Category Archives: Psychology

September 14, 2012 · 3:46 pm

Thomas Szasz, critic of psychiatry, dies


Did you see the obituary notice for Thomas Szasz, a 92-year-old psychiatrist who made it his life’s work to attack his own profession? If not, read the NYT’s article here. Szasz’ beef with psychiatry centered on two complaints: the diagnostic system treated individuals as having “things” rather than describing what they do (thus making it seem like people have diseases AND the coercive nature of treatments (forced treatment and meds for psychotic individuals.

What makes Szasz important to Christian counseling is that many biblical counselors and nouthetic counselors touted Szasz in their criticism of secular psychology and psychiatry. The Bobgans and Jay Adams used Szasz quotes to bolster their own criticisms.

How he was right AND wrong about diagnoses

Szasz was right in that DSM diagnoses tend to treat problems as discrete disease states when in fact they are descriptions of clusters of symptoms. More Venn diagram than discrete thing. Yet, Szasz and his ilk often used examples of diagnoses that he thought were not disease states. Well, some of these diagnoses have turned out more disease than not disease. Take ADHD for example. Many critics complained that there wasn’t anything that could be seen under a telescope…thus ADHD isn’t a real disease. Well, we can see significant differences in brain activity in the frontal lobes of those carrying the diagnosis. While we can’t yet point to a specific cellular structure or gene (and we likely never will since it is more complex than just biology), we are understanding the biological aspects of a number of mental health diagnoses.

Szasz was right that some portions of psychiatry treated those diagnosed as victims and ignored responsibility. Interestingly, as our understanding of genes and brain functioning have improved, the victim mentality has decreased. We are doing better in identifying responsibility even as we are more articulate about the effects of the Fall on the body.

We should thank critics like Szasz for pointing out serious flaws in the foundation of mental health philosophy and practice. And yet we should avoid the all/nothing approach that Szasz and his opponents took in criticizing or defending psychiatry. One common human reaction is to either (a) always look to be the critic, or (b) always look to explain away criticism. Both responses are normal but disastrous to helping others.

3 Comments

Filed under History of Psychology, Psychiatric Medications, Psychology, Uncategorized

Tagged as , ,

September 7, 2012 · 3:49 pm

What is it like to go to war? Book note


Just began reading Karl Marlantes’ What it is Like to go to War (Atlantic Monthly Press, 2011). If you have loved ones who have served in combat I highly recommend you read this to understand a bit of their experiences. Karl Marlantes is a veteran of the Vietnam War and in this book details the spiritual and psychological impact of killing and combat. While his view of God would vary from most Christians, I think most believers will find his descriptions of war’s destruction on a person very accurate.

Marlantes considers the spiritual nature of war,

Many will argue that there is nothing remotely spiritual in combat. Consider this. Mystical or religious experiences have four common components: constant awareness of one’s own inevitable death, total focus on the present moment, the valuing of other people’s lives above one’s own, and being part of a larger religious community such as the Sangha, ummah, or church. All four of these exist in combat.

Most of us, including me, would prefer to think of a sacred space as some light-filled wondrous place where we can feel good and find a way to shore up our psyches against death. We don’t want to think that something as ugly and brutal as combat could be involved in any way with the spiritual. However, would any practicing Christian say that Calvary Hill was not a sacred space? (p. 7-8)

Just prior to this quote he tells of a harrowing experience where he was in charge of a small band of men defending US interests with no opportunity for backup. Decisions he made led to the deaths of enemies and fellow marines. In a break in the action, a chaplain was flown in bringing, “several bottles of Southern Comfort and some new dirty jokes.” (p. 7) He tells how this “help” wasn’t what he really needed,

I felt responsible for the lives and deaths of my companions. I was struggling with a situation approaching the sacred in it terror and contact with the infinite, and he was trying to numb me to it. I needed help with the existential terror of my own death and responsibility for the death of others, enemies and friends, not Southern Comfort. I needed a spiritual guide. (p. 7)

Consider the book if you live with, love, or work with a veteran of combat.

2 Comments

Filed under Post-Traumatic Stress Disorder, Psychology, ptsd

Tagged as , , ,

August 24, 2012 · 10:10 am

Forgetting Abuse? Some thoughts on motivated forgetting


Could someone really forget something as horrifying as a rape or sexual abuse? How come some people say they never stop reliving a bad experience while others say they have forgotten and cannot remember what happened? How do we best understand these two, seemingly, opposing reactions?

