Posted on

Boundaries in Church Therapy

Many people ask me, “How does it work for the professional therapist to see clients at his or her own church? Doesn’t that violate counseling boundaries?” This is a great question that is worthy of attention. Clearly professional counselors are bound by ethical codes, such as the one created by the American Counseling Association. Boundaries must be in place to protect the therapeutic relationship, the client, and the counselor.

Licensed therapists practice in a variety of settings, such as hospitals with a group milieu and agencies that offer wraparound services (multiple providers offering different aspects of treatment all around a common goal). Those in private practice typically only see the client in the office and do not interact with clients outside the office. For the private practice setting this is absolutely essential for both the client and the counselor as this is the agreed-upon context in which the work can take place.

Church therapists are professionals working on a church staff. You are a part of the church’s leadership team, offering insights and education to pastors as well as providing care in the context of the church. Your office is in the church building. When thinking about appropriate boundaries, it is critical to first look at the context of treatment. Where and how have both you as the counselor and your client agreed upon for treatment to take place? In church therapy, both the counselor and the client have entered into treatment with the understanding that work will take place in the church building, that the pastors are a part of the treatment team (be sure to have the client sign releases for any pastor or other provider to whom you may speak), and that the counselor will be present in other areas of the church building at other times when therapy is not in session.

Now we enter the more complicated realm: when the church therapist and client see each other in the church setting but OUTSIDE the therapy office, how do they interact? I personally begin treatment with the client by talking about this before we begin any work. I assure them that I will never ask them follow-up questions or get therapy updates outside of the therapy office. I ask the client to use my voicemail to reschedule appointments rather than approaching me in church. Once I was even asked if I would ever share a prayer request about one of my clients… (That would be a big NO!). My clients and I may wave or say hi in the church building, just as I would with anyone else. The goal here is to make your interaction with clients at church mirror your interaction with anyone else. Remember, even the fact that a client is coming to see you must remain confidential along with the content of the therapy itself. Only those for whom the client has signed a release form can know that he or she is in treatment with you. To be a successful church therapist, you MUST be on guard to keep very tight lips.

Because the church therapist is on church staff in the role of professional therapist, anytime he or she is in the church building he or she is in that role. Those in private practice or agency work have the right to expect that their church experience will be their own and will not become complicated with client interactions. Their place of work is outside of the church setting, and as a result their client interactions are all separate from their church lives. However, the church therapist is one who has felt a calling to church leadership AND to counseling. Therefore, your expectation is to be “on” when you are at church. This is more similar to the role of pastor in the sense that your social/spiritual life is supplementally fed outside of your church.

It is critical for the church therapist to realize that he or she cannot develop many intimate friendships at church. I personally have a small handful of confidants, 2-3 of whom attend my church and 2-3 of whom do not. Those I trust who do attend my church never ask about my work and I never discuss it with them. We also have a clear understanding that (much like the pastor) when we are at church I am in the role of on-staff therapist. Within that church leadership role, I lead ministries related to prayer and caring for the soul. My focus is not on catching up with my friends at church. Rather, we set aside intentional times to connect outside of church. I will talk in more detail about this in a later post about self-care for the church therapist.

The American Counseling Association has some helpful information on this topic. Here is a useful link  related to dual relationships: http://ct.counseling.org/2006/12/new-guidelines-on-dual-relationships/

The following article which can be read in its entirety on web.ebscohost.com also offers help on this topic:

Haug, I. E. (1999), Boundaries and the Use and Misuse of Power and Authority: Ethical Complexities for Clergy Psychotherapists. Journal of Counseling & Development, 77: 411–417. doi: 10.1002/j.1556-6676.1999.tb02467.x

*One final note: the article focuses on “clergy psychotherapists” in which the therapist IS the pastor. In my definition of church therapy, the church therapist is on staff for the primary purpose of providing counselor and does not take on pastoral roles with clients. This role definition is useful in the development of clear role expectations.

Posted on

Christian Mindfulness

The word “mindfulness” is defined as “a quality or state of being conscious or aware of something.” While this idea has Buddhist origins, the direction of one’s awareness is what can make this practice different between Christians and Buddhists. That being said, there are many aspects of mindfulness that would be the same regardless of religious belief. For example, relaxing your body and paying attention to your own thoughts as they come in to your mind is neither Christian nor Buddhist.

