Before discussing specific credentials, it’s helpful to first identify all mental health care providers as falling into two broad categories: in general, they will either be counselors or therapists.
Christian Counselors look at person’s existing challenges, problems, or life events and then apply biblical principles to these issues that will help clients make healthful decisions and work toward life change. Counselors, however, are more generalized in their approaches. Just as high-school guidance counselors apply general principles uniformly to all students without taking time to investigate the specifics of the individual, so counselors apply generalized knowledge to their clients. Counselors are not trained in how to uncover the complexities of the individual (to look into the individual in depth), or in how individual characteristics play into a specific life event. For example, how does a person being neglected as a child play into the problems that person faces today in his marriage? How does neglect affect the ability to trust or listen or find significance or develop healthy self-esteem or handle conflict? While counselors may be equipped to offer principles or skills about communication or behavioral techniques, they aren’t trained to look at internal dynamics or to dig into the roots where the problem psychologically originates.
Christian Therapists, on the other hand, have significant training in how a person operates internally; that is, how life experiences from childhood onward have influenced how people operate today. They then use biblical truths and principles to transform these issues so Godly functioning from the inside out can occur. They’re able to take their clients’ daily life struggles and provide the correct framework from which to approach these issues, not just generally but also specifically and individually. Therapists look at the individual’s behaviors and investigate the internal root of those behaviors (why the individual is operating that way and where the behaviors come from). And because therapists identify origins of behavior, they are better equipped to provide diagnostic services.
Under the category “therapists” we find psychiatrists (MDs), licensed clinical psychologists (usually PhDs), and licensed clinical social workers.
- Psychiatrists: are licensed medical doctors (MDs), have had four years of intense medical training in medical school taking two years of clases then 2 years of supervised clinical rotations of which 1400 hours were psychiatry. This includes exposure to the most complex spectrum of mental health issues because they can prescribe medications. After medical school, Psychiatric residency provides 10,000 hours of supervised clinical training that involve treating complex cases, plus educational courses and practical experience. Psychiatrists, because of their medical training see more complicated issues and difficult cases than other therapists. And because they are MDs, they can prescribe medication, order diagnostic evaluations and medical tests (imaging, EEG, blood work, etc.). Psychiatrists are the only mental-health caregiver able to do so.
- Clinical psychologists: usually PhDs, have had graduate educational training, plus 2,000 hours of supervised patient contact followed by 2000 hours of internship before obtaining their PhDs. Then, after receiving their PhDs, they must complete 2,000 additional hours in a supervised internship before they can obtain their licenses. Total patient contact before receiving their licensure is 6,000 hours (compared to the 10,000 hours a psychiatrist receives).
- Social workers: often have Masters degrees and are licensed by the state. They must complete 60 educational credits in various subjects including therapy, evaluation, and treatment skills, and then (while working on their Masters) complete 900 hours of supervised direct-patient-contact internships. Once they complete their internships and they receive their Masters degrees, they must complete 3600 hours of supervised patient practice before taking their state licensing exams.
Under the category “counselors” we find a variety of practitioners. Counselors can be either licensed or unlicensed.
- Unlicensed counselors take roughly 50 credits of education (often Bible specific and not counseling specific), an additional 45 hours of class time, and 300-500 supervised clinical time working with clients.
- Licensed counselors complete similar educational requirements as those of their unlicensed counterparts, but to obtain licensure they must also complete an additional 3,600 hours of supervised clinical time.
If we were to stereotype different types of providers (in general) by levels of training, they would fall in this order (greatest to least): psychiatrist, licensed clincal psychologist, psychologist, licensed social worker, social worker, licensed counselor, counselor.
As in any professional, great, average, and poor clinicians can exist for each professional listed above.
To whom should you go?
The general rule of thumb for determining expertise in mental-health-care providers is this: The less time a practitioner has spent in supervised clinical practice, the less exposure he/she has had to various health issues and disorders. On the other hand, the more time a prospective provider has spent in clinical supervision, the greater his/her exposure will have been to complex mental health cases.
So, generally, go the practitioner with the greatest expertise you can afford. Within that parameter, try to match the practitioner’s expertise with your needs/issues. If, for example, life throws you a curve, but you’re otherwise functioning healthfully, then a counselor would be fine. But if you experience repeated patterns of issues over long periods of time, then working with someone who can explore what’s really going on inside (the root of you repetitive struggle) would be more appropriate. In this case, a therapist would be the better choice.
