Mental Health and Personality
Mental Health from a Christian Perspective
Personality Theories
Psychoanalytic
Humanistic
Behavioral
Cognitive
Disorders
Anxiety Disorders
Mood Disorders
Schizophrenic Disorders
Personality Disorders
Therapy
Psychoanalytic
Humanistic
Behavioral
Cognitive
Counseling for Missionaries
Member Care
Reentry
Debriefing
Chapters 11, 12, and 13 in Dewey’s introductory text are relevant.
(Chapter 15—Personality, Chapter 16—Psychological Disorders, and Chapter 17—Therapy, in Myers 8th edition are also relevant.)
Another applied area of psychology is mental illness and mental health. Although psychology is very diverse in its study of behavior and mental processes, many people think of it as primarily about mental illness and therapy. At its beginning in 1879, modern psychology was not about therapy at all. During the first half of the twentieth century a few psychologists became interested in mental illness and therapy, primarily because of Sigmund Freud the psychoanalyst.
However, during World War II as the need for clinicians grew rapidly because of “shell shock” (now called PTSD, Post Traumatic Stress Disorder) psychologists were increasingly called in to help the overloaded physicians. The army then began training clinical psychologists, and the field grew rapidly in civilian life after the war. During the last half of the century many psychologists emphasized the treatment of mental illness and focused on negative emotions such as depression and anxiety.
About the turn of the century some psychologists began writing about the necessity of developing a positive psychology. The January 2000 issue of the American Psychologist was a special issue containing 15 articles about such things as happiness, optimism, and wisdom. The introductory article is available at http://www.bdp-gus.de/gus/Positive-Psychologie-Aufruf-2000.pdf).
Mental Health from a Christian Perspective
Figure 9:1 Mental Health from a Christian perspective.
HUMANS
Created . . . . . . . . . . . in the. . . . . . . . . Image of God
Like Animals Like God
Overt Behavior. . . . . . Definition. . . . . .Mental Processes
Understand. . . . . . . . . Goals. . . . . . . . .Make people
Creation like God
Psychoanalysis. . . . . . Systems. . . . . . .Humanistic
Behaviorism Psychology
Experimental . . . . . . .Methods . . . . . . Descriptive
Physical. . . . . . . . . . .The Person . . . . Spiritual
Immaturity. . . . . . . . .Development. . .Maturity
Sensation . . . . . . . . . .Awareness . . . .Perception
(States of Consciousness)
Learning . . . . . . . . . .Intellect . . . . . .Cognition
(Memory)
Biological . . . . . . . .Motivation. . . . .Cognitive
Physiological. . . . . .Emotion. . . . . . .Conscious
Physical . . . . . . . . . Health. . . . . . . . .Mental
Mental health fits into our Christian perspective as shown in the lower part of Figure 9:1 (Health….Mental). The definition of psychology includes the study of our Godlike mental processes, so mental health clearly fits on the lower right side of our perspective.
Although helping people to develop their Godlike attributes is our goal as Christians, this chapter will primarily be about the personality theories psychologists have developed to explain the psychological disorders people have as well as to provide guidance to treat such disorders.
Personality Theories
Personality is how all of the areas we have discussed are integrated in a whole person. Each of the systems of psychology discussed in the Prologue has an approach to personality so this section is specifically about psychoanalytic, humanistic, behavioral, and cognitive theories of personality. Three of these approaches were presented in the Prologue in terms of their assumptions, definitions, goals, and methods; but we will review them briefly here relative to personality theory.
Psychoanalytic
Freud maintained that the mind had three levels of consciousness.
· Conscious. What a person is aware of at the moment
· Preconscious. What a person can bring into consciousness at any time, commonly called memory
· Unconscious. Things that a person cannot bring into consciousness
Freud proposed three structures of personality.
· The id, which is an innate unconscious reservoir of energy seeking instant gratification. It operates on the pleasure principle.
· The ego, which is the rational part of personality on all three levels of consciousness. It develops as a child copes with the world. It operates on the reality principle, tries to gratify the id’s desires, and is basically what we have called cognition.
