1. Journal of Psychology and Theology
2011,Vol. 39. No. 1,44-58
Copyright 2011 by Rosemead School of Psychology
Biola University, 0091-6471/410-730
THE EFFECTS OF A MANUALIZED
GROUP'PSYCHOTHERAPY INTERVENTION
ON CLIENT GOD IMAGES AND
ATTACHMENT TO GOD: A PILOT STUDY
MICHAEL J. THOMAS, GLENDON L. MORIARTY,
EDWARD B. DAVIS, AND EUZABETH L. ANDERSON
Doctoral Program in Clinical Psychology
Regent University
The goal of this pilot study was to examine the
effects of an 8-week, manualized, outpatient group-
psychotherapy intervention on client god images and
attachment to God. Participants were 26 adults who
reported a Christian religious affiliation and who
sought religiously based, group-psychotherapy treat-
ment for difficulties in their emotional experience of
God (i.e., negative god images). The treatment pro-
tocol reflected a psychotherapy-integrationist
approach to treating god-image difficulties. Treat-
ment chiefly included psychoeducational, dynamic-
interpersonal, and cognitive interventions, although
it also included allegorical-bibliotherapy and
art/music interventions. The pre- and post-test ques-
tionnaire included the Attachment to God Inventory
(R. Beck & McDonald, 2004) and a brief God adjec-
tive-checklist, along with several open-ended ques-
tions. Participants reported experiencing adaptive
shifts in their god images and attachment to God.
Specifically, when pre- and post-questionnaire rat-
ings were compared, they reported experiencing God
emotionally as more accepting, intimate, and sup-
portive and as less disapproving, distant, and harsh.
In addition, they reported experiencing significantly
both less attachment anxiety with God and less
attachment avoidance with God. Furthermore, they
reported experiencing more congruence between
their emotional experience of God (god images) and
Portions of this article are reprinted from the primary author's
dissertation ("The Effect of a Manualized Group Treatment Pro-
tocol on God Image and Attachment to God," Thomas, 2009)
and from one secondary author's dissertation "Authenticity. Inau-
thenticity. Attachment, and God-Image Tendencies Among Adult
Evangelical Protestant Christians," Davis, 2010). The authors
wish to express thanks to Abrielle Conway, Seth Rainwater, Sher-
their theological beliefs about God (god concepts).
The interventions that were deemed the most thera-
peutically effective were the allegorical-bibliotherapy
and the cognitive-restructuring interventions. Clinical
implications and limitations are discussed.
A
s Hathaway (2003) has highlighted, within
the broad field of mental health, the past 20
years have marked a significant increase in
the clinical attention that is devoted to reli-
gious/spiritual issues. For example, the American
Psychological Association's (2002) Ethics Code now
includes religion among the domains of diversity that
mental-health professionals must address in a respect-
ful and culturally responsive manner (Hays, 2007;
Richards ÔC Bergin, 2000). Another such develop-
ment is the inclusion of the Religious or Spiritual
Problem diagnostic category (V62.89) in the Diag-
nostic and Statistical Manual of Mental Disor-
ders-Fourth Edition-Text Revision (American Psy-
chiatric Association, 1994; see Turner, Lukoff,
Barnhouse, 6c Lu, 1995). As its name implies, this cat-
egory is meant to be used "when the focus of clinical
attention is a religious or spiritual problem" (Ameri-
can Psychiatric Association, 1994, p. 685). For reli-
giously/ spiritually oriented clients, god-image diffi-
culties are a common Religious or Spiritual Problem
that motivates them to seek psychotherapy (Allmond,
ley Saget-Menager, and Stephanie Nowacki-Butzen, for their
group cofacilitation, and to NicholasJ. S. Gibson, Mark Blagen,
Stephanie Nowacki-Butzen, for their instrumentation consulta-
tion. Correspondence concerning this article should be
addressed to Michael J. Thomas, Psychology Department, East-
ern University, 1300 Eagle Road, Mclnnis Learning Center 222,
St. Davids, PA 19087 E-mail: mthomall@eastern.edu.
44

2. THOMAS, MORIARTY, DAVIS and ANDERSON 45
2009). In particular, such clients often experience a
clinically significant discrepancy between their god
concepts and their god images (Yarborough,
2009)—that is, between their head knowledge of a
divine attachment figure (DAF; e.g., God, Allah,
Jesus, Buddha, Krishna, etc.) and their heart knowl-
edge of that same flgure, respectively (Davis, 2010;
Moriarty &C Davis, in press).
In the current article, we report findings from a
pilot study of an 8-week, manualized, outpatient
group-psychotherapy intervention (entitled "Discov-
ering God") that was designed to treat god-image dif-
ficulties, with a speciflc view toward improving client
god images and attachment to God. Our treatment
protocol reflected a psychotherapy-integrationist
approach (Norcross & Golfried, 2005; cf. Moriarty
6c Davis, in press). It chiefly included psychoeduca-
tional, dynamic-interpersonal, and cognitive inter-
ventions, although it also included allegorical-biblio-
therapy and art/music interventions. In the section
that follows, we will briefly describe our psychody-
namic-cognitive conceptualization of god images, on
which both our treatment manual and our clinical
interventions were based.
D E F I N I T I O N S , D E V E L O P M E N T , A N D
D Y N A M I C S
Definitions
As Davis (2010) has described, god images are
the affect-laden mental representations that underlie
a person's embodied, emotional experiences in rela-
tionship with a DAF, such as God, Allah, Jesus, Bud-
dha, or Krishna. They are primarily comprised of
implicit relational knowledge (i.e., "gut-level procedu-
ral knowledge of how to perceive and be in relation-
ship with a general or speciflc relational partner,"
Moriarty & Davis, in press; cf. Hall, 2004; Kihlstrom,
2008; Lyons-Ruth et al., 1998). Basically, god images
"guide and integrate how a person experiences [the
DAF] at an emotional, physiological, largely nonver-
bal, and usually implicit level (i.e., outside of con-
scious awareness; Davis, 2010; cf. Fogel, 2009; Nof-
fke Sc Hall, 2007)" (Moriarty & Davis, in press). Hall
(2007) has thus described god images as a type of
attachment filter (p. 24), through which embodied,
emotional experiences with a DAF are mediated.
In contrast, god concepts are the belief-laden
mental representations that undedie a person's con-
scious, linear knowledge about a DAF. They are
chiefly comprised of semantic memory (i.e., "general
knowledge about the world, including words and con-
cepts, their properties and interrelations," Smith &:
Kosslyn, 2007, p. 541; cf. Davis, 2010; Siegel, 2010).
