Thomas, Moriarty, Davis and Anderson, 2011

Journal of Psychology and Theology2011,Vol. 39. No. 1,44-58

Copyright 2011 by Rosemead School of PsychologyBiola University, 0091-6471/410-730

THE EFFECTS OF A MANUALIZEDGROUP'PSYCHOTHERAPY INTERVENTIONON CLIENT G O D IMAGES ANDATTACHMENT TO GOD: A PILOT STUDYMICHAEL J. THOMAS, GLENDON L. MORIARTY,EDWARD B. DAVIS, AND EUZABETH L . ANDERSONDoctoral Program in Clinical PsychologyRegent University

The goal of this pilot study was to examine theeffects of an 8-week, manualized, outpatient group-psychotherapy intervention on client god images andattachment to God. Participants were 26 adults whoreported a Christian religious affiliation and whosought religiously based, group-psychotherapy treat-ment for difficulties in their emotional experience ofGod (i.e., negative god images). The treatment pro-tocol reflected a psychotherapy-integrationistapproach to treating god-image difficulties. Treat-ment chiefly included psychoeducational, dynamic-interpersonal, and cognitive interventions, althoughit also included allegorical-bibliotherapy andart/music interventions. The pre- and post-test ques-tionnaire included the Attachment to God Inventory(R. Beck & McDonald, 2004) and a brief God adjec-tive-checklist, along with several open-ended ques-tions. Participants reported experiencing adaptiveshifts in their god images and attachment to God.Specifically, when pre- and post-questionnaire rat-ings were compared, they reported experiencing Godemotionally as more accepting, intimate, and sup-portive and as less disapproving, distant, and harsh.In addition, they reported experiencing significantlyboth less attachment anxiety with God and lessattachment avoidance with God. Furthermore, theyreported experiencing more congruence betweentheir emotional experience of God (god images) and

Portions of this article are reprinted from the primary author'sdissertation ("The Effect of a Manualized Group Treatment Pro-tocol on God Image and Attachment to God," Thomas, 2009)and from one secondary author's dissertation "Authenticity. Inau-thenticity. Attachment, and God-Image Tendencies Among AdultEvangelical Protestant Christians," Davis, 2010). The authorswish to express thanks to Abrielle Conway, Seth Rainwater, Sher-

their theological beliefs about God (god concepts).The interventions that were deemed the most thera-peutically effective were the allegorical-bibliotherapyand the cognitive-restructuring interventions. Clinicalimplications and limitations are discussed.

As Hathaway (2003) has highlighted, withinthe broad field of mental health, the past 20years have marked a significant increase in

the clinical attention that is devoted to reli-gious/spiritual issues. For example, the AmericanPsychological Association's (2002) Ethics Code nowincludes religion among the domains of diversity thatmental-health professionals must address in a respect-ful and culturally responsive manner (Hays, 2007;Richards ÔC Bergin, 2000). Another such develop-ment is the inclusion of the Religious or SpiritualProblem diagnostic category (V62.89) in the Diag-nostic and Statistical Manual of Mental Disor-ders-Fourth Edition-Text Revision (American Psy-chiatric Association, 1994; see Turner, Lukoff,Barnhouse, 6c Lu, 1995). As its name implies, this cat-egory is meant to be used "when the focus of clinicalattention is a religious or spiritual problem" (Ameri-can Psychiatric Association, 1994, p. 685). For reli-giously/ spiritually oriented clients, god-image diffi-culties are a common Religious or Spiritual Problemthat motivates them to seek psychotherapy (Allmond,

ley Saget-Menager, and Stephanie Nowacki-Butzen, for theirgroup cofacilitation, and to Nicholas J. S. Gibson, Mark Blagen,Stephanie Nowacki-Butzen, for their instrumentation consulta-tion. Correspondence concerning this article should beaddressed to Michael J. Thomas, Psychology Department, East-ern University, 1300 Eagle Road, Mclnnis Learning Center 222,St. Davids, PA 19087 E-mail: [email protected].

44

THOMAS, MORIARTY, DAVIS and ANDERSON 45

2009). In particular, such clients often experience aclinically significant discrepancy between their godconcepts and their god images (Yarborough,2009)—that is, between their head knowledge of adivine attachment figure (DAF; e.g., God, Allah,Jesus, Buddha, Krishna, etc.) and their heart knowl-edge of that same flgure, respectively (Davis, 2010;Moriarty &C Davis, in press).

In the current article, we report findings from apilot study of an 8-week, manualized, outpatientgroup-psychotherapy intervention (entitled "Discov-ering God") that was designed to treat god-image dif-ficulties, with a speciflc view toward improving clientgod images and attachment to God. Our treatmentprotocol reflected a psychotherapy-integrationistapproach (Norcross & Golfried, 2005; cf. Moriarty6c Davis, in press). It chiefly included psychoeduca-tional, dynamic-interpersonal, and cognitive inter-ventions, although it also included allegorical-biblio-therapy and art/music interventions. In the sectionthat follows, we will briefly describe our psychody-namic-cognitive conceptualization of god images, onwhich both our treatment manual and our clinicalinterventions were based.

D E F I N I T I O N S , D E V E L O P M E N T , A N DD Y N A M I C S

DefinitionsAs Davis (2010) has described, god images are

the affect-laden mental representations that underliea person's embodied, emotional experiences in rela-tionship with a DAF, such as God, Allah, Jesus, Bud-dha, or Krishna. They are primarily comprised ofimplicit relational knowledge (i.e., "gut-level procedu-ral knowledge of how to perceive and be in relation-ship with a general or speciflc relational partner,"Moriarty & Davis, in press; cf. Hall, 2004; Kihlstrom,2008; Lyons-Ruth et al., 1998). Basically, god images"guide and integrate how a person experiences [theDAF] at an emotional, physiological, largely nonver-bal, and usually implicit level (i.e., outside of con-scious awareness; Davis, 2010; cf. Fogel, 2009; Nof-fke Sc Hall, 2007)" (Moriarty & Davis, in press). Hall(2007) has thus described god images as a type ofattachment filter (p. 24), through which embodied,emotional experiences with a DAF are mediated.

In contrast, god concepts are the belief-ladenmental representations that undedie a person's con-scious, linear knowledge about a DAF. They arechiefly comprised of semantic memory (i.e., "general

knowledge about the world, including words and con-cepts, their properties and interrelations," Smith &:Kosslyn, 2007, p. 541; cf. Davis, 2010; Siegel, 2010).Essentially, they guide and integrate how a personthinks and talks about a DAF at an abstract, theologi-cal, conceptual, and usually explicit level (i.e., inside ofconscious awareness; Davis, 2010). As such, god con-cepts may be thought of as a type of doctrinal filter,through which theological, abstract thoughts and dis-cussions about a DAF are mediated (cf. Hall, 2007).

Development and DynamicsGod-image development and dynamics. It is

beyond the scope of this article to comprehensivelydescribe the development and dynamics of godimages and god concepts (see Davis, 2010; Moriarty& Davis, in press, for such reviews). However, wewill provide a brief summary here, highlighting thepoints that group-participants read about in ourtreatment manual (see Thomas, 2009, Appendix G,for a copy of this manual).

