Category Archives: Psychology

September 12, 2008 · 5:19 am

“I apologize for being late…”: bad behaviors by your counselor


Just skimmed, “‘I apologize for being late’: The courteous psychotherapist” (in the 2008 (v. 45:2)Psychotherapy: Theory, Research, Practice, Training, pp 273-277) by Rolfs Pinkerton. Pinkerton details how our bad behaviors can harm (gasp!) the therapeutic alliance but that courteousness and correcting the behavior can help alleviate the problem. No surprise here.

But wait, what are some of the bad behaviors (no not the really bad and really obvious ones) he’s concerned about. Let’s see how we rate:

1. Being more than 15 minutes late. Apologies help but if it is a regular problem then…

Hmm. I’m usually 5 minutes late. Does that count as bad?

2. Falling asleep or being obviously worn out.

I try to solve this by drinking caffeine.

3. Forgetting names, using the wrong one or the wrong pronunciation.

So, when I pray for my “brother” or “sister” is it obvious that I’ve forgotten their name? Actually, I do pray that way sometimes and I haven’t forgotten a thing.

4. Repeatedly checking the clock.

I have an internal clock and so I try not to ever look. Probably why I’m regularly 10 minutes behind by the end of the day. So, how much is too much?

5. Taking calls.

Never do that. But I have forgotten to silence the phone. I hate it when that happens.

6. Drinking or eating in front of the client without offering some.

Oops. Did I mention that I caffeinate? Didn’t think that was rude. Hmmm. I have clients coming in bringing their Starbucks and I never feel left out. I wouldn’t eat in front of them. Do I get partial credit?

How about you? If you are a counselor, what are your faux pas? If you ever were a client, what annoying (not illegal or immoral ones–those are pretty clear) habits irk/irked you? (Be gentle with us and be sure to protect the guilty. We’re rather fragile.)

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September 3, 2008 · 1:15 pm

Biblical Counseling is too focused on big truth?


Haven’t had much time to write of late since the pressure is on for more formal writing assignments. But, in prep for a presentation in a few weeks I have been thinking about this question. Is the biblical counseling model of change too much focused on truth? Heretical thought for some I’m sure. (For those who don’t remember I consider myself both a biblical counseling and a Christian psychologist).

Let me start with some shoddy diagrams of two classic models of change.

1. Presenting problem –>Diagnosis Made–>Counselor generated insight (reality/truth) –> Corrective action (counseling as troubleshooting ways to cement corrective action outside of session). Counseling in this model focuses on truth/reality applied to counselees life outside of session. Benefit? Problem/solution focused; objective change. Drawback? Feelings and Relational activity is minimized (though not denied). The relationship is used to get to the activity of change.

2. Presenting problem  –> Diagnosis Made (but may not be told) –>Counselor generated insight (NOT given) –>Introspection via counselor generated questions. Counseling in this model focuses on introspection and counselee generated insight. Benefit? No pressure to perform, feelings encouraged. Drawback? No real relationship focus as it is purely 1 way. No focus on objective change (assumed it will naturally happen).

So, model one is more cognitive. Model two is more dynamic. Both models want or respect the valuate of relationship but usually see it as a necessity to get to what really heals (truth or insight).

The biblical model is most like model one. In many respects, the focus on truth is good. We fallen creatures need constant reorientation. We are easily deceived. And yet, which truth? Notice Jesus with the woman at the well (John 4). He doesn’t start out with the biggest truth (she’s an adulterer). Notice that we often need more immediate truthes to be the focus. Peter needs the hand as he sinks, not a lecture. David needs Nathan’s story first. We learn that God doesn’t tell us all our sins right off the bat. We couldn’t take it. Do we in the biblical counseling world over-focus on the big truths of faith, trust, sin, idolatry, etc. that we miss the “smaller” truths that God is with us, that his hand is present right now in some small tangible way?

So, how about this model for change that is both solution focused AND interpersonal.

Presenting Problem –>Collaborative Diagnosis/Goal setting –> *[empathy ->validation ->here/now ->collaboration on meeting goals/objectives and responding to thoughts, feelings, behaviors] –> small habit change attempts –> post hoc insight.

In this model the primary work is in the interpersonal dynamics (the stuff in the brackets) and insight is more what happens after change takes place: “Oh, that’s what I was thinking then and this other way helped me to change that.” If this alternative model is a bit more accurate in portraying how people actually do change via God’s grace then this is my big question: how might this model change how we use the Scriptures in counseling.

