Like Herrod, Americans are flocking to counseling that incorporates a spiritual or religious element. Faith-based therapies—from pastoral counseling to ecumenical Christian counseling to fundamentalist Bible-based treatment—have surged in popularity. The American Association of Christian Counselors has grown from 15,000 members in 1999 to 50,000 today. Specialized services are also thriving: It is becoming increasingly easy to find Christian-based eating disorder treatment centers or Christian life coaches.
Faith-based counselors vary in amount of religious training and psychological expertise. They differ in how much religion they incorporate into their practices and in the populations they serve. Some aim to holistically integrate mind, body and spirit for people of all faiths. Others seek to apply Scripture rather than social science to the resolution of human problems. But all of them, and especially the burgeoning evangelicals, reflect a growing divide in America. According to Harold Koenig, co-director of the Center for Spirituality, Theology and Health at Duke University in Durham, North Carolina, "They're turning away from mainstream cultural institutions to create their own therapeutic solutions to the stresses of modern living."
America has always accommodated a push and pull of secular and religious impulses. It may be that the rise in Christian counseling is "a way for religion to regain the role it lost to doctors and therapists" in the mid-20th century, says John Portmann, associate professor of religious studies at the University of Virginia in Charlottesville. "After all, religion has always been about suffering." But whether people are looking to overcome depression, relieve anxiety or address a family problem, they may prefer faith-based counseling simply because it's in a language that fits them and their culture most snugly.
Same Problems, Two Paths
In general, faith-based counseling favors short-term approaches. Most Christian and pastoral counselors are open to psychopharmacology and other medical interventions, though they usually do so through referral and eschew drugs for problems such as anxiety or depression. Methods of secular psychotherapy—cognitive and behavioral techniques, for example—are also used in religious clinics. And people look to Christian counselors to solve the same personal and interpersonal problems.
"There's a growing awareness in the counseling field and in seminaries that Christianity and spirituality in general are integral to a person's well-being," says Paula Baylor, a Christian counselor and graduate advisor at Eastern University in St. Davids, Pennsylvania, a school that trains faith-based counselors. "We're trying to integrate cognitive, psychodynamic and psychoanalytical practices with a Christian perspective."
Theology and therapy have never been very tight. Atheist Sigmund Freud famously viewed religion as a pathology, and religious Americans, particularly fundamentalist Christians, have long held psychotherapy suspect as a hallmark of secular America. "Historically, psychology and psychotherapy have been alienated from religion," observes Scott Richards, professor of counseling psychology at Brigham Young University and author of books on spiritual strategies for psychotherapy.
"Not only was Freud antireligion, but the behaviorists who came afterward were extremely eager to avoid religion in order to establish psychology as a respected science," Richards contends. Consequently, psychotherapists were careful not to broach religion in their practices. Over time, however, the values of psychotherapy have made inroads into religious as well as secular culture.
Observant Americans may feel most comfortable seeking help outside the traditional psychological profession because mental health professionals tend to be less religious than the general population. Nearly three-fourths of Americans say their whole approach to life is based on religion. But only 32 percent of psychiatrists, 33 percent of clinical psychologists and 46 percent of clinical social workers feel the same. The majority of traditional counselor training programs have no courses dealing with spiritual matters.
Yet studies show that people prefer counselors who share their religious beliefs and support, rather than challenge, their faith. Religious people often complain that secular therapists see their faith as a problem or a symptom, rather than as a conviction to be respected and incorporated into the therapeutic dialogue, a concern that is especially pronounced among the elderly and twentysomethings. According to a nationwide survey by the American Association of Pastoral Counselors (AAPC), 83 percent of Americans believe their spiritual faith and religious beliefs are closely tied to their state of mental and emotional health. Three-fourths say it's important for them to see a professional counselor who integrates their values and beliefs into the counseling process. More people said they would prefer to see a religious counselor (29 percent) than a psychiatrist (27), psychologist (17) or family doctor (13).
Women are more likely to favor religious counseling than men, and African-Americans strongly embrace faith-based counseling. The AAPC survey found that African-Americans, devout evangelicals, people without a college degree, the elderly and people age 18 to 29 are most likely to fear that a professional counselor won't take their religious beliefs into serious consideration when treating them.
"People come to Christian counselors for two reasons," says Randolph Sanders, executive director of the Christian Association for Psychological Studies, an association of Christians in mental health and behavioral sciences. "One is faith perspective; they want a therapist who resonates with their worldview. The second is moral ethics; they want a counselor who understands what guides their decisions."
The origins of Christian counseling lie with the clergy, whom parishioners traditionally consulted about emotional and spiritual well-being. The progenitors of faith-based counseling may well be psychologist William James, Freudian psychiatrist Smiley Blanton and Norman Vincent Peale, the New York preacher and apostle of self-esteem whose widely broadcast sermons and 1952 best seller, The Power of Positive Thinking, urged people to realize their psychological potential.
In 1957, some 42 percent of Americans sought counseling for their personal problems from the clergy. Even today, the amount of time clergy spend counseling parishioners is equal to that of all members of the American Psychological Association practicing 35 to 40 hours per week.
But pastors are not always trained to treat those who consult them. "When I was a Presbyterian minister, people from my congregation would come see me, but I wasn't a counselor," says R.J. Ross. So in 1972 he started the Samaritan Ministry and ran the Denver-based Samaritan Institute, a professional association of 500 faith-based counseling centers, to equip pastors with therapeutic training. "We needed to find a way to be sensitive to people's physical and psychological needs as well as their spiritual centers."
