Category Archives: Psychology

June 14, 2011 · 2:49 pm

Competing Models of Christian Counseling? Who is Right?


A couple of recent pieces have me thinking about (a) models of Christian counseling and, (b) the intramural conversation amongst Christians on which model is most Christian. One piece is David Powlison’s article in the Summer 2011 issue of the Westminster Today magazine (this link is to the magazine site but the current issue is not yet up). The second is by Ed Welch–a blog on Biblical Counseling Coalition website.

This is not a new topic for me. From my “About Me” page you can see that I have training in biblical counseling and also in clinical psychology. I respect the folks at CCEF who had a huge impact on my life and thought–especially that lovely editor they employ ;). While getting my PsyD I published on the historic divide between biblical counselors and Christian psychologists and the need to build bridges. I’m an associate editor for Edification, a Christian Psychology peer-reviewed journal.

All that to say, I have some thoughts on some ways we might move beyond right/wrong while still being concerned about building a clear, cogent, God-honoring model of Christian counseling.

Drop the labels

Yes, we should drop our labels. What is the difference between a Christian counselor, Christian psychologist, integrationist, or biblical counselor? These differences are as varied as the numbers of people who use them. Yes, there are probably some benefits to communicating a personal stance with one of these terms. But, for every benefit, there are probably any number of negatives, including the use of the label as a curse. “Are you that kind of biblical counselor” (whatever kind you find offensive)? “Are you a Christian who happens to be a psychologist or a Christian psychologist?”

In addition to dropping labels, we should also drop broad brush judgments. Calling Christian psychologists “syncretistic” is offensive and ill-fitting. Calling biblical counselors “psychology bashers” does not accurately portray their nuanced approach. Saying that psychology and biblical counseling is “fundamentally incompatible” (from either side of the debate) ignores the benefits that both sides gather from each other.

No labels? What then?

Facets. I’m sure there going to be problems with this idea too but let us choose to focus on facets of counseling models. For example:

  • How does Scripture shape counseling foundations and goals?
  • How do we learn from, utilize, and critique psychological constructs, data, etc?
  • How does typical human development trajectories influence our understanding of the change process?
  • How do we learn from those who do not share our epistemic foundations?
  • How do we articulate diverse counseling goals (suffering well? symptom reduction? discipleship? skill acquisition? insight?) as all working toward the common goal of glorying God and enjoying him forever.

Listen first, repent first

In Ed’s blog post (linked above on the BCC site), he captures the most essential characteristic needed if we are going to learn from each other. We ought to,

listen and enter into the world of the other person (or in this case the other counseling perspective) in such a way that the person representing the perspective says, “Yes, that’s me. You understand.”

It is a sad thing that we counselor types start with diagnosing other model builders without listening first to both the content of that model and the person behind it. We treat our fellow counselors in ways we would never treat a client. How should we listen to others? Can we see what they see? Can we see what they see that we tend to ignore? Can we see the benefits of what they do and the potential liabilities they see in our model?

Be willing to repent where you have unfairly labeled, categorized, and marginalized one who was working for Christ’s kingdom–even if you think you have been hurt more.

List own weaknesses first

Most debates, whether between thinkers or spouses, rarely succeed in winning over the other person. Why? Because we are too busy defending, explaining away, pointing out the weaknesses of the opponent to actually deal with reality.

Wouldn’t it be refreshing to hear a counseling model builder express his/her models weaknesses or needed growth points first before exploring the deficits of the another? “My model doesn’t yet have a good understanding of ____. Your model does so much better with that and I want to learn from you.”

Build the center

Rather than start with the differences (which do indeed exist), what if we cataloged the similarities and areas of agreement among Christian models of counseling? In addition, what if we recognized those things we might not have noticed with out the help of those outside our own community. For example, Scripture may speak a great deal about loving neighbors but a particular model of psychology may flesh out what loving a very unique population of client ought to look like. Even if Scripture is sufficient, we do not diminish it when we acknowledge we hadn’t made a particular application without our neighbor’s help.

