Category Archives: christian psychology

August 15, 2012 · 8:12 am

The Cost of Reconciliation: Adding Insult to Injury

It is time to get back into the swing of writing again. Regular readers will note I have take a vacation from blogging. During my time off I have enjoyed reading about Powell’s trip down the Colorado River, a couple of books about the DRC, and a counseling book which I plan to review this fall.

But, before I start my own writing, I want to draw your attention to this short post on reconciliation. I have just one added note to this post. The choice of becoming vulnerable must always be made by the victim. Any forced reconciliation continues the abuse and is false through and through.

The Cost of Reconciliation: Adding Insult to Injury.

What do you think?

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Filed under Abuse, christian counseling, christian psychology, Psychology

Tagged as reconciliation

July 26, 2012 · 9:59 am

What is therapeutic presence?

If you go to a counselor, you’d probably prefer that person to be awake versus asleep, to pay attention to you versus check their smart phone, to respond to what you are talking about versus make non sequitur responses. As I’ve noted here before, it is probably better to have a counselor who cares about you than one who has a big bag of techniques–though most of us would prefer our counselors to care AND be competent.

Therapeutic presence is a way of talking about the act of being with our clients in such a way as to build safe, trust-filled relationships where clients can grow and change. I think most people can easily identify failures of therapeutic presence. Try these on for fun:

CLIENT: I’m just so depressed.

THERAPIST: You think you are depressed? Let me tell you about depression. I have a client who just lost job, family, church, home. Now, that is something to be depressed about. You just had a bad day, that’s all.

Or,

CLIENT: I don’t understand why God would take away this job from me.

THERAPIST: Well, theologically speaking, God does things for all sorts of reasons. He sometimes does this to cause us to trust him more, to reveal some sin, to give him glory.

Notice how both responses fail miserably to be either therapeutic or present with the person in the moment of counseling. Not hard to miss, right? So here’s a question: Why do so many of us counselors, even seasoned ones at that, fail the “presence” test?

My answer? When we fail to be present in helpful ways, it reveals a lack of preparation and a lack of attention to purpose.

Shari Geller and Leslie Greenberg (in Therapeutic Presence: A Mindful Approach to Effective Therapy. APA, 2012) define the building blocks of therapeutic presence as

how therapists prepare for being present (in personal life and in session)
the process (or therapist activities) of being present (aka purposing to be present)
the experience of being present

Sound like mumbo-jumbo? Here’s another way of putting it. What does a counselor need to do to be ready to be in tune with their clients? What do they do to stay in tune when with clients, and are they aware of when they are failing to be in tune? (If I am unaware, then I am likely to get out of tune.)

Here are some things counselors ought to be asking themselves:

Do I have adequate space to move from my private life to being present with my clients? Do I have enough space between clients? The answer is not always an amount of time, but what we do during the space between.
As I prepare for sessions, what am I meditating and praying about? For example, if I pray for clients to be free from something that has them bound up, I could accidentally encourage myself to push for change or to talk about a subject that the client is not able or ready to talk about. I’m all for praying for healing. I just think we have other prayers to pray as well. “Lord, help me to be with the client today and not focused on my own personal goals for them.”
Am I staying present with their mood, their cognitions, their silences in such a way that it is as easy to talk about what is happening in the session as it is to talk about what happened in the past or might happen in the future?
When I sense a disconnect, am I quick to invite dialogue and learn (vs. avoid or defend/explain away)?

Therapeutic presence isn’t everything. I could be present with someone and no healing might take place. But without therapeutic presence, I will only be a barrier to whatever growth is taking place. When I do it well, I imagine that I might see just a tiny glimpse of how Jesus was with the woman caught in adultery, the Samaritan woman, or with Peter after he had abandoned Jesus.

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Filed under biblical counseling, christian counseling, christian psychology, Christianity, counseling, counseling skills, Psychology, Uncategorized

Tagged as christian counseling, mental health, Psychology, psychotherapy, Relationships, therapy

July 17, 2012 · 12:28 pm

Guest Post at Society for Christian Psychology

www.christianpsych.org, the on-line home for the Society for Christian Psychology has posted a recent post of my own on their site and newsletter. You can find it here. Check out the rest of their site to find great full-length articles and journals. The Society is a division of AACC.

2 reasons why finding the root problem may not be a good goal for counselors

How important is it for a counselor to diagnose the client’s root problem? Consider these analogies:

Imagine being diagnosed with cancer in one part of your body but having your doctor tell you that it isn’t important to discover whether the source of that cancer lies elsewhere. You wouldn’t be happy and you would likely seek another opinion. Or, consider this analogy: you keep cutting off the tops of dandelions only to find that they keep coming back. Not a very wise decision. Instead, you find the tap-root and remove it if you really want to stop the weed from growing.