· The superego, which is the moral part of personality on all three levels of consciousness. It demands consideration of right and wrong and strives for perfection. It is basically what people call the conscience.
Because the id and the superego are often in conflict, the ego is frequently caught trying to resolve these differences so that the pleasure seeking id can be satisfied in ways acceptable to the superego. Of course, this all takes place unconsciously so that people have no idea why they feel anxious. However, as they develop through several psychosexual stages, people develop defense mechanisms to reduce the anxiety. More detail in Freud’s own words is available below.
A General Introduction to Psychoanalysis by Sigmund Freud, translated by G. Stanley hall (1920) is available at (http://www.questia.com/read/102189232?title=A%20General%20Introduction%20to%20Psychoanalysis).
Several more of Freud’s books are available at
http://onlinebooks.library.upenn.edu/webbin/book/search?author=freud&amode=words.
For further information about specific topics in psychoanalysis click on the following links to parts of Chapter 11 in Dewey’s on-line text.
Humanistic
As noted in the Prologue, Carl Rogers and Abraham Maslow became leaders in a movement to emphasize the Godlike aspects of human beings. This movement became known as humanistic psychology or the third force. Neither man developed a theory as complex as Freud’s, but they both emphasized positive aspects of persons. Since people are basically good, fundamentally free to make choices, basically rational, and aware of themselves, they will realize their potential if the right conditions are present in their lives.
Maslow emphasized helping people move through the steps in his hierarchy of needs toward the goal of self-actualization. Rogers believed that people could be helped by being genuine as well as experiencing acceptance and empathy. People who experience these grow toward reaching their potential.
Articles and books by Rogers and Maslow are not yet in the public domain to be posted on-line, but lists of their writings are found at http://www.nrogers.com/CRRBiblio.pdf, and http://www.maslow.org/sub/m_bib.htm. Many of the books are available on-line used at reasonable prices.
Behavioral
Behaviorists did not make major contributions to personality theory, but they did attempt to offer some explanations. John Dollard and Neal Miller wrote Personality and Psychotherapy in the early 1950s. They attempted to account for personality in an analysis of the stimulus-response psychology of the behaviorists at mid-century. However, rather than just beginning with behavioral concepts, they tried to provide an explanation of some to the psychoanalytic therapy of the day (http://nealmiller.org/?p=259). Therefore, they produced a book that appealed to neither the psychoanalysts nor the behaviorists.
A few years later Joseph Wolpe wrote The Practice of Behavior Therapy and promoted the technique of systematic desensitization. This was an actual application of the concepts of stimulus-response psychology to the analysis of personality and used behavioral techniques to treat people. Though failing as an overall approach to personality, behavioral techniques were soon united with some cognitive concepts and cognitive-behavioral therapy became very popular (http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy).
Cognitive
In the 1960s, George Kelly wrote A Theory of Personality, a cognitive theory, in a style that read like a geometry book with a general postulate and logically derived corollaries. It was virtually ignored; however, a few years later Aaron Beck began writing influential books with “Cognitive Therapy” in the title and founded the Beck Institute for Cognitive Therapy and Research (http://www.beckinstitute.org/). Cognitive therapy is firmly entrenched today but is often combined with other approaches as well, such as cognitive-behavioral or cognitive-social.
For further information about personality in general, click on the following links to parts of Chapter 11 in Dewey’s on-line text.
Disorders
Theories of personality are of interest in their own right, but most people use them to explain normal behavior and psychological disorders as well as to suggest treatments. Two common disorders among missionaries, as among people in general, are anxiety and depression (one of the mood disorders).
Anxiety Disorders
People with anxiety disorders worry more than usual. Rather than worrying only about such things as the unstable political situation or the safety of their children, they seem to be anxious about everything. They even worry about such things as car repairs and having enough money for retirement. Sometimes their hands get cold and clammy, and they begin to have trouble sleeping. They begin to wonder about such questions as these: Can I have anxiety if I am really committed to Christ? What causes anxiety? Will I ever get over it? What can I do to prevent and get rid of it? Some of these questions need consideration.
