Category Archives: counseling

May 1, 2009 · 5:42 am

Physiology Phriday: Dieting starves your brain?


I heard a psychiatrist recently tell her depressed client that she should not go on a diet to lose weight. The client was confused. She thought that losing weight would help her with her self-esteem. She had not been exercising and had put on 15 pounds over the past 3 years. So, she asked her doctor why not. This was the explanation (paraphrased):

Exercise does provide a natural antidepressant and so I heartily encourage you to start an exercise program. However, many diets consist of decreasing foods rich in carbohydrates. Getting more protein is good but your brain needs glucose to produce neurotransmitters (e.g., serotonin) and foods rich in carbs are more easily turned into glucose. When you starve your body of glucose, your brain is the first place that starves.

Maybe this explains a bit of yo-yo dieting. The person is feeling poorly about weight, reduces foods that provide simple sugars in order to lose weight, starves their brain of serotonin (thereby creating a greater feeling of depression), and then caves to a binge in order to feel better. 

Don’t know if this supposition is true, but it might be important for those on antidepressants to make sure that they are keeping a balanced diet and exercising frequently.

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April 30, 2009 · 5:38 am

Identified by your betrayals?


This past Sunday one of our pastors, Erik Larsen, asked this question:

Are you too identified by your betrayals?

He was asking whether we form our identity around the script of being betrayed and use our experiences of being betrayed as shaping our sense of all of life. I think we could also consider whether we shape our identity around our betrayals of others?

What forms your sense of self and the world? A serious violation of your trust?A major failure? How might you begin to reconstruct your sense of self around the whole picture of who you are?

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April 21, 2009 · 11:59 am

What is a competent counselor?


Today, I begin an introduction to pastoral counseling class for MDiv students with my colleague Jenn. In six short weeks we will expose them to biblical foundations of understanding people and their problems, the basic helping skills, and provide them opportunities to practice on each other.

So, what makes for a competent counselor? There is a famous book on this topic. Jay Adams focuses in his landmark, bulldozing book on the problems of secular psychology and the need for a new understanding of how people change that fits with Scripture and a confidence that all people, especially pastors, are capable of leading others to change.

Important work, but misses some of the nuances that we have now about Christian models of change. For some of my thoughts on a more robust model of counseling that I seek to impart here at Biblical, see this post from several years ago.

But I want to focus here on the talents or capabilities of the counselor. And here I list 7 factors needed to be a competent counselor

1. Spiritual maturity. Not only must the counselor know the bible, its story line, etc., they must also have understood and experienced the Gospel, show a maturing trajectory towards holiness and awareness of the diversity within the Christianity. In the words of one of my theology colleagues, they must know the difference between dogma and doctrine and opinion.

2. Self-awareness/insight. One can be spiritual mature, but not particularly insightful about the self. The competent counselor has a grasp of their own narrative (and how the Gospel story is changing it) and how it impacts past and present relationships. The competent counselor understands strengths and weaknesses and is not defensive.

3. Capable of building trusting relationships. Nothing much good comes from counsel provided by standoffish and stand-above kinds of counselors. The competent counselor is able to build trusting relationships by being interested in individuals (more so than in outcomes), able to walk in another’s shoes, cross cultural lines, and able to empower others more than tell others what to do

4. Flexibility in response styles. The competent counselor understands the need to use a variety of conversational responses depending on the needs of the client. This means sometimes questions are appropriate, other times silence. Other responses include reflections, summarizing, focusing, confronting, joining, problem-solving, self-disclosing. Counselors who only use one or two of these styles will not be able to work well with clients who find those particular styles problematic. The competent counselor is intentional in her or his choices of responses.

5. Assessment and Hypothesis skills. The competent counselor is able to move from their counselees problems and descriptions to a wider view of the person and their situation and back again. This counselor is able to pull multiple pieces of data into a cohesive understanding of the situation. In doing so she forms and tests possible hypotheses that clarify motivation for behavior as well as point to interventions. For example, is the child’s behavior merely rebellious or is it ADD or anxiety based?

6. Observation skills.The competent counselor not only understands people, their needs, solutions, and has the capacity to use multiple response styles, but also is observant regarding their own impact on the counselee. They observe subtle reactions form clients and seek to moderate their counseling style and/or gently explore the meaning of the reaction. Without these skills, the counselor blithely works toward a goal without knowing if the counselee is really following.

