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?

14 thoughts on “Biblical Counseling, Case Study (from TWW)

  1. In this case study, you have plenty of issues on both ends:

    Emily is all over the map. Tim can’t accept even the most basic pushback. It would be nice to know what kind of work Tim does in his day job. He may be bringing a lot of stress home with him. They clearly have communication issues, and I doubt that this is all on Tim.

    At the same time, if he’s bipolar, he needs to take his medicines diligently. If you’re a Biblical counselor, you need to impress on him that, given that he has been diagnosed with a very serious illness, an integral part of his Biblical responsibility is taking his medications as directed by his physician.

    This principle is not just about mental illness, either. If you are diabetic–or at risk for diabetes–you owe it to your family to do the right things that are conducive to good health: proper diet, active lifestyle, perhaps even meds if those become necessary. Ditto for heart disease.

    Emily seems to want kids. That, in and of itself, is not a bad thing. At the same time, it would behoove her to consider how and why she is communicating things the way she is communicating them to Tim. If he’s bipolar, it’s probably a good idea to first get that under control and get established in a functional household before considering bringing a child into the mix.

    And her premise that God is telling her to get a divorce, that’s a load of crapola. While, if Tim keeps it up, divorce may become inevitable, that threshold has not been reached and the “for better or worse” clause is still in play.

    She clearly has issues, but Tim needs to get his meds under control and then there needs to be some serious consideration regarding communication issues. Is she intentionally pushing his buttons and being contentious where she does not need to be? Maybe, maybe not. From the given information, we don’t know those details, but I would dig to try to find out what is driving both her pressing him and his disproportionate escalation in his responses.

    On the surface, this could be a case where they might need to reconsider their approach to communication: she needs to be more content and accomodating, and he needs to understand that using a sledgehammer to take out a wasp on his wife’s head is a very bad idea. He’s escalating things beyond all recognition, and that has put them in a very bad spot.

    They each have serious issues, but we need to first begin with getting to why Tim is providing disproportionate escalation, as that is the most imminent threat: if he keeps it up, he is heading for a domestic violence conviction and/or a divorce.

    Is that all due to the bipolar disorder? Is that his own dark depravity? Is it both? If so, in what proportion?

    But defusing that–which likely includes medication and/or some sort of professional therapy in addition to BC–is the emergent issue.

  2. I think also that certain men/women with issues of a psychiatric/medical conditions or personality traits shouldn’t marry. For certain people who are married its better that they not be married in the 1st place. Even if they are saved in Christ those conditions don’t go away usually unless miraculously.

    The best way to deal with most problems is preventing them from happening in the 1st place. Its not guaranteed but a lot of issues could be avoided.

    • There is a fine line there. Schizophrenia and perhaps other psychotic conditions could be prohibitive.

      Eating disorders aren’t the end of the world, provided she is serious about getting it under control. That can take time, but most bulimics I’ve known have recovered. Ditto for the 2 anorexics I’ve known.

      Bipolar disorder is a rough one; I’ve seen couples work through it–that included diligence on the medications–and I’ve seen some marriages end disastrously with one bipolar in the mix. I’ve known one marriage that ended in a suicide; he was bipolar and not diligent with taking his meds.

      If the two know about these matters going in, and get appropriate counsel regarding their risks and the importance of working hard to overcome those risks, it can be workable. But it is important to stress the gravity of the risks.

      Marriage is tough enough; adding particular mental illnesses jacks that up an order of magnitude.

      When I was single, I ruled out marrying a gal if I knew she was bipolar.

  3. “those red lines have not been crossed”

    What are those red lines, that Emily ends up in the hospital? Maybe twice?

    IMO, Emily draws the line. She is the one who will have to suffer the consequences when Tim hurts her. Men who are not in such danger should be VERY careful before telling those who are when they are ‘allowed’ to leave.

    • The red line is physical abuse. And when/if that happens, she needs to do the responsible thing and press the charges.

      Why must she do this?

      (a) without action, all I see is talk. Saying “he’s abusive” is not the same as going to the police and pressing the charges and seeing it through to conviction.

      (b) Any domestic violence conviction–even a misdemeanor–will cause him to lose his firearm rights. This is important if you wish to make it harder for him to commit violence with a firearm.

      (c) by pressing the charges, that gives him a record against which any future potential wives can evaluate the risks.

      (d) I hate to be cynical, but I have seen more than my share of crap accusations of “abuse” that, when you get down to it, are just code words for “I just want out of the marriage.” I’ve seen wives file for divorce, and then–after the fact–make up nebulous stories about how abusive he was in order to justify both the divorce and the subsequent remarriage,

      Again, my red line is physical abuse. And that needs to be reported to authorities.

      It’s the right way, and it’s the responsible way.

      And I would also challenge you to show me a Biblical precedent for a “preventative divorce”. I’ll stand by my statement on that.

    • What makes this a tough one is (a) we need to have a framework in which abused spouses have appropriate recourse, and yet (b) we must combat the culture of divorce that has taken over since the advent of “no-fault” divorce.

      Moreover, the Church, in the process, needs to more effectively deal with the larger issue of divorce and remarriage, as Jesus said some things on the matter that are very hard, and no amount of hermeneutical gymnastics will escape the hard line he laid down.

      With abuse, it’s a thorny issue. Only the hardest of hardcore fundamentalists–most of whom are in the IFB world–would say that an abused spouse needs to stay with her (his) husband (wife).

      The issue here, though, is what constitutes abuse. Shouting matches? Gawd I hope not, as almost every couple in world history has qualified as abusive if that is the case. I would contend that if you’ve been married for 6 months or more, and have not had at least one good all-out shouting match, then you aren’t doing it right. Happily-married couples will fight; they just don’t beat each other up, and they tend to not hold grudges that allow things to fester.

      For me, I draw the line at physical abuse. If he (or she) starts inflicting bodily harm, then I’d say that red lines have been crossed and, while the marriage may indeed be salvageable, it’s definitely on extremely thin ice.

      • Physical abuse is clearly defined and evidence thereby can be attained much more easily. It definitely can be prosecuted since we don’t tolerate assault in general society either.

        It also seems to indicate that crime never entirely follows stereotype. There are women who murder who according to statistics make up 10% of murderers yet only 2.9% of the 10% by women are punished:

        And then you note the instances of predators that do not look evil and can be quite charismatic.

      • ”I would contend that if you’ve been married for 6 months or more, and have not had at least one good all-out shouting match, then you aren’t doing it right. ”

        Have you seen such marriages with such a thing as you described last? With no shouting matches?

          • It’s all about the results. These included folks I knew from prior church lives, and two of them were from my seminary days.

            When I say “disaster”, I’m not talking about abuse, but rather divorce.

            These couples had no realistic expectations going in, and weren’t prepared to deal with even very basic disagreements that every couple is bound to have.

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