Category Archives: counseling skills

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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Filed under counseling, counseling science, counseling skills, News and politics, Psychology, teaching counseling, Training, Uncategorized, Violence

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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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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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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Ruminating: The Mental Health Killer


I teach a course on psychopathology. Each week we consider a different family of problems. We explore anxiety disorders, mood disorders (depression, mania), and anger/explosive disorders in the first few weeks in the class. Later on, we look at eating disorders, addictions, trauma, and psychosis.

While each of the presentations of problems vary widely from each other, there is ONE symptom that almost every person with a mental health problem experiences–repetitive, negative thought patterns. Rumination.

The content of the repetitive thoughts may change depending on the type of problem (i.e., anxious fears, depressive negative thoughts, illicit urges, fears of weight gain, hypervigilance, irritability, etc.) but the heart of the problem in most mental health challenges are negative thought patterns leading to an experience of either impulsivity or paralysis. These patterns can look like obsessional worries about germs (triggering ruminative “why” questions as to the root causes of the obsessions). The pattern can look like repeated negative self-attributions for perceived mistakes. Whatever the pattern, the person finds it difficult to break out of the negative thoughts and attempts at distractions seem futile since the thought or feeling returns in seconds to minutes.

Is there anything that helps?

Yes, there are things that you can do to reduce the “noise” level of these repetitive thoughts. It is important, however, to remember two important factors

  • patterns in place for years or decades are harder to change. Give yourself the grace to fail as you work to change them.
  • As with pain management, the goal should not be the complete elimination of negative thoughts and feelings. Realistically, anxious people will have some anxiety. Depressed people will feel darker thoughts. Addicts will have greater temptations. But lest you give up before you start, this does not mean that you must always suffer as you do now.

Consider the following three steps as a plan of action to address the problem of rumination.

  1. Build a solid foundation of health. Every house needs a foundation if it is going to  last. Your mental health foundation starts with your physical body: Exercise, diet, and sleep. Did you know that daily exercise, getting a good 8 hours of sleep each night, and eating a diet rich in protein supports good mental health and may even prevent re-occurrence of prior problems? Will this solve all your problems. No! But failing to get good sleep and eat a balanced diet of proteins will exacerbate your problems. Sleep is especially needed. The lack of it will multiply your problem. Of course, getting sleep is difficult when you are worrying or depressed. Thus, work to develop a different bed-time routine. Shut off your electronics, do mindless activities like Sudoku, develop rituals that help promote sleep. If you are having trouble with this or your diet or exercise, find a trusted person to review your situation. And avoid all/nothing thinking that often leaves us paralyzed when we can’t reach our goals. On this point, read the next step.
  2. Prepare for change by accepting your struggle. What, I thought this was helping me out of my struggle? Acceptance is the beginning of change. Consider this examples. You struggle with intrusive negative thoughts about your belly. You don’t like how it looks. You’ve tried dieting and exercise, but still it is flabby. Every time you look at yourself, every time your hand rests on your belly, you hear (and feel) that negative narrative. The first step in change is to accept the body you have and to find ways to like it, even love it. Sounds impossible but it is necessary to accept all your parts. This does not mean that you won’t continue to exercise and eat well. Marsha Linehan suggests that one part of change is to accept the problem as it is. In her Dialectical Behavior Therapy model she speaks of choosing willingness over willfulness. Willingness opposes the response “I can’t stand this belly” by saying, “my belly is not as I would like but it is not all of who I am.” “I can’t stand it…” becomes a willful and yet paralyzing response. Whereas acceptance acknowledges the reality and chooses goals that are within one’s power to achieve (e.g., healthy eating choices). Acceptance is not giving up but preparing for realistic change.
  3.  Start to move. Consider these action steps as the beginning movements you undertake in a long process towards the goal:
    1. “So what?” Our ruminations are often filled with interpretations and assumptions. There are times we can challenge them by attacking the veracity of the assumptions. But we can also ask, “so what?” So what if I have OCD? So what if have to fight every day to stay sober? So what if I have to manage my schedule so as to not trigger a bipolar episode? Challenge the worst thing that you are afraid of.
    2. Develop a counter narrative. Rumination is a narrative. Begin by writing and rehearsing a counter narrative. It won’t have much power at first compared to your internalized rumination but it will gain power over time. Work to refine it. Choose to repeat it as often as you see the trigger for the rumination. Make sure your counter narrative doesn’t include self-debasing or invalidating comments. If you have trouble writing one, use Scripture passages that speak of God’s narrative, through Christ, for you. Be encouraged that developing alternative storylines has shown capacity to alter chronic nightmares. If nightmares can be changed, then even more thoughts and feelings during the day.
    3. Practice being present. Much of our lives are run on auto-pilot. When we are in that mode, it is easy to fall into rumination. Work to stay present, to be mindful and attuned to your surroundings. Notice ruminations but let them slide on out of view and bring yourself back to the present. Use your senses that God gave you to enjoy the world he made. Smells, sounds, sights, taste, and touch all give you means to enjoy that world. Start practicing staying in tune with it, a few minutes at a time and build your capacity as you go.

