Our faculty blog at http://www.biblical.edu carries my post today. Check it out to see what 3 recommendations I make to our incoming students as they kick off their MA in Counseling program tonight!
Category Archives: Psychology
Why counseling? To be fixed or found?
Chuck DeGroat and Johnny LaLonde have written a post that some might find helpful when considering therapy or counseling (I use these words interchangeably). At some point in our lives, we all feel like life is getting out of control. We need help. We begin to wonder if there isn’t someone out there who can help us. But, even as we think these thoughts, we may also think, “what is the point? How can therapy fix this problem?”
Well, to give a partial answer, check out this first post over at Q Ideas. The authors argue that we should all be in therapy. However, they suggest that the purpose of such counseling is not so much to fix our problems but to understand ourselves, to admit our weaknesses, to be “found” or known. Now, these may sound like things that only wealthy people have the time to do. And yet, I would argue that in our isolated, individualized society, the normal communal means of being understood, supported, known, etc. are not often present in our lives.
Three paragraphs in this first post jump out for attention:
Don’t I go to therapy to get fixed? Believe it or not, I don’t advocate therapy because it fixes people. Now, while some forms of therapy help people get past difficulties that stifle them (e.g. panic attacks, major depression, bipolar symptoms), Christians should recognize there is always a deeper and more transformative purpose to counsel and care.
This was the ancient art called curam animarum—the care of souls. And the wisest therapists will foster this process. Now, the vast majority of clinicians practicing today have been trained in fix-it strategies—cognitive and behavioral solution-based processes which are aimed at quick, painless fixes. This is what sells. This is what insurance tends to pay for. But there is a profound difference here—fix-it strategies try to remove pain while deep soul care attempts to learn from it. Sometimes in the process we are afforded the mercy of pain relief. But it is not the goal. And so I counsel people to search carefully, to interview therapists, to ask many good questions.
And then this reflection:
But at the same time, I’m not convinced Christian therapists do this as well as secular therapists at times. Let me explain. Many settle for what Dietrich Bonhoeffer called “cheap grace,” a quick fix approach which stands in stark contrast to the “costly grace” of searching and knowing ourselves, through exploring our stories and examining our motives. This kind of care is, indeed, much more rare. Christian counseling which is reduced to mere Bible memorization, or repentance or a behavioral regimen misses the point.
Fixed and found?
I imagine that the authors would agree that both are possible. Therapy can lead to being fixed and found, to find relief and care for the soul. Therapies that ignore the need for immediate mercy and relief are of little value. I once talked to someone who had just completed a decade of psychoanalysis (3 sessions per week!). His therapist, a well-known analyst had just released him as having completed analysis. My new friend was looking for a therapist to deal with his longstanding panic disorder. I have also seen Christian counselors who have so emphasized discipleship that they paid little attention to easy helps for their addict clients. On the flip side, simple behavior change (now that is an oxymoron!) may provide some relief but miss insight into self and what God is up to in the world. In seeking only relief, we miss out on deepening our relationships with God and others. A superficial life lived may hurt lest, but is it worth living?
Note at the bottom of the post there is a link to another post about how to choose a counselor. If you are looking for one, consider one who can have difficult conversations with you, one who does not over-simplify the problem, one who cares about your growing relationship with Christ, one who can provide ideas to bring immediate relief, and best of all, one who listens more than talks.
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When trauma isn’t “post”?
Over the last year or so I have been doing some thinking about those experiencing ongoing trauma. We talk of PTSD, Post-traumatic Stress Disorder, as a set of symptoms experienced after a traumatic event or time. But some people continue to live in ongoing trauma. I’m reading James Fergusson’s The World’s Most Dangerous Place: Inside the Outlaw State of Somalia. Early in the book, he talks of seeing “Sister Mary, a warm-hearted big-bosomed Ugandan in combat fatigues, dispensing medicines from a table in the ruins of the villa’s kitchen.” (p. 45). Sister Mary explains that there are two medical problems she sees. The one she treats most often is diarrhea. But, she says, the other problem she could not treat,
The people here are stressed, she explained. They are traumatized. They do not know where to turn.
You talk a lot in the West about PTSD-Post-Traumatic Stress Disorder…but for these people there is no “post”. The trauma never ends.
