Evaluating Interpersonal Psychotherapy (IPT) Through a Biblical Worldview

Camille McDaniel, LPC (00:28)
Welcome back to another episode of Christ in Private Practice, and we are still in the middle of our Summer Faith Integration Skills Lab series. So throughout this series, we’ve been discussing how Christian counselors can integrate their faith ethically ⁓ while remaining clinically, you know, grounded and competent in evidence-based practices. And well, we’re going to be talking about evidence-based practices, but we were talking about

grounded in our ethics and you know our professionalism, making sure that we’re doing things right and in order, everything from informed consent to how to do certain assessments that some may have not heard of. I know I got feedback that some had not. And so

We’ve kind of just been discussing everything else, you know, spiritual readiness of our clients and scripture integration, making sure that we are aware of spiritual bypassing, no matter where it’s coming from, and and many other things. So beginning with this episode, we’re shifting our attention to evidence-based treatment modalities. And that’s going to be the case for this episode and even our next episode. And just looking at, ⁓ you know, how they point us.

To ⁓ helping our clients and how they integrate with a biblical worldview. So for each modality, we’re going to look at you know what the modality is and how does it work, and how we should evaluate things in our counseling space while using this modality through a biblical worldview. And then what does ethical integration look like in our clinical practice? So today’s focus is

Going to be on interpersonal psychotherapy or IPT for short.

So I will either say as we move forward, I’ll either say interpersonal psychotherapy or I will say IPT. And what we are going to be doing is we’re going to evaluate interpersonal ⁓ psychotherapy carefully and identify where it aligns with a biblical worldview, recognize where scripture extends beyond the scope of that model, and then discuss what ethical integration looks like.

When clients want faith integration explicitly integrated into their counseling experience,

So for today, we’re going to have some learning objectives, which will be outlined on our website underneath this podcast.

Episode, but just a couple of them is going to be describing the foundational principles of interpersonal psychotherapy. We’re gonna summarize the current research and we’re gonna take a look at some other things that have been coming up as potential trends or not potential, I shouldn’t say potential, but as trends that are going on within the United States of America and possibly in other areas of the world. But I’ll be talking about research that has already been stated for the United States, and we’re gonna look at four interpersonal problems.

That are addressed with interpersonal psychotherapy in that modality. And then we’re going to evaluate IPT through a biblical worldview and apply the IPT principles ethically while integrating scripture when clinically appropriate. And then we’ll go on from there. So before we get into interpersonal psychotherapy, let me first ask you a question.

Why would a treatment model focus specifically on relationships? Well, I know that you’re probably thinking, like, obviously, because relationships are a very key factor in the health and well-being of many people who are walking on this earth. ⁓

And you would be right if you said that, because relationships really do have a very profound influence on our mental health. And so as counselors, we know that many psychological symptoms don’t occur in isolation. They oftentimes do develop within the context of some form of relationship. Like a client might be

depressed ⁓ following the death of a spouse or you may have a client who has some unresolved marital conflict or maybe they are taking care of aging parents ⁓ at this particular time. Maybe they have just located to a new city and they just don’t know anybody. You know, there’s a lot going on ⁓ as it relates to different types of relationships that people may be experiencing and how that impacts them.

Is what we’re going to be taking a look at as far as using this modality. And certainly, certainly, biological factors, cognitive, environmental, you know, all of those do contribute to mental health for sure. We already know that. But interpersonal psychotherapy ⁓ is not saying that those things are not.

Valid. They’re just it’s that theory is just saying that relationships explain a lot of psychological

So we’re going to just take a look at the interpersonal relationships that our clients might be experiencing and look at an important part of how that comes into impacting emotional distress. That is really the perspective, and it has become increasingly relevant as research continues to demonstrate the relationship between social connection and then our overall.

overall health and wellness.

I want to start by sharing something that kind of leads into our talk about interpersonal psychotherapy. ⁓ and that is that in 2023, the Office of the US Surgeon General released they like released something called our epidemic of loneliness and isolation, and it was the healing effects of social connection and community. And the advisory identified that loneliness and social.

