Category Archives: counseling skills

October 25, 2023 · 6:00 am

Am I doing this trauma healing thing right? Part 3, 6 red flags that you might need a new helper


In in our series about the challenges of undertaking this journey toward healing after trauma, we began by looking at key landmarks along the way that every pilgrim needs to keep in sight (Part 1). These include taking care of our bodies and becoming curious about what helps us find stability. In Part 2 we looked at some myths and beliefs about healing that can hinder our recovery. In Part 3 I want us to consider some things that “helpers” (AKA, therapists, pastoral counselors, counselors, friends, mentors, etc.) do that hinder recovery. If you spot any of these red flags, it might mean you need to have a heart-to-heart with your helper or, if need be, look for someone new to travel with you on your journey.

Before we dive into the underbelly of bad therapy, I want to remind readers that I really believe in therapy. Good therapy helps us understand ourselves, helps us explore parts we have been too ashamed to look at, and helps us gain perspectives and skills to use in our most important relationships. And bad therapy can take away what shred of hope we have for change. It is this reason why I have spent my career educating and training clergy and mental health professionals on 4 continents. Good therapy and help is possible and most of us helpers want to do what is good and right for you. So, let’s highlight here six red flags, behaviors that DO NOT help, so that both survivors and helpers can avoid them.

Making everything spiritual

Not everyone pursues a faith-based therapist or helper. But many do, and for good reason. Faith, religion and spirituality are core features of most of the world’s population. So, it makes sense that we seek helpers who also share our values. In addition, trauma almost always creates spiritual struggles and at least temporary discontent with previously accepted beliefs. Voicing those complaints and questions to and about God are essential to the journey of recovery and will determine whether faith helps us cope or becomes added strain.

However, when your helper uses every opportunity to infer a spiritual meaning and application while you wrestle with your pain, this might be a red flag. Pain is pain, confusion is confusion. It is okay to sit with it, voice it repeatedly, and not make some eternal or mystical application. When a counselor is quick to make a reference to spiritual meaning in your story, it means they are likely not really sitting with you in the ashes of your pain. They might not be as wrongheaded as the story of Job’s friends who jumped to accusations of sin, but pressuring you to accept a spiritual answer to the deeply painful why trauma or what now questions often invalidates your pain and misses opportunities for needed lament. Some call this spiritual by-passing.

The premature offering of spiritual answers, no matter how accurate, often add to the pain of the one who is suffering.

Rejecting your faith or the changes in your faith.

While forcing spiritual conversations is problematic, so also is it when our helpers challenge our faith, changes in our faith, or even question why we have a particular faith or religious practice. You might think this problem is only found among pastoral or biblical counselors. However, I have witnessed many licensed mental health professionals also evidence this red flag. Consider some of the lines I have had clients repeat back to me from their former helpers:

  • You can’t believe that about God. He wouldn’t do anything to hurt you.
  • If you don’t forgive, you will become bitter and miss out on blessings.
  • If you aren’t in church, you are rejecting God’s goodness.
  • Yes your abuse is bad, but God says…
  • Your faith community is toxic. You need to leave this patriarchal religion.

If changes and discontent in our former ways of construing faith is so problematic, then why are there so many psalms of lament in the Bible? These poems express our deep questions and complaints. In Psalm 42 the writer laments how he no longer leads the worship procession and is now full of questions for God. Does God respond and tell him to stop this line of thinking and feeling? No. Instead, if you accept that the Psalms are given to us by God, then such expressions are invited by God as an act of communion.

Emphasizing techniques while missing the relationship.

There are many therapy models out there in use. Some are general models (e.g., Judith Herman’s three phase model of trauma recovery) and others are more regimented or manualized (e.g., Trauma-Focused CBT). In recent years, there has been a proliferation of EMDR certified specialists. And still many more employ various techniques from many models in an eclectic manner.  

