Category Archives: counseling

March 16, 2010 · 9:41 am

Cancer stories


We’ve all heard them. We’ve all told them. Either our own or someone else’s. If you are the person telling the story, you likely are trying to encourage hope and fight in the cancer sufferer. If you are the person listening to the story, you likely want to desperately believe that the miracle or cure story is going to be your story.While the success story of another is momentarily comforting, it doesn’t last.

Truth is, you don’t know your own story, whether you have cancer or not. You don’t know if you will live to be 100 or die tomorrow. Most of the time we don’t think about our mortality. Life is too busy to contemplate morbid thoughts.

Cancer in you or your loved one changes that. You wonder what your story is. You hope it is not like one person’s story and you try to hope that it is like the success stories you hear. But, you just don’t know.

Along with the stories come treatment recommendations and advice. These can be helpful, confusing, contradictory, or downright hurtful. It is true that your doctor matters. It is true that some traditional treatments are very effective and also very damaging. It is true that some have benefited from alternative or complementary treatments. It is also true that people die from both. What is also true is that the plethora of advice adds to the confusion.

Here might be some better things we can do and say:

1. What would you like me to pray for?

2. What is your next treatment decision and who are you talking to?

3. Can I ______ (something specific)?

And if you know the person well, you might ask:

1. What “stories” are you meditating on that you need to stop?

2. What is the one thing that is true for you right now? Or, what manna is God giving you for today?

3. What information would be helpful for your next decision?

4. Let’s talk about something other than cancer…how’s your garden coming?

5. What stories would you like to hear right now?

For counselors out there. It is a good reminder to limit the number of stories we tell our clients. These can encourage. Yes, it is true, people do get over depressions or anxiety attacks. They do repair broken marriages. These stories may encourage the person to take a step of faith. Or, they may cause them to stop, because those stories aren’t theirs.

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March 12, 2010 · 9:10 pm

Do you have a pet psych test?


Uh, by that I mean whether or not you have a favorite psych test. We’ll save tests for pets for another day.

There are many out there who love the Myers Briggs (MBTI). Others love the DISC. When people have a pet test it is usually because the test provides a quick and dirty profile in order to understand and categorize a person’s behavior. Actually, and sadly, we often like certain tests because they allow us to pigeon hole others (as in, “your such a J”).

But, I do have favorite tests. I love to review the couple version of the 16PF with both long-time marrieds and those seeking pre-marital counseling. When I was doing parent competency assessments, there were a number of lesser known tests that illustrated a parent’s capacity to be flexible (and so hopefully less rigid and abusive). When it comes to personality assessment, the MMPI-2 and the Rorshach (Exner scoring) are my favorites.

But lately, most of my assessments have been with pastors. I’ve found a number of great little tools to illustrate compassion fatigue and other at-risk problems. These assessments lack the depth and rigor of a personality test but work great as conversation starters and self-evaluation tools. With these I don’t have to explain what they mean.

How about you? Got a favorite test you’ve taken? Given? Why is it your favorite?

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March 10, 2010 · 10:28 am

Here’s a cache of info on abuse trauma


If you are interested in reading some of the most recent research literature on complex trauma and treatment, take a look at the Trauma Center at JRI in Brookline, MA. Click their “publications” tab for a host of full-text articles on the topic. Bessel van der Kolk, MD is one of the foremost researchers exploring trauma’s impact on the brain.

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February 23, 2010 · 6:13 pm

Dealing with unexpected losses


Some years ago, my wife and I wrote an article for CCEF’s Journal of Biblical Counseling entitled, “The Bible and the Pain of Infertility.” Of all my published writings, this article has garnered the most responses from readers. I don’t think it is because it is so well written as much as it touches many where they most hurt. Even though the article is about infertility, readers have commented that they found it related to their loss of a loved one, the unexpected loss of a career, a chronic disease.

Not that long ago I was asked to review a chapter manuscript on pastoral care of infertile couples. I was shocked to learn that he could find no serious work (than ours) attempting to think pastorally about infertility. Not sure he is right but it probably means we need more on the topic.

