Category Archives: counseling skills

April 24, 2009 · 2:16 pm

Physiology Phriday: Depressed? Check your thyroid


One of the most common mistakes made by counselors is to forget to encourage their clients to get specific medical work-ups. There are three key reasons for this problem.

1. Most clients describe their struggles with causes already in place. “I’m depressed because I have a bad marriage, because life isn’t going the way I had hoped.” We counselors accept their initial diagnosis and fail to dig further.

2. We know that counseling works. And so we help them work on their thinking, feeling, and behaviors. We do what we do best

3. When we do send someone to the doctor, we rarely get a clear answer.

Nonetheless, it is essential that your clients have had recent blood work. Case in point. Low thyroid levels often leads to experiences of confusion, mental dullness, and depression. (FYI, overactive thyroid may lead to irritability and anxiety). While there may be real counseling work to be done (everybody needs some help), it would be a tragedy to miss real mercy care (i.e., a better functioning thyroid).  

Check here for some info on hypothyroidism: http://www.endocrineweb.com/hypo1.html

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April 21, 2009 · 11:59 am

What is a competent counselor?


Today, I begin an introduction to pastoral counseling class for MDiv students with my colleague Jenn. In six short weeks we will expose them to biblical foundations of understanding people and their problems, the basic helping skills, and provide them opportunities to practice on each other.

So, what makes for a competent counselor? There is a famous book on this topic. Jay Adams focuses in his landmark, bulldozing book on the problems of secular psychology and the need for a new understanding of how people change that fits with Scripture and a confidence that all people, especially pastors, are capable of leading others to change.

Important work, but misses some of the nuances that we have now about Christian models of change. For some of my thoughts on a more robust model of counseling that I seek to impart here at Biblical, see this post from several years ago.

But I want to focus here on the talents or capabilities of the counselor. And here I list 7 factors needed to be a competent counselor

1. Spiritual maturity. Not only must the counselor know the bible, its story line, etc., they must also have understood and experienced the Gospel, show a maturing trajectory towards holiness and awareness of the diversity within the Christianity. In the words of one of my theology colleagues, they must know the difference between dogma and doctrine and opinion.

2. Self-awareness/insight. One can be spiritual mature, but not particularly insightful about the self. The competent counselor has a grasp of their own narrative (and how the Gospel story is changing it) and how it impacts past and present relationships. The competent counselor understands strengths and weaknesses and is not defensive.

3. Capable of building trusting relationships. Nothing much good comes from counsel provided by standoffish and stand-above kinds of counselors. The competent counselor is able to build trusting relationships by being interested in individuals (more so than in outcomes), able to walk in another’s shoes, cross cultural lines, and able to empower others more than tell others what to do

4. Flexibility in response styles. The competent counselor understands the need to use a variety of conversational responses depending on the needs of the client. This means sometimes questions are appropriate, other times silence. Other responses include reflections, summarizing, focusing, confronting, joining, problem-solving, self-disclosing. Counselors who only use one or two of these styles will not be able to work well with clients who find those particular styles problematic. The competent counselor is intentional in her or his choices of responses.

5. Assessment and Hypothesis skills. The competent counselor is able to move from their counselees problems and descriptions to a wider view of the person and their situation and back again. This counselor is able to pull multiple pieces of data into a cohesive understanding of the situation. In doing so she forms and tests possible hypotheses that clarify motivation for behavior as well as point to interventions. For example, is the child’s behavior merely rebellious or is it ADD or anxiety based?

6. Observation skills.The competent counselor not only understands people, their needs, solutions, and has the capacity to use multiple response styles, but also is observant regarding their own impact on the counselee. They observe subtle reactions form clients and seek to moderate their counseling style and/or gently explore the meaning of the reaction. Without these skills, the counselor blithely works toward a goal without knowing if the counselee is really following.

7. Ability to care for self. Finally, the competent counselor recognizes personal limits, boundaries and actively seeks to sustain a life of personal care. Far too many counselors confuse sacrificial giving with bypassing appropriate care for one’s own spiritual well-being. Just because one is spiritually mature one day does not mean such maturity is permanent. Neglecting personal care will likely diminish all other counselor competencies over time.

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April 20, 2009 · 11:03 am

Practicum Monday: The green counselor


No one wants to be a green counselor. “Hi, I’m an intern and you are my first counselee.” Who wants to say that? Also, no one wants to entrust their most significant problems to a green counselor. “I see you haven’t any experience, so let me expose my most tender parts to you and see what you can do.”

Houston, we have a problem.

Every counselor has to get their start somewhere just as every surgeon cuts a live human being for the first time. Young single folk counsel conflict-riddled married individuals or offer parenting advice while not yet a parent. Individuals with no history of addictions sit with folks in their 10th inpatient stay in a treatment center.

Is there any way this goes well? YES! Let me tell you why going to an intern with a good supervisor is good, even sometimes better than getting a seasoned counselor by them self.

