Integrative Psychotherapy. By Mark R. McMinn and Clark D. Campbell. Downers Grove: InterVarsity, 2007, 403 pp., $29.00.
Mark McMinn and Clark Campbell have written a refreshing and remarkably versatile text on Christian counseling and cognitive therapy. Integrative Psychotherapy is clearly written and very readable, avoiding both the pop psychology genre and the laboriously technical textbook genre. The primary strength of the book, however, is that it manages to stay readable while covering considerable ground. Integrative Psychotherapy manages to double as both a primer on the integration of psychology and evangelical theology and a primer on cognitive therapy; thus, both clinicians and educators will find this a useful resource. The biggest challenge for educators will be whether to use this book for its position on integration or for training students in the use of cognitive therapy.
As psychologists, McMinn and Campbell clearly target professional counselors and their educators, although theologians and scholars of pastoral care will benefit from their coverage of the role of counseling in Christianity. Integrative Psychotherapy is not a self-help book and will probably be more for clinical use than for the individual looking for helpful principles. Pastors looking for a single reference style primer on pastoral care would probably be better suited to go with Gary Collin's Christian Counseling (2007), which is now in an updated third edition, or a similar title.
McMinn and Campbell provide a strong case for integrating psychology and theology, and this text is an exemplar of this position. Those who believe that to know truly the Creator one should study both God's creation (general revelation) as well as God's Word (special revelation) will be at home with McMinn and Campbell's arguments. They do an excellent job of discussing the imago Dei and harmartiology. Their coverage of models of pastoral care and henneneutics is good but not nearly as in-depth or comprehensive as their coverage of the imago Dei. They do not provide a summary of alternative Christian approaches to counseling such as historical or modern models of pastoral care or chaplaincy, spiritual direction or spiritual formation, biblical counseling such as Jay Adam's Nouthetic Counseling, or Christian Psychology, the latest entry into the debate on Christian counseling (see Stephen Greggo's review of Eric Johnson's Foundations for Soul Care: A Christian Psychology Proposal, in this issue of JETS). A better summary of differing views is Johnson and Jones's (2000) Psychology and Christianity: Four Views,
McMinn and Campbell provide a solid evangelical foundation for their work. Their references include historical staples such as Augustine, Calvin, and Earth; contemporary evangelicals like Bloesch, Erickson, Hoekema, Plantinga, Sproul, Grenz, and Packer; as well as authors popular with evangelicals such as C. S. Lewis, Willard, and Nouwen (a Roman Catholic priest and psychologist who has been surprisingly popular among many evangelicals). McMinn has written previously on sin, and readers should be pleasantly surprised to find a more complex and robust discussion of sin and guilt than is often present in Christian self-help books. Less robust, however, is the coverage of the role and work of the Holy Spirit in counseling, change, or transformation. If evangelical theologians historically have given brief attention to pneumatology, Christian counselors of all approaches have certainly done so.
McMinn and Campbell hit their stride when discussing psychology and cognitive therapy. Teachers who have been looking for a current foundational cognitive-behavioral therapy textbook need look no longer. Integrative Psychotherapy provides an excellent background on the development of cognitive therapy, its theoretical underpinnings, and the core techniques and interventions for anxiety disorders and depressive disorders. It does not cover the counseling of couples, intervention with personality disorders, or addictions. Fortunately, there are many good texts covering these specific populations and their treatment.
Integrative Psychotherapy provides one of the best summaries of outcome research and its importance to date. To counseling faculty this chapter alone is worth the cost of the book. Comparable coverage by Lambert (2003) or Wampold (2001) will cost more than twice as much and require reading hundreds of pages. Hubble, Duncan, and Miller ( 1999) provide equally readable coverage of common factors of change, but McMinn and Campbell have condensed all that Hubble, Duncan, and Miller cover into one chapter and added a primer on the statistics of meta-analysis and Prochaska and DiClemente's stages of change. This is probably the clearest and most succinct coverage of outcome research available and will be invaluable to pastors, theologians, and graduate students wanting to understand this material without having to take a graduate course in statistics.
Equally as good is the chapter on the development of cognitive therapy. This chapter provides a thorough understanding of the theoretical groundwork of cognitive therapy and the major milestones without getting bogged down in names, dates, and competing schools of thought. McMinn and Campbell are not compelled to pay homage to the popularly considered founders of psychology. This leaves the reader free to grasp cognitive therapy without having to try and understand psychoanalysis or Gestalt therapy along the way. The authors do not neglect relevant concepts, however, including major contributions from developmental, social, and interpersonal psychology. Postmodern readers will appreciate the discussion on constructivist cognitive therapies, even if cognitive theorists appear to have pinned the hopes of cognitive therapy on empirically supported treatment manuals rather than on promising contributions to postmodern notions of collaboration, raeta- individual and community narratives, multidirectional influence, and co-constructed meaning.
