Monday, December 09, 2019

Nouthetic Counseling: My Response to Jay Adam's Answers


I took a counseling class 40 years ago in college. Our text book was the one pictured above. I decided
to look into Jay Adams' website to review what I had forgotten from 40 years ago. I was too 
young and inexperienced 40 years ago to realize what this counseling method could do if taken to
it's logical end. Now 40 years later, I find horror stories online about the damage this kind of counseling
has had especially for those who are in abusive relationships or who have been sexually abused by
church leaders or others. 

It is my prayer that what I have written here will cause you to do further research before involving 
yourself in this type of counseling either as a counselor or counselee. It is not appropriate for all 
counseling situations. What I have presented here  is taken from Jay Adam's answers on his website. 
 I have seen other quotes from his books elsewhere that have left me scratching my head, however, 
due to space and length I can not cover everything. I'm currently in the process of reading Jay Adams'
"The Christian Counselor's Manual". I plan to write another post once I have finished reading it.

Nouthetic Counseling is useful for some marriage counseling issues that do not involve abuse,
interpersonal relationship issues that do not involve abuse, emotional or physical and general
situations dealing with Christian living in general. It is poorly suited for those suffering from mental
disorders not stemming from organic causes that can be identified. The reason for this is that
there are mental illnesses that have causes not yet identified by medical science or that are flatly
ignored by the conventional medical establishment. These people who fall through the cracks 
and can not get a definitive diagnosis for their mental problems are considered to be acting out of sinful 
 impulses. The Biblical Counselor has no way of knowing if the person before him is one
who has fallen through the cracks and if they were properly diagnosed there would be a perfectly good
 reason for their mental trouble. To treat the previous person as being simply acting in sinful ways would 
heap guilt on a person who is bewildered by their own behavior because they can't control it. But I'm 
getting ahead of myself here. I will talk more about this later.



By change we mean that counseling is done because there is something in another Christian's
life that fails to meet the biblical requirements and that, therefore, keeps him from honoring God. All  
counseling—Biblical or otherwise—attempts change. Only Biblical counselors know what a
counselee should become as the result of counseling: he should look more like Christ. He is the
Standard. Biblical counseling is done by Christians who are convinced that God is able to make
the changes that are necessary as His Word is ministered in the power of the Spirit. It is their
hope to help every interested church develop a nouthetic counseling program that will be a 
blessing to all of the members of that congregation. The importance of such counseling in 
churches is underscored by the words of Paul as he described his ministry in Ephesus:


Therefore, be alert, remembering that for three years, night and day, I didn't stop counseling each one  
of you with tears. (Acts 20:31)”

What about the person who comes for counseling because they have been abused
verbally/emotionally by another Christian and they need help resolving the issue because the 
other person refuses to participate in resolving things? 

In practice, what happens is that the person coming for counseling is scrutinized for sin
(see highlighted quote above) in their life and told they need to change whatever sin the 
counselor says they see in their life. Which is all good and fine if indeed there is something that 
the person needs to change.  
Later in Jay Adam’s answers, he talks about having both the offender and the person offended in 
the office together to work through their differences. Some times this is not done. The person who
comes for help is heaped with all the responsibility and guilt for fixing the problem and the offender is 
not dealt with for their part in the relationship breakdown.


“Truly Christian counseling (Nouthetic Counseling, or that which is in line with Nouthetic 
Counseling, but does not use the name) is Bible based from start to finish. See the answer to the 
previous question for more details. What makes the difference, fundamentally, is whether or not a 
system is grounded on the promise that the Bible has all the answers for life and godliness. The 
Bible teaches this in such passages as 2 Peter 1:3 where the promises of God are said to provide just
 such help. And, in addition, in 2 Timothy 3:17, from three distinct perspectives, Paul says the Scriptures
 are sufficient for every task an elder is called to do. What makes the difference between those systems
 that call themselves Christian and truly are, then, is whether it includes extraneous materials as well.  
Christian counseling, to warrant the name, must assert (and in actual practice
demonstrate) the sufficiency of the Scriptures for counseling.”

