Bringing quality mental health care into the church setting
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.
I’d love to hear your reactions and thoughts — post a comment below and be sure to subscribe to this great podcast!
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.
I am excited to announce the launch of my brand new ebook, Becoming the You God Sees. This easy-to-read Christian mental health resource introduces you to a step-by-step guide for how to get emotionally and spiritually unstuck. I reveal the 3 secrets to getting unstuck so that you can unleash your full potential and be every single thing God made you to be.
I want to get this into as many hands as possible, so this week (Oct 10-14) it is FREE on Amazon. Be sure to bookmark the page and set a reminder on your phone so that you do not miss this deal. Even better: tell all your friends about it through Facebook or Twitter by joining my Thunderclap campaign. The Thunderclap will automatically post for you on Thursday, Oct 12 at 9pm EST. Let’s get this resource into the hands of as many people as possible. Will you join me?
In my work as a counselor over the past 12 years, I have worked with so many who do not love themselves. They hate the version of themselves that they have become. My claim has always been that if you do not love yourself you do not know the you that God created. What we hate are the effects of abuse, sin, disorder, or dysfunction. Life in this broken world messes us up. But we can get free. And we can live free lives. This ebook (which includes links to my weekly live coaching call and online course) offers a path to freedom. I hope that you will take this journey with me, and pass it on to someone you know who wants to discover their true identity.
I’m all for trusting God. Really I am. I live my life in such a way that I am increasingly dependent on God. But even on my best days, I know that I cannot possibly trust God enough. I can’t understand him enough. I can’t thank him enough. I certainly can’t do anything to give back all that he has given to me. That word “enough” is automatically a comparative one — an arbitrary measure of a quantity that satisfies some type of requirement. “Enough” doesn’t even exist in relationship to God because we never can get there.
I’ve known a lot of people who have struggled with symptoms of mental illness as Christians. Many I know and work with are facing depression, anxiety, trauma symptoms and bipolar disorder just to name a few. And sadly they are often given “Christian-y” answers by well-meaning people who want to make everything better. They are told in subtle and not-so-subtle ways to “trust God more.” Just like “enough,” “more” is an arbitrary comparison to something else. If I have a dollar and you give me “more,” you could give me one penny or one million dollars. How do we know when “more” is “enough”?
If on my best days I’m doing all I can to trust God with my life, then I am spiritually growing and seeking the Lord. On my worst days, I’m still trusting to the degree that I can. If someone is struggling with physical symptoms of a brain disorder, they have a lot they are working to trust God about. And I know that there is no degree to which they can trust God “more” to have their symptoms erased. I believe in miraculous healing for cancer and anxiety and diabetes and broken legs, but I certainly would not encourage people with these disorders to muscle up some more faith like they’ve got it just laying around to spare. I’m going to walk alongside them through their daily struggles and take on their burdens as my own. I’m going to weep with those who weep. I want to lighten their load with any supernatural ability the Holy Spirit gives me, not throw a greater burden on them to make myself feel better.
And this is why “trust God more” is the wrong answer when people are hurting — it abandons them in their own pain. We might as well say, “Okay, run along now. Go fix your physical and spiritual suffering yourself. And if you can’t, I’ll shake my head and be disappointed in your poor choices.” We may not say those words, but we imply them when we tell people to trust God more. Instead of hanging the wounded out to dry, let’s draw them in closer. Instead of “trust God more,” let’s say, “I’ll carry hope for you while you cannot,” or “I’m here for you if you need anything at all. I will pray for you daily in the midst of your pain.” Reach out. Call. Bring a meal. Intercede. Write a note. Care. Against such things there is no law.
Church leadership comes with pressure. Eyes are watching how you handle yourself. People are evaluating your performance. Those whom you serve can become critical and judgmental when they disagree with your preaching or ministry. Admission of sin can lead to the loss of your job. So what do you do when you need mental health treatment and you have a church to lead?
Establish Weekly Accountability and Support
If you are a pastor or ministry leader and you do not have a clear list of people with whom you can be 100% honest, you are on your way to a major fall. Sin can trap us all, and the only way to avoid snares is to catch them early. Most problems don’t start out as major problems. Who are you calling when you are tempted in an area that has owned you before? Who do you lean on when you have a discouraging day? Who do you tell when you have thoughts you would rather not say aloud?
