Serious Issues
The title of today’s article has been a “hot-button” issue ever since Jay Adams launched the modern nouthetic biblical counseling movement. Here’s expanded wording of our title:
Should biblical counselors provide physiological interventions for embodied-souls, or should we refer counselees to outside “experts” when it comes to matters of the body?
There are additional ways that people tend to word this issue. Some say:
It is outside the lane of the biblical counselor to discuss physiological interventions.
The doctor, nutritionist, and fitness coach address the body; the pastor and counselor address the soul.
I tend to counter with what I believe is a more biblical, theological, and historical (church history) approach:
God calls us to be soul physicians of embodied-souls who minister compassionately and comprehensively to the whole person, including engaging in conversations about physiological interventions (or psycho-physiological interventions).
Serious, Civil Conversations
Embodied-souls, physiological interventions, informed counseling, the legitimacy or illegitimacy of extra-biblical information, and the use or non-use of extra-biblical information are all serious issues without simplistic answers.
Serious issues call for serious, civil conversations. We need good-faith conversations about these matters, not accusations about others who seek to think through these issues biblically.
So, let’s think about these issues logically and theologically…
The Convergence of Multiple Issues
Let’s start by thinking logically about the convergence of several interrelated issues.
Issue #1: The Lane Issue: One issue involves whether biblical counselors should even engage in physiological interventions for embodied souls. Is the physical even our lane—one area of focus?
Issue #2: The Competency Issue: A related issue involves what folks like Brad Hambrick and I have written about for years: the competency of the counselor. While the Scriptures are all-sufficient, no counselor is all-competent because no counselor is all-knowing, all-informed, all-trained, all-experienced. “Who is competent to address physiological/psycho-physiological issues?”
Take the two issues together and you have the context for some of our current discussions/debates about biblical counseling and physiological interventions. We might frame a third issue like this:
Issue #3: The Equipping Issue: If a pastor-counselor does not believe they are competent (they are untrained, unexperienced, uninformed) to address physiological interventions for embodied souls, then what do they do?
- Do they defer and refer to outside experts because addressing matters of the body is outside their lane?
- Do they seek to become equipped to address matters of the embodied-soul: informed, trained, and perhaps even certified in one of these physiological intervention categories?
- If they seek to become equipped to address psycho-physiological issues, where do they turn to become equipped?
- Do they turn exclusively to the Bible, believing the Bible has all the knowledge they need for exercise, diet, sleep, neuroplasticity, etc.?
- Do they turn to extra-biblical resources, assessed under the lens of a scriptural worldview?
This is where the “proverbial rubber meets the road.” We can incessantly debate about physiological interventions, but what is a counselor to do and say in an actual counseling session when a counselee brings up embodied issues?
A Case Study: The Overweight, Under-Exercising, Not-Sleeping Counselee
Envision a counselee coming to see you. They describe themselves as overweight, not exercising, out of shape, and never getting a good’s night sleep.
Let’s further imagine that after time spent connecting, time spent understand the larger issues, time spent interacting and asking questions, and time spent exploring biblical principles about the body as the temple of the Holy Spirit, that this counselee asks us some very specific questions.
- “Specifically, what would good exercise look like for me? Healthy eating? How can I practice better sleep habits?”
- “What practical physical homework should I be doing to engage in healthy stewardship of my body?”
- “What books should I be reading—which ones do you recommend on exercise, healthy eating, and good sleep? Or, should I just be meditating on verses about my body as the temple of the Holy Spirit?”
Case Study Question #1: “How Might We Go About Answering These Questions?”
I see three primary options for how a biblical counselor might respond to these questions.
- Option #1: Nothing But the Bible
Some counselors might answer those questions and only go to Bible verses to counsel a person on what good exercise looks like, what a good diet involves, what healthy stewardship of the body looks like, and how to get a good night’s sleep.
Since this is a case study, any good biblical counseling supervisor is going to ask you some follow-up questions, such as:
- “If you choose the nothing-but-the-Bible approach to physiological issues, then what specific biblical passages would you turn to in order to provide specific counsel on good exercise, good eating habits, and getting a good’s night sleep?
