Christian counseling: Nouthetic vs. Biblical

Last night, I spent some time on the phone with my husband’s friend’s sister (aka my former pastor’s sister). We’ll call her Natalie.

Natalie was very sweet and kind, really encouraging and strengthening me by sharing her testimony of faith in God. She suffers from anxiety and panic attacks, which has led her to take Paxil (on and off) for the past 7 years. She says the drug has helped her tremendously and who am I to knock the drug (knowing what I know about Paxil/Seroxat) when she has seen the wonders that it has worked in her life?

I briefly explained my story of depression, history of suicide, and diagnosis of bipolar disorder. Although she couldn’t fully relate, she was very sympathetic and understanding. In fact, our conversation was so fruitful, I ended up taking notes!

Jay AdamsWe briefly touched on the issue of Nouthetic counseling (NC). She has undergone the course and simply needs to be certified. The counselor I currently see is associated with the Christian Counseling Education Foundation (CCEF), which has roots in NC and was founded by the man—Jay Adams—who developed the method. However, CCEF is now known for what is called biblical counseling. The organization has since moved away from pure Nouthetic methods and become more a bit more varied, taking bits and pieces of psychology (and perhaps psychiatry) that line up with the Bible. Adams, disagreeing with the organization’s approach, founded the Institute for Nouthetic Studies and uses the Bible as the sole counseling textbook. According to the wiki entry on Nouthetic counseling, Adams developed the word Nouthetic based on the “New Testament Greek word noutheteō (νουθετέω), which can be variously translated as ‘admonish,’ ‘warn,’ ‘correct,’ ‘exhort,’ or ‘instruct.'”

NC was developed back in the ’70s as a response to the popularity of psychology/psychiatry. Many Christians reject some of the teachings of such popular psychologists as Freud, Jung, Adler, Maslow, etc. Adams’ highly successful book, Competent to Counsel, criticizes the psychology industry and counters its teaching with a Nouthetic approach.

But NC has its Christian critics.

Natalie said that while she enjoyed the Christ-centered foundation that the method is built upon, the Nouthetic method is vehemently against psychiatric medication. Even one of the oft-cited passages on depression in the Bible, Elijah’s experience in I Kings 19, is dismissed as mere “pouting.” NC takes the approach that much of mental illness is a product of a person actively engaging in sin and the person simply needs to get his or her behavior “right with God.” As a result of this teaching, many Nouthetic counselors believe that no amount of medication can “cure” this kind of sin. I have a friend who suffers from PTSD—he endured a lot of trauma as a child—and his symptoms worsened after his experience with a Nouthetic counselor who simply told him that he was the one in the wrong and that he needed to repent of his sin. Although he currently attends a seminary that strongly teaches NC, he is in the extreme position where he feels that no good can come out of it, even with a Bible-based approach that would include the Nouthetic method.

Blame It on the BrainOn the other hand, CCEF uses a mix of secular psychology and Nouthetic counseling. CCEF comes from the view of not “throwing out the baby with the bathwater.” While they disagree with many ideas of thought in psychology, they choose the ones that line up with Scriptural principles and apply them. An interesting book on mental illness that’s written from this point of view is Blame It on the Brain? by Ed Welch. While many of our problems and disorders may have their roots in sin, we shouldn’t discount physical factors. For example:

  • I’m more likely to have a mixed-mood episodes when I’m severely tired.
  • I often suffer from fatigue and irritability during the middle of my cycle (about 12-16 days in) and toward the end of my cycle (25-28 days in)
  • A total of 6 hours of sleep over the course of 2 days makes me more susceptible to depression, anxiety, and some paranoia.

Those are just a few of the ways that I keep an eye out on the known physical factors that affect me. But I’m sure there are unknown physical factors in play too and they need to be treated as well.

Depending on the person, a pure Nouthetic approach may work just fine but for someone with a complex history like mine, merely telling me to repent of my selfishness and lack of faith won’t work. CCEF’s biblical approach—using the Bible as the foundation for counseling, not as the only counseling textbook—has helped me to:

  • recognize the factors that have shaped me into the person I am,
  • evaluate and root out any pervading sin in my life, and
  • focus on Christ and his work on the cross to “die to self” and become more like him.

