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Church Therapy in Crisis Situations

The Church Therapy model creates accessible mental health care within the church setting, decreasing stigma and changing a church’s internal culture around mental health issues. The presence of a therapist on a church staff provides ongoing day-to-day support and care. However, one of the best advantages of the Church Therapy model is the presence of a trained and licensed mental health professional when a crisis arises. Skills like de-escalation, crisis intervention, conflict resolution and trauma/grief processing are extremely valuable when moments of crisis occur in the church.

A couple years ago our church experienced the loss of a young woman dear to the hearts of many in our congregation. She had been with us for several years before having to move out of state with family as her health declined due to cancer. She died on a Wednesday morning, and her death became known to us that afternoon. As my husband prepared for the Wednesday night service and small group time, we realized that some people in each small group would be experiencing significant grief, while others who were more new to the congregation did not know the woman who had passed away. The small group leaders were unsure how to handle a group with such varied needs.

In talking through our options, my husband and I decided it would be best for me to lead a grief group for all who needed to process our friend’s death. About 10-12 people joined me that night, allowing the usual small groups to function as they normally would in discussion on the Bible passage presented. Those who joined me were distraught, feeling a range of emotions as anyone would in the midst of the untimely death of a young person. We walked through our initial thoughts and feelings: what was it like to hear the news? What were our first reactions? From there we shared memories and stories, moving from deep despair into laughter and joy. We found closure in thinking about what we might say to our friend if we could tell her one more thing, and we spent time in prayer for the requests that we knew were dearest to her heart.

The grief group was a healing time, met with gratefulness on the part of those who got to participate as well as on the part of the small group leaders who had felt ill-equipped to know how to help the grieving. In fact, we were able to conduct a grief group a second time more recently after another sudden, tragic death. There are many other types of crisis situations that have also arisen in our congregation, such as domestic disputes that made their way into the church auditorium, people in active psychosis attending the service, and interpersonal conflicts between church members to name a few. These situations have been handled with care and skill because of my professional training in these areas, and without those skills many of these situations could have escalated into a much worse crisis. The pastors and ministry leaders have been able to gain new crisis response skills as well, creating a broader range of people who may be a first-responder in an unexpected crisis.

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The Church as the Therapeutic Milieu

Throughout my career in the mental health field I have worked in almost every type of therapeutic setting out there — inpatient hospital, outpatient clinic, in-home outreach, group home/residential setting, and the church. I believe it is because of my wide range of experiences that I have come to view the church as a therapeutic milieu, with staff addressing a variety of needs and peer groups in which to work out therapeutic problems. Church Therapy is not tremendously different in therapeutic structure from secular mental health agencies that provide therapists, case workers, psychiatrists, crisis teams and the like all working together on a single case. But unlike these secular settings, Church Therapy works with the whole person, including their spiritual development as an integral part of addressing their mental health needs.

Recently I was working with a client who has difficulty with trust in relationships. We have spent a good deal of time in individual therapy processing the trauma that is at the root of her lack of trust, and we have wrestled through what it means to build safe relationships. Because she has been hurt within her former church, we had a critical therapeutic decision: run from the church because it is not safe or run to the church in a new way that rebuilds trust and actually allows Christ to restore what was broken.

One of the things that is essential in any therapeutic milieu is safety. Whether you are on an inpatient unit or in a client’s home, there are various boundaries and structures that make that environment safe or unsafe. And just as there are many secular therapeutic settings that turn out to be unsafe because those structures collapse, there are many church settings where there is not relational, emotional, or spiritual safety. Let this not cause us to give up altogether on the church context. Rather, we must build new church cultures and structures that restore safety and rebuild trust. The Church Therapy model is designed to do just that, bringing a professional counselor onto a church staff in order to influence the church culture in a direction of emotional safety and create accessible mental health services within the church.

As I worked through strategies with my client about how to work on building trust, I raised the idea of using our Wednesday night small group setting as a means of testing the waters. Here we have exactly what we are looking for: a place to build relationships slowly focusing on a Bible discussion rather than on personal issues. The fact that the small group structure exists in a context with which we are both familiar creates a tremendous opportunity for healing. Safety is there because I can oversee the entire process from a therapeutic standpoint. I can help her navigate the challenges because I am heavily involved in the Wednesday night program as a church staff member. Were I operating in a off-site, private practice, I would not have the opportunity or influence to guide that process correctly. And without that ability to sculpt and shape the context to which I am sending a client, a great deal of damage could be done if the small group turns out to be emotionally unsafe after all. I also have the ability to help the client interpret and understand various social dynamics because I have first-hand knowledge of those dynamics. I am not merely relying on the client’s report of what happened in a small group; I am a direct witness to the program as a church staff member.

The Church Therapy model does not exist merely to provide mental health services within the church as a set apart ministry. The Church Therapist uses the entire church context as a therapeutic milieu in which the client can grow and experience transformation.

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Christ in Counseling

Mention the words “church” and “counseling” in the same sentence and I assure you the response will be surprising. While the Church has been a place people have turned to during emotional struggles for centuries, the development of modern psychology has sparked an intense debate within the Church. What causes mental illness or emotional struggles? What is the best way to address those issues? Should a pastor provide counseling or is that the job of a professionally licensed therapist? Does embracing certain aspects of psychological study mean we are compromising our faith?

