Category Archives: counseling science

February 3, 2009 · 11:31 am

Improving Case Conceptualization?


For my counselor readers: What books or other helps have you encountered that improved your ability to conceptualize cases?

When we teach counseling skills we do the following (we do more than this but this is the general trajectory):

  1. Build basic helping/counseling skills (if you can’t connect with a person and build a trusting relationship, any knowledge you might have will be useless!)
  2. Expose students to a wide variety of problems (so they can understand and describe common problems in living or common pathologies–even if they are not sure of the causes of these problems)
  3. Explore human growth and development from a descriptive and biblical viewpoint (this at the same time as #2 so that they learn about common problems  and sufferings as well as what healthy and Godward lives look like in a fallen world)
  4. Teach case conceptualization (marrying client information (e.g., background info, presenting problems, attempts to solve the problems, etc.) with theoretical understanding of the person/problem/desired outcome.
  5. Build intervention repertoire during fieldwork.

#4 is the hardest, especially in a generalist program that doesn’t spend a great deal of time on theoretical models (we teach models as part of every course and our model of Christian psychology (biblical anthropology along with process oriented model) isn’t as defined as the old models (e.g., Rogers, Freud, etc.).

If you were teaching counseling to practicum students who needed help with conceptualizing cases, what resources would you turn to?

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January 13, 2009 · 5:38 am

Does “Zero Tolerance” work?


The December 2008 edition of the American Psychologist takes up this question when their task force on the matter publishes the article, “Are zero tolerance policies effective in the schools? An evidentiary review and recommendations (pp 852-862).

What did they find?

1. “…despite a 20-year history of implementation, there are surprisingly few data that could directly test the assumptions. Moreover, zero tolerance policies may negatively affect the relationship of education with juvenile justice and appear to conflict to some degree with current best knowledge concerning adolescent development.” (abstract, p. 852)
2. Zero tolerance is based on several assumptions that the authors found wanting

a. school violence is at a crisis level and increasing still. No (is this because of the policies?)
b. Zero tolerance increases consistency of discipline and sends a clear message. Not found in the data.
c. Removal of violent children will create a better climate for those who remain. Data suggests the opposite, schools with higher suspension rates have lower climate ratings.
d. Swift punishment is a deterrent. Not borne out in the data. Opposite may be.
e. Parents are overwhelmingly in favor of the policy. Mixed data here at best, depending on whether your child is a victim or offender.

3. Impact on minority and disabled children? The assumption was the zero tolerance wouldn’t be a respecter of persons. Data suggests disproportionate discipline of students of color not based on poverty or wealth. The suspicion is that teachers may need some help breaking down cultural stereotypes.

There’s a lot more in the article but I’ll stop here. Interestingly, the policy was created to be more fair across the board. The article suggests more wise implementation with more options for psychological care (no surprise there) rather than immediately going to the juvenile justice route. Either way, the problem has to do with wisdom. If you give administration options (akin to Judges discretion with repeat offenders) some will use it well, others not so much. If you make rules, they work well in decisions IF making the decision the same way every time is the goal. But of course, no one really wants that since wisdom dictates different responses. But then underlying prejudices will come back into play. However, it appears the policy doesn’t really address prejudice and stereotype anyway.

Is there a better solution?

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January 7, 2009 · 4:49 am

Psychology for the (Christian) Masses


So, the other night I had woke up with thistitle in my head that I couldn’t get it out of my mind. Its an academic’s kind of dream/wake state–a book idea. I wondering if you have ideas to flesh this out a bit after reading some of mine.

The title came, I think, as a result of a Miroslav Volf’s comment that consumerism, not religion, was the opiate of the people. Lightbearer provided us with the context of Karl Marx’s quote. And many of summarize his point but saying that something (religion, psychology, anything) is for “the masses.”

So, I got to thinking about the tendency among evangelicals to fall into one of two trap about psychology. Either they use it unthinkingly (cut and paste bible verses on theories without much thought) OR they reject it because psychology is unbiblical and only rank secular humanism. But, I can’t tell you the amount of conversations I’ve had about the benefits of psychological study–whether about medication, therapeutic interventions, professional ethics, etc. where it was clear that few had ever drilled down below pop psychology to understand both its value and presuppositional foundation.

So, here’s my thought. What if we developed a resource for Christians to come to that would give thoughtful, sometimes lighthearted, but always honest answers (and nonanswers when they are better) about psychology, psychotherapy, medications, psychological testing, etc.

Here’s some of the questions that tend to come up most frequently (from my memory of the last 2 months)

1. Is it wrong to take psychiatric medications for my depression? Shouldn’t I be able to either handle it or get over it using spiritual resources?

