Category Archives: Counseling

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.

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48.  http://www.psmag.com/health-and-behavior/evangelical-prayer-bible-religion-born-again-christianity-rise-biblical-counseling-89464

49.  http://www.rpmministries.org/2011/08/the-law-and-church-counseling-part-two—the-legal-history-and-climate/

50.  http://www.psmag.com/health-and-behavior/evangelical-prayer-bible-religion-born-again-christianity-rise-biblical-counseling-89464

51.  http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=1979-31736-001

52.  http://www.antipsychiatry.org/psychoth.htm

53.  https://www.psychologytoday.com/blog/matter-personality/201212/why-psychotherapy-efficacy-studies-are-nearly-impossible

54.  http://www.theguardian.com/society/2014/may/26/misjudged-counselling-psychological-therapy-harmful-study-reveals

55.  http://www.theguardian.com/commentisfree/2014/apr/30/psychiatric-drugs-harm-than-good-ssri-antidepressants-benzodiazepines

56.  http://www.antipsychiatry.org/drsmith1.htm

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A Skeptic’s View of Counseling Part 7: Whose Turf?

We’ve seen differences among various groups within the Christian Counseling Movement regarding the theory and practice of counseling; the questions before us now are who will counsel, and under whose aegis.

The current practice varies between pastoral/church officers only to free-standing fee-for-service clinics, reflecting the diverse ecclesiologies within Evangelicalism. JE Adams wrote:

“In short; God gave the task of counseling as a life calling to the ruling officers of His church. This may be demonstrated in many ways. I shall mention two:

“the New Testament commands the shepherd-teacher—as such—to counsel;

we see from descriptions of his work that he is precisely the one who, in the early church, did counseling.

“While God assigned the counseling task informally to all Christians just as all are expected to teach, exhort, and perform other tasks informally), He assigned the work of formal nouthetic counseling to the church elder.* Such counseling is a part of his official job description (36).”

D Powlison of CCEF concurs:

“According to the Bible, caring for souls—sustaining sufferers and transforming sinners—is a component of the total ministry of the church, however poorly the contemporary church may be doing the job. There is no legitimate place for a semi-Christian counseling profession to operate in autonomy from ecclesiastical jurisdiction and in subordination to state jurisdiction. The Lord whose gaze and will the Bible reveals lays claim to the cure of souls. If counseling is indeed about understanding the human condition, if it deals with the real problems of real people, if it ever mentions the name of Jesus Christ (or should mention, but doesn’t), then it traffics in theology and cure of souls; it ought to express and come under the church’s authority and orthodoxy(37).”

If counseling is strictly a church ministry, what of reimbursement?  Adams’ answer to the question of whether a counselee will be charged for services is

“I hope not. Since biblical counseling is done under the auspices of local congregations, it is usually offered as a free service to the members of the church and to the community. If any sort of financial arrangement is made, that will ordinarily not go beyond the amounts needed for added heat, light and secretarial services. The counselor himself will counsel as a ministry. If, where there is no fee charged, as counselee wishes to give an offering, he should make out his check to the church, not to the counselor (38).”

CCEF begs to differ, and posts fees of $95.00/hr for a counselor, $50.00 for an intern, and $100.00 for the initial hour to cover set-up costs.  A discount is available to those who consent to be videotaped (39).  It bears mentioning that CCEF, while headquartered at a seminary, and whose counseling staff are members of churches and practice under the aegis of the seminary and, like it, is a para-ecclesiastical organization answerable to no church body.

At the other end of the spectrum are the many independent, for-profit, integrationist clinics like Christian Counseling Services in Lynchburg, VA.  The practice describes itself as

“…a private agency of professionally trained therapists who hold advanced professional degrees.  We adhere to the standards of practice as regulated by state law, and are committed to providing services to individuals, couples and families.  Our staff is composed of dedicated Christians who combine professional skills with a sensitive, Biblical approach (40).”

Its services are usually covered by most major insurers, and payment is expected at the time of service (41).   The profiles of its counseling staff reveal one ordained minister out of full-time ministry, the rest being clinical social workers and counselors (42).  Needless to say, there is no ecclesiastical aegis.

So, which is right:  ecclesiastical, para-ecclesiastical, or independent?  Ideally, since counseling is a form of ministry of the Word, counseling has historically been recognized as the domain of the clergy.  However, this is problematic for several reasons.  First of all, there is a “credibility gap” resulting from the church’s having sloughed-off its troubled members onto secular or even independent Christian counselors for so long; it would be hubris for the church to now demand a return to the status quo ante without proving itself both worthy of and prepared to resume an effective ministry of cure of souls (more on this later). Secondly, there is an established tradition of independent and interdenominational evangelical agencies and personnel doing work historically regarded as churchly; eg mission work (Independent Board of Presbyterian Missions), education (Ligonier Ministries), Bible translation (Wycliffe, Trinitarian Bible Society), seminaries (Westminster Theological Seminary), camps and retreat centers, etc.  These organizations answer to no church board, raise their own money by fees and donations, and pay employees; why, then, is counseling off limits to all but the institutional church and without fee for service?

A third and more personal problem is that of what has been known as the “seal of the confessional;” ie the sacrosanctity of what is confessed to a cleric.  While the RCC is very explicit in defending this practice and will not yield on it, the same cannot be said of Evangelicals, who have no theology of the confessional. Blogger Nick Barden at “The Evangelical Pulpit (patheos.com)” wrote:

“Unsurprisingly, many Protestant churches have found themselves accused of covering up myriad sins. Clergy are torn between seeking to keep in confidence the confessions of a repentant sinner, while recognizing the need for temporal authorities to intervene and administer justice. Add to the mix that American jurisprudence has a bifurcated doctrine on the issue – clergy are often classified as mandatory reporters, but a distinction is drawn between those who approach a pastor as a ‘friend and adviser’ and those who approach the pastor as a penitent.

Here the ill-defined ecclesiology and political theology which often afflicts us, particularly those of non-denominational persuasion, blurs that line between ‘adviser’ and ‘clergy’ in our churches. Does the repentant sinner speak to Pastor Bob, or Bob simpliciter? It may be that Pastor Bob himself does not know. The implications are enormous, not just in regards to keeping the confidence of the penitent. It is essential that we may give a defense of our actions to a scrutinizing world (43).”

The degree of privilege depends largely upon state laws, which provide more protection to clergy in churches which clearly state the obligation of members to confess than to those churches which have a looser or non-existent concept of confession (44).

There are two other aspects to the problem of communication between pastor and parishioner.  One is gossip resulting from a minister who breaks the seal by telling others (including his wife and children, who are not ministers) what was understood by the parishioner to have been spoken in confidence, with consequent embarrassment and social consequences.  A RC priest is under threat of excommunication for breaking the seal, while Evangelical minsters face no such threat – which, given the lax disciplinary milieu of the modern church, would provide scant deterrence anyway.  Another is the fear of discipline in the form of public humiliation; churches in which confession is a sacrament generally privately discipline what is privately confessed; there is no such safeguard among Evangelicals, which may hinder a parishioner from going to his pastor; independent counseling centers alleviate this burden.