I say all this because CCEF has put the article up for free on the top of their homepage. Click here for their homepage. Click the image at the top of their page and it should take you to the full text article.

Enjoy. Pass it on to others you think might benefit, especially those who suffer in secret.

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February 17, 2010 · 11:40 am

Thoughts on sport, romance, and perversion


I’m not particularly the romantic type but certain things tend to spawn warm fuzzies in me. One such thing is the Olympics. Watching young men and women throw their all into sport for the chance to win (even though most won’t even come close) is one of those things. I recall the same feelings as I lived and breathed track and cross-country running in high school. I have fleeting desires of being able to race that fast, throw every cell into an activity, to think that succeeding will be the best. But then, my aching ankles and knees remind me of the consequences of doing so…

Pairs figure skating, in my mind, is one of the best illustrations of sport, romance, and perversion. It is definitely a sport. Have you ever tried to skate? To skate and jump off the ice…and not have a brain injury? To catch someone spinning over your head? To do all that and look graceful? But pairs are also supposed to be artistry and poetry.  The couple skates in a way to tell a  romantic or romantic/tragic story. But with the new scoring system couples are rewarded with moves, jumps, catches, positions. They are not as well rewarded for fluidity, artistry, and poetry. Maybe I’m showing my age but I found very few of the skating pairs very interesting this year. The couple that won certainly were interesting, both on the ice and their personal story. But, many just skated to music and did the moves they knew would get higher scores.

In my mind, it perverts the romance of the sport. Sure, the skaters are athletic. Sure, the moves they do are amazing taken one at a time. But, I would liken it current pop hip-hop lyrics that skip all the romance and just flaunt or demand raw sexual activity. Forget the dinner and the candles, just give me sex!

If you were watching the long program of pairs, you may have seen a Canadian couple. They fell and so wouldn’t have medaled. However, I think they had more romance and art in their skating than all of the first three combined.

Which leaves me one question. Are we beyond romance in this day and age? Missed something on television? You can catch the 30 second clip of the most important points on video. Don’t want to watch a whole football game? You can get the highlights instead. Seems we like things raw and to the point.

Maybe this is the sin of Cliffs Notes 🙂

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February 10, 2010 · 5:38 am

Delusions and hallucinations: What are they?


Most of us trust our thoughts, feelings, and perceptions. If we hear something, we assume it to be real. Imagine someone telling you that what you feel or heard wasn’t real. Would you be inclined to believe them? Probably not. And the more they tried to convince you that you were crazy, the more you might see them as trying to deceive you.

That is a little piece of the world of those who experience psychotic symptoms–where they believe, feel, hear, experience things that others deny are real.

So, what is happening when someone comes to believe they are Jesus Christ in the flesh? What is happening when someone hears a voice telling them that they should die?

Possible explanations:

1. Misinterpretation of feelings and perceptions. I walk into a room and the hair of my neck rises. Does it mean that there is a lot of static electricity in the room? That I’m nervous in crowds? Or that someone is beaming thoughts at me? One explanation is that I’m mis-reading the data.

2. Mis-firing of neurons in the perception areas of the brain. I know that isn’t exactly the scientific language we ought to use but it is true that certain electrical stimulation of the brain leads to perceiving smells and sights that are not real. Elevations of dopamine and other neurotransmitters are possible causes of psychosis.

3. Real supernatural experiences. It is possible that spiritual forces are at play and the person is hearing what is being sent to them. Now, whether those forces are telling the truth or not may be the question the person ought to entertain. Further, labeling these symptoms as supernatural does not necessitate a supernatural response (e.g., casting out demons). Deception may be broken by basic Christian responses (e.g., prayer, submission to the Word) and by medications.

As a Christian psychologist I believe all three are at play in any disease. We are individuals with broken bodies that do not work right. We are mis-perceiving and vulnerable to deception. I cannot say for sure that someone who believes themselves to be a prophet is lying. However, if they are not evidencing the fruit of the Spirit in their lives then I do question the validity of their identity.