So why should Christians practice mindfulness and how is it best done from a Christian worldview?

Mindfulness Brings Awareness of God’s Presence

God is always with us, as he said he will never leave us or forsake us. Yet as Christians we are only partially aware of God’s continual presence. Mindfulness can help bring back a more full awareness of God’s presence as we connect to him in intentional and mindful prayer.

You can practice this by finding a quiet place with no distractions. Close your eyes and focus your thoughts on God. You can have 2-3 Bible verses memorized or on index cards that you reflect on. If your thoughts wander, simply bring them back gently to the verses you have selected. (Colossians 3:15 is a great example). After you have meditated on these verses, bring your awareness onto the presence of God. You can imagine sitting at his feet or you can picture him hugging you. You can also picture him dwelling in you. As you do this, you can relax your body and breathe more slowly, just resting in his awesome presence. When we are actively aware of God, we connect with the Kingdom of Heaven and we can experience greater levels of peace.

Mindfulness Helps Us Renew Our Minds

Romans 12:2 tells us that as a Christian you should “be transformed by the renewing of your mind.” Mindfulness is a skill that takes practice, as we mentally train ourselves to focus on God and his word. Our brains are constantly adapting to new experiences and changing through learning. Relaxation and mindfulness creates actual changes in the brain (a concept known as neuroplasticity). Focusing our attention on God through mindfulness helps renew our minds as we reduce stress in our bodies and bring healing to our brains.

Increased awareness of the presence of God, of our own bodies and of the thoughts in our minds helps us to be intentional. A lack of awareness brings more chaos as we fall into a trap of rushing through our day with little awareness of God or our own needs. Mindfulness, whether practiced alone in a quiet place or simply as a momentary check-in in the midst of a crowd, helps us intentionally refocus on God and his Kingdom. Mindfulness can also help slow our bodies down, which is quite counter-cultural for us Americans. Jesus was never in a hurry, and he was continually mindful of his Father and his mission.

Mindfulness Gives Us Grace For Ourselves and Others

A common struggle people have when beginning to practice mindfulness is that of cluttered or racing thoughts. The moment you close your eyes, your mind can be flooded with all the worries and stress of your day. Too often our reaction is to push those things away or become frustrated that they are in the way of focusing on God. In this process we can actually grow in the area of giving ourselves and others grace. We can pay attention to these thoughts without judgment as we observe the areas in which we need the most help from God. We can then invite him into those worries and cluttered thoughts and allow him to align our thoughts to his.

One important aspect of mindfulness is acceptance of yourself in a non-judgmental way. Christians can sometimes get nervous with this language because they fear that in reducing judgment on themselves they will give into their sinfulness or stop growing in Christ. “I’m okay, you’re okay” feels like lying to ourselves and simply covering over sin. But at the heart of the Gospel is the idea that we are loved and accepted as we are. If we are in Christ, then he alone is our judge and he chooses to love us. We can align our perspectives with his in this way, and while practicing mindfulness become more aware of God’s unconditional love and acceptance for us. Allow his love for your to bring peace and healing into your mind and soul today.

Posted on

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.

Posted on

Addressing Dual Relationships: Should Pastors Counsel?

In most ethical codes for counselors, there is mention that the counselor should seek to avoid dual relationships that are deemed harmful to the client. There are some areas that are never a good idea (having a sexual relationship with a client) and there are some grey areas (living in a small town and coaching Little League where a client’s child is a participant). Some dual relationships can be prevented, and some are unavoidable especially in smaller communities. Christian communities, even within large cities, can often feel small, with many overlapping circles. Unless you live very far from where you work, even the Christian counselor in private practice is likely to have some unavoidable dual relationships with clients.

Dual relationships, however, are not always harmful. The very first question to be asked with dual relationships is this: does the relationship help or harm the client? In an article published on the website of the American Counseling Association, one of the authors gives an example in which he counsels parents who are raising children with muscular dystrophy. The counselor is knowledgeable in this area because he too has a child with muscular dystrophy. As the counselor serves on agency boards and is active in the community in support of causes related to muscular dystrophy, he frequently interacts outside the counseling arena with his clients. This example is highlighted as a beneficial dual relationship, in which the counselor actually gains MORE credibility with his clients because of his work outside the therapy context.

