Category Archives: counseling skills

August 18, 2009 · 7:35 am

Cultural sensitivity or watered down


Having been in meetings yesterday and today about our next steps regarding counseling training in Rwanda, I’m wrestling with the best way to address cultural differences in whatever training we do. And specifically I’m wrestling with a particular dilemma forming in my mind:

Teach what we know about counseling NOW but be unaware of subtle but important cultural differences vs. listen, learn, and teach LATER what we know (but in culturally relevent terms)

It is not the first time that I have been asked to do something sooner rather than later with these words. “Don’t worry about the cultural relevance. We’ll tell you when something doesn’t work or our students will do the application to their own situations. If you try to be culturally sensitive, it will end up being watered down. We want our students to get the best education, something that the US would recognize.”

Why do I struggle with this request? Well, in my head it sounds like, “hey, come bring your colonialistic methods of evangelism and we’ll handle it.” I struggle with it because I know American counseling culture has significant problems with it. And, I struggle with it because I know that some students (this is a universal truth!) are really good at critical thinking while others blindly ape what we say without much thought at all. AND YET, I know that waiting until I’m culturally aware enough to teach means I wouldn’t do so for a very long time.  

So, part of my struggle is not wanting to look like a culture boob by just assuming that what I teach US students is what Rwandans would need. I suspect the answer is (a) being courageous enough to risk looking like a fool, but (b) flexible enough to change on a dime when I am aware of a disconnect.

Hmmm. I may have a problem with both.

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August 10, 2009 · 9:54 am

Happenings


I’m passing on a couple of items from my schedule…

1. Speaking. I’ll be speaking at Macedonia Baptist Church (Norristown, PA) on the next two Wednesdays (8/12 and 8/19) for their Summer Bible Conference (theme: Mental Health Awareness). This week will be on Sexual Addiction and the 19th will be on the topic of Anxiety.

2. School. We start late this year on 9/14. For those interested in our course offerings, check out Biblical’s site for course listings. Note that we have entry level, advanced, and post-MA courses on Monday nights. I’m teaching an on-line course (Social & Cultural Foundations of Counseling) and two face to face classes (Counseling & Physiology, Psychological Assessment). Should be fun!

3. Conference 1. The AACCis hosting it’s World Conference in Nashville Sept. 16-19. My colleague, Bryan Maier, and myself will be speaking there. On the 16th, Diane Langberg and myself will be presenting a 3 hour preconference workshop about addressing the problem of pastoral sexual abuse. Later in the week, I’ll be lecturing on the use of the Bible with trauma clients.  If you like zooy places, then come as that is the best description I have for the Opryland Hotel.

4. Conference 2. November 13-15 is the annual CCEF conference, entitled, Sex Matters. I’ll be presenting on the 14th, “When Sex in Marriage Doesn’t Work.”

5. Newly published. The latest issue of the Journal of Psychology & Christianity(v. 28:2) is just out on the topic of Theophostic Prayer Ministry and related issues. I and my George Schwab have an article in that edition: “God as healer: A Closer Look at Biblical Images of Inner Healing.” Plus, a number of the other articles site previous work that Bryan Maier and I did a few years ago where we critiqued TPM’s theological bases. 

6. In the works. I’ve just completed work on a booklet, “Sexual Addiction: When is Residential Treatment an Option?” It is intended to be an ebooklet published by a local ministry. We are researching the best way to publish such a booklet for those caught in the trap of an addiction. If any of you have any great ideas for the best way to get that out on the Internet (including issues around document delivery, sales, and pricing), I’d love to hear about it.

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Filed under "phil monroe", Anxiety, christian counseling, christian psychology, counseling, counseling skills, sexual addiction, teaching counseling

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August 6, 2009 · 5:15 am

Most common sexual dysfunction?


I’m doing some prep for a November talk at CCEF‘s annual conference which I am entitling, “When sex in marriage doesn’t work.” I’ll be giving a brief overview of how counselors can be a help to couples facing sexual dysfunction (whether biological, psychological, or relational). But in my prep today I ran across this little telephone survey result from 2002 where callers asked married men and women between the ages of 40 and 80 about their most frequently experienced sexual problem.

Any guesses yet?

For men, 26.2% reported problems with “early” ejaculation. [No definition given for “early.” Usually early or premature means earlier than he wanted.] Another 22% said the problem was ED. It is interesting that we are bombarded with ED commercials but I can’t say that I’ve ever seen PE treatments advertised in mainstream media. This is probably due to the number of baby boomers with cash seeking to turn back the hands of time.

For women? No surprises. 33% report problems with interest/desire and nearly 22% report problems with lubrication.

