Theophostic Prayer Ministry in clinical practice: issues and concerns.

Hunter, Linda A. ; Yarhouse, Mark A.

Theophostic Prayer Ministry (TPM) has been used in pastoral care settings for over ten years and Smith (personal communication, March 26, 2004) states that this is the setting for which he envisioned TPM as it came to fruition. Regardless of Smith's vision, TPM appears to be a model being used or considered for use by some Christian psychologists struggling to provide services to individuals desiring integrative treatment (Hardy, personal communication, April 05, 2004; Lehman, CAPS International Conference, Panel discussion, April 7, 2005; Meadows, personal communication February 23, 2004). Other Christian psychologists suggest that there are many critical concerns with the use of TPM that must first be addressed before moving forward and implementing the intervention in a licensed clinical setting (Entwistle, 2004a, 2004b, CAPS International Conference, Panel discussion, April 7, 2005; Maier & Monroe, 2003; Monroe, CAPS International Conference, Panel discussion, April 7, 2005).

It is hoped that the discussion to follow will shed light on a few on the critical concerns that have been discussed in Christian circles, published in recent literature, and presented at various conventions. The intent of this discussion is not to persuade the reader to adopt a particular viewpoint or to choose sides but rather the intent is to present factual information that will give the Christian psychologist the tools by which he or she can make an informed decision regarding the viability of TPM for clinical use in a selected setting. The concerns selected for this discussion will include TPM training requirements; the offering of TPM as a form of counseling; reoccurring emotions after receiving TPM; claims that TPM is maintenance free and the ensuing theological concerns; and the status of current research.

Training Requirements

Smith (2005b) put forth a Basic Seminar Manual as a guideline for becoming equipped to apply the principles of TPM in ministry sessions. He suggested that twelve to sixteen weeks be allowed to study the manual if the trainee is part of a group training experience. Smith also conducts Basic Training Seminars in which individuals in a group setting may watch Basic Training Videos and then witness in vivo demonstrations by those selected to lead the seminars. Once the Basic Seminar Manual has been completed the individual may contact the Theophostic headquarters, give indication that he or she has successfully completed the study of the training manual, and subsequently receive a seal to place on the Certificate of Completion that came with the training packet. At the bottom of the Certificate of Completion one will find the following statement: "This certificate does not certify, qualify or credential its holder with any level of expertise in administering Theophostic Ministry but rather signifies their completion of training" (Smith, personal communication, September 29, 2005).

Those sympathetic to TPM basically agree with Smith in that the Basic Training Seminar is necessary as a starting point for training to facilitate TPM but not sufficient in and of itself to qualify one to practice TPM (Hardy, personal communication, April 05, 2004; Meadows, personal communication February 23, 2004). The level of continued training and accountability then becomes predicated upon the arena in which the TPM sessions are conducted. Some such as Hardy (personal communication, April 5, 2004) state that continued training and supervision are essential for TPM facilitators and further "not just any lay person" is equipped to administer TPM. Meadows (personal communication February 23, 2004), who also conducts TPM training seminars, suggests that accountability and continued training is also an essential element for those facilitating TPM sessions.

Entwistle, Associate Professor of Psychology at Malone University, has published several critiques of TPM and displays concern for the ease in which one might come to facilitate TPM sessions (2004b).

I think the critical issue is in the amount of lay training; I do not think a video series is anything close to sufficient. I think lay counseling can be useful, but I am worried about the amount of training and the lack of supervision generally available in TPM training. (Entwistle, personal communication, April 5, 2004)

Smith (2005a) recognizes the need for accountability and the inherent risks of facilitating TPM sessions. "You may cause more harm than good if you seek to lead a person to the places of pain in his or her mind without all the tools you need to deal with what you open up" (p. 22). Therefore Smith (2005b) "recommend[s] that those who minister would have basic gifts in this area, be well equipped, and receive careful supervision.. .holding themselves accountable to a local church, pastor, counseling organization, state licensure board, or other form of accountability" (p. 5). These caveats notwithstanding Smith states that accountability is beyond the scope of his TPM ministry. "I'm not an institution; I'm simply a person who wrote a book" (Smith, personal communication, March 26, 2004).

