Counseling Those Who Suffer
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McMinnChapters1and2.docxMcMinn, M. R. (2012). Psychology, Theology, and Spirituality in Christian Counseling. Tyndale House Publishers, Inc.. https://mbsdirect.vitalsource.com/books/9781414349237
Psychology, Theology, and Spirituality in Christian Counseling
Mark R. McMinn
Chapter 1
Religion in the Counseling Office
written with James C. Wilhoit
After lying awake in bed for several hours, as she does most mornings, Jill drags her tired body downstairs, starts the coffeemaker, plops the Yellow Pages on the kitchen counter, and “lets her fingers do the walking” to Counselors. Jill knows she is depressed, overwhelmed with feelings of guilt and inadequacy, and she knows she needs help. But she worries about finding the right counselor, recognizing that her choice could have profound implications on her spiritual life.
Counselor A might tell Jill that her depression is worsened by her silly religious ideas. What she really needs, according to this counselor, is to think clearly and logically about the world, relax her neurotic demands for perfection, and begin finding ways to enjoy life. Counselor A tells Jill that as soon as she grows beyond her religious faith, she will be well.
Counselor B is more interested in listening than in telling Jill what to do. Jill’s religious values have meaning for her, so Counselor B listens and responds to Jill empathetically: “Your religious values seem very important to you. It sounds as if you want to do the right thing, but you’re not always sure what the right thing is. What I hear you saying is that you want God to help you through this difficult time in your life.” This counselor assumes that Jill needs a supportive companion or a transitional object to help her learn new ways of relating to others and herself. Religion can be discussed in therapy, but the power of change is found in the therapeutic relationship.
Counselor C tells Jill that depression results from personal sin. She feels guilty because God has given us all the gift of guilt so that we remember to confess our sins and depend more on him. By looking carefully at Scripture, the counselor helps Jill find areas of sin in her life, admit her fallenness, and ask God for forgiveness.
These are just a few of the possible counseling approaches hidden behind block ads and telephone numbers in Jill’s Yellow Pages. How will she decide? Will Jill reach out to the right counselor for help? Will she find someone to help her toward greater emotional and spiritual health?
Jill is not alone in her search for spiritually sensitive counseling. In a survey of Florida residents randomly selected from telephone listings, a greater number of respondents preferred help from a pastor than from a psychologist, social worker, psychiatrist, or community mental health center.3 Similarly, in an analog study with middle-aged adults, participants found religiously sensitive counselors more trustworthy, likable, and approachable than agnostic or atheistic counselors.4
Counselors Are Confused Too
Religion and religious values have become a frequent topic of discussion for many counselors in recent years, and most counselors have thought a great deal about the confusion their clients face in choosing a good therapist.5 But when it comes to religious values in the counseling office, our clients are not alone. Many counselors feel confused too.
Counselor A sounds confident in rejecting religion but is having problems finding evidence to support such a view. Strident atheists, such as Albert Ellis, have argued for years that religion causes illness.6 But as their claims have been contradicted by research evidence, they have become more cautious in their rejection of religion.7 Ellis, for example, now says it is fanatical and rigid religious beliefs, not religion per se, that cause problems. Ellis even endorsed the Bible as a useful self-help book in a 1993 article: “I think that I can safely say that the Judeo-Christian Bible is a self-help book that has probably enabled more people to make more extensive and intensive personality and behavioral changes than all professional therapists combined.”8
Counselor B has always been open-minded and willing to accept any widely accepted religious belief as an important aspect of mental health. But some of the recent critiques of postmodernism have Counselor B wondering: If we accept any belief as valid, then do any beliefs have merit? If all truth is constructed by one’s own values and beliefs, then can’t truth also be deconstructed, so that nothing is ultimately true?9
Counselor C is a biblical counselor who rejects all secular theories of counseling in favor of using Scripture as the source of all knowledge. But every now and then Counselor C reads about the integration movement in psychology and theology and privately wonders if some psychological techniques may help resolve some emotional problems. What about the finding that panic attacks can be effectively treated with twelve sessions of breathing training and cognitive therapy?10 Or what about the list of empirically validated treatment procedures being developed by the Clinical Psychology Division of the American Psychological Association (APA)? Each procedure on the list has been verified effective by at least two double-blind controlled-outcome studies.11 Can biblical counselors continue to say that psychotherapy and counseling don’t work when there is so much evidence to the contrary?
It is good we have a group of religious counseling specialists—those who have spent many hours preparing to transcend the confusion faced by clients and most counselors. These specialists integrate Christian theology and psychological techniques and help their clients with both spiritual and emotional growth. They cling to the truth of Christ as revealed in Scripture and deliberately allow their beliefs to saturate their counseling methods. They respect and honor people’s Christian values while helping them understand and change their emotional pain. They help people like Jill. Surely they never feel confused when people like Jill come for help. Right?
Wrong. Even those involved in the Christian counseling movement often face feelings of confusion in the counseling office. The counseling office is where the integration of Christian beliefs and counseling techniques becomes most practical, and it is often where we feel most bombarded with unanswered questions. When should we pray with clients? Is forgiveness reasonable for a survivor of sexual abuse? Should we confront sin or wait for our clients to recognize it on their own? Is reconciliation always a reasonable goal? Are there times when divorce is acceptable? Do I have any evidence that this religiously oriented counseling approach is effective? Are the spiritual disciplines a necessary part of emotional healing? Is one theoretical approach to counseling more compatible with Christianity than another? Can Scripture memory contribute to denial and unhealthy defenses? Are positive self-talk and self-esteem contrary to Scripture?
What seems clear in the latest scientific journal or latest professional book somehow seems fuzzy in the counseling office. Even biblical principles, which we hold to be true and authoritative, sometimes seem difficult to apply as we work with our clients.
This is a book about counseling process and techniques. Although I will review a number of surveys, scientific studies, Scripture passages, and theoretical models, my primary purpose is to focus on the problems we face in the counseling office. I don’t have all the answers, and I cannot promise that those who read this book will never again feel confused and uncertain about religious issues in the counseling office. But perhaps this book will help Christian counselors and researchers unite around certain key questions and perspectives so that our interventions become increasingly relevant and effective.
The Frontier of Integration
When Jill finally finds a Christian counselor, she schedules an appointment, rehearses what she will say, and shows up ten minutes early for her first appointment. Her counselor, Dr. N. T. Gration, ushers Jill into the office and listens to her story. Jill begins by describing how distant she feels from everyone, including God. Now in her early thirties, Jill does not feel satisfied in her career as an accountant. None of her dating relationships has turned into a stable, long-term commitment. She has stopped communicating with her parents because a former counselor told her to. Jill’s parents, she says with an emotionless face, never took the time to figure out that her older brother sexually abused her for five childhood years. Jill’s intellect tells her that God loves her, but her emotions scream out that she is abandoned, drifting all alone in a cruel world.
Fortunately, Dr. Gration is an expert in integrating Christianity and psychology. She graduated from a psychology doctoral program at a Christian institution; she has read hundreds of books and articles about integration; and she has even written a few articles herself. Jill made a good choice in deciding to see Dr. Gration.
But Dr. Gration isn’t always sure how the articles and books she has read help her with the struggles her clients face. Is it wise for Jill to isolate herself from her parents? Is it reasonable for Jill to forgive her parents, or even her brother? What counseling approaches might help Jill feel closer to God? Dr. Gration can go to the local university library or to her old course notes from graduate school, but she probably won’t find answers to these questions.
Dr. Gration’s dilemma illustrates the slow evolution of the integration movement in psychology and Christianity—an evolution outlined by Everett Worthington, Jr., in a 1994 article in Journal of Psychology and Theology.12 Worthington describes three stages of interdisciplinary integration—blending psychology and theology into a framework for Christian counseling. In the first stage, before 1975, a variety of articles introduced rudimentary concepts that were mostly unrelated to one another. In the second stage, between 1975 and 1982, integration models flourished. Integration journals were filled with schematic drawings of how Christianity and psychology can be related. Following this period of model madness, since 1982 the integration movement has become increasingly relevant and practical. We have considered how our theories of counseling can and should be enhanced or modified by Christian values, and we have started reporting empirical studies that help build a scientific base for our claims.
Thus, it appears we are making good progress in what Worthington calls interdisciplinary integration. But what about Dr. Gration’s questions about Jill? These pertain more to intradisciplinary integration—that which occurs within the disciplines of counseling and psychotherapy. In other words, how do I implement religious values and beliefs into my treatment of this client? In this regard, the journals and professional books are less helpful. In 1983 Gary Collins wrote this about the Journal of Psychology and Theology:
The Journal of Psychology and Theology does publish practical articles and the “publications policy” clearly indicates that applied papers are welcome. Nevertheless the major emphasis in the Journal appears to be theoretical. I suspect that relatively few pastors or full-time professional care givers find the articles to be of practical help in their counseling work. It would be helpful to see more of an applied perspective in this publication. . . We must give more attention to the previously mentioned issue of integration methodology. How do we do integration? What skills and methods are involved?13
Worthington concludes, and I agree, that Collins’s call for practical integration methods has not produced much change: “Practice-focused, training-oriented articles have been scarce to non-existent.”14
But things may be starting to change. The International Congresses on Christian Counseling in 1988 and 1992 have brought together Christian counselors from around the world to discuss counseling techniques and methods. The American Association of Christian Counselors (AACC) publishes Christian Counseling Today, a popular periodical with many practical counseling suggestions. Integrative counseling methods may be the next frontier for Christian counselors and researchers to explore. This is a book for those wanting to investigate the frontier of intradisciplinary integration.
Life on the Frontier
A number of personal and professional challenges face Christian counselors as we confront this new frontier of intradisciplinary integration.
Challenge 1: Moving from Two Areas of Competence to Three
Dr. Gration has a master’s degree in theology and a doctorate in psychology. She is well prepared for interdisciplinary integration. But she feels unprepared for many of the practical questions Jill brings to the counseling office. What more does she need?
For Christian counselors doing interdisciplinary integration, two areas of competence are necessary and sufficient: psychology and theology. When psychologists without theological training attempt to do integration, they often minimize the importance of doctrine, psychologize Christian beliefs, and overlook the historical and sociological context of today’s psychology. Orthodox Christian theology keeps counselors grounded in the midst of a profession easily swayed by new theories, fads, and sensationalistic claims. When theologians without psychological training attempt to do integration, they often misrepresent the nuances of psychological science and misunderstand the complexities of clinical applications. So the best interdisciplinary integration work usually comes from those who have formal or informal preparation in both psychology and theology. Even the titles of our integration journals demonstrate these two essential ingredients: the Journal of Psychology and Theology and the Journal of Psychology and Christianity.
Intradisciplinary integration introduces a need for a third area of competence. If we are to bring religious issues out of the scholarly journals and into the Christian counseling office, we must understand spirituality and the process of spiritual formation. The importance of spirituality in emotional healing has been known for centuries in the Catholic Church and is particularly evident in monastic life and spiritual direction. But contemporary Protestant counselors have often overlooked spiritual disciplines. Those attending seminaries for counseling degrees receive training in psychological theory and techniques and in theological theory and techniques. What are the techniques of spiritual formation? How does one learn spiritual passion and devotion? These questions are often overlooked, even in the best training programs, leaving counselors with only two of the three essential components of training. Just as a tripod with one leg missing is of little value, a Christian counselor who lacks understanding of spirituality will be handicapped in bringing religious issues into the counseling office.
What If This Happened?
Your client, Jim, places his head between his palms, sighs deeply, and begins describing the spiritual darkness he feels. A Christian for many years, Jim has viewed his spiritual life as a pilgrimage. Many times he has felt overwhelmed with God’s gracious presence and kindness. At other times he has felt distant from God. He understands what Saint John of the Cross called the “dark night of the soul.” But this time, the night seems darker and deeper than ever before. He feels alone, sad, confused, and empty. He comes to you, a Christian counselor, for help.
This is a multiple-choice question. Which would you do?
1. Diagnose Jim with depression, arrange for antidepressant medication to be prescribed, and begin a regimen of cognitive therapy for depression.
2. Encourage Jim by reminding him that his feelings do not determine his faith. Even though God seems far away, nothing can separate Jim from God’s love revealed in Christ (e.g., Rom. 8:35-39).