Essentially, they guide and integrate how a person
thinks and talks about a DAF at an abstract, theologi-
cal, conceptual, and usually explicit level (i.e., inside of
conscious awareness; Davis, 2010). As such, god con-
cepts may be thought of as a type of doctrinal filter,
through which theological, abstract thoughts and dis-
cussions about a DAF are mediated (cf. Hall, 2007).
Development and Dynamics
God-image development and dynamics. It is
beyond the scope of this article to comprehensively
describe the development and dynamics of god
images and god concepts (see Davis, 2010; Moriarty
& Davis, in press, for such reviews). However, we
will provide a brief summary here, highlighting the
points that group-participants read about in our
treatment manual (see Thomas, 2009, Appendix G,
for a copy of this manual).
As Davis (2010) has detailed, our conceptualiza-
tion of god-image development and dynamics is
based on Hall's (2004) relational-spirituality theory
(cf. Hall, 2007; Hall, Fujikawa, Halcrow, Hill, &
Delaney, 2009). Consequently, it is undergirded by
the central organizing principles of that theory, as
enumerated in Hall (2004):
Central Organizing Principle #J. People are fundamentally
motivated by, and develop in the context of emotionally signif-
icant relationships, (p. 68)
Central Organizing Principle #2. There are multiple codes
of emotional information processing which provide a theoret-
ical framework for understanding the way in which close rela-
tionships are processed and internalized, thereby shaping the
patterns of our relationships with God, self and others, (p. 69)
Central Organizing Principle #3. Implicit relational repre-
sentations are repetitions of relational experiences, sharing a
common affective core, that are conceptually encoded in the
mind as non-propositional meaning structures. They are the
memory basis for implicit relational knowledge; that is, our
"gut level" sense of how significant relationships work. (p. 71)
Central Organizing Principle #4. Implicit relational repre-
sentations, formed particularly from experiences [in] early
relationships with caregivers, shape the emotional appraisal of
meaning and subsequent patterns of relationship, (p. 72)
Central Organizing Principle #J. Implicit relational represen-
tations and knowledge form the foundation of our knowledge
of self and others because they are processed automatically, and
are not under the direct control of knowledge in the form of
words that [are] processed in a linear manner, (pp. 73-74)

3. 46 GROUP-PSYCHOTHERAPY, GOD IMAGES, ATTACHMENT TO GOD
Our treatment manual reflected a psychotherapy-
integrationist approach (Norcross 6c Goldfried,
2005; cf. Moriarty &C Davis, in press). As such, our
conceptualization of god-image development and
dynamics highlighted ideas from several theoretical
traditions. For example, from the classical-psycho-
analytic tradition (Freud, 1913/1950, 1930/1962;
Jones, 1991, 2007), we stressed the pervasive and
long-lasting influence of early-childhood experi-
ences in relationship with one's caregivers. From
the object relations tradition (Rizzuto, 1979; Winni-
cott, 1951/1975,1971), we emphasized the process-
es of internalization (Davis, 2010; Moriarty, 2006;
Schäfer, 1968) and of separation-individuation
(Mahler, Pine, & Bergman, 1975), the former via the
caregiver-child relationship and the latter via the use
of God as a transitional object (Moriarty, 2006; Win-
nicott, 1951/1975, 1971). From the cognitive tradi-
tion (A. T. Beck, Rush, Shaw, & Emery, 1979;
DeRubeis, Tang, & A. T. Beck, 2001), we under-
scored the concepts of core beliefs (Moriarty,
2006), automatic thoughts (A. T. Beck et al, 1979),
self-schemas (Markus, 1977; Markus &C Kunda,
1986), and cognitive distortions (DeRubeis et al.,
2001). Last, from the attachment tradition (Bowlby,
1973; Collins, Guichard, Ford, ôc Feeney, 2004), we
underlined the interconnections among internal
working models of self, God, and others, particular-
ly the reliable similarities between one's global (i.e.,
generalized) internal working models of self and
one's global internal working models of God (Ben-
son ÔC Spilka, 1973; Bud & Mueller, 1993; Yarbor-
ough, 2009; cf. Davis, 2010; Hall et al., 2009; Mori-
arty ÔC Davis, in press).
In this latter regard, our conceptualization of
god-image development and dynamics affirmed the
implicit-relational-knowledge correspondence
hypothesis (Hall, 2004, 2007; Hall et al., 2009),
which posits that individuals' experiences in rela-
tionship with human attachment figures (e.g., care-
givers, peers, romantic partners, and coreligionists)
undergirds and parallels their experiences in
embodied, emotional relationship with Cod.
Importantly, according to this hypothesis, people's
implicit relational knowledge of how to perceive
and be in relationship with God is reflected in their
implicit religious/spiritual functioning (i.e., "their
felt religious/spiritual experience at a relational,
motivational, emotional, and physiological level,"
Moriarty ôc Davis, in press) but not necessarily in
their explicit religious/spiritual functioning (i.e..
"their religious/spiritual behaviors and consciously
articulated beliefs; e.g., religious/spiritual commit-
ment, church attendance, and theological beliefs,"
Moriarty & Davis, in press; see Davis, 2010; Hall et
al., 2009, for reviews).
There is preliminary research support for the
implicit-relational-knowledge hypothesis (Davis,
2010; Hall et al., 2009). For example. Hall et al.
. (2009) found that adult participants from the four
main attachment groups (secure, anxious, avoidant,
and fearful) differed significantly on three of four
implicit religious/spiritual functioning indicators
(interpersonal unforgiveness, spiritual community,
and attachment anxiety with Cod) but did not exhib-
it significant differences on the explicit reli-
gious/spiritual functioning indicator (explicit reli-
gious/spiritual commitment).
God-concept development and dynamics. In con-
trast to their god images, people's god concepts are
highly related to their explicit religious/spiritual his-
tory and functioning. Hoffman (2005) has
described god concepts as mainly deriving from
informal and formal learning, via such avenues as
religious/spiritual texts and the teaching and model-
ing of parents and religious/spiritual leaders (Davis,
2010; Crimes, 2007).
