Cognitive Biblical
Therapy Coursework
Counseling Through God’s
Transformative Word
Course 3, Chapter 9
Chapter 9
Personality Patterns, Client Issues, and Professional Networking
a. Deriving the Pattern Active-Sincere Personality
b. Potential Physical Issues
c. Potential Psychological Issues
d. Roles of Psychiatrist and Psychologists
e. Networking and Co-Counseling
f. Helpful Networking Tools
g. Impact of Human Experiences on Client Understanding
Essay Questions: Answering the section questions (red buttons) is a great way to prepare for the end of the Chapter Quiz. You may notice, to gain full credit for the answers in Course 3 will require more details. Yet remember, these questions are for your review, not for grading purposes. The section questions will provide Dr. Wilkinson’s feedback to your answers.
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Required Written Materials (forms) see Chapter 1 zip file. Supplemental Materials also see Chapter 1 linked forms.
Course 3 Chapter 9
Personality Patterns, Client Issues, and Professional Networking
Deriving the Active-Sincere Personality from the Questionnaire Scores
Question 1. The last personality type isn't as much personality as it is an example of the characteristics of a sincere person who is also a Christian. This person is erratic, but in a unique way. Usually, this person is a leader in the church and in some cases, will be a pastor. This person is very sincere, wants to do what's right and very determined. They attend church regularly and know the scriptures, understand salvation, but still have trouble dealing with life issues. They may have grown up as a Christian, or have gone through Bible studies. But in their sincerity, they have some very unique scores.
This graph is labeled “Wants help.” And the questions follow the same process of grouping the scores high, medium and lows. And the highest scores of things that the person has the least amount of trouble with are: C (envy), and I (keeps a record of wrong). These high scores indicate that there's no desire to impute motives to others. There isn't an attitude of pride or rebelliousness against God. But this person gives confusing messages that make them look like a hypocrite. This intense level of sincerity shows an extreme attempt to do what's right.
The next set of scores, the medium ones are: B (kind), D (boastful), F (rude), G (self-seeking), L (protects), and N (hope). These scores indicate extreme emotions and are quick to judge while wanting to do what is right. These middle scores show tendencies that these elements of Agape love are generally difficult for them. For this sincere person the lowest scores are: A (patience), E (pride), H (easily angered), and J-K (does not delight in evil, but rejoices with the truth). They have trouble with trust, trusting God or being trustworthy and with perseverance. They do everything on their own strength, so when everything falls apart, they feel like a failure. Looking at the graph, you will see a wide range of scores, from about 14 to 22, that's patience and envy. Pride is at 14 while doesn't keep a record of wrong is at 21, trust is at 15, perseveres at 18 then never fails at 14.
This pattern shows the double messages, for example they tend to be impatient, but not envious. They appear to be rebellious, prideful, and do what they want, yet they're not very selfish. They don't bring up the past in order to beat somebody up with it, yet they constantly focus on the negative. They think everything's hopeless, nothing is going to change and God can’t help us. They are afraid, but offer no protection to anyone else. They say, think and feel whatever they want, wherever they want, whenever they want, and justify it with “I just can't change.” They don't seem to trust God, yet hope God will help, but unsure that He will. They don't know God's character, believe in God to enable them to find His answers to problems, or live in peace in the midst of difficulty. They can come across to others as “righteous” and be critical of others who do not think, value or act like they want them to act, which comes across as judgmental. Rather than being like the apostle Paul, learning to be at peace in all situations, whether he had little or much, this person lives insecurely depending on himself. Unfortunately, it's the Christian who professes Jesus who demonstrates these patterns.
This individual has a higher general score overall in relation to knowledge of God's character, but his/her difficulty lies in applying the knowledge to his/her everyday life. Because of this, this person appears to be erratic, hypocritical and manipulative, according to that low score on pride. That's not so much a real score, but because their understanding of how to obey and follow God is next to zero, they appear to be prideful. In some situations, they are prideful. In general, the passive person is the one who really is rebellious, prideful. The sincere person tends to be oblivious to what they are doing, but still do it anyway. The sincere person has to surrender to God the process they use to solve problems, think, and deal with difficult life problems. Most sincere clients are so relieved to find an answer to their difficulties that they take to it pretty quickly. There is great potential here for these people to learn the process of patience and to apply their new knowledge to their human characteristics. Because of the lack of skills in problem solving, they may be withdrawn, or other times seem intensely spiritual.
This individual has a higher general score overall in relation to knowledge of God's character because of his/her Bible study experiences and church attendance. There is deep frustration, because of their inability to actually live out these Christian principles while in trials and difficulties. Their lack of application of knowledge sets up a tug of war between who God really is, and who he is perceived to be. So, living out this reality of what they know in their mind versus what they do in their lives has become a frustration to them. Some of the problems that this person has in relationships is they feel like a hypocrite at times. While they may give out a lot of scripturally based information, or “ought” and “should” or moral values, they feel like a complete failure in the midst of that. Relationships reflect this struggle, and the person may be seen as a religious zealot, a highly frustrated person, or a very defeated and inconsistent person. Their greatest difficulty lies in knowing what to do, but not knowing how to do it. This erratic pattern is very frustrating, not only to them, but also to other people.
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Explain how to derive the score pattern for the Active-Sincere Personality Type and include the elements of Agape Love for each high, medium, and low score category.
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Dr. Dan's Answer:
How to Derive the Score Pattern
The Active-Sincere profile is derived using the same method — reading the composite graph left to right and identifying high, medium, and low clusters. The defining feature is a wide range of scores with dramatic inconsistency between elements: sharp peaks in some areas and dramatic valleys in others, creating a pattern that appears contradictory and confusing. The spread typically ranges from about 14 to 22 points between the highest and lowest elements.