- “Show me your biblical theology that demonstrates that the Bible claims to provide every piece of information you need to provide specific counsel about the nature of healthy exercise, good eating habits, and good sleep.”
- Option #2: The Bible Plus
Other counselors might answer those questions and go to extra-biblical sources. These might be resources written by Christians about health, exercise, diet, and sleep—but even these resources most assuredly reference extra-biblical information. Or, these resources might be written by non-Christian experts in health, exercise, diet, and sleep.
Here are some case study follow-up questions for this counselor from their supervisor:
- “Please defend biblically your decision to follow a “Bible-Plus” process. How does referencing material, written by a Christian or a non-Christian, with extra-biblical information, fit with your concerns about the integration of secular and biblical sources?”
- “Is it only wrong to ‘integrate’ when it’s done in the counseling office, but it’s okay to ‘integrate’ when it’s done in a book? Or, is it not ‘integration’ when the topic is the body?”
- “If it’s not ‘integration,’ but simply the wise, appropriate use of science about the body, then is there a need to be critical about counselors who talk about the body?”
- “How do you know that the book is not “peddling pseudo-science”? Do you have the training to assess the accuracy of the information presented in these resources? If so, did that training come only from the Bible, or also from extra-biblical sources?”
- Option #3: Refer and Defer
Still other counselors, like those who believe that embodied matters are “outside their lane,” might choose not to counsel about these matters. They might specifically say, “It’s outside my lane and focus to counsel specifically about exercise, diet, weight-loss, and sleep. Ask your doctor, dietician, a sleep expert, or read a good resource.”
Their case study supervisor might follow-up with interactions like these:
- “Why is that approach not simply ‘kicking the can down the road’? If you’re concerned about the integration of secular information, why refer them to a physician, nutritionist, or sleep expert who possibly is unregenerate and almost assuredly uses extra-biblical information?”
- “Have you considered referring them to a biblical counselor who has expertise in these physiological issues, or do you consider it outside the lane of every biblical counselor, even those equipped with physiological training, to counsel about the body?”
- “Biblically, based upon a theological anthropology of embodied-souls, where is your dividing line between when an issue is outside your lane and when it is inside your lane? How do you discern when an issue is an embodied-soul psycho-physiological issue versus when it is a body-only physiological issue?”
Case Study Question #2: Referrals Gone Bad—“What Do You Do When Your Referral Provides Unbiblical Counsel”?
Let’s imagine that the counselor in this case study chose the third option. They referred out their overweight, under-exercising, poor-sleeping counselee to a doctor, dietician, exercise coach, and sleep expert. Let’s imagine that the counselee did that homework, and returned the next week and shared some results and questions like these:
- Referral Gone Bad #1
The counselee returns and says,
“You told me to ask my doctor about these matters. For good sleep, he said I should do some deep breathing exercises before bed, and also some progressive muscle relaxation in bed. Those seem like the ‘secular therapeutic interventions’ I’ve heard you criticize. Do you agree with my doctor’s orders?”
If this were your case study, your counselee, how would you respond to this legitimate question? What biblical passages would shape your response?
- Referral Gone Bad #2
Your counselee also shares:
“My doctor referred me to a sleep specialist. Boy, he seemed like he was peddling pseudoscience about the nervous system. Should I keep seeing him? If not, how can I find a sleep specialist whose framework and worldview is not opposed to what you teach me each week?”
How would you respond? What theological principles would you use in your response?
- Referral Gone Bad #3
Your relentless counselee adds:
“For sleep, you also referenced some material by Jay Adams. When I studied it further, his ten specific principles all came from a secular sleep study, or from secular nervous system studies of his day, or kind of seemed like ‘folk wisdom,’ common sense stuff. So, it is okay for Jay Adams to counsel me about sleep, but you said it was outside your lane to counsel me about sleep? Why is that? Also, it’s okay for Jay Adams to depend upon secular sources regarding healthy sleep?”
