Persistent Depressive Disorder (Dysthymia)

Posted on by Greg E. Gifford

By David Wong

I. Definition

  1. Biblical Perspective
    1. Persistent Depressive Disorder is “a continuous long-term (chronic) form of depression.”[1] Asher and Asher say that “the primary diagnostic feature is clinical depression (see Depression) that lasts more or less continuously for two years (one year in children and adolescents).”[2]
    2. Persistent Depressive Disorder is similar in nature to Major Depression, but Persistent Depressive Disorder “usually has fewer or less serious symptoms than major depression”[3]
      1. Major distinctive characteristic is the time frame and severity of the disorder.
  2. Secular Perspective
    1. DSM V
      1. “Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.”[4]
        1. 1 year for adolescents and children
      2. Treatments/Methodologies
        1. One of the significant treatments applicable to those diagnosed with Persistent Depressive Disorder through Psychology is Psychotherapy.
          1. Psychotherapy refers to therapeutic treatment of mental disorders without the use of medication.
          2. Some common therapies include[5]:
            1. Cognitive Behavioral Theory
            2. Interpersonal Therapy
            3. Dialectic Behavioral Therapy
            4. Psychodynamic Therapy
            5. Psychoanalytical Therapy
            6. Supportive Therapy
            7. Other Therapies include:
              1. Animal Assisted Therapy
              2. Creative Arts Therapy
              3. Play Therapy
              4. Yoga
              5. Psychotherapy does not necessarily have to be strict as to the type of psychotherapy being used. Psychologists may combine elements from several styles of psychotherapy, “they blend elements from different approaches and tailor their treatment according to each client’s needs.”[6]
        2. Medication
          1. Psychology also advocates for the use of anti-depressants as medication for depression as well. Some common medicines include[7]:
            1. Selective Serotonin reuptake inhibitors (SSRIs)
            2. Tricyclic Antidepressants (TCAs)
            3. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
            4. Other Types[8]
            5. Atypical Antidepressants
            6. Monoamine oxidase inhibitors (MAOIs)

II. History

  1. DSM III
    1. Categorized as Dysthymic Disorder (Depressive Neurosis) under 300.40 in Affective Disorders.
    2. Dysthymia was originally introduced in the DSM III[9]
    3. Dysthymia occurs when, during the last two years, the “individual has been bothered most or all of the time by symptoms characteristic of the depressive syndrome but that are not of sufficient severity and duration to meet the criteria for a major depressive episode.”[10]
      1. Duration of 2 years for adults
      2. Duration of 1 year for children and adolescents
    4. “The manifestations of the depressive syndrome may be relatively persistent or separated by periods of normal mood lasting a few days to a few weeks, but no more than a few months at a time”[11]
  2. DSM V
    1. Classified as Persistent Depressive Disorder (Dysthymia) under 300.4 (F34.1) as a Depressive Disorder.
    2. The major change from the DSM IV to the DSM V is that Dysthymia is gone, replaced with persistent depressive disorder
      1. This new condition includes both chronic major depression and dysthymia because of the “inability to find scientifically meaningful differences between these two conditions”[12]
    3. Evidence of the Problem
      1. The DSM V says that those experiencing two (or more) of the following are likely to have Persistent Depressive Disorder[13]:
        1. Poor appetite or overeating
        2. Insomnia or Hypersomnia
        3. Low energy or fatigue
        4. Low self-esteem
        5. Poor concentration or difficulty making decisions
        6. Feelings of hopelessness

III. Etiology

  1. Potential Causes of Persistent Depressive Disorder (Psychological View)
    1. The exact cause of Persistent Depressive Disorder is unknown. However, it could be a result of such causes as:
      1. Biological Differences or Brain Chemistry[14]
        1. Scientists have identified many different neurotransmitters that may play a role in depression, and this includes neurotransmitters like[15]
          1. Acetylcholine
          2. Serotonin
          3. Norepinephrine
          4. Dopamine
          5. Glutamate
          6. Gamma-aminobutyric acid (GABA)
  1. Inherited Traits
    1. “Depression does not have a clear pattern of inheritance in families.”[16]
    2. However, “people who have a first-degree relative with depression appear to have a two to three times greater risk of developing the condition than the general public”[17]
  2. Life Events
    1. “Traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger persistent depressive disorder in some people”[18]
  3. Potential Causes of Persistent Depressive Disorder (Spiritual)
    1. Biblical counselors must recognize that physical, physiological, and biological issues occurring with the counselee do have the ability to influence the response of the counselee.
      1. However, while physical, physiological, and biological issues can influence a person, they cannot force a person to respond with sin.
    2. “Depression unrelated to drugs or a physical illness are often indicative of wrong thinking or other spiritual problems”[19]
      1. The person must respond to their sin with confession to the Lord and repentance from their sin
        1. Persistent depressive disorder is not, in and of itself, a sin
          1. Sinful actions and habits may lead to persistent depressive disorder, and persistent depressive disorder may result in sinful actions and habits
          2. However, Persistent depressive disorder is not, in and of itself, a sin
        2. Spiritual Symptoms
          1. Guilt
          2. Anxiety
          3. Suffering
          4. Feelings of Inferiority
          5. Hopelessness
  4. Physical Symptoms
    1. Poor appetite or overeating
    2. Insomnia or Hypersomnia
    3. Low energy or fatigue

IV. Examining the Heart

  1. Heart Themes
    1. Fear of Man
      1. “Instead of a biblically guided fear of the Lord, we fear others”[20]
      2. The most radical treatment for the fear of man is the fear of the Lord.
        1. The sufferer must first “know that God is awesome and glorious, not other people”[21]
      3. The action the counselee must take to remedy the fear of man is to “need them less and love them more”[22]
      4. Relevant Passages
        1. Proverbs 29:25
        2. Matthew 10:28
        3. Galatians 1:10
        4. Mark 12:30-31
      5. Control
        1. Wrong thinking and belief that control will bring us satisfaction or happiness.
        2. “We don’t know what’s best for us because we’re not the Creator.”[23]
        3. Show counselee that God is in control and that He is working for good
          1. God is Sovereignly in control
          2. God is Good and acts according to His goodness
          3. God is Faithful and always fulfills His promises for our good
  2. Comfort
    1. Obedience to God oftentimes means stepping outside of your comfort zone
      1. John 14:15
      2. 1 John 5:3
      3. Romans 12:1-2
    2. Chief end of man is to glorify God and enjoy Him forever.
  3. Biblical Solutions
    1. Counseling Agenda
      1. Involvement
        1. Seek to build a relationship with the counselee
          1. Enter the person’s world[24]
            1. Includes listening to the counselee to discern where they are struggling[25]
          2. Incarnate the love of Christ[26]
            1. “As Christ’s ambassadors, it’s not just what we say that God uses to encourage change in people; it’s also who we are and what we do”[27]
          3. Inspiration
            1. Provide hope to the counselee that Scripture has answers to their problems and that lasting change is possible
              1. “Hope is more than convincing people that things will get better, or helping them decide what to do”[28]
              2. Hope “helps people who are dealing with the unthinkable to view life from the perspective of God’s glory and grace and their identity as His children”[29]
                1. Romans 15:4
                2. 1 Corinthians 10:13
                3. Galatians 3:26
                4. John 1:12
    2. Inventory
      1. Gather physical data
        1. Sleep
        2. Diet
        3. Exercise
        4. Illness
        5. Medication
      2. Discern their heart through speaking and asking appropriate questions to better understand them
      3. Information the counselor wants to know[30]
        1. The situation
        2. The responses
        3. The thoughts
        4. The motives
    3. Interpretation
      1. Involves “accurately analyzing or conceptualizing the data and explaining it to the counselee” [31]
        1. Discern biblical categories that best describe the counselee [32]
          1. Saved or Unsaved?
          2. Spiritually mature or immature
          3. Unruly, fainthearted, weak?
            1. 1 Thessalonians 5:14
      2. Formulate a Working Interpretation[33]
      3. Determine possible reasons for the problem
      4. Consider the Counselee’s heart
      5. Test the Validity of Your Interpretation[34]
    4. Instruction
      1. Instruction should be biblically based[35]
        1. “Counseling that is faithful to the Bible effectively communicates the original meaning of the biblical text in a way that is relevant to the situation and heart of the person you are counseling”[36]
      2. Specific Instruction as to Depression
        1. Physical and Physiological Issues
          1. The counselor must provide biblical instruction as it relates to the physical or physiological aspects of their lives
            1. The extent of this counsel should be to counsel the counselee against unhealthy actions and habits as well as instructing the counselee to undertake healthy living (i.e. sleeping habits, eating habits, exercising, etc.)
              1. For issues that are medical, or may require more professional attention, the counselor should encourage the counselee to see their medical practitioner
            2. Instruct on the heart
              1. Potential heart themes for those struggling the Dysthymia
                1. Control
                2. Comfort
                3. Fear of Man
              2. The role of feelings
              3. Various problems and issues the counselee may be struggling with[37]
                1. Guilt
                2. Anxiety
          2. Suffering
            1. Inferiority
            2. Hopelessness
            3. Laziness
            4. Self-control
    5. Inducement[38]
      1. Fire up the counselee to make certain decisions and commitments that will facilitate change
      2. “Bring counselees to the realization that biblical change involves personal choice”[39]
      3. Promotes a concern about heart sins as well as behavioral sins[40]
        1. “Nothing less than heart repentance and heart change will please God and produce change that is genuine and lasting”
      4. “Secure a commitment from counselees to put off the desires, thoughts, and actions that hinder biblical change and to replace them with ones that promote biblical change”[41]
    6. Implementation
      1. Ephesians 4 Model
        1. Put off the Old
          1. Identify factors that hinder biblical change and take steps to eliminate them[42]
        2. Renewal of the Mind
          1. Provide practical action for the counselee to engage in, in the hopes that the counselee would be personally engaged with Scripture and contain a renewed perspective pertaining to their issues and problems as well as their heart
            1. Prayer
            2. Bible Reading
            3. Biblical instruction
          2. Put on the New[43]
            1. Should be specific as to the counselee according to the Ephesians 4 model
          3. Homework
            1. Homework should provide specific and practical action for the counselee to take
            2. Assigned Bible Reading for the counselee to do and meditate upon
              1. Ephesians 4
              2. 1 Corinthians 10:13
              3. Romans 15:4
            3. Homework should “assist the counselee to apply the truths learned about God, self, and others to the specifics of his living situation, making biblical corrections and instituting new biblical habits”[44]
    7. Integration
      1. Ensure that they are getting involved in their local Church
        1. Sunday Service
        2. Bible Studies
        3. Fellowship Groups
        4. Accountability
      2. At this point, the counselor would like their local church to be shepherding and guiding this person
        1. This includes ongoing discipleship and accountability within the Church
        2. Ensuring that the counselee is surrounded by strong believers that are devoted to the Word and are committed to discipling and keeping the counselee accountable in their living
      3. Recommended Books
        1. How to Help People Change by Jay E. Adams
        2. Counseling: How to Counsel Biblically by The Master’s College
        3. Instruments in the Redeemer’s Hands by Paul David Tripp
        4. When People are Big and God is Small by Edward T. Welch
        5. The Christian’s Guide to Psychological Terms by Marshall and Mary Asher
  1. Recommended Homework Resources
    1. A Homework Manual for Biblical Living by Wayne Mack
    2. Depression Homework Assignment Samples from IBCD
      1. https://ibcd.org/depression-homework-assignment-samples/

 

 

Bibliography

American Psychiatric Association. 1987. Diagnostic and Statistical Manual of Mental       Disorders : Dsm-Iii-R. 3Rd edition, revised. Washington, DC: American Psychiatric      Association.

