The Table Video

William Hurlbut, Brad Strawn, Nancy Duvall & Gregg Ten Elshof

Panel Discussion 4

Consulting Professor in the Neuroscience Institute, Stanford University Medical Center
Evelyn and Frank Freed Professor of the Integration of Psychology and Theology, Department of Clinical Psychology, Fuller School of Psychology
Professor of Psychology at Rosemead School of Psychology and the Institute for Spiritual Formation, Biola University
CCT Scholar-in-Residence and Executive Board Member / Professor of Philosophy, Biola University
May 11, 2013

A panel of six psychologists respond to questions from their audience regarding their arguments. The panelists focus on the integration of the physical and spiritual aspects of a person in psychological therapy and consider the ways that the Bible can contribute to this end.

Transcript:

And has been our practice so far, we’ll begin with our plenary speakers, give them a moment to reflect on their commentators, and then we’ll open things up to the floor. Dr. Hurlburt, can we start with you?

All I have to say about my commentator is I think he’s a great guy and he said a lotta good things. [panelists laugh] [audience laughs and claps]

Yeah, I liked mine, too. [chuckles] I think that Nancy pointed out a couple things I needed to clarify and try to do better with, and the terminology is so true, self is elusive and slippery. I keep wanting to say like “whole embodied persons” because I want to not have self, again, be an inner agent or some aspect of mind only, but that we know just even how we’re wired that the brain, if you will, takes information from the body about where it is spatially located in the world, and all that information’s also really important, so I keep wanting to come back to whole embodied persons, and that because we’re embedded, yeah.

I didn’t mention it here, but I like to think about selving, opposed to self. [panelist laughs] We’re always selving, we’re always interacting. That certainly is clear in children, and I think it’s happening in adults, as well. I think the whole person interprets present experience. It’s interesting philosophical question, “Who’s doing the interpreting?” I guess I honestly have to say I don’t know what to do with that in a particular, say, analytic philosophy language, perhaps, but I think the person is interpreting.

I’m interpreting; some of that interpretation is conscious, and some of it is offline. Automaticity is a kind of interpretation. Where is automaticity? It’s diversely through ourselves, and again I say, through our whole bodies because we might have a kind of offline memory because of a kind of spatial location we are in the world, and not just because we see something that reminds us of something.

So I think it’s the whole person that is interpreting, and again, I think that’s what the selves are doing, they’re interpreting, and I think, again, they’re multiple in some sense because different experiences activate different self-states in us, but it’s a really important, good question. And I would say with you, too, my last comment to Nancy is that yeah, I agree that relationships are fundamental. I really like the idea of desiring. James K. Smith, who is a philosopher at Calvin, says we’re not thinking beings, we’re desiring creatures, and for me, desire, for the human person, is primarily for relatedness, so I think that’s foundational, but I do think the way in which we learn to relate becomes, perhaps, emergent, and we can see that through various attachment styles.

And if someone, for example, is insecurely attached, that continues throughout the lifespan, typically. And so because we have learned a certain way of being, we continue to act in those ways, which becomes reinforcing, so I think, yeah, I agree, relationality is a kind of given. It’s what we desire, but the forms it takes are what are impacted or emerge based on these experiences we have with others in the world.

Okay, so we can open things up to the floor.

Audience Member: Dr. Strawn, you made me suddenly feel very, very old. Isn’t this post-Cartesian psychotherapy basically what we used to call reality therapy way back in the seventies?

Oh, yeah, oh, I thought you were gonna say more. [laughs] What’s interesting for me, just as a side note, is that as I’ve been thinking about this and working on this. For example, I often call myself a relational psychoanalytic psychotherapist, and one of my very bright students was reading this paper, a doctoral student, and he said, “It sounds like you’re advocating “for a relational psychoanalytic behavioral therapy,” which, it got me thinking that the more I think about this post-Cartesian, embodied, embedded way of being in the world, and the more I become interested particularly in embodied cognition, which I think about all of thought as being formed through embodied experiences in the world, that a lot of these arbitrary lines in the sand between theories drop off.

So even though, like Nancy mentioned, in the longer version of the paper, I critique dualistic tendencies within other psychotherapies, that doesn’t mean I don’t think that there’s other good things in those psychotherapies or that they can be practiced in more embodied and embedded ways. I think CBT, for example, can be practiced in very embodied and embedded ways or very dualistic ways, same thing for reality therapy, rational emotive therapy. And so, again, for me, it starts with the anthropology, and then we look at aspects of theories that fit within that particular anthropology that we can use.