Did the respondents seek help? 75% had not.  Another study of men after prostate surgery reveals that those who do seek help quit soon after. Seems that while there are a number of medical and psychological interventions that can help to a degree, nothing turns back the clock to one’s twenties.

A caveat. The researchers only got a 9% response rate for their random calls. Why didn’t more participate? Did those who participated have more or less problems than those who refused?

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June 4, 2009 · 10:18 am

Biblical Seminary Summer Offerings


Every summer we have a summer counseling institute where we offer electives for current students, alum, and other interested parties (graduate counseling credit counts for required CEUs!). This summer we have three fabulous offerings!

1. **ON-LINE** Models of Counseling(2 credits) by Dr. Bryan Maier. From 7/6 to 8/31. This class has NO on-site time. If you have ever wanted to study the historic models of counseling from a Christian perspective this class is for you. Bryan really understands the basics of these models, offers great insights and careful thinking. Plus, Bryan’s material includes narrated PowerPoints and short videos made to stimulate your thinking. 

2.  Theology of Suffering & Disability(2 credits) by Jerry Borton and Kevin Kain. Class meets two weekends (7/10-11, 7/24-25). Jerry works for Joni & Friends and both Jerry and Kevin have intimate understanding of Cerebral Palsy. This is not, per se, a counseling course but open to all who want to think biblically about suffering and disability and apply that to their counseling or ministry practices.

3. Counseling Victims in the Criminal Justice System(1 credit) by Jenn Zuck. Class meets one weekend (August 7-8). Jenn has tremendous experiences working with victims of abuse and crimes in the justice system. Sadly, the church has not supported these individuals as it could have (I have heard several Christian prosecutors tell me that they have yet to see a pastor come in support of the victim, but many times observed the pastor supporting the alleged perpetrator). If you don’t live in the area, consider a visit. Class meets Friday night and Saturday. Philadelphia is a great town to visit!

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Filed under Abuse, biblical counseling, Biblical Seminary, christian counseling, christian psychology, counseling, counseling and the law, counseling skills, education, seminary, suffering, teaching counseling

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May 29, 2009 · 5:51 am

I’m not worthy…


…to be on the same page as David Powlison and Mike Emlet! Check out CCEF’s home page. They have the audacity to put my mug up there (advertising next year’s annual conference) right next to David. That should never be!

Fun.

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May 22, 2009 · 8:49 am

Physiology Phriday: Side Effects of Meds


In a perfect world, our medicines would fix our problems and not create additional ones. Sadly, we don’t live in that world. Antidepressants may induce weight gain, foggy-headedness, flatness, impotence–things that wouldn’t necessarily make one feel better. Stimulants create problems with weight loss, rebound agitation, even tics in some individuals. Pain meds may create dependency.

Some encounter the side effects of psychotropic drugs and decide to tough it out. Others play around with dosages (on their own). Still others keep trying to find that right compound. All of it creates work. As a counselor, it is wise to monitor med compliance, dosage changes (doctor approved or otherwise) and side effects. Given that most clients see their medical doctor or psychiatrist only once every 6-8 weeks, do not assume they’ve talked to anyone or are still on their medications. Make sure to also ask how they feel about the meds as this may change. Even though the counselor isn’t in charge of medications, counseling issues related to the medication and the feelings about it surely are our domain. One clear benefit to our “med checks” is that we can help them get the most out of their 15 minutes with the psychiatrist by zeroing in on what they should talk to the doc about.

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Filed under christian counseling, christian psychology, counseling, counseling skills, Psychiatric Medications

May 19, 2009 · 10:19 am

Dialog between Christian Psychology and Biblical Counseling


Yesterday Robert Kelleman made a comment on an old blog post of mine about my model of counseling. In that comment he said the following:

Your readers might find of interest my summary of last week’s symposium on biblical counseling where Eric Johnsons (SCP), myself (BCSFN), David Powlison (CCEF), and Steve Viars (NANC, FBCM) discussed with Jeremy Lelek (ABC) the state of biblical counseling/Christian psychology:

http://tinyurl.com/r8kf7r

To me, true biblical counseling and true Christian psychology should be the same thing. They use biblical psychology (understanding people, diagnosing problems, and prescribing solutions) theory to guide their biblical counseling (sustaining, healing, reconciling, and guiding) practice.

Bob Kellemen

The link takes you to Bob’s own site and has links to christiancounseling.com where DVDs of the dialogue will be available. It is good to hear of the unity among these cousin models of counseling.

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May 11, 2009 · 1:27 pm

Practicum Monday: Learning counseling skills from videos


Counseling education includes the usual academic exercises as well as hands-on practice. There is no substitute for the practice piece. But, videos can provide students with good illustrations of various counseling activities, styles, processes, etc.

