Developments in Biblical Counseling

[Eoghan]

Jay Adams started nouthetic counseling in 1970's at Westminster Seminary. His fundamental starting point was both the inerrancy of Scripture and it's sufficiency. Rejecting any synthesis with secular, humanistic psychology Adams began to develop an approach that was consistent with reformed theology and took the view that Scripture had no deficiencies that needed supplementing with secular psychology. For those not familiar with nouthetic counseling I would recommend Competent to Counsel (one 'l') by Jay Adams.

Using the analogy of a property Adams pictures the psychologist on the one hand and the psychiatrist encroaching on the Pastor's property and mowing his grass. Pastors have been content to let others mow their lawn so to speak. (p22)

This book reviews how the next generation have developed this distinctively Biblical counseling. Perhaps Adams needed to be strident to adequately convey the distinctively Biblical school of thought. Ideally he would have preferred the term 'Biblical' but felt the term was already overused and compromised. The second generation of Biblical counselors seem to show more empathy. (p83)

There were perhaps three points that stood out for me. First was the explanation of 'ortho - doxy' as right belief, 'ortho - praxy' as right deed and 'ortho - gnosis' right knowledge of God which bridges the gap (p55). Second was the description of the effect of Altzeimers in weakening the mind. Thus a formerly morally upright patient began to display crude and lustful language - no longer able to disguise the state of his heart as he once was (p77). Third was the application of Biblical principles to divorce. Where a couple separates, apart from adultery or the desertion of an unbelieving spouse, they should repent and seek reconciliation. If needs be, this can lead to the excommunication of the unrepentant spouse.


A fascinating book documenting the way the likes of Edward Welch have been less confrontational as they have developed this aspect of pastoral work. As a Christian this is not merely academic but offers insights into my own heart and the ongoing work of the Cross in sanctification.

 

[Susan777]

“Thus a formerly morally upright patient began to display crude and lustful language - no longer able to disguise the state of his heart as he once was” (p77).

I have seen this many times in stroke patients and in some forms of dementia. It is always distressing to the family. But I would never assume that it was a moral failure. It is beyond the person’s control because of damaged inhibitory areas of the brain but it’s incorrect to say that it reveals one’s moral status.

 

[Eoghan]

I think the point that Welch was making is that everyone has sin in their heart. Normally this is restrained by conscious control. When that is disrupted it exposes our sinful nature inherited from Adam.

In evolutionary terms it would be described as animal instincts. As a creationist I would reject that explanation and look for a more Biblical explanation, as would Welch.

 

[Susan777]

I think the point that Welch was making is that everyone has sin in their heart. Normally this is restrained by conscious control. When that is disrupted it exposes our sinful nature inherited from Adam.

In evolutionary terms it would be described as animal instincts. As a creationist I would reject that explanation and look for a more Biblical explanation, as would Welch.[/


I agree with what you are saying but perhaps it was just an unfortunate quote on his part.

 

[Pergamum]

If I ever go crazy in a nursing home and say a few bad things, I hope it's not a Nouthetic Counselor that deals with my family.

 

[Pergamum]

From the description of nouthetic "confrontation" in the book:

"These three elements came to be classified as “change through confrontation out of concern,” now popularly known as the three Cs. Adams rejects the idea that “confrontation” has a negative implication. “Nothing could be further from my mind as I use it,” he says. The word implies authority but not belligerence. It might have been as well to speak of “nouthetic consultation” except that it would be too “neutral.” Adams writes, “The positive aggressiveness and willingness to put one’s self on the line in reaching out to help another in a face-to-face encounter that is inherent in nouthesia is better expressed by the word confrontation. For me it is a good and more positive term than consultation.”

This leads me to ask why "confrontation" is used at all instead of comfort of counsel. I believe we are all sinners, yes, but we are also broken and fallen in sin. This means that chemicals, hormones, brains, don't work. Too much is attributed to sin and not the brokenness. What the suffering person needs is not always confrontation, but comfort. "You are a sinner" is not always the right answer when dealing with the bereaved or struggling.

 

[Pergamum]

Other thoughts:

1. I have a friend who goes to a church where a nouthetic counselor is pastor. When the friend speaks of feelings or says, "I feel" this pastor corrects him. The pastor speaks against feelings and says we should think or believe, not feel, even to the point of interrupting folks mid-sentence to correct them, ..no, no, no...you don't feel... you either believe it or you don't. Don't speak of feelings...

