Category Archives: counseling

May 12, 2014 · 12:58 pm

Counselors talking about themselves? Additional thoughts


Last week I described some research supporting counselor self-disclosures, research that suggests clients appreciate disclosures revealing (a) similarities between counselor and client, and (b) vulnerabilities or personal emotions. While this research flies in the face of conventional wisdom in most counselor training programs, I cautioned counselors to ask some questions first before talking too much about self. With this post, I would like to press the caution just a bit more.

Why do counselors talk about themselves?

Why do counselors talk about their personal life with clients? Read the following numbered list to see some of the main reasons (and the sub-points in italics as illustrations of that reason). Then, consider the bracketed sub point as an alternative to self-disclosure.

  1. We want to put clients at ease and we think knowing something about ourselves might help
    • I can see you are anxious about whether taking antidepressants is appropriate for faithful Christians. I take them and it has only helped my faith.
      • [You’re not alone with that question so let’s explore the pros and cons to taking an antidepressant. Why don’t you start by telling me the reasons you’ve heard or thought about for not taking Prozac?]
  2. We believe our personal history will help a client understand, accept, or challenge something about their struggle
    • I know this treatment for panic disorder is difficult for you but I can tell you it works. It worked for me.
  3. We want to please an inquiring client
    • Yes, I am married and I have 2 children.
      • [Sure, I don’t mind telling you who is in my family, but could you first tell me why that is an important question for you?]
  4. We want to earn their respect and believe that our history will help
    • Well, for starters, I want you to read my book. It is now in its second edition and has been translated into 4 languages. I think you will find it very helpful for your problem.
      • [I’d like for you to start reading about your problem. There are a couple of books out there that I think you might find helpful, including one I wrote. But, feel free to look these over on Amazon and choose the one that seems right for you.]
  5. We like talking about ourselves; our personal stories seem difficult to avoid
    • You and I have a lot in common. My wife has the same problems as your husband. So, I know how lonely you must feel. We’ve tried…
      • [Though you are not saying so, I wonder if you feel lonely in your marriage.]
  6. We see the relationship more like a friendship with mutual sharing
    • I’m so glad to see you today. You are a bright light in a dull day. I look forward to our stimulating conversations. Just yesterday I was thinking about you and wishing to have coffee with you to discuss your career future. 
  7. We want to be seen as human rather than just professional
    • Yes, it has been a stressful day. I could use a back rub after all these sessions today.
      • [You know, some days are harder than others, but I’m curious why you asked this today?]
  8. We want the client to help us in some way
    • I was thinking about your need to work and my need to have someone edit my website. Or, I’m headed out on a mission trip next month. Well, I am if I can get enough donations. I’m about $1000 short thus far but I know God will come through.
      • [neither of these need to be said!]

Is it necessary? Is it helpful?

While self-disclosures may improve client perceptions of counselors, I suspect that empathic, client-centered therapists evoke these same feelings by asking good questions making observant reflections yet still minimizing disclosures, especially those where we initiate them and those that force the conversation to our personal history. There are some disclosures that are in response to client questions (e.g., have you ever struggled with addictions? Are you married? Do you believe in medications? Are you angry with me?) that warrant an answer. When giving this answer, work hard at keeping it brief and returning to the client’s story.

Don’t forget about social media self-disclosures

Clients sometimes “hear” our disclosures through social media. Imagine a client reading, “Well, that was a difficult session, glad I’m done for the day” having been that counselor’s last appointment! Blogs (like this!), Twitter, Facebook, and Instagram can be forms of self-disclosure. Be wary of these. Conventional wisdom says to avoid social media contacts with most clients so as to avoid harm to the counseling relationship. While we need not require an outright ban of these connections, a thoughtful counselor will review connections via social media for potential harm.

Be human

Despite these efforts to avoid letting our selves intrude too far into the session, sometimes life gets in the way. A counselor has a health or a family crisis. Clients have ways of finding this out and often want to ask how things are going. Here it is appropriate to say something brief, thank them for their concern and then start the session. In other situations a client discovers a shared passion for food, a sporting team, a connection through mutual friends. Enjoy these connections, acknowledge them, but be sure not to linger there during the session proper. We are, after all human. Don’t be surprised when counselor and client humanness come into contact.

