Christians and psychotherapy haven’t always had the best relationship. Growing up as I did, adjacent to cultural fundamentalists, I absorbed the following dominant assumptions:

• You don’t need counseling if you have Jesus.
• Counselors disapprove of homeschooling and Christianity and might want to take you away from your parents.
• The only good counselor is a Christian counselor (and even then, how do you know if they’re Christian enough?)
• Depression, anxiety, and pain will go away if you pray hard enough.

Then I earned my Bachelor’s degree in Family Psychology and my Master’s degree in Counseling. I became a state-licensed counselor. And along the way, I realized how destructive these assumptions are to men, women, and children who have been brought up to believe them.

I have had people come to me in whispers and in tears, asking if I thought they lacked faith because their pain wasn’t going away. I’ve also experienced people, in the wake of the recent Duggar scandal, saying that they believe counseling makes things worse because you just go over and over the same thing, reopening old wounds. I’ve further heard statements that equate reconciling with your abuser to a state of being fully healed, when that is actually something an individual has to decide for themselves. And, I’ve seen “counseling” used as a label for everything from actual mental health counseling to hard labor camps and victim-blaming.

Which is why I have three objectives today:

1. To define the word counseling within this subculture in all its incarnations, promoting a higher level of clarity in the discussion of healing from sexual and spiritual abuse.
2. To identify potential paths of healing for those who are hurting, and for their friends and family, who want to know what recommendations to offer.
3. To begin a dialogue on standards for helpful and appropriate counseling methods for effective healing for sexual abuse within the cultural fundamentalist (or ex-cultural fundamentalist) community.

Counseling, no doubt, is a difficult thing to conceptualize. But we have a starting point, courtesy of the American Counseling Association, a nationally recognized authority on professional counseling standards. In a meeting with delegates from 31 different counseling organizations, the following definition was agreed upon. “Professional counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.” (http://www.counseling.org/about-us/about-aca#sthash.HgG8W5G4.dpuf)

In other words, counselors work with what you want to be different about your life and help you change it.

People who call themselves counselors come from all different backgrounds and levels of experience. To determine which person is the right fit for your needs, you will want to look into two pieces of information: their education level and their license or certificate to practice.

• State-licensed counselors have a minimum of a Master’s level education in counseling, including core courses such as human development and theories of counseling. They may also have a Ph.D. or Psy.D. in Counseling or a related discipline. In order to qualify for state licensure, they must have passed a knowledge-based exam and an ethics (jurisprudence) exam. They must have also completed a certain number of hours practicing counseling under supervision by a specially-trained counselor supervisor. While each state varies in its requirements, to the best of my knowledge the minimum number of hours required is 1500, and the most I have seen is 4500. In order to remain licensed, a counselor must complete a certain number of continuing education credits every so often, including education in ethics. For my state of Texas, I had to complete a 3000-hour internship and now must maintain 24 continuing education credits and take a jurisprudence exam every 2 years.
• Licensed marriage and family therapists have very similar requirements, but their education is based more in studying the dynamics of family systems and treating the family as a whole. Counselors can be dually licensed as marriage and family therapists and licensed professional counselors.
• “Interns” or “Associate counselors” are counselors-in-training who have graduated from their Master’s or Doctoral program but are still completing their requirements for state licensure. Some of these interns and associates can be quite competent and may be a great option for those who need to stay within a budget. Ask these (and all) counselors about how long they have been practicing as a counselor and their experience working with survivors of spiritual abuse and sexual assault.
• Psychologists have doctoral degrees in psychology but may or may not be practicing counselors. They can also pursue positions in research and teaching, among other things. Licensure as a psychologist is also done at the state level, and requires a period of supervision.
• A psychiatrist is a medical doctor (M.D. or D.O.) who has been through medical school and completed a residency in psychiatry. They are not automatically trained in counseling; rather, their training focuses on dispensing medication for psychiatric (mental) illnesses. Some residency programs do train their doctors in counseling, so it’s important that you ask about each individual’s experience with the counseling aspect, as that requires an entirely different skill set than prescribing medication.
• Pastoral counselors have advanced training in ministry and psychotherapeutic techniques. Properly, they have licenses from the state as well as spiritual training and competency. Since this designation can be co-opted by lay counselors without the appropriate level of training, I encourage you to rely on the definition and recommendations of the American Association of Pastoral Counselors, though they are not a licensing agency of themselves.
• Christian counselors (not used here to refer to licensed counselors who integrate faith into their treatment), sometimes also called Biblical counselors,  have been through some type of certification program. These programs are largely unregulated and they vary in competency. This certification is usually based on completing large amounts of reading in approved theological texts and providing recommendations from pastors or elders.
• Nouthetic or (strict) Biblical counselors believe that all counseling should be based in the Bible and on Biblical principles. In my opinion, the “counseling” orientation represented in the article There is No Victim: A Survey of IBLP Literature on Sexual Abuse (https://www.recoveringgrace.org/2014/04/there-is-no-victim-a-survey-of-iblp-literature-on-sexual-assault-and-abuse/) represents Nouthetic or strictly Biblical counseling, which tends to support the assigning of personal responsibility to all parties involved.

