Frequently Asked Questions

The dictionary defines counseling as the active exchange of opinions or ideas, or the process of advising or giving guidance solicited from a knowledgeable person. The field of counseling today has a very mixed history. Counseling has been taking place for thousands of years. We know in ancient times from biblical history counseling was conducted by spiritual and religious leaders. Christian churches practiced what we came to call counseling. The bible teaches us to "admonish the unruly, encourage the timid, help the weak, and be patient with all men" (I Thessalonians 5:14). This is not only counseling, it is what we now call "differential therapeutics," or applying specific treatment following an accurate and careful diagnosis.

The scientific community of psychologists and psychiatrists has been writing about counseling and psychotherapy since the late 1800’s. Much of the field of secular psychology and psychiatry dates back to the early writings of Sigmund Freud. Freud was clearly antagonistic toward religious faith, and did not hold to a world view that was compatible with the gospels. Freud went so far as to say that religion was the "universal obsessional neurosis." Since Freud’s writings, the Christian church has struggled with how to approach the field of psychology and psychiatry.

A variety of approaches have developed as Christians wrestle with whether or not psychology and Christian faith are compatible with one another. Worthington (1991) suggested that there were four possible positions that counselors might take regarding the integration of counseling.

The first category he calls "across the gap." In this approach therapists who do not value religious faith choose to ignore it, and see the religious faith as harmful to clients.

The second position is the "collaborative approach." In this approach therapists who are not personally religious are committed to respecting religious faith and values in their clients.

The third position represents those who are religious and have a faith orientation but who have been trained in secular approaches and were taught that dealing with religious issues were irrelevant or inappropriate in counseling.

The fourth position is the "conjoint" position in which therapist who personally hold to a religious value system are committed to dealing with the religious commitment and spiritual issues of their clients.

In a classic article written for Christianity Today in 1975, Gary Collins suggested that today’s Christian counselors fall into five categories. The first category Collins called "the main stream." Main stream pastoral counselors generally have taken Clinical Pastoral Education training (CPE). The CPE approach takes a pastor with a theological education through an essentially secular training program in counseling. The clinical pastoral education movement has historically been theologically liberal and somewhat antagonistic toward conservative evangelical theology (Collins, 1975).

The next category that Collins outlined were the "evangelical pastoral counselors." The most outspoken of such counselors is Jay Adams, professor of practical theology at Westminster Seminary. Adams advocates Biblical Counseling, in which only the bible is used to support a counseling approach that is primarily educational and confrontive.

The third category of Christian counselors are the "Christian professionals." Examples of the Christian professionals would include Clyde Narramore (considered to be the father of Christian counseling), James Dobson, Bruce Narramore, Frank Minirith and Paul Meier, and Gary Collins. The Christian professionals have been trained and have received degrees and credentials in the secular counseling approaches, but who also have a strong commitment to biblical evangelical theology. Each of these counselors have developed a model for integrating their knowledge and skills from the field of psychology with biblical truth.

The fourth model Collins defined were the "theoretician researchers." The theoretician researchers are those who have taken a scientific, scholarly and research approach. These are generally university professors who are in the process of developing and testing theory.

The fifth and final category that Collins outlined are the "evangelical popularizers." The evangelical popularizers would include Bill Gothard, Tim LaHay, Charlie Shedd, and Norman Wright. The evangelical popularizers produce useful but simplistic self help material for the lay public.

Since the writing of Collins article in 1975, all five categories are alive and well. Evangelicals have increasingly steered away from the clinical pastoral education movement. Seminaries have strongly embraced the evangelical pastoral counseling and the Christian professional movement in counseling. Many seminaries have developed masters and doctoral programs integrating both theology and the practice of psychology and counseling. Christian graduate schools have flourished with strong enrollments in the areas of psychology, counseling, and marriage and family therapy. In spite of the increase in Christian counseling, a number of authors have been critical of whether or not Christianity and psychology are compatible at all.

Lawrence J. Crabb (1977) suggests that Christians have taken one of four positions: The first position is referred to as "separate but equal". The bible and theology are considered valid in the areas in which they speak, and psychology is considered valid in the area in which it speaks. The separate but equal counselor may switch back and forth between psychology and theology. An attempt is made to separate the two disciplines and keep them separate.

The second approach is the "tossed salad" approach. Crabb suggests that this approach is like a salad bowl in which a variety of ingredients are thrown into the bowl and tossed about. The problem with the tossed salad approach is that psychological notions are often accepted uncritically and without an understanding of the conflicting world views (i.e., humanism, existentialism, modernism, etc.) which are often represented in psychology. Consequently a number of unbiblical ideas may creep into this counseling.

