Christian Counseling and the Life of Jesus

counseling image 2This is the fourth in a series of posts which examines the 95 Theses for an Authentically Christian Commitment to Counseling published by the Association of Certified Biblical Counselors and authored by Dr. Heath Lambert. I offer this critique from my perspective as a psychology professor and mental health counselor. For prior posts in the series on the first fourteen theses, click here. Today, I examine thesis 15.
Is Jesus the Standard for Everything?
This section focuses on Jesus as a standard for Christian mental health.

  1. Counselors require a standard to know what changes must be pursued in the lives of the troubled people they wish to help and, because the Bible portrays Jesus Christ as that perfect standard for human living, it is impossible to accomplish authentically Christian counseling without reference to him (1 John 2:5-6).

I can’t tell what this statement means in a practical sense. Knowing that Jesus is perfect in every way doesn’t tell me what kind of changes human beings should pursue in counseling. Three possibilities occurred to me which I will frame as questions:

  • Does Lambert mean Christian counselors should always pursue change in every dimension of personality (i.e., behavioral, emotional, cognitive, moral)?
  • Is he referring to the outcomes of counseling? Does he mean that Christian counseling should lead to clients being perfect as Jesus is perfect?
  • Or does he mean that counselors should only deal with issues depicted in the Bible’s accounts of the life of Jesus?

Each of these questions deserve a separate article for a full response. For the purpose of this post, I will briefly reply to each one.
Symptom v. Personality Change
Historically, counselors have debated the scope of counseling. Should counseling focus on symptom removal or on deeper personality change? Modern approaches aim for symptom relief while older approaches such as psychoanalysis focus on personality change.
I see nothing in the Bible which requires all counseling to deal with every level of human functioning. I believe counseling may properly deal with one aspect of functioning (e.g., symptom reduction versus deep personality change). In fact, Jesus at times healed diseases without any obvious attention to other areas of life. The needs of clients should guide counselors in planning their interventions.
Can We Be as Healthy as Jesus?
Although Jesus healed diseases in others, there are no recorded instances of Jesus suffering with medical or mental disorders. Does that mean he lived in such a way that he never suffered health problems? Or did His divine nature prevent those effects of a sinful world? Many theologians believe Jesus was unable to sin.* In like manner, could it be that Jesus was unable to experience mental or physical disease? Since He healed others, perhaps He healed Himself at the first sign of any disease. Or, on the other hand, is it possible that Jesus could have gotten cancer or suffered with bipolar disorder? Charles Spurgeon did not believe Jesus was ever ill. In his sermon, “Help for Your Sickness,” Spurgeon said no “disease was upon him.”
Spurgeon on sickness
Is Jesus a Perfect Standard for Every Aspect of Living?
Jesus is an example of obedience to the Father, holy living, and sacrifice. He modeled a life of virtue and was the substitute for our transgressions. He is our example for moral conduct and virtuous reflection. About this, most Christians agree. However, there is much Jesus didn’t cover during his short time on Earth.  Jesus’ teachings are the standard as far as they go.
We don’t know much about the life of Jesus outside of His mission to rescue people from sin. While the New Testament speaks in general terms about the humanity of Jesus, I don’t think it is possible to know with certainty what that means for mental health treatment.
Jesus didn’t deal with much of what we need to know to live today. He never chose a college, a spouse, or a profession. He never invested in a retirement account or purchased insurance. He didn’t play sports or watch movies. What He taught us we should emulate. However, on many aspects of human living, He offered no specific example or teaching.  We must use our minds in community with others to figure out how to pursue the rest.

For the earlier posts in this series, click here.

 
*This is certainly true of theologians who teach at Southern Baptist Theological Seminary where Heath Lambert also teaches counseling. In a 2015 article, Denny Burk wrote:

Jesus’ impeccability in this regard has provoked some people to wonder whether his experience of temptation can ever be as intense as that of the sinners that he came to save. Can he really have known our weaknesses when he himself was not capable of sinning? (p. 104)

Burk believes Jesus did know the temptation but was unable to sin.

The text plainly says that God cannot be tempted by evil. In what way are we tempted by evil that God is not tempted by evil? Verse 14 gives the answer. We face temptations that arise from our “own desire” (1:14). By contrast, because Jesus never desired evil, Jesus never faced temptations arising from “his own sinful desire.” His heart never in any degree fixated on evil. Temptation had no landing pad in Jesus’ heart nor did it have a launching pad from Jesus’ heart. The same is not true of sinners, who are often carried away by their own desires, as James describes it. (p.105)

 

Petition Reignites Biblical Counseling Controversy at Southern Baptist Theological Seminary

counseling image 2In September, I wrote about a controversy at Southern Baptist Theological Seminary involving the Christian psychology of Eric Johnson and the Biblical counseling of Heath Lambert. According to Johnson, his version of Christian psychology is no longer compatible with how SBTS wants counseling taught at the school. Thus, he had to step down from his position. It is not clear if he was fired or negotiated a settlement of some kind.

Reviving Eric Johnson’s Position Revisited

At the time, a petition was constructed to register discontent with Johnson’s ouster. Now, an update has been posted to the petition with a broader aim. The petition to SBTS now asks:

Given the obvious harm that these consequences would cause both to the standing and reputation of Southern Seminary, the following are recommended steps that should be taken and questions to be asked next week as the Board of Trustees visit Southern Seminary:

 

  • Offer immunity and anonymity to any and all professors who would be willing to speak with the trustees regarding this situation. Many of them know far more than we do but are terrified of speaking out for fear of ending up like Professor Johnson. Allow them to simply affirm, deny, or elaborate upon anything said in this letter without the fear of disciplinary actions.
  • Reconsider the silencing effects that the removal of tenure in 2014 has had up the seminary’s faculty, as they have been afraid to speak up for their terminated colleague, Professor Johnson. Please take steps to reinstate tenure. Tenure ensures the continuity of an institution’s identity, maintains the financial security for faculty families, and establishes boundaries that prevent the president from wrongfully firing professors. Before the removal of tenure in 2014, professors could be justifiably removed for moral or doctrinal transgression. There is no added benefit to the new faculty contract policy aside from the consolidation of power within the office of the president. The reason alumni are writing this letter is because all the faculty and staff members who contacted us were afraid that they would lose their job by speaking out.
  • Southern Seminary’s counseling program is very important in the life of Southern Baptist Churches, as it is on the front lines of pastoral and congregational soul care. Is it in the best interest of the churches that Southern Seminary serves to train up future pastors in a monologuing counseling department? Should pastors not study under both biblical counselors and Christian psychologists as they learn how to care for the complex needs of their churches?
  • Ask President Mohler directly whether any ACBC-affiliate (church, person, organization) was involved in his termination of Johnson. If Mohler refuses to provide a direct “yes” or “no” answer, ask him whether or not his reluctance to speak about the termination is the result of a non-disclosure agreement. It is imperative that the truth come out so that the Seminary can move on and begin a healing and reunifying process.
  • Based upon the findings of the above mentioned investigations, if it is found that there was any improper conduct that led to the termination of Professor Johnson, we recommend that the Board of Trustees extend a public apology to Johnson and offer to reinstate him in his original position at Southern Seminary.

This Story Is About More Than Eric Johnson and Heath Lambert

Johnson’s personnel matter is wrapped up in a broader issue. Will Southern Baptist pastors be exposed to one narrow approach to counseling or will they have access to training and teaching which takes psychological insights into account? Why this matters to a broad audience is that many people go to their pastors for counseling or for recommendations for counseling. It would be tragic and potentially dangerous for pastors to refer only to Biblical counselors.
Note to the folks at SBTS, mental illness is real and the Bible doesn’t say much about it. Recently, I featured representatives of Biblical counseling and Christian psychology in a discussion about a case. It was clear to me that the Biblical counseling approach left important components out. Furthermore, there are many problems in living which Scripture doesn’t address.
 

Should Christian Counselors Talk Only About The Bible And Jesus?

If a resource is authoritative, does that make it all you need?

counseling image 2If a resource is authoritative, does that make it all you need? According to the 95 Theses for an Authentically Christian Commitment to Counseling, the Bible is both authoritative and sufficient for all counseling conversations. In this post, I challenge that claim.
This is the third in a series of posts which examines the 95 Theses from my perspective as a psychology professor and mental health counselor. For prior posts in the series on the first eleven theses, click here. Today, I examine statements eleven through fourteen.

What Does the Bible Claim?

11. When the Bible claims to address all the issues concerning life and godliness, it declares itself to be a sufficient and an authoritative resource to address everything essential for counseling conversations (2 Pet 1:3-4).

