The faculty blog at Biblical Seminary has posted one of mine about mindfulness from a Christian perspective. Actually, it is a call to develop a theology of mindfulness–or what I prefer to call watchfulness. While you are there, check out some of the other postings by my colleagues.
Category Archives: christian psychology
One Definition of Christian Psychology
At a recent conference, Diane Langberg submitted the following definition of Christian Psychology. I present it below, verbatim, for your consideration. In some ways she doesn’t say anything new. However, it is quite different from our usual definitions.
Let me explain my seeming contradiction by first giving you C. Stephen Evans definition of Christian psychology,
[It is] psychology which is done to further the kingdom of God, carried out by citizens of that kingdom whose character and convictions reflect their citizenship in that kingdom… (p. 132)
As you would expect, Dr. Evans offers a philosophically astute definition.
Or, consider Eric Johnson’s tome, Foundations for Soul Care: A Christian Psychology Proposal. In this book of 700 plus pages, he explicates a Christian psychology framework as doxological, semiodiscursive, dialogical, canonical, and psychological approach to soul repair. If you are looking for a theologically and epistemologically rich entry point to Christian psychology, I can’t point you to a better place than this book.
Like these two examples, many of our current definitions focus on matters of epistemology, theology, and psychology. Many definitions also emphasize the work of critical evaluation of existing psychological theory and research.
Now turn to Dr. Langberg’s definition. Notice how she emphasizes the character, the preparation, and actions of the counselor. Notice further that the focus on outcomes is bidirectional–on counselee and counselor.
Christian psychology as practiced in the counseling relationship is a servant of God, steeped in the Word of God, loving and obeying God in public and in private, sitting across from a suffering sinner at a vulnerable crossroad in his/her life and bringing all of the knowledge and wisdom and truth and love available to that person while remaining dependent on the Spirit of God hour by hour. That work, no matter what you call it, will be used by God to change us into His likeness; that work will result in His redemptive work in the life sitting before us; that work will bring glory to His great Name.
What I take from Dr. Langberg’s definition is an emphasis on action, the Spirit’s work and the counselor’s work (in self and other). While the epistemological definitions are necessary if we are going to think critically about our work, so to is this action-oriented definition. It reminds us that for all our thinking and theorizing, it is God’s work in our private and public lives that is used to bring healing and hope to others.
Your thoughts?
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5 Approaches to Counseling and Christianity
There was a recent conference in Tennessee where the authors of the recently published, “Five Approaches to Counseling and Christianity” (IVP) presented their approaches, dialogued with each other, and showed brief vignettes of their counseling model in action. You might like to see some of the papers and slide presentations by each of the authors. Do so by following this link. At the bottom of each bio, you can find the link to their presentation. They do not have the video clips of counseling available. I, for one, hope they make them available for sale. Despite the diversity of theories, I suspect their actual counseling activities do not differ all that much.
Phil
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The priority of relationships in the mission of God
I teach at a missional seminary. You might wonder what “missional” is all about. Well, I’ve tried to articulate why missional is all about redemptive and redeeming relationships. Such relationships change the ways we relate to those we seek to serve, whether here in the U.S. or in any other part of the world. To read a bit about how missional relates to serving others in Africa, read this post over at the Biblical Seminary faculty blog. It came out on Halloween but Hurricane Sandy made her appearance a few days earlier so I doubt many saw this.
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More on “Can Your Body Make You Sin?”
I’ve written about this topic here and here before. In those posts I argue that there is a better question for counselors to consider than the one of culpability. Last night, we started the 2012 edition of Counseling & Physiology with the question of culpability and whether or bodies/brains can cause us to sin outside of our will. We also looked at our tendency to focus on judging whether a person is culpable for their sins (e.g., someone with Tourette’s who swears, someone with a TBI who is easily enraged, someone who is chronically anxious or still another who falls prey to addictive behavior). One of my main goals was to get students thinking about whether they under or overestimate the body’s role in counseling problems.