Many have jumped to conclusions about the Church Therapy model, asserting that I have somehow sold out on my faith because I have studied psychology and advocate for professional licensure. Previously on Twitter, a person I do not know who has never asked a single question about this model wrote to me: “Counseling minus Christ equals deception.” Whoa. I have learned not to take these comments personally, but it did get me thinking about how to articulate my views on the role of Christ in counseling. First of all, I want to clarify that the Church Therapy model is primarily focused on counseling those who are already following Christ. Of course there may be some who are in a seeker-phase of the spiritual journey, but typically those who come to a church for counseling are already Christians. I do not believe it is the role of a counselor to proselytize in a counseling session, so for this reason Church Therapy does not seek to gain new converts.

Counseling in the Church Therapy model is part of the discipleship process as spiritual growth and emotional health provide increased freedom. Christ is 100% at the center of this process because he alone is able to supernaturally change lives. However, that does not mean that my primary methods are quoting Scripture or praying with clients. At times these can be helpful, but more often psychological strategies such as Motivational Interviewing or Cognitive Behavioral Therapy are far more effective in helping a person overcome various emotional challenges. For this reason, training in the Bible is not enough to train a person to be an effective counselor. Even basic helping skills like active listening, though useful on some level, are not enough to train a person to be a competent counselor.

So how can it be that I claim Christ is at the center yet I highlight modern psychological techniques as superior methods for therapy? Perhaps an illustration would help clarify this point. A couple of years ago, I walked alongside some friends whose baby had lost oxygen for nearly 15 minutes at birth. He was rushed into the NICU and placed on a cooling pad, an advanced treatment for babies at risk for brain damage at birth. The baby had to be on the cooling pad for 72 hours before any testing could be done to assess brain damage. During this time the goal was to slow the development of brain cells in order to stop any further damage. That was the longest 72 hours I have ever experienced as we prayed and fasted and poured everything we had into seeking a miracle for this baby (who the doctor’s warned would probably be very brain damaged). Every day that I see that little boy, who has little to no signs of brain damage today, I see a walking miracle. Was Christ at the center of his healing? Absolutely. Did the doctors use a modern method to facilitate that process? Yes.

Using researched strategies to address mental health issues is no different. We no longer have to accept the ideologies of Freud, Jung or Skinner in order to believe that modern psychology has a lot of knowledge to offer. Even most secular counselors do not hold tightly to these early definitions of psychology. The Church Therapy model connects biblical, psychological and biological truths in order to most effectively move a person towards healing and life change as they deepen in their walk with Christ.

Unfortunately, even many Christian counselors do not view counseling as part of the discipleship process and they counsel many non-believers. They can help them change certain aspects of their life, help them cope, or improve their communication skills. But this does not move them into deeper relationship with Jesus. The Church Therapy model is a true integration of Christian faith and psychological study. Both are in mind at all times as the Holy Spirit moves in the midst of effective therapeutic strategies.

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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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Cultivating Peace

Whether or not you experience mental illness, you need to take time to care for your mental health. Each of us can practice daily routines and habits that will help us decrease stress. For those that do have symptoms of a mental illness, these practices will help with symptom management. Taking time for your mental health also helps you refocus on God and connect you with your spiritual journey.

Here are some tips for cultivating peace in your life:

Slow down

When we look at the life of Jesus, we see a very different era and culture. I do not think most of us can truly imagine life without electricity. Or cars. Or gadgets that speed up every task we have to do. Try to picture a life in which you walk everywhere, slowly. You go to bed when it gets dark and rise when the sun does. Our bodies were designed to live at this pace, and in our modern society we have pushed our bodies to the limits. Jesus lived slowly, and even though this was in a different historical and cultural context, I think there is much we can learn from the pace at which Jesus lived life.

Connect to the Spirit

Another regular habit that Jesus displayed was connection with the Father. We have that same connection available to us through the Holy Spirit. One of my favorite verses is found in 1 Corinthians 2:15-16: “Those who are spiritual can evaluate all things, but they themselves cannot be evaluated by others. For, ‘Who can know the Lord’s thoughts? Who knows enough to teach him?’ But we understand these things, for we have the mind of Christ.” I find it amazing to think that we have the ability through the Spirit to know and understand the Father’s thoughts. Aligning our minds with His directly allows us to cultivate peace in our lives as we rid ourselves of foolish or distorted thinking.

Attend to your surroundings

If you are living in chaos (relationally, in your schedule, or in your physical space) it will be very difficult to find peace. Relational conflict, chaotic time management, or living in a messy space will disrupt the inner peace. Often, your outward surroundings are a reflection of what is going on inside your heart. And often inner peace can be cultivated by taking care of the things in your outer environment. Taking time to clean up, organize your schedule, or resolve a conflict with a friend are ways to cultivate peace in your life. Tying up loose ends helps your brain feel finished, and you may find your sleep and mood improve. Simple things like lighting a candle, putting on soothing music or having some fresh flowers in the room can also go a long way to creating a peaceful space.

Peace grows in our lives when we actively work to develop it. Any fruit of the Spirit must be planted, watered, and nurtured in order to bear fruit. As we expand our hearts and minds and surrender to God more and more, we open up more space for the Spirit to dwell.

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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.