Category Archives: christian psychology

July 19, 2011 · 9:30 am

The real damage done in abuse?


I’ve written before on the damage done when a community fails to respond to abuse in a justice oriented way. But here is a more succinct and apt quote by Miroslav Volf:

If no one remembers a misdeed or names it publically, it remains invisible. To the observer, its victim is not a victim and its perpetrator is not a perpetrator; both are misperceived because the suffering of the one and the violence of the other go unseen. A double injustice occurs—the first when the original deed is done and the second when it disappears. (italics mine)

Abuse victims sometimes tell us that the most significant damage to them is when community members (family, leaders, peers) fail to “see” or act justly when they hear of the abuse. It was bad enough to be sexually abused (yes, that is real damage too) but far worse to be told it didn’t happen or be told to take it for the sake of the larger community (e.g., you wouldn’t want to harm his reputation, destroy the family, cause others to fall away from Christ, etc.).

I saw this quote in the first pages of The Long Journey Home: Understanding and Ministering to the Sexually Abused, to be released soon by Resource Publications, an imprint of Wipf & Stock. I have the typeset PDF and the editor, Andrew Schmutzer, says the book will be released in August. This book (over 500 pages!) may become the place to turn for Christians seeking to understand the scourge of sexual abuse in all its ugly forms. Chapters are written by those who are expert in the social sciences, theology, and pastoral care. The line up is phenomenal. You can see the title page/table of contents (TOC Long Journey Home) to see the gamut of chapters and authors.

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July 14, 2011 · 5:41 am

Whose shame do you carry?


Diane Langberg and I talked recently about the concept of shame. She mentioned reading an interesting mystery that had a couple of lines about shame that might be powerful imagery for some. The novel, C.J. Sansom’s Sovereign, is about a hunchbacked lawyer. About 200 pages in the lawyer has an encounter with King Henry the 8th. The King scorns the lawyer publicly for his hunch (at which everyone laughed).

His first reaction?

“Now I had met him. I felt for a second that he shown me what I was, an unworthy creature, a beetle crawling on the earth.” (p. 221)

Then anger arises in the lawyer. Why? for he recognizes the weight on him is not his own shame, but that of the king.

Whose shame do you carry? Most often we carry either the clear shame of our own misdeeds OR the shame foisted on us by the misdeeds of others. And it seems that the shame put upon us by abuse and maltreatment weighs us down the most. Often those who mistreat us do so in ways to make us believe that in fact we are worthy of shame or that they are righteous in their treatment of us.

What would happen if you saw it not as your own but thrust upon you by those who mistreated you? If you could hand it back (metaphorically), would your own back straighten? Would you feel less dirty and self-negating? If you suffer from shame due to mistreatment, try to imagine that the feelings are not yours but in fact the abusers.  Imagine what life might be like if you were to shed that shame that does not belong to you.

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July 13, 2011 · 5:51 am

Book Note: “Why the Church Needs Bioethics”


Just received a copy of Why the Church Needs Bioethics: A Guide to Wise Engagement with Life’s Challenges (Edited by John F. Kilner; published 2011, Zondervan). Using 3 case studies, a wide variety of authors discuss “better birth” (fertility), “better life”, and “better death.”

Authors include Richard Averbeck (OT and Counseling), Kevin Vanhoozer (theology), DA Carson (NT), and Stephen Greggo and Miriam Stark Parent (Counseling). In addition, there are business, law, medical, education, pastoral care, bioethics, and intercultural ministry authors.

I got a little chance to play a part in this book as a “critiquer” (p. 9) Stephen Greggo authors chapter 3, “Wisdom from Counseling” as a counseling response to the case study of Betty and Tom, a couple who are considering using Betty’s sister’s eggs and Tom’s sperm and to implant embryos into Betty. I got a chance to read and react to this chapter some time ago all because of a little article my wife and I wrote in 2002 and published in 2005.

On page 71, Greggo and Parent say,

A recent search of the leading peer-reviewed journals that inform Christian MHPs [mental health providers] and pastoral counselors yielded only a single article to guide a Christian counselor who might be dialoging with  Betty and Tom.

Their footnotes reveal that they searched The Journal of Biblical Counseling, The Journal of Psychology and Christianity and the Journal of Psychology and Theology between the years 2000 and 2009.