In the second post listed above I indicate the possibility of a better question than culpability. However, one of my students last night raised a question that went something like this,
Doesn’t the fact that you will choose how to respond to a client indicate that you have to judge the cause of the problem? If you encourage a client to consider psychoactive medications, aren’t you suggesting it is a body problem? If you focus on habits or heart issues, aren’t you assuming the problem is primarily a spiritual, will or behavioral control problem?
This was a great question and my answer was something like the following.
No and yes. Functionally, you will choose an area to work first. This does not mean you think that the type of intervention you choose indicates the main problem. It may only indicate that you think one intervention is an easier entry gate to counseling than another.
Here’s an example. Even if my client is severely depressed and I believe that the primary cause of this depression is their longstanding bitterness and anger towards God, I may encourage a psychiatric evaluation and the consideration of an antidepressant. It may be that once their mood improves, we can make better progress in investigating some spiritual matters in their life.
Human sins and weaknesses have multi-factored sources
Have you ever thought of the various sources of human sin? Here’s a visual of all of the things I think of that are a part of nearly every human sinful behavior. The sizes of the factors surely change depending on the situation. For some, will, high-handed rebellion, may be most of the pie. In other cases, bodily weakness may be the prime source. Also, some of these surely overlap and are not distinct. I may have started out in a rebellious state when I started doing drugs. Now, my body and psychological habits are equal players in why I maintain a drug habit.
What else would you add to this chart? Note that I place “will” in the smallest concentric circle. I imagine that we have far less conscious control over sin than we sometimes ascribe. Habits, unconscious motivations, and foolish (unthinking) choices probably dictate more of our behavior than our direct, willful, planned rebellion. Of course, none of this has ANY influence over culpability or morality as Scripture clearly indicates our guilt even when we are unaware of the Law’s commands. When Jesus says, “Father, forgive them for they know not what they do,” it tells us that consciousness of sin has little to do with our need for forgiveness.
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Filed under biblical counseling, christian counseling, christian psychology, counseling, sin
What good is a diagnosis?
At the recent AACC conference Dr. Michael Lyles, a board member of AACC and practicing psychiatrist, stated the following,
A diagnosis is only a word on a page if it doesn’t serve a function.
What kind of function was he thinking about?
- Does it explain a set of symptoms?
- Does it point to a treatment plan?
- Does is help differentiate between overlapping symptoms?
I’m a firm believer that our current DSM diagnostic system is at once both flawed and useful. It is flawed in that DSM diagnoses don’t address causes or do much to point to treatment. It is useful when used carefully to help differentiate between overlapping sets of symptoms–even as it needs considerable overhaul to do a better job. Take differentiating between Major Depression and hypothyroidism instigated depression. The two look identical. But using a multiaxial diagnosis, a person could rule out Major Depression if they were able to make a positive diagnosis of low/inactive thyroid function.
So, until we have a better nosological system (i.e., a replacement for the DSM), I will continue to use it. In years to come we will, however, recognize it for the blunt instrument that it is.
Right Diagnosis…Wrong Focus?
Consider the following case study (not a real person, devised from several stories) as an illustration for the problems we have moving from current diagnostic categories to proper treatment.
Tom is 27, married, father to one young daughter, working part-time as a youth pastor and going to seminary full-time. He comes to counseling on the encouragement of his primary care doctor. One month ago during final exams and an overly busy ministry schedule, Tom began experiencing rapid heartbeat, shortness of breath, feelings that he was losing his mind, and chronic fear of dying. After experiencing 4 panic attacks in rapid succession, he began worrying that something was terribly wrong and that he was about to die. His doctor first ruled out a physical origin for these symptoms, taught him breathing and distraction exercises to interrupt the buildup of panic, prescribed an anti-anxiety medication, and recommended he make an appointment with a therapist. During the first session, Tom details his history of stress, reports he has been able to forestall 2 more panic attacks but admits he still struggles with fears of dying, lacks assurance of salvation, and feels flooded with guilt that he worries so much. Upon further exploration, Tom believes the bible teaches him that he should not fear if he has “perfect love”. He has read all of the verses about anxiety and feels condemned for his struggle.
