Challenging Beliefs without Challenging Faith with Dr. Stevan Lars Nielsen

Part 2 with Dr. Stevan Lars Nielsen, a Clinical Professor and psychologist at Brigham Young University, jointly affiliated with Counseling Psychology and Special Education and Counseling and Psychological Services at Brigham Young University.

Part 2 begins with Dr. Nielsen addressing the challenges therapists face when navigating religious beliefs and the influence of religious leaders on clients' emotional well-being. He dives into the complexities of grief, the role of psychotherapists in addressing religious beliefs, the importance of emotional understanding in therapy, and shares insights from his experiences with clients, particularly those grappling with grief and religious questions and the need for therapists to navigate these sensitive topics carefully.

 Links & Show Notes

Counseling and Psychotherapy With Religious Persons: A Rational Emotive Behavior Therapy Approach

Handbook of Spiritually Integrated Psychotherapies

Stevan Lars Nielsen, “Rational-Emotive Behavior Therapy and Religion: Don’t Throw the Therapeutic Baby Out With the Holy Water!” Journal of Psychology and Christianity, 13(4), 312-322.

Stevan Lars Nielsen & Albert Ellis, “A Discussion with Albert Ellis: Reason, Emotion and Religion” Journal of Psychology and Christianity, 13(4), 327-341.

A Practitioner’s Guide to Rational-Emotive Behavior Therapy by Raymond A. DiGiuseppe et al.

Albert Ellis Institute

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https://psychotherapyandappliedpsychology.com/

Transcript

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[MUSIC] In the first part of this conversation, my guest and I talked about religion, rational emotive behavior therapy, and how a client's own religious commitments can become a useful clinical resource. In this second part, we move into the trickier terrain. How do you work with religious beliefs without becoming a preacher? How do you avoid becoming a debunker? And how do you help clients think differently without accidentally arguing with the wrong part of their experience? We also get into what therapists can do when religious leaders become part of the client's distress. How to think about clients who are questioning their faith, and why clinical humility matters in this work? Near the end, my guest reference is the OQ, which is the outcome questionnaire 45. It's a measure of psychological distress that clients complete before each session, so therapists can track whether clients are improving over time. It comes up briefly, but it's useful context for understanding the outcome research he describes. But first, if you're new here, I'm your host, Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia. This is psychotherapy and applied psychology where I talk with leading researchers about what matters in practice, what's behind the findings, and what they wish clinicians knew sooner. And if you enjoy the show, please subscribe in your podcast player or on YouTube, like and subscribe. That small click makes this surprisingly big difference for the podcast. This episode begins with my guest responding to the idea that clinicians might use religious texts as a resource when working with clients whose faith is central to their lives. So without further ado, here's the rest of my conversation with Dr. Stevan Lars Nielsen. Right, but here's the source of the crack. Look, you believe in this Bible. You believe in Jesus Christ. Did you know he said there are no good people? They're all surprised, although almost all of them read the New Testament three, four times, right? So when in their eyes and out their ears, they read it and it just didn't, they just didn't get it. Well, that's not a surprise. You know, it's it's really counterintuitive, right? Now, my guess is that the reason they don't get it is that we have, did I talk to you about received wisdom, we have received wisdom and received knowledge that we don't examine. So in all industrial countries, the predominant word we use for for dusk is sunset and the predominant word for dawn is sunrise. Well, that's received wisdom because the sun appears to move, right? Sun doesn't move, the earth rotates. Now, you could say evening, you could say, you could say lots of different words, but sunrise and sunset in the song, right? Sunrise, Sunset from Fiddler on the Roof, that's received wisdom because of what it appears. We say to the ends of the earth, well, that's very ancient, that comes from the time when we thought the earth was flat. There are people in the flat earth society, they're very tiny minority, but we don't we believe the world is a globe, we doesn't have any ends, right? But we still say the ends of the earth, right? And so to say good or bad people, that's probably a combination of received wisdom and evolution. From what I can tell, evolutionary psychologists, they would say probably that baboons have the social organization most like humans. Now baboons, they live in troops that might be from 20 to 200. And they have very strict social organizations with an alpha male, alpha female and on down. That organization helps them because no baboon is a is a match for a full grown leopard, but no leopard is a match for a baboon troop, right? They have cries, they have organizations, so they will climb trees when they're attacked by predators. They'll kill a leopard if it's alone. They'll certainly kill lion cubs and and cheetah cubs and and leopard cubs if they find them unattended, so they're well organized. Well, when we evolved, we became well organized, except we were smarter than baboons. So no human is a is a match for a lion or an elephant, right? But no elephant or lion is a match for a hunting party because we can put together as a group of humans all kinds of ways to kill that lion or kill that even a hippo or an elephant. How would we do that? Well, it would somehow trap it and then kill it with spears, right? Well, that comes from our organization and our ability to communicate. So probably we have within us the evolved idea that our leader is better than us. They're superior to us and that keeps us organized. But we're not in the in the environment of evolutionary adaptation anymore. And leadership is much fuzzy than it used to be, right? And I don't think anybody believes that that the king is is better than the prime minister or the prime minister is better than them. Well, some people might believe that, but not many. And I don't think there are many, many people in the United States who think the president of the United States is better than them. Not even many Maggar Republicans think he's better than them, something might, doesn't matter. But no, we're more likely to look at better skills than we are a better person. But we don't think about it. We don't think about it, right? Now, the scriptures offer a unique way to dive into that idea. And there are lots of scriptures that are very clear for disputing each one of these ideas in the Latter-day Saints scriptural canon, also in the Bible, which is in the Latter-day Saints scriptural canon. And when I've treated Muslims, I'll say, well, look, what does the Quran say