This wide range reflects a person who has genuine knowledge of God's love in some areas (gained through Bible study, church attendance, or Christian community) but virtually no ability to apply that knowledge in daily conflict and relationships. The result is a person who looks like a hypocrite — not because they are intentionally deceptive, but because the gap between what they know and what they do is wide and visible to everyone around them.
Score Categories for the Active-Sincere Personality
| Score Category | Elements of Agape Love |
|---|---|
| HIGH SCORES (Least Difficulty) |
C — Envy I — Keeps No Record of Wrong These two high scores reveal the heart of the Sincere person: they genuinely do not want to impute evil motives to others, and they are not driven by envy. There is no deliberate rebelliousness against God here — they truly want to do right and do not hold grudges or use the past as a weapon. These genuine qualities make them appear so contradictory when their low scores are revealed. |
| MEDIUM SCORES (Some Difficulty) |
B — Kindness D — Boastful F — Rude G — Self-Seeking L — Protects N — Hope The Sincere person has some awareness of these concepts but is prone to extreme emotions and quick reactions that undermine their good intentions. They may be kind in one moment and cutting in the next. Their hope fluctuates depending on circumstances — they believe God can help in theory, but that confidence collapses in real-life conflict. |
| LOW SCORES (Greatest Difficulty) |
A — Patience E — Pride H — Easily Angered J-K — Does Not Delight in Evil / Rejoices in Truth M — Trust O — Perseveres P — Never Fails The low score on Pride is the most important diagnostic marker — but unlike the Passive person's low pride score (willful rebellion), the Sincere person's low pride score reflects an inability to apply what they know. They appear rebellious but are actually oblivious. They say and feel whatever they want in the moment, not out of defiance but out of genuine frustration and lack of skill. Low scores on patience, trust, perseverance, and never fails confirm this person does everything on their own strength — and when it fails, they feel like a complete failure. |
Spiritual and Relational Profile
The Sincere person knows who God is supposed to be, but their inability to live out that knowledge creates an ongoing tug-of-war between their head and their life. They may quote Scripture fluently while their relationships are in chaos. In counseling, they are often the most responsive client of all four types — they already want to change and are simply missing the tools. Most Sincere clients are deeply relieved to find a practical, biblical answer and take to the process of patience quickly. The key is helping them surrender the problem-solving process itself to God — not just the knowledge, but the application.
Next Steps in the Counseling Process
At this point in the counseling process, you have given and analyzed the questionnaire to expose the personality, explained the personality strengths and weaknesses, taught the spiritual concepts, and there is some improvement, but there still seem to be unsolved problems. This may appear in a pattern that is reoccurring and somewhat predictable. At this point in this case, you have to look at two other alternatives. In general, there are three potential reasons that the presenting problem is still not resolved. The first one is physical health. The second one is psychological or mental illness. And the third is unresolved spiritual issues such as salvation, rebelliousness, bitterness or unresolved anger. Similar to observing and identifying personality traits and types presented by the client, pay attention and gather these details of their physical, mental, emotional, spiritual and relational health that impacts their ability and capacity to understand and take action.
Potential Physical Issues
Question 2. By now, you've probably seen the people somewhere around six to eight sessions. There's an element of frustration that you're feeling, and they may be somewhat frustrated, disappointed or hopeless. So, you have to take this next step (When to Refer) which honestly is somewhat difficult. You have to talk to the individuals about these other two options. Physical illness is the easiest one to start with, and will provide the quickest answers in most cases. A medical doctor can do a physical exam, order a fairly thorough blood work analysis, and other tests that seem appropriate. For example, one client was incoherent and had a loss of mobility. Although she had been seeing doctors for about three years, they could find no physical reason for her condition and suggested psychological treatment. Because I was in a city where there was a large research clinic, I had access to some individuals that were trained in brain research and clinical psychology. They did an interview evaluation, and referred her to another specialist at Mayo Clinic and a neurologist. After their evaluation, they learned she was suffering from Lou Gehrig's disease and Alzheimer's disease. Both of these are not easily found through routine physical exams and bloodwork. These are only diagnosed through observation. Fortunately, one specialist had extensive experience as a brain research scientist studying those two diseases. The Lord helped them quickly get an accurate diagnosis. Unfortunately, there's no cure for either of those diseases. She went to be with the Lord about six months later. Often physical health is a place where the problem lies, and that is the most manageable step for the client to take.
There will be different types of symptoms: lack of eye contact, disjointed physical movements, slow or slurred speech, fatigue, lack of interest in normal everyday events or special occasions. These types of symptoms differ from the spiritual or the psychological in that the client is aware that there's a difficulty, but may not know how serious the problem is or what to do about it. The physical is more random. If it's a specific disease, it will have symptoms that are fairly definable or predictable. But if the illness doesn’t have known symptoms or a pattern, it is difficult to diagnose. No one can predict when you will get cancer, when Lou Gehrig's disease will start, or what genes you get from in your own family. Knowing family history can be helpful in watching for specific symptoms.
Potential Psychological Issues
Question 3. Talking to the client about a psychological issue is difficult. When nothing physical is found, you have to suggest to the individuals that there may be something wrong with the way they perceive things. They hear you say that they are crazy. Perhaps they have had a diagnosis before, and they refuse to go back to treatment or take medication. They may ask about their spouse needing an evaluation. There isn't anything negative about having an illness, but when you recommend a psychological evaluation, you must be very careful how you convey this. For example, you may say, “We've tried the spiritual work which hasn't made much change. The physical exam didn’t find a disease, so our next step is to have a psychological evaluation done to see if they find anything that contributes to the problem.” If your client is part of a couple, have both of them go through the physical and psychological assessments so that one doesn’t feel picked on. Avoid using the word psychiatric because it has a negative connotation.