Make any sense?  If anyone has artistic capability to render these diagrams I’d love to see how you’d do them.

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August 29, 2008 · 12:23 pm

Society for Christian Psychology Conference


Folks, those interested in the field of Christian psychology and counseling should consider making last minute plans for a September conference in Chicago. The Society for Christian Psychology: www.christianpsych.org, a division of the AACC, is holding a great conference Sept 18-20 in the northwestern suburbs of Chicago. It will be small and very intimate conference and the speakers are great. You can read more on the site but with theologians Kevin Vanhoozer andTremper Longman, and quality counselors like Leslie Vernick, Mike Emlet, and many more doing breakouts, the conference ought to be quite meaty!

So, if you want to grow in your understanding of Christian models of change, haven’t decided to go and you’ve always wanted to take a road-trip to the windy city, then take the plunge and sign up.

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August 26, 2008 · 5:34 am

On the problem of cutting: The secret under the sleeve


Writer Amy Sondova, a former student and now friend of mine, has expertise in many areas including the problem of cutting. Playing on my friendship with her I asked if she would write here just a little on the topic. Here’s what she wrote (following her bio):

Who is Amy? Amy Sondova is a writer specializing in media writing, including interviews and reviews, as well as blogging. Having interviewed over 30 of the top musicians, writers, and speakers in the Christian media, Amy has also written countless columns, reviews, and articles on various topics including mental illness, self-injury, working with teenagers, and Christianity. As well as holding a B.A. in communications, Amy holds a M.A. in biblical counseling, and has worked as a professional therapist. You can visit Amy’s blog at amysondova.comor check out her online e-zine, BackseatWriter.com, a faith-based site focusing on God, culture, music, mental health, and photography.

Cutting: The Secret Under the Sleeve

 

By Amy Sondova  She’s a cutter—one of the many in a growing community of self-mutilators who wear their pain, anger, and frustration by cutting various parts of their bodies with sharp objects.  You would not know she’s a cutter to look at her; she smiles broadly, perhaps a little too broadly at times. She seems normal if not a little melancholy.  But look in her eyes and then you will see her torment. You can always tell a cutter by the lack of luster in her eyes.

 

Cutting is a form of self-injury–the act of purposely injuring oneself using a sharp object such as a razor, scissors, knife, etc.  In addition to cutting, self-injury also includes carving, scratching, branding, marking, picking and pulling skin and hair, burns or abrasions, biting, and head banging.   Most self-mutilators are between the ages of 11 to 30 and 97% are female.  

 

Not only is cutting a stress relieving coping mechanism, but the physical pain creates a sense of livelihood, and most times physical pain is dull compared to the piercing pain in her soul.   No one can see her inner turmoil, so she has transformed her emotions onto her flesh to make you and everyone else understand that she is hurting.

 

Cutting is not usually an act of suicide.  One cutter wrote on her website, “I don’t want to die.  I self-injure to stay alive, to deal with the unbearable.  If I wanted to die, then I wouldn’t be here now” (Secret Shame, 2004.) 

 

Along with sexual and other types of abuse, there are several mental disorders associated with self-injurious behavior, which include borderline personality disorder, obsessive-compulsive disorder, post-traumatic stress disorder, clinical depression, bipolar disorder, and multiple personality disorder.  Remember, even if an individual suffers from a mental illness along with her cutting, she is more than her diagnosis.  She is human being created in the image of God.

 

The only hope for a cutter lies in God because no one can ever understand the pain except for Him. He sees the inner torments and can provide relief.  There is no hope attached to the end of the razor blade…only the manifestation of a tortured soul.  Self-mutilation is still taboo in many churches today, but as their forms fill our pristine halls, the church cannot cover its eyes any longer.  We must be prepared to minister to what many are calling “the new anorexia” before a generation mutilates itself beyond recognition.

 

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August 20, 2008 · 5:53 am

Helping with one hand, hurting with the other


As humans we have the capacity to split ourselves. One minute we can help another, the next we can harm. A friend of a friend of mine recently admitted to taking advantage of another in a vulnerable position. This person seems quite wise. He has good advice when I’m stuck. He is able to see through knotty situations. People come to him for advice and counsel. And to a person they feel the better for it. But now it is evident that he manipulated someone for financial benefit. It wasn’t illegal but certainly immoral and unethical.

