Category Archives: christian counseling

May 5, 2010 · 5:56 am

Summer Counseling Courses


Want to learn more about counseling this summer? Are you in ministry and want to sharpen your skills? Already a licensed mental health provider and need CEUs*? Want to explore…

  • How to counsel people diagnosed with Borderline Personality Disorder?
  • How to help those diagnosed with a chronic condition?
  • How to use the Old Testament better in counseling?
  • How to better understand and evaluate the major models of counseling?

Just a reminder that this summer Biblical is offering 4 electives for students, alum and any auditors who might find the topics of interest. The first three of the four courses are only one credit and delivered in a weekend formats(Friday night and Saturday) with some pre-class reading/assignments. The fourth is a two credit course delivered in a completely on-line format.

For information about each of these course, the professors, the costs, and how to apply, click this link. It will take you to the Biblical website and a PDF of our flyer.

* Note: For those seeking CEUs, there are two ways you may be able to count them as fulfillment of your licensure requirements. Biblical Seminary is an accredited graduate institution and these courses are offered as graduate education in counseling and psychology. Most mental health licensure bodies accept graduate courses (shown on a transcript) as meeting the requirements for approved CE providers. You will need to check with your board to see if that applies to you. Second, we have applied for CE provider status for my class (Borderline Personality Disorder) from the State Board of Social Work, Marriage & Family Therapy, & Professional Counseling. If approved, we will be able to provide licensed attendees with 9 clock hours at the cost of ONLY $175.

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May 4, 2010 · 10:47 am

Clicking with your counselee


In every first session with a client I tell them that part of their job is evaluate whether I am the right therapist for them. While it is very important that your counselor is well-trained, if you don’t click with your counselor, the work you are trying to do will be much harder. Now, of course it often takes a few sessions to determine whether you can form a trusting, collaborative relationship or not.

I am always thankful when a client is willing to raise the “fit” problem with me. It gives us an opportunity to explore the disconnect, fix it if possible or happily refer to someone else. Too frequently disconnected clients choose to either keep plugging away (but being less and less vulnerable) or just fade away and you never know what went wrong.

But what if the counselor doesn’t connect with the client…and the client doesn’t know it? What should the counselor do?

1. Use supervision or consultation to explore the disconnect. Maybe the disconnect will reveal something useful about the counselee. Maybe it will reveal some pride or prejudice in the counselor. Maybe it will reveal some naiveté or lack of competency or empathy or conflict over goals. Or, maybe it will reveal some cultural differentness that is really hard to overcome.

2. Assess whether or not (again using supervision) whether progress is being made. Is the counselee growing in insight? Gaining control? Showing more fruits of the Spirit? Seeing a decrease in anxiety or depression? The counselor may need to reassess their goals for the client.

3. Consider attempting more “here and now” to explore what is going on in the relationship between counselor and counselee. HOWEVER, do not do this to tell them how you are feeling NOR to be condescending. This action is designed to help both of you to be more present and decrease disconnection.

4. If all else fails, refer. This would be appropriate if (a) you believe you are not competent to help them or impaired in some way (and you should communicate your lack–in a limited way–to the client when discussing referral), or (b) you believe the problem is that counseling is harmful (and again you should discuss why you think this way and what the options might look like for them. Remember to avoid abandoning them. Referrals are specific, take time, and are for their best interest, not yours.

The bottom line is that the onus is on the counselor to work through the disconnect and to do all that he or she can to fix the problem or to tolerate it if the client is making good progress. This is what it means to “love one another.” We fail to do so if we either ignore the problem or use the disconnect to get rid of counselees that do not feed our egos.

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April 26, 2010 · 7:46 pm

First session requirements?


Today marks the third week of my Practicum and Professional Orientation class. This is the first opportunity for many of my students to begin live counseling experiences in their Practicum settings. Most seem to be settling in nicely.

If you have been a green counselor in your first session then you know the terror of: “What will they say???? What will I say????” It doesn’t matter if you have a 10 year file on the client or a 1 sentence “presenting problem”, the green counselor cannot predict the outcome of the session–hence the fear.

To alleviate some of the fear, let’s review what makes for a good first session.

1. Introductions. Make sure they know who you are and who is supervising you. Give them a chance to tell you why they are coming for counseling. Sometimes what they say differs from what they wrote on the forms.

