Tag Archives: biblical counseling

New book for those who wonder about the value of diagnoses and medications in biblical counseling


What kind of messages about mental health diagnoses and medications do you receive in your community? What do you hear about these in the church? Silence? Warm embrace? Implicit or explicit rejection?

Mike Emlet, a former family practice physician and now counselor, has written a small book to introduce readers to a nuanced and biblical take on the value of diagnoses and medications. Descriptions and Prescriptions: A Biblical Perspective on Psychiatric Diagnoses & Medications (New Growth Press, 2017) comprises 22 short chapters exploring the pros and cons of both arenas for those who are “too cold” or “too warm” towards the use of mental health diagnoses and medications.

In the first section Mike explores some of the weaknesses of the current DSM (psychiatric diagnostic system). Those who are “too cold” and who think the system is fraught with problems may find themselves saying “yes, exactly.” But rather than just stop there, he begins to articulate implications for ministry responses—how to go deep to understand the person behind the diagnosis. There is much the pastor or counselor can learn.

One key point is made here and in later chapters: we live in bodies and Scripture takes this seriously. So learn about the symptoms a person experiences.

So, you might think this book is negative on the value of diagnoses. It is not. Chapter 9 begins to describe the potential value of diagnoses, especially to those who tend to see mental health problems ONLY as spiritual and ONLY or usually involving just the will. If there is one thing the reader should get from this chapter is that humility is in order. If you don’t put much stock in diagnoses you likely don’t put much stock in published research exploring symptom clusters. As an example, Mike briefly discusses the multivariate experiences of those with obsessions and compulsions. This little window into the problem of OCD should remind us that we must work hard to understand the many subtle forms of obsessional thinking and consider how best to describe and care for the person suffering with them.

On the final page of chapter 9, Mike takes on one crucial criticism—that since you can’t see structural differences in the brain that implicate a particular diagnosis then the diagnosis isn’t real. From his point of view, this is a simplistic understanding of biology and diagnoses.

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The second section explores the challenges and benefits of psychiatric medications. Mike gives a very brief overview of the categories of medications and how they work (what we know and what we don’t know). He summarizes the research as indicating a modest positive effect, though also showing that other means are quite effective (placebo and counseling). Such results show us that there are a range of helpful responses. While it is true that medications for anxiety and depression aren’t cures and aren’t without their side effects, it is important to remember that the individual in front of you may in fact benefit immensely. Thus it is good to remember that we don’t offer advice to others based on population statistics. Rather wisdom is in order for this particular person.

 

 

In probably the best part of the book, Mike walks the reader through a wisdom approach to the use of medications—walking the tightrope as he suggests. Too much suffering and too little suffering can be hazardous to our spiritual health. We can make idols out of medications or out of not taking them. Medications aren’t good or bad on their own. It is how we approach them that matters.

He makes this statement nearing the end of the book,

“I hope you have seen that there is not a clear-cut “right” or “wrong” answer. There is no universal “rule” that we can apply to all people at all times. There is no simple algorithm. Rather, the use of these medications is a wisdom issue, to be addressed individually with those we counsel. There will always be a mix of pros and cons, costs and benefits to carefully consider.”  (p. 87)

This answer may frustrate those who want a clear-cut “this is right/wrong” response. However, counselors are not umpires calling what is “fair” or “foul.” Instead we are walking with and helping others look for relief (what can I do to make the moment better?) and look for acceptance (what is God up to in my life?).  Sometimes relief means medications, other times it means examining thoughts, habits, perceptions, etc. Sometimes acceptance means pursuing other goals beyond symptom relief, other times it means understanding accepting that God has, in his providence, allowed them to have a body that needs external supports.

Book Recommendation: Great first text for those who either over-estimate the value of mental health diagnoses or medications or those who minimize their value. Author leans to a conservative approach and probably spends more time speaking to those who might over-value medications. Yet, he also repeatedly affirms that biblical counseling must take seriously the fact that humans are embodied souls and that diagnoses and medications have value, albeit limited value. Great text to start the conversation and lead to deeper study about our responses to suffering, especially for beginning pastoral counselors and lay helpers.

