Category Archives: christian psychology

January 4, 2010 · 12:39 pm

Psychopathology Monday


Happy New Year all. Our semester begins today with the first session of Psychopathology for the first year students. Before launching into the various forms of mental illness and emotional maladies, we consider the larger concept of suffering. Without a careful understanding of (a) the nature, causes, and theology of suffering, (b) the meanings of suffering, and (c) our beliefs and responses to suffering, we counselors become a dangerous lot. We fall prey to simplistic understandings and responses–and fall prey to false hope and false despair.

Sound like a great way to start of the New Year? It does to me because we now have an opportunity to look at ourselves and our world with more realistic eyes than we may have during the stress of the holidays.

Coincidentally, we had a Sunday School class yesterday on the topic of suffering. Our church has buried 10 people who died before their time (so it seems to us!) in the past 5 years. Not only have we had these tragedies, we’ve also splanted a church and been in a transitional malaise for maybe 7 years? The class allowed individuals to talk about suffering and heartache. Good class. We heard those who felt that what was going on was a message from the Lord, from those who just felt confused and in pain, from those who felt the nearness of the Lord during these normal ups and downs of life in a fallen world.

What was said in multiple ways was that one’s perspective or expectations about suffering really impact how one feels about the struggle of life. If you expect life to always be healthy then repeated sicknesses and death will set you back. Someone said there that if you lived in a dirt hut that moving into a trailer would seem wonderful but if you lived in a palace, the trailer would seem a terrible thing.

So, what should we think about suffering and the seeming explosion of death and heartache?

  1. God is saying something AND yet He may not be sending some special message to us
  2. Our actions may cause some of our own suffering but living more righteous lives does not prevent suffering
  3. Suffering is to be expected in this world AND yet it is NOT THE WAY IT IS SUPPOSED TO BE
  4. Isolation and failure to connect to others in suffering ALWAYS makes that suffering worse
  5. Even those who only observe those in suffering suffer as well and need to connect with others in order to avoid despair
  6. Good may come out of suffering, but suffering itself is not good
  7. God, through the cross, bears our suffering and yet it still hurts
  8. It will not last forever

Finally, how do you respond to suffering? Turn away? Become numb? Angry? Probably all the above, right? Take a moment to consider how you respond to suffering right in front of you and watch yourself for those trite statements that can hurt those who are already in pain.

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December 14, 2009 · 5:14 am

Rwanda meetings


This coming week I have the pleasure of meeting up with several folks interested in the next step in our Rwanda efforts. We will be meeting with Rwandan church and gov’t officials to discuss possible training efforts before next Memorial period. Along with meetings in the DC area, we will tour, together, the Holocaust museum. I understand this will include a behind the scenes interaction with curators, holocaust survivors and others. Cool!

Hopefully, we will come out of these meetings with a clear plan for our next, yet-to-be scheduled trip. I don’t know if I’m alone in this experience, but meetings seems to drag on when I would rather start doing something. I know, at one level, how important listening is. But brainstorming and planning are way more fun! I hope we’ll get to that!

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December 8, 2009 · 1:54 pm

End of semester thoughts


Looking at a stack of papers I need to grade and yet not feeling the energy to do so. Late night classes take more out of me than I care to admit. My physiology class ended with student presentations and a look at bipolar disorder. As we concluded the class, I asked them to remember that,

  1. Even with all the advances in neuroscience, we must humbly admit we still know little how we are fearfully and wonderfully made.
  2. It is good for counselors to keep learning about the body and at the same time hold what they know lightly. Tomorrow may bring evidence to the contrary
  3. Yet, what we know about the body can be helpful. We ought not to look down upon our ignorance but remember that doctors do not always explain or walk with patients
  4. There are great medical interventions available, but (and that but shouldn’t diminish what I said before it),
  5. Over and over we saw that the basics (maintaining balance in life, self-care, mindfulness) are so important to health, perspective, etc. No, they aren’t magic interventions. Yes, they pay-off over time rather than immediately.

On this last point I am pondering a bit and so let me be hyperbolic. Most people who come to see me for paid counseling come because they think (naively) I have some expertise that will shed light on their situation and a solution to their problems. They want me to do something. Why else pay that kind of money? And yet much of what I have to offer isn’t rocket science. Beyond a few fun techniques, what I have to offer is a listening ear, a willingness to walk with the other person in their travail, and encouragement to keep going back to the basics. Most people like the first two but balk at the last one. Why do we balk at going back to the basics? Two reasons: (1) we want something that will fix the problem NOW, and (2) we’ve tried the basics and they didn’t seem to work (see reason 1).

Examples of what I mean.

  • If you are a parent and you go to a counselor to deal with your young child’s behavior problem. More than likely, you will get some counselor telling you to use some reinforcement strategies. And what do many parents say? “I tried that and it didn’t work.” Chances are they did try it and either they didn’t keep at it or they didn’t realize they were doing something that reinforced the wrong thing, or they had a misguided view of what success should look like
  • A couple is struggling with fighting. They go to the counselor who encourages them to return to the basics of respectful talk. Usually, they will feel like they have already tried it–and it didn’t work. Chances are… You get the picture.

