A biblical response to the psycho-secular view of depression
A flood of depression is now overwhelming both the church and society as a whole. According to the World Health Organization clinical depression is a leading cause of disability in the UK and other Western nations. Such is the size of the problem that in the UK over 30 million prescriptions for anti-depressants are issued each year. Depression is now so common that GPs are required to screen patients for symptoms of the illness. Psychiatrists see more people suffering from depression than from all other emotional problems put together.
Â To deal with the growing number of depressed Christians many churches are now organizing seminars to give church leaders and congregations advice on how to deal with the problem. Some pastors consider the issue to be so important that the whole church is encouraged to attend a depression seminar. A recent New Word Alive conference held a seminar on depression which estimated that 25% of women and 10% of men in churches are suffering with depression. Â
The burden of depression can be judged by the large number of books on the subject that are available from the local Christian book shop. A search of Wesley Owen website produced 93 titles, which includes the following: How to Win over Depression; Pathways Through Depression; 100 Ways to Overcome Depression; Seeing Beyond Depression; New Light on Depression; Victory Over Depression; Finding Your Way Through Depression; Comfort for Depression; Living with Depression; Coping with Depression and so on.
Â In this article I describe the secular ideas behind the growth of depression before considering a biblical response. In doing so, we are entering what many will regard as a highly controversial arena. Depression is now so common that there is hardly a family in the UK or USA that is not in some way affected. Moreover, to even question the reasons for the growth of depression is seen as unsympathetic. Yet there is something wrong when we see churches arranging seminars, run by counsellors and psychiatrists, to deal with their depressed congregations.
Â In my research into the Christian counselling movement, using my experience as a doctor and public health specialist, I have sought to understand the epidemic that is now engulfing the church. I believe that the Christian response to depression has become confused and influenced by secular ideas. So I would ask you to bear with me, as I seek to explain a biblical response.
Â Depression seminars, usually given by Christians with experience in counselling, emphasize two things. The first is that Christians suffer with depression just like everybody else. The second point is that clinical depression is a disease just like diabetes or cancer, often caused by a chemical imbalance in the brain. Therefore, Christians suffering from clinical depression are sick and need to be treated. The cure is to have suitable counselling and, if necessary, to take anti-depressants.
Â So how can we make sense of this growing emphasis on depression in the church? Fifty years ago, when I was a medical student, recognizable clinical depression was a relatively rare condition. In the first part of the 20th century only two syndromes were mentioned in psychiatric text books, the depressive phase of manic depression and severe depression in old age known as involutional melancholia. When the first antidepressant was developed in the 1950s, the drug manufacturer Geigy was reluctant to market it, judging that there were not enough people with depression to make the drug profitable.
Â But times have changed and the last four decades have been characterized by a growing interest in the subject, spurred on by the growth in the mental health industry and the development of an increasing number of antidepressant drugs.
Â The criteria for depression are laid down by the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association. The third edition of the Diagnostic Manual (DSM-III), published in 1980, created an entirely new way of looking at depression by introducing a descriptive symptom-based approach to mental disorders. The list of symptoms for establishing a diagnosis of clinical depression was constructed from the majority opinion of mental health specialists. In other words, the diagnostic criteria are now based on the opinions of psychiatrists and psychological counselors and not on any objective diagnostic criteria. Depression is now diagnosed by a long list of symptoms created by the profession that stands to benefit from increasing the number of depressed people in society.
Â According to the American Psychiatric Association âdepression is a serious medical illness that negatively affects how you feel, the way you think and how you act. Depression has a variety of symptoms, but the (two) most common are (first) a deep feeling of sadness or (second) a marked loss of interest or pleasure in activities. Other symptoms include: changes in appetite that result in weight losses or gains unrelated to dieting, insomnia or oversleeping, loss of energy or increased fatigue, restlessness or irritability, feelings of worthlessness or inappropriate guilt, difficulty thinking, concentrating, or making decisions and thoughts of death or suicide or attempts at suicide.â
Â Under this regime, the diagnosis of depression is highly arbitrary and totally subjective. Diagnostic problems abound. Take inappropriate guilt. By what criteria does a psychiatrist differentiate between inappropriate and appropriate guilt. Moreover, it is difficult to separate depression from the mood changes that are part of life. We must underline the fact that there are no clear, objective diagnostic criteria. There is no physical sign, blood test or X-Ray that can confirm the diagnosis. All depends on what the client says and how the psychiatrist or counselor interprets the symptoms.