The third category that Crabb refers to is the "nothing buttery." In this approach the Christian counselor accepts nothing but the scripture as the basis for Christian counseling. The writing of Jay Adams would fall in to this category. Adams suggests that psychology has nothing to offer the Christian counselor, and psychology is always in conflict with biblical ideas. If one is true to this position there is never a need to study any counseling approaches, medicine or psychology.

The fourth approach and the approach that Larry Crabb takes is the position he calls "spoiling the Egyptians." In the spoiling the Egyptian’s position the Christian counselor is first thoroughly grounded in the Word of God. Just as God made provision for the Israelites carried out of Egypt the spoils the Christian counselor critiques the findings of modern psychology and takes from them tools which are consistent with our biblical perspective. The Word of God is absolute in authority, and the only truly and fully reliable source of knowledge. Psychology on the other hand is a field that attempts to use the scientific method to investigate a variety of man’s problems, and seeks to determine what works in helping people resolve their problems. This approach recognizes that scripture is "ALL TRUTH," but may not contain "all truth". Knowledge exists beyond the scripture about many subjects including psychology, medicine, family life, etc. The Christian counselor operating from this approach takes what is useful and consistent with scripture while discarding the rest.

Basic Assumptions. Christian Family Institute counselors have worked together to compare ideas about the integration of psychology, and marriage and family therapy with biblical theology. Counselors recognize that Christian counseling must first start with a Christian who has been brought to new life in Christ. Prior to our conversion we were dead in our sins and transgressions (Eph. 2:1). "But because of His great love for us, God, who is rich in mercy, made us alive in Christ even when we were dead in our sins and transgressions" (Eph. 2:4). As counselors we recognize that spiritual things can not be understood unless one is born of the spirit of God. To the non-Christian, spiritual things seem foolish (I Cor. 2:14). After one has become a Christian and begins to grow in faith and a knowledge of God’s Word, our entire value system is shaped by our Christian faith, our bible study, and our life of prayer.

As we grow as Christians, all of our principles are transformed by scripture. Whatever other wisdom we might find useful from psychology and other sources must be judged by scripture.

At Christian Family Institute, counselors are called to counsel. Counseling is not a profession unrelated to our faith. Just as ministers are called to the ministry, Christian counselors are called to the ministry of counseling. The scripture indicates that each Christian is given spiritual gifts for the purpose of ministry to the Body of Christ (I Cor. 12:7). For Christian counselors, spiritual gifts will be manifested in the style of counseling that the counselor provides.

As Christian counselors we recognize that all people have a need for Christ. As Christian counselors we also recognize that God’s Word is absolutely reliable and authoritative in all it speaks to, particularly matters of faith, lifestyle, and morality. Christian counselors derive their sense of morality from God’s absolute Word. In practice we are committed to loving all persons whether or not they are Christians.

Human beings function and malfunction as a result of a complex and seamless interaction between biological, psychological, social, and spiritual forces. Malfunction in any one of these areas produces a ripple effect. If a person has a cavity in one tooth, the pain may radiate to many surrounding areas. So also do symptoms spread in any of the bio-psycho-social-spiritual dimensions.

As Christian counselors we also recognize the value of psychology, marriage and family therapy, counseling, psychiatry, and medicine. Persons who consult with us are often concerned about problems these disciplines may address. For one client the issues that bring them to counseling may be of a moral nature involving guilt and confusion. The next client that comes to us may be experiencing the consequences of sin in their life. The next person who comes may have been sinned against by others who were abusive and are attempting to recover from the damage that was done to their life. The next client who comes to counseling may be experiencing psychological symptoms related to a genetic or medical condition. As Christian counselors we depend on the Holy Spirit as well as our training in these disciplines in order to be effective in helping people with their concerns.

This approach would be classified by Collins (1975) as a "Christian Professional" model. We would classify it as a "spoiling the Egyptians" approach according to the Crabb (1977) model.

The Local Church. Christian Family Institute was founded in 1977 for the purpose of providing Christian Counseling to the body of Christ. Christian Family Institute was originally started with the assistance of local churches with a variety of denominational labels. Though each member of the staff of Christian Family Institute is an active leader in a local evangelical church, Christian Family Institute does not represent any single church or promote divisive doctrine to clients who seek our assistance. Christian Family Institute is committed to being a resource to all churches. Consequently counselors at Christian Family Institute are committed to respecting the denominational and theological commitments of our clients and those who refer clients to Christian Family Institute.

