Category Archives: Psychology

January 18, 2011 · 7:48 pm

Adult Asperger’s?


DSM-IV-TR, the current DSM edition

Image via Wikipedia

In last night’s Psychopathology class I was discussing the significant changes throughout the history and editions of the Diagnostic & Statistical Manual (I-VI), especially in regard to the growth of mental health diagnoses. That led us to talk about a couple of diagnoses, once added, that have become “popular.” By popular I don’t mean en vogue or fun or the like. What I mean is that there has been a significant increase in the usage of that diagnosis.

What diagnosis? Asperger’s Syndrome.

Why? Some feel it is because the diagnosis is known and now those who went undiagnosed now are more likely to receive a correct diagnosis. Others feel that therapists are over diagnosing–lumping in every kid who has any hint of a social quirk.

It will be interesting to see what happens to the numbers being diagnosed when DSM5 comes out (2013?) and Asperger’s is subsumed into a generic Autistic Spectrum Disorder. I’d be willing to bet that fewer people will get the diagnosis because of stigma alone.

Whether over or under used, there are adults who meet criteria for this diagnosis and who might be helped (along with their spouses) if they had some hooks to use to understand what was happening in their relationships. If you are involved in counseling folks who meet criteria for this diagnosis…or think you might, check out the this website.

Click the link “tests” and check out a couple of the free adult forms you might use in the diagnostic process. They may not be quite as robust in their statistical properties, but they do give you a good way to narrow the conversation with your clients.

6 Comments

Filed under counseling, counseling science, Psychology

Tagged as , ,

December 6, 2010 · 2:20 pm

Serious mental illness and Christianity: Questions about responsibility


Today marks the end of the semester and the end of Counseling & Physiology. At the end of this course I ask students to talk amongst themselves regarding what they have learned in the course and what questions remain. The most frequent questions have to do with this:

What of a person’s struggles can be viewed as physiological; what is spiritual? What is the client responsible for?

[I should explain. We looked at problematic behaviors (e.g., cursing, aggression, etc.) after brain injury and the physiology of bipolar disorder. The class took bodily weaknesses quite seriously and recognized that sometimes our expectations of individuals exceeds capacity.]

At the end of this post I’m going to give you what I think are some better questions to ask. But first: Simultaneously, a couple of my old blog posts are getting a lot of attention these days–both having to do with the problem of serious mental illness, faith, and the response of the church. I highly recommend you skim the posts (both are incredibly short) but hang out with the comments.

https://wisecounsel.wordpress.com/2007/06/26/serious-mental-illness-and-faith-what-to-do/

https://wisecounsel.wordpress.com/2006/11/14/living-faith-bombshell-honest-wrestling-with-mental-illness-and-divorce/

These two posts are some of the most viewed and most commented on. Each and every comment reveals a world of heartache, alienation, and confusion about how one should think about mental illness, healing, responsibility, and the Christian faith. Clearly, we have not talked about this problem enough in the church–either to those with chronic mental illness or to their loved ones. Far too many are suffering alone.

Does it matter what of your problems are physical and what are spiritual?

Let’s say that you are a parent of a 3-year-old. Due to no fault of your own, your child misses their afternoon nap. It is now 6 pm and your child is both hungry and tired. She sees some candy and begins to whine for it. You know that you will feed the child in 15 minutes. You decline to give the candy and your child now has a temper tantrum. What do you do? Or, what SHOULD you do? You most likely provide mercy and kindness as you try to calm the child down. If the child screams, cries, and maybe even strikes you…has she sinned? Yes. Does it matter at the moment? Probably not so much as you acknowledge the child is limited by her lack of sleep.

Now, let’s extend the analogy. Would you treat your 40-year-old spouse in a different manner if they also had a tantrum because they were tired and they wanted dinner NOW? Of course, you would determine their moral capacity to be greater than the 3-year-old.

Back to our question…is it necessary to consider the division between spiritual and physical problems? Here’s why I think not. Problems are problems. Physical problems are spiritual problems in that we don’t do things only with our body and leave out our spirit. And spiritual problems always include the body. We don’t have spiritual experiences outside our neurons. Further, I still have to respond to the 3 or 40-year-old now (illustration above). Yes, I need to discern how to respond. Do I teach, comfort, discipline, rebuke, encourage? Am I responding with grace and mercy? Less important (though highly desirable) is my efforts in trying to keep the problem from happening again. Isn’t that really what is behind the physical/spiritual question: Who is going to make sure that x problem is taken care of?

