Biblical counseling is a “school” or method of counseling that believes the Bible is sufficient for the problems that we encounter in life.
It eschews psychology and “secular” research, and focuses on using the Bible to counsel people.
Many Christian counselors are not biblical counselors. To become a counselor you can use, in general, four routes:
Four Types of Counseling Christians Do
- Biblical Counseling: Unlicensed counselors who use the Bible alone. They often focus on advising clients what changes they must make.
- Pastoral Counseling: General counseling that incorporates many psychology findings, but is limited in scope to allow pastors to do some basic counseling
- Integrated Licensed Counseling: Training in integrating your faith and psychology and evidence-based therapies to help people. They do not tell clients what to do but rather give them tools to think through their situation.
- Licensed Counseling: Training in evidence-based therapies and psychology without a faith component. Again, they do not tell clients what to do.
Licensed counselors could include Licensed Marriage and Family Therapists (LMFT); Licensed Clinical Social Workers (LCSW); Licensed Clinical Pyschologists, and other professions that include licensure.
The term “biblical counselors” does not encompass all Christian counselors.
I know that biblical counselors go into counseling because they love Jesus and want to help people.
For the vast majority of biblical counselors, the intent is pure and good.
However, that does not mean that the results are necessarily pure and good.
On this blog, I tend to avoid controversial subjects that aren’t directly related to sex or marriage because I’m already controversial enough; I don’t want to turn people away about things that aren’t central to my main subjects.
When it comes to biblical counseling, then, I would prefer not to talk about it. I know that this topic is really hurtful for many biblical counselors. Nevertheless, this does directly relate to how we handle sex and marriage in the church, because in doing our research for our books, we heard so many stories of people who received very well-meaning but ultimately harmful counseling from biblical counselors.
I’m hoping that by raising these issues we can raise awareness of the different types of counseling, and help people “stay in their lane”, so to speak.
With that, I’d like to share my four concerns about biblical counseling.
Yesterday on my Facebook post about this so many people shared great points and great stories, and I’ll incorporate these where they fit.
1. Biblical counseling can too often fail to define the problem appropriately
Biblical counseling tends to see all issues through the lens of “what can this person do differently or think differently to get in line with Christ?” The focus then is on fixing the person who is coming in for counseling.
This is entirely appropriate when the person has guilt from past sin, or when they’re confused about what to do with their life, or when they have general malaise and feel unmotivated in life and they need to work through some things.
In fact, biblical counseling would likely be the BEST course of action when a person needs to be told to repent (something licensed counselors can’t do).
However, I can think of three situations where this isn’t an appropriate approach:
When Biblical Counseling May not Be Appropriate
- Trauma: When a person has undergone trauma, that “fight, flight, or freeze” response has been triggered and not resolved. This isn’t a sin or faith issue but instead a trauma response issue, and needs proper therapies to help through it. Treating panic attacks or externalizing behaviours or fears that are trauma responses as sin or lack of faith actually exacerbates trauma.
- Mental Illness: Our brains are organs; they are part of our physical bodies, and they can go wrong. Most biblical counseling programs see spiritual roots to all, or most, mental illnesses.
- Dysfunctional or Abusive Relationships: Having someone focus on what they should be doing or thinking differently to exhibit the fruits of the Spirit is warranted when they are in fact thinking or acting badly. But in many relationship situations, the fault is not shared Telling a person who is responsible for 10% of the problems that they have to own their stuff and work on themselves rather than identifying a perpetrator and a victim is not a good or safe idea. Sometimes the reason a wife may feel exhausted and depressed is not because she isn’t grateful or submissive, but is instead because she bears all the mental load, her husband ignores her, and she’s forlorn. It’s an entirely appropriate response to the situation.
Of course, some biblical counselors would handle all of these situations appropriately!
But the stories that I have heard, and the curriculum that I have seen, tends to raise red flags for me in each of these three categories. I shared a few years ago on the blog about a homework assignment a woman was given when she went to biblical counseling at Harvest Bible Chapel in Chicago for help with her cheating husband. She was told to complete the form 98 Ways I May be Sinning Against My Husband–a checklist I found throughout biblical counseling websites across the United States, which originated from a biblical counseling textbook and is still handed out by a biblical counseling professional development center (while there isn’t an equivalent one for men).
In my post yesterday where I shared commenters’ thoughts about biblical counseling, I shared a comment where one biblical counselor defended her counseling practice, which actually demonstrates the problems I’m talking about. She claimed that they now treat abuse really well. They make sure to get the woman to safety, and then: “we work through any heart issues with her (bitterness, resentment, anxiety, fear, etc).” The problem is that someone escaping abuse is in a trauma recovery situation. She needs trauma therapy. Being told instead that she needs to deal with her bitterness actually exacerbates the trauma.
Let’s hear from some other commenters, most of whom were reacting to #2 and #3 above:
Anytime I have gone for ministry, I have been made to repent repeatedly for sins I didn’t consent to, or commit, but were atrocities committed against me.
And when I am still bound by shame, they blame me for not choosing to “walk in freedom”, failing to see that their insistence on my self-condemnation binds me into toxic shame far more than anything my abusers did to me.