Acknowledge differences

We will not see eye to eye. We will disagree. Let us acknowledge these where they arise. Let us make sure the differences are real and categorize them into those that are peripheral and those that are substantial. For example, David Powlison speaks about the need for a counseling/care for the soul model back in the 1950s. Despite quality practical theology and discipleship programs, he asked,

But what was the quality [in the 50s] of corporate wisdom in comprehending the dynamics of the human heart? What sustains sufferers and converts sinners? Westminster Today, 4:1 (2011), p7

Right away I ask myself, are these the only two options (sustaining, converting) for Christian counselors? Is it possible also to have the role of treating symptoms? Teaching skills? Reducing suffering? I’m fairly sure that this initial difference is not really there. I suspect David does not reject mercy ministry to reducing suffering. But in dialog, he and I might end up agreeing that some biblical counseling models fail to focus on skill intervention in their quest to address the human heart. And we would likely agree that some christian psychology models fail to address the spiritual discipline of suffering well and the need for conversion. Might we end up agreeing that we want a full-orbed model that neither diminishes nor over-promises symptom care or sanctification?

Promote each other

Finally, we do well to promote each other at our conferences and learning communities. We encourage wide-ranging reading, critical interactions (note, not criticizing), and sharpening of each other. And we commit to lovingly correcting those of our “friends” who speak ill about our neighbors. We reject the fear of defending an outsider for fear of being rejected ourselves. 

 

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May 14, 2011 · 11:53 am

Lithium in your water? Might it be beneficial?


Here’s an interesting finding. A research team compared the top ten lithium-enriched regions of Austria (areas with naturally occurring lithium in the water) to the top ten lithium depleted regions of the same country. Those regions with greater naturally occurring lithium levels had statistically fewer suicides than those regions that had low naturally occurring lithium. The research does not prove a causal link between suicide levels and lithium levels in the water. It could be that there are better treatments or facilities in those regions. But, it does give you pause.

Lithium is, you may recall, a salt which is used to treat affective disorders like bipolar disorder. For many years doctors considered it the gold standard treatment. Many still do even though compounds like Wellbutrin and some anti-psychotics are also used to treat bipolar disorder.

While NO ONE is considering prophylactic use of Lithium (like we do now with fluoride in the water), this research does beg the question: at what point would preventative Lithium be appropriate? In other words, how many lives would need to be saved to make it something that we would want to give to everyone? Or, should we only give it to those who are deemed at-risk?

Assume for a moment that the cause for the lower suicide rate is the presence of Lithium in the water. Further assume that the research data is accurate in finding that the suicide rate in the Lithium enriched areas is 11:100,000 while the suicide rate in the depleted area is 16:100,000. I doubt that anyone would promote public distribution in order to save 5:100,000 but I do wonder what the number would need to be before anyone would recommend blanket addition to the water supply.

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May 6, 2011 · 12:45 pm

Guest post/article on www.christianpsych.org


For those interested in Christian psychology and its future, you can read a short essay I wrote on the topic here

Check out the site for other interesting blog entries. It shows the diversity of ideas and interests in the field.

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March 31, 2011 · 5:01 am

Are you a delay discounter?


Delay discounting is a term coined by those researching various types of impulsivity: risky behaviors, ADHD, gambling, obesity, etc. In appears that people may be inclined to one form of delay discounting over another. And monetary delay discounting is predictive of a number of serious problems (e.g., obesity, willingness to share needles with other drug users, sexual acting out).

One researcher defined delay discounting as a,

preference for smaller, immediate rewards over larger, delayed rewards.

It can also be used to explain why I say yes to things long in the future without adequately counting the cost. I jump at the impulse to do something fun or interesting without adequately evaluating just how much work is involved. What is interesting is that many of us “delay discounters” fail to learn from our experiences. I’d like to think I can learn from mistakes and sometimes we do…for a short-time. But memory for the pain of saying yes fades and then I’m back saying yes without fully counting the cost.

How about you? Are you a delay discounter? What entices you to discount the cost?

Feel free to respond but I won’t be able to get back to you…I’m off to an academic presentation in Indianapolis that I agreed to 9 months ago, something I signed up for without thinking fully about the timing in the semester.

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March 8, 2011 · 5:58 am

How many patients can you see in a day?


Ask a counselor and you might hear of one who has seen 10 clients in a day…10 hours of therapy. I suppose I”ve done as many as 12 or 13 but that was a rare case and likely some emergency.

What about seeing 40… in one day!?

That is what some psychiatrists do. Of course, to do that many, most patients are seen only for 15 minute med checks rather than the 90 minute first session for first-time patients. Psychiatrists used to be the primary therapists. But with the advent of psychiatric medicines,  many psychiatrists no longer do therapy and only make diagnoses and prescribe/manage medicines. For an interesting view from the psychiatrist’s chair, check out this NY Times article interacting with a local psychiatrist who has worked through the transition from therapist to med manager.  See how he tries to not get too involved with patient problems given that he hasn’t the time to do much on the fixing end.