Disconnection were significant public health concerns and summarized basically decades of research that ⁓ demonstrated that the social connection influences both mental and physical health. And that among those findings were several

Things that kind of captured the attention of mental health professionals. For example, approximately one in two adults in the United States reports experiencing loneliness. The advisory had also concluded that inadequate social connection is associated with increased risks of depression and anxiety, cardiovascular disease, dementia, stroke, and even ⁓ premature death. So

The statistics

you know, most frequently cited from the advisory was that the health effects of chronic social isolation isolation. I couldn’t get that one out. So the effects that like the ongoing effects of social isolation are comparable to smoking up to 15 cigarettes a day.

Yes, and you can look this up absolutely for yourself because I, you know, was able to retrieve this and so will you you will be able to as well. But whether or not we remember all of the statistics that the advisory, you know, looked into, came up with over the decades of research that they did, the main thing that we really can’t ignore is that relationships influence health. It influences people’s resilience in life, you know, to be able to come back.

from adversities of different types, right? And ⁓ it influences recovery. So as counselors,

This doesn’t really surprise us. We’re very familiar with the healing effects of community, but think about clients that you have seen over the last month or so. When you, you know, you’re hearing what I’m sharing, but I want for you to be thinking about your own experiences in practice, ⁓ you know, with the clients that you’re serving. How many of your clients are grieving? How many of your clients are experiencing marital conflict?

conflict or like I was talking about before, aging parents. how many of them have actually gotten divorced this year or

even like you know toward the end of last year so more recently this has been a significant change in their life. How many of your clients are actually talking about feeling lonely, feeling like they just can’t make friends in this adult stage of their life? ⁓ you know, how many of them really do not have meaningful support systems that they can rely on, that they can lean on and turn to. So for a lot of clients, relationships are not simply

Just part of background noise, if you will. It actually is pretty central to understanding some of the problems that they are presenting with. And I know that from a cultural lens, a multicultural lens, that this is very important, especially when you are working with individuals of from different countries, from different cultures, where community and family and friends.

Friendships and relationships are key, very, very central to how they move throughout this world. the Surgeon General’s advisory gives us like a very compelling public health reason to pay attention to relationships. And as Christian clinicians, we also have additional reason from a biblical point of view. Because from a biblical worldview, relationships are actually.

Not just beneficial for psychological well-being, but they are a part of God’s design for humanity. And ⁓ you know, that kind of is reflected, not kind of, it is reflected in scripture. So when we look at

⁓ Genesis, when we look at Genesis chapter 2, actually verse 18, the verse says, And the Lord God said, It’s not good that man should be alone. I will make him a helper, comparable to him.

People were created for relationship, and interpersonal psychotherapy also recognizes that relationships profoundly influence emotional well-being. interpersonal psychotherapy is based on clinical observation and empirical research,

And then scripture reveals God’s design and his purpose for human humanity in general, as well as human relationships. And so when you take both the empirical research and you also combine that with biblical truth.

Then now we have a guide that we’ll be using for our discussion for this podcast episode. And our goal is to evaluate IPT through a biblical worldview to see how it aligns.

Interpersonal psychotherapy was developed in the 1970s by psychiatrists Gerald Klerman and Myrna Weisman, and it was developed as a time-limited structured treatment for major depressive disorder. But since that time in the 70s, IPT has accumulated a lot of research, some substantial amounts of research that

Support its effectiveness for ⁓ not only depression, but also for several additional clinical disorders, including postpartum depression and depression in adolescence, and some eating disorders, as well as ⁓ some mood disorders and some other challenges mentally.

IPT asks, what diagnosis does this person have, and what is happening in this person’s relationships that may be contributing to the distress described by this diagnosis? And that question shifts our attention toward ⁓ interpersonal context of a client’s symptoms. So to organize the work, IPT focuses on four interpersonal problem areas.

areas.

And those four areas provide a framework for understanding how relationship difficulties may contribute to emotional distress and where therapeutic intervention may be most helpful. So we’re going to examine each of these four

problem areas individually. And we’re going to start with the first area. And the first problem area is grief. So in IPT it recognizes grief as natural response to the loss of an important relationship. Now

Oftentimes when we hear about loss and we hear about grief, we automatically kind of go and shift toward ⁓ death for many people. Now, for mental health professionals, we know that grief can mean a lot of things, that loss can mean a lot of things. And we we recognize that people have ways of of losing and having grief in many different ways. Like pregnancy can be a loss, or a pregnancy loss can be something that is grieved. ⁓ you know, health challenges might create.

