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Cognitive-Existential Therapy: A Theoretical Integration Model of Psychotherapy
James A. Saunders
Liberty University
Running head: COGNITIVE-EXISTENTIAL THERAPY 1
Abstract
Christianity and psychology are typically viewed either as enemies or only compatible in a
convoluted, safe form of “Christian Counseling.” The purpose of this paper is to suggest that
Christians who counsel can utilize the principles of psychology if they adopt the premise that all
truth is God’s truth. In light of this assertion, Cognitive-Existential Therapy (CET) is presented
as a theoretical integration model of psychotherapy compatible with a Christian worldview. The
philosophical assumptions and models of personality, health, and abnormality associated with
CET are explored. Additionally, on overview of the model of psychotherapy is provided.
Structurally, CET blends perspectives from existential theory with the object relations concept of
“attachment,” and the cognitive therapy aim of identifying faulty core schemas which exist in the
three domains of “being.” Health, according to CET, is found in living a balanced life with an
awareness of one’s limited freedoms, responsibilities, choices, and impact on others. CET is
conducted collaboratively and focuses on guided discovery, cognitive restructuring of automatic
thoughts and core maladaptive schemas, and adaptive meaning-making. The model holds
promise for practitioners who embrace both Christianity and theoretical integration.
Key words: core schemas, meaning-making, domains of “being,” responsibility, choice
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Cognitive-Existential Therapy: A Theoretical Integration Model of Psychotherapy
Theology and science are often viewed as having a longstanding, oppositional
relationship. The seeming incompatibility which exists between these two disciplines is perhaps
nowhere more evident than in the realms of Christianity and psychotherapy. In the past,
champions from both camps have drawn the proverbial “line in the sand,” asserting the absolute
benefit of their respective position while waging war against any possible merits of the other
discipline. Sigmund Freud, for example, was a staunch atheist who viewed religion and faith in
God as mere illusions. This stance led him to either ignore or treat poorly the spiritual life or
religious motivations of those with whom he worked (Jones & Butman, 1991, p. 77). From the
Christian perspective, Jay Adams “clearly perceived psychology as the enemy of the church in a
territorial dispute” (Entwistle, 2010, p. 165). This posture against the worthiness of secular
psychology for a Christian context led him to develop “Nouthetic Counseling,” a biblical model
constructed on the sufficiency of Scripture alone.
In recent years, many Christian psychologists have advanced the position that a healthy
merging of faith and science is not only feasible, but profitable (see Clinton & Ohlschlager,
2002; Collins, 1988; Entwistle, 2010; Jones & Butman, 1991; McMinn, 1996). Entwistle (2010)
asserts that “both psychology and Christian theology provide useful perspectives through which
we can study and understand human behavior, and together they can give us a more complete
and accurate picture of human nature and functioning than either perspective can provide alone”
(p. 3). However, the interaction of these two disciplines should be conducted responsibly. As
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McMinn (1996) has cautioned, “intradisciplinary integration—bringing the Christian faith into
the counseling office—requires us to evaluate carefully the goals of therapy and to challenge the
views of healing that surround us in the mental health professions” (p. 17).
This paper proposes an alternative approach to understanding the relationship between
Christianity and psychotherapy. Rather than viewing the two disciplines as mutually exclusive
or striving to merge them into a convoluted form of “Christian counseling,” a competent
Christian who counsels can embrace psychological principles and practices in a manner that is
compatible with a Christian worldview. This is best done if one adopts the premise that all truth
originates with God. This “unity of truth” means that “from God’s perspective, all truth fits
together cohesively. All truth is ultimately under God’s sovereignty. . . . [and] if something is
true, it cannot contradict other things that are true” (Entwistle, 2010, 147-148).
With this foundational assertion in mind, this paper sets forth the key principles of
Cognitive-Existential Therapy, a theoretical integration model which is compatible with a faith
perspective. Philosophical assumptions and models of personality, health, and abnormality will
be explored. Additionally, a brief model of the therapeutic process will be addressed. This
theoretical overview is intentionally broad in scope due to the time and research constraints of an
eight week course. Specific applications of the principles as they might relate to gender,
ethnicity, or socio-economic issues have been omitted. This theory is presented in order to
stimulate interest and prompt further exploration of the options which exist for practitioners who
embrace Christianity and theoretical integration.
