Blessings for your Easter Sunday!
May Christ resurrect every place in your heart, whether wounded, weary, or wondering.
Kristen
Happy Easter!
Pastor Training Video: Psychological First Aid
I’m excited to bring you this brand new Pastor Training Video on the topic of Psychological First Aid (PFA). In this video, I overview the 8 core actions of PFA which are used when responding to crisis situations. This can be a help for church staff members, ministry leaders, or lay volunteers.
Watch the video here (under 10 minutes) and then check out these additional resources where you can learn much more about PFA:
Free online courses:
https://learn.nctsn.org/enrol/index.php?id=38
https://www.coursera.org/learn/psychological-first-aid
World Vision PFA Field Guide:
https://www.wvi.org/health/publication/psychological-first-aid
What is Mental Illness?
I often speak about the Church’s response to “mental illness.” Often used interchangeably are words like “mental health issues” or “emotional struggles.” Defining these terms is important in this dialogue, as doing so ensures that we all know exactly what types of problems we are trying to address.
The Diagnostic and Statistical Manual, 5th Edition (DSM-5) states this definition:
“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (p. 20).
The term “mental illness” can conjure up a variety of images, including other problems (such as homelessness or addiction issues) that sometimes co-occur with severe and chronic mental illnesses. Movies like A Beautiful Mind or Girl, Interrupted portray psychotic symptoms that are present with disorders such as schizophrenia. But are these mental models accurate when we think of the term “mental illness”? When we speak of the Church’s response to mental illness, are we simply trying to reach these severe cases?
Mental illness is far more common than we realize. According to the National Alliance on Mental Illness, in any given year 20% of American adults experience symptoms of a mental illness. This means that 1 in every 5 people are experiencing symptoms of depression, anxiety, bipolar disorder, adjustment disorders, PTSD and many other mental illnesses each year. Some may argue that those statistics might not represent the Church, as a faith and hope in Christ would offer a way out of these symptoms. However, if the Church is doing its job to reach the hurting, then our churches should be filled with more suffering, not less.
Notice that the statistic says 1 in 5 each year. That means that mental illness is not forever. Many people experience a single episode of depression that resolves with temporary medication and treatment and they never experience mental illness again. For others, mental illness is a chronic disease that requires life-long management. The Church can and should be a beacon of hope to the suffering, and hopefulness has a healing impact spiritually, psychologically, and biologically. But as with any illness, simply becoming a Christian will not make the symptoms go away. It is in this way that we as the Church must have a continual response of acceptance, love, and understanding to avoid stigmatizing and shaming those who continue to struggle throughout their journey with Christ.
Cultivating Peace
Whether or not you experience mental illness, you need to take time to care for your mental health. Each of us can practice daily routines and habits that will help us decrease stress. For those that do have symptoms of a mental illness, these practices will help with symptom management. Taking time for your mental health also helps you refocus on God and connect you with your spiritual journey.
Here are some tips for cultivating peace in your life:
Slow down
When we look at the life of Jesus, we see a very different era and culture. I do not think most of us can truly imagine life without electricity. Or cars. Or gadgets that speed up every task we have to do. Try to picture a life in which you walk everywhere, slowly. You go to bed when it gets dark and rise when the sun does. Our bodies were designed to live at this pace, and in our modern society we have pushed our bodies to the limits. Jesus lived slowly, and even though this was in a different historical and cultural context, I think there is much we can learn from the pace at which Jesus lived life.
Connect to the Spirit
Another regular habit that Jesus displayed was connection with the Father. We have that same connection available to us through the Holy Spirit. One of my favorite verses is found in 1 Corinthians 2:15-16: “Those who are spiritual can evaluate all things, but they themselves cannot be evaluated by others. For, ‘Who can know the Lord’s thoughts? Who knows enough to teach him?’ But we understand these things, for we have the mind of Christ.” I find it amazing to think that we have the ability through the Spirit to know and understand the Father’s thoughts. Aligning our minds with His directly allows us to cultivate peace in our lives as we rid ourselves of foolish or distorted thinking.
Attend to your surroundings
If you are living in chaos (relationally, in your schedule, or in your physical space) it will be very difficult to find peace. Relational conflict, chaotic time management, or living in a messy space will disrupt the inner peace. Often, your outward surroundings are a reflection of what is going on inside your heart. And often inner peace can be cultivated by taking care of the things in your outer environment. Taking time to clean up, organize your schedule, or resolve a conflict with a friend are ways to cultivate peace in your life. Tying up loose ends helps your brain feel finished, and you may find your sleep and mood improve. Simple things like lighting a candle, putting on soothing music or having some fresh flowers in the room can also go a long way to creating a peaceful space.