We recognize that the church holds an important place in the lives of believers. The church has as its purpose to provide instruction, facilitate fellowship, be a place of worship, encourage, and provide emotional support. As counselors, sometimes clients express conflicts with their church. It is important for us as counselors to first encourage problem-solving in the relationships we are in before exploring other options. We respect the unique authority that the local church holds in the life of the believer. Working with the church and issues at the interface with the church is a delicate relationship requiring good communication to maintain this relationship. This is further complicated by the fact that some clients do not wish for their church or pastor to know of the problems they face. The client owns the right to confidentiality, and their wishes on this matter are respected.

Christian Family Institute is committed to integrating a strong biblical faith with the latest developments in the fields of psychology, marriage and family therapy, counseling, and medicine. Christian Family Institute is not only committed to providing care to Christians, but also professional counseling services to those who are non-Christians, and may be wounded and are alienated from the church.

Christian Family Institute recognizes the importance and the authority of the local church in the life of believers. Christian Family Institute counselors recognize that they are not pastors, nor are they a substitute for a pastor in a person’s life. Counselors at Christian Family Institute refer clients back to their pastors when clients are wrestling with theological issues or decisions that may be contrary to the teachings of the local church. Pastors are routinely invited to come to Christian Family Institute with members of their congregation when pastoral care may also be necessary. Whenever clients are wrestling with decisions such as divorce, we recommend that those clients consider discussing that issue with their pastor or church leadership.

Marriage Christian Family Institute is committed to marriage and to helping people be successful in marriage. Because the bible condemns divorce except under certain circumstances, Christian Family Institute is committed to preserving marriages and assisting people to make their marriages healthier whenever possible.

Free Will. We are aware, however, that God has granted men free will to choose their own path. Though our bias is in the direction of biblical decision making in all walks and aspects of life, we recognize that our clients have the freedom to make decisions that may be absolutely contrary to scriptures teaching. As Christian counselors we believe it is our duty to help Christians recognize when their decisions are contrary to the teachings of the Word of God. Beyond helping people recognize what their church may teach, or what the bible may teach, we do not believe it is our right to impose our views in a coercive way or a manipulative way on our clients.

Moral and Controversial Issues. On a variety of controversial issues, counselors at Christian Family Institute hold to a biblical perspective. We believe that the Bible is trustworthy and speaks with reliability and authority to the difficult issues of morality and life decisions. We also believe that the truth of scripture must be applied with grace and not condemnation. We are committed to loving and caring for those who struggle. We are also committed to inviting clients to consider the wisdom of scripture as it may apply to their lives. We are strongly committed to restoration and reconciliation. If clients are open, we attempt to assist people to find forgiveness from their Heavenly Father, and to find reconciliation to one’s fellow man. We are committed to helping people overcome the guilt that sin produces in their life. We are committed to helping those who are disenfranchised from the church or have been wounded by Christian people find healing for their wounds and reconciliation back to the church. We are convinced that the institution of the church was ordained to foster spiritual, emotional, and relational health. To that end whenever possible, we attempt to assist our clients in considering the church and its healing resources for their lives.

Psychology is a mixture of science and philosophy. One function of psychology is theory construction. Psychology attempts to formulate theory to explain man’s behavior, his nature, and how he lives, changes, and develops disorder. This is an area of psychology that clearly overlaps the field of theology. It is in this area that psychology most displays its inadequacy. Traditional psychology is a science that is desperately looking for a world view, while actively rejecting the Christian world view. Psychology attempts to construct a secular religion defining the nature of man.

It is our view that only the bible holds the answers to the true essence of who man is, his needs, what is truth, what is moral, and what is right. It is the bible alone that holds the answers to man’s deepest needs. It is only in the bible that we find that the nature of man is sinful and that man has a God-shaped vacuum within. It is only in the bible that we learn of man’s need for God, and that abundant and eternal life can only be achieved through reconciliation with God. It is only in the bible that it is revealed that Jesus Christ is the answer to man’s sin problem, and that his sins can be forgiven only through the acceptance of Jesus Christ’s provision of salvation and eternal life. Following the acceptance of Jesus Christ, grace transforms the Christian into a new creature. Day by day throughout the rest of the believer’s life, God gradually transforms that person into the image of Jesus Christ. It is the scripture alone that offers answers to problems such as guilt, our need to be forgiven and our need to forgive others, and it is only the bible that gives us guidance about our priorities, and what is a healthy lifestyle.

Psychology at the end of the twentieth century has endorsed the philosophy of post-modernism. The post-modernist perspective suggests that there is no such thing as absolute truth. Everything is relative. What is true and right can only be determined in a particular context and circumstance. The field of psychology has also embraced pluralism, holding that society is a mixture of distinct ethnic religious and cultural groups, and that we are to live in harmony and give up notions that would separate us. Both pluralism and post-modernism hold that no single philosophical system or world view holds the answers to the complex questions and nature of our social and physical world. We believe that post-modernism is in direct conflict with a biblical Christian world view. Psychology alone does not hold the answers to men’s purpose and is not the answer to mans moral dilemmas. Post-modern psychology is a dangerous philosophy on a collision course with Biblical Christianity.