I found it really helpful to go to a LCSW counselor who didn’t have an agenda other than my health, and no emotional involvement other than simple human care. She had professional boundaries and the emotional space to help me process my grief, and all she cared about was my healing.
I didn’t even look for a Biblical counselor but knowing what I know now I’m grateful I didn’t. Honestly any form of spiritual pressure over my depression, anxiety and grief might have sent me into more suicidal ideation.
We also heard from some where the “sin leveling” approach was really harmful–where the approach was assuming that everyone had something to repent of and that reconciliation is always the goal:
(TW: description of rape)
“Biblical counseling” advised and encouraged my mother to invite my rapist and his parents into our home for a round table discussion on “why we should keep these two apart going forward so they aren’t tempted to sin again and have sex before marriage”.
At 17yrs old I was forced to sit at a kitchen table with my mother, MY rapist (19), and both his parents for an “open discussion” on what went wrong and how to ensure we didn’t have “unsupervised” contact anymore. The rapist was a school friend of mine that had invited me over to his home to watch a movie while his father was in the other room. After giving me massive amounts of alcohol I blacked out and he proceeded to violently rape me in the bedroom of his parents home and then drove me home and dumped me on my doorstep, drunk. This wasn’t a “sex before marriage” situation. It was rape. Full stop.
There’s not enough money in the world that would ever have me setting foot in another “church” again in my life.
2. Biblical Counselors most likely have little training to adequately know when they are out of their depth
Even if biblical counselors are told that they should refer out people with mental illness issues, if they are not trained on the DSM (the manual for identifying mental illnesses and personality disorders and other issues), they often miss these diagnoses.
So, there are benefits to both! Licensed counselors are not there to give advice (and certainly can’t do so from a Biblical perspective). But they ARE trained in appropriate treatments and therapeutic interventions for both individual diagnoses and couples counseling.
If an individual or a couple are specifically seeking Biblical guidance, they’re not going to find that from a licensed counselor. They literally cannot find that because it is inappropriate for a licensed counselor to provide biblical guidance.
There is, and should be, room for both. A licensed counselor is going to say “what feels right for you?” And a Biblical counselor is going to ask “what actions will glorify God in your life?”
The problem is when Biblical counselors practice outside of their scope and can’t identify (or don’t care) when there are deeper issues at play that require (or at least would benefit from) therapeutic intervention.
I think both have an important role, and the issue, as I’ve seen it, is that a licensed counselor may encourage a client to seek spiritual support if those systems are important to them, whereas a Biblical counselor doesn’t always recognize the importance of actual therapy and think that “just trust God” is a cure-all for actual issues.
3. Biblical counseling too often ignores evidence-based therapies
Along with that, biblical counseling doesn’t train people in what we know are evidence-based therapies for some maladies. I don’t believe that we need to flee “secular” research. When studies have been done that shows that Cognitive Behavioural Therapy or EMDR helps with different conditions, we don’t need to flee them because they aren’t directly in the Bible (though I would argue that 2 Corinthians 10:5–taking every thought captive to Christ–shows CBT perfectly).
Our medical therapies that we use today aren’t in the Bible either, but we don’t flee from them. Jesus is the Truth; He said that we could judge a tree by its fruit. If something has been shown to bear good fruit, we should rejoice in that and embrace it, because it tells us more about how God made us.
4. There’s no guarantee of confidentiality or accountability with biblical counseling
Finally, and perhaps most importantly, unlike licensed counselors who have strict ethical guidelines around how they practice and strict guidelines around confidentiality, biblical counseling has none of that.
Yes, there can be bad licensed counselors as well, but as one commenter said:
While it can come down to individual “practitioners” who do the most direct harm, licensure has accountability for those individuals, whereas “biblical counseling” does not. And so often the latter has abusive power structures in place to keep people from turning to other resources when an “individual” “biblical counselor” fails them.
There is actually no guarantee of confidentiality in most biblical counseling situations.
It’s common practice with biblical counselors to require clients to sign consent forms acknowledging that the counselor can share information with the church leadership when the counselor thinks that’s appropriate. (I have an example of a biblical counseling consent form here).
This has been greatly misused in far too many cases (James MacDonald, now disgraced megachurch pastor, used information gleaned in counseling sessions to have power over their congregants, according to various news reports.)
My plea to biblical counselors
Keep doing research outside typical biblical counseling fields. Read books that aren’t from biblical counselors (The Body Keeps the Score, about trauma, is a great place to start. I realize that the author was credibly accused of harrassment himself, but the book is filled with wonderful research).
Read some critiques of biblical counseling. Learn to recognize your own limitations and know what you can do and what you shouldn’t do.
Many biblical counselors have become trauma-informed and are well-versed in many of these issues, and do great counseling. But it takes an openness to explore resources outside of your typical professional development.
And, if you’re willing, taking extra courses so that you can qualify for licensure is a very good idea.
