What is wrong with the therapeutic approach to counseling?

Article
03.01.2010

In a nutshell, “the therapeutic” borrows a wonderful metaphor from medicine—”healing”—but treats it as a literal reality. Of course, when you are healed from having cancer, the flu, or a broken leg, that’s a literal healing. Something bad happens to you. You are in some essential way passive, a victim, acted upon by forces external to your identity and responsibility as a moral agent. You are a “patient.” You “have” or “suffer from” some disease or dysfunction. With healing, your body has now been restored, and that’s good.

But counseling deals with a different kind of problem. Of course, sometimes there’s a medical context within which counseling-type problems play. Counseling might deal with your despair, fear, and regrets (at having cancer), or with the grouchiness and complaining that always make you hard to live with (and get exacerbated when you catch the flu and feel lousy), or with your heavy drinking (that caused the car accident in which your leg was broken). Counseling is about you and how you live, not about what you have, catch, and suffer from. Or counseling might deal with your anxiety in social situations, your spasms of panic, fantasies of murderous anger, drug use, misuse of food, and sexual immorality. Those feelings, behaviors, and thoughts might have become your lifestyle after you were sinned against by a sexual molester, but counseling’s not essentially about “your abuse.” That’s a social or criminal problem, just as cancer is a medical problem. Wise counseling pays close attention to these circumstances, but it ends up being about your reactions to having been abused.

Counseling might deal with problem behaviors—anger outbursts, substance abuse, laziness, stealing—that get you in trouble with school, court, employer, or family. Or it might deal with subtly powerful reactions to your parents and siblings, to the way you misformed your identity as a player within the perverse patterns of jockeying for power, love, status, or comfort that characterized your family’s particular way of being sinful and unhappy. Wise counseling helps you re-form your identity, in Christ, as God renews your mind. Or counseling might deal with feelings of vague unease over the meaning of life that have arisen as you’ve passed mid-life and watch old age approaching. Or it might deal with any sort of troublesome feelings, thoughts, or behaviors—whatever your life context.

All of the things that counseling deals with are problems in you and how you live. These are moral, spiritual, personal, psychological, emotional, relational, lifestyle, identity issues. They are not essentially like what’s happening to your body that needs healing[1]. However you are acted upon (that may provoke, constrain or influence you) these are ways you act. You react to and act upon your world, just as much as your world acts upon you. Counseling inevitably deals with your behaviors, emotions, thoughts, motives, values, worldview, memories, addictions, attitudes, relationships, beliefs, choices, desires. When a bitter and broken relationship is restored, when a suicidal man finds reasons to live, when an immoralist repents and learns to love people rather than use them, when a timid girl takes a step of courage, these can appropriately be called “healing”—as a metaphor. But the bad things came out of your heart, to put it biblically. Unlike a cancer patient, you are essentially responsible. Unlike a flu sufferer, you are an actor, someone who does, thinks, chooses, wants, reacts. Unlike the healing from a broken leg, as you change how you live, you are being made into a good person, someone who lives a better life. Your identity, ruling desires, and lifestyle are changing, not your physiology.

The Bible uses healing as a metaphor in exactly this way. When Jesus says He is a physician for the sick, He adds, “I did not come to call the righteous, but sinners to repentance.” He means the morally sick, the psychologically and spiritually warped, people whose relationships and identity are bent all out of shape. He means counseling issues. Repentance (metanoia) is the transformation of all that you are and do from the inside out.

But the therapeutic approaches to counseling—in principle, in professional self-image, in propaganda, in core theoretical commitments, in diagnostic categories—treat these moral aspects of our humanity as if they are essentially the same kind of thing as a physical sickness. They deal with the exact same human problems that wise pastoral counsel deals with. But they radically mis-define those problems, and so misconstrue the solutions, mistreat the problems, and miscounsel the people.

In practice the therapeutic rarely goes all the way in treating you like a victim. God’s creation, providence, and common grace typically limit the extent to which a false view can impose it’s distortion upon reality. But the essential logic of the therapeutic is this: your personal problems arise from being acted upon. At the deepest levels of causality, you are simply passive, a victim of determining forces outside your moral agency and responsibility. Why are you are the way you are? Why do you do the things you do? The modern social sciences have decisively cast their vote for deterministic causalities: nature and/or nurture, genetics and/or upbringing, hormones and/or family history, your body, and/or your society. No you is responsible for you. You are a product of other forces. The ideological commitment of secular social science to nature/nurture causality explains you by what acts upon you. The therapeutic approaches to counseling are the many children of this mindset.

