Category Archives: counseling

July 12, 2010 · 1:48 pm

Emotional Arousal: Too much or too little?


I am doing some prep for my upcoming class on the treatment of Borderline Personality Disorder (BPD). [Links: summer institute brochure, and CEU information for LPCs] Many theorize that BPD is really a problem of emotional (over) sensitivity resulting from a combination of psychological factors (trauma, loss, attachment injuries, or chronic invalidation) and biological predispositions (high base-line emotional experiences, slow return to baseline once activated, and chronic and inappropriate scanning environment for danger).

If a person is prone to intense emotional experiences, they are likely to get the message that their emotional expression is out of line. Thus, they may either try to avoid emotions (leaving them less aware of how they feel and maybe more likely to be taken advantage of) or give in and respond out of their full expression (leaving them less likely to be able to solve the problem given their high state of arousal).

Are you a person of high emotional arousal? Do you know or live with one? Do you struggle with thinking that high arousal is wrong? Theoretically, most of us do not think strong emotions are wrong. But practically those who experience their own intense emotions and those who live with them do think they are wrong. “I shouldn’t feel this way…she shouldn’t feel that way.”

Counselors do not seek the goal of eliminating or even tempering emotions. What they seek is to avoid the “why” or “because” that often follows the strong feelings. It appears that the big problem is not the feelings but the beliefs and interpretations that one holds during and after the emotional experience. I feel this way because…(I’m stupid, a loser) or because…(others hate me) leads to cementing emotions and beliefs together in such a way that lead to more easily experiencing invalidation.

Looking to get into this a whole lot more in a few weeks (July 30-31)!

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July 10, 2010 · 11:09 am

Gardening illustration that works for persistent problems in life


5 years ago a friend of mine asked if I wanted some purple cone flowers for my flower garden around my house.

Having admired them in other gardens, I said yes and promptly planted them in a spot next to some other flowers. Turns out they were Brown Eyed Susans, a relative of the intended flower. And, further, they spread terribly. I enjoyed them the first summer but began ripping them out the next year as they spread through the iris and choked out some other plantings.

Now, some five years later, I am still pulling these plants. They grow and spread quickly. I never let them flower but pull them as soon as I can make sure I get them and not another plan that might be right in the same spot. When I pull them I know that some little root fiber remains and so I’ll be back pulling again in a week or so.

The truth is I will never be free from these plantings. I do have some choices:

  • ignore them and let them take over the garden (BTW, they would be fine in an isolated spot surrounded by grass so they couldn’t take over another planted area)
  • be irritated that I can’t get rid of them and thus fail to see the beauty around them
  • stay vigilant but enjoy the garden
  • try shock and awe by killing everything in that spot.

I find this is much like our persistent life problems. Whether by naive choice or by something beyond our control, we develop persistent struggles with things like anxiety, depression, addictions, relational challenges, etc. While God sometimes provide miraculous removal of these struggles, we rarely find complete freedom from these kinds of struggles. We may not be in crisis mode forever, but total relaxation and assumption of no return of the problem is rare also.

So, we too have some choices:

  • be angry and bitter that the problem continues to have some place in our life
  • blame others for our problems
  • ruminate on why only we seem to have these problems
  • try shock and awe and so destroy lots of other things
  • accept the need to stay vigilant, going after the roots and shoots as soon as we notice them.

Does this illustration work for you?

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July 2, 2010 · 11:17 am

Does porn use give a Christian grounds for divorce?


Brad Hambrick, a counselor in Georgia, has written an article exploring whether or not pornography use might provide grounds for divorce. It is a worthy read. His final answer is a qualified no but includes a lot of other helpful thoughts about the experience and what repentance ought to look like. Too often we get caught up in a yes/no focus to this question and miss significant issues. Seems there are several questions that need to be answered,

1. Is porn use a form of adultery given Jesus’ equating lust and adultery?

2. Does failure to repent or repetitive acts such porn use destroy the covenant so that it is impossible to live at peace with a spouse? In this case, the question is less about porn and more about refusal to honor a covenant. David Instone-Brewer writes about this from a NT perspective on the OT. I blogged about his thoughts some time ago and you can search “divorce” on this blog and find multiple entries.  Instead of divorce, we could insert repetitive gambling away family income, repetitive risky behaviors.

