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Christian Counseling as Mission

July 27, 2011

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Christian Counseling as Mission

“Christianity is missionary by its very nature, or it denies its very raison d’etre.” David J. Bosch, Transforming Mission, (1991, p. 9)

Most Christian counseling, as in the world of personal computers with Windows and Mac, has run one of two competing operating systems.  The first and most popular, integrationism, basically cuts and pastes Christian principles with secular psychotherapies and packages itself within the secular mental health world: licensure, certification, clinics, agencies, and hospitals.  In the same way that there are many Windows-compatible programs available in cyber-world, integrationism is remarkably compatible with many different counseling theories and methods.  And like Windows, its security system is spotty so it is not infrequently compromised by the invasion of Trojan horse concepts and methodological viruses that  corrupt its system.

The second and much less popular operating system, biblical counseling (“nouthetic” in early versions), takes the Bible as its primary (and in extreme versions, only) text and avoids both secular psychotherapies and the mental health licensing guilds and institutions.  Like Mac devotees, biblical counselors are very comfortable in their own world and seem to care very little about interaction with or impact upon other systems.  Also, like Apple aficionados, its users are die-hards, absolutely convinced that their system is superior, and they cannot understand why anyone would use anything else. 

It is my contention that both of these “operating systems” suffer from interface problems which have impaired their Kingdom impact in the mental health culture.1 I shall argue that Christian counseling has from its very inception failed to think missiologically, and that as a result, we have been essentially ineffective as Christians in the mental health culture.

Entailed in this proposal is a view of the mental health system as a distinct culture within the City of Man in America.  It is, like all cultures, characterized by unique customs and practices, a common language (with various dialects), and a dominant worldview.  This worldview includes particular categories and concepts and excludes others, with characteristically modern plausibility structures, methodologies, meta-narratives, and mini-narratives.   It is composed of leaders and followers, producers and consumers, like-minded citizens who co-operate by means of an overt or covert consensus, with both written and unwritten rules.   

This particular sub-culture is also distinctively secular.  Its practitioners and their concepts, methods, and social structures are notoriously, and some self-consciously, nonreligious, at least from their perspective. Early founders of this subculture, such as Freud and Jung, and many who have followed them, have been acutely aware that their developing profession was competing with and displacing pastors and churches in the understanding and care of the human soul.2 I am proposing that there is good reason from our perspective as Christians to view this mental health subculture as a mission field, or at least as a kind of un-reached people group.  I am presupposing that Christianity is “missionary by its very nature” and am contending that our failures to recognize the mental health subculture as pervasively non-Christian, and desperately in need of the Gospel of God, have impaired our impact in that field. 

The Mental Health Profession: A Culture in Transition

Oddly, this mental health profession, in spite of its original intent to understand and cure the soul, psyche, or mind, began abandoning its birthright in the 1960’s through an externally oriented, mindless behaviorism, continued this abandonment process with the amoral cognitive psychology of the 1970’s (stemming in part from subhuman information processing theories of computer science), and finally left behind any remaining vestiges of the soul in the last two decades of the 20th Century when biological psychiatry and managed care companies urged us all to “listen to Prozac.” 3

This disenchantment of psychology has not lasted, however. It should be no surprise that in the 21st Century the mental health professions, having abandoned the soul and quite literally lost its mind, began looking for it again.  Postmodern turns in philosophy and pluralistic developments in culture have provided the context for a re-valuing of the soul and spirit. Religion and spirituality are now recognized by both APAs (the American Psychological and the American Psychiatric Associations) as legitimate fields of investigation (i.e., the psychology of religion) and as a palliative for sick souls and societies [cf. especially the research on the health effects of religious faith by Larson (1994, 2001) and Koenig (1997, 1999, 2001)].

“Spiritual” and religiously and morally loaded forms of psychotherapy (Buddhist, Hindu, feminist, gay-affirmative, transpersonal, and new age) exist alongside all the other “scientific” therapeutic offerings.  Increasingly, Christian counseling is no longer the merely tolerated stepchild, but instead is often allowed to have a place in the new mental health family. 

It is even becoming more common for the preferred providers lists of health insurers to include a category for Christian Counselors. Early entrants in this re-enchantment of the mental health subculture could be seen in the late 20th Century in the inclusion of 12 Step AA/recovery programs and Christian mental health clinics and hospital programs like New Life, Minirth-Meier, and Rapha.

In other words, the mental health field is no longer a closed country, but instead has begun to open the door, recasting itself as tolerant and inclusive of all religions and moralities. Increasingly, therapists, doctors, and patients no longer have to check their gods at the door before entering.  I recently met with the Licensed Professional Counselors board member in my state who oversees educational requirements to consider the possibilities of developing a license-eligible track for students at the seminary in which I teach.  I was sure we could meet their course requirements, but wary about the willingness of the licensing board to accept our degree, since it is an M.A. in “Biblical Counseling.”  To my surprise, he responded to my question about our degree designation without hesitation, “No problem.  We’ve accepted stranger degrees.”

