Category Archives: biblical counseling

Normalizing Psychiatric Problems: Pro and Con


One of the hallmarks of the Biblical Counseling movement has been the clear articulation that psychiatric problems are not different in kind from any other set of problems. This assertion is made by some for a couple of reasons:

  1. To make sure everyone knows that the bible speaks to every kind of experience. if one draws lines between “regular” anxiety and pathological anxiety, those who meet the criteria for a DSM diagnosis might think that biblical material cannot speak to their situation–that they need to go elsewhere for help. God cares for and addresses every concern.
  2. To level the playing field between professionally trained counselors and biblical counselors. If the roots of human problems are common no matter the outer expression of them, then pastors and lay counselors can understand the issues (pride, suffering, fear, despair, etc.) and walk alongside anyone. One may not need special training to help another.
  3. To communicate to the healthy that they are not different from the more obviously unhealthy. The point is to reduce stigma and promote unity.

Consider the pros and cons of this viewpoint.

Pro:

  • Reduction of stigma and ghettoization
  • Increase normalization (“so, I’m not so different from others) and similarity with the rest of humanity
  • Increase the confidence and courage of leaders to address and dialogue about all forms of suffering

Con:

  • Decrease in interest in the specific experiences of suffering thus narrowing problems down to a simplistic cause (sin?)
  • Possible over-confidence of some leaders leading to a reduction of empathy and listening to the experiences of other; failure to consider body/mind issues not specifically elaborated on in the Bible.
  • Failure to recommend outside helpers with specific expertise and training; dismissal of the need to have professional counselors who may have greater practice with certain kinds of interventions\

When I teach my Psychopathology course I want my students to see just a bit of themselves in descriptions of people with thought disorders, addictions, eating disorders and the like. I want to normalize these kinds of problems so that students don’t think of clients with the problem as somehow different from their own experiences. While I may not binge, I may be able to empathize with those who do. However, I do not want them to think their brief binge as exactly the same as someone else’s experience. Otherwise, they might assume it would be easy to “just say no” to the binge.

When I teach my Physiology course, I want my student so to see the complexity of the brain and body and thus recognize the unique forms of suffering some go through. I want them to realize just how little we understand how much the body influences our experience of the world and of self. However, I do not want them to medicalize psychiatric problems. If they did that they might believe that counseling has little influence on psychiatric disorders. They might think that biblical reflections on anxiety and depression have no place in the healing of serious problems in living.

What is your experience regarding christian leaders handling of psychiatric problems? Do you see too little normalization? Too much? Do you see minimization of psychiatric suffering?

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Reminder for Christian Counselors: We are voice, not Word


In G. Campbell Morgan‘s commentary on John, Morgan comments on John’s own recognition that he was not the foretold Christ but one who preceded the Christ and pointed to him. He says (commenting on chapter 3:22-36),

Then followed the last great statement. I have never read these final words of John without feeling their dignity and majesty. None greater ever feel from human lips. “He must increase, but I must decrease.” ….There was no unwarranted derogation of his own personality or work; but the content of the star as its lustre is lost in the rising glory of the sun.

….John the evangelist was thus showing the difference between the voice and the Word…

Surely this is what counselors must remember. Too often we want to be the sage wisdom, the Word. We want to be listened to; to be seen as wise. But, let us never forget that we are only conduit to the Word.

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Preaching to the 20%?


I’m representing Biblical Seminary this weekend at the Shepherd Press Marriage & Family conference being held in Harrisburg. Dave Harvey opened the conference with a very good sermon on showing mercy and kindness to family members. He stressed the importance of Luke 6:36 and the need to show mercy to sinners just as God does for us. This goes against our typical human desires for revenge or at least punishment for the misdeeds of others.

But, without taking anything away from the good sermon I found myself asking this question. How would ______ hear the call to have mercy on a sinner spouse. ______ represents a person I know who has been emotionally and financially abused by her husband. She finally was able to bring truth to light and has a reprieve from his sin while he is living with his parents. However, she faces strong pressure by others to reconcile (despite little evidence of true repentance in the husband).  Knowing what I know about this woman, I suspect she would feel more pressure to have mercy and allow her husband to return to the home.

I think most sermons really preach to the 80%. 80% hear this and recognize that mercy may be shown in numerous ways. Even allowing truth to come to light is an act of mercy. Mercy may be treating someone better than they deserve but may not mean playing the part of the fool and thinking that a few tears and words are enough. But what of the 20% who are weighed down with guilt and assume that a general principle must be applied in a very black/white manner? How do we care for them when exhorting all Christians on to the Gospel saturated life?

