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The State-of-the-Art of Christian Counseling

A Personal Perspective from a Christian Psychologist

By, Dr. Brian Campbell, (2015)

The purpose of this paper is to provide a broad overview of the history and subsequent development of my career as a Christian counselor.  As the story unfolds, I hope to provide the reader with interesting insights into important topics that are relevant to contemporary Christian counseling.  As we travel along the road of my life’s journey, I will stop to address important topics such as the theoretical underpinnings of Christian counseling, as well as more practical topics such as finances, and how to set up a private practice. Eventually, I will provide my view of the current state-of-the-art of Christian counseling, followed by a discussion of what I see to be the future of Christian counseling in our ever-changing society.

I pray that the information I provide will be helpful for LU students who are pursuing careers in professional Christian counseling.

My Bio:

A few words about me… I am a born again Christian. My wife, Claire, and I have been married for 38 years. We have three grown children, and six beautiful grandchildren (I’m not biased—ha! ha!).

I completed my undergraduate degree in psychology at Grove City College, Grove City, PA. Then I travelled to St. Andrews, Scotland (notice my last name is Campbell) to study for my doctorate in psychology. While there, I met my wife-to-be, Claire. We married in Scotland, and I returned home to complete my pre-doctoral clinical psychology internship at the Veteran’s Hospital in Pittsburgh, PA.

I then went on to do a Postdoctoral Fellowship in Developmental Disabilities in a program affiliated with Brown University, located at the Center for Reproductive Medicine and Child Neurology, in Rhode Island Hospital. Following my postdoctoral education, Claire and I decided to move south (we had had enough of the winters in St. Andrews, and Pittsburgh—where I was born and grew up) and I took up a position as an Assistant Professor of Clinical Psychology at Nova University, located in Ft. Lauderdale, FL.

We stayed at Nova for over 10 years. During that time, I primarily taught doctoral level courses in our APA approved Ph.D. and Psy.D. clinical psychology programs. In addition, I taught some Master’s level courses in our psychology counseling program. When I left Nova, I had been promoted to the rank of Associate Professor. After 10 years as a professor, I decided to go into private practice as a Christian counselor. Claire and I moved to Lake Mary, Fl., where I set up an office and was in private Christian Counseling from 1990 until 2015.  

Over the years, I have written three Christian counseling books and I have developed a Christian Counseling website (Counseling4Christians.com) which won an award as a "Top Counseling Resource."   In my capacity as an online professor at Liberty University, I returned to the profession of teaching, which is my first love, and my spiritual gift. 

My Calling:

Many students pursuing a career in Christian counseling feel a special calling on their life. They feel that God is at work in their lives and that God has called them to serve others through a career in Christian counseling. In my own life, there were two flashpoints that influenced the course and direction of my life. The first occurred when I was 18 years old.

God gifted me with a very good singing voice. As a child, I sang solos in church since I was about six years old. When I was older, I took professional singing lessons, sang in a touring choir at Grove City College, and also participated in college opera productions. 

Backing up a step, when I was 18 years old (in 1968) I was selected to sing in an ecumenical singing group of young people who were selected to go to Bogotá, Colombia to sing at the Ecumenical Congress held by the Catholic Church and overseen by Pope John Paul the IV. Our mission was to help soothe the tensions between Protestants and Catholics in South America. (By the way, I was raised Presbyterian).

When we arrived in Bogotá, we were filmed on TV and then whisked away to meet the Pope. In the blink of an eye I was standing on the podium with the Pope nearby. Then I looked up and glimpsed am astonishing sight.  There were over one million people gathered in the audience that day. There was literally a sea of white handkerchiefs waving at the Pope that seemed to go on forever. I had never seen so many people in one place, and I probably never will again.

As God preordained, I was chosen to sing some solo lines in one of the songs we had prepared. I will never forget standing up to the microphone and singing (in Spanish):

Of my hands I give to You O Lord 
Of my hands I give to You 
I give to You as You gave to me 
Of my hands I give to You

There are no words to express the joy and peace that I felt at that moment. But little did I know that another event later on that day would be even more significant and literally change the course of my life.

When the Pope came to visit this Bogotá, all the orphan children living on the streets of Bogotá and sleeping under newspapers, were rounded up and put into special camps. Our choir members decided to visit one of those camps. It was there that I encountered a young boy who came up to me, put his arm around me, but was clearly unable to speak.  He was completely mute. I tried to talk to him, but he couldn’t speak at all.  But although he couldn’t speak, the way he held me spoke volumes.

