Biblical Counseling for Bulimia

It is no secret that I'm a believer in biblical counseling. NANC, the National Association of Nouthetic Counselors, is the biggest and most organized body of certified biblical counselors in the United States and abroad (check the link to the right - there is a directory of counselors arranged by state, province and country).

Why biblical counseling?

For one thing, biblical counselors promote a high view of God. Often, in therapy or inpatient centers that clam to be "faith-based" or "Christian", the patient is actually encouraged to envision God any way she would like (think of the 12-Step programs' caveat of "higher power" or "God, however we imagine Him to be".) Scripture is clear about God's nature, attributes, conditions for blessings, and expectations on His children. This is not to say there isn't a sense in which God's grace is common and His love unconditional. God loves the prodigal with an unfathomable depth of mercy, but the wayward sinner is called to repentance. We are not to remake God in our own image, but rather worship Him as He has revealed Himself to be. Any other option leaves us worshiping a false god and a contrived "jesus".
Biblical counseling deals with sin. Unlike secular counseling, which takes God and His Word completely out of the equation, or integrationist "Christian" counseling which inadvertently makes the bulimic more comfortable in her sin, biblical counseling confronts the sin head-on and helps the eating disordered girl (or woman) recognize the ungodly thought patterns and beliefs that led to the behavior in the first place. Calling bulimia (which is self-destructive, idolatrous and evidences lack of self-control) a sin is not condemning - we all sin. I sin every day, despite the fact that I haven't thought of purging in 6 years. (I once actually believed that if I overcame my addictions to food and alcohol, I would be the World's Best Christian. Hah! Ask my husband. Still hasn't happened).

Realizing that bulimia, like drunkenness, is a sin rather than a disease or genetic predisposition should come as a relief to the bulimic who wishes to put it to death. Sin can be confessed as such, repented of, and forgiven. Look at it logically: there is no sin that cannot be forgiven. Scripture commands us to repent (turn away from) our sin, and assures us that when we take it to God, we will meet with mercy and grace - not condemnation. Since we are urged to repent, is it possible there is a s in that we cannot turn from? NO. God would never instruct us to do something He has not given us the means to accomplish.

Finally, biblical counseling provides accountability. Particularly besetting sins such as eating disorders typically take a bit of time to be put to death entirely. Renewing one's mind with the washing of the Word requires consistency and discipline. A nouthetic counselor gives her client homework, including reading from the bible, personal reflections, and memorization of key passages. The assignments are tailored to the type of spiritual battle the client is waging, and they pray together as well as examine what the Bible says. No provision is made for rationalization of the behavior or humanistic philosophies of the personality. Biblical counseling upholds the Scriptural position that this type of discipleship should take place in conjunction with the local church.

Why Group Therapy is Unbiblical

Common secular (and faith-based) treatment of addictions, including eating disorders, incorporates some sort of "group therapy" or support group. However, in my study of nouthetic counseling and particularly in reading Jay Adams' material, I have come to the conclusion that such an approach is unbiblical and should therefore be avoided. In "Competent to Counsel", Adams quoted an agnostic psychologist as saying that group sessions typical devolve into a cathartic, collective confessional for the participants, with no real solution to their problem. Keep in mind that "Compentent to Counsel" was written in the late sixties - well before the rise in popularity of the "culture of confession" we see on Oprah!

In my own experience, back in my college days when I was forced to attend various groups, I have personally witnessed the uselessness of this type of "therapy". Facilitated by a compassionate woman with a background in behavioral psychology, a typical group will hhave around a dozen girls and women of various ages feeling very sorry indeed for themselves and each other. Some truly want to change; others are there against their will. Regardless of background or motive, they all have one thing in common: they are either anorexic or bulimic (or some combination of both). Common sense dictates that when you have a group of individuals involved in aberrant (or unhealthy) behavior thrust together, a sort of comraderie will develop. This has both positive and negative effects: while the participants may benefit by shared compassion and the ability to be vulnerable, what prevails is a sense of "us versus them" - a strength in numbers mentality that makes it less likely any of the group participants will actually forsake her unhealthy eating patterns. Never is the focus put on the solution - new life in Christ. The focus remains squarely on the individual, and since we love to talk about ourselves, it stays there.

The net result of a "support group" is to make the bulimic morbidly introspective and even more firmly entrenched in her eating disorder. BT, DT.

Since group therapy never directly confronts the sin issue inherent in bulimia, the noetic effect of sin makes it all the easier for the participants to gradually rationalize their behavior. The enabling effect of the group is rarely overt - tips on effective purging and water-loading will not be tolerated - but the women, seeing so many others with the exact same problem, have no real incentive to change. As sin is personal, so is repentance. Ultimately, each one of us must truly grow to hate our particular sin (by seeing it through God's eyes) and get on our knees before Him. The role of a biblical counselor is to walk beside the struggling Christian as she recognizes the root of her behavior and resolves to live for Christ.

