SACRED TEXTS

DONALD F. WALKER, SAMEERA AHMED, AVIDAN MILEVSKY,

HEATHER LE!7IS QUAGLIANA, AND ANISAH BAGASRA

Early one morning, a foolish young rabbit lay sleeping beneath an

apple tree"tucked away in a corner of a forest. As the rabbit tried to sleep,
he began to ask himself what would happen if the earth were to break apart.
After thinking more about this, he sat up and asked out loud, "W'hat if the
earth broke up today?" While he considered this possibility, he began to look
around the forest and listen for signs of danger.
Just as he began looking around, he heard the sound of a loud crash
behlnd him. Without turning to see what had happened, the rabbit jumped
up, began running, and started yelling, "The earth is breaking upl" over and
over again while he ran as fast as he could. He continued running through
the forest, gathering animals with him as he ran.
Before long, a pack ofrabbits, bears, elephants, and snakes were bound'
ing and slithering through the jr-rngle, until they ran underneath a brave lion
that was perched on a mountaintop that overlooked the forest. From there,

DOI: 10.1037i i3947-008

Spirituallnterorcntions inChiltl and Adolescenr Pslchotherapl, D. F. Walker and W. L. Hathau,ay (Editors)
Copyright O 20i3 by the American Psychological Association. A11 rights reservccl.

155
 the lion could see that unless he intervened, the herd of animals would run
Mannarino, & J,
over the edge of the cliff they were advancing on.
& Yeh, 2009). ir
The brave lion decided to help them and leapt from rhe mounrainrop
treatment that u-,
to the front of the pack. He asked them why they were running and was told
tice applied specr
that the earrh was breaking up. The lion replied that the iru, not break- spiritual traditi.,r
ing up, and he struck the ground with his paw ro prove it."arth
He then askecl the Thus, in ii
pack who had told them this.
ent world relisrc
when the foolish littie rabbit told the lion that he had heard the earth 'V7e
provide m..r,
breaking up under an apple rree, the lion had an idea, and returned with the
texts in the con:,
rabbit to the rree where he had been sleeping. The lion sniffed around the
ages. As a resuir.
tree until he found the apple that he was looking for. He told the rabbit
that second of the rh
the sound of the apple falling had been the reason for his thinking that
the ing religious anj
earth was breaking up, and they returned to the pack of animals ro reassure
and Wade (2r-'.1>,
them that it had all been a mistake.
sacred texts fr.,m
This fairy tale, described in Foolish Rabbit's Big Mistake (Martin &
Islam, andJudais:
Young, 1985), is a story recommended for use in an empirically supported
Next, we presena
treatmenr manual for childhood anxiety (Kendall & Hedkte, 2o0o). kenclall
training in hehav
and Hedkte (2000) have used the fable to help anxious chiiclren learn to
sacred texts. Atrr-
identifu cognitive errors relared to anxiety by following the main character in
cognitive-behar-:
the story. Kendall begins by teaching children to idenilfy the foolish rabbit,s
we discuss the us,
thlnking errors. Then, Kendall asks clients to generare adaptive self-talk and
actions to help the main character in the story cope effectively with anxiety-
physical and s.r*
of study in inc.rr:
provoking thoughts. Kendall's rationale for using a lictional story to discuss
cents. Across sc.-
cognitive errors and pracrice replacing them is that using a make-believe
use ofsacred tesr.
character is less threatening to a child than asking the child io directly discuss
his or her own anxiety-provoking experiences, ar least initiaily.
children ofren learn about life through srories and parables. This has
been the case for generations, from Aesop's fables (Aesop,
O\ EF
J,,r,"s, & Ashliman,
2003) to Grimm's fairy tales (Grimm, Grimm, Grimm, & Dalton, 2oo3).
For
children raised in religiously committed families, stories describing character
Christianity
formation, rules for living, and ways to deal with aclversity are oii"., purr",1
down in sacred rexts,_including the Bhagavad Gita (Hinduis,r), th" Hnly
The Christi:
Bibie (christianity), the Qur'an (lslam), the Tipikita (Bud<lhism), ancl the
ment (inherireJ ::
Torah and Talmud (Judaism).
of Jesus Christ an.
Indeed, every major world religion has a way of life that is communicared
sion). Within tht
through a sacred text. In counseling and psychotherapy, the incorporation of
(Matthew, Mark.l-
sacred texts is commonly used to address client and ieliglous issues (Garzon,
These books ii.er. ;
2005;Johnson, Ridley, & Nielsen, 2000; Tan, zooT). This practice has been
least 100 separate (
alternately referred o as religion-accommodadue or spiritualfi oriented. psycho-
therapy (Mccullough,1999; Richards & worthingion, 2oio). The idea
Catholic, Eastem t
of Fundamentalisr Pr,
adapting standard psychotherapy approaches with children to be more cultur-
in the existence of ,
ally sensitive to diverse populations is nor new (see, e.g., cohen, Deblinger,
(Jesus), and rhe H.

t56 V/ALKER ET AI,.

rimals rvould run Mannarino, & de Arrellaneo, 2001;Huey & Polo, 2010;Lau,2006; McCabe
& Yeh, 2009). In a sense, the approaches to incorporating sacred texts into
:he mountaintop treatment that we advocate represent an extension of culturally modified prac-
'ring and was told tice applied specilically to children, teens, and families for whom religious and
:1-r u'as not break- spiriual tradition is a highly important aspect of diversity.
ie then asked the Thus, in this chapter, we discuss the use of sacred texts from differ-
ent world religions in the context of child and adolescent psychotherapy.
i l-reard the earth We provide more in-depth discussion of spiritual interventions using sacred
:turned with the texts in the context of empirically supported psychotherapy treatment pack-
,riied around the ages. As a result, our approach to using sacred texts falls squarely within the
.i the rabbit that second of the three categories for considering spiritual interventions (add-
hrnkrng that the ing religious and spiritual content to secular treatments) identified by Post
l.nals to reassure and \X/ade (2009). We begin the chapter by providing an overview of the
sacred texts from several major world reiigions, with a focus on Christianity,
,::ke (Martin & Islam, and Judaism because these are religions that we are more familiar with.
:ically supported Next, we present a model for addressing spiritual and religious issues in parent
,. lJ00). Kendall training in behavioral interventions for childhood disruptive behavior using
hrldren learn tcr sacred texts. Afterward, we consider the role of sacred texts in the context of
r:in character in cognitive-behavioral treatment for childhood anxiety and depression. Then
: tbolish rabbit's we discuss the use of sacred texts in the context of treatment for childhood
:ile self-talk and physical and sexual abuse. W'e conclude the chapter by discussing the future
:-r'ri'lth anxiety- of study in incorporating sacred texts in treatment for children and adoles-
- .tor1, to discuss cents. Across sections, we present a series of case studies demonstrating the
: make-believe use of sacred texts in psychotherapy with chiidren, teens, and families.
-, Jirectly discuss
i11v.
r.rbles. This has OVERVIEIr OF SACRED TE,XTS FROM MAJOR
r.-s, &Ashliman, !uORLD RELIGIONS
:iron, 2003). For
.iibing character Christianity
:re often passed
:ism), the Holy The Christian Bible is broadly divided into two sections: an Old Testa-
ji'rism), and the ment (inherited from Judaism) and a New Testament (focusing on the life
of Jesus Christ and the early church in the years afterhis death and ascen-
s communicated sion). Within the New Testament, four books, called the synoptic Gospels
incorporation of (Matthew, Mark, Luke, andJohn) record the life and teachings ofJesus Christ.
, issues (Garzon, These books were probably written between 60 and 100 AD (Walsh, 2005). At
:rctice has been least 100 separate Christian sects exist, roughly broadly divlded among Roman
rtriented psycho- Catholic, Eastem Orthodox, Mainline Protestant, Evangelical Protestant, and
J). The idea of Fundamentalist Protestant denominations. Christians are unique in their belief
, he more cultur- in che existence of one God existing in three persons: God the Father, the Son
,hen, Deblinger, (Jesus), and the Holy Spirit. Christians of varying denominations are united