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Filed under addiction, christian counseling, christian psychology, Cognitive biases, counseling skills, mental health, Mindfulness, Uncategorized

Making the Church a Safe Place for victims of abuse


This Saturday I will be attending and presenting Cairn University’s Faith in Practice conference hosted by their counseling center and department (free but you need to register). I will be speaking about how we can make the church a safer place for adult victims of abuse and trauma. If you want to peak at the slides, click here: 2016 Cairn U Presentation.

The presentation that I will do will only be one hour so that limits what I can do. What I wish I could do is also talk much more about the systemic factors that make churches less safe places for vulnerable people. While we can all grow in better understanding the nature of trauma and how to walk alongside victims, our institutions can be systematically harmful, even when the individuals within the system have no intention to hurt others. Thus we need to keep examining the ways our systems operate that can be toxic to some. While this presentation doesn’t cover these questions, it can be good to ask,

  1. How do we handle recent or older allegations of mis-handling difficult cases?
  2. How do we handle allegations of child abuse (the victims, the family, the alleged perpetrator and family, and congregation)?
  3. Are we a safe place for people who are broken and not all tidied up?
  4. Does our system allow for ongoing lament? (Corporate and individual)?

 

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Filed under Abuse, Christianity, church and culture, counseling skills, Post-Traumatic Stress Disorder, suffering, trauma

Counseling Advice From Lady Gaga?


Lady Gaga has a new song about the aftermath of sexual assault. Unless you’ve been living in a cave, you likely have heard of Lady Gaga who is known for crazy getups and stunts. Known in my household as the lady who wore the meat dress, she sings these words (I’ve included just a few lines) in the song “Til it happens to you.”

You tell me it gets better, it gets better in time
You say I’ll pull myself together, pull it together, you’ll be fine
Tell me, what the hell do you know? What do you know?
Tell me how the hell could you know? How could you know?

Till it happens to you, you don’t know how it feels, how it feels
Till it happens to you, you won’t know, it won’t be real
(How could you know?)
No it won’t be real
(How could you know?)
Won’t know how I feel

Her message is clear: If you haven’t been raped or assaulted (or experienced any other sort of trauma) you can’t possibly know what it is like. And since you can’t know what it is like, stop giving superficial comfort and advice.

Is Lady Gaga right? Does she offer sound counseling advice?

Yes and no. Yes, we are far too willing to offer platitudes to people in pain and wonder why they get angry and hurt and avoid us altogether. Lady Gaga captures the sentiment of the doubly hurt–first by the initial trauma and second by foolish words. The ancient Greek Aeschylus aptly puts it this way

It is an easy thing for one whose foot is on the outside of calamity to give advice and to rebuke the sufferer

Our quips roll easily off the tongue, but they injure the already wounded. Before you speak to someone and offer your ideas, do your friend a favor and be quiet. Ask them again (and again) to tell you what they experienced (past or present tense). But I don’t think Gaga goes far enough. I would argue that EVEN IF you have experienced the same trauma as the person in front of you, stop thinking that you know what they are feeling and struggling with. You may, but you may not as well. Do not assume your experience is theirs. Listen. More than you think you need to. Assumptions of “getting it” communicate that their pain doesn’t really matter to anyone.