7. Ability to care for self. Finally, the competent counselor recognizes personal limits, boundaries and actively seeks to sustain a life of personal care. Far too many counselors confuse sacrificial giving with bypassing appropriate care for one’s own spiritual well-being. Just because one is spiritually mature one day does not mean such maturity is permanent. Neglecting personal care will likely diminish all other counselor competencies over time.

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April 20, 2009 · 11:03 am

Practicum Monday: The green counselor


No one wants to be a green counselor. “Hi, I’m an intern and you are my first counselee.” Who wants to say that? Also, no one wants to entrust their most significant problems to a green counselor. “I see you haven’t any experience, so let me expose my most tender parts to you and see what you can do.”

Houston, we have a problem.

Every counselor has to get their start somewhere just as every surgeon cuts a live human being for the first time. Young single folk counsel conflict-riddled married individuals or offer parenting advice while not yet a parent. Individuals with no history of addictions sit with folks in their 10th inpatient stay in a treatment center.

Is there any way this goes well? YES! Let me tell you why going to an intern with a good supervisor is good, even sometimes better than getting a seasoned counselor by them self.

1. You get two heads instead of one. Even if the supervisor is not in the room, you get a young, determined-to-do-it-right counselor and a supervisor on his or her toes (who loves to teach and wants nothing bad to happen) thinking about you and planning carefully. They talk about the intricacies of your situation at great depth, they consider the options, and carefully review the outcome. If you only have a seasoned counselor, they may perform better (relationship wise) in sessions, but they probably aren’t thinking as critically as they could. I can attest that I am thinking much more carefully about clients during supervision (as supervisee or supervisor) than when I am not there.

2. Book knowledge actually does help. The further a person gets away from textbooks, articles, etc. the more they rely on old knowledge. Teaching counselors and green counselors are fresh from their reading and thinking about key problems. For example, the student having just completed an ethics course will be more sensitive to boundary violations than the one who has grown accustomed to thinking they will always do the right thing. Sometimes resident doctors are more aware of subtle health issues because they are running down every article to learn and running down every symptom.  

Now surely a seasoned counselor provides many good benefits. Working with an intern or medical resident often takes longer to get to a good outcome. They just aren’t as fluid. They are still learning–learning on you. A seasoned counselor will make fewer mistakes. But if they are a humble learner, the green counselor will catch on quickly and repair any damage. Whether green or seasoned, the most dangerous character problem in counselors is arrogance and listening only to him or herself.

But the intern can manage some of this by dealing with his or her own anxiety. Confidence does actually help. It enables you to think clearly, consider options, be honest about your own weaknesses, offer the client help in finding someone else if you aren’t the right fit. It is like baseball. If you are afraid of getting hit, you’ll likely not catch or hit the ball. If you have confidence, you’ve got a better shot of catching it and/or at least making contact when hitting.

 

All that said, I have to tell you a story about my “first time.” I had just completed a 13 week internship where I counseled 2 separate clients with my supervisor in session and by myself. I could be given good grades for trying hard, but probably was too impatient to get to the good stuff of people’s problems–the stuff of repentance. In a moment of insanity my supervisor set me up as a staff counselor in a satellite center. On my first night I saw a person who said the Lord had told her I was the counselor for her but now was rethinking she had misheard. How could an 18 year old be right for her (ahem, I was all of 24!)? After trying to find out the issues, she said if I couldn’t figure it out, she definitely had misheard God. The next client was a couple. In the course of the session, the husband actually stood up and started choking his wife. I stood up–not knowing what else to do–and he fled the building.

There’s nothing like baptism by fire 🙂

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April 10, 2009 · 5:49 am

Psychiatric vs. Psychological evaluations: What is the difference?


In place of my usual physiology Phriday post, I give you this…

“I think I need a psychiatric evaluation? Can you test me?” These are some of the questions I get from time to time. And they reveal an ongoing confusion about testings, assessment, evaluations, the world of psychiatry, psychology, and neurology. Interestingly, if you type in “psychiatric evaluation” into wikipedia, you actually get redirected to an entry on psychological evaluations and testing. So, let me try to differentiate a bit here:

What is a psychiatric evaluation? It is done by a psychiatrist who is a physician with special psychiatry training (courses and residencies). This evaluation is comprehensive but medical in nature. Expect the person to ask for your physical, behavioral, and cognitive histories, order blood tests or other medical exams, evaluate (by observation and interview) your mood, your reality testing, and mental status etc. Ultimately, after an extensive (and usually expensive) interview, the doctor will arrive at a psychiatric diagnosis (if appropriate) and may also recommend medicines to help with the problem–which they can prescribe. A few also provide ongoing talk therapy but most do not. Rather, they recommend you find a therapist for that part. They will follow up with med checks as needed to titrate or refine your medicines. When a person has a very difficult, complex, or lengthy history of mental health, or, when the person is needing a diagnosis for legal reasons, a psychiatrist is a good choice. They are usually gifted at extracting subtle physical and behavioral matters that may help correctly pinpoint the problem. While a person might well get anti-depressants from their regular doctor, a good psychiatrist is better able to deal with complex matters and follow you more closely to get the right compound and dosage.