Whether your issues are acute (sudden) or chronic (on-going), if your issues are affecting you physiologically (physical health or functioning) or relationally (how you interact with your family, friends, or co-workers), or if your issues are compromising your ability to function daily in healthful ways, then you really need to see a therapist. If you are suicidal, hallucinating, or have significant functioning struggles due to mood or emotion management problems, a psychiatrist is the place to start.
**Who probably does NOT need counseling?
Counseling/therapy is usually for people experiencing something new or different and who are wondering how to navigate the change. Counseling is also for those whose struggles are compromising their abilities to function daily in appropriate, healthy, God-honoring ways. Those whose lives are relatively unchanged, who’s internal functioning (e.g.: self-esteem, self-control) is fine, whose interactions with others (family, co-workers) remain healthy, whose abilities to adapt quickly and effectively to life’s bumps and rigors remain in tact, and whose relationships with God are being managed well (their spiritual growth is moving forward)—all of these do not need a therapist or counselor.
In evaluating whether or not counseling/therapy is in order, it’s important to remember that Jesus is the only human being every to possess perfect brain chemistry. We all, because of our fallenness, have diseased/contaminated brain chemistries to some extent. Ideally we’re growing toward Chirstlikeness in our functioning, despite our fallen natures. If we’re in that process and we’re able to identify the issues that impede our progress in Christlikeness, and if we have people who will help us with these issues (friends, accountability partners, etc.) then finding a counselor isn’t as high a priority as if we haven’t identified our issues or don’t have someone with whom we can talk or work through our issues.
**How does Christian counseling differ from secular counseling?
Secular treatment tends to be more relativistic. It accentuates self, encourages positive feelings, focuses on the individual and what makes him/her happy, and often takes the approach that is most benign, most neutral, or least confrontational. Secular counselors/therapists will also often minimize or completely overlook the spiritual dimension of a person’s problems (faith issues, sin, prayer, spiritual support and intervention, spiritual warfare, etc.). In the worst cases, they can be hostile to faith issues.
Christian treatment, on the other hand, or at least good Christian treatment, addresses the whole individual: the spirit (spiritual aspects of our natures), the mind (our thought processes and emotions), and the body (physical issues, disease, biochemical issues, etc.). Christian mental-health-care providers seek to offer biblical insight and counsel in all three realms. They will hold themselves and their patients to a biblical standard of truth as the backdrop or foundation for their counsel and treatment. Christian clinicians will also work toward their client’s life transformation; they won’t just focus on managing behavior or on what makes the client feel good.
Be careful, however, not to make assumptions based solely on whether a practitioner is Christian or secular. There can be very good secular clinician and very bad Christian clinician. In addition, just because someone claims to be a Christian doesn’t mean he/she will provide biblically-based treatment. That’s why interviewing a potential caregiver is so important.
**Sidebar: Know When to Walk—Provide a list of warning signs of an unethical counselor
If your treatment provider exhibits any of the following, immediately head for the door. These are clear warnings that he/she may be unethical:
- Exhibits inappropriate/unprofessional behaviors (lies, gossips, etc.)
- Behaves inappropriately sexually (in any way)
- Requests to do physical exams, especially that involve intimate touch
- Flirts with you or behaves suggestively
- Requires you to be sedated
- Requires payment in cash (not accepting other payment forms)
- Advertises himself/herself differently than how he/she is credentialed
- Misrepresents himself/herself in any other way
- Asks you to invest financially in his/her practice or products
- Attempts to sell you products other than workbooks or books, especially of his/her making
- Refuses to provide standard consent forms or forms relating to privacy/confidentiality
- Breaches confidentiality in any way
- Has no affiliations or means to verify credentials
If these exist or occur, a phone call to your state’s licensing board or other authorities may be in order.
What should you ask when interviewing a counselor/therapist?
When interviewing a potential caregiver, the following are legitimate questions to ask, and you should expect your caregiver to treat your questions with respect, thoughtfulness, and honesty. Beware of any candidate that refuses or is reluctant to answer your questions.
- What are your credentials (education, licenses, background, specializations, etc.)?