Expanding on the earlier work of Jones and Butman ( 1991), McMinn and Campbell review at some length the philosophical strengths and weaknesses of cognitive therapy. They highlight this therapy's relative simplicity, goal-focus, tendency to be timelimited, and empowering nature. Moreover, they discuss how it avoids both a strict determinism and total freedom of choice. At the same time, they raise numerous concerns with cognitive therapy, including its pragmatic rationalism; faulty assumptions about human motivations, reason, and health; and the inability (disinterest?) of semantic cognitive therapy to propose a theory of personality. For example, McMinn and Campbell note that human relationships are of less importance than reason in a cognitive model, but most people value relationships over reason. They observe that people do not enter therapy to acquire rational thinking; rather, people enter therapy to feel better. And ultimately, the authors aver, without some existential foundation, cognitive approaches have little to offer a hurting and broken world where conflict, pain, and death are inevitable. McMinn and Campbell make a particularly compelling case that while cognitive therapy is largely based on the notion that people develop unhealthy negative schemas about themselves and the world, in reality social psychology teaches that people are just as likely or more likely to make overly positive (self-serving) cognitive errors.
The primary focus of Integrative Psychotherapy is its attempt to build a uniquely Christian model of counseling that uses truths learned from God's created order (science as understood to be the study of the principles of how creation works) within a wholly biblical understanding of who created the world, what is the meaning of creation, and what is wrong with creation. McMinn and Campbell propose a three domains-ofintervention approach. Each domain is modeled after an aspect of the imago Dei, and interventions in each domain corresponds to different cognitive-behavioral and interpersonal techniques.
The first domain is presented as consistent with humanity's functional creation-reflecting God's image in that "humans have the capacity to manage themselves and their environment, to behave in particular ways that reflect God's character" (p. 114). Counseling interventions that fall in this category aim to improve or enhance adaptive behavior, to reduce symptoms that prompt individuals to seek counseling. This first domain is described as "symptom-focused'' and a thoughtful treatment is given to "a ministry of common grace" (p. 123) that seeks to reduce human suffering and increase the capacity for coping with distress. McMinn and Campbell argue that counselors need to accept that not every client has deep-seated problems that will require lengthy treatment or a sustained focus on the past. They are also pragmatic enough to recognize that not every client is introspective; accordingly, such individuals should be helped to find symptom relief without the counselor feeling compelled to address every personality quirk that might be improved with prolonged psychotherapy. Interventions that are suggested for use in this domain include skill building, problem solving, and cognitiverestructuring. Integrative Psychotherapy spends considerable time explaining thought records, cognitive rehearsal, and other mainstays of cognitive therapy. Counseling students will find the chapter on applying symptom-focused treatment to anxiety problems very practical. Pastors and theologians may be tempted to skim the coverage of specific disorders such as phobias, panic attacks, and posttraumatic stress disorder.
The second domain is patterned after God's structural image-the notion that "human beings share something substantive with God, often identified as our rational and moral capacity" (p. 128). Counseling interventions in this second category aim to correct faulty beliefs and distorted cognitions by helping "people interpret and find meaning in their lives" (p. 129). This second domain is schema-focused, looking beyond automatic thoughts to core assumptions and beliefs. McMinn and Campbell argue that core beliefs are more resistant to change than automatic thoughts. They describe core beliefs as organized perceptions of how the world works; such perceptions are reinforced by experiences rooted in the general brokenness of sinful humanity living in a fallen world. Individuals suffer both because of the devastating effects of specific sins and because of the distorted conclusions the sinful mind comes up with. An orthodox understanding of original sin necessitates appreciating how widespread and recalcitrant human distortions of truth and experiences are. Helping clients make meaning of the world requires the counselor to be equally adept at schema deactivation and creating a biblical identity in Christ. McMinn and Campbell come close to espousing the counselor's need to be skilled in spiritual formation or discipleship, but they stop short of such an endorsement. While they place Integrative Psychotherapy on a continuum of soul care, they remain uneasy with advocating for traditional faith practices within the counseling session. It is important for the client to be clearly informed of the service they are paying for/receiving, but some practitioners may hold spiritual disciplines as indispensable to such transformative work.