The fourth problem is that the institutional church is structurally incapable of reclaiming counseling at this time, with no evidence of taking any measures to rectify the situation.  According to Powlison:

“How can this problem be remedied? Let me identify five needs. First, the church needs to become wise in the face-to-face care of souls. We cannot practice, teach, or regulate what we do not know how to do or think…

“Second, we need creedal standards for the care and cure of souls, or at least a widely recognized corpus of practical theological writing…

“Third, we need educational institutions committed to the Bible’s distinctive model of understanding persons and change. For many years seminaries taught virtually nothing substantive about progressive sanctification and the particulars of hands-on, case-wise, heart-searching, life- rearranging care for souls…

“Fourth, we need cure of souls to become part of the church’s qualifying procedures that recognize fit candidates for ministry…

“Fifth, we need ecclesiastically grounded supervisory structures for cure of souls. The secular mental health professions usually offer continuing education, case supervision, and discipline for morals offenses (breach of trust in sexual, financial, or confidentiality matters). The church has often offered continuing education in the form of books, seminars, and doctor of ministry programs. The church has often disciplined for morals or doctrinal offenses. But cure of souls tends to drop through the cracks; it is an optional activity with optional beliefs and practices (45)….”

Conspicuously absent from this list, and emphasized in the article from the Valparaiso University Law Review (see footnote 44), is the nature of the counseling relationship, especially regarding its seal for ministers and its importance vis-a-vis status as sacrament, sacramental (46), or holy rite (47), so as to enjoy the protection of the law.

Thus, if Mother Kirk is serious about reclaiming the cure of souls, she has her work cut out for her.  The problem, though, is what a parishioner seeking guidance today is to do:  if his pastor is inadequate or averse to counseling, the choices for a particular area may be very limited, making all of the above discussions academic at best.  I hope to offer suggestions for solving this problem, as well as providing some final thoughts, in the next article.

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36.  http://www.nouthetic.org/who-should-do-counseling

37.  http://www.ccef.org/cure-souls-and-modern-psychotherapies

38.  http://www.nouthetic.org/will-i-be-charged-a-fee-for-nouthetic-counseling

39.  http://www.ccef.org/counseling/philadelphia

40. http://www.lynchburgcounselor.com/index.html

41.  http://www.lynchburgcounselor.com/7.html

42.  http://www.lynchburgcounselor.com/2.html

43.  http://www.patheos.com/blogs/evangelicalpulpit/2015/03/american-protestantism-and-the-seal-of-confession/

44.  http://scholar.valpo.edu/cgi/viewcontent.cgi?article=2062&context=vulr

45.  http://www.ccef.org/cure-souls-and-modern-psychotherapies

46.  https://www.crossroadsinitiative.com/library_article/49/Sacramentals__their_role_in_Catholic_Sacramental_Life.html

47.  Those rites other than baptism or eucharist referred to as sacraments by catholic churches of various stripes (eg RC, EO, etc); see https://anglicanrose.wordpress.com/st-louis-affirmation/

A Skeptic’s View of Counseling Part 6: Integrationism Redux

Before proceeding with my discussion on integrationist counseling, let me state that I have no dog in this fight.  While I have no patience for “psychobabble” in any of its secular or Christian guises, and my libertarian heart wishes to see a wall of separation between our legal and  mental health systems, my Lutheran heart balks at what appears to be a “theology of glory” in the Christian counseling movement; ie that all problems of living can be rectified in this life by mere application of some religious programming and activity.  I believe that life this side of heaven is and will remain a vale of tears, and that we, however sanctified in this life, will go to the grave, or meet Christ should he return soon, laden with our besetting sins.  Our hope is in Christ alone, not our feeble activities and efforts; ie theology of the cross.  I say this only because, up until now, a reader might misconstrue me as a gung-ho partisan of Biblical counseling out to bash psycho-heretics who don’t see that way clearly.  As I hope you will see at the conclusion of this series,  this would be a misconstruction.  With that said, let us proceed.

Much criticism has been leveled at JE Adams for too narrow a focus on specific sins rather than the general nature of fallen man and original sin, leading to a reductionistic method ignoring much of life’s complexities.  As such, not all counseling can be reduced to confrontation about specific sins.  Bradley Cochran at theophilogue.com put it succinctly:

“…Adams unfortunately reduces all methods for counseling down to nouthetics. Biblical Counseling = Nouthetic Counseling. In fact, he oversimplifies the nature of real-life counseling by reducing it down to ‘problem solving,’ and then speaking of the ‘problem’ only in terms of sin. However, to be faithful to the biblical sources, one must include a variety of problems as well as a variety of methods. We must ‘admonish [noutheteite] the unruly,’ but we also must ‘encourage [parameutheisthe] the fainthearted’ (1 Thess 5:14). Adams could have just as easily reduced all counseling down to paramouthetics and walked us through a thousand methods for paramouthetic engagement. With Adams’ reductionistic approach, it does not surprise the reader that he never mentions the biblically revealed methods of admonishing with psalms, hymns, and spiritual songs sung in thankfulness to God (Col 3:16). Such a method seems out of place with Adams’ narrow, cognitively-oriented categories of problem solving.

“Furthermore, since not all troubles are sin problems, not all methods include nouthetics. Most counseling relationships might inevitably involve a need for varying degrees of nouthetic confrontation (as do most real friendships). However, sometimes I have the ‘problem’ of indecisiveness in an important decision. I get counsel from my mentor all the time because he is older than me and sometimes provides a different, more informed perspective on life which enables me to make a better decision. When I go to him for counsel on life’s big decisions, he does not probe my life looking to confront me for some sin (although if he did, he might surely find I am a sinner). Rather, he simply offers his advice, encouragement, prayer, and support. This is right and biblical (25).”

Christian psychiatrist Richard Winter similarly opined:

“Others have suggested parakleo is a more appropriate Greek word to associate with counselling.  It means one who ‘beseeches,’ ‘comforts,’ ‘comes to one side,’ ‘entreats,’ and ‘consoles’…both words are applicable to the concept of Christian counselling. At times one is ‘weeping with those who weep,’ ‘bearing one another’s burden’ and at times one is confronting (26).”

Dr Phillips concurs:

“Nouthetic Counseling thus reduced everything to issues of behavior that can be confronted nouthetically. As Adams put it here, ‘when they raise questions about life, pain, meaning, and purpose and the like, though they may not realize it, they are talking about problems with God. Every complaint—and men are full of them—in the final analysis is against God.’  All human problems are thus reduced to moral confrontation (27).”

In other words, those whose only tools are hammers treat all problems as nails.  To be fair, these criticisms are leveled specifically at the nouthetic party; CCEF has mitigated these problems to a degree, although it has introduced  others (see below).

Another criticism has been raised vis-a-vis the amount of time appropriate to spend with a client who may not be meeting the therapist’s expectations for problem resolution.  According to Phillips:

“One can be sympathetic of this approach(ie nouthetic counseling – ed) because it aims to forestall what Adams called ‘blameshifting’ and the victim mentality. However, the liability is that it gives insufficient attention to the important contexts and causes of sin and that it leads to a highly pragmatic and behaviorist approach to the human person. In his PhD thesis The Biblical Counseling Movement: History and Context, David Powlison wrote that

“‘Adams’ counseling was oriented towards producing specific action, toward building new skills and habits in his counselees. His counseling was a training program in problem-solving, a ‘how-to’ course in godly living. He exhorted his readers, ‘Problems must be viewed as projects, not topics.’ … He believed that motivated counselees could change relatively rapidly but not instantly. He thought most discrete problems could be significantly remedied in six to twelve weeks if both counselor and counselees stayed on task.’

