Guest post by David Powlison
The following video is Bob Newhart’s spoof of a counseling moment. It is a sheer delight. I trust you will heartily enjoy the fictional Dr. Switzer’s interplay with the fictional Katherine Bigman, and will forward it to all your friends. It is, of course, a takeoff on the “Dr. Phil,” “Dr. Laura,” cognitive-behavior therapy (CBT) that so dominates the American psychotherapy world.
Newhart’s wit also creates a perfect foil for understanding the contrast between what our world offers and the riches of biblical counseling. Here are a half dozen contrasts:
1. The Bible gives a vision for lifelong transformation and mutual aid—as well as for the 5-minute moment of insight, or the 5-week and 5-month seasons of change, or the 5-year unfolding movement of progressive transformation and deepening. “Encourage one another daily, as long as it is called ‘Today,’ that none of you may be hardened by the deceitfulness of sin.” The encouragements of the gospel of grace meet us again and again. They are always new-to-you in some way. Yet they always embrace the Christ who is the same yesterday, today, and forever.
2. Our Father never simply says “Stop it!” to the Katherine Bigmans or anyone else. He knows we can’t change on our own. We have a living Savior, who died to give us mercy and lives to give us grace in times of need. The Word willingly became flesh and dwelt among us. We simply are not able to “Just say No.” If we happen to say No to one self-destructive behavior, our self-absorption will merely express itself in another, perhaps less obvious, form of self-destruction. Jesus sympathizes with our weaknesses. He was tempted in all ways as we are, yet without sin. We need help from outside ourselves—and he helps. On our own, sins and miseries are fundamentally inescapable. The fear of being buried alive, the compulsion to self-induced vomiting, and the instinct to pursue destructive relationships are certainly first-order human miseries, confusions, and sins. Our Father’s “Stop” always comes with lots of ways, reasons, and help to “Go.”
3. Wisdom doesn’t speak in boilerplate. It’s never a one-size-fits-all formula. Or, contrary to the Christianese equivalent, it’s never 3-steps-to-Victory. So every psalm, every letter, every gospel, every prophet is different. The same redeemer God speaks and engages diverse people. And because the people face different problems and are prone to different struggles, his words and actions always come hand-crafted. Same with your words and actions. That’s what it means to counsel the living Christ to another. You might affirm one person, and challenge another, and teach another, and walk beside another, and listen to another, and weep with another . . . and do any or all of the above with the same person, depending. Such flexibility is not eclecticism. Wisdom from God is an appropriate, flexible, and timely wisdom. See 1 Thessalonians 5:14 and Ephesians 4:29 for starters.
4. Human responsibility is never by oneself and to oneself. It is always relational. For example, like all therapists, Dr. Phil meets with men and women whose lives are tragically wrong-headed and tragically alone. He, like Bob Newhart, sees the wrong-headedness. It’s easy to see that something’s wrong. But he doesn’t see—can’t see—that the person inhabits the barren-universe-of-self. The real world overflows with God and with opportunities to love others. But when you watch Dr. Phil counsel or when you meet with strugglers, that essential, desperate aloneness will break your heart. God awakens us first to see that we are not alone, drifting across an uncharted sea. “The fear of the Lord is the beginning of wisdom,” now and always.
5. To bluntly confront such a frightened struggler violates the ABCs of biblical wisdom: “comfort the faint-hearted, hold on to the weak, be patient with them all.” If Katherine Bigman were a conscienceless serial adulterer, filled with self-righteous bitterness, and aggressively blameshifing others for all her problems . . . then she’d be a candidate for “admonish the unruly.” But she presents herself as confused and needy. You’ll respond appropriately. Of course, warning and moral exhortation are facets of comprehensive wisdom. But biblical admonishment is premised on entirely different assumptions than the accusatory severities of a Dr. Phil. You hold out an entirely different hope for change. You are never hectoring. You never deliver personal threats. You never cast a person back on his or her own resources, as if flesh might tame unruly flesh. And you always hold out offers of mercy and hope to those who begin to take seriously what they look like to God. You always invite another person out of a life of futility and into a life positively worth living.
6. To counsel biblically is to fundamentally identify with the people with whom you converse. “Let anyone who thinks that he stands take heed lest he fall. No temptation has overtaken you that is not common to man” (1 Cor. 10:12f). Katherine Bigman is a struggler, but she is not a nut. Which of us does not instinctually live in bondage to the fear of death? Or self-destructively worry about how we compare with other people and what they think about us? Or make a significant contribution to unfruitful relationships? To sympathetically identify with another is to become able to love. Only a man ignorant of our common humanity would ever lecture a struggler to shape up. The essential dynamic of biblical counseling is always tender and personal. “The God and Father of our Lord Jesus Christ . . . comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted by God” (2 Cor. 1:4). “He can deal gently with the ignorant and wayward, since he himself is beset with weakness” (Heb. 5:2).
And so forth. Don’t ever think that biblical counseling is just CBT dolled up with some Bible verses. And “Stop it!” if you ever treat people that way! Wisdom is a wonderfully different creature. When our Father stops us from doing something wrong, he always starts us walking along a delightfully different path.
[I originally post this in 2007. One commenter thought that Dr. Powlison was building a straw-man and sought to defend cognitive-behavior therapy (CBT). For those interested in going a bit deeper, keep reading below the jump:
I can see how my post can be taken as a “straw man” argument. Perhaps the difficulty comes in my attempt to combine humor with seriousness. I intended the video to be purely humorous and enjoyable. Of course Bob Newhart does not give an adequate representation of any real therapy. It’s only a takeoff.
