The faculty blog at Biblical Seminary has posted one of mine about mindfulness from a Christian perspective. Actually, it is a call to develop a theology of mindfulness–or what I prefer to call watchfulness. While you are there, check out some of the other postings by my colleagues.
Category Archives: biblical counseling
5 Approaches to Counseling and Christianity
There was a recent conference in Tennessee where the authors of the recently published, “Five Approaches to Counseling and Christianity” (IVP) presented their approaches, dialogued with each other, and showed brief vignettes of their counseling model in action. You might like to see some of the papers and slide presentations by each of the authors. Do so by following this link. At the bottom of each bio, you can find the link to their presentation. They do not have the video clips of counseling available. I, for one, hope they make them available for sale. Despite the diversity of theories, I suspect their actual counseling activities do not differ all that much.
Phil
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More on “Can Your Body Make You Sin?”
I’ve written about this topic here and here before. In those posts I argue that there is a better question for counselors to consider than the one of culpability. Last night, we started the 2012 edition of Counseling & Physiology with the question of culpability and whether or bodies/brains can cause us to sin outside of our will. We also looked at our tendency to focus on judging whether a person is culpable for their sins (e.g., someone with Tourette’s who swears, someone with a TBI who is easily enraged, someone who is chronically anxious or still another who falls prey to addictive behavior). One of my main goals was to get students thinking about whether they under or overestimate the body’s role in counseling problems.
In the second post listed above I indicate the possibility of a better question than culpability. However, one of my students last night raised a question that went something like this,
Doesn’t the fact that you will choose how to respond to a client indicate that you have to judge the cause of the problem? If you encourage a client to consider psychoactive medications, aren’t you suggesting it is a body problem? If you focus on habits or heart issues, aren’t you assuming the problem is primarily a spiritual, will or behavioral control problem?
This was a great question and my answer was something like the following.
No and yes. Functionally, you will choose an area to work first. This does not mean you think that the type of intervention you choose indicates the main problem. It may only indicate that you think one intervention is an easier entry gate to counseling than another.
Here’s an example. Even if my client is severely depressed and I believe that the primary cause of this depression is their longstanding bitterness and anger towards God, I may encourage a psychiatric evaluation and the consideration of an antidepressant. It may be that once their mood improves, we can make better progress in investigating some spiritual matters in their life.
Human sins and weaknesses have multi-factored sources
Have you ever thought of the various sources of human sin? Here’s a visual of all of the things I think of that are a part of nearly every human sinful behavior. The sizes of the factors surely change depending on the situation. For some, will, high-handed rebellion, may be most of the pie. In other cases, bodily weakness may be the prime source. Also, some of these surely overlap and are not distinct. I may have started out in a rebellious state when I started doing drugs. Now, my body and psychological habits are equal players in why I maintain a drug habit.
What else would you add to this chart? Note that I place “will” in the smallest concentric circle. I imagine that we have far less conscious control over sin than we sometimes ascribe. Habits, unconscious motivations, and foolish (unthinking) choices probably dictate more of our behavior than our direct, willful, planned rebellion. Of course, none of this has ANY influence over culpability or morality as Scripture clearly indicates our guilt even when we are unaware of the Law’s commands. When Jesus says, “Father, forgive them for they know not what they do,” it tells us that consciousness of sin has little to do with our need for forgiveness.
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Filed under biblical counseling, christian counseling, christian psychology, counseling, sin
What good is a diagnosis?
At the recent AACC conference Dr. Michael Lyles, a board member of AACC and practicing psychiatrist, stated the following,
A diagnosis is only a word on a page if it doesn’t serve a function.
What kind of function was he thinking about?
- Does it explain a set of symptoms?
- Does it point to a treatment plan?
- Does is help differentiate between overlapping symptoms?
I’m a firm believer that our current DSM diagnostic system is at once both flawed and useful. It is flawed in that DSM diagnoses don’t address causes or do much to point to treatment. It is useful when used carefully to help differentiate between overlapping sets of symptoms–even as it needs considerable overhaul to do a better job. Take differentiating between Major Depression and hypothyroidism instigated depression. The two look identical. But using a multiaxial diagnosis, a person could rule out Major Depression if they were able to make a positive diagnosis of low/inactive thyroid function.