Once you have established who those people are (could be as few as 2-3), then you need to have regularly scheduled times that you talk. You can’t wait until you feel the need to reach out. Church leaders need weekly check-ins. Most of the time when a problem is in its earliest stages of formation, those who know you best will spot something that is off. My best friend is more than happy to call me out when needed, and often in ways I did not see myself. We all have blind spots, so we need people who are hearing our detailed thoughts and getting a weekly report on our actions.
Seek Help Outside Your Circles
When your closest friends spot red flags, it may be time to seek additional help. If that discouraging day turns into a few weeks of despair, your friends will hopefully spot that pattern and encourage you to talk to a professional. Don’t put that off and simply wait for things to get better or return to “normal.” Chances are there are things you need to work through, and if you have never been to counseling then it’s a great time to start exploring all that lies underneath the surface.
That being said, pastors cannot always seek mental health treatment or counseling in their local communities. These counseling practices might be the referral sources for parishioners of the church, and a pastor may feel unsafe talking to someone closely tied to the church. Don’t hesitate to drive an hour to get to counseling. It’s worth it and you will not regret getting the help as early as possible when you notice a problem. There are also some online counseling options now, which can help you connect with a counselor completely outside your sphere of influence.
Be Willing to Walk Away
If fear of losing your job or your ministry is causing you to solve your own problems in secret, you have an even bigger problem than you think. You need to be willing to lay even the ministry to which you have been called at the foot of the cross and walk away. If your stress level is so high that you are struggling to function through a day, or if you are so depressed that you are having fleeting thoughts of suicide, it is time to step away from ministry for a season. If you keep going and try to push through your problems without seeking help, you are far more likely to become disqualified for the long-term. Taking a 6-month or year-long leave of absence to take care of your mental health is a lot better than reaching a point where you can no longer serve as a leader at all.
You are not a superhero, nor are you called to save the world. Pastors and church leaders must take care of themselves and their families first. If you take time away from ministry for a season, God may show you some broken places that need healing. Or he may reveal to you some new next steps in your calling. When you attend to your needs and seek help from God and others, you are making a physical and spiritual decision to choose to live in health. Satan is eager to devour you in any way he can, so don’t give him room to work by ignoring your own mental health.
One of the biggest complaints I hear from pastors about the Church Therapy model is that there are not enough Christian counselors to meet the mental health needs in their congregations. (Ironically, the Christian counseling graduates complain that there are no churches trying to hire counselors… We’re trying to fix that with the Residency Program!)
Because there are so many reasons not everyone can make it into a counseling office, I’ve decided to bring more of my insights about emotional health to you, your friends and your fellow church members. FreedomForToday.com offers daily devotional insights from a Christian counselor’s perspective. I’ve started in Galatians 5 and will work my way through a variety of passages in the Bible that connect with our mental health.
Subscribe to Freedom For Today to get a daily devotional sent straight to your inbox! And don’t forget to share the page on Facebook and Twitter with all your friends.
If you are looking for more Christian self-help resources, check out my books page as well! I can’t reach everyone from my counseling office, but my books offer a lot of the wisdom I share with my clients every single day. Pass on these resources to your church so that we can continue to talk openly about emotional and mental health on a daily basis. Enjoy!
Hi everybody! An extra post in here to share this interview that I did with Robert Vore and Steve Austin on their CXMH podcast (which is awesome, go subscribe!). These guys are such great leaders in the conversation about mental health in the church.
This is one of the most comprehensive interviews I have ever given about how the Church Therapy model works, and I’m super excited to share it with you! Thanks for listening and supporting the cause of fighting the stigma of mental illness in our churches.
Last week I laid out 3 reasons why counselors should not also be in the role of evangelist with their clients who are non-believers. This week, we’ll follow up on that topic by talking about why counselors in the church setting are an important part of the discipleship process for those who are already following Christ.
