Oct 15, 2018
Counseling Students – When to Refer?
Rick Whitlock provides excellent guidance for counseling students as a campus minister and when to refer them to others for help.
We now live in an era when it is well-attested that there is a “mental health crisis” sweeping across universities in this nation1. Between 1992 and 2002 at 11 large midwestern universities, visits to university counseling centers rose 42%. For the past 10 years about 90% of counseling center directors believe they are treating an increasing number of students with severe pathology. At many schools, including Purdue University where I minister, the demand for counseling and psychological services has dramatically outpaced the capacity and availability of the university’s counseling center. Anxiety and depression rates have increased substantially. And while students’ struggles with mental health has been capturing headlines, recent studies also suggest that university staff are also succumbing to increased stress-related issues due to the relentless pressures of research and teaching expectations.
How can campus ministers most helpfully engage in the myriad mental health struggles on our campuses?
In a previous article “Are Campus Ministers Counselors?”, I argued that campus ministers have a vital role to play in counseling students through the trials and difficulties of their lives. Our primary counseling role is not to give good advice, fix our student’s problems or act as therapists, though all this is appropriate at times. Our primary counseling role is to reveal the whole counsel of God (Acts 20:27) — his plans for the fullness of time to restore us and the world from the persistent pains and problems that result from living under sin (Psa. 33:11; Eph. 1:9-10). Our first counsel is to connect students to the story God has revealed in Scripture, the pages of which recount the gracious plan of God accomplished by Christ on the Cross and applied to our hearts by the Spirit.
I quoted Pierre & Reju’s orienting question as we seek to minister: “What does faith in Christ look like in this person’s troubles?” We can always start there with any problem. But I suggest we go further and also ask: “And how can I best help them walk by faith in these troubles?”
Asking the second question opens us to self-reflection on our stock answers about how faith works and how the pain, problems and pressures can be resolved. That is, all Christians have an answer they consider as the standard understanding of how people heal, grow, and change, and this answer is, implicitly or explicitly, linked to our stock answers about where counseling does or does not fit within our theological and ecclesial framework.
One of the major challenges we face today is the multiplicity of views on counseling in the church. At the risk of over-generalizing, there seems to be, as pastor Tim Keller has written, churches that have “uncritically adopted secular models of counseling based on the expressive individualism of the Enlightenment and modern romanticism” while, in reaction, other churches have insisted “that strong preaching and exhortations to repentance and obedience will suffice to help people with their problems” and have therefore disregarded counseling in shepherding God’s people. Essentially, on the spectrum of counseling views, there are churches and Christian counselors that either express too little Christian distinctiveness (and therefore rely on psychological theories and techniques) or too much Christian simplism (and therefore rely on simplistic Christian understandings of and calls to repentance).
Amy Simpson, an editor at Christianity Today, writes that “in general, the church tends to handle mental illness in one of three ways: ignore it, treat it exclusively as a spiritual problem, or refer people to professionals and wash their hands of their trouble.”
Taking Keller and Simpson collectively, we might see that views of counseling and views of people go hand in hand. We can ignore the complex problems our students bring up; we can treat them as simply needing repentance and belief to cure their struggles; or, conversely, we can risk sending them the message that the gospel isn’t powerful enough to help but professional counseling is. However we respond, we respond as God’s people, his church, his ministers, and we and we want to show the Gospel message is God’s power of salvation and that growth in our salvation (1 Peter 2:1-3) takes into account every aspect of our life and the whole church body.
Without spelling out a full philosophy of counseling, I’d like to argue that what we need is biblical balance. For all good theology is practical and keeps us from unhelpful extremes:
- Do we tend towards only spending time making leaders of well-qualified and healthy students but ignore or farm out troubled students to others?
- Do we tend to think that since sin is our root problem that repenting from personal sin is the solution to most troubles without taking into account that people are not just sinners, but sinned against?
- Do we tend to empathize with those who are victims and sinned against but struggle to help them repent of personal sin and take full responsibility for themselves?
So, first, we have to understand our role as campus ministers (as relayed in the previous article). And, second, we have to take stock of our stock answers and approaches to providing help to students by asking whether our methods are truly matching the message of Scripture. And, third, as a result of knowing our role and growing our understanding of how our Christian faith intersects with counseling, we have to know when we are in over our heads in helping students in this climate of mental health crisis.
The Scriptures seem intent on showing us that we need one another within the church and that various gifts are given within the church body in order to build the body up in truth and love. This opens the door for Christian ministers and pastors to utilize the gifts found in their local church body or the broader church universal to shepherd the flock towards the substantial healing and growth that is available in Christ.
On the very first day of this Fall 2018 semester, I received a phone call from some other campus ministers asking about how to handle the suicidal ideation of an international student who’d experience a difficult breakup. I’ve also spent the past several years helping students who experienced childhood sexual abuse. And those challenged by eating disorders. I seek to apply the Gospel to these scenarios with them over time (and that may be for another article). But in most cases, even as I am a trained counselor, I still seek to create a network of helpers for these students. It allows me to maintain my role of being a campus minister and to not carry the emotional weight of their struggles on my own.
So when should we begin to utilize the resources of the broader body of Christ to refer students?
1. Feeling Stuck.
If you are starting to feel dread or frustration at meeting with a student because you feel that you are either (a) going to have the same difficult conversation yet again or (b) consistently worrying that you lack the training or ability to handle the depths of their struggles, it’s time to consider referring to others who can help you and your student become unstuck in the conversation and provide a level of skill or ability for which you haven’t been trained.
