After working with patients for these 20+ years, I have broken the process of healing into five segments or stages, all of which I believe are biblically supported although none of these are dependent on one particular denomination. (A "mere" listing.) All the seven deadly sins (or character defects) may be individually or collectively addressed at any point along these five stages. These stages are only clinical observations and hopefully general guidelines. They are not rules and shouldn’t be approached legalistically.
Stage 1: Hope
All recovery—whether from drugs, depravity, or desperate fear—begins with a promise of hope, that there is “another way” to be, to live, to feel, to love and be loved. This hope is offered in different ways by different people, but I have found it best received by my patients in the form of personal and true stories of redemption (mine or others), of living examples of other people’s recoveries, of their emotional, mental and spiritual salvations.
When we see the pain of the other person’s struggles, feel the roller coaster of his unfolding temptations and challenges, identify with her frustrations and longings and then witness her release and deliverance…we can begin to hope. If it happened for them, perhaps it can happen for me…? All a good psychotherapist needs is one good perhaps and the work can at least get started.
Most of my initial work with patients is an infusion of hope. Some are so habituated to sadness, to pain, to loss, to deprivation, that they simply cannot imagine anything but the way they’ve always been. “But you are here in my office, so there must be some small ember still burning,” I tell them. But many need quite a bit of tender care—a very careful fanning—for that flame to begin to burn again. And even then, pacing is so important. Pacing is a clinical term meaning that I am walking with the patient rather than running in front of him or dragging behind him. If I move too fast, if it seems that the promise is too big, it can feel overwhelming and that can be just as frightening as endless hopelessness. In fact, in some cases, it can be even more so. Change can be as terrifying as it is exciting and inspiration may need to be delivered in soft breaths rather than gusting winds.
Stage 2: Surrender
Surrender is a word that gives a good many Americans and especially modern psychotherapists the shudders. What we are told to want for ourselves is power and control. We are carefully and consistently taught in graduate school to nurture in our patients their “self-empowerment” and imbue in them a solid sense of control. This can be important and necessary in very measured doses, particularly in situations in which a person has been abused and even the most personal controls have been denied them. But it can go too far and be endowed too freely.
Even some evangelists have turned scripture into a tool of narcissistic manipulation when they tell us that if we aren’t living the lives we think we ought to be living (read: rich), that our faith is questionable. In that philosophy (which is theologically slippery at best, dangerous at worst) you can tell where a person is spiritually by what he owns and how well his career is doing. Ask and ye shall receive, they remind us. But instead of its focus on the spiritual it has become a modern, media spin on the Doctrine of the Elect and Predestination: How do we know you have found God’s favor? Because you’re successful. How do you get to be successful? By God’s favor. So, the goal is to be successful, to acquire wealth, prestige, and power. Somewhere along the line even the ministers have forgotten, “Blessed are those who are persecuted for righteousness’ sake, for theirs is the kingdom of heaven. Blessed are you when they revile and persecute you, and say all kinds of evil against you falsely for My sake. Rejoice and be exceedingly glad, for great is your reward in heaven, for so they persecuted the prophets who were before you.”
For me, personally, surrender has finally come to mean that I have accepted the utter Majesty and Mystery of existence, my supreme lack of control over the great flow of the river in which I am floating, and my complete dependence on the Infinite Mercy and Love of God believing it is impossible for me to fully merit it. This is not where I start off with my patients, however. I hope my reasoning for this will become clear shortly.
In the beginning of my own rebirth into sanity, the idea of surrender terrified me. I know from my own experience that surrender is at the very least an uncomfortable concept for most people. And some are not just tentative about it, they are panic-stricken, which is only reasonable since they have not yet come to trust that the universe is purposeful, creative, and meaningful. (For me that is God and, again, my surrender only came when I came to believe that God actually loved me.) For many of those just coming into therapy, the universe has been a hurtful, oft-meaningless, chaotic, unfair place. We cannot surrender to the abyss, to a vast darkness, to a deist blob that couldn’t care less whether we existed or not, to a universe without love or meaning. I certainly can’t imagine doing that. And I didn’t. I couldn’t. So, I present it in the way it was successfully presented to me—with great care and in small steps: Initial surrender means to accept reality. That’s it. Not to like it or excuse it. Just to accept it as real.
Accepting reality is something people can consider even when reality is harsh, even when they are scared, hurt, or confused. Accepting reality is the underpinning of sanity. Denial is the basis for all insanity. When surrender is presented initially in this way, it becomes manageable.