But also, Lady Gaga is wrong (and I get it, this is art not counseling skills training!). It is possible to help others even when you have not had their experience. As long as you approach your work with humility and the heart of a student, you can do much good. You bear witness to their experience through your reflections and observations. You can ask good questions and paint word pictures of trajectories of growth. Do not think that just because you did not have the trauma, you have nothing to offer. Offer yourself (more than your words). If you fail to offer yourself out of fear of not being adequate, you also harm by not giving the present of being understood.

But let Gaga’s anthem be a challenge to those of us, myself included, who speak before listening and who assume rather than learn. We won’t get it. But we can bear witness.

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Filed under Abuse, christian counseling, counseling, counseling skills, Post-Traumatic Stress Disorder, sexual abuse, sexual violence, trauma, Uncategorized

What does recovery look like after traumatic experiences


After trauma, what does recovery look like? Is it possible to “move on?” How can you when you can never unsee or unremember what happened to you? 

Is it possible to experience joy rather than emotional pain when remembering past or ongoing hurts? If so, just what does that look and feel like for the victim? What can be expected if I am “healed”? Can I be free from the typical experience of trauma (e.g., Hopelessness, despair, anxiety, confusion, shame, anger, loss of identity, feeling stuck but the demand to act as if the trauma did not take place, and spiritual angst over the goodness and love of God)?

As Diane Langberg has so aptly reminded us, “Trauma is the mission field of this century.” Around the world there is much openness to talk about the impact of trauma and to use spiritual practices as part of the recovery process. In Christian language, we talk about healing the wounds of the heart and one of the best programs out there is the Trauma Healing Institute’s, Healing the Wounds of Trauma. This program is based on the strong Christian belief that God, through the work of the Holy Spirit and the Scriptures,  is in the business of healing wounded hearts. At the heart of this belief sits two important passages:

Isa 61:1-4 The Spirit of the Lord Yahweh is upon me, because Yahweh has anointed me, he has sent me to bring good news to the oppressed, to bind up the brokenhearted, to proclaim release to the captives and liberation to those who are bound, to proclaim the year of Yahweh’s favor, and our God’s day of vengeance, to comfort all those in mourning, to give for those in mourning in Zion, to give them a head wrap instead of ashes, the oil of joy instead of mourning, a garment of praise instead of a faint spirit. 

2 Cor 4: 16-18 Therefore we do not lose heart, but even if our outer person is being destroyed, yet our inner person is being renewed day after day. For our momentary light affliction is producing in us an eternal weight of glory beyond all measure and proportion, because we are not looking at what is seen, but what is not seen. For what is seen is temporary, but what is not seen is eternal.  

These two beautiful passages present a picture of recovery. Good news, release, favor, comfort, joy and beauty in place of mourning and oppression. Renewal in the face of affliction. But what does this mean in real life? Does a “double portion” instead of shame feel like to a victim of sexual trauma? What does renewal and release feel like after a natural disaster? 

Prognosis for Complete Recovery?

If you suffer a serious knee injury requiring surgery, you will need time for rehabilitation. But rehab does not necessarily mean you will recover the full range of motion you once had, or that  your knee will be entirely pain free when you are finished with physical therapy. Your prognosis for recovery depends on many factors such as age, extent of injury, physical health prior to the accident, and availability of quality care. Even with the best care provided to top athletes, recovery may not lead to return to top form. For example, an Olympic skier may be able to ski again but not at a quality that allows for competitive skiing. 

What about the prognosis for spiritual and emotional recovery? Of course, just as in the knee injury example, the answer must be “it depends.” Still, considering the two passages above, words like liberation, joy, release, and renewal shape our imagination for recovery. Do we imagine complete recovery to top spiritual and emotional form, without pain and limitation? It appears to me that we sometimes imagine emotional and spiritual healing without taking consideration the reality of broken bodies and a fallen world. We are not guaranteed a pain free life or faith without distressing questions. In fact, Paul’s beautiful words in 2 Corinthians bear this out. afflicted in every way, persecuted, perplexed, persecuted, struck down, always carrying around death, burdened, groaning and more. Yes, he also says not crushed, not despairing, not destroyed, but alive. But both must be considered together at the same time if we are indeed to imagine our prognosis. Recovery means comfort and lament, joy in mourning, perplexed while trusting, dying yet alive. 

