I’ve written a post over at our Biblical Seminary faculty blog about the art of disagreeing with others in public. By public I mean the kinds of conversations that take place in face-to-face with an opponent, discussions of a thinker’s position in a classroom, or the kind that take place on Internet sites (e.g., blogs like this, news sites, etc.).
Check out my 5 tips to more loving disagreements. Try it out with your next conflict with a friend or family member.
Filed under Christianity, conflicts, counseling skills, Doctrine/Theology
Counselors talk about trauma as if all traumas lead to traumatic reactions. They do not. Some people have significant distress from what might be considered slight traumatic experiences (surely an oxymoron!) while others appear not have any negative or ongoing reactions to very large distressing events.
There’s another problem. We sometimes talk as if all traumatic reactions are the same. This is also not the case. While the symptoms of posttraumatic stress disorder (PTSD) are well-known to many (i.e., intrusive re-experiencing of trauma experiences, emotional numbing and other attempts of avoiding memories or triggers, and hypervigilance), you can find counseling students and practitioners who are less aware of a cousin of PTSD: Complex Trauma.
I’m reading Treating complex Traumatic Stress Disorders: An Evidence-Based Guide, edited by Christine Courtois and Julian Ford (Guilford Press, 2009). This is an excellent text if you are interested in exploring the symptoms, neurobiology, and treatment protocols for complex trauma. In the foreword, Judith Herman helps the reader clarify the main difference between regular and complex trauma
These days, when I teach about complex PTSD, I always begin with the social ecology of prolonged and repeated interpersonal trauma. There are two main points to grasp here. The first is that such trauma is always embedded in a social structure that permits the abuse and exploitation of a subordinate group… The second point is that such trauma is always relational. It takes place when the victim is in a state of captivity, under the control and domination of the perpetrator. (xiv, emphases mine).
For trauma to become complex one needs to experience the trauma at the hands of those who are most perceived to control a social unit (family, community, etc.). It needs to be repeated and woven into the fabric of distorted relationships. You can see that prolonged abuses experienced as a child prior to development of an understanding of the world and of the self would have more devastating impact than an unfortunate and distressing event that happens as an adult. If I experience a horrific accident and an unexpected attack by a stranger, I would not, usually, begin to feel unsafe amongst friends and family. I would likely continue to trust them even as I might not trust the larger community. However, if I experience repeated abuse by a teacher, a parent, a relative, a church leader as a young child, I do not have the prior experiences of safety to rely on and thus, I am likely to experience all of the symptoms of PTSD and then some more.
Courtois and Ford give a cursory description of complex trauma on the first page of the book,
…involving traumatic stressors that (1) are repetitive or prolonged; (2) involve direct harm and/or neglect and abandonment by caregivers or ostensibly responsible adults; (3) occur at developmentally vulnerable times in the victim’s life, such as early childhood; and (4) have great potential to compromise severely a child’s development.
Adding to the typical symptoms of PTSD, complex trauma victims also struggle to regulate emotions, impulses, somatic experiences, consciousness, and evidence significant distortions in views of the self and others leading to difficulty forming trust relationships and finding meaning in life and faith.
Those interested in learning more about the current thinking on complex trauma conceptualization and treatment may find this book useful. Others may wish to check out the latest articles at www.traumacenter.org, one of the leading centers in the country focused on the problem of trauma.
In the last week we have been discussing the best words used to describe the process of trauma recovery (see related post below). While words are important and carry much meaning, it may be more helpful to consider what recovery goals are in order for trauma victims. While we know recovery road can be long and arduous, it helps to know when we make progress and a general sense of the direction we are headed. In the days before GPS, if you went on a long car trip you probably consulted a map on several occasions in order to make sure you were headed in the right direction. So also, when you are working to get better after a traumatic experience, you want some sense you are still working on good goals. This need is especially great if the traumatic symptoms are complex and the treatment not brief (think war, genocide, child sexual abuse, etc.)