What can people do when trauma isn’t post? Do they have to wait until the traumatic experience is in the past in order to deal with it? What can we do for others who remain in precarious and life-threatening situations? A friend raised this question when working with a group of refugees in a UN temporary camp. Some of the suggestions that were given this friend
1. Helping refugees find some way to hang on to small measures of empowerment: set up classes for children, build huts for those who are just arriving, develop “positions” for adults to fill so the camp runs smoothly and has a modicum of safety.
2. Reinstate religious and cultural traditions where possible
3. Practice corporate lament along with other worship activities
4. Allow people to tell as much story as they wish, whether by voice or artistic rendering
Notice that these are finding ways to cope by (a) making the moment better and (b) bearing witness, even if they can do nothing about the crisis. When a person feels some level of ability to respond to a difficult situation, that person often experiences less trauma than those who are unable to express any agency. Further, when they feel that they matter to others (someone listened to whatever they had to say), they tend to have less long-lasting PTSD symptoms.
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Filed under Abuse, Psychology, Uncategorized
Treatment of complex trauma: Why mistrust of the counselor is necessary and good!
I am reading Christine Courtois and Julian Ford’s, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach (Guilford Press, 2013). I won’t be blogging through each chapter but I do recommend it for those working with adult survivors of child sexual abuse, especially those who are new to “complex trauma.”
The first two chapters give an overview of complex trauma reactions and diagnoses. If you want to know more about complex trauma, see this post about another edited book by these two authors. Chapter three, “Preparing for Treatment of Complex Trauma” begins the meat of the book. In this chapter they take up the ever important issue of empathy, safety, and respect as foundation to therapy. They emphasize the need for,
safety within the therapeutic relationship with a therapist who is empathic and respectful yet is emotionally regulated with appropriate and defined boundaries and limitations. (54)
Challenging Counselor Safety Is Common and Good?
This empathy and trust relationship is both foundation and method of treatment (59). But while the therapist is responsible to see that at safe therapeutic relationship has been built, it requires the client to be involved in building such an environment. The truth is that the client’s role in building safety in the counseling office is by passive and active testing of limits. Most counselors tolerate suspicious questions the first or second time. But, it is important for counselors to,
being prepared to patiently and empathically respond to active or passive tests or challenges to trustworthiness as legitimate and meaningful communication that deserves a respectful reply in action as well as in words. (60, emphasis mine)
If the therapist understands and does not take mistrust as a personal affront, the therapeutic relationship can evolve gradually. The client can begin to recognize that the therapist actually “gets” why he or she is initially skeptical, self-protective, or “realistically paranoid” and does not pressure the client to be a “happy camper” but instead works to earn trust by being honorable, reliable, and consistent. This also implies a view of the client’s initial mistrust as expectable in light of the client’s history–that is, as a strength rather than as a deficiency or pathology. (63)
Sometimes clients can present in an opposite way–to be entirely deferential and affirming the counselor before a track record can be developed. Therapists with these clients need also to be prepared to encourage a healthy level of distrust.
What is not helpful is “artificial neutrality or passive and intellectualized detachment on the part of the therapist…” (64). It is my sense that we usually do this when we are afraid of the client. Not so much afraid of being injured, but afraid of failing or being consumed by the trauma. Or, we get consumed by our own history. A healthy therapist must stay emotionally present yet aware of own internal machinations. A healthy therapist must be able to predict some of the angst that arises in treatment of complex trauma and able to prepare self and client for this inevitable distress.
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How do trauma symptoms pass to the next generation?
As a clinician, I have had anecdotal experiences that the trauma experienced by a parent is passed on to a child who presents with many trauma symptoms despite not having experienced the initial trauma. We have witnessed what looks like this kind of transmission in places like Rwanda where children born after the genocide seem to experience many of the same symptoms of their parents.
Thus far, the data about generational transmission has been mixed. Looking at 2nd and 3rd generations of holocaust survivors, some research indicates that later generations can be affected; some research indicates no secondary traumatization. The problem with this research is that much is focused on the content of transmitted symptoms rather than the process. In the latest issue of Psychological Trauma (v. 5:4, 384-391), Lotem Giladi and Terece Bell have published a study looking at both content and process of trauma symptom transmission (“Protective Factors for Intergenerational Transmission of Trauma Among Second and Third Generation Holocaust Survivors”). The authors hope to have a clearer picture of risk and protector factors. As they say,
“The research question was not whether 2G and 3G experienced greater psychopathology than controls, but rather why some of them still carry some Holocaust-related psychological distress whereas others do not.” (384)
These researchers tested whether psychological concepts of differentiation of self (a Bowen concept indicating the ability to balance need for connectedness with family and need for being a separate self) and family communication (a previous study indicated that 2G holocaust survivors suppressed communication of negative emotion around their parents).