Can committed missionaries have anxiety? The first missionary, Paul, certainly did: “When I could stand it no longer, I sent to find out about your faith. I was afraid that in some way the tempter might have tempted you and our efforts might have been useless” (1 Thessalonians 5:5 NIV). Paul had only been able to teach the Scriptures for three weeks (Acts 17:2-3) before he was driven out of town, and he was concerned that the church would not last. The word for “stand it no longer” means “to cover, or conceal” (like a roof). Paul is saying that when he could conceal it no longer, he sent Timothy back to find out how they were doing (1 Thessalonians 5:1-2).
Paul had the same feelings about the Philippian church, the one he had started just before the church in Thessalonica. Paul wrote, “I think it necessary to send back to you Epaphroditus ….so that when you see him again you may be glad and I may have less anxiety” (Philippians 2:25-28 NIV).
This was a general feeling for Paul as a missionary. After a long list of stressful events, he wrote, “Besides everything else, I face daily the pressure of my concern for all the churches (2 Corinthians 11:28 NIV).
What does the Bible say about anxiety? Although the Bible has much to say about anxiety, the King James Version never uses the words “worry” or “anxiety,” but a modern translation does. Solomon wrote, “An anxious heart weighs a man down, but a kind word cheers him up” (Proverbs 12.25). Jesus also warned us that in the last days we must “Be careful, or your heart will be weighed down with…the anxieties of life” (Luke 21:34). Anxiety often results in depression, and both of these are most unpleasant emotions that distress us.
Not only is anxiety unpleasant, but it also has negative consequences in our lives. In explaining the parable of the sower Jesus pointed out, “The worries of this life and the deceitfulness of wealth choke it (the word), making it unfruitful” (Matthew 13:22). Wealth may not be a problem in the lives of missionaries, but the worries of life may well make them unfruitful. We will consider other things the Bible says about anxiety later.
Will I ever get over anxiety? Some people report feeling anxious all their lives, others just for several months or years. Stress often makes anxiety worse. Missionaries can control the level of their anxiety, but they must remember that some anxiety is a normal part of life, and they have to deal with it as it arises, perhaps on a daily basis.
What can I do about anxiety? The most important thing is to do something; do not just wait for it to go away. Notice that Paul did something about his concern for the Thessalonians. He sent Timothy to strengthen and encourage them. After that he wrote them letters. He did the same thing with the Philippians. When we pinpoint the cause of our anxiety,we should do something about it.
The Bible tells us to take our anxieties to God. Paul, who sent Epaphroditus to see the Philippians to reduce his anxiety, also told them, “Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God” (Philippians 4:6 NIV). Then God’s peace could come into their thoughts and feelings.
Peter also acknowledged that we will have anxiety and told us, “Cast all your anxiety on him because he cares for you” (1 Peter 5:6). The writer of Ecclesiastes said, “So then, banish anxiety from your heart” (Ecclesiastes 11:10).
Sometimes, however, even after putting our worries on God the physiological responses that are a part of anxiety still occur. Learning relaxation techniques such as the following can decrease these responses.
· Deep, relaxed breathing
· Tensing and relaxing muscles
· Shrugging and rotating your shoulders
Who can I see for help? If self-help does not work, the kind of treatment received depends on whom a person sees for help.
· Pastor. Missionaries, like other Christians, often think their feelings of anxiety and worry have a spiritual basis, indicating a lack of faith. Such feelings may, and a “spiritual check-up” with your pastor is a good place to begin. If this works, fine. But if it does not, then it is good to see a mental health professional.
· Psychologist/Counselor. Anxiety may be caused by your way of thinking about things. A psychologist or other counselor may be able to help you change your way of thinking, and such cognitive therapy may be an effective treatment for anxiety.
