Psychological Barriers to the Way of the Cross

Abuse: Some Pastoral And Clinical Considerations

• Physical, (hitting, battering, etc.);
• Sexual, (forcible intercourse, inappropriate touching, glancing, language etc.);
• Psychological (calling someone by demeaning terms "You idiot, loser" (actually mild, often far worse);
• Neglect (legally denying food, shelter, education, and necessary care).

Elevating Motives

Self Esteem: From Through and Toward Christ

Compassion and Love: Developing Chaplaincy and Pastoral Counseling Skills

St. Matthew (14: 14-22) tells to us that when Jesus saw how hungry the people were that He was speaking that "He was moved with compassion for them." Let's put ourselves in the place of Jesus. Jesus is about halfway through His three year ministry. His cousin and friend, John the Baptist, whom Jesus called the "greatest of Prophets", was just martyred for reproving the sins of the rulers. Jesus wanted rest, peace, and solitude. In situations like this He often went off to pray.

But Galilee was a difficult place to be alone. It was a small country, about 50 miles north to south and 25 miles east to west. The Jewish historian Josephus wrote that at this time of Christ there were about 204 towns and villages with at least 15,000 people each. Galilee was not a place of solitude. The only place to find rest was on opposite shore of the Sea of Galilee about eight miles across the water.

And then even more people came by. They want to Jesus to heal them and hear His words. He needs to make a choice: tend to his need for peace and solitude or care for the people. St. Matthew tells that Jesus stayed. The multitude he was serving stayed all day and became hungry. The apostles advised Jesus send them away so they can get their own food, and again Jesus was faced with a choice. He needed solace, but the people needed Him.

How does Jesus react? With compassion. What is compassion? Compassion is the deep awareness of the suffering of others coupled with the desire to relieve it. Compassion is related to the psychological construct of empathy. Empathy is the ability to think and feel what others are thinking and feeling.

In terms of human development, empathy is the foundation of pro-social behaviors such as altruism. (Lewis and Haviland, 1993) Compassion is a precursor of love (agape). Love is what we do for the good and welfare of others. How can we love, how can we work for the good and welfare of others, if we are not aware of their suffering nor have a desire to relieve it? We love others only if we can first sense their needs.

It would have been so easy for Jesus to justify his own needs, and none of us would fault Him if he did. There are times when we need to meet our own needs, and no one would fault us either. But Jesus did something different and demonstrated that at appropriate times we need to be guided by compassion guide us and set aside our own needs.

We see example of this in a new mother, who sets aside her need for rest to feed her newborn. Is it any easy self-denial? Many times it is not. Is it a compassionate self-denial? Absolutely.

A young girl who went to India to work with Mother Teresa of Calcutta She had no medical or nursing skills. One of her assignments was to comfort the most sick on the verge of death. These patients had all manner of afflictions. Many were incontinent. Others would vomit blood.

The girl observed another worker who could clean and nurse the patients with a great amount of skill and experience. She felt inadequate because all she could do was hold their hands, lovingly stroke them, and pray with them. She grew discouraged until Mother Teresa pointed out the joy in the patient's faces when she entered the room. In her own simple way she met a very great need for love, comfort and prayer in these dying patients. (Conroy, 2003)

All Christians are to discern the needs of one another and relieve them if we can. We are to live lives of compassion just like Jesus did. How we accomplish this is based on our own personality and talents. This vocation is universal, but we fulfill each in our own way.

Christians should do a "compassion assessment" of the needs of those around them. Then they should do a "talent assessment" of their skills to determine how to relieve those needs. Let us put aside our needs for the good of the neighbor, and that will lead us to find rest in God.

Conroy, S. (2003). Mother Teresa's Lessons of Love and Secrets of Sanctity. Charlotte, NC: Our Sunday Visitor.

Article link: http://www.orthodoxytoday.org/articles5/MorelliCompassion.php

The Beast of Anger

The spiritual-cognitive components of anger were long recognized by our Church Fathers. St. Basil recognized the loss of reason in anger. "It makes a man completely bestial. In fact, it does not even allow him to be a man at all, because he ho longer has the help of his reason."

An interesting spiritual issue arises in this context. In order for us to perceive ourselves to be "intruded on" to the extent that it justifies, anger, vengeance, and retaliation we have to have to see ourselves as 'important.' St. Basil tells us "Anger nurses a grievance. The soul, itching for vengeance, constantly tempts us to repay those who have offended. I am so important, so above others I have the "right" to act uncharitably toward other.

What is the root of this reaction? The passion and sin of pride. St Mark the Acetic (Philokalia V. I) wrote: "The passion is strengthened especially by pride. And as long as it is so strengthened it cannot be destroyed. ...Thus the structure of evil in the soul is impossible to destroy so long as it is rooted firmly in pride." From the Shepard of Hermas (Book II Commandment 5) who saw the Holy Spirit choked by anger: "For he is choked by the vile spirit, and cannot attend on the Lord as he wishes, for anger pollutes him. For the Lord dwells in long-suffering, but the devil in anger." Abba Agathon wrote that anger can produce spiritual death: "An irascible man, even if he is capable of raising the dead, will not be received into the Kingdom of Heaven." Another holy desert father Abba Poimen saw anger as obliterating he who would consider himself a monk: "A complaining, vindictive monk, prone to anger, cannot exist,". That is to say that, any who have such faults are not actually monks, even if they wear the schema."

Mankind is created in the image of God and as creatures of God we are called to be "like" Him. (Gen. 1:26) The Church Fathers define the image of God in us as our free will and intelligence. To be like Him meant that mankind must choose "the good." For our first parents, choosing good was to obey their Creator -- not to make themselves into gods by tasting the fruit of knowledge of good and evil (Gen. 2:17). Noting mankind coveted a spiritual power above it's created nature Blessed Augustine interpreted this passage to mean that Adam and Eve thought of themselves as having the knowledge of God.