2. Recognizing Signs.
If you are recognizing signs of anxiety, depression, eating or sexual disorders, or any number of feelings and behaviors that you don’t know what to do with, it’s time to consider referring. It may even be that your student knows the God and the Gospel, and that makes this even worse for them, because they believe simplistically that because they know God all their other symptoms will go away. They need a minister who keeps graciously and patiently showing them that God’s love is present even when our obedience isn’t, but also a counselor who can specifically address their addictions, habits and behaviors.
3. Experiencing Disruption.
If a student is disruptive to your meetings or groups, and is disruptive to their own schedule, relationships, classes, and learning, it may be time to refer. A trained professional is often able to suss out the particular underlying conditions that contribute to your student’s impulsive, compulsive, self-destructive or self-sabotaging attitudes and behaviors. Encouraging them to contribute to your body of believers may mean asking them to spend some time outside that group with a counselor whose job is to play a very particular role in that student’s life so that all their friends and family don’t have to.
So how should we begin to utilize the resources of the broader body of Christ to refer students?
1. Talk with counselors, psychologists, and pastors.
Talk with counselors who are trusted in your area or by your church. Schedule an appointment with them to ask them about their specialties and how they’ve helped others. Bring a list of the struggles you see in students and see if these counselors can describe a wise plan for working with people in these various conditions and troubles. Have a counselor come to your large group to provide introductory teachings on anxiety and depression and suicide and what can be done about them. Ask pastors your know in your area who they refer to and when they do so.
2. Have an up-to-date referral list.
At our campus ministry and church we have readily available lists of places to refer to, particularly in a crisis. We will give out the addresses of a couple local hospital emergency rooms that are particularly equipped 24/7 to do psychological assessments. We refer to a walk-in mental health and addiction treatment center that will help formulate plans for patients. We have counselors we refer to in the community and at the counseling and psychological services at the university. We all save the national suicide prevention lifeline in our phones (1-800-273-8255).
3. Talk regularly against the stigma and shame of mental health struggles.
When we normalize the realities of mental health in a broken world and normalize the expectation that many believers struggle and need to seek help, we can work against the stigmas and stereotypes that often attend perceptions of those needing help as weak, crazy, too broken, too sinful. Many students feel great shame about their persistent and uncontrollable struggles. As participants on our college campuses, campus ministers have the opportunity to spread Christ’s compassion by how we speak to and handle the mental and emotional worlds of our students. While we wouldn’t wish for anyone to experience mental and emotional health struggles, we also wouldn’t wish for anyone who does to experience such things alone. One of the great battles in mental and emotional health is the lie that no one else could understand our struggles or that “I must be the only one who feels this way; everyone else seems to have it all together.” But our Christian understanding of sin and its results (the brokenness of the Fall) tell us that no one has it together and even those who are doing well are in danger of trusting in their own efforts or success rather than the gracious compassion of Christ in saving us from ourselves. As the body of Christ, the last thing we are to be is fearfully distant from those who struggle or left to struggle alone. “Bear one another’s burdens, and so fulfill the law of Christ” (Galatians 6:2; cf. Romans 15:1; 1 Thessalonians 5:14).
4. Talk regularly about the ministry of the whole body of Christ.
Just as we can normalize our students’ expectations that every one of us needs various forms of help and any number of us will experience mental health difficulties, we can also normalize our expectations that God has gifted the whole body of Christ for the work of the ministry and helping one another, not just those of us who are pastors or campus ministers. There are others God has gifted to extend his compassion and healing in very particular ways.
5. Start a counseling fund for your ministry.
It may seem like a burden to raise more money, but this is one that is worth it. If you could help alleviate some of the financial strain for your students by offering to pay for the first three sessions or subsidizing their counseling fees for the semester, it goes a long way towards showing them that you are in their corner and on their side, and that you have skin in the game, too. And not just so they’ll behave better but so they’ll be cared for. I personally was helped by a counseling fund that paid for some of my initial counseling sessions when I was in seminary, and I’m forever grateful.
6. Partner with the Office of the Dean of Students and university counseling centers.
Depending on your relationship with the university, this may seem tricky. At Purdue we are fortunate to have a great relationship with our university’s president and office of the dean of students (ODOS). But even if that is not true in your case, seeking to partner with the ODOS might demonstrate to them that you care not just about getting students into your ministry but about the health of the whole campus. Many university administrators are hungry for and happy to have any additional help that can support the well-being of their students. This may just be one more way we can be salt and light.
7. Read books and articles on addressing mental health.
A great article to start with is the one by Tim Keller mentioned above — “Four Models of Counseling in Pastoral Ministry.” Some good books to start with include Jeremy Pierre & Deepak Reju, The Pastor and Counseling: The Basics of Shepherding Members in Need (2015); and W. Brad Johnson & William Johnson,The Minister’s Guide to Psychological Disorders and Treatments, 2nd Edition (2014). I can also make a number of other recommendations based on specific needs or to go deeper into an understanding how theology, psychology and spirituality integrate.
8. Get counseling yourself.
There’s nothing quite like humbly admitting you’ve got your own unresolved problems, difficult past, and ongoing pet sins. Evidencing a lack of fear and a full heart of faith that God calls us to journey ever deeper into our inner heart realities in order to give them over to him can be a gift not only to you but to your students by showing them that you, too, can benefit by understanding your own health. We all need to grow in grieving and forgiving sins against us, and repenting of our own sins, and seeking the health of your marriage, family, and own emotional health. Sometimes I tell my students that I’ll give them the gift of going second — I’ll share what I’ve learned by working through some of my own pains and the past before asking them to be so vulnerable. It’s often an relief to them to know that they aren’t alone in their struggles and that help is out there.
1For students to have a mental health crisis, they have to have experienced an emotional or stress-related problem within the past 12 months that significantly affected their well-being and/or academic performance