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Over-confidence? Under-confidence? Assessing counselor tendencies


Every counselor desires to be effective, to handle client concerns and problems with competency. We do this work because we long to see others recover quickly and we do not want to get in the way of needed and desired growth. Early career counselors often feel out of their league and so seek out all the help they can get: supervision, books, essays, and peer-consultation. This is the proper way to learn and become better at our craft.

But what happens when we begin to feel competent and confident? Do we stop feeling needy? Stop seeking input? If we do stop pursuing growth and increased competency, skills and capacities will erode. We might think all is well, we’ve got this under control, but in reality we would enter dangerous territory. Imagine wanting to be an Olympic athlete and yet forgoing training.

Erosion happens.

So, should we want to feel less competent? No. The goal is not to feel ineffective nor to lack confidence in what we do. I would not want a second-guessing surgeon to operate on me. Rather, it is important to maintain regular (not obsessive!) self-examination and invitation to others to give you input and feedback.

For the possibly under-confident counselor:

Where do you feel you need help, are less competent than you would like? What are your common responses to that feeling? Who have you talked to about this problem? Where have you sought help? What continuing education have you completed? While it is good to get help to “know what to do” don’t forget that a large portion of therapeutic success is attributed to who you are in the session. Be sure to focus on your listening, and “bearing-witness” skills. Remember to be a student of the client.

For the possibly over-confident counselor:

Do you still have supervision? If not, why not? Look over your caseload. Who are you working with who you have not reviewed assessment, diagnosis and treatment plans with another (note: peer supervision can be done without revealing confidential or private information)? When was the last time you verbalized your case conceptualizations with a critical eye to the potential myopia that plagues us all? What continuing education have you completed that can revise and improve your skills?  While relationship-building skills are the most important, do not stop learning and growing in knowledge and understanding.

It is good to remember that  our skills WILL erode without attention, just like muscles with grow flabby without exercise. One such muscle for the Christian counselor is that of prayer. Consider your recent counseling activities and ask how prayer has fit into your work. Is it a perfunctory or an afterthought? Does is change depending on how you feel about your competency? What does it reveal about your therapeutic operating system (e.g., what is the source of power to change?)

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What to do with our emotions? #CCEF16 


Continuing a summary of the Emotions conference, CCEF faculty member Alisdair Groves presented two plenary talks having to do with our emotions. In the first he defined emotions as the expression of what we value, desire, even worship. Our emotions are ours and they are complex responses to our histories. However, they are windows into what is most important to us. 

In the second plenary he asked what we can do with our emotions. Before giving suggestions as to what to do with our emotions he suggested two unhelpful responses: deify them or deny them. The larger culture may over-value our emotions as our self, but Groves feels the church can do this as well by expecting spiritual highs (“amped”) all the time and that life in the valley is a sign of a problem. The flip side is a stoic response, stiff upper lip. He reminded the audience that both extremes do have a valid point but skew in the wrong direction. 

So, what to do? Engage our emotions. Note he did not suggest we change them, vent them, or embrace them. More specifically, he made a couple points:

  1. Engage your body. Take care of it. Eat and sleep well. You will be better able to engage your negative emotions when you are your physical best. He quoted someone who said, “eating is the most over-used anti-depressant while exercise is the most under-used anti-anxiety tool.” 
  2. Engage your emotions in the Lord. He gave several dos and don’ts. Don’t vent. Don’t stew. Do bring your pain to God. Do connect with others over your pain and ask for their help, do insert Scripture and other goods into your life (like turning on a faucet of good clean water). Do repent. Not so much repent of your negative emotions but bring them to God and recognize you need to repent of those things that are not of God (e.g., bitterness, unforgiveness).

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Question for you: Do our emotions only show what we love/worship/value? (Note, I do not believe this is what Alisdair was teaching the audience!)