Yeah.

A sense of loss and grief. You know, a career might end for someone, and your children might leave home and then you’re an empty nester, or there might be friendships that you’ve had for decades, even, and they come to an end. You know, ⁓ there’s just a lot of different ways that people might ⁓ have a loss or might be grieving. It might even be a role that you have, like that you had your identity in. You always knew yourself for this particular role in life, and now that has.

changed. ⁓ It might have changed, but still you kind of have that role in different ways, or the role might have gone away altogether. But IPT will help clients process the loss and then identify how that loss has affected their relationships and their daily functioning.

And then gradually IPT helps the client to adapt to life without whatever it is that ⁓ that they used to have or you know that they used to be known for or that they they used to be able to experience.

One of IPT strengths is that it normalizes grief while helping clients to avoid becoming permanently stuck in that grief. And again, this is really good. I know Western culture by and large is not really great with ⁓ feelings of sadness, of grief, of loss. And so sometimes the idea can be to, you know, do anything and everything to get over it, hurry up and get over it. I do know that.

that some other cultures, ⁓ sometimes more eastern and other areas of the world, may actually lean into a period of time of grief, of acknowledging, of being able to come together and give that.

thing, whatever it was that is is lost, give it time to process. So again, this just allows you to slow down and maybe take a look at just different different individuals even and how they might ⁓ process these types of things so that we can move forward and better understanding our clients and being able to actually sit with them ⁓ in it. And we’ll get to that a little bit more later.

Well, let’s take a look at evaluating IPT through a biblical worldview. Because overall, this does align well with a biblical worldview. Scripture consistently presents grief as a normal human response to loss. And and I think one of the we have like a lot of examples, but there’s an example with ⁓ Lazarus. everybody heard of, or if you have heard of, the death of Lazarus, ⁓ and then

His ⁓ ultimately being resurrected. But in the book of John, chapter 11, verse 33 through 36, it says, Therefore, when Jesus saw her weeping, and the Jews who came with her weeping, he groaned in the spirit and was troubled. And he said, Where have you laid him? And they said to him, Lord, come and see. Jesus wept. Then the Jews said,

see how he loved him. So in looking at that scripture, you know,

People generally heal when grief is acknowledged and processed instead of just minimized and rushed. And if you notice in that scripture, the Lord like sat with the people, like not literally sitting, but I mean, he was with the people. He saw how troubled they were. He asked them, you know, ⁓ what was happening, where did where was he laid? He allowed himself to feel and even show that feeling outwardly, right? And then others were.

Able to then see how much he cared about Lazarus. So, you know, where now scripture actually goes beyond just relationship and just the experiences that might be had with regards to grief. Scripture goes beyond IPT in that it it offers hope.

IPT helps clients to adapt after a loss, a relational loss. Scripture also points, though, believers to hope in Christ and the promise of resurrection and of healing and God’s presence even during times of suffering.

So what might this look like in your everyday counseling session if you were to ⁓ you know integrate this in looking at this first ⁓ problem area?

So imagine that you have a client who explicitly wants their Christian faith integrated and they are and they’ve experienced a loss, a death loss. And they say, you know, I know my spouse is with the Lord, but I just cannot stop crying. And maybe I just don’t have enough faith, you know, that the Lord will fix this, and that’s why I just can’t stop crying.

An IPT therapist would likely begin by exploring the loss itself. Like, how has this changed your life? ⁓ you know, what things are different for you now? What relationships have changed in your life? What daily routines are no longer the same? What support systems do you have during this period of time in your life? and if the client

Desires, like you know, in this case they do desire explicit faith integration. Then the client, I mean, or the counselor rather, the counselor might then add, you know, I’m hearing that you’re grieving deeply and you’re also questioning your faith because of the grief. And as we’ve talked about in previous ⁓ kind of episodes.

Those don’t have to be opposing experiences. So I’m just pausing real quick here to say in previous episodes, remember, we talked about two things can exist. You can have great deep relationship with the Lord, and you can also have very human emotions of grief, just the way the Lord did. Jesus wept. That didn’t mean that all of a sudden he wasn’t God, but instead it meant he was feeling things in this human body.

