The dictionary defines counseling as “opinion or instruction given in directing the judgment or conduct of another.” The field of counseling today has a very mixed history. Counseling has been taking place for thousands of years. We know in ancient times from biblical history counseling was conducted by spiritual and religious leaders. Christian churches practiced what we came to call counseling. The bible teaches us to “admonish the unruly, encourage the timid, help the weak, and be patient with all men” (I Thessalonians 5:14). This is not only counseling, it is what we now call “differential therapeutics,” or applying specific treatment following an accurate and careful diagnosis.

The scientific community of psychologists and psychiatrists has been writing about counseling and psychotherapy since the late 1800’s. Much of the field of secular psychology and psychiatry dates back to the early writings of Sigmund Freud. Freud was clearly antagonistic toward religious faith, and did not hold to a world view that was compatible with the gospels. Freud went so far as to say that religion was the “universal obsessional neurosis.” Since Freud’s writings, the Christian church has struggled with how to approach the field of psychology and psychiatry.

A variety of approaches have developed as Christians wrestle with whether or not psychology and Christian faith are compatible with one another. Worthington (1991) suggested that there were four possible positions that counselors might take regarding the integration of counseling.

The first category he calls “across the gap.” In this approach therapists who do not value religious faith choose to ignore it, and see the religious faith as harmful to clients.

The second position is the “collaborative approach.” In this approach therapists who are not personally religious are committed to respecting religious faith and values in their clients.

The third position represents those who are religious and have a faith orientation but who have been trained in secular approaches and were taught that dealing with religious issues were irrelevant or inappropriate in counseling.

The fourth position is the “conjoint” position in which therapist who personally hold to a religious value system are committed to dealing with the religious commitment and spiritual issues of their clients.

(Adapted from our corporate web site: www.cfitulsa.com.)

In a classic article written for Christianity Today in 1975, Gary Collins suggested that today’s Christian counselors fall into five categories.

The first category Collins called “the main stream.” Main stream pastoral counselors generally have taken Clinical Pastoral Education training (CPE). The CPE approach takes a pastor with a theological education through an essentially secular training program in counseling. The clinical pastoral education movement has historically been theologically liberal and somewhat antagonistic toward conservative evangelical theology (Collins, 1975).

The next category that Collins outlined were the “evangelical pastoral counselors.” The most outspoken of such counselors is Jay Adams, professor of practical theology at Westminster Seminary. Adams advocates Biblical Counseling, in which only the bible is used to support a counseling approach that is primarily educational and confrontive.

The third category of Christian counselors are the “Christian professionals.” Examples of the Christian professionals would include Clyde Narramore (considered to be the father of Christian counseling), James Dobson, Bruce Narramore, Frank Minirith and Paul Meier, and Gary Collins. The Christian professionals have been trained and have received degrees and credentials in the secular counseling approaches, but who also have a strong commitment to biblical evangelical theology. Each of these counselors have developed a model for integrating their knowledge and skills from the field of psychology with biblical truth.

The fourth model Collins defined were the “theoretician researchers.” The theoretician researchers are those who have taken a scientific, scholarly and research approach. These are generally university professors who are in the process of developing and testing theory.

The fifth and final category that Collins outlined are the “evangelical popularizers.” The evangelical popularizers would include Bill Gothard, Tim LaHay, Charlie Shedd, and Norman Wright. The evangelical popularizers produce useful but simplistic self help material for the lay public.

(Adapted from our corporate web site: cfitulsa.com)

Since the writing of Collins’ article in 1975, all five categories are alive and well. Evangelicals have increasingly steered away from the clinical pastoral education movement. Seminaries have strongly embraced the evangelical pastoral counseling and the Christian professional movement in counseling. Many seminaries have developed masters and doctoral programs integrating both theology and the practice of psychology and counseling. Christian graduate schools have flourished with strong enrollments in the areas of psychology, counseling, and marriage and family therapy. In spite of the increase in Christian counseling, a number of authors have been critical of whether or not Christianity and psychology are compatible at all.