What did they find? 2G and 3G both showed greater levels of secondary trauma than controls (though all amounts of STS were in normal range) and surprisingly, the 3G group did not show less secondary trauma than did the 2G group. Indeed, greater differentiation of the self and better family communication among the generations of holocaust survivors positively correlated with few secondary trauma symptoms.
So, how do trauma symptoms get transmitted to the next generation? We do not really know yet but one possible answer is that trauma tends to influence emotion regulation, anxiety regulation, and thus decreased self-soothing behaviors. This may get passed on to the next generation via suppressed negative feelings (children who do not want to make matters worse) and identification with the parent’s distress (and partially responsible for it).
For those readers who might wonder if their own trauma is causing secondary trauma in children, consider these things:
- Most of the 2G and 3G holocaust survivor families are not terribly harmed. Most do well. So, it is not a given that your family is being harmed by your trauma symptoms
- Open communication about the trauma symptoms and impact on family (without laying blame!) is likely helpful. Also communicate how coping with trauma symptoms can also teach a family some positive lessons as well (patience, gentleness, boundaries, etc.)
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Filed under Abuse, Post-Traumatic Stress Disorder, Psychology, Uncategorized
Tuza 2.0: Day Four
[June 26, 2013]
The conference has begun. We have 30 high level caregivers here, 17 of whom attended Tuza 1.0. One of the things we expect is that all of the planning as to how long things will take does not ensure we will be able to stay on schedule. While we expect it, it requires a lot more cultural sensitivity and flexibility than us Westerners usually like to display. When I go to a conference, I don’t want to “waste” time playing games and getting to know my neighbors. Just fill my head up with knowledge, thank you very much. But that is not the way most of the world lives. So, our conference began, appropriately so, getting to know each other. Truth be told, this kind of beginning is necessary if we are going to trust each other!
Our first session included a short review of basic helping skills followed by a roleplay with Carol King. After a large group discussion, we broke attendees up into groups of 4 to form quads (counselor, counselee, and 2 observers). Many attendees remarked at how helpful the quads were for practicing skills. It seems that most have not had this experience before.
After coffee break (coffee plus a bowl containing a little donut with peppers and carrots inside and little fried (whole) fish!), one of our attendees presented a case for large group discussion. The case was of a teen who had experienced sex trafficking and was severely wounded in an attempt to kill her.
Our afternoon session featured a presentation by Dr. Barbara Shaffer on the topic of domestic violence. She spoke about the common cycle of domestic violence (tension building–>violence–>calm), the basis for protection from the scriptures, and gave basic goals when meeting with a person who is domestically abused.
During our large group discussion, we heard from several men and women that men are increasingly abused in Rwanda society. There was some discussion about how much this is an issue. It appears that since the genocide, women have had greater need to be independent and so traditional relationships between men and women are disrupted. Women, these individuals claimed, are more likely to be argumentative than in past eras. Also, we learned that in a separation, children under 7 may be forced to go with the father (or his family) since children belong to the father and not the mother. Not all attendees agreed with this view. We ended the day with small group discussions about how to tell when a person is experiencing domestic violence and how to engage that person in some basic information gathering and invitation to talk further.
One of the major changes we have in our schedule is the fact that we decided it was important to translate in real-time. We had planned that English proficiency would be high enough to do the training in English. However, it appears that substantial concepts are being missed. Even though this doubles the time it takes to do a talk and training, we believe this is best for the attendees. We give them written text of the talk in English and at the same time give it orally in English and Kinyarwandan.
Some of us ended our work day with a fun swim in Lake Kivu. The water was a perfect temperature and clear many feet down. We swam for about 40 minutes then got ready for dinner. The swim was refreshing after a long day of concentrating and listening. Listening across accents and experiences can really wear you out.