American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental       Disorders : Dsm-Iv. 4th ed. Washington, DC: American Psychiatric Association.

American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders:             Dsm-5. 5th ed. Arlington, VA: American Psychiatric Association.

“Antidepressants: Selecting One That’s Right for You.” Mayo Clinic. November 17, 2017.           Accessed April 16, 2019. https://www.mayoclinic.org/diseases-conditions/depression/in-       depth/antidepressants/art-20046273.

Daniel Wiswede, et al. 2014. “Tracking Functional Brain Changes in Patients with Depression     under Psychodynamic Psychotherapy Using Individualized Stimuli.”                     https://doi.org/10.1371/journal.pone.0109037.

“DSM5 Diagnostic Criteria Persistent Depressive Disorder.” 2013.

“Dysthymia – Harvard Health Publications.” 2010. January 6, 2010.                       https://web.archive.org/web/20100106064958/http://www.health.harvard.edu/newsweek/ Dysthymia.htm.

Edward T. Welch, 1997. When People Are Big and God Is Small : Overcoming Peer Pressure,     Codependency, and the Fear of Man. Resources for Changing Lives. Phillipsburg, N.J.: P      & R Pub.

Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub.,        2014.

Moore, Beverly. “The Illusion of Control.” Biblical Counseling Coalition. February 02, 2018.      Accessed April 18, 2019. https://www.biblicalcounselingcoalition.org/2018/02/02/the-           illusion-of-control/.

 “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic.           Accessed February 16, 2019. https://www.mayoclinic.org/diseases-conditions/persistent- depressive-disorder/symptoms-causes/syc-20350929.

Publishing, Harvard Health. n.d. “What Causes Depression?” Harvard Health. Accessed   February 19, 2019. https://www.health.harvard.edu/mind-and-mood/what-causes-        depression.

Reference, Genetics Home. n.d. “Depression.” Genetics Home Reference. Accessed February      19, 2019. https://ghr.nlm.nih.gov/condition/depression.

Robin L. Cautin and Scott O. Lilienfeld, eds. 2014. The Encyclopedia of Clinical Psychology.     Hoboken, NJ, USA: John Wiley & Sons, Inc. https://doi.org/10.1002/9781118625392.

Tripp, Paul David. 2002. Instruments in the Redeemer’s Hands : People in Need of Change          Helping People in Need of Change. Resources for Changing Lives. Phillipsburg, N.J.: P      & R Pub.

 “Understanding Psychotherapy and How It Works.” n.d. Https://Www.Apa.Org. Accessed          February 17, 2019. https://www.apa.org/helpcenter/understanding-psychotherapy

[1] “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic. Accessed February 16, 2019. https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929.

[2] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub., 2014, 143.

[3] “Dysthymia – Harvard Health Publications.” 2010. January 6, 2010. https://web.archive.org/web/20100106064958/http://www.health.harvard.edu/newsweek/Dysthymia.htm.

[4] American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders: Dsm-5. 5th ed. Arlington, VA: American Psychiatric Association, 168.

[5] Daniel Wiswede, et al. 2014. “Tracking Functional Brain Changes in Patients with Depression under Psychodynamic Psychotherapy Using Individualized Stimuli.”  https://doi.org/10.1371/journal.pone.0109037.

[6] “Understanding Psychotherapy and How It Works.” n.d. Https://Www.Apa.Org. Accessed February 17, 2019. https://www.apa.org/helpcenter/understanding-psychotherapy.

[7] Robin L. Cautin and Scott O. Lilienfeld, eds. 2014. The Encyclopedia of Clinical Psychology. Hoboken, NJ, USA: John Wiley & Sons, Inc. https://doi.org/10.1002/9781118625392.

[8] “Antidepressants: Selecting One That’s Right for You.” Mayo Clinic. November 17, 2017. Accessed April 16, 2019. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273.

[9] American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders : Dsm-Iv. 4th ed. Washington, DC: American Psychiatric Association, 209.

[10] American Psychiatric Association. 1987. Diagnostic and Statistical Manual of Mental Disorders : Dsm-Iii-R. 3Rd edition, revised. Washington, DC: American Psychiatric Association, 222.

[11] Ibid.

[12] American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders: Dsm-5. 5th ed. Arlington, VA: American Psychiatric Association, 168.

[13] “DSM5 Diagnostic Criteria Persistent Depressive Disorder.” 2013, 3.

[14] “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic. Accessed February 16, 2019. https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929.

[15] Publishing, Harvard Health. n.d. “What Causes Depression?” Harvard Health. Accessed February 19, 2019. https://www.health.harvard.edu/mind-and-mood/what-causes-depression.

[16] Reference, Genetics Home. n.d. “Depression.” Genetics Home Reference. Accessed February 19, 2019. https://ghr.nlm.nih.gov/condition/depression.

[17] Ibid.

[18] “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic.

[19] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub., 2014, 61.

[20] Edward T. Welch, 1997. When People Are Big and God Is Small : Overcoming Peer Pressure,   Codependency, and the Fear of Man. Resources for Changing Lives. Phillipsburg, N.J.: P & R Pub, 14.

[21] Ibid., 95.

[22] Ibid., 193.

[23] Moore, Beverly. “The Illusion of Control.” Biblical Counseling Coalition. February 02, 2018. Accessed April 18, 2019. https://www.biblicalcounselingcoalition.org/2018/02/02/the-illusion-of-control/.

[24] Tripp, Paul David. 2002. Instruments in the Redeemer’s Hands : People in Need of Change Helping People in Need of Change. Resources for Changing Lives. Phillipsburg, N.J.: P & R Pub, 126.

[25] Ibid., 128.

[26] Ibid., 133.

[27] Ibid., 134.

[28] Ibid., 157.

[29] Ibid.

[30] Ibid., 189.

[31] Master’s College. 2005. Counseling : How to Counsel Biblically,147.

[32] Ibid., 150.

[33] Ibid., 157-160

[34] Ibid., 159-160.

[35] Ibid., 163.

[36] Street, John D. 2013. Men Counseling Men. Eugene, Or.: Harvest House, Chapter 2.

[37] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub., 2014, 61-62

[38] Master’s College. 2005. Counseling: How to Counsel Biblically, 176-177

[39] Ibid.

[40] Ibid.

[41] Ibid.

[42] Ibid., 190.

[43] Ibid., 193.

[44] Tripp, Paul David. 2002. Instruments in the Redeemer’s Hands: People in Need of Change Helping People in Need of Change, 343.

Post-Partum Depression

Posted on by Greg E. Gifford

By Andrea Johnson

I. Definition

Postpartum depression (PPD) refers to the intense sadness women sometimes experience after giving birth.[1] It must occur within the first four weeks of giving birth and last for a period of two weeks or longer.[2]

II. Secular Perspective

The DSM IV was the first resource to place postpartum depression under the category of major depression. Therefore, PPD is viewed/treated similarly to major depression, with the exception of the use of medication, because some anti-depressants are not recommended for mothers who are breastfeeding. PPD has a prevalence of 13% amongst new mothers[3], and it generally self-resolves within two weeks to three months. PPD often disrupts the mother’s interpersonal relationships, and can even harm child development.[4]

Those who are a part of the feminist camp do not approve of PPD being a specific category at all. PPD is offensive to them because they do not want women to have a specific disorder that does not pertain to men, as this would cause women to potentially appear weak. They argue that because men do not have a specific label for any hormonal or emotional imbalances, neither should women.

Secular treatment for PPD includes interpersonal psychotherapy, short-term cognitive behavioral therapy, pharmacotherapy, hormonal therapy, and in extreme cases, psychiatric hospitalization.

III. Biblical Perspective

Postpartum depression affects both the inner and outer man. Body and soul are distinguished, but they cannot be separated (2 Corinthians 4:16). PPD affects the woman as a whole – her physical body is experiencing hormonal changes, lack of sleep, shock to new motherhood, and physical pain due to childbearing, meanwhile her thinking, attitude, motivations, desires, and reactions are all being affected. Where there is a physical problem, there will also certainly be a spiritual problem.[5] Therefore, a woman who is experiencing PPD should care for both her physical body and her inner heart. 1 Corinthians 6:19-20 says that our bodies are the temple of the Holy Spirit. So the woman experiencing postpartum depression should be cared for as a whole person, both the physical outer man and the spiritual inner man.

Depression/anguish is not seen as a sin in and of itself in the Bible. We see this in the examples of David (Ps. 42, 2 Sam. 12:15-24), Job (Job 2:9, 4:9), and even Jesus (Isaiah 53:3, Luke 22:44). Postpartum depression means that a woman is experiencing real pain that is both physical and spiritual, and she should be cared for equally in both areas.

IV. Evidence of the Problem

Common themes and patterns for women experiencing PPD are lack of sleep, transitional shock, hormonal withdrawal, and previous depression[6]. Common expressions of PPD are crying spells, insomnia, depressed mood, fatigue, anxiety, poor concentration, lack of interest in daily activities, increased or decreased appetite, hypersomnia, phychomotive behavior, feelings of worthlessness or inadequacy about being a mother, guilt about being depressed, and recurring thoughts of death regarding either her or the baby.[7] Women experience these expressions in varying degrees ranging from mild (i.e. the “baby blues”) to severe (i.e. postpartum psychosis). There are several risk factors that greatly contribute to a new mother’s chance of experiencing PPD[8]. These include previous depression, prenatal depression, prenatal anxiety, life stress, poor marital relationship, lack of social support, child care stress, and temperamental or sick infants.