The science of psychology is the more useful part of psychology for Christians. The scientific study and systematic observation of human behavior has produced vast knowledge about man’s problems, what factors contribute to such problems, and strategies for helping individuals overcome them. It is this aspect of psychology that we embrace. In all cases, we filter psychological information through the grid of scriptural truth. What fits consistently with the scripture is useful, and anything that conflicts in any way is discarded. Psychology has given us great insight into such subjects as the nature, causes, and treatment of depression. Psychology and psychiatry have also assisted us greatly in distinguishing which disorders may have a more psychological root and which may have a more biological root cause.

One feature that is unique about Christian Family Institute is that we integrate a family systems perspective on counseling. A family systems perspective is always sensitive to the individuals who may seek counseling, but also considers the impact that counseling may have on our client’s relationships. Our family relationships are our most important resources, therefore Christian Family Institute is committed to helping people make their relationships healthier.

Systems theory is a way of viewing and thinking about interrelated systems and sub-systems. An example is that the human body is a system made up of sub-systems such as the respiratory system, the circulatory system, the neurological system, etc. This individual is also a part of larger systems such as the nuclear family, the extended family, the church, the community, the work organization, etc. Each system is made up of smaller sub-systems, and each system is a sub-system of a larger system.

Individual behavior cannot be understood without understanding the various systems and sub-systems the individual is part of. Spiritual, psychological, biological, and social systems are at work, and each has an effect the other. Effective counseling begins with listening and gathering information about all of these related systems. The effective counselor must develop skills in formulating spiritual, psychological, and family assessments.

The Christian Family Institute Model is also a problem-solving and solution-focused model. That means that we work collaboratively with the client to establish clear and specific treatment goals and treatment plans. We do not impose our plans on people’s lives.

The Context of Christian Counseling. Christian counseling practice varies according to the context in which it is practiced. If a person comes to their pastor in the church, they usually expect that the focus of that counseling will be spiritual and that the Bible will be employed as the central resource. The focus on spiritual issues is implicit in the context. When clients come to a Christian who is also a licensed mental health professional in a counseling center, the expectations and context are less clear. The Christian who is also a mental health professional possesses a number of tools and competencies which may be employed as is appropriate to the situation and expectations of the client. Even in a Christian counseling center such as Christian Family Institute, the clients come with very divergent expectations. Some come expecting pastoral counseling similar to what they would experience if they went to their local church. Others come to see a professional regardless of their faith perspective. A small portion of clients are actually hostile to faith and defiantly dare the counselor to speak of faith. The counselor in this context must carefully attempt to assess the motives and expectations of each client. This is made particularly difficult if clients are not clear themselves.

When Christian Family Institute chose it’s name, it was not intended to exclude those who are not Christians. The name was chosen to inform clients of a number of things. For those who are Christians, it serves to let them know that their faith will be respected, encouraged and harnessed as a resource in helping them solve their issues. For those who are not Christians, it serves as a way of being honest about what our worldview is. We believe that is difficult to be value-neutral in the therapy office. That does not mean it is appropriate to impose our values on our clients. In fact that would be unethical and even unchristian. However to deny our worldview would be deceptive.

If a non-Christian comes to CFI, they have a general idea of what we believe. Early in the process we will usually discuss the role faith plays in a client’s life. Part of that discussion will help the therapist and client determine if and how faith elements will be handled. Sometimes even Christians don’t want much faith talk in their therapy sessions for a variety of reasons. Perhaps they are in a spiritual crisis or they have grown tired of simplistic faith talk and have been turned off by it.

We have seen clients from all faith perspectives. That includes a wide variety of Christian faiths, other faiths, and those with atheistic and agnostic viewpoints. Part of our motivation to be helpers is rooted in our faith, however, that does not mean we will force our faith on our clients. We will respect our client’s desire about the role of faith in therapy.

Prospective clients have formed their expectations of counseling based on what they have heard from other people, read, and seen on television and in the movies. When a client comes to counseling, all of these previous experiences lead the client to have a certain set of expectations about what the experience will be like. If a person has watched One Flew Over the Coo-Coo’s Nest, they may fear that psychiatric and mental health services are primarily for the seriously disturbed, and that those services may involve abuse of the client. In recent years, society has come to view counseling in a more positive light. Counseling is now seen as a service that is socially accepted and not just for those who have severe emotional disorders.