2. How do you know if the problem is demonic or psychiatric?

3. Should I ever go see a secular therapist?

4. Isn’t Mindfulness really just a Buddhist form of meditation?

5. Should I go for healing prayer for my mental health problem?

6. Isn’t ADD/ADHD just a fad?

7. Can I divorce my spouse because they refuse treatment?

8. Can pedophiles ever return to the church in a safe manner?

9. Can leaders who abuse their roles ever be restored to leadership?

I’m sure there are more. What else would YOU want to read about regarding psychology/psychotherapy from a christian perspective?   

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November 12, 2008 · 5:06 am

Ideas don’t change people…


Trying to find intellectual ways of saying something I believe is rather simple (for an academic paper I am to deliver):

Ideas don’t change you, stories do.

Was reading an unpublished OT theology paper and the author mentioned the shift in approach to truth, from the Hebraic story to the Platonic “idea” or concept. Truth is best embodied in experience and yet we idolize systematizing truth.

How many of you turned to Christianity because of its great concepts or because someone convinced you of a truth by force of logic? How many because you had an experience that changed your perspective?

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September 19, 2008 · 5:01 pm

Overheard at the Society for Christian Psychology


In Chicago for the annual conference for the Society for Christian Psychology. My head is full. Good conversations with colleagues from different parts of the country. This is a unique opportunity to have philosophers, theologians, and counselors talking together about Scripture and counseling.

I’ll blog more about this but Kevin Vanhoozer, a theologian from TEDS, gave two talks about counseling as acting into the theodrama of Scripture. He likened the playwright as God, the Holy Spirit as the director, the theologian as the dramaturg (a person who is to research the history of the play, give rich detail about its meaning, etc.), and the counselor as the acting coach.

Nice imagery I think.

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September 3, 2008 · 1:15 pm

Biblical Counseling is too focused on big truth?


Haven’t had much time to write of late since the pressure is on for more formal writing assignments. But, in prep for a presentation in a few weeks I have been thinking about this question. Is the biblical counseling model of change too much focused on truth? Heretical thought for some I’m sure. (For those who don’t remember I consider myself both a biblical counseling and a Christian psychologist).

Let me start with some shoddy diagrams of two classic models of change.

1. Presenting problem –>Diagnosis Made–>Counselor generated insight (reality/truth) –> Corrective action (counseling as troubleshooting ways to cement corrective action outside of session). Counseling in this model focuses on truth/reality applied to counselees life outside of session. Benefit? Problem/solution focused; objective change. Drawback? Feelings and Relational activity is minimized (though not denied). The relationship is used to get to the activity of change.

2. Presenting problem  –> Diagnosis Made (but may not be told) –>Counselor generated insight (NOT given) –>Introspection via counselor generated questions. Counseling in this model focuses on introspection and counselee generated insight. Benefit? No pressure to perform, feelings encouraged. Drawback? No real relationship focus as it is purely 1 way. No focus on objective change (assumed it will naturally happen).

So, model one is more cognitive. Model two is more dynamic. Both models want or respect the valuate of relationship but usually see it as a necessity to get to what really heals (truth or insight).

The biblical model is most like model one. In many respects, the focus on truth is good. We fallen creatures need constant reorientation. We are easily deceived. And yet, which truth? Notice Jesus with the woman at the well (John 4). He doesn’t start out with the biggest truth (she’s an adulterer). Notice that we often need more immediate truthes to be the focus. Peter needs the hand as he sinks, not a lecture. David needs Nathan’s story first. We learn that God doesn’t tell us all our sins right off the bat. We couldn’t take it. Do we in the biblical counseling world over-focus on the big truths of faith, trust, sin, idolatry, etc. that we miss the “smaller” truths that God is with us, that his hand is present right now in some small tangible way?

So, how about this model for change that is both solution focused AND interpersonal.

Presenting Problem –>Collaborative Diagnosis/Goal setting –> *[empathy ->validation ->here/now ->collaboration on meeting goals/objectives and responding to thoughts, feelings, behaviors] –> small habit change attempts –> post hoc insight.

In this model the primary work is in the interpersonal dynamics (the stuff in the brackets) and insight is more what happens after change takes place: “Oh, that’s what I was thinking then and this other way helped me to change that.” If this alternative model is a bit more accurate in portraying how people actually do change via God’s grace then this is my big question: how might this model change how we use the Scriptures in counseling.

Make any sense?  If anyone has artistic capability to render these diagrams I’d love to see how you’d do them.