Â Professor of Psychiatry, Gordon Parker, in an article in the British Medical Journal argues that depression is being hopelessly over diagnosed. He gives as an example a study of 242 teachersâover time ninety-five percent reported symptoms and feelings that were consistent with a diagnosis of depression. Parker argues that a low threshold for diagnosing clinical depression risks treating normal emotional states as illness.Â
Â Here it is important for us to recognize two essential characteristics of the model of depression constructed by the American Psychiatric Association. First, we must understand that the model is secular in approach, in that it ignores the spiritual dimension of life. Second, it is psychological in orientation in that it is based on the ideas and opinions of people working in the mental health industry. As a secular, psychological model it sees depression as a serious medical illness.
Â The term psycho-secular accurately describes this view of depression. The diagnostic criteria are so broad and non-specific that a large section of the population is at risk of being labelled clinically depressed. A direct consequence has been a massive increase, over the last four decades, in the number of people diagnosed with depression. It seems highly likely that depression is being over diagnosed. The mental health industry has succeeded in medicalising human misery, sadness and unhappiness. Here I must point out that there are some cases of manic depression that do constitute a true mental illness.Â Â Â
Â The Chemical Imbalance Hypothesis
As we have already seen, the idea of a chemical imbalance is widely accepted as an important underlying cause of psycho-secular depression. According to this theory, a chemical imbalance of the neurotransmitters in the brain causes depression, just like a low level of insulin causes diabetes. The chemical imbalance theory, not surprisingly, is widely quoted by drug companies that produce anti-depressant drugs. They claim that their drugs cure a chemical imbalance.
Many Christian seminars on depression in the UK teach that Christians are just as prone to a chemical imbalance as anyone else and therefore need the benefits that come from anti-depressant drugs.
Â However, both the drug companies and the Christian counselling movement are presenting a misleading picture, for the chemical imbalance hypothesis is not supported by the scientific evidence. Dr Joanna Moncrieff, Senior Lecturer in Psychiatry at University College London, in her book The Myth of the Chemical Cure (2007) exposes the view that psychiatric drugs correct chemical imbalances as a dangerous fraud. She says: âIt is high time that it was stated clearly that the serotonin imbalance theory of depression is not supported by the scientific evidence or by expert opinion. Through misleading publicity the pharmaceutical industry has helped to ensure that most of the general public is unaware of this.â
Â Dr Moncrieff makes the point that the chemical imbalance theory supports the vested interests of the psychiatric profession, the pharmaceutical industry and the modern state, and argues that âthe marketing of antidepressants has persuaded a large proportion of the population of Western countries to take prescribed drugs to deal with the problems of living.â She explains that the view that drugs can cure problems make people see themselves as powerless victims of their biology and this stores up untold misery for the future when they come to realize that their problems have not gone away.
Â In view of the lack of scientific evidence to support the chemical imbalance hypothesis, the Irish Medicines Board has recently banned GlaxoSmithKline from claiming in their patient information leaflets that paroxetine (Paxil) corrects a chemical imbalance.
Professor David Healy of the North Wales Department of Psychological Medicine, said: âThe serotonin theory of depression is comparable to the masturbatory theory of insanity. Both have been depletion theories, both have survived in spite of the evidence, both contain an implicit message as to what people ought to do. In the case of these myths, the key question is whose interests are being served by a widespread promulgation of such views rather than how do we test this theory.â
Â Cognitive Therapy (CT)
Having accepted that depression is an illness, many therapists, both secular and Christian, now believe that cognitive therapy is the most effective treatment. Such is the enthusiasm for CT that the British Government has launched a major initiative to train around 3,600 therapists over the next few years in the hope that almost a million patients can receive treatment for depression on the National Health Service. The Department of Health hopes that CT will become the most widely used talking therapy in the Health Service.
Â Church based seminars make a special point of emphasizing the benefits of CT. I attended one such event where the Christian psychiatrist giving the talk recommended a Christian self-help book, Iâm not supposed to feel like this (2002), to the congregation. The authors, two Christian psychiatrists and a Baptist pastor, claim that the principles of Cognitive Behaviour Therapy are a proven and effective treatment that is fully compatible with the Christian faith. A review of the book in Evangelicals Now said that CBT might just as well be called Christian and Biblical Therapy when explained from a Christian standpoint.