When God further revealed His Will in the form of the Law: the Ten Commandments (Deut 5: 6-21). and other proscriptions listed for His people. When the fullness of time had come and God sent His "only Begotten Son" our Lord God and Savior Jesus Christ, He revealed to us the fullness of what it was to be "like" Him. Our Lord tells us "And now I give you a new commandment: love one another. As I have loved you so you must love one another." (John13:34,35).

What greater love could the Father have for us that even though He is God, nevertheless, send His Son to take on our nature so we -- all mankind -- can be lifted up to Him? "For God so loved the world that He gave His only begotten Son: that whosoever believeth in Him may not perish, but may have life everlasting." (John3:16). Let us ponder some of the things Our Lord has told us about love. "If you forgive the faults of others your Heavenly Father will forgive yours. If you do not forgive the faults of others, neither will your Heavenly Father forgive you." (Mt. 6:14-16). "My son your sins are forgiven." (Mk. 2:5). "If you want to avoid judgment, stop passing judgment. " (Mt. 7:1).

How do we achieve this love shown to us by the Father and His Son, Our Lord, God and Savior Jesus Christ? St. Paul tells us: "Get rid of all bitterness, all passion and anger, harsh words, slander and malice of every kind. In place of these, be kind to one another, compassionate, and mutually forgiving, just as God as forgiven you in Christ." (Eph. 4:31). Our calling as part of God's creation, as a member of Christ's body, the Church, is to grow and actualize ourselves; to find those imperfections in us that are barriers preventing us from being "like God"; that prevent us from loving and forgiving. In keeping with St. Paul's words, our emotions, such as anger, are just such an imperfection or barrier. By making ourselves less angry we can grow in the love of God and our neighbor.

Current research psychology has helped us understand the cognitive structure supporting and triggering anger. Besides aiding in helping us to understanding how anger comes about, this research also helps us to employ psychological techniques that can aid in overcoming and preventing anger. The cognitive-behavioral model of emotional dysfunction (Beck, Shaw & Emery, 1979; Ellis, 1962) has been shown to be effective in this regard.

Beck points out the theme of anger is "significant intrusion." We feel some one has intruded on us or on someone or something we love and posses that we consider to be an extension of ourselves. According to this model, emotions such as anger are produced by distorted or irrational beliefs, attitudes and cognitions. Situations (something that someone has said or done or events that have happened) do not produce or cause our upset.

We upset ourselves over people and events, by our "interpretations" of them, thereby making ourselves dysfunctionally angry, anxious or depressed or simply functionally annoyed, concerned and disappointed. If our thinking is clear, rational and non-distorted we have normal feelings like: bearable nuisances, caring and livable letdowns. If our "interpretations" are irrational or distorted we get enraged, intensely worried and despondent. Ellis has long pointed out that emotions such as anger add to our problems like in a 'domino effect.' Originally we have a problem, the "Activating Event." Our angry emotional response is a new problem added to the original, which in turn is linked to other dysfunctional outcomes, etc.

This was so clearly perceived by one of our spiritual fathers so early after Our Lord's message, the Shepard of Hermas said: "But anger is foolish, and fickle, and senseless. Now, of folly is begotten bitterness, and of bitterness anger, and of anger frenzy. This frenzy, the product of so many evils, ends in great and incurable sin." (Book II, Commandment 5)

Cognitive psychological research has found support for seven cognitive distortions relating to anger and the other dysfunctional emotions:

• Selective Abstraction is focusing on one event to the exclusion of others. A mother , for example, pays attention to the "D" on her son's report card while ignoring the "A's" and "B's." This "D" now becomes the focus of anger.
• Arbitrary Inference is drawing a conclusion unwarranted by the facts in an ambiguous situation. For example, a parishioner says "Hello" to the Parish Priest in the Church Hall, the Priest doesn't reply, the person concludes the Priest doesn't like him or her and has a right to be angry.
• Personalization, an event occurs that an individual concludes is directed to them personally. A patron in a busy restaurant perceives the waiter is purposely not waiting on his or her table. The patron never entertains the waiter may be under stress attempting to serve other patron's needs. The patron, concludes, they have a 'right' to be angry.
• Polarization is the tendency to see things in all or nothing terms. 'Cynthia, Jack's wife misses making dinner one evening, because he 'categorizes' events into polarities he views her as a "bad" wife. All the categories between the absolute categories of good and bad are missed. He has the right to be angry at a "bad" wife.
• Generalization is the tendency to see things in always or never categories. 'Jack' comes home late from work. His wife 'Jill' feels her husband will always be inconsiderate and never change. Not only is she angry at his lateness, but his future lateness as well.
• Demanding Expectations, the belief that there are laws or rules that must or have to be obeyed. A mother believes he son should not talk back because she is his "mother." She has the "right" to be angry. (Note God gave us free will, He 'asks' us to obey His commandments. Like Christ, parents can 'prefer and constructively work' toward obedience from their children, but they have no guarantees their children will respect them.) Of spiritual help here is to reflect on the life of Our Lord. He was bruised, derided, cursed, defiled, crucified and died for our salvation. He Himself told us: No servant is greater than his master (Mat. 10:24) ---why would we expect to be treated any differently than Our Lord. It is a blessing if we are treated and honored, but we have no guarantee) A program of rewards for appropriate behavior and punishment, without anger, for inappropriate behavior would be constructive.
• Catastrophizing, the perception that something is more that 100% bad, terrible or awful In the example above, the mother feels that it is terrible, the end of the world, her son answered back, which of course triggers increasing anger.

After recognizing our recognizing and labeling the cognitive distortions , eliciting anger, clinicians aid patients in re-structuring them. There are three questions that lead to restructuring.: 1) Where is the evidence? 2) Is there any other way of looking at it?. 3) Is it as bad as it seems? Using the examples above some restructured interpretations might be: (Selective Abstraction): True, my son got a "D", but he also received some A's and B's); (Arbitrary Inference): "Father didn't say Hello, he may not like me, but maybe he has something on his mind and he didn't even hear me." (Personalization): "The waiter is so busy with other tables, maybe he doesn't even see me." (Polarization): "My wife, Jill missed dinner today, there are many other things that make up our relationship besides one dinner" (Generalization): "Let me talk to Jack about his work schedule and at least ask him to call me if he is going to be late" (Demanding Expectations). "I prefer that my son not talk back to me, let me praise him when he talks correctly and fine him a nickel whenever he talks back."

