Category Archives: counseling

November 30, 2010 · 5:23 am

Life amidst brokenness?


As one who makes a living listening to brokenness, there are times when troubles seem everywhere. Everyone is swimming in a pool of their own tears–to quote the former PBS motivational speaker John Bradshaw. Sometimes, the pool seems pretty deep…cancer, mental illness, sexual abuse, infidelity, mania, marital discord, identity confusion, etc.

If not careful, we counselors can begin to believe that brokenness is the ONLY reality–a dreadful position if all we have to offer our clients is a knowing sad smile. On Sunday I went to a class on Isaiah, what some call 2nd Genesis because of the prophetic descriptions of re-birth and redemption of Israel through the work of Emmanuel.

In the class, someone said something that has been banging around in my head. It went something like this (gist, not quote)

It is not a challenge to see brokenness around us–that is easy. The challenge is to see God’s re-creative activity. Oddly, we call reality (God’s activity in redeeming us) a myth and prefer myth (superficial Christmas peace) over the reality of God’s working through brokenness to make us whole. I repeat, the challenge is to see God’s recreation and Glory.

Not sure how much of that was said and how much of that is just my own thoughts. But, still, the challenge for us is to see re-birth and not merely dying and death. What looks like an ugly stump (Isaiah 11:1) to us is a fruit bearing shoot.

See if you can catch glimpses of growth and rebirth today!

4 Comments

Filed under Biblical Reflection, christian counseling, christian psychology, Christianity, counseling, Doctrine/Theology, Uncategorized

Tagged as , ,

November 19, 2010 · 6:46 pm

International Suffering and Trauma Treatment


Am working with a student on building a future course for students, licensed mental health providers, NGO workers to train them on the matters of trauma treatment in international settings with the course goal to take these trainees to a location where they train local trainers to use lay trauma healing measures.  I am imagining a course that is primarily on-line (using a course website, discussion board, webcasts, etc.) with some face-to-face time just prior to having the international experience. The course would enable licensed therapists to receive continuing education credits with the ultimate goal that those who complete this experience would be then prepared to replicate it in other parts of the world. Topics would include:

  1. Overview of trauma symptoms and the things that cause them (genocide, war, trafficking, domestic abuse, rape, natural disasters, etc.)
  2. Overview of local culture and customs re: health, strength, and medical intervention to ensure culture consistency and avoiding colonialistic approaches.
  3. Introduction to training lay trainers
  4. Secondary trauma and compassion fatigue issues

I have two reasons for a course like this: 1. trauma is everywhere, and 2. interventions need to be sustainable (not relying on western therapists to keep doing the direct service) and maintained by local individuals.

So, here’s my question: If you had an opportunity to shape a course like this, what would you want to see as part of the course? What would you want to avoid?

6 Comments

Filed under Abuse, counseling, counseling science, Post-Traumatic Stress Disorder

Tagged as ,

November 15, 2010 · 9:53 am

Can you change your nightmares?


Blogging has been much harder this fall with a busy teaching and traveling schedule. I’ve been doing a lot of reading and thinking about best practices to deal with trauma in international settings–specifically in the Great Lakes region of Africa. Diane Langberg and I have been consulting with a Christian organization to help develop those practices with a local, sustainable mindset.

One of the recent items I read had to do with attempts to address repetitive “posttraumatic nightmares.” Bret Moore and Barry Krakow published, “Imagery Rehearsal Therapy: An Emerging Treatment for Posttraumatic Nightmares in Veterans” in the September 2010 issue of Psychological Trauma: Theory, Research, Practice, and Policy (v. 2, 232-238).

Imagery Rehearsal Therapy (IRT) attempts to alter nightmares by changing the storyline of the nightmare. The authors view nightmares as learned behavior such as insomnia. The CBT style treatment entails

  1. education about the relationship between nightmares and insomnia.
  2. education about cognitive restructuring via imagery
  3. client selects a particularly disturbing nightmare (maybe not the most disturbing one first)
  4. Client then instructed to “change the nightmare anyway you wish” (notice they are not asked to make it positive or even less distressing)
  5. Client then rehearses (over sessions) the new dream through imagery techniques

Previous controlled studies indicate a reduction in nightmare frequency and intensity. This particular summary article reports that the evidence is there that veterans find it helpful even at 12 months post treatment with 4 sessions.

A couple of things to note. There may be some effect of desensitization from rehearsal of the initial dream (exposure therapy) though the exposure is brief. Also, the client does not spend time rehearsing the actual traumatic events in this therapy–only the nightmares.

