interpersonal and experiential approaches often implicate the avoidance of painful emotion in the etiology and maintenance of psychological disorder (Mackay, Barkham, Stiles, & Goldfried, 2002). Furthermore, multiple schools of thought have found empirical support that facilitating in-session emotional experience is both potent and efficacious (Wiser & Goldfried 1998). For example, standard reviews of humanistic and psychodynamic therapy outcome (e.g., Orlinsky, Ronnestad, & Willutzy 2004) suggest a strong relationship between emotional experiencing in the treatment session and positive therapeutic outcome. Similarly, positive outcome in cognitive therapy has also been found to be correlated with emotional experiencing (Castonguay, Goldfried, Wiser, Raue, & Hayes, 1996; Wiser & Goldfried, 1998).

Relationship between Symptom Reduction and the Capacity for Virtue

Treatment goals in a psychotherapy of virtue have been described generally as management of emotional life, so one can better live in relationships with others, leading towards the development of further rational and volitional virtues (Moncher, 2001). Ultimately the goal is the ability to live a responsible, happy, fulfilling life, which is to say, the morally good life. In contrast, psychological symptoms: inhibit freedom, inasmuch as they promote compulsively consistent (dys)function; are motivated by excessive fear, anxiety, or some similar dysfunctioning emotion; or, are not rationally successful in solving a problem or promoting social relationships. Moreover, symptoms can be concretely effective in reducing the perception of psychological needs, and once they are habitual, allow much less opportunity to practice and to enjoy virtuous behavior.

Because the psychological symptoms of an individual provide an apparent, albeit temporary and dysfunctional, solution to one's difficulties (and distort perception), it is critical that these be addressed prior to considering how the individual might explicitly grow in virtue. Further, while virtue (at a basic level) as defined in Catholic anthropology has an objective character that cannot be changed by either the therapist or the patient, the expression of the virtue (its associate virtue strengths and practices) will vary crossculturally. Therefore, the therapist must be aware of his or her own formation and cultural views about how particular virtues might be expressed. This includes not only ethnic or racial considerations, but also gender, as the expression of virtue strengths and practices acceptable for or tolerated of males and females will vary by culture (see Ashley, 2006; Dueck & Parsons, 2004). Healing of symptoms and growth in virtues are on correlated continua: a person cannot be healed on the one dimension without in some way exploring growth on the other. Therefore, it is helpful conceptually, for both the therapist and the client, to realize that failure to address psychological barriers creates a real obstruction to genuine work on growing in virtue strengths. In other words, not only is it important and helpful to assist clients in reducing emotional distress and related symptoms for their own comfort, it also is necessary to help them understand (rational virtue) and manage (volitional and social virtue) their emotional life (emotional virtues) in order to free them for growth in developing virtue strengths that might be underdeveloped or disordered.

Why and When a Priority on Emotional/embodied Healing?

Within its concerns for overall psychological health, which include relational, cognitive, and volitional domains, psychotherapy often needs to give a priority to emotional/embodied healing for a number of reasons. First, on the anthropological level, the biological based embodiment of cognition and affection influence reason, will, and all practical action. Of particular interest for our purpose are both the emotions and the biocognitive functions (classically called the inner senses); these latter include imagination, memory, the synthetic sense, and the evaluative sense that underlie our pre-rational (and pre-conscious) attraction or repulsion to something or some person. Lack of development or psychopathology at this embodied level negatively influence human capacity to read emotions and to enact one's rational plans and desires with appropriate promptness, ease, and pleasure. It is difficult for some and impossible for others to access fully this capacity to reason responsibly and choose freely without formative attention to their emotional life. "Training our emotions to respond to the direction of reason is a most difficult task, and its achievement is called virtue" (R. McInerny, 1999), which, we would stress, is an ongoing, developmental process. However, again, this is not to suggest that emotions do not have their own unique, positive contribution to human understanding and flourishing.

