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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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Is Suicide a Choice?

I recently spoke at a church about suicide and sin. We wrestled over the word “capacity.” At what point does a person’s brain choose for them? Where is the line between sin and a lack of ability? For some, suicide is a deliberate choice made out of desperation. For others, it is final escape from years of being worn down by mental illness. Still others commit suicide in the midst of a psychotic break. Often, unsuccessful attempts are deep cries for help.

One of the things I find most heartbreaking when a public figure dies by suicide is that the world rushes in to judge what happened. I did not know Kate Spade or Anthony Bourdain. I did not know Robin Williams. I cannot speak to the lives they were living or what they may have been going through. But I once sat with a woman living in poverty in a trailer park in Missouri as she got her stomach pumped in the ER. I have comforted children who had already reached places of pain so deep that they had begun to self-mutilate. I have written safety plan after safety plan to help my clients develop options to keep living. I have asked people their reasons for keeping on going. I have listened to people’s “fool proof” plans to kill themselves that in a way brought comfort and a sense of control to them. I have made practice calls with my clients to suicide hotlines in order to break the barrier that might exist in the midst of crisis.

If you have not had the privilege of walking alongside people in their journeys of pain, then you may want to label their experiences. Often, as Christians, we have a certain theology to maintain and we try to fit stories (from “out there”) into our existing worldview. I would challenge you to consider letting the experiences of others shatter your worldview. Broaden your concepts of sin and disease. Step into the heart, mind, and soul of someone who is feeling so lost, desperate, or depressed that death sounds better than life. Develop authentic relationships with people who are different from you. Being a non-judgmental friend just might save somebody’s life.

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Groups, Workshops, and Classes: How the Church Therapist Can Expand the Reach

Church Therapy is primarily focused on providing mental health services such as individual, couple, and family counseling in the church setting. However, the Church Therapist can play a key role in the life of the church in many other ways. In the infographic explaining the Church Therapy model, consultation is mentioned, and this is primarily done with the pastors on specific cases or general questions about mental health issues.

For the general congregation, the Church Therapist can be a valuable resource even for those who do not directly seek counseling services. For example, I lead a weekly Recovery Group that is free and open to anyone. Other ideas could include peer-support groups for mental illness that the Church Therapist oversees as well as issue-specific groups like a trauma group or depression group. This type of group therapy can be billed through insurance companies.

The Church Therapist can also offer workshops. I offer psychoeducational workshops on my books as well as other helpful materials out there related to emotional health for the Christian life. Workshops can be half-day or full-day, and can be held in the church auditorium to avoid overhead costs of renting space. Making this type of event a norm in your church helps keep mental health at the forefront of conversation and offers people valuable tools for their own positive growth.

Finally, the Church Therapist can teach Sunday School or elective classes on topics related to mental health and the Christian life. I have created an 8-week small group curriculum designed to decrease stigma and educate Christians about mental illness. These classes can provide education for the whole congregation, whether or not they personally struggle with mental health issues. This information helps create a culture of understanding which goes a long way when a person comes to anyone in the church expressing a struggle.

The presence of a therapist on staff at a church creates a culture that has an ongoing dialogue about emotional and mental health issues. This culture, through all the various ways the Church Therapist engages with the congregation, opens doors of safety for those who are suffering so that they can get the help they need.

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5 Tips For Making Your Church Emotionally Safe

Many pastors and churches want to respond well to mental health needs in their congregations and communities, but often they do not know where to start. While it is important to offer ministries such as professional counseling, lay counseling, peer support groups and classes, you can start improving your response simply by increasing the emotional safety of your church. You don’t need to find leaders and start ministries if you don’t have the infrastructure yet. Begin with these 5 simple tips for making your church emotionally safe.

