Because life is a series of edits

Therapy, Counseling, and Drugs (Oh, My!)

In Humanity, Seminary on March 15, 2007 at 5:54 pm

“Personality disorders are among the most problematic and vexing disorders
the pastor is likely to face in his or her day-to-day life in the church.”

The Pastor’s Guide to Psychological Disorders and Treatments, pg. 74

“I’m schizophrenic, but we’re better now.”
T-Shirt for sale at Union Station

Reading The Pastor’s Guide for my Intro to Counseling class, I began to wonder if I should change degree programs, forsaking the M. Div. and going more the M.A.C. route. After all, if indeed “every pastor…regularly encounters pastoral care issues that require counseling intervention,” (xi) and “the average pastor reports spending between 10 percent and 46 percent of his or her time counseling,” (1) why not cut to the chase, forget trying to pass Beginning Hebrew (which I’ve failed twice already), and get a counseling degree? Megan says I’d be as good or better at it as at pastoring. What do we need pastors for anyway (other than to refer parishioners to counselors)?

This was one thought I came away with after reading The Pastor’s Guide. While quite helpful in better understanding the areas of psychological disorders, maladaptive personalities, family distress, and the mental health industry in general, I felt that the guide seemed more a justification as to why pastors should simply refer parishioners to therapy, rather than as a handbook to help pastors in their actual counseling. While I’m not switching degree programs (at least not until I try Hebrew one more time), I do still have questions pertaining to differences between pastoring and counseling people, and how those might one day play themselves out in any church ministry I might lead.

Make no mistake: I’m not coming from a purely Nouthetic perspective, nor do I have anything against using medications for the treatment of chemical problems (though that wasn’t always the case). I see a psychiatrist myself every quarter and have been taking an anti-depressant for a year-and-a-half now that has seemed helpful. I also see a student counselor in the M.A.C. program here once a week, as well as meet with at least one of my pastors or elders every other week, and believe there’s freedom to do all this in the name of redeeming what God has created, but is fallen – me, in other words.

I don’t agree, however, with treating problems and disorders with drugs alone, nor would I encourage talking therapy that doesn’t come from the perspective or (at minimum) the acknowledgment of biblical principles in a patient’s therapy. Medications are fine (and often needed), but “the power of God for salvation to everyone who believes” (Romans 1:16) is found in the gospel – not in my daily Celexa tablet – and the latter needs to serve and be subject to the former for biblical sanctification of the justified Christian to take place. Like the rest of you, of course, I’m still trying to understand how that works.

That said, I probably most appreciated chapter six – “Selecting a Mental Health Professional” – in thinking through the need for “carefully evaluating MHPs in your community before you refer a parishioner to one of them for help” (131). Coming from a small town, I had never really thought about the need to develop a network of counseling professionals for future pastoral ministry (the pastor was usually it – and for free!), but I want to think more about the idea in the context of my own personal (and still developing) convictions as to what (if any) steady partnership should exist between the pastor and the counselor in helping a person in all of life.

I don’t want to be overly dogmatic and say there isn’t a happy medium that could or should exist, but I also don’t want to arrive at a decision made only for pragmatic reasons (i.e. I just don’t have time to counsel everybody who wants/needs it, so I’ll just “farm them out”) instead of real ones.

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  1. When someone is physically sick, he needs a doctor, but he also needs a pastor. If someone’s house is robbed, he needs the police, but he also needs a pastor. If someone is wronged at his work, he may need a lawyer, but he also needs a pastor. People need farmers, mechanics, electricians, baseball play-by-play radio announcers, and (gulp) even politicians, but we also need pastors.

    I guess it’s more difficult for counselors and pastors to distinguish their “territory” and how they both play roles in helping someone deal with his issues. But a counselor is someone whose professional service we purchase. Hopefully counselors will indeed have a biblical worldview and freely offer the grace of the gospel in all of their counsel. Yet, pastors are God’s appointed agents called to serve us sacrificially in Jesus’ name and administer to us His promised grace through His Word and sacraments.

    In making that distinction, it could sound like I’m saying that pastors are better or more important than counselors. But I’m really not, just like I wouldn’t say that pastors are more important than farmers or doctors. They are all important, necessary. But its important to recognize that they have different roles.

    p.s. I say all this in response to your question, “What do we need pastors for anyway?” which I know was for rhetorical effect, but it got me thinking.

  2. I just re-read my post, and in that one paragraph I managed to say the word “important” like twelve thousand times. That’s gotta be a record.

  3. Rhetorical question, yes, Nick, but I’m glad you took the time to respond. Appreciate your thoughts here (“importants” and all).

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