So, until we have a better nosological system (i.e., a replacement for the DSM), I will continue to use it. In years to come we will, however, recognize it for the blunt instrument that it is.
Right Diagnosis…Wrong Focus?
Consider the following case study (not a real person, devised from several stories) as an illustration for the problems we have moving from current diagnostic categories to proper treatment.
Tom is 27, married, father to one young daughter, working part-time as a youth pastor and going to seminary full-time. He comes to counseling on the encouragement of his primary care doctor. One month ago during final exams and an overly busy ministry schedule, Tom began experiencing rapid heartbeat, shortness of breath, feelings that he was losing his mind, and chronic fear of dying. After experiencing 4 panic attacks in rapid succession, he began worrying that something was terribly wrong and that he was about to die. His doctor first ruled out a physical origin for these symptoms, taught him breathing and distraction exercises to interrupt the buildup of panic, prescribed an anti-anxiety medication, and recommended he make an appointment with a therapist. During the first session, Tom details his history of stress, reports he has been able to forestall 2 more panic attacks but admits he still struggles with fears of dying, lacks assurance of salvation, and feels flooded with guilt that he worries so much. Upon further exploration, Tom believes the bible teaches him that he should not fear if he has “perfect love”. He has read all of the verses about anxiety and feels condemned for his struggle.
Tom meets criteria for Panic Disorder, without Agoraphobia. This is a highly treatable problem and within a few short sessions, Tom is likely to gain mastery over his body in that he will no longer evidence panic attacks. This, of course, is not the same as saying he will stop experiencing worry, guilt over his chronic worry, or start having assurance of his salvation. Logic, disputing worries, distractions, exploring and altering core beliefs may help reduce the symptoms that brought Tom to his doctor and counselor. A good Christian counselor may also be able to reconnect Tom to Scripture in ways that help him experience God’s care for him in spite of his fears (e.g., hearing the gentle voice of Luke 12 vs. a harsh rebuke).
But has the diagnosis been properly made? Yes. Tom met the criteria for an anxiety disorder. No. Tom’s counselor also helped him discover a deep layer of shame that may have been the source of his anxiety. Without the latter, the former is not altogether helpful.
So, should the diagnosis be an anxiety disorder or shame? Until we have shame as some form of a diagnosis, I’m okay with maintaining the anxiety disorder as a good description of external symptoms. But, Tom and others like him will need wise counselors who can dig a bit to discover diverse multiple shaping factors (e.g., biopsychosociospirtual) that lead to a common expression of symptoms.
What good is a diagnosis? I concur with Dr. Lyles: not much.
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7 questions about your church’s abuse policy
Over at Biblical Seminary’s faculty blog, I have a new guest post up pointing readers to 7 important questions to ask as they review their church’s existing abuse policy. One of the questions ISN’T whether or not your church HAS an abuse policy. I assume that every church has one already.
Read the post here.
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The Five Minute Antidote for Anxiety
I’m an anxious person by trait. It is a common trait, especially in graduate school (in combination with narcissism. I say this also in self-disclosure; both features support successful completion of doctoral studies). Anxious people tend to spend considerable time ruminating through “What if…” questions along with should, coulda, woulda thinking. We worry about our past failures coming to light and whether we’ll be up to the challenge the future presents.
Sound pretty negative way to live? It is. The only way we differ from depressed people is that we still have some thought that our worry might save us from disaster. As you can imagine, such worry robs us of joy. It keeps us from enjoying the present or seeing God’s gracious hand on our lives. And we compound our problems by then shaming ourselves for failing to follow God’s command, “Do not be afraid.”
The Five Minute Antidote
Part of the problem with anxiety is that we are trying to control/manage every possible outcome in order to avoid future disaster(s). Fearful people know that the answer to their anxiety will not include,
- Just not caring anymore. We’ve tried that…it doesn’t work.
- Making sure we get it RIGHT. Tried that too. Didn’t work.
So, what might work? Try this on for size,
What is God’s plan for me for the next five minutes?