If I am attacked and react in fear, does this show what I worship? Or does it show I value my life and my dominion is being stolen from me? I think Alisdair is right in that often our emotions do reveal our assumptions, perceptions, and yes, our values. But I believe and I think he would believe that emotions reveal our humanness AND our imaging of God’s emotions as well. They reveal the good and bad of relationships. I would argue that emotions are to be (a) listened to, (b) accepted, and (c) evaluated from the vantage point of life in Christ. Now, that last phrase, life in Christ, needs great unpacking. It would be easy to make that mean something like, “since Jesus has saved you, your negative emotions have no place here. In everything give thanks.” That would not be an accurate picture of what I mean by Life in Christ. Life in Christ with the hope of heaven does not deny what is broken in the life. It REQUIRES lament, confusion, anger, jealousy, even as it requires hope, joy, peace, and comfort. So, our emotions reveal something about ourselves and something about God and the world he has made. 

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Emotions: Why do we demean them so?


This morning I am on my way to represent my school at CCEF’s annual conference. This year the topic is “Emotions: Engaging the Expressions of our Heart.” I’ll try to post some reflections of what I hear throughout the conference.

Truth be told, emotions have gotten little consideration in the biblical/Christian counseling world. When I was a Westminster student back in the late 80s/early 90s David Powlison wrote an essay called “Crucial Issues in Biblical Counseling.” I recall one of those crucial issues to be that of developing a more robust theology of emotions. Nearly 30 years later, we still need that work to be done in evangelical circles. I’m hoping to hear some of that this week.

We evangelicals have prized thinking over feeling, as if one is less biased or less “fallen” than the other. This is not new. Early Christians worked to clarify the personhood of Jesus and shut down false views. The protestant reformation was intended to correct errors in thinking and belief that had infiltrated the Church. Thus, belief and repetition of those beliefs have been prized over listening to emotions. Right thinking is even prized, sadly, over right behavior.

One of the negative results of this problem for Christian counselors is the temptation to invalidate the feelings and experience of clients. Most counselors assume their helpful, gently corrective responses will bring a level of comfort and reduction in emotional pain. Far too frequently, the client is left feeling more alone and upset–even when they know the counselor as spoken truth. Why? Consider this made up exchange and see how you would feel if you were the client.

Client: [who feels that many overlook her competencies] I can’t believe my sister did that to me. Why would she be so hurtful and cut me out of my mother’s birthday celebration planning? I feel so rejected.

Counselor: You know, some people are like that. Really, you shouldn’t be bothered by her. Hasn’t she done this before to others? Be thankful that you didn’t have to do all that planning.

Does thinking or emotions have to trump the other? We are designed to think and feel, to experience our world through emotions and thoughts; each informing the other.

Here’s how we would know we are making headway:

  1. We stop trying to talk people out of their feelings. We start listening to what our feelings can tell us about ourselves and our world
  2. We worry less that emotional experiences are biased. We know they are but still recognize them as real experiences of the world.
  3. We look more for corrective emotional experiences than assuming that thinking always changes feeling.
  4. We know that God cares about our painful feelings and so we bring them to God, knowing that He too has felt sadness, jealousy, anger, and angst. He has compassion on us and offers us opportunities to see him in the midst of the struggle.

Sure, our feelings are not always (ever?) accurate. They need correction. They need perspective that God, Scripture, and wise friends can give. But rather than starting out with pointing out emotional or logic errors in our counselees, how about we get down in the mud and share in the experience as we walk together.

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Learn the Shape of Yourself and Other Advice for Counselors


The best counselors know themselves well. No, I don’t mean that the best counselors are self-centered. Rather, good counselors understand their biases, foibles, strengths and challenges. The best counselors know themselves inside and out and notice when they start to project their own thoughts and feelings onto others.

