Category Archives: christian counseling

April 29, 2009 · 5:21 am

Can your body cause you to sin, part 3


As promised, I offer you a vignette to consider as we think about the matter of culpability and involuntary sins.

Consider a 2 year old that has missed his daily nap, is hungry, and tired of being out in public. He has a meltdown. He kicks, screams, cries, refuses his mother’s comfort because he wants some object he cannot have. The good parent recognizes the child’s distress, whispers in his ear to comfort him, says “no” firmly to his kicks, and finds something for him to eat and a place to take a nap. Has the child sinned? He surely has demanded something, acted aggressively, maybe even disobeyed by going after the object after his mother said to stop. Yes, he sinned. But was it really voluntary? Well, maybe partly. But don’t we consider the circumstances and the fact that his body is not helping matters. We forgive, we overlook, we understand, we help. We do so because we know his choices are not really voluntary.

Now, we may have another reaction altogether when we see our little boy (fully rested and fed) look us in the eye and try to bite his baby brother after we just told him to stop. We know he has great voluntary control here and is in a power struggle. And we respond with appropriate discipline.

We could easily have considered a vignette of a brain injured man or a panic disordered woman. We respond to individuals based not on whether something is sinful or not but on how much voluntary control we think they have and the circumstances in play (environment, biology, understanding, etc.).

So, our bodies can cause us to sin. In the classic sense, we are guilty whether it is voluntary or not. And yet we, and God himself, varies responses to such sins based on a variety of factors. We do not ascribe innocence to those less culpable but do try to determine levels of responsibility. Thankfully, all of it is covered by the cross.

Here’s one way this might matter. I find many afraid to seek biological aids for what they determine to be spiritual problems (addictions, depression, anxiety, etc.). If we see body and soul together, then both body and soul interventions are working toward the same goal.

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April 28, 2009 · 12:20 pm

Can your body make you sin, part 2


Yesterday I posted an introduction to this topic. Today, I want to give my answer to the first question:

Is it possible that my body (against or apart from my will) might cause me to sin?

  • What is gained and/or lost if we say yes? If we say no?

My answer: Yes.

I suppose you might like some defense of this position. Okay, here’s my best shot in five minutes:

1. Nothing is done by a person apart from their cells. We mediate all worship, desire, etc. through our cells. When we do good or evil, all of us are involved.

2. Sin is not merely an act, but a disposition. All of me is tainted and not functioning as it was originally intended, including my physical body (and don’t I feel the effects of being over 40!).  The dualist position is more in danger of treating sin as only what we consciously choose.

3. I don’t have to know that I broke the law (biblical or federal) to be guilty of violating the law. I didn’t know I was speeding but I still got a ticket. In the OT, lack of intention or knowledge violating the law did not protect against impurity or guilt (e.g., Lev. 4:22; 5:3).

4. If the body is broken and under sin’s curse it stands to reason that our bodies function in ways that are out of accord with our will. If they can move without our control (e.g., Parkinsonian tremors) can they not also move in such a way that violates God’s design for us. We have scientific evidence of this. Stimulate a certain part of the brain, and you will have rageful feelings. Stimulate another part and you may have sexual thoughts. Consider, as a commenter suggested yesterday, a person with Tourettes. There is some evidence of temporary volitional control (a surgeon is able to stop a tick during an operation) but other evidence that the ticks, and in some cases, curses burst out against the conscious effort of the person.

Saying yes to this question violates our Western sensibilities:

If we accept that our bodies can act against or without the will, what do we gain or lose? I think the primary concern by many would be that somehow we will either be held culpable for sins we didn’t want to commit or claim innocence for sins we didn’t willfully commit. And this gets to our thinking patterns here in the West. We want to be only held accountable for things we did do and not held accountable for things we either didn’t do or didn’t have any control over.

It strikes us as evil to be held accountable for that which we didn’t know was wrong. I once got a ticket for making a u-turn on a Chicago city street at 11 pm when no one (but the cop!) was around. There were no signs. I wasn’t familiar with Chicago rules, was lost in an unsavory neighborhood. And yet I still got the ticket. It didn’t seem right. But I did violate the law.