First, I revised parts of this post to more away from the word “integrational.” Apparently, it’s a pejorative term that’s thrown around for non-Nouthetic teaching so I wouldn’t want to confuse anyone seeking help who stumbles upon this post.

Second, after rereading this post, I realized that it sounds like a plug for CCEF. The post wasn’t written with that intention but in a way it is. I know how the services that CCEF provides (not only counseling but also conferences, books, etc.) have helped me and this could probably be considered a “customer testimonial.” I haven’t been paid to say anything for or against Nouthetic counseling; this is just an explanation of my experience.

28 thoughts on “Christian counseling: Nouthetic vs. Biblical

  1. If you have any interest in a brilliant Christian woman blogger who is also a Jungian Psychologist check out Third Eve.
    the woman is amazing.
    I don’t know where you get that Jungian theory can be downright “silly.”
    My Jungian analyst is also a Christian.

  2. If you have any interest in a brilliant Christian woman blogger who is also a Jungian Psychologist check out Third Eve.
    the woman is amazing.
    I don’t know where you get that Jungian theory can be downright “silly.”
    My Jungian analyst is also a Christian.

    1. Again,,, not a chance. “My Jungian analyst is also a “Christian.” Who cares? My brother, who just left his wife and children is also a “Christian” pastor. Who cares what they call themselves. You will know them by their fruit.

  3. Hi,
    Interesting post! Thanks for explaining the difference between NANC and CCEF – I couldn’t figure it out, since “biblical” is synonomous for “nouthetic” counseling, to distinguish it from “Christian counseling” – which is integrationist by definition. (Sorry to use that term – but it is. Trying to integrate the secular humanist premise of behavioral psychology with the Bible is impossible, although many have tried).
    There are several nouthetic counselors in my church, and NANC/Jay Adams is popular. I agree with him, and am interested in understanding CCEF better to see whether or not I can endorse their views in a book I am writing on biblical repentance from eating disorders. What I’m not clear on is why they completely discourage meds for all kinds of depression and some conditions that clearly have a physiological base – like PPD, bipolar, etc. These are not spiritual issues (as eating disorders and addictions are). Anyway, great blog. I’ll bookmark it and will be sure to visit later.

    1. CCEF has been perceived as but does not “completely discourage medicine for all kinds of depression”. Check out the 2011 National Conference in Louisville Kentucky at The conferences are invaluable. I have been taking CCEF class for two years and have found the foundation Biblical, balanced and solid.

  4. I’m the PTSD sufferer the poster refers to. I want to clarify a couple of things. I don’t believe no progress can come from nouthetic counseling. I think that, in general, the approach can be extremely dangerous for certain types of people.
    I would consider myself an integrationist. I don’t have a problem with calling sin, sin. However, I’m concerned that nouthetic counselling is very shallow and simplistic in its understading of the human mind, and because of its hostility to secular psychology can miss red flags for very serious disorders.
    I’ve not seen a nouthetic counselor in a formal setting. I know many of them and have some training in it myself. I’ve been immersed in the culture that goes with it and have come to intensely dislike it. However, I recognize there is a spectrum and am less hostile to nouthetic counselors that tend toward integration.

  5. Jay Adams and his nouthetic counselors are woefully ignorant of Christian biography. They must not know anything about Martin Luther’s fight with depression, how open he was about it, and how concerned he was about good pastoral care of Christians with mental illnesses. His detailed description has been called the DSMIV of his day.

  6. How do I get in touch with Gianna? I am interested in her book on eating disorders. Though my daughters underlying cause seems to be depression. I don’t want to overlook the spiritual issues of the illness.

