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Biblical Counseling, Turf Wars, and Healthy Dialogue

In a previous post, “Is Scripture Enough?,” I wrestled with some of the questions long debated in the Christian counseling realm. Biblical counselors have argued for the past 50 years that study of the Bible alone is enough to make a pastor qualified to counsel. Others like myself who are trained in psychology and mental health care assert that additional training is necessary to assess and treat mental health issues. Both Dr. Heath Lambert and Brad Hambrick are biblical counselors who have recently articulated their thoughts on biblical counseling, with Dr. Lambert re-positioning towards earlier claims that the Bible alone is enough and Hambrick arguing for a greater level of training on mental health issues.

Dr. Lambert’s 95 Theses offers a series of position points, and the reason this conversation is so important is listed in his Thesis #3:

“The confusion that exists on the part of Christians has been a distressing source of conflict among brothers and sisters in Christ who debate these issues, and has caused pain in the lives of troubled Christians who seek counseling care.”

The confusion, conflict, and even “turf war” that has existed in the Church for the better part of 50 years has harmed people who are most in need of help. Because of this conflict, some pastors have at times discouraged mental health treatment when intervention was needed. In some cases, suicide has been the result.

Both pastors and Christian counselors need to improve working together. I do not believe we are at odds with each other, but rather working together towards common goals for the betterment of those who need our help. Pastors have a critical role in soul care and shepherding, but that role and skill set has limitations. Counselors who have been trained to recognize, assess, and treat symptoms of disorders including post-traumatic stress disorder, major depressive disorder, generalized anxiety disorder, bipolar disorder, schizophrenia, and a variety of personality disorders can and should play a role in holistic Christian care. The Bible does not offer evidence-based treatment models for these disorders, nor does it speak to medication or other forms of treatment. Conversations like these are critical to enhance the care of those entrusted to us. For too long these conversations could not take place at all because emotions ran high and debates turned ugly. We all need to rise above this tone in order to produce fruitful dialogue as I believe we are now seeing in much greater volume. 

Perhaps because Jay Adams in the 1970’s created a category called “organic disorders,” biblical counselors have sometimes seen things in black-and-white terms. It is either a spiritual problem or a medical one. We cannot divide problems or human beings in such a fashion. When we do, we limit treatment options and actually may contribute to the over-prescription of medication. If someone is experiencing symptoms of PTSD, they would benefit greatly from working with a Christian counselor who has specialization in trauma work. If their symptoms were seen as purely medical, sending them to their primary care physician (who also has less trauma training than a licensed and specialized counselor would) would likely result in a quickly written prescription. Even medical problems can be treated with non-medication options, just as someone with high cholesterol could make dietary and exercise changes instead of (or in addition to) taking medication.

Additional research is needed to continue to create best practices and evaluate effectiveness of certain counseling structures. I would respectfully disagree with Lambert’s Thesis #10 and claim that psychology is an increasingly scientific discipline. Most modern counselors of any stripe would agree that Freud’s scientific methods were lacking. If Dr. Lambert wishes to disagree with both Freud’s humanism and his lack of scientific process, I wholeheartedly stand with him. I do not believe that is where the field of psychology lies today.

Important work is being done in and for the Church by many skilled clinicians and researchers. If biblical counselors cannot acknowledge the positive contribution of this work, they will increasingly fade to the background and become obsolete.

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A Story That Needs To Be Told

Scott was a man well-known to our church and to our city. He was a hard worker, a family man, an adopter of neighborhood kids, and a master in the kitchen. His favorite was breakfast… Bacon and eggs.

When your surprise 50th birthday party becomes your funeral, there is a lot for a family to process. Of course, those who knew Scott well knew that he battled addiction for a long time. His emotional struggles lay very deep underneath a surface that most saw as a friendly face. Scott had accountability partners, went to church every week, got group support, and prayed for miracles daily. The consensus among his friends and family was that no one wanted to be rescued from addiction more than Scott. There is no greater amount of faith that a person could possess to bring about a deliverance. And while we all asked, “Why?” we also knew that Scott’s prayers truly had been answered. Addiction can no longer hold him in its grip.

