1 THE CRUCIAL ROLE OF CHRISTIAN COUNSELING
APPROACHES IN TRAUMA COUNSELING

FRED C. GINGRICH AND
HEATHER DAVEDIUK GINGRICH

For he has not despised or scorned the suffering of the afflicted one;
he has not hidden his face from him but has listened to his cry for help.

PSALM 22:24

So many are deeply wounded as a result of the trauma they have experienced. How can we even begin to meet the need? Where do we start? What do secular approaches have to offer, and where do they fall short? How are we as Christian counselors in a unique position to journey with survivors?

We have no definitive answers to these and similar questions. We will attempt, however, to address some overarching topics that we hope will give you a framework from which to approach your reading of the chapters that follow.

In this chapter we begin by addressing the question of the goal of trauma treatment. We go on to examine a specific model of trauma recovery, the 4-D model (Frewen & Lanius, 2015), describing and evaluating it. We then suggest that an expanded version of this model addresses some of its shortfalls. Our intention is to provide you with an idea of what recovery looks like, which will influence how you view further discussions on treatment as you read various chapters in this book.

The next section of the chapter looks at the area of research with respect to evidence-based practice for trauma treatments (EBTTs). It serves as an overview of the terminology and issues surrounding EBTTs and directs readers to helpful resources on the topic.

We then turn our attention to ethical issues surrounding trauma treatment and introduce the area of trauma and spirituality. Finally, we make some brief comments about the need for additional and ongoing effort to wrestle with our theology of suffering—the crux of what we as Christians have to offer.

What Is the Goal of Trauma Treatment?

The various chapters of this book imply a variety of ways of conceptualizing trauma and present a multitude of treatment approaches to trauma. Of course, to some degree the choice of trauma treatment utilized depends on the particular population, the background of the treatment provider, and a number of contextual factors. Obviously, treatment will be different if the client is a recent victim of a natural disaster rather than a sexual-abuse survivor of long-term, complex interpersonal trauma. Regardless of the type of trauma, though, the ultimate goal is healing.

But what are the hallmarks of healing? Is a decrease in posttraumatic symptoms such as intrusive reexperiencing in the form of flashbacks or nightmares what we mean by healing? Or is healing more than symptom reduction? Do trauma survivors need to have wrestled personally with the existential/spiritual questions related to how to make meaning out of suffering in order to be considered healed? But then again, none of us will be fully whole, that is, fully healed, this side of eternity. So perhaps the often-used metaphor of healing as a journey, a process, rather than as an end goal, would be most helpful when thinking about therapeutic work with trauma survivors. Successful termination of therapy, then, would come at the point in the journey at which the client determines they are healed “enough” for at least the time being.

A Model of Trauma Recovery: The 4-D Model

In our perusal of the literature, our attention was drawn to the 4-D model of a victim’s sense of self as it relates to trauma and recovery (Frewen & Lanius, 2015). While not the only or necessarily even the best model of trauma therapy, it offers a clinically helpful conceptual framework to which we have added additional theoretical constructs including spirituality.

Description of the model. The model suggests that there is, ideally, movement happening for the client from a sense of identity emerging from a traumatized self to an identity of a recovered self. This movement fits with the idea of trauma healing as a journey that we alluded to above; it is a process, and our goal as clients and clinicians is to see some progression toward healing, although the movement may be quite different depending on numerous factors such as type of trauma, severity, and pretrauma adjustment.

The original four dimensions of the Frewen and Lanius (2015) model refer to time, body, thought, and emotion. Figure 1.1 illustrates the original model.

**Figure 1.1.** 4-D model sense of self from trauma to recovery (Frewen & Lanius, 2015, p. 304)

The dimensions and descriptions of movement from a sense of traumatized self to a sense of recovered self are as follows:

Time. I am fixated/focused on the past—the trauma—and I am moving toward becoming more focused in the present.
Body. At times I feel outside my body, that my body does not belong to me, and that things happened to my body, and I am moving toward a clearer sense of being my body and that it belongs to me, that my identity and body are integrated (cf. Levine, 2010, 2015; van der Kolk, 2015).
Thought. Thoughts and voices or messages are intrusive and take control, and I am moving toward a sense of owning and being in control of my thoughts.
Emotion. Either I can’t feel anything, I don’t know what I’m feeling, or I feel too much, and I am moving toward being able to feel and knowing what I’m feeling, and it is not overwhelming me.