My plea to those who want to go into counseling
Please pursue the licensed route. You can still learn how to integrate your faith with counseling when you take counseling at a Christian university through a track heading towards licensure. But remember that Jesus is the Way, the Truth, and the Life. When we study his creation–including humanity–and make discoveries, we’re pursuing Jesus because we’re learning about Truth. We don’t have to be scared about learning things from outside the Bible. Psychology can teach us so much, and there are so many evidence-based therapies for depression, trauma, relationships, and more.
I know this is an emotional topic for many. I just ask that biblical counselors listen to some of the comments on yesterday’s Facebook post. If you could only see the emails that I get constantly! As Rachael Denhollander, the abuse advocate who was the first to go public about the Larry Nassar gymnastics abuse scandal said, she has yet to meet any trauma survivor who went to a biblical counselor who didn’t emerge more hurt than before. When we treat trauma like a faith issue, we further traumatize the victim.
I know you mean well and you love Jesus. But as this person said:
Biblical counseling made things worse for me after I sought help after leaving a multi-trauma complex abuse situation. The intent seemed kind but it was so damaging.
I know you don’t want to do damage. Nobody does! And that’s what this blog is about: looking at where harm is being done, even if it’s unintentionally, in the Christian church, and calling us to more.
If you have a heart for Jesus and a love for people, you can be an amazing counselor. Just, please, educate yourself on some of these drawbacks, and make sure that you avoid them.
Thank you.
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Help me with this one–how can we handle this better? I know that so many biblical counselors feel attacked right now, but I also feel this is vitally important. How can we advocate for the best care in the Christian church? Let’s talk in the comments!
You say “how can we handle this better?” I suggest you understand the nuances in the world of Biblical counseling. You are categorizing a whole field based on one subset (type) of biblical counseling. Within their own camps there has been separation which has allowed biblical counselors to move away from sin leveling. Research ACBC, ABC, IBCD, IABCD, BCC, and you will notice the difference.
Which would you say are the healthy ones? I know the ACBC is very problematic; are the other ones better? Are the healthy ones taught the DSM and how to recognize when outside help may be warranted?
I think you’re highlighting part of the problem by listing out all these acronyms. The issue isn’t that all biblical counseling is terrible. It’s that some of it is healthy and some of it is really, really bad, but there doesn’t seem to be a clear way for a prospective counselee to know what they’re getting themselves into.
There are other options for spiritual guidance than biblical counselors! As one of the comments said, there are times people want spiritual guidance and advice and want to be, essentially, *discipled.* A spiritual director could be a much better fit for that than a biblical counselor. Many spiritual directors go through 3-year training programs and learn how to guide people while still supporting their autonomy and decision making.
Great point! Thank you.
I do think the autonomy/decision making is vital.
How can we handle this better? Such a huge topic, but here are a few general thoughts.
1) Know your limits. And have a rigorous safeguarding policy. I’ve volunteered with ministries that work with vulnerable people, and the FIRST thing we do is safeguarding training. Among other things, this covers confidentiality, what ‘red flag’ issues to look for (mental health issues, signs of possible abuse etc) and when to get help. And also WHERE to get help, so if A happens, then you speak to the team leader, if B happens, you refer to your mental health professional, if C happens you call social services etc. If this kind of policy were put in place in every church counselling team, then everyone would know when they had a situation for which they could provide Biblical counsel and when they needed to be either signposting to a professional or notifying the authorities.
2) Stop being so scared to call out sin for what it is. I’ve just been reading an online discussion on social media about church leaders using their power to sexually abuse women, and it’s scary how many people are trying to ‘tone down’ what those leaders have done by saying that ‘we’re all sinners’ and ‘there will be fault on both sides’. I guess it feels more comfortable and less confrontational to take the line of ‘everyone is a sinner and we all need to repent’, but that’s not following the example of Jesus. He wasn’t afraid to confront those who were oppressing and abusing those weaker than themselves, and He never watered down His condemnation by saying ‘oh, I do realise that your victims are sinful too’. (Thinking particularly of the young lady in your example who was raped but was then treated as being equally in the wrong as her rapist)
3) Remember that we’re all works in progress. I find it really weird that we accept this for the most part, but then get judgy because someone who has experienced horrific abuse isn’t jumping up and down with enthusiastic longing to forgive their abuser. The Bible says that He who HAS begun a good work in us WILL carry it on to completion – it doesn’t say HAS completed it. God, who is constantly at work in us, will work on our anger, fear or bitterness when the time is RIGHT. And maybe instead of focusing on the ‘mote’ of how the other person hasn’t yet forgiven their abuser, we should be focusing on that giant plank of self-righteousness in our own eye?!!!
I’m sad to see how many people Biblical counseling has hurt. I’m sad to see the terrible teaching of some Biblical counselors. My husband and I went through Biblical counseling and it was very good for us. I was very clearly told that my husbands sexual sins were not my fault, which was a something I needed to be told. We were met w/so much grace and love. It sounds like my experience is maybe in the minority. 🙁
I’m so glad you had that experience, SL! That’s wonderful. What was your husband then referred to?
I have a dear friend who is in the process of getting her license as a marriage and family therapist. In another two years when both my kids are in school full-time, I intend to pursue my master’s to become a licensed counselor as well.
