Category Archives: counseling

November 12, 2009 · 3:33 am

On-line counseling courses through Biblical Seminary


Those interested in taking an on-line, graduate-level counseling course might wish to consider this new joint offering from my school, Biblical Seminary, and the Christian Counseling & Educational Foundation (CCEF).

Counseling in the Local Church (2 credits)

The course is taught by Dr. Tim Lane, Director of CCEF and runs from 1/18/2010 to 3/19/2010. It is completely on-line with mp3 lectures, assignments, and threaded discussions with others in the class. You can register here for this class. If you have Internet access and an undergraduate degree, you can take this class.

Later in Spring 2010 we will offer David Powlison’s Dynamics of Biblical Change.

CCEF started Biblical’s counseling program back in the mid 80s and has continued to lend their faculty to courses here and there at Biblical. They have been offering on-line and residential courses (non-accredited credits) for 25 years. In my personal opinion, our joint venture brings together quality biblical counseling and theological expertise with practical and professional counseling expertise!

Now, we have a chance to work together to provide on-line students with quality teaching from CCEF but now for academic credit. (You must have an undergraduate degree already)

What can you do with these credits? Well, for one, you could apply them to a number of Master’s degrees at Biblical. They could count as elective credits in our MA Ministry, MDiv, or MA Counseling program. Second, you might seek to have them transferred to your own local graduate school program. Biblical Seminary is ATS and Middle-States accredited and so will be considered a legitimate institution. However, you should know that every school sets its own polices regarding transfer of credits. Usually they look to see if the course fulfills a course they would have required in their own program. Remember that it is up to you to find out if they will transfer.

Or, you can just take them because you want to be enriched! We’d love to have you as a student!

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November 11, 2009 · 5:59 am

Stress & Christian mindfulness, part 2


In the last post I reviewed some simple definitions of mindfulness, including some of the Buddhist ideas behind a version of mindfulness. In this post I want to consider how mindfulness, when reconsidered in the light of Christian thought, can be a valuable part of counseling practice.

A thought about mindfulness and the brain

Let me detour to one more thought about biology and mindfulness. What happens in the brain when a person is practicing mindfulness? Thought and feeling patterns result in neural activity in the brain (or is it the other way around?). Repeated neural activity creates stronger connections between neurons (increased synaptic activity and denser connections with neurons in the same neighborhood. Repeated activity leads to greater blood flow and activation in particular regions of the brain. Neuroscientists call this neuroplasticity.

Thus affective and cognitive patterns can indeed change your brain. Think about this. What patterns of thought do you engage in on a repetitive basis? Do you have a habit of fantasizing? Mulling over bitter or jealous thoughts? While some of these may come naturally to you, what you do with them may actually change or strengthen neural connections in the brain–for better or for worse.

Is mindfulness healthy or relativistic?

Mindfulness, no matter whether you take a religious, consciousness, or relational approach to it, includes the stepping back from shoulds, oughts, and other judgments. One might think that this would be dangerous for Christians. Within Christianity, there are rights and wrongs, truth and lie, righteousness and unrighteousness. The Bible is, among other things, the single guide for Christians to determine how to live for God. SO, it begs the question whether Christians should be wary of anything that seems to let go of shoulds and oughts?

Another view of shoulds and oughts

In my experience, those suffering from anxiety and depression suffer from a disorder of judgments. They are flooded by shoulds and oughts. Their self-talk does not seem to come from the Lord but are already laced with prejudice. “You should have been more vigilant against danger AND you weren’t. You’re a failure.” “You shouldn’t be rebellious BUT you are always a screw-up.” “I shouldn’t have to suffer this way AND God must not care for me.” Notice that most of these forms of judgment are careful consideration of the facts and experiences but well-formed opinions that may be based on only a smidgen of the actual events in their present circumstances.  Notice that these forms of ruminative thinking come in disguise as careful, logical thinking. They are not. What they are narratives–well-practiced narratives–that have an already formed conclusion that we repeat regardless of the actual facts of our lives.

Mindfulness, then, is stepping back from these narratives. Mindfulness is a practiced discipline of just noticing and describing events so as to process them more carefully instead of automatically repeated a script or mantra. Mindfulness provides the opportunity to discover “what is” rather than compound suffering by focusing on what we just assume. Consider Dan Siegel (The Mindful Brain, p. 77)

When the mind grasps onto preconceived ideas it creates a tension within the mind between what is and what “should be.” This tension creates stress and leads to suffering.”