I covered this thesis in the last post but I want to say something else about it. There I pointed out that living a “godly life” doesn’t mean the absence of emotional disturbances. A godly life is certainly possible for the person who believes God’s promises, but this by itself doesn’t prevent mental illness. The Bible does instruct us in moral teaching but is not a medical or psychological text. We need knowledge not contained in the Bible to provide the best care for many human problems.
Here again are the verses which form the basis for the statement:

His divine power has given us everything we need for a godly life through our knowledge of him who called us by his own glory and goodness. Through these he has given us his very great and precious promises, so that through them you may participate in the divine nature, having escaped the corruption in the world caused by evil desires.

One must read into these verses to say that “the Bible claims to address all the issues concerning life and godliness.” One could assume that the Bible is an aspect of his divine power, but the verse doesn’t limit God’s divine power to the Bible. I think Biblical counselors make a claim for the Bible that it doesn’t make for itself.

Authoritative Doesn’t Mean Sufficient

12. Christians must not separate the authority of Scripture for counseling from the sufficiency of Scripture for counseling because, if Scripture is to be a relevant authority, then it must be sufficient for the struggles people face as they live life in a fallen world (2 Pet 1:3-21).
13. The authority and sufficiency of Scripture for counseling means that counselors must counsel out of the conviction that the theological content of Scripture defines and directs the conversational content of counseling.

Sufficiency does not necessarily follow from authority. One may see the Bible as authoritative when it speaks but not believe it speaks about everything. There can be no doubt that the Bible doesn’t speak about everything. The Bible does say some things about medical issues (e.g., Timothy was told to take a little wine for his stomach’s sake, 1 Tim. 5:23), but doesn’t describe brain surgery procedures or how to do a heart catheterization. Taking some wine instead of tainted water might be good advice, but it isn’t sufficient for most of our other medical questions.

Does Jesus Solve Every Problem?

14. The Bible teaches that the person and work of Jesus Christ provide God’s sufficient power to solve every problem of humanity so, according to Scripture, he is the ultimate subject of every counseling conversation (Col 2:2-3).

Surely, Dr. Lambert and the Biblical counselors don’t mean that Jesus actually solves “every problem of humanity.” A quick look around wherever you are will demonstrate that Jesus hasn’t solved every human problem. One can argue that Jesus has the power to solve them all but decides not to do it, but you can’t argue that all problems are solved.
Since all problems aren’t in fact solved, what happens in those counseling conversations where Jesus didn’t solve the problem? Do client and counselor keep talking about the power of Jesus in a theoretical sense? I can’t imagine how it would be helpful to keep telling a chronically depressed person that Jesus has the power to solve every human problem, just not yours.
By analogy, one would not say Jesus is the subject of every medical visit. Most evangelicals believe Jesus could heal any illness, but that He doesn’t often do so. Because we believe Jesus provides sufficient power to solve every medical problem, is it necessary for a Christian physician to make Jesus the subject of every medical conversation? Of course not, if I have a medical need, I want extra-biblical medical knowledge brought to bear on my problem along with prayer.

SERIES: Evaluation of the Association of Certified Biblical Counselors’ 95 Theses

I am evaluating a proposal by Heath Lambert, the executive director of the Association of Certified Biblical Counselors, for an authentically Christian approach to counseling. Lambert listed 95 theses on the ACBC website which he believes defines an appropriate Christian method. I disagree with most of the points and am writing this series to offer another perspective. To read all posts in this series, click here.  To read a similar series on Biblical counseling v. Christian psychology, click here.

Biblical Counseling v. Christian Psychology: Tim Allchin Reacts to McConnell and Throckmorton

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In this final article in the Biblical Counseling v. Christian psychology series, Biblical counselor Tim Allchin provides his reactions to A.J. McConnell and me. I will have some additional remarks at the conclusion of this post.

Allchin: Thank you for letting me take part in this series.  I enjoyed the interaction and perspectives and the shared heart we have for helping this young man thrive (click here for the case of school refusal).  I also appreciated the fact that we could disagree without choosing to divert the conversation into name-calling or mockery.  Too many of these conversations have carried the tonality that was often found in the comments section but the main articles modeled a better way of interaction.  I hope biblical counselors and Christian psychologist and secular counselors can learn from each other and learn to discuss our differences with respect.  We will often disagree, but Christian counselors must be committed to conversations that are full of grace and truth.
Regarding the case study, I agree with Dr. Allen Frances when he states that “accurate diagnosis in kids is really tough and time consuming. Misdiagnosis in kids is really easy and can be done in 10 minutes. Accurate diagnosis in kids leads to helpful interventions that can greatly improve future life. Misdiagnosis in kids often leads to harmful medication and haunting stigma.”  All three counselors clearly care about the child and want him to be treated carefully and bring different perspectives to the table.

Two questions I would raise in response to the critiques of biblical counseling and the case study mentioned:

What is the best way to view anxiety?  Is anxiety a cognitive, physiological or spiritual issue? It is all three.  Anxiety is not best viewed as purely a physiological disorder disconnected from any current or past thought process that have solidified one’s viewpoint of life.  This is confirmed by the fact that the evidenced based research confirms CBT is the most effective mental health treatment for anxiety disorders.  I agree with AJ’s statement, “a child with this condition, is experiencing a significant amount of fear that they do not know how to respond to appropriately.” Even adults don’t know how to respond to our fears on our own.   More than 500 times in scripture the condition of fear is address either in command or narrative.   Why is this such a strong theme?  Fear is part of our fallen condition which needs to be redeemed and transformed.  It is there from birth and in some ways will be there till we die, but hope for the anxious is not found in relaxation, medicine or distractions.  It is found in the cross, where Jesus died and where the new creation is consummated.  Our anchor in anxiety within a Christian counseling model should be Romans 8:38-39  “For I am sure that neither death nor life, nor angels nor rulers, nor things present nor things to come, nor powers, 39 nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord.”  If we have the hope of the world, why would we hide it?
Anxiety is clearly a spiritual condition as well if we are to take seriously the words of Jesus, “Do not be anxious about tomorrow,” “which one of you by being anxious can add a single hour to his span of life,” “Do not fear those who kill the body, but cannot kill the soul.”  In the case of PANDA’s (which is likely a small portion of overall anxiety cases), physiological feelings that mimic the physiological feelings of anxiety are not the same as cognitive and spiritual anxiety. Throckmorton writes, “Depression, panic disorders, eating disorders, etc., represent mind-body dysfunctions which require the help of science to understand and treat. I appreciate that Tim Allchin recommends good medical care, but in doing so it appears to me that he goes beyond the scope of the 95 Theses.” But Heath Lambert writes in Theses 84 “It is a misunderstanding of the essential nature of human beings—with a body and a soul—for Christians to minimize the importance of medical treatment in their care for troubled people (1 Tim 5:23).”  If any part of anxiety is a spiritual issue, then it is a heart issue. Again Lambert asserts in Theses 83,  “It is a misunderstanding of the essential nature of human beings—made with a body and a soul—for Christians to present physical interventions as solutions to spiritual problems.”  In reality, every counseling issue is also a spiritual heart issue (Proverbs 4:23).  With our heart, we choose to care for our God-given body (I Cor. 3:16-17).  With our heart, we choose to embrace new ways of thinking about our anxieties (I Peter 5:7-9).  We respond to physical pain, emotional trauma, and relational disappointment with a spiritual response, not just a physical one (James 1:2-4).  Certainly, we need a medical response to physiological issues, but thriving physiology is not sufficient to help people thrive.  They need to know, fear and love God to thrive.  This is an essential evangelical commitment that shouldn’t be placed aside, even in the counseling office.
Why does this matter?  Throckmorton writes “Techniques are judged by their utility in solving a problem.”  Biblical counselors would insist that anxieties are both physiological and spiritual in nature.  Just because you might be able to sever the physiological difficulties associated with anxiety does not mean that you have solved the spiritual struggle of anxiety.  It’s not that we would minimize the physiological care, but we would see it as inadequate and incomplete for holistic care. Second, we would view many physiological symptoms that accompany anxiety as able to be reduced through healthier thought patterns and physical care (sleep, exercise, nutrition and structure) in keeping with the pattern laid out in scripture.   The spirit of man is real, even if it can’t be measured and it needs to be treated.  Conversely, the spirit of man resides within a physical body that impacts how the spirit functions and it needs to be treated as well.  This dualist nature of man is routinely described within the commands and narratives of scripture and corresponds with good science in the contemporary culture.   It also corresponds how the Christian church has wrestled with these issues through the entirety of the history of the church.  I like how David Powlison brings a balance to this tension, “If you don’t seek to meet people’s physical needs, it’s heartless. But if you don’t give people the crucified, risen and returning Christ, it’s hopeless.”
Does biblical compliance help a young person thrive? 
Throckmorton’s critique of biblical counseling was that the “biblical counseling approach is wrong to put emphasis on lack of biblical compliance, especially with childhood mental health concerns. It is too easy to feel false guilt tied to the belief that mental and emotional problems stem from lack of biblical compliance. This focus can also distract a counselor from more pressing problems in a client’s life.”  I would ask in response,  “Is there ever a downside to someone who chooses biblical compliance as a way of life?”  For instance, Jesus said, “If you love me, keep my commandments,” “my ways are not burdensome,” and “teach them to observe all that I have commanded you.”  How could a Christian counseling model not intentionally teach that biblical compliance is of utmost importance to thrive in life?
Biblical Counseling is careful lest we create “better functioning rebels” who behavior and symptoms improve but whose heart is no more tender towards the Lord.  I would argue that all of us in our natural state are rebels and offensive towards God.  This applies to everyone regardless of what diagnosis they face.  The cancer patient is a rebel towards God.  However, the Bible does not teach that cancer is a punishment for sin or that the cancer patient received cancer because of their sin.  Still, “no one is righteous, not one.” However, I absolutely agree that Jesus’s conversation were deeper than simply than a declaration of the sinfulness of humanity. They were full of questions that revealed grace, hope, judgment, doctrine, empathy and correction. They were the full orb of conversational dynamics that were flexible to meet the heart condition of those he encountered.  He was the “good shepherd” in every way.  His conversations sought to increase the faith of those he came in contact with.  Those who were seeking answers, terminally ill, spiritually tormented, downtrodden from life, trapped in sin, oppressed by systemic injustice, hard-hearted by traditions, similar heart conditions to those who would often seek counsel in any psychologists or biblical counselors office today.  Jesus had an agenda to seek to strengthen their faith and love for him.   This is at the core of Christianity.  Biblical compliance without heart change was offensive to Jesus. He referred to it as “whitewashing a tombstone.”
Finishing with a few things I learned:
Biblical counselors are always looking for creative ways to help people apply the principles of the Word of God to everyday situations.  Both psychologists gave some creative answers about how to help a young person thrive and to help his parents love him well.  I appreciated reading the creativity and much of that is adaptable in a biblical counseling context.
Christian psychologists and biblical counselors often speak about the same things in different language.  It required all of us to be patient to understand the perspectives that each brings to the table. I think we made a good attempt to do that and the christian counseling community would benefit if we all did that more.

