Category Archives: counseling

August 13, 2009 · 9:05 am

Are you a genetic fatalist?


Definition of a genetic fatalist: If I have genetic markers for _____, then I will have _____ problem.

Maybe this doesn’t happen to you but I find that when I have conversations about a wide variety of counseling related issues, they end up hitting upon the genetic question? Whether we are discussing anxiety, depression, alcoholism, sexual identity or similar concerns, I can count on being asked,

“Do you think it is genetic?”

The questioner seems to think that if the answer is “Yes,” then the individual in question has no responsibility for the situation–or no control over what is taking place. “If my alcoholism is genetic then it wasn’t my fault.” “If my son’s sexual identity confusion is genetic then he can’t do anything about it.”

Here’s what I want to say to most of these questions:

1. Probably but we don’t really know. There are lots of researchers trying to discover genetic markers and how our genes express themselves. Some we understand really well (like eye and hair color) and others we understand less well.

But even if tomorrow we discover that your husband’s OCD is genetically based, what does that mean? Is he forever trapped in acting on his OCD?

2. Thinking about genes this way doesn’t really help us right now. We all have genetic markers for various cancers and diseases but not all of us contract the problems. Women may have markers for breast cancer but never have the disease. How can that be? It can be that way because disease states or mental health matters are multifactorial in their origination. There may be genetic markers as well as environmental insults as well as psychological stressors that all work together to either protect from the disease or cause it to get started.

So, are you a genetic fatalist? Do you give your deciding vote to genetic markers when considering responsibility and control regarding behavioral issues, mental health problems, personality?

4 Comments

Filed under christian psychology, counseling, News and politics, personality, Psychology

Tagged as , , ,

August 10, 2009 · 9:54 am

Happenings


I’m passing on a couple of items from my schedule…

1. Speaking. I’ll be speaking at Macedonia Baptist Church (Norristown, PA) on the next two Wednesdays (8/12 and 8/19) for their Summer Bible Conference (theme: Mental Health Awareness). This week will be on Sexual Addiction and the 19th will be on the topic of Anxiety.

2. School. We start late this year on 9/14. For those interested in our course offerings, check out Biblical’s site for course listings. Note that we have entry level, advanced, and post-MA courses on Monday nights. I’m teaching an on-line course (Social & Cultural Foundations of Counseling) and two face to face classes (Counseling & Physiology, Psychological Assessment). Should be fun!

3. Conference 1. The AACCis hosting it’s World Conference in Nashville Sept. 16-19. My colleague, Bryan Maier, and myself will be speaking there. On the 16th, Diane Langberg and myself will be presenting a 3 hour preconference workshop about addressing the problem of pastoral sexual abuse. Later in the week, I’ll be lecturing on the use of the Bible with trauma clients.  If you like zooy places, then come as that is the best description I have for the Opryland Hotel.

4. Conference 2. November 13-15 is the annual CCEF conference, entitled, Sex Matters. I’ll be presenting on the 14th, “When Sex in Marriage Doesn’t Work.”

5. Newly published. The latest issue of the Journal of Psychology & Christianity(v. 28:2) is just out on the topic of Theophostic Prayer Ministry and related issues. I and my George Schwab have an article in that edition: “God as healer: A Closer Look at Biblical Images of Inner Healing.” Plus, a number of the other articles site previous work that Bryan Maier and I did a few years ago where we critiqued TPM’s theological bases. 

6. In the works. I’ve just completed work on a booklet, “Sexual Addiction: When is Residential Treatment an Option?” It is intended to be an ebooklet published by a local ministry. We are researching the best way to publish such a booklet for those caught in the trap of an addiction. If any of you have any great ideas for the best way to get that out on the Internet (including issues around document delivery, sales, and pricing), I’d love to hear about it.

3 Comments

Filed under "phil monroe", Anxiety, christian counseling, christian psychology, counseling, counseling skills, sexual addiction, teaching counseling

Tagged as , ,

August 6, 2009 · 5:15 am

Most common sexual dysfunction?


I’m doing some prep for a November talk at CCEF‘s annual conference which I am entitling, “When sex in marriage doesn’t work.” I’ll be giving a brief overview of how counselors can be a help to couples facing sexual dysfunction (whether biological, psychological, or relational). But in my prep today I ran across this little telephone survey result from 2002 where callers asked married men and women between the ages of 40 and 80 about their most frequently experienced sexual problem.

Any guesses yet?

For men, 26.2% reported problems with “early” ejaculation. [No definition given for “early.” Usually early or premature means earlier than he wanted.] Another 22% said the problem was ED. It is interesting that we are bombarded with ED commercials but I can’t say that I’ve ever seen PE treatments advertised in mainstream media. This is probably due to the number of baby boomers with cash seeking to turn back the hands of time.