While I’m sure I would vigorously disagree with Siegel on what a preconceived idea is, on what can be healthy “should be’s”, and much more, he has a point worth considering. Have you ever engaged in a fantasy conflictual conversation with someone you are about to meet. You play out yourself winning, being mistreated, standing up for what is right, and so on. Notice how such conversations aren’t useful. They only increase your level of stress because your brain responds to the inner drama as if it were really happening, when it has yet to happen. In this way, Siegel is right. We create tension that leads to suffering.

Using mindfulness in Christian Counseling

I’m running out of room here and won’t be able to do justice, in this post, to the most practical part of mindfulness. [Isn’t that just like us academics. We spend all our time pointing out problems but we never solve anything!]. Mindful practice may include time practicing being present in one’s surroundings. The counselor may encourage clients to take in their surroundings. While many thoughts may race through the brain, the mindful person may choose to not follow them but “drink in” the creation beauty around them–things growing, art, or anything that is a delight to the senses. This form of discipline must be practiced in de-stressed times so that it will be available during a crisis–just like a basketball player practices free-throws over and over so as to make the shot when there is only 1 second left on the clock.

Such work is the work of taking every thought captive. and resting (a la Psalms 131) without grasping after things “too wonderful” for us.

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November 3, 2009 · 5:38 am

Philip Cushman’s prophetic words


One of my all-time favorite books is Philip Cushman’s Constructing the Self, Constructing America: A Cultural History of Psychotherapy. In this 1995 book he details the social constructed nature of psychotherapy. My Social & Cultural Foundations class is reading a summation of this book published in article form and so I picked the book back up and read through some of my more favorite parts.Here’s some of my choice quotes from the beginning:

“When social artifacts or institutions are taken for granted it usually means that they have developed functions in the society that are so integral to the culture that they are indispensable, unacknowledged, and finally invisible.” (p. 1)

“It [psychotherapy] is thought of as a scientific practice, yet it is anything but standardized or empirical, and it has not yet developed a disciplinewide consensus about how to think about patients or what to do with them. It is thought of as a medical practice, yet it has an enormous social and political impact.” (p. 2)

“…in order to understand American psychotherapy, we must study the world into which it was born and in which it currently resides.” (p. 4)

“Origin myths describe the origins of the discipline in such a way as to demonstrate the discipline’s utility for those in positions of power. This means that mainstream historians will shy away from portraying psychology as critical of the status quo and will avoid including within their work a critical exploration of the sociopolitical frame of reference in which the discipline is embedded.” (p. 5)

“…I will argue that the current configuration of the self is the empty self. The empty self is a way of being human; it is characterized by a pervasive sense of personal emptiness and is committed to the values of self-liberation through consumption. The empty self is the perfect complement to an economy that must stave off economic stagnation by arranging for the continual purchase and consumption of surplus goods. Psychotherapy is the profession responsible for treating the unfortunate personal effects of the empty self without disrupting the economic arrangements of consumerism. Psychotherapy is permeated by the philosophy of self-contained individualism, exists within the framework of consumerism, speaks the language of self-liberation, and thereby unknowingly reproduces some of the ills it is responsible for healing.” P. 6

Now, soon after 2000, Cushman wrote about the transition from the empty self to the “multiple self.” By this he was not talking about MPD or DID. He felt that the younger generation was no longer looking to find their true self in therapy but to maintain a fragmented self in a chaotic world. In this sense, “who am I at church, work, school, friends, dating, etc. and how can I keep all my pieces from crashing down altogether.”

But, it is interesting to read his view of psychotherapy as supporting the consumeristic economy (even encouraging it). I wonder how our current economic woes will impact the world of therapy….

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November 2, 2009 · 11:40 am

Technoethics?


At September’s AACC conference I attended a presentation entitled, “Technoethics” by Jana Vanderslice, a psychologist from Texas. She got me thinking about the use of e-mail and other Internet-based technologies with counselees. Here are some of the issues:

1. E-mail. Do you have a policy about your use of e-mail with counselees? Do you inform them about the limits or possible problems that might be encountered? Problems such as security and confidentiality, whether or not you will read them “in time”, what becomes of them (printed out and kept in a file?), whether or not you provide brief counseling through e-mail and possible charges, etc. Dr. Vanderslice suggests having a start to the email that says, “Confidential! This is not meant to take the place of in person consultation…”

2. If you do e-mail counseling, do you (a) know who you are emailing? What data do you collect from the person you provide email counseling to? And (b), do you think about how your email may sound if it is printed off and/or forwarded to others. You should assume that your electronic communications may be passed on. Further, if you have regular e-mail contact, how will you deal with the nature of always being at the beck and call of clientele?

