Christian Counseling: Origins, Trends, and Key Principles

Introduction to Christian Counseling

The evangelical Christian community has developed an approach to counseling that has been described as "Christian counseling" (Lartey, 2003, p. 106). A growing number of practitioners have recognized the value of integrating the heart of Christian counseling — the Holy Bible — with psychological approaches in their counseling practice (Lartey, 2003). In this regard, Lartey emphasizes that "evangelical Christian counselors seek to base their counsel on a particular reading and interpretation of the Bible that is based on an experience of salvation through personal faith in Jesus Christ" (2003, p. 107). The personal experiences and faith of Christian counselors represent the fundamental interpretive and theological perspective applied to the enormous range of problems that accompany modern life (Lartey, 2003). According to Collins (2007), "Counseling attempts to provide encouragement and guidance for those who are facing losses, decisions, or disappointments. Counseling can stimulate personality growth and development" (p. 36).

The primary differences between evangelical Christian counselors and conventional counselors concern the extent to which Christian counselors are prepared to apply "secular" psychological knowledge within their doctrinal and biblical framework (Lartey, 2003). Views in this area exist along a continuum. At one end stands Jay E. Adams (1970), who maintains that no psychology whatsoever is needed for Christian counseling to be effective. At the other end stands Gary R. Collins, a practicing Christian counselor with a PhD in clinical psychology from Purdue University (Lartey, 2003). Collins believes that a rebuilding of psychology is needed for Christian counseling — one that builds on the theistic premise that "God exists and is the source of all truth" (1977, p. 118). Collins has written extensively on Christian counseling, including his seminal work, Christian Counseling: A Comprehensive Guide (2007), and is a founding editor of the peer-reviewed journal Marriage and Family: A Christian Journal (Clinton, 2003) and a frequent contributor to the Christian Association for Psychological Studies (Allison, 2006). In sum, Christian counseling is described as:

". . . a solidly biblical approach to counseling, one which draws from secular psychology without betraying its Scriptural premise, one which realistically faces the deep (and not so deep) problems of people and honestly evaluates its success in dealing with them, and, most importantly, one which clings passionately and unswervingly to belief in an inerrant Bible and an all-sufficient Christ" (Lartey, 2003, p. 106).

This perspective — adopted by Collins and like-minded practitioners — represents an important aspect of Christian counseling: a commitment to using secular psychology in combination with the Scriptures to provide a holistic counseling approach not otherwise available (Lartey, 2003).

Despite a growing body of research on Christian counseling, there remains a dearth of knowledge within the Christian community concerning the optimal approach to helping people deal with personal problems (Meadors, 2012). As Meadors points out, "Some believe that Christians should submit only to biblical counseling, while others support psychological counseling so long as it is integrated with the Scriptures" (2012, p. 2). Moreover, there has been a growing recognition that spirituality is an important component of effective mental health practice (West, 2004). Fully 50 percent of mental health professionals identify with some type of religious affiliation, and these practitioners hold that personal prayer is valuable and that spirituality is personally relevant (Weld & Eriksen, 2007).

Consequently, a number of mental health counselors regard spirituality as an important part of every client's well-being (Meadors, 2012). As Weld and Eriksen emphasize, "prayer is the most frequently used spiritual intervention by Christian counselors. Even practitioners working in secular settings regularly incorporate prayer into their practices in some way" (2007, p. 328). Although the majority of practitioners who subscribe to these tenets believe it is inappropriate to pray with a client, most feel that praying for a client is appropriate (Weld & Eriksen, 2007). Moreover, an overwhelming majority of counseling clients feel it is important to have their spirituality or religion incorporated into the counseling context, due in part to the fact that most Americans (approximately 80%) believe in God and in the efficacy of prayer (Weld & Eriksen, 2007). Weld and Eriksen further emphasize that "Christian clients expect prayer to be included in Christian counseling. Because sensitivity to clients' expectations helps build the therapeutic alliance, which in turn contributes to positive outcomes, methods for including prayer in counseling with some clients need to be examined" (2007, p. 329).

