Category Archives: Psychology

August 13, 2010 · 5:58 am

Who diagnoses ADHD? Comments on CNN story


CNN has run a story on the issue schools/teachers encouraging parents to get their child tested for ADHD and on medications. You can read it here. The writer quotes a doctor complaining about teachers who suggest diagnoses and treatment. Then parents go to their doctor and ask for meds to treat something that has yet to be properly diagnosed. Being a psychologist I am sympathetic with the Doc–but only to a point. True, many people fancy themselves as experts because a family member or some other experience with a mental health diagnosis. And so, whenever they see something that reminds them of it they talk as if they had done a thorough assessment. The Doc goes on to point out other problems that may create similar symptoms (anxiety, abuse, learning disabilities, etc.)–thus the need for professional evaluation.

But that is where my sympathy ends. Teachers do have front row seats to child problems. We need them to speak up. Yes, they needn’t throw out diagnoses as if they are experts. But we do want them to let parents know that something might be up and the need for further evaluation.

So, who should diagnose? Yes, ADHD is considered a medical diagnosis. But, counselors and psychologists are just as capable of making the diagnosis–sometimes even better.  If a Doc (psychiatrist, physician, etc.) makes the diagnosis, 9:10 times it is on the basis of 30 minutes to 1 hour of an interview with parent and child along with a physical examination. For most people with the symptoms, that is probably enough. However, most psychologists will collect data from 2-3 sources (parent, teacher, church) using interviews, checklists, psychological tests, and even computer based assessments. That kind of assessment may be more capable of ferreting out subtle learning disabilities or learning differences as well as developing a plan of action for changing the environment (school plans (IEP/504), parenting strategies, etc.

It is interesting that the article makes no mention of the use of counselors in this process.

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August 10, 2010 · 9:58 am

Quote about psychology and conversion


Check out this quote from G. Campbell Morgan,

No psychology will ever effect conversion. Regeneration must affect psychology.

The Gospel According to John, 1908, p. 58; emphases mine

The context of these two sentences are Morgan’s description of Jesus words to Nicodemus in John 3:3. He is not talking about psychology in the more modern sense we might intend today. What he is saying is that one must be “born again” in order to see the kingdom of God. One cannot think, feel, or perceive the real truth about God–no matter how psychologically mature and aware–without the work of the Spirit.

Notice his use of the words effect and affect. I didn’t have great English grammar education so I will assume some of you also might miss the meaning. Here’s my rewrite of his sentences

Psychological maturity cannot bring you to full awareness of God and creation but conversion will definitely impact your psychological well-being, you soul.

If you are interested in reading this book, you can find the full text on-line here. His comments on the interaction between Nicodemus and Jesus are very enlightening and provide a different perspective than is often given. He gives Nicodemus a lot more credit than do many preachers.

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Filed under Biblical Reflection, christian psychology, Christianity, Doctrine/Theology, philosophy of science, Psychology, Uncategorized

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July 28, 2010 · 5:16 am

Last chance for cheap Counseling CEs!


My weekend course on Counseling individuals with Borderline Personality Disorder begins this Friday night (6 pm) at Biblical Seminary. Class meets 3 hours on Friday and then from 9 to 5 on Saturday. It is not too late to sign up for CEs. If you are LPC and in need of a bunch of continuing education, these will count towards your requirements.

Check out this page for more information on CEs at Biblical and how to register.

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July 27, 2010 · 5:54 am

When helping harms


Just before vacation I caught a PBS television show on how economic development (funded by international aid) often ends up hurting while trying to help. Here’s a link to the documentary website. The show covers two areas of Kenya and the pros/cons of trying to raise the living standards of those who live there.

This is not a new problem and reminds me again that there is a book I need to read (When helping hurts).

As a counselor who has traveled to Africa to try to help, I am very interested in finding appropriate methods to provide emotional support and care to traumatized peoples. What are some of the ways we counselors might unintentionally hurt those we want to help?

1. Pressuring clients to do something we think is important (e.g., stand up for yourself, say no to a violent spouse, speak the truth about your abuse, etc.) without considering the consequences. I once read about some African women who sought counseling for rape. Problem was that by going to the rape counseling center, they communicated to their village that they had been raped–and were later killed for being defiled.

2. Assuming that counseling can only be done by licensed professionals. We could train counselors in another country but if these folks couldn’t get paid to counsel because their clients are all subsistence farmers, we have only created additional frustrated individuals.

3. Similar to the last point, if the trainers are all westerners, then they will likely fail to understand culture specific resources/challenges and may reinforce the assumption that only westerners are competent to provide the care.

What are some other ways you have seen western counselors unintentionally harm the helpee?

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Filed under counseling, counseling skills, Cultural Anthropology, Psychology, suffering

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July 26, 2010 · 10:53 am

Ecstasy (MDMA) as treatment for PTSD?


Back from vacation and reading up on my piles of emails. This one came via my Medscape.com subscription to psychiatric news–Ecstasy-assisted Psychotherapy May Help Patients with Treatment-Resistant PTSD. You can read about it here on WebMD.