Why is this capacity so important? A counselor must see and note the difference between yourself and the client in front of you. This is vitally important if you are going to be of any help to that person. When we fail to see the difference, we end up counseling the other person as if they were an extension of ourselves. As a result, we fail to challenge our own biases and assume what helped us will help them.

Enter writer Mary Karr to illustrate this problem from the vantage point of writing a memoir.

Mary, author of several memoirs, has written a new book on how to write a memoir. I heard her being interviewed on NPR’s Fresh Air program today (find the audio here) and was taken by her advice to writing students. In response to a question about how to know if memory of events is accurately described, Mary tells of how she stages a fight (unbeknownst to her students) and then asks them to write about what they saw. As you might expect, each student sees something different. Why? Because they project their own lives and experiences onto the event. Even those with perfect recall, those who can get the dialogue just right, never fail to project their own assumptions into the story. Mary reminds listeners that it is impossible not to project ourselves into our observations. “We don’t so much as apprehend the world as we beam it from our eyeballs.” What can we do about this problem? She implores that writers to,

Learn the shape of yourself. Learn what you tend to project onto the landscape so that you can account for that tendency in your life and question it…

Learn to know the shape of yourself. What excellent advice for counselors.

Just last week I met with a man with decades of cross-cultural missions work on several continents. We spoke about the best ways to help students and new arrivals succeed cross-cultural ministry. This man reminded me that the best cross cultural education is not reading volumes about another culture (as good and helpful as that can be) but learning to know oneself inside and out so as to see the projections we tend to place on “the other.”

Want to avoid hurting others? You will surely need to know good counseling techniques and methods. you will want plenty of experience differentiating between types of problems. But, if you fail to really understand yourself and your tendencies, your utilization of those techniques may not be what the client needs.

Best advice to know yourself?

  1. Don’t take yourself too seriously.
  2. Ask your friends who you really trust to give it to you straight about your annoying habits.
  3. Get into your own therapy and don’t hide who you really are from the counselor.

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Criticism of Biblical Counseling: Are Joyce’s Concerns Valid?


Katheryn Joyce has recently published a long post about the rise of Biblical counseling and the concerns some have about the movement [read it here].

Most people who have thoughts about counseling and Christianity tend to fall into one of to categories: Those who oppose biblical counseling as dangerous and those who oppose the various versions of Christian psychology as shallow and full of humanistic ideology. Very few people try to maintain identity in both worlds. If you have read my “about me” you will find I’m one of those who does accept the label of biblical counseling and Christian psychology (more on this below)

I encourage both proponents and opponents of Biblical Counseling to read her essay. Let me even take the liberty to suggest some starting questions to keep in mind as you read. While the essay may not answer the questions, having them in mind will keep you from solidifying stereotypes of either sides.§ If you are inclined to reject biblical counseling, consider these questions:

  1. Where might I find a more thorough history of biblical counseling and its various permutations?
  2. What main biblical counseling author voices are missing in this piece? [Note that the mentioned ACBC was, until recently, known as NANC (National Association of Nouthetic Counselors)]
  3. What failures in Christian psychology movement(s) led to the need for a biblical counseling movement?

If you are inclined to defend biblical counseling, consider these questions

  1. Even if some of the bad examples of biblical counseling do not represent you or the heart of the movement, what aspects of the movement may support or encourage some of these distortions?
  2. How might you better communicate “sufficiency of Scripture” to outsiders?
  3. Does biblical counseling seek to eliminate symptoms or improve spiritual responses to symptoms? How might it better acknowledge the body when talking about the causes of mental health problems?
  4. Where does fear of “integration” hinder the maturation of biblical counseling as a movement?

Indeed, these questions have already been asked and answers given in a variety of locations. Readers unfamiliar with biblical counseling should start with websites such as this one, CCEF, ACBC, BCC, and the Society of Christian Psychology to find further and deeper readings on related topics.