I helped compile this book for Scott’s wife and two daughters to help provide for them this Christmas. Less than a month ago they lost their husband and father and immediately had to jump into Thanksgiving and the holiday season. I believe that Scott’s story needs to be told, and I also believe that those of us who claim to care about mental health and addiction need to do more than talk about it. For me, this is a James 1:27 moment. We demonstrate the love of Jesus when we do something practical to care for orphans and widows.

This is a family I personally know well. It is just one situation, but it is one for which we can make a genuine difference.

All proceeds of this book will go directly to Scott’s wife, Lisa. Buy it. Share it.

Take in the pictures and letters that tell a story of a man deeply missed. Help break the stigma of addiction by participating in the storytelling of those whose voices have been lost to a fatal illness.

You can also support Scott’s family by donating here: https://www.gofundme.com/scottmacefamilyfund

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Not All Holidays Are Happy

It really doesn’t matter if you say “Merry Christmas” or “Happy Holidays,” for some who are struggling with depression or grief neither one may feel quite right. There can be a lot of pressure during Christmastime to be jolly. Unfortunately, we may plaster on a smile to get through our 17 Christmas parties all the while feeling lost and alone. What can we do to acknowledge that pain continues and even intensifies during the holidays? How can we be honest when we are struggling, or allow others be safe enough to share their true feelings?

Don’t Assume

Just because someone is smiling does not mean they are truly feeling okay. Don’t assume a smile means that a person is feeling happy. Instead, look for overall body language — does the person look off into the distance or seem distracted? Are they keeping to themselves or answering with short, basic answers? If you are feeling great this holiday season, it can be easy to get lost in your own world and miss the struggles of those around you. On the other hand, if you are having a hard time right now, you may try to stay away from those who could actually lift your spirits even just for a little while. We need each other, even when we are not all in the same emotional space.

Don’t Convince

“Come on, it’s Christmas!!” Trying to convince someone to cheer up when they are depressed or grieving will not work. Statements like this make people feel worse, like they are just dragging everyone else down or can’t live up to expectations. If someone else is feeling happy and you are sad, or if someone else is sad and you are happy, let that be the case. Don’t try to drag someone into happiness. Instead, show compassion. Try to put yourself in the other person’s shoes and allow them to be where they are. Being a good friend means you are willing to be around another person even when they are struggling. Don’t try to fix or remove the pain, but acknowledge and validate it instead.

Do Listen

“Do you hear what I hear?” The only way we can hear each other is to listen. Tolerate feelings different from your own by inviting someone to share honestly about what is going on for them. If you are going through a difficult time, find a safe friend to open up to. And be willing to listen to their holiday cheer, giving yourself permission to be where you are even as they are in a different place. When a friend tells you they are not in the stereotypical “holiday spirit,” listen for long enough to hear the whole reason why. Don’t feel like you need to respond. Just listening is enough. The only thing we need to say to each other this holiday season is, “I’m here for you.”

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Invisible Wounds

What if 20% of the people in your congregation were paralyzed and had to use a wheelchair? Most likely, the church would add ramps and find other ways to make the church accessible, accommodating these disabilities. Yet because we do not see mental illnesses (or even invisible illnesses such as chronic pain), we tend to doubt their existence and we certainly do not accommodate people suffering with these types of brain disorders or emotional difficulties. We do not seek to adapt to their needs and often we do not even seek to understand their needs.

What does it mean to be like Christ to all of those hurting in our midst? What does it mean to seek to understand another person’s experience? Psalm 34:18 says, “The Lord is close to the brokenhearted; he rescues those whose spirits are crushed.” If we as the Church are to be like Christ, then we must also seek to be close to the brokenhearted and rescue those who are struggling with emotional problems and mental illnesses. What would it look like for your church to be a place where the brokenhearted are rescued? How can you reach out to the marginalized in your community?