In addition to the above restructuring questions the "mental ruler technique" (Burns, 1980) is particularly helpful in dealing with Catastrophizing. A situation in the example above a child 'talking back' to his/her parents is evaluated on a 0 to 100 scale, with 0 being the most pleasant thing you could picture happening to you. People infrequently have trouble imaging a very pleasant event (0). Sitting on a sun drenched tropical beach is a typical image. People frequently need help imaging a "graphic" worst event (100).

Use of an example such as the particularly horrifying death of a medical missionary in Southeast Asia several years ago can be of help. After starvation failed to kill this individual, his captors placed chopsticks in his ears and hammered then in, a little each day, until the chopsticks penetrated his brain and the missionary died. Using the "mental-ruler technique' and the restructuring questions, it can be seen that the mother whose son answered back is surely not the same as chopsticks in the ears, in fact, it is probably no more that a 10 or 20 on the mental-ruler scale. Thus successful catastrophizing challenging and a more realistic evaluation. Instead of viewing this a "catastrophe" is now is viewed as a manageable problem to be solved.

These psychological techniques have to be applied rigorously and consistently. They should be used whenever we find ourselves starting to become angry. One helpful way is to excuse yourself and leave the room for a few minutes to collect our thoughts, making sure the psychological "restructuring and reinterpretation is also permeated by Our Lord's teaching and His self-emptying life for us.

We can reflect on the words of St. Mark the Acetic: Do you want the tree of disorder -- I mean the passion of bitterness, anger and wrath -- to dry up within you and become barred, so that with the axe of the Spirit it may be 'hewn down and cast into the fire' together with every other vice (Matt. 3:10) ...If this is really what you want keep the humility of the Lord in your heart and never forget it...Call to mind who He is, and what He became for our sakes. Reflect first on the divine light of His Divinity revealed to the essences above [the angels] (Eph 1:21)...Then think to what humiliation He descended in His ineffable goodness, becoming in all respects like us who were dwelling in the dwelling of darkness and the shadow of death (Mat 4:16)." Petition Our Lord's help in this way to help restructure.

This "time-out" can be accomplished by something as simple as going to the restroom. Restructuring should can also be incorporated into evening prayer, especially during the examination of conscience and prayer for forgiveness of sins. This active approach toward our becoming like Christ is our vocation as Christians. St. James tells us "So you see, then, it is his actions that a person is put right with God, not by his faith alone" (James 2:24). All the wishing or prayer we do, if it does not lead us to actively make ourselves like Christ is empty.

"Since you are God's dear children you must try to be like him, Your life must be controlled by love ..." (Eph. 5: 1-2). Work, vivified by prayer and the sacraments, is the way to advance in our likeness in Christ. Only then will we be able to say with Christ: "Father forgive them for they know not what they do" (Lk 23: 34) This is true anger management.

Beck, A.T., Rush, S., Shaw, B. & Emery, G (1979). Cognitive therapy of depression. NY: Guilford Press.
Burns, D. (1980). Feeling good: The new mood therapy. NY: The New American Library.
Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus, NJ: Lyle-Stuart.
Palmer, G.E.H., Sherrard, P. & Ware, K. (1979). The Philokalia 1, London: Faber and Faber

Article link: http://www.orthodoxytoday.org/articles5/MorelliAnger.php

O Happy Guilt, O Joyful Sorrow: An Orthodox Understanding

O Happy Guilt, O Joyful Sorrow: An Orthodox Understanding

V. Rev.Fr. George Morelli Ph.D.

Understanding Guilt in Eastern and Western Christianity: Clinical and Pastoral Helps for Chaplains, Mental Health Clinicians and Clergy

In the Orthodox Christian tradition, The Philokalia (Greek: love of the good) ranks as the authoritative compilation of teaching about Christian life and discipline by the Fathers of the Church. In the reference work The Philokalia: Master Reference Guide, author B.S. Stapakis notes there is no reference to "guilt" in the first four volumes of the Philokalia. The reason for this absence is that the Western Christian concepts about how guilt factors into salvation differs markedly from the Christian East.

The late Orthodox historian Fr. John Meyendorff wrote:

"The development of penitential practice and theology in the Byzantine world was distinct from its Western counterpart in that it never knew the influence of legalistic interpretations of salvation...Byzantine theologians never succumbed to the temptation of reducing sin to the notion of a legal crime, which is to be sentenced, punished or forgiven..."

He goes on to say that the prevailing view sees penance as "liberation and healing rather than that of judgment."

Contrast Meyendorff's conclusion with the Catholic Encyclopedia where guilt is described as liability to punishment incurred by transgressing a law. The process that pronounces a person guilty of transgression is compared to a "court of law," and that "in the Christian life, guilt has this primary objective sense." The subjective ramification of this objective decree is psychological remorse, or from the other direction, psychological remorse is the evidence of objective guilt.

The Catechism of the Catholic Church approaches the matter a bit differently. It does not have a specific entry for "guilt" but states that in the confession or disclosure of sin "...man looks squarely at the sins he is guilty of, and takes responsibility for them" (1455).

Nevertheless, despite this softening of the juridical motif where the pronouncement of transgression is likened to a court of law, the theme of psychological remorse remains. This is evident in the belief that "a temporal punishment for sin remains" even when sins are forgiven as well as the subsequent practice of granting indulgences that continues even today. Indulgences, "Opens...the treasury of merits of Christ and the saints to obtain from the Father of mercies the remission of temporal punishments due for their sins" (1478).

Orthodox Christianity does not hold to the notion that guilt is a punishment for sin. Guilt certainly exists as an indicator that sin has occurred, but confession and repentance are understood in more therapeutic terms, as a means by which the sinner is restored to communion with God and through which spiritual healing is affected and not as the process by which punishment is imposed.