I want to reiterate that I think Dave Harvey did a good job. I do think that it may be too easy for the rest of us to assume that the more vulnerable among us will be able to nuance the big virtues of the Christian faith; that they will know that to emphasize one (e.g., truth-telling) does not mean a rejection of another (e.g., forgiveness).

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Coming to Peace with Psychology 2


In chapter 3 and 4 of his Coming to Peace with Psychology (IVP, 2010), Everett Worthington continues to show us how we are not near as good at intuiting facts as they really are. We us heuristics (rules of thumb). Hidden factors influence our views, ideas, experiences, and behaviors. In chapter 3 he gives an example of clinical judgment about trauma vs. research data. He suggests that most clinicians believe that the vast majority of survivors of traumatic experiences will have some form of PTSD. In contrast to this assumption, George Bonanno provides research data suggesting that some 10-30 percent of trauma survivors have chronic problems. Another 5-10 percent have delayed problems. However, the rest recover quickly or are resilient altogether. His point? Clinicians think resiliency in the face of trauma is rare when in fact it is quite common.

I find this example a bit strange. He did not cite sources pointing to the fact that clinicians assume PTSD in most survivors. I would have expected that he, a scientist, would have done that. Most therapists I know don’t go fishing for PTSD when no symptoms exist.

I think his deeper point still stands. We humans believe what we believe in the face of inconsistent data. So, he wants to explore what more objective research about human behavior might give us in our quest for consider the relationship between psychological science (not psychotherapy) and Christianity.

These first 4 chapters appear to be Worthington’s efforts to make sure we recognize that empirical research can teach us much about human nature; that research is going to be useful in building a model relationship between psychology and Christianity. Good for him! Let’s see how he begins to deal with the disciplines of psychology and theology in the next chapters.

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Coming to Peace with Psychology 1


In the first chapter of Coming to Peace with Psychology: What Christians can Learn from Psychological Science (IVP, 2010) Ev Worthington makes this point: We’re not as good at predicting human behavior as we would like to think. Science can help us. Or, the flip side, we are really great at formulating post hoc explanations (after we read scientific data) that help us think that we knew it all along (p. 28). You know, like when you get the answer of some piece of trivia, you feel you knew it all along. He provides several examples of surprising data that prove that we aren’t that good at predicting human behavior. Why is this important? We humans need help understanding our world. We don’t always make good choices even though we have massive data about humanity (biblical, experiential, etc.). So, he asks at the end of chapter one, how does psychological science relate to theology given that theology looks not to “thin slices” of large amounts of data but to Scripture?

In chapter two, Ev shows how his approach to the scripture/science relationship differs from previous attempts. He starts with the origin of the debate, makes an allusion to the Renaissance but quickly turns to the issue of counseling because it is in counseling where Christians are most concerned about whether they are receiving godly or ungodly wisdom. He points to usual suspects: secular models, rejection of Christian worldview, especially in academia, rejection of traditions and authorities. These cultural phenomena lead many Christians to be wary of liberal, free-wheeling, therapists. The call for “Christian counseling that was centered on biblically consistent beliefs and values was answered by Christians trying to integrate current counseling theories with Reformed theologies.

While there are variations on this theme, Worthington thinks one belief ties them together: Scripture and our human interpretations of it provide a clearer picture of reality than do human attempts to read general revelation. And, those disciplines that cover the nature of person (vs. “harder” sciences) have more distortion to them. Thus, there is a need to develop Christian filters to get rid of distortions in psychology.

He then singles out a few individuals who have diverse but generally favorable takes on the filter model: Robert C. Roberts, Eric Johnson, and David Powlison. Each has a different take on the problem of psychology and theology but all agree that there needs to be some critical evaluation of the underpinnings of psychological science. Interestingly, he dismisses each view (gently) for not being able to survive mainstream psychology.

Following these three, he points to three scientists who happen to be Christian: Malcolm Jeeves, David Myers, and Fraser Watts. Each, says Worthington, uses some form of a perspectivalist approach: two disciplines looking at overlapping data from different points of view (and asking different questions).

He ends the chapter saying that psychological science (Not psychotherapy) can be the bridge between science and theology–though I’m not sure he has spelled that out yet. Further, instead of just making Scripture trump (filter model) or Psychological research trump (Myer’s approach), we need a longer dialog when there seems to be conflict between Scripture and psychology.

He will take up “who do we trust during a conflict” in the next chapter.

