Category Archives: counseling skills

GTRI 2014: Day 8 Kigali


July 8, 2014

Tuesday. Yesterday was a deep dive into Rwanda for GTRI students. They heard directly from Rwandan caregivers and spent time trying to weigh the genocide and its ongoing impact. Today we begin meeting and interacting with trauma healing and recovery caregivers in a conference setting. At a local hotel about 100 Rwandans gathered to kick off the Bible Society’s trauma healing community of practice and the inauguration of the Rwandan Association of Christian Counselors. The purpose of this meeting was to introduce both projects to the public and to invite the media and dignitaries to be present. The Rev. Emmanuel Kayijuka game some opening remarks and an Anglican Bishop offered a brief bible study of John 4:1-3, the woman at the well. He pointed out that she was likely a prostitute and an DSC_0233abused woman, abused by men, by society and desperate. Why else gather water at noon. He also pointed out that after her healing, she became a woman on a mission of healing, seeking social contact for the purpose of evangelism. After these reflections, Dr. Jean Mutabaruka presented a paper looking at the relationship between trauma, PTSD, and complicated grief. He pointed to 12 types of trauma in Rwanda, including sexual/physical/emotional abuse, witnessing violence, discrimination, poverty, etc. At the end, he raised a few general questions regarding the management of the mourning period/process each year.

After the professor finished, both Diane Langberg and I made a few brief remarks in response. Dr. Harriet Hill presented an overview of trauma healing project, in Rwanda and around the world. She showed the latest trailer of a documentary (much about the Congo project) about bible based trauma healing slated to be aired on ABC network this fall. Fun to see people I know in this trailer. David from the Rwandan Bible Society reviewed the progress to date: 2,918 trained people using Healing Wounds of Trauma material. Many of these are able to train others while the rest are better able to care for themselves.

New President: Baraka Credit: Heather Evans

The second half of the day included a presentation by Baraka Paulette Unwingeneye about the efforts thus far to form the Rwandan Association of Christian Counselors. This group of counselors and caregivers have been meeting with us since 2011 and are ready to be birthed. As Baraka said it, it may be like an elephant’s gestation, but now we are near the final month. We had presentations from Narcisse about the needed documents to be filed to make the association official, myself about the benefits and processes to form an associations. Then, those in attendance voted in a president, vice-president, secretary, treasurer, advisors, and conflict managers. This may not sound very moving, but I assure it was!

Fun too

While we come to Rwanda for serious matters, not everything has to be intense. As our day was ending, we quickly changed from our conference clothes to go out for a bit of shopping: the Simba market for coffee and tea, and another market selling typical Rwandan traditional items (clothes, woven bowls, banana leaf art. I looked and looked for a blue African traditional shirt but came up empty.

This marks our last night at Solace. Tomorrow we move on to the conference proper about 50 minutes or so south in Muhanga (Southern Province). Though we are about to begin the training in earnest, I think I am beginning to relax. A year’s worth of planning is now well under way. Despite a few surprises and schedule changes, most everything is working as planned. No problems with transportation, food, water, housing. Meetings planned have more or less happened.

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GTRI 2014 Trip: Day 3


[These are journal entries from my recent trip To Uganda and Rwanda during the first weeks of July.]

Day 3, July 3

Today was the 2nd and final day of the first ever Community of Practice for the Bible Society of Uganda trauma healing volunteers. Another long day as the program did not end until about 7 pm! Today I presented on an overview and update on the impact and treatment of PTSD. This is a group that likes to ask questions! We discussed the role of demonic in PTSD and how to know the difference. Many of the participants were quite interested in discussing how to educate local pastors in understanding the nature of dissociation. I also participated in teaching the new lesson (added chapter to Healing The Wounds of Trauma material) on domestic violence. In discussing why victims “choose” to stay in DV situations we had some lively discussion about whether the Bible teaches that women must stay. Very productive I think and gave some people a new perspective on the need to bring this hidden scourge out into the light.

The conference ended with reports, public conference evaluations (loved the very direct and loving evaluation of my presentations: have me speak more, have me slow down!), the handing out of the certificates, and final words. One of the most moving items was that I received “thank yous” in every mother tongue present. Seemed like there were at least 30 different languages represented. It was hard not to be choked up. I recognized a few (Arabic, Swahili, Kinyarwandan).