There are only two reasons why anyone would see so many clients in one day

1. Economics. More volume, more money. Plain and simple.

2. Demand. Good psychiatrists are hard to come by. Even more true if you are talking about child psychiatry! If you find a good one, chances are you have to get in line.

Now, before anyone thinks I’m taking shots at psychiatrists, let me tell you I am not. A good psychiatrist is a very helpful aid to us psychologists. Family Docs and other general practitioners may be able to prescribe but I find psychiatrists (good ones!) really know their compounds and are much better at titrating doses. And not all of them just throw pills at the problem. Even in short interactions, the psychiatrist to whom I refer has been able to help my clients understand themselves just a bit better.

Back to the original question: just how many different people can you meet with in a day and still be attentive? When I started out counseling, I could barely see two people in a row before being overwhelmed. Now, I regularly see 8-10 on a day (okay, I only do this one day per week, but before becoming a prof I did 25-30 per week). I can attest that it is a learned skill and I don’t think the last client gets less of me than the first. That said, there is a limit and a point at which what I do suffers.

What is your patient/client limit?

For me, it is less about the number of sessions and more about whether I eat and have a moment to go to the bathroom. There’s nothing that kills the focus as much as a bursting bladder and 45 minutes to go!

I’ll leave you with a funny story. At a doctoral practicum I saw clients late into the evening. My last client of the evening (same person each week) had a habit of bringing me Starbucks coffee. I think he was trying to make sure he was going to get his money’s worth out of me!

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March 2, 2011 · 5:17 am

What causes mental illness and do you have any choice?


The common medical assumption is that mental illness is the result of multi-faceted vulnerabilities in combination with stressors. A person may have some vulnerability markers but those alone are not likely to result in mental illness without biologic, social, or environmental stressors “turning on” the markers.

If you want to see this model in action, you should watch a most troubling episode of “Independent Lens” on your local PBS channel. It aired in Philadelphia last night. You can find more about the episode here on their website and watch clips of the show.

The hour long episode follows a 16 year old girl, Cyntoia, facing life for murder. You will see extended conversation with the girl, her adoptive mother, her biological mother (who she never really related to). Her bio mother drank throughout her pregnancy, smoked crack and prostituted herself. Cyntoia was being prostituted and was at a “john’s” house when she shot him thinking he was going to kill her.

You can see that Cyntoia probably meets criteria for Borderline Personality Disorder. Watch her mother for a bit and you can see that she comes by it quite naturally. They both have a similar pattern of speech and attitude. There is a long history of suicide and paranoia in the extended family. Very interesting to see how this young woman talks to the forensic psychiatrist.

Choices?

Watch and wonder how Cyntoia could have avoided her predicament. She started out with poor genes, alcohol exposure and poor attachment opportunities. She lists 36 people she had sex with (she felt obligated to have sex with those who wanted her). The issues are legion.

Even more brutal is to watch the interviews with her adoptive mother who is trying to wrap her head around the facts that come out during the investigation. Watch also how Cyntoia talks about her and to her. Notice that there is love.

Very rarely would you get this kind of information from 3 generations of rape and sexual abuse (and adoptive mother’s story).

Watch the episode and consider this question: just how much choice do some people have? Even with her incredible insights (e.g., “everybody wants admiration, everybody wants to be desired. That is my **** problem too.”), this young woman had 3 strikes against her.

The truth is we often believe people have easy choices to avoid trouble. Cyntoia’s story reminds us that trouble begins generations before some people are conceived.And even when we acknowledge that Cyntoia could have made choices to tell adults about her abuse or to escape her pimp, we are left with the gnawing question, would we have made any different choice if in her place? For the record, I am a firm believer in that we do have choices to make. But some have a whole lot more than others and the roadsigns to better choices are bigger for some of us than others.

Challenging story which also pulls on your vision of redemption, restoration and appropriate punishment for minors who commit murder.

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Filed under Abuse, addiction, cultural apologetics, Psychology, stories, suffering

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February 25, 2011 · 11:09 am

Strengths profile


I’m advising one of our DMin students on his dissertation. He is researching how the use of Gallup’s Strengthfinders assessments and some training materials from World Harvest Mission might help build better functioning ministry teams.