In a previous post I began a short series on the controversies of repressed and recovered memories. In that post I made a few general comments about the nature of memory. It isn’t a particular structure or substance or even stored as one discrete movie but rather is a whole brain process connected to context, mood, and self/other-perception. Memories do not exist outside of narrative or story (unfortunately for those with traumatic histories, these narratives are usually quite jumbled up making it difficult to tell the story well). In general, stories help us remember and remembering tells a story.

In this post I want to address the matter of forgetting abuse. Is it possible? The short answer is yes. Common to forget all of it? No. Common to forget portions? Yes. And even more common to have the experience of a new memory even without ever having forgotten the abuse (this I will address in the next post). It is possible to forget, to no longer have access to one’s own history. But, the bigger question is “how” and “why” rather than “if”.

Complicating factors

Laboratory studies re: memory cannot replicate the experience of sexual abuse or trauma. Thus, we have some rather weak experiments or post hoc, retrospective studies. What these studies point to is that (a) most people don’t forget entire episodes, (b) some forgetting does happen, and (c) some confabulation or memory error also happens (e.g., eye-witness accounts are more frail than we imagine them to be). But even when we get a good study, we find it hard to apply the information to real life. For example, one retrospective study located a number of child abuse victims decades after their ER visit to a hospital. A goodly number denied ever having been abused. While the study could reveal some form of forgetting, we might also be witnessing lying and/or alternative interpretations.

So, we have to admit at the outset we have a large supply of anecdotes of full forgetting, partial forgetting, and no forgetting, and an equally large supply theories and explanations based in part on experience and low power correlational studies. Now, anecdotes and poorly supported theories aren’t reasons to doubt the reality of forgetting trauma (or the reality of false recovered memories). They are, however, good reminders to be wary of applying some general knowledge as complete answer to any specific case. Each case of forgetting trauma needs to be evaluated on its own merits (more on this when I get to a post on clinical/practical interventions).

One more complication. Adults who reveal child sexual abuse experiences rarely have any corroborating witnesses or forensic evidence. They have their memories and that is about it. Families, offenders, and communities have much to lose to admit such abuse could have happened. Thus, outside therapeutic environments, adults have few opportunities to be heard or believed.

By what mechanism do we forget traumatic experiences

“Normal” forgetting happens in a variety of ways. Each of these may be a partial answer as to why someone might forget something very powerful.

  1. Distraction leading to failure to encode. If you are introduced to someone and immediately forget their name (happens to me ALL the time), it is because the information never got encoded (too distracted by preparing to say my own name??). Distractions may come in the form of attending to something very specific or not attending to anything at all. Some victims of abuse report that their memories are fuzzy because they could only focus on the flower pattern on the wall during the actual abuse.
  2. Other memory intrusion. A previous memory may interfere with the clear encoding of a new memory or a new memory may interfere with the recall of an old memory. Victims of extended abuse often report difficulty in remembering when it started and stopped, who was present, etc., especially when  the perpetrator also provided more normal love and attention. The memories (and their competing narratives) make it hard to remember.
  3. Motivated Forgetting. I like but hesitate to use this term. “Motivated” could sound like “willful” or “intentional.” And while some motivated forgetting is intentional, most just happens outside the conscious experience of the one doing the forgetting. If I have a conflict with my wife and I spend the next 5 hours rehearsing her supposed sins against me, I may have difficulty recalling my own misuse of words. I may not consciously say to myself, “I am going to do this so I won’t be able to remember my angry words to her,” but I am engaging in what I call “motivated forgetting.” Obviously, abuse victims would rather NOT remember what happened to them and would rather maintain a positive view of a loved one who did the abuse. Victims may encourage motivated forgetting through several means (again, without conscious decision): repeating a false narrative (“He didn’t mean to do that and I am at fault.”) created by themselves or others, using conscious decision not to think about an event, dissociating during abuse and then dissociating when not being abused, focusing on another possible threat.

Now, these forms of forgetting may not sound like they would lead to the complete forgetting of an event. And that would be true for the vast majority of abuse victims. But, I think we need to remember that it is possible given enough anecdotes of some who recover memories (apart from suggestion by therapist or others) on their own and that do get corroborated by others. Is it common? No. Can mental health professionals cause false memories? Yes (but that is for another post in this series!).