When your helper is overly enamored with a particular technique, it can become a problem as they may not be able to recognize when that beloved technique does not help you. When your therapist wants to jump into “doing stuff to you” then it is likely they aren’t really seeing or hearing you. And just because a particular technique has empirical evidence for success, it doesn’t mean it is right for you. Sadly, when a disciple of a model oversells a technique, the real reason may be that it promotes their own sense of competence as a clinician.

When a therapist suggests a course of action or an intervention, do they take time to explain what positive or negative response might happen? Do they find out how you feel about it? Do they check in with you and notice if you are anxious, concerned, or not having a good reaction? If you are flooded during a session (e.g., frozen, overwhelmed, etc.) and your therapist doesn’t seem to notice, show curiosity, or take the time to help you find ground again, you might need to find help elsewhere. If in response to your stress, they fill up the space with more words of explanation or defense, they might not be as trauma sensitive as they need to be.

Pressure to progress, mislabeling your hesitation as refusal.

Therapists love to help people. That is why we do this work. We want to see people get better and we have confidence that healing can and will happen. But sometimes, our motivation to help people also include the hidden desire to feel helpful. This desire can become a demand that the client feels in their bones. “I have to progress and get better or they will become disappointed in me or see me as resistant.”

If you have felt this pressure, take a moment and consider possible roots. Sometimes this fear of being resistant is something the survivor has come to believe about themselves (or, were told by their abusers!). But other times it is a message from their helper. Signs of demands, disgust, irritation, frustration, coercive speech, pouting all point to the possibility that the therapist is communicating to you that you need to get better FOR THEM.

We will explore how to determine if a therapist is right for you in the next post but suffice it to say here, your resistance to an intervention is something to listen to with curiosity. It is the beginning of regaining your voice and power. Instead ask, “What might your hesitation be saying?” Listen to it and don’t immediately judge it. If your therapist does label it as refusal, consider other helpers.   

Therapist talking about self a lot.

Who does most of the talking in your session? You or your therapist? When your therapist talks, is it for the purpose of inviting you to explore your own reflections? Or, when they speak, do they share paragraphs and essays about their work or themselves? How much do they talk about their own experiences? Self-disclosure by the therapist is not always wrong. It can be helpful in tiny doses. But when it happens frequently it often distracts from the work that needs to be done by their client.

Therapy is not the place for therapists to talk about themselves (or to sell their own products). Ask yourself, “do I get to talk about the things that are most important to me during my sessions?”  

Boundary crossings.

Trauma experiences, especially betrayal traumas, often contain boundary violations and maltreatment by someone who was supposed to protect and respect another. When helpers confuse or cross needed boundaries, this can delay healing or cause more harm. What kinds of boundary crossings do I mean? I have witnessed therapists trying to be all things for a client. They are not just the therapist but also become friend, “parent figure,” employer, pastor, landlord, and sadly, sexual partner. This last boundary crossing—sexual and romantic relationships—is always an abuse of power and a violation of the sacred trust of therapy. It is also a criminal act in most jurisdictions and always an ethical breach.

Most crossings are not meant for harm. A client can’t afford therapy so a clinician barters—provides therapy and in re-payment the client performs some work. A client has administrative skills and so the clinician invites the client to help run his or her business. Another client is isolated and so a therapist invites them to their own bible study group. On the surface these might seem mutual and helpful.  But what if the client doesn’t respond well to the therapy? What if the therapist is unhappy with the work completed? What if learning about the personal life of the therapist creates confusion about what is discussed at the next session?

When therapists encourage dual relationships without ample discussion of the possible ramifications, they prioritize their own benefit at the expense of the client’s wellbeing.

I see a red flag, what should I do?

No therapist is perfect, and we all make therapeutic mistakes. It is the response to mistakes that makes all the difference between good and harmful therapies. The question you must ask yourself,

“is it safe to bring up concerns and questions about what happens in therapy?”

Can you talk about the process and raise concerns without your therapist becoming defensive? Most therapists want to provide good care and do not want to do things that harm their clients. So, it stands to reason that many will respond with concern and work with you repair the rupture and find out what works best for you going forward. If, however, you have reason to believe that you will be mis-treated for bringing up a concern, then consider whether it is time to find another therapist.