One exception to the Orthodox understanding occurred among some teachers who came under the influence of the western ideas in the eighteenth and nineteenth centuries. A prime example is St. Tikhon of Zadonsk (1724-1783) who "borrowed heavily from the west," according to Bishop Kallistos Ware. St. Tikhon "... drew upon German and Anglican books of devotion; his detailed meditations upon the physical sufferings of Jesus are more typical of Roman Catholicism than Orthodoxy." St. Tikhon's prayer life was influenced heavily by St. John of the Cross' Dark Night of the Soul.

St. Theophane the Recluse, a student of St. Tikhon wrote a magnum opus, The Path to Salvation, a reinterpretation of True Christianity written by his beloved teacher. "Judge and condemn yourself, and only yourself...your bad will alone is to blame (guilt of your sin). So blame yourself," wrote St. Theophane.

St. Theophane's western approach to guilt is demonstrated by his view of the majority of Christians as "...people who are more or less depraved in their present lives..." wrote Bishop Ware. The problem here is not acceptance of responsibility within which St. Theophane is in total conformity with the spiritual fathers of the Church. Rather the problem is in his emphasis on the depravity of the individual as such as a "state of being" that functions as a component of guilt and is only realized through the experience of guilt.

Modern society holds back no barriers discussing guilt. Barnes and Nobel lists no less that 1,143 titles dealing with guilt. Some psychologists posit that guilt is a developmental stage that a person may pass through (Erickson 1950). Dealing with the deleterious effects of guilt is also a focus of clinical research psychologists. Bandura (1974) argues that guilt, shame or dissatisfaction occurs when an individual compares their behavior to their internal standards and finds that it either violates or falls short of those standards.

Cognitive-behavioral psychology has done much to define the meaning of guilt and distinguish between the functional and dysfunctional uses of the term. One of the basic premises of the cognitive-behavioral approach is to distinguish between the individual (their being, so to speak) from what they do (their thoughts, feelings and actions). From the outset patients are taught this important distinction. Treatment focus starts with the evaluation of the thoughts, emotions and actions without evaluating the "self" (Morelli, 2001, 2004). The value of the individual is simply they are "human" and humans can do good or bad things.

This view is congruent with the Christian view although the Christian view goes further. The scriptures teach that we are created in God's image and called to be like Him. Further, "...God saw everything that he had made, and behold, it was very good. (Gen. 1:31). The things we do may be wrong or even evil but our actions cannot negate the existential truth that we are made in God's image and thus good remains.

St. Isaac of Syria stated, God "...has created all for man and has given him mind and word, by which, rising on high, he can enter into communion with God, contemplating and glorifying Him." From the Christian perspective the value of the human being rests in this capacity to contemplate, commune with, and ultimately glorify, God.

Humans made in God's image are called to be like Him and experience theosis, or God dwelling in them. St. Maximos the Confessor wrote that, "Deification is an enhypostatic and direct illumination which has no beginning but appears in those worthy as something exceeding beyond their comprehension. It is indeed a mystical union with God, beyond nous and reason in the age when creatures will no longer know corruption." Bishop Hierotheos Vlachos (1994) concluded that "...the vision of the uncreated light is man's deification."

How, then, do we properly understand and deal with guilt? The first step is to frame any experience of guilt in the broader context that the penitent was created good, and his essential goodness rests in the capacity to experience the life of God.

One of the major components of guilt is the cognitive construct of "badness" (Burns, 1980, Ellis, 1962). The first cognitive distortion (Morelli, 2004) that leads to guilt is to perceive the "self" as bad instead of the "thought, feeling or action" as bad. In psychological terms this is a fundamental breakdown in reality testing. In spiritual terms, this demonstrates a lack of knowledge about our divine value and potential at best; at worst it broadcasts hopelessness and despair.

Psychologically speaking, a person is still a human despite bad things they have done. This is true no matter what the horror of actions committed from a societal viewpoint.

Spiritually speaking, no matter how darkened the mind or evil an act, cleansing is still possible. The strongest example in scripture is King David who had an affair with a colleague's wife and then had the colleague killed but still obtained forgiveness (2 Samuel 11). The affair and murder did not consign King David to a state of unredeemable darkness (a perpetual state of "badness" to use the psychological terminology). The Psalmist in reference to David's sin wrote:

Have mercy on me O God, according to thy steadfast love: according to thy abundant mercy blot out my transgressions. Wash me thoroughly from my iniquity, and cleanse me for from my sin (Psalm 50: 1,2).

From a cognitive-psychological viewpoint the next step is to evaluate the "badness" of the thoughts, emotions and behaviors. There are basically two options. The first is to assess if the thought or action is objectively bad, immoral and/or unethical. The second option is to assess if the thought or action is cognitively distorted, that is, not bad at all or not as bad to the degree that it is being perceived. The psychologically healthy response is to assume responsibility for the thought or action commensurate with an objective assessment of the transgression.

Once again this was beautifully expressed by the Psalmist, "For I know my transgression and my sin is ever before me" (Psalm 50:3). A transgression should not be denied, but acknowledged.

A common theme in distorted evaluations is that they have a "demand" and "over-evaluation" factors. Feelings of guilt are often accompanied by "should statements" such as "I should not have done this bad thing," "I am worthless, others will look down on me," and "I thought I could never do such a thing." Individuals see themselves as above being able to do or say bad things.

One of the prayers in the Eastern Church funeral service gets it right, "...there is no man who is alive and does not sin." The denial of the capability to fall short and do bad things is actually a subtle form of pride, and pride is sin.

Even the greatest of saints had a sense of falling short and would turn around through the gift of tears (Staniloae, 2003). Peter, for example, wept after denying Our Lord three times (Matthew 26:75). Should these tears be understood at as psychological self-deprecation? No! The "gift of tears" is really penthos - the "mourning for the loss of God's presence" (Chryssavgis, 1990). They constitute a "joyful sorrow" through which a person is transformed by the grace of God.

Burns, (1981) describes the "guilt cycle" that often follows a transgression. A person's cognitive processes are trapped in an endless loop: "I am bad, I am worthy of condemnation, I am guilty thus I deserve to suffer." Emotional reasoning is the fuel that feeds this loop: "Because I feel guilty I am guilty; I am inherently bad, I deserve punishment."