3. What would be evidence of repentance? Does any relapse equate to total failure? How many relapses equal refusal to repent?

Rather than just focus on the “big” question, it might be helpful to ask more immediate concerns. Does the porn user agree to utter transparency? Are they demanding something in return for their abstinence? Are they still trying to control their treatment?

For those who follow the link, I’d be curious your response. Read it from a user’s perspective and also of the victim spouse.

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June 29, 2010 · 11:01 am

Statistics and physiology: why getting it right matters


With recent advances in brain imaging and gene mapping we have significantly more data to help us understand human behavior. For example, we can see how folks with PTSD react to triggers using SPECT scans. We can understand how some folks have genetic markers that indicate a propensity for certain kinds of addictive behavior.

Enter this news story on NPR about one researcher who discovered he had the brain scan of a sociopathic killer–the very kind of people he was studying.

It is essential that we understand how to interpret these kinds of studies that often make the news. I am not an expert in brain scanning but let’s review a simple statistical principle. If you evaluate that 100% of people who have a particular problem (in this case sociopathic murder) have a particular brain scan signature, what can you say about its application to the general public? NOTHING. You cannot say, yet, that having that brain scan signature puts you at risk for becoming a murderer. What we need to know is whether or not that brain scan exists in the general public. I am willing to bet that if we did a large-scale study, we would find that 99% (maybe even higher) of those with a similar signature would NOT be killers. Thus, we cannot predict anything on the basis of the scan.

A similar (non) relationship exists between childhood abuse and becoming a child abuser. Yes, when we research pedophiles we find a high correlation between childhood sexual abuse and those who are in prison. But, when we look at the general public and victims of sexual abuse, we find that less than 1/2 of 1% go on to abuse others. Thus, abuse victims are not likely to become abusers.

However, these studies are not meaningless. In the case of the underactive frontal/orbital lobe, we do see certain features often present in individuals with ADHD: impulsivity, emotional lability, ego-centrism, lesser ability to learn from mistakes, difficulties in planning and forethought, etc. Rather than try to predict big events (like murder), we might use these kinds of studies to understand the common experiences and activity of those with a particular signature. This does not absolve people of responsibility or suggest they cannot make changes in how they operate. But, it might help us grow in understanding that what might be easy for one person may be more difficult for another. Just like we would want to give someone with dyslexia more time to read and comprehend a piece of literature, we might want to make some allowances for someone with a quiet frontal lobe.

It might mean that we understand that everyone thinks thoughts that ought not be repeated but that some have a harder time not saying it. And in the case of those “some”, we might be more willing to cut them slack even while we call them to account for saying what they say.

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June 22, 2010 · 4:40 pm

Christian interventions in counseling


Regular readers of this blog will know that I believe that Christian counseling is not merely counseling done by Christians or merely the use of specific christian interventions. Rather, Christian counseling is founded on Christian/biblical ways of perceiving the world, the problems in it, and the goal of imaging Christ from start to finish.

However, it is good to think about the specific use of certain christian practices in counseling: meditation, prayer, bible reading and application, casting out demons, absolution, etc. How are we to think about these practices? Do they have a place in professional counseling? What are limits we ought to place on them? When should we refrain? How do we secure informed consent?

Elsewhere I have published on the guidelines we ought to consider when using Scripture in counseling. I will not repeat them here but for those who have not read that article, I do think Scripture is something that CAN be used in counseling–even OUGHT to at times. What is of more importance to me is HOW and WHEN and WHY.

Let me here consider the most commonly used practice: prayer. Here are some shaping values before we consider any practical application.

1. Prayer is talking and listening to God. It is not a technique and should not be treated as such. It is not magic. It is, from a Christian perspective, sharing one’s heart, praising, questioning, interacting with the Creator of the universe who remarkably wants to relate to me. At its heart prayer is submissive acknowledgment of God–even when praying like Job.

2. Prayer then needs to be a free act without trace of coercion. The one praying must not be coercive (you talk to God not at another person). The one being prayed for ought not feel obligated to say anything.

3. People have diverse (and not always happy) experiences regarding prayer, faith, relationship with God, etc. So, what is comforting to you may be triggering for another.

4. Prayer is intimate. Prayer often results in our setting aside defenses and becoming vulnerable and needy.

5. Prayer is power. Praying for someone gives the one praying a position of power.

So, how might a counselor consider these values and use prayer in counseling.