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May 9, 2014 · 10:36 am

Should therapists talk about themselves to clients? Surprising information


How do you feel when your counselor begins to self-disclose during a session? When they do, is it helpful or a lapse in their judgment?

This is a common conversation in counselor training programs. Generally, most models of counseling and therapy discourage counselor-self-disclosure; some models do so more than others. The reasons for discouraging counselor self-disclosure vary from breaking the unconscious projection (analytic) to just confusing clients because we change the subject from client to counselor.

But a recent article in the April 2014 Journal of Counseling Psychology, suggests that self-disclosure might actually help more than we think. Henretty, Currier, Berman, and Levitt completed a meta-analytic review of 53 studies examining counselor self-disclosure versus non disclosure. And “overall” they found that clients have favorable perceptions of disclosing counselors.

Why? It appears that when a client perceives great affinity/similarity with a counselor, they rate that counselor higher. Also, when a counselor reveals something difficult or painful (a vulnerability?), it makes them more human to their clients. Some examples of this negative valence might include, “when you said that, I felt really sad.” Or, “Let’s talk about your anxiety, having suffering with it some years ago, I suspect you…”

Not so fast!

So revealing similarities with clients and being human make clients feel more similar and possibly more understood. This makes sense. Client/Counselor matching seems to correlate with better outcomes. However, before counselors go talking about themselves they ought to consider a few things.

  1. Why am I doing this? Is what I have to say for them or really for me? (Too often, we speak to talk about self)
  2. Is what I say really going to keep my clients focused on themselves or distract them to my story?
  3. Am I sure that what I say will show similarity? The truth is that we *think* we have a similar story but the times we are sure we know what our clients are feeling we are most likely to stop listening and then miss the client.
  4. How often do I do it?

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April 29, 2014 · 12:39 pm

Urban trauma or bad kids?


Psychiatrist Michael Lyles gives an excellent presentation on the nature of urban trauma at the 2014 ABS Community of Practice. He points out how much of what gets labeled as uncaring violence is better seen through the lens of urban trauma reactions. In addition, he discusses the response of the church. Not to be missed!

Michael Lyles – COP 2014 from American Bible Society on Vimeo.

After his presentation, Police chaplain and urban pastor Rev. Luis Centano gave this response regarding trauma in the city of Philadelphia.

Rev. Luis Centeno – COP 2014 from American Bible Society on Vimeo.

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April 16, 2014 · 1:10 pm

New Pennsylvania Mandated Reporting Bills Signed Into Law


My local newspaper informs me that Governor Corbett signed into law HB 431 436 and SB 21 and 33 into law today. The paper reports what this means:

“Senate Bill 21 ensures that virtually anyone who works with children in a professional or volunteer capacity, including school personnel, personnel at colleges and universities, youth sports coaches, child care providers, religious leaders, physicians and other health care workers, social services workers, law enforcement officers, librarians, emergency medical service providers and employees and independent contractors for each of those entities are required to report suspected child abuse.

“House Bill 436,” Stephens continued, “adds attorneys for organizations caring for children to this list of reporters, while preserving the attorney client privilege, bringing Pennsylvania in line with a majority of states across the U.S.”

So, anyone who works with or volunteers with children is now considered a mandatory reporter. Attorneys who work for those organizations who serve children cannot keep quiet when child abuse is reported to them. Mental health and other health professionals continue to be mandated reporters when potentially abused children present to them or their colleagues.

Besides expanding who is mandated to report suspected child abuse, HB431 also now requires evidence of 3 hours of training on child abuse recognition and reporting for all seeking PA licenses AND evidence of 2 hours of continuing education on the same subject for all who seek to renew their PA licenses. 30 CE hours are still the minimum required per licensing period, but now 2 of those 30 must be about child abuse recognition and reporting. Not sure if that means the existing mandate to take at least 3 hours in ethics will be on top of the 2 for child abuse reporting or if the 2 for child abuse reporting will count towards the 3 in ethics.