What comes next?

In our final post of this series, we will explore how to interview for a good therapist and how to determine what model of therapy might be best for you.

For further reading, why do counselors talk about themselves?

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November 29, 2019 · 3:43 pm

Counselor failures: A short series


I recently passed my 29th year anniversary of mental health practice and 18th year as a psychologist. I’m not quite old but also have a few years under my belt. When I first began counseling as a counselor in my very early twenties I was fairly committed to proving my value. I wanted to diagnose problems and offer wise solutions. I’m embarrassed to say that I often thought I could do so in the first 15 minutes of a session. Sometimes I was right, but I can say for sure I hadn’t earned the right to speak. Needless to say, I wasn’t particularly helpful in those early sessions. Thankfully, I learned that if I was going to be helpful I needed to stop worrying about whether I sounded smart and had something valuable to say and instead spend my energy entirely on the work of listening and understanding the person in front of me.

Not listening to clients might be the first and most common failure counselors make. It can happen throughout a session or for just thirty seconds during a momentary lapse of concentration. While beginner counselors may struggle to listen well, seasoned therapists can lose their edge without even recognizing it.

Not listening can happen by means of trying to dictate goals. It can happen when we therapists talk about ourselves. It can happen when we misdiagnose a client. It can happen when we are bored, or irritated, or caught up in our own world of pain.

This little series is dedicated to therapist failures. We’d rather believe that our mistakes are really client resistance or family interference. But as we own our mistakes, we acknowledge that counseling is a human interaction that requires our willingness to evaluate our end of that interaction. While this series is written for mental health practitioners, I suspect clients will also benefit from this look inside, if for no other reason than to identify when they are not feeling heard.

Some related thoughts previously written

I’ve written a couple of blogs recently on related topics. The first is embedded in my last blog,

I’m going to skip over the large problem of counselors pressing for any change whatsoever. (Suffice it to say that pressing a client for forgiveness, confession, reconciliation, or any other action rarely works and more often causes harm. You cannot heal a trauma caused by misuse of power with more force–even if your goal is good.)

https://philipmonroe.com/2019/11/24/some-thoughts-on-when-restoration-hurts/

I will write more on the problem of choosing the wrong goals for counselees–or the problem of choosing goals in the first place. A few months ago I wrote about the problem of choosing reconciliation as a goal.

Some years ago, I wrote this list of common mistakes made by novice counselors.

Come back for the first post exploring the setting of goals in counseling and how not listening leads to the likelihood of failure.

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April 13, 2017 · 4:13 pm

Complex Trauma: Going Deeper, By Diane Langberg


As part of our staff meeting today we watched this video by Diane Langberg. It reviews the 3 stages of typical trauma recovery process plus focuses on the impact of the work on the counselor. Self-care is a common conversation these days. However, a few lines stuck out to me:

Unless we take care of ourselves, we will not be able to bear witness…. Vicarious trauma is not something done to us but a consequence of having empathy…. Evil and suffering also provide an opportunity to expose the weak places in [the counselor]…. Seek out the antidotes to the poison that you sit with…[these antidotes] are not just good coping mechanisms but part and parcel to living the life obedient to God.

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April 10, 2017 · 11:40 am

Diane Langberg: Living with ongoing trauma


A few years ago, Dr. Diane Langberg gave a talk about ongoing trauma experiences, when there is no “post” in the posttraumatic stress disorder. When there is no after trauma yet (e.g., ongoing domestic violence, living in a war zone, etc.), what kinds of help and hope might a survivor hold on to? Is there anything that can be done?