1. Be sensitive

Awareness is the first step towards addressing any issue. Sensitivity begins with educating yourself and those around you about what mental illness is and what it is not. For example, when many people hear the term “mental illness” they picture someone who is psychotic and/or homeless. These stereotypes cause stigma and prevent us from truly understanding the needs around us. Social anxiety, for example, is likely to go quite unnoticed in a church setting because someone facing those symptoms will be likely to fade into the background (or not return if they felt pressure to shake a lot of people’s hands). Someone struggling with depression may seem fine while at church, but they may be in bed most days the rest of the week. Be on the lookout for people who seem to hang out on the fringes of your church and build relationship with them. Do more listening and less fixing.

One side note: if you are not a pastor then it may be helpful to consider that your pastor may be the one struggling with mental health problems. Encouragement and care can be a two-way street, so take time to check on your pastor now and then.

2. Avoid pity

When you develop relationships with those experiencing a mental health disorder, avoid pity. Pity tends to increase shame as people feel like others are simply trying to fix them or make their problems disappear. Pay attention to the person’s strengths — what are their spiritual gifts? What are some ways to get plugged into the church that would not require extensive commitment? Where are they at in the spiritual journey and what wisdom do they have to share with others? Focusing on strengths helps us all see that mental illness does not put a person on the fringes of the kingdom of God. When we pity and marginalize people, we force them out to the fringes of society. But God does not operate this way and neither should the Church. Everyone can be used by God in meaningful and important ways.

3. Talk about mental illness regularly

Stigma increases when we put judgment and labels onto issues that we do not understand. There is much even in the medical and mental health communities that is not yet understood about brain dysfunction. But we do know that the brain is a complex organ in the body that can experience a variety of diseases just like the rest of the body. Talking about mental illness and acknowledging the physical impact of stress, anxiety, depression, trauma or Bipolar Disorder (to name just a few) is important to decrease stigma. Pastors, be intentional about talking about mental illness from the pulpit. Acknowledge the struggle that 1 in 5 American adults face every year as they experience symptoms of a mental illness. List “depression” or “anxiety” right alongside “cancer” or “diabetes” when you are talking about disease, and avoid talking about depression as a spiritual issue that goes away with prayer. My rule of thumb is this: if you cannot replace the words “mental illness” (or the name of a mental health disorder) with “cancer” in your sentence, then you should not say it.  (For example, “My friend told me she has anxiety, and I told her that she should rest in God’s presence and he will remove it” replaced with “My friend told me she has cancer, and I told her that she should rest in God’s presence and he will remove it.” Should we all rest in God’s presence? Yes. Can he heal all diseases supernaturally? Yes. Would you be likely to say that to a person who told you they had cancer? Unlikely.)

4. Be knowledgeable about resources

Take time to find out where there are Christian counselors and mental health agencies in your area. Call them and find out which health insurances they take or if they have waiting lists. Find out if there are emergency services in your area for those who are feeling unsafe or suicidal. Ask if you can visit or tour the closest psychiatric hospital and find out their visiting policies. Gather a list of hotlines, including the National Suicide Hotline (1-800-273-8255) or others local to your area. Call them to see what you can expect when someone calls. Also remember that your church is a resource. Just as you might make meals or babysit or visit those who are sick, do all of those things for people who are experiencing depression or other mental health symptoms.

5. Walk alongside

Mental illness is not always chronic. But even with single-episode illnesses, symptoms do not “clear up” in a short amount of time. Someone may experience a depressive episode, for example, anywhere from two weeks to a year or more. Others may have chronic symptoms that do not ever fully go away even with treatment. Still others may go through cycles where they are well for a time and then re-experience symptoms. If you become frustrated when someone is depressed, begins to feel better for a while, and then re-enters a new depressive episode, you are not creating emotional safety for that person. Be willing as a church to walk alongside those with mental illness for as long as it takes. Even if that means they have more emotional needs than others might. As you walk alongside, do not presume to know what a person needs. Ask how you can be of help, and if they are not sure then just be consistent in checking on them or making a meal “just because.” Showing that you care can go a long way towards creating trust and emotional safety.