As Davis (2010) has detailed, our conceptualiza-tion of god-image development and dynamics isbased on Hall's (2004) relational-spirituality theory(cf. Hall, 2007; Hall, Fujikawa, Halcrow, Hill, &Delaney, 2009). Consequently, it is undergirded bythe central organizing principles of that theory, asenumerated in Hall (2004):Central Organizing Principle #J. People are fundamentallymotivated by, and develop in the context of emotionally signif-icant relationships, (p. 68)

Central Organizing Principle #2. There are multiple codesof emotional information processing which provide a theoret-ical framework for understanding the way in which close rela-tionships are processed and internalized, thereby shaping thepatterns of our relationships with God, self and others, (p. 69)

Central Organizing Principle #3. Implicit relational repre-sentations are repetitions of relational experiences, sharing acommon affective core, that are conceptually encoded in themind as non-propositional meaning structures. They are thememory basis for implicit relational knowledge; that is, our"gut level" sense of how significant relationships work. (p. 71)

Central Organizing Principle #4. Implicit relational repre-sentations, formed particularly from experiences [in] earlyrelationships with caregivers, shape the emotional appraisal ofmeaning and subsequent patterns of relationship, (p. 72)

Central Organizing Principle #J. Implicit relational represen-tations and knowledge form the foundation of our knowledgeof self and others because they are processed automatically, andare not under the direct control of knowledge in the form ofwords that [are] processed in a linear manner, (pp. 73-74)

46 GROUP-PSYCHOTHERAPY, GOD IMAGES, ATTACHMENT TO GOD

Our treatment manual reflected a psychotherapy-integrationist approach (Norcross 6c Goldfried,2005; cf. Moriarty &C Davis, in press). As such, ourconceptualization of god-image development anddynamics highlighted ideas from several theoreticaltraditions. For example, from the classical-psycho-analytic tradition (Freud, 1913/1950, 1930/1962;Jones, 1991, 2007), we stressed the pervasive andlong-lasting influence of early-childhood experi-ences in relationship with one's caregivers. Fromthe object relations tradition (Rizzuto, 1979; Winni-cott, 1951/1975,1971), we emphasized the process-es of internalization (Davis, 2010; Moriarty, 2006;Schäfer, 1968) and of separation-individuation(Mahler, Pine, & Bergman, 1975), the former via thecaregiver-child relationship and the latter via the useof God as a transitional object (Moriarty, 2006; Win-nicott, 1951/1975, 1971). From the cognitive tradi-tion (A. T. Beck, Rush, Shaw, & Emery, 1979;DeRubeis, Tang, & A. T. Beck, 2001), we under-scored the concepts of core beliefs (Moriarty,2006), automatic thoughts (A. T. Beck et al, 1979),self-schemas (Markus, 1977; Markus &C Kunda,1986), and cognitive distortions (DeRubeis et al.,2001). Last, from the attachment tradition (Bowlby,1973; Collins, Guichard, Ford, ôc Feeney, 2004), weunderlined the interconnections among internalworking models of self, God, and others, particular-ly the reliable similarities between one's global (i.e.,generalized) internal working models of self andone's global internal working models of God (Ben-son ÔC Spilka, 1973; Bud & Mueller, 1993; Yarbor-ough, 2009; cf. Davis, 2010; Hall et al., 2009; Mori-arty ÔC Davis, in press).

In this latter regard, our conceptualization ofgod-image development and dynamics affirmed theimplicit-relational-knowledge correspondencehypothesis (Hall, 2004, 2007; Hall et al., 2009),which posits that individuals' experiences in rela-tionship with human attachment figures (e.g., care-givers, peers, romantic partners, and coreligionists)undergirds and parallels their experiences inembodied, emotional relationship with Cod.Importantly, according to this hypothesis, people'simplicit relational knowledge of how to perceiveand be in relationship with God is reflected in theirimplicit religious/spiritual functioning (i.e., "theirfelt religious/spiritual experience at a relational,motivational, emotional, and physiological level,"Moriarty ôc Davis, in press) but not necessarily intheir explicit religious/spiritual functioning (i.e..

"their religious/spiritual behaviors and consciouslyarticulated beliefs; e.g., religious/spiritual commit-ment, church attendance, and theological beliefs,"Moriarty & Davis, in press; see Davis, 2010; Hall etal., 2009, for reviews).

There is preliminary research support for theimplicit-relational-knowledge hypothesis (Davis,2010; Hall et al., 2009). For example. Hall et al.

. (2009) found that adult participants from the fourmain attachment groups (secure, anxious, avoidant,and fearful) differed significantly on three of fourimplicit religious/spiritual functioning indicators(interpersonal unforgiveness, spiritual community,and attachment anxiety with Cod) but did not exhib-it significant differences on the explicit reli-gious/spiritual functioning indicator (explicit reli-gious/spiritual commitment).

God-concept development and dynamics. In con-trast to their god images, people's god concepts arehighly related to their explicit religious/spiritual his-tory and functioning. Hoffman (2005) hasdescribed god concepts as mainly deriving frominformal and formal learning, via such avenues asreligious/spiritual texts and the teaching and model-ing of parents and religious/spiritual leaders (Davis,2010; Crimes, 2007).

In the case of religious/spiritual persons whoreport having a personal relationship with a DAF, it islikely that their god concepts are relatively adaptiveand "accurate," from the standpoint of their primaryreligious/spiritual texts (e.g., the Bible, Book ofMormon, Qur'an; Davis 6c Moriarty, 2008). Howev-er, religious/spiritual individuals often experiencedisparities between the DAF they believe in explicitly(god concepts) and the DAF they experience implic-itly (god images; see Davis, 2010; Lawrence, 1997;Moriarty, 2006; Moriarty &C Davis, in press). Thedegree and qualitative nattire of such disparities v allvary from person to person. Significant disparitiesmay reflect the operation of what Bucci (1997) hastermed desymboHzation or dissociation, whereby"the connections between the subsymbolic and thesymbolic components of the schémas are cut"(Bucci, 1997, p. 202; cf. Davis, 2010; Davis & Moriar-ty, 2008) or what interpersonal neurobiologists (e.g.,Badenoch, 2008; Siegel, 2010) have referred to as alack of integration, where integration is defined asthe "linkage of differentiated parts of a system [e.g.,the mind/brain]" (Siegel, 2010, p. 262; see Davis,2010, for a review).


RESEARCH ON PROMOTING GOD-IMAGECHANGE THROUGH PSYCHOTHERAPY

Research on promoting god-image changethrough psychotherapy is admittedly sparse. At thetime of wriring this article (February 2011), therewere only two published, peer-reviewed studies inthis area: Tisdale et al. (1997) and Cheston, Pied-mont, Eanes, and Lavin (2003).

Tisdate et at. (1997)

First, Tisdale et al. (1997) examined god-imagechange through religiously based, object-reladons-oriented, mulrimodal inpatient-psychiatric treat-ment. All participants were self-identified evangelicalChristians and most of them were Caucasian and ofmiddle or upper-middle socioeconomic status. Themean age was 37 (range: 17-65 years old). Most par-ticipants had a primary diagnosis of Major Depres-sive Disorder and had never before been psychiatri-cally hospitalized. The average length ofhospitalization was 20.2 days (range: 10-43 days).

The following self-report measures were adminis-tered at admission (N = 99), at discharge (N = 99), at6 months following discharge (« = 67), and at 12months following discharge (« = 30): (a) the BellObject Relarions Reality Tesring Inventory (Bell,1991; measuring object relations maturity and realitytesting); (b) the Personal Self subscale of the Ten-nessee Self-Concept Scale (Fitts, 1965; measuringoverall self-worth); (c) the Presence, Challenge, andAcceptance subscales of the God Image Scales(Lawrence, 1997; measuring God's felt presence,desire for one's growth, and valuation of one's lov-ability, respectively); and (d) the Religious Experi-ence Questionnaire (Edwards, 1976; measuring theoverall experience of God emotionally as loving andclose). Psychiatric inpatient treatment included thefollowing interventions: (a) pharmacotherapy (asneeded), (b) 30 minutes of individual psychotherapy(5 days per week), (c) 90 minutes of group psy-chotherapy (7 days per week), (d) 60 minutes of reli-giously based psychoeducation (7 days per week),and (e) milieu treatment (e.g., occupational therapy,community meetings, and vocational counseling; asneeded; Tisdale et al., 1997).

