Integrating Professional and Pastoral Counseling

By James M. Rochford

Many modern people (including those in Christian circles) hold that counseling should be left to the professionals. The reasoning goes like this: If I have a cavity, I visit my dentist; if my toilet is clogged, I call my plumber; and if I need counseling, then I should call my counselor—not my pastor. Of course, for biologically-caused problems, we should seek medical and professional help, and as Christians, we should certainly utilize the help of professionals. Yet there are a number of reasons for urging common, everyday pastoral counseling within the Christian community today.

The New Testament (NT) teaches that ALL Christians should be capable of counseling one another

The NT authors use at least five terms that refer to counseling fellow Christians. These NT passages are given in the context of Christian community (not professional, individualistic contexts).

“Teaching” (didasko) is used 97 times in the NT. It means “to tell someone what to do, tell, instruct” or “to provide instruction in a formal or informal setting, teach.”[1] Paul writes, “With all wisdom teaching and admonishing one another” (Col. 3:16; cf. 1:28).

“Exhort” (parakaleo) is used 107 times in the NT. It means to “to ask to come and be present where the speaker is, call to one’s side” or “to urge strongly, appeal to, urge, exhort, encourage.”[2] Paul states that all Christians are able to do this. He writes, “Encourage one another” (1 Thess. 5:11). Likewise, the author of Hebrews writes, “Encourage one another day after day, as long as it is still called ‘Today,’ so that none of you will be hardened by the deceitfulness of sin” (Heb. 3:13; cf. 10:25).

“Admonish” (noutheteo) is used 9 times in the NT. It means “to counsel about avoidance or cessation of an improper course of conduct, admonish, warn, instruct.”[3] Paul claims that all Christians are able to instruct each other in this way. He writes, “I myself also am convinced that you yourselves are full of goodness, filled with all knowledge, and able to admonish one another” (Rom. 15:14).

“Reprove” (elencho) literally means, “to scrutinize or examine carefully, bring to light, expose, set forth” or “to bring a person to the point of recognizing wrongdoing, convict, convince.”[4] Paul writes that we should “not participate in the unfruitful deeds of darkness, but instead even expose them” (Eph. 5:11). He tells Titus, “These things speak and exhort and reprove with all authority” (Titus 2:15). Jesus tells us, “If your brother sins, go and show him his fault in private; if he listens to you, you have won your brother” (Mt. 18:15).

“Rebuke” (epitimao) occurs 33 times in the NT. It means “to express strong disapproval of someone, rebuke, reprove, censure also speak seriously, warn in order to prevent an action or bring one to an end.”[5] Paul writes that Timothy should “rebuke” others with “great patience and instruction” (2 Tim. 4:2).

God calls for “spiritual” Christians to restore immature believers into maturity (Gal. 6:1), and the Bible tells all Christians to speak the truth in love (Eph. 4:15-16).

We have no guarantee that a professional counselor will give biblical wisdom on complex issues

Professional counselors will often give direction which contradicts biblical wisdom or even imperatives. In one case, a sex addict went to a counselor, only to hear, “You should consider dating around more.” Those massively depressed are often told that they should learn to “love themselves more,” which directly contradicts a Christian worldview. Crabb writes, “If scientific surveys report that couples who have enjoyed premarital sex experience greater emotional satisfaction in marriage than couples who were married as virgins, the data exist only because of sinful processes that distort life from the way it was meant to be.”[6] He adds, “We have the explicit promise of the Holy Spirit’s help when we come to the Bible in an attitude of teachable humility and personal honesty. Scientists have no such promise in their study.”[7]

When beleaguered Christians seek counseling, they are usually in a very vulnerable state. Depression, anxiety, grief, or other crippling conditions are ruining their lives, and they are often not in the best state of mind to discern false teaching. Yet it is precisely during this season of life that the individual will be taking counsel from a person, who may or may not hold to biblical convictions.

Professional counseling is tremendously expensive

While rates vary, professional counseling usually costs the client about $65 per session. For most issues, insurance will not cover a person to go seek professional help. Additionally, many people never “graduate” professional counseling. Instead, they visit the counselor indefinitely, which only costs the counselee never ending time and money.

When should I refer someone to professional counseling?

It’s not always clear when to send someone to professional counseling, yet it’s always a safe bet to contact a professional counselor if we sense a need to send someone for professional help. Several signs are key:

Suicidal ideation. Amateur counselors often worry that if they ask someone about suicidal thoughts or self-harm, that this might cause this to happen. Yet the opposite is true. You should ask directly if you suspect someone may have thoughts about hurting themselves. It’s important to get them to verbalize these thoughts, since they are less likely to act on them if they talk about it.