3. Your Social networking accts. Do you use twitter? Do you have a Facebook or MySpace account or the like? Do you “friend” your clients? Do you have anything personal on the web you’d rather your clients didn’t see? This becomes a form of self-disclosure. There may be things revealed about yourself on-line that you would never reveal to a client. Remember, if the client is in the same Facebook network, they can likely see more of you than you might realize.

4. Google searches. Similarly, it might be worth your while to search yourself and see what is out there. Did you know that there are “rate my counselor” type sites out there? Many of these exist to help you find healthcare providers in your area, but include ratings by current or former clients. Do you know what others are saying about you?

5. IT and other providers. Who has access to your accounts and computer? Does your IT dept (if you are in a larger organization) know to honor HIPAA regulations? If you use a vendor (e.g., Geek Squad), they need to sign an agreement to maintain the privacy of the clientele data on your email or database. Can you encrypt email and/or WORD documents?

Can you think of other technoethics issues?

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October 26, 2009 · 9:13 am

PTSD and surgery mortality rates


Today I begin “Counseling & Physiology”, a crash course (6 weeks!) for my students to explore the mind/body connections and how counselors pay attention to the body even if not their primary focus.

Last week I saw this news item on my Medscape.com feed: “Veterans with PTSD twice as likely to die after surgery”

Here are some of the highlights from a research study done at the San Francisco VA and UC San Francisco:

  1. 10 year retrospective study of 1792 vets (ending in 2008). 7.8% had established dx of PTSD. On average vets with PTSD were 7 years younger than those without the diagnosis (you would think then, younger = higher survival rates). Surgeries studied were elective surgeries.
  2. 25% increase in mortality 1 year post surgery for vets with PTSD, even if surgery happens years after getting out of the service
  3. Mortality rates for these vets were higher than those with Diabetes
  4. PTSD is an independent risk factor for mortality
  5. DX of PTSD was associated with increased cardiac issues (may point to why the mortality rates are higher

Sobering research if you ask me. Let us not become lazy in our thinking. Emotional problems such as severe depression and anxiety (which PTSD tends to bring both together) have a substantial impact on the entire person, affecting every part of the person from cells to spirit. Neither let us believe that if the cells are involved in such a disorder that there is nothing that counselors can do. Clients can learn to manage and even defeat some of the symptoms of PTSD by taking control of their thought life.

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October 23, 2009 · 1:51 pm

The practice of unlicensed counseling


The practice of counseling, therapy, psychotherapy and other related terms is restricted to those with proper licensing in most, if not all, US states. Makes sense on most levels, right? You wouldn’t want to go to an unlicensed doctor for your appendectomy. In opposition to Holiday Inn’s ads, you wouldn’t want just anybody doing professional work on you. License control is supposed to protect the public from harm. Bad docs and bad therapists should lose their license and not be allowed to practice.

But with counseling and therapy, it gets a bit sticky. Lots of different professions do similar activities. Unlike surgeons, you have people from widely divergent schools of thought and training doing very similar things. LCSWs, LSWs, LMFTs, Psychologists, Psychiatrists, LPCs all do talk therapy. They all diagnose and intervene per their view of what is wrong and what needs to change (thoughts, behaviors. feelings, etc.).

And it gets stickier. Pastors, clergy, and religiously trained individuals do many of these as well. While they may not give DSM or ICD9 diagnoses and bill insurance companies, they do talk therapy with people who are depressed, anxious, angry, on the verge of divorce–just like all of those licensed people above.  In my world, there are pastoral counselors, biblical counselors, pastors who counsel, christian counselors, etc. Most of these in PA are not licensed by any body. (In PA we don’t have a pastoral counselor license as some states do.)

In an effort to tighten controls, there is a state effort underfoot (HB 1250) to tighten who can practice as a counselor. There were already controls but now the new bill would disallow someone like myself to hire or supervise an unlicensed (but in my opinion competent) person UNLESS they were actively in the process of becoming licensed.

Why does this matter?

1. There are many competent people doing counseling related work that are not licensed (nor could they be since their training is of a religious or pastoral nature). Should the state control these individuals? Right now they haven’t been actively going after these folk. The law will continue to remain vague: Here’s the restriction for LPC practice:

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 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. [underline indicates new change in this paragraph]

Who decides what “engage in the practice of…or use any words…” constitutes? Obviously, one cannot intentionally lie but does the term therapy indicate a license?

