Category Archives: christian counseling

November 10, 2009 · 5:25 am

Stress & Christian mindfulness, part 1


I’ve written about mindfulness in the past and based on numbers of folks coming to my blog looking for information about Christianity and mindfulness, I thought I might write just a bit more here. My intention is to write in two parts. Part 1 will cover some basics about stress and the idea of mindfulness. Part 2 will explore how Christian counselors might think critically about the topic and consider its use in their practice.

If this is not a term you are familiar with, you may wish to explore the goodly number of books in your local store discussing the topic. Why the interest? There is clear evidence that mindfulness has positive health benefits by reducing our stress responses to the chaos in our lives. Mindful individuals appear to have greater amounts of patience, able to avoid impulsive responses to stress, process rather than react to emotions, have greater capacities to be curious, open, accepting, and loving.

Stress and your body

It is well-known that small amounts of stress activate the body but larger amounts make us sick. But, did you know that the same biological response system that fights viral intruders activates with high levels of stress? Your immune system works in this manner (okay, my simplistic rendition): Your body senses an intruder. The microphages that come in contact with a virus act like little ants sending messages to their buddies to come and defend the colony. One of the messenger chemicals is interleukin-1. Your resulting fever is evidence that the body is working. But to work this hard, other bodily systems get such down. Your stomach and intestines stop or slow down their contractions, you lose your appetite, sexual drive, you have difficulty thinking clearly. These sick symptoms are more likely the result of your body’s defense mode than the virus that has intruded.

The SAME thing happens with high stress. Your pleasures centers shut down to conserve energy. Such activity decreases clarity of thought and pleasure and thus increases experiences of depression and anxiety. See how a vicious cycle of stress/distress leads to greater symptoms of depression/anxiety–a vicious cycle!

What is mindfulness?

Well, it depends upon who you ask. Definitions range from Buddhist forms of meditation, to being present in the moment, to being aware, to centering prayer, to having a nonjudgmental stance. So, for some it is a religious activity. For others it is a form of consciousness. And still others describe it as a relational “attunement” (e.g., a mother’s awareness of the meaning of her infant’s needs even before the cry; a service dog who picks up subtle clues that it’s owner is about to have a seizure). The truth is that each one of these fragments of definitions captures a little bit of what one observes in someone who is able to, in the moment, stand back from the chaos in their life and not react to it. Such people seem to be alert (not dissociated) to the moment, are being in the moment rather than reacting and doing something, are more likely to be describing events, feelings, perceptions, etc. rather than judging them.

In Dan Siegel’s The Mindful Brain (W.W. Norton, 2007), he lists a number of component parts to mindfulness:

  • Intention (rather than reactive), attention (aware), attitude (open, curious, non-judgmental)
  • Nonreactive to inner experiences (I notice my inner experience, but I am not merely my inner experience)
  • Observation, noticing, describing, labeling
  • Attending to sensations; acting with awareness
  • Either focused attention on the present or merely noticing all that passes through the mind

What about the Buddhist part?

There are two terms you’ll find when reading up on Buddhist meditation: vipassana (insight, clear thinking), samatha (concentration or tranquility). I’m not a Buddhist scholar but I do believe I’m in the ballpark about these next bullet points:

  • The goal is to get beyond (ab0ve) the experience of good and evil; of pleasure and pain to a higher level of experience
  • The goal is personal transformation and character development; awareness leading to the drying up of demands (desires?)

It is important to point out that Buddhism is not the only religion that espouses meditational practices. Christianity, from the beginning of the Church, has promoted the concept of meditation, albeit in significantly different form and purpose.

How ought we Christians to think about it?

Some might suggest that engaging in practices that encourage openness, neutrality (which is a misrepresentation of Buddhist practices) open oneself up to the occult. Others might be suspicious of hidden, subtle belief systems (personal transformation vs. Spirit-led transformation). These are legitimate questions. And yet I contend that we do not need to reject these concerns to acknowledge that God has given all humans the capacity to observe and grasp concepts that are true and right–even if we might staunchly disagree with their personal philosophies. This does not mean we take a concept into our life and practices without considerable critical thinking, but it does mean we are open to learning something that our own tradition has lost, ignored, or deemed unnecessary to healthy living.  I’ll attempt to do just that in the next post.

