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

photo-1437603568260-1950d3ca6eab_opt
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.

How Would a Biblical Counselor Handle This Case?

photo-1473508476344-269a87b502ee_optOn Monday, I wrote about the conflict between adherents of biblical counseling and Christian psychology. Biblical counseling denies the role of psychology in counseling while Christian psychology (as proposed by former Southern Baptist Theological Seminary professor Eric Johnson) uses the research and insights of psychologists to enhance counseling.
In the recent post, I mentioned a document titled 95 Theses for an Authentically Christian Commitment to Counseling. The document was written by Heath Lambert, a SBTS professor and executive director of the Association of Certified Biblical Counselors. Lambert said that the theses were written to stimulate debate. This post and future posts on the topic are written as a response to the theses.
I want to start by discussing the following statements and present a case study. I intend to send this post to Dr. Lambert and will post any response he sends.

The Nature of Counseling and the Content of Scripture
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.
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.
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.
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).

According to the statements above, a Christian approach to counseling should address life’s difficulties, and involve the Bible and Jesus Christ alone as the solutions to all problems. At the outset, we might have a disagreement about the proper subject matter for counseling. I accept the reality of mental and emotional disorders and believe that counseling conversations may also involve techniques and information which do not come directly from the Bible. But I am getting ahead of myself. Let me first present the case (some identifying details have been changed).

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 realize this puts any respondent at a disadvantage. I have the details and know how the case turned out. However, I am curious to know if this kind of situation would be taken on by a biblical counselor. Given the statements concerning the sufficiency of the Bible to handle all problems, I wonder how a biblical counselor would begin and what kind of interventions would be considered.
If I don’t hear from ACBC, then I will give my best guess about how a biblical counselor would respond based on the 95 theses, and then explain how I responded, and why I think this case is relevant to the discussion about biblical counseling and Christians in psychology.
To read all posts in this series, click here.

Spoonman – Chris Cornell, RIP

Chris CornellI was sad to hear about the untimely death of Soundgarden front man Chris Cornell apparently by suicide. His talent was undeniable and many of the songs he crafted came from a special creative place. I believe Spoonman is in the top ten rock songs of all time.
 
[youtube]https://www.youtube.com/watch?v=T0_zzCLLRvE[/youtube]
I pray his family can find peace.

Mark Driscoll Takes On Anorexia, Might Be Demonic

Driscoll AnorexiaMark Driscoll’s most recent video takes on the question: is anorexia a sin (click the link to view the video)?
The prompt for the video is a letter from a young woman who says she has struggled with anorexia for years. In her note, she asks Driscoll if anorexia is a sin.
First, Driscoll expresses appropriate concern for the writer. I share that concern. Anorexia is a baffling condition. However, there are good treatment protocols and with competent help, those who struggle with it can find help.
Unfortunately, Driscoll doesn’t refer her to anything like competent help. She tells him that her pastor said an eating disorder is a disease and her Christian 12 step program said it is rooted in sin. She wants to know what Driscoll thinks.
The right answer is that she has a condition that should be treated medically. Sounds like she needs to get out of that 12-step group.
From his website, here is the list of factors he uses to answer her question.
DriscollEatingDisorders
In Driscoll’s way of thinking, anorexia could be almost anything, including idolatry or the work of demons. Speaking of demons at 8:40 into the clip, Driscoll says:

This is where Satan, demons are lying to you, tempting you. The Bible says that Satan is the accuser of the children of God. He accuses them day and night in Revelation 12:10 there are accusations. If you start realizing this oppression, you can get out of it by acknowledging what God has to say. Oppression, an accusation, is often in the second person, you are unlovable, you need to punish yourself, you don’t appear attractive, whatever the oppression is, it’s telling you something that’s just not true. And so, what you need to understand is that’s demonic, that God doesn’t speak to you that way and if you’re hearing in the second person, maybe someone is talking to you, a spiritual being is lying to you, I’ll get to that in just a moment, and the way out is deliverance, you have victory in Christ, Colossians 2 says He has disarmed and defeated the powers and principalities of evil, triumphing over them through his victorious forgiveness of sinners on the cross.

He adds that the oppression may have come on her and that it might even be generational in her family such that women in her family are “under this kind of demonic torment and oppression and God wants you to rebuke that and walk in freedom and deliverance.”
This point reminds me of Driscoll’s Mars Hill Church spiritual warfare sermons where he describes demon trials for oppressed people.
Driscoll’s last point gets closer to where he should have started and ended. He tells the young woman that she may have medical problems, although he doesn’t specifically refer her for treatment.
For more information on eating disorders, check out this NIH website.
PS – I find some of what Driscoll said about acceptance of body image to be incompatible with what he and his wife wrote in Real Marriage about cosmetic surgery. Read Tim Chailles reaction to the Driscoll’s approval of cosmetic surgery.