Here are some better questions:

1. What can I do to help bring increasing comfort, hope, and encouragement–right now?

2. What response is my client capable of–right now (post hoc)?

3. What spiritual or physical interventions might be of help–right now?

4. How can I encourage my client to accept/respect their body (and its limits)–right now?

5. How can I encourage my client to see the hand of God in their life–right now?

6. What community resources and/or involvement can be made available–right now?

Notice the emphasis is on practical/mercy ministry, increasing insight, and commitment to seeing self from God’s point of view (rather than “normal”, “acceptable” as defined by church or larger community).

7 Comments

Filed under biblical counseling, christian counseling, christian psychology, Christianity, Psychiatric Medications, Psychology, Uncategorized

Tagged as , , ,

November 29, 2010 · 10:14 am

“Niceness is a decision”?


Cover of "Predators: Pedophiles, Rapists,...

Cover via Amazon

For “light” reading over the break, I decided to read Anna Salter’s book, Predators, Pedophiles, Rapists, and other Sex Offenders (Basic Books, 2003). I’ve known of this book for some time and viewed her DVDs which cover a chunk of the book’s topic. **I don’t recommend you read this book at night or at all if you have any history of sexual abuse.**

The book reviews research on those who commit these kinds of crimes. What I found most helpful is her treatment of the problem of deception, common techniques, and how both the average person AND expert clinicians are easily seduced by the presentation and lies of offenders. She closes out the book with chapters on detecting deception and protecting children from abusers.

But one particular paragraph caught my eye. The context of what you read below is her discussion of the necessity of a double life (appearances of sincerity, likeability, honest, etc.) in order to gain access to children. As she says, “a surly and obnoxious person would have little access…” (p. 38)

“Niceness is a decision,” writer Gavin De Becker wrote in the The Gift of Fear. It is “a strategy of social interaction; it is not a character train.” There are days I want to tattoo this on my forehead. De Becker is right, but who believes him? (ibid)

Do you agree? Niceness is a decision not a character trait?

Niceness is an action, a behavior. Frankly, any of the fruits of the Spirit may be short-term behaviors as well. I can choose to be gentle or patient for a time. But true fruits come from Holy Spirit induced character change. But what bubbles up in us when no one is looking tells a bit more about who we really are.

We ought to be just a bit more suspicious about ourselves and be wary of the tendency to pat ourselves on the back for being nice–especially if we find ourselves doing calculations on the benefits we might receive for our good behavior.

7 Comments

Filed under Abuse, Christianity, Christianity: Leaders and Leadership, deception, personality, Psychology

Tagged as , , , ,

November 23, 2010 · 10:37 am

Pastoral Narcissism | LeadershipJournal.net


A friend recently sent me this Leadership article link  (below) on the topic of pastoral narcissism. He wondered if those two words were oxymoronic. Yes, he’s right…but no, we do often seek out self-promoting leaders. It makes us feel good.

I encourage you to read the essay–but not so you can point your finger at some TV personality pastor. Read the essay and consider how you might be tempted to promote yourself in a conversation this holiday week. Or, check to see if you ever dream about your own “brand.”

Pastoral Narcissism | LeadershipJournal.net.

3 Comments

Filed under Biblical Reflection, Christianity, Christianity: Leaders and Leadership, Psychology

November 15, 2010 · 9:53 am

Can you change your nightmares?


Blogging has been much harder this fall with a busy teaching and traveling schedule. I’ve been doing a lot of reading and thinking about best practices to deal with trauma in international settings–specifically in the Great Lakes region of Africa. Diane Langberg and I have been consulting with a Christian organization to help develop those practices with a local, sustainable mindset.

One of the recent items I read had to do with attempts to address repetitive “posttraumatic nightmares.” Bret Moore and Barry Krakow published, “Imagery Rehearsal Therapy: An Emerging Treatment for Posttraumatic Nightmares in Veterans” in the September 2010 issue of Psychological Trauma: Theory, Research, Practice, and Policy (v. 2, 232-238).

Imagery Rehearsal Therapy (IRT) attempts to alter nightmares by changing the storyline of the nightmare. The authors view nightmares as learned behavior such as insomnia. The CBT style treatment entails

  1. education about the relationship between nightmares and insomnia.
  2. education about cognitive restructuring via imagery
  3. client selects a particularly disturbing nightmare (maybe not the most disturbing one first)
  4. Client then instructed to “change the nightmare anyway you wish” (notice they are not asked to make it positive or even less distressing)
  5. Client then rehearses (over sessions) the new dream through imagery techniques

Previous controlled studies indicate a reduction in nightmare frequency and intensity. This particular summary article reports that the evidence is there that veterans find it helpful even at 12 months post treatment with 4 sessions.