“Adams push for instant results, his rapid but superficial methodology meant that more complicated cases could fall through the gaps. In an article that Richard Winter wrote titled, ‘Jay Adams – is he really biblical enough?’ Winter said

“’I would imagine that those who find it difficult to change rapidly do not stay with Jay Adams in counseling and are seen by him, not as failures in his theory or method, but rather as people who are in deep rebellion or sin. It goes without saying that this may be damaging to such individuals (28).'”

This is an odd position for a system which claims to uphold the sufficiency of Scripture, given Scripture’s silence on how long a counseling relationship should continue.  One might retort that stringing a counselee along for an hefty hourly fee sounds mercenary, but if the counselor is up front with him that the desired result may require a long haul then the counselee is free to dispose of his time and money as he sees fit. Once again, though, this accusation of quick fix applies to the nouthetic rather than the Biblical counselors.

Both Biblical and nouthetic counseling claim the high ground of sufficiency of Scripture, but supporting that claim might prove difficult.  Characteristic of Biblical counseling is concept of “idols of the heart,” which are anything challenging one’s devotion to God.  In an article entitled “Idols of the Heart and Vanity Fair”  Powlison stated:

“The notion of idolatry most often emerges in discussions of the worship of actual physical images, the creation of false gods.  But the Scriptures develop the idolatry theme in at least two major directions pertinent to my discussion here.  First, the Bible internalizes the problem.  ‘Idols of the heart’ are graphically portrayed in Ezekiel 14:1-8.  The worship of tangible idols is, ominously, an expression of a prior heart defection from YHWH your God.3 ‘Idols of the heart’ is only one of many metaphors which move the locus of God’s concerns into the human heart, establishing an unbreakable bond between specifics of heart and specifics of behavior: hands, tongue, and all the other members.  The First Great Commandment, to ‘love God heart, soul, mind, and might,’ also demonstrates the essential ‘inwardness’ of the law regarding idolatry.  The language of love, trust, fear, hope, seeking, serving—terms describing a relationship to the true God—is continually utilized in the Bible to describe our false loves, false trusts, false fears, false hopes, false pursuits, false masters (29).”

The problem with this metaphor is that that is not how Scripture uses the phrase.  Since Powlison, like Adams, adheres to the Reformed faith, let us look at how The Reformed view Ezek 14:1-8.  John Calvin wrote:  “First, he says that they have set up idols in their hearts; by which words he means  that they were addicted to superstition, so that idols obtained a high rank in their hearts…so on the other hand the Prophet says that these men had given supreme sway to idols (30).”  Per Matthew Poole:  “Have set up their idols in their heart; resolved idolaters, their heart was totally addicted to their idolatrous worship and ceremonies; immersed in it (31).”  Since the idols Ezekiel referred to were literal rather than metaphorical, there is no reason to interpret the text metaphorically. Adams similarly opines:

“It would be interesting—perhaps even very helpful—IF we were told in the Bible that we could look for, and discover, distinct, so-called ‘idols of the heart,’ but what Solomon, speaking to God, said is ‘You know the heart, for You alone know every human heart. (1 Kings 8:39 HCSB).’

“It would make counseling easier, I agree, but, then, there’s that clear statement that ‘God alone knows the heart.’

“It’s time, therefore, for those who do so, to stop devising systems for doing what He ‘alone’ can do. Besides, the Bible doesn’t speak of ‘idols of the heart’ anyway. It does speak in Ezekiel—once—of the idols that the Israelites were carrying on/in (both prepositions are used) their hearts as they were being deported to Babylon to remove idolatry from their midst.  They took them along in their minds since they could not carry the physical idols themselves. But there is nothing about producing idols in the heart. By the way that you continually hear about idols of the heart, you’d think that the Bible required counselors to look for them.  It doesn’t (32).”

In other words, the Biblical counseling pot is calling the Christian counseling kettle black; that is to say, each adds to Scripture in its own way.

Can the same be said of nouthetic counseling?  Phillips answers with an emphatic yes, charging nouthetics with being a baptized form of behaviorism:

“If counselors must ignore idols of the heart, then what must counselors look for according to Jay Adams? With B.J. Skinner the answer is simple: behavior.

“I do not say that the Nouthetic focus on only behaviour can never work. In fact, I do believe that in many contexts it can be useful. I can say this because I take an integrationist approach. Precisely because people are so complex and different, we must remain open to a creative application of a variety of approaches and not get locked into just one. But that is precisely what the one-size-fits-all Nouthetic paradigm denies when it rejects the entire discipline of psychology and psychoanalysis. It is the same problem with all the other psychological theories that use a single-factor explanation to explain all of experience…

“The Nouthetic model fails to understand people as God actually created them because it fails to attend to the whole of their life experience. It circumscribes the behavioral to being the most important and denies the relevance of issues that may be upstream of behavior… Given its behaviorist orientation, the Nouthetic model tends to reduce all human neurosis to either organic dysfunction or sin. Emotional, social or psychological problems that do not fall into one of those two categories didn’t seem to exist for within Adams’ schema. Not surprisingly, therefore, sociocultural and interpersonal trauma received scant treatment in Adams’ voluminous writings. By reducing all human problems to issues that can be addressed with either medication or direct moral confrontation, the Nouthetic model ended up excluding vast swabs of the human person from the picture.

“Again it is worth repeating that even when the problems that sin creates are manifested in issues of specific behavior, in order to address these issues it is sometimes necessary to back upstream and consider the broader effects of fallenness in the entire network of a person’s social, relational, emotional and psychological background. These more diffuse issues can sometimes be like pealing off the layers of an onion before you even get to the point of being able to deal with the specific areas of sin and idolatry. It is this aspect which Nouthetic counseling functionally denies.  ‘Nouthetic counseling in its fullest sense,’ Adams once wrote, ‘then, is simply an application of the means of sanctification.’  Seeing everything in terms of behavior and sanctification led Adams to minimize the sense in which meeting one’s psychological and social needs can also play an important role in a counselor’s goals(33).”

According to Winter:

“Jay Adams’ methods of counselling are strikingly similar to behavioural counselling.  Certainly with his  analysis of presentation problems, performance problems, and pre-conditioning problems he could have taken this straight out of a behavioural textbook. He also stresses ‘modelling,’ ‘role-play,’ ‘homework’ and other things which are common in behaviouristic jargon.  He emphasises that in doing the right thing, practising the right response, the right feelings and attitudes will follow.

“Jay Adams would presumably say that he found these methods in scripture and that he has not borrowed from the behaviourists.  But can he insist, as we have seen earlier, that the behaviourists do not have any insights true to the way we are made (34)?”

Journalist Kathryn Joyce observed:

“In practice, despite its rejection of secular psychology, biblical counseling draws both on psychoanalysis, with its focus on getting to the root of problems, and on behaviorism, with its stress on correcting habits. A constant refrain in biblical counseling is the command for counselees to ‘put off’ bad and sinful thoughts, and to ‘put on’ biblical, God-pleasing thoughts instead (35).”

To paraphrase these three observers:  if nouthetic and Biblical counseling walk and quack like integrationist ducks, then integrationist ducks they are; what is really at the heart of the issue between the schools is the degree and manner of integration.  One might argue that the nouthetic and Biblical schools filter secular technique and doctrine through the sieve of Protestant orthodoxy and radically reinterpret what passes through the screen, but that leaves us with the issue of the porosity of the filter.  The picture changes from one of two radically opposed positions to that of ends of a spectrum, and which end is most consistent with the teachings of Scripture.