Yes, the Scripture is sufficient for life and godliness. However, there are counseling situations that may  
not be as cut and dried as the counselor may think. Situations where the counselor is sure 
the counselee’s emotional problems are all spiritual when they are not. Much damage can be 
done to someone whose emotional problems stem from something out of their control such as 
unknown food or chemical sensitivities. I will get into that later.

I have read horror stories of sexual abuse by a church leader on a young person in the church and it 
 was not reported to the police because Biblical Counseling was being employed to take care of 
the situation.

In another story I read, the abused and her parents come to the pastor to report sexual abuse on 
the daughter by the youth leader. In Biblical Counseling fashion, the pastor looked for some sin in 
the girl's life that he could confront and he admonished her for her clothing choices. Nothing was 
done about the abuser until years later when as an adult the girl saw his name in the paper in 
connection with another abuse case and she came forward to report her story.

Sadly, while the Bible is sufficient for life and godliness when it is used incorrectly or used but the
appropriate authorities are not brought in as well, Biblical Counseling does much damage to the
counselee.


“Faith that God's promises are reliable and are valid for us, is absolutely necessary. If a Christian
doubts this, then it is clear that he should expect no help.

A person who doubts is like a wave of the sea that is driven and tossed by the wind. That person
shouldn't suppose that he will receive anything from the Lord, because a double-minded person is
unstable in all of his ways (James 1:6-8).

Faith is so essential that without faith it is "impossible to please God" (Hebrews 11:6).

Now, the important fact to comprehend is that Nouthetic counseling, unlike many other forms of
counseling, at its foundation, isn't a technique or system. In the final analysis, it is a matter of 
calling upon a Person for help. There is nothing mechanical about it. When one is in the proper 
relationship with God, he may expect Him to bless and answer his prayers. When he is not, he 
must first become properly related through repentance and faith if he would have God do so.

God is the believer's heavenly Father. When he believes and obeys Him, he may expect God to
answer his prayers according to what is best for him (not always what the believer thinks is best).
That is the confidence that we have; but "let him ask in faith, without doubting." The reason why
many believers fail to receive the help that they desire is two-fold: 1) they fail to ask ("You don't 
have because you don't ask." James 4:2) and 2) they ask "wrongly-to waste it on [their] pleasures"
(James 4:3). These failures both demonstrate a lack of biblical faith! So, let a counselor and his
counselee both come to counseling full of faith. Faith leads to hope, hope leads to endurance, and
endurance leads to the changes that God desires.”

But it is a technique and a system.  Certain steps must be followed…”Nouthetic counseling is
counseling that involves face to face confrontation by one person to another, out of loving concern for  
him, in order to bring about the changes God desires in his life. That in a nutshell, is what 
Nouthetic counseling is all about.” Confrontation, Concern and Change. This is the technique and 
system.  Confrontation: find something wrong with the counselee and confront them. Concern:
couch the confrontation in concern for the counselee. Change: expect the counselee to change/take a
certain action. This is the system and there are techniques spelled out in the book on how to knock down
objections that the counselee might have. 

It is interesting in The Christian Counselor's Manual, there is a whole chapter dedicated to technique. 
Simply put, there has to be a framework for counseling...a pattern that is generally followed or nothing
will get accomplished. For Adams to insist it is not a technique or a system is denying the obvious.

In Christian counseling, there is the dimension of prayer and relying on the Holy Spirit to lead and guide. 
Adams is correct in this. Ideally that should take the counseling sessions in the right direction, however, 
counselors are not perfect and they make mistakes. They can make wrong assumptions about the 
counselee or the problem that they have come to get help with. They must listen carefully to what the 
counselee is saying and not make wrong assumptions. This where the counseling sessions will fall apart. 
 But since Adams has conditioned the success of the counseling on both the counselor and the counselee
having faith that God will work, if the counseling fails to produce the changes the counselor decided 
needed to be made, it's easy to brush it off and chalk it up that the counselee didn't have enough faith 
to follow through with the changes the counselor expected. In reality it could be that the counselor's 
wrong assumptions are confusing the issue and he is telling the counselee to take action or make 
changes that aren't making sense to the counselee and that is why it's not having a good outcome.


