Category Archives: christian counseling

PTSD: A New Theory? An Old Treatment


Researchers Liberzon and Abelson at the University of Michigan have published an essay articulating a new way of conceptualizing what is happening in the brains of those with Posttraumatic Stress Disorder. While you can’t read their essay for free, you can read this good summary here.

What is their new theory? the neurobiological problem of PTSD is “disrupted context processing.” In simple terms, I fail to respond to the “stimulus” in its proper context when I am triggered by old experiences in a new setting. Even more simply, when I wake up on full alert in the middle of the night after smelling wood-smoke in my sleep I initially fail to recognize the context (my neighbor burns wood) and immediately think my house is on fire (as it once was). Thankfully, the alertness is less than it used to be and I don’t always get up to check on my house.

The authors suggest that 3 separate and current brain models are inadequate in their scope of understanding the brain’s activities in PTSD. From their perspective the “fear model” (Fight/flight learning), the “overactive threat detection model” and the “executive functioning model” work best when integrated into one unified theory with their new label. And, in true humble researcher fashion, they request help in testing this model to see if indeed it can carry the freight.

An Old But Essential Treatment?

It is good to have a better handle on what is happening in the brain when someone experiences PTSD. Neurobiological research is growing by leaps and bounds. It is hard, frankly, to keep up. And yet, let us not forget an old but essential part of PTSD treatment, the person of the therapist. Humans are designed to be in relationship. PTSD has a way of shattering connections with others and thus the treatment must reverse the disconnect. Being present and bearing witness to trauma will always be the first and primary intervention every therapist must learn. Our temptation is that we want to move beyond the bearing witness phase into change phases. While this is understandable (we want others to get better as fast as possible), we sometimes want this for our own reasons–to avoid the pain we experience in sitting with traumatic experiences of others.

Let us remember that we therapists (and pastors, friends, etc.) are the primary intervention when we are present with those who suffer, when we become a student of their suffering. All other treatment activities stem from this foundation. To use a different analogy, consider Dr. Diane Langberg’s meditation, “Translators for God” (Day 26 of In our Lives First). In this meditation she describes the experience of being translated in a seminar. The translator must fully understand both languages in order to accurately communicate the speaker’s words into the heart language of the hearers. Counselors are translators for God and for healing. And yet, if they do not deeply learn the heart language (pain and trauma experience) of the client, they will not be able to connect the client to healing and to the God who heals.

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Your lack of self-care harms others, so what are you going to do about it?


Advent and the end of the year provide opportunities for some self-reflection in preparation for the start of the coming year. So…how are you doing? Are you taking care of yourself? This is especially important if you are a service provider such as a counselor or caregiver. 

Last October, a meta analysis of healthcare providers’ self-care (or lack thereof) and its relationship to quality of service indicates a clear negative relationship: lack of self-care leads to great likelihood of harm to patients. 

Eighty-two studies including 210,669 healthcare providers were included. Statistically significant negative relationships emerged between burnout and quality (r = −0.26, 95 % CI [−0.29, −0.23]) and safety (r = −0.23, 95 % CI [−0.28, −0.17]). In both cases, the negative relationship implied that greater burnout among healthcare providers was associated with poorer-quality healthcare and reduced safety for patients

What is even more telling is that patients can tell and do perceive when we are burned out. You think your bitterness, your lack of sleep, your losing your first love of helping isn’t showing? It is. 

Now, there are many reasons why we don’t steward ourselves (hearts, bodies, and minds) well. Sometimes we are in systems that actively discourage taking care of the self. In Christian settings, focusing on the self doesn’t seem to comport with “being poured out like a drink offering.” Others of us never learned how. Still others struggle with guilt. How can I take care of me if others have less help than I do? Yet others don’t take time to pour back in to self because it isn’t comfortable. Serving others is easier and provides more immediate rewards.  

What is your reason? 

If you were going to do something on a consistent basis to recognize your need to be cared for, what would you do? For your spiritual needs? Professional growth? Physical needs? Relational needs? See if you can come up with one thing for each arena–things you can do on a consistent basis. For example, you might decide to read Diane Langberg’s daily devotional for the next 40 days, In Our Lives First, as a means to do something for both your ministry skills growth and spiritual vitality. 