But which videos to watch? The classics (masters in unstaged vignettes)? Training videos (usually staged with actors)? One of the first videos I ever saw was of Salvador Minuchin at the Child Guidance Clinic. There he was in a room, unashamedly smoking a cigarette, and manipulating (in the best sense of the word!) a family with an eating disordered girl. I was taken with his larger-than-life presence in the room and his ability to be irreverent. Needless to say, I could never emulate him. In fact this video that I loved made me wonder if I had what it took to be a therapist.

Last week and this week the practicum class has been viewing Mark McMinn’s christian counseling video produced by APA. One ought not expect the APA to be up on Christian counseling (and its many varieties) but this video is useful for many reasons. First, Mark illustrates a relational style of cognitive therapy and so what he does in this first session is usable in almost any method of counseling. Second, the counselee is not an actress. She is a real person with real concerns (which students relate well to!). Third, Mark doesn’t merely focus on her problems but does a great job highlighting her strengths and resources. Finally, Mark isn’t a big personality–meaning we can all see ourselves doing what he does.

We use mock vignettes as well. I participated in making some mock counseling videos at Regent in Virginia Beach. Mock sessions tend to focus on discrete skills and are better in 2-3 minute vignettes rather than full sessions, and for beginning students rather than those about to graduate.

If you ever took a counseling class that used videos, what counseling videos did you watch and were they helpful?

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May 5, 2009 · 5:54 am

Rwanda!


My on again off again trip is now on. I have tickets and yesterday I got my shots! Our small group of psychologists (4) will be leaving on June 22 and returning July 1. We will be going as the guests of the Right Rev. Alexis Bilindabagbo, Anglican Bishop of the Gahini diocese. You can learn a bit about him here.

We will be meeting with pastors, government officials, victims, and perpetrators of the 1994 genocide. Our goal is to immerse ourselves into the culture to learn how best to provide trauma training and counseling education at the graduate level for pastors and key leaders of the church right in Rwanda. While we know quite a bit about trauma and counseling training, we wish to avoid the mistakes of assuming we know best what this particular people need and what works within their cultural milieu.

I hope to be able to give you more details as the time approaches and to blog from Rwanda when I have Internet access.

FYI, each of us are paying our own way. Some donors at Biblical Seminary gave generously to underwrite a small portion of the trip. Further, the American Association of Christian Counselors is helping to sponsor this trip. So, if someone wants to give to the trip, I’m sure we can find a way to provide you a receipt for tax purposes :). Email me at pmonroe[at] biblical [dot]com and we’ll figure it out.

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May 4, 2009 · 1:26 pm

Practicum Monday: counseling mistakes?


I’d like to compile a list of mistakes mostly likely to be made by novicecounselors. In the past I’ve written on some of the mistakes or foolish behavior of counselors and some of you have helped contribute stories like the counselor who fell asleep during the session, the counselor who ate a meal, who tried to set the counselee up with a son or daughter, the counselor who took phone calls, etc. Most of these mistakes wouldn’t be made by the typical counselor, even one who had never counseled before.

So, what are the most common mistakes of the novice counselor? Not sure, here are some I’ve observed:

1. Failing to collect enough data during the first sessionto assess matters of suicidality or mental status. Novice counselors tend to either drill too deep on one topic (and so miss other important matters) or stay on the surface and fail to ask questions they think might embarrass the client

2. Promising too much. We want the client to have hope and we hope they don’t see us as novice, so we promise the world. Such temptations lead sometimes to offering our phone number to call at all hours, to agreeing to meet outside of sessions, too allowing sessions to go beyond the planned limit.

3. Encouraging. Beginning Christian counselors sometimes fail to let the counselee sit with their pain. Instead, they trot out verses to comfort and encourage. Often, these passages fall flat without their intended result.  

4. Writing too much. Progress notes may look like novellas. When you don’t know what is important, everything is documented.

5. Going along with the parents. Novice counselors often seen kids and their parents. It is easy to become railroaded into allowing the parents to use the session to gang up on the kids. Novice counselors have a hard time managing the parents and the kids in the same session.

What mistakes did you make? Did you experience at the hands of a novice?

When I started, I hated the question about my age (I was 24 but looked younger). I tried all sorts of creative ways to illustrate my experience and to be vague about my actual age. I’m sure I never convinced anyone. They stayed because they didn’t want to start over. I should have just said (nicely), “your right, I’m young. We can either find you another client now or we can try the following intervention and if you don’t like what I’m doing, we can find you someone else then. What would you like to do?”

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