Category Archives: counseling skills

October 15, 2010 · 1:02 pm

Save the Date! March 17-19 2011


Dr. Diane Langberg and Bethany Hoang (IJM) will be doing our next Conversations with Christianity and Culture seminar March 17-19, 2011 on the topic of sexual abuse in the christian community. They will also be speaking about sex and human trafficking.

This is a free conference at Biblical Seminary. I’ll post on-line registration information here when it is available but I’m tell you this now so you get it on your calendar.  You won’t want to miss their presentations.

We expect to offer CEUs for mental health providers for the conference (probably very nominal fee) and academic credit too (in the form of ind. study) for those wanting to do some further work on the topic.

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October 12, 2010 · 4:34 pm

Skype counseling? Know of anyone doing it well?


I recently set up an acct with SKYPE to participate in an upcoming meeting. I’ve had past requests to use SKYPE in counseling people unable to come to the Philadelphia area. While I’m open to doing this (at least for brief consultations), there are a number of issues to resolve. I’m interested in hearing from readers having used it for counseling (feel free to remain anonymous). What was it like? How were confidentiality and informed consent handled? Was any mention of jurisdiction mentioned? Not sure what I mean, read on to consider these issues:

  1. Confidentiality & Privacy. Are SKYPE video conferences really private? What is the likelihood that someone can tap in?
  2. Informed Consent. Read any good Telehealth informed consent forms lately? Seems that you have to consider how to deal with crises that might be happening in another state. Insurances cannot be used. What about what files are maintained? I believe it is possible to record SKYPE calls.
  3. Jurisdiction. It is clear that licensed mental health practitioners must not practice in another jurisdiction (i.e., state) without getting licensed or approved for that jurisdiction. But what about consultations? What about Internet based interactions? Which state has jurisdiction? Some seem to think that the state of the “caller” is going to want to maintain control of the care of its citizens. Others think that informing “callers” that the point of service resides with the Counselor will be enough. Check out what they say at eCounseling.com.

This is what is known as a “Point-of-Service” issue. In our terms of service which both clients and counselors agree to upon eCounseling.com sign up, it states the following in section 5.8: 5.8 POINT-OF-SERVICE. For a client who resides outside their eCounselor’s state of residence and professional licensure, there is an important issue that should be understood by clients before counseling begins: By utilizing these counseling services, the client agrees that he or she is soliciting the services of a professional outside of his or her state of residence. By doing this, the client agrees that the “point-of-service” of counseling is to occur in the counselor’s state of residence and licensure, not the client’s. In essence, the client is using the telephone or the Internet (the “information highway”) to virtually travel to the counselor (the counselor’s state of professional practice). Hence, counselors are accountable to and agree to abide by the ethical and legal guidelines prescribed by their state of licensure and residence. By agreeing to solicit the counselor’s services, the client agrees to these terms. If you do not understand, or have any questions regarding this issue, please feel free to ask the counselor about this issue, or contact eCounseling.com support at support@ecounseling.com DISCLAIMER: The above should not be construed as legal advice. If you have questions about legality or liability, please contact a qualified legal professional.

What do you make of these issues?

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September 21, 2010 · 4:00 pm

Coming to Peace with Psychology 4


Worthington’s Relational Model of Integration

**In case you are tempted to snooze through this long post or get bored by the endless attempt to construct a relationship between psychology and christian faith, skip to the last paragraph!**

In the conceptual world of integrating psychology and Christianity, there are four common depictions: Christian faith trumps psychology, psychological science trumps Christian faith, dialogical model, and parallel but separate levels of explanation. In Coming to Peace with Psychology (IVP, 2010), we have seen in the previous two posts that Everett Worthington wants to argue that psychological science (a) has something to offer beyond theory, (b) can teach us something about ourselves and God that Scripture does  not reveal, and (c) can interact with, influence, and be influenced by Christian faith. In sum, he argues for a relational, interactive levels of explanation view of integration.

Beginning in chapter six, he lays out a relational model, akin to a deepening love relationship,

…the fields of Christian theology and psychological science will become more committed to each other to the degree that we are satisfied with the union, invest in the union and don’t play around with alternatives (such as a conflict model). I believe that, in fact, psychological science and Christian theology are already married. In some ways it is like an arranged marriage. Because God reveals the divine character through both special and general revelations, the two disciplines are joined together. The question we face is, how committed will each discipline be to this arranged marriage? (p. 101)

In chapter seven and eight, Dr. Worthington digs deeper into the proposed relationship partners (psychological science and theology) and illustrates each domain’s way of collecting “data” and subsequent conflicts between the two. Psychological science deals in the realm of material.