For women? No surprises. 33% report problems with interest/desire and nearly 22% report problems with lubrication.

Did the respondents seek help? 75% had not.  Another study of men after prostate surgery reveals that those who do seek help quit soon after. Seems that while there are a number of medical and psychological interventions that can help to a degree, nothing turns back the clock to one’s twenties.

A caveat. The researchers only got a 9% response rate for their random calls. Why didn’t more participate? Did those who participated have more or less problems than those who refused?

Leave a comment

Filed under christian counseling, counseling, counseling skills, marriage, Psychology, Sex, sexuality

Tagged as , , ,

August 3, 2009 · 1:04 pm

Itchy?


I have poison ivy. During the day I’m able, sort of, to distract from the constant itch. I want to scratch but I refuse to give in to the temptation. But at night, the itch seems to quadruple in strength. It screams at me: “Scratch me NOW!” And without much thought, I scratch away. Further, itches appear in other spots and I begin to wonder if I will have breakouts elsewhere. Did I touch my eye? What if it shows up there? Oh, and there’s that itch in my groin…” Certainly my mood takes a hit.

This experience got me thinking about cognitive/emotional and relational “itches” that all of us have. They may be desires, fears, beliefs, etc. During the day work enables us to set them aside for a time. But then evening arrives and with less to distract us, they come rushing at us with a vengeance. And we begin to scratch at the itch by ruminating, fantasizing that you have a different life, predicting the worst outcome, impulsively trying to get rid of the problem, or drowning with alcohol, food, or media.

What is your “itch?” Do you have mechanisms to deal with the itch without making it worse by “scratching?” How might you identify the underlying beliefs and “conversations” you have with the itch that make it much more difficult to deal with?

Soon, my poison ivy will be long gone. But many of our emotional itches never stop. Like Nash in the movie version of “A Beautiful Mind”, the itch did not go away even though he was able to distance himself from it and remind himself that he did not need to respond to it.  

This is a part of what it means to “take every thought captive.”

1 Comment

Filed under christian psychology, counseling, Mindfulness, Psychology

Tagged as , ,

July 31, 2009 · 8:46 am

The grace of restriction?


I admit it, I hate restrictions. I like the freedom to do what I want. When someone tells me I can’t do something, I want to do it all the more. Have you ever wanted to NOT “keep off the grass” just because the sign was there? Or, have you thought you should be able to handle saying no to a great temptation all by yourself?

In working with men who have done things that have caused their loved ones or church community to trust them less, I sometimes see significant push back when it comes to natural consequences or restrictions put in place to protect the man from himself.  These push backs come in the form of

  • But I said I was sorry. Why won’t you forgive me?
  • You don’t believe in grace. If you did you wouldn’t keep me from having free access to the church (said by a convicted sex offender)
  • I shouldn’t have to have someone checking up on me or controlling my Internet access. If I don’t control myself and say no, then I’ll never learn to do it myself.

This last one is a bit murky. On the surface, the man is accurate. If he doesn’t learn to manage his own impulses, the moment he isn’t under restriction, he’s likely to act out. But here is the deeper issue. He doesn’t want restrictions because he sees them as painful reminders of his past transgressions.

Let me suggest that grace comes in the form of limits and restrictions. A man who abused his power as public school teacher and sexualized a child has served his time. He loves children and “only” offended once. He wants to work with kids in his church and is angry that the church has said no. “But I’m gifted with helping troubled children and I’ve had 15 years of great reports and plenty of parents who tell me they would trust me with their children. Why can’t I do what God made me to do?”

Now, there may be some explanation as to how this man might not ever be a threat again. And yet, might he also realize that restrictions from certain populations of people might actually be a grace to him–a freedom from temptation, from deception, from stresses that formerly led him down a path of fantasy and rumination about being a hero to children?

I haven’t worked this out fully in my head but I do think there can be much grace in restriction. I certainly see my children receiving a grace from not being allowed to watch certain shows or have unfiltered Internet access.

What grace have you received from a restriction? Was it both a blessing and a suffering?

