Counseling the (Really) Hard Cases

Sexual abuse. Schizophrenia. Anorexia. Porn. Postpartum depression. Paralyzing fear. Bipolar disorder. Obsessive-compulsive disorder. Dissociative identity disorder. Addiction. Adultery. Homosexuality.

Soberingly, the list goes on.

Counseling the Hard Cases: True Stories Illustrating the Sufficiency of God’s Resources in Scripture, edited by Stuart Scott and Heath Lambert, offers refreshing hope. From beginning to end, the contributors share real-life stories showing how the truths of Scripture have been unleashed to bring help, hope, and healing into the lives of those battling some of the most difficult situations our fallen world presents.

When facing the messiest issues, does God’s Word contain adequate resources for hope and change? Is it sufficient for the hard stuff, too? The testimony of story after story in Counseling the Hard Cases shouts a resounding yes.

I corresponded with Lambert and Scott, professors of biblical counseling at The Southern Baptist Theological Seminary in Louisville, about their book, misunderstandings related to counseling, practical advice for ministering to those enslaved by various sins, and more.


What one thing do you want every reader to know when he or she finishes the book? 

We want the readers of our book to put it down possessing a fresh sense of the glory and power of Christ. It is a glorious truth that Jesus came to die for our sins and seal us for the day of redemption. Too many Christians, however, minimize all the work that Jesus does in the lives of his people while they’re awaiting his return. Jesus came to save us, not just fully and finally at his return, but also progressively as we live the Christian life. This salvation includes his power to help us overcome our most difficult problems. Our prayer is that those who read these stories of real change amid the deepest problems will be encouraged to trust Jesus to help them in areas they’ve never considered or have perhaps even discounted. 

What was the most surprising thing you learned while editing this book?

The most surprising thing was how encouraged we were by the great work Christ is doing in biblical counseling ministries all across the world. We knew Jesus’ grace is sufficient to change people diagnosed with schizophrenia, bipolar disorder, dissociative identity disorder, and obsessive compulsive disorder—to mention just a few case studies in the book. We knew because we believe the Bible’s testimony about Christ’s power in these issues, and because we’ve seen it in our own ministries. Even though we knew it, we were deeply thankful to see that power so mightily at work in the lives of the people in this book. There were times we wept with joy over the powerful grace of Jesus realized in the lives of those so full of sin, pain, and suffering. It was an amazing grace to participate in a project where we got to see the mercy of Jesus at work in the lives of others, and to share those stories with readers.

What is the most common misunderstanding you hear among evangelicals about biblical counseling? 

We think the most common misunderstanding continues to be the widespread belief that the Bible simply isn’t sufficient for the kinds of hard cases we share in the book. Most Christians tend to believe the Bible is helpful for garden-variety problems only. If you’re having trouble with your prayer life, if your marriage is a bit rocky, if you have questions about the existence of God, or if you’re a little sad, then the resources of Scripture can help. If, however, you’ve been diagnosed with borderline personality disorder, are suicidal, or have been declared to have post-traumatic stress disorder after enduring sexual abuse from your father, then you need something more. We want to point people to the wonderful news that Scripture has the resources to help with all the counseling-related problems people face—from the garden variety to the extreme. The Bible has power to address these problems because Jesus Christ is alive and has resources to address them. When we reduce the contents of Scripture to addressing only easy problems, we reduce the power of Christ to addressing only easy problems. By his resurrection power, Jesus means to redeem us from every struggle we face. The Bible isn’t limited to providing guidance for problems that are only mild in nature.

What are some helpful principles for counseling a believer struggling with pornography?

This is a massive question. In fact, it is so big that each of us has addressed it in more detail. Heath Lambert has a forthcoming book titled Finally Free: Fighting for Purity with the Power of Grace (Zondervan, 2013) about how to overcome struggles with pornography. Stuart Scott has a booklet coming out this fall titled Killer Faith: Conquering Sin Habits. A huge issue like this one needs a fuller treatment, and we hope those resources help.

One passage we can point to here, however, for some initial guidance is Romans 13:13-14: ”Let us walk properly as in the daytime, not in orgies and drunkenness, not in sexual immorality and sensuality, not in quarreling and jealousy. But put on the Lord Jesus Christ, and make no provision for the flesh to gratify its desires.” As Paul encourages Christians to flee sexual immorality (like pornography), he urges two things. First, make no provision for the flesh. This is an exhortation for believers to do everything they can to eliminate their access to pornography. Believers struggling with pornography make provision for the flesh whenever they do things like keep their problem a secret from Christian friends, look at tempting material that isn’t “pornographic” but increases sinful sexual desire, leave the internet on their computer and phones unfiltered, and are unaccountable with their time alone. A believer isn’t serious about pursuing change until he eliminates the provisions he makes to commit sin. Second, put on Jesus Christ. It isn’t enough to fight to keep from looking at immoral pictures. We need to fight to look at Jesus. This means a successful fight against porn involves not only the things you aren’t doing, but, more importantly, the things you are doing. John Owen says, “Be sure to get an interest in Christ; if you intend to mortify sin without it, it will never be done.” When the battle becomes about seeing Jesus in all his beauty, grace, glory, power, mercy, and love, then there isn’t room left in your heart for porn.

