Reflections on Biblical Counseling and Mental Illness from a Believing Psychiatrist

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Over the past decade, I've had the privilege of engaging with church elders, care teams, pastors, Biblical Counselors, and recovery leaders to better understand how churches approach the care needs of their members. More recently, over the past four months, I've deepened that engagement through conversations with clergy and counselors while preparing to launch Innkeeper's Care—a psychiatric practice designed to support faith-based organizations in caring for their people struggling with moderate to severe mental health struggles. My goal was to understand both what is being offered and the underlying philosophies of care among Biblical Counselors. Most are deeply committed to the well-being of those entrusted to them and sincerely desire to honor God and His Word. The approaches vary widely: some churches outsource care by offering benevolence support or referring out; others keep care in-house to avoid conflicting care philosophies or loss to follow-up; and some blend in-house care efforts with referrals for specialized needs.

In recent posts, I've raised concerns about how many interventions in psychiatry and psychology are often confounded by the placebo response, and how many new interventions may find their efficacy by mimicking spiritual practices used outside of their spiritual context. This piece now turns the lens inward—toward the faith community itself. I write as someone from within the camp—a psychiatrist and a man of faith—with a deep love for the Church, and a growing concern about the messaging and practices within Biblical Counseling. While many Biblical Counselors I've encountered were compassionate, wise, and balanced, the messaging at the institutional level of some Biblical Counseling organizations tells another story—one that continues to pit psychiatry and psychology against Biblical Counseling, sometimes resorting to straw man arguments or downplaying the nature and treatment of mental illness—contributing to skepticism toward psychiatry within some Church circles.

This has contributed to worsening stigma, delays in diagnosis and treatment (often up to 10 years), and poorer outcomes for Christians struggling with moderate to severe mental illness.

Let me be clear: my goal is not to dismiss Biblical Counseling. Rather, I'm calling for continued alignment with Scripture that engages the reality of mental illness and the value of collaborative evidence-based care. This is a plea from a brother in Christ who loves the Church and wants to see it care well for the suffering.

It’s worth noting that not all who use the title “Biblical Counselor” fall into the category I’m addressing here. Some have come from Christian counseling or secular therapy backgrounds—not to reject clinical tools, but to re-anchor their care in Scripture. Rather than discarding evidence based methods like CBT or psychiatric collaboration, they thoughtfully integrate them under Biblical authority, recognizing the value of both spiritual and scientific insight. However, for the purposes of this blog, I’m using the term Biblical Counseling to refer specifically to those who are critical of thoughtful integration with psychology and psychiatry—especially those associated with institutional models that emphasize the sufficiency of Scripture as a closed system of care.

The Erosion of a Historic Partnership

To understand the current tensions, we must recognize that the antipathy between some evangelical circles and psychiatry represents a relatively recent cultural shift rather than a historic theological position. Anglican pastor Richard Baxter recognized in 1673 that melancholy required medical treatment alongside spiritual care, comparing it to treating "falling sickness" or "a broken head." Christian physicians like Benjamin Rush, the father of American psychiatry, saw no conflict between their faith and psychiatric practice. However, the introduction of psychoanalysis in the early 20th century, particularly Freud's explicit critique of religion, began to create tensions. The 1960s marked a decisive turning point when Presbyterian minister Jay Adams launched the Biblical Counseling movement, arguing that psychiatric categories were invalid and that spiritual frameworks were sufficient for addressing psychological distress.

This historical rupture has had profound consequences, deepened by several legitimate concerns that have driven the wedge further. The relative lack of representation of faithful psychiatrists within evangelical churches has meant that many congregations have had little exposure to physicians who could bridge the theological and clinical divide. Concerns about overtreatment and the pathologization of normal spiritual struggles—turning grief into depression, conviction into anxiety—have resonated with pastors who witness the medicalization of what they rightly see as ordinary human experience. Additionally, the perceived psychologization of sinful behaviors—reframing moral failures as psychological disorders—has raised legitimate questions about accountability and the nature of human responsibility before God.