This is my first time getting to see how the Strengthfinders works. So, Drew, the student, gave me the assessment. This tool returns the top five strengths themes (out of 34) based on my answers to the questions on the test. Here is my Gallup profile (in order of strength) with a few descriptive sentences:

Relator

Relator describes your attitude toward your relationships. In simple terms, the Relator theme pulls you toward people you already know. You do not necessarily shy away from meeting new people—in fact, you may have other themes that cause you to enjoy the thrill of turning strangers into friends—but you do derive a great deal of pleasure and strength from being around your close friends. You are comfortable with intimacy. Once the initial connection has been made, you deliberately encourage a deepening of the relationship. You want to understand their feelings, their goals, their fears, and their dreams; and you want them to understand yours. For you a relationship has value only if it is genuine.

Individualization

Your Individualization theme leads you to be intrigued by the unique qualities of each person. You are impatient with generalizations or “types” because you don’t want to obscure what is special and distinct about each person. Instead, you focus on the differences between individuals. You instinctively observe each person’s style, each person’s motivation, how each thinks, and how each builds relationships. You hear the one-of-a-kind stories in each person’s life. Because you are such a keen observer of other people’s strengths, you can draw out the best in each person. This Individualization theme also helps you build productive teams. While some search around for the perfect team “structure” or “process,” you know instinctively that the secret to great teams is casting by individual strengths so that everyone can do a lot of what they do well.

Strategic

The Strategic theme enables you to sort through the clutter and find the best route. It is not a skill that can be taught. It is a distinct way of thinking, a special perspective on the world at large. This perspective allows you to see patterns where others simply see complexity. Mindful of these patterns, you play out alternative scenarios, always asking, “What if this happened? Okay, well what if this happened?” This recurring question helps you see around the next corner. There you can evaluate accurately the potential obstacles. Guided by where you see each path leading, you start to make selections. You discard the paths that lead nowhere. You discard the paths that lead straight into resistance. You discard the paths that lead into a fog of confusion. You cull and make selections until you arrive at the chosen path—your strategy. Armed with your strategy, you strike forward. This is your Strategic theme at work: “What if?” Select. Strike.

Intellection

You like to think. You like mental activity. You like exercising the “muscles” of your brain, stretching them in multiple directions. This need for mental activity may be focused; for example, you may be trying to solve a problem or develop an idea or understand another person’s feelings. The exact focus will depend on your other strengths. On the other hand, this mental activity may very well lack focus. The theme of Intellection does not dictate what you are thinking about; it simply describes that you like to think. You are the kind of person who enjoys your time alone because it is your time for musing and reflection. You are introspective. In a sense you are your own best companion, as you pose yourself questions and try out answers on yourself to see how they sound. This introspection may lead you to a slight sense of discontent as you compare what you are actually doing with all the thoughts and ideas that your mind conceives. Or this introspection may tend toward more pragmatic matters such as the events of the day or a conversation that you plan to have later. Wherever it leads you, this mental hum is one of the constants of your life.

Learner

You love to learn. The subject matter that interests you most will be determined by your other themes and experiences, but whatever the subject, you will always be drawn to the process of learning. The process, more than the content or the result, is especially exciting for you. You are energized by the steady and deliberate journey from ignorance to competence. The thrill of the first few facts, the early efforts to recite or practice what you have learned, the growing confidence of a skill mastered—this is the process that entices you. Your excitement leads you to engage in adult learning experiences—yoga or piano lessons or graduate classes. It enables you to thrive in dynamic work environments where you are asked to take on short project assignments and are expected to learn a lot about the new subject matter in a short period of time and then move on to the next one. This Learner theme does not necessarily mean that you seek to become the subject matter expert, or that you are striving for the respect that accompanies a professional or academic credential. The outcome of the learning is less significant than the “getting there.”

Pretty good description I think…I like to relate to a small group of people. I like getting deep with a few. I enjoy the work of seeing the individual differences of friends, staff, clients, etc. I’m pretty good at getting a plan of action going right away. I’m not so good at carrying it out because I love to think and learn and so new information is always available and since I like to think about a wide diversity of things, it can be hard to stay focused on any one thing for too long. 

What I like about this particular tool is that it looks at a variety of strengths rather than personality traits.

Anybody have experience with this tool?