A couple of things to note. There may be some effect of desensitization from rehearsal of the initial dream (exposure therapy) though the exposure is brief. Also, the client does not spend time rehearsing the actual traumatic events in this therapy–only the nightmares.

Some thoughts:

  1. This treatment makes sense. Ever have a dream that seems to go on and on, or one that you go back to upon waking up in the middle of the night. Often we may find ourselves trying to make the dream turn out okay. This treatment uses our fully awake brains to rehearse something we want to think about.
  2. If nightmares are the result of a collection of anxieties then it stands to reason that repeating new thoughts and images will begin to make associations in the brain that might compete with the anxieties.
  3. Christian living emphasizes re-telling the truth to ourselves. Consider how OT authors remind readers of the Exodus or Paul reminds the Ephesian readers of their prior state (chapters 1-3). What we rehearse does have an impact on our brains.
  4. Finally, some of our nightmares seem written in indelible ink. Do you still have test anxiety nightmares 20 years after your last class? I do. But I feel differently about them now than I might have back when I was still worried about school. It may be that we begin to feel differently about the nightmares. The less we are bothered by them the more infrequent they will be.

5 Comments

Filed under counseling, counseling science, counseling skills, Psychology

Tagged as , , , ,

November 1, 2010 · 10:18 am

Coming to Peace with Psychology 6


After a long hiatus I return to my summary/review of Everett Worthington’s Coming to Peace with Psychology (IVP, 2010). If you are new here just search his last name in the search bar on my blog and you can quickly catch up.

Chapter 10 is the second chapter in the last section of the book (“What Psychological Science has to Offer Theology”). This chapter covers the limitations of psychological science. Up to this point he has been lauding the value of psychological science as a marriage partner with theology. In fact, the purpose of the book is to argue for such a relationship over those who he sees as being overly critical of psychological science (due mostly, in his mind, to the anecdotal nature of psychological theory).

What does he point to as the limits of his science?

  • Despite amazing advances in psychological science, counseling hasn’t changed much (hmmm, does he consider this a limit of science or is this a complaint about practitioners?)
  • Psychological science must focus on general truths and so may not be as applicable to any one person
  • Scientists are not without bias (but then he goes on to say that given the review process, truth is a lot more likely than not)
  • Science can’t reveal the eternal (but it can reveal things of eternal value)
  • Inability to precisely predict behavior
  • No ultimate “proof” (but, probability is possible)
  • Scientist biases include “heuristics” (picking answers from an “available” list), confirmation biases, etc. which reveal our human self-serving nature.
  • Emotional experiences tend to make us more certain of our perceptions and beliefs.
  • human limitations on what we can remember, understand, perceive, do.

Notice from his list that he focuses on common human limits of knowing. This is a good start but insufficient. It treats science biases in an individualistic manner. I find this ironic given that I believe he has much awareness of family systems. In fact, systems add an additional bias–group think as example number one. Funny too that he gave very few illustrations from science of these various biases. For the most part, he illustrated them from everyday life or from theology. So, we are left with a chapter that admits to some general limits on how far psychological science can take us but no clear acknowledgment of systematic biases in the world of psychological science.

Now, let me be clear. I am not one who believes that psychological science is always biased all the time. And even when it is, there can be much to be learned from it. Nor do I believe that those within biblical studies or theology are unbiased either. But, I do think we need to recognize how specifically these biases send psychological science in some wrong directions.

Leave a comment

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

Tagged as , ,

October 22, 2010 · 5:07 am

Normalizing Psychiatric Problems: Pro and Con


One of the hallmarks of the Biblical Counseling movement has been the clear articulation that psychiatric problems are not different in kind from any other set of problems. This assertion is made by some for a couple of reasons:

  1. To make sure everyone knows that the bible speaks to every kind of experience. if one draws lines between “regular” anxiety and pathological anxiety, those who meet the criteria for a DSM diagnosis might think that biblical material cannot speak to their situation–that they need to go elsewhere for help. God cares for and addresses every concern.
  2. To level the playing field between professionally trained counselors and biblical counselors. If the roots of human problems are common no matter the outer expression of them, then pastors and lay counselors can understand the issues (pride, suffering, fear, despair, etc.) and walk alongside anyone. One may not need special training to help another.
  3. To communicate to the healthy that they are not different from the more obviously unhealthy. The point is to reduce stigma and promote unity.

Consider the pros and cons of this viewpoint.