Some clients come to counseling expecting the counselor to be a judge in settling relational conflicts. Clients who come with this expectation attempt to present their case in a convincing way, expecting the counselor to rule in favor of one or another. Other clients come to counseling expecting that counseling will involve the counselor listening only. This expectation has been fostered by the writings of Carl Rogers in his humanistic psychology. Most clients today find the client-centered non-directive approach disappointing, and do not find it satisfactory. Others who have read Jay Adams work Competent to Counsel, expect that the counselor hunt down "the sin" that is the cause of the problem.

The Christian Family Institute model of counseling involves listening to clients tell their story. Clients are asked in the early phase of the first counseling session what brings them to counseling. Clients are encouraged to share the distress of their life that has caused them to seek professional services. Clients are also encouraged to bring other involved family members to the counseling session when possible. Unlike individual approaches to counseling, a family systems approach attempts to respect each person’s unique perspective on the problem. Family and marital counseling also encourages family members to talk to one another and to resolve their disputes with one another. Individual counseling sometimes fosters a belief that the counselor is siding with one person against another and may put the counselor in a position of operating with only half of the facts.

As counselors listen to each family member’s perspective on the problem, the counselor attempts to establish counseling goals in collaboration with family members that meet their needs and expectations. In a marriage counseling session, one partner may complain that there is not enough communication while another partner complains that there is not an adequate sexual relationship. The counselor attempts to establish mutually agreeable goals for the resolution of the problem to both partners’ satisfaction.

An individual may come to counseling expressing a desire to overcome problems with depression. A counselor needs to hear their client’s own theory about what may be contributing to their depression. The counselor also may help the client investigate new areas they have not considered. In counseling, clients may be helped to discover their blind spots about the problem that brings them to counseling. After goals are established, the counselor then helps the client plan a strategy for resolving the problem.

Counselors use a variety of tools and techniques to help people change the things that they seek to change. At times a skilled counselor may ask a series of diagnostic questions or administer tests designed to assist them and their client in gaining greater insight into the nature of the problem. At other times counselors recognize that clients may lack life skills such as communication skills, conflict resolution skills, skills to enhance and sustain intimacy, and skills in the management of their thought life and emotions. Counselors may teach clients new skills to help them overcome the problem that brings them to counseling.

Counselors often use homework assignments as a tool for enabling clients to translate learning from the counseling session into their daily life. If clients are open to what the bible has to say, and if clients are receptive to prayer, the Christian counselor may utilize teaching from scripture, bible study assignments, and prayer as tools to assist people in growing in their knowledge of God’s will, and in their relationship to Him and others.

Occasionally a couple comes to counseling where the Christian spouse has coerced their non-Christian spouse to come to a Christian counselor. Occasionally the Christian will attempt to align themselves with the counselor, hoping they will side with them against their partner. Sometimes the Christian has been preaching and judging their spouse, and their secret hope is that the Christian counselor will join them in preaching to their non-Christian partner. It is extremely important that the Christian counselor assist these clients in learning a more effective way to disagree with their partner. It is also important for the Christian counselor not to take sides against any family member, but to always show respect to all family members.

As professional Christian counselors, we are committed to respect each person’s right to self determination and the exercise of free will. Though we attempt to steer our clients in a biblical direction, we never take responsibility for their life. We never coerce anyone to take a particular position. Advice may be given in the form of helping people identify alternatives and assisting clients in considering the pros and cons of each possible course of action. Counselors may assist clients by suggesting steps that may be taken to achieve a particular outcome. Counselors may gently and respectfully challenge myths, faulty thinking or reasoning, inconsistencies, and immoral behavior.

Though Christian counselors recognize man’s need for God, Christian counselors are not primarily evangelists. As is the case with all Christians, we are commanded in the great commission to go and make disciples. We at Christian Family Institute take a relational evangelism perspective. We hope to build loving and respectful relationships with all people, and to let our Lord’s light shine from our Christian lives. We show compassion for the struggles that people experience. We never give advice contrary to scripture.

Some Christians have defined "Christian Counseling" as only giving "spiritual and Biblical counsel." This model assumes that the only tool a Christian needs is to read scripture to clients, and this is then called "Christian counseling". We believe that whenever we help a client live an abundant life that is more conformed to the will of God, or find practical answers to problems, this is Christian counseling. Therefore, there is no distinction between the "secular" and "spiritual" realms. If we help a single parent manage impulses to mismanage money, this is "spiritual" counseling. We believe "secular counseling" is done without regard for spiritual and Biblical truth.

We always give scriptural advice, but in the case of clients who are resistant to Christianity or the bible, we may not initially share the source of that information. As clients find biblical solutions to be useful and effective in their life, we look for opportunities to share with those clients the sources of that wisdom. In this way we look for opportunities to witness to clients about God’s love and his practical wisdom for living our lives. We are particularly sensitive to not charge in where we are not welcome. Some clients may never give us an opportunity to speak with them about spiritual things. We believe it is our obligation to feed the hungry by providing loving, considerate care and practical solutions for life’s problems even if they are not open to the solution to their biggest need for God.