Where the Concerns are Valid

Not acknowledging benefits from psychological research. Joyce notes that a good biblical counseling session looks a lot like a good professional counseling session. Why? Well, it is obvious that change happens best in the context of kind, compassionate relationships. Why the similarity? While it is true that psychotherapists didn’t discover empathy, it is true that psychotherapy research has expanded our understanding of the best way to encourage trust relationships in therapy. In addition, some of the cognitive, affective, and dynamic interventions developed from these models are used within biblical counseling. I have absolutely no problem from biblical counseling deriving benefit from interventions developed in other models of therapy. I only desire biblical counselors or acknowledge that benefit. It is clear Jay Adams benefited from Mowrer (and said so to boot). We can do the same. We can admit that Marsha Linehan has revolutionized our understanding of how we work with people exhibiting symptoms of borderline personality disorder.

Emphasizing false dichotomies. Joyce quotes Heath Lambert in this piece (near the end),

“I’m concerned [that] if we say, ‘Oh my goodness, people with hard problems need physicians and need a drug,’ we’re going to lose much of what the Bible has to say about hard problems.”

The quote above is in the context of dealing with difficult or serious mental illness. He worries that if the church creates two categories of problems (normal and special), those with serious problems will no believe that the bible has things to say about those suffering with suicidal ideation or schizophrenia. It seems that some biblical counselors take a negative stance on psychiatry and medical intervention because they fear doing so will hinder the work of the Spirit through the bible. I would argue that this dichotomy does not need to exist. I agree that the bible speaks to everyone, whether they are having difficulty or easy problems. I don’t think that use of medications or medical practitioners has to hinder pastoral care. The message that others get when we suggest that medical intervention need to be avoided is that somehow it is less spiritual to seek a medical intervention. This is patently false. Now, not every medicine is worth taking. Some may create more problems then they solve. But that fact should not cause us to lump all professional/medical care into the same category.

Where the Concerns are Overplayed

Heath Lambert gets it right when he claims that all counseling models will fail, due primarily to the quality of the practitioner. Biblical Counselors do much work that is commendable and successful. Joyce’s piece may suggest that most biblical counselors are ineffective and incompetent. This is not true. Matthew Stanford suggest he has never seen a biblical counselor do well with difficult cases. That may be the experience of my friend, but I can attest to seeing biblical counselors working well with people with serious personality disorders, delusions and other difficult mental illnesses. Now, the truth is, these counselors have succeeded because they did not follow the stereotype and reject learning from professional psychology. Further, these same counselors did not take “sufficiency” to mean that they could only use the bible in considering how to respond to their clients.

Take a moment and read her piece. Review the questions above and keep an open mind to both sides of this story.

[§ I have written on the relationship between Christian psychology and biblical counseling in the Journal of Psychology and Theology, volume 25, 1997. You can buy that essay here.]

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Training Trauma Healers For The Church


Over at our faculty blog site you can find my summary of a recent trauma recovery training for pastors and church leaders. Biblical co-sponsored this training with the American Bible Society in an attempt to bring a well-established, scripture-engaged trauma healing model to the Philadelphia area. Read more about the model and its value as well as see a picture of the training (thanks Heather Drew).

Trauma comes to us in all shapes and sizes. Traumatized outsiders (i.e., immigrants), child sexual abuse, domestic violence, community violence, racial injustice and natural disasters are here, not just something that is “over there.” While we may have more professional mental health resources here than other communities have access to, we still do not have enough to serve the need. And even if we did, the best models of recovery connected traumatized people to their faith and their communities. What better place to do that than in the church?

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Video: Making the Church a Safe Place for Trauma Recovery


In October I represented Biblical Seminary’s Global Trauma Recovery Institute at a conference co-hosted by the World Reformed Fellowship and North West University in Potchefstroom, South Africa. Previously I posted the accompanying slides here. Now, WRF has made available the video for this presentation. Presentation runs about 30 minutes plus a Q and A at the end with another speaker.

Main objectives of the video?

  • Understand the experience of psychosocial trauma
  • Make the church a safer place for those who have been traumatized

Link to video here.

