PTSD, Memories, and Biblical Counseling

Traumatic events including war, active shooter incidents, stabbings, bombings, hijackings, natural disasters, and violent crime happen all too frequently. They affect not only military personnel and first responders, but also innocent bystanders, students, church members, and employees. Anyone can be impacted by a traumatic event. They are not predictable and are very devastating to those affected. It is the thesis of this author that the Bible is sufficient for ministry to those impacted by trauma and that the church in general, and biblical counselors in particular, should be prepared for and even seek out opportunities for ministry in such contexts.¹John Babler, Biblical Crisis Counseling: Not If, But When. (Scotts Valley: CreateSpace Independent Publishing Platform, 2014).

Additionally, almost anyone who struggles with the aftermath of a traumatic event will have some difficulty and concerns with memories of the event. Biblical counselors who understand traumatic events in general, and who have considered the biblical teaching on memories can provide effective counsel to those struggling with trauma. In this paper the author will present examples of actual traumatic events, provide an overview of the world’s approach to such events, and then suggest a model through which Christians can minister effectively to those who have been impacted by trauma.

It Can Happen Anywhere 

It was a typical Friday toward the end of the school year when the shots rang out in the suburban Texas high school. When the school district assistant police chief heard the shots, he quickly ran from the front of the school towards the area where he believed the shots were being fired. As he got to the end of the hallway, he carefully looked around the corner and saw the shooter and the barrel of his gun. A shotgun blast rang out, shattering the glass window just a few feet behind him. A second blast was fired and hit in the same area. The assistant chief realized that he needed to move to a place of cover. As he ran down the hallway the shooter shot at him again, this time through the door of the classroom as he ran by, and missed him for the third time. He found cover a few feet down the hallway and the next time he looked out he noticed a S.W.A.T. team stacked at the end of the hall where he had just been. Since his uniform that day did not obviously distinguish him as a police officer, he was concerned that he might be hit by “friendly fire.” While the S.W.A.T. team was attempting to address the shooter, he ran down the hall the other way to silence the fire alarm that had been set off and was adding to the chaos. After he silenced the alarm he circled back to his original position and found that one of his officers had been shot in the upper arm. The officer had been hit in an artery and was bleeding profusely and running around. The assistant chief slowed him down and then put a tourniquet on his officer’s arm to stop the blood flow. The assistant chief was not alone in dealing with this traumatic incident as his wife was a captain of a neighboring police department and was on the scene as well. One can imagine that such an experience would bring about significant physical, emotional, mental, and spiritual challenges. 

It was early one morning in a Fort Worth, Texas neighborhood when a young mother home with her two daughters heard a noise. As she listened further she thought someone was outside her home. She called her husband and asked him to come home from work. She continued to hear noises and realized that someone was trying to break in the house. With 911 on the phone she took her two daughters and retreated into a closet in the bedroom where she was able to access a handgun and lock the door. She placed the baby in a dresser drawer and had the older girl sit on the floor in a corner of the closet. It was not long before they heard the intruder jiggle the handle on the closet. She told him that if he opened the door, she had a gun and would shoot him. He stepped away from the door and went into another room apparently waiting to see if she and the girls would come out. The sirens of the approaching police cars motivated the intruder to leave and just as the husband pulled up in front of the house the intruder was fleeing out the front door. While no one was physically injured, the family was impacted dramatically. 

At home, at school, and even at church traumatic events can occur without the slightest warning. One of the biggest challenges faced by those experiencing trauma is in the area of memories. Memories of the event(s) can become pervasive and debilitating. Biblical counselors have much to offer in these situations. 

The World’s Wisdom 

Trauma is recognized by many in the world as a significant issue that can have serious effects. Due to factors such as the prominence of live media coverage for traumatic events, the increased frequency and severity of large-scale traumatic incidents, and a greater awareness of such incidents by people in general, there is a growing focus on helping people deal with trauma.²Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. (Leicester: Gaskell and the British Psychological Society, 2005). There also seems to be a growing expectation that people who experience traumatic events are going to have significant struggles processing and recovering from the events.³Trauma, including one-time, multiple, or long-lasting repetitive events, affects everyone differently. Some individuals may clearly display criteria associated with Post-Traumatic Stress Disorder (PTSD), but many more individuals will exhibit resilient responses or brief subclinical symptoms or consequences that fall outside of diagnostic criteria. The impact of trauma can be subtle, insidious, or outright destructive. How an event affects an individual depends on many factors, including characteristics of the individual, the type and characteristics of the event(s), developmental processes, the meaning of the trauma, and sociocultural factors.” Trauma-Informed Care in Behavioral Health Services. (Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2014). The world has categorized such difficulties under the umbrella diagnosis of Post-Traumatic Stress Disorder (PTSD). PTSD is a formal diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but is also frequently used informally as a label for people who have experienced trauma themselves or who have been involved in or witnessed one or more traumatic events.⁴Diagnostic and Statistical Manual of Mental Disorders: DSM-5. (Arlington, VA: American Psychiatric Association, 2017.)

