By Tim Clinton
George Ohlschlager &
Anthony J. Centore
I hadn’t seen Eileen for nearly a year, so I was delighted when she called to come back into counseling. Eileen had been a model client. She worked diligently to understand her problem and her situation. She was intent to incorporate and learn from my insights and interpretations, and was always polite and thankful about gains she had made. The problem was that she really didn’t get any better.
She had come into counseling complaining of depression, anxiety, and other symptoms that looked like a classic case of SAD—seasonal affective disorder. Since she could trace the onset of tail-spin symptoms from November onward the two previous years, I was convinced the diagnosis was a no-brainer.
As a mild SAD sufferer myself who has struggled with it for numerous winters, I was confident in both my assessment and treatment plan. Eileen purchased a set of UV lights to work under in the evening, simplified and focused her life, worked effectively at scrubbing some toxic ‘depressogenic’ thinking out of her self-talk, and was praying and growing closer to the Lord in all this. She was doing everything right—and, I thought, so was I—but she wasn’t getting well.
In fact as the winter wore on she complained of worsening depression and anxiety. I knew that anxiety was present in most depressive episodes and, being the resourceful counselor I like to think I am, I thought I was dealing with a treatment-resistant form of depression that underlay the SAD disorder. I did what most good counselors do in this situation—I punted and referred Eileen to a local psychiatrist.
The psychiatrist diagnosed Eileen with a recurrent major depression, and a SAD disorder only secondarily. She prescribed Serzone, a stronger antidepressant that worked both serotonin and dopamine receptors in the brain. Eileen dutifully began the medication, worked through her bodies’ adjustment to it, and showed some improvement in about two weeks. Now we were getting at the core of it—and it looked like a biological disorder at its root!
After a couple more sessions, Eileen’s HMO benefits ran out and she decided to end counseling with me. We reviewed her progress—and lack of it—and Eileen was extremely grateful for all the help I had given her. We didn’t discuss the nagging question that seemed to be in the back of both of our minds—that we were missing something. I think we still weren’t quite sure what was going on—but, hey, we couldn’t afford such expensive speculations anyway.
When she came in again I was amazed how healthy and alive she was. My first thought was so self-inflated—that I really had helped her the year before and the fruit of that work was shining a healthy glow in her face. She was happy to see me again and thanked me all over the work that we had done together. I then queried what she had come in for, thinking there were some loose ends or unresolved issues that she now ready to work on.
No, she replied, she had merely come to tell me what happened that last year—what the problem really was. That summer she had cleaned out an old storage room in her basement and had found stachybotris—black mold—covering most of a wall behind a large storage shelf. During the winter, when she had her house closed up, the heating system provoked mold growth and carried its microscopic spores throughout the house.
Eileen had been sick with black mold poisoning—something that, just like the course of SAD, got progressively worse as winter carried on—and cleared up each spring when she opened up her house. Eileen had the mold removed professionally and repainted her storage room—presto, mold gone and no more trouble.
I was dumb-struck as she told her story. I must have looked quite guilty, because at one point she stopped and said, “George, no, I’m not blaming you! If anyone is at fault it’s my doctor and the psychiatrist who are probably most responsible for missing it. But I don’t blame anyone here—who knew??!”
Who knew, indeed! This episode taught me that, as a clinician, it’s more than what you know and don’t know that counts for competence. Sometimes it’s what you think you know that, in fact, you really don’t.
The pearl-of-conclusive-wisdom to be drawn here is this: Stay humble and be tentative about what you think you know in counseling. Just when you start to think you have it all figured out—that you’re an expert and ready to start writing books on the subject—bang, along comes someone whom God uses to bring you down a few pegs on the humility scale. Life and counseling for that matter, is so complex, so full of mystery that overconfident assurance can be just as wrong, just as toxic for your patients as ignorance and a lack of confidence.
While empirical data now shows that client variables are most potent in effecting outcome, the counselor and the quality of the counselor-client relationship follows closely. As one studies and spends time doing counseling, it doesn’t take long to learn that one of the most important ingredients in the counseling relationship is the counselor him or herself. As a counselor, what you believe, how you feel and act, what you do and don’t do, matters — a lot. Hence, building an effective caring and counseling ministry starts with you.