Second, on the clinical level, this anthropology points to a preferred sequence of intervention. Because we are first bodily-emotional and relational from the moment of conception (prior to the development later in life of the rational and volitional aspects), often the more serious woundedness in a person occurs at the emotional and relational levels. In other words, for a therapeutic process to continue to fruition, it must address sensitively the natural developmental processes and the healing of emotional wounds, in order to lay a firm foundation for the pursuit of growth in the free and responsible use of rationality and will. Clinicians observe that clients who struggle with mental disorder (e.g., addictions, phobias, compulsive behavior) routinely report a problematic gap between their intellectual understanding of the objects and events around them and their habitual emotional reactions to those objects and events. An important component of psychotherapy is the development of the client's ability to disengage from rapid, pre-conscious associations (found in their body and expressed in emotions) and to consider their perceptions from a more objective and sophisticated perspective. However, this cannot be accomplished strictly through rational and discursive procedures. The automatic and habitual manner of a client's emotional life must be experienced and recognized by the client before they can become more insightful regarding themselves (Palmer, 2005).

Theoretical work in experiential-humanistic therapy outlines two ways in which emotions are relevant in treatment. First, providing an empathetic, validating relationship and a collaborative alliance creates the safe environment in which clients can experience their emotions. Second, engaging in evocative, explorative, and meaning-making reflections, as well as emotionally stimulating tasks, gives clients deeper and immediate contact with emotions and helps clients make sense of them. An empathic, strong, therapeutic alliance is needed to create a safe atmosphere such that it is possible to have a specific focus in the clinical task of understanding, accepting, and healing the emotional wounds which bind people to the past and prevent them from the free exercise of their will in the present and future. Therefore, it is not accidental that the "talking cure" that has developed in psychotherapy is person-to-person, relational, and that the therapeutic alliance is frequently identified as one of the common factors in positive therapy outcome (Lambert & Ogles, 2004). The therapeutic alliance includes not only a personal bond between therapist and client in which the client views the therapist as caring, understanding, and knowledgeable, but also an agreement with regard to the goals of treatment and the means by which these goals are achieved, which should be appropriate to the dignity of the human person (Goldfried & Davila, 2005). The effectiveness of therapy is impacted greatly by the trust that the patient has in the therapist and his or her character and motivations. At this juncture, the therapist's character formation is an issue inasmuch as the patient must trust that the therapist not only knows the psychology but also is a proper guide as the process moves toward growth. Having a shared faith perspective (or even a more general recognition of spiritual resources) with the patient may facilitate this process and accelerate the readiness of the patient (as was the case with Sr. Lydia) to take the emotional and interpersonal risks necessary for healing.

While the therapeutic approach discussed here can be effective with non-Christians if modified to be consistent with the patient's worldview, the therapist's understanding of and attention to formation in growing virtue in his or her own life would be necessary to maintain as objective a view of the subject matter as possible, given the impact of sin and the consequent personal frailties and social injustices that occur. Rooted in the Christian anthropology discussed here, clinicians should come to understand themselves as well as their patients in terms of the types of complete flourishing and freedom that are necessary to actively pursue a good life. Sweeney et al. (in press) stress the importance of the person of the therapist in light of the traditional Catholic teaching on vocation. In addition to referring to the general call to holiness (Baum, 1965, Lumen Gentium) and one's state in life (as married, consecrated religious, or ordained), vocation also reflects the unique and personal work to which God calls each person. For example, clinicians can love and serve God and neighbor through the profound gift and responsibilities that becoming a mental health professional brings:

(T)herapists understand that their encounter with the client is providential and not random.... Such a sense of vocation and service motivates therapists not only to observe the ethical principles existing within the mental health professions, but also to put into practice Christian love and self-giving for the good of the client. Thus, Catholic therapists have a sense of responsibility for the client and a holy accountability to God for the service rendered or withheld the person in need (Matthew 25:31ff). (Sweeney et al, in press, p. 6)

In this way, the therapist's orientation toward their own growth and development is significant in the treatment process.