Now, sometimes, we can’t. I think that pure behaviorism would be a problem for me because it doesn’t take cognition. Pure behavior doesn’t take it, and I think, again, some types of cognitive therapy, which I think we could probably put reality therapy under, if it’s practiced certain way, I would have trouble with it, but I think there’s, again, aspects of it that would work very well, and I would say the same thing for existential psychotherapy or other kinds of therapy. And again, I’m not really advocating for a loose, strange eclecticism because, for me, what informs what theories I can utilize and what techniques I can utilize have everything to do with my anthropology of the person.

Audience Member: Professor Strawn, this is directed at you, and I’d like to talk about terminology a little bit, and you can answer me either as a colleague here at the conference, or otherwise, perhaps, as a therapist because I have a little bit of a personal issue that I need to air with you. And I’m, as far as I know, the person who coined the term holistic dualism, and when you used that in the lecture today, it has nothing to do with how philosophers use the term dualistic holism, and so I think there are two things going on in your lecture today. One is for you to giving a very good presentation of your kind of therapy, and I’m illuminated, and I’m totally in agreement with it, but I am a dualistic holist or a holistic dualist, and see, there’s a rhetorical subtext to your presentation, and that is that if you’re a dualist and you go with the implications of dualism, you’re gonna mess stuff up.

You’re gonna fail it to integrate, you’re gonna individualize, you’re gonna reify egos as apart from bodies, you’re gonna commit all of these egregious sins. And if you’re a monist, and you go with the implication of monism, you’re not. Then you’re gonna be holistic, you’re gonna be integrative, and it’s gonna be very healthy, and you can play lip service, “Oh yeah, “there are good dualists and there are bad monists,” but the rhetorical subtext is not that message. And I really think that it would be wonderful if we could all go home from this conference and realize that we’re talking past one another.

It may very well be that psychotherapy has been influenced by 17th-century Cartesianism, and no changes have been made, and that is the major reason for all the goof-ups in psychotherapy, but I doubt if that’s true. And there are Cartesians at this conference, perhaps Professor Swinburne is one, or perhaps Stu Getz is one, and I doubt, if by their basic inclinations or their preferred kind of psychotherapy, they’d like to be treated as isolated egos not in relationships, and all that other kinda stuff. What we got, philosophically, was a whole lotta caricature, or otherwise simply failure to understand what philosophers mean by these terms. And I don’t think philosophers have the right to do that to psychologists.

We don’t understand what you guys are doing sometimes, but then we oughtn’t to criticize and engage in this kind of rhetoric, but, according to your anthropology, we oughta be reciprocal now, and we oughta speak the truth in love, we oughta try to understand one another, and we really oughta get past this. And so I’m gonna just call for us to do that.

No, I appreciate that and I hear that, I respect that. I think my paper is, in part, a call to say “Let’s talk about it,” and maybe I coulda said that more clearly. I do think that probably you did put your finger on something that probably is true that I think that, frequently, psychotherapists are practicing in philosophical areas but are not very philosophically-minded.

And so I think there is a responding or dealing with things that’re maybe outmoded or not the way that they are now intended, and I think part of the problem is we have a hard time understanding each other’s language and being at places like this, where we can actually talk to each other. So I appreciate hearing more from you.

Audience Member: Can I just suggest the same thing that I did to Professor Joel Green yesterday? What we wanna all be talking about is integration, and mutuality, and participation, and interaction.

Right, right.

And if we do that, that’s not monism, it’s integration, it’s interaction, it’s mutuality, and one can be an anthropological monist and do that, one can be an anthropological dualist and do that, or one can be a dualist or a monist and not do it. And there’s just no strong conceptual connection between these things, and there’s no strong existential connection such that if somebody’s a dualist, he’s inclined to get it wrong, and if somebody’s a monist, he inclined to get it right. I think that’s just category mistakes. It’s making connections that aren’t real.

Audience Member: This is for Dr. Strawn or your commentators, if they’d like to respond to this. You mention sin, and you mentioned it once, and it was not very clear to me what you meant by sin. I have some background of my own in, ‘scuse me, Christian therapy, and 12-step groups, and things like that, and I came to realize that sin is a very multi-faceted thing in the life of someone who’s trying to seek psychological wholeness, or however you wanna describe it.