Interesting…a date rape drug being used to treat PTSD. There is some irony here I think in that many a date-raped woman was taken advantage of when slipped this drug.

How is it purported to work? By reducing or blocking symptoms (intrusive, emotionally laden feelings when thinking about traumatic events) and thereby allowing therapy to do its work. The therapy was done in an intensive manner rather than spaced out as most people do therapy. One wonders if prolonged exposure therapy was used as the therapy. If not, would PE therapy do as well or better than traditional PTSD therapy and MDMA?

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Filed under Abuse, Anxiety, counseling, counseling science, Post-Traumatic Stress Disorder, Psychiatric Medications, Psychology

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July 12, 2010 · 1:48 pm

Emotional Arousal: Too much or too little?


I am doing some prep for my upcoming class on the treatment of Borderline Personality Disorder (BPD). [Links: summer institute brochure, and CEU information for LPCs] Many theorize that BPD is really a problem of emotional (over) sensitivity resulting from a combination of psychological factors (trauma, loss, attachment injuries, or chronic invalidation) and biological predispositions (high base-line emotional experiences, slow return to baseline once activated, and chronic and inappropriate scanning environment for danger).

If a person is prone to intense emotional experiences, they are likely to get the message that their emotional expression is out of line. Thus, they may either try to avoid emotions (leaving them less aware of how they feel and maybe more likely to be taken advantage of) or give in and respond out of their full expression (leaving them less likely to be able to solve the problem given their high state of arousal).

Are you a person of high emotional arousal? Do you know or live with one? Do you struggle with thinking that high arousal is wrong? Theoretically, most of us do not think strong emotions are wrong. But practically those who experience their own intense emotions and those who live with them do think they are wrong. “I shouldn’t feel this way…she shouldn’t feel that way.”

Counselors do not seek the goal of eliminating or even tempering emotions. What they seek is to avoid the “why” or “because” that often follows the strong feelings. It appears that the big problem is not the feelings but the beliefs and interpretations that one holds during and after the emotional experience. I feel this way because…(I’m stupid, a loser) or because…(others hate me) leads to cementing emotions and beliefs together in such a way that lead to more easily experiencing invalidation.

Looking to get into this a whole lot more in a few weeks (July 30-31)!

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July 6, 2010 · 2:33 pm

Suffering and Divine Sovereignty?


What is similar and different counselors and beauty queens? Well, we both want to end human suffering and seek world peace BUT the counselor no longer talks as if it is possible in this life. We know that sitting in suffering is, in fact, an important act in this life.

So, for all you counselor types out there, I have a theology book for you. Currently, I am reading Suffering and the Goodness of God, edited by Christopher Morgan and Robert Peterson (Crossway, 2008).

Not all theology books are stuffy. Really. This one is very readable and helpful. Chapter one (Robert Yarbrough) lists 11 theses about suffering. I will not repeat them all here but each one is illustrated from Scripture and personal experience. Here is a taste:

1. Suffering is neither good nor completely explicable

2. Suffering in itself is no validation of religious truth

3. Accounting for suffering is forced upon us by our times

4. Suffering may be a stumbling block to Gospel reception

5. Suffering Creates teachable moments for Gospel reception (though this does not make suffering, in itself, good)

7. Suffering is the price of much fruitful ministry

10. Suffering unites us with other sinners we seek to serve

Lest you think this book takes a happy view of suffering, consider this quote:

It is certainly true that it is primarily God himself who in his redemptive activity has “caused us to be born again to a living hope through the resurrection of Jesus Christ from the dead” (1 Pet. 1:3). But this new birth does not take place in a vacuum. Rather it unfolds amidst earthly life, which is manifestly to some extent a vale of tears.

We sometimes wish to talk about “new birth” and redemption as if our suffering does not continue in this life.

The rest of the book addresses OT and NT interactions with suffering, the problem of evil and oppression and two chapters written by theologians about their own personal suffering. A good read if you realize you cannot ignore suffering or go back to some prior period of naiveté.

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June 29, 2010 · 11:01 am

Statistics and physiology: why getting it right matters


With recent advances in brain imaging and gene mapping we have significantly more data to help us understand human behavior. For example, we can see how folks with PTSD react to triggers using SPECT scans. We can understand how some folks have genetic markers that indicate a propensity for certain kinds of addictive behavior.

Enter this news story on NPR about one researcher who discovered he had the brain scan of a sociopathic killer–the very kind of people he was studying.

It is essential that we understand how to interpret these kinds of studies that often make the news. I am not an expert in brain scanning but let’s review a simple statistical principle. If you evaluate that 100% of people who have a particular problem (in this case sociopathic murder) have a particular brain scan signature, what can you say about its application to the general public? NOTHING. You cannot say, yet, that having that brain scan signature puts you at risk for becoming a murderer. What we need to know is whether or not that brain scan exists in the general public. I am willing to bet that if we did a large-scale study, we would find that 99% (maybe even higher) of those with a similar signature would NOT be killers. Thus, we cannot predict anything on the basis of the scan.