The DSM-5 can be intimidating and mysterious to those untrained in the behavioral sciences. The criteria from the DSM-5 that lead to a diagnosis of PTSD are not complex and an awareness of them can be useful for the biblical counselor. The author presents them here so that the reader will be familiar with how the formal diagnosis is made and have a working knowledge of the world’s diagnosis. The DSM-5 categorizes PTSD under the heading of Trauma- and Stressor-Related Disorders. The diagnostic criteria for Post-Traumatic Stress Disorder are as follows:

Post-Traumatic Stress Disorder 

Note: the following criteria apply to adults, adolescents, and children older than six years. For children six years and younger, see corresponding criteria below.

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the

following ways: 

1. 1. Directly experiencing the traumatic event(s). 
   2. Witnessing, in person, the event(s) as it occurred to others. 
   3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
   4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related.

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic events occurred:

1. 1. Recurrent involuntary, and intrusive distressing memories of the traumatic event(s). 

Note: in children older than six years repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. 

1. 2. Recurrent distressing dreams in which the content and/or effect of the dream are related to the traumatic event(s).

Note: in children, there may be frightening dreams without recognizable content. 

1. 3. Dissociative reactions (e.g., Flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)

Note: in children, trauma specific reenactment may occur in play. 

1. 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

1. 5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic events.

C. Persistent avoidance of stimuli associated with the traumatic event(s) beginning after the traumatic event(s) occurred as evidenced by one or more of the following:

1. 1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). 
   2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). 

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 

1. 1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). 
   2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am not bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”). 
   3. Persistent, distorted cognitions about the causal consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. 
   4. Persistent negative emotional states (e.g., fear, horror, anger, guilt, or shame). 
   5. Markedly diminished interest or participation in significant activities. 
   6. Feelings of detachment or estrangement from others. 
   7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

E. Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

1. 1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. 
   2. Reckless or self-destructive behavior. 
   3. Hypervigilance. 
   4. Exaggerated startle response. 
   5. Problems with concentration. 
   6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). 

F. Duration of the disturbance (criteria B, C, D, and E) is more than one month. 

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 

One of the ongoing challenges in the field of biblical counseling is how to appropriately respond to and interact with the behavioral sciences.⁵“Serious questions arise concerning the true scientific nature of psychology as greater reliance is placed upon the so-called “behavioral” sciences. Much of the espoused scientific evidence is no better than opinion research.” John MacArthur, Think Biblically! Recovering a Christian Worldview. (Crossway: Wheaton. 2003). Anyone who has worked with men and women in the military or emergency services, individuals who would be most frequently exposed to traumatic events and most likely to struggle with them, could affirm that they know many who exhibit at least some of the symptoms described above in the DSM-5 diagnosis.⁶Bret A. Moore and Walter E. Penk, Treating PTSD in Military Personnel, Second Edition: A Clinical Handbook. (New York: Guilford, 2019.)The fact that the PTSD diagnosis to some degree accurately describes people who have been exposed to traumatic events indicates that the behavioral sciences can be helpful to biblical counselors at a descriptive level. One task of those in the behavioral sciences is to observe human behavior.⁷Jonas Ramnero, ABCs of Human Behavior: Behavioral Principles for the Practicing Clinician. (Oakland: New Harbinger Publication, 2011.) Research observations made by studying those impacted by trauma can provide helpful information. 

While we may be able to benefit from such descriptive data, biblical counselors should recognize the impact of sin upon one’s observations and even upon one’s motive to observe or study specific symptoms. This reality should cause us to be appropriately skeptical of even descriptive data from the behavioral sciences.The secular world has been devoting time and resources to identify those who struggle with dealing with traumatic events.⁸“Post-traumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported “most serious” traumas.” Ronald C. Kessler, “Posttraumatic Stress Disorder in the National Comorbidity Survey.” Archives of General Psychiatry 52, no. 12 (1995): 1048. Considering the observations (descriptive data) of those who have studied people in the military and emergency services and how they react to and struggle with traumatic events can be helpful to biblical counselors.I do not wish to disregard science, but rather I welcome it as a useful adjunct for the purposes of illustrating, filling in generalizations with specifics, and challenging wrong human interpretations of Scripture, thereby forcing the student to restudy the Scriptures. However, in the area of psychiatry, science largely has given way to humanistic philosophy and gross speculation.” Jay Adams, Competent to Counsel. (Grand Rapids: Zondervan, 1986). Such observations should help us recognize that the church needs to be prepared to address traumatic events, not only with those in the military and emergency services, but also with those who less routinely deal with traumatic events. Many of these individuals are in our churches and communities.

