A Skeptic’s View of Counseling Part 8: Criticism, Rebuttal, and Closing Remarks
The September 2014 issue of Pacific Standard Magazine ran an interesting article by Kathryn Joyce entitled “The Rise of Biblical Counseling,” in which she assessed the strengths and weaknesses of Christian and Biblical counseling. While the attempt at fairness and balance was obvious, a problem with the article was presuppositional, positing a false dichotomy between religious and “scientific” secular counseling, and hence, between religion and science.
Ms Joyce’s subtitled the article “For millions of Christians, biblical counselors have replaced psychologists. Some think it’s time to reverse course (48)”. Prominent among the “some” are those for whom counseling was a negative experience with sometimes deleterious effects; however, the whole stories are not provided, leaving one wondering if the problem was counseling, the counselor, or the client as main problem. For example, the article starts with the story of the eventual suicide of Kenneth Nally, a 24-year-old man who attempted suicide while under psychiatric care and taking the antidepressant Elavil on which he intentionally overdosed. He had become an Evangelical in college and attended Grace Community Church in Los Angeles under Pr John MacArthur, although raised in a Roman Catholic family. Rather than being committed to a psychiatric hospital, which was contrary to his and his father’s wishes, he spent time at Pr MacArthur’s house. Several days later sans warning or note, Nally went into a closet with a shotgun and killed himself.
Almost a year later, the case wound up in the California courts, the Nallys suing GCC for malpractice in not having referred Kevin to experts who could have prevented the suicide. Victories for the Nallys in lower courts were eventually overturned by the California Supreme court, and finally SCOTUS refused to hear the case. This left Christian and Biblical counseling safe from statist mission creep, and with an honest opinion from courts declaring themselves incompetent to rule in spiritual matters.
Absent from Ms Joyce’s article was the following:
“The records show that in the two-month period between February 1979 and his death, Ken saw at least four physicians, one psychiatrist, a psychologist, and a psychologist’s assistant, and had several counseling sessions with pastors at Grace Community Church. Ken’s parents, Walter and Maria Nally, could have sued anyone who had seen their son over the few months prior to his death, but they chose Grace Community Church.
“They charged among other things, wrongful death based upon ‘clergyman malpractice’ and negligent counseling. They alleged that following a suicide attempt, the pastors ‘actively and affirmatively dissuaded [Ken] from seeking further psychological and/or psychiatric care.’ Despite the records showing that the pastors encouraged Ken to keep his appointments with physicians and outside counseling professionals, the case went through the California court system twice before the Supreme Court of California exonerated the church in November 1988 (49).”
Furthermore, Nally was taking an antidepressant under the care of a mental health professional, and that was insufficient to prevent his bona fide suicide attempt. If the mental health system and Big Pharma could not stop the attempt, why should GCC have been singled out for malpractice litigation? Indeed, is suicide a result of malpractice in the first place; ie is it the fault of someone other than the decedent? Ms Joyce’s example better illustrates the inability of any system of care to work ex opere operato, since Nally had the benefit of care and still committed suicide.
Ms Joyce’s implied second contention – that of the superiority of “scientific” versus religious counseling – follows closely on the first. For instance, her comment “From the perspective of most mental health professionals, biblical counseling is at best a murky phenomenon (50)” shows a clear bias towards the mental health establishment. She then relates examples of rather egregious nincompoopery committed under the guise of Biblical counseling, as well as internet traffic regarding abusive and incompetent counseling, suggesting that Biblical counseling is on shaky ground when compared with that of the mental health establishment.
The foremost problem with her contention is that it rests on no evidence. Indeed, one can google “psychiatric counseling harmful” and pull up many an entry, particularly the “repressed memories” debacle, which cost many innocent people their good names, jobs, families, and friends – not to mention the cost of defending themselves in court. Psychologist JA Durlak, writing in Psychological Bulletin comparing the efficacy of professional psychologists with paraprofessionals, concluded:
“Paraprofessionals achieve clinical outcomes equal to or significantly better than those obtained by professionals. In terms of measureable (sic) outcome, professionals may not possess demonstrably superior clinical skills when compared with paraprofessionals. Moreover, professional mental health education, training, and experience do not appear to be necessary prerequisites for an effective helping person (51).”
