13th September 2014 - One Day Conference "Mission and Minds: Cultural Challenge" - London

Conference Picture
This world is God’s world, and mission is joining God in his caring for, sustaining and transforming His world, with the goal of re-establishing harmony between God and his creation, including humankind. It is a privilege and joy to be part of God's mission in the university setting. We are focusing on crossing the boundary between academia and the church - this is a really important issue.
Purpose: To explore how to see academic work as part of God crossing cultures on His mission and delighting in using academics like us in this work

Biblical counselling for the abused

A research paper comparing some forms of Christian counselling with generic psychological therapy for survivors of sexual abuse in childhood was recently discussed in the e-mail group of the Network (now British Association) of Christians in Psychology.  A personal perspective on this paper that was developed subsequently is offered below, after a brief analysis of the position of Christian academics / psychologists in general and within psychology in particular.

Richard Meiser-Stedman (Institute of Psychiatry, King's College London)

Towards a Christian perspective on Mental Health:
psychological problems and the church - the case of child sexual abuse

Academics who are Christians have the dilemma of trying to satisfy the analytical rigour of their particular field of enquiry, while belonging to a community whose members do not have regular opportunities to consider recognised experts' views of the evidence pertaining to everyday problems and dilemmas and the reasoning relevant to an issue being faced. 

For the Christian psychologist, this dilemma is particularly acute.  Most people are "folk psychologists", developing their own models of how and why other people behave. Everybody is an intuitive psychologist about how other people will (or should) act or react.  Our psychological ‘models' are informed by our worldview.  For an individual Christian or community of Christian believers, Scripture clearly has the capacity to be a major influence on such models.  As the Bible regularly refers to the individual believer's (or non-believer's) mental state, it is easy for Christians to apply what they consider to be biblical principles to abnormal mental states.  Yet the Bible cannot deliver a specific solution to every psychological problem; when referring to mental distress the Bible is more likely to be referring to entirely reasonable responses to catastrophic events (e.g. the exile in Babylon) than it is to what we would call mental illness.

The Christian physician is able to tackle physical ailments using the treatments that the profession regards as best from experience or increasingly often from research using appropriate criteria of success. Yet these treatments are not drawn directly from Scripture.  The individual physician may avoid a line of treatment because it conflicts with what is widely understood to be a biblical theme or command, but otherwise is able to draw on the resources of academic medical research and general professional ethics to select an approach suited to the individual's circumstances. 

Similarly the Christian psychologist is able to offer solutions to psychological complaints that do not arise solely out of a specifically biblical view of human nature but are informed in part by empirical research into what generally happens in specified circumstances.

However, many Christians regard Psychology with suspicion because influential figures such as Freud have propounded theories that involve an explicitly anti-Christian worldview. It is of course entirely appropriate - indeed essential - that Christians examine psychologists' ideas for metaphysical presuppositions about the influences on our behaviour and feelings.  Yet it would be unwise to throw out the baby with the bathwater.   Results of psychological investigations over the past century have much to teach us, both in our individual Christian lives and in our church family (e.g. Watts, Nye & Savage, 2001).

Secular therapies and biblical counselling

An opportunity to consider some of these issues is provided by the report of an investigation of experiences by Christians of "biblical" and "professional" counselling for survivors of child sexual abuse (Fouque & Glachan, 2000).

The authors specify "biblical counselling" as an approach that "teaches that the ultimate healing of the pain and suffering lies in repentance from personal sin, in the acceptance of God's forgiveness and in a willingness to enter into a new commitment to God" (page 202).   They state that "professional" or "pastoral" counselling involves a "non-directive therapeutic approach" that "seeks an integration of psychological and spiritual insights in the care and counsel of individuals."  The authors express a major concern about at least some biblical counseling, that it is a "directive and authoritative approach to counselling survivors of sexual abuse [which] may be an inappropriate model, in view of their previous experiences of negative control by powerful authority figures" (page 205).