There are consequences for both the mother and the infant that can arise from the presence of PPD, such as behavioral and cognitive development in the child[9], disrupted mother-infant bonding, disruption of interpersonal relationships for the mother, and disruption to the mother’s marriage[10].

V. Examining the Heart

It is important to investigate each scenario to find out what each woman is struggling with individually. PPD is looks different for different women, both physically and spiritually. Sinful heart themes that may be present are: pride in the unacceptance of physical weakness, a wrong view of motherhood, false expectations for motherhood, resistance to connecting with the local church/asking for help. Women who are new mothers may want to prove to themselves and others that they are a capable mother. In addition, their view of “capable/good motherhood” may not be biblical. This may contribute to a depressed state because women will never live up to an unrealistic and unbiblical standard of good motherhood. Motherhood must be learned, it is not simply known. Women experiencing PPD will often ignore their own physical pain in an attempt to focus on their child, when they should also be caring for themselves physically, and asking for necessary help. Sleep deprivation has been found to be one of the leading factors of depression[11], but women are often not aware of the implications of their sleep deprivation and other physical stress they are experiencing. This could be rooted in the pride of not wanting to accept their physical limitations, and not wanting to look like an incapable mother by asking for assistance.

VI. Biblical Solutions

A woman experiencing PPD must ensure she has a biblical perspective of motherhood, humbles herself to admit her physical weakness, and ask for help from the local church. She also needs to understand that it is good to take care of her physical body, as this will impact her inner soul as well. Heath Lambert and Stuart Scott recommend that a woman with PPD should seek help from her husband/friends/the local church, so that she is able to tend to her immediate physical needs of sleep and food. She should study Romans 5:1-5 to be encouraged that her suffering is not pointless, and she has the opportunity to see the Lord’s hand through her depression. She should confess sins of pride and any unrealistic expectations she has placed on herself. Finally, she should gain a biblical understanding of motherhood by learning from other women who have gone before her, as Titus 2:3-5 commands.

Homework would include prayer, studying Romans 5:1-5, meeting with an older woman from church, and setting a daily schedule. Setting a schedule will help the new mother ensure that she is getting rest, food, and daily tasks accomplished, and will help her to find out what areas she specifically needs help in (i.e. meal prep, laundry, house cleaning, etc.)

Recommended books include: Overcoming Fear, Worry, and Anxiety by Elise Fitzpatrick; Women Counseling Women by Elise Fitzpatrick; Depression: Looking Up from the Stubborn Darkness by Edward T. Welch; and Lies Women Believe by Nancy Lee DeMoss.

 

 

 

BIBLIOGRAPHY

Anderson, Gary R. 2017. Postpartum Depression: Prevalence, Risk Factors and Outcomes.         Health Psychology Research Focus. Hauppauge, New York: Nova        Biomedical. http://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=n  ebk&AN=1453453&site=ehost-live&scope=site&custid=s8898283.

Andrews-Fike, Christa. 1999. “A Review of Postpartum Depression.” Primary Care         Companion to The Journal of Clinical Psychiatry 1 (1):        914. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181045/.

Asher, Marshall and Mary. The Christian’s Guide to Psychological Terms, 2nd ed. 2004.

Bernard-Bonnin, Dr. Anne-Claude. “Maternal Depression and Child Development.” US National Library of Medicine. October 2004. Accessed April 13, 2019. https://www.ncbi.      nlm.nih.gov/pmc/articles/PMC2724169/.

Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC:    American Psychiatric Association, 2000.

“Interview with Charles Hodges & Jim Newheiser {Transcript}.” 2017. IBCD. March 24, 2017. https://ibcd.org/004-interview-with-charles-hodges-jim-newheiser-transcript/.

O’Hara, Michael W. 2009. “Postpartum Depression: What We Know.” Journal of Clinical           Psychology 65 (12): 1258–69. https://doi.org/10.1002/jclp.20644.

STUART, SCOTT, and MICHAEL W. O’HARA. 1995. “Interpersonal Psychotherapy for           Postpartum Depression.” The Journal of Psychotherapy Practice and Research 4 (1): 18        29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330386/.

 

[1] Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American

Psychiatric Association, 2000.

[2] Asher, Marshall and Mary, The Christian’s Guide to Psychological Terms, 2nd ed., 2004, 149.

[3] Anderson, Gary R. 2017, Postpartum Depression: Prevalence, Risk Factors and Outcomes, Health Psychology Research Focus, Hauppauge, New  York: NovaBiomedical, http://search.ebscohost.com/login.aspxdirect=true&AuthType=shib&db=nebk&AN=1453453&site=ehost-live&scope=site&custid=s8898283.

[4] O’Hara, Michael W. 2009, “Postpartum Depression: What We Know,” Journal of Clinical Psychology 65 (12): 1258–69, https://doi.org/10.1002/jclp.20644.

[5] “Interview with Charles Hodges & Jim Newheiser {Transcript},” 2017, IBCD, March 24, 2017, https://ibcd.org/004-interview-with-charles-hodges-jim-newheiser-transcript/.

[6] Asher, Marshall and Mary, The Christian’s Guide to Psychological Terms,

[7] Andrews-Fike, Christa, 1999, “A Review of Postpartum Depression,” Primary Care Companion to The Journal of Clinical Psychiatry 1 (1):914, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181045/

[8] O’Hara, Michael W. 2009, “Postpartum Depression: What We Know,” Journal of Clinical Psychology 65 (12): 1258–69, https://doi.org/10.1002/jclp.20644.

[9] Bernard-Bonnin, Dr. Anne-Claude, “Maternal Depression and Child Development,” US National Library of Medicine, October 2004, Accessed April 13, 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724169/.

[10] STUART, SCOTT, and MICHAEL W. O’HARA, 1995, “Interpersonal Psychotherapy for Postpartum Depression,” The Journal of Psychotherapy Practice and Research 4 (1): 18 29, https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3330386/, 20.

[11] “Interview with Charles Hodges & Jim Newheiser {Transcript},” 2017, IBCD, March 24, 2017, https://ibcd.org/004-interview-with-charles-hodges-jim-newheiser-transcript/.

Dementia

Posted on by Greg E. Gifford

By Theresa Egger

I. Definition

 Dementia is a syndrome wherein an individual experiences inhibited cognitive functioning to the extent that it interferes with daily life. Dementia is not synonymous with aging and it is distinguishable from the inevitable consequences of aging which include dulled senses and occasional forgetfulness.[1] Dementia is not a disease. Rather, it is a syndrome meaning that it is a group of symptoms which occur together. [2] Additionally, dementia is not synonymous with Alzheimer’s. Alzheimer’s is one specific disease that causes dementia. This means that everyone who has Alzheimer’s disease has dementia, but not everyone with dementia has Alzheimer’s. Although the term dementia is never found in Scripture, the Bible is living and active and therefore still offers relevant truths for this situation (Hebrews 4:12). First, Genesis 3 tells us that illness is the result of the fall. Like all physical disorders, this is not part of God’s original design. Because of sin, bodily decay and ultimately death are inevitable. Additionally, Scripture offers instructions for how the believer should respond to dementia. Finally, God’s Word offers hope for those who have been affected by this illness.

The secular world’s primary treatment for dementia is medication.[3] Healthy dieting is also often encouraged either to reverse or prevent dementia. [4] There are also several therapies intended to help the individual with dementia improve their memory or feel more comfortable. Examples include reminiscence therapy, music therapy, reality orientation and aromatherapy.[5]

In the past, individuals with dementia were referred to as senile however today, dementia has replaced the term senile.[6] The first edition of the DSM referred to dementia as a “chronic brain syndrome associated with senile brain disease.”[7] In the DSM-II it was considered an “organic brain syndrome.”[8] The DSM-III relabeled dementia as an “organic mental disorder.”[9] Interestingly, however, the DSM-IV categorized dementia as a cognitive disorder dropping the term “organic” because it implied that there are mental disorders which don’t have a biological base.[10] Finally, the DSM-V has dropped the term dementia all-together and renamed it a major neurocognitive disorder.[11]

II. Evidence of the Problem

Symptoms[12]

  1. Impairment in abstract thinking.
  2. Impaired judgment: inability to reason and make logical decisions.
  3. Other disturbances of higher cortical function such as language and motor skills.
  4. Personality change: Individuals with dementia may become angered more easily or irritable.

Dementia is a physical problem and therefore there is always a physiological cause. Examples of potential causes:[13]

  1. Alzheimer’s disease[14]
  2. Frontotemporal dementia (Pick’s disease).
  3. Traumatic brain injury.
  4. Lewy Body Dementia.
  5. Vascular Dementia/Binswanger’s disease.
  6. Brain tumors
  7. Parkinson’s disease.
  8. Huntington’s disease.
  9. Creutzfeldt-Jakob disease.
  10. HIV-AIDS.
  11. Normal-pressure hydrocephalus.
  12. Degenerative dementia of old age.

III. Examining the Heart

Dementia is not a spiritual problem but a physical one. Thus, the individual with dementia does not need to be encouraged toward repentance and heart change unless there have been sinful manifestations that have resulted from the dementia. For example, individuals with dementia may become angered more easily than they did prior to developing this illness. However, this does not mean that the dementia is causing the angry outbursts. A person’s body cannot cause them to sin.[15] Rather, anger is most likely a heart issue that was present before the illness, but has now been publically manifested because they are no longer able to hide it.[16] In these instances a potential heart theme to consider is control. While addressing sin in an individual with dementia will be much more complicated, the biblical instruction to lovingly confront our brother or sister in sin still applies (Matthew 18:15-17; Galatians 6:1-3).

Another issue that often arises within the discussion of dementia is the salvation of the individual with dementia. Is the person with dementia able to make the confession of faith which Romans 10:9 states is required for salvation? First, we must remember that the Gospel is profound yet simple enough for a child to understand (Matthew 18:3; Mark 10:15). Furthermore, we must trust that God is sovereign over an individual’s salvation. If God has elected that person for salvation, they will be saved (Romans 8:30). Thus, we should continue evangelizing and trust God with the results (Romans 10:14). Finally, if the individual with dementia did make a confession of faith and exhibited fruits of repentance prior to their illness, we can trust that God will keep His promise to preserve them until the end if they are truly His (Ephesians 4:30).[17]

IV. Biblical Solutions

Because dementia is a physical problem, the majority of counseling will involve coming alongside of the caregiver.[18] For this reason, the following counseling agenda has been focused towards providing hope and biblical instruction for the primary caregiver of the individual with dementia.