How is this possible. Can salt water and fresh come from the same source? It should not be possible but it is. I meditate on this in my own life. I can be gracious to my kids one minute and harsh the next. I can heal and I can kill the soul. We all have this capacity and so we must be on guard against complacency. It is easy to stand in judgment of the one who commits a heinous crime. When this person is a believer, we begin to question their honesty and integrity and disbelieve that any good done prior to the crime was of value. And while we should do that since something was clearly wrong and somehow the person has disconnected from his/her soul, we ought also to explore our own soul for the same disease.

May God help us to be unwilling to entertain or ignore self-deception.

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August 14, 2008 · 5:28 am

Birth trauma? Maternal PTSD?


The August 5, 2008 Wall Street Journal ran a short article on a new postpartum illness akin to PTSD. The author, Rachel Zimmerman, reports that though”PTSD is commonly associated  with combat veterans and victims of violent crimes, but medical experts say it also can be brought on by a very painful or complicated labor and delivery in which a woman believes she or her baby might die.”

While Postpartum depression has received more attention of late (the paper reports the NIH statisticof 15% of mothers affected), there is some speculation that as many as 9% meet criteria for PTSD, and most of these who have given birth to children with serious and immediately life-threatening health issues. These find themselves re-experiencing the traumatic birth, avoidance of places that bring these flashbacks up, and persistent symptoms of increases arousal and hyper-vigilance. Per the article more states are now trying to screen and/or education new moms to this problem. NJ requires all mothers to be screened for depression prior to discharge.

As an adoptive father, I recall well the anxiety and hyper-vigilance of bringing home our first child when he was 4 days old. I didn’t sleep for days, or so it seemed. I worried about his breathing. I felt like I had lost my independence for the rest of my life (I was the stay-at-home dad at the time). It was an overwhelming time for us. And we were healthy, he was healthy, and we were not recovering from the trauma of even a normal birth.

So, I can well assume that if you add all of the normal birth trauma plus medical crises, helplessness, etc. that these experiences can result in symptoms like PTSD. I would suspect, however, that for most people these symptoms would dissipate quickly, especially if the medical crises passes in a day or two. So, we should be careful not to overreact to transitory symptoms and medicate everyone with a struggle. If it is PTSD, then the symptoms should persist for more than a month.

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August 8, 2008 · 5:07 am

APA’s resolution on religious, religion-based, and/or religion-derived prejudice


Just got my 2007 annual report from the American Psychological Association. I rarely read this thick document except for the ethics violation reports. But I saw that the board and council passed the above-named resolution. Some key passages to consider in the long document:

Prejudice based on or derived from religion and antireligious prejudice has been, and continues to be, a cause of significant suffering in the human condition. …

Prejudices are unfavorable affective reactions to or evaluations of groups and their members…

…it is a paradoxical feature of these kind of prejudices that religion can be both target and victim of prejudice, as well as construed as justification and imperative for prejudice. The right of persons to practice their religion or faith does not and cannot entail a right to harm others or to undermine the public good.  …

While many individuals and groups have been victims of antireligious discrimination, religion itself has also been the source of a wide range of beliefs about and attitudes and behaviors toward other individuals…

Allport and his colleagues observed that the relationship between religion and prejudice is curvilinear rather than linear, with highly religious individuals having lower levels of prejudice than marginally religious adherents.

It is important for psychology as a behavioral science, and various faith traditions as theological systems, to acknowledge and respect their profoundly different methodological, epistemological, historical, theoretical, and philosophical bases. Psychology has no legitimate function in arbitrating matters of faith and theology, and faith traditions have no legitimate place arbitrating behavioral and other sciences.

The document goes on to list multiple “whereas” and “therefore be it resolved” statements. The gist of which is to say, don’t discriminate; respect religion and spirituality; avoid prejudice; give no preference (as an Association to either belief or unbelief; recognize that psychology and religion cannot adjudicate either party’s tenets (but psychology can comment on the psychological impact of spiritual beliefs and religion can comment on theological implications of psychology); and try to collaborate if you can.

Problems galore despite their effort not to just paint religion as the bad guy. I’ll post just two. First, what is prejudice? They mention it as an “unfavorable affective reaction.” Okay. So, if I gently and cognitively say that my faith disapproves of certain behaviors or beliefs and based on those differences I decide not to hire you in my private, faith-based school, is that prejudice? I think some would say so. Currently, the debate over the appropriateness of having someone seek counseling to change sexual orientation has plenty of folk arguing that the problem is not affective but cognitive. If you believe you can or should change your orientation then you are accepting dominant prejudices.