Two take-aways I want to remember:

  1. We need special materials for ex-combatants. First, much of the focus in Uganda has been on child soldiers. But the country is full of adult ex-combatants who were in Amin’s military or subsequent militaries and who now feel disconnected and distanced from current society. Some report that if they get together for sharing with other ex-combatants, they get reported (falsely) for starting a rebel group. One reported being jailed briefly for such a matter. Several told me that they were suffering terribly from being in POW camps and from the violence they witnessed. But most importantly, they noted that much of the trauma healing materials only speak of soldiers as the cause of trauma and so they feel more isolated when they read about or attend trauma healing exercises. No one, they feel, speaks of the trauma of seeing comrades die, of being forced to carry out commands against their will.
  2. Trauma healing volunteers, financing, and the need for View from my roomtangibles. Some of the volunteers believe that they must bring tangibles when coming to do trauma healing work. Words are not enough and participants expect some sort of handout: soap, money for transport, etc. The discussion we had about this ranged from criticism of this part of Ugandan culture and the need to develop a donor rather than handout culture to recognition that this culture has been formed, in part, by well-meaning foreign (Muzungu) NGOs that offer handouts as a means to increase participation in projects. Some volunteers noted they had been falsely accused of pocketing monies intended for participants when they didn’t come with any “gifts.” In addition, many discussed the difficulty of funding the trauma healing groups and the need to find sustainable funding using micro-enterprise.

My day had three other stimulating experiences. First, I was interviewed by a journalist for television broadcast. Supposedly, it aired across the nation this evening, though I did not see it. Second, a woman told me of meeting Joseph Kony about 4 years ago (during the failed attempt to negotiate with him). She said that he was very winsome and crafty. If she didn’t know better, she could have fallen for his lines. I guess this is one of the reasons he is able to stay “missing” by convincing others to help hide him. Finally, I received a text from my wife letting me know that the US government warned of a terror plot at Entebbe airport tonight (about 10 miles from here). I’m planning on being there tomorrow to fly to Kigali. I guess I will evaluate the treat in the am.

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GTRI 2014 Trip: Day 1 and 2


unnamed[I’ve been back for a couple of weeks but just now getting to write about this trip. These notes from each day come from my journal and don’t represent all that I did each day.]

Today (July 1), I landed midday at Entebbe airport just outside Kampala, Uganda. Entebbe is on the shores of Lake Victoria. I was met by Justus Rubarema of the Bible Society of Uganda as well as Klero Onuha of the Bible Society of South Sudan. Both men worth getting to know! We waited a bit for Margaret Hill’s plane arriving from Nairobi. Once gathered, we made for the Lweza Conference Centre about half way to the city of Kampala. Lovely grounds. Peaceful. Enjoyed the little monkeys eating flowers and looking for handouts (I had none).

I arrived at this conference (Community of Practice for Trauma Healing practitioners trained by the Bible Society) feeling fairly awake despite 26 hours of travel time. It may have helped a bit that I was unexpectedly bumped to business class on Qatar Airways from Philadelphia to Doha (a 13 hour leg). I suspect the lay flat seats had something to do with my feeling pretty good. Feeling good, I invited Margaret to go on a small walk around the area and on a quiet road outside the compound. Discussed some of her techniques to help quiet distress in participants where violence and trauma was ongoing (e.g., Bangui, CAR). We discussed the use of the “butterfly hug” as a means to calm. Also, discussed the use of drawing a place “bien etre” rather than a “safe place” since most participants she had did not have such a safe place at the present time. We finished our discussion of how to safeguard the mis-use of these calming techniques so that they would not be mis-represented as being more than they are, techniques used to help someone in the midst of distress.

Ended our day with a meal of rice, bananas, potatoes and chicken. Off to bed in hopes of getting on the right time zone quickly.

Day 2

First full day of the conference (and FULL it was, 8am to 6:30pm). Attendees are all Ugandan plus Klero from South Sudan. Most are volunteers for the Bible Society, trained to provide healing groups using the Healing Wounds of Trauma materials. Some work with children, some with adults, some with ex-combatants, some with refugees, and some with women with HIV. The purpose of this conference is to add to their knowledge and skill base plus problem-solve as to how to provide more trauma healing experiences around the country—with almost no budget. Most of the country is well-represented including a number from Gulu and also the Nakivale refugee camp. More men than women. A couple of academic types are also present, representing both the Ugandan Counseling Association and the Ugandan Christian Counseling Association. Plus, one nun representing the faculty of a nearby Catholic college.