The essence of Christian counseling, as are all things Christian, is hidden in the person of Christ (Col. 1:26-27). The challenge of Matthew 22:42 (KJV) must be clearly understood and embraced by those who would call themselves a Christian counselor, “What think ye of Christ? Whose son is he?” It is a wonderful and, at times, elusive knowledge this revelation of Christ himself, but one that is freely given to us when we seek it earnestly (Matt.7: 7-11). We labor to outline this essence—the essence of Christ the caregiver—in this chapter, as well as the process by which Christian counseling works in and through the person of the counselor.
We do this so that Christian counselors are guided by a “roadmap” that helps them serve those in need in a way that honors Christ and brings unity to the Church. This tall order we see as a new millennium goal—in no way do we presume to fulfill it with this book or those that follow. We endeavor to be catalysts, acknowledging our small part in a growing field, pointing the way and encouraging action that will bring the ministry-movement to a fuller maturity.
Making sense of all the counseling information, theories and techniques now available, and shaping it into a useful treatment approach, and applying it effectively and consistently in the lives of hurting people requires the adoption of a counseling model that is intensely personal at its core. As a counselor, ‘you can’t treat what you don’t see’ and ‘you can’t see what you don’t understand’. Therefore, cultivating a meaningful counseling relationship and process that answers core questions like “What works for this client, with this problem, in this situation, at this time in their life with you as the counselor under the direction of the Holy Spirit is challenge to your time together.
In fact, in the practice of ministry with people expecting or wanting change, the theoretical must transformed into the personal. Clients are usually unwilling or are not interested in exploring the nuances and ramifications of some theoretical position that you, as a counselor, have embraced and are high about. Rather, they merely want to know “will this work for me and mine?”
On the other hand, they are almost always interested in you as a counselor—what you do, and say, and believe really does affect counseling outcome. Constructing a personal model or style of intervention is a developmental process that every counselor must engage in to be fruitful in one’s work.
One cannot delegate responsibility without authority. How does a counselor establish a position of strength and authority in counseling? It starts with a sure foundation — a foundation built on truth.
Scripture first. The foundation for Truth is given to us in the Bible — the standard by which everything else is evaluated. II Timothy 3:16 boldly declares that “All Scripture is given to us by inspiration of the Holy Spirit and is profitable for teaching, for reproof, for correction and for training in righteousness.”
Further, II Peter 1:3, reminds that “His divine power has granted to us all things that pertain to life and godliness, through the knowledge of him who called us to his own glory and excellence.” If we are going to help people break free in this life we start by knowing that “They are darkened in there understanding and separated from the life of God because of the ignorance that is in them due to the hardening of their hearts.” (Ephesians 4:18). Hence new life is tied directly to their relationship with God in Christ and that “The fear of the Lord is the beginning of wisdom” (Proverbs 9:10).
The journey then becomes a life of faith that focuses on the washing and renewing of our minds and “destroying arguments and every lofty opinion raised against the knowledge of God, and to take every thought captive to the obedience of Christ, .his ways not ours. Why? Because as Proverbs 16:25 declares we naturally follow after our own ways and not necessarily God’s ways…’ there is a way that seemeth right unto a man but the ends thereof are the ways of death”.
Hence an effective system for responsible Christian counseling involves the Chalcedonian pattern of logic. This occupies three features.
- Two terms are placed in a relationship where they exist unaltered and autonomous.
- The terms are related so that they coexist inseparably.
- One term is deemed logically prior, given authority over the other.
When two disciplines conflict on some point (such as psychology and theology) the logically prior discipline (theology) prevails. For example, considering the purpose of prayer, in practice secular psychology often overrules theology (wrongly) and prayer is used primarily as a means to request healing.
By using the Chalcedonian model, prayer is brought back to its proper (theological) main purpose—communion with God. One of the great dangers in this involves both disciplines — where truth is tainted by our fallible interpretations and understanding of it. The wise counselor will approach the pursuit of truth with both a spirit of expectation and humility.