Philosophical Assumptions and Model of Personality
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Cognitive-Existential Therapy (CET) integrates theoretical principles from cognitive-behavioral
therapy, existential theory, and object relations therapy concepts of “attachment.” The following
core principles of a Christian worldview (partially attributed to Jones & Butman, 1991) also
undergird the system of CET and will serve as a launching point for further considerations of this
modality’s philosophical assumptions and model of personality: (a) all
truth is God’s truth and is useful in helping us to better know ourselves and discover how to
grow into our God-intended fullness, (b) God is the uncaused Cause from whom all of life and
truth originate, (c) humans are created to fulfill godly purposes, (d) humans are created to be
unique; our uniqueness can only be understood in the context of relating to others and exploring
differences, (e) by God’s sovereign design, humans are finite and imbued with limited freedom,
(f) humans are accountable for their choices and ought to behave responsibly, (g) authentic living
can only be achieved by existing in the context of godly principles of right and wrong; there are
absolutes to behavior and appropriate consequences to all actions, (h) human capacity to make
choices dictates that we are capable of deceiving self and others, (i) human suffering directly
results from the interaction of four domains: 1) personal moral error, 2) the consequences of
other people’s actions, 3) natural evil and the impact of our finitude, and 4) supernatural forces of
evil aiming to thwart God’s purposes, (j) humans have an innate desire to belong and can only
experience true personal fulfillment through attachment and interactions with others, (k) humans
develop internal schemas based on their early learning contexts; these perceptions can be
reinforced by one’s interpretation of current experience, and (l) human behavior is guided by
perceptions and will generally encompass actions intended to engender safety, security, control,
and positions of significance. These core beliefs influence the practice of a CET therapist.
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(CET) draws heavily from the existential philosophy of its originator, Søren Kierkegaard.
Accordingly, CET supports a growth model which presumes that meaning and purpose of life
issues are ultimately realized through responsible living before God (Jones & Butman, 1991, p.
289). This assertion is justified and compatible with a Christian perspective as evidenced in the
exhortation of Solomon in Proverbs 12:13-14: “Here is my final conclusion: Fear God and obey
his commands, for this is the duty of every person. God will judge us for everything we do,
including every secret thing, whether good or bad” (NLT). CET unashamedly adopts
Kierkegaard’s concept of the self as being ultimately realized in a transparent openness before
God. CET acknowledges that this assertion stands in stark contrast to secular versions of
existential therapy which answer life’s questions with skepticism and the mantra that “truth is
relative” (Jones & Butman, 1991, 290).
Like Kierkegaard, CET advocates that “in a temporal and limited sense, we are the
authors of our lives” bound in an effortful struggle to come to terms with three core
incompatibilities: (a) infinitude and finitude, (b) possibility and necessity, and (c) eternity and
temporality (Jones & Butman, 1991, p. 279). According to Jones and Butman (1991), “the crux
of Kierkegaard’s ideas comes in his assertion that to be a true self is to synthesize our opposing
tendencies as we are grounded in God” (p. 280). In essence, CET adopts the view that humans
are constantly defining themselves—engaging in meaning-making—in relation to the
aforementioned three areas. Proper human functioning consists of striving for a balanced
existence and making responsible choices in the face of conflicting stimuli. Additionally,
humans become “known” to self and others by the actions and approaches that they take in each
arena (Comer, 1995, p. 55). This understanding of meaning-making, living a balanced life, and
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being known by our actions is consistent with a Christian worldview (see Ecclesiastes 7:14-18
for a discussion of meaning-making and living a balanced life; see Matthew 7:15-20 for a
discussion about being known by the “fruits” (actions) one produces).
CET, like traditional existential therapies, asserts that humans come to understand their
sense of “being” concurrently in three realms of existence: (a) Umwelt, “being” in the physical
world, (b) Mitwelt, “being” in relation to others, and (c) Eigenwelt, “being” in one’s subjective
experience (Murdock, 2009, pp. 185-185). Meaning-making occurs simultaneously in each
realm. Jones and Butman (1991) note that “because we are capable of self-awareness, we can
reflect and make choices in all aspects of being, thereby increasing our possibilities for freedom”
(p. 286). From the cognitive therapy perspective, early attempts at meaning making are
synonymous with core schematic development. The thoughts, assumptions, and attitudes of a
person directly influence behavior towards self, the world, and others. Therefore, faulty core
schemas can easily contribute to distorted realities in each of these realms. In order to correct
these cognitive distortions, Edwards (1990) has noted that “articulation of the clients’ personal
meanings is a necessary first step, and this is followed by a testing of those meanings against
other aspects of their experience and meaning framework” (p. 109). Additionally, borrowing
from object relations therapy, CET recognizes that attachment relationships greatly influence
early schematic development. If these core schemas are faulty they will potentially bias or
contaminate any attempts at meaning-making. Research has shown that “schemas constructed
out of the attachment interaction have relational and evaluative content” through which one
judges concepts of self, the “rules” of the world, and others (Ottens & Hanna, 1998, p. 318).