Challenging and restructuring this error in thinking is critical at this stage. Ask the person if feelings are fact. Use this example: People once strongly felt that the world was flat. Today we know today the world is round and revolves around the sun. No matter how strongly we might feel about something, feelings are not facts!

The key to dealing with 'guilt' from this point on is again found in the words of the Psalmist: "thou desires truth in the inward being; therefore teach me wisdom in my secret heart....Then I will teach transgressors thy ways and sinners will return to thee" (Psalm 50: 6,13). Clinically and pastorally I use the term "debriefing" to describe this process of dealing with guilt.

Debriefing is a neutral term that is action oriented. It has no surplus meanings that might evoke irrational interpretations and strong emotions. The National Aeronautics and Space Administration (NASA) debrief astronauts after a space flight. The military debrief units after operations. Police and fire units debrief their personnel after incidents. The focus on debriefing is to understand the causes of events, the effectiveness of interventions, the consequences, suggestions, and plans for improvement.

The Church Fathers obviously used different terms. The term examination of conscience covers some of the meanings. The purpose of debriefing is to set the groundwork for a more successful operation in the future. Focusing on self-downing and punishment interferes with this process. The church calls for a metanoia which the Shepherd of Hermas defines as a call for great understanding and discernment (Chryssavgis 1990). Metanoia means a fundamental change of mind; a transformation of outlook.

Moreover, a change of mind indicates a change in emotion and a change in behavior which further indicates a plan of action to bring about this change. Here is where understanding and discernment can be married to behavioral plans. For example, it is folly for a person who has an alcohol problem to continue working as a bartender. A major change, a new plan is needed -- a metanoia of mind, heart, feeling and action.

One issue that usually arises is how do I make up for my past badness, transgressions and sins? The answer is again found in the words of the Psalmist: "Then I will teach transgressors thy ways and sinners will return to thee." To make up for the past put all effort on the present and future. Teach transgressors -- first ourselves and, in humility, others. The past cannot be changed; it can only serve as classroom to learn what to do in the present and future.

As our Lord taught us: While it is still time, fill our lamps with oil.

"And while they went to buy, the bridegroom came, and those who were ready went in with him to the marriage feast; and the door was shut. Afterward the other maidens came also, saying, 'Lord, lord, open to us.' But he replied, 'Truly, I say to you, I do not know you.' Watch therefore, for you know neither the day nor the hour" (Mat. 25: 1-13).

Behavioral psychology can be useful in planning. Instead of using vague abstract terms, like "I will try and do better," I recommend concrete, specific pinpointed tasks along the order of: I resolve to ____________ (with the concrete action written in). I give specific behavioral homework assignments and require the penitent or patient to report if and when they are completed. For example, an alcoholic may be assigned to list, call and make an appointment at treatment center by, say, noon the next day and report back to me with the exact list, people he spoke with, the time he called, and more. Obviously the homework assignments are targeted to the specific problems (or sins) the individual struggles with.

If repentance changed Peter who denied Christ into a leader of the apostles, the disciples who fled from the Cross into founders of the Church, or Saul the Pharisee who martyred Christians into Paul the great missionary, so too can we, despite our failures and sins, become zealous disciples of Christ for the rest of our lives. Jesus told us that he who has been forgiven much loves much (Luke 7:47). This is love in action, not self-flagellation, and can be the greatest and most joyful way to overcome sin. "O Happy Guilt" encompasses the true meaning of guilt that can be the source of our liberation, healing and deification.

Bandura, A. (1974). Behavior Theories and Models of Man. American Psychologist, 29, 859-869.
Burns, D. (1980). Feeling Good: The new mood therapy. New York: Avon
Catechism of the Catholic Church. (1996). Washington, DC: National Conference of Catholic Bishops.
Chryssavgis, J. (1990). Repentance and Confession. Brookline, MA: Holy Cross Press.
Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.
Erickson, E. H. (1950). Childhood and Society. New York: Norton
Meyendorff, J. (1974). Byzantine Theology. New York: Fordham University.
Morelli, G. (2001). Response to Faros In J. Chirban (Ed), Sickness or Sin? Spiritual discernment and differential diagnosis. Brookline, MA: Holy Cross Orthodox Press.
Morelli, G. (2004). Christian Asceticism and Cognitive Behavioral Psychology. In S. Muse (Ed.), Raising Lazarus: Integrating Healing in Orthodox Christianity. Brookline, MA: Holy Cross Orthodox Press.
Staniloae, D. (2003). Orthodox Spirituality. South Canaan, PA: St. Tikhon's Seminary Press.
Stapakis, B.S. (2004). The Philokalia: Master reference guide. Minneapolis: Light & Life.
Stravinskas, P. M. J. (1991). The Catholic Encyclopedia. Huntington, IN: Our Sunday Visitor
Vlachos, Bishop Hierotheos, (1994). Orthodox psychotherapy: The science of the fathers. Levadia, Greece: Birth of the Theotokos Monastery.
Ware, T. (1984). The Orthodox Church. London: Penguin.

Article link: http://www.orthodoxytoday.org/articles6/MorelliGuilt.php

Depression: A Clinical and Pastoral Guide

According to the World Health Organization (2005) depression effects over 121 million people world wide and is the leading cause of disability measured by Years Suffered with Disability [YLD]. The effects of depression are varied with insidious consequences both to the suffering patient, their families and society in general.

 Attenuated mood, loss of interest or pleasure, low self esteem, self worth and guilt, sleep disturbances, appetite irregularities, energy loss, lowered concentration and significant cognitive impairment are characteristic of the disorder. Such characteristics often become chronic and result in significant diminishment in social and occupational functioning. Even an individual's ability to care for themselves in ordinary daily health and hygienic activities are effected.

At the worst end of the spectrum, depression results in suicide, with the loss of about 850,000 thousand lives every year. Depression was known to the Old Testament Patriarch Job who tells us: “My eye has grown dim from grief [depression], it grows weak because of all my foes.” (Job 17:7). The prophet Jeremiah tells us: “My grief [depression] is beyond healing, my heart is sick within me.”(Jer 8:18).