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August 5, 2008 · 5:34 am

Like a kid in a candy shop


I got two books in the last week that are like candy for me:

1. A Year with CS Lewis (Zondervan). My friend John Freeman gave it to me as a gift. Daily readings from Lewis. Can’t wait to get started on it.

2. Clinical Supervision: A competency-based approach. Yes, really, I’m excited by this. Saw a copy at my friend Mike Emlet’s office and had to get my own. This book has great assessments for both supervisees and supervisors. One of the most important parts of counseling training is the supervision. And many times it is the weakest since many do not know how to supervise well. I’m hoping to get some good ideas from this to help our students make the most out of their internships.

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June 23, 2008 · 1:00 pm

Last Practicum Monday: Christian counselors in a secular world


Today marks the end of the 2007-8 school year for our MA Counseling students. Some have completed their final credits and others are half-way to their diplomas but I’m sure all are glad the school year is over.

Our students here do fieldwork in a variety of settings: churches, christian private practices, nonprofit social services (hospice, pregnancy centers), and secular or state/federal financed mental health facilities. Those who work in secular settings are often faced with questions about their faith from colleagues and supervisors. Are they going to try to get their clients saved? Will they leave their faith at the door? And students struggle to know what to do with helping clients in some ways (new communication skills) but not being able to help them in deeper ways (putting trust in God during difficult times). Just how should Christians working in secular mental health agencies function? 

First, I very much believe that Christians should be in all aspects of society if they have any hopes of being salt and light in the world. Far too frequently we sequester ourselves from the world and then wonder why they persist in using caricatures of us.

So, if we are going to be in the world but not of it, how might we do it as counselors in a secular setting? I suggest 3 things to consider as we interact with supervisors/colleagues, clients, and our own self:

1. When dealing with an  Agency/Supervisor/Colleague

  • Get to know your context and its/their history with Christians and Christianity
  • When you hear slams or other suspicious questions be sure to explore the “back story” and validate, if appropriate, the bad experiences with naive or offensive behaviors by Christians
  • Discern who you might be able to have a reasonable conversation with regarding the nature of faith and psychology, philosophy of science, ethical care of people (including the exploration of their faith traditions), and the fact that all counseling is evangelistic to some construct of health). In this conversation be sure to using starting points that the other will understand (e.g., ethics, empirical evidence, concerns, etc.) just as St. Paul does at the Areopagus.
  • Communicate that you do not see your job as coercing anyone. You are not responsible for our clients behavior, neither are we for their beliefs. When we raise questions about faith it is to provoke their thinking a bit further

2. When dealing with clients

  • Be sure to ask early in clinical work about faith traditions, current practices, and experiences. These questions fit with what the AMA suggest as important for healing, as community and spiritual resources are quite powerful in the medical literature
  • When given an opening (e.g., questions about God, faith, etc.) pursue gently NOT with statements but questions that may reveal further beliefs, fears, wants, desires, demands, etc.
  • Further, ask how they came to believe what they do believe
  • Point out inconsistencies in belief/behavior; raise possibilities, pros/cons, potential places for hope that may lead to further discussion of God’s handiwork in their lives; Point out places where they seem to recognize their inability to love enough, tolerate enough (gently of course)
  • Be wary of the habit of “telling” others the truth. Many times clients already know the “right” answer. Exhortations may be useful at times but more often than not they cause individuals to become passive–even when they agree with your point.
  • Be ready to answer their questions about YOUR faith with honesty (e.g., what does belief in God look and feel like when everything is caving in?). Be sure not to sugarcoat the Christian life. Be ready to talk about your hope in a broken world (not just for eternity but for now)
  • And if you do talk about your faith, immediately turn it back to them for them to react, explore, challenge, etc.

3. To ourselves

  • Answer the following questions
    • Can I work with integrity within this system?
    • Is giving a “cup of cold water” (e.g., better communication skills) enough for right now?
    • Can I defend what I do say about the Christian faith in my sessions?
    • Am I giving the impression that I believe that there are many ways to God?
  • Develop a theology of mercy ministry akin to God’s providing rain, sun, and health to the just and unjust alike

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June 16, 2008 · 12:54 pm

Are counselors and psychologists an impaired lot?


We’re closing in on the last of the school year. Two weeks to go. Tonight in our ethics class we’ll be discussing the matter of abuse of power, impaired clinicians, and similar issues. In the world of counseling we discuss the problem of impaired counselors/students/trainees when we talk about those who,

(a) do not have the requisite skills, 
(b) have character/attitude deficits, or
(c) reactions to current crises,

AND are unwilling or unable to repair the situation.