about the worth of humans? And what it says is that we're all the same. What does it say about free agency? Oh, we're free to do what we want. What does it say about good and bad events in our lives? Well, it says that we're going to get good and bad experiences. And that's regardless of who you are. You're going to have good and bad experiences. Oh, could you show that to me in the Quran? And they'll show me. And I'll say, well, look, what you said to yourself is that somehow you're a bad person because you see them. Does the Quran say that? That you're a bad person or that you did a bad thing? And they'll show me in the Quran. What it says. So that's that's how did you say it? You're trying to put a wedge in. How did you say it? I think it's a crack. A crack? Yeah, that's putting a crack into their belief, right? But I'm using something they believe in. They may not believe it yet, but they believe in the Bible. They will accept most things in the Bible. They would certainly accept that because it's written three times in the New Testament, the Christ said. And then in the the the Book of Mormon and the Doctrine and Covenants, Pearl of Great Price, which is that that's the other part of the Latter-day Saint canon. There are many similar things like that that I can and by the way, I'm using this to manipulate their beliefs. Let's be clear about it. When I try and get in the lap, I'm being manipulative. When I'm using these scriptures, I'm being manipulative. I'm trying to displace their self-defeating beliefs. Now do I feel bad about it? No, I don't feel bad about it because because these beliefs are completely subjective and arbitrary. Human rating, demanding, catastrophizing, frustration intolerance. They have no truth value. They're completely arbitrary, completely subjective. They really exist in individuals one at a time. Now we can turn them into philosophical statements. We can we can have an article of faith that we write down that gives people or takes away from value. Right. And the Nazis had such a document. They had documents about the values of different races. So they wrote it down based on races. So they had racism, right? US Constitution in order to make a compromise in the Constitution for what kind of representation the states in the South would get. They gave enslaved people all blacks. Three-fifths value. And that was a compromise so that the South, the slave states, wouldn't overwhelm the non-slave states in terms of representatives in the US Congress, right? Yeah, but you know, those those political compromises and those ideas, they're still completely arbitrary and subjective. When I when you're, I guess I had a couple thoughts. One is in a way because you have a scripture in some ways it becomes a tool that you don't have with non-religious clients, right? It becomes a resource that you can actually pull on and say, well, if you're if you're saying that this is God's word and you believe this or whatever would be there, that it becomes, yeah, it becomes something that you can use to facilitate your work with your clients and their sort of beliefs and their unhelpful beliefs wherever. Yeah, there's just it becomes this resource that you don't you don't have with non-religious clients. And I'm also thinking that I think one of the challenges is, okay, well, what if I don't know about this particular religion or this particular scripture, but what is like as you're talking, what I'm thinking is that now that we have these large language models, right? You could say in whatever religious texts, hey, help me find verses or whatever that talk about the value of human beings and blah, blah, blah, right? That's great. Yeah. That's right, that's right. So I would say, in fact, you know, this suggests to me that that's maybe it's time for another article or maybe an update of my book in which I say, look, you can arm yourself if you're a rational emotive behavior therapist. Now, cognitive behavior therapy has a few differences. Cognitive therapy has, as designed by Aaron Beck and his followers, a little bit different, and I can tell you what some of the differences are, but you can arm yourself with ideas from religion that really hit these three and a half ideas. Now, I wrote an article for a book about REBT in which I said, really, in a more abstract sense, you can say that what we're working on in sessions is non-acceptance. What does that mean? You're not accepting events. You're not accepting yourself or you're not accepting other human beings. And, you know, act, I'm not sure many of them have read much about Albert Ellis, although they're a sizeable number of REBTers who now practice act, and that makes sense to me, yeah. But, you know, Hayes was not the first guy to talk about acceptance. Al Ellis talked about that early on, and what we're trying to get people to do is accept themselves. Not everything they do. Now, of course not. That doesn't make sense to accept your mistakes, to accept things that are a problem. You don't accept things that are a problem, unless you can't change them. And, what are things you can't change? Well, you sometimes can't change other people. So, you'd better learn to accept their misbehavior. That doesn't have to mean, that doesn't mean you have to stay around them, right? And so, you asked about religion. Well, that's good. What if my clients are not religious? Well, you know, you can only do so much in a session anyway, right? You've got 50 minutes to an hour. Maybe you'll have a longer session. There's only so much you can pack in, and you don't want to pack so much in they can't remember it, right? You want to have them leave with some simple. So, there are many non-religious disputations that can be quite powerful. So, here's one. People often will get angry about this or that thing, the family stuff, right? And they'll be angry at their parents, they'll be angry at a brother or angry at a sister. Well, so, here's an intervention that is an attempt to get them away from their shoulds, and they're awfulizing. And what I'll say is, well, what's the difference between how your mother behaves around you and the weather? Well, my mother doesn't rain on me. Right, right? But you're from, and let's say they're from Seattle or, you know, they're from Vancouver, or they're from Phoenix. Okay, well, here you are from Vancouver. How much does it rain there in Vancouver? Maybe I ought to ask, when does it not rain in Vancouver, right? Well, so, do you tell yourself it's awful when it rains? When do you tell yourself it's awful? Yeah? Oh, you're from Phoenix. What do you tell yourself that heat is awful? What can you do about the heat? Or from Minnesota? Do you tell yourself it's terrible? It is so cold in Minnesota. Your family, you've lived there all your life, right? Well, what happens if you go out and shake your fist at the cold? You might get, you know, frostbite, but it's not going to change the cold, right? Let's see, what are you telling yourself about the way your brother or your husband or your wife or your parents about their acting? Well, I heard you, you just told me, you talked about this, you just told me they shouldn't behave that way. When did they