Shedding light on Theophostic Ministry 2: ethical and legal issues.
Theophostic Ministry (TPM) takes as a starting point the concept that current symptoms are due to past events in which a "lie" entered the mind (such as the belief "I am unlovable") which originated in a historical situation (such as having been a victim of sexual abuse). TPM seeks to release current suffering by asking Christ to appear in the memory and counter the "lie" with the light of his truth, resulting in symptom relief. In his materials, Ed Smith, the founder of TPM, has variously referred to his approach as "TheoPhostic Counseling" (1997, p. 5), "the TheoPhostic process" (1997, p. 7), "TheoPhostic Procedure" (1997, p. 60), "Theophostic Ministry" (2000, p. 1), or sometimes simply as "TheoPhostic" (1997, p. 7) or "Theophostic" (2000, p. 3). Smith (2000) revised his terminology, asserting, "Theophostic is truly not counseling, but rather ministry" (p. 2). In deference to this change, the term "Theophostic Ministry" or "TPM" will be used in the present work except when quotations involve other terminology.
Smith (2000) clearly made changes in TPM based on some awareness of litigious vulnerability, notably the change in name from Theophostic Counseling to Theophostic Ministry. Furthermore, he and a collaborator recently published a book to help "prayer ministers" (a category in which Smith includes people practicing TPM) "to live thoughtfully and carefully in a litigious society" (Wilder & Smith, 2002, p. 6). The focus of the present article is on legal and ethical issues that may be posed by TPM theory, practice, and training. In developing an understanding of TPM, a good place to begin is with a summary of its history and its practitioners.
Ed Smith and his wife, Sharon, "own and operate Alathia Center for Biblical Counseling" which provides TPM to clients and training for those interested in his method (Smith, 1997, p. 2). (1) According to Wilder and Smith (2002), Smith received an MRE in Marriage and Family Counseling and completed coursework toward a Doctor of Education degree in Marriage and Family Counseling from Southwestern Baptist Theological Seminary, possesses a Doctor of Ministry degree from Midwestern Baptist Theological Seminary, and is "a licensed ordained minister" in the Southern Baptist denomination (p. 171).
Origins of TPM
Smith (1997) recounted that the insight that became TPM came to him in response to a prayer in which he asked God to show him a way to quicken the therapeutic process. In some of his writing, Smith's words easily lead to an impression that he claimed special revelation of his method. For instance, Smith (1997), expressing dissatisfaction with other therapeutic methods, "asked God for a better way. So as I came to the end of myself, He gave me Theophostic" (p. 7). Such statements give an appearance that Smith has asserted claims to special revelation: "As God was revealing this method to me ..." (Smith, 2000, p. 35, italics added). Later in the same book Smith declared, "God began to pour this information into my mind.... I could not write down the new information fast enough to keep up with what God was saying to me" (Smith, p. 199).
While some of Smith's writings make it appear as if he alleged to have received divine revelation of his method, he denied any intent to do so. The Theophostic website contains the following disclaimer by Smith: "For the record, I do not believe that I have received any revelatory information from God nor have I ever made such a claim.... Insight I have had, Divine revelation I have not" (Theophostic Ministries, n.d., Misconceptions, Answer to Objections #7 section). Notwithstanding Smith's denial, it is troubling that his writings have sufficiently left the impression he made such claims that he has found it necessary to issue such a denial, and that, to date, he has not revised his materials to eliminate this impression.
Practitioners of TPM
Regardless of how one interprets Smith's comments about the origins of TPM, his method has become quite popular in some circles. Smith asserted that 15,000 people have been taught his method through his basic Theophostic training seminar, with nearly another 1,000 per month completing a videotape-training course in TPM (Wilder & Smith, 2002). Smith asserted that up to 300,000 people have received Theophostic Ministry (Bidwell, 2001). Individuals trained in Theophostic methods appear primarily to be lay counselors. Garzon, Paloma, Gorsuch, Borden, and Terjsland (2001) collected survey data from participants at an Advanced Training in Theophostic Ministry seminar. It appears that slightly less than 1/4 of the sample identified themselves as mental health professionals, nearly another 1/4 identified themselves as pastors or pastoral counselors, and approximately 1/2 as "Lay Counselors" or "None of the Above" (Garzon et al., 2001). Due to limitations of the survey data, and because the sample was non-representative, the data cannot be generalized to the larger population of individuals trained in TPM. The data do suggest, however, that Theophostic practitioners are apt to be paraprofessionals or nonprofessionals, although some licensed mental health professionals appear to be seeking Theophostic training and, presumably, practicing it as a therapeutic method.