1 Comment

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

Tagged as , , ,

July 20, 2009 · 5:59 pm

Evaluating Models of Counseling


I’m a little late to post this here but I am the Society of Christian Psychology’sguest blogger of the month. Here’s the post that I put up for today on how to parse the next hot new model of counseling you come across. Check it out at:

http://christianpsych.org/wp_scp/2009/07/20/evaluating-models-of-christian-psychology/

Leave a comment

Filed under christian counseling, christian psychology, counseling, Psychology, teaching counseling

Tagged as , , ,

July 17, 2009 · 5:47 am

Rwanda Day 8 (and 9)


Our final day in Rwanda! We fly out at 7:45 pm. This was a day packed right up to the last minute to get to the airport. Just like the Bishop to make sure we use every second! We had lunch with the Commission to prevent Genocide and the rector of KHI to present the beginnings of our proposal to them. We proposed a 3 pronged response to the needs we observed:

1. Information dispersal: (a) 1 page informational statements to educate adults and children about the symptoms of trauma, simple things to do if one witnesses another having a trauma reaction (grounding), and ways to remember the genocide without creating more trauma. This would be sponsored by the Commission; (b) basic workshops for psychiatric nurses, doctors, HIV workers, and pastors), (c) helping community care givers, and (d) developing better ways to run the memorial 100 days using their own new theme of Hope.
2. Support the sending of key Rwandans to the US to complete MA/PhD in Counseling so they can return as teachers
3. Developing a Masters degree counseling programfor KHI to run that is Christian based (at least a track of it would be.

Our proposal was met with enthusiasm!

We thought we were going to end the day with a bit of shopping. I got a bit of coffee and a few trinkets. However, on our way to the airport, we detoured to see the  Minister of Education. He had been unavailable earlier in the week and now wanted to meet us before we left. Though we should have been at the airport, we flew across the city to meet with him for 15 minutes. As an MD, he was able to give us some good guidance.

Got to the airport and through security (much laxer than the US). A large number came to see us off. Sadly, the Bishop was not allowed to get on the plane. Something wrong with his visa (he got back to the States where his family is staying til December two days later). Our plane left one hour late and very full of children (expats on the way to holiday in Europe). Going up the stairs to the plane I got what I hope not to be my last sniff of the cooking fires. After the doors closed the attendants went through the cabin spraying something to kill mosquitoes (repeated after our brief stop at Entebbe, Uganda). They said it wasn’t dangerous to us but I wonder just the same.

After a full day in Rwanda, we travelled to Belgium (10 hours), had a lay over of several hours (where I purchased some Belgian chocolate), and then another 8 hours to Newark. Sadly, I cannot sleep on planes so I enjoyed several “Bourne” movies. Our team was not able to sit together on the flight to the US and this was sad. As we got off the very full flight, we lost track of Leah. We went in the wrong customs line and she must have gotten through before us.

So, we end our trip with much to process, little time to do it, and no time to do it together. I have grown fond of my new acquaintances in Rwanda and teammates Leah and Josh. But, now it is time to sleep as 40 plus hours of being awake is taking its toll!

3 Comments

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

Tagged as , ,

July 16, 2009 · 5:16 am

Rwanda Day 7


Started the day as usual with some quiet meditative reading on the porch overlooking the lake and the distant sound of many children getting water on the other side (yelling Muzungu (white person) to get my attention). Diane read us this quote from John Fawcett’s “Christ’s Precious” (published by W. Milner in 1839, p. 82)

I am but a stranger in this world, wherever I may be situated, or however I may happen to be distinguished. And such, it is my privilege that I am so. [However] when I look not upon myself as a stranger and a pilgrim, when I am captivated with anything in this place of my exile, I forget myself, and act far beneath my character, as a candidate for an immortal crown.

Fitting. It is easy in the US to forget our “exile” status. We focus, instead, on our own status. But here in Africa, there is little to do but remember how fragile life is and how we must depend on God for our daily existence.

Today we met with Justin Remera, a psychiatric nurse at Gahini hospital. The hospital was built in 1920s. He is the head of mental health. He sees some 30 patients per day and has a caseload of 500 with PTSD. He sees lots of “epilepsy” and has documented some 350 new cases in the past 2 years. But they have normal EEGs, thus it is trauma related not brain injury. Justin told us that there is an openness to therapy here because they see the benefits.

Problems noted by him? no medications other than Haldol. Infrastructure needs. His office is the size of a small closet and he has had violent patients and no escape (his desk and chair are away from the door). Also, next to his office are rooms where patients were screaming (while we were there). Seems they may have been doing some minor surgery without anesthetic. He also mentioned problems with demobilizing military and their own trauma as well as his own burnout.

Next we went to Kigali and met with the the permanent secretary of Defense. One of the persons there talked about having 520 peer counselors in the military to deal with the problem of HIV. Nothing dealing with PTSD. They have NO chaplains in their military.

Next, we visited the National Council of Protestant Churches of Rwanda. Specioise told us that 52% of the country are protestant. They have a program to deal with gender based violence, to educate the the church about laws designed to protect women. Their booklet combines Rwandan laws and biblical passages.