Eternal perspective. Christians must also approach the counseling relationship with an eternal perspective of life, and of hope in Christ. Psalm 42:5 evinces this point: “Why are you downcast, O my soul? Why so disturbed within me? Put your hope in God, for I will yet praise him, my SaviorÃ¢â¬Â…
As Christians we believe that if a person suffers from emotional disorders, that the Lord is “near unto the brokenhearted and saves the crushed in spirit” (Proverbs34:18 ESV) whether in this life or in the one to come. However, if one dies without Christ the consequences are eternally devastating. As Christian Workers we wish to create better people on earth, so that they may serve God more fully. However, we do not wish to promote better adjusted people at the expense of their salvation, or by denying their need for sanctifying growth.
A war of the mind and spirit. Christian counseling, in large part, is a war for the mind. Failure identity and negative thinking leads one with a serious drinking problem to think “I am an alcoholic” versus the truth “I am a child of God who struggles with alcoholism.” Of course, we do not mean to minimize that man presents a fallen sin nature. I John 1:8 tells us “If we say we have no sin we are deceiving ourselves and the truth is not in us.”
However, there is a serious difference between having a sin problem and being sin (Colossians 2:6-10, Romans 6:11 Galatians 5:16, Ephesians 1:18). This is an important distinction for Christian Counselors. If we accept the theology that our clients are sin, there is no helping them. However, is we correctly show our clients that they are created in the image and glory of God, and that sin is something that mars that image, help becomes a process of aiding a client to repent, accept forgiveness, and mature as a child of God.
In the modern day profession, counselors still participate in numerous roles. The following list is a general overview:
- Counselor—Although this word can be ambiguous, having multiple meanings (i.e. see wardrobe counseling), counseling generally focuses on helping clients navigate problem issues: relational, behavioral, spiritual, or emotional.
- Consultant—Often understood as the role of an “expert guide,” here a counselor helps the client to troubleshoot a situation, or make important life decisions.
- Teacher—Sometimes known as “psycho-education,” teaching is a significant part of the helping process. With teaching, the counselor imparts insight into a client’s issues and strategies for coping (i.e. answers to the questions “What is stress” and “How can I decrease my stress?”). With Christian counseling, teaching also encompasses presenting solid biblical truths.
- Supervisor—This is a professional-to-professional relationship where counselors participate in “peer-supervision,” or it is where an experienced counselor oversees, and is held liable for, the practice and progress of a novice counselor.
- Researcher—The practice of research is what allows counselors to know whether what they are doing is working, and is an empirical method of discovering the truth of God. Research is what promotes positive revisions in counseling treatments that meets the modern mind with contemporary need.
Counseling, as a profession, usually attracts kind and noble persons. Healthy motivators for one pursuing a career in counseling, or a lay counseling ministry, include the desire to help others and a perceived “calling” that is confirmed by a body of Christian believers. However, not everyone in counseling is motivated by such pure desires; even the better counselors usually show a mixture of noble and not-so-noble motivations for their pursuits.
Therefore, before one makes the decision to pursue the practice of counseling, a prospective counselor is wise to complete some self-exploration. If you are considering a counseling ministry, a few of the major introspective questions include:
- Do I have any unresolved personal issues I should “work on” before attempting to become a counselor?
- Am I spiritually mature enough to lead others to a place of spiritual maturity?
- Am I willing to be open, dependable, compassionate, and generally non-judgmental—even when clients frustrate me?
- Am I willing to repeatedly expose myself to the emotional and psychological stress that is intrinsic to the counseling process?
- Am I willing to provide care to clients that I do not like, and what do I do with those that I intensely dislike?
- Do I understand that not everyone will improve through counseling?
- Am I willing to undertake extensive preparation, training, and supervision?
- Am I willing to participate in rigorous continuing education for as long as I practice counseling?
Concerning the effective counselor, a Christian counselor’s success depends on several distinguishing characteristics including personality, spiritual gifts, professional training, commitment to the gospel and biblical worldview.
Personality. Regarding personal qualities, an effective counselor will often possess:
- A natural interest in and compassion for people
- Emotional intelligence and the ability to accurately assess feelings
- The facility to engage a variety of persons in conversation
- A disposition that allows one to listen well
- An understanding and mastery of empathy
- Meaningful introspection and self-reflection
- The capacity to suspend one’s personal needs to help others
- The ability to tolerate relational intimacy (therapeutic alliance)
- The ability to lessen, not increase, a client’s anxiety
- The ability to establish healthy boundaries
- The aptitude to not let counseling relationships adversely affect the counselor’s home life
- Unwavering ethics and integrity
Spiritual gifts. It is true that God has equipped some people with gifts to be counselors, and this calling is good motivation to become a counselor. However, as one writer states, “people helping is everybody’s business,” each of us has the ability through meaningful, empathic relationships to help someone every day of our lives.
