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Distinctions of the Therapeutic Relationship

Dale Johnson: This week on the podcast, we are doing something slightly unusual. We have more than one person here in the room with me. We are having three folks who are contributing—myself, Dr. Sam Stephens, who is our Director of Training Center Certification here at ACBC, and also Dr. Rhenn Cherry, who is our Director of Donor Relations and Finance. Today, we are going to start a month-long journey, as we’ve done in the past couple of years. This is Mental Health Awareness month, the month of May. In years past, we have contributed in some way, shape, or form to discuss this idea of mental health. It is quite a dominant idea and way of thinking that is a major part of our culture, and I think it’s helpful for us to consider some ideas and then help us to think biblically through those things. You can go back to the last couple of Mays and you can see how we’ve dealt with mental health—maybe even from more of an academic perspective, some of the history of the ideas of mental health, where we got those ideas from, a little bit of a history of psychology, and so on.

This year, what I want to do is I want us to work through some very practical outworkings of the system of mental health. Now, I want to give a clarification that I think is really important. We’re not saying that people who are involved in mental health are inherently evil, okay? You don’t go into a helping profession with a disdain for people. We move into those spaces and areas because we see hurting people and we want to help. I think for us as believers, we do need to have some clarification in approaches, in systems, in philosophies, in how we go about doing our business under such an umbrella. Today, we want to talk about the this very common idea of the therapeutic relationship.

I think it’s important for us, especially as biblical counselors, to understand some of that distinction. For many of you who maybe are being introduced to biblical counseling, and you have a license to counsel, you’re very familiar with codes of ethics and a therapeutic relationship that is promoted in your style of therapy or counseling, but biblical counseling is distinct. We want to make sure that we help to distinguish some of those key aspects of the way the therapeutic relationship is promoted. The way we do biblical counseling looks differently; that’s not on accident. We’re doing this on purpose because we see different things in the Scripture that promote ideas of biblical relationships that are hindered or limited in a secular, therapeutic relationship. 

Let’s talk about that issue. The therapeutic relationship is simply the engagement of the counselor with a counselee in a secular setting. What I want us to do, if we can, today is just a few different types of considerations where we talk about some of those limitations and why there may be a problem biblically with us considering or promoting or practicing these types of therapeutic relationships. Sam, I want to start first with you, if we can, and talk about one of the things that we see consistently, and codes of ethics and this idea of therapeutic relationship is clinical distancing. Help us to understand how this is promoted in a secular sense, and then we’ll discuss why biblically this might be problematic for us.

Sam Stephens: Sure. Actually, just to go off what you said in introducing this topic, why we thought this was an important thing to discuss at the beginning of this month, this Mental Health Awareness month, and the podcast dedicated to this topic is because this really does frame our discussions for mental health. When you look at most codes of ethics for national accrediting bodies or even state boards of examiners for professional counselors, the first section in most of these is going to deal with this very topic. Why is that important? It’s because counseling is conversation. Counseling is relationship. I think that you really can’t understand the fullness of how people think about counseling in a mental health context and a secular context without looking at some of the tenants of how that relationship should work.

And you mentioned even in that intro, the concept of “counselee.” Well, in these secular professional relationships, that’s not the term that’s used. We use that term because it brings relationship back in a little bit more intimacy. It’s the term client. I would encourage our listeners to listen to some of our podcasts on these topics from last year. That’s all very purposeful. We’re moving into a medical context when we use the word client. Sometimes even, depending on the expertise or training of the counselor, in psychiatry “patient” is used. 

Regarding clinical distance, this is one of the key tenants of this therapeutic relationship. It’s all about avoiding what they would call multiple or dual relationships. This would be, and has been identified as, non-counseling activity. Professional counselors, those accredited by these national bodies, either by government oversight or in the professional disciplines, are instructed that with family members, personal friends, co-workers, people that you know, that you have a relationship with, you are not to counsel. Actually, that’s a liability, not a strength, to engage with people that you know and have a relationship with.

