When seeking out professional counseling, should the devoted believer pick a therapist who can understand and support their beliefs or pick a therapist who uses techniques that produce results? This is a common dilemma Christian consumers of professional counseling face. Unlike other health professions, psychological counseling focuses on what the clients believe.
While it is the ethical responsibility of professional therapists to not impose their values and beliefs on their clients, some psychological theories are not consistent with Christian beliefs. Christian based therapy seeks to alleviate and improve their clients emotional well being while at the same time supporting their beliefs. My goal as a Christian therapist is to use evidenced based treatments that don’t conflict with my client’s beliefs and to acknowledge the limitations of those approaches when it creates conflict.
As a definition, Evidence Based Treatment (EBT) in the mental health field is counseling theory and technique that has been peer reviewed and shows scientific results in improving psychological problems. When it comes to using EBTs with clients with a Christian world view an important consideration is whether the approach is in line with their beliefs.
For example, theorist and therapist Carl Roger’s Humanistic Theory (which has been scientifically studied) took the position that human beings are “basically good” and they just need an enviornment of “unconditional positive regard to grow”. While there is some overlap in this idea in terms of human being’s need for grace, this theory contradicts a basic Christian teaching that all human beings have a “sinful nature” and are not inherently good on their own.
So, what should a therapist do who is working with a Christian client? Reject all together the EBT that does not completely fit the Christian view point or ignore the client’s concern and proceed with the contradicting idea? My view point lands in the middle. We need to use EBTs where they will benefit our clients and make efforts to find spiritual parallels to the EBT’s concepts.
Where there are differences, I think it is ok to acknowledge them and talk the limits of the EBT through with the client. A saying I have heard used in AA meetings fits this idea, “take what you can use and leave the rest.”
EBT’s commonly target symptoms associated with the psychiatric diagnosis. They are popular with insurance companies and mental health clinics where controlling costs is a priority. Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) and Eye Movement Desensitization Reprocessing (EMDR) are all examples of commonly used EBTs. Using these therapies as examples, I will illustrate some different approaches the Christian consumer of counseling takes in picking a treatment approach.
CBT is widely used for the treatment of depression and anxiety problems by activating behavior and modifying thoughts that improve mood symptoms. It is one of the more widely researched therapies and is shown to effectively benefit those who suffer from depression and anxiety. The cognitive part of CBT has the patient evaluate where they are focusing their thoughts and how that focus ends up affecting how they feel.
If a person’s thought is super negative, then they are likely to feel unpleasant emotions, and subsequently, cease to engage in rewarding behaviors. This is a treatment approach that easily can be found in Christian beliefs. CBT teaches patients how to modify their thinking, so they are less at risk to be overwhelmed by negative emotions.
In Philippians 4:8 (NIV), the apostle Paul teaches a similar concept: “Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable – if anything is excellent or praiseworthy – think about such things.”
For the Christian consumer, CBT can fairly easily adopt Christian concepts and parallels. There are so many teachings in the Bible about where to direct thoughts and behaviors it is an easy jump.
DBT, by contrast, has some roots in Zen Buddhism.
DBT was developed in a research setting to address the self-destructive behavior and frequent hospitalizations of those who suffer from Borderline Personality Disorder. Teaching skills in mindfulness, mood regulation, distress tolerance, and interpersonal skills is the core part of the treatment.
The practice of Mindfulness, which is a big part of DBT, is based on the Buddhist teaching that man’s efforts to escape suffering often merely perpetuate it. Learning to live in the present without excessive focus on the past or future can create better opportunities for coping. The question that some Christian believers can have, “should I participate in a therapy that is not directly influenced by Christian beliefs?”
I would say “yes,” as long as the parallel belief can be incorporated into the patient’s belief system. For example, the concept of being “mindful” is not exclusively a Buddhist concept. It is also very Christian. “Be still and know that I am God” is part of Psalm 46:10 (NIV) and exhorts the reader to be mindful of God. Finding purpose and meaning in suffering is also a Christian teaching.
The consumer would have to trade enlightenment of the “Wise Mind” concept of DBT for seeking a closer connection to God as their goal. I would say this is an effective evidenced based mental health treatment that the Christian consumer would need to find Christian versions of DBT concepts that fit their belief system.
EMDR is a treatment used for traumatic stress related disorders that is somewhat belief neutral. It has elements of cognitive and biofeedback combined with rapid eye movements to aid suffers in re-processing trauma. All of the treatments have shown scientific efficacy in improving symptoms that they target and are widely used in the mental health field.
In a treatment like this, the patient is working closely with a trained therapist to process life trauma’s and developing a new way of thinking about them. The Christian consumer would be best served to let their therapist know that they want to use imagery and thoughts that support their faith.
For example, early in EMDR treatment, the typical practice is to use imagery to create a “safe place” to imagine when trying to cope with a traumatic memory. A Christian patient may use the imagery of being hugged by Jesus or of walls surrounding them to evoke feelings of safety. In this type of therapy, it is okay to actively incorporate concepts of faith that aid in healing along with the techniques being applied.
Based on their experience and training, licensed therapists should be able to tell their clients whether they can provide treatment for their problems that supports their faith at the same time. If the therapist has inadequate knowledge or experience they are supposed to acknowledge that to the client and typically refer them to a therapist who can meet the need. It is appropriate for the patient to ask questions, interview different therapists before choosing one, and ask if the treatment will support their faith-based belief system.
Ethics, as defined by professional associations like AAMFT (American Association of Marriage and Family Therapists), should be employed by therapists when formulating a treatment plan for their clients. One ethical guideline I use when I pick a therapeutic approach to a client’s presenting complaints is AAMFT’s ethical code 1.9:
“Marriage and family therapists continue therapeutic relationships only so long as it is reasonably clear that clients are benefiting from the relationship.”
An application of this ethic I commonly use is in deciding when to use an EBT. If a client comes in with depression symptoms and tells me they have limited time and resources to pay for therapy, I am not going to implement a long-term psychodynamic approach to their problems. EBTs are frequently the method of choice because they offer targeted symptom relief versus an undefined measure of progress that is common in more theoretical approaches.
When making an appointment with any therapist, it may be helpful to decide beforehand if you are looking for a long-term change or symptom relief. Maybe you would like long-term help but can only afford symptom relief at the time you seek therapy.
If you just want symptom relief and the therapist tries to talk you into a long-term therapy, getting a second opinion could be helpful. Sometimes the therapist is correct and going for the roots of the problem is the best approach. On the other hand, sometimes they are improperly ignoring the client’s request and are trying to sell a more expensive therapy. Therapists are obligated to offer referrals when they cannot meet a client’s counseling request.
In summary, not all mental heath treatments line up with Christian beliefs. EBTs are the type of treatment that have proven results. Most are belief neutral or can easily be adapted to fit the Christian worldview like the EBTs mentioned above. Ultimately, the Christian consumer should ensure a good fit when seeking out a therapist to aid with their counseling needs.
The therapist should ensure they are picking an approach that is benefitting their client while supporting their deeply held spiritual beliefs. Christian consumers of counseling services should ensure they are feeling a good fit with their therapist and they are actively being helped by the process.
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