In this final article in the Biblical Counseling v. Christian psychology series, Biblical counselor Tim Allchin provides his reactions to A.J. McConnell and me. I will have some additional remarks at the conclusion of this post.
Allchin: Thank you for letting me take part in this series. I enjoyed the interaction and perspectives and the shared heart we have for helping this young man thrive (click here for the case of school refusal). I also appreciated the fact that we could disagree without choosing to divert the conversation into name-calling or mockery. Too many of these conversations have carried the tonality that was often found in the comments section but the main articles modeled a better way of interaction. I hope biblical counselors and Christian psychologist and secular counselors can learn from each other and learn to discuss our differences with respect. We will often disagree, but Christian counselors must be committed to conversations that are full of grace and truth.
Regarding the case study, I agree with Dr. Allen Frances when he states that “accurate diagnosis in kids is really tough and time consuming. Misdiagnosis in kids is really easy and can be done in 10 minutes. Accurate diagnosis in kids leads to helpful interventions that can greatly improve future life. Misdiagnosis in kids often leads to harmful medication and haunting stigma.” All three counselors clearly care about the child and want him to be treated carefully and bring different perspectives to the table.
Two questions I would raise in response to the critiques of biblical counseling and the case study mentioned:
What is the best way to view anxiety? Is anxiety a cognitive, physiological or spiritual issue? It is all three. Anxiety is not best viewed as purely a physiological disorder disconnected from any current or past thought process that have solidified one’s viewpoint of life. This is confirmed by the fact that the evidenced based research confirms CBT is the most effective mental health treatment for anxiety disorders. I agree with AJ’s statement, “a child with this condition, is experiencing a significant amount of fear that they do not know how to respond to appropriately.” Even adults don’t know how to respond to our fears on our own. More than 500 times in scripture the condition of fear is address either in command or narrative. Why is this such a strong theme? Fear is part of our fallen condition which needs to be redeemed and transformed. It is there from birth and in some ways will be there till we die, but hope for the anxious is not found in relaxation, medicine or distractions. It is found in the cross, where Jesus died and where the new creation is consummated. Our anchor in anxiety within a Christian counseling model should be Romans 8:38-39 “For I am sure that neither death nor life, nor angels nor rulers, nor things present nor things to come, nor powers, 39 nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord.” If we have the hope of the world, why would we hide it?
Anxiety is clearly a spiritual condition as well if we are to take seriously the words of Jesus, “Do not be anxious about tomorrow,” “which one of you by being anxious can add a single hour to his span of life,” “Do not fear those who kill the body, but cannot kill the soul.” In the case of PANDA’s (which is likely a small portion of overall anxiety cases), physiological feelings that mimic the physiological feelings of anxiety are not the same as cognitive and spiritual anxiety. Throckmorton writes, “Depression, panic disorders, eating disorders, etc., represent mind-body dysfunctions which require the help of science to understand and treat. I appreciate that Tim Allchin recommends good medical care, but in doing so it appears to me that he goes beyond the scope of the 95 Theses.” But Heath Lambert writes in Theses 84 “It is a misunderstanding of the essential nature of human beings—with a body and a soul—for Christians to minimize the importance of medical treatment in their care for troubled people (1 Tim 5:23).” If any part of anxiety is a spiritual issue, then it is a heart issue. Again Lambert asserts in Theses 83, “It is a misunderstanding of the essential nature of human beings—made with a body and a soul—for Christians to present physical interventions as solutions to spiritual problems.” In reality, every counseling issue is also a spiritual heart issue (Proverbs 4:23). With our heart, we choose to care for our God-given body (I Cor. 3:16-17). With our heart, we choose to embrace new ways of thinking about our anxieties (I Peter 5:7-9). We respond to physical pain, emotional trauma, and relational disappointment with a spiritual response, not just a physical one (James 1:2-4). Certainly, we need a medical response to physiological issues, but thriving physiology is not sufficient to help people thrive. They need to know, fear and love God to thrive. This is an essential evangelical commitment that shouldn’t be placed aside, even in the counseling office.
Why does this matter? Throckmorton writes “Techniques are judged by their utility in solving a problem.” Biblical counselors would insist that anxieties are both physiological and spiritual in nature. Just because you might be able to sever the physiological difficulties associated with anxiety does not mean that you have solved the spiritual struggle of anxiety. It’s not that we would minimize the physiological care, but we would see it as inadequate and incomplete for holistic care. Second, we would view many physiological symptoms that accompany anxiety as able to be reduced through healthier thought patterns and physical care (sleep, exercise, nutrition and structure) in keeping with the pattern laid out in scripture. The spirit of man is real, even if it can’t be measured and it needs to be treated. Conversely, the spirit of man resides within a physical body that impacts how the spirit functions and it needs to be treated as well. This dualist nature of man is routinely described within the commands and narratives of scripture and corresponds with good science in the contemporary culture. It also corresponds how the Christian church has wrestled with these issues through the entirety of the history of the church. I like how David Powlison brings a balance to this tension, “If you don’t seek to meet people’s physical needs, it’s heartless. But if you don’t give people the crucified, risen and returning Christ, it’s hopeless.”
Does biblical compliance help a young person thrive?