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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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I Have a Mental Illness and It’s Time I Talked About It

I have had a mental illness since I was four years old. But let’s start with last Friday. I got a concussion and a pretty bruise on my face after I fainted. Why did I faint? Because my brain is broken and sometimes it takes over my entire body.

Before I tell you my diagnosis, I want you to know that this is the first time I am openly talking about this. And last week’s incident made me realize that I do all the things I fight against when it comes to stigma and mental illness. I compare myself to other people who have emotional pain and mental health challenges and I decide not to talk about me because I feel like it’s not such a big deal compared to what others go through. I minimize my experience and brush it off as something I can live with. And I can. I’ve gotten good at living with it and hiding it. Sometimes I’ve called it my “kryptonite.” This is the one thing in my life that can take me down and render me absolutely powerless. And this week showed me that my mental illness can cause other damage too. I’m lucky that my concussion wasn’t worse.

Ok, so here goes: I have a mental illness. It is called Blood/Injection/Injury type Specific Phobia. I remember so vividly the first time I learned that it had a name and research to back it up. Doctors my whole life had just basically said, “Well, that’s weird.” I’ve been tested for seizure disorders (with no results or explanations doctors have found worthy of writing in my chart). But a kind mentor who is a psychologist opened up the DSM (IV at that time) when I was in college and he showed me myself in those pages. He was the first person that knew what I had and could show me a diagnosis in black and white.

Specific phobias are different because avoidance is usually the best way to function most of the time. If you have a fear of snakes, don’t go to the reptile exhibit. Sounds easy, right? But sometimes life doesn’t let you avoid everything, and in my case like all humans I occasionally need medical treatment. Or I hear people talk about their medical experiences. Or someone I love is in the hospital. These encounters don’t happen every day, so it is easy for me to minimize. But the reality of my mental illness is that sometimes I cannot stay present with a person telling me the story of their pain. And I cannot go visit people in the hospital. And I have to work harder than everyone else to go get bloodwork done. And I have to let my husband take our children to any difficult medical appointments. And I only have those children because I found out about natural childbirth and realized I could have a needle-less and hospital-free childbirth. Which I did, twice.

I have had two rounds of treatment for my phobia, once in college (after I learned it was a thing) and once about six years ago (when my counselor training came in handy and I did it to myself). Systematic desensitization is the most effective treatment, and in my first treatment experience I had about ten sessions with a counselor working through a hierarchy of anxiety-producing things while practicing relaxation. We started with the easiest and worked our way up to me going and getting my flu shot (yes, that was the hardest medical trigger I could even face at the time). And I did it. That treatment helped me overcome the anxiety enough so that in my adulthood I would not choose to avoid medical treatment altogether. At that time, I knew that I would be entering into grownup life and I could make my own decisions. Which meant if I wanted to avoid the doctor or dental work or hospitals, I could. But that can come with some serious consequences, and so my first round of treatment helped me be willing to face adult decisions.

My second systematic desensitization came when my dad was in the ICU for three weeks. I went to the hospital every day to be with my dad and my family. I spent hours in the waiting room, only to actually see my dad for about 30 seconds. I went in with my husband the first time and told him I would be staying no more than 30 seconds. It might have been 10 honestly. I knew I needed to get in and get out and succeed so that I could teach myself it was okay. And I did. After about a week, I could sit with him for 15 minutes, and eventually I think I made my way up to an hour. I wish I could say that that cured my fear of hospitals, but sadly I would have to start all over again if someone in my family was hospitalized. I can’t visit someone once. It has to take 3 weeks.

You might not think that my unusual illness has intersected with my faith, but it most certainly has. Like many other Christians with all kinds of mental illnesses, I hoped at one point that Jesus would be enough to carry me through and overcome my challenges. In college there were many ministry opportunities, and one of them was visiting AIDS patients in a nearby hospital. Of course I thought this was very worth doing, and I asked Jesus to let faith be enough for me to do his work. With great faith and a lot of prayer I signed up for that ministry and attended the training. I made it through literally three minutes of that training before I had to get up and leave the room. I stood outside the door crying, trying not to faint, and wrestling with myself. I asked Jesus why he wouldn’t help me overcome this since my heart was so very much in the right place. As the training video continued to play, the leader came out to the hallway and asked if I was okay. I told her a brief version of my story and how I wanted to be able to minister to anyone. She said some of the kindest words I had ever heard: “Kristen, you don’t have to be able to do everything.”

