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Counseling Adolescents with Cognitive Behavioral Therapy: Biblical Application for Modern Therapy

Counseling Adolescents

Adolescence primes the mind, body, and spirit for many cognitive, biological, and spiritual changes as adulthood is entered. These changes include, but are not limited to, psychosocial development, puberty, cognitions, and identity formation. Due to these changes, adolescence has been labeled a sensitive period. A sensitive period is one in which individuals are more susceptible to environmental stimuli with an increased likelihood of developing certain traits (Dyer et al, 2020). Sin also seeks to pervade and complicate this stage in life, bringing added stressors of new temptations and trauma. When the balance within the mind-soul-spirit-body composition is disrupted, counseling is vitally important to restore the image of God in adolescents. This paper will address counseling adolescents through the Christian theory of psychotherapy, using the cognitive-behavioral (specifically the trauma-focused model) and prayer techniques. Further, research questions such as does psychotherapy have a place in Christian counseling, has cognitive-behavioral therapy been proven to alleviate or diminish symptoms in clients, and can prayer restore and protect adolescents will be addressed.

Counseling Remains Consistently High in Need for Adolescents

Adolescence has been studied to be a sensitive period of development. Because of this, counseling adolescents is important to ensure a healthy transition into adulthood and the image of God is restored to avoid lasting damage. Before adolescence, young people will have already encountered abuse, neglect, and trauma due to sin. These encounters shape the psyche, scar the soul, morph the spirit, and damage the body. Emotional disorders remain the main clinical reason children and adolescents are placed in therapy (Batra et al, 2021). Among the other prevalent disorders are depression, anxiety, personality, eating, behavioral, and neuro-development disorders, and learning difficulties. These disorders can occur as a reactionary response to triggering stimuli or be the result of susceptibility due to genetics.

Nature and nurture both correlate with adolescent development. For instance, poor relationships between parents results in the damage of children’s and adolescents’ emotional well-being (Batra et al, 2021). Physical illness can also impact psychological balance, even apart from the existence of trauma or abuse, and become risk factors for mental illness. Counseling in the adolescent stage and bringing the restoration of the image of God is important since research has found that God is viewed in more relational and interpersonal terms in adolescence due to the increased ability for abstract thought. Adolescents turn to God for psychosocial and spiritual issues such as identity, purpose, and comfort and understanding during life’s conflicts. This relational viewing of God has been evaluated empirically to hold more importance than relationships with parents (Cook et al, 2020).

Psychotherapy and Its Impact for Adolescents

Psychotherapy is a counseling intervention that reveals cognitive and emotional processes and helps clients understand and cope with them. An empirical assessment of psychotherapy in children and adolescents was systematically reviewed in an updated study in 2021. Practice-based evidence revolving around different trauma topics identified 29 studies of mix groups of children almost completely in a naturalistic setting with the focus on children and adolescents aged 3-12 years old (Batra et al, 2021). Children who had experienced a range of trauma encounters (e.g., abuse, neglect, domestic violence, etc.) with differing clinical presentations (symptoms of emotional, behavioral, and nuero-developmental disorders) showed outcomes that psychotherapy was highly beneficial (Batra et al, 2021). Favorable outcomes for psychotherapy were also seen cross culturally as mental health disorder statistics lowered while all functioning adolescent domains improved. Patients became more adaptive, symptoms reduced, and interpersonal patterns and relationships became less rigid.

Psychotherapy in Christianity has been viewed as an unsteady relationship, mainly due to client and therapist beliefs. Some therapists retreat from identifying sin, especially if they are unregenerated, and vice versa for clients. However, mental disorders and sin are both realistic inside and outside of a clinical setting. Not all mental disorders can be tied to sin while not all sin can cause mental disorders. Likewise, mental disorders do not strip Scripture of its power nor of patient responsibility for their actions or thoughts. Recognizing patterns of behaviors or thoughts is a step towards recovery and therapists who have and maintain a biblical worldview will have the most value to clients. Psychotherapy alone cannot heal nor replace God or fellowship within the church. All scripture is profitable (2 Timothy 3:16-17) and is a light (Psalm 119:105). Fellow Christians are called to bear each other’s burdens (Romans 12:15) and encourage and exhort each other (Hebrews 3:12-13). God instructs that fellowship is needed with Him and prayer establishes communication and confession (Hebrews 10:19-23).

Struggles that are faced in this life are the result of the fall (Genesis 3) and when sin is recognized, confronted, and repented of, God can be reconciled with, and healing be established (Ephesians 2:1-10). For the patient in need of restoration from their own sin or someone else’s sin to them, psychotherapy is a vessel for recovery but not the main source. Upon conversion, inward sanctification by the Holy Spirit actively and continuously puts sin to death and helps the converted to live according to God’s precepts (Romans 12:2, Philippians 2:12-13).