I find it surprising that there are no other articles than ours (full text here) and gratifying to see our essay summarized in this volume. While there are a number of good full length books, there is a serious need for good Christian counseling articles dealing with infertility and assisted reproductive technology (ART) because this is where many counselors start their study on a given topic.

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June 28, 2011 · 9:43 am

“I tried that…it didn’t work”: Responding to failures in counseling


One of the things a counselor does in meeting a new client is to ask, “tell me what you have tried thus far to solve this problem.” We ask this question because we know we are not the first stop for most folks trying to solve a problem. Whether it is a parent seeking a way to manage a child’s misbehavior, a couple seeking help in changing the way they talk to each other, or an individual trying to address an ongoing anxiety problem, most people have tried and not found adequate success–which is why they come to see us.

But, let me tell you what goes through my head when I suggest a couple of options/approaches my client might try and they respond with, “I tried it…it doesn’t work.” My internal, private response?

Define try. Define work.

Now that probably sounds negative but I don’t mean it that way at all. What I mean to communicate is that I do not yet know what this person tried, for how long, and what result, if any, was achieved. What I do know is that my work is cut out for me because the client statement usually conveys a closedness to trying that particular intervention (or similar ones) again. My job is to ask questions to understand each word: try and work.

Tried it.

There are a couple of commons ways people try solutions to problems. They may try something without proper consultation. They may try something in an intermittent manner. Let me give you some examples. Parents may try a reinforcement strategy with a child but fail to find a powerful enough reinforcer to make the system work. Or, a couple may try a speaker/listener technique but revert in the middle back to a debate/invalidating mode. A couple may need to take a “time out” or break to avoid a conflict escalation but the one asking for a break may do so using it as a power move (“I’m outta here!) rather than a de-escalation attempt.

Didn’t work.

A good technique may or may not work, depending on any number of reasons. Some interventions really won’t work for a particular person or setting. However, it is important to recognize that some interventions fail to work for reasons already mentioned above and others may fail to “work” because of client expectations. For example, a parent may try a particular intervention with their child to reduce angry outbursts. Then, the parent returns to counseling the next week and tells the counselor the intervention didn’t work. Upon deeper investigation the parent does admit that the number of outbursts reduced, the duration of the outbursts shortened. Why did they feel that the intervention didn’t work? Well, last night they have a horrible blowout and very small irritating interactions each day. So, the intervention may have worked even though the parent is feeling very worn out and discouraged. Or, in the couple illustration, listening technique may enable the couple to fight less but one spouse feels that the other has a history of being self-centered and thus cannot trust the reasons they are now trying to do a better job. So, they interpret short-term success as not real or legitimate.

Setting the stage for homework

Counselors often give homework. For homework interventions to work, a counselor should: (a) make a very clear explanation of what should be done, when, and how often, (b) what results, if any, to note, (c) the short and long-term purpose of this intervention, and (d) follow up next week to see how the  client fared and what alterations might need to be made in the following week.

Counselors do well not to oversell the value of the intervention, admit that not all interventions work and that troubleshooting is an essential part of counseling, write down their homework requests for clients, and make sure that the homework given fits the client’s level of commitment to the process.

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June 20, 2011 · 10:36 am

Must Read: Diane Langberg on “Trauma as a Mission Field”


My supervisor, mentor, and colleague, Dr. Diane Langberg has been telling us for some time that “trauma is the mission field of our time.” Recently, however, a few Christian NGO/Missions leaders have heard this line in one of her talks and have become electrified by it. I cited it last week in a board meeting at Biblical as I was trying to make the case that developing postgraduate trauma training at Biblical fits our mission: following Jesus into the world.

But, some of you have not heard her give one of these talks. For you, I point you to the World Reformed Fellowship website so you can read a report she made on June 5 regarding the problem of trauma and the opportunity of the church to have a hand in healing this man-made scourge. Below is an excerpt of that short report. Do go to the WRF link and read it in its entirety. The report is not long but it is powerful and includes a couple of specific comments from two leaders in Africa.

