Category Archives: counseling

September 23, 2008 · 5:52 am

More comments from the SCP conference


Some tantalizing quotes from our recent conference unapologetically taken out of context for your tasting pleasure:

Bill Hathaway: “Psychology is a social construction that gives us pockets of truth about the real world.”

From a presentation on the history of the psychology of religion project begun in the 19th century. He was talking about this historical project that was originally undertaken to explore and explain religious experience. Of course, the explanation was also reductionistic since it was undertaken from a naturalistic worldview–one that rejected the possibility of the supernatural. We should admit that all human explanations are reductionistic. But some more closely approximate the world as God created it. 

Another Hathaway quote: “We don’t need to be therapy prostitutes, doing whatever the client wants.”

I’ll leave that one without explanation.

JKA Smith: “All science is hermeneutic, a take or interpretation of things…Science is culture…so the interaction between faith and psychology or theology and science is cross cultural.” And, “The most important questions of Christian psychology are these, What’s at issue…What’s at stake?”

Richard Schultz:

“Biblical interpretation is not complete by coming to the meaning of any one text.” On the necessity of reading the bible in light of the whole, or, the importance of building a biblical theology.

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September 12, 2008 · 5:19 am

“I apologize for being late…”: bad behaviors by your counselor


Just skimmed, “‘I apologize for being late’: The courteous psychotherapist” (in the 2008 (v. 45:2)Psychotherapy: Theory, Research, Practice, Training, pp 273-277) by Rolfs Pinkerton. Pinkerton details how our bad behaviors can harm (gasp!) the therapeutic alliance but that courteousness and correcting the behavior can help alleviate the problem. No surprise here.

But wait, what are some of the bad behaviors (no not the really bad and really obvious ones) he’s concerned about. Let’s see how we rate:

1. Being more than 15 minutes late. Apologies help but if it is a regular problem then…

Hmm. I’m usually 5 minutes late. Does that count as bad?

2. Falling asleep or being obviously worn out.

I try to solve this by drinking caffeine.

3. Forgetting names, using the wrong one or the wrong pronunciation.

So, when I pray for my “brother” or “sister” is it obvious that I’ve forgotten their name? Actually, I do pray that way sometimes and I haven’t forgotten a thing.

4. Repeatedly checking the clock.

I have an internal clock and so I try not to ever look. Probably why I’m regularly 10 minutes behind by the end of the day. So, how much is too much?

5. Taking calls.

Never do that. But I have forgotten to silence the phone. I hate it when that happens.

6. Drinking or eating in front of the client without offering some.

Oops. Did I mention that I caffeinate? Didn’t think that was rude. Hmmm. I have clients coming in bringing their Starbucks and I never feel left out. I wouldn’t eat in front of them. Do I get partial credit?

How about you? If you are a counselor, what are your faux pas? If you ever were a client, what annoying (not illegal or immoral ones–those are pretty clear) habits irk/irked you? (Be gentle with us and be sure to protect the guilty. We’re rather fragile.)

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September 3, 2008 · 1:15 pm

Biblical Counseling is too focused on big truth?


Haven’t had much time to write of late since the pressure is on for more formal writing assignments. But, in prep for a presentation in a few weeks I have been thinking about this question. Is the biblical counseling model of change too much focused on truth? Heretical thought for some I’m sure. (For those who don’t remember I consider myself both a biblical counseling and a Christian psychologist).

Let me start with some shoddy diagrams of two classic models of change.

1. Presenting problem –>Diagnosis Made–>Counselor generated insight (reality/truth) –> Corrective action (counseling as troubleshooting ways to cement corrective action outside of session). Counseling in this model focuses on truth/reality applied to counselees life outside of session. Benefit? Problem/solution focused; objective change. Drawback? Feelings and Relational activity is minimized (though not denied). The relationship is used to get to the activity of change.

2. Presenting problem  –> Diagnosis Made (but may not be told) –>Counselor generated insight (NOT given) –>Introspection via counselor generated questions. Counseling in this model focuses on introspection and counselee generated insight. Benefit? No pressure to perform, feelings encouraged. Drawback? No real relationship focus as it is purely 1 way. No focus on objective change (assumed it will naturally happen).

So, model one is more cognitive. Model two is more dynamic. Both models want or respect the valuate of relationship but usually see it as a necessity to get to what really heals (truth or insight).

The biblical model is most like model one. In many respects, the focus on truth is good. We fallen creatures need constant reorientation. We are easily deceived. And yet, which truth? Notice Jesus with the woman at the well (John 4). He doesn’t start out with the biggest truth (she’s an adulterer). Notice that we often need more immediate truthes to be the focus. Peter needs the hand as he sinks, not a lecture. David needs Nathan’s story first. We learn that God doesn’t tell us all our sins right off the bat. We couldn’t take it. Do we in the biblical counseling world over-focus on the big truths of faith, trust, sin, idolatry, etc. that we miss the “smaller” truths that God is with us, that his hand is present right now in some small tangible way?