Don’t over-think it. What is just one thing you can do (or stop doing if it isn’t helping) to make your self a bit more refreshed? 

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Filed under christian counseling, continuing education, Meditations, Uncategorized

Over-confidence? Under-confidence? Assessing counselor tendencies


Every counselor desires to be effective, to handle client concerns and problems with competency. We do this work because we long to see others recover quickly and we do not want to get in the way of needed and desired growth. Early career counselors often feel out of their league and so seek out all the help they can get: supervision, books, essays, and peer-consultation. This is the proper way to learn and become better at our craft.

But what happens when we begin to feel competent and confident? Do we stop feeling needy? Stop seeking input? If we do stop pursuing growth and increased competency, skills and capacities will erode. We might think all is well, we’ve got this under control, but in reality we would enter dangerous territory. Imagine wanting to be an Olympic athlete and yet forgoing training.

Erosion happens.

So, should we want to feel less competent? No. The goal is not to feel ineffective nor to lack confidence in what we do. I would not want a second-guessing surgeon to operate on me. Rather, it is important to maintain regular (not obsessive!) self-examination and invitation to others to give you input and feedback.

For the possibly under-confident counselor:

Where do you feel you need help, are less competent than you would like? What are your common responses to that feeling? Who have you talked to about this problem? Where have you sought help? What continuing education have you completed? While it is good to get help to “know what to do” don’t forget that a large portion of therapeutic success is attributed to who you are in the session. Be sure to focus on your listening, and “bearing-witness” skills. Remember to be a student of the client.

For the possibly over-confident counselor:

Do you still have supervision? If not, why not? Look over your caseload. Who are you working with who you have not reviewed assessment, diagnosis and treatment plans with another (note: peer supervision can be done without revealing confidential or private information)? When was the last time you verbalized your case conceptualizations with a critical eye to the potential myopia that plagues us all? What continuing education have you completed that can revise and improve your skills?  While relationship-building skills are the most important, do not stop learning and growing in knowledge and understanding.

It is good to remember that  our skills WILL erode without attention, just like muscles with grow flabby without exercise. One such muscle for the Christian counselor is that of prayer. Consider your recent counseling activities and ask how prayer has fit into your work. Is it a perfunctory or an afterthought? Does is change depending on how you feel about your competency? What does it reveal about your therapeutic operating system (e.g., what is the source of power to change?)

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Does your counselor have these two important skills? 


I love working with counselors-in-training. We get to discuss everything from diagnoses to interventions, ethics to theology, character development to politics. I know I’m biased but along with the population of Lake Wobegon, our students “are all above average.” 

That said, there are two extremely difficult counseling skills every student needs to learn–frequently the hard way. To be an effective counselor, you have to be able to conceptualize a person and their presenting problems well (e.g., wrong assessment leads to wrong treatment) and you have to maintain a clinical alliance throughout the course of treatment. Of course, a counselor needs to be of good and mature character. She needs to have a bank of excellent questions to ask, a knowledge of common intervention strategies, and a good ear to hear what the client is trying to express. These things are necessary foundations for the skill of conceptualization and alliance.

Conceptualization

When you come to counseling to discuss a challenge in your life you want the counselor to be able to understand and put your situation into proper perspective. You expect them to have some expertise beyond your own–otherwise why go? As you tell your story, it always has missing and disjointed parts. There are dead ends and mysteries that may start out feeling important that in time become less a focus than other issues. Your counselor needs to put the problems you raise into some context. What lens to view the problems should be used? 

  • Is the conflict between a mother and teen best understood by the lens of enmeshment, Attention-Deficit, autism, sinful pride, depression, anxiety, rebellion or…?
  • Is the conflict between a husband and wife best understood as lack of knowledge, demandingness, personality disorder, emotional abuse, etc.

An effective counselor uses multiple lenses to view his counselee and holds those lenses loosely in recognition that first impressions need refinement. 

Do you feel heard or pigeon-holed by your therapist? Does your therapist discuss possible ways to look at the problem you have and thus different ways to approach solutions? 