While admittedly Smith's organization possesses no governing authority nor has the means to hold facilitators accountable, this is not to say that he has relinquished all concerns regarding this issue. At a recent conference, Renn, (CAPS International Conference, Panel discussion, April 7, 2005) who held the position of Ministry Operations Director for TPM validated the concerns for lack of training and accountability and countered with the steps that have and are being taken to provide and inform those who not only facilitate TPM but those who seek the ministry.

 We make every effort that we can to
 not only educate those who are training
 the trainees but those who are
 going for ministry where they can get
 information, have informed consent,
 and know what they are getting into
 before they're doing it.

While it appears both those sympathetic to and critical of TPM agree ongoing support and continued training are needed, what this should look like and how it should be accomplished remains debatable. Some pastoral counselors such as Powlison (2001) would strongly suggest that both counseling and ensuing accountability belong squarely under the covering and authority of the church; which then begs the question: Is TPM a ministry or a form of counseling?

TPM: Ministry or Counseling?

TPM in its original debut was known as Theophostic Counseling; however as legal and ethical questions arose Smith quickly adapted to the criticisms and after several revisions settled on the name Theophostic Prayer Ministry (Entwistle, 2004b). In a further effort to assist those facilitating TPM, he along with Wilder and Smith (2002) offered suggestions for navigating this controversy in Keeping Your Ministry Out of Court. Some have argued that TPM, no matter the name, is still a form of counseling which attempts to bring resolution to emotional distress (Entwistle, 2004b; Monroe, personal communication, April 05, 2004).

Smith (2005b) argues that TPM is not a form of counseling nor is it intended to be used as a tool to replace counseling. TPM "is prayer and, therefore, is not intended to replace good mental health care or medical oversight from a qualified physician or mental health professional" (p. 2).

Renn holds that as the new ministry began to grow and take shape the name was changed to reflect and more clearly define what was taking place during a TPM session. "That [the name change] was a result of the growing understanding of what was actually taking place in a Theophostic session, the essence of which is asking God to communicate His truth to someone as they submit their lives to him" (CAPS International Conference, Panel discussion, April 7, 2005). He further stated that "TP [Theophostic prayer] practitioners are not counselors as such--but they are facilitators and I agree ... that there is a place for intervention and there is a place for counseling and we have never suggested that there isn't. But our particular calling and our particular ministry is to view it as a prayer session."

While TPM may not offer advice or assist with problem solving strategies, Entwistle (2004b) believes that when TPM is viewed through the lens of psychotherapy one will find that it "adopts techniques similar to those of cognitive restructuring, exposure and desensitization therapies [and] identifying psychodynamic defense mechanisms" (p. 27). Lehman, a "licensed physician and board certified psychiatrist" sympathetic to TPM (CAPS International Conference, Panel discussion, April 7, 2005) appears to agree somewhat with Entwistle stating that TPM shares commonality with several empirically validated psychotherapeutic interventions:

 My assessment is that Theophostic is
 theoretically sound--the key being
 that I perceive the core principles of
 Theophostic include the most important
 core principles of Cognitive
 Therapy, Exposure Therapy, and
 EMDR which I think are three of the
 most research supported modalities
 of therapy. This is a significant overlap
 that is meaningful. Theophostic
 includes some important additional
 principles that further enhance its
 efficacy even beyond the other techniques
 I just mentioned.