Peace grows in our lives when we actively work to develop it. Any fruit of the Spirit must be planted, watered, and nurtured in order to bear fruit. As we expand our hearts and minds and surrender to God more and more, we open up more space for the Spirit to dwell.
A Different Kind of Silence
There has been a lot of talk lately about the silent suffering of those in the Church who are battling mental illness. The hurting are often voiceless, their experiences kept hidden from view so as to keep the Church looking all put together. While Jesus’ own ministry gathered a pretty rough-around-the-edges crowd, the American Church today seems to strive for the opposite. Those who don’t fit the mold are cast aside and left to find Jesus by themselves.
On blogs like this one and on podcasts like CXMH, many have begun to speak out in order to raise awareness about mental health issues. These forums allow stories to be told, myths to be dispelled and dialogue to be engaged. This is much needed to decrease stigma within the Church, so that we stop blaming those who are suffering. Those who have been muted are now able to test the waters of authenticity in hopes of not being shamed back into silence once again.
Today I am calling for a different kind of silence. I am asking my fellow brothers and sisters in Christ to respond with silence as those who were once voiceless begin to speak. Many rush to fix, critique or blame those who express their suffering. Some even do it using Scripture to shame and harm the very ones to whom God extends grace and hope. What if we, who do not face a daily battle with mental illness, simply responded with silence to those who do? What if we just listened? What if we were simply present and didn’t run away from the suffering? What if we just offered a supportive nod or a warm embrace? What if we wrote down for ourselves every verse in the Bible that advises a tight rein on the tongue and applied it to ourselves?
If we took a voluntary vow of silence and listened to those who now speak out to share their stories, what kind of spiritual and physical healing could take place? Might some chains be broken loose as we follow Christ’s example in accepting those around us without condemnation? How might the American Church change if we all followed the wisdom of Proverbs 17:28: “Even fools are thought wise when they keep silent; with their mouths shut, they seem intelligent”?
Why “Christian Counselors” Need to be Licensed by the State
Sometimes “Christian counseling” gets a bad name. And for good reason. There have been many cases of churches handling issues such as sexual abuse “in house” or pastors committing acts of spiritual abuse. It is important to distinguish what Christian counseling should be in contrast to what it sometimes is. In Christian circles, there are more nuanced terms, including “biblical counseling,” “nouthetic counseling,” and “deliverance” ministries. How can we tell the difference between all these things, especially when we are in need of help?
From the beginning of my writing about Church Therapy, I have always maintained that church therapists (or any other form of Christian counselor) should be licensed at the highest level. I recently obtained my National Board Certification as a Certified Clinical Mental Health Counselor to continue to advocate for Christian counselors to adhere to the highest standards in our society and to demonstrate that Christians can and should provide the best quality care. Because those in the Christian community often do turn to their churches first for help, professionally trained and licensed Christian counselors need to be immediately accessible and available to help.
Having a therapist on a church staff can prevent improper handling of abuse situations because licensed counselors are mandated reporters. (This is legally different for counselors versus pastors in many states.) A licensed counselor is always obligated to report child abuse to authorities, whereas in many states pastors or non-professionals have blurry lines.
A professionally trained and licensed church therapist can also educate the congregation and pastoral staff around issues of mental illness, sexual abuse, and trauma, and in doing so create a culture in which these types of issues are handled with appropriate treatment. Rather than a secretive, “in-house” approach, church therapists are actively connected to the community. I am in regular contact with my clients’ psychiatrists, doctors, and case workers, and when needed local authorities. There is no suspicion of those outside the church, but rather cooperation to make sure every available resource is utilized to protect victims and to care for those in crisis.
Finally, in the Church Therapy model I advocate for use of evidence-based therapeutic practices. We need to be using treatment models that have been proven to work, integrating neuroscientific, biblical, and psychological principles to handle mental health issues in ways that succeed. There is no perfect treatment approach, but we must apply the highest levels of truth and research to inform our treatment rather than making up our own uninformed theories. What untrained, lay counselors in the church produce for treatment models is no more biblical, and certainly no more scientific, than the humanistic theories of Freud. And in fact it does far more damage because it is done in the name of Jesus.