It is important to ask the individual if they have considered a plan for suicide, or if they’ve ever had these thoughts before in the past. If they say “I wish I were dead,” this is not taken nearly as seriously as if they say “I’m thinking about taking an overdose, and I have some pills.” If they have a plan it must be taken seriously and you should take them to mental health facility or hospital. In our area, OSU’s Harding Hospital or Netcare is usually contacted for help.

Biological causes. Certain conditions can greatly benefit from medication, including Major Depression, Bipolar Disorder, Dysthymic Disorder, Panic Disorder, Schizophrenia, and Trichotillomania (hair pulling). Recent evidence suggests that eating disorders may benefit from medication, but group therapy can also be quite helpful. Medication can restore balance in brain function, so that a person can have the relief needed to change their lifestyle and battle their false-belief systems.

The most biblical type of psychotherapy is probably cognitive behavioral therapy. This form of therapy attempts to identify wrong thinking and replace it with the truth. This is particularly good therapy for OCD, social anxiety disorder, and phobias. For instance, Dr. Jeffrey Schwartz (a Research Psychiatrist at UCLA School of Medicine) documented tremendous success in using cognitive behavioral therapy working with OCD patients. In fact, he reported, “Depressed patients scored significantly higher on this scale after cognitive therapy compared to a medication only group.”[8]

Before exploring medication, it is often helpful to have a blood test to check for an imbalance in thyroid or for anemia. Hypothyroid and anemia can lead to fatigue, while hyperthyroid can lead to anxiety. This is a relatively cheap test, which can help identify common biological causes for depression and anxiety.

Questions to consider before sending to pastoral counseling

Have you checked with others to get a second opinion?

Has the counselee tried to open up about this problem with more than one qualified person?

Is the counselee practicing the basic means of growth?

Have you tried to study something on this subject? Have you tried to read some literature on this subject to help your person?

Conclusion

The professional counselor is not an enemy—but an ally. Like all spiritual gifts, the Body of Christ should have experienced and professional Christian counselors to help in complex circumstances, and to help equip younger believers—just like any other area of gifting. Because counseling is such an important need, we not only need to benefit from “million dollar” counselors, but we also need a million more “one dollar” counselors to help meet such a growing need.

Confidentiality

The law binds secular counselors from breaking confidentiality with their clients. Of course, the Bible certainly teaches that we should have discretion, and teaches against gossip. But it doesn’t hold confidentiality in an absolute sense.

The Bible speaks AGAINST gossip

Jesus tells us to admonish our brother “in private” (Mt. 18:15). Paul likewise writes against “gossip” as a destructive sin in the Body of Christ (Rom. 1:29; 2 Cor. 12:20; 1 Tim. 5:13; 2 Thess. 3:11). The Proverbs speak against gossip on a variety of occasions:

(Prov. 20:19) He who goes about as a slanderer reveals secrets, therefore do not associate with a gossip.

(Prov. 11:13) He who goes about as a talebearer reveals secrets, but he who is trustworthy conceals a matter.

(Prov. 16:27-28) A worthless man digs up evil, while his words are like scorching fire. 28 A perverse man spreads strife, and a slanderer separates intimate friends.

(Prov. 17:9) He who conceals a transgression seeks love, but he who repeats a matter separates intimate friends.

(Prov. 25:9-10) Argue your case with your neighbor, and do not reveal the secret of another, 10 or he who hears it will reproach you, and the evil report about you will not pass away.

Gossip inevitably leads to hurt feelings, broken trust, and a loss of vulnerability. When our dirt has been flaunted to others, it leads us to hold back in relationships, guarding ourselves in the process.

The Bible speaks FOR transparency

On the other hand, the Bible speaks about sharing information in certain situations—for the sake of the individual or the health of the Christian community. Jesus taught that we should keep each other’s sins “private” (Mt. 18:15). Yet in cases where the person refuses to change, Jesus exhorts us to tell “one or two” others (Mt. 18:16), and even in extreme cases to “tell it to the church” (Mt. 18:17). Paul writes, “If anyone is caught in any trespass, you who are spiritual, restore such a one in a spirit of gentleness” (Gal. 6:1). If we couldn’t talk to spiritual members about a sinning brother, then how could they help? The elder who “continues in sin” should be rebuked “in the presence of all” (1 Tim. 5:20). Chloe informed Paul of sin in the church in Corinth—even mentioning specific people (1 Cor. 1:11; 5:1). Paul rebuked Peter publicly in Antioch, and even wrote a letter about it (Gal. 2:11ff). Elsewhere Paul speaks about how Demas deserted him (2 Tim. 4:10). We might compare these two perspectives like this below:

Gossiping

Consultation

Shared to hurt others

Shared to help others

Shared with immature people

Shared with mature people
Shared instead of confronting an individual about their issue

Shared in addition to getting counsel in how to confront a person

 

What is at stake if we keep confidentiality?