Scientists can believe in many nonmaterial causes within reality but simply exclude them from the “map” of a particular science. They do so because, by convention, that science aims to explain materialistic relationships among variables. By analogy, an aerial photograph will not reveal the presence of an underground river…even though the photographer knows [it exists] (p. 107).

This material (data) is best collected using observational, correlational, and experimental methods. He acknowledges (ever so briefly) limits to these kinds of studies, especially alluding to the biases inherent in psychological hypotheses. Moving on, he reviews the nature of theology, its subsets (biblical, exegetical, historical, etc.), and methods reading its “data.” Finally, he reviews the relationship between the two. “At their root there is no conflict between God’s truths as revealed in Scripture and nature” (p. 115). However, both disciplines suffer from human error (e.g., errors in scientific conclusions, errors in translating or interpreting Scripture) and so he does not want to prioritize theology over psychology (the primary reason for this book—to correct what he sees as a mistake within some in Christian psychology).

What is the real problem between psychology and theology? In chapter eight, Dr. Worthington points out three problems that lead to unnecessary perception of conflict between the two disciplines:

  • trying to integrate clinical psychology and theology (rather than psychological science)
  • using a filter approach that presupposes a higher authority given to theology
  • denial that one can learn about God through nature by some Christian thinkers

While not devaluing clinical psychology, Dr. Worthington does not believe it to be “apt relational partner” to theology (though maybe more helpful to practical theology). Why? He lists a couple of reasons: clinical psychology is anecdotal, experiential and therefore not objective; clinicians may be more prone to having less theological training while pastoral counselors may have less than adequate knowledge of empirically supported treatments; therapists view people through their models rather than seek to construct data informed models.

Next he goes after Eric Johnson for his views on Scripture. Worthington wants to take Johnson to task for failing (his perception) to admit the weaknesses within human activities of theology and the interpretation of Scripture. While Johnson wants to argue for the uniqueness of biblical authority in Christian psychology, Worthington wants to argue for the ability (albeit limited) of general revelation to reveal surprising information about the nature of persons—even to those who reject Christian faith. I suspect that both agree with the other but see an imbalance (not enough credit given to Scripture re: human nature vs. too much credit given to Scriptural interpretation and not enough acknowledgment of disagreement amongst Christians).

Finally, Worthington concludes this chapter by summarizing his view of the impact of sin on science. His main point is that he is opposed to a Dutch Reformed emphasis on the noetic effects of sin. He quotes passages that state that nature communicates about God and the humans are therefore responsible for knowing God. He does not believe, however, that nature is sufficient in telling us about God and so we need Special Revelation for salvation. In the end, he wants mutual respect and humility to reign between experts of each domain in order to promote harmonious dialogue and learning.

A Challenge

In the remainder of the book Dr. Worthington intends to illustrate what psychological science has to offer the “marriage” between the two. Books like this are written to try to bring balance to what is perceived to be imbalanced. Here, Worthington thinks too little credit is given to researchers’ ability to perceive human nature in ways that might reveal new things about the nature of God and humanity—things beyond Scripture. In another book, you might find more criticism of the biases of psychological research and the failure to acknowledge the impact of belief systems on data collection and analysis. Notice both sides are reacting against a perception of bias and control.

Here’s the challenge. Whether you lean toward Worthington’s arguments or those that give priority to Scripture and the Christian faith, consider where your views might be shaped by (a) experiences of being mis-represented by someone on the other side, and (b) too easy use of an obvious error on the other side (e.g., Worthington seems to brush over the problem of presuppositional biases in science or gives general revelation too much credit when Rom 1 tells us that humans deny its message well; Johnson seems to brush over numerous biblical interpretation conflicts, fails to interact deeply with current psychological research). Instead, see if you can build your view by first detailing the weaknesses (or mis-uses) of your discipline or view and then construct a proposed relationship from a positive framework that accounts for the aforementioned weaknesses rather than builds off of the mistakes of your epistemological opponent.

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August 16, 2010 · 10:33 am

Counseling those with chronic conditions


My friends and colleagues here at Biblical Seminary–Jenn Zuck and Bonnie Steich–are teaching a class this weekend about the role of counseling in helping those with chronic conditions. Need CEUs anyone? Info here.

This is such an important issue given our increase in capacity to manage or maintain life with chronic conditions. Some cancers now are more like chronic conditions. HIV can be a chronic condition. And of course there are the more well-known problems such as MS, chronic fatigue, fibromyalgia, neuropathy, diabetes, liver dysfunction, etc.