· Psychiatrist. Drugs, hormonal imbalance or other physical factors can cause anxiety. A psychiatrist is in the best position to evaluate such symptoms. A psychiatrist may also prescribe a minor tranquilizer to reduce intense anxiety temporarily so that you can learn to deal with it effectively.
Can I prevent anxiety? People can decrease anxiety by trying to take measures to prevent problems, but such actions seldom completely prevent anxiety. An example is Paul and the Thessalonians. He noted that he had tried to prepare them for the problems he knew were coming, “In fact, when we were with you we kept telling you that we would be persecuted. And it turned out that way, as you well know” (3:4). Thus Paul tried to anticipate problems, and he took steps to prevent the church from falling away. However, he still was not sure, and he sent Timothy to find out how they were doing. Even after Timothy’s encouragement and glowing report, Paul still said, “Night and day we pray earnestly that we may see you again and supply what is lacking in your faith” (3:10). He seemed still to have some anxiety about their faith, but it was no longer at the point where he could not stand it.
Missionaries can use their anxiety as a motivation to do something about the problem, which will often lower anxiety. This will be less distressing and make them more fruitful.
More information about anxiety is at http://www.missionarycare.com/brochures/br_anxiety.htm, and http://www.missionarycare.com/brochures/ss_anxiety.htm.
Also for further information about anxiety disorders click on the following links to parts of Chapter 12 in Dewey’s on-line text.
Mood Disorders—Depression
Depressed people realize that they have been feeling really sad, tired, discouraged about the future, unable to concentrate for some time, and they begin to wonder what is wrong. They just wish they could feel happy and enjoy life again. They begin to wonder about such questions as these. Certainly committed Christian missionaries could not be depressed, could they? Wouldn’t God keep them from that? Should you pray? See someone for counsel? See your physician? Will you get better? How long will you feel like this? Let’s consider some of these questions.
Can God’s people be depressed? Depression is the “common cold” of psychological disorders. About 20 of every 100 women and about 10 of every 100 men experience clinical depression at some time in their lives. Christians sometimes deny that they feel depressed, but many do, as did God’s choice people thousands of years ago.
· David, king: “How long must I wrestle with my thoughts and every day have sorrow in my heart?.…My life is consumed by anguish and my years by groaning; my strength fails because of my affliction” (Psalm 13:2; 31:10 NIV).
· Job, layman: “Why did I not perish at birth, and die as I came from the womb?….I have no peace, no quietness; I have no rest, but only turmoil” (Job 3:11, 26 NIV).
· Elijah, prophet: “I have had enough, Lord. Take my life; I am no better than my ancestors (1 Kings 19:4 NIV).
· Jonah, missionary: “O, Lord, take away my life, for it is better for me to die than to live” (Jonah 4:3 NIV).
Can committed missionaries today be depressed? Maybe heroes and heroines of the faith in Bible times became depressed, but what about some of our great missionary founders. Examples of what they said show their feelings:
· A. B. Simpson, founder of the Christian and Missionary Alliance: I fell “into the slough of despond so deep that…work was impossible…I wandered about deeply depressed. All things in life looked dark and withered.”
· Adoniram Judson, missionary to Burma: “God is to me the Great Unknown. I believe in him, but I find him not."
· Mary Morrison, wife of Robert Morrison (China) Robert wrote, “My poor afflicted Mary…She walks in darkness and has no light.”
· David Brainerd, missionary to native Americans: “I live in the most lonely melancholy desert….My soul was weary of life. I longed for death, beyond measure.”
Will I ever get over depression? The good news is that although depressed people often feel so bad that it seems hopeless, most people recover from their depressions in a few months to a year or more without professional help. Depressions come, and, usually within months, they go. The bad news is that when people become depressed, the condition may interfere with their work and relationships. Some become so hopeless that they may try to take their own lives before they start to improve. Some types of depression do not get better without treatment; in fact, they can get worse. Other bad news is that about half the people who have depression once have it again.
What can I do about depression? Many people begin by trying to treat it themselves. Here are some things you might do:
· If you have not been doing all the things listed below as preventives, do them.