* Nouthetic counseling comes from the Greek word "noutheo", which generally is translated "to admonish". However, the term, coined by Jay Adams, encompasses more than a general admonition. The idea behind nouthetic counseling is that since sin is behind most of the problems and sufering Christians struggle with in their day to day life, by identifying and confronting the specific sin, rebuking the unscriptural beliefs that have spawned it, and exhorting and encouraging the client to repent of the behavior and seek God, the individual's heart will be changed and the sin abandoned. The Bible is rightly seen as the ultimate authority and is consulted as the ideal pattern for relationships and behavior.

On Second Thought....

Last week, I posted a rather hard-hitting entry about the proliferation of eating disorders in Eastern Europe (Serbia in particular) and speculated on what the reason for that may be. Quite honestly, I was writing off the cuff after stumbling across a Serbian Facebook fan page glorifying the behavior (which now has well over 300 members) and based on my own cultural observations living in the Balkans. Somehow, my post wound up on Twitter, which is really strange as I don't "Tweet". In any event, I was really quite shocked given that eating disorders were completely unknown in Eastern Europe just over a decade ago.

However, yesterday I have begun a very edifying correspondence with a young woman from Serbia, and I have decided to remove the original post. She and I have been discussing the sociological factors (such as commercialism) which lead to idolatry. While my original article certainly wasn't inflammatory, it could have offended any Slavs who were reading by making them think I was unfairly singling them out. The more I reflect, the more obvious it seems that the mind-set that glorifies addictions is the same inner working that causes all sin.

Which, last I checked, is a scourge common to all of humanity.

Whenever we seek to fill an inner void, whatever means we pursue to stoke our own pride, however we attempt to satisfy a legitimate pleasure by illegitimate means, we are sinning. An idol is anything we want badly enough that we are willing to sin in order to obtain it. For the anorexic or bulimic, food has become an idol. (Often, this addiction goes hand in hand with the misuse of alcohol). These snares that so easily entangle us can all be broken by faith and surrender to the One Who made us: Jesus Christ. It goes without saying that He is as active in the lives of His children in Eastern Europe as He is in North America, South Africa, or anywhere else on the globe. A time is coming when every nation will bow at His throne and every tongue will indeed confess Him as Lord, but until then, it is up to us to spread the message of His love and redemption. He is infinitely patient and indescribably gentle with those who seek Him, and will heal you in the deepest places as you daily grow in Him.

There is certainly no shortage of online "pro ana" and "pro mia" sites here in the United States, although broadly speaking EDs have received more negative publicity for a longer period of time than they have abroad. Perhaps in response to the relative "novelty" of this particular addictive sin, it is currently more "trendy" in some corners of the globe. In many ways, rebellion of certain types is more subtle or understated in varying areas, but that does not mean that the underlying problem (the sinfulness of our hearts) is any less.

For example, last summer I was back in Bulgaria and struck by the extreme, over-sexualized media culture. All along the roads, even in the most rural areas, billboards of nearly naked women in provocative poses were used to sell everything from pizza to latex paint. Newspapers feature full-frontal nudity. AS soon as we drove across the border into Greece, the soft-porn ads stopped - on the surface, the cultuural mindset seemed much more conservative and similar to here in the United States. However, it would be naiive (and inaccurate) to assume that the Greeks are "holier" or less of sinners than the Bulgarians. The Bible says that "All have sinned and come short of the glory of God" (Romans 3:23; emphasis mine) and "All have turned aside, they have together become corrupt; there is no one who does good, not even one." (Psalm 14:3). The entire course of Scripture upholds the fact that we, as fallen humanity, are all in the same boat - and the solution is one and the same. God offers His repentance freely to all.

Whether our sin is adultery, stealing, fornication, bulimia, cutting, lying, or whatever, God wants us to know that He is holding His hands open all day long to us even in our stubbornness and rebellion (Isaiah 65:2).

Which way will you go?

Does God Use Our Failure?

You bet He does. As the Steven Curtis Chapman song goes,

"You took the hopeless, the life, wasted, ruined and marred
And made it new ....You redeem and You transform,
You renew and You restore
You make all things new!"

This morning I received a testimony from a sister in the Lord who is struggling both with her eating disorder and with believing she still has value to the Lord. Interestingly, she touched on an issue that has real and lingering effects on how we see God when we've failed: her relationship with her earthly father.