What would your response sound like? What biblical principles would you base your response on?
- Referral Gone Bad #4
While your head is still spinning, your counselee continues:
“You told me to go to a fitness coach for healthy exercise. I checked out several. They all seemed pretty secular. I found one who seemed to have some spirituality in his bio. He told me about several books by a secular athletic trainer who uses “Tao” principles for whole-person health. I read up on that, and it’s comes from the pagan world. Should I follow that book? If not, where would you send me for exclusively ‘Christian’ exercise principles?”
Again, your mentor-supervisor wants to hear your biblically-based response to these questions about your refer-defer choice…
- Referral Gone Bad #5
Your counselee is relentless. They now share:
“You told me to find a nutritionist and ask them about healthy eating. I searched for several. They all seemed really ‘secular.’ I finally found one who advertised as a Christian. He told me about diet principles that all came from secular sources—none of them ever talked about the body as the temple of the Spirit, none of them ever factored in God, or spiritual disciplines. Are those sources okay for me to use?”
Your biblically-based response?
- Referral Gone Bad #6
One last question from the counselee you referred out because you believed it was outside your lane to discuss physiological issues.
“You mentioned some Christian authors on the body. When I looked at their footnotes and sources, most of what they said about exercise, sleep, and healthy stewardship of my body came from secular studies. Is it okay for me to use the Christian books you recommended when they are filled with extra-biblical sources? Why is it okay for me to read those books, but not okay for you to talk to me about similar topics with similar resources?”
Your biblically-based response?
Case Study Question #3: “Did Your Referral Just ‘Kick the Can Down the Road’?”
In our case study, perhaps it was the counselor’s conviction that issues of the body are outside their lane. Perhaps they believe that they can distinguish between body issues versus soul issues versus embodied-soul issues. Perhaps they believe that the Bible dichotomizes between into body or soul rather than embodied-soul. Perhaps they believe it is “integrative” to use extra-biblical resources about the body in biblical counseling. Whatever the conviction, the case study supervisor might ask:
- “Did not your refer and defer approach simply kick the can down the road?”
Your supervisor might add:
- “Yes, you didn’t engage in conversations about physiological interventions. However, now your counselee has engaged in conversations about physiological interventions with an unredeemed person and/or with secular extra-biblical resources. Help me to understand your biblical thinking behind that.”
We’re concerned about secular information when it comes to the body. So, do we just push the issue down the road by saying, “it’s outside my lane”? Then our counselee goes to medical helpers who practice outside our worldview.
Case Study Question #4: “Might It Be Wiser for Your Counselee to Discuss These Issues with an Informed Redeemed Counselor?”
Your case study supervisor might then ask you,
- “Which do you think is better? Referring a struggling counselee to an outside ‘expert’ who may or may not be redeemed and who almost certainly relies on extra-biblical material, or you becoming informed, trained, and certified so you can help them directly?”
- “Which do you think is better? Referring a struggling counselee to an outside ‘expert’ who may or may not be redeemed and who almost certainly relies on extra-biblical material, or referring your counselee to a fellow biblical counselor who is informed about these issues?”
The Founder Speaks
Should biblical counselors counsel about the body or refer out? Should biblical counselors become informed about psycho-physiological interventions or is that outside their lane?
Over fifty years ago, Jay Adams addressed these questions very specifically. First, he countered the mantra that doctors deal with the body; counselors with the soul.
“These problems [of trying to divide body and soul] cannot be solved either by Skinnerian reductionism: man is only an animal (all is organic), or on the other hand by simplistic categorization: the nonorganic is the province of the pastor; the organic is the province of the physician” (The Christian Counselor’s Manual, 438).
Instead, Adams insisted that it is not outside the lane of the nouthetic biblical counselor to address the body with specific counseling about physiological interventions—counsel he draws not only from Scripture, but also from the science, neuroscience, and “nervous system studies” of his day.
“Pastoral care is ongoing and total. It is to be seen as extending over the body” (The Christian Counselor’s Manual, 438, emphasis in the original).
