Jay Adams started nouthetic counseling in 1970's at Westminster Seminary. His fundamental starting point was both the inerrancy of Scripture and it's sufficiency. Rejecting any synthesis with secular, humanistic psychology Adams began to develop an approach that was consistent with reformed theology and took the view that Scripture had no deficiencies that needed supplementing with secular psychology. For those not familiar with nouthetic counseling I would recommend Competent to Counsel (one 'l') by Jay Adams.
Using the analogy of a property Adams pictures the psychologist on the one hand and the psychiatrist encroaching on the Pastor's property and mowing his grass. Pastors have been content to let others mow their lawn so to speak. (p22)
This book reviews how the next generation have developed this distinctively Biblical counseling. Perhaps Adams needed to be strident to adequately convey the distinctively Biblical school of thought. Ideally he would have preferred the term 'Biblical' but felt the term was already overused and compromised the next generation seem to show more empathy. (p83)
There were perhaps three points that stood out for me. First was the explanation of 'ortho - doxy' as right belief, 'ortho - praxy' as right deed and 'ortho - gnosis' right knowledge of God which bridges the gap (p55). Second was the description of the effect of Altzeimers in weakening the mind. Thus a formerly morally upright patient began to display crude and lustful language - no longer able to disguise the state of his heart as he once was (p77). Third was the application of Biblical principles to divorce. Where a couple separates, apart from adultery or the desertion of an unbelieving spouse, they should repent and seek reconciliation. If needs be, this can lead to the excommunication of the unrepentant spouse.
A fascinating book documenting the way the likes of Edward Welch have been less confrontational as they have developed this aspect of pastoral work. As a Christian this is not merely academic but offers insights into my own heart and the ongoing work of the Cross in sanctification.