We are the church. That means we are the body of Jesus Christ and He is our Head. In the physical realm, a body that does not follow its head is a sick body. That is also true in the spiritual realm. We are His people and I believe with all my heart He has called us to go out of ourselves and follow Him into the suffering of this world bearing both His character and His Word. And we do go – we send missionaries and the Scriptures; we provide food, clean water, education and jobs for many. And we should. We have rarely, however, seen trauma as a place of service. If we think carefully about the extensive natural disasters in our time such as earthquakes, hurricanes and tsunamis and combine those victims with the many manmade disasters – the violent inner cities, wars, genocides, trafficking, rapes, and child abuse we would have a staggering number. I believe that if we would stop and look out on suffering humanity we would begin to realize that trauma is perhaps the greatest mission field of the 21st century.

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June 14, 2011 · 2:49 pm

Competing Models of Christian Counseling? Who is Right?


A couple of recent pieces have me thinking about (a) models of Christian counseling and, (b) the intramural conversation amongst Christians on which model is most Christian. One piece is David Powlison’s article in the Summer 2011 issue of the Westminster Today magazine (this link is to the magazine site but the current issue is not yet up). The second is by Ed Welch–a blog on Biblical Counseling Coalition website.

This is not a new topic for me. From my “About Me” page you can see that I have training in biblical counseling and also in clinical psychology. I respect the folks at CCEF who had a huge impact on my life and thought–especially that lovely editor they employ ;). While getting my PsyD I published on the historic divide between biblical counselors and Christian psychologists and the need to build bridges. I’m an associate editor for Edification, a Christian Psychology peer-reviewed journal.

All that to say, I have some thoughts on some ways we might move beyond right/wrong while still being concerned about building a clear, cogent, God-honoring model of Christian counseling.

Drop the labels

Yes, we should drop our labels. What is the difference between a Christian counselor, Christian psychologist, integrationist, or biblical counselor? These differences are as varied as the numbers of people who use them. Yes, there are probably some benefits to communicating a personal stance with one of these terms. But, for every benefit, there are probably any number of negatives, including the use of the label as a curse. “Are you that kind of biblical counselor” (whatever kind you find offensive)? “Are you a Christian who happens to be a psychologist or a Christian psychologist?”

In addition to dropping labels, we should also drop broad brush judgments. Calling Christian psychologists “syncretistic” is offensive and ill-fitting. Calling biblical counselors “psychology bashers” does not accurately portray their nuanced approach. Saying that psychology and biblical counseling is “fundamentally incompatible” (from either side of the debate) ignores the benefits that both sides gather from each other.

No labels? What then?

Facets. I’m sure there going to be problems with this idea too but let us choose to focus on facets of counseling models. For example:

  • How does Scripture shape counseling foundations and goals?
  • How do we learn from, utilize, and critique psychological constructs, data, etc?
  • How does typical human development trajectories influence our understanding of the change process?
  • How do we learn from those who do not share our epistemic foundations?
  • How do we articulate diverse counseling goals (suffering well? symptom reduction? discipleship? skill acquisition? insight?) as all working toward the common goal of glorying God and enjoying him forever.

Listen first, repent first

In Ed’s blog post (linked above on the BCC site), he captures the most essential characteristic needed if we are going to learn from each other. We ought to,

listen and enter into the world of the other person (or in this case the other counseling perspective) in such a way that the person representing the perspective says, “Yes, that’s me. You understand.”

It is a sad thing that we counselor types start with diagnosing other model builders without listening first to both the content of that model and the person behind it. We treat our fellow counselors in ways we would never treat a client. How should we listen to others? Can we see what they see? Can we see what they see that we tend to ignore? Can we see the benefits of what they do and the potential liabilities they see in our model?

Be willing to repent where you have unfairly labeled, categorized, and marginalized one who was working for Christ’s kingdom–even if you think you have been hurt more.

List own weaknesses first

Most debates, whether between thinkers or spouses, rarely succeed in winning over the other person. Why? Because we are too busy defending, explaining away, pointing out the weaknesses of the opponent to actually deal with reality.

Wouldn’t it be refreshing to hear a counseling model builder express his/her models weaknesses or needed growth points first before exploring the deficits of the another? “My model doesn’t yet have a good understanding of ____. Your model does so much better with that and I want to learn from you.”

