Gatekeeping for Faith Leaders, Part 3: Let’s Talk about Safety

NOTE: The following article is in no way meant to be a replacement for formal, in-person training on mental health first aid.

Welcome back to our Gatekeeping for Faith Leaders series! If for some reason you missed our first two installments, I highly encourage you to begin by reading Part 1, How do I know When to Refer Someone to Counseling, and Part 2, What is my Role after I Refer Someone to Counseling?

Do not be fooled by the order of these installments. Safety in crisis situations, despite it being the metaphorical caboose of this discussion, is probably the most important of the three topics. I intentionally left it for last to make sure that we had fully discussed the roles and relationships between the mental health and faith leader communities prior to discussing crisis situations. Why? Well, the last thing I want to happen to someone reading this article is for them to assume that we in the mental health field expect you to take on tasks for which you have not been trained or prepared.

So please, hear my plea and read installments 1 and 2 before delving into this topic of Safety.


The Importance of Gatekeeping in a Crisis

A year or two into my counseling training, I was out of town visiting a small church, and a teenager came forward at the end of service for prayers. It was a Sunday night with sparse attendance. The usual prayer was said on his behalf before dismissal, and everyone went their separate ways. Within minutes, my father found me and asked me if I was comfortable talking to this young adult who had expressed some suicidal ideation, as there was no one else available trained on the topic.

First, I was floored. I was green to the counseling world and did not even have a degree in it yet, much less a license. Thankfully I had just recently completed my crisis counseling class and had role-played this scenario what felt like hundreds of times. I did have some experience working with teenagers with suicidal ideation in the inpatient hospital where I was currently employed, but all of these scenarios were under strict and appropriate supervision.

Surely I am not the only one here, I thought. This cannot be happening.

But my second train of thinking was, if not me, who?

It absolutely frightens me to think of how often this scenario could be happening in our churches. I praise God that this teen chose to share his thoughts in a safe space—that act of courage still brings tears to my eyes– but how safe was the space, really, if no one was trained in helping him seek further professional care?

Research on this topic concludes that gatekeeping training in religious settings is a very strong protective factor for suicidality, especially since many individuals speak with close friends and family prior to dying

by suicide. For many people, the church is an important line of defense. But faith leaders must know what to do [3,4,8].

Some things to consider:

When I spoke with this individual that evening, I did not pretend to be his therapist—that was not my role. I didn’t pretend to be his parent or guardian, either, but after chatting with him I made sure they were fully in the loop. I used skills that I had learned to assess the situation in the moment, decide how to address his current state, and ensure that follow-up care was obtained.

In a very serious case, follow-up care could have looked like calling a hotline with him, calling 911, or driving him to the emergency room. Thankfully the most appropriate steps for him were to be closely observed by a family member who would assist him with speaking to a professional immediately the next day.


I was no hero that evening. I just happened to be someone who knew how to ask a few questions and take action according to the answers. Gatekeeping is just that: a way of leading someone to the next, most appropriate step. These scenarios can feel nerve-wracking, and in our fear and great care for someone we can often get caught up in details that keep us from being immediate in making sure the next connections to professional care are made.

Think of this role like being trained in CPR: you are on the scene until a professional arrives or the person can get to a professional with your help.

Whether you have been trained to respond or not, these scenarios will absolutely arise. And honestly, I hope that they do—because it is a fact that people are struggling with mental health concerns in droves–and I would rather the people in our church communities reach out to you than suffer in silence. When they reach out and you are trained in gatekeeping, then we can work together in our revolving-door fashion to help them.

When a person seeks crisis support from faith leaders, we know that they have a built-in system of support already, and a community willing to walk with them through it.

As mentioned above, this article is not a replacement for training, but instead a call to action for you to obtain crisis training in a manner that allows you the opportunity to ask pertinent questions and hopefully role-play scenarios you may encounter. If you or your congregation would be interested in receiving specific training on this topic from ChristianWorks, we encourage you to reach out to us.


Here are some various resources for Mental Health First Aid training and/or Suicide Prevention Training:

Question. Persuade. Refer

Mental Health First Aid from the National Council for Wellbeing

Mental Health First Aid from Texas Health and Human Services

Some of the things that you will learn in a Mental Health First Aid Training or Suicide Prevention Training are:

– Risk factors of suicidality

– Warning signs that a person may be thinking about suicide

– How to actively engage in conversation with a person you believe could be in danger to themself.