Throckmorton’s critique of biblical counseling was that the “biblical counseling approach is wrong to put emphasis on lack of biblical compliance, especially with childhood mental health concerns. It is too easy to feel false guilt tied to the belief that mental and emotional problems stem from lack of biblical compliance. This focus can also distract a counselor from more pressing problems in a client’s life.” I would ask in response, “Is there ever a downside to someone who chooses biblical compliance as a way of life?” For instance, Jesus said, “If you love me, keep my commandments,” “my ways are not burdensome,” and “teach them to observe all that I have commanded you.” How could a Christian counseling model not intentionally teach that biblical compliance is of utmost importance to thrive in life?
Biblical Counseling is careful lest we create “better functioning rebels” who behavior and symptoms improve but whose heart is no more tender towards the Lord. I would argue that all of us in our natural state are rebels and offensive towards God. This applies to everyone regardless of what diagnosis they face. The cancer patient is a rebel towards God. However, the Bible does not teach that cancer is a punishment for sin or that the cancer patient received cancer because of their sin. Still, “no one is righteous, not one.” However, I absolutely agree that Jesus’s conversation were deeper than simply than a declaration of the sinfulness of humanity. They were full of questions that revealed grace, hope, judgment, doctrine, empathy and correction. They were the full orb of conversational dynamics that were flexible to meet the heart condition of those he encountered. He was the “good shepherd” in every way. His conversations sought to increase the faith of those he came in contact with. Those who were seeking answers, terminally ill, spiritually tormented, downtrodden from life, trapped in sin, oppressed by systemic injustice, hard-hearted by traditions, similar heart conditions to those who would often seek counsel in any psychologists or biblical counselors office today. Jesus had an agenda to seek to strengthen their faith and love for him. This is at the core of Christianity. Biblical compliance without heart change was offensive to Jesus. He referred to it as “whitewashing a tombstone.”
Finishing with a few things I learned:
Biblical counselors are always looking for creative ways to help people apply the principles of the Word of God to everyday situations. Both psychologists gave some creative answers about how to help a young person thrive and to help his parents love him well. I appreciated reading the creativity and much of that is adaptable in a biblical counseling context.
Christian psychologists and biblical counselors often speak about the same things in different language. It required all of us to be patient to understand the perspectives that each brings to the table. I think we made a good attempt to do that and the christian counseling community would benefit if we all did that more.
I have appreciated the tone and content of this exchange involving Allchin and McConnell. I believe the series is a good model for how to discuss deep differences among counselors of various types.
My Response to Allchin
Regarding Allchin’s remarks, I am skeptical of the following claims:
Allchin: What is the best way to view anxiety? Is anxiety a cognitive, physiological or spiritual issue? It is all three.
Sometimes it is all three and sometimes it isn’t. Sometimes and for some people, anxiety comes as the result of faulty thinking and/or a lack of trust. At other times and for other people, anxiety is more like a faulty fire alarm. It just goes off with a full blown anxiety reaction without any spiritual or cognitive trigger. Effective counseling interventions reflect the assessment of different types of anxiety. While I might consider emphasizing patience in the case of anxiety as faulty fire alarm, I would not be inclined to use verses about one kind of fear as an intervention for another kind of fear. Lumping all experiences of anxiety together can lead to misapplications and ultimately unhelpful interventions.
Allchin: Certainly, we need a medical response to physiological issues, but thriving physiology is not sufficient to help people thrive. They need to know, fear and love God to thrive. This is an essential evangelical commitment that shouldn’t be placed aside, even in the counseling office.
We don’t have a definition of thrive, but I am skeptical about this in a general sense. According to Christianity, we need to know God to be redeemed. If thriving is defined as being in a relationship with God, then only those in such a relationship can be described as thriving. However, non-believers prosper and can be well-adjusted and happy.
Another problem I have with this statement is the claim that evangelical commitments shouldn’t be placed aside in the counseling office. While that may be defensible when counseling Christians who seek it, I can’t see how this works with non-believers.
Allchin: Just because you might be able to sever the physiological difficulties associated with anxiety does not mean that you have solved the spiritual struggle of anxiety. It’s not that we would minimize the physiological care, but we would see it as inadequate and incomplete for holistic care.
Allchin argues that a spiritual struggle must invariably occur with anxiety as a psychophysiological experience. I disagree. Anxiety might provoke a spiritual crisis but I believe anxiety can happen to any human, no matter how spiritually sound. For me, the care of the individual is what drives how holistic my interventions will be.
Allchin takes my disinterest in biblical compliance in the case of the school refusal as a sign that I minimize or disregard compliance with the Bible.
Allchin: I would ask in response, “Is there ever a downside to someone who chooses biblical compliance as a way of life?”
I never argued that being compliant with the Bible isn’t a good thing. I did argue that we should not assume that non-compliance is behind the problems bring to counseling. Since I didn’t see any link between the school refusal symptoms and the boy’s religious life, why would I spend time focusing on something that wasn’t mission critical?
Allchin’s answer is that all people are sinners and so all people need an intervention at that level. While I agree that all people are fallible and subject to problems, I don’t think Christian counselors must address specific sin as a component of medical and psychological treatment.
Again, I appreciate the participation of Drs. Allchin and McConnell. The exchange has taught me a lot about Biblical counseling and helped me sharpen my perspectives.