Christians, Pastors, and Mental Health Treatment

Desiring God, the ministry of John Piper, continues to receive negative reaction to a Twitter message about mental health posted on Tuesday (2/6/18).


Many readers, including me, felt the tweet implied that the cause of mental illness is a lack of faith. However, many believers experience emotional distress and many non-believers don’t. The tweet and later effort to put it in the context of a 2007 article fell flat. Adding insult to injury, Desiring God had nothing else to say, leaving the tweet in place and offering no apology. As Phoenix Preacher Michael Newnham wrote, “Being a Christian Celebrity Means Never Having to Say You’re Sorry…”

Being a Christian Celebrity Doesn’t Mean You Are an Expert at Everything

Some of them think they are. And their fans often put them in that role. I rather like what Newnham has to say about his approach as a pastor to mental health concerns.

As a pastor my “expertise” is limited and I’m as broken and fallible as you are.
In some ways, maybe more so.
I don’t know how to fix your sex life, raise your kids, manage your finances, or treat your ills.
I’m not even that good at what I’m trained to do.
My job is to help you grow in the grace and knowledge of Jesus, just as I am growing as well.
My job is to be present when you need me, to the best of my ability.
My job is to pray with and for you, that God will give you wisdom about the problems that are beyond my scope of expertise…which are most of them.
Sometimes, my job is to give you a referral to someone I trust can help you.

This is really good. Keep all of the Desiring God ministries and give me men and women like this in community churches everywhere.

Therapy Helps

The Desiring God tweeter should meet some Christians who found help from psychotherapy. I am the first to acknowledge (and call out) the shoddy and quack therapists, but I also know that therapy can be a lifeline to people when everything else (including the church) has failed them. Read the response of this Christian blogger with who responded to a challenge about therapy.

Last night I read a disturbing sentiment on someone’s blog. In effect, she said she doesn’t support therapy because there is nothing therapy can provide that can’t be provided through a relationship with God. This disturbs me because so many Christians feel this way or similar, and it is essentially a way of saying that all mental illness or emotional issues are a result of a broken relationship with God or a failure of faith. I can’t tell you how hard it is to hear this; I lost many friends who made this conclusion out of ignorance or arrogance.

In response, she wrote:

The first thing to be said here is that yes, God can and does have the ability to heal anything. Read this blog if you doubt that. Yes, my hard work and new variations of meds and finding the right (and strange) combination of meds matters, along with many other things like vitamins and diet and sunshine, but that I’m in remission (partial or otherwise) is nothing less than a miracle.
However, I firmly believe that God uses tools to heal. For those with mental illness, one of those tools can be therapy. I don’t know a single therapist (even the really bad ones I’ve had and there were several of those) who have claimed to be a cure for anything just by themselves. Instead, therapy provides support while you do what needs done, just like a cast supports a fractured arm.
Bipolar illness damages my relationship with God. I am not good at connecting with anyone and I need help to do so. That’s one place therapy comes into play. I also need help with things that should be basic. Reading the Bible and understanding it is one of them. I can’t follow a “real” Bible. I use a children’s version when I can, but truthfully that’s not a lot. I just have a lot of emotions surrounding the inability to handle the real Bible that make it hard to stomach my watered down one. Maybe a better person wouldn’t struggle with the anger that I can’t be an adult in all things, but I do. It’s a side effect of an illness that took away so much of what I wanted in life.

This person didn’t get sick by staring in a mirror, nor was the remission due to looking away from it. The Desiring God-style advice yielded frustration and as she said, condemnation from Christians. I urge pastors to put aside fear and reach out to local experts in mental health for referrals when someone in your congregation needs help. Not all encounters will go well but begin seeking referral sources now as you would sources for other medical and health specialties.
A Christian organization which may provide assistance is Christian Association for Psychological Studies.

