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Challenges of the Therapeutic Relationship

Dale Johnson: This week on the podcast, I’m joined once again by Dr. Sam Stephens, who is our Director of Training Center Certification. He also teaches at Midwestern Baptist Theological Seminary as instructional faculty in biblical counseling. I love hanging out with Sam, and today we’re going to continue our discussions during the month of May, Mental Health Awareness Month. I want us to engage Sam off of some of the things we talked about last week. I want us to dive a little bit deeper as we talk about the implications of the therapeutic relationship. We’re not trying to take a hammer and smash the idea that the relationship itself is unimportant. No, absolutely not. The relationship that you have is important, which is why we care about this idea so much. The Bible does describe how we are to engage one another, for the purpose of mutual edification and growth in the things of God in dealing with the brokenness that we all experience. That’s why it’s such an important topic for us to address.

What I want to do is to take some of the ideas that we talked about last week—the clinical distancing that we talked about in the therapeutic relationship. That is certainly biblically problematic. The way we think about the role of the counselor himself or herself as the facilitator, the means of empowering the client for the purpose of change and how the therapy relationship really is some sort of unlocking of a mysterious means to growth and healing and health and that sort of thing. But for us as Christians, it presents a distinct dilemma. A part of that dilemma, or some of the challenges that we would face as Christians, is that those requirements in codes of ethics bump up against, not just the way in which we engage in relationship, but even what we think to be true from perspective of a worldview that would be limited. If you are licensed counselor and you are under these types of codes of ethics, it would be a limiting factor, there would be challenges. If you hold to a biblical worldview, you are convinced that the Scriptures are true and the way in which you engage in some problems in the counseling room. I want us today, Sam, to talk through that idea, the therapeutic relationship and the implications of it or the challenges of it, specifically for those who are believers in the way in which they engage these types of relationships.

One of the particular areas I think it’s good for us to talk about is, what do we do in areas where there are moral conflicts that differ in what we think as the counselor and maybe the values of the client? Because last week we talked about the therapeutic relationship that it’s important that we as the counselor respond to the client in their values and help them to empower themselves on the basis of their values. Well, what happens when part of what’s contributing to the counselee’s brokenness is some sort of moral issue? The Christian counselor has a massive dilemma, some major challenges. Are we going to obey the codes of ethics or the moral basis that we see from Scripture? 

Sam Stephens: Something you said in your intro really stuck out to me and I think it’s very important that we highlight it once again for our listeners. You mentioned, and we talked about this last week, that the counselors in these therapeutic relationships empower clients to change. But the question is change into what? And we brought this up last week, what are we being conformed to? Are we actually even calling clients to change? I know of several different situations, some of this is probably antidotal, but it does represent how therapy generally works and that therapy focuses on client preferences, client values, client beliefs, these codes of ethics that we’ve been studying and using as just an example of how these professions work in these types of relationships, consistently hone in on this particular topic.

And I think that’s what makes all this very problematic when we talk about moral issues, spiritual issues, specifically. What are we actually doing in counseling? What is the role of the counselor? Are we just facilitators? Is our goal just to bring up things that our clients needs to hear? For example, I want to pull some examples from this code of ethics that I’ve been looking at from the American Mental Health Counselors Association. This Code of Ethics was updated in 2020. From the counselor’s perspective, they are responsible to empower clients, not necessarily to change, just very generally to empower clients, but they should not offend. They should not do anything that would push up against the client’s values, their background, anything that would challenge or defeat anything that would promise success for the client. And in fact, there was even a section about calibrating effectiveness. What is effectiveness in counseling anyway? And this is very interesting that the counselor has to self-educate, self-correct, any inherent bias against the client. This can interfere with the entire therapeutic process.

One thing that sticks out to me, in particular when you discuss moral issues, very generally. But one thing that I know our counselors, our listeners, probably deal with on a pretty regular basis, our culture is infatuated with it right now is sexuality. Specifically sexual orientation and gender identity. 

Dale Johnson: Before we go there, and we’re going to go there because I think this is very illustrative of a part of the challenges and problems. Before we go there, we’re certainly not saying that the client or the counselee’s values are unimportant, they are actually very important. In fact, the values of the counselee are probably driving. If we believe a biblical view of anthropology, actually, those values are motivating factors. Those things are driving the lens by which people see their life. It’s how they’re interpreting the things that are going on. It’s helping them to pursue or motivating them to pursue the things that they’re pursuing. We want, as counselors, to know the values of the people that we’re engaging, but a basis of biblical counseling is to listen for unbiblical thinking and to learn to correct it with biblical truth. Why? Because we believe that some of those values that we inherently have based on our sinful disposition, in our lust of pursuing what pleases the self, biblically is some of the most detrimental pieces of who we are and what leads to some of the major problems that we experience.