In 2005 American Counseling Association Code of Ethics was updated to increase clarity about dual relationships and opened the door for beneficial dual relationships to exist. This change was of tremendous help to the Christian community, as counselors available to help church members face this problem daily. Can you see clients from your own church? Can a pastor serve as both a pastor and a counselor? Are these two roles or one?

The Church Therapy model suggests that the professional on-staff counselor is always in the role of counselor. Most larger churches no longer have only one pastor; rather, a team of church leaders work together to handle preaching, teaching, pastoral care/visitation, mercy ministries, and discipleship. Because of the growing awareness of mental health issues within the church, more of these problems are coming to light and are requiring treatment. A church therapist can serve as the person who handles these issues, both with individual therapy and with groups, leaving other pastors freed up to focus on other responsibilities.

Pastors will always meet with parishioners to help them walk through life’s challenges. But when these challenges involve complex emotional issues that will take more than 2-3 meetings to resolve, the church therapist can take over. Because in this model the church therapist is a licensed professional, he or she can properly assess, diagnose, and treat these mental health issues within the context of discipleship and spiritual growth. In this team approach, the pastor can do more of what pastors do very well: admonish, teach, correct, and offer care and support.

When the pastor attempts to counsel in a therapeutic sense in addition to all these other roles, the power differential becomes too great. I have personally seen very complicated situations in which pastors are involved in both counseling and church discipline. In my opinion, the person providing a safe place to talk and work through issues cannot be involved in making church discipline decisions. This dual role undermines therapeutic safety and trust. The Church Therapy model allows for the person undergoing church discipline to continue to see the church therapist, even if he or she has had to be removed from ministries or other areas of the church. In this way, the church continues to offer an option for healing and restoration and the therapist maintains a safe relationship with the client.

Pastors play many roles: shepherd, mentor, coach, leader, guide, teacher, host, and hospital visitor. Adding therapy into that mix often leads to confusion and boundary crossing on the part of both the pastor and the client. Ethical, professional therapy done right will keep the therapy space sacred. Even when the church therapist interacts with the client in other parts of the church building, the therapeutic relationship is kept at the forefront. Confidentiality and clear expectations have been established and are maintained as the top priorities of the church therapist. A pastor simply cannot maintain all of this and do his or her job of leading well.

Posted on

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.

Posted on

Pastor Training Video: Discipleship in the Midst of Depression

Check out this Pastor Training Video, in which I offer tools for helping someone who is struggling with depression to move forward spiritually. Too often, we use traditional discipleship methods when working with someone who has a mental illness. These methods may not work due to additional challenges that the symptoms of a mood or anxiety disorder can bring.

How do you as a pastor come alongside this person and connect them to their own path of spiritual growth?

Watch the video to find out! It’s worth 10 minutes of your time.

 

Posted on

The Impact of Trauma on Relationships and Spiritual Growth

Throughout my career as a counselor, I have worked with many people who have experienced trauma, some of whom suffer from Post-Traumatic Stress Disorder (PTSD). When we think of PTSD, we sometimes assume these are veterans or victims of violent crime. Less obvious, and certainly far less often disclosed, are victims of sexual abuse by family members. Sadly, this is a common occurrence and as a result  many in the Church suffer with lasting affects of this quiet type of trauma.

I have seen commonalities in the responses of those who have been hurt or traumatized by family members. Their relationships with God and with other close, seemingly “safe” people are affected by the trauma of their pasts. This is especially true in a church context, in which the family environment can be triggering for those who have experienced abuse at the hands of those who were supposed to be trusted authority figures.

I created a worksheet that helps explain these patterns, which disrupt one’s relational and spiritual life. It also shows a way to break the cycle using mindfulness of the present.

Click here to view the worksheet: Trauma Response Cycle

Please feel free to share this worksheet with others, and check out my books on Amazon for other helpful resources on mental health and spiritual growth.

 

Posted on

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.

Posted on

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.