3. Explore Jim’s inner spiritual longings, and allow him to grieve about his feelings of distance from God.
4. Consider all of the above possibilities.
The first option reflects the approach that might be taken by many psychologists who have no religious training or experience. The second choice might be added by counselors with theological understanding. The third requires an understanding of spiritual formation. Those who yearn for God and take the spiritual life most seriously always experience periods of spiritual darkness and loneliness; it is part of the spiritual quest for Christians. Only those counselors aware of psychological symptoms, theological principles, and spiritual formation will be able to discern the best treatment for Jim.
Unlike competence in psychology and theology, understanding spirituality does not lend itself to credentials. In The Spirit of the Disciplines, Dallas Willard writes that a spiritual life “consists in that range of activities in which people cooperatively interact with God—and with the spiritual order deriving from God’s personality and action.”15 Spiritual training is experiential and often private. It is rarely found in the classroom or represented by graduate degrees, but it is found in private hours of prayer and devotional reflection, in church sanctuaries where Christian communities worship, in quiet disciplines of fasting and solitude.
There is another reason that spiritual competence cannot be represented as a credential on a curriculum vitae: those with the richest spiritual life recognize that spiritual competence is, in one sense, an oxymoron. We can become more or less competent in the spiritual disciplines, training ourselves to experience God more fully, but we can never be spiritually competent. Christian doctrine teaches that we are spiritually incompetent, in need of a Redeemer. The spiritual life directs us away from illusions of competence and causes us to confront our utter helplessness and dependence on our gracious God. When we recognize our weakness, then Christ’s strength can work through us (2 Cor. 12:10).
Balancing Christian theology, psychology, and spiritual formation is important in a time when so many conflicting and confusing messages bombard us. If we drift away from Christian theology, we find ourselves in the strange world of spiritualism.16 Many writers speak of a spiritual quest that is born out of insatiable human curiosity about the world. The quest at times seems quite narcissistic, its goal and focus involve personal well-being, and some writers applaud those who have sacrificed families and other relational responsibilities in their search for meaning. Christian spirituality does not begin merely in our quest for understanding. It begins in our understanding that something is deeply wrong with us—a realization that can lead to a renewed dedication to the values of the gospel.
If the spiritual life of the Christian counselor is important for intradisciplinary integration, then the distinction between professional life and personal life becomes difficult to define because the Christian counselor’s piety and personal practices affect the counseling process and outcome.
Challenge 2: Blurred Personal-Professional Distinctions
Though most professional-ethics codes make a distinction between the personal and professional life of the counselor, this distinction is blurred for the spiritually sensitive Christian counselor. If a Christian counselor gets up early in the morning and prays for a client, is this an illustration of the counselor’s personal life or professional life? If counselors train themselves, through practicing spiritual disciplines, to remain kind and calm in the presence of angry, provocative circumstances, is it personal or professional when they apply those skills with difficult clients? The professionalization of counseling has led to the myth that all that is relevant are those things that clients observe, such as a counselor’s demeanor, affective response, and display of empathy. I disagree: the kind of therapeutic relationships that foster healing are not formed merely from well-chosen techniques but grow out of the person’s inner life.17 In this sense, counseling is both professional and personal.
To justify a clearly defined division between a counselor’s personal and professional life, we must view the counselor as a dispenser of healing technology—one who treats specific symptoms with specific techniques that make a person feel better. To some extent this is true—certain counseling techniques work better than others with certain disorders. But ideally a Christian counselor is also a healing agent—one whose spiritual life spills over in interactions with everyone, including clients.
It is now clear that counseling is effective.18 It is also clear that the effects of counseling cannot be solely attributed to the techniques used by the counselor. A number of other ingredients, called “nonspecific factors,” affect the outcome of counseling.19 The most important of these nonspecific factors appears to be the counseling relationship. In a 1993 review of the counseling literature, psychologists Susan Whiston and Thomas Sexton reported that a strong therapeutic relationship is one of the best indicators of success in psychotherapy.20 Most people seeking counseling are not looking for a specific set of techniques but for a relationship with someone who has values they respect.21 They seek this relationship because they are wounded, driven to sorrow by the natural consequences of living in a fallen world. In the midst of a Christian counseling relationship they often move from brokenness and sorrow to hope and restoration.
Is this therapeutic bond personal or professional? It is both. A counseling relationship is professional in many ways: it occurs at a specified time and place; a fee is often charged; the client discloses much more than the counselor; and the relationship is terminated at a specified time. A Christian counseling relationship is also personal: both counselor and client invest energy and emotion in the relationship; both use words that emerge from their personal histories and ways of understanding the world; both pray outside of the counseling sessions that the relationship might help the client; and both are brothers or sisters in Christ.
This blending of personal and professional can be seen in the increasing interest in values and psychotherapy.22 The myth of value-neutral counseling has been shattered, and now researchers and clinicians are trying to understand the place of values in counseling. Two psychologists started a recent journal article with, “It is now an accepted fact that psychotherapy is a value-laden enterprise. . . [Values] are inextricably woven into the counseling process.”23 If this is true, then how can counseling ever be reduced to a set of professional behaviors? Professional behaviors are important, but a value-laden process must also rely on personal qualities and perspectives.
Thus, the Christian counselors best prepared to help people are those who are not only highly trained in counseling theory and techniques and in theology but also personally trained to reflect Christian character inside and outside of the counseling office. This character cannot be credentialed with graduate degrees or learned in the classroom; it comes from years of faithful training in the spiritual disciplines—prayer, studying Scripture, solitude, fasting, corporate worship, and so on.24 On this new frontier of intradisciplinary integration, the personal life of the counselor is an essential ingredient for productive professional work.
Challenge 3: Expanded Definitions of Training
If intradisciplinary integration requires an awareness of spirituality in addition to theology and psychology, how are we doing at preparing ourselves for intradisciplinary integration? To answer this, we must consider both professional and personal training.
Moon, Bailey, Kwasny, and Willis surveyed eighty-seven religiously oriented graduate training programs to determine the coverage of Christian disciplines in their training programs.25 Unfortunately, only twenty program directors provided usable data, despite two mailings from the authors. Although many of the disciplines—including various forms of meditation and prayer, confession, worship, forgiveness, fasting, and simplicity—were seen as having scriptural support and therapeutic utility, they were not emphasized in the graduate curricula. The authors conclude, “The results of this study generally support the hypothesis that instruction in the Christian disciplines is a rarity.”26 Despite the low rate of training in Christian disciplines, the authors go on to note the increasing receptivity to religion and religious issues among mental health professionals. They conclude, “Christian counseling can legitimately make more use of explicitly Christian techniques that arise from within the Christian tradition.”27 Thus, it appears that professional training in spiritual-guidance techniques is lacking, even in religiously oriented training programs.
If the distinction between personal and professional life blurs for the spiritually sensitive Christian counselor, then it is important not to leave this discussion of training at the professional level. Adams surveyed 450 members of the Christian Association for Psychological Studies (CAPS), received 340 completed surveys, and found that the best predictors of using spiritual-guidance techniques in professional work were personal factors.28 Two of the three strongest predictors were the spiritual well-being of the counselor and the practice of personal devotions. The personal life of counselors appears to be revealed in their professional work.
Just as professional training is essential for competent counselors, personal training is important for those who see the spiritual life as an essential component of effective Christian counseling. As Dallas Willard suggests in The Spirit of the Disciplines, whether playing a piano or performing surgery, it is disciplined preparation and not just an exertion of willpower at the moment of performance that produces masterful results. A counselor cannot simply walk into the office and “put on” an effective counseling demeanor, even if the counselor uses prayer, Scripture, and other religious interventions during the session. The substance of spiritually sensitive counseling goes deeper than technique; the care, disciplined objectivity, trustworthiness, empathy, wisdom, and insight must come from within.
The spiritual disciplines provide a way for deep internal change that mere willpower can never bring about. The disciplines are God’s provision for enabling us to become what we could never become through human effort. Christian therapists who are sensitive to the spiritual life recognize the importance of personal training in developing habits of holiness. They are, as Eugene Peterson (borrowing from Nietzsche) tells us, the product of a “long obedience in the same direction.”29
This does not mean that the spiritual disciplines themselves are spiritual. When we assume that having a personal devotional time defines our spirituality, we miss the point of the disciplines and risk an externalized faith that is disturbingly similar to the outward form of righteousness displayed by the hypocritical religious leaders who plotted to kill Jesus. The disciplines are not spiritual, but they provide opportunities to experience God. They are vehicles of spirituality that bring us face-to-face with God’s grace. God transforms us as we invite change through using the spiritual disciplines.
Challenge 4: Confronting Dominant Views of Mental Health
Conversations about Christian counseling methods often focus on techniques and specific interventions. Many practical techniques will be considered throughout this book. However, spiritually sensitive counseling is not merely a matter of implementing a set of techniques in the counseling office.
Beneath every technique is a counseling theory, and beneath every theory is a worldview. Because we are sometimes too eager to import psychological techniques into Christian counseling, we overlook the troubling theoretical and worldview implications of the techniques we use. As Christian counselors face this new frontier of intradisciplinary integration, we must deliberately look at the worldview assumptions that underlie our theories and techniques.30
Most contemporary forms of Christian counseling are religious adaptations of mainstream counseling techniques. For example, many Christian writers and therapists have adapted techniques from Albert Ellis’s Rational-Emotive Therapy (RET) to Christian counseling.31 Though Ellis is an outspoken atheist, many Christians have accepted his techniques as legitimate. One has even described RET as “perhaps the most compatible with biblical teaching of all current major psychotherapeutic systems.”32 But can we really accept RET without critically evaluating the underlying hedonistic, relativistic worldview?33 We can bend Christian assumptions to conform to existing techniques, but at some point our belief system snaps, and we are left with only theistic scraps saturated by atheistic definitions of mental health. Intradisciplinary integration—bringing the Christian faith into the counseling office—requires us to evaluate carefully the goals of therapy and to challenge the views of healing that surround us in the mental health professions.
What If This Happened?
Chris is a bright, motivated Christian, intent on serving Christ and others. After college Chris applies to graduate school in clinical psychology and is readily admitted to a top program. He arrives on campus, meets his new adviser, pays his tuition, and begins attending classes. Chris is immediately overwhelmed with the quantity of work required: he learns psychometrics, test administration, counseling theory, counseling techniques, basic science areas in psychology, professional ethics, and so on. Because he is busily involved in research and studying, he doesn’t stop to ask questions about the goals of professional interventions.
Five years later, doctoral degree in hand, Chris is ready to begin his work as a Christian psychologist. He is armed with an arsenal of therapeutic concepts and techniques: systematic desensitization, progressive relaxation, cognitive restructuring, analysis of resistance, projective identification, unconditional positive regard, daily record of automatic thoughts, and many more. Here’s the irony: Chris has never been taught and never stopped to question why he is using these techniques. What is the goal of therapy? How do we define healing?
One example of the worldview challenges facing Christian counselors is seen in the widespread assumption that mental health requires us to feel good about who we are. In 1967, when Dr. Thomas Harris set out to convince a culture that “I’m OK—you’re OK,” he probably didn’t realize the impact his words would have.34 Now, by the time people are willing to seek help from a counselor, pastor, or friend, most have already formulated the problem. It goes something like this: “I have problems because people have hurt me, and I have spent my life trying to please them. Well, I’m tired of being hurt by others. Now I realize that I am okay, and it’s time to take care of myself. So please help me learn how.”
In other words, “Help me look out for myself and feel good about who I am so that I can be happy.” We’re bombarded with similar messages every day:
“You have to look out for yourself; no one else will.”
“Go ahead, you deserve it.”
“No one else can tell you what’s right and wrong for you.”
“You’re a good person. You need to believe in yourself.”
“Assert your rights.”
“Speak your mind.”
Counselors often accept these definitions of mental health uncritically and shape their clinical work accordingly.