Desiring God and Mental Health: Name It Claim It for Your Brain (UPDATED)

Update at the end of the post…
Last week, I wrote about Kenneth and Gloria Copeland who think you can speak cures for PTSD and the flu. Today, I present a different form of name it claim it – John Piper’s Desiring God and anti-mirror therapy for mental health. Earlier today, Desiring God tweeted:


Repeat after me: Mental health is health. Mental illness is illness. Brain is body.
I suspect John Piper would cringe to think he has something in common with the Copelands but turning mental health into a spiritual fruit is in that ballpark.
Copeland says soldiers can get rid of their PTSD with a dose of Scripture. Desiring God prescribes a spiritual refocus as if those who are mentally healthy are spiritually sound.
Perhaps I am sensitive to this message due to my clinical experience with Christians. I have seen the damaging effects of messages like this and know how Christians with mental health diagnoses hear this.
Tweets like the one from Desiring God reinforce the misconception that mental health conditions can be overcome by willpower or positive thinking. Those who struggle have to deal with their illness and the stigma from those in the church who spiritualize their illness. Although beyond the scope of this post, an important issue is that, generally speaking, evangelicals have not grappled with the reality of brain as body. Consciousness arises from brain and does not reside in a spiritual substance independent of body. Like it or not, if you don’t deal with this, I don’t think you understand who we are as human beings. Knock out certain parts of our brain and we become different people. I don’t think I have ever heard a sermon or Sunday school series on the religious significance of our brains.
Some people using the Tweet advice will find comfort because they have positive associations in their brains to images of God which might take their minds off a negative personal preoccupation. However, someone else with different brain chemistry and history may not make the same associations. They may try to work their brains in the same way, but due to something out of their conscious control, their feelings do not respond in the same way. They do not and cannot find mental health no matter how long they stop staring in the mirror.
When those who don’t succeed with anti-mirror therapy go to church, they feel even worse because their faith is questioned. They are told, even if subtly or indirectly, that they don’t have enough faith. If they just believed harder or put God first, or dealt with the sin in their lives, then the advice would work.
Last year, a friend of mine wrote about the frustration of depression:

Occasionally, bouts of depression are triggered by obvious catalysts, like losing a job or loved one or some kind of overt trauma. Often, though, nothing is “wrong”. We’re not upset or sad or angry or stressed about anything particular, but our body is deploying hormones as though we’re being attacked.
It is these episodes that are most frustrating to the friends and family of people who have depression; they don’t know what to do to help because there’s seemingly nothing wrong. The victims of those moments find it doubly frustrating, as a silent, crushing dread slowly bears down on our souls, challenging us to find a name for it.

This frustration is compounded by Christians conflating mental health with spiritual status. If the Desiring God tweet had said enlightenment or satisfaction or something other than mental health would come from staring at God’s beauty, that would be fine. I hope John Piper and his crew will pull that tweet and clarify that they are not the Copelands.
 
UPDATE (2/6/18): Not long after I published this article, Desiring God posted the following Tweet:


The link is to a 2007 tribute by John Piper to Clyde Kilby. This follow up tweet is confusing because the original tweet which aroused so much reaction isn’t found in the 2007 article. The closest statement to it is this statement attributed to Kilby by Piper:

Stop seeking mental health in the mirror of self-analysis, and start drinking in the remedies of God in nature.

This isn’t at all what Desiring God originally tweeted. The “remedies of God in nature” could easily refer to medication or therapy or an experience in nature. Since Piper quoted it approvingly I don’t really know what Kilby meant. In any case, I am less concerned with the Kilby article and more concerned with the spin engaged in by whoever is running the Twitter account at Desiring God.

Kenneth Copeland Issues Confusing New Statement About PTSD

Yesterday afternoon, The State (SC) newspaper ran a story with this headline:

PTSD patients with weak faith should visit doctor, televangelist tells Fort Jackson

The televangelist in the title is Kenneth Copeland who, at the last minute before his controversial scheduled speech to troops at Fort Jackson, Columbia, SC, issued a new confusing statement about post-traumatic stress disorder.  The full statement is provided at that article; I think the title of the news article is accurate.
You’ll recall that Kenneth Copeland, along with self-styled historian David Barton, told soldiers suffering with PTSD to get rid of PTSD by reading Bible verses and rebuking Satan. That advice brought condemnations from a variety of Christian and other groups, including those who advocate for veterans.
In his new statement, Copeland denigrates the faith of people who seek medical help while appearing to give his blessing to treatment.  He says:

From our perspective, a Christian should ask the Lord what steps of recovery should be taken to receive natural help for the disorder. Many Christian organizations exist to give Bible-based help to those that suffer from PTSD.
Our first priority as Christians should always be to find scriptures that offer hope for healing and deliverance from the maladies that we are confronted with. Prayer, application of God’s Word, and ministry from professionals will bring the lasting help that those suffering need.

Brother Copeland would be the first to tell you the doctor is your best friend if you are sick and your healing has not yet fully shown up. It takes time for your faith to develop. For that reason, it is perfectly all right to pursue medical attention as well. In fact, to refuse to consult a doctor or perhaps stop taking medication (prescription or over-the-counter) before faith is fully developed for healing is potentially dangerous. That would be considered ‘presumptuous’ faith.