For those who profess to be Christians, we attempt to help people see the church as a place for continued emotional support, the need to belong, and a place for continued instruction following the termination of therapy. For those who profess to be Christians and are not involved in local churches, we attempt to help people see the local church as the ultimate "aftercare" resource.

Private practice professionals engaged in counseling customarily charge anywhere from $60 to $150 per hour. Many clients find these fees to be prohibitive. What many clients do not realize is that health insurance may provide for Christian counseling just as it provides for the services of a physician. Health insurance companies, PPO’s, HMO’s, and companies with self insurance often reimburse for a portion, and sometimes all, of the counseling fees in order to maintain good emotional health.

The cost of not resolving emotional and family problems very often exceeds the cost of counseling. Failure to resolve such problems leads to increased medical costs, legal fees which may be incurred in divorces and possibly arrests, decreased productivity in work and school, hindered spiritual and emotional growth, and not experiencing joy in life.

Christian Family Institute is committed to serving all persons regardless of their financial ability and resources. If a client is highly motivated to seek Christian guidance and if they are committed to putting into practice the counsel they receive, we will find some means to take care of our clients.

Most HMO’s and self insured plans provided by employers control or limit which professionals a person may seek services from. Christian Family Institute may provide reduced fee services for clients when our services are not included in such plans. We also provide counseling at a reduced fee under hardship circumstances.

Christian Family Institute is a ministry as well as a business. We have a heart for ministry to all people. We seek to provide services or link people with services no matter what there financial condition may be. On the other hand, Christian Family Institute is a business. The Institute is funded entirely by client fees and does not receive any other financial support or government assistance. We function under the Biblical principle that a workman is worthy of his hire (Luke 10:7). Combining the principles of ministry and business we seek to be good stewards over the resources God has provided for us. As Christian professionals, we are also committed to donating a portion of our professional services. That means we discount fees according to a client’s ability to pay. If you have a client in need of professional counseling services, call the office of Christian Family Institute and we will help that client either make an appointment or link them with a counselor who can provide the service.

As an added resource, Christian Family Institute provides close supervision to graduates of masters and doctoral programs seeking licensure. These trainees are available on a limited basis to see clients at significantly reduced fees. Care is given to match clients financial resources, the level of their need, their counselor preference, and the skills of the counselor.

One of the most asked questions we hear is "Do you take my insurance?" We love it when the answer is a clear-cut "yes" or "no". Unfortunately, we find ourselves frequently saying "it depends". It depends not only on your insurance company, but on which of the dozens (or sometimes hundreds) of policy’s your insurance company offers that you might have. Just because you have XYZ insurance doesn’t mean we know which particular policy XYZ offers that you have.

For some policies we are "in-network"; for others we are "out-of network" but can still work with you and your insurance. For still others, we are out-of-network but cannot work with your insurance.

In-Network. This means that we have a contract with your insurance company. Our contract with the insurance company may spell out what we can charge, how many session we can provide, or how often we have to report back to the company on the progress being made in treatment. Some contracts are with Christian Family Institute as a group and others are with individual therapists. The therapist you originally requested may not be in-network but one of our other clinicians is; in other words, one of our therapists is likely to be able to work with you and your insurance.

The sad truth is that insurance companies are requiring more and more from therapists while paying less. Also, it appears that insurance companies have a preference for contracting with large hospital-based networks: they can do one-stop-shopping as they negotiate fees for surgery, oncology, pediatrics, etc. as well as mental health. This may mean that some companies prefer not to contract with individual providers or small groups. For these reasons we are constantly re-evaluating our insurance contracts.

Out-of-Network. This means that we are not contracted with your insurance company. Some policies will reimburse you for counseling services that are provided by a clinician who is not under contract with them. Usually you will be reimbursed at a somewhat lower rate than if you had seen someone in-network. Other policies (usually HMO’s) will not reimburse anything to you if you see an out-of-network clinician.

It is important to remember that out-of-network means we have NOTHING to do with your insurance, co-pays, or deductible. This is YOUR insurance: you are the one with a contract with the insurance company, not CFI. We may, if you request it, offer to submit claims on your behalf. We do this as a courtesy and convenience for some of our clients. It does not mean that we are offering to act as if we were in-network; it is merely a free service we offer so your counseling experience will be as simple and hassle-free as possible.