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April 5, 2017 · 6:27 am

Why we need a theology of trauma


[Previously published April 2015 at http://www.biblical.edu. The faculty blog no longer exists there thus re-posting here]

We live in a world shaped by violence and trauma. This week that I write 147 Christian Kenyan university students were killed because of their faith. Such horrific forms of violence shock us. But they shouldn’t given that in our own country violence and trauma are everyday occurrences. While some of our local brothers and sisters face actual death, all of our communities are shaped by soul-crushing abuse and family violence. Take the most conservative numbers we have—1:6 males and 1:4 females have experienced sexual assault before age 18—and realize that a large portion of your friends and acquaintances have traumatic experiences.

In a congregation of 100, 20 of your fellow church members are walking around with invisible wounds of sexual violence on their bodies and souls. And that number says nothing about those walking around with other invisible wounds, such as caused by domestic violence, racial prejudice, sexism, bullying and the like. Were we to include these forms of interpersonal violence the number would likely reach 70!

As my friend Boz Tchividjian asks, what would the sermons and conversations look like if 20 of our mythical congregation of 100 had just lost a house in a fire or a child to premature death? Wouldn’t we be working to build a better understanding of God’s activity in the midst of brokenness rather than passing over pain as a mere hiccup of normal life?

Yet, we continue to imagine trauma as some sort of abnormal state.

Ruard Ganzevoort[1] tells us that, “When one looks at issues like these, we must conclude that our western societies are to no less degree defined by violence and trauma, even if everyday life is in many ways much more comfortable” (p. 13). Thus, Ganzevoort continues, we must “take trauma and violence not as the strange exceptions to an otherwise ‘nice’ world” (ibid, emphasis mine). He concludes that while we have a strong theology for sinners, we have a less articulated theology for victims.

What if we were to read the Bible in such a way to build a theology of trauma for victims? What would it look like? I would suggest that Diane Langberg’s maxim sets the stage quite nicely: the cross is where trauma and God meet. Jesus cries out due to the pain of abandonment by the Father. Since we do have a high priest who understands our trauma (Hebrews 4:15), we can read the entire canon from the frame of trauma—from the trauma of the first sin and death to the trauma of the cross to the trauma just prior to the coming new heavens and earth.

Key Themes in a Theology of Trauma

Reading the Bible through the lens of trauma highlights a few key themes beyond the foundation of a God who Himself knows trauma firsthand in the unjust torture and death of Jesus:

Anguish is the norm and leads most frequently to questions

When more than 40% of the Psalms are laments (and that doesn’t count the primary themes of the prophets!) we must recognize that anguish is most appropriate forms of communication to God and with each other. But we are not alone in the feelings of anguish. God expresses it as well. Notice God expresses his anguish over the idolatry of Israel (Eze 6:9) and Jesus expresses his when lamenting over Israel (Luke 13:34) and cries out in questions when abandoned by the Father (by quoting—fulfilling—Psalm 22).

Despised and rejected, a man of sorrows, acquainted with grief.

Peace happens…in context of chaos

Psalm 23 comes to the lips of many during times of trouble as it expresses peace and rest during times of intense trouble. Shadows of death yet comfort; enemies around yet feasts. Peace happens but rarely outside of chaos and distress. Consider Jeremiah 29:11, frequently quoted to those going through hardship to remind them that God has a plan. He does have one, but recall that the plan was to live in exile among those who see the Israelites as foreigners and second-class citizens!

The kingdom of God in the present does not promise protection of bodies

Try reading Psalm 121 aloud among those who have survived genocide or been raped repeatedly by soldiers. “The Lord will keep you from all harm.” Really? You lost 70 family members? You cannot maintain your bladder continence due to traumatic injury to your bladder? Where was your protection? Our theology of God’s care must take into consideration that He does not eliminate disaster on those he loves. Recall again the trauma wrought on those God chose to be his remnant. They were the ones ripped from families and enslaved by the Babylonians.

God and his people are in the business of trauma prevention, justice, and mercy responses

The kingdom of God is not for those who have pure beliefs. The kingdom of God is for the poor in Spirit, the persecuted, those who provide mercy and those who hunger for justice (Matthew 5). True or pure religion is practiced by those who care for the most vulnerable among us (James 1:27). Jesus himself is the fulfillment of healing as he claims Isaiah 61 as fulfilled in his personhood and mission (Luke 4:18-21). We his people are the hands and feet to carry out that binding up and release from oppression.