These contemporary messages of mental health are not all wrong. People really are hurt by others, and the scars that remain can be devastating. Some emotional problems are almost purely the result of past wounds, prior conditioning, and faulty self-image, and they can be effectively treated with counseling techniques. Although the contemporary messages of mental health are not all wrong, they are not all right either. They tell us we are not sick but are victims of our genetics, life circumstances, and neurochemicals. After all, we’re okay. So contemporary pop psychologists instruct their readers to look out for their own needs, give up silly ideas of altruism or forgiveness, and get out of relationships that are not fulfilling. Their message is clear: happiness comes by avoiding discomfort, sacrifice, and pain. Psychologist Albert Ellis wrote, “The emotionally healthy individual should primarily be true to himself and not masochistically sacrifice himself for others.”35 This type of hedonistic, individualistic ethic is not compatible with Christian spirituality. In Scripture we are instructed to look out for the interests of others (Phil. 2:4) and to prefer one another in honor (Rom. 12:10). Those who see hedonism and shallow independence as the goal of counseling deny the spiritual life and the role of brokenness in healing.
Christian doctrine teaches us to view ourselves as participants in sin rather than as innocent victims, that sickness is a part of our nature, and that recognizing our spiritual condition is a prerequisite to healing. Every Christian must be a broken person. To enter the kingdom, we must acknowledge that the inner peace we yearn for can never come by our own efforts but only by admitting we are powerless to conquer our self-centeredness and by turning over the rule of our life to Christ. Our sinful hearts show themselves through what we do and what we fail to do. We end up broken not only because we are victims but also because we have hearts of rebellion and stubborn independence.
The Christian gospel gives hope for broken people, but only after they recognize their brokenness. Brokenness was the experience of the Bible heroes: Abraham, Moses, David, Elijah, Paul. Our society may tell us to avoid brokenness by looking out for ourselves, but the heroes of our faith, who really knew what it was to live, were all people who had been broken.
From a Christian worldview, a client might describe a problem more like this: “I have problems. It’s tempting to believe I have spent my life trying to please others, but I suppose I have done that to cover my faults, to hide the parts of me that I don’t like. I say I’ve been pleasing others, but really I’ve been trying to please myself. I’m left with a sense of despair. I feel that there is something terribly wrong with me (and everyone else, too). And I can’t fix it on my own.”
In our sickness and pain, we grope for answers, for better understanding, for meaningful relationships. Our sickness leads us to God. God can restore and use broken vessels for divine purposes. David wrote:
I waited patiently for the Lord;
he inclined to me and heard my cry.
He drew me up from the desolate pit,
out of the miry bog,
and set my feet upon a rock,
making my steps secure.
He put a new song in my mouth,
a song of praise to our God.
Many will see and fear,
and put their trust in the Lord.
Psalm 40:1-3
The good news of Christianity is that God brings us out of our brokenness and draws us into relationship. The Christian message is one of hope. We have been restored to God through the work of Christ.
So what does the Christian counselor do when sitting with sobbing clients who feel a deep sense of inadequacy and neediness? Is the best treatment to convince these clients that they are wrong, that they are actually wonderful people who have misinterpreted the world? Or is it more reasonable to reflect on the role of brokenness in healing and to recognize that inadequacy and neediness are prerequisites to restoration and hope? Counseling, when practiced by those who respect brokenness as part of healing, is a reflection of redemption. Those who enter therapy in the midst of their pain experience a restorative counseling relationship that brings acceptance, hope, and meaning into their broken lives. In this sense, counseling mimics the gospel—people are broken, and broken people are restored in the context of a healing relationship.
Challenge 5: Establishing a Scientific Base
Of course, one can err in either direction. We can become so intent on avoiding a “secular” worldview that we end up rejecting all that psychology and counseling theory have to offer. Sometimes our zeal for Christian counseling starts to look like excessive confidence, or even pride. Sometimes we act as if our methods have been scientifically validated or as if they do not need to be scientifically validated because we have found a more direct route to truth. These are dangerous views that sometimes alienate us from our colleagues in various mental health fields.
Thus, we also face scientific challenges. Christian counselors who wish to be accurately understood among mental health professionals must use the language of science that is common among these professions. This poses a challenge for Christian counselors, especially those in academic and research settings, to demonstrate scientifically the unique interventions Christian counselors use in the counseling office and their effectiveness.
With regard to the first question—What do Christian counselors do in the counseling office?—it is important to remember that Christian counselors are a diverse group with varying backgrounds and perspectives on the use of Christian disciplines in counseling. Worthington, Dupont, Berry, and Duncan evaluated ninety-two counseling sessions led by seven Christian counselors.36 Religious homework, quoting from Scripture, discussing the Christian faith, and prayer were frequently used techniques, but all techniques were used in fewer than half of the sessions, and Christian counselors varied considerably in their use of spiritual-guidance techniques. As expected, counselors were more likely to use religious techniques with highly religious clients than with marginally religious clients, but the number of religious guidance techniques used was not a good predictor of counseling outcome, even with religious clients. The authors conclude: “For the Christian psychotherapist, it is not the mere number of spiritual-guidance techniques used that is important in influencing clients’ perceptions of effective therapy. Rather, the choice of which techniques to use at what time is more important.”37
Ball and Goodyear found that prayer is the most commonly used spiritual intervention among CAPS members, accounting for approximately one-fourth of the spiritual interventions reported.38 Referring to Scripture and teaching religious concepts were frequently reported on a paper-and-pencil questionnaire but infrequently reported when some of the same respondents were interviewed and asked to describe five critical incidents in treating Christian clients. Conversely, techniques that had no religious foundation were infrequently reported on the pencil-and-paper questionnaire but frequently reported during interviews. Thus, it seems likely that what Christian counselors want to do in counseling sometimes varies from what they actually do.
What can we conclude from these studies? The most obvious conclusion is that research evidence regarding spiritual-guidance techniques in counseling is sparse and needs to be a high priority for the Christian counseling movement. Many Christian counselors are using spiritual techniques in therapy, including prayer, religiously oriented homework, Scripture, and faith-related discussions, but perhaps not as often as they would like.
How effective are religiously oriented therapies in counseling? Five outcome studies that attempt to answer this question are reviewed by psychologist W. Brad Johnson.39 It is striking that three of the five studies demonstrated significant methodological inadequacies. It is even more striking that among the many hundreds of psychotherapy outcome studies, only five studies have investigated religiously oriented therapies. Three of the studies indicated no difference in effectiveness between religious and nonreligious forms of therapy for depression.40 The two remaining studies demonstrated an advantage for religiously oriented therapies with religious depressed clients.41 However, in the most comprehensive study reported to date, Rebecca Propst and her colleagues found that a religious form of cognitive therapy was most effective if delivered by a nonreligious therapist.42 This is an intriguing finding that will require more research to be understood.
It is important to recognize that all reported outcome studies of religiously oriented interventions compare religious and nonreligious versions of well-established cognitive interventions for depression. We can only speculate on the effectiveness of Christian counseling interventions that are built on different worldview and theoretical assumptions. Much more research is needed as Christian counselors continue to articulate intradisciplinary integration.
Challenge 6: Defining Relevant Ethical Standards
This new frontier of intradisciplinary integration introduces new ethical challenges as well. Only those treatments that have been effective in two independent double-blind studies with adequate control groups are included on the APA’s list of empirically validated psychological procedures. In the near future, insurance companies may require counseling to be conducted according to an approved treatment protocol. Because no religiously oriented interventions have been evaluated in two independent double-blind studies, none are on the list. This is both a scientific challenge, as described previously, and an ethical challenge. Will Christian counselors continue to thrive if their techniques are not endorsed by third-party payers? What ethical principles must be followed in such a dilemma?
What If This Happened?
As you begin your first session with a distressed couple, Will and Patty, Will looks you in the eye and says, “We’re doing some research on the best counseling approach. We figure this will take some time and cost some money, and we want to be sure to get the best help available.”
Patty quickly adds, “We’re wondering what you mean when you say you’re a Christian counselor. How does Christian counseling differ from other counseling? And how confident can we be that our relationship will get better?”
At the heart of Will and Patty’s questions is the ethical principle of informed consent. When people come to a counselor for help, they should be given thorough and accurate information about the proposed counseling procedures, should be informed of alternative treatment approaches, and should sign a written consent form.43 With each client, we must ask ourselves several questions. Was this person freely given a choice to participate based on a full understanding of the counseling procedures and the alternatives available? Does he or she know the nature of the counseling services and the likelihood of success? Giving a standard answer to these questions is impossible because Christian counselors are a diverse group, offering many different approaches to counseling. It’s not just that we use different techniques or styles; we don’t agree on what Christian counseling is.
When Worthington reviewed the research on religious counseling, he found three types of assumptions.44 First, some people assume religious counseling is any type of counseling delivered by a religious person. This assumes that the counselor’s availability as an agent of God’s grace will have a healing effect on a client, even if no religiously oriented techniques are used. From this perspective, a discussion of Christian counseling techniques misses the point because the relational aspects of counseling are valued above techniques. This view is partly right; a great deal of evidence suggests that the relational aspects of therapy are essential for good outcome.45 However, it is not clear what is Christian about this counseling, and Propst and her colleagues found no advantage for religious therapists using nonreligious therapy in treating depressed clients.46
The informed-consent procedure for Christian counselors in this group is not particularly difficult because their counseling services do not differ significantly from non-Christian counseling. These counselors can develop informed-consent forms that look like the industry standard. There is one problem though: the relational therapies are not well represented on the APA’s list of empirically validated procedures. Thus, when describing alternative treatments, the form should include a description of treatment approaches that are quicker, less expensive, and effective.
Second, some people believe that religious counseling is applying counseling techniques within formal religious practice. Biblical counselors and Christian counselors who use spiritual-guidance techniques as their primary means of intervention are operating from this view of counseling. Although these counselors are often criticized as being “too religious,” it is interesting to note that those receiving pastoral counseling in the Propst et al. study showed as much progress as those in the religious cognitive-therapy condition, and they maintained their gains during the two-year follow-up period.47
Often Christian counselors in this category are practicing not within the mainstream mental health community but as extensions of church and parachurch ministries. Usually they are not seeking insurance reimbursement for their services and often do not consider informed consent an important part of their work. Nonetheless, informed consent is becoming an important obligation for all counselors because those seeking our services are often unaware of the options available. Informed-consent procedures will play a prominent part in the AACC code of ethics currently being developed.
Third, some see religious counseling as “supercharged” secular counseling, adding religious elements to well-established counseling models. Propst et al. found that standard cognitive therapy enhanced with religious imagery and religious arguments to counter irrational thoughts was superior to standard cognitive therapy in relieving depression.48 However, this view perpetuates the problem mentioned earlier, that a Christianized form of therapy can be built on flawed, misleading, and damaging worldview assumptions.
Counselors working from this perspective are sometimes inclined to use standard informed-consent forms and then “throw in” the religious interventions as an extra part of treatment. This is probably not wise, because Propst reported two separate studies that suggest religious elements change the effectiveness of treatment.49 Thus, Christian counselors from this third perspective should attempt to describe both their therapeutic model and their religious adaptations of the model.
For many Christian counselors, none of these three approaches to counseling seems satisfying. Perhaps we need a fourth option—an empirically validated Christian counseling model of personality, mental health, and therapy. Many questions would need to be answered: What is human personality? What motivates humans? What goes wrong to create mental health problems? What should the competent counselor do in the counseling office to restore clients to mental and spiritual health? Developing this fourth option will require philosophers, theologians, researchers, and clinicians to collaborate in building a scientifically respected and theologically sound model for Christian counseling; this task probably will require several decades of work. If we build our counseling models prematurely, they will not be taken seriously—even by those within the Christian counseling movement.
This discussion of ethical challenges has been limited to informed consent, but many more ethical tensions arise when considering intradisciplinary integration. These will be explored throughout the remaining chapters.
Summary
Intradisciplinary integration is a recently emerging frontier for Christian counselors. The question is not how we understand the relationship between psychology and theology but how we practically use the Christian faith in our counseling. Change brings challenge, and Christian counselors face several significant challenges as they bring religion into their counseling offices. Religious interventions require us to understand spiritual formation, place priority on personal spiritual training as well as professional development, challenge prevailing models of mental health, work toward a stronger scientific base, and sensitively recognize ethical issues.
Upon Reflection
I’ve wondered what it would be like to write a book with a stunning opening sentence—the kind that reverberates in people’s minds for decades. Richard Foster’s Celebration of Discipline is a great example with its poignant first line: “Superficiality is the curse of our age.”50 I’m afraid my opening sentence of chapter 1 is doomed to fall short. Jill’s Yellow Pages don’t seem particularly relevant these days. Who even uses Yellow Pages anymore? Nowadays Jill will google counselors, because the name Google has become a verb, or she will facebook them, because Facebook is fast becoming a verb.