As I said before, I am not a pastor or minister or rabbi and do not wish to usurp their roles as teachers of Scripture. I do not preach. Although I pray (all the time) and ask for guidance and clarity, I do not insist on their acceptance of God in any particular form especially in the beginning of treatment. I will ask what they believe and start the process with them, right where they are. Again, this is pacing and it is a vital component to good therapy.*2
So, what can they surrender to? I keep it simple. They can surrender to the fact that their lives are not working, or the unhappiness they live with at home, or the way they feel and make other people feel when they’re drinking. They surrender to the facts first.
Why? We surrender first to reality because as we’ve been told: “The truth shall set you free.”
I remember the first time someone told me that I needed to face the truth. I can still feel the rumble of resistance in every muscle, the blood in my arms and the quickening of my heart. NO. The truth, I wanted to tell them, is nothing but pain. And, looking back on it, I was right. The truth was pain. But what I didn’t know then was that the “truth” was in process, it was my reality already whether I saw it or not, acknowledged it or not, liked it or not. Not facing it didn’t make it disappear. It made it harsher and more painful. I was a prisoner to my own denial. Accepting the truth (just the facts, ma’am) would only give me freedom to choose.
Surrender in this way, taken in these gentle, baby steps, is what gets us strong enough to make the fuller, sweeter surrender, to take the leap into the love—both human and Divine—that is, as C.S. Lewis and Peter Kreeft call it, our heart’s deepest longing.
Stage 3: Honesty
If truth is what we need, then honesty is what we must give. Why isn’t my life working? Why is my spouse always angry? Why am I so easily offended? Why do I have trouble stepping out of the house? What do I feel? What do I need? What do I stumble over myself again and again and again?
This is a coming-clean, a venting, an admission of wrong-doing, a confession of mistakes and a map of wrong turns. It is what Alcoholics Anonymous has called a Fourth Step, what the Church calls a moral reckoning or examination of conscience, and the Jews a “tikun” or correcting. And it is absolutely necessary, whether one is an alcoholic or not, whether one is in a 12-step program or not, whether one belongs to a religion or not.
It is a brave step, this one. It takes courage to say “I really loused up that relationship,” or “I was a coward when it came to my career,” or “I was as abusive as she said I was.”
Interestingly, it is at this point that the need for hope returns. Hope may need to be infused at many junctures along the way, but this is definitely one of them. It is very painful to look at all we’ve done wrong and it is terribly hard to imagine that it can ever be any different. In my work, this is a good time to remind someone of what is possible, returning again to the stories—the true stories—of redemption and the view from the top of the mountain.
Quite a while back I knew a young woman (details are disguised to protect identity) who had been seen by numerous therapists. She had been diagnosed with PTSD, Bipolar disorder, borderline personality disorder and sociopathy. She had been medicated, treated with a dozen different techniques, restrained to keep her from cutting, and finally been written off as hopeless. When I saw her she felt hopeless.
We spoke about her life, both current and past. After about a month of piecing together her history, we landed on the issue of an abortion she’d had when she was 15. She had been so afraid: the boy who had father the child had abandoned her, her parents were busy with work and a very high-level social life, and she had no older or wiser siblings to guide her. Her life with the family’s church had been cut off earlier because everyone had been simply too busy to bother with it. (She had been raised and baptized Catholic.) Ultimately her support and direction came from the media and from the information available at school.
I asked her about the abortion and how she felt about it. She answered with honest curiosity, “Why are you asking?”
“Because it’s a big event, especially for a little girl,” I said.
“No one else seemed to think so.”
“What do you mean?”
“Everyone else seemed to think it was no big deal. You just go and do it.”
“Did you see it as no big deal?” I asked.
She started to cry.
It took some time, many tears, and forgiveness, but she was neither borderline, bipolar, nor hopeless. She was guilt-ridden. In an effort to be what her surrounding culture believed she was supposed to be, she had to lie about how she felt, what she wanted, and what she really needed. Telling the truth was her first step out of the pain and the pathology.
This is accountability. It is a way of owning our mistakes, by way of which we can move forward to owning our achievements. If everything is everyone else’s fault, then we are the victims of happenstance and mischief and there truly is no hope. People are awfully skittish about being accountable because they have been shamed and blamed to excess, but this is not about shame. This is the yellow brick road to freedom.
Stage 4: Service
What does it take to make it better once we know what we’ve been doing wrong?
This is actually a more controversial question in psychotherapeutic circles than one may imagine because according to many people in the field, one must always focus on the positive. And by in large, they make a convincing point. Noticing what works often works. For some patients, I am the first one in their entire lives to say, “I see you. I see what is good in you. Let us look further to see what else you have that is good and can get better.”