Indeed, is there any evidence to prove the claim that trained and licensed professional therapists perform better than sympathetic laymen? Lawrence Stevens, JD, at antipsychiatry.org, wrote:
“The June 1986 issue of Science 86 magazine included an article by Bernie Zilbergeld, a psychologist, suggesting that ‘we’re hooked on therapy when talking to a friend might do as well.’ He cited a Vanderbilt University study that compared professional ‘psychotherapy’ with discussing one’s problems with interested but untrained persons: ‘Young men with garden variety neuroses were assigned to one of two groups of therapists. The first consisted of the best professional psychotherapists in the area, with an average 23 years of experience; the second group was made up of college professors with reputations of being good people to talk to but with no training in psychotherapy. Therapists and professors saw their clients for no more than 25 hours. The results: “‘Patients undergoing psychotherapy with college professors showed … quantitatively as much improvement as patients treated by experienced professional psychotherapists”‘ (p. 48). Zilbergeld pointed out that ‘the Vanderbilt study mentioned earlier is far from the only one debunking the claims of professional superiority’ (ibid, p. 50) (52).”
How does one define – let alone, measure – effective counseling? Psychiatrist DM Allen, MD, wrote in Psychology Today:
“Unfortunately, (random controlled trials) of psychotherapy are a lot different than, say, drug studies, because there are a nearly infinite number of factors which help to decide whether a course of a given type of psychotherapy will lead to a positive outcome, and there is simply no way to control for them all. We cannot even agree what a ‘successful’ result should be. Symptom relief? Personality change? Improved relationships? Better ability to love and work? Personal growth and fulfillment? All of the above (53)”
As mentioned in Part 3 of this series, psychological therapies are not always benign. In an article published in The Guardian concerning misapplied psychotherapy, health editor Sara Boseley stated that “Counselling and other psychological therapies can do more harm than good if they are of poor quality or the wrong type, according to a major new analysis of their outcomes (54).” Ms Joyce appears to have conflated inept Biblical counselors/counseling with Biblical counseling per se, while ignoring the very same problems in secular counseling. She also assumes, with no evidence, that the degrees and licensing of secular counselors convey an expertise absent from the Biblical camp; this does not appear to be the case.
What about psychotropic medication, the veritable crown jewel of the mental health establishment? It would appear that there is less than meets the eye here as well.
Peter C. Gøtzsche is director of the Nordic Cochrane Centre and member of the Council for Evidence-based Psychiatry (cepuk.org). Cochrane is a highly-respected source depended on by physicians in all specialties and subspecialties for the practice of evidence-based medicine. In an article published in The Guardian he wrote of manifold problems caused not only by the promiscuous use of psychotropic drugs, but by the drugs themselves. Not only does he question efficacy, but safety as well. His concerns also reflect unethical behavior by Big Pharma in marketing and influencing research. He wrote:
“First, the definitions of psychiatric disorders are so vague that many healthy people can be diagnosed inappropriately. Second, some of the psychiatrists who wrote the diagnostic manuals were on the industry’s payroll, and this may have also led to significant diagnostic inflation. Third, the companies’ behaviour has been worse in psychiatry than in any other area of medicine, with billion-dollar fines paid for the illegal marketing of psychiatric drugs for non-approved uses. The rise in sales reflects patient dependency on these SSRIs: they may have great difficulty stopping even when they taper off the drugs slowly. Withdrawal symptoms are often misdiagnosed as a return of the disease or the start of a new one, for which drugs are then prescribed. Over time, this leads to an increase in the number of drug-dependent, long-term users.
“Another major problem with psychiatric drugs is that they can cause the symptoms they are supposed to alleviate. Unfortunately, psychiatrists tend to increase the dose or add another drug when a patient reports negative effects.
“The problem is that many of these drugs simply do not work as people suppose. The main effect of antidepressants is not the reduction of depressive symptoms. They are no better than placebo for mild depression, only slightly better for moderate depression, and benefit only one out of 10 with severe depression. In around half of all patients, they cause sexual disturbances. The symptoms include decreased libido, delayed orgasm or ejaculation, no orgasm or ejaculation and erectile dysfunction. Studies in both humans and animals suggest that these effects may persist long after the drug has been discontinued.