Could it be any clearer? The Christian Counselor’s Manual says that nouthetic counseling is “to be seen as extending over the body”.
Adams continues,
“James 5:14-16, for instance puts the organized church squarely in the business of dealing with organic illness” (The Christian Counselor’s Manual, 438).
“That the body affects the soul and the soul the body in so many obvious, as well as subtle, ways is a fact that the Christian counselor must always remember. His work, therefore, constantly involves the organic dimension” (The Christian Counselor’s Manual, 438–439, emphasis added).
The nouthetic biblical counselors work “constantly involves the organic dimension.”
Adams further insists that the nouthetic biblical counselor must be physiologically-informed.
“He will strive always to work from this biblical presupposition in ways that are consistent with it. He should take the time and trouble, therefore, to study the fundamental functions of the human body” (The Christian Counselor’s Manual, 438–439, emphasis added).
Adams took his own counsel by being informed by and using the nervous system studies of his day. On pages 96-97 of Competent to Counsel, Adams uses his understanding of 1970s neuroscience (“the nervous system”) to say: “The Nervous System Corresponds to the Nouthetic Approach” (96/Header).
Adams proposes that there are two sides to the human nervous system. One side is emotional and involuntary. The other side is associated with problem-solving and voluntary action and has to do with behavior (Competent to Counsel, 96).
“Something might be said about the human nervous system with respect to behavior and feeling in counseling. There are basically two sides to this system. One side is emotional and involuntary. The other side, associated with problem-solving and voluntary action has to do with behavior. The importance of this fact is that it is in the client’s behavior that changes can be made directly, because behavior, in contrast to emotion, is controlled by the voluntary, not the involuntary side of man. Emotional states flow secondarily from the behavioral or the voluntary system. The former involves the involuntary control of visceral and vascular emotional responses, whereas the latter involves action responses by the skeletal musculature. Communication between both the nervous systems must be supplied by sensory pathways of the central system. There is a close relationship or a connection between the two so that they can’t really be divided as precisely as one might on paper” (Competent to Counsel, 96-97).
You can agree or disagree with the neuroscience; you can agree or disagree with Adams’s application of it; you can’t deny that Adams was nervous-system-informed.
Adams was so informed by science that he used sleep research to provide very specific nouthetic counsel about sleep. In What About Nouthetic Counseling? (1976), Adams discusses how nouthetic counselors address sleep issues with counselees—including suggesting ten specific physiological interventions (61-62).
Revisionist History
A revisionist history of Jay Adams that claims he was not an informed counselor who used physiological interventions is not compelling because his writings are readily available. See INC: Informed Nouthetic Counseling for how Adams was:
- BINC: Behaviorism-Informed Nouthetic Counseling
- NINC: Neuroscience-Informed Nouthetic Counseling
- SINC: Science-Informed Nouthetic Counseling
- PIINC: Physiological Intervention-Informed Nouthetic Counseling
- SPINC: Secular Psychology-Informed Nouthetic Counseling
- CGINC: Common Grace-Informed Nouthetic Counseling
- CBRINC: Co-Belligerent-Research-Informed Nouthetic Counseling
To understand how Adams used physiological interventions, see: Jay Adams on Embodied-Souls, Trauma, Neuroscience, Sanctification, and Physical Interventions.
To see how Adams was informed and influenced by O. H. Mowrer, the behavioral psychologist, see: Meet the Man Who Influenced Jay Adams and the Modern Nouthetic Counseling Movement: O. Hobart Mowrer.
For a biblical, theological, and historical (church history) study of physiological interventions for embodied-souls, see: Physiological Interventions and Relief-Oriented Care for the Embodied-Soul in Biblical Counseling.
Your Thoughts
Serious issues require serious, civil, biblically-based conversations. As you think about these matters, how do you answer the central questions: “Is it inside or outside the biblical counselor’s lane to provide physiological interventions for embodied-souls?” “Should biblical counselors counsel about the body or refer out?”