Budgets & Billing: Making Church Therapy Work
Once you have thought through the ethical implications of the Church Therapy model (click here for posts in the “Ethics” category), you may find yourself asking, “So how does this work practically?” There are a variety of different options for making church therapy work for your church.
The Ministry Model
In some churches, counseling is viewed as a ministry and there is no charge for meeting with a counselor. Most often, the counselor is the pastor and this differs from Church Therapy because here counselors are not serving both as a pastor and as a professional counselor for their church. That does not mean that a church therapist cannot be on the church payroll. In some contexts in which money is plentiful, a church (or group of churches) could pay a salary to a Christian professional therapist and enable them to offer free counseling to church members. Unfortunately most churches are either not in the position to pay a professional counselor a salary or they do not prioritize it. Other churches may feel that because a professional counselor can earn fees from other sources they should do this and free up church monies for other needs. Additionally, in the ministry model a counselor can choose to donate a few hours a week to be a counseling minister for free, but this is limited unless the counselor has no need for an income.
The Self-Pay Model
In this model, the clients pay a certain fee per session. This can be done in a variety of ways, but most common would be a sliding scale fee based on income. You can also have a set fee that everyone pays regardless of income but doing this will limit access to your services. Regardless of what exact amount you charge per session, you have two options for processing that money. The counselor can be officially self-employed and manage the money on his or her own, or the counselor can be an employee of the church and turn in all fees collected into the church. The church bookkeeper would then take out all taxes from the fees collected (both the employer and employee portions of Social Security and Medicare) and pay the counselor according to the rate agreed upon. In the self-employed option, the counselor may or not pay rent to the church for office space. If the counselor is officially an employee of the church, some of the fees collected may be set aside to cover building use costs. Either way, the fees collected cover all taxes and costs of the counselor’s position unless the church is willing to cover building costs and increase the pay of the counselor.
The Insurance Model
Using insurance to pay for counseling has some wonderful advantages and some serious downfalls. In this model, the counselor must already have a license and usually a few years past state licensure in order to obtain contracts with insurance companies. Essentially, the church is inviting the counselor to come on church staff to set up a private practice. Because insurance companies can only contract with an identified clinician, this model requires that the counselor be officially self-employed. Reimbursements from insurance companies are paid directly to the counselor and he or she is responsible for all self-employment taxes and record keeping. If you live in an area that has primarily low-income clients, insurance payments can mean that you can earn a living wage and the client will typically pay nothing. In a more affluent area, the client’s insurance may require a higher co-pay or your clients may be able to self-pay at a higher rate than an insurance company! The downsides of working with insurance companies include bureaucratic headaches, claim submissions, mandatory diagnosing, and session limits. In this model it is up to the church to determine whether or not to charge the counselor rent for office space or donate the space to the counselor in exchange for some staff responsibilities.
The Hybrid Model
If the church therapist is working towards licensure or newly licensed, he or she can seek out a partnership with a larger mental health agency. In my early days as a church therapist, I began with the self-pay model but because I live in an economically depressed area I found that even $5 was more than people could afford to pay. The church did not have money to pay me a salary so I maintained another part-time job for needed income. Within my first year I developed relationships in our community and ultimately pitched the idea of a partnership to the VP of a secular mental health agency. The agency hired me to work as a fee-for-service clinician with them doing outreach in the community via my church office. I was clear throughout the process that I was offering professional Christian mental health counseling and in the end they paid me at a slightly higher rate because I had this specialty! They also agreed to pay the church a set amount monthly for the use of the office space. This model worked well until I was able to secure my own contracts with insurance companies. Again the downfall is mandated diagnosing and significant amounts of paperwork.
I offer consultation services to any church seeking to hire a church therapist onto their staff. What model might work best for your setting? I’d love to hear your thoughts and comments.
How Christians Should Talk About Mental Illness
Christian mental health can be a touchy subject. Specifically, there is debate about what language is appropriate for the conversation. Mental health is something we all need to work to maintain, while mental illness refers to specific disorders related to brain functioning. The degree to which faith plays a role in our mental health is also a common question. This week, many tweeted on this subject using #IFGathering2018 (from a Christian women’s conference held in Austin, Texas) due to conversation there about mental health issues. There was also a heated debate about a tweet from John Piper’s ministry (Desiring God): “We will find mental health when we stop staring in the mirror, and fix our eyes on the strength and beauty of God.”