1. You get two heads instead of one. Even if the supervisor is not in the room, you get a young, determined-to-do-it-right counselor and a supervisor on his or her toes (who loves to teach and wants nothing bad to happen) thinking about you and planning carefully. They talk about the intricacies of your situation at great depth, they consider the options, and carefully review the outcome. If you only have a seasoned counselor, they may perform better (relationship wise) in sessions, but they probably aren’t thinking as critically as they could. I can attest that I am thinking much more carefully about clients during supervision (as supervisee or supervisor) than when I am not there.

2. Book knowledge actually does help. The further a person gets away from textbooks, articles, etc. the more they rely on old knowledge. Teaching counselors and green counselors are fresh from their reading and thinking about key problems. For example, the student having just completed an ethics course will be more sensitive to boundary violations than the one who has grown accustomed to thinking they will always do the right thing. Sometimes resident doctors are more aware of subtle health issues because they are running down every article to learn and running down every symptom.  

Now surely a seasoned counselor provides many good benefits. Working with an intern or medical resident often takes longer to get to a good outcome. They just aren’t as fluid. They are still learning–learning on you. A seasoned counselor will make fewer mistakes. But if they are a humble learner, the green counselor will catch on quickly and repair any damage. Whether green or seasoned, the most dangerous character problem in counselors is arrogance and listening only to him or herself.

But the intern can manage some of this by dealing with his or her own anxiety. Confidence does actually help. It enables you to think clearly, consider options, be honest about your own weaknesses, offer the client help in finding someone else if you aren’t the right fit. It is like baseball. If you are afraid of getting hit, you’ll likely not catch or hit the ball. If you have confidence, you’ve got a better shot of catching it and/or at least making contact when hitting.

 

All that said, I have to tell you a story about my “first time.” I had just completed a 13 week internship where I counseled 2 separate clients with my supervisor in session and by myself. I could be given good grades for trying hard, but probably was too impatient to get to the good stuff of people’s problems–the stuff of repentance. In a moment of insanity my supervisor set me up as a staff counselor in a satellite center. On my first night I saw a person who said the Lord had told her I was the counselor for her but now was rethinking she had misheard. How could an 18 year old be right for her (ahem, I was all of 24!)? After trying to find out the issues, she said if I couldn’t figure it out, she definitely had misheard God. The next client was a couple. In the course of the session, the husband actually stood up and started choking his wife. I stood up–not knowing what else to do–and he fled the building.

There’s nothing like baptism by fire 🙂

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April 13, 2009 · 11:11 am

Practicum Monday: The secret to a good experience


A new semester begins today and I pick up teaching again after a sabbatical. It feels good to get back in the saddle again. Practicum and Professional Orientation starts today and so my students begin their first fieldwork assignments around the region. If they are at all like I was when I first began counseling work, they will be nervous and worried about doing well and doing the right thing. But I have a secret for them. This nervousness will actually help them do well and, for the most part, mistakes in counseling often turn out to be good for both counselee and client. Counseling is more like art and less like surgery. And since counseling is relational art, the opportunity to “do over” actually provides wonderful realism to the healing.

However, there is another secret to good practicum experiences: good supervision. Good supervision makes or breaks an experience. And good supervision requires the active participation of both supervisor and supervisee.

The Supervisor: Supervisors come with a variety of skills, personality, and style. Some are quite directive and keep a tight rein on your practice attempts. Others are very hands-off, wanting you to try stuff yourself and so they respond to your questions and concerns rather than seek you out. Others are very process oriented and focus on your experience more than what you actually do.

The Supervisee: Some students come with hundreds of questions (some out of curiosity but most out of anxiety). Others want very specific directions and then try to act them out as was given. Others still want to talk about their own experiences and have a harder time recalling client responses.

Practicum students do well to prepare for supervision:

1. Before you begin, have some discussion about how the supervisor likes supervision to go? Do they have an idea about how they want you to function in it? Do they want it to happen just after your counseling experiences for the week so you can debrief? Just before so you can best remember what was decided?

2. When you bring your cases to supervision, come prepared to concisely summarize history, presenting problems, attempts to solve prior to counseling, family systems, current crises if present, work thus far in your counseling. Also, come prepared with a specific objective question you would  like to have answered. The more specific your question, the more likely you will come away with an answer.

3. Be sure to ask the supervisor to help you refine your hypotheses. This is a good opportunity to consider alternative ideas.

4. Schedule time when the supervisor can either watch you live or listen to a taping. There is NO better supervision possible. Scary? Yes. But essential if you do intend to become a good counselor

5. Be willing to ask (nicely) the why question when your supervisor gives you directives that don’t make sense. More than doing the right thing, you want to understand the critical thinking behind the right response.

6. Use your relationship with the supervisor to grow as a professional. This is one of your future colleagues. If there are conflicts between you, practice the good art of resolution. Don’t avoid and don’t attack.

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February 4, 2009 · 5:37 am

Try your hand at diagnosing clients…


Ever wondered if your counselor really knows what is in the Diagnostic & Statistical Manual (DSM, ver. 4TR)? Or do they just do the flip and dip method (let the large book open to any page and blindly point to a spot on the page)? Let’s hope not. Well, some professors are trying to increase the accuracy of their students via video vignettes.

