Category Archives: Psychology

March 12, 2010 · 9:10 pm

Do you have a pet psych test?


Uh, by that I mean whether or not you have a favorite psych test. We’ll save tests for pets for another day.

There are many out there who love the Myers Briggs (MBTI). Others love the DISC. When people have a pet test it is usually because the test provides a quick and dirty profile in order to understand and categorize a person’s behavior. Actually, and sadly, we often like certain tests because they allow us to pigeon hole others (as in, “your such a J”).

But, I do have favorite tests. I love to review the couple version of the 16PF with both long-time marrieds and those seeking pre-marital counseling. When I was doing parent competency assessments, there were a number of lesser known tests that illustrated a parent’s capacity to be flexible (and so hopefully less rigid and abusive). When it comes to personality assessment, the MMPI-2 and the Rorshach (Exner scoring) are my favorites.

But lately, most of my assessments have been with pastors. I’ve found a number of great little tools to illustrate compassion fatigue and other at-risk problems. These assessments lack the depth and rigor of a personality test but work great as conversation starters and self-evaluation tools. With these I don’t have to explain what they mean.

How about you? Got a favorite test you’ve taken? Given? Why is it your favorite?

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March 10, 2010 · 10:28 am

Here’s a cache of info on abuse trauma


If you are interested in reading some of the most recent research literature on complex trauma and treatment, take a look at the Trauma Center at JRI in Brookline, MA. Click their “publications” tab for a host of full-text articles on the topic. Bessel van der Kolk, MD is one of the foremost researchers exploring trauma’s impact on the brain.

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February 12, 2010 · 5:36 am

The good and bad of new diagnoses


A draft of the next edition of the Diagnostic & Statistical Manual (DSM-V) has been posted to their website and open for comments by users. The website breaks out the changes being considered in categories so it is easy to find your area of interest.  The final edition isn’t expected until 2013.

Diagnostic changes can be a help and a problem at the same time. When DSM IV removed Multiple Personality Disorder in favor of multiple diagnoses for clarifying dissociative symptoms, that helped clinicians be more descriptive of their client’s struggles. In this new proposal, they plan on eliminating Asperger’s Disorder and subsuming a number of diagnoses (Retts, PDD, etc.) into one diagnosis: Autistic Disorder. I would think this would not be helpful as it reduces specificity.

How about this new entry: Temper Dysregulation Disorder with Dysphoria? A new diagnosis for children? I think it may help in that it might hinder the ever popular “bi-polar” label given too quickly to children (and accompanied with serious meds). On the other hand, it probably will make quite a few roll their eyes. The label doesn’t have that ringing medical sound to it. Not that I’m disparaging the symptoms it tends to cover. There are children who mood is so easily dysregulated, whose reaction to frustrations are way over the top. These children tend to be impulsive to boot. Something isn’t right, but what best identifies their struggles; the etiology of their problems?

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February 10, 2010 · 5:38 am

Delusions and hallucinations: What are they?


Most of us trust our thoughts, feelings, and perceptions. If we hear something, we assume it to be real. Imagine someone telling you that what you feel or heard wasn’t real. Would you be inclined to believe them? Probably not. And the more they tried to convince you that you were crazy, the more you might see them as trying to deceive you.

That is a little piece of the world of those who experience psychotic symptoms–where they believe, feel, hear, experience things that others deny are real.

So, what is happening when someone comes to believe they are Jesus Christ in the flesh? What is happening when someone hears a voice telling them that they should die?

Possible explanations:

1. Misinterpretation of feelings and perceptions. I walk into a room and the hair of my neck rises. Does it mean that there is a lot of static electricity in the room? That I’m nervous in crowds? Or that someone is beaming thoughts at me? One explanation is that I’m mis-reading the data.

2. Mis-firing of neurons in the perception areas of the brain. I know that isn’t exactly the scientific language we ought to use but it is true that certain electrical stimulation of the brain leads to perceiving smells and sights that are not real. Elevations of dopamine and other neurotransmitters are possible causes of psychosis.

3. Real supernatural experiences. It is possible that spiritual forces are at play and the person is hearing what is being sent to them. Now, whether those forces are telling the truth or not may be the question the person ought to entertain. Further, labeling these symptoms as supernatural does not necessitate a supernatural response (e.g., casting out demons). Deception may be broken by basic Christian responses (e.g., prayer, submission to the Word) and by medications.