The irony, however, is striking: while our predecessors in the faith pioneered integrative approaches to mental health care, many contemporary evangelicals have retreated into an either/or mentality that would have been foreign to earlier generations of Christian physicians and pastors. Understanding this trajectory helps explain why some evangelical communities remain entrenched in their skepticism while others are rediscovering the wisdom of their spiritual ancestors who saw no contradiction between faithful discipleship and medical intervention.

The Lens of Biblical Counseling

Biblical Counseling, as defined by the ACBC, is a personal discipleship ministry under church oversight, relying on the sufficiency of God's Word to reorient disordered desires, affections, and behaviors toward restored worship and fellowship. The ABC describes it as a fluid event and process of Spirit-empowered ministry, rooted in God, exalting Jesus, and offered in love. Ed Welch at CCEF argues that Biblical Counseling is a hybrid of discipleship and Biblical friendship. All three definitions reflect a heartfelt commitment to guide people toward Christ through Scripture.

A common critique within these circles is that psychology and psychiatry focus merely on behavior modification or symptom relief, neglecting true heart change—whereas Biblical counseling claims to address spiritual roots and fruits. Yet, even when well-intentioned, this perspective can become myopic and reductionist, overlooking—or even dismissing—the devastating realities of untreated mental illness.

When someone is drowning in dysfunction—imminent job loss, panic attacks, imminent relational trouble, or suicidal thinking—timely and effective interventions are essential. To prioritize spiritual insight over life-saving care is like a lifeguard trying to teach how to tread water to a drowning swimmer from the shore instead of diving in to rescue! Christ modeled a better way. He fed the hungry and healed the sick while also addressing spiritual heart issues (Mark 5:1–20).

Mental illness is not just spiritual. It has distinct features:

Predictable patterns: Unusual, ongoing symptoms that impair daily function following a predictable course of illness

Biopsychosocial roots: Involving brain circuitry, neurotransmitters, trauma, and social stressors

Proven treatments: Conditions respond predictably to targeted, studied interventions

Some Biblical Counselors—due to limited training or mistrust of psychology—filter all symptoms through a spiritual lens. This can lead to spiritualizing symptoms of mental illness, attributing them to "unbelief" or "sin." When misapplied, this heaps guilt on those already suffering. Expecting repentance alone to relieve clinical symptoms often leads to disillusionment. The hierarchical structure of some counseling contexts can subtly pressure people to reshape their distress to fit a preferred theological narrative—a form of spiritual bypassing that distorts both diagnosis and discipleship.

Though the intention may be to help, this method can burden the vulnerable and diverge from Christ's example of compassionate, embodied care.

The Theological Contradiction

Many Biblical Counselors operate from a Reformed theological tradition: God's sovereignty, human depravity, and sanctification. But ironically, their method in practice can resemble charismatic "faith healing"—implying that right thinking or repentance will result in emotional relief. The message becomes: Align with Scripture, and your symptoms will disappear—or God will give you grace to endure.

While rarely stated explicitly, it's implied. And if you're still suffering? Then perhaps you're "not believing the Gospel in the moment."

This kind of approach can be devastating for someone suffering from religious OCD or major depression—conditions already marked by obsessive guilt, self-condemnation, and a sense of hopelessness. For such individuals, fixation on their perceived sinfulness is constant and crushing. In some theological circles, it's common to remind people that their condition is even more spiritually dire than they realize. While this may be well-intentioned—meant to magnify grace—it can land destructively on someone whose inner world is already dominated by shame and fear. They're already tormented by their perceived spiritual failure—hammering the same point can feel less like conviction and more like condemnation. And even if grace is preached afterward, the brain circuits most active in these states are primed to latch onto negative appraisals and filter out the hope. This is where clinical acumen becomes essential: not to dilute truth, but to discern how it’s delivered, and when, so that grace can actually be received.