· Replace negative with positive thoughts.
· Keep a journal of what you think and feel.
· Give yourself affirmations.
· Listen to relaxing music.
· Get more light or less heat.
· Change your normal routine.
· Set realistic goals and record reaching them weekly.
Who can I see for help? If self-help does not work, the kind of treatment you receive depends on whom you see for help.
· Pastor. Missionaries, like other Christians, often think their feelings of sadness, guilt, and worthlessness have a spiritual basis. A talk with your pastor for a “spiritual check-up” is a good place to begin. If this spiritual treatment works, fine. But if it does not, then it is good to see a mental health professional.
· Psychiatrist. Depression may have as its cause a chemical imbalance, and psychiatrists tend to emphasize chemical treatment. If your depression is caused by your blood pressure medication, for example, that may need to be changed. If you have an imbalance in the serotonin in your brain, an antidepressant, such as Prozac or Zoloft, may help.
· Psychologist/Counselor. Depression may be caused by your way of thinking about things. Cognitive therapy, which helps you change the way you think about things, is widely used by psychologists and other counselors, and it may help your depression.
We have come to expect instant fixes for any problems we have, and people must be aware that none of these professionals can bring about a cure in a few days. All of these usually take several weeks, but they do often shorten the depression. In addition, depression may have several causes, so that people need several different kinds of treatment at the same time. They can pray long, but if depression is a result of their way of thinking or a side effect of a medication, God may answer prayer through counseling and/or appropriate medication.
More information about depression is at http://www.missionarycare.com/brochures/br_depression.htm, and at http://www.missionarycare.com/brochures/ss_depression.htm.
Also for further information about mood disorders click on the following links to parts of Chapter 12 in Dewey’s on-line text.
Schizophrenia
Some people become so disturbed that they lose contact with reality.
· They may have disorganized thinking in which they have false beliefs called delusions, such as that they are Jesus Christ. No matter what evidence is given, they continue to believe.
· They may have disturbed perceptions in which they have hallucinations, sensory experiences with no stimulus. They hear things or see things that are not there.
· They may express emotions that are completely inappropriate for the situation, such as laughing when told that a family member has died or becoming sad when told that someone has donated large amounts of money to their support.
For further information about schizophrenia click on the following links to parts of Chapter 12 in Dewey’s on-line text.
Personality Disorders
Personality disorders are long-lasting, inflexible behavior patterns that disturb social functioning. Because they persist for so long and interfere with group functioning, they are difficult for missionaries. All of them are difficult, but probably the most disruptive is the borderline personality disorder. Such people soon become “high maintenance” in that their instability soon requires all the time of people in leadership over them (http://www.nimh.nih.gov/health/publications/borderline-personality-disorder-fact-sheet/index.shtml).
For further information about personality disorders click on the following links to parts of Chapter 12 in Dewey’s on-line text.
Finally, remember that disorders are culturally defined, change with the context, and change from time to time. People in some cultures go around naked all the time while in other cultures they would be arrested for doing so. People in many cultures may consider killing other people to be unacceptable, but when war breaks out with another tribe, killing people from that tribe may be highly desired.
In the United States homosexual activity was considered a disorder from 1952 through 1973. However, in December of 1973 enough members of the American Psychiatric Association no longer viewed it as a disorder, so it just became an alternate lifestyle. In the 1960s a child who tended to get distracted, was restless, and interrupted was called rambunctious or perhaps labeled as having “Minimal Brain Dysfunction.” However in 1980 the American Psychiatric Association viewed it as a disorder and called it attention-deficit hyperactivity disorder (ADHD), now a common diagnosis for active children.
For further general information about disorders click on the following links to parts of Chapter 11 in Dewey’s on-line text.
Therapy
As mentioned previously, each theoretical approach to personality has proposed what causes psychological disorders and suggested what needs to be done to treat those disorders.
