Category Archives: Psychology

October 29, 2009 · 8:40 am

Your opportunity to help asylum seekers


For my licensed mental health readers, you might be interested in checking out Physicians For Human Rights (PHR) an organization that helps asylum seekers get proper evaluation as part of determining their application for asylum. PHR has an “Asylum Network” that you can join for free and be contacted if there is a case in your area. These are usually pro bono cases. PHR also provides an extensive guide for those doing psychological evaluations of torture and/or persecution on the website. If you are looking for something exciting to do, I would think this would be a good choice–an opportunity to immerse yourself in another’s world and to care for the “alien” among us in obedience to God. My friend who does this says that you are not required to take cases offered to you and that you determine how many cases you might want to do in a year’s time.

Check them out! I plan to join.

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Filed under Abuse, christian counseling, christian psychology, counseling skills, missional, Post-Traumatic Stress Disorder, Psychology

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October 27, 2009 · 5:48 am

Dichotomy vs. Trichotomy?


In the world of Christian counseling past, thinkers (philosophers, theologians, model builders) pondered whether it would be good to consider humanity in two parts (body/soul) or three parts (body/soul/spirit or psyche). These days I can’t recall anyone even raising this as an issue that competent counselors should consider. This absences does beg the question(s): Is pondering the substances of humanity not particularly needed anymore? Is it that our academic predecessors already answered the question?

I’m not sure but I lean to the first reason–most people think this isn’t particularly relevant to their work counseling others. I tend to agree with caveats. When I sit with someone, I try to consider their whole being. We can’t possibly discuss their body without considering their mind. We can’t possibly talk about spiritual matters without using the body. I can just imagine this. “Now, let’s discuss your stomach pain, but we will not consider your thoughts or your spiritual well-being in this part of the conversation…[room goes silent]”

And yet many counselors continue to function like this in implicit ways. The counseling professional who feels incompetent to talk about faith matters (or that it somehow violates ethics) may choose to ignore spiritual matters (e.g., “I deal with only the psyche and I leave faith matters to the pastor). Well-intended, but in denial of the whole person in front of them. Then there are those counselors who see themselves as only dealing with faith or spiritual matters; matters of the will. These counselors may implicitly neglect, even reject, the role of the body in counseling concerns.

We counselors need to consider whether we tend to neglect a part of the person in front of us when we ignore body or spirit issues. Thus, it can be helpful to examine our practical theology of persons. Note I didn’t answer the question in the title. There are a good many who do a fine job debunking the trichotomy position. However, a practical monism likely works better in the session–that the whole person in front of me functions as a unity that cannot nor should not be divided into pieces.

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October 26, 2009 · 9:13 am

PTSD and surgery mortality rates


Today I begin “Counseling & Physiology”, a crash course (6 weeks!) for my students to explore the mind/body connections and how counselors pay attention to the body even if not their primary focus.

Last week I saw this news item on my Medscape.com feed: “Veterans with PTSD twice as likely to die after surgery”

Here are some of the highlights from a research study done at the San Francisco VA and UC San Francisco:

  1. 10 year retrospective study of 1792 vets (ending in 2008). 7.8% had established dx of PTSD. On average vets with PTSD were 7 years younger than those without the diagnosis (you would think then, younger = higher survival rates). Surgeries studied were elective surgeries.
  2. 25% increase in mortality 1 year post surgery for vets with PTSD, even if surgery happens years after getting out of the service
  3. Mortality rates for these vets were higher than those with Diabetes
  4. PTSD is an independent risk factor for mortality
  5. DX of PTSD was associated with increased cardiac issues (may point to why the mortality rates are higher

Sobering research if you ask me. Let us not become lazy in our thinking. Emotional problems such as severe depression and anxiety (which PTSD tends to bring both together) have a substantial impact on the entire person, affecting every part of the person from cells to spirit. Neither let us believe that if the cells are involved in such a disorder that there is nothing that counselors can do. Clients can learn to manage and even defeat some of the symptoms of PTSD by taking control of their thought life.