On your side of observing behavior patterns that clients have, someone that's having psychological problems may have a pattern of being irrational or illogical. For example, the couple had been married for 14 years. The husband came and explained that they were in the beginning of the phase where everything gets very bad. He had observed this over the years at different times of the year. Different triggering events caused a predictable response. When this occurred, the response was totally illogical: everything's awful, our marriage was over, we were through, you don't love me, I'm packing my bags. That would build to a crescendo, and then the wife would say, “No, I'll stay.” Even though the pattern and the thoughts were irrational, the pattern was fairly predictable. Psychological difficulties exist when the person isn't processing reality correctly. But the way they are illogically processed can be predictable. In another case, I referred them for a psychological evaluation. Even though we had been through six months of counseling, the wife told the exact same story to the doctor that she had told me. Rather than the reality, she held on to her false perceptions of her husband: he's violent, he's beaten me, he doesn't listen. He breaks things. He smashes mirrors at times. I fear for my life. We had talked about those things over and over, but the pattern of the response was exactly the same.
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Describe the potential issue of physical illness and its impact on counseling and how it should be addressed.
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Dr. Dan's Answer:
The Issue
After approximately six to eight sessions of counseling -- during which the questionnaire has been analyzed, the personality type identified, and Word Studies taught -- there are cases where a predictable, recurring problem remains unresolved. When this occurs, the counselor must consider three possible explanations: physical illness, psychological or mental illness, or unresolved spiritual issues. Physical illness is the first and often easiest alternative to explore.
Symptoms to Watch For
Physical symptoms may include: lack of eye contact, disjointed physical movements, slow or slurred speech, unusual fatigue, and a lack of interest in normal everyday events or special occasions the person would typically enjoy. Physical illness tends to be more random in its presentation unless it follows the predictable pattern of a diagnosed disease. Family medical history can be helpful in identifying specific risk factors.
Impact on Counseling
Physical illness can severely limit a client's ability to process information, engage emotionally, or follow through on counseling homework. A client who appears spiritually resistant or emotionally flat may simply be suffering from a condition impairing their neurological or physical functioning. Misidentifying a physical illness as a spiritual or character issue can cause tremendous harm -- leading the client to feel condemned, misunderstood, or hopeless when the real problem is medical.
How It Should Be Addressed
The counselor should establish a referral relationship with a trusted family physician willing to see counseling clients when requested. When physical symptoms are observed or progress stalls unexpectedly, the counselor refers the client for a thorough physical examination including blood work. If the initial exam is inconclusive, the counselor should not hesitate to pursue a second or third opinion, or a specialist referral. In one case, a client with incoherence and loss of mobility had been seen by multiple doctors for three years without a diagnosis; a referral to a research clinic and eventually a neurologist at Mayo Clinic revealed Lou Gehrig's disease and Alzheimer's -- conditions only detectable through specialized observation.
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Describe the potential psychological issue and its impact on counseling and how it should be addressed.
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Dr. Dan's Answer:
The Issue
When no physical cause is found and spiritual work has not produced expected results, the counselor must consider the possibility of a psychological or mental health difficulty. This is the most sensitive area to raise with a client, because the recommendation of a psychological evaluation can easily be heard as "I think you're crazy." The counselor must navigate this conversation with great care, precision, and compassion.
Symptoms to Watch For
Psychological difficulties are characterized by irrational or illogical thinking that exists in a predictable, cycling pattern. Unlike random confusion, psychological problems show a consistent cycle of distorted perception and response -- for example, a wife who after six months of counseling continued to respond to specific triggering events with identical catastrophic thinking ("everything's awful, our marriage is over"), building to a crescendo and then resolving, only to repeat at the next trigger. The key diagnostic feature is not just irrationality, but predictable, cycling irrationality that does not respond to biblical intervention.
Impact on Counseling
A client with an unaddressed psychological condition cannot benefit from CBT counseling in the usual way. They are blocked from processing new information and applying what they have learned, even when they appear engaged in sessions. Progress will plateau, patterns will repeat, and both counselor and client will feel frustrated. Pushing through without addressing the psychological component is ineffective and can damage the client's trust in both the counseling process and God.
How It Should Be Addressed
The counselor should avoid words like "psychiatric," "crazy," or "mentally ill," and instead frame the issue as one of processing -- information is not being processed correctly, which is a medical difficulty rather than a character flaw. A helpful analogy is that of kidney stones: just as a small tablet corrects the body's inability to process chemicals correctly, medication can help the brain process reality correctly. If the client is part of a couple, both partners should be referred for assessment so that neither feels singled out. The counselor should establish a referral relationship with a trustworthy psychiatrist -- ideally a practicing Christian -- and remain involved after diagnosis, monitoring side effects and linking psychiatric treatment to the ongoing spiritual work.
Potential Spiritual Issues
Question 4. The spiritual difficulties evidence themselves through those parts that are in Corinthians that God says love is not like: rudeness, pride, self-seeking, the lack of submission to God, and the unwillingness to say, “I could be wrong.” This becomes clearer as you progress through the study with a client, because you, as the counselor, can confront the decisions to continue with these actions, attitudes, and behaviors. If the client refuses to surrender these things to God, there may be no resolution of the problem. The major difference between this difficulty and the other two, is that the element of willfulness is clearly seen and confirmed by God within the counselor's own mind, and any other individual who is involved. You got to the place where the client refuses to change. Sometimes this becomes clear, because the client is still sarcastic, bitter, or playing the victim. Sometimes a client is really emotional and doesn't want to give it up. They may agree that they need to change, but refuse. He or she may call you with the same basic issues, but have not followed up with doing their part to pray, confront, or set boundaries. They may act willing to change, but refuse to do the hard work of change.