not? Now, I'm not saying it's good, please understand, I'm not saying it's good, but what if you could say they're going to keep behaving this way, and I'm going to keep not liking it? But they're not going to change much, they're not going to change any much more than the heat in Phoenix in the summer. Or the rain in Vancouver in the winter. Is Vancouver like Seattle just mostly missed? Yeah, very similar Seattle, yep. Yeah, so you don't even, you don't even set it on, you don't even set the windshield wipers on... Right. Just bounce it every once in a while. Yeah, okay. Well, you could say you hate it, most people don't mind it that much, but you could just say,"I don't like it." Now, just imagine that you could say, "Well, I don't like it, but I can't stand with that feeling any different." Now, I don't necessarily say it that way, how you get it to them, how you make the crack, that's the art of psychotherapy. And the best way to practice that art, I think, is to say, "Well, what does it you want help here? How do you want me to help you there?" Your parents aren't here, so I don't know that I can do much to change your parents. We can talk about things you might change in your behavior, and then I would say to myself, maybe assertiveness, maybe assertiveness. But what is it you would like to change during this session we're having today in regards to your parents? And I work with college students, so they're pretty right. They'll say, "Well, I'd like not to get so angry." "Oh, okay, well, I think we can do that. I think we can get angry." "All right, I'd like to be less discouraged about what my parents say to me." "Oh, well, I think we can work on that." Yeah. Does that make sense? And when you say, for clarification, when you say, "awful, terrible," those words, you're using them to be like equivalent to, "It's not acceptable," or, "I cannot stand this." That's exactly right. That's exactly right. It's not the words, it's the beliefs that go with them. It's not the words, it's the beliefs that go with them. But the words are a pretty good tool, they're a pretty good tool. But they're an exact, and people will say, "Oh, man, are things." And by the way, I sometimes have this fun experience. I'll use the word "should" in a faculty meeting, and somebody will immediately call me out on it. And I'm delighted. Because that means they're thinking about sheds, right? Doesn't bother me at all. But, you know, if I say, "Well, it should rain again before July." I'm not saying it must rain. I'm saying the probability is very high that's going to rain. It will likely rain again. Yes. Very likely to rain. By the way, yesterday, my wife and I drove to Jackson Hole, Wyoming, and we got snowed on. Didn't stick on the road. We were glad for that. We didn't have to drive on a slippery road. But it was snowing up there. We're like two-thirds of our drive. Wow. You're quite a May. How do you distinguish between challenging irrational or unhelpful beliefs and challenging religious beliefs? Well, that's an excellent question. I would seldom do the latter. I would seldom do the latter. Now, I'm not equating them. But I would seldom, I might do this a little more. I would seldom challenge psychotic beliefs. I would challenge arbitrary demands or awfulizing or human rating about religious beliefs or psychotic beliefs. So, I once had a client that helped me clarify this, who he had been released from, I'm not going to tell you too much, but he had been released from the military with a 50% disability because he had service connected paranoid schizophrenia. It becomes schizophrenic. After two years or more of his enlistment, and he was given a medical retirement with a 50% disability, and here he was a student at BYU. This is a long time ago. This is more than 30 years ago. And he was an education student. He was an elementary education student. And he had this delusion that women could read his mind, and they could know that he was having sexual thoughts about it. Well, I believe that, of course. Because women have had any sense, they know that all men are having sexual thoughts about it. I may have said that too. I mean, you may have chuckled, I don't know. He could laugh occasionally. But he said, "No, they are." And then I tried to talk him out of that belief. And see what I was doing is I was disputing the activating of him. And at the end of a session, I would actually have him to the point where he would agree that they couldn't read his mind. And I would say stuff that would get him to laugh, and that's good. I would say, "Well, maybe they can see, you know, if you get really turned on, they could see a lump in your pants because you got an erection that you would laugh." And that helped, right? But the next week, he was back with that delusion. And two weeks in a row, he came back with that delusion and full power. And I said, "Okay, well, wait, wait, wait, you know I don't believe it." But let's say it's true. Let's say they can read your mind. "Well, they'd be offended," he said. And I said, "No, wait a minute, all of them?" And he chuckled and said, "Well, maybe not. Wouldn't someone be flattered if they knew you were getting turned on by him?" "Well, they might." But, you know, suppose they're married or they have boyfriends, they might tell their boyfriends or their husbands or their brothers that, you know, I'm having sexual thoughts about them. And those guys may come and find me and kill me. Could you read a quite paranoid, yeah? And by this time, I'd seen that I was trying to dispute the wrong thing. And so, when he said that, I said, "Oh, well, now you know I don't think that. But tell me, friend, I forget his name right now, friend, who of us really gets to decide how we're going to die? Why are you telling yourself that you must not die in this way? I don't think you will. But who of us gets to decide exactly how we're going to die?" He accepted that. Why is it terrible if these guys beat you to death? I mean, it's a lousy way to die. We don't know this can happen. I don't think it's going to happen. But isn't the real problem here that you're terrified of people you don't even know? Because they might do something that you think is terrible. I didn't say it exactly that way. He didn't have that delusion anymore. Next three weeks in a row, he didn't have that delusion. He had new ones. Because he had schizophrenia. But the thing I was doing is I was trying to dispute the delusion rather than disputing his awfulizing about it. So let's say somebody has cancer. Well, it doesn't make sense to say, or they're worried about their child. It doesn't make sense to say, "Oh, your child's going to be fine." Well, you don't know that, right? That's disputing an activating event that really is better not disputed. Even in the case, although it's probably better to at least do some disputing of psychotic activating events and thoughts, that's probably a good idea. But the power there is the idea that's unacceptable that this might happen. Certainly unwanted. But you see, the thing I want, the least, I really don't want that. That's the last thing I want to have happen on this planet. That's different than it's unacceptable