– What questions to ask and how to respond to the answers given

– How to “triage” the situation to guide the person toward immediate, most effective care for the situation

– How to enlist help from the individual’s support system

– What crisis resources exist in your area

Some quick tips that have helped me (I cannot stress enough that this is not a replacement for training): If you are unsure of what to do or the situation feels out of control, call a 24/7 hotline or 911. I have used this rule of thumb both in the counseling room and as a layperson. Often an individual will not want to call on their own, but you can offer to do it for them and talk on speakerphone. This keeps you from operating in isolation to keep the person safe.

– Remember that you are the first line of defense, but not the last. You are not expected to do this singlehandedly. Just as if you were performing CPR compressions while waiting on medics, you are a critical part of care but are not expected to serve as the professional.

– Be proactive. Do not receive “I’ll call the hotline/my mom/my friend when I leave” as an acceptable answer. You will be staying with the person until they take the next step toward support or safety, whatever that step may be (full training will make sure you know what these steps are and how to assess the situation).

DFW Resources and Hotlines

National Suicide Hotline: 998

North Texas Hotline: 214-828-1000

DFPS Youth hotline: 1-800-989-6884 (call or text)

ADAPT 24/7 Mobile Crisis hotline: 866-260-8000

North Texas Behavioral Health Authority: 1-877-653-6363 or 1-214-366-9407


1. American Psychiatric Association Foundation. (2018). Mental health: A guide for faith leaders.

2. American Psychiatric Association Foundation. (2018). Quick reference on Mental Health for faith leaders. Retrieved April 26, 2023, from

3. Bazley, R., Pakenham, K., & Watson, B. (2019). Perspectives on Suicide Prevention amongst members of Christian faith-based organizations. Community Mental Health Journal, 55(5), 831–839.

4. Bazley, R., Pakenham, K., & Watson, B. (2019, January 2). Perspectives on Suicide Prevention amongst members of Christian faith-based organizations – community mental health journal. SpringerLink. Retrieved April 25, 2023, from

5. 5. Mental health first aid. Mental Health First Aid. (2023, March 28). Retrieved April 20, 2023, from

6. Mental health first aid. Texas Health and Human Services. (n.d.). Retrieved April 25, 2023, from

7. QPR Institute . (n.d.). QPR Institute: Practical and proven suicide prevention training. QPR Institute Practical and Proven Suicide Prevention Training QPR Institute (en-US). Retrieved April 20, 2023, from

8. 8. Wood, D. S., Ohri, F., Hudnall, G., & Cahoon, L. (2022). Suicide gatekeeper training outcomes in educational and religious settings. Journal of Human Behavior in the Social Environment, 33(2), 225–231.

The Sandwich Generation: Caretaking Times Two

The Sandwich Generation: Caretaking Times Two

The day Hurricane Katrina swept herself 150 miles inland into my hometown, my parents were in a pretty difficult stage of their Sandwich Generation era.

Papaw, my paternal grandfather, sat with us at the kitchen table while we watched the forest surrounding my parents’ house begin to fall trees, one by one. My Mamaw, his wife, was in a temporary medical facility half an hour away.

Our house was miraculously unscathed, but both cellular towers and landlines were down for days, power was down for over a week, and my dad spent the night in his car at the gas station with half of the rest of our town waiting for the gas truck to arrive.

Only then were we able to drive the distance to where my Mamaw was located to know for sure that she was safe.

We drug mattresses across town and all lived at my dad’s workplace for a few days until power was restored, because the August heat and humidity was simply too dangerous for my grandparents.

My memories of Hurricane Katrina are incredibly mild compared to others, and I also recognize that it also stands out as an extreme circumstance of caretaking. But for some reason that experience stands out as one of the first moments I was brutally aware of the burdens placed on my parents in simultaneously raising three children and managing the care of their aging parents.


What is the Sandwich Generation?

The Sandwich Generation is a term used to describe caretakers who are caring for both younger and older family members. Typically you may see this in the form of parents who have children still at home but who also are active in the caretaking of their own aging parents.

Why is this phenomenon happening?