As I’ve mentioned, the therapeutic can rarely be entirely consistent (except when it takes a radical medical-biological approach and pours all energies into changing the physical body; the only other consistent approach would be to pour all energies into changing society). Let me give two examples of the inconsistency. First, most classic personality theories and schools of psychotherapy express some form of the nature/nurture determinism that is the hallmark of the therapeutic outlook. Primary caregivers did not meet your psychological needs; your hardwired instincts exist in standing conflict; society conditioned your drives so that you behave in unproductive, unsatisfying ways; your genetics are miswired and your biochemistry unbalanced; you were traumatized by sexual abuse, racism, or violence; you have the disease of alcoholism or suffer from obsessive-compulsive disorder; and so forth.

But there have always been other popular approaches to counseling that treat people as responsible: existential therapy, reality therapy, logotherapy, rational-emotive therapy, cognitive-behavioral therapy, philosophical counseling, Dr. Laura, Dr. Phil. Strictly speaking, these should not be called “therapies” at all. They are actually moralistic systems teaching practical philosophies of life. Most of them tend towards some version of stoic philosophy. They exhort those they counsel to get a grip and take responsibility for their beliefs and choices. Notice, though, that even with the responsibility “therapies,” your final responsibility is to yourself, not to God. Your final trust is in yourself, not in Christ. Your righteousness is your own birthright or achievement (“Deep down, you are OK”). It is not the gift of Another who came to die for you, who alone is worthy.

Second, even with the more “therapeutic” and deterministic theories/therapies, one repeatedly encounters the odd notion that you are not responsible for your problems—as we’ve seen, responsibility is assigned to upbringing, genetics, experiences of trauma, unmet needs—but you are responsible for getting better! You don’t get blamed for the bad things about yourself, but you do get credit for the good things. You didn’t cause what’s wrong; you do cause what’s made right. This is an unwitting tip of the hat to God-ordained reality. No form of counseling can operate for long unless it assumes some kind of human responsibility. But this particular calculus of human responsibility does exhibit a wonderfully effective logic. It enhances sinners’ deeply rooted self-righteousness. It maintains our repression of the knowledge of God. It erases our radical need for outside help.

All these secular counseling models, whether therapeutic or stoic in core logic, unite in calling you to a responsibility that is only to yourself. They proclaim the need for and validity of fundamental self-trust: Blessed is the man who trusts in mankind (to invert Jeremiah 17:5). They unite in systematically suppressing awareness of your responsibility to God and your need for fundamental trust in Christ’s saving invasion of your condition. At the end of the day, they unite to proclaim, “All the answers to human problems lie within ourselves. The advances of medical science, the untapped resources of the individual human soul, and the nourishing effects of good interpersonal relationships will save us from what is wrong with us.” A purely bio-psycho-social problem has by definition a purely bio-psycho-social solution. If we don’t have any problem with God, we don’t need anything from God to solve the problem.

The bottom line on the therapeutic approaches to counseling? An ideological commitment to passivity (in assigning cause) and to human self-trust (in working for cure) means that your personal and interpersonal problems can never be evils coming out of your bent, untrustworthy heart. Therefore they cannot be sins against God. Therefore you do not need a Savior’s forgiveness to deliver you, and a Shepherd’s ongoing presence and power to change you.

Therefore a Christian’s counseling ought to offer the starkest alternative to the therapeutic.

1We happen to be in a window of history, c. 1995-2004, when attempts to biologize/medicalize all behavior is the current fad. This too will pass. The essence of our humanity will always resist materialistic reductionism.

Further resources:

Philip Rieff, The Triumph of the Therapeutic, Chicago: University of Chicago Press, 1987.

Os Guinness, “America’s Last Men and their Magnificent Talking Cure,” Journal of Biblical Counseling, 15:2, 1997, pp. 22-33. Originally published in No God but God, edited by Guinness and John Seal.

David Powlison, “Biological Psychiatry,” Journal of Biblical Counseling, 17:2, 1999, pp. 2-8.

Ed Welch, “Who Are We?: Needs, Longings, and the Image of God in Man,” Journal of Biblical Counseling, 13:1, 1994, pp. 25-38.

By:
David Powlison

David Powlison teaches and counsels at the Christian Counseling & Education Foundation’s School of Biblical Counseling and at Westminster Theological Seminary.