It’s not that we’re dismissing as if the values are unimportant or that it doesn’t matter in the counseling room, absolutely it does, and we want to know those values. But the basis by which we judge those values, we have a backdrop and that backdrop is the never changing, unalterable truth of God. Remember, this is the thing that will stand forever, everything else will pass away, but the Word of the Lord will stand forever. We are to see, to judge, to think through, to discern the client’s or the counselee’s values, they are important, but to judge those, to discern those from a certain perspective and that’s what makes it difficult, that’s what makes it challenging for someone who is a Christian who believes in biblical truth to engage in these types of things according to those codes of ethics. Because, now we see the limitations, right? How do I engage in promoting the therapeutic relationship in order to condone the values of the client? Because we think that’s what empowers them towards help. That is it is a difficult thing to do. Especially when the client himself or herself is valuing something that is an unbiblical pursuit, that is leading to detriment in their life. 

Sam Stephens: I think that’s key though. No one’s values—the counselor’s or the client’s or counselee’s—should be the basis for what is true. This is an inherent thing that we’re thinking about in biblical counseling. We as the counselors are in much as much need as the counselee to consistently, daily repent, turn back to the Lord. Our thinking is futile thinking at times, sometimes it’s skewed. Yes, we’ve been made alive in Christ. We have a new mind, He has given us wisdom and knowledge through His Spirit. But we’re also fallen, and we need to go back to the Word. The Word is the basis and standard for the content of our counseling, direction of the counseling, the goal and method of our counseling and so I’m glad you made that clarification. That’s exactly right. 

Dale Johnson: Yeah, I think so. That’s important. Now that we’ve established the idea that we’re not just dismissing values out of hand, we need to nuance that there. That’s important. But let’s get back to the original topic of the issue of sexuality. This is probably the most forward way that we see limitations in state codes of ethics and that are written into the codes of the state statutes in various places that govern the relationship, the therapeutic relationship between counselor and client. One of those areas is a very important moral issue. Listen, I just want us to use this, Sam and I are going to talk through this as an illustration of one type of moral issue. But listen, here’s the fact of the matter: When you look at a system, like the mental health system, it will not cease or stall at just making a declaration on one moral topic in what they think is most healthy, they can’t do that. If they’re going to be consistent with the secular nature of their own worldview, it will reach into other areas of morality where they will make very clear statements on what they believe to be good or evil, what they believe to be healthy or unhealthy. This is just one area, this area of sexuality, where we see there are moral issues, ethical dilemmas, if you want to call it that, especially for the Christian who’s trying to be faithful to the Scriptures, but then also who is wrestling with this standard of a code of ethics. So let’s walk into this world of sexuality. 

Sam Stephen: To be honest with you, this is a burden that our brothers and sisters who are trying to counsel in these secular contexts have to bear that biblical counselors don’t have to. When we counsel under the authority of the Church of Jesus Christ we have complete freedom and should have complete freedom to counsel Christ, the gospel, the truth of the Word without any issue, as clear as day. Our brothers and sisters that are striving to be—and I believe many of them definitely are striving to be—faithful to the Scriptures, but they are counseling under the dual role, if you will, of the church and the state, they are increasingly coming across their own moral quandaries. How do they remain faithful and counsel what the Scriptures clearly teach, when everything from the state board of examiners that govern licensing in particular states to these larger, professional, accrediting bodies, teach the direct opposite.

In the realm of sexuality in particular, this is directly from this AMHCA code of ethics from 2020 that regarding sexual orientation and gender identity among other issues. We’re just highlighting these two specifically because they’re hot topic issues right now, have been for a while. That counselors should not in any way discriminate against those people. Now obviously, we would agree, in discrimination as a broadly used term. We should all obviously treat every counselee, every person, with dignity, respect, and love, we would clearly affirm that. But what’s being said here is something very different. It’s that we are not providing any type of moral assessment, any type of, really general assessment or critique on our client’s lifestyle, view of living, particular values as we’ve already discussed it. For a Christian, that’s very problematic. Living in a same-sex lifestyle, living in a mindset that you’re a different sex than what God designed you and gave you as, is sinful as the Scriptures speak about that. We need to be able to address that with clarity, love, gentleness, winsomeness, but we have to speak to it.