I don’t think many people realize the amount of time and training people have to spend to become licensed counselors as opposed to biblical counseling certification. Not only do you have to go through an entire Master’s program, which will require core classes in fundamentals of psychology, counseling, ethics, etc- you also have to spend hundreds of hours in a clinical setting doing counseling under supervision. And after that you have to take an extensive state licensing exam, and have your license approved by a state board! This is a multi-year process (and can be very expensive!) The training for a biblical counseling certification can’t even compare.
Very true!
I have an ex mil who has taken a few Bible courses through a Bible school and thinks that she is qualified as a helper. But there is no vetting of these people in these situations. These people need to be screened. Licensed counselors who have gone to school for 6 years to do the counseling have to go through some process of vetting. The fact that biblical counselors don’t is problematic.
Definitely agree with this. My mother did a correspondence course in counselling and ever after referred to herself as a ‘counsellor’. Yes, that’s the same mother that told me to cover up for my grandfather and hide the fact that he was abusing 3 generations of women in his family.
I have a friend who has done a similar course before becoming a ‘women’s worker’ in her church. The difference is, she doesn’t view herself as being a qualified counsellor – she said it’s just given her more confidence in knowing what to say/not to say when people share issues and when to offer support herself and when she needs to encourage them to refer to a professional.
Both course materials were excellent. The difference is in the use that has been made of them by the learner.
Such a good distinction!
Perhaps part of the problem is that “you don’t know what you don’t know.” People completing biblical counselling programs have been given just enough information to think they have adequate knowledge or expertise on a topic and perhaps this has even been expressed by the program, however they have failed to acknowledge the limitations of their knowledge and training. Wrap that up in dogma or spiritualized language, and of course there will be bad outcomes with the method.
I think this is a huge issue. Probably the biggest.
I’d just ask too that people realize that this can be a form of pride. We all need more humility to understand that we may not be adequately trained in something.
When deep in trauma funk, we were told by a biblical counsellor to ask our church mentors to pray for us for a month, then to let us know what we should do. We didn’t trust ourselves (nor our screaming gut telling us what to do) because of the trauma we were (non)-functioning from. So we followed this “godly” advice. Our mentors told us what to do. Looking back, it was clearly the opposite of what our gut was telling us, but we didn’t trust ourselves, and our biblical counsellor didn’t help us to tune inward and listen to ourselves. That decision cost us many years of our lives, added a TON of trauma that we are still trying to recover from it. In some ways we never will really recover because the damage was done.
> > the Bible is sufficient for the problems that we encounter in life.
I would say that the Bible is sufficient for spiritual and moral problems the we encounter in life, but it doesn’t cover things like emotional issues and abuse.
Also, the fact is that a fair amount of people using the Bible for ALL problems often misinterpret what the Bible is saying and view nearly all problems through a lens of “What is the woman in the relationship doing wrong to cause the problem in the first place”?
It seems like they start from a belief that “Your desire shall be for your husband and he will rule over you” means “Your desire will be to rule over your husband but that’s upside down. He has to rule over you” and go from there.
It seems like sin-leveling always references “he is without sin among you, let him cast the first stone.” The interesting thing is, we don’t know a lot about what really happened in that situation. Christ came to fulfill the law; the law did proscribe stoning for adultery. I realize that Christ was pointing to a new way, but could it be that the woman was raped, not wilfully adulterous? How much agency dod she have? Could it be that her judges had set her up, like the woman in the Apocrypha, for thei own purposes? Could it be that the sin they recognized in their own hearts was not just “we are all sinners” but something more pertinent with which Christ rebuked them? I realize this is an extra-biblical hypothesis and we cannot take that from the text as written. But is an oddly specific situation to use as a principle for minimizing sin.
Sorry for the typos. My phone is getting old.
I think the most significant thing about all the sermons and teachings I’ve ever heard on that particular event is that ***the man was not dragged out into public too.***
Pretty sure adultery takes two, so why didn’t they bring the guy along to the party in the square?
Oh, hmmm, maybe it’s because the idea that women are always responsible for men’s sexual sin is a lot older than the modern evangelical church’s theory has been given “credit” for.
That could be due to people misinterpreting the story in the Garden of Eden. Eve eats the fruit, then somehow tricks Adam into eating it, and off of humanity is now in sin, thanks to the wickedness of women.
Never mind that Adam was right there with her, although as we’ve discussed here, many retellings of that story have Adam nowhere to be found when Eve first eats the fruit.
Yeah, because translators choose to not make it perfectly clear in English that the word “you” in the Hebrew is the plural form, not the singular. I wonder why that would be?
If I were cynical, I’d suggest it doesn’t suit their purposes to make it clear the serpent was addressing both Adam and Eve. 🙄🙄🙄
(Sorry, Sheila, for getting off topic.)
I say that if Adam had been doing right as a Husband, he would have been there protecting Eve and she wouldnt have eaten from the fruit! Lol So really its his fault🤣
Like Jo R, I think the significance of the teaching in this passage is that it takes two people to commit adultery, yet only one (the woman) had been brought for judgment. (Jesus writes in the dust before answering her accusers – we have no way of knowing what He wrote, but I’ve heard one preacher speculate that it might have been ‘where is the man?’!!!)