While the effectiveness of church-based paraprofessional counseling has been demonstrated (e.g., Toh & Tan, 1997), it is notable that guidelines to establish paraprofessionals' competence are needed (Scanish & McMinn, 1996). Smith provides TPM training to interested individuals, who may or may not have any lay or professional counseling experience, through brief seminars or videotapes that can be ordered from Theophostic Ministries (Theophostic Ministries, n.d., Training section). Given the lack of prerequisite experience and the limitations of Smith's three-day seminar training format, and the even more limited video training, the sufficiency of TPM training to establish technical and ethical competence is dubious. Other ethical and legal concerns to be addressed include claims of divine guidance within TPM, claims of guaranteed healing and superiority of method, application of TPM to diagnoses without adequate demonstration of empirical effectiveness, inefficiency of empirical support for TPM methods, whether TPM should be classified as a ministry or a counseling intervention, and concerns about Smith's response to critique.
DIVINE REVELATION IN TPM
Smith's assertion that God literally reveals himself in TPM must be evaluated against the backdrop of guided imagery or a claim to special revelation. Smith (1997) asserted
TheoPhostic is not guided imagery, but rather divinely guided healing. The pictures and images people may or may not see are not suggestions made by the therapist. These pictures are an unfolding of truth from God, which results in complete healing of the memory being dealt with. (p. 10)
Contrary to Smith's claim, TPM unquestionably provides direction by instructing clients to look for God in their "memories". For instance, in one case Smith (1997) clearly directed his client by saying, "Look for the Lord Jesus. If you do not see Him, at least try to sense His presence" (p. 55). In another case he reported, a client indicated that he was angry with God and wanted to hit Him. "That is all right," replied Smith, "Go ahead and hit God" (p. 21). Such direction does not necessarily preclude the possibility of divine revelation in TPM, but such directives are consistent with imagination guided partly by therapist suggestion (e.g, Spanos, Burgess, Burgess, Samuales, & Blois, 1999). Smith (2000) recognized that some clients with differing theological views might be resistant to looking for Jesus in their memories. Such discernment, rather than being merely problematic, might reflect a question well worth asking: Is the appearance of Jesus in TPM the product of revelation or imagination?
Guided imagery involving memory and visualization of Christ is a common element of Inner Healing techniques, however, most Inner Healing adherents part company with Smith's view of literal revelation. Seamonds (1985), for instance, was clear in distinguishing the ministry of the Holy Spirit from human visualization of His presence.
While [visualizations of Jesus] are pictures based on biblical symbols, the form of the mental images by which we visualize His presence is the product of our imaginations. But the fact of His presence pictured by these images is guaranteed by the promises of Scripture. (p. 68, italics in original)
While Seamonds conceived of the Spirit as in some mystical way guiding the process of counseling and memory recall, he was clear that the appearance of Jesus was to be understood as a matter of visualization rather than revelation.
If one rejects the critique that the appearance of Jesus in Theophostic Ministry is mere guided imagery, as Smith does, one is left with the concept that God literally and directly reveals Himself in an individual's memory, which would seem to be a claim to divine revelation. Smith (2000) countered, "I am not suggesting that what God is revealing to people is new revelation.... What happens in a Theophostic moment is God personalizing His Word for the individual" (p. 3). Whether or not this revelation is "new" in the sense that it goes beyond scriptural truths, it is clearly a claim to special revelation. According to the late theologian Carl F. H. Henry, "the term 'revelation' means intrinsically the disclosure of what was previously unknown ..." (quoted in Elwell, 1984, p. 946). Special revelation is variously transmitted by God's "word and deed," the latter including theophanies, miracles, dreams, and visions (Alexander & Rosner, 2000, p. 733). The concept of literal apparitions of Jesus occurring in TPM clearly falls into the category of special revelation.
