Tennessee's New Counseling Law & Jesus

As has been reported in so many places this week, Governor Bill Haslam signed into law a Bill that willprotect psychotherapists from legal repercussions if they refuse service to any person based on their own strongly held principles.This bill was supposedly necessary because some Counseling professional organizations have re-written their codes of ethics to say that a counselor cannot refuse treatment to a client solely because of religious beliefs. (Oddly, the final version of this bill allowed for any "sincerely held principle" and not just religious belief - a distinction is potentially more concerning to me.)

I am going to admit that I have had some mixed feelings about this bill.  As a Pastoral Counselor who is a member of the American Association of Pastoral Counselors, my own code of ethics says that I will not discriminate in providing assistance to any person on the basis of “race, ethnicity, gender identity, sexual orientation, religion, health status, age, disabilities or national origin…However, it also says that if I am unable or “unwilling for appropriate reasons, to provide professional help or continue a professional relationship, every reasonable effort is made to arrange for continuation of treatment with another professional.”  In my mind, “an appropriate reason” might be that I am not trained to deal with a particular issue, but it might mean that a therapist cannot overcome strong personal feelings (positive or negative) for a client and can no longer provide objective care.  I would think that if I am convinced that it will affect my own faith walk to sit and provide care to a person who lives a life I don’t agree with, then perhaps I would want to refer them to another person.  It would seem like good care.  While this is how this bill is presented, I do not believe there are larger issues here.  

Some have argued that this puts a person in crisis at risk of abandonment.  (This Bill actually has a clause to say that you cannot refuse treatment to a person in crisis.)  Others have argued, myself included, that this law will hurt those in rural areas in particular because in many such places, there are fewer resources to which a person can be referred and there may be not be adequate help available.  Others have argued well about how the members of the LGBTQ community (among other groups) are already bullied and rejected and for a trusted therapist to reject the client once certain things may be revealed in session would be re-traumatizing.  Others have argued against this law on the basis of solid professional practice.  However, as I have reflected on this, I have come to a different reflection on this law that is grounded in my experience of being a Pastoral Counselor who seeks to embody the love of God for each person. 

Each time I agree to sit with a client, I am invited to share in the depth of that client’s story.  If I am doing my job well, the relationship deepens as more is revealed about the person in front of me.  Part of the healing for that person involves them feeling heard and understood as they share the twists and turns of hurts and struggles by someone who does not rush to make judgement, but allows the story to unfold.  As the story unfolds, we realize the vast number of experiences, thoughts, feelings, beliefs, and relationships that make up the person in front of us.  Hopefully we began to understand the human being in front us from inside the context of his or her own experience.  The ideal therapist maintains sufficient objectivity to help the person with us begin to find a new narrative.  This objective “being with” is not writing the new narrative – not telling a person what to do – but sitting with them and offering reflection and questions that allow the person to find new meaning. 

However, if I we reduce another person to one aspect of their personhood, that is prejudice.  If we make a decision to reject a person based on that one thing, that is discrimination.  Those who support the new law in Tennessee seem to be seeking a legal protection for doing this very thing on the basis of their religion.  It is for me, however, my religion that compels me to be the therapist I am.  I seek to be the kind of therapist that I am because I have experienced the love of God in a relationship like the one I described earlier.  When I look at the life of Jesus, I see a man who time and again, looked at a person and did not see the labels and categories that other people used to judge and divide, but saw the person inside the person – the person beyond the label.  Good therapy – secular or religious – should seek to embody this reality. We should not be seeking ways to legally reject people, but Godly ways to understand, love, and connect.

For 31 years, the staff of Insight Counseling Centers(Formerly the Pastoral Counseling Centers of Tennessee) has sought to meet each client where they are, to provide a sacred and caring space that allows for open self-reflection, and to help the person develop into who they understand God to be calling them to be.  We seek to understand our clients’ story from their inside out and to hold that story with respect and care.  We have always sought to embody a “Counseling Unconditionally” that mirrors our understanding of God’s love for us.  We will continue to do this.  You are welcome here.