This seems to be a Jay Adams thing.

2. Also, it does appear that to nouthetic counselors, you are guilty until proven innocent. From the book we read, "“Depressed persons whose symptoms fail to show any sign of a biochemical root should be counseled on the assumption that they are depressed by guilt."

Being untrained in these areas, Adams is not competent to determine these biochemical causes.

3. This assumption of guilt makes many counselors assume sin on the part of the counselee, but much less is written about the role of sin on the part of the counselor. I've heard many nouthetic counselors speak with over-certainty on the problems of certain church members, even to the point of enacting church discipline to lovingly correct them, and yet they entertain no possibility of their flaws in counseling. They give "homework" to the counselee, give them hoops to jump through, and any resistance to the prescribed regimen is an evidence of their ongoing sin issues (issues that can then be dealt with by church discipline). If you join Nouthetic Counseling to a church tradition that often elevates the opinion of the pastor and exercises heavy church discipline, there is a potential to abuse the counselee and coerce him or her into changing. I've heard from one counselee that his pastor gave him "homework" to do that was not beneficial and felt like hoops to jump through, but when he resisted the pastor said this was sinful resistance to correction, and then mentioned that his sin issues make make him a candidate for church discipline.

For instance, see how there is a potential for abuse from this article here: https://www.biblicalcounselingcoali...s-of-church-based-biblical-counseling-part-1/

Here is the paragraph that I am alarmed by:

"When I counsel people from other churches who pull away from needed counsel or reject the clear biblical counsel I give, the most that I can do is try to advise the other church. I think of one couple who bounced around from one parachurch or professional counselor to another no less than ten times until they came to me for counseling. I was able to connect them back to their pastors to receive the long overdue disciplinary care of their local church."

Notice how the counselor assumes that he gives "clear biblical counsel" and see how he advocates keeping people under the control of the local church for "disciplinary care." Do you see the potential for coercion or abuse? What if the couple merely finds the counselor to be ineffective? They will, instead, be assumed to be running from parachurch to parachurch. But not if they are made to stick through church discipline. Sounds very controlling to me.


4. Nouthetic counselors go by a different definition of confidentiality than secular counselors. Confidentiality is not guaranteed and reports could be made to your pastor. I am ok with this in reference to one's wife, but not the pastor. Some problems are your pastor's domain and some are not.

5. Finally, I would ask, "What empirical evidence do we have that Nouthetic Counseling is superior to other forms of counseling?" If it works, we ought to have evidence, right?

 

[Stephen L Smith]

This means that chemicals, hormones, brains, don't work. Too much is attributed to sin and not the brokenness. What the suffering person needs is not always confrontation, but comfort. "You are a sinner" is not always the right answer when dealing with the bereaved or struggling.

Also, it does appear that to nouthetic counselors, you are guilty until proven innocent. From the book we read, "“Depressed persons whose symptoms fail to show any sign of a biochemical root should be counseled on the assumption that they are depressed by guilt."

Martyn Lloyd-Jones, an esteemed medical doctor, was very critical of Jay Adams at this point. In his classic 1974 Randall Short lecture at the British Christian Doctors association he said "One of the best known is Jay Adams with his widely selling Competent to Counsel. But he is just a populariser of Thomas Szasz and he is simply affirming, with Scasz, that there is no such entity as mental illness that the patients are really suffering from sin and need to be dealt with purely in a scriptural manner. These writers reprimand those sufferers and counsel them with great severity." You can hear this classic lecture on mental illness here: Part A https://www.mljtrust.org/sermons-online/itinerant-preaching/body-mind-and-spirit-part-a/ Part B https://www.mljtrust.org/sermons-online/itinerant-preaching/body-mind-and-spirit-part-b/

I have a friend who goes to a church where a nouthetic counselor is pastor. When the friend speaks of feelings or says, "I feel" this pastor corrects him. The pastor speaks against feelings and says we should think or believe, not feel, even to the point of interrupting folks mid-sentence to correct them, ..no, no, no...you don't feel... you either believe it or you don't. Don't speak of feelings...

