During the past twenty-five years evangelicals have become much more alert to the special needs of people who are emotionally and psychologically disturbed. Biblically based counseling, as developed by Jay Adams, Bill Gothard, and others, has shown that the solution to emotional problems may often lie in the forthright application of biblical principles. Healing ministries, especially those that emphasize the healing of memories, have often been helpful to troubled persons who have not found relief through psychiatry. At the same time, Christians trained in psychology and psychiatry have attempted to show that their disciplines may play a role in the healing process.
We should remember, however, that the traditional ministries of the church have always had a healing influence. Indeed, I believe that the church does most for mental health when it does its regular business. As God heals us spiritually through conversion, confession, worship, Bible study, and prayer, he also brings us powerful resources for the healing of our emotions and personalities. Not only is spiritual health more important than emotional health, it facilitates emotional health as it brings peace of mind and freedom from guilt.
Spiritual health does not, during this life, guarantee emotional health; but emotional disturbances that are not resolved through the direct spiritual ministries of the church often respond to the sense of warmth and caring acceptance found within a fellowship of believers. As it brings men and women into a relationship with God, the church also brings them into a relationship with one another. John reminds us, “This commandment we have from Him, that the one who loves God should love his brother also” (1 John 4:21, NASB). In a technological, hedonistic society where many find their lives lacking in meaningful relationships, the church’s capacity to provide love and fellowship can be a powerful agent of mental health. Man’s greatest need, after his need for God, is to give and receive human love. This need often goes unfulfilled. The mobility that is prevalent in our society brings a separation of extended families, and divorce severs nuclear family ties. The motivation of individual fulfillment tends to diminish those ties that are left. A caring Christian community can counteract this trend.
Many of the problems that do not respond to the love of a Christian may respond to biblically based counseling. However, there is still a place for the healing role of psychotherapy. To understand its potential value, let us first distinguish psychotherapy from biblically based counseling. Biblical counseling is largely didactic and inspirational; it identifies biblical principles that may help resolve problems in living and encourages the troubled person to apply these principles in his life. Psychotherapy, on the other hand, tries to help the troubled person understand himself. It is relatively nondirective. Its goals are to develop insight and a corrective emotional experience within a relationship.
The biblical counselor must qualify for the work by being a man or woman of God. The psychotherapist’s primary qualification is a technical one: He or she must be well versed in the science of psychology. The biblical counselor directs the light of Scripture on problems that are difficult to resolve even when they are well understood; his concerns are such things as true guilt over real sin, the fear that life has no meaning, and the fear of death. The psychotherapist must understand the complexities of mental functioning because he tries to help people who don’t really understand what is wrong with them. Good candidates for psychotherapy are people who have a persistent sense of unease even though “it doesn’t make sense” for someone in their circumstances to be upset. In short, then, biblical counseling and psychotherapy differ in style, immediate objectives, and the kinds of problems they treat.
The fundamental components of psychotherapy are the secure relationship that develops between the patient and the therapist and the verbal interchange that arises out of that relationship. As the patient comes to feel secure in the presence of the psychotherapist, he tends to present clues, in his words and his actions, to the nature of the unconscious conflict that underlies his apparently inexplicable symptoms.
One of the primary tools of the psychotherapist is “transference,” the tendency of the patient to react to the therapist in the same manner in which he reacted to earlier important figures in his life. This tool becomes very important, because most unconscious conflicts have their genesis in early relationships and because many aspects of those relationships, which the patient may live out in the transference, are not available to his conscious recall. Psychoanalytic theory assumes that transference inevitably develops in therapy; it is not created by the therapist, but is simply observed by him. Similar reactions occur in everyday life. For example, the knot in the stomach of many a conscientious person when he is in the presence of judges, policemen, teachers, and other figures of authority is probably a transference-like phenomenon rising out of his early respect for, and fear of, an authoritarian parent.