The first basic step in addressing this area you have done by working through the methodology. The second is going to be the medical. I set up an agreement with my own family physician. He will take referrals for my clients, when I need a physical exam for people. The third one is referring to the psychiatrist. I just interviewed a lot of them (psychiatrist). I called them, I made appointments, I talked to them, I gave them examples of what kind of evaluation I wanted, diagnosis, and feedback. You look for a person who is a professing, practicing Christian first. If you can't find a Christian in the field, you can still work with a non-Christian. You're establishing a professional relationship, so that you have a network when you need it. Some may want some portion of a fee. Most don't. They're willing to work with you and receive insurance payment.
Roles of Psychiatrist and Psychologist
Question 5. A psychologist is trained only in various psychotherapies such as Psychodynamic Analysis by Sigmund Freud, Client Centered therapy by Carl Rogers and Rational Emotive therapy by Albert Ellis. There's existentialist therapy, communications therapy, systems therapy, Gestalt therapy, I think when I went through school, there were about 250 therapies. They were all based on secular humanism, which is the belief in man's goodness or man's ability, rather than talking about the soul of man, the Holy Spirit, or Jesus. Psychologists are not medical doctors and therefore can't prescribe these psychotropic medications. They are not trained in psychiatry at all. Most of them will have someone on referral staff. Most psychologists will have a psychiatrist who they refer people to. Some will only use a medical doctor, because medical doctors can prescribe psychotropics. You'll find that most medical doctors do not have training in what the drugs do or how the brain functions. They often prescribe medications for anxiety, OCD, ADD or depression. Sometimes a client has had many medical visits and inappropriate diagnosis, so that the client needs the psychiatrist to provide a current and accurate diagnosis. They have the knowledge to analyze the current medications to find out which ones are appropriate. Sometimes these medications are addictive, and if the person stops taking them just too quickly, they can have side effects, or in severe cases, they could literally die.
The psychiatrist is a very important part of your network. He or she is a medical doctor who has been specifically trained in the functioning of the brain. They base their practice on the concept of a medical model of mental illness or difficulty. They believe that the chemical functioning of the brain can become impaired, and that medication, called psychotropics, can restore the brain’s ability to process information and enable the client to return to a normal life. This is a valid belief. When the brain begins to function, the initial problem can be resolved. The new or renewed spiritual health can enable the individual to lead a normal life. Now you're going to return them to your counseling, but that's after they gain the ability to process what they've learned. You will be surprised how much they have learned; they were just blocked from actually using it.
Psychologists and psychiatrists do a marvelous job of identifying and labeling human behavior, and at times, are a necessary part of Biblical counseling. In other words, the Diagnostic Statistical Manual (DSM-V-TR) in the latest revision is something you should have in your library, because there will be times when either the diagnosis you get is in there, or a client comes with an old diagnosis you will need to read about. Though, only use the DSM-V-TR for understanding of your client’s diagnosis, do not use it to diagnose unless you are qualified to do so. If you receive client forms from another professional, you'll be able to read the description of the human behavior such as narcissism, borderline personality, depression or anxiety, and understand what others already observed. This can guide your own observations and help you make your own conclusions. It saves time, and the labels are accurate, so it's worthwhile to utilize what they've identified as a difficulty. These descriptions can also help resolve medical difficulties or affirm an observation of behavior that is crucial to the effectiveness of your biblical counseling. The psychologist or psychiatrist will be there to assist when a client is suicidal by placing a client in the hospital for immediate treatment. Some people come in so upset that you can't work with them at that time. They need help to protect themself from themself (suicidal, homicidal, hallucinating, paranoid, catatonic, etc.) in a clinic where they can’t escape, receive medication they need, and be left alone. Do further research about “psychiatric hospital admissions”, both inpatient and outpatient services. When a client is fragile, mentally/emotionally unstable, an evaluation at a local psychiatric hospital or unit of the hospital can determine the best level of care and be able to access a psychiatrist within 24 hours or a week’s time.
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Describe the potential spiritual issue and its impact on counseling and how it should be addressed.
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Dr. Dan's Answer:
The Issue
The third potential explanation for unresolved problems in counseling is spiritual in nature. Spiritual difficulties are evidenced through the very attributes Agape love is not: rudeness, pride, self-seeking, a lack of submission, and unwillingness to say "I could be wrong." The critical distinguishing feature -- as opposed to physical or psychological issues -- is willfulness: the client can change but refuses to.
Symptoms to Watch For
Signs of a spiritual presenting problem include: continued sarcasm, bitterness, or playing the victim after substantial teaching has been provided; agreeing change is needed but refusing to do the work; calling with the same issues session after session without having prayed, confronted, or set boundaries as agreed; appearing willing to change in session but showing no effort outside it; and a pattern of emotional resistance tied to a deliberate choice not to submit rather than to confusion or inability.
Impact on Counseling
A spiritually resistant client represents the most challenging counseling scenario because no amount of knowledge, patience, or process can substitute for a person's own willingness to submit to God. The counselor cannot manufacture ownership -- it must come from the individual's free choice to surrender their will to God. If that surrender never comes, counseling will be a frustrating cycle of surface engagement without genuine change. The counselor must not take this personally -- pride is the root of all sin, and some people choose to remain in rebellion.