But like all good humor, it has a point. And that point was only my starting point for making positive points about biblical ministry. (And high-level criticisms of Dr. Phil and even the most sophisticated CBT. They have essential commonalities at the level of worldview and change dynamic, though they have many secondary differences.)
I do question several things in the second half of Elliot’s post. He raises points that many people raise, and I hope a careful answer can be helpful in clarifying some very important matters:
CBT has been proven to be decidedly successful in treating symptoms of anxiety and clinical depression, something for which Biblical counseling alone is unfortunately not very effective. However, I do think Biblical counseling can play a great role in addressing the causes of those disorders, an area that CBT specifically chooses not to enter into.
First, it’s important to recognize that any number of things can treat symptoms successfully. Give your life to some cause (any cause). Get better exercise. Cut out the caffeine. Hang out with more constructive friends. Volunteer to help needy people. Take a vacation in a beautiful place. Become a Hindu or Buddhist, and learn calming meditation techniques. Take psychoactive medications. Become schooled in ANY therapy. Any organized worldview and constructively purposeful lifestyle “works” better than a disorganized worldview that has no sense of bigger meaning and purpose. If I had to choose from that list of options for managing a fallen world in a psychologically-successful way, I’d pick Buddhism combined with finding a good cause. But God wants us to become part of his redemption of a fallen world, not simply to manage our reactions. And God calls us to give ourselves to the best cause. So wise biblical counseling will “treat symptoms” effectively, but on a more substantial foundation.
Second, symptom alleviation, per se, is never proof that something is right and true. For example, any and all therapies can teach you to manage your emotions and make better choices. They all tend to be “ascetic”—calling you to step back from the morass of experience and instinctive reactions. They teach you categories to reinterpret your life and experience. In other words, all therapies are theological and ministerial. CBT’s particular practical theology alleviates symptoms by teaching people Stoic philosophy. (Martha Nussbaum’s The Therapy of Desire gives a wonderful scholarly treatment of the “discipleship” processes of the Stoics and other Greek philosophers.) The Stoic world view disciples you to be less upset by what’s happening to you. How? You become more internally centered on self-reliance, and retain a certain detachment from what happens to you. You become more “philosophical,” rather than becoming swallowed up in the disappointment, angst, anger, and fear caused by disappointed desires. That’s one kind of discipleship.
Christianity disciples you a different way. Christ teaches us to be more engaged with what’s going on, and with what’s wrong, but to view it and engage it through the eyes of redemptive love in Christ. We don’t quell our desires (the apatheia of Stoicism); we turn from the rule of our desires to the rule of God. Thus we redeem and retune our desires to function as they are meant to function. Wise biblical counseling also “successfully treats symptoms of anxiety and clinical depression,” but via a dynamic that generates faith and love, not a dynamic of self-reliance.
Third, CBT is certainly one option in the supermarket of ways to feel somewhat better and be less upset by life. It happens to be the option of choice currently, but if history is any guide (and it is!), that hegemony will eventually fade as the flaws in CBT become widely obvious to the culture, and something else appears more compelling. But, sticking with our cultural moment, what is the cash-value of a form of symptom-alleviation whose essential process is to inculcate a more psychologically-successful form of “leaning on your own understanding”? It does not teach a person to “trust in the Lord with all your heart,” to live in relationship to Him-with-whom-we-have-to-do. So it calms people down, but at the cost of becoming anesthetized to fundamental realities. By contrast, the psalms can be very upset – filled with anguish, anxiety, apprehension, pain—but it is an upset qualified and shaped by faith and love. So the psalms also know the peace-in-relationship of psalms 23 and 131, and the relational joys of the royal psalms and the hallulujah psalms. Psalms are far more “psychologically healthy” than a successful CBT patient, whose equanimity is successfully self-referential. And of course they are far more “psychologically healthy” than a prospective CBT client who is a nervous wreck, whose upset is unsuccessfully self-referential.
Fourth, I think it’s a mistake to think we can detach symptom alleviation from what any therapy/cure is doing at the level of the human heart. CBT in fact does “enter into the causes,” but in a way pointedly contrary to Christian faith. Any professed cure has implications for the heart’s loyalties and trusts. But a biblical gaze helps us see how Stoicism misdisciples the human heart into a false trust. False trust in a false message is why CBT “works.” No therapist of any kind can escape being an evangelist for what he or she believes is true. In CBT you feel better because you trust yourself more, and affirm your basic OKness more consistently. That’s entering into causes (unwittingly, while pretending that your answer is “objective/realistic,” and that you are theologically neutral). CBT carefully rewrites the inner script by making autonomy from God more successful and less frustrating.
Finally, I’m not sure what Elliot means by “biblical counseling alone.” I suspect he means citing Bible verses, doing Bible study, practicing the means of grace (prayer, preaching, sacrament, worship, small groups, accountability). (???) But to reduce wisdom to religious activities and theological words is exactly what actual biblical counseling aims to blow up and rebuild. Such spiritualizing is why the church usually lacks a vision for real counseling ministry, and thus is so vulnerable to things like CBT that pretend to operate in a different sphere (“symptoms,” not “causes”). If biblical counseling is a comprehensive wisdom, just as CBT is a comprehensive wisdom (founded on a different faith), then why can’t wise biblical counseling accomplish everything CBT accomplishes—and far more? It will do so on a sound rather than faulty basis, creating reliance on Christ rather than reliance on self. If something really deals with causes, it will also deal with symptoms, by definition. Morphine eases the pain of cancer; removing the tumor also eases the pain of cancer. If our worst cancers are operable by the means of mere words communicated in a relationship of trust, then why not skillfully employ the words of Christian faith rather than the words of Stoic faith?