Questions about the APA Guidelines for PTSD treatment?


Check out this opinion piece (rebuttal) published in Psychology Today by Jonathan Shedler. It challenges the notion that randomized control trials (RCTs) are the “gold standard” to determine the best forms of treatment in the real world. While RCTs can answer certain questions, he argues they cannot answer the most important questions. As a result, the APA recommended treatments are all short-term treatments but will not be able to tell us whether those who undergo the treatment really get better and what options are available for those who drop-out of treatment (there is a significant drop-out rate with several of these recommended treatments).

For those interested in this controversy, I’d like to find out if you have (a) heard anyone challenging Shedler’s criticism and (b) what alternatives are offered by them. I’ve seen zero challenges to his piece to date.

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Filed under Post-Traumatic Stress Disorder, ptsd, trauma

Jonah 4: Do YOU have a right to be angry about injustice? Jonah’s anger is not the problem…


Last Sunday I did something I rarely do (at least in the United States). I preached. In the sermon I explore Jonah’s anger and our anger about injustice. I point out that the problem is not that Jonah is angry but that he is hardened and blinded. And then I end with the good news about how God relates to angry people and what he does to injustice.

You can listen here: 

(recording by New Life Glenside, original here)

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Filed under "phil monroe", anger, Justice

Shame and ministry of seeing vulnerable people


When Jesus saw her [someone crippled for 18 years], he called her forward and said to her, “Woman, you are set free from your infirmity.” (Luke 13:12)

When Jesus saw him lying there and learned that he had been in this condition for a long time, he asked him, “Do you want to get well?” (John 5:6)

When he saw the crowds, he had compassion on them, because they were harassed and helpless, like sheep without a shepherd. (Matthew 9:36)

When you think of Jesus’ ministry, you may think about the miracles or the sermons or the conflicts with the priests or the conversations with his disciples. But notice how much of his ministry is the work of seeing invisible and burdened people; people with shame. He sees lepers, the blind man Bartimaeus, the bleeding woman, the Samaritan woman, the centurion with a sick child, the rich young ruler and many more.

He had to see them; he had to go through Samaria. Why did he have to go? He had to go in order to meet broken people where they lived (or sat or lay).

Crossing the chasm of shame 

This past weekend I taught at Biblical Seminary on the topic of pornography and sexual addiction. The MDiv course, was designed less to help current and future pastors help addicts and more to help ministry leaders address their own struggles with sexual shame.  The truth is that we all carry around in our being some form of sexual shame. It is something we want to hide and keep from others. We don’t want this shame to be seen, even if our shame is caused by the sins of others.

During the class I asked everyone to consider one of their experiences of shame and to then list on separate post-its what sensations, images, feelings and thoughts that it might evoke (HT to the post-it queen herself–Heather Drew–for this idea!). Then, I had them consider what sensations, images, feelings and thoughts they had when they recalled a time they felt loved and cared for by someone who knew that shame story they carried. Students then placed their post-its on opposite walls of a hall. Silently the class first examined the shame side and then moved to consider the grace side. While it was easy to move from shame to grace in our activity, we considered the chasm shame creates and the impossibility of really being seen AND loved at the same time.

When I asked students how they moved from shame to grace in their own lives, the stories contained a common element. There was someone who pursued them, who stuck out a hand and drew them out of their shame. This someone was someone who saw them and love them just the same.

This is the central ministry of Jesus. He crosses the chasm of shame and sees (and touches) the unloved. Lest you think that God the father is a distant member of the trinity, remember that his first action after Adam and Eve sinned was to go find them. He pursued them. He saw them. He engaged in conversation. He provided a covering for them. Some of the most beautiful images of this ministry of seeing us in our shame and pursuing us just the same is found in the book of Hosea. Depicted as a wayward wife who has returned to prostitution, God’s people are pursued by him, bought back from the pimp and invited back into the marriage bed.

The main ministry of Jesus is pursuit of broken people, to see them and touch them. It is not to put them in a program of change as we are often want to do. Rather, Jesus invites those he loves to remain connected to him, to follow him. Consider the invitations Peter received before and after the crucifixion:

Peter said to him, “you shall never wash my feet.” Jesus answered him, “if I do not wash you, you have no share with me.” (John 13:8)

He said to him the third time, “Simon, son of John, do you love me?” Peter was grieved because he said to him the third time, “Do you love me?” and he said to him, “lord, you know everything; you know that I love you.” Jesus said to him, “Feed my sheep.” (John 21:17f)

What if the work of the church is to see and serve shamed individuals? How might this change how we evaluate Christian ministry outcomes?

 

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Filed under Biblical Seminary, pornography, sexual addiction, Uncategorized

If you thought about posting #metoo, consider taking this poll.