As a Christian psychologist I believe all three are at play in any disease. We are individuals with broken bodies that do not work right. We are mis-perceiving and vulnerable to deception. I cannot say for sure that someone who believes themselves to be a prophet is lying. However, if they are not evidencing the fruit of the Spirit in their lives then I do question the validity of their identity.

Counselees experiencing intruding sensations and perceptions can break their influence when they are able to attend to other “data”. For example, “I feel others are out to get me but I will live as one who trusts in the Lord rather than in my ability to prove to others that I am in danger.” “I will not use violence or rage to be heard.” “I will not isolate in order to be safe.” “I feel like God has me here for a special reason but I will not neglect caring for my children nor abuse those who do not think I have a special calling.”

Counselors will find more success joining counselees, accepting their reality, rather than merely attacking their beliefs. It is possible that my counselee is a prophet but I can still encourage them to faithful work, love, and honor of those around them.

[Note: I’m not covering the issues of medications, hospitalization, and other psychiatric treatments in this post. These are important and not merely ancillary to the care of those struggling against psychotic symptoms. I am only musing on the possible causes of delusions and hallucinations.]

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February 8, 2010 · 8:29 am

Do no harm?


[This is the second guest post I am making over on the www.christianpsych.org. You’ll have to click the link to read the whole post…]

Every counseling ethics code in existence includes this principle: Do no harm. This maxim is drilled into the heads of counseling students (and any other medical professional as well). Our work should help, not hurt. Who could disagree?

But pause for a minute and consider how you might evaluate whether an intervention helps or harms. What criteria will you use? From what vantage point will you evaluate the criteria you choose? If a medical treatment extends life for an ill patient that would seem good—unless it keeps them alive and in a vegetative state with no possibility of recovery. Some would then wonder if the treatment was indeed best. Or, is it harmful if marriage counseling encourages truthfulness between spouses leading to the revelation of a terrible betrayal leading on to divorce and financial ruin? If honesty is your criteria for helpfulness, then the intervention is sad but helpful. If stability is your criteria, then such counseling is harmful. We could go on and on. Do we use client interpretation of whether treatment is helpful or counselor observation? Do we consider the difference between short and long term evaluation? And importantly for Christians, do we consider only statistical analyses or do we also consider biblical categories (e.g., intervention “A” leads to increased positive affect but encourages clients to pray to another deity).

Despite the muddy water I just churned up, I want to argue that Christian psychology is well poised to help Christian counselors provide treatment that does not harm. This society includes some of the best philosophers, theologians, sociologists, clinicians, and researchers of our day. These members are interested in looking at how people grow and change, how the bible connects with everyday life, common human struggles and effective interventions, etc.

How then do we go about refining our practices and avoiding harm? Let me suggest some steps we might take:

[rest of post on www.christianpsych.org.]

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February 5, 2010 · 1:28 pm

Mental Retardation passe?


Did you see the news stories about Rahm Emanuel’s use of the word, “retarded” as a slur against his political opponents? It has spawned a number of conversations about the term mental retardation. Some are arguing for the removal of this term in legal and medical arenas. It is too closely connected to the abusive use of the word. Others, probably a small minority, even suggest not using the word retarded in other contexts unrelated to intellectual capacity (e.g., retarded growth, retarding energy consumption).

I’m not much of a fan of this latter idea. I remember when a DC official was castigated for using the term “niggardly” (having absolutely nothing to do with race) just because it sounded like the other “n” word. However, maybe we do need another term. Some are suggesting, “intellectual disabilities” “neurodevelopmental disorder” as options.

I’m for terms that are very descriptive and less pejorative. However, I will also say that stigma and the use of terms to harm will not change as the human heart that does such activity has not changed.

What do you think?

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January 22, 2010 · 11:53 am

Update on PA HB 1250


Posted previously here about the bill proposed to go to the PA legislature that will change the Licensed Professional Counselor credential from a title act to a practice act. This would further restrict non-licensed counselors from “styling” themselves as a licensed counselor, from offering the services of a counselor. Already one cannot call themselves a professional counselor or similar titles. But these changes would eliminate many from practicing. This bill (see here for bill with highlighted changes. Go to page 10 to see most pertinent changes and list of exempted individuals) is being voted on by the committee on 1/27.

