Category Archives: counseling

Can Mental Health Practitioners Predict Future Violence?


Yesterday, a gunmen killed five and wounded at least eight others at the baggage claim for a Florida airport. Initial news reports allege the shooter had recently experienced psychotic-like symptoms. I am sure that in the coming days we will learn more details about the shooting and about the recent history of the shooter. Among the details there will be plenty of questions. Did anyone know this might happen? Could someone—especially in positions of power (FBI? Mental Health?)—have prevented it by reporting or removing access to guns?

Of course, it is easy to ask these questions and develop opinions after the fact. And yet we need to ask them if there are possibilities to learn from possible mistakes. What follows attempts to give the public a brief but better understanding of risk assessment when mental illness and violence combine. (NOTE: this is not a comment on the above sad situation or those cases where violence is unrelated to mental health.)

A little history of predicting future violence

Violence risk assessment is part of the sub-division of forensic psychology and psychiatry. Expert witnesses are used in court proceedings to report on the existence of mental illness, the probability of imminent dangerous behavior, and the options for most effective/least restrictive treatment required to reduce illness and increase safety.

How do clinicians make these opinions? In the not-too-distant past, expert witnesses usually used their wisdom shaped by years of experience. Much to the chagrin of experts, it turns out that clinical intuition isn’t all that effective. For some professionals, it is little better than chance! (Interested readers can check out Monahan’s 1984 oft-quoted research quoted in this rebuttal article.) Other options include actuarial methods (collecting risk factors just like an insurance company does to determine how much to charge your 18 year old son for car insurance) and test data. Both of these methods seek to eliminate feelings in the decision-making process. Actuarial data can certainly help us. Knowing someone has a history of violence and criminal behavior helps us predict future behavior. Knowing someone has schizophrenia may slightly increase risk of violence, but no more than it would for those who have problems managing impulses. And this would not be a reason to lock someone up (though it may be a reason to limit access to handguns). Assessment tools filled out by the person suspected of violence have a couple of problems with them but the main one is that very few of the most violent have been identified in treatment as possibly benefiting from assessment. And when we do give these assessments, the data rarely is clear—this kind of response means they will be violent, this one means they will not. We’re far better at identifying “faking good” or “faking bad” results than we are in determining whether the results mean future violence.

The best assessment to date requires that we have adequate history, survey of known risk factors, interviews, and test data. But as I said above, if the person suspected has not been in treatment or has done well to present as being merely disturbed but not dangerous, what can be done?

One More Complication

In our current society, we believe deeply that individuals have the right to self-determination. This means they have the right to refuse treatment. This right trumps nearly every other value. It doesn’t matter if the treatment would really help. The person is permitted to refuse. The only exceptions are involuntary commitments to address imminent danger to self or other. And as soon as the danger passes, the treatment can be refused again even if the treatment might avoid a relapse.

Bottom line for Practitioners

We can do better in responding to risk factors that might lead some to violence. We can learn more about these factors. We can equally promote confidentiality and privacy for our most distressed clients and yet be quick to warn others when signs of imminent violence are present. We can ask better questions. We can use non-cognitive approaches to get a better picture of their internal experiences. And yet, we can only work with the information we have. Contrary to popular belief, we are not prophets. In addition, most of our outpatient clients are not even remotely dangerous (in 27 years of clinical work, I have only needed to report two clients for imminent risk to others).

What we can do is assert the need for better and more available treatment options.

Family members are really the frontline of help for most distressed individuals. They are more likely to hear the murmurings that might indicate violence. This requires greater public education about the nature of mental illness and violence risk assessment and the kinds of ways to respond. Church leaders can also be better educated as to what kinds of options are available for those parishioners who are struggling with similar kinds of emotional distress. Let us be willing to lead the way in educating our communities and churches about mental health challenges and healthy responses. If we did a better job surrounding those with severe mental illness (and isolating them less) we would likely have less mental health induced violence.

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Filed under counseling, counseling science, counseling skills, News and politics, Psychology, teaching counseling, Training, Uncategorized, Violence

Over-confidence? Under-confidence? Assessing counselor tendencies


Every counselor desires to be effective, to handle client concerns and problems with competency. We do this work because we long to see others recover quickly and we do not want to get in the way of needed and desired growth. Early career counselors often feel out of their league and so seek out all the help they can get: supervision, books, essays, and peer-consultation. This is the proper way to learn and become better at our craft.

