Category Archives: christian psychology

May 19, 2010 · 5:51 am

Suicide assessment mistakes


Yesterday’s post was about suicide. Counselors sometimes fail to adequately evaluate suicidal ideation, plan, or intent in their counselees. Some years ago, I ran across a research study looking at the most common mistakes made by 215 masters level counselors when dealing with suicidal clients. I’ve lost the bibliographic data for the article and couldn’t find it easily in Psychlit…

Here are some of the mistakes (in no particular order):

  • Superficial reassurance (“you have so much to live for”
  • Avoidance of strong emotions (not allowing client to express strong despair–usually with first bullet point)
  • Professionalism (cold and distant, possibly seen as uncaring in assessment)
  • Inadequate assessment (failure to explore fully because of nervousness or fear of asking)
  • Failure to identify precipitating causes (most suicides have both current and historical precipitating events. Counselors may identify historic event (e.g., divorce 4 years ago) but miss the current precipitant.)
  • Passivity; failure to be empathic (25% took this stance)
  • Insufficient directness. No contract to not harm, no next steps
  • Overbearing advice. Counselee needs to be involved in the planning for safety
  • Stereotyping response (“She’s just a borderline!”)
  • Defensiveness (usually about whether hospitalization is necessary)

Every counselor worries about how they will perform when addressing the serious problem of suicide risk assessment. We do well to review (a) our natural inclinations when stressed (e.g., do we tighten up, become over-controlling, too professional?), (b) our standard of practice when confronted with despairing or suicidal clients, and (c) our assessment procedures with all clients. While there is no way to prevent the suicides of highly motivated people, we can increase our capacity to respond well to those the Lord sends our way.

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May 12, 2010 · 12:24 pm

Professional communications by counselors: What do they reveal?


What we say and how we say it can tell someone quite a bit about our character. We counselors earn our keep with words. And yet, it is our words that may do the most harm to others. As a result, I encourage us to take stock of our words. What do they reveal about us? Oh, and don’t just consider the words you use in a session. How you talk to a colleague, about a colleague, to another professional may reveal your character more than you think. Consider the following communication issues:

1. Client put-downs. In agencies where counselors share clients with other professionals (e.g., psychiatrists, social workers, community workers, etc.), it is common for conversation to descend into put-downs. No doubt these professionals care about their clients. But if they are frustrated with the client, does it result in blaming the client? Making fun of their idiosyncracies? “He’s such a narcissist; She’s so Borderline”. These kind of comments reveal more about the speaker than the one spoken about.

2. Professional Lingo. Every guild has its lingo. Read a psychiatric or psychological evaluation and you will likely come across a number of words that only make sense if you are on the inside. The client probably wouldn’t really know what is being said about them with translation help. What do your progress notes communicate? Who are you writing for? How might our lingo hinder our work. I highly suggest that use the client as a standard to evaluate all our written communications. If the client couldn’t understand or could possibly be harmed by what we write, the think better of it.

3. Professional Territorialness. We communicate with other professionals about our clients. Does our communication reveal any condescending attitudes? Any unnecessary hierarchy? How do you talk about another professional to clients? To other colleagues? Do we withhold data for power reasons? For fear of mis-use by the other. If so, we have serious issues to address. Leaving them unaddressed will only injure the client.

4. Unprepared staffings. Staff communications regarding shared clients often include off-the-cuff comments about clients. These kind of statements can sound as if they are well supported by data. Sadly, we can offer up anecdotes about a client and they are weighted as heavily as objective test data. Can we support our comments and insights with data? Are there other data that might challenge our offered hypotheses?

5. General coarseness. I once had a supervisor who used the “F” word in every sentence (and in every form of speech possible). He relished the power he got from using that word. I’m not opposed to ever using curse words but they usually reveal more about the user than the situation. More recently, I’ve noticed how frequently we use genital imagery to talk about important character traits. “Do you have the stones to do that?” I heard this question asked in prime-time television. Why couldn’t they just talk about the trait of courage? I do think that language has a way of devolving in the heat of battle. Counselors work in the trenches and so it stands to reason that they might slip here some.

6. General grumbling. It is easy to slip into the habit of grumbling. I am tempted to revel (yes revel since I think I enjoy it some) in pointing out the failures of other people. I feel better when I can see their mistakes that I would never commit. We grumble against people, against institutions, against policies; against pretty much anything that irritates us.