Okay, so back to what you might say as a clinician. You might say, you know, something, ⁓ I’m hearing that you’re grieving deeply and that this is causing you to question also your faith while you’re grieving. Would it be helpful for us to explore what scripture says about grief while continuing to process the loss together?

Again, we didn’t avoid the feelings, we didn’t rush them through the feelings. ⁓ we didn’t say, you know, don’t don’t worry about it, don’t cry. You know, God has a plan, or you know, at least your your spouse is resting in the arms of the Lord. We didn’t say any of that. Why? Because we want to remember other episodes for the Summer Skills Lab has talked about that timing and rushing and spiritually bypassing people through pain instead of sitting with them and allowing.

them to come to ⁓ the healing that they need on their on their own terms to some degree and within their own time frame, right? Those so those statements when we kind of you know talk to what many people feel can be very encouraging. Like, well, you know, he’s in heaven with the Lord, and ⁓ you know, the Lord has a plan for everything. You know, those statements are

Theologically true, but the timing ⁓ can unintentionally minimize the person’s grief. Now let’s move on to problem area number two. So problem area number two in this IPT model or modality is called role disputes. Okay, so role disputes are

Occur when people have different expectations about important relationships and those differences create ongoing conflict or emotional distress. So the disputes can occur sometimes between spouses, parents, and children, adult siblings, between friends, ⁓ co-workers on the managers, co-workers, you know, any anything having to do with employment.

It can have to do with, you know, a caregiver and aging parents. So there can be a lot of ⁓ role disputes, you know, the disagreement itself is not always the problem.

But more often the distress is developed because expectations are unclear and communication has broken down, and then that causes trust to be damaged. And each person believes that the other person should already understand what they need, what the individual needs. So let’s take an example here. We’re going to consider a couple who happens to be married. And so one spouse believes that spending quality time together is essential.

Feeling loved. But then the other spouse believes that working long hours is the main way to demonstrate love and responsibility. Well, the conflict develops because each person evaluates the relationship through a different set of

one of the strengths of IPT is that it helps clients to identify these interpersonal patterns and to clarify the expectations and in therefore improve communication and determine whether the relationship can actually move toward resolution, compromise, or even acceptance at all.

So it’s the goal of the IPT clinician to improve interpersonal functioning and reduce the distress associated with the conflict. And now let’s take a look at IPT in this second challenge through a biblical worldview.

So scripture doesn’t ⁓ present families ideally. I mean, you know, scripture is very like just real and raw. Okay, so it records the complexity of human relationships with great detail in some cases and great honesty.

We’re gonna take a look, for example, at Cain and Abel, The conflict didn’t begin with violence. That wasn’t the beginning. it actually started with jealousy and anger and an unwillingness to address what was happening in Cain’s heart.

And God even warned Cain before the murder even occurred in Genesis chapter four, verse six through seven, it says, So the Lord said to Cain, Why are you angry? And why has your countenance fallen?

If you do well, will you not be accepted? And if you do not do well, sin lies at the door, and its desire is for you, but you should rule over it. And within that context, God is confronting Cain, ⁓ you know, on his heart posture before he kills his brother, and it’s not.

you know, a a teaching of conflict resolution skills, but it is actually exposing the danger of allowing unchecked anger, unchecked jealousy, essentially unchecked sin to just rule over your heart. So in in IPT, The deterior deteriorating relationship between the brothers

Others

is where much of the focus would be. Scripture goes even further by explaining what is happening beneath the relationship.

Okay, so we’ll take a look at Jacob and Esau. Their relationship had a lot going on. These two brothers ⁓ had a story of gosh, there was favoritism.

There was deception and manipulation, and there then resulted in unresolved resentment because Jacob purchased Esau’s birthright. Esau gave his birthright away, really. ⁓ but their mom even was in on it, right? So again, if we’re looking at interpersonal relationships, mom Rebecca helped Jacob.

To deceive their father, the boy’s father Isaac, in order to receive a blessing, so that Jason Jacob could receive a blessing that was really supposed to be for his brother Esau. And then, you know, the conflict that followed basically separated the brothers, Jacob and Esau, for years. Again, scripture is revealing.

How family dysfunction and deception and unresolved conflict can impact people for generations. And ⁓ you know, eventually there was reconciliation in this particular case of the brothers. So

The Bible doesn’t minimize us taking a look at relational conflict and some of the problems that can come forward because of things that are underlying and things that are explicitly expressed.