Some have wondered why we have to make such a big deal of semantics. The Piper tweet had some truth to it despite being wrong on a lot of levels (and certainly a poor choice of words for a platform such as Twitter). God will indeed restore us all eternally, and we absolutely need to fix our eyes on Jesus just to make it in this world. But since there are still so many Christians who look at mental health as a mind-over-matter type of situation, statements like that one evoke a “too soon” kind of response.
So how should Christians talk about mental health and mental illness? Here are some do’s and don’ts that can help you as you engage in conversations, both in and outside of the church:
Do
Talk About Mental Illness
Silence is worse than missing a little nuance every now and then. Missteps in our speech allow us to engage in dialogue, while silence causes those who are struggling to feel isolated and marginalized. Pastors, work mental illness into your sermons. As much as you mention physical illnesses, mention the reality of mental illness as disorders that impact our bodies and our lives.
Use Language That Works For Other Illnesses
Someday, we’ll stop using the phrase “mental illness” altogether. In and of itself, “mental illness” creates a false dichotomy between “mental” and “physical,” as if our brains are not included in the list of major organs that can be impacted by disorder and disease. But for now, when you talk about mental illness, make sure the same phrase could be applied to other physical illnesses.
My tweet in reply to the Piper tweet is an example: “Let’s try this with cancer instead: ‘We will find our cancer healed when we stop staring in the mirror, and fix our eyes on the strength and beauty of God.’ Eternally, yes. Practically, no.”
Allow Those With Mental Illness To Define Their Own Terms
The people who get to say the most about mental illness are the ones who have faced it. Their language matters and gets to set the tone. I have known some people with depression who talk very openly about the ways that prayer and Scripture helped them tremendously to climb out of a dark time. Others have been hurt by misapplied Bible verses that made them feel more hopeless or to blame. Meet each person where they are — they get to say what works for them and fits their experience.
Don’t
Use Names of Mental Disorders Casually Or As a Joke
“You’re so OCD right now…”
“Our perspective can be so schizophrenic…”
“We’re all ADD nowadays…”
Most of the time, people who are speaking like this have no idea what the disorders to which they refer actually involve (references to schizophrenia are often very misplaced and inaccurate even if the comparison was appropriate, which it isn’t). People in your audience are struggling, or they know someone who is. Casual references to deeply painful experiences are extremely insensitive. Your words matter, so don’t be surprised when you tap on someone’s pain if they get more than a little upset about it.
Tell People To Have More Faith Or Pray Harder
This one gets me because it isn’t even a good understanding of the Gospel… If the strength of my faith or the muscle of my prayers is what can heal or save me, then I have radically misunderstood what seemed like an obvious and desperate need for the power of Jesus. Healing is a God-thing, not a try-harder-thing. Good spiritual practices do play a role in mental health for all of us, but watch out for language that puts the healing back into the hands of the sufferer. If anything, you are the one who can carry that person to Jesus with the faith that you have on their behalf.
Discourage Treatment
Mental health problems require proper treatment, sometimes including medication. Counseling, inpatient/hospital programs, and medication intervention are all essential to managing and improving mental health. When we as Christians speak doubtfully about treatment options, we discourage those who are unwell to get help. Imagine if you had cancer and your friends all told you that going to the doctor would be a lack of faith because God could heal you. (Sadly, I know of a situation in which this exact scenario happened and the outcome was tragic.) There are some, like those in the Christian Science religion, that do not believe in medical treatment. But Christianity does not have this as a tenet of faith, and we have no problem visiting doctors for all sorts of problems. Become educated about the mental health treatment programs in your area, including emergency services, so that you can help someone in a crisis connect with the appropriate resources.
A little attention and caution goes a long way. Ephesians 4:29 is a helpful reminder for us all:
“Do not let any unwholesome talk come out of your mouths, but only what is helpful for building others up according to their needs, that it may benefit those who listen” (NIV).
May we build each other up according to our needs and benefit all who listen.
Christians Die of Mental Illness Too
I was deeply saddened along with thousands of others a few years ago when Rick and Kay Warren’s son, Matthew, took his own life. As a mental health professional committed to serving the church, I have sat with many Christians who struggle with concepts of “joy” and “peace.” Unfortunately, the church has typically been a place where those with mental health struggles feel out of place and misunderstood. How can you be a Christian and at the same time want to put an end to your life?
I think it is important to first acknowledge the reality of mental health problems among Christians. In the same way that we see people in the church dying of cancer, riddled with disease, and struggling with physical disabilities we also see many in the church suffering from mental illness. Even this dichotomy of “physical” versus “mental” is false; the brain is a physical part of our bodies and it can become disabled like any other part of the body. Yet we maintain this idea that we can control our emotions, and that when we struggle with finding joy or peace we lack faith.