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November 9, 2009 · 5:44 am

Thinking about moral responsibility and agency in TBI


Tonight I will assigned my Counseling & Physiology students a response paper to the following case study. As you read this fictional case, consider how you might answer these two questions:

  1. What are the spiritual issues in this case and how do you consider Tim’s limitations in considering these spiritual issues? What is his personal accountability in light of his functional limitations and injury?
  2. How might you advise Tim’s wife and pastor as they struggle to understand and respond to Tim’s inappropriate behavior?

Tim is a 34-year-old, married man and deacon in his church. Prior to a serious car accident 2 years ago, Tim was a successful general contractor generating income over $200,000 a year. 2 years ago, Tim suffered a traumatic brain injury when a drunk driver, traveling at a very high rate of speed, slammed into his vehicle. Damage to his brain was located in the frontal and temporal lobes. Tim spent a total of six months in the hospital and in rehab. Initially, He was in a coma for 3 weeks and not expected to recover. However, he did emerge from unconsciousness and with rehab regained his capacities to walk and talk. His memory is mostly intact, missing only the week prior to the accident and the five weeks post accident. He seems to be able to form new memories but complains that he has to write everything down or he will forget tasks. He also complains that it is hard for him to find words. His friends notice that his speech is slower now. He is oriented to person, place, and time.

Tim’s wife and pastor ask you to meet with him. Tim complies. In session he is affable, talkative, but unsure why others think he needs counseling. He notes that he works hard every day, uses his daily contacts in business to talk about God’s miraculous work in his life. He admits that he smokes now and should quit but that shouldn’t be reason enough to warrant counseling. He signs a release to talk to his wife and pastor.

You learn from his wife that Tim has numerous problems that did not exist prior to the accident. Most notably: he doesn’t complete work; fails to bill clients properly; seems to over-estimate what he can complete; work done does not meet his pre-accident quality; he is easily angered and even aggressive; he curses and smokes 2-3 packs per day (none prior to accident); he drinks; he spends beyond his means; he has periods of deep depression; he engages in foul language about sex; is demanding of sexual activity with his wife (but cannot perform since the accident); he flirts with other women.

Tim refuses to return for further appointments. His wife and pastor come to you to discuss options and how to think about Tim’s behavior. The church board has removed Tim from his diaconal position this week and is likely to initiate church discipline after it was discovered that he made a sexual comment to an 18-year-old girl (he commented (spoke admiringly) about her breast size).

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October 29, 2009 · 8:40 am

Your opportunity to help asylum seekers


For my licensed mental health readers, you might be interested in checking out Physicians For Human Rights (PHR) an organization that helps asylum seekers get proper evaluation as part of determining their application for asylum. PHR has an “Asylum Network” that you can join for free and be contacted if there is a case in your area. These are usually pro bono cases. PHR also provides an extensive guide for those doing psychological evaluations of torture and/or persecution on the website. If you are looking for something exciting to do, I would think this would be a good choice–an opportunity to immerse yourself in another’s world and to care for the “alien” among us in obedience to God. My friend who does this says that you are not required to take cases offered to you and that you determine how many cases you might want to do in a year’s time.

Check them out! I plan to join.

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October 27, 2009 · 5:48 am

Dichotomy vs. Trichotomy?


In the world of Christian counseling past, thinkers (philosophers, theologians, model builders) pondered whether it would be good to consider humanity in two parts (body/soul) or three parts (body/soul/spirit or psyche). These days I can’t recall anyone even raising this as an issue that competent counselors should consider. This absences does beg the question(s): Is pondering the substances of humanity not particularly needed anymore? Is it that our academic predecessors already answered the question?

I’m not sure but I lean to the first reason–most people think this isn’t particularly relevant to their work counseling others. I tend to agree with caveats. When I sit with someone, I try to consider their whole being. We can’t possibly discuss their body without considering their mind. We can’t possibly talk about spiritual matters without using the body. I can just imagine this. “Now, let’s discuss your stomach pain, but we will not consider your thoughts or your spiritual well-being in this part of the conversation…[room goes silent]”

And yet many counselors continue to function like this in implicit ways. The counseling professional who feels incompetent to talk about faith matters (or that it somehow violates ethics) may choose to ignore spiritual matters (e.g., “I deal with only the psyche and I leave faith matters to the pastor). Well-intended, but in denial of the whole person in front of them. Then there are those counselors who see themselves as only dealing with faith or spiritual matters; matters of the will. These counselors may implicitly neglect, even reject, the role of the body in counseling concerns.