“It follows that if those who do counseling as a life calling are the elders of the church, and they 
are ordained to their office by the church, Christians ought to do counseling under the auspices of the 
 church. Christians ought not to do counseling under other auspices since there is no rightful authority
to do so. However, there are many who have arrogated to themselves the "right" to counsel apart
from the church. It is precisely from this biblically lawless situation that much of the confusion
about counseling among Christians stems.”

No room for women to counsel other women who might have issues of a sensitive nature and 
don’t feel comfortable talking to a man.

If a Biblical Counseling pastor is going to be consistent with Jay Adams model, then he should not
encourage support of counseling ministries such as Union Gospel Mission and others who work 
with and counsel addiction cases. These are parachurch ministries and counseling is done by 
people not ordained to their office by the church and women also work as full time counselors 
there.


There are various reasons why people are hesitant to divulge data. Some have to do with 
mistrust. "What will the counselor do with this information?" they ask themselves. They wonder 
whether it will soon find its place in a sermon as an illustration or whether it will come back to 
haunt them as a piece of gossip spread around the congregation. Every counselor must keep 
information as private as the Bible requires.* When people have had a bad experience of this sort
in the past you must reassure them that it will not happen again.”

I am familiar with a case where a family member sent a letter to the Biblical Counselor concerning another 
family member. It was stated in the letter that it should be kept confidential. It was 
not. The counselee was told about it.  This sort of thing breeds distrust in the Biblical Counselor.


Depression usually comes from handling a "down" period wrongly. By slacking off when one feels
down, he allows responsibilities to slide and pile up. That, in turn, makes him feel worse. But, if he
continues to give in to his feelings even more will pile up, which leads to worse feelings, and so on
ad infinitum. He follows his feelings rather than meets his responsibilities. To help him, call on him to
act responsibly---regardless of how he feels. The more a depressed person acts in accordance with
his feelings instead of assuming his responsibilities, the worse he feels. The sooner he begins to act
responsibly, regardless of his feelings, the sooner his depression will lift.”

This might be good advice for someone who is capable of assuming his responsibilities but 
chooses not to because he/she just doesn’t feel like doing it. However, this advice doesn’t work too well 
if one is incapable of fulfilling their responsibilities due to physical impairment or for the one that is
 experiencing depression as a result of multiple sensitivities to food, chemicals or molds in 
the environment. Overwhelm sets in as things slide due to not being able to do the work because
they can’t physically do it. So what kind of counsel is given this person? See my comments later on 
 sensitivities.


“People with "nervous breakdowns," on the contrary, are anxious to do something, but perplexed
about what to do. That is because they have run out of resources. They have painted themselves
into a corner and don't know how to get out of it. If they ran from problems eventually there is no
place to run. If they lied their way out of difficulties, and people stopped believing their lies, they
found themselves up a creek without a paddle. In other words, their "tried and true" patterns have
broken down (certainly not their nerves!)* Sinful patterns eventually let people down. But because
they don't know what to do instead, they cease functioning.
People with "nervous breakdowns" are ready to listen to alternative ways of dealing with life's
problems. There is great opportunity to help them make radical changes for good. However, you
must be sure that you are not merely providing them alternatives. Rather, they must acknowledge the
 sin of their previous ways, repent of it and adopt God's ways out of a genuine desire to please Him. 
There is danger that they will grasp for what you offer as an expedient when faced with a 
difficult situation. Warn against this and take the time to instruct them thoroughly. They must make 
lifelong changes; not changes to meet some portending problem.”