It was at that moment I distinctly remember saying silently to myself, “I’d really like to help kids like this when I get older.”  I was scheduled to attend Grove city College after the summer break. Because of my experience with this young boy, I decided to major in psychology.  And as Paul Harvey used to say, “And now you know the rest of the story…”  But this was not the end of the story.  Jump forward 22 years, when I was 40 years old.

As mentioned above, the first 10 years of my professional career were spent teaching doctoral level clinical psychology at Nova University in Fort Lauderdale Florida.  At that point, I had reached the rank of Associate Professor of Clinical Psychology, and I was effectively tenured.  But I wasn’t happy.  For years, I had been struggling financially trying to support my three children and still have my wife stay at home to raise the kids.  When I was first hired at Nova, in 1980, my salary was $16,500. Ten years later, even after my promotion, I was only making $38,000 a year.  To put things in perspective, my brother’s wife was a home economics high school teacher in Pennsylvania.  She only had a bachelor’s degree, and for a nine-month contract she was earning $55,000 a year.

So, at age 40, I decided to leave the University try to make my career in private practice. At that time, psychologists had just received approval to bill Medicare for services. I landed a big contract with a nursing home facility and was going to “make my millions” serving elderly residents. Unfortunately, the contract fell through three months after it began.  There I was-- a wife and three little children, with no money and no job. To say I panicked would be understatement.  However, in retrospect, it is clear that these events were ordained by God.

I tried everything to get work. I was going to wear a sandwich board that said: “Will talk for food.” But God kept the door tightly shut until I was well and truly broken. One day, in utter exhaustion, I stopped my car along the road, got down on my knees, looked up and told God that I couldn’t go any further.  I remember holding out my arms, as if presenting a gift, and saying, Thy will be done!

At that moment, in an instant, I felt a peace that transcended all understanding. I had finally submitted my will, to God’s will.  I know He must have been waiting a long time for me to say those words. I was instantly filled with the Holy Spirit, and my life would never be the same again.

My “born-again” experience shaped the course of my life and my career as a Christian counselor.  At that point, I didn’t know what I was going to do or where I was going to go.  I just knew I could trust the Creator of the universe to guide my steps.  I was finally nestled firmly in God’s will, rather than my own will.  If my mind started to wonder I started to worry, I would shake my head, look up, and turn everything back over to God. Then, “peace like a river” would flow into my heart.

Now that I was filled with the Holy Spirit, the next part of my story unfolded fairly quickly.

 

Decision Making

 

Many if you undoubtedly feel called by God into the Christian counseling ministry.

But I strongly recommend that you stay open to God’s plans and not your own.  His ways are not our ways, and it is often difficult to discern the path ahead. 

 

Stay in the moment and stay in connection with God. Completely abandoned your will to God’s will.

 

“Trust in the Lord with all your heart and lean not on your understanding in all your ways acknowledge him and he will make your paths straight.” (Proverbs 3:5)

 

As the Scripture suggests, we are not wise enough to direct her own paths.  I frequently have to tell myself to “get your little pea brain out of the way” and turn everything over to our heavenly Father.  Make tentative plans for the future, but then turn them over to God.  Don’t try to insist on your plans when roadblocks consistently block your progress.

 

Turn to God and ask for guidance and direction. Be prepared to change course and change direction at any point in time. Abandon yourself to God’s will and don’t fear that there are minor changes or even major changes in the course of your direction. Remember when Jesus told the rich man to “drop everything” and follow Him.  Even bold and radical changes are sometimes in order to properly follow God.

 

You may even find that your time spent as a counseling student is brief, and that God will move you on serve in other areas of his kingdom—even before you finish your degree.   As you study, just do your best with the talents God has given you.   If you have limitations, accept them.  Not everyone is equally skilled in all areas of life.

 

And how do you make decisions as you move along the path of life?  Personally, I look for “peace.”  If I abandon my will to God’s will, I feel a deep sense of peace.  I am no longer making the calls—God is.  Wherever He wants me to go, I will follow.  But God rarely speaks directly to me to tell me where I should go, or what decision I should make. 

 

When I am faced with a decision, I pray to God for wisdom and guidance.  If no clear answer emerges, I just keep doing what I am doing, and wait on the Lord.  If a clear answer does emerge, the door that opens up is characterized by peace.  I walk through the door without any fear or trembling.

 

Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.  And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.” (Philippians 4:6-7).