The National Alliance for Mental Illness estimates that 1 in 5 adults experience symptoms of a mental illness each year. More research needs to be done to determine how representative the church-going population is. But what if it were 20% of your congregation? 20% of the community surrounding your church? Desperately in need of understanding and compassion. These invisible wounds often prevent a person from feeling like they fit in at church, or may stop them from coming altogether. If they come, they might feel like a “less-than” Christian because they don’t feel the way everyone else seems to feel. They are likely to be told that they should “trust God more” to make their mental illness go away.

It is time that we as the Church no longer turn a blind eye to the invisibly wounded. It is time to stop judging and blaming and giving pat answers and rise up to bring the Gospel back to its actual message: Jesus came for everyone. Regardless of how you feel or whether you could get out of bed today, Jesus is for you. Jesus makes his table accessible to all.

 

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Gratitude Is Good For You

I recently downloaded an app called Bliss, which simply prompts you to write three things you are grateful for every day. There are additional positive writing prompts in the app, but I have found that just cultivating a daily habit of gratitude has helped me keep my mind on what is important. Our world is so full of negativity and complaining that it is easy to get pulled down into those traps. Thankfulness brings an awareness of God and the gifts he has given rather than dwelling on our perceived lack.

Numerous studies have revealed positive effects of gratitude on emotional well-being and overall satisfaction with life. There is power in thinking about and even speaking aloud the truths about what is good in life. The Bible gives us wisdom in this area of thankfulness as well. Colossians 2:7 says,

“Let your roots grow down into him, and let your lives be built on him. Then your faith will grow strong in the truth you were taught, and you will overflow with thankfulness.”

Just a chapter later in Colossians 3:15 Paul writes,

“And let the peace that comes from Christ rule in your hearts. For as members of one body you are called to live in peace. And always be thankful.”

During this week where those in our country have the word “thanksgiving” rolling off the tongue, don’t skip over the practice of gratitude. Even better, when you think about what you are thankful for, set a rule for yourself that you cannot list any material possessions. Rather ask questions like, “What work is God doing right now in and through me? How has he cultivated more of my heart this year? What people are closer to me now than ever before? What trials is he carrying me through?”

May you be spiritually and emotionally well as you fix your heart on God and develop a grateful spirit.

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Should Christian Counselors Work in Secular Environments?

In last week’s post, I addressed the question, “Is Scripture Enough?” and explored the Christian counselor’s role in bringing healing to those with mental illness. The Church Therapy model suggests that pastors and professional Christian counselors can work well as a team to support those in their care. However, presently very few licensed counselors work in church settings. Some have private practices that are advertised as Christian-focused, while others have practices that do not overtly state that they are Christian. Many Christians who are counselors would not identify themselves as “Christian counselors,” but instead would say that they are simply Christians who are professional counselors by trade.

One line in last week’s post got me and a few others thinking about where Christian counselors should work. I wrote, “…many of these Christian counselors have chosen to work completely outside the framework of the Church or discipleship. I find this to be tragic, as many well-trained Christian counselors do not see it as their role to serve the Church.” Does this mean that all Christians who are trained as counselors should work in church settings? Would that even be possible?

First, allow me to reject my own question that serves as the title to this post. There is no “should” when it comes to ways God can choose to call people. Christians work in secular settings in all kinds of different professions, from doctors to carpenters to teachers. I am not about to limit the work of the Holy Spirit by making a blanket statement that all Christian counselors must be called to work in a church or alongside a church directly. We are all ambassadors and ministers of the Gospel when we care for and bring love to our neighbors. We weep with all who weep, not just other believers.

On the other hand, the Church has at times been a hostile place to licensed counselors as the mental health debate has raged on over the past 50 years. The thing that I find tragic is that many Christian counselors I have personally known would have loved to work in a church or come alongside in some way to use their gifts for the edification of the Church. Yet there were no in-roads for them to do so. Many I knew in my graduating class at Gordon Conwell ended up in secular settings not because of a calling, but because that was where they could find a job. Even my church did not “hire” me so much as give me the opportunity to create something that did not exist and for which they could offer no money. The pastors and I have had to figure out a lot along the way, including how to create a sustainable role for me both financially and structurally. I started writing this blog as a way to flesh out all the different aspects of how to make it possible for counselors and pastors to work side-by-side.