The purpose of this study is to provide a critical and systematic review of the relevant literature in general, and of Gary R. Collins's book Christian Counseling in particular, concerning the origins and trends in Christian counseling and how this approach can be used to provide timely and essential interventions for people in need.

Living in the 21st century can be daunting, and many people find themselves at a loss when coping with the demands of modern life. Collins (2007) reports that "people come with marriage problems, crises, depression, interpersonal conflicts, and other problems" (p. 64). Identifying opportunities to help people with personal problems by drawing on both the Holy Bible and secular psychotherapeutic interventions is therefore a timely and valuable enterprise. As Clinton and Hawkins point out, "This is a new and exciting day in Christian counseling, a ministry and profession expanding in both worldwide influence and membership" (2011, p. 141). Spirituality and faith-based counseling are increasingly being regarded as the fifth force in mental health care (Koenig, 2004). Clinton and Sibcy further stress that "when people seek mental health services, they often start with a pastor, priest, or rabbi, and, regardless of the context, they usually want their faith addressed as part of the therapeutic process" (2012, p. 142). Additionally, a growing number of religious leaders are recognizing that psychological training is a prerequisite for effective counseling in cases involving serious emotional and behavioral disorders (Meadors, 2012).

Given the strong belief in the need to incorporate spiritual and religious elements into counseling, approaching the process thoughtfully makes good sense. Resources are by definition scarce and time is of the essence when helping people overcome personal problems; it is therefore incumbent on Christian counselors to draw on the resources that will provide the most effective counseling approach.

Growing out of the evangelical Protestant tradition during the 1970s and early 1980s, the Christian psychiatry movement in the United States was started by Mansell Pattison, chairman of the department of psychiatry at the University of Georgia, and William P. Wilson, head of biological psychiatry at Duke University (Koenig, McCullough & Larson, 2001). Both were well-respected psychiatrists who organized training programs for psychiatrists seeking to incorporate Christian practices and beliefs into the psychotherapy and treatment of mental disorders (Koenig et al., 2001). By the mid-1980s and early 1990s, Christian psychiatry had established units in tertiary health care facilities as well as independent treatment centers specifically developed for evangelical Christian clients (Koenig et al., 2001). Some of the best-known Christian psychiatric networks were the Rapha mental health centers, the Minirth-Meier New Life treatment centers, and the Kairos mental health centers, all staffed by Christian psychiatrists and mental health workers (Koenig et al., 2001). According to Koenig and his associates, "Frank Minirth and Paul Meier have written a number of popular self-help books related to this practice that have been hugely successful" (2001, p. 1195). Other prominent figures who have acquired large followings through popular self-help books include Gary Collins (Christian Counseling: A Comprehensive Guide, 2007) and James Dobson (Dare to Discipline, 1970) (Koenig et al., 2001).

In academic psychology, Allen Bergin, a Brigham Young University professor, was instrumental in integrating religious practices and beliefs into the practice of psychotherapy (Koenig et al., 2001). In 1980, Bergin published an essay arguing that psychotherapists cannot be fully effective unless they conceptually integrate clients' religious belief systems into their practice (Koenig et al., 2001). According to Bergin (1980), "Religious communities that provide the combination of a viable belief structure and a network of loving, emotional support should manifest lower rates of emotional and social pathology and physical disease" (p. 102). This combination was termed "theistic psychotherapy" by Bergin, who described it as "a comprehensive orientation that includes a theistic conceptual framework, a body of religious and spiritual therapeutic interventions, and guidelines for implementing theistic perspectives and interventions" (1980, p. 99).