The problem with the behavioral sciences is that they move beyond the descriptive task of observation to the prescriptive task of attempting to resolve the issues being observed.⁹“The distinction that must be maintained between the two branches of psychology is the difference between descriptive psychology and prescriptive psychology (counseling or clinical psychology). One involves the study of the soul; the other involves its cure. One merely describes human behavior; the other prescribes its therapy.” Lou Priolo, “Presupposition Four: The Bible and Psychology,” The Journal of Modern Ministry 2, no. 1 (2005). In the case of what is identified as PTSD, while the observations may be beneficial, the prescriptive values are antithetical to biblical teaching. Theories in the behavioral sciences include not only observations of people—they also posit methods of how to treat such people. It is important to note that method is not neutral and so we should avoid attempting to “parse” some “appropriate or acceptable” techniques out of the psychological prescription. There are many competing theories and little agreement as to which prescriptive theory is best or most effective. 

In 1980, PTSD was included as a diagnosis in the DSM-III.¹⁰American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders III. (Washington, D.C.: American Psychiatric Association, 1985). 12Jeffery Mitchell, “When disaster strikes … The critical incident stress debriefing process.” Journal of Emergency Medical Services 13, (1983). Jeffrey Mitchell wrote an article in 1983 in the Journal of Emergency Medical Services introducing the idea of critical incident stress debriefing.¹¹Jeffery Mitchell, “When disaster strikes … The critical incident stress debriefing process.” Journal of Emergency Medical Services 13, (1983).Mitchell and George S. Everly Jr. developed the international critical incident stress foundation and began to offer formalized training in what became known as critical incident stress management (CISM).¹²Mitchell, Jeffrey T., and George S. Jr Everly. “Critical Incident Stress Management and Critical Incident Stress Debriefings: Evolutions, Effects and Outcomes.” Psychological Debriefing (1983). This approach of dealing with and attempting to prevent PTSD is focused primarily on emergency responders and then expanded and developed classes for businesses, schools, and airlines. CISM became a staple in the emergency services and was frequently offered or mandated for those who responded to traumatic calls.¹³Everly, George S., and Jeffrey T. Mitchell. Critical Incident Stress Management -CISM: A New Era and Standard of Care in Crisis Intervention. (Ellicot City, MD: Chevron Pub., 1999.) It resulted in an organization known as the International Critical Incident Stress Foundation (ICISF) that provides and facilitates training in the Mitchell model.¹⁴“About Us.” ICISF. Accessed July 6, 2019. https://icisf.org/about-us/. A similar treatment approach for victims was developed by the National Organization of Victims Assistance (NOVA). Both approaches are still broadly used today. In 2003 Brian Bledsoe wrote an article in a different EMS publication stating unequivocally that CISM is ineffective.¹⁵Brian Bledsoe, “EMS Myth #3: Critical Incident Stress Management (CISM) Is Effective in Managing EMS-Related Stress.” EMS World. Last modified December 1, 2003. Accessed July 6, 2019. https://www.emsworld.com/article/10325074/ems-myth-3-critical-incident-stress-management-cism-effective- managing-ems-related-stress.  He cited research that showed that debriefings were neutral at best, but might even cause people’s PTSD to be extended.¹⁶New South Wales Health Department. Disaster Mental Health Response Handbook: An educational resource for mental health professionals involved in disaster management. NSW Health Department, Sydney, NSW, 2000, www.nswiop. nsw.edu.au. 

Bledsoe recommended that instead of debriefings, emergency services workers should be provided psychological first aid.¹⁷“The last thing we want to do is provide a service that may actually harm our colleagues. Like many archaic and anecdotal EMS practices, CISM is a bad idea and does not work. Let’s put it behind us and practice, instead, simple psychological first aid” Bledsoe, EMS Myth #3. He suggested that psychological first aid should include listening to concerns, conveying compassion, assessing needs, ensuring that basic physical needs are met, and keeping the person from further harm. In 2006 a section of the Department of Veterans Affairs developed a formal program to help those with PTSD called psychological first- aid.¹⁸“Psychological First Aid: Field Operations Guide: 2nd Edition.” PsycEXTRA Dataset (2006). While many in the field have embraced and are committed to psychological first aid, the ICISF and NOVA continue to offer training and present research to defend the effectiveness of their approaches. 