In the last week I have had three conversations about identifying the source or primary cause of someone’s emotional struggle. In each case I was asked questions about the source of the problem.

Is it a chemical imbalance? Is it the result of childhood trauma? Is the primary problem his sin?

I understand these questions. They are reasonable and important to ask. As a counselor, I am trying to assess how a particular psychological problem develops in an individual. But, maybe these questions aren’t as helpful as they first appear. Here are two reasons why we ought not put too much stock into seeking out the root problem and a suggestion for a different approach than the “why” question.

“Why” questions almost always lead to a simplistic/categorical answer. Most psychological (or spiritual) problems have multi-factored roots. There are biological predispositions, experiences, behavioral choices/habits, perceptions, beliefs, etc. all working together to “allow” the problem to develop. Usually, we do not find this kind of complexity very helpful. We like to narrow things down to single or primary problems. Narrowing down to either/or categories helps us “understand” the problem and exert energy towards a single solution. However, when we demand a primary cause, we will almost always misrepresent the problem and may communicate to others a distorted image of what is taking place. Saying that a psychological problem is the result of sin or neurochemicals or family upbringing ALWAYS flattens the problem and as a result puts too much hope in any intervention.
“Why” rarely leads to the most important question, “so, now what?” Let’s say that we can figure out why you struggle with Obsessive-Compulsive Disorder (OCD). Your mother contracted a virus during the 7th month of her pregnancy and that virus altered your prenatal brain and caused your OCD. Okay…so now what? Notice how the why question provides interesting information and possibly helpful in eliminating the problem in future expecting mothers…but as enticing as it is, the diagnosis doesn’t help much with the, “so now what do I do about it.” In fact the desire to figure out the “why” never is as clear and easy as I have just made it in the virus example and so the search for “why” doesn’t lead to the “so now what” question at all. Now, I don’t want you to think that I care little for historical data gathering. The multifactorial etiology of our problems are worth exploring. We ought to take a look at how early childhood experiences shape our current behavior. We ought to explore the possibility of a biological predisposition to our anxiety. We ought to examine how our beliefs about self, other, and God influence our current problems. However, we explore these historical facets not because they answer the “why” question but because they help us understand “how” we function and whether we want to alter some of these shaping influences.

An Alternative Approach?

I’ve just tipped my hand in the last point. How is a better question. Finding out how a particular feature (belief, habit, experience, perception, biological process, etc.) influences current life and how a person might respond to or engage differently over a problematic emotional expression is more likely to bear good fruit. Consider these examples:

How does your history with pornography and secret shame influence your seeking accountability from your other men in the church?
How do you react to trauma triggers and what different responses to triggers might you want to practice?
How do you want to think about or assess your unwanted sexual desires and feelings?

So, asking why we do what we do or why we are the way we are is interesting but not always the most helpful question from a counselor. Instead, explore your perceptions, reactions, thoughts about what is happening and explore how you might come to feel, think, or engage the problem from a different perspective or with a different goal in mind.

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Filed under christian counseling, christian psychology, Christianity, counseling, counseling skills, Uncategorized

Tagged as Diagnosis, Mental disorder, mental health

May 5, 2012 · 8:15 am

Do your labels help or hurt?

I have a post over at the Seminary’s faculty blog today. You can find it here.

Counselors label all the time. Even when we don’t offer official DSM diagnoses, we label things as good, bad, healthy, unhealthy, dysfunctional, sinful, etc. The key question counselors face is WHEN and HOW to share their views on a subject. Just because we can see something is wrong doesn’t mean we ought to share it yet. While you may wish your family doctor to share suspicions of Lyme’s disease with you on the first visit, your counselor may need to earn the right to say, “I think you have become embittered over your husband’s insensitivity.”

If you are in a position of authority (parent, teacher, boss, counselor, leader, etc.) consider how quickly you use labels and whether or not they invite dialogue and action. If the result of our labeling is increased passivity in the one being labeled, then maybe we need to consider that our labeling is part of the problem.

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Filed under biblical counseling, christian counseling, christian psychology, counseling, counseling skills, Psychology

Tagged as Christianity, Diagnosis

April 16, 2012 · 10:48 am

In Counseling, Who is the Teacher?

Most counselors and therapists get into the field of counseling because they want to help people. This is a good thing! Imagine if they only wanted to make money or to be the center of attention. But, underneath the goal of wanting to help people lurks an insidious goal:

being seen as wise.