.SACRED TEXT.S 157

in their belief that all of humanity is separated from God the Father because in Muslim cultui
of sin and that belief in the person of Jesus and the atoning work of his death of the individual
and resurrection are necessary for salvation from sin. identifii and sepa
Protestant Bibles contain 66 individual books (39 in the Old Testament Parents m?1z presr
andZT in the New Testament). Roman Catholic and Eastem Orthodox ver- have difficulq'ac
sions of the Bible maintain an additional 10 and 13 books, respectively, as than with their I
canon. Christian denominations vary widely in their approach to interpreting Muslim families i
the Bible. Most denominations emphasize the importance of considering the to navigate throu
cultural context in which the original works were written. However, denomi-
nations differ widely in the importance they place on scripture as a source of Judaism
authority for knowing truth. Depending on the specific sect, scripture is typi-
cally balanced against the authority of religious leaders, reason, tradition, and The two pri
personal experience as sources of knowledge. Protestants and Roman Catho- Bible, known as i
lics differ most widely on the role of church leadership in interpreting scrip- tions. The Torah
ture. Roman Catholics consider the Pope to have been appointed by the direct (the Pentateuch)
successors of the apostle Peter, and consider all of the modern'day apostles to the founding of t
have been appointed by the direct successors of the original apostles, or 12 dis' The Nevi'im ("Pr
ciples, of Christ. As a result, Roman Catholics are more likely than Protestant Jewish prophet er
Christians in particular to weigh their own personal interpretations of scrip- The Nevi'im also
rure againsr those of the Pope and their religious leaders. Protestant Christians kingdoms and det
emphasize a priesthood of all believers and are more likely to interpret scrip- the temple inJeru
ture in the light of tradition, reason, and personal experience. tures"), is a colleci
leaders leading up
Islam The TalmuJ
the era of the Sec,
The word Islam means "peace" and implies submission to God. Islam 475 CE) pertaini
is a monotheistic and Abrahamic faith, and its followers are referred to as the application t
Muslims. The Qur'an, the Muslim holy book, was revealed to the Prophet prayer, keeping tL
Muhammad by God and serves as the primary source of guidance for Muslims. and dietary resrrii
The Sunnah, or the sayings, actions, and approval of the Prophet Muham' resource for undei
mad, serve as the secondary source of religious guidance for Muslims. Both discussions abour
the Qur'an and the Sunnah are considered sacred texts by Muslims. life, emotions, dre
Clinicians working with Muslim clients should realize that there is no Clinicians rl
hierarchical religious structure in Islam, whlch can result in religious schol- stand the substar
ars having differences of opinion on the interpretation of varying aspects of denominations ofl
Islam, including issues affecting mental health. For example, parents may ing is further highl
justify family rules for their teenager using the Qur'an and Sunnah as their with Jews, given ri
evidence, but their teenager may provide evidence from the sacred texts that taken by the vari,
may have an alternative perspective, which can complicate psychotherapy. Jews are Orthodo:
Another issue that may affect treatment is the sometimes indistinguish- OrthodoxJer,
able intertwining of culture and religion in different Muslim cultures. Islam People oflsrael ar \
consists of principles and behaviors to be adapted to one's culture, resulting its commands" (Si

t58
:ather because in Muslim cultural traditions that differ depending on the cultural context
rk of his death of the individual. As a result, it is often hard for parents or their children to
identify and separate rvhich beliefs are in fact cultural and which are religious.
J1d Testament Parents may present ethnic cultural values as Islam, which their children may
Orthodox ver- have diffrculty accepting because they identify more with American culture
cspectively, as than with their parental ethnic culture. Therefore, clinicians working with
i.r interpreting Muslirn families are recommended to use a religious and cultural consr-rltant
.',nsidering the to navigate through religious and cr-rltural issues that may affect treatment.
.'cr-er, denomi-
: .lS a SOUTCe Of Judaism
ripture is typi-
:radition, and The two primary Jewish sacred texts are the Bible and the Talmud. The
\t'rm?n Catho- Bible, known as the Tanach, consists of 24 books divided among three sec-
:.preting scrip- tions. The Torah ("Teacl-ring") is the lirst section and contains five books
,i br the direct (the Pentateuch) focusing on the creation of the rvorld, the early history of
-iav apostles to the founding of the jewish people, and the basic commandments for living.
siles. or 12 clis- The Nevi'im ("Prophets") is the second section, concemed mainly with the
han Protestant Jewish prophet era following the Jewish people's entry into the land of Israel.
-:tions of scrip- The Nevi'im also describes the Hebrew monarchy and its division into two
:-rnt Christians kingdoms and details the prophecies warning of the irnpending destruction of
:nrerpret scrip- the temple in Jerusalem. The linal section, the Ketuvirn ("'S7ritings" or "Scrip-
tures"), is a collection of prophesies, reflections on living, and stories ofJewish
leaders leading up to and during the Babylonian exile (McDonald, 2007).
The Tahnud is a vast collection of rabbinic discussions occurring during
the era of the Second Temple and the years after its clestruction ( 100 BCE-
r., God. Islam 475 CE) pertaining to the practical interpretation of the Bible. It covers
: referred to as the application of blbhcal law in daily Jer,vish life, including the laws of
... the Prophet prayer, keeping the Sabbath, holidays, interpersonal matters, marital issues,
:.- tbr Mr-rslims. and dietary restrictions (Steinsaltz, 2010). In addition to being the primary
.lhet Muham- resource for understanding ]ewish law, the Talmud also contains numerous
\Ius1ims. Both discussions about living in general, including insights into the meaning of
isiims. life, emotions, dreams, internal conflicts, well-being, and character grorvth.
irat there is no Clinicians r.vorking rvith Jewish populations are encouraged to uncler-
:clisior-rs schol- stand the substantial differences that exist between men-rbers of various
'i-ine aspects of denominations of Jews (Langman, 1995, 1999) . The need for such unclerstand-
c, parents may ing is further highlighted when considering the appropriate use of sacred texts
,-rnnah as their with Jews, given the diverging approaches toward the Bible and the Tahnr-rd
icred texts that taken by the various denominations. The three primary denominations of
sr-chotherapy. Jews are Orthodox, Conservative, and Reform.
s rn.listingr-rish- OrthodoxJelvs "accept that G-d gave the Torah, the Hebrew Bible, to the
cr-rltr-rres. Islam People of ]srael at Mor-rnt Sinai, along rvith a divinely ordained interpretation of
rlture, resulting its cornmands" (Schnall,2006, p. 277).Orthodox Jews apply the teachings

SACRT'D TEXTS 159

of the Bible and the Talmud to all aspects of life, including daily routines, \X/ebster-
personal interactions, family life, and business matters. Because the Talmud is ment program
,"". u, equally authoritative as the Bible, the use of both passages from both pliance with p.:
,"rr, ,o.,id be appropriate with and accepted by an Orthodox Jewish client. at home and ir
Conservative and Reform Jews practice a more egalitarian Judaism and training progre
emphasize the need to view Jewish law in the context of modernism. Con- ents of childre
,"ruutiu" Jews may be more likely than Reform Jews to ascribe divinity to the programs cont
Blble. However, both denominations view the Talmud as discussions with in a group con
historical value but little legislative authority (De Lange, 2000). As such, the addresses paret
Lrse of the Bibie in therapeutic interventions may be more appropriate
with management'
Conservative and Reform Jews than the nse of the Talmud' Eyberg's
was originalh'
adapted for o1.
INCORPORATING SACRE,D TEXTS INTO PARE,NT TRAINING vidual therapr
techniqLle to t
Two out of three psychotherapy referrals for children and teens are for the child. Evk
behavior problems that are frequently addressed through parent training in child for gooJ
behavioral interventions (Barkley, 7006). Highly religious parents often imbue the ways in u'i
their parenting role with sacred significance-a process some have referred tionship rvith
to u, ,orr.r,f cation of parenting (Mahoney, Pargament, Murray-Swank, &
Murray-Swank, 2003). Elsewhere, we have argued that because religiously Pretreatment
.o*-itt"d parents frequently view their parenting role as a sacred calling, it With Religio
can be important for psychotherapists to help them understand parent train-
ing in lighr of that importance (walker, Reese, Hughes, & Troskie, 2010). In parer:
Th."" of the more prominent, empirically supported parent training treat' to explore ar:

ment packages available are Barkley's (1997) Defiant Children parent training specific paren
program, Webster-Stratton's (2005 ) Incredible Years parent training program, cally support,
u.,JEyb"rg', parent-child interacrign therapy (PCIT; Zisser & Eyberg, 2010). sons. First, u'
These treaim"rrts hu,r" been demonstrated to redr-rce disruptive behavior among directives rci-
children and to increase parental self'efficacy related to parenting practices apply them. S
(Barkley, 2006; Hood & Eyberg, 2003; Webster-Stratton, 2005)' religious insr:
believe that
Summary of the Three Programs openly discu.
the parent's r
Barkley's (1997) De{iant Children parent training program is designed religior-rslv cc
to provicle approximately 1 Z sessions of parent training and can be adapted to and psycht,ti
family therapy or collateral treatment for parents or administered in a parent or outright r.
group format. Barkley (1997) developed the Deliant Children parent training that thcl'u'i
fr,,giu- for parenrs of chilclren r,vith a cognitivc or clevelopmental level of being tre:'rt.-.
ut l"utt 2 years of age but suggested in the manual that children as yoLlng as ment motlLlli
a par' education, I
1B months of age may bene{rt frclm treatment. Barkley also recommendecl
allel version olthe program for teenagers (Barkley, Edrvards, & Robir-r, 1999). or-rt, and (cl)