I presented on an update to listening skills which seemed well-received. This group is very willing to discuss, raise questions, and debate. I like it! It was requested that I offer some counseling sessions after dinner and so I did. Two men requested it and so I got a chance to hear about their ministries, their hearts, and their difficult struggles, both from the past and in the present. One of the things I am seeing here is that Ugandans need the wisdom of Solomon, the heart of David, and the integrity of Daniel, even when trying to deal with so-called Christian bosses. One fun fact is that the power went out right in the middle of one of the sessions. No problem. We could keep talking in pitch-dark! But by the time I fumbled with lighting a nearby candle, a generator kicked on and power was restored.

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My next two weeks in East Africa


Starting Monday I will be off traveling to Kampala, Uganda and then on to Rwanda for Global Trauma Recovery Institute. I welcome your prayers for myself, my students, and the attendees. In addition, Diane Langberg and myself will be leading a group of 12 Americans (10 GTRI students) on a listening/dialogue immersion trip throughout Rwanda. Some of the highlights of our trip(s) will include,

  • 2 day trauma healing community of practice in Kampala with the Bible Society of Uganda
  • 3 day trauma healing community of practice in Rwanda with the Bible Society of Rwanda
  • Afternoon mini-conference with pastors in Southern Province, Rwanda
  • Day with the newly forming Association of Christian counselors in Rwanda
  • Visits to NGOs working with trauma victims and street children
  • Church services
  • Visits to genocide memorials
  • Visit to a refugee camp
  • Numerous conversations, formal and informal over the next two weeks

I will make some attempts to update all on my trip as I go. You can follow me here and @PhilipGMonroe or @BTSCounseling. If you are interested in seeing more about the GTRI engagement model, check out this short video. And, if you would like BTS to continue doing this kind of missional work, feel free to go here and donate before the end of our fiscal year, June 30.

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Traumatic Nightmares? Two Treatment Possibilities


Many who suffer from PTSD or other traumatic reactions also experience chronic nightmares. It is bad enough to have to deal with intrusive memories and triggers during the day but being robbed of peaceful sleep can send you over the edge, both in terms of physical and emotional health. Christian counselors may be tempted to ignore these nightmares (how can you stop something you have little control over?) or overly spiritualize the content of the dream.

But we ought not neglect the problem of nightmares. It is well-known that reductions in quality of sleep make all mental illnesses worse. Nightmare sufferers understandably avoid sleep but of course this creates a vicious cycle of insomnia, anxiety, and increased avoidance strategies.

There are two intervention options (among many) that appear to have fairly robust positive data indicating helpfulness. (For detailed descriptions of these two and others including the analyses of value, see this pdf): Prazosin (medication) and Imagery Rehearsal Therapy (IRT).

Prazosin is an anti-hypertensive (alpha blocker) that may work on the problem of too much norepinephrine in PTSD patients. It seems to improve sleep length and REM time. Interestingly, beta blockers have been found to increase nightmares rather than reduce them. I am no physician and so cannot evaluate the value of this medication for clients but would encourage clients with chronic, severe and re-occurring nightmares to talk with their doctor about whether Prazosin might work for them. The studies I have reviewed primarily examined the value of this medication for veterans with extreme nightmare problems. The most significant downside to medication treatment is that it only works when the medication is taken. Stop the medication, the nightmares may come back. However, some relief may be beneficial and thus the medication then has value.

Imagery Rehearsal Therapy (IRT) is a short-term therapy that does not work on the actual content of the traumatic experience or attempt to treat PTSD. Instead, it treats nightmares as a primary sleep disorder problem. There are variations on IRT but most versions last between 4 and 6 sessions and may be delivered in individual or group formats. Sessions include education about the nature of nightmares, sleep hygiene protocols, and the imagery replacement protocol. While some of the IR protocols are done imaginally, others ask nightmare sufferers to (a) write down the details of the distressing nightmare, and (b) write a new ending to the nightmare. As Bret Moore and Barry Krakow describe, the therapist does not dictate the new outcome of the revised dream but encourage the sufferer to “change the nightmare anyway you wish” (Psychological Trauma, v. 2, 2010). The nightmare sufferer then rehearses (multiple times) the new ending and is instructed to ignore the old nightmare.