Overall, participants reported experiencing adap-tive changes in their god images, when their admis-sion and discharge scores were compared. Specifical-ly, at the end of their psychiatric-inpatient treatment,they reported experiencing God emotionally as

more close, loving, accepting, and present, com-pared wnth when they entered treatment. These ther-apeutic gains were maintained over the course of the12-month follow-up, although without furtherimprovements. It is important to note that adaptivechanges in participants' god images were consistent-ly associated with adaptive changes in their self-images. In fact, these adaprive shifts in self-imageswere dramatic in comparison to the adaptive shiftsin god images, suggesting that god-image change isassociated with (and perhaps even mediated by)improvements in self-images. Improvements in self-worth were also retained across the 12-month fol-low-up period (Tisdale et al., 1997; cf. Davis, 2010;Moriarty 6c Davis, in press).

Cheston et al. (2003)

In a similar study, Cheston et al. (2003) examinedgod-image change through general (i.e., not neces-sarily religiously based) outpatient individual-psy-chotherapy. Participants included a nonrandomizedconvenience sample of 98 adults—30 in the treat-ment group (23 women, 7 men; mean age: 39.3years) and 68 in the control group (53 women, 15men; mean age: 50.1 years). All participants complet-ed two self-report measures—the God AdjectiveCheck List (Gough ÔC Heilbrum, 1983; measuringgod-image characteristics) and the Brief SymptomInventory (Derogatis, 1993; measuring psychologicalsymptoms). The 30 individuals in the treatmentgroup completed these measures within 4 weeks ofbeginning psychotherapy (time 1) and then either attermination or at the end of 6 months (time 2),whichever came later. The 68 individuals in the con-trol group completed these measures at point of firstcontact (time 1) and then from 2 to 6 months later(mean intertest interval: 4 months). For the indi'vidu-als in the treatment group, the mean intertest inter-val was 6.7 months (range: 6-19 months), and themean number of sessions was 20 (range: 2-52 ses-sions). Of note, at time 1 and time 2, each psy-chotherapy-client's therapist completed the Dero-gatis Psychiatric Raring Scale (Derogatis, 1978; aclinician-rated measure of psychological symptoms)on the respective client. Also, at time 2, the therapistrated the client's overall emotional growth (single-item measure) and overall spiritual growth (single-item measure).

When self-ratings at time 1 and time 2 werecompared, psychotherapy participants reported


experiencing significantly decreased psychologicalsymptoms over time, whereas control participantstended to reliably remain asymptomatic. Similarly,psychotherapy participants reported experiencingadaptive changes in their god images over time,whereas control participants tended to reliably expe-rience Cod in an emotionally healthy manner. Morespecifically, psychotherapy participants reportedexperiencing Cod emotionally as lower in trait neu-roticism and as higher in trait agreeableness; howev-er, this treatment effect was only evidenced amongthose clients who showed high emotional growthover time, as per clinician-rating. Moreover, theclients who evidenced high spiritual growth overtime tended to show a concomitant shift in experi-encing Cod emotionally as more loving, caring, andcompassionate (Cheston et al, 2003). As Moriartyand Davis (in press) have concluded

Cheston et al.'s study suggests the possibility that the commonfactors of psychotherapy (e.g., empathy, positive regard) mayfacilitate god-image change indirectly, via other forms of emo-tional change, such as improvements in self-image and adap-tive shifts in implicit relational knowledge.

Furthermore, as Cheston et al. (2003) indicated:"The psychological and spiritual selves of clients maybe integrally connected; thus, when something shiftsfor one part of the self, it shifts for another part ofthe self as well" (Cheston et al., 2003, p. 106).

Current State of the Research EvidenceTaken together, Tisdale et al. (1997) and Cheston

et al. (2003) have offered research evidence thatadaptive god-image change can be effected through(a) religiously based, object-relations-oriented, multi-modal inpatient-psychiatric treatment (Tisdale et al.,1997) and (b) general outpatient individual-psy-chotherapy (Cheston et al., 2003). However, each ofthese studies suffered from notable methodologicallimitations. For example, for ethical reasons (e.g.,psychiatric inpatients ethically cannot be put onto awaiting list), Tisdale et al.'s study did not have a con-trol group, thereby limiting internal validity. In addi-tion, Tisdale et al. did not evaluate the relativeeffects of the different inpatient-treatment compo-nents, thereby limiting treatment specificity (i.e.,conclusions regarding the active ingredients ofpatient change; Chambless ôc Hollon, 1998; Chamb-lessôcOllendick,2001).

Cheston et al.'s (2003) study was more method-ologically rigorous. Even so, there were noteworthy

limitations in that study also. For instance, the treat-ment group was small (N = 30), thus limiting power,and females were over-represented {n = 23), thus limit-ing external validity. Moreover, Cheston et al. did notrandomly assign treatment and control participants,limiting the study's internal validity. Furthermore, theydid not evaluate the degree to which reli-gious/spiritual components were explicitly addressedin psychotherapy, limiting an understanding of thetreatment specificity (Chambless ÔC Hollon, 1998;Chambless ÔC OUendick, 2001). In sum, the researchevidence on promoting god-image change throughpsychotherapy participation is still preliminary.

The Current Study

In our pilot study, we sought to build on thisresearch by (a) studying a manualized treatmentintervention and (b) studying the specific impact ofreligiously based, psychotherapy integrationist, out-patient group-psychotherapy. Building on the above-mentioned research findings, we predicted the fol-lowing, with regards to group-participants' answerson the pre- and post-questionnaires:a. Hypothesis 1. We predicted that group participants would

report experiencing less attachment anxiety with God.

b. Hypothesis 2. We predicted that group participants wouldreport experiencing less attachment avoidance with Cod.

c. Hypothesis 3. We predicted that group participantswould report experiencing Cod emotionally as moreaccepting, intimate, and supportive.

d. Hypothesis 4. We predicted that group participants wouldreport experiencing Cod emotionally as less disapproving,distant, and harsh.

e. Hypothesis 5. We predicted that group participants wouldreport experiencing more congruence between their emo-tional experience of Cod (god images) and their theologicalbeliefs about Cod (god concepts).

METHODParticipants

Participants were adults who sought group-psy-chotherapy treatment for difficulties in their emo-tional experience of Cod (i.e., negative god images).As such, each group member had a primary diagno-sis of Religious or Spiritual Problem (V62.89; Amer-ican Psychiatric Association, 1994). Several mem-bers had a secondary diagnosis of Major DepressiveDisorder or Anxiety Disorder Not Otherwise Speci-fied. Notably, 10 group members were concurrently


receiving religiously based, outpatient individual-psychotherapy and/or pharmacotherapy.

Screening and attrition. Thirty-seven individualsparticipated in the study's screening session. At thatpoint, four participants decided not to participate inthe study, and one person was screened out becauseother clinical difficulties were more prominent andnecessitated more in-depth treatment than our man-ualized group-psychotherapy intervention was ableto provide. Thirty-two participants began the group-psychotherapy process, but six individuals droppedout, for various reasons (e.g., one individual movedout of the area, two decided to solely participate inindividual-psychotherapy, and three did not providea reason).