 

 

After my “born-again” experience, some marvelous things started to happen. I sold my house within two weeks in Fort Lauderdale and, at the same time, I was offered a job in Christian counseling in Orlando Florida. The doors opened up so quickly and so smoothly that I felt like I was riding a wave of peace. No more fear. No more anxiety.  Just a great sense of excitement about what God was going to do in my life.  I wasn’t sure of everything, but I knew for certain I was going to be a Christian counselor.

Historical Perspectives: 

I entered the field of Christian Counseling in 1990.  At that point in time, major health insurance carriers typically allowed for patients to spend up to 28 days in and inpatient psychiatric facility—no questions asked. 

Christian inpatient programs were springing up around the country, and were operating within the publically funded inpatient psychiatric facilities.  I had privileges at one of the hospitals and I became a service provider for one of the programs. National organizations such as RAPHA were spreading across the country and it began to look like there may be a real Renaissance of Christian counseling.

However, at about the same time, other forms of insurance companies started to emerge. HMOs, PPOs and other less traditional insurance companies started compete in the market. Most of these insurance companies undercut the traditional “large players” such as Blue Cross Blue Shield. The competition drove down prices and reimbursements. To cut costs, the length of stay in psychiatric facilities was dramatically reduced. The month-long Christian inpatient programs could no longer be sustained. As a result, they dropped out almost completely.  The average length of stay in psychiatric facilities dropped to an average of three days.

Private Christian inpatient facilities still exist, but the costs are often exorbitant. You can view a list of some of these programs on my Internet site: Treatment Centers.  Most of these programs focus on addictions and eating disorders, using traditional 12-step programs that evolved out of the treatment of alcoholism.  Many of the programs are only available ‘out-of-state.”

Bottom line, in today’s world, you are unlikely to find very many psychiatric facilities that offer Christian oriented counseling – especially public sector facilities. Unfortunately, if you do send someone to an inpatient facility, very little psychological treatment is likely to take place. The focus is on medication management and release as soon as client is stable. This usually occurs within the first three days of inpatient “treatment.”

As far as I know, there are no longer any long-term Christian oriented treatment programs in publicly funded psychiatric facilities.  However, private practice Christian counseling has continued to survive since I entered the field in 1990.  Interestingly, I named my private  practice “New Life Christian Counseling Center.” Some of my friends advised me to not put the word Christian in the title because I would miss out on the non-Christians who might want treatment from me.

But I stuck true to my calling. I kept the word Christian in the title of my business. And God honored this decision.  Here is what happened…

There are a lot of Christians in the Orlando area. When they would call up their insurance companies to ask for a referral, they would specify they wanted a Christian counselor. Of course, I was one of the few providers who used the word Christian in the title of their business. As a result, when the referral specialists for insurance companies would look down the list of providers, my name stood out as being distinctively Christian oriented.  Bottom line…I started getting all the referrals. To this day, before I retired, I never did any advertising at all. It was clear that God brought these people to me because I honored Him. 


 

 

 

Honor God and He will honor you.

 

And my God will meet all your needs according to his glorious riches in Christ Jesus.  (Philippians 4:19)

 

When God gives any man wealth and possessions, and enables him to enjoy them, to accept his lot and be happy in his work--this is a gift of God.  He seldom reflects on the days of his life, because God keeps him occupied with gladness of heart.  (Ecclesiastes 5:19-20)

 

And God is able to make all grace abound to you, so that in all things at all times, having all that you need, you will abound in every good work.  (2 Corinthians 9:8)

 

 

Theoretical Perspectives:  

Interestingly, the story of my career threads through many of the major theoretical developments that have ultimately led to contemporary Christian counseling. As I recount my story, you’ll be able to see how early theoretical models of psychology were combined to arrive at the most efficacious treatment modality for Christian counselors, namely: Christian Cognitive – Behavioral Therapy (CCBT).

            Psychoanalysis: Candidates for licensure in psychology are required to undertake a 2000 hour (one year) APA approved predoctoral clinical psychology internship.   In 1978, I returned from Scotland, to undertake my predoctoral internship at the VA Hospital in Pittsburgh.  The great majority of internships at that time were based almost exclusively on psychoanalysis.  Although I knew virtually nothing about psychoanalysis prior to the internship, I am a fast learner and I dove into the model head first.

I mastered the terminology of id, ego, superego, and all the other esoteric terms that form part of the psychoanalytic “language.”  However, psychoanalysis never really “sat well” with me. I was too much of a scientist, and the scientific literature supporting psychoanalysis was scant and lacking in many ways.  I did not like the “reflective” and nondirective nature of the treatment model. Over the year that I provided treatment, I can honestly say that I’m not sure if I helped many people.  Yes, I did observe evidence of catharsis and abreaction, but not much else.

