Constructing a Neuroscientific Pastoral Theology of Fear and Hope

Contemporary therapeutic circles utilize the concept of anxiety to describe a variety of disorders. Emotional reductionism is a detriment to the therapeutic community and the persons seeking its help. This dissertation proposes that attention to the emotion of fear clarifies our categorization of particular disorders and challenges emotional reductionism. I propose that the emotion of fear, through its theological relationship to hope, is useful in therapeutic practice for persons who experience trauma and PTSD. I explore the differences between fear and anxiety by deconstructing anxiety. Through this process, I develop four categories which help the emotion of fear stand independent of anxiety in therapy. Temporality, behaviors, antidote and objects are categories which distinguish fear from anxiety. Together, they provide the impetus to explore the emotion of fear. Understanding the emotion of fear requires an examination of its neurophysiological embodiment. This includes the brain structures responsible for fear production, its defensive behaviors and the evolutionary retention of fear. Dual inheritance evolutionary theory posits that we evolved physically and culturally, helping us understand the inescapability of fear and the unique threats humans fear. The threats humans react to develop through subjective interpretations of experience. Sometimes threats, through their presence in our memories and imaginations, inhibit a person's ability to live out a preferred identity and experience hope. Understanding fear as embodied and subjective is important. Process theology provides a religious framework through which fear can be interpreted. In this framework, fear is developed as an adaptive human response. Moreover, fear is useful to the divine-human relationship, revealing an undercurrent of hope. In the context of the divine-human relationship fear is understood as an initial aim which protects a person from a threat, but also preserves them for novel future relationships. Utilizing a "double-listening" stance, a therapist hears the traumatic narrative and counternarratives of resistance and resilience. These counternarratives express an orientation towards hopeful futures wherein persons thrive through living out a preferred identity. A therapeutic practice incorporating the emotion of fear will utilize the themes of survival, coping and thriving to enable persons to place their traumatic narrative within their meaning systems.

Clinical Implications for Working with Gay Men A Self Psychological Treatment Approach.

Specific training for conducting psychotherapy with gay men is limited for psychologists, particularly when using a Self Psychology theoretical orientation (Robertson, 1996). In fact, psychologists often are faced with conflicting and contradictory points of view that mirror society's condemnation of homosexuality (Robertson, 1996). This paper is written from a self-psychological perspective to address the lack of a constructive body of literature that explains the unique treatment needs which impact gay men. Estimates of the prevalence of male homosexuality have generated considerable debate. A common assumption is that there are homosexual and non-homosexual men. However, scientists have long been aware that sexual responsiveness to others of the same sex, like most human traits, is continuously distributed in the population (Michaels, 1996). Still the presumption exists that such traits are stable within each man over time (Michaels, 1996). Conflating same-sex sexual experiences with a categorization of the man as homosexual is problematic, in that defining sexuality solely on the basis of experience excludes people who fantasize about sex with others of the same sex but never have sexual contact. Thus, most modern conceptions of sexual orientation consider personal identification, sexual behavior, and sexual fantasy (McWhirter, Sanders & Reinisch, 1990). Gay men's mental health can only be understood in the context of homosexuality throughout history, since religious and moral objections to sexual attraction between men have existed for centuries. Men who desired other men were regarded as sinful and depraved if not ill or abnormal, and same sex contacts were not distinguished from lewd behaviors (Weeks, 1989). Although most people, regardless of sexual orientation, have experienced some feelings of personal rejection, rarely do heterosexuals become targets for disapproval based on the nature of their attractions and behaviors relative to the same and to the other sex. For lesbians, bisexuals, and gay men, however, homosexuality becomes the focus of aspects of themselves that make them feel hated and hateful (Isay, 1989). While gay men and lesbians are often considered together because of the same-sex nature of their relationships and the similar issues that they may experience in their treatment within society, there are many issues where they might be best studied separately. Issues involving with health, parenthood, sexuality and perceived roles and status in society, for example, are often related more to gender than to any shared concept of a 'gay and lesbian community'. Many issues surrounding lesbians and lesbian culture will have more to do with women's issues, and some issues involving with gay men will have more to do with the gay male subculture and with masculinity. The author of this paper has limited experience in working with lesbian and bisexual individuals, and although it is likely that some of the concepts articulated in this paper could translate to working with lesbian and bisexual individuals, further research is indicated to examine the beneficence of utilizing a Self Psychological orientation in psychotherapy with lesbian women and bisexual individuals. This paper presents an overview of the literature including historical treatments of homosexuality, the history of Self Psychology, key principles in Self Psychology, research on Self Psychology, identity development models for gay men, and Self Psychological perspectives on identity development related to gay men. The literature review is followed by a section on treatment implications for psychologists seeking to treat gay men, including case vignettes based on work from my own practice. I have preserved the anonymity of clients by changing demographics, and rearranging and combining presenting issues and historical backgrounds among the case examples.