Pro:

  • Reduction of stigma and ghettoization
  • Increase normalization (“so, I’m not so different from others) and similarity with the rest of humanity
  • Increase the confidence and courage of leaders to address and dialogue about all forms of suffering

Con:

  • Decrease in interest in the specific experiences of suffering thus narrowing problems down to a simplistic cause (sin?)
  • Possible over-confidence of some leaders leading to a reduction of empathy and listening to the experiences of other; failure to consider body/mind issues not specifically elaborated on in the Bible.
  • Failure to recommend outside helpers with specific expertise and training; dismissal of the need to have professional counselors who may have greater practice with certain kinds of interventions\

When I teach my Psychopathology course I want my students to see just a bit of themselves in descriptions of people with thought disorders, addictions, eating disorders and the like. I want to normalize these kinds of problems so that students don’t think of clients with the problem as somehow different from their own experiences. While I may not binge, I may be able to empathize with those who do. However, I do not want them to think their brief binge as exactly the same as someone else’s experience. Otherwise, they might assume it would be easy to “just say no” to the binge.

When I teach my Physiology course, I want my student so to see the complexity of the brain and body and thus recognize the unique forms of suffering some go through. I want them to realize just how little we understand how much the body influences our experience of the world and of self. However, I do not want them to medicalize psychiatric problems. If they did that they might believe that counseling has little influence on psychiatric disorders. They might think that biblical reflections on anxiety and depression have no place in the healing of serious problems in living.

What is your experience regarding christian leaders handling of psychiatric problems? Do you see too little normalization? Too much? Do you see minimization of psychiatric suffering?

7 Comments

Filed under biblical counseling, christian counseling, christian psychology, Christianity, counseling, counseling science, Psychology

Tagged as , , , , ,

October 19, 2010 · 5:46 pm

Suffering for Christ? How should we respond to discrimination due to faith?


In 1 Peter 2: 12 we are commanded to, “live such good lives among the pagans that, though they accuse you of doing wrong, they may see your good deeds and glorify God on the day he visits us.” Peter goes on to tell us that our good deeds include showing proper respect for everyone. And still later he reminds us to follow the actions of Jesus who did not retaliate when he was insulted and mistreated at the cross.

Recently, a friend was mistreated due to her faith. Actually, the mistreatment was based on assumptions rather than facts. The one doing the mistreatment made false allegations about my friend’s beliefs and attitudes. This was in a professional setting where my friend expected to be treated as any other and not singled out like this. Thankfully, the episode was brief. But what if it wasn’t? How should we respond to mistreatment for reasons of faith?

Some things we shouldn’t do:

1. Sarcasm and biting back. One of the things that bothers me in the political arena is the amount of sarcasm and belittling used against each other. Not that this behavior is new–it isn’t–but it does seem more intense than before. It would seem that the goal for liberals is to catch conservative family values defenders not living up to their standards.  And conservatives put down liberals for being open to anything and everything (except conservatives). When attacked for reasons of faith, let’s not spend our time making public comments about the missteps of our accusers.

2. Say nothing at all. Silence isn’t always wrong but it may not be right either. It can be good to overlook some mistreatment as a mercy to the attacker. Sometimes when we know someone is having a bad day or is themselves a recipient of mistreatment, we may choose to overlook hateful comments. However, saying nothing as a matter of course may also eliminate an opportunity to speak truth in love to the offending party.

What can we do?

1. Deserved or undeserved? First, we can check to see if we have brought an attack on by our own behavior. If we have, we ought to address the matter right away. If the attack is not the result of our own foolish actions, then this is not about us but about God. Hopefully, this little bit of assessment can take the personalized part of the pain out of the equation.

2. Work to understand. Where are these comments coming from? What might be revealed behind the hurtful statements about our attackers experiences? It is possible that their attack comes from a bad experience from another person of faith who did not represent well the true meaning of Christianity. We can then validate their pain even if not their expression of it.

3. Speak the truth in love via a point of contact. Look for the value that you share together. Speak to that issue first. Often, some issue of respect, justice or shared concern can be a point of contact to engage an attacker. MLK wrote a letter from his jail cell in Birmingham, AL to white evangelicals who had written to ask him to stop raising tensions via nonviolent protests. He begins with a point of contact–their shared faith, their genuine good will and sincerity regarding their concerns. He attempts to speak their language first about the necessity of prophetic voices among God’s people. Surely he moves on to accuse them of inaction and maintaining the status quo–thus not caring for all of God’s people. But he ends with invitations to dialogue more and even requests that they forgive him if he has overstated their complicity in the problem of Jim Crow. In professional worlds, we may begin with discussions of shared ethical standards. We may want to point out failures by our accusers to keep their own standards, but first we need to establish common ground.

4. Bless, do not curse. Look for ways to bless and/or encourage an accuser if at all possible. Find reason to offer mercy rather than retaliation.