As an aside, all of the psychiatrists in my generation were also trained in psychoanalysis. Today, comparatively few psychiatrists utilize this treatment paradigm. In fact, most psychiatrists do not provide counseling at all. Without an acceptable treatment model, psychiatrists were “left out in the cold.”  Today, most psychiatrists simply provide psychotropic medication.  In fact, I would go so far as to say that most authorities today would consider it unethical to provide treatment based on the psychoanalytic model. Once again, psychologists are to provide treatments that represent the highest standards of care available in the community.

Note:  For an additional discussion of a psychiatrist’s role in mental health, as well as a look at the training of psychiatrists vs. psychologists, please see the following article:  Psychiatrists vs. Psychologists.

            Behavior Modification:  After completing my predoctoral clinical psychology internship at the V.A., I returned to Scotland to complete the writing of my doctoral dissertation.   Over the course of the next year, I completed the dissertation and successfully defended it.  I was awarded my Ph.D. in psychology from the University of St. Andrews, Scotland.

In addition to a 2000 hour pre-doctoral supervised internship, psychologists are also required to obtain 2000 hours of post-doctoral supervised experience.  Therefore, during the time I was completing the writing my doctoral dissertation, I decided to apply for a postdoctoral fellowship back in the United States. 

I was fortunate enough to receive a fellowship in the “Psychology of Developmental Disabilities” in a program affiliated with Brown University and the “Center for Reproductive Medicine and Child Neurology” at Rhode Island Hospital. My supervisor for the postdoctoral training was Dr. James Mulick-- a radical behaviorist. During the course of my postdoctoral training, under the watchful eye of Dr. Mulick, I became an expert in behavior modification and applied behavioral analysis.

At this point, I want to stop for a moment to “turn back the clock.” The origins of behavior modification can be traced to the work of John B. Watson, during the early part of the 20th century. Watson rejected Wilhelm Wundt’s (the “Father of Psychology”) emphasis on studying thoughts, images, and feelings.  In 1913, Watson wrote an article entitled, “Psychology as the Behaviorist Views it.” Watson was focused on developing a branch of psychology that only focused on observable behavior – not introspection (i.e., that which takes place “between the ears” and cannot be observed).

Psychology as the behaviorist views it is a purely objective experimental branch of natural science. Its theoretical goal is the prediction and control of behavior. Introspection forms no essential part of its methods, nor is the scientific value of its data dependent upon the readiness with which they lend themselves to interpretation in terms of consciousness.”  (Watson, 1913)

With its focus on observable behavior, rather than mental states, Watson labeled his new science as behaviorism.  Watson’s work laid the foundation for another version of behaviorism that was developed by B. F. Skinner in Harvard. (Interestingly, both Watson and Skinner were atheists.)

Skinner’s version of behaviorism focused on how behaviors are strengthened or weakened by their consequences. If the consequences are positive (i.e., Reinforcing) and the frequency of the behavior will increase. On the other hand, if the consequences are negative (i.e., Punishing), and the frequency of behavior will decrease.  He placed great emphasis on the environment and how it influences behavior.

By studying pigeons, Skinner deduced a wide range of “rules” that apply to animal behavior and, by extrapolation, to human behavior. These rules of behavior change are referred to as behavior modification.  As an explanatory model of human behavior, behavior modification focuses on the so-called “ABC” model of behavior change.

Antecedents-Behavior-Consequences

Behavior modification focuses on what happens before a behavior occurs (Antecedents), and what happens after a behavior occurs (Consequences). By controlling what happens before the “target” behavior occurs, and/or controlling what happens immediately after the behavior, you can increase or decrease the frequency of the “target” behavior.

Out of this model, the concepts of positive reinforcement and punishment were given birth.  The “laws” of behavior modification were derived mainly from the study of animals in laboratory experiments.  Later on, the concepts of behavior modification were extended into the study of human beings by Nate Azrin, a student of Skinner, and a colleague of mine at Nova University.

Dr. Azrin showed that the concepts of behavior modification could be applied in psychiatric settings and in settings for the mentally retarded (old terminology).  The state hospitals served as a “human laboratory” where environmental factors could be controlled and manipulated to effect change.  The outcomes tended to be highly successful and the efficacy of behavior modification was clearly established.