Professional or other counselor training. Christian counselors, to truly be equipped, must be knowledgeable about a wide variety of topics and issues. He or she must be educated toward understanding the many needs and complaints that are prevalent today, as well as their treatment. This means formal education, and specialized clinical trainings for anyone desiring to practice as mental health professional. For the lay helper in church-based ministry, it demands some degree of structured training in basic helping skills and process to properly direct the gift that has already shown forth.
Second, for the helping professional particularly, training also involves learning how to see contemporary mental health issues in the light of Christian theology. Third, continuing education is key for a Christian counselor to stay current with his/her counseling approach! It is not only our strong recommendation—it is an important ethical standard.
Commitment to the Gospel. Remember, the goal of Christian counseling is the restoration of the image of God in man, and maturity in Christ. Unlike secular psychology, the elimination of suffering is not necessarily the end-all of life’s objective. Christian counselors must be dedicated not only to helping clients heal their emotional, maladaptive, and social problems, but also to restoring clients’ relationship with God.
Biblical worldview. This characteristic involves an awareness of the spiritual realm of life, including, especially, how the Scriptures the nature and structure of that spiritual world.
A discerning counselor accepts the truth about good and evil in the world, is able to clearly discriminate one from the other, and engage in genuine warfare with the “enemy,” willing and prepared to seek the Holy Spirit’s guidance in the counseling process. The expert counselor also shows the facility to bring forth good fruit, and the wisdom to know when to convict and admonish, and when to comfort a client.
Gender references aside, I Timothy 3:2-4 mentions qualities that would benefit a Christian counselor. The character qualities, social relations, and circumspect behavior of a Christian leader are all noted herein:
Now the overseer must be above reproach, the husband of but one wife, temperate, self-controlled, respectable, hospitable, able to teach, not given to drunkenness, not violent but gentle, not quarrelsome, not a lover of money. He must manage his own family well and see that his children obey him with proper respect.
A comprehensive biblical worldview also involves a clear and useful understanding of natural revelation—respect and facility with the world of science. This encompasses all useful knowledge of human emotions, thoughts, relationships, physiology, etcetera as presented in clinical research, and is discussed in more depth later.
Integrating training, experience and character. This involves the amalgamation of one’s scriptural knowledge and clinical education with practice. In metaphor, experience is the bridge between the understanding of art theory and creating great art.
Great art for Christian counselors is using biblically sound, research-based treatments at the right time, in the right way, with the right client. Moreover, it is encouraging the supernatural healing touch of God in counseling—fully expressing both sides of the Parakaleo philosophy, which is the ability to both admonish and give comfort as need requires. Lastly, great art is reinforcing a commitment bond with clients, building and maintaining strong rapport from intake to termination—and beyond.
Though there are many counseling approaches, theories, and techniques and though the way a counselor engages a client will be influenced by situation and presenting needs, there are a series of core conditions for establishing an effective environment that are almost universally seen as important in the counseling relationship.
Genuineness. In order to be effective, a counselor must live out the change he/she desires to see in a client. For example, a counselor with anger problems is not in suitable condition to counsel a client to better manage anger. Moreover, a counselor who is not living out his/her faith in Christ is not spiritually prepared to participate in Christian counseling (as a counselor, that is).
Warmth. This characteristic is simply necessary to promote a sense of comfort in the client. A counselor who comes off cold or abrasive will be ineffective in establishing relationship or rapport with those seeking help. Without rapport, the core of the counseling alliance is void.
Positive regard. Though this differs from the secular concept of “unconditional positive regard” where anything the client believes, desires or does is acceptable, positive regard should be given universally to the client as a person created in the image of God. This is widely known as the principle of hating the sin, loving the sinner. In addition, Christian counselors need to know when to “hold off” on conviction for a time, and simply console and show compassion for a hurting client.