Of course even our feelings must be grounded in scripture. Perhaps the concern here is the problem of a secular approach to feelings.

Finally, I would ask, "What empirical evidence do we have that Nouthetic Counseling is superior to other forms of counseling?" If it works, we ought to have evidence, right?

I believe in Biblical counselling in the Dr Lloyd-Jones tradition. My evidence is Heb 4:12 "For the word of God is living and sharper than any two-edged sword, piercing to the division of soul and of spirit, of joints and of marrow, and discerning the thoughts and intentions of the heart." Even in distancing ourselves from Jay Adams, we must not forget the power of scripture to change lives.

I was going to add, Pergamum, in light of your own health situation and personal trials, I have found another recommendation of Dr Lloyd-Jones extremely helpful. Dr Lloyd-Jones said this of the Puritan Richard Sibbes ‘I shall never cease to be grateful to..Richard Sibbes who was balm to my soul at a period in my life when I was overworked and badly overtired, and therefore subject in an unusual manner to the onslaughts of the devil..I found at that time that Richard Sibbes, who was known in London in the early seventeenth century as “The Heavenly Doctor Sibbes” was an unfailing remedy.. The Bruised Reed and the Soul's conflict quieted, soothed, comforted, encouraged and healed me.’ Notice those words Perg "quieted, soothed, comforted, encouraged and healed me". That is why I find Sibbes a blessing.

The Bruised Reed is published by Banner of Truth; the Soul's Conflict by Puritan Publications.

Dr McMahon on why we should read Sibbe's Soul's conflict

 

[Pergamum]

Martyn Lloyd-Jones, an esteemed medical doctor, was very critical of Jay Adams at this point. In his classic 1974 Randall Short lecture at the British Christian Doctors association he said "One of the best known is Jay Adams with his widely selling Competent to Counsel. But he is just a populariser of Thomas Szasz and he is simply affirming, with Scasz, that there is no such entity as mental illness that the patients are really suffering from sin and need to be dealt with purely in a scriptural manner. These writers reprimand those sufferers and counsel them with great severity." You can hear this classic lecture on mental illness here: Part A https://www.mljtrust.org/sermons-online/itinerant-preaching/body-mind-and-spirit-part-a/ Part B https://www.mljtrust.org/sermons-online/itinerant-preaching/body-mind-and-spirit-part-b/

Of course even our feelings must be grounded in scripture. Perhaps the concern here is the problem of a secular approach to feelings.

I believe in Biblical counselling in the Dr Lloyd-Jones tradition. My evidence is Heb 4:12 "For the word of God is living and sharper than any two-edged sword, piercing to the division of soul and of spirit, of joints and of marrow, and discerning the thoughts and intentions of the heart." Even in distancing ourselves from Jay Adams, we must not forget the power of scripture to change lives.

I was going to add, Pergamum, in light of your own health situation and personal trials, I have found another recommendation of Dr Lloyd-Jones extremely helpful. Dr Lloyd-Jones said this of the Puritan Richard Sibbes ‘I shall never cease to be grateful to..Richard Sibbes who was balm to my soul at a period in my life when I was overworked and badly overtired, and therefore subject in an unusual manner to the onslaughts of the devil..I found at that time that Richard Sibbes, who was known in London in the early seventeenth century as “The Heavenly Doctor Sibbes” was an unfailing remedy.. The Bruised Reed and the Soul's conflict quieted, soothed, comforted, encouraged and healed me.’ Notice those words Perg "quieted, soothed, comforted, encouraged and healed me". That is why I find Sibbes a blessing.

The Bruised Reed is published by Banner of Truth; the Soul's Conflict by Puritan Publications.

Dr McMahon on why we should read Sibbe's Soul's conflict

Thank you. Oh, wow....that wig, though! I've got to get me one of those.

 

[Eoghan]

I seem to have opened a can of worms here.

I have sat listening to psychologists talk about our less acceptable behaviour as the leftovers of when we came down from the trees. I quietly contradicted him - in that not everyone accepts that origin story. In Van Til presuppositional terms secular psychology has a VERY different starting point.

I recall a sermon from my favourite reformed baptist pastor. He was discussing the secular intolerance in marriage and the idea of falling in and out of love. The charge is that if you don't feel it then you are a hypocrite. He summed it up nicely, "what others call obedience, we call obedience!"

