Missionary Care

Ronald L. Koteskey

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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? Who will pay? Let us consider 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 prefield 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.

When and where should I seek counsel?

The simple answer is the sooner the better right where you are. People tend to wait too long and think they have to go back “home.”

• Before the problem arises. Many times you anticipate a problem arising. Learn about raising children before you have them. Prevention is always better than restoration!
• As soon as the problem arises. You may not have seen the problem coming, but as soon as you see you have a problem, look for help. This is especially important if trauma is involved. Then you need to talk with a competent person within 36-72 hours of the trauma.
• After the fact. If you were unable to find counsel before or during the crisis, talk with someone about it when you get the chance; do not let it build inside you. Paul was grateful when Stephanas, devoted to the service of the saints, visited him and “refreshed my spirit” (1 Corinthians 16).

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 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.

Who will pay the bill?

Someone may volunteer to counsel you for free. If there is a charge, you can, of course, pay the bill yourself.

If you want a third party, such as an insurance company, to pay the bill, you will probably have to seek counsel from a competent professional, someone with professional credentials. Of course, you may request to see a Christian mental health professional if you wish. If your insurance company is paying, be sure to check what your co-payment is, how many sessions the insurance company allows, and specific referral procedures.