The reasons for that are many. One that continues to come up is that actually engaging in these dual relationships, again, counseling clients that you know, that you have a relationship with in any different type of situation, actually can pose a risk of harm to the client. It actually can impair your professional practice. According to the Texas state board of examiners of professional counselors, the whole point in avoiding these dual relationships is to maintain professional boundaries. You want to keep that very distant. The reason this is really important is I have students every semester that either have studied psychology, studied clinical counseling in some aspect formally, and I always get this question: Is it okay for me to counsel my family members? Or if I bring up the fact that I counsel people that I know—people in my church, for example—I get a lot of very quizzical looks. “Why do you do that?” And my answer back to that is, “Why shouldn’t I do that?”

I think about, for example, a passage or verse that I know most of our listeners are very familiar with in Romans 15, verse 14, Paul is admonishing the people he’s writing to, he’s speaking to: Listen, you all know the Word, you have the Holy Spirit, you’re filled with knowledge from God. You are able and you should admonish one another. You should speak the truth in love to one another. There’s no concept of this clinical distance relationship. This concept is not in the Scriptures. It’s foreign to the Scriptures actually. When we think about the therapeutic relationship, as we’re talking about it now, this is the first tenet that we have to be concerned about and think about. There’s a big distinction between how the Bible talks about the intimacy of one anothering—engaging with people that we do know and don’t know—versus the professional boundaries that have to be kept in a professional counseling context.

Dale Johnson: Sam, the way that you’re describing this therapeutic relationship, really in and of itself, is seen in some ways as being empowering. I think that’s really important for us to understand that this is some sort of a part of the mystery of how this person is going to be changed. It creates an environment where that type of change for the person is possible.

Now, I do want to make sure that we nuance this here. I am not saying that state governments should not employ codes of ethics, okay? That is not what we’re saying. What we’re trying to say is that the way in which we engage in biblical counseling is quite distinct by nature of the relationships that we have with people and how we’re to engage those who are hurting from a biblical perspective. You mentioned the apostle Paul in Romans 15, you can see how he does this even in 1 Corinthians 1:3, where he talks about comforting. He’s gone through all this suffering and the Lord is using this in so many ways to now help him minister to those who are being afflicted and he’s going to comfort them in the way in which he’s been comforted. He’s engaging deeply in really a very transparent way, in the way the Lord has taught him. The therapeutic relationship sort of builds this idea that there’s an expert that has particular knowledge, that they’re going to impart in some way to the client, and that’s going to be a means of change. When the government engages in these codes of ethics or these limitations, if you will, in limiting dual relationships, their desire I think is good. They’re trying to keep people from harm. I think it’s important that we consider what the state is trying to do. They’re not trying, themselves, as some sort of regulation arm to create some sort of environment necessarily. What they’re trying to do, from their perspective, is to keep the counselee or the client safe to some degree. What we’re just noticing is that the engagement of that relationship is an anti-biblical pursuit. But let’s acknowledge, let’s be fair, that some of these engagements and some of the limitations are for the sake of the clients themselves in order to protect them. 

Sam Stephens: Right. And I actually want to speak to that too, regarding maintaining professional boundaries. What might be a natural consequence, whether intentional or not, to all of this is that this clinical distance also makes counseling a service-oriented product. I think that’s what you’re speaking to. Clients come to therapists to get what they want out of therapists. You see that actually fleshed out in a broader sense when you look at many of these codes of ethics. Again, I think what you said is fair and good. A lot of these things are to protect both parties, and that’s just a wise thing. I mean, ACBC has standards of conduct and doctrine—things that give us clarity on how to proceed in a wise and winsome way, that’s fine. But some of the elements in here, I think really warp the whole purpose of counseling.