For our final meeting, we visited with Jean Baptiste at World Vision. He is new to WV in Rwanda but not new to WV (previously in Mali). He is a tall man with much presence. He spoke very openly and honestly about the issues of NGOs in the country and the problem of lukewarm Christians. He suggested they were much more problematic than rank atheists or Muslims. He gave us some advice as how to work with both churches and government officials. Josephine, a woman Diane had worked in Rwanda on previous trips, was there and spoke of the continued need to train and care for Rwandan caregivers.

Our day ended in Gahini with a farewell dinner. Members of the church and community (the local mayor) attended a dinner at the Seeds of Peace retreat houses. The dinner was outside under a canopy. During dinner we watched the local youth perform traditional dances with drums, singing and costumes. The young women danced with wooden milk bottles on their heads. We learned their trick. A heavy stone in the bottom of the bottle helps it stay on their head. Ouch! The night ended with gifts from our hosts to us and a few words of thanks from us.

Leave a comment

Filed under christian psychology, counseling, counseling science, Psychiatric Medications, Psychology, Rwanda

Tagged as , , ,

July 9, 2009 · 8:59 am

Rwanda Day Four


Spent the day traveling around Kigali. First stop was Ndera hospital, the only psychiatric hospital in the country. It sits atop a dusty hill just outside the city. Upon entering the gate and getting out of the cars, we were welcomed by patients asking for water and money. The hospital has a 19th century or impoverished cold war era feel about it. Sterile cement block buildings set in a square. Sparse is an overstatement. We learned many staff and patients were murdered during the genocide. This hospital has over 200 patients (but just 12 beds for children). Psychiatric nurses provide the bulk of the care. Their “intake” room had one chair, one table and very little light. Patients lie on the grass outside in various states of unhealth. They have many with PTSD and schizophrenia diagnoses. Their only medication is Haldol. No “atypicals” or newer medications. A woman started screaming just outside our door. Translated: “Why does everyone hate me?”

From this hospital we traveled to the National Memorial Center to tour the genocide museum and grounds where some 300,000 have been interred. I couldn’t handle the room filled with poster size pictures of young children in happier days. The small print told of their favorite foods and activities…and how they were hacked to death.

Another lunch with a Christian counselor, Ms. Paulette, who told of her counseling work and training of lay counselors. After lunch, we met with the executive secretary of the Commission to educate about and prevent genocide. This handsomely dressed man shows the signs of his own trauma. he desires our help to guide the country to remember in healthier ways. Right now they play videos of the actual genocide and so during their 100 day memorial (April to July) they see so much trauma responses. He wished us to start right away.

Here’s a thought in my head: Does Rwanda need us or do we need Rwanda. I am amazed at how community minded this country is. They have no choice. People sacrifice for the good of all. They make do with a little. They are action oriented and start doing things rather than waiting to get it right. Risk calculation is not part of their thinking. What amazing things we could do in this country if we would learn from these people on how to put neighbor ahead of self.

1 Comment

Filed under christian counseling, christian psychology, counseling, Post-Traumatic Stress Disorder, Psychiatric Medications, Psychology

Tagged as , ,

July 8, 2009 · 8:56 am

Rwanda Day Three


Awoke to the call to prayer by the local imam. Did not sleep well. Sinus headache due to the ever present charcoal smoke. We left Butare for Kigali to meet with with the president of the senate (2nd in command of the country) but he was suddenly unavailable. Something about the presence of UN VIPs. I guess that trumps us. Instead we met with the a key person at the ministry of mental health. She lamented the need to use BA level psychology grads and lay helpers to do the vast majority of their   counseling. Lunch at Moucecore where we learned more about their ministry to prevent HIV, to protect children’s rights, teach the bible and train individuals to be community leaders.     

After lunch we met with the rector (dean) of Kigali Health Institute. They confirmed the need for masters and doctoral counselors with knowledge of mental health problems. They have no problems with specifically christian counseling training and would like us to help them create a masters program and also teach or do distance ed for them. From this meeting,we drove across the city to Barakabao Foundation another ministry of the Bishop to care for over 5000 orphans. These orphans are in either foster families or child-headed homes–and they do it all with 12 staff. As some of the staff spoke, you could see their own stress and trauma. When it comes to orphans, they see 5 different types: genocide orphans, orphans whose parents died in refugee camps in the DRC, orphans born through rape, those whose parents died due to HIV, and those whose parents are in jail.

The day ended in Gahini at the retreat house. The hot meal and bed are welcome sights after such a long day of meetings. On the good note, I had a 2 minute call home. Sam answered and was overjoyed to hear me. Told Kim I was fine. Not sure if I’ll get further opportunities. I admit I’m homesick. I’ve not gone this long of a time without talking to Kim.

Leave a comment

Filed under christian psychology, counseling, Psychology, Rwanda

Tagged as , ,