Ironically, the charismatic tradition—with its emphasis on divine healing—often shows more theological consistency here. Charismatics typically don't create a false dichotomy between medical illness and psychiatric illness when it comes to healing. They'll pray for diabetes and depression with equal fervor, acknowledging both as legitimate conditions requiring God's intervention. This represents a functional, if unintended, alignment between charismatic theology and Biblical Counseling: both traditions tend to spiritualize mental health struggles, though through different lenses. Charismatics often attribute illness to direct demonic influence or spiritual warfare, while Biblical Counselors typically point to lack of faith in God's Word or hidden or under-appreciated sin. Both approaches, while theologically distinct, share the problematic tendency to bypass the medical realities of mental illness in favor of purely spiritual explanations.

Scripture reminds us that individual suffering is not always proximally tied to sin. Even Spirit-filled believers experience profound suffering as part of God's sanctifying work (Romans 8:23; 2 Corinthians 12:9) or just as a consequence of living in a fallen world! To imply otherwise without clear and convincing causal evidence contradicts the very theology Biblical Counseling claims to uphold.

The Science Denial

Some Biblical Counselors argue, "Psychology doesn't have the right anthropology." But this misses the point. Psychology is not a worldview—it's a field of study that focuses on understanding mental processes and behavior through observation, experimentation, and analysis, using the scientific method. Cognitive Behavioral Therapy (CBT), for example, isn't a secular creed. It's a clinical tool refined by observable outcomes.

To dismiss therapy as "secular" is like rejecting antibiotics because microbiology doesn't cite Genesis. God's common grace works through Scripture, prayer, and community—but also through medicine and evidence-based care.

Ironically, despite years of critique against psychology and psychiatry, Biblical Counseling has yet to demonstrate unique spiritual or clinical efficacy through any scientifically validated methods beyond that of a placebo response. The observed improvements are only anecdotal and may simply reflect the beneficial effects of behavioral activation, social support, and expectancy bias—factors all found in spontaneous remission.

One could argue that consistent pastoral support, spiritual disciplines, and church community—without several $275/hour sessions—yield similar and even superior spiritual and mental health outcomes.

The other side of this coin represents a major opportunity to cement the benefits of Biblical counseling. My hypothesis remains that Biblical Counseling is efficacious in improving functional outcomes in mental illness. The next generation of Biblical Counselors has a unique opportunity to lead this charge. By collaborating with academic centers—such as Christian universities, seminaries with research programs, or secular institutions open to faith-based inquiry—they can design and conduct peer-reviewed, double-blind studies to evaluate Biblical Counseling's impact on mental health outcomes. Such studies could measure variables like symptom reduction, quality of life, spiritual well-being, and treatment adherence, comparing Biblical Counseling (alone or in combination with medical interventions) to standard care or placebo controls.

The Dangerous Conflation

Scripture is sufficient for life and godliness, teaching, rebuking, correcting, and training in righteousness (2 Timothy 3:16–17), and it is not a clinical manual for bipolar disorder, OCD, or schizophrenia—just as it's not a flight manual for piloting jets.

Progressive sanctification and genuine repentance do not predictably lead to psychological relief in many people struggling with significant mental illness. A believer may walk in hope yet still battle intrusive thoughts, panic attacks, or mood swings. Insisting that right scriptural thinking, reordering of affections/desires leads to feeling better oversimplifies complex conditions and risks serious clinical and theological error.

On the other hand, while psychological and psychiatric interventions can alleviate symptoms, enabling our spiritual vitality to shine through our bodies( cognition, affect, and behaviors) in this age, such relief does not itself constitute genuine faith or healthy spiritual functioning. Biblical counselors are rightly concerned about this aspect of the conflation.

The Monetization Concern

Scripture warns against peddling God's Word for profit (2 Corinthians 2:17). At the same time, charging for counseling is not unbiblical—after all, "the laborer is worthy of his wages" (1 Timothy 5:18). The ethical concern isn’t the fee itself, but the structure and implications of the relationship. When Biblical counseling is framed as discipleship or friendship—rather than therapy—but functions as a fee-for-service model, it creates a relational dissonance. Can a model built on hourly billing truly reflect Christian shepherding? When the client stops paying, the relationship ends.