The trend among counselors is away from offering a convenience filing: more and more mental health professionals are giving clients a "super-bill" (an insurance friendly receipt) and leaving the client to navigate the insurance-billing waters completely on their own. So far, CFI has been able to resist this trend and continues to offer our clients assistance in billing their insurance.

Why see an Out-of-Network Clinician?

1. Because we are not a large hospital-based conglomerate; we are not a bureaucracy and we don’t act like one. Each therapist has the freedom to negotiate directly with clients regarding fees, number of sessions, and payment plans. There are no layers of bureaucratic approval to get in the way of the counselor-client relationship.
2. The name Christian Family Institute conveys our world-view and our approach to treatment. Our statement of faith is published for the whole world to see. Respect for your faith may be worth paying a little extra, if necessary, to ensure a counseling philosophy that is compatible with – and not hostile to – people of faith.
3. We always keep the family in mind even if only one person is present in the counseling session. Marriage and family therapy is a speciality that not all therapists have training in. Yes, we see individuals for a variety of reasons; all of our counselors are licensed to diagnose and treat mental health issues. Our therapists are also skilled at working with marriage, parenting, and family issues as well. People trained in individual therapy can actually do marriages and families more harm than good when they act outside their training.
4. The word "Institute" speaks to CFI’s commitment to training and education. CFI clinicians have served on state licensing boards, professional associations, and as university professors training the next generation of therapists. We are committed to offering continuing education to the mental health community. We are, in other words, experienced professionals who take pride in our craft. The staff of Christian Family Institute have many years of experience as leaders of their profession. Remaining on the cutting edge translates into the best possible clinical experience for clients.

"But my insurance company says… something different than what CFI has told me." We only pass on whatever information your insurance company has told us. It is not us giving you a different answer; it is your insurance company telling us one thing and you another. Over the years we have discovered that it is possible to get an answer from an insurance company ("how much will you pay for out-of-network services?"), hang up the phone, immediately call the insurance company back, and get a completely different answer on the second phone call. Sometimes this may have to do with the fact that your insurance company has hundreds of similar policies and the clerk on the phone simply looked at the wrong policy. Other times, it may be that you called one phone number, while we called a different number for the same company: it appears that some insurance companies are so large the left hand simply doesn’t know what the right hand is doing.

Remember: if we are out-of-network then we have NOTHING to do with your insurance (other than doing you a favor and submitting a claim for you). If your insurance company isn’t paying on a claim, then let us know and we will do all we can to help you straighten out your insurance. But in the final analysis, you are the one with a contract with the insurance company, not us. Therefore, the final responsibility for seeing that your bill is paid rests on you.

Nearly all helping professionals at some time or another find themselves needing to make a referral to another specialist. Whether one is a physician, pastor, or a psychologist, we sometimes find that the client’s needs and goals can best be met by someone who has special training beyond what we possess. Sometimes we discover that the client’s needs conflict with our own needs, as in the case of a pastor who may have a client in need of intense, long term counseling. To provide such counsel with very many people would distract the pastor from his responsibility of ministering to the whole church.

Referral is a skill. Making a referral is like any intervention in a professional’s toolbox. If the helping professional is skilled in making referrals, clients often follow through and seek the services of the one to whom they are being referred. As with any skill, referral may be ineffective if we are not confident and competent in making referrals.

Helping professionals are sometimes reluctant to make referrals because they feel guilty that they are not able to help, or they may feel that referral casts doubts about our competence. We may be fearful that the client will perceive the referral as rejection. When a client expresses resistance to seeing a professional therapist, we may be tempted to attempt to provide the counseling ourselves, even though it may be against our better judgment.

Referral is particularly advisable when we recognize that we do not have the competence, training, or experience in dealing with the unique problems that are being presented to us. To practice beyond one’s training is considered unethical for professionals and is frequently a factor in malpractice lawsuits. Helping professionals must not allow their own feelings of guilt or fear of a client feeling rejected to keep us from doing the professional and competent thing which is sometimes to refer.

It is best not to work with some clients. It is advisable to refer when we find ourselves sexually attracted to a client, when we find ourselves angry, when we dislike our client, or in cases where there is a potential conflict of interest due to our other relationships with a client. Dual relationships increase the possibility of our objectivity and judgment being hindered when making diagnosis or treatment decisions.

Referral is appropriate whenever we have provided counseling services to a person who is not showing signs of improvement. After a reasonable period of receiving counseling, clients should show signs of improvement. If they do not, it is our ethical responsibility to not continue counseling when it is not producing progress. We also have an obligation not to abandon a client in distress, but we are responsible to facilitate a referral to another helping professional.

The first step in making an effective referral is believing that referral is an appropriate and professional service which is in the client’s best interest. If we believe that the client is being short changed by our referring them, we will often not be effective in making referrals.