Lawrence J. Crabb (Effective Biblical Counseling: A Model for Helping Caring Christians Become Capable Counselors) suggests that Christians have taken one of four positions: The first position is referred to as “separate but equal”. The bible and theology are considered valid in the areas in which they speak, and psychology is considered valid in the area in which it speaks. The separate but equal counselor may switch back and forth between psychology and theology. An attempt is made to separate the two disciplines and keep them separate.

The second approach is the “tossed salad” approach. Crabb suggests that this approach is like a salad bowl in which a variety of ingredients are thrown into the bowl and tossed about. The problem with the tossed salad approach is that psychological notions are often accepted uncritically and without an understanding of the conflicting world views (i.e., humanism, existentialism, modernism, etc.) which are often represented in psychology. Consequently a number of unbiblical ideas may creep into this counseling.

The third category that Crabb refers to is the “nothing buttery.” In this approach the Christian counselor accepts nothing but the scripture as the basis for Christian counseling. The writing of Jay Adams would fall in to this category. Adams suggests that psychology has nothing to offer the Christian counselor, and psychology is always in conflict with biblical ideas. If one is true to this position there is never a need to study any counseling approaches, medicine or psychology.

The fourth approach and the approach that Larry Crabb takes is the position he calls “spoiling the Egyptians.” In the spoiling the Egyptian’s position the Christian counselor is first thoroughly grounded in the Word of God. Just as God made provision for the Israelites carried out of Egypt the spoils the Christian counselor critiques the findings of modern psychology and takes from them tools which are consistent with our biblical perspective. The Word of God is absolute in authority, and the only truly and fully reliable source of knowledge. Psychology on the other hand is a field that attempts to use the scientific method to investigate a variety of man’s problems, and seeks to determine what works in helping people resolve their problems. This approach recognizes that scripture is “ALL TRUTH,” but may not contain “all truth”. Knowledge exists beyond the scripture about many subjects including psychology, medicine, family life, etc. The Christian counselor operating from this approach takes what is useful and consistent with scripture while discarding the rest.

(Adapted from our corporate web site: cfitulsa.com)

Basic Assumptions. The counselors I work with have worked together to compare ideas about the integration of psychology, and marriage and family therapy with biblical theology. Counselors recognize that Christian counseling must first start with a Christian who has been brought to new life in Christ. Prior to our conversion we were dead in our sins and transgressions (Eph. 2:1). “But because of His great love for us, God, who is rich in mercy, made us alive in Christ even when we were dead in our sins and transgressions” (Eph. 2:4). As counselors we recognize that spiritual things can not be understood unless one is born of the spirit of God. To the non-Christian, spiritual things seem foolish (I Cor. 2:14). After one has become a Christian and begins to grow in faith and a knowledge of God’s Word, our entire value system is shaped by our Christian faith, our bible study, and our life of prayer.

As we grow as Christians, all of our principles are transformed by scripture. Whatever other wisdom we might find useful from psychology and other sources must be judged by scripture.

Counselors are called to counsel. Counseling is not a profession unrelated to our faith. Just as ministers are called to the ministry, Christian counselors are called to the ministry of counseling. The scripture indicates that each Christian is given spiritual gifts for the purpose of ministry to the Body of Christ (I Cor. 12:7). For Christian counselors, spiritual gifts will be manifested in the style of counseling that the counselor provides.

Christian counselors must recognize that all people have a need for Christ. As Christian counselors we recognize that God’s Word is absolutely reliable and authoritative in all it speaks to, particularly matters of faith, lifestyle, and morality. Christian counselors derive their sense of morality from God’s absolute Word. In practice we are committed to loving all persons whether or not they are Christians.

Human beings function and malfunction as a result of a complex and seamless interaction between biological, psychological, social, and spiritual forces. Malfunction in any one of these areas produces a ripple effect. If a person has a cavity in one tooth, the pain may radiate to many surrounding areas. So also do symptoms spread in any of the bio-psycho-social-spiritual dimensions.