In his assertion that TPM is in fact counseling, Monroe (personal communication, April 5, 2004) suggests that one look not to the literal definition of counseling but rather to the intent of the session:

 All therapeutic models implicitly or
 explicitly suggest a model of health
 that the counselees work towards.
 That makes all counselors into evangelists.
 We have an idea of health
 and we teach, model, or cajole people
 towards that idea based on our
 theories of change. TPM also has a
 model of health. The counselee is
 educated as to the problem (lies
 embedded in memories), encouraged
 to review memories and the lies
 attached, and then to wait for their
 encounter with Jesus. Smith wants to
 say that counselors don't give advice
 or try to talk people into disbelieving
 lies. He's only partly honest here.
 The very fact that he has "found" a
 way to solve the problem and educates
 clients to the process is a form
 of advice and counsel. Would anyone
 suggest that Gestalt therapists who
 use the empty chair technique aren't
 doing counseling? Many times they
 do not suggest the conversation the
 client should have--but its still therapy.
 It seems that Jesus is the trump
 card. If Jesus says it, then it's not me.

Monroe (personal communication, April 5, 2004), agreeing with Entwistle (2004b), states that the primary reason for the change from Theophostic Counseling to the now accepted Theophostic Prayer Ministry is most likely more closely linked to legal issues than content and process issues. For some critics Theophostic Counseling by any other name is still counseling.

Maintenance-free victory juxtaposed against resurfacing emotions

The discussion will now turn to the issue of TPM being represented as 'maintenance free' in the midst of resurfacing emotions and the theology embedded in this claim. Claims that TPM is 'proven effective' and the empirical support for, or lack thereof, will then be addressed.

According to Smith (2005b), prerequisites for "maintenance-free victory" involves (1) following an emotion back to the memory in which it is rooted, (2) discerning the lie that one came to believe in the midst of the event, (3) allowing Jesus to reveal His truth about that lie, and (4) choosing to believe the revealed truth. If and when these components are successfully navigated then the individual will neither continue to experience the negative emotions associated with that memory nor will they have recurring present experiences which trigger these same negative emotions. "When people receive truth from the presence of Christ in places where they have harbored lies, the outcome is immediate and radical change in people's lives as a result of mind renewal" (Smith, 2005b, p. 12).

The complexity of these two issues, what facilitates the change allowing one to walk in maintenance-free victory and what if emotions resurface, have concerned critics such has Entwistle and Monroe. At a recent conference, Monroe took significant issue with one of Smith's (2005b) definitions of TPM found on page 11 of the manual: "Theophostic Prayer Ministry is intentional and focused prayer with the desired outcome of an authentic encounter with the presence of Christ, resulting in mind renewal and subsequent transformed life." This definition of TPM when taken in tandem with Smith's model for change (discussed above) for Monroe holds the connotation that Smith is "suggesting that the peace of Christ is something that you will get from this [TPM] ... and unintentionally or intentionally it is presented that it is an all or nothing kind of thing; you get it all and it is sort of that mystical ahhh." Monroe's concern: what about life after the 'ahhh' for the client who continues to struggle?

Asserting that much is still to be discerned about the 'peace of Christ' Monroe offered Psalms 88 and Psalms 77 as examples and suggested that "the peace of Christ is not the absence of pain" but rather at times can "look pretty dark and dismal and painful." Using this example as the impetus for a discussion of sanctification, Monroe suggested one might be led to believe Smith has confused salvation with sanctification and does not support the progressive side of sanctification. As a result, those who successfully say no to negative emotions but struggle to do so as are missing out. Monroe suggests "we have to have a bit more of a progressive sanctification" than Smith's model allows.

Others such as Miller (2006) from the Christian Research Institute (CRI) also take issue with Smith's posture on sanctification stating:

 In the years after Smith developed
 TPM he was zealous to interpret his
 new method of inner healing in
 biblical terms, and to place it within
 the context of Christian sanctification.
 The teaching that emerged from this
 effort is where many of the valid theological
 criticisms of TPM have been
 lodged. He took biblical texts and
 terms and infused them with meaning
 derived from the TPM process.
 (p. 34)

Miller (2006) also agrees with Monroe (CAPS International Conference, Panel discussion, April 7, 2005) in that when statements such as "[t]rue victory is the absence of battle and struggle" (Smith, 2005a, p. 65) are made "Smith's choice of words here confuses the biblical concepts of salvation and sanctification" (Miller, 2006, p. 34). Miller suggests:

 [b]oth are by grace through faith, but
 salvation involves no human
 works ... whereas sanctification, by
 definition, is where human works
 enter the picture and become important.
 In other words, works done for
 salvation are unbiblical, but works
 that flow out of salvation are quite
 biblical and a sign of true salvation.
 (p. 35)

Miller (2006) further asserts that Smith runs the risk of demoralizing someone who has been struggling for years with homosexuality, for example, but has daily resisted the impulses only to be told that he is not victorious because he is not living in "maintenance-free victory" (Smith, 2005b, p. 7).

Erickson (2001) holds "one major issue over which there has been disagreement throughout church history is whether the process of sanctification is ever completed within the earthly lifetime of the believer" (p. 327). He suggests that there are two fundamental views held on sanctification: incomplete (progressive) or complete (perfection). Those who subscribe to the incomplete or progressive model of sanctification hold that "perfection is an ideal which will never be attained within this life. They maintain that as much as we should desire and strive after complete deliverance from sin, sinlessness is simply not a realistic goal for this life" (p. 327). However, "the believer is constantly exhorted to work and to grow in matters pertaining to salvation . striving for both removal of sinfulness and development of holiness" (p. 326-327).

Those who subscribe to complete or entire sanctification "hold that it is possible to come to a state where a believer does not sin, and that indeed some Christians do arrive at that point. This does not mean that the person cannot sin, but indeed he or she does not sin ... [however this does not mean] that there is no longer any temptation or struggle ... " (Erickson, 2001, p. 327). Miller (2006) in agreement with Monroe (CAPS International Conference, Panel discussion, April 7, 2005) suggests that regardless of the personal theological posture held by Smith, his continual use of phrases such as "maintenance free victory" (Smith, 2005b, p. 7) and "[t]rue victory is the absence of battle and struggle" (Smith, 2005a, p. 65) are not only confusing but also implicitly suggest that TPM on some level provides the necessary steps to achieve complete sanctification.

In his response to Monroe, Renn (CAPS International Conference, Panel discussion, April 7, 2005) summarily dismissed part of Monroe's concerns simply stating that 'we' do not believe sanctification is an 'ahhh' moment followed by an immediate arrival to a higher plain "never to return to any more struggle" but is rather a combination of both times of peace and times of struggle. What Renn did concede, however, is that some TPM terminology such as "maintenance free victory" (Smith, 2005b, p. 7) was misleading and "it could be commonly misinterpreted as you have one session and then you are done. I don't think he [Smith] ever believed that. I don't think that's what we do." Evidence for this rebuttal may be found in Smith's (2005b) manual:

 We have never suggested that people
 are completely made whole within
 their minds simply by participating in
 a few sessions. We have clearly
 taught that renewal occurs memory-by-memory
 and lie-by lie, over the
 course of a lifetime. I don't believe
 that a single session of this ministry
 will resolve all the pain in a person's
 life, since mind renewal is a lifelong
 journey. (p. 7)

While Monroe (CAPS International Conference, Panel discussion, April 7, 2005) does allow that Smith (2005b) has backed away from some of the earlier claims he still holds that Smith alludes to some type of revelatory moment that is then followed by the need for ongoing work with additional lie-based pain embedded within other memories.

Also of concern to several Christian psychologists is Smith's model for how change occurs. Although Renn stated that Monroe's suggestion of a mystical "ahhh" is not what is believed within TPM and Smith (2005b) has requested that his theology be debated apart from that of the critical concerns for TPM, critics such as Maier and Monroe (2003) hold that request to be futile:

 We do not dispute that some of the
 principles of his model of change
 might be interpreted quite differently
 if seen through a different theological
 lens. However, we do not believe it
 is possible to separate Smith's interpretation
 from the principles, since
 his interpretations of how people
 grow and change are reflected
 throughout his training manual. (p.171)

One of the most contentious issues of Smith's theology and his model of change appear to be in his view of sin. Although he asks that theology be placed to the side, Smith (2005b) gives some indication of his theology in the manual when he differentiates between "willful sin and emotional woundedness" (p. 98).