Build the center

Rather than start with the differences (which do indeed exist), what if we cataloged the similarities and areas of agreement among Christian models of counseling? In addition, what if we recognized those things we might not have noticed with out the help of those outside our own community. For example, Scripture may speak a great deal about loving neighbors but a particular model of psychology may flesh out what loving a very unique population of client ought to look like. Even if Scripture is sufficient, we do not diminish it when we acknowledge we hadn’t made a particular application without our neighbor’s help.

Acknowledge differences

We will not see eye to eye. We will disagree. Let us acknowledge these where they arise. Let us make sure the differences are real and categorize them into those that are peripheral and those that are substantial. For example, David Powlison speaks about the need for a counseling/care for the soul model back in the 1950s. Despite quality practical theology and discipleship programs, he asked,

But what was the quality [in the 50s] of corporate wisdom in comprehending the dynamics of the human heart? What sustains sufferers and converts sinners? Westminster Today, 4:1 (2011), p7

Right away I ask myself, are these the only two options (sustaining, converting) for Christian counselors? Is it possible also to have the role of treating symptoms? Teaching skills? Reducing suffering? I’m fairly sure that this initial difference is not really there. I suspect David does not reject mercy ministry to reducing suffering. But in dialog, he and I might end up agreeing that some biblical counseling models fail to focus on skill intervention in their quest to address the human heart. And we would likely agree that some christian psychology models fail to address the spiritual discipline of suffering well and the need for conversion. Might we end up agreeing that we want a full-orbed model that neither diminishes nor over-promises symptom care or sanctification?

Promote each other

Finally, we do well to promote each other at our conferences and learning communities. We encourage wide-ranging reading, critical interactions (note, not criticizing), and sharpening of each other. And we commit to lovingly correcting those of our “friends” who speak ill about our neighbors. We reject the fear of defending an outsider for fear of being rejected ourselves. 

 

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May 31, 2011 · 5:40 am

Healing, recovery, restoration and other words for “getting better”


Recovered. Healed. Better. Restored. Resolved. Whole. What words do you use when describing positive change regarding traumatic events like abuse, the pain of adultery, or other like experiences? And more importantly, what do those words convey to yourself and others?

Why am I thinking about this? Soon, I will begin teaching an on-line summer class called “Healing Trauma in International Settings.” To be honest, I’m a little uncomfortable with the title I chose. Words matter and “Healing” conveys a message. Imagine replacing “healing trauma” with

Trauma treatment

Trauma recovery

Trauma care

Now, maybe I’m being overly sensitive but consider some of these other kinds of problems we face

  • You break your tibia during an aggressive move on the basketball court. Your leg heals and you go back to your basketball playing. Here we use healing to denote that you regained your former capacity to play sports. You are back to normal or near normal.
  • You cut your finger while slicing vegetables. You go to the hospital to get stitches. While you have a scar, your finger heals and you use it again. In time you have only a slight scar to remind you of that day.
  • Your house sustains a fire. You lose belongings. Your insurance company restores your house and replaces your possessions.
  • Your car is stolen. The police recover it and return it to you (with fuzzy dice attached)
  • You have a protracted conflict with a family member. At some point, you have a heart to heart and resolve your differences.

My examples all convey a resolution of a problem where the problem recedes, maybe even disappears. But what about trauma? Is there a form of resolution and healing of rape or sexual abuse or domestic violence where the memories disappear? Should there be? Wouldn’t forgetting these experiences place the person in danger of living in unreality and, in some cases, at risk of re-injury? Here are some important questions:

  • What does healing from an affair look like? How do you know you have “recovered”? What symptoms or experiences would remain?
  • What does healing from a rape look like? What would be expected if you “pretty well recovered”? What is to be expected to not change?

As a counselor I do not want to under or over-sell the recovery process. Victims do find tremendous healing but to assume all vestiges of a traumatic experience go away would be false. Unfortunately, we who have not been traumatized sometimes expect the kind of recovery where victims go back to a way of life and thinking as if the trauma never happened.

If we are honest, we wish to live in a world without lasting consequences from sin and suffering.

We want people to “get over” their pain and go back to a way of life as if it never happened. It would be like asking a person who lost a leg to hope they will run exactly like they did before losing the leg. Indeed, they may run again. But never as fast and never as easy. There will be a stump to care for, a hip to learn new motion, phantom pains to re-interpret, and limits to accept.