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The power and perversity of labels


English: Photo of Paulo Freire

[Previous version published  in 2006]

That was great!

You are a liar!

We humans have powerful tendencies to label and categorize. It may be something that Adam passed on to us. Notice that Adam got to name the animals as he saw fit. I suspect that being made in the image of God provides us an innate drive to name things as they are?

But what happens when things don’t fit our categories? We either have to expand our definitions or shove square pegs into round holes.

  • The color line comes to mind. Those who are biracial face the repeated question, “What are you?” And the “one drop” rule still is holds power: one drop of African heritage blood in your recent ancestry makes you “Black” in this country.
  • How about those who don’t fit gender stereotypes. I’ve heard the pain of many who were accused of being gay because they didn’t fit someone’s image of a man or a woman. These labels were so powerful that they caused confusion. “If being a man means…(fill in the blank), then I must not be one. Maybe I’m gay.”

The Counselor’s Power to Label

Counselors hold tremendous power when as they label, especially those who represent both the counseling and the Christian worlds. We label right and wrong, righteous and unrighteous. We label idols of the heart. We want our counselees to see themselves and God in proper form. We see how distortions in labels (e.g., God doesn’t love me; I’m incapable of changing) harm and we want to provide healthier labels.

But, HOW and WHEN we label may be more important than whether our labels are actually correct. The temptation for counselors is to label too quickly, before the counselee is ready. If that happens, the counselee is passive and the counselor’s label is just one more among a chorus of opinionated acquaintances.  

Take a look at how Jesus interacts with sinners and self-proclaimed holy men. Who is he more likely to label? Who does he engage with deep questions? What are his means for helping others see themselves? Notice how the Pharisees were quick to label what was authentically Jewish and what was not. Notice that the Lord seems less interested in that and more interested connecting to others. He was not neutral about sin. However, he engages others in novel ways to show them the righteous path and their need for a savior.

Who Does the Labeling Matters

I’ve been enamored with the late Paulo Freire, a liberation theologian from Brazil. He describes how unthinking, impoverished, people become empowered when they are given the power to name things (problems, solutions). They do not, he says (in Cultural Action for Freedom), learn by being filled up with words and labels by dominant culture individuals. If this were the case, then counseling would only be a matter of memorizing the right words and phrases. No, counseling is a dialogue where the counselee is an active, creative subject in the process of change. In Learning to Question: A Pedagogy of Liberation, (by Freire and Faundez), they say,

I have the impression…that today teaching, knowledge, consists in giving answers and not asking questions.

The same could be said about counseling. It is the asking of questions that encourages us to search for answers. Without questions, we may never redefine the problem. When we counselors label (whether we are talking about DSM labels or right/wrong labels) without engaging  the client in the process, we rob them of their words.

What Can We Do?

Freire suggests a three-step dialogical model that may work also in building an effective counseling relationship: Investigate (ask exploratory questions, examine beliefs, myths, etc.), Name (code and decode, a process of un-naming and naming what is going on), and Problematize (identify problem and solutions).

Avoid the Temptation to Give the Gift of Your Knowledge

Freire says that gifts given by oppressors only perpetuate injustice. If the “gift” of your knowledge perpetuates the divide between the counselor (the healthy/wise one) and the counselee (the sick/naive one), then your gift may only serve to perpetuate their illness. This does not mean you should never speak or offer advice. But ask yourself, “does the way I speak to clients encourage and energize (all the better if in the form of a pushback) or cause passivity?

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The Power of a Counselor’s Words: Guest post over at biblical.edu


I’ve been thinking and musing about the power we counselor’s wield with our words. To be honest, I do so without always being aware of the impact. It is so easy to say, “that’s abusive” to a victim with the idea that I am validating her experience without realizing I have just crushed another part of her life.

So, if you want to read some of these musings and a gentle corrective to those of us who call ourselves biblical counselors, click here to find the blog I posted for October 18, 2013.  [posted prior to leaving for South Africa]

 

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