Sprouts of Justice and Recovery?

Isaiah describes sprouts of justice and righteousness beginning in the recovery of the oppressed (Isa 61:11). As a gardener, I see sprouts as the beginning of hope. After planting seeds, the tiny sprouts give me hope for a later harvest but that hope is still tempered with the knowledge of the challenge of getting sprouts to develop into fruited plants. I have to be vigilant about bugs, weeds, and drought. I need to cultivate and fertilize or my sprouts will not turn into much. And even if I do everything right, the seed may be weak or the weather may mean I only have spindly or stunted plants that cannot bear much fruit. Yet, the sight of sprouts brings the hope that empowers us to keep at the gardening work. 

So, what are these sprouts of justice and recovery that victims of trauma may first see that encourage hope and further empowerment? Consider some of these: 

  • Capacity to Name Truth and Justice

Recovery begins when oppressed people find words to name injustices done to self and other. For example, a victim of domestic violence may become well aware of the subtle signs of verbal and emotional coercion, long before any physical violence. They become the canary in the mine, aware of poison that others may not yet sense. 

As this capacity grows beyond a mere sprout, the person may be able to speak the truth aloud, even with courage to say it to leaders. 

As naming capacity grows, it moves from awareness of personal risk to capacity to notice and care for the injustices others experience

  • Accepting weaknesses without hopelessness

Part of recovery requires honest reflection of the damage done. Signs of recovery include the ability to recognize limitations and working within capacity without self-hatred (though there may be lament for losses of previously held abilities). When we truly accept the “new normal” we then can stop evaluating daily life from the perspective of who we used to be

As we accept our limits, we can then begin to see the opportunities we do have even within our limitations

  • Identify resilience and new capacities in the midst of struggle

There may be new capacities we never observed before (e.g., the capacity to speak up to power, the ability to withstand rejection, increased empathy for the pain of others). We now notice these resiliences and growth as they stand on their own

Though we will not call the suffering good, we will be able to identify blessings that we have received in spite of and as a result of the trauma experienced 

Be Careful Not to Damage the Sprouts

For those who are not attempting the impossible, to “move on” from trauma and abuse, it is good to remember that sprouts are tender and can be easily damaged with too much interference. You may need to leave a few weeds you see near the fledgling plants so as not to disturb their roots or bruise the green shoots. How do we do this to the sprouts of recovery? We may unintentional limit growth by questioning why the person learning to speak the truth isn’t doing it in a even-tempered manner. Sadly, too often those in domestically violent marriages are told to stop being so dramatic and to calm down when they begin to speak about the truth of the violence they have experienced. Or, we can point out the sins of the victim as if somehow their responsive sins eliminate their right to speak up about the trauma they experienced. Or, we can hear someone accepting brokenness and accuse them of not trusting God for complete healing. 

Nurture recovery as you would a tender plant. It is a scandalous act of grace! By paying attention to safety needs, by bearing witness to trauma, by being willing to lament and to stay connected, we provide a greenhouse for such plants to grow into levels of recovery never before dreamed of. 

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Filed under Abuse, biblical counseling, christian counseling, christian psychology, Christianity, counseling skills, pastors and pastoring, Post-Traumatic Stress Disorder, ptsd

Free Counseling Journal For Counselors


For my counselor readers, I want to let you know of a free counselor journal. Click here for free access with search capacity. It is published by NBCC and is open access to anyone who wants to try to stay current on counseling literature.

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Filed under continuing education, counseling, counseling science, counseling skills, Counselors

Criticism of Biblical Counseling: Are Joyce’s Concerns Valid?


Katheryn Joyce has recently published a long post about the rise of Biblical counseling and the concerns some have about the movement [read it here].

