Rethinking Integration: A Prodding Case in Brazil

I like integration - as long as I can apply the concept clinically on my own terms. These include having resources available that modern science affords: Psychiatric consultations, medical evaluations, and quality inpatient services. Such go hand-in-hand with my Christian cognitive behavioral integration approach. I see all of these together as gifts from God to help people. Multicultural cases, however, can challenge my typical integration approaches and standard clinical practices. This especially occurs when I am outside my familiar U.S. practice setting, as was the case with Lucia, a 3 2 -year-old woman I met while attending a week-long emotional healing conference in Sao Paulo, Brazil, conducted by Neil Anderson (Freedom in Christ Ministries). Dr. Anderson gave me permission to accompany him on this trip in order to participate in the conference and make qualitative research observations. Before introducing Lucia, it's appropriate to take a look first at the conference itself. Briefly, Dr. Anderson's conference revolved around two of his written works, Victory Over the Darkness (1990a, revised 2000a) and The Bondage Breaker (1990b, revised 2000b). These works focus on God's acceptance and the role of the world, flesh, and the devil (I Jn 2:16; Gal. 5:19-21; Eph. 6:12) in cultivating secular values instead of Christian values. Anderson espouses the development of a positive self-identity through understanding Christ's love for us, and encourages the utilization of sacred text passages to cognitively restructure maladaptive self-perceptions. Teaching sessions and worship sessions alternated throughout the conference. Participants included three hundred ministers and their spouses, primarily indigenous to Brazil. Individual "discipleship counseling" appointments were available to those needing more intensive ministry (Anderson, 2003). These appointments generally lasted 4-8 hours and utilized Anderson's structured Steps to Freedom in Christ approach (Steps or Steps to Freedom) found in the above works. The Steps have some features similar to the historical prayer of examen (cf., Foster, 1992, pp. 27-36). They involve confession, renunciation, prayers of repentance, and the utilization of sacred text passages from the Bible to affirm God's forgiveness and love. Further description will be found in Lucia's intervention details below. Of course, Lucia is a pseudonym, and the identifying demographic information has been altered to protect her confidentiality. The Client Lucia was a 32-year-old married enculturated Brazilian woman with 2 male children (7 and 9 years old). Since she did not speak English, a translator with a bicultural Brazilian/United States background assisted her treatment. As is common in developing countries, the translator had little formal psychological training. I spent about 45 minutes orienting him to the psychological interview process to make the session more productive. Clearly, much more training time and a female translator would have been optimal; however, Lucia's crisis condition precluded postponing the session for further preparation. Lucia described Major Depression and panic attack symptoms. These lasted over the last 2 years, worsening during the last 6 months to the point of mood congruent auditory hallucinations. The voices focused on condemnatory and worthlessness themes and she described them as now occmring constantly. It should be noted that the translation process may have impacted the accurate assessment of the extent of these auditory hallucinations. However, Lucia displayed no looseness of associations, disorganized speech or bizarre behaviors suggestive of Schizophrenia. Agoraphobic symptoms also had emerged in the last six months. Lucia's history provided clinical clues to her condition. She was raised and currently lives in the same small subtropical town as her relatives, about 10 hours from Sao Paulo. Her parents were still alive and married, and she described their socio-economic status as poor to lower middle class. …