Tennessee Governor Signs Bill Allowing Counselors To Refer Based On Counselor's "Sincerely Held Principles"

Previously, I posted a link to a Tennessee bill which gives permission to counselors to refer clients over conflicts with a counselor’s “sincerely held beliefs.”
Last week, Tennessee Governor Bill Haslam signed the bill into law. His reasoning was summarized in a statement after he signed the bill:

The following is the Gov. Haslam’s statement on Senate Bill 1556 (http://www.capitol.tn.gov/Bills/109/Amend/HA1006.pdf):
“Although Senate Bill 1556 has received attention for its perceived focus, my job is to look at the actual substance of the legislation. After considerable thought and discussion with counselors both for and against the bill, I have decided to sign Senate Bill 1556. There are two key provisions of this legislation that addressed concerns I had about clients not receiving care. First, the bill clearly states that it ‘shall not apply to a counselor or therapist when an individual seeking or undergoing counseling is in imminent danger of harming themselves or others.’ Secondly, the bill requires that any counselor or therapist who feels they cannot serve a client due to the counselor’s sincerely held principles must coordinate a referral of the client to another counselor or therapist who will provide the counseling or therapy,” Haslam said.
“The substance of this bill doesn’t address a group, issue or belief system. Rather, it allows counselors – just as we allow other professionals like doctors and lawyers – to refer a client to another counselor when the goals or behaviors would violate a sincerely held principle. I believe it is reasonable to allow these professionals to determine if and when an individual would be better served by another counselor better suited to meet his or her needs.”
The bill was signed by the speakers on April 13 and transmitted to the governor for action on April 15.
The bill language is available at http://www.capitol.tn.gov/Bills/109/Amend/HA1006.pdf.

While I appreciate the amendments requiring care in cases of homicidal or suicidal risk, I don’t support this bill. This bill allows discriminatory actions toward anyone, including religious people, based on a vague condition of a counselor’s conflict involving “sincerely held principles.” While I believe some conflicts could be so great that a referral would be the best course of action in the immediate situation, this bill points counselors in another direction. For mental health care to be fully integrated with health care, a value of treating all people is required. I don’t want a health care system where providers are allowed to delay care based on personal disagreements with patients. I do think providers should be allowed to decline performing certain treatments (e.g., abortion, hypnosis, EMDR, etc.) but I don’t think a referral based on personal disagreement should be the norm in health care.
 

Q & A With Jackie Quinn, Director of Communications at Mercy Multiplied

Last Sunday, Jennifer Miller’s article posted on Slate.com about Nashville-based ministry Mercy Multiplied raised concerns about religiously based residential treatment for women. Miller interviewed several former residents who told troubling stories about their time in one Mercy’s four residential facilities. Specifically, the former residents said they were discouraged from taking medication for mental illness, and said the program encouraged the removal of demons as a means of ridding residents of their emotional pain and problems. Calling themselves survivors, they said they were harmed by their time in the ministry.
To find out more about Mercy’s point of view, I contacted Jackie Quinn who is Director of Communications at Mercy Multiplied. The following is a Q&A with Quinn (one question also has a response from CEO Christy Singleton) which covers some of the key concerns raised by the Slate article (my questions are in bold print, following by Quinn’s replies).
Throckmorton: Do you have a direct response to the Slate article?
Quinn: Mercy is not responding to the Slate article.
Are Mercy’s counselors licensed by the state?
Counselors are not required to be licensed by the state; however, about half are licensed or pursuing licensure. Here are the credentials for counselors as found on our website under Program FAQs:

Each counselor at Mercy is required to hold a bachelor’s degree from an accredited university in social work, psychology, counseling or a related field. 80% of our counselors have master’s degrees.

What kind of graduate degrees are held by your counselors? Are they in counseling or ministry or both?
(In response, Quinn gave me a list of degrees held by 15 counselors. In summary, five have MA or MS degrees in counseling, with two having a master’s degree in marriage and family therapy. The remaining master’s degree titles are social work (MSW), clinical mental health counseling, education with a concentration in clinical counseling, human services counseling, counseling and human services, professional counseling and family ministry.)
Do all girls go through Nancy Alcorn’s 7 step model?
As stated on our website under Program FAQs, “Trained counselors lead residents through the program curriculum,” Choices That Bring Change, so yes, all resident go through this curriculum (below is the full excerpt from our website):

Our Christian-based program curriculum, “Choices That Bring Change,” is the result of our three decades of ministering to girls in crisis and combines biblical principles of healing and unconditional love with best-practice clinical interventions, as outlined in Ditch the Baggage by Nancy Alcorn.