Some thoughts:

  1. This treatment makes sense. Ever have a dream that seems to go on and on, or one that you go back to upon waking up in the middle of the night. Often we may find ourselves trying to make the dream turn out okay. This treatment uses our fully awake brains to rehearse something we want to think about.
  2. If nightmares are the result of a collection of anxieties then it stands to reason that repeating new thoughts and images will begin to make associations in the brain that might compete with the anxieties.
  3. Christian living emphasizes re-telling the truth to ourselves. Consider how OT authors remind readers of the Exodus or Paul reminds the Ephesian readers of their prior state (chapters 1-3). What we rehearse does have an impact on our brains.
  4. Finally, some of our nightmares seem written in indelible ink. Do you still have test anxiety nightmares 20 years after your last class? I do. But I feel differently about them now than I might have back when I was still worried about school. It may be that we begin to feel differently about the nightmares. The less we are bothered by them the more infrequent they will be.

5 Comments

Filed under counseling, counseling science, counseling skills, Psychology

Tagged as , , , ,

November 1, 2010 · 10:18 am

Coming to Peace with Psychology 6


After a long hiatus I return to my summary/review of Everett Worthington’s Coming to Peace with Psychology (IVP, 2010). If you are new here just search his last name in the search bar on my blog and you can quickly catch up.

Chapter 10 is the second chapter in the last section of the book (“What Psychological Science has to Offer Theology”). This chapter covers the limitations of psychological science. Up to this point he has been lauding the value of psychological science as a marriage partner with theology. In fact, the purpose of the book is to argue for such a relationship over those who he sees as being overly critical of psychological science (due mostly, in his mind, to the anecdotal nature of psychological theory).

What does he point to as the limits of his science?

  • Despite amazing advances in psychological science, counseling hasn’t changed much (hmmm, does he consider this a limit of science or is this a complaint about practitioners?)
  • Psychological science must focus on general truths and so may not be as applicable to any one person
  • Scientists are not without bias (but then he goes on to say that given the review process, truth is a lot more likely than not)
  • Science can’t reveal the eternal (but it can reveal things of eternal value)
  • Inability to precisely predict behavior
  • No ultimate “proof” (but, probability is possible)
  • Scientist biases include “heuristics” (picking answers from an “available” list), confirmation biases, etc. which reveal our human self-serving nature.
  • Emotional experiences tend to make us more certain of our perceptions and beliefs.
  • human limitations on what we can remember, understand, perceive, do.

Notice from his list that he focuses on common human limits of knowing. This is a good start but insufficient. It treats science biases in an individualistic manner. I find this ironic given that I believe he has much awareness of family systems. In fact, systems add an additional bias–group think as example number one. Funny too that he gave very few illustrations from science of these various biases. For the most part, he illustrated them from everyday life or from theology. So, we are left with a chapter that admits to some general limits on how far psychological science can take us but no clear acknowledgment of systematic biases in the world of psychological science.

Now, let me be clear. I am not one who believes that psychological science is always biased all the time. And even when it is, there can be much to be learned from it. Nor do I believe that those within biblical studies or theology are unbiased either. But, I do think we need to recognize how specifically these biases send psychological science in some wrong directions.

Leave a comment

Filed under christian counseling, christian psychology, Christianity, counseling, counseling science, Psychology

Tagged as , ,

October 22, 2010 · 5:07 am

Normalizing Psychiatric Problems: Pro and Con


One of the hallmarks of the Biblical Counseling movement has been the clear articulation that psychiatric problems are not different in kind from any other set of problems. This assertion is made by some for a couple of reasons:

  1. To make sure everyone knows that the bible speaks to every kind of experience. if one draws lines between “regular” anxiety and pathological anxiety, those who meet the criteria for a DSM diagnosis might think that biblical material cannot speak to their situation–that they need to go elsewhere for help. God cares for and addresses every concern.
  2. To level the playing field between professionally trained counselors and biblical counselors. If the roots of human problems are common no matter the outer expression of them, then pastors and lay counselors can understand the issues (pride, suffering, fear, despair, etc.) and walk alongside anyone. One may not need special training to help another.
  3. To communicate to the healthy that they are not different from the more obviously unhealthy. The point is to reduce stigma and promote unity.

Consider the pros and cons of this viewpoint.

