Category: The Church Therapy Model

In the world of biblical counseling, a phrase you often hear is “organic disorders.” These are the types of problems that are biologically based and may require medical treatment, and Jay Adams (founder of the biblical counseling movement) expressed from the start that organic disorders are to be treated differently from other types of emotional problems.  In Competent to Counsel Jay Adams notes, “Organic malfunctions affecting the brain that are caused by brain damage, tumors, gene inheritance, glandular or chemical disorders validly may be termed mental illnesses. But at the same time a vast number of other human problems have been classified as mental illnesses for which there is no evidence that they have been engendered by disease or illness at all” (Grand Rapids, MI: Baker Book House, 1970. p. 28).

Adams was and still is making a great point that the term “mental illness” has become so broad that almost anyone can qualify for one. Surely, any counselor or psychiatrist who uses the Diagnostic and Statistical Manual of Mental Disorders (DSM) must approach its use ethically and responsibly. There are many ways in which the mental health field has been too quick to turn to medication or labels to solve problems. In addition to Adams, there are many secular psychiatrists and mental health professionals who sound the same alarm (for example, Saving Normal by Allen Frances, M.D.).

So let us begin this dialogue with a few clarifications. First, it is my position the DSM-V (or any previous version) does an imperfect job at presenting various disorders but its classification of symptoms when carefully researched and used responsibly is useful to the counselor in identifying organic disorders. Secondly, the very nature of Church Therapy promotes counseling by a Christian professional in the church context for people who are already Christians or seeking to be so. Third, Christians experience organic disorders related to brain dysfunction as do non-Christians.

With these specific guidelines in mind, how does one define an “organic disorder”? Is it only organic if it is a physical problem that can be verified by a medical test? Or is it possible that organic disorders are often diagnosed even by physicians through observation of behaviors or self-report? Do medical tests alone validate a disease, or are our medical and scientific capabilities limited in some ways? Thinking back in history, there have been many (wrong) theories about physical problems. We probably all remember learning about the body “humors” and flawed medical practices like leeching. These medical theories were unscientific and wrong, but they pointed to something right: there is a physical problem going on in the body. In early medical times, they may not have been able to measure various diseases and disorders but that does not mean these disorders were not real. Certainly no one would argue that diabetes suddenly came into being upon the discovery of the blood sugar test.

If organic disorders may be present even when we have not developed an adequate medical test to diagnose them, how do we assess these disorders? We live in a time that is perhaps past the infancy stage in our true medical knowledge and testing of the brain, but we are not far past toddlerhood in how much more we have to learn. Some brain imaging tests, like PET scans and even more advanced measures, are providing new understandings but are unlikely at this point to be used on a regular basis to diagnose things like depression. At our present scientific capabilities, dysfunctions of the brain (certainly a critical bodily organ) are not particularly measurable beyond brain damage, blunt trauma, or certain forms of dementia.

If after a careful and well-researched look at the DSM we agree that at least in some cases there is such a thing as clinical depression, for example, who should assess and treat this organic disorder? How do we determine when depression symptoms are organic and when they are not? Is it possible to make that distinction? It is here that I find the role of the church therapist critical, and it is why I insist that a church therapist must be a professionally trained and licensed provider with a biblical view of persons. If one is not trained in psychopathology, human development, or evidence-based cognitive therapies I do not believe one will assess organic disorders accurately. You will either dismiss all mental illnesses as non-organic or you will leave all the power of assessment in the hands of primary care physicians and psychiatrists who are likely not Christians.

Theory is wonderful to create and study, but we also must look at actual practice to guide our thinking. In reality, a biblical counselor who is untrained in psychopathology will not have enough information to accurately assess organic disorders when they see them. Let’s assume, for a moment, that a biblical counselor does feel he or she has encountered a true organic disorder. To whom does the biblical counselor refer? If they send the person to a primary care doctor, it is most likely that the doctor (also not highly trained in the specialty of psychiatric diagnosing and medication) will have a medical view and not a biblical one and will write a prescription for a medication. If the biblical counselor sends the person to a psychiatrist, again they will be treated by someone who is not likely to share a biblical view of persons and will prescribe medications. Either way, the person will have about 7-10 minutes with the medical professional treating him or her. It is unlikely that any medical tests will be performed, since as mentioned earlier these types of measures either do not exist yet or are too costly. In these scenarios, we abdicate our role with the client and leave assessment and treatment of organic disorders to someone likely to medicate and unlikely to agree with the Bible. Or, perhaps more likely in biblical counseling situations, disorders such as Bipolar Disorder, ADHD, Major Depression, PTSD, or Generalized Anxiety Disorder will not be viewed or treated as organic.