  1. The counselor should seek to build involvement with the counselee by praying for her and showing genuine compassion. This can be done by listening well and seeking to be a friend.[19] Because of the nature of the situation it will also be helpful to offer to help with meals, home care and even house chores. Show the counselee you love them by offering to help in practical ways.
  2. During the inventory process the counselor should ask questions in three areas. First, ask questions regarding the physical well-being of the individual with dementia. This will help you gain a better understanding of the situation. Secondly, ask questions about the caregiver’s well-being. It is essential that we minister to them as whole people because the physical and spiritual components influence one another.[20] Finally, ask questions about the caregiver’s spiritual health. Ask her to share her testimony. Can she verbalize the Gospel? Ask about Scripture-reading, prayer and church attendance. This will help you know where she is at spiritually and enable you to discern whether she is a strong believer who simply needs to be encouraged, or if she is an unruly counselee who needs to be admonished (1 Thessalonians 5:14).
  3. Instilling hope in the counselee will be absolutely crucial for the counseling process. This hope should be founded on God’s promises contained in His Word. Because dementia is an illness, offer comfort from passages which assure believers that there will be a future resurrection. Revelation 21:4 assures us that in the eternal state there will be no more pain or death. Additionally, the promises of God’s presence with His people can provide invaluable hope and comfort during difficult seasons (e.g. Psalms 94:14; Matthew 28:20; Hebrews 13:5).
  4. Interpretation will involve discerning what the counselee is responsible for. Because Dementia is a physical problem, there is not sin to be repented of in this initial diagnosis.[21] There may, however, be some sins that have arisen in response to this trial. This must be addressed in counseling.
  5. Instruction should be offered in the area of sufferology. Suffering is the result of living in a fallen world. Therefore, the counselee is not responsible for the trial but how she responds. Additionally, because the individual with dementia is very forgetful and frequently repeats themselves, patience is one area that will likely need to be addressed. Point the counselee to 1 Corinthians 10:13 which reminds us that God won’t let us be tempted beyond what we are able.[22]
  6. During inducement, it will be crucial to point the counselee back to the example of Christ. It might be helpful to do a study on love and point the counselee to Christ who loved the church by sacrificing His own life. The parable of the unmerciful servant in Matthew 18 is another good passage which reminds us of the forgiveness that God has extended to us which is our motivation to forgive others.
  7. Homework should include prayer, repentance (1 John 1:9) and Bible study. Potential passages to do Bible studies on are 1 Corinthians 13, Philippians 4:4-8, and Hebrews 4:14-16.
  8. Finally, integration will be absolutely essential for the caregiver. Encourage your counselee to get involved in a small group at church. The church will be able to provide practical help as well as spiritual encouragement and accountability for the counselee during this tiring season. God has given believers the body of Christ to help one another in this way (1 Thessalonians 5:14).

Recommended books

Adams, Jay E. How to Handle Trouble God’s Way. Phillipsburg, NJ: Presbyterian and Reformed Pub, 1982.

Deane, Barbara. Caring for Your Aging Parents: When Love Is Not Enough. Colorado Springs, Colo.: NavPress, 1989.

Drew, Holly Dean, and Theological Research Exchange Network. “Counseling the Caregiver: Addressing the Biblical Responsibility and care of Aging Parents,” 2002.

Fitzpatrick, Elyse. Women Counseling Women. Eugene, Or.: Harvest House, 2010.

Welch, Edward T. Blame It on the Brain: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience. Resources for Changing Lives. Phillipsburg, N.J.: P & R Pub, 1998.

Welch, Edward T. Counselor’s Guide to the Brain and Its Disorders: Knowing the Difference between Disease and Sin. Grand Rapids, Mich.: Zondervan, 1991.

 

 

 

[1] Ed Welch. Blame it on the Brain. (Phillipsburg, N.J.: P & R Pub, 1998), 71.

[2] Consumer Dummies. Alzheimer’s and Dementia for Dummies. (Hoboken, NJ: John Wiley and Sons, 2016), 8.

[3] Kenneth Partridge. The Brain. (New York: H.W. Wilson, 2009), 114.

[4] Neal D. Barnard. Power Foods for the Brain. (New York, NY: Hachette Book Group, 2013)

[5] Consumer Dummies. Alzheimer’s and Dementia for Dummies. 150-155

[6] Welch. Blame it on the Brain. 70

[7] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 22

[8] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-II. 24

[9] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-III. 107

[10] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 123

[11] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-V.

[12] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R. 107

[13] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. (Bemidji, Minn.: Focus Pub, 2014), 56.

[14] Ed Welch. Counselor’s Guide to the Brain and Its Disorders, (Grand Rapids, Mich: Zondervan, 1991), 108.

[15] Elyse Fitzpatrick. Women Counseling Women. (Eugene, Or.: Harvest House, 2010), 127

[16] Welch. Blame it on the Brain. 78-79

[17] Wayne Grudem. Biblical Doctrine. (Leicester, England: Inter-Varsity Press, 1004), 337.

[18] Welch. Blame it on the Brain. 63

[19] Stuart Scott and Heath Lambert. Counseling the Hard Cases. (Nashville, Tenn.: B & H Academic, 2012), 182.

[20] Ibid., 213.

[21] Welch. Blame it on the Brain. 63

[22] Fitzpatrick. Women Counseling Women.  247

Reactive Attachment Disorder (RADs)

Posted on by Greg E. Gifford

By Julie DeVore

I. Definition:

The Reactive Attachment Disorder (RADs) is characterized by a difficulty in forming healthy attachment in relationships.

II. Biblical Perspective

The Reactive Attachment Disorder is marked by a lack of attachment and trust which leads to destructive behavior. Children who struggle with RADs must learn to trust God. They must be comforted as sufferers and held accountable as sinners.

Scripture speaks to the child who has experienced great neglect and emotional pain. Scripture comforts the sufferer through the attributes of God. The pain children experience from neglect is not their own fault. However, when pain from neglect leads a child to not trust God, be self-autonomous and disobedient, they must be called to repentance.

The counselor must distinguish suffering from sin, and counsel each accordingly. One suffers because he struggles to attach due to neglect; however, one sins when he allows this detachment to cause him to disobey.

Scripture that comforts the sufferer:

  1. Psalm 139 – Promises that their birth was purposeful and planned by God.
  2. Genesis 1:27 – Created valuable in the image of God.
  3. 3 Corinthians 1:3 – God Comforts us
  4. Psalm 10:14, 17-19 – God defends the Fatherless; God is the Perfect Father.
  5. Romans 8:27-29 – God works all things for good.
  6. Romans 8:31-39 – Nothing can separate us from God’s unconditional love.
  7. Hebrews 4:14-16 – God grieves and sympathizes with our weakness.
  8. Philippians 4:6 – God is our peace.

Scripture that challenges the sinner:

  1. Romans 3:23 – Everyone has sinned in some manner.
  2. Proverbs 3:5-6 – God is to be trusted.
  3. Psalm 37: 3-7 – Confess sin of self-reliance.
    1. Trust in the Lord
    2. Delight yourself in the Lord
    3. Commit your way to the Lord
    4. Be still before the Lord and wait patiently
  4. 1 John 1:9 – Confess sin, God forgives.

III. Secular perspective

Definition: Reactive Attachment Disorder is defined in the DSM-V as “[1]a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers…” A child diagnosed with RADs “[2]minimally seeks comfort” and “Minimally responds to comfort.” The DSM explains that they have “[3]Persistent social and emotional disturbance…” The lack of relationship and attachment forms because a “[4]child has experienced a pattern of extremes of insufficient care…” This is insufficient care from neglect, and lack of basic needs such as food, comfort and stimulation. RADs may be [5]described as “persistent” if it has been present longer than 12 months. The [6]DSM describes this condition as uncommon, occurring in less than 10% of neglected children. Therefore, not every neglected child has RADs, but neglect is the definitive factor of someone who may be diagnosed with RADs.

In 1994, the DSM divided Reactive Attachment Disorder into two specific phenotypes:

  1. Inhibited – “[7]persistent failure to initiate and to respond to most social interactions in a developmentally appropriate way.”
  2. Disinhibited – “[8]Predominant disturbance in social relatedness is indiscriminate sociability or lack of selectivity in the choice of attachment figures.”

There are [9]three criteria that distinguish RADs from other disorders: Attachment, Timing & Cause.

  1. Attachment – “[10]There is a lack of attachment, exhibited by disturbed social relatedness.”
  2. Timing – The “[11]onset of symptoms of abnormal behavior begins prior to age five.” RADS is distinctive because it stems from abuse and neglect that occurred before the age of 5 years old.
  3. Cause – The cause of RADs is rooted in neglect.

Secular Therapy Methods: 

Because the problem with RADs is attachment, the therapy goal is relearned attachment. Catherin Cain, author of Attachment Disorders: Treatment strategies for traumatized children teaches that “[12]children with RAD need to go through these developmental stages [Trust and Autonomy] a second time in order to experience them in a healthy way…”

  1. Dependence and Love Therapy: The American Psychiatric Association teaches that “[13]Children with RAD need to become as dependent upon the adult as a newborn infant is, in order to rebuild the bonds of trust … ” Linda Rice explains that “[14]the child with RAD needs to return to this state of dependency and rely on the caregiver for everything. The caregiver should decide what the child will eat and what the child will wear … ask permission to eat, sleep, use bathroom, or play.”
  2. [15]Holding Method – In this method, therapists encourage forced attachment by encouraging the caregiver to hold the child until child resists. They encourage pressure which creates discomfort in the infant. They are seeking to force a response from the child.
  3. Re-Birthing Method – Reenact giving birth for an adoptive child to promote attachment with the foster mom. However, Candace a [16]10-year old girl died by suffocation in the “rebirthing” method.

IV. History

The Reactive Attachment Disorder is a newly recognized Psychological Label. It was first described in 1980 in DSM-III as “pathogenic care.” In 1994 the DSM-IV Subdivided RADs into inhibited & disinhibited phenotypes. Then in 2013 the DSM-V broke the category into two different Disorders: Reactive Attachment Disorder of Infancy and Early Childhood and Disinhibited Social Engagement Disorder.

