Anna Badkhen asks, “How do you heal an entire country suffering from shell shock. She describes conditions in Afghanistan. You can see she asks a great question but labors, as we all do, to come up with an answer that makes sense in a place that is still unstable (and therefore still traumatizing) and that fits the cultural and economic realities of the region.
Check out this short essay,
PTSDland – By Anna Badkhen | Foreign Policy.
Filed under Abuse, counseling skills, Psychology, ptsd
Why do we have to study theology? I don’t need that to be a good counselor?
These are words I have heard from students studying counseling and/or psychology in both university settings and seminaries. What would you say?
Biblical and theological training in professional programs?
Most Christian institutions offering counseling or psychology graduate programs require some level of theological engagement. Otherwise, why exist? Some do so via specific course work while others embed the theological or biblical material into classic counseling courses. At Biblical, we do both. We require traditional counseling courses such as Marriage & Family, Helping Relationships, Psychopathology, Social & Cultural Foundations, etc. In these courses we explore counseling theory and practice from an evangelical Christian psychology perspective. We also require students to complete courses like, “Counseling & the Biblical Text” and “Counseling & Theology: Cultural Issues” where they engage biblical texts and theological study as they consider how it forms counseling theory/practice and shapes the character of the counselor.
Is all counseling theological?
Yes. And David Powlison in the most recent CCEF NOW magazine (2-4) talks about this very fact. Here are some choice tidbits,
…counselors deal with your story. In fact, they become players in that story. By word and deed, even by their line of questioning, they inevitably offer some form of editing or rescripting, some reinterpretation of your story.
Counseling is inescapably a moral and theological matter. To pretend otherwise is to be naive, deceived, or duplicitous.
…all counseling uncovers and edits personal stories…. All counseling must and does deal with questions of true and false, good and evil, right and wrong, value and stigma, glory and shame, justification and guilt.
All counseling explicitly or implicitly deals with questions of redemption, faith, identity, and meaning.
Thus, if value-free counseling is not possible (the very questions we ask lead clients in one direction or another), then it stands to reason that every counselor ought to explore the theologies (doctrines, interpretations, beliefs, etc.) he or she brings into the counseling room. Who is God? How does God operate? What is the purpose of the Bible? Does it have anything to say about my life, my attitudes, my relationships? What is sin? What is my purpose in life? What does God think about my suffering? And on we could go.
But counseling is NOT theologizing
But lest you think that Christian counselors spend a great deal of time plying clients with the right answers, on sin hunts, or catechising clients, let us remember that exhortation rarely makes for good counseling. In fact, most clients are well aware of their sins–even those who do not call themselves “believers.” And those who have correct theology are not less likely to have trouble in their relationships or less likely to struggle with racing thoughts or depression or less likely to get caught in addictive behavior.
Instead, good christian counseling consists mainly of,
Wait, just what is Christian about these three points? Couldn’t unbelieving counselors agree with this list? Sure they could. What makes these three activities Christian is the submission of both counselor and client to core convictions and practices of Christ followers.
Recently I ran a conference about abuse within the church. In these kinds of venues (this blog and conferences) I am asked about a couple of related problems—the problem of false memories of abuse and the reliability of recovered memories of abuse.
While I intend to address these matters here (and in future blogs), I want to reiterate something that I think gets lost in most conversations about recovered and/or false memories.
Sexual abuse is real. The vast majority of adult reporters of abuse during childhood never forgot the details.
Why say this first? Discussions of rare and extreme cases (i.e., repressed memories, recovered memories, and false memories) tends to create undue suspicion for all adults who choose to reveal their child abuse later in life. It is my experiences that conversations about false memories or recovered memories lead many to assume that a report of extensive or horrific abuse is probably false. So, let us remember that as we take up the matter of fully repressed memories of abuse, we are talking about a very small percentage of people.
But, the issue of repressed and/or recovered memories and the construction of false memories is indeed worthy of a careful review given the strong feelings on both sides of the recovered memory debate. In order to be as careful as possible, I want to consider a few topics that may help us understand the issue. First, I will explore foundational topics (memory, forgetting, repression, and dissociation). Then, I’ll explore the how trauma is known to create confusion, self-doubt, and “motivated” forgetting. Finally, we’ll take up the practice of counseling victims of sexual abuse and the particular matter of dealing with memory retrieval in counseling. Strap in!
Just in case you NEED to know my opinion at the outset…
I find Partlett and Nurcombe’s 1998 summary of an APA report on the topic to be fairly comprehensive,
The plain point here is the consensus set forth by the Working Group:
1. Controversies regarding adult recollections should not be allowed to obscure the fact that child sexual abuse is a complex and pervasive problem in America that has historically gone unacknowledged.
2. Most people who were sexually abused as children remember all or part of what happened to them.
3. It is possible for memories of abuse that have been forgotten for a long time to be remembered.
4. It is also possible to construct convincing pseudomemories for events that never occurred.
5. There are gaps in our knowledge about the processes that lead to accurate and inaccurate recollections of childhood abuse.[1]
I would add one more point: most people (myself included) in this debate are motivated by strong feelings as well as “facts.” These feelings may be the result of experiences with those who appear to be abused or appear to be falsely accused.