Of course, we must continue to expect that the Cross will still be offensive; we will see uniquely post-modern versions of intolerance and exclusiveness, with attempts to censure Christian perspectives with spurious labels like “oppressive,” “intolerant,” “violent,” or “totalizing.”  Nonetheless, it is a new day, and one that calls us to re-evaluate both the field and ourselves. I contend in this paper that evangelical missiologists provide some insights that are crucial for this task of reevaluation and redeployment.

The Mission: The Subversion and Redemption of Secular Psychology

Up to this point, most Christian counseling has been both modern and correlationist in its methodology:  modern in that it has granted science functional parity with theistic revelation, and correlationist in that it has parroted secular methodologies and institutions.  Correlatively, pragmatism has dominated our efforts as Christian counselors, which of course is not all bad.  As a consequence, however, our attention to the practical elements in counseling has superseded our theoretical and conceptual development.  As a result of a confluence of these and surely other factors, the presumed distinctiveness of a Christian psychology is not well developed.   Contemplate for a moment how different you might expect a psychology to be wherein the guiding meta-narrative:

1. Claims that the human psyche/soul was originally created to be ruled and loved by a Good King with unlimited power who in his perfect wisdom also created and governs everything else in the universe.

2. Claims that the Good King created these embodied souls to worship, serve, love, and follow him and that He even made them like himself so that they could do this meaningfully and freely.

3. Claims that these souls which were designed for love and loyalty to their King, instead betrayed and rebelled against Him. This brazen rebelliousness was contagious and became a family trait, so that every person since suffers from this contrarian disease, a soul psychosis so pathological that schizophrenia pales in comparison.

4. Asserts that the only lasting cure for this epidemic comes from the Good King himself, who for love and glory sent his Son to live with the diseased on their terms, and then transferred the deadly virus to him. The Good King’s Son, after appearing to have been terminated by the disease, rises from death and reigns, inaugurating a process by which he actually reverses and eventually cures the disease.

5. That then proclaims this cure is available, free of charge, to “whosoever will” simply acknowledge that they are in fact hopelessly sick and then trust and follow the Good King.

This peculiarly Christian narrative subverts the foundational narratives and metaphysical, epistemological, and anthropological presuppositions of the secular psychologies, rather than offering up junior versions of their non-Christian systems.  This strange narrative confronts the defensive denial of spiritual realities, so prominent in the regnant psychotherapies, with a divine diagnosis (of both their systems and their patients) and cure for souls.  From the perspective of our definitive narrative, the secular psychotherapies are desperately in need of repentance and redemption, not because they are all wrong but because they are fundamentally wrong about the most important things.

Our goal should not be simply to obtain a seat at the psychological table, but instead to invite those who dine in the Mental Health Café to a banquet dinner with fare beyond their wildest dreams: a Chef that offers living bread and living water and even life beyond this one.  Would not a retooling of C. S. Lewis’ (1980) inimitable challenge in The Weight of Glory be apropos?  “We are half-hearted counselors, fooling about with Freud and Rogers and Beck when infinite joy is offered us by Another Counselor, like an ignorant child who wants to go on making mud pies in a slum because he cannot imagine what is meant by the offer of a holiday at the sea.  We are far too easily pleased”  (modified from Lewis, 1980, pp. 3-4).

If the Christian faith is intrinsically a missionary movement and the prevailing mental health establishment is part of what the New Testament calls “the world” or “this present evil age” (Galatians 1:4), then failures in this dimension – at the interface between a Christian psychology and the mental health culture – are central and not incidental. Wells (2006) asserts that “theology, if it is true to its own nature, must be missiological in its intent” (p. 9).   I am proposing that Christian counseling if it is true to its own nature must be missiological in its intent, or it denies its very essence, its raison d’etre.

Contextualization: In the World but Not of It

Contextualization is a missiological concept that helpfully describes both the pathogens that have impaired our impact as Christian psychologists and counselors and also commends a cure for them. Missiologists such as Hesselgrave (1991), Hiebert (1994), and Kraft (1979, 1983) have been discussing contextualization for three decades. Simply stated, contexualization is the apprehension and the effective communication of the legitimate implications of the gospel (broadly understood as God’s Word in Christ and the Scriptures) for a given situation.  Hesselgrave and Rommen (2000) point out that “Christian contextualization can be thought of as the attempt to communicate the message of the person, works, Word, and will of God in a way that is faithful to God’s revelation, especially as it is put forth in the teachings of Holy Scripture, and that is meaningful to respondents in their respective cultural and existential contexts” (p. 200, italics added,).   