This is double talk. On his broadcast in 2013, he told PTSD sufferers

Any of you suffering from PTSD right now, you listen to me. You get rid of that right now. You don’t take drugs to get rid of it. It doesn’t take psychology. That promise right there will get rid of it.

In this command, Copeland addressed anyone suffering from PTSD. Now he wants people to think he qualifies his advice. He didn’t apologize or say he was wrong before. He simply pretended he didn’t say it. The answer is still the same. Develop your faith, get rid of that. You don’t need drugs or psychology when you have faith. Copeland’s new statement continues:

God is not competing with doctors or medicine. Like any loving father, He will use any avenue available that you allow Him to work through to help you get well. Getting you well is His desire. Any good doctor will tell you he does not do the healing. He only assists your body to work the way it was created and designed to function by God.

This new moderate sounding Copeland emerged the day before his scheduled visit to Fort Jackson. However, he doesn’t explain what changed in his beliefs, if anything. He doesn’t say he was wrong before nor does he express any regret for his previous bad advice.
As far as I can determine, Copeland’s appearance went as scheduled today.

Military to Hear From Kenneth Copeland Who Teaches PTSD Can Be Cured by Bible Verses and Rebuking Satan

A military religious freedom watchdog group is asking Commanding General Major General Pete Johnson to uninvite Kenneth Copeland from theKenneth Copeland Jet February 1 prayer breakfast at Fort Jackson, South Carolina. Kenneth Copeland has a rather checkered history but the main reason for the outrage is Kenneth Copeland’s past teaching on how to address post-traumatic stress disorder. On that topic, the head of the Military Religious Freedom Foundation Mikey Weinstein told the General:

But there’s something else that makes Copeland an even more outrageous choice to speak to any military audience. He has claimed that PTSD isn’t real because it isn’t biblical, saying on a 2013 Veterans Day episode of his TV show:
“Any of you suffering from PTSD right now, you listen to me. You get rid of that right now. You don’t take drugs to get rid of it, and it doesn’t take psychology. That promise right there [referring to a Bible verse he had just read] will get rid of it.”
Copeland’s guest that day, Christian nationalist pseudo-historian David Barton, wholeheartedly agreed, adding that warriors in the Bible fighting in the name of God were “esteemed” and in the “faith hall of fame” because they “took so many people out in battle.”

At the time, Barton and Copeland took a lot of heat over that “advice.” Before I go on, here is the segment:

Gospel Destroying and Demonic Advice

The Gospel Coalition’s Joe Carter called this advice “gospel destroying” and “demonic.” Copeland still has aspects of this advice on his website (source and source). I did a short series on PTSD which highlighted damaging aspects of Copeland’s and Barton’s advice. In short, their advice was insulting to PTSD sufferers. The military should warn their people about Copeland, not invite him to lecture them.

Copeland Disqualified Himself

I hope the General decides to find another speaker. In my opinion, Copeland disqualified himself to speak to our service men and women. In addition to his bogus advice about PTSD, he teaches that people who recite certain Bible verses will survive war. In essence, his teaching is that Christians will survive if they do the right things and recite the right magic Bible verses (Psalm 91 is one he suggests). In his PTSD video, he claims that the Bible gives a promise of survival to soldiers who fight for God. I don’t know what happens to people who don’t believe these things according to Copeland.
I can’t imagine what he will say that will be of general benefit or encouragement to people of all faiths. His teaching in his Veteran’s Day video and on his website requires a rather close adherence to his specific interpretation of the Bible. There are many Christians who reject this approach, not to mention those of other faiths and no faith. Surely, General Johnson can find someone who can bring people together and respect troops of all faith traditions.
Here is the announcement in the Fort Jackson newsletter:

National Prayer Breakfast to take place Feb. 1 at NCO Club sponsoring the National Prayer Breakfast for the Fort Jackson Community 7:30-9 a.m. Feb. 1 at the NCO Club. Nationally recognized televangelist Kenneth Copeland will be the speaker. Tickets are available from your unit. The event is free, but offerings will be accepted at the event. Attire will be duty uniform or civilian equivalent. The purpose of the NPB is to emphasize the importance of prayer for the Nation, Fort Jackson, our armed forces, and our Families. The themes for the breakfast are: prayers for the nation, community relationship and spiritual fitness.

