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Guidelines on the involvement of Christian psychologists in the provision of psychotherapy and counselling to local church communities

The prevalence of psychological and emotional distress in church communities appears to be at least as great as that in the secular population, if not greater. Some of our non-Christian colleagues might suggest that this is because the Christian walk and its convictions create stress. An alternative view is that those who recognise their own psychological frailty are often amongst the first to turn to God, in comparison with the more psychologically robust, who may go through life with a sense of self-sufficiency, not encountering the kind of existential crisis which often precipitates a search for a deeper meaning to life.

The caring church community may also attract those with long-term psychological difficulties, as it seeks to reach out to those who, in turn, value the unconditional social and emotional support on offer.

Christian psychologists are often approached by church members who seek help for psychological problems. Equally, they may also be approached by church leaders or clergy for advice about how an individual might best be helped, where they might obtain professional mental health services, or indeed, whether the psychologist might be able to see the person him/herself. In addition to the convenience of being able to consult an easily accessible, known and respected fellow church member, there may also be other reasons why we find ourselves in this situation.

The realm of the psyche is viewed by many (rightly or wrongly) as being much closer to the spiritual than, for example, the medical or biological aspects of the person. Whereas most Christians would not think twice about seeing the nearest non-Christian medical doctor for assistance with a fractured bone or other apparently purely physical malady, when it comes to psychological difficulties, many feel that only a Christian specialist will do.

There may be a feeling that only a Christian psychologist, psychiatrist, therapist, is likely to respect and truly understand the spiritual context of emotional disorder, or that only a fellow Christian can be trusted with the candid disclosure of the most intimate details of the sufferer's thoughts and life. Some of us have witnessed the dismissing of a patient's Christian belief as irrelevant, or, worse still, the construing of Christian conviction as a cause of psychopathology, by our non-Christian colleagues. In some cases, Christians vulnerable to psychotic breakdown have been explicitly advised to terminate all church or fellowship contacts.

Problems of one-to-one work in one's own church

No sooner has one agreed to see one fellow church goer, than the flood-gates may be opened to a subsequent deluge of potentially overwhelming referrals.

Normally the psychologist will be seeing such people in his/her own time rather than during NHS working hours, for example. Some may feel the emotionally demanding nature of their day-to-day work is quite enough without the added complications and stresses of a further church-referred clinical burden.

Once a therapist-client relationship has been embarked upon, subsequent church-related contact will always be coloured or distorted by this. The psychologist and a former client may never again be able to relate to each other as ordinary Christian equals, and awareness of intimate details may cause subsequent embarrassment on both sides.

Boundary issues

In most cases, church-referred clients will know the psychologist's home address, telephone number, may be acquainted with their family members, and may have visited their home. Under these circumstances it will be very tempting for the client to attempt contact with the psychologist at unexpected and unrestricted times. Church attendance for the psychologist may become yet another opportunity for consultation on the part of the client. In short it may become extremely difficult for the psychologist to maintain any of the boundaries normally associated with professional practice, and which serve to safeguard the psychologist's own mental health.

Sometimes this blurring of boundaries can lead to the deliberate exploitation of Christian therapists by Christian clients, who may use their common faith and church membership as a lever for preferential treatment, or as a license to make use of the psychologist at any time, day or night, etc.

Rescuer fantasy and cruciform effect

Many of us find it very difficult not to respond to persons in psychological need within our church fellowships. This may, in part, be due to unrealistic perceptions or expectations of our ability to meet such need. Such idealistic therapeutic enthusiasm may lead to over-involvement when individuals continue to have problems. Consequent therapist distress and client demand are viewed as sacrificial on the part of the therapist - a form of 'taking up one's cross'.

Perhaps we need to say "no" in many instances, both to ourselves and to others, and learn to live with the consequences.

Possible ways of contributing psychological expertise while containing demand and maintaining boundaries:

Clinical and counselling psychologists as a resource to the local church in relation to expert advice, education and supervision

Many churches have pastoral care workers or even church counsellors in addition to clergy/elders, whose function is to support those in distress. Psychologists could offer teaching, workshops, group and/or individual supervision, consultation, etc, to any or all of these. As well as assisting with skill-development, psychologists may also be able to advise on local mental health services, and to facilitate appropriate referrals where necessary.

Cross-church working

One way of avoiding the boundary difficulties described above is to have reciprocal referral arrangements between two or more churches, such that the psychologist would never see anyone from their own church, but may be called upon to see those from others.

Offering a maximum of a single session in one-to-one work

The psychologist may be willing to see a church member on a single occasion, in which the nature of the problem is assessed, and advice about possible referral avenues and types of treatment available is given. Worries about spiritual implications and potential areas of complication with unsympathetic non-Christian clinicians might also be addressed.

Setting clear limits for any therapeutic involvement

If the psychologist does engage in therapy with a church member, the duration and extent of such therapy needs to be made explicit from the outset, and boundaries clarified. Open-ended treatment will probably not be in either the client's or the therapist's interest.

Many of these comments and suggestions might be viewed as rather callously therapist-protection oriented, although protecting the therapist from exploitation and over-involvement also protects the client's interests. Nevertheless for many of us exactly the same issues and conflicts arise in the case of a fellow church member with psychological problems, as they do when a close friend or family member develops a mental health problem. There are no simple solutions.

Michael Wang, 1994

[The above emerged from draft form, via discussion within the Hull regional BACIP Group, and thence to discussion within a Seminar during the November 1994 national BACIP Conference, before its formal adoption as a recognised BACIP document]

Last updated Tuesday 26 June 2007.