Contextualization is a fruitful concept that has New Testament roots.  In Acts 17:16ff, Luke describes how St. Paul engages the Athenians in the public square on their turf and in their terms.  He winsomely commends the Athenians for their religiosity and even quotes their philosophers and poets as cobelligerents in his polemical appeal. Early on, Paul is more concerned with establishing a point of contact and gaining a hearing than challenging their idolatry, which he inoffensively reframes as “objects of worship.”  But he does not stop there.  He finds another conceptual bridge in their altar to the unknown theos, whereby he both challenges their false beliefs and at the same time offers genuine fulfillment for the desires of their heart.  Paul’s method of contextualization begins with a “Yes” to their intractable impulse to worship, which he links to God’s creational design, but ends with a clear “No” as he confronts their ignorance and pleads with them to repent of their misdirected, vacuous worship.  Paul proclaims both the “No” and the “Yes” of the Gospel.

Saint John the evangelist employs a similar strategy in the beginning of his gospel where he lifts the impersonal philosophical (and religious) term “logos” out of the Greek culture of his hearers and then reframes and redefines it in distinctively personal, Christ-centered terms. John strategically co-opts both their terminology and desire for reason/logic/truth and redeploys them to teach that Christ is the Truth and the Way and the Life.  He says “Yes” to their God-given desire for understanding and order, but “No” to their impersonal and Christ-less definition.

Newbigin’s (1986) model for communication follows a similar pattern:

1) The communication has to be in the language of the receptor culture.  It has to be such that it accepts, at least provisionally, the way of understanding things that is embodied in that language; if it does not do so, it will simply be an unmeaning sound that cannot change anything.

2) However, if it is truly the communication of the gospel, it will call radically into question that way of understanding embodied in the language it uses.  If it is truly revelation, it will involve contradiction, and call for conversion, for a radical metanoia, a U-turn of the mind.

3) Finally, this radical conversion can never be the achievement of any human persuasion, however eloquent.  It can only be the work of God.  True conversion, therefore, which is the proper end toward which the communication of the gospel looks, can only be a work of God, a kind of miracle – not natural but supernatural. (Newbigin, 1986, pp. 5-6)

Bosch(1991), another missiologist, also wrote about the reinterpretation of life in uniquely Christian terms, “Christians [and I would assert Christian Counselors] find their true identity when they are involved in mission, in communicating to others a new way of life, a new interpretation of reality and of God, and in committing themselves to the liberation and salvation of others.  A missionary community is one that understands itself as being both different from and committed to its environment; it exists within its context in a way which is both winsome and challenging” (p. 83).

So, Christian psychologists on mission must “learn the language of the receptor culture” and then seek a distinctively Christian engagement with the mental health profession, and its academy and institutions in a way that is both winsome and challenging, since it is our aim to communicate a new way of life, a new interpretation of reality.  Let us no longer allow the prevailing secular paradigms (whether psychoanalytic, cognitive-behavioral, family systems, or whatever) to provide the primary cues or structures for our own paradigm.  Of course, we should for the glory of God acknowledge His common grace that sometimes shines through these systems, but finally we must persuade them with the truth and beauty and hope of the gospel of a full-orbed Christian perspective.  But let us not forget the profoundly spiritual nature of this task as we pray that eyes would be opened to see the glory that shines only in the face of a psychology that delights in our Good King, the Creator and Redeemer of souls.

The Risks of Contextualization

We must be aware, however, as perceptive missionaries traversing cultural boundaries, that contextualization is not a risk-free process.  Another benefit of the missiological concept of contextualization is that it alerts us to two types of pathology that can infect the interface between faith and culture, and in our case between the Faith’s psychology and the diverse array of other psychologies extant in the mental health culture. 

The first type of pathogen is over-contextualization, which is essentially syncretism, and is found most frequently in naïve or weak forms of integrationism.  Bavinck’s (1960) description of accommodation on a mission field describes this virus well:

It points to an adaptation to customs and practices essentially foreign to the gospel.  Such an adaptation can scarcely lead to anything other than a syncretistic entity, a conglomeration of customs that can never form an essential unity. “Accommodation” connotes something of a denial, of a mutilation…The Christian life does not accommodate or adapt itself to heathen forms of life, but it takes the latter in possession and thereby makes them new. (Bavinck, 1960, p. 179)

Noll and Wells (1988) also describe the risks inherent within the process of building bridges between cultures via contextualization:

This interpretive journey from Word to world is fraught with peril even as it is ripe with potential.  Bridges built between God’s Word and our world are susceptible of carrying traffic in both directions… most of the traffic has been moving in the wrong direction. Twentieth-century people have allowed the cognitive constraints and the psychological conventions of our own day to limit what the Bible may say.  This reverses the proper situation.  It is the Bible that deserves to prescribe the cognitive horizon for the twentieth century, just as it has been for every century.  Much more than the Bible, it is the twentieth century that needs to be demythologized. (pp. 15-16)

The concept of over-contextualization invites us to challenge ourselves, asking if we have assimilated secular theories and methods and accommodated to the secular mental health system to the point that our psychology and counsel has lost its missional, even prophetic edge.  Do we understand our vocation, both with patients and the profession, as mission?  Are we disseminating more than common grace?  Is the Word of God normative and is the Son of God transformative in our counsel?  If not, it is likely that we suffer from an over-contextualization virus.