If a friend or family member approaches me and says he or she is attracted to persons of the same sex, how should I respond and proceed? 

This question requires a much lengthier response than we can provide here. Still, we can make several comments by way of setting up some boundaries for a response. First, you need to find out if your friend is a believer or an unbeliever. You may already know, but since the gospel is God’s power, understanding whether he or she is a believer is crucial in determining how you will do ministry. Second, be committed to help over the long-term. Overcoming same-sex attraction is often a lengthy battle that requires a long-term commitment. Your loved one will be vastly helped knowing he or she is not alone in the struggle. Third, listen well to the specifics of the struggle. Different people struggle with same-sex attraction for different reasons. You need to be sure you understand the dynamics of your friend’s struggle so you can work on their actual problem—not just the one you think he or she has. Fourth, find someone who knows more than you who is able to help. As you seek to help there will be things you’re unsure of, so find a wise and loving Christian who may have experience with these issues to give you guidance. Finally, don’t freak out. Too many Christians react sinfully to such reports and perpetuate the impression that Christians don’t have the resources to help. The reality is that folks with same-sex attraction aren’t fundamentally different than anybody else, since we all know what it’s like to have sexual desires that God says are sinful. We can speak to such strugglers with joy and hope because we all need the same Savior from sexual sin. That Savior powerfully cleanses and changes us from all our sexual struggles, including homosexual attraction (1 Cor 6:9-11).

In light of all of this, perhaps a helpful initial response would be something like, “I’m so glad you told me this. I love you and want to help. I may not have all the answers right now, but I know Jesus does and we’ll figure out together what he says. Let’s pray right now and ask him for his forgiveness, power to change, and wisdom to proceed.” One of the case studies in our book concerns a man with homosexual struggles, so folks can turn there for more guidance.

The scandal at Penn State has brought the horrors of sexual abuse to the forefront of the public’s mind. Why are authorities so tempted to cover up for the alleged abuser?  

James 3:16 says, “For where jealousy and selfish ambition exist, there will be disorder and every vile practice.” This passage is incredibly illuminating. Wherever you find a practice that is vile and disorderly, jealousy and selfish ambition are at the root. The authorities at Penn State were more consumed with their reputations, jobs, financial packages, and football program than with caring for the vulnerable. Their jealousy and selfish ambition led to the judgment that a child’s safety is expendable. We should condemn them sternly, yes, but also repentantly since we too possess selfish hearts and follow selfish pursuits.

  • Steve Cornell

    I will be interested to learn how the authors suggest that the Bible functions to help those facing more significant neurological based conditions. The part that will “place” the work in this regard is the meaning of this paragraph:

    “We knew Jesus’ grace is sufficient to change people diagnosed with schizophrenia, bipolar disorder, dissociative identity disorder, and obsessive compulsive disorder—to mention just a few case studies in the book. We knew because we believe the Bible’s testimony about Christ’s power in these issues, and because we’ve seen it in our own ministries.”

    What kind of “change” should be expected? The blend of disorders mentioned here is curious and raises questions about what is meant by “change.” The line “we believe the Bible’s testimony about Christ’s power in these issues” is also important. How does Christ’s power function in relation to neurologically based schizophrenia or bipolar disorder? Although I have no reason to think otherwise,I confess to hoping that this book is biblically holistic and based on a carefully integrated theology of creation, corruption, redemption and glory – to come. Only then will it faithfully reflect “the Bible’s testimony.”

    Again, I am not suggesting the book leans in this direction but those who propose counseling solutions that are one-dimensionally oriented toward the spiritual wrongly reduce the fullness of the Imago Dei and the corruption of that image in humanity. They also misrepresent the tensions and hope located in the already/not yet of redemption.

    In regard to biologically based issues (particularly, neurological), I have encouraged those in medical professions not to reduce diagnosis and remedy to one dimension as if humans are merely bodies with physical needs. But those in my line of work must also guard against reduction of humans to the spiritual. Honoring a fully biblically based theological anthropology involves respect for the multidimensional way God created humans and acknowledgement of the range of effects of sin and divine judgment on humanity.

    Just for conversation, what would we mean if we said, “We knew Jesus’ grace is sufficient to change people diagnosed with sleep Apnea, epilepsy, autism, muscular dystrophy, multiple sclerosis, cerebral palsy, …” ?