So, why do some remember minute details of trauma? They rehearse them (whether they want to or not). Why do some forget them? Their memories degrade due to forms of memory loss discussed above. Other factors are also likely: natural capacity to dissociate, age/development of victim, culture where abuse took place (e.g., a one-time event in a rather safe environment will have a different impact than repeated experiences where safety has never been present).

In my next post I want to take a few minutes to discuss dissociation, repression, and the experience of re-remembering child abuse later in life.

3 Comments

Filed under Abuse, christian counseling, christian psychology, counseling science, memory, Post-Traumatic Stress Disorder, Psychology, ptsd, Uncategorized

Tagged as ,

August 20, 2012 · 2:33 pm

Of Babies and Bath Water: Navigating the Controversies of Repressed and Recovered Memory


Recently I ran a conference about abuse within the church. In these kinds of venues (this blog and conferences) I am asked about a couple of related problems—the problem of false memories of abuse and the reliability of recovered memories of abuse.

While I intend to address these matters here (and in future blogs), I want to reiterate something that I think gets lost in most conversations about recovered and/or false memories.

Sexual abuse is real. The vast majority of adult reporters of abuse during childhood never forgot the details.

Why say this first? Discussions of rare and extreme cases (i.e., repressed memories, recovered memories, and false memories) tends to create undue suspicion for all adults who choose to reveal their child abuse later in life. It is my experiences that conversations about false memories or recovered memories lead many to assume that a report of extensive or horrific abuse is probably false. So, let us remember that as we take up the matter of fully repressed memories of abuse, we are talking about a very small percentage of people.

But, the issue of repressed and/or recovered memories and the construction of false memories is indeed worthy of a careful review given the strong feelings on both sides of the recovered memory debate. In order to be as careful as possible, I want to consider a few topics that may help us understand the issue. First, I will explore foundational topics (memory, forgetting, repression, and dissociation). Then,  I’ll explore the how trauma is known to create confusion, self-doubt, and “motivated” forgetting. Finally, we’ll take up the practice of counseling victims of sexual abuse and the particular matter of dealing with memory retrieval in counseling. Strap in!

Just in case you NEED to know my opinion at the outset…

I find Partlett and Nurcombe’s 1998 summary of an APA report on the topic to be fairly comprehensive,

The plain point here is the consensus set forth by the Working Group:
1. Controversies regarding adult recollections should not be allowed to obscure the fact that child sexual abuse is a complex and pervasive problem in America that has historically gone unacknowledged.
2. Most people who were sexually abused as children remember all or part of what happened to them.
3. It is possible for memories of abuse that have been forgotten for a long time to be remembered.
4. It is also possible to construct convincing pseudomemories for events that never occurred.
5. There are gaps in our knowledge about the processes that lead to accurate and inaccurate recollections of childhood abuse.[1]

I would add one more point: most people (myself included) in this debate are motivated by strong feelings as well as “facts.” These feelings may be the result of experiences with those who appear to be abused or appear to be falsely accused.

Issue one: Memory and Memory Retrieval

Let me start by stating the obvious: this isn’t a neuropsychology primer on memory and I am not an expert in memory. However, there are a few things on which I think we can agree:

  1. memory is a whole brain biochemical process. While structures like the hippocampus are clearly involved in memory storage, no one structure handles all aspects of memory storage or recall.
  2. memory is multi-faceted. Researchers differentiate between recognition and recall memory, explicit and implicit memory, short-term, long-term, and working memories…and much more.
  3. memory-making is a process.  The formation of memory requires attention, perception, encoding, storage, and retrieval. Thomas Insel calls it a 5 act play. A person moves from perception to long-term encoding to retrieval and finally, expression of memory.
  4. relational and affective context influences memory formation and memory retrieval
  5. the act of recall may change memory,

The concept is simple: memories are not fixed; they are periodically retrieved, and modified each time they are retrieved. This process of strengthening a memory by retrieval is called reconsolidation. One profound implication of this concept is that what you recall is not only a reflection of what you first learned, but also a product of each time you have recalled the original information.

How does this relate to our issue of recall of abuse?