Recovery and renewal during and after trauma likely will not eliminate the consequences of violence until the final return of Jesus Christ

Despite our call to heal the broken and free those enslaved, we are given no promise that the consequences of violence are fully removed until the final judgment. Rarely do we expect lost limbs to grow back or traumatic brain injuries to be erased upon recovery from an accident. Yet sometimes we assume that traumatic reactions such as startle responses, flashbacks, or overwhelming panic should evaporate if the person has recovered. A robust theology of trauma recognizes we have no promise of recovery in this life. What we do have is theology of presence. God is with us and will strengthen us guiding us to serve him and participate in his mission to glory.

There is much more to say about a theology of trauma for victims. We can discuss things like theodicy, forgiveness, restorative justice, and reconciliation. But for now, let us be patient with those who are hurting as they represent the norm and not the exception. And may we build a missional theology of trauma, not only for victims, but also for all.

[1] Ganzeboort, R. Ruard (2008). Teaching that Matters: A Course on Trauma and Theology. Journal of Adult Theological Education, 5:1, 8-19.

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March 28, 2017 · 9:32 am

Summer Counseling Institute @ BTS


The BTS Graduate School of Counseling has 2 course offerings this summer: a course on addictions and a course on counseling interventions that move beyond talk therapy. Both are equal to 1 credit or 9 CE credits for professional counselors. The addictions course (Jessica Hansford, LPC, CAADC) will be entirely online and delivered over the course of the month of July. The beyond talk therapy course (Heather Drew, LPC) will be delivered live July 21-22 at our Hatfield campus (with pre and post course work due for those who want graduate credit).

If you want to refresh your counselor knowledge and skills, both courses will give you some new ways to engage counselees.

Link above provides course descriptions. To apply, click here.

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January 7, 2017 · 2:05 pm

Can Mental Health Practitioners Predict Future Violence?


Yesterday, a gunmen killed five and wounded at least eight others at the baggage claim for a Florida airport. Initial news reports allege the shooter had recently experienced psychotic-like symptoms. I am sure that in the coming days we will learn more details about the shooting and about the recent history of the shooter. Among the details there will be plenty of questions. Did anyone know this might happen? Could someone—especially in positions of power (FBI? Mental Health?)—have prevented it by reporting or removing access to guns?

Of course, it is easy to ask these questions and develop opinions after the fact. And yet we need to ask them if there are possibilities to learn from possible mistakes. What follows attempts to give the public a brief but better understanding of risk assessment when mental illness and violence combine. (NOTE: this is not a comment on the above sad situation or those cases where violence is unrelated to mental health.)

A little history of predicting future violence

Violence risk assessment is part of the sub-division of forensic psychology and psychiatry. Expert witnesses are used in court proceedings to report on the existence of mental illness, the probability of imminent dangerous behavior, and the options for most effective/least restrictive treatment required to reduce illness and increase safety.

How do clinicians make these opinions? In the not-too-distant past, expert witnesses usually used their wisdom shaped by years of experience. Much to the chagrin of experts, it turns out that clinical intuition isn’t all that effective. For some professionals, it is little better than chance! (Interested readers can check out Monahan’s 1984 oft-quoted research quoted in this rebuttal article.) Other options include actuarial methods (collecting risk factors just like an insurance company does to determine how much to charge your 18 year old son for car insurance) and test data. Both of these methods seek to eliminate feelings in the decision-making process. Actuarial data can certainly help us. Knowing someone has a history of violence and criminal behavior helps us predict future behavior. Knowing someone has schizophrenia may slightly increase risk of violence, but no more than it would for those who have problems managing impulses. And this would not be a reason to lock someone up (though it may be a reason to limit access to handguns). Assessment tools filled out by the person suspected of violence have a couple of problems with them but the main one is that very few of the most violent have been identified in treatment as possibly benefiting from assessment. And when we do give these assessments, the data rarely is clear—this kind of response means they will be violent, this one means they will not. We’re far better at identifying “faking good” or “faking bad” results than we are in determining whether the results mean future violence.