First sentences aside, the point of this chapter is to set the agenda for the book—to pronounce intradisciplinary integration as my primary topic. The theoretical underpinnings of integration are important, but the point of this book is to consider what actually happens in the counseling office.
Looking back from my present-day vantage point, I am pleased that many Christian researchers and writers have focused on the practical dimensions of integration. The American Association of Christian Counselors continues to sponsor books with practical utility, and the Christian Association for Psychological Studies has recently started a series with InterVarsity Press, including various books that address practical dimensions of integration. Contemporary journals and magazines have also offered many practical suggestions for how integration is done in the counseling office.
Honestly, the success of this movement toward practical integration scares me a bit. I’ll explain more about this feeling of trepidation, but before I do that, I want to offer what I should have given fifteen years ago: a careful definition of intradisciplinary integration.
How Do We Integrate?
I asked Jennifer Bearse, a current doctoral student in clinical psychology, to reflect a bit on her quest to understand integration. Her words, which I think would be echoed by many counseling and psychology students, demonstrate this quest for a practical understanding of integration.
As a Christian, I believe I have access to a source of healing power that goes far beyond what I can even imagine to help me work with my clients in their pursuit of healing and growth. But learning how to appropriately bring that power into my work as a therapist has been a challenging journey with many twists, turns, and detours, long on ambiguity and short on competence. How do I, a therapist with a Christian worldview, engage this power in a way that is full of grace and respect for my clients, some of whom may operate from entirely different worldviews?
To integrate is to incorporate parts into a whole. I believe this is a good description of the work we do with our clients—we help them pull together into a healthy whole the pieces of themselves and their lives that have become splintered for any number of reasons. From my perspective this would certainly include the use of spiritual techniques and interventions, but my clients may not always agree with this approach. How do I work to the best of my ability with clients who do not accept the legitimacy of Christ’s healing power? How do I use my faith in a way that will bring the greatest benefit to my clients without ignorantly and carelessly imposing my belief system onto them? Is it possible that the greatest work occurs when I simply live my life, both inside the counseling office and out, in a way that reflects the love and grace of Christ to those around me? Is this where integration truly begins? Answers to these questions are imperative to my development into the effective and grace-filled therapist I aspire to become.
Jennifer’s questions are important. Notice how she is thinking of the practical matters of what happens in a counseling office. Questions like these are why I wrote this book in the first place, and why I am updating it now. I don’t have all the answers, but I think you’ll find helpful information in these pages.
Defining Intradisciplinary Integration
Twenty years ago, Steven Bouma-Prediger, then a doctoral student at University of Chicago, wrote an article in the Journal of Psychology and Theology in which he outlined four approaches to the integration of psychology and theology.51 The article was an important one in the field, but somehow I missed noticing it until the late 1990s. When I finally found the article, it helped me distill ideas that had been bouncing around in my head when I first wrote this book. As an aside, Dr. Bouma-Prediger is now a theologian teaching at Hope College in Holland, Michigan. He has gone on to write important works on a Christian understanding of creation care and the environment. He is a fine scholar, always worth reading.
In his 1990 article, Bouma-Prediger describes interdisciplinary, intradisciplinary, faith-praxis, and experiential integration. Interdisciplinary integration brings together two or more different disciplines—psychology and theology, for example—and attempts to find connections between the two fields. The work is mostly theoretical. Intradisciplinary integration occurs within a discipline. This is the primary focus of Psychology, Theology, and Spirituality in Christian Counseling. My goal is to provide a practical resource within the fields of counseling and psychology that is theologically and spiritually responsible. Faith-praxis integration is primarily ethical. Faith should affect the way we live, including the types of clients we see, the fees we charge, the ways we relate to friends and family members, and so on. Experiential integration has to do with our personal relationship with God, including how we experience God’s presence and healing in our daily lives.
Bouma-Prediger’s taxonomy provides a helpful vocabulary for what I was trying to write in the early 1990s. This book is about intradisciplinary integration, providing useful ideas about how we do Christian counseling in a way that is faithful to psychology, theology, and spirituality. Throughout the book you will find hypothetical dialogues between counselor and client. I have offered these because I want this book to be practical and helpful. I think this has contributed to the book’s success. Counselors—and students training to be counselors—are looking for specific examples of how to do this work well.
Here, then, is a definition of intradisciplinary integration that I ought to have given fifteen years ago: Intradisciplinary integration in Christian counseling is both conceptual and relational. Conceptually, it draws upon important ideas from theology, psychology, and counseling theory and offers practical suggestions for how these concepts are applied within the discipline of Christian counseling. And practically, intradisciplinary integration in Christian counseling is thoroughly relational—emerging out of a counselor’s relationships with God and others, and ultimately influencing clients’ relationships.
Notice that this definition draws upon all of Bouma-Prediger’s categories. In essence, it is meta-integration—integrating four views of integration. Bouma-Prediger’s categories were never intended to be categories in isolation, but rather interconnected ways of seeing the complex relationships between psychology, theology, and spirituality.
My Trepidation
I mentioned earlier that today’s movement toward applied integration is both gratifying and a bit scary for me. It is gratifying because as counselors we need specific tools, and now we have them. We have models for how to help clients forgive one another, flowcharts for when and how to pray with clients, ways of using silence to help promote awareness of sin and inner conflict, cognitive restructuring tools to help people think differently about spiritual and religious forms of anxiety, and so on. Many of these tools are addressed in this book, and I am pleased the ideas written in these pages have been helpful over the years.
So why am I fearful about the practical direction integration has taken? Because intradisciplinary integration was never intended to be isolated from interdisciplinary, faith-praxis, and experiential integration. Properly conceived, intradisciplinary integration flows out of a deep appreciation for theology and a profound personal transformation caused by a life in Christ. If we turn Christian counseling into a toolbox—a set of strategies for change—then we risk cheapening the integration endeavor. If intradisciplinary integration consists of merely a set of skills, then one need not even be a Christian to offer Christian counseling.
Counselors and students of counseling are now more inclined to ask about practical, intradisciplinary integration than about theoretical models or theological perspectives on integration. I’m likely to hear a question such as “When is it ethical to pray with a client?” or “Would it be appropriate to suggest a lonely client find a local church?” The theoretical questions of decades past—about various models of integration or the psychological implications of Pelagianism, or how various views of atonement influence counseling methods—have largely disappeared from our discourse in Christian counseling. There is something unsettling about this movement that feels almost like a backlash or an overreaction to the excessive model building of earlier decades. Sometimes it seems we are asking the practical, applied questions too quickly, and answering them quickly also, often without considering the deep substantive issues underlying the questions.
Over the years I have noticed a sharp decline in the biblical and theological proficiency of new psychology graduate students in Christian doctoral programs. I see this as a reflection of the larger direction of the church and the Christian families who attend: we tend to focus more on applied ethics—how we ought to live—than on the biblical and theological foundations of our faith. This may be an important corrective to the hours and hours of flannel-board Bible lessons that many of us learned in our childhood, but I fear we may be overlooking something important by veering so far toward matters of practical theology to the detriment of biblical, historical, and systematic theology.
So, am I reversing what I said in 1996? No, not at all. I think practical matters of intradisciplinary integration are still critically important, but they are closely related to the thoughtful interdisciplinary dialogue between psychology and theology and to the personal qualities of the counselor that are developed through the process of spiritual formation. If we neglect these connections, then we end up with a shallow sort of integration that emerges more from a counselor’s toolkit than from the deep, abiding, formative work of God’s Spirit in our lives and in our offices.
Final Thoughts
As described in the updated introduction, I wrote this book during a time of personal struggle and spiritual redefinition. Dr. James Wilhoit, who cowrote chapter 1 with me, taught the spiritual-formation class that changed my life. I remember Jim pressing us to distinguish between counselors who are simply dispensers of healing technology and those who understand the richness of spiritual transformation. Now I stand at the dawn of 2011 with Jim’s words—along with the first line of Richard Foster’s book—still reverberating in my mind. Superficiality is the curse of our age. Who will we be as Christian counselors? Will we be those who learn all the right tricks to help people feel better, or will we be those who seek deep wisdom through study, meaningful relationships in Christian community, and spiritual humility? Who will we be?
Acknowledgment
I appreciate the words of Jennifer Bearse, included as a sidebar in this update. Jennifer was an undergraduate student in my counseling class in the 1990s, and then, after a career in business, she decided to return for doctoral training in clinical psychology. So now I again have the privilege of having her as a student, and as a member of my research team.
Additional Reading
Christian Smith and Melinda Lundquist Denton, Soul Searching: The Religious and Spiritual Lives of American Teenagers (New York: Oxford University Press, 2005).
Bibliography
Bouma-Prediger, Steven. “The Task of Integration: A Modest Proposal.” Journal of Psychology and Theology 18 (1990): 21–31.
Foster, Richard J. Celebration of Discipline: The Path to Spiritual Growth. San Francisco: HarperCollins, 1988.
Chapter 2
Toward Psychological and Spiritual Health
With their minivan fully loaded, cartop carrier securely fastened, dog safely kenneled, and the iron turned off, the Johnson family pulls out of the driveway for their family vacation. Wendall Johnson is behind the wheel, humming a tune, when family members start asking questions.
“Are we almost there?” his six-year-old asks.
Chuckling to himself, Wendall answers calmly, “You must be looking forward to getting there, Brian.”
Scowling at Brian and feeling a bit smug about her twelve-year-old sophistication, Monica rephrases the question. “Dad, about how long does it take to drive where we are headed?”
“Yeah,” Brian adds, “are we almost there yet?”
Wendall stops humming his tune just long enough to reply, “I’m not sure, Monica, but we’ll all know when we arrive. Brian, this could be a long trip or a short trip. It’s just too early to tell.”
From the passenger seat, Rhonda Johnson gasps and exclaims, “Honey, we forgot to bring the road map!” The kids join the panic and ask a flurry of new questions.
“Calm down, Rhonda! Kids, don’t worry so much. I’ve come on many vacations before, and I know what I’m doing. We all just need to trust the process. Everything will turn out fine.”
The Johnson family is not relieved.
Neither are many of our clients when we explain the counseling process to them. Sometimes I try to picture the anxiety of a first-time counseling client. After trying for many weeks or months to cope without counseling, the potential client finally sets an appointment and shows up for that first interview. The concerns, which are quite normal, are seen in the questions. What type of counselor are you? Have you worked with others who have had these problems? How long will this take? What has caused my problems? These are the same questions Wendall Johnson’s family members were asking him. Do you know how to get where we are going? How long will it take?
Sometimes our answers are just as frustrating as Wendall Johnson’s. We look empathically at our anxious clients and say, “This must be a difficult step for you to come to counseling, and you’re feeling anxious about how long it might take.” Or we assure them that counseling is complex and that it is impossible to tell how long it will take until the journey is underway. We tell ourselves not to be anxious about where things are headed in counseling with the tired words, “Just trust the process.”
On one hand we are wise to believe in the process of counseling. A confiding, trusting relationship with a counselor helps people get better.52 But we are also wise to believe in road maps. Process alone helps, and most people eventually get better, but a road map helps make the process efficient. If the Johnsons have a basic understanding of geography, they will eventually get to their destination, even without a map, through trial and error. But that’s not what Brian or Monica or Rhonda wants! They want to get there as soon as possible. Similarly, our clients want to reach their destination as soon as possible, and they want a counselor who knows how to help them reach their destination.
My theoretical road map for counseling is cognitive therapy.53 I like having a map. It helps me give direct answers to my clients’ questions. After a few sessions, I can usually predict with reasonable accuracy how long counseling will take and what we will be doing in the sessions. A strong therapeutic relationship and trust in the counseling process are essential ingredients of effective counseling, but a theoretical map helps, too.