As Christian counselors we also recognize the value of psychology, marriage and family therapy, counseling, psychiatry, and medicine. Persons who consult with us are often concerned about problems these disciplines may address. For one client the issues that bring them to counseling may be of a moral nature involving guilt and confusion. The next client that comes to us may be experiencing the consequences of sin in their life. The next person who comes may have been sinned against by others who were abusive and are attempting to recover from the damage that was done to their life. The next client who comes to counseling may be experiencing psychological symptoms related to a genetic or medical condition. As Christian counselors we depend on the Holy Spirit as well as our training in these disciplines in order to be effective in helping people with their concerns.

This approach would be classified by Collins (1975) as a “Christian Professional” model. We would classify it as a “spoiling the Egyptians” approach according to the Crabb (1977) model.

(Adapted from our corporate web site: cfitulsa.com.)

Prospective clients have formed their expectations of counseling based on what they have heard from other people, read, and seen on television and in the movies. When a client comes to counseling, all of these previous experiences lead the client to have a certain set of expectations about what the experience will be like. If a person has watched One Flew Over the Cuckoo’s Nest, they may fear that psychiatric and mental health services are primarily for the seriously disturbed, and that those services may involve abuse of the client. In recent years, society has come to view counseling in a more positive light. Counseling is now seen as a service that is socially accepted and not just for those who have severe emotional disorders.

Some clients come to counseling expecting the counselor to be a judge in settling relational conflicts. Clients who come with this expectation attempt to present their case in a convincing way, expecting the counselor to rule in favor of one or another. Other clients come to counseling expecting that counseling will involve the counselor listening only. This expectation has been fostered by the writings of Carl Rogers in his humanistic psychology. Most clients today find the client-centered non-directive approach disappointing, and do not find it satisfactory. Others who have read Jay Adams work Competent to Counsel, expect that the counselor hunt down “the sin” that is the cause of the problem.

The Christian Family Institute model of counseling involves listening to clients tell their story. Clients are asked in the early phase of the first counseling session what brings them to counseling. Clients are encouraged to share the distress of their life that has caused them to seek professional services. Clients are also encouraged to bring other involved family members to the counseling session when possible. Unlike individual approaches to counseling, a family systems approach attempts to respect each person’s unique perspective on the problem. Family and marital counseling also encourages family members to talk to one another and to resolve their disputes with one another. Individual counseling sometimes fosters a belief that the counselor is siding with one person against another and may put the counselor in a position of operating with only half of the facts.

As counselors listen to each family member’s perspective on the problem, the counselor attempts to establish counseling goals in collaboration with family members that meet their needs and expectations. In a marriage counseling session, one partner may complain that there is not enough communication while another partner complains that there is not an adequate sexual relationship. The counselor attempts to establish mutually agreeable goals for the resolution of the problem to both partners’ satisfaction.

An individual may come to counseling expressing a desire to overcome problems with depression. A counselor needs to hear their client’s own theory about what may be contributing to their depression. The counselor also may help the client investigate new areas they have not considered. In counseling, clients may be helped to discover their blind spots about the problem that brings them to counseling. After goals are established, the counselor then helps the client plan a strategy for resolving the problem.

(Adapted from our corporate web site.)

An individual may come to counseling expressing a desire to overcome problems with depression. A counselor needs to hear their client’s own theory about what may be contributing to their depression. The counselor also may help the client investigate new areas they have not considered. In counseling, clients may be helped to discover their blind spots about the problem that brings them to counseling. After goals are established, the counselor then helps the client plan a strategy for resolving the problem.

Counselors use a variety of tools and techniques to help people change the things that they seek to change. At times a skilled counselor may ask a series of diagnostic questions or administer tests designed to assist them and their client in gaining greater insight into the nature of the problem. At other times counselors recognize that clients may lack life skills such as communication skills, conflict resolution skills, skills to enhance and sustain intimacy, and skills in the management of their thought life and emotions. Counselors may teach clients new skills to help them overcome the problem that brings them to counseling.

