Category Archives: christian counseling

August 16, 2010 · 10:33 am

Counseling those with chronic conditions


My friends and colleagues here at Biblical Seminary–Jenn Zuck and Bonnie Steich–are teaching a class this weekend about the role of counseling in helping those with chronic conditions. Need CEUs anyone? Info here.

This is such an important issue given our increase in capacity to manage or maintain life with chronic conditions. Some cancers now are more like chronic conditions. HIV can be a chronic condition. And of course there are the more well-known problems such as MS, chronic fatigue, fibromyalgia, neuropathy, diabetes, liver dysfunction, etc.

How do you respond to those who seem to be struggling with a long-term condition? Especially when the condition is vague and not visible to the eye? Do you get worn out comforting that person?

I just read a study where they assessed whether major life events or daily hassles were more negatively impacting chronic pain conditions. It turns out that daily hassles increase chronic conditions symptoms far more than do major life stressors. It makes sense but also challenges us to consider how we might overlook the “normal” life of counselees and secretly want them to stop their whining and complaining about how hard it is to …

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August 9, 2010 · 3:07 pm

When life doesn’t follow the “plan”


One of the more significant causes of emotional/psychological suffering is the experience that life isn’t turning out as expected. While we all conjure up something different when we hear “normal”, we do have something that we assume is the normal expectation for how life should unfold. Most of us assume we will go to college, graduate on time, get married, have kids, start a career (or several over the course of our life), develop economic stability and growth, stay healthy, retire, find fulfillment, etc. Unexpected events will happen, we tell ourselves, but the general plan or trajectory should continue.

But then we hit more than a bump in the road. We don’t get married, can’t have kids, lose a job, divorce, get sick (or watch a loved one die before their time). When we suffer we are forced to come face to face with the fact that life does not have guarantees–except that there will be suffering and that suffering is not something we can get beyond, try as we might.

Christians are not immune from having expectation. In fact, we may have even more than those who don’t have the “hope of heaven.” We assume we will have peace and joy and that God will deliver us just as he delivered Daniel, David, Esther, etc. We recite Psalm 23 but gloss over the hard parts (death, enemies). Or, consider, for example, the pattern found in Psalm 107: Sin/Weakness leads to suffering…the people cry out in their trouble…the Lord hears and saves/blesses them with good things…  We like this pattern and expect to get the “happily ever after” that the pattern seems to promise.

Notice that as soon as God isn’t delivering us from our pain, we begin to look for the reasons. Maybe there is a new technique to prayer to try. Maybe there is a sin to confess. Maybe it is due to judgment on our country for its errant ways. We want to blame someone!

The truth is the “plan” isn’t as detailed as we would like it to be. Yes, there is a normal trajectory of life: growth…maturation…passing on to the next generation. But promises for obtaining specific outcomes are not given. We only assume they are assured until we discover one of our assumptions blown up by reality.

The same goes for our assumptions of the “rescue plan.” Either God does not deliver on his promises to care for his children OR his care looks markedly different from what we assumed it would be. And, it appears that God’s plan for rescue is global rather than individual. He did repeatedly rescue Israel during the time of the Judges…but some years and oppression went by each time and some of the chosen people did not survive.

Does this depress you? It can. Especially when we take note of more and more suffering and see less of the “normal” life we once expected. As we age we notice that death is everywhere–as if it wasn’t there so much when we were younger. If it doesn’t depress you, you may find yourself struggling with bitterness. How can God really exist or be good?

Or, you can consider John Calvin’s words (thanks John Freeman for showing them to me) and consider one blessing amidst the disrupted “plan.”

With whatever kind of tribulation we may be afflicted, we should always keep this end in view–to habituate ourselves to a contempt of the present life, that we may thereby be excited to meditation on that which is to come. For the Lord, knowing our strong natural inclination to a brutish love of the world, adopts a most excellent method to reclaim us and rouse us from our insensibility, that we may not be too tenaciously attached to that foolish affection…the whole soul, fascinated by carnal allurements, seeks it felicity on earth. To oppose this evil, the Lord, by continual lessons of misery, teaches His children the vanity of the present life.(as quoted in L. Boettner’s Immortality, p. 31)

If Calvin stopped there we might think he was a stoic–one who hated any pleasure. However, he is not. He says this “contempt” of this life should not lead to hate pleasure or “ingratitude” for good things.

So, consider for a moment what “plan” you expected and your reaction to not getting it. Or, better yet, what “plan” did you expect that you actually got but then found out that said plan didn’t deliver the goods you thought were to come with it?