How do you respond to those who seem to be struggling with a long-term condition? Especially when the condition is vague and not visible to the eye? Do you get worn out comforting that person?

I just read a study where they assessed whether major life events or daily hassles were more negatively impacting chronic pain conditions. It turns out that daily hassles increase chronic conditions symptoms far more than do major life stressors. It makes sense but also challenges us to consider how we might overlook the “normal” life of counselees and secretly want them to stop their whining and complaining about how hard it is to …

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August 13, 2010 · 5:58 am

Who diagnoses ADHD? Comments on CNN story


CNN has run a story on the issue schools/teachers encouraging parents to get their child tested for ADHD and on medications. You can read it here. The writer quotes a doctor complaining about teachers who suggest diagnoses and treatment. Then parents go to their doctor and ask for meds to treat something that has yet to be properly diagnosed. Being a psychologist I am sympathetic with the Doc–but only to a point. True, many people fancy themselves as experts because a family member or some other experience with a mental health diagnosis. And so, whenever they see something that reminds them of it they talk as if they had done a thorough assessment. The Doc goes on to point out other problems that may create similar symptoms (anxiety, abuse, learning disabilities, etc.)–thus the need for professional evaluation.

But that is where my sympathy ends. Teachers do have front row seats to child problems. We need them to speak up. Yes, they needn’t throw out diagnoses as if they are experts. But we do want them to let parents know that something might be up and the need for further evaluation.

So, who should diagnose? Yes, ADHD is considered a medical diagnosis. But, counselors and psychologists are just as capable of making the diagnosis–sometimes even better.  If a Doc (psychiatrist, physician, etc.) makes the diagnosis, 9:10 times it is on the basis of 30 minutes to 1 hour of an interview with parent and child along with a physical examination. For most people with the symptoms, that is probably enough. However, most psychologists will collect data from 2-3 sources (parent, teacher, church) using interviews, checklists, psychological tests, and even computer based assessments. That kind of assessment may be more capable of ferreting out subtle learning disabilities or learning differences as well as developing a plan of action for changing the environment (school plans (IEP/504), parenting strategies, etc.

It is interesting that the article makes no mention of the use of counselors in this process.

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July 27, 2010 · 5:54 am

When helping harms


Just before vacation I caught a PBS television show on how economic development (funded by international aid) often ends up hurting while trying to help. Here’s a link to the documentary website. The show covers two areas of Kenya and the pros/cons of trying to raise the living standards of those who live there.

This is not a new problem and reminds me again that there is a book I need to read (When helping hurts).

As a counselor who has traveled to Africa to try to help, I am very interested in finding appropriate methods to provide emotional support and care to traumatized peoples. What are some of the ways we counselors might unintentionally hurt those we want to help?

1. Pressuring clients to do something we think is important (e.g., stand up for yourself, say no to a violent spouse, speak the truth about your abuse, etc.) without considering the consequences. I once read about some African women who sought counseling for rape. Problem was that by going to the rape counseling center, they communicated to their village that they had been raped–and were later killed for being defiled.

2. Assuming that counseling can only be done by licensed professionals. We could train counselors in another country but if these folks couldn’t get paid to counsel because their clients are all subsistence farmers, we have only created additional frustrated individuals.

3. Similar to the last point, if the trainers are all westerners, then they will likely fail to understand culture specific resources/challenges and may reinforce the assumption that only westerners are competent to provide the care.

What are some other ways you have seen western counselors unintentionally harm the helpee?

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July 12, 2010 · 1:48 pm

Emotional Arousal: Too much or too little?


I am doing some prep for my upcoming class on the treatment of Borderline Personality Disorder (BPD). [Links: summer institute brochure, and CEU information for LPCs] Many theorize that BPD is really a problem of emotional (over) sensitivity resulting from a combination of psychological factors (trauma, loss, attachment injuries, or chronic invalidation) and biological predispositions (high base-line emotional experiences, slow return to baseline once activated, and chronic and inappropriate scanning environment for danger).

If a person is prone to intense emotional experiences, they are likely to get the message that their emotional expression is out of line. Thus, they may either try to avoid emotions (leaving them less aware of how they feel and maybe more likely to be taken advantage of) or give in and respond out of their full expression (leaving them less likely to be able to solve the problem given their high state of arousal).

Are you a person of high emotional arousal? Do you know or live with one? Do you struggle with thinking that high arousal is wrong? Theoretically, most of us do not think strong emotions are wrong. But practically those who experience their own intense emotions and those who live with them do think they are wrong. “I shouldn’t feel this way…she shouldn’t feel that way.”