Those men knew the law – they’d just been quoting it after all! – and they knew that BOTH parties should be put to death for adultery. The only exception was where the woman had been raped, when only the man would be punished because she had been an unwilling victim. So while there might have been circumstances where it would be appropriate to punish only the man, there were NEVER any circumstances where it was appropriate to punish only the woman.
So these men were pretending to be super-righteous and upholding the law while all the time, they were twisting the law to punish the woman while letting the man escape any kind of sanction. And then Jesus lays their hypocrisy open with one sentence!
I think the woman was the mistress of of one of them or had been passed around (not trying to be vulgar) this group. This man probably no longer wanted her and saw this situation as a way to kill two birds with one stone. Get rid of the mistress plus put Jesus on the spot and then spin it to turn the people against him. The pharasees model what abusive, narcissistic and manipulative people look like.
A bit late, but a comment to a post yesterday when a poster said that she felt that some churches, pastors and Christian writers have an actual hatred of women.
I didn’t want to believe this, but in come cases it seems to be true. Building on what something JoR said a long time ago, some things go far beyond just male patriarchy.
Male patriarchy is one thing, and I disagree with it, but it can be somewhat benevolent. For example, let’s take my favorite fictional couple, Donny and Marcia (from the Mental Load series).
Donny and Marcia believe in male Patriarchy. Donny loves Marcia and their children, and cares for them, and values them, and respects them. When an issue comes up, Donny takes EVERYBODY’S thoughts, needs, feelings, wants, etc. into account. However, Donny, and Donny alone, makes the final decision every time. If Donny is a good and loving husband, this isn’t all that bad, although it’s still wrong.
Some go a step further than that, however, and say that the wife doesn’t count AT ALL. Her feelings, needs, pain, etc. mean NOTHING, and that when Donny makes decisions, he should only consider HIS OWN thoughts.
But even that isn’t enough for some. Some claim that whenever there’s a problem in the marriage, it’s always the fault of the wife, for not submitting enough, not having enough sex, not praying enough, not being a good enough gatekeeper, not being a good Christian, etc.
And even that isn’t enough sometimes. We see that some actually protect abusers, demand that women remain in abusive situations (since it’s likely their fault anyway) and even act like a woman removing herself from an abusive situation is worse than the abuse itself.
Then we have pastors who demand that we forgive pedophiles to the extent that we should let them babysit our children unsupervised, wonder out loud if that 5 year old girl “tempted” her father into molesting her, and otherwise blame the victim. They happily keep abusers in the church and kick out “wicked” women who leave and abusive situation.
That’s far, far beyond simple male patriarchy, and such extremes can only be called hatred.
Patriarchy *is* hatred of women. There is no such thing as “benevolent patriarchy” there are only good me who try to practice patriarchy and fail to take its principles to their logical conclusion. That’s why in many ways The Gospel Coalition and and people like Al Mohler and Kevin DeYoung are more dangerous than people like Doug Wilson and Voddie Baucham. Wilson and his ilk don’t try to hide their hatred of women- their patriarchy is out there for everyone to see. But TGC tries to make patriarchy (complementarianism) look soft and attractive and pretend they don’t *really* think women are inferior. But you’ll notice that they never actually call out the people like Doug Wilson. They can’t. They know that his beliefs are the logical conclusion of their own, even though they desperately don’t want people to see it.
Good MEN, not good me 🤦🏻♀️
I hope this doesn’t muddy the waters, but there ARE a number of very valid criticisms of secular/scientific therapy.
Pointing this out for people who are trying to work through bad faith/invalid criticisms of psychology from their church community who now may second guess themselves if they learn or experience something in secular therapy that doesn’t seem right.
I hesitate to point this out and I’m sure some will take issue, but I think the gaps and harms in secular psychology help to feed the problems within biblical counseling. For example, there’s no such thing as “biblical surgery”. No one is claiming that the bible tells us how and when to remove someone’s kidney. But the medical field has a far more rigorous diagnotic criteria and evidence base for treatments than psychology and psychiatry. Many psyhologic and psychiatric treatments (including SSRIs) fail to consistently outperform placebos. Bessel Van Der Kolk even points this out in the end of “The Body Keeps the Score”, that distance running, yoga, group singing, and other non-therapeutic practices have similar clinical effect on depression and anxiety as antidepressants. This makes it difficult to root out bad practice because “good practice” has a fairly weak definition.
I’m not saying psychotherapy should be ruled out at all times and in all cases. I’m not trying to discourage anyone from seeking therapy or medication, but I don’t think secular psychology serves as a strong alternative to biblical counsel, rather that both are part of a set of theories that are problematic and should be approached with caution and healthy criticism.
Sheila’s big point is that people generally behave better when there are real accountability measures in place. Licensing is a good one that’s easy to verify, but maybe also ask the question “if you made a mistake or violated the terms of our contract, how would I hold you accountable for that?”