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(25) http://theophilogue.com/2007/09/28/psychology-is-the-devil-a-critique-of-jay-adams-counseling-paradigm/

(26) republished at http://books.google.com/books?id=G6ZUFNi6Js8C&pg=PA9&dq=Criticism+of+Jay+Adams&hl=en#v=onepage&q=Criticism%20of%20Jay%20Adams&f=false

(27) http://www.salvomag.com/unpragmatic-thoughts/?p=305

(28) ibid

(29) republished at http://www.ccef.org/idols-heart-and-vanity-fair

(30) Calvin’s Commentaries (Grand Rapids, MI:  Baker Books, 1993)

(31) Poole, Matthew.  A Commentary on the Holy Bible (Carlisle, PA:  The Banner of Truth Trust, 1975)

(32) http://www.nouthetic.org/blog/?p=4825

(33) http://www.salvomag.com/unpragmatic-thoughts/?p=305

(34) http://books.google.com/books?id=G6ZUFNi6Js8C&pg=PA9&dq=Criticism+of+Jay+Adams&hl=en#v=onepage&q=Criticism%20of%20Jay%20Adams&f=false

(35) http://www.psmag.com/health-and-behavior/evangelical-prayer-bible-religion-born-again-christianity-rise-biblical-counseling-89464

A Skeptic’s View of Counseling Part 5: The Integrationists

Integrationists – those counselors who combine the teachings of Scripture with the doctrines and practices of secular psychology (albeit reinterpreted and filtered through a Christian grid) – take strong exception to bring caricatured as amalgamators and “psychoheretics.”  Indeed:

“So-called psychoheretics—those who believe that Scripture does not intend to be sufficient for generating a comprehensive counseling model— do see an essential role for the secular psychologies. Psychological disciplines offer some sort of necessary truth; psychological professions offer some sort of necessary and valid practice. But the so-called psychoheretics still claim that the Bible must provide the final authority. That Scripture is not sufficient does not mean the Bible is irrelevant or that it ought to be subordinated to secular psychologies, but that the Bible itself mandates looking and learning from outside. The Bible itself resists biblicism (16).”

Biblicism is the primary counter-charge of the integrationists against the Biblical counseling movement.  The problem is in defining what is meant by biblicism.  Integrationist counselor Robin Phillips defines it thusly:

“To put it simply, Biblicism is an approach to scripture which emphasizes the Bible’s complete clarity, self-sufficiency, internal consistency, self-evident meaning and, above all, its direct applicability of the Bible to every department of human life (17).”

However, the OED simply defines biblicism as “Adherence to the letter of the Bible,” which could make a conservative Evangelical like Dr Phillips a biblicist as well, depending upon the hermeneutic of the accuser.  Since Dr Adams adheres to the Westminster Confession of Faith, which does not teach that the Bible is completely and entirely perspicuous – and, in fact, teaches the opposite (18) – Dr Phillips’ objection comes off as self-defeating.

Phillips’ reasoning also conflicts with what Scripture says about itself vis-a-vis its applicability to all of life (eg 2 Tim 3:16-17, Ps 19, Ps 119); moreover, in his article quoted above he fails to demonstrate both how Scripture is deficient for counseling, and what secular psychology brings to the table that complements Scripture.  The lack of example and evidence reduces his claim to mere assertion.  Even Phillips’ example of the neurophysiologic basis for the subconscious is unhelpful to his argument, as subconscious thought is one thing, while the clinical practice of interpreting dreams is something else entirely, and not necessarily validated by neurophysiology.  Thus the relevance of Dr Phillips’ observation to the issue of counseling is questionable.

Exculpation and fostering of a victim mentality is a charge frequently brought against clinical psychology, and not only by conservative Christians.  Dr Phillips stated:

“It is also a caricature of modern psychology to imply that the discipline does not encourage people to take responsibility for their problems. This caricature often arises out of the idea that to diagnose problems as being symptoms of childhood trauma or victimization is to relieve the agent of responsibility. However, these two things need not be interconnected and often are not. While I am certainly not an expert on this subject, in my experience undergoing sessions of psychotherapy in England, talking with others who have undergone similar processes, and reading bestselling pop psychologists like Scot Peck, Norman Doidge and others, I have never come across someone urging a patient to identify as a victim in order to stay there and never move on, nor someone encouraging the agent to abrogate responsibility(19).”

On the contrary, SL Halleck, MD, a psychiatrist, wrote in the Marquette Law Review:

“…the psychiatrist has no scientific guidelines to help him determine who to excuse (for criminal behavior)…The assignment of personal responsibility is more correctly based on philosophical or moral rather than scientific considerations…As a scientist the psychiatrist may be a hard determinist but in his day to day practice he knows that if he is ever going to help people overcome their difficulties he must constantly implore them to assume responsibility for their actions…This is true even when the patient is considered to be mentally ill and even when his behavior is believed to be unconsciously determined. It is only when the psychiatrist enters the courtroom that he is asked questions which tempt him to forget his own teaching.

“What seems to happen in the criminal insanity trial is that psychiatrists of different value orientations examine the same patient and agree about psychiatric questions but disagree about moral questions…When they are asked to comment upon the question of the offender’s responsibility for his behavior, however, psychiatrists answer this question in terms of their… own belief systems…

“To excuse a criminal offender the psychiatrist must somehow find a way of relating the highly arbitrary concept of mental illness to the philosophical concept of responsibility.  The legal rules which are supposed to guide the psychiatrist to a rational definition of this relationship are based on a presumption that mental illness is a clearly definable entity.  I and many other psychiatrists have repeatedly emphasized that it is not…

“When a psychiatrist testifies in a criminal insanity proceeding he must either deceive himself or he must deceive others…Many (forensic psychiatrists) believe that mental illness is an affliction and have convinced themselves that their expertise in human behavior enables them to determine at precisely what point one is ill enough to be non-responsible.  Other psychiatrists know better…(20).”

For example, in 2011 Toronto resident Richard Kachkar deliberately drove a stolen snow plow into police Sgt  Ryan Russell, killing him.  The defense attorneys entered a plea of insanity, yet

“The three psychiatrists, including Dr. Philip Klassen who was hired by prosecutors but testified for the defence, all acknowledged there were hard-to-explain aspects of Mr. Kachkar’s behaviour and presentation.

“For one thing, his purported psychosis at the time in question resolved unusually quickly afterwards, and without the help of any anti-psychotic medication.

“A series of other doctors, who saw him either in hospital (only after Sgt. Russell was struck and killed and Mr. Kachkar was shot were police able to stop his rampage throughout the city) or in jail, saw no symptoms of psychosis.

“For another, the lack of memory Mr. Kachkar claimed about the incident itself was atypical, and at least one psychiatrist suspected he may have been exaggerating it (21).”

So much for objective science, yet the appeal to such continues in Dr Phillips’ “spoiling the Egyptians” argument:

“Let’s make this practical and see only one of the many ways that attentiveness to the indirect teaching of scripture can help validate psychology. Since the Bible teaches the existence of an objective world that operates according to fixed laws that are knowable (Gen 1-2), it indirectly endorses the entire project of observing how the world works, including observations which assist us in understanding how the human brain and human behavior operate. Such scientific inquiry should rightly be perceived as an extension of the dominion mandate of Genesis 1:28. If a biologist observes how biological organisms work so as to assist gardeners, or if a psychologist observes how people operate in order to better help counselors, they are both working under the umbrella of the Genesis creation account (22).”