The Apostles and Church Fathers equally knew the deleterious effects of depression. “…worldly grief produces death,” states St. Paul. (Rm 7:10). This ‘death’ is in the world  of personal, family social and occupational functioning, and more importantly “spiritual death” of the soul blocking out the light of God’s love and leaving the depressed individual  in the darkness of despair. St John Cassian tells us: "But first we must struggle with the demon of dejection who casts the soul into despair. We must drive him from our heart. It was this demon that did not allow Cain to repent after he had killed his brother, or Judas after he had betrayed his Master.” (Philokalia I).

 Because we are made in God’s image and likeness, we can use our intelligence to help understand and treat mental disorders such as depression. The best use of our “intelligence” today is scientific research. One of the fruits of this research is the Cognitive-Behavioral Model of Emotional Dysfunction (Beck, Rush, Shaw & Emery, 1979,; Ellis, 1962; Morelli, 2001, 2004; Morelli, 2006 January 01; 2005 September 17).

According to this model, emotions such as depression are produced by distorted or irrational beliefs, attitudes and cognitions. Situations, (some event that has happened or something that someone has said or done) do not produce or cause emotional upset, rather we upset ourselves by our irrational “interpretations” of events around us.

 Recent research by Izard (1993) has revealed additional sensory-motor and affective neural pathways of emotional activation. Morelli (1996) has pointed out however, that because of the reciprocal interaction of these events, cognitive behavioral intervention is usually effective with patients suffering from emotional disorders activated by any of the three (cognitive, sensory-motor, affective) pathways. Thus understanding and restructuring the cognitive distortions that produce dysfunctional emotions, and more specifically depression, can still be effective both clinically and pastorally.

-Selective Abstraction is ‘focusing on one event while excluding others.’ In one of my recent cases, “Jack” an engineer, selectively focused on a reprimand, he just received from his supervisor, while ignoring the praise he received the previous week from the Senior Project Manager. This irrational perception led to his depression.

-Arbitrary Inference is ‘drawing a conclusion unwarranted by the facts in an ambiguous situation.’ The same patient mentioned above, the engineer, concluded his next evaluation (given by his supervisor) would be unsatisfactory. This led to further depression.

- Personalization is attributing an event that occurs is being done to you ’personally.’ Another patient “Linda” became depressed when during a business meeting (attended by her section comprising about 25 people), her supervisor made a said some in the section are not “team players”. She immediately “personalized” the statement, of course with no evidence that the boss was directing it at her.

-Polarization is perceiving or interpreting events in ‘all or nothing’ terms. “Cynthia”, another patient of mine, became depressed after receiving a ‘B’ in a college course. She “polarized” events into two categories, good student-bad student. A ‘B’ fell into the bad-student pole. She failed to seen that all events can be graded on a continuum between two poles. On such a scale a ‘B’ is closer to an ‘A’ that to an ‘F’ for example.

-Generalization is the tendency to see things in ‘always or never’ categories. Another patient, “Mary” became depressed during marital therapy, when she irrationally concluded that her husband will “never” change and will “always” be the same. Her dysphoria led to a self defeating pattern of behavior which further distanced her and her husband an set herself up for the very thing she did not want: a poorer marriage.

-Demanding Expectations are beliefs that there are laws or rules that ‘have’ to be obeyed. “Kim” came into treatment because she was depressed over her son’s talking back to her. She irrationally believed that there is a “law in the universe” that says that children should do what mothers ask and if not she has the right to get upset. God “asks” us to obey Him. He gave us free will. Christ Himself, respected the free will of the creatures he created as shown by the gentleness of His admonitions Like Christ, parents should prefer and constructively work toward reasonable obedience from their children. A program of rewards for appropriate behavior and punishment for inappropriate behavior administered without anger, anxiety or depression would be constructive.

-Catastrophizing is the perception that something is more than 100% bad, terrible or awful. “Kim” erroneously reacts to her son’s talking back as the “end of the world.”

-Emotional Reasoning is the judgment that one’s ‘feelings are facts.’ Sandy has a “feeling” that her new boss does not like her. When asked how she knows this she responds that her “feelings are always right”. She fails to distinguish a feeling as real which it is versus a feeling ‘proving something’, which is impossible. For example, I tell patients: “No matter how strongly some people ‘felt’ during the time of Christopher Columbus the world was flat, it did not make it so”.

Beck, (1976) points out that besides the cognitive distortions, depression involves the cognitive theme of “loss”, and in addition, what he calls the cognitive triad: a negative view of self, world and future. In other words if a clinician were to analyze the “self-talk” of depressed patients, these themes as well as the cognitive distortions would be present. One example from above will illustrate this. “Jack” the engineer who received the reprimand from his boss, thinks of losing his bosses respect and esteem and further perceives he is less of a person, thinks others will see him as incompetent, and he may loose his job and never find another one. This cognitive feedback loop of distortions, loss, and triad, produces a cascade of deepening depression.

Effective clinical intervention involves helping the patient to first recognize and label the cognitive distortions and themes. This is followed by helping the patient restructure the distortions.

 1) Where is the evidence?

 2) Is there any other way of looking at it?

 3) Is it as bad as it seems? This can be illustrated with “Jack” the reprimanded engineer mentioned above.

Answering these questions “Jack” might come up with an alternate more rational perception, “True my boss criticized my project, but in fact, he has praised other work I have done and even last week the Senior Project Manager was real pleased with something else I was working on; just because I was reprimanded for one error doesn’t mean all my work is bad and unappreciated and it surely doesn’t mean I will loose my job and be out in the street.”

Following this cognitive restructuring process “Jack” begins to feel less depressed. The next step is to help “Jack” become more behaviorally ‘pro-active.’ “Jack” was helped to “debrief” the error. Debriefing involves understanding what brought the error about, and to developing a plan to change these circumstances to bring about  more effective current and future functioning. This behavior change process interacts with the ongoing cognitive restructuring to produce even less depression. The person’s mood begins to elevate.