In the case of religious/spiritual persons who
report having a personal relationship with a DAF, it is
likely that their god concepts are relatively adaptive
and "accurate," from the standpoint of their primary
religious/spiritual texts (e.g., the Bible, Book of
Mormon, Qur'an; Davis 6c Moriarty, 2008). Howev-
er, religious/spiritual individuals often experience
disparities between the DAF they believe in explicitly
(god concepts) and the DAF they experience implic-
itly (god images; see Davis, 2010; Lawrence, 1997;
Moriarty, 2006; Moriarty &C Davis, in press). The
degree and qualitative nattire of such disparities v^all
vary from person to person. Significant disparities
may reflect the operation of what Bucci (1997) has
termed desymboHzation or dissociation, whereby
"the connections between the subsymbolic and the
symbolic components of the schémas are cut"
(Bucci, 1997, p. 202; cf. Davis, 2010; Davis & Moriar-
ty, 2008) or what interpersonal neurobiologists (e.g.,
Badenoch, 2008; Siegel, 2010) have referred to as a
lack of integration, where integration is defined as
the "linkage of differentiated parts of a system [e.g.,
the mind/brain]" (Siegel, 2010, p. 262; see Davis,
2010, for a review).

4. THOMAS, MORIARTY, DAVIS and ANDERSON 47
RESEARCH ON PROMOTING GOD-IMAGE
CHANGE THROUGH PSYCHOTHERAPY
Research on promoting god-image change
through psychotherapy is admittedly sparse. At the
time of wriring this article (February 2011), there
were only two published, peer-reviewed studies in
this area: Tisdale et al. (1997) and Cheston, Pied-
mont, Eanes, and Lavin (2003).
Tisdate et at. (1997)
First, Tisdale et al. (1997) examined god-image
change through religiously based, object-reladons-
oriented, mulrimodal inpatient-psychiatric treat-
ment. All participants were self-identified evangelical
Christians and most of them were Caucasian and of
middle or upper-middle socioeconomic status. The
mean age was 37 (range: 17-65 years old). Most par-
ticipants had a primary diagnosis of Major Depres-
sive Disorder and had never before been psychiatri-
cally hospitalized. The average length of
hospitalization was 20.2 days (range: 10-43 days).
The following self-report measures were adminis-
tered at admission (N = 99), at discharge (N = 99), at
6 months following discharge (« = 67), and at 12
months following discharge (« = 30): (a) the Bell
Object Relarions Reality Tesring Inventory (Bell,
1991; measuring object relations maturity and reality
testing); (b) the Personal Self subscale of the Ten-
nessee Self-Concept Scale (Fitts, 1965; measuring
overall self-worth); (c) the Presence, Challenge, and
Acceptance subscales of the God Image Scales
(Lawrence, 1997; measuring God's felt presence,
desire for one's growth, and valuation of one's lov-
ability, respectively); and (d) the Religious Experi-
ence Questionnaire (Edwards, 1976; measuring the
overall experience of God emotionally as loving and
close). Psychiatric inpatient treatment included the
following interventions: (a) pharmacotherapy (as
needed), (b) 30 minutes of individual psychotherapy
(5 days per week), (c) 90 minutes of group psy-
chotherapy (7 days per week), (d) 60 minutes of reli-
giously based psychoeducation (7 days per week),
and (e) milieu treatment (e.g., occupational therapy,
community meetings, and vocational counseling; as
needed; Tisdale et al., 1997).
Overall, participants reported experiencing adap-
tive changes in their god images, when their admis-
sion and discharge scores were compared. Specifical-
ly, at the end of their psychiatric-inpatient treatment,
they reported experiencing God emotionally as
more close, loving, accepting, and present, com-
pared wnth when they entered treatment. These ther-
apeutic gains were maintained over the course of the
12-month follow-up, although without further
improvements. It is important to note that adaptive
changes in participants' god images were consistent-
ly associated with adaptive changes in their self-
images. In fact, these adaprive shifts in self-images
were dramatic in comparison to the adaptive shifts
in god images, suggesting that god-image change is
associated with (and perhaps even mediated by)
improvements in self-images. Improvements in self-
worth were also retained across the 12-month fol-
low-up period (Tisdale et al., 1997; cf. Davis, 2010;
Moriarty 6c Davis, in press).
Cheston et al. (2003)
In a similar study, Cheston et al. (2003) examined
god-image change through general (i.e., not neces-
sarily religiously based) outpatient individual-psy-
chotherapy. Participants included a nonrandomized
convenience sample of 98 adults—30 in the treat-
ment group (23 women, 7 men; mean age: 39.3
years) and 68 in the control group (53 women, 15
men; mean age: 50.1 years). All participants complet-
ed two self-report measures—the God Adjective
Check List (Gough ÔC Heilbrum, 1983; measuring
god-image characteristics) and the Brief Symptom
Inventory (Derogatis, 1993; measuring psychological
symptoms). The 30 individuals in the treatment
group completed these measures within 4 weeks of
beginning psychotherapy (time 1) and then either at
termination or at the end of 6 months (time 2),
whichever came later. The 68 individuals in the con-
trol group completed these measures at point of first
contact (time 1) and then from 2 to 6 months later
(mean intertest interval: 4 months). For the indi'vidu-
als in the treatment group, the mean intertest inter-
val was 6.7 months (range: 6-19 months), and the
mean number of sessions was 20 (range: 2-52 ses-
sions). Of note, at time 1 and time 2, each psy-
chotherapy-client's therapist completed the Dero-
gatis Psychiatric Raring Scale (Derogatis, 1978; a
clinician-rated measure of psychological symptoms)
on the respective client. Also, at time 2, the therapist
rated the client's overall emotional growth (single-
item measure) and overall spiritual growth (single-
item measure).
When self-ratings at time 1 and time 2 were
compared, psychotherapy participants reported

5. 48 GROUP-PSYCHOTHERAPY, GOD IMAGES, ATTACHMENT TO GOD
experiencing significantly decreased psychological
symptoms over time, whereas control participants
tended to reliably remain asymptomatic. Similarly,
psychotherapy participants reported experiencing
adaptive changes in their god images over time,
whereas control participants tended to reliably expe-
rience Cod in an emotionally healthy manner. More
specifically, psychotherapy participants reported
experiencing Cod emotionally as lower in trait neu-
roticism and as higher in trait agreeableness; howev-
er, this treatment effect was only evidenced among
those clients who showed high emotional growth
over time, as per clinician-rating. Moreover, the
clients who evidenced high spiritual growth over
time tended to show a concomitant shift in experi-
encing Cod emotionally as more loving, caring, and
compassionate (Cheston et al, 2003). As Moriarty
and Davis (in press) have concluded
Cheston et al.'s study suggests the possibility that the common
factors of psychotherapy (e.g., empathy, positive regard) may
facilitate god-image change indirectly, via other forms of emo-
tional change, such as improvements in self-image and adap-
tive shifts in implicit relational knowledge.
