David Murray and Bob Kellemen Interact about Depression
A couple of days ago, my friend, David Murray posted: I’m Thinking about Going to the Doctor for Depression Meds.
Since then, being friends, David and I have posted comments on my blog and David plans to blog a response to my response (which I look forward to reading and learning from).
Since blog comments can get lost in the shuffle of quick blog reading, I thought it would be fair and helpful today to post David’s blog comment and my response to David’s blog comment.
Thanks for interacting with my short piece. I hope this will be a good educational exercise for us all.
I suppose I’m at a bit of an advantage in knowing more of the facts of this particular case over a period of time. Still, I think we’re probably about 80-90% agreed on the possible ways forward.
Just one little factoid: I did ask him to discuss more than anti-depressants with his doctor. “Tell the doctor everything – don’t hold back, don’t minimize, don’t play it down – just tell exactly how you are feeling.”
I deeply appreciate your supportive words about medications. They cannot be repeated often enough. I just wish that everyone’s experience of encouraging church and counseling environments was the same as yours.
You’re right, there was a context-specific reason for the wording of my para on side-effects. From what I’ve seen the side-effects are most marked in two situations: (1) When meds are all people rely on and do nothing else to improve their overall physical, mental, spiritual health or (2) People are taking meds who don’t actually need them. There are other scenarios, of course, but these are two disasters waiting to happen and account for a lot of the med side-effects statistics.
I’m kind of surprised that you see CBT as the “major” area of disagreement between us. I could perhaps understand that if I was proposing CBT as a comprehensive therapy. However, I’m pretty sure I made it clear that this was only a part of a holistic approach that included the body, the mind, the soul, Christian friendship, pastoral counsel, and church worship. I do not believe CBT, even Christian CBT, is comprehensive, but can be part of a comprehensive package of holistic care. I think any fair reading of my piece would recognize that.
I hope to post a fuller explanation of this at my blog tomorrow as I fear you are beating a bit of a straw man here. In fact maybe two straw men – (1) CBT as the only solution and (2) CBT as antichristian. I did not propose (1) and I don’t believe (2) is true.
I probably should have included a recommendation to seek out a biblical counselor. However, that was not available to me in this situation. Also, I have not found many biblical counselors who are good practitioners in changing the kind of thinking patterns that I had in view here. They are good for many, many human problems, including some aspects of depression, but there are areas of anxiety/depression that I’ve found need a few sessions of specialist help and can have hugely beneficial impact not just in the short-term but in building new habits of thinking and acting for the long-term. Nothing spooky here! Just well-trained and experienced practitioners who have helped many to see themselves and their world more truthfully and realistically.
You know I love your own holistic model – which you summarized on your blog – and I use it to train my own counseling students. I continue to learn a lot from you, Bob, and hope you can see that I’m striving after that comprehensive compassionate care that we both believe is nothing other than biblical Christianity.
Thank you for interacting with my post about your post. I look forward to your follow-up blog post.
When I first saw your post, it raised the two concerns I highlighted in this post (concerns especially for the reader who was struggling with depression): 1.) Is it compassionate to omit the side-effects and efficacy of anti-depressant?, and 2.) Is CBT, with a non-Christian or Christian counselor the best, most comprehensive, Christ-centered, gospel-centered counsel to recommend to a depressed person? (I did note in the post that your overall approach emphasized a comprehensive focus; so my concern was and is about CBT as the therapy of choice.)
But I had no plans to post a public response or even a comment response on your post. You know my commitment to “a positive presentation of biblical counseling,” which typically leads me to avoid public disagreements…especially with a good friend like you.
However, a significant number of people contacted me asking me for my thoughts, my response, etc., because they had the same two concerns. And most of those people who contacted me either had struggled with or currently struggle with depression. They in particular were concerned about what felt like a pejorative “shot” at those who have concerns about meds side-effects and efficacy (your “opposition to medication” comment). And they in particular had concerns about your recommendation for CBT with a non-Christian or a Christian counselor. So, I reluctantly penned this post. Most posts take me an hour at most. This one took me a good 8 hours over the course of several days. I wanted to be that careful to be fair and balanced in my response to you.
I’m sure that in your response to my response, you can make a case for your compassionate and comprehensive focus. I tried to make that overall case on your behalf. I guess my question to you would be, “Do you see how your comments about those who oppose meds and your comments about non-Christian CBT could cause concern for some people struggling with depression and for people committed to biblical counseling—compassionate and comprehensive soul care?”
Trust me, I get it about blog posts—we can’t say everything in the less-than-1,000 words you used in your post. I saw my post not as “anti-your-post,” but as providing additional context to support that parts of your post (the 80%-90% agreement you note) that I could cheer on!
Perhaps another way of saying this is, “Could you see that there may have been 10% of your post about this significant issue that could cause concern or some confusion—not just for other counselors, but for the very people you want to help—those struggling with depression?”
That’s what ultimately led me to post—my concern that someone struggling with depression would read your post and assume that meds have few side-effects and are always effective. And my concern was for someone struggling with depression who would read your post and assume that since David recommended it, CBT with a non-Christian will be something that would support and advance their Christ-centered worldview. You are currently posting much on worldview—another reason your recommendation of a non-Christian CB therapist seemed to me to be a bit confusing a tad inconsistent.
Is it possible that in your desire to encourage someone to get help, there were two pieces of your counsel that might have ended up being a little less helpful…?
One final thought…as you know, I did highlight that your original counsel was person-specific and situation-specific. However, you did specifically say in your post that you wanted your words to be helpful to others and that you added more counsel that went beyond this one person. Given that, I think it is fair for someone to engage with you about whether your public counsel was 100% compassionate and 100% comprehensive… Granted, nothing I say or write is 100% anything!
One aspect of your comment could take not only a blog post, but a book to respond to was when you said that:
“I have not found many biblical counselors who are good practitioners in changing the kind of thinking patterns that I had in view here. They are good for many, many human problems, including some aspects of depression, but there are areas of anxiety/depression that I’ve found need a few sessions of specialist help and can have hugely beneficial impact not just in the short-term but in building new habits of thinking and acting for the long-term. Nothing spooky here! Just well-trained and experienced practitioners who have helped many to see themselves and their world more truthfully and realistically.”
I’m sorry you have not found many biblical counselors who are good practitioners in these areas. I have found many who are. In fact, if we are not good in these areas, I don’t think we are good, compassionate, comprehensive biblical counselors.
That does not mean that every individual counselor is an expert in every area. It does mean that, as Stuart Scott and Heath Lambert’s book, Counseling the Hard Cases indicates, biblical counseling by definition should be able to address the types of issues you mention.
A compassionate, comprehensive biblical counselor should be skilled in the very areas you raise: 1.) changing thinking patterns, 2.) addressing anxiety/depression (see my work Anxiety: Anatomy and Cure as one example, 3.) in building new habits of thinking and acting for the long-term, and 4.) helping others to see themselves and their world more truthfully and realistically.
I believe that biblical counselors do much more comprehensive work than those four areas you outline—but they at least should be able to provide loving and wise counsel in those four areas.
Thanks again for your friendship. And I agree with you—our hopefully somewhat mature interactions could be instructive to many—not just in the content of what we say, but also in the manner in which we interact with each other.
PS: This time my comment/post took about 20 minutes—no “editing,” just my “gut” response to your comments, David.
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