So, how about this model for change that is both solution focused AND interpersonal.

Presenting Problem –>Collaborative Diagnosis/Goal setting –> *[empathy ->validation ->here/now ->collaboration on meeting goals/objectives and responding to thoughts, feelings, behaviors] –> small habit change attempts –> post hoc insight.

In this model the primary work is in the interpersonal dynamics (the stuff in the brackets) and insight is more what happens after change takes place: “Oh, that’s what I was thinking then and this other way helped me to change that.” If this alternative model is a bit more accurate in portraying how people actually do change via God’s grace then this is my big question: how might this model change how we use the Scriptures in counseling.

Make any sense?  If anyone has artistic capability to render these diagrams I’d love to see how you’d do them.

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August 6, 2008 · 10:59 am

The root of conflict in couples?


We often say that most conflict between spouses boils down to money, sex, or power–and the first two are also all about power in the relationship. I think that is true. But, don’t forget that the power struggle may be less about the two people and more about a life-long pattern of feeling powerless  and unsafe in the world. In psychology terms we talk about this as the lack of secure attachment.

Here’s a few summary statements about attachment that I wrote up some time ago. I have no idea where these thoughts came from or why I wrote them so I apologize now for plagarizing them. They may well be my own thoughts or someone else’s…

1. Attachment injuries are often the culprit behind continuously conflicted couples.

2. Fights, then, are more symbolic than content driven.

3. Attachment insecurity precedes most conflict: the feeling of being alone, abandoned, rejected, etc.

4. Injuries usually are trauma based (or the perception of) in the present marital relationship or much earlier in childhood. There is a “violation of connection”

5. Two common problems result: (a) numbing, and (b) obsessional repeating/self-reminder of the experience of the violation. (example: the person repeatedly recalls the time 5 years ago that their spouse treated them as an object)

6. As a result of #5, the person experiences (a) and increased desire/”need” for a safe haven, but (b) lacks trust in the spouse, and (c) is vigilant for any sign of relational danger (i.e., reads ambiguous data in the worst possible manner)

7. The other spouse feels pushed/pulled at the same time and commonly physically and/or emotionally withdraws

8. The cycle perpetuates itself allowing both parties to solidify their labels for each other

9. The GOAL of therapy is to get a commitment to stop the cycle/script and to have each party soften towards each other so as to see the desires behind the emotion/behavior. If couples can see beyond the criticism or withdrawal to common desires of intimacy, they may be able to re-interpret and validate that desire while at the same time supporting a healthier way of expressing that desire.

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July 11, 2008 · 5:00 am

How do you listen to people’s problems all day long?


This is a question we counselors get from time to time, especially when someone is embarrassed that they need a counselor or think they shouldn’t be having problems (or that they are weak for having them).

Today in staff meeting we watched a video on vicarious trauma. This term has been mis-identified with burnout and secondary trauma. In short it isn’t about our symptoms or having our own trauma but about the changes in us after taking in large amounts of other people’s pain.

Individually, hearing any one person’s problems isn’t much of a burden. But when you add all together it gets heavy at times. What do I mean? Well, we begin to see danger of abuse everywhere. We begin to think that all leaders are abusing power. Interestingly, one of the speakers on the video said that early career therapists tend to struggle more with fears and later career therapists struggle more with cynicism.

Most of the problem is the result of the loss of hope. And yes, therapists sometimes lose hope. That is why we have staff meeting so that we can remember that hope comes not from our ability to change the world but that we fallen creatures look to the power of the cross to change us and our clients.

I’m not sure what nonbelieving clients hope in and how they manage living with the weight of the brokenness in the world.

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July 1, 2008 · 2:02 pm

Power grabs by therapists


We counselors and therapists have ways of asserting our power over our clients. Usually, we do it via subtle messages and phrases. I was reminded of this fact last week during a seminar by Paul Wachtel of CUNY. He told of a case he had of a semi paranoid and hostile client who made many complaints. After one such complaint against him, Wachtel responded with,

Isn’t it interesting that you see me as being just the way your father was

These type of insights offer pseudo-neutral “observations” that are really accusatory and given to show our intellect (but draws them away from their affective state). Further, when we are irritated and make a statement like this we are really saying that my frustration isn’t about me but is about you. I’m objective here, you are not.

When we give insights to clients we need to ask whether or not the client already understands them, will feel that we are working WITH them (not talking at them), and be motivated to do more exploration. As Wachtel stated, insights are often “implicitly adversarial” (never about us either!).