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April 15, 2014 · 5:59 am

Comparing ACA and AACC ethics codes: Multiple Relationships


Continuing our review of the ACA and the AACC codes for counselors, let’s take a look at how both codes address the matter of multiple or dual relationships. (See first and second posts about comparing the ACA and AACC code of ethics for counselors and mental health professionals.)

Multiple or dual relationships between counselor and client (or client’s family) are those that combine the professional relationship with one of another sort. If a counselor of a client is also that client’s pastor, that would be a multiple relationship. Other types could combine counselor and friend, counselor and business partner, counselor and employer, and increasingly possible, counselor and social media “friend.” Both codes are concerned about the formation of dual relationships because they become fertile ground for counselor judgment bias and harm to the client. Both see that once a counseling relationship has been formed, that relationship ought to be clear take priority over all others.

The ACA code of ethics prohibits outright the following dual relationships:

  1. Counselor and sexual partner: Counselors may not have sex with clients or their family members
  2. Counselors may not start counseling work with former sexual partners
  3. Counselors must wait at least 5 years before engaging in sexual activity with former clients (and even then may be prohibited)
  4. Counselors may not provide services to friends and family
  5. Counselors are prohibited from engaging in personal virtual relationships (social media) with current clients

Beyond the sexual arena, the ACA code warns counselors to avoid dual relationships or “extending the boundary” of the counselor or supervisor relationship

Counselors avoid entering into nonprofessional relationships with former clients, their romantic partners, or their family members when the interaction is potentially harmful to the client. This applies to both in-person and electronic interactions or relationships. (A.6.e)

When a counselor agrees to provide counseling services to two or more persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person. If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from roles appropriately. (A.8)

So, notice the focus: avoid “extending the boundary” or what we used to call forming multiple relationships with current or former counselees or their family members. Document when you do so to illustrate informed consent, limiting of potential harm, and efforts made to rectify harm when it unintentionally happens

What about the AACC code?  It begins (ES1-140) with these paragraphs,

Dual relationships involve the breakdown of proper professional or ministerial boundaries. A dual relationship exists when two or more roles are mixed in a manner that can harm the counseling relationship and/or the therapeutic process. This includes counseling, as well as personal, fraternal, business, financial, or sexual and romantic relationships. Not all dual relationships are necessarily unethical—it is client exploitation that is wrong, not the dual relationship in and of itself. However, it remains the responsibility of the counselor to monitor and evaluate any potential harm to clients. (emphasis mine)

While in a counseling relationship, or when counseling relationships become imminent, or for an appropriate time after the termination of counseling, Christian counselors do not engage in dual relationships with clients. Some dual relationships are always avoided—sexual or romantic relations, and counseling close friends, family members, employees, business partners/associates or supervisees. Other dual relationships should be presumed as potentially troublesome and avoided wherever possible. (emphasis mine)

The AACC code then prohibits counseling relationships with family and close friends and warns against those “best avoided” (e.g., business associates, club members, etc.). Finally the code addresses counseling relationships within the church,

Christian counselors do not provide counseling to fellow church members with whom they have close personal, business, or shared ministry relations. Dual relationships with any other church members who are clients are potentially troublesome and best avoided, otherwise requiring justification. Pastors and church staff helpers should take all reasonable precautions to limit the adverse impact of any dual relationships. (ES-140-f)

This wording marks a change from the previous AACC code where dual relationships were more positively addressed. The old rule stated this, “Based on an absolute application that harms membership bonds in the Body of Christ, we oppose the ethical-legal view that all dual relationships are per se harmful and therefore invalid on their face.  Many dual relations are wrong and indefensible, but some dual relationships are worthwhile and defensible.”

Agreements? Disagreements? Both codes ban the ending of counseling relationships for the purpose of changing the professional relationship to different relationship, or to engage in sexual activity with a client or a member of the client’s family. The AACC codes requires 3 years before marrying a former client (assuming all other concerns raised are not an issue) whereas the ACA code requires 5 years before engaging in an intimate relationship. The ACA code as extensive concerns about the teacher/student relationship as well as the supervisor/supervisee relationship. The AACC code says little about these (though some can be inferred). The biggest difference, however, is found in the stronger language banning dual relationships in the ACA code where the AACC code warns against possible harm but leaves the door open as long as the counselor knows they have to prove no harm happened and informed consent.