Counselees experiencing intruding sensations and perceptions can break their influence when they are able to attend to other “data”. For example, “I feel others are out to get me but I will live as one who trusts in the Lord rather than in my ability to prove to others that I am in danger.” “I will not use violence or rage to be heard.” “I will not isolate in order to be safe.” “I feel like God has me here for a special reason but I will not neglect caring for my children nor abuse those who do not think I have a special calling.”

Counselors will find more success joining counselees, accepting their reality, rather than merely attacking their beliefs. It is possible that my counselee is a prophet but I can still encourage them to faithful work, love, and honor of those around them.

[Note: I’m not covering the issues of medications, hospitalization, and other psychiatric treatments in this post. These are important and not merely ancillary to the care of those struggling against psychotic symptoms. I am only musing on the possible causes of delusions and hallucinations.]

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February 8, 2010 · 8:29 am

Do no harm?


[This is the second guest post I am making over on the www.christianpsych.org. You’ll have to click the link to read the whole post…]

Every counseling ethics code in existence includes this principle: Do no harm. This maxim is drilled into the heads of counseling students (and any other medical professional as well). Our work should help, not hurt. Who could disagree?

But pause for a minute and consider how you might evaluate whether an intervention helps or harms. What criteria will you use? From what vantage point will you evaluate the criteria you choose? If a medical treatment extends life for an ill patient that would seem good—unless it keeps them alive and in a vegetative state with no possibility of recovery. Some would then wonder if the treatment was indeed best. Or, is it harmful if marriage counseling encourages truthfulness between spouses leading to the revelation of a terrible betrayal leading on to divorce and financial ruin? If honesty is your criteria for helpfulness, then the intervention is sad but helpful. If stability is your criteria, then such counseling is harmful. We could go on and on. Do we use client interpretation of whether treatment is helpful or counselor observation? Do we consider the difference between short and long term evaluation? And importantly for Christians, do we consider only statistical analyses or do we also consider biblical categories (e.g., intervention “A” leads to increased positive affect but encourages clients to pray to another deity).

Despite the muddy water I just churned up, I want to argue that Christian psychology is well poised to help Christian counselors provide treatment that does not harm. This society includes some of the best philosophers, theologians, sociologists, clinicians, and researchers of our day. These members are interested in looking at how people grow and change, how the bible connects with everyday life, common human struggles and effective interventions, etc.

How then do we go about refining our practices and avoiding harm? Let me suggest some steps we might take:

[rest of post on www.christianpsych.org.]

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February 1, 2010 · 5:49 am

Blogging this month for the Society of Christian Psychology


This month (really, the 4 Mondays of February), I’ll be the guest blogger at the Society for Christian Psychology’s site. You can find it at www.christianpsych.org or from my links on this page. Here’s a tease from my first post:

Should Christian Psychology become a Profession?

Right now, in the Commonwealth of Pennsylvania, lawmakers are considering a bill that would place more restrictions on who can provide counsel. Currently, the state has a number of mental health credentials. Among those is the Licensed Professional Counselor credential for those with a requisite master’s degree and post graduate supervised practice. If passed, the new bill will not only protect the title of “Professional Counselor” but also the practice of professional counseling. Per the law, one may not “style” themselves as a counselor unless they are licensed as such.

Who does this effect? This will especially impact the many Christian counselors who are not licensed but practice a form of counseling (aka biblical counseling, Christian counseling, etc.). While these counselors do not provide diagnoses or bill insurances they do collect fees, keep progress notes, maintain confidentiality, and provide counsel for those struggling with issues such as anxiety, anger, depression, marital conflict and the like. So, the 64 million dollar question: Do these unlicensed Christian counselors “style” themselves as professional counselors? And who decides the line between the two? As an aside, the bill does contain an exemption for pastoral counselors. Pennsylvania does not yet define that title but in other locales that title is reserved for those ordained, trained in a pastoral counseling graduate program, and doing work in church-related institutions.

Here’s where the bill gets interesting. It describes what typifies a profession that might overlap with counseling but have a separate (and thus exempted) identity and practice. Here are some of the criteria they might use to discern a separate profession (note my bolded text to emphasize interesting details):

[For the rest of this post, click here.