There are sins you do, there are sins that are done to you, there are sins that are done to your parents, this type of thing, and I was just curious if you could clarify if there’s a positive role for sin to play in therapy, or clarify what you meant by that.

Yes, I think that the comment I made regarding sin was about a kind of, again, hopefully, there’s not many Christian counselors out there, but we’d know, there have been, that categorized all non-organic problems as a sin in terms of a kind of personal choice made by the person, a cognitive decision, and so it was sin, so if they would confess their sin and repent, then they would get better.

And so I think we’ve seen some abuses of that. However, at the end of my paper, when I started talking, and just hinting at this whole idea of ethical discourse in psychotherapy, I think there really is a place to talk about morals, and values, and sin, and I think that people engage in sinful behaviors, and so some of the behaviors that an addict engages in, for example, may be sinful in that they hurt self and other, and so there needs to be a kind of accountability about that. I think psychotherapy that gets locked into a secular model of APA ethics doesn’t know what to do with that because it’s not our place to bring any sort of moral judgment into the conversation. I don’t think that’s realistic.

I think it happens all the time, first of all. A lotta times it happens coercively, underneath, because the therapist doesn’t make his or her value commitments overt. But again, we don’t know how to do that under APA ethics, but I think this idea of psychotherapy as moral discourse, we have to be able to talk with people about these various perspectives and get them to think about how do they think about this, how does their community think about this, are there alternative ways to think about this.

And so, for me, there’s certainly a place of sin in our behavior, I think how we do it is very tricky, given both the need to develop secure attachments with people and be therapeutically helpful, and also, because we, literally, as licensed psychologists, have this group of people staring down our throat, telling us what we can and cannot do, to a certain extent. But it’s a good question. There’s not an easy answer, I don’t think. Did you wanna say something about that?

Not really, but, [Dr. Strawn laughs] Is this working, am I on? I think a larger thing is in therapy I’m always looking for what is keeping this person from doing a reasonably healthy thing. And I know that, in sessions, sometimes there’ve been some things they told me about that I clearly label as sin, and actually, they were Christians and they did.

And then when they finally got to the point where they recognized that this was not good for them, we raised a question, and the person had finally said something about “I’m sinning, “and it’s messing up my relationship to God,” and I kinda said, “So how come you’re doing that?” So I always look at it, I’m trying to get from their perspective and help them work from their perspective, and a lotta Christians will get there in due time, and what is keeping them from doing a reasonably healthy thing? That’s a good question.

Mediator: Here, in the back?

Audience Member: Yes, [speaks away from the microphone]

Oh, there we go.

Audience Member: My question’s a little bit in the same vein as the gentleman that asked the question about sin, and maybe Professor Strawn could address this, and then anybody else that wanted to comment, but it’s my view that the church has given over the care-taking of the soul to the professionals, the psychologists and therapists, who are, by-and-larged, trained not to make value judgments, as you alluded to, and to also tend to not wanna talk about sin, as you also alluded to.

I have a friend that’s a psychologist and he said to me that 90% of what he does is help people see how selfish they are, in marital therapy, not so much adjustment disorders, and that sorta thing. So I think this is very problematic, and I’m wondering, when you had mentioned somebody that asked a therapist “Are you doing biblical counseling?” That almost sounded pejorative to me, so I’m just wondering, as far as integration with your point of view, how you take sin and the fact that the church seems to have given over these issues to people who tend to not wanna talk about ’em.

Yeah, I would agree with you, and in the book that Warren Brown and I just wrote, we really attempt to take this discussion back into the church, and I think you could definitely make the argument that the reason we have all these professionals who care for the soul is because, in some sense, I think, at least in the western United States, we could make the argument, and others have, that individualism has become the dominant narrative, and so we no longer see ourselves a dependent, or like in a McAteerian way, disabled, that we need the other, and so church becomes nothing but a loose association of the independently spiritual.

I want to say that the holy church forms holy people, and so I think what the good therapist does is keeps encouraging the person back into communities, their communities, their cultural communities, where there are resources, hopefully, there should be resources for them to do the kind of work that maybe can’t be done in psychotherapy. I think that psychotherapeutic theory and science, the psychological science, can tell us much about how, for example, a really effective small group might be run in the church.