Cognitive Behavioral Therapy in Adolescents

Cognitive Behavioral Therapy is a psychosocial technique used to reduce symptoms of multiple cognitive and emotional illnesses. Clients who have experienced posttraumatic symptoms (PTSS) from abuse (e.g., mental, emotional, physical, and sexual abuse, domestic violence, etc.) neglect, and other traumatic encounters undergo Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). The BESTFORCAN study on 580 participants each ranging from 5–20-year-olds with at least one caregiver present for each client conducted in 2020 provided empirical evidence that showed children and adolescents who are exposed to traumatic experiences are more likely to develop impairments educationally, mentally, and physically. TF-CBT improved externalizing of symptoms along the PTSS spectrum as well as depression and anxiety (Albrecht et al, 2020).

Spiritual issues tied to abuse, neglect, and other traumatic encounters have been tediously evaluated as well. A two-case study method on 347 participants between 11-17 years old and caregivers ranging from 27-79 years old was implemented in 2019. This study evaluated spiritual struggles particularly after sexual abuse. Both case study findings revealed a correlation between adolescent adjustment issues and divine spiritual struggles. Higher levels of divine spiritual struggles were evaluated alongside an increase in adolescent adjustment disorders. Religious activity also impacted cognitive processes. (Cook et al, 2019).

Prayer and Religiosity in Counseling Adolescents

Religiosity expresses religious sentimentality and adolescents often express this as they cling to faith in hard times. Prayer and religiosity were examined in a cross-legged, 10-wave longitudinal study in 2020 of 489 participants from 12-20 years old. Empirical evidence tested the hypothesis that adolescence was a sensitive period, especially for spiritual development. Further, this evidence revealed that due to the increased capacity of abstract thought and emotional openness, adolescents were more susceptible to conversion and willing to engage in religious activities. Categories of religiosity such as public practice (congregational attendance), private practice (prayer) and salience were evaluated. Religiosity overall resulted in protection from high-risk behaviors (premarital sex, substance use, etc.), antisocial behaviors (delinquency, aggression, etc.) and mental disorders such as depression (Dyer et al, 2020).

Religiosity increased stability throughout adolescence, decreased the desire for destructive behavior, and protected cognitive maturation and identity formation. However, results of the previously mentioned study also noted that religiosity tended to decline after adolescence with many factors being nature, nurture, and life events.


Adolescence remains a sensitive period for growth and maturation cognitively, emotionally, spiritually, and biologically. Sin complicates this transitional period in life by introducing factors such as trauma (e.g., child neglect and abuse, sexual assault and abuse, traumatic events, and life changes, etc.) and the havoc these encounters create. Much care has been taken in empirical research to show that counseling intervention bears abundant fruit in the outcomes of its clients. The Christian theory of psychotherapy with the techniques of cognitive-behavioral therapy and added religiosity proved to have the best overall outcome with clients since healing was established on a biblical foundation. God himself performed several crisis interventions throughout the Bible (Genesis 3:1-19; 29:31, Psalm 59:16; Psalm 107:6, 13, 19, 28; Jeremiah 1:19, etc.). Overall, therapy itself cannot heal, but does provide a vessel for the Holy Spirit to reveal sin and help people (even adolescents) to take measures to triumph over it.


Albrecht, B., Barke, A., Christiansen, H., Elbert, D.D., Lechner-Meichsner, F., Muche, R., Rosner, R., Steil, R., & Zarski, A.C. (2020). Best for CAN-bringing empirically supported treatments to children and adolescents after child abuse and neglect: study protocol. European Journal of Psychotraumatology 11(1), 1837531. 10.3389/fpsyg.2021.662671.

Batra, P., Cirasola, A., Kennedy, E., Midgley, N., Mortimer, R. (2021). The evidence-base for psychodynamic psychotherapy with children and adolescents: a narrative synthesis. Frontiers in Psychology 12(1), 662-671.

Cook, K., Jouriles, E.N., Mahoney, A., McDonald, R., Kurth, C., & Rancher, C. (2019). Divine spiritual struggles and psychological adjustments among adolescents who have been sexually abused. American Psychology Association, 10(3), 334-343.

Dyer, J.W., Goodman, M., & Hardy, S.A. (2020). Religiosity from age 12-20: stability, change, and bidirectional effects of attendance, prayer, and salience. International Journal for the Psychology of Religion, 1834745.

English Standard Version Bible (2011). Crossway.

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