Psychoanalytic
Psychoanalytic approaches to personality propose that the causes of psychological disorders are conflicts at the unconscious level, often as a result of past experiences. Therefore these approaches use methods which they believe will reveal what is going on in the unconscious. Since people cannot directly access their unconscious voluntarily, psychoanalysts use methods such as the following.
· Free Association. Patients relax and say whatever comes into their minds whether or not it is “acceptable.”
· Dream Analysis. Patients report their dreams and psychoanalysts “interpret” what the covert content of the dreams means about the unconscious conflicts.
· Interpretation of Resistance. If patients hesitate during a session or “forget” to come to a session, psychoanalysts interpret this as resistance to allowing something into consciousness.
Using these and related means of getting at what is happening in the unconscious, psychoanalysts say that patients improve.
For further information about psychoanalytic therapy click on the following links to parts of Chapter 13 in Dewey’s on-line text.
Humanistic
Humanistic approaches to personality assume that people have innate resources for growth toward actualization of their potential. Disorders are caused by something not allowing this growth to occur. Humanistic psychologists also emphasize the future rather than the past, consider conscious thoughts, and help clients accept responsibility for their own lives. Though they do not restrict themselves to particular methods, humanistic therapists emphasize acceptance, empathy, and genuineness.
For further information about humanistic therapy click on the following links to parts of Chapter 13 in Dewey’s on-line text.
Behavioral
Behaviorists assume that the cause of psychological disorders is that people have learned incorrect responses at some time in their past. Of course, the obvious thing is to have the people learn to stop making these incorrect responses or to have them substitute appropriate responses in their place.
The “Learning” section of chapter five contains descriptions of how techniques of both classical conditioning and operant learning are applied to extinguish some responses and reinforce others to make them more likely.
For further information about behavioral therapy click on the following links to parts of Chapter 13 in Dewey’s on-line text.
Cognitive
Cognitive theories of personality propose that psychological disorders are the result of faulty thinking. People who hold incorrect beliefs about themselves and others or who have faulty ways of thinking about what happens to them develop disorders. Their faulty thinking leads to inappropriate emotions and behavior.
Of course, the way to help these people is to correct their beliefs about themselves and their ways of thinking. Psychologists may challenge incorrect beliefs and teach better ways of thinking.
For further information about cognitive therapy click on the following links to parts of Chapter 13 in Dewey’s on-line text.
As mentioned previously psychologists often combine these major approaches, and they have also developed other[YM1] theories of personality. In addition, psychiatrists treat the same disorders, usually from a physiological perspective. Psychiatrists often maintain that the disorders are caused by a chemical imbalance in the body so they often prescribe psychoactive drugs to correct that imbalance.
This is often confusing to missionaries who are looking for help. They do not know what is wrong—they just want something to help. Here is information for those people.
Counseling for Missionaries
Suppose you have been struggling with a problem for some time and cannot seem to solve it. You have thought about going to someone for counseling, but you have reservations. Does that mean there is something wrong with you? What does the Bible say? To whom do you go? Will what you say get back to headquarters? Here are answers to some of these questions.
Does needing counseling mean that something is wrong with me? In our individualistic culture, some people believe that if you need help solving a problem, then you must be weak, not spiritual enough, or even mentally ill. That is not the case. We all need help from others just to know how to solve some of the normal problems that are a part of life. How should I discipline my children? What is my responsibility to my aging parents? How can I solve this conflict with my spouse?
A counselor will not make the decision for you but will help you explore your dilemma to make the decision. He or she may provide information, suggest action you can take, explore the implications of the various options you have, and so forth.
What does the Bible say about counseling? The Bible makes it clear that you may receive good or bad counsel, and it is up to you to seek out good counsel. Christ was called the “Wonderful Counselor” (Isaiah 9). As Jesus was leaving, he promised “another Counselor” would come to be with us forever, the Holy Spirit (John 14-16). This other comforter, the “Paraclete” is “one called or sent for to assist another.” A counselor is basically a helper, one to come alongside in time of need. We are repeatedly urged to seek counsel from the Lord.