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

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October 23, 2009 · 1:51 pm

The practice of unlicensed counseling


The practice of counseling, therapy, psychotherapy and other related terms is restricted to those with proper licensing in most, if not all, US states. Makes sense on most levels, right? You wouldn’t want to go to an unlicensed doctor for your appendectomy. In opposition to Holiday Inn’s ads, you wouldn’t want just anybody doing professional work on you. License control is supposed to protect the public from harm. Bad docs and bad therapists should lose their license and not be allowed to practice.

But with counseling and therapy, it gets a bit sticky. Lots of different professions do similar activities. Unlike surgeons, you have people from widely divergent schools of thought and training doing very similar things. LCSWs, LSWs, LMFTs, Psychologists, Psychiatrists, LPCs all do talk therapy. They all diagnose and intervene per their view of what is wrong and what needs to change (thoughts, behaviors. feelings, etc.).

And it gets stickier. Pastors, clergy, and religiously trained individuals do many of these as well. While they may not give DSM or ICD9 diagnoses and bill insurance companies, they do talk therapy with people who are depressed, anxious, angry, on the verge of divorce–just like all of those licensed people above.  In my world, there are pastoral counselors, biblical counselors, pastors who counsel, christian counselors, etc. Most of these in PA are not licensed by any body. (In PA we don’t have a pastoral counselor license as some states do.)

In an effort to tighten controls, there is a state effort underfoot (HB 1250) to tighten who can practice as a counselor. There were already controls but now the new bill would disallow someone like myself to hire or supervise an unlicensed (but in my opinion competent) person UNLESS they were actively in the process of becoming licensed.

Why does this matter?

1. There are many competent people doing counseling related work that are not licensed (nor could they be since their training is of a religious or pastoral nature). Should the state control these individuals? Right now they haven’t been actively going after these folk. The law will continue to remain vague: Here’s the restriction for LPC practice:

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 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. [underline indicates new change in this paragraph]

Who decides what “engage in the practice of…or use any words…” constitutes? Obviously, one cannot intentionally lie but does the term therapy indicate a license?

2. There are many who provide pastoral care who are not ordained clergy. They have graduated from seminary-based programs that are not professional counseling programs. Yes, the current standard makes clear that it does not seek to limit the work of those acting under the legal auspices of a religious institution (i.e., are ordained by the church). But, should the state regulate those who provide biblical counsel but are not ordained? As long as these individuals make clear (informed consent) what it is they do and what they do not do, shouldn’t they be able to make a living? Research indicates that lay people can have tremendous success in helping those with depression and anxiety.

I’m all for protecting the public. But while licenses limit who gets to perform certain duties, it does not eliminate unethical or harmful practice. Further, much of psychotherapy is art as well as science. Artists can learn their trade in a variety of locations. What we need to do is to make sure the public can clearly identify the kind of counseling (and limits of) each counselor does. Second, those who provide biblical counseling ought to have some authoritative body. It would be great if they were recognized and “licensed” by denominations or organizations (e.g. the AACC who is trying to do this).

But I would hate to see the many seasoned, unlicensed counselors lose their ability to ply their trade.

That raises a question of analogy. Can anyone make a legal living cutting hair for a fee without a license?

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October 22, 2009 · 5:00 am

Remembering Little Albert


The latest issue of American Psychologist has a very interesting story about the search for John Watson’s baby Albert. Remember from your Psych 101 class that John Watson, a behaviorist at Johns Hopkins in the 1920s, attempted to condition the infant to be afraid of white rats by pairing scary sounds with the presentation of the rat. Most every history of psychology tells the story how his condition fear generalized to other furry objects.

For a couple of generations the story ended there. Myths held that the mother took the child away out of her anger; that Watson later deconditioned him. Neither are true. But these researchers decided to spend a great deal of time and energy seeing if they could discover who he was. With Watson burning his own notes before his death, they didn’t have much to go on.

I won’t relay all the details here but suffice it to say they likely discovered who Albert was (Douglas Merritte) and who his mother was (Arvilla, a wet nurse who lived/worked at the university as a wet nurse after becoming pregnant out-of-wedlock for the second time).

Sadly, the boy died before he turned seven (unclear but maybe due to meningitis). So, we haven’t any knowledge of the impact of Watson’s research on him.