During my postdoctoral internship, under the tutelage of Dr. James Mulick, I mastered many of the techniques of the modification and applied them in state facilities for dual-diagnosed individuals (mentally retarded/psychotic).  Many of these individuals exhibited extremely disruptive behaviors or self-injurious behaviors. Using behavior modification techniques, Dr. Mulick and I successfully teamed together to treat individuals with severely disruptive behaviors that were preventing them from integrating into society.

One of my first cases in the State Hospital involved working with projectile vomiter.  I smile as I wonder how Jay Adams would handle this case.  This young man was in the back wards of the hospital.  He was mentally retarded and had lived in the hospital most of his life.  To protect himself from others, he had learned (serendipitously) a very primitive response to keep others away.  He would throw up on them.  He had become so proficient at this that he could project his vomit about ten feet.

This case could not be treated with scripture memory or cognitive restructuring.  Behavior modification was the only applicable treatment technique.  With the help of my supervisor and a cram course on behavior modification techniques, I started treatment with this young man.  Our treatment consisted of giving him an abundance of liquids.  We did this so that he would have enough liquid to keep throwing up on us.

I remember entering the behavior-training unit dressed in a yellow raincoat and galoshes.  We gave this young man drinks by putting them down next to him and letting him drink.  After he gulped down the drink, we would approach him.  He would then self-protectively try to vomit on us (I was working with two other therapists). 

We would then place the man on a soft mat that was near the table where we were working.  He did not like to be touched and was very defensive.  Using behavioral techniques of “shaping, “fading,” and “negative reinforcement,” we let him up when he quieted down.  The “punishment” he received for his vomiting worked well, and his projectile vomiting sharply decreased.  The fact that he was eventually able to be around other people in the hospital setting was extremely rewarding (to me).

As my fellowship proceeded, I learned to work effectively with individuals who exhibited a wide range of behavioral disorders.  We did not do “talky” therapy.  We used strict behavior modification techniques.  Most of the clients improved significantly and the quality of their lives improved immeasurably.  

            The Behavior Training Unit (BTU): Following my postdoctoral experiences, I started my teaching job at Nova University in our doctoral level clinical psychology programs.  Unfortunately, as I mentioned earlier, university professors don’t always get paid very much. As a result, I decided to take a consulting position in South Florida State Hospital to offset my expenses.  A student of mine and I set up a Behavior Training Unit (BTU) where we treated some of the most violent and aggressive people in the world. We set up for unit so as to optimize the utilization of behavior modification techniques. In our BTU, we taught new skills and rewarded appropriate behavior, while at the same time punishing undesirable behavior.

Some the people we worked with her self-injurious-- hitting their heads on tables or the floor hundreds of times a day. Others ate inediles (zippers, nails, bolts, etc.), drank their own urine, put class up their vaginas, or bit people’s noses or fingers off. I think you get the point. These are very disturbed individuals who developed extremely maladaptive behaviors.

You might be surprised to learn that, using behavior modification techniques (with highly trained behaviorists in a controlled setting), we were able to help almost all the individuals improve their behavior to the point that they were able to be integrated back into society. Behavior modification techniques were clearly powerful and effective.

Unfortunately, many of you may not have received any training at all in behavior modification techniques. If so, I strongly recommend that you take a course in behavior modification. One of the books that I highly recommend is: “Principles of Everyday Behavioral Analysis, by Keith Miller.  You can get the third edition on Ebay for under $20.00.  The 4th edition is much more expensive, but the book is excellent in terms of teaching how to understand and apply behavior modification techniques to human behavior.

            Child Behavior Problems:  Throughout my career, I have utilized behavior modification techniques to treat child behavior problems.  Using behavioral techniques, I can help parents: get their children to sleep through the night; to eat their food; to go to bed at night; to behave themselves in public; to stop having tantrums; to eliminate biting or hitting; to reduce sibling fighting; to control adolescent behavioral outbursts; and to stop whining behavior.  I wonder if Jay Adams could possibly be effective in treating these disorders—especially if the child (and his parents) are non-Christians.  I would suggest he would not have much that he could do to help, except pray (not to minimize the power of prayer).

To help introduce behavior modification techniques, as applied to childhood problems, I will refer you to a document I use with parents that I developed called:  “How to Teach Your Child to Whine—or Not!”  It is located on my internet site.  I often use it as a handout with my clients.

Some of the specific behavior modification techniques/concepts used with children are:  Reinforcement; Punishment: Timeout; Extinction; Response Cost; Toke Economy; Differential Reinforcement of Incompatible Behaviors (DRI); The Premack Principle; Overcorrection; Discriminative Stimulus (SD); and, Schedules of Reinforcement.

