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Seven strategies for treating Christians with depression.

Cognitive Behavioral Therapy for Christian Clients with Depression: A Practical, Tool-Based Primer by Michelle Pearce, West Conshohocken, PA: Templeton Press, 2016. 248 pp. ISBN 978-1-59947-491-5 (paperback), $13.97; ISBN 978-1-59947-492-2 (e-book), $7.69.

Michelle Pearce (Ph.D., Yale University) is an assistant professor and clinical psychologist at the Center for Integrative Medicine at the University of Maryland, Baltimore School of Medicine. Her research interests include integrating religion/spirituality into the practice of psychotherapy.

Most clinicians are familiar with the effectiveness of Cognitive Behavioral Therapy (CBT), which has been adapted for Christian clients (e.g., Jennings, Davis, Hook, & Worthington, 2013). Pearce offers clinicians a primer integrating CBT with Christian spirituality (CCBT) applied by using seven specific interventions, which she calls treatment tools. Following three introductory chapters, seven chapters explain the treatment tools.

Pearce begins by explaining that faith is important to psychotherapy because a religious identity and worldview govern how clients view their life experiences, including the experience of depression. She supports her claim of importance through statistics about the prevalence of depression in the context of the substantial proportion of the U.S. population who identify as Christian.

Chapter two introduces assessment. Pearce explains that she and her colleagues learned from experience that not all Christians desire CCBT. Drawing on the work of Kenneth Pargament (1997), she outlines key features of spirituality, which clinicians can include when taking a client's history. Next are suggestions for assessing depression, gaining informed consent, and assessing the possible role of faith in a client's presenting problem. Chapter three completes the set of introductory chapters with guidance on introducing the CCBT model to clients. The model includes physiology with the usual CBT triad (thoughts, feelings, behavior). Following the explanation of the CCBT model, Christian spirituality is introduced by referencing three elements--beliefs, practices, resources.

Part II includes the seven chapters describing the treatment tools as is organized using the following repeated subsections: chapters begin with a case study, followed by a discussion of the contribution of a Christian approach, a scientific rationale for using the tool, and Christian elements related to the specific tool (e.g., Scripture). Details on how to use the tool in therapy include activities and a sample clinician-client dialogue.

I will provide a brief parenthetical description of the seven tools so you can get a sense of what to expect. I use Pearce's words for these interventions. 1. Renewing your mind: Planting truth (learning to memorize scripture and use prayer to create a positive mindset). 2. Changing your mind: Metanoia (using Christian truths to combat common maladaptive cognitions). 3. Finding God and the blessing in suffering: Redemptive refraining (look for God at work; strategies to reframe suffering). 4. Reaching out and connecting (the importance of social interaction; strategies to connect with supportive others in a faith community). 5. Letting go and letting God: Acceptance and forgiveness (assessment of hurts and resentment, a process of forgiveness and surrender to find intrapersonal freedom). 6. Saying thanks: Gratitude (the value of increasing the expression of gratitude, which can counter some dimensions of depression). 7. Giving back: Service (improve one's mental state through acts of love and kindness).

Pearce concludes her text with a summary chapter and recommendations for preventing relapse such as finding ways for clients to practice their CCBT tools, developing hope, and engaging local support. Suggestions for modifying treatment and seeking clergy consultation are also included. Three appendices include: (a) a recommended role for clergy accompanied by a list of signs of depression, (b) a list of religiously integrated manuals and workbooks, and (c) client handouts (e.g., The 7-CBT tools; 10 common distorted thinking styles). The 12-page reference section reflects an appreciation of general clinical psychology references as well as entries by leading psychological scientists who identify as Christian.

Pearce offers clinicians a well-written summary of CBT with specific biblical texts to help Christian clients modify dysfunctional beliefs. Her references indicate a strong familiarity with CBT literature. And her presentation of psychotherapist-client dialogue reflects clinical experience in using CBT with Christians. Her spiritual recommendations emphasize scripture and prayer that would reasonably accommodate many Christians who identify faith as important to daily living.

