Grace and Mindfulness in Psychotherapy 

There is an increasing recognition in the provision of therapy that therapists need to be sensitive to religious clients. One example where this has been put into practice is  in third-wave Cognitive Behavioural Therapies (CBT) like Mindfulness-Based Cognitive Therapy (MBCT).
 
Some Christians perceive MBCT to be problematic  because of the Buddhist roots of the mindful awareness or meditative practices that lie at the heart of it. These practices are actually neutral practices, that can be utilized by anyone, but the perception of there being a problem needs to be addressed. William Hathaway and Erica Tan tackle this in an article entitled “Religiously Oriented Mindfulness-Based Cognitive Therapy.”[i]. 
The authors point out that there are ethical and cultural rationales for such an endeavour which respects and prioritizes working with the client’s worldview.[ii] In the article they present a case study of a client, who is described as a ‘depressed conservatively Christian client.’[iii].  The client had experienced recurrent bouts of depression, and so MBCT was an appropriate therapy of choice, but with the therapists working in a ‘religiously congruent cognitive approach.’[iv]
 
The key thing to highlight, and this would aid any therapist working with MBCT and depressed clients who are also Christians, was the importance of the theological concept of God’s grace in helping this client to see the congruence between her faith and this mindfulness-based approach.  Part of the client’s negative patterns of thinking was expressed in self-contempt through such expressions as feeling ‘she was a weak Christian who must be a disappointment to God.’[v] As a client she herself raised the question of how she might understand MBCT from a Christian point of view, and the therapist dealt with this in a client-centred way, helping the client make sense of this from her own personal religious beliefs.[vi] A religiously congruent approach was thus adopted as an act of listening deeply to what the client was asking for.
 
The client acknowledged ‘that her belief in grace and God’s unconditional love meant that God accepts her as she is.’[vii] This definition of grace is congruent with the emphasis on acceptance in MBCT, which involves accepting and facing the reality of negative, thoughts, feelings and bodily sensations rather than trying to avoid them, as well as accepting that ‘”thoughts are not facts.”’[viii].  Grace as God’s ‘unrelenting’[ix] acceptance as well as acceptance in mindfulness are not passive resignation in the face of reality, but a facing of reality through a compassionate, non-judgmental attitude. It involves love and truth coming together in an act of ‘clear seeing.’ There is an action plan in grace and acceptance that enables us to respond rather than react to the reality we face.
 
Another key element in grace and acceptance is realising that ‘”thoughts are not facts.”[x]’ We are bigger than our thoughts and feelings, which are passing events in the mind. They can be noticed and let go, rather than judged, avoided, resisted or focused on in a hyper-sensitive way.  However, as with many Christians, for this client the concept of grace had remained a ‘metacognitive proposition,’ existing only as an idea in the head, which needed to become a ‘metacognitive insight,’ which became a felt, realised and remembered experience in life.[xi] This process can begin to happen through the mindful awareness practices.
 
 In this case the client’s metacognitive propositions and insight about God did change through the experience of grace, ‘Ruby’s perception of God changed from feeling as though He demanded perfection to believing that He was able to meet her in times of weakness and brokenness without punishment.’[xii] The client was able to extend that grace to others in her family. Wider research suggests that self-compassion seems to lead to a greater capacity for compassion for others.
 
The authors make the point that by respecting religious diversity and client autonomy, therapists ‘may be required to refrain from certain treatments,’ but they also recognize that within Christian theology and spirituality there are many resources that can offer ‘parallels to mindfulness.’[xiii].  Grace as God’s active acceptance of us as we are is one of those resources, and can enable Christian clients with depression and other mood disorders to access mindfulness-based approaches if they want to.
 
This piece of work is an important example of developing religiously congruent approaches within psychotherapy, that enable Christian clients to benefit from the secular therapies, including mindfulness. This happens through ensuring the client is well-informed about the secular psychotherapies and enabling them to access their faith as a resource in mental health. Further work needs to be done in this area, as well as further research in using Christian contemplative practices which are part of the spiritual landscape, but can also offer mental wellbeing through their practice.

Shaun Lambert

[i] William Hathaway & Erica Tan, “Religiously Oriented Mindfulness-Based Cognitive Therapy,” Journal of Clinical Psychology 65, no. 2 (2009): 158.
[ii] Hathaway, 160.
[iii] Hathaway, 158.
[iv] Hathaway, 164.
[v] Hathaway, 165.
[vi] Hathaway, 166.
[vii] Hathaway, 166, my italics.
[viii] Hathaway, 162.
[ix] William Hathaway & Erica Tan, “Religiously Oriented Mindfulness-Based Cognitive Therapy,” Journal of Clinical Psychology 65, no. 2 (2009): 166.
[x] Hathaway, 162.
[xi] See John D. Teasdale, “Metacognition, Mindfulness and the Modification of Mood Disorders,” Clinical Psychology and Psychotherapy 6, (1999): 146-155, for this important distinction between metacognitive propositions, and the shift required for them to be metacognitive insights.
[xii] Hathaway, 168.
[xiii] Hathaway, 169.