    Can the grace of our Lord meet people with transforming effect in relation to these conditions? Yes! Would we suggest that His grace will “change” people in the sense of removing/overcoming these conditions? No! At least, not in this life. But the hope of the gospel is not limited to this life. The application of Scripture about glory to come offers hope that can change perspective and thus enrich life in God-intended ways in profoundly important ways in all circumstances! These changes can be celebrated even if they fall short of changes that are only meant to come when “the Lord Jesus Christ, — by the power that enables him to bring everything under his control, will transform our lowly bodies so that they will be like his glorious body” (Philippians 3:20-21).

    I am looking forward to seeing how the authors of this book approach these matters.

    • Kyle

      Very helpful comment.

    • Rachael Starke

      Steve, thank you for calling out that paragraph and articulating my own concerns with it so well.

      There seems to be a conflation here of sin issues that can lead to addiction and its physical and/ or mental consequences (e.g. porn, alcoholism), with mental conditions that can manifest themselves in sinful ways (e.g. schizophrenia, bipolar disorder).

      With respect and love (and hope!) this might perhaps just be due some less that tight writing by our brother Matt.

      If this book really does conflate issues as broad as alchoholism and homosexuality with mental illness, it would need to make a case for that approach. Respectfully, the sub-title alone makes me concerned that this work will fall heavily on the side of those who are argue for the Bible against other avenues, such as medication or secular mechanisms of any kind, rather than those who argue for those things being appropriate when fully submitted to the Bible (like David Powlison).

      • Matt Smethurst

        Thanks, Rachael. I certainly didn’t mean to imply that the book conflates “issues as broad as alcoholism and homosexuality with mental illness.” I’ve updated the post accordingly.

        Perhaps you’ll be encouraged to read David Powlison’s endorsement:

        “‘Counseling the Hard Cases’ changes the conversation about counseling. Friends of biblical counseling will find themselves stretched to grow at every point. Critics of biblical counseling will see longstanding caricatures dissolve. True wisdom comes exquisitely balanced. The book breathes forth the fragrance of such wisdom. I hope all readers share something of my bottom-line response: Father of all mercies, make my life and my counseling embody more love and more truth, more of all good gifts and worthy skills.”

        • Rachael Starke

          Thanks Matt – I appreciate the clarification and yes, indeed, the endorsement definitely is encouraging!

  • Barchetta

    “The scandal at Penn State has brought the horrors of sexual abuse to the forefront of the public’s mind.”

    This piqued my interest a bit in that I also was sexually abused by a male friend of the family for several years. Truthfully, I probably could have helped the authors with a chapter of their book in that my story is also one of victory through Jesus Christ – most of the time. The Penn St coverage was a bad thing for me and I suspect a lot of other people who’ve suffered abuse. I’m curious though, one of the things that I know is that it takes years to work through some things and, I imagine, many people are never completely healed. How does biblical counseling address the patience that – can – be required as God works in your life?

  • Andrew

    One thing I’m disappointed with in this article is the complete lack or mention of the work of the Holy Spirit in these matters. Simple Biblical knowledge is completely ineffective without the unveiling work of the Holy Spirit. The simple knowledge must become spiritual knowledge for it to have an impact.

    All my life I was raised to know that Jesus died for me. I didn’t really understand that and have spiritual knowledge of that until much later in life as the Holy Spirit removed the veil over my eyes.

    I do like the Biblical content of this post, but I would add to it that prayer and direct counsel from God are what we should seek through God’s word. He is the greatest counselor. Once any man has had developed within him a love for God that forsake all other things in his life he will certainly overcome anything.

    • Lucas

      Neither Lambert or Scott neglect the work of prayer and the Holy Spirit in their work. Their books speak on these subjects, so if your looking for a fuller perspective that’s a good place to go.

      In a nutshell, here is a very brief definition of biblical counseling from Dr. Scott.

      Biblical Counseling:
      1. Discerns desires, thinking and behavior that God wants to change, this is a matter of the heart.
      2. It uses Gods word by the Holy Spirit to change desires, thinking and behavior, this involves human effort and divine power.
      3. Seeks the sanctification of the christian into Christ-likeness for the glory of God.

      His very definition of biblical counseling includes the work of the Holy Spirit.

      You should seek a fuller explanation by reading their books.


  • Jeff Wadley

    Based on my reading from the article, it would appear that the very book that the authors wrote is “extra-biblical” in its nature. Yet, they are saying that only Biblical texts are useful and effective in counseling those in the church.

    Can you really have it both ways? Does a Christian psychologist (who may very well be an oxymoron to the authors) have anything to offer in the church?