As mentioned in a previous post, this works for STEM but not for ideologically-driven fields like clinical psychology which teach theories and canons of human behavior at variance with Scripture, and that on very shaky empirical grounds (23).  Thus, since clinical psychology is not a science like botany or agricultural science is, and conflicts with Scripture, it cannot fall under the Dominion (Creation) Mandate.

On a more ecclesial note, Phillips proffers the “heads I win, tails you lose” argument:

“…Jay Adams explicitly urges counselors not work with anyone who does not want to be helped…The Nouthetic model kicks in after the Prodigal son has returned and wants help, but is useless in helping a counselor know how to pursue someone who is in such rebellion that moral confrontation may simply drive the person further away. The Nouthetic model looks at a person in such a situation and puts the onus entirely on him or her to return and seek help, thus denying the numerous times in scripture where the Lord proactively pursues His lost sheep Luke 15:3–7 or in the prophetic corpus where the Lord goes after His wayward people Israel to bring them back.

“The Nouthetic model thus sits comfortably with a type of Calvinist mentality which rests confident in the knowledge that since God is going to make sure the elect get saved and the wicked get punished, all we have to do is maintain the integrity of the body by putting sinners out of it, and God will bring the sinner back if he wishes. Since God is in charge, we don’t have to concern ourselves with doing everything we can on our end to help the struggling sinner. The speed with which the Nouthetic model moves to church discipline, its lack of concern for finding creative ways to help a sinner who is unrepentant, and its opposition to trying to help a person who does not explicitly desire such help, all fit comfortably within this hyper-Calvinist framework.

“Pastors whose thinking has been tinctured by this paradigm, suddenly find themselves in a win-win situation. If a struggling sinner is put under church discipline or excommunicated, the sinner is either part of the elect or not. If he is not, then the discipline will inevitably drive the sinner further away and the church will be purified (that is, the visible church will be brought more into alignment with the invisible). But if the sinner is not part of the elect, then the discipline will cause him to come back as surely as the prodigal son came back. In both cases, struggling to understand any psychological issues the sinner may be struggling with so as to better help him, is at best irrelevant and at worst a dangerous distraction (24).”

The problems with this seductive argument start with a fundamental misunderstanding of Calvinism – which is always a controversial subject – in confusing Calvinism with hyper-Calvinism.  This is just plain sloppy polemics.  Secondly, there is nothing inherent in Calvinism to produce such ecclesial behavior; indeed, I am personally aware of non-Calvinistic counseling situations in which parishioners were shafted by counselors and churches, and other examples could easily be found on the internet.  Thirdly, since integrationists are so enamored with medical models, consider the diabetic who smokes like a chimney, drinks like a fish, eats like a pig, and lies like a potato:  physicians have scores of such patients, and could tell you just how hard it really is to motivate someone with no perceived responsibility for his own health cum accountability for his noncompliance; ie just how hard it is to help someone who does not wish to be helped.  There comes a point where any further attempts to cajole such a person into a therapeutic alliance is nought but casting pearls before swine and answering fools according to their folly – two things Scripture enjoins against.  Fourthly, such pursuit means that someone who wishes to be helped may not have ready access to a counselor’s service, as we all have limited time and other resources; endlessly pursuing the militantly disinterested suggests a counselor with messianic pretensions.  Finally, there is a conflict of interest in that pursuit of the recalcitrant Christian by a professional counselor charging an hourly fee therefor smacks of mercenary intent, which clearly conflicts with the Seventh (Eighth) Commandment.  It is an entirely different issue when a minister, church officer, or church member engages in such on his own time and dime; even then, resources are limited and other demands on such must be met.

The above does not mean to suggests that the integrationists have no substantial arguments against the Biblical counselors; this will be fleshed out in the next post.

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(16) http://www.ccef.org/cure-souls-and-modern-psychotherapies

(17) http://www.salvomag.com/unpragmatic-thoughts/?p=305

(18) Westminster Confession of Faith Chapter 1:  Of the Holy Scripture:  “VII. All things in Scripture are not alike plain in themselves, nor alike clear unto all: yet those things which are necessary to be known, believed, and observed for salvation are so clearly propounded, and opened in some place of Scripture or other, that not only the learned, but the unlearned, in a due use of the ordinary means, may attain unto a sufficient understanding of them.”

(19)  http://www.salvomag.com/unpragmatic-thoughts/?p=305

(20) http://scholarship.law.marquette.edu/cgi/viewcontent.cgi?article=2394&context=mulr

(21) http://news.nationalpost.com/2013/03/22/christie-blatchford-mental-illness-no-excuse-for-doing-wrong-prosecution-tells-jury-as-murder-trial-nears-end/

(22) http://www.salvomag.com/unpragmatic-thoughts/?p=305

(23) the volume of literature decrying the sheer politics masquerading as science behind the DSM-5 bears this out.

(24) http://www.salvomag.com/unpragmatic-thoughts/?p=305

A Skeptic’s View of Counseling Part 4: Anti-psychology’s Alternative

As mentioned in a previous post, critics of psychology see it as a challenge to the sufficiency of Scripture to address the human condition in a way science, technology, engineering, and mathematics (aka STEM) are not.  Why this dichotomy?  In brief, STEM is a function of the Cultural (or Creation) Mandate of Genesis 1:28:

“And God blessed them, and God said unto them, Be fruitful, and multiply, and replenish the earth, and subdue it: and have dominion over the fish of the sea, and over the fowl of the air, and over every living thing that moveth upon the earth.”

Herein God gives man the charge to explore, explain, manage, harness, and modify the physical word for God’s glory and man’s good.  Through human faculties inherent in man being made in imago Dei, man has developed STEM as well as the arts in order to fulfill his God-given role as a “sub-creator” a la Tolkien, thinking God’s thoughts after him and working with the stuff of creation.  However, Genesis 3 goes on to tell of the Fall, due to which man, despite having the Law of God written on his heart and being ever face-to-face with a wrathful God and the reality of sin, is spiritually dead and wholly bent upon his own autonomy, having all of his faculties tainted by sin.  In such a fallen world, STEM is often used as an engine of evil and cruelty, and the arts so perverted as to gleefully flip God off; German and Japanese medical experimentation on hapless prisoners, the more notorious photographs of Robert Mapplethorpe, and “Piss Christ” are handy examples.  In fine, fallen man is in denial of his need of repentance and reconciliation with God, as well as the consequences of failing to show proper fealty to the King of Kings.

So where does psychology fit into this?  The most basic answer is that, unlike STEM, psychology (in its clinical guise) represents the attempts of rebellious and autonomous man to define, diagnose, and rectify the problems of living in a fallen world apart from any reference to God’s own decrees regarding man’s problems and the solutions therefor; as mentioned in an earlier post, psychology is a de facto secular religion and hence in competition with the claims of Christianity.  In its very vocabulary (normal vs abnormal, gender vs sex, and concepts like self-esteem, -actualization/-fulfillment) psychology norms and moralizes without any standard other than the shifting fads of politics (11), its practitioners function as a secular pastorate and, given the forensic ramifications of their diagnoses, there is no separation of Church and State.  This being said, the critics rightly and well-nigh rhetorically ask of what use such a “science” can possibly be to assisting Christian brethren foundering in their lives; like Christian Science, clinical psychology is neither.