Alliance

Alliance is a hard thing to describe but it encompasses a trust relationship where therapist and client work in concert to explore and resolve a problem. There is agreement on the problem definition and the process of therapy.  There are several things that seem to be part of this concept but fall in two key categories: techniques and stance. A good therapist asks great questions that enable a person to feel heard as they tell their story. A good therapist validates the person even if they do not agree with interpretations of the client. A good therapist makes sure that the client knows they are more than the sum total of their problems. Finally, a good therapist checks in with a client to find out how they are experiencing the therapy session and approach. But good questions and feedback are not the full picture of alliance. The therapist needs a stance that reflects being a student of the person; of collaboration over action. It reflects an understanding of pacing and the client’s capacity to process information.  

A counselor can understand a problem but if they rush ahead or lag behind in pacing, the alliance will fail. Consider this example. Therapist A meets with a client with a domestic violence victimization problem. It is clear to the therapist that the client needs to move out and that the client is resistant to this idea. The clinician presses the client to leave and challenges her to see her husband as an abuser. While the counselor may be correct, the confrontive and authoritative stance is unlikely to bear much fruit and will either create defensiveness or passivity in sessions. One sure sign of poor alliance is when a therapist is constantly thinking about how to get his or her client to do something. 

Meanwhile, Therapist B meets with the same client and explores the ambivalence she has towards her husband and the abuse. Options are discussed, less for movement sake and more for examination of fears and opportunities, hopes and despair. Both therapists have the same sets of good questions, but one is more aware of the pacing of the client and meets her where she is where the other one forces a pace the client is not ready to match. This does not mean a counselor never pushes a client but it does mean they never do that without the understanding and agreement of the client. 

Alliance is not a static feature. It grows and shrinks during the course of a relationship. There are ruptures and hopefully repairs. Sometimes a rupture leads to an even stronger alliance if the repair leaves the client feeling cared for and respected. Ruptures are not always caused by the counselor but it is the counselor’s job to notice and to work to resolve. 

Do you feel like you are on the same page with your therapist? Do you have evidence (not just fears) that your counselor is frustrated by you? When you have a “miss” in a session, does your therapist acknowledge it and talk about how you are feeling about therapy? If you bring up an rupture, are you listened to? 

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Does trusting God remove anxiety?


Over the years of doing therapy with Christians I have noticed how many feel guilty for their anxieties. “If only I could trust God more…I say I believe he is good but clearly I don’t trust him because I can’t stop being anxious.” Still others express distress that their faith in God does not change their feelings of hurt over past relational wounds and fears it will never get better.

It seems we believe this maxim: If I really trust in God, I will be at peace. I will not struggle with the brokenness around me or with the unknown future.

Is this true? Is it possible to trust God fully and experience chronic negative emotion?

Let me suggest a better maxim and then illustrate it with a couple of Psalms.

Because I trust God completely, I bring him my angst again and again.

At the recent #CCEF16 conference on emotions, David Powlison referred to Psalm 62:8a, Trust in him at all times, O people; He noted that this assertion is strong. But what does it look like in action? David pointed us to the next line (8b) Pour out your hearts to him, for God is our refuge. Trusting God looks a lot like venting, crying out in our confusion, sharing our fears and despairs.

Take a closer look at this Psalm. The writer is under assault by others. He likens himself to being a tottering fence, something easily knocked over. He is asking his enemies, “how long are you going to harm me?” He knows their intent. But their evil is the worst sort, one that pretends to be good but is really evil. They take delight in lies. With their mouths they bless, but in their hearts they curse. It is likely the psalmist could say, “with friends like this, who needs enemies?”

So, how does he talk to himself? Look at the cyclical pattern: reminder-pain-reminder-warning-reminder

  1. He starts with some truth. My only rest (or silence/peace) is in you God. You alone are my fortress. I will never [ultimately] be shaken.
  2. He laments. But you enemies are trying your best to destroy me, a weak, tottering fence.
  3. He reminds himself. Remember, look for rest and peace in God alone, it is only there you can find it, even when the ground is shaking
  4. He warns self and others. Don’t trust in your position, don’t trust in ill-gotten gain. And if God blesses you, don’t trust in the blessing
  5. He cycles back to truth. Remember this one thing: God you are strong AND loving. You will remain righteous in your dealings with us.

While the Psalm ends, I suspect the writer could easily have kept the pattern going, as in starting again with the first verse or adding more to the pattern.