2. Help the client tell their story without too much interruption. Don’t be too quick to jump in and direct with too many questions.

3. Gathering the following data (again, without too much interruption):

  • content and scope of problem (frequency, duration, intensity)
  • solutions attempted, things that help/harm, prior counseling attempts
  • current family/community make-up
  • other mental illness
  • relevant medical history, current meds, sleep quality
  • substance abuse
  • spiritual dynamics
  • supports, strengths
  • typical mood, suicidality
  • Other important factors (employment, finances, relational conflicts, etc)
  • dreams, hopes, goals

4. Summarize (briefly) and discuss possible initial directions or goals as well as alternatives they may wish to consider

5. Counseling model and nuts and bolts of professional care (confidentiality limits, scheduling, contacting you, payment options, etc.)

That will be more than enough for an hour. Most likely, you get great data in some areas and just a tad in others that will require you to follow-up in the next week. The more talkative the client is, the less data you can gather. The less talkative, the more likely you will get the data but the less likely you’ll form a good connection (Q & A leads to very passive clients more often than not).

It is good to have these very general categories in mind as you start that first session. Be wary of either forgetting the categories or obsessively forcing the client to answer all the history questions. You may end up with a wonderful piece of history for a client who never returns.

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April 13, 2010 · 3:32 pm

Book idea: Sexual Crises in the Church


Pastors and church leaders have to navigate a variety of sexual crises that may arise in their congregations. These crises may or may not be crises for some churches even while they devastate another community. And surely these are not the only crises a church may face. But matters of sexuality often unnerve the leadership.

What crises am I referring to? Sexual abuse allegations, date-rape, infidelity among attendees and, pastoral (or leader) sexual abuse, couples living together, sex offenders returning to church, sexual addictions, individuals struggling with sexual or gender identity issues, etc.

Where would they turn to get helps in thinking about the various issues, practical pastoral responses (to the individuals involved as well as the entire congregation)? I’m thinking about a one source document that might survey biblical foundations, explore possible responses as well as prevention plans where appropriate. Why wait til the Crisis to consider how one might want to think about it?

Anyone seen such a resource? I’ve got some other writing assignments but I could imagine an edited volume on the topic. Maybe I’ll skip grading today and see if I can start a proposal.

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April 9, 2010 · 9:58 am

Seeing clients outside the office


Much of what we do in counseling or therapy is enculturated. Confidentiality, the 50 minute session, avoiding dual relationships…these things developed out of the culture of psychoanalysis. Now, that is not a criticism. I personally agree that good therapy requires privacy and the assurance of confidentiality. Who would talk about the deepest matters of the heart if they thought it would be broadcast to the world? And it isn’t as if this is a modern invention. Pastors have been practicing this since the early church.

One of those culture founded practices is seeing patients only in the office setting. Supposedly, this would maintain the “frame” of the counseling hour so as to avoid unnecessary outward intrusions. Further, it maintains one picture of the therapist. Having coffee with your therapist at the local diner would completely change that frame–and reduce confidentiality when your neighbor comes up and says, “Oh, I saw you go into the diner with Dr. Monroe. How do you know him?”

But there are some reasons why a counselor might intentionally see a client outside the office. Here are some reasons I have:

  1. Observation of a child in a school or home setting as part of an assessment
  2. Visiting a client in the hospital (either as a courtesy call or as part of a treatment continuity plan)
  3. Joint meeting with other providers (therapists, pastors, care team) at another location
  4. Part of a treatment plan (e.g., to practice walking over a bridge, get on an elevator, etc.

I have been asked to have coffee by current clients. I have been invited to house-warming parties. I have been asked to attend other celebrations. I’m more inclined to attend celebrations for kids or if the relationship is quite limited (wedding of a pre-marital client seen for 6 sessions only). I have taken clients outside my office for one reason or another (a brief walk, thrown a ball with a kid, etc.).

Whatever you choose to do. Be sure to evaluate the effect it will have on your relationship with the client. What potential pit-falls exist? Talk to them about it. Afterwards, continue to see if such actions introduce any relationship confusion. Be wary of informality. You don’t have to be stiff but informality breeds complacency and soon you are doing things you never dreamed of doing. Also be especially wary if the client has any history of abuse or boundary violations. Take care to protect those boundaries for their sake.