Esad Boskailo, as noted on p. 94 in his memoir (written and reported by Julie Lieblich) works toward these three goals that in turn support the ultimate goal: thriving (notice that the goal is not being free of symptoms, free of triggers, or back to life as if the trauma did not happen).
I think these do function well as helpful signposts or intermediate goals in the process of recovery from traumatic experiences. Now, I don’t believe these goals are necessarily in sequence. For some clients, they stumble on something that gives new meaning to life and thus are better able to acknowledge losses. Others get to work on building better coping mechanisms (e.g., a vet puts away items that cause him or her to dissociate, an adult victim of CSA stops cutting and develops acceptance strategies, etc.) and then can acknowledge losses.
So, in the murky water of therapy (and it surely is murky!), the trauma victim can find some comfort in activities pointing to these intermediate goals. Each day they reject self-condemnation for not being who they used to be before the trauma, they are moving toward thriving. Each day they embrace available coping resources (e.g., a friend who will call or pray), they are moving toward thriving. Each day they find one meaningful experience, they are moving toward thriving.
the how we meet these goals is, of course, the 64,000 dollar question…and not something we can set in stone. I will write on some general activities that are common in most treatment modalities in the coming days.
Most counselors and therapists get into the field of counseling because they want to help people. This is a good thing! Imagine if they only wanted to make money or to be the center of attention. But, underneath the goal of wanting to help people lurks an insidious goal:
being seen as wise.
Being seen as wise (notice the difference between being wise and being seen as wise) tempts us to become the teacher, the teller, the obnoxious sage. Teaching, telling, training are all activities that may happen in counseling, but only when necessary. Truth be told, we counselors resort to teaching and telling because it gives us a job to do and makes us feel good. This is especially true when we work with the most severely traumatized people. Here someone is hurting in front of us. We can see that they are stuck. Who wouldn’t want to pull them out of the mud? Now, there may well be important teaching moments–gently instructing someone on the symptoms of trauma and/or the physiology of trauma. This might be important for the client who believes that the symptoms are really signs they are sinning and that they can just choose to stop being triggered.
“The patient is the ultimate teacher about trauma, and a good therapist is a good listener.” (Boskailo, p. 81)
While the counselor has much to offer in regard to teaching, training, and goal setting, we must remember that the client is the one teaching us about their trauma experiences and how much they can deal with at a given time. For example, Boskailo reminds us (see above link for book) that while telling the trauma story is an important part of the healing process, the “how” of telling (and the “how much”) is something each client will need to teach us. One client may need to tell and re-tell the same story each week. Another may be better helped by drawing. Still another may tell once and never again.
We counselors are the student in these kinds of matters. It is our job to listen well and learn well!
Recovery. Healing? Restoration? These words contain both information, movement, and emotion. What words do you like to use when describing the process of getting better after a traumatic experience? How do you communicate that you are better but not so much better that you have no more bad memories; that you have no more nightmares; that you are not triggered into panic when you see someone who abused you?
What words do you shy away from?
Let’s consider healing first.
Some hear healing language as a completed task. “I have been healed.” Past tense. If I was in a wheelchair but now I walk…would I say I have been healed if I walk with a limp or need a walker to get around? Do you ever hear someone say, “I was healed, in part.” Would it be better to say I am being healed or I am recovering. Compared to Greek verb tenses, our English language doesn’t communicate well the ongoing state of something. In Greek, we can communicate a present perfect tense such as, “I was and am currently being healed” all in one verb form. But in English, we cannot communicate such an ongoing process without more words. Thus, when we use the shortcut, “I am healed,” it sounds like a finished job.