1. Assessment of client. What is my client’s faith tradition, experiences with prayer, history of abuse by leaders of the church, understanding of God? Have they ever felt coerced to pray, coerced by the prayers of others? Have they been publicly prayed against? Do they value prayer?

2. Assessment of self. Why am I praying for my clients (out loud)? What messages am I trying to communicate? What do my prayers reveal about my own faith?

3. Consent. Have I explained why I pray for my clients? Do they really have the right to say no?

4. Review. How are my prayers received? What impact, if any, do they have?

What does this look like for me? I don’t pray with every client. I don’t choose to start my sessions with prayer (at least the first one) until I have a better sense of my client’s experience with prayer. I work very hard not to use prayer as an effort to disarm (though I think it can do this) or to preach a message, but only to make supplication to God for healing, for care for the downtrodden. When I use imagery in prayer I make sure that it is grounded in common biblical images (God as shepherd, Christ as lamb, etc.). I never ask clients to pray but many of them choose to do so. And, I do let clients pray for me when they want to. It is part of how believers care for each other.

I do believe that prayer is extremely important but that I do not need to do it to be actively asking God for healing or guidance. I will say that when conflictual couples pray, they often find that it is hard to stay angry and embittered and pray. It can be helpful, either in reducing bitterness or by discussing bitterness and its impact.

It should not be used when clients do not want it, might be confused by it, or if it is not authentic to the counselor. It is considered good professional ethics to utilize resources from a client’s life. However, it would not be good to fake (e.g., my praying in a way that would please a member of a cult, an atheist praying as if he or she believed what she said, my talking to God even though I am no longer practicing as a Christian, etc.).

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June 18, 2010 · 10:04 am

Check out a counseling office designed just for kids


Check out this video of Julie Lowe showing off (in a good way!) her counseling office designed for counseling kids. Julie is at CCEF and an adjunct at Biblical Seminary. She is a Licensed Professional Counselor (LPC) and trained in play therapy. Here’s the link. [Link was broken, now fixed]

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June 17, 2010 · 5:41 am

Looking for summer education?


My school, Biblical Seminary, has a variety of summer classes, from on-site intensives to weekend only to totally on-line. Click the link if you are trying to figure out what enrichment you will pursue this summer. The page that pops up will list both classes and free events. Those of you looking for counseling CEUs may be able to get credit too!

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June 16, 2010 · 9:21 am

Ethical blunders: Root causes?


Finishing up the Ethics course in the next week. There are two kinds of ethical errors in counseling: conscious violations of ethical practice and blunders.

Forrest Gump’s quotable line, “Stupid is as stupid does,” is ringing in my head as I write this post. We do stupid stuff–stupid as in without thinking. Most of our blunders are just that–things we never intended but did absent forethought. Example? Oh, I don’t know, like walking through a dark room while talking on a cell phone and resulting in a face plant over an unseen chair. That kind of thing…and the real reason why I’m hearing Gump in my head.

We all go through parts of our life in unthinking auto-pilot. Consider the equivalent in counseling: Starting a first session but forgetting to cover informed consent because you are focused on helping the person in front of you. Or, handing out personal contact information because the client asked nicely (but never considering ulterior motives). Or, calling back a spouse of one of your clients and discussing issues but failing to remember you do not have a release to speak to them. These are some of the unthinking blunders we may make.

Are there root causes to blunders? Try on some of these:

1. Naiveté. Taking the comments of others without considering context or motives. I am not suggesting that good counselors need to be suspicious. Rather, we need to be realistic, critical thinkers who employ wisdom. We need to consider motives, consequences, impact, etc. We need to think beyond the immediate moment.

2. Reactivity. Some of us are just more reactive or instinctive driven. This may be personality driven. However, it may also indicate that we are being driven by unexamined desires (e.g., “I want this person to like me”; “I want to defend myself from an accusation”).

3. Over-confidence. Sometimes our blunders come from overconfidence. We’ve all heard the evidence that talking on the cell phone while driving raises our risks of having an accident. But most of us do it anyway. Why? We don’t think or perceive ourselves as compromised. We consider ourselves better than the rest. Sometimes, blunders in counseling come from an unsupported confidence in self–I will act right because I am an ethical person.  When we are overconfident we have placed our trust in something that may be good but not right in a particular situation.