The Goals of the Client and the Counselor Go Together
A therapeutic process requires a high level of respect for the client and his or her own goals. This autonomy is important because if the counselor is driving the therapeutic process with his or her own agenda, there is too much room for abuses of power and manipulation. That context is not a safe space in which to heal. However, when a client who is seeking to grow in their relationship with Jesus comes to the church to meet with the Church Therapist, the client almost always desires spiritual understanding as a part of their mental health care. One of the biggest complaints I hear from my clients who have been to secular therapists is that they did not feel their secular counselor could truly understand their spiritual lives. In the Church Therapy model, both the Jesus-following client and the counselor understand with full disclosure from the start that in the therapeutic process the client would like to grow closer to God.
Emotional Freedom and Spiritual Freedom Go Together
One of the key reasons that mental health care is part of the discipleship process for Christians is that emotional freedom and spiritual freedom go hand-in-hand. Usually when emotional brick walls are hit and a person is emotionally stuck, their spiritual life also gets stuck and they have trouble moving forward in their relationship with God. When trusting others is a challenge due to abuse in the past, for example, the client often struggles with how to understand what it means to trust God. Or some who face symptoms of depression or anxiety as Christians can at times get stuck feeling like a second-class Christian due to stigma that blames them for their symptoms. Growing in the ways they treat the symptoms of mental illness frees them up to engage more fully with God when they stop blaming themselves. When clients become emotionally free in a certain area, they are also spiritually growing because their emotional state no longer holds them back.
The Church and the Counseling Process Go Together
One of my favorite aspects of the Church Therapy model is that it is a team approach. The church context provides more than just one therapist working with one client. Rather, a client is a participant in the church community and the Church Therapist can use that context to more fully help the client grow. At times when a client is going through a depressive episode, for example, the Church Therapist can (with the permission of the client, of course!) alert the pastoral staff who can go do a home visit or bring a meal. Or when a client is struggling with social anxiety, the Church Therapist can help recommend a small group or activity that would be safe or manageable for that client. The therapeutic process is a holistic one, in which the whole church body provides space for healing. When a therapist is present on a church staff, it creates an emotionally safe, stigma-free culture in which this is possible.
Mental health care and discipleship are a perfect fit, and it is one reason why churches need to be a part of the solution in responding to mental health needs. Next week, I’ll follow up on this topic and explore why it is so critical for churches to provide quality mental health care.
Yesterday I held the first Freedom Workshop of 2017: “Understanding Mental Illness.” We had such a great time, thanks to all who came out! Listening in on some of the group discussions got me so pumped, as people talked through the physical, psychological and spiritual issues related to mental health. One point I heard in the discussion was related to the role of the counselor: should he or she be someone who evangelizes to the client, guiding a non-believer into faith? Or is that not the role of the counselor? What about those who are already following Christ? What is the role of counseling in the discipleship process?
We know that pastors are called to evangelize and disciple. This is an incredibly important job! In the Church Therapy model, pastors are able to freely serve in these ways and church therapists are able to function in a different role. Without this model, when pastors are also trying to provide counseling, the roles become much more complex and the lines are blurry. When someone needs mental health care and they seek out a counselor, they may or may not also be exploring faith questions.
In Part 1, we will explore three reasons why a counselor/therapist should not also take on the role of evangelist. Next week, we’ll do Part 2, exploring ways that counselors can play an important role in the discipleship process for those who are already following Christ. So let’s take a look at why counselors should not be in the role of evangelist with clients who are not Christians:
Vulnerability and Power
In a counseling situation, there is an automatic power dynamic present. This is not created by the particular counselor or client, it is inherent in the relationship which is one-sided. The counselor is viewed as the “expert” (whether or not he/she is actually skilled) and the client is the one in need. In normal healthy relationships, there is a mutual give and take, where both parties give sometimes and take at other times. In a healthy therapeutic relationship, the boundaries and ethical guidelines keep the one-sidedness healthy even though that would be imbalanced in a “real life” scenario. The fact that the counselor and client are not friends, but rather have a professional relationship that has specific limits, means that the counselor has a tremendous amount of power. The client is coming in vulnerable, sharing deep emotions and experiences (while the counselor does not share deeply at all). The counselor seemingly provides the guidance and help, doing all of the emotional supporting of the client.