This pattern of truth, honest admission of pain, reminder of truth is a far better picture of the reality of life hidden in Christ than the false stoic (or Zen) image of being unperturbed by the chaos in and around us. God does not remove us from the storm. Instead, we express our trust (as much to remind ourselves as in bold assertion), we lament, we groan, we pour out our troubles and we circle back to the one truth we can hang our hope on.

You can see this pattern also in Psalm 42 and 43 with slight variations: Remember when I used to be out in front leading the worship but now my tears are my only food. Why am I like this? I hope in God. But I am downcast. Day and night God is loving…but it seems you have forgotten me in my oppression? Vindicate me. You are my stronghold so why is this not getting better? Free me so I can worship you…yet I am still in despair even as I hope in you.

If you feel guilty much of the time when thinking about your level of trusting God, consider this alternative narrative: it is the greatest act of trust to keep bringing God your troubles, even when things or your response to them do not get easier.

So, does trust in God remove our anxieties? Not as much as we might think. But, if you could no longer feel guilty about your angst, might you in fact feel more peace as you trust God through the storm?

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Abusive Marriages: Restoring the voice of God to the Sufferer


In breakout format, Darby Strickland presented on this topic today at #CCEF16. She defined emotional abuse using the word oppression instead. She defined it as a pattern of coercive controlling and punishing behaviors whereby one spouse seeks to control and dominate the other. Oppressors enslave others, but tend to self-justify behaviors.  The oppressor tends to be entitled (people are there to please them; people should sacrifice for their well-being). They tend to dominate others and threaten as a means of control. Oppressors are willing to wound to keep control (which Darby reminds us is the opposite of how Jesus wields power–he was willing to be wounded for others). On the other hand, oppressors tend to be self-deceived, lack remorse and blameshift when accused.

Sometimes abuse is misunderstood as an anger problem. But the reality is that the root is self-worship and control. The only thing that matters are their words, their rules, their emotions, and their physical and sexual needs that must be obeyed. It is “enforced worship.”

Darby then explored emotional abuse in particular. Symptoms include a chronic pattern of rejecting, neglecting, degrading, terrorizing, isolating, exploiting, belittling, deceiving, blaming, ignoring, shaming, and threatening. She also talked about “gas lighting” which is the attempt to make someone think that something that did happen never happened. Within emotional abuse is also spiritual abuse. The use of Scripture, doctrinc, or position of leadership to abuse. It can be subtle but it lording power over others, demanding submission, and use Scripture to shame.

Darby pulls no punches when she describes behaviors by oppressive and abusive men (yes, women can do this as well, but this talk is focused on the experience of oppressed women). It is destructive to souls and does not reflect any part of Jesus Christ. She was equally clear on the destructive impact on victims. Eccl 4: the dead are happier than the oppressed.

What does God say about oppression?

  • Not your fault. Evil comes out of the heart of the one doing it: Mark 7. You might be a stressor by just being a person.
  • You do not deserve this. (Victims and leaders look for reasons, like Job’s friends). Heb 10:17. Your sins and lawless deeds I will not remember anymore. God is your rescuer, not your punisher
  • It is not a marriage problem. Luke 6:45 shows us that evil comes out of the evil person’s heart. It is not merely some interaction problem. Do not ask the oppressed to serve the oppressor more. It emboldens oppressors.
  • Oppression violates God’s design for marriage. It is not to be submitted to but rather brought into the light. He tells the head to reject control for self sacrifice.
  • God sees your suffering. Jesus sees and knows oppression too.
  • God cares about your safety. Do you think that God cares more about you keeping your vows than he does about your safety? 
  • God’s desire is to rescue you. I will rescue my flock and they show no longer be a prey (Ex 34:22)

Draw near to God through laments; he does not ask you to forget your suffering. Learning to lament is a process. It may not be “sanctified speech” when you first start to speak. That is okay, just begin to speak. Listen for the content, less focus on the tone. Then, you can ask God to help shape your expression. To counter the shaming words, remember who God says about you. “Remember who Jesus is because he is everything your oppressor isn’t.” He woos you, he does not demand subjection.

She closed with Proverbs 12:18: The words of the reckless pierce like swords. But the tongue of the wise brings healing.

