Mental health

Review: Beyond the Clinical Hour

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A cover image of "Beyond the Clinical Hour" by Sells, Trout, and Sells.

Beyond the Clinical Hour, James N. Sells, Amy Trout & Heather C. Sells. IVP Academic (ISBN: 9781514001042), 2024.

Summary: A proposal for collaborative efforts between mental health professionals and congregations to multiply the resources available to address the burgeoning mental health crisis,

Wherever I turn, I read about the rising incidence of mental health needs for every age group. Every counseling center I know has long wait lists to see a counselor. And clinicians are running hard and face issues of overwork and burnout. And sometimes our unaddressed mental health crises spill into the news in mass shootings, road rage, or people who died “unexpectedly” or of “undisclosed causes.” More quietly, millions struggle with depression or various forms of anxiety that sometimes constrain the full expression of their gifts.

The writers of this book contend that the mental health crisis is far outstripping the available resources of mental health professionals and the traditional model of the clinician meeting for 50 minutes once a week with a client (the clinical hour), serving roughly 200 clients in a year. They propose that by collaborating with local faith communities, they can multiply the resources available to meet this crisis. This can take various forms from consultations with pastors on pastoral care with people with mental health needs to providing or supporting facilitation of various support groups, to working with churches to set up “para-professional” care ministries with trained and supervised volunteers. In the latter model, clinicians might scale back their own caseload to work with such ministries, multiplying their own efforts.

They address a concern raised in churches with how “Christian” counseling is. The second part of the book addresses integration. The authors propose a “thick,” embodied type of integration where theology is relationally fleshed out. They begin from a trinitarian base of what it means as counselors to be attached to the Father (coram Deo), Son (Immanuel), and Spirit (Paraclete) and then to draw upon one’s clinical training to most effectively care for people. They advocate for training that fosters both theological acuity and clinical excellence and is embodied in hospitality, justice, and compassion.

The third part of the book addresses how a collaboration with the church can thrive, avoiding the result of well-intentioned but poorly trained and supervised people doing harm in the name of good. They elaborate the theological foundations of Christian care and delineate what is necessary for good oversight of church counselors. The growing field of consultation and the various ways from informal consultation to workshops and training to planning and consultation to set up church-based programs of mental health care. They introduce practices of church development and program development–extending mental health to the corporate life and mission of the church. And they discuss both the economics of creating sustainable programs and ethical standards that should govern all such efforts.

I missed any discussions of legal liabilities and legal compliance issues. Perhaps these are too specific to address in this book but it seems they might be acknowledged. I also wondered if there might be some scaling of what sorts of collaboration might be possible for churches of different sizes. It seemed to me that some forms, like a church-based, trained “para-professional” counselors staffing a care ministry would necessitate a congregation of some size and financial resources whereas informal consultation arrangements might serve smaller congregations well.

The authors of this work offer an intriguing proposal. We just can’t train enough professionals fast enough to meet our current mental health crisis. But there may well be a hidden resource in the church and the possibility of collaborations that both multiply the efforts of clinicians and enhance the ministry and mission of congregations. They offer enough stories of examples of where this is happening to make the case for exploring these possibilities more widely. And might such a collaboration renew the church’s ancient practice of the “cure of souls” bringing both theological and psychological insight into this honored calling?

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Disclosure of Material Connection: I received a complimentary copy of this book from the publisher for review.

Review: On Getting Out of Bed

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On Getting Out of Bed, Alan Noble. Downers Grove: InterVarsity Press, 2023.

Summary: Written for those whose experience of life or mental state make even getting out of bed a challenge, offering encouragement that even this is courageous and testifies to the goodness of God, and of life.

What’s the bravest thing you ever did?…

Getting up this morning

Cormac McCarthy, The Road

This epigraph opens this personal essay from Alan Noble. He writes for those for whom life is hard. It may be the circumstances they face: grieving a loss, dealing with chronic illness and suffering, abuses and injustices, addictions, and experiences of failure. It may be that one is overwhelmed with the brokenness of the world. It may manifest as a mental affliction, either accompanying such difficulties or apart from them, including depression, anxiety disorders, obsessive-compulsive disorders, or panic attacks. Sometimes you just feel blue, or exhausted, or lethargic. And in these circumstances, even getting out of bed is hard.

Noble doesn’t deny the benefit that may come from mental health care. He also acknowledges that it doesn’t always readily change things, as important and as valuable as he believes it to be. For him it still comes down to a choice that we are able to make: to get out of bed. The question sometimes is having good enough reasons to do so.

He contends that as human beings, we image the invisible God. Our very existence is good, as is the God who brought us into existence. Our actions, in consequence, bear witness to another. The choice is to get out of bed today. Even though we do not know what the day holds, getting out of bed is a decision to live and to attest that life is worth the risk. It is an act both of worship to God and witness to others.