Â The founders of CT are Albert Ellis and Aaron Beck. Both understood that beliefs influence behaviour and claimed that mental illness is caused by irrational beliefs.Â Aaron Beck claims that core beliefs that are framed in absolute terms often make us feel depressed and anxious. Beckâs view of absolute rules is similar to that of Ellis, although perhaps not expressed in such intemperate language. The aim of CT is to remoulded moral absolutes to make them more flexibleâto do away with absolute âoughtsâ, âmustsâ and âshouldsâ.
Â The aim of the therapist is to make people feel better by challenging their core beliefs. Any belief that produces anxiety or guilt must be realigned. Self-criticism and self-blame are unhelpful and must be corrected. There is no acceptance that the reason people feel depressed is because their actions have been wrong. So the ultimate aim of CT is to help a client achieve self-improvement through remolding their irrational core beliefs. The therapist is prepared to challenge Godâs moral law in order to sooth a conscience disturbed by wrongdoing.
Â An example will illustrate the amorality of cognitive therapy. A married woman goes to see a therapist because she feels depressed after having an affairâ she feels that adultery is wrong and she is troubled by her conscience. The therapist identifies her extreme core beliefs about adultery as the cause of her depression. She is helped to remould her beliefs so that she no longer believes that an affair is always wrong, but that it depends on the circumstances. The therapist says that her self-blame is irrational, for she was in love and just expressing her true feelings. He convinces her that she is suffering from false guilt and persuades her to see her affair as a positive experience. The therapist helps her to change her moral position on adultery and this is supposed to make her feel better.Â Â
Â The two masters of CT, Aaron Beck and Albert Ellis, met for the first time at Convention of the American Psychological Association in 2000. In the discussion that followed it became clear that they were at one in understanding that belief systems underlie behaviour. They agreed that absolute moral laws, that tell us how we should behave, must be changed through cognitive strategies.Â Ellis believes that a true faith in God is a form of mental illness.
Â The Christian version of cognitive therapy is essentially the same as that used by secular therapists. But it is a grave error to teach that the thoughts and beliefs of a Christian need to be remolded by a cognitive therapist, and not the word of God.
Â Can a Christian benefit from cognitive therapy? Should we trust the therapistâs view of our core beliefs? The answer to these questions is no, for the cognitive therapist does not acknowledge that sin causes guilt and misery. His therapy is to persuade us to feel good in our sin. He leads us away from Godâs word, and encourages selfishness, irresponsibility and amorality. Churches that embrace CT and encourage Christians to place their hope in the doctrines of Ellis and Beck are in serious error.
Â Christian counselling movement and depression
Before considering a biblical response to depression, we need to understand that the Christian counselling movement is committed to the psycho-secular view of depression. Gary Collins, in his book Christian Counseling, a comprehensive guide, claims that Christians, like everyone else, get depressed. Â He reinforces this statement by referring to men of God who were depressed, quoting the examples of Job, Moses, Jonah, Peter and the whole nation of Israel. He also refers to the passion of Jesus in the Garden of Gethsemane as an example of depression in the Bible. The implication is that these men of God, and even our Lord, suffered with psycho-secular depression. Therefore itâs okay for ordinary Christians to suffer with depression.
Â Collins attacks those who do not support his view. âThe teaching of some well-intentioned Christian leaders seems to make the depression worseâŚ When people are told to âtrust in God and the depression will go away,â there can be guilt and deeper discouragement if the depression persists.â Those who, like Collins, hold this position argue that it serves no useful purpose to quote the Bible, for a person suffering with depression is unable to benefit from Scripture, indeed to do so might actually make the depression worse. But this is a false view. Scripture shows that God spoke to Job in his despair, to Jonah in his anger, to Elijah in his despondency, to Peter in his remorse and to David in his misery after his adultery with Bathsheba.
Â The Christian counselling movement has inculcated the psycho-secular view of depression right into the heart of Christendom. This is why so many churches are now having seminars on depression for their congregations. This is why books on how to overcome depression are best-sellers. Many Christians accept at face value the view of depression developed by the world of psychiatry, and then turn to Scripture to try and make sense of the condition. But this is the wrong approach, for we should start with Scripture, not with the wisdom of the age that comes from experts in mental illness.
