165 - Spirituality and The Avoidant Personality

Spirituality and The Avoidant Personality
By L. Rebecca Propst

"I have often discussed with patients the neediness of God, and that by virtue of being in God's image, they could still feel needy and be in God's image... Initially, these ideas are just too new for many of the patients I deal with. The general thrust of their acquired theology has always taught them that following Jesus means there will be no pain. "'

Let me begin with a forty-two-year-old single female elementary school teacher who sought counseling because of loneliness and extended periods of crying. She admitted to feeling guarded in all of her friendships and intermittently experiencing intense waves of sudden sadness as she relived failed relationships with men. Her only social outlet was attendance at a local church in which she took care of the nursery and helped with Sunday school.

She admitted to being fearful of initiating further friendships with men or women, lest she be humiliated and rejected. When asked about frequenting social settings so she could initiate some new relationships, she replied, "Oh, I could never do that." She felt that her mood swings and especially her intense weeping indicated that there was something "terribly wrong" with her.

This patient met the clinical criteria for a psychiatric diagnosis of dysthymia, or depression, manifested by feelings of low self-esteem and a persistent sense of hopelessness and helplessness. Her helplessness was indicated not only in her fear of initiating social relationships but also in the face of her parents' absolute control of her activities. For example, they demanded that she spend every weekend and holiday with them.

Therapy proceeded by helping her establish more independence from her parents, as well as building some social skills and teaching her to monitor and restructure her thoughts. She had some initial improvement in mood, and she was successful in distancing herself from her parents. But she found it difficult to record her negative emotions and to initiate new social contacts. Her response to thought-recording was that "it was too painful." She had the same response to

L. Rebecca Propst is Associate Professor, Graduate School of Professional Studies, Program in Counseling Psychology, Lewis and Clark College, Portland, Oregon. The present article is adapted from a lecture delivered in the Finch Lecture series at Fuller Theological Seminary's Graduate School of Psychology. Dr. Propst is the author of Psychotherapy in a Religious Framework: Spirituality in the Emotional Healing Process (1988).

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beginning new social contacts. I began to suspect more than dysthymia. Her extreme and pervasive social discomfort, present since childhood, together with her extreme fearfulness and avoidance of criticism indicated that she had a secondary diagnosis of an avoidant personality disorder.

After a period of therapy, she began to express mild suicidal ideation as a result of attending a wedding. Her comments to her friends were, "I am not going to be here much longer; I really want to go and be with Jesus." Upon exploring her suicidal thoughts, her underlying motivation was that she was "tired of the pain, and really wondered if the struggle was worth it. . . . What's the use, I have lost the chance for happiness and marriage." Apparently, the wedding had resurrected some unresolved grief, and she wanted out of the pain. Suicide appeared to be the easiest, surest way.

Her problem was further aggravated by her church, where it was explicitly assumed that Christians should always experience joy. Her reaction to this expectation was to feel even more withdrawn and depressed because this did not fit her own experience.

Despite the non-dualist claims of Christianity that the spiritual is not antithetical to the physical or the psychological, I find that often contemporary Christians actually practice a much more dualistic lifestyle than many of the contemporary practitioners of rival faith claims, who are much more likely to integrate the physical or the psychological with the spiritual. Perhaps this explains the popularity of some of the more avant-garde religions. Life is not lived in separate little boxes. We cannot be psychological one day and spiritual the next. Christian spirituality and our contemporary understanding of mental health are, I think, two sides of the same coin and are used to enhance, elucidate, and enrich each other. In this approach, neither discipline is eviscerated as is often the case when they are brought together. Instead, each discipline must be dealt with in its complexity. At this point, I will resist formal theoretical definitions of the relationship between good Christian spirituality and good psychological health. Spirituality should be taken out of the corners of our modern existence and become, instead, the defining point of our existence. Theoretically, we are not cognitive-behaviorists, or psychoanalysts, but Christians. Let us see how the avoidant personality disorder can be defined as a problem in Christian spirituality and how Christian spirituality can aid in the treatment of that disorder.