160 \X/ALKER ET AI,,

rt daily routines, Webster-Stratton's (2005) Incredible Years is a multidimensional treat-
use the Talmud is ment program for parents, teachers, and children designed to increase com-
issages from both
pliance with parent and teacher reqLrests and to eliminate disruptive behavior
ior ]ervish client. at home and in school settings. The Incredible Years consists of two parent
rian Judaism ancl training programs, the BASIC and ADVANCE parenting programs for par-
ro.lernism. Con- ents of children ages 2 to 12. Both the BASIC and ADVANCE parenting
re divinity to the programs contain 14 sessions that have video vignettes for parents to discuss
iiscussions with in a group context. The program begins by buiiding parenting skills; it then
JJ). As such, the addresses parental interpersonal issues, such as problem-solving skills, anger
-rrpropriate with management, and social sllpport.
Eyberg's (2005) PCIT is usually conducted in 16 sessions or ferver. It
rvas originaliy developed for r-rse with preschoolers ages 3 to 6 but has been
adapted for older children. PCIT has traditionally been conducted in an indi-
TRAINING vidual therapy format in which the therapist lirst demonstrates and explains a
techniqr-re to the parent and then provides live coaching for the parent with
rnJ teens are for the child. Eyberg uses the acronym PRIDE to teach parents to praise their
r.ent training in child for good behavior, reflect on what their child says, imitate and describe
ents often imbue
the rvays in which their child plays, and be enrhzslastlc in br-rilding their rela-
:re have referred
tionship with their child.
-rra1'-Su,ank, &
:-ir,-.e religiously
Pretreatment Considerations for Parent Training
:-icred calling, it With Religious Parents
nJ parent train-
Troskie, 2010). In parent training rvith religious parents, we encolrrage psychotherapists
: training treat- to explore and consider ways in which a parent's religiotis text prescribes
r p.rrent training
specilic parenting practices that may or lnay not be compatible with ernpiri-
-.rining program,
cally supported parenting interventions. This is important for several rea-
i E1'herg, 2010).
sons. First, rvhen psychotherapeutic practices are compatible with religious
'behavior
among directives related to parenting, religious parents will more readily receive ancl
-nting practices apply them. Seconcl, when psychotherapists perceive areas of conflict bet',veen
r). religious instructions related to parenting and their treatment protocols, lve
believe that they should demonstrate respect for parental religior-rsness by
openly discussing areas of potential disagreernent and, if necessary, respecting
the parcnt's right to not incorporate all aspects of the program. Finally, when
r.rm is designed religiously committed parents sensc conflicts betrveen their religious tenets
in be aclapted tcr
and psychotherapy practices, they may passively avoid irnplementing them
L'rcd in a parent
or outright refuse. Openly discussing are as of clifference mirkes it more likely
parent training
that they r.vill choose to participate, ultimately benefiting the child client
rnental level of being treated. In the foilorving discr-rssion, we consider four cornmon treat-
rell its yollng as ment modlrles across ernpirically supportecl parenting programs: (a) psycho-
runencled a par-
eclucation, (b) teaching attending skills, (c) using psychotherapeutic time
. Robir-r, 1999).
out, ancl (d) using a token econolny.

.SA(]RED TEXT.S 161

Integration of Sacred Texts With Parenting Modules Teaching Atten.

The atten
In this section, we describe the use of sacred rvritings in parent training cess of gir.ing p
modules from difTerent empirically supported parent training programs. Our
programs. In tl
intention is to describe the use of sacred writings in such a way that practi- ment for desirc
tioners can incorporate our clinical recommendations across empirically
behavior and :

sr-rpported parent training manuals such as Barkley's (1997) Deliant Teen

selectively atte
manual, Eyberg's (2005) PCIT manual, or'lTebster-Stratton's (2005) Incred-
specilic, labele.
ible Years manual. As a result, we focus on modules that are common across
arenolv"). In ..
these and orher parent training programs.
their child beir
In our ci:
Pslchoeducation
(particularlr t:
When providing psychoeducation to parents about the causes of child- object to the n.
hood misbehavior, psychotherapists may find it helpful to discuss parents' iors. Occasit'rn:-
beliefs about religious and spiritr-ral explanations (e.g., the role of sin) for their example, Jeri-i.i
'i
child's misbehavior. This is important for trvo reasons. First, some parents that neecls ttr
who are highly religior-rsly committed might blame their child's misbehavior thoughts ofpe.
on sin or another spiritual cause on the part of the child. For example, sorre pr-rnishment (.:,
Muslirn parents may blame mental health symptoms or child misbehavior on parenting pr.rcl
possession by supernatural beings referred to as jlnns. The notion of sr-rper- Other p-'.:
natural beings does exist in Islam; horvever, there is a difference of opinion that their ci-rii.i
among scholars regarding their role in mental health symptoms. Supernatural some religir-,us :
causes are more typically attributed to symptoms and diagnoses that are dif- cally man,-lat..i
licult for the family to understand, such as psychosis, mania, or schizophrenia. that psychc-rrl-r.
Therefore, a religious consultant should be contactecl in such cases. Our clini- tions that ini'. .

cal cxperience has been that religious parents' spiritual attributions abor-rt support sclecti'.
child misbehavior vary to some degree dependir-rg on the religion of the par- For exampie. '.'
ent. Some conservative Judeo-Christian parents more frequently attribr-rte cussion of a c. :
child rnisbehavior as being relatcd to sin in cases in which the child has rocl spoils rl-rt ;
been diagnosed lvith a neurodeveloprnental dlsability (e.g., attention-cle{icit/ Walker -'.:

hyperactivity disorder) or an alrtism spectrum disorder and the parent or par- of this passasc
ents are unaware of the cxtent to which the condition results in difirculty in with thc cr.,.'.
behavioral regulation. the context ..- i
Conversely, other religiously committed parents might believe that their children ratl-r.r
child's spirituality naturally prevents them from having a diagnosable con- as a s$,itch or a
dition that needs treatment. One of us (Avidan Milevsky) once treated an parent trarnrr.
Orthodox Jewish teenager referred by his pediatrician because of concerns cally repre.cir:,
over the teen's symptoms of anxiety. During the initial stages of treatrnent, the A sin-ii1--,:
teen's mother said that he was a "big masmid" (i.e., someone who is extremely punishment i:r.
engaged ir-r the study of the Bible), and as a resr-rlt of this presumed spiritual rejected. Ftrr :
maturity, she founcl it difhcult to believe that her son needed psychotherapy. specilicaili' sr-.-:

162 WALKER ET AL,

 T e aching Att ending Skills

The attending skills module is a foundation for later teaching the pro'
rarent training cess of giving parental commands to increase compliance in most parenting
frograms. Our programs. In this module, parents provide positive and negative reinforce-
av that practi- ment for desirecl behavior, which involves selectively attending to desired
)ssempirically behavior and ignoring mild forms of undesired behavior. When parents
Dehant Teen selectively attend to desired child behaviors, they are encouraged to provide
(1005) Incred-
specific, labeled verbal praise (e.g., "l love it when you play quietly like you
ITIT)ITIOrI aCTOSS
are now"). In our parenting work, we commonly encourage parents to "catch
their child being good."
In our clinical experience, some highly religiously committed parents
(particularly those who self-identify as conservative or fundamentalist)
auses of child- object to the notion of providing positive reinforcement for desirable behav-
iscuss parents' iors. Occasionally, these objections are gror-rnded in religious instruction. For
--,isin) for their example, Jewish parents may view evil as an inclination within their children
, some parents that needs to be sr-rbdued. This behef is based in part on Genesis 5:6: "The
'smisbehavior thoughts of people are evil all day." As a result, Jewish parents may believe in
:sample, some punishment (as opposed to positive reinforcement) as a religiously congruent
.rishehavior on parenting practice.
rtion of super- Other parents object to the use of positive reinforcement on the grounds
rce of opinion that their child should behave without having to be rewarded. Furthermore,
,. Supernatural some religious parents have been taught that cotporal punishment is a specifi'
es rhat are dif- cally mandated practice in their religious tradition. In response, we suggest
.chizophrenia. that psychotherapists explore scriptural passages from various religious tradi'
r.es. Our clini- tions that involve corporal punishment or that could alternatively be used to
.b,utions about support selective attention and positive reinforcement as parenting practices.
ion of the par- For example, when working with Christian parents, we encourage open dis-
:ntly attribute cussion of a commonly cited passage that instrr-rcts parents that "sparing the
rhe child has rod spoils the child" (Proverbs 13.24).
entlon-deficit/ Walker and Quagliana (2007) proposed an alternative interpretation
'
Parent or par- of this passage that notes that in biblical times, shepherds also guided sheep
in difficulty in with the crook of the rod rather than striking them with it. Considered in
the context of child rearing, this verse could encourage parents to guide their
lieve that their children rather than (or in addition to) striking them with an object such
Lgnosable con- as a switch or paddle. When reconceptualized this way, Christians receiving
nce treated an parent training could view the rod in Proverbs 13:24 as a tool that is symboli-
se of concerns cally represented by the r-rse of selective attention.
treatlnent, the A similar dynamic may exisl in Muslim families, for whom corporal
ro is extremely punishment may be a culturally accepted practice but one that is religiously
un-red spiritual rejected. For example, one hadlth (or saying of the Prophet Muhammed)
si'chotherapy. specifically states, "Do not abuse anyone." Prohibitions against abuse extend