But what happens when we begin to feel competent and confident? Do we stop feeling needy? Stop seeking input? If we do stop pursuing growth and increased competency, skills and capacities will erode. We might think all is well, we’ve got this under control, but in reality we would enter dangerous territory. Imagine wanting to be an Olympic athlete and yet forgoing training.

Erosion happens.

So, should we want to feel less competent? No. The goal is not to feel ineffective nor to lack confidence in what we do. I would not want a second-guessing surgeon to operate on me. Rather, it is important to maintain regular (not obsessive!) self-examination and invitation to others to give you input and feedback.

For the possibly under-confident counselor:

Where do you feel you need help, are less competent than you would like? What are your common responses to that feeling? Who have you talked to about this problem? Where have you sought help? What continuing education have you completed? While it is good to get help to “know what to do” don’t forget that a large portion of therapeutic success is attributed to who you are in the session. Be sure to focus on your listening, and “bearing-witness” skills. Remember to be a student of the client.

For the possibly over-confident counselor:

Do you still have supervision? If not, why not? Look over your caseload. Who are you working with who you have not reviewed assessment, diagnosis and treatment plans with another (note: peer supervision can be done without revealing confidential or private information)? When was the last time you verbalized your case conceptualizations with a critical eye to the potential myopia that plagues us all? What continuing education have you completed that can revise and improve your skills?  While relationship-building skills are the most important, do not stop learning and growing in knowledge and understanding.

It is good to remember that  our skills WILL erode without attention, just like muscles with grow flabby without exercise. One such muscle for the Christian counselor is that of prayer. Consider your recent counseling activities and ask how prayer has fit into your work. Is it a perfunctory or an afterthought? Does is change depending on how you feel about your competency? What does it reveal about your therapeutic operating system (e.g., what is the source of power to change?)

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Is your empathy really self-serving?


Empathy, or feelings of understanding or identification with another, seems to be a primary vehicle of human expression of love and compassion. In the world of therapy, empathy seems the foundation for all good counselor work. Sure, we can act in kind, compassionate, yet robotic ways but knowing that someone gets you and helps you is better.

But this begs two questions: Are empathy and altruism connected and parallel? And, is our empathy really self-serving? Taking the second question further, could our empathic responses be destructive to the very people with whom we want to help? Psychologist Paul Bloom thinks so (short video of his contra empathy point of view). While I think his argument against empathy is seriously flawed and really merely an argument against naïve, superficial, and self-serving do-gooderism–a significant problem in our society where we solve problems on emotion and often without taking the time to understand either cause or consequence–the bigger question is whether or not we ever really have concern for others outside of self-interest. And if we discover that all empathy is self-serving, does that deny the Christian virtue of self-denial and voluntary submission to others?

What is at the heart of our empathic, altruistic behavior?

We all have numerous instances where we have witnessed self-sacrificing behavior. The reason these instances stand out in our memories is that they are unusual and somewhat rare experiences. But consider the more run-of-the-mill expressions of empathy. You see a GoFundMe page for a friend in need and you give. Your church is seeking donations for Thanksgiving baskets and you buy groceries. Your neighbor is sick and you mow her lawn. Do we do these behaviors for them? Or do we do it, in large part, for ourselves?

Josh Litman’s paper “Is Empathy Ultimately Just Narcissism?” seeks to summarize the research literature about whether empathy and altruism are positively correlated and whether empathy is really about the other or about self-interest. His answer? Empathy and altruism may not be all that connected. Empathy is better understood as feelings of “oneness” or connectedness to the other. When I identify more with someone, I’m more likely to feel empathy and do self-sacrificial for them.

In conclusion, this paper defends a non-altruistic, egoistic strain of empathic concern. It might be heavy-handed to call it narcissism, but evidence has shown that empathic concern is certainly motivated by self-interested factors rather than selflessness.

Could this be the reason why more people changed their Facebook profile images to a French flag after the Paris bombings and far fewer chose a Turkish flag after the most recent airport bombing? Do we more closely identify with one group over another and thus feel more empathy and make more statements of support and care?

Does this proclivity to more strongly identify with some more than others reveal self-interest and self-concern? If so, does that make our caring of others all about ourselves and cause us to suspect the warmth and empathy we get from others?

So you, too, must show love to foreigners, for you yourselves were once foreigners in the land of Egypt. (Deut 10:19, NLT)

Oneness and love in the created and the Creator

I think empathy can be self-serving (I care for you because I want to be cared for) but I do not think it must be this way. Rather, I would argue that we have been designed to understand our world by means of our experiences. Because I understand what it could feel like to lose my home to a flood I am moved to donate time and talent to help rebuild a home. Because I see your humanness, I am able to empathize with your losses and then consider what possible ways I might respond.