Questions that arise from the model. We believe that these dimensions are a helpful starting place from which to assess trauma and healing from trauma. However, some questions arise from looking at these dimensions more carefully. Consider the following:

To what degree does inclusion of the body as one of the four dimensions make sense? To begin with, the brain and nervous system are crucial parts of the body that recent research findings have shown to be deeply affected by trauma (see chap. 3). Additionally, if we are to be true to a biopsychosocial model of the person (McRay, Yarhouse, & Butman, 2016), we must take seriously the physically disorienting dimension of trauma in terms of somatoform symptoms, and even where the body is in place and time (i.e., with respect to symptoms of depersonalization and intrusive reexperiencing of physical symptoms that can be part of flashbacks). Trauma tends to disintegrate this biopsychospiritual connection, resulting in dissociated aspects of a sense of self and experience (Gingrich, 2013). Also, a strong argument can be made for a biblical anthropology that rests on our being created as an embodied, unified body-soul-spirit (Benner, 1998). Jesus’ resurrection and ascension as an embodied person affirms that the body is essential to our existence. His body was tortured, and even after the resurrection he carried the signs in his body. Of course, the dimensions of thought and emotion are also essential to a biblical anthropology and to our understanding of what trauma destroys and what mental health in God’s image looks like.
To what degree does the movement from trauma to recovery involve an increased sense of an integrated self and individual identity, as well as identity within or as part of a group (e.g., familial, ethnic, religious)? We briefly looked at the separation of the physical sense of self from the other aspects of self in the discussion of the body in the bullet point above. We also alluded to disintegration of the psychological and spiritual aspects of self. However, the relational dimension of identity that is central in more group-oriented cultures is not addressed by the model. The broader sociopolitical and economic contexts of trauma also are often vastly underacknowledged. This would be particularly evident in disasters, war, and other mass casualty contexts.
The dimensions of the model, considered in combination, point to some of the complexity of trauma symptoms. But the model does not take into account the differences in severity and life disruption that individuals may experience in response to trauma. Since behavioral symptoms are often most readily observed by others, what does a reduction in symptoms in the other dimensions look like? Change in behavioral symptoms such as compulsive, avoidant, or dissociated behavior, for example, are more easily seen, yet some of the emotional distress may actually be more disturbing for the client.
Meaning making is a key component of the trauma healing process. This has been emphasized in Park’s research (e.g., 2013; Slattery & Park, 2015). Has the survivor been able to make meaning of the suffering? How will the survivor’s future be affected? What is the role of hope, and how do our current circumstances interact with the future trajectory of God’s involvement with humanity (i.e., our “blessed hope,” Titus 2:13; see also 1 Thess 4:13-18)?
What is the place of spirituality in the emergence, continuity, and healing of the self? How crucial is it? How does it operate to facilitate healing? Where is God in the midst of the trauma narratives people tell? From our perspective, a model of trauma must consider spirituality as it interacts with all dimensions. For instance, with respect to the dimension of time, we suggest that faith, and particularly a biblical perspective, includes extensive attention to the history of God working in and through difficult situations over time. We believe, therefore, that whichever trauma model we adopt, we should consider spirituality as a key element of what is negatively affected as a result of trauma, along with taking into account the role of spirituality in how trauma negatively affects the whole person and the community and how healing from traumatic experiences can occur.
Is the ultimate goal simply a recovered self, or is there something more that our spirituality has to offer? Specifically, while the literature (see appendix) refers extensively to coping, resilience, and posttraumatic growth, Christian faith provides hope that the biblical concept of shalom is a real possibility. Referring to biblical passages such as Isaiah 2:2-3 and 11:6-9, Wolterstorff (2013) argues that shalom, often translated as “peace,” is a much richer concept: “But Shalom goes beyond peace, beyond the absence of hostility. Shalom is not just peace but flourishing, flourishing in all dimensions of our existence—in our relation to God, in our relation to our fellow human beings, in our relation to ourselves, in our relation to creation in general” (p. 114). Flourishing is more than basic recovery from trauma—it is the essence of what our Christian faith has to offer (see chap. 2 in this volume for a further discussion of this dimension).