With Christian families, I also refer them to a chapter in “Godly Counsel” dealing with scriptures relating to the topic of parenting.  I am an advocate of corporal punishment (at certain ages and with certain children).  Spanking is, in essence, a behavior modification procedure (termed “punishment”), so I want to make sure that my parents are ok with using punishment.  Of course, I remind them that “God disciplines those he loves.”  Please have a look at my chapter on parenting.  If parents do not agree to corporal punishment, I use alternative treatments.

Please note: Most of the child behavior problems I have dealt with in my private practice do not require me to conceptualize them with respect to issues of faith, or from a Christian perspective. For example, teaching a parent how to toilet train her child does not require conceptualizing the problem from a “Christian perspective.” A combination of behavior modification techniques works very well to accomplish toilet training. In fact, Nate Azrin (who I mentioned earlier), used behavior modification techniques to develop his book entitled, “Toilet Training in Less Than a Day.”  Personally, I have used his techniques to toilet train difficult children in less than a day.  It really does work --if you know what you’re doing.

Here are some books that you might want to consult if you plan to use behavior modification techniques with children:

“Parents are Teachers”  by Gerald Patterson.
“SOS Help for Parents” by Lynn Clark

            The Switch to Cognitive Therapy: The Behavior Training Unit at South Florida State Hospital provided stunning results for the overwhelming majority of clients with whom we worked. Setting up a “Clockwork Orange” type of environment, we were able to control most aspects of the client’s environment and provide adequate positive reinforcement and other behavioral techniques to bring about significant changes. We talked very little in the BTU. We were mainly focused on observable behavior and making consistent changes in the environment to bring about significant changes in behavior.  This certainly was not “therapy” as most people would conceptualize it. However, the dramatic changes in behavior were evidence that the procedures we were utilizing worked – in fact, they worked extremely well.

Then one day, I observed something that caused me to re-think the behavioral model that focused strictly on observable behavior. My mind was changed by a woman named Connie (pseudonym). Connie was an extremely violent and aggressive woman who had been tied in four-point restraints (arms and legs tied to a chair) for most of her waking day.  [This was the “treatment” she received prior to her treatment in the Behavior Training Unit].  She would struggle most of the day to get out of the restraints. As a result, she developed extremely strong muscles. When we decided to take her into the BTU, we had to use six trainers for a period of 12 hours in order to get her to comply. During that time, she tried to bite us on several occasions. She had already bitten off the nose of one of the other clients, and the nipple off one of the female nurses. She was very dangerous.

After she started attending the BTU, she settled down somewhat. The consistency of our intervention, and the increase in positive reinforcement in the environment, seemed to reduce her overall emotionality. However, even though BTU changed very little from one day to the next, I noticed something curious about Connie. On some days she would behave very well; however, on other days, her behavior became completely out of control.  As a result, I started watching, her more closely.

Then one day I heard her say, under her breath, “My mother’s going to get you! She’s going to save me!”  On the days that she was saying this to herself, her behavior got totally out-of-control. It became clear at that point, that in order to change her behavior we were going to have to deal with her “thinking.” So, I determined that we were going to have to punish her thinking—namely, the notion that she was going to be saved or rescued by her mother. This became a focus of treatment, and it worked very well. I won’t go into details of how we punished her thinking. However, I will tell you that once she “gave up” the irrational belief that her mother was going to save her, her behavior changed dramatically and she was ultimately able to go to a group home and then transition to the community.

This single event caused me to re-think the strict behavioral model. The event highlighted to me that I needed to focus on “thinking” as well as behavior in order to bring about significant change in people’s lives. This led me to explore the cognitive model of therapy.

            Cognitive Therapy:  The precursor to modern cognitive therapy was pioneered by Albert Ellis in the 1950s.  His cognitive approach to treatment went through several name changes:  Rational Therapy (RT); Rational Emotive Therapy (RET); and, finally, Rational Emotive Behavioral Therapy (REBT).  Ellis’ therapy focuses on helping individuals become aware of, and change, irrational thinking and beliefs, and help them develop a more rational way of thinking, expressing emotion, and behaving.

Ellis’ work in the 50s was followed closely by Aaron Beck’s “cognitive therapy” which was advanced in the 1960s.  Beck proposed that thinking, emotion, and behavior were all “connected.”  Like Ellis, Beck believed that a primary focus of therapy should be on identifying and changing irrational thinking and beliefs that people had adopted.  Interestingly, as was the case with behavior modification, cognitive therapy developed as a reaction to psychodynamic therapies. 