Trained counselors lead residents through the program curriculum, helping them explore issues of faith, forgiveness, family, overcoming abuse and past hurts, and general life principles. In addition to the curriculum, program resources feature internationally acclaimed teachers such as Beth Moore, Priscilla Shirer, Joyce Meyer, Dave Ramsey, Andy Stanley and Charlotte Gambill. Residents participate in both individual and group counseling on a weekly basis.
Are girls ever asked to let Jesus reveal a past trauma?
Our counseling procedures do not permit the use of restored memory therapy or other imagery techniques designed to evoke memories.
Let me be more specific. Do counselors ever indicate to girls that Jesus has revealed a past trauma to either the girl or the counselor? This could be theophostic type counseling or some similar approach.
Mercy counselors do not use theophostic counseling or restored memory therapy or any technique like you are describing in your question.
What is Mercy’s position regarding the use of medication to treat mental and emotional problems.? Is medication discouraged for girls who are depressed or anxious?
Regarding medication from the website under program FAQs:

Although we are not a medical facility, some of the young women who enter our program have medical issues that need to be managed. To that end, our homes employ medical staff, and we provide adequate medical care for residents – including care from outside professionals who are called upon to help on a regular basis, as there is not a physician on staff.
Mercy does not discourage the use of medication. In fact, Mercy values the role medical intervention and pharmaceuticals have in helping young women struggling with depression, anxiety and other psychiatric conditions. Mercy staff follow directions from outside physicians with regard to medication as it is not our place to make medication determinations. The overwhelming majority of our residents are on some kind of medication during their stay at Mercy some of which they have in place before coming and some of which is prescribed after they come into the program. As is common in therapy and counseling, when a young women progresses through processing pasts hurts and trauma, she may find that certain medications do not seem to be needed anymore. However, this is something she would handle with the outside physician she sees and not determined by Mercy staff.

About medication, is this a change in policy or belief since the 2008 video of Nancy Alcorn (see video below) saying that you don’t medicate demons?
The belief about medication does not reflect a change in policy or belief. Mercy has always had that stance and belief.
Can you help me reconcile your statement about medication and the sermon in 2008 where Nancy Alcorn says “Jesus did not say to medicate a demon.”
I was not working at Mercy in 2008, so I checked with Mercy’s Executive Director, Christy Singleton, who was working here, for a response. Here is her response:

As you likely have discovered in your research, Nancy is from a Charismatic background, and the video you reference from 2008 was filmed during a worship service in which Nancy was speaking to a Charismatic congregation. Ever since Jesus taught his disciples to overcome the evil of the world, often referenced as “demons” or “demonic forces” in English translations of the Bible, Christians from many traditions have been rejecting evil, praying against evil forces, praying against the devil, and asking God to relieve them from oppression of demonic forces, or demons. Mercy follows in this same Christian tradition of rejecting all forms of spiritual darkness. (This is not just a Charismatic stance; witness any Methodist confirmation or baptism and attend to the liturgy.) Certainly, in a Charismatic church, you would expect to hear the term “demon” or “demons” to reference the evil Christians are to reject. In this video, Nancy was addressing a Charismatic congregation and speaking about spiritual issues. That being said, Nancy’s statements are not incompatible with our stance regarding medication, nor has Nancy ever been against medication when medication is warranted.
Simply put, Mercy does not discourage the use of medication. In fact, Mercy values the role medical intervention and pharmaceuticals have in helping young women struggling with depression, anxiety, and other psychiatric conditions. Mercy staff follow directions from outside physicians with regard to medication. In fact, the overwhelming majority of our residents are on some kind of medication during their stay at Mercy; sometimes the medication was in place before attending our program, and sometimes the medication is prescribed after they come into the program. In many situations young women graduate from our program still on medication. It is important to note that every case is different. As is common in therapy and counseling, when a young woman progresses through processing pasts hurts and trauma, she may find that certain medications do not seem to be needed anymore. However, this is something she would handle with her physician and is not determined by Mercy staff.

The clip of Nancy Alcorn talking about removing demons and not medicating them is below and full sermon is also embedded below.
[youtube]https://youtu.be/7o9HDXqBl0c[/youtube]
Full sermon:
[youtube]https://youtu.be/-r-PEFhZ3uE[/youtube]