V. Evidence of the Problem

Linda Rice, author of Parenting the Difficult child explains that RADs children are some of the hardest people to counsel. Rice synthesizes some of the common [17]characteristics of RADs:

  1. Lack of eye contact
  2. Lack of ability to give and receive affection on parents’ terms
  3. Demanding, clingy
  4. Indiscriminately affectionate
  5. Superficially engaging and charming
  6. Lying
  7. Poor friendships
  8. Abnormal eating
  9. Theft
  10. Destructive to self or others
  11. Learning delays
  12. Cruel to animals
  13. Poor impulse control
  14. Intense control battles
  15. Hypervigilance/hyperactivity

VI. Etiology

            The main spiritual problem that must be addressed is the child’s lack of trust in God. Then the counselor can begin moving the child to put off his old habits and put on new as their life is being renewed (Colossians 3). However, trust in God must be first. Otherwise, we are encouraging behavior modification instead of internal heart change (James 1:16).

While there are some physical causes that affect RADs, they do not excuse the spiritual need of trust for God. Neglect has caused it to be difficult for a RADs child to trust God and others. However, this does not excuse their lack of trust in God.  

Studies have shown that the neurons also play a quintessential role in the development of a child. Catherine Cain, author of Attachment Disorders: Treatment Strategies for Traumatized Children explains that, “[18]the more the child is exposed to during the early years of life, the more the brain structure the child will have to work with in later years. This is why early childhood experiences are so important. If not used, the neurons are eventually depleted. By the time the child is ten, half of the original one thousand trillion neurons are gone. It is as if the brain is preprogramed with more neurons than we could ever possibly use so that the brain has the ability to adapt to whatever environment it is born into and then discard what it does not need.” Cain further explains that learning is accomplished through patterns in the brain. However, “[19]a chaotic environment, or one that is not predictable, makes it difficult for the brain to figure out patterns it needs in order for these behavioral patterns to form.” Because of this, “[20]a young child left in a poor environment with minimal stimulus during the first two years of life does not stand a chance against a child raised in a rich environment with lots of experiences and sensory input.” Therefore, neglect and neurons do in fact play a major role in the physical causes of RAD.  However, while they should be considered, they should never be the sole resource. A counselor must take in both the physical and spiritual elements of an individual.

VII. Examining the Heart

Possible Heart Themes:

  1. Lack of Trust
  2. Self-Preservation
  3. Autonomy
  4. Fear
  5. Disobedience
  6. Anger
  7. Bitterness

Possible Heart Idols:

  1. Control
  2. Self – Reliance

VIII. Biblical Solutions

The core of counseling must be rooted in Scripture. As Biblical counselors we believe that Scripture is sufficient to counsel every need (1 Timothy 3:16-17). Linda Rice, in her book Parenting the Difficult Child describes five common factors in Reactive Attachment Disorder. Using these 5 labels can help inform our biblical counseling (see Appendix 1).

She recognizes that RADs stems from Neglect. When a child suffers from neglect, Biblical counselors must emphasize the comfort and love of God. The counselor teaches identity in Christ (Psalm 139 & Genesis 1:27) and God’s sovereignty. He is Comforter (1 Corinthians 1:3), Perfect Father and Defender (Psalm 10); He works all for good (Romans 8:27-29), and nothing can separate us from his love (Romans 8:31-39). God comforts the sufferer.

The next stages are Lack of Trust and Self Preservation/Autonomy. The child has “learned” from their neglect experience that people are not trustworthy. Therefore, they trust themselves. We must lead them to the perfect, trustworthy God. He will not fail them. We are commanded to trust Him (Proverbs 3:5-8). Failure to trust God is a sin that must be addressed.

The final stages are Emotions and Habituation. The RADs child lives off emotions and forms destructive habits. Change must take root from within the desires of one’s heart (James 1:16). Old habits must be put off, they must be renewed, and new habits must be put on. (See Colossians 3:5-17).

Picture1

This cycle of Neglect to Lack of Trust/Autonomy to Emotions to Habituation forms habits that are hard to break. Rice explains that it is [21]difficult to change because:

  1. If desire doesn’t change, we don’t change
  2. Because its hard/uncomfortable
  3. Habits are hard to break

But we believe that hope for change is possible through the power of Christ and Scripture.  (Ephesians 5:8 and Jude 1:24-27).

 

 

 

 

 

 

 

 

 

 

 

 

 

[22]Appendix 1:

 

 

 

 

 

Recommended Resources:

Asher, Marshal and Mary. The Christian’s Guide to Psychological Terms. USA, 2014.

“Biblical Answers for Attachment.” n.d. Faith Therapy. https://www.faiththerapy.org/answers-by-topic/attachment/. 19 February 2019.

Cain, Catherin Swanson. Attachment Disorders: Treatment Strategies for Traumatized Children. Lanhand : Jason Aronson Publishing, 2006.

Emlet, Michael R. “Loving Others as Saints, Sufferers and Sinners (Part 2).” The Journal of Biblical Counseling (2018): 40-65.

Hollinger, Kevin. Rative Attachment Disorder: Helping Adoptive Parents Think Biblically About Attachment. Westminster Thological Seminary, 2007. Thesis.

Rice, Linda J. Parenting the Difficult Child. USA: SeedSown Press, 2012.

Works Cited

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington: American Psychiatric Association, 1994. Fourth edition.

—. DSM-V. Washington, DC: American Psychiatric Publishing, 2013.

Cain, Catherin Swanson. Attachment Disorders: Treatment Strategies for Traumatized Children. Lanhand : Jason Aronson Publishing, 2006.

Hollinger, Kevin. Rative Attachment Disorder: Helping Adoptive Parents Think Biblically About Attachment. Westminster Thological Seminary, 2007. Thesis.

Rice, Linda J. Parenting the Difficult Child. USA: SeedSown Press, 2012.

The Holy Bible – ESV. Illinois: CrossWay, 2011.

Wilson, Samantha. “Attachment Disorders: Review and Current Status.” Journal of Psychology (2001): 37-.

 

[1] (American Psychiatric Association) 265

[2] (American Psychiatric Association) 265

[3] (American Psychiatric Association) 265

[4] (American Psychiatric Association) 265

[5] (American Psychiatric Association) 266

[6] (American Psychiatric Association) 265

[7] (American Psychiatric Association) 116

[8] (American Psychiatric Association)116

[9] (Rice) 15

[10] (Rice) 15

[11] (Rice)15

[12] (Cain) 151

[13] (Cain)151

[14] (Rice) 151

[15] (Wilson) 11

[16] (Hollinger) 40

[17] (Rice) 51

[18] (Cain) 27-28

[19] (Cain) 31

[20] (Cain) 34

[21] (Rice) 51

[22] (DeVore, 2019) & (Rice) – This figure I created while reading Parenting the Difficult Child.

Anxiety (Generalized Anxiety Disorder)

Posted on by Greg E. Gifford

By Julie Golan

I. Definition

Biblical perspective

The Bible would describe anxiety as a sinful worry, often about the future (Matthew 6:25-34; Philippians 4:6). There are references in Scripture to good kinds of fear, however. The fear of the Lord, for example, is something that the Bible instructs all people to have (Deuteronomy 10:12, Psalm 33:8, Matthew 10:28). Additionally, there is biblical concern that is not sinful, which Paul uses to express genuine care, particularly in the body of Christ (1 Corinthians 12:25, 2 Corinthians 11:28-29, Philippians 2:20).

The majority of Scriptural texts mentioning anxiety or worry are in reference to sinful practices. In Matthew 6, Jesus instructs: “do not be worried about your life, as to what you will eat or what you will drink; nor for your body, as to what you will put on” (Matthew 6:25). He goes on to explain God’s provision for “the birds of the air” and “the lilies of the field”, demonstrating how much more He will provide for those who are His own (Matthew 6:26-30). Concluding, Jesus says, “So do not worry about tomorrow; for tomorrow will care for itself. Each day has enough trouble of its own” (Matthew 6:34). In Philippians, Paul commands the church to “be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known to God” (Philippians 4:6). Peter also speaks on anxiety, instructing the recipients of his letter to cast “all your anxiety on Him, because He cares for you” (1 Peter 5:7). The previous verse explains that doing so is an act of humility before the Lord (1 Peter 5:6-7). Before sending Israel into the promised land, God commanded Joshua to “Be strong and courageous! Do not tremble or be dismayed, for the Lord your God is with you wherever you go” (Joshua 1:9). Here, God reminded Joshua of His faithful character and promises, by which there was no need for fear. Again, God reminds those in Israel “with anxious heart” that they need not fear because of God’s promise for ultimate deliverance (Isaiah 35:4). Furthermore, there are many examples in the Psalms where believers have expressed deliverance from fear and that they need not fear because of God’s character and promises (Psalm 23:4, 27:1, 56:3-4, 118:6).

Secular Perspective

In a broad sense, the DMS 5 anxiety as “the anticipation of future threat”.[1] However, there are many different manifestations of anxiety within the realm of psychology. The DSM 5 separates anxiety into seven broad categories: separation anxiety disorder, selective mutism, specific phobia, social phobia, panic disorder, agoraphobia, and generalized anxiety disorder, substance/medication-induced anxiety disorder, anxiety disorder due to another medical condition, other specified anxiety disorder, unspecified anxiety disorder.[2]

Secular treatment for anxiety will primarily be done through medication and psychotherapy. The Harvard Mental Health Letter provides almost 10 different types of medication that can help anxiety and suggests three different types of psychotherapy.

II. History

Fear has existed since the fall, when Adam and Eve hid from God in the garden because they knew their nakedness (Genesis 3:8-10). In terms of anxiety, some have suggested that “Ancient Greek and Latin authors reported cases of pathological anxiety, and identified them as medical disorders” as early as the 3rd-4th century B.C.[3] In modern psychology, Sigmund Freud “coined many of the terms used for various anxiety disorders” in the early DSM books.[4] Beginning with a 1894 article [5], Freud became the first major psychologist to distinguish different types of anxiety. From his work came the popularization of panic attacks, obsessiveness, and phobias.[6] “Freud’s early work unified under the umbrella of ‘anxiety’ a variety of previously distinct syndromes or symptoms that had been associated with broader conditions.” [7] His work paved the way for the “diagnostic revolution of 1980.” [8] Up until this point, there was still a broad understanding of anxiety. However, the introduction of the DSM 3 in 1980 brought about a “large variety of distinct and categorical definitions of anxiety” unlike anything prior.[9] Since, developments and diagnoses of anxiety have only increased.

III. Evidence of the Problem

Generalized anxiety disorder (GAD) is “characterized by a pattern of frequent, persistent excessive anxiety and worry that is out of proportion to the impact of the event or circumstance that is the focus of the worry”.[10] Diagnostic criteria include finding it difficult to control worry, impaired functioning, and physical symptoms such as restlessness and irritability. To be diagnosed with GAD, an individual must be experiencing these symptoms regularly for a minimum of 6 months.