We counselors need to consider whether we tend to neglect a part of the person in front of us when we ignore body or spirit issues. Thus, it can be helpful to examine our practical theology of persons. Note I didn’t answer the question in the title. There are a good many who do a fine job debunking the trichotomy position. However, a practical monism likely works better in the session–that the whole person in front of me functions as a unity that cannot nor should not be divided into pieces.

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October 23, 2009 · 1:51 pm

The practice of unlicensed counseling


The practice of counseling, therapy, psychotherapy and other related terms is restricted to those with proper licensing in most, if not all, US states. Makes sense on most levels, right? You wouldn’t want to go to an unlicensed doctor for your appendectomy. In opposition to Holiday Inn’s ads, you wouldn’t want just anybody doing professional work on you. License control is supposed to protect the public from harm. Bad docs and bad therapists should lose their license and not be allowed to practice.

But with counseling and therapy, it gets a bit sticky. Lots of different professions do similar activities. Unlike surgeons, you have people from widely divergent schools of thought and training doing very similar things. LCSWs, LSWs, LMFTs, Psychologists, Psychiatrists, LPCs all do talk therapy. They all diagnose and intervene per their view of what is wrong and what needs to change (thoughts, behaviors. feelings, etc.).

And it gets stickier. Pastors, clergy, and religiously trained individuals do many of these as well. While they may not give DSM or ICD9 diagnoses and bill insurance companies, they do talk therapy with people who are depressed, anxious, angry, on the verge of divorce–just like all of those licensed people above.  In my world, there are pastoral counselors, biblical counselors, pastors who counsel, christian counselors, etc. Most of these in PA are not licensed by any body. (In PA we don’t have a pastoral counselor license as some states do.)

In an effort to tighten controls, there is a state effort underfoot (HB 1250) to tighten who can practice as a counselor. There were already controls but now the new bill would disallow someone like myself to hire or supervise an unlicensed (but in my opinion competent) person UNLESS they were actively in the process of becoming licensed.

Why does this matter?

1. There are many competent people doing counseling related work that are not licensed (nor could they be since their training is of a religious or pastoral nature). Should the state control these individuals? Right now they haven’t been actively going after these folk. The law will continue to remain vague: Here’s the restriction for LPC practice:

Only individuals who have received licenses as licensed professional counselors under this act may style themselves as licensed professional counselors and use the letters “L.P.C.” in connection with their names. It shall be unlawful for an individual to style oneself as a licensed professional counselor, advertise or offer to engage in the practice of professional counselor or use any words or symbols indicating or tending to indicate that the individual is a licensed professional counselor without holding a license in good standing under this act. [underline indicates new change in this paragraph]

Who decides what “engage in the practice of…or use any words…” constitutes? Obviously, one cannot intentionally lie but does the term therapy indicate a license?

2. There are many who provide pastoral care who are not ordained clergy. They have graduated from seminary-based programs that are not professional counseling programs. Yes, the current standard makes clear that it does not seek to limit the work of those acting under the legal auspices of a religious institution (i.e., are ordained by the church). But, should the state regulate those who provide biblical counsel but are not ordained? As long as these individuals make clear (informed consent) what it is they do and what they do not do, shouldn’t they be able to make a living? Research indicates that lay people can have tremendous success in helping those with depression and anxiety.

I’m all for protecting the public. But while licenses limit who gets to perform certain duties, it does not eliminate unethical or harmful practice. Further, much of psychotherapy is art as well as science. Artists can learn their trade in a variety of locations. What we need to do is to make sure the public can clearly identify the kind of counseling (and limits of) each counselor does. Second, those who provide biblical counseling ought to have some authoritative body. It would be great if they were recognized and “licensed” by denominations or organizations (e.g. the AACC who is trying to do this).

But I would hate to see the many seasoned, unlicensed counselors lose their ability to ply their trade.

That raises a question of analogy. Can anyone make a legal living cutting hair for a fee without a license?