Some thoughts. For those looking for deeper philosophy of science dialogue, you will need to look elsewhere. This is not Worthington’s focus. Rather, he wishes to give scientific endeavors some room at the table so that it can be taken seriously. To do so, he needs to show how both the filter and the separate-but-equal approaches miss the mark.

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Coming to Peace with Psychology I (Review)


I’ve arrived as a blogger! No, I’m not getting paid to write and I’m not getting millions of hits each day. But I am getting a new perk. Someone has seen fit to send me complimentary books just in case I might wish to review them here. Free books! Do you know how cool that is? To an academic and book lover, it is just about the best perk ever.

[I guess this is a good time for a disclaimer. I only review books I find interesting. And even if the book comes wrapped in Ben Franklins (this one wasn’t for some reason), I promise to tell you what I really feel about the book]

Today, I received Ev Worthington’s new book, Coming to Peace with Psychology: What Christians Can Learn From Psychological Science (IVP, 2010). You may be familiar with Dr. Worthington’s work on marriage enrichment, marriage and family therapy, and forgiveness. This is my first experience with him writing about the relationship of psychology and Christianity. Here are a few of his thoughts from the introduction and the enclosed “Author Q & A” about why we might need a new book on this topic:

  • “In this book I will claim that we can know people better, and even know God better, by heeding psychological science.” (p. 11)
  • “People have been integrating theology and psychology for years, but a vast majority of the integration has come from psychotherapists. Only a small minority of integrators have been psychological scientists…. While psychotherapists try to generalize about human nature on the basis of the clients they have seen and the models of helping they were trained in, psychological scientists measure the whole range of people–those 15 percent who were clients with some psychotherapist and about 85 percent more who are not.” (Author Q & A)

Wow. He lays down the gauntlet. The problem with previous integration has been the emphasis on anecdotes from therapists. If only we had more integration models by scientists. In fact, he is right–to a degree. Much of integration is highly theory driven. But is that bad?

[Rabbit trail: What are the common “sins” of theologian integrators? Clinician Integrators? Research Integrators? Theologians put far too much emphasis on their constructs and exegesis; clinicians put too much emphasis on “what works”; researchers put too much confidence in p values. In fact none have the corner on the market of truth. But again, Worthington’s book may be very helpful. He is right that both clinicians and biblical counselors fail to interact deeply enough with psychological research. Either they dismiss scientific methods by pointing out its weaknesses or they generalize from a small data point into a grand theory even though the data cannot bear the weight of the theory.]

Let’s hear some more from Worthington about the direction of his book:

  • His theses: Psychological science helps both Christians and non-Christians (a) understand God’s creation in human beings, (b) know about God more because the study of image bearers points to God, and (c) live more virtuously. (p. 13)
  • So, he sees psychology as a common grace to refine us all. This is very interesting. Usually integrative literature has cited common grace as what allows humans to rightly perceive. Here, the discipline IS common grace.
  • The relationship between psychology and Christianity is an “emerging marriage”– one that has possibilities of conflict and yet greater intimacy.

Finally, you might be interested in just what approach Ev Worthington will take in connecting psychology and Christianity. In the past some have described integration as a recycling project, a filter to get rid of non-Christian worldviews, a recasting effort, or a perspectival or level of explanation project. He mentions two: filter and perspectival approaches. The filter tries to have theological/biblical constructs as interpreting science. He finds this problematic. The perspectival model tries to separate the two disciplines as different ways of knowing.

So what does Worthington suggest? A new model he calls a relational approach.

That’s enough for this post. Next post I’ll make some comments on his first section (where he addresses some of the problems in previous integration by pointing to some psychological science).

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Marriage & Family Conference


Biblical Seminary is co-sponsor of a Marriage and Family conference in Harrisburg, PA run by Shepherd Press Authors. The conference runs October 1-2, 2010. You can find out more information here. I tell you about our sponsorship because those of you associated with Biblical Seminary (friend, alum, student, etc.) are eligible for a discount. Using their website, http://www.SPA2010.com, enter BIBLICAL as a code to receive the discounted registration.

Maybe we’ll see you there.

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Last chance for cheap Counseling CEs!


My weekend course on Counseling individuals with Borderline Personality Disorder begins this Friday night (6 pm) at Biblical Seminary. Class meets 3 hours on Friday and then from 9 to 5 on Saturday. It is not too late to sign up for CEs. If you are LPC and in need of a bunch of continuing education, these will count towards your requirements.

Check out this page for more information on CEs at Biblical and how to register.

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Does porn use give a Christian grounds for divorce?