Content vs. Process

When meeting new clients (and others), I encounter a variety of comments that reflect common misconceptions about psychotherapy.  One is that the focus of therapy is for me to evaluate the client and tell them what to do.  Many people start their therapy a bit defensive because they are fearful of my judgment or correction.  Some people have mocked the process of therapy by saying that therapists never tell you what to do and only “Listen”.  Others have said to me, “Why am I paying you to listen to me when I could just be talking to a friend or family member?”  The difficulty with all of these assessments is that they assume over-activity or inactivity on the part of therapist.  With the distortions of the therapeutic process portrayed in film and television, I cannot really blame people for these misconceptions.  Unfortunately, there are also a number of people in the world practicing some type of counseling who contribute to these stereotypes by their methods of practice.  The very terms we use for this type of care are also confusing – counseling, therapy, psychotherapy, psychoanalysis, etc.   In a previous post, I commented on the technical differences in these various terms.  However, what makes the process of psychotherapy different from talking with a friend or other type of helper is the attention to the process of therapy.  Because this part of the relationship is often managed in subtle ways, people often perceive that the therapist is not doing much, but the reality that is that the process is rich with reflection.

Fundamentally, what makes any type of counseling or psychotherapy beneficial is the quality of the established relationship.  However, in the process of psychoanalysis, psychotherapy, and Pastoral Psychotherapy, the therapist is mindful of the dynamics of the relationship, monitors these things, and uses them (hopefully) for the client’s benefit.  These types of dynamics can exist in other relationships with friends, etc, but it is rare.  Psychotherapy is, by definition, a relationship between two (or more in the case of couple or family therapy) people for the benefit of one of them.  Everything the therapist does or says should be for the benefit of the client.  In order to do this, the therapist must be aware of many dynamics that are simultaneously at work in the counseling office.

When a person comes to therapy, the issues they wish to discuss and the struggles they have with these issues constitute the “content” of the session.   However, the forces that motivate a person’s behavior are also important.  The therapist should be reflecting on the selection of material presented and the content of the material.  After a particularly painful session of dealing with something like grief, a client may come in the next session and talk about more mundane or superficial issues.  The therapist’s job is to note the shift in tone and help bring to awareness the change.  When a client presents a memory of events, the therapist is focusing on how the person was affected and how they behaved in the events presented, but he or she is also focused on how the person seems to be feeling as they are presenting the material.  The therapist should not make assumptions about what the client felt, how they are feeling, or why they behaved in a certain way.  The job of therapist is to note that such feelings and motivations exist and to ask questions to raise the client’s awareness.  This is why it has become cliché for a therapist to ask questions like “How did you feel when that happened?”

Completely out of the awareness of the client (at least it should be) is the therapists’ reflections on another set of dynamics in the room – his or her own.  As the client is sharing, the therapist is also monitoring his or her own feelings about what is being shared.  He or she is monitoring the experience of the person and noting what they observe and hear.   The therapist is monitoring how his or her own story is connected to the client’s story.  The goal for the therapist is to be able to separate his or her own experiences from the experiences of the client.  In order to do this effectively, the therapist should have done sufficient therapy for their own personal issues and to receive adequate supervision and/or consultation on their work.  The therapist becomes less effective when he or she assumes what the client will or should feel instead of allowing the client to discover what they actually feel.

While the therapist may provide some education on common dynamics of interaction or personal development, their primary goal is to allow the client to discover how he or she plays out these dynamics in their own life.  Any intervention or action on the part of the therapist should be in the service of this self-discovery or to help provide an environment that contrasts the clients’ previous hurtful experiences.  By observing the clients actions, monitoring feelings, and dealing with the dynamics of the client’s relationship with the therapist, the therapist creates the opportunity for growth and healing.  The client’s experience of the resulting relationship between therapist and client can then grow beyond the walls of the therapy office to the other parts of the client’s life.  The goal for the therapist is to create independence for the client and not to foster dependence.  Advice-giving and such activities, while helpful, only keep the client dependent on the counselor.  When the therapist helps the client discover his or her own ways of dealing with things, then they are able to apply that understanding to novel situations.  The experience of this growth within a therapeutic relationship is generally experienced by client and therapist as deeply meaningful.  In pastoral psychotherapy, this growth and self-reflection will often include reflections on faith, God, and spiritual development and the process of the therapy itself can be experienced as quite spiritual or holy. 

So, far from doing nothing or doing everything for a client, the therapist works with the content of the client’s issues while monitoring the internal and relational process of therapy.  The therapist should maintain a calm exterior, but should always be actively reflecting internally.  I have found this process personally, professionally, and spiritually enriching.   I know that the quality of a good friendship can accomplish similar purposes, but for me, there is no substitute for a meaningful therapeutic relationship.