How It Should Be Addressed
The counselor addresses spiritual resistance by confronting it directly -- with the tools of Agape love: patience, kindness, and truth. The counselor names what they observe and holds the standard of Agape love without lowering it under emotional pressure. Three types of spiritual difficulty require different responses: lack of salvation (the client has never received Christ and has no Holy Spirit resource); rebelliousness (a saved person willfully resisting God); and unresolved bitterness or anger (a person so wounded they are unable or unwilling to forgive). All require honest confrontation and a call to submission. If the client ultimately refuses, the counselor accepts that outcome, having been faithful. God is responsible for the outcome; the counselor is responsible for the faithfulness of the process.
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What important roles do Psychiatrists and Psychologists play in your counseling practice?
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Dr. Dan's Answer:
The Psychologist
A psychologist is trained in various psychotherapies rooted in secular humanism rather than in the soul, the Holy Spirit, or the person of Jesus Christ. Psychologists are not medical doctors and cannot prescribe psychotropic medications. Their primary value to the biblical counselor is in behavioral identification and labeling -- they are highly skilled at observing and categorizing human behavior patterns in precise, clinically useful ways.
The Diagnostic Statistical Manual (DSM), developed by the American Psychological Association, is the primary tool through which psychologists organize their observations. The CBT counselor should have a current edition in their library, because clients will often arrive with prior diagnoses -- narcissism, borderline personality, depression, anxiety -- that accurately describe observable behavior patterns. These labels help the counselor verify their own observations, save time in assessment, and integrate prior professional work rather than starting from scratch.
The Psychiatrist
The psychiatrist is a medical doctor specifically trained in the functioning of the brain. Their practice is based on a medical model of mental illness -- the belief that chemical functioning of the brain can become impaired and that psychotropic medications can restore the brain's ability to process information. When the brain functions correctly through medication, previously blocked learning becomes accessible, and the client can apply what they have been taught in counseling.
The psychiatrist plays several critical roles: providing accurate diagnoses when prior diagnoses are outdated; managing psychotropic medications with specialized knowledge of their effects and interactions; placing clients in hospital settings when they are suicidal or in acute crisis (the counselor does not have the legal or medical authority to do so); and collaborating on the overall treatment plan. Neither the psychologist nor the psychiatrist should be viewed as an adversary -- both share the goal of helping troubled people heal, and most are open to working alongside a professional who also addresses spiritual health.
Networking and Co-counseling
Question 6. You can work with a psychiatrist for the right to go into the hospital or clinic, and actually conduct Biblical counseling. Most of them are open to that, but you will need to verify your credentials, but this is a realistic form of treatment if you're seeing some of these psychiatric difficulties. You don't have the legal right or the medical background to put someone in a clinic, so the psychiatrist or the medical doctor is vitally important to you. Most people are open to God to some degree, and will be accepting of you being both a professional and focused on spiritual health. In most cases they will be grateful to work with you, because their goal is the health of their client. It's important to remember that the whole network made up of professionals are committed to the healing of troubled individuals. Don’t see them as godless enemies. It's important to represent ourselves professionally and to understand their professional concepts in order to work with them as realistically as possible. They have skills and abilities that we don't.
I touched on this earlier, but avoid any words or phrases that communicate the thoughts of your indicating that the client is crazy, insane or mentally il. Avoid the word psychiatric because it is frightening to some people; instead use psychologist or psychology. You want to stress the reason is information is not being processed correctly by the client, and avoid any indication that the person is stupid, dumb, crazy or not able to understand. These types of things may have been said to the client. You need to indicate there is no value being attached to the problem; only an inability to think clearly due to a medical difficulty. I have a tendency to produce kidney stones, and I usually have to carry with me two little, small diuretic tablets. I often take one of those out of my pocket as an example of my body not functioning correctly; it doesn’t process chemicals correctly, so I accumulate mineral deposits in my kidneys. This pill corrects that from occurring. Even though I had nine stones in 10 years; I haven't had any stones in the last 10 years. There's no difference between my taking this pill for my body, and the potential you have for some medication to enable you to understand things as they're really happening. Thinking clearly will allow you to function freely with a sense of consistency and balance.
Helpful Networking and Useful Tools
One major source of information will be coursework you've had in psychology that dealt with abnormal behavior. Another source of information is the Diagnostic Statistical Manual (DSM-V-TR) latest edition developed by the American Psychological Association, that contains the latest mental illness diagnoses. They are organized by numbers and then defined with the types of symptoms collected over periods of time. This is a very detailed work that is ongoing work and can be purchased along with other manuals of this type to define behavior, list symptoms, and suggest treatment. There are manuals that describe different types of medications. The Physician's Desk Reference is the best known one. Because they are revised yearly, you can get the old one from hospitals or medical professionals. They're current enough for your use, because they're fairly expensive. Another resource is a secular book club focused on psychiatry and psychology. I get monthly catalogs to keep current on clinical books. These can provide help on using the manual and finding literature on specific research, though again, only for reference purposes, not diagnosing your client.
One of the most crucial parts of referring a client to a psychiatrist occurs between you and the psychiatrist. You need to explain your evaluation and why you are making the recommendation for the doctor to evaluate and consider treatment. Be sure to communicate with the doctor and their office in a respectful tone, only referring to your observations, client’s input, symptoms and lack of functioning, while not referring to a diagnosis.