  7. After research it has been discovered that faith based couple and family counseling services are considered to be most effective for saving and restoring relationships. Christian marriage counselors are concentrated on revealing and discussing all aspects of relationship conflict through couples individual therapy sessions and group counseling. This is based on the God’s principle and belies and every one believes in god so this is strongly responsive for behavior altercation of troubled couples and families, which is necessary for developing long-term healthy family and marriage relationships.

  8. I took a Bible College course on nouthetic counseling back in the early 80’s when Adam’s book and teachings were very popular. Since then, I have retired after 15 years as a Police Chaplain, retired from 8 years of prison ministry, and have been active in all sorts of lay ministry activities for 30 years. I have also served in the pastoral office. These years of experience have shown me that no two counseling cases are ever alike …. and the Holy Spirit is the best counselor available to us. Years ago, I adopted a personal counseling method that strongly urges a combination of a complete medical evaluation coupled with a loving but firm nouthetic counseling program. I was Baptised in the Holy Spirit many years ago. The Gifts of the Holy Spirit, when used properly, will root out underlying causes of mental and spiritual illnesses. There have been times when the words of knowledge and/or wisdom, for instance, led me to recommend a physical examination as a first line of counseling defense for the counselee. Those same Holy Spirit Gifts have led me to examine spiritual issues that have affected the counselee’s soulish realm (mind, will, and emotions), when they have tried to deflect those matters onto supposed “physical” causes. My conviction is that a qualified and balanced counselor should never be afraid of the medical community. I see great cause for alarm with the secular psychological community, as these “professionals” simply refuse to acknowledge the spiritual side and can only offer bandaid helps in issues of the soulish realm. They are much more enabling to some clients, more so than in actually leading them to freedom. They have no comprehension or understanding of a human’s spiritual makeup. One cannot have the mind of Christ apart from the indwelling of the Holy Spirit. I am convinced that only in Jesus can we be made free and be made whole people. Jesus has the answers to every emotionally distraught person’s dilemma. That healing power is dispatched through the Word and by the touch of the Holy Spirit upon the Christian’s life. Yes, there are times when medical science must be coupled with Biblical counseling to achieve victory.

  9. Please be aware that nouthetic counseling rejects psychology but accepts psychiatry. Leaders in the field including Babler, Penley, and MacArthur readily acknowledge that there are valid organo-chemical conditions that cause psychological problems and require medical intervention.

    Psychology is based on a humanistic, behavioral-cognitive, or psychoanalytical foundations that are in conflict with God’s word and in some cases the principles of good science. When used in an integrated approach with God’s word they can create some relief in the life of a believer, but it is similar to using a narcotic for a broken arm: The pain is gone but the dangerous condition remains.

    Unfortunately, there is a professionalism gap between christian/integrated counselors who tend to be professional counselors and biblical/nouthetic counselors, who are often church staff or elders and counseling part-time. The individuals in the above article/comments are blaming the approach when the NANC counselor wasn’t even certified in one case and “shallow and simplistic understanding of the human mind”.

    Since God is the design engineer on the human mind and the creator of this world (fallen, yes, but still subject to his divine and perfect knowledge), He and only He know the heart and only his power, exercised through Prayer, the Word and wise counselors (the Church) can correct the heart of the problem.