IV. Etiology

According to the Harvard Mental Health Letter, GAD can occur due to other psychiatric disorders such as “substance use disorder or alcohol dependence”.[11] It also notes that “severe or constant stress can produce a hyperactive anxiety reaction”.[12] Spiritual causes for anxiety are often rooted in not trusting God, as suggested by Dr. John MacArthur in his book Anxious for Nothing.[13]

Spiritual symptoms of anxiety can include doubting God’s faithfulness to be true to His character and/or promises. Physical symptoms of GAD can include fatigue, trouble sleeping, trembling, nervousness, sweating, nausea, and irritability.[14]

V. Examining the Heart

One heart theme behind anxiety could include a desire for control. The person struggling with anxiety desires their circumstances to be different and is not meditating on and trusting in God’s sovereignty within the situation. An idol within a desire for control could include the worship of comfort. A sinful desire for comfort could tempt one toward anxiety for the future, health, safety, and more.

VI. Biblical Solutions

Jay Adams suggested the method of “eliminating fear by love”.[15] Essentially, transferring the focus off the one struggling and onto loving others, ultimately God. “Love toward God means focusing upon how one may trust, worship, and serve Him; love toward one’s neighbor likewise focuses upon a giving relationship to him”.[16]  Dr. John MacArthur suggests an agenda that has an emphasis on prayer, and in doing so practicing obedience to Philippians 4:6.[17]

Recommended Books

“Anxious for Nothing: God’s Cure for the Cares of Your Soul” by John MacArthur

“Overcoming Fear, Worry, and Anxiety: Becoming a Woman of Faith and Confidence” by Elyse Fitzpatrick

“Overcoming Anxiety: Relief for Worried People” by David Powlison

 

Recommended Homework Resources

A Homework Manual for Biblical Living by Wayne Mack

Discussion Guides in Anxious for Nothing by John MacArthur

Fear Homework Assignment Samples from The Institute for Biblical Counseling and Discipleship: https://ibcd.org/fear-homework-assignment-samples/

 

Bibliography

[1]Black, Donald W., and Jon E. Grant. DSM-5 Guidebook : The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing, 2014.

[2] Black, Donald W., and Jon E. Grant. DSM-5 Guidebook : The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing, 2014.

[3] Marc-Antoine Crocq. A History of Anxiety: from Hippocrates to DSM. The National Center for Biotechnology Information. 2015.

 [4] Marc-Antoine Crocq. A History of Anxiety: from Hippocrates to DSM. The National Center for Biotechnology Information. 2015.

[5] “The Justification for Detaching from Neurasthenia a Particular Syndrome: The Anxiety-Neurosis”.

[6] Horwitz, Allan V. Anxiety : A Short History. Johns Hopkins University Press, 2013, P 80

[7] Horwitz, Allan V. Anxiety : A Short History. Johns Hopkins University Press, 2013. P 80

[8] Horwitz, Allan V. Anxiety : A Short History. Johns Hopkins University Press, 2013. P 80

[9] Horwitz, Allan V. Anxiety : A Short History. Johns Hopkins University Press, 2013. P 6

[10] Horwitz, Allan V. Anxiety : A Short History. Johns Hopkins University Press, 2013. P 6

[11] Harvard Health Publishing. “Generalized Anxiety Disorder.” Harvard Health Blog. Accessed December 01, 2018.

[12] Harvard Health Publishing. “Generalized Anxiety Disorder.” Harvard Health Blog. Accessed December 01, 2018.

[13] MacArthur, John. Anxious for Nothing : God’s Cure for the Cares of Your Soul. Vol. 3rd ed, David C. Cook, 2012.

[14] Generalized Anxiety Disorder. Mayo Clinic.

[15] Jay Adams, The Christian Counselor’s Manual, 416.

[16]  Jay Adams, The Christian Counselor’s Manual, 416.

[17] John MacArthur, Anxious for Nothing, chapter 2.

Depression

Posted on by Greg E. Gifford

By Hannah Giesbrecht

I. Definition:

Depression is defined as a mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.

II. Biblical perspective

Depression comes in a variety of different ways and it affects different people differently. Depression can become a debilitating state that comes as a result of spiritual or physical infirmities. The Bible views depression as a trial, a time of suffering that, if viewed with an eternal perspective and treated in a biblically way, will ultimately increase our faith. Depression results as a lack of biblical hope and trust in God. However, depression can be the result of physical imbalances, so regular doctor’s visits are crucial for someone who may be struggling with depression. Our physical body does affect our spiritual and mental health. Depression is characterized by hopelessness, joylessness, guilt, shame, sadness, and worthlessness. Whenever anything or anyone other than God is the focal point of our worship and desire, this kind of idolatry impacts our behavior, our thoughts and our emotions. Romans 5:14 says, “For whatever was written in former days was written for our instruction, that through endurance and through the encouragement of the Scriptures we might have hope.” The Scriptures are sufficient for our every need and that includes battling depression; God’s Word is overflowing with truth that brings hope and peace.

Counseling that skillfully employs and applies God’s Word is a necessary duty of Christian life and fellowship. Scripture is superior to human wisdom and the Word of God is a more effective discerner of the human heart than any earthly means. Our Heavenly Father is the only effective agent of recovery and regeneration. All the treasures of wisdom and knowledge are found in Christ Himself. It is the job of biblical counselors to point counselees to the everlasting hope found in Christ and His Word, because Scripture is sufficient.

III. Secular perspective

  1. Diagnostic criteria for depression based on DSM-IV:[1]

Based on the 9-item depression module from the MINI participants are classified in the following way:

  • Major depressive episode: 5 or more symptoms, including of the key symptoms.
  • Sub-threshold depressive symptoms: 2-4 symptoms, may or may not include a key symptom.
  • Non-depressed: 0-1 symptoms

Symptoms:

  1. Depressed mood*
  2. Loss of interest*
  3. Significant weight loss or gain or decrease or increase in appetite
  4. Insomnia or hypersomnia
  5. Psychomotor agitation or retardation
  6. Fatigue or loss of energy
  7. Feelings of worthlessness or excessive or inappropriate guilt
  8. Diminished ability to think or concentrate, or indecisiveness
  9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan

*key symptoms

  1. Depression is the persistent feeling of sadness or loss of interest that characterizes major depression can lead to a range of behavioral and physical symptoms.

Therapies recommended to those with depression:

  1. Cognitive Behavioral Therapy
  2. Behavior Therapy
  3. Psychotherapy

Secular treatment consists of antidepressants. Medication often prescribed to depression patients includes:

  1. Bupropion
  2. Venlafaxine
  3. Mirtazapine
  4. Duloxetine
  5. Amitriptyline

Recommended specialists:

  1. Clinical psychologist
  2. Psychiatrist
  3. Primary care provider (PCP)
  4. Emergency medicine doctor

IV. History

Many scholars think that depression was first recognized as early as the time of the Ancient Greeks. The Greeks thought the disease was due to an imbalance in the four basic bodily fluids, or humors. Later, Aretaeus of Cappadocia noted that sufferers were dejected and stern, without any real cause. The name given to depression then was known as Melancholia, which was a far broader concept than today’s depression. In the 11th century, Persian physician Avicenna described melancholia as a mood disorder. Avicenna’s work, The Canon of Medicine, alongside the work of Hippocrates and Galen, became the standard of medical thinking in Europe. In the 18th century, German physician Johann Christian Heinroth argued that melancholia was a disturbance of the soul due to moral conflict. The term depression was derived from the Latin verb deprimere, which means, “to press down.” In the 19th and 20th centuries, English psychiatrist Henry Maudsely proposed a general category of affective disorder. Depression and reactive depression came to refer to a mood and not a reaction to outside events. In the 21st century, humanistic theories of depression have represented a forceful affirmation of individualism.

Depression has also been called clinical depression, major depression and major depressive disorder. Current treatment of depression implies that depression is a biomedical disease, which is why most psychiatrists prescribe antidepressants. The expert panels for treating depression (Depression Guideline Panel 1993; Katz and Alexopoulos 1996; Ballenger et a. 1999; WHO Collaborating Centre for Mental Health Research and Training 2000) recommend a clinical approach can be summarized as follows. Providers should:

  1. Recognize the presenting symptoms of depression and its causes.
  2. Make an explicit diagnosis of depression.
  3. Educate the patient and family, and stress that depression is treatable.
  4. Engage the patient and family in choosing treatment.
  5. Assess patients’ progress regularly.

Usually, treatment of depression begins with a patient visiting a health-care provider and reporting symptoms that suggest a mood disorder. Oftentimes the emotional symptoms of depression are hidden behind physical symptoms like complaints of fatigue.

V. Evidence of the Problem

Common themes and patterns observed in the lives of those who have been diagnosed with depression are extreme sadness, anxiety, listlessness, and feeling blue. Those who struggle with depression are often fatigued, over time becoming restless and irritable. Sleep is often restless, tossing and turning all night. Nightmares occur frequently, making restful sleep even more difficult. Another common theme is utter hopelessness. Many of those who are depressed are also suicidal. Depression is a despair that consumes you.

Severe depression can be debilitating, and there are several key expressions, recognizable as symptoms of depression. some cases where the activity level is as minimal as possible. Depression can have severe long term effects on one’s daily functions, as well as relationships with friends and families. Guilt and feelings of worthlessness overcome the counselee. Everything is negative, dwelling on past sad experiences, sins, failures and disappointments. Minor problems become major problems as one imagines the worst possible scenario. Some people lose unhealthy amounts of weight, while some people struggle to eat at all. People lose interest or pleasure in what used to interest you. Many people have trouble concentrating, feeling as though thoughts and movements have been slowed down; like your brain is fuzzy and in slow motion.[2] Depression takes a big toll on one’s physical self as well as one’s spiritual self. Many believers struggle to pray when they are feeling depressed.

VI. Etiology

Depression is an issue that affects people physically and spiritually. There isn’t an over arching “rule of thumb” for theories of depression. It manifests itself differently in different people. However, hope is found in the Person of Jesus Christ, not a pill. Sometimes the source of the problem is physical, then spiritual, sometimes vice versa. There are several spiritual symptoms and physical symptoms that can be seen in most cases of depression.