 

 

 

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April 14, 2014 · 11:20 am

Free CEs! faith and trauma in the public sphere


On April 23, 2014, I will be the keynote speaker for the 8th annual Faith & Spiritual Affairs Conference put on the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). The conference theme: Trauma and Healing: Faith Communities Respond. My particular talk is geared to illustrate the necessity of engaging the faith community in trauma recovery efforts. Trauma almost always challenges a person’s faith and when mental health professionals do not pay attention to spiritual matters, treatment will likely stall. I will highlight several faith founded trauma recovery interventions being used today in church settings. 

The conference is free to all who register. But registrations are limited. Held at the Philadelphia Convention center. The breakout speakers list includes the Director of Place of Refuge, Dr. Elizabeth Hernandez.

To register click here. NOTE: enter fsac2014 as the redemption code to get into the conference website. CEs provided for SW and PC. Biblical Seminary, an NBCC approved provider, is the co-sponsor to offer counseling CEs. Other CE providers offering CEs as well.

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April 11, 2014 · 10:48 am

New Ethics Codes for Counselors


Both the American Counseling Association (ACA) and the American Association of Christian Counselors (AACC) have published 2014 editions of their codes of ethics (links above to pdf of codes). Given these new documents, I highly encourage all Christian counselors (both professional and pastoral/lay) to review these two codes. Even if you do not belong to either the ACA or the AACC, you should spend some time with these documents. Here’s why:

  • The codes represent the current thinking of the ACA and the AACC about best practices for counselors. Even if you disagree, you need to know where you diverge (both for integrity sake with clients and for protection from unnecessary risk)
  • It is easy to become sloppy about ethical matters. We tend to believe what we do is good. Reviewing our practice habits against a standard can reveal slippage
  • It can be helpful to clients to know what code of ethics you subscribe to. Reading codes can help you determine which code you subscribe to and your reasons for doing so

Comparing Values and Principles

The following chart shows similarities and differences regarding the bases for ethics codes. It is worth reviewing these to see how they compare and contrast. In the next post, I will compare a few specific standards.

Content AACC ACA
Mission 1. help advance the central mission of the AACC—to bring honor to Jesus Christ and promote excellence and unity in Christian counseling;

2. promote the welfare and protect the dignity and fundamental rights of all individuals, families, groups, churches, schools, agencies, ministries, and other organizations with whom Christian counselors work;

3. provide standards of ethical conduct in Christian counseling that are to be advocated and applied by the AACC and the IBCC, and are respected by other professionals and institutions; and

4. provide an ethical framework from which to work in order to assure the dignity and care of every individual who seeks and receives services.

 1. enhancing human development throughout the life span;

2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts;

3. promoting social justice;

4. safeguarding the integrity of the counselor–client relationship; and

5. practicing in a competent and ethical manner.
Principles Compassion in Christian Counseling – A Call to Servanthood Competence in Christian Counseling – A Call to ExcellenceConsent in Christian Counseling – A Call to Integrity

Confidentiality in Christian Counseling – A Call to Trustworthiness

Cultural Regard in Christian Counseling – A Call to Dignity

Case Management in Christian Counseling – A Call to Soundness

Collegiality in Christian Counseling – A Call to Relationship

Community Presence in Christian Counseling – A Call to Humility

 autonomy, or fostering the right to control the direction of one’s life;nonmaleficence, or avoiding actions that cause harm;beneficence, or working for the good of the individual and society by promoting mental health and well-being;justice, or treating individuals equitably and fostering fairness and equality;

fidelity, or honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in professional relationships; and

veracity, or dealing truthfully with individuals with whom counselors come into professional contact.

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April 1, 2014 · 8:33 am

GTRI featured in an online, free journal


Our Global Trauma Recovery Institute is featured in the most recent issue of the EMCAPP Journal for Christian Psychology Around the World. Pages 172-211 include an overview of GTRI, two essays by Diane Langberg (The Role of Christ in Psychology; Living to Trauma Memories) and one by me (Telling Trauma Stories: What Helps, What Hurts).