for it to happen. Because unacceptable is absolutistic. The last thing I want to have happen is very strong, but it's not absoluteistic. And that absolute must not happen. That's completely subjective and arbitrary. And why say that? Because they're asking for help. They're asking for help. Now, in the environment of evolutionary adaptation, that kind of absolutism, probably contribute to the success of our species. Do you know how to view certain things as awful? The view, as I said before, to view the leaders better. To view certain things as things that must happen, that probably contributed to our evolutionary success. Now, people misunderstand evolution. When they say, when they say survival of the fittest, that's wrong. It's survival of those who fit the circumstance. Those who are evolutionary, those species that fit the circumstance are not in any objective way or in any, how to say this, hierarchical way better. They just fit the environment of evolutionary adaptation better. So they survive better. They pass on their genes better. So they fit the environment. They are not more fit in the sense that they're better. So one of the things that I'm hearing you say, which I think is a really important thing to take note of, is the disputing, what one does with the activating event. So in this case, a belief. You gave the, I think actually pretty helpful analogy of the person who has a psychotic belief, which is this belief that you don't necessarily agree with. It's not about arguing against the belief. It's against their response to maladaptive reaction to what, what's your experience with when there are, when you have clients who have, say, religious leaders in their community that maybe are your experiencing is not particularly helpful. How do you deal with, even if you have some anecdotes or how you might think about dealing with that situation? Well, one is very common. I'm going to give you a specific one. You know, members of the Church of Jesus Christ of Latter-day Saints, they believe in something called the Word of Wisdom. And the Word of Wisdom has several prohibitions. It's prohibited to drink alcohol. It's prohibited to use tobacco products, except as poultices. You can make a poultice with tobacco leaves and put it on a bruise or something like that. It's prohibited to use to drink coffee or tea. It's prohibited to use all illegal drugs. It's, it's acceptable to use legal drugs when prescribed by a physician. In the state of Utah, where we have a law allowing for medicinal marijuana, it's allowed to use edibles if prescribed by a physician. No smoking. Okay. An exceptional because smoking is bad for your lungs. Okay. Smoking is bad for your lungs. Okay. Well, once I had a client who said she was violating the Word of Wisdom by eating candy bars. That's not anywhere in the Word of Wisdom. It's called the Word of Wisdom from the 89th section of the doctrine and covenants of the Church of Jesus Christ of Latter-day Saints. Okay. Well, there's this thing called the Word of Wisdom. And that's where the prohibitions are. Although it's really said this is advice. It said this is advice. And it says, you know, eat meat sparingly, eat lots of fruits and grains. But it's not, it's not written by a nutritionist. But she said she was violating the Word of Wisdom because she's eating candy bars. I said, that's not in the Word of Wisdom. She said yes it is. And I immediately pulled back because I could see we were about to get into an argument about the activating of am. Is she really living the Word of Wisdom? Now, this is this is a little vague in my memory. But I said, okay. All right. That's fine. Why must you live the Word of Wisdom perfectly? That's what I began to work on because she was telling herself she must not violate the Word of Wisdom. See, imagine identical twins. I don't remember if I did this with her, but I've done it with a number of people. A number of people. Imagine we have identical twin sisters. And one of them says, I must not eat chocolate. And the other one says, you know, I'd really like to limit my sweet chocolate. Who's going to end up thinking more about chocolate? Who's going to be hungrier for chocolate? Right. If they eat a little mini snickers, who's going to feel the most guilty? And if they feel guilty, are they going to think more or less about chocolate? And that's pretty straightforward for most people, right? Everybody know, whenever you ask a question in psychotherapy, you want to be ready for the answer that you don't want to get. Right? But see, well, I caught myself, you know, sort of trying to dispute her activating event. All right. Now, leaders who say things. Recently, I had a client who, well, there are several problems. And one of them was he had very thought-oriented, obsessive-compulsive disorder, disorder. So he was really filled with scrupulosity, lots of scrupulosity. And OCD doesn't turn off your testosterone. And he would look at pornography and masturbate. Now, he was return missionary, he'd gone on a mission. And so that gave him access to the LDS temple. He had to have a special certificate or recommend to go into the temple. And that's where that's where Latter-day Saints get married for time and eternity. And they can do, they can do vicarious work for the dad, like baptisms and so on. And so that's that scene of as the height of worship among Latter-day Saints. Well, for a long time, he'd had a bishop who said,"Well, we need to have you go to the temple more often to control these sexual urges." And then he chained, and then there was a new bishop, and the bishop says, "Oh, wow, you can't go to the temple for a while now." And that big change just filled him with guilt. Now, that's the first, one of the first times in a couple of years that I thought, well, you know, maybe be helpful if I talk to your bishop about this. To let him know about your diagnosis and some of the things. Because he knew he had OCD. He'd been lots of treatment, lots of psychotherapists. And I was just about to do it. And then he, I forget what happened. Well, he went home for the summer. And I think he was in a state where I didn't have PSYPACT, so I couldn't talk to him. But he's moving with a different bishop, the home bishop. The home bishop was much more helpful for him. So that change happened, you know. Now, if a bishop says something that really upsets them, and I'll say, "Okay, well, how can I help?" How can I help you with this? Because I can't change what the religious leader says, right? But I can say, "Well, what does he want to help with?" Now, we can start to work on where they're having self-defeating emotions about it. Now, if they're annoyed with it, I think that's fine. If they're furious about it, well, fury and annoyance, fury is self-defeating. If they're discouraged about it, well, discouragement is pretty much inherently self-defeating. If they're sad about it, that's probably reasonable. But that will manifest itself in how the emotion works in their life, right? So grief is a pretty good example. If you lose something that's precious to you, it makes perfect sense that you would have grief. So if they come to me because they have grief, I