Oneness does help us empathize. But empathy is not the same thing as love. True love, as an action verb, requires a willingness to expend self for the sake of another. True love enlarges the population you are one with. So, straight people find themselves in the experiences of gay people; Christians in the experience of Muslims; liberals in the experience of conservatives. True love moves beyond simplistic understandingfile-nov-02-12-21-19-pms with oneness and best reflects the character of God who self-sacrificially loves beyond measure, choosing to take up our infirmities as his own.

In your relationships with one another, have the same mindset as Christ Jesus: Who, being in very nature God, did not consider equality with God something to be used to his own advantage; rather, he made himself nothing by taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself by becoming obedient to death—even death on a cross! (Phil 2:5-8, NIV)

For we do not have a high priest who is unable to empathize with our weaknesses, but we have one who has been tempted in every way, just as we are—yet he did not sin.(Heb 4:15, NIV)

 

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Does your counselor have these two important skills? 


I love working with counselors-in-training. We get to discuss everything from diagnoses to interventions, ethics to theology, character development to politics. I know I’m biased but along with the population of Lake Wobegon, our students “are all above average.” 

That said, there are two extremely difficult counseling skills every student needs to learn–frequently the hard way. To be an effective counselor, you have to be able to conceptualize a person and their presenting problems well (e.g., wrong assessment leads to wrong treatment) and you have to maintain a clinical alliance throughout the course of treatment. Of course, a counselor needs to be of good and mature character. She needs to have a bank of excellent questions to ask, a knowledge of common intervention strategies, and a good ear to hear what the client is trying to express. These things are necessary foundations for the skill of conceptualization and alliance.

Conceptualization

When you come to counseling to discuss a challenge in your life you want the counselor to be able to understand and put your situation into proper perspective. You expect them to have some expertise beyond your own–otherwise why go? As you tell your story, it always has missing and disjointed parts. There are dead ends and mysteries that may start out feeling important that in time become less a focus than other issues. Your counselor needs to put the problems you raise into some context. What lens to view the problems should be used? 

  • Is the conflict between a mother and teen best understood by the lens of enmeshment, Attention-Deficit, autism, sinful pride, depression, anxiety, rebellion or…?
  • Is the conflict between a husband and wife best understood as lack of knowledge, demandingness, personality disorder, emotional abuse, etc.

An effective counselor uses multiple lenses to view his counselee and holds those lenses loosely in recognition that first impressions need refinement. 

Do you feel heard or pigeon-holed by your therapist? Does your therapist discuss possible ways to look at the problem you have and thus different ways to approach solutions? 

Alliance

Alliance is a hard thing to describe but it encompasses a trust relationship where therapist and client work in concert to explore and resolve a problem. There is agreement on the problem definition and the process of therapy.  There are several things that seem to be part of this concept but fall in two key categories: techniques and stance. A good therapist asks great questions that enable a person to feel heard as they tell their story. A good therapist validates the person even if they do not agree with interpretations of the client. A good therapist makes sure that the client knows they are more than the sum total of their problems. Finally, a good therapist checks in with a client to find out how they are experiencing the therapy session and approach. But good questions and feedback are not the full picture of alliance. The therapist needs a stance that reflects being a student of the person; of collaboration over action. It reflects an understanding of pacing and the client’s capacity to process information.  

A counselor can understand a problem but if they rush ahead or lag behind in pacing, the alliance will fail. Consider this example. Therapist A meets with a client with a domestic violence victimization problem. It is clear to the therapist that the client needs to move out and that the client is resistant to this idea. The clinician presses the client to leave and challenges her to see her husband as an abuser. While the counselor may be correct, the confrontive and authoritative stance is unlikely to bear much fruit and will either create defensiveness or passivity in sessions. One sure sign of poor alliance is when a therapist is constantly thinking about how to get his or her client to do something. 

Meanwhile, Therapist B meets with the same client and explores the ambivalence she has towards her husband and the abuse. Options are discussed, less for movement sake and more for examination of fears and opportunities, hopes and despair. Both therapists have the same sets of good questions, but one is more aware of the pacing of the client and meets her where she is where the other one forces a pace the client is not ready to match. This does not mean a counselor never pushes a client but it does mean they never do that without the understanding and agreement of the client. 