Even this brief overview of significant research shows there is disagreement and changing perspectives in the world’s assessment of what is labeled PTSD. The descriptive research may be helpful, but the prescriptive suggestions for how to treat those suffering from traumatic incidents is not unified. There continues to be debate among practitioners and researchers in the field as to whether CISM or Psychological First Aid is more effective. At the end of this paper, the author will present a biblical model of crisis counseling that will enable the biblical counselor to minister effectively to those suffering from trauma. 

Memories 

Memories are a significant part of PTSD. This can be seen in the DSM-5 criteria and through basic observations of people who have experienced traumatic events. Research into memories and PTSD reveals a number of theories. The National Institute of Health completed a study attempting to determine whether memory deficits after a traumatic event were caused by PTSD or if there are pre-existing memory deficits that serve as a risk factor for the development of PTSD following trauma exposure.¹⁹Kristin W. Samuelson, “Post-traumatic stress disorder and declarative memory functioning: a review.” Dialogues in clinical neuroscience vol. 13,3 (2011). The conclusion of the study was that it is likely that memory dysfunction is both a pre-existing risk as well as a consequence of the disorder. 

A Psychology Today article in 2016 by Nathan Lents related a study where subjects were shown graphic scenes of traumatic events but some of the scenes had been removed leaving some gaps in the details.²⁰Nathan Lents. “Trauma, PTSD, and Memory Distortion.” Psychology Today. (Sussex Publishers, 2016.) The participants scored well on their recognition and remembrance of scenes that they had viewed, but many also “recognized” scenes that they had not seen. Some participants reported symptoms similar to PTSD just from watching the videos. In another study Karim Nader, a neuroscientist at New York University, was able to use a chemical that inhibited protein synthesis in a group of rats to cause them to forget a “memory.”²¹Karim Nader. “Memory as a new therapeutic target.” Dialogues in clinical neuroscience vol. 15,4 (2013).This study has led to some (overconfident) anticipation that in the not-too-distant future a pill can be developed to help people forget thoughts that are troublesome.²²Jonah Lehrer. “The Forgetting Pill Erases Painful Memories Forever.” Wired. (Conde Nast, July 12, 2018.)  

While the DSM diagnostic criteria do present descriptive data, does the person who meets the criteria for the diagnosis actually have a mental disorder? Is there a better biblical description or label? Finally, is it possible that someone who meets the diagnostic criteria might not be impaired, but exhibiting normal responses to trauma? The author would argue that while PTSD is a common term used within the culture, wide use and acceptance of the term in biblical counseling might be counterproductive. It may bring a victim mentality to those dealing with trauma and eclipse normal reactions to serious trauma. Rather than focusing on PTSD the focus should be on whether a Christian is pleasing God and obeying His Word. 

By definition, those who are struggling with symptoms of what is labeled PTSD have experienced a traumatic event.²³DSM-5. This reality may make it difficult for those who want to help, as they wonder if they are competent. Whether biblical counselors or not, for those who have experienced little trauma in their lives it is easy to conclude that people need help from someone who has experienced such things or who has received specialized training. With the prominence and severity of bad memories, those who want to help may feel insecure. It is a common mistake for those new to biblical counseling to allow the problem or the counselee to eclipse and distract them from the truth and sufficiency of God’s Word. 

Focusing on the person or the problem rather than on God and His Word is very tempting. Helping people who struggle with truly traumatic issues can induce even the most experienced biblical counselor to be distracted from the task of ministering Scripture. Instead there is temptation to focus on the situation and circumstances surrounding the counselee. When biblical counselors help people handle bad memories from trauma it is important to remember that no matter how horrific the trauma, God’s Word has answers. Under the guidance of the Holy Spirit the counselor can provide answers, direction, wisdom, and comfort through Scripture. 

While memories resulting from trauma are significant and can become life-dominating, Scripture teaches that people are not powerless over their thoughts, but Christians can take all thoughts captive and obey Christ.²⁴2 Corinthians 10:5b It is common to hear people after traumatic events say they cannot quit thinking about the incident. Since we are not powerless over our thoughts, biblical counselors can help counselees learn that they can take thoughts captive and teach them how to do so.