Sister Lydia: Treatment Goals

The goals of treatment with Sister Lydia included helping her to integrate her emotional life with the consciously willed, but forced 'virtuous' external acts which came at a cost to herself; this cost arose because the acts were not supported by the emotions she experienced, which were primarily remnants from past unresolved conflicts and fears, but also the result of underdeveloped virtues. Reaching this goal requires: (a) healing the emotional wounds through a more accurate reflection of the reality of what she was living, along with (b) emotional/ psychological forgiveness of the parents [who have already been spiritually forgiven], and subsequently (c) separation clarity regarding what was past and what is present, with respect to the meaning of the emotions she perceives. In the short term, she needed to access, allow herself to experience, and in an appropriate way express her feelings in the context of a trusted therapeutic relationship which prepares her to process more clearly her emotions outside of the therapy session (as we see below). In the long term, she can achieve a more temperate ideal as is expected from her in the convent, but in order to facilitate this growth, she will first need to experience, reflect upon, and heal in the present, the pain from the past. (This is naturally a typically extensive process, and only the highlights of her transformation are noted here).
 During a visit home, Sister Lydia
 experienced a difficult time with her
 family. She was most interested in
 connecting with her youngest sister,
 now a teenager whose only interest
 seemingly is shopping for clothing,
 which only infrequently expressed
 any degree of modesty. This outing
 became a family affair, with the
 usual criticism, hostility, and anger
 being expressed between members.
 Further, there was an incident
 where she was being harassed by
 some men. At this point she chose to
 return to the car and wait for the
 others in order to process her emotions,
 allowing herself to identify the
 frustration she felt at not being able
 to spend time alone with her sister
 which would have allowed for more
 intimate, serious sharing between
 the two, as well as her frustration
 with her father's lack of protection of
 her from the scandal of being insulted
 by the men. Processing this, Sister
 Lydia became aware that her 'frustration'
 was in fact disguised hurt
 and sadness. She realized that the
 scandal and injustice she experienced
 was coming from outside of
 her, that is, from her family members.
 Therefore, she became focused
 more so on sadness for her loved
 one's who must be suffering greatly
 themselves to have treated her this
 way; she then was able to let go of
 her upset. In this way, her initial
 narrower focus on practicing the
 faith and modestly protecting her
 chastity resulted in her more foundational
 expression of the love she
 had for her family.


Psychotherapy Processes as Preparation for Growth in Virtue

We have argued that the therapeutic process must at times prioritize healing embodied/emotional wounds in order to stabilize the person's foundation for growth in the capacity to become free and responsible agents. Because of their ability to motivate and energize, the cultivation of emotions in developing virtue is importantly correlated with the education of reason and the strengthening of the will. Although we may act badly under the influence of disordered emotions, emotions themselves are not inherently disordered and an important range of virtue (such as perseverance, patience, courage, modesty, hope) stems from the knowledge attained by and the controlled employment of emotion. Further, the mere repetition of external acts does not guarantee the growth of virtue: for example, an adult working with children may control her anger much of the time, but she will often lose her temper too, at least until she has learned to understand her emotions differently and take a constructive emotional posture when offended by children's antics. A person who suddenly errs after long years of apparently virtuous behavior might do so for at least two reasons. First, because she never had these habits and for years she had been depending upon external factors to keep control of herself (Klubertanz, 1965). Second, she may simply err, which means that her dysfunctional emotional outburst or isolated bad act or mistake neither destroys the disposition to act well nor demonstrates that it never existed; but the untypical event does mean that even virtuous dispositions are not inerrant and that people need to continue to forge them in new and challenging situations, including times of distraction, fatigue, and other trials at cognitive, volitional, relational, and emotional levels, as we see in later events in Sister's therapy:
 Sister Lydia had been on a pastoral
 assignment working with young children
 from disadvantaged homes, and
 she observed how they were spontaneous
 and intense in their expressions,
 both joyful and otherwise. She
 marveled at the clarity with which
 they expressed their emotions, recognizing
 their deep, bodily knowledge of
 their experienced emotions. During
 therapy, she reflected on how, despite
 these strengths, the children did not
 have the ability to modulate their
 emotions, this not having been nurtured
 in their families. In contrast,
 Sister Lydia, as an adult and with her
 education and religious formation,
 has been able to learn to identify fitting
 responses and is able to perform
 them often. Further, having begun to
 discuss these issues in therapy, on this
 assignment she was able to recognize
 more clearly her own interior emotions.
 For example, she reflected on
 how the Sisters often live in close
 quarters with each other. She reported
 constantly feeling as if she was a burden
 to others, while not thinking at all
 they were a burden to her when they
 were in her space. This lack of attention
 to her own natural, affective
 reaction is able to be traced back to
 how in her family of origin she was
 never comfortable coming into close
 proximity of others, always feeling as
 if she was going to be attacked or otherwise
 met with a negative response.
 These two experiences, being with
 the spontaneous emotionally intense
 children and experiencing herself to
 be a negative burden without the natural
 recognition of the corresponding
 burden imposed, led Sister Lydia to
 reflect on how it is typical for her to
 feel as she does during times of
 duress. Through processing this in
 therapy sessions with her natural
 expression of emotions accepted and
 validated by the therapist, she was
 able to discover that it is not shameful
 to have these feelings, and further that
 she can allow herself private emotional
 release [e.g., crying during
 Eucharist adoration]. Having allowed
 herself to process the natural emotions,
 she then feels self-possessed to go
 about her day, having neither denied
 her experience nor acted it out as was
 the norm in her family of origin. As
 she recognizes her emotions more
 clearly, differentiating when they are
 accurate and helpful, and when they
 are not, she can also recognize how
 she can internalize her life goals and
 progress in reading her emotions, in
 affective self-mastery, and in responsible
 spontaneity.