 
This tip came from fellow Patheos blogger Hemant Mehta (who got it from Chris Rodda).

What's Next for Evidence-Based Practice at SAMHSA?

NREPP SAMHSA statementOn January 11, Assistant Secretary Elinore McCance-Katz addressed the controversy over the terminated National Registry of Evidence-Based Programs and Practices. After several days of silence from SAMHSA, the McCance-Katz sought to explain why SAMHSA ended the registry which lawmakers and mental health providers alike had both lauded and criticized.
Her defense of the move was forceful and appealed to the nation’s opioid addiction crisis. In a conference call with reporters she said, “We in the Trump administration are not going to sit back and let people die.” Without giving any instances linked to NREPP, she added that people will die “if we leave things up on the website that don’t help people.”
In her statement, McCance-Katz lamented that the registry was inadequate. She especially regretted the lack of evidence-based treatments for severely mentally ill persons. She added, “If someone with limited knowledge about various mental and substance use disorders were to go to the NREPP website, they could come away thinking that there are virtually no EBPs for opioid use disorder and other major mental disorders – which is completely untrue.” In fact, I was able to find two such treatments but they were short term interventions.
McCance-Katz also faulted developers of evidence-based practices. She said:

We at SAMHSA should not be encouraging providers to use NREPP to obtain EBPs, given the flawed nature of this system. From my limited review – I have not looked at every listed program or practice – I see EBPs that are entirely irrelevant to some disorders, “evidence” based on review of as few as a single publication that might be quite old and, too often, evidence review from someone’s dissertation.
This is a poor approach to the determination of EBPs. As I mentioned, NREPP has mainly reviewed submissions from “developers” in the field. By definition, these are not EBPs because they are limited to the work of a single person or group. This is a biased, self-selected series of interventions further hampered by a poor search-term system. Americans living with these serious illnesses deserve better, and SAMHSA can now provide that necessary guidance to communities.

There is some evidence for her criticism. I found at least one program which had next to no peer reviewed evidence (“moral reconation therapy”). The journal listed as providing the bulk of the data was a newsletter published by the originators of the therapy.

Plenty of Blame to Go Around

However, one proponent of evidence-based practice said SAMHSA shouldn’t assign blame exclusively on developers and providers. Steven Hayes, Foundation Professor of Psychology at the University of Nevada and one of the developers of Acceptance and Commitment Therapy told me that SAMHSA set the standards for developers and should raise them if the agency wants better results.
Hayes told me, “If SAMHSA was unhappy with the standards, why didn’t they raise them?” Hayes said there are gaps in research knowledge, but wonders how SAMHSA is going to bridge that gap by terminating NREPP. Hayes asked, “If large bodies of such research exist, why didn’t researchers submit the data before? If it existed, why didn’t SAMHSA just take steps to ensure that it was submitted to NREPP?”
Hayes continued, “The reasons there are gaps in research knowledge is that gaps can only be filled by creativity, linked to adequate funding to test creative ideas. Of course SAMHSA can declare that providers should do this or do that based on what their experts say, but this will be a far more political process and it is certain to be both conventional and more dominated by experts who are beholden to those with strong financial interests in the current system.”
Hayes is concerned that drug companies may play an outsized role. He said, “We know who those voices are in the main. We are already at a place in which more than 60% of those with mental health needs receive medications only, and 10% or less receiving psychosocial methods only. Given the issues of side effects, long term effects, opponent processes, and cost effectiveness, the data simply do not support this huge imbalance.”
Since NREPP was a way for developers to get their programs to the public, Hayes said, “Cutting off one of the few avenues program developers had available to them to provide scientifically valid information to the public, will likely leave the public with access to fewer voices and less information rather than more.”

Timing of SAMHSA’s Move to the Policy Lab

One of my concerns about the termination of the NREPP has been the lack of anything to replace it. Chris Garrett, spokesman for SAMHSA told me that SAMHSA is sensitive to this concern and provided this statement:

SAMHSA is working as expeditiously as possible to stand up the Policy Lab in order to carry forward this important work. Expert staff from SAMHSA are being reassigned to the Policy Lab as it stands up. We expect basic operations of the Lab to follow within the next month. In the meantime, SAMHSA has a number of evidence-based approaches already available on our website in the form of Treatment Improvement Protocols and Technical Assistance Publications. We highly recommend their use. The TIPs series can be found here. The TAPs series can be found here. The SAMHSA store also has a number of toolkits that describe evidence-based practices, as well as provide instructions on how to implement them.