 The only cure for willful sin is the
 death of Jesus Christ on our behalf.
 We don't need to be renewed of sin.
 our sin was absolved at the cross.
 Woundedness, however, usually happens
 as a result of someone else's
 sinful actions, not our own, or circumstances
 that were beyond our
 control. Then with our wounds
 come lies that we did not ask for.
 These wounds need the touch of a
 risen Lord to be resolved. Jesus'
 blood absolves our sins, but His
 stripes ... resolve our wounds. We
 need a wounded Lord who understands
 our situation to renew our
 wounds." (p. 98)

Maier and Monroe (2003) suggest Smith's view of sin and model of change is clearly depicted in the tenets of a TPM session from which is noticeably absent any confession, forgiveness, or repentance of sin:

Healing is not something that just happens to us out of the blue. We cannot expect that God will take away our anxieties when we serve idols of the heart of perfection and when our fear of the creature outweighs our fear of God. He asks us to first repent of our sinful ways, turn, and then he will heal (2 Chron 7:14). (Maier & Monroe, 2003, p. 186)

Attempting to reconcile Smith's sin theology and model of change led Maier and Monroe (2003) to suggest that Smith equates the heart with sin and the mind with emotions. The distinction between "mind and heart seems artificial, especially when Scripture seems to use the terms more interchangeably (e.g. Matt 22:37). Sin continues to plague believers who are in constant need of repentance and forgiveness (e.g. Romans 7:1; 1 John 1: 8-10)" (p. 176). At the conference Monroe stated:

 With the idea that the heart has
 already been changed but the head
 needs mind renewal, one can get
 into a semi-Pelagian view that sin is
 only a willful conscious activity. And
 the subconscious, foolish, naive stuff
 I do is more just problems with my
 mind. According to Smith the problem
 that people have in life is that
 there are these lies that were planted
 or developed ... and they are still
 being lived out. I actually think he is
 raising the conversation about the
 affect of lies and I think that is a
 good thing. I do disagree on what
 we should do about it.

This leads to another critical concern regarding lies and emotions and begs the question: what does one do when the same emotions resurface after a TPM session? Smith, (personal interview, March 26, 2004) suggests that when the same emotions reemerge "there is some other memory that is attached to that same feeling." Suppose an individual has a presenting anger issue and during the process of TPM recalls the root memory and receives mind renewal in this area yet three weeks later is emotionally in the same place as before the TPM sessions and anger is once again an issue for this individual. Smith puts forth that one of two things has occurred: either there are more memories with embedded lies that carry the same or similar emotion or there are still other lies embedded within the original memory.

However, Entwistle (personal communication, April 5, 2004) appears more concerned with what these recurring emotions look like from the client's perspective. He suggests that when using Smith's TPM model, the client is led to believe that once Jesus reveals the truth and mind renewal occurs, then if the same emotions resurface he or she is in a dilemma with one of three options from which to select: "God did not heal or His healing is temporary; something other than memories is the cause of the feelings; or there is another memory" (personal communication, April 5, 2004). By default Smith is forced to select the third choice as the "first two choices would obliterate TPM and the theology behind it" (personal communication, April 5, 2004). Entwistle suggests that the TPM rubric paints a much more dismal picture for the client:

I am much more concerned for the individual who thinks, hopes, believes that they are free and then finds out they are not. Now what? They must either lose hope or go on a hunt for some memory that will free them. This sounds a lot like a new Gnosticism. There is special knowledge out there that once learned, will free me. (personal communication, April 5, 2004)

Entwistle (CAPS International Conference, Panel discussion, April 7, 2005) rather suspects that some individuals emerging from TPM may have been exposed to something other than an "authentic encounter with the presence of Christ" (Smith, 2005b, p. 7) and repeatedly suggested at the CAPS Conference that for him this is the watershed issue on which the entire viability of TPM is predicated.