To avoid any confusion for your client, you may need to explain the treatment and recommend the client to cooperate with the psychiatrist or tell them that you don’t agree with the recommendation (if qualified) and to get a second opinion. The best method of co-treatment is to get the results of the evaluation and recommendation for treatment, so that you can discuss this with your client. You can also encourage them to get details of their prescribed medication(s) from their prescribing doctor or nurse practitioner. There are any number of interventions that you can do on your part to give the client a sense of support and safety. In other words, you can monitor the process, and link that with the spiritual understanding to see the overall situation that needs remediation.
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Describe some important networking tools and how they can lead to a co-counseling situation.
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Dr. Dan's Answer:
Key Networking Resources
The Diagnostic Statistical Manual (DSM) — Current edition. Familiarity with the DSM establishes professional credibility with psychologists and psychiatrists and creates a common language for discussing client behavior. It also helps the counselor read and interpret documentation received from other professionals.
The Physician's Desk Reference (PDR) — Lists all known medications, their mechanisms of action, dosing guidelines, side effects, and contraindications. When a client is placed on psychotropic medication, the counselor can use the PDR to explain what to watch for and monitor for side effects, greatly increasing the client's sense of safety and support during the medical process. Previous editions are often obtainable from hospitals at low or no cost.
Coursework in abnormal psychology — Provides essential context for recognizing when a client's presentation goes beyond the scope of typical spiritual counseling and requires professional evaluation.
Professional journals and book clubs — Monthly catalogs focused on clinical psychology keep the counselor current on new research, evolving diagnoses, and treatment approaches, maintaining professional credibility in collaborative relationships.
How Networking Leads to Co-Counseling
The path to co-counseling begins with intentional relationship-building — personally calling psychiatrists, making appointments, meeting face to face, giving real examples of the kind of evaluation and feedback needed, and establishing a professional relationship before a referral is ever needed. This upfront investment pays dividends when a client is in crisis.
Co-counseling occurs when the biblical counselor and a psychiatrist (or psychologist) are simultaneously involved in a client's care. The counselor provides the spiritual assessment, Word Studies, and process of patience; the psychiatrist provides diagnostic evaluation, medication management, and if necessary inpatient hospitalization. Both communicate directly about the client's progress — with the client's knowledge and consent — so that medical and spiritual dimensions of care are coordinated. In some cases, with a cooperative psychiatrist, the counselor may even be granted access to counsel a client inside a hospital or clinical setting.
Impact of the Human Experiences on Client Understanding
Question 7.The last section of this third course will deal with the human side of the client which has been shaped by their experiences most of which occurred during childhood. Specifically, how they were parented shaped their view of God. Since the person parenting represented authority, they represented God to the child. This parent is whoever raised them: biological parent(s), step-parent(s), aunt, uncle, foster parents, and in a few cases an older sibling. Typically, those raised by a parent who is rigid, unyielding, cruel, dictatorial, and perfectionists, see God the same way. For example, a woman told me that if she didn't wash her dishes a certain way, her father would come and scream at her, shake her like a leaf until she had a complete emotional breakdown. That is how she saw God: demanding, unforgiving, angry and unloving. Some people had nobody; they were abandoned, or left with relatives who didn't attend to them. To those people God is absent. Their spirit can be so crushed, that when they pray, they don't feel anything, sense anything, or hear anything.
For example, I will share a case with you to help you understand the patterns a client had. If you have a client with this image of God, you need to stop counseling and focus on his concept of God. We need to talk about what you experienced, and how you were raised, how you felt, and how you reacted. We will discover part of why you have trouble in conflict and use poor coping skills. The client who has this difficulty comes to you with a preset concept.
The pure human part is his temperament and personality, emotional makeup, memories and patterns of behavior or reactions. Early experiences form reaction patterns based on conflict resolution and problem-solving skills. These are not unbreakable patterns, but they are there until they are modified. They are preprogrammed response patterns that function much as the physical reflex of a knee jerk response, when a person’s knee is taped with a rubber mallet. My client, Mark, had good days and he had bad days, because his father had good days and bad days. His father was drunk every other day throughout his whole life while growing up. Mark began to perceive his father as good on a good day, when he wasn't drunk, screaming or yelling. He saw his father as bad on days when dad would come home screaming and yelling at his mom who Mark would try to protect by being the referee. On the good day, Mark would be asked to play his guitar so that his dad could demand intimacy and closeness. His father would say, for example, “Mark, go get your guitar so that you can play it for me and we can sing together.” This was very difficult for him to experience, because he knew the next day would be the bad day where he would experience violence, anger and disrespect from the same man that asked for intimacy.
Mark had a burning sense of resentment toward his father, which he never expressed, because he believed those resentments proved that he was wrong. Rather than express his emotions, he was supposed to love his father and not question him. This led Mark to self-doubt, questioning his own abilities to reason, and a lack of confidence in his own intelligence and discernment. His thoughts were, “This is phony and wrong. I hate this and it isn't right. I wish it had stopped.” The next thoughts were, “It must be me, and I must be the one that's having the problem. I'm really a jerk, because I'm supposed to love my dad, and I need to just shut up.” So, he played his guitar and sang along, while underneath, he was just mad and angry. He did nothing about it. He tended to have that reaction pattern with any conflict.
An example of these tactics is found in an event Mark shared with me. Mark left some dishes out on the table on a good day for his dad. He wasn't drunk. But even when he wasn't drunk, he was still manipulative. When his father came into the kitchen, he explained how he felt mistreated. He said, “So this is what I get for all my caring, love, and hard work for this family. You left this dish on the table as a sign of disrespect, and to make everything harder for everybody!” Mark didn't know how to respond, because he hadn't been taught how to respond. He moved the dish, felt bad, and suffered self-doubt and false guilt. Being respectful and submissive, he apologized to his dad, but underneath he was mad, thinking this isn't fair. This guy's a jerk. I just hate him. The next phase of his learned response is blaming himself and trying to figure out what he did wrong. This self-doubt is where the basic distortion of God's love began. This pattern of conflict, self-accusation, overt manipulation on his father's part, began to form in Mark a concept of conflict and authority that he transferred to God.