For counselors, both secular and biblical, my plea would be: ADMIT IT WHEN YOUR SOLUTION DOESN’T WORK – and DON’T blame it on your patient. It’s not possible for you to be the right resource for everyone and every problem. Even if you believe the bible is indeed the single source for answers, that doesn’t mean your interpretation and application will be correct all the time. Build a network of people with different strengths and skill sets than you and be ready to refer someone when your help is not effective.
Hi Sarah! Actually, studies have shown that SSRIs do perform better than placebos. I agree that there are big issues with them in some cases, but they have been shown to also be a big help, which is why the FDA approved them. Depressed teenagers who take SSRIs do kill themselves less often.
This rhetoric that “antidepressants don’t work” is why people who don’t need them don’t take them. Rebecca waited five years to go on them and blamed herself for her anxiety when going on an extremely low dose cleared up so many issues. And she was doing a lot of cardio and yoga at the same time too!
So I just don’t want to make it sound like we’re anti-SSRI. I do think trying other things is often a better first-course treatment, but I don’t think we should discount them.
But I agree–all counselors need to be very willing to say when a treatment isn’t working and then change course. Keith is very conscious of that when he tries to help teens with mental illness, because it is a big problem!
Here’s a report on a 2018 meta-analysis with data on 116,000 patients, double-blind randomized studies, that did find that SSRIs outperformed placebos.
Possibly another factor to consider is that antidepressants can be mis-prescribed, which will increase the number of cases where they don’t work.
I was told I needed to take anti-depressants in my mid 30s, when what I actually needed was a minor operation. And I was again offered anti-depressants in my mid 40s when what I needed was medication for asthma. I refused the medication in both cases and kept pushing for tests to get me the diagnosis I needed, but if I’d accepted, there would have been two separate cases where ‘antidepressants didn’t work’. Because I wasn’t actually suffering from depression!
I don’t know what it’s like in other countries, but in the UK, we have a huge issue with women’s health concerns (especially once they get towards age 40) not being taken seriously. I know at least a dozen women who have had serious physical health issues put down to ‘depression’ or ‘stress’ by their doctor.
Yes, I do think this is a huge issue.
I also think far too many people are put on anti-depressants when it’s simply that their life is untenable. Like they have reasons to be depressed! And if we dealt with those reasons, there wouldn’t be a need for the medication.
Last point is a factor in a lot of my cases, although things are SLOWLY getting better. Someone is understandably distressed because of trauma, abuse or even just dealing with a marriage breakdown. Other side tries to say “well you know, this person clearly needs psychiatric help”, implying that this somehow makes them unreliable and possibly dangerous. That gets repeated to police and/or Children’s Aid. You then get a vicious cycle where someone really is feeling upset and overwhelmed, because they are having their children taken out of their care, and told they need psychiatric assessment and treatment when the main issue is how they are being treated. Too often, the system is set up to judge people instead of quickly mobilizing the basic things they need (ie safe housing, food, practical help with kids, supportive counselling, efficient and fair resolution of family issues).
We are seeing a shift to recognizing that mental health is important for everyone and that appropriate therapy is a good thing and not a sign of something being “wrong” with a person, but even recently I’ve seen some simply awful stuff.
Yes, I can see that happening completely.
This is the kind of thing that we talked about a lot in my university courses when I studied psychology, and people do often make the mistake of thinking that since running (or eating healthy or whatever else it is) works as well as SSRIs, SSRIs must not be that effective or necessary. Let me explain it like this:
Depression is multi-faceted. That means there are multiple different routes that can lead to depression. Therefore, there are multiple different things that can help someone with depression.
Someone who has been malnourished for a long time who is experiencing depression due to malnutrition may find that their depression alleviates when they start eating kale. But does that mean everyone who is depressed just needs to eat more greens? No. Again, multi-faceted disorder.
Someone who lives a very sedentary lifestyle may experience depressive symptoms, too, and they may find that their depression lifts when they begin to be active again and start getting endorphins flowing. But does that mean that everyone who is depressed needs to just go for a run (something that I was told many times)? No.
Some people will have depression because their spouse died, and grief counselling helps them get through the worst of it. Does that mean that I needed grief counselling for my depression?No. I had nothing I was grieving.
For many people, depression is purely a brain chemistry issue that requires SSRIs. Running, eating healthy, therapy alone–it won’t work. It doesn’t matter if pressing the gas pedal is what makes the car go forward if there’s no gas in the tank.
Studies have shown repeatedly that SSRIs are effective, and are more effective than placebos (here’s one from the lancet, there are many, MANY more like this: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext)
Just because client A needs nutrition, client B needs exercise, and client C needs grief counselling does not mean that client D needs any of those things. Client D may need SSRIs. And it’s confusing to understand how there are different routes to recovery, but that’s why it takes a lot of schooling to become a psychologist or a counsellor! And why it’s even more important that we are aware of the dangers of places like biblical counselling because this stuff is complicated, making it easy to accidentally promote harmful beliefs and weigh down people with heavy burdens when they are already struggling to just keep breathing.
just to add some research to the mix. 🙂
“And why it’s even more important that we are aware of the dangers of places like biblical counselling because this stuff is complicated, making it easy to accidentally promote harmful beliefs and ***weigh down people with heavy burdens when they are already struggling to just keep breathing***.”