Are you watching #metoo trending in social media settings? It is sobering to remember that the numbers of men and women who have suffered sexual assault, harassment, and abuse are astronomical. Such posts have the opportunity to help others recognize this hidden wound that many carry around their entire lives. I’m grateful when a victim is able to voice something that has held power over them for far too long. It can be part of the healing journey. And yet I also know that voicing our pain can lead to further pain. I’ve created this anonymous poll to find out how those who have considered posting #metoo (whether you posted or not does not matter) to see how the hashtag trend is impacting them. Results will only show how many numbers of votes per option.

Thankful for all who respond here.

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Filed under Abuse, sexual abuse, Uncategorized

What if we view anxiety as what it means to be human?


Do you often feel guilty that you struggle with anxiety? Do you beat yourself up afterwards? When you hear, “Be anxious for nothing but in everything and with thanksgiving present your requests to God” (Phil 4:6-7) do you feel more burdened knowing that you are often anxious and filled with worry?

Indeed the Scriptures speak very frequently about our anxieties and worries. Might it be that it is a human experience (this side of the Fall) that will not be removed? If you worried less about your worries; if you felt less shame and guilt for them, how might that change how you respond to your worries?

Discuss!

I leave you with this thought as you ponder your way of responding to your worry. Psalm 56:3 says, When I am afraid I put my trust in you. It doesn’t say that such trust erases fear. You can be afraid and be full of anxiety and trust God in the middle of that experience. One does not necessarily invalidate the other.

 

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Trauma-informed Churches: Clinical, Pastoral, and Theological Support for Victims of Trauma


Today I will be presenting a one hour breakout at the 2017 AACC World Conference in Nashville, TN. If you are interested in seeing the slides, down them here.

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Filed under Abuse, counseling, trauma

Spiritual Abuse and Toxic Systems: Therapeutic and Congregational Interventions


Today Dr. Diane Langberg and I will be presenting Spiritual Abuse and Toxic Systems in a 3 hour pre-conference seminar at the 2017 AACC World Conference. Take a look if you like.

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Filed under Abuse, teaching counseling, trauma, Uncategorized

The disconnect with some creeds: statements vs. conversation; orthodoxy vs. orthopraxy


If you read much news about Christianity then you may be aware of the “Nashville Statement.” It has surfaced in a number of locations with much commentary pro and con. There are those who disagree with the affirmations and denials, those who agree, and those who may agree–at least in part–but find something important missing. This final group commonly notices the cold expression of facts and beliefs that seems devoid of human connection. It appears to these individuals that love and relationship are missing, that it is a statement about people rather than to people.

At the same time, I am reading Heal us, Emmanuel: A Call for Racial Reconciliation, Representation, and Unity in the Church. This is an edited volume containing the voices of Presbyterian pastors from all walks of life about race problems in the church. Though a book about an entirely different subject as the Nashville Statement, there are two details that might help us identify the significant limitations of creedal statements:

  • Ideological statements vs. redemptive conversations. When talking about the problems of racial disunity in the United States it could be easy to mis-understand which conversation we should be having at a given time. While it is good to discuss what we think are the facts, causes, and solutions to systemic discrimination, sometimes those conversations are destructive. For example, if you begin to talk about an injustice you just experienced and the listener responds by saying, “well, that might have happened but it really isn’t a big problem” chances are you will not continue long in that conversation. Why not? You were not loved, not listened to, not shown compassion. What you needed was someone to validate you and to show concern for your experience. Statements of belief, important as they are, rarely meet people in their pain and confusion. Pastoral letters often do as they invite the other into a conversation. This point is made by Rev Lance Lewis in chapter 1 (especially on pages 3-6). In that section he suggests that ideological/political conversations alone “rob us of the opportunity to show genuine concern and love for the Black community.” Conversations, on the other hand, start with experience and move towards grounding in redemptive and theological foundations.
  • Creedal orthodoxy vs. orthopraxy. In chapter 5, “We’ve come this far by faith” Rev Stan Long makes this statement, “Dr. [Carl] Ellis once stated that for the White Christian community, creedal orthodoxy is supreme. It is the primary evaluative tool. However, for the Black Christian community, ethical orthopraxy is supreme. We determine  the authenticity of one’s confession through ethics, not creed.” Creedal statements often talk about facts in the abstract and rarely how it looks on the ground, in real life. Statements such as these, especially about what others should do/not do, might better start out with the author’s own failings to love the other well. While creeds are important–the church often recites ancient creeds each Sunday–what one does after the service tells us more about whether those creeds mean much.

As a Presbyterian, I am a creedal Christian. I do think there are lines to be drawn in life. There are boundaries to be observed and even protected. There are beliefs to be stated in black and white text. However, I don’t think creeds make good conversationalists as they cannot provide in-the-moment wisdom (who am I talking to, what do they need now?) nor do they reveal the kind of person you are and have been to the other person in the conversation. And if we creedal Christians are honest, we have not always done well engaging the ones we believe are operating outside the lines we cherish.