I think there has been a focus on Jay Adams, where the emphasis of the book was really the second generation of biblical counsellors. I particularly appreciated "Looking Up From the Darkness" by Edward Welch. As I recall it had a very favourable review by Sinclair Ferguson. He is from the second generation counsellors and demonstrates the less confrontational approach.

 

[RamistThomist]

I think much of the resistance to nouthetic counseling could be ameliorated by being up front and rejecting the idea that depression = guilty conscience simpliciter.

 

[Eoghan]

I think much of the resistance to nouthetic counseling could be ameliorated by being up front and rejecting the idea that depression = guilty conscience simpliciter.

Very perceptive - might I recommend, "Depression- Looking Up From the Stubborn Darkness, by Edward Welch". That should tick the box. You can even download it for 30 days at https://www.slideshare.net/pedidu/depression-looking-up-from-the-stubborn-darkness-full-114768703

 

[greenbaggins]

As I see things, the nouthetic counseling model did correct some serious problems in secular counseling. If (and this is a big if!) the problem was a sin problem, then obviously the secular guys weren't going to cut it. They made zero progress with patients, because the problem was being diagnosed completely wrongly.

However, in the correction of the secular mindset, the nouthetic model over-balanced the other way in diagnosing all problems as sin problems in the individual. The medical issues and nutritional issues that become integral at this point are not issues necessarily directly related to that person's sin, and yet they could be the root problem of the mental illness. I used to believe "mental illness" was psychobabble for "I'm trying to blame my sin on something other than myself." However, on the analogy of physical deformities not being the direct result of the sufferer's sin, there needs to be a MUCH more compassionate approach to mental illness, and a recognition that pastors quickly get out of their depth when they try to take the medical and nutritional issues into account. There is a place for dealing with mental health issues in a non-nouthetic way, if the problem is not sin in that individual's life, but rather something completely different. In fact, if the nouthetic model diagnoses a given issue as a sin issue when it is actually medical or nutritional, it could do serious damage to a person. Lloyd-Jones is correct in his critique of Adams on this point.

In other words, I think the nouthetic model is helpful when applied to a problem that is within its proper purview. It is the best way of dealing with a counseling issue that involves sin or the need of a new way of looking at things biblically. It is not adequate to deal with all mental health issues. Not even close.

 

[Reformed Covenanter]

Nouthetic counselling makes the same mistake as all other Neo-Calvinist fads, namely, it tries to get the Bible to tell us more than it actually does. The sad fruit of its false teaching in relation to mental illness is to further oppress those who are already downtrodden. Well-meaning brethren who fall into this trap may think that they are doing the work of God, but they are in fact imbibing the spirit of antichrist and setting themselves above God's law by inventing doctrines of men.

 

[Pergamum]

I have heard nouthetic counselors say the goal of all counseling is salvation or sanctification for the counselee. And yet counseling is not evangelism necessarily. It is still a victory when an alcoholic stops drinking but doesn't yet believe in Christ. A urologist, after all, is not a failure if he only unblocks your urine duct but you are discharged from the hospital unsaved. He did his job. If a counselor helps with OCD patterns, it is a success even though the patient does not believe.

 

[py3ak]

I think it's always good when ministers or Christians are able to alleviate misery in those around them. But some miseries are stubborn, and resist alleviation. Persevering in faith with unalleviated misery is a demonstration of the faith that overcomes the world. It seems to me that the presupposition "if you do everything the counselor says things will get better" is a dreadful mistake.

 

[Solparvus]

I appreciate this discussion. I have a friend who is convinced God is severe toward him and is terrified to believe, though I know even men such as Baxter didn't dare attribute despair purely to sin. He understood there really could be a physical aspect. I've wanted to deliver a hard word in places, yet the assessment of a godly friend of mine is that this one in despair may not be physically well. Been wondering about reading Adams too.

These things are not straightforward.

 

[Eoghan]

For the record, I have never known Jay Adams not to acknowledge the distinction between medical and spiritual ailment. Why this seems to be overlooked is quite beyond me. In my reading of Adams books and in his Journal of Pastoral Practice, there is clearly a desire for medics to minister to medical problems and for pastors to diagnose and treat spiritual problems.