Pilot-study sample. In the end, 26 adults (11 men,15 women, M ge = 29.6, SDage = 6.56, age range: 19-46 years old) completed the 8-week group-psy-chotherapy intervention. Most were Caucasian grad-uate students (from various disciplines), of middle toupper-middle socioeconomic status. Twenty-five par-ticipants reported a Protestant-Christian affiliation;one, a Catholic-Christian affiliation. A total of sevenpsychotherapy-groups were conducted, each usingthe same 8-week manualized treatment protocol. Themean number of group participants was 3.7, and allgroups included both male and female participants.

Group Psychotherapists

Each group was facilitated by two doctoral-levelstudents in clinical psychology—one male and onefemale. In total, there were seven group psychothera-pists who facilitated these groups. Each psychothera-pist participated in a 4-hour training that was aimedat preparing them to effectively cofacilitate theirrespective group, in faithful adherence to the manu-alized treatment protocol. Partly to ensure adequateclient care and partly to ensure protocol adherence,this article's second author (GLM) met with the psy-chotherapists weekly for group supervision.

Procedures

Recruitment. This study was conducted at a mid-Atlantic, religious university. Participants were pri-marily recruited from the student body of that insti-tution, via on-campus publicity efforts (e.g., emails,flyers, word-of-mouth). A few other participantswere recruited from the surrounding community, vialocal churches and a local community mental healthcenter. The recruitment materials emphasized how

the group was dedicated to helping people developincreased congruence between their head and heartknowledge of God. The flyers were labeled "Discov-ering God: A Group Therapy Experience" and fea-tured a large wardrobe with a young girl peekinginside, thereby alluding to C. S. Lewis's (1950-1956/2001) classic book T^e Lion, the Witch, andthe Wardrobe.

Manualized treatment protocol. Prior to thescreening session, all prospective participants readand signed an informed consent form and then com-pleted a demographic form. Of the pilot-study sam-ple (N = 26), all participants completed the pre-testquestionnaire following session 1 and the post-testquestionnaire following session 8. They alsoreceived a copy of the study's debriefing form, fol-lowing session 8. The entire manualized treatmentprotocol consisted of eight, 90-minute group-psy-chotherapy sessions. See Table 1 for an overview ofthe manualized treatment protocol (see Thomas,2009, Appendix G, for a copy).

M A T E R I A L S

The pre- and post-test questionnaire included theAttachment to God Inventory (R. Beck &c McDon-ald, 2004) and a brief God adjective-checklist, alongwith several open-ended questions. The Attachmentto God Inventory (AGI) is a 28-item self-report mea-sure of adult attachment tendencies in emotionalrelationship with God. It is a self-report, survey-based measure of implicit relational spirituality (Hallet al., 2009) and thereby of god images. The AGIconsists of two subscales—the Anxiety subscale (mea-suring anxiety about abandonment; e.g., "I worry alot about my relationship with God") and the Avoid-ance subscale (measuring avoidance of intimacy;e.g., "I am uncomfortable being emotional in mycommunication with God"). Each subscale contains14 items, some of which are reverse-scored and all ofwhich involve rating along a seven-point Likert scale(ranging from 1 = disagree strongly to 4 = neu-tral/mixed to 7 = agree strongly; R. Beck &cMcDonald, 2004).

Our brief God adjective-checklist was developedfor this study. It consisted of three positivelyvalenced trait adjectives—flccepi/n^, intimate, andsupportive—and three negatively valenced traitadjectives—disapproving, distant, and harsh.Respondents rated the degree to which the traitadjective tended to describe how they experienced

50 GROUP-PSYGHOTHERAPY, GOD IMAGES, ATTAGHMENT TO GOD

TABLE 1An Overview of the Manualized Treatment Protocol

Session

1

2

3

4

5

Context

In-session

Post-session

Homework

In-session

Homework

In-session

Homework

In-session

Homework

In-session

Homework

Intervention description

Welcome and introductions

Group overview, ground rules, and basic rationale

Completion of the Draw-A-God figure-drawing (Moriarty, 2006)

Psychoeducation on god images and god concepts

Discussion of god-image/god-concept discrepancies

Completion of the pre-test questionnaire ^ ; •:.

Parent/God-Image Grids exercise examining the relative impact of early • 'caregiver-child relationships on god images (Moriarty, 2006)

Review of homework

Psychoeducation on and discussion of the connections between early-childhoodexperiences (e.g., wounds) and subsequent god-image difficulties

Dynamic-interpersonal exercise in which members play the role of "the Real God,"speaking to another member's wounds

Psychoeducation on god-image development (psychodynamic view)

Select a meaningful song/hymn and read its lyrics twice daily

Review of homework

Psychoeducation on an orthodox Christian theology of god images, followed byan introduction to a cognitive-theory view of god images

Discussion and film clip of the thoughts-feelings connection

Write a spiritual-journal letter to oneself from the Real God

Continue to read the meaningful song/hymn twice daily

Further psychoeducation on a cognitive-theory view of god images

Psychoeducation on the God Image Automatic Thought Record (GIATR;Moriarty, 2006), followed by verbal practice completing one

Complete the GIATR in writing, at least 3 times during the week

Attend a 30-minute individual-psychotherapy session with a group cofacilitator,to discuss treatment progress and to complete a GIATR

Begin to sing the meaningful song/hymn twice daily

Psychoeducation on cognitive distortions, interspersed with applied discussion

Complete the GIATR in writing, at least 3 more times during the week

Start to read the C. S. Lewis ( 1950-1956/2001) book The Horse and His Boy

Continue to sing the meaningful song/hymn twice daily, and add anotherson^hymn

(Table 1 continues on next page)


T A B L E 1 (contirmed from previous page)An Overview of the Manualized Treatment Protocol

Session

6

7

8

Context

In-session

Homework

In-session

Homework

In-session

Post-session

Intervention description

Psychoeducation on schémas and god images, interspersed with applieddiscussionContinue to complete CIATRs and to read The Horse and His BoyContinue singing the songs/hymns twice daily but may change them atany time

Psychoeducation on allegorical-bibliotherapy and its use in changinggod imagesDiscussion of reactions to The Horse and His Boy, focusing onexperiences of AsianExercise of watching and discussing reactions to a film clip depicting AsianContinue to complete CIATRsContinue singing the songs/hymns twice daily but may change themat any timeWrite down a word of encouragement for each group member, to sharenext session

Croup overview, reflections, and celebrationDynamic-interpersonal exercise in which members encourage and thankone another for their respective growth-promoting contributions to thegroupCompletion of the post-test questionnaire

Cod emotionally, using a five-point Likert scale thatranged from 1 {very accurate) to 3 {neutral) to 5{very inaccurate).

On both the pre- and post-test questionnaires,participants were asked to rate how similar theiremotional experience of Cod (god images) was totheir theological beliefs about Cod (god con-cepts), using a ten-point Likert scale in whichlower scores indicated lower congruence and high-er scores indicated higher congruence. Last, on thepost-test questionnaire only, participants wereasked three exploratory, open-ended questions.Specifically, they were asked to identify (a) the psy-chological intervention that most influenced theiremotional experience of Cod, (b) the treatment-manual component that most influenced theiremotional experience of Cod, and (c) the primarymechanism by which interactions with other groupmembers influenced their emotional experiencewith God.

RESULTSHypotheses 1 and 2

We predicted that group participants would reportexperiencing less attachment anxiety with Cod(Hypothesis 1) and less attachment avoidance withCod (Hypothesis 2). Paired-samples í tests yielded sup-port for each of these hypotheses (see Table 2). Only20 pilot-study participants completed the ACI,because it was not administered to the first psychother-apy group (« = 4), and two other group members didnot complete all the ACI items, for tmknown reasons.