This world of limits is one God wants us to live in and one we detest. Our first parents saw the limits of their wisdom and desired to get wisdom on their own. We too love the happily ever after story where humans obtain health and healing apart from limitations. We tell the stories of miraculous healing as if we no longer live in a broken world.

Let us endeavor to tell true stories of healing that glorify God and remind us that we depend upon him for every breath.

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May 27, 2011 · 4:27 pm

Introduction to Healing Trauma course


Starting July1 I will be teaching an on-line course, Healing Trauma in International Settings. Here’s the introductory video for students to watch during week one that tells what I plan to have them do during the course. Don’t worry, most of the course ISN’T watching me talk. You can see the full syllabus here.

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May 18, 2011 · 9:22 am

Physiology of fear


Regions of the brain affected by PTSD and stress.

Image via Wikipedia

Had a conversation regarding fear and anxiety with someone yesterday. In light of that I am resurrecting a post I wrote from 2007 (with a few edits) regarding the physiology of fear. We often view fear as only a spiritual or faith problem. But for those who want to know what is going on in their bodies when they experience fear, consider the following:

(Those interested in other posts on anxiety can search that and related terms in the search box at the upper right hand of this blog)

…

Am teaching on anxiety, panic, and OCD tonight. Definition of anxiety: Responding to ambiguous stimuli (life situations) by reading them in the worst or most dangerous possible light. The Scriptures teach us that fear and worry are not good things. Time and time again God tells his people not to be afraid. We see that God wants us to see life through a different set of eyes, much as Elisha wanted his servant to see the army of angels instead of their enemies (2 Kings 6). But given the numerous encouragements to not give in to fear, we must admit it is a common struggle for every human being. Some struggle more than others.

What is going on with those whose lives are filled with worry and fear? Are they less spiritual? More sinful? It is easy to say, “buck up” to folks who are anxious–and entirely unhelpful to most. Logical challenges to fear (e.g., really, what is the chance you will die in a plane crash today?) may help some in the moment, but usually don’t get to the root of the matter. Jesus encourages fearful people by pointing them to see life from 40,000 feet. He doesn’t deny risk and suffering but encourages folks to keep their eyes on him. And with Peter, he reaches out to grab him even when he does start looking at the waves.

But what of the physiology of anxiety? What do we know and how does the christian counselor make use of the data?

  1. Fear responses are quickly learned and seemingly etched into the amygdala. One bad experience of food poisoning from a turkey sandwich at Applebees means my stomach tenses a little when I see deli turkey, even without remembering the food poisoning. Imagine what happens if you suffer repeated assaults or worse! The earlier the person is exposed to deep fears, the more likely they suffer from hyperarousal and startle responses.
  2. Neurotransmitters are involved which means you act first and think later. There’s little conscious cognitive processes involved until after anxiety is under way. Fear inducing stimuli lead to immediate neurotransmitter changes that then divert blood from organs to muscles. Tension builds, shallower, less effective breathing begins. Carbon Dioxide levels decrease in the blood stream which in turns creates pain, numbness, and a sense of danger. And so the cycle continues. During and after, we make attributions and so enhance the connections of the feared stimuli and our flight response. The higher the perception of pain, the greater fear/flight response. Despite medical advances, most of our medications either shut down the feed-back loop (beta blockers, anti-anxiety meds like xanax) or attempt to increase the available neurotransmitter serotonin associated with positive outlook.
  3. OCD, in particular, has some probable links to early exposure to viruses such as Strep and Flu. There is a higher incidence of OCD in people born during winter months and who live in colder climates. The link is not clear.
  4. PTSD patients have higher right hemisphere brain activity (than do non-PTSD individuals) when exposed to anxiety provoking stimuli. Further, it appears that trauma patients have greater difficulty coming back to “center” after a trigger. Likely the hypothalamus and other brain structures are overactive in the stress response and do not “cool” down quickly.

That’s just a few things we think we know about the physiology of fear. Now, what do we do with fear from a spiritual standpoint?