As Christian counselors, we would avoid communicating that every conflict must end in reconciliation because we already know that that’s not always possible. I mean, obviously, there was no reconciliation between Cain and Abel. There was reconciliation, though, that happened many years later between Jacob and Esau.

Reconciliation is not always

Going to be safe either. It just depends on the situation that people find themselves in and who they who’s involved. So we are just very careful to not always try to go toward reconciliation because we wanna make sure that that is even first of all, make sure it’s possible.

Make sure it’s safe, and that probably should go first. We want to make sure it’s safe, reconciliation is safe, and then we want to look at is reconciliation even possible? Because it does require the participation from more than one person. So in our clinical practice, what does this look like? So we’re going to take the example of maybe a spouse saying, you know, nothing I ever do is good enough. And then

The other spouse says, well, they never listen and I’ve been asking for help for years. At first glance, it may appear to be a communication problem.

As therapy continues, something deeper emerges in that one spouse equates providing financially for the home as loving their family deeply. But the other spouse actually experiences love primarily through emotional connection and shared responsibility. Now, neither spouse is intentionally setting out to hurt the other one in this example. They’re just operating from different

assumptions about what a healthy marriage looks like. So there’s some distortion and an IPT-informed therapist would explore the expectations that each person has. So what does each person expect from the marital relationship?

How are those expectations communicated to one another within the relationship? Where are misunderstandings occurring? And then what interpersonal patterns keep the conflict going on and on?

This is where I think ⁓ Christian clinicians can maintain an important distinction that IPT can help improve the communication by being able to evaluate expectations. It can also reduce, after clarifying those expectations, it can reduce relational distress. Scripture

Addresses those areas, but it also addresses something even deeper. And that is looking at

What is happening within the heart that is contributing to this conflict? So, when integrated ethically, IPT and scripture provide a more comprehensive understanding of the client’s relational struggles while also honoring both clinical practice and biblical worldview.

Let’s go to problem area number three. Problem area number three has to do with role transitions. So the third interpersonal problem area in IPT is role transitions. And life has a ton of them. I mean.

Yeah, some transitions you expect, you know that they’re coming, and then others are unexpected. So, regardless of whether they’re welcomed or whether you wish they would have never shown up, the transitions often require people to let go of one role while learning to live in another. Here are some examples of that. So graduating from high school and leaving home.

I know for clients that I have supported in the past, that actually was a big stressor because of what they expected from having to ⁓ move.

On out of their parents’ home and move into an unfamiliar space when they go away to college, and you know, everything that comes along with just moving to another stage of life. Or it could be ⁓ graduating from college and going into the workforce. There’s a lot of transitions. Marriage is a transition, becoming a parent is a transition, becoming an empty nester is a transition, getting certain promotions or ⁓ careers, retirement. You know, there are there are just many different things that.

that

can happen in your life, a job loss, you know, an illness, a disability. There are many different things that can contribute to these transitions. Even like for those in the military. ⁓

military deployment or even returning home after serving ⁓ your country. So many clinicians are seeing an increasing number of clients in what is commonly referred to as the sandwich generation. And the sandwich generation are individuals who are caring for aging parents and simultaneously raising children or supporting young adult children. So the emotional demands it

Can be significant no matter what your transition is. Clients often report exhaustion or guilt. They sometimes have competing priorities. And that can sometimes lead to strains in relationships in their life. Sometimes marital strains, sometimes strains with friendship and other family members, or financial stress, and just the feeling that everyone needs something from them while no one is actually

Particularly taking care of them. So an IPT-informed therapist recognizes that emotional distress often develops because clients are not only grieving what has changed, but they’re also sometimes struggling to adapt to new expectations and new responsibilities and identities. Notice that the transition itself is not viewed as the problem.

The difficulty lies in adapting to the transition, not necessarily the transition itself.

So let’s take this ⁓ this stage and let’s evaluate this through a biblical worldview. So when we evaluate, what we quickly notice is that scripture is absolutely filled with people navigating major life changes, transitions. So

In many ways, the Bible narrates a story of transition. You know, the Joseph, he transitioned from being the favorite son, then he was a slave because his brothers set him up, you know, and then he was a prisoner, and then he was ruling over like he had high favor.