What about recovery? Restoration? Renewal? Recovery words are popular amongst former addicts. For them it connotes that they are no longer using but making the daily choice for sobriety. However, they recognize the danger exists of falling back into drunkenness and so they communicate that they are in a lifelong process. For some, however, recovery sounds like a failure–failure to find victory and failure to accept a new identity. The truth is, few people outside of AA use the word recovery in every day speech. The other “r” words are more likely used in Christian circles but not so much in discussion of life after trauma.
I have just finished reading Wounded I am More Awake: Finding Meaning after Terror by Julia Lieblich and Esad Boskailo (2012, Vanderbilt 
University Press). Julia helps tell Esad’s (a Bosnian doctor) experience of being held in 6 different concentration camps. He is now a psychiatrist in the US and works with trauma victims. However, he faced much brutality in being treated worse than one would treat an animal and so was not in good physical or psychological shape when he came to the U.S. I commend the book to those who want a basic understanding of trauma and of this thing we are trying to call healing and recovery. Listen to these quotes from Boskailo the psychiatrist,
I can’t take away what happened” [said to another survivor]. But [I] can help [you] imagine a better future.
“You are fifty, not twenty-five. You will never be the person you were twenty-five years ago. Even if you didn’t have trauma, you would not be the same.”
What Boskailo is arguing for is integrating trauma into one’s present life. One cannot go back and recover what was lost. A trauma survivor is never going to be free from losses suffered. To do so would be to deny truth. Integration means allowing the reality of trauma and its losses while finding meaning and value to live in the present with hope and even joy. Integration requires acceptance and willingness to look for meaning and purpose.
I like the connotations of integration. But, I am not sure I like the word integration since it also doesn’t connote some level of arrival at a good enough place. What word would you use?
church should be the safest place in the world! Unfortunately, it isn’t always. Even worse, when abuse does happen, the church may not always protect the victims. While this shouldn’t surprise us since the church is full of sinners, we ought always to be working to make it a place free from abuse. Is your church working to protect the congregants from abuse? Is it ready to respond to an abuse allegation?
This summer I will be co-teaching with Boz Tchividjian (Liberty Law School prof and former prosecutor) a weekend course/conference on preventing and responding to abuse in the church. We are inviting church leaders to join our MDiv and counseling students at Branch Creek Church, Harleysville, PA. The class will run Friday night, July 20 and all day Saturday, July 21, 2012. All the details you need can be found on this Abuse Course Flyer.
Would you consider personally inviting your pastor or church leader by passing on this brochure?
For non-student registrations, click here. If you want to see a syllabus, click here.
Every counselor, social worker, psychologist, and other mental health workers get professional ethics education. Such training is designed to teach us to “do no harm.” What mental health professional gets into the field to do harm? We all believe we are going to work for the betterment of our clients.
Rarely is it because we don’t know the rules. Consider the most recent issue of the APA Monitor on Psychology and the short ethics piece by Alan Tjeltveit (a colleague of mine and fellow CAPS member) and Michael Gottlieb. (You can read the electronic version here; turn to page 68.) In it, the authors nail the reason why with this quote,
Too many professionals complete their training without the emotional education and awareness needed to avoid self-deception and to act in the prudent, considered manner that society expects and that represents professional ethical excellence. (p. 72)
We fail to take a skeptical (note…not fearful) stance toward our own thoughts, feelings, and attitudes. Since we know we are going to work for the good of others we often stop considering that some other values that we hold might get in the way. For example, I might value avoiding conflict and so not address a safety concern with my client for fear they will get angry with me. Or, as the authors of the article point out, I might practice when I am too distressed to help others–because I believe I can still manage the situation (see page. 70).
As necessary as it is to keep taking ethics updates from continuing education providers, it is even more important to have a close colleague who doesn’t take you too seriously and is willing to ask the hard questions. Yes, we need an operating sense of values. We need to be tuned to our conscience. We need the Holy Spirit’s help in loving our neighbor as ourself. But, more importantly, we need to stop trusting in our own judgment and acknowledge that hidden values sometimes operate more powerfully than we expect. Desires to be liked, to avoid conflict, to maintain power, to satisfy longings have ways of creeping in. One of the reasons God puts us in community is that we need others to speak into our lives.