Pearce's model does not obviously draw upon any specific historical model integrating Christian theology and psychology, nor does she draw upon or sketch a theological foundation that might integrate Christian theology with CBT. I would assess her approach as religiously accommodating--an approach that begins with an effective clinical model and identifies sacred texts and practices that are compatible with the model. Although Pearce opines that her approach may be used by nonChristian clinicians, I question the efficacy of such use without supportive empirical evidence, given evidence that clinician authenticity and relationship variables are important to counseling outcomes (e.g., Hubble, Duncan, Miller, & Wampold, 2010).

At least three topics could be expanded upon to illustrate a more in-depth connection between research, practice, and faith in a future edition. One, Pearce acknowledges the forgiveness work of Christian scholars like Worthington and Enright but does not offer specific guidance in the way that Enright and Fitzgibbons (2015) do in their chapter devoted to forgiveness therapy for depressed clients. Two, Pearce identifies the term spiritual struggles in the chapter about suffering (ch. 6) but does not include the extensive research by Exline and her colleagues (e.g., Exline & Rose, 2013), which has helped clarify many of the distressing beliefs held by Christians when they experience such struggles. And three, although she briefly mentions hope in the conclusion, the topic deserves a greater role in the treatment of depression especially given its critical role in psychotherapy and its prominence in Christian theology (e.g., Edwards & Jovanovski, 2016).

Overall, I think this book offers clinicians an important guide to using CBT with Christian clients. Although many clinicians will find it helpful, I think it is particularly suited for those who did not graduate from a program emphasizing the integration of Christian theology with psychotherapy.


Edwards, T. M. & Jovanovski. A. (2016) Hope as a therapeutic target in counselling--In general and in relation to Christian clients. International Journal for the Advancement of Counselling, 38, 77-88. doi:10.1007/s10447-016-9257-8

Enrighr, R. D. & Fitzgibbons, R. P. (2015). Forgiveness therapy: An empirical guide for resolving anger and restoring hope. Washington DC: American Psychological Association.

Exline, J. J. & Rose, E. D. (2013). Religious and spiritual struggles. In R. F. Paloutzian & C. L. Park (Eds.), Handbook of the psychology of religion and spirituality (2nd ed.), (pp. 380-398). New York: Guillord.

Hubble, M. A., Duncan, B. L., Miller, S. D., & Wampold, B. E. (2010). Introduction. In B. L. Duncan, S. D. Miller, & B. E. Wampold, M. A. Hubble (Eds.), The heart and soul of change: Delivering what works in therapy (2nd ed.), (pp. 23-46). Washington, DC: American Psychological Association, doi: 10.1037/12075-001

Jennings, D.J. II, Davis, D. E., Hook, J. N., & Worthington, E. L. Jr. (2013). Christian-accommodative cognitive therapy for depression. In E. Worthington, E. Johnson, J. Hook, 6c J. Aten (Eds.), Evidence-based practices in Christian counseling and psychotherapy, (pp. 81-100). Downers Grove, IL: InterVarsity Press.

Pargament, K. I. (1997). Spiritually integrated psychotherapy: Understanding and addressing the sacred. New York: Guilford Press.

Reviewer for This Issue

SUTTON, GEOFFREY W. PhD. Address: Evangel University, 1111 N. Glenstone Ave. Springfield, MO 65802. Email: Title: Emeritus Professor of Psychology, Evangel University. Degrees: PhD (Psychology), University of Missouri-Columbia. Specializations: Psychotherapy and the Psychology of Religion.
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Title Annotation:Cognitive Behavioral Therapy for Christian Clients with Depression: A Practical, Tool-Based Primer
Author:Sutton, Geoffrey W.
Publication:Journal of Psychology and Theology
Article Type:Book review
Date:Mar 22, 2017
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