Our Expanded Model of Trauma Recovery: A Multidimensional Model

While no model can encompass all possible dimensions, we think that by adding the dimensions of behavior, relationships, identity, and spirituality, as well as the recovery aspects of coping, resilience, posttraumatic growth, and flourishing, the model is made more robust. Descriptions of these additional dimensions follow:

Behavior. I don’t always understand why I act the way I do, and I feel as though I don’t have control over my actions, and I am moving toward having a better understanding of and sense of control over my actions.
Relationships. I don’t have healthy relationships; either I don’t feel close to anyone and so experience emotional distance, or I feel swallowed up by the other person, or I’m terrified of being abandoned, or I feel continually victimized, and I am moving toward feeling connected without fear of abandonment or need to distance.
Spirituality. I have no sense of purpose in my suffering; if God is even a consideration, either I don’t believe in God or I believe in a God who is judgmental and punitive, and I am moving toward a sense of meaning that has resulted from my trauma; if I have a sense of relationship with God, there is more of a sense of connectedness to God without fear of reprisal.
Coping, resilience, posttraumatic growth, and flourishing. My life is overwhelmingly negative, and I am moving toward finding healthy ways to cope, discovering strengths and capacities for resilience, actually growing as a result of the trauma, and even flourishing in life.
Identity. My sense of self is diffuse; I don’t feel as though I am an integrated whole, and I am moving toward having a sense of myself as an integrated whole; I know who I am.

Evidence-Based Trauma Treatments (EBTTS)

As counselors we are ultimately interested in the arrow in figure 1.2. What can help us to help others move from a traumatized self to a recovered self? Below the arrow we have included three concepts that occur frequently in the trauma treatment literature, specifically coping, resilience, and posttraumatic growth. There are obvious overlaps in the definitions and treatment implications of these concepts, as can be readily seen by perusing the references in this section of the appendix at the end of the book. Without focusing on the subtleties in definitions, it is clear that trauma treatment will involve one or more of these processes. As counselors, whether we are helping clients to simply get through their week, assisting them to better cope with their circumstances and symptoms, facilitating their return to pretrauma functioning, or helping them to grow through this difficult experience, we want to implement treatments that are more likely to be effective than not.

**Figure 1.2.** Multidimensional model of self from trauma to recovery. Note: broken line represents diffuse identity; solid line represents integrated identity.

In the contemporary world of mental health treatment, there is rightly a concern that theorists, therapists, and those funding treatment programs (whether clients or institutions) subject their claims of understanding and of the effectiveness of treatments to research. Our creative programs and techniques, our wishful thinking, or even our hypotheses derived from rich clinical experience must be supported by scientific evidence. Christian counseling has not been quick to fully endorse this perspective since there is a pervasive belief that our faith operates beyond science and the power of God to effect real change should not be doubted. A helpful and convincing response to this issue is provided by Worthington (2010).

So a model such as we have described in figure 1.2 should be supported by research focusing on the key concepts in the model, and the treatment applications of such a model should be assessed as to their clinical effectiveness. This is beyond the scope of this book; however, it is essential to situate this book within the broader scientific community. Hence authors were instructed to heavily support their claims with research studies related to their topics. In addition, we will review in a cursory way the current state of the field regarding empirically supported trauma treatments.