I think the key issue in evaluating TPM is whether or not it is a method in which Jesus or the Holy Spirit is directly and divinely revealing things in people's memory and perhaps appearing in those memories . what I would like to suggest is the possibility that it might not be actually Jesus appearing; the possibility that what we might be seeing is actually someone's God representation that is their understanding of what Jesus or God might say to them. If that is the case, then there are a number of possibilities that I think we need to take seriously. one of which is the possibility that someone could have false ideas of what God would say. A second thing is that when a memory is 'revealed' it might actually not be a legitimate memory. And that we would have to look at the possibility of iatrogenetically created false memories. (CAPS International Conference, Panel discussion, April 7, 2005; see Entwistle, 2004a for further discussion on false memories)

While Entwistle repeatedly referenced this claim, Lehman and Renn continually offered support for TPM fostering authentic encounters with Jesus. Lehman made space for the possibility that it was not always Jesus who showed up in TPM sessions and in fact stated it was crucial for the facilitator to continually assess for this possibility and learn to discern the difference between the appearance of Jesus and one's idiosyncratic image of God.

 On a regular basis the person's own
 mind tries to help in my assessment
 [and] what I think I see clinically, is
 that you can tell the difference. Jesus
 is a lot better at everything than a person's
 own mind trying to help. In the
 place in the story where it's time for
 Jesus to speak, thoughts and all kinds
 of stuff comes that is not Jesus; you've
 got to discern that. But in my experience
 there are times where it is really
 the Lord. It's an important question; I
 think you can tell the difference. And
 one of the biggest differences I think
 you see is if you follow the actual
 fruit; people trying to do it themselves
 tends to be very meager, pathetic fruit.
 And when I feel like the living Jesus
 Christ is present in some way, the
 content is just so much more powerful,
 more profound, mature, balanced,
 it is beautiful.

Agreeing with Lehman, Renn states "the Holy Spirit is in the fruit producing business; when He is present and when He acts and when He does things people's lives are transformed" (CAPS International Conference, Panel discussion, April 7, 2005). Renn was also quick to point out that facilitators are trained to use the Bible as their guide when discerning if Jesus is authentically present.

Thus far the discussion has considered some positions by those both critical and sympathetic of TPM. Appearing to be common ground throughout the discussion is concern for clearly and fairly representing the essence of TPM, concern for client welfare, and accountability for facilitators. Innately embedded within these issues are implications for client expectation. In other words, 1) what are client expectations for TPM based on propaganda and 2) is there empirical support for the claims being made. Claims such as "proven effective with ... " are powerful assertions which, when made by licensed mental health providers, can often impel clients to hold elevated levels of treatment outcome expectations and subsequently seek treatment expecting successful outcomes. Efficacy statements such as these will now be reviewed through the lens of current research.

Proven effective with ...

What are reasonable client expectations when he or she reads "proven effective with ... " or similar statements and should there be a reasonable expectation that the goods can be delivered; does current TPM research support efficacy claims? This is debatable and certain facets of research possibilities for TPM were debated at the aforementioned CAPS conference in April 2005 although the discussions had more to do with Entwistle's concern of "Is it Jesus? Is it not?" The discussion that ensued did serve to highlight the complexity of researching something of this nature. Conceding that change does often occur in TPM, Entwistle asserts that the inherent theory driving TPM is virtually impossible to research for ethical reasons yet it holds the impetus for change:

Whether or not it is Jesus, if the client believes it is that speaks volumes in terms of what they would expect. So again, I am certain that this is something we cannot evaluate empirically. We can't put Jesus in a laboratory. But one thing I think we could do, although I think it would be fun to take it to an ethics committee, would be to actually do some Loftus-type research with suggestions that Jesus said something. But I think that would be hard to get through the ethics board and probably most Christian colleges wouldn't want you doing that anyway. (Entwistle, CAPS International Conference, Panel discussion, April 7, 2005)

Lehman responded to this by saying for him the data point is "video tapes of live sessions" and in vivo observations: "Part of what I would encourage for data, if you are considering pondering the point of what Dr. Entwistle is raising [Is it Jesus?] is to actually see it, ponder it, and be carefully discerning as you do that and ask in your own heart as you do that--what does this feel like?"