Simply put, baby boomers are getting older and living longer, but “there’s been no significant change in the level of mild to moderate disability for older people.” While people may be living longer lives, those lives are not necessarily healthier ones [8].

Also, census data tells us that the mean age of women having children is increasing [5]. Families are having children later than generations before us. There was a time in which seasons of empty nesting and middle age seemed to be concurrent life events, but now middle age finds many families still in the active child-rearing stage of life.

How many people are part of this sandwich generation?

12% of parents (as defined as someone who has a child under the age of 18 in their home) in the United States also serve as unpaid caregivers for one or more adults [4].

This number is estimated to be about 11 million people, or 28% of all caregivers [1].

What are the impacts/ challenges for sandwich generation caregivers?

Adults in this sandwich generation may be constantly attending to medical events, balancing personal careers, and often struggling to find time for partners or the management of their own homes [3]. Even if a loved one has full-time residential or in-home medical care, sandwich generation caretakers are probably still actively present for emergency room visits and doctor’s visits, and help with managing insurance concerns, finances, and general tasks.

Most sandwich generation families are also impacted financially, by directly helping cover medical and living expenses for loved ones, or indirectly by needing to decrease work hours to manage family the member’s care [8].

It is estimated that “a third of sandwich generation caregivers report a high level of emotional stress and a fifth report high levels of financial and physical strain” [1].

One can see how the emotional toll of this role is warranted.

And, the management of emotions can be quite complicated for someone in the Sandwich Generation.

Maybe a person feels…

Guilt for being less present with their spouse or children

Frustration if the parent they are caretaking was not always kind or supportive to them

Anticipatory grief while making end-of-life decisions for a loved one whose health is declining

Stress over finances or time management

Confused about how to manage the changing mental state of the person they are caring for

…and none of these feelings are wrong! They are normal and often expected, but they may require some extra support at times.

How caring for yourself heals the whole sandwich

Caring for a parent can, as we say in the counseling world, “bring up a lot” for a person. Imagine for a moment that your brain has a cardboard box of every experience and resulting emotion you’ve had regarding your parent: it’s a hodgepodge of good, bad, and ugly memories. Maybe this box is shoved in a forgotten closet under some vintage Christmas decorations and the Pythagorean theorem and your first boyfriend’s home phone number. You stashed it there to keep yourself from swinging too heavily into hurt or even rage. Maybe your relationship with your parents is best at balance when you’ve decided to avoid certain topics. But all of those topics are right here in this box.

The relationship balance is skewed when you begin more actively managing your parent’s day-to-day life tasks. The role of caregiver shifts from parent to child, and each of you responds accordingly. Chances are, this box gets pulled out into the daylight and dumped in the front yard of your brain.

These are tough emotions to manage. Family work is tough and complicated, even if your childhood was seemingly ideal.

A therapist can help you sort through this box, reorganize it, and heal—even in the midst of a sandwich generation time of life.

And you know what is best about healing your own childhood wounds? You become a better parent to your children. This is where you can stop the generational hurt for good while actively repairing relationships in the whole sandwich.

The Sandwich Generation will not fade from reality.

The US Census Bureau projects that by 2034, people over the age of 65 will outnumber children for the first time in United States history [6].

This is a phenomenon that has countless impacts on society as a whole.

I think often about the time that I will most likely be an active-duty member of the Sandwich Generation, myself. Is anyone ever really ready for the caregiving roles to turn on end?

There are ways we can prepare ourselves for the caretaking roles in our future, and support those who are in these roles now.

What you can do now.

-Begin having conversations with your parents now about their wishes and plans for this upcoming time of life prior to any major medical events or decline of mental capacities. While you may need to reassess some of these points later, this allows you to at least know what their current thoughts are on particular topics. Assisting your aging parents in maintaining as much dignity as possible as you slowly (or quickly, in some cases) begin to manage areas of their lives is of great importance.

– Understand how they manage finances. Have a trusted place for passwords. A New York Times article on this topic identified that it “may take years” for an aging parent to accept help, especially in the area of finances [3]. Who do they trust most to be the go-to for handling money management?

– Ask your parents about their medications. Are their medications being well-organized? If something happens, do you know what they take and when? Often, aging individuals begin to struggle with keeping track of medications and basic doctor’s appointments. Even if it seems like a while before your own parents could need this help, it is important to know where the information exists.

