[This is a follow up course to Orthodox Christian Spirituality and Cognitive Psychotherapy: An Online Course, that appeared in four parts over the years 2012-2013. This second course is specifically oriented to explain Orthodoxy to mental health practitioners,and serve as a useful resource for Orthodox Clergy and laity as well. Ethically, mental health practitioners should incorporate the spiritual values of their patients in the therapeutic process. The course would serve as an introduction of the Eastern Orthodox ethos and cultural traditions to these professionals.
One of the most frequently questions I am asked as Chairman of the Chaplain and Pastoral Counseling Department of the Antiochian Archdiocese is for a referral to an Orthodox mental health practitioner. Sadly Orthodoxy is not a majority spiritual tradition in North America and Orthodox practitioners are few. So careful questioning by potential patients, family and clergy of a potential practitioner regarding the practitioner's understanding and respect for the spiritual values of their patients is very important. This course is meant to aid in this inquiry.
It also should be noted that this course is an updating and reworking of a recently published chapter: Psychotherapy with members of Eastern Orthodox Churches, (Morelli, 2014).]
You doctors, must take good care of your patients in order to avoid unpleasant situations. You should have a practical mind. Generally speaking, every one of us must take advantage of his mind which is a gift from God.
(Saint Paisios of the Holy Mountain) [1]
Considerations in the Psychotherapy for Orthodox Christians
Cognition, emotion and behavior interact with each other in complex ways.Emotion and Neural Processes
There are currently various psychological models to explain this interaction. One model, based on Darwinian evolutionary theory, is that emotion develops as an adaptive value to a stimulus. From the different laboratories of Izard (1993, 2001, 2002), Plutchik (1984) and Tomkins (1991) come remarkably similar findings on the presence of primary emotions shortly after birth.
These researchers agree on six emotions (fear, anger, joy, disgust, interest and surprise) out of about eight or ten primary emotions. Phylogenetically, these emotions occur before the brain structures supporting cognition initiate development. That is, subcortical brain areas such as the hypothalamus and the limbic system develop before the cerebral cortex.
Researchers have shown that emotional responding in lower animals appears to be an innate reaction to certain stimuli. In human brain architecture, the limbic system and hypothalamus are connected by neural structures to these later developing cortical structures, allowing communication between these two areas. Research on neurophysiological processes and psychopharmacological processes summarized by Izard suggests that these areas serve as the possible neural architecture (subcortical and cortical) pathways of emotion. Early Christians knew nothing of the taxonomy and biological substrates that are understood today. They were limited to the understanding of their times. The word 'passion' is the term used by the Church Fathers that most closely describes what today's scientific investigation calls emotions.
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Cognition, Emotion, and Psychospiritual Perspectives
The research literature demonstrating the cognitive elicitation of emotion is ubiquitous. Appraisals, anticipations, attributions, beliefs, construals, inferences, judgments and memories of stimulus situations all fall in the cognitive domain. In one early pivotal study out of Richard Lazarus' laboratory (1991), appraisal strategies of subjects were manipulated before they viewed a film depicting an aboriginal male puberty rite.
Subjects in a neutral or "intellectualized" condition displayed significantly less emotion as measured by self-report and physiological monitoring than subjects in the "sensitized" condition. Other studies in this area use variations of this paradigm. In recent years, a substantial body of information has been collected on cognitive-emotion interaction. (Bandura, 1986; Erwin, 1980; Galanter, E. 1962; Kahneman, D. 1973; Marmor, J. 1962; Posner & Snyder, 1975; Shriffren, 1988).
Cognition research has also been extended to the behavioral processes of parenting (Patterson, 1976).
Cognitive-Behavioral principles in parenting have been outlined in a series of Smart Parenting articles available at www.orthodoxytoday.org/archive/morelli.
The question arises, in use of psychospiritual intervention to address emotional disorders, as to what extent cognition plays a role in initiating, sustaining and possibly attenuating emotional responding. If one were to maintain that emotions can be triggered even in humans by subcortical processes, would cognitive processes have any role in their modulation?
This is not a trivial question; it is at the foundation of the various Cognitive therapies and goes to the heart of the moral and spiritual teachings of the Church Fathers. Fundamentally: "To what extent can we control our emotions, or what the Church Fathers refer to as our "passions?" Is it true that emotions generated at more basic systems levels, such as subcortical or neural processes, are less cognitively controllable than cortical (cognitive) processes? To what extent do individual differences play a part in such control processes? In other words, are some individuals able to control the various systems of emotional activation over others?
Inasmuch as we have no comprehensive individual difference model of emotion activation, we must proceed with caution and at best heuristically. Each person should be evaluated individually as to what emotion systems are influencing an emotional reaction as well as the person's ability to have cognitive control of these systems. Some patients with lower levels of cognitive control may benefit from interventions targeting the neural sensori-motor or affective systems directly (i.e., psychotropic treatment, environmental change) as the primary treatment. Patients with higher levels of cognitive control may benefit from more focused cognitive treatment programs (i.e., Beck's [1995] Cognitive Therapy: Basics and Beyond). It has been my clinical observation, however, that even patients with limited cognitive resources (with the exception of low-functioning cognitively impaired individuals) benefit from some cognitive interventions. This makes neurophysiological sense if it is remembered that in humans the brain's subcortical (emotion) and cortical (cognitive) pathways are connected. These findings in no way contradict the teachings of the Church Fathers who point out that man, created in God's image, has "free will." However, as the Fathers tell us, any number of factors may diminish the capacity of voluntary-involuntary acts.
ENDNOTES
1 Former Elder, now Saint Paisios of the Holy Mountain was officially canonized a saint by Patriarch Bartholomew of Constantinople and the Holy Synod on 13 January 2015. (www.omhksea.org/2015/01/ecumenical-patriarchate-officially-entered-elder-paisios-among-the-list-of-saints/) Among the Orthodox, the pathway to sainthood is usually started by the popular acclamation that someone is worthy (Axios!) of sainthood. This was the certainly the case of saintly Elder Paisios. His Feast Day will be on 12 July. My readers may want to pray the Apolytikion and Kontakion of the new saint:
Apolytikion in Tone 1
The offspring of Farasa, and the adornment of Athos, and the imitator of the former righteous, equal in honor, O Paisios let us honor O faithful, the vessel full of graces, who hastens speedily to those who cry out: glory to Him Who gave you strength, glory to Him Who crowned you, glory to Him Who grants through you healings for all.
Kontakion in Plagal Tone 4
The most-famed ascetic of the Holy Mountain, and the newly-enlightened light of the Church, let us praise him with hymns with all our heart, for he leads the faithful towards a perfect life, filling them with rivers of gifts, therefore we cry out: Hail, O Father Paisios.
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