In physiology, we see that care for the body includes mindful meditation (My friend and former professor says a substitute word would be “watchfulness”) on the world as God sees it, developing and maintaining good circadian rhythms, watching food intake, exercise, maintaining healthy relationships and social supports. In every mental illness, these things are shown to decrease the severity of symptoms and delay relapse.

Here’s the problem: we forget the basics and because they don’t give immediate results, we go searching for other fast-acting mechanisms. For example, I want to feel safe. Instead of engaging in centering prayer over the long haul, I fall prey to the temptation to act in such a way to avoid all possible danger–thereby increasing my fears of danger.

If I don’t exercise (and I don’t much) I rarely get immediate feedback that my body is falling apart. If I don’t eat right, I don’t immediately gain 10 pounds. If I don’t pray, I don’t immediately get embittered. So, I assume that these basics aren’t all that important. Or, I know they are important but since they don’t pay off now, I don’t do them. I only do what demands I do it to avoid a crisis.

How do we stay on track with the basics? We need another person(s) willing to keep us on a short leash. As a kid I ran because I had a friend who was going to wonder where I was. As a doctoral student, I played basketball at 6 am because my peers would  ask me where I was. I lost some weight a couple of years ago because my wife and I worked together. Notice that the social accountability is a key facet to help us build the disciplines long enough to see that the pay off is more than can be delivered by an exciting new technique.

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December 1, 2009 · 12:04 pm

Chronic pain and the Christian faith


Last night’s Counseling & Physiology class covered the topic of chronic pain. There are a number of syndromes and disorders that cluster around pain as the presenting problem: Chronic Fatigue, Fibromyalgia, Irritable Bowel Syndrome, Rheumatoid Arthritis, Osteoarthritis, back pain, etc. Depending on which research study you read, some 9-17% of the population struggles with some form of chronic pain.

While these various forms of pain are quite different, there are some commonalities. Chronic and diffuse pain sufferers frequently experience some form of inflammation, fatigue, sleep disruption, negative mood, and poor memory (its hard to pay attention to new information when you are weighed down by pain). We don’t really know what causes what but we do know that these symptoms form a vicious cycle. If you don’t get restorative sleep, you experience more fatigue, you are more prone to negative thought patterns, your pain levels go up, memory goes down…and thus you don’t sleep well the next night, and so on. Researchers describe this vicious cycle in terms of “allostatic load”–the deleterious effects of chronic stress hormones without restorative sleep.

Because of the diffuse nature of pain (vs. focal) and the lack of obvious objective evidence of that pain (a big red spot, a swollen limb, etc.), chronic pain sufferers and their families struggle to understand whether or not the pain is real and what they are truly capable of doing. How do you measure pain levels? It’s pretty subjective! Thus, it encourages more “I should be able to…” thinking in all parties. Those not suffering chronic pain do more damage by implying that the person is just looking for attention, is just being lazy. Those suffering pain who either deny the pain and try to do too much or refuse to engage the world and withdraw from it do damage to themselves–real physical damage.

As with all physiological problems, one’s mood, one’s perceptions, one’s focus, one’s stress levels impact severity of the problem. While chronic pain is not just in one’s head, how one responds to chronic pain may help alleviate or elevate the pain sensations. Ironically, many pain sufferers resist counseling because they fear that others will believe that their symptoms are all in their head. Those who refuse to acknowledge the psychological factors in pain sensation and management miss out on important means to cope with the pain and to lower pain perceptions.

Chronic pain sufferers must accept the need to adjust their lifestyle to accommodate more rest. They must fight to get the best restorative sleep possible. These are probably their primary practical responses–even above medical treatments (and I’m not knocking medical treatments nor saying that just getting sleep will solve the problem).

One of the biggest challenges for pain sufferers is the matter of hope and faith. When we suffer problems, we often hope they will go away. And when they do not, or only get marginally better, it is easy to slide into despair. Despair usually is the result of things not going the way we hoped or expected they would. Part of dealing with chronic pain is grieving what is lost in order to accept–even enjoy–what strength and health we do have. Without hope, we lose what self-efficacy we once had, thus not doing the basic care-taking activities within our grasp. Interestingly, one of the clearest signs of this struggle is the massive dropouts in pain management research. Frequently, dropouts number about 50% in these studies. This means that before a study gets too far along many are dropping out because they assume the new treatment isn’t going work.

Faith is not that things will go my way right now but that God is in control, cares/protects me, and is working for my ultimate redemption–even when the opposite seems to be true. Faith is acting in a manner consistent with said assumptions even while grieving over real losses. Such faith enables us to be mindful of our thoughts so that we do not practice into beliefs counter to what we have come to know as true.

The chronic pain sufferer who grieves well (asks God for relief, stays in community with others, seeks relief through human means yet has an attitude of waiting on the Lord, and yet still willing to explore and confront hidden sin in self) begins to see that in the midst of the pain, God is there and providing momentary help. Such a person need not act as if the pain were nothing but will look for and rejoice in 5% improvement, 10% more comfort, etc, rather than demanding complete healing as the determinant as to whether God is present with them in their distress.