_____

You might find it interesting that Darby chose to not take questions at the end. Her reason is that knowing that 25% of the christian world has experienced domestic abuse. Thus, she expected a number of victims in the room. She felt that taking questions might subject some, inadvertently, to further pain. (She was willing to take questions afterwards in private).

I very much appreciated her strong words to identify the pattern and indicate the primary concern for care for the victim. I know she has written and spoken on the topic of working with oppressors. This was not that talk.

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What to do with our emotions? #CCEF16 


Continuing a summary of the Emotions conference, CCEF faculty member Alisdair Groves presented two plenary talks having to do with our emotions. In the first he defined emotions as the expression of what we value, desire, even worship. Our emotions are ours and they are complex responses to our histories. However, they are windows into what is most important to us. 

In the second plenary he asked what we can do with our emotions. Before giving suggestions as to what to do with our emotions he suggested two unhelpful responses: deify them or deny them. The larger culture may over-value our emotions as our self, but Groves feels the church can do this as well by expecting spiritual highs (“amped”) all the time and that life in the valley is a sign of a problem. The flip side is a stoic response, stiff upper lip. He reminded the audience that both extremes do have a valid point but skew in the wrong direction. 

So, what to do? Engage our emotions. Note he did not suggest we change them, vent them, or embrace them. More specifically, he made a couple points:

  1. Engage your body. Take care of it. Eat and sleep well. You will be better able to engage your negative emotions when you are your physical best. He quoted someone who said, “eating is the most over-used anti-depressant while exercise is the most under-used anti-anxiety tool.” 
  2. Engage your emotions in the Lord. He gave several dos and don’ts. Don’t vent. Don’t stew. Do bring your pain to God. Do connect with others over your pain and ask for their help, do insert Scripture and other goods into your life (like turning on a faucet of good clean water). Do repent. Not so much repent of your negative emotions but bring them to God and recognize you need to repent of those things that are not of God (e.g., bitterness, unforgiveness).

_______

Question for you: Do our emotions only show what we love/worship/value? (Note, I do not believe this is what Alisdair was teaching the audience!)

If I am attacked and react in fear, does this show what I worship? Or does it show I value my life and my dominion is being stolen from me? I think Alisdair is right in that often our emotions do reveal our assumptions, perceptions, and yes, our values. But I believe and I think he would believe that emotions reveal our humanness AND our imaging of God’s emotions as well. They reveal the good and bad of relationships. I would argue that emotions are to be (a) listened to, (b) accepted, and (c) evaluated from the vantage point of life in Christ. Now, that last phrase, life in Christ, needs great unpacking. It would be easy to make that mean something like, “since Jesus has saved you, your negative emotions have no place here. In everything give thanks.” That would not be an accurate picture of what I mean by Life in Christ. Life in Christ with the hope of heaven does not deny what is broken in the life. It REQUIRES lament, confusion, anger, jealousy, even as it requires hope, joy, peace, and comfort. So, our emotions reveal something about ourselves and something about God and the world he has made. 

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Feeling Bad about Feeling Bad? 


This morning, Winston Smith of CCEF faculty opened the #CCEF16 conference on this topic. A few days ago I wrote about the toxicity of ruminating on negative thoughts and feelings. We often struggle even more when we berate ourselves for our reactions to life.

Winston began by asking the audience how they feel about their painful feelings. He noted that how we feel about our emotional experiences shape how we experience emotions. He finds feeling bad about feeling bad is especially problematic for Christians as they often feel that their negative things should not amount to much in light of the cross of Jesus Christ. If my anxiety only means that I don’t believe and trust God then I can only suffer more. It becomes an “inescapable feedback loop.”

If the Gospel itself only becomes a cause for greater shame and guilt, then something is off, says Smith. Instead, Smith says, “our negative emotions are designed to deepen our relationship with Christ and with each other.”

Winston took the time to look at Jesus’ emotional expression at Lazarus death (and soon to be resurrection). Jesus loses it. He is in anguish. This emotional distress reveals his divinity not merely his humanity. Notice that the good purpose of Lazarus’ death it doesn’t removed Jesus’ anguish. “What would biblical counselors say to Jesus as he wept? ‘I know Jesus that you are feeling bad but this is going to be for the good.’ Jesus is not having a moment of doubt…no, he is coming face to face with the brokenness of this world and all that it will cost him…and he is emotional and he weeps.”