Brad Hambrick, a counselor in Georgia, has written an article exploring whether or not pornography use might provide grounds for divorce. It is a worthy read. His final answer is a qualified no but includes a lot of other helpful thoughts about the experience and what repentance ought to look like. Too often we get caught up in a yes/no focus to this question and miss significant issues. Seems there are several questions that need to be answered,

1. Is porn use a form of adultery given Jesus’ equating lust and adultery?

2. Does failure to repent or repetitive acts such porn use destroy the covenant so that it is impossible to live at peace with a spouse? In this case, the question is less about porn and more about refusal to honor a covenant. David Instone-Brewer writes about this from a NT perspective on the OT. I blogged about his thoughts some time ago and you can search “divorce” on this blog and find multiple entries.  Instead of divorce, we could insert repetitive gambling away family income, repetitive risky behaviors.

3. What would be evidence of repentance? Does any relapse equate to total failure? How many relapses equal refusal to repent?

Rather than just focus on the “big” question, it might be helpful to ask more immediate concerns. Does the porn user agree to utter transparency? Are they demanding something in return for their abstinence? Are they still trying to control their treatment?

For those who follow the link, I’d be curious your response. Read it from a user’s perspective and also of the victim spouse.

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Christian interventions in counseling


Regular readers of this blog will know that I believe that Christian counseling is not merely counseling done by Christians or merely the use of specific christian interventions. Rather, Christian counseling is founded on Christian/biblical ways of perceiving the world, the problems in it, and the goal of imaging Christ from start to finish.

However, it is good to think about the specific use of certain christian practices in counseling: meditation, prayer, bible reading and application, casting out demons, absolution, etc. How are we to think about these practices? Do they have a place in professional counseling? What are limits we ought to place on them? When should we refrain? How do we secure informed consent?

Elsewhere I have published on the guidelines we ought to consider when using Scripture in counseling. I will not repeat them here but for those who have not read that article, I do think Scripture is something that CAN be used in counseling–even OUGHT to at times. What is of more importance to me is HOW and WHEN and WHY.

Let me here consider the most commonly used practice: prayer. Here are some shaping values before we consider any practical application.

1. Prayer is talking and listening to God. It is not a technique and should not be treated as such. It is not magic. It is, from a Christian perspective, sharing one’s heart, praising, questioning, interacting with the Creator of the universe who remarkably wants to relate to me. At its heart prayer is submissive acknowledgment of God–even when praying like Job.

2. Prayer then needs to be a free act without trace of coercion. The one praying must not be coercive (you talk to God not at another person). The one being prayed for ought not feel obligated to say anything.

3. People have diverse (and not always happy) experiences regarding prayer, faith, relationship with God, etc. So, what is comforting to you may be triggering for another.

4. Prayer is intimate. Prayer often results in our setting aside defenses and becoming vulnerable and needy.

5. Prayer is power. Praying for someone gives the one praying a position of power.

So, how might a counselor consider these values and use prayer in counseling.

1. Assessment of client. What is my client’s faith tradition, experiences with prayer, history of abuse by leaders of the church, understanding of God? Have they ever felt coerced to pray, coerced by the prayers of others? Have they been publicly prayed against? Do they value prayer?

2. Assessment of self. Why am I praying for my clients (out loud)? What messages am I trying to communicate? What do my prayers reveal about my own faith?

3. Consent. Have I explained why I pray for my clients? Do they really have the right to say no?

4. Review. How are my prayers received? What impact, if any, do they have?

What does this look like for me? I don’t pray with every client. I don’t choose to start my sessions with prayer (at least the first one) until I have a better sense of my client’s experience with prayer. I work very hard not to use prayer as an effort to disarm (though I think it can do this) or to preach a message, but only to make supplication to God for healing, for care for the downtrodden. When I use imagery in prayer I make sure that it is grounded in common biblical images (God as shepherd, Christ as lamb, etc.). I never ask clients to pray but many of them choose to do so. And, I do let clients pray for me when they want to. It is part of how believers care for each other.

I do believe that prayer is extremely important but that I do not need to do it to be actively asking God for healing or guidance. I will say that when conflictual couples pray, they often find that it is hard to stay angry and embittered and pray. It can be helpful, either in reducing bitterness or by discussing bitterness and its impact.

It should not be used when clients do not want it, might be confused by it, or if it is not authentic to the counselor. It is considered good professional ethics to utilize resources from a client’s life. However, it would not be good to fake (e.g., my praying in a way that would please a member of a cult, an atheist praying as if he or she believed what she said, my talking to God even though I am no longer practicing as a Christian, etc.).

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