Biblical counseling, particularly in its more traditional or nouthetic variants, carries a second and opposite type of pathogenic risk: under-contextualization.  Biblical counselors have been developing distinctively biblical concepts and methods for thirty-five years, but many are decisively “Amish” in their attitudes toward the mental health world and “secular” research.  These counselors view any form of cooperation with the mental health establishment as worldly capitulation and ungodly compromise.  As a result, meaningful and persuasive interaction is next to nil, and the bits of interaction that do occur are often characterized by poorly informed critique or condemning dismissal of those whom they view as mere opponents.  For these biblical counselors, the secular mental health establishment is a closed country, and unfortunately one that they would just as soon not take the risk of entering.  While many integrationist mental health professionals water down their message and methods to the point that they are functionally secular, these biblical counselors tend to retreat and keep their message and methods to themselves.  Traditional biblical counselors rarely leave their church and parachurch ministries and are not given a hearing when they do because they speak in language that is more bitter than sweet.  The Gospel falls on deaf ears because they fail to contextualize their message in ways that seem conceptually relevant and demonstratively compassionate. As a result, their good news – a practical biblical model of counseling that could be quite useful – is never heard.4

What has been absent from both of these operating systems is a missional mindset that drives and informs redemptive engagement, and yet steers clear of avoidant separatism at one extreme, and accommodating syncretism at the other.

To summarize, contextualization is simply the effort to faithfully proclaim and apply Christian concepts and practices to everybody everywhere and in everything.  Paraphrasing Kuyper (1998), there is not one square inch of this planet to which the Lord Christ does not say, “Mine.”  Contextualization is a working out of this notion that the Truth of God is redemptive, as He reclaims and renews everything: purifying that which has been corrupted by sin at all levels – universal (conceptual models and systems, philosophies and psychologies) and particular (real lives and particular problems).  Contextualization applied to counseling then would be this process of saying “Yes” and “No” to secular psychology at each level of their model(s): 

1. Conceptual, theoretical framework

2. Methods and practices

3. Socio-cultural, institutional delivery system

Let us consider two examples of contextualization. The first begins at level one, the conceptual and theoretical framework, but also carries consequences at level two, clearly affecting counseling methods and practices.  Our second example of contextualization will address level three, the socio-culturally embedded delivery system for the practice of counseling. Our contextualizing mission begins with a provisional acceptance of a couple of the primary landmarks found within the mental health landscape: the concept of mental disorder and the institution of professional licensure/certification.  We will start with “Yes” and then proceed to “No” and then outline a redemptive contextualization which subverts and converts their concept, practice, and system.

Deconstruction and Reconstruction of “Mental Disorder”

It goes without saying that the purpose of psychotherapy and counseling is to help individuals suffering from mental disorders.  That is the custom in our age; if your life is broken and you do not know how to fix it, we have designated experts who have developed a nosological system (a language, in other words) to diagnose the problem.  And then, based upon their categorization and conceptualization of your problem, these experts have been trained in logically related methods and procedures to provide a cure for your problem.  This is the custom in our culture, and it is embedded in a particular worldview and conveyed by a particular meta-narrative and a unique language.  However, missionally-minded counselors would remain aware that the language for describing mental disorders is a product of a particular culture with a particular philosophy of life and a particular view about the nature of persons and their problems.  Learning the language of mental disorders is not unlike learning the language of another culture.  Every language has its strengths and weaknesses, pays attention to some data and ignores others, and in an important sense does not just describe reality but also defines it.

We can easily say “yes” to the observations of psychologists and psychiatrists that people are disordered.  There seems to be something wrong with many of us at the level of thought, behavior, emotion, and relationship. Who would argue that people, some more than others, are mentally disordered?  Of course, how you help people with these disorders is a direct function of how you understand what is meant by the concept of “mental disorder.” This is where the rub lies.  In this case, the linguistic questions are the most important: what do they/we mean by “mental,” and what do they/we mean by “disorder.”  Words, especially key words for critical concepts, always carry worldview freight. As a result, careful definition and interpretation is crucial when aiming to interact redemptively with the language of mental disorder, a key concept in the mental health culture. 

Dutch missiologist Visser ‘t Hooft (1967) describes a related process on the mission field in a foreign culture: 

Key-words … when taken over by the Christian Church are like displaced persons, uprooted and unassimilated until they are naturalized.  What is needed is to re-interpret the traditional concepts, to set them in a new context, to fill them with biblical content….  Words from the traditional culture and religion must be used, but they must be converted in the way in which Paul and John converted Greek philosophical and religious concepts. (p. 13)

Johnson (2007) discusses the importance of translating worldview loaded concepts from a “foreign” psychological community which has its own distinct literature and language: 