A licensed mental health professional at the Master’s or doctoral level working in a church setting has a unique role to play in assessment and treatment. This church therapist will have received training on how various disorders and symptoms present themselves, and with training and experience he or she gains an ability to diagnose disorders such as those mentioned above. Because the church therapist is a mental health professional but not a medical professional, he or she has the ability to maintain a biblical view of persons and use many additional techniques to help organic disorders that do not require medication. Just as exercise and diet can be an effective treatment for someone with heart problems, so too can various therapeutic strategies be applied before medication is deemed necessary. Organic disorders do not mandate medication. If medication is necessary, the church therapist can communicate with the psychiatrist or doctor and maintain an active role to ensure that over-prescribing is minimized.

The team approach in church therapy allows the right treatment for parishioners. When everyday life problems are getting a person down, they can receive biblical or pastoral counseling from their pastor. They can participate in mentoring and discipleship by a pastor or lay person, learning how to understand and apply the Bible to their lives. And in cases in which the pastors feel that a person may have a more complex problem or organic disorder, their first referral is to the church therapist, not to an outside provider. In this way, pastors, biblical counselors, and church therapists can all work together addressing needs according to a biblical worldview and with a goal of healing.

The point of diagnosing is not to give someone a label or a free pass on an area of sin. Just the opposite! With proper diagnosis and treatment by a professional who has studied the varying presentation of disorders, a person can be effectively helped and can move forward emotionally and spiritually. The church therapy model is a call for professionals to enter the church setting to provide a full complement of care based on the needs of the individual. Some Christians have organic disorders; should we not offer the best possible care in the context of the church?

Biblical counseling, pastoral counseling, Christian therapy, church therapy… aren’t these all the same thing? If you have been confused about different approaches you have seen to counseling within the church, you are not alone! Many churches have a pastor who does biblical or pastoral counseling, others refer out to professional Christian therapists, and church therapy suggests a hybrid model. Your church’s view of mental health may be very different from other churches around you. If you are a pastor, perhaps you have wrestled with finding the right approach for your parishioners.

Let’s start with biblical counseling. This approach was founded in the 1970’s by Jay Adams, who rejected secular psychology and in his book Competent to Counsel he argued that pastors have everything they need to know for counseling in the Bible alone. At the time, Adams was making a very important statement for Christians: our fundamental understanding of human beings must come from the Bible. All Christian counselors must evaluate humanistic philosophies carefully and reject concepts that are in opposition to biblical teaching. That said, today there is so much information and research on the brain, human behavior, and effective counseling strategies that fits very well with a biblical view of persons. However, because of Adams’ rigid stance on psychology some biblical counselors today continue to reject psychology as a whole when it has much to offer.

Pastoral counseling is slightly different from biblical counseling in that it is not a specific counseling approach, but rather a general term for counseling done by pastors that is focused primary on a person’s spiritual life. A pastor may or may not have training in more complex emotional issues, so in pastoral counseling there is more of a focus on giving wise advice and helping a person though a specific brief problem. Usually, when a pastor feels that the person needs more in-depth counseling, he will refer them to a different type of counselor for emotional help.

Many pastors today have a list of professional Christian counselors to whom they refer their parishioners. These counselors have Master’s or doctoral level training in counseling or psychology and many have come from Christian colleges and seminaries. Many Christian programs integrating psychology and theology exist to train Christians who want to study and use both in their work in the mental health field. Christian counselors often have private practices or work at Christian counseling centers and see clients outside a church setting. They are trained to handle complicated emotional and mental health issues including assessing safety and evaluating specific symptoms.