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November 13, 2009 · 4:00 am

When Sex in Marriage Doesn’t Work


Today is the first full day of the CCEF annual conference in Valley Forge, PA. The conference is entitled, “Sex Matters” and so all plenary and breakouts are on said theme. It is not too late to drop by if live in the area and want to register. I believe they will still take walk-ups.

Besides the faculty-led plenary sessions, Lauren Winner (Girl Meets God; Mudhouse Sabbath, & Real Sex) will speak on Saturday. For those of you who can’t come, CCEF sells mp3 downloads on their website.

I will be providing an hour long seminar entitled, “When Sex in Marriage Doesn’t Work” at 4 pm today. We will focus on desire, arousal, technique, and relationship problems (whether perceived, physical or emotional) couples sometimes encounter. Slides and an additional home-grown sex therapy questionnaire is available here (#16 on the list, scroll to the bottom).

The best part is that after I’m done, Biblical Seminary is hosting a pizza party for current students and alums (5:30p) at our information table.

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November 11, 2009 · 5:59 am

Stress & Christian mindfulness, part 2


In the last post I reviewed some simple definitions of mindfulness, including some of the Buddhist ideas behind a version of mindfulness. In this post I want to consider how mindfulness, when reconsidered in the light of Christian thought, can be a valuable part of counseling practice.

A thought about mindfulness and the brain

Let me detour to one more thought about biology and mindfulness. What happens in the brain when a person is practicing mindfulness? Thought and feeling patterns result in neural activity in the brain (or is it the other way around?). Repeated neural activity creates stronger connections between neurons (increased synaptic activity and denser connections with neurons in the same neighborhood. Repeated activity leads to greater blood flow and activation in particular regions of the brain. Neuroscientists call this neuroplasticity.

Thus affective and cognitive patterns can indeed change your brain. Think about this. What patterns of thought do you engage in on a repetitive basis? Do you have a habit of fantasizing? Mulling over bitter or jealous thoughts? While some of these may come naturally to you, what you do with them may actually change or strengthen neural connections in the brain–for better or for worse.

Is mindfulness healthy or relativistic?

Mindfulness, no matter whether you take a religious, consciousness, or relational approach to it, includes the stepping back from shoulds, oughts, and other judgments. One might think that this would be dangerous for Christians. Within Christianity, there are rights and wrongs, truth and lie, righteousness and unrighteousness. The Bible is, among other things, the single guide for Christians to determine how to live for God. SO, it begs the question whether Christians should be wary of anything that seems to let go of shoulds and oughts?

Another view of shoulds and oughts

In my experience, those suffering from anxiety and depression suffer from a disorder of judgments. They are flooded by shoulds and oughts. Their self-talk does not seem to come from the Lord but are already laced with prejudice. “You should have been more vigilant against danger AND you weren’t. You’re a failure.” “You shouldn’t be rebellious BUT you are always a screw-up.” “I shouldn’t have to suffer this way AND God must not care for me.” Notice that most of these forms of judgment are careful consideration of the facts and experiences but well-formed opinions that may be based on only a smidgen of the actual events in their present circumstances.  Notice that these forms of ruminative thinking come in disguise as careful, logical thinking. They are not. What they are narratives–well-practiced narratives–that have an already formed conclusion that we repeat regardless of the actual facts of our lives.

Mindfulness, then, is stepping back from these narratives. Mindfulness is a practiced discipline of just noticing and describing events so as to process them more carefully instead of automatically repeated a script or mantra. Mindfulness provides the opportunity to discover “what is” rather than compound suffering by focusing on what we just assume. Consider Dan Siegel (The Mindful Brain, p. 77)

When the mind grasps onto preconceived ideas it creates a tension within the mind between what is and what “should be.” This tension creates stress and leads to suffering.”

While I’m sure I would vigorously disagree with Siegel on what a preconceived idea is, on what can be healthy “should be’s”, and much more, he has a point worth considering. Have you ever engaged in a fantasy conflictual conversation with someone you are about to meet. You play out yourself winning, being mistreated, standing up for what is right, and so on. Notice how such conversations aren’t useful. They only increase your level of stress because your brain responds to the inner drama as if it were really happening, when it has yet to happen. In this way, Siegel is right. We create tension that leads to suffering.

Using mindfulness in Christian Counseling

I’m running out of room here and won’t be able to do justice, in this post, to the most practical part of mindfulness. [Isn’t that just like us academics. We spend all our time pointing out problems but we never solve anything!]. Mindful practice may include time practicing being present in one’s surroundings. The counselor may encourage clients to take in their surroundings. While many thoughts may race through the brain, the mindful person may choose to not follow them but “drink in” the creation beauty around them–things growing, art, or anything that is a delight to the senses. This form of discipline must be practiced in de-stressed times so that it will be available during a crisis–just like a basketball player practices free-throws over and over so as to make the shot when there is only 1 second left on the clock.

Such work is the work of taking every thought captive. and resting (a la Psalms 131) without grasping after things “too wonderful” for us.

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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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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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