It’s a Heart Issue 

Memories may be very challenging and prominent to those dealing with trauma and they should not be minimized. They can, however, be a distraction from the real issue. As Henry Brandt said, “the heart of the problem is the problem of the heart.”²⁵Henry Brandt, and Kerry L. Skinner. Heart of the Problem Workbook. (Nashville: Broadman & Holman, 1998.) When counseling those struggling with memories related to trauma the counselor must be careful not to focus primarily on the traumatic event or memories, but rather on God and His Word. The traumatic memories can be a distraction from God and His Word. The traumatic event and memories are very significant and often counselees need intense support. The biblical counselor should take advantage of being a part of the church. The church is a body and while the counselor works on assisting the counselee with God’s Word, others in the body should be called upon to assist, serve, and encourage the counselee. This can free the counselor to help the counselee focus on heart issues he or she may need to address. 

Ministry to someone struggling with bad memories needs to go beyond the counseling room and formal biblical counsel to include other members of the church with a goal of ministering to the whole person and frequently his or her family as well. While a major role of biblical counselors is to lovingly confront those who are in sin and call them to repentance, they also realize that in a fallen world people can face significant crises that are not a direct result of their own personal sin (Job 1-2). In such cases biblical counselors purposefully and patiently walk with, serve, love, encourage and help those suffering, calling upon others in the church to assist based on their gifts and roles.²⁶John Babler and Nicolas Ellen ed., Counseling by the Book (Fort Worth, TX: CTW, 2014.) There are significant emotional, physical, and spiritual challenges that come with ministry to those who have experienced trauma. Utilizing others in the church to assist the biblical counselor can be very helpful to the counseling process. 

Normalize that which is Normal 

The author has found that a major task in helping people after traumatic events is to normalize many of the thoughts and emotions that they are experiencing.²⁷John Babler. Biblical Crisis Counseling: Not If, But When (Fort Worth, TX: CTW, 2014. Culture encourages people who have struggles both minor and major to seek out a diagnosis. A diagnosis is believed to be helpful or necessary for people to understand their struggle. It is also believed to be foundational to recovery from the issue. Such an emphasis has resulted in over-diagnosis that negatively impacts the field of psychiatry.²⁸As the editor of the DSM IV, Allen Frances’ comments are important. “Even though we had been boringly modest in our goals, obsessively meticulous in our methods, and rigidly conservative in our product, we failed to predict or prevent three new false epidemics of mental disorder in children—autism, attention deficit, and childhood bipolar disorder. And we did nothing to contain the rampant diagnostic inflation that was already expanding the boundary of psychiatry far beyond its competence.” Allen Frances. Saving Normal: An Insider’s Revolt against out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. (New York: William Morrow, 2014) He argues that in the midst of the diagnostic inflation prominent in psychiatry, the concept of normal has been lost.²⁹Allen Frances. Saving Normal: An Insider’s Revolt against out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. (New York: William Morrow, 2014) In the author’s experience in trauma ministry, only a minority of people who struggle with significant traumatic events have ongoing challenges that require long-term, intensive help. Most people need encouragement and support as well as assurance that what they are experiencing is normal. For example, it would be more concerning if someone who experienced an event like those cited at the beginning of this paper was not struggling with memories of the event. When something out of the ordinary, especially as significant as trauma, occurs a natural response is to try to understand the issue, why it happened, and whether it might happen again. It is natural to attempt make sense out of it. 

Lt. Col. Dave Grossman trains military and law enforcement personnel to help prepare them for the challenges specific to their jobs. The biggest challenge they may face is the fact that they might have to take someone else’s life. Grossman’s research on killing (he calls Killology) and his resulting books, On Killing and On Combat, present information on the typical physiological and psychological responses people exhibit to killing specifically and to trauma in general.³⁰Dave Grossman, and Loren W. Christensen. On Combat: The Psychology and Physiology of Deadly Conflict in War and in Peace. (Millstadt, IL: Warrior Science Pub., 2008); Dave Grossman, On Killing: The Psychological Cost of Learning to Kill in War and Society. (New York: Little, Brown and Co., 2009.) His goal is to help military and law enforcement personnel prepare for the unseemly possibility of having to take someone’s life, as well as to help them be aware of likely reactions that they may have before, during, and after such an event. In On Combat, he addresses the issue of memories and PTSD. One of the first things he emphasizes is that it is possible to be involved in a traumatic event and not suffer PTSD. This is illustrated in history as the Old Testament provides examples of many people who were regularly subjected to traumatic incidents and apparently did not suffer debilitating symptoms. 