The third domain seeks to address humanity's interpersonal aspirations as reflective of God's relational image; accordingly, relational conflicts are reflective of the destructive impact sin has on relationships. While the first two domains are examples of integrating cognitive therapy with faith, the third domain leaves cognitive-behavioral foundations and integrates faith with more interpersonal and psychodynamic concepts. This addition helps to offset the logic-heavy shortcomings of cognitive-behavioral therapy. This section retains the clear readable style of the rest of Integrative Psychotherapy but unfortunately, in a parallel to the strengths and weaknesses of cognitive therapy and interpersonal therapies, this section is the least comprehensive and the most ambiguous. Just as cognitive therapy is liked because of its simplicity and clear techniques, psychodynamic approaches can be incredibly complex with few concrete interventions.
Integrative Psychotherapy sets the objectives of this third domain as addressing "spiritual longings, relational wounds, unresolved conflicts and personality problems" (p. 319). To achieve this goal it is proposed that "the power of a transformative relationship" (p. 321) is required. While ultimately Christ is the transformative relationship, how does a counselor facilitate that? A challenge for the authors is to describe a biblical role for the counselor that is still "clinical" and not pastoral. They meet the challenge head on, although how successfully they achieve this goal is debatable. The language may be more familiar to spiritual directors and psychoanalysis than traditional cognitive therapists. Indeed, it may seem to students of contemporary psychodynamic approaches that a well-known hero has emerged at the end of the story to rescue the Integrative Psychotherapy counselor from the inevitable personality-disordered client. Friends of cognitive-behavioral therapy on the other hand may suddenly find themselves in strange territory as McMinn and Campbell abandon talk of schemas and automatic thoughts in favor of comments such as "some clients must first T)OITOW' the therapist's observing ego in order to see things clearly" (p. 322).
Integrative Psychotherapy briefly describes the contributions of interpersonal psychiatry, object-relations, and family systems theory. These approaches just cannot be adequately described in a couple of paragraphs, although McMinn and Campbell manage to maintain their readable style throughout. The seasoned psychotherapist will find these chapters agile and seamless for the extensive ground covered. Those unfamiliar with these approaches will have a harder time comprehending the magnitude of what lies within this domain. The authors defend the inclusion of an interpersonal component stating, "It is not so much that we are rejecting the cognitive model of conceptualizing and treating personality disorders as it is that we find it inadequate in its current form to address the deeply entrenched interpersonal patterns that plague many relationships" (p. 331). The weakness of this section of the book is not necessarily in what the book espouses; it is just that the language and concepts of interpersonal, systemic, and psychodynamic approaches require more explanation than a chapter or two can provide readers unfamiliar with the terrain.
McMinn and Campbell do a good job of highlighting the clinical and biblical significance of the relationship between the counselor and client. With its emphasis on grace, truth, presence, and soul-care, the chapter on applying relational-focused interventions will probably resonate particularly well with pastors and chaplains. This section should also refresh clinicians tired of a discipline increasingly focused on empiricallysupported treatment manuals, techniques, and studies of effect sizes. If some of the earlier chapters on treating disorders seemed weighted toward psychology, this one weighs in toward faith and the transformative work of the person of Christ. The counseling student may be left asking, "But what does that look like? How do I do that?" Instructors may want to direct those students to traditional interpersonal sources, although even with a bookshelf of psychodynamic texts, I still find myself asking those questions. Of course one could always relate a story from an early desert father or strike a contemplative pose and say, "It isn't so much something you do; it's who you are."
Integrative Psychotherapy is an immensely readable text that will reward its readers with its coverage of the basis for integration, its summary of outcome research, its summary of the development of cognitive-behavioral therapy, and its attempt to build a uniquely Christian model of counseling that applies the truths from both God's Word and his created order. It will stretch readers not well versed in both Scripture and psychology, but it also represents how far integration has progressed in that it is assumed that readers will be familiar with both disciplines. In this regard Integrative Psychotherapy exemplifies the type of integration in which most practitioners still do not engage: a serious examination of current research into human behavior and a commitment to both studying and abiding by God's unchanging and inerrant Word. Though I don't think this is the only counseling book that should adorn the bookshelves of pastors, theologians, and therapists, I do recommend that all scholars of pastoral care and counseling read it and find shelf space for it.
Justin M. Smith
Phoenix Seminary, Phoenix, AZ…