How do Christians respond to fellow believers with mental illness? If a Christian with bipolar disorder, for example, is in a manic phase he might be praised for his great faith and capacity to serve others without tiring. But upon entering a depressive phase, he is thrust into doubt and despair and others may wonder where he lost his faith in God. Too often, we use emotions as a means of judging a person’s spiritual life. Yet emotions are changing and easily disrupted; the truth of the Gospel does not depend on our emotional state.
With my clients struggling with despair and doubt I have suggested that feelings are not an accurate measure of their spiritual well-being. Finding meaning in obedience, knowledge, and truth can help provide an anchor for faith in the midst of turbulent emotions. Ultimately, the consistent and unfailing compassion of Christ is offered to all of us regardless of our own emotional state. It is this love, this peace, perhaps not felt within ourselves but known to be true that offers hope. When I do not feel peace, He is peace. When I do not feel joy, He is joy. When I do not feel love, He is love.
The church needs to be a place where those who struggle are welcome. The Church Therapy model creates a culture within the church that says, “We expect you to need help with your emotions.” Church Therapy cannot take away mental illness, but with it we can properly assess and treat those suffering in our midst. Sadly, no amount of therapy can prevent every tragedy. We can only turn to God’s mercy and grace to help us in the midst of our deep suffering and pray, “Come quickly, Lord Jesus.”
No Place for Shame to Hide
It’s everywhere you go, chasing you like a shadow. It stops in to your job or your home uninvited when you least expect it. It lurks in dark corners that you pretend are not there, except in those times you run into the dark to feel hidden for a while.
Shame. A byproduct of a broken heart. Not quite regret, though they are close friends. Embarrassment is a distant cousin. But shame lives in the core of your identity. It seems to define who you are, it whispers lies about what others think.
Everyone has a past. Some carry good memories, others bad, and still others have empty spaces where memories have been forgotten, intentionally or otherwise. These memories give definition to identity. Without memory, we would simply float in a confused vacuum with nothing tying us to anything else. But with memory, pain lingers and wounds are carried far beyond the original damage done.
Imagine walking into a church for the first time in your life, your past and shame following close behind. Truth hitting lies and lies fighting right back, eager to keep the prize they have won in your heart. This is the context of the church. Truth and lies in a bitter battle for souls.
Sadly, many churches lose this battle. Some don’t try to fight. Some fight lies with more lies. And some have good intentions but ran out of weapons long ago. But there are some places where safety exists. Where the healing power of Jesus can reach into this heart-battle and command an end. Where freedom is found and hope is given.
But then what? What is the next step in rebuilding an identity crippled and withered for so many years? For many, it’s therapy. A place to talk, explore, be understood, and develop new ways of seeing oneself. When the church refers people to therapists outside the church, a gap is created. It’s an unintentional gap, but a gap nonetheless. And it is in that tiny crack where shame can hide and resurface long after the “issues” seem done.
This crack is the place in which a person can hide with their doubt and fear. They can develop a “church self” and a “therapy self.” Between those is that place where a person can wonder if the church would really accept them if they knew everything the therapist now knows. And it is the same place where that person can also wonder if the therapist truly cares or if it is just a job. It is the reason that in traditional therapy, clients and therapists are terrified of running into each other in another setting. Reality: this is actually another person I am interacting with! Shame must flee within the confines of those four therapy walls, but shame does not like encountering acceptance in a different context. Fear shouts, “You can’t love me here! Only there!” And often therapists are unsure how to treat clients as people no matter where they are, with awkwardness translating into, “I didn’t sign up to see you right now…”
Church Therapy closes this relational gap, as the church provides therapy within its own context of safety. A licensed professional who is present in the church as a leader and staff member communicates, “We accept you. Tell us everything and we will still be here. You are person who is loved.” It creates a different level of presence that breaks down those artificial barriers that are stigmatizing even though they are accepted practice in the counseling world. I can’t stop caring about my clients when they (or I) leave my office. They can’t write me off as caring only because it is my job to do so. I am present in their lives in a holistic way, on a team with their pastors who are providing additional support and care. Shame is smacked in the face as acceptance and understanding replace fears of rejection. A fully authentic spiritual community reproducing greater authenticity as it accepts each member unconditionally. It is here that healing is found as Christ’s love penetrates every dark corner of the mind and forms a new creation, doing away with the old for good.