It’s difficult to get an objective perspective with a counselee, if we agree to confidentiality. When a person comes to us for counsel, we need to always remember that they are not going to be objective about their perspective. Sin has a deceiving effect on our minds (Heb. 3:13; Jer. 17:9-10). By getting an outside perspective from a third party or loved one, we get further objectivity. It’s interesting to routinely hear one perspective from the counselee—only to get a completely different (and even contradictory) perspective from another person involved.

It’s difficult to offer the counselee a support system, if we agree to confidentiality. The author of Hebrews encourages us to counsel each other because of the deceitfulness of sin (Heb. 3:13). This means that we need multiple people to help us in regards to spiritual growth. We shouldn’t carry the unrealistic expectation that a counselor can shoulder this burden all alone.

It’s easy for a client to twist the words of a counselor, if we agree to confidentiality. One of my professors (a professional Christian counselor) once addressed the issue of confidentiality. A student asked what a professional counselor should do, if a counselee was misrepresenting him or slandering him based on the content of their recent counseling session. My professor responded, “Not only can you not defend yourself, but you can’t even admit to meeting with that person to a third party!” This would have a terrible cost on Christian community, whereby a person in counseling could twist the words of a counselor or other parties involved.

Western culture extols the right of individual privacy, but it does so at the expense of relationship and community. As followers of Christ, we need to defend both. We not only need to discourage gossip, but we need to encourage transparency.

What if someone asks for confidentiality?

When somebody says, “I need to tell you something, but I need you to promise to not tell anyone,” it’s wise to retort, “I can’t promise confidentiality, but I do promise to be discrete with the information. If you trust me enough to confide in, then you should trust me enough to handle this information in a discrete way.” The issue usually is not “Is the information confidential?” But rather, “What is the most responsible and helpful way to respond?”

Assessing Different Counseling Theories

Christians adopt various models for pastoral counseling. Before we begin looking at the practical application of counseling, we really should question what our theory of Christian counseling should be—assessing a few standard approaches.

(1) Only Scripture: Nouthetic Counseling

On one extreme, we find “nouthetic counseling.” The Greek word noutheo means “to correct” or “admonish.” Thus admonition of immoral behavior rests at the center of this view. The most popular example of this approach would be Christian counselor Jay Adams in his book Competent to Counsel (1970). Adams writes, “Nouthetic confrontation, in its biblical usage, aims at straightening out the individual by changing his patterns of behavior to conform to biblical standards.”[9]

Adams (who holds to a strict VanTillian and Reformed view) believes that scientific discovery can help the Christian counselor, but it shouldn’t be trusted. He writes, “Because non-biblical systems rest upon non-biblical presuppositions, it is impossible to reject the presuppositions and adopt the techniques which grow out of and are appropriate to those presuppositions.”[10] Instead of seeing believers as having a sinful nature, Adams holds that the Greek word sarx refers to our sinful body. He writes, “When Paul speaks of the body as sinful, he does not conceive of the body as originally created by God as sinful… but rather the body plunged into sinful practices and habits as the result of Adam’s fall.”[11] Regarding the mentally ill, he writes,

What then is wrong with the ‘mentally ill’? Their problem is autogenic; it is in themselves… Apart from organically generated difficulties, the ‘mentally ill’ are really people with unsolved personal problems.[12]

The idea of sickness as the cause of personal problems vitiates all notion of human responsibility… People no longer consider themselves responsible for what they do wrong.[13]

While changing our actions is important, this isn’t enough. We would agree with the goal of this form of counseling, but not its methods. Sin is far more complicated than simply changing behavior, and while admonition has its role, we need to have a more complex solution to help others with it.

(2) Consistent with Scripture: Christian Psychology

On the other extreme, other Christian counselors hold that our counseling model should simply be consistent with Scripture. That is, we should develop a paradigm that works, as long as Scripture doesn’t contradict whatever we discover.

While this view is admirable in some respects (because it tries to incorporate truth in the realm of psychology), it moves too far to the opposite extreme. The Bible teaches how to be relationally, emotionally, and spiritually centered; thus our model should arise and emerge from Scripture—not merely be consistent with it. Consider if a parent left their teenager home alone for the weekend, warning them, “Do not throw any parties in the house while we’re gone!” When they return, they find that the teenager didn’t throw a party in the house, but threw a party on top of the house—on the roof. Technically, this is consistent with the parent’s instructions, but it doesn’t at all fit with the parent’s will for their kid.