The best assessment to date requires that we have adequate history, survey of known risk factors, interviews, and test data. But as I said above, if the person suspected has not been in treatment or has done well to present as being merely disturbed but not dangerous, what can be done?

One More Complication

In our current society, we believe deeply that individuals have the right to self-determination. This means they have the right to refuse treatment. This right trumps nearly every other value. It doesn’t matter if the treatment would really help. The person is permitted to refuse. The only exceptions are involuntary commitments to address imminent danger to self or other. And as soon as the danger passes, the treatment can be refused again even if the treatment might avoid a relapse.

Bottom line for Practitioners

We can do better in responding to risk factors that might lead some to violence. We can learn more about these factors. We can equally promote confidentiality and privacy for our most distressed clients and yet be quick to warn others when signs of imminent violence are present. We can ask better questions. We can use non-cognitive approaches to get a better picture of their internal experiences. And yet, we can only work with the information we have. Contrary to popular belief, we are not prophets. In addition, most of our outpatient clients are not even remotely dangerous (in 27 years of clinical work, I have only needed to report two clients for imminent risk to others).

What we can do is assert the need for better and more available treatment options.

Family members are really the frontline of help for most distressed individuals. They are more likely to hear the murmurings that might indicate violence. This requires greater public education about the nature of mental illness and violence risk assessment and the kinds of ways to respond. Church leaders can also be better educated as to what kinds of options are available for those parishioners who are struggling with similar kinds of emotional distress. Let us be willing to lead the way in educating our communities and churches about mental health challenges and healthy responses. If we did a better job surrounding those with severe mental illness (and isolating them less) we would likely have less mental health induced violence.

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December 16, 2016 · 11:15 pm

Over-confidence? Under-confidence? Assessing counselor tendencies


Every counselor desires to be effective, to handle client concerns and problems with competency. We do this work because we long to see others recover quickly and we do not want to get in the way of needed and desired growth. Early career counselors often feel out of their league and so seek out all the help they can get: supervision, books, essays, and peer-consultation. This is the proper way to learn and become better at our craft.

But what happens when we begin to feel competent and confident? Do we stop feeling needy? Stop seeking input? If we do stop pursuing growth and increased competency, skills and capacities will erode. We might think all is well, we’ve got this under control, but in reality we would enter dangerous territory. Imagine wanting to be an Olympic athlete and yet forgoing training.

Erosion happens.

So, should we want to feel less competent? No. The goal is not to feel ineffective nor to lack confidence in what we do. I would not want a second-guessing surgeon to operate on me. Rather, it is important to maintain regular (not obsessive!) self-examination and invitation to others to give you input and feedback.

For the possibly under-confident counselor:

Where do you feel you need help, are less competent than you would like? What are your common responses to that feeling? Who have you talked to about this problem? Where have you sought help? What continuing education have you completed? While it is good to get help to “know what to do” don’t forget that a large portion of therapeutic success is attributed to who you are in the session. Be sure to focus on your listening, and “bearing-witness” skills. Remember to be a student of the client.

For the possibly over-confident counselor:

Do you still have supervision? If not, why not? Look over your caseload. Who are you working with who you have not reviewed assessment, diagnosis and treatment plans with another (note: peer supervision can be done without revealing confidential or private information)? When was the last time you verbalized your case conceptualizations with a critical eye to the potential myopia that plagues us all? What continuing education have you completed that can revise and improve your skills?  While relationship-building skills are the most important, do not stop learning and growing in knowledge and understanding.

It is good to remember that  our skills WILL erode without attention, just like muscles with grow flabby without exercise. One such muscle for the Christian counselor is that of prayer. Consider your recent counseling activities and ask how prayer has fit into your work. Is it a perfunctory or an afterthought? Does is change depending on how you feel about your competency? What does it reveal about your therapeutic operating system (e.g., what is the source of power to change?)