Special cognitive intervention procedures however, must be done with Demanding Expectations, Catastrophizing and Emotional Reasoning. As alluded to above, patients with Demanding Expectations frequently try to forcibly impose a personal set of rules on others or the world around them.

Because of the way God made the universe: the ‘Physical Laws of Nature’ (e.g. gravity) are inviolate. God made all objects in the universe to function by these laws out of necessity.

 God’s moral  commandments to us, society, governmental family and personal rules, are of a different category. They function by virtue of God’s gift of “free will.” Individuals  are free to chose to obey or disobey these moral precepts. We cannot violate the laws of gravity, but we can disobey His commandments

 God out of His love for us does not want us to choose to disobey his statutes. Of course to disobey these voluntary laws or rules have differing degrees of consequences for violators.  The most severe being choosing “hell”: the absence of God.

This is not to trivialize God’s commandments, society’s laws, parental values or family rules. God ‘wants us’ to obey Him. So too, for example, parents ‘should want,’ that is prefer, (not demand) their children respect and obey them. (Morelli, 2006, January 01; Morelli, 2005, September 17; Patterson, 1976). When ‘demands’ are made and not obeyed  anger follows. This is in and of itself sinful and sabotages the obedience to the  rules God out of His love, wants us to obey. Our interactions with one another whether in parental, family, social or occupational settings should also be on this level of ‘requested love’ and not ‘sinful demands.’ If not two demons appear: the demon of dejection and the beast of anger (Morelli, 2005, October 14).

 A special cognitive technique has been shown to be effective with Catastrophizing (Burns 1980, Morelli, 2005, October 14). The “Mental Ruler Technique” involves evaluating a situation on a 0 to 100 scale, with 0 being the most pleasant thing you could picture happening to you. Patients infrequently have trouble imaging a very pleasant event (0). Sitting on a sun drenched tropical beach is a typical image. Patients frequently need help however, imaging a “graphic” worst event (100).

 Use of the example of the particularly horrifying death of a medical missionary in South East Asia several years ago has been helpful. After starvation failed to kill him quickly, his captors placed chopsticks in his ears and hammered them in a little each day, until they penetrated his brain with his resulting death. Patients or parishioners will frequently speak with me about the death of loved one especially a child as “the” most awful thing on earth. This is frequently said in a sanitized abstract way. ‘Pounding chopsticks’ is much more powerful than ‘death.’ This a much more  effective “100.”

 While the clinician and/or parish priest surely must help the individual with the grieving process allowing for the expression of feelings, care should be taken not to endorse a “catastrophe” mental ruler appraisal. Thus for example, while the loss of a child is a bad thing and for which one has appropriate sorrow and grief, unless it reaches the dimensions of “100” it is surely less than the “most” terrible thing on earth.

 Catastrophic evaluations also frequently broadcast a lack of commitment to God. The follower of Christ has the experience  of God Who freely gives life and calls this life  back to Him. God  does all out of  love for us  even though on a human level it may  it is out of our understanding and seemingly meaningless. The Christian knows God  has a greater, higher, beyond human understanding.

 For us presently on earth this is all dimly revealed. As St. Paul told the Corinthians: “For now we see in a mirror dimly, but then face to face. Now I know in part; then I shall understand fully, even as I have been fully understood.” (1 Cor. 13:12).

Emotional Reasoning also requires special cognitive intervention, because depressed patients tenaciously hold onto the irrational erroneous belief that feelings are proofs of the truth or falsity of events. How many times has a parishioner or patient said something like: “I just feel I will never [get better…find a job…get over this…make friends …etc.]. As mentioned above, such individuals frequently mistake a feeling or emotion as real or felt (which it is) versus proving the truth or falsity of the event one has the feeling about.

 Giving the depressed individual  extensive practice with ‘feelings and events’ is an effective starting point. For example, the clinician or priest may ask  the individual to recall an event that he/she felt “really sure about”, that turned out to be untrue.

 One of my patients recalled an instance in which they “felt certain” they had failed an exam. [Another common example is a ‘strong feeling’ someone does not like or approve of them.] In all cases the depressed individual  explores what happened when they discovered they had ‘felt’ incorrectly. What lesson is there in this discovery? The individual above found out they had done well in the test, when they had previously “felt” they failed: What does this say about feelings as facts? This helps to break down the feeling-fact [emotional reasoning] connection.

Behavioral practice accompanies the cognitive restructuring procedures. This includes the filling out restructuring charts (see Burns, 1980) as well as to in vivo exposure to challenging social and environmental events related to the depression. For example “Jack” our erstwhile patient, may be encouraged to go to his supervisor and ask for feedback regarding other projects he has worked on.

Behavioral assignments decrease depression by providing realistic information that then may be processed through veridical cognitions. Increased behavioral activity itself has been shown to ameliorate depression (Beck, et. al. 1979). It may be hypothesized this dysthemic attenuation takes place due to the mediation of yet unspecified CNS neurotransmitters.

It behooves the Orthodox Christian counselor or pastor to use spiritual as well as psychological means to help depressed persons.  With the Orthodox Christian patient, spiritual intervention can be initiated concomitant with the cognitive-behavioral intervention. Prayer, selected spiritual reading, and the sacraments provides spiritual healing for mind body and spirit.

 Care that the patient does not misinterpret scriptural passages and spiritual reading and thereby increasing the depression. The patient may well make his/her own the words of Job: “For the arrows of the Almighty are in me; my spirit drinks their poison; the terrors of God are arrayed against me…. Can that which is tasteless be eaten without salt, … My appetite refuses to touch them; they are as food that is loathsome to me.” (Job:6: 4-7). If reading were to stop here, surely the depressed individual  might consider God has abandoned as Job thought initially that God abandoned him.

 Of course, Job was faithful to God despite his adversity and in the end God rewarded him. Rather a prayer of hope can be made: “But thou, O LORD, be not far off! O thou my help, hasten to my aid! Deliver my soul from the sword, my life from the power of the dog. Save me from the mouth of the lion, my afflicted soul from the horns of the wild oxen! I will tell of thy name to my brethren; in the midst of the congregation I will praise thee:” (Ps. 21:19-22).