I

The basic characteristic of the avoidant personality is, of course, avoidance. These individuals avoid human and social relationships because of their excessive fear of criticism or embarrassment. They also avoid any of their own negative feelings or thoughts because they feel they will not be able to tolerate them. The patient mentioned above worked very hard at avoiding pain, covering even painful words

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with nervous smiles. If she got a tear in her eye, her entire face became beet red, further aggravating her embarrassment. Her stated philosophy was, "It is better to avoid people than to be hurt again. Suicide is an option; I am tired of the struggle. I want to be with Jesus, and then I will not have to feel the pain."

Does this extreme avoidance of discomfort conflict with healthy Christian spirituality? Indeed, it does. Contrast the stance of the avoidant personality with the description of the experience of falling into the hands of the living God by Thomas Kelley in his book, Testament of Devotion:

It is an overwhelming experience to fall into the hands of the living God, to be invaded to the depths of one's being by his presence, to be, without warning, wholly uprooted from all earth-born securities and assurances, and to be blown by a tempest of unbelievable power which leaves one's old proud self utterly, utterly defenseless, until one cries, "All Thy waves and Thy billows are gone over me."¹

The avoidant personality, on the other hand, fears and avoids anything that is nonsecure or uncomfortable. These individuals avoid negative emotions, fear rejection, avoid people and any situation that might result in criticism or embarrassment.² Essentially, they believe that "it is bad to feel bad" and yearn for distracting "fixes."

Therapy includes using the methodology of cognitive-behavioral psychotherapy, with Jesus presented as the model of whole humanness. The human Jesus, as Barth would insist, is a source of our knowledge of the nature of humanness as created by God.³ In Jesus, human nature is revealed in its intended form. "Jesus is one nature with us . . . we are invited to infer from his human nature the character of our own, to know ourselves in Him, but in Him really to know ourselves."⁴

Psychologically, cognitive therapy requires a patient to experience negative emotions and to record thoughts and images accompanying them. Avoidant personalities find this difficult. The therapist, however, must increase the patient's tolerance for negative emotions. This is done by a gradual approach to increasingly more intense "dysphoric" or threatening situations. One may also ask the patient what he or she fears will happen, or one can even increase tolerance for negative emotions by actually having a patient practice feeling badly by focusing on certain things that are feared.⁵

¹ Thomas Kelley, A Testament of Devotion (New York: Harper & Brothers, 1941), p. 56.
² Judith Beck and Christine Padesky, "Avoidant Personality Disorder," in Cognitive Therapy of Personality Disorders, edited by A.T. Beck and A. Freeman (New York: Guilford Press, 1990), pp. 299 ff.
³ Karl Barth, Church Dogmatics: The Doctrine of Creation, Vol. 111, Part 11, translated by H. Knight, G.W. Bromiley, J. Reid, and R. Fuller (Edinburgh: T. & T. Clark, 1960), p. 54.
⁴ Ibid.
⁵ Arthur Freeman, James Pretzer, Barbara Fleming, and Karen Simon, Clinical Applications of Cognitive Therapy (New York: Plenum Press, 1990).

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Paradoxically, as the tolerance for negative emotions grows for avoidant personalities, they may experience more intense sadness, fear, or anger as they bring into awareness memories that they had avoided for many years. It is only after they can tolerate the emotions or negative thoughts that they can argue with them. In addition to avoiding painful emotions, these individuals must also choose to experience the painful aspects of their everyday existence and relationships that they have been trying to avoid in order ironically, to reduce their suffering. In other words, these individuals will also need some social-skills training and gradually increasing involvement in relationships to prevent relapse.⁶

II

There are five themes from Christian spirituality related to the notion of nondefensiveness in the avoidant personality.