Garrett said users could search for “toolkits” in the SAMHSA store to access these resources.
 
 

Many Questions Unanswered About the Future of Evidence-Based Policy at SAMHSA (UPDATED)

UPDATE (1/12/18) – Last night, SAMHSA Asst. Secretary Elinore McCance-Katz released a statement about the termination of NREPP.  The full statement is at the link and the end of this post. She also held a brief conference call with reporters. Although I wasn’t on it, I communicated with two people on the call. On the call and in her written statement, Dr. McCance-Katz criticized the NREPP. On the call, she was quoted by a reporter on the call as saying, “We in the Trump administration are not going to sit back and let people die,” she said, which will happen “if we leave things up on the website that don’t help people.”
There still is no time table for the implementation of the Policy Lab or any new approach. The statement is light on specifics. When I ask about when and how this is going to happen, I have gotten no responses. I hope to have another post later today with reactions to the Asst. Secretary’s remarks and am holding out hope that SAMHSA might address the issues of timing and implementation.
………………………………..
(Original post begins here)
One thing is clear. The National Registry of Evidence-Based Programs & Practices contract has been terminated. SAMHSA’s statement about the registry first posted here on this blog is now on the NREPP website (see the statement in red below):
NREPP SAMHSA statement

What Now?

In one form or another, the question on the minds of many mental health researchers and advocates is “what now?” After I received the statement above on 1/8, I asked a SAMHSA spokesman when researchers would be able to submit programs or update new programs. There has been no answer. It appears that SAMHSA discontinued NREPP even though the agency is not prepared to “reconfigure its approach” to evidence-based practice. Thus far, something is being replaced by nothing.
Media accounts of NREPP’s demise reflect the reaction of the mental health community. The Week‘s headline this morning reads, “Trump officials froze a federal database of addiction and mental health treatments. Nobody’s sure why.
On Tuesday, Think Progress led with “Without warning, the government just ended a registry of mental illness and drug abuse programs.” The subtitle? “And didn’t bother to warn program participants ahead of time.”
Yesterday, the Boston Globe‘s health news service Stat began:

The Trump administration has abruptly halted work on a highly regarded program to help physicians, families, state and local government agencies, and others separate effective “evidence-based” treatments for substance abuse and behavioral health problems from worthless interventions.

Also out this morning, the Washington Post covers much of the same ground but provides no details from SAMHSA about when the new process will begin.
I say again, SAMHSA replaced something with nothing and did so in the middle of an addiction epidemic.

Rep. Grace Meng Wants to Know What’s Going On with NREPP

Rep. Grace Meng represents the Sixth District of New York and is a member of the House Appropriations Committee. On January 5, unaware of the impending controversy over NREPP, she wrote SAMHSA to praise NREPP and ask how she could help support the registry. She closed her letter by saying,

Again, thank you for the NREPP.  I feel that the registry and its website are crucial public health tools.  Respectfully, I wish to know how you will grow the NREPP and its website, how you intend to review more opioid abuse-specific programs, and how I may be of help to you in these endeavors.

When Rep. Meng learned about the NREPP’s termination, she followed up with another letter on January 8 requesting the answers to several questions. The first question was “Why, with specificity, was this contract terminated?” That was followed by nine additional questions:
Meng question NREPP
These are good questions. I would add, why did SAMHSA terminate NREPP when it appears that SAMHSA doesn’t have another evidence-based process ready to go?
 