Most people who have thoughts about counseling and Christianity tend to fall into one of to categories: Those who oppose biblical counseling as dangerous and those who oppose the various versions of Christian psychology as shallow and full of humanistic ideology. Very few people try to maintain identity in both worlds. If you have read my “about me” you will find I’m one of those who does accept the label of biblical counseling and Christian psychology (more on this below)

I encourage both proponents and opponents of Biblical Counseling to read her essay. Let me even take the liberty to suggest some starting questions to keep in mind as you read. While the essay may not answer the questions, having them in mind will keep you from solidifying stereotypes of either sides.§ If you are inclined to reject biblical counseling, consider these questions:

  1. Where might I find a more thorough history of biblical counseling and its various permutations?
  2. What main biblical counseling author voices are missing in this piece? [Note that the mentioned ACBC was, until recently, known as NANC (National Association of Nouthetic Counselors)]
  3. What failures in Christian psychology movement(s) led to the need for a biblical counseling movement?

If you are inclined to defend biblical counseling, consider these questions

  1. Even if some of the bad examples of biblical counseling do not represent you or the heart of the movement, what aspects of the movement may support or encourage some of these distortions?
  2. How might you better communicate “sufficiency of Scripture” to outsiders?
  3. Does biblical counseling seek to eliminate symptoms or improve spiritual responses to symptoms? How might it better acknowledge the body when talking about the causes of mental health problems?
  4. Where does fear of “integration” hinder the maturation of biblical counseling as a movement?

Indeed, these questions have already been asked and answers given in a variety of locations. Readers unfamiliar with biblical counseling should start with websites such as this one, CCEF, ACBC, BCC, and the Society of Christian Psychology to find further and deeper readings on related topics.

Where the Concerns are Valid

Not acknowledging benefits from psychological research. Joyce notes that a good biblical counseling session looks a lot like a good professional counseling session. Why? Well, it is obvious that change happens best in the context of kind, compassionate relationships. Why the similarity? While it is true that psychotherapists didn’t discover empathy, it is true that psychotherapy research has expanded our understanding of the best way to encourage trust relationships in therapy. In addition, some of the cognitive, affective, and dynamic interventions developed from these models are used within biblical counseling. I have absolutely no problem from biblical counseling deriving benefit from interventions developed in other models of therapy. I only desire biblical counselors or acknowledge that benefit. It is clear Jay Adams benefited from Mowrer (and said so to boot). We can do the same. We can admit that Marsha Linehan has revolutionized our understanding of how we work with people exhibiting symptoms of borderline personality disorder.

Emphasizing false dichotomies. Joyce quotes Heath Lambert in this piece (near the end),

“I’m concerned [that] if we say, ‘Oh my goodness, people with hard problems need physicians and need a drug,’ we’re going to lose much of what the Bible has to say about hard problems.”

The quote above is in the context of dealing with difficult or serious mental illness. He worries that if the church creates two categories of problems (normal and special), those with serious problems will no believe that the bible has things to say about those suffering with suicidal ideation or schizophrenia. It seems that some biblical counselors take a negative stance on psychiatry and medical intervention because they fear doing so will hinder the work of the Spirit through the bible. I would argue that this dichotomy does not need to exist. I agree that the bible speaks to everyone, whether they are having difficulty or easy problems. I don’t think that use of medications or medical practitioners has to hinder pastoral care. The message that others get when we suggest that medical intervention need to be avoided is that somehow it is less spiritual to seek a medical intervention. This is patently false. Now, not every medicine is worth taking. Some may create more problems then they solve. But that fact should not cause us to lump all professional/medical care into the same category.

Where the Concerns are Overplayed

Heath Lambert gets it right when he claims that all counseling models will fail, due primarily to the quality of the practitioner. Biblical Counselors do much work that is commendable and successful. Joyce’s piece may suggest that most biblical counselors are ineffective and incompetent. This is not true. Matthew Stanford suggest he has never seen a biblical counselor do well with difficult cases. That may be the experience of my friend, but I can attest to seeing biblical counselors working well with people with serious personality disorders, delusions and other difficult mental illnesses. Now, the truth is, these counselors have succeeded because they did not follow the stereotype and reject learning from professional psychology. Further, these same counselors did not take “sufficiency” to mean that they could only use the bible in considering how to respond to their clients.

Take a moment and read her piece. Review the questions above and keep an open mind to both sides of this story.

[§ I have written on the relationship between Christian psychology and biblical counseling in the Journal of Psychology and Theology, volume 25, 1997. You can buy that essay here.]

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Filed under CCEF, christian counseling, christian psychology, Christianity, counseling skills, Psychiatric Medications, Psychology, Uncategorized