Neurological Evaluation. Stating the obvious, a physician with neurological specialties and qualifications does a neurological evaluation. Neurologists specialize in…wait for it…the nervous system (brain, spinal cord, and 12 cranial nerves). A neurological evaluation includes many of the things evaluated by psychiatrists but with special attention to your motor and sensory systems, your reflexes, and similar kinds of things. You might more likely see a neurologist when you obviously have a neurological issue. Neurologists are more likely to specialize in ADHD, brain injuries, and psychiatric problems that result from dementias or other known physical problems. They are often better able to give and interpret MRIs and other imaging that might be appropriate. They will also prescribe and follow medications.

Psychological Evaluation, AKA testing, psych assessment. These are offered, mostly, by doctoral level psychologists. These evaluations will cover much of the same history, mental status, and provide diagnoses when appropriate. Interviews, just like the previous two options, are essential. However, what sets psychological evaluation apart is its use of standardized tests. These may be paper and pencil or electronic. They may be filled out by the client or by family members. The results provide a snapshot of behavior, or cognitive functioning, or mood by contrasting the individual results against a peer group. For example, a child may complete a computerized test to assess attention span. The results are compared to thousands of children taking this test who either are “non ADHD” and or ADHD. A good psychologist collects data from multiple data points (test data, interviews by client and maybe family, observations, etc.) and uses that data to make interpretations and recommendations for ongoing care. Usually, the best psychological evaluations begin with a very objective, specific question. Just throwing a bunch of tests at a person to “see what comes up” isn’t all that helpful. Just because something pops up doesn’t mean it is meaningful.

It is true that masters level therapists (licensed or not) give and interpret some tests. But most of the best tests can only be given and interpreted by doctoral level, licensed psychologists.

There are other types of evaluations. Neuropsychologists are doctoral psychologists with specialized training and help pinpoint brain injury, unravel more complex learning disabilities, etc. Neuropsychiatric evaluations are done by another similar but slightly different professional. You can check out their interesting history on this wikipedia page.

So, how do you choose what is best for you? Answer a few questions.

1. What do I really want to know when it is all said and done? What might help me decide how to proceed? The more specific you are, the more likely you can get the answer you want.

2. Do I think I need to focus more on physical options or behavioral options?

3. Do I think I’m likely to need medications? The physician types are better. Psychologists cannot prescribe meds (unless you live in Hawaii or are in the military).

4. If I am given a diagnosis, what do I need it for? Both doctoral level psychologists and psychiatrists are capable of giving you diagnoses. However, some people or systems value one opinion over another. Figure out if it matters for your purposes.

5. Am I looking for specific behavioral/relational suggestions? Then psychological evaluations are more appropriate.

6. Am I looking to form an ongoing therapeutic talk based relationship? See the psychologist.

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April 8, 2009 · 5:16 am

Ramp up your helping skills!


Biblical Seminary is offering community education (non-degree) for those not able or not eligible for graduate education. It is a way to get a taste of what we do here. Starting next Monday night, Jenn Zuck (one of our counseling adjuncts) will be teaching an introductory counseling skills class for 6 weeks. If you’ve wanted to ramp up your listening and helping skills, wanted to see what we teach counseling students, or just wanted to improve your family relationships, you should enroll in this course.

By the way, the course isn’t just for your head. You will practice some new skills and you will find that your spiritual life will also be enriched.

Here’s the link for more info (flyer and syllabus): http://www.biblical.edu/pages/embark/about-us-upcoming-eventstest.htm

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March 31, 2009 · 5:42 am

The Value of Psychological Testing


My friend, former teacher, mentor, Ed Welch, has posted a blog on the CCEF website on the topic of psychological testing and how biblical counselors might view it. You can see his blog here as well as my comment on their site: http://www.ccef.org/psychological-tests-are-you-or-against#comment-28

Ed, as you will see, isn’t really against testing, recognizes value in it, but doesn’t really think they are all that special–no more so than a really good interview. And, in part, he is right. A really good counselor/interviewer and learn a lot. In my mind, though, testing provides confirmation of what you are learning about the counselee PLUS uncovers subtle data that you might not get quickly or at all (especially through the more objective forms of testing).