would want to know more about the grief, how long has it been going on, right? What effect is it having on you? And sometimes it makes perfect sense that people would be experiencing grief. So it's not unreasonable, if you've been dating somebody for a year or more, and then you break up, that you'd be experiencing grief. That's like a divorce. In many ways, it's like a divorce. So you might be experiencing grief. And so I'd want to know what it is they want to help it. Well, I just don't think I should be this sad. Well, now we know where to jump in. Because it makes a lot of sense to have grief, but if you tell yourself you shouldn't have grief, then every time you have your sad, you have a second problem. You're getting mad at yourself for being sad about something that most people feel sad about. Does that make sense? So I'd want to know what they're telling themselves about what the religious leader said and how I can help in the context of what the religious leader said. What do you see your role when you're working with clients who are questioning their religious beliefs? Well, a good question. It certainly happens. I would say maybe once a year, maybe twice a year that comes up, they don't ask me, actually. Maybe once or twice a year, they ask me what to do about it. Now less than that, I would say once a year or less, a client will ask me what my advice is about that. And I think I'm on thin ice there. See, I don't think anybody wants a psychotherapist to be like a missionary, right? I don't think that's a wanted. So I think what I would say and I think what I did say the last time this came up is, well, how can I help with your questions here? And what it usually turns to is that they're afraid about what their family's going to do. They're worried about what's going to happen with their friends. They're worried what's going to happen with their romantic other, right? The romantic person. If they change their allegiance to the church. So that, you see how that's sort of a secondary consequence. And I don't think most, most BYU students think that they're going to get good answers to psychologists anyway. I don't think they think they're going to get good answers to psychology. I don't think they come to us thinking we're going to be theologians. Now I have twice. I have had the following happen twice. Isn't that right? Well, at least once because it was recent. I think it happened in a distant past. Somehow I've sort of fallen into a network of seeing lots of people from Taiwan and mainland China. And they'll sort of hint at this. Oh, you know, so and so? And I'll just, my face will be blank because I can't admit who I've treated and what I haven't. Well, he, she had me come see you. Oh, interesting. But I don't admit it, right? So recently, I had somebody come to see me and I met with her for like two years. And she, she's from mainland China. And she was Navius. And she had a boyfriend who was a BYU non-believer. And they were going to move in together. They may have moved in together already. But she wanted me to talk to her about the church. She wanted me to explain things in the church. So she wanted me to be like a missionary, but she wasn't, she was curious, okay? And I said to her several times, well, really, I think you want to talk to missionaries about this. Well, maybe, but I trust you more. She said that. And so I said, okay, well, so this is what the church believes. Now, you may want to go on beyond that by talking to missionaries. And that's very rare. That's one of the first times that's ever happened. I think I had another Chinese student asked me those questions a long time ago, but I'm not sure. Certainly this client did. And last beginning of April, she said, you know, I think I'm done. I think I don't need help anymore. So I'm going to stop now. So okay, we were always welcome to come back. And she said, well, I will if I need it. But she really wanted me to answer questions about the church and about the Book of Mormon. And I had to be quite careful. I wasn't saying, I didn't say to her, as missionaries would say, well, if you read the book of Mormon and pray about it, then you get a testimony. I would say, well, you know, if you were talking to the missionaries, the missionaries would tell you, see how I've put some space in there, that if you read the book of Mormon and pray about it, you'll, you'll, the spirit will tell you the truth. That's what the missionaries would tell you. Maybe you want to talk to missionaries. So I see it being thin eyes for a psychotherapist to then become a missionary. So I would not do that. I would not do that. And if somebody's a member of the church and they're having questions, then again, I would try and back away with from that. And I don't know if, I think almost all my colleagues here would agree with that approach. Because to become somebody who preaches religion, I don't think I'm doing that when I use scriptures to dispute irrational beliefs. If you're preaching religion to a client, that's really a dual relationship, I think. And I think that's, that's on the edge or is unethical. So for me to do missionary work, I think that would be on the edge or actually be unethical. Right? So I wouldn't do that. But I, but for her, I said, well, this is what they would tell you. This is the belief. Have you heard that before? Yeah, I have heard that. But what about this? I say, well, this is the belief. This is what I think somebody in the religion department tell you about that. Would you engage with them in, like if a person was questioning, would you engage with them in helping them think through that even from a more, you know, not a missionary perspective, but a, like, just, you know, almost agnostically, right? Like to help them sort of process that. Well, I would be adopting the agnostic position. But I, I would be cautious about trying to have them distinguish the pluses and minuses. I might say, well, maybe what you want to do is take a sheet of paper and put down the pluses and minuses. Does this seem reasonable or does it seem unreasonable? And write that down just as a way to, to remind yourself of things you thought, you know, because again, I just don't see it as the role of a psychotherapist to become a missionary or not, not, just not a missionary. I don't see it as the role of a psychotherapist to become a debunker, a skeptical debunker of religious ideas. I don't think that's appropriate. Now, it would be hard in either case and it would, it would devolve to you presenting your beliefs about religion to the client. Now, if they ask you, I think it's quite appropriate to tell them true. No, I'm not a believer. Yes, I'm a believer. But then to go a step further and say, look, it's, it's nuts for you to believe that. That's really blending your, your diagnostic ability. I mean, even to say that, that's sort of giving a diagnosis, you're nuts if you believe that. And that's not true. People who are religious are not necessarily nuts. I mean, you could say that what they believe doesn't make sense, but it makes sense to millions of religious people, billions of religious people and thousands of theologians that have fine minds, clear