Sometimes I feel a nagging dissatisfaction with my theoretical map. I wonder, for example, if teaching my clients positive self-talk sometimes feels trite and superficial, as if I am trying to put a Band-Aid on a gaping wound. How should a cognitive therapist interpret a recent study that suggests the reason cognitive therapy works is that good cognitive therapists employ the same relational and affective sensitivity in counseling that good psychodynamic therapists employ?54 And how do I make sense of the many clients for whom standard cognitive therapy simply doesn’t work? Those who come with chronic personality-adjustment problems often don’t respond to cognitive therapy unless the therapeutic methods are substantially altered.55 And then there is the biggest concern of all: most forms of cognitive therapy are silent about the spiritual life, and the few Christianized versions of cognitive therapy seem simplistic and naive, as if a cognitive therapy worldview has been unquestionably accepted and then cloaked with a few strategic Bible verses and religious-imagery exercises.
This is not to say that we should give up the theoretical maps that counselors and psychologists have spent decades developing and researching. The maps we have borrowed from psychology have been helpful and have led us to this new frontier of intradisciplinary integration. But can they lead us further? At the frontier, we need better maps.
Mapping Spiritual and Psychological Health
Christian counseling is more complex than other forms of counseling because our goals are multifaceted. Whereas the behaviorist can focus on symptom reduction and the psychoanalyst on ego strength, Christian counselors are concerned with spiritual growth as well as mental health. Yet most of the maps we use for therapy are based only on mental health and have been developed with the assumption that mental health can be separated from the spiritual life—an assumption that most Christian counselors do not share.
We need a map for spiritual growth. This map must be true to Scripture and theologically sound yet completely relevant to the various mental health problems we see. Furthermore, it must be a practical map, not one of those complex figures that can be understood only by philosophers and theologians and has limited use in the counseling office. And ideally it should be a map that we can superimpose on the standard theoretical maps of counseling. Most of us do not want to replace our theoretical commitments to behavioral, cognitive, psychodynamic, family systems, and other forms of therapy, but we want a deeper understanding of the spiritual life and spiritual wisdom to see ourselves, our clients, and our counseling relationships more accurately. Finally, it should be a map that assumes neither a one-to-one correspondence between spiritual and psychological health nor complete separation between the two.
The map I begin with is simple, almost embarrassingly simple, but it provides an important starting point for discussions about religious issues and interventions in subsequent chapters.
A Pattern of Healing
The healing motif woven throughout the narrative of human history reflects a common pattern to healing and health. We see this pattern in good literature, in Scripture, in the church calendar, in one another’s lives. Figure 1 demonstrates the pattern graphically.
This pattern begins with our distorting what is good into something evil. God created humans with volition, a capacity for agency and selfhood. This capacity for self is good; it allows us to choose to be loving and kind, to enter into meaningful relationships with God and others, to exercise creative energy in our work and play, to set and reach goals. But we, like Adam and Eve, are prone to take our freedom too far, asserting our self-sufficiency and freedom without considering the consequences.
The consequences of unbounded independence are woundedness, brokenness, and pain. The adult who asserts willful independence by abusing a child causes great pain in many lives. The young child who overestimates his or her capacity to handle the demands of a busy shopping mall ends up lost and alone, crying for a loving parent. The husband or wife who cares more about freedom and independence than about sacrificial love and mutual submission ultimately faces great pain. And, as we see throughout the Old Testament, a nation that turns away from God faces pain and loss.
Eventually the myth of self-sufficiency sours, and we are left staring at our neediness, confronted with the brokenness and pain that have shadowed independence throughout human history. Sometimes pain is caused by personal rebellion; other times deep wounds result from the rebellion and sin of others.
We often think of brokenness and neediness as bad, but the gift of pain draws us into community with God and one another. In the midst of deep pain and brokenness, an adult abused as a child reaches to a counselor for help. A child lost in the mall instinctively wails until Mom and Dad come running. A couple in crisis learns how to listen to one another, to understand what sacrificial love means. The Old Testament nation of Israel, though repeatedly rebellious against God, also repeatedly repented and experienced God’s rich blessings.
At the heart of Christian spirituality is a healing relationship with God. We were broken and dead in our life of sin when “God, who is rich in mercy, out of the great love with which he loved us even when we were dead through our trespasses, made us alive together with Christ” (Eph. 2:4-5). Brokenness is a prerequisite to understanding God’s grace, but the Christian gospel does not leave us in a state of broken despair. Easter follows Lent. The apostle Paul was blinded so he could receive true sight. Jonah, Esther, Elijah, Moses, Peter, Elizabeth, David, Joseph, Anna, and virtually every other Bible hero knew the joy of God’s grace because they endured difficult circumstances and times of suffering. Redemption gives hope and meaning to fallen humans. “Weeping may linger for the night, but joy comes with the morning” (Ps. 30:5).
This simple pattern can be seen all around us. Consider these examples from three areas: human development, spiritual growth, and psychological change.
Example 1: Human Development
From the perspective of human development, we see this pattern emerging as children learn to distinguish themselves from the rest of their world. They explore, become autonomous, and often grow stubborn.56 Parents complain of the terrible twos, but it would be even more terrible if a two-year-old sat passively staring into space all day. The energetic, exploring, ambitious two-year-old exemplifies the human quest for understanding and adventure. Although this drive for autonomy is an essential good in human development, there is a natural limit to autonomy, and that limit is defined by pain. As children encounter the trials of hunger, injury, or loneliness, they naturally turn to their caregiver for help and comfort.
Example 2: Spiritual Growth
The same pattern can be seen in the spiritual life. In order to draw close to God, to understand his grace and love, we must also understand our need for God. James writes, “‘God opposes the proud, but gives grace to the humble.’ Submit yourselves therefore to God. . . Humble yourselves before the Lord, and he will exalt you” (James 4:6-10). The apostle Paul reflects on this pattern when he describes his fallenness and his struggle with excessive independence in Romans 7 and then reflects on God’s immense grace in the next chapter. Paul could not find God’s healing love until he acknowledged his broken, needy condition.
Spiritual transformation, from a Christian perspective, always involves an awareness of neediness, as illustrated on Wheaton College’s campus in 1995. Students sensed the stirring of the Holy Spirit for revival on campus, and hundreds corporately confessed the limits of their abilities to handle the stresses and temptations of college life in their own power. Each evening for almost a week, more than a thousand students met for prayer and confession until the early morning hours. After the week of corporate confession, small accountability groups were formed, and students continued to meet together, confess their sins, and seek spiritual and emotional restoration. This spiritual revival was a beautiful reflection of this simple pattern of healing. College students value independence—breaking away from family and developing one’s own identity is the crisis of early adulthood, according to Erik Erikson.57 But college students, like the rest of us, sometimes overadjust and assert too much independence. In the midst of campus revival, students acknowledged their brokenness and their need. Men and women waited in line, sometimes for hours, to get to the microphone and publicly confess their fallen condition. They brought their symbols of excessive independence—CDs, magazines, and books that caused them to stumble spiritually—and voluntarily handed them over to be destroyed. Perhaps the most moving and powerful part of the revival process was not watching students confess in a crowded auditorium but what happened next. Each time someone left the microphone, he or she was immediately surrounded by a group of concerned students, faculty, and staff. They knelt on the floor and prayed for one another. Healing relationships with God and others were established when brokenness and need were openly acknowledged.58
Example 3: Psychological Change
A third example of this pattern of healing can sometimes be seen in psychological growth. The proliferating recovery movement is based on the assumption that people must acknowledge their powerless, broken condition before they can improve. By attending twelve-step meetings frequently, recovering addicts repeatedly acknowledge their brokenness and draw together with others in a healing community. This same process is sometimes seen in the counseling office.
What If This Happened?
When Karen and Bill arrive for their first counseling session, anger is painted all over their faces. Bill describes his feelings of betrayal and hurt over Karen’s recent affair. Karen feels justified, blaming Bill’s emotional distance and lack of affection. As the weeks go by, each begins to take more responsibility. Eventually they both confront their personal selfishness and sinfulness and express sorrow and remorse to one another. With time, their relationship heals, and they draw close to one another.
Karen and Bill started counseling in a state of stubborn self-sufficiency. Each had transgressed, valuing self above other, avoiding blame by accusing each other. But with time they each accepted their fallen, needy, broken condition. From their point of brokenness they could reach out to one another and establish a healing bond.
All these examples demonstrate this simple pattern of healing: our independence goes too far; we acknowledge our brokenness and our need; and we are welcomed into loving relationship with God or others. Unfortunately, life doesn’t always work as neatly as these examples might imply. As they grow, some children continue to assert excessive independence and seem unable to recognize their need for others. Sometimes spiritual brokenness turns into chronic helplessness and despair. Some couples never acknowledge their responsibilities in counseling, and they end up bitter and divorced. Many people in recovery end up sinking back into patterns of addiction. Thus, this simple pattern of healing is not an adequate road map to understand the complexities of psychological and spiritual health.
Problems with the Map
Maps only represent reality, and simple maps omit many complexities for the sake of making reality easily understood. If the Johnson family ends up buying a simple map on their family vacation, they might find the freeways that take them close to their destination. But the complexities—the back roads leading to the mountain cabin—will be omitted. The simple map isn’t wrong; it just leaves out details.
The pattern of healing discussed thus far captures and helps simplify much about spiritual and psychological health, but it leaves out many details. There are several valid criticisms of this simple model of health.
Problem 1
First, this pattern of healing implies a linear progression that is not true in every situation. Sometimes we enter a state of brokenness not because of our own stubborn independence but because we are wounded by others’ sins. Sometimes we see our brokenness only after experiencing a healing relationship. Sometimes a healing relationship enhances our capacity for a healthy sense of self. Sometimes brokenness has a different effect and leads us away from healthy relationships rather than toward them.
Problem 2
Second, this model of health assumes insight and self-awareness, an assumption that does not hold true for everyone. It assumes the capacity to assert one’s will, but many people have learned to be passive and helpless in life, rarely exerting their will. It assumes an ability to see value in brokenness, but many people retreat into a victim stance or maladaptive defenses in the presence of pain. It assumes that people have the social skills to enter into healthy human relationships, an assumption that does not apply equally well to all people. When counselors assume their clients are insightful and have self-awareness, they risk oversimplifying complex and difficult psychological problems.
What If This Happened?
Jill comes for her first counseling session complaining of how badly people treat her at work, how her love relationships have not worked out well, and how difficult other people are. She describes her emotions with intensity. In fact, intense is a good way to describe her life. She pursues relationships intensely, experiences anger, love, joy, and fear intensely, and even talks intensely. By the end of the first session you can tell that she likes you intensely and looks forward to your next meeting. As the weeks pass, you find her unpredictable and difficult. Her moods are volatile and intense. She calls you at home frequently, and she accuses you of saying things you don’t remember saying.
You think about this simple road map of health and decide she needs to understand her sin and brokenness before she can find a healing relationship with a therapist or anyone else. You suggest that Jill memorize certain Bible passages and confess her past sins against God and others. But as you start narrowing in on her weaknesses and problems, she decompensates. She starts cutting her wrists at home, calling you in the middle of the night with suicidal plans, showing up at your office at unscheduled times, demanding to see you. Jill has become worse rather than better.
Jill’s pattern of behavior, consistent with the condition known as borderline personality disorder, needs to be considered before applying this (or any) model of health. She is unable to cope with her sense of brokenness because she has not yet learned a capacity for understanding and placing appropriate value on herself. In a psychological sense, Jill invalidates her own experience, looking to others to understand what she should be thinking and feeling.59 Thus, her fragile emotional resources and her mechanisms of self-protection keep her from looking insightfully at her own brokenness. She will decompensate if a counselor pushes her toward confessing personal sin. There is hope for Jill, and she may eventually be strong enough to see herself more clearly, but only after the therapeutic relationship is safe and consistent enough that she begins to understand and value her own experiences as distinct from others’.
Problem 3
A third problem with this simple model of health is the difficulty of properly understanding a healthy state of brokenness. This is like walking a tightrope. If we lean too far in one direction—the direction counselors have typically leaned—then we view all human discomfort as problematic and may try to excuse our clients prematurely from their healthy sorrow. Discomfort often motivates insight, and when we use clinical tricks to erase misery prematurely from our clients’ lives, we short-circuit their opportunities for emotional and spiritual growth. Throughout Scripture and throughout the history of the Christian church, God has used pain to bring people to maturity. What if Job had gone for cognitive therapy and learned to talk to himself in different ways?
“It’s not awful that my family died, I can always have another family.”
“My friends are saying some tough things, but it doesn’t really matter what they think anyway.”
Or what if David had learned “healthy” self-talk after Nathan confronted him about adultery and murder?