Sound goofy? How is it that a person can just decide to have a different dream? However, the evidence that this therapy works is quite robust. Numerous studies with veterans and civilians indicates it is effective in reducing unwanted nightmares. Most treatment protocols suggest starting with nightmares with content unrelated to actual traumatic events.

Thus, Christian counselors ought to review these two treatments and consider learning the IRT protocol to bring relief to chronic nightmare sufferers.

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Counselors talking about themselves? Additional thoughts


Last week I described some research supporting counselor self-disclosures, research that suggests clients appreciate disclosures revealing (a) similarities between counselor and client, and (b) vulnerabilities or personal emotions. While this research flies in the face of conventional wisdom in most counselor training programs, I cautioned counselors to ask some questions first before talking too much about self. With this post, I would like to press the caution just a bit more.

Why do counselors talk about themselves?

Why do counselors talk about their personal life with clients? Read the following numbered list to see some of the main reasons (and the sub-points in italics as illustrations of that reason). Then, consider the bracketed sub point as an alternative to self-disclosure.

  1. We want to put clients at ease and we think knowing something about ourselves might help
    • I can see you are anxious about whether taking antidepressants is appropriate for faithful Christians. I take them and it has only helped my faith.
      • [You’re not alone with that question so let’s explore the pros and cons to taking an antidepressant. Why don’t you start by telling me the reasons you’ve heard or thought about for not taking Prozac?]
  2. We believe our personal history will help a client understand, accept, or challenge something about their struggle
    • I know this treatment for panic disorder is difficult for you but I can tell you it works. It worked for me.
  3. We want to please an inquiring client
    • Yes, I am married and I have 2 children.
      • [Sure, I don’t mind telling you who is in my family, but could you first tell me why that is an important question for you?]
  4. We want to earn their respect and believe that our history will help
    • Well, for starters, I want you to read my book. It is now in its second edition and has been translated into 4 languages. I think you will find it very helpful for your problem.
      • [I’d like for you to start reading about your problem. There are a couple of books out there that I think you might find helpful, including one I wrote. But, feel free to look these over on Amazon and choose the one that seems right for you.]
  5. We like talking about ourselves; our personal stories seem difficult to avoid
    • You and I have a lot in common. My wife has the same problems as your husband. So, I know how lonely you must feel. We’ve tried…
      • [Though you are not saying so, I wonder if you feel lonely in your marriage.]
  6. We see the relationship more like a friendship with mutual sharing
    • I’m so glad to see you today. You are a bright light in a dull day. I look forward to our stimulating conversations. Just yesterday I was thinking about you and wishing to have coffee with you to discuss your career future. 
  7. We want to be seen as human rather than just professional
    • Yes, it has been a stressful day. I could use a back rub after all these sessions today.
      • [You know, some days are harder than others, but I’m curious why you asked this today?]
  8. We want the client to help us in some way
    • I was thinking about your need to work and my need to have someone edit my website. Or, I’m headed out on a mission trip next month. Well, I am if I can get enough donations. I’m about $1000 short thus far but I know God will come through.
      • [neither of these need to be said!]

Is it necessary? Is it helpful?

While self-disclosures may improve client perceptions of counselors, I suspect that empathic, client-centered therapists evoke these same feelings by asking good questions making observant reflections yet still minimizing disclosures, especially those where we initiate them and those that force the conversation to our personal history. There are some disclosures that are in response to client questions (e.g., have you ever struggled with addictions? Are you married? Do you believe in medications? Are you angry with me?) that warrant an answer. When giving this answer, work hard at keeping it brief and returning to the client’s story.

Don’t forget about social media self-disclosures

Clients sometimes “hear” our disclosures through social media. Imagine a client reading, “Well, that was a difficult session, glad I’m done for the day” having been that counselor’s last appointment! Blogs (like this!), Twitter, Facebook, and Instagram can be forms of self-disclosure. Be wary of these. Conventional wisdom says to avoid social media contacts with most clients so as to avoid harm to the counseling relationship. While we need not require an outright ban of these connections, a thoughtful counselor will review connections via social media for potential harm.