Subsequently, the ascendance of cognitive therapy and behavioral therapy ultimately resulted in the convergence of the two models, giving rise to cognitive-behavioral therapy.  Since I had already developed skills in behavioral therapy (grounded in behavior modification), I set out to learn the new paradigm of cognitive therapy. As I already mentioned, my shift to this modality was occasioned by the dramatic change I saw in Connie when we focused on changing her thinking and beliefs.

As I studied cognitive therapy, I started conceptualize how I could apply behavioral therapy techniques to “thinking.”  That is, I viewed thinking as an overt behavior that could be rewarded or punished-- similar to other observable behaviors.

Here are some Cognitive Therapy techniques/concepts:  Cognitive Restructuring; Cognitive Distortions; Self-Talk; Automatic Thoughts; Irrational Beliefs; Magnification; Minimization; Selective Attention; Confirmatory Bias; and Overgeneralization.

            The Switch to Christian Cognitive-Behavioral Therapy: As I studied in utilized cognitive therapy techniques, I was impressed by how effective the treatment modality appeared to be. When I combined the cognitive therapy approach with my knowledge of behavior modification techniques, it wasn’t long before I saw the effectiveness of the newly emergent cognitive-behavioral therapy.

As mentioned earlier, cognitive therapy focuses on helping the client defeat irrational beliefs and replace them with rational “truths.”  One day, I was supervising one of my doctoral students (who happened to be a Christian) and he raised a very interesting question. He was doing research on cognitive therapy and asked whether or not it would be possible to use the Truths of the Bible as a tool to defeat irrational thinking and beliefs. This was an “epiphany” moment for me.  In an instant, I realized that this opened up a whole new “world” of possibilities.

Since I had been raised as a Christian, just a moment’s reflection on the Bible opened up a new avenue of therapy. I instinctively knew that the Truths of the Bible would provide the most powerful tools for helping people change irrational thinking and bringing about mental health. I thought to myself, now I have it all. I could extend cognitive therapy by utilizing the best mental health textbook ever written – the Bible.

Over the next 25 years, I worked in earnest in my private practice to develop the Christian Cognitive-Behavioral Therapy (CCBT) model.  Unbeknown to me, other Christian psychologists (such as Tan ()) were developing similar models. I developed tools for identifying irrational beliefs, challenging irrational beliefs, and replacing them with biblical truths. I constructed a PowerPoint presentation entitled, “Take Captive Every Thought” which explains the model that I had been developing over many years of counseling.  Most of the additional information I have developed is presented in this Google document.  I invite you to look over this information. It includes important private practice documents, assessment tools, and videos showing my approach to Christian Cognitive – Behavioral Therapy (CCBT).

Contemporary Research Trends: Contemporary research on psychological disorders has firmly established Cognitive-Behavioral Therapy (CBT) as the “treatment-of-choice” for the overwhelming majority of psychological disorders.  Since counselors are called to provide the highest standard of care for our clients, there are significant ethical considerations that come into play if you consider providing any alternative treatments for your clients. Although the Christian component of CCBT has not been adequately researched, the extension of CBT utilizing Christian perspectives still falls firmly within the CBT model.

I have discussed the ethical considerations surrounding CCBT elsewhere. I believe this information is extremely important as you consider a career in Christian counseling. I invite you to read the following article: Ethical Considerations of Christian Cognitive-Behavioral Therapy (CCBT).

Financial Considerations: In Florida, master’s level counselors practice as Licensed Mental Health Counselors.  Nationally, the salary range for Mental Health Counselors is from 34-61 thousand dollars per year (Payscale.com).

            Insurance Reimbursement: Licensed psychologists are qualified to receive third-party payment from most insurance companies, including Medicare.  Licensed Mental Health Counselors cannot bill Medicare.  However, they can apply to become part of an insurance company’s “network of providers.”  As an “in-network” provider, counselors provide services under special contracted fees, and receive referrals from the insurance company. 

As an “in-network” provider, most clients will expect that the counselor will bill their insurance company for them.  If so, you will normally have to use specialized billing software and you will have to have someone trained in billing to work in your office.  As an alternative, you can contract with special “billing companies,” who will file the insurance for you (for a fee).

In my private practice, the overwhelming majority of my clients used their insurance plans to cover some, or most, of the cost of my services.  My wife worked as my office manager, and she also did the billing.  Since I saw 25-35 clients a week, this was a full-time job for her.