Furthermore, as Cheston et al. (2003) indicated:
"The psychological and spiritual selves of clients may
be integrally connected; thus, when something shifts
for one part of the self, it shifts for another part of
the self as well" (Cheston et al., 2003, p. 106).
Current State of the Research Evidence
Taken together, Tisdale et al. (1997) and Cheston
et al. (2003) have offered research evidence that
adaptive god-image change can be effected through
(a) religiously based, object-relations-oriented, multi-
modal inpatient-psychiatric treatment (Tisdale et al.,
1997) and (b) general outpatient individual-psy-
chotherapy (Cheston et al., 2003). However, each of
these studies suffered from notable methodological
limitations. For example, for ethical reasons (e.g.,
psychiatric inpatients ethically cannot be put onto a
waiting list), Tisdale et al.'s study did not have a con-
trol group, thereby limiting internal validity. In addi-
tion, Tisdale et al. did not evaluate the relative
effects of the different inpatient-treatment compo-
nents, thereby limiting treatment specificity (i.e.,
conclusions regarding the active ingredients of
patient change; Chambless ôc Hollon, 1998; Chamb-
lessôcOllendick,2001).
Cheston et al.'s (2003) study was more method-
ologically rigorous. Even so, there were noteworthy
limitations in that study also. For instance, the treat-
ment group was small (N = 30), thus limiting power,
and females were over-represented {n = 23), thus limit-
ing external validity. Moreover, Cheston et al. did not
randomly assign treatment and control participants,
limiting the study's internal validity. Furthermore, they
did not evaluate the degree to which reli-
gious/spiritual components were explicitly addressed
in psychotherapy, limiting an understanding of the
treatment specificity (Chambless ÔC Hollon, 1998;
Chambless ÔC OUendick, 2001). In sum, the research
evidence on promoting god-image change through
psychotherapy participation is still preliminary.
The Current Study
In our pilot study, we sought to build on this
research by (a) studying a manualized treatment
intervention and (b) studying the specific impact of
religiously based, psychotherapy integrationist, out-
patient group-psychotherapy. Building on the above-
mentioned research findings, we predicted the fol-
lowing, with regards to group-participants' answers
on the pre- and post-questionnaires:
a. Hypothesis 1. We predicted that group participants would
report experiencing less attachment anxiety with God.
b. Hypothesis 2. We predicted that group participants would
report experiencing less attachment avoidance with Cod.
c. Hypothesis 3. We predicted that group participants
would report experiencing Cod emotionally as more
accepting, intimate, and supportive.
d. Hypothesis 4. We predicted that group participants would
report experiencing Cod emotionally as less disapproving,
distant, and harsh.
e. Hypothesis 5. We predicted that group participants would
report experiencing more congruence between their emo-
tional experience of Cod (god images) and their theological
beliefs about Cod (god concepts).
METHOD
Participants
Participants were adults who sought group-psy-
chotherapy treatment for difficulties in their emo-
tional experience of Cod (i.e., negative god images).
As such, each group member had a primary diagno-
sis of Religious or Spiritual Problem (V62.89; Amer-
ican Psychiatric Association, 1994). Several mem-
bers had a secondary diagnosis of Major Depressive
Disorder or Anxiety Disorder Not Otherwise Speci-
fied. Notably, 10 group members were concurrently

6. THOMAS, MORIARTY, DAVIS and ANDERSON 49
receiving religiously based, outpatient individual-
psychotherapy and/or pharmacotherapy.
Screening and attrition. Thirty-seven individuals
participated in the study's screening session. At that
point, four participants decided not to participate in
the study, and one person was screened out because
other clinical difficulties were more prominent and
necessitated more in-depth treatment than our man-
ualized group-psychotherapy intervention was able
to provide. Thirty-two participants began the group-
psychotherapy process, but six individuals dropped
out, for various reasons (e.g., one individual moved
out of the area, two decided to solely participate in
individual-psychotherapy, and three did not provide
a reason).
Pilot-study sample. In the end, 26 adults (11 men,
15 women, M^ge = 29.6, SDage = 6.56, age range: 19-
46 years old) completed the 8-week group-psy-
chotherapy intervention. Most were Caucasian grad-
uate students (from various disciplines), of middle to
upper-middle socioeconomic status. Twenty-five par-
ticipants reported a Protestant-Christian affiliation;
one, a Catholic-Christian affiliation. A total of seven
psychotherapy-groups were conducted, each using
the same 8-week manualized treatment protocol. The
mean number of group participants was 3.7, and all
groups included both male and female participants.
Group Psychotherapists
Each group was facilitated by two doctoral-level
students in clinical psychology—one male and one
female. In total, there were seven group psychothera-
pists who facilitated these groups. Each psychothera-
pist participated in a 4-hour training that was aimed
at preparing them to effectively cofacilitate their
respective group, in faithful adherence to the manu-
alized treatment protocol. Partly to ensure adequate
client care and partly to ensure protocol adherence,
this article's second author (GLM) met with the psy-
chotherapists weekly for group supervision.
Procedures
Recruitment. This study was conducted at a mid-
Atlantic, religious university. Participants were pri-
marily recruited from the student body of that insti-
tution, via on-campus publicity efforts (e.g., emails,
flyers, word-of-mouth). A few other participants
were recruited from the surrounding community, via
local churches and a local community mental health
center. The recruitment materials emphasized how
the group was dedicated to helping people develop
increased congruence between their head and heart
knowledge of God. The flyers were labeled "Discov-
ering God: A Group Therapy Experience" and fea-
tured a large wardrobe with a young girl peeking
inside, thereby alluding to C. S. Lewis's (1950-
1956/2001) classic book T^e Lion, the Witch, and
the Wardrobe.
Manualized treatment protocol. Prior to the
screening session, all prospective participants read
and signed an informed consent form and then com-
pleted a demographic form. Of the pilot-study sam-
ple (N = 26), all participants completed the pre-test
questionnaire following session 1 and the post-test
questionnaire following session 8. They also
received a copy of the study's debriefing form, fol-
lowing session 8. The entire manualized treatment
protocol consisted of eight, 90-minute group-psy-
chotherapy sessions. See Table 1 for an overview of
the manualized treatment protocol (see Thomas,
2009, Appendix G, for a copy).