SACRED TEXTS 163

tli
tii
til

It
 to verbally abusive behavior such as belittling children. For such parenrs, a
found in Gali
reminder from the Qur'an may help refrarne their behavior in religious terms:
focus on a rel;
"o you who believel Ler not a group scoff at another group, it may be that the children and a
latter are better than the former" (Qur,an 49:11).
ciated rvith th
It is imperative to be. aware that parental openness to considering ner, Muslim p
alternative views of particular scriptural passages varies widely. In general,
the Qur'an ttr .
parents from mainline denominations (across religious falth traclitionsj
have conseque
are probably more open to considering new ways of thinking about speciflc
br-rt for his ou-:
passages. Parents from conservative traditions are more hkely
to accept a hurt; and no !
reframing of a particular scripture when it is done by a psychoth"rupirt
(Qur'an 17:15'
from their own faith tradition. In religiously mixed pry.httir"rrpy dyrdr,
many religiously committed parents are more willing to consider a, uit..-
Creating aTok:
native reconceptualization of a particular passage if rheir psychotherapist
has demonstrated respecr for and a desire to work within;heir particular This treai
faith tradition. manr-ral develtrf
However, some conservative or fundamentalist religious parents simply PCIT.ln imple:
will not consider an alrernarive interpretarion of theircu.i.d lviirir-rgr, erren if to specific desir.
their psychotherapist is from rhe same faith tradition. one of .,s (Milevsky), diately, throush
having completed rabbinical ordinarion, was working in a psychoth".opy r",- are stratified st
ting and with orthodox Jewish clients. Despite hir oidlr,ruilon, he founcl that larger reu,ard. t:-
the parents he was working with would nor consider challenges to their reli- tem, in particit,
gious beliefs abour parenting. Although he was a tailored to rhc c
Jewish rabbi he found him-
self having to obtain a release of information and collaborate with his clients, !7e enc..ri:
rabbis in order to work with them on parent training. This anecdote illustrates omies are coml-:
the danger that psychotherapists may face ,h..r .hull"nging parental reli- among both Tc,.
gious beliefs. 'we encourage psychotherapists to rread hghtly when parenting cleci.r
walking
on sacred ground related to parenting and to collaboral as necessary rith he willnor dep::
clergy members from their clients' religious tradirions. size to Judeo-C
and the neerl rr-
Psychotherapeutic (Jse of Time Out of a child. Use.
challenging son:
Parents bring a wide range of experiences with time out when they
present for parent training. some parents have previously attempted Jewish parenrs !
time on this concepr
out with their children unsuccessfully and are therefore opposed-to furure
tion he may L,ec,
attempts to use this intervention. others prefer corporal punishment (often
Similarly, in rh.
on the religious grounds that we have cited) and are oppnr"d to a noncorporal
said, "Don't tak.
form of intervention. Either way, time out is a .rrorr component of most
ability" (Bukhar
parenting programs because it is typically the only punishment suggested
for an individual's.i
misbehavior.
comes on the b:
\7e encourage psychotherapists to ask parents *,hether time out is an parents who insi
intervenrion that is compatible or incompatible with their religious tradi-
can be drarv int.-
tions for parenting. For example, among christian parents, time out could
treat each indir-r;
be considered as congruent with the idea that "people reap what rhey
sow,, personality.

164 \T/ALKER ET AL
 such parents, a found in Galatians 6:7-8. Psychotherapists mighr encourage parenrs to
,religious terms: focus on a religious reference to the consequences of misbehavior among
may be that the children and a1lo'"v their children to experience natural consequences asso-
ciated with their behavior (walker & Quaglian a, zooT).ln a similar man-
to considering ner, Muslim parents may be encouraged to use the following verses from
lelr'. In general, the Qur'an to assist parents and their children to understand that behaviors
rith traditions) have consequences: "lThoever chooses to follow the right path, follows it
s about specific but for his own good; and whoever goes astray, goes but astray to his own
:eli' to accept a hurt; and no bearer of burdens shall be made to bear another's burden"
svchotherapist (Qur'an 17:15).
,therapy dyads,
rsider an alter- Cr eating a T oken Economy
svchotherapist
heir particular This treatment component is a prescribed part of the Defiant children
manual developed by Barkley (1997) and an optional part of treatment within
parents simply
PCIT. In implementing a token economy, parents must link individual rewards
rrirings, even if to specific desired behaviors. In addition, behaviors must be reinforced imme-
diately, through verbal praise, the use of a small roken, or both. Finally, rewards
us (Milevsky),
are stratified so thar these tokens are rhen exchanged for daily privileges or
:hotherapy set-
larger rewards that the child can earn over rime. within Barkley'i (1997) svs-
. he found that
tem, in particular, a key feature of the module is that particular rewards are
es ro their reli-
he found him-
tailored to the child's unique interests.
i'ith his clienrs' \7e encourage psychotherapisrs to highlight ways in which token econ-
dote illustrates omies are compatible with religious prescriptions for parenting. For example,
among both Jewish and Christian parents, an often-cited scripture about
: parenral reli-
u'hen walking parenting declares, "Train a child according to his way; even when he is old
he will not depart from ir" (Proverbs 22:6). This verse can be used to empha-
recessary with
size to Judeo-chrisrian parenrs the imporrance of flexibility in parenring
and the need to railor parenting (including rewards) ro rhe individual needs
of a child. Use of this verse can be integrated when working with parents on
challenging some of their faulty cognitions abour the musts of parenting. For
,ut rvhen they
Jewish parents specifically, the Talmud (Tractate Sabbath, 156a) expands
:tempted time on this concept by stating, "lf an individual is born with a violent diiposi-
osed to future tion he may become a murderer or a medical practitioner or a circumciser."
(often Similarly, in the sunnah of the Prophet Muhammed, ir is recorded that he
'hment
a noncorporal said, "Don't take upon yourselves, except the deeds which are within your
rnent of most ability" (Bukhari). These statemenrs reinforce the importance of assessing
r suggested for an individual's disposition and sreering the individual toward adaptive out-
comes on the basis of his or her unique temperament. Thus, authoritarian
rime out is an parents who insist on specific behaviors that their children must abide by
:ligious tradi- can be draw into a therapeutic discussion using scripture abour the need to
.me out could treat each individual child according to the child's unique temperament and
hat they sow" personality.