Alliance is not a static feature. It grows and shrinks during the course of a relationship. There are ruptures and hopefully repairs. Sometimes a rupture leads to an even stronger alliance if the repair leaves the client feeling cared for and respected. Ruptures are not always caused by the counselor but it is the counselor’s job to notice and to work to resolve. 

Do you feel like you are on the same page with your therapist? Do you have evidence (not just fears) that your counselor is frustrated by you? When you have a “miss” in a session, does your therapist acknowledge it and talk about how you are feeling about therapy? If you bring up an rupture, are you listened to? 

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Does trusting God remove anxiety?


Over the years of doing therapy with Christians I have noticed how many feel guilty for their anxieties. “If only I could trust God more…I say I believe he is good but clearly I don’t trust him because I can’t stop being anxious.” Still others express distress that their faith in God does not change their feelings of hurt over past relational wounds and fears it will never get better.

It seems we believe this maxim: If I really trust in God, I will be at peace. I will not struggle with the brokenness around me or with the unknown future.

Is this true? Is it possible to trust God fully and experience chronic negative emotion?

Let me suggest a better maxim and then illustrate it with a couple of Psalms.

Because I trust God completely, I bring him my angst again and again.

At the recent #CCEF16 conference on emotions, David Powlison referred to Psalm 62:8a, Trust in him at all times, O people; He noted that this assertion is strong. But what does it look like in action? David pointed us to the next line (8b) Pour out your hearts to him, for God is our refuge. Trusting God looks a lot like venting, crying out in our confusion, sharing our fears and despairs.

Take a closer look at this Psalm. The writer is under assault by others. He likens himself to being a tottering fence, something easily knocked over. He is asking his enemies, “how long are you going to harm me?” He knows their intent. But their evil is the worst sort, one that pretends to be good but is really evil. They take delight in lies. With their mouths they bless, but in their hearts they curse. It is likely the psalmist could say, “with friends like this, who needs enemies?”

So, how does he talk to himself? Look at the cyclical pattern: reminder-pain-reminder-warning-reminder

  1. He starts with some truth. My only rest (or silence/peace) is in you God. You alone are my fortress. I will never [ultimately] be shaken.
  2. He laments. But you enemies are trying your best to destroy me, a weak, tottering fence.
  3. He reminds himself. Remember, look for rest and peace in God alone, it is only there you can find it, even when the ground is shaking
  4. He warns self and others. Don’t trust in your position, don’t trust in ill-gotten gain. And if God blesses you, don’t trust in the blessing
  5. He cycles back to truth. Remember this one thing: God you are strong AND loving. You will remain righteous in your dealings with us.

While the Psalm ends, I suspect the writer could easily have kept the pattern going, as in starting again with the first verse or adding more to the pattern.

This pattern of truth, honest admission of pain, reminder of truth is a far better picture of the reality of life hidden in Christ than the false stoic (or Zen) image of being unperturbed by the chaos in and around us. God does not remove us from the storm. Instead, we express our trust (as much to remind ourselves as in bold assertion), we lament, we groan, we pour out our troubles and we circle back to the one truth we can hang our hope on.

You can see this pattern also in Psalm 42 and 43 with slight variations: Remember when I used to be out in front leading the worship but now my tears are my only food. Why am I like this? I hope in God. But I am downcast. Day and night God is loving…but it seems you have forgotten me in my oppression? Vindicate me. You are my stronghold so why is this not getting better? Free me so I can worship you…yet I am still in despair even as I hope in you.

If you feel guilty much of the time when thinking about your level of trusting God, consider this alternative narrative: it is the greatest act of trust to keep bringing God your troubles, even when things or your response to them do not get easier.

So, does trust in God remove our anxieties? Not as much as we might think. But, if you could no longer feel guilty about your angst, might you in fact feel more peace as you trust God through the storm?

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Entering into the Emotions of Others: Thoughts by Winston Smith


Winston Smith delivered an extraordinary plenary about how we enter into the pain of others. He began by telling the story from Good Will Hunting, an exchange between the Matt Damon character and his therapist, Robin Williams. The exchange illustrated the difference between having loads of knowledge about love or hurt and a true experience of love (or hurt). Knowledge knows nothing in comparison to experience. Winston then talked about an early counselor experience he had where he listened to a person’s pain but only critiqued it rather than entering in. He acknowledged the danger of biblical counselors to whip out a 3 trees chart and assessing them, thereby invalidating their experiences of pain. 