It’s like, I go to a drive-through at a restaurant and order what I want, I get what I want. Therapy is the same way. The client comes in, and that professional distance keeps counselors in their role of basically, essentially making sure that clients feel empowered. In fact, one of these codes of ethics even says it’s the responsibility of the counselor to empower their clients. That’s pretty broad, but you do see the gist there. That’s what they’re supposed to be doing. Even making sure they don’t offend the client in any way—their use of language, how they’re even talking about the client’s problem. This is where the mental health complex really differs from what we’re trying to accomplish. The clients come in, they really run the show. I think you see that too, we discussed this earlier, when you look at the different waves of psychotherapy for example, moving from Freudian psychoanalysis and that being very highly educated and use of very particular language and years of in-depth training, all the way to humanistic psychology, which really is client-centered. A lot of what’s done today in these therapeutic relationships is out of an eclectic group of all those types of things. We come back to the point, though, that it really is now a service-oriented product. People come to get what they want. It’s the counselor’s job to give the clients what they want. 

Dale Johnson: We can appreciate that the government in its regulation, codes of ethics, they’re wanting to protect a client. That’s healthy. That’s helpful. But we have to talk, now let’s dive in a little deeper, about the way we see this therapeutic relationship, as if it is sort of the the key behind the mystery that helps to unlock what’s going to happen in the counseling room. This is sort of viewed as a primary means for this client to change. That gets into the role of the counselor.

I want to back up. You mentioned Freud, and even talk therapy has changed quite a bit. Freud and his psychoanalytic thinkers basically were seen as the experts. They were seen as the healers, so to speak. They went through a long process of learning the intricacies of psychodynamic thinking. You would go to them and they would tell you, this is what’s wrong, using different types of methodologies and forms, catharsis and word association, all these things. Then they would help you to work through coping mechanisms, giving you tools, so to speak. They were seen as experts, you go to them and they empower you. Now, what we see is this transition, particularly with humanistic psychology, really seeing the development of the relationship itself, not necessarily coming to some sort of expert, but now engaging in this “therapeutic relationship,” which we see change with Rogers and people like that in humanistic psychology, where it’s the relationship itself that’s actually therapeutic. That’s a very different spin on things, which is sort of where we are now.

What it does—and you see this reflected in some of the codes of ethics—is it changes the way we see the role of the counselor in relation to the client. Let’s talk specifically about that and then maybe distinguish how we would be different in a biblical counseling setting. 

Rhenn Cherry: When I knew we’re going to talk about this subject, I did a little research and came across an organization called welldoing.org. They claim to be the UK’s leading therapist matching service to that point for in-person and online therapy and coaching, they would say. They claim to represent about 1100 therapist members, all of whom are verified as members of their professional associations annually. They claim that their aim is to make it as easy as possible for you: “Our focus is always on finding you the right therapist or coach, not the closest our cheapest.” Then they go on to make a really interesting statement. They say, “Research has shown that the fit between client and practitioner is more important to the success of therapy than any other element.” Now, they don’t cite the research that they’re supposedly quoting. Here’s what welldoing.org has to say about the “therapeutic relationship.” I’m going to quote here, “The therapeutic relationship is the connection and relationship developed between the therapist and client over time. Without this important relationship, there can be no effective or meaningful therapy. This applies to all forms of counselling and psychotherapy, and regardless of the theoretical orientation of your therapist or counsellor, the relationship developed between you will be considered of high importance.” 

Here we see that this matchmaking organization places a premium on the therapeutic relationship. We would expect that; their market is those who seek a therapist and they market their ability to connect them to one of their 1100 therapists. But should counseling in the church place such an emphasis on this therapeutic relationship? Does the Bible give support to this concept? I think we can all agree that biblical counseling is totally dependent on the presence and the work of the Holy Spirit in the lives of both the counselor and the counselee. That is a common bond between them that allows for, and actually enables, the honesty and transparency required for God-honoring change. We need to be careful not to ignore the Holy Spirit or nudge Him out.