The connection between religious beliefs and psychotherapy was made explicit in Bergin's characterization of theistic psychotherapy: "The foundational assumptions of this approach are that God exists, that human beings are the creations of God, and that there are unseen spiritual processes by which the link between God and humanity is maintained" (1980, p. 99). A further assumption is that people who draw on spiritual resources as part of their treatment will experience an enhanced ability to respond to therapy and improve their life condition (Bergin, 1980). As Richards notes, "No other mainstream tradition has adequately incorporated theistic spiritual perspectives and practices into its approach, and so this orientation fills a void in the field" (2009, p. 12).

There have been several recent initiatives designed to incorporate spirituality and religion into health care. Well-known proponents of this integration include Bernie Siegel, a Yale surgeon; Larry Dossey, a cardiologist from Texas; and Dale Matthews, an internist headquartered in Georgetown (Koenig et al., 2001). Koenig and his associates also note that "Christian physicians and dentists in the United States for the past two decades have organized themselves into the rapidly growing Christian Medical and Dental Society, which in 2000 had more than 14,000 dues-paying members around the country, 95% of whom are physicians (in 1995 it had only 7,000 members)" (2001, p. 58).

Origins of Christian Counseling

These trends have been supported in large part by the fact that many health care professionals are themselves religiously affiliated and are recognizing the advantages of bringing clients' religious beliefs and practices into the therapeutic relationship (Koenig et al., 2001). Koenig et al. emphasize that "the fact that a substantial number of health professionals are themselves religious, have made efforts to partner with religious professionals, and use patients' religious beliefs to speed healing contributes to the view that religion can have positive effects on health, particularly mental health" (2001, p. 58). There is also sufficient evidence to suggest that religion has a positive effect on both physical and mental health (Koenig et al., 2001). However, an important caveat is that improved mental and physical health generally cannot be achieved if becoming religious is pursued solely for that purpose; extrinsic application of religion may actually worsen health outcomes (Koenig et al., 2001).

Collins himself cautions against this tendency: "My greatest criticism of the field of counseling and psychology and my greatest concern about it is that an individual who is knee-deep in sin . . . might be tempted to go to a psychologist or a counselor and talk away his guilt instead of getting on his face before God and asking for forgiveness" (Gary Collins interviewed by James Dobson, "Christians and Psychology," Focus on the Family, cassette CS502). Koenig and his colleagues further advise that "what is even more important than the health effects of religion, however, is that many, many people, particularly in the United States, depend heavily on religious beliefs and practices to cope when they are physically ill" (2001, p. 59). They conclude that "if many of our patients cognitively and emotionally deal with their illnesses by relying on religious faith, then health care professionals should be aware of this. Furthermore, if they are not clearly harmful to patients, these beliefs should probably be supported" (2001, p. 59).

A fundamental principle of Christian counseling holds that the guidance needed to help people overcome personal problems is readily available in the Scriptures. As Meadors points out, "A necessary presupposition of biblical counseling is that God has indeed provided every essential truth the believer needs for a happy, fulfilling life in Christ Jesus" (2012, p. 10). The redemptive qualities of Christian counseling extend beyond resolving immediate problems to helping people improve their lives in general. According to Meadors, "This is a goal of biblical counseling — escaping the corruption of the world. We are not told merely to cope or to survive as victims. We are not told just to do the best we can; we are told we can escape the corruption of the world through obedience to the truths of God's Word" (2012, p. 10).

Christian counseling remains a dynamic and evolving discipline. According to Clinton and Sibcy (2012), "Christian counseling continues to develop, with expanding thought, ideas, theory, research, and practice" (p. 142). The current trend is "toward developing innovative, biblically based and empirically supported treatment strategies, anchored and rooted in Judeo-Christian theology, and salted with solid psychological science to treat a wide array of clinical issues" (Clinton & Sibcy, 2012, p. 143).