One final observation concerns CET’s view of personhood in relation to character
formation and virtuous living. CET upholds the idea that absolute truth exists and genuine
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spiritual (transcendent) living consists of cultivating relationship with a higher being. From a
faith perspective, this revolves around “the Christian virtues and a commitment to God’s
kingdom and the lifestyle that this entails” (Jones and Butman, 1991, p. 290). Returning once
again to the existential musings of Kierkegaard, Jones and Butman (1991) have observed that
through [the] choices we make we are in fact constructing our ultimate selves. Through
dishonest, rebellious, sinful choices we create a self truly worthy of judgment from God.
Through conversion unto the forgiveness available in Christ and with the empowerment
of the Holy Spirit, we can create selves that ever more closely approach the ‘new self’
that God would have us become (Col 3:9-17) (p. 291).
Models of Health and Abnormality
Traditional models of existential therapy have viewed health and abnormality in terms of
“authentic” living. Accordingly, themes of health involve courage, determination, and a
willingness to grapple with personal anxieties related to our experiences of “being” (or not
“being”) in the world (Murdock, 2009, p. 187). Conversely, themes of abnormality revolve
around one’s inability to effectively and genuinely “manage” their experiences. Jones and
Butman (1991) have applauded the fact that existential therapy is a leading modality in
encouraging persons to consider such issues as (a) death, (b) choice, (c) isolation, (d) meaning,
(e) growth, (f) responsibility, and (g) guilt (p. 289). CET accepts the premise that a modicum of
anxiety is healthy and should serve to keep us honest as we wrestle with such weighty matters.
Healthy angst humbly reminds us of the significance of our freedoms and calls us to consider the
weight of our responsibilities and the often powerful consequences of our choices (Jones &
Butman, 1991, p. 286).
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Another “authentic” health theme of traditional existentialism is the ability to live in such
a way as to not deceive oneself or others. Jones and Butman (1991) have asserted that “in order
to fulfill our destiny, we must be a self in truth, relentlessly. To be whole, we must be deeply
rooted in our being, not the being of others” (p. 286). From the CET perspective, then, it is
imperative that personal attempts at meaning-making involve clearly established identities and
an avoidance of the temptation to “become something other than who we are” (Jones & Butman,
1991, p. 286). This is in keeping with a Christian worldview as evidenced by Christ’s pivotal
statement on the importance of consistency in relating to others: “Just say a simple, ‘Yes, I will,’
or ‘No, I [will not].’ Your word is enough. To strengthen your promise with a vow [or
superfluous speech or behavior] shows that something is wrong.” (Matthew 5:37, NLT).
Ultimately, CET views personal health as an achievement of balance in the following areas: (a)
being responsible, (b) being honest with self and others, (c) appreciating personal limitations and
one’s finitude, and (d) acting in a beneficial and respectful manner toward others.
Concerning abnormality, CET modifies Yalom’s notion (quoted in Murdock, 2009) that
people “fall into despair as a result of a confrontation with harsh facts of the human condition”
(p. 187) by incorporating an appreciation for the cognitive distortions and core maladaptive
schemas which contribute to the development of such a fatalistic mindset. Accordingly, CET
strives to help people overcome their dysfunction in all three domains of existence: Eigenwelt
(self), Mitwelt (self in relation to others), and Umwelt (the world in which we exist). CET asserts
that cognitive restructuring of core schemas is important because “people’s problems are
generally not about events or circumstances in themselves, but about what these mean or what
the possible choices are, as defined by their presuppositions” (Ecker & Hulley, 1996, p. 110, as
quoted in Ottens & Hanna, 1998, p. 322). Beck (as quoted in Ottens & Hanna, 1998) asserts that
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freedom from despair and maladaptive living “is dependent on the development of versatility,
flexibility, and adaptability . . . accepting one’s own limitations . . . and widening the span of
acceptable goals so that ‘all the eggs are not in one basket.’” (p. 317).
In terms of achieving healthy living, CET works to help people recognize that changes in
their perspective will directly impact their sense of meaning-making. CET strives to help people
understand that “meanings are not carved in stone[.] [People are free] to investigate, experiment
with, and invent meanings of their own—meanings that may be more compatible with their
pattern of interests and needs than those with which they started” (Efran, Lukens, & Lukens,
1990, p. 53). From the Christian perspective, this view is tempered by the exhortation of St.