Support and challenge. There is an intricate balance of supporting clients through the “tough stuff” they are dealing with, while at the same time challenging their destructive beliefs and sinful choices. Counselors must strive to find a healthy balance in their relationship with clients; one where a client can approach the counselor with confession and feel supported, while at the same time moved to grow in a healthy, Christ-like direction.
In Competent Christian Counseling we promoted 1 Thessalonians 5:14-18 as the penultimate biblical statement of Christian counseling:
And we urge you, brothers, warn those who are idle, encourage the timid, help the weak, be patient with everyone. Make sure that nobody pays back wrong for wrong, but always try to be kind to each other and to everyone else. Be joyful always; pray continually; and give thanks in all circumstances, for this God’s will for you in Christ Jesus.
This extraordinarily powerful mandate should be the motto of every Christian counselor. In fact, when taken back to the full-color of the Greek language this passage incorporates every Greek term that denotes the helping endeavor in the Scriptures, and reflects the many dimensions of counseling today:
Urge [parakaleo]: Literally meaning to call to one’s side, and incorporates a wider range of responsive behaviors in counseling, traveling among and between “comforting,” “consoling,” “encouraging,” and “beseeching” or “admonishing.”
Warn [noutheteo]: Coming from the root meaning “mind,” it is the seat of consciousness that includes “understanding,” “feeling,” “judging,” and “determining.” It is characterized by a confrontational style of directive challenge to root out sin and follow the right path.
Encourage [paramutheomai]: Means to “comfort,” “soothe,” console,” or “encourage;” especially in connection with someone experiencing deep grief.
Help [antechomai]: Refers to holding-up or supporting someone who is weak and in deep need of assistance; to support something very fragile.
Be Patient [makrothumeo]: Literally meaning “long-tempered,” this carries the idea of “forbearing,” “suffering,” and “enduring.” It connotes the idea that we tend to be impatient and expect too much too quickly from those engaged in the change challenge.
In addition, there are several “core skills” of Christian counseling that are compatible with the theme of this passage.
Active listening. Also known as effective listening, this is a process where the counselor omits his/her biases, inner-conflicts, and disagreements to focus completely on the client. Active listening also involves:
- Verbal and non-verbal expressions to encourage the client to tell his/her story
- Withholding of judgment (or revulsion) even while the client presents disquieting information
- Attending to both what the client is saying, and what the client is omitting (the ability to accomplish this will increase with training and experience)
- Attending to a client’s nonverbal communication, and emotional themes
- Waiting out moments of silence
Attending. This means to provide undivided attention to the counselee. In addition, the counselor attends by maintaining an open posture, eye contact (without staring), forward lean and courteous gestures that assure the client the counselor is “present” in the counseling session.
Empathic response. Responding to the client’s dialogue in a way that reframes what the client has said and that focuses on the emotion being communicated. This assures the client that you are understanding what he/she shares in session, and it also proves the client with the therapeutic opportunity to hear his/her story told from another perspective.
Probing. This is the process of asking questions for the purpose of deepening the content of the therapeutic encounter (skills will greatly increase with continuing education and training). Probes often begin with the words who, what, where, when, or how (though not generally “why”) and should be designed in a way that the counselee can provide extensive feedback from a single query (i.e. When did you first feel depressed?).
Goal setting. Deciding the specific objective(s) of the counseling relationship: Includes developing a course of action, and using research-supported biblically-based methods to lead the client from his/her current condition to a more functional, healthy, Christ-centered state.
Robert Kellemen in his recent work “Soul Physicians” provides a vignette called “The Tale of Two Counselors” where two professionals are both ineffective in treatment of a client for different reasons. The first counselor (a pastoral counselor), after a client sobbingly tells him about the sexual abuse he endured at the hand of an uncle, responds with a 30 minute sermon on the client’s sinfulness. The second (a professional Christian counselor) was equally ineffective, responding with empathy and compassion, but lacking any skills in helping the client “move forward” or deal pragmatically with his present relationship problems.
Counseling is not simple and there are many ways a counselor can go wrong in the (what should be) therapeutic process. Some mistakes are rooted in the motivation of the counselor, others in the counselor’s approach.
Poor motivators for prospective counselors. It is widely said that persons in counseling programs enroll for two reasons. Reason one is they wish to help others, reason two is they wish to help themselves overcome their own issues. Most often it is a combination of the two. Prospective Christian counselors should examine their motivations for wishing to minister through the practice of counseling.
