Integrating Counseling Practice and Theology

Virginia Todd Holeman

Imagine a typical counseling session where a counselee talks with a counselor about a particular life dilemma. If I were a fly on the wall, I could probably tell what theoretical counseling orientation (e.g., cognitive-behavioral, psychodynamic, family systems, narrative) the counselor adopts by listening to the way the counselor interacts with the client. What might be more difficult to discern, however, are the theological commitments that shape the counselor’s work. Does theology matter to the practice of counseling?

I specify counseling practice because much has been written about the philosophical integration of psychology and theology. Less has been written about the ways the practice of counseling and theology interact. In this essay I take up that question: What difference does theology make when a counselor sits with a client? Thanks to a grant from the Wabash Center for Teaching and Learning in Theological Education, I have had an opportunity to attend to this matter.

The questions that are central to many theologies are often the same questions that are addressed by counselors: What motivates human beings? What do healthy human relationships look like? What behaviors and attitudes contribute to human thriving? What is the goal of life? What makes life go awry? What is the source of pain? What does one do when life is painful? How does one make sense of pain? To what degree are humans responsible for what happens to them? What do vibrant communities look like? What behaviors and attitudes contribute to creating vibrant communities? How does one respond to social injustice and oppression?

These common questions suggest that theology can have a prominent voice within the practice of counseling. However, the authoritative sources for these two disciplines differ. The practice of counseling draws primarily upon empirical research from the social sciences. Theological constructions draw from a variety of sources including philosophy, church history, and Scripture, to name a few. Empirical research can yield answers to questions about “what works” whereas theology provides an explanation as to “why” life happens in the way it does, and what life “should” look like. When persons seek counseling, they are often asking what they can do to change things and wondering why their life is like it is. Counseling helps clients develop skills to cope with the dilemmas in their lives while theological reflection can help clients make meaning of these same dilemmas.

The integration of counseling practice and theology can take two forms: explicit and implicit integration. Explicit integration occurs in the interaction between the counselor and client, and is entered into with the client’s consent. Explicit integration can involve using religious or spiritual interventions or engaging the client in unequivocal theologically oriented conversations. For example, explicit integration includes reading sacred texts as part of a session or as a homework assignment, referring to biblical stories as part of the counseling conversation, praying with a client, or assigning spiritually formative disciplines or activities to the client. It also includes the kind of language a counselor adopts. Does a counselor use the language of sin, repentance, grace, forgiveness, or holiness? Is the presence of God openly acknowledged at some point during the session? Moreover, explicit integration can incorporate the “Christianization” of secular counseling approaches. When a significant overlap exists between Christian beliefs and a particular counseling approach, a Christian who counsels can adapt that secular theory for Christian clients. For instance, M.R. McMinn and C.D. Campbell (Integrative Psychotherapy: Toward a Comprehensive Christian Approach [InterVarsity, 2007]) have developed integrative psychotherapy, a sophisticated blending of theology, spiritual formation, and cognitive-behavioral therapy. Also, E.L. Worthington Jr. (Hope-Focused Marriage Counseling: A Guide to Brief Therapy [InterVarsity, 2005]) has developed hope-focused marriage counseling, an approach that draws upon findings from empirical research on marriage, brief therapy, and sound biblical principles.

Although explicit integration is evident to the client, implicit integration may not be so readily discernable. A counselor engages in implicit integration when theological assumptions and commitments direct and shape how the counselor understands the client and the client’s problem. Implicit integration happens within the counselor. Christians who counsel in secular settings may be limited to implicit integration. Even pastoral counselors may engage in implicit integration when working with those who are hostile to “religious” things.

Implicit integration is denoted by a counselor’s presuppositions about God’s role in human life and how these presuppositions shape the way a counselor relates to a client. I will share four ways that a Wesleyan-holiness theology contributes to my own implicit integration. First, I look for evidence of God’s prevenient grace. As a Wesleyan I believe that God is already at work to quicken a client’s ability to respond to God and the ways of God so that if the client chooses, the client can align his or her life with the telos of holiness (cf. M.H. Mann’s Perfecting Grace: Holiness, Human Being, and the Sciences [T&T Clark, 2006] 155). My role as a counselor is to join in this work that God has already begun in that client’s life, and, if the client is searching for God, to act as a guide to point out those places where God’s fingerprints are evident if the client is unable to identify them him- or herself. If a client is not interested in spiritually oriented discussions in general or the Christian life in particular, then my observations are private ones, and I continue to work with the client’s goals.