THIS. Thanks, Rebecca.
Hi Sheila and Rebecca – thank you for the responses and the research links, I will look at them. I don’t want to criticize/shame anyone’s individual use of SSRIs or cause further distraction here. I am also fully aware that is Rebecca’s area of expertise.
I appreciate this blog’s encouragement for people to be critical thinkers and analyze data. What I was trying to say is to keep the critical thinking hat if you move to secular counsel/therapy.
Very well said. I wish this concept had been explained as clearly in my training. Mental health disorders are highly complex and there are no one size fits all treatments. Even SSRI’s aren’t one size fits all. Some people have to try several before finding one that helps, and there’s no real way to predict what will work for a given person.
The other piece that people forget is that there are other evidence-based treatments besides medications. CBT, ECT, EMDR, etc. But at least in the IS these are hard to access. However, medication is more readily available, which can result in it being prescribed as a first line or as mono therapy when it shouldn’t be.
I will say the best counselors I have seen are the ones who actually attended a four year university and held a masters degree. I have experience with ‘Biblical Counselors’ and I won’t go into detail except to say, I will not set foot on their doorstep again.
I am a pastor and I agree with you. I am baffled at what these counselors advice. Lord have mercy! I often refer people to therapists in those three areas.
I’m about to finish my first level of training with ABC. I also have a Bachelor of Social Work from York University. You should know that I have not been assigned anything to read by Jay Adams. I understand where your critiques are coming from. If I were you, I would tread lightly on “exposing” biblical counselors as BAD. In your article, you gave a pass for the author of “The body Keeps the Score” that you did not grant Jay Adams. I know it’s not the same, but it does display that it is possible to learn from people in where they have succeeded and in where they went wrong. I think that there are many biblical counselors like me who were trained in the secular space and found it lacking depth. Mental illness is rapidly on the rise. We know that this can not fully be contributed to genetic “Chemical imbalances” as those genetic changes would not have had enough time to evolve. The truth is, we are both soul and body, and there are many things contributing to our mental well-being. However, our position to Christ offers us an ultimate well-being.
Brittany, I completely agree that we need a soul component! But I have heard too many stories of people who were so harmed, especially coming out of traumatic situations, because biblical counselors told them to focus on their own sin.
I really hope it’s changing. But if it is, then I think it’s incumbent on biblical counselors to distance themselves in some way from Jay Adams, from Master’s Seminary, from John Street, from ACBC, from all of these really toxic things. Perhaps it means changing their name and making it clear that they understand trauma and they do believe that people can need medication for some mental illnesses?
And I also think there needs to be MUCH better confidentiality and accountability things put in place for biblical counselors so that there is something akin to licensing. This is just too important.
And regarding van der Kolk, his message was never the problem. His ethics and morality were. But his message was spot on. I would rather have a surgeon who was an awesome surgeon but a terrible person than a surgeon who was a terrible surgeon but an awesome person. The problem with Adams is that his message was consistently wrong (and abusive). What he taught was wrong, and yet his messages and perspectives have affected a whole branch of counseling, even if he’s been largely rejected. The ideas are still there–that the Bible is all you need; that counseling doesn’t need privacy, and in fact privacy is bad, because healing is done under church leadership; and more. I don’t really think there’s a valid comparison between van der Kolk and Adams.
I notice several current or recent trainees in biblical counseling pushing back on this series. It’s great if they’re right and “the bad stuff” isn’t mainstream anymore. But places like TMU were teaching harmful things for years, and fairly recently (the lectures Julie Roys reported on were from 2012). Even if every single training program has since stopped promoting these ideas (doubtful), there are bound to be many alumni out there still actively counseling others from that foundation. In the absence of shared standards, Biblical counseling is 100% caveat emptor, so people need to know about these issues.
Yes, that’s how I feel too. And I think the good biblical counselors (of which there are many) need to lobby for a change of name to distance themselves from this, and also lobby for standards and confidentiality and accountability.
You might be right. I think what you said about differentiating Van der kolk’s personal morals or actions from his psychotherapy work has a lot to do with why I have pursued biblical counseling. I think we are decieving ourselves if we think we can separate our ethics and morality from what happens in the counseling room. Personally, God convicted me that I could not pretend to be supportive of behaviour that I knew angered God. I also could not pretend to be some sort of blank slate with no biases. You are right that Jay Adams is implicated in this as his personal sin clearly affected his practice in that case.
Remember also that the Jay Adams book with this awful case study is 50 years old- I am only 30. He is a separate wave of counseling then I will be emerging into, so I really don’t feel connected to his work and would rather build up new things!
It is sad to hear that confidentiality has not been apart of the BC cases you have heard. That is not how I have been trained. It may be an oppressive policy specific to the church.
If you are at all interested in the currently most adored biblical counseling scholar- check our David Powlison. You can not deny his gentle heart. To see current academic writing, check out the CCEF Journal of Biblical Counseling.