Â As a consequence there is now great confusion around the issue of depression in the church. A vast range of conditions, feelings, disorders, emotions and symptoms have been lumped together into the catch all basket of depression. Adding to the confusion is the fact that the mental health industry has used the word âdepressionâ to describe a range of emotional responses. The result is that human emotions, which all people experience as part of life, have become medicalised. Now when a person feels sad, miserable or upset they are candidates for inclusion into the depression net. To understand the issue of depression we must start with the Scriptures.
Â The Fall and emotional suffering
It is clear from Scripture that man, created in the image of God, has an emotional aspect to his personality. In his state of innocence in the Garden of Eden, man was in a state of emotional bliss, for all that God had created was very good and man was without sin. Adam and Eve were perfectly content, for they knew the joy of communion with God.Â
Â When Adam and Eve sinned they became separated from the presence of God and spiritually dead. Their emotional life was seriously impaired, for they felt afraid, ashamed and guilty. Their relationship became stressful as Adam blamed his wife for their condition. Life outside Eden, banished from Godâs presence, was difficult, frustrating, painful and sorrowful. Men strove to rule over women. Brothers were filled with envy, anger and hatredâan angry Cain killed his brother Abel. The Fall had a catastrophic affect on human emotionsâhenceforth all people would experience emotional despondency and suffering.
Â Adam and Eve, if they had filled in a screening questionnaire, would have been diagnosed as suffering with âclinical depressionâ, and a psychotherapist would have prescribed a course of cognitive therapy. But Scripture teaches that their wretched condition was caused by their spiritual separation from God. They needed a Saviour not a therapist.Â
Â So to understand emotional suffering we must see it in the context of the Fall. In his systematic theology Robert Reymond explains âEvery part of his beingâhis mind, his will, his emotions, his affections, his conscience, his body â has been affected by sin (this is what is meant be the doctrine of total depravity). As a result of the Fall, manâs body is subject to disease and decay. We see this in diseases such as epilepsy, schizophrenia, dementia and manic-depressive illness. There is a small group of people who suffer with genuine mental illness.Â Â
Â Here then is a fundamental truth. The emotional integrity of man has been shattered by the Fall. All people, because of their sin, are subject to emotional suffering, described in Scripture by various terms, such as a downcast soul, bitterness of soul, sorrowful spirit, grieving heart, anguish of the soul. The mental health industry, however, has medicalized emotional suffering by moving it from the spiritual realm into the secular arena. The result is that emotional suffering is no longer a spiritual condition of the soul, but a disease of the mind that needs medical treatment. Human misery and unhappiness now lie firmly in the secular domain of the psychotherapist and psychiatrist.Â Â Â Â
Â Emotional suffering in Scripture
Emotional suffering is a recurring theme throughout Scripture. We can identify three broad categoriesâthe first is the sorrow of the soul that comes from living in a fallen worldâwhat Scripture describes as a downcast soul. The second is the emotional suffering associated with adverse circumstances, such as that experienced by Job and Hannah, and the third is emotional suffering caused by personal sin. However, these are broad categories with considerable overlap, for all people are subject to the suffering that results from living in a fallen world, and adverse circumstances and sin often go together.
Â Sorrow of the soul
Scripture gives many examples of godly men who experienced sorrow of the soul. When Jacob was told that his son Joseph had been devoured by a wild beast he refused to be comforted and said, âI shall go down into the grave to my son in mourningâ. In Lamentations the prophet Jeremiah expresses profound emotional despondency because of the great disaster that has come upon Jerusalem. In his distress the prophet wrote: âMy eyes bring suffering to my soul because of all the daughters of my cityâ (Lamentations 3:51). Nehemiah wept, mourned and was sad for many days when he learned that the wall of Jerusalem was broken down. In a similar way, we live in a fallen world in which we experience the suffering and sadness caused by disease, bereavement, natural disasters, accidents and congenital abnormalities and âwe groan within ourselvesâ (Romans 8:23).Â Â
Psalms 42 and 43 give a clear description of spiritual despondency among Godâs people. The psalmist is in despair because he is far from the house of God. And so he asks: âWhy are you down cast, O my soul? Why are you disquieted within me?â (Psalm 42:5). He is reproached by his enemies with the continuous taunt âWhere is your God?â In a moment of despair the psalmist feels abandoned by GodââWhy have you forgotten me? Why do I go mourning because of the oppression of the enemy?â (Psalm 42:9).