Because of this power dynamic, the counselor simply cannot also play the role of an evangelist because the client is too vulnerable. To take advantage of this situation would really not allow the person to freely consider his or her beliefs. The counselor’s desire for the client to convert, and the power that the counselor has over the client to guide his/her choices, sets up a forced system in which the client may say “yes” without being truly free to say “no.” The client may be unaware of this lack of freedom, but over time it will reveal itself and could actually be detrimental to the client’s spiritual journey in the long run.
Bait and Switch
Another reason that a counselor cannot also play the role of evangelist is that it could be a “bait and switch” kind of scenario. “Come to our office, we offer free counseling!” may be the tagline. People who are in need, and possibly lacking in finances or health insurance, may be drawn into this counseling ministry believing that it will help them work through their emotional issues. If the counseling ministry sign read, “Come to our office, we want to convert you!” some might not enter. But that is typically not the advertisement, thus creating a bait and switch. Your church is advertising mental health services when it is really offering Bible study and personal evangelism. Now, even if we truly believe deep down in our hearts that the only way for people to get well is to follow Jesus (true, by the way, for one’s spiritual life, but not true for the symptoms of a mental illness which often persist even for the Christian), it is unethical to lure people into your office with the wrong set of assumptions about what will take place there.
Respect for the Journey
The spiritual journey does not always occur in a linear fashion. (Step 1: Have problems in your life and realize you can’t do it on your own. Step 2: Turn your life over to Jesus. Step 3: Get better from all your problems.) An evangelist has one goal: share the Gospel to win souls for Christ. A counselor’s goal is to meet a person where he/she is at, working collaboratively on the goals the client sets for him/herself. We cannot have an agenda going in. Instead, we must respect the journey of the client. If he/she wants to explore spiritual issues, then by all means (but without an agenda), help them explore. We do not need to get antsy about this — the Holy Spirit is more than able to draw the client to Him when that person is ready. Let’s lay that burden down and trust the Lord to lead them in their journey, while we as counselors simply come alongside as a fellow explorer.
If the client does some spiritual exploring and decides that they want to know more about Jesus, the counselor should at that point connect the client with a local church. They can attend services and the pastor can help them learn to study the Bible. The counselor can continue to be involved to do the work of healing the emotional issues that created the need for mental health services. Over time, these services may not be needed if the positive support of the church creates an adequate social system that meets the client’s needs. In the case of chronic/persistent mental illness, the counselor will likely remain a support in addition to other positive social supports.
Stay tuned for next week’s conversation about how the counselor can play an important role in the discipleship process for those who have already given their lives to Christ.
Every Sunday, unintended messages are delivered from pulpits around the country. Pastors, tasked with the incredibly difficult job of understanding the Word of God and delivering it in memorable form to their congregations, cannot be expected to be perfect in every word they say. And I would certainly never suggest that perfection is the goal for sermon delivery. However, when we fight the stigma of mental illness, it helps to increase awareness as to the subtle messages that penetrate through our Christian words, whether intended or not.
So what are some of the unintended messages found in sermons (and in Christian conversation)?
1. Your mental illness will go away with increased faith or trust in God.
The symptoms of mental illness are physical. I prefer the term “brain disorder” and I hope that through advances in neuroscience we can get even more precise in our language. While there are many positive steps a person can take to improve their symptoms and create balance in their lives, simply white-knuckling your way into health via sweaty prayers is not going to do it. We have to stop suggesting that this can work. Prayer is powerful and supernatural and absolutely essential. But use prayer towards mental illness in the same way you would use it with other physical disorders.
2.You are doing something sinful or spiritually off track if you experience anxiety or depression.