Be human

Despite these efforts to avoid letting our selves intrude too far into the session, sometimes life gets in the way. A counselor has a health or a family crisis. Clients have ways of finding this out and often want to ask how things are going. Here it is appropriate to say something brief, thank them for their concern and then start the session. In other situations a client discovers a shared passion for food, a sporting team, a connection through mutual friends. Enjoy these connections, acknowledge them, but be sure not to linger there during the session proper. We are, after all human. Don’t be surprised when counselor and client humanness come into contact.

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Comparing ACA and AACC ethics codes: Multiple Relationships


Continuing our review of the ACA and the AACC codes for counselors, let’s take a look at how both codes address the matter of multiple or dual relationships. (See first and second posts about comparing the ACA and AACC code of ethics for counselors and mental health professionals.)

Multiple or dual relationships between counselor and client (or client’s family) are those that combine the professional relationship with one of another sort. If a counselor of a client is also that client’s pastor, that would be a multiple relationship. Other types could combine counselor and friend, counselor and business partner, counselor and employer, and increasingly possible, counselor and social media “friend.” Both codes are concerned about the formation of dual relationships because they become fertile ground for counselor judgment bias and harm to the client. Both see that once a counseling relationship has been formed, that relationship ought to be clear take priority over all others.

The ACA code of ethics prohibits outright the following dual relationships:

  1. Counselor and sexual partner: Counselors may not have sex with clients or their family members
  2. Counselors may not start counseling work with former sexual partners
  3. Counselors must wait at least 5 years before engaging in sexual activity with former clients (and even then may be prohibited)
  4. Counselors may not provide services to friends and family
  5. Counselors are prohibited from engaging in personal virtual relationships (social media) with current clients

Beyond the sexual arena, the ACA code warns counselors to avoid dual relationships or “extending the boundary” of the counselor or supervisor relationship

Counselors avoid entering into nonprofessional relationships with former clients, their romantic partners, or their family members when the interaction is potentially harmful to the client. This applies to both in-person and electronic interactions or relationships. (A.6.e)

When a counselor agrees to provide counseling services to two or more persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person. If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from roles appropriately. (A.8)

So, notice the focus: avoid “extending the boundary” or what we used to call forming multiple relationships with current or former counselees or their family members. Document when you do so to illustrate informed consent, limiting of potential harm, and efforts made to rectify harm when it unintentionally happens

What about the AACC code?  It begins (ES1-140) with these paragraphs,

Dual relationships involve the breakdown of proper professional or ministerial boundaries. A dual relationship exists when two or more roles are mixed in a manner that can harm the counseling relationship and/or the therapeutic process. This includes counseling, as well as personal, fraternal, business, financial, or sexual and romantic relationships. Not all dual relationships are necessarily unethical—it is client exploitation that is wrong, not the dual relationship in and of itself. However, it remains the responsibility of the counselor to monitor and evaluate any potential harm to clients. (emphasis mine)

While in a counseling relationship, or when counseling relationships become imminent, or for an appropriate time after the termination of counseling, Christian counselors do not engage in dual relationships with clients. Some dual relationships are always avoided—sexual or romantic relations, and counseling close friends, family members, employees, business partners/associates or supervisees. Other dual relationships should be presumed as potentially troublesome and avoided wherever possible. (emphasis mine)

The AACC code then prohibits counseling relationships with family and close friends and warns against those “best avoided” (e.g., business associates, club members, etc.). Finally the code addresses counseling relationships within the church,

Christian counselors do not provide counseling to fellow church members with whom they have close personal, business, or shared ministry relations. Dual relationships with any other church members who are clients are potentially troublesome and best avoided, otherwise requiring justification. Pastors and church staff helpers should take all reasonable precautions to limit the adverse impact of any dual relationships. (ES-140-f)

This wording marks a change from the previous AACC code where dual relationships were more positively addressed. The old rule stated this, “Based on an absolute application that harms membership bonds in the Body of Christ, we oppose the ethical-legal view that all dual relationships are per se harmful and therefore invalid on their face.  Many dual relations are wrong and indefensible, but some dual relationships are worthwhile and defensible.”

Agreements? Disagreements? Both codes ban the ending of counseling relationships for the purpose of changing the professional relationship to different relationship, or to engage in sexual activity with a client or a member of the client’s family. The AACC codes requires 3 years before marrying a former client (assuming all other concerns raised are not an issue) whereas the ACA code requires 5 years before engaging in an intimate relationship. The ACA code as extensive concerns about the teacher/student relationship as well as the supervisor/supervisee relationship. The AACC code says little about these (though some can be inferred). The biggest difference, however, is found in the stronger language banning dual relationships in the ACA code where the AACC code warns against possible harm but leaves the door open as long as the counselor knows they have to prove no harm happened and informed consent.