While psychological ethics are built on “Do no harm,” we know that the bible also supports this. Watch out for your weaker brother or sister!

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April 8, 2010 · 9:51 am

Counseling Ethics and Electronic media


Once before I wrote a bit on this topic. Just how much should we use electronic media to work with clients? While most counseling takes place face to face, counselors speak with their clients using the phone, e-mail, texts, live chat, video conferencing, even through “second life” formats using avatars.

In the latest edition of the Pennsylvania Psychologist, I saw another little article reminding us counselors how to manage these electronic methods. Rachael Baturin suggests the following tips:

  1. Always clarify what kind electronic connectivity you will have and the nature of those interactions. For example, use of email to receive documents and make scheduling changes but wary of too long or too informal style emails. If you look like a friend (sharing personal stuff back to the client), it blurs boundaries
  2. Anticipate and respond to abuses of your policy (e.g., frequent texting, demanding emails)
  3. Avoiding the use of e-mails and texts for emergency contacts from clients. Use the phone or answering service for that
  4. Establish a general turnaround policy (how long you will likely take to respond to emails)
  5. Inform clients about privacy issues. Such as, use of work email to contact them, possibility of a shared email.
  6. Maintain a copy of every email or electronic contact. Or summarize them in the next case note.
  7. Use the standard text at end of email msgs to remind them of confidentiality and the possibility of errors in sending.
  8. Remember, tone of voice is missing in emails. Be sure to be extra careful about this

A couple of additional matters not mentioned:

Be clear on whether you bill for time on emails BEFORE you start emailing back and forth. Recognize that SKYPE or other kinds of video conferencing to other countries may not be as private as you might think. Other countries may do more to monitor NGOs and others serving abroad. If you get emailed journals, ask the person to use an agreed upon password for their Word documents. That way, if the email goes awry, no-one else can view the contents but you and your client.

Bottom line? Don’t be lulled into unprofessional activities on-line. Assume everything you send (chat, texts, email) may be printed out or shared with someone else. How would what you are saying or doing look to a court of law determining whether you acted in the best interests of your client and whether or not you held yourself to a high standard of care?

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March 29, 2010 · 2:23 pm

Another shot at understanding integration of psychology and christianity


Over the 40 plus years of our profession’s existence, Christian counselors have tried in numerous ways to model the relationship between Christianity/theology/bible and the study of psychology. Unfortunately, many model building efforts created more barriers than dialogue among brothers and sisters. Counselors staked out territory with titles such as biblical counseling, integration, levels of explanation.

However, in recent years, more authors have tried hard to articulate a distinctly Christian view of persons and a humble articulation of the change process that builds on the good insights of others (e.g., McMinn & Campbell’s Integrative psychotherapy, Johnson’s Foundations of Soul Care, Malony & Augsburger’s Christian Counseling, etc.). These authors have taken the time to examine their control beliefs, theological assumptions, and more in order to make their psychology truly Christian and not merely a rehash of secular ideas.

If you like thinking about epistemology and yet still interested in application to real life, you ought to check out John Coe and Todd Hall’s Psychology in the Spirit: Contours of a Transformational Psychology (IVP, 2010). I’m just getting into it and so do not have much to say just yet. However, this is a great time to be a Christian psychologist. After a decade or more of avoiding these kinds of treatises for being practical (to a fault) and superficially Christian in our psychology, we have something substantive to sink our teeth into. This is no superficial treatment of Christian theology and human efforts (and their failings) to understand the nature of persons-in-relationship. For example,

1. They start out with the Fall. They acknowledge its full impact on human knowing and observing, that psychology from human eyes will always contain some distortion.