SACRED TEXTS 165

Case Study: Parent Training Using Sacred Texts following hadit
a child shouid,
one of us (Sameera Ahmed) saw a 7-year old girl named Farima because During th
of her repeated angry outbursts, irritabiliry, defiance, and acting-out behav- that he was unc
ior. During her initial intake, her parents indicated that these behaviors only tion to her. In
took place at home and that her teachers at school reported that she was a affection. She :
model student. encouraged the
Exploring family dynamics revealed that the morher was the discipli- A man pa-,
narian of the family and was overwhelmed by demands at work and loneli- and said. "l
ness because of a lack of her family and a social network. Fatima's father was The Proph
supportive of his wife but unable to assist her because of long work hours and people. A p
feeling unsure of how to parent Fatima. Her parents reported difficulties with to him."
setting limits with their daughter and giving mixed or unclear messages about In subseqr
their expectations of her, and they were inconsistent in following through physical sensati
with discipline. Exploring Farima's daily schedule, Ahmed observed that activities to te
Fatima was often sleep deprived, lacked relaxation time because of a stressful activities to cal
family schedule, and ate junk food to substitute for main meals. The lack of hadlths of the I
developmentally appropriate needs being met, coupled with a stressful home should either cl
life and the need to enhance parenting skills, appeared to be contributing to water) to decre;
the negative parent-child interaction. While assessing for sources of social The sessit
support, the family indicated that Islam served as a source of spiritual direc- ational anah'sis
rion for how they lived their life. In addition, they reported obtaining great to their anger .
support from their religious community. used the folioivr
The initial session began with helping Fatima's parents reframe the pre- positive commu
senting problem. Ahmed reminded them of a Qur'anic verse, "But it may
O you s'h.r
happen that you hate a thing which is good for you, and it may happen that
the latter a
you love a thing which is bad for you. Allah knows, what you know not"
insult one -
(Qur'an 2:216), to reframe their child's behavior as an opportunity to adjust
after havin,
the presenr family lifestyle and dynamics. She provided psychoeducation indeed rl'r.-:
about normative developmental needs for sleep, nutrition, and relaxation
to promote Fatima's development. The next few sessions involved parent Through this p:
rraining that focused on building the following parenting skills: identifying positive comml
Fatima's behavior patterns, increasing opportunities for positive parent-child The final sessiL-rr
interaction, and communicating effectively. help equip the i
During the early stages of psychotherapy' Fatima's parents expressed
concern about increasing opportunities for positive parent-child interac-
rions as a parenting goal. Both parents felt that Fatima had been very dis- COGNITIVE
respecdul and should be expected to comply with parental requests even in
the absence of a nurturing interaction from them. To challenge this belief,
Ahmed reminded Fatima's parents that the Prophet Muhammad was known In this sec

to have taken time out to play with children and encouraged others as well to cognitive-behai
strengthen the attachment between children and caregivers. She quoted the We begin b1're'

166 UTAI-KER ET N-.

 folbwing hadith, in which the Prophet Muhammed said, "Those who have
a child should acr like a child with him."
Fatima because During the early phases of psychotherapy, Fatima's father also adrnitted
:ing-out behav- that he was uncomfortable providing emotional and physical displays of af{ec-
: behaviors only tion to her. In response, Ahmed processed his discomfort in giving Fatima
i tl-rat she was a affection. She also quoted a hadith showing how the Prophet Muhammad
encouraged the display of affection with children:
;as rhe discipli- A man passed by as the Propher Muhammed was kissing his grandson
'ork and loneli-
and said, "l have ten children, yet I have never kissed anyone of them."
Li.na's father was The Prophet replied, "We have nothing to do rvith those harsh hearted
ri'ork hours and people. A person rvho shorvs no mercy to others, God will show no mercy
Jiiticulties with ro him."
'rnessages about
In subsequent sessions, Ahmed rhen helped family members identify
Lori,ing through
physical sensations associated with anger and taught relaxation exercises and
I observecl that
activities to be practiced by Fatima and her parents at home. In identifying
use of a stressful
activities to calm one's anger, Ahmed reminded the family of the varying
als. The lack of
hadiths of the Prophet in which he advised that a person in a srate of anger
stressful home
.r
should either change his or her position or make ablution (a ritual wash with
contributing to water) to decrease his or her state of anger.
oLlrces of social
The sessions that followed helped Fatima and her parents to do a situ-
f spiritr,ral direc- ational analysis and identlfy negative self-statements that were contributing
obtaining great to their anger during negative parent-child interactions. The family then
used the following Qur'anic verse as a springboard toward developing more
reframe the pre- positive communication:
:se,"But it may
ray happen that O you who believe, let not a group scoff at anorher group, ir may be that
the latter are better than the former. . . . Nor defame one another, nor
vou know not"
insult one another by nicknames. How bad is it to insult one's brother
:tunity to adjust
after having good faith. And whosoever does not repenr, then such are
s1'choeducation
indeed rvrongdoers. (Qr-rr'an 49 :ll)
and relaxation
nvolved parent Through this process, Fatima and her parents were able to establish more
iills: identifying positive communication and develop a positive parent-child relationship.
vc parent-child The fina1 sessions focused on effecrive problem solving within rhe family to
help equip the family for future challenges.
rents expressed
r-child interac-
,1 been very dis- COGNITIVE-BEHAVIORAL THERAPY FOR CHILDHOOD AND
rcquests even in TEENAGE ANXIETY AND DEPRESSION
enge this belief,
mad rvas known In this section, we consider the use of sacred texts in the context of
crthers as well to cognitive-behavioral therapy (CBT) for childhood anxiety and depression.
She quoted the We begin by reviewing secular protocols for each of these disorders. Next,

SACRED TEXTS 167

 we discuss ways to incorporate sacred writings
into treatment components
of protocols for each disorder. we concrud" Cognir
b"y p..r..,ii;;;;rr" srudy using
amalgamated client data demonstraring the ,";r.p";;;"Jr]u.."d
rexrs inro
the rreatment of childhood anxiety ur-ri d.p."rrio.,. Ir
have a
Cognitive-Behavioral Therapy for Childhood Stark, I
Anxiety
revietv:
Kendall and Hedtke's (2006) coping cat manuar psychcr
is a widery used, empir-
ically supported treatment for childhood anxiety (Kendall, depress
Hudson, Choud-
hury, webb, & pimentel, 2005). The manual'** family,
d";;iop"d for children
ages 7 to 13 and is designed_to complete in these
rreatmenr in 17 sessions, although
Kendall has encouraged psychotherapists to appry area $,i
the manual flexibry. coplng
car reGrs to a drawing of a car that is ,r"d irr,i,. childho
.rritJt -mpanion work-
book to the psvchotherapist manuar. Throughout manual.
;.;;;, ;he coping cat
(specific
is present to illustrate rreatment conceprs
,.rd to allow the .rrira a practice
them in workbook exercises. As part oith" treatment, applicat
chirdren are taught a
four'srep procedure, summarized [y th. FEAR itself car
r.rorry*, r"ii'"t*sf,rghtened?
(b) expectingbad things to hrpp..,i (c) attitud.esand W:
actions'rrrri,,irr help? and
(d) results and rewards. Treaiment using goals an,
the coping cr, *rr,rrr begins with
rapport building with an anxious child chent.
N:"; , pry.hoth"rrpist using 1.
the coping cat manual wirl help the chird ,o
ia".,ii6irffi; feelings and 2.
somatic responses to anxiety. Afterward, reraxation
training i, i.rtrodu."d, i., :
which the child is taught diaphragmatic breathing
once the child has practiced r"rr*utio, training,
r;J;-r-; relaxation. 3. 1

,",r"rur sessions are typically t

spent teaching the child about self-talk u.,d
,rlirtr,-,g ,h";hilJ i" modifizing
his or her self'talk in anxiery-provoking situarions. Acr
As part of this process, rhe
chtld ts encouraged to .raruate the ri[elihood that for 20 ses
happen, norice his or her own serf-tark, then
;;hi;;;egative wiil tional mt
modify ,lri, ,"ii-*rr. and cor-
responding actions to more-effectively deal are taugh
with ,,hrt"u". r*rro. is causing
the ch-ild anxiery. Finarly, the child.ii"r,, is taught ing skilis r
to evaluare the results of 'We,
his or her efforts to cope and to reward him-
or herserf with praise or rangible
rewards for successfully coping in anxiety-provoking ventions
,i,rur'ior,r. a separate,
parallel manual exisrs for adtlescents .ril"d treatmenl
th" b.a.r.-irojrr, manual
(Kenda1l,Choudhury,Hudson'&Webb,2oo2), encouragi
Parental involvement in the program is also and teach
encouraged for several
reasons' First, some parents may themselre,
hu,r" ,"*i",y ir,r?.iuld b. .or-r-
tributing to their child's anxiety. In addition, nonanxious Using Sar
parenrs are arso
encouraged to participate to reinforce the and Deprr
coping lessons that their chil-
dren^are learning. A number of outcome
studies have demonstrated that
the coping cat manual is more effective than placebo, Tan
,,o ,r"rr*enr, or an
alternative form of rreatment across different ible with (
clinical trials (Kendail, Furr,
& Podell, 2010). foundatior
on learnin

168 vALKERET Ar,.