I have appreciated the tone and content of this exchange involving Allchin and McConnell. I believe the series is a good model for how to discuss deep differences among counselors of various types.

My Response to Allchin

Regarding Allchin’s remarks, I am skeptical of the following claims:

Allchin: What is the best way to view anxiety?  Is anxiety a cognitive, physiological or spiritual issue? It is all three.

Sometimes it is all three and sometimes it isn’t. Sometimes and for some people, anxiety comes as the result of faulty thinking and/or a lack of trust. At other times and for other people, anxiety is more like a faulty fire alarm. It just goes off with a full blown anxiety reaction without any spiritual or cognitive trigger. Effective counseling interventions reflect the assessment of different types of anxiety. While I might consider emphasizing patience in the case of anxiety as faulty fire alarm, I would not be inclined to use verses about one kind of fear as an intervention for another kind of fear. Lumping all experiences of anxiety together can lead to misapplications and ultimately unhelpful interventions.

Allchin:  Certainly, we need a medical response to physiological issues, but thriving physiology is not sufficient to help people thrive.  They need to know, fear and love God to thrive.  This is an essential evangelical commitment that shouldn’t be placed aside, even in the counseling office.

We don’t have a definition of thrive, but I am skeptical about this in a general sense. According to Christianity, we need to know God to be redeemed. If thriving is defined as being in a relationship with God, then only those in such a relationship can be described as thriving. However, non-believers prosper and can be well-adjusted and happy.
Another problem I have with this statement is the claim that evangelical commitments shouldn’t be placed aside in the counseling office. While that may be defensible when counseling Christians who seek it, I can’t see how this works with non-believers.

Allchin: Just because you might be able to sever the physiological difficulties associated with anxiety does not mean that you have solved the spiritual struggle of anxiety.  It’s not that we would minimize the physiological care, but we would see it as inadequate and incomplete for holistic care.

Allchin argues that a spiritual struggle must invariably occur with anxiety as a psychophysiological experience. I disagree. Anxiety might provoke a spiritual crisis but I believe anxiety can happen to any human, no matter how spiritually sound. For me, the care of the individual is what drives how holistic my interventions will be.
Allchin takes my disinterest in biblical compliance in the case of the school refusal as a sign that I minimize or disregard compliance with the Bible.

Allchin: I would ask in response,  “Is there ever a downside to someone who chooses biblical compliance as a way of life?”

I never argued that being compliant with the Bible isn’t a good thing. I did argue that we should not assume that non-compliance is behind the problems bring to counseling. Since I didn’t see any link between the school refusal symptoms and the boy’s religious life, why would I spend time focusing on something that wasn’t mission critical?
Allchin’s answer is that all people are sinners and so all people need an intervention at that level. While I agree that all people are fallible and subject to problems, I don’t think Christian counselors must address specific sin as a component of medical and psychological treatment.

Summary

Again, I appreciate the participation of Drs. Allchin and McConnell. The exchange has taught me a lot about Biblical counseling and helped me sharpen my perspectives.

Biblical Counseling and Sufficiency of the Bible

counseling image 2I am in the process of evaluating the 95 Theses published by the Association of Certified Biblical Counselors. The first post is here.  Today, I evaluate theses six through eleven. These statements seem to be key components of biblical counseling.

6. When people experience difficulties as they live in a fallen world, they require wisdom about life to help them face these problems (Prov 19:20).
7. The wisdom to confront life’s difficulties is most often communicated in conversations our culture refers to as counseling.
8. The issues of concern in counseling pertain to problems people face as they relate the difficulties in their life to the faith and practice described in Scripture.

I agree that counseling conversations often relate to common problems with work and family and that clients often want advice about them. I also agree that many problems in living are illustrated in Bible stories. In these situations, Christians could be well served by getting advice from someone who has studied the Bible thoroughly and has a knack for application. However, I don’t believe that all counseling problems involve requests for advice or guidance. Some relate to mental illness in self or others. I will say more about those counseling conversations below.
Furthermore, people today face problems never contemplated by people in the Bible. For instance, advice about what college to attend, what major to take, or what career to pursue, etc. are all specific issues which require specific, individualized conversations. The Bible doesn’t give any specific advice about how to choose a college or academic major.
Although clients may benefit from biblical principles about decision making, a conversation about the specific college and major still requires an individualized focus which could involve various career assessments and information about occupations not mentioned in the Bible.

9. Because counseling problems concern the very same issues that God writes about in his Word, it is essential to have a conversation about the contents of the Bible to solve counseling problems.

I may not understand the meaning of this statement, but on the surface, it seems inadequate and unrealistic. Frequently, counseling problems are similar to those described in the Bible, but often they are much different. We live in a different era and culture. There are daily demands which are radically different than anything reported in the Bible.

10. The subject matter of counseling conversations is the wisdom needed to deal with life’s problems, and so counseling is not a discipline that is fundamentally informed by science, but by the teaching found in God’s Word.

As I demonstrated in my article on school refusal, all conversations don’t require Bible knowledge in order to address the problems people bring to counseling. We could have talked about the Bible in my sessions with the school refusal family, but I can’t see how it would have addressed the main reason they came to see me. On the contrary, we discussed a solution which did not come from my study of the Bible but rather my study of family systems theory. I could have consulted the Bible for days and not come up with that.
Although the case of the boy with school refusal ended well, I now realize he might have had a medical problem which triggered separation anxiety. The problem I wrote about — PANDAS — was discovered by scientists at the NIMN, not theologians in the Bible. There are many other problems which afflict humans in the mind and mood which we have come to understand through science. Counselors, biblical or otherwise, ask for trouble when research is ignored.

11. When the Bible claims to address all the issues concerning life and godliness, it declares itself to be a sufficient and an authoritative resource to address everything essential for counseling conversations (2 Pet 1:3-4).

Actually, these verses don’t say that the Bible addresses “everything essential for counseling interventions.” I think Dr. Lambert and his supporters engage in eisegesis and not exegesis of these verses. Second Peter 1:3-4 reads:

3 His divine power has given us everything we need for a godly life through our knowledge of him who called us by his own glory and goodness. 4 Through these he has given us his very great and precious promises, so that through them you may participate in the divine nature, having escaped the corruption in the world caused by evil desires.