2. They acknowledge that redemption and not merely creation is what shapes our identity. “By creation, human love, and natural goods, we discover a “self.” By redemption and transformation, we are enabled to slowly die to our autonomous self and open to our new identity as self-in-God.” (p. 35)

3. “Ultimately, we are not merely arguing for a new model or a way to relate psychology to Christianity; rather, we are arguing for a new transformational model for doing psychology and science, which inherently and intrinsically is already Christian and open to the Spirit.” (ibid)

4.   They are interested in a spiritually formative and relational psychology that cares about the person, the process, and the product (p. 37)

I’m looking forward to the ride. Not sure I’m going to be happy. I’ve read a bit further and am not sure why they spend more time knocking down models that most of us would consider their first cousins (e.g., Christian psychology). That seems to be something from our profession’s past that isn’t as helpful. However, I really appreciate that an early chapter tells both of their stories; their maturation through a period where their faith wasn’t as central to their work as Christian professors of psychology. Often, these kinds of books do NOT include admissions of growth and change. Too often, authors act is if they have always thought this or that way.

I’ll keep you posted with book notes as I go.

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March 25, 2010 · 5:02 am

Considering a doctoral program?


In recent weeks I have had several students ask me about the pros/cons of doctoral programs in psychology. I would point those who know they want to attend a traditional clinical psych program to this book by the APA. It offers lots of helpful data on programs and what they require.

For those not sure what they want to do or if they should pursue doctoral studies, consider the following. If readers have additional questions we should consider, post them in a response and we’ll expand on these. This is my first pass:

What career doors do I want to open that are not available to me now? Do I want to teach? Do I see myself in private practice? In a research job? in the business world?

The PhD in Clinical Psych from an APA accredited program (and with an APA approved predoctoral internship) probably opens the most doors of all. This degree allows you to teach in both undergrad and grad depts., work in research settings, government settings, private practice, etc. There are specific kinds of jobs that it might not help: such as an area focusing entirely on social psychology or developmental psychology.

One caveat. If you want to teach in a MA Counseling program that is either seeking or already obtained CACREP accreditation (counseling accreditation sponsored by the ACA), you will need a PhD in Counselor Education (which entitles you to work towards an LPC credential). This is a recent and troubling change (turf warfare with psychology).

Part of your work dream should answer whether or not you are looking to work in either a secular or faith environment. Now, you can change your mind but there will be some doors that are easier to open with secular degree and other doors that a Wheaton/Fuller/Regent degree will open more easily.

What areas of counseling/psychology most excite you?

Try to be creative here. Think more than just private practice, 50 minute hour. Who do you know who is doing what you would like to do? Find out where they got their education? Be bold, ask them (even if you do so by email) what they would recommend as an educational route to do the kind of work they do now.

Programs tend to have both a model of psychology (some are CBT others are more analytic) and a focus (specialties). Further programs tend to either be scientist focused or practitioner focused.

Many programs are generalist, but it is helpful to have a specialty. Child? Forensic? Neuropsych? Geropsych? Marriage & Family?

Look at what the professors are publishing at the schools you are thinking about attending. Anything there excite you? FYI, professors love those who are excited to help them with their research

PhD or PsyD?

There are some differences. Typically, the PhD student completes a very rigorous dissertation (has more coursework in research and stats) but has fewer practice hours (maybe 800 total) leading up to their yearlong pre-doctoral internship year.

PsyD students tend to have a less rigorous dissertation (though my PsyD program acted more like a PhD) but have far more practice hours under their belts (maybe 2000!).

PsyDs do get teaching jobs but less likely in undergrad programs because of old assumptions (i.e., PsyDs are practitioners and PhDs are scientists).

Secular vs. Christian programs?

The first question: what is your current theological/biblical literacy level? How well do you understand the depths and complexities of your faith? How well versed are you in the controversies surrounding Christianity, Psychology, biblical counseling, integration, etc.? Your answer will dictate how ready you are to jump into a PhD or PsyD in clinical psychology. If your faith is weak, then you may want to strengthen it in an MA program at a Seminary. Or do some reading on your own. Psychology is not just an art and science, but a philosophy. You want to know what philosophy, even religion, you are imbibing. Sometimes the glittering images of psychology cause students to neglect the source of the power of change.

Practical matter: Christian doctoral programs in Psychology tend to be a year longer (because of extra bible/theology courses). Being a graduate of these programs will not harm you in secular settings (usually) if the program is accredited by the APA.

Obviously, programs and schools have identity. You graduate from Harvard, you get an identity. You graduate from Fuller, you get an identity—fair or not.

In my experience, secular programs tend to have less issues about a student’s Christian faith than do quasi-Christian programs or those housed in catholic institutions. These programs have had more fundamentalist-liberal wars and so you find faculty more sensitive.