Issue one: Memory and Memory Retrieval
Let me start by stating the obvious: this isn’t a neuropsychology primer on memory and I am not an expert in memory. However, there are a few things on which I think we can agree:
The concept is simple: memories are not fixed; they are periodically retrieved, and modified each time they are retrieved. This process of strengthening a memory by retrieval is called reconsolidation. One profound implication of this concept is that what you recall is not only a reflection of what you first learned, but also a product of each time you have recalled the original information.
How does this relate to our issue of recall of abuse?
Return with me to my first point. Most child sexual abuse is never fully forgotten. Some memories may be lost, others distorted, still others intentionally forgotten. Memory, as we have seen here is not a structure but a narrative.[2] In most cases, the story being told has much merit, even if some important details are perceived rightly. Thus memory retrieval during therapy (something that WILL happen whether therapist or client wants it) plays a powerful role in the re-storying work of therapy.
In my next post on this topic, I will make some comments about forgetting, motivated forgetting, dissociation, and repression.
[1] Partlett, DF & Nurcombe, B (1998). Recovered memories of child sexual abuse and liability: Society, science, and the law in comparative study. Psychology, Public Policy, and Law, 4, p. 1273
[2] “Rememberings—whether valid or invalid—are communicated by means of narratives.” Sarbin, TR (1998). The social construction of truth. Journal of Theoretical and Philosophical Psychology, 18, p. 145.
As someone who wants to advance faith-based global trauma recovery efforts, I am always on the prowl for effective interventions that could be sustainably used by local caregivers. However, it is always important to ask whether a popular or up-and-coming intervention has been fully vetted. Sadly, “does it work?” and “does it work here?” are often not fully answered before an intervention is promoted as the next best thing.
One of the most popular forms of immediate trauma intervention is called “Critical Incident Stress Debriefing,” a one time group intervention designed to forestall long-term trauma due to stressors. When you think of CISD, think of interventions with police or fire fighters or military after a traumatic experience.
But, does it work? This post here provides a helpful summary of the critique, even though it was published 2 years ago. As I read this I remembered an American Psychologist article on the same topic–but for the life of me I can’t find it. My recollection of this fantasy article is that these interventions seem to be helpful for about 50% of those who participate but that at this point it is not possible to tell which 50% will find it helpful. And further, a portion of the other 50% are actually harmed by it.
Filed under counseling, counseling science, counseling skills, Psychology
If you go to a counselor, you’d probably prefer that person to be awake versus asleep, to pay attention to you versus check their smart phone, to respond to what you are talking about versus make non sequitur responses. As I’ve noted here before, it is probably better to have a counselor who cares about you than one who has a big bag of techniques–though most of us would prefer our counselors to care AND be competent.
Therapeutic presence is a way of talking about the act of being with our clients in such a way as to build safe, trust-filled relationships where clients can grow and change. I think most people can easily identify failures of therapeutic presence. Try these on for fun:
CLIENT: I’m just so depressed.
THERAPIST: You think you are depressed? Let me tell you about depression. I have a client who just lost job, family, church, home. Now, that is something to be depressed about. You just had a bad day, that’s all.
Or,
CLIENT: I don’t understand why God would take away this job from me.
THERAPIST: Well, theologically speaking, God does things for all sorts of reasons. He sometimes does this to cause us to trust him more, to reveal some sin, to give him glory.
Notice how both responses fail miserably to be either therapeutic or present with the person in the moment of counseling. Not hard to miss, right? So here’s a question: Why do so many of us counselors, even seasoned ones at that, fail the “presence” test?
My answer? When we fail to be present in helpful ways, it reveals a lack of preparation and a lack of attention to purpose.
Shari Geller and Leslie Greenberg (in Therapeutic Presence: A Mindful Approach to Effective Therapy. APA, 2012) define the building blocks of therapeutic presence as
Sound like mumbo-jumbo? Here’s another way of putting it. What does a counselor need to do to be ready to be in tune with their clients? What do they do to stay in tune when with clients, and are they aware of when they are failing to be in tune? (If I am unaware, then I am likely to get out of tune.)
Here are some things counselors ought to be asking themselves:
Therapeutic presence isn’t everything. I could be present with someone and no healing might take place. But without therapeutic presence, I will only be a barrier to whatever growth is taking place. When I do it well, I imagine that I might see just a tiny glimpse of how Jesus was with the woman caught in adultery, the Samaritan woman, or with Peter after he had abandoned Jesus.
I recently watched a 2 hour CE (made free by the APA until 12/31/12) about the common stresses of military personnel and their families. While it didn’t have any information on particular counseling interventions, it did do a decent job giving a brief overview of military lingo and differences between the branches (e.g., why you would NEVER want to refer to a Marine as a soldier). The speaker is from the Deployment Psychology training institute and that site will provide you with ample clinical training continuing education. Some of the on-line trainings are free (unless you want CE credits).