Simply put, Christian counselors must evince both emotional health and spiritual maturity to be effective. Even with proper education—or a clinical license—not everyone is prepared to serve as a counselor. Here are a few of the many ailing, perhaps unconscious, motivators common to persons who decide to practice counseling.
- Need for Relationships: Counselors must have their intimacy needs filled adequately if they intend to help clients with their inter-relational problems. If a counselor is motivated to counseling by a need for intimacy, he/she will be inclined to use relationships with clients to fill his/her emotional emptiness.
- Messiah Complex: Counselors (often novice counselors) believe they can heal everyone. This unfortunately is not the case. As a counselor you may find that some clients do not improve much, or at all. Counselors need to accept their limits, and the limits of the counseling process.
- Need for Control or Power: For one desiring power or control over others, counseling is not the proper profession. Effective counselors often operate with the premise that it is the client who is in control of the counseling process. Also, the desire to control others is a negative personality trait sometimes possessed by those present in the “helping professions.”
- Living Vicariously: This is yet another example of the counselor trying to fulfill his/her needs through the experiences and lives of clients. Vicarious Rebellion: Sometimes counselors with unresolved issues will live out their rebellion through the dysfunction of their clients.
- Atonement: Some may feel motivated to help others as a service of atonement—to compensate for some wrong one has done in his/her past. Counselors should first repent of their sins, and fully accept the forgiveness given by God, before counseling.
- Self Significance: Wishing to make a difference in people’s lives is different from desiring to be a counselor in order to be a person who has made a difference, for with the later the focus is on the counselor, not the client. Counselors should understand their innate significance as children of God, and not approach counseling as an avenue to becoming a significant person.
Here is a list of several common mistakes that can be made in the counseling process.
- Rescuing—Saving a client instead of empowering a client to save him/herself
- Self-Disclosure and Transparency—Extreme openness that moves the focus of the counseling session off of the client, and onto the counselor
- Assuming the Meaning of the Problem—Presuming without adequate investigation, testing or data.
- Catching the Panic—Instead of the counselor decreasing a client’s anxiety, it is when the client’s anxiety disrupts the stability of the counselor. Note: A client’s crisis is not the counselor’s crisis.
- Silence—Or better stated, lack of. Silence is sometimes more meaningful than words, and is necessary for deep introspection. Counselors should not feel the need to fill the void of silence in counseling.
- Demanding Clients—counseling is a mutual, collaborative engagement. Neither the counselor nor the client should have a disposition that is “demanding.”
- Advice giving—Counseling is not advice giving. Instead, it is heavily rooted in empowering clients to advise themselves.
- Realistic Goals—Setting grandiose goals will only discourage. Instead, create small objectives and encourage clients as they succeed.
- Sexuality—Healthy sexuality means the counselor deflects sexual advances made by clients.
- Lacking sympathy—Remember, many people who enter counseling are broken and hurting. A counselor therefore must maintain an attitude of grace and sympathy to promote healing.
- Being overly emotionally involved—it is good to desire the best for your clients, and it is normal to feel upset when clients are hurting, or are not improving. However, counselors must establish emotional boundaries so that they can continue to objectively and effectively help clients.
You may be overwhelmed with all this, thinking to yourself “I am not this perfect!” Indeed, if this is the first time you have been exposed to these issues of motivation and competence and you are not beleaguered, reconsidering whether you should continue down the road of counselor training, something is wrong.
Counselors should be responsibly concerned about their competence, ability, stability, spirituality, and more. It is the constant introspection that makes them good counselors; and it is their prolonged growth that makes them great counselors. This is only the launching ground, and the journey is long for the Person of the Counselor: for they are to be always growing in knowledge, character and skill.
Anthony J. Centore, Ph.D. serves as the Special Assistant to the President for the 50,000-member American Association of Christian Counselors, and is an Adjunct Graduate Professor for the Center for Counseling and Family Studies at Liberty University. He has authored numerous book chapters, articles, and is a columnist for Christian Counseling Today magazine. Anthony is author of The Clinical Training Guide for Online Counseling and Telephone Counseling. Anthony practices counseling in Boston and Cambridge, Massachusetts. See ThriveBoston.com
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