Hypotheses 3 and 4

We predicted that group participants wotJd reportexperiencing Cod emotionally as more accepting, inti-mate, and supportive (Hypothesis 3) and as less disapvproving, distant, and harsh (Hypothesis 4). Pairedsamples t tests yielded support for each of thesehypotheses (see Table 3). All 26 pilot-study partici-pants completed the brief Cod adjective-checklist.


T A B L E 2

Contrast ofPre- and Post-Test Scores on the Attachment to God Inventory (TSI = 20)

Variable

Attachment anxiety with Cod

Attachment avoidance with God

Pre-test

M{SD)

69.90(17.5)

50.60(178)

Post-test

M{SD)

56.50(20.5)

43.70(14.5)

i(19) P

4.25 .001

3.57 .002

Note. For each subscale of the Attachment to God Inventory, higher scores indicate higher levels of the assessed attachment tendency,and total subscale scores can range from 7 to 98.

TABLE 3Contrast ofPre- and Post-Test Scores on the Brief God Adjective-Checklist (N = 26)

Variable

Positively valenced trait adjectives

Accepting

Intimate

Supportive

Pre-test

M{SD)

3.08(13)

3.23(14)

2.73(13)

Negatively valenced trait adjectives

Disapproving

Distant

Harsh

2.15(1.2)

165 (0.9)

3.00(14)

Post-test

M{SD)

180 (0.7)

185(10)

185 (0.9)

3.62(0.9)

3.58(13)

4.04(0.9)

Note. For each trait adjective, lower scores indicate higher levels of the degree to which the

i(25)

5.94

5.72

3.00

-6.54

-6.68

-4.24

P

.001

.001

.006

.001

.001

.001

trait adjective self-reportedly describesone's emotional experience of God, with scores ranging from 1 (very accurate) to 3 (neutral) to 5 (very inaccurate).

Hypothesis 5

We predicted that group participants wouldreport experiencing more congruence betweentheir emotional experience of God (god images)and their theological beliefs about God (godconcepts) at the end of treatment. As stated pre-viously, on the pre- and post-test questionnaires,participants were asked to rate how similar theiremotional experience of God was to their theo-logical beliefs about God, using a ten-point Lik-ert scale in which lower scores indicated lowercongruence and higher scores indicated highercongruence. (All 26 pilot-study participants com-pleted this item.) To quantify this god-image/god-concept discrepancy, we categorizedrespondents based on their item-rating: (a)

Severe Discrepancy (rarings of 1 to 3), (b) Mod-erate Discrepancy (4 to 5), (c) Mild Discrepan-cy (6 to 7), and (d) Minimal Discrepancy (8 to10). On the pre-test questionnaire, the frequencybreakdown was as follows: (a) Severe Discrep-ancy {n = 10), (b) Moderate Discrepancy {n =9), (c) Mild Discrepancy {n = 5), and (d) Mini-mal Discrepancy {n = 1). In contrast, on thepost-test questionnaire, the frequency breakdownwas as follows: (a) Severe Discrepancy {n = 1),(b) Moderate Discrepancy {n = 4), (c) MildDiscrepancy {n = 12), and (d) Minimal Dis-crepancy {n = 9). To statistically examine thisquasi-interval data, we conducted a paired-sam-ples t test, which revealed support for Hypothesis5aswell, i(25)=-5.84,/?<.001.


T A B L E 4

Most Commonly Cited Answers to Open-Ended Questions on the Post-Test Questionnaire (n = 23)

Commonly cited answer

Most influential intervention

The Horse and His Boy (allegorical-bibliotherapy)

God Image Automatic Thought Record (cognitive restructuring)

Psychoeducation on connections between early-childhood experiences and subsequentgod-image difficulties

Most influential treatment-manual component

God Image Automatic Thought Record (cognitive restructuring)

Parent/God-Image Grids exercise examining the relative impact of early caregiver-childrelationships on god images (Moriarty, 2006)

Psychoeducation on connections between early-childhood experiences and subsequentgod-image difficulties

Primary mechanism of group-member influence

Open sharing and insightful comments from other group members (interpersonal inputand output)

Feeling as if they were not alone and as if they were experiencing similar difficulties toother group members (universality)

Safe environment allowed for authentic interaction among group members(cohesiveness and catharsis)

n

9

7

4

9

9

4

13

10

6

%of«

39%

30%

17%

39%

39%

17%

57%

43%

26%

Exploratory Analyses

As stated above, on the post-test questionnaire,participants were asked to identify (a) the psychologi-cal intervention that most influenced their emotionalexperience of Cod, (b) the treatment-manual compo-nent that most influenced their emotional experienceof Cod, and (c) the primary mechanism by whichinteractions with other group members influencedtheir emotional experience with Cod. See Table 4 forthe most commonly cited answers to each of thesethree open-ended questions. Only 23 participantsanswered this portion of the questionnaire.

D I S C U S S I O N

Summary of Findings

In sum, on average, participants in our 8-week,manualized, outpatient group-psychotherapy inter-vention reported experiencing adaptive shifts in theirgod images and attachment to Cod. Specifically,when pre- and post-questionnaire ratings were com-pared, they reported experiencing Cod emotionally

as more accepting, intimate, and supportive and asless disapproving, distant, and harsh. In addition,they reported experiencing significantly both lessattachment anxiety with Cod and less attachmentavoidance with Cod. Furthermore, they reportedexperiencing more congruence between their emo-tional experience of Cod (god images) and their the-ological beliefs about Cod (god concepts). Last, theinterventions that were deemed the most therapeuti-cally effective were the allegorical-bibliotherapy andthe cognitive-restructuring interventions.

Clinical Implications

Our pilot study has several implications for clini-cians who are addressing god-image difficulties in clini-cal practice. Perhaps most substantively, our findingssupport Rizzuto's (1974) claim that god images areindeed changeable. Our findings provide further sup-port that psychotherapeutic treatment can lead toadaptive changes in god images, as Tisdale et al. (1997)and Cheston et al. (2003) have previously shown.


Our results also provide prehminary support forthe possibility that group psychotherapy is an effec-tive treatment format for treating negative godimages. This finding is consistent with the findingsof O'Hare (2003), whose small-scale dissertationstudy (N = 6) also revealed evidence that group psy-chotherapy can lead to adaptive god-image change.

As stated above, our participants were asked toidentify the primary mechanism by which interac-tions with other group members influenced theiremotional experience with God. Here, the mostcommonly cited answers were (a) open sharing andinsightful comments from other group members(interpersonal input and output), (b) feeling as ifthey were not alone and as if they were experiencingsimilar difficulties to other group members (univer-sality), and (c) that the safe environment allowed forauthentic interaction among group members (cohe-siveness and catharsis). Speaking of god-image treat-ment in a group-psychotherapy format, Moriarty andDavis (in press) have highlighted the potential for therelationships among group members to provide yetanother change mechanism, in addition to actualpsychological interventions. Our findings supportthis possibility. Indeed, group members consistentlyreported that their interactions with other groupmembers had a substantive positive impact on theirgod images, particularly the open sharing andinsightful comments from other group members(interpersonal input and output). In addition, manyparticipants initially felt as if they were alone in theirgod-image struggle, but through meeting other peo-ple who had similar problems (universality), theywere able to connect with each other and to growtoward health—individually and collectively. In short,our results are consistent with the reliable researchfinding that interpersonal input, interpersonal out-put, and universality are among the therapeutic fac-tors that outpatient group-psychotherapy partici-pants frequently cite as powerful changemechanisms (see Yalom &C Leszcz, 2005, p. 88). Ourparticipants also felt as if the safe environment of thegroup allowed for authentic interaction amonggroup members, and this cited change mechanismseems to relate to the therapeutic factors of cohesive-ness (related to the experience of safety) and cathar-sis (related to the experience of authentic interac-tion; Yalom & Leszcz, 2005, p. 88).