5. Activate, do not withdraw. In professional settings, use the existing system well so you can to gain a hearing,  and not just for yourself. Remember, the Apostle Paul uses his Roman citizenship to seek justice against false accusers and abusers. Using his right to appeal to Caesar enabled him to speak to numerous individuals and groups that he might not otherwise have met. It was this simple act that God used to spread the Gospel to Europe and then to the whole world.

Leave a comment

Filed under Biblical Reflection, christian counseling, christian psychology, Christianity, ethics, Evangelicals, Psychology, Uncategorized

Tagged as , , , , ,

October 18, 2010 · 11:11 am

Practicing new ways of feeling?


As you fall asleep, do you have a common thought or feeling pattern? As you wake up? In the shower? We are creatures of habit in this regard–we maintain our perceptions (of self, of the world) even in the light of contradictory information or experiences. This is why a pessimist always expects the worst and a narcissist always expects to be right. If you could categorize all your thoughts and feelings, what would your perception pattern look like? Hypervigilant? Discouraged? Embittered? Hopeful?

Now, can you change this pattern? For example, if you are not inclined to be hopeful, can you practice hopeful responses–even when things really do go south? And if you can change the pattern, what does that change look like?

Here are some of my thoughts…I would love to hear from you about what you do to practice something other than your usual way of looking at the world.

1. It is possible to re-write our narratives. How we talk to ourselves about an event either will solidify a feeling or begin to change it. For example, my wife recently had a sleepless night. She was able to use that time to talk to the Lord even while she was feeling out of sorts. In the morning, she had a positive, if also tired, way of feeling about the night.

2. Change does not look like zero experiences of an old narrative running through our head. Change looks like being able to recognize the old but also a new pattern as well. This change is not merely talking yourself out of one schema and into another. Rather, mindful awareness of threads of your experience that have been there all along get more play and so therefore become more salient over time.

3. Change isn’t permanent. Just as a professional athlete cannot go without practice, we cannot expect effortless maintenance of a new way of feeling.

3 Comments

Filed under counseling, Mindfulness, Psychology, Uncategorized

Tagged as , , ,

October 12, 2010 · 4:34 pm

Skype counseling? Know of anyone doing it well?


I recently set up an acct with SKYPE to participate in an upcoming meeting. I’ve had past requests to use SKYPE in counseling people unable to come to the Philadelphia area. While I’m open to doing this (at least for brief consultations), there are a number of issues to resolve. I’m interested in hearing from readers having used it for counseling (feel free to remain anonymous). What was it like? How were confidentiality and informed consent handled? Was any mention of jurisdiction mentioned? Not sure what I mean, read on to consider these issues:

  1. Confidentiality & Privacy. Are SKYPE video conferences really private? What is the likelihood that someone can tap in?
  2. Informed Consent. Read any good Telehealth informed consent forms lately? Seems that you have to consider how to deal with crises that might be happening in another state. Insurances cannot be used. What about what files are maintained? I believe it is possible to record SKYPE calls.
  3. Jurisdiction. It is clear that licensed mental health practitioners must not practice in another jurisdiction (i.e., state) without getting licensed or approved for that jurisdiction. But what about consultations? What about Internet based interactions? Which state has jurisdiction? Some seem to think that the state of the “caller” is going to want to maintain control of the care of its citizens. Others think that informing “callers” that the point of service resides with the Counselor will be enough. Check out what they say at eCounseling.com.

This is what is known as a “Point-of-Service” issue. In our terms of service which both clients and counselors agree to upon eCounseling.com sign up, it states the following in section 5.8: 5.8 POINT-OF-SERVICE. For a client who resides outside their eCounselor’s state of residence and professional licensure, there is an important issue that should be understood by clients before counseling begins: By utilizing these counseling services, the client agrees that he or she is soliciting the services of a professional outside of his or her state of residence. By doing this, the client agrees that the “point-of-service” of counseling is to occur in the counselor’s state of residence and licensure, not the client’s. In essence, the client is using the telephone or the Internet (the “information highway”) to virtually travel to the counselor (the counselor’s state of professional practice). Hence, counselors are accountable to and agree to abide by the ethical and legal guidelines prescribed by their state of licensure and residence. By agreeing to solicit the counselor’s services, the client agrees to these terms. If you do not understand, or have any questions regarding this issue, please feel free to ask the counselor about this issue, or contact eCounseling.com support at support@ecounseling.com DISCLAIMER: The above should not be construed as legal advice. If you have questions about legality or liability, please contact a qualified legal professional.

What do you make of these issues?

5 Comments

Filed under christian counseling, christian psychology, counseling, counseling skills, Psychology

Tagged as , , ,