Some of this may be true for some people, but it is an over-generalization.  There are people on the
autism spectrum, for instance, who when overwhelmed by various stimuli, whether it be noise, lights,
too much information at once, stress...they shut down.  Their nervous system doesn’t work right and
they are in constant fight or flight mode. This is not simply sinful behavior. They have a real
struggle with these things and they are doing the best they can with what they have been given to work
 with.  ( do some study on the vagus nerve to understand this better) To confront them and 
tell them they are sinning because they retreat and shut down is to add insult to injury and does 
them great damage.


“Bizarre behavior may result from widely differing causes.* It could arise from a brain tumor (an
organic cause), sleep deprivation (significant sleep loss over 2-4 days),** hallucinogenic 
substances (intentionally or unintentionally ingested), strange thinking (out of kilter with others),
fear (for instance, when a drug pusher constantly "looks over his shoulder" to see if someone is 
following), camouflaging (to avoid detection of some wrong by throwing people off the track) and
so on. Having checked out the organic possibilities and found no reason to refer a counselee to a 
physician, counsel him.

Don't accept the claim that a person is "out of touch with reality" unless some organic cause for
"catatonic" behavior has been detected. Counsel the individual as if he is in touch with reality. If 
what you say is threatening enough,*** he will respond. Try to learn what it is he is attempting to avoid.  
Investigate each case to discover what is behind it, and counsel accordingly.”

*** For instance, "If you will not talk or take care of your personal needs, we will have to leave you
here to soil your underwear and deficate in your clothing."

I am appalled by what is said here.  I happen to be friends with a Christian lady who is 
schizophrenic. She tells me if she does not take her medicine she begins hearing voices in her 
head. Obviously, the medication is helping her to think more clearly.  

The idea of using threats with a counselee is appalling and on a basic level not Biblical.  The Bible
teaches us to be gentle with the weak, and to be kind. Where is the Biblical warrant to use threats
in counseling? 


“Whether we are speaking about married couples or any other individuals who are having 
difficulties with one another, it is always proper to deal with everyone together. Why is that? For 
several reasons, all of which are biblical.

First, you should not speak about another behind his back. James 4:11, instructs us, "Brothers, 
don't speak against one another; whoever speaks against his brother or judges his brother speaks 
against the law and judges the law." How is that? The Old Testament in many places forbids 
gossip, slander and the like. If one disregards the law in this manner by engaging in these things,
in effect, he declares the law unimportant, wrong, or something of the sort. He "speaks against 
the law and judges the law!"

Now, not only does the Bible forbid tale bearing and slander, Proverbs 18:17 shows how foolish it 
is to do counsel one party alone. If you counsel with one, the other is not there to respond to what he 
says and give his view of the matter. Proverbs warns that when the first speaks he can seem 
most convincing until the second comes to examine him. Why would a counselor wish to counsel when 
 another was not present to supplement, alter or otherwise change his perception of the 
events by giving his interpretation? It makes no sense to listen to two biased or distorted stories,
and then try gleaning the truth from these two widely differing accounts.

When both parties are present, commitments made by one or both are known to all. Otherwise,
the one not present may fail to learn about them or only receive a distorted report. And if one or 
the other person seeks forgiveness, etc.and the other is on the scene to grant it.

There is every reason, then, to invite all invite all who are involved in a problem to be present at 
every session. It is foolish not to do so.”

I am familiar with a case where the counselee was verbally/emotionally abused by another in the
church and this person was struggling to deal with it. The counselor never brought the other party in
to mediate a discussion between the two to help resolve the issues.  Rather, all attention was placed
on the one who came for counseling and what they did wrong. The offender’s wrongdoing was
ignored.


“Nouthetic counselors think that these approaches are unsound because they are unbiblical.
Moreover, they assume that the counselee's emotions are "damaged" or that his memories need
"healing." There is no reason to think that either of these suppositions is true. Emotions are working
just fine when a counselee is having unpleasant past memories (otherwise he would not feel so bad).
And memories simply don't get sick; the idea is preposterous -- even as a metaphor.