  • Luke

    I don’t have difficultly with the idea that scripture is sufficient to address issues as difficult as those described. I have however, seen few examples of people who have the maturity to utilize the truth of the scriptures to do so. You have to have a pretty deep well and a lot of wisdom to deal with harder cases, whether you are a biblical counselor or otherwise. I wouldn’t want people to get the impression that just because scripture is sufficient, that means that you are.

    Also, based on what’s presented here, a psychological diagnosis is presupposed. It’s not that I don’t think a biblical counselor could address an issue like disassotiative identity disorder, but a lack of understanding of the disorder they are dealing with could (and has for some) result in some serious damage.

  • Bob Kellemen

    While I can understand some of the questions that Steve and others have raised, I think two issues are very important to consider.

    1.) This is a brief blog post interview–not the book. Having read the (excellent) book, it is clear that the editors and chapter authors have a robust understanding of the complex mind-body issues. I’d really encourage everyone to buy the book and first devour the excellent introduction that addresses what is and is not meant by the sufficiency of Scripture.

    2.) I think we may be missing the major point of the book and the blog post–God’s Word is comprehensively sufficient to guide God’s people in conceptualizing “people/problems/solutions.” We can trust God’s Word to give us wisdom to address the deep soul issues of suffering and sin that people face in our fallen world. His Word equips us to for every good work including being competent to counsel the hard cases.

  • Steve Cornell

    Thanks Bob. I indicated that I could not directly apply my concerns to the book itself because I have not read it. I certainly hope that no one reaches wrong conclusions from my comment. I plan to get the book but I am encouraged by your mention that contributors work from “a robust understanding of the complex mind-body issues.”

    My larger concern (which you’re already familiar with and is not attached to the book itself to my knowledge) is what we mean (and perhaps, do not mean) when we say, as you did, “God’s Word is comprehensively sufficient to guide God’s people in conceptualizing “people/problems/solutions.” We can trust God’s Word to give us wisdom to address the deep soul issues of suffering and sin that people face in our fallen world.” I also hold this view also but I know that there are different ways of conceptualizing and applying it. The phrase “comprehensively sufficient to guide” must be applied in different ways and measures depending on the issue. We (as I think many agree) should never suggest to a parent whose child has a verified condition of ADHD that all they need is Scripture to address this matter. Do they need Scripture? Yes. The issue is how Scripture will be applied and how it will function to guide and encourage. Do they need medicinal aid? Perhaps, in some cases, and clearly, in others. The same applies to variables regarding bipolar conditions, schizophrenia and biologically based depression. I think most agree that those who oppose all medicinal aids for neurological conditions are an outer fringe group who promote a version of Christianity that is inconsistent with Scripture.

    When you wrote: “His Word equips us to for every good work including being competent to counsel the hard cases.” I agree (and I think you agree) as long as it is not based on a truncated theology (as I discussed in my first comment). Those who respect the multi-dimensional way God created humans will consult with physicians and neurophysiologists in areas of expertise and information not directly addressed in Scripture.

  • Heath Lambert

    I am so thankful for all of the thoughtful comments posted by those who have read the interview. The issues being raised are good and important ones.

    The central issue being raised seems to be the doctrine of the sufficiency of Scripture as it relates to the intersection of spiritual and medical issues. Several are expressing concern that our book may neglect the latter in favor of the former.

    As Bob helpfully mentioned, above, I would encourage you to read the book. When you do I think you will find that our work expressly avoids spiritualizing biological issues. We think that Scripture teaches the importance of the body. A biblical model, therefore, will make room for medical treatments alongside the work of counselors.

    In my introduction I give a theoretical explanation of what sufficiency does and does not mean. In the case studies that follow we illustrate that principle in true stories of troubled people. Each contributor walks a careful balance between the body and soul (including the two medical doctors and one nurse that wrote chapters).

    My prayer is that readers of the book will see how relevant the Scriptures are to providing all the different kinds of help that God provides his people.

    And of course our book also makes clear that all of this work relies, not just on the Bible, but on the powerful Holy Spirit that God gives to his people to empower them to change.

    • Rachael Starke


      Thank you so much for this! This issue is painfully close to my heart because I have Christian family members with schizophrenia and bipolar disorder. It has been profoundly discouraging to watch my family pursue medication and secular psychiatric counselling exclusively, with all of its false arguments and saviors. The first wave of the nouthetic counselling movement seemed to be somewhat reactive in its seeming rejection of the idea that conditions like schizophrenia might actually have a chronic, brain-based component, rather the simply be the result of entrenched sinful thinking. It seems like that is beginning to be corrected. What a wonderful thing for the church if those wrestling with these afflictions can be given real hope for the here and now, in the midst of their afflictions, through the gospel of grace.

      • Heath Lambert

        Thanks so much, Rachael. God bless you.

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