If a student has a strong theological base, I would probably go for a secular institution unless you want the Wheaton/Fuller credential to open Christian doors.

Counseling Psychology vs. Clinical Psychology programs?

Not much of a distinction here anymore. I think the clinical one is more valuable (my bias) but once you have the degree, no one explores your transcript.

Would you rank the Christian doctoral program?

No. Each one has their own strengths and liabilities. I would look at the professors at each and what they are writing/doing. Try to go learn from some professors you’ve come to respect. For example (and this is a limited sample. Some schools I haven’t really known much about)

Regent University (VA Beach): Mark Yarhouse, Jen Ripley and Bill Hathaway are topnotch Christian psychologists. With Mark you get the sexual ethics research as well as someone well-versed in Puritan writings. With Jen, you might get access to her and Ev Worthington’s work (forgiveness, couples, etc.). Of course Ev is at VA Commonwealth and so you might want to go right for him.

Wheaton: There are a number of great faculty there. But let me mention just three. Sally Schwer Canning is doing child and urban stuff. Bob Gregory is doing neuropsych stuff and William Struthers just published on porn and the male brain.

George Fox: At Wheaton I came to really respect Mark McMinn. He is now at George Fox (Oregon). He’s great to study under for psych testing and his integrative model. Plus, if you get in on his research team, he’ll teach you how to be a survey king or queen. He is a publishing machine!

Biola: Todd Hall and Jon Coe just published a key work called Psychology in the Spirit. It is going to be a significant work.

On-line vs. residential programs

Online programs only if they are APA accredited (psychology programs that is). You have to be a self-starter. These still get negative reactions from some of those in the position to hire you. In the PhD in counselor ed, both Regent and Liberty have programs with good quality eworlds.

Residential provides lots of time to interact with profs on a daily basis. There isn’t a way to really do this in the on-line programs (which tend to have lots of students in them!). You can get good peer relationships in on-line programs, sometimes even better than in person.

I’m sure I’ve left something out. What else should we consider? Of course, you should get your MA from Biblical Seminary. That way, you will be prepared to think Christianly, biblically, and yet able to think psychologically about the world. 😉

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March 15, 2010 · 9:23 am

How the church misrepresents healing of addictions


Now, a post title like this deserves a long and fair answer. Lacking the time, I’m only going to address one issue–that of the healing process with addictions. If you ask a person in AA how they defeat addictions they will quickly point out the need for God (or higher power) and the need for community in changing their lifestyle. They need a sponsor, they need to feel they are fighting with others to maintain their sobriety. Will power will not be enough.

I suspect that most Christians would agree. But, here’s the problem. When we are asked about the healing agent for any sinful or repetitive problem, we point to Jesus. True, without God we do not have a shot of defeating our nemeses. When we talk like this it can sound like an isolationist, just me and God, healing process.

One of my students said it well. When he got saved out of his addictions he got new friends, new discipleship activities, and a new view of the reality of addictions (friends died). He had new activities to replace the old, new reinforcement patterns, etc. And, while he points to the saving grace of God, it wasn’t an isolating event.

That is our problem. We continue to think of our sanctification as a me and God experience. AA does a better job (often) than the church in reminding each other of the need for support without any condemnation for needing years and years later.

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February 23, 2010 · 6:13 pm

Dealing with unexpected losses


Some years ago, my wife and I wrote an article for CCEF’s Journal of Biblical Counseling entitled, “The Bible and the Pain of Infertility.” Of all my published writings, this article has garnered the most responses from readers. I don’t think it is because it is so well written as much as it touches many where they most hurt. Even though the article is about infertility, readers have commented that they found it related to their loss of a loved one, the unexpected loss of a career, a chronic disease.

Not that long ago I was asked to review a chapter manuscript on pastoral care of infertile couples. I was shocked to learn that he could find no serious work (than ours) attempting to think pastorally about infertility. Not sure he is right but it probably means we need more on the topic.

I say all this because CCEF has put the article up for free on the top of their homepage. Click here for their homepage. Click the image at the top of their page and it should take you to the full text article.

Enjoy. Pass it on to others you think might benefit, especially those who suffer in secret.

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