Moses, he had a transition. He was prince of Egypt, you know. Well, he was born of, you know, a Jewish mom, but then they were trying to kill the baby boys. Mom puts him in a basket, floats him down the river, you know, then a princess, an Egyptian princess, picks him up and you know, takes him as her own. And so he’s raised as a prince. ⁓ and then he’s a shepherd, and later he is leading Israel out of Egypt.

I mean, my goodness, that these are these are these are no small transitions, okay? And the the Bible has many other transitions. ⁓ you know, I’ll name a couple of like David, you know, becomes king. He was he David was shepherd and and then he’s king Esther. Remember Esther, Esther was an orphan, and Esther then had favor with the king. He she became queen, she saved her people.

and an IPT-informed therapist will help clients to adapt psychologically to these changing roles. Scripture adds another dimension by reminding believers that identity is ultimately grounded in their relationship with God rather than any particular life role.

And that that’s especially meaningful for clients whose identity has become almost entirely connected to their career or to their relationship status or to being a parent or like another role that may have changed over time. And so what does that all look like in our practice, you know, in our clinical practice?

So imagine that you had a client who retired recently after 40 years as a teacher, and they tell you, you know, everyone keeps congratulating me and all, but I feel lost. I don’t I don’t know what to do anymore. I don’t know who I am anymore.

An IPT informed therapist is going to explore that transition itself. So they may ask questions like, Well, what has changed? What do you miss the most? What relationships have changed for you since retiring? What role did teaching play and how you viewed yourself? So as therapy progresses, the client realizes that they didn’t simply just lose a job. They literally lost their job.

Daily routine and purpose, you know, their community, their structure, their identity. So if the client has requested Christian counseling to explicitly be integrated into their sessions, then the conversation can naturally expand. And then the therapist could ask,

As you’ve been thinking about this next season of life, how has your faith shaped the way you’re viewing this transition? And that that question again gets the client exploring, and as they’re exploring, it allows you to assess, right? because the client can be taking a look at, well, what is my what is my new purpose? What’s my what’s my calling in this season of my life? And and who am I at this season of my life, you know?

You just want for them to be able to see that, hey, maybe it’s not, it’s not that I am just randomly lost, but I didn’t realize how important this relationship of being a teacher for four decades was. I didn’t realize how much this.

Actually, integrated so many needs for community and structure and identity in my life, and now that is changing. And what we would do is ultimately we would want to help our clients by integrating you know their faith.

what is timely, what is appropriate, you know, what is ethical into their experience so that they can take a look both psychologically at their experiences and their faith ⁓ and how their faith will help them as they are making this significant life transition and adapting to what might be a little bit of an unknown future. Okay.

Now, here is the final problem area for interpersonal psychotherapy, and that is interpersonal deficits.

The fourth interpersonal problem area has traditionally been called interpersonal deficits. However, many IPT umed clinicians actually prefer the term chronic interpersonal difficulties because they say that the original term can kind of unintentionally imply that there is a deficit within the individual and who they are rather than just recognizing that there is a long standing relationship.

Relational pattern that may be presenting a challenge. So, regardless of the terminology, this area focuses on clients who struggle to establish, maintain, or deepen meaningful relationships. And some clients describe ⁓ in this stage chronic loneliness. Others might report.

repeatedly experiencing conflict. Some avoid close relationships because there’s fear of rejection. And then other ⁓ others might desire connection, but then they lack the confidence or the effective interpersonal skills in order to obtain that.

And then there might be other clients that you have that are withdrawn after like years of maybe disappointments or abandonment and some type of betrayal. So unlike temporary loneliness, because temporary loneliness might occur

⁓ let’s okay, you get a promotion, you move to a new city. You might feel a little lonely because all of your friends and family are, you know, back home, but you actually meet some people quickly. You make friends at the job and then you know you hear about some extracurricular activities through the job and you kind of get connected and it doesn’t really last that long.

But but instead with this ongoing chronic loneliness, these patterns, you know, tend to persist over like multiple relationships and even can persist over like different life stages. So you can see how it can kind of actually linger for quite some time.

An IPT informed therapist is going to provide a framework for helping clients to identify and improve unhealthy interpersonal patterns that might be showing up that just continue to keep them from being able to sustain these close connections that they want to be able to sustain or that are preventing them from even getting.