Instead, he suggest a better path

  1. Enter in. Really listen to them. Don’t imagine how you would feel in that situation as that will cause you to think and respond to yourself, not to the concerns and needs of the one who you want to help.
  2. Connect to their experience. Don’t go first to fixing or giving perspective. That can be helpful in the right time. When you are trying to connect, that is NOT the right time.
  3. Care. Let their grief become yours. Caring does not mean agreeing. And when you see strong responses or biases, we start to think that care means to correct. There is something true enough that you can start with their experience. 

(By the way, I find most first year counseling students really believe they are ready and willing to do these. But here’s where the challenge lies. You sit with someone and they begin telling you their pain. You convey a few connecting and caring responses and then after 5 minutes, you have nothing else to say. You are already wanting to comfort, give perspective, gently correct. We really do struggle with sitting with another’s pain. It makes us uncomfortable)

There is a cost to entering in. It will cost you your comfort. 

These 3 steps are quite hard even as they are simple. They are skills to be learned, but Winston reminds us that it is mostly hard because of something within. Why hard? You have to connect to something inside yourself that enables you to connect with them. You need to connect to fear, to grief, to despair, to rage. It will cost you something to do this well. You have to be willing to be uncomfortable. 

So why would we do this? Sincere love calls us to enter in. It isn’t just a motive; love is a person. We can do this because we know and are connected to Jesus. His nature is love, willing to leave his comfort zone and enter into the world of another. He becomes one of us. Want to give the same love to others? Experience God’s entering into your world. 

He ended with 1 John 4:12: No one has ever seen God. But if we love each other, God lives in us, and his love is brought to full expression in us. So enter in with boldness. 

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Emotions in the face of suffering: Thoughts by Joni Eareckson Tada


“Most people think that living with quadriplegia is overwhelming. And it is.” Speaking at #CCEF16, she says this even as she says that now, nearly 50 years later, she would not give up her intimacy and depth in Christ, deepened through suffering, in order to walk. How do we bring these two opposing experiences together.

Joni tells us there are 1 billion disabled people in the world, most living in the developing world–people who are at greatest risk of being abused, neglected, and not protected. 

She spoke of her chronic pain that grew over the years and exploded in the mid 2000s and how it robbed her of joy and capacity to do the work she wanted to do. “It (the pain) made my quadriplegia a walk in the park.” “I know I am under the sovereignty of God but now his sovereignty seemed so scary.” “My depression lifted the day I was diagnosed with stage 3 breast cancer.” She said this with a smile, “Oh God, you might be taking me home now.” 

“I knew in my head that God is sovereign and that I trust him. Why can’t my emotions fall in line?” She then used the idea that in this life we experience “splashovers” of hell and “splashovers of heaven.” “There is nothing more sweet than finding Jesus in your moment of hell.” Pain tends to bring us into self-focus. But when we see the affliction of Jesus on the cross, our focus is changed. It doesn’t mean we no longer suffer but that our suffering done in and with Christ, “no longer afraid of it.” There is comfort in the promises of God even in the dark seasons. 

How can counselors convince others that Jesus is enough even if the pain is not able to be fixed? We start by counseling with compassion (being with them in their pain and suffering). When the sufferer sees they have a place in the body of Christ, that they are not isolated, this is of great importance. Spiritual community helps the sufferer to accept the pain as their own. God never intended us to suffer alone. Together, healing begins. We don’t just declare God is over all suffering, we demonstrate it through deep relationships. 

Someone who knows suffering can say things that many able-bodied people cannot say, or cannot be heard to say. Joni’s voice is prophetic for the Church. She calls us to walk with those with disabilities rather than avoid. May we listen. May be validate their pain first as we sit with them. May we never tired to hear of their difficulties. May we never put our need for assurance that “everything will turn out right” ahead of their need to be heard and loved. 

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3 negative consequences of having too many options


I prefer having choices to make over not having the option to choose how I spend my time. And yet, just like any medication you might take, the freedom to choose brings with it some potentially dangerous side effects. I’d like you to think about 3 and then consider a couple of modifications about how you make choices.

Consider the differences between choosing a mate today versus 50 years ago. According to Daniel Jones (listen at the 17 minute mark), in previous generations people chose mates from close proximity–from their block, building, or neighborhood. Now, we have endless choices if we are willing to use the Internet.  Consider the differences in choosing professions. In the past, your father was a farmer, you became a farmer. Now, not only can you pursue any career, you have to choose from endless post-secondary educational schools on your way to that career.

How can having choices/options lead to negative consequences?