Conclusion

A Catholic-Christian anthropology provides insights into psychotherapy as a means to: (a) assist in positive growth in dispositions, that is, developing emotional, relational, rational, and volitional virtue strengths and related practices; (b) understand the disorder and negative expressions of our human nature, that is, the destructuring practices and vice; or, what is most frequent, (c) understand the mixture of positive growth and weakness (an intermediate state) in a life-long pathway punctuated with times of peace and others of struggle. A psychotherapy of virtue requires a therapist who is attentive to the importance of his or her own person in the therapeutic relationship and employs the most effective psychotherapeutic techniques, but who also has the sensitivity to recognize the therapeutic potential of spiritual resources within the client (in terms of generosity and self-giving, pardon and reconciliation, courage and daring, patience and justice) in the midst of human weakness and pathologies.

Further work on a coherent Catholic-Christian anthropological foundation for a psychotherapy of virtue should assist the therapist to help the client, on the one hand, to be freed from his psychological pathologies for a healthier human life, and on the other, to be freed in order to be able to participate more fully in the complete flourishing offered only by God. Even if the word 'virtue' is never mentioned, we believe that symptom reduction is facilitated by at least a preparation for, if not also an outright growth in virtue as a coherent part of psychotherapy. For the client who brings with him an intention to employ spiritual resources, this involves the transformation of the human virtues and the Christian ones as well.

This manuscript is based on a paper originally presented at the Society for Christian Psychology Conference, Chattanooga, TN, October 2006. Correspondence regarding this article should be addressed to Frank J. Moncher, Ph. D., The Institute for the Psychological Sciences, 2001 Jefferson Davis Highway, Suite 511, Arlington, VA 22202; fmonch@ipsciences.edu

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Frank J. Moncher

Craig Steven Titus

The Institute for the Psychological Sciences

Note

(1.) The case study is an actual patient of the first author who was seen in psychotherapy over the course of several months. She was referred by a colleague who responded to the patient's request for a therapist who shared and understood her faith commitments. In accord with ethical practice, certain descriptive facts and unessential details are disguised in order to protect anonymity.

Authors

Frank J. Moncher (Ph.D. in Clinical-Community Psychology, University of South Carolina, 1992) is Associate Professor of Psychology and Director of the Psy.D. Program at the Institute for the Psychological Sciences. Dr. Moncher's interests include integration of Catholic thought into psychotherapy, child and family development issues, assessment of candidates for religious life, and the understanding of living consecrated religious life.

Craig Steven Titus (STD/Ph.D. in Moral Theology, University of Fribourg (Switzerland) is Research Professor at the Institute for the Psychological Sciences. He is author of Resilience and the Virtue of Fortitude: Aquinas in Dialogue with the Psychosocial Sciences (Catholic University of America Press, 2006). He has also edited (2009, in press) The Psychology of Character and Virtue (Arlington, VA: The Institute for the Psychological Sciences Press) and Philosophical Psychology: Psychology, Emotion, and Freedom (Arlington, VA: The Institute for the Psychological Sciences Press).
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Date:Mar 22, 2009
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