With her permission, I am posting an excerpt from her letter to me, as I believe it will edify other readers who struggle with the same feelings. The book she references, pictured above, is a slim volume Gospel for Asia's president K.P. Yohannan wrote (the ministry often sends me freebies, which I love to pass on to those who may benefit). Of course, "When We Have Failed - What Next?" is not specific to eating disorders, but discusses the intense feelings of self-condemnation we all experience when we "disappoint" God in any way. Yohannan counters these instincts by presenting the biblical model - how God gently forgives, redeems and restores His children when they fall. The book can be downloaded for free at Gospel for Asia's ministry website, along with the other books in the "Journey with Jesus" series.

"I can't remember when I first began believing that I was garbage. I was young. I think I never understood what redemption and forgiveness was really like. When I dissapointed my Dad especially with sin, I could never figure out when his anger ceased. I once read that many girls develop their notion of what God is like,(wether right or wrong), through their relationships with their fathers and the examples they set. It made sense to me. I love my father and he is a good man but he was human and not without flaw. It was not his intention to do so, but his words, "I don't know when I'll ever be able to trust you again.", left a mark on me as deep as a whip would have. "I am not to be trusted.", were words that were etched into the foundation of my growing being. His inability to visably show love toward me from the first signs that I'd hit puberty and was pining after a boy (even though he was from church), never feeling I pleased him or made him proud until I got married (at 20) and showed him I could be a good wife and a loving mother, may have been a catalyst in whatever warped my relationship with God. I thought my father's face was a reflection of His. I thought He must feel the same way about me as my earthly father. " I must prove myself to God to re-gain his love and countenance.", were more words that resounded in me, Whenever I failed, I wanted to hide until I was strong enough (in what? I don't know) to get it right again and face God. My father rarely looked me in the eye while I was an adolecent, so I actually envisioned God with his face turned away from me in disgust, back then , and even more intensely, later when I first began to battle post pardom depression with my second child. This wrong perception of God carried on with the torrent of unhealthy coping mechanisms I learned and used (unsuccessfully) to try to replace my pain and despair over not being able to be a happy mother.

I know it must have pained God to know I thought he'd be so cruel, as to turn his back on me when I needed him most. I've realized this as my relationship with him renewed over the years, through my rises and falls but there is still a part of me that automatially feels the old lie when I fail. But I know that I'll never be good enough and I DON'T HAVE TO BE. This book helped remind me of that and how I need to throw the old vision away.

I want to keep letting him take hold of and fix all my twisted, broken parts....especially my ED. I have been struggling in vain to rise out of this all time low wt. for some time now but since I'm not ill or much under my BMI, I keep letting the deciever convince me that I am fine. I know I'm not and that I am chosing to remain in this sinful sickness.

I feel ready and strong today. Tomorrow I may feel weak and afraid but I will try to let him fill me with His strength and resolve over and over. I know i will probably make some mistakes, but I do believe that I will finally be fully delivered. I surrender all. I will recommitt myself and keep giving over my will as many times as it takes if I fail. I will no longer insult God by considering myself to be rubbish and treating my body and mind as such.

I remember the love I saw in my father's eyes as a child when he'd wake me from a nightmare and read the Bible to me till I could go to sleep. I felt his love. Llikewise, I remember as a child, knowing that I was special and unique to God and that for Him, no one could replace me. There was nobody like me. One day, (I think I was 5), I stood in my front yard, yelling up to the clouds, "Jesus!", over and over, unabashedly, gleefully wondering if He'd reply. The fact that I barely remember any of my childhood, but that those 2 beautiful memories, remain vivid, makes me feel that in his timlessness, He did answer me that day. I'm just now hearing Him 27 years later, "Remember how you you knew my love for you as a child. You knew me then and I have not changed. I'm still watching you shout to me and waiting for you to start calling my name again unashamed, with the innocence that I have bestowed on you with the shedding of my blood. You are still my child. If you've ever dissapointed me, I don't remember it. I have you now." . That's what I feel him telling me now and I am weeping with warmth and a bit of sadness at all the wasted years "that the locusts have eaten.", but I am not really sad. I know "He will restore..." He has called for me by name.

Now I am excited to see what he can make of me. I hope that someday, I am strong and steady enough in my recovery/repentance of all my addictions, that I can help others suffering in some way too. I never feel more blessed than when I have shared my savior with another. Believe it or not, I have managed to witness in my life, (even if I didn't always have it all staight) between my falls. Thank you for allowing God to use you as a vessel of help and hope for us that are still in the depths of, or trying to find our way out of the pit."

Thank you for sharing your heart, sister. I believe others will also be able to learn and grow from your insights - we're all here to support and encourage one another.