  • memories are both fragile and yet not so. You recall what the house you grew up in looks like, even if you haven’t seen it in 30 years. And yet, your recall may or may not be particularly accurate. You may remember a large house even when it is much smaller to your adult eyes.
  • repetitive recall along with high levels of emotion may solidify memory. Most of us know exactly where we were on the morning of September 11, 2001.  You remember this because you talked about it, played it over in your mind, and because of the powerful biochemical process kicked off when you heard of the first plane crashing into the twin towers.
  • Most child sexual abuse has little corroborating evidence, especially when revealed decades later. This leaves victims by themselves to sort through the narratives they and others tell about their history.  The result? Ample opportunities for both denials of actual abuse as well as false memory.

Return with me to my first point. Most child sexual abuse is never fully forgotten. Some memories may be lost, others distorted, still others intentionally forgotten. Memory, as we have seen here is not a structure but a narrative.[2] In most cases, the story being told has much merit, even if some important details are perceived rightly. Thus memory retrieval during therapy (something that WILL happen whether therapist or client wants it) plays a powerful role in the re-storying work of therapy.

In my next post on this topic, I will make some comments about forgetting, motivated forgetting, dissociation, and repression.

[1] Partlett, DF & Nurcombe, B (1998). Recovered memories of child sexual abuse and liability: Society, science, and the law in comparative study. Psychology, Public Policy, and Law, 4, p. 1273

[2] “Rememberings—whether valid or invalid—are communicated by means of narratives.” Sarbin, TR (1998). The social construction of truth. Journal of Theoretical and Philosophical Psychology, 18, p. 145.

11 Comments

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

Tagged as , , , ,

August 15, 2012 · 8:12 am

The Cost of Reconciliation: Adding Insult to Injury


It is time to get back into the swing of writing again. Regular readers will note I have take a vacation from blogging. During my time off I have enjoyed reading about Powell’s trip down the Colorado River, a couple of books about the DRC, and a counseling book which I plan to review this fall.

But, before I start my own writing, I want to draw your attention to this short post on reconciliation. I have just one added note to this post. The choice of becoming vulnerable must always be made by the victim. Any forced reconciliation continues the abuse and is false through and through.

The Cost of Reconciliation: Adding Insult to Injury.

What do you think?

5 Comments

Filed under Abuse, christian counseling, christian psychology, Psychology

Tagged as

July 31, 2012 · 4:39 pm

Critical Incident Stress Debriefing: Does it work?


As someone who wants to advance faith-based global trauma recovery efforts, I am always on the prowl for effective interventions that could be sustainably used by local caregivers. However, it is always important to ask whether a popular or up-and-coming intervention has been fully vetted. Sadly, “does it work?” and “does it work here?” are often not fully answered before an intervention is promoted as the next best thing.

One of the most popular forms of immediate trauma intervention is called “Critical Incident Stress Debriefing,” a one time group intervention designed to forestall long-term trauma due to stressors. When you think of CISD, think of interventions with police or fire fighters or military after a traumatic experience.

But, does it work? This post here provides a helpful summary of the critique, even though it was published 2 years ago. As I read this I remembered an American Psychologist article on the same topic–but for the life of me I can’t find it. My recollection of this fantasy article is that these interventions seem to be helpful for about 50% of those who participate but that at this point it is not possible to tell which 50% will find it helpful. And further, a portion of the other 50% are actually harmed by it.

 

 

6 Comments

Filed under counseling, counseling science, counseling skills, Psychology

Tagged as , , , , , ,

July 27, 2012 · 9:54 am

Slides for Abuse in the Church available here


For those of you who attended or are interested, all PowerPoint slides for our recent Abuse in the Church: Biblical, Legal, & Counseling Perspectives are now available. In the future, we will also make available the audios and video…but that will take a bit of time since we are doing the editing in-house.

The slides from my talk can be found separately on this site. Click the “Articles, Slides…” link at the top of the page and then scroll to the bottom for one file containing all 4 slide sets. Boz Tchividjian’s are made available here (PLEASE NOTE: DO NOT alter or disseminate these slides without Boz’ permission–contact www.netgrace.org):

Plenary One: Offenders in the Church BT

Plenary Two: Minimizing the Opportunities BT

Breakout: When Faith Hurts BT

Leave a comment

Filed under Abuse, biblical counseling, Christianity, counseling, Psychology

Tagged as , , , ,

July 26, 2012 · 9:59 am

What is therapeutic presence?