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January 22, 2010 · 11:53 am

Update on PA HB 1250


Posted previously here about the bill proposed to go to the PA legislature that will change the Licensed Professional Counselor credential from a title act to a practice act. This would further restrict non-licensed counselors from “styling” themselves as a licensed counselor, from offering the services of a counselor. Already one cannot call themselves a professional counselor or similar titles. But these changes would eliminate many from practicing. This bill (see here for bill with highlighted changes. Go to page 10 to see most pertinent changes and list of exempted individuals) is being voted on by the committee on 1/27.

Note that the exempted parties include “pastoral counselors”. In PA they are not defined. However, in other states they are defined and licensed. Thus, who will determine who is a pastoral counselor and what to do with the overlap between the two? In other states, a pastoral counselor must be ordained and trained in pastoral counseling. Also, psychologists supervising unlicensed people with counseling degrees may be exempted but there is still fuzziness in the law.

It all comes down to the definition of “styling.” See this quote from page 10:

Only individuals who have received licenses as licensed professional counselors under this act may style themselves as licensed professional counselors and use the letters “L.P.C.” in connection with their names. It shall be unlawful for an individual to style oneself as a licensed professional counselor, advertise or offer to engage in the practice of professional counselor counseling or use any words or symbols indicating or tending to indicate that the individual is a licensed professional counselor without holding a license in good standing under this act.

Section 3.  The act is amended by adding a section to read:

Section 16.4  Unlicensed practice prohibited.

No person shall engage in the practice of as a licensed social work worker, licensed clinical social work worker, licensed marriage and family therapy therapist or licensed professional counseling counselor in this Commonwealth unless the person holds a valid license to do so as provided in this act. The provisions of this section shall not apply to the following persons:

If you are in PA and one of these representatives (scroll down for the list) are from your district, you may wish to register you opinion on the matter.

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January 20, 2010 · 3:09 pm

Harmful counseling?


This month’s edition of American Psychologist has several interesting articles about the negative effects of therapy. The article by David Barlow, “Negative effects from psychological treatments”, provides a good overview of the effectiveness research controversies. But instead of focusing on how best to collect data about the benefits of a treatment, he gives some attention to looking more clearly at who benefits from a treatment and who is made worse (using dismantling type studies).

The next article (by authors Dimidjian and Hollon) gets at the definition of harm. Defining harm is rather complex. That a client may not get better from a treatment or may get worse during a treatment is not necessarily evidence that the treatment caused harm. And true to form, we have to accept that some treatments may both harm and help (they give the illustration of a nursing mother on medications: it may help her and yet harm her baby). Or, a treatment may make someone worse at first but then help them later on. Or, the treatment may be just fine but the practitioner may use it in a way that is good or bad. Finally, a treatment may be thought of as harming a patient when in fact what is seen is the normal trajectory of the disease.

So, how do you get at understanding whether a counseling treatment harms? They offer a number of methods for research which I won’t get into here.

Finally, the last article covers training implications (Castonguay et al). They cite therapists’ frequent underestimation of treatment failure and client deterioration. Looks like about 5-10% of clients get worse in treatment. If one wants to train counselors to avoid more failure how might one do that? Castonguay et al suggest that one do so by beefing up (a) proper therapy skills, and (b) skills to identify potentially harmful treatments. On p. 45 the authors include a table of training recommendations, which include

  • expose trainees to list of potentially harmful treatments
  • help trainees monitor change and deterioration
  • enhance relationship skills
  • learn and practice interventions that are empirically supported
  • prevent and repair a variety of relational pitfalls
  • adjust treatment choice, expectations, etc. based on client characteristics
  • Address trainee’s issues (anxiety, hostility, defensiveness, naiveté, etc.) that may hinder counseling

Every counselor fears harming another; fears not helping enough. And it is often unclear whether our work is having its intended impact in the moment. However, there are things we can do to keep the communication lines open and thus listen to our clients about what is helping or not helping. This is what keeps us on our toes. What works for one person harms another. We must not get wedded to one way of helping.

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