(3) Emerging from Scripture: The views of Dr. Larry Crabb

We agree with the view of Dr. Larry Crabb in his book Understanding People. Crabb received his PhD in clinical psychology from the University of Illinois, and he is a well-known Christian counselor who holds to a high view of Scripture as well. He writes,

Revelation must be the basis upon which we develop and defend our counseling ideas… It is my view that counseling models must demonstrate more than mere consistency with Scripture; they must in fact emerge from it.[14]

The difference between “guided by” and “consistent with” is enormous. The theorist who is guided by the Bible more fully acknowledges its authority. Someone who depends for guidance on another source and then seeks to maintain biblical consistency will tend to regard the Bible merely as helpful. The product of the latter way of thinking should not properly be called “biblical.”[15]

Nature was not designed to be a textbook on life. The Bible was. The problems people bring to a counselor always involve a malfunction in life: anxiety that keeps agoraphobics indoors; depression that takes the joy and meaning out of living; compulsions that drive people to do things which interfere with normal functioning—all obstacles to effective living. If counselors are supposed to help people live their lives as life was meant to be lived, and if the Bible is the book where God tells us how to solve our problems in order to live, then it follows that we should expect the Bible to provide more help to counselors than the scientific study of nature.[16]

Human problems, in this view, are best understood as defensive attempts to handle the pain of fear and tension in significant relationships. By responding to each other defensively, we minimize the chances of gaining the closeness we legitimately want. The result is a profound loneliness that strengthens our determination to protect ourselves from the hurt we fear. People are caught up in a vicious cycle of hurt, defensive retreat, more hurt, more retreat.[17]

Under this view, our counseling model should arise from Scripture. While Scripture doesn’t answer every question about how to counsel others, it answers the primary questions of love, significance, relationships, and identity. Based on this framework, we ground our core counseling theory on biblical teaching, while incorporating psychological and medical studies to supplement this central approach.

[1] Arndt, W., Danker, F. W., & Bauer, W. (2000). A Greek-English lexicon of the New Testament and other early Christian literature (3rd ed., p. 241). Chicago: University of Chicago Press.

[2] Arndt, W., Danker, F. W., & Bauer, W. (2000). A Greek-English lexicon of the New Testament and other early Christian literature (3rd ed., p. 764-765). Chicago: University of Chicago Press.

[3] Arndt, W., Danker, F. W., & Bauer, W. (2000). A Greek-English lexicon of the New Testament and other early Christian literature (3rd ed., p. 679). Chicago: University of Chicago Press.

[4] Arndt, W., Danker, F. W., & Bauer, W. (2000). A Greek-English lexicon of the New Testament and other early Christian literature (3rd ed., p. 315). Chicago: University of Chicago Press.

[5] Arndt, W., Danker, F. W., & Bauer, W. (2000). A Greek-English lexicon of the New Testament and other early Christian literature (3rd ed., p. 384). Chicago: University of Chicago Press.

[6] Crabb, Larry. Understanding People: Deep Longings for Relationship. Grand Rapids, MI: Zondervan, 1987. 43.

[7] Crabb, Larry. Understanding People: Deep Longings for Relationship. Grand Rapids, MI: Zondervan, 1987. 44.

[8] Schwartz, Jeffrey. “A Role for Volition and Attention in the Generation of New Brain Circuitry.” Journal of Consciousness Studies, 6, No. 8–9, 1999. 135. See also Schwartz’ books Schwartz, Jeffrey, and Rebecca Gladding. You Are Not Your Brain: The 4-step Solution for Changing Bad Habits, Ending Unhealthy Thinking, and Taking Control of Your Life. New York: Avery, 2011. Schwartz, Jeffrey, and Beverly Beyette. Brain Lock: Free Yourself from Obsessive-compulsive Behavior: A Four-step Self-treatment Method to Change Your Brain Chemistry. New York, NY: Regan, 1996.

[9] Adams, Jay. Competent to Counsel: Introduction to Nouthetic Counseling. Grand Rapids, Michigan: Zondervan, 1970. 46.

[10] Adams, Jay. Competent to Counsel: Introduction to Nouthetic Counseling. Grand Rapids, Michigan: Zondervan, 1970. 102.

[11] Adams, Jay E. More Than Redemption. Phillipsburg, NJ: Presbyterian and Reformed. 1979. 160.

[12] Adams, Jay. Competent to Counsel: Introduction to Nouthetic Counseling. Grand Rapids, Michigan: Zondervan, 1970. 29.

[13] Adams, Jay. Competent to Counsel: Introduction to Nouthetic Counseling. Grand Rapids, Michigan: Zondervan, 1970. 5.

[14] Crabb, Larry. Understanding People: Deep Longings for Relationship. Grand Rapids, MI: Zondervan, 1987. 29.

[15] Crabb, Larry. Understanding People: Deep Longings for Relationship. Grand Rapids, MI: Zondervan, 1987. 38.

[16] Crabb, Larry. Understanding People: Deep Longings for Relationship. Grand Rapids, MI: Zondervan, 1987. 43.

[17] Crabb, Larry. Understanding People: Deep Longings for Relationship. Grand Rapids, MI: Zondervan, 1987. 83.