Let us be diligent to explore what our communication reveals about our hearts and character and let us resolve, with God’s help, to love others even when they are not watching–and to model that love in our speech.

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May 11, 2010 · 10:12 am

Changing Your Narrative in Counseling?


If you have gone to counseling, then you probably wanted something to change in you or something connected to your life. If you have counseled someone or been their wise friend, you also wanted something to change. There are a variety of ways to try to calculate or observe change. Is there a reduction of unwanted behavior or an increase of hoped for behavior? Is there a change in affective or perceptual change (i.e., do I feel better or have more hope?)? Is there more insight? More acceptance of what cannot be changed? Greater responsibility taking for what can be changed? Is there greater congruence between faith and practice, head and heart?

While everyone (counselor, counselee, insurance company) wants objective evidence of positive change to prove that counseling was worth the cost and effort, the most powerful and most valuable change gets little attention. What is that change? Script or narrative change. We all live by a storyline. We use that story line to make sense of our world and of ourselves. However realistic we think we are, we never really use all the data to determine our reality. Rather, we use scripts to fill in blanks and supply us with the “truth.” Don’t think this is true? Just examine the common fights of a couple. Most likely you can remove the content of the fight and you will find an enduring pattern of feelings and perceptions about self and other in each spouse.

How did we get these scripts? We have experiences of self in the world? We make interpretations of what we experience. Others communicate interpretations for us. But we are not blank slates, we come to these experiences with a distorted imago dei–a God-given image and agency that is both active and yet distorted due to Sin.

So, how does counseling change a script or life narrative? There are a couple of options. You can begin with behavior change. Changes in behavior may cause someone to re-evaluate view of self and other. For example, a person may move from “I can’t” to “I can” based on the evidence in behavior change. You can begin with insight. What is my dominant life narrative and is that really accurate or is there a better one to live by? You can begin with relationship. This form of intervention is less clear but probably more powerful than the first two. By focusing on the “here and now” you are having an impact on narrative as it plays out in the moment. In opposition to insight which pulls narratives apart, this form of intervention is predominantly an experience that shapes the narrative in a more implicit fashion. In other words, we realize the change sometime after the fact.

What you cannot do is exhort someone into a new script. When we try (and we do sure try: “Don’t be afraid of ____ …It isn’t that bad…”), we fail. Even if the counselee “buys” the new script, they have only listened to you say it. They have not yet written it on their heart. Passive acceptance ought not be mistaken for real change. In fact, sometimes hearing the needed change over and over only makes the person more resistant to it. A change in script must be practiced and owned for it to become real. That is why an addict may well become sober by accepting the limits imposed by others and still yet remain an addict at heart.

Narrative changes usually take time. It is possible for powerful experiences to create instant change in our view of self and other. Certainly conversion experiences are evidence of massive script changes. Many of us have had powerful “a-ha” moments that also change our perception of self and the world. But most of our script changes happen via the drip method–water dripping on rock does indeed make changes when viewed over the long haul. When we look back on our lives, we often note places where we have indeed changed–sometimes for the better, sometimes not.

———

For more on intervention points in counseling, check out this post I wrote 2 years ago. I tried my hand at illustrating both the script and the intervention points.

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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 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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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 12, 2010 · 9:10 pm

Do you have a pet psych test?


Uh, by that I mean whether or not you have a favorite psych test. We’ll save tests for pets for another day.

There are many out there who love the Myers Briggs (MBTI). Others love the DISC. When people have a pet test it is usually because the test provides a quick and dirty profile in order to understand and categorize a person’s behavior. Actually, and sadly, we often like certain tests because they allow us to pigeon hole others (as in, “your such a J”).

But, I do have favorite tests. I love to review the couple version of the 16PF with both long-time marrieds and those seeking pre-marital counseling. When I was doing parent competency assessments, there were a number of lesser known tests that illustrated a parent’s capacity to be flexible (and so hopefully less rigid and abusive). When it comes to personality assessment, the MMPI-2 and the Rorshach (Exner scoring) are my favorites.

But lately, most of my assessments have been with pastors. I’ve found a number of great little tools to illustrate compassion fatigue and other at-risk problems. These assessments lack the depth and rigor of a personality test but work great as conversation starters and self-evaluation tools. With these I don’t have to explain what they mean.

How about you? Got a favorite test you’ve taken? Given? Why is it your favorite?

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