Orthodox Christians may also be given spiritual reading that includes the Church Fathers on despondency. St. Symeon the New Theologian tells us:

 “Contrition of heart, then excessive and untimely, troubles and darkens the mind, destroying the soul’s humility and pure prayer and paining the heart. This induces a hardening to the point of total insensibility; and by means of this the demons reduce spiritual people to despair.”…when this happens you should sit down in a solitary place by yourself, collect yourself, concentrate your thoughts and give a could counsel to your soul saying: ’Why, my soul, are you dejected and why do you trouble me?....my salvation lies not in my actions but in God… Put your hope in God…Yet by virtue of my faith in God I hope that in His ineffable mercy He will give me salvation….resolutely enter your normal place of prayer and falling down before the God of love, ask with a compunctive and aching hear, full of tears, to be freed from the weight of listlessness and from your pernicious thoughts.” (Philokalia, IV)

The Prayer Against Despondency of Fr. Arseny can be so powerful for those depressed:

PRAYER OF FR ARSENY TO THE MOTHER OF GOD

            “O my beloved Queen, my hope, O Mother of God, protector of orphans and protector of those who are hurt, the savior of those who perish and the consolation of all those who are in distress, you see my misery, you see my sorrow and my loneliness. Help me, I am powerless, give me strength. You know what I suffer, you know my grief—lend me your hand because who else can be my hope but you, my protector and my intercessor before God? I have sinned before you and before all people. Be my Mother, my consoler, my helper. Protect me and save me, chase grief away from me, chase my lowness of heart and my despondency. Help me, O Mother of my God!”

 One factor that deserves special consideration in the treatment of depression is suicide. Suicide should be immediately addressed by the clinician chaplain or clergy with severely depressed individual. An unlicensed or certified clergy or chaplain should immediately seek a mental health licensed specialist.

This is a clinical emergency and more than one concurrent session may be needed. One effective cognitive-behavioral clinical technique is a paradoxical approach  to first explore with the individual all the ‘favorable’ reasons to commit suicide. This helps the clinician understand the potentially suicidal depressed individual from  their viewpoint.

 Feeling understood the suicidal person may then may feel empowered to explore the reasons ‘not’ to commit suicide. Of course the latter exploration coupled with cognitive restructuring, and spiritual intervention is the psycho-spiritual healing factor.

 Such individuals may also require psycho-pharmacological treatment. In no case should a suicidal patient be released without attenuation of suicidal ideation.

 In situations in which Orthodox Christians have successfully taken their lives, merciful and major pastoral consideration should be given to the scientific research findings that suicide-depressed patients have a significant impairment of cognitive function.

In as much as ‘deliberateness’ is a major factor in evaluation of the culpability of “sinful” thoughts and actions, most suicides are most probably  ‘involuntary.’ Severely depressed individuals have sharply attenuated cognition. Most depressed patients are not capable of sufficient reflection and willfully rejecting God and his gift of life.

A person who commits suicide under such conditions  would not be blameworthy in terms of voluntary sin and thus consideration of the usual Orthodox Funeral and Memorial should be given. Depression is so insidious, not only because it takes away life’s pleasures hopes and aspirations, but because it also robs us of the sight of God.

In the depths of despair we do not pray to Whom we do not see. We see ourselves cut off from Him who is the source of all life. However using our intelligence, we may use scientific clinical approaches, which as outlined above, have been shown to be effective in the treatment of depression, enlivened with the Holy Mysteries, the channels of Grace given to us by Christ a genuine healing can be commenced.

The Church is the healing Body of Christ. All the parts of His Body work toward healing of the sick member. Christ is the vine the source of strength for the branches.  

He who dwells in the shelter of the Most High, who abides in the shadow of the Almighty, will say to the Lord, "My refuge and my fortress; my God, in whom I trust." his faithfulness is a shield and buckler. You will not fear the terror of the night, nor the arrow that flies by day, … nor the pestilence that stalks in darkness, nor the destruction that wastes at noonday. (Ps 90: 1-2, 5-6)…

Arseny, Father. (1998). (V. Bouteneff, Ed.-Trans). Father Arseny 1883-1973: Priest, prisioner, spiritual father. Crestwood, NY: St. Vladimir’s Seminary Press

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 Beck, A., Rush, A., Shaw, B. & Emery, G. (1979). Cognitive therapy of depression. NY: Guilford.

Burns, D. (1980). Feeling good. NY: William Morrow.

 Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus,,NJ: Lyle Stuart.

Izard, C. (1993). Four systems for emotion activation: Cognitive and noncognitive processes. American Psychologist. 100, 1, 68-90.

Morelli, G. (1996). Emotion, cognitive treatment, sacred scripture and the church fathers. Paper presented at the annual meeting of the Orthodox Christian Association of Medicine, Psychology & Religion, Brookline, MA.

Morelli, G. (2001). Response to Faros In J. Chirban (Ed), Sickness or Sin?: Spiritual Discernment and Differential Diagnosis. Brookline, MA: Holy Cross Orthodox Press.

Morelli, G. (2004). Christian asceticism and cognitive behavioral psychology. In S. Muse (Ed.), Raising Lazarus: Integrating Healing in Orthodox Christianity. Brookline, MA: Holy Cross Orthodox Press.

Palmer, G.E.H., Sherrard, P., & Ware, K. (Eds.). (1995). The Philokalia: The complete text compiled by St. Nikodimos of the Holy Mountain and St. Makarios of Corinth: Vol.4. Winchester, MA: Faber and Faber.

Palmer, G.E.H., Sherrard, P., & Ware, K. (Eds). (1979). The Philokalia: The Complete Text Compiled by St. Nikodimos of the Holy Mountain and St. Makarious of Corinth (Vol. I).Winchester, MA: Faber and Faber.

Patterson, G. (1976). Living with children: A training program for parents and teachers. Champaign, Ill.: Research Press.

World Health Organization. (2005). Depression. Retrieved July 12, 2005. http://www.who.int/mental...