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Increasing Accessibility: When Proximity Works

Since the time of Freud and his trained psychoanalysts, there has been a belief in the counseling world that counselors must be distant from their clients. While boundaries are critical to any successful therapy experience, human connection does not need to be rejected. Carl Rogers certainly did his part to change this idea, emphasizing the importance of genuineness and unconditional positive regard given by the counselor. Now there is much data to support the idea that the relationship between the therapist and the client is the largest factor in the success of the therapy.

Despite this move towards relationship and connection, the mental health field still has systemic flaws when it comes to decreasing stigma and increasing accessibility to services. Many still believe that all dual relationships must be avoided, despite changes made in 2005 to the American Counseling Association’s code of ethics allowing for “helpful” dual relationships. Many therapists believe that they cannot be known at all by their clients, even though it is often helpful for clients to hear that their counselor shares in human experiences.

Within the church context, extending genuine love to others is a key principle demonstrated by Jesus himself. Human connection, infused with the love of God, is a powerful force of change that can produce healing. Church therapy, then, must be centered around the idea that we foster genuine love within our therapy. Within this framework, the church therapist is one who is known and who is available. There is no stigma in needing love, since this is the state in which we all find ourselves. There are no barriers to accessibility of counseling, because it is available to all in the church who are in need.

When a person experiences a problem in life (whether it be trauma, depression, anxiety, or adjustment problems), one of the most difficult things he or she could do would be to go to an unfamiliar office in a building they have not seen before and talk to a stranger about the deepest hurts of the soul. Without church therapy, this is the only option for obtaining professionally trained help. But church therapists have had the opportunity to demonstrate to those in the church that they are trustworthy. Proximity, usually avoided in counseling relationships, actually offers safety and comfort. The church therapist’s office is located right within the church walls, directly in the place of deep security and familiarity.

Many in the mental health field would argue that anonymity and distance make therapy a safe experience for the client and therapist.  For some, this may be true. However, it is my belief that proximity and familiarity actually offer a kind of safety that allows those who would otherwise avoid counseling to feel able to enter in. Church therapy promotes accessibility and decreases stigma because it creates a church culture that says, “We expect you to need help. We are here for you.” This culture inherently encourages those who might not have sought help otherwise to come and receive services that can free them from emotional burdens.

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Perfectionism Versus Excellence

I once attended a church conference in which I was struck by the church’s culture of excellence. The leaders and staff had a quality about them that was striking — they all gave their work everything they had while maintaining a humility that was authentic. While they were proud of their ministries and put on the conference in order to share all they had learned, it was not about their own efforts or an ego-boost.

This experience got me thinking about the differences between perfectionism and excellence. First of all, perfectionism and excellence are on opposite ends of the pride-humility spectrum. Perfectionism is rooted in pride because ultimately it is all about striving to be the best. But my best can never be the best. If my best were the best, then I would be the standard-setter. And if I were the standard-setter, I could also be the judge of others who failed to meet that standard. It is here we see that in perfectionism we are taking God’s place as the standard-setter and judge. He alone is perfect.

Excellence, on the other hand, is rooted in humility. It is cultivated in a system in which there are clear roles, expectations and authority structures. Excellence is driven by one’s character — the end result does not matter nearly as much as how you got there. Hard work, dedication, calling and team-building are all central to a culture of excellence.

Matthew 5:48 says, “But you are to be perfect, even as your Father in heaven is perfect.” Perfectionists for Jesus! But wait a second… This statement comes during the Sermon on the Mount, in which Jesus is contrasting the outward acts of law-following with the inward heart of Spirit-following. Here Jesus is saying, “Guys, if you want to get to heaven relying on your law-following, then perfection is your only option because God is perfect. The only way to get to Him through the law is perfection.” The obvious implication is that being perfect is impossible, just as relationship with the God based on our own works is impossible. We cannot be perfect and we are in desperate need of a Savior.