(1) Suffering freely chosen in order to accomplish a purpose is a strong theme in Christian theology. Jesus describes his own suffering as freely chosen: "I lay down my life for the sheep.... The Father loves me because I lay down my life, to receive it back again. No one has robbed me of it; I am laying it down of my own free will" (John 10:15, 18 NEB).

Dorothee Soelle in her critique of post-Christian apathy states that we are so dominated by the goal of avoiding suffering that we wall out the world and assume we have a God who does the same. But pain can be good if it furthers the process of its own abolition.⁷ Similarly, Moltmann reminds us that, in Christ, we are shown a misery that is not passive. Through his own suffering, the crucified God comes to those who think they are abandoned by God.⁸ If we can assume that Jesus is a model for human wholeness, then the chosen suffering of Jesus takes on new meaning for our own mental health, especially in the context of the avoidant personality.

When our avoidant personality admitted that she had the assumption that it was always easier to avoid pain, I gently asked her whether Jesus had that assumption. She said, "No, he certainly experienced a lot of it." I then emphasized the idea that Jesus had made the choice to go to the cross. Facing that pain resulted in a transformation, namely, the resurrection. She paused and said she thought that her church had done her a disfavor. She felt that she had received the message that it was always better to avoid pain. She also smiled and told me to continue to share these ideas with her because she thought they were starting to sink in.

⁶ Beck and Padesky, pp. 278 ff.
⁷ Dorothee Soelle, Suffering, translated by E. Kalin (Philadelphia: Fortress Press, 1975), pp. 41-45.
⁸ Jurgen Moltmann, The Crucified God, translated by R. Wilson and J. Bowden (New York: Harper & Row, 1973).

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(2) Christian spirituality provides a second related theme for the therapy of the avoidant personality, namely, the value and legitimacy of neediness. McGill states that sharing in the life of God means that real life is letting go of self.⁹ We are saved from a self-enclosed security. But when we let go of ourselves as self-contained beings, we are usually then confronted with a condition of need in our existence. This is not necessarily bad because McGill, for example, bases our neediness on the neediness of Jesus. More specifically, he states that power in Jesus is a derived powerfulness, and therefore a needy powerfulness. Jesus' sweating drops of blood in the garden, his cry on the cross, "My God, my God, why hast Thou forsaken me?" (Matt. 27:46), and his weeping in front of the tomb of Lazarus certainly are vivid examples of this neediness.¹⁰ Jesus was dependent upon the Father, but being dependent does not make him less divine. Indeed, as McGill reminds us, this was the controversy surrounding the debate between Athanasius and Arius at the Council of Nicea in A.D. 325. Does the derived powerfulness, and therefore the needy powerfulness, of Jesus make him less divine? The council said no.¹¹

I have often discussed with patients the neediness of God, and that by virtue of being in God's image, they could still feel needy and be in God's image. It is all right to experience those feelings. A common response of patients is to say, often with tears in their eyes, "That makes it easier for me to deal with my emotions." At other times, when discussing Jesus' suffering, the same patients will often state that they had never thought it relevant to the pain in their life. Initially, these ideas are just too new for many of the patients I deal with. The general thrust of their acquired theology has always taught them that "following Jesus means there will be no pain."

I find these themes of Jesus' neediness most useful when the patient has just become aware of some aspect of neediness. Typically, the countenance of the individual will change to express dismay. I usually inquire about the individual's thoughts and assumptions at that moment. Awareness of self-criticism usually produces further dismay. It is at this moment that the neediness of Jesus becomes an answer for the self-criticism for his or her own neediness.

Neediness as an aspect of Christian spirituality can also be approached in another way. When discussing an avoidant personality's needy feelings of loneliness and emptiness, it is important to acknowledge that these feelings are realistic, but perhaps one's thoughts about these feelings ought to be examined.