In addition, we are told to have many counselors at the human level. Even Solomon with all his wisdom often advised having counselors, many counselors (Proverbs 11:14, 12:15, 13:10, 15:22, 20:18, 24:6). Of course, we are also warned not to take the counsel of the wicked.
What kind of counselor should I see? There are more than half a dozen different types of people you may choose. All will counsel you, but various ones have different “tools” they are more likely to use.
· Wise lay person. You may simply want to talk with someone you believe has experienced much in life and is very wise. This person is likely to give advice and urge you to take a particular course of action.
· Pastor/pastoral counselor. People in this role are likely to look for spiritual problems and are more likely to pray with you, lay hands on you, anoint you with oil, or apply Scripture to your situation.
· Clinical psychologist /counseling psychologist / counselor. These individuals are most likely to talk with you and help to detect problems in your thoughts, feelings, and behaviors.
· Clinical social worker. This individual is likely to look at your relationships with others as a source of your problem.
· Psychiatrist. This is a person trained as a physician and is more likely to look for a physical basis for your problem, to give you medication to improve your thinking or emotional balance.
Ideally all of these individuals should look at all causes, spiritual, psychological, social, and physical, but each has his or her emphasis. You may even want to talk to two at the same time, telling each that you are seeing another. Find someone who is competent, in whom you have confidence, and to whom you can relate.
If the person you first talk with is unable to help, feel free to see someone else. Of course, continue with the first person long enough to find out whether or not the treatment works. All approaches may take several sessions for noticeable improvement to occur.
Should I see someone inside or outside the mission? This is up to you. The important thing is to find a competent person to whom you can relate, and these kinds of people are found both within mission organizations and outside them. It is a matter of personal preference, but find someone who really listens—to be heard often means to be healed.
One study found that a person’s missionary status influenced whether counsel was preferred from within or outside the organization. Missionaries in candidacy or pre-field orientation tended to prefer counsel from someone within the organization. Missionaries who had experienced significant difficulties on the field preferred counsel from someone not affiliated with the mission.
Should I see a professional? Again, this is up to you. The idea that persons are qualified to give counsel only because of their education and credentials from a governmental agency is a modern Western one. For most of history, people simply sought counsel from those they perceived as wise.
Today agencies license or certify professionals who have met specified educational standards and have had a minimum of supervised experience. These credentials assure you that the person has met the criteria of some board of the state.
Dozens of studies have been done comparing professional and paraprofessional helpers, and the research has usually not found significant differences in the outcome of the two. The paraprofessionals, people with some counseling training, were usually just as effective as the professionals in helping people resolve most problems.
Of course, if you are thinking about harming yourself, see a professional who can evaluate how likely you are to do so and who can take effective steps to prevent harm.
Will what I say be kept confidential? That is something you want to establish before you begin talking about your issue. This is usually done at the first session when you will be given an informed consent statement if you see a professional. This statement should have in writing the procedures that will be followed while you are seeing the professional, including the confidentiality policy.
In most states in the USA professionals are legally required to break confidentiality if harm is involved or if ordered to do so in a court of law, such as in a custody dispute for children.
Most informed consent statements will have the following limitations on confidentiality:
· If you say you intend to harm yourself, the counselor will take whatever steps are necessary to prevent that, including telling others.
· If you say you intend to harm someone else, the counselor will inform the intended victim and authorities where you live and where the intended victim lives.
· If you report abuse of some helpless person, such as a child, or aging adult, the counselor will report that to protective services.
· If a judge compels a counselor to reveal something in court, most counselors will do so.
Of course, the informed consent statement may include other conditions as well, so read it carefully before signing it. The statement is meant to make it clear to all involved when confidence will be broken.
If someone else (insurance company, governmental agency) is paying for you to be counseled, they will at least be told that you are talking to the counselor, and most require some diagnosis as well. That becomes a part of your medical record.
More information about counseling is at
http://www.missionarycare.com/brochures/br_counseling.htm.