Counselors often use homework assignments as a tool for enabling clients to translate learning from the counseling session into their daily life. If clients are open to what the bible has to say, and if clients are receptive to prayer, the Christian counselor may utilize teaching from scripture, bible study assignments, and prayer as tools to assist people in growing in their knowledge of God’s will, and in their relationship to Him and others.

Occasionally a couple comes to counseling where the Christian spouse has coerced their non-Christian spouse to come to a Christian counselor. Occasionally the Christian will attempt to align themselves with the counselor, hoping they will side with them against their partner. Sometimes the Christian has been preaching and judging their spouse, and their secret hope is that the Christian counselor will join them in preaching to their non-Christian partner. It is extremely important that the Christian counselor assist these clients in learning a more effective way to disagree with their partner. It is also important for the Christian counselor not to take sides against any family member, but to always show respect to all family members.

As professional Christian counselors, we are committed to respect each person’s right to self determination and the exercise of free will. Though we attempt to steer our clients in a biblical direction, we never take responsibility for their life. We never coerce anyone to take a particular position. Advice may be given in the form of helping people identify alternatives and assisting clients in considering the pros and cons of each possible course of action. Counselors may assist clients by suggesting steps that may be taken to achieve a particular outcome. Counselors may gently and respectfully challenge myths, faulty thinking or reasoning, inconsistencies, and immoral behavior.

Though Christian counselors recognize man’s need for God, Christian counselors are not primarily evangelists. As is the case with all Christians, we are commanded in the great commission to go and make disciples. We at Christian Family Institute take a relational evangelism perspective. We hope to build loving and respectful relationships with all people, and to let our Lord’s light shine from our Christian lives. We show compassion for the struggles that people experience. We never give advice contrary to scripture.

Some Christians have defined “Christian Counseling” as only giving “spiritual and Biblical counsel”. This model assumes that the only tool a Christian needs is to read scripture to clients, and this is then called “Christian counseling”. We believe that whenever we help a client live an abundant life that is more conformed to the will of God, or find practical answers to problems, this is Christian counseling. Therefore, there is no distinction between the “secular” and “spiritual” realms. If we help a single parent manage impulses to mismanage money, this is “spiritual” counseling. We believe “secular counseling” is done without regard for spiritual and Biblical truth.

(Adapted from our corporate web site.)

Nearly all helping professionals at some time or another find themselves needing to make a referral to another specialist. Whether one is a physician, pastor, or a psychologist, we sometimes find that the client’s needs and goals can best be met by someone who has special training beyond what we possess. Sometimes we discover that the client’s needs conflict with our own needs, as in the case of a pastor who may have a client in need of intense, long term counseling. To provide such counsel with very many people would distract the pastor from his responsibility of ministering to the whole church.

Referral is a skill. Making a referral is like any intervention in a professional’s toolbox. If the helping professional is skilled in making referrals, clients often follow through and seek the services of the one to whom they are being referred. As with any skill, referral may be ineffective if we are not confident and competent in making referrals.

Helping professionals are sometimes reluctant to make referrals because they feel guilty that they are not able to help, or they may feel that referral casts doubts about our competence. We may be fearful that the client will perceive the referral as rejection. When a client expresses resistance to seeing a professional therapist, we may be tempted to attempt to provide the counseling ourselves, even though it may be against our better judgment.

Referral is particularly advisable when we recognize that we do not have the competence, training, or experience in dealing with the unique problems that are being presented to us. To practice beyond one’s training is considered unethical for professionals and is frequently a factor in malpractice lawsuits. Helping professionals must not allow their own feelings of guilt or fear of a client feeling rejected to keep us from doing the professional and competent thing which is sometimes to refer.

It is best not to work with some clients. It is advisable to refer when we find ourselves sexually attracted to a client, when we find ourselves angry, when we dislike our client, or in cases where there is a potential conflict of interest due to our other relationships with a client. Dual relationships increase the possibility of our objectivity and judgment being hindered when making diagnosis or treatment decisions.