 

 

 

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Free CEs! faith and trauma in the public sphere


On April 23, 2014, I will be the keynote speaker for the 8th annual Faith & Spiritual Affairs Conference put on the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). The conference theme: Trauma and Healing: Faith Communities Respond. My particular talk is geared to illustrate the necessity of engaging the faith community in trauma recovery efforts. Trauma almost always challenges a person’s faith and when mental health professionals do not pay attention to spiritual matters, treatment will likely stall. I will highlight several faith founded trauma recovery interventions being used today in church settings. 

The conference is free to all who register. But registrations are limited. Held at the Philadelphia Convention center. The breakout speakers list includes the Director of Place of Refuge, Dr. Elizabeth Hernandez.

To register click here. NOTE: enter fsac2014 as the redemption code to get into the conference website. CEs provided for SW and PC. Biblical Seminary, an NBCC approved provider, is the co-sponsor to offer counseling CEs. Other CE providers offering CEs as well.

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Comparing ACA and AACC ethics codes: Addressing counselor values impact


Over the next few post I plan to review similarities and differences between the ACA and AACC codes (see this post for the first in this mini-series). Today I want to look at how the two codes talk about counselors as they manage their own value systems with their clientele.

The ACA code raises the issue of values like this:

  • Section A Introduction

Counselors actively attempt to understand the diverse cultural backgrounds of the clients they serve. Counselors also explore their own cultural identities and how these affect their values and beliefs about the counseling process.

  • A.4.b. Personal Values

Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

In addition, the ACA clearly states that when there are significant values differences, a counselor is NOT to make referral on the basis of values differences alone. Values clashes cannot be treated as lack of competency in a particular area of counseling.

  • A.11.b. Values Within Termination and Referral

Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

The AACC code addresses the value systems of the counselor in these sections

  • ES1-010 Affirming Human Worth and Dignity

…Christian counselors express appropriate care towards any client, service-inquiring person, or anyone encountered in the course of practice or ministry, without regard to race, ethnicity, gender, sexual behavior or orientation, socioeconomic status, age, disability, marital status, education, occupation, denomination, belief system, values, or political affiliation. God’s love is unconditional and, at this level of concern, so must that be of the Christian counselor.

  • ES1-120 Refusal to Participate in Harmful Actions of Clients

Within this section are paragraphs discussing the application and limits of the “do no harm” virtue to certain client behaviors deemed not to fit within the biblical framework articulated at the beginning of the ethics code. The AACC code expressed an ethic to avoid supporting or condoning (while respecting and continuing to help) in the following areas: abortion-seeking, substance abuse, violence towards others, pre or extramarital sex, homosexual/bisexual or transgender behavior, and euthanasia. On this last issue, the ACA notes that the duty to breach confidentiality may be optional (thus indicating a values insertion since in all other cases we have a duty to breach confidentiality so as to warn others or protect the life of our client).

  • 1-530: Working with Persons of Different Faiths, Religions, and Values

Counselors work to understand the client’s belief system, always maintain respect for the client and strive to understand when faith and values issues are important to the client and foster values-informed client decision-making in counseling. Counselors share their own faith orientation only as a function of legitimate self-disclosure and when appropriate to client need, always maintaining a posture of humility. Christian counselors do not withhold services to anyone of a different race, ethnic group, faith, religion, denomination, or value system.

  • 1-530-a: Not Imposing Values

While Christian counselors may expose clients and/or the community at large to their faith orientation, they do not impose their religious beliefs or practices on clients.

  • 1-550: Action if Value Differences Interfere with Counseling

Christian counselors work to resolve problems—always in the client’s best interest—when differences between counselor and client values become too great and adversely affect the counseling process. This may include: (1) discussion of the issue as a therapeutic matter; (2) renegotiation of the counseling agreement; (3) consultation with a supervisor or trusted colleague or; as a last resort (4) referral to another counselor if the differences cannot be reduced or bridged (and then only in compliance with applicable state and federal law and/or regulatory requirements).

Differences between codes?