The language of EBTTs and the research process. Researchers use various terms to describe different processes and levels of research support. “Research supported,” “empirically supported,” “evidence-based practice,” “evidence-based treatments,” and “empirically validated approaches or treatments” are examples. In general, the terms “evidence-based” and “empirically validated” refer to two levels of scientific support with the latter generally being seen as a more rigorous level of support. “Evidence-based” suggests that the concepts and interventions in a given approach are derived from research; that is, the ideas have research support. “Empirically validated” suggests that the particular strategy/program/intervention has been the subject of research to determine if it is effective.

As an example of research evidence building support for treatment effectiveness, in 2005 Bradley, Greene, Russ, Dutra, and Westen conducted a meta-analysis of 26 studies focused on the effectiveness of various psychotherapy approaches to the treatment of posttraumatic stress disorder (PTSD). The treatment approaches included 13 exposure-based therapies, five cognitive behavior therapy treatments other than exposure, nine approaches combining cognitive behavior therapy and exposure, 10 eye movement desensitization and reprocessing approaches, and seven other approaches.

The value of such research is that it begins to provide a rationale and scientific evidence to support the use of specific trauma treatment approaches. Specifically, for PTSD, Bradley et al. (2005) conclude that “on average, the brief psychotherapy approaches tested in the laboratory produce substantial improvements for patients with PTSD. Of patients who complete treatment, 67% no longer meet criteria for PTSD” (p. 223). However, there are limitations in generalizing the results to all trauma patients. Bradley et al. noted that the majority of these studies were conducted in laboratory settings. The authors suggested examining what exclusion criteria were used (i.e., which types of patients were excluded and included in the studies), comorbidity (i.e., did patients fit criteria for more than one diagnosis?), the types of trauma studied, the specific criteria used to determine a successful treatment outcome, and whether follow-up data was obtained. Also, the research studies did not address the differences in the efficacy of specific treatments.

In response to the limitations of the above-mentioned studies, further research studies fine-tuned the evidence for various treatments. As the research builds the case, research summaries such as that by Cook and Stirman (2015) provide updates on the EBTT literature for PTSD. Over the years, these compilations of evidence for particular treatments encourage the refining of treatment approaches and comparisons of treatment efficacy and ultimately provide hope for those suffering.

This research process and emphasis on EBTTs in the field should lead Christians to conduct studies in the field of Christian trauma counseling. Worthington (2010) argues that this research process should not diminish the faith or belief of Christians in the authority of Scripture; good science will ultimately confirm our biblical and theological values.

In this book we will include both evidence-based and empirically validated trauma treatments under the rubric of EBTTs. Research on specific treatments in some areas of trauma (e.g., dissociative disorders, complex trauma, survivors of sex trafficking) is still in its infancy. Therefore, just because a particular treatment approach has not been identified as an EBTT does not necessarily mean that it will not be helpful or even the treatment of choice. For this reason we did not insist that chapter authors discuss only EBTTs. However, a few additional reflections on EBTTs are in order.

Common elements in EBTTs. Chorpita (2003, 2007, 2010, 2013, 2014) and his coauthors are some of the many researchers addressing the issues of common factors or elements in evidence-based treatment. While not specifically addressing trauma treatments, much of this research can be helpful in supporting trauma treatments and specific elements such as spirituality in treatment. We have summarized below what Girguis (2016) has identified as the common elements in EBTTs:

1.Psychoeducation: studying prevalence rates, normalizing trauma and trauma responses, educating people that physiological reactions to trauma are hardwired
2.Relaxation and coping: utilizing dialectical behavior therapy, acceptance and commitment therapy, and recent developments in cognitive behavior therapy, all of which emphasize the helpfulness of relaxation
3.Cognitive processing: recalling thoughts, behaviors, and affect related to memory; identifying misattributions and cognitive distortions
4.Exposure: eliciting memory, sitting with it, gradually acclimatizing while remembering

Critique/challenges of current EBTTs. We have a number of concerns regarding the current state of EBTTs.