Through His divine power, we have the Bible (although the New Testament wasn’t fully together at this time), we have the Holy Spirit and the church. These resources provide sufficient moral teaching to let us know what God requires of us. Because of those divine resources, we can have a place in God’s Kingdom. This is Peter’s focus in the chapter.
However, the Bible does not promise to provide the best way to assess and treat medical and mental disorders. I can’t find that promise in 2 Peter or anywhere else. Those disorders are valid subjects of counseling conversations. Often with the involvement of several healthcare professionals, people find relief from these problems.
Peter promises that resources are available to live “a godly life” not a problem-free life. As a matter of experience, I have known many godly people who experience mental and emotional disorders. Godly Christians and non-Christians experience these conditions. Assertions to the contrary are contrary to reality.  I believe biblical counselors who hold to thesis eleven read into 2 Peter something that wasn’t intended.
The authority and sufficiency of Scripture for counseling is the key tenet of biblical counseling. There are numerous overlapping statements in the 95 Theses. I will pick up my critique of this theme in the next post.
To read all posts in the 95 Theses series, click here.
 

Series: Evaluation of 95 Theses for an Authentically Christian Commitment to Counseling

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This week Tim Allchin, biblical counselor from Chicago, will help me complete the series I started on Biblical counseling v. Christian psychology (read the prior posts here).  This series was triggered by the news that Christian psychologist Eric Johnson was fired/taking early retirement from Southern Baptist Theological Seminary. With Johnson’s departure, the seminary is committed completely to a biblical counseling model. One expression of that model can be found in a document written by Heath Lambert titled 95 Theses for an Authentically Christian Commitment to Counseling.
With this post, I want to start a new series during which I will critique one or more of the theses from my vantage point as a mental health counselor and psychology professor.
I offer this series in keeping with the stated desire of Heath Lambert, the author of the theses and executive director of the Association of Certified Biblical Counselors:

And so I offer these theses for the purpose of debate. But they are also offered with a prayer. My prayer is that the spirit of the Reformers to recover the emphasis on divine grace in their day would be the commitment that Christians would have today regarding counseling.

Thus, I welcome the reaction of Dr. Lambert at any time during the series.

Counseling in Contemporary Culture

I will list one or more of the theses and then comment. There isn’t much to disagree with in the first three theses:

1. Christians in the twenty-first century live at a time when the counseling practice of many evangelical churches is marked by chaos and confusion regarding the nature of counseling.
2. Secular therapy has defined the nature and terms of counseling for more than a hundred years, and Christians responding to its influence have been confounded by it—not knowing whether to consume this secular therapy in an undiluted form, to combine it in some way with resources from the Christian tradition, or to reject it entirely in favor of an approach that relies exclusively on scriptural resources.
3. The confusion that exists on the part of Christians has been a distressing source of conflict among brothers and sisters in Christ who debate these issues, and has caused pain in the lives of troubled Christians who seek counseling care.

In don’t know how many are in “chaos” but I would agree that some Christians are confused about counseling. Generally, there is much we don’t know about mental health and brain based diseases and so it seems reasonable that Christians would also experience the confusion which goes along with that. Number two captures the broad historic responses to psychology by those in the church.

4. It is a matter of urgency that Christians coalesce around an understanding of counseling that is authentically Christian (Col 3:14).

Let me go out on a limb here and say that I doubt Christians will ever “coalesce” around any one understanding of anything. I disagree that it is a matter of urgency to come to one understanding. However, I do think it would be good if those who hold different views could discuss them rationally and on the merits. We can and should disagree agreeably without casting doubts on the spiritual commitment of ideological opponents.
Furthermore, the diversity of settings within which counseling is conducted make it unlikely that one view will ever win the day. Some Christians work in the public sector, others work in private settings such as the church. I don’t think we have a one-size-fits-all audience, so we won’t have just one approach to counseling.

5. A commitment to counseling that is authentically Christian requires believers in Christ to understand the nature of counseling, which resources must be used in counseling, and to possess growing skill in caring for people in need of counseling.

I don’t disagree, although I know that my definition of the nature of counseling and resources allowed is much broader than Lambert’s.
Again, I welcome Dr. Lambert’s reaction at any time. I don’t have a specific time table for the series and will post as time permits.
 
For more on Biblical counseling v. Christian psychology, see this series.
For all posts in the 95 Theses series, click here.

Christian Psychology v. Biblical Counseling: A. J. McConnell Reacts to Allchin and Throckmorton

Greek_uc_psi.svgI am in the middle of a series comparing and contrasting Christian psychology and Biblical counseling. Using a case of school refusal as a prompt, I have featured the conceptualizations of Biblical counselor Tim Allchin, and Christian psychologist A.J. McConnell as points of comparison to my description of how the case turned out. Today, A.J. McConnell sums up his views in this reaction to Allchin and me.  Next week, Dr. Allchin will provide a similar reaction to McConnell and me. After Allchin’s reaction, then I will wrap up the series.*

Overall, I have enjoyed reading the varying perspectives presented on this topic in both the responses by Dr. Tim Allchin and Dr. Warren Throckmorton as well as the comments provided by other readers in the comments section. Before I comment on Dr. Allchin’s and Dr. Throckmorton’s approaches, I wanted to briefly respond to a few of Dr. Throckmorton’s critiques on my conceptualization.
Dr. Throckmorton wrote:
“I have concerns about advocating techniques a client doesn’t ordinarily believe in or engage in as a technique….While there is research which links stress reduction with meditation, I believe Christian prayer should be a voluntary and spontaneous response to God rather than a prescribed technique of counseling.”
I agree with your statement and would never recommend or prescribe a technique that is contrary to a person’s belief system. If a Christian requests that I integrate Biblical principles with my knowledge of psychological interventions, I always first assess what spiritual disciplines they use in their daily life. This usually leads to a discussion on how they can use these disciplines as an adjunct with other interventions.
Dr. Throckmorton also stated:
“I must add that counseling is about much more than advice or guidance in moral decision making.”
I also agree with this statement. Not every issue brought into a counseling session is a moral issue. For example, I believe that an individual pursuing treatment for anxiety is looking for practical strategies they can use to stop having anxious thoughts and/or physical manifestations of anxiety. Similar to how a medical intervention can help anyone regardless of their religious beliefs, psychological science has provided several effective interventions that can help reduce anxiety or other mental health concerns.
My response to Dr. Allchin:
I enjoyed reading Tim Allchin’s conceptualization of the case example and respect his point of view. I found myself agreeing with many of Tim’s general interventions. Specifically, I agreed on the following points:

  1. I agree about medications not being the first option in this case. There are cognitive and behavioral interventions, for example, that can be used before even considering the need for medications. As Dr. Throckmorton discussed in his response about the role of PANDAS and separation anxiety, I would recommend the parents speak to the child’s pediatrician in order to rule out any underlying medical factors to this problem.
  1. I also agree that establishing a relationship with the child and family is vital for effective therapy. There are several research studies that indicate a strong therapeutic alliance is one of the strongest, if not the strongest, factor in effective outcomes in therapy. In other words, having a good relationship between a therapist and the child is just as important, and even more important, than the specific interventions used.
  1. I also agree with some of the examples of using a physical redirect as a replacement for anxious thoughts or behaviors. An example of a principle associated with behaviorism indicates that a behavior you are trying to extinguish needs to be replaced by an alternative behavior. Identifying alternative behaviors or physical redirects is a common strategy used by counselors.