How might your mood, your attitude, your perspective change if “the plan” was focused on meeting/seeing God each day? What would you stop striving for? What would you set aside as a waste of time? What would you notice that right now escapes your glance?

One final comment. I don’t think that this change in “plan” reduces the pain of suffering or stops our goal-directed activity in this life. We are designed to growth, develop, change, find pleasure, pursue economic stability for self and other. Further, suffering always hurts, no matter what good comes of it. Just because good comes from pain doesn’t mean pain is itself good. Our problem is that we sometimes often forget a deeper design of relationship with God.

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July 28, 2010 · 5:16 am

Last chance for cheap Counseling CEs!


My weekend course on Counseling individuals with Borderline Personality Disorder begins this Friday night (6 pm) at Biblical Seminary. Class meets 3 hours on Friday and then from 9 to 5 on Saturday. It is not too late to sign up for CEs. If you are LPC and in need of a bunch of continuing education, these will count towards your requirements.

Check out this page for more information on CEs at Biblical and how to register.

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July 10, 2010 · 11:09 am

Gardening illustration that works for persistent problems in life


5 years ago a friend of mine asked if I wanted some purple cone flowers for my flower garden around my house.

Having admired them in other gardens, I said yes and promptly planted them in a spot next to some other flowers. Turns out they were Brown Eyed Susans, a relative of the intended flower. And, further, they spread terribly. I enjoyed them the first summer but began ripping them out the next year as they spread through the iris and choked out some other plantings.

Now, some five years later, I am still pulling these plants. They grow and spread quickly. I never let them flower but pull them as soon as I can make sure I get them and not another plan that might be right in the same spot. When I pull them I know that some little root fiber remains and so I’ll be back pulling again in a week or so.

The truth is I will never be free from these plantings. I do have some choices:

  • ignore them and let them take over the garden (BTW, they would be fine in an isolated spot surrounded by grass so they couldn’t take over another planted area)
  • be irritated that I can’t get rid of them and thus fail to see the beauty around them
  • stay vigilant but enjoy the garden
  • try shock and awe by killing everything in that spot.

I find this is much like our persistent life problems. Whether by naive choice or by something beyond our control, we develop persistent struggles with things like anxiety, depression, addictions, relational challenges, etc. While God sometimes provide miraculous removal of these struggles, we rarely find complete freedom from these kinds of struggles. We may not be in crisis mode forever, but total relaxation and assumption of no return of the problem is rare also.

So, we too have some choices:

  • be angry and bitter that the problem continues to have some place in our life
  • blame others for our problems
  • ruminate on why only we seem to have these problems
  • try shock and awe and so destroy lots of other things
  • accept the need to stay vigilant, going after the roots and shoots as soon as we notice them.

Does this illustration work for you?

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July 6, 2010 · 2:33 pm

Suffering and Divine Sovereignty?


What is similar and different counselors and beauty queens? Well, we both want to end human suffering and seek world peace BUT the counselor no longer talks as if it is possible in this life. We know that sitting in suffering is, in fact, an important act in this life.

So, for all you counselor types out there, I have a theology book for you. Currently, I am reading Suffering and the Goodness of God, edited by Christopher Morgan and Robert Peterson (Crossway, 2008).

Not all theology books are stuffy. Really. This one is very readable and helpful. Chapter one (Robert Yarbrough) lists 11 theses about suffering. I will not repeat them all here but each one is illustrated from Scripture and personal experience. Here is a taste:

1. Suffering is neither good nor completely explicable

2. Suffering in itself is no validation of religious truth

3. Accounting for suffering is forced upon us by our times

4. Suffering may be a stumbling block to Gospel reception

5. Suffering Creates teachable moments for Gospel reception (though this does not make suffering, in itself, good)

7. Suffering is the price of much fruitful ministry

10. Suffering unites us with other sinners we seek to serve

Lest you think this book takes a happy view of suffering, consider this quote:

It is certainly true that it is primarily God himself who in his redemptive activity has “caused us to be born again to a living hope through the resurrection of Jesus Christ from the dead” (1 Pet. 1:3). But this new birth does not take place in a vacuum. Rather it unfolds amidst earthly life, which is manifestly to some extent a vale of tears.

We sometimes wish to talk about “new birth” and redemption as if our suffering does not continue in this life.

The rest of the book addresses OT and NT interactions with suffering, the problem of evil and oppression and two chapters written by theologians about their own personal suffering. A good read if you realize you cannot ignore suffering or go back to some prior period of naiveté.