Tom meets criteria for Panic Disorder, without Agoraphobia. This is a highly treatable problem and within a few short sessions, Tom is likely to gain mastery over his body in that he will no longer evidence panic attacks. This, of course, is not the same as saying he will stop experiencing worry, guilt over his chronic worry, or start having assurance of his salvation. Logic, disputing worries, distractions, exploring and altering core beliefs may help reduce the symptoms that brought Tom to his doctor and counselor. A good Christian counselor may also be able to reconnect Tom to Scripture in ways that help him experience God’s care for him in spite of his fears (e.g., hearing the gentle voice of Luke 12 vs. a harsh rebuke).
But has the diagnosis been properly made? Yes. Tom met the criteria for an anxiety disorder. No. Tom’s counselor also helped him discover a deep layer of shame that may have been the source of his anxiety. Without the latter, the former is not altogether helpful.
So, should the diagnosis be an anxiety disorder or shame? Until we have shame as some form of a diagnosis, I’m okay with maintaining the anxiety disorder as a good description of external symptoms. But, Tom and others like him will need wise counselors who can dig a bit to discover diverse multiple shaping factors (e.g., biopsychosociospirtual) that lead to a common expression of symptoms.
What good is a diagnosis? I concur with Dr. Lyles: not much.
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Speakers vs. teachers?
At AACC National conference in Branson this week. Good to see a number of old friends and colleagues. Have heard a few good ideas as well. At conferences like these there are plenary and breakout sessions where I can get continuing education. The plenary sessions include widely known individuals and the breakouts may also feature well-known counselors as well as “regular” people like me.
Here’s what I notice when I come to a place like this: there are speakers and teachers and usually a person is either one or the other. The speaker is someone who often displays a great sense of humor, knows how to tell stories, and can move and motivate the audience with information that may not be that new but is packaged in a captivating way. Teachers, on the other hand, tend to deliver new content, provide step-by-step description of interventions and give the audience some new way to think or act. Now, teachers can motivate and be humorous and speakers can deliver new content. But commonly these two types of speakers are very different in style.
Have you noticed this difference in conferences you attend and do you gravitate to one more than the other?
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Filed under christian counseling, christian psychology
Guest post over at Christianpost.com
The website, www.christianpost.com has picked up one of my recent blog posts about whether our bodies can cause us to sin. Never heard of the site before but nice to be noticed. You can see the post here if you missed it on my site: http://blogs.christianpost.com/guest-views/can-your-body-cause-you-to-sin-11696/
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Forgetting Abuse? Some thoughts on motivated forgetting
Could someone really forget something as horrifying as a rape or sexual abuse? How come some people say they never stop reliving a bad experience while others say they have forgotten and cannot remember what happened? How do we best understand these two, seemingly, opposing reactions?
In a previous post I began a short series on the controversies of repressed and recovered memories. In that post I made a few general comments about the nature of memory. It isn’t a particular structure or substance or even stored as one discrete movie but rather is a whole brain process connected to context, mood, and self/other-perception. Memories do not exist outside of narrative or story (unfortunately for those with traumatic histories, these narratives are usually quite jumbled up making it difficult to tell the story well). In general, stories help us remember and remembering tells a story.
In this post I want to address the matter of forgetting abuse. Is it possible? The short answer is yes. Common to forget all of it? No. Common to forget portions? Yes. And even more common to have the experience of a new memory even without ever having forgotten the abuse (this I will address in the next post). It is possible to forget, to no longer have access to one’s own history. But, the bigger question is “how” and “why” rather than “if”.
Complicating factors
Laboratory studies re: memory cannot replicate the experience of sexual abuse or trauma. Thus, we have some rather weak experiments or post hoc, retrospective studies. What these studies point to is that (a) most people don’t forget entire episodes, (b) some forgetting does happen, and (c) some confabulation or memory error also happens (e.g., eye-witness accounts are more frail than we imagine them to be). But even when we get a good study, we find it hard to apply the information to real life. For example, one retrospective study located a number of child abuse victims decades after their ER visit to a hospital. A goodly number denied ever having been abused. While the study could reveal some form of forgetting, we might also be witnessing lying and/or alternative interpretations.