2. There are many who provide pastoral care who are not ordained clergy. They have graduated from seminary-based programs that are not professional counseling programs. Yes, the current standard makes clear that it does not seek to limit the work of those acting under the legal auspices of a religious institution (i.e., are ordained by the church). But, should the state regulate those who provide biblical counsel but are not ordained? As long as these individuals make clear (informed consent) what it is they do and what they do not do, shouldn’t they be able to make a living? Research indicates that lay people can have tremendous success in helping those with depression and anxiety.

I’m all for protecting the public. But while licenses limit who gets to perform certain duties, it does not eliminate unethical or harmful practice. Further, much of psychotherapy is art as well as science. Artists can learn their trade in a variety of locations. What we need to do is to make sure the public can clearly identify the kind of counseling (and limits of) each counselor does. Second, those who provide biblical counseling ought to have some authoritative body. It would be great if they were recognized and “licensed” by denominations or organizations (e.g. the AACC who is trying to do this).

But I would hate to see the many seasoned, unlicensed counselors lose their ability to ply their trade.

That raises a question of analogy. Can anyone make a legal living cutting hair for a fee without a license?

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October 20, 2009 · 9:12 am

Diane Langberg on the web


Dr. Diane Langberg now has her own website. Check out www.dianelangberg.com for more information about her speaking (both schedule and available audios–both free and for purchase) and her counseling practice. You can see a list of her associates and their specialties. Her resources page has lots of good book, article, and website suggestions regarding a wide variety of issues.

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October 17, 2009 · 12:23 pm

The most important counselor capacity


Okay, so really there are a number of important counselor qualities and skills. You have to be able to be quiet and listen, to have good questions, and comments, to be able to follow a line of thinking, to have some idea of a goal, etc. But, maybe the most important quality is the ability to be self-reflective. Reflexive responses may be useful (these come from the gut) but they can be dangerous in that we have little thought and review of these kinds of responses.

At the retreat today I suggested that the unexamined life may create more opportunity for damage in counseling than the lack of knowledge of how to help a person. We may assume that our “truth-telling” capacity is good when it is really merely harsh. We may assume our “listening” skills are good when really, we are hiding from dealing with the big pink elephant in the room. We may think our advice and information is very important when really it merely exists to show off what we know.

We looked at Galatians 6:1f where we are called to help others by restoring gently, carrying burdens, and watching our own lives closely. (I got this from Paul Tripp some years ago). This passage shows where we may fail to care well for others.

Of course, there is also the danger of the over-examined life. Such a life leads to rumination, anxious second-guessing, and paralysis by analysis.

Retreat is going well, but wet and cold…

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October 13, 2009 · 5:21 am

Fear and trust hand in hand?


This week I’ll be speaking to a group of counselors about complex PTSD. One of the hallmarks of C-PTSD is the combination of chronic relational fear AND chronic shame/guilt over having said fear. It manifests itself as, “I’m afraid of you but I know it’s my fault for being afraid.” (NOTE: the reverse is not necessarily true: that those who have chronic fears, trust problems, and self-condemnation have PTSD or C-PTSD.) My focus at that training will be on this question: How do you lead someone (in therapy) in the repetitive work of “Do not give in to fear”?

On Sunday, Tim Lane of CCEF preached a sermon about fear and disappointment. In that sermon he mentioned our propensity to “flail ourselves”–assuming that we must be doing something wrong–if we experience fear. Instead of focusing on the experience, we ought to examine our responses to fear. Do we shut down? Do we believe that we are alone and isolated? Do we turn inward and act only in self-interest?

He gave us this quote from CS Lewis (Screwtape Letters): “The act of cowardice is all that matters, the emotion of fear is, in itself, no sin.”

Here’s my question: Is it possible to be afraid and to trust nonetheless without much reduction in the level of fear? Don’t we assume that if we act in a trusting way that our fears should abate? Especially in light of trusting God? Is it possible to trust God fully and yet fear? What might such fear and trust together look like? If we could do both at the same time, would it reduce inappropriate self-condemnation?

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October 6, 2009 · 9:48 pm

Check out my podcast on sexual addiction


CCEF is giving away my talk last year at their annual conference on sexual addiction. You can listen to it her: http://www.ccef.org/counseling-strategies-individuals-addictions

I’ll be back there this November to talk about another sex topic: when sex in marriage doesn’t work. No, I don’t have it on the brain, it was their request and conference title….well, I guess that doesn’t exonerate me afterall.

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