thinkers, and there are plenty of scientists who are very naturalistic and very empirical in their point of view, who are believers. They're plenty of them. They're a minority in most scientific communities, but they're not nowhere. There are lots of them, right? Francis Collins, you know who that is. He was, I think he was head of NIH. He said, he's a geneticist as I remember. I think I do. Yeah. Well, he's, he's a Christian. He's Christian. He came here to BYU, because he's a Christian presented that thing. He presented to us about that. Well, I mean, he's, he's very bright, but there are, there are lots of aggressive atheists who would say, well, if you believe in that, you're not very bright. You believe in a fairy tale. Well, that, that, that just causes people to dig in their heels, right? The aggressive atheists, they're not, they're not doing a service to the world at large. They're, they're sort of making themselves feel good by making fun of people who are religious, right? Do you know who Michael Shermer is? I'm sure. So he has a, he has a podcast called the skeptic. He has a magazine called the skeptic. And he's an atheist. No, but he would say, I'm a strong agnostic because I don't think you can know. He's a former evangelical and he's an atheist now. But he would say, he would also agree that the, oh, what's his name? The strong atheist, like Sam Harris and, you know, I mean, he would say they do a bit of a disservice. You say that, that's too strong, right? That doesn't help anybody. But he doesn't, his clarity doesn't believe. Fine. That's my, I mean, it's, it's, it's honest to say that. I don't think I have to say it's psychotherapist. It doesn't come up that off. So from the, from the REBT community or even other parts of the sort of psychotherapy community world, what kind of pushback have you gotten for your work and writing and thinking on these issues? Well, first of all, I'm sort of flatter to anybody notices. Not much pushback, not much pushback. And so I published an article in the REBT journal that shows that with my clients here at BYU, the REBT years that are here have better outcomes than on REBT on their OQ 45. And then about eight years ago, we got a grant from the Templeton Foundation. It was a subgram from a big grant that three professors should BYU got to do a treatment oriented outcome study, not an RCT. And so what we did is we paid therapists who want this paid to keep track of their interventions. And among the interventions, we asked them to keep track of was the use of scripture in therapy. And it was spiritually oriented psychotherapy. It's in, it's summarized in this book. I don't know if you can see it. The handle of spiritually integrated psychotherapy. Yeah. And it's an APA book. And the, it was the, the research itself, the grant was obtained by Scott Richards, P. Scott Richards, Kavika Allen, who's here at BYU. Scott Richards is retired. And Dan Judd, Daniel K Judd. Now he was the dean of religion here at BYU. He's retired now. He just happened to be my neighbor around the court. We're good friends, not only each other for a long time. And they got a $3.8 million grant from the Templeton Foundation to do this research. And they gave about $100,000 grant to do treatment oriented studies of spiritually oriented therapy. And so what we did here at BYU is have clients complete questionnaires about their spiritual beliefs in addition to the OQ-45 that they already complete. And then do session by session measures of the, of how their therapy went. And whether spirituality was addressed in their sessions, we paid them to do this. And then at a follow-up, we had them write about their alliance with their therapist. And that's being studied by one of my doctoral students right now. She's, she's looking at how the alliance from session to session and at three or more months after the therapy ended, how that went for them right. So we'll be able to look at what kinds of interventions we're done. And we paid therapists an extra $5 to keep track of their interventions. And they could just code it on a check mark right. Now this is what we found. If people used scripture in therapy sessions for each use of a scripture, the final OQ score, and this is after adjusting for the first OQ score and other predictors, would draw by 0.8 points. Little more than 0.8. So each use of a scripture was worth a lower, less distressed, OQ, about one point of distress. That was pretty good. And if you just looked at how many scriptures, if you, if you looked at just did they use scriptures or not, it was, as I remember, it was like a nine point difference. So that's pretty good, right? So we've, now it's not a control trial. That'd be a little different to assign people to receive religious scripture in REBT or not receive religious scripture in REBT. That would be something else, right? Now REBT's done quite well in randomized control trials, by the way. But to add religion, that would be a different thing, right? Right, because I'm thinking about what are the, what are the various explanations for why scripture use was correlated with, right? And one of the things that pops out immediately is that the therapists who use scriptures, where you scripture, we're willing to engage clients at that level, right? So it could have been a certain amount of responsiveness to those needs. And even a comfort in a, who knows, right? Like so there could be all sorts of explanations for what's going on there. But that's interesting. Yeah. And then, but I think that's pretty compelling to me to keep using my scripture. But the most important thing would be to the clients want it. And if they're not believers, zip, right? And talking about religious is only going to annoy them. Right? So I have a whole host of things to say if people aren't religious. Right. So so as we're sort of finishing up here, I can't help but since you've sort of worked with two of the more well-known, preeminent, famous, psychotherapy folks to get just sort of your experience of that. So you worked with Linehan when she was earlier in her career. So and I knew her before I ever met Alex. It was, could you tell then or did you have a guess then that all right, this person, she's going to be, she's a rocket ship taken off. Well, she was certainly different from most of the faculty members of UIU. How so? Well, was she going to be successful or not? I don't know. I don't know that I thought that. But she was very nice to me. And I was her, I was her research assistant for a year and a half. So she paid me extra money to work for her. Okay. She had me buy her, get her a personal computer. When that was brand new stuff and get a word processing program on her, on her personal computer. There was a big thing. It wasn't small. And and and a spreadsheet. And I bought the computer and set it up for her and showed her how to use it. And then she loved that. But then I watched how she did psychotherapy. And she also did our practicum. She did our first practicum in the clinic there at the University of Washington. Now here's something that might be a little interesting for you. My wife and I went to church at the Latter-day St. Institute of