Do you want to avoid ethical missteps? Who exists in your life who has the access and capacity to speak into your life; to ask questions others might not think to ask?
American Bible Society (Photo credit: Wikipedia)
It is my pleasure to announce that I and Biblical Seminary are the recipient of a sizeable grant to launch our new Global Trauma Recovery Institute–training for lay and professional recovery experts in the US and around the world. The grant (from an anonymous donor and the American Bible Society) funds the Seminary’s collaborative program with ABS to provide deeper training for those active in both trauma recovery efforts in the US or in training local facilitators in east/central Africa.
ABS is involved in a trauma healing/scripture engagement project, focused in Africa but with other works going on around the world. This project has been under the work of ABS’ She’s My Sister initiative in the Congo. The bible societies were founded on bringing scripture to bear on the current issues of the time–specifically slavery. So, it make sense that ABS is interested in helping traumatized individuals recover from wounds by showing how God cares and is active in their recovery. Through connections with a few of my students, I and Diane Langberg have become co-chairs of the advisory council to the above-named initiative.
The generous grant will enable Biblical to do the following
Dr. Diane Langberg is the leading Christian psychologist with expertise in trauma recovery. Her teaching has taken her to South America, the Caribbean, Africa, Asia, and Europe. Her books on sexual abuse remain popular with both clinicians and victims. She joins Biblical Seminary as a Clinical Faculty member (clinical faculty are practitioners who also lecture and train) and will have a leadership role in the shaping and delivery of the curriculum and trainings. It is safe to say that the counseling department has been most influenced by Dr. Langberg’s training and supervision.
Until we launch the institute website, the best way to keep yourself informed is to do one of the following: subscribe to this blog where I will be posting updates; keep checking with www.biblical.edu for more information, or email me at pmonroeATbiblicalDOTedu and I will put your name on a growing list of those who want to be on our mailing list.
I have a new post on the faculty blog over at www.biblical.edu. You can read it here. When any church faces the sad and grievous reality of abuse within their own community, leaders must respond. If not prepared, leaders may make decisions based on knee-jerk reactions rather than a set of previously discussed core values.
Check out the tale of two church committees (my original but discarded title of the blog).
Filed under Abuse, Christianity, counseling skills
Cover via Amazon
At the recent PCA mercy conference, I attended Steve Corbett’s seminar on rethinking benevolence practices. If you are unfamiliar with Steve, if you are involved in mercy or diaconal ministries, you absolutely should read his book, When Helping Hurts: Alleviating Poverty without Hurting the Poor. Or, go to this site if you want to know more about asset-based benevolence and the Chalmers Institute. The book and site will give you a clearer view of different kinds of poverty (material, being, purpose), the important distinctions between relief work, rehabilitation, and development work (and why pure relief may not be all that helpful outside of very immediate crises). What I found most helpful was his differentiation between need-based development (tends to focus on what is missing and outside resources can help) and asset-based development (which focuses more on existing assets that can be mobilized…and thus likely to be more sustainable).
Counseling that hurts?
We kindly Christians care about the world and about emotional, spiritual, cultural, and economic poverty. We want to help. Counselors want to help. It is necessary to review whether the help we offer is really all that helpful in moving individuals from passivity to activity. One of the hardest things to do in benevolence and counseling is to recognize when you are working harder than the one you are trying to help–and to then stop without withdrawing emotional support. For example, you counsel a person who is stuck in an abusive marriage. You so much want to help that person get to safety. But note several problematic responses
One of the most important things to remember is that even if a person rejects our advice, we are still offering help. We are giving them opportunity to consider a new way of thinking. We are helping them weigh pros and cons. We are one safe place. If they reject our help, we will be sad. But we ought not feel guilty.
Musings on Faith and Psychology 