To be fair, this is not aimed at those Biblical Counselors who carry their fiduciary responsibilities with integrity—many of whom clearly articulate boundaries, offer flexible or subsidized care, and avoid overstating what Biblical Counseling alone can accomplish. But when counseling is framed as discipleship or friendship, while functioning as a fee-for-service model, it creates a relational dissonance that deserves scrutiny But in parachurch organizations and private practices, the “counseling-as-discipleship” language is often paired with financial arrangements that more closely resemble professional services than spiritual friendship. Imagine telling someone, “I’ll walk with you like a brother in Christ… as long as you pay me weekly.” That doesn't sound like genuine friendship—it sounds like a contract. And like any fee-for-service model, the longer the relationship continues, the more money is made. If this dynamic goes unexamined, it can subtly incentivize prolonged dependency under the guise of care.

The reality is this: Biblical counseling occupies a fiduciary role, even if it uses the language of friendship or discipleship. And fiduciary roles carry sacred responsibility—not just to speak truth, but to steward power, money, and influence with integrity. That’s not a reason to avoid Biblical counseling. It’s a reason to stop pretending it's something it’s not or at least acknowledge the dissonance.

The Millstone Warning

Jesus warned in Matthew 18:6: "Whoever causes one of these little ones who believe in me to stumble..." When counselors shame those seeking medication, minimize trauma related disorders, or label anxiety disorders as unbelief, they risk becoming stumbling blocks to the very people Christ fiercely protects.

The Intellectual Dishonesty

Some Biblical Counselors construct straw man arguments against modern psychiatry—quoting outdated Freudian theories (largely abandoned for decades), pop-psychology fads, or caricaturing therapy as secular humanism—without engaging current research, experts, or clinical realities. When such misrepresentations are framed as theological discernment, the result is not truth-telling but distortion, which undermines the care of souls and risks bearing false witness (Exodus 20:16). At the same time, Biblical Counselors have a vital role in vehemently confronting pseudoscience and pop psychology that have infiltrated both community therapists and Christian counselors alike, often masquerading as legitimate care. These distortions—whether oversimplified self-help tropes or unproven therapeutic trends—cause significant long-term harm to mental health and weaken the Christian witness of faithful practitioners. True discernment requires engaging the best available science with humility while boldly challenging falsehoods, ensuring that care reflects both God's truth and His compassion.

The Peril of Perseverance: When God-Given Interventions Are Overlooked

Within some strands of Biblical Counseling, there's a strong emphasis on "persevering through difficulty," often accompanied by the assertion that suffering inherently leads to sanctification. While the Bible undeniably teaches the refining power of trials (Romans 5:3–5, James 1:2–4) and the importance of endurance (Hebrews 12:1), an over-romanticization of difficulty can become deeply problematic, particularly when effective, God-given interventions for genuine mental illness are available. This approach, though well-intentioned, can inadvertently inflict harm by pressuring counselees to "persevere" through conditions that are demonstrably treatable, thus neglecting both compassion and the stewardship of God's common grace.

The Fallacy of Historical Precedent

Some Biblical Counselors argue that because believers in past centuries relied solely on Scripture and prayer, we should do the same today. But this reasoning is both historically romanticized and theologically inconsistent.

Consider diabetes. For centuries, the faithful suffered and died from it because the mechanisms were unknown. Today, we have insulin and dietary protocols—discovered through God-given human inquiry. Would we now say, "God provided back then, so skip the insulin"?

Mental illness is no different. In the past, Christians endured depression, anxiety, and psychosis with prayer and community alone—not because it was ideal, but because no other tools existed. Through God's common grace, neuroscience and psychology have revealed biological underpinnings—brain circuits, neurotransmitters, trauma—that can now be addressed with proven treatments.

To reject these advancements as "unbiblical" is to ignore God's provision in the present. Scripture never asks us to freeze in time. Paul told Timothy to "take a little wine for your stomach" (1 Timothy 5:23)—a practical medical recommendation. Jesus met people's physical needs while also addressing their hearts.

Faithfulness isn't rejecting modern tools—it's stewarding them wisely. Romanticizing the past at the expense of present help is not faith; it's neglect.