  1. Spiritual symptoms
    1. Hopelessness
    2. Continual lack of peace
    3. Not trusting in God
    4. Feelings of despair
    5. Discouragement
    6. Disappointment
    7. Despondency
    8. Lack of motivation
    9. Difficult to focus
    10. Diminishing prayer life

2. Physical symptoms

  1. Restlessness, unexplainable unhappiness
  2. Drastic change in weight
  3. Headache
  4. Brain fog
  5. Blurred vision
  6. Excessive crying
  7. Sadness
  8. Lack of concentration
  9. Irritability
  10. Social isolation

 

VII. Examining the Heart

  1. Heart themes
    1. Incorrect view of the faithfulness of God
    2. Hopelessness
    3. Incorrect view of the sovereignty of God
    4. Fear of man – guilt that others will think of you differently if they knew you struggled with depression.
    5. Lack of trust in the Lord (control)

2. Idols of the heart

  1. Pride
  2. Control,
  3. Self – reliance,
  4. Comfort
  5. Selfishness

 

VII. Biblical Solutions

  1. Counseling Agenda

Depression of one of the common temptations of man. 1 Corinthians 10:13 says, “No temptation that have overtaken you but such as is common to man.” One of the first steps a counselee can make towards change is admitting that God is capable of helping overcome depression. Another practical step a counselee can take is to commune with God through His Word. Lamentations 3:17-24 says, “I still dare to hope when I remember this: The faithful love of the Lord never ends! His mercies never cease. Great is his faithfulness; his mercies begin afresh each morning. I say to myself, ‘The Lord is my inheritance; therefore, I will hope in him’” God is faithful, capable, sovereign, eternally good and we desperately need hope every day of our lives! Christians struggling with depression need to fix their eyes on the Lord, the Author and Perfecter of faith. Romans 8:28 says, “And we know that for those who love God all things work together for good, for those who are called according to his purpose.” There is a reason and a purpose for the trial of depression, but believers are called to depend on Him through it all. Hebrews 6:19 says, “We have this as a sure and steadfast anchor of the soul, a hope that enters into the inner place behind the curtain.” Christ is our sure and steadfast anchor, which offers hope through Him and His Word.

Recommended Resources:

Adams, Jay E. A. The Theology of Christian Counseling. Grand Rapids, MI: Zondervan,

1979.

Adams, Jay E. The Christian Counselor’s Manual. Grand Rapids, MI: Zondervan, 1973.

Bridges, Jerry. Trusting God: Even When Life Hurts. Colorado Springs, CO: NavPress.

Busenitz, Nathan. Living A Life of Hope. Uhrichsville, OH: Barbour Publishing, 2003.

Lane, Timothy S., and Paul David Tripp. How People Change. Greensboro NC: New

Growth Press, 2008.

Somerville, Robert B. If I’m A Christian, Why Am I Depressed? United States of

America: Xulon Press, 2014.

Welch, Edward T. Depression: Looking Up from the Stubborn Darkness. Greensboro,

NC: New Growth Press, 2011.

Welch, Edward T. Depression: The Way Up When You Are Down (Resources for

Changing Lives). Greensboro, NC: New Growth Press, 2011.

Tada, Joni Eareckson. A Place of Healing: Wrestling with the Mysteries of Suffering,

Pain, and God’s Sovereignty. Colorado Springs, CO: Wolgemuth & Associates,

Inc. 2010.

Mack, Wayne A. Out of the Blues: Dealing with the Blues of Depression and Loneliness.

Minnesota: Focus Publishing, 2006.

Mack, Wayne A and Deborah Howard. It’s Not Fair! Finding Hope When Times Are

Tough. P & R Publishing: 2008.

Adams, Jay. What Do You Do When You Become Depressed? Phillipsburg, NJ:

Presbyterian and Reformed, 1975 (pamphlet).

Bridges, Jerry. Trusting God. Colorado Springs, CO: NavPress, 1989.

 

 

 

Recommended homework resources

Sample 1(taken from Robert Somerville’s book: If I’m a Christian, Why Am I Depressed?[3])

Somerville recommends journaling what you’re going through, as you’re learning and growing.

  • Journal a paragraph or two describing the anguish you feel.
  • Write out 1 Corinthians 10:13 in your journal and on a 3×5 card.
    • Memorize it.
    • On the back of the card write out a prayer, paraphrasing the verse as a prayer back to God. It might look like this: “Father, I thank You that You are faithful and that all our problems are common to man. I thank You that You never give us a temptation, test, or trial that is greater than we can handle. I thank You that You always provide a way through the problem so that we can handle it. Lord, as I face my depression today help me to look for the way out that You have provided so that I might be able to endure.”
    • Review the card and pray it back to God several times each day.
  • Read 1 Corinthians 10:13, Hebrews 4:14-16, and 1 John 1:9 and answer the following questions on each verse:
    • What has God promised you?
    • What hope and encouragement do you get from these three passages?
    • How will you respond to God’s promises in your situation?

 

 

[1] Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, by the American Psychiatric Association.

[2] Somerville, Robert B. If I’m A Christian, Why Am I Depressed? United States of America: Xulon Press, 2014.

[3] Somerville, Robert B. If I’m A Christian, Why Am I Depressed? United States of America: Xulon Press, 2014.

Biblical Counseling

Posted on by Greg E. Gifford

By Jill Freeman

I. Overview

Biblical counseling is defined by its commitment not only to the inerrancy but also the sufficiency of Scripture to counsel people through life. While the psychological counselor would say that the Bible does not address many modern-day problems[1], Biblical Counseling boldly proclaims that “His divine power has given us everything we need for life and godliness through our knowledge of him who called us by his own glory and goodness.”[2]

However, this stands in contrast not only with secular psychology but with integrationist “Christian psychology”.[3] MacArthur notes, “In recent years…there has been a strong and very influential movement within the church attempting to replace biblical counseling in the church body with ‘Christina psychology’—techniques and wisdom gleaned from secular therapies and dispensed primarily by paid professionals. That is, they quote Scripture and often blend theological ideas with the teachings of Freud, Rogers, Jung, or whatever school of secular psychology they follow.”[4] These integrationists would claim that biblical counseling believes “God has allowed human beings to discover truth in almost every filed of human study except psychology.”[5] However, our ultimate source of truth must always be the Bible. Paul is pretty clear when he says, “See to it that no one takes you captive through hollow and deceptive philosophy, which depends on human tradition and the basic principles of this world rather than on Christ.”[6] Bulkley asks, “Am I misreading Paul? Is he in error to suggest that we can find all wisdom in Christ?”[7]

MacArthur gives a list of ideas that “many Christians are zealously attempting to synthesize with biblical truth”[8]:

Human nature is basically good.

People have the answers to their problems inside them.

The key to understanding and correcting a person’s attitudes and actions lies somewhere in that person’s past.

Individuals’ problems are the result of what someone else has done to them.

Human problems can be purely psychological in nature, unrelated to any spiritual or physical condition.

Deep-seated problems can be solved only by professional counselors using therapy.

Scripture, prayer, and the Holy Spirit are inadequate and simplistic resources for solving certain types of problems.[9]

            In contrast, the truly biblical counselor would not affirm these anti-biblical truths. But, are we then throwing away the whole of psychology? MacArthur answers this by saying that “Certainly it is reasonable for people to seek medical help for medical problems…It is also sensible for someone who is alcoholic, drug addicted, learning disabled, traumatized by rape, incest, or severe battering, to seek help in trying to cope with their trauma…In extreme situations medication might be needed to stabilize an otherwise dangerous person.”[10] However, he points out that these are not the norm and should not be the norm for dealing with spiritual problems.[11]

If biblical counseling is not these things, what is it? MacArthur defines the common commitments of Biblical Counseling below:

  • God is at the center of counseling.
  • Commitment to God has epistemological consequences.
  • Sin, in all its dimensions
  • The gospel of Jesus Christ is the answer.
  • The biblical change process which counseling must aim at is progressive sanctification.
  • The situational difficulties people face are not the random cause of problems of living.
  • Counseling is fundamentally a pastoral activity and must be church-based.[12]

Macarthur notes that “These seven commitments have unified the biblical counseling movement … but there are numerous other issues that demand clear biblical thinking and firm commitment…”[13]

II. History & Impact

The Biblical Counseling movement sprang up in the 1970’s; “that rediscovery is linked primarily to the life and efforts of one man: Jay E. Adams.”[14] Adams became a believer in high school and in college earned a Bachelor of Arts in classics and a Bachelor of Divinity. In 1952, Adams was ordained and pastored for the next thirteen years; yet he was troubled by his inability to help people solve their problems.[15] Then, in 1965, Adams began a fellowship program with O. Hobart Mowrer, who influenced Adams greatly as he observed Mowrer dealing with people’s problems as moral issues. Although Mowrer did not follow a biblical approach,[16] through working with him, Adams was persuaded to begin much study on the conscience, guilt, anthropology, and change.[17] In 1970, after much study, “Adams’ personal rediscovery of biblical counseling initiated a widespread rediscovery for the entire church.”[18] Powlison notes that, “The publication of Competent to Counsel (CtC) in 1970 marked the inception of a discernible nouthetic counseling movement and triggered lively controversy in the evangelical community.”[19]

In the time leading up to the Biblical counseling movement, several factors stood as a backdrop to the movement. First, revivalism had sprung up, in which the primary goal was to draw a crowd and convert them to Christ.[20] Neither of these are bad things, yet revivalism tends to focus on the masses, conversion, and instant change, while Biblical counseling focuses on individuals, conversion and discipleship, and the change process.[21] Another factor which had major significance in relation to Biblical Counseling was modernism: “In this controversy higher criticism and Darwinism worked to undercut the confidence that many ministers and ordinary Christians had in the authority of the biblical text. The Bible’s teaching on the origins of the world, its understanding of the problems of people, and even the words of Scripture itself all came under fire.”[22] Modernism obviously played a major role in undermining the belief that Scripture is sufficient in counseling. In addition to this, the psychological revolution, including Wilhelm Wundt and Sigmund Freud propelled the culture into a greater need for truly Biblical Counseling. Lambert notes that Freud actually “argued for a class of ‘secular pastoral workers’ with the goal of secularizing the counseling task.”[23] Wundt’s belief that all psychological problems stemmed from physiological problems had great impact on the church, which began to follow Wundt’s persuasion that psychology was merely a scientific (and not theological) field.[24] Lambert notes, “The absence of theology in counseling was the order of the day when, in 1970, Jay Adams published Competent to Counsel. In that book and many others in the 1970s Adams sought to alert Christians to their failures in the area of counseling and began pointing the way to the resources laid out in Scripture for helping people.”[25]

In 1966, Adams started a counseling center with Gardner McBride, called the Christian Counseling and Educational Center (CCEC). Then in 1968, the ministry was expanded and the Christian Counseling and Educational Foundation (CCEF) was formed, which became a source not only of counseling, but also of training and published resources. CCEF continued to grow, hiring its first full-time employee in 1974, and expanding its sites across the country. Soon, “the need for a professional association became evident. Concerns for the growing group of practitioners included certification for biblical counselors, accountability for standards of biblical commitment and ethics, fellowship and interaction among biblical counselors, ongoing in-service training, and protection from lawsuits. To meet these and other needs, Adams joined with several men to found the National Association of Nouthetic Counselors (NANC) in 1976.”[26]

Since the founding of NANC (now known as the Association of Certified Biblical Counselors: ACBC), several other biblical counseling resources, ministries, and educational programs have sprung up. These include The Journal of Biblical Counseling (originally known as The Journal of Pastoral Practice), Faith Baptist Counseling Ministries (FBCM), and The Master’s University and Seminary. Meanwhile, several Christian organizations have continued down the path of secular psychology and integration, hiring psychologists and teaching psychology in their colleges and seminaries.