Millions in the military encountered horrific and repetitive trauma during World War II, but the vast majority of them did not develop the symptoms of what is now labeled PTSD. They may have had a variety of struggles, but most were able to work through them. To help people understand, Grossman used the illustration of a woman who had been married fifty years when her husband died. It takes time for the woman to grasp the reality of the loss of her husband— after all there had been decades of memories, habits, and communication. For a time she may weep uncontrollably when his name is brought up in conversation and she might even set a place at the table for him for a few days after his death.³¹Grossman, On Combat: the Psychology and Physiology Biblical counselors should recognize and understand that it will take time for her to adjust to the reality of her husband’s death after many years of marriage. 

Grossman emphasizes the fact that a traumatic event can have a similar, significant impact on one’s life and that it will take time to adjust to the reality that the trauma has occurred. Grossman argues that there are many normal, expected responses to having dealt with trauma including reliving or re-experiencing the event. People should not only be made aware of the fact that memories of a traumatic experience are normal but be taught how and what to do should they have these memories.³²Grossman, On Combat: the Psychology and Physiology  

Helping with Memories: Foundation 

Biblical counselors are uniquely prepared to teach people what to do when they have memories of a traumatic event. Normalizing the fact that they are having such memories, the counselor should first pay attention to the importance of a strong foundation for the counselee’s life. 

Traumatic events and the stress that accompanies them impacts and disrupts lives. Schedules change, priorities adjust, and new questions arise. Such disruptions and changes can frequently have a negative impact on one’s relationship with God. Before or in conjunction with teaching about how to deal with memories, the counselor should remind the counselee of the most important aspect of the Christian life. In Matthew 22, Jesus answers a question and clearly teaches what is most important in life: 

“Teacher, which is the great commandment in the Law?” And He said to him, “‘You shall love the Lord your God with all your heart, and with all your soul, and with all your mind.’ This is the great and foremost commandment. The second is like it, ‘You shall love your neighbor as yourself.’ On these two commandments depend the whole Law and the Prophets. (Mt. 22:36-40, NASB) 

God’s Word is clear about the foundational priorities for the Christian. Even amid trauma and crisis, biblical counselors need to lovingly remind counselees of the fact that their relationship with God is to be the priority of their lives. Asking questions about the state of their relationship with God and providing practical homework assignments is a vital precursor to dealing with bad memories. 

God-centered love does not stop at a mere recognition of its importance. It must be lived out in the daily routine of life. Most Christians could correctly answer the question, “What did Jesus say was the most important commandment?” but have never even considered what it means for day- to-day living. Many have not considered the fact that it is even a command. To disobey it is sin. What does it look like to love God with all our heart, soul and mind? How does one’s commitment to obeying the Great Commandment affect his response when challenged by crisis, depression, “burn out,” or overwhelming grief? Counselors must help those they counsel work out the daily practical application of loving God with all their heart, soul, and mind. Homework assignments that focus the counselee’s attention on God are vital. Such assignments include Bible study, purposeful prayer, and spiritual journaling. 

At the appropriate time, the counselor should challenge the counselee to prayerfully consider what practical love for their neighbors looks like as well. What does it mean to love your neighbor, even amid bad memories from trauma? What if loving them requires a personal sacrifice? As the counselee grows, these and other questions can be addressed as part of the counseling process as the counselor helps the counselee discover the answers in Scripture.

Helping with Memories: Teaching 

One of the primary tasks of a Biblical counselor is to teach. Scripture provides a vast treasure of wisdom appropriate for counseling people struggling with bad memories. After at least beginning to address the foundational issues presented by Jesus in Matthew 22 the following points of Biblical teaching should be considered. 

It is not unusual for even mature believers to have questions about God after having gone through significant trauma. After introducing Jesus’ teaching to, “. . . love the Lord your God with all your heart, and with all your soul, and with all your mind”³³Matthew 22:37 it is very natural to ask the counselee about his or her understanding of God in the aftermath of the traumatic event(s). Jesus’ commandment to love God is a good way for the counselor to address the counselee’s theology of God. In the context of trauma, Psalm 139 can be particularly apropos for the counseling task as it reveals God’s love, His sovereignty, His knowledge, and His intricate involvement in our lives. It is long enough to allow ongoing use throughout the counseling relationship and it can be useful in introducing the importance of the heart. Psalm 23 is also valuable as the counselor can use this very familiar chapter of Scripture and teach through the significance of God being a loving Shepherd and discuss this in light of the trauma and resulting memories. 