Our American judicial system isn’t the only system that holds us accountable for involuntary acts. Romans teaches us that because of Adam’s sin, all are sinners. I bear the culpability for his sin (and I make plenty of my own as well). I bear the impact of his choices in my entire being. Further we see OT prophets confessing the sins of the community as if they were their own.

So, in short, I think we can answer yes to the question about whether our bodies can make us sin. They can because we (body and soul) are tainted by the Fall. It doesn’t make us more or less out of sorts with God whether our sin is chosen or involuntary. Happily, God doesn’t just forgive willful sin, he forgives sin period and makes it possible to not sin by imputing his righteousness to us.

For those still thinking about culpability, I’ll give a little vignette tomorrow to chew on.

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April 24, 2009 · 2:16 pm

Physiology Phriday: Depressed? Check your thyroid


One of the most common mistakes made by counselors is to forget to encourage their clients to get specific medical work-ups. There are three key reasons for this problem.

1. Most clients describe their struggles with causes already in place. “I’m depressed because I have a bad marriage, because life isn’t going the way I had hoped.” We counselors accept their initial diagnosis and fail to dig further.

2. We know that counseling works. And so we help them work on their thinking, feeling, and behaviors. We do what we do best

3. When we do send someone to the doctor, we rarely get a clear answer.

Nonetheless, it is essential that your clients have had recent blood work. Case in point. Low thyroid levels often leads to experiences of confusion, mental dullness, and depression. (FYI, overactive thyroid may lead to irritability and anxiety). While there may be real counseling work to be done (everybody needs some help), it would be a tragedy to miss real mercy care (i.e., a better functioning thyroid).  

Check here for some info on hypothyroidism: http://www.endocrineweb.com/hypo1.html

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April 21, 2009 · 11:59 am

What is a competent counselor?


Today, I begin an introduction to pastoral counseling class for MDiv students with my colleague Jenn. In six short weeks we will expose them to biblical foundations of understanding people and their problems, the basic helping skills, and provide them opportunities to practice on each other.

So, what makes for a competent counselor? There is a famous book on this topic. Jay Adams focuses in his landmark, bulldozing book on the problems of secular psychology and the need for a new understanding of how people change that fits with Scripture and a confidence that all people, especially pastors, are capable of leading others to change.

Important work, but misses some of the nuances that we have now about Christian models of change. For some of my thoughts on a more robust model of counseling that I seek to impart here at Biblical, see this post from several years ago.

But I want to focus here on the talents or capabilities of the counselor. And here I list 7 factors needed to be a competent counselor

1. Spiritual maturity. Not only must the counselor know the bible, its story line, etc., they must also have understood and experienced the Gospel, show a maturing trajectory towards holiness and awareness of the diversity within the Christianity. In the words of one of my theology colleagues, they must know the difference between dogma and doctrine and opinion.

2. Self-awareness/insight. One can be spiritual mature, but not particularly insightful about the self. The competent counselor has a grasp of their own narrative (and how the Gospel story is changing it) and how it impacts past and present relationships. The competent counselor understands strengths and weaknesses and is not defensive.

3. Capable of building trusting relationships. Nothing much good comes from counsel provided by standoffish and stand-above kinds of counselors. The competent counselor is able to build trusting relationships by being interested in individuals (more so than in outcomes), able to walk in another’s shoes, cross cultural lines, and able to empower others more than tell others what to do

4. Flexibility in response styles. The competent counselor understands the need to use a variety of conversational responses depending on the needs of the client. This means sometimes questions are appropriate, other times silence. Other responses include reflections, summarizing, focusing, confronting, joining, problem-solving, self-disclosing. Counselors who only use one or two of these styles will not be able to work well with clients who find those particular styles problematic. The competent counselor is intentional in her or his choices of responses.