In contrast, there are also areas in which I disagree with Allchin regarding this case. Here are a few examples:
Dr. Allchin wrote:
“What does the Bible say he needs to “put off” regarding fearful behaviors that lead to disobedience?”
Separation anxiety is a disorder and I do not believe that it comes from a spirit of disobedience towards God, the school, or the child’s parents. A child with this condition is experiencing a significant amount of fear that they do not know how to respond to appropriately.
Dr. Allchin also wrote:
“I would seek to help them identify emotions, behaviors, habits, beliefs, and heart motivations….. Biblical counselors seek to determine Action Steps that help a child function in a way that pleases God.”
Again, I perceive these quotes as indicating the problem is a “heart” issue rather than an issue of mental health. I did not get the sense in reading the case description that the child or family were exhibiting any oppositional, defiant, or other behaviors that would lead me to suspect any issues with their core belief system. Therefore, I would not focus on “heart motivations” or steps a child needs to do to “please God” in this situation.
On a side note:
I appreciate the role of Biblical counselors in our profession. They bring a unique perspective that is certainly applicable to many mental health concerns and they use the Bible as a strong resource to help others in need. However, Biblical counseling is not always appropriate for everyone. I would also make the same statement in regards to Christian Psychology and the western approach to Psychology in general. One reason why I chose psychology rather than becoming a pastor or a Biblical counselor is because I feel God called me to serve others as a psychologist. My role as a psychologist is not to convert people to Christianity. I’ll focus on that mission in my personal life. I work with many individuals that do not share my personal beliefs. My approach to everyone I work with, regardless of their religious views, is to respect them and not unnecessarily judge them for the choices and decisions they have made. I have worked with several individuals that have explicitly voiced their hatred towards the church, God/Jesus, and/or have expressed a belief in atheism. Their beliefs do not change how I approach them in counseling or treat them as a person when they are in my office. I feel that my professional role allows me to interact with a broader population. I enjoy the diversity and challenge when I meet people with other perspectives on life. It doesn’t compromise my faith or my relationship with Jesus. It helps me understand the world. I’m curious to how Biblical counselors would address these types of situations.
Response to Dr. Throckmorton’s conceptualization:
I am happy to hear that there was a successful resolution to this case example. The use of a paradoxical intervention was intriguing and one I may consider in the future if I encounter a similar situation. I have used paradoxical interventions in other situations involving working with families; however, this is not usually my first approach when addressing an issue of separation anxiety. My preference is a Cognitive-Behavioral approach given its strong research efficacy in treating this diagnosis. There is always a risk when using a paradoxical intervention that it will backfire and not have the intended outcomes that are desired by the therapist.
I appreciate Dr. Throckmorton’s willingness to review and consider new information in regards to this case example, as illustrated by the discussion of the role of PANDAS and its psychological impact on children. Personally, I have not researched any information on this topic but your post has reminded me of the importance of staying updated on scientific research findings in order to provide competent services to the individuals that we serve.
A quick note on other comments Throckmorton made about the 95 theses:
Similar to your opinion, I also disagree with Dr. Lambert’s theses statements #45 and #46 regarding the use of diagnostic labels in the DSM. These diagnoses are real conditions. Some are mentioned in the Bible. Other diagnoses are not. This does not make the DSM invalid. My specialty is in neurodevelopmental disabilities and I cannot recall symptoms of an autism spectrum disorder, for example, being discussed in the Bible.
I also take issue with Theses #72 and #73 regarding state licensure:

  1. The process of requiring a state license to counsel is not required by the Bible, is used by the state to enforce counseling practices founded on secular therapy, and is unnecessary for those wishing to grow in God’s wisdom to counsel.
  2. The only authentically Christian motivation for pursuing a state license to counsel is the missional desire of making Christ known to all people in all places, especially in those places where the authority of the state allows only licensed individuals to talk to troubled people.

These statements suggest that a professional counselor’s primary role is to convert others to the Christian faith. As Christians, we do not demand these expectations from Christians in other professions. We also do not expect other Christian professionals to not pursue a state license to practice medicine, nursing, law, accounting, teaching, etc. Most states require mental health professionals to obtain a license in order to practice. This provides a level of accountability and protects the public from harmful practices. Having a state license does not compromise a person’s faith. I find these statements to be judgmental and they place unnecessary guilt on an individual that has decided to pursue state licensure. If a Christian does not pursue a state license, it limits their ability to serve others. If this was the case, Christians would primarily only be able to provide counsel to others if they walked through a church door seeking help.

Thanks to Dr. McConnell for his participation in this series.
To read all posts in this series, click here.
*Even though I will wrap up this part of the series next week, I intend to start a new one featuring critique of Heath Lambert’s 95 theses.

Why We Need Science in Counseling: Another Look at a Case of School Refusal

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Last week, I started a series comparing and contrasting biblical counseling and Christian psychology. I presented a case of school refusal and asked a biblical counselor and a Christian psychologist to comment. Today, I discuss how the case turned out and offer a few observations.
From the initial post, here is the case:

A mother and her second grade son attended the first session together. The father was at work. A meeting with them revealed that the youngster was afraid to remain in his school classroom. The boy attended a local public school and had never been afraid to go to school before. However, within the first month of school, his pattern was to enter school and remain in his classroom. After just a few minutes, he bolted from the room to the school office seemingly in terror and asked for his parents. This had been going on for about a month nearly every day. He remained in school on days his class attended field trips or out of class activities (e.g., library days). The parents had tried alternating morning rides to school and his father had carried him back into the classroom on multiple occasions only to have the same result. He bolted from the class looking for his parents.
On examination, the boy had male typical interests, played rough and tumble sports, was tall for his age, and was socially popular. He had never displayed separation anxiety beyond the norm prior to this year. In all respects except the fear of remaining in his classroom, the boy and his family (one older female sibling) seemed entirely normal and unremarkable from a mental health standpoint. The parents were leaders in their Christian church and the boy happily attended Sunday School and had professed a belief in Jesus as his Savior.

Monday, biblical counselor Tim Allchin addressed the case. Tuesday, Christian psychologist A.J. McConnell did the same. To get the most out of this post, you should read those posts before you read this one. Today, I will briefly react to Allchin, then to McConnell, and then I will describe what happened. Finally, I want to discuss why science must be a part of counseling work.

Tim Allchin and Biblical Counseling

Allchin advocated a multi-faceted assessment of emotions, thoughts, behavior, physical health and compliance with biblical morality. He said his interventions would also be multi-faceted depending on what he learned in the assessment process. With the exception of assessment of biblical compliance, this is similar to how many Christian counselors proceed.
To highlight my differences with the biblical counseling approach, I will list one of Allchin’s statements and then reply to it.

Allchin: “My working assumption would be that some sort of traumatic experience is likely the genesis of this behavior.

While a traumatic experience could be involved in such a case, I try not to conduct assessments with strong assumptions about cause. I worry about the effects of confirmation bias in such instances. Fear is indeed involved in school refusal but a traumatic experience is not of necessity at the root of the fear.

Allchin: “I would want the child and parent to know that even a child’s beliefs determine actions, resulting in feelings that either escalate or calm.

Sometimes people have fears for which there is no discernible cognitive or environmental trigger. They just arise. Sometimes beliefs and thoughts follow feelings. Biblical counselors and cognitive therapists may disagree with me, but if I have learned anything from social psychology, it is that the link between attitudes and behavior goes both ways. I have worked with clients who experience negative mood states and then try to make sense of them by catastrophic thinking. Their thoughts then push them into a downward spiral but sudden anxiety was the first step in that process.

Allchin: “…biblical counselors seek to determine Action Steps that help a child function in a way that pleases God:”

Because I don’t assume a link between biblical compliance and mental health, I didn’t do this. If a child is misbehaving in other ways, then I might focus more on situational compliance (e.g., following guidelines at home and school), but since the complaint of the parent and school is refusal to stay in class, I focused on that.

Allchin: “Additionally, I am going to have conversations about the following with a christian family is being counseled: What does the Bible say he needs to “put off” regarding fearful behaviors that lead to disobedience? (Repentance)” etc…

I did not do any of this. Again, since I do not believe mental health is of necessity tied to biblical compliance, I don’t have these conversations unless the client raises the matter. Most clients who organize their lives around their faith will bring these things up without prompting.
Overall, in my view, the biblical counseling approach is wrong to put emphasis on lack of biblical compliance, especially with childhood mental health concerns. It is too easy to feel false guilt tied to the belief that mental and emotional problems stem from lack of biblical compliance. This focus can also distract a counselor from more pressing problems in a client’s life.

A.J. McConnell and Christian Psychology

Dr. McConnell’s approach is quite comprehensive and reflects a broad training in assessment and psychotherapy. The only qualm I have about Greek_uc_psi.svgMcConnell’s religious techniques is one that I also have with biblical counseling and that is the use of spiritual disciplines as counseling techniques. While there is research which links stress reduction with meditation, I believe Christian prayer should be a voluntary and spontaneous response to God rather than a prescribed technique of counseling. Techniques are judged by their utility in solving a problem. If clients are anxious and they view prayer as a kind of incantation or method to achieve a change in mood, how will they judge prayer if their anxiety persists? If prayer is a means to express something to God, it can never fail. If it is a technique, then it can and does fail. I have concerns about advocating techniques a client doesn’t ordinarily believe in or engage in as a technique. I will have more to say about this aspect of biblical and Christian counseling in my series wrap up post.