Pro:

  • Reduction of stigma and ghettoization
  • Increase normalization (“so, I’m not so different from others) and similarity with the rest of humanity
  • Increase the confidence and courage of leaders to address and dialogue about all forms of suffering

Con:

  • Decrease in interest in the specific experiences of suffering thus narrowing problems down to a simplistic cause (sin?)
  • Possible over-confidence of some leaders leading to a reduction of empathy and listening to the experiences of other; failure to consider body/mind issues not specifically elaborated on in the Bible.
  • Failure to recommend outside helpers with specific expertise and training; dismissal of the need to have professional counselors who may have greater practice with certain kinds of interventions\

When I teach my Psychopathology course I want my students to see just a bit of themselves in descriptions of people with thought disorders, addictions, eating disorders and the like. I want to normalize these kinds of problems so that students don’t think of clients with the problem as somehow different from their own experiences. While I may not binge, I may be able to empathize with those who do. However, I do not want them to think their brief binge as exactly the same as someone else’s experience. Otherwise, they might assume it would be easy to “just say no” to the binge.

When I teach my Physiology course, I want my student so to see the complexity of the brain and body and thus recognize the unique forms of suffering some go through. I want them to realize just how little we understand how much the body influences our experience of the world and of self. However, I do not want them to medicalize psychiatric problems. If they did that they might believe that counseling has little influence on psychiatric disorders. They might think that biblical reflections on anxiety and depression have no place in the healing of serious problems in living.

What is your experience regarding christian leaders handling of psychiatric problems? Do you see too little normalization? Too much? Do you see minimization of psychiatric suffering?

7 Comments

Filed under biblical counseling, christian counseling, christian psychology, Christianity, counseling, counseling science, Psychology

Tagged as , , , , ,

October 21, 2010 · 5:24 am

Reminder for Christian Counselors: We are voice, not Word


In G. Campbell Morgan‘s commentary on John, Morgan comments on John’s own recognition that he was not the foretold Christ but one who preceded the Christ and pointed to him. He says (commenting on chapter 3:22-36),

Then followed the last great statement. I have never read these final words of John without feeling their dignity and majesty. None greater ever feel from human lips. “He must increase, but I must decrease.” ….There was no unwarranted derogation of his own personality or work; but the content of the star as its lustre is lost in the rising glory of the sun.

….John the evangelist was thus showing the difference between the voice and the Word…

Surely this is what counselors must remember. Too often we want to be the sage wisdom, the Word. We want to be listened to; to be seen as wise. But, let us never forget that we are only conduit to the Word.

3 Comments

Filed under biblical counseling, Biblical Reflection, christian counseling, christian psychology, Christianity, counseling, Uncategorized

October 18, 2010 · 11:11 am

Practicing new ways of feeling?


As you fall asleep, do you have a common thought or feeling pattern? As you wake up? In the shower? We are creatures of habit in this regard–we maintain our perceptions (of self, of the world) even in the light of contradictory information or experiences. This is why a pessimist always expects the worst and a narcissist always expects to be right. If you could categorize all your thoughts and feelings, what would your perception pattern look like? Hypervigilant? Discouraged? Embittered? Hopeful?

Now, can you change this pattern? For example, if you are not inclined to be hopeful, can you practice hopeful responses–even when things really do go south? And if you can change the pattern, what does that change look like?

Here are some of my thoughts…I would love to hear from you about what you do to practice something other than your usual way of looking at the world.

1. It is possible to re-write our narratives. How we talk to ourselves about an event either will solidify a feeling or begin to change it. For example, my wife recently had a sleepless night. She was able to use that time to talk to the Lord even while she was feeling out of sorts. In the morning, she had a positive, if also tired, way of feeling about the night.

2. Change does not look like zero experiences of an old narrative running through our head. Change looks like being able to recognize the old but also a new pattern as well. This change is not merely talking yourself out of one schema and into another. Rather, mindful awareness of threads of your experience that have been there all along get more play and so therefore become more salient over time.

3. Change isn’t permanent. Just as a professional athlete cannot go without practice, we cannot expect effortless maintenance of a new way of feeling.

3 Comments

Filed under counseling, Mindfulness, Psychology, Uncategorized

Tagged as , , ,

October 15, 2010 · 1:02 pm

Save the Date! March 17-19 2011


Dr. Diane Langberg and Bethany Hoang (IJM) will be doing our next Conversations with Christianity and Culture seminar March 17-19, 2011 on the topic of sexual abuse in the christian community. They will also be speaking about sex and human trafficking.

This is a free conference at Biblical Seminary. I’ll post on-line registration information here when it is available but I’m tell you this now so you get it on your calendar.  You won’t want to miss their presentations.