To some extent, the authors' fears were confirmed by their data. They compared views between Christians who had only received what was called biblical counselling and Christians who had received both biblical and professional counselling.  In summarising their results, Fouque and Glachan state that "Christian counsellors are negatively perceived as significantly more directive, more powerful and controlling than non-directive professional counsellors. In addition, professional counselling was perceived as having a more positive outcome than Christian counselling" (page 213). Even more disturbingly, they conclude that "these negative responses towards biblical counselling bear out some of the initial concerns that biblical counsellors may unknowingly engage in fresh abusive cycles which the survivor is powerless to prevent" (page 215).

Substantiation of evidence of this sort would obviously have very serious implications for what these authors identify as a biblical approach to counselling.  However, there are a number of significant flaws in this research. The participants in the study were recruited from a support group set up in the Anglican Diocese of Southwark (in London), and the group contained a high proportion of Anglicans.  Those having problems referred themselves to this group; we have no idea how many people were entirely satisfied with a counselling approach specified as biblical and had no further need for support.  For example, the uses of the Bible in the counselling as the authors define them may have been unfamiliar to such people and could even have been unacceptable in principle to them.

This in turn raises the issue of the sort of "biblical counselling" the participants received. Do the authors mean "nouthetic counselling," in which a Christian is confronted with biblical texts, with the object of adopting a more Christ-like life?  Do they mean "deliverance ministry," where psychological problems are attributed to demonic activity? Or does the term include a more integrated "pastoral counselling", where insights are drawn both from both biblical values and from secular psychological or counselling perspectives?  These approaches tackle the problems in distinctive ways, are driven by very different rationales, and potentially therefore have quite different outcomes from other approaches, Christian or secular.

Of more general significance, the items in the research questionnaire assessing the counselling, as presented in the article, indicate that some of the issues that the authors were attempting to investigate were not adequately addressed.  For example, the authors of the study seem to believe that the call for Christians to forgive those who persecute them also assumes that the victims are culpable for their ill-treatment.  Clearly it is essential that survivors of child sexual abuse do not blame themselves, but likewise it could prove very damaging to deny that any form of forgiveness of the abuser can have a role in healing.

Another major weakness is that no information is given on how the overall helpfulness of either form of counselling was assessed.  Furthermore, no descriptions of the actual findings are given - only a statistical test that the two groups did differ.  That is, the article fails to specify how "helpful" either form of counselling was.  In any case, assessing the effectiveness of counselling or any other intervention solely by how "helpful" that the process was felt to be is not an adequate measure of outcome.  Those who consume excessive amounts of alcohol might regard it as a "helpful" way of coping with distress, but that is not a basis for commending the practice!

My particular field of research concerns the responses of children to trauma.  Sexual abuse in childhood can have a considerable and complex effect on a person's mental health, and in complex ways (Barker-Collo & Read, 2003; Spataro, Mullen, Burgess, Wells & Moss, 2004).  One of the ‘gold standard' treatments for children or adults who have suffered trauma is prolonged exposure to recall of the traumatic events: the child or adult remembers at length and in great detail what they have been through.  For individuals having serious mental problems, e.g. post-traumatic stress disorder, this form of therapy is undoubtedly very unpleasant.  It is very direct too - a feature of counselling that the authors of this article deem to be inappropriate.  Having "nice" therapy, however, does not necessarily mean that it is doing much good.

Foque and Glachan (2000) characterise some charismatic evangelical interventions as focusing "on the problems of sexual abuse mainly from a spiritual warfare stance."   I share these authors' view that such a stance may not be beneficial.  It may merely attempt a "quick fix" of what can often be long-term problems.  As noted above, churches do not struggle alone with physical ailments and refuse to accept medical treatments because they are not directly drawn from the Bible, and yet clearly some Christian communities are failing to consider that psychological approaches to mental problems have been tested by research that has been published only after review by relevant experts.