Powlison explains that, “The nouthetic counseling movement entered the 1980s full of optimism. Jay Adams’s ‘counseling revolution’ had enjoyed a rapid and clamorous expansion.” However, “Nouthetic counseling’s popularity plateaued by 1980. During the decade that followed, momentum stalled, while the evangelical psychotherapists enjoyed spectacular success in capturing the mind, the respect, and the institutions of conservative Protestantism.”[27] Yet, “around 1990, even as the therapeutic movement among evangelicals came into full flower, nouthetic counseling institutions began to grow, and doubts about psychotherapy became increasingly evident among conservative Protestants.”[28]

 

III. Works/Publications

 

Bibliography

Bulkley, Ed, Why Christians Can’t Trust Psychology. Eugene: Harvest House Publishers, 1993.

Lambert, Heath. The Biblical Counseling Movement After Adams (Forward by David Powlison). E-book. Wheaton: Crossway, 2011. http://web.b.ebscohost.com/ehost/ebookviewer/ebook/bmxlYmtfXzExNDA0NjhfX0FO0?sid=d98e0c80-83a7-4f47-8a46-926e1f54fd78@sessionmgr101&vid=0&format=EK&rid=1

Macarthur, John. Counseling: How to Counsel Biblically., Nashville: Thomas Nelson, Inc., 2005.

Powlison, David. The Biblical Counseling Movement., Greensboro: New Growth Press, 2010.

 

 

[1]  Ed Bulkley, Ph. D. Why Christians Can’t Trust Psychology (Eugene: Harvest House Publishers, 1993), 258

[2] Ibid. 258, quoting 2 Peter 1:3 NIV

[3] As defended throughout Ibid.

[4] John MacArthur, Counseling: How to Counsel Biblically (Nashville: Thomas Nelson, Inc.), 3

[5] Bulkley, Why Christians Can’t Trust Psychology, 26: quoting Gary R. Collins, Can You Trust Psychology? (Downers Grove: InterVarsity Press, 1988), 94

[6] Ibid. 25 quoting Col. 2:8 NIV

[7] Ibid. 25

[8] MacArthur, Counseling: How to Counsel Biblically, 7

[9] List from Ibid. 7

[10] Ibid. 8

[11] Ibid. 8-9

[12] Ibid. 27-29

[13] Ibid. 29

[14] Ibid. 23

[15] Ibid. 21-22

[16] Ibid. 22. Also supported in: Powlison, The Biblical Counseling Movement (Greensboro: New Growth Press, 2010), chapter 2

[17] MacArthur, Counseling: How to Counsel Biblically, 22

[18] Ibid. 23

[19] Powlison, The Biblical Counseling Movement, 51

[20] Heath Lambert. The Biblical Counseling Movement After Adams (Forward by David Powlison)., E-book, (Wheaton: Crossway, 2011) chapter 1

[21]Ibid. http://web.a.ebscohost.com/ehost/ebookviewer/ebook/bmxlYmtfXzExNDA0NjhfX0FO0?sid=77ea82de-9491-46fb-bc3e-05099ad1f38a@sdc-v-sessmgr05&vid=0&format=EK&rid=1

[22] Ibid.

[23] Ibid.

[24] Ibid.

[25] Ibid.

 

[26] Ibid. 24

[27] David Powlison, The Biblical Counseling Movement, 201-202

[28] Ibid. 219

Jay E. Adams

Posted on by Greg E. Gifford

By Ethan Berthiaume

I. Known For

Jay E. Adams is a reformed American Christian author who is best known for influential writings that helped found modern Biblical Counseling. He has written over 100 books, the most famous of which being Competent to Counsel. Jay Adams introduced the method of “nouthetic” counseling, which centers around conforming to scriptural principles for the purpose of spiritual growth. This method eventually became a movement which we know today as Biblical Counseling. Adams has been called a “father of Biblical Counseling” for his foundational influence on the methods and movements that shaped it (Powlison, 44).

II. Biography

Jay Adams was born to Joseph Edward and Anita Louise Adams in Baltimore, Maryland on January 30, 1929. He was married to Betty Jane Whitlock on June 23, 1952. They had four children: Holly, Todd, Clay, and Heather (“Jay E. Adams – Exodus Books”).

Jay became came to know Christ at the age of 15 after being gifted a copy of the New Testament by a friend. Adams became fascinated with God’s word, and he majored in Greek solely for the purpose of having an understanding what God’s word teaches (Adams, Ligonier Ministries).

Adams went on to study and receive formal theological and seminary training at several different schools. These include the Reformed Episcopal Seminary, John Hopkins University, Pittsburgh-Xenia Seminary, Temple University School of Theology, and the University of Missouri. He then went on to pastor at several churches alongside the East Coast in Pennsylvania and New Jersey. Adams began working as a professor at Westminster Theological Seminary in Philadelphia, and eventually became the director of the Doctoral program at Westminster Theological Seminary in California. Following this, he went on to plant churches in South Carolina, where he pastored until 1999 (“Jay E Adams, Ph. D.”).

Jay Adams first became interested in counseling early in his pastoral ministry after experiencing a difficult situation with the death of a man he failed to comfort in a difficult circumstance. After this, Adams asked the Lord to help him become effective in counseling ministry. While studying at the Temple University School of Theology, Adams took a course on psychological counseling. Here, he was discouraged by how foundationally speculative the methods were. Adams became more interested in the Biblical view of psychology while studying under Psychologist, O. Hobart Mowrer (1907-1982). Mowrer taught counseling techniques that integrated sin as an influence on mental health. While Adams did not entirely agree with all of Mowrer’s views, he became more fascinated with applying the Bible to the techniques of soul care. Adams continued to study and develop a model founded on Biblical principles known as “nouthetic counseling”. In 1970, he published his most famous work, Competent to Counsel, which argued that that all Christians can become fully equipped for the work and ministry of soul care if their methods were centered around biblical principles and views of man (Powlison, 35-45).

The publication of this book caused much controversy in the Christian community, as more and more pastors began to adopt Adam’s method of “nouthetic counseling” into their ministry. This movement eventually grew into what we now know today as Biblical Counseling (Powlison, 44).

Adams was honored at the first International Congress on Christian Counseling in 1988 in Atlanta as one of the three fathers of Christian Counseling, for his essential influence on the movement (Powlison, 43).

Jay Adams Retired in 1999 from pastoral ministry but has continued to write and lecture on Biblical Counseling. He founded the Institute for Nouthetic Studies (INS) in the year 2001. At the time of this publication, he currently resides in South Carolina and is still involved in teaching at INS (“Jay E Adams, Ph. D.”)

Jay Adams was revolutionary for his time, as psychology had taken a preeminent role in the art of soul care. Adams challenged the skeptical theories of psychology and developed a model that helped push the church towards scripture-based methods of helping people.

III. Important Theological Views

Nouthetic Counseling

Jay Adam’s most prominent, and certainly most well-known accomplishment is his method of nouthetic counseling. The word nouthetic comes from the Greek word noutheteō, which means to “instruct” or “admonish.” Adams himself states that this method is based upon three scriptural principles: concern, confrontation, and change. Adam’s most famous work, Competent to Counsel, goes in-depth with this method, describing the role of a counselor to encourage believers towards the repentance of sin. This method also includes the factor of the Holy Spirit, whom Adams believes is the sole source of true Biblical change in a believer’s life (Adams, Ligonier Ministries).

An important distinction of Jay Adams models is their rejection of psychological theories and models that contradict the Bible. This mainly has to do with the issue of sin as it relates to a believer’s behavior, a factor that is most often excluded from modern psychological models. Adams’ method of nouthetic counseling is distinct in that it holds to the Bible as the sufficient and authoritative tool for equipping believers for all things needed for life and godliness (2 Timothy 3:16-17).

IV. Works/Publications

Jay Adams has written over 100 books that relate to pastoral ministry and counseling. These have been translated into 16 different languages. The most famous and influential of published works are: Competent to Counsel (1970), The Christian Counselors Manuel (1973), A Theology of Christian Counseling (1979), Shepherding God’s Flock: A Handbook on Pastoral Ministry, Counseling, and Leadership (1974) (“Adams, Jay E. 1929- [Worldcat Identities]”.)

 

Bibliography

“Jay E. Adams – Exodus Books”. Exodusbooks.Com, https://www.exodusbooks.com/jay-e-

adams/2716/. Accessed 30 Nov 2018.

Adams, Jay. “Competent To Counsel: An Interview With Jay Adams By Jay Adams”. Ligonier Ministries. 2014. Accessed 30 November 2018

“Jay E Adams, Ph. D.”. Nouthetic.Org, http://www.nouthetic.org/about-ins/our-faculty/8-about-ins/6-jay-adams-biography. Accessed 29 Nov 2018.

“Adams, Jay E. 1929- [Worldcat Identities]”. Orlabs.Oclc.Org,

http://orlabs.oclc.org/identities/lccn-n50-36855/. Accessed 30 Nov 2018.

Collins, Gary R; Johnson, Eric L; Jones, Stanton L (2000). Psychology & Christianity. Downers

Grove, IL, USA: InterVarsity Press. pp. 36–37. ISBN 0-8308-2263-1.

Powlison, David. The Biblical Counseling Movement. New Growth Press, 2010, pp. p. 35-44.

Ligonier Ministries, 2014, https://www.ligonier.org/learn/articles/competent-counsel-interview-jay-adams/. Accessed 1 Dec 2018.