How the School Refusal Case Turned Out

As both Allchin and McConnell recommended, I did a comprehensive assessment of the youth and family. I asked the teacher and parents to complete a Connors Rating Scale and also interviewed the father. My working hypothesis after the first couple of interviews was that the boy experienced separation anxiety and was particularly focused on his mother. The boy couldn’t articulate why he was worried about her, he just was. He even expressed his confidence that she was fine at home, but he still worried about her when he was at school. I found no evidence of bullying, trauma, or social stigma. In a way, the simplicity of the symptom made the assessment process more complicated.
Since my working hypothesis was that the boy was experiencing separation anxiety, I decided to try what probably seemed odd and counterproductive to the parents. Drawing from the family systems tradition, I told the mother that she should stay with the boy during the entire school day, including lunch. I secured cooperation from the school for mother and son to do his classwork in a private room at the school. The mother and son initially seemed relieved at the suggestion. School officials were glad that the boy would be at school.
That seemingly paradoxical move brought mother and son together for extended periods of time. My belief was that the technique might actually cause them to want distance. I also felt that the risk was low since I would probably learn in short order more about the problem if the technique didn’t work to promote going back to class.
It didn’t take long for both mother and son to want distance. By the second week, the boy asked to go to recess and lunch without mother. After about three weeks, the boy was back in the classroom with very few residual problems. Through the winter, the parents described occasional new and random fears (e.g., the dark, going to a new place) but these were overcome with some gentle coaxing or the promise of a small reward.
From my vantage point, the child’s religious life had little, if anything, to do with his sudden and unprecedented separation anxiety. Likewise, I couldn’t find much evidence that his thought processes or beliefs preceded his fears. Rather, it became clear that his fears came first and the emergence of them evoked efforts from his parents, his relatives, himself and eventually me to explain his fears. When I couldn’t find an antecedent event or thought pattern, I decided that a more behavioral intervention might help clarify the picture. As it turned out, the intervention achieved the result desired by everyone in the situation.

What Happened?

Reflecting on this case, I have come up with two very different theories about why this case turned out well. The first is very much tied to the intervention. In this theory, I think natural apprehension about the first day of school may have accidentally become associated with the classroom. When he went to class, he experienced an undefined worry which was reinforced by the relief of leaving the classroom. To reverse the accidental pairing of classroom and worry, I put the mother in the school situation which initially brought relief. As the days went by, the inevitable frustration and friction produced by near constant contact with his mom replaced his anxiety over separation from her. His worried thoughts became replaced with other thoughts that did not evoke anxiety. When he was able to leave her for a time, he felt relief which reinforced the separation. I also believe that the mother had her fill of him and whatever worries she had about his safety and well being at school were replaced with other preoccupations. I was surprised by how quickly things changed.
I did not get this strategy from my study of the Bible. I am not sure where I would go to look for it in the Bible.

Could School Refusal Have Resulted from Strep Throat?

Long after this case was resolved, I learned about another possible cause of sudden separation anxiety and impulsive behaviors – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). The disorder results from the action of the antibodies created by the immune system to fight Streptococcus bacteria. The NIMH website provides a good description of the action involved:

The strep bacteria are very ancient organisms that survive in the human host by hiding from the immune system as long as possible. It hides itself by putting molecules on its cell wall so that it looks nearly identical to molecules found on the child’s heart, joints, skin, and brain tissues. This hiding is called “molecular mimicry” and allows the strep bacteria to evade detection for a long time.
However, the molecules on the strep bacteria are eventually recognized as foreign to the body and the child’s immune system reacts to them by producing antibodies. Because of the molecular mimicry by the bacteria, the immune system reacts not only to the strep molecules, but also to the human host molecules that were mimicked; antibodies system “attack” the mimicked molecules in the child’s own tissues.
Studies at the NIMH and elsewhere have shown that some cross-reactive “anti-brain” antibodies target the brain—causing OCD, tics, and the other neuropsychiatric symptoms of PANDAS.

As explained to me in 2009 by Susan Swedo, the scientist who identified PANDAS, the antibodies attack healthy brain cells and interfere with moods and emotions.

The science is clear now. We not only have a direct relationship between the anti-strep antibodies and the anti-neuronal antibodies, but also have demonstrated that the antibodies interact with receptors in the brain that could produce the symptoms observed.

Since learning about PANDAS, I have wondered if the school refusal case described in this series could have had the post-strep disorder. I didn’t ask about recent infections or strep throat as I would now. The sudden onset and then rather quick disappearance of separation anxiety and impulsive behavior fit the profile for other PANDAS kids I have known.
It should be obvious that I didn’t learn about PANDAS from the Bible. In future cases, knowing about PANDAS could alter my treatment strategies and solidify my conviction that a Bible based conversation about “perfect love casting out fear” might induce unwarranted guilt in a client with PANDAS.

Why We Need Science in Counseling

I understand why biblical and Christian counselors want to look to the Bible when they give advice to Christian clients. Although I don’t believe all good advice is in the Bible, I think the Bible as the rule of faith and practice, plays a vital role in developing sound advice.
Having said that, I must add that counseling is about much more than advice or guidance in moral decision making. Mental health professionals are called on to help treat mental and emotional disorders. According to Heath Lambert’s 95 Theses, these disorders are not the best descriptions of the problems people bring to counseling. Theses 45 and 46 state:

45. The Bible’s lack of technical and secular labels for counseling problems, such as those found in the Diagnostic and Statistical Manual of Mental Disorders, does not disprove Scripture’s sufficiency and authority for counseling because God uses his own, superior language to describe people’s problems (Rom 1:24-32).
46. The lack of biblical language in the Diagnostic and Statistical Manual of Mental Disorders demonstrates that the thinking of secular individuals is insufficient to grasp the true nature of people, the problems they bring to counseling, and the solutions necessary to bring about real and lasting change.

I will grant that DSM series has undergone numerous changes over the years. However, I don’t think mental disorders are simply linguistic inventions. Depression, panic disorders, eating disorders, etc., represent mind-body dysfunctions which require the help of science to understand and treat. I appreciate that Tim Allchin recommends good medical care, but in doing so it appears to me that he goes beyond the scope of the 95 Theses.  For instance, this statement seem to negate the importance of science:

10. The subject matter of counseling conversations is the wisdom needed to deal with life’s problems, and so counseling is not a discipline that is fundamentally informed by science, but by the teaching found in God’s Word.

Other statements in the 95 Theses document direct counselors to only use the Bible.

9. Because counseling problems concern the very same issues that God writes about in his Word, it is essential to have a conversation about the contents of the Bible to solve counseling problems.
11. When the Bible claims to address all the issues concerning life and godliness, it declares itself to be a sufficient and an authoritative resource to address everything essential for counseling conversations (2 Pet 1:3-4).
12. Christians must not separate the authority of Scripture for counseling from the sufficiency of Scripture for counseling because, if Scripture is to be a relevant authority, then it must be sufficient for the struggles people face as they live life in a fallen world (2 Pet 1:3-21).
13. The authority and sufficiency of Scripture for counseling means that counselors must counsel out of the conviction that the theological content of Scripture defines and directs the conversational content of counseling.
14. The Bible teaches that the person and work of Jesus Christ provide God’s sufficient power to solve every problem of humanity so, according to Scripture, he is the ultimate subject of every counseling conversation (Col 2:2-3).

In fact, it isn’t essential to have a conversation about the contents of the Bible to solve every counseling problem. Furthermore, I can think of situations where those kind of conversations have been counterproductive. I agree with A.J. McConnell when he wrote:

When Christians are told that Jesus and the Bible are all that is needed in counseling, this assumes that the person is in a mindset where they can accept Biblical advice and adequately apply it to their situation. In contrast, the nature of a disorder is that a person is suffering and they require counseling, medication, or a combination of both to become well.

Some Bible based conversations are so far off the mark that they evoke a false guilt which can be crippling. Some Bible based conversations lead bipolar people to go off their medication often leading to disastrous consequences. I feel sure that Tim Allchin and responsible biblical counselors don’t want to create those results but I am not convinced that biblical counselors who follow the 95 Theses closely would be able to avoid it. On that point, McConnell wrote:

Children and/or adults might feel unnecessary guilt from the church if they need to pursue professional assistance with a psychologist, psychiatrist, or other medical professional to treat a disorder. Most Christians and churches do not shame an individual for pursuing medical interventions for diabetes, cancer, hypertension, etc. The same approach should be taken for mental illness in order to reduce this unnecessary guilt. Overall, I recommend finding a specialist that aligns with your beliefs (2 Corinthians 6:14).

I hope this series has helped to clarify the range of opinions among Christians who work in counseling. Tomorrow, I hope to wrap up the series with reactions from McConnell and Allchin. And you can have the last word in the comments section.
To see all posts in this series, click here.

Christian Psychology v. Biblical Counseling: A Christian Psychologist Responds to a Case of School Refusal

Greek_uc_psi.svgLast week I posted the case of a young child with school refusal. I treated the child without relapse and wondered how a biblical counselor would conceptualize the case. I was especially interested in how Health Lambert would respond, because Lambert recently wrote a document titled Ninety-Five Theses for an Authentically Christian Commitment to Counseling. Lambert is the executive director of the Association of Certified Biblical Counselors and promotes biblical counseling which is to say counseling that relies on solely on the Bible for the answers to the problems addressed in counseling. I became interested in Lambert’s approach because of an accusation that he was involved in the firing of popular Christian psychologist Eric Johnson. Lambert later denied any role but it is clear that his biblical counseling model is the dominate approach at the Southern Baptist Theological Seminary, the flagship theological school of the Southern Baptist Convention. Unfortunately, I have not had a reply from Dr. Lambert.