Due to the complexity of TPM, the inherent subjectivity, and the ethical issues raised, very little empirical validation has occurred. Garzon (2004), the leading researcher studying the efficacy of TPM has conducted some surveys which "indicate that a large sample of practitioners believe TPM is highly effective for many conditions and that many clients are also reporting positive experiences" (p. 107). He further reports that sixteen case studies have also been completed with "clinically significant reductions in symptoms levels" (p. 107) in fourteen of the sixteen cases as indicated by the Symptoms Checklist 90R. Of these fourteen, ten were considered to be symptom free and thirteen "maintained their gains at a three-month follow-up testing" (p. 107).

In respect to the newness of the research and the lack of other empirical data, Garzon (2004) enlisted the assistance of other "mental health professionals who do not use TPM and did not know the form of therapy being used" (p. 107) to interview the sixteen individuals, review the clinical records, and rate the client's level of improvement. The results of this follow-up analyses revealed that eleven clients had "much improved," two showed "moderate improvement," and three were perceived to have "mild improvement." (p. 108). A full detailed report of Garzon's research may be found on the official TPM website under "Research Findings." On this webpage, Garzon summarizes the surveys and case studies by stating:

All these measurements indicate client improvement in most cases. Combined with the practitioner survey results reported earlier, these studies support the need for a more thorough scientific evaluation of Theophostic Ministry using true experimental designs. Such designs are needed before clear statements about efficacy can be made. (Retrieved from www. theopostic.com on April 22, 2006)

It appears efficacy claims are being made, however, the issues at hand may be: are the assertions made for a pure form of TPM (as put forth by Smith) or made on a model of therapy predicated on a modified form of TPM? Two examples of statements regarding efficacy, although lengthy, will be quoted in order for the reader to appreciate the complexity of the issue at hand. At the aforementioned CAPS conference, Lehman stated:

 I am a licensed physician and a
 board certified psychiatrist. My personal
 clinical experience in a way
 provides empirical data in the form
 of a series of case studies. In my personal
 practice I have diagnosed and
 treated patients with major mental illnesses,
 major depression, phobias,
 post traumatic stress disorder, panic
 disorder, addictions, eating disorders.
 And in my work using a Theophostic
 based therapy many of these patients
 have found and resolved traumatic
 memories. The signs and symptoms
 then decreased as we addressed
 those issues, those memories. And
 almost all of these patients had sustained
 improvement, significant
 enough to allow significant medication
 decreases. Some of the patients
 have had as far as I can tell as a psychiatrist
 complete resolution of their
 clinical syndrome, their clinical picture,
 have come off their medications
 and have done well for up to six
 years; no meds, no return. So that is
 just a clinical data point that is significant.

Critically reading this statement, the key operative phrase might possibly be "Theophostic based therapy." What does that entail and how does it differ, if any, from TPM? It remains unclear at this point if Lehman practices TPM as put forth by Smith or if his model is a derivative of TPM.

Another statement similar in nature can be found on the website for a Christian counseling center with licensed mental health providers on staff:

Theophostic[R] Counseling has proven effective with ... Sexual abuse issues, rejection issues, false guilt issues, marital conflict needs, traumatic memories, post-traumatic stress syndrome, eating disorders, children's issues, grief and loss, homosexuality, all lie-based counseling issues. (Christian Psychotherapy, Retrieved February 19, 2006, from http//www.christianpsychotherapy.com/theophos.htm)

As with Lehman's statement this raises the question, is Theophostic[R] Counseling and TPM one and the same; is it different and if so in what way; and is it reasonable to expect the average client to know the difference?