What is actually happening is that non-biblical methods of dealing with painful past incidents are
being substituted for biblical ones. Confronting persons who have wronged you, forgiving them upon  
repentance, and putting away all bitterness and anger are God's ways of dealing with 
unpleasant memories. These biblical approaches are not always pleasant; in certain cases they 
may even involve bringing charges leading to church discipline. But they are the Scriptural ways to 
handle past wrongs. Visualization experiences or expecting healing miracles from Jesus Christ 
upon the asking are ways never set forth in the Bible. Can you imagine the apostles using them? 
Advising Titus or Timothy to do so? Of course not. Then neither should we do so.”

So the expectation is that unpleasant memories magically disappear if a person has forgiven the
wrongdoer. Therefore, if the unpleasant memories persist, then it is assumed the counselee has 
not really forgiven the offender and is in sin.

Some wounds take longer to heal. Forgiveness can be granted, but unpleasant memories are still
going to pop up depending on the severity of the wound and the things that trigger them. To blame
the counselee and tell them they must not have really forgiven the person because unpleasant
memories resurface only piles false guilt on top of what they are dealing with and to tell them to
ignore the unpleasant memories adds confusion if the unpleasant memories are believed to be a
signal of unforgiveness.


You need to understand that apart from injuries, tumors, and other brain problems, there is no 
such thing as mental illness. Those who use this terminology—unless they are speaking 
metaphorically—are using words inaccurately. All true "illness" is organic. Yet, these people, by adopting 
medical terminology, cloud the issue. How could a non-organic entity (whatever it may be) cause a  
non-organic illness? The very idea is preposterous. It is the body that becomes ill. Don't be 
deceived by medical terminology used to describe a non-medical problem.

Such problems are, in reality, problems in living. Advocates of "mental illness" have all sorts of 
names for such problems that describe effects, not causes (etiology). Ask them if there is a bodily test  
that has determined that there is a true bodily illness, and they will be stumped.*

Christian counselors deal with all problems in living. These problems have to do with loving God 
and one's neighbor. They are solved by dealing with thinking, attitudes and the behaviors that 
result from them. When these are unbiblical, they need to be changed by the Spirit working 
through His Word as it is ministered prayerfully. Don't be deceived by terminology, and don't allow 
anyone to medicate you for anything other than a true illness. Otherwise, the medication may 
mask the real problem and lead to a life of dependency upon it. Be sure that there is a medical 
reason—nothing less—for calling something an illness, some problem affecting the tissue in the 
body, not merely attitudes and thinking.”

The brain is where thoughts and emotions originate. Medical science has even been able to 
separate out the sections of the brain that do these things and many more. For instance, the
frontal lobe is where executive functions and emotions take place. It matures earlier in girls and
around 25 in boys. That’s why auto insurance is higher for boys than girls, because driving a car
takes executive function and they have more accidents than girls due to slowed executive 
function. 



There are so many things that can go wrong in the brain. They don’t even know half the stuff that
can go wrong in the brain that might affect a person mentally. To say if there isn’t a medical test 
for mental illness means it doesn’t exist is to ignore the fact that medical science simply may not 
have developed a test yet. It is cruel to tell a person their problem is all their sinful fault when it 
may not be.

I for one, know for a fact that there are people with mental health issues due to food and
environmental chemical sensitivity, who are not getting the help they need because it's expensive and
insurance won’t pay
  1. Mainstream medical doctors refuse to recognize it.
  2. There are very few doctors who will test for it
  3. Because of the above, few people are aware of it.


I have experienced this type of testing and my husband and I were treated for five years for
sensitivities. It was tremendously helpful until our insurance blew us off and we could no longer
afford the treatment.

I was having panic attacks in the grocery store, severe headaches at Tupperware rallies, general brain 
 fog, lack of concentration and lack of energy.

My husband was having huge issues with depression, suicidal thoughts, brain fog, anger, lack of
energy etc. Oh, and we were infertile.

We were referred to the Center for Environmental Medicine by missionary friends of ours.  Their
daughter had extreme mood changes. She could be fine one minute and the next mouthing off and
angry. It was found that she had multiple food and chemical sensitivities. Once treatment was 
started it was a night and day change for her.