  10. The relationship between the organic and the inorganic intrigues me. I definitely notice the difference lack of sleep, caffeine and sugar over-use have on me. I certainly struggle more with depression and lust when I’m tired. The thing I’ve done is to take whatever steps I can to control certain variables such as; reducing caffeine and sugar intake and that has allowed me to sleep through the night instead of waking up for 2hrs. (usually from 3ish-5ish). BUT, once I’ve acknowledged the fact that I’m out of balance for whatever reason, I still accept the responsibility for my moods. First, I ask the Lord to reveal any sin in my life and I try to truly repent as He enables. I yield my life; heart, goals, dreams, desires etc. to Him giving a “clean-slate” a “blank-check”. I ask the Lord for help by His grace and mercy; I ask for His power. Instead of blaming my mood on anything else but me I spend more time in the Word, prayer, listening to good Christian music. I ask friends for prayer. I then do what Piper says about joy; I “FIGHT!!!” for it; I CHOOSE it.
    I NEVER want to blame my bad moods on the organic. The inorganic has tremendous influence on the organic but the organic doesn’t have mastery over the inorganic (“I will be not be mastered by anything” I Cor. 6:12).
    So, are there cases of true chemical imbalances that require medication? (I have a brother with very severe Schizophrenia–I know it’s a broad term….) I have to wonder how much demonic influence is involved; I’ve always detected a cruel and evil ‘spirit’ in all his ways growing up. There are many factors that lead me to think that evil spirits torment him and I pray for his ultimate salvation and deliverance. Once I’ve completed this training I intend on talking to my brother and seeing if NC might help him; I realize that his salvation is the top-priority. His medication allows for somewhat coherent conversations and I wonder if it’s possible that if he becomes truly born-again and begins cooperating with the Lord’s sanctification of him if he might be weened off of the meds?
    I am studying NC counseling and am convinced that the Bible is enough to counsel from as a source for all our answers. I think it’s easy to sell God short and not truly avail ourselves of His power and willingness to help.

  11. I believe that any “packaged” counseling approach can be dangerous. The bottom line for me in my 33 years of pastoral counseling is that the word of God is sufficient to address the problems and disorders faced by humanity. Sometimes however, a person just needs a good night’s rest. Sin may not be the issue in every case, so to approach every case as a sin issue is not the answer. Nor is the answer to attempt an integrated therapy approach. If we believe God made us and sustains us, then why would we adopt the world’s assessment?

    Rightly and sensitively applied, God’s Word is effective to heal, transform and restore.

  12. I just came across your post here when doing some reading on “nouthetic”. Great job in the presentation. I appreciate the drift I see in CCEF’s approach to biblical counseling. Have you looked into the Biblical Counseling Coalition? Just google and you’ll find it – I contribute there (very rarely right now) but am to increase in contributions after 2011 surgery.

    Have a blessed day!

  13. Truth Seeker, I totally agree with you. I am a graduating student of NC, an evangelical by birth, pentecostal by experience and a baptist schooled (seminary). As far as my understanding is concerned, It seems to me that my facilitators seem to be disagreeing with medicines for some reasons, but they never totally disagree with medicines. In fact, for many times, they recommend going to medical doctors for an appropriate medicine to take………and so on……..
    Let me just repost the portion of your comment which I am in total agreement.
    The Gifts of the Holy Spirit, when used properly, will root out underlying causes of mental and spiritual illnesses. There have been times when the words of knowledge and/or wisdom, for instance, led me to recommend a physical examination as a first line of counseling defense for the counselee. Those same Holy Spirit Gifts have led me to examine spiritual issues that have affected the counselee’s soulish realm (mind, will, and emotions), when they have tried to deflect those matters onto supposed “physical” causes. My conviction is that a qualified and balanced counselor should never be afraid of the medical community

  14. I’m in agreement with much of Jay Adams thinking on counselling issues, although I will say that I’ve interacted with a few biblical and/or nouthetic counselors that seem to be a bit smug, so full of “the right answers” that they needn’t really spend the time to explore what’s really happening beneath the surface before making a judgement. They seemed to forget that the point wasn’t that “they saw” but that I needed to see too. The impatient almost condescending phariseeism I encountered made embracing the truth seem as if I was embracing something that would harm me not help me.

    From what I’ve gleaned, Jay Adams has spent much time studying to show himself approved, and is a seasoned, mature christian with some humility. It seems as if in the process of educating NC counselors, something is failing to be imparted that cannot be gauranteed by correct answers on the application process and a pastoral endorsement, anymore than a correct doctrinal statement equals a church that in practice fleshes out what the bible describes. One can take all the correct biblical courses they want but the kind of character that makes one a good counselor comes of seeing one’s own sin so well that one is left clothed with humilty and mercy, ie, the hungry beggar telling another beggar where to find food, and not the superior and wise oracle telling an errant twit how to get it right. Biblical confrontation is so important but without the love, mercy and humilty it isn’t very biblical no matter how factually true it is.