The Story of "Dan"

This is the client story shared at the Pastoral Counseling Centers of Tennessee’s Fundraising Concert Last Night.  It includes a few more details that time allowed last night.  Dan’s story reflects some of what is so meaningful about the work of Pastoral Counseling.

Dan was one of the first clients I ever saw when I came to the Pastoral Counseling Centers of Tennessee (PCCT)  as a trainee.  I saw him regularly for several years.  At one time, Dan had been a fairly successful musician, but that was before he was diagnosed with a pretty serious mental illness.  When I first met him, Dan was receiving medication and case management from another agency, but he had come to the Pastoral Counseling Center because he had a strong sense of faith and he wanted counseling that would reflect his love of God.  He had had seen at least two counselors before me at PCCT.   Early in my work with Dan, he was very focused on his own needs and had a very limited way of looking at the world.   He had a very simplistic and concrete way of seeing the world; almost childlike in many ways.   He sometimes still had delusions of being attacked by Satan and being burned by the fires of hell.  He would call me in between our sessions   sometimes when he was feeling anxious about something and tell me that he was being burned from the inside out by the fires of hell.  I had no way to make sense of this, but I would listen to him and talk with him about the various anxieties in his life, and I would pray with him.  As we talked through the years, he would sometimes tell me of a dark time in his life when he was not medicated for his mental illness and when he often used illegal drugs and alcohol.  He told me of other things that he had done that he was ashamed of and we would talk about those things.   Dan had a guitar, but he had not played in a long time because he associated the guitar with those dark times in his life.  He said he missed playing and so I began to help him think of ways that God could redeem his guitar and take it back from those dark places.  We talked about how his guitar could be a way of mediating God in his life and the creativity of playing could connect him to God’s creativity.  He began playing his guitar regularly and reported that it was a soothing activity.  He would play when anxious and found some relief in that.  Though he had very little money and resources, he began to save money and periodically he would purchase other guitars until he own at least four different types of guitars.   He grew to enjoy finding the various sounds and tunes he could get from each of these guitars.

 Over time, Dan had moved from being focused more on himself to telling me that he really wanted to figure out how to show love to others.  He really wanted to find a way to share the gift of his music with others.  He developed an amazing sense of gratitude.  In the past few years he had been getting “meals on wheels” and he expressed gratitude for those meals every day.  He would describe to me the content of the meals in detail to me and then would say, “I can’t believe how lucky I am that I get this great food every day.”  At Christmas he would sometimes receive boxes from a local church and he would become tearful as he would describe to me the contents of those boxes and he would say, “I can’t believe people are so good to me.” 

     When Dan would feel overwhelmed by the things of his life, he would come and talk things through with me and he would always come back to an affirmation that he knew that God loved him and things would be okay.  I tried to work with him so that his experience that God would provide him could help him avoid feeling anxious, but he seemed to always have something that he was concerned about.  Dan took the bus to our offices and he would sometimes arrive an hour or more before his appointment.  I would apologize to him that he had to wait to see me and he would say, “It’s okay Chris, the people here are so nice and it is so peaceful here, I can just feel the love of God when I am here.”

  Throughout the time I knew him, Dan would sometime wind up in the hospital with various medical issues.  A year or so ago, he was in the hospital and had a pretty serious condition that he feared would take his life.  Because he was so afraid of dying, he called the office and asked if I would come to visit him.  I know it is not in the counseling rule book, but I went to visit him in the hospital.  He was panicked as he told me that he was afraid to die because he was afraid of going to hell.  I told him, “Dan, I don’t know anyone who has loved God more than you.  I cannot imagine why you would  wind up in hell.”    Dan told me that there were three things that he wanted to tell me that he had never told me before.  There in his hospital room, Dan confessed to me the secrets that he had never told me in the years that we had been visiting.  I have to confess that there was nothing in that confession that shocked me and nothing that  I thought was that bad.  However, for him, these were the dark things that made him feel ashamed – things he had feared confessing to anyone and things that he felt would keep him from God’s grace.    We talked that day about scriptures of forgiveness that he knew and I prayed with him that God would forgive him and comfort him.  Dan was released from the hospital a couple of weeks later and moved to a skilled nursing facility.  I got a call a few weeks later that Dan had died.  I felt sure that Dan had died with a bit more peace than he had lived with in his life.  Dan was one of the more challenging clients I ever had and I know we gave him help and comfort in his life, but I learned so much from my time with him.  In the later years of our relationship as he would find joy in the simple things in life and as he would be grateful for the smallest of gifts he challenged me to deal with my own materialism and to appreciate all that I had.  Dan was grateful to God though he did not have much of what we generally might think brings happiness.  He did a great deal with very few resources.  Dan did amazing things with his limited resources.  He carefully budgeted his money and he would pay me $15 cash each time at each session he had with me.  I am grateful for the donors who support the work of PCCT with their time and money because they make it possible for people like Dan to be seen by our counselors.  It is truly a blessing to be a part of this work.