Paul in Romans 12:2: “[Do not] copy the behavior and customs of this world, but let God
transform you into a new person by changing the way you think. Then you will know what God
wants you to do, and you will know how good and pleasing and perfect his will really is” (NLT).
Model of Psychotherapy
From the CET perspective, the role of psychotherapy is to provide insight into the early
maladaptive core schemas and relational attachments that people construct in an effort to make
meaning out of their life experiences. Coupled with this goal of awareness is the intentional
cognitive restructuring of beliefs, assumptions, and attitudes toward more healthy, balanced
perceptions of self in relation to the core domains (Eigenwelt, Mitwelt, and Umwelt) (Ottens &
Hanna, 1998). Speaking to the merits of a theoretical integration between cognitive and
existential therapies, Edwards (1990) noted that
When [cognitive] interventions are used skillfully, they are quite in accord with
phenomenological [existential] principles in that clients’ personal meanings and values
are taken as the starting point and clients are invited to test them against other aspects of
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their experience. [Additionally], phenomenological therapy offers a deeper vision of
human nature and of the possibilities of the therapy situation. It provides a framework in
which client and therapist can grapple with issues that are ill-defined or that emerge from
the deeper levels of meaning in the client’s world (p. 118).
Similar to traditional modalities of cognitive and existential therapy, the CET therapist
takes an active role in the counseling process. Comer (1995) notes that the therapeutic
relationship is a central determinant to the success of therapy and that the following elements of
collaboration must exist: (a) therapist and client must be open to each other, (b) each must
commit to working hard, and (c) each must adopt a willing position toward growth and learning
(p. 155). Additionally, from the existential perspective, “the therapist’s authenticity serves as a
model for the client as they examine the meaning of existence and scrutinize the therapy
encounter itself” (Comer, 1995, p. 155). Unlike traditional models of existential therapy, the
Christian CET therapist can demonstrate authenticity by drawing the client’s attention to the
ultimate need for an encounter with a higher being. This is in keeping with the original
existential theory of Kierkegaard, who postulated that humans move through three distinct
phases in their quest of meaning-making: (a) “the aesthetic stage, wherein the essence of life is
believed to be having one’s own way”; (b) “the ethical stage, wherein one commits oneself to
ethical principles to guide one’s life”; and (c) the religious stage, “which is constituted by a
trusting personal relationship with the transcendent God” (Jones & Butman, 1991, p. 280).
The cognitive therapy process of guided discovery is a primary driver of CET. Clients
are socialized to the tenets of the cognitive model and made aware of how the process of therapy
will directly impact their context of meaning-making. The principal techniques utilized in CET
are (a) the downward arrow, “where the meanings of an event are traced to its fundamental
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consequences” and faulty core beliefs (Ottens & Hanna, 1998, p. 320); (b) guided imagery,
where the use of images and role-play help to “conjure up the problem situation” and assist the
client to “identify cognitions associated with the feelings” (Murdock, 2009, p. 342);
(c) questioning, where through inquiry the therapist draws “inferences from a client’s attitudes
and expressions until a particular belief is identified . . . It can also be done by exploring the
presuppositions inherent in a dysfunctional belief and identifying them at that deeper level”
(Ottens & Hanna, 1998, p. 320); and (d) thought recording, which involves the client “recording
various occurrences of ATs between counseling sessions” (Murdock, 2009, p. 339) coupled with
counselor review of the responses to these automatic thoughts at the next session. All CET goals
and interventions serve to expose the client to the following principles in the context of meaning-
making: (a) the role of schemas in mediating emotional responses to situations, (b) the
importance of construing personal meaning from experiences, (c) faulty information-processing
that contributes to distorted perceptions of reality, (d) and value in the scientific method for
providing evidence to adjust one’s view of reality (Ottens & Hanna, 1998, p. 312).
Conclusion
Christianity and psychotherapy have long been thought to be incompatible. During the
last decade supporters of these disciplines have vacillated between seeing them as enemies and
blending them into a theory of “Christian Counseling.” An alternative approach exists, wherein
Christians who counsel can embrace psychological principles and practices in a manner that is
compatible with a Christian worldview. This paper asserted that this is best accomplished when
one adopts the premise that all truth originates with God.
Cognitive-Existential Therapy (CET) was presented as a theoretical integration model of
psychotherapy which comports with a faith perspective. Rooted in the existential theory of
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Søren Kierkegaard, CET asserts that man’s fundamental purpose in meaning-making is to exist
as an authentic self with God. CET blends additional concepts of existential theory with the
cognitive aim of identifying faulty core schemas which exist in the three domains of “being.”