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October 20, 2009 · 9:12 am

Diane Langberg on the web


Dr. Diane Langberg now has her own website. Check out www.dianelangberg.com for more information about her speaking (both schedule and available audios–both free and for purchase) and her counseling practice. You can see a list of her associates and their specialties. Her resources page has lots of good book, article, and website suggestions regarding a wide variety of issues.

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October 17, 2009 · 12:23 pm

The most important counselor capacity


Okay, so really there are a number of important counselor qualities and skills. You have to be able to be quiet and listen, to have good questions, and comments, to be able to follow a line of thinking, to have some idea of a goal, etc. But, maybe the most important quality is the ability to be self-reflective. Reflexive responses may be useful (these come from the gut) but they can be dangerous in that we have little thought and review of these kinds of responses.

At the retreat today I suggested that the unexamined life may create more opportunity for damage in counseling than the lack of knowledge of how to help a person. We may assume that our “truth-telling” capacity is good when it is really merely harsh. We may assume our “listening” skills are good when really, we are hiding from dealing with the big pink elephant in the room. We may think our advice and information is very important when really it merely exists to show off what we know.

We looked at Galatians 6:1f where we are called to help others by restoring gently, carrying burdens, and watching our own lives closely. (I got this from Paul Tripp some years ago). This passage shows where we may fail to care well for others.

Of course, there is also the danger of the over-examined life. Such a life leads to rumination, anxious second-guessing, and paralysis by analysis.

Retreat is going well, but wet and cold…

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October 15, 2009 · 5:03 am

Vernick on Domestic Violence.


Leslie Vernick wrote a nice summary posting on domestic violence at http://www.christianpsych.org. Read her comments here. She reminds us the truth about domestic violence and how Christians ought to respond to it.

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October 12, 2009 · 12:21 pm

On political and marital fights


Recently presented on the matter of marital conflict. On the way home I had a vigorous (and fun!) political debate with a colleague. I came to the realization that there are many similarities between both conflicts. Conflict is almost always about power with the particular issues (or the content of the conflict) a very distant second. We take positions because we see the dangerousness of the other person’s position or direction (and our loss of power). For example, if we follow our spouse’s financial behaviors, we’ll end up in the poor house. If we allow Obama to make decisions, he’ll ruin America. And just like in marital conflicts, we ascribe intent–he WANTS to destroy us all.

What I notice is that while we barely admit our own failings, we love to play out the failings of our opponent/spouse. Obama is taking advantage of a financial crisis to get some of his interests cared for (which of course fails to acknowledge that Bush got the Patriot Act because of a crisis). We could easily say the same in reverse.

My colleague and I most definitely agree on some things–that most politicians are narcissists, that they are more interested in winning than cooperating for the greater good. Truth be told, marital conflict has some similarities. Being heard, getting the other to acknowledge our points may be more important to us than finding a common bond.

It should surprise us that these similarities exist. Since Eden, we’ve been fighting for position and power.

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October 9, 2009 · 9:06 am

Christian slander


How easy it is to slander other Christians, to paint them in the worst possible light. We see something out of place in someone’s life and repeat that story to others. While it may be a true story, does it really capture them in totality? Does it provide the best review of their value and personhood? What do we gain by repeating these true but incomplete stories?

In my world, it is very easy to do this with public figures. I find myself tempted to do so when I see a public figure giving a terrible lecture or training. I want to point out their superficiality, their mis-representation of either psychology or christianity. And while I do believe there ought to be room for critique and wise review of public works, it is easy to cross the line into slander.

How do you evaluate whether you are giving a careful critique or have lapsed into slander? APA format in writing allows us to make a statement about another and conclude it with a “citation.” For example, “Monroe (2009) believes that Christianity and psychology are one and the same.” Note that I do not even need to give real evidence in my citation. I only have to cite an entire book. You can take me at face value and conclude I’m a lunatic.

Where I struggle is when I am critiquing with substance what I believe to be a problem in someone’s work, how do I do so without vilifying their entire body of work. Someone may indeed write heresy. I can call it out but does the reader get the impression that I believe that everything the person has said is suspect? The same goes for a preacher who is later discovered to have been in an affair. Does this invalidate his prior sermons?

Tough questions. Few answers. My impression is that it is so easily possible to do good and do evil at the same time. That our motives in pointing out others’ mistakes are of utmost importance. So, I can be right in my critique and entirely wrong in my doing it.

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