These literatures may be different enough from each other that we could liken them to two different languages.  [Later in this chapter Johnson avers that in some domains, “dialects” may be a more appropriate analogical term, especially where worldview has less impact such as in neuropsychology and memory and types of intelligence.]  If that is so, the concept of integration may not be the best metaphor for the task facing the Christian soul care community with reference to modern psychology literature, but translation…the translation metaphor offers a different, and possibly a more profitable way of conceiving of the Christian psychological community’s interpretive task, than the modern understanding of integration.  Integration seems to imply that the task is relatively unproblematic; the texts of modern psychology and Christian theology are all equally true; Christians simply need to read and put together the truth, like the pieces of a puzzle.  Translation, on the other hand, better conveys that there is a problem here [italics added]. (pp. 227-228)

Deconstruction

Indeed, a careful examination of the concept of “mental disorder” in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) does reveal that “there is a problem here.” The definition of this term in the introduction to the DSM-IV-TR (2000) is essentially an apology.

The term mental disorder unfortunately implies a distinction between ‘mental’ disorders and ‘physical’ disorders that is a reductionistic anachronism of mind/body dualism [italics added]…The problem raised by the term ‘mental’ disorders has been much clearer than its solution, and, unfortunately, the term persists in the title of DSM-IV because we have not found an appropriate substitute.  (p. xxx)

In other words, the term “mental” is embarrassing to the authors of the DSM – IV because it implies (if not denotes!) immaterial, spiritual, and psychical substances, a product of a dualistic worldview which does not comport well with their monistic, naturalistic, biologically reductionistic one.  What a naturalistic monist means by “mental” and what a Christian dualist means by “mental” are categorically different, and far from inconsequential.  We are not talking about the same things.

Another obvious question is how do they/we define “disorder”?  It should go without saying that the critical starting point for understanding a disorder is apprehending the proper order.  What is a properly ordered mind/soul?  Secular definitions of “mental disorder” are self-consciously atheistic and amoral, as if the mind is a God-free zone. There is an intentional avoidance of moral and spiritual appraisal.  The secular criteria for abnormal or disordered behavior are merely biological, social, or statistical – because they refuse to acknowledge the Divine order and Orderer.  Spiritual and moral “data” are ruled out, a priori, as potentially meaningful in the description of mental disorders.

Let me give an example which illustrates how a Christian perspective on “mental” and “disorder” might impact diagnosis and treatment.  Suppose twin brothers, Paulo and Pedro Pagan, lose their younger brother Daniel after he drank too much one night and while driving home in his pickup ran off the road and into a tree.  Paulo responds to his brother’s tragic death with shock and then an existential crisis.  His brother’s death hits him like a rubber mallet between the eyes.  He stands beside Daniel’s casket before his burial, views the lifeless body and thinks, “That could be me.”  Paulo begins to ponder questions about life and death that he had previously avoided.  He realizes that someday he will die just like Daniel and wonders about both Daniel’s and his own destiny.  Is there really a God?  If so, am I ready to stand before him?  Is this heaven and hell stuff true?  He begins waking up at night, worried and anxious.  He tries to reassure himself that all is well; there is no reason to worry.  However, his fears continue to nag him, and he is unable to repress the mounting anxiety precipitated by Daniel’s death. One week later while driving home after work, he has a panic attack.  He thinks he is having a heart attack and heads for the emergency room, where he is examined and diagnosed with panic disorder.

Pedro, on the other hand, seems to take his brother’s death in stride.  No existential crisis for Pedro.  After a brief period of shock and mourning, he tells himself that all is well – no problem, you live, you die.  He stands before his brother’s casket, views Daniel’s dead body with sadness, but no anxiety.  He thinks, “No heaven. No hell. Don’t worry.  Be happy.”  He experiences very little fear and when he does he quells it quickly with various forms of false assurance.

Here is the diagnostic question.  If God is real and the Bible is true, and Pedro and Paulo are in fact pagan, which one is disordered?  Is not Pedro’s lack of fear way out of order?  Is not Paulo’s anxiety and panic a God-given red light on his emotional dashboard warning him that he has sinned and falls short of the glory of God and that someday he will face that Lord of glory naked, without the protective covering of the robe of Christ?  And if this is true would not panic, even terror, be appropriate?  Is not Paulo’s anxiety the grace of God speaking words of truth? 

Here is the treatment question.  Would you have helped Paulo if you had merely medicated him or taught him to reduce his anxiety with a cognitive-behavioral counseling regimen?  Or would you have just helped him put out a warning light and failed to address the sickness in his soul that was producing a very meaningful danger signal?   If emotions are isolated from the “one with whom we have to do,” they are inevitably misinterpreted, often misdiagnosed, and sometimes reflexively medicated or otherwise falsely assuaged.  

If our emotions do not exist in a God-free zone but instead always occur before the One with whom we all have to do, is not Pedro out of touch with reality and his lack of fear an affective disorder of psychotic proportions?  What kind of “treatment” would you recommend for Pedro?  Does he not need “help”?  Should he be “counseled”?