1.Trauma is experienced by the whole person, and its impact is beyond simple exposure to a traumatic event. Trauma’s effects are cognitive, emotional, physiological, spiritual, and communal.
2.The current EBTTs have a strong cognitive emphasis and tend to favor variations of cognitive restructuring as treatment methods. Emotionally focused, physiological interventions, memory processing, and alternative therapies such as expressive therapies (play therapy, somatic therapies, etc.) may be particularly helpful in accessing additional aspects of traumatic experience.
3.EBTTs appear to focus on the impact of trauma and pay little attention to the pretrauma functioning and mental health of the trauma victim. However, if, for instance, the victim’s global meaning of life before the trauma consisted of significant cognitive distortions and tendencies to misattribution, treatment will need to tease out the trauma-caused mental health consequences from the individual’s premorbid functioning. If a victim’s use of spiritual resources prior to a trauma was dysfunctional, then how does this impact posttrauma growth?
4.The issue of therapist values in trauma treatment is particularly difficult since hearing trauma narratives is bound to result in intense countertransference responses within the therapist. The ethical dimension of trauma treatment needs to be explored in greater depth in the trauma treatment literature (see below).

Resources for further information on EBTTs. The following paragraphs describe sources of information related specifically to the research on trauma treatments. Some programs may include a spirituality component, but research findings are not detailed enough to support a claim that the inclusion of spirituality is empirically supported.

1.Division 12 (the Society of Clinical Psychology) of the American Psychological Association provides a list of research-supported psychological treatments categorized by disorder. For PTSD, Hajcak and Starr (2016) list seven treatment approaches with varying levels of research support:
- Prolonged exposure (strong research support)
- Present-centered therapy (strong research support)
- Cognitive processing therapy (strong research support)
- Seeking safety (for PTSD with comorbid substance use disorder, strong research support)
- Stress inoculation therapy (modest research support)
- Eye movement desensitization and reprocessing (strong research support, controversial)
- Psychological debriefing (no research support, potentially harmful)
2.The National Child Traumatic Stress Network (NCTSN; www.nctsn.org) lists 44 evidence-based interventions for children who have experienced trauma. They range from specific psychotherapy models for individuals, families, and groups to advocacy programs for specific populations. Some programs include cultural components, and some include training guidelines. Examples are child-parent psychotherapy (CPP) for families with children who are zero to five years old; parent-child interaction psychotherapy (PCIP); structured psychotherapy for adolescents responding to chronic stress (SPARCS); and trauma-focused cognitive-behavioral therapy (TF-CBT), which is probably the best-researched approach utilizing a version of exposure therapy (i.e., remembering a traumatic experience and pairing it with relaxation).
3.The California Evidence-Based Clearinghouse for Child Welfare (CEBC; www.cebc4cw.org) rates treatments for a wide variety of mental health problems for children, adolescents, and adults. For example, under the category “Trauma Treatment (Adult),” four therapies qualify as “well-supported by research evidence,” two as “supported by research evidence,” and five with “promising research evidence.”
4.The Substance Abuse and Mental Health Services Administration (SAMHSA) maintains the National Registry of Evidence-Based Programs and Practices (NREPP; http://nrepp.samhsa.gov) with information on almost 400 interventions, some of which are trauma-focused.
5.In 2015 the International Society for Traumatic Stress Studies (ISTSS; www.istss.org) published the second edition of Effective Treatments for PTSD along with practice guidelines for a significant list of treatments: psychological debriefing for adults; acute interventions for children and adolescents; early cognitive-behavioral interventions for adults; cognitive-behavioral therapy for adults, children, and adolescents; psychopharmacotherapy for adults, children, and adolescents; eye movement desensitization and reprocessing (EMDR); group therapy; school-based treatment for children and adolescents; psychodynamic therapy for adult and child trauma; psychosocial rehabilitation; hypnosis; couples and family therapy for adults; creative therapies for adults and children; and treatment of PTSD and comorbid disorders.
6.The International Society for the Study of Trauma and Dissociation (ISSTD; www.isst-d.org) has published guidelines on their website for the treatment of adults with dissociative identity disorder, as well as guidelines for the evaluation and treatment of children and adolescents with dissociative symptoms. The society offers courses on the treatment of complex trauma and dissociative disorders as well as two levels of certificates in the treatment of complex trauma and dissociation.
7.An international prospective treatment study named the Treatment of Patients with Dissociative Disorders (TOP DD) has provided strong evidence for specific treatment approaches in work with individuals diagnosed with dissociative disorders. More information on this longitudinal study can be found at https://topddstudy.com.