There are some of those out there, we sometimes find. A lotta times they’re, I think, aimed primarily at the head and not the whole body, not the whole person. They don’t know what to do with attachment kinds of things and relatedness, like Nancy was talking about. There gets to be exclusion issues, sometimes around doctrine, “Do you believe the right thing?” all that sorta stuff, so I think I’m with you, if I’m hearing you.

I want to encourage my clients that are Christian to get back into a church if they’re not in one. I don’t mind using the bible in psychotherapy. Oftentimes, biblical stories and images come to my mind, which I might readily share, if I feel it’s therapeutically appropriate. But again, the history of integration, there was a group of people that called themselves biblical psychologists, and if you didn’t start with opening the bible and finding the issue and claiming that it was sin and repentance was what was called for, then you were not considered a Christian psychologist.

And I used to resist the word Christian psychologist when I was in graduate school. I used to say, “I’m a psychotherapist who’s a Christian.” I embrace Christian psychologists now because that’s my fundamental way I understand myself in relationship to the body of Christ, my whole person, and so it just fits for me, I think. I don’t advertise as that, exactly, but [laughs] I don’t [speaks away from microphone]. [murmurs]

Audience Member: Dr. Strawn, Daniel Stern talks about when infants develop a verbal or symbolic self, there is an inevitable separation between reality and one’s representation of reality, which sounds to me a bit like an interior and exterior kind of perspective, and on top of that, Antonio and Hanna Damasio have found that when one considers one’s physical self as opposed to one’s mental self, different portions of the posteromedial cortices light up. So I hate to throw out a yes-or-no question at you, but maybe you can extrapolate a bit. Does it seem that we’re developmentally and neurologically wired toward dualism?

I would wanna say no, as you can imagine, obviously, [several people laugh] but there are those who argue that we are. I have a colleague that, I think, would argue that we are. And in that sense I guess I would, phenomenologically, again, now here we are, persons, and I’m working primarily with adults clinically, and I don’t love the word integration in some ways ’cause it feels like you’re forcing things together, but I do want people to experience themselves as both-and.

Yes, we think, yes, we have ideas, yes, we play with concepts, we imagine, I think, in embodied ways, I think we think, but this body, this thing I live into and what I do with it and how it impacts me, Stern talks about cross-modal matching or interpretation so that even small infants can switch from one system to another, and I wonder in some ways if, this is totally speculative on my part, but I wonder if there’s some ways in our society that primes us to separate out thinking and the body.

We certainly have separated out thinking and feeling for a long time, and so is there some way that the body, again, gets degraded, something in society or culture and the realm of the mind and thought is what’s best. But I’ve found clinically that when people can better understand and think about themselves as whole, that there’s something powerful that can take place.

Again, it doesn’t necessarily mean that I think and I feel in my body, and that sort of thing, but I would wanna move people toward a more holistic understanding of themselves. Again, because I want them to know that what they do, this is the behavioral part of me, I want them to know that what they do matters, and what they do influences how they think.

Audience Member: Hi, thank you for hearing my question. I have a question generally for the panel about definitions. As one trained in hard sciences, I find it hard to think about states, like self-states, without the underlying systems. How much is it proper, good, or helpful to consider self-states apart from the underlying system? Maybe it’s equivalent to ask: how much can we separate soul, the verb, from soul, the noun? Does that make sense?

Can you repeat the last bit of the question?

Audience Member: Sure, yeah. I was just wondering on how to phrase this in a way that would make sense, but I’m wondering if it’s equivalent to ask how much can we separate soul, the verb, from soul, the noun? [panelists discuss away from microphone]

I don’t know, I would think that they’re both at the same time. Think of a river, we use the noun river, but it’s moving, and you can’t step in the same river after the next moment. So I think it’s both.

I don’t know about the process question, with the process, I’m not quite sure. Again, I think how I understand self-states is that environmentally stimuli trigger these action maps of self and other in the world. So for example, again, if I have an insecure attachment action map, something might happen in my environment that triggers that insecurity, and so then I go into a whole set of behavioral scenarios that initially may be offline and may become conscious over time that I engage in.

