What’s wrong with the therapeutic model of counseling?

  1. In short, “the therapeutic” borrows a wonderful metaphor from medicine—“healing”—but reduces counseling problems to one aspect of a more complicated problem. Just as doctors aim to heal people, counselors speak of counseling in the same terms. But the problems which enter the counseling office are more complicated than that, involving not just the physical aspects of a person, but the mental, emotional, and spiritual. More importantly, the spiritual is always primary.
  2. Physical body parts, when broken or damaged, require healing. When you break your leg, your leg needs to heal. When you develop an ulcer, your stomach needs to heal.
  3. Folly and sin, whether our own or someone’s against us, also hurt us in ways that require “healing.” In other words, sin does have physical and mental effects. Sin damages, and “healing” is a good metaphor for describing a part of what needs to occur to individuals with counseling problems. Through sin and the curse, creation itself becomes “damaged,” including our physical and mental persons. Addiction, for example, has physical effects on the brain.
  4. But the Bible also says that sinners are responsible for how we choose to think, believe, speak, and act (Jer. 17:9-10; Matt. 12:33-37). The medical metaphor of “healing” typically presents only one aspect of what needs to occur. The Bible is concerned not only with questions of damage, but questions of guilt, justice, and Lordship. When a bitter and broken relationship is restored, or when a suicidal man finds reasons to live, or when an immoral man repents and learns to love people, these things can only be called “healing” metaphorically (or partially).
  5. Counseling must therefore consider questions of faith, trust, repentance, and Christ’s lordship. Whether the problems being addressed are a result of a person’s own sin or someone else’s (typically both), much of counseling should focus on helping the person learn to live in light of the gospel in the very face of sin and the harm which has been done. Is God good? Is he trustworthy, even in the face of someone else’s sin? Does justice belong to him? Has one been purchased out of sin? What does repentance mean? What does it mean to find worth, justification, and boasting in the cross of Christ?
  6. The essential logic of the therapeutic is this: your personal problems arise from being acted upon. It takes the metaphor of “healing” and puts more weight on it than it can bear. Yes, we have been acted upon. But unlike the flu patient, we are also actors. We think, desire, choose, and react.  Unlike a cancer patient, we are essentially responsible. Although therapeutic counseling deals with the same problems that wise pastoral counseling deals with, they radically mis-define those problems, and so misconstrue the solutions, mistreat the problems, and mis-counsel the people.
  7. Bottom line: an approach to counseling that views people as fundamentally passive victims of circumstances has little room for the biblical gospel. That gospel proclaims that we’re all active sinners who face the wrath of a holy God who mercifully sent his Son to satisfy that wrath by atoning for our sins and rising from the grave in order that we, God’s forgiven and adopted children, would no longer serve sin, but God (Romans 3:23-26, 6:12-23). 

(This material has been partly drawn from David Powlison’s article “What’s wrong with the therapeutic approach to counseling?”)

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