In summary, EBTTs for all disorders related to trauma are still somewhat limited. PTSD has been studied the most, and there is substantial evidence of the effectiveness of specific treatment approaches. Further research is needed to broaden the varieties of trauma-related disorders studied, the specific types of trauma studied, and the treatment approaches studied. Yet we have hope that treatment can be helpful, so for Christians this becomes a challenge and a call to respond.

“Whenever and wherever human beings endure suffering and humiliation, take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.”

Nobel Laureate Elie Wiesel

Moral, Ethical, and Legal Dimensions of Trauma Treatment

As with any counseling book, at some point and to some degree the moral, ethical, and legal dimensions of the topic need to be addressed. We have not included a specific chapter on ethics. This is partly due to space limitations but is more a result of our assessment that everything that has been written about ethics in the mental health professions is applicable to the treatment of trauma. In addition, much has been written on the ethics related to the use of spirituality and religious resources in counseling and psychotherapy, so it does not need to be repeated here. However, for readers interested in the topic of ethics in Christian counseling, the sidebar “Examples of References on the Moral, Ethical and Legal Aspects of Counseling” will direct you to some resources.

Examples of References on the Moral, Ethical,
and Legal Aspects of Counseling

Chapelle, W. (2000). A series of progressive legal and ethical decision-making steps for using Christian spiritual interventions in psychotherapy. Journal of Psychology & Theology, 28(1), 43-53.

Corey, G., Corey, M. S., Corey, C., & Callanan, P. (2014). Issues and ethics in the helping professions (9th ed.). Stamford, CT: Cengage.

Doherty, W. J. (2009). Morality and spirituality in therapy. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed.). New York, NY: Guilford Press.

Koocher, G. P., & Keith-Spiegel, P. (2016). Ethics in psychology and the mental health professions: Standards and cases (4th ed.). New York, NY: Oxford University Press.

Myers, J. E. B. (2016). Legal issues in clinical practice with victims of violence. New York, NY: Guilford Press.

Sanders, R. K. (Ed.). (2013). Christian counseling ethics: A handbook for psychologists, counselors and pastors (2nd ed.). Downers Grove, IL: IVP Academic.

Tan, S.-Y. (1994). Ethical considerations in religious psychotherapy: Potential pitfalls and unique resources. Journal of Psychology & Theology, 22(4), 389-94.

See also the codes of ethics of the American Association for Christian Counselors (www.aacc.net), the Christian Association of Psychological Studies (www.caps.net), and the North American Association of Christians in Social Work (www.nacsw.org).

We would briefly like to address what we believe to be a moral mandate, namely, that mental health professionals take a stand against the perpetration of trauma and support victims regardless of how the trauma happened. After all, mental health professionals are often the ones who most deeply interact with trauma victims. For those of us who identify as Christians, the mandate should be all the stronger if our moral convictions are based in Scripture. Value-neutral counseling has been clearly shown to be unhelpful (Corey, 2016). Mental health professionals must condemn interpersonal trauma. Of course, we do so with all the skills and sensitivity we can muster, but there is no professional rationale for avoiding taking the side of the victim whether that be in domestic violence contexts or in the aftermath of a natural disaster wherein some may argue that the disaster was God’s judgment.

“Power without love is reckless and abusive, and love without power is sentimental and anemic. Power at its best is love implementing the demands of justice, and justice at its best is love correcting everything that stands against love.”

Martin Luther King Jr., 1967

Trauma and Spirituality

Christian counseling has a rich literature, both academic and popular, on the role of spirituality in the healing process (see sidebar “Sample of References on Spiritual Resources in Counseling”). However, only recently has literature appeared on the specific relationship between Christian spirituality and trauma counseling.