The second step in making referrals is to know the professionals and other resources available in our community. It is important to get to know professional Christian counselors, hospital personnel, and a variety of physician specialties such as family physicians, pediatricians, obstetricians and gynecologists, and psychiatrists. As we get to know these professionals and how they work, we can feel more confident that those we refer will be in good hands.

A third step in making effective referrals is to be able to convince clients that the referral is necessary. It is important that we be honest with our clients and that we let them know when there is a more professionally skilled person who is best to treat them, or that we may have conflicts in dealing with a particular client or their problems. It is also important that we have enough self confidence and integrity to be able to be honest about the limits of our professional competence. We each have an area of specialty. No professional can be all things to all people.

A fourth step in making effective referrals is to be able to educate the client about what the professional we are referring them to will be able to do for them that we are not able to do. It is also helpful if we can assist the client in becoming more comfortable with the person we are referring to by informing them that we know the person personally, and that in our experience with them they can be trusted and are helpful.

A fifth step in making effective referrals is the ability to allow clients to express themselves and their feelings about referral. Some clients may be angry, some clients may feel depressed or betrayed, and other clients may be afraid. It is important to allow the client to discuss these feelings. It may be necessary for us to offer reassurance and clarification of any misunderstandings. It is also important that we allow clients to know that we do care for them and that we intend no malice or harm by making the referral. Redefining what your relationship will be like after the referral is completed is strongly recommended.

The sixth step is getting the client to make a commitment to follow through with a referral. If we simply say to a client, “I suggest you call a counselor,” and we are not specific about who we are referring to, the chance of follow through is extremely small. If we ask the client if they will commit to making the phone call, and when they will make the phone call to make to appointment, then there is a significantly increased chance of follow through.

Sometimes it is a good idea to allow the client to make the phone call from your office. Particularly, when the client has made a commitment to follow through with a referral, but we sense that if the client hesitates the resolve will weaken, it is a good idea to have the client make the phone call from our office. Sometimes it is effective to ask the client if you can make the phone call for them. Making the initial phone call sometimes makes it easier for the client to follow through.

Most professional offices will ultimately require that the client make a call themselves directly before appointments will be established. If a client is unwilling to talk with a counselor or with an intake counselor over the phone they are often likely to cancel or not show up for their first appointment. Also, many professionals give instructions to help prepare the client for their first appointment and obtain information that will reduce some of the initial paperwork.

A seventh step in making effective referrals is agreeing on what information will be shared with a new professional. If we have previously provided counseling, testing, or any other service, it is important to discuss with the client whether they wish those results be forwarded to the professional we are referring to.

Professionals require a signed release in order to disclose information. Counselors are bound by a code of ethics and laws that require guarding client information and client confidentiality. In the case of pastors and physicians making referrals to professional counselors, it will be necessary to sign a two way release of information in order for information to legally be exchanged as we serve as teammates in helping our clients. It is important that we explain to our clients that working together is in their best interest. As we are able to communicate we are able to work as a team which often speeds the process and increases the chance of successful outcome.

The final step in making effective referrals is follow up. It is important for us to check with clients to make sure that they made the telephone call and established an appointment. It is also important for us to follow up with our clients following their first appointment with their counselor. When people come for counseling they are often confused, anxious, and sometimes disoriented. Sometimes clients will come away from sessions with mistaken impressions or misunderstandings of something that was said in the counseling process. Counseling is a painful process and sometimes raises resistance.

The Problem Of Mis-information. Sometimes clients keep important information from their counselor and expect their counselor to have the ability to read minds or have magical insight so as to know facts without their telling us. As the referring professional, if we communicate with the counselor, we can often help work through whatever resistance or anxiety the client may have continuing the counseling process.

It may also be necessary for the referring professional to give feedback to the counselor on how the client perceived the counseling process. It is helpful to encourage counselees to discuss their anxieties and concerns directly with the counselor. Many clients fear conflict and may not be assertive enough to tell their counselor when the counselor is off the subject or has misinterpreted some of the facts. Also it is important for counselees to be able in the counseling relationship to tell the counselor when they disagree with what is being said. These skills make for the most effective counseling outcomes. Sometimes those refereed need a little encouragement in order to be able to make the counseling relationship effective.

Nearly every professional counselor has had clients who have misquoted, quoted out of context, or selectively misrepresented what was said during counseling sessions. Manipulation is a frequently used coping strategy in clients with emotional problems. Unfortunately, these clients also manipulate the various care-givers providing them with services, and can threaten to sabotage the counseling process. The best solution to this problem is for care-givers to communicate directly with one another. In this way the various helpers can cooperatively develop a treatment plan and coordinate the services they provide. Any attempts to manipulate will be discovered.