So, we have to admit at the outset we have a large supply of anecdotes of full forgetting, partial forgetting, and no forgetting, and an equally large supply theories and explanations based in part on experience and low power correlational studies. Now, anecdotes and poorly supported theories aren’t reasons to doubt the reality of forgetting trauma (or the reality of false recovered memories). They are, however, good reminders to be wary of applying some general knowledge as complete answer to any specific case. Each case of forgetting trauma needs to be evaluated on its own merits (more on this when I get to a post on clinical/practical interventions).
One more complication. Adults who reveal child sexual abuse experiences rarely have any corroborating witnesses or forensic evidence. They have their memories and that is about it. Families, offenders, and communities have much to lose to admit such abuse could have happened. Thus, outside therapeutic environments, adults have few opportunities to be heard or believed.
By what mechanism do we forget traumatic experiences
“Normal” forgetting happens in a variety of ways. Each of these may be a partial answer as to why someone might forget something very powerful.
- Distraction leading to failure to encode. If you are introduced to someone and immediately forget their name (happens to me ALL the time), it is because the information never got encoded (too distracted by preparing to say my own name??). Distractions may come in the form of attending to something very specific or not attending to anything at all. Some victims of abuse report that their memories are fuzzy because they could only focus on the flower pattern on the wall during the actual abuse.
- Other memory intrusion. A previous memory may interfere with the clear encoding of a new memory or a new memory may interfere with the recall of an old memory. Victims of extended abuse often report difficulty in remembering when it started and stopped, who was present, etc., especially when the perpetrator also provided more normal love and attention. The memories (and their competing narratives) make it hard to remember.
- Motivated Forgetting. I like but hesitate to use this term. “Motivated” could sound like “willful” or “intentional.” And while some motivated forgetting is intentional, most just happens outside the conscious experience of the one doing the forgetting. If I have a conflict with my wife and I spend the next 5 hours rehearsing her supposed sins against me, I may have difficulty recalling my own misuse of words. I may not consciously say to myself, “I am going to do this so I won’t be able to remember my angry words to her,” but I am engaging in what I call “motivated forgetting.” Obviously, abuse victims would rather NOT remember what happened to them and would rather maintain a positive view of a loved one who did the abuse. Victims may encourage motivated forgetting through several means (again, without conscious decision): repeating a false narrative (“He didn’t mean to do that and I am at fault.”) created by themselves or others, using conscious decision not to think about an event, dissociating during abuse and then dissociating when not being abused, focusing on another possible threat.
Now, these forms of forgetting may not sound like they would lead to the complete forgetting of an event. And that would be true for the vast majority of abuse victims. But, I think we need to remember that it is possible given enough anecdotes of some who recover memories (apart from suggestion by therapist or others) on their own and that do get corroborated by others. Is it common? No. Can mental health professionals cause false memories? Yes (but that is for another post in this series!).
So, why do some remember minute details of trauma? They rehearse them (whether they want to or not). Why do some forget them? Their memories degrade due to forms of memory loss discussed above. Other factors are also likely: natural capacity to dissociate, age/development of victim, culture where abuse took place (e.g., a one-time event in a rather safe environment will have a different impact than repeated experiences where safety has never been present).
In my next post I want to take a few minutes to discuss dissociation, repression, and the experience of re-remembering child abuse later in life.
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Of Babies and Bath Water: Navigating the Controversies of Repressed and Recovered Memory
Recently I ran a conference about abuse within the church. In these kinds of venues (this blog and conferences) I am asked about a couple of related problems—the problem of false memories of abuse and the reliability of recovered memories of abuse.
While I intend to address these matters here (and in future blogs), I want to reiterate something that I think gets lost in most conversations about recovered and/or false memories.
Sexual abuse is real. The vast majority of adult reporters of abuse during childhood never forgot the details.
Why say this first? Discussions of rare and extreme cases (i.e., repressed memories, recovered memories, and false memories) tends to create undue suspicion for all adults who choose to reveal their child abuse later in life. It is my experiences that conversations about false memories or recovered memories lead many to assume that a report of extensive or horrific abuse is probably false. So, let us remember that as we take up the matter of fully repressed memories of abuse, we are talking about a very small percentage of people.