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February 22, 2011 · 11:47 am

One treatment protocol for many DSM diagnoses?


Could we devise one mental health treatment for many counseling problems? Given that so many problems have similar symptoms (anxiety, mood dysregulation, vigilance, intrusive and unwanted thoughts, etc.) and appear to involve common neurobiological processes (limbic systems), might we be able to find a single treatment for multiple expressions of problems?

David Barlow and others say yes.

The Renfrew Center (an eating disorder clinic) publishes Perspectives: A Professional Journal of the Renfrew Center Foundation, a free journal. In their Winter 2011 issue they have a brief article by David Barlow and Christina Boisseau about a new “transdiagnostic unified treatment protocol” (UP) that can be applied to all anxiety and depressive (and eating) disorders. Let me summarize a few points from the article:

  • 70 to 80% of clients with eating disorders also have anxiety disorders, 50% meet criteria for depression
  • A number of anxiety and depressive disorders have emotional dysregulation as a central theme
  • Etiology of these diagnoses may be best accounted for by “triple vulnerability theory”: biological vulnerability to negative mood…early negative childhood experiences due to attachment issues or unpredictable environment leading to an elevated sympathetic nervous system…and psychological learning from an event focusing on a particular issue (anxiety, panic, observation of parent’s panic, etc.)
  • The Unified Protocol (UP) focuses on “the way that individuals with emotional disorders experience and respond to their emotions” (p. 3). UP consists of 5 core modules
    • emotional awareness training (focus on “nonjudgmental present-focused awareness”)
    • cognitive reappraisal (“identifying and subsequently challenging core cognitive themes”)
    • emotion driven behaviors (EDB) and emotional avoidance (identifying maladaptive EDBs, learn new responses and avoid avoiding emotions)
    • awareness and tolerance of physical sensations (self-explanatory…as they relate to emotions)
    • emotion exposure (“…goal is to help patients experience emotions fully and reduce the avoidance that has served to maintain their disorders(s)”)
  • These modules are flexible and shaped to the individual needs of the client

Obviously, there is much work to be done to validate this protocol but it makes sense. You can see the CBT foundation but also a greater focus on emotion rather than cognition.

Those interested in the full text and references can find it here!

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February 16, 2011 · 9:57 am

More on Narcissism


Hadn’t read my Monitor on Psychology (Feb 2011 edition) til this morning and saw that the cover story is on the possible rise of narcissism in young folk these days. Now, this magazine is popular and doesn’t go too deep into reporting on research…and I haven’t followed up on the studies to read them for myself, but…

  • one study has 80% of middle school students scoring higher on self-esteem in ’06 than ’88
  • Another shows an increase in the lifetime prevalence of NPD
  • However, no nationally representative samples comparisons have been done to really shed light on whether a rise is truly taking place
  • One meta study of 85 studies (between ’82 and ’06) suggests an increase of narcissism among college students

The article goes on to muse about whether materialism and social networking lead the way toward narcissism but also wonders whether the decrease in availability to easy credit will lower the self-promoting trend a bit.

In an ironic twist, it appears that the DSM 5 may not include NPD as a diagnosis. Rather. It will include a more general diagnosis (see below taken from the DSM5.0rg site). Strangely, one of the “types” is NOT narcissism.

The essential features of a personality disorder are impairments in identity and sense of self and in the capacity for effective interpersonal functioning. To diagnose a personality disorder, the impairments must meet all of the following criteria:

A.    A rating of mild impairment or greater in self and interpersonal functioning on the Levels of Personality Functioning.

B.    Associated with a “good match” or “very good match” to a personality disorder type or with a rating of “quite a bit like the trait” or “extremely like the trait” on one or more personality trait domains.

C.    Relatively stable across time and consistent across situations.

D.    Not better understood as a norm within an individual’s dominant culture.

E.    Not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

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February 9, 2011 · 5:57 am

Sex Offender Residential Treatment Programs?


After I posted earlier this week about resources for the church to use in caring for sex offenders in the congregation, I got a call asking if I knew of any residential sex offender treatment programs for those having been convicted of a sex crime.

Let me pose this question to readers:

1. Do you know of any quality residential offender treatment programs for post incarceration? Programs would need to accept voluntary admission clients.

2. Do you know of any Christian versions?

Most Christian programs focus on sexual addictions and all that I know of do not accept individuals with felony convictions (usually due to zoning restrictions set up by the community).

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