We see in Galatians 6:1, “Brothers, if anyone is caught in any transgression, you who are spiritual should restore him in a spirit of gentleness.” This is the concept of restoring a regenerate Christian’s usefulness within a local body of Christ. Jay Adams even wrote the book Ready to Restore, most of us have read it. He focused on this key verse, Galatians 6:1. He made the point, the goal of counseling is to restore every Christian counselee’s usefulness within a local body. One of the most significant restored abilities actually is the ability to counsel others, if you read that book. We counsel our brothers and sisters with this objective, the goal of restoring them to usefulness to a local body, regenerate believers. This command, if you read Galatians 6:1, it’s a command. It involves anything but an arm’s length transaction or relationship, so to speak. It involves up close, loving confrontation with the Word and it utilizes the common bond of the Holy Spirit between the counselor and the counselee. Ideally, the counseling is taking place in the context of a local church, under the authority of Scripture, under the direction of the Holy Spirit. 

Dale Johnson: Yeah, that’s right. I mean Proverbs 27:5-6, “better is open rebuke than hidden love” and “faithful are the wounds of a friend.” Well, when we think about our responsibility, it’s not just from the perspective of confronting—although my goodness we have responsibility to do that without question in the Scriptures because we’re conforming not to our opinion, but we’re conforming to truth. That’s a distinction here. It’s not just helping people feel comfortable in their own skin, right? We have a different responsibility. I would also argue though for us to offer comfort well, it can’t take an arm’s length relationship. It takes an intimate, transparent relationship that we engage with a person and we grow in compassion and love to care for them and their story in the ways in which they’ve experienced brokenness, really to minister the Scriptures appropriately and to see the need of the moment, whether it will take rebuke in a certain moment or whether it will take encouragement and edification in a certain moment to give the word that’s appropriate for the need. 

But there’s really this idea, Rhenn, as you just mentioned, that it’s empowering, right? This role of the counselor with the client and the client really becomes central, but it’s really facilitated by the counselor in fostering some sort of means of help. 

Sam Stephens: Actually, in one part in this code of ethics that I was exploring, it talked about the counselor working with the client to devise individual treatment plans that are consistent with a client’s values, their background, and to offer reasonable promise of success. Again, this whole service-oriented idea. That’s all very broad and very general, but this should be very concerning to us as biblical counselors. Like you said, Dale, I think you worded this very well, what are we conforming to? Who are we conforming to? Is it our clients’ particular values? Those could be good. They could also be very, very bad. I don’t know about you both, but I’ve had counselees that have really been thinking very wrongly about their relationship with God, the Scriptures, their worldview is really skewed. I don’t want to orient my counseling to their warped views. That’s what you were mentioning, Rhenn, about Galatians 6:1. What are we restoring people to? Proper relationship with God and fellow man. And how is that done? God’s way.

Dale Johnson: Yeah, and in our worldview, that takes us—in our sinfulness and in our dealing with suffering—to conform to God’s ways, to trust in God’s heart in things. That means we have to engage people on that level. In fact, we believe distinctly as Christians that the most healthy way to live life, abundant life, is our consistent conforming to Christ. What we see happening here, essentially, in this therapeutic relationship is, it’s now describing what God says is evil—every man living and doing what’s right in his eyes—we’re now calling it good. We’re saying this is a pass toward help. We’re essentially describing that the counselor’s responsibility is to affirm or find the way to help the person pursue, based on his own values, living life in his own wisdom, in a way that he’s comfortable with. And that is the key that unlocks the power for him to pursue mental health. I think this is a disservice. In the Christian world, I applaud their desire to want the person to feel better, but we have a distinct responsibility in our worldview from the Scriptures in engaging in biblical counseling that in love, in gentleness, that we want to restore a person to what is most healthy and that’s conforming to the image of Christ. Sometimes that means the denial of what we pursue in ourselves.