Historically, assertions of special revelation have typically been treated with caution, knowing that fraudulent claims of revelation are not uncommon and can be dangerous (e.g., Is. 56:10; Jer. 23:25-28; Mt. 7:22-23; 1 Jn. 1:1-3; Rev. 19:20). Likewise, the power of the human mind to manufacture "visions" through dissociation, hypnosis, and suggestion cannot be underestimated. While one must be wary of claims of special revelation, neither the theological nor psychological concerns stated above preclude such revelation. Thus, one is left to discern the veracity of such revelation on other grounds.
The rationale for why Jesus should reveal himself in the memory of someone undergoing TPM is not clearly articulated by Smith. Extrapolating from his writing, however, the rationale may be found in Smith's understanding of omnipresence. Smith (2000) wrote, "The fact is, Jesus is 'ever-present' and does reside in every memory event ..." (p. 134). Smith used this line of argument to suggest that Jesus can bring present relief through His literal presence in a person's memory. However, the idea that God's omnipresence resides within human memory or that God is somehow required to reveal his presence within one's memory is neither part of orthodox theology nor a concept found in scripture. Scripture recounts numerous individuals who periodically encountered God personally or in visions (e.g., Moses, Samuel, Peter), the psalmists often cried out in desperation at encountering God's silence and seeming absence, and scripture made known that there were times in which revelation was rare (e.g., 1 Sam. 3:1). Thus, Smith's contention about such personal revelation within TPM has questionable legitimacy.
GUARANTEED HEALING AND SUPERIORITY OF METHOD
In his materials, Smith (1997, 2000) has not guaranteed healing of all distress (what he calls "total recovery") using TPM, but he has maintained that TPM will bring about complete recovery of a specific memory within a Theophostic session. Despite being met with skepticism about TPM, Smith has insisted on the effectiveness of his method (see Smith, 1997, p. 60). Smith's conclusions in this regard are almost exclusively based on case study material, which can neither substantiate the hypothetical mechanisms of TPM nor demonstrate empirical efficacy beyond individual cases. Additionally, it may well be that TPM is effective in some cases, though the mechanism of effectiveness may be extraneous to the theory behind it (e.g., placebo effect, hypnotic symptom reduction, etc.).
Smith's (1997, 2000) claims about TPM have not been tempered by the lack of empirical data on TPM, nor tentatively phrased in the manner of good theory. His assertions have extended in ways that, absent empirical evidence, are potentially dangerous, such as the claim that TPM can remove the need for psychopharmacological intervention (Smith, 2000, p. 77). In his client manual, Smith (1997) made similar claims, but at least issued a warning not to go off medication without seeking the advice of a medical doctor. However, his contention that most TPM clients will no longer need psychopharmacological intervention portends knowledge of epidemiology and medicine that are utterly unsubstantiated by empirical research, and outside of the realm of Smith's stated training and expertise.
Superiority of Method
Smith's (1997, 2000) client and training manuals include declarations that TPM is superior to other therapeutic methods. For instance, Smith's (1997) client manual includes the assertion, "Even the current so called 'brief therapy' is slow compared to the instantaneous release found using TheoPhostic counseling" (p. 9). Smith (2000) asserted that other counseling approaches are not biblical, reflect a salvation of works, and are less effective than TPM since they offer only "tolerable recovery" rather than "genuine recovery" (pp. 21-22).
TPM practitioners may or may not belong to professional associations. Wilder and Smith (2002) rightly point out that "one need not be a member of an association for its statements to be used as a standard of conduct if it can be argued that the association represents the standard for your group" (p. 90). Organizations for both licensed and unlicensed counselors have published standards that may be applicable to TPM practitioners. For example, claims that imply, guarantee cure, or advertise superiority over other methods of intervention have been condemned in the ethical codes of most professional counseling groups (e.g., APA, 2002; AAPC, 1994). The AAPC Code of Ethics contains the following guideline: "We make only realistic statements regarding the pastoral counseling process and its outcome" (AAPC, III-B section). While Smith and others who use TPM may believe in its efficacy, published claims regarding its effectiveness exceed the available empirical data. The AAPC Code of Ethics also forbids the use of statements "implying unusual, unique, or one-of-a-kind abilities", statements "concerning the comparative desirability of offered services," and the use of client testimonials (AAPC, VIID section). All three of these are common in Smith's publications and on the Theophostic website.