Reconstruction

Emotions, theorists tell us, are a product of our cognitive appraisals, our concerns and our beliefs – in other words our interpretations of reality form the web out of which we construct our complex of affect and feeling (Arnold, 1960; Lazarus, 1991; Roberts, 2003).  While it does seem that our bodies and brains are wired for a set of primary emotions, these visceral responses are shaped by our construal of reality, our worldview – right and wrong, order and disorder, God or no God, heaven and hell, gospel or no gospel. 

A Christian psychology re-situates and re-configures emotions and mental disorders within a divine perspective that changes everything. A Christian psychology says “yes” to the obvious: something is desperately wrong with us. However, a Christian reconstruction of the concept of mental disorders begins by bringing every one of us to our knees.  The Bible provides a shocking diagnosis: we are all disordered!  The God described in Scripture is an equal opportunity diagnostician, declaring everybody everywhere with a terminal spiritual and moral disease. “Truly the hearts of the sons of men are full of evil; madness is in their hearts while they live,” (Ecclesiastes 9:3, NKJV).  The biblical account tells us that all creation, including both body and soul, has been infected with a contagious, killer psychosomatic virus called sin.  Before this Holy and Loving God, every soul is declared insane. 

A Christian psychology also says “yes” to the immaterial, unseen reality of the mind, soul, and psyche.  In a sense the authors of the DSM-IV are right; we are “anachronistic.” We believe that the Ancient of Days has indeed set eternity into the hearts of men (Ecclesiastes 3:11, NKJV).  It is here that we are made like him, in his image, but also made for him and are accountable to him. We can acknowledge the possibility that some of our problems may be physiological – all creation has been infected by the sin virus.  But, regardless of the relative degree of health or sickness in our bodies, the Bible says that it is our hearts that are the source of our insanities.  The body may be sick or diseased, but our hearts are the fountainhead out of which flow all things “mental” – actions, words, thoughts, intentions, beliefs, attitudes, affects, desires, emotions, and delights. A diseased body may cause us to suffer, but it does not make us sin.  The Biblical witness, especially in the writings of St. Paul, is that there is something wrong with our minds.  They are infected with this contagion that the Bible calls sin.  People and patients do not make sense, at least not in any way that is remotely Christian, apart from a proper understanding of this mental disease that the Bible calls sin. 

We see in the Pedro and Paulo vignette that a distinctively Christian conceptualization of mental disorders subverts and redeems the secular conceptualization because it is shaped by a distinctively Christian understanding of human reality as pervasively spiritual and moral.  As a consequence, how we understand “help” or good counsel or even who needs counseling is radically reconfigured.  The view of mental disorders and psychotherapy within the Kingdom of God deconstructs and reconstructs the modern mental health perspective.

A Missiological Reconstrual of Mental Health Licensure

Let us consider another instance of redemptive contextualization: a re-conceptualization of state licensure or certification wherein we examine the possibility of reframing these professional processes as missionary platforms for Christian counseling – a kind of visa on the one hand that grants access, permitting the psychologist or counselor to enter and travel in the mental health world, and on the other, a kind of union card that legitimizes one’s work and right to be heard and to be engaged in meaningful discourse.  Let us begin with a Christian deconstruction of the state-sanctioned social delivery system for the care of souls and then consider a reconstruction – a missiological rationale for participation in professional board jurisdiction over soul care in the public sector. In this process we will see the benefits and liabilities of participating in soul care under this modern and secular rubric of licensure.

Deconstruction

Who should sanction and regulate distinctively Christian counseling, the training rites for and the actual practice of soul care?  To which institution, the church or the state, should jurisdiction belong for psychology and psychotherapy?  Is secular “ordination” really necessary for diagnosing and counseling sick souls, or is it only permissible and tolerated as a legitimate means to Kingdom ends (not unlike Luther’s perspective on the relationship between marriage and the state)?  Finally, and less optimistically, to what extent is licensure a pagan institutionalization of secular pastoral workers (Freud, 1927), playing the role of priest and theologian (Jung, 1933), thus fulfilling a definitively religious function?  The answers to these questions depend upon your view of counseling, of mission, and your understanding of the proper relationship between gospel and culture.

A good place to start is simply to recognize that the regnant American mental health system was not created ex nihilo.  There is a logical and sequential flow from a particular culture’s psychological (1) concepts and theories which give rise to (2) an emphasis on particular methods and practices which then eventuate in the development of (3) uniquely congruent social structures and institutions for the implementation of its concepts and the delivery of its practices. State licensing and certifying boards are not givens of the natural order (Powlison, 2001). They are jurisdictional entities situated within a particular culture in which a modern, secular, empirical model of psychology reigns and embodies its methods, practices, and players.  It has not always been this way, and it is not this way everywhere. Licensure of persons who choose a vocation devoted to understanding and caring for souls is a mid to late 20th Century development in the not so wild, wild West.