A Necessary Caveat: The Other Side of the Integration Problem

It’s important to add that the dangers are not limited to Biblical Counseling alone. Many forms of Christian integration are equally, if not more problematic. In many settings, integration happens without a coherent theological framework—blending pop-psychology concepts with vague “Christianese,” often delivered by highly savvy communicators who know just enough to be dangerous. The result is models that offer neither clinical rigor nor spiritual depth. At worst, it becomes the worst of both worlds: extrapolated science paired with reductionist and, usually, theologically careless eisegesis. That critique warrants its own reflection—and will be the focus of a future post. For now, this piece centers on Biblical Counseling, precisely because of its influence and the clarity with which it often claims to stand apart from these very pitfalls.

The Way Forward

Biblical Counseling holds profound potential to offer hope and wisdom, grounded in Scripture's truths about human nature and God's presence in our suffering. Yet, some seem more focused on opposing psychiatry/psychology than championing these strengths. We can stand firmly with Biblical Counselors who rightly remind us that symptom relief is not always equivalent to healing. For the Christian, pain and suffering—though products of a fallen world—take on profound meaning. A meaning no psychological model can fully explain.

But to truly honor Christ, Biblical Counseling must embrace humility and collaborate with faithful practitioners of evidence-based care:

• Discern between primary spiritual problems or struggles and psychiatric disorders presenting with spiritual complaints

• Recognize that spiritual concerns may be correlated but not necessarily causally linked to the acute dysfunction

• Embrace God's common grace in medicine, therapy, and observation-based interventions as tools that complement Scripture

• Combat stigma of mental illness within the church by not effectively throwing the "psychological/psychiatric" baby out with the bathwater

• Maintain proper boundaries and accountability, especially when acting outside the authority and covering of the local church. There are now virtual Biblical Counseling services that care across states and even globally!

• Recognize and avoid dual relationships in counseling-related settings—such as when someone serves simultaneously as a supervisor, Biblical counselor, and elder to the same individual. These overlapping roles can blur boundaries, create confusion, and increase the risk of harm. As a corollary, appropriate informed consent should be obtained before any discipleship or counseling begins. This includes a clear explanation of the limits of confidentiality within the context of Biblical counseling, full disclosure of any dual relationships or potential conflicts of interest, and confirmation that the counselee understands these nuances.

• Establish collaborative partnerships for comprehensive care: Churches and Biblical counselors should identify and partner with faithful psychiatrists with experience working in faith-based settings and who can work within the church's theological framework. This allows for intervention through Biblical counseling while reducing risk that treatable psychopathology isn't missed when symptoms persist or worsen. Rather than waiting months or years to refer, churches can establish protocols for referrals earlier in the course of care when progress stalls—not to replace pastoral care, but to rule out underlying medical and psychiatric conditions that might be clouding the big picture. The psychiatrist becomes a trusted collaborator, working alongside pastoral staff and counselors to support the member holistically, ensuring both spiritual and medical needs are addressed with wisdom and discernment. Similar models are already being used with Biblical Counseling organizations like Boston Center for Biblical Counseling

• Engage honestly with the best available science and revise care with discernment and humility

There is also a quiet, faithful contingent within Biblical Counseling—practitioners who hold tightly to Scripture while drawing thoughtfully from clinical wisdom. They recognize both the limitations of psychology and the risks of reductionist theology. They are often the ones doing the hard work of soul care with discernment, compassion, and restraint—less visible in the public discourse, but deeply trusted in the lives of those they serve. Their voice is needed not just in the counseling room, but in the boardroom, in training programs, in conference keynotes, in organizational leadership.

Our brothers and sisters deserve care that reflects both the God who inspired Scripture and the God who has gifted us with insight to alleviate suffering. By aligning Biblical wisdom with evidence-based care, we reject false dichotomies and embrace faithful stewardship of all God has provided.

Reflections on Biblical Counseling and Mental Illness from a Believing Psychiatrist- Short Version

Over the past decade, I’ve engaged deeply with pastors, Biblical Counselors, and church leaders to understand how faith communities care for mental health needs. Recently, while preparing to launch Innkeeper’s Care—a psychiatric practice designed to support faith-based organizations—I’ve had extended conversations with clergy and counselors. My goal has been to explore both current offerings and the philosophies behind them.