Biblical Counseling v. Christian Psychology: The Series

Instead, yesterday I posted the case conceptualization of Tim Allchin, a biblical counselor in Chicago who runs a ACBC approved training site. In today’s post, I provide a case conceptualization from A.J. McConnell, a Christian psychologist who attempts to integrate the Bible and psychology. Although those outside of Christianity might not see much difference between the two approaches, historically adherents of the two approaches have accentuated the differences.
Tomorrow, I will describe my approach and provide the results of treatment. In addition, I plan to discuss both Allchin’s and McConnell’s approach. Also, I will critique my own plan and talk about how I would approach a similar case now.

A Case of School Refusal

Here is the case:

A mother and her second grade son attended the first session together. The father was at work. A meeting with them revealed that the youngster was afraid to remain in his school classroom. The boy attended a local public school and had never been afraid to go to school before. However, within the first month of school, his pattern was to enter school and remain in his classroom. After just a few minutes, he bolted from the room to the school office seemingly in terror and asked for his parents. This had been going on for about a month nearly every day. He remained in school on days his class attended field trips or out of class activities (e.g., library days). The parents had tried alternating morning rides to school and his father had carried him back into the classroom on multiple occasions only to have the same result. He bolted from the class looking for his parents.
On examination, the boy had male typical interests, played rough and tumble sports, was tall for his age, and was socially popular. He had never displayed separation anxiety beyond the norm prior to this year. In all respects except the fear of remaining in his classroom, the boy and his family (one older female sibling) seemed entirely normal and unremarkable from a mental health standpoint. The parents were leaders in their Christian church and the boy happily attended Sunday School and had professed a belief in Jesus as his Savior.

Below, Dr. McConnell responds:

My name is Dr. AJ McConnell and I am a clinical psychologist. My clinical expertise is in the diagnosis, assessment, and treatment of individuals with neurodevelopmental disabilities. I also have significant experience working with individuals with anxiety disorders, depressive disorders, marriage and family concerns, and other mental health conditions.
As a Christian, I will integrate the Bible and my expertise in the science of psychology when working with an individual that has requested and provided consent for faith-based counseling. There are seven main reasons why I wanted to provide a response to the Dr. Throckmorton’s case example.

  1. My experience as an individual that has attended church throughout my life is that most churches often minimize mental health and there are a lack of churches with adequate resources to help and serve the mentally ill. It is simply not a significant focus of Christianity in America.
  2. There is still a stigma regarding mental health, particularly among Christians. The brain is an organ in the human body. Similar to other organs (i.e., heart, lung, pancreas, etc), the brain may need treatment when medically necessary. Science indicates that many psychological disorders have a biological cause. For example, low levels of the neurotransmitter, Serotonin, contributes to symptoms of depression. Furthermore, low levels of GABA is associated with anxiety.
  3. When Christians are told that Jesus and the Bible are all that is needed in counseling, this assumes that the person is in a mindset where they can accept Biblical advice and adequately apply it to their situation. In contrast, the nature of a disorder is that a person is suffering and they require counseling, medication, or a combination of both to become well.
  4. Children and/or adults might feel unnecessary guilt from the church if they need to pursue professional assistance with a psychologist, psychiatrist, or other medical professional to treat a disorder. Most Christians and churches do not shame an individual for pursuing medical interventions for diabetes, cancer, hypertension, etc. The same approach should be taken for mental illness in order to reduce this unnecessary guilt. Overall, I recommend finding a specialist that aligns with your beliefs (2 Corinthians 6:14).
  5. One of the impressions from reading the 95 Theses written by Heath Lambert was that mental illness is the consequence of sin. I agree that we live in a fallen, sinful world, but Jesus rebuked the notion that a disorder / illness is always a consequence of an individual’s sin (see John 9:1-7).
  6. There is confusion among the Christian church regarding the field of psychology. Psychologists do provide counseling. However, we also specialize in other areas, such as psychological testing / assessments. For example, one of my specialties is in psychological assessments that determine if an individual meets criteria for an autism spectrum disorder, learning disability, or intellectual disability. My assessments are used by schools to assist students that need special education services. I strongly believe that there are psychological interventions that do not contradict the Bible.
  7. I admit that my views are not perfect. I have never meet Dr. Heath Lambert but I would assume that we would agree on most things with only a few minor differences. I believe a healthy and constructive debate regarding Biblical Counseling and Christian Psychology can be beneficial in both a professional and spiritual sense (Proverbs 27:17).

Regarding the case example, here would be my proposed approach using an integration of the Bible and psychological interventions:
Stage One: Initial Assessment
Based on the description provided, I would assume the child met DSM-5 criteria for a Separation Anxiety Disorder.
The first step is conducting a comprehensive initial assessment with the child and his mother. This would involve asking questions regarding the nature of the child’s anxiety at home, school, and church. Given the sudden onset of symptoms, I would also assess for any recent family stressors, abuse, bullying, and/or academic difficulties. Next, I would ask both the child and his parents what they have attempted to resolve the issue prior to starting counseling. I believe it is also important to gain an understanding of how they view the Bible and what verses and other spiritual practices, if any, they have been implementing to better understand and resolve their situation.
As a psychologist, I would collect data to assist in determining the appropriate diagnosis and to help guide treatment. Examples include having the child, parent(s), and teacher complete the BASC-3. I would also have the child complete the Beck Youth Inventory – Second Edition, specifically, the anxiety and self-concept inventories. If resources were available, a “Functional Behavior Assessment” would be completed. This would provide information on what happens in the classroom immediately before the child attempts to leave the classroom and what the consequence of the behavior is. This helps identify the function or purpose of the child’s behavior.
Stage Two: Treatment
My treatment approach would integrate Biblical principles and science. Cognitive-behavioral therapy (CBT) is an evidence-based approach for this type of case example (see http://effectivechildtherapy.org/concerns-symptoms-disorders/disorders/fear-worry-and-anxiety/ for a list of evidence-based approaches for anxiety). The premise of CBT is that an individual’s thoughts, emotions, and behaviors are interrelated and influence each other. A part of the psychologist’s role in CBT is to assist individuals in identifying and modifying any “thinking errors” and/or maladaptive behaviors that are contributing to a problem.
Cognitive Interventions:

  • Discuss patterns of thinking errors that are common for children with anxiety.
  • Help child identify his “self-talk.” In other words, what does the child tell himself or think about when he is feeling anxious. Similarly, what thoughts does he have to help him feel less anxious. A worksheet I use has children fill out thought bubbles in cartoon examples to help them understand the concept of “self-talk.”
  • Help child identify how to rate the intensity of his anxiety on a scale from 1-10. I will have some children and/or parents use the Daylio app to track their level of anxiety.
  • Identify and study Bible verses on anxiety in order to understand how God thinks about anxiety. This provides a healthy and Biblical model of how to think about anxiety.

Behavioral Interventions:

  • Replace worrying and anxious thoughts with prayer.
  • Biblical meditation. Meditate on verses regarding anxiety as well as verses regarding the protective nature of God.
  • Teach and practice deep breathing exercises.
  • Teach and practice progressive muscle relaxation exercises
  • Teach assertive communication if teasing / bullying is occurring within the school setting.
  • In-vivo exposure to anxiety-producing situations. This should be presented in a hierarchical order ranging from least anxiety provoking to most-anxiety provoking.
  • Real life exposure to anxiety-producing situation at school.

Other interventions:

  • Discuss and educate child and parents on how God created the human body. A simple description is explaining that the Limbic system in or brain processes our emotions (e.g., fear) and that our autonomic nervous system is either in a state of relaxation or activation against stress. Therefore, we cannot both be calm and anxious at the same time. Exercises such as deep breathing, muscle relaxation, and other relaxing activities forces our body to calm down in response to stress and anxiety.
  • I also have children create or draw a list of coping skills they can use when feeling anxious. I encourage them to focus on activities in four areas: creative tasks, social outlets (who they can talk to), physical activities, and relaxation. This will help the child identify things that he/she can do when he begins to feel the first signs of anxiety at school.
  • Develop plan with parents and school staff on how to approach situations in which the child feels anxious. Designate a space where the child can take a break and/or meet with an available staff person to discuss anxiety.
  • Have child carry picture of parents and/or a personal belonging of his parents that he can hold onto in the classroom.
  • Use a visual schedule with the child so that he can see the daily routine of the school and also help him identify what time of day he will get to go home and see his parents.
  • Provide child with a notebook that he can use to write a letter or draw a picture for his parents when he first arrives into the classroom.
  • Have parents provide child with a short note that he can only read once he enters the classroom.