To call licensure modern, secular, empiricist, or pagan is not to say that it is all bad.  We need not negate the common graces that flow through this human delivery system.  However, even though God has ordained culture, insofar as it is secular and pagan, he has not ordered it (Hesselgrave, 1981).   His common grace is evident in this mental health culture, but His special grace is essential to re-order it for His greater glory.  More succinctly, licensure and certification, just like democracy and capitalism, are not all bad, but they are in desperate need of redemption. 

The missiologist J. H. Bavinck (1960) describes non-Christian cultural customs and practices and the intended effects of redemption upon them:

The Christian life takes them in hand and turns them in an entirely different direction…Even though in external form there is much that resembles past practices, in reality everything has become new, the old has in essence passed away and the new has come.  Christ takes the life of a people in his hands, he renews and re-establishes the distorted and deteriorated, he fills each thing, each word, and each practice with a new meaning and gives it a new direction.

(p. 179)

Reconstruction

Commenting on Christian mental health work in the secular city, Powlison (2000, 2001), editor of the Journal of Biblical Counseling, cautiously admits,

It is not necessarily wrong for Christians to work within the secular mental health system if they can do so without being forced to communicate false ideas, diagnostically and prescriptively, to those they counsel.  Sometimes in God’s common grace Christians are given great freedom within an ostensibly secular setting…(p. 55)

…No evangelical should object if the guiding intention of evangelical psychologists were to infiltrate the secular mental health system. (p.145)

 In fact that is precisely what I am proposing – an infiltration, a benevolent invasion of the secular mental health establishment for the Glory of God and the good of men.  Invasion and infiltration – aggressive mission terminology – simply acknowledge the ambivalent spiritual realities and the revolutionary nature of the task.  Licensure grants us status as resident aliens in the City of Man, but let us never forget that we are above all else agents in God’s worldwide, unstoppable redemptive revolution.  An army of intentionally and radically Christian psychologists should turn the mental health world upside down because it would announce the arrival of another King.

In this scheme, licensure or certification would simply be one part of faithful and relevant contextualization of Christian Psychology in the public square.  Participants would continually remind themselves that they are ambassadors, representing and requiring the empowerment of Another.  They would remain cognizant that their primary citizenship is in the City of God, and that even though they have been granted a “visa” and “union card” for the City of Man, they are strangers and aliens living in the allegedly secular city.  They would realize that their legitimacy before God to minister to souls requires no sanction from the state, but also would seek this sanction with a Pauline motive – becoming all things to all people so that some might be saved (understanding salvation in comprehensive, holistic terms).  They would be aware that this world is in fact God’s stage for redemption and take seriously the charge to be in the world, but also not of the world.  They would understand the ongoing temptation toward syncretism, remaining mindful of Paul’s admonition to be careful to avoid being taken captive by “persuasive” and “plausible” but empty philosophies that do not acknowledge the treasures of wisdom and knowledge found only in Christ (Colossians 2:3-8, 23).  They would understand how to avoid falling in love with the world and the things in it (1 John 2: 15), but at the same time be a friend of sinners (Matthew 9:10-13, 11:19). Rather than seeing licensure or certification as granting bona fide Coram Deo affirmation and validation, they would see it as a legitimate means to partner with God in the Missio Dei, just as Paul did in terms of his public status with respect to the law in 1 Corinthians 9:19-23.

A Christian reconstruction/redemption of state licensure/certification could also be funded by the concept of a missionary platform.  A good starting point in understanding a platform is with the plain meaning of the term: a platform is something you stand on.  For modern foreign missionaries, their platform would include their missionary visa, missionary identity, and the work of a missionary. As missionaries began knocking on the doors of “closed countries,” however, they found that they were not permitted to enter as missionaries, nor to do the work of a missionary, as it had been previously conceptualized.  They began to examine other venues by which they might be allowed to legitimately enter and work within these restricted countries (Rankin, 2006).  Paul's adage, “I have become all things to all men, that I might by all means save some” (1 Corinthians 9:22 NKJV), sanctioned and provided impetus for this new wineskin, that missiologists refer to as a “creative access platform” (Barnett, 2005).

Just in case some of you are starting to feel uneasy ethically, let me note that platforms must be honest and legitimate endeavors.  Missionaries must do what they claim to do.  Legally and economically, they must play by the rules of the relevant governing bodies, and yet not compromise their biblical principles and ethics.  This means that for psychologists and counselors who choose this vocational road to contextualization, their platform (licensure or certification) must be legitimate and not inherently wicked, just as platforms for missionaries in closed countries must be valid and ethical, a potential vehicle of God’s common grace. State licensure and laws, board regulations, and professional ethical codes must not compromise a psychologist’s or a counselor’s Christian commitments.  It also means that they must avoid deceptive “the end justifies any means” motives and crass “bait and switch” strategies. 