M A T E R I A L S
The pre- and post-test questionnaire included the
Attachment to God Inventory (R. Beck &c McDon-
ald, 2004) and a brief God adjective-checklist, along
with several open-ended questions. The Attachment
to God Inventory (AGI) is a 28-item self-report mea-
sure of adult attachment tendencies in emotional
relationship with God. It is a self-report, survey-
based measure of implicit relational spirituality (Hall
et al., 2009) and thereby of god images. The AGI
consists of two subscales—the Anxiety subscale (mea-
suring anxiety about abandonment; e.g., "I worry a
lot about my relationship with God") and the Avoid-
ance subscale (measuring avoidance of intimacy;
e.g., "I am uncomfortable being emotional in my
communication with God"). Each subscale contains
14 items, some of which are reverse-scored and all of
which involve rating along a seven-point Likert scale
(ranging from 1 = disagree strongly to 4 = neu-
tral/mixed to 7 = agree strongly; R. Beck &c
McDonald, 2004).
Our brief God adjective-checklist was developed
for this study. It consisted of three positively
valenced trait adjectives—flccepi/n^, intimate, and
supportive—and three negatively valenced trait
adjectives—disapproving, distant, and harsh.
Respondents rated the degree to which the trait
adjective tended to describe how they experienced

7. 50 GROUP-PSYGHOTHERAPY, GOD IMAGES, ATTAGHMENT TO GOD
TABLE 1
An Overview of the Manualized Treatment Protocol
Session
1
2
3
4
5
Context
In-session
Post-session
Homework
In-session
Homework
In-session
Homework
In-session
Homework
In-session
Homework
Intervention description
Welcome and introductions
Group overview, ground rules, and basic rationale
Completion of the Draw-A-God figure-drawing (Moriarty, 2006)
Psychoeducation on god images and god concepts
Discussion of god-image/god-concept discrepancies
Completion of the pre-test questionnaire ^ ; •:.
Parent/God-Image Grids exercise examining the relative impact of early • '
caregiver-child relationships on god images (Moriarty, 2006)
Review of homework
Psychoeducation on and discussion of the connections between early-childhood
experiences (e.g., wounds) and subsequent god-image difficulties
Dynamic-interpersonal exercise in which members play the role of "the Real God,"
speaking to another member's wounds
Psychoeducation on god-image development (psychodynamic view)
Select a meaningful song/hymn and read its lyrics twice daily
Review of homework
Psychoeducation on an orthodox Christian theology of god images, followed by
an introduction to a cognitive-theory view of god images
Discussion and film clip of the thoughts-feelings connection
Write a spiritual-journal letter to oneself from the Real God
Continue to read the meaningful song/hymn twice daily
Further psychoeducation on a cognitive-theory view of god images
Psychoeducation on the God Image Automatic Thought Record (GIATR;
Moriarty, 2006), followed by verbal practice completing one
Complete the GIATR in writing, at least 3 times during the week
Attend a 30-minute individual-psychotherapy session with a group cofacilitator,
to discuss treatment progress and to complete a GIATR
Begin to sing the meaningful song/hymn twice daily
Psychoeducation on cognitive distortions, interspersed with applied discussion
Complete the GIATR in writing, at least 3 more times during the week
Start to read the C. S. Lewis ( 1950-1956/2001) book The Horse and His Boy
Continue to sing the meaningful song/hymn twice daily, and add another
son^hymn
(Table 1 continues on next page)

8. THOMAS, MORIARTY, DAVIS and ANDERSON 51
T A B L E 1 (contirmed from previous page)
An Overview of the Manualized Treatment Protocol
Session
6
7
8
Context
In-session
Homework
In-session
Homework
In-session
Post-session
Intervention description
Psychoeducation on schémas and god images, interspersed with applied
discussion
Continue to complete CIATRs and to read The Horse and His Boy
Continue singing the songs/hymns twice daily but may change them at
any time
Psychoeducation on allegorical-bibliotherapy and its use in changing
god images
Discussion of reactions to The Horse and His Boy, focusing on
experiences of Asian
Exercise of watching and discussing reactions to a film clip depicting Asian
Continue to complete CIATRs
Continue singing the songs/hymns twice daily but may change them
at any time
Write down a word of encouragement for each group member, to share
next session
Croup overview, reflections, and celebration
Dynamic-interpersonal exercise in which members encourage and thank
one another for their respective growth-promoting contributions to the
group
Completion of the post-test questionnaire
Cod emotionally, using a five-point Likert scale that
ranged from 1 {very accurate) to 3 {neutral) to 5
{very inaccurate).
On both the pre- and post-test questionnaires,
participants were asked to rate how similar their
emotional experience of Cod (god images) was to
their theological beliefs about Cod (god con-
cepts), using a ten-point Likert scale in which
lower scores indicated lower congruence and high-
er scores indicated higher congruence. Last, on the
post-test questionnaire only, participants were
asked three exploratory, open-ended questions.
Specifically, they were asked to identify (a) the psy-
chological intervention that most influenced their
emotional experience of Cod, (b) the treatment-
manual component that most influenced their
emotional experience of Cod, and (c) the primary
mechanism by which interactions with other group
members influenced their emotional experience
with God.
RESULTS
Hypotheses 1 and 2
We predicted that group participants would report
experiencing less attachment anxiety with Cod
(Hypothesis 1) and less attachment avoidance with
Cod (Hypothesis 2). Paired-samples í tests yielded sup-
port for each of these hypotheses (see Table 2). Only
20 pilot-study participants completed the ACI,
because it was not administered to the first psychother-
apy group (« = 4), and two other group members did
not complete all the ACI items, for tmknown reasons.
Hypotheses 3 and 4
We predicted that group participants wotJd report
experiencing Cod emotionally as more accepting, inti-
mate, and supportive (Hypothesis 3) and as less disapv
proving, distant, and harsh (Hypothesis 4). Paired
samples t tests yielded support for each of these
hypotheses (see Table 3). All 26 pilot-study partici-
pants completed the brief Cod adjective-checklist.