Teaching that counselees are not powerless over their thoughts is a very liberating aspect of what the biblical counselor can offer one struggling with bad thoughts after trauma. The Bible teaches that believers can take every thought captive (2 Cor. 10:5b), and this has been both surprising and encouraging for counselees. This idea of taking thoughts captive to the obedience of Christ is presented in the context of spiritual warfare (2 Cor. 10:3-5a) so in helping the counselee learn the process of taking thoughts captive, the counselor can introduce the teaching on the armor of God in Ephesians 6:10-17. Teaching specific ways counselees can take thoughts captive built upon the truths of Ephesians 4:20-22 will help give hope as well as a focal point of work for counselees. This goes far beyond the efforts most counselees have made to stop thinking the intrusive thoughts by willing themselves to stop. The idea of putting off thoughts, being renewed in the spirit of the mind, and putting on thoughts that honor God can allow the counselor to suggest and monitor the counselee as he or she works with God’s help to overcome memories. 

Techniques can include consciously and prayerfully replacing thoughts with Scripture, God honoring music, prayer, fellowship with others, or intense conversations with the counselor or other mature believers who know about the situation. Depending on the severity of the symptoms and how recent or severe the trauma is, it can also be important to make sure that the counselee does not have extended time alone with nothing to accomplish. As a reminder, ministry and teaching done in the aftermath of traumatic situations should include multiple people from the church body to assist the counselor. 

An overarching challenge and goal of ministering to people who have memories of trauma is to help them take the focus off the trauma and themselves. Reminding them they have hope is important. Romans 8:28-29 can be used to help them see that God will bring good out of evil— specifically that they will become more like Christ. Romans 15:4 ties hope specifically to Scripture and is a good verse to work through as well. As mentioned earlier, the Bible is a treasure of wisdom for helping those struggling with bad memories resulting from trauma. The suggestions in this paper are designed to serve as illustrations and suggestions to assist other biblical counselors in becoming confident and competent in helping people in very challenging situations. 

Helping with Memories: A Model 

In September 1999 a gunman interrupted a See You at the Pole (SYATP) rally at Wedgwood Baptist Church in Fort Worth, Texas. He killed 7 and wounded 7. The author had the opportunity to minister and provide counsel to many after this traumatic event. After ministering in the aftermath of that tragedy, the author and his colleague, Dr. David Penley began the process of searching the Scriptures to see what could be learned about ministry amid trauma and crisis. A ministry model was developed that can be helpful as an overarching schema for biblical counselors ministering to those struggling with bad memories from trauma. 

The model is presented below: 

Foundation – Effective Biblical ministry to those impacted by trauma should be based on four foundational principles. The ministry must be: 

1. Biblical. That is, it must focus on glorifying and honoring God (1 Cor.10:31), and 

recognize that Scripture is sufficient for ministering to those dealing with trauma as well as superior to the any of the world’s approaches. It recognizes and purposefully pursues the ultimate, eternal values of evangelism for the lost and discipleship for the saved, while being sensitive to people and context. 

2. Relational. Biblical ministry focuses on relationships—both loving God and loving neighbor (Mt. 22:36-40). The relationship with those being ministered to is not a professional/client relationship, but rather a discipling relationship modeled after Jesus’ example. 
3. Comprehensive. The focus of a Biblical response is ministering to the whole person. If 

a person needs food, clothing, or shelter the appropriate response is to do everything possible to provide for them, in Jesus’ name. 

4. Practical. A Biblical response is hands on, challenging, sometimes messy, and does not hide behind supposedly helpful platitudes. It is not, “Take two Scriptures and call me in the morning.” 

Tools of Ministering to those Impacted by Trauma – Based upon this foundation are five ministry activities to assist those in crisis. They are showing compassion, listening, serving, ministering Scripture, and praying. As you read the brief descriptions of each of these ministry activities below, consider the implications of the four foundational principles above (biblical, relational, practical, comprehensive).

Showing Compassion – Jesus’ life provides our example for true compassion. He left Heaven to walk among humans. He saw the people and recognized their need. He was moved with compassion and motivated by love. He took action to help. 