:nt components Cognitive-Behavioral Therapy for Childhood Depression
case study using
:.rcred texts into In addition to treatments for anxiety, several evidence-based treatments
have also been developed for childhood and adolescenr depression (see
Stark, Streusand, Krumholz, & Parel, 2010; and Weersing & Brent, 2010, for
reviews). The ACTION program developed by Stark et al. (2010) is a group
psychotherapy and assumes that there are multiple pathways to childhood
jelv used, empir- depression, including difliculties stemming from neurochemical, behavioral,
iuJson, Choud- family, and cognitive causes. Stark et al. further suggested that disturbances
:eJ for children in these areas are reciprocal, such that psychotherapeutic changes in any one
rsierr-is, although area will subsequently improve functioning in other areas contributing to
Itiexibly. Coping childhood depression. Similar to Kendall and Hedtke's (2006) Coping Cat
:npanion work- manual, Stark et ai.'s ACTION program is currently geared toward children
:he Coping Cat (specifically 9- to 13-year-olds), and they have focused recent research on the
:i'ii1.1 to practice application of the model in treating depression among girls, but the manual
rcn are taught a itself can be used rvith boys as well.
;lin.g frightened? Writing for school-age children, Stark et al. (2010) summarized the main
:r ri'ill help? and goals and psychotherapeutic steps in the program in the following manner:
lral begins with
1. If you feel bad and don't know rvhy, use coping skills.
ot1-rerapist using
,rus feelings and Z. If you feel bad and you can change the situation, use probiem-
r. introduced, in solving,kills.
..c1e relaxation. 3. If you feel bad and it is due to negative thoughts, change the
rros dre typically thoughts. (p.94)
rlJ in modifying According to Stark et al. (2010), the group is intended to last to last
rhis process, the for 20 sessions, with tr.vo individual meetings for participants (although addl-
1s negative will tional meetings can be scheduled). During the group meetings, parricipanrs
'lt-talk and cor- are taught the interrelationship among thoughts, feelings, and behaviors; cop-
ressor is causing ing skills for depression; and then problern soiving and cognitive resrrucruring.
r.ie the results of 'Weersing
and Brent (2010) have used cognitive-behavioral inter-
raise or tangible ventions in individual psychotherapy r.vith adolescents. The focus of their
-.ns. A separate, treatment rnodel involves identifying and changing cognitive distortions,
Project manual encouraging adolescents to engage in activiries that promote a positive mood,
and teaching problem-solving skills to cope with their negative emorions.
:ecd for several
:r could be con- Using Sacred Texts in Empirically Supported Treatments for Anxiety
r,arents are also and Depression
rl-rat their chil-
ronstrated that Tan and Johnson (2005) contended that sacred writings are compat-
reatment, or an ible with CBT in several ways. For instance, both emphasize beliefs as rhe
(Kendall, Furr, foundation for understanding psychopathology and healing. They also fucus
on learning, which parallels a teacher-disciple dynamic found in many world

SACRED TEXTS 169

religions. Finally, they give prominence to modifying one's thoughts and reports feelins
behavior, which parallels exhortations to change one's heart and behavior never leave us
in many people's spiritual traditions. Furthermore, CBT treatment packages in which Jesus
that use sacred texts from major world religions have been developed for occur when a
Christian, Jewish, and Muslim clients (see Tan & Johnson, 2005). The bulk and refcrenc.-s
of outcome studies using these spiritually oriented forms of CBT have been teenage clienr
done with adult and adolescent participants. Spiritually oriented CBT typi- in his or her 1r;
cally uses scripture in several r.vays. These include (a) cognitive disputation iife r-rsing the i.
using passages from sacred texts to challenge clients' irrational beliefs, (b) use you cor-rnt tl-rc -
of religious imagery to alleviate anxiety, and (c) readings from sacred texts man is given u:
in or outside of session as an adjunct to homework assignments for psycho- A thir.l ri
therapy (Tan & Johnson, 2005). and teer-rs is b','
r.vhich gr-ridej
Challenging Irrational Beliefs and Replacing Self-Talk Using struggling n'irir
Sacred Writings rvhile engaein.
CBT alsr
Our clinical experience has been that elements from the evidence-based the psychotl-re:
practices for childhood anxiety and depression are particularly effective with and ther-r disc..
religiously committed child or adolescent clients when sacred texts are incor- in the ne\t s..
porated into treatment. Sacred texts are used in several ways. First, telling the of sacred tex:.
child (regardless of age) that the treatment that he or she is engaging in is Althougl-r the;
consistent lvith tenets from the child's religious and spiritual tradition makes rvere used in .---

it more likely that the child will engage in it. It also makes it more likely that
the parent will participate and that the parent will believe in its effectiveness, Case Studr: U
if the parent bringing the child in for treatment is of the same faith tradition
asthe child. One ..rf ...
Second, we have found that using scriptural passages is particularly ultra-OrtherJc:.
helpful when helping clients to challenge irrational beliefs and replace dam- at an all-girls r
aging self-talk related to their irrational beliefs. As Tan and Johnson (2005) therapy atter S
pointed out, disputation using sacred writings can occur at several levels. At related to l'rcr
an indirect level, a psychotherapist can indirectly refer to truth from a client's about gettinr s:
scripture rvithout citing speci{ic chapters or verses. For example, in develop- concerns. Du:r:
ing a cognitive-behavioral treatment for anxiety, Rosmarin, Pargament, and minor hea.l...cir
Mahoney (2009) disputed irrational beliefs relatecl to anxiety among Jervish indicated tl-rar ,
clients by asking them to consider whether God and anxiety can coexist. This a home inr'.rsl.
disputation is consistent with what Jewish people know about God from the in CBT irnd i-i.
Bible, without guiding a client to a specific chapter or verse. As part of th. .
Cognitive disputations using sacred texts can also occur when using in God ar-rd h;'
more specific references to scriptural passages at varying levels of direct refer- as Hash'gnch.; I
ence. For instance, a clinician might refer to speci{ic teachings or examples ing anxiefi'. \i:
from a client's sacred text without including a chapter and verse rvhere it ing with trusi :

might be found. For example, a Christian teenage client with depression r.vho the chapter tiir

170 U/ALKER ET AL.

:'s thoughts and reports fecling all alone rnight be reminded that Jesus said that he rvoulcl
rrr and behavior never leave us or forsake r-rs without attempting to identify a speci{ic passage
lrment packages in which Jesr-rs said this. More directly, disputation using sacred writings can
r .leveloped for occur when a psychotherapist uses scriptural passages from a client's faith
lC05). The bulk ancl references chapter and verse in the clisputation. For example, a Muslim
CBT have been teenage client who reports feeling depressed and focuses on negative details
=nted CBT typi- in his or her life might be challenged to focus on positive events in his or her
:rive disputation life using the follo"ving verse: "And He gives you all that you ask for. But if
rl beliefs, (b) use yolr count the favors of Allah, never will you be able to number them. Verily,
:.rm sacred texts man is given up to injustice and ingratitude" (Qur'an 14:34).
.cnts for psycho- A thlrd way in rvhich sacred writings can be used in CBT rvith children
and teens is by drar.ving on sacred texts for religious imagery in situations in
which guided imagery is called for. For example, a Christian child rvho is
sing struggling rvith anxiety rnight be asked to imagine Jesus holding hirn or her
while engaging in guided imagery for relaxation training.
CBT also often involves completing homework assignments outside of
. er-rdence-based the psychotl-rerapy office. Passages of scripture can be assigned for homework
'r'effective with and then discussed in session. We present the application of this pracrice
i i.-rts are incor- in the next section, in rvhich we offer a case study demonstrating the use
First, telling the of sacred texts in CBT for a teenager experiencing anxiety and depression.
:s engaging in is Although the case is an amalgamation from several clients, the interventions
:ra.lition makes r.vere used in each of the cases that rvere drawn on for this case presentation.
rL)re likely that
r:s effectiveness, Case Study: Use of Sacred Texts in the Treatment of Teenage Anxiety
re i;irh tradition
One of us (Milevsky) provided psychotherapy for Sarah, a 17-year-old
r-rltra-Orthodox Jewish girl, at the recommendation of one of her teachers
'. is particularly
nJ replace dam- at an all-girls religious high school. Her teacher referred Sarah for psycho-
'l.rhnson
(2005) therapy after Sarah con{ided in her about her pervasive fears and anxieties
everal levels. At related to her own health and safety. Sarah presented with pervasive fears
rh iiom a client's about getting sick and acute anxieties pertaining to personal injury and safety
rple, in develop- concerns. During her initial intake, she reported that every time she felt a
Pargament, and minor headache or pain, she feared that she had cancer. In addition, Sarah
:\' among jewish indicated that she was anxious being alone at night for fear of experiencing
::n coexist. This a home invasion. Milevsky, an ultra-Orthodox Jerv himself, engaged Sarah
ur God from the in CBT and helped her challenge some of the irrational aspects of her fears.
As part of the cognitive restructuring, he integrated discussions about trust
-cur u,hen using in God and how Sarah's beliefs abor-rt God's daily interventions, referred to
1s ofdirect refer- as Hash'gacha Pratis (personal supervision), were antithetical to experienc-
nqs or examples ing anxiety. Milevsky encouraged Sarah to read the classic Jewish text deal-
I verse where it ing with trust in God, Durles of the Heart (lbn Pekuda, 1996), specifically
r depression who the chapter titled "The Gates of Trust." This chapter highlights the various