Are you striving for perfection? Is your Christian walk rooted in pride or in humility? May we become a Church that is deeply humble, devoted to our Father, and excellent in all we seek to do for His kingdom.

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Learn. Listen. Love.

When it comes to mental illness, there is a lot we don’t understand. Even neuroscientists who devote their lives to the study of the brain are still trying to figure out the puzzle. Sadly, Christians are often uninformed or misinformed about mental illness, causing too-frequent judgmental responses. And often these responses are systemic and subconscious, so they go undetected by those who perpetuate them. Any stigma or bias against the experience of another individual causes harm and creates shame and blame.

Learn

I believe as followers of Jesus we can do better. I think change can happen when we start by learning. Educate yourself on the latest research on the brain. Read about the symptoms of mental illnesses and find out more about common medications used to treat depression, anxiety and mood disorders. There are some great resources out there, including the National Alliance for Mental Illness and PsyPost.org.

Listen

The next step is to listen. All the statistics and facts and research in the world do not speak to an individual’s situation nearly as well as their own voice. When a friend shares that he or she is struggling with depression or anxiety, just listen. Then listen more. Then keep listening. It is so tempting to put in your opinion, give advice, or turn the conversation back to yourself. Be present with that person and sit with their story.

Love

Finally, may we truly be the Church towards those who are hurting and demonstrate love. Not love if they get better. Not tough love to teach them a lesson. Actual, real, agape love with no strings and no expectations. Love them for who they are and where they are at. Let them be on their own journey and choose to walk alongside. Make a meal, give a ride, babysit, mow a lawn. Whatever your spiritual gift is, use it to love that person who is suffering. When we love, we embody the Spirit of God just as Christ did while on earth. May it be said of the Church that we demonstrated compassion and love to every person we encountered no matter the struggle.

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What is Mental Illness?

I often speak about the Church’s response to “mental illness.” Often used interchangeably are words like “mental health issues” or “emotional struggles.” Defining these terms is important in this dialogue, as doing so ensures that we all know exactly what types of problems we are trying to address.

The Diagnostic and Statistical Manual, 5th Edition (DSM-5) states this definition:

“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (p. 20).

The term “mental illness” can conjure up a variety of images, including other problems (such as homelessness or addiction issues) that sometimes co-occur with severe and chronic mental illnesses. Movies like A Beautiful Mind or Girl, Interrupted portray psychotic symptoms that are present with disorders such as schizophrenia. But are these mental models accurate when we think of the term “mental illness”? When we speak of the Church’s response to mental illness, are we simply trying to reach these severe cases?

Mental illness is far more common than we realize. According to the National Alliance on Mental Illness, in any given year 20% of American adults experience symptoms of a mental illness.  This means that 1 in every 5 people are experiencing symptoms of depression, anxiety, bipolar disorder, adjustment disorders, PTSD and many other mental illnesses each year. Some may argue that those statistics might not represent the Church, as a faith and hope in Christ would offer a way out of these symptoms. However, if the Church is doing its job to reach the hurting, then our churches should be filled with more suffering, not less.

Notice that the statistic says 1 in 5 each year. That means that mental illness is not forever. Many people experience a single episode of depression that resolves with temporary medication and treatment and they never experience mental illness again. For others, mental illness is a chronic disease that requires life-long management. The Church can and should be a beacon of hope to the suffering, and hopefulness has a healing impact spiritually, psychologically, and biologically. But as with any illness, simply becoming a Christian will not make the symptoms go away. It is in this way that we as the Church must have a continual response of acceptance, love, and understanding to avoid stigmatizing and shaming those who continue to struggle throughout their journey with Christ.

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A Different Kind of Silence

There has been a lot of talk lately about the silent suffering of those in the Church who are battling mental illness. The hurting are often voiceless, their experiences kept hidden from view so as to keep the Church looking all put together. While Jesus’ own ministry gathered a pretty rough-around-the-edges crowd, the American Church today seems to strive for the opposite. Those who don’t fit the mold are cast aside and left to find Jesus by themselves.