The result was the most destructive, the greatest distortion, Mark would break down weeping and crying, and throw himself in his room and be absolutely frustrated and in a sense of pain and suffering. His father had driven him to this, but would come into his room, stand by him, and be totally silent. He would pat his head or back for a brief time, and then walk away. It seemed like the father needed that point of submission, on Mark's part, to sense control. The cycle would start again and repeat over and over. This act of submission, this breakdown in crying, signified to Mark that he had paid his price through punishment. He had broken down, which is the ultimate example of how wrong he had been and deserved to break down. And now his father loved him. Now they were close. Now they could start over. This is the exact way he viewed the altar in his church. He would sin, worry about his salvation, then go to the altar and weep. People would pat him on the back or head and say encouraging words in quiet voices. They'd all shake hands and smile, and then he'd walk away, all set for another cycle. This was a consistently repeating pattern, and one that he not only assumed was right, but that God literally wanted from him. The altar became the parallel to his bedroom, and the people in the church and the pastor became the parallel to his father. The Scripture took the place of his earthly father's rules once he left the home. His same feelings of inadequacy to meet the demands of the Scripture, led him back to the same feelings about failing God that he had when he felt he'd failed his earthly father. God was disappointed. God was upset. God didn't like what he did, but God would forgive him, if he would go through this cycle. And it became a trap. His faith became a trap.
There were other concepts that came from this distortion of God's character and love. He experienced such beliefs as God always asking Christians to do impossible or awful things in order to test their faith. His immediate response would be to say no, and then grit his teeth and do it anyway, all the while feeling guilty, because of his anger at this unfair, yet loving God. Another result of his experience with his father was that he always felt that he was wrong in any conflict with anybody, especially God. This was an unthinking response he felt, rather than a reasoned response based on the facts. He was always the guilty party. This led others to manipulate him fairly easily, and had a history of broken relationships. He subconsciously sought manipulative people who appeared to be caring, but were actually seeking to draw him into a dependent relationship.
Self-doubt was a strong response that developed. He would agonize over decisions, sometimes for hours, that were trivial and of no consequence. For example, he would think about going to a party, finally decide to go, then sit outside in his car at the party, and pray over whether or not to go in. He thought, “Who should he be witnessing to? What did God really want? How sinful is this to go and have fun when others need help?” Mark had never developed clear guidelines for making decisions. He also had no clear sense of liberty in his relationship to God. In other words, no freedom to be a saint, saved by grace, not perfect, but accepted by God wherever Mark is. By a loving God who wants him to have friends, water ski, or to parties. He had no sense of God's caring love or support in areas such as free time or leisure or rest. He would sit outside anywhere he went to enjoy, and become gripped with fear and agonize over what decisions he made. For example, he wondered if he was supposed to witness to the guy when he left work, rather than leave work at five so he could make it to the concert. Did God tell him to witness to him? Did he disappoint God by going to the concert? Does he really love God by going to the concert? He would sit in his car for hours, running that cycle of thoughts about being obedient.
When Mark felt he was in a conflict with God, Mark would doubt His salvation. He would view God as asking him to do things, yet never being satisfied with what he'd done. He viewed God as never satisfied with the level of his effort, not only what he tried to do and how he tried to do it. For example, he had one severe episode where he saw a man walking beside the road, who was obviously homeless and poor. He stopped and gave him a ride back to where the man was living, which was in sort of a shack. Mark also gave him some money. He got about 20 miles back towards home, when he was hit with tremendous conviction and guilt. You didn't give him a Bible? Did you even ask? He turned around, drove back, and gave him the Bible. He left a second time and got another 20 miles towards home, when more tremendous guilt and conviction hit. You needed to bring him food. You didn't do enough. This bondage became so great, that he dropped out of college, and moved into the shack with a man, so that he could disciple him. Eventually, had a nervous breakdown and had to be hospitalized. Those self-doubts controlled his life.
He'd feel confused over Scripture, and he could take the most positive message and turn it into something negative and condemning. He felt God could love him only because he was God, and for no other reason. He obviously wasn't good enough. It took someone powerful like God to love someone as awful as him. That thinking meant obviously no one else could love him. He would say things like, “If they really knew me, they would reject me. If someone tried to get close to him, he would explain how unlovable he is. He believed that God loved him only because God has to, not because he necessarily wants to.
The active, the problem solver, usually has a harsh God. Do it now. Do it quick. This is right. This is wrong. The passive person has a manipulative God, who never gives them real clear messages. Mark had somewhat of a God like that; someone you can't ever actually trust. The passive-active type personality tends to have an absent God, nobody at home God. The attempt to work with God causes the person to be overbearing and the active personality, dictatorial type, actions, attitudes. They not only see God that way, but they also represent God that way to other people. The passive person will tend to have a sort of a double standard, and see things through a manipulative slant and see it as OK to manipulate others. Passive people may be weak, wimpy and not have a clear sense of trust in God, or closeness to God. The hardest type to work with is the passive-active, because they lack any concept of God at all. You have nothing to work with, so you as a counselor have to build their initial concept of God from the ground up. Also, the person feels apathetic to God, because of their sense of abandonment, and disbelief that anyone cares about anything within this person's life.