Professional Christian counselors are an asset to the Church and pastors must begin creating pathways for them to serve in churches. Some may be called to work in secular settings but may desire to serve the local church by offering a workshop on a mental health topic or leading a Stephen’s Ministry. Others may have a burden and desire to work on a church staff, and pastors can make that possible through the Church Therapy model.

My message is simple: every single believer has valuable gifts and all of them are welcome in the kingdom of God. Pastors and professional counselors are working towards the same ends with different roles, gifts, and skill sets. Until this spiritual war is over, we are in an “all-hands-on-deck” place. We can’t afford to send anyone away because we want to debate about psychology and theology. People need help, and we need to make every resource available where they need it most: the Church.

 

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Is Scripture Enough?

There is a lot happening in the church/mental health world, largely because there are some growing divides within the biblical counseling movement. I am still wading through some recent videos and posts by Heath Lambert, Brad Hambrick, and others in order to write a comprehensive response. One question I want to tackle today is related to the sufficiency of Scripture. This question is common in the world of biblical/Christian counseling: to what degree is the Bible sufficient as we counsel others?

What is Scripture For?

The Bible is sufficient for all people from a spiritual standpoint. The Scripture reflects God’s choice to reveal aspects of himself to us through words that can be read. If he wanted us to know more, he would have said more. So in that sense, the Bible is sufficient for all of us. Also, the Bible helps us understand why the world is the way it is. We know how sin entered the world, we know the results of sin, and we know that the only way out of this sin-cursed world is through Jesus. So the Bible is sufficient for understanding why we live in a world filled with disease and disorder, and understanding how to be rescued out of it. Scripture also offers a lot of wisdom for living. When a person needs spiritual wisdom to handle common life problems that we all experience, the Bible is sufficient in teaching us how to come closer to the heart of God and an imitation of Christ.

What Are We Talking About?

When it comes to counseling and the sufficiency of Scripture for conducting it, the problem with most of these conversations is that we talk about different things as if they are the same thing. Sometimes, for example, it is not clear if we are talking about giving “wise counsel” (spiritual advice) or if we are talking about psychotherapy (a process of working with and healing the brain). Also, it is not always clear if we are talking about counseling people who are already Christians or those who do not know Christ. Thus, many debates become convoluted because different circumstances require different answers.

Different Roles, Different Functions

I have written before on the role of the pastor and how it is different than the role of a counselor. A pastor’s job can include direct evangelism to unbelievers, whereas a counselor’s job does not. (I did two posts on evangelism in counseling versus discipleship that fleshed this out.) There are many roles within the body of Christ, and all Christians play a role in advancing the kingdom. Ephesians 4:11-16 makes it clear that there are different roles and different giftings that work together to edify the church. (Interestingly, evangelists are listed separately from pastors, so even those roles can be and often are very distinct.)

When functioning as a counselor, one is not in a role of trying to convince or proselytize. Instead, the counselor meets a person where he or she is at and allows them to take the lead in exploring spiritual issues. Counselors are trained to assess a person’s psychological symptoms, whereas pastors are not. The Bible is not sufficient (nor is it attempting) to assess or treat biological disorders including depression, anxiety, bipolar disorder, PTSD, schizophrenia and others. The Bible also does not offer specific evidence-based treatment methods that can be used by counselors to effectively treat mental disorders.

What’s The Real Problem in Christian Counseling?

In the Christian counseling world, the word “integration” is often used to describe the process of synthesizing theology and psychology. I have been trained at integrationist programs and in some ways I fall into this category. However, the integrationists have a problem in that their theory often does not translate into integrated practice. They may have a biblical view of persons (made in the image of God), but many of these Christian counselors have chosen to work completely outside the framework of the Church or discipleship. I find this to be tragic, as many well-trained Christian counselors do not see it as their role to serve the Church. I believe that much of the biblical counseling argument is actually related to the fact that many Christians who are trained as counselors choose to function in a secular way. Their arguments are often not relevant to my understanding of what integration is; thus, they get tangled up in the wrong questions and dig their heels in in all the wrong places.