And the Word became flesh and dwelt among us… John 1:14 

Seeing the people, He felt compassion for them because they were distressed and dispirited like sheep without a shepherd. Matthew 9:36 

When He went ashore He saw a large crowd, and felt compassion for them and healed their sick. Matthew 4:14 

Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who 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 Corinthians 1:3-4 

Rejoice with those who rejoice, and weep with those who weep. Romans 12:15 

Listening – God’s Word teaches us that it is wise to listen. Jesus’ example shows us that asking questions is part of effective listening. Listening requires time and a willingness to humbly refrain from interrupting with our own opinions or quick-fix answers. As we listen and ask questions, our goal is to move a person toward biblical hope. 

While they were talking and discussing, Jesus himself approached and began traveling with them. But their eyes were prevented from recognizing Him. And He said to them, “What are these words you are exchanging with one another as you are walking?” And they stood still, looking sad. One of them named Cleopas answered and said to Him, “Are you the only one visiting Jerusalem and unaware of the things which have happened here in these days?” And He said to them, “What things?” Luke 24:15-19a 

This you know my beloved brethren. But everyone must be quick to hear, slow to speak, and slow to anger. James 1:19 

He who gives an answer before he hears, it is folly and shame to him. Proverbs 18:13 

Serving – Jesus’ example as a servant reminds us that no task is too menial for us. As Christ washed the disciples’ feet, so too must we be willing to serve those we minister to. Our service cannot be limited to offering counsel, but must be comprehensive, including practical service, such as providing food, shelter, transportation, childcare, and the like. 

You call me Teacher and Lord and you are right, for so I am. If I then, the Lord and Teacher, washed your feet, you ought to wash one another’s feet. John 13:13-14 

But a Samaritan who was on a journey, came upon him, and when he saw him, he felt compassion and he came to him and bandaged up his wounds, pouring oil and wine on them, and he put him on his own beast, and brought him to an inn and took care of him. Luke 10:33-34

Be hospitable to one another without complaint. As each one has received a special gift, employ it in serving one another as good stewards of the manifold grace of God. 1 Peter 4:9-10 

Ministering Scripture – Ministering Scripture begins with Jesus’ example of confronting people with the Truth of God’s Word and the truth of their circumstances. Each crisis situation is different and therefore the approach we use as we minister Scripture will vary. Sometimes we must minister the direct commands of Scripture. Sometimes we minister Scripture by relating stories from the Bible. Still other times, we may share the comfort found in the pages of Scripture. Remember to point people to the hope found in Scripture. 

Prayer – Jesus’ life vividly portrays the importance of prayer in life and ministry. Prayer is vital before, during, and after ministry. Pray for those you minister to. Pray with people you minister to. Pray with and for those who minister alongside you. Solicit prayer support from others. 

After He had sent the crowds away, He went up on the mountain by Himself to pray; and when it was evening, He was there alone. Matthew 14:23 

Simon, Simon, behold, Satan has demanded permission that he may sift you like wheat; but I have prayed for you that your faith may not fail… Luke 22:31-32a 

Brethren pray for us. 1 Thessalonians 5:25 

Therefore, confess your sins one to another and pray for one another so that you may be healed. The effective prayer of a righteous man can accomplish much. James 5:16 

Application of the Model 

This model does not prescribe formulas and packaged responses to those dealing with trauma. Effectively using the model requires a deep understanding of God’s Word and how to apply it to life’s circumstances. It requires prayerful sensitivity to the leadership of the Holy Spirit. Learn to depend on God’s Word and to teach others to as well when you have opportunities to minister to those responding to trauma. 

Conclusion 

The first story shared at the beginning of the paper was taken from the author’s experience ministering to police officers after the Santa Fe High School shooting. Over a period of a week the author was able to utilize the above model with a variety of police officers, including the assistant chief, and see the healing process begun. Memories were discussed, Scripture was presented, and God’s people provided encouragement. The second story conveys a traumatic event that happened to the author’s daughter-in-law and grandchildren. They were shared to give a glimpse, especially to those who do not have much experience ministering with people who have been involved in traumatic situations, of how significant and challenging such ministry can be. All of those involved in these stories grew from their trauma. There were challenges (as there should be) and issues with memories (as would be expected), but these did not become debilitating. They were assisted by believers and family members who listened, prayed, loved, served, were patient, and helped them see God in the midst of the challenges. They did not isolate themselves nor focus on the situation rather than God. They responded in appropriate, normal (although unique) ways to the trauma and experienced growth. 

The Bible is indeed sufficient for ministry to those impacted by trauma, and it is the author’s hope that this brief paper has provided encouragement to the reader to prepare for and seek out ministry opportunities with those who have experienced trauma. Biblical counselors are uniquely qualified to assist people dealing with trauma and should take advantage of such occasions to show forth God’s love and minister His Word.