“This was a bad thing to do, but other people do bad things all the time, too. I don’t have to upset myself about this.”
“I have learned from my mistakes, and there is no point in blaming myself or thinking of myself as a bad person.”
But God used pain to shape Job’s and David’s characters. Here is what Job and David really said:
[Job said,] “I had heard of you by the hearing of the ear, but now my eye sees you; therefore I despise myself, and repent in dust and ashes.” (Job 42:5-6)
[David said,] “For I know my transgressions, and my sin is ever before me. Against you, you alone, have I sinned, and done what is evil in your sight, so that you are justified in your sentence and blameless when you pass judgment. Indeed, I was born guilty, a sinner when my mother conceived me.” (Ps. 51:3-5)
As we sensitively allow our clients to feel pain and brokenness, they are able to see themselves, others, and God more accurately.
We face the danger of idealizing pain if we lean too far in the other direction on this tightrope. Some forms of pain are almost always destructive and should not be seen as a gateway to insight. When we confuse a healthy awareness of human fallenness with unhealthy experiences, such as helplessness and clinical depression, we risk hurting those seeking our help. In the midst of clinical depression, people are not sad simply because of the human condition; they are surrounded by unrealistic feelings of worthlessness and hopelessness. A healthy awareness of human fallenness enhances our relationship with God by getting our eyes off ourselves and onto God’s magnificent character. Clinical depression does just the opposite, trapping people in a cycle of self-absorption and sapping spiritual and psychological insight.
Problem 4
Fourth, this simple map implies that health is tantamount to close relationships. This is true only in our relationship with God. Other relationships sometimes disappoint and devastate and evoke our self-sufficiency and sinfulness in ways that are far from healthy. Many close relationships do more damage than good.
Even a counseling relationship, though a significant part of effective treatment, is prone to self-serving distortion, manipulation, and abuse.60 When the counseling relationship works well, it is because it mimics the redemptive relationship Christians experience with God through Jesus Christ. Unfortunately, we counselors sometimes forget that our best work is only a poor imitation of God’s redemptive nature, and we start seeing ourselves as powerful saviors.
“The closer, the better” is a good motto for our relationship with God, but because of our human capacity to distort and serve ourselves, it is not a good motto for a counseling relationship. Effective counseling requires us to scrutinize the counseling relationship, looking for indications of excessive dependency, monitoring and understanding feelings of transference and countertransference, always keeping the client’s welfare our first priority. Closeness in itself does not produce health, but a counseling relationship carefully modeled after Christ’s redemptive relationship with humankind can draw people toward greater spiritual and psychological health.
Problem 5
Fifth, this simple model of healing implies that our human sense of self is bad because it leads to rebellion and self-sufficiency. This is only partly true. It is correct that we are in a lifelong struggle to keep our independence, our will, within the boundaries of God’s will. John the Baptist, after a time of high-visibility ministry, said, “He [Jesus] must increase, but I must decrease” (John 3:30). We face the same task today—a challenging task in the midst of a culture that values self-determination and independence. But self, as defined by psychologists throughout the past century, is not all bad. When clinicians and personality theorists speak of self, they do not refer to reckless independence but to a capacity to distinguish one’s own identity from others in the environment.61 The capacity to make decisions, to function when a loved one is absent, to have preferences, to set goals, and to discuss feelings requires an awareness of self.
Thus, the simple model of healing described here may be a helpful way to conceptualize spiritual and psychological health under many circumstances, but it can be dangerous if improperly applied in a counseling relationship. We need a map with more sophistication to guide us through the many nuances of counseling.
A More Detailed Map
A more comprehensive perspective on psychological and spiritual health requires us to consider self, brokenness, and healing relationships as interactive rather than linear.
All three parts of the triangle contribute to health. An accurate sense of self allows us to recognize our responsibility to God, others, and ourselves. Having a healthy awareness of brokenness keeps us humble and helps us fight our natural propensity toward self-centeredness. Healing relationships allow us to experience grace and hope in the midst of life’s trials.
Some forms of therapy focus more on one component than others. Behavioral treatment, for example, teaches new skills to compensate for previous maladaptive learning. Behaviorists teach clients to have a healthier, more confident sense of self. Psychologist Albert Bandura calls this self-efficacy.62 Traditionally, cognitive therapists have focused on an accurate sense of self, but more current forms consider the importance of relationships as well.63 Psychodynamic therapists focus on the therapeutic relationship as essential, while looking for growth in the client’s self-awareness.64 Biblical counselors focus on the state of brokenness and to some extent on the therapeutic relationship.65 Though different approaches emphasize different parts of this model, all three components are important for spiritual and psychological health.
In a state of spiritual and psychological health, the three components interact and contribute to the others. We become increasingly willing to discuss our brokenness as we feel secure in close relationships, and our relationships become closer as we honestly admit our faults. An accurate understanding of self helps us admit our needs and allows us to be full partners in meaningful relationships, and recognizing our needs contributes to our awareness of ourselves. We are able to draw close to God as we humble ourselves, and we are able to humble ourselves as we draw close to God.
A balanced sense of self, brokenness, and close relationships with God and others bring maturity and health. Unfortunately, the converse is also true: a misunderstanding or deprivation of any part can lead away from health.
Accurate Sense of Self
Those who have an accurate understanding and acceptance of themselves are freed to experience greater emotional or spiritual health. This is not the same as saying that we should all love ourselves more. In many ways, we love ourselves too much.66 Rather, I am suggesting that we should understand ourselves accurately enough that we can stop worrying about whether we are bad or good. To be healthy, we need to move beyond a preoccupation with self.
Psychologist Abraham Maslow studied and wrote about the concept of self for many years. Though Maslow would not agree that the Christian faith can help lead people to emotional health, his reports of the characteristics and desires of healthy people who have moved beyond preoccupation with self (he called them self-actualizers) are remarkably similar to the fruit of the Spirit described by the apostle Paul in Galatians 5:22-23.67
Paul and Maslow
Fruit of the Spirit
Love
Joy
Peace
Patience
Kindness
Goodness
Faithfulness
Gentleness
Self-control
Characteristics of Self-Actualizers
Autonomy, Task-Centeredness
Efficient perception of reality
Unhostile sense of humor
Fellowship with humanity.
Acceptance of self and others
Spontaneity
Peak experiences
Continued freshness of appreciation
Profound relationships
Desires of Self-Actualizers
Balance, Harmony
Completion
Goodness, Values, Truth
Justice
Individuality, Richness
Simplicity
Aliveness, Playfulness
Unity, Beauty
The fruit of the Spirit described by Paul do not correspond perfectly with the characteristics of emotional health described by Maslow. And emotional health is not exactly the same as spiritual well-being. However, we see substantial overlap. The more accurately we understand ourselves, the more freedom we have for emotional and spiritual health.
Faulty Sense of Self
When a healthy sense of self has not been established, people easily slip into a variety of psychological and spiritual problems.
What If This Happened?
Jeff is a twenty-six-year-old single male who is still living with his devout Christian parents. As a child, he was given a clear sense of right and wrong, and he worked hard to please his parents. Because his home lacked affection, Jeff learned to equate his worth with his outward display of piety. During his years at a Christian college, feeling lonely and isolated, Jeff became obsessed with pornographic magazines and videos. After graduating, he became a missionary. During his missionary work, he continued to view pornography frequently and secretly. In the midst of his shame and confusion, Jeff became more withdrawn and isolated. He eventually had a brief psychotic episode that resulted in the loss of his missionary position. Since returning to his hometown, he has renounced his religious faith. Jeff now works in a fast-food restaurant, is a heavy drinker, and thinks about killing himself almost every day.
Jeff’s situation demonstrates what can happen without a healthy sense of self. During his childhood years, Jeff developed a belief that his value depended upon his ability to perform. When he was longing for a hug, he received interrogation about his personal quiet times. While other kids were going to the ballpark with their fathers, Jeff was trying to please his father by sharing Campus Crusade’s four spiritual laws with neighborhood children. When other children were being rocked to sleep on their mothers’ laps, Jeff was sitting at the dining-room table, fighting back yawns during family devotions. Jeff’s parents had the best intentions, and their spiritual passion is to be commended, but Jeff grew up without a healthy sense of self. He saw himself as an extension of his parents, a worker bee for the kingdom of God, but never as a choosing, autonomous, creative agent made in the image of God.
The results for Jeff were devastating. His unhealthy sense of self led to self-absorption (he spends hours thinking about himself and his lack of worth), self-hate (he wants to die and even plans ways to kill himself), and a lack of self-restraint (as seen in his pornography and alcohol-use patterns). In psychodynamic terms, he has poor ego strength, as seen in his difficulty in making responsible choices, his overwhelming feelings of shame, and his impulsive choices.
Jeff needs a counselor who will help him catch a glimpse of the warmth he longed for as a child, within the boundaries of an appropriate therapeutic relationship. Jeff needs to grow into an accurate understanding of himself as a person created in God’s image.
Accurate Sense of Need
Just as an accurate sense of self leads to health and a distorted sense of self inhibits health, an accurate view of human fallenness fosters health, while a distorted view leads to denial and distortion. Richard Foster reminds us: “The closer we come to the heartbeat of God, the more we see our need and the more we desire to be conformed to Christ.”68
The idea of admitting that one is needy is not popular in contemporary Western society. We see it as a sign of weakness and vulnerability. Some build persuasive arguments that emotional health comes with autonomy and individuality. But there is only one way to spiritual health, and that requires us to recognize that we need God. Spiritual leaders throughout history have written about their hunger and need for God. In the sixth century Benedict of Nursia described a ladder of humility—twelve steps that help us recognize our need for God: reverence for God, doing God’s will, obedience to others, enduring affliction, confession, contentment, self-reproach, obeying the common rule, silence, seriousness, simple speech, humble appearance.69 Though today’s Protestants might challenge several of these steps, each of them points toward acknowledging need as a mechanism of spiritual growth.
Faulty Sense of Need
Unfortunately, many people have an unhealthy awareness of their need, which complicates counseling. Other times, counselors actually foster an unhealthy sense of need by confusing need with victimization.
What If This Happened?
Jeff’s therapist, Dr. Ura Vicktem, immediately recognizes Jeff’s pain and his tendency to suppress emotions in order to avoid conflict. She encourages Jeff to explore his childhood pain, to talk to an empty chair as if his father were sitting in it. Eventually Jeff grows stronger, develops more confidence, and begins developing a healthy sense of self. Because Jeff is stronger now, Dr. Vicktem concludes that Jeff is ready to confront his parents. He does so, expressing his childhood pain and requesting that they not contact him until he has recovered fully from his childhood of “toxic faith.”
The good news is that Dr. Vicktem has improved Jeff’s sense of self and has provided a caring relationship for Jeff. In a psychological sense, Jeff may be healthier than he was before therapy started. The bad news is that Dr. Vicktem has perpetuated a problem that saturates the practice of psychotherapy by using Jeff’s self-pity as a tool for building rapport. Rather than coming to a healthy sense of brokenness and an awareness of personal vulnerability, Jeff has become a victim of his past. With the help of Dr. Vicktem, he has become bitter and cynical about parents who loved him dearly but who did not know how to express their love.
Effective counseling often helps people identify pain from their past and sometimes requires people to confront parents, past abusers, and others. But when the pain, anger, confrontation, and therapy become a way of life, the counseling is no longer effective. In a spiritual sense, Jeff is no healthier than he was before therapy, and he may be further from understanding his personal need for God.
Like many situations counselors face, treating Jeff requires a careful balance of support and confrontation. With Dr. Vicktem, Jeff received high support and low confrontation. At the other extreme of high confrontation and low support, Jeff will find different perils.
What If This Happened?
Jeff’s therapist, Mr. U. R. Cinner, believes Jeff’s pain results from his personal rebellion and choices that have drawn him away from God. His parents were not perfect, but they taught him right and wrong and provided him with an essential understanding of Christian doctrine.
Mr. Cinner confronts Jeff about his sinful choices. He has rebelled against God and others by obsessively viewing pornography, poorly controlling his use of alcohol, and deliberately disavowing his religious faith. Jeff needs to repent and to be drawn back into Christian community by joining a local church.