  • Dissatisfied. You are always wondering if there is something better out there. Again, consider Daniel Jones as he discusses online dating sites,

“…it turns you into a flaky person who is always looking for something better, that can become a kind of mania…if you have a moment of boredom, you think there are 12 more possibilities in your inbox…”

Later in the same interview, Jones tells us that the issue of today is “not labeling relationships. Based on his college student interviews, many young people today are loathe to identify someone as their partner or lover. They tend to resist labeling someone as a boy or girlfriend. The failure to accept normal labels not only lead to potential of chronic dissatisfaction but also confusion–if you don’t know when a relationship begins, ends or what it is founded upon. It would seem that commitment to a relationship would suffer if it never is named as such.

Dissatisfaction leads to comparing self against others and both lead to depression.

  • Anxious. Coupled with the tendency towards feeling dissatisfied with life, more choices lead many to anxiety. What if I made the wrong decision? What if the next person I meet would make a better spouse? What if I’m missing out on something important? Continual choice and/or rumination over choices increases the sense of importance for the choices we have.

Anxiety leads to chronic stress and chronic stress begins to break down our immune system.

  • Fatigued (cognitive and emotional). We find ways to simplify life. A colleague of mine has a system to know what to wear each day so as to avoid the “What am I going to wear today” question. We (try to) put our keys in the same place to avoid the stress of looking for them every time we leave the house. When we live with too many open choices and options, we burn more glucose and our brains become less efficient. We numb our feelings or we become edgy.

Fatigue leads to poor decision-making (impulsive, reactive, unthinking). This is why we blow diets more at 10 pm than we do at 9 am. This is why those with addictions are more likely to use later in the day than early in the morning. When we are emotionally and cognitively fatigued, we are prone to feel greater anxiety and dissatisfaction. The “gift” of choice continues to give.

Can We Do Anything About This?

Now, rest assured that I am not advocating for life to return to a place of no choice (arranged marriage, one career path, etc.). Choice has enabled me to learn about myself and given me many wonderful experiences that as a boy growing up in Vermont I never imagined. But are there ways we can minimize the common negative consequences of too many choices?

  1. Examine your view of God’s will. I meet many people who fear making a choice God does not want them to make. They fear they will somehow end up on plan B of life as punishment from God. While there are many very black and white decisions (should I cheat on my taxes? Is it okay to kill my annoying neighbor?) most decisions are not that clear. What if most of your decisions are neither right nor wrong? Whether you go to university A or B, marry person A or B is less of concern for God than we might think. Typically God seems more interested in our motives than some of our daily choices. Consider seeing God’s will as guardrails on a road rather than a pinpoint decision.
  2. Limit your decision-making time. It can be a habit of some to mull over future decisions long before the decision needs to be made. Do you find yourself worrying about the challenges of next week? While it might seem wise to think through your decisions in a thorough way, anxious rumination is not helpful. Limit when you think about big ticket future decisions. For example, if you are considering a career change, set a specific time during the week to search out available options. Then, when you find your mind mulling over options outside that set time, you can say to yourself, “I’m going to think about that during the scheduled time, not now!” When you do make a decision, use the same technique to limit when you review/evaluate that decision, thereby limiting time for “what ifs.”
  3. Challenge post decision “if only” regrets. I made a major career decision 17 years ago. I chose to become a seminary professor over an Ivy League appointment. For the first few months at Biblical Seminary I found myself wondering if I had made the right choice. I imagine this was the result of financial struggles (the other job paid double) and the overwhelming stress of creating grad courses from scratch (the other job was something I had ample experience to do). So, I could easily see that I chose the harder job for less pay. That became the truth I believed for a bit. But, the real truth is that I chose a job that had immense freedom and opportunity for growth. I would not have been able to travel the world as I do now. Of course, I couldn’t know all that then. So, work to challenge your assumptions about the future. Yes, like me, you will grieve when doors close. But remember, God is at work in providing a future for you, even in tough locations and times.

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4 Reasons I Promote Scripture-Based Trauma Healing


[Note: broken link fixed. If anyone is interested in taking this course with me this summer, see here.]

As a psychologist I have had a front row seat to observe the destruction that traumatic experiences have on individuals and families. And as a professor training future counselors I see the necessity of passing on best practices for treating those with symptoms of posttraumatic stress disorder (PTSD). New understandings of trauma’s impact on bodies, minds, souls, and relationships appear on the pages of our academic and clinical journals. As a result, I read daily about innovative attempts to hasten trauma recovery for individuals and even whole communities.