A similar (non) relationship exists between childhood abuse and becoming a child abuser. Yes, when we research pedophiles we find a high correlation between childhood sexual abuse and those who are in prison. But, when we look at the general public and victims of sexual abuse, we find that less than 1/2 of 1% go on to abuse others. Thus, abuse victims are not likely to become abusers.

However, these studies are not meaningless. In the case of the underactive frontal/orbital lobe, we do see certain features often present in individuals with ADHD: impulsivity, emotional lability, ego-centrism, lesser ability to learn from mistakes, difficulties in planning and forethought, etc. Rather than try to predict big events (like murder), we might use these kinds of studies to understand the common experiences and activity of those with a particular signature. This does not absolve people of responsibility or suggest they cannot make changes in how they operate. But, it might help us grow in understanding that what might be easy for one person may be more difficult for another. Just like we would want to give someone with dyslexia more time to read and comprehend a piece of literature, we might want to make some allowances for someone with a quiet frontal lobe.

It might mean that we understand that everyone thinks thoughts that ought not be repeated but that some have a harder time not saying it. And in the case of those “some”, we might be more willing to cut them slack even while we call them to account for saying what they say.

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June 22, 2010 · 4:40 pm

Christian interventions in counseling


Regular readers of this blog will know that I believe that Christian counseling is not merely counseling done by Christians or merely the use of specific christian interventions. Rather, Christian counseling is founded on Christian/biblical ways of perceiving the world, the problems in it, and the goal of imaging Christ from start to finish.

However, it is good to think about the specific use of certain christian practices in counseling: meditation, prayer, bible reading and application, casting out demons, absolution, etc. How are we to think about these practices? Do they have a place in professional counseling? What are limits we ought to place on them? When should we refrain? How do we secure informed consent?

Elsewhere I have published on the guidelines we ought to consider when using Scripture in counseling. I will not repeat them here but for those who have not read that article, I do think Scripture is something that CAN be used in counseling–even OUGHT to at times. What is of more importance to me is HOW and WHEN and WHY.

Let me here consider the most commonly used practice: prayer. Here are some shaping values before we consider any practical application.

1. Prayer is talking and listening to God. It is not a technique and should not be treated as such. It is not magic. It is, from a Christian perspective, sharing one’s heart, praising, questioning, interacting with the Creator of the universe who remarkably wants to relate to me. At its heart prayer is submissive acknowledgment of God–even when praying like Job.

2. Prayer then needs to be a free act without trace of coercion. The one praying must not be coercive (you talk to God not at another person). The one being prayed for ought not feel obligated to say anything.

3. People have diverse (and not always happy) experiences regarding prayer, faith, relationship with God, etc. So, what is comforting to you may be triggering for another.

4. Prayer is intimate. Prayer often results in our setting aside defenses and becoming vulnerable and needy.

5. Prayer is power. Praying for someone gives the one praying a position of power.

So, how might a counselor consider these values and use prayer in counseling.

1. Assessment of client. What is my client’s faith tradition, experiences with prayer, history of abuse by leaders of the church, understanding of God? Have they ever felt coerced to pray, coerced by the prayers of others? Have they been publicly prayed against? Do they value prayer?

2. Assessment of self. Why am I praying for my clients (out loud)? What messages am I trying to communicate? What do my prayers reveal about my own faith?

3. Consent. Have I explained why I pray for my clients? Do they really have the right to say no?

4. Review. How are my prayers received? What impact, if any, do they have?

What does this look like for me? I don’t pray with every client. I don’t choose to start my sessions with prayer (at least the first one) until I have a better sense of my client’s experience with prayer. I work very hard not to use prayer as an effort to disarm (though I think it can do this) or to preach a message, but only to make supplication to God for healing, for care for the downtrodden. When I use imagery in prayer I make sure that it is grounded in common biblical images (God as shepherd, Christ as lamb, etc.). I never ask clients to pray but many of them choose to do so. And, I do let clients pray for me when they want to. It is part of how believers care for each other.

I do believe that prayer is extremely important but that I do not need to do it to be actively asking God for healing or guidance. I will say that when conflictual couples pray, they often find that it is hard to stay angry and embittered and pray. It can be helpful, either in reducing bitterness or by discussing bitterness and its impact.

It should not be used when clients do not want it, might be confused by it, or if it is not authentic to the counselor. It is considered good professional ethics to utilize resources from a client’s life. However, it would not be good to fake (e.g., my praying in a way that would please a member of a cult, an atheist praying as if he or she believed what she said, my talking to God even though I am no longer practicing as a Christian, etc.).

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June 17, 2010 · 5:41 am

Looking for summer education?


My school, Biblical Seminary, has a variety of summer classes, from on-site intensives to weekend only to totally on-line. Click the link if you are trying to figure out what enrichment you will pursue this summer. The page that pops up will list both classes and free events. Those of you looking for counseling CEUs may be able to get credit too!

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