Note that the exempted parties include “pastoral counselors”. In PA they are not defined. However, in other states they are defined and licensed. Thus, who will determine who is a pastoral counselor and what to do with the overlap between the two? In other states, a pastoral counselor must be ordained and trained in pastoral counseling. Also, psychologists supervising unlicensed people with counseling degrees may be exempted but there is still fuzziness in the law.

It all comes down to the definition of “styling.” See this quote from page 10:

Only individuals who have received licenses as licensed professional counselors under this act may style themselves as licensed professional counselors and use the letters “L.P.C.” in connection with their names. It shall be unlawful for an individual to style oneself as a licensed professional counselor, advertise or offer to engage in the practice of professional counselor counseling or use any words or symbols indicating or tending to indicate that the individual is a licensed professional counselor without holding a license in good standing under this act.

Section 3.  The act is amended by adding a section to read:

Section 16.4  Unlicensed practice prohibited.

No person shall engage in the practice of as a licensed social work worker, licensed clinical social work worker, licensed marriage and family therapy therapist or licensed professional counseling counselor in this Commonwealth unless the person holds a valid license to do so as provided in this act. The provisions of this section shall not apply to the following persons:

If you are in PA and one of these representatives (scroll down for the list) are from your district, you may wish to register you opinion on the matter.

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January 20, 2010 · 3:09 pm

Harmful counseling?


This month’s edition of American Psychologist has several interesting articles about the negative effects of therapy. The article by David Barlow, “Negative effects from psychological treatments”, provides a good overview of the effectiveness research controversies. But instead of focusing on how best to collect data about the benefits of a treatment, he gives some attention to looking more clearly at who benefits from a treatment and who is made worse (using dismantling type studies).

The next article (by authors Dimidjian and Hollon) gets at the definition of harm. Defining harm is rather complex. That a client may not get better from a treatment or may get worse during a treatment is not necessarily evidence that the treatment caused harm. And true to form, we have to accept that some treatments may both harm and help (they give the illustration of a nursing mother on medications: it may help her and yet harm her baby). Or, a treatment may make someone worse at first but then help them later on. Or, the treatment may be just fine but the practitioner may use it in a way that is good or bad. Finally, a treatment may be thought of as harming a patient when in fact what is seen is the normal trajectory of the disease.

So, how do you get at understanding whether a counseling treatment harms? They offer a number of methods for research which I won’t get into here.

Finally, the last article covers training implications (Castonguay et al). They cite therapists’ frequent underestimation of treatment failure and client deterioration. Looks like about 5-10% of clients get worse in treatment. If one wants to train counselors to avoid more failure how might one do that? Castonguay et al suggest that one do so by beefing up (a) proper therapy skills, and (b) skills to identify potentially harmful treatments. On p. 45 the authors include a table of training recommendations, which include

  • expose trainees to list of potentially harmful treatments
  • help trainees monitor change and deterioration
  • enhance relationship skills
  • learn and practice interventions that are empirically supported
  • prevent and repair a variety of relational pitfalls
  • adjust treatment choice, expectations, etc. based on client characteristics
  • Address trainee’s issues (anxiety, hostility, defensiveness, naiveté, etc.) that may hinder counseling

Every counselor fears harming another; fears not helping enough. And it is often unclear whether our work is having its intended impact in the moment. However, there are things we can do to keep the communication lines open and thus listen to our clients about what is helping or not helping. This is what keeps us on our toes. What works for one person harms another. We must not get wedded to one way of helping.