Second, the whole document stinks of the separation of science and faith–as if science is all empirical and faith is all unsubstantiated belief. Also, what do those psychologists do who find themselves well trained in both worlds. It would seem from this document that the psychologist training trumps theological training. Again this is thought to be best for “the public good” and yet they do not recognize this as value, non-emprically based statement.

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August 6, 2008 · 10:59 am

The root of conflict in couples?


We often say that most conflict between spouses boils down to money, sex, or power–and the first two are also all about power in the relationship. I think that is true. But, don’t forget that the power struggle may be less about the two people and more about a life-long pattern of feeling powerless  and unsafe in the world. In psychology terms we talk about this as the lack of secure attachment.

Here’s a few summary statements about attachment that I wrote up some time ago. I have no idea where these thoughts came from or why I wrote them so I apologize now for plagarizing them. They may well be my own thoughts or someone else’s…

1. Attachment injuries are often the culprit behind continuously conflicted couples.

2. Fights, then, are more symbolic than content driven.

3. Attachment insecurity precedes most conflict: the feeling of being alone, abandoned, rejected, etc.

4. Injuries usually are trauma based (or the perception of) in the present marital relationship or much earlier in childhood. There is a “violation of connection”

5. Two common problems result: (a) numbing, and (b) obsessional repeating/self-reminder of the experience of the violation. (example: the person repeatedly recalls the time 5 years ago that their spouse treated them as an object)

6. As a result of #5, the person experiences (a) and increased desire/”need” for a safe haven, but (b) lacks trust in the spouse, and (c) is vigilant for any sign of relational danger (i.e., reads ambiguous data in the worst possible manner)

7. The other spouse feels pushed/pulled at the same time and commonly physically and/or emotionally withdraws

8. The cycle perpetuates itself allowing both parties to solidify their labels for each other

9. The GOAL of therapy is to get a commitment to stop the cycle/script and to have each party soften towards each other so as to see the desires behind the emotion/behavior. If couples can see beyond the criticism or withdrawal to common desires of intimacy, they may be able to re-interpret and validate that desire while at the same time supporting a healthier way of expressing that desire.

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August 5, 2008 · 5:34 am

Like a kid in a candy shop


I got two books in the last week that are like candy for me:

1. A Year with CS Lewis (Zondervan). My friend John Freeman gave it to me as a gift. Daily readings from Lewis. Can’t wait to get started on it.

2. Clinical Supervision: A competency-based approach. Yes, really, I’m excited by this. Saw a copy at my friend Mike Emlet’s office and had to get my own. This book has great assessments for both supervisees and supervisors. One of the most important parts of counseling training is the supervision. And many times it is the weakest since many do not know how to supervise well. I’m hoping to get some good ideas from this to help our students make the most out of their internships.

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July 28, 2008 · 5:47 am

What makes you feel like a ______ (man/woman)?


In a weak moment last week when I couldn’t take NPR or news radio I surfed the local radio stations in my car. Here are two phrases I heard in the span of 5 minutes. I have no idea who the artists are nor am I all that interested…

“Man, I feel like a woman.”
“I’m yo man…” (but something about needing to get down at her place because he had a girl at home)”

Suffice it to say I’m not going back anytime soon to the music on the radio. But, I will admit it got me thinking about how we know what feelings are quintessentially male or female. In the first song the woman feels like a woman because she has the power of attraction but does her own thing. In the second song, I assume the male singer feels like a man because he can sexually please a woman all night long.

What makes us male or female? (No, I’m not talking genetics here.) Sometimes we look at behaviors and interests. Sometimes we look at attitudes or attraction to the opposite sex. But most of the time I think we look at how others perceive us. If they treat us the way we think our gender should be treated (or, is commonly treated even if we don’t like it), then we feel like our gender. When we are invisible to others, treated differently (or so we perceive) based on our interests, behaviors, body type, etc. then we may feel that we are not like most of our gender.

Why is this important to consider? I have clients who have wondered about their orientation due to their feeling different than most of their friends of the same gender.

The simple answer is to assume that God makes a diverse group of males and females and that we ought not interpret our differences as having that much meaning. Of course, we rarely find the simple answer helpful. So what are we to do when we do not feel like others of our gender? Is this a big issue out there or just something we counselors see?

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