Most of us have no clue what God is planning for us next year or even next week. But, I suspect most of us can discern what we need to do right now…for the next five minutes,
- I need to make dinner
- I need to read this assignment for school
- I need to attend to my child’s homework
- I can call a friend who is grieving
We usually know the one thing we can do for the next five minutes. Do that with as much focus as you can. Here’s what you are likely to discover: your anxiety decreases, or at least does not increase. When we stop the ruminations or internal conversations, our anxieties decrease and our ability to be present increases. So, when you find yourself in an anxious stew, try to ask yourself, What is one thing I can do for the next five minutes or What does God want me to do for the next five minutes? Consider this your method of living out Psalm 131, where you are are stilled and quieted like a weaned child, content with what He has for you for the next five minutes.
Oh, did you think this will solve all your anxiety problems? No, of course not. But where God does give you something to focus your attention, call that a success. Part of the Christian life is repetition–repeated worship, repeated repentance, repeated obedience, repeated trust. So, do pray for God to remove your “thorn” but look for five minute relief. Notice when it works and then ask God for another five minute focus on the thing he has for you RIGHT NOW.
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Filed under Anxiety, biblical counseling, christian counseling, counseling
Is All Counseling Theological?
Why do we have to study theology? I don’t need that to be a good counselor?
These are words I have heard from students studying counseling and/or psychology in both university settings and seminaries. What would you say?
Biblical and theological training in professional programs?
Most Christian institutions offering counseling or psychology graduate programs require some level of theological engagement. Otherwise, why exist? Some do so via specific course work while others embed the theological or biblical material into classic counseling courses. At Biblical, we do both. We require traditional counseling courses such as Marriage & Family, Helping Relationships, Psychopathology, Social & Cultural Foundations, etc. In these courses we explore counseling theory and practice from an evangelical Christian psychology perspective. We also require students to complete courses like, “Counseling & the Biblical Text” and “Counseling & Theology: Cultural Issues” where they engage biblical texts and theological study as they consider how it forms counseling theory/practice and shapes the character of the counselor.
Is all counseling theological?
Yes. And David Powlison in the most recent CCEF NOW magazine (2-4) talks about this very fact. Here are some choice tidbits,
…counselors deal with your story. In fact, they become players in that story. By word and deed, even by their line of questioning, they inevitably offer some form of editing or rescripting, some reinterpretation of your story.
Counseling is inescapably a moral and theological matter. To pretend otherwise is to be naive, deceived, or duplicitous.
…all counseling uncovers and edits personal stories…. All counseling must and does deal with questions of true and false, good and evil, right and wrong, value and stigma, glory and shame, justification and guilt.
All counseling explicitly or implicitly deals with questions of redemption, faith, identity, and meaning.
Thus, if value-free counseling is not possible (the very questions we ask lead clients in one direction or another), then it stands to reason that every counselor ought to explore the theologies (doctrines, interpretations, beliefs, etc.) he or she brings into the counseling room. Who is God? How does God operate? What is the purpose of the Bible? Does it have anything to say about my life, my attitudes, my relationships? What is sin? What is my purpose in life? What does God think about my suffering? And on we could go.
But counseling is NOT theologizing
But lest you think that Christian counselors spend a great deal of time plying clients with the right answers, on sin hunts, or catechising clients, let us remember that exhortation rarely makes for good counseling. In fact, most clients are well aware of their sins–even those who do not call themselves “believers.” And those who have correct theology are not less likely to have trouble in their relationships or less likely to struggle with racing thoughts or depression or less likely to get caught in addictive behavior.
Instead, good christian counseling consists mainly of,
- loads of stimulating questions designed not to get the “right” answer but to awaken the client to how they think, act, believe, relate, etc.
- Short observations to stimulate more critical understanding of the personal narratives being written, and
- Collegial exploration and practice of new narratives, perceptions, and behaviors.
Wait, just what is Christian about these three points? Couldn’t unbelieving counselors agree with this list? Sure they could. What makes these three activities Christian is the submission of both counselor and client to core convictions and practices of Christ followers.