As we have combed through both the Christian and the secular literature that specifically links the concepts of spirituality and trauma, we have been pleasantly surprised to find out that quite a bit has been written. We initially set out to do a traditional literature review on the topic of trauma and spirituality. However, we decided that readers might benefit more from being exposed to specific articles and books on the topic, including a brief summary of the main focus of the content of each. To this end, the appendix at the end of the book provides a selected bibliography of much of the literature along with brief comments culled from the abstracts of these references. The appendix is categorized by topic and lists a total of 190 references, each addressing the relationship of spirituality to an aspect of trauma.

While chapter authors all discuss some aspects of Christian spirituality as they relate to particular types of traumas, they do not extend their discussion to include spirituality beyond orthodox Christian belief. However, the appendix includes a number of references that represent other faith perspectives (e.g., Buddhism and Hinduism). While it has been encouraging to see a greater openness to using spirituality and spiritual resources in treatment within the mental health professions, Christian spirituality is not always welcome. Yet the existence of publications that discuss the relevance of other religions and broader issues of spirituality to the practice of trauma therapy bolsters a sense within the field of the overall importance of spiritual dimensions of trauma. This may provide Christian counselors an increased voice with respect to the relevance of Christian spirituality to trauma survivors.

Sample of References on Spiritual Resources in Counseling

Appleby, D. W., & Ohlschlager, G. (2013). Transformative encounters: The intervention of God in Christian counseling and pastoral care. Downers Grove, IL: InterVarsity Press.

Bade, M. K., & Cook, S. W. (2008). Functions of Christian prayer in the coping process. Journal for the Scientific Study of Religion, 47(1), 123-33.

Bänziger, S., Janssen, J., & Scheepers, P. (2008). Praying in a secularized society: An empirical study of praying practices and varieties. International Journal for the Psychology of Religion, 18(3), 256-65.

Campbell, E. (2015). Utilizing the Serenity Prayer to teach psychology students about stress management. Journal of Psychology & Theology, 43(1), 3-6.

Hathaway, W. L. (2009). Clinical use of explicit religious approaches: Christian role integration issues. Journal of Psychology and Christianity, 28(2), 105-22.

Hunter, L.A., & Yarhouse, M.A. (2009). Considerations and recommendations for the use of religiously-based interventions in a licensed setting. Journal of Psychology and Christianity, 28(2), 159-66.

McMinn, M. (1996). Psychology, theology and spirituality in Christian counseling. Wheaton, IL: Tyndale.

Moon, G. W., Bailey, J. W., Kwasny, J. C., & Willis, D. E. (1991). Training in the use of Christian disciplines as counseling techniques within religiously oriented graduate training programs. Journal of Psychology and Christianity, 10(2), 154-65.

Plante, T. G. (2009). Spiritual practices in psychotherapy. Washington, DC: American Psychological Association.

Richards, P., & Bergin, A. (1997). A spiritual strategy for counseling and psychotherapy. Washington, DC: American Psychological Association.

Tan, S.-Y. (2011). Mindfulness and acceptance-based cognitive-behavioral therapies: Empirical evidence and clinical applications from a Christian perspective. Journal of Psychology and Christianity, 30(3), 243-49.

Whittington, B. L., & Scher, S. J. (2010). Prayer and subjective well-being: An examination of six different types of prayer. International Journal for the Psychology of Religion, 20(1), 59-68.

Worthington, E. L., Jr., Johnson, E. L., Hook, J. N., & Aten, J. D. (Eds.). (2013). Evidence-based practices for Christian counseling and psychotherapy. Downers Grove, IL: IVP Academic.

Resources on the Theology of Suffering

Anderson, R. S., (2010). Self-Care: A theology of personal empowerment and spiritual healing. Eugene, OR: Wipf and Stock.

Boase, E., & Frechette, C. G. (Eds.). (2016). Bible through the lens of trauma. Atlanta, GA: SBL Press.