If you do not “accept insurance,” your clients will need to pay you “out-of-pocket” and seek reimbursement from their insurance company.  However, the client may be able to qualify for partial reimbursement for your services as an “out-of-network” provider.  In such cases, you provide the client with a receipt of services, which includes a code that specifies the type of services you provided, and the client’s diagnosis.  With regard to diagnosis, you should be aware that certain diagnoses (for example, the old DSM-IV “Axis II: Personality Disorders”) do not qualify for reimbursement from most insurance companies.

With the advent of “Obamacare” and other changes in insurance benefits, it is increasingly difficult to “negotiate” the quagmire of insurance companies.  This is often a “real headache” and a major impediment to providing services to clients.  Unfortunately, in today’s world, clients expect to use their insurance benefits, and it is often difficult for them to pay “out-of-pocket” because of economic factors.

To illustrate how things have changed over the years, in 1980, when I first started providing counseling services, I charged $125.00 dollars an hour—and I received $125.00 from most insurance companies.  This was an era before HMO’s and PPO’s etc.  When I retired (in 2015), I was charging $135.00 per hour.  However, I only received $70 dollars an hour from most of the insurance companies.  Mental Health Counselors receive about $10.00 an hour less (i.e., $60.00 per hour).  However, remember, in order to receive third-party payment, you need to have specialized “billing” software and staff, which means your overhead is more costly.  Bottom line, you may want to bill clients $40-50 dollars “out-of-pocket” and avoid the nightmare of insurance altogether.

However, you should also be aware that one of my friends who is a Licensed Mental Health Counselor, regularly charged his clients $150.00 an hour “out-of-pocket” and actually received this amount.  He did not bill the client’s insurance company.  However, this man was extremely well known in the Christian community and had somewhat of an “exclusive” clientele (i.e., wealthy clients).  This man did radio shows and TV shows, and maintained a “high profile” in the community. Also, he was very good at marketing himself and his private Christian counseling practice.

            Alternative Models:  One of my creative friends (a Christian counselor), decided to set up a non-profit corporation and to work in conjunction with a local church.  He sought and received donations from the church members and outsides who donated to his non-profit counseling corporation (and got tax “write-offs”).  He provided counseling on the church premises and avoided costly overhead.  In return, he provided services to church members at a special reduced fee.  He drew a salary from the corporation, so he had a steady income—regardless of the number of clients he actually saw per week.  He did not bill insurance companies for the services he provided.  The fees were strictly “out-of-pocket” and could be adjusted based on the income of the client.

Future Directions:  

            Insurance:  The future of third-party payment for services is “terra incognita.” Before you “dive headfirst” into the insurance “morass,” make sure you talk to others who are already in private practice Christian counseling. 

            Insurance Mandating Treatment:  As a provider for many different insurance companies, I can tell you that insurance companies are increasingly getting into the business of monitoring and dictating the type of treatment you can provide to clients.  For example, one of the companies I contracted with started to mandate that psychologists provide cognitive-behavioral therapy.  I think that this trend will continue in the future.  Personally, I had no problem providing treatment plans that utilized CBT.  Where appropriate, and when I had the client’s written approval, I added the “Christian” component to the CBT model. 

            In the future, it may not be so “easy” to add the “Christian” component; in fact, I predict that more and more restrictions will be placed on providers who work with insurance companies.   In fact, even if you choose to “opt out” of the insurance quagmire, contemporary society is starting to “enter into the counseling room” and restrict the type of treatment that is being offered.

            Laws that Restrict Christian Counseling:  As you are probably aware, California has passed laws that restrict a counselor from helping clients re-orient from a homosexual lifestyle (to a heterosexual lifestyle) if the client is under 18 years old—even if both the minor and his/her parents desire such change.  I’m sure that similar laws will be forthcoming regarding “transgender” clients.  I predict that laws that restrict counseling will increase in number and scope in the future—especially with regard to sexual orientation.  As a result, such trends will result in significant ethical dilemmas for Christian counselors.

            Licensing Laws: As you plan for your future career as a Christian counselor, you will want to pay special attention to the licensing laws in the state where you would like to practice.  Licensing requirements differ from state-to-state.   In Florida, there are two “licensed categories” for master’s level counselors:  1. Licensed “Mental Health Counselor,” and 2. Licensed “Marriage and Family Therapist.” The general statutes governing the profession—including educational and supervision requirements-- are provided in the Florida Statutes.  You will want to make sure that you locate the statutes and requirements for the particular state in which you want to counsel, and carefully study the requirements for licensure