    On a different note, the comments about diet ie, sugar and caffeine,have validity. Sugar, I am told, is a few molecules off of resembling heroin or speed in its chemical structure and refined sugar in large doses does affect emotional stabilty. We forget that everything God designed was perfect and good for the purpose of nourishing and balancing our bodies, which form the house of our spirit and a temple for the Holy Spirit. We think of what we eat as a trivia issue more about taste but it has a huge significance. There are foods that lead to death and decay and foods that lead to life, and regeneration. If you eat the stuff in the form God made it, you honor Him by acknowledging that He knew what He was doing and thought the whole thing out in far greater detail than we ever bother with in our lifetime. Don’t believe me? Its taken scientists many years just to begin to understand the complex array of information stored in human DNA! How marvelous. As one doctor put it, food is a drug and your body is a drug delivery system. When the bible says that all foods are to be received with thanksgiving, I don’t think refined and processed stuff, totally stripped of its God given nourishing attributes and loaded with man made toxic chemicals is what is being referred to, but the stuff God made. Its very interesting that anytime I get snared by sin and begin that downward spiral, the foods I gravitate towards are the kind that gratify the flesh (, mind set on flesh = death) and are devoid of real nutrients and quite literally if I continue to consume them, lead to death. In every way, to the minutest detail God’s word is confirmed true. There is nothing, not even what we eat that is spiritually neutral. Counselors would do well to take a second deeper look at how our eating habits not only affect us but can also indicate what our heart orientation really is even if everything else looks good. Well, I have blathered on more than enough, thank you for your kind induglence everyone.

  15. I agree, Counselors would do well to look at diet as part of a comprehensive approach to helping clients. With regard to sugar, it is akin to heroin and just as addicting, even though the addiction doesn’t take hold as rapidly as does heroin. But the results are the same. I know this from personal experience, having become depressed and psychotic due to sugar addiction. Thank God I am now well due to proper diet, counseling, prayer, and vitamin therapy..
    Author Barbara altman
    Cry Depression, Celebrate Recovery

  16. In the NC conferences I have attended in the past few years, the instructors are not saying medication is always bad, but are often used in cases where biblical correction later solved the issue. They teach there are many times the doctors prescribe drugs with little regard. Worldly physicians do not take into account what God has to say.
    The instructors willing talk about biblical correction as well as adjustment to medication, diet, etc.

  17. Either there are Brain diseases which are physiological or there are not. Since the Brain is part of a body in which many physical problems occur that require medical attention, perhaps the Brain can have problems also? The 1% or more of the population who are Schizophrenic have a genuine medical problem. Have a broken leg? I would not recommend going to a Biblical or Nouthetic counselor for talk therapy. Have a broken Brain? Talk therapy will not heal you. Neither will gifts of the spirit or voodoo words of knowledge. We can be thankful for the medical research and studies that have given us many varied medications to aid in controlling Brain disease. Post control success may then be followed by Christian talk therapy and the Holy Spirit intervention with guidance.

  18. Interestingly, PTSD is not a physical problem. There is no discernible change in the brains chemical makeup or processes. The same is true for Bipolar disorder and a great majority of ALL “disorders” that have been invented by the pysco-therapy crowd. There are some diagnose-able chemical and physical problems that contribute to what we would call “mental illness” but for the most part almost all mental illnesses are simply made up.

    As a personal example, a friend of mine was suffering with depression. She saw a doctor and the doctor prescribed some medication. He did not examine her chemical makeup nor did he examine any brain processes. He had no idea whether or not her problem was a physical one or not but nonetheless he prescribed medication to alter her physical state (without knowing what her physical state was) This is unethical practice, but such is the standard practice of our day.

    My church seeks to determine whether or not the source of “mental illness” stems from a physical problem by having patients get a full physical examination. If there are no physical abnormalities, then the problem is most likely not a physical one but a spiritual one, as are 99% of people’s problems.