Â The psalmist finds the answer to his spiritual despondency in a heart felt prayer to his God. âOh, send out your light and your truth! Let them lead me; let them bring me to your holy hill and to your tabernacleâŚ Hope in God; for I shall yet praise himâ (Psalm 43:3, 5).
Â Notice the response of the psalmist. First, the he comes to his senses and remembers the promises of the God whom he serves. He does not give in to his feeling of despair but rather takes himself in hand and wrestles through his despondency. Second, the psalmist challenges his emotionsââWhy are you downcast, O my soul?â He tests his emotional response and decides that he should be led by the light and truth of Godâs word, not by his emotions. His hope is in the living God, the God for whom his soul thirsts (Psalm 42:2).
Â Scripture teaches that the soul, the inner essence of each living being, is the seat of emotional suffering; it is not a chemical disturbance in the brain that causes a man to be downcast. The message of Scripture is that the cure for emotional suffering does not lie in ourselves or in psychological counselling but in trusting the promises of God. God has created the soul of man, and God alone can heal a broken downcast soul.Â
Â Adverse circumstances
Both New and Old Testament provide examples of emotional suffering related to adverse circumstances. In his second letter to the Corinthians, Paul describes his suffering in the cause of Christâthere are over thirty references to the stress and despair that the great apostle endured in the name of Christ. Paul wants the Corinthian church to know of the great hardship, both physical and emotional, he suffered during his missionary journey in Asia. Such were the sufferings and troubles of Paul and his companions that they âwere burdened beyond measure, above strength, so that we despaired even of lifeâ (2 Corinthians 1:8). But God allowed this to happened, according to Paul, âthat we should not trust in ourselves but in God who raises the deadâ (2 Corinthians 1:9). Paul not only accepted suffering as a part of serving Christ, he viewed it as a privilege to suffer for his Lord. He wanted to know Christ, and to share in the fellowship of His sufferings, for he knew that Godâs grace was sufficient.
Â Godâs servant Job went through extreme emotional suffering because of the tragic events that God allowed Satan to afflict on him. His suffering was so severe that he cursed the day he was born. Job experienced fear, misery and dread; he sighed and groaned in despair (Job 3). Despite his doubts in trying to understand how God had allowed him to suffer so much, Job retained his faith in God. A Christian suffering with emotional despondency, caused by adverse circumstances, has much to learn from the example of Job, a man whose faith in God did not waver even in the face of the most terrible suffering. Jobâs testimony is given for our comfort.Â
Â The prophet Jeremiah experienced adverse circumstances when his life was threatened, and he was put in the stocks, and later thrown into a dark muddy pit. In his emotional struggle he cursed the day he was born. Jeremiah was able to gain victory over his emotional suffering through his faith in Godâs promises. When he faced the greatest stress, when his adversaries were waiting for him to slip so that they could prevail over him, when all was against him, Jeremiah had this testimony, âThe Lord is with me as a mighty, awesome Oneâ (Jeremiah 20:11). He placed his faith in his Lord who had said, âBlessed is the man who trusts in the Lord, and whose hope is the Lord.â
Â In Psalm 55 King David describes his intense emotional turmoil, probably caused by the rebellion of Absalom and the betrayal of his friend and counsellor Ahithophel. âMy heart is severely pained within me, and the terrors of death have fallen upon me, fearfulness and trembling have come upon me, and horror has overwhelmed meâ (Psalm 55:4-5). Having given voice to his emotional suffering, David calls upon God â âAs for me, I will call upon Godâ (v16). He casts his burden on the Lord, for he trusts that the Lord will sustain him (v22) and concludes his lamentââBut I will trust youâ (v23). The testimony of David confirms the biblical approach to victory over emotional despondency.
Â The biblical answer to emotional suffering that comes from adverse circumstance is to cleave to God and trust his promises. While we cannot always understand why God allows his people to suffer adverse circumstance, we must, like Paul, Job, Jeremiah and David trust the God who has promised that in the face of our enemies he will not leave us alone. âHe will be with you, he will not leave you nor forsake you; do not fear nor be dismayedâ (Deuteronomy 31:8).