- Where I can verify your credentials?
- Do you think your credentials will fit my needs?
- What is your expertise?
- How much experience do you have with people like me or with my diagnosis?
- How much experience do you have with people in my age group or season of life?
- If needed, can you order additional diagnostic tests for me?
- Can you prescribe medications if I need them?
- Will you keep our conversations confidential?
- Are your facilities such that our conversations can’t be overheard?
- How long do you expect me to be in therapy?
- How often do you need to see me?
- Can you offer regular appointments?
- How much do you charge?
- Do you take any insurances? Which ones?
- Can I cancel an appointment if I need to? Will I be charged for a cancelled appointment?
- Do you provide an emergency contact number for off hours?
- With whom do I interface when I have questions (you? receptionists? other staff?)?
- What will your strategy be for dealing with my issues: homework? behavioral strategies? talk therapy? Will you be able to offer more than behavior management? Will you get at the root of my problems (what’s inside me)?
- (For psychologists only) Do you perform psychological or psycho-educational testing? If so, what do you charge for these tests?
After you’ve inteviewed your potential caregiver, here are some other questions to consider on your own:
- Do I feel comfortable with this treatment provider?
- Are his/her offices clean, comfortable, and welcoming?
- Do I have a dependable way to get to and from his/her offices?
- Can I afford him/her?
- Will my insurances cover any of my treatment with this provider?
- Do his/her credentials and areas of expertise match my needs/diagnosis?
- Do his/her office hours match my scheduling needs?
- Do I agree with his/her treatment plan for me?
- Will his/her treatment plan address my whole person (spirit, mind, and body)?
- Do I trust this person?
If you answer “no” to several of these questions, this provider is probably not the best caregiver for you.
What can a client do to make counseling work? OR What is a client’s responsibility to help ensure successful therapy?
- Show up on time.
- Pay attention to the clinician.
- Ask for homework. Then do the homework.
- During the week, take some part of each day to do some honest self-assessment and try to apply what you are learning in the treatment.
- Be honest in both self-assessment and in what you tell the clinician.
- Don’t hold anything back. It you have a question abort yourself, treatment, or the clinician, don’t hesitate to ask.
- Find someone to discuss the treatment with and practice some of the things you are learning on.
- Be in prayerful consideration about the issues you are working on.
- Pray for your clinician for wisdom and skills to examine and help you.
- As you do your Bible Study, examine what God is trying to show you about the issues on which you are working.
- Don’t take clinician’s comments personal as they are only trying to help you grow.
- Be intentional.
- Want to change.
- Be willing to tolerate growing pains.
- Inform those close to you that you are trying to change and the relationship will take a different course.
1. Are you struggling to connect with God and /or not growing in your abilities to apply the Bible to you daily functioning?
2. Do you struggle to have an accurate perspective of situations or yourself?
3. Do you struggle with sadness, apathy, or despair?
4. Do you have low motivation in life?
5. Do you struggle to make meaningful connection in relationships?
6. Are you worrier or have difficulty with change?
7. Do your emotions often cause trouble to you or others?
8. Do you have any habits which impede your functioning or other have asked you to stop?
9. Do you have any physical problems which are hard to diagnose or get worse with stress.
10. Do you honestly like who you are?
If you answered “yes” to any of the questions, exploring that issue with a therapist might be the 2nd best step toward life transformation after accepting Christ as your Savior.
What are the benefits of counseling?
Is counseling/therapy an ongoing process, or do clients “get well” and discontinue therapy?
The following answers can apply to both of then questions.
The benefits from counseling/ treatment can be life transforming, helping a person actualize the freedom from our baggage, sin, and dysfunction that Jesus won for us on the Cross. We all have distortions from our childhood which interfere with our ability to see God, ourselves, and life situations from a Godly perspective. These distortions, baggage, or issues also interfere with our ability to apply Biblical skills to our daily functioning.
We need to address spirit, mind, and body (especially our brain chemistry) in comprehensive ways to be alike to lead the lives God intended, growing to Christ lilaceous and being salt and light to others.
I even have one patient who enjoys life and functions pretty well, better than 90%, of our society. He comes to treatment to get even better stating “my job is to glorify God as much as possible. Treatment helps me maximize my functioning, awareness and impact on others”