Eastern Orthodox

Orthodox Pastoral Care and Psychotherapy

If there is any subject bound to divide members within the Orthodox Church today, it is the relationship between Orthodoxy and psychotherapy. Indeed, a line could be drawn down the middle of any Church nave with members on each side intent on coming to blows. One side is bound to consist of ROCOR1 priests and laity, enthusiastic converts, and the boomer faithful; on the other stand dual vocation priest-therapists, intellectuals, and younger, seasoned faithful. Each wields the same Tradition, patristic teaching, and Faith calling out the other some variety of “syncretist” or “ecumenist” on the one hand and “hyperdox” or “rigorist” on the other. Unfortunate as it may be (and as stereotyped as these groups may be) this is the reality we are living.

The entire debate appears to revolve around two fundamental questions: what is the interplay between Orthodox Christianity and psychotherapy? And should Orthodox pastors and laity make use of therapeutic relationships, techniques, and coping strategies? How each group answers these questions is informed by a subtler (and profusely wider) schism of theological vision. This rupture is made most evident in how each faction approaches the world outside the walls of the Church. On the one extreme, there is a mullish dismissal of any secular body of knowledge (and thus psychotherapy) which discloses a considerably larger Weltanshauung characterized by scrupulous rigidity of thought, a perspective that takes a black-and-white view of the world and patristic tradition. On the other side is an overly malleable inclusiveness that accepts everything without discernment. But what if there is a third way?

In 2011, then Hieromonk Alexis Trader (now Bishop Alexis of Bethesda) published an important study entitled, Ancient Christian Wisdom and Aaron Beck’s Cognitive Therapy. According to Bishop Alexis, there are three possible paradigms for Christian integration of science and medicine, including psychology: dismissive rejection, superficial merging, and discerning openness. Calling attention to the third option, Trader demonstrates how this stance animated the Church Fathers’ attitudes towards the science and medicine of their day. Here, Trader intimates that psychology cannot be monolithically rejected. Freud’s Oedipus Complex may be met with raised eyebrows but Beck’s suggestions in Cognitive Behavior Therapy (and other schools of psychotherapy not to mention therapy generally) should be approached with a discerning openness. Not all psychology and therapeutic practices work from the same model, not all psychology is Freudian!

With swaths of Orthodox who seem content in taking the easy road of rejection and the vast majority of secular sources fighting for unexamined acceptance of cultural truisms, this raises the question of how should we go about practicing discerning openness?

Certainly, the chronic malady plaguing the current Orthodox mentality is its boorish inflexibility. With the slew of social maxims changing at an alarming rate, the stubborn rebuffing of social issues has become for many the flagship virtue of Orthodoxy. While this may be thought of as dogmatic rigidity, it plays out socially as well with a one-dimensional rejection of tools that aid human thriving in various domains, such as psychology and therapy. The result? An insular separatism categorized by a parochial insistence that the healing of human persons is the Church’s business and no one else’s (unless you need your appendix taken out, then go to the doctor).

It could be that psychology impinges upon what many believe is the Church’s domain: inner healing. Certain medical science is accepted by general consensus – tylenol is swallowed without a thought – but don’t dare seek therapy or take depression or anxiety medication. These are spiritual maladies! But are they? The cacophony of voices that chime in on this topic is enough to drive one mad in its own right. Such provincialism seems on the doorstep of offering tickets to snake handling shows. (Assuredly there are certain Orthodox that are even militantly hesitant to seek physical medical care. Where does the line stop?) This cancerous infirmity of perception is growing and threatens the existence of the Church itself. This is not to say the Church should conform to cultural ideology, but it does seem that both dismissiveness and acquiescence miss the golden mean.

The nuance required by discerning openness is missing in much of what defines today’s Orthodoxy. Herein I would suggest that we must hold two things in tension: we must be inflexible and unchanging in dogma but willing to adjust our myopic perspective concerning the unchangeableness of the Orthodox Church. The Church as the custodian of dogma does not admit change but the Church as existing in the world does and must; the Church as a mosaic of limited, fallible individuals can (and does) fall victim to idiosyncratic beliefs that develop into compelling misleading perspectives. Our understanding that Jesus Christ is 100% God and 100% man remains uncompromisingly inflexible. But as human beings living in time among a vast sea of human beings that are still in process, we must admit flexibility, openness, acceptance, and freedom. The first is dogma, the second is pastoral care or interpersonal flexibility. And the second is the Church as being-in-the-world.

We should celebrate the Church’s implacable rigidity of dogma together with it’s pastoral, interpersonal flexibility. Sadly, the latter portion seems to be on the verge of extinction. And being that this interpersonal aspect is the experienced reality of those living in the world, the degree of flexibility or inflexibility will inevitably play out relationally as either positive or negative experience.