The promising field of interpersonal neurobiology has emerged as a potential vehicle for further integrating Christian counseling with mainstream health care methodologies. Clinton and Sibcy note that it "strongly emphasizes the role of attachment relationships across the whole spectrum of caregiving — ranging from parent-child to teacher-student to professional-therapeutic — in shaping both the brain and the mind" (2012, p. 143). They suggest this field may provide evidence-based approaches many authorities consider a prerequisite for legitimate counseling interventions: "[Interpersonal neurobiology] may provide a legitimate theoretical and practice structure because it aims to provide a broad theoretical framework for integrating various lower-level theories. It may eventually become a fulcrum for integrating Christian counseling and psychology with contemporary neuroscience and attachment theory" (p. 143).

It is also the fundamental responsibility of Christian counselors to provide their services within the parameters of professional ethical guidelines (Schneller & Swenson, 2010). According to Schneller and Swenson, "For those who provide counseling or therapy in a Christian context there are further ethical guidelines to heed, including the American Association of Christian Counselors, American Association of Pastoral Counselors and Christian Association for Psychological Studies" (2010, p. 344). Despite their differences in application, these professional codes share common features: maintaining client confidentiality, acting as an advocate for client welfare, protecting clients from exploitation, and resolving therapeutic relationship issues appropriately (Schneller & Swenson, 2010).

The use of lay helpers has become a focus of interest in Christian counseling settings, though a paucity of timely and relevant studies concerning their efficacy remains. Garzon and Tilley (2009) note that "some conservative Christian groups, such as Nouthetic biblical counseling, exhibit a high distrust of psychology and thus have little interest in research or collaboration with mental health professionals" (p. 131). The fundamental principles of Jay Adams's Nouthetic Model — Elements of Dehabituation and Rehabituation — are as follows:

1. Becoming aware of the practice (pattern) that must be dehabituated (put off). Unless the client knows exactly what he is doing, he will not know how to correct the practice. The counselor and counselee should be aware of the nature, frequency of occurrence, and the associated occasions for the attitude or behavior pattern that must be put off.

2. Discovering the biblical alternative. There is a proper practice, pattern, or habit to replace every improper one. Counselors must read the Scriptures with an eye ever alert for passages that indicate the proper alternatives.

Recent and Current Trends in Christian Counseling

3. Structuring the whole situation for change. The structure of one's activities, surroundings, and associations should be consistent with and aid the counselee's avowed desire to put off a sinful practice. Equally important, he must structure for the new practice that he wishes to develop, rearranging his environment, associates, schedules, activities, or other impediments that might become an occasion for sin.

4. Breaking links in the chain of sin. It is necessary for the counselor to break down an activity into its steps or stages or links. There are two points at which one can stop an action: the point of resistance and the point of restraint.

5. Getting help from others. Change is difficult. Once a pattern has become a habit, it has become almost a part of one's nature. When adults attempt to replace a sinful response with a biblical one that is pleasing to God, they often need reminders and encouragement.

6. Stressing the whole relationship to Christ. The counselor should not focus solely on detailing the concrete and specific changes that must be made. Counselees may tend to focus upon the change and forget the more basic fact that this all has to do with pleasing God and living for the honor of His Son, Jesus Christ.

7. Practicing the new pattern. Patterns do not develop automatically. They become a part of one's life through practice. Discipline is the key — it is the secret of godliness, and godliness is the goal of the Christian life (Meadors, 2010, p. 51).

Meadors argues that authentic evangelical integrations of Christianity and psychology should conform to the following minimal qualifications: (1) psychology must come under the authority of Scripture, meaning that when scriptural teaching contradicts any other idea, even one supported by empirical evidence, that idea must not be accepted as truth; (2) the counselor must fervently insist that the Bible is God's infallible, inspired, inerrant revelation in propositional form; and (3) Scripture must have "functional control" over the counselor's thinking — not merely as accepted doctrine, but as doctrine put into thorough and consistent practice. To achieve this level of conformance, Christian counselors should: (a) demonstrate serious interest in the content of Scripture; (b) spend at least as much time studying the Bible as studying psychology; and (c) create opportunities to benefit from the Spirit's gifts through regular fellowship in a Bible-believing local church (Meadors, 2012, p. 8).