Our research provides preliminary support forthe use of a manualized group-therapy protocol inthe treatment of god-image difficulties, as well as for

the use of a psychotherapy-integrationist approach insuch treatment (Norcross &c Goldfried, 2005; cf.Moriarty &C Davis, in press). When we asked partici-pants to identify the treatment-manual componentsthat were the most influential in promoting adaptivechange in their god images, the most frequently citedanswers were (a) the GIATR (cognitive restructur-ing), (b) the Parent/God-Image Grids exercise(examining the relative impact of early caregiver-child relationships on god images [Moriarty, 2006]),and (c) psychoeducation on connections betweenearly-childhood experiences and subsequent god-image difficulties. All these components relate to thechange mechanism of increases in self-understand-ing, which is another mechanism that outpatientgroup-psychotherapy participants often cite as effec-tive (Yalom & Leszcz, 2005, p. 88).

Next, our results provide preliminary evidencethat allegorical-bibliotherapy and cognitive-restruc-turing interventions are particularly effective mecha-nisms for promoting adaptive shifts in god imagesand attachment to God. With regard to allegorical-bibliotherapy interventions, Moriarty and Davis (inpress) have discussed the use of the Chronicles ofNarnia series (Lewis, 1950-1956/2011):

Christian clients readily identify with the characters who inter-act with Asian (i.e., God). Through identification with thesecharacters, clients learn to make sense of difficult personal sit-uations and to experience God emotionally as more affirmingand experience-near, particularly during trying times.

Indeed, in our study, thirty-nine percent of the partic-ipants stated that reading C. S. Lewis's The Horseand His Boy was influential in improving their godimages. This book specifically addresses the role ofGod in the pain and suffering of different charactersin the book. Although we did not ask our partici-pants what specific elements of the allegorical-biblio-therapy were impactful for them, we did have a fewnotable observations. First, participants stated theywere able to empathize with many characters in thenovel. Many characters inappropriately perceivedAsian (i.e., God) to be distant and harsh when in facthe was intimate and intentional in how and when heinteracted with each character. Given that many par-ticipants initially experienced God emotionally asdistant, it was profoundly healing for them to read anovel in which the God-figure (Asian) is convincinglyand poignantly portrayed as ever-present and experi-ence-near. Thus, the impactful theme that emergedthrough reflecting on the novel was that althoughGod may seem distant or harsh at times, God's


actions are perhaps more appropriately viewed asintimate, intentional, loving, and caring, even whenthey do not feel like it in the moment. Remarkably,by and large, group participants were able to inter-nalize this message and to generalize it to their ownemotional experience of God.

Second, in their experience of the allegorical-bib-liotherapy intervention, participants reported thatthey experienced relief from reading and reflectingon the words Asian spoke in the novel. In TheHorse and His Boy (1950-1956/2011), when Asianenters into the allegorical-narrative, he often speakswords that encourage, affirm, and empower thecharacter(s) with whom he is interacting. Many par-ticipants reported that these words from Asian wereencouraging, afflrming, and empowering for them aswell, particularly as it related to promoting their abil-ity to experience God emotionally as more accept-ing, intimate, and supportive.

With regard to the use of cognitive-restructuringinterventions (e.g., GIATRs), it is noteworthy topoint out that our use of GIATRs was quite incorpo-rative of emotions (see Moriarty ÔC Davis, in press,for a description of this intervention and for a copyof the GIATR). Here, we were mindful of the dan-gers Moriarty and Davis (in press) have addressedelsewhere:

While treating god-image concerns with cognitive-behavioralinterventions, it is easy to focus solely on thoughts and behav-iors, thereby fostering surface-level shifts in client god con-cepts instead of promoting deeper-level changes in client godimages. Fortunately, cognitive-behavioral techniques can beused in ways that affirm and involve both cognition and emo-tion, (cf. Cozolino, 2010)

LimitationsLack of a control group. As stated above, both Tis-

dale et al.'s (1997) and Cheston et al.'s (2003) stud-ies had notable limitations, and our pilot study wasno exception. Perhaps most notably, as with Tisdaleet al.'s study, our pilot study did not have a controlgroup (and thus there was no random assignment),given the exploratory nature of our research. Conse-quently, we are unable to offer deflnitive conclusionsregarding what caused the changes in participants'god images and attachment to God.

Limits to treatment specificity. This threat toour study's internal validity is also related to the factthat, during at least a portion of our study, ten of ourgroup-therapy participants were concurrently in indi-vidual psychotherapy, most often for the treatment

of depression and/or anxiety. Therefore, it is difflcultto specify the degree to which our study's flndingswere due to our group-psychotherapy intervention,compared with the relative influence of other factors(e.g., individual psychotherapy, extratherapy factors).

Low sample size. Another limitation of our studywas its low sample size (N = 26). Having such a lownumber of participants limited our study's power.Even so, the fact that all our hypotheses were statisti-cally supported with such low power providespromising evidence that true differences in the exam-ined variables exist.

Limits to external validity. One more limitationof our study was the demographic makeup of oursample. Our population of interest was adults whoreport having difflculties in their emotional experi-ence of God (i.e., negative god images). Even thoughour sample was generally representative in terms ofgender (11 men, 15 women), it was over-representa-tive of young, highly educated, Caucasian, Protes-tant-Christian adults, of middle to upper-middlesocioeconomic status. Thus, study's findings aremost appropriately generalized to young adults whoare demographically similar to our sample.

Use of self-report, survey-based measures. Anoth-er hmitation of our study was the sole use of self-report, survey-based measures. As Gibson (2007)and Moriarty and Davis (in press) have explained,such measures are the most popular way to clinicallyassess god images. However, these measures may bequite limited in their abihty to validly assess respon-dents' heart knowledge of God (god images), partic-ularly given the embodied, emotional, implicit, non-verbal nature of god-image functioning (see Davis,2010; Moriarty & Davis, in press). In assessing godimages (which largely involve right-brain mediatedprocesses) via self-report, survey-based measures(which tend to tap into largely left-brain mediatedprocesses; Moriarty &C Davis, in press; cf. Gibson,2007), there is often a danger that respondents willdeduce the "right" (i.e., researcher-expected) answerand thus respond in a biased manner. Gibson (2007)has raised such concerns and has offered some sug-gestions for using self-report, survey-based measuresin the most optimal manner. Following Gibson's sug-gestions, we framed questions in ways that explicitlyasked respondents to discriminate between theirhead and heart knowledge of God.