If you go to a counselor, you’d probably prefer that person to be awake versus asleep, to pay attention to you versus check their smart phone, to respond to what you are talking about versus make non sequitur responses. As I’ve noted here before, it is probably better to have a counselor who cares about you than one who has a big bag of techniques–though most of us would prefer our counselors to care AND be competent.

Therapeutic presence is a way of talking about the act of being with our clients in such a way as to build safe, trust-filled relationships where clients can grow and change. I think most people can easily identify failures of therapeutic presence. Try these on for fun:

CLIENT: I’m just so depressed.

THERAPIST: You think you are depressed? Let me tell you about depression. I have a client who just lost job, family, church, home. Now, that is something to be depressed about. You just had a bad day, that’s all.

Or,

CLIENT: I don’t understand why God would take away this job from me.

THERAPIST: Well, theologically speaking, God does things for all sorts of reasons. He sometimes does this to cause us to trust him more, to reveal some sin, to give him glory.

Notice how both responses fail miserably to be either therapeutic or present with the person in the moment of counseling. Not hard to miss, right? So here’s a question: Why do so many of us counselors, even seasoned ones at that, fail the “presence” test?

My answer? When we fail to be present in helpful ways, it reveals a lack of preparation and a lack of attention to purpose.

Shari Geller and Leslie Greenberg (in Therapeutic Presence: A Mindful Approach to Effective Therapy. APA, 2012) define the building blocks of therapeutic presence as

    • how therapists prepare for being present (in personal life and in session)
    • the process (or therapist activities) of being present (aka purposing to be present)
    • the experience of being present

Sound like mumbo-jumbo? Here’s another way of putting it. What does a counselor need to do to be ready to be in tune with their clients? What do they do to stay in tune when with clients, and are they aware of when they are failing to be in tune? (If I am unaware, then I am likely to get out of tune.)

Here are some things counselors ought to be asking themselves:

  • Do I have adequate space to move from my private life to being present with my clients? Do I have enough space between clients? The answer is not always an amount of time, but what we do during the space between.
  • As I prepare for sessions, what am I meditating and praying about? For example, if I pray for clients to be free from something that has them bound up, I could accidentally encourage myself to push for change or to talk about a subject that the client is not able or ready to talk about. I’m all for praying for healing. I just think we have other prayers to pray as well. “Lord, help me to be with the client today and not focused on my own personal goals for them.”
  • Am I staying present with their mood, their cognitions, their silences in such a way that it is as easy to talk about what is happening in the session as it is to talk about what happened in the past or might happen in the future?
  • When I sense a disconnect, am I quick to invite dialogue and learn (vs. avoid or defend/explain away)?

Therapeutic presence isn’t everything. I could be present with someone and no healing might take place. But without therapeutic presence, I will only be a barrier to whatever growth is taking place. When I do it well, I imagine that I might see just a tiny glimpse of how Jesus was with the woman caught in adultery, the Samaritan woman, or with Peter after he had abandoned Jesus.

1 Comment

Filed under biblical counseling, christian counseling, christian psychology, Christianity, counseling, counseling skills, Psychology, Uncategorized

Tagged as , , , , ,

July 14, 2012 · 3:02 pm

Info for those wanting to serve veterans and their families


I recently watched a 2 hour CE (made free by the APA until 12/31/12) about the common stresses of military personnel and their families. While it didn’t have any information on particular counseling interventions, it did do a decent job giving a brief overview of military lingo and differences between the branches (e.g., why you would NEVER want to refer to a Marine as a soldier). The speaker is from the Deployment Psychology training institute and that site will provide you with ample clinical training continuing education. Some of the on-line trainings are free (unless you want CE credits).

Leave a comment

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

Tagged as , , ,

July 2, 2012 · 10:12 am

2nd Post: Can Your Body Make You Sin?


Over at Biblical Seminary’s Faculty Blog you can read my second of two posts on the topic of bodily weakness, sin, and culpability. I conclude with the realization that there is something more important in this conversation than ascribing blame or parsing fault.

I’m curious about your thoughts. How much does culpability really matter when determining your response to those whose bodies seem to cause them to sin?

1 Comment

Filed under counseling, Doctrine/Theology, Psychology, Uncategorized

Tagged as ,