Religion that was associated with the University of Washington. The most major universities will have an Institute of Religion where students at the University can go and attend college level religion classes, right? Well, it just so happened that the Institute of Religion where we went to church was exactly across 15th Avenue, Northeast from the psychology building at the University of Washington. There was even a crosswalk from the Institute to the stairs that went up to the training clinic. So that's how close the church and the Institute were. And during my fourth year there, third and fourth year, I sat down with Allen Bergin and the department. And we set up him, the department in the Institute, sponsoring him to come and give a talk at the Department of Psychology and at the Institute building. Department of Psychology in the afternoon, the Institute building in the evening. And the Washington Department of Psychology, they were fine with that. I started to went up there with a chip on my shoulder. They were going to discriminate, I guess, because I was a little just now. They were just as nice to me as they could be. All my, all my other students and all the faculty, they were just as nice as they could be to me. So it worked out great. Okay, Marsha Linehan. She and I got along really well. A lot of students didn't get along with her. And I don't know why. But you know, she's written the autobiography in which she talks about her own psychiatric problem. And she admits that she had borderline personality disorder, right? Which ironically is the thing she studied the most, right? And one day, I was, I was just happened to be up at the front desk in the training clinic. And one of the, a client came to the front desk and said, you know, there's somebody having a big argument. We could hear it in the therapy room. And it was Marsha arguing with a graduate student. I never had an argument with her. I don't, but she, she had several screaming arguments with graduate students. I don't know what that was about. But somehow she just set people off or they set her off or something. She and I remain good friends. Now, she's in a, she's in her decline right now. And I haven't talked to her for a long time. But she and I stayed close. And she really provided me with lots of great interventions. She's very intervention oriented. And she told me a lot of good things. Here's one of the most valuable things she ever told me. She said, if you meet somebody who has an assertiveness problem, a night, no, she, she said, if you meet somebody who has problems with their identity, they don't know who they are. You want to think assertiveness problem. And that has proven to be so true. People who are unassertive don't know who they are because they don't know what they want. And they won't say what they want. And they don't do what they want. So if somebody doesn't know who they are, they have this identity problem. You want to think unassertive. You want to help them be unassertive. And she said that to me is just, or she said that to us in the primary practice, in our practice, in our classrooms throw away. And it just stuck in my mind. And I have found it to be true with every client I've ever had who has these identity questions and identity crisis. They're typically unassertive. And if you're unassertive, you don't even know what you want. And why don't you know what you want? Because you won't go after it. So it's not, you know what you want. You go after it. You go after it. And you find out what you want. And if you don't do either of those things, you don't even know who you are. Those things are linked in the mind, right? And so she just said that as a throw away. But it's been so true. And of course, in her book, assertiveness is a big part of what she does. And a big part of behavior therapy, assertiveness trains a very big part of behavior therapy. It's a big part of REBT, big part of what I do, teaching people how to be more assertive. It's relatively simple, but not easy for people to do when they're socially anxious. So she had a big impact on this. And she brought in, she brought in, what's his name? He's retired now. She brought in the director of the Seattle Institute for Rationally Motive Therapy. And he talked to us for a while. And then she would coach us in doing that. And I remember really clearly is to strike, stuck in my mind, the whoever, the one of the TAs for the class sat down with me. And I just couldn't get that it was unwanted, but acceptable that somebody could stole one, my briefcase. I had my, you know, my general exam questions. I had a bunch of note cards where I'd written down how I was supposed to do my generals, you know, answers and questions and answers and questions. We had your comprehensive exams. Yeah, that's my comprehensive exams. And we had 24 topics and we had to be ready. We had to answer three or four of those 24 topics. So I had to add all these notes for my comprehensive. And my briefcase was stolen out of my car. They broke the window of my car and stole my briefcase. And I felt just, you know, first of all, it was tired and upset because I've been studying about it. I didn't have these test materials, preparation materials for my comprehensive. And I was furious that this had happened. And so we had a little therapy session. We all had an opportunity to do a therapy session. And the TA did REBT, RET at the time with me. And she just couldn't help me see that it was acceptable that unwanted. But why shouldn't your stuff get stolen? Do you have some force field around you that prevents your stuff from getting stolen? And I kind of got man at her. And that just sticks very clearly in my mind. And that was that was my introduction to having somebody do RET with me. I couldn't accept it at the time. But she was a TA, you know, she was a graduate student. So that's part of why I couldn't accept it. And I was still in the middle of being furious about it. And then I got, I had a nice calculator that was stolen, but somebody found the briefcase and it had my name and it was broken open. And I got my cars, but it took two months. And so it delayed my comprehensive by about six months. So then, of course, I have to follow up. You talked briefly or a little bit about working with Albert Ellis, but just more generally, what was your experience working with him? He's always very nice to me. He's always very nice to me. Every year I would write a birthday song for him. I call him on the phone and sing him a birthday song. So the one he liked the best was he's born in Pittsburgh, born in the little bird of P-A, and then I forget the rest of the words. Albert, and this is the tune is "Davy, Davy Crockett." Albert, Albert Ellis, scourge of the crazy idea. Well, he liked those. He liked those. And he liked the songs I wrote. He had lots of songs. And so I have a rational emotive hymnal that I give my clients from the Rational Tabernacle Choir, Music and the Broken Word. And so if they're of a mind to laugh, I'll have them learn these rational emotive songs that make fun of those irrational ideas. Well, he liked that. He liked that. And so we wrote several articles together. Now, when I was