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June 22, 2010 · 4:40 pm

Christian interventions in counseling


Regular readers of this blog will know that I believe that Christian counseling is not merely counseling done by Christians or merely the use of specific christian interventions. Rather, Christian counseling is founded on Christian/biblical ways of perceiving the world, the problems in it, and the goal of imaging Christ from start to finish.

However, it is good to think about the specific use of certain christian practices in counseling: meditation, prayer, bible reading and application, casting out demons, absolution, etc. How are we to think about these practices? Do they have a place in professional counseling? What are limits we ought to place on them? When should we refrain? How do we secure informed consent?

Elsewhere I have published on the guidelines we ought to consider when using Scripture in counseling. I will not repeat them here but for those who have not read that article, I do think Scripture is something that CAN be used in counseling–even OUGHT to at times. What is of more importance to me is HOW and WHEN and WHY.

Let me here consider the most commonly used practice: prayer. Here are some shaping values before we consider any practical application.

1. Prayer is talking and listening to God. It is not a technique and should not be treated as such. It is not magic. It is, from a Christian perspective, sharing one’s heart, praising, questioning, interacting with the Creator of the universe who remarkably wants to relate to me. At its heart prayer is submissive acknowledgment of God–even when praying like Job.

2. Prayer then needs to be a free act without trace of coercion. The one praying must not be coercive (you talk to God not at another person). The one being prayed for ought not feel obligated to say anything.

3. People have diverse (and not always happy) experiences regarding prayer, faith, relationship with God, etc. So, what is comforting to you may be triggering for another.

4. Prayer is intimate. Prayer often results in our setting aside defenses and becoming vulnerable and needy.

5. Prayer is power. Praying for someone gives the one praying a position of power.

So, how might a counselor consider these values and use prayer in counseling.

1. Assessment of client. What is my client’s faith tradition, experiences with prayer, history of abuse by leaders of the church, understanding of God? Have they ever felt coerced to pray, coerced by the prayers of others? Have they been publicly prayed against? Do they value prayer?

2. Assessment of self. Why am I praying for my clients (out loud)? What messages am I trying to communicate? What do my prayers reveal about my own faith?

3. Consent. Have I explained why I pray for my clients? Do they really have the right to say no?

4. Review. How are my prayers received? What impact, if any, do they have?

What does this look like for me? I don’t pray with every client. I don’t choose to start my sessions with prayer (at least the first one) until I have a better sense of my client’s experience with prayer. I work very hard not to use prayer as an effort to disarm (though I think it can do this) or to preach a message, but only to make supplication to God for healing, for care for the downtrodden. When I use imagery in prayer I make sure that it is grounded in common biblical images (God as shepherd, Christ as lamb, etc.). I never ask clients to pray but many of them choose to do so. And, I do let clients pray for me when they want to. It is part of how believers care for each other.

I do believe that prayer is extremely important but that I do not need to do it to be actively asking God for healing or guidance. I will say that when conflictual couples pray, they often find that it is hard to stay angry and embittered and pray. It can be helpful, either in reducing bitterness or by discussing bitterness and its impact.

It should not be used when clients do not want it, might be confused by it, or if it is not authentic to the counselor. It is considered good professional ethics to utilize resources from a client’s life. However, it would not be good to fake (e.g., my praying in a way that would please a member of a cult, an atheist praying as if he or she believed what she said, my talking to God even though I am no longer practicing as a Christian, etc.).

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June 18, 2010 · 10:04 am

Check out a counseling office designed just for kids


Check out this video of Julie Lowe showing off (in a good way!) her counseling office designed for counseling kids. Julie is at CCEF and an adjunct at Biblical Seminary. She is a Licensed Professional Counselor (LPC) and trained in play therapy. Here’s the link. [Link was broken, now fixed]

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June 17, 2010 · 5:41 am

Looking for summer education?


My school, Biblical Seminary, has a variety of summer classes, from on-site intensives to weekend only to totally on-line. Click the link if you are trying to figure out what enrichment you will pursue this summer. The page that pops up will list both classes and free events. Those of you looking for counseling CEUs may be able to get credit too!

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June 16, 2010 · 9:21 am

Ethical blunders: Root causes?


Finishing up the Ethics course in the next week. There are two kinds of ethical errors in counseling: conscious violations of ethical practice and blunders.