Victim-blaming happens because it is easier than trying to understand a currently very mysterious physical phenomenon. Our theology makes us feel better when it fits in nice rows of boxes. But life is messy and disorder is ugly and when we don’t have answers we get fidgety. And so, however unintentionally, we victim-blame when we respond to a person with depression by saying, “Have you tried giving it over to God?” or even worse, “Focusing on yourself is selfish and you just need to get out there and serve others.” Or quoting Scripture about anxiety to an anxious person. Every person I have ever met who is experiencing anxiety would LOVE to throw it all at the feet of Jesus and feel better. Unfortunately, the brain does not work that way. Normal, everyday life worries? Sure. But persistent, chronic symptoms? No. There is nothing a person experiencing symptoms of a brain disorder did to cause their illness, nor is there anything spiritual they can do to make it go away. That does NOT mean they are disqualified from the Christian life. Rather, it means we have to understand that sitting in God’s presence and choosing to follow him daily while continuing to experience mental illness is a noble endeavor. Those that maintain their faith in the midst of such darkness are in my mind some of the most amazing Jesus-followers. (And history would agree… the Desert Fathers, Mother Teresa and others experienced periods of deep depression.)
3. Everyone is able to work harder and doing so will result in spiritual (and possibly material) success.
This American message is simply not the message of the Bible. If everyone had the same shot at success, God would not need to mention the oppressed so much. Those who are privileged enough to never experience racial, socioeconomic, gender, biological or intellectual disadvantage often do not understand why not everyone is given the same head start. At times, we marginalize those experiencing depression, anxiety or other brain disorders by viewing them as “lazy” (even if we don’t quite say it but instead just think it when we decide in our minds what they “should” be doing better). Many people I have worked with are simply unable to work because of a mental health condition. On the outside, they might appear able-bodied. But their minds may not provide the stability or stamina required to maintain full-time or even part-time work. We have to watch out for the subtle ways that even in our body language we communicate judgment.
What can we do to correct some of these messages?
1. Talk about mental illness like you talk about cancer.
Those of you that follow this blog or my Twitter handle (@ChurchTherapist) have probably heard my rule on this… If you cannot replace the mental health term in your sentence with the word “cancer” you probably should not say it. About a month ago on Twitter, someone made a comment that “in 10,000 years, all the anxiety you feel right now will seem silly.” Now, they probably were not thinking about mental illness. But when you use the word “anxiety” you are talking to people who experience clinical levels of anxiety whether you want to be or not. So I tweeted back something like, “In 10,000 years from now, all the cancer cells ravaging your body right now will seem silly. Hmm, guess not…” See how that really is completely insensitive and something we would NEVER say to a cancer patient? We have to change our casual language when using mental health terms.
2. Acknowledge the struggle of mental illness from the pulpit as a regular caveat.
Something as simple as, “I know some of you are struggling with anxiety or mood problems that you just can’t seem to shake. Even pastors experience that too” would be a phenomenal start. As you do your sermon prep (or as you engage in conversations in small groups or with friends), think about how what you are saying would sound to someone who is struggling with a life controlling physical problem they cannot make go away. When you talk about Paul’s thorn in the flesh, mention mental illness as another type of thorn. Do all you can to acknowledge and validate the physical reality that disorder can happen in the brain too. And when the brain experiences dysfunction, it is a confusing and frustrating experience.
3. Practice multi-level discipleship.
Not everyone in your church has the same reading level. You have a range of ages, and even among the adults there is likely a variance in education level or intellectual functioning. Yet for some reason we kind of aim for a middle and hope for the best, leaving some to fall through the cracks. Now, if we are only talking about reading level, then it is possible a mentor would come alongside to help a person understand the Bible better (or give them an easier version to read). But what about the varying biological and emotional capacities that occur in our churches? Not everyone is able to show up for the potluck. Is that the only option in your church for developing community? If it is, the person with social anxiety disorder will never get to connect. Does being plugged into ministry mean you are on a schedule and you have to show up on that schedule or you’re off the team? If so, someone who experiences depressive episodes or chronic pain issues will end up disqualified. Be creative, finding ways to make accommodations for those who are struggling emotionally or physically. Disciple each person from where they are at, rather than expecting them to rise to a certain capability in a set amount of time.
Ultimately, we must all watch out for the ways in which the American cultural ideals of success and achieving your dreams by pulling yourself up by your bootstraps work their way into our conversations and theology. God’s heart is for the poor, the oppressed, the disabled, the marginalized and the hurting. As the Church, we must practice an embrace that is as safe as Jesus’ — not full of judgment and condemnation but rather full of love and restoration. We cannot give up on those who are unable to follow our “normal” growth tracks. We must patiently walk alongside, offering support, help and hope.