Counselors do not seek the goal of eliminating or even tempering emotions. What they seek is to avoid the “why” or “because” that often follows the strong feelings. It appears that the big problem is not the feelings but the beliefs and interpretations that one holds during and after the emotional experience. I feel this way because…(I’m stupid, a loser) or because…(others hate me) leads to cementing emotions and beliefs together in such a way that lead to more easily experiencing invalidation.

Looking to get into this a whole lot more in a few weeks (July 30-31)!

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June 22, 2010 · 4:40 pm

Christian interventions in counseling


Regular readers of this blog will know that I believe that Christian counseling is not merely counseling done by Christians or merely the use of specific christian interventions. Rather, Christian counseling is founded on Christian/biblical ways of perceiving the world, the problems in it, and the goal of imaging Christ from start to finish.

However, it is good to think about the specific use of certain christian practices in counseling: meditation, prayer, bible reading and application, casting out demons, absolution, etc. How are we to think about these practices? Do they have a place in professional counseling? What are limits we ought to place on them? When should we refrain? How do we secure informed consent?

Elsewhere I have published on the guidelines we ought to consider when using Scripture in counseling. I will not repeat them here but for those who have not read that article, I do think Scripture is something that CAN be used in counseling–even OUGHT to at times. What is of more importance to me is HOW and WHEN and WHY.

Let me here consider the most commonly used practice: prayer. Here are some shaping values before we consider any practical application.

1. Prayer is talking and listening to God. It is not a technique and should not be treated as such. It is not magic. It is, from a Christian perspective, sharing one’s heart, praising, questioning, interacting with the Creator of the universe who remarkably wants to relate to me. At its heart prayer is submissive acknowledgment of God–even when praying like Job.

2. Prayer then needs to be a free act without trace of coercion. The one praying must not be coercive (you talk to God not at another person). The one being prayed for ought not feel obligated to say anything.

3. People have diverse (and not always happy) experiences regarding prayer, faith, relationship with God, etc. So, what is comforting to you may be triggering for another.

4. Prayer is intimate. Prayer often results in our setting aside defenses and becoming vulnerable and needy.

5. Prayer is power. Praying for someone gives the one praying a position of power.

So, how might a counselor consider these values and use prayer in counseling.

1. Assessment of client. What is my client’s faith tradition, experiences with prayer, history of abuse by leaders of the church, understanding of God? Have they ever felt coerced to pray, coerced by the prayers of others? Have they been publicly prayed against? Do they value prayer?

2. Assessment of self. Why am I praying for my clients (out loud)? What messages am I trying to communicate? What do my prayers reveal about my own faith?

3. Consent. Have I explained why I pray for my clients? Do they really have the right to say no?

4. Review. How are my prayers received? What impact, if any, do they have?

What does this look like for me? I don’t pray with every client. I don’t choose to start my sessions with prayer (at least the first one) until I have a better sense of my client’s experience with prayer. I work very hard not to use prayer as an effort to disarm (though I think it can do this) or to preach a message, but only to make supplication to God for healing, for care for the downtrodden. When I use imagery in prayer I make sure that it is grounded in common biblical images (God as shepherd, Christ as lamb, etc.). I never ask clients to pray but many of them choose to do so. And, I do let clients pray for me when they want to. It is part of how believers care for each other.

I do believe that prayer is extremely important but that I do not need to do it to be actively asking God for healing or guidance. I will say that when conflictual couples pray, they often find that it is hard to stay angry and embittered and pray. It can be helpful, either in reducing bitterness or by discussing bitterness and its impact.

It should not be used when clients do not want it, might be confused by it, or if it is not authentic to the counselor. It is considered good professional ethics to utilize resources from a client’s life. However, it would not be good to fake (e.g., my praying in a way that would please a member of a cult, an atheist praying as if he or she believed what she said, my talking to God even though I am no longer practicing as a Christian, etc.).

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June 18, 2010 · 10:04 am

Check out a counseling office designed just for kids


Check out this video of Julie Lowe showing off (in a good way!) her counseling office designed for counseling kids. Julie is at CCEF and an adjunct at Biblical Seminary. She is a Licensed Professional Counselor (LPC) and trained in play therapy. Here’s the link. [Link was broken, now fixed]

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June 17, 2010 · 5:41 am

Looking for summer education?


My school, Biblical Seminary, has a variety of summer classes, from on-site intensives to weekend only to totally on-line. Click the link if you are trying to figure out what enrichment you will pursue this summer. The page that pops up will list both classes and free events. Those of you looking for counseling CEUs may be able to get credit too!

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