One such person, Dr. Aaron Rochlen of U. Texas, has a website with 5 video vignettes available on his website (http://www.edb.utexas.edu/psychopathologypractice/index2.html) for students to watch and then try their hand at giving a DSM diagnosis.

Warning. Site is free. There are no answers given so don’t bother submitting your diagnostic considerations as they won’t go anywhere unless you send them to someone. Second warning: At least one of the “clients” uses some curse words.

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February 3, 2009 · 11:31 am

Improving Case Conceptualization?


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

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

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

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

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

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November 11, 2008 · 5:29 am

The addict in us all


Later this week, CCEF will hold their annual teaching conference in Valley Forge, PA. The theme this year is addictions. I have the pleasure of teaching on Friday along with their faculty/staff. Also teaching are Diane Langberg, John Freeman, Leslie Vernick and guest appearances by Mark Driscoll and music by the Gettys. Will have my slides up here after the conference. I will be outlining two main techniques useful in the early stages of counseling those struggling with addictions.

Should be a fun time. If you come, stop by the Biblical Seminary table to chat…

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September 12, 2008 · 5:19 am

“I apologize for being late…”: bad behaviors by your counselor


Just skimmed, “‘I apologize for being late’: The courteous psychotherapist” (in the 2008 (v. 45:2)Psychotherapy: Theory, Research, Practice, Training, pp 273-277) by Rolfs Pinkerton. Pinkerton details how our bad behaviors can harm (gasp!) the therapeutic alliance but that courteousness and correcting the behavior can help alleviate the problem. No surprise here.

But wait, what are some of the bad behaviors (no not the really bad and really obvious ones) he’s concerned about. Let’s see how we rate:

1. Being more than 15 minutes late. Apologies help but if it is a regular problem then…

Hmm. I’m usually 5 minutes late. Does that count as bad?

2. Falling asleep or being obviously worn out.

I try to solve this by drinking caffeine.

3. Forgetting names, using the wrong one or the wrong pronunciation.

So, when I pray for my “brother” or “sister” is it obvious that I’ve forgotten their name? Actually, I do pray that way sometimes and I haven’t forgotten a thing.

4. Repeatedly checking the clock.

I have an internal clock and so I try not to ever look. Probably why I’m regularly 10 minutes behind by the end of the day. So, how much is too much?

5. Taking calls.

Never do that. But I have forgotten to silence the phone. I hate it when that happens.

6. Drinking or eating in front of the client without offering some.

Oops. Did I mention that I caffeinate? Didn’t think that was rude. Hmmm. I have clients coming in bringing their Starbucks and I never feel left out. I wouldn’t eat in front of them. Do I get partial credit?

How about you? If you are a counselor, what are your faux pas? If you ever were a client, what annoying (not illegal or immoral ones–those are pretty clear) habits irk/irked you? (Be gentle with us and be sure to protect the guilty. We’re rather fragile.)

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July 31, 2008 · 10:00 am

Don’t Miss: Destructive Relationships Seminar


Shameless promotion for a class at Biblical. You can come for Friday night or both Friday and Saturday. Check it out and get a free book with your registration!

Summer Counseling Seminar at Biblical Seminary

Who should attend:

Counselors

Lay Counselors

Church leaders

 

Popular author and speaker, Leslie Vernick, is offering a weekend seminar on her new book

 Abusive and Destructive Relationships

Seeing Them! Stopping Them! Surviving Them!

Friday August 8th 6-9pm &

Saturday August 9th 9am-5pm

Audit rate only $142

Or

Friday night only for the Topic Overview for $30

Overview includes: general definitions, how to say “no” and mean it, having the courage to make choices, how to invite someone into healthy change to break destructive patterns, how to speak thoughts and feelings in a constructive way.

Sign up by Wednesday August 6th and receive the book FREE          http://cart.leslievernick.com/images/book_emotional_catalog_home.jpg

 

 

Call Bonnie at 1-800-235-4021 x 117

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July 11, 2008 · 5:00 am

How do you listen to people’s problems all day long?


This is a question we counselors get from time to time, especially when someone is embarrassed that they need a counselor or think they shouldn’t be having problems (or that they are weak for having them).

Today in staff meeting we watched a video on vicarious trauma. This term has been mis-identified with burnout and secondary trauma. In short it isn’t about our symptoms or having our own trauma but about the changes in us after taking in large amounts of other people’s pain.

Individually, hearing any one person’s problems isn’t much of a burden. But when you add all together it gets heavy at times. What do I mean? Well, we begin to see danger of abuse everywhere. We begin to think that all leaders are abusing power. Interestingly, one of the speakers on the video said that early career therapists tend to struggle more with fears and later career therapists struggle more with cynicism.

Most of the problem is the result of the loss of hope. And yes, therapists sometimes lose hope. That is why we have staff meeting so that we can remember that hope comes not from our ability to change the world but that we fallen creatures look to the power of the cross to change us and our clients.

I’m not sure what nonbelieving clients hope in and how they manage living with the weight of the brokenness in the world.

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