Member Care
Missionaries may have heard about member care, but wonder about it. They are doing all right and wonder why anyone would need help. What is member care anyway? Since God cares for them, why would missionaries need member care from other people? If missionaries did need it, who would give it to them? How would missionaries go about getting such care, if they ever did need it?
What is member care? Many words can be used to describe what takes place in member care. Some of those words are friendship, encouragement, affirmation, help, and fellowship as well as sharing, communicating, visiting, guiding, comforting, counseling, and debriefing. All of these, and more, are facets of member care given by someone who understands the special needs of missionaries.
Of course, all Christians have the care given by the Holy Spirit, the one whom Jesus promised in John 14-16. Translated “comforter,” “counselor,” or “advocate,” the Greek word (paraclete) literally means one called or sent for to assist another, someone who has been invited to stand by our side.
In addition to the Holy Spirit, God often uses other people to come alongside and help us, whether we are missionaries or in other vocations. Most people in the passport country have others they can call on for help, whether pastor, counselor, or friends in a small group—such as a Bible study group. Among missionaries who are members of some mission agency or church, the term used for this process of having someone come alongside to offer help is “member care.” This may be something as routine as a regularly scheduled visit from a pastor asking, “How are you doing?” Or it may be as rare as a psychologist rushing to get to an individual within a couple days for a trauma debriefing to help prevent post-traumatic stress disorder.
Who needs member care? In modern individualistic western cultures where people learn to “make it on their own,” even Christians may believe that they do not need help from anyone except God. They may believe that asking for help is a sign of immaturity or weakness, a lack of faith or spirituality, or perhaps a symptom of illness—either mental or physical.
At the training sessions during the orientation of his twelve disciples Jesus told them where to go, what to take, what to do, and how to deal with conflict. He was not kidding when he went on to tell them to be on their guard because he was sending them out like sheep among wolves (Matthew 10). Today as many face the wolves of missionary life whether they are malaria, dengue fever, parasites, depression, anxiety, conflict, burnout, grief, guilt, temptations, assault, the violent death of a colleague, or demonic forces, they may need someone to come and stand by their side.
At the similar orientation session for the seventy-two others, Jesus sent them out in twos (Luke 10). No one went alone. First Church in Antioch commissioned Paul and Barnabas to leave on their first term (the first missionaries), and as they left, John went with them as well (Acts 13). When Paul and Barnabas could not agree on who should go along with them on their second term, they parted company and went out as two missionary teams of two each (Acts 15). There were no “Lone Rangers” (even the Lone Ranger had Tonto, his national companion). Instead of being a sign of weakness, a lack of faith, or a symptom of illness, asking someone for help is a sign of normality, reality, and health.
Who gives member care? Of course, anyone who cares can give member care. It may be a high school friend, a distant relative, a retired neighbor from your childhood, or anyone else. However, most often member care comes from four major sources.
· Your Sending Church. Ideally much member care comes from your home church. Members can send letters, call you by telephone, send packages of special things you miss, communicate with you by e-mail, and come visit you. Unfortunately, in these days of much education (going to college and then to seminary) missionaries often lose close connections with their home churches. They may have not really bonded with the last church attended before going overseas so that the churches commissioning them may not really feel like their sending church. Thus they may receive little member care.
· Other Missionaries. The people most likely to deeply understand what you are going through and be able to empathize with you are other missionaries. The missionaries you work with are the ones best able to come alongside, but if you share too much, that may affect your working relationships. You may be able to form a bond with missionaries from other agencies in the area, if there are others nearby.
· Your Agency. Many medium-size and large agencies now have people whose assignment is to give member care. These may be pastors, veteran missionaries, counselors, and so forth. They may be at centers in different parts of the world, or they may travel from country to country giving care to missionaries in that agency.
· Member Care Specialists. At times you may prefer to talk with someone completely outside your agency. You may have personal problems that you do not want to share with anyone in the agency or for which you think there is no help in the agency. Pastors, counselors, social workers, psychologists, and psychiatrists who specialize in missionary care are available to come alongside and help.