For background, see my first post on the termination of NREPP.
…………..
Statement of Elinore F. McCance-Katz, MD, PhD, Assistant Secretary for Mental Health and Substance Use regarding the National Registry of Evidence Programs and Practices and SAMHSA’s new approach to implementation of evidence-based practices (EBPs)
Thursday, January 11, 2018
SAMHSA and HHS are committed to advancing the use of science, in the form of data and evidence-based policies, programs and practices, to improve the lives of Americans living with substance use disorders and mental illness and of their families.
People throughout the United States are dying every day from substance use disorders and from serious mental illnesses. The situation regarding opioid addiction and serious mental illness is urgent, and we must attend to the needs of the American people. SAMHSA remains committed to promoting effective treatment options for the people we serve, because we know people can recover when they receive appropriate services.
SAMHSA has used the National Registry of Evidence Programs and Practices (NREPP) since 1997. For the majority of its existence, NREPP vetted practices and programs submitted by outside developers – resulting in a skewed presentation of evidence-based interventions, which did not address the spectrum of needs of those living with serious mental illness and substance use disorders. These needs include screening, evaluation, diagnosis, treatment, psychotherapies, psychosocial supports and recovery services in the community.
The program as currently configured often produces few to no results, when such common search terms as “medication-assisted treatment” or illnesses such as ”schizophrenia” are entered. There is a complete lack of a linkage between all of the EBPs that are necessary to provide effective care and treatment to those living with mental and substance use disorders, as well. If someone with limited knowledge about various mental and substance use disorders were to go to the NREPP website, they could come away thinking that there are virtually no EBPs for opioid use disorder and other major mental disorders – which is completely untrue.
They would have to try to discern which of the listed practices might be useful, but could not rely on the grading for the listed interventions; neither would there be any way for them to know which interventions were more effective than others.
We at SAMHSA should not be encouraging providers to use NREPP to obtain EBPs, given the flawed nature of this system. From my limited review – I have not looked at every listed program or practice – I see EBPs that are entirely irrelevant to some disorders, “evidence” based on review of as few as a single publication that might be quite old and, too often, evidence review from someone’s dissertation.
This is a poor approach to the determination of EBPs. As I mentioned, NREPP has mainly reviewed submissions from “developers” in the field. By definition, these are not EBPs because they are limited to the work of a single person or group. This is a biased, self-selected series of interventions further hampered by a poor search-term system. Americans living with these serious illnesses deserve better, and SAMHSA can now provide that necessary guidance to communities.
We are now moving to EBP implementation efforts through targeted technical assistance and training that makes use of local and national experts and will that assist programs with actually implementing services that will be essential to getting Americans living with these disorders the care and treatment and recovery services that they need.
These services are designed to provide EBPs appropriate to the communities seeking assistance, and the services will cover the spectrum of individual and community needs including prevention interventions, treatment and community recovery services.
We must do this now. We must not waste time continuing a program that has had since 1997 to show its effectiveness.
But yet we know that the majority of behavioral health programs still do not use EBPs: one indicator being the lack of medication-assisted treatment, the accepted, life-saving standard of care for opioid use disorder, in specialty substance use disorder programs nationwide.
SAMHSA will use its technical assistance and training resources, its expert resources, the resources of our sister agencies at the Department of Health and Human Services, and national stakeholders who are consulted for EBPs to inform American communities and to get Americans living with these disorders the resources that they deserve.

Trump Administration Halts Contracted Work on NREPP and Shifts Evidence-Based Focus to SAMHSA's Policy Lab (UPDATED)

UPDATE (1/8/2018) – This morning, I received this statement from a SAMHSA spokesman:

Although the current NREPP contract has been discontinued, SAMHSA is very focused on the development and implementation of evidence-based programs in communities across the nation.  SAMHSA’s Policy Lab will lead the effort to reconfigure its approach to identifying and disseminating evidence-based practice and programs.

The Policy Lab is referred to on SAMHSA’s website and is led by Christopher Jones. The Policy Lab was created by the 21st Century Cures Act and is an evolution of SAMHSA’s Office of Policy, Planning and Innovation. Clearly, the issue with the change from NREPP isn’t with the term “evidence-based” since the above statement uses the term and the Cures Act requires evidence-based interventions. For the exact language of the Cures statute, scroll to the end of this post.
——————-
(original post starts here)
Yesterday (Jan 4, 2018), a contractor for the Substance Abuse and Mental Health Services Administration alerted program participants that funding for work onnrepp the National Registry of Evidence-Based Programs & Practices had been terminated “for the convenience of the government.” According to a source with the contractor, the work was not terminated due to any problems with their work but because the administration did not want to continue it. According to my source, this action follows a freeze in the work which had been in effect since September, 2017.
The NREPP is an effort to alert the public and professional community about evidence-based practices in mental health treatment and prevention. According to SAMHSA’s 2018 budget justification, NREPP helps meet the requirements of the 21st Century Cures Act which requires the government to provide accurate information about what works in the treatment of mental illness and drug/alcohol addiction. SAMHSA is responsible to post this information on an agency website. SAMHSA requested $2.8-million in FY 2018 for NREPP.
According to an email I obtained which was later posted on Twitter by someone else, Development Services Group alerted their constituents that their contract to manage the NREPP’s contents and website had been terminated on December 28, 2017.
The email stated:

It is with great regret that we write to inform you that on December 28, 2017, we received notification from SAMHSA that the NREPP contract is being terminated for the convenience of the government.
This cancellation means that we can no longer make any updates to your program profile. We thank you for the help and cooperation you gave so that we could complete your review.
We are deeply saddened by the government’s sudden decision to end the NREPP contract, under which we have been able to provide and strengthen science-based information about mental health and substance use treatment and prevention programs, both nationally and internationally.
All comments and concerns should be directed to NREPP@SAMHSA.hhs.gov

According to DSG, it isn’t clear what will become of NREPP. The reason the process of evaluating programs was given to a contractor was because SAMHSA did not have a sufficient number of staff to do the job. The website may remain but at present no additional guidance has come from SAMHSA. According to DSG, all materials are being returned to the government and not sent to another contractor.
My calls and emails to SAMHSA have not been returned.
It isn’t clear how SAMHSA will meet the mandates of the Cures Act without a functioning evidence-based program. Another open question is why the program was halted in the middle of the fiscal year without cause (“for the convenience of the government”).
(Updates will be added to this posts through the day)
——————
The entire text of the 21st Century Cures Act is here. For the section relevant to the Policy Laboratory and the work on evidence based practices and programs, see below.

SEC. 7001. ENCOURAGING INNOVATION AND EVIDENCE-BASED PROGRAMS.
    Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.)
is amended by inserting after section 501 (42 U.S.C. 290aa) the
following:
``SEC. 501A. <<NOTE: 42 USC 290aa-0.>>  NATIONAL MENTAL HEALTH AND
                          SUBSTANCE USE POLICY LABORATORY.
    ``(a) In General.--There shall be established within the
Administration a National Mental Health and Substance Use Policy
Laboratory (referred to in this section as the `Laboratory').
    ``(b) Responsibilities.--The Laboratory shall--
            ``(1) continue to carry out the authorities and activities
        that were in effect for the Office of Policy, Planning, and
        Innovation as such Office existed prior to the date of enactment
        of the Helping Families in Mental Health Crisis Reform Act of
        2016;
            ``(2) identify, coordinate, and facilitate the
        implementation of policy changes likely to have a significant
        effect on mental health, mental illness, recovery supports, and
        the prevention and treatment of substance use disorder services;
            ``(3) work with the Center for Behavioral Health Statistics
        and Quality to collect, as appropriate, information from
        grantees under programs operated by the Administration in order
        to evaluate and disseminate information on evidence-based
        practices, including culturally and linguistically appropriate
        services, as appropriate, and service delivery models;
            ``(4) provide leadership in identifying and coordinating
        policies and programs, including evidence-based programs,
        related to mental and substance use disorders;
            ``(5) periodically review programs and activities operated
        by the Administration relating to the diagnosis or prevention
        of, treatment for, and recovery from, mental and substance use
        disorders to--
                    ``(A) identify any such programs or activities that
                are duplicative;
                    ``(B) identify any such programs or activities that
                are not evidence-based, effective, or efficient; and
                    ``(C) formulate recommendations for coordinating,
                eliminating, or improving programs or activities
                identified
[[Page 130 STAT. 1221]]
                under subparagraph (A) or (B) and merging such programs
                or activities into other successful programs or
                activities; and
            ``(6) carry out other activities as deemed necessary to
        continue to encourage innovation and disseminate evidence-based
        programs and practices.
    ``(c) Evidence-Based Practices and Service Delivery Models.--
            ``(1) In general.--In carrying out subsection (b)(3), the
        Laboratory--
                    ``(A) may give preference to models that improve--
                          ``(i) the coordination between mental health
                      and physical health providers;
                          ``(ii) the coordination among such providers
                      and the justice and corrections system; and
                          ``(iii) the cost effectiveness, quality,
                      effectiveness, and efficiency of health care
                      services furnished to adults with a serious mental
                      illness, children with a serious emotional
                      disturbance, or individuals in a mental health
                      crisis; and
                    ``(B) may include clinical protocols and practices
                that address the needs of individuals with early serious
                mental illness.
            ``(2) Consultation.--In carrying out this section, the
        Laboratory shall consult with--
                    ``(A) the Chief Medical Officer appointed under
                section 501(g);
                    ``(B) representatives of the National Institute of
                Mental Health, the National Institute on Drug Abuse, and
                the National Institute on Alcohol Abuse and Alcoholism,
                on an ongoing basis;
                    ``(C) other appropriate Federal agencies;
                    ``(D) clinical and analytical experts with expertise
                in psychiatric medical care and clinical psychological
                care, health care management, education, corrections
                health care, and mental health court systems, as
                appropriate; and
                    ``(E) other individuals and agencies as determined
                appropriate by the Assistant Secretary.
    ``(d) Deadline for Beginning Implementation.--The Laboratory shall
begin implementation of this section not later than January 1, 2018.
    ``(e) Promoting Innovation.--
            ``(1) In general.--The Assistant Secretary, in coordination
        with the Laboratory, may award grants to States, local
        governments, Indian tribes or tribal organizations (as such
        terms are defined in section 4 of the Indian Self-Determination
        and Education Assistance Act), educational institutions, and
        nonprofit organizations to develop evidence-based interventions,
        including culturally and linguistically appropriate services, as
        appropriate, for--
                    ``(A) evaluating a model that has been
                scientifically demonstrated to show promise, but would
                benefit from further applied development, for--
[[Page 130 STAT. 1222]]
                          ``(i) enhancing the prevention, diagnosis,
                      intervention, and treatment of, and recovery from,
                      mental illness, serious emotional disturbances,
                      substance use disorders, and co-occurring illness
                      or disorders; or
                          ``(ii) integrating or coordinating physical
                      health services and mental and substance use
                      disorders services; and
                    ``(B) expanding, replicating, or scaling evidence-
                based programs across a wider area to enhance effective
                screening, early diagnosis, intervention, and treatment
                with respect to mental illness, serious mental illness,
                serious emotional disturbances, and substance use
                disorders, primarily by--
                          ``(i) applying such evidence-based programs to
                      the delivery of care, including by training staff
                      in effective evidence-based treatments; or
                          ``(ii) integrating such evidence-based
                      programs into models of care across specialties
                      and jurisdictions.