Forrest Gump’s quotable line, “Stupid is as stupid does,” is ringing in my head as I write this post. We do stupid stuff–stupid as in without thinking. Most of our blunders are just that–things we never intended but did absent forethought. Example? Oh, I don’t know, like walking through a dark room while talking on a cell phone and resulting in a face plant over an unseen chair. That kind of thing…and the real reason why I’m hearing Gump in my head.

We all go through parts of our life in unthinking auto-pilot. Consider the equivalent in counseling: Starting a first session but forgetting to cover informed consent because you are focused on helping the person in front of you. Or, handing out personal contact information because the client asked nicely (but never considering ulterior motives). Or, calling back a spouse of one of your clients and discussing issues but failing to remember you do not have a release to speak to them. These are some of the unthinking blunders we may make.

Are there root causes to blunders? Try on some of these:

1. Naiveté. Taking the comments of others without considering context or motives. I am not suggesting that good counselors need to be suspicious. Rather, we need to be realistic, critical thinkers who employ wisdom. We need to consider motives, consequences, impact, etc. We need to think beyond the immediate moment.

2. Reactivity. Some of us are just more reactive or instinctive driven. This may be personality driven. However, it may also indicate that we are being driven by unexamined desires (e.g., “I want this person to like me”; “I want to defend myself from an accusation”).

3. Over-confidence. Sometimes our blunders come from overconfidence. We’ve all heard the evidence that talking on the cell phone while driving raises our risks of having an accident. But most of us do it anyway. Why? We don’t think or perceive ourselves as compromised. We consider ourselves better than the rest. Sometimes, blunders in counseling come from an unsupported confidence in self–I will act right because I am an ethical person.  When we are overconfident we have placed our trust in something that may be good but not right in a particular situation.

4. Fear. Yes, fear. It can lock us up causing us to stop using our training and intellectual capacity. This is the counseling version of driving right into the thing you were trying to avoid. Fear paralyzes.

5. Group think. Group think happens when we stop asking questions and as a whole foreclose on other hypotheses. An agency may create this problem by how it manages staff meetings, supervision. As a group we may become comfortable with an ethical breach in such a way that it becomes normal–unseen.

Can you think of other root causes of unthinking ethical blunders?

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June 15, 2010 · 5:54 am

Gain: Ethical boundaries relating to client gifts


[note: I found this document in my Ethics course files. I think I wrote this some time ago…but I don’t remember. It is possible that I received a WORD document with this in it from someone else. If so, I apologize for posting without acknowledging the source. Ah, the joys of aging.]

Professional counseling is founded on the assumption of the patient/practitioner relationship. The practitioner/expert provides a needed and appropriate service and the patient pays a reasonable fee—or their insurance company does for them. However, the extremely personal nature of counseling work often creates strong feelings between client and therapist and consequently the client may wish to bring a token gift signifying their thankfulness for a job well done.

Gifts beyond the token category provide therapists with “gain” and likely disrupt the fee/service relationship mentioned in the previous paragraph. While gain may not cause actual harm and may be unavoidable, the wise counselor remains aware of possible sources of gain and their consequences.

Consider the following examples and check whether you think they may be problematic:

  • A Board member of the counseling center offers one of the counselors tickets to a ball game
  • A Client offers his private counselor tickets to a ball game.
  • A student offers her teacher tickets to a ball game

Should the counselor in any of these scenarios accept the tickets? Does the cost of the gift or the wealth of the person giving a gift matter? Would it change your answer if the gift were a week’s stay at a beach house? Does it matter if the student is currently in a class with the teacher or not?

Gifts are a form of gain. Others may come in other forms of benefit for the counselor. If the counselee owns a publishing company, should the counselor accept an offer to have him or her publish his next book? If the counselor has a non-profit ministry, should he or she accept client gifts to that ministry? If a client offers to sit for a testimonial ad for the counselor’s new technique, should the counselor accept?

Gifts, though, represent expressions of thankfulness and thus a policy of rejecting all gifts may bring harm to the counseling relationship.

Wise Counselors explore with their clients any possibilities of gain and their potential consequences. Counselors consider how gains may harm the client or create an indebtedness that in the future clouds clinical judgment. For example, counselors do not accept gifts or fee sharing from treatment facilities in return for referrals. On the other hand, a cup of coffee brought to the session likely is just a cup of coffee, a friendly gesture. Christmas cookies are a small but personal thank you for a job well done. But, don’t assume that small gifts can not produce a quid pro quo (this for that) interaction. So, back to our first line in this paragraph. Take the time to explore the meaning of an offered gift and be willing to talk about it with clients.

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