Bringing True Integration Into The Church

The Church Therapy model reflects true integration: Christian counselors trained in both theology and psychology serve the church in a professional capacity on a team with pastors in the work of discipleship. This therapeutic work is specifically for those who are already believers or seeking to explore their faith, so the work of evangelism has already been done. Emotional and spiritual growth happen together, and when people hit a wall in their discipleship process because of a mental health problem or emotional brokenness they can receive professional counseling within the church setting. Pastors must preach, teach, evangelize, and train. Counselors must listen, reflect, come alongside, and bring healing. When we ask, “Is the Bible sufficient?” we must also ask, “Is the Church bringing healing in every way possible?” Pastors cannot do it all, nor should they. Multiple roles are best done by multiple people. The Bible guides us all, but quality mental health care requires additional training and knowledge that licensed Christian counselors can uniquely provide.

My desire is for biblical counselors to continue to recognize that their training programs do not include courses or practical experiences on assessing/diagnosing mental health symptoms. Therefore, they (as well as pastors) cannot be the ones to decide what type of depression a person might be experiencing. Pastors who do biblical counseling also must recognize the complex power dynamics that occur when one tries to be both evangelist and counselor. On the other hand, my desire is for integrationist Christian counselors to recognize that integration can only truly happen when one is serving the body of believers (whether on a church staff or in a Christian center/practice). Helping someone spiritually without knowing how to assess and treat their mental health is not counseling. But helping someone heal emotionally without helping them spiritually leaves them stuck as well. When counselors engage in the work of healing to bring both mental and spiritual wellness, they are playing a significant role in bringing about the kingdom of God here on earth. Pastors, invite professional Christian counselors in and listen to our expertise on emotional and mental health. Christians who are professionally trained counselors, return to a place of serving the Church and re-engage in the work of discipleship. Perhaps then we can find a Church that is safe for everyone.

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NEW Interview!

This week I was privileged to be interviewed for the second time for the Church & Mental Health (CXMH) podcast. In the interview, I share my thoughts about how I see the tides turning in the conversations about mental health in the church.

Listen to the interview here.

I’d love to hear your reactions and thoughts — post a comment below and be sure to subscribe to this great podcast!

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Connecting Pastors and Counselors

The debate over mental health in the church was alive this week on Twitter after a pastor posted a thread of comments attacking psychology and calling mental illness “SIN” (his emphasis). After weighing in on the conversation, I tweeted some thoughts. One tweet got a lot of attention: “For every pastor equating mental illness with sin, there are so many more partnering with therapists to bring wellness to those suffering.” It was a message of hope, and it resonated with many who are also seeing the tides turn on this nearly 50-year-old schism.

One of the distinctives of the Church Therapy model is the team approach connecting pastors and therapists. Both roles work seamlessly together to come alongside people who are seeking to grow spiritually and emotionally. Of course I advocate for an increase in the number of churches who bring licensed therapists on staff, but that is not the only way to build a partnership. If you are a counselor and you obtain authorization from the client, you can reach out to their pastor. Pastors, you can reach out to counselors (who will at that point have to have the client sign a release before returning your call).

So what should pastors and counselors talk about? Can they even speak the same language to understand the issues going on for the client? Here are three ways pastors and counselors can get on the same page:

Start With The Client’s Goals

Both pastors and therapists need to remember that the work is not about them. The work is about the client’s process of growth. Start the conversation by talking about what the person has said to each of you about what they want to work on. As an example, let’s imagine a case in which a person is struggling with social anxiety. The therapist could share with the pastor some information about this disorder and ways they are using relaxation or cognitive-behavioral strategies to decrease anxiety symptoms. The pastor could offer insight about ways this anxiety may have manifested at church so that the therapist has a more clear sense of the impact of symptoms. Both could offer thoughts on what the process of healing or change would look like for the person. What would you each notice as emotional and spiritual growth? What do you each see as the problem areas or root causes of issues? Remember, use your perspectives to collaborate instead of debate. You each have something important to offer as you help the person.