SACRED TEXTS 171

aspects of belief in God, including the idea that God has knowledge of, and we present u,a
power over, the workings of all aspects of the world and that God in his mercy version ofeac
is compassionate to all. These ideas helped counter the client's anxious feel-
ings by challenging her low tolerance for uncertainty with the realization that Affectiue Expr,
although she may be uncertain about her health and safety, God has knowl- Within r
edge of her situation, is in control of it, and is concerned for her welfare. tion involves
After several weeks of spiritually oriented CBT r-rsing sacred texts, Sarah thought inter
experienced a minimization of her fears and anxieties. rnodule also ir
have been at,r
tic interventi.
TRAUMA.FOCUSED COGNITIVE-BEHAVIORAL THERAPY FOR which chiidre:
CHILDHOOD PHYSICAL AND SEXUAL ABUSE color in the or
\ff/e recently developed a model for addressing religious and spiritr-ral Thought inte:
away) or non,
issues in trauma-focused CBT for children and adolescents (Walker et al.,
Unwanted th.
2010). This spiritually oriented approach to trauma-focused CBT (TF-CBT)
special event.
incorporates aspects of personal religiousness, including reference to sacred
unrvanted th.-
texts for clients from any world religious and spiritual tradition. Although we
Elseu'he:
encourage psychotherapists to address a range of religious and spiritual issues
positive imae.
(with religiously committed clients) across TF-CBT modules, we focus on the
ments if the c1
use of sacred texts in specific TF-CBT treatment modules here.
writings from i
(\X/alker et ai
Overview of Trauma-Focused Cognitive-Behavioral Therapy
a Christian t.
thoughts th:r:
The secr-rlar version of TF-CBT has a number of treatment components,
who had rape;
summarized by Cohen, Mannarino, Deblinger, and Berliner (2009) using the
her to stop h.
PRACTICE acronym. According to Cohen et al., this acronym stands for
Christran hr r
psy choeducation, par ental tr eatment, relaxation, aff ectiue expression and modula-
says that ther.
tion, cognitive coping skills , tratlma narratiue and cognitive processing of the trauma,
In addrtr,
in uio,.to desensitization to trauma reminders, conjoint parent-child sessions, and
and images tor
enhtncing safety atd fua,tre deuelopment. Psychotherapists typically begin treat-
to generate t1-r,
ment with one or more assessment sessions before proceeding with the
aged to consui
manualized treatment. The treatment components are presented in a session-
by-session manner in theory bur are intended to be flexibly appiied so that
tradition. In i
member their,
psychotherapists can engage in any single component at any point in time
psychotherapr,
during psychotherapy.
consent anJ r
passagesfrom .
Application of Sacred Texts Within Spiritually Oriented
Trauma.Focused Cognitive-Behavioral Therapy Modules
Cognitive Co;:.

Throughout this section, we begin by briefly reviewing each TF-CBT This m.'.
module as well as secular treatment interventions within each module. Then, the relationsh:

172 WALKERET AL
rL)wledge of, and we present ways in which sacred writings can be incorporated into the secular
lod in his mercy version of each TF-CBT module.
it's anxious feel-
realization that Affective E xpression and Modulntion
'
God has knowl-
Within the standard TF-CBT manual, affective expression and modula-
her rvelfare.
tion involves teaching clients feeling identiflcation, techniques to engage in
-reJ texts, Sarah
thought interruption, and positive imagery. The standard protocol for this
module also involves teaching affective expression to parents of children who
have been abused. Feeling identification is typically done using a therapeu-
tic intervention such as the color-your-life technique (O'Conner, 1983), in
JEF.APY FOR
which children choose different colors ro represenr different feelings and then
USE
color in the outline of a human figure with the colors that they have chosen.
Thought interruption is usually done either verbally (telling a thought to go
us and spiritr-ral
away) or nonverbally (such as snapping a rubber band on one's own wrist).
rWalker et al.,
Unwanted thoughts are then replaced with positive imagery in the form of a
rBT (TF-CBT)
special event, place, or experience. For example, children sometimes replace
:IeOCe tO SaCfed
unwanted thoughts with the memory of their most recent birthday.
:. -{lthough we
Elsewhere, lve have argued that techniques such as thought stopping,
"i .piritual issues
positive imagery, and coping self-talk might be more powerful treatment ele-
n'e focus on the
ments if the client was encouraged to use stories, songs, or passages from sacred
:i.
writings from their personal religious and spiritual tradition as part of TF-CBT
(Walker et a1., 2010). For example, one of us (Donald F. \X/alker) treated
ap)-
a Christian teenage girl who had been raped and had intrusive, unwanted
thoughts that she was a sinner and that it was her fault for flirting rvith the boy
1t COlTrpOnents,
who had raped her after a party at a friend's house. In this case, \X/alker helped
lJ.l9)using the
'nvm stands for her to stop her thoughts by singing the lirst few lines of "Jesus Loves Me," a
:,n andmodula- Christian hymn. She was then instructed to recite a verse from Romans that
says that there is no condemnation for those who are in Christ (Romans 8: 1 ).
:1of the traLtma,
iJ ses.slons, and In addition to sr-rggesting that psychotherapists use sacred writings, songs,
and images for thought stopping, we have also suggested that lf clients are unable
rilv begin treat-
to generate these writings, songs, or images on their own, they can be encour-
,Jing with the
:cd in a session-
aged to consult rvith a nonoffending clergy member from their personal faith
:pplied so rhat tradition. In doing this, they can ask for assistance without telling the clergy
r point in time member their specific reason for asking, if they wish. We have also encouraged
psychotherapists to obtain their child clients'and parents' informed assent and
consent and to consult with clergy themselves to locate potentially helpfui
passages from their sacred text to be used in treatment ('!7alker et a1., 2010).

C o gnitiu e C oping and Pro cessing I

each TF-CBT This module in the TF-CBT manual involves helping children to see
module. Then, the relationship between their thoughts (reflected in their self-talk) and their

SACRED TEXTS 173

behaviors and feelings, an exercise that Cohen et al. (2009) referred to as the Cognitiue Coplng a
cognitiue triangle. Children and teens are then taught to replace the dysfunc-
In this trear
tional thoughts contributing to their distress with alternative thoughts that
tion and correctic
can help them to feel better. Psychotherapists are encouraged at this point
mon cognitive en
in treatment to focus on non-trauma-related cognitions rather than trauma-
(Cohen, Mannari
related thoughts, whlch are addressed in the second Cognitive Coping and
psychotherapists t
Processing module, which occurs after the client has discussed his or her
trauma-related coi
trauma narrative at length.
religiously commir
In psychotherapy with religiously committed clients, referring to pas-
religious contenr (
sages from their sacred texts may help them to generate self-talk that will help
committed a sin ar
them to think more rationally and to feel better. For example, in our expe-
\7e have als,
rience adolescent girls sometimes blame themselves when they have been
tions involving so
raped. One of us (Walker) has also seen teenage rape victims who, in blaming
For example, Btrtt
themselves, also worry that God will judge them for being raped. Walker has
number of religio
typically directed those clients to biblical passages that speak to God's uncon-
physical or sexuai
ditional love and God's right to judge the person who raped them in helping
sacred writings u'.
them to assign blame to the other person and avoid self-condemnation.
level to "the devil
about abuse that l
Trauma N arrati+te
very powerful and
In describing one's trauma narrative, Cohen et al. (2009) typically ever, we also beli
asked children to describe what happened before the event, during the event can also be pou-er
itself, and afterward. The telling is often done by creating a book with the clients' religious a
client about what happened, although any means that is congruent with the theistic religious L
client's personality is allowable. Some children prefer to write a song or poem part of believers (r
abollt an abusive event. During this treatment module, Cohen et al. also can be particularh
typically asked children what they were thinking and feeling when the abuse by a parent 1v[gr t1.r

was occurring and concluded by having child or teen clients discuss what was ahuse could he rea
different in their life since the abuse occurred. her despite rvhat h
Elsewhere, we have suggested that because the chief aim of the first
module is to help clients integrate the traumatic experience into their life, Summary o{ Spiri
psychotherapists should help religiously committed children and teens to Cognitive-Behar-
explore parallels to their own narrative in stories from the sacred texts of
their religious and spiritual traditions (Walker et al., 2010). For example, the Our purpose r
biblical story of Job might be particularly beneficial for Jewish and Christian for accommodatin,
clients to discuss (Pargament, Murray-Swank, Magyar, & Ano, 2005). This done that previous
story describes an ongoing discussion that occurs between God and Job about complete discussiLrr
Job's suffering after losing his family and his house after a disaster. Although CBT. Instead, n'e h
this example uses a story that is familiar to Judeo-Christian clients, we believe cally be related to c
that psychotherapists should explore similar stories for clients from various have also presentei
faith traditions. For additional spiritually oriented techniques that one might to spirituality usins
use in this module, see Walker et al. (2010). conclude this secri,