These close connections in the first place.

Let’s imagine that you have a client who says, I haven’t had a close friend in a long time. It’s been at least a decade. And then when you take further assessment, it’s revealed that every meaningful friendship has actually ended in conflict for them. So the client assumes that people will eventually reject them. So they just withdraw before even having an opportunity to experience a deeper level relationship. And IPT

Informed therapist is going to begin exploring those relational patterns. So they might start asking questions like, what typically happens when relationships become close for you?

What do you notice yourself doing? What assumptions do you make about other people’s intentions? And what keeps those friendships from developing further? And so then over time, the therapist helps the client to recognize recurring interpersonal patterns while practicing at the same time healthier communication styles, feeling safer with people and in certain environments, practicing vulnerability and then practicing.

Relationship skills. And if the client has requested Christian counseling explicitly, then the therapist might also ask: How does your relationship with God influenced the way you view trust and forgiveness or even connection with other people?

because it involves, you know, authentic relationships. We want to know like how has that impacted authentic relationships that are encouraging, that have mutual care, that are loving, or that has it accountability involved. People aren’t afraid to be accountable or take accountability.

So, for some clients, rebuilding trust in relationships may also involve like healing from maybe church hurt, maybe spiritual abuse. We just want to be aware of that. That’s a possibility, you know, and we don’t want to minimize those experiences because they deserve some very, you know, careful assessment. and just like any other relational injury.

And so as we’ve examined these four interpersonal problem areas, there is a theme that does emerge.

IPT reminds us that relationships are often central. They are central to understanding psychological distress. And when we evaluate IPT through a biblical worldview, we find that scripture takes relationships very seriously because relationships have always been a part of God’s design for humanity. And it’s significant in the way that people experience suffering and even the way that people experience healing and growth.

So the question that we want to ask ourselves: how do Christian counselors integrate these insights ethically without turning therapy into a Bible study or reducing scripture to a clinical technique?

so there’s a couple of principles that I’m going to share with you.

We are going to begin with a clinical assessment no matter what modality you’re using, but we are going to begin with any kind of ⁓ clinical assessment for evidence-based treatment.

Because good treatment assessment is going to help us to develop the right types of interventions.

The second principle is that we’re going to explore the client’s theology before assuming it, right? And because every Christian may interpret scripture in different ways, and some may be more proficient in understanding their ⁓ the scripture that guides their faith versus others.

So we don’t want to just assume that because we are using similar language as our clients, that we are all on the same page. But instead, we want to make sure to ask. And so we are going to ask things like, what has your faith taught you about this situation? ⁓ we are going to ask, how has this experience affected your relationship with the Lord?

What scriptures come to your mind when you think about this? You know, those kinds of questions can allow you to better assess where your client is at. And it also is a way of showing your client that you really do respect their faith and that you are with them and involved with them and walking this journey with them and taking the time to understand their worldview through through their eyes ⁓ much better. Principle number three.

We want to let scripture inform therapy rather than end the conversation. And we talked about this when we were talking about spiritual bypassing. We want to just be mindful of how we are using scripture to resolve the distress of our clients and we just make sure that we’re not using it too quickly because that can kind of ⁓ shut down the experience of processing, the experience of sharing and talking about the

the sadness or the grief or the distress that that one might be experiencing. So we’re just careful of that, not to move our clients through grief faster than they actually need to be moved and therefore ⁓ not allowing the full process to unfurl.

And so now on principle four. Distinguish forgiveness from reconciliation.

We talked about forgiveness in the last episode. We talked about forgiveness as it relates to ⁓ the research that was done with it and being able to make sure that it is a positive outcome versus a negative one because we want forgiveness to be aligned with the client’s timing and ⁓ and their free will to do so if they so choose. And just know though that some clients do just assume that forgiveness automatically

Then requires of them to reconcile. They they don’t know that you forgiveness and reconciliation are two different things, and you can have forgiveness and maybe never have reconciliation where you come together with that other person. Sometimes it’s not possible. Sometimes it’s not safe. ⁓ you know, and so just kind of helping clients and being able to assess whether or not that is some type of belief that they hold.

As clinicians, we do have to remember again that that decision to forgive is not ours. It definitely belongs to the client.