-Have contact information for your parents’ trusted professionals. Who are their doctors, lawyers, and faith leaders? Who mows the lawn or cleans the house? These are people you may be in direct contact with in the future. Know who they are.

Know who your support system will be in this endeavor. Do you have siblings who can share the load? Do you have trusted friends willing to help with driving your parents or your kids to different places? Talk to your circle about how you can support one another when and if you become a sandwich generation caretaker. Maybe your brother-in-law is great at understanding investment accounts, while your sister has no problem talking assertively to insurance companies and managing medication schedules. Your next-door neighbor loves dog-sitting, a lady at church does in-home hair appointments for the elderly,

and your best friend is great at cracking jokes just exactly when you need them. Lean on these individuals.

Believe me, you will need them.


While my parents have not had children to raise for quite some time now, their active-duty roles as caretakers to aging parents is currently creeping toward the 20-year mark. Watching my parents serve family members humbly and patiently (and sometimes not so patiently, to be honest) all this time has offered me a long-term case study in generational family systems.

I could easily paint a rosy picture for you and say that it has been glorious for them to be so present and that not a night of sleep or moment taken from other areas of their lives has been lost. But honestly, it has been very challenging at times to witness my parents through this season of life. It reminds me that serving another person, however much we love them, is never without sacrifice or hardship.

And yet, difficulty should not sway us from serving the best we can, in the most reasonable and sustainable way that we can for everyone involved. Remember, the health of the whole sandwich is important.

Sweet side effects of these difficulties exist, though. The New York Times article, It’s Pretty Brutal: The Sandwich Generation found that 23 percent of sandwich generation caretakers identify that the experience has strengthened their relationship with their aging relative.

I can think of several memories with my grandparents, like those from the weeks following Hurricane Katrina, that I kind of wish I never had to know.

But however raw and heartbreaking some of those moments felt, I witnessed them for the reality that they were, and I am a better person for all of them.

The most honest approach any of us can have about the prospect of aging parents, caretaking, and decision-making for the years of someone’s final season of life is this:

We honor our relative’s dignity and autonomy as much as possible, make the best decisions with the options we have at our disposal at the time, lean into tenderness, patience, and forgiveness, and find that grief and bravery can co-exist.

Shoot, this may just be the definition of being human.


1. Caregiving and the sandwich generation. Mental Health America. (n.d.). Retrieved April 20, 2023, from

2. The economist/YouGov poll December 28 – 31, 2019 – 1500 US adult citizens. (2020, January). Retrieved April 21, 2023, from

3. Grose, J. (2020, February 18). ‘it’s pretty brutal’: The sandwich generation pays a price. The New York Times. Retrieved April 25, 2023, from

4. Livingston, G. (2018, November 29). More than one-in-ten U.S. parents are also caring for an adult. Pew Research Center. Retrieved April 21, 2023, from

5. Mathews, T. J., & Hamilton, B. E. (2016, January). Mean age of mothers is on the rise: United States, 2000–2014 – CDC. Retrieved April 21, 2023, from

6. United States Census Bureau. (2018, March 13). Older people projected to outnumber children for first time in U.S. history. Retrieved April 20, 2023, from

7. United States Census Bureau. (2020, June 25). 65 and older population grows rapidly as baby boomers age. Retrieved April 21, 2023, from

8. Waters, S. (2022, May 27). The sandwich generation, understanding who they are. The Sandwich Generation, Understanding Who They Are. Retrieved April 20, 2023, from

The Fruits of the Spirit: Some Considerations for Christians who are Counselors

The Fruits of the Spirit: Some Considerations for Christians who are Counselors

The individual views expressed in this particular article are based on the work and worldview of the writer and do not represent the general beliefs of every ChristianWorks staff member or counselor.

I have spent quite some time thinking about what it means to be both a counselor and a Christian and what that looks like in practice. It is a topic that courses through my brain cells literally every day since I began training as a professional counselor. Goodness–even before then, probably. I am perpetually considering how my counseling practice is informed and impacted by my Christian faith—and, of course, what that means for my clients.