9. 52 GROUP-PSYCHOTHERAPY, GOD IMAGES, ATTACHMENT TO GOD
T A B L E 2
Contrast ofPre- and Post-Test Scores on the Attachment to God Inventory (TSI = 20)
Variable
Attachment anxiety with Cod
Attachment avoidance with God
Pre-test
M{SD)
69.90(17.5)
50.60(178)
Post-test
M{SD)
56.50(20.5)
43.70(14.5)
i(19) P
4.25 .001
3.57 .002
Note. For each subscale of the Attachment to God Inventory, higher scores indicate higher levels of the assessed attachment tendency,
and total subscale scores can range from 7 to 98.
TABLE 3
Contrast ofPre- and Post-Test Scores on the Brief God Adjective-Checklist (N = 26)
Variable
Positively valenced trait adjectives
Accepting
Intimate
Supportive
Pre-test
M{SD)
3.08(13)
3.23(14)
2.73(13)
Negatively valenced trait adjectives
Disapproving
Distant
Harsh
2.15(1.2)
165 (0.9)
3.00(14)
Post-test
M{SD)
180 (0.7)
185(10)
185 (0.9)
3.62(0.9)
3.58(13)
4.04(0.9)
Note. For each trait adjective, lower scores indicate higher levels of the degree to which the
i(25)
5.94
5.72
3.00
-6.54
-6.68
-4.24
P
.001
.001
.006
.001
.001
.001
trait adjective self-reportedly describes
one's emotional experience of God, with scores ranging from 1 (very accurate) to 3 (neutral) to 5 (very inaccurate).
Hypothesis 5
We predicted that group participants would
report experiencing more congruence between
their emotional experience of God (god images)
and their theological beliefs about God (god
concepts) at the end of treatment. As stated pre-
viously, on the pre- and post-test questionnaires,
participants were asked to rate how similar their
emotional experience of God was to their theo-
logical beliefs about God, using a ten-point Lik-
ert scale in which lower scores indicated lower
congruence and higher scores indicated higher
congruence. (All 26 pilot-study participants com-
pleted this item.) To quantify this god-
image/god-concept discrepancy, we categorized
respondents based on their item-rating: (a)
Severe Discrepancy (rarings of 1 to 3), (b) Mod-
erate Discrepancy (4 to 5), (c) Mild Discrepan-
cy (6 to 7), and (d) Minimal Discrepancy (8 to
10). On the pre-test questionnaire, the frequency
breakdown was as follows: (a) Severe Discrep-
ancy {n = 10), (b) Moderate Discrepancy {n =
9), (c) Mild Discrepancy {n = 5), and (d) Mini-
mal Discrepancy {n = 1). In contrast, on the
post-test questionnaire, the frequency breakdown
was as follows: (a) Severe Discrepancy {n = 1),
(b) Moderate Discrepancy {n = 4), (c) Mild
Discrepancy {n = 12), and (d) Minimal Dis-
crepancy {n = 9). To statistically examine this
quasi-interval data, we conducted a paired-sam-
ples t test, which revealed support for Hypothesis
5aswell, i(25)=-5.84,/?<.001.

10. THOMAS, MORIARTY, DAVIS and ANDERSON 53
T A B L E 4
Most Commonly Cited Answers to Open-Ended Questions on the Post-Test Questionnaire (n = 23)
Commonly cited answer
Most influential intervention
The Horse and His Boy (allegorical-bibliotherapy)
God Image Automatic Thought Record (cognitive restructuring)
Psychoeducation on connections between early-childhood experiences and subsequent
god-image difficulties
Most influential treatment-manual component
God Image Automatic Thought Record (cognitive restructuring)
Parent/God-Image Grids exercise examining the relative impact of early caregiver-child
relationships on god images (Moriarty, 2006)
Psychoeducation on connections between early-childhood experiences and subsequent
god-image difficulties
Primary mechanism of group-member influence
Open sharing and insightful comments from other group members (interpersonal input
and output)
Feeling as if they were not alone and as if they were experiencing similar difficulties to
other group members (universality)
Safe environment allowed for authentic interaction among group members
(cohesiveness and catharsis)
n
9
7
4
9
9
4
13
10
6
%of«
39%
30%
17%
39%
39%
17%
57%
43%
26%
Exploratory Analyses
As stated above, on the post-test questionnaire,
participants were asked to identify (a) the psychologi-
cal intervention that most influenced their emotional
experience of Cod, (b) the treatment-manual compo-
nent that most influenced their emotional experience
of Cod, and (c) the primary mechanism by which
interactions with other group members influenced
their emotional experience with Cod. See Table 4 for
the most commonly cited answers to each of these
three open-ended questions. Only 23 participants
answered this portion of the questionnaire.
D I S C U S S I O N
Summary of Findings
In sum, on average, participants in our 8-week,
manualized, outpatient group-psychotherapy inter-
vention reported experiencing adaptive shifts in their
god images and attachment to Cod. Specifically,
when pre- and post-questionnaire ratings were com-
pared, they reported experiencing Cod emotionally
as more accepting, intimate, and supportive and as
less disapproving, distant, and harsh. In addition,
they reported experiencing significantly both less
attachment anxiety with Cod and less attachment
avoidance with Cod. Furthermore, they reported
experiencing more congruence between their emo-
tional experience of Cod (god images) and their the-
ological beliefs about Cod (god concepts). Last, the
interventions that were deemed the most therapeuti-
cally effective were the allegorical-bibliotherapy and
the cognitive-restructuring interventions.
Clinical Implications
Our pilot study has several implications for clini-
cians who are addressing god-image difficulties in clini-
cal practice. Perhaps most substantively, our findings
support Rizzuto's (1974) claim that god images are
indeed changeable. Our findings provide further sup-
port that psychotherapeutic treatment can lead to
adaptive changes in god images, as Tisdale et al. (1997)
and Cheston et al. (2003) have previously shown.

11. 54 GROUP-PSYCHOTHERAPY, GOD IMAGES, ATTACHMENT TO GOD
Our results also provide prehminary support for
the possibility that group psychotherapy is an effec-
tive treatment format for treating negative god
images. This finding is consistent with the findings
of O'Hare (2003), whose small-scale dissertation
study (N = 6) also revealed evidence that group psy-
chotherapy can lead to adaptive god-image change.