Most counselors I’ve encountered are sincere and committed to honoring God while caring for others. Models vary: some churches outsource care; others keep it in-house; and many combine efforts with outside referrals. But messaging from some Biblical Counseling institutions paints a troubling picture: psychiatry and psychology are often portrayed as secular adversaries rather than potential allies. This posture has fostered stigma, delayed treatment, and worsened outcomes for Christians with moderate to severe mental illness.

I write not as an outsider but as a psychiatrist and brother in Christ. My plea is for deeper theological alignment with Scripture—one that engages the full reality of mental illness and partners with evidence-based care.

A Lost Partnership

Historically, Christian leaders like Richard Baxter and Benjamin Rush saw no conflict between faith and medicine. But the 20th-century rise of psychoanalysis and later, Jay Adams’ Biblical Counseling movement, reframed psychiatric categories as invalid. This shift, combined with the absence of faithful psychiatrists in many church spaces, widened the divide. Some skepticism is understandable—many pastors rightly push back against over-medicalization and the reframing of sin as disorder. But in rejecting modern care wholesale, we’ve lost the integrative wisdom of earlier generations.

Strengths and Shortcomings

Biblical Counseling is rightly rooted in Scripture and discipleship. Yet a common refrain—“we address spiritual roots, not symptoms”—can become reductionist. When people are drowning in panic attacks or suicidal despair, we must offer more than theological insight. Christ met urgent needs while also addressing heart issues.

Mental illness has recognizable patterns, biopsychosocial causes, and effective treatments. Filtering all distress through a spiritual lens can lead to misdiagnosis, guilt, and delayed care. Some contexts subtly pressure counselees to conform to a theological narrative—a form of spiritual bypassing that burdens the vulnerable.

Theological Inconsistencies

Ironically, while many Biblical Counselors hold to Reformed theology, their methods can resemble charismatic faith healing—implying that repentance or doctrinal alignment will resolve emotional suffering. For those with OCD or major depression, this is not only ineffective but harmful. While charismatics spiritualize suffering through warfare language, some Biblical Counselors do the same by over-assigning blame to doubt or sin.

Scripture is clear: suffering is not always linked to sin. Even Spirit-filled believers suffer profoundly. To suggest otherwise, without evidence, undermines the theology Biblical Counseling claims to uphold.

Misunderstanding Science

Critics argue psychology lacks a biblical anthropology. But psychology isn’t a worldview—it’s a method of observing patterns and responses. CBT isn’t a creed; it’s a tool. Dismissing science as secular misses how God uses common grace through medicine, research, and experience.

Despite years of critique, Biblical Counseling hasn’t yet produced data proving unique clinical efficacy beyond placebo. That’s not a dismissal—it’s a challenge: conduct high-quality studies through partnerships with seminaries and Christian universities. Prove what many believe anecdotally to be true.

Cost, Commodification, and Dangerous Substitutes

Charging for counseling isn’t inherently wrong. But high fees for unproven care while discouraging psychiatric treatment raise ethical questions. A fee-for-service model that ends when the client stops paying is not shepherding.

In the vacuum left by rejecting mainstream care, some Biblical Counseling circles have aligned with the wellness industry—endorsing expensive, untested treatments cloaked in spiritual language. These alliances exploit desperation and erode trust.

A Call to Humility and Collaboration

The way forward involves:

• Distinguishing spiritual issues from psychiatric conditions

• Acknowledging biopsychosocial contributors to suffering

• Embracing legitimate medical science as complementary to Scripture

• Creating protocols for early referral—not after months of failed care

• Partnering with psychiatrists who respect theological frameworks

• Avoiding dual relationships and maintaining accountability

Faithfulness to Christ means stewarding all that God provides—including scientific insight. True Biblical Counseling must retain its theological rigor while engaging modern knowledge with discernment and humility.

Our brothers and sisters deserve care that honors both God’s Word and His providential gifts. The Church must no longer force a false choice between Scripture and science. We can—and must—walk in both.