The good news is that Mr. Cinner has not overlooked the role of personal sin in Jeff’s situation, as Dr. Vicktem had. The bad news is that Mr. Cinner’s emphasis on personal sin and brokenness has further damaged Jeff’s sense of self. Coming to a counselor was a bold act of self-care for Jeff, and in return he received the same judgmental advice he had been telling himself for years. Jeff may cancel his next counseling appointment and sink further into feelings of helplessness.
Somewhere between these extremes, Christian counselors need to create a nurturing, safe relationship in which clients can acknowledge and discuss their sin.70 Nestled in this haven is permission to talk freely about human fallenness. Jeff is a fallen human, permeated by the effects of sin. So are his parents, siblings, childhood friends, peers at work, and counselor. In the midst of this haven, Jeff can safely explore his feelings of sadness, grief, and anger about past and present relationships. He can also explore his own broken, needy condition, a discovery that allows him to empathize with his parents and others who have hurt him. Just as Jeff has been hurt, he has hurt others. As he acknowledges true brokenness, he is able to draw close to God and others.
This is a difficult balance for Christian counselors to maintain. When we slip too far in one direction or another, we risk hurting our clients by damaging their often fragile sense of identity or by socializing them to blame others for their pain.
This difficult balance can be illustrated with a multiple-choice question. In the midst of a counseling session, Jeff says, “I feel so empty and ugly inside. I feel as if I’m a bad person. But I’m not a bad person, am I? When I think I am a bad person, then I get really depressed and start thinking about suicide and stuff.”
How does the counselor respond? I see three possible options.
Option 1: “You are not a bad person, Jeff.”
Option 2: “Let’s consider some of the ways you feel you’re a bad person.”
Option 3: “It seems important to you not to think of yourself as a bad person.”
Although any of these responses might be appropriate under some circumstances, my preference is option 3. Option 1 tends to dismiss personal responsibility, build excessive dependency in the counseling relationship, and prevent Jeff from exploring his feelings and dealing with his internal sense of brokenness. Option 2 might lead Jeff to explore his sinfulness, but it detracts from the important emotions he is exploring. Also, Jeff might be less interested in really exploring his worth than he is in knowing how the counselor will respond to his provocative question, “I’m not a bad person, am I?” Option 3 allows Jeff to explore not only his feelings of inadequacy but also his sin. Furthermore, Option 3 is a less-affirming response, one that might prevent Jeff from becoming excessively dependent on his therapist’s approval.
This example illustrates the sensitive balance Christian counselors must maintain to nurture a client’s fragile identity while allowing for an honest discussion of personal fault and human fallenness. It also illustrates how the counseling relationship must be carefully monitored.
Accurate Understanding of Healing Relationships
Spiritual health, from a Christian perspective, is defined by the nature of one’s relationship with Jesus Christ. Psychological health also requires a capacity for intimate relationships. Thus, the Christian who is psychologically and spiritually whole enjoys healthy, intimate relationships with Christ and others. This is not to say that relationships are tantamount to health. Many counseling clients already have good capacity for relationships but are struggling with faulty learning patterns or difficult life circumstances. But as their self-efficacy improves and their learning patterns change, they often experience even greater freedom for healthy, meaningful relationships.
In some forms of counseling, the therapeutic relationship is the prototype of a healthy relationship. Some clients have rarely experienced a confiding, intimate relationship with good boundaries until they come for counseling. They learn about trust, respect, care, and empathy by observing and interacting with the counselor. In this sense, a good counselor is a minister of God’s grace, even to those who know nothing of a gracious God.
Though he does not claim to have a Christian perspective, leading psychotherapy researcher Dr. Hans Strupp is convinced that “therapists’ skills contribute materially to the outcome of therapy and that these skills, rather than being specific techniques, are much more accurately described as the ability to manage the complex human relationship that is the essence of psychotherapy.”71 Counseling often involves applying specific techniques to specific problems, but the therapeutic relationship may be an even more important variable in good counseling.
Faulty Understanding of Healing Relationships
Sometimes the power of the counseling relationship is misunderstood or misused, and a healthy healing relationship gives way to a neutral or damaging relationship. What goes wrong in these counseling relationships?
The counselor sometimes enjoys the power of the healing relationship too much, resulting in a number of problems.
What If This Happened?
Jeff finds a therapist, I. M. Savyer, and immediately likes him. Mr. Savyer is attentive, interested, respectful, and empathetic. In fact, Mr. Savyer is the nicest person Jeff has ever known. Together, Mr. Savyer and Jeff explore the pain of Jeff’s childhood, concluding that his parents were rigid, unaffectionate people who cared more about the family’s reputation than Jeff’s welfare. They look at other important people in Jeff’s life and come to equally cynical conclusions.
After every session, Jeff feels better. Something about being with Mr. Savyer just makes him feel better. He is thankful he found a good counselor.
Although Mr. Savyer has exercised good listening skills, he seems to be forgetting that he is participating in a transitional relationship for Jeff. Although Jeff feels better after each session, he still spends most of his week in his “real world,” interacting with the people he is criticizing in Mr. Savyer’s office. Without intending to do so, Mr. Savyer may be contributing to Jeff’s tendency toward splitting—a phenomenon in which clients see some people as all good and others as all bad. The counselor in this case is seen as all good, and the rest of the world is all bad.
A related problem is that Jeff may become excessively dependent on his counselor. Some feelings of dependency are transferred onto a counselor by virtually all clients, but when the dependency becomes excessive, clients often are injured by being caught in an unrealistically long counseling relationship and by experiencing excessive pain when the counseling relationship is terminated.
In some extreme cases, the counselor uses the power of the healing relationship to meet his or her own needs. When a counselor begins perceiving the counseling relationship as a way to meet his or her own needs, an exploitive relationship often results.72 Soon the counselor begins disclosing personal problems to the client. Sometimes sexual intimacies occur, and the relationship becomes emotionally or sexually damaging to the client.
Counselors are fallen humans, just as clients are. We need a keen sense of humility in the work we do, and we need to remember that we are only modeling healthy relationships with our clients. We are not saving them but pointing them toward a Savior and toward healthy earthly relationships that can be an ongoing part of their lives.
Counselors play three roles simultaneously. First, we are full participants in the interpersonal interactions that occur in counseling sessions. Second, counselors are observers, carefully noting the quality of the relationship and critically evaluating what is and is not going well in the relationship. Third, we are engineers of the counseling relationship, adjusting the relationship by becoming more compassionate and understanding when a client feels alienated and isolated, becoming more distant and guarded when a client becomes too dependent, and asserting appropriate boundaries throughout the counseling relationship. The relationship we establish with clients is an important part of the healing process.
Assessment as the Rate-Limiting Step
When chemists compute the rate of chain reactions, they refer to the slowest reaction in the chain as the rate-limiting step. The entire process can go no faster than the rate-limiting step. Commuters find the same thing during rush hour, as their travel time is defined by the freeway bottleneck where four lanes merge into two. In counseling, good assessment is similar to a rate-limiting step. The effectiveness of counseling is limited by the accuracy of the counselor’s ongoing assessment. A theoretical map, such as the one presented in this chapter, promotes competent assessment by providing a gauge by which we can measure our clients’ needs and progress.
I was on a television show recently in which a leading figure in biblical counseling announced that students in psychology, including students in the Wheaton College doctoral program, were taught not to pray with their clients. As quickly as I could jump into the conversation, I denied the claim. Many students in Christian psychology programs, including those at Wheaton, are encouraged to pray with clients under many circumstances. However, before using any counseling intervention, including prayer and other religious interventions, it is wise to anticipate the possible effects. Sometimes it is best not to pray with clients in a session, and other times it can be a valuable part of Christian counseling.
Should a counselor have clients memorize Scripture? Is it wise to pray with clients during a counseling session? Should a counselor confront sin in a client’s life? Should clients be encouraged to forgive those who have hurt them? The answers to these questions, which will be considered in detail throughout the remainder of this book, will vary from one client and one situation to the next. Just as a good basketball coach is able to watch several players at once and call the best play for the moment, an effective counselor watches these three components of psychological and spiritual health—healthy sense of self, awareness of personal brokenness, and confiding relationships—and adjusts the treatment accordingly.
Effective counseling requires an ongoing assessment of treatment goals and the client, as well as an accurate self-assessment of the counselor.
Ongoing Assessment of Goals
Maggie comes for counseling because of her recurrent stress-related tension headaches. Kristin comes for counseling because she has been suicidally depressed for several months. Maggie is happily married, successfully employed, and spiritually vital. Kristin lives alone, drifts from job to job, and feels God could never love her. Clearly, the goals for treating Maggie and Kristin will be different.
Current standards of care suggest that counselors should define goals and the nature of the counseling with their clients at the beginning of the counseling relationship.73 It is wise to review these goals every session or two so the counseling can remain effectively focused. Maggie and her counselor set two goals: reducing the frequency of her headaches to no more than twice per week and experiencing greater satisfaction with her career. Kristin and her counselor set four goals: reducing her levels of depression, finding and maintaining at least one meaningful relationship, finding secure employment, and deepening her understanding of God’s love.
These goals will need to be reviewed frequently throughout treatment. Whatever religious interventions are selected can be evaluated in light of these goals.
Ongoing Assessment of the Client
At first glance, it may appear that Kristin needs religious interventions much more than Maggie. After all, Maggie just needs some relief from her headaches, and Kristin needs radical life transformation. But a closer look tells a different story.
Maggie enters into counseling in a relatively healthy state. She has an accurate awareness of herself; she is aware of her strengths and skills, including her tendency to worry too much about unimportant things at work. She recognizes she needs help, which reflects her awareness of human brokenness and need. And she has healthy relationships in her life. Maggie is in a position of strength and will probably not slip into a state of self-hate, begin seeing herself as a hopeless victim, or become excessively dependent on her counselor. Her counselor can use spiritual interventions with confidence. In fact, a published study has demonstrated Christian forms of devotional meditation to be an effective way of releasing muscle tension.74 This type of spiritual intervention might be ideal for Maggie.
Spiritual interventions might also be appropriate for Kristin, but her counselor should be careful to consider the possible implications before using the interventions. Kristin and her counselor might find it helpful to pray together at the end of each session, but the counselor should remember that prayer is an intimate activity, and Kristin might easily become excessively dependent on her counselor. Believing in the power of prayer, the counselor might choose instead to pray for Kristin privately, outside of the counseling sessions. Similarly, Kristin and her counselor might consider using forgiveness of a past abuser as a treatment strategy. But it will be important for the counselor to recognize Kristin’s weak sense of self-identity. Does she really understand the implications of forgiveness before she understands the toll exacted on her life by her abuser? Can she understand the act of forgiveness before she better understands that God has forgiven her? These are important questions for her counselor to consider before using religious interventions.
Ongoing Assessment of the Counselor
Making decisions about treating Kristin and Maggie is made challenging enough by their different personalities and different treatment goals, but it becomes even more challenging when we remember that counselors also bring styles and personalities into the counseling process. Some counselors are naturally confrontive and work to help their clients quickly see personal sin and begin making better choices. Other counselors are naturally supportive and work to make therapy a safe place to explore a variety of feelings. Some are primarily trained in psychology, some in theology, some in counseling, and some in pastoral care. Some are Reformed, some charismatic, some Anabaptist, and some from other denominations. Some experience a profound spiritual life, and others struggle with spiritual disciplines and personal piety. Some are professionally trained, and some are peer counselors. Some are psychodynamic, some humanistic, some behavioral, some cognitive, and some come from a myriad of other theoretical perspectives. All these differences affect our choices in using spiritual interventions.
The naturally confrontive counselor may need to develop extra patience in order to wait for clients to grow strong enough to benefit from prayer, Scripture memory, personal confession, and so on. The psychodynamic therapist may have to work hard to recognize the simple beauty of Christian humility and not confuse it with masochism or a defense against grandiosity. The naturally supportive counselor may need to develop both distancing skills to prevent excessive dependency and confronting skills to keep clients out of chronic victim roles. The behavior therapist may need to exert extra effort to evaluate the therapeutic relationship. The professionally trained counselor may need to remember Christ’s transforming power, which is rarely taught in the classroom.
Good assessment, and good counseling, starts and ends with a simple Socratic admonition: Counselor, know yourself. To this we must also add: know your client, know your goals, and know your theoretical road map.