Church therapy is a hybrid model, bringing the professional Christian counselor onto a church staff. I have set up this blog in order to create and establish church therapy as a reproducible model throughout the wider church body. You can read more on the “What is Church Therapy?” page. I believe that Jay Adams was right in his feeling that we must stay faithful to the Bible and that the church needs to be able to directly respond to all sorts of problems. However, I feel that pastors and counselors need extensive training on both psychology and theology to do therapy effectively. Church therapy decreases stigma, increases accessibility, and promotes the idea that the church should be offering the BEST and most effective treatments for mental health problems occurring in the church.

Church Therapy is a model of counseling ministry that connects Christian professional counselors to church leadership. In addition to the non-profit, outsourcing model used by Church Therapy Associates, here’s a snapshot of how it can work with one licensed counselor on a church staff:

Too often, pastors with many roles to play in the church are overburdened and unable to adequately provide counseling well. In other churches, there may be a pastor specifically assigned to the task of offering counseling, but his or her training does not include studies of human behavior, mental health disorders, or evidence-based therapeutic techniques. In the Church Therapy model, those who are called both to church staff and to professional counseling find their niche.

In the past, many who would espouse a biblical counseling model argued with an integration of psychology and theology. Humanistic philosophies, they argued, must be rejected because they are at odds with the Bible. I agree with this statement, and at the time (in the 1960s and 1970s) it was an important statement to make. Freud, Jung, and many others were forming theories that sought to answer questions about humanity, such as “Who are we at our core?” and “What connects all of us as humans?” The Bible has offered answers on these topics for centuries and these early psychology theorists were often in opposition to biblical ideas. (Freud did assert that “religion is a system of wishful illusions together with a disavowal of reality”… Christians naturally must disagree with that!).

Despite our rejection of humanistic philosophies, we need to give credit to Freud, Jung, Rogers, Adler, and so many others who were pioneers paving the way into the study of human behavior. The behaviorists bolstered the idea that human behavior could be manipulated, or “conditioned,” and this led into a study of why and how this happens. Questions about why we seek certain rewards, including food and drugs, began to have some clearer answers.

Enter the 21^st century and you begin to hear words like “evidence-based practices” and “epigenetics”.  You are going to be hard pressed to find any pure psychoanalysts out there (who can afford it, anyway?). All types of theories, both regarding the human condition and on which treatment modalities work best, have been explored and studied. With epigenetics and findings about neuroplasticity, we now know that our genes are not set in stone but can be “locked” or “unlocked” depending on stressors in the environment. The nature versus nurture debate ended in a tie. We know our brains can change with experience, and that secure, loving human connections heal the brain.

It is my assertion that those who study to serve the church as a counselor must be skilled to the highest level, and I personally believe that guidelines provided by states for counseling licensure provide a rigorous framework for study. I believe that the church should be providing the BEST care of all available options.

I do not assert one specific treatment approach over another (for example, brief cognitive-behavioral therapy versus a family systems model). I believe that God has gifted even counselors differently, and as long as your approach is well-informed biblically and psychologically and is grounded in empathy the counselor must use the approach best suited to his or her style and personality.

So why is Church Therapy not often done? There are many reasons, largest of which I believe is a lack of in-roads. Pastors must be open to understanding the need for therapy, and must see the scope of therapy needed in the congregation. The rates of sexual abuse among women, for example, are extremely high (up to 1 in 3!). If the church is attracting broken people, the rates of trauma as well as depression or other types of mental illness will be even higher. Those who are vocal enough may end up with a referral to a Christian counselor outside the church but most often they do not follow up. Thus their spiritual development is stunted as they repeat negative relationship patterns or continue in unresolved trauma and grief.

It has been my observation that there are many who attend seminary in hopes of providing counseling in a church setting. But upon graduation, there are not church jobs listed, so they begin to work for a secular agency and typically end up in a private practice seeing both Christians and non-Christians. This presents difficulties in fulfilling their original calling to church leadership.

Having a counselor on church staff decreases stigma about getting help and increases accessibility of services. Professional therapists on church staff can also provide guidance on emotional health and its connection to spiritual health. And with licensure, a professional counselor on church staff can generate revenue through billing insurance companies, leaving church funds available for other needs.

To learn more about how the Church Therapy model works, click here to see all my posts in this category. Thanks for visiting!