Today, pastoral counselors increasingly come from the laity. While that opens the field to licensed practicing counselors, clinical social workers and psychologists, it may open it too wide; some people adopt the title "counselor" with little or no professional training.
Generally, those who call themselves "Christian counselors" or "Bible counselors" tend to be more evangelical and fundamentalist than those who call themselves pastoral counselors. Their therapy typically includes prayer and proselytizing and relies heavily on Scripture. Virginia's John Portmann is wary of what sometimes passes as therapy among Christian counselors. "Many people doing Christian counseling are not equipped to deal with major issues like depression," he says. "There's this faith that the Scriptures can provide all the answers you need."
Services are either free or paid out-of-pocket, and counselors are similarly free to offer "therapy" however they like, without regard to any professional guidelines. "Because there are so many approaches to Christian counseling and no standard of care in the faith-based counseling world, anyone can say they're a Christian counselor," laments Anne McWilliams, assistant professor of pastoral care and counseling at the United Theological Seminary in Dayton, Ohio. McWilliams often fields inquiries from students who tell her they feel called to be a counselor. Such students are typically fundamentalists who view biblical text as the only answer. "The difficulty is, you can find anything you want in the Bible," McWilliams says.
She poses a hypothetical case involving domestic violence and divorce. A literal interpretation of Jesus' teaching: Divorce is wrong, period. The Bible supports that. It also supports the idea that suffering itself is salvation. "So a strict Bible-based counselor might tell that client to endure the violence because that's God's will," McWilliams explains. Of course, she observes, the Bible could also tell a client to leave her marriage because Jesus abhorred violence and held matrimony to be sacred; domestic abuse is a violation of that sanctity. In Christian counseling, she says, what you hear depends on the belief system of the counselor.
Increasing numbers of counselors lack education or accreditation as mental health professionals. The Sarasota-based National Christian Counselors Association requires only that its 5,000 members enroll in either a $3,000 eight-course program it developed or a one-course program with its for-profit arm, the Academy of Christian Counseling. And it urges members to shun state licensing so they may be free to promote their religious beliefs. "If a young woman comes into our offices to discuss her pregnancy, we'll tell her abortion is not the way to go," says Steve Baran, the organization's president. "When you're state licensed [as a counselor or therapist], you can't do that because you can't impose your personal beliefs. But as Christians, we need to be able to do that."
State-licensed mental health professionals are well trained in physical and emotional counseling, Baran concedes, but they aren't trained to deal with people spiritually. "Our counselors speak what the Bible says. When a person comes to see us, first and foremost we have to make sure that person's relationship with Jesus Christ is correct and good."
Not all counselors are so doctrinal. "Our approach is to look at a person's faith and values and incorporate them in the healing process, not to change their theological position," says Ross of Denver's Samaritan Ministry. The religious background of its counselors varies enormously, depending largely on the diversity in a given region. The outpost in Hawaii, for example, was founded by an Episcopalian, a Methodist and a Buddhist.
At the Spiritual Care Department at UCLA Medical Center, anyone who proselytizes on the job is dismissed, says director Sandee Yarlott. "We're trying to develop standards that run across all faiths," she says.
At the Chicago Christian Counseling Center in Orland Park, Illinois, all counselors are state-licensed mental health professionals; few have theological training. "We believe that every life is sacred and meant to bring God glory," says executive director Bruce Frens. "But we also believe every person is an integrated whole-body, mind and spirit." Rather than counsel a battered wife to stand by her man because the Bible forbids divorce, Frens would make her safety a priority and help empower her to confront the situation and leave—not very different from what most secular therapists would advise.
Nevertheless, the greatest growth remains Christian and largely evangelical. Duke University's Harold Koenig cites evangelicals opening their own Christian counseling centers and for-profit clinics, founding Christian hospitals and employing lay counselors in church settings. "There's a large evangelical population in this country, and in those circles Christian counseling is becoming increasingly well known and popular. And while some religious Christians have started seeing professional counselors, what this really is is a backlash against that movement."
But Does It Work?
The big question is whether faith-based counseling works any better than secular psychotherapy—or whether it works at all. Unfortunately, little quantitative or qualitative research on outcomes has been conducted, and the answer depends a lot on the belief system of whom you ask. Most Christian and pastoral counselors are, not surprisingly, true believers.
But faith-based counseling may share one fundamental fact with most psychotherapy: The active ingredient is the strength of the relationship between counselor and client.
Spiritual counseling is clearly the way to go for certain people, particularly highly religious ones, says Koenig. "There's a lot of practical wisdom in the Bible in terms of how to think of oneself, how to relate to others and how to live your life. When you take positive aspects of those teachings, it can be very healing and therapeutic."
Learn More About It
Christian Coaches Network: www.christiancoaches.com, 425-558-1845. Trains coaches through an online distance learning program.
Remuda Ranch: www.remudaranch.com, 800-445-1900. Christian-based treatment center for women and girls with eating disorders.
SmartMarriages: www.smartmarriages.com, 202-362-3332. Hosts programs that train lay couples to teach marriage education classes in churches and synagogues.
Pamela Paul is the author of The Starter Marriage and The Future of Matrimony (Random House, 2002).