    Some people justify the use of drugs by saying “these drugs helped me” but the same could be said if a person were prescribed cocaine. A drug that disables a person’s capacity for cognition is not a cure. It’s the equivalent of prescribing a pain killer for a broken bone, it may end the pain but stop taking it and you find that the ailment is still there.

    1. Sufficiency of Scripture has been the solution for hundreds of years. I suppose if they were not sufficient for spiritual and moral guidance, then God did leave and he is guilty of saint neglect.

      American Christians have suppressed the Word of God over the last few decades, so much so, that they do not tolerate hearing the truth about their sin so the culture has morphed most of them to believe that they need psychology and psychoactive meds to be sanctified. They do not believe that Scripture us sufficient. It is just another deception from the enemy.
      2 Timothy 3:16-17
      2 Timothy 4:2-5
      If you are not really a believer, one who has been born of the Spirit (many who profess to be Christians are not, just like in the time of the Apostles), then Scripture is sufficient “that every man of God may be complete, equipped for every good work.
      The church in America is scripturally illiterate. If you do not know the Word, how can it sanctify you?

    2. Would you care to back that up with evidence? From what I’ve read there’s overwhelming evidence for physical differences in the brain for those with and without disorders such as PTSD and severe depression etc. The question even in the scientific community is now why the difference and how to treat it. Medications work for some but not all, they make some worse, and for some it is a miracle lifesaver, the scientific literature is full of this, they’re not hiding it. The same with non-medication therapies.

      While we’re talking about it, shouldn’t every believer be receiving grace filed loving spiritual counseling all the time? If that were the case those who needed to see specialist help wouldn’t be choosing one over the other because they would be getting both.

      Perhaps we shouldn’t be arguing about which therapy is the best but asking why our churches and communities are failing to provide the loving healing places of true companionship that they should be and instead are looking like the world were people are isolated and bombarded by media 95% of their lives? Just a thought?

  19. There is a divisive spirit that rears it’s head through opinions expressed based on one perspective (experience) of a topic. Care is best taken not to discount or dismiss ideas related to mercy at work. Are all Christians always “good”? Are all non believers always “bad”? We know the answers to these questions, though it still confounds some, and we shy away from the answers. God makes right judgements- we struggle in this area. Perfect knowledge and perfect understanding makes all the difference. Pride says “I know enough to…”, or “My way is superior.” Humility keeps asking, seeking, and knocking. Leave room for misunderstanding, misperceptions, and other “mis”es. When we preserve our relationships (what God values above opinions), we increase our chances of seeing the problem with a fresh set of eyes and an angle we hadn’t considered. Humility can capitalize where pride misses it entirely. Unity is where we are all being led… to prosper us. Division destroys the house. Love covers a multitude of sins. God has mercy on all His children- even those in rebellion. Working together gracefully by the power of His Spirit, we will progress. Leave room for setbacks and failures along the way – they are a part of the journey and the more difficult they are overcome, the greater the significance is the accomplishment. God smiles.

  20. As someone who has been NANC certified for seven years and does a lot of pastoral counseling from that perspective, I was a little disappointed at your description of NC as it relates to organic (physical) factors in counseling. You painted Adams and the NC position as one that discounts physical and organic causation in relation, while in truth, they do not. Ed Welch’s book, which you did positively endorse, swims nicely in NANC streams, so to paint them in opposition was unfortunate at best and inflammatory at worse. I believe NANC and CCEF are much closer in practice than you may think – not to discount your experience with a NC counselor. If that was what he believed, that is unfortunate. But he would not be indicative of the entire movement.

  21. If anyone has time to listen to it, Martin Lloyd-Jones, who trained as a doctor and then became a pastor did a great talk in 1974 looking at how to diagnose the problems people face, considering whether it is primarily physical or spiritual and spiritual issues are broken down into cases where people need a greater grasp of Gospel truths and cases of ritual attack. It’s quite long and is split into two recordings. It’s particularly relevant to this thread because in one part of talk he gives a critical appreciation of Jay Adams, highlight what he did well but also mentioning problems.

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