These kinds of linguistic power grabs aren’t just done by analytic oriented therapists (who might be inclined to make distant insights into clients’ unconscious). Cognitive therapists do the same by implicitly and explicitly telling clients that they are irrational and if only they could think like we therapists, they would be so much better.

Let’s not forget that the words we use with clients tell something about ourselves–maybe more than we wish they would.

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June 27, 2008 · 10:11 am

Another training opportunity…


I’m probably doing too many ads here but as I’m off today for conference with Paul Wachtel (see my “on my nightstand” for a link for his book), I thought I would tell you all about a conference this fall by CCEF. This year they are teaching on addictions. I, along with Diane Langberg, Leslie Vernick, John Freeman, and the usual crew of CCEF faculty, are going to be doing a number of great teachings on the problem of addictions. My talk will be for counselors trying to work with addicts. Check out www.ccef.org for more details.

CCEF Annual Conference

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June 23, 2008 · 1:00 pm

Last Practicum Monday: Christian counselors in a secular world


Today marks the end of the 2007-8 school year for our MA Counseling students. Some have completed their final credits and others are half-way to their diplomas but I’m sure all are glad the school year is over.

Our students here do fieldwork in a variety of settings: churches, christian private practices, nonprofit social services (hospice, pregnancy centers), and secular or state/federal financed mental health facilities. Those who work in secular settings are often faced with questions about their faith from colleagues and supervisors. Are they going to try to get their clients saved? Will they leave their faith at the door? And students struggle to know what to do with helping clients in some ways (new communication skills) but not being able to help them in deeper ways (putting trust in God during difficult times). Just how should Christians working in secular mental health agencies function? 

First, I very much believe that Christians should be in all aspects of society if they have any hopes of being salt and light in the world. Far too frequently we sequester ourselves from the world and then wonder why they persist in using caricatures of us.

So, if we are going to be in the world but not of it, how might we do it as counselors in a secular setting? I suggest 3 things to consider as we interact with supervisors/colleagues, clients, and our own self:

1. When dealing with an  Agency/Supervisor/Colleague

  • Get to know your context and its/their history with Christians and Christianity
  • When you hear slams or other suspicious questions be sure to explore the “back story” and validate, if appropriate, the bad experiences with naive or offensive behaviors by Christians
  • Discern who you might be able to have a reasonable conversation with regarding the nature of faith and psychology, philosophy of science, ethical care of people (including the exploration of their faith traditions), and the fact that all counseling is evangelistic to some construct of health). In this conversation be sure to using starting points that the other will understand (e.g., ethics, empirical evidence, concerns, etc.) just as St. Paul does at the Areopagus.
  • Communicate that you do not see your job as coercing anyone. You are not responsible for our clients behavior, neither are we for their beliefs. When we raise questions about faith it is to provoke their thinking a bit further

2. When dealing with clients

  • Be sure to ask early in clinical work about faith traditions, current practices, and experiences. These questions fit with what the AMA suggest as important for healing, as community and spiritual resources are quite powerful in the medical literature
  • When given an opening (e.g., questions about God, faith, etc.) pursue gently NOT with statements but questions that may reveal further beliefs, fears, wants, desires, demands, etc.
  • Further, ask how they came to believe what they do believe
  • Point out inconsistencies in belief/behavior; raise possibilities, pros/cons, potential places for hope that may lead to further discussion of God’s handiwork in their lives; Point out places where they seem to recognize their inability to love enough, tolerate enough (gently of course)
  • Be wary of the habit of “telling” others the truth. Many times clients already know the “right” answer. Exhortations may be useful at times but more often than not they cause individuals to become passive–even when they agree with your point.
  • Be ready to answer their questions about YOUR faith with honesty (e.g., what does belief in God look and feel like when everything is caving in?). Be sure not to sugarcoat the Christian life. Be ready to talk about your hope in a broken world (not just for eternity but for now)
  • And if you do talk about your faith, immediately turn it back to them for them to react, explore, challenge, etc.

3. To ourselves

  • Answer the following questions
    • Can I work with integrity within this system?
    • Is giving a “cup of cold water” (e.g., better communication skills) enough for right now?
    • Can I defend what I do say about the Christian faith in my sessions?
    • Am I giving the impression that I believe that there are many ways to God?
  • Develop a theology of mercy ministry akin to God’s providing rain, sun, and health to the just and unjust alike

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June 16, 2008 · 12:54 pm

Are counselors and psychologists an impaired lot?


We’re closing in on the last of the school year. Two weeks to go. Tonight in our ethics class we’ll be discussing the matter of abuse of power, impaired clinicians, and similar issues. In the world of counseling we discuss the problem of impaired counselors/students/trainees when we talk about those who,

(a) do not have the requisite skills, 
(b) have character/attitude deficits, or
(c) reactions to current crises,

AND are unwilling or unable to repair the situation.