The crucial importance of transference lies in its clarification of issues not only in past relationships but also in the patient’s current life. The problems that started in the past usually carry over into the present. Transference causes current maladaptive reactions—the things that caused the patient to seek treatment in the first place—to be dramatized while they are actually occurring. If the patient has problems with authority figures, he will react to the therapist as he reacts to real authorities in his life, and so his problems can be examined when they occur.
Psychotherapy thus becomes a laboratory in which the patient can learn insight, that is, self-understanding with a sense of conviction. If the therapist simply announces his conclusion that the patient has a certain problem, the patient may respectfully (if he respects people in authority), or even skeptically, make a note of the therapist’s theory. He may say, “My doctor says my problem is.…” But when the maladaptive behavior comes to his attention when it is actually occurring, he develops insight and says, “Now I know that my problem is.…”
When the unconscious basis for emotional symptoms is discovered through psychotherapy, it is usually found to involve (1) an impulse and (2) a prohibition from the superego or conscience. The goal of therapy is not to eliminate the prohibition or, putting it conversely, to gratify the impulse. The goal of the therapist, who attempts not to impose his own moral standards, is to uncover the conflict and make it conscious so that the patient can then use his conscious mind to resolve it. The therapist assumes that the counter-productive solution, such as the neurotic symptom of anxiety, has evolved in the unconscious and would not be necessary if the conscious mind applied itself to the problem.
Let us suppose that a patient with free-floating anxiety always experiences it in situations where he is confronted with an authoritarian male. At the beginning of his treatment he may not even have made this connection. Perhaps he is aware only that he may sometimes feel very disagreeable anxiety when his conscious mind sees nothing to be frightened of. The basis for this anxiety may become apparent to the therapist as he notices that in the therapy sessions the patient’s anxiety attacks always occur after he, the therapist, has taken some sort of positive or authoritative position. The therapist will want the patient to see not only what circumstances provoke his anxiety but also why those circumstances are threatening to him. Very often this will help the patient develop insight into the traumatic early-life experiences that caused him to have an unnatural fear of authority figures.
In the initial achievement of insight, the therapist plays the role of an objective outsider who guides the patient in his efforts at self-observation and self-understanding. In the subsequent phase of therapy, often called “working through,” the therapist may also play the role of teacher. He will encourage the patient to continue his efforts to understand himself and to see how his fear of authority figures is interfering with his present life. He will help the patient judge when his reactions to authorities are excessive and when they are not. He will attempt to help the patient develop new modes of dealing with authority figures, and he will encourage him to practice his new behavior in the psychotherapy sessions.
For example, if a patient is so fearful of authority that he is always apologizing, even when he has nothing to be apologetic about, the psychotherapist will encourage him to stop apologizing. If he deferentially accepts everything that the therapist says, he will be encouraged to question the therapist’s statement when he is not convinced by them. The psychotherapeutic relationship is a laboratory learning experience that helps the patient not only to observe old patterns but also to establish new, more effective ones.
Psychotherapy becomes a laboratory in which the patient can learn insight, that is, self-understanding with a sense of conviction.
The working-through also involves the analysis of the patient’s resistances. The person who is not able to express resentment directly usually has developed some devious techniques for expressing it indirectly. For example, the patient made anxious by authority figures may unconsciously express his resentment toward them through passive-aggressive techniques. He may deferentially agree with everything the therapist says but may also come late for most of his sessions, offering apparently valid excuses. In time it may become evident that the excuses are less valid than they seem and that the lateness is the patient’s way of thumbing his nose at the therapist because he is afraid to confront him directly.
Then the therapist must point out that the patient’s problem is making life hard for him in two ways: He is incapacitated by the symptom, anxiety, and his way of coping with it, of expressing his resentment, alienates other people and interferes with his own conscious goals. Of course, if the patient happens to be getting enough gratification from his coping behavior, his symptom may prove quite resistant to psychotherapy.