The different types of counseling practiced by these individuals is too varied to represent completely here, but these are a few of the ones you are most likely to encounter and potentially benefit from:

• Cognitive-behavioral counseling (my preferred theoretical orientation, so note the bias I have) purports that we can find healing by adjusting any one of an interrelated triangle of cognition (thought), behavior (action), and affect (feeling) the remaining two points can be improved as well. For example, by gaining a better understanding of the fact that you are not to blame for your own sexual abuse (thought) you stop accepting blame (action) and experience less shame and guilt (feeling).
• Eye Movement Desensitization and Reprocessing (EMDR) is a specific type of treatment for survivors of trauma that involves having the client focus on specific traumatic experience while the therapist walks them through different stimuli such as eye movements and tapping. While I do not personally practice EMDR and thus cannot speak with experience, EMDR has been subject to peer-reviewed research and, to the best of my knowledge, can have significantly favorable results for trauma survivors.
• Group therapy ideally consists of 6 to 8 fellow sexual abuse survivors, either in fairly similar circumstances and background, or intentionally of different backgrounds and genders, to provide a different therapeutic experience. While this can be difficult due to the potential of feeling triggered by others’ experiences, it can also normalize your experience, reducing loneliness and shame. It may be necessary and appropriate for you to receive individual counseling before and/or during the group therapy experience.
• TF-CBT (Trauma-Focused Cognitive Behavioral Therapy) is a newer but promising form of traditional cognitive-behavioral therapy that focuses on teaching coping and relaxation skills, and working with parents and children together. To find a certified TF-CBT therapist, visit http://www.tfcbt.org/.

Now you know who you might see in the role of a counselor and what kind of therapy you might want to pursue. But that doesn’t tell you yet what might go on in the counseling office, and it can be intimidating not knowing what to expect. So here are some things you can probably expect your therapist to do while you are in session with them (individual experiences will of course vary):

• Actively listen to you: Your counselor will try to absorb the full range of the messages you are giving them throughout the session, noting body language, tone, context, and more.
• Reflect your feelings or message: Your counselor will try to demonstrate their  understanding of what you are going through by reaffirming back to you the main points of your message (content) or the main feeling(s) you display. Accurate understanding is verified by saying, “Did I get that right?” or “Would you add to that?”
• Re-frame your experience: Your counselor might take an experience that you have had in one context and put it into another context for the purpose of your greater understanding of your own experience, or understanding of your experience from an outside perspective. For example, a sexual assault survivor who has blamed herself for not reporting the abuse may feel freer upon exploring the oppressive nature of her environment which made it nearly impossible to talk about what happened to her.
• Allow you to express emotion in silence: Your therapist may use silence to provide a supportive and non-judgmental environment in which you can be free to express the things you usually must censor around other people in your life.
• Educate you: It might be appropriate for your therapist to share with you facts about sexual abuse survivors, the nature of trauma recovery, the habits of sexual predators, or other relevant information to clear up misconceptions and assumptions.

Speaking of misconceptions to clear up, let’s talk about some potential “junk” you might have in your mind from your experiences with cultural fundamentalism, even if you are no longer in that world.

You might have heard:

• Christians don’t need counseling because they have Jesus. When our car has issues, we take it to a mechanic. When we’re ill, we visit the doctor. Mental health therapy is not designed to eliminate or replace your faith (or lack of faith, if that is the case for you.) Instead, it helps you get better understanding of the past so you can change your behavior, feelings, and thoughts in the present and experience a future in line with your goals for yourself. It says absolutely nothing about the state of your own faith journey if you choose to take advantage of the tools of counseling.

• Counselors might take my kids away from me. Counselors have no power to take your children from you, even if we wanted to, which most of us don’t. That’s because we know it’s hugely devastating to the child and we don’t want it to happen unless it’s truly better for the child to be in a different environment. Regardless, that’s not our call to make. We are legally required to report all incidences of confirmed or suspected abuse of children, the elderly, the mentally disabled, or someone else who cannot speak up for themselves. If that happens, we will make a report to Child Protective Services, who will follow up on it through their own process. It’s always possible that a good family could be unfairly penalized in this case. But I can tell you from the many cases I have had to report, these people hear the worst of the worst. It’s highly unlikely that your child would be taken away from you without some pretty serious and substantiated abuse claims.

• If you don’t see a Christian counselor they will disrespect your faith/you can’t get anything from them. No good counselor should disrespect any faith, period. If you want your counselor to pray with you or use Biblical teachings, then seek out a pastoral counselor as recommended above. Psychology is a “soft” science, so it’s not completely objective. But we learn techniques and tools that can help you regardless of what your faith is.

If you or someone you love has experienced sexual abuse, you should know that the survivor (not victim — just because you were victimized doesn’t mean that you stayed there!) has the right to decide for him- or herself whether or not they want professional counseling. A survivor should also know that it’s okay to do so on his or her own timetable. You will know when you’re ready if you open yourself up to the possibility. If finances are an issue, many times the local rape crisis center offers free counseling to the community, so no one who needs it should have to go without.

Counseling is not a shameful option, and it is not an un-Christian option. It is a way to empower you to accomplish your goals in mental health, wellness, and more. If you’re reading this today and think you might benefit from counseling, contact RAINN.org for the name of your local rape crisis center, reach out to Recovering Grace and ask for a counselor recommendation, or use the Find-A-Therapist tool (https://therapists.psychologytoday.com/rms/?utm_source=PT_Psych_Today&utm_medium=House_Link&utm_campaign=PT_TopNavF_Therapist) to view profiles of counselors in your area.

I’d also enjoy hearing from you in the comments below or via email at [email protected]. Please note that email is not a secure form of communication, so please do not share intimate details that might compromise your privacy.

Counseling photo copyright: lisafx / 123RF Stock Photo