Psalm 19 starts off as a paean to creation as God’s handiwork, illustrating the concept of  general revelation which is reechoed in Romans 1:19f.  However, the Psalm breaks at v 7, in which the perfection and uses of God’s Law (aka “special revelation”) as the source of all wisdom and perfection.  Along with 2 Tim 3:16 and other verses, it is clear that the faithful Christian looks to Scripture alone as the source for not only norms, but even of a method for living a life to God’s glory and true fulfillment.

So what does this look like in practice?  There are two schools of counseling which claim to meet the test of Christian orthodoxy:  nouthetic, as founded by the aforementioned Rev JE Adams, and its offshoot, Biblical, an example of which is the aforementioned CCEF at Westminster Theological Seminary.  The differences between the two schools are more on matters of emphasis than commitment to the sufficiency of Scripture; according to Dr Heath  Lambert, an assistant professor of Biblical counseling at Boyce College and The Southern Baptist Theological Seminary:

“There are no massive fault lines in the movement between ‘biblical’ and ‘nouthetic’ labels. Regardless of the name a person uses, the people in the movement are committed to using the Scriptures as the source of wisdom that drives the change process in conversational ministry (12).”

Looking at nouthetic counseling as prototypical, how does this all play out?  Per nouthetic counselor Rev Craig Day:

“The counseling term ‘Nouthetic’ is from the NT Greek word noutheteō (νουθετέω), which can be translated as ‘admonish,’ ‘warn,’ ‘correct,’ ‘exhort,’or ‘instruct’ from the Bible as used in Colossians 1:28 ‘We proclaim Him, admonishing every man and teaching every man with all wisdom, so that we may present every man complete in Christ (13).”

Rev Day goes on to define the essential points of nouthetic counseling:

“1. God is at the center of counseling.

“2. Commitment to God has epistemological consequences.

“3. Sin, in all its dimensions is the primary problem counselors must deal with.

“4. The gospel of Jesus Christ is the answer.

“5. The change process counseling must aim at is progressive sanctification.

“6. The situational difficulties people face are not the random cause of problems in living.

“7. Counseling is fundamentally a pastoral activity and must be church-based (14).”

The root problem according to this method is sin, either as specific sins or general sinfulness, resulting in negative life consequences, reactions, and relationships.  Rev Day proceeds:

“Sin, in all its dimensions (e.g., both motive and behavior; both the sins we do and the sins done against us; both the consequences of personal sin and the consequences of Adam’s sin) is the primary problem counselors must deal with. Sin includes wrong behavior, distorted thinking, an orientation to follow personal desires, and bad attitudes. Sin is habitual and deceptive, and much of the difficulty of counseling consists in bringing specific sin to awareness and breaking its hold. The problems in living that necessitate counseling are not matters of unmet psychological needs, indwelling demons of sin, poor socialization, inborn temperament, genetic predisposition, or anything else that removes attention from the responsible human being. The problem in believers is remnant sin; the problem in unbelievers is reigning sin. Sin is the problem (15).”

The goal of counseling, then, is the identifying and resolution of the sinful attitudes and behaviors resulting in the counselee’s predicament(s), and so guiding him to use the means of grace to become more mature and useful in the Christian life, solving the particular problem(s) at hand in a manner glorifying to God and hence ultimately for the counselee’s good.  This may involve having to confront in love a counselee’s excuses, blame-shifting, and an host of other sinful and maladaptive attitudes and behaviors in order to effect such change. There will be no references to the diagnoses found in DSM-V, but rather to Scripture as understood from the perspective of creedal Protestantism.

Integrationists – those who combine Scripture with psychology- beg to differ with the above assessment of both their endeavors as well as that of the Biblical counselors; the next post will outline the integrationist position.

NB:  special thanks to Rev Craig Day of Caleb Counseling in Charlotte, NC for his review and assistance.

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(11) “Under an extremely insensitive and inaccurate headline, ‘Redefining Crazy: Changes to the Bible of Psychiatric Disorders,’ TIME.com reported:

“’What will not be added to the DSM is hypersexual disorder—sex addiction—even though many APA members argued for its inclusion. According to one member of the APA’s Board of Trustees, ‘the evidence just wasn’t there.’ Other mental-health professionals note that the DSM is subject to political influence. ‘This is a huge money-maker for the American Psychiatric Association,’ says Marsha Linehan, a University of Washington professor and a leading expert on personality disorders. In short, the approval this weekend of DSM-5 ends years of editing but begins years of debate.” Republished in http://www.healthnewsreview.org/2012/12/critic-calls-american-psychiatric-assoc-approval-of-dsm-v-a-sad-day-for-psychiatry/

(12)  http://www.thegospelcoalition.org/article/two-sides-of-the-counseling-coin

(13) http://www.calebcounseling.org/about-uhttps://wordpress.com/post/77274817/33#s/about-nouthetic-counseling

(14) ibid

(15) ibid

A Skeptic’s View of Counseling Part 3: The Problems with Psychology

Last week I touched on the controversial nature of the influence of secular psychology in Christian counseling.  The opponents, Biblical counseling establishments like CCEF and Jay Adams’ Institute for Nouthetic Studies, cite the following reasons:

  1. psychology, by its very definition and etymology (“the study of the nature, functions, and phenomena of the human soul or mind”(3)), encroaches upon the proper realm of theology;
  2. this encroachment is based upon naturalistic (hence erroneous) presuppositions rather than revealed truths about man’s nature, morality, and life’s purpose, and is thus a religious rather than scientific endeavor;
  3. the utility of psychology lies only in its being descriptive (ie observations scientifically verified) rather than prescriptive (ie in providing moral or legal guidance), where it is as scientific and credible as phrenology; and
  4. as a false religion, the presuppositions and conclusions of psychology are not neutral or “scientific,” but are opposed to God.  Since Scripture is true, and addresses the human condition from the perspective of the Creator, there is no valid reason to go outside of it to counsel men on overcoming the problems of living; in fact, to do so is to presume to be wiser than God.

It is no accident that Jay Adams, the father of the Biblical Counseling movement, is an adherent of Reformed theology, because his and others’ objection to modern psychology is a function of the presuppositional apologetics of the late Dr Cornelius Van Til, who was chairman of the Department of Apologetics at Westminster Theological Seminary – where Dr Adams taught and where CCEF is headquartered.  In his engaging and intriguing pamphlet “Why I Believe in God,”  Van Til has an imaginary conversation with an unbeliever in which the former’s apologetic method is unpacked and applied.  Germane to the discussion of psychology as a false religion is this particular quote:

“I must make an apology to you at this point. We who believe in God have not always made this position plain. Often enough we have talked with you about facts and sound reasons as though we agreed with you on what these really are. In our arguments for the existence of God we have frequently assumed that you and we together have an area of knowledge on which we agree. But we really do not grant that you see any fact in any dimension of life truly. We really think you have colored glasses on your nose when you talk about chickens and cows, as well as when you talk about the life hereafter. (4)”

From the Van Tilian perspective, there is no neutrality towards God’s word; secular psychology “cannot see any fact…truly” because it is based in false presuppositions about the nature of man, seeing him through the “colored glasses” of an anti-Christian worldview.  As a false system, then, psychology can be of no use for guiding Christians – or so it goes.