These codes of ethics, however, bar us from doing that. I want to read to you a statement out of this organization that speaks to what they would call Affirmative Therapeutic Intervention. This framework is for addressing sexuality in particular. What this means is that the therapist addresses the stress-inducing stigma experienced by sexual and gender minorities with interventions designed to, and this is the key, reduce that stress helping the client overcome negative attitudes about themselves. This becomes now, the thrust of the counsel this affirmative intervention, we’re not speaking to the fact that with my client, my counselee, there’s wrong thinking here. There’s sinful living here, there’s sinful heart attitudes leading to behavior here. I can’t go there. My concern is, are there negative stressful impacts on my client? That’s my biggest concern. And this goes back to the general idea of therapy. It’s assuaging guilt. It’s assuaging bad feelings, bad feelings equal bad living. It’s just across the board. And so now, this is my goal of counseling. So you see how easily it warps against the whole intention and purpose of counseling? 

Dale Johnson: Yeah, that’s right. We very clearly have a view of sexuality, where sexuality is good. The relationship monogamously between a man and woman in covenant marriage is healthy and good, designed by God. Anything that’s not an expression of that, the Bible describes as sexual immorality and for us to limit the way that we describe that, or what we think is most helpful for a person, again, doing that in gentleness and kindness and love. That becomes an issue for us who believe where we are compromising the truth. We are forced to decide which authority are we going to comply with.

Now, I understand and I want to give this caveat, Sam, I think it’s important that people understand historically why states may have reacted in this way regulating, right? And listen, the church is to a large degree at fault here. It’s because homosexuality, for example, was a part of the DSM, the Dignostic and Statistical Manual of Mental Disorders from 1952 all the way to 1980. And first of all, that’s a poor framework. It’s not to say that homosexuality is an “abnormality.” That’s a faulty description and this is an example of the ways when we define problems wrongly, we seek solutions wrongly. The church, to a large degree, began to run after that and say, “Yes, it is an abnormality and we’re going to use conversion or reparativet herapy to aid this.” The goal became heterosexuality. And it makes some sort of statement as if homosexual lust and sin is distinct and different from heterosexual lust and sin. Reparative therapy simply attempts to pursue a person to be heterosexual to some degree. There were all kinds of, I would even consider some of them barbaric types of acts, that were condemning, that were adding to the stress of young people in the types of therapies that were used in reparative or conversion therapies. I would completely dismiss those.

The reason is because they were not right-sizing the problem as it’s described in Scripture. They were not pursuing the right means biblically of restoration. When you don’t call something the way that the Bible calls it, like sin, now Jesus is not the hope for that, right? It’s some sort of method that now gives me hope, which actually adds to the condemnation. The person who’s struggling with same-sex attraction feels like they can’t do anything right, because now they can’t even overcome this issue. When the reality is, the Scriptures make very clear that the pathway toward restoration is to seek forgiveness in relation to God and to be at peace with Him, being justified by faith in Christ, so that you can now be at peace with God. That led to the problem. Where conversion therapy, reparative therapy, was being utilized under religious guise, the church fell for this, and it was adding to the stress. It was condemning unnecessarily in different ways those who struggle with this sinful pattern of same-sex attraction.

The government responds this way, but now it puts us in a dilemma, especially those who are licensed by the state. For example, what we’re talking about is not hypothetical in the state of California. If you’ve listened to a podcast very long, you’ve heard me talk about Senate Bill 1172, which makes very clear that if you’re dealing with a minor who is same-sex attracted, even if the minor wants help, and the parents wants help, there is a limitation in your engagement in what’s called sexual orientation change efforts. No matter on any moral basis. It is forbidden for those who are under the state’s responsibility. There is provision for non-licensed religious providers. What does that do for a believer? Now, I can’t even engage in what I believe will be the most helpful way for this person to rid them of guilt, to rid them of shame, to rid them of stress and difficulty in what they’re striving for and what they’re striving against. This is a part of the problem that the mental health system itself pursues in terms of therapeutic relationship. It always will spill over into defining its own morality, which is not complementary to the Scriptures. It becomes contradictory in and of itself and it puts those who are Christians in that world in a very difficult place.

When we think about this issue of therapeutic relationship, I hope what you’re seeing of described is the reasons that we’re concerned, right? It’s not some sort of basic desire that, you know, we want to protect the client, that’s healthy. That’s good. But it’s the means by which we do it that it now becomes limiting in in us, having to compromise our moral beliefs are what we believe to be true from the Scripture that are non-negotiable issues. As that invades the church, we begin to dilute the doctrine that we think is so important that gives life to people. And so, this is our concern. As we think about the system of mental health in one application of that in terms of the therapeutic relationship, which is sort of termed in a way that leads toward help and we’re saying, “Does it really?” When we think about our conviction scripturally, it seems to be in competition.