sitting with him in the hotel room in Toronto, asking these questions, the editor of the Journal of Psychology Christianity, he asked to come and sit in. I said, "Sure, that's fine." Now I said it, fine. And then a guy named Brad Johnson, he came and sat in. He was also writing an article for that special issue with the Journal of Psychology Christianity. And I got to know Brad really well. And he did a dissertation on rational emotive behavior therapy, or rational emotive therapy at time, with Christian clients. He went to, well, one of the two religious schools in Los Angeles. It wasn't Rosemead, it was Fuller. He went to Fuller Theological Seminary. That's where he got his PhD in clinical psychology. And then he did an internship in the Navy, and was a Navy psychologist for a while. So he and I had that in common. And for his dissertation, he did a religiously-oriented REBT, or regular REBT with clients, and showed that religiously-oriented was at that. I think a religiously-oriented REBT was better than a control, and slightly better than religiously-oriented RET. And then we did some collaboration. Well, he came and sat in with, while I was having the interview with Al, and then we continued to talk. We did a couple of articles together, and a couple of presentations at APA. And I forget when we did our presentations at APA, but then Al also spoke with our presentations. And then we wrote a book together with Al Ellis, counseling and psychotherapy with religious clients, the REBT behavior therapy approach. I'm the first author. Brad Johnson is the second author, and then Al is the third author. And he wrote one chapter, summarizing REBT. And then Brad and I did the other ones. Still in print, still being sold. I'm not going to get rich on the royalties, like most academic books, I'm not going to get rich on the royalties, but still in print. I think it's a good book. Yeah, use the proceeds to buy updated stationery for the Ellis Institute. Yeah, something like that. Well, this has been fantastic. But before we end, is there anything -- what I wanted to ask was, are there any specific resources and you've given several books and articles that I will link all in the show notes? Are there any other additional resources that you want to point people who are interested in learning more about any of the stuff we've touched on? Well, yeah, I think the primary practicum and the advanced practicum at the Albert Ellis Institute in New York City is some of the best supervised training anyone will ever get. And here's the reason. You get very direct instruction from the Institute faculty. And then you get very direct supervised experience in these little mini-bouts of psychotherapy. So if you go to the Institute or you go to one of their video programs, then you're going to get, you're going to find yourself doing -- let me see -- you're going to find yourself doing eight sessions, many sessions of 10 to 15 minutes, and receiving eight mini sessions of 10 to 15 minutes of REBT. And you're going to get supervision. You're going to see supervision for all of those mini sessions. That's just about the best way to learn to do psychotherapy. Is to have experts watch it along with other learners who are not novices at doing psychotherapy, because none of them are novices. They have them watch and show you and explain to you how to do it. That's the way to learn to do rational emotive behavior therapy. And then I would read my book. I think my book is a nice introduction to rational emotive therapy, as well as rational emotive behavior therapy, as well as a nice introduction to rational emotive behavior therapy, religious rational emotive behavior therapy. And it gives you an outline for how you do a session. And there are between seven and ten steps you can do in every REBT session that will keep you on track with your client. The first step is, well wait, what is it you want help with here? And that can reorient the session. That's one of the most valuable things to say in any psychotherapy session. Wait, what is it you want help with here? Because I'm getting a little lost. I want to give you what you want in the session. Another excellent book to read is any book by Ray DiGiuseppe. He's the director of training at the Albert Ellis Institute. I'm not going to take time to pull one down, but he's written an excellent handbook on doing rational emotive behavior therapy. And it goes through and shows you the steps of what to do in the session. Talks about differences. I did want to say this one thing about a difference between cognitive therapy and rational emotive behavior therapy. So I heard Aaron Beck say this and I've heard many other cognitive therapists. They say now that they are the cognitive therapy. They really are working on the A activating event. So I heard Aaron Beck at APA say the following. One of his early clients was a surgeon. He was really worried that he'd made a mistake in a surgery. Of course, you know, you don't want surgeons to make mistakes, but they're human, so they will make mistakes. He was worried he was going to be sued for malpractice. And if he was sued for malpractice, he was worried he might lose his license. And if he lost his license, you know, he'd become impoverished. He could sort of see himself living on the street. And so Beck talked to him, talked to us, and this was an APA, by the way. Beck was given an award by the American Psychological Association for his scientific contributions to psychotherapy. And he said, "Well, what I did is I tried to show him step by step and little increments. It was very unlikely that he was going to end up living on the street." Okay. See, that's the activating event. And then he said, "I suppose it's possible that it could have happened. And you know, I would like Albert Ellis to show me why that would be terrible." He actually said that at APA. Well, that's a fundamental difference between rational emotive behavior therapy and cognitive therapy in rational emotive behavior therapy as soon as you see those ideas and they're clear in what the client communicates with you, those arbitrary absolutes, do you jump in and work on them? As soon as you see them, because they have a completely subjective arbitrary value or meaning. They're not tied to any reality except the realities we may, right? Now, there could be realities about whether you are found to have committed malpractice or whether you're found to have done on something unethical or whether you're going to lose your license to practice your profession. Those are realities that may or may not occur. And they're not irrelevant. They're quite relevant, not irrelevant at all. But what we can best work with as a psychotherapist, at least that's, this is the REBT view, you can work on those arbitrary absolutes. Wonderful. Of course. And I'll link all these things, but Lars has been wonderful. I can't tell you how much I appreciate it. Well, it was nice, nice opportunity. Thank you. Ladies and gentlemen, Dr. Stevan Lars Nielsen. That's a wrap on our conversation. As I noted at the top of the show, be much appreciated if you spread the word to anyone else who you think might enjoy it. Until next time.