Cloud, H., & Townsend, J. (2001). How people grow: What the Bible reveals about personal growth. Grand Rapids, MI: Zondervan.

Dykstra, R. C. (2016). Meet the terrible resistance: Childhood suffering and the Christian body. Pastoral Psychology, 65(5), 657-68.

Eiesland, N. L. (1994). The disabled God. Nashville, TN: Abingdon Press.

Epstein, M. (2014). The trauma of everyday life. New York, NY: Viking.

Griffith, J. L. (2010). Religion that heals, religion that harms: A guide for clinical practice. New York, NY: Guilford Press.

Hall, M. E. L., Langer, R., & McMartin, J. (2010). The role of suffering in human flourishing: Contributions from positive psychology, theology, and philosophy. Journal of Psychology & Theology, 38(2), 111-21.

Hubbard, M. G. (2009). More than an aspirin: A Christian perspective on pain and suffering. Grand Rapids, MI: Discovery House.

Kreeft, P. (1986). Making sense out of suffering. Ann Arbor, MI: Servant Books.

Langberg, D. (2015). Suffering and the heart of God: How trauma destroys and Christ restores. Greensboro, NC: New Growth Press.

Martin, J. (2016). Seven last words: An invitation to a deeper friendship with Jesus. New York, NY: HarperCollins.

McGrath, A. (1995). Suffering and God. Grand Rapids, MI: Zondervan.

Peterman, G. W., & Schmutzer, A. J. (2016). Between pain and grace: A biblical theology of suffering. Chicago, IL: Moody.

Ting, R. S.-K. (2007). Is suffering good? An explorative study on the religious persecution among Chinese pastors. Journal of Psychology & Theology, 35(3), 202-10.

Yancey, P. (1988). Disappointment with God. Grand Rapids, MI: Zondervan.

Yancey, P. (1988, February 19). How not to spell relief. Christianity Today.

Yancey, P. (1990). Where is God when it hurts? Grand Rapids, MI: Zondervan.

Familiarity with the literature on how broader spiritual practices from other religions can be used in counseling trauma survivors can also serve as a springboard for Christian clinicians to examine new ways of incorporating aspects of Christian spirituality into treatment. As an example, while holy name repetition as a stress management intervention (Oman & Driskill, 2003) may not be a common religious practice in many Christian contexts, its use in other religions (e.g., mantra/mantram in Hinduism and Buddhism) may encourage Christians in the use of spiritual exercises such as meditation, the Jesus Prayer, and lectio divina.

The literature on trauma and spirituality clearly shows that it is common for trauma survivors to be confronted with questions about life and death, spirituality, and meaning. Trauma tends to shake the foundations of survivors’ spiritual belief systems, whether these beliefs are expressed in explicitly religious terms or as existential questions that are ultimately spiritual in nature. Therefore, the importance of appropriately incorporating spirituality into the treatment of trauma cannot be overstated.

Conclusion: A Call for a More Robust Theology of Suffering

We trust that this book will serve as a good summary of what is known about Christian spirituality and trauma, as well as provide a valuable resource for Christian mental health professionals who desire to be involved in responding to suffering people. We also hope that this book will challenge Christian therapists to continue to enter the dark world of human depravity and to bring the light and healing of Christ.

As we complete the process of editing this book, we are more aware than ever of the great need for a robust and realistic theology of suffering. Despite the fact that we all work with traumatized people, Christian counselors have not been quick to engage this topic theologically. Our colleagues who are biblical scholars and theologians also have not been quick to provide us with practical resources for our work in this area (Anderson, 1990; Charry, 2001). Of course, some literature does exist (see the sidebar “Resources on the Theology of Suffering” and chap. 2 in this volume), but we hope that this book will encourage other authors to develop our thinking and add to the available resources with respect to the intersection of psychology, counseling, the Bible, theology, and the human experience of suffering. This may be the primary way the church and the gospel will be able to connect to people’s experience in an era that is increasingly closed to the traditional avenues of sharing our Christian faith.

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