Bears Will Be Bears

While a bear from the wild may be captured to live in a zoo or such place and a wild bear may be trained to ride a bike in the circus, for the most part, wild bears do what wild bears do.  Several years ago, while trying to emphasize a point about how to deal with some types of difficult people, I began to pick on bears.  I could have easily picked on some other animal, but the bears were an easy target.  I have sometimes heard horrible stories about how a bear somewhere had attacked an innocent hiker.  More frequently we hear stories of how a bear somewhere entered a campground and ate all the campers’ food.  Bears, being bears, do not judge the ethics of their actions.  If you get too close to a mama bear’s cub, she will attack to protect her baby.  If a bear is hungry, it will seek out food and eat whatever is most convenient.  The bear does not judge a camper’s goodness or badness.  The bear does not care how hard it was for the camper to haul the food to the camp site.   The bear is just doing what the bear does.  The first time that a bear eats a camper’s food, the camper may be angry with the bear, but once it has been established that bears are present and that bears will eat your food, one can hardly be angry with the bear if the bear does this again.  This is why campers often have to hang their food in trees or put their food in a boat on a lake away from the camp site.  Bears will do what bears do.  There is nothing that will make the bear change its behavior, so, the camper must change how he manages the camp site and the food.

Like the camper, many of us have people in our lives that do things that hurt or annoy us.  There are people that continually try to rob of the good things in our lives.  Our first instinct is to take these behaviors personally and wonder why we have been singled out.  We may feel anger at the person and may even make attempts to change their terrible ways.  However, if we begin to think of them as bears, we realize that these problematic people are not doing these things “to us” because they do these things to everyone; it is just their nature.  We do not have to take it personally because it is not personal.  The bear is just doing what bears do.  The bear’s behavior is not a judgment on us because the bear is not taking our value into account at all.  Just as campers must find ways to protect their food from the bear’s attacks, we must find ways to alter our ways when we encounter the “bears” in our lives.  There is not one universal way for dealing with “bears”.   Often the way we need to respond is dependent on our situation.  In some cases, doing whatever the equivalent of hanging our food in a tree is sufficient to protect us from the bear’s attack.  However, as some of clients have pointed out, there are times when the bears are so persistent that not camping in those areas at all may be necessary.  One client once heard me talk about the bears and told me that the “bears” in her life had completely ruined “camping” for her altogether.  In this metaphor, we must assume that not “camping” is not an option.  We cannot allow the actions of some bears to ruin our experience in the great outdoors.  We cannot let others rob us of the joy of living.  I know sometimes it feels like we should just avoid every situation where there might be bears, but the reality is that bears are everywhere.  (I saw a news story this week of bears wrestling in a backyard in Florida.  Who knew there were bears in Florida?).  We cannot change the bears, but we sure can change how we relate to them.  The bears in our lives can be crafty and sometimes can trick us into letting our guard down, but when we do, we must look at ourselves and how we were deceived and not at the bear because the deception may be in the “bear’s” nature.  If we are picking on bears, then I would say that we cannot avoid every single animal simply because there are bears in the world.  Not all animals act like the bears.  However, all the animals have their own way of relating.  Some of those animals can be quite docile and affectionate. 

Most of us have some “bears” in our lives.  Some bears live in our own homes with us and some are people at work, school, or church.  Sometimes figuring out the emotional equivalent of “hanging your food in a tree” can be tricky, but it can usually be done.  “Leaving the woods” or never “camping” are rarely the best options.   If you are having difficulty with a “bear” in your life, a good therapist might be helpful.  A good trustworthy friend can often be helpful as well.  Just remember that bears will be bears and you can learn to co-exist with them.  Happy Camping.