174 U/ALKER ET AL.

 referred to as the Cognitiue Coping and Processing II
lace the dysfunc-
In this treatment module, the primary intervention is the explora-
ve thoughts that
tion and correction of trauma-related cognitive errors. For example, a com-
scd at this point
mon cognitive error is the belief that the world will never be safe again
i-rer than trauma-
(Cohen, Mannarino, & Deblinger, 2006). W'e have previously encouraged
::ir-e Coping and
psychotherapists to explore religious and spiritual content when examining
-ussed his or her
trauma-related cognitive errors (\Yy'alker et al., 2010). We believe that some
religiously committed clients may have maladaptive cognitions that contain
referring to pas-
religious conrenr (such as believing that God abandoned them or that they
rlk that rvill help
committed a sin and were being punished by God in allowing the abuse).
ple, in our expe- 'W'e
have also suggested that such cognitions are more likely in situa'
ihei.have been
tions involving some form of religion-related abuse (Walker et al., 2010).
, n'htr, in blaming
For example, Bottoms, Nielsen, Murray, and Filipas (2003) found that a
rieJ. Walker has
number of religion-related abusive experiences involved justification for
. :.r God's uncon-
physical or sexual abuse by a parent or religious clergy member in which
:hem in helping
sacred writings were used to justify the abuse. This is analogous on some
:iemnation.
level to "the devil quoting scripture for his purpose." Obviously, messages
about abuse that have been distorted from sacred texts are, unfortunately,
very powerful and damaging to clients' spiritual and emotional lives. How-
, l.',--r9) typically ever, we also believe that such damage, when rooted in sacred writings,
;uring the event can also be powerfully undone rvhen challenged using other passages from
i t.-ok rvith the clients' religious and spiritual tradition. For clients practicing from mono-
:'!grllent with the theistic religious backgrounds, passages that speak to right conduct on the
a .r song or poem part of believers (in opposition to the abuse that a perpetrator committed)
-.,hen et al. also can be particularly powerful. For example, a child who was sexually abused
: n'hen the abuse by a parent who told her rhat God would send her to hell if she disclosed the
liscuss rvhat was abuse could be reassured, by citing passages from the Bible, that God loves
her despite what her parent told her.
t ain of the first
:e into their life, Summary of Spiritually Oriented Trauma.Focused
:en and teens to Cognitive-Behavioral Therapy
; sacred texts of
Frrr e\ample, the Our purpose in this section was not to comprehensively present a model
.l-r and Christian for accommodating client spirituality within the TF'CBT model. \il/e have
rno, 2005). This done that previously and refer the reader to Walker et al. (2010) for a more
..J and Job about complete discussion of ways to address spirituality and religiousness within TF'
s.rster. Although CBT. Insread, we have hlghlighted ways in rvhich sacred writings may specili-
ients, u,e believe cally be related ro clienrs' beliefs about abuse that they have experienced. We
nts from various have also presented methods to confront potentially irrational beliefs related
'sthat one might to spirituality using sacred rexts as a resource for healing within TF-CBT. We
conclude this section with a case study illustrating these concepts.

SACRED TEXTS 175

Case Study: Using Sacred Texts in Trauma-Focused
Cognitive-Behavioral Therapy
At the L.
!7e recently published an amalgamated case example demonstrating the Kendall and H
use of sacred writings in spiritually oriented TF-CBT (Walker et al., 201O). child and adol
Kristy was a 7-year-old Caucasian girl who r.vas referred for psychotherapy clients undersr
after sexual abuse by her father. Her father was a deacon, a position of lay thror-rghout tl-u
leadership, in a Baptist church. In an attempt to intimidate Kristy into and spiritual tr
remaining silent about the abuse, her father told her that she would go to hell with children :
and God would hate her if she ever reported the abuse. Afterward, Kristy was this assertion.
removed from her biological parents' home and placed in foster care before several ernpiric
being referred for TF-CBT.
ing parent tralr
and TF-CBT t,
As a result of her father's threats, Kristy came to view God as an angry
practice in ti-ris
and frightening {igure. During psychotherapy, she reported that she feared
treatments for i
God would be angry with her and then abandon her if she talked about the
body of literatL
abuse with her psychotherapist. Before discussing her trauma narrative, dur-
anticipate tl"re
ing the first cognitive coping and processing module her psychotherapist
trating olrr apr
addressed her fears by engaging in a collaborative process of identifying and
research usin! :
challenging Kristy's hehefs about God. As part of this process, they looked for
discrepancies between the God that Kristy had been taught about at church
in the Bible and the God described by her father. Eventually, Kristy was able
to recognize the inaccurate view of God that her father had threatened her
with. This process laid the groundrvork for identifuing and challenging many
Aesop, R. D. L..
other destructive statements Kristy's father had made.
Afterward, when Kristy described her trauma narrative to her psycho-
Barnes S. \
therapist, she decided to make a story book. In the book, she drew pictr-rres Barkley, R. (i9v
of u,hat happened rvhile her psychotherapist wrote or-rt the description. Dur- Barkley, R. (Ei.
ing Kristy's telling of the trauma narrative, her psychotherapist asked Kristy NY: Guir:--:
r.vhere she thought God was when the abuse occurred. Kristy said that God Barkley, R. -{.. :
ivas there, helping her, when it happened. In her picture of the abuse, she Neu'Ytr;^. -

depicted God as a star in the sky, helping her in the midst of the abuse. Bottoms, B. L.. -\
After discussing the trauma narrative with her psychotherapist, Kristy phl,sical :':--
hacl some cognitive errors related to God that were not specific to the abuse. slon, \1,i]:-..
At this point in psychotherapy, she was in foster care and did not attend Cohen, J. A.. L-. ^
church with her foster family. As a result, she was afraid that God did not tance t t .;:
know where she was and wondered whether God continued to care for her. empiric.ri :.
To address these fears, her psychotherapist cited passages from the Bible sug. 60020c7
gesting that God is everywhere and knows everything that people do. Her Cohen, J. A.. \1
psychotherapist reminded Kristy that God was with her all of the time. She matic A-i..; :'.
also told Kristy that she could talk to God anytime by praying. Referring Cohen, J. A.. \1
to sacred writings in this fashion helped Kristy to cope with her foster care fsl31.i6v...- ;
placement and, ultimately, to resolve her abuse. M. j. Frie::

176 !.iALKER ET AL,

 CONCLUSION

At the beginning of this chapter, rve used a story recommended in

:nlLrnstrating the Kendall and Hedtke's (2006) Coping Cat manual to illustrate our point that
:er et al., 2010). child and adolescent psychotherapists have often used stories to help their
r ps)'chotherapy clients understand and cope with the challenges of life. \7e have asserted
r position of lay throughout this chapter that the sacred writings found in various religious
i:tc Kristy into and spiritual traditions will be particularly poignant in use in psychotherapy
r','truld go to hell witl-r children and teens from religiously committed families. In keeping with
ri'ar.l, Kristy was this assertion, we have described the use of sacred texts in the context of
riter care before several empirically supported psychotherapies for children and teens, includ-
ing parent training for behavior problems, CBT for depression and anxiety,
itrJ as an angry
and TF-CBT for physical and sexual abuse. We view the emerging clinical
:l-rat she feared
practice in this area as an exciting crossroads at which empirically supported
treatments for children and teens are being informed by a growing, substantial
,.^lked about the
body of literature on the psychology of religion and spirituality. We eagerly
.r narrative, dur-
anticipate the day when our conceptual models and the case studies illus-
rsvchotherapist
trating our approach are supplemented by a considerable body of empirical
rJentifying and
research using sacred texts in psychotherapies with children and adolescents.
. they looked for
-..'l'rrut at church
. Kristy rvas able
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In the 18th
of coping with t.
childhood mon;
and empirical re
gious and spiriri-
& Lagatutta, 2C
of becoming cit-,
range of religiou
In this chi
children and aJ
for considering
therapy. Next. '
ommendations
for the use of p
provide an ovel

DOI: 10.1037/139+i-
Spiriutal lntert enartr:
Copyright O 2013 br

180 UTALKER ET N,,