Being seen as wise (notice the difference between being wise and being seen as wise) tempts us to become the teacher, the teller, the obnoxious sage. Teaching, telling, training are all activities that may happen in counseling, but only when necessary. Truth be told, we counselors resort to teaching and telling because it gives us a job to do and makes us feel good. This is especially true when we work with the most severely traumatized people. Here someone is hurting in front of us. We can see that they are stuck. Who wouldn’t want to pull them out of the mud? Now, there may well be important teaching moments–gently instructing someone on the symptoms of trauma and/or the physiology of trauma. This might be important for the client who believes that the symptoms are really signs they are sinning and that they can just choose to stop being triggered.

In Counseling, Who is the Teacher?

“The patient is the ultimate teacher about trauma, and a good therapist is a good listener.” (Boskailo, p. 81)

While the counselor has much to offer in regard to teaching, training, and goal setting, we must remember that the client is the one teaching us about their trauma experiences and how much they can deal with at a given time. For example, Boskailo reminds us (see above link for book) that while telling the trauma story is an important part of the healing process, the “how” of telling (and the “how much”) is something each client will need to teach us. One client may need to tell and re-tell the same story each week. Another may be better helped by drawing. Still another may tell once and never again.

We counselors are the student in these kinds of matters. It is our job to listen well and learn well!

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Tagged as christian counseling, christian psychology, Christianity, Counseling psychology, mental health, Posttraumatic stress disorder, Psychology, psychotherapy, trauma

April 10, 2012 · 12:21 pm

Invite your pastor (or key leader) to attend our “abuse in the church” conference, July 20-21 2012

church should be the safest place in the world! Unfortunately, it isn’t always. Even worse, when abuse does happen, the church may not always protect the victims. While this shouldn’t surprise us since the church is full of sinners, we ought always to be working to make it a place free from abuse. Is your church working to protect the congregants from abuse? Is it ready to respond to an abuse allegation?

This summer I will be co-teaching with Boz Tchividjian (Liberty Law School prof and former prosecutor) a weekend course/conference on preventing and responding to abuse in the church. We are inviting church leaders to join our MDiv and counseling students at Branch Creek Church, Harleysville, PA. The class will run Friday night, July 20 and all day Saturday, July 21, 2012. All the details you need can be found on this Abuse Course Flyer.

Would you consider personally inviting your pastor or church leader by passing on this brochure?

For non-student registrations, click here. If you want to see a syllabus, click here.

Ethics violations: Why we all think we won’t screw up…and one thing you need to protect yourself from you

Every counselor, social worker, psychologist, and other mental health workers get professional ethics education. Such training is designed to teach us to “do no harm.” What mental health professional gets into the field to do harm? We all believe we are going to work for the betterment of our clients.

So, why do we sometimes fail to act in accord with good professional ethics?

Rarely is it because we don’t know the rules. Consider the most recent issue of the APA Monitor on Psychology and the short ethics piece by Alan Tjeltveit (a colleague of mine and fellow CAPS member) and Michael Gottlieb. (You can read the electronic version here; turn to page 68.) In it, the authors nail the reason why with this quote,

Too many professionals complete their training without the emotional education and awareness needed to avoid self-deception and to act in the prudent, considered manner that society expects and that represents professional ethical excellence. (p. 72)

Self deception

We fail to take a skeptical (note…not fearful) stance toward our own thoughts, feelings, and attitudes. Since we know we are going to work for the good of others we often stop considering that some other values that we hold might get in the way. For example, I might value avoiding conflict and so not address a safety concern with my client for fear they will get angry with me. Or, as the authors of the article point out, I might practice when I am too distressed to help others–because I believe I can still manage the situation (see page. 70).

The One Protection You Most Need

As necessary as it is to keep taking ethics updates from continuing education providers, it is even more important to have a close colleague who doesn’t take you too seriously and is willing to ask the hard questions. Yes, we need an operating sense of values. We need to be tuned to our conscience. We need the Holy Spirit’s help in loving our neighbor as ourself. But, more importantly, we need to stop trusting in our own judgment and acknowledge that hidden values sometimes operate more powerfully than we expect. Desires to be liked, to avoid conflict, to maintain power, to satisfy longings have ways of creeping in. One of the reasons God puts us in community is that we need others to speak into our lives.

Do you want to avoid ethical missteps? Who exists in your life who has the access and capacity to speak into your life; to ask questions others might not think to ask?

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Filed under Abuse, christian counseling, christian psychology, counseling, counseling science, counseling skills, ethics, Uncategorized

Tagged as continuing education, ethics, mental health, Mental health professional

March 28, 2012 · 3:13 pm

Global Trauma Recovery Institute Launched! Dr. Langberg Joins Biblical Faculty

American Bible Society (Photo credit: Wikipedia)

It is my pleasure to announce that I and Biblical Seminary are the recipient of a sizeable grant to launch our new Global Trauma Recovery Institute–training for lay and professional recovery experts in the US and around the world. The grant (from an anonymous donor and the American Bible Society) funds the Seminary’s collaborative program with ABS to provide deeper training for those active in both trauma recovery efforts in the US or in training local facilitators in east/central Africa.