Theological objections are not the only barriers to the acceptance of psychology in conservative Christian circles, and not all objections are ostensibly Christian.  The late psychiatrist Thomas Szasz, MD, questioned the existence of mental illness as an oxymoron:

“The phrase ‘the myth of mental illness’ means that mental illness qua illness does not exist. The scientific concept of illness refers to a bodily lesion, that is, to a material — structural or functional — abnormality of the body, as a machine. This is the classic, Virchowian, pathological definition of disease and it is still the definition of disease used by pathologists and physicians as scientific healers.

“The brain is an organ — like the bones, liver, kidney, and so on — and of course can be diseased. That’s the domain of neurology. Since a mind is not a bodily organ, it cannot be diseased, except in a metaphorical sense — in the sense in which we also say that a joke is sick or the economy is sick. Those are metaphorical ways of saying that some behavior or condition is bad, disapproved, causing unhappiness, etc. In other words, talking about ‘sick minds’ is analogous to talking about ‘sick jokes’ or ‘sick economies.’ In the case of mental illness, we are dealing with a metaphorical way of expressing the view that the speaker thinks there is something wrong about the behavior of the person to whom he attributes the ‘illness.'(5)”

Dr Szasz unpacked this concept more fully in his epic volumes The Myth of Mental Illness and The Myth of Psychotherapy, which remain classics of libertarian thought and scientific clarity, separating empirical wheat from philosophical chaff by highlighting the difference between brain and mind.

Research psychiatrist EF Torrey expressed similar belief to Dr Szasz:

“The term (mental illness) itself is nonsensical, a semantic mistake. The two words cannot go together … you can no more have a mental “disease” than you can have a purple idea or a wise space (6).”

He elaborated:

“The mind cannot really become diseased any more than the intellect can become abscessed. Furthermore, the idea that mental ‘diseases’ are actually brain diseases creates a strange category of ‘diseases’ which are, by definition, without known cause. Body and behavior become intertwined in this confusion until they are no longer distinguishable. It is necessary to return to first principles: a disease is something you have, behavior is something you do (7).”

A purported science built upon a mistaken metaphor is no science at all, but rather is quackery.  Thus orthodox opponents of psychology appeal to both sound theology and science, reminding psychologizers that all truth is indeed God’s truth, but falsehood is of the Devil, and that spoiling the Egyptians meant plundering their wealth rather than their belief system.

More concretely, the anti-psychology side points out the deleterious ramifications of psychological doctrine in the exculpation of criminals and scoundrels so rampant in modern society in general, and specifically in public education and jurisprudence, as if the chief end of  psychologists were to stay the hands of the civil magistrates, parents, and teachers.  Journalist Kathryn Joyce wrote on the subject of Biblical counseling:  “Many of its tenets have the ring of common sense and would probably resonate with those who worry about over-medicating children with diagnoses like ADHD or who roll their eyes at seemingly exculpatory diagnoses for bad behavior—sex addiction for cads, or oppositional defiant disorder for brats (8).”  Other concerns include the fostering of the victim mentality, thereby enabling a client to dodge personal responsibility; the mislabeling of sin as sickness; a utilitarian versus covenantal view of life; and a failure to take the demands of Christianity seriously by okaying immoral behavior in the name of “personal fulfillment” or “self-actualization;” in fine, normalizing living as if God did not exist.

Critics also point out the risks of psychotherapy. In an article published in The Guardian:

“Talking therapies are usually helpful to people who are distressed, but in a minority of cases where it goes wrong it can leave vulnerable people more depressed than when they first sought help, the authors say.

“Prof Glenys Parry, chief investigator of the (UK) government-funded AdEPT (Adverse Effects of Psychological Therapies) study, said that there needs to be greater recognition of the potential for counselling to make people worse.

‘Most people are helped by therapy, but … anything that has real effectiveness, that has transformative power to change your life, has also got the ability to make things worse if it is misapplied or it’s the wrong treatment or it’s not done correctly,’ she said (9)”

An article in The Psychologist states the problem more emphatically:

“When someone undergoes psychotherapy, the hope, obviously, is that they will recover. But if they don’t, what is the worst that can happen? That the therapy will prove ineffective? In fact, therapy can be harmful, with research showing that, on average, approximately 10 per cent of clients actually get worse after starting therapy (10).”

That being said, critics are a dime a dozen and nobody ever got hurt playing armchair quarterback.  IMHO to be taken seriously, the anti-psychology side needs to have an alternative therapy in which benefits outweigh risks, is of proven efficacy, and meets the criteria of Christian orthodoxy. I will explore their claims of having such a therapy in the next installment.

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3) Oxford English Dictionary

4) republished at http://www.reformed.org/apologetics/index.html

5) http://www.psychotherapy.net/interview/thomas-szasz

6) republished at http://ic.galegroup.com/ic/ovic/ViewpointsDetailsPage/DocumentToolsPortletWindow?displayGroupName=Viewpoints&jsid=732788b94379e91d6d299e2af247ccfb&action=2&catId=&documentId=GALE%7CEJ3010154214&u=oak30216&zid=0afe4219448f258f6cf7f7d30ef108c2

7) ibid

(8) http://www.psmag.com/health-and-behavior/evangelical-prayer-bible-religion-born-again-christianity-rise-biblical-counseling-89464

(9) http://www.theguardian.com/society/2014/may/26/misjudged-counselling-psychological-therapy-harmful-study-reveals

(10) https://thepsychologist.bps.org.uk/volume-21/edition-1/when-therapy-causes-harm

A Skeptic’s View of Counseling Part 2: Rationale and Controversy

A Skeptic’s View of Christian Counseling Part 2:  Rationale

Why does anybody go for counseling?  The whole concept behind counseling is that the counselee is experiencing problems of living and needs expert advice wisely applied in order to alleviate suffering and to more competently navigate the seas of existence.   Most often, the counselee seeks this help on his own initiative.  With some problematic behaviors like juvenile delinquency, violence, or substance abuse, the counseling may be a court-ordered alternative to incarceration, or part of an inmate’s program of “correction.”

Seeking the help of a counselor/mental health professional is very different to seeking medical help, in that the former constitutes an admission of personal weakness cum inability to handle one’s own problems, for which society stigmatizes such people with pejoratives, indelible psychiatric diagnoses, and other forms of social opprobrium. Furthermore, the counselee must confess his weaknesses and failings while exposing his innermost thoughts to the examination of another.  This is a much more invasive procedure than a physician’s internal exam, as the mind constitutes an even more personal space than wherever a doctor may insert his fingers or instruments.  Thus, seeking counseling is a risky business for any perspective client.

For the serious Christian, counseling poses another set of problems on top of the above, namely, it is a direct challenge to Christian truth claims.  Scriptural claims that believers are in-dwelt by the Holy Ghost, that the Scriptures are sufficient to guide the faithful in all of life, that God provides “means of grace” for believers (ie Word and Sacrament per Lutherans; Word, Sacrament, Prayer, +/- Church Discipline per Reformed); and countless encomia to take one’s self in hand and rejoice amidst trials of life (eg Psalm 42).  Furthermore, appearing helpless before a non-Christian counselor, however sympathetic he may seem, is widely believed to be a poor witness for Christ; there is some truth in this contention.  For these reasons many Christians prefer to be counseled by fellow believers who shares their worldview.