Throughout my time in the mental health field, I have had the privilege of gaining powerful insights from mentors and supervisors who have been willing to engage in this topic with me. They have challenged me to consider how my personal views on topics such as death, salvation, worship, marriage, and family life show up both covertly and overtly in the counseling room. Through these practices, I have come to determine that an examination of our worldviews and how they relate to our counseling work is incredibly important.

How does what I believe about *insert topic here* shape my work? As counselors, we should be asking ourselves this question as often and easily as we reflect feelings during a session.

You and I could chat for days upon days about the intersection of theology and psychology and the implications of such. And I would thoroughly enjoy the conversation!

But ultimately, I think one of the major things that counseling-as-a-Christian comes down to is the representation of the fruits of the Spirit.

These are the foundational points that I have come to for my own practice:

  1. We are people of the Spirit (Galatians 5:25)
  2. As such, the fruits of the Spirit should be evident in all that we do (Galatians 5). That does not exclude the counseling room. (Galatians 5:23).
  3. We are people who believe in a God who is able to do more than we are able to imagine (Ephesians 3:20). We are never alone.

But do I really act like these truths are just that: true?

Allow me to share with you some ways I think the Spirit’s fruits can be evident in the counseling room when we are showing up to work as people of God.


Galatians 5:13 “Through love serve one another.”

As Christians, we are meant to be servants driven by love for God and each other. As counselors, this is displayed by our service to the greater community by helping individuals, children, couples, and families process hurts and pursue individual goals.

As an Adlerian-leaning therapist, I am reminded of one of the components of Adler’s theory of Individual Psychology: Social Interest. Social interest is just that: “a feeling of cooperation with people, the sense of belonging to and participating in the common good” [1].

When we serve through love as counselors, we operate with selflessness and give attention to the needs of others to help them better operate in their social and familial environments. We serve the individual, but also the community at large.


As disciples of Christ we understand that joy differs from happiness in that it is not conditional on external circumstances, but on an internal “peace that passes understanding” (Philippians 4:7).

This does not mean we exude a façade of toxic optimism in the counseling room, but that the balance of our own emotional stability is not based solely on the ups and downs of life.

This kind of joy, in my opinion, is an antidote to burnout for Christians who are counselors.

Some weeks in the therapy room are incredibly hard. They are often triggering to our own hurts and can stir up anguish for us long after the client has left the building.

But with God, we are able to both mourn and celebrate with our clients in a single day, knowing that the battle for our souls is already won, and the traumas and hardships of this life do not define the end of any story.

“The joy of the Lord is your strength” (Nehemiah 8:10).

“For his anger is but for a moment, and his favor is for a lifetime; weeping may tarry for the night, but joy comes with the morning” (Psalm 30:5).


A peaceful presence in the counseling room is more than just appearing calm.

I like to think about my micro-interactions with clients over the grand scale of the counseling relationship.

Do I appear scattered and unorganized in managing administrative tasks, or do I offer a comfortable experience for my clients that make them feel safe in their dealings with me?

A quick Google search of the definition of the word “peace” describes it as “free from disturbance.” As a counselor, the peace I receive from the Lord is exuded in the way I handle myself from the beginning to the end of my time with a client.

As for my own personal peace, I remember that “He who is in you is greater than He who is in the world” (I John 4:4), and

“The peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus” (Philippians 4:7).

With the supernatural kind of peace we have from Christ, we are able to offer a peaceful counseling experience to our clients.


You already know that counseling is often very slow work. It requires a kind of patience that is biblically described as “longsuffering” (Ephesians 4:2;).

As an ethical and effective counselor providing empathy to a client, longsuffering is to be expected. You will second-handedly experience many of the emotions your client is daily experiencing, because you have elected to be a safe haven into which those emotions can pour.

The Lord, who is all-powerful and all-knowing and holy, is patient with us as he longsuffers through our obvious human-ness and sin.

We, however, are called as counselors to be patient with other humans through their human-ness while we likewise, behind other doors, wrestle with our own human-ness and the effects of a fallen world on our

lives. We do not claim to be all-knowing or all-powerful. Instead, we share in the longsuffering as best as we can with the help of God himself, who has for generations shown patience with his people.

The Lord is not slow to fulfill His promise as some count slowness, but is patient toward you, not wishing that any should perish, but should all come to repentance (2 Peter 3:9).