A Funny Anecdote:
Charging phones and readers can be quite a challenge in Africa. You can have a converter and the right plug and find out that your device will not charge. For some reason, I could not charge my phone or nook while in Kigali. However, I was grateful to find that I could charge my devices in my room here at Bethany Centre. Well, last night I awoke at midnight to flames shooting out of my converter right at my head and mosquito net. I yelled, “FIRE” and quickly yanked the blackened plastic out of the wall while sparks continued to fall on flammable material. Thankfully, nothing caught on fire. I opened the patio door and threw the converter outside. My room stunk of that awful burnt plastic smell. In my stupor I wondered if I should call the front desk and ask them to make sure there wasn’t any ongoing problems with the outlet. As I stood thinking about it, I heard/saw outside flourescent lights grow tremendously brighter and then explode, first one, then another, then another. Deciding that I now needed to call the front desk, I turned the light on so I could dial the phone. The overhead light also exploded and sparks fell to the bed/net below. Again, I pounced wanting to make sure nothing caught fire. It did not. I used my phone light to dial the front desk. Minutes later, a sleepy voiced answered. I requested someone come soon to check on me and to ensure something wasn’t terribly wrong. No one came. The next morning I related my story and learned that several others had no power and their lights blew as well. Later we learned that some wires crossed and caused the power surge. It ended well and we had no further electrical problems the rest of the conference.
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Why do some spiritual leaders abuse power?
The topic of spiritual abuse has been in the news of late. In looking at the problem of cover-ups of sexual abuse within the church, we can see that not only bodies are violated and harmed, but spiritual abuse also happens to victims, their families, and those in the community who know about the abuse but are coerced to remain silent and still. Of course spiritual abuse happens outside of sexual abuse. In fact, I would hazard a guess that most of spiritual abuse happens apart from sexual abuse.
As I defined it in an earlier post, spiritual abuse is: the use of faith, belief, and/or religious practices to coerce, control, or damage another for a purpose beyond the victim’s well-being (i.e., church discipline for the purpose of love of the offender need not be abuse).
Over at www.whitbyforum.com, Carolyn Custis James is blogging each Monday about the problem of spiritual abuse. You can see the first post here along with the topics she’ll look at over the next 6 weeks. Today, she will be raising some questions about the abuser and I may comment on her site as I can [note: this is written earlier and if all happens as planned, I am traveling in Rwanda today]. For those of you who don’t know of Carolyn, she is the author of Half the Church: Recapturing God’s Global Vision for Women.
What Do We Know About Those Who Abuse?
The truth is we do not have empirical survey evidence for those who use spiritual tools to harm or manipulate others. But, we can say something about the kinds of reasons why someone might want to coerce and manipulate. We know things about this activity because we all have participated in coercive acts. We have used others for our own purposes. In the words of an old Larry Crabb book, we have chosen manipulation of over ministry to those we love. So, in this way, we can learn a bit about why some try to control others by looking at why we try to control others:
- Fear. We fear losing control, having someone disrupt our plans. We worry that we will be left, abandoned, rejected. We worry that what is important to us will not be cherished and valued by others so we seek to control the outcome. Notice that much of what we want as outcomes are good things. In spiritual matters, it is not good for people to do things that dishonor God. So, we may try to force our kids or parishioners to do what they ought to do. But force violates the picture of love God gives us in the Scriptures. He does not force us to come to him. He draws and woos us.
- Love of Power. We must admit that we sometimes control others because we like seeing the evidence of our own power. Ever had someone trying to do something to you and you wanted to prove that you could beat them at their game? Maybe you thought, “I’ll show you who’s the boss around here!” This is nothing less than a love of one’s own power. God gives us power. Power is not wrong. But the use of it to serve self (even if in the name of God) is an abuse of power. Spiritual leaders have power of words and these words can be easily used to glorify self.
- Efficiency. Power works. It gets us what we want. If the outcome is good, then the means seem good. End of story. Spiritual abuse works. People fall in line. They remain orderly and do not disturb church leader’s good goals.
- Ego. Self is part of why we treat others as objects. We think about self, needs, desires, wants, and expectations. The stronger the ego, the more confidence we have that our way of seeing the world, our expectations, our outcomes are the right ones. And the stronger our confidence, the deafer we become to other ways of seeing the world. Narcissism sometimes operates out of fear (see bullet point 1) but also operates out of arrogance and pride. We become blind to others, insensitive to needs of others. Ego in ministry is a worship of self in place of worship of God—a God who illustrates sacrificial leadership!
- Habit. I would argue that many of us engage in controlling behaviors without much thought at all. It is habit or learned behaviors from others. It is said, rather crassly, that starving people tend to starve others. It means that we who have been controlled or manipulated tend to learn the habits of controlling behavior (like tug-of-war, it is natural to pull back in the opposite direction). But in doing so we may become controlling ourselves. So, many are unaware that they may be attempting to control others. Spiritual abuse has been passed down in the name of godly leadership and so many are just doing what they learned from others.
