My experience in combat propelled me into the world of psychology and psychotherapy. I received the best care the Department of Veterans Affairs had to offer. Many cutting-edge, evidence-based therapies were used to get me “well.” This second article will explain my experience with modern therapies and then propose a biblical approach.
I was given a diagnosis of Post-Traumatic Stress Disorder (PTSD), so I was being treated for “trauma.” My caregivers embraced Trauma-Informed Care. The phrase “trauma-informed” has no agreed-upon definition. Part of being trauma-informed means “viewing trauma through an ecological and cultural lens and recognizing that context plays a significant role in how individuals perceive and process traumatic events, whether acute or chronic.”1Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. (Pg. xix) This definition is genuinely subjective and is twisted to mean anything, essentially. A wise biblical counselor should seek to understand the experience that the person who claims a traumatic experience is trying to express. A simple yet effective way to do this is by using a grid like the 6 S’s—source of authority, sin, salvation, sanctification, system of change, and sparring/apologetics.
One common therapy is Cognitive Behavioral Therapy (CBT).2A helpful examination of CBT can be found: https://biblicalcounseling.com/resource-library/essays/the-cbt-therapist-in-us-all-a-biblical-evaluation-of-cognitive-behavioral-therapy/ By seeking to condition my thinking and address deeper beliefs, the therapist sought to address what was dysfunctional. Based on our grid, we can look at the source of authority. Who defines what dysfunction is? Well, with CBT, the therapist and I became the authorities to define what “truth” would make me happier or healthier. The second aspect of our grid is sin. The only sin in CBT is that the person is not “properly” functioning. Salvation is non-existent. In fact, the best solution is an acceptance of the “new normal.”3One therapist told me that my goal with anxiety was to learn to cope, and that I may be able to have some symptoms relieved, but that I would deal with this for the rest of my life.
Meanwhile, sanctification, which refers to biblical change into the image of Jesus Christ, is obviously absent in CBT. Instead, holiness is exchanged for wholeness in this counseling modality. I once asked, “What is our goal here?” The reply was, “to get you back to the way you were before the war.” There was no growth in holiness. With regards to “sparring or apologetics,” the main attraction to CBT is that it has been empirically demonstrated to be successful. However, it is based on testimonials from people who described a change in their feelings or actions. Certainly, correlation does not mean causation. It cannot and has not been empirically proven to cause change in the person, rather, feelings of wholeness have been observed. Essentially, CBT is only focused on what is subjectively helpful, not what is true according to Scripture.
The therapies that were given to me, like CBT, had me relive past events to lessen the pain and assuage any guilt I might have been experiencing. Instead of pointing me to God in my suffering, sin, and real guilt, it told me to emphasize my circumstances and self, which led to greater hopelessness. I didn’t realize it, but I was like the woman with the blood issue, suffering at the hands of many doctors until I touched the hem of Christ’s robe in the Scriptures (Mark 5:25-27). The chemical bath of medication leads to all sorts of physical complications, including massive weight gain. The serotonin theory they so confidently pushed has turned out to be false.4Sussex Publishers. (n.d.). Serotonin imbalance found not to be linked to depression. Psychology Today. Retrieved August 10, 2022, from https://www.psychologytoday.com/us/blog/how-do-you-know/202207/serotonin-imbalance-found-not-be-linked-depression I was essentially a guinea pig for pharmaceuticals.
When I see those in the biblical counseling world promoting Trauma-Informed Care, my alarm bells go off. I understand the desire not to harm someone further. I even sympathize with those who struggle with hormonal changes due to difficult experiences, the subsequent medication, or even the adrenaline that comes from reliving the experience. Understanding how someone reacts to various forms of suffering can be helpful. But you do not need the wisdom of the hour to provide counsel. Scripture is sufficient for counseling, even in complex cases like mine.
When someone is presenting problems like those associated with PTSD, a brief definition is helpful. PTSD can be understood as “the whole person’s response to intense suffering, that often results in significant life disruption. As a result, anger, fear, sadness, shame, and guilt are often exhibited as a result.”5This definition is modified from Dr. Curtis Solomon and Dr. Charles Hodges in ACBC Essays Volume 2, 2019. Counseling Post-Traumatic Stress Disorder: Plotting the Course.
I have found it helpful to use four horizons to navigate intense suffering.
Horizon 1: Present
In this horizon, I am seeking to gather information about their relationship to Christ, church membership, and family relationships. I am also seeking to orient them to the goal of counseling. The goal is to help them glorify God, by walking in obedience to His Word, moving them along the process of becoming more like Christ. This means bringing in biblical texts to reorient our counselee’s goal. 2 Corinthians 1:9 tells us that “Indeed, we felt that we had received the sentence of death, so that we would not trust in ourselves but in God who raises the dead.” The intense suffering the counselee experienced is to make them more God-dependent, this means removing the “D” from the label of PTSD.
Horizon 2: Near Past
In this horizon, I am examining what the counselee has done as a result of the situational heat. Has the console pursued comfort or safety in alcohol or drugs? Have they become enslaved to caffeine? What responsibility is the counselee taking for their response? Is there blaming of others for sinful behavior? If there is sinful behavior as a result of intense suffering? Are they confessing and repenting of it? Many helpful resources are available to a counselor seeking to aid someone in their suffering biblically. Steve Viars’ book Putting Your Past in its Place: Moving Forward In Freedom and Forgiveness provides a useful place to start when helping sort out difficult experiences from the near past. At the same time, take care not to blame the counselee for the event itself, if it was innocent suffering.
Horizon 3: Past Event
In this horizon, the goal is to understand what the counselee thinks caused their problems. Sometimes, this can be a series of events over a period of time. A careful examination of what caused the suffering will provide clues as to how the counselee interprets the event. While exploring this horizon, I am looking for expressions of guilt or shame, anger or bitterness, essentially listening for fruit responses so that we can get to the root. I find that the Psalms help in expressing pain over past suffering. Working through a Psalm like Psalm 73 and writing your own lament based on the Psalm. This provides insight into the event and the immediate response to the event, and it also helps to distinguish between feelings of guilt and objective guilt.6Robert Jones, “Distinguishing Between Guilt and Guilt,” Biblical Counseling Coalition (blog), July 18, 2017, http://biblicalcounselingcoalition.org/2017/07/18/distinguishing-between-guilt-and-guilt/.
Horizon 4: Future
At this juncture in counseling, I want to chart the way forward. I want to combat the “perpetual victim” mentality. James 1:2-4 is helpful as we approach “Post-Traumatic Sanctification.”7Solomon, Curtis, ACBC Essays Volume 2, 2019. Counseling Post-Traumatic Stress Disorder: Plotting the Course. We can help believers to take false thoughts captive in obedience to Christ (2 Corinthians 10:5), helping them behold Christ and be transformed (2 Corinthians 3:18). The intense suffering and trials we go through mold us and conform us into the image of Christ (Romans 8:28-29).
As in my experience, Trauma-Informed Care considers my ongoing symptoms as incurable or only manageable. However, the biblical way of addressing the cares of the soul is the only way to provide true, lasting, and eternal hope. If we believe that each individual is made in the image of God, the counselor can and should trust that Scripture alone is sufficient to conform the individual back into the image of Christ. Holiness, not wholeness, must be our aim. A careful and biblical understanding of the complexity of suffering and sin will enable the biblical counselor to offer help to those in need. And my prayer is that we are not taken captive by human tradition and empty philosophy (Colossians 2:8), but instead, we must be resolved to plumb the depths of Scripture to see what God has revealed to us in the pages of Scripture, which will revive the soul (Psalm 19:7).