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Filed under Christianity, Christianity: Leaders and Leadership, Uncategorized

Job Opening: Director of the Graduate School of Counseling at BTS


Folks, most of you know I made a move from Directing the Graduate School of Counseling at Biblical Seminary to a new job at the American Bible Society. BTS is now advertising for my replacement: GSOC Director Ad 9-17 FINAL.  Please share this and pray that they find the right person capable of leading the counseling programs into their next area of growth. The MA counseling program, if I can say so myself, is top-notch and a rare find for those seeking both licensure and biblical-theological depth.

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Filed under Biblical Seminary, christian counseling, christian psychology, counseling, Counselors

New book for those who wonder about the value of diagnoses and medications in biblical counseling


What kind of messages about mental health diagnoses and medications do you receive in your community? What do you hear about these in the church? Silence? Warm embrace? Implicit or explicit rejection?

Mike Emlet, a former family practice physician and now counselor, has written a small book to introduce readers to a nuanced and biblical take on the value of diagnoses and medications. Descriptions and Prescriptions: A Biblical Perspective on Psychiatric Diagnoses & Medications (New Growth Press, 2017) comprises 22 short chapters exploring the pros and cons of both arenas for those who are “too cold” or “too warm” towards the use of mental health diagnoses and medications.

In the first section Mike explores some of the weaknesses of the current DSM (psychiatric diagnostic system). Those who are “too cold” and who think the system is fraught with problems may find themselves saying “yes, exactly.” But rather than just stop there, he begins to articulate implications for ministry responses—how to go deep to understand the person behind the diagnosis. There is much the pastor or counselor can learn.

One key point is made here and in later chapters: we live in bodies and Scripture takes this seriously. So learn about the symptoms a person experiences.

So, you might think this book is negative on the value of diagnoses. It is not. Chapter 9 begins to describe the potential value of diagnoses, especially to those who tend to see mental health problems ONLY as spiritual and ONLY or usually involving just the will. If there is one thing the reader should get from this chapter is that humility is in order. If you don’t put much stock in diagnoses you likely don’t put much stock in published research exploring symptom clusters. As an example, Mike briefly discusses the multivariate experiences of those with obsessions and compulsions. This little window into the problem of OCD should remind us that we must work hard to understand the many subtle forms of obsessional thinking and consider how best to describe and care for the person suffering with them.

On the final page of chapter 9, Mike takes on one crucial criticism—that since you can’t see structural differences in the brain that implicate a particular diagnosis then the diagnosis isn’t real. From his point of view, this is a simplistic understanding of biology and diagnoses.

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The second section explores the challenges and benefits of psychiatric medications. Mike gives a very brief overview of the categories of medications and how they work (what we know and what we don’t know). He summarizes the research as indicating a modest positive effect, though also showing that other means are quite effective (placebo and counseling). Such results show us that there are a range of helpful responses. While it is true that medications for anxiety and depression aren’t cures and aren’t without their side effects, it is important to remember that the individual in front of you may in fact benefit immensely. Thus it is good to remember that we don’t offer advice to others based on population statistics. Rather wisdom is in order for this particular person.

 

 

In probably the best part of the book, Mike walks the reader through a wisdom approach to the use of medications—walking the tightrope as he suggests. Too much suffering and too little suffering can be hazardous to our spiritual health. We can make idols out of medications or out of not taking them. Medications aren’t good or bad on their own. It is how we approach them that matters.

He makes this statement nearing the end of the book,

“I hope you have seen that there is not a clear-cut “right” or “wrong” answer. There is no universal “rule” that we can apply to all people at all times. There is no simple algorithm. Rather, the use of these medications is a wisdom issue, to be addressed individually with those we counsel. There will always be a mix of pros and cons, costs and benefits to carefully consider.”  (p. 87)

This answer may frustrate those who want a clear-cut “this is right/wrong” response. However, counselors are not umpires calling what is “fair” or “foul.” Instead we are walking with and helping others look for relief (what can I do to make the moment better?) and look for acceptance (what is God up to in my life?).  Sometimes relief means medications, other times it means examining thoughts, habits, perceptions, etc. Sometimes acceptance means pursuing other goals beyond symptom relief, other times it means understanding accepting that God has, in his providence, allowed them to have a body that needs external supports.

Book Recommendation: Great first text for those who either over-estimate the value of mental health diagnoses or medications or those who minimize their value. Author leans to a conservative approach and probably spends more time speaking to those who might over-value medications. Yet, he also repeatedly affirms that biblical counseling must take seriously the fact that humans are embodied souls and that diagnoses and medications have value, albeit limited value. Great text to start the conversation and lead to deeper study about our responses to suffering, especially for beginning pastoral counselors and lay helpers.

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Filed under Psychiatric Medications, Psychology, Uncategorized