Biblical counseling has the reputation of being anti-psychotropic medication. We do believe it is over prescribed and often masks problems that could be otherwise solved and addressed. However, a good biblical counselor does not refuse to involve the medical profession when their counselee is in trouble. A good counselor refers their struggling counselee to a medical doctor for evaluation, even when they are reasonably confident it will result in the counselee beginning a mood altering medication.

Consider the case of a young college aged counselee I will call Addy. Addy was raised in a Christian home and had always follow God outwardly (she was moral) even though she was not sure she knew Him inwardly. She confessed that she frequently doubted her salvation.

Addy came into my office describing symptoms of depression. She wants to cry all the time, she doesn’t sleep well, and she wants to lay in bed instead of going to class. She believes she is ugly and uninteresting. Addy spends her free time alone in her room and has little interaction with other people outside of class. She said she is having difficulty interacting with her college age peers, does
not feel like she fits in, and thinks the other young women at school have it much better than she does. Addie said she doesn’t care about anything. She was sorrowful and teary through our entire meeting.

College was her first time living away from home and she confessed to being initially shocked by college life. She was unprepared for the social structure, the excessive drinking and drug use, and the blatant immorality. At first it all seemed like so much fun and even though she knew it was wrong she went along with the crowd. Soon, Addy found herself involved with a young man and began to participate in sexual behaviors with him. Each time he left her bed or she left his she struggled to live with the guilt and fear that her family would learn of her activities.

When she would go home for family visits her parents knew something was wrong but they could not put their finger on it. They chalked it up to the new pressures of college life. Over time, Addy’s parents became increasingly concerned at the changes they saw taking place in their once vivacious and happy daughter. Nothing they said or did would alleviate the sorrow that emitted from her. It was not until the day Addy began expressing a desire to kill herself that her parents understood the seriousness of her situation. Not knowing where else to turn, her parents brought her to my office.

As she began to talk through what brought her to this emotional tailspin I learned that in addition to her immoral activities with the young man she had turned to self-harm as a way to deal with the guilt and shame. Addy had been cutting her abdomen and her thighs, and her cutting behaviors had escalated in a short amount of time. She shyly agreed to show me the long slices in her skin; some very fresh and others in varying stages of healing. While initially the cutting brought her relief, the guilt, shame and fear that followed only added to the burdens she was already carrying.

At the conclusion of our first visit, Addy agreed to a safety contract in which she agreed she would not self-harm between now and the next time we met. We discussed alternatives to cutting, including calling me or a friend from church who was also aware of the situation. The contract also contained numbers for crisis hotlines she could call if she was suicidal.

When Addy return to the following week while she had completed some of her homework, her self-injurious behaviors had not stopped, and in fact, Addy was more depressed than ever. She spoke openly of suicide and the criteria was such that I knew referring Addy for a medical evaluation was of the utmost importance for her safety and well-being. I recommended to Addy that she be evaluated for depression and she went right over to the office of a psychiatric group nearby. The evaluation revealed nothing organic that would account for her depression, and her physician prescribed a low dose antidepressant. Addy’s physician agreed that medication was not the answer to her problems, but was intended to stabilize her emotions during the time of biblical counseling.

During the next two weeks of counseling, we spent time going through the Psalms, specifically the Psalms of lament. I encouraged her to follow the pattern we find in the Psalms of crying out to God in our pain and rejoicing in His faithfulness.

When Addie returned on week three she was a different person. Gone were the thoughts of suicide and depression and she was ready to get down to the hard work of biblical growth and change. First, we tackled her spiritual state. She recognized that although she had lived in a Christian home her whole life that she did not have a saving faith in Christ. This season of depression was used by God to show her she needed Christ to indwell her heart and life.

Week after week we met together and dug out the roots that fed the thoughts, beliefs, and desires that brought her feelings of depression. She recognized, confessed, and repented of her sins before God and chose to confess to her parents as well. She met with the young man from college and not only ended that relationship, but she was able to give him the gospel and ask his forgiveness for her part in their sexual involvement. All through this process, Addy learned to take her thoughts captive, how to stand strong in the Lord instead of focusing on pleasing people, and made her daily goal to glorify God by how she lived. As she progressed we decreased our visits from weekly to bi-weekly and then monthly check-in times. She continued to maintain her spiritual disciplines and made steady progress in sanctification.

Six months after beginning counseling, Addy and her doctor agreed it was time to begin to taper the medication. We began to meet weekly again to help her biblically address the feelings that would arise as the medications were no longer blocking her emotions. It took three months to wean her off the medication. There were some definite struggles with emotional outbursts and anxiety throughout the process, but as we met together studying and her applying God’s Word to her heart and life she would level out and stabilize.

Medication assisted biblical counseling was what Addy needed to stabilize her emotions long enough to deal with her underlying sin, and other spiritual issues in her life. The medication was a bridge that allowed her the ability to deal with her heart. Used in this way, it is a great help to the counselee and the counselor.

Today Addy has graduated college and is a mentor for teenage girls in her church. She plans to pursue biblical counseling.