First, we ought to be aware of those who are attracted to being counselors. Jeffery Barnett, et al, report the following data from other studies (as cited in the 2007 Professional Psychology: Research & Practice, 38(6), pp 603-612):

  • 70% of female psychologists had been either sexually or physically abused as children
  • 33% of male psychologists report the same
  • 33% of psychologists report being abused as adults
  • They feel the effects of these difficulties (and other family crises) just as non counselors
  • They may be less likely to get help due to knowledge and professional identity
    • 60% acknowledged being significantly depressed during some point of their career
    • 29% reported being suicidal at some point
    • 4% had made suicide attempts

Gizara & Forrest (2004 Professional Psychology: Research & Practice,35(1), pp 131-140) reported supervisors experiences of trainee impairment in APA accredited internships (doctoral level). Many of the supervisors had a hard time defining impairment in counseling but had sort of what I call the “I know it when I see it” mentality. What they often described were the disruptive, persistent relationalconflicts that are obvious to most. They did identify that it is hard for supervisors to address these matters because they (a) are trained to be empathic and to try to save everyone, and (b) not wanting to deal with conflict, destroy a career, or make oneself vulnerable to attack that they are holier than thou.

But, I noticed not much discussion or research regarding the one who doesn’t have obvious abrasive relational skills who is prone to using clients and others to make themselves feel good. This kind of person is dangerous not because they disrupt the counseling center but because they are so well liked that they make others overlook “minor” ethical infractions. Further, the person is rarely cognizant of their using others for their own sense of well-being.

To answer my question. No, I don’t think counselors are an impaired lot–at least any more than others. If we are aware of what drives us to be counselors (the good AND the self-serving), are willing to be counseled, discipled, held accountable, etc. (are willing to be transparent), and see our work as God’s first, then I think we are rather a safe lot.

Watch out for those of us who think we have arrived or no longer need teaching. I’m reminded of Aslan’s question to Prince Caspian at his coronation:

Aslan: Do you feel yourself sufficient to take up the kingship of Narnia?

Caspian: I-I don’t think I do sir. I’m only a kid.

Aslan: Good, If you had felt yourself sufficient, it would had been a proof that you were not.     

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June 9, 2008 · 11:43 am

Practicum/Ethics Monday: Multiple Relationships


All counseling ethics codes address the potential problem of multiple or dual relationships (when counselors have other relationships with their clients or former clients (e.g., counseling a friend or a child of a friend, having a former client as a business partner, etc.). Some codes make it appear that dual relationships are either always or likely wrong and so should be avoided. The AACC code is a bit more liberal in that it (rightly) defines the problem as increasing the problem of exploiting or harming the client. However, this code explicitly defends the biblical nature of dual relationships since we are all brothers and sisters of the same body. Other codes have recognized that it is not possible to always avoid dual relationships. But all codes remind the counselor that it is their duty to defend the healthiness of any dual relationship. In essence, it will be “guilty until proven innocent.”

There are 3 forms of dual relationships (sexual and client; nonsexual social and client; financial and client). Not every dual relationship is with the client (e.g., a counselor has a relationship with the mother of a teen client, a client is under discipline at your large church where you provide consultation to the elders). Dual relationships may happen AFTER counseling is over (begin a friendship with a former client). Finally, it is not merely harm or exploitation that may be the negative outcome of a dual relationship. A counselor may find that a dual relationship hinders or decreases her effectiveness to provide adequate care. [See Lamb et als article in the 2004 Professional Psychology: Research & Practice (35:3), pp 248-254 for a study on these issues].

This last one is the one I want to hang out with for a bit. I had a former client who I had known and highly respected before we started counseling. At the beginning we explored the potential harm that might come from this dual relationship. Both of us deemed that we could manage the slight dual relationship. And I think we did well and the client found the counseling helpful. However, there was a period in the counseling where the client became severely depressed and suicidal. I found myself less willing to hospitalize because I had an image of this client in my head that was much more stable than was actually true. Now, I never like or want to hospitalize. Most psych hospital stays provide protection but little more in the way of healing. But, I know I would have been much quicker to pull the trigger (bad pun I guess) if I hadn’t previously formed an opinion of health before starting the counseling relationship. We should not forget the possibility of reduced effectiveness in dual relationships.

Let me take this one step further. You may have a client who shares your same faith or doctrinal positions, graduated from the same school (but a different time). Any of these connections MIGHT cause you to be less effective in your work because of bias, groupthink, etc. These are not reasons to NOT counsel them but things to keep in mind. Reduced effectiveness because of dual relationships should not be neglected just because we are too busy talking about the rare counselor who decides to have sex with his clients.

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