Counselors often use what they call “additive” words to help flesh out the thoughts, feelings, and experiences of their clients. For example,
CLIENT: I feel so frustrated about how long it is taking for me to hear about the job I applied for.
COUNSELOR: You’re feeling anxious?
Certainly, my example is superficial and simple but you get the point. Frustrated doesn’t really adequately describe the true feelings of the client. We sometimes need help with defining what we really feel, think, or believe. This word addition happened to me today in a powerful way.
Today I was telling someone about a repeated discouragement I have experienced in recent months. In describing my experience I used the word “rumination” to describe the re-occurring thought pattern. She deftly said just one word.
“Grumbling?” [well, in fairness, that is what I remember]
That one word changes everything. When I choose to describe myself as having a repeating thought–a rumination–I am accurate if I am speaking only about the repeating part of the thought pattern. But notice that “rumination” doesn’t evaluate attitude or belief. What my trusted friend was trying to tell me was that I was allowing myself to have a pity party. I was accepting the disappointment feelings without any evaluation of what it was that I believed about the situation at hand. Truthfully, she was right. I was accepting the thoughts and feelings as accurate rather than interpretative of my situation.
Now, I am not arguing that those who have actual ruminations (a part of OCD) are all grumbling. But, it is a good reminder that the words we use do shape our perceptions of our life! We do not just respond to disappointments, we interpret them.
Filed under Cognitive biases, counseling, counseling skills
How important is it for a counselor to diagnose the client’s root problem? Consider these analogies:
Imagine being diagnosed with cancer in one part of your body but having your doctor tell you that it isn’t important to discover whether the source of that cancer lies elsewhere. You wouldn’t be happy and you would likely seek another opinion. Or, consider this analogy: you keep cutting off the tops of dandelions only to find that they keep coming back. Not a very wise decision. Instead, you find the tap-root and remove it if you really want to stop the weed from growing.
In the last week I have had three conversations about identifying the source or primary cause of someone’s emotional struggle. In each case I was asked questions about the source of the problem.
Is it a chemical imbalance? Is it the result of childhood trauma? Is the primary problem his sin?
I understand these questions. They are reasonable and important to ask. As a counselor, I am trying to assess how a particular psychological problem develops in an individual. But, maybe these questions aren’t as helpful as they first appear. Here are two reasons why we ought not put too much stock into seeking out the root problem and a suggestion for a different approach than the “why” question.
An Alternative Approach?
I’ve just tipped my hand in the last point. How is a better question. Finding out how a particular feature (belief, habit, experience, perception, biological process, etc.) influences current life and how a person might respond to or engage differently over a problematic emotional expression is more likely to bear good fruit. Consider these examples:
So, asking why we do what we do or why we are the way we are is interesting but not always the most helpful question from a counselor. Instead, explore your perceptions, reactions, thoughts about what is happening and explore how you might come to feel, think, or engage the problem from a different perspective or with a different goal in mind.
I have a post over at the Seminary’s faculty blog today. You can find it here.
Counselors label all the time. Even when we don’t offer official DSM diagnoses, we label things as good, bad, healthy, unhealthy, dysfunctional, sinful, etc. The key question counselors face is WHEN and HOW to share their views on a subject. Just because we can see something is wrong doesn’t mean we ought to share it yet. While you may wish your family doctor to share suspicions of Lyme’s disease with you on the first visit, your counselor may need to earn the right to say, “I think you have become embittered over your husband’s insensitivity.”
If you are in a position of authority (parent, teacher, boss, counselor, leader, etc.) consider how quickly you use labels and whether or not they invite dialogue and action. If the result of our labeling is increased passivity in the one being labeled, then maybe we need to consider that our labeling is part of the problem.
Ever had a person tell you they can’t trust you when you know they can? What was your response? if you are like most people, you notice the tendency to want to defend yourself. No, really, you can trust me. Why don’t you give me a chance? Or maybe your response isn’t one to beg but to back away and treat the person with a cool demeanor.
What should counselors do when a client doesn’t or won’t trust their intentions or motivations?Janina Fisher (see previous post) reminds us that the right responses is…acceptance validation. Especially with clients who experienced invalidation in violence and abuse. Notice that the effort to press a client to trust you or distancing from them sends the exact same message: your feelings and experiences are wrong and something to be rejected. Not surprisingly, clients feel invalidated once again.
What does validation look like?
You are right. You don’t know if you can trust me. Trusting important people meant that you got hurt in the past. So, not trusting me is understandable. So…what should we do? Validation doesn’t mean that we agree with whatever our clients say but that we find the truth and we underline it. Further, it means that we give the power back to our clients since many of them experienced being controlled.
Too often we think we know what is best for our clients and we try to indoctrinate them to our wisdom. Even when we are right, our efforts may unwittingly re-enact the stealing of power to set proper boundaries. Even when our clients want us to convince them that we are okay and worthy of trust, we ought to be careful. In everyday life we have to trust others, live with the possibility that our trust may be violated…and that we will need to respond to such violations with grace and truth. Promises to always be trustworthy perpetuate the myth that protection from all pain is possible in this life.
Musings on Faith and Psychology 