The questions just posed are not a new area of concern for Smith and he has repeatedly and clearly asked that if an individual is not facilitating TPM in its purest form to please call what is being done by another name (2005b; personal communication March 26, 2004). Smith is evidently concerned with the surfacing of models that are not TPM in its purest form but rather models that hold only partly true to TPM principles and guidelines. As previously stated, the ease with which one can obtain the training packets and facilitate TPM sessions as well as the lack of supervision might more readily lend TPM to use beyond what Smith originally intended, such as blending it with other forms of counseling.

To summarize the foregoing, in the area of requirements, critics and supporters alike seem to agree that additional training is needed. The disagreements appear to be around what that additional training would entail and how it would be provided.

On the issue of whether TPM is a ministry or a form of counseling, significant disagreement remains, as some view TPM as strictly prayer and quite distinct from counseling, particularly professional counseling with a licensed mental health professional. others view TPM as counseling and see it being used in hybrid models by licensed mental health professionals.

The issue of sanctification continues to be an area for discussion. We tend to agree with Erickson (2001) that this may reflect differences regarding progressive and complete sanctification. But the lack of clarity on this matter may have significant impact on "consumer" expectations of TPM in actual practice. We encourage more discussion and clarification on this matter, as well as how these expectations and the different experiences are conveyed to the public.

We are encouraged that research is being conducted on TPM. As with any new model, we recommend a conservative approach in which we share with the public what we know and do not know about a particular intervention, and an expanded informed consent may be appropriate (see Hunter & Yarhouse, 2009).

Finally, at this point in its history, we see TPM as a continually developing model of prayer in a ministry context. Smith appears to be taking an approach that is responsive to some of the concerns that have been raised (rather than hardening his "position" in a way "against" those who have been critical of his work).

Conclusion

It is hoped that this discussion shed light on a few of the critical concerns surrounding TPM that have been discussed in Christian circles, published in recent literature, and presented at various conferences. The intent of this discussion was not to persuade the reader to adopt a particular viewpoint or to choose sides but rather the intent was to present factual information that will give the Christian psychologist some tools by which he or she can make an informed decision regarding the viability of TPM for use in a selected setting.

References

Christian Psychotherapy (n.d.). What is Theophostic[R] Counseling? Retrieved February 19, 2006, from http//www.christianpsychotherapy.com/theophos.htm

Entwistle, D. N. (2004a). Shedding light on Theophostic Ministry 1: Practice issues. Journal of Psychology and Theology, 32, 26-34.

Entwistle, D. N. (2004b). Shedding light on Theophostic Ministry 2: Ethical and legal issues. Journal of Psychology and Theology, 32, 35-42.

Entwistle, D. N., Lehman, K., Monroe, P. G., Renn, B. (2005). Theophostic Prayer Ministry: Diverse perspectives on a controversial technique. (L. A. Hunter, Moderator). Panel discussion at the meeting of the Christian Association for Psychological Studies International Conference (CAPS), Dallas, Texas, April 2005.

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Linda A. Hunter

Nebraska Mental Health Centers

Mark A. Yarhouse

Regent University

Linda A. Hunter, Psy.D., received her doctoral degree in Clinical Psychology from Regent University. She is a provisional licensed psychologist completing her clinical psychology residency at Nebraska Mental Health Centers in Lincoln, Nebraska. Her research interest continues to be ethical concerns in integration of religiously based interventions and psychotherapy in clinical practice.

Mark A. Yarhouse, Psy.D., received his doctoral degree in Clinical Psychology from Wheaton College. He is the Hughes Chair of Christian Thought in Mental Health Practice and Professor of Psychology at Regent University, Virginia Beach, Virginia. His research interests include sexual identity, family therapy, and applied/clinical integration.

Please address correspondence regarding this article to Linda A. Hunter, Psy.D., Nebraska Mental Health Centers, 4545 S. 86th Street, Lincoln, Nebraska 68526. Email lhunter@nmhc-clinics.com