The journal also contains an essay by Edward Welch (www.ccef.org) where he muses his development as a biblical counselor, explores the matter of emotions and some of the stereotypes of biblical counseling. The journal also includes a large number of essays about Paul Vitz as well as a number about the Society of christian Psychology.

Take a look!

 

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March 19, 2014 · 10:11 am

Mapping urban domestic trauma


Our community of practice continues with a presentation by Michael Lyles, MD who presented on the problem of trauma in urban settings. [Watch his talk here] He pointed out how we often think about violence and the connection with trauma in international settings but fail to connect the two in American urban settings. We see angry young men and women who seem calloused and do not value life. Yet, often what is happening is that we have hypervigilant individuals who choose to manage their trauma reactions by being alert and on edge and ready to attack before being attacked. When you bring together poverty, violence and a traumatized population, you develop a chronically traumatized person, meeting most criteria for PTSD but never getting diagnosed.

One study mentioned a few statistics about violence prevalence. 55% of urban children have experienced sexual abuse (compare that to about 15% of US population); 39% have witnessed domestic violence. 27% experienced physical abuse.

To highlight the problem he pointed out a 2o12 Philly Magazine report on trauma in our city. Between 2001 and 2012, more than 18,000 people were shot. During that time some 3800 murders. He noted that suicide rates run about 20% and that number goes even higher when you include “academic suicide”–dropping out of life. In addition, he pointed to the connections between trauma and adrenal overload, hypertension, diabetes, and other physical illness. He also pointed to the scarring that takes place in the amygdala.

He noted a good book to consider: John Rich, MD (Drexel University) Wrong Place, Wrong Time: Trauma and Violence in Lives of Young Black Men.

He ended his presentation considering the role of “Chief Musician” as found in the Psalms. These are folks who listen to the story, don’t debate it, set it to words/music that are appropriate.

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March 11, 2014 · 6:33 am

How does small-time tyranny last?


Tyrants use fear to control subjects. Thus, we understand how North Korean leader Kim Jong Un is elected by 100% of his constituency. To abstain or cast any other vote would be suicide. But since most do not live under such oppression we may wonder how individuals cave to lower-level tyranny here in democracies or locations where we have choice about who we vote for and where we live and work. Why do organizations allow dictatorial leadership? Can’t we all just walk away?

Thanks to one of my students, Dan McCurdy, I pass on this recording from This American Life about a “small-time” tyrant in an upstate New York school district. The story is about the dictatorial dealings of a facilities manager of the school district–not of a principal, teacher, or even a school board member.

How is it possible for one with so little power (so we would normally assume) could wield such power over employees? How could he set off bombs, fire individuals, vandalize homes, threaten others with harm, simulate sex, and more without getting fired?

How? It is simple. He was,

surrounded above and below, by people who looked the other way. (near the end of the above recording)

Why do we look the other way?

We look away for all sorts of reasons. Consider a few of them:

  • Fear that no one will come to our defense if we stand up to abuses (which of course will be true if no one else sees or responds)
  • Need to protect what we have (e.g., position, income, career, reputation, etc.)
  • Cover up own failings (e.g., if he goes down…I will go down)
  • Perceive benefits outweigh consequences (i.e., in this case, school board received lowered energy costs, fewer worker complaints)
  • The people who complain of injustice matter little to us
  • Believe psychological abuse does not really happen

In Anjan Sundaram’s Stringer, he describes the most powerful of dictators are ones who instill fear when present and yet also instill fear of what life might be when that person is gone.

What to do?

When we hear of crazy stories such as the one in the recording, we shake our head and imagine ourselves standing up to power, standing up for the little guy. Too often our imagination never see the light of day. So, how can we keep ourselves sensitized to injustice and ready to act for the good of the weakest community member?

  • Identify our current fears. Who has power over us? What does love and grace look like when responding to this power?
  • Identify places we have chosen safety over truth. Who can help us rectify this problem?
  • Identify those places where we have power over others. Who do we have power over? How do we wield it? Who has God-given us the responsibility to protect? Where do we need to give power back (when taken or used inappropriately)?
  • Fix eyes on how Jesus uses power. How does he wield it with those who have the most power? The least power?
  • Identify habits of cover-up. Where, for reasons of shame, guilt, or comfort do we cover up and present self as someone we are not?

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