Typically, the avoidant personality firmly believes that negative feelings are bad, and, therefore, he or she is unhealthy. When my avoidant schoolteacher was confronted with this possibility, she eagerly concurred that those were her thoughts. In a use of Beck's

⁹ Arthur McGill, Suffering: A Test of Theological Method (Philadelphia: Westminster Press, 1968), pp. 95 ff.
¹⁰ Ibid. pp. 99 ff.
¹¹ Ibid. pp. 73 ff.

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triple column technique,¹² I asked her to rate her belief in the notion that Jesus was vulnerable and in pain, but still healthily human. She stated she believed that. I then asked her to rate her belief in the statement that though she was vulnerable and felt pain, she was still a healthy human. She stated that she could only believe that halfway. There was a moment of silence, and then she looked at me and smiled, "I guess I expect more of myself than I do of Jesus." In still other discussions of neediness, we have discussed Psalm 42 as an expression of neediness, and the patient wept in response to the emotions expressed in the psalm. Somehow, the biblical references to desolation and neediness were sufficient to give permission for weeping.

(3) The notion of choosing new possibilities and taking risks is a third theme from Christian spirituality useful in the present context. John Cobb reminds us that Jesus as the Logos was the one who uniquely chose the possibilities of God, rather than the choices dictated by his personal past.¹³ Indeed, each choice made away from the path dictated by the personal past results in a clearer expression of the image of God in our lives and a greater freedom from our own defensiveness. As our schoolteacher took risks in asserting herself with her parents and choosing what for her was a risky path, she found herself less controlled by the comments and criticisms of her parents. Her energy became less divided between the demands and criticisms of her parents (both in the present and those internalized from the past) and her growing desire to try new risky paths.

True mental health entails the ability to choose God's possibilities and the choices that God would have us choose, rather than those choices which our personal past would dictate. In the case of the avoidant personality, God's choice is often the choice of painful risk. The choice dictated by the personal past would be the choice of playing it safe because one was criticized for doing otherwise. Our teacher patient reported that she grew up in a highly critical environment, so it was hard not to play it safe. Most patients have told me that they changed when they were willing to pay the price and to make choices that might entail personal risk.

(4) Closely related to the theme of neediness is the theme of vulnerability, which is our fourth important spiritual consideration for the avoidant personality. Lest it be supposed that choosing the risky path immediately results in happiness forever after, one must realize that choosing the path offered by God results in vulnerability. This is also a strong theme in Scripture. "Divine folly is wiser than the wisdom of humanity, and divine weakness stronger than human strength .... He has chosen what the world counts weakness" (1 Cor. 1:25 ff.); "for

¹² Aaron Beck, John Rush, Brian Shaw, and Garry Emery, Cognitive Therapy of Depression (New York: Guilford, 1979).
¹³ John Cobb, Christ in a Pluralistic Age (Philadelphia: Westminster Press, 1975), pp. 136 ff.

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my power is perfected in weakness, wherever I am weak, then I am powerful" (2 Cor. 12:9). The Apostle Paul experienced the fact that the weakness and the limitation of human existence are the necessary presuppositions for the operation of the divine power that is made perfect in this weakness and limitation. Paul declares that he found freedom from self in that weakness (2 Cor. 12:9-10).¹⁴

Experiencing vulnerability is difficult for an avoidant personality. When asked to write a brief essay on the psychological value to her of experiencing weakness as expressed in verses of Scripture such as those previously mentioned, the schoolteacher with the avoidant personality distorted the assignment and immediately jumped to the idea, "He promises to be with me and to be all-sufficient to fill all of my needs. Even though this is true, I may not feel it at this time. His word promises that after the hard times are past and weakness is over, I will be strong again through his power.... All of this sounds great and wonderful, but since I have only experienced the weakness part of the coin, it is hard for me to understand the strength and power that will come. But, since God's word says it, I must believe and trust it." Rather than focusing on the emotion of weakness itself, she avoided that and jumped instead to the idea that God promises there will be no pain. No doubt, her reactions were at least partly conditioned by what I call "promise" theology picked up through her church contacts. God promises that everything will be all right. This is a difficult pill to swallow for one who is suffering. This is perhaps an example of what Richard Lovelace calls spiritual gluttony, which he contends is so much a part of the modern church.¹⁵ This gluttony focuses only on the joy and the promises of God that obedience will supposedly bring and not on the high cost of obedience "promised" in Scripture. As would be expected, an inadequate theology has a detrimental effect on mental health. The difficulty with the often-used contemporary notion of biblical promises is that it does not acknowledge the suffering that can come from faithfulness. A triumphant church rather than a persecuted church makes it difficult for the hurting to be part of that church.