May I ask for quotations from Adams if he says differently?

 

[Eoghan]

Adams on schizophrenia type symptoms, " To begin with, a good medical checkup is the place to start. Counselees with problems of this sort may have an organic problem; perhaps a tumour on the brain, or as may be more likely a perceptual disorder resulting from chemical malfunctionsin the body." The Christian Counselor's Manual p384
Migraine Headache by Bob Smith in the Medicine & Health section of Volume 3 No.2 of The Journal of Pastoral Practice, discusses triggers such as caffeine and monosodium glutamate.

 

[Pergamum]

Adams wrote his books, in part, because he felt modern psychology was ignoring sin, right?

And didn't he call his approach Confrontation instead of comfort? Confrontation of what? of sin.


An examination of a quote:

Adams asks:
How is it that Christian ministers refer parishioners who lack self-control to a psychiatrist who has never been able to discover the secret of self-control in his own life? Outwardly be may appear calm and assured, !nature, patient, and even suave, Can this be his actual inward condition if he does not know Jesus Christ? Can he have this fruit of the Spirit apart from the Spirit? (Adams, 1970, p. 21).

First, This selection above assumes the counselor is a master of self-control. More than any secular counselor.

Notice also how Adams takes a slap at psychiatrists every chance he gets. He sounds like Thomas Szasz.

There is also an assumption I have seen that counselors often assume counselees are lying or covering up or have bad motives, but that the counselor never does. This often causes the counselor to exercise undue authority over a church member; questioning the counselor, after all, is a sign of ongoing covering up which needs to be rebuked, even with church discipline. In practical day-to-day terms, this equates to the pastor who is a counselor leveraging nouthetic counseling to lord his authority over his parishioners.

Also. this quote above also assumes all counseling must result in salvation or it is a failure. I don't believe it to be so. If we are a surgeon and we take out the appendix of an evil man and he remains evil, but the surgery was a success, well...the surgery was still a success. If a man goes to a psychologist for OCD symptoms or alcoholism and is helped, well, then he is helped.

Also, notice the quote above distrusts the outwards appearances of the patient and assumes his outward demeanor is somehow not genuine. I believe nouthetic counseling encourages counselors to assume the counselee is lying or covering up.

Adams also frequently cites examples of persons using "mental illness" to cover up sin. (Adams, 1970, pp. 29-35).


Personal story:

When I was with a mission org, they had a counselor assigned and would talk to people as they were passing through or at conferences. He'd ask us questions about how we felt or responded to things. I'd answer. Then he'd say, "Did you really feel like that?" Now, I understand the need or desire to probe and dig a bit, but this happened so much, that I simply began to respond by saying, "Did you hear me the first time?" or "What did I just say?" And then he replied back, "What is the root of your frustration?" I thought, "Your annoying habits, buddy!" but began to answer back with questions each time because I was sick of the process, "And why do you ask?" He'd then ask the same question to my wife. Thankfully my wife would answer back, "My husband already answered." It felt antagonistic, like we were under an examination.

 

[Pergamum]

For the record, I have never known Jay Adams not to acknowledge the distinction between medical and spiritual ailment. Why this seems to be overlooked is quite beyond me. In my reading of Adams books and in his Journal of Pastoral Practice, there is clearly a desire for medics to minister to medical problems and for pastors to diagnose and treat spiritual problems.

May I ask for quotations from Adams if he says differently?

The definition of Nouthetic Counseling given by many Nouthetic Counseling websites is this:

"Nouthetic counseling is counseling that uses Scripture to confront people about their sin with the goal of helping to restore them to usefulness (Gal. 6:1)."

Notice the emphasis on confrontation and on sin? If this is your "philosophical lens" by which you see every patient, then some predictable generalities are bound to happen.

 

[Rom]

I don't recognize the above version of Nouthetic Counseling from my time here at RPTS. Dr. Scipione (who worked with Jay Adams) was our instructor until this year.

Dr. Scipione stressed that we ought to work with medical doctors to determine if there is a physiological issue with those whom we are counseling. This was stressed over and over. We were told, make friends with doctors in your congregation!

And in our counseling sessions, if comfort and hope are not given to those you counsel, you'd get severely docked. If nouthetic counseling were practiced in the ways described above, I'd run away too!