But, the issue of repressed and/or recovered memories and the construction of false memories is indeed worthy of a careful review given the strong feelings on both sides of the recovered memory debate. In order to be as careful as possible, I want to consider a few topics that may help us understand the issue. First, I will explore foundational topics (memory, forgetting, repression, and dissociation). Then, I’ll explore the how trauma is known to create confusion, self-doubt, and “motivated” forgetting. Finally, we’ll take up the practice of counseling victims of sexual abuse and the particular matter of dealing with memory retrieval in counseling. Strap in!
Just in case you NEED to know my opinion at the outset…
I find Partlett and Nurcombe’s 1998 summary of an APA report on the topic to be fairly comprehensive,
The plain point here is the consensus set forth by the Working Group:
1. Controversies regarding adult recollections should not be allowed to obscure the fact that child sexual abuse is a complex and pervasive problem in America that has historically gone unacknowledged.
2. Most people who were sexually abused as children remember all or part of what happened to them.
3. It is possible for memories of abuse that have been forgotten for a long time to be remembered.
4. It is also possible to construct convincing pseudomemories for events that never occurred.
5. There are gaps in our knowledge about the processes that lead to accurate and inaccurate recollections of childhood abuse.[1]
I would add one more point: most people (myself included) in this debate are motivated by strong feelings as well as “facts.” These feelings may be the result of experiences with those who appear to be abused or appear to be falsely accused.
Issue one: Memory and Memory Retrieval
Let me start by stating the obvious: this isn’t a neuropsychology primer on memory and I am not an expert in memory. However, there are a few things on which I think we can agree:
- memory is a whole brain biochemical process. While structures like the hippocampus are clearly involved in memory storage, no one structure handles all aspects of memory storage or recall.
- memory is multi-faceted. Researchers differentiate between recognition and recall memory, explicit and implicit memory, short-term, long-term, and working memories…and much more.
- memory-making is a process. The formation of memory requires attention, perception, encoding, storage, and retrieval. Thomas Insel calls it a 5 act play. A person moves from perception to long-term encoding to retrieval and finally, expression of memory.
- relational and affective context influences memory formation and memory retrieval
- the act of recall may change memory,
The concept is simple: memories are not fixed; they are periodically retrieved, and modified each time they are retrieved. This process of strengthening a memory by retrieval is called reconsolidation. One profound implication of this concept is that what you recall is not only a reflection of what you first learned, but also a product of each time you have recalled the original information.
How does this relate to our issue of recall of abuse?
- memories are both fragile and yet not so. You recall what the house you grew up in looks like, even if you haven’t seen it in 30 years. And yet, your recall may or may not be particularly accurate. You may remember a large house even when it is much smaller to your adult eyes.
- repetitive recall along with high levels of emotion may solidify memory. Most of us know exactly where we were on the morning of September 11, 2001. You remember this because you talked about it, played it over in your mind, and because of the powerful biochemical process kicked off when you heard of the first plane crashing into the twin towers.
- Most child sexual abuse has little corroborating evidence, especially when revealed decades later. This leaves victims by themselves to sort through the narratives they and others tell about their history. The result? Ample opportunities for both denials of actual abuse as well as false memory.
Return with me to my first point. Most child sexual abuse is never fully forgotten. Some memories may be lost, others distorted, still others intentionally forgotten. Memory, as we have seen here is not a structure but a narrative.[2] In most cases, the story being told has much merit, even if some important details are perceived rightly. Thus memory retrieval during therapy (something that WILL happen whether therapist or client wants it) plays a powerful role in the re-storying work of therapy.
In my next post on this topic, I will make some comments about forgetting, motivated forgetting, dissociation, and repression.
[1] Partlett, DF & Nurcombe, B (1998). Recovered memories of child sexual abuse and liability: Society, science, and the law in comparative study. Psychology, Public Policy, and Law, 4, p. 1273
[2] “Rememberings—whether valid or invalid—are communicated by means of narratives.” Sarbin, TR (1998). The social construction of truth. Journal of Theoretical and Philosophical Psychology, 18, p. 145.
Musings on Faith and Psychology 