However, I think going fully in either direction—focusing only on the positive or focusing only on all the wrongdoing—is a mistake. There must be a balance, an acknowledgment of both aspects or inclinations of our natures. As the first story of Adam and Eve illustrates, we are not wholly good or wholly evil. We have capacities in either direction and to become good or to continue to be good, it takes a conscious effort and awareness of both those inclinations. We must nurture the one and starve the other.
How is that best done?
First and foremost, through service and good works, even when we don’t feel like it and would rather watch TV. There is nothing better for someone who is full of self-pity and hypochondria than to get out of his own shell and volunteer with people whose lives are thoroughly broken. I had one young woman volunteer at an old age home. I had another at a soup kitchen. It doesn’t matter how we give, but in order to grow, we must start somewhere.
Through humility even when we feel boastful or proud or angry or indignant. We must do for others, like say we are sorry, even when we want to dig our heels in and be proud.
Through patience and generosity even when we feel deprived and impatient.
Service to others is seen by many as a healing of a higher order, which is why it comes later in the 12-Steps of A.A.—we can only offer what we have learned or gained. “If you want to keep it [recovery], give it away,” recovering addicts and alcoholics are told. The meaning there is clear—you must first have it to give it.
There is another side to this, though. Some of us call it “Act as if.” There are people who contend that we only learn what we teach and only get what we give away. I think it works both ways and it is up to a good clinical team (meaning the patient and the therapist) to determine when and how to go about this. I am no Solomon on this issue. What I know, though, is that service—at any time it seems possible and right—is beneficial to the mind, the heart, the body, and the soul.
Stage 5: Forgiveness
Without forgiveness, we are stuck in the wrongdoing and don’t get to move forward into our new lives. My feeling is that pride is usually the blockage on this. We won’t forgive because we’re right, damn it! And we want to be vindicated even more than we want to be free or happy.
As we saw with our Sonia from before, resentment, hatred, and vengeance are powerful toxins and they can make a person ill for a lifetime. She, like so many others, confused forgiveness with appeasement, acceptance with excuses. They are not the same.
Forgiveness never denies the wrongdoing (Romans 3:10,23). It rejects its very essence, in fact. But it forgives the doer, who clearly knows no better or is too sick to ever see the difference. It does not make any pretenses for the one committing the evil act, either. Forgiveness does not ever mean we need to open our door to those who would do us harm. It doesn’t ask us to be fools. The irony is that the less one forgives, the more hardhearted, vengeful and angry one becomes and therefore the less one is able to see the truth of any kind. Hatred does not only reject joy, it doesn’t recognize a real threat when it is there.
When we are asked to forgive, we are asked to acknowledge human nature (including our own as both good and bad), be humble, and finally to free ourselves.
Forgiveness is often the last step in this small ladder to emotional and spiritual freedom.
As Corrie Ten Boom, a Christian woman who survived a Nazi concentration camp during the Holocaust, said, "Forgiveness is to set a prisoner free, and to realize the prisoner was you."
As I vainly explained to Sonia, we are the ones who suffer when we choose not to forgive because with the resentment we hold onto the hurt and anger and pain that first brought us to our knees.
One of the best examples of forgiveness is the story of Joseph and his brothers, who had collectively betrayed him and left him to die because of their own envy and greed. He crawled to survive, then was enslaved and thrown in prison. Many years passed. Still, when his brothers came to Egypt many years later, he not only forgave them after he saw that they had changed (and showed true repentance), he rejoiced in them.
Suffering: Is it Necessary?
There is one last issue I’d like to briefly address and that is the notion of suffering. I haven’t allotted it its own stage of recovery because it involves all of them.
The worst part of modern psychotherapy is that it does not allow for the existence of suffering. It insists on happiness as a human “right” and promotes its open-throttled pursuit along with everyone else in mass media and entertainment. This is the parting of ways between what is ordinary psychotherapy (and even those preaching the Prosperity Gospel I mentioned earlier who believe they can petition God for whatever worldly goods or emotional rewards they desire, quoting “ask and ye shall receive” as if it offered proof of God as the Great Pez Dispenser) and a holistic psychotherapy that is based in traditional Biblical values.
Part of the problem is that the modern age of psychotherapists see happiness—which is defined as the attainment of some desired goal—as the end goal of healing.
Orthodox Jews and Christians have a different take on this subject. While it is seen as normal to want to be happy, to be healthy, even to have material comfort it is not seen as the purpose of our existence. It is not even seen as terribly important. It is considered far more critical to be good than to get what you [think you] want. Happy is fine. Goodness and purposefulness and joy—they are far better and reach in far deeper.