(5) Increasing one's toleration for "dysphoric" emotions requires a different theological emphasis. A fifth theme from Christian spirituality is also an important part of the healing process for these individuals. This is the theme of "the dark night of the soul." I have frequently asked my depressed patients, as well as patients with an avoidant or dependent personality, about their familiarity with the notion that emotional darkness is an indispensable part of the spiritual journey. Such a concept is usually entirely foreign to them.

Spiritual writers frequently remind us that "darkness" is part of the

¹⁴ ICE Walter Grundmann, "Dunamai," in Theological Dictionary of the New Testament, translated by G. Bromiley, edited by G. Kittel (Grand Rapids: Eerdmans, 1964), 11, 284-317.
¹⁵ Richard Lovelace, Dynamics of Spiritual Life (Downers Grove, IL: Intervarsity Press, 1979).

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spiritual journey. St. John of the Cross states that many beginners in the faith want peace instead of God.¹⁶ They want gratification of spiritual experiences and not obedience. In order to wean the young Christian from this misplaced desire, John of the Cross believes that God takes away all pleasures of the senses, such as pleasurable spiritual feelings, and then finally takes away all understanding. In this "night," the soul begins its search for God and has great pain because it does not feel the presence of God and does not understand what is happening. The individual is awakened spiritually by this pain and is being taught by God, even though he or she does not understand what is being taught. Richard Lovelace, in his discussion of St. John of the Cross, calls this sanctification by faith.¹⁷ Ultimately, darkness of emotion and confusion regarding these patients' original assumptions about emotions and spirituality are required before they can progress. I often hear at this juncture, "I am going to have to think about that one." The avoidant personality will usually not think about it, so as to avoid any confusion, and such ideas must be repeatedly presented.

For the patient with an avoidant personality, the journey toward emotional health or sanctification is a painful one, as it is for all of us. Beck and Padesky tell us that the avoidant personality engages in wishful thinking about the future - wishful thinking that perfect relationships will arise without personal effort.¹⁸ This wishful thinking arises partly because such individuals typically do not believe they can secure such a relationship with their own efforts. Wishful thinking also arises because such an individual does not want to risk the pain that may be involved in actively pursuing such a relationship.

The successful treatment of an avoidant personality results when such an individual will say, "I guess this is something I must do. I must face this." Like John Bunyan's pilgrim Christiana, as she approached the wicker gate at the start of her journey in The Pilgrim's Progress, the patient must acquire a determination to succeed:

Wherefore methought I saw Christiana and Mercy go up to the gate.... So Christiana began to knock, she knocked and knocked again.... But instead of any that answered, they all thought that they heard as if a dog came barking upon them, a dog, and a great one too; and this made the women and children afraid.... At last they thought of knocking again, and knocked more vehemently than they did at the first. Then said the keeper of the gate, "Who is there?". . . and he opened unto them.¹⁹

¹⁶ St. John of the Cross, Dark Night of the Soul, translated by E.A. Peers (New York: Doubleday, 1959).
¹⁷ Lovelace, p. 118.
¹⁸ Beck and Padesky, p. 265,
¹⁹ John Bunyan, The Pilgrim's Progress (New York: New American Library, 1964), pp. 173-174.