5. Assessment and Hypothesis skills. The competent counselor is able to move from their counselees problems and descriptions to a wider view of the person and their situation and back again. This counselor is able to pull multiple pieces of data into a cohesive understanding of the situation. In doing so she forms and tests possible hypotheses that clarify motivation for behavior as well as point to interventions. For example, is the child’s behavior merely rebellious or is it ADD or anxiety based?

6. Observation skills.The competent counselor not only understands people, their needs, solutions, and has the capacity to use multiple response styles, but also is observant regarding their own impact on the counselee. They observe subtle reactions form clients and seek to moderate their counseling style and/or gently explore the meaning of the reaction. Without these skills, the counselor blithely works toward a goal without knowing if the counselee is really following.

7. Ability to care for self. Finally, the competent counselor recognizes personal limits, boundaries and actively seeks to sustain a life of personal care. Far too many counselors confuse sacrificial giving with bypassing appropriate care for one’s own spiritual well-being. Just because one is spiritually mature one day does not mean such maturity is permanent. Neglecting personal care will likely diminish all other counselor competencies over time.

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April 20, 2009 · 11:03 am

Practicum Monday: The green counselor


No one wants to be a green counselor. “Hi, I’m an intern and you are my first counselee.” Who wants to say that? Also, no one wants to entrust their most significant problems to a green counselor. “I see you haven’t any experience, so let me expose my most tender parts to you and see what you can do.”

Houston, we have a problem.

Every counselor has to get their start somewhere just as every surgeon cuts a live human being for the first time. Young single folk counsel conflict-riddled married individuals or offer parenting advice while not yet a parent. Individuals with no history of addictions sit with folks in their 10th inpatient stay in a treatment center.

Is there any way this goes well? YES! Let me tell you why going to an intern with a good supervisor is good, even sometimes better than getting a seasoned counselor by them self.

1. You get two heads instead of one. Even if the supervisor is not in the room, you get a young, determined-to-do-it-right counselor and a supervisor on his or her toes (who loves to teach and wants nothing bad to happen) thinking about you and planning carefully. They talk about the intricacies of your situation at great depth, they consider the options, and carefully review the outcome. If you only have a seasoned counselor, they may perform better (relationship wise) in sessions, but they probably aren’t thinking as critically as they could. I can attest that I am thinking much more carefully about clients during supervision (as supervisee or supervisor) than when I am not there.

2. Book knowledge actually does help. The further a person gets away from textbooks, articles, etc. the more they rely on old knowledge. Teaching counselors and green counselors are fresh from their reading and thinking about key problems. For example, the student having just completed an ethics course will be more sensitive to boundary violations than the one who has grown accustomed to thinking they will always do the right thing. Sometimes resident doctors are more aware of subtle health issues because they are running down every article to learn and running down every symptom.  

Now surely a seasoned counselor provides many good benefits. Working with an intern or medical resident often takes longer to get to a good outcome. They just aren’t as fluid. They are still learning–learning on you. A seasoned counselor will make fewer mistakes. But if they are a humble learner, the green counselor will catch on quickly and repair any damage. Whether green or seasoned, the most dangerous character problem in counselors is arrogance and listening only to him or herself.

But the intern can manage some of this by dealing with his or her own anxiety. Confidence does actually help. It enables you to think clearly, consider options, be honest about your own weaknesses, offer the client help in finding someone else if you aren’t the right fit. It is like baseball. If you are afraid of getting hit, you’ll likely not catch or hit the ball. If you have confidence, you’ve got a better shot of catching it and/or at least making contact when hitting.

 

All that said, I have to tell you a story about my “first time.” I had just completed a 13 week internship where I counseled 2 separate clients with my supervisor in session and by myself. I could be given good grades for trying hard, but probably was too impatient to get to the good stuff of people’s problems–the stuff of repentance. In a moment of insanity my supervisor set me up as a staff counselor in a satellite center. On my first night I saw a person who said the Lord had told her I was the counselor for her but now was rethinking she had misheard. How could an 18 year old be right for her (ahem, I was all of 24!)? After trying to find out the issues, she said if I couldn’t figure it out, she definitely had misheard God. The next client was a couple. In the course of the session, the husband actually stood up and started choking his wife. I stood up–not knowing what else to do–and he fled the building.