Second, the therapeutic relationship also reflects my theological commitments. Wesley taught that when one is embraced by God’s love through salvation, then God’s love for others can flow through the believer into the world. We are “vehicles of God’s grace” for each other (cf. M. Suchocki, “The Perfection of Prayer,” in Rethinking Wesley’s Theology for Contemporary Methodism, ed. R.L. Maddox [Kingswood, 1998] 52). Therefore I want to be a channel through whom the love of God for this client can flow. This means that I need to be participating in the life of God so that the ways of God and the goals of God are primary in my own life. Equally important, however, is that my therapeutic relationship with this client reflects God’s love for that client; that is, I must relate rightly to this client. For me this includes (1) inviting the client to be an active participant in the counseling process with a heavy emphasis on collaboration not therapist domination, (2) working on the goals that the client identifies, (3) managing myself appropriately within the context of the therapeutic relationship, (4) treating the client with respect, (5) developing my skills of empathy so that I can speak the truth in love, and (6) being knowledgeable about and adhering to the ethical standards established for the profession of counseling.

Third, theological considerations serve as another lens through which I understand the client’s problem. Theology identifies a telos for the Christian life. Mann suggests that holiness awakens “our capacity for ever greater receptivity and responsiveness to God’s call” (167) and that aligning our life with God’s call is the telos of holiness. So I may ask myself, To what degree is the client’s life lining up with holy living? If my client is not a Christian, I keep these musings to myself. However, because I also believe that healthy living is not necessarily contradictory to holy living, I can work with the goals that my client has presented and help that client live in the healthiest (holiest?) way possible.

Fourth, I believe that the problems in living that Christian clients present to a counselor may impede their ability to live fully for God. From a theological perspective, I consider myself a “specialist in applied sanctification” as I see counseling as a way to increase a Christian client’s capacity for responding to God. Mann writes, “Psychotherapeutic tools can be effective means of grace by helping free otherwise bounded persons to achieve more appropriate responsiveness to God” (170).

How might one picture this proposed relationship between theology and the practice of counseling? (This picture of integration developed in conversation with Edward D. Decker.) Imagine four concentric circles with permeable boundaries. The outermost ring represents a counselor’s theological understanding and commitments. This ring may be quite thin if the counselor has little more than a Sunday school understanding of the Bible and has done little theological study beyond what is available in the popular Christian press, or it may be quite thick if the counselor has invested time in formal or informal theological and biblical study. The thickness of the ring determines the depth of theological resources that a Christian who counsels can draw upon. A thin ring may limit a Christian who counsels to explicit integration strategies. A thicker ring will result in more thoughtful use of explicit and implicit integration.

The second ring represents therapeutic commitments and training. Insights from the social sciences may serve as a tool for understanding our human bent toward sinning. Formal counselor education focuses on helping students to develop sets of skills so that they can provide the most effective counseling possible upon graduation. Becoming a licensed mental health professional involves meeting a set of educational criteria established by each state’s licensing boards, passing board examinations, and completing a specified number of counseling hours under the supervision of another licensed mental health professional. For most licensed professional counselors, counseling psychologists, marriage and family therapists, and social workers, this ring is well developed. It may be less developed for pastors who have had little formal training in pastoral counseling or for lay counselors.

The third ring represents one’s professional and personal ethics. This includes disclosure of one’s Christian orientation as part of securing a client’s informed consent for treatment and being cognizant of the ethical codes of professional conduct. This ring too may vary in thickness, depending upon how knowledgeable a counselor is about the specifics in a code of ethics, how this code overlaps with their own moral formation, and how well-versed a counselor is in thinking ethically about complex counseling cases.

Finally the inner most circle represents what actually happens during an individual session or over the course of treatment, where the integration of theology, therapeutic orientation, and ethical commitment is embodied by a counselor as she or he works with a client.

Because the boundaries between each of the rings are permeable, I propose that a counselor can engage this model in a “top-down” or “bottom-up” manner. For example, a counselor can start with a theological insight and consider how this theological concept aligns with their therapeutic orientation, their ethical commitments, and their work with clients. Or a counselor might ponder a specific therapeutic impasse and work “up” through the rings by reflecting on the ethical principles that affect a therapist’s decisions and by seeking additional therapeutic and theological information that might give them new insights into the situation. The model also allows one to raise a question of coherence. To what degree is there alignment between the various layers? If we picture a column with four layers instead of four concentric circles, then we might be able to see the degree to which things “stack up.” If there is coherence between the levels, then the column will stand straight and tall. However, if a counselor’s theology has no interface with his or her therapeutic thinking then the blocks will not be quite vertically aligned.

When does this integration take place? As the model implies, much of the preparatory work for integration happens outside of the counseling session through formal or informal study of theology and counseling, through counselor supervision, and through discussions with other Christians who counsel. When counselors dedicate time to becoming well-versed in theology, the practice of counseling, and professional ethics, then they have the raw data of integration. When they meet with clients, they will be able to engage in explicit or implicit integration in as seamless a way as possible.

Posted Mar 01, 2010