It seems people think about testing in one of two ways: either they think testing uncovers secrets that couldn’t be gotten without a test or they dismiss it as pure theory. It is neither. Good testing provides a response profile that one can look at and compare to either the general population or a specific population. That, in itself, isn’t all that helpful but when combined with a specific assessment question, the examiner can interpret the data and build good hypotheses to direct future counseling and intervention.

I love to do psych testing. I find that interacting with test results and counselees provides dialog points that wouldn’t have been as easily discovered or talked about without the data in front of us. For example, if someone takes a personality test and one of the scales suggests that they are approaching the test in a manner consistent with those who are trying to look better than they really are, that provides an opportunity to discuss an pattern in their life that we might not have had the chance to do so easily.

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March 30, 2009 · 5:51 am

Readings for Christian Psychology


Had a prospective student in recently asking about good readings to start with before beginning the Masters degree. My answer? It depends on your background and interests. So, I’m going to post a few of my recommendations today for the student with a college/university/grad background in psychology but who wishes to be more informed about the Christian world of counseling theory and practice.

Historical and Theoretical Foundations

Eric Johnson’s massive tome, “Foundations for Soul Care” (IVP 2007). At over 600 pages, you might be intimidated but you should try out Part 1 (ch. 1-3) which gives you historical and theoretical backgrounds. The rest is great too (check out p. 172 for a good illustration). Also, the Appendix 1 may help as well.

Eric also edited “Psychology & Christianity: 4 views” (IVP). You can see 4 different stances to christian counseling. The book isn’t the best because it does not, in my opinion, allow each model to be well represented. However, the first chapter does provide historical background and you can see the failings of each of the four views in their debates with each other.

Examples of Christian Counseling

Anything written by David Powlison or Ed Welch (www.ccef.org) will do just fine. Ed’s “When People Are Big…” book is a good start. More recent editions such as his book on addictions and depression are popular reads but helpful. David’s writings are best contained in their (now defunct) Journal of Biblical Counseling or on their website.

If you haven’t read anything by Larry Crabb, one of the most well-known Christian counselors, you might start with his “Finding God.” He has a dozen or more books to choose from but that one may be his best.

Want someone who best illustrates the integrationist model? Try Mark McMinn’s “Integrative Psychotherapy” (IVP). This book may be the most comprehensive effort to articulate both theory and practice by any Christian counselor to date. Or, look at any of Mark Yarhouse’s work. You can find his writings at www.regent.edu or http://psychologyandchristianity.wordpress.com/.

Want more of a theological foundation? Consider C. Plantiga’s “Not the Way its Supposed to Be” (Eerdmans).

There’s way more but that will get you started. If you really need more check out www.christianpsych.org for its lists of good books.

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March 19, 2009 · 1:54 pm

What if a negative person followed you around all day?


Tomorrow I’m posting about the problem of repetitive thoughts. Was talking in supervision, today, about the problem and my eminently wise supervisor suggested that one of the issues about repetitive thoughts is that we forget that they aren’t reality and so we listen to them. Actually, she said it much nicer but that is the best I can do.

She suggested telling clients to consider (write down) these repetitive, negative thoughts and imagine that they were being said by someone following them around. This objectifies the thoughts and gives one an opportunity to talk back to them.

So, imagine that someone is following you around and saying aloud your thoughts. What would you want to do to them? How might that picture help you to reject certain negativistic self-talk or rumination about others?

Kind of like Gollum’s (Lord of the Rings) debate with himself. We all have a little Gollum in us, right?

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February 16, 2009 · 2:23 pm

Wanna see a MA Counseling program in action?


For those of you in the Philadelphia region and considering an Masters degree in Counseling you are hereby invited to our March 9th “taste of Biblical Seminary.” This open house is just for those interested in a counseling degree and will expose attendees to what we do at Biblical. You’ll come hear from profs and students, have a meal with us, have time to ask current students anything you want, and then sit in on our classes. You’ll leave with a very clear sense of what we are about.

For more information and an opportunity to have a meal with me, check out this pdf on our website: http://www.biblical.edu/images/embark/PDFs/infoeventmar09.pdf

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