In addition, the missional counselor should have a genuine sense of calling and gifting as a counselor, along with the relevant training, in the same way that medical missionaries must have the relevant calling, education, and training as a nurse or physician. Barnett’s (2005) comments in The Changing Face of World Missions are helpful here. He contends that

God provides each believer with a platform from which to serve him and to communicate the gospel.  Platforms are a product of God’s calling, equipping, and gifting.  They provide a legitimate reason and right for sharing the faith among the nations.  They are not a cover for covert activities but a basis for living among, interacting with, and communicating the gospel to those around us… (p. 211)

If you are going to hide your purpose of witnessing from the one to whom you were sent by God to be a witness, you will fail in your mission…A missionary who hides her witness is not a missionary. (p. 225)

Barnett summarizes the motives for a platform as: accessibility, legitimacy, identity, strategic viability, and integrity. Licensure or certification as a mental health professional does indeed provide access to and legitimize one’s presence in an array of settings: hospitals, residential treatment centers, community mental health centers, hospice and nursing homes, etc.  It provides a recognized and well-reputed identity that lends integrity to our particular views and voices.

Summary

I hastily note, particularly in view of the deconstructive critique above, that there is an important difference between choosing to teach English or guide tours as one’s platform and choosing to be a licensed clinical psychologist, social worker, or professional counselor.  That difference is the pervasive and ever-present, albeit often unrecognized, moral and spiritual nature of mental health work.  We are not simply teaching second languages or pointing out tourist sites, but diagnosing and mending human minds, teaching people a language to describe themselves and their problems, and pointing out a path for redemption.  In other words, choosing counseling as one’s vocation is much more essentially missiological because of the very nature of the work: the care and cure of the human soul.

And, like missions work in foreign cultures, “secular” mental health work brings special opportunities but also poses unique risks. Powlison (2001) elucidates these as follows:

Christians must realize that when they are barred from mentioning sin and Christ, they can only describe problems, but they cannot accurately diagnose them; they can only suggest the outward shell of solutions, but they cannot get to the deep issues that plague the heart.  Christians in such settings are still free to know people, to love them and to provide various outward mercies, but they are limited to being relatively superficial and moralistic in the content of their counsel.  Unfortunately, in my observation, well-meaning Christians in mental health settings typically are far more profoundly socialized and enculturated than they realize.  They fail to recognize that they are working in a radioactive zone, and they absorb faulty diagnostic, explanatory, and treatment models without knowing that they have done so. (p. 55)

Radioactive, yes.  Deadly, no.  There are risks, but they are not necessarily fatal. 

An option that we do not have, in my view and in view of the Missio Dei and the Great Commission, is not to go.  We are not just permitted or allowed to go.  We have already been both chosen and commissioned to go.  How on earth could we keep distinctively Christian care and cure for souls to ourselves by means of either syncretistic over-contextualization or callous under-contextualization?  Is there any other truth that can set people free?  Does not the love of Christ compel us to go?  Did He not die for all so that those who live might no longer live for themselves, but for Him who for their sake died and was raised (2 Corinthians 5.14-15)?

Who will go?  Who will effectively proclaim the gospel of Christ-exalting biblically faithful counseling in psychiatric hospitals, correctional institutions, residential treatment centers, day treatment centers, group homes, nursing homes, hospices, community based agencies, and mental health centers?  Missiologist Hesselgrave (1995) answers,

Effectiveness is primarily a matter of contextualizing or shaping the Gospel message to make it meaningful and compelling to the respondents in their cultural and existential situation. Both the decontextualization and the recontextualization tasks are best accomplished by persons who are “expert” in the cultures and languages involved, who understand cultural dynamics, and who ideally are themselves bicultural. [italics added]  (p. 119).

The remedy I have suggested for our operating system viruses, contextualization, entails becoming bicultural.  No small task.  But ours is a holy task, a divinely empowered vector rooted in the mission of God himself, who sent the Son, who sends us to counsel Christianly.  Christian Counseling must be missionary by its very nature, or it denies its raison d’ etre.

Notes

1 For polemical purposes, I have chosen to paint in broad strokes.  Surely, there is a spectrum within each of these counseling models/operating systems and between them as well.  Johnson (2007) does a good job in his pending book of delineating two types of integrationism – weak and strong – and two types of biblical counseling – traditional and progressive.

2 Freud (1927) argued, “The words ‘secular pastoral worker’ might well serve as a general formula for describing the function which the analyst, whether he is a doctor or a layman, has to perform in his relation to the public” (p. 93).  Jung (1933) also claimed, “Patients force the psychotherapist into the role of a priest, and expect and demand of him that he shall free them from their distress.  That is why we psychotherapists must occupy ourselves with problems which, strictly speaking, belong to the theologian.” (p. 241).

3 See Robinson (1995) for further elucidation and critique of the behavioral and biological takeover of modern psychology.

4 It is only fair to note that many non- “biblical counselors” have never read past Jay Adams’ early writings in the 70’s.  While Adams’ thought was seminal, the works of Powlison (2003), Welch (1998), Tripp (2002), and other faculty at the Christian Counseling and Education Foundation (CCEF) has extended, nuanced, and sweetened the biblical counseling movement.  In addition, Adams’ work targeted pastors, while the audience of CCEF is much broader.

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