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January 13, 2010 · 5:28 am

Follow-up on expressing vulnerable feelings to a loved one


Yesterday I commented on a series of studies indicating that expressing insecurities to a romantic partner might lead to perpetuating them (because of our impressions of our vulnerabilities, what we think they think of us, and our suspicions that they don’t really care). Today, I want to list the major findings of the 5 studies. See what you think of these interpretations of the data:

  • “Study 1 demonstrated that people believe expressions of regard toward interpersonally insecure and vulnerable others are relatively inauthentic.” (p. 436).
  • “Studies 2A, 2B, and 4 suggest that, when people believe they have expressed vulnerabilities to a romantic partner or friend, they believe they are viewed especially vulnerable, which in turn predicts their suspicion regarding the authenticity of the other’s expressions of positive regard and acceptance.” (ibid)
  • “Study 4 suggests that this process can operate independently of the partner’s appraisals of vulnerability and reported authenticity.” (ibid)
  • Study 5 seems to show that when subjects appraise themselves as vulnerable they doubt a new acquaintance’s expressions of pleasure (even though the new person didn’t see the subject as vulnerable.
  • Studies 3 and 4 seem to indicate that when you have doubts about your partner’s authentic expression of love, you then perceive acts of caring in a more pessimistic manner. “In particular, authenticity doubts may result in a downward estimation of the partner’s true regard and acceptance, as expressions of positive are presumed to be exaggerated and clandestine rejection can be inferred from the partner’s presumed cautious orientation.” (ibid)

SO, do you think those who express vulnerabilities then are only placated and thus receive inauthentic expressions of kindness? Have you experienced yourself devaluing objective kind acts by re-interpreting them through a lens of pessimism? “He’s only doing that because he wants me to let him have his way.” Now, that could be true, but if you find yourself regularly dismissing acts of caring then you might want to explore where your assumptions are coming from.

What should we do? We should express our insecurities and then seek to listen to our loved one with the best possible interpretation and seek to be specific and concrete in pointing out how their actions/attitudes impact us. If we are the one listening to a loved one tell us that they are not feeling secure, then we ought to express warmth, concern, etc. Put off the defensiveness and put yourself in their shoes. If you were worried, you would want another to comfort and care for you–not call you an idiot for thinking that way.

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January 12, 2010 · 5:06 am

Perpetuating vulnerable feelings?


Feel unsure of your mate’s love for you? Should you tell them that you are not feeling safe or secure in the relationship? When you tell them (accuse them of not caring?) and they profess their love for you, what will tell you that you can believe their promises? What will tell you to doubt their words?

Two Yale University psychologists (E. Lemay, Jr and M. Clark) explore this problem in 2008 in their “Walking on Eggshells: How Expressing Relationship Insecurities Perpetuates Them” (Journal of Personality & Social Psychology, v95, 420-441).

Their study is fairly long (5 studies in fact). But here are some key points.

When people feel insecure about a partner’s regard and acceptance, they often judge their own prior behavior as having communicated insecurity and emotional vulnerability to the partner. Consequently, they come to believe that they are viewed as especially insecure and vulnerable. Then, due to shared beliefs that people walk on eggshells around insecure, vulnerable others, such reflected appraisals of vulnerability elicit doubts about the authenticity of the partner’s expressions of regard and acceptance. Once authenticity is doubted, positive expressions are discounted, negative expressions are augmented, and hidden negative regard is inferred even when partners are accepting and actually hold positive regard. (p. 436)

What they are saying is that our own anxiety fuels are belief that they know we are vulnerable and are tiptoeing around us and that we doubt they love us and then we read their actions through a lens that denies the evidence of love and declares their love to be inauthentic. Which of course, we then share with them. Repeat this action and sooner or later they don’t want to be declared a liar anymore and distance from us thereby proving our deepest fears of abandonment.

In short, anticipated rejection leads to presumption that it has happened and that any activity countering that presumption is rejected and re-read through the lens of rejection. Because that is what we believe happens to weak people–they are abandoned.

So, should we keep our fears to ourself? No say the researchers. Then what should be done? The researchers say only a little on this (since it is not the focus of their research here). But, challenging cognitive distortions are at the top their list? What distortions in particular? Believing that others see you as weak as you feel; challenging the interpretations of another’s motivation. Also in their suggestions is practicing reading the commitment of the mate to the relationship by re-appraising and collecting the evidence of authentic responses from that mate.

The next time you feel the need to express your fears that your mate doesn’t really love you check to see whether your insecurity isn’t already telling you the answer you fear and rejecting evidence to the contrary. Dig a little and you may be able to find evidence that shows they love you. Then, be specific and tell them one concrete thing you would like to see changed, something that bothers you. Do it in love so as to not trigger their fears that you do not love them. Be wary of listening too much to your fears!

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