Mercy Multiplied Is Subject of Slate Exposé

Mercy Multiplied (formerly known as Mercy Ministries) consists of several in-patient facilities which claim to assist young women recover from abuse, eating disorders, and various other mental and emotional conditions. On Sunday, online magazine Slate revealed unflattering and disturbing results of an investigation of the ministry through the eyes of several former patients.
If the reports are true, then Mercy Multiplied should be shut down.
These stories reminded me of the 1990s controversy over repressed memories and especially the Philadelphia area counseling center Genesis Associates. Former Mercy girls told Slate they were led to believe they had been sexually abused and involved in sex trafficking via imagery techniques. They claim that in counseling sessions girls were told by their counselors that God had reveal certain past abusive events. Residents were urged to cast out demons and refuse needed medications.
There seemed to be some similarities to the demon trials described by Mark Driscoll.
This morning, I asked Mercy Multiplied’s Director of Communication Jackie Quinn for a response to the Slate article but did not get a response.
One cannot know if these allegations are true or wide spread but it does provide a cautionary tale to people who are considering counseling to avoid these kind of techniques. I hope Mercy Multiplied will address the possible use of visualization techniques where false memories might be implanted.
From the mid-1990s, here are some clips of Genesis Associates from the documentary Divided Memories.
[youtube]https://www.youtube.com/watch?v=VWoxGEr0nmw[/youtube]
[youtube]https://www.youtube.com/watch?v=waBha5AOAyI[/youtube]
[youtube]https://www.youtube.com/watch?v=yZckrmKCzlU[/youtube]

Tennessee Bill Allows Counselors To Refer Based on Sincerely Held Principles

A controversial bill which would allow counselors to refer clients based on the counselor’s “sincerely held principles” was passed by the Tennessee Senate earlier this week. Already passed by the House, the bill now awaits action from Governor Bill Haslam. He has not declared his position on the final version of the bill.
Originally, the bill referred to a counselor’s “sincerely held religious beliefs” as being a reason why referral would be allowed. Earlier this week, the Senate voted to amend the bill to change that language to allow referrals due to a counselor’s “sincerely held principles.”
The most current version of the bill states:

No counselor or therapist providing counseling or therapy services shall be required to counsel or serve a client as to goals, outcomes, or behaviors that conflict with the sincerely held principles of the counselor or therapist; provided, that the counselor or therapist coordinates a referral of the client to another counselor or therapist who will provide the counseling or therapy.

The bill does not allow such referrals if the client is suicidal or homicidal. In such cases, counselors provide services.
While I opposed the earlier language as well, the amended standard of “sincerely held principles” would greatly expand the reasons counselors could discriminate against clients. Counselors who don’t like a client’s politics could fall back on their “sincerely held” political views to refer. One can imagine many scenarios where the views of a counselor and a client conflict.
The practical implications are frightening. Minority clients in rural areas may not be able to find a compatible counselor. Clients may lose trust in the profession and decline to seek help when needed. The legislation does not provide any restrictions on when such referrals may be conducted. What if a counselor learns of a conflict after 20 sessions into counseling? According to this bill, the counselor would be able to refer the client, possibly undoing weeks of progress.
According to the Chattanooga Times Free-Press, this bill has a direct tie to the case of Julia Ward at Eastern Michigan University. Representative Jack Johnson told the Times Free-Press that the American Counseling Association is to blame because they changed their ethics code to forbid referrals based on religious beliefs in response to the 6th Circuit case where Ward was kicked out of Eastern Michigan because she referred a gay client and refused to comply with the educational requirements to get experience counseling gay clients.
I was the expert witness on behalf of Ward in that case and I oppose this bill. Generally, I think counselors must refer clients when they believe they might be harmful to clients, even if the harm includes the effects of counselor bias. However, the problem in such a case is with the counselor and not the client. The focus of an ethical counselor must always be the benefit of the client, not the comfort or rights of the counselor. This bill is so broad that the counselor can refer simply because of a disagreement over ideology, an unacceptable deviation from the nature of the counselor’s role. It seems unavoidable that referred clients will experience stigma and lose trust in the profession.

Patheos Links of Interest: Kirk Franklin, Anxious Bench, Godless in Dixie, Stacy Dash, Kyle Roberts

Reading an Anxious Bench post by Thomas Kidd, it occurred to me that Patheos is a very diverse site. With that in mind, I decided to go exploring. Here I am going to post some links I found interesting. I am not recommending everything said by these authors but am posting them because I think they might be of interest to readers.
Should Evangelicals Embrace the “Benedict Option”? Well, should they/we?
We Love Close Calls… Until They Happen to Us – Nice devotional post on waiting through hard times by Kirk Franklin. Wait, what? Kirk Franklin blogs at Patheos?! Nice.
I Was Wrong – Stacy Dash apologized for her defense of Bill Cosby.
Stop Saying that Teaching Children Creationism is Child Abuse – A good one from the Atheist channel’s Neil Carter.
“Can We Go Home, Now?” My Mom, Alzheimer’s Disease, and Our Longing for Home Kyle Roberts on the Progressive channel writes a truly touching reflection on his mom’s wish to go home.
I hope to go exploring more often…