First, we ought to be aware of those who are attracted to being counselors. Jeffery Barnett, et al, report the following data from other studies (as cited in the 2007 Professional Psychology: Research & Practice, 38(6), pp 603-612):

  • 70% of female psychologists had been either sexually or physically abused as children
  • 33% of male psychologists report the same
  • 33% of psychologists report being abused as adults
  • They feel the effects of these difficulties (and other family crises) just as non counselors
  • They may be less likely to get help due to knowledge and professional identity
    • 60% acknowledged being significantly depressed during some point of their career
    • 29% reported being suicidal at some point
    • 4% had made suicide attempts

Gizara & Forrest (2004 Professional Psychology: Research & Practice,35(1), pp 131-140) reported supervisors experiences of trainee impairment in APA accredited internships (doctoral level). Many of the supervisors had a hard time defining impairment in counseling but had sort of what I call the “I know it when I see it” mentality. What they often described were the disruptive, persistent relationalconflicts that are obvious to most. They did identify that it is hard for supervisors to address these matters because they (a) are trained to be empathic and to try to save everyone, and (b) not wanting to deal with conflict, destroy a career, or make oneself vulnerable to attack that they are holier than thou.

But, I noticed not much discussion or research regarding the one who doesn’t have obvious abrasive relational skills who is prone to using clients and others to make themselves feel good. This kind of person is dangerous not because they disrupt the counseling center but because they are so well liked that they make others overlook “minor” ethical infractions. Further, the person is rarely cognizant of their using others for their own sense of well-being.

To answer my question. No, I don’t think counselors are an impaired lot–at least any more than others. If we are aware of what drives us to be counselors (the good AND the self-serving), are willing to be counseled, discipled, held accountable, etc. (are willing to be transparent), and see our work as God’s first, then I think we are rather a safe lot.

Watch out for those of us who think we have arrived or no longer need teaching. I’m reminded of Aslan’s question to Prince Caspian at his coronation:

Aslan: Do you feel yourself sufficient to take up the kingship of Narnia?

Caspian: I-I don’t think I do sir. I’m only a kid.

Aslan: Good, If you had felt yourself sufficient, it would had been a proof that you were not.     

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June 9, 2008 · 11:43 am

Practicum/Ethics Monday: Multiple Relationships


All counseling ethics codes address the potential problem of multiple or dual relationships (when counselors have other relationships with their clients or former clients (e.g., counseling a friend or a child of a friend, having a former client as a business partner, etc.). Some codes make it appear that dual relationships are either always or likely wrong and so should be avoided. The AACC code is a bit more liberal in that it (rightly) defines the problem as increasing the problem of exploiting or harming the client. However, this code explicitly defends the biblical nature of dual relationships since we are all brothers and sisters of the same body. Other codes have recognized that it is not possible to always avoid dual relationships. But all codes remind the counselor that it is their duty to defend the healthiness of any dual relationship. In essence, it will be “guilty until proven innocent.”

There are 3 forms of dual relationships (sexual and client; nonsexual social and client; financial and client). Not every dual relationship is with the client (e.g., a counselor has a relationship with the mother of a teen client, a client is under discipline at your large church where you provide consultation to the elders). Dual relationships may happen AFTER counseling is over (begin a friendship with a former client). Finally, it is not merely harm or exploitation that may be the negative outcome of a dual relationship. A counselor may find that a dual relationship hinders or decreases her effectiveness to provide adequate care. [See Lamb et als article in the 2004 Professional Psychology: Research & Practice (35:3), pp 248-254 for a study on these issues].

This last one is the one I want to hang out with for a bit. I had a former client who I had known and highly respected before we started counseling. At the beginning we explored the potential harm that might come from this dual relationship. Both of us deemed that we could manage the slight dual relationship. And I think we did well and the client found the counseling helpful. However, there was a period in the counseling where the client became severely depressed and suicidal. I found myself less willing to hospitalize because I had an image of this client in my head that was much more stable than was actually true. Now, I never like or want to hospitalize. Most psych hospital stays provide protection but little more in the way of healing. But, I know I would have been much quicker to pull the trigger (bad pun I guess) if I hadn’t previously formed an opinion of health before starting the counseling relationship. We should not forget the possibility of reduced effectiveness in dual relationships.

Let me take this one step further. You may have a client who shares your same faith or doctrinal positions, graduated from the same school (but a different time). Any of these connections MIGHT cause you to be less effective in your work because of bias, groupthink, etc. These are not reasons to NOT counsel them but things to keep in mind. Reduced effectiveness because of dual relationships should not be neglected just because we are too busy talking about the rare counselor who decides to have sex with his clients.

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