Generally, if there’s going to be a restoration of the relationship, there has to be some accountability that was taken. You have to rebuild trust. There has to be, you know, ⁓ you know, some truthfulness that comes forward with thoughts, feelings. There may be even some repentance ⁓ that comes forward in that, or people do that on their

is gonna focus on creating safety. ⁓

Creating boundaries, processing the client’s relationship with the Lord while also allowing the questions about forgiveness to come forward, processing that through their faith so that they can develop this level of release over time appropriately. Appropriately. Principle five.

Remember that boundaries can be biblical. Because some clients might believe that setting boundaries is selfish, it’s cruel, it’s unloving. Others might believe that love actually requires limited access to themselves. And neither is accurately reflected in the scriptures. So we don’t want to ad lib the scriptures. We want to just let them let them know and help them to understand that these boundaries can be very.

Biblical because they can create safety, and that it doesn’t have to mean that we hold resentment and it doesn’t have to mean that we hold anything negative. It’s saying that I recognize that this other other person or this environment ⁓ is not ready to be safe, and therefore I can ⁓

I can actually offer these boundaries or put up rather, I can put up these boundaries to ensure that I am safe because I know this individual is not gonna do it for me or this environment is not gonna do it for me. And so if I don’t do it for myself, it may not at all get done. Yeah. And we just process with with clients accordingly. Principle six is that church hurt.

Is an interpersonal issue. So one area where interpersonal psychotherapy can be particularly kind of helpful is working even with clients who have experienced hurt in the church. Sometimes ⁓ the hurt that they experience involves disappointments. Maybe it involved expectations of certain people. And those expectations weren’t realized. It might have been some conflict, it might have been portrayal, or it may have been abuses.

But those experiences ⁓ affect multiple relationships in their life simultaneously. And so ⁓ clients who are experiencing ⁓ relationship with the church, it might be, you know, that that’s changed a little bit since what they experienced, or they may notice that there’s been a change in their experience or their relationships with leaders in the church or even other believers inside and outside of the church.

Sometimes it’s even impacting their relationship with the Lord. So as Christian clinicians, we want to avoid minimizing those experiences, you know, with statements that are again, they’re not intentionally cruel. They they are really coming from a place oftentimes of trying to help and support the client, but it may not be as helpful. And those statements might look like, you know, well, you know, ⁓ there is no perfect church.

Or you know, church is for the sick, not for the whole. those are some things that, you know, ⁓ come up and again, there is no perfect church. That’s true. And and church is for us to be able to to get healing as well spiritually, to get understanding and education and to come together in community. Yes.

But we we have to just be careful that some of those statements, even though maybe coming from a place to help, they they can harm. And so instead, we just want to assess, we want to ask questions, we want to just explore, we want to listen, we want to help clients to differentiate between the actions of people and the character of God.

Because sometimes when people have experienced hurt or spiritual abuses, they may attribute those actions, those characteristics of those people to the character of God. And that work, it takes time for some people. That does take time for some people. And that’s okay. The ⁓ the seventh principle: integration should feel natural. All right, so

A question that you can ask yourself is: would bringing the scripture into this conversation genuinely help this client move forward in their treatment goals at this time? And if the answer is yes, move on forward thoughtfully, right? Respectfully.

compassionately, ethically, professionally? But if the answer is no, then we want to continue moving forward in our therapeutic approaches without the addition. Because Christian counseling is not ⁓ the nature of Christian counseling is not measured by how many verses we’re able to quote and how many times we’re able to explain scripture. It really instead is measured by how faithfully we care for people.

While we are honoring God and while we are honoring their choice to have their faith in Christ explicitly used within the sessions, and making sure that we are accurate in our use of those things that we do present in the session that aligns with their Christian faith.

So interpersonal psychotherapy reminds us that relationships matter and research supports that conclusion, and then our clinical experiences support that conclusion. And when evaluated through a biblical worldview, we recognize that scripture consistently presents relationships as part of God’s design for humanity.

So I want to thank you for joining me today for another episode of the Summer Faith Integration Skills Lab. And next time we are going to continue examining more evidence-based treatment modalities through a similar framework where we discuss the treatment modality and we start to look at whether it aligns up biblically with or aligns with a biblical framework so that we can continue to move forward strongly.

Stronger and stronger in helping those who are sent our way. Until we meet again, thank you again and God bless.