As easy a solution as seeing a Christian counselor would appear to be, this solution is fraught with difficulty.  For instance, what exactly is a Christian counselor:  a Christian who happens to counsel; a Christian who combines a counseling background with some Christian theology mixed in; or a Christian whose counseling is (allegedly) based in sound theology?  Let’s make it even more confusing by asking if there really is such a thing as a Christian counseling distinct from its secular counterpart, not just in its behavioral and attitudinal goals, but in its methodology.  Since the first type of Christian counselor makes no claim to be anything different to his secular colleagues,  I will not discuss him.

The second fellow, who amalgamates secular counseling with the teachings of Scripture, defends his practice by appealing to common grace, the chestnut that “all truth is God’s truth” and the claim of spoiling the Egyptians a la Exodus 11:2-3 such that secular methods are indeed compatible with Scripture; and that he is able to differentiate between sacred carp and secular bones – “the best ensue, the worst eschew.”  Per Christian counselor Patrick Yates,

” Christian Counseling combines modern methods of counseling with Scriptural principles, using Biblical Truths as the reference point for integration. In this model of therapy neither the Scriptures, nor modern counseling technique is ignored, instead, the counselor seeks the best possible means to address the issues with which clients struggle, and since God has invited his people to ask for wisdom, the counselor maintains a prayerful attitude, seeking God’s guidance as the counseling moves forward. (1)”

Compare the above with the following quote from Dr Ed Welch of the Christian Counseling Educational Foundation (CCEF):

“Biblical counseling is a hybrid of discipleship and biblical friendship, neither of which can be mistaken for a passing fad. “God has spoken” is the driving principle of biblical counseling. Scripture speaks with great breadth, to all the common problems we all encounter, from loneliness to schizophrenia. God speaks with great depth, getting to the very heart of problems. Scripture indicates that all life is lived before the face of God, “that all life’s problems are ‘religious’ or ‘spiritual’ (2)”

Herein lies the difference between the second (aka “Christian counselor” or CC) and third type of counselor (aka “Biblical counselor” or BC) in that the former consciously albeit selectively borrows from secular counseling, while the latter appeals only to Scripture (the validity of this claim will be examined later).  Both positions claim fidelity to Scripture, but the former position is analogous to the Roman Catholic partim-partim view (ie the truth is found partly in Scripture and partly in psychology) while the latter asserts the Protestant position of the formal sufficiency of Scripture (ie all that is necessary to counsel in a Christian manner is found in Scripture)…or so it may seem.  Herein, too, is the major contention in Christian counseling, viz, reliance on the presuppositions, conclusions, and techniques of modern psychology, in kind versus degree.

The reason for this controversy may be appear obscure, nit-picky, or even entirely overblown.  After all, psychology is universally recognized as a scientific field with clinical application like medicine; it is also taught in many if not most conservative Christian colleges and universities. There are many Christians in the field as both researchers and clinicians, and such folk are providing aid and comfort to both Christian and unbelieving sufferers in accordance with Christ’s command to show love to one’s neighbor.  One does not take umbrage at surgeons using techniques developed by non-Christians, and even the most cretinous anti-Semite in Christendom would not refuse a polio vaccine because its inventor was a Jew.  Even big names in Evangelicalism tout the usefulness of psychology, so why the fuss?  This will be the topic of my next post.

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1) http://www.thechristiancounselor.net/patrick-yates-lpc-christian-counseling/why-christian-counseling

2) http://www.ccef.org/what-biblical-counseling-anyway

A Skeptic’s View of Christian Counseling Part 1: Prolegomena

Judging by the numbers of counseling centers, counseling schools, books and other instructional media, and church involvement, the Christian counseling movement has developed quite a momentum.  My first exposure to this was as a post-grad in an evangelical church which introduced Gary Sweeten’s “Apples of Gold” program to teach the congregation so-called “active listening” in order to help people help others with their problems of living. For a variety of reasons, the attempt was a complete failure resulting in the church council ditching the program.  Years later, while trying to sort medical from spiritual problems with one of our children, we were very blessed to have had the assistance of a seminary-trained counselor whose common sense and empathy helped us deal with some of our son’s behaviors.  However, in another encounter a few years later, we found ourselves dealing with another counselor trained at the same seminary whose ineptitude and ignorance resulted in what can charitably be described as quackery; fortunately for us, the only damage done us was the loss of the counseling fee though it had the potential for far worse given the issues we were seeking help for.   I include these anecdotes only to say that I’m not writing from inexperience or ignorance, and that I’m not being completely dismissive.

Articles on the history of Christian counseling are legion, so I won’t bore you with a recap.  Suffice it to say that, prior to the 1960’s, churches often ceded the field of counseling to the secular world, giving disturbed members short shrift.  This is in spite of well-near two millennia of pastoral work historically referred to as “cure of souls” and seen as inseparable from the pastoral office.  The near triumph of scientism and specialization in the western world lead to the rise of psychology and psychiatry and the capitulation of the Church to the world.  Much credit for the reversal of this trend in Christian circles goes to the work of Rev Jay E Adams in the 1960’s, giving rise to the Christian counseling movement (CCM) as we see it today.

As secular counseling had been established since the time of Freud, it was and remains imperative for the CCM to differentiate itself from its secular rival in order to justify its separate existence and retain credibility.  Nonetheless, all studies, statements, and ballyhoo aside, the two movements have a number of similarities, which is to be expected.  It is to these that one should first review in order to gain a good understanding of the situation.

The most obvious similarity is that both Christian and secular counseling involves counseling.  Disagreements on just how one is to counsel has resulted in competing schools, each with their own diagnostic and treatment paradigms, specialized jargon, etc.  Some of these schools are mutually exclusive, and even mutually antagonistic; each side also features eclectic practitioners.

Secondly, both movements are inherently religious due to making truth claims resulting from underlying world-views. The CCM posits man as created by God in His image and hence responsible to Him to obey His moral law, and who, body and soul, suffers from both the general consequences of Adam’s Fall and from specific sins.  Secularists believe that man’s evolved antecedents slithered out of a bowl of primordial soup, he is born a blank slate, suffers a variety of slings and arrows from a variety of slingers and archers (including himself), and is responsible to himself and others.  CCM purports to gain its authority through Holy Writ and a view of science tempered by such, while the secular counselors vary in their claims of practicing art or science.  These contrasting views often but not always lead to contrasting recommendations.

Lastly but most importantly, both movements constitute self-interested guilds whose prestige and profits depend upon credibility and maintaining a client base.  These aforementioned schools charge tuition, grant degrees and certification, regulate and discipline their practitioners, often require continuing education, and collect fees for service.  In short, both sides view their practitioners as professionals with specialized skills and expertise.

The consequences of this for counselees are not always benign.  In the American mental health system, a diagnosis can have negative effects on the counselee’s employability, ability to purchase or own firearms, insurability, and can put him in the crosshairs of the legal system (eg involuntary commitment, forced medication).  While Christian counselors lack the backing of the State apparatus (DG!), counseling under church aegis can result in discipline or ostracism. This can lead to adverse social consequences including loss of face and/or of one’s position in the church, the ability to peacefully transfer to another church, etc.  Often, for both sides, labels applied prove indelible, resulting in no return to the status quo ante.