There’s nothing like baptism by fire 🙂

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April 17, 2009 · 5:28 am

Physiology Phriday: Will I be on meds for the rest of my life?


During the course of discussing a person’s anxiety or depression, the conversation turns to the possibility of using antidepressants. Inevitably, I am asked, will I have to take them forever? Clearly, the questioner does not want to and sees the possibility of taking medication for the rest of their life to be unacceptable. So much so that many resist starting or even going to see a psychiatrist in order to consider whether they might take a medication. Rarely do they ever ask if the medications will help.

Consider for a minute why a person might ask this question. Here’s some of the reasons I think I’m asked this question:

1. Everybody is on them and they never get off (from the viewpoint that too many people take them for every little hangnail and then allow themselves to stay on the crutch forever, never solving their problem)

2. Medicines are for weak people, I’m not weak. (Not sure if the person would have the same response if their medical doctor said their thyroid wasn’t working and so they would need synthroid for the rest of their life)

3. It is only a spiritual problem. Taking the medication will solve the problem but not the spiritual problem. I’ll be avoiding the real issues.

4. I hate medicines of all kind. I hate remembering to take them and I hate their side effects.

5. I don’t think they will really work.

Can you think of other reasons? Now, antidepressants do work from a research vantage point. They are not the silver bullet. They will not make a bitter, angry, depressed person, less bitter. They may help them sleep better, improve their mood, and thus more clearly come to terms with their bitterness. Medications never block the heart from spiritual matters. Only the person who does not want to deal with spiritual matters will use them to avoid looking more deeply inside. God can be found in both suffering and comfort. Whether we will look for him is a bigger question.

So, what if you need them for the rest of your life? What if they really do make it possible to function well? Is our distaste for medicines due to their side effects or due to the fact that we have to accept that we are weak and broken people?

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April 15, 2009 · 5:37 am

Lewis on our choices impact on the self


In my CS Lewis reader, Lewis says that Christians often think about the consequences of choices either bringing reward or punishment from God. He suggests another way to look at our choices (entry for 17 March):

I would much rather say that every time you make a choice you are turning the central part of you, the part of you that chooses, into something a little different from what it was before. And taking your life as a whole, with all your innumerable choices, all your life long you are slowly turning this central thing either into a heavenly creature or into a hellish creature: either into a creature that is in harmony with God, and with other creatures, and with itself, or else into one that is in a state of war and hatred with God, and with its fellow-creatures, and with itself. (From Mere Christianity)

Does this not help us consider which creature we are forming as we make our many mindless choices every day?

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April 13, 2009 · 11:11 am

Practicum Monday: The secret to a good experience


A new semester begins today and I pick up teaching again after a sabbatical. It feels good to get back in the saddle again. Practicum and Professional Orientation starts today and so my students begin their first fieldwork assignments around the region. If they are at all like I was when I first began counseling work, they will be nervous and worried about doing well and doing the right thing. But I have a secret for them. This nervousness will actually help them do well and, for the most part, mistakes in counseling often turn out to be good for both counselee and client. Counseling is more like art and less like surgery. And since counseling is relational art, the opportunity to “do over” actually provides wonderful realism to the healing.

However, there is another secret to good practicum experiences: good supervision. Good supervision makes or breaks an experience. And good supervision requires the active participation of both supervisor and supervisee.

The Supervisor: Supervisors come with a variety of skills, personality, and style. Some are quite directive and keep a tight rein on your practice attempts. Others are very hands-off, wanting you to try stuff yourself and so they respond to your questions and concerns rather than seek you out. Others are very process oriented and focus on your experience more than what you actually do.

