Next Thursday, July 23 at 1pm EST I will be hosting a free webinar to consider this case study. Our goal in this twice-monthly series of webinars is to teach one primary counseling concept or skill each month and then provide a case study that allows participants to become more proficient at utilizing that skill or concept.
- Pastors, chaplains, and ministry leaders looking to enhance their pastoral care skills
- Counselors wanting CEU credits to help them learn more about the intersection of their faith and practice
- Leaders in church-based counseling ministries looking to grow in their case wisdom
- Undergraduate students looking to discern a calling to vocational ministry or a career as a professional student
- Friends and small group leaders committed to walking faithfully alongside their peers in tough times
Concept for July
Have you ever noticed that when people debate about counseling it doesn’t always sound like they’re talking about the same thing? While it’s easy for all of us to fall in the trap of having different conversations about the same subject, this is particularly true when we are discussing a word with as many meanings as the word “counseling.”
The reality is counseling is a word like “dog.” It has a very broad semantic range; meaning everything from “poodle” (a cat that barks) to “Great Dane” (a horse that people allow to live in their house). Counseling can be informal (every helpful conversation) or very formal (a conversation initiated when one individual’s personal and social resources are overwhelmed by a particular struggle and they seek someone with expertise in their area of struggle to guide them).
My goal in this post is not to address what level of formality is best for counseling; or, more accurately, better for a given counselee. That is a subject I explored in chapter 15 of the Biblical Counseling Coalition book Scripture and Counseling (relevant excerpt here).
Instead, my goal in this post is to examine the kinds of things counseling can be about. In helping counseling students think through what a given counselee is asking for or needs in a given counseling relationship, I have found these three categories to be helpful.
- Problems in Living
- Meaning of Life Questions
- Mental Health Concerns
Problems in Living
Sometimes the focus of counseling is on the choices and underlying beliefs-values of the counselee. A counselee recognizes that one or more areas of life are not going well. The disruption becomes significant enough that they decide that an assessment of their choices-beliefs-values needs to be made and that the subsequent changes will be “worth it” (motivation occurs when the status quo is perceived to be more painful than change).
This type of counseling might include improving marital communication, learning the best ways to respond to an addicted family member, understanding how to most effectively parent in a blended family, honoring God when anger is intense, resolving guilt over choices for which someone feels great regret, etc…
Meaning of Life Questions
Other times, the focus of counseling is on how to make sense of life in light of some hardship, transition, or unrelenting question. A counselee may face the death of a loved one, a mid-life crisis, or a dilemma about whether they truly know what it means to love. While a counselor may recommend changes in the counselee’s beliefs, values, or choices, the focus of counseling is more on the over-arching meaning of life (e.g., more worldview level than practical).
Mental Health Concerns
Still other times, the focus of counseling is on disruptive experiences such as flashbacks after a trauma, difficulty discerning reality from fantasy in one’s thinking, a chronic obsessive-compulsive pattern, or a disruptive-elevated mood marked by grandiosity and impulsivity (mania). In these areas, while choices and beliefs will play a significant role in any remedy, there are good reasons to believe that the origin of the disruption is occurring at a level of personhood other than volition (choice) and cognition (belief).
For the moment, assume these are three distinct (yes, overlapping like Venn diagram, but with significant area of non-overlap) areas of personal struggle. Based on this assumption, let’s ask two questions.
- Question: Which of these three areas does counseling focus on? Answer: Yes (all three), and it depends on the needs of the counselee and training / experience of the counselor.
- Question: What happens if we treat these three areas as if they were all the same? Answer: We hurt people; even with the best of intentions.
Question One Reflection: All three of these areas can rightly be the focus of “helpful conversations” (broadest definition of counseling) where people seek to find relief from the hardships of life. Any given counselor (formal helping role), is going to better at one or two of these areas than another. If we are a friend (informal helping role) walking with someone who is struggling in an area where we are less experienced, we should have the humility to say, “I don’t know a lot about that area, but your struggle/question is real and deserves attention. Let’s find someone who knows this struggle/question well, and I’ll walk with you as you seek God’s direction on this matter.”
Question Two Reflection: Notice the phrase “with the best of intentions.” I do not believe that therapists or pastors – nor lay people from a biblical or psychological perspective – intend to offer unhelpful (possibly harmful) advice when a life struggle gets mis-categorized. But even with that benefit-of-the-doubt, let’s look at what happens when we default a given struggle into a category for which it does not belong.
- When we treat meaning of life questions or mental health concerns as problems in living, we communicate, “If you do and believe the right things, then your soul will necessarily be settled. An unsettled soul is a sign of sin or unbelief.”
- When we treat problems in living or mental health concerns as meaning of life issues, we communicate, “If you rightly understand the big picture, then all the details come into focus and individual choices become clear. An unsettled soul reveals that your functional theology is in error or incomplete.”
- When we treat meaning of life questions or problems in living as mental health concerns, we communicate, “Your life struggle is ‘happening to you’ when, in fact, the primary contributor to the struggle is your choices, beliefs, values, or conceptualization of what makes for a satisfying life.” We offer comfort that contributes to passivity in the area(s) that our friend would most need to change in order to experiencing the lasting peace and joy they desire.
If you are intrigued by this post and want to explore it further, I would commend Allen Frances’ book Saving Normal where Dr. Frances warns against the unintended consequences that have arisen with the over-medicalization of problems in living and meaning of life concerns. If you are intrigued, but not enough to read a 300 page book, consider this post where I interact with the quote below from Dr. Frances.
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“Mental disorders should be diagnosed only when the presentation is clear-cut, severe, and clearly not going away on its own. The best way to deal with the everyday problems in living is to solve them directly or to wait them out, not to medicalize them with psychiatric diagnosis or treat them with a pill. Prematurely resorting to medication short-circuits the traditional pathways of restorative healing – seeking support from family, friends, and the community; making needed life changes, off-loading excessive stress; pursuing hobbies and interests, exercise, rest, distraction, a change of pace. Overcoming problems on your own normalizes the situation, teaches new skills, and brings you closer to the people who were helpful. Taking a pill labels you as different and sick, even if you really aren’t. Medication is essential when needed to reestablish homeostasis for those who are suffering from real psychiatric disorder. [However,] Medication interferes with homeostasis for those who are suffering from the problems of everyday life (p. 32).” Allen Frances in Saving Normal
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