As stated above, our participants were asked to
identify the primary mechanism by which interac-
tions with other group members influenced their
emotional experience with God. Here, the most
commonly cited answers were (a) open sharing and
insightful comments from other group members
(interpersonal input and output), (b) feeling as if
they were not alone and as if they were experiencing
similar difficulties to other group members (univer-
sality), and (c) that the safe environment allowed for
authentic interaction among group members (cohe-
siveness and catharsis). Speaking of god-image treat-
ment in a group-psychotherapy format, Moriarty and
Davis (in press) have highlighted the potential for the
relationships among group members to provide yet
another change mechanism, in addition to actual
psychological interventions. Our findings support
this possibility. Indeed, group members consistently
reported that their interactions with other group
members had a substantive positive impact on their
god images, particularly the open sharing and
insightful comments from other group members
(interpersonal input and output). In addition, many
participants initially felt as if they were alone in their
god-image struggle, but through meeting other peo-
ple who had similar problems (universality), they
were able to connect with each other and to grow
toward health—individually and collectively. In short,
our results are consistent with the reliable research
finding that interpersonal input, interpersonal out-
put, and universality are among the therapeutic fac-
tors that outpatient group-psychotherapy partici-
pants frequently cite as powerful change
mechanisms (see Yalom &C Leszcz, 2005, p. 88). Our
participants also felt as if the safe environment of the
group allowed for authentic interaction among
group members, and this cited change mechanism
seems to relate to the therapeutic factors of cohesive-
ness (related to the experience of safety) and cathar-
sis (related to the experience of authentic interac-
tion; Yalom & Leszcz, 2005, p. 88).
Our research provides preliminary support for
the use of a manualized group-therapy protocol in
the treatment of god-image difficulties, as well as for
the use of a psychotherapy-integrationist approach in
such treatment (Norcross &c Goldfried, 2005; cf.
Moriarty &C Davis, in press). When we asked partici-
pants to identify the treatment-manual components
that were the most influential in promoting adaptive
change in their god images, the most frequently cited
answers were (a) the GIATR (cognitive restructur-
ing), (b) the Parent/God-Image Grids exercise
(examining the relative impact of early caregiver-
child relationships on god images [Moriarty, 2006]),
and (c) psychoeducation on connections between
early-childhood experiences and subsequent god-
image difficulties. All these components relate to the
change mechanism of increases in self-understand-
ing, which is another mechanism that outpatient
group-psychotherapy participants often cite as effec-
tive (Yalom & Leszcz, 2005, p. 88).
Next, our results provide preliminary evidence
that allegorical-bibliotherapy and cognitive-restruc-
turing interventions are particularly effective mecha-
nisms for promoting adaptive shifts in god images
and attachment to God. With regard to allegorical-
bibliotherapy interventions, Moriarty and Davis (in
press) have discussed the use of the Chronicles of
Narnia series (Lewis, 1950-1956/2011):
Christian clients readily identify with the characters who inter-
act with Asian (i.e., God). Through identification with these
characters, clients learn to make sense of difficult personal sit-
uations and to experience God emotionally as more affirming
and experience-near, particularly during trying times.
Indeed, in our study, thirty-nine percent of the partic-
ipants stated that reading C. S. Lewis's The Horse
and His Boy was influential in improving their god
images. This book specifically addresses the role of
God in the pain and suffering of different characters
in the book. Although we did not ask our partici-
pants what specific elements of the allegorical-biblio-
therapy were impactful for them, we did have a few
notable observations. First, participants stated they
were able to empathize with many characters in the
novel. Many characters inappropriately perceived
Asian (i.e., God) to be distant and harsh when in fact
he was intimate and intentional in how and when he
interacted with each character. Given that many par-
ticipants initially experienced God emotionally as
distant, it was profoundly healing for them to read a
novel in which the God-figure (Asian) is convincingly
and poignantly portrayed as ever-present and experi-
ence-near. Thus, the impactful theme that emerged
through reflecting on the novel was that although
God may seem distant or harsh at times, God's

12. THOMAS, MORIARTY, DAVIS and ANDERSON 55
actions are perhaps more appropriately viewed as
intimate, intentional, loving, and caring, even when
they do not feel like it in the moment. Remarkably,
by and large, group participants were able to inter-
nalize this message and to generalize it to their own
emotional experience of God.
Second, in their experience of the allegorical-bib-
liotherapy intervention, participants reported that
they experienced relief from reading and reflecting
on the words Asian spoke in the novel. In The
Horse and His Boy (1950-1956/2011), when Asian
enters into the allegorical-narrative, he often speaks
words that encourage, affirm, and empower the
character(s) with whom he is interacting. Many par-
ticipants reported that these words from Asian were
encouraging, afflrming, and empowering for them as
well, particularly as it related to promoting their abil-
ity to experience God emotionally as more accept-
ing, intimate, and supportive.
With regard to the use of cognitive-restructuring
interventions (e.g., GIATRs), it is noteworthy to
point out that our use of GIATRs was quite incorpo-
rative of emotions (see Moriarty ÔC Davis, in press,
for a description of this intervention and for a copy
of the GIATR). Here, we were mindful of the dan-
gers Moriarty and Davis (in press) have addressed
elsewhere:
While treating god-image concerns with cognitive-behavioral
interventions, it is easy to focus solely on thoughts and behav-
iors, thereby fostering surface-level shifts in client god con-
cepts instead of promoting deeper-level changes in client god
images. Fortunately, cognitive-behavioral techniques can be
used in ways that affirm and involve both cognition and emo-
tion, (cf. Cozolino, 2010)
Limitations
Lack of a control group. As stated above, both Tis-
dale et al.'s (1997) and Cheston et al.'s (2003) stud-
ies had notable limitations, and our pilot study was
no exception. Perhaps most notably, as with Tisdale
et al.'s study, our pilot study did not have a control
group (and thus there was no random assignment),
given the exploratory nature of our research. Conse-
quently, we are unable to offer deflnitive conclusions
regarding what caused the changes in participants'
god images and attachment to God.
Limits to treatment specificity. This threat to
our study's internal validity is also related to the fact
that, during at least a portion of our study, ten of our
group-therapy participants were concurrently in indi-
vidual psychotherapy, most often for the treatment
of depression and/or anxiety. Therefore, it is difflcult
to specify the degree to which our study's flndings
were due to our group-psychotherapy intervention,
compared with the relative influence of other factors
(e.g., individual psychotherapy, extratherapy factors).
Low sample size. Another limitation of our study
was its low sample size (N = 26). Having such a low
number of participants limited our study's power.
Even so, the fact that all our hypotheses were statisti-
cally supported with such low power provides
promising evidence that true differences in the exam-
ined variables exist.