4. Fear. Yes, fear. It can lock us up causing us to stop using our training and intellectual capacity. This is the counseling version of driving right into the thing you were trying to avoid. Fear paralyzes.

5. Group think. Group think happens when we stop asking questions and as a whole foreclose on other hypotheses. An agency may create this problem by how it manages staff meetings, supervision. As a group we may become comfortable with an ethical breach in such a way that it becomes normal–unseen.

Can you think of other root causes of unthinking ethical blunders?

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June 15, 2010 · 5:54 am

Gain: Ethical boundaries relating to client gifts


[note: I found this document in my Ethics course files. I think I wrote this some time ago…but I don’t remember. It is possible that I received a WORD document with this in it from someone else. If so, I apologize for posting without acknowledging the source. Ah, the joys of aging.]

Professional counseling is founded on the assumption of the patient/practitioner relationship. The practitioner/expert provides a needed and appropriate service and the patient pays a reasonable fee—or their insurance company does for them. However, the extremely personal nature of counseling work often creates strong feelings between client and therapist and consequently the client may wish to bring a token gift signifying their thankfulness for a job well done.

Gifts beyond the token category provide therapists with “gain” and likely disrupt the fee/service relationship mentioned in the previous paragraph. While gain may not cause actual harm and may be unavoidable, the wise counselor remains aware of possible sources of gain and their consequences.

Consider the following examples and check whether you think they may be problematic:

  • A Board member of the counseling center offers one of the counselors tickets to a ball game
  • A Client offers his private counselor tickets to a ball game.
  • A student offers her teacher tickets to a ball game

Should the counselor in any of these scenarios accept the tickets? Does the cost of the gift or the wealth of the person giving a gift matter? Would it change your answer if the gift were a week’s stay at a beach house? Does it matter if the student is currently in a class with the teacher or not?

Gifts are a form of gain. Others may come in other forms of benefit for the counselor. If the counselee owns a publishing company, should the counselor accept an offer to have him or her publish his next book? If the counselor has a non-profit ministry, should he or she accept client gifts to that ministry? If a client offers to sit for a testimonial ad for the counselor’s new technique, should the counselor accept?

Gifts, though, represent expressions of thankfulness and thus a policy of rejecting all gifts may bring harm to the counseling relationship.

Wise Counselors explore with their clients any possibilities of gain and their potential consequences. Counselors consider how gains may harm the client or create an indebtedness that in the future clouds clinical judgment. For example, counselors do not accept gifts or fee sharing from treatment facilities in return for referrals. On the other hand, a cup of coffee brought to the session likely is just a cup of coffee, a friendly gesture. Christmas cookies are a small but personal thank you for a job well done. But, don’t assume that small gifts can not produce a quid pro quo (this for that) interaction. So, back to our first line in this paragraph. Take the time to explore the meaning of an offered gift and be willing to talk about it with clients.

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June 13, 2010 · 5:37 pm

Ethics training without tears?


I once saw a title of a text, “Statistics without tears.” Few people are in tears in my Ethics class but most have looks of fear. Thus, my question. Is it possible to teach ethics to counselors without incurring fear?

Counselors, by nature, want to do what is right for their clients. They want to solve problems. They also want to avoid harming clients AND facing lawsuits or licensing board complaints. So, you can understand that my students take great interest in a course where we discuss standards of care and the bases for ethical practice.

I try to focus on the underlying values that guide counselor behavior. I try to remind students that suicide and lawsuits are extremely rare (as long as you aren’t trying to do things that are controversial or fail to consider the wise counsel of supervisors). But, bottom line, you have to discuss practical cases where errors matter–breaches of confidentiality, failure to warn or protect in the face of imminent harm, dual relationships, practicing outside of competency, etc. It is these vignettes that raise our fears.

I’ve tried to reduce student fears but in the end some fear is good. Fear that leads us to be careful, to ask for supervision, to double-check our motives may not be a bad thing. When fear paralyzes or leads to self-protection alone, then it is not helpful.

In the end, we must trust that God will not abandon us, even if we make mistakes. We must remember that humility will take us a long way and that every path we take has risk associated with it. Our job is to remain learners as we walk with others in their difficulty. As soon as we stop asking good questions about our clients or about our actions, we now enter risky practice.

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