Wilder and Smith (2002) offered a unique approach to avoiding the aforementioned issue. Noting that licensed professionals can be sued for making claims that their techniques are better than others, they opined that the same is not true of ministers. "Ministers, on the other hand, must only face backbiting and criticism for claiming to be better than other ministries" (p. 60). Whether or not the claim that ministers cannot be sued for claiming superiority is disputable. Even ministers, however, should be responsible to limit their claims to what is defensible in the light of available evidence, and evidence regarding effectiveness and efficacy can be sought empirically.
EFFECTIVENESS AND EFFICACY
Whether or not a treatment method is theoretically coherent, it may provide amelioration from suffering. The history of psychology is replete with examples of treatment methods whose theoretical underpinnings were ultimately found wanting, but which nonetheless provided a degree of relief for some individuals, whether as a mere placebo effect or as a direct result of treatment efficacy. Smith's (1997, 2000) argument for the effectiveness of TPM is almost exclusively based on case studies. To establish whether or not it works, Smith advocated that practitioners simply try TPM. While case studies may point to effectiveness in singular situations, efficacy cannot be reliably established or generalized via case study, personal experience, or client testimonial.
Garzon, et al. (2001) attempted to look at this question by surveying individuals who were attending an Advanced TPM training seminar regarding perceived efficacy of TPM. Of course, perceived effectiveness--especially by those committed to a method--is not comparable to empirical outcome data. Similarly, in surveying individuals attending a TPM seminar, one would have to temper the results by noting that the survey was administered to a self-selected, and hence presumably biased, sample. However, to date, no true outcome studies with adequate controls have been conducted. Future research, using manualized delivery of TPM, would be necessary to adequately evaluate its efficacy. At the present, without the establishment of empirical support, TPM is being applied to the treatment of diverse disorders and conditions.
APPLICATION OF TPM TO DIAGNOSES
Genuine Recovery, Smith's (1997) orientation manual for individuals undergoing TPM, is apparently aimed primarily at victims of abuse. The majority of the case examples provided in the book involve sequelae of sexual abuse. Smith admitted that TPM was developed "primarily for ministering to adult sexual abuse survivors" (Wilder & Smith, 2002, cover page). Smith's (1997, 2000) materials, however, make it clear that the method has been applied well beyond this population. According to the Theophostic Ministries' website, TPM has been "highly effective" in the treatment of "Sexual Abuse Issues," "Marital Issues," "Substance Abuse and other addictive behaviors," "Traumatic memory," "Post traumatic stress syndrome," "Grief and Loss," "Eating Disorders," "Children's issues," "Dissociative Disorders," "Homosexuality," "Satanic Ritual Abuse," and "All lie-based issues" (Theophostic Ministries, n.d., [paragraph] 3 & 4). On the other hand, Smith (1997) asserted, "When a person is suffering from true mental illness or brain damage, this method will not work.... Many people we see have been labeled as mentally ill, when in fact they were suffering from lies" (pp. 43-44). Smith thus seems to have confused the issue of whether TPM effectively treats legitimate mental disorders or simply misdiagnosed mental disorders. Further, he made bold claims that many entities that would typically be called mental disorders are the result of hidden lies in memory. Thus, Smith's (1997) assertion that many wrongly diagnosed individuals are merely "suffering from lies" would appear to be at variance with his (2000) claim that traditional mental illnesses are based on lies.
Garzon et al. (2001) surveyed individuals using Theophostic counseling. Their responses to the item "I have treated the following conditions with Theophostic ministry" included depression, anger, generalized anxiety, sexual abuse, abuse, panic, phobias, DID, addictions, and eating disorders. It is troubling that TPM is being used to treat serious and diverse disorders absent any published empirical research on TPM supporting its efficacy across such applications.