In short, our study had many of the same limi-tations as Tisdale et al.'s (1997); both studies maybe classified as Type 3 studies, according to the


seminal classification system espoused in AGuide to Treatments That Work (3rd ed.;Nathan & Gorman, 2007). Nathan and Corman(2007) have described:

[Type 3 studies] are clearly methodologically limited. General-ly, Type 3 studies are open treatment studies aiming at obtain-ing pilot data. They are highly subject to observer bias and canusually do little more than indicate if a treatment is worth pur-suing in a more rigorous design Such studies can, ofcourse, provide a great deal of naturalistic information but areprone to all of the problems of uncontrolled data collectionand retrospective recall error, (pp. vii-viii)

Notably, because of its higher degree of methodolog-ical rigor, Cheston et al.'s (2003) study may be classi-fied as a Type 2 study, which Nathan and Corman(2007) have described in the following manner:

[Type 2 studies] are clinical trials in which an intervention ismade, but some aspects of the Type 1 study requirement aremissing. For example,... a trial in which two treatments arecompared but the assignment is not randomized.... Suchstudies clearly do not merit the same consideration as Type 1studies but often make important contributions and generallyshould not be ignored, (p. vii)

Future Research on God Images

It is important to note that, as of yet, no specifiedpsychological-interventions have enough researchevidence to be deemed either "well-established" or"probably efficacious" in treating negative godimages (Chambless & Hollon, 1998; Chambless &Ollendick, 2001). For the god-image research litera-ture to continue to grow and mature. Type 1 studiesare especially needed. Here, Nathan and Corman(2007) have explained:

[Type 1 studies] are the most rigorous and involve a random-ized, prospective clinical trial. Such studies also must involvecomparison groups with random assignment, blinded assess-ments, clear presentation of exclusion and inclusion criteria,state-of-the-art diagnostic methods, adequate sample size tooffer statistical power, and clearly described statistical meth-ods, (p. vii)

Future psychotherapeutic-outcome research on godimages should also be conducted with samples thatare more representative of age, race/ethnicity, reli-gious/spiritual affiliation, and socioeconomic sta-tus than was our pilot-study sample. Furthermore,future research should utilize a multimodal assess-ment approach, ideally including some combina-tion of clinician-rated measures; implicit measures(e.g., a reaction-time test; Yarborough, 2009); pro-jective assessments; and self-report, survey-basedmeasures (see Cibson, 2007; Moriarty &; Davis, in

press, for reviews). Moreover, future researchshould explore the specific mechanisms of thera-peutically mediated change in god images, in bothindividual-therapy and group-therapy formats. Last,future research should further examine the use oftreatment manuals, perhaps even exploring optionsof either using another therapeutic modality (e.g.,narrative-experiential; Moriarty & Davis, in press)or meeting in a different counseling context (e.g., achurch-based setting).

REFERENCESAllmond, J. A. (2009). God images in Cbristian psycbology,spiritual direction, and pastoral counseling {Doaorai disserta-tion). Retrieved from ProQuest Dissertations 8c Theses. (AAT3370134).

American Psychiatric Association. ( 1994). Diagnostic and statis-tical manual of mental disorders, fourtb edition. Washington,DC: Author.

American Psychological Association. (2002). Ethical principles ofpsychologists and code of conduct. American Psycbologist, 57,1060-1073.

Badenoch, B. (2008). Being a brain-wise therapist: A practicalguide to interpersonal neurobiology. New York, NY: Norton.

Beck, A. T, Rush, A. J., Shaw, B. E, 8c Emery, G. (1979). Cogni-tive therapy of depression. New York, NY: Guilford Press.

Beck, R., 8c McDonald, A. (2004). Attachment to God: TheAttachment to God Inventory, tests of working model correspon-dence, and an exploration of faith group differences. Journal ofPsychology and Theology. 32,92-103.

Bell,M. (1991). An introduction to the Bell Object RelationsReality Testing Inventory. Unpublished manuscript.

Benson, P. 8c Spilka, B. (1973). God image as a function of self-esteem and locus of control. Journal for tbe Scientific Study ofReligion. 12,297-m.

Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation.New York, NY: Basic Books.

Bucci, W. (1997). Psychoanalysis & cognitive science: A mul-tiple code tbeory. New York, NY: Guilford Press.

Buri, J. R., 8c Mueller, R. A. ( 1993). Psychoanalytic theory and lov-ing God concepts: Parent referencing versus self-referencing. TbeJournal of Psycbology: Interdisciplinary and Applied. 127,17-27

Chambless, D. L, &C Hollon, S. D. (1998). Defining empiricallysupported therapies. Journal of Consulting and Clinical Psy-cbology. 66,7-18.

Chambless, D. L., & Ollendick, T. H. (2001). Empirically support-ed psychological interventions: Controversies and evidence.Annual Review of Psycbology, 52,685-716.

Cheston, S. E., Piedmont, R. L, Eanes, B., 8c Patrice, L (2003).Changes in clients' images of God over the course of outpatientpsychotherapy. Counseling and Values, 47,96-108.


Collins, N. L., Guichard, A. C, Ford, M. B., & Feeney, B. C.(2004). Working models of attachment: New developments andemerging themes. In W. S. Rholes &J. A. Simpson (Eds.), Adultattachment: Theory, research, and clinical implications (pp.196-239). New York, NY: Guilford Press.

Cozolino, L. (2010). The neuroscience of psychotherapy:Healing the social brain (2nd ed.). New York, NY: Norton.

Davis, E. B. (2010). Authenticity, inauthenticity, attachment,and God-image tendencies among adult evangelical Protes-tant Christians (Doctoral dissertation). Retrieved from Pro-Quest Dissertations Sc Theses. (AAT 3400639). Retrieved fromhttp://caps.net/communities/christian-psychoanalysts/cp-eon-tinued-learning.

Davis, E. B., & Moriarty, G. L. (2008, August). Depression andGod images. In W. H. Hathaway (Chair), Appropriate reli-gious/spiritual treatment goals: Converging trends and pro-fessional roles. Symposium conducted at the 116th Annual Con-vention of the American Psychological Association. Boston, MA.

Derogatis, L. (1978). The Derogatis Psychiatric Rating Scale.Minneapolis, MN: National Computer Systems.

Derogatis, L. (1993). Brief Symptom Inventory: Administra-tion, scoring, and procedures manual (3rd ed.). Minneapolis,MN: National Computer Systems.

DeRuheis, R. J., Tang, T Z., & Beck, A. T., (2001). Cognitive Ther-apy. In K. S. Dobson (Ed.), Handbook of cognitive-behavioraltherapies (2nd ed., pp. 349-392). New York, NY: Guilford Press.

Edwards, K.J. (1976). Sex role behavior and religious experience.In W. Donaldson, Jr. (Ed.), Research in mental health and reli-gious behavior. Adanta, GA: Psychological Studies Institute.

Fitts, W. H. (1965). Manual for Tennessee (Department ofMental Health) Self Concept Scale. Nashville, TN: CounselingRecordings and Tests.

Fogel, A. (2009). The psychophysiology of self-awareness:Rediscovering the lost art of body sense. New York, NY: Norton.

Freud, S. (1950). Totem and taboo (]. Strachey, Trans.). NewYork, NY: Norton (Original work published 1913).

Freud, S. (1962). Civilization and its discontents (¡. Strachey,Trans.). New York, NY: Norton (Original work published 1930).

Gibson, N.J. S. (2007). Measurement issues in God imageresearch and practice. In G. L. Moriarty & L. Hoffman (Eds.),God image handbook for spiritual counseling and psy-chotherapy: Research, theory, and practice (pp. 227-246).Binghamton, NY: Haworth Press.

Gough, H. G., & Heilbrum, A. B. (1983). The adjective checklist manual. Palo Alto, CA: Consulting Psychologists Press.

Grimes, C. (2007). God image research: A literature review. In G.Moriarty &c L. Hoffman (Eds.), God image handbook for spiri-tual counseling and psychotherapy: Research, theory, andpractice (pp. 11-32). Binghamton, NY: Haworth Press.

Hall, T. W. (2004). Christian spirituality and mental health: A rela-tional spirituality framework for empirical research. Journal ofPsychology and Christianity, 23,66-81

Hall, T. W. (2007). Psychoanalysis, attachment, and spiritualitypart I: The emergence of two relational traditions. Journal of Psy-chology and Theology, 35,14-28.

Hall, T. W, Fujikawa, A., Halcrow, S. R., Hill, P. C, & Delaney,H. (2009). Attachment to God and implicit spirituality: Clarifyingcorrespondence and compensation models. JoMrna/ of Psychol-ogy and Theology, 37,117-141.