With a world filled with trauma, it is clear to me we need an army of psychologists and mental health practitioners. How else could we address problems faced by 60 million displaced peoples in the world at present? How else could we address the scourge of sexual abuse, where worldwide 1:4 women and 1:6 men have experienced sexual violation before they reach the age of 18?

So, given the needs I have just mentioned, why would I spend considerable time and effort to promote a bible-based trauma healing training program? Let me tell you four key reasons I think this program is essential to address the world-wide problem of trauma. [Note, this is NOT a paid advertisement.]

Trauma disrupts faith and identity. The church must be at the center of the response

While many practitioners recognize the physical and psychological symptoms of PTSD, fewer have noticed that trauma disrupts and disables faith and connection to faith practices. Just now the scientific community is beginning to track this problem and acknowledge the role faith plays in the recovery process. Some are brave enough to suggest that failing to utilize faith practices and communities in the recovery process is tantamount to unethical practice! But most mental health practitioners have had zero training and experience engaging faith questions as part of treatment. The field of psychology is waking up from more than 100 years of training practitioners to ignore, even reject, faith as essential to healthy personhood. If faith is essential to most people on the planet then any intervention must engage faith and spiritual practices if it is going to consider the whole person.

Dr. Diane Langberg recently reminded a world gathering of national Bible Society leaders that trauma needs in the world are far too large for any government to handle. The only “organization” in the world situated to respond to at both a micro and a macro level is the Church. But is the church prepared? We need the church willing to understand the nature of trauma and participate in supporting faith and Bible-based healing responses. These responses include practices the church has not always been known for: validating, supporting and comforting victims, speaking up about injustice, inviting individual and corporate lament, re-connecting oppressed people to God. We need the church to be a safe community for victims.

The Healing the Wounds of Trauma (HWT) program fills this void. It offers basic trauma education, illustrates how God responds to traumatized peoples and provides simple yet effective care responses average believers can enact without being professional caregivers.HWT_USA_2014

While I believe we psychologists with specialized skill sets are essential to trauma recovery, much of what we do can be done by every day individuals. I tell my students that most of counseling is not rocket-science. Being present, listening well, building trust, validating, asking good questions, and walking with someone in pain is largely what helps counselees get better. With a little training, the church can be at the forefront of the trauma healing.

But we need an army…of capable trainers who reproduce

There are approximately 2.2 Billion Christians in the world today. If we decided (and I am not suggesting this AT ALL!) to only serve traumatized Christians, we do not have enough capable practitioners to serve those in need. The ONLY way we would be able to serve this population is to train up capable trainers (wise, able to work well with others, understand group dynamics, know when to be quiet, etc.) who are then able to reproduce themselves and make even more trainers who subsequently serve ever increasing populations. This creates a cascade effect—1 trains another who each, in turn, trains others. Conservatively speaking, one training of 35 future trainers could reach up to 15,000 traumatized people in 3 training generations.

To maintain quality, the program must be able to be delivered and passed on in a consistent manner. The HWT program is designed not merely to educate participants regarding trauma symptoms and good care/healing practices but how to pass on such knowledge and skill to others. The facilitator (trainer) handbook provides a wealth of information to ensure that the quality does not erode as the information is passed on.

Experiential learning trumps lectures every time

In the West, we cherish academic lectures as the primary training mode. Lectures enable a speaker to give a large amount of information in a short period of time, with minimal interruption. A good lecture casts vision, identifies problems, and points to effective responses. But a lecture cannot produce skilled practitioners. Any academic mental health program worth attending will require practicums where head knowledge is put into repeated practice.

Consider this scenario. My father is capable of building a house. He sits me down and he spends hours gong over the steps to building an addition to my house. I listen, take notes, and even handle the tools that will be used. Am I prepared now to build the addition? No! If I am to build a proper addition, I will need to do so under his close supervision. In fact, most of the hours of lectures are not necessary at all. What will be more effective is his teaching me as we build together.

The HWT program is all about experiential learning. Participants learn as they experience trauma and trauma healing through story, dialogue, and practice. First applied to self and then in consideration of others. This is in stark contrast to most continuing education programs that amount to little more than monologues and passive audiences. While the monologue may give more information, it is highly unlikely that participants can in turn teach what they heard to others. The HWT program is not designed to deliver large amounts of new academic information. And yet, what participants get via experience and practice will be far more easily passed on when they become the teacher. There will be no army of trainers if we cannot quickly get experience and practice and pass on what we learn in simple everyday language.