Surely the accuracy of this statement is confirmed by the insistent austerity of the elder churchgoer who opposes the paint change in the Church hall, liturgical language changes, or even priest-to-priest diversity in pastoring. Though inconsequential to dogma, such a parishioner or clergyman clings to these as though the very life of Christ in the Church is at stake, as though the Church, and Christ Himself, were being blasphemed. Such intransigence evokes pharisaical imagery, with these stalwart “defenders of the faith” carrying around in phylacteries their own personal lists of intractable beliefs.

Just look at the calendar fiasco in the middle of the twentieth century, when churches split down the middle (literally brother against brother) over the bishops’ decree to switch to the Gregorian calendar. New churches were started to maintain the Julian calendar a stone’s throw from the other “sellout” Church. Consider the same phenomena with the Old Believers in seventeenth century Russia, who refused to assent to the Russian Liturgical reforms of Patriarch Nikon. How much more verification of this fact needs to be pointed out?

Unsurprisingly, the rise of the internet and influx of Orthodox publications readily available in English has allowed brigades of these Orthodox “elites” to launch newfangled crusades that spill the blood of those traveling the via media with the credo that a juste milieu is compromise and cannot be tolerated. It would seem that a portion of Orthodoxy in America, made up as it is of converts (I am one myself, after all), has integrated a militant strain that sees every social movement as an attack on Christian values and the Christian America. This is eerily similar to the kind of militancy traced among American Evangelicals by Kristin Kobes Du Mez in Jesus and John Wayne, leaving one to wonder: has the Orthodox phronema been hijacked by convert fundamentalism?

It should go without saying that this question concerning the role of therapy in the life of the Orthodox faithful is one that, I believe, is of the utmost importance. And ultimately the question, for me, comes down to pragmatics: does it work? Does therapy contribute to human thriving? The answer is an indisputable yes – and is verifiable scientifically and interpersonally.

Orthodox theology itself relies on this latter kind of verification, as characteristic of Metropolitan Hierotheos Vlachos’ work, calling Orthodoxy the Science of Spiritual Medicine, the cure of the soul. And when one asks, “how do we know Orthodoxy is true?,” we respond, “look at the Saints, do what they say, live the Orthodox life, and see if it works.” Where is this mentality when it comes to therapy? It’s a double standard.

With the stigma of seeking therapy rapidly dissolving over the last decade (and in particular with the traumas of a global pandemic this last year2), psychologists have experienced a boom in demand. The clientele is diverse and includes those Orthodox faithful who dare darken its door (or Zoom waiting room, as the case may be). Finding that their basic struggles are not necessarily shameful sins but distress tolerance and emotional regulation, therapy works wonders. Yet the experience of these Orthodox may be denigrated or even shamed in a Church where many are outspoken about disparaging therapy and psychology. Where does this leave them?

Life is messy. To overspiritualize by asserting more prayer or asceticism is needed for the cure is to place a double burden on the afflicted. It turns into a blame game wherein people are told, “you are not healed because you have not done enough.” Saying this to someone who may be clinically depressed because of neurochemical deficiencies is akin to claiming one was born blind because of his parents’ sin or someone with cancer that they just need to “pray harder” and they’ll be okay. There should be space for therapy and medication in the Orthodox Church just as there is space for cancer treatment and vaccinations, despite what some might claim.

I would even suggest that psychological healing – the healing of trauma – must be prior to or concurrent with spiritual healing, just as the healing of the Appetitive aspect precedes the healing of the Incensive and the Rational aspects of the soul. Remaining spiritually divorced from this process (and it is a process) is bound to perpetuate self-defeating behaviors, thought patterns, and even mental illness just as being spirituality divorced from the material is bound to unintentionally perpetuate gnosticism. This is not to say that healing on all levels is impossible within the Church. It is. Cancer can be healed at the service of unction. Yet even though we recognize this possibility, we still expect the patient to seek medical intervention.

Priests are not therapists. Confession is not therapy. Being a priest does not qualify one to offer psychological counseling or therapeutic advice. For some reason, these statements are bound to be controversial. Yet we understand that being a priest does not qualify one to diagnose appendicitis. He may know something of how the symptoms present but he certainly should not operate in the OR.

When taking an approach of discerning openness, psychotherapy and Orthodoxy operate in two distinct domains. They are related but they are not opposed just as in the case of Orthodoxy and science or Orthodoxy and medicine. Psychology and therapy are tools we have access to in the modern world, tools that we would do well to utilize.

Our challenge as Orthodox Christians today is to rediscover the beauty of the Church – not in inflexible dogma, which has been the focus of many in recent days, but in flexible cooperation and collaboration with the tools available to us. We must challenge the bystanders who wag their finger at the world exclaiming, “that is not Orthodox!” At best these statements are ignorant; at worst, they are utopian. The Church may be unchanging in dogma but we must be open to change in other arenas of life. And sometimes we get it wrong in these other arenas. It’s time we dare to admit it.

Show Notes

Benjamin Cabe

Benjamin Cabe

Benjamin Cabe is an Eastern Orthodox Christian who aspires to learn from, and write within the framework of, the teachings of the Church Fathers. He is an artist, writer, animator, husband, and father. In his free time, he enjoys spending time with his family, reading, writing, and composing music.

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