What Can We Do From Inside The System?
There is little that we can do to stop others who want to abuse, especially when they are knowingly predatory. However, much of the above motives do not fall into intentional abuse—even the love of power. In the cases of naïve or unthoughtful abuse, we can bring truth to light in a couple of ways:
- Validate: “What?” you might be asking, “Won’t that encourage them?” On the contrary, validation often opens the validated to conversation and dialog where bare confrontation leads to defense and counter-attack. So, if you see someone who is seeking a good end (e.g., obedient children) but using coercive means, try to validate the good goal even as you suggest alternatives or point out that the means seems to be control oriented or objectifying.
- Raise questions: What outcomes are you seeking? How do you think the manipulated person might be feeling? How might you convey concern for the person as well as the situation? How might a good goal become perverted in the intensity by which we seek that goal?
- Say ouch. Sometimes just saying, “I’m hurt” can signal to some that they have over-stepped boundaries.
Not all should stay inside an abusive system. But, for those who feel they can stay, these are some of the things they can do. I would love to hear what else others have tried.
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Dr. Langberg on Dissociation (part II): DID, Principles and Cautions
Over at my other site, www.globaltraumarecovery.org, we now have part II of Dr. Langberg’s talk (March 2013) on dissociation. This video covers the concepts of Dissociative Identity Disorder (DID) and complex trauma. She ends with 10 principles and cautions for therapists working with clients who dissociate and/or who present with alternate personalities and identities.
Check out the video here. If you missed the first video or want to find other free resources, click around on that website.
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Dissociation: What is it? What can be done?
For those of you who love or are helping PTSD or complex trauma victims, you may find this video link helpful. Dr. Diane Langberg (after an introduction by me) explores the experience and process of dissociation, or “leaving” the present. She discusses why it happens and what is going on when a person dissociates. At the end of the video, she explores a few helpful ideas for helping to ground the individual in the present.
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Filed under Abuse, counseling science, counseling skills, Psychology, Uncategorized
Of dogs and addictions
Our six-year-old cocker spaniel has learned a new trick. After having lived with us for over 1.5 years, she has figured out that she can open the pull-out cabinet drawer that contains our trash. This only happens when we leave her penned in the kitchen. I suspect we left some wonderful smelling meat scraps in it one night and the desire enabled some higher level problem-solving skills (she’s not the brightest dog in the world). Now that she has learned how to do this, we’ve taken to bungy cording the drawer. A few nights ago, we forgot and came home to a mess of coffee grounds and torn up trash all over the floor.
Interestingly, our dog responds in quite a predictable manner. Normally, when we come home, she is at the door to greet us by dancing around and putting her front paws on our legs. But each time we have come home to a mess she has made, we see her cowering and ready to bolt. The last time we came home to this mess, she squeezed out the door before we could get into the house so she could run away. No, we don’t beat her. She knows she has done wrong.
I’ve wondered what goes on in her head during the time she is into the trash. Does she know it is wrong? When does she start feeling bad. The moment we arrive? Has she been cowering and feeling guilty as soon as she spreads trash around? One more funny behavior: when we send her to her crate (in the basement) for a time out, she goes right away. But then, after a bit, we see her outside of her crate but sitting patiently. Then, she’s at the bottom of the stairs looking to see if we will let her up. Then, her front paws on the first step, waiting in anticipation that we’ll say all’s forgiven.
And this relates to addictions how?
Most individuals who struggle with an addiction have the strong feeling of guilt even as they partake. Guilt rarely is enough to stop us from acting out. Even knowing that we may well be caught does not stop us as much as you might think it would. The desire to have what is right at our fingertips can easily overwhelm all sensibilities and logic–that will race back to us as soon as we finish partaking or as soon as someone finds out. Our initial response may include running away. Guilt and shame prevail for a time and then we creep back into life hoping that the troubles we have caused will blow over and life will return to normal.
Of course, we are not dogs and so we must use the gifts God has given us (a brain capable of higher order planning, the Spirit) to learn from our mistakes and misdeeds. We can
- remove ourselves from proximity to the addictive agent
- plan for accountability, especially during vulnerable times
- examine the roots, shoots, and fruits of our addictions with a trusted friend/counselor
- remind ourselves of the power to say no and the foolish, false promises of addiction
For more of what I have written about addictions and interventions search the word in the seach box at the top of this page.
Musings on Faith and Psychology 