The Supervisee: Some students come with hundreds of questions (some out of curiosity but most out of anxiety). Others want very specific directions and then try to act them out as was given. Others still want to talk about their own experiences and have a harder time recalling client responses.

Practicum students do well to prepare for supervision:

1. Before you begin, have some discussion about how the supervisor likes supervision to go? Do they have an idea about how they want you to function in it? Do they want it to happen just after your counseling experiences for the week so you can debrief? Just before so you can best remember what was decided?

2. When you bring your cases to supervision, come prepared to concisely summarize history, presenting problems, attempts to solve prior to counseling, family systems, current crises if present, work thus far in your counseling. Also, come prepared with a specific objective question you would  like to have answered. The more specific your question, the more likely you will come away with an answer.

3. Be sure to ask the supervisor to help you refine your hypotheses. This is a good opportunity to consider alternative ideas.

4. Schedule time when the supervisor can either watch you live or listen to a taping. There is NO better supervision possible. Scary? Yes. But essential if you do intend to become a good counselor

5. Be willing to ask (nicely) the why question when your supervisor gives you directives that don’t make sense. More than doing the right thing, you want to understand the critical thinking behind the right response.

6. Use your relationship with the supervisor to grow as a professional. This is one of your future colleagues. If there are conflicts between you, practice the good art of resolution. Don’t avoid and don’t attack.

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April 8, 2009 · 5:16 am

Ramp up your helping skills!


Biblical Seminary is offering community education (non-degree) for those not able or not eligible for graduate education. It is a way to get a taste of what we do here. Starting next Monday night, Jenn Zuck (one of our counseling adjuncts) will be teaching an introductory counseling skills class for 6 weeks. If you’ve wanted to ramp up your listening and helping skills, wanted to see what we teach counseling students, or just wanted to improve your family relationships, you should enroll in this course.

By the way, the course isn’t just for your head. You will practice some new skills and you will find that your spiritual life will also be enriched.

Here’s the link for more info (flyer and syllabus): http://www.biblical.edu/pages/embark/about-us-upcoming-eventstest.htm

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April 3, 2009 · 5:53 am

Physiology Phriday: Your brain and your food


We all love certain kinds of foods and when we eat them, our pleasure quotients increase dramatically. Some recent work in brain imaging suggests that women with propensity for bulimia show “greater activation of key reward regions of the brain” after tasting a chocolate milkshake. These same individuals may also experience decreased activity in parts of the brain that control self-regulation and impulse control (as reported in the April 2009 Monitor on Psychology, pp. 48-49).

This area of research is new and so the results need replication plus interpretation. Does the brain function this way after years of bulimic behavior. Or, does the brain instigate or tempt such behavior (strong reward response plus increased impulsivity) with it’s prior functioning?

Of course, the individual struggling with bulimia cares only a little about the why. They really concern themselves with the what. How do I eat with moderation? How do I not eat for emotional reasons? Unlike alcoholics who can always avoid alcohol, everyone has to eat, and eat everyday.  So, what to do when your brain responds the way it does to food? Here’s a couple of practical ideas to start you down the right path:

1. Get a “coach” or counselor who you will be completely honest with. This coach will help you construct an eating schedule and an array of responses to eating or purging temptations.

2. Construct a realistic eating schedule that avoids avoiding food. Keep a food journal. Be honest. Keep troubleshooting with your coach until you find something that works best for you. Remember to check out your schedule (times and foods allowed) with a nutritionist.

3. Construct and use an array of behavioral responses to eating temptations. These include distractions, connections with others, ways to make the moment better, crisis call opportunities.

4. Develop mindful techniques to focus on eating, on stopping eating, on other forms of pleasure God has given you–even on the difficult emotions that you feel.

5. Identify controlling automatic thoughts and lies in your “script” that drive you in particular emotional and behavioral directions. These can be about your body image, about your relationships, etc. Begin responding to them with truth from God’s point of view. Make sure your coach and others know what truthes you are trying hard to believe.

6. As you recognize triggers, temptations, etc., also identify “ways of escape” offered you by God.

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