To get out of bed is to do the next thing, not to just to keep existing, but to be faithful to God as we do “whatever good work He has put before us.” It also means recognizing that how we are feeling doesn’t excuse our responsibilities to one another, which includes the support of others who struggle to get out of bed. We help each other.

He honestly faces the reality of suicidal ideation, and without condemning the decisions of those who have chosen not to live, he contends that while we may not be able to “snap out of it,” “it does mean that for Christians who understand that the preservation of our life is an essential act of God’s love for us. suicide is not an option we can entertain” (p. 52). With the apostle Peter, he proposes that it will not always be so bad and that God will “restore, confirm, strengthen, and establish you.” Meanwhile, we get out of bed.

And what about the times when we still can’t? The call is not to keep our struggle private, but to share it with those who love us. Sometimes, when our minds are not working right, we need others who see things better than we. And we need to trust them.

Noble, while not disclosing his own psychological history, plainly shares out of his own struggles to get out of bed at times. His own vulnerability both de-stigmatizes the struggle, and lends credibility to his call to take the next step of getting out of bed. His honesty about both his own and others struggles let us know that if we’re in this space, we are not there alone. And his account, as powerfully as any, attests to an underlying goodness of God, and the goodness of what God has made. His use of key passages in Cormac McCarthy’s The Road, effectively underscores the conviction of life’s goodness that keeps us getting out of bed.

This is a book that honestly faces despair without wallowing in it. It points us to the best thing we can do in such times, which is to simply get up, put on the coffee, get dressed, and step into our days, believing we will be met there by God and his people.

For anyone struggling with thoughts of suicide or who is concerned for someone or needs emotional support, the 9-8-8 Suicide and Crisis Lifeline is open 24/7. The call is free and confidential.

Or, text HOME to 741741 from anywhere in the United States, anytime. Crisis Text Line is here for any crisis. A live, trained Crisis Counselor receives the text and responds, all from a secure online platform.

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Disclosure of Material Connection: I received a complimentary review copy of this book from the publisher.

Staying Intellectually Fit — Five Practices

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One of the challenges of entering one’s seventh decade is staying physically fit and supple. I hear a good deal about core strength, flexibility, healthy diet,and cardio-vascular health. Truth be told, I could be doing more in some of these areas, but that’s for another post!

Source: jonathankurten.com

Source: jonathankurten.com

An aspect of life I hear much less about is staying intellectually fit. Here are some thoughts that might parallel some of the practices we pursue for physical health.

1. Work out with somebody else. What I have in mind here is that people decline mentally as well as physically when they are isolated. Pursuing some mentally engaging activity with others — whether a book group, a painting group, a choral group (all pursuits of mine!), or some other interest group that involves people and conversation — all that can help keep us mentally fit.

2. Healthy diet is important for our minds as well. A little “mind candy” is probably something all of us indulge in. A steady diet of “mind candy” might not be so helpful. A balanced intellectual diet might mean not getting all our mental stimulation from one source, like the television, or graphic novels. Mixing that up with books, discussions with friends, and different perspectives are all important. I would also suggest not being a “junkie” in any one area–particularly a news junkie! That seems to me to be a prescription for depression.

3. Are you developing your “core strength”? What I take this to mean is cultivating the core convictions and practices around life’s most basic issues, whatever those might be for you. For me as a Christian, this involves things like prayer, reading of scripture, self-examination, and the regular practice of gratitude. “Core strength” seems to me critical to navigating the challenges of getting older and those who haven’t addressed this sometimes spend their later years very badly and unhappily.

4. Attending to our mental “cardio” health seems vital as well. We can experience a “hardening” of our thought life when we nurse bitterness, anger, unforgiveness, or resentment. Similarly, I’ve watched people develop skewed views of reality where they worry themselves about conspiracies, rivalries, or killer bugs on every surface. All this impinges on how we think and hear the ideas of others. Mental “cardio” involves letting go of anger and bitterness, and, at least for me, trusting that I will live as long as God wants me to and realizing that worry will probably only shorten my life, not lengthen it.

5. Mental flexibility is another quality that sometimes seems to deteriorate with age. It is easy to begin to think in ruts. After all, it took us six decades to get to where we are, why change now? One thing I try to do is replay those mental tapes from when I was in my 20s that said, “I never want to become an old ‘stick in the mud'”! All of us knew people like that. The question is, are we becoming like that? Some of this is trying new things–for me this has been in the area of art. I still don’t think I have much artistic talent, but drawing makes me see things differently, and that is good. Do you just read the writers who agree with you or get all your news from one news outlet with a particular perspective? While disagreement can be uncomfortable, it also enlarges my view of the world and at very least helps me see why someone could see things so differently than I.

You may have thought I’d be trying to tell you to read lots of books! While I think books have a place in intellectual vitality, I think it goes far beyond books to a healthy lifestyle of intellectual fitness.

How have you sought to foster intellectual vitality in your life?