Good training hinges on contextualization

If trauma is universal, then it might be thought easy to deliver trauma healing training across cultures. This is not so. If I prepare a lecture or training on trauma in my context (the megalopolis of the Northeastern seaboard of the United States) but deliver it on a different continent, my training may be of minimal value. The reason it is sure to fail is that what I had to offer didn’t fit the context; it didn’t speak to the heart of that audience. Good training must be contextualized so that participants immediately recognize trauma in their settings and that interventions make sense. Imagine if I deliver a talk on good conflict skills to a hierarchical society but emphasize the need to speak in “I” language (I need, I feel, I would like)? Such interventions will rightly be rejected as inappropriate. And if experience holds, whatever else I say will also be rejected.

The HWT program is founded on contextualization. Not only has it been translated into many different heart languages, the central stories and illustrations are also contextualized so that the participants can see themselves in the stories and interventions. At heart of each lesson, participants are asked about their own culture’s take on the particular problem. In dialogue, they compare responses to that of biblical passages highlighting trauma, grief, loss, and pastoral care. Nearly every major training point addresses context and encourages participants to develop creative interventions in keeping with key biblical and psychological foundations.

Is the HWT program all a traumatized person needs? No, it doesn’t assume this. Is the HWT program perfect? Of course not. I continue to make suggestions for improvement and the authors and developers are some of the most flexible I know, always looking for ways to improve the materials and training program. There are many other solid programs out there, but few programs I know have refined the content and delivery systems to be able to scale out across the globe. I’m grateful for the opportunity to serve the Mission: Trauma Healing team at the American Bible Society as co-chair of their advisory council and occasional trainer.

For a more visual exposure to this training, see this downloadable documentary.

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Filed under Abuse, Christianity: Leaders and Leadership, counseling, Missional Church, Post-Traumatic Stress Disorder, ptsd, teaching counseling, trauma, Uncategorized

Counseling Advice From Lady Gaga?


Lady Gaga has a new song about the aftermath of sexual assault. Unless you’ve been living in a cave, you likely have heard of Lady Gaga who is known for crazy getups and stunts. Known in my household as the lady who wore the meat dress, she sings these words (I’ve included just a few lines) in the song “Til it happens to you.”

You tell me it gets better, it gets better in time
You say I’ll pull myself together, pull it together, you’ll be fine
Tell me, what the hell do you know? What do you know?
Tell me how the hell could you know? How could you know?

Till it happens to you, you don’t know how it feels, how it feels
Till it happens to you, you won’t know, it won’t be real
(How could you know?)
No it won’t be real
(How could you know?)
Won’t know how I feel

Her message is clear: If you haven’t been raped or assaulted (or experienced any other sort of trauma) you can’t possibly know what it is like. And since you can’t know what it is like, stop giving superficial comfort and advice.

Is Lady Gaga right? Does she offer sound counseling advice?

Yes and no. Yes, we are far too willing to offer platitudes to people in pain and wonder why they get angry and hurt and avoid us altogether. Lady Gaga captures the sentiment of the doubly hurt–first by the initial trauma and second by foolish words. The ancient Greek Aeschylus aptly puts it this way

It is an easy thing for one whose foot is on the outside of calamity to give advice and to rebuke the sufferer

Our quips roll easily off the tongue, but they injure the already wounded. Before you speak to someone and offer your ideas, do your friend a favor and be quiet. Ask them again (and again) to tell you what they experienced (past or present tense). But I don’t think Gaga goes far enough. I would argue that EVEN IF you have experienced the same trauma as the person in front of you, stop thinking that you know what they are feeling and struggling with. You may, but you may not as well. Do not assume your experience is theirs. Listen. More than you think you need to. Assumptions of “getting it” communicate that their pain doesn’t really matter to anyone.

But also, Lady Gaga is wrong (and I get it, this is art not counseling skills training!). It is possible to help others even when you have not had their experience. As long as you approach your work with humility and the heart of a student, you can do much good. You bear witness to their experience through your reflections and observations. You can ask good questions and paint word pictures of trajectories of growth. Do not think that just because you did not have the trauma, you have nothing to offer. Offer yourself (more than your words). If you fail to offer yourself out of fear of not being adequate, you also harm by not giving the present of being understood.

But let Gaga’s anthem be a challenge to those of us, myself included, who speak before listening and who assume rather than learn. We won’t get it. But we can bear witness.

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Filed under Abuse, christian counseling, counseling, counseling skills, Post-Traumatic Stress Disorder, sexual abuse, sexual violence, trauma, Uncategorized