Even though you are working with the spiritual, you must clearly explain to the client that this human part is a separate part of the counseling process. Once the human side of the problem is understood, you will help them understand how their experiences have shaped their thinking. Mark and I spent quite a bit of time talking about the things that happened, how he felt, situations, and circumstances such as helping the poor man. As you talk through these experiences, you clarify for them the correct understanding of God. You help them see the truth about how God was there, helping by weaving truth into the fabric of this is what happened. This is how you see God. What's the parallel here? Mark, here are the connections between these thoughts about God and how you view the Scripture. You establish first that you're going to identify these experiences and pathways of thought that were established. In working with Mark, we also identified the good day, bad day thinking concerning his father’s drinking, and how he associated that pattern to God. This basically meant that Mark had a god who was an alcoholic; a good day, bad day god. This allowed him to identify this thinking when it occurred, and to reject this pattern through the power of the Holy Spirit. He learned how to recognize it before it took control of his whole thinking and feeling processes. In other words, before he spent three hours out in the car when it hit him in the doorway, he knew to stop and say, “Wait, I need to work through patience. God give me grace. Help me understand also.”
You want to identify the distinct personality type that the individual has so that you know their tendencies and can teach them how to evaluate their responses in order to reject the negative ones. There's no moral quality to personality. There's no soul in personality. There's no sin, there's no salvation. It's just purely the tool, the instrument, the vehicle through which we all live and respond in life. We can recognize our personal tendencies in that personality, but don't have to be controlled by it.
My tendency is to withdraw, run away, and look for paradise, be emotional, irresponsible and lazy. That's not going to leave me until I'm dead and gone to heaven. But I have to understand that tendency, so that I don't give it more power and authority than it should rightly have when it hits me. A third action that you can take with your client is simply mental and emotional healing. Ask the client to be in prayer, specifically asking God to heal the mental and emotional damage that was done during those growing up years, so that there can literally be healing. Some of these wounds and scars are so deep that they have destroyed the person's emotions and mind. Each of us has unique experiences that destroy us. God can heal us. Now that we've identified these tendencies, and identified the parts needing to be healed, pray with them specifically about them. “Jesus, my brain's busted because I’ve got a good day, bad day god, and I don't want to see you that way. And when I do, I want to be free of it. I want to understand it, and I don't want to be controlled by it.” So have them pray specifically for healing, both mental memories and deep emotions.
I pray that this course has been one that has clarified for you the concepts and very practical application of the methodology. The next course will include a library of different types of presenting problems, and Course 5 will show you how to start a counseling ministry in various settings. I pray that this third course has served you well, and that you've learned some things about biblical counseling and personalities and how to use the methodology. We'll continue our discussion in course four. And thank you for your attention and your effort.
Copyright 1987, 1990, 1993 by Daniel D. Wilkinson. All rights reserved. For more information concerning this material, write to:
The Biblical Christian Counseling Ministries, Inc., 2730 Radcliffe Dr., Florissant, MO 63031.
Any reproduction of this material without the express written consent of the author is prohibited. Printed in the U.S.A..
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Explain how our human experiences influence our view of ourselves, God, and how we relate to others.
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Dr. Dan's Answer:
The Formative Power of Early Experience
The most powerful formative experience is how the client was parented. Because the parent represents authority in a child's world, they become, in that child's mind, a representation of God. The way that person exercised authority directly shaped the child's concept of who God is and how He relates to people. Those raised by a rigid or perfectionistic parent see God as demanding and unforgiving. Those who were abandoned see God as absent — their spirit can be so crushed that when they pray, they feel nothing.
How Experience Forms Response Patterns
Early experiences form reaction patterns that function like physical reflexes — preprogrammed responses to conflict, authority, and intimacy that operate automatically until modified through knowledge and the work of the Holy Spirit. The case of Mark illustrates this: his alcoholic father alternated between warm, demanding "good days" and violent, abusive "bad days." Mark learned to split his world into safe and dangerous with no stable middle ground — and this created in him a concept of God equally unpredictable: "good day, bad day" — never consistent.
The Impact on Self-Image
These distorted experiences produce profound damage to a person's self-image. Mark developed burning resentment he could never express, leading to self-doubt, a pattern of blaming himself in every conflict, and becoming easy prey for manipulative relationships. He agonized over trivial decisions for hours, paralyzed by guilt — and his faith deepened his bondage because the altar of his church became the parallel to his childhood bedroom: temporary relief from guilt, only for the cycle to begin again.
The Impact on Relationship with God
Because Mark could never satisfy his father, he could never satisfy God. He viewed God as always asking for more, never pleased, always disappointed. Each personality type tends toward a distinct distortion: the Active person sees a harsh, performance-based God; the Passive person sees a manipulative God who gives no clear messages; the Passive-Active person sees an absent, disinterested God.
The Counseling Approach
The counselor addresses these distortions in three steps: first, by talking through the client's formative experiences to identify specific distortions; second, by weaving truth into those experiences — showing the client where God was actually present and what His real character looks like in contrast to the authority figure's behavior; and third, by praying specifically for mental and emotional healing. Once the pattern is named and understood, the person can catch themselves at the doorway before the cycle takes full control, and respond instead through the process of patience, empowered by God's grace.
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Here’s what is ahead in Courses 4, Dr. Wilkinson will provide further discussion about personalities through case studies around the client’s Analysis Questionnaire for Agape Love (AQAL) scores. Then focusing on 22 counseling topics, he will walk you through more case studies, scoresheets and graphs, along with outlining the diagnostic symptoms and treatment plans for these various issues. Dr. Wilkinson’s case studies, explanations and applications have a way to inspire all of us as vessels of God’s Word and Spirit, with those He sends to us. What a privilege!
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