Hathaway, W. L. (2003). Clinically significant religious impair-ment. Mental Health, Religion & Culture, 6,113-129.

Hays, P A. (2007). Addressing cultural complexities in practice(2nd ed.). Washington, DC: American Psychological Association.

Hoffman, L. (2005). A development perspective on the Godimage. In R. H. Cox, B. Ervin-Cox, & L Hoffman (Eds.). Spiritu-ality and psychological health (pp.129-147). Colorado Springs,CO: Colorado School of Professional Psychology Press.

Jones, J. (1991). Contemporary psychoanalysis and religion:Transference and transcendence. Binghamton, NY: Vail-BallouPress.

Jones, J. (2007). Psychodynamic theories of the evolution of theGod image. In G. Moriarty & L. Hoffman (Eds.), God imagehandbook for spiritual counseling and psychotherapy:Research, theory, and practice (pp. 33-55). Binghamton, NY:Haworth/Routledge Press.

Kihlstrom, J. F. (2008). The psychological unconscious. In O. P.John, R. W. Robins, & L A. Pervin (Eds.), Handbook of person-ality: Theory and research (3rd ed., pp. 583-602). New York,NY: Guilford Press.

Lawrence, R. T. (1997). Measuring the image of God: The GodImage Inventory and the God Image Scales. Journal of Psychol-ogy and Theology, 25,214-226.

Lewis, C. S. (2001). The chronicles of Narnia. New York, NY:HarperCollins Publishers (Original worb published 1950-1956).

Lyons-Ruth, K., Bruschweiler-Stern, N., Harrison, A. M., Mor-gan, A. C, Nahum, J. P, Sander, L.,...Tronick, E. Z. (1998).Implicit relational knowing: Its role in development and psy-choanalytic treatment. Infant Mental Health Journal, 19,282-289.

Mahler, M., Pine, F., & Bergman, A. (1975). Psychological birthof the human infant: Symbiosis and individuation. New York,NY: Basic Books.

Markus, H. (1977). Self-schemata and processing informationabout the self. Journal of Personality and Social Psychology,35,63-78.

Markus, H., & Kunda, Z. (1986). Stability and malleability of theself-concept. Journal of Personality and Social Psychology,5J, 858-866.

Moriarty, G. (2006). Pastoral care of depression: Helping clientsheal their relationship with God. Binghamton, NY: HaworthPress.

Moriarty, G. L, & Davis, E. B. (in press). Client God images: The-ory, research, and clinical practice. In K. O'Grady, E. Worthing-ton, Jr., &J. Aten (Eds.), The psychology of religion and spiri-tuality for clinicians: Using research in your practice. NewYork, NY: Routledge.

Nathan, P E., & Gorman, J. M. (2007). Preface. In P. E. Nathan &J. M. Gorman (Eds.), A guide to treatments that work (3rd ed.,pp. vii-ix). New York, NY: Oxford University Press.


Noffke, J. L., Sc Hall, T. W. (2007). Attachment psychotherapyand God image. In G. L. Moriarty Sc L. Hoffman (Eds.), Godimage handbook for spiritual counseling and psychothera-py: Research, theory, and practice (pp. 57-78). Binghamton,NY: Haworth Press.

Norcross, J. C. Sc Goldfried, M. R. (Eds.). (2005). Handbook ofpsychotherapy integration. New York, NY: Oxford UniversityPress.

O'Hare, C. A. (2003). Challenging god images: Implementinga Christian component within a standard group therapyintervention (Doctoral dissertation). Retrieved from ProQuestDissertations & Theses. (AAT 3062350).

Richards, P. S., Sc Bergin, A. E. (2000). Handbook of psy-chotherapy and religious diversity. Washington, DC: AmericanPsychological Association.

Rizzuto, A. ( 1974). Object relations and the formation of the imageof God. British Journal of Medical Psychology, 47,83-99.

Rizzuto, A. (1979). The birth of the living God. Chicago, IL:University of Chicago Press.

Schäfer, R. (1968). Aspects of internalization. New York, NY:International Universities Press.

Siegel, D. J. (2010). The mindful therapist: A clinician's guideto mindsight and neural integration. New York, NY: Norton.

Smith, E. E., Sc Kosslyn, S. M. (2007). Cognitive psychology:Mind and brain. Upper Saddle River, NJ: Pearson Prentice Hall.

Thomas, M.J. (2009). The effect of a manualized group treat-ment protocol on God image and attachment to God (Doc-toral dissertation). Retrieved from ProQuest Dissertations Sc The-ses. (AAT 3357122).

Tisdale, T. T., Key, T. L., Edwards, K. J., Brokaw, B. E, Kemper-man, S. R., Cloud, H., ... Okamato, T. (1997). Impact of treat-ment on God image and personal adjustment, and correlations ofGod image to personal adjustment and object relations develop-ment./oMrna/ of Psychology and Theology, 25,227-239.

Turner, R. P., Lukoff, D., Barnhouse, R. T, Sc Lu, E G. (1995).Religious or spiritual problem: A culturally sensitive diagnosticcategory in the DSM-FV. Journal of Nervous and Mental Dis-ease, 283,435-444.

Winnicott, D. W. (1971). Playing and reality. New York, NY:Basic Books.

Winnicott, D. W. ( 1975). Transitional objects and transitional phe-nomena. In D. W. Winnicott (Ed.), Through paediatrics to psy-cho-analysis (pp. 229-242). New York, NY: Basic Books (Originalwork published 1951).

Yarborough, C. A. (2009). Depression and the emotional expe-rience of God (Doctoral dissertation). Retrieved from ProQuestDissertations Sc Theses. (AAT 3392180).

Yalom, I. D., Sc Leszcz, M. (2005). The theory and practice ofgroup psychotherapy (5th ed.). New York, NY: Basic Books.

AUTHORSTHOMAS, MICHAEL. J. Address: 1300 Eagle Road, Mclnnis222 St. Davids, PA 19087 Title: Visiting Assistant Professor, East-ern University. Michael also serves as a psychologist within theBrandywine Hospital Eating Disorder Program in Coatesville,Pennsylvania. Degree: Psy.D. Areas of Specialization: Clinicaland research interests include eating disorders, god images, reli-gious and spiritual issues, and positive psychology.

MORIARTY, GLENDON, L. Address: 1000 Regent UniversityDrive, Virginia Beach, VA 23456. Email Address: [email protected]. Phone: 757.352.434L Title: Associate Profes-sor, Department of Psychology, Regent University. Degree: Psy.D.Areas of Specialization: Psychodynamic psychotherapy, emo-tional experience of God/God images, integration of psychologyand technology.

DAVIS, EDWARD. B. Address: 13800 Biola Avenue, Rose Hall158 La Mirada, CA 90639. Email: [email protected]. Title:Assistant Professor, Rosemead School of Psychology (Biola Uni-versity). Degree: Psy.D. Areas of Specialization: His academic,clinical, and research interests include personality psychology, psy-chological assessment, interpersonal neurobiology, psychology ofreligion/spirituality, god images, attachment, narrative identity,mindful awareness practices, and supervision/mentoring.

ANDERSON, ELIZABETH, L. Address: LSU Student HealthCenter Mental Health Services, Room 252 Baton Rouge, LA70803. Email Address: [email protected]. Title: Doctoral Psy-chology Intern, Southern Louisiana Internship Consortium(SLIC). PsyD. Doctoral Candidate in Clinical Psychology, RegentUniversity. Degree. M.A. Areas of specialization: integration ofpsychology and spirituality; emotional experience of God/Godimages; psychodynamic psychotherapy; positive psychology; andinterpersonal, Yalom style, dynamic group psychotherapy.

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