This and That: Ravi Zacharias, Husbands as Holy Spirit, Another Fake Jefferson Quote, Dissociative Identity Disorder

Here are a few things I have been thinking and reading about.

Ravi Zacharias, Ligonier Ministries, and His Oxford Thing

UPDATE: As of January 10, the bio has been changed to remove the claim that Zacharias is a senior research fellow at Wycliffe Hall.
I thought Ravi Zacharias would be more careful after his brush with controversy over his credentials. However, he is speaking for Ligonier RZIM logoMinistries this summer and they are billing him as a current “senior research fellow at Wycliffe Hall, Oxford University.” Problem is, he’s not. Even though Wycliffe Hall is a Permanent Private Hall at Oxford and he once held an honorific title there, he was never considered on faculty at Oxford. I have seen the correspondence from Oxford on the subject and it is clear that he does not have any position now with Wycliffe or Oxford (source, source, sourcesource).
Since December 19, I have been corresponding with Ligonier about this without any change in the description or response from them. Apparently, false claims aren’t a big deal.

Are Husbands Responsible to Sanctify Wives?

photo-1453748866136-b1dd97284f49_optThis piece by Sarah Lindsay directed me to this piece by Bryan Stoudt. Stoudt argues that husbands are responsible “to be instruments of his sanctifying work in the lives of our wives.” This means husbands are supposed to correct their wives without being too angry or too passive. Apparently the process doesn’t go both ways. Wives get to be corrected but not to correct.

Trump Supporter Sheriff Clarke Posts Fake Jefferson Quote

You can’t make this up. On December 31, Trump supporter and former Milwaukee County sheriff David A. Clarke posted to twitter a quote falsely attributed to Thomas Jefferson.


A person who claims the liberal media posts fake news posted a fake quote and has so far refused to admit it. His defenders question Monticello.

Dissociative Identity Disorder Documentary

I have always been skeptical about Dissociative Identity Disorder (aka Multiple Personality Disorder). A friend recently pointed me to this 1993 documentary on the subject featuring the work of discredited therapist Colin Ross. One may generalize some aspects of the therapists’ mistakes to what reparative therapists do to falsely consider their techniques to be useful.

Feel free to comment on any and all topics. Add some of your own. What are you reading about? I’ve also been reading articles on free will and determinism, arguments against Calvinism, why there is something rather than nothing, whether or not hydrolized wheat is gluten free, autogynephilia, lost cities of Finland, arguments against an immaterial soul, the Collective Unconscious, the Milgram experiment, the history of Fleetwood Mac, and a few other things.
I might get on some theme soon or then again, I might not.

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

photo-1474367658825-e5858839e99d_opt
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.