Health, according to CET, is found in living a balanced life with full awareness of one’s limited
freedoms, responsibilities, choices, and impact on others. CET is conducted collaboratively and
focuses on guided discovery, cognitive restructuring of automatic thoughts and core maladaptive
schemas, and adaptive meaning-making. In summary, the proposed model of psychotherapy has
promise for practitioners who embrace both Christianity and theoretical integration.
Appendix
Critique of Teresa Carver’s Counseling Theory Paper
I enjoyed reading your counseling theory paper. Overall, I found it to be very
informative and consistent with the MFT concepts I have studied at both Liberty and in my other
graduate studies. I appreciated your use of Scripture to support several of your assertions. For
example, in your discussion of the importance of communication, your referenced Colossians
3:21 which speaks about fathers not exasperating their children. Though this verse does not
mention “communication” specifically, it does imply the importance of behaviors, speech, and a
positive relationship and, therefore, was appropriate to your usage. Similarly, your reference to
Numbers 14:18 was fitting to the section on family dysfunction and its generational pattern of
impact. One Scriptural counter to your argument which I thought of, though, is found in Ezekiel
18 were God specifically addresses individual responsibility for sin. I think your general
observation that sins (patterns of behavior/relating) may be repeated in future generations or will
at least have a trickledown effect is well taken. However, I believe that a gelling of these two
concepts, family patterns and personal responsibility, is necessary for an accurate assessment of
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the “problems” for which families might seek counseling. Balance is necessary in both
individual and family contexts; otherwise one could always lay the blame for behavior at the feet
of someone else (or their entire family of origin). I would like to have seen additional references
to Scripture throughout the paper, but those that you selected were very appropriate.
An additional strength of your paper relates to your use of MFT terminology and
concepts. In all truth, my favorite section was the Models of Abnormality, in which you
referenced specific terms like scapegoating, double-binds, and implicit/explicit family rules. I
thought you did an excellent job, given the parameters and constraints of the assignment, of
explaining these concepts and drawing them out, especially for someone who might not be very
familiar with this model of therapy. Thank you for your effort. God Bless, James.
Critique of Melissa Langley’s Counseling Theory Paper
I enjoyed reading your paper. I thought that you did an excellent job of providing an
overview of each of the selected theories. At first, I was not sure about the manner in which you
formatted your arguments, as the paper read more like a report than a synthesis of all the
theories. However, when I read the “Discussion and Conclusions” section I realized that you
saved the majority of your Christian critique until the end. Given the approach you adopted, I
thought that was a fitting way to bring your arguments together.
The two criticisms that I would offer concern some APA formatting issues and the lack of
any Scriptural references. According to the chart in our APA Publication Manual (2010), it is my
understanding that first level headings are to be centered, written in bold face, with upper and
lowercase lettering (p. 62). Words such as “Introduction” or “Body” do not need to be included
as headings—this inclusion in your text led to the rest of your headings becoming second level
rather than primary. Additionally, a few times you excluded page numbers from your internal
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citations. Finally, while I concur with many of your comments and observations about the
validity and compatibility of your chosen theories to a Christian worldview, you elected not to
offer any scriptural references by which to substantiate your arguments. Inclusion of even a few
passages would have given greater credibility to your position and strengthened your assertions.
Reference:
American Psychological Association (2010). Publication Manual of the American
Psychological Association (6th ed.). Washington DC: American Psychological
Association.
References
Clinton, T., & Ohlschlager, G. (2002). Competent Christian counseling. Colorado Springs, CO:
WaterBrook Press.
Collins, G. R. (1988). Christian counseling: A comprehensive guide (Rev. ed.). Dallas, TX:
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Comer, R. J. (1995). Abnormal psychology. New York, NY: W. H. Freeman and Company.
Edwards, D. J. A. (1990). Cognitive-behavioral and existential-phenomenological approaches to
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Efran, J. S., Lukens, M. D., & Lukens, R. J. (1990). Language, structure, and change:
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Entwistle, D. N. (2010). Integrative approaches to psychology and Christianity: An introduction
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Jones, S. L. (1991). Modern psychotherapies: A comprehensive Christian appraisal. Downers
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McMinn, M. R. (1996). Psychology, theology, and spirituality in Christian counseling. Carol
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Murdock, N. L. (2009). Theories of counseling and psychotherapy: A case approach. Upper
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Ottens, A. J., & Hanna, F. J. (1998). Cognitive and existential therapies: Toward an integration.
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