Therefore, being image bearers of God require us that we experience and name negative emotions, especially in light of our experience of injustice and brokenness. And the more in tune we are with the glory and love of God we ought to feel intensification of negative feelings in response to things that are not right. We could even say that we have a calling to have negative emotions.

Jesus chose to enter into Mary and Martha’s pain. That is what love does. He concluded by telling a story about a man with a child with a serious medical problem. The man was somewhat sheepish that he felt anger, fear and helpless when the daughter was having a crisis. Winston asked, “what are you going to do for my friend? Are you going to try to fix it? No, We shouldn’t try to fix his feelings.” Let’s move beyond the “repent and repress” response to our negative emotions.

This is the opening plenary and there will be more to come. One of the areas I hope they cover is the skill of validating and sitting with the negative emotions of others. This is hard to do but an essential skill, first in order to comfort and be present with others in their pain. Second, as we learn to sit with the pain of others, we can also help teach others to be okay with their emotional experiences. The more we accept, the more we can then choose how we want to respond.

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Emotions: Why do we demean them so?


This morning I am on my way to represent my school at CCEF’s annual conference. This year the topic is “Emotions: Engaging the Expressions of our Heart.” I’ll try to post some reflections of what I hear throughout the conference.

Truth be told, emotions have gotten little consideration in the biblical/Christian counseling world. When I was a Westminster student back in the late 80s/early 90s David Powlison wrote an essay called “Crucial Issues in Biblical Counseling.” I recall one of those crucial issues to be that of developing a more robust theology of emotions. Nearly 30 years later, we still need that work to be done in evangelical circles. I’m hoping to hear some of that this week.

We evangelicals have prized thinking over feeling, as if one is less biased or less “fallen” than the other. This is not new. Early Christians worked to clarify the personhood of Jesus and shut down false views. The protestant reformation was intended to correct errors in thinking and belief that had infiltrated the Church. Thus, belief and repetition of those beliefs have been prized over listening to emotions. Right thinking is even prized, sadly, over right behavior.

One of the negative results of this problem for Christian counselors is the temptation to invalidate the feelings and experience of clients. Most counselors assume their helpful, gently corrective responses will bring a level of comfort and reduction in emotional pain. Far too frequently, the client is left feeling more alone and upset–even when they know the counselor as spoken truth. Why? Consider this made up exchange and see how you would feel if you were the client.

Client: [who feels that many overlook her competencies] I can’t believe my sister did that to me. Why would she be so hurtful and cut me out of my mother’s birthday celebration planning? I feel so rejected.

Counselor: You know, some people are like that. Really, you shouldn’t be bothered by her. Hasn’t she done this before to others? Be thankful that you didn’t have to do all that planning.

Does thinking or emotions have to trump the other? We are designed to think and feel, to experience our world through emotions and thoughts; each informing the other.

Here’s how we would know we are making headway:

  1. We stop trying to talk people out of their feelings. We start listening to what our feelings can tell us about ourselves and our world
  2. We worry less that emotional experiences are biased. We know they are but still recognize them as real experiences of the world.
  3. We look more for corrective emotional experiences than assuming that thinking always changes feeling.
  4. We know that God cares about our painful feelings and so we bring them to God, knowing that He too has felt sadness, jealousy, anger, and angst. He has compassion on us and offers us opportunities to see him in the midst of the struggle.

Sure, our feelings are not always (ever?) accurate. They need correction. They need perspective that God, Scripture, and wise friends can give. But rather than starting out with pointing out emotional or logic errors in our counselees, how about we get down in the mud and share in the experience as we walk together.

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Ruminating: The Mental Health Killer


I teach a course on psychopathology. Each week we consider a different family of problems. We explore anxiety disorders, mood disorders (depression, mania), and anger/explosive disorders in the first few weeks in the class. Later on, we look at eating disorders, addictions, trauma, and psychosis.

While each of the presentations of problems vary widely from each other, there is ONE symptom that almost every person with a mental health problem experiences–repetitive, negative thought patterns. Rumination.