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November 2, 2016 · 12:18 pm

Is your empathy really self-serving?


Empathy, or feelings of understanding or identification with another, seems to be a primary vehicle of human expression of love and compassion. In the world of therapy, empathy seems the foundation for all good counselor work. Sure, we can act in kind, compassionate, yet robotic ways but knowing that someone gets you and helps you is better.

But this begs two questions: Are empathy and altruism connected and parallel? And, is our empathy really self-serving? Taking the second question further, could our empathic responses be destructive to the very people with whom we want to help? Psychologist Paul Bloom thinks so (short video of his contra empathy point of view). While I think his argument against empathy is seriously flawed and really merely an argument against naïve, superficial, and self-serving do-gooderism–a significant problem in our society where we solve problems on emotion and often without taking the time to understand either cause or consequence–the bigger question is whether or not we ever really have concern for others outside of self-interest. And if we discover that all empathy is self-serving, does that deny the Christian virtue of self-denial and voluntary submission to others?

What is at the heart of our empathic, altruistic behavior?

We all have numerous instances where we have witnessed self-sacrificing behavior. The reason these instances stand out in our memories is that they are unusual and somewhat rare experiences. But consider the more run-of-the-mill expressions of empathy. You see a GoFundMe page for a friend in need and you give. Your church is seeking donations for Thanksgiving baskets and you buy groceries. Your neighbor is sick and you mow her lawn. Do we do these behaviors for them? Or do we do it, in large part, for ourselves?

Josh Litman’s paper “Is Empathy Ultimately Just Narcissism?” seeks to summarize the research literature about whether empathy and altruism are positively correlated and whether empathy is really about the other or about self-interest. His answer? Empathy and altruism may not be all that connected. Empathy is better understood as feelings of “oneness” or connectedness to the other. When I identify more with someone, I’m more likely to feel empathy and do self-sacrificial for them.

In conclusion, this paper defends a non-altruistic, egoistic strain of empathic concern. It might be heavy-handed to call it narcissism, but evidence has shown that empathic concern is certainly motivated by self-interested factors rather than selflessness.

Could this be the reason why more people changed their Facebook profile images to a French flag after the Paris bombings and far fewer chose a Turkish flag after the most recent airport bombing? Do we more closely identify with one group over another and thus feel more empathy and make more statements of support and care?

Does this proclivity to more strongly identify with some more than others reveal self-interest and self-concern? If so, does that make our caring of others all about ourselves and cause us to suspect the warmth and empathy we get from others?

So you, too, must show love to foreigners, for you yourselves were once foreigners in the land of Egypt. (Deut 10:19, NLT)

Oneness and love in the created and the Creator

I think empathy can be self-serving (I care for you because I want to be cared for) but I do not think it must be this way. Rather, I would argue that we have been designed to understand our world by means of our experiences. Because I understand what it could feel like to lose my home to a flood I am moved to donate time and talent to help rebuild a home. Because I see your humanness, I am able to empathize with your losses and then consider what possible ways I might respond.

Oneness does help us empathize. But empathy is not the same thing as love. True love, as an action verb, requires a willingness to expend self for the sake of another. True love enlarges the population you are one with. So, straight people find themselves in the experiences of gay people; Christians in the experience of Muslims; liberals in the experience of conservatives. True love moves beyond simplistic understandingfile-nov-02-12-21-19-pms with oneness and best reflects the character of God who self-sacrificially loves beyond measure, choosing to take up our infirmities as his own.

In your relationships with one another, have the same mindset as Christ Jesus: Who, being in very nature God, did not consider equality with God something to be used to his own advantage; rather, he made himself nothing by taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself by becoming obedient to death—even death on a cross! (Phil 2:5-8, NIV)

For we do not have a high priest who is unable to empathize with our weaknesses, but we have one who has been tempted in every way, just as we are—yet he did not sin.(Heb 4:15, NIV)

 

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October 28, 2016 · 1:28 pm

Does your counselor have these two important skills? 