Summary
Throughout Scripture and history we see a healing pattern that requires humans to recognize limits to their self-sufficiency and reach out in their state of need to a gracious God. This same pattern can help us understand emotional health, but we must be cautious not to apply such a simple model in a haphazard or perfunctory way. A more careful look suggests that spiritual and psychological health require a confident (but not inflated) sense of self, an awareness of human need and limitations, and confiding interpersonal relationships with God and others. Effective Christian counseling strengthens all three of these areas. Unfortunately, there are many difficulties in the process of counseling, and a faulty understanding of self, brokenness, or counseling relationships can increase the client’s concerns and problems. From the basis of this theoretical map, we can begin to consider the potential value and dangers of using religious interventions in counseling.
The remainder of this book will use the foundation established in these first two chapters as a framework to consider a variety of religious interventions such as prayer, use of Scripture in counseling, forgiveness, and so on. Each chapter will have three main sections.
First, each chapter will consider a few relevant issues from the existing literature in psychology, Christian theology, and spirituality in order to provide a foundation on which to build an accurate understanding of the religious intervention. Volumes have been written from each of these three perspectives, and I am not so grandiose as to presume competence or time for a thorough review of any of this book’s topics from psychological, theological, and spiritual-formation perspectives. Rather, my goal in each remaining chapter will be to highlight one or more themes from these three foundational perspectives and discuss its relevance to Christian counseling.
Second, each chapter will evaluate each religious intervention according to the model of psychological and spiritual health described in this chapter. Each chapter will evaluate the interventions by asking three questions: Will this help establish a healthy sense of self? Will this help establish a healthy sense of need? Will this help establish a healing relationship?
Third, each chapter will discuss the six challenges for intradisciplinary integration, as described in chapter 1.
Upon Reflection
In rereading this chapter almost fifteen years after writing it, I am happy to have a chance to add a few additional observations about psychological and spiritual health. Many Christian counselors have found the three-dimensional model of health described here to be useful, particularly because it offers a multidimensional perspective on health. Health is not merely biological, psychological, social, or spiritual; health involves all these, and more.
Still, I think it is possible to enhance the view of health originally presented in this chapter by considering the rich theological truth of what it means to be made in the image of God. A more nuanced view of what the Bible says about this topic will help us serve our clients better. Second, an introduction to positive psychology is fitting. Third, it is important to note the development of the “third wave” of cognitive-behavioral therapy.
Imago Dei
As I mentioned in the introduction, my view from 2011 involves a good deal more theological reflection than what appeared in the earlier edition. The three dimensions of health described in chapter 2 reflect the major theological themes of creation (sense of self), fall (sense of need), and redemption (healing relationship). These are good as far as they go, but there is another theological perspective on health to consider: the imago Dei.
We don’t have to look far in the Bible to find the idea of imago Dei. The first chapter of Genesis makes the remarkable claim that humans are created in the image of God. Theologians and philosophers have pondered what this means for centuries, but here’s one thing we know for sure: the more we resemble God’s image, the healthier we are. Jesus, the perfect image bearer, is the exemplar of psychological and spiritual health.
In Integrative Psychotherapy (2007), Clark Campbell and I explore three views of the imago Dei in relation to counseling and psychotherapy: functional, structural, and relational.75 Though philosophers and theologians have debated these views, there is no doubt that all three reveal dimensions of God’s majestic character, reflected however dimly in human nature. Functional views emphasize how we are made to be stewards and managers over creation. Health involves effectively managing ourselves, others in our charge, and the rest of creation. Structural notions of the image focus on human ontology—the nature of our being. We are rational and moral creatures, far more so than those in the rest of creation. Relational perspectives suggest that humans do not carry the image by themselves, but that God’s image is revealed in relationship. When a counselor and a client sit comfortably surrounded by a sense of safety, something beautiful about God’s image is being demonstrated.
These three perspectives on the imago Dei correspond nicely with three major perspectives in psychology, as shown in table 1. This should not surprise us, because God is the author of all truth. If theologians and philosophers study the image of God in humans, and psychologists study human behavior, it seems reasonable that they would come to some similar conclusions, whether or not the psychologists acknowledge God as the creator of humanity. After all, this is God’s world, and everything we study has God’s fingerprints all over it.
Functional change in counseling occurs mostly through technique-oriented approaches such as behavioral and early cognitive-behavioral therapies. Clark Campbell and I refer to these as symptom-oriented approaches, where the goal is to help clients function better by addressing symptoms that cause concern. Most of the techniques that counselors use for behavior change, such as activity monitoring, behavioral activation, the triple-column method, and so on, are designed to enhance human functioning. These are known as the first and second waves of cognitive-behavioral therapy, with first wave being behavioral-change strategies and second wave being cognitive-change strategies.
Structural views address how humans understand themselves in relation to the world around them. Clark Campbell and I refer to these as schema-oriented approaches to counseling, because they address how clients understand and make meaning of life. More recent developments in cognitive therapy fit well with schema-oriented approaches.76 When we are working with a depressed client, for example, there will be symptom-oriented issues to address, but these functional concerns are usually related to particular ways the client views self, others, and the world. Effective Christian counseling needs to consider these meaning-making structures.
Relational views in theology and psychology assert that humans are at their best in the context of close, confiding relationships. From a Christian perspective, this involves both our relationship with God and our relationships with others. The traditions of psychodynamic and interpersonal psychotherapy emphasize that effective counseling is more about the relationship between counselor and client than any techniques the counselor may use. The longer I do this work, the more I lean toward relational perspectives on healing. I still find great value in functional and structural interventions, but I think the relational dimension of counseling may be the most important of all.
Earlier I mentioned that Jesus—the perfect image bearer—is the exemplar of health. This may seem confusing when we look at table 1, because the sense of need that Jesus experienced surely would have been different from what the rest of us experience in our sin-stained condition. As the only sinless human, for example, Jesus would not have experienced moral conviction of sin in the same way that you and I do. This is true enough, but we must be careful here not to slip into a docetic heresy (the belief that Jesus wasn’t fully human). The power of the gospel rests on the fact that Jesus did experience need. Though not guilty of personal sin, Christ chose to be mired in the midst of compromised humanity. God, who had no need, became needy in order to be in relationship with us.
You must have the same attitude that Christ Jesus had. Though he was God, he did not think of equality with God as something to cling to. Instead, he gave up his divine privileges; he took the humble position of a slave and was born as a human being. When he appeared in human form, he humbled himself in obedience to God and died a criminal’s death on a cross. (Philippians 2:5-8, NLT)
Jesus spent nights with “no place even to lay his head” (Matthew 8:20, NLT). He felt hungry and sleepy and heavy with grief. He was misunderstood and maligned. “The Word became human and made his home among us” (John 1:14, NLT). He sweat drops of blood in Gethsemane and ultimately was crucified as he bore our sin.
Jesus had need. I am convinced that he experienced profound awareness of both his need and ours. If we want to understand spiritual and psychological health, we can look confidently to Jesus, the “visible image of the invisible God” (Colossians 1:15, NLT).
Positive Psychology
Both theology and psychology are driven by questions about the way things are, and the questions change over time as we learn and discover new things. In 1996 (the same year this book was originally published), Martin Seligman became president of the American Psychological Association and started to ask a new question: what if we started to study what is right with people and not just what has gone wrong? His basic observation was that “psychology and psychiatry had done reasonably well with mental illness: suffering, victims, depression, anger, substance abuse, and anxiety. But they had done very poorly with mental health: positive emotion, engagement, purpose, positive relationships, and positive accomplishment.”77 This reflects a fundamental shift in the way we looked at psychological health. Do we strive for the absence of psychological illness or for the presence of psychological health? These are two very different goals.
From a Christian perspective, positive psychology can contribute to our view of psychological and spiritual health because we no longer need to look solely at our need for healing but rather can celebrate and be grateful for the image of God in ourselves, in others, and in our relationships. We can look at what is “true, and honorable, and right, and pure, and lovely, and admirable” (Philippians 4:8, NLT)—the imago Dei—in humanity. In short, we can be grateful. Research in positive psychology has shown that grateful people are happier, healthier, less depressed, and more self-confident than others. As we develop an accurate view of self, both the good and not so good, we can be grateful and, in turn, healthier.
Third-Wave Cognitive Therapy
When I wrote this chapter in 1996, I described myself as a cognitive therapist. At times I still do, but I am especially drawn to the evolving forms of cognitive-behavioral therapy (CBT). First-wave approaches came out of the behavior-therapy movements and focused on how to use behavior-modification methods to change how people behave. I’ve never been particularly drawn to first-wave approaches, though I recognize some can be very effective. Second-wave approaches emphasize changing thoughts in order to change feelings and behavior. These were prominent when I wrote this book in 1996, so when I described myself as a cognitive therapist, it was this approach that I had in mind. But even back in 1996 I was uneasy with the formulaic approach. Changing thoughts doesn’t always change feelings and behaviors, and I have found it much harder to change dysfunctional thinking than the pioneers of cognitive therapy seemed to imply. The third wave of cognitive therapy—exemplified by Steven Hayes’s Acceptance and Commitment Therapy, Zindel Segal and colleagues’ Mindfulness-Based Cognitive Therapy for Depression, and Marsha Linehan’s Cognitive-Behavioral Treatment of Borderline Personality Disorder (which explains Dialectic Behavior Therapy)—emphasizes a more patient, accepting approach of dysfunctional beliefs. The goal is to become more flexible and open to experience rather than anxiously try to combat every unwanted thought and feeling. The third-wave therapies emphasize social context, relational factors, and the need to honestly accept and acknowledge our struggles rather than to deny and resist them.
But here’s the rub: most of the third-wave cognitive therapy approaches have ideological connections with Buddhism—a fact that will make some Christians nervous about incorporating these ideas into Christian counseling. Still, I return to what I suggested earlier, that God’s fingerprints are everywhere in creation, so it need not worry or surprise us when people of different faiths (or no faith) help us see important aspects of God’s creation. Third-wave CBT helps us see some fundamental truths about human nature that are also taught in Christianity. The idea of patiently accepting our painful thoughts and feelings, accepting them rather than pushing them away, is very consistent with the Christian idea of human brokenness and sanctification. We are not immediately healed of all pain when making a Christian commitment. Rather, we are on a long journey that requires patience, time, and God’s persistent grace. We limp along on this journey, and the more impatient we become with the limp, the more inclined we are to injure others and ourselves along the way.
A healthy sense of self, need, and relationship requires some of the patience and acceptance seen in third-wave CBT. Christ tenderly transforms us, sometimes over many years. Similarly, Christian counselors sit patiently with clients as they move toward greater psychological and spiritual health.
Final Thoughts
If you are being trained or have been trained in a mental health profession, as I was, it is easy to resort to definitions of health offered by the dominant guilds of psychology, social work, counseling, and so on. Often these are useful views of health, but let’s not forget the deep wisdom of Scripture and Christian tradition. In Christianity we see both our belovedness and our brokenness, and we learn to trust in God’s loving, redemptive presence. Our great hope is in Christ, the perfect image of God and the one who saves us from our propensity to get lost. Positive psychology is an encouraging trend, and there is much to learn from third-wave cognitive therapy, but let’s not forget the essence of Christian theology as our fundamental foundation for Christian counseling. Our faith teaches us who we are and how we flourish.
Acknowledgment
I appreciate the assistance of Nicholas Wiarda in helping me research and write this update. Nick grew up in Wheaton, Illinois, so he and I watch Chicago Bears games whenever we can. He is now a doctoral student in clinical psychology at George Fox University and part of my research team.
Additional Reading
Shane J. Lopez, ed., Positive Psychology: Exploring the Best in People (Westport, Conn.: Praeger, 2008).
Mark R. McMinn and Clark D. Campbell, Integrative Psychotherapy: Toward a Comprehensive Christian Approach (Downers Grove, Ill.: InterVarsity Press Academic, 2007).
Bibliography
McMinn, Mark R., and Clark D. Campbell. Integrative Psychotherapy: Toward a Comprehensive Christian Approach. Downers Grove, Ill.: InterVarsity Press Academic, 2007.
Seligman, Martin E. P. “Positive Health.” Applied Psychology: An International Review 57 (2008): 3–18.
Young, Jeffrey E., Janet S. Klosko, and Marjorie E. Weishaar. Schema Therapy: A Practitioner’s Guide. New York: Guilford, 2003.