MINISTRY VERSUS COUNSELING INTERVENTION
Some of the major issues that could potentially pose ethical problems and legal liability--such as making unsubstantiated promises of cure, claiming superiority of method, and application to a broad range of diagnoses without documented empirical evidence of efficacy--have already been noted. A fundamental question that may mitigate the degree or type of legal exposure, however, is whether TPM is indeed a counseling technique or a religious practice. Smith (2000) revised the name of his approach from Theophostic Counseling to Theophostic Ministry:
If you are a lay minister, I encourage you to discontinue the use of the word "counseling" as a description of what you do. The legality of this term may be a point of indictment you want to avoid. We are removing this word from all of our promotional materials since Theophostic is truly not counseling, but rather ministry. (p. 2)
Wilder and Smith (2002) went so far as to claim "the words counseling, counselee, client, therapy or any terms that depict counseling ... [are] not descriptive of Theophostic Ministry" (p.6). Two issues seem to be important at this juncture. First, counseling does not cease to be counseling by calling it "ministry" anymore than surgery ceases to be surgery by calling it by another name. The issue is not what it is called, but what it is. Thus, the crucial question is whether Theophostic procedures fall under the definition of counseling imposed not by Smith, but by State regulatory agencies. Secondly, while some states have title laws that protect the use of titles (such as "psychologist" or "social worker"), most states have practice laws that limit the use of certain types of interventions to appropriately trained and credentialed individuals. Merely avoiding the title "counselor" may not be sufficient to avoid the legal entanglements of practicing without a license.
If a state that has practice laws were to deem that TPM is a method of counseling, laypersons using this method could potentially find themselves in legal jeopardy for practicing without a license. For licensed individuals who adopt TPM methods, the matter is equally hazardous. If TPM is considered to be a religious practice, then one could conceivably be found to have committed fraud if billing for TPM as a professional service. In this regard, Wilder and Smith (2002) rightly noted that "care needs to be taken in billing to insure that ministry services are not billed to insurance as therapy" (p. 113), since doing so would constitute fraud. In the event that TPM is considered to be a spiritual intervention consistent with psychological practice, the issues of informed consent and avoiding the imposition of therapist values must still be addressed (Scott & Potts, 1995).
Wilder and Smith (2002) published a book intended to minimize exposure to litigation. Neither Smith's (e.g., 1997, 2000) materials nor the Theophostic Ministry website (at the date of this article) comply with Wilder and Smith's suggestion that unlicensed individuals should "avoid all terminology and jargon that belongs to the professional community such as dissociation, multiple personality, alters, subconscious, disorders, etc." (p.48). On the other hand, in what can only be acknowledged as sound advice, Smith advised, "If you are unaware of what the state and local laws are for ministry in your area, you are a lawsuit waiting to happen. There really is no excuse for being ignorant of your local laws and requirements" (p.8).
SMITH'S RESPONSE TO CRITICISM
Defense Without Data
Critics of Smith and TPM have emerged, largely on internet sites, and almost without exception the critics have not come from within the professional mental health community. Bobgan and Bobgan (1999) wrote a book extremely critical of Theophostic Counseling. The book is predictably critical of Smith's method, since the authors have written numerous books that assert that psychotherapy is inconsistent with orthodox Christianity, condemning James Dobson, Larry Crabb, and 12 Step programs, among others. However, the authors made a number of well-reasoned criticisms, including critiques of Smith's use of scripture and his "extravagant, extreme, and extraordinary claims" (Bobgan & Bobgan, p. 13). Smith (2000) responded by reproving the authors (though not by name) for attempting to publicly expose his errors rather than approaching him in private, citing the injunction of Matthew 18:15. When private sin against an offended party is at issue, such privacy is called for, but when doctrinal correctness is at issue, public reproof is clearly acceptable, as evidenced by Paul's public pronouncement of his opposition to Peter's hypocrisy (Gal. 2:11), as well as several of the epistles directly condemning rival doctrines, and instructions to contend against false teaching (e.g., I Tim. 1:3; Jude 1:3-4). Furthermore, the work of professionals in virtually all disciplines is subject to public critique so that knowledge may increase by the free exchange of ideas. Consequently, there does not seem to be a defensible rationale--theologically or academically--which should protect Smith's published work from public discourse.
Smith (1997, 2000) has clearly been aware that his method has been met with skepticism. Smith (2000) admitted that many lay ministers and pastors trained in TPM have become discouraged by "skepticism" about TPM (p. 251). Smith recommended confronting this obstacle through "avoidance of the name Theophostic" (p. 252), instead simply describing it as "a Biblical approach to ministry that allows Jesus to bring truth to the lies one believes" (p. 253). Such a proposal seems incongruously deceptive for a method supposedly based on exposing lies with truth.