“The US Food and Drug Administration has shown that antidepressants increase suicidal behaviour up to the age of 40, and many suicides have been reported even in healthy people who took the drugs for other reasons (for example, for stress or pain). Another report also said that, among people over 65, antidepressants are believed to kill one out of every 28 people treated for one year, because they lead to falls and hip fractures. Indeed, it is not clear whether antidepressants are safe at any age (55).”
In other words, the science behind these not-so-benign drugs is very questionable, while the ethics of Big Pharma are blatantly lacking. The good doctor is not the only one raising these issues. Psychiatrist DC Smith, MD, writing at antipsychiatry.org, refuses to prescribe psychotropics for the following reasons:
“(1) ‘Mental illnesses,’ even severe ones, are relational (I’d say spiritual as well). Psychiatry, by focusing almost exclusively on biology, is making itself increasingly irrelevant.
“(2) Psychoactive substances provide at best, temporary relief, but always make things worse in the long run. They make things worse directly (chemically) and indirectly by distracting from the real issues.
“(3) All psychoactive substances have rebound and withdrawal-related problems. ‘Relapse’ rates, in general, during withdrawal from psychiatric drugs, are about 10 times higher than would be expected if the drug had never been taken.
“(4) ‘All biopsychiatric treatments share a common mode of action — the disruption of normal brain function’ (Peter Breggin, M.D., Brain Disabling Treatments in Psychiatry, Springer Pub. Co., 1997, p. 3). Drugs never correct imbalances. They never improve the brain. They ‘work’ by impairing the brain and dampening feelings in various ways (56).”
So much for science versus religion. Ms Joyce’s above-mentioned quip about Biblical counseling being “at best a murky phenomenon” in the eyes of the mental health establishment at best looks like the equivalent of nanny-nanny-boo-boo in a juvenile turf battle, and at worst fallacious and self-serving. Recall that Kevin Nally took his life when 24 years old, reread the FDA statement above showing “that antidepressants increase suicidal behaviour up to the age of 40,” and one can see the prescient wisdom of the California and US Supreme Courts in finding for Grace Community Church. I am neither suggesting that Nally died as a result of his psychiatric care, nor in any way impugning the care he was given – by any of the parties, including GCC – nor the quality of the caregivers. As hard as this may sound, if any blame is to be apportioned, it should fall on Nally alone, as nobody made him commit suicide and no adult(s) can legitimately be held accountable for the decision of another adult not under his (their) control. I am saying that: all counseling is art rather than science; both secular and Biblical counseling can be misapplied; there are incompetent counselors in all genres of counseling; and there is no evidence suggesting Biblical or Christian counseling to be inferior to the secular (pseudo-)scientific variety.
All this being said, what is the troubled Christian making diligent use of the means of grace to do should he need counseling? Unfortunately there is really no good solution. If the church is incompetent, a shark tank, and work-shy; secular counseling contra Deum; and free-standing counseling centers unaccountable, it would seem that he is in a bind. The bind, though, is neither of his making nor under his control, and hence he need not worry all that much about it. Ideally he should be counseled by his pastor, as the pastor-parishioner relationship should display the mutual love and trust essential to any therapeutic alliance. Furthermore, our sins and imperfections notwithstanding, a church community should be one of mutual understanding and support, as well as a place where iron can sharpen iron in a non-threatening atmosphere. If neither is the case for our troubled believer, he should seriously consider changing churches.
He should also always seek the counsel of a wise friend who has proven himself faithful. Absent this, he should seek out either a godly church officer or layman within or without the congregation who has weathered a similar storm, as such a person could prove a trove of sage counsel and a sympathetic ear. Indeed, there does not appear to be any better therapists than such as these.
Absent this, the Christian in question may just have to cope, as all too many of us have had to. Somehow, throughout history and prior to the era of the professionalization of help, troubled believers managed to overcome suffering with the means of grace and true friendship. I suggest that today is really no different, except for the widespread belief that everything broken or imperfect can now be fixed in five quick and painless steps. This theology of glory could suggest to a suffering Christian that he is either a spiritual failure or unregenerate, compounding his distress. It is here and other similar places that the church can show itself to be either the hospital for sinners God intended it to be, or a morgue. As for seeking out a Biblical counselor, for which he will either pay directly as fee for service or be asked for a donation, I find it hard to recommend what amounts to paying for friendship, particularly when mine and acquaintances’ experiences therewith have been less than positive.