I have come to accept the fact that my mental illness will be understood by very few people. I have come to accept the fact that I am not able to do everything. Anxiety gets in my way, and when I do not flee fast enough, it takes me down. Literally. Hard smack on the concrete floor. (And no, I did not go to the emergency room last week… But I had my husband do a phone consult with a medical professional for me and I have been resting at home non-stop since it happened.) My phobia interferes with my ministry and sometimes it changes my ability to be a present counselor. If I do not flee fast enough, my brain will check out for me. My mind has a mind of its own.

I am still afraid that people reading this will think I am being dramatic. Even others who have a mental illness might judge me because what they face is far more pervasive. But I decided to tell my story because we need to stop comparing ourselves and let every story stand alone. I decided to tell my story because we need to name mental illness and broaden the picture of what those words mean. I decided to tell my story because I know first hand that faith is not enough to overcome illness. Miracles can happen, and if I ever visit you in the hospital or donate blood or listen to your story of surgery then you will know that a miracle has occurred. Until that happens, I will name my illness and honor the limitations it places in my life. If I had not been afraid to seem weird or disruptive last week while sitting with another person’s pain, I would have laid down on the floor first so that my fainting would not injure me. I let stigma stop me, and I don’t plan to do that anymore.

 

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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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Why Pastors and Counselors Need Each Other

One of the most important distinctives of Church Therapy is that the church therapist works in tandem with the pastors. It is my firm belief that pastors and professional counselors need each other in order to best help those in their care. The partnership that pastors and counselors on the same church staff have is unique because there is a united team providing wraparound services to each parishioner. In other contexts in which pastors refer church members out to a nearby Christian counselor or other mental health agency, collaboration on the case (if any exists) is generally limited to an occasional phone call. There is not a team framework for understanding the person’s discipleship and mental health needs.

A church therapist’s office is in the church, often right beside the pastors’ offices. There is opportunity for casual interactions — spontaneous check-ins that can often guide and shape the clinical and spiritual understanding of a person in the midst of crisis or pain. The church therapist can attend staff meetings or consult with pastors when they unsure how to guide a parishioner through an emotional struggle.

This team approach is also surprisingly comforting to clients. Every client who attends the church must sign a release of information before the church therapist can speak with the pastors. I always explain how our team approach works and why it can be helpful to the client. The client has the right to refuse this information-sharing or limit what types of information can be shared. Overwhelmingly, my clients express positive feelings about the team approach — a sense of safety in knowing that those whom they are choosing to trust with their spiritual and emotional growth will be working together to care for them in a unified way.

The other benefit of the team approach in Church Therapy is a reduction in stigma. Those who receive mental health services through the church know that they are loved and accepted by the church staff in every type of interaction.

As much as the mental health field is making a push towards reducing stigma about mental illness, there are subtle ways in which our common therapeutic structures emphasizing anonymity in therapy actually create stigma. There is still an overriding belief that a therapist should never share any personal information (even when therapeutically beneficial), and that the client and therapist should never run into each other in any other context.

Anonymity in therapy can be useful, but it can also be detrimental as clients often feel an artificial tone in the relationship. The church setting creates a place where clients can be loved by a whole team of people in a variety of ways throughout their week. Their spiritual leaders have come alongside them, worshiped along with them, and demonstrated consistent structures of caring for the whole person.

Church Therapy creates a culture of safety, where pastors and the church therapists are on the same team, all in agreement that mental illness is real and needs professional treatment. In that context it is an act of courage and a sign of forward movement when a parishioner enters the therapy room. And whole-person care is able to extend far beyond the four walls of the counselor’s office.