Last, as a psychologist, I would continue to collect data to determine if treatment is effective. This would include obtaining feedback from the child and parents, reviewing parent and teacher behavioral logs, and/or additional administration of psychological tests (e.g., BASC-3).
I can be reached via email if anyone would like to provide feedback to my case conceptualization.

Tomorrow, I will react to the Allchin and McConnell and present my approach.
To read all posts in this series, click here.

Biblical Counseling v. Christian Psychology: A Biblical Counselor Responds to a Case of School Refusal

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Last week I posted the case of a young child with school refusal. I treated the child without relapse and wondered how a biblical counselor would conceptualize the case. I was especially interested in how Health Lambert would respond, because Lambert recently wrote a document titled Ninety-Five Theses for an Authentically Christian Commitment to Counseling. Lambert is the executive director of the Association of Certified Biblical Counselors and promotes biblical counseling which is to say counseling that relies on solely on the Bible for the answers to the problems addressed in counseling.
To date, Lambert has not replied to my requests. Instead, I am happy to include the case conceptualization of Tim Allchin, a biblical counselor in Chicago who runs a ACBC approved training site. Tim’s response to the case came from his comment on the original post.

Biblical Counseling v. Christian Psychology: The Series

The question in the original post has now grown into a series. My plan is to present the original case again here along with Tim’s comments. I will make some brief comments.  Then I plan to present a conceptualization by a Columbus, OH Christian psychologist A.J. McConnell on Tuesday. I will also comment on A.J. contribution. Then on Wednesday, I will provide the rest of the story. I will describe how the case turned out and raise some questions about the Ninety-Five Theses. On Thursday, I will wrap up the series.

A Case of School Refusal

Last week, I wrote about the following case:

A mother and her second grade son attended the first session together. The father was at work. A meeting with them revealed that the youngster was afraid to remain in his school classroom. The boy attended a local public school and had never been afraid to go to school before. However, within the first month of school, his pattern was to enter school and remain in his classroom. After just a few minutes, he bolted from the room to the school office seemingly in terror and asked for his parents. This had been going on for about a month nearly every day. He remained in school on days his class attended field trips or out of class activities (e.g., library days). The parents had tried alternating morning rides to school and his father had carried him back into the classroom on multiple occasions only to have the same result. He bolted from the class looking for his parents.
On examination, the boy had male typical interests, played rough and tumble sports, was tall for his age, and was socially popular. He had never displayed separation anxiety beyond the norm prior to this year. In all respects except the fear of remaining in his classroom, the boy and his family (one older female sibling) seemed entirely normal and unremarkable from a mental health standpoint. The parents were leaders in their Christian church and the boy happily attended Sunday School and had professed a belief in Jesus as his Savior.

I sent a link to the post to the executive director of the Association of Certified Biblical Counselors Heath Lambert via Twitter with hopes that he might respond in keeping with his Ninety-Five Theses. Dr. Lambert did not reply but biblical counselor Tim Allchin did via the comments section of the post. I appreciate the care he put into his answer and I have reproduced it below.

Tim Allchin
I serve at the director of the Biblical Counseling Center in the Chicago area which is an ACBC certified training center. We have nearly 200,000 hours of counseling experience on our counseling team. However, I don’t speak for Heath Lambert or ACBC officially so this is some of my thoughts. I also speak as a father of adopted children and often hearing the stories of other adopted children in families that are part of our lives. I remember the separation anxiety in my own children upon returning to regular work after we completed adoption and having to work through this with them. I know as a parent this is heart-wrenching at times. As a biblical counselor, I have often worked with children through anxiety, (some with similar circumstances to the case study), and recognize the complexity of human experience in a fallen world. I am firmly committed to the idea there is no better anchor than Christ that an anxious soul can cling to for comfort, peace and relief. Additionally, there is no more reliable guide to the human experience than the scriptures.
My general approach:
In this case, we have physical, emotional, habitual patterns that all interact with the spiritual life of the child and the parent. My starting point would be to gather data on all of these areas from both the child, school teacher and the parent. The child’s fear is a mixture of thoughts, actions and desires that need to fleshed out to understand what possibly triggers this type of response. My working assumption would be that some sort of traumatic experience is likely the genesis of this behavior. I would want the child and parent to know that even a child’s beliefs determine actions, resulting in feelings that either escalate or calm. We need to work from both the outside-in and eventually from the inside-out.
A couple other points I would make clear:
1. We would look at good science to determine and evaluate exercise, rest, nutrition. Additionally, we believe that a life of consistent structure and spiritual encouragement patterns help children and adults thrive. Additionally, a biblical counselor would not oppose all medication in a case like this but it wouldn’t be our first, or likely even second recommendation. We would seek to make progress in thought patterns and structural changes before medicine.
2. We would work with parents to seek to help the child put simply actions steps into place on a consistent basis.
3. Relationship with a child is key to the counseling process. Things like art, music and play are bridges into a child’s world and we would likely use them to build trust.
4. Biblical Counselors have written no less than 10 books on fear and anxiety over the past decade. We would do research into the observations of others who have worked with people over several decades now that biblical counseling has been practiced faithfully in the North American church context. A faithful biblical counselor doesn’t wing it, he studies what God has to say and how others have faithfully ministered the word to those in these contexts. In our own center, we have counseled 1000’s of hours with kids and 10,000’s of hours with the issue of anxiety and panic attacks. Those who paint all biblical counselors as amateurs likely haven’t ever talked to a serious student of biblical counseling. Perhaps I’m too defensive here, but I often see that mindset in threads in these types of articles.
Below would be a bit of the process that I would think through:
First a biblical counselor would seek to gather data:
I would seek to help them identify emotions, behaviors, habits, beliefs, and heart motivations.
What do they desire most of all? (3 Wishes/Changes Game)
What is NOT said? (Avoiding talk of certain people or topics)
HOW is something said? (Tone, emotions)
Data gathering with kids questions or open-ended sentences
Second, a biblical counselors seeks to determine Action Steps that help a child function in a way that pleases God:
Particularly with boys, we would seek to have a physical redirect when anxiety takes over. I have assigned things like stress balls, legos, physical exercise (jumping jacks, push-ups etc.), appropriate yard work/cleaning projects. Second, I have them select one verse about how God cares for them in difficulty and write it on a card and place it in their pocket and seek to have them review to redirect their mind from anxiety to truth. Third, I let them know that the adults around them are going to help them when those anxious moments come, not be critical of them. We want to help them grow. Fourth, I will have do a simple journal so they can learn to articulate what they were thinking. I often remind parents that the debrief after a difficult moment is the most important time to reach the heart of a child.
Additionally, I am going to have conversations about the following with a christian family is being counseled:
What does the Bible say he needs to “put off” regarding fearful behaviors that lead to disobedience? (Repentance)
What does the Bible say he needs to “put on” to better love God and neighbor as self? (Replacement)
What is the child’s response to things out of his control?
What changes are eventually able to be brought under Holy Spirit and self-control? (Heart attitudes, thoughts and
actions)
What developmental assets does a child have that could support them through this struggle?
I want to determine if any of these are triggers for their anxiety: Because all biblical stories point back to Christ, I want to demonstrate examples of others in scripture who struggle with anxiety and how they found hope in the promises of God. Possible triggers are (not all of these are really plausible in the case study you laid out but they could be in others):

  • False concept/doctrine— “God has abandoned me.” “I’m all alone”- Elijah “Everybody hates me.”
    “I can’t…”
    • Reaction to an event — death, abuse, loss, disappointment, expectations unfulfilled
    • Guilt — run and hide like Adam & Eve. Pr 28:1; fear of punishment. Ps 51
    • Comments from others — accept others’ view of me-fat, ugly, stupid; “You’re no good/worthless/destined to fail.”
    • Change of health — actual diagnosis or fear of diagnosis
    • Change in a relationship — a wrong relationship caused anxiety; divorce; separation. Php 4:1-4
    • Feeling out of control — Failure to focus on God’s sovereign control in the midst of my chaos. Ps 55:22
    • Stress/tiredness/illness — Elijah – 1Ki 19; David. Ps 42:5,11; 46; 49:15
    • Lose of temporal security — job, spouse. Ps 48:14; 50:15; 60:11-12
    • A thought — Fear of man – Ps 56:3,4; Fear of lost salvation Ps 51:12; 74:12; Fear of circumstances. Ps 62:5-8

I welcome interactions, critique, push-back and challenge and will seek to learn from others as I read.

Some of what Allchin offers here is very consistent with what many professional counselors do. Of course, the emphasis on biblical thinking and repentance as a part of a cure is not.
I can’t speak for Mr. Allchin, but I imagine he will read any comments left for him. Please make them constructive and polite. Tomorrow, Christian psychologist A.J. McConnell will provide his conceptualization of this case.
To read all posts in this series, click here.