  1. Worship. Worship/meditation on other things takes our attention away from the fear stimulus. It forms habits and relationships as we repeat what we want to believe until we actually own it and believe it on its own merits.
  2. Fight. We do challenge our thinking as soon as we can. Yes, the fight/flight chemicals are coursing through our veins but we challenge just the same so we can break some of the connections and the ways we reinforce our fears. One other way we fight may seem a bit odd. We admit there are real things that are scary and overwhelming out there. We do not try to deny the reality of suffering (past or future) but admit it over and over. It is scary to die. I was assaulted in that alley. I am in pain and more may be coming. But, God is with me and it is good to call on him and ask him tough questions about his protection of me.
  3. Stay Present. Being present in the moment is essential to avoiding living in the fear of the past or the future. Some fear is indeed in the present but most are not. When I am able to focus or describe the now, I am less likely to be imagining a future feared event. “Right now I am sitting at my desk and looking at a picture of my children and enjoying the smiles on their faces. Right now I am getting ready for bed and working on a sudoku puzzle and noticing that I am getting tired.”
  4. Work. Building habits where I do not allow myself to run from the feared situations (where appropriate!). Moving myself closer to some of the feared scenarios in a slow and consistent manner. No, this is not flooding (where you are dumped in the pit of snakes because you have a phobia of snakes…). Allow the work to take the time to reorient the deep recesses of the brain. Don’t expect or look for immediate change!

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May 17, 2011 · 5:56 am

What is the difference between a trial and a stressor?


Words matter. The words you use to describe an event really do shape how you will view it and how you will respond to it. For counselors, the words they use to conceptualize a client/case will shape how they see clients and how they will attempt to intervene. This is why I take considerable time in my Practicum class to practice case conceptualization.

Most beginning counselors are good at collecting information. But, for most, that data might well be a hopelessly knotted  ball of twine.  Where to start pulling? How do we make sense of the various pieces of data? And since data never comes to us uninterpreted, which “data” do we tend to gravitate to? Behaviors? Family history? Motivations? Biology? Environment? Client beliefs? But even more confusing are the words we use to describe these sectors of life–and the meaning they convey!

Stressor v. Trial?

Here’s how language influences case conceptualization. Your client experiences long-term family discord due to an adult child with schizophrenia. The family member routinely goes off medications and the police have to be called in order to transport him or her to the hospital after threatening self-harm. Your client comes to counseling to seek support for handling this difficult situation. As you can imagine, the client feels alone, worn down, and wondering how to keep going despite no sense that the situation will get better any time soon.

What do you imagine might be the impact of calling this family situation a trial? And how might you view it differently if you called it a stressor. Notice any differences? Benefits of each? Drawbacks of either? In your mind, are they equivalent? (See Eric Johnson’s brief discussion of these two words and their similarities/differences in regard to Christian psychology in his Foundations for Soul Care, p. 240)

Here is my thinking. Within Christian tradition, a “trial” signifies a difficult time or season but from a spiritual or divine perspective. It conveys a purpose–a testing or proofing of one’s faith. We tend to view trials (or desire to at least) from an eternal point of view, “testing of your faith produces perseverance…”  (Jas 1:3). Notice that while “trial” does signify difficulty, the focus is largely on the purpose it serves.

On the other hand, a “stressor” is something that causes stress or distress in a person’s life. Notice that this word carries no sense of eternity, divine value or purpose. It merely describes a facet of life that is troubling a person’s life.

Imagine with me a counselor who uses “trial” to describe the distress in the life of the client mentioned above. How do you expect that might shape the counselor’s view of the situation and thus response sets to that client? Would our counselor be more likely to view the trial as something to endure, more likely to engage in spiritual conversations so as to find comfort and peace in the middle of the storm? Would their conversations tend toward the hope of heaven? Is it possible that using the language of trials might cause a counselor to ignore the real-time experience of distress?

Now imagine the counselor who uses “stressor” to describe the same distress. Would this counselor be more likely to discuss in detail the physical, psychological impact of living with a mentally ill and unstable family member? Would this counselor then be more focused on finding ways to decrease the moment-by-moment stress levels? Is it possible that using the language of stressor might cause a counselor to ignore an eternal perspective?

Hopefully, you can see the value of both word meanings and the interventions described. It is possible to use the language of trials and focus in on the details of how that trial impacts the client. And it is possible to use the language of stressors and keep in mind an eternal perspective. Whatever language, the interventions off stress education and reduction and hope building are necessary interventions.

If you are a counselor or counseling student, observe the language you use to describe your clients and their lives. How does that language influence your view of them and the interventions you might use with them?

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