I don’t know if that’s what you’re interested in there, but the issue with verb and self for multiple versus singular, again, I think that people are both multiple and singular, and some people who write about this talk about that it is important to have a unitary sense of self, and we can have that, and there’s a number of ways that we have it, part of that might be hearing ourselves narrate ourselves, talking to ourselves, we have a certain sense of continuity of myself over time.

But I’ve found clinically it’s helpful to help people think about that, at times, certain things get triggered in me, and then I feel a certain way, and I don’t always feel that way, but sometimes I do with this particular type of person, or this particular sort of scenario, and I find that it actually gives them a little bit greater self efficacy if they can understand that, and they can begin to do something and work with it. So I don’t know if that gets at your question or not.

And let me just comment, I think that the integration so that these self-states get consolidated, we know that people with dissociative identity disorder, as they bring things together, there’s this more whole sense of self and that kind of thing, and then, I’ve just found this clinically, I find it, in terms of the theory, terms of my favorite researchers and this kind of thing, and I think it’s scriptural. What is it, Psalm, is it 86:11? Unite my heart to fear thy name. And I think the goal is integration, to bringing it together, but that’s not always easy.

And I would have a slightly different take on that. I probably wouldn’t say the goal is integration, but the goal is to be able to do what Philip Bromberg calls standing in the space between these different self-experiences, if you wanna call ’em that. Whereas DID, dissociative identity disorder, is the worst case scenario where there’s no awareness between these self-states, versus, I think, an healthy, adaptive multiplicity, is that I know that when I go home and I see my kids tonight, that this self-state-ish thing of dad will emerge, which I don’t feel particularly right now, although I can imagine as I think about it, [chuckles] but I need to be able to stand in the space between these and feel comfortable with that, not so that I don’t get overwhelmed with one self, and you probably agree with that, some extent?

Yeah, I’m not arguing for homogenization, I’m just saying I think integration can incorporate the self-states with the underlying unity. “When I get tired, I get this way, “when I’m with this person, I tend to be this way,” but I know that I am all of that, so I think integration is the goal.

Audience Member: This is addressed to both Dr. Hurlburt and Dr. Strawn. I spent my career in cross-cultural work starting with Native Americans, except they’re called First Nations up in northern Canada. You’ve presented evidence that even from before birth, the infant is programmed to relate to people, to faces, and continuing to do that throughout life, and so whether we call if a self or a soul, your self-soul develops within a particular set of relations within a particular culture.

What happens when you being people from culture A and radically different people from culture B and try and relate to each other? It seems to me that this has enormous implications for that, and I’d be glad to hear anything you have to say about it.

Yeah, it’s gonna be a clash, it could be a clash, and closer to home, that’s how I would describe marriage, [chuckles] when two cultures come together. [audience members laugh] So for example, you take a group of students on a trip somewhere, and they have culture shock, and if they live there long enough, they begin to assimilate.

I would say their whole persons are shaped and formed and changed, and maybe there’s something happening in the brain as well, and then they go back home, and I have a friend who went and was in a very poor country, and he came home, and he broke down in tears as he walked through the grocery store where there was a whole aisle of dog food because now it’s a reverse culture shock.

So I do think it has important implications. If we can recognize again that my experiential worlds shape the way in which I see and how I interpret, then when I’m sitting with someone else, whomever that other person is, if it’s my spouse, or my friend, or my pastor, or someone from another culture, what is their experiential world?

This is mentalizing, that’s my idea, mentalizing. How do I understand that they have a subjectivity that’s not mine, and they may overlap or it may not, and how can we have conversation, and again, I also think that’s what happens in psychotherapy. I think you have two different subjectivities who hold different values and beliefs, and somehow they have to have a conversation about that. I think that’s, again, interesting to think about in terms of spiritual formation, and how we do church, and all the people sitting in the congregation, and what happens when the preacher is preaching, and who is the preacher preaching to, and does the preacher understand his or her people, and what are those people hearing, and. So all communication becomes complicated, I think, because of this, but yeah, it’s maybe most clearly seen.

Audience Member: It’s a little more complicated when we come from such [speaks faintly].

Right.

We’re just a little bit past our advertised stop time, so–

We didn’t have a question for Keith. [speaks faintly] [panelists laugh]

So let me propose that we thank again our speakers. Thank you. [audience applauds]

That’s it. [panelists chat]

And thank you all again for joining us for these great two days, God bless, have a good evening.

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