What I find amazing is that it was considered ethical to seek and reveal this information in today’s American Psychologist. We are called to provide the highest standards in clinical and research settings, which include anonymity. Why was it okay to reveal this information now when the person in question isn’t able to determine whether he would want this information released. Maybe existing relatives helping with the search gave permission.

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September 23, 2009 · 1:00 pm

Your choices/experiences shape your grandchildren?


Anybody see the Nova episode on PBS last night? I caught only 15 minutes of it. Apparently it aired in 2007. Here’s a transcript of it.

The part I watched was about the impact of diet and chemical exposure on the lifespan and health two generations later.Very interesting!

Check out this little snippet:

NARRATOR: The diagram showed a significant link between generations, between the diet in one and the life expectancy of another.

OLOV BYGREN: When you think that you have found something important for the understanding of the seasons itself, you can imagine that this is something really special.

MARCUS PEMBREY: This is going to become a famous diagram, I’m convinced about that. I get so excited every time I see it. It’s just amazing. Every time I look at it, I find it really exciting. It’s fantastic.

NARRATOR: Much about these findings puzzles researchers. Why, for instance, does this effect only appear in the paternal line of inheritance? And why should famine be both harmful and beneficial, depending on the sex and age of the grandparent who experiences it?

Nonetheless, it raises a tantalizing prospect: that the impact of famine can be captured by the genes, in the egg and sperm, and that the memory of this event could be carried forward to affect grandchildren two generations later.

MARCUS PEMBREY: We are changing the view of what inheritance is. You can’t, in life, in ordinary development and living, separate out the gene from the environmental effect. They’re so intertwined.

NARRATOR: Pembrey and Bygren’s work suggests that our grandparents’ experiences effect our health. But is the effect epigenetic? With no DNA yet analyzed, Pembrey can only speculate. But in Washington state, Michael Skinner seems to have found compelling additional evidence by triggering a similar effect with commonly used pesticides. Skinner wanted to see how these chemicals would affect pregnant rats and their offspring.

Application to counseling and psychology? Do you think about the impact of your behaviors and experiences on the next generation? Do you think about your grandparents choices and experiences on your daily life? Your mood? We could easily become either fatalists (I’m controlled by others) or deniers (I’m in charge of me). But consider how trauma or suffering is passed on in family lines.

Which do you tend to be? A denier or a fatalist?

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September 23, 2009 · 5:58 am

Teaching style and outcomes


My seminary, Biblical Seminary, focuses on teaching excellence when choosing new professors. We want teachers who are experts in their field but who can also teach. Hence, we had a daylong seminar yesterday about teaching adult learners. We discussed and explored a number of things (e.g., what do adult learners want, how do they best learn, the uses and limits of PowerPoint, etc.). But this one line stuck with me that I have re-written to apply to my own field:

Does how you teach counseling courses model the kind of counseling you wish your students to emulate?

For example. If humility and dialogical/interpersonal factors are big in counseling, do we teach that way or do we just do straight lecture and/or get defensive when others disagree with us?

I think we do a pretty good job with the attitudinal side of things. We try hard to model listening and humility. However, I think I still struggle with the interactive side of teaching. And here’s my defense for that struggle 🙂

1. Classes I teach tend to be higher order with complex and very specialized content (e.g., psychological testing, psychopathology, reliability, validity, research, ethics, etc. ). Some information has to be delivered by me via lecture.

2. Several of these courses last just 6 weeks. There is no time to meander and muse in these classes.

3. The emphasis on PowerPoint leads to spending inordinate time building quality slides and away from contemplating more interactive learnings.
Despite these complications I’m going to try to pay more attention to hands on learning. I want us to emulate our kind of psychological practice.

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September 18, 2009 · 5:13 am

Engaging Biblical Texts in Trauma Therapy


Today I present my 1 hour CE training at the AACC conference. In this presentation I briefly review (a) complex PTSD and its typical symptom presentation, (b) material from my recently published work on best practices for using Scripture in counseling. Then I consider the particular application to therapy with trauma survivors. The goal is not get individuals to believe the truth but to experience it via the interpersonal relationship of therapy.

If you are interested in more, see the pptx slides I have up on my page “Articles, Slides, Etc.” (# 15 on the list).