Make A Two-Part Plan

Wraparound treatment provides help from multiple angles. What can the pastor do to help the person grow spiritually and connect better at church? What can the therapist do to see the church context as a safe space for the client to practice skills and grow? Sometimes traditional discipleship models have cracks through which those with mental health difficulties fall. Could the therapist and the pastor come up with accommodation ideas that could help the client succeed both emotionally and spiritually? Additionally, the pastor and the therapist can unify their key focus or message so that both are helping the person narrow in on one or two key truths from spiritual and psychological angles.

Keep Talking

There is unfortunately a long history of distrust between pastors and counselors. This post assumes that the counselor is a Christian, but pastors can be involved even with non-Christian therapists. However, there are likely to be some pretty major obstacles of distrust to overcome. Pastors, let the therapist know you respect and value their work. Tell them about changes you see in the person’s progress, especially if you have known the person a long time or were the one to recommend treatment. Counselors, don’t treat pastors as though they are not the “expert” or assume they are hostile to psychology. Even if they have some questions, respond non-defensively and do not presume questions mean attack. Develop a genuine relationship with each other so that you can continue to collaborate on other clients. Pastors, you could invite therapists to come do a training with your staff. Counselors, you could invite pastors to your office for lunch and conversation with yourself and perhaps a group of your colleagues.

We all need to work together to fight stigma and support those in the church body who are facing mental health challenges. When we focus on the person, we can set aside old debates and start new conversations about how to be of help. That makes therapy a great addition to the person’s healing and growth process, and it makes church a safe place for them to be emotionally.

 

 

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Guest Post: Barry Pearman

I am excited to welcome guest blogger Barry Pearman, a Christian mental health advocate from Auckland, New Zealand. His website Turning the Page aims to empower people’s mental health through faith, hope, and love. You can also follow him on Twitter @barrypearman. 

Why You Need To Stand Close

by Barry Pearman

She was short in stature but large in observation. She would watch, listen and ponder. Underneath though, there was wisdom that needed to be discovered, explored and known. I brought her onto the leadership team and asked her many questions. At the time I was pastoring a church (within a church) that focused on supporting those with disabilities, primarily those related to major mental illnesses. This woman on my team struggled with hearing voices (schizophrenia) and had been in psych hospitals for many years. And she was full of Christ.

Who do you listen to?

Social activist Jim Wallis once wrote, “Only those willing to stand close enough to listen will ever hear those closest to the problem.” Who are you choosing to stand close to? Who are you sitting, or kneeling or washing the feet of? This idea is captured in one of my favorite Bible characters, unnamed but deeply known, from Ecclesiastes 9:14-17:

“There was a little city, and few men within it; and a great king came against it, besieged it, and built great bulwarks against it. Now a poor wise man was found in it, and he by his wisdom delivered the city; yet no man remembered that same poor man. Then I said, ‘Wisdom is better than strength.’ Nevertheless the poor man’s wisdom is despised, and his words are not heard. The words of the wise heard in quiet are better than the cry of him who rules among fools.” 

We all live in little cities. Small groupings where hopefully everyone knows your name. It might be at work, the gym, the cafe, the church. When a problem comes, we often run to the powerful, the authorities, and the leaders who are usually distant from the ditch. We do not seek “the poor man’s wisdom,” when often the quiet cries of the marginalized are the most important.

Spend Time in the Gutter

My heart is for those who struggle with mental health issues. Often discounted, their voices need to be heard. Many have a wisdom that is ‘better than strength’ yet it is despised and silenced. Today I would ask you to seek out the poor. Listen to them. They have seen things from the gutter that you need to see. Getting down into the gutter yourself is a way to understand and listen to those who need to be understood. Let’s not give out our good advice, band-aid prayers, or disempowering charity. Let’s just sit and listen. Life will change for each of us as we enter into this work of Christ. May we never be the same again.