Limits to external validity. One more limitation
of our study was the demographic makeup of our
sample. Our population of interest was adults who
report having difflculties in their emotional experi-
ence of God (i.e., negative god images). Even though
our sample was generally representative in terms of
gender (11 men, 15 women), it was over-representa-
tive of young, highly educated, Caucasian, Protes-
tant-Christian adults, of middle to upper-middle
socioeconomic status. Thus, study's findings are
most appropriately generalized to young adults who
are demographically similar to our sample.
Use of self-report, survey-based measures. Anoth-
er hmitation of our study was the sole use of self-
report, survey-based measures. As Gibson (2007)
and Moriarty and Davis (in press) have explained,
such measures are the most popular way to clinically
assess god images. However, these measures may be
quite limited in their abihty to validly assess respon-
dents' heart knowledge of God (god images), partic-
ularly given the embodied, emotional, implicit, non-
verbal nature of god-image functioning (see Davis,
2010; Moriarty & Davis, in press). In assessing god
images (which largely involve right-brain mediated
processes) via self-report, survey-based measures
(which tend to tap into largely left-brain mediated
processes; Moriarty &C Davis, in press; cf. Gibson,
2007), there is often a danger that respondents will
deduce the "right" (i.e., researcher-expected) answer
and thus respond in a biased manner. Gibson (2007)
has raised such concerns and has offered some sug-
gestions for using self-report, survey-based measures
in the most optimal manner. Following Gibson's sug-
gestions, we framed questions in ways that explicitly
asked respondents to discriminate between their
head and heart knowledge of God.
In short, our study had many of the same limi-
tations as Tisdale et al.'s (1997); both studies may
be classified as Type 3 studies, according to the

13. 56 GROUP-PSYCHOTHERAPY, GOD IMAGES, ATTACHMENT TO GOD
seminal classification system espoused in A
Guide to Treatments That Work (3rd ed.;
Nathan & Gorman, 2007). Nathan and Corman
(2007) have described:
[Type 3 studies] are clearly methodologically limited. General-
ly, Type 3 studies are open treatment studies aiming at obtain-
ing pilot data. They are highly subject to observer bias and can
usually do little more than indicate if a treatment is worth pur-
suing in a more rigorous design Such studies can, of
course, provide a great deal of naturalistic information but are
prone to all of the problems of uncontrolled data collection
and retrospective recall error, (pp. vii-viii)
Notably, because of its higher degree of methodolog-
ical rigor, Cheston et al.'s (2003) study may be classi-
fied as a Type 2 study, which Nathan and Corman
(2007) have described in the following manner:
[Type 2 studies] are clinical trials in which an intervention is
made, but some aspects of the Type 1 study requirement are
missing. For example,... a trial in which two treatments are
compared but the assignment is not randomized.... Such
studies clearly do not merit the same consideration as Type 1
studies but often make important contributions and generally
should not be ignored, (p. vii)
Future Research on God Images
It is important to note that, as of yet, no specified
psychological-interventions have enough research
evidence to be deemed either "well-established" or
"probably efficacious" in treating negative god
images (Chambless & Hollon, 1998; Chambless &
Ollendick, 2001). For the god-image research litera-
ture to continue to grow and mature. Type 1 studies
are especially needed. Here, Nathan and Corman
(2007) have explained:
[Type 1 studies] are the most rigorous and involve a random-
ized, prospective clinical trial. Such studies also must involve
comparison groups with random assignment, blinded assess-
ments, clear presentation of exclusion and inclusion criteria,
state-of-the-art diagnostic methods, adequate sample size to
offer statistical power, and clearly described statistical meth-
ods, (p. vii)
Future psychotherapeutic-outcome research on god
images should also be conducted with samples that
are more representative of age, race/ethnicity, reli-
gious/spiritual affiliation, and socioeconomic sta-
tus than was our pilot-study sample. Furthermore,
future research should utilize a multimodal assess-
ment approach, ideally including some combina-
tion of clinician-rated measures; implicit measures
(e.g., a reaction-time test; Yarborough, 2009); pro-
jective assessments; and self-report, survey-based
measures (see Cibson, 2007; Moriarty &; Davis, in
press, for reviews). Moreover, future research
should explore the specific mechanisms of thera-
peutically mediated change in god images, in both
individual-therapy and group-therapy formats. Last,
future research should further examine the use of
treatment manuals, perhaps even exploring options
of either using another therapeutic modality (e.g.,
narrative-experiential; Moriarty & Davis, in press)
or meeting in a different counseling context (e.g., a
church-based setting).
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AUTHORS
THOMAS, MICHAEL. J. Address: 1300 Eagle Road, Mclnnis
222 St. Davids, PA 19087 Title: Visiting Assistant Professor, East-
ern University. Michael also serves as a psychologist within the
Brandywine Hospital Eating Disorder Program in Coatesville,
Pennsylvania. Degree: Psy.D. Areas of Specialization: Clinical
and research interests include eating disorders, god images, reli-
gious and spiritual issues, and positive psychology.
MORIARTY, GLENDON, L. Address: 1000 Regent University
Drive, Virginia Beach, VA 23456. Email Address: glen-
mor@regent.edu. Phone: 757.352.434L Title: Associate Profes-
sor, Department of Psychology, Regent University. Degree: Psy.D.
Areas of Specialization: Psychodynamic psychotherapy, emo-
tional experience of God/God images, integration of psychology
and technology.
DAVIS, EDWARD. B. Address: 13800 Biola Avenue, Rose Hall
158 La Mirada, CA 90639. Email: edward.davis@biola.edu. Title:
Assistant Professor, Rosemead School of Psychology (Biola Uni-
versity). Degree: Psy.D. Areas of Specialization: His academic,
clinical, and research interests include personality psychology, psy-
chological assessment, interpersonal neurobiology, psychology of
religion/spirituality, god images, attachment, narrative identity,
mindful awareness practices, and supervision/mentoring.
ANDERSON, ELIZABETH, L. Address: LSU Student Health
Center Mental Health Services, Room 252 Baton Rouge, LA
70803. Email Address: elizan2@regent.edu. Title: Doctoral Psy-
chology Intern, Southern Louisiana Internship Consortium
(SLIC). PsyD. Doctoral Candidate in Clinical Psychology, Regent
University. Degree. M.A. Areas of specialization: integration of
psychology and spirituality; emotional experience of God/God
images; psychodynamic psychotherapy; positive psychology; and
interpersonal, Yalom style, dynamic group psychotherapy.

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