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September 14, 2009 · 11:17 am

Psych assessment and the new semester


And so we begin the new semester today. I’m teaching Psychological Assessment tonight to our advanced professional counseling students (recent grads looking to complete licensure courses). Psych assessment covers a wide variety of formal and informal assessment techniques for counselors. Among them are the use and interpretation of psychological tests. It is my experience that most people with superficial exposure to psychological tests have one of two responses

1. Inordinate value of testing and what it can do

2. Inordinate suspicion of testing and what it can do

Most of these responses come from quick reactions to some personal exposure to tests. Those who give too much value to tests may have taken a test and had it “nail” them. For instance, someone takes the Myers-Briggs (MBTI), finds out they are an INTJ and that it explains why they nearly lose their mind around their boss who is an ESFP. Those who are suspicious of testing often have had a bad experience of testing (test mis-use, a negative evaluation or they have had a course that exposes them to the weaknesses of some test construction and research.

The truth is that tests do have both limits (some way more than others) and value. Never underestimate the power to abuse a test or the data that comes from one. A relative of mine once was turned down from a job because some wacko decided he had repressed issues from a simple drawing.

However, those who say that they can get all they need from a clinical interview fail to recognize the value of learning how one functions in comparison to a large sample of peers. And several data points like that can really flesh out a personality or learning profile.

I’d be curious to hear reader’s experiences with testing (their administration and/or interpretation). Did you have a positive or negative experience and why?

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September 9, 2009 · 11:45 am

ICAT as a new therapy model?


Take any psychotherapies class and you will get your usual dose of the classic models built on grand schemes attempting to explain the meaning of life and human behavior: psychoanalysis (and later versions of object relations), humanist/client-centered, behaviorism, cognitive (and later combinations of the two), and various forms of family systems models. Students in advanced courses may learn a bit about various combinations of these models but usually such classes leave learners picking and choosing a theoretical home–or becoming eclectic by trying to take parts of each model.

But nowadays, models are built not to explain the meaning of life but to show “what works” in therapy. Sometimes model builders stumble onto a technique and then attempt to provide evidence how and why such interventions work. For example, I would classify Les Greenberg’s EFT, Francine Shapiro’s EMDR and Marsha Linehan’s DBT (though DBT has much more robust evidence supporting and has validity whereas Shapiro’s techniques have reliability but lack validity in my mind) as these kinds of models.

Now comes another model to try to capitalize on a number of proven techniques: Integrative Cognitive Affective Therapy. Right now, it seems to be used and studied for the treatment of Bulimia. But, I expect to see it grow over the years to any number of problems (just as DBT is not just used for Borderline Personality Disorder anymore).

What is ICAT? It is an attempt to improve upon the weaknesses of Cognitive-Behavioral Therapy (CBT) while maintaining the robust empirical power of the model. What are CBT’s weaknesses? Stephen Wonderlich says they are “1) a limited view of emotional responding; 2) inadequate consideration of interpersonal factors; 3) insufficient attention to therapist-client relationship; and 4) overemphasis on conscious-controlled cognitive processing.”*

ICAT attempts to improve on CBT by paying very careful attention to emotion, mindfulness, and other aspects of a person’s experience of self and world. Again, Wonderlich describes ICAT as “a collection of interventions drawn from an array of cognitive behavioral and emotion-focused therapies and based on a testable theoretical model…”

ICAT for Bulimia exists in a 21 session form as of now. It focuses on experiencing and identifying key emotions involved in the Bulimic process, making initial changes to eating habits, developing alternative coping mechanisms to deal with distressing emotions, dealing properly with desires, practicing self-regulation and challenging discrepancies between ideal and actual self. What makes it different from CBT is its focus on emotion and collaborative work between patient and counselor.

In many ways, it seems to adapt other model’s focus on validation, affect, mindfulness, and distress tolerance. Over and over it appears that understanding and addressing subtle emotional interpretations of life are the building blocks to changing pathological behaviors.This is not the first attempt to build an affective version of CBT. Some attempted to talk about constructivist CBT but that did not take hold. I suspect this model has a better chance at catching on.

*Wonderlich, Stephen (Summer, 2009). “An introduction to Integrative Cognitive Affective Therapy for Bulimia Nervosa” Perspectives: A Professional Journal of the Renfrew Center Foundation, pp 1-5.

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