What is even more troubling to me is that I see people wanting the rewards of happiness without even the minimum of self-sacrifice. Americans particularly believe it is their “right.” We have been told so repeatedly by the media and psychologists, and even a whole generation of “hip” preachers. Do what makes you happy. It’s all that counts.
The philosophical pinnacle of this thinking is in New Age theology, where sickness, injury and tragedies are defined as self-inflicted manifestations of poor core programming. In that epistemology, Mystery is abolished and we are responsible for everything that happens to us and around us. If abundant health and wealth and beauty are our birthrights, then suffering means we have either done something wrong to deserve it or written bad scripts for our lives.*1
Given this mental and emotional mulch we are planted in, it is no wonder that we are so worried about our bodies, our bank accounts, and our images. We fret about face lifts more than we do about whether we have a neighbor that needs our help because she has been bed-ridden for a week.
Denying suffering has a price that is incomprehensibly enormous. Because when we deny suffering (which as Buddha said is inevitable in this life), we must also deny death. And to deny death, we must deny life.
Why should it be included in psychotherapy, though? Shouldn’t we want to banish it forever? Why shouldn’t we want to avoid it altogether? What’s in it for us, anyway?
This is the answer I came up with: By being present for suffering, we become present for the whole of life, for the wholeness of another person. And the reward is nothing less than the ability to love-and be loved—fully. We suffer because we love and want to continue loving. It is a poignant irony, I think. In our attempt to avoid suffering, we cut ourselves off from the one thing that can mitigate it: each other.
And this is what Pope Benedict had to say when asked a similar question:
Anyone who really wanted to get rid of suffering would have to get rid of love before anything else, because there can be no love without suffering, because it always demands an element of self-sacrifice, because, given temperamental differences and the drama of situations, it will always bring with it renunciation and pain. When we know that the way of love–this exodus, this going out of oneself–is the true way by which man becomes human, then we also understand that suffering is the process through which we mature. Anyone who has inwardly accepted suffering becomes more mature and more understanding of others, becomes more human. Anyone who has consistently avoided suffering does not understand other people; he becomes hard and selfish.
There is one man I know who has cut himself off from emotional entanglements altogether in an attempt to ward off the pain of loss. I don’t pretend to assume his reasons; they may be many. I know he has experienced the pain of abandonment and witnessed painful deaths. What I can see are the blatant effects of his decision on his life: heavy drinking, isolation, neglect. Even when he is surrounded by those who would love him, he is utterly alone.
Unfortunately, in this world what binds us together and what gives us meaning is a complex amalgam of emotions and experiences. It’s not all skipping through the park. People get sick. We get hurt. We make mistakes. We are fallen. And we cannot save ourselves. I am convinced of that. Healing is always dyadic. It is always someone else’ hand—God’s, a spiritual adviser’s, a friend’s, a spouse’s, a parent’s—that reaches in to pull us out. This is life. If we are to help our patients, we must acknowledge their suffering and help them through it. Our compassion is a function of our love. And if we don’t offer that, what can we hope for from our patients?
The other day I had what my husband calls a “wave” of grief for a dog we recently lost to cancer. I was looking at her picture. My husband followed my gaze and knew what I was feeling. He put his arms around me and said, “It’ll pass.”
I looked into myself, then up at him, “I’m not sure I ever want it to pass completely.”
It surprised me and scared him a little until I explained: To me, joy and happiness are not the same things. Happiness is ephemeral and depends largely on the vagaries of circumstance. It is a transient emotional state that is context-specific and is quickly antidoted by pain or sorrow. Joy is a spiritual state and is therefore, like love, bigger than suffering, than sadness, than pain. Its source is not earth-bound and as such it is independent of the situation in which I may find myself. Joy gives to life. Happiness receives from it. So, I told him and sighed, I can be joyful and still be terribly, awfully sad. I can have hope and simultaneously lament the state of the world. I may suffer. But I love. Deeply. With my eyes and arms and heart wide open. And that kind of love bears me up.
*1. I explored this issue in much greater depth in an article entitled “Be Happy: The American Refusal to Deal with Suffering” at: www.americanthinker.com/judith_acosta/
*2. Clinical Pacing is always accompanied by its companion Leading. In order to help move a person from one place to another (emotionally or physically) we need to first be with them where they are and then slowly, almost imperceptibly lead them to a new place. It is like a good dancing partnership based in the fullness of rapport and trust.