Referral is appropriate whenever we have provided counseling services to a person who is not showing signs of improvement. After a reasonable period of receiving counseling, clients should show signs of improvement. If they do not, it is our ethical responsibility to not continue counseling when it is not producing progress. We also have an obligation not to abandon a client in distress, but we are responsible to facilitate a referral to another helping professional.

(Adapted from our corporate site: cfitulsa.com.)

The first step in making an effective referral is believing that referral is an appropriate and professional service which is in the client’s best interest. If we believe that the client is being short changed by our referring them, we will often not be effective in making referrals.

The second step in making referrals is to know the professionals and other resources available in our community. It is important to get to know professional Christian counselors, hospital personnel, and a variety of physician specialties such as family physicians, pediatricians, obstetricians and gynecologists, and psychiatrists. As we get to know these professionals and how they work, we can feel more confident that those we refer will be in good hands.

A third step in making effective referrals is to be able to convince clients that the referral is necessary. It is important that we be honest with our clients and that we let them know when there is a more professionally skilled person who is best to treat them, or that we may have conflicts in dealing with a particular client or their problems. It is also important that we have enough self confidence and integrity to be able to be honest about the limits of our professional competence. We each have an area of specialty. No professional can be all things to all people.

A fourth step in making effective referrals is to be able to educate the client about what the professional we are referring them to will be able to do for them that we are not able to do. It is also helpful if we can assist the client in becoming more comfortable with the person we are referring to by informing them that we know the person personally, and that in our experience with them they can be trusted and are helpful.

A fifth step in making effective referrals is the ability to allow clients to express themselves and their feelings about referral. Some clients may be angry, some clients may feel depressed or betrayed, and other clients may be afraid. It is important to allow the client to discuss these feelings. It may be necessary for us to offer reassurance and clarification of any misunderstandings. It is also important that we allow clients to know that we do care for them and that we intend no malice or harm by making the referral. Redefining what your relationship will be like after the referral is completed is strongly recommended.

The sixth step is getting the client to make a commitment to follow through with a referral. If we simply say to a client, “I suggest you call a counselor,” and we are not specific about who we are referring to, the chance of follow through is extremely small. If we ask the client if they will commit to making the phone call, and when they will make the phone call to make to appointment, then there is a significantly increased chance of follow through.

Sometimes it is a good idea to allow the client to make the phone call from your office. Particularly, when the client has made a commitment to follow through with a referral, but we sense that if the client hesitates the resolve will weaken, it is a good idea to have the client make the phone call from our office. Sometimes it is effective to ask the client if you can make the phone call for them. Making the initial phone call sometimes makes it easier for the client to follow through.

Most professional offices will ultimately require that the client make a call themselves directly before appointments will be established. If a client is unwilling to talk with a counselor or with an intake counselor over the phone they are often likely to cancel or not show up for their first appointment. Also, many professionals give instructions to help prepare the client for their first appointment and obtain information that will reduce some of the initial paperwork.

A seventh step in making effective referrals is agreeing on what information will be shared with a new professional. If we have previously provided counseling, testing, or any other service, it is important to discuss with the client whether they wish those results be forwarded to the professional we are referring to.

Professionals require a signed release in order to disclose information. Counselors are bound by a code of ethics and laws that require guarding client information and client confidentiality. In the case of pastors and physicians making referrals to professional counselors, it will be necessary to sign a two way release of information in order for information to legally be exchanged as we serve as teammates in helping our clients. It is important that we explain to our clients that working together is in their best interest. As we are able to communicate we are able to work as a team which often speeds the process and increases the chance of successful outcome.

The final step in making effective referrals is follow up. It is important for us to check with clients to make sure that they made the telephone call and established an appointment. It is also important for us to follow up with our clients following their first appointment with their counselor. When people come for counseling they are often confused, anxious, and sometimes disoriented. Sometimes clients will come away from sessions with mistaken impressions or misunderstandings of something that was said in the counseling process. Counseling is a painful process and sometimes raises resistance.

(Adapted from our corporate web site: www.cfitulsa.com.)