I love working with counselors-in-training. We get to discuss everything from diagnoses to interventions, ethics to theology, character development to politics. I know I’m biased but along with the population of Lake Wobegon, our students “are all above average.” 

That said, there are two extremely difficult counseling skills every student needs to learn–frequently the hard way. To be an effective counselor, you have to be able to conceptualize a person and their presenting problems well (e.g., wrong assessment leads to wrong treatment) and you have to maintain a clinical alliance throughout the course of treatment. Of course, a counselor needs to be of good and mature character. She needs to have a bank of excellent questions to ask, a knowledge of common intervention strategies, and a good ear to hear what the client is trying to express. These things are necessary foundations for the skill of conceptualization and alliance.

Conceptualization

When you come to counseling to discuss a challenge in your life you want the counselor to be able to understand and put your situation into proper perspective. You expect them to have some expertise beyond your own–otherwise why go? As you tell your story, it always has missing and disjointed parts. There are dead ends and mysteries that may start out feeling important that in time become less a focus than other issues. Your counselor needs to put the problems you raise into some context. What lens to view the problems should be used? 

  • Is the conflict between a mother and teen best understood by the lens of enmeshment, Attention-Deficit, autism, sinful pride, depression, anxiety, rebellion or…?
  • Is the conflict between a husband and wife best understood as lack of knowledge, demandingness, personality disorder, emotional abuse, etc.

An effective counselor uses multiple lenses to view his counselee and holds those lenses loosely in recognition that first impressions need refinement. 

Do you feel heard or pigeon-holed by your therapist? Does your therapist discuss possible ways to look at the problem you have and thus different ways to approach solutions? 

Alliance

Alliance is a hard thing to describe but it encompasses a trust relationship where therapist and client work in concert to explore and resolve a problem. There is agreement on the problem definition and the process of therapy.  There are several things that seem to be part of this concept but fall in two key categories: techniques and stance. A good therapist asks great questions that enable a person to feel heard as they tell their story. A good therapist validates the person even if they do not agree with interpretations of the client. A good therapist makes sure that the client knows they are more than the sum total of their problems. Finally, a good therapist checks in with a client to find out how they are experiencing the therapy session and approach. But good questions and feedback are not the full picture of alliance. The therapist needs a stance that reflects being a student of the person; of collaboration over action. It reflects an understanding of pacing and the client’s capacity to process information.  

A counselor can understand a problem but if they rush ahead or lag behind in pacing, the alliance will fail. Consider this example. Therapist A meets with a client with a domestic violence victimization problem. It is clear to the therapist that the client needs to move out and that the client is resistant to this idea. The clinician presses the client to leave and challenges her to see her husband as an abuser. While the counselor may be correct, the confrontive and authoritative stance is unlikely to bear much fruit and will either create defensiveness or passivity in sessions. One sure sign of poor alliance is when a therapist is constantly thinking about how to get his or her client to do something. 

Meanwhile, Therapist B meets with the same client and explores the ambivalence she has towards her husband and the abuse. Options are discussed, less for movement sake and more for examination of fears and opportunities, hopes and despair. Both therapists have the same sets of good questions, but one is more aware of the pacing of the client and meets her where she is where the other one forces a pace the client is not ready to match. This does not mean a counselor never pushes a client but it does mean they never do that without the understanding and agreement of the client. 

Alliance is not a static feature. It grows and shrinks during the course of a relationship. There are ruptures and hopefully repairs. Sometimes a rupture leads to an even stronger alliance if the repair leaves the client feeling cared for and respected. Ruptures are not always caused by the counselor but it is the counselor’s job to notice and to work to resolve. 

Do you feel like you are on the same page with your therapist? Do you have evidence (not just fears) that your counselor is frustrated by you? When you have a “miss” in a session, does your therapist acknowledge it and talk about how you are feeling about therapy? If you bring up an rupture, are you listened to? 

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