The content of the repetitive thoughts may change depending on the type of problem (i.e., anxious fears, depressive negative thoughts, illicit urges, fears of weight gain, hypervigilance, irritability, etc.) but the heart of the problem in most mental health challenges are negative thought patterns leading to an experience of either impulsivity or paralysis. These patterns can look like obsessional worries about germs (triggering ruminative “why” questions as to the root causes of the obsessions). The pattern can look like repeated negative self-attributions for perceived mistakes. Whatever the pattern, the person finds it difficult to break out of the negative thoughts and attempts at distractions seem futile since the thought or feeling returns in seconds to minutes.

Is there anything that helps?

Yes, there are things that you can do to reduce the “noise” level of these repetitive thoughts. It is important, however, to remember two important factors

  • patterns in place for years or decades are harder to change. Give yourself the grace to fail as you work to change them.
  • As with pain management, the goal should not be the complete elimination of negative thoughts and feelings. Realistically, anxious people will have some anxiety. Depressed people will feel darker thoughts. Addicts will have greater temptations. But lest you give up before you start, this does not mean that you must always suffer as you do now.

Consider the following three steps as a plan of action to address the problem of rumination.

  1. Build a solid foundation of health. Every house needs a foundation if it is going to  last. Your mental health foundation starts with your physical body: Exercise, diet, and sleep. Did you know that daily exercise, getting a good 8 hours of sleep each night, and eating a diet rich in protein supports good mental health and may even prevent re-occurrence of prior problems? Will this solve all your problems. No! But failing to get good sleep and eat a balanced diet of proteins will exacerbate your problems. Sleep is especially needed. The lack of it will multiply your problem. Of course, getting sleep is difficult when you are worrying or depressed. Thus, work to develop a different bed-time routine. Shut off your electronics, do mindless activities like Sudoku, develop rituals that help promote sleep. If you are having trouble with this or your diet or exercise, find a trusted person to review your situation. And avoid all/nothing thinking that often leaves us paralyzed when we can’t reach our goals. On this point, read the next step.
  2. Prepare for change by accepting your struggle. What, I thought this was helping me out of my struggle? Acceptance is the beginning of change. Consider this examples. You struggle with intrusive negative thoughts about your belly. You don’t like how it looks. You’ve tried dieting and exercise, but still it is flabby. Every time you look at yourself, every time your hand rests on your belly, you hear (and feel) that negative narrative. The first step in change is to accept the body you have and to find ways to like it, even love it. Sounds impossible but it is necessary to accept all your parts. This does not mean that you won’t continue to exercise and eat well. Marsha Linehan suggests that one part of change is to accept the problem as it is. In her Dialectical Behavior Therapy model she speaks of choosing willingness over willfulness. Willingness opposes the response “I can’t stand this belly” by saying, “my belly is not as I would like but it is not all of who I am.” “I can’t stand it…” becomes a willful and yet paralyzing response. Whereas acceptance acknowledges the reality and chooses goals that are within one’s power to achieve (e.g., healthy eating choices). Acceptance is not giving up but preparing for realistic change.
  3.  Start to move. Consider these action steps as the beginning movements you undertake in a long process towards the goal:
    1. “So what?” Our ruminations are often filled with interpretations and assumptions. There are times we can challenge them by attacking the veracity of the assumptions. But we can also ask, “so what?” So what if I have OCD? So what if have to fight every day to stay sober? So what if I have to manage my schedule so as to not trigger a bipolar episode? Challenge the worst thing that you are afraid of.
    2. Develop a counter narrative. Rumination is a narrative. Begin by writing and rehearsing a counter narrative. It won’t have much power at first compared to your internalized rumination but it will gain power over time. Work to refine it. Choose to repeat it as often as you see the trigger for the rumination. Make sure your counter narrative doesn’t include self-debasing or invalidating comments. If you have trouble writing one, use Scripture passages that speak of God’s narrative, through Christ, for you. Be encouraged that developing alternative storylines has shown capacity to alter chronic nightmares. If nightmares can be changed, then even more thoughts and feelings during the day.
    3. Practice being present. Much of our lives are run on auto-pilot. When we are in that mode, it is easy to fall into rumination. Work to stay present, to be mindful and attuned to your surroundings. Notice ruminations but let them slide on out of view and bring yourself back to the present. Use your senses that God gave you to enjoy the world he made. Smells, sounds, sights, taste, and touch all give you means to enjoy that world. Start practicing staying in tune with it, a few minutes at a time and build your capacity as you go.

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