Â Sin and emotional suffering
A fundamental biblical principle is that sin causes emotional suffering. The greatest example in the Bible occurs in the Garden of Gethsemane when our Lord, before the Cross, began to be troubled and deeply distressed. His soul was exceedingly sorrowful, even to death (Mark 14:33-34). Such was his emotional agony that he sweated great drops of blood (Luke 22:44). The cause of Jesusâ emotional agony was the realisation that he who knew no sin would become sin for us (2 Corinthians 5:21).
Â A theme that runs through the Bible is that sin causes a troubled spirit, a guilty conscience, spiritual darkness and deep distress. The Lord warns Israel of the consequences of not obeying his laws. âThe Lord will give you a trembling heart, failing eyes, and anguish of soul. Your life shall hang in doubt before you; you shall fear day and night, and have no assurance of lifeâ (Deuteronomy 28:65-66).
Â King Saul is an example of sin causing emotional despondency. Saulâs misery was caused by his disobedience to Godâs commandments when he did not completely destroy the Amalekites, preferring to be popular with his men. Undoubtedly, a counsellor who followed the psycho-secular approach to mental illness would have diagnosed Saul as suffering from clinical depression. Scripture tells us that Saul was disobedient, self-serving and full of self-pity.Â Â Â
The harm caused by the psycho-secular view of depression
A major problem with the psycho-secular view of depression is that it has no understanding of the true causes of emotional suffering, in that it does not recognize the spiritual nature of man. It does not recognize the effect of sin on the human personality. The medicalising of emotional suffering, by attaching a label of depression, means that an unregenerate sinner is not responsible for his miserable condition, for he is sick and in need of therapy. When a sinner is convinced that a chemical imbalance is the cause of his misery it is difficult for him to see his need for salvation. And when he is on anti-depressants his senses are dulled and he is unable to think clearly. In this state, it is exceedingly difficult for him to seek the forgiveness of God.
Â Scripture is clear that in a fallen, sinful world suffering, both physical and emotional, are a part of the Christian life. The question is how a Christian deals with emotional suffering. Contrary to what the Christian counselling movement says, the answer is to trust in the promises of God. The apostle Peter tells Christians not to be surprised at the painful trials they were suffering, as though something strange was happening to them. âBut rejoice in the extent to which you partake of Christâs sufferings, that when his glory is revealed, you may also be glad with exceeding joyâ (1 Peter 4:13). The God of all grace, allows his people to suffer for a while in order to prefect, establish, strengthen and settle them (1 Peter 5:10).
Â A great paradox of the Christian faith is that joy may be the outcome of suffering and sorrow for Christâs sake, since Christian joy is a gift of the Holy Spirit and comes from a deep trust in the nature and character of God. Christians have this assurance that all things, yes even our emotional sufferings, work together for good to those who love God, to those who are called according to his purpose (Romans 8:28). God our Father allows suffering, including emotional suffering, as a means of developing the Christian character, as a means of conforming his children to the image of Christ.
In conclusion we should understand that the secular view of depression, by medicalising emotional suffering, has removed it from the spiritual arena and the influence of the church. This means that many people with emotional suffering are being referred to psychotherapists and psychiatrists and not pastors and church elders. The so-called epidemic of depression among Christians is not a true epidemic, but one generated by the false teachings of the Christian counselling movement. What must we do? First, we must recognize the danger imposed by psychobabble and the therapeutic gospel. Second, as true believers, we must rethink the issue of depression and emotional suffering in the light of biblical truth.
 Gordon Parker, Is depression over diagnosed? Brit Med Jour, 18 August 2007, volume 335, p328
 Ibid. Is depression over diagnosed?, p328
 Ibid. mindfreedom news.
 Joanna Moncrieff, The Myth of the Chemical Cure, Palgrave MacMillan, 2008, p221
 Chris Williams, Paul Richards and Ingrid Whitton, Iâm not supposed to feel like this, Hodder and Stoughton, 2002, p2
 Evangelicals Now, September 2002, book review by Gaius Davies
 Ibid. Cognitive Therapy and the Emotional Disorders, p293
 American Psychological Association, 108th Convention, Washington DC, August 4-8, 2000
 Gary Collins, Christian Counseling: A comprehensive guide, W Publishing Group, 1988, p106
 Ibid. Christian Counseling: A comprehensive guide, p106
 Ibid. Christian Counseling: A comprehensive guide, p116