We expect to offer CEUs for mental health providers for the conference (probably very nominal fee) and academic credit too (in the form of ind. study) for those wanting to do some further work on the topic.

3 Comments

Filed under Abuse, christian counseling, christian psychology, counseling, counseling science, counseling skills

Tagged as , , , ,

October 12, 2010 · 4:34 pm

Skype counseling? Know of anyone doing it well?


I recently set up an acct with SKYPE to participate in an upcoming meeting. I’ve had past requests to use SKYPE in counseling people unable to come to the Philadelphia area. While I’m open to doing this (at least for brief consultations), there are a number of issues to resolve. I’m interested in hearing from readers having used it for counseling (feel free to remain anonymous). What was it like? How were confidentiality and informed consent handled? Was any mention of jurisdiction mentioned? Not sure what I mean, read on to consider these issues:

  1. Confidentiality & Privacy. Are SKYPE video conferences really private? What is the likelihood that someone can tap in?
  2. Informed Consent. Read any good Telehealth informed consent forms lately? Seems that you have to consider how to deal with crises that might be happening in another state. Insurances cannot be used. What about what files are maintained? I believe it is possible to record SKYPE calls.
  3. Jurisdiction. It is clear that licensed mental health practitioners must not practice in another jurisdiction (i.e., state) without getting licensed or approved for that jurisdiction. But what about consultations? What about Internet based interactions? Which state has jurisdiction? Some seem to think that the state of the “caller” is going to want to maintain control of the care of its citizens. Others think that informing “callers” that the point of service resides with the Counselor will be enough. Check out what they say at eCounseling.com.

This is what is known as a “Point-of-Service” issue. In our terms of service which both clients and counselors agree to upon eCounseling.com sign up, it states the following in section 5.8: 5.8 POINT-OF-SERVICE. For a client who resides outside their eCounselor’s state of residence and professional licensure, there is an important issue that should be understood by clients before counseling begins: By utilizing these counseling services, the client agrees that he or she is soliciting the services of a professional outside of his or her state of residence. By doing this, the client agrees that the “point-of-service” of counseling is to occur in the counselor’s state of residence and licensure, not the client’s. In essence, the client is using the telephone or the Internet (the “information highway”) to virtually travel to the counselor (the counselor’s state of professional practice). Hence, counselors are accountable to and agree to abide by the ethical and legal guidelines prescribed by their state of licensure and residence. By agreeing to solicit the counselor’s services, the client agrees to these terms. If you do not understand, or have any questions regarding this issue, please feel free to ask the counselor about this issue, or contact eCounseling.com support at support@ecounseling.com DISCLAIMER: The above should not be construed as legal advice. If you have questions about legality or liability, please contact a qualified legal professional.

What do you make of these issues?

5 Comments

Filed under christian counseling, christian psychology, counseling, counseling skills, Psychology

Tagged as , , ,

October 1, 2010 · 10:48 pm

Preaching to the 20%?


I’m representing Biblical Seminary this weekend at the Shepherd Press Marriage & Family conference being held in Harrisburg. Dave Harvey opened the conference with a very good sermon on showing mercy and kindness to family members. He stressed the importance of Luke 6:36 and the need to show mercy to sinners just as God does for us. This goes against our typical human desires for revenge or at least punishment for the misdeeds of others.

But, without taking anything away from the good sermon I found myself asking this question. How would ______ hear the call to have mercy on a sinner spouse. ______ represents a person I know who has been emotionally and financially abused by her husband. She finally was able to bring truth to light and has a reprieve from his sin while he is living with his parents. However, she faces strong pressure by others to reconcile (despite little evidence of true repentance in the husband).  Knowing what I know about this woman, I suspect she would feel more pressure to have mercy and allow her husband to return to the home.

I think most sermons really preach to the 80%. 80% hear this and recognize that mercy may be shown in numerous ways. Even allowing truth to come to light is an act of mercy. Mercy may be treating someone better than they deserve but may not mean playing the part of the fool and thinking that a few tears and words are enough. But what of the 20% who are weighed down with guilt and assume that a general principle must be applied in a very black/white manner? How do we care for them when exhorting all Christians on to the Gospel saturated life?

I want to reiterate that I think Dave Harvey did a good job. I do think that it may be too easy for the rest of us to assume that the more vulnerable among us will be able to nuance the big virtues of the Christian faith; that they will know that to emphasize one (e.g., truth-telling) does not mean a rejection of another (e.g., forgiveness).

7 Comments

Filed under biblical counseling, christian counseling, counseling

Tagged as , , , ,