Many people doing research on cancer are heavily flawed, and yet they have made great strides.
Would you accept cancer treatment if that treatment was discovered by someone who had had multiple affairs?
Learning about trauma’s effect on the brain is also a physical thing. I think that’s important to note. There is a double standard going on here, and when multiple studies have shown the efficacy of EMDR and other treatments for trauma, it really is unethical to say that this is not so.
My experience with biblical counseling came immediately after my husband and I chose to put distance in our relationship with my spiritually and emotionally abusive parents. We were supported in our decision by our pastor and the couples that we’ve gone to for marriage counseling our entire marriage. But other people in our church and family, didn’t like what we were doing and had to put their two cents in as well.
The Biblical counseling I’ve heard (unsolicited) is, in fact, only possible when you ignore other parts of the Bible. I was told “I was unforgiving and bitter” and “just needed to forgive, work on my sin of bitterness, and continue to have a relationship with my parents”. However that advice completely ignores what Jesus himself says in Matt 18! The response to abuse we are told to give in Matt 18 and Titus 3:10-11 is to “treat them like a tax collector or gentile” and “…have nothing to do with such a person.” That’s just the two passages I can think of off the top of my head. I know there’s more in both the old and new testaments.
Furthermore that advice ignores how Jesus treated abusive people. He loved the Pharisees, he died for the Pharisees, but he didn’t choose to have a friendly relationship with them! If someone has to pick and choose from what the Bible says the I really don’t think they’re a Biblical counselor.
Yes, the proof-texting approach to counseling does not work. We need to use the entire wisdom of Scripture, and the wisdom that we have learned through science (because God did give us brains!)
The only counseling we ever did together was required pre-marriage counseling. And it was a joke. The pastor gave us a workbook to walk through, which I eagerly did, but my fiance barely cracked it open. That should have been a flag to the pastor, but it wasn’t. I believe he did challenge my fiance about it, but fiance had a way of responding that could shut anyone up. Again, a flag, but the pastor brushed it off.
When the pastor counseled us and asked us questions, I did 99% of the answering while my fiance sat like a rock, just waiting for the session to be over. CLEAR flag. But, nope, nothing from the pastor.
Do you know what he told us at the end of our sessions? He said that he was currently counseling 3 couples for marriage and that we were the best couple out of the 3, and the most ready for marriage!! Ok, that was SCARY.
Deep down my spirit was SCREAMING for him to recognize the red flags. I was hurting very deeply that my fiance didn’t care a fig about the importance of the counseling. When he did speak, he said the rote right thing and that was enough for the pastor.
The pastor ignored so many clear and obvious signs…like counseling 101 stuff, and I don’t mean to peg it all on my fiance at the time, because I was exhibiting red flag stuff left and right, too.
He was a non-denominational pastor with little training and no accountability. He was another one of those people who can grab a cheap ordination and “plant a church” based on just being a nice guy who loves Jesus. But, pastoring a church takes so much more than just being someone who loves Jesus. You can’t be a shepherd with absolutely no knowledge of sheep. You can’t be a shepherd just because “sheep are cute” and it looks so pleasant to sit in green pastures with your precious flock frolicking about. Sheep are some of the most challenging livestock to care for. No one should own sheep who hasn’t learned a lot about their care. You also need a support system, like a vet or other experienced shepherds to help you because YOU’RE GOING TO NEED HELP! (Sure, in some cases, God does call the uneducated to become leaders and pastors, but then He equips them. You can know them by their fruits.)
That is so sad. I agree–most pastors are not trained at all for this.
Here’s what I believe: Psalm 107 talks about how the Lord delivers many different people but the first several stanzas follows a certain structure. It starts with who the person is, and then talks about their need, their cry out to the Lord, the Lord’s deliverance, how He delivered them, and how they are to respond.
For the hungry and thirsty wanderers, He provided a city for them to dwell in. For the hopeless prisoners, He broke them free of their chains and bondage. For the fools, He gave them a second chance. For the scared sailors, He calmed the waters and provided them safe passage to their destination.
Why do I mention this? Because God can deliver people, but He does not only deliver people in one way. No, He delivers them according to what He sees they need, and prisoners in captivity do not need still waters.
Just based off of this alone, I refuse to believe God can only heal and deliver people through the Bible. If there was only one way for healing and deliverance and that one way worked for all people, then God would’ve used the same method of deliverance for every single person in different kinds of calamity.
I believe our God is big enough and creative enough to deliver and heal through Christian counselors, and through medication, and this doesn’t have to discount Biblical counseling, it means that that is just not the path of deliverance God has chosen for the individual.
I’m sure there are many individuals for whom God has ordained deliverance and healing through Biblical counseling. There are also many for whom the path is a licensed counselor. And that’s okay!
But we are all called to respond to Gods deliverance in our lives in the same way:
“Let them thank the Lord for his steadfast love, for his wondrous works to the children of man.” (Psalm 107:8)
Many blessings!
Great thoughts, Anon! Really good. Thank you.
Sheila.