As an academic psychologist, I have a responsibility in addition to draw attention to broader issues about counselling.  In the case of counselling (whether "biblical" or "professional") offered for survivors of child sexual abuse, the training in delivery of such services is often unregulated, and the consequences of its practice are unmonitored.  Counselling often is not led by theory that can be subjected to empirical analysis. 

There may be a role for counselling in the secular world and in the churches in addressing more general issues, such as problems in relationships, unrealistically low (or high) self-esteem, or uncertainty over major decisions in life.  This however does not warrant its use in tackling major problems that individuals have in mental health.

Evidence-based psychological treatment exists for people who have experienced child sexual abuse. Cognitive-behavioural therapy (CBT), based on testable theories from academic psychology, has been successfully used with sexually abused children (Ramchandani & Jones, 2003) and with adult women who have been sexually assaulted (Foa, Dancu, Hembree, Jaycox, Meadows & Street, 1999).  While CBT practitioners themselves may not be value-neutral, the underlying theory of CBT does not assume a specific worldview, unlike those secular forms of counselling that are inspired by humanist doctrines.   Unfortunately, at present professionally applied psychological therapy is difficult to obtain, partly because of a longstanding shortfall of qualified practitioners relative to demand.   Yet this should not lead to ill considered action: another C-A-N- Perspective cites advice from experienced practitioners within the British Association of Christians in Psychology.

General implications
In the introduction to their paper, Fouque and Glachan note that many people who have experienced sexual abuse turn to clergy for help.  It is therefore important that church leaders are trained in how the survivors of abuse can be supported and cared for.

In itself this study tells us little about the provision that the churches should make for members and other enquirers who have experienced abuse.  Nonetheless, it may be helpful in drawing our attention to a number of issues about the churches' care for people experiencing mental distress.

Fouque and Glachan (2000) barely scratch the surface of the evaluation of Christian ministries to the abused.  What if they had employed a far more rigorous methodology for examining Christian counseling in this area?  For example, if someone conducts a randomised controlled trial which did indeed find that some forms of Christian counselling had a less positive outcome for survivors of child sexual abuse than other approaches, including secular ones, how would this finding be received by Christian communities?

Clearly it could be dangerous to persist with interventions shown not to meet criteria for best practice or even to be harmful.  On the other hand, it may not be wise for pastors to resort immediately to referrals to secular mental health professionals, without considering what their particular Christian community can do. To return to the example of physical complaints, most churches would accept the validity of medical interventions, while persisting in being supportive in everyday practical ways. How survivors of child sexual abuse (or for that matter, a sufferer of mental illness) can be generally encouraged and supported by their churches is an issue that needs addressing jointly by Christian pastors and counsellors and by academically qualified and service-recognised psychologists who are Christians.

To conclude, Christian psychologists need to work more closely with church leaders to build up an understanding of mental health problems within the local church and better access to the most appropriate help available for those with such difficulties. The recent document "Promoting mental health: a resource for spiritual and pastoral care", produced by the Church of England and the National Institute for Mental Health in England, goes some way in this regard.  A more explicit theology of mental illness and severe psychological problems is also needed to inform the way in which churches seek to support brothers and sisters who are struggling with such mental health difficulties.

Barker-Collo, S., & Read, J. (2003). Models of response to childhood sexual abuse: their implications for treatment. Trauma, Violence & Abuse 4, 95-111.
Foa, E. B., Dancu, C. V., Hembree, E. A., Jaycox, L. H., Meadows, E. A., & Street, G. P. (1999). A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology 67, 194-200.
Fouque, P., & Glachan, M. (2000). The impact of Christian counselling on survivors of sexual abuse. Counselling Psychology Quarterly 13, 201-220.
Spataro, J., Mullen, P. E., Burgess, P. M., Wells, D. L., & Moss S. A. (2004). Impact of child sexual abuse on mental health: prospective study in males and females. British Journal of Psychiatry 184, 416-421.
Watts, F., Nye, R., & Savage, S. (2001). Psychology for Christian ministry. London: Routledge.

The author is grateful to Prof. Michael Wang for his comments on an earlier version of this paper.