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Guest post over at Christianpost.com
The website, www.christianpost.com has picked up one of my recent blog posts about whether our bodies can cause us to sin. Never heard of the site before but nice to be noticed. You can see the post here if you missed it on my site: http://blogs.christianpost.com/guest-views/can-your-body-cause-you-to-sin-11696/
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Slides for Abuse in the Church available here
For those of you who attended or are interested, all PowerPoint slides for our recent Abuse in the Church: Biblical, Legal, & Counseling Perspectives are now available. In the future, we will also make available the audios and video…but that will take a bit of time since we are doing the editing in-house.
The slides from my talk can be found separately on this site. Click the “Articles, Slides…” link at the top of the page and then scroll to the bottom for one file containing all 4 slide sets. Boz Tchividjian’s are made available here (PLEASE NOTE: DO NOT alter or disseminate these slides without Boz’ permission–contact www.netgrace.org):
Plenary One: Offenders in the Church BT
Plenary Two: Minimizing the Opportunities BT
Breakout: When Faith Hurts BT
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Filed under Abuse, biblical counseling, Christianity, counseling, Psychology
What is therapeutic presence?
If you go to a counselor, you’d probably prefer that person to be awake versus asleep, to pay attention to you versus check their smart phone, to respond to what you are talking about versus make non sequitur responses. As I’ve noted here before, it is probably better to have a counselor who cares about you than one who has a big bag of techniques–though most of us would prefer our counselors to care AND be competent.
Therapeutic presence is a way of talking about the act of being with our clients in such a way as to build safe, trust-filled relationships where clients can grow and change. I think most people can easily identify failures of therapeutic presence. Try these on for fun:
CLIENT: I’m just so depressed.
THERAPIST: You think you are depressed? Let me tell you about depression. I have a client who just lost job, family, church, home. Now, that is something to be depressed about. You just had a bad day, that’s all.
Or,
CLIENT: I don’t understand why God would take away this job from me.
THERAPIST: Well, theologically speaking, God does things for all sorts of reasons. He sometimes does this to cause us to trust him more, to reveal some sin, to give him glory.
Notice how both responses fail miserably to be either therapeutic or present with the person in the moment of counseling. Not hard to miss, right? So here’s a question: Why do so many of us counselors, even seasoned ones at that, fail the “presence” test?
My answer? When we fail to be present in helpful ways, it reveals a lack of preparation and a lack of attention to purpose.
Shari Geller and Leslie Greenberg (in Therapeutic Presence: A Mindful Approach to Effective Therapy. APA, 2012) define the building blocks of therapeutic presence as
- how therapists prepare for being present (in personal life and in session)
- the process (or therapist activities) of being present (aka purposing to be present)
- the experience of being present
Sound like mumbo-jumbo? Here’s another way of putting it. What does a counselor need to do to be ready to be in tune with their clients? What do they do to stay in tune when with clients, and are they aware of when they are failing to be in tune? (If I am unaware, then I am likely to get out of tune.)
Here are some things counselors ought to be asking themselves:
- Do I have adequate space to move from my private life to being present with my clients? Do I have enough space between clients? The answer is not always an amount of time, but what we do during the space between.
- As I prepare for sessions, what am I meditating and praying about? For example, if I pray for clients to be free from something that has them bound up, I could accidentally encourage myself to push for change or to talk about a subject that the client is not able or ready to talk about. I’m all for praying for healing. I just think we have other prayers to pray as well. “Lord, help me to be with the client today and not focused on my own personal goals for them.”
- Am I staying present with their mood, their cognitions, their silences in such a way that it is as easy to talk about what is happening in the session as it is to talk about what happened in the past or might happen in the future?
- When I sense a disconnect, am I quick to invite dialogue and learn (vs. avoid or defend/explain away)?
Therapeutic presence isn’t everything. I could be present with someone and no healing might take place. But without therapeutic presence, I will only be a barrier to whatever growth is taking place. When I do it well, I imagine that I might see just a tiny glimpse of how Jesus was with the woman caught in adultery, the Samaritan woman, or with Peter after he had abandoned Jesus.
Musings on Faith and Psychology 