Our Union Learning Community today included a session on pastoral counselling. This led to some discussion about the Biblical Counselling Movement, it’s history and different approaches to counselling. Here are some quick jotted notes on the subject.
Different Christian approaches to counselling
You may hear people talk about Christian Counselling and Biblical Counselling. It is important to note a distinction between the two. Biblical Counselling refers to one specific approach to counselling which is not shared by all “Christian Counsellors.”
One important factor when talking about Christian Counselling is how it relates to secular counselling models, psychology and psychiatry.
RF Hurding identifies five main approaches to the relationship
Assimilative – accepting secular models wholesale without modification. Christians are trained in theory and methods and encouraged to use them when counselling.
Perspectival – Treats Christian/Biblical counsel and secular counselling as separate fields. Under this approach, a pastor is likely to focus on preaching and discipleship and encourage people requesting counselling whether for emotional health issues or relationship matters to see a professional counsellor.
Excluding – insists that Christians are the ones who are competent to counsel and that the content and methodology should be taken from Scripture. Secular models are rejected. Biblical Counselling is an example of this.
Integrationist – Believes that it is possible to integrate Biblical approaches with the best aspects of secular psychology and psychiatry. Indeed at the most positive end of the spectrum, it is argued that this is necessary because the Bible does not detail every circumstance that believers might face in life. Psychology and Psychiatry fill in the detail.
Jay Adams and the Biblical Counselling Movement
Jay E Adams is considered the father of the Biblical Counselling Movement. In the 1970s, he was concerned at what he saw as the encroachment of secular counselling underpinned by humanist philosophy onto what was the rightful domain of Christian pastors. He was concerned that pastors were too readily relinquishing their responsibility for counselling the flock.
He argued that there were proper medical conditions with underlying organic causes that should be treated medically and spiritual problems that needed spiritual treatment. He saw counselling as an attempt to create a third space that was not supported by evidence. Adams was willing to listen to the observations of psychologists in terms of the science of behaviour if underpinned by evidence but not to employ secular philosophies and methods.
He wrote two seminal works, The Big Umbrella and Competent to Counsel. The first argued that people were being sucked in under a big umbrella of emotional health who were not sick. The result was that people were becoming dependent upon therapy and medication without evidence that this was necessary or that it worked. In Competent to Counsel, he argued that the believer is competent to counsel others. His view is that every Christian can counsel other Christians. He draws this from the call to bear one another’s burdens. Most believers do this by responding re-actively to the challenges that their brothers and sisters face. Elders/Pastors however have a specific responsibility to pro-actively challenge people within the congregation. The reason for this becomes clear when we understand his diagnosis.
Adams argued that the root cause of all problems was sin. Often mental health problems were an outworking of past and present sinful behaviour. This worked itself out in some people as they used mental health as an excuse to opt out or avoid challenge. For others, the problem was deeper. Deep seated sin, guilt and shame led to the disintegration of their personality.
Adams argued that the solution was to lovingly confront sin. This led to him employing the term Nouthetic Counselling based on a Greek word referring to confrontation.
Critics of Adams think that his approach is simplistic and doesn’t fully comprehend the complexities of mental and emotional health. They also consider his approach harsh and are concerned at the emphasis on confrontation. Others have suggested that far from being a separate and distinctively Christian/Biblical approach, Nouthetic Counselling is in fact similar to some behaviourist models of counselling. If so, there is the risk that the approach can become legalistic.
The harshness was particularly perceived in his focus on sin as the root cause. Whilst he recognised that many people were sinned against such as the victims of sexual abuse, he does seem to give the impression that the problem still lies with their sinful response to what happened to them.
It is worth noting that second and third generation Biblical Counsellors put a greater emphasis on nuancing the approach. These are represented by people like David Powlinson, Paul David Tripp, Ed Welch and Heath Lambert. In particular there is a greater emphasis on the different factors that can affect a person as well as their own sin. A Christian is a sinner, sufferer and saint at the same time. This means that the counselee may be suffering because of specific harm done to them, their suffering may be physical and emotional. In addition, their suffering may not be down to specific sin against them but from the struggle of life in a fallen world.
Some personal reflections
Personally, I sit broadly within the Biblical Counselling approach. However, I do think there are valuable lessons to be learnt from a variety of methods including CBT. The reason I sit within this approach is that I believe that our approach to life should be fully under the authority of Scripture and so I am concerned about the implications of some of the underpinning philosophies associated with secular approaches.
Here are a couple of things we discussed in our session.
- There is a complex interrelationship between our physical heath, cognitive beliefs, behaviour and feelings. I have written a little bit more about this in How Do You Know?
- There is an ongoing conversation about medication and how effective it is. Part of the challenge is as to whether medication effectively treats root causes or symptoms. Whilst there is the risk of dependency, in my view there may still be the benefit of taking medication which deals with symptoms in the same way that the first response to a physical injury is to bandage the wound and provide pain-killers. Medication may create the space in which a conversation can take place about underlying root causes.
- There are many people suffering severe physical symptoms from conditions where no organic causes have been identified. These are often labelled as syndromes. We noted that challenges included first of all that the absence of evidence is not the evidence of absence, failure to identify an organic cause does not mean that one is present. Secondly, people may seek out a diagnosis which provides them with a label without the stigma of a mental health problem. Thirdly, that what people often hear in these contexts is “it is all in your head” and for “all in your head” they are likely to read “you are making it up.” Fourthly, they may be experiencing physical distress without any awareness of mental distress or anxiety. Fifthly, a label that links to physical symptoms may still seem to offer more hope of a future cure. Generally speaking, the patience does not just want a label for their symptoms, they want to know what is causing them and what the cure is.
- Churches have not always dealt with problems relating to mental health in a loving and helpful way.
- Mental and emotional health may be exacerbated when people experience prejudice and exclusion.
I have tried to give a quick overview of the subject area. From time to time we run a Pastoral Care workshop which includes a theology of pastoral care, sessions on medical aspects of pastoral care and lots of practical
 RFH Hurding, “Pastoral Care, Counselling and Psychotherapy” Pages 78-87 in A Dictionary of Christian Ethics and Pastoral Theology (Eds David J Atkinson and David H Field),
 I have used the categories of Culprit, Victim and Faithful Servant.
 Dave Williams, How Do you know? 4-5. Available at https://faithroots.files.wordpress.com/2014/09/how-do-you-know-webversion.pdf