Biblical Counseling, Case Study (from TWW)

Irrespective of what you think of TWW and their War on Complementarianism, Dee is providing the “Biblical Counseling” (BC) movement a well-deserved pounding.

You might wonder why I say that, given that, recently, I defended BC as a tool in the toolbox?

Keep in mind that, as I presented it:

  1. Unlike the BC movement–Jay Adams, Heath Lambert, etc.–I am not dismissive of professional therapists (licensed family therapists, psychologists, even psychiatrists). There are times when such professionals are very necessary. And there are times when psychotropic medication is necessary for a client to even reach a position where he or she can receive Biblical counsel.
  2. Given that teaching is a spiritual gift, and given that counseling is a form of teaching, not everyone is competent to counsel.
  3. As with all things, Callahan’s Law applies: “A man’s gotta know his limitations.”
  4. Being competent as a counselor requires a lot more than taking a few courses and passing an exam. Even an MDiv degree from a reputable seminary doesn’t necessarily qualify such a one. This is because such a body of knowledge requires spiritual mileage. Knowing the academics of the doctrine of sin is one thing; dealing with it in your own life–i.e. getting the log out of your own eye–is where the real learning is done.

I would also add the following caveats about BC:

  1. Some proponents, particularly Jay Adams, have been dismissive of demonic influence on this earth, claiming that because Jesus came to destroy the work of the devil, that today’s issues do not involve demons but are just a matter of getting someone to see the Bible the way you do on an issue.
  2. The BC folks are dismissive of most, if not all, licensed professionals. They see such professionals as anti-Biblical, promoting a paradigm that is opposed to Scripture. They believe that “Sola Scriptura” means “Nolo Medicare”, when in fact Scripture provides no such admonition.

As I’ve said before, there are two types of people who are bipolar: (a) those who take their medicine and (b) those who do not take their medicine.

The latter are often very irrational when their mood swings kick in: they will not reason with you, no matter how convincing you are. A lot of BC counselors errantly assume that such folks are just living in rebellion and will not receive Godly counsel, when in fact that such folks–once they have their medicine–are very rational and reasonable. (In fact, if they are not being reasonable, you may need to direct them to professional help, as they may need medication.)

And it’s not just folks who are bipolar. Schizophrenics, those who suffer from chronic depression, and even mothers in the throes of post-partum depression often need medication. We can ruminate all day about the source of the problem, but the fact remains: (a) with medication, they are rational; (b) minus medication, they are not.

The same can also hold true for folks with eating disorders, depending on the severity of the disorder. I’ve known gals who had to be hospitalized for anorexia; one was a middle school classmate of mine who is now a FB friend; one is a top-tier triathlete; one was a classmate of mine at SBTS. They needed meds. I’ve also known others who did not need meds. It’s not a one-size-fits-all.

In Dee’s article, she provides a case study from a BC exam. I will provide it, and my answers.

Here is the case study:

Tim and Emily
Tim and Emily come from a church across town, and have asked to meet you because of some help that you offered their friends several months ago.  They are coming because of a persistent problem they have had in their marriage.  They explain that in their six years of marriage Tim has always had a “short fuse.”  He regularly “loses it” when he comes home from work which fills the evenings with tense communication.  Their weeks are filled with arguments about everything from dinner being ready on time, to whether they should have kids. Tim thinks Emily is a good wife, admits the problems are his fault, but says he just doesn’t know how to “maintain control.”  About a year ago Tim went berserk screaming at Emily, kicking the kitchen table and throwing plates on the floor in response to Emily’s complaint that he came home late without calling.  Emily was always uncomfortable with Tim’s previous pattern of outbursts, but this was different.  She was truly scared.  Tim was too.  In tears she told Tim that something had to change.

Tim talked to his pastor who told him that he needed to see a professional therapist.  Tim followed the advice and made an appointment with the Christian counselor whom his pastor recommended.  Tim met with the therapist for a few sessions, who ultimately recommended he see a psychiatrist for medical care.  When Tim met with the psychiatrist he was told that he had bi-polar disorder and began to take the medications prescribed by the physician.

Tim was initially discouraged to learn that he had a disease that would likely last his entire life, but he was thankful to have a plan to deal with problem.  Emily was also encouraged that there was now at least something they could do.

Their encouragement quickly gave way, however, when after several months on the medication Tim had still not really changed.  While his temperament seemed milder in general the loss of control, and screaming were still present.  It was at this point that Emily began to regret ever marrying Tim.  All the arguments together with the couple’s lack of children were taking their toll.  She realized she was in a marriage that she did not want to be in, but didn’t think she had any options.

Then last week Tim “went completely crazy.”  Emily suggested on a Saturday morning that Tim should cut the grass because he had not done it the week before.  Tim did more than scream and throw things this time.  As he yelled and became more “worked up” he threw the phone at Emily.  He missed her, knocking a hole in the wall, but they both knew he had crossed a line.

Emily said she couldn’t take it anymore and wanted out of the marriage.  She told him that if something didn’t change very quickly she was going to leave.  That is when he reached out to his friend who recommended you.

Tim and Emily both profess faith in Christ, and relate their testimonies of conversion in their teen years.  Both are also terribly discouraged.  Tim doesn’t know how to treat Emily better since he is “plagued” by this disease.  Emily loves Tim and would like their marriage to work, but she is worn out with the lack of change.  She feels badly about wanting to leave because she knows he has an illness, but she is increasingly convinced that God is telling her to divorce Tim.

1.     How will you decide whether to pursue Tim and Emily as believers or unbelievers?  What difference will their status as Christians make in your counseling?

2.     Describe, as fully as you are able, your strategy to help Tim and Emily think biblically about his diagnosis and their use of bi-polar and illness language.

3.     Emily is “Convinced that God is telling her to divorce Tim.”  Write out your word-for-word response to Emily on this matter.  In your response, be sure to address the themes of biblical decision-making and permission for divorce and remarriage.

4.     What strategy would you employ to see repentance, reconciliation, and restoration happen between Tim and Emily?

5.     Describe a detailed plan of restoring marital communication that you would pursue with Tim and Emily.

Here are my answers:

  1. They are believers. They have their issues, but they are believers. What does that mean? (a) while BC is important to helping them unpack and resolve baggage, they need professional help; (b) Tim needs to see his psychiatrist–ASA-freaking-P–because he may need to have his meds re-evaluated, assuming he is currently taking them as-directed; (c) a professional therapist may be necessary during that process.
  2. For one thing, we need to determine if Tim is taking his meds as-directed by his physician. If he is skipping his meds, then we must confront that head-on, as he is within inches of earning a domestic violence conviction. If he is bipolar, he needs to take his meds, and he may need to take them for the rest of his life.
  3. I would contend that such thinking is not Biblical: while it is possible that, if the trend continues, red lines could get crossed and divorce could become inevitable, those red lines have not been crossed and there is no Biblical precedent for a “preventative divorce”. The Biblical admonitions about divorce are in play, and, as presented in this case, there are no extenuating circumstances as yet. That, however, can change if the trend continues.
  4. First, both Tim and Emily need to be in a position where they can even receive Biblical counsel in the first place. That means they need to see professionals to ensure such issues–that require professionals–get resolved. And that includes getting medications in line where that is necessary. Once those are taken care of, then we can talk about the dynamics that drive their conflict with respect to the Scriptures. She may need to respect him more; he obviously is lacking in the “love your wives as Christ loved the Church” department. It is likely that each has matters that require acknowledgement and repentance.
  5. That is a stupid question, given that such a “plan” is dependent upon in-depth, detailed discussion.

How would you score that, Dee?