Smith's (2001) reply to criticism in several cases has been to insinuate that people are attacking him out of their own personal woundedness. It seems unlikely that all opponents of Smith's views are motivated by the biases and ill will that he perceives. Contrary to Smith's assertions, the data simply are not in, and absent those data, his claims are, at best, unsubstantiated.
The Quest for "Undeniable Evidence"
While Smith himself has seemingly been content with case studies and client testimonials, he has recognized that his method will be met with resistance unless empirical evidence can support his claims. Smith (2001) issued a personal appeal to raise funds for research on TPM to be conducted at the "Theophostic Ministry Research Center," "a subdivision of Regent University's 'Christian Interventions Research Institute'" (p. 3). While Smith sought to raise money to validate the effectiveness of TPM methods, Wilder and Smith (2002) issued opposing advice in claiming "ministry and prayer should not be evaluated by professional standards ..." (p.21). Obviously, Smith cannot have it both ways.
Of the studies to be performed at Regent University, Smith (2001) wrote, "Their research will provide undeniable evidence of what the Lord Jesus is doing through Theophostic Ministry" (p. 3). Given that this research may well end up surveying the very people from whom Smith solicited money for the research (i.e. TPM practitioners), an added confound may be introduced into a sample that will likely already be biased by prior commitment to the method under investigation.
Contrary to Smith's presumption of empirical support for TPM, good science does not presume its conclusions at the outset; in fact, good science predicts the null hypothesis. Good science holds hypotheses tentatively, being willing to modify them based on the evidence. Good science may well find that TPM is efficacious for a certain subset of the population--particularly those who seek TPM out based on a shared mindset--but it is likely that many of Smith's claims will lack the "undeniable evidence" that he has proclaimed in advance. In the meantime, the current state of affairs for TPM includes a large number of unsubstantiated claims, some very questionable assumptions both theologically and psychologically, and some significant potential legal and ethical issues.
Since its inception by Smith in 1995, TPM's growth as an intervention strategy among paraprofessionals appears to be significant, with some interest evidently initiated from professional mental health practitioners as well. Nevertheless, significant concerns exist. Smith's current methods of teaching TPM through brief seminars and videotaped materials may be inadequate to establish ethical and technical competence. Claims that TPM involves divinely guided healing in which a literal appearance of God should be expected are not well supported. Ethical and legal concerns exist regarding apparent claims guaranteeing healing and claiming superiority of method. Application of TPM to a wide variety of mental disorders without sufficient empirical validation is troubling. Also at issue is the legal question of whether TPM should be considered a religious intervention or a counseling procedure, and the ethical issue of trying to settle this question simply by changing the name from Theophostic Counseling to Theophostic Ministry. Finally, Smith's failure to welcome public analysis and critique of TPM is problematic. While further research may well find that TPM is effective with some populations, current claims in its behalf raise troubling ethical and legal concerns.
(1) A previous edition of Smith's client manual, Genuine Recovery--In an Instant!, listed Smith and his wife as the owners of "Family Care Counseling Center located in Campbellsville, Kentucky" and the publisher as "Family Care Publishing" (Smith, 1996, pp. i-ii). Wilder and Smith (2002) refer to Smith as the owner and director of "Alathia (truth) Equipping Center" (p. 171). Theophostic materials are self-published through Alathia, Inc.; the name is presumably taken from the Greek word [alpha][lambda][eta][theta][epsilon][iota][alpha], usually translated as true, worthy of credit, or truthful (Moulton, 1978).
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ENTWISTLE, DAVID N. Address: Dept. of Psychology, Malone College, 515 25th St., NW, Canton, OH 44709. Title: Associate Professor of Psychology. Degrees: MA, PsyD, Rosemead School of Psychology, Biola University. Specializations: Teaching of Psychology; Clinical Psychology; Integration of Psychology and Theology.
DAVID N. ENTWISTLE
Correspondence concerning this article may be addressed to David N. Entwistle, PsyD, Dept. of Psychology, Malone College, 515 25th St., NW, Canton, OH 44709. Email: email@example.com.
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|Title Annotation:||psychological research|
|Author:||Entwistle, David N.|
|Publication:||Journal of Psychology and Theology|
|Date:||Mar 22, 2004|
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