Is it just me, or do all of the fruits of the Spirit begin to feel like they are overlapping? Kindness seems to meld together with goodness and patience so well that I begin to have a hard time differentiating between them all if I think about it too much.

But maybe that is the point. I like to imagine that God’s nature is only so much describable to the human brain using human language. One day in glory when we will see his nature fully, it will all make sense.

Until then,

“as we have opportunity, let us do good to everyone” (Galatians 6:10).


“Be kind to one another, tenderhearted, forgiving one another, as God in Christ forgave you” Ephesians 4:32).


Let us often recall that every individual who steps into our counseling spaces is a person created in the image of God (Genesis 1:26-17).

We know that after creating the earth and its inhabitants, God called it all “very good” (Genesis 1:31).

And while not every thought or action or reaction of an image-bearer is “good” or holy, I believe that at the core of who we are, God has placed his likeness—and with that, a desire to seek to know Him and reflect back to Him the goodness that he created from the beginning (Romans 2:19-20).

I think that a major part of my role as a counselor is to reflect the goodness of Christ toward my clients so that His goodness within them is sparked. I would hope that, despite my many flaws, that each person I meet recognizes the Christ in me, even if they do not have words to name the attributes as that just yet.

Goodness is contagious because goodness comes from God. May our work in the counseling room activate the goodness in our clients and their recognition of their status of image-bearers in this fallen world.


In the book of Daniel when Daniel and his buddies are facing a deadly fiery furnace, Daniel proclaims that he has faith that the Lord will deliver them. But then he completes his statement by saying, “and if not, He is still good” (Daniel 3:18).

He is still good.

When I feel completely helpless during a client emergency. When my own life feels out of order and I am still showing up to provide care to the people who have hired me. When there is an international pandemic and resulting mental health crisis.

He is still good.

At the most difficult times we face as professionals in the helping field, we must continue to remember that God is faithful in his protection (Proverbs 2:8), mercy (Psalm 40:11), and renewed compassion (Lamentations 3:22-23) for us. Moreover, He is all of these things to my clients, as well.

Our faithfulness is displayed in our ability to renew compassion for our clients as the Lord renews compassion for us. Renewed hope, renewed mercies, and renewed fruits of the Spirit when they despair.


Gentleness does not mean that you lack assertiveness or clear boundaries with a client or in the workplace. It means that you are able to employ boundaries and hard truths with an element of softness and understanding. You are respectful of other image-bearers in your dealings with them.

Phil 4:5 “Let your gentleness be known to all; the Lord is near.”

Titus 3:2 “Slander no one, be peaceable and considerate, and be always gentle to everyone.”


Self-control in the counseling room could look different for everyone. I tend to think that it is much more than stifling a yawn or holding back an eye-roll (though if I must say, a well-placed eye-roll in certain contexts can be a powerful response if done well).

But usually, self-control–if you ask me–is related to fear.

When I am fearful that I am not a “good enough” counselor I am more likely to take on too many clients during hours I had previously chosen to hold open for spending time at home with my family. Then I am not serving anyone well. I become burnt out and bitter, and both my professional life and personal life are impacted.

When I am fearful a client is not moving quickly enough toward goals, maybe I talk too much in a session instead of trusting the process of the client’s own journey. I forget to listen well.

When I am fearful of what my coworkers think of me, I have a tendency to act differently around them instead of speaking boldly and confidently on a topic I am passionate about.

See? Fear is a powerful motivator. It is impulsive. But self-control slows us down. It requires placing trust in our creator who is the most Wonderful Counselor (Isaiah 9:6).

We are people of the spirit. We are not alone. And whenever a tricky parallel process or client crisis derails our day, we can slow down and lean into the skills we have been taught. We can call a professional peer to consult with them. And always, we can remember that

“God gave us not a spirit of fear but of power and love and self-control” (2 Timothy 1:7).


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2. Keller, T. (2004). Four Models of counseling in Pastoral Ministry. Retrieved February 16, 2023, from

3. Loy, J. (2021, March 3). Four models of Christian Counseling (#1 & #2). New Ground Counseling. Retrieved February 16, 2023, from

4. Loy, J. (2022, July 25). Why use spiritual disciplines in therapy? New Ground Counseling. Retrieved February 16, 2023, from