Why collaborate with a bible society?

ABS is involved in a trauma healing/scripture engagement project, focused in Africa but with other works going on around the world. This project has been under the work of ABS’ She’s My Sister initiative in the Congo. The bible societies were founded on bringing scripture to bear on the current issues of the time–specifically slavery. So, it make sense that ABS is interested in helping traumatized individuals recover from wounds by showing how God cares and is active in their recovery. Through connections with a few of my students, I and Diane Langberg have become co-chairs of the advisory council to the above-named initiative.

What does this mean for Biblical?

The generous grant will enable Biblical to do the following

Commission a research study of the psycho-social impact of trauma in the African context
- in collaboration with Wheaton College’s Humanitarian Disaster Institute
- WHY? We need better understanding of the scope of the problem and what locally led interventions will be the most effective (both in terms of success and sustainability)
Develop introductory and advanced global trauma recovery courses that enable MA and postgraduate students to develop specialization in training local trauma recovery facilitators here and around the world
- These courses will be delivered in a hybrid format starting late 2012; delivered in hybrid system (on-line and in-person)
- Mental health continuing education credit will be possible
A hands-on practical experience under the direction myself and Dr. Langberg will be the capstone experience for students who complete the entire training
- Likely 2013 in an African context
A website providing free and homestudy CE materials for those unable to come to the Philadelphia area
Consultation groups formed for those seeking help with cases and projects in domestic and international trauma recovery

How is Dr. Langberg involved?

Dr. Diane Langberg is the leading Christian psychologist with expertise in trauma recovery. Her teaching has taken her to South America, the Caribbean, Africa, Asia, and Europe. Her books on sexual abuse remain popular with both clinicians and victims. She joins Biblical Seminary as a Clinical Faculty member (clinical faculty are practitioners who also lecture and train) and will have a leadership role in the shaping and delivery of the curriculum and trainings. It is safe to say that the counseling department has been most influenced by Dr. Langberg’s training and supervision.

How can I find out about these courses and consultation groups?

Until we launch the institute website, the best way to keep yourself informed is to do one of the following: subscribe to this blog where I will be posting updates; keep checking with www.biblical.edu for more information, or email me at pmonroeATbiblicalDOTedu and I will put your name on a growing list of those who want to be on our mailing list.

Helping that hurts?

Cover of "When Helping Hurts: Alleviating...

Cover via Amazon

At the recent PCA mercy conference, I attended Steve Corbett’s seminar on rethinking benevolence practices. If you are unfamiliar with Steve, if you are involved in mercy or diaconal ministries, you absolutely should read his book, When Helping Hurts: Alleviating Poverty without Hurting the Poor. Or, go to this site if you want to know more about asset-based benevolence and the Chalmers Institute. The book and site will give you a clearer view of different kinds of poverty (material, being, purpose), the important distinctions between relief work, rehabilitation, and development work (and why pure relief may not be all that helpful outside of very immediate crises). What I found most helpful was his differentiation between need-based development (tends to focus on what is missing and outside resources can help) and asset-based development (which focuses more on existing assets that can be mobilized…and thus likely to be more sustainable).

Counseling that hurts?

We kindly Christians care about the world and about emotional, spiritual, cultural, and economic poverty. We want to help. Counselors want to help. It is necessary to review whether the help we offer is really all that helpful in moving individuals from passivity to activity. One of the hardest things to do in benevolence and counseling is to recognize when you are working harder than the one you are trying to help–and to then stop without withdrawing emotional support. For example, you counsel a person who is stuck in an abusive marriage. You so much want to help that person get to safety. But note several problematic responses

Coerce. Even though what you want (safety) is good, forcing someone to safety from a violent spouse is merely replicating abuse. Yes, paternalism and control, even when done for a good cause, merely replicates inappropriate authority in the life of another adult.
Ascribe motivation. When we get frustrated, we may desire to apply motives to the person.She doesn’t want to get out. She isn’t willing.In fact, it may be that she if afraid and cannot imagine a future outside of her current difficulty.
Reject. There are times when we have to walk away from a counselee. However, even when we do so, we ought to communicate an open invitation for help in the future from ourselves or someone else. We are not God. We do not make final judgments.

One of the most important things to remember is that even if a person rejects our advice, we are still offering help. We are giving them opportunity to consider a new way of thinking. We are helping them weigh pros and cons. We are one safe place. If they reject our help, we will be sad. But we ought not feel guilty.