On blogs like this one and on podcasts like CXMH, many have begun to speak out in order to raise awareness about mental health issues. These forums allow stories to be told, myths to be dispelled and dialogue to be engaged. This is much needed to decrease stigma within the Church, so that we stop blaming those who are suffering. Those who have been muted are now able to test the waters of authenticity in hopes of not being shamed back into silence once again.

Today I am calling for a different kind of silence. I am asking my fellow brothers and sisters in Christ to respond with silence as those who were once voiceless begin to speak. Many rush to fix, critique or blame those who express their suffering. Some even do it using Scripture to shame and harm the very ones to whom God extends grace and hope. What if we, who do not face a daily battle with mental illness, simply responded with silence to those who do? What if we just listened? What if we were simply present and didn’t run away from the suffering? What if we just offered a supportive nod or a warm embrace? What if we wrote down for ourselves every verse in the Bible that advises a tight rein on the tongue and applied it to ourselves?

If we took a voluntary vow of silence and listened to those who now speak out to share their stories, what kind of spiritual and physical healing could take place? Might some chains be broken loose as we follow Christ’s example in accepting those around us without condemnation? How might the American Church change if we all followed the wisdom of Proverbs 17:28: “Even fools are thought wise when they keep silent; with their mouths shut, they seem intelligent”?

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Why We Blame People For Their Mental Illnesses

Most people in and out of the Church can accept that mental illness is real when manifested in a visible way. Someone who has witnessed a person with schizophrenia in a psychotic episode would have no doubt that that illness is real (though some in the Church might actually assess that as demon possession). But what about someone living in reckless ways during a manic episode of bipolar disorder? What about someone who struggles with suicidal thoughts? Where is their faith? Is that sin or illness or both? Are those even the right questions to be asking?

Enter a theology of sin that is not big enough for biological factors to be at play. Those of us Christians who have the privilege of being mentally well generally believe that we are able to control all of our thoughts and choices. When we are tempted, we need to flee from temptation. When we worry, we need to cast our cares on God. These are the responsibilities of the Christian to stay on the narrow path. Perhaps even in this theology we place ourselves in too powerful a position over our own lives. We have to remember that if we have it together, that is solely by the grace of God. Romans 9:16 is helpful here: “So it is God who decides to show mercy. We can neither choose it nor work for it.”

But how do malfunctions of the brain factor in here? Are some more capable of self-control than others? In my book, On Edge: Mental Illness in the Christian Context, I use an example of a person with developmental disabilities. Certainly (hopefully!) no one would expect a person of limited intellectual capacity to have a well-developed theology in order to enter the kingdom of God. (And by the way this is not a requirement Jesus placed on anyone regardless of capacity.) Can, for example, a non-verbal person with autism receive salvation if they cannot understand the Gospel and cannot “confess with their mouth that Jesus is Lord”? Or are they shut out from the Kingdom?

Similarly, a person struggling with depression may not be able to consistently engage at church. They may struggle with doubt or have thoughts of killing themselves. Is this because of a lack of faith? Or is their disordered brain incapable of overcoming these thoughts no matter how much faith they try to muster? And why is it their responsibility to fix this themselves?

This is where the Church has to do its job: demonstrate love and compassion. Why is it not the entire Church’s responsibility to spiritually carry those who are struggling to carry themselves? Why do we not enter into these situations to offer care and non-judgmental support? Why do we have to have a neat and tidy explanation and evaluate the person’s spiritual standing before helping them?

I would like to challenge the Church to rise up to support, love and defend those with mental illness even when we don’t know how to understand or explain it. Let us reach out with open arms to those who are marginalized, misunderstood and downtrodden. Let’s show the love of Jesus and get off the judgment seat in every way. Messages from the pulpit that support a “try harder” theology are unhelpful for all of us. May we live and preach the Gospel in its entirety.

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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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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.