There are many but let me identify two. Notice that the most significant difference between the two is on the basis of the AACC code biblical/christian ethic regarding what is good and what is harmful behaviors. Both codes express the need to respect persons without regard to their beliefs, values, identities, and actions. The AACC code differentiates between imposing of values and exposing of values. What is the difference between exposing and imposing? I suspect it will be in the eye of the beholder. However, I suspect that one of the results of the ACA code is that faith and spiritual values will be less likely to be brought up by counselors since “not imposing” is more emphasized than “exploring.” There is much literature out there suggesting that the failure to explore and utilize spiritual resources actually harms clients in that it slows recovery.

Both codes address the issue of values differences between client and counselor. Both point to a path (though different) about what to do when this happens. The ACA code places pressure on the counselor to work it out while the AACC code suggests a path to resolution either with re-negotiation or referral. Which one sounds better to you?

When the difference is with a colleague? 

Both ACA and AACC codes addresses differences with colleagues. In section D (Relationships with other professionals), the ACA code states,

D.1.a. Different Approaches. Counselors are respectful of approaches that are grounded in theory and/or have an empirical or scientific foundation but may differ from their own. Counselors acknowledge the expertise of other professional groups and are respectful of their practices.

The AACC codes says something similar,

1-710-a: Honorable Relations between Professional and Ministerial Colleagues. Christian counselors respect professional and ministerial colleagues, both within and outside the church. Counselors strive to understand and, wherever able, respect differing approaches to counseling, and maintain collaborative and constructive relations with other professionals serving their clients—in the client’s best interest.

Fun facts

The ACA code never uses the word “faith”, does suggest counselors need to address self-care (includes spirituality), and does suggest counselors seek to utilize client’s spiritual resources…”when appropriate.”

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New Ethics Codes for Counselors


Both the American Counseling Association (ACA) and the American Association of Christian Counselors (AACC) have published 2014 editions of their codes of ethics (links above to pdf of codes). Given these new documents, I highly encourage all Christian counselors (both professional and pastoral/lay) to review these two codes. Even if you do not belong to either the ACA or the AACC, you should spend some time with these documents. Here’s why:

  • The codes represent the current thinking of the ACA and the AACC about best practices for counselors. Even if you disagree, you need to know where you diverge (both for integrity sake with clients and for protection from unnecessary risk)
  • It is easy to become sloppy about ethical matters. We tend to believe what we do is good. Reviewing our practice habits against a standard can reveal slippage
  • It can be helpful to clients to know what code of ethics you subscribe to. Reading codes can help you determine which code you subscribe to and your reasons for doing so

Comparing Values and Principles

The following chart shows similarities and differences regarding the bases for ethics codes. It is worth reviewing these to see how they compare and contrast. In the next post, I will compare a few specific standards.

Content AACC ACA
Mission 1. help advance the central mission of the AACC—to bring honor to Jesus Christ and promote excellence and unity in Christian counseling;

2. promote the welfare and protect the dignity and fundamental rights of all individuals, families, groups, churches, schools, agencies, ministries, and other organizations with whom Christian counselors work;

3. provide standards of ethical conduct in Christian counseling that are to be advocated and applied by the AACC and the IBCC, and are respected by other professionals and institutions; and

4. provide an ethical framework from which to work in order to assure the dignity and care of every individual who seeks and receives services.

1. enhancing human development throughout the life span;

2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts;

3. promoting social justice;

4. safeguarding the integrity of the counselor–client relationship; and

5. practicing in a competent and ethical manner.

Principles Compassion in Christian Counseling – A Call to Servanthood Competence in Christian Counseling – A Call to ExcellenceConsent in Christian Counseling – A Call to Integrity

Confidentiality in Christian Counseling – A Call to Trustworthiness

Cultural Regard in Christian Counseling – A Call to Dignity

Case Management in Christian Counseling – A Call to Soundness

Collegiality in Christian Counseling – A Call to Relationship

Community Presence in Christian Counseling – A Call to Humility

autonomy, or fostering the right to control the direction of one’s life;nonmaleficence, or avoiding actions that cause harm;beneficence, or working for the good of the individual and society by promoting mental health and well-being;justice, or treating individuals equitably and fostering fairness and equality;

fidelity, or honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in professional relationships; and

veracity, or dealing truthfully with individuals with whom counselors come into professional contact.

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Filed under AACC, christian counseling, christian psychology, Christianity, counseling, counseling and the law, counseling skills, Uncategorized