One objection Christians raise to the type of psychotherapeutic process I have outlined is that it encourages the patient to deny responsibility for his own behavior. But in fact the psychotherapeutic approach may solidly reinforce, rather than undermine, the requirement that the patient behave responsibly. It assumes that the symptom itself is a sign of a failure to behave responsibly, and therefore the therapist’s effort to remove the symptom is always in the service of replacing it with responsible behavior. Furthermore, psychotherapy resists the patient’s resistances, which represent a tendency to be comfortable with the symptom because of the subtle way he has developed of expressing the impulse that gives rise to the symptom.
The psychotherapist may assume that at first the patient will be unable to control his symptom because of its roots in his unconscious mind, but even then he at least expects the patient to behave responsibly enough to enter into the treatment that may bring him freedom from the symptom. Even at the beginning of treatment there is no necessity that the symptom, which the patient cannot control, be considered nonsinful. Christians who object to the psychotherapeutic approach seem to assume that the psychotherapist is excusing the patient’s behavior when he assumes that the patient cannot control it. This is a curious objection, in view of the fact that the Bible emphasizes man’s responsibility before God even though he is a fallen creature with an inevitable tendency to sin that he cannot control.
A second Christian objection to psychotherapy is that it advocates the resolution of conflicts by the unbridled expression of impulses. This is as invalid as the first. Neither Freud nor his followers thought that solutions came through impulsive abandon or through the destruction of the conscience. They assumed that the conscience was an essential part of the personality and a necessary device for man living in society. They could not value social relatedness, as they did, without realizing that the impulse gratification of each individual had to be controlled. In The Future of an Illusion Freud portrayed religion as a destructive force in society, but he clearly argued that moral values are necessary for the preservation of culture. He stated, “The strengthening of the superego is a highly valuable psychological possession for culture. Those people in whom it has taken place, far from being the foes of culture, become its supporters.” We may argue that Freud had no philosophical justification for maintaining morality without religious underpinnings, but the fact remains that he did recognize the need for moral values.
It may be said that psychotherapy is an undeifying process because it encourages excessive introspection.
Some other objections to the process of psychotherapy are more difficult to resolve. It may be said that psychotherapy is an unedifying process because it encourages excessive introspection in general and focuses on man’s baser desires in particular. Encouraging a patient to express his sexual fantasies is seen as contrary to Paul’s injunction that we think on “whatsoever things are pure.”
The example of Scripture itself may be helpful in resolving this point. The Bible deals rather explicitly with some sordid events. When it does so, its descriptions are not prurient; that is, they do not encourage the reader to revel in the sordidness. The position of the writers of the Bible seems to have been that it is more important to be factual than to be pure, if being pure would involve ignoring some significant facts. This same position could be taken by every psychotherapist; the therapy should not encourage sensual gratification through fantasy, but it should allow the patient to be more honest about the current contents of his fantasy life.
The more general objection that psychotherapy requires the patient to be overly introspective is perhaps the truest objection. However, it is no different than the objection in general medicine that the patient should not take medicines because every medicine has potential side effects. Some people would actually take this extreme position, but most people would agree that medicine, when carefully prescribed by a doctor, should be taken as a necessary evil: The potential benefit outweighs the risk. Similarly, the introspection involved in psychotherapy may be viewed as a potential hazard that is outweighed by the potential benefits of the treatment.
I believe that Scripture positively endorses the principles of psychotherapy. Psychotherapy can relieve suffering; it is based on an honest and caring human relationship; and its primary goal is the growth of the patient. Miracles of healing have their place, and confrontation with biblical principles is essential. But there is also a place for therapy that occurs within a caring relationship and has as its goal the enhancement of the patient’s capacity to give and receive love.
Robert H. Humphries is a senior staff psychiatrist with the Silver Hill Foundation, a private psychiatric hospital in New Canaan, Connecticut. He also maintains a limited private practice.