This study used a critical and systematic review of the literature as its research approach. This approach is consistent with the guidance provided by Fraenkel and Wallen (2001), who advise that "researchers usually dig into the literature to find out what has already been written about the topic they are interested in investigating. Both the opinions of experts in the field and other research studies are of interest. Such reading is referred to as a review of the literature" (p. 48). Gratton and Jones (2003) likewise maintain that a critical review of the relevant literature represents an important step in all types of research, noting that "a literature review is the background to the research, where it is important to demonstrate a clear understanding of the relevant theories and concepts, the results of past research into the area, the types of methodologies and research designs employed in such research, and areas where the literature is deficient" (p. 51).

A well-conducted literature review can achieve a number of valuable outcomes, including: (1) helping describe a topic of interest and refine research questions; (2) presenting a clear description and evaluation of relevant theories and concepts; (3) clarifying the relationship to previous research and identifying overlooked research possibilities; (4) providing both methodological and substantive insights; (5) demonstrating powers of critical analysis by exposing assumptions underpinning previous research; and (6) justifying new research through a coherent critique of what has gone before (Wood & Ellis, 2003, p. 255).

Besides the primary text, Christian Counseling (2007) by Gary Collins, the study also consulted public and university libraries as well as reliable online research resources including EBSCOHost and Questia. Selected websites dedicated to Christian counseling were also consulted.

A summary of the chapters in Collins's text, Christian Counseling, together with key points, is provided in the tables below.

The Changes in Counseling: Counselors must work with people experiencing the enormous array of problems that modern life introduces, and must therefore be prepared to respond meaningfully to a wide range of personal and family issues. Effecting lasting changes in people requires: commitment from the person who wants to change; the setting of attainable goals; active efforts to prevent relapse; and support from other people.

The Counselor and Counseling: Irrespective of the setting, Christian counselors seek to answer four questions: What is the real problem? Should I try to help? What could I do to help? Would someone else be better qualified to help? Christian counselors must also possess a strong sense of direction and a genuine interest in helping others.

The Church and Counseling: Besides having a divine mandate to heal, the church has the greatest potential for being a healing and caring community. Spiritual direction, unlike conventional counseling, does not focus on problem solving and advice-giving; instead, it involves at least two people engaged in prayer seeking to forge enhanced spiritual awareness and a stronger relationship with God.

The Community and Counseling: There are seven types of help that everyone needs in times of crisis: (1) tangible help in the form of money, food, clothing, or other provisions; (2) physical assistance such as transportation, lawn care, grocery shopping, or house cleaning; (3) guidance including advice or practical suggestions; (4) listening while feelings, concerns, frustrations, and fears are expressed; (5) feedback giving people information about themselves or their actions; (6) social participation including informal conversation and relaxation; and (7) spiritual support encouraging participation in worship, spiritual disciplines, and other activities that can stimulate hope, peace, and an awareness of God's presence (p. 52).

The Core of Counseling: Because each counselee is unique, no "one-size-fits-all" approach works equally well with everyone. Counseling often proceeds in an iterative rather than a step-by-step fashion. Goals of counseling include: relief from symptoms; self-understanding; learning new skills; help in changing behavior; resolving conflict; support and encouragement; spiritual growth; and self-development (p. 81).

Legal, Ethical, and Moral Issues: A determination must be made as to which counselor is best qualified to help in each case. Christian counselors must be aware of relevant legal guidelines while also recognizing that their moral and ethical obligations extend beyond legal requirements. Multicultural competence is a prerequisite for effective Christian counseling in at least five areas: awareness of one's own cultural values and biases; awareness of each counselee's cultural perspectives; understanding how culturally diverse counselees see the world; understanding cultural adaptation; and developing and using culturally appropriate counseling strategies (p. 115).