My husband and I were tested and found to have multiple food and chemical sensitivities that 
caused our reactions too.

Sadly, we can’t afford the treatment anymore and the doctor is 8 hours' drive from us now.  Five 
years of treatment helped me a lot. We were able to have children three years after beginning 
treatment.The dr predicted that.  Building codes have mandated safer materials, so I am able to 
tolerate new buildings better. I use outgassed Tupperware and glass in my kitchen and always 
shop areas of grocery stores that require plastic bags last. I spend as little time shopping in 
physical stores as I can.  By lessening my chemical load, I can tolerate most of the foods I tested 
sensitive too.

Rick, on the other hand, has suffered a lot as a result of not being able to afford treatment. He has
struggled with sensitivities to almost everything he eats and a majority of his reactions hit him in 
the head.

For Biblical Counselors to say there is no such thing as mental illness and that a person is just in 
sinBby wrong thinking is extremely presumptuous and cruel.   They may be dealing with someone like
 I described above.  

Just because conventional medical doctors can’t find the organic problem for someone’s mental
problems doesn’t automatically mean the person has a sinful, wrong thinking pattern. Food and
environmental sensitivity may be wreaking havoc on them. 

 If Biblical Counselors could spend three days sitting in the testing room of the Center for Environmental Medicine, I guarantee it would upend the presuppositions they have about mental illness.

There is no absolute way for a Biblical Counselor to know if the person before him is dealing with an 
 organic/food/chemical/environmental problem causing mental issues.  

Medical science doesn’t have a test for everything and new discoveries are being made every day,
while there are tests for food/chemical/environmental sensitivity, mainstream doctors won’t 
recognize it and insurance companies won’t pay for it. 

So there is a huge swath of people who present with undiagnosed causes for their mental health
issues and Biblical Counselors assume sin is the issue, heaping guilt on a bewildered counselee that
doesn’t understand why, no matter how hard they try, they feel and react the way they do.


But not all of an individual counselee’s problems may be traced to some specific sin in his life. It may
be that he has been injured by others, misled, and so on. While he bears responsibility for how he
handles wrongdoing toward himself, nevertheless, he is certainly not responsible for everything that
occurs.”

And yet, in the case I am familiar with, this is exactly what happened to the counselee...everything
was made out to be his fault and the offenders were largely ignored in the equation.

From:

There are, of course, many organically-caused problems. Our counselors regularly refer counselees
to physicians whenever they suspect that something organic may be behind their behavior. They do
not want to miss a brain tumor, an aneurysm, or anything else that might require medical treatment.
While Nouthetic counselors refuse to diagnose, since we are not trained to do medical work,
whenever we suspect that something more than heart-motivated behavior is operating, we will send
counselees to a physician for a medical checkup.

For some time the problem of when to refer to a physician was a serious difficulty. There were no
guidelines. Now, since the recent publication of The Christian Counselor’s Medical Desk 
Reference, by Bob Smith, MD, we have a helpful guide to enable us to make much better 
judgments about the matter. This book, written and published under Nouthetic counseling 
auspices, meets a real need. It alone cannot make the determination as to whether or not to refer a 
counselee to a physician, but it helps counselors to become aware of the signs and symptoms that may
 indicate the presence of a physical illness. The very fact that this publication was produced within 
Nouthetic circles gives the lie to the charge that we do not believe in medicine to treat truly organic 
problems.

What we do deplore is the use of medicine to deal with problems that have no organic cause. We are 
 adverse to masking those difficulties with medicine. For instance, if one’s conscience is 
troubling him by triggering unpleasant feelings, we think that the solution to the problem is not 
found in drugs but indealing with whatever it is that activated the conscience in the first place. In 
such cases the counselor deals with sin, not with the feelings. That is the bottom line. For help on
 so-called “chemical imbalances,” for instance, see The Christian Counselor’s Medical Desk 
Reference.”

See my response above on mental illness.

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