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Heal thyself? Do we have the capacity?


Those who follow the Christian faith wholeheartedly believe that God is the “great physician” and eschew the belief that humans heal themselves. As a result of this belief, Christians sometimes react rather strongly to humanistic language of “self-healing.”

But before you do, consider this: if we assume that God is indeed the creator of all things, then we must also assume he puts into place the many corrective features found in the body. The liver and kidneys remove toxins from the body; blood clots when we cut ourselves; we sneeze to get rid of irritants; we sleep to rejuvenate what has become run down. In better words, Richard Mollica says,

This force, called self-healing, is one of the human organism’s natural responses to psychological illness and injury. The elaborate process of self-repair is clearly seen in the way physical wounds heal. At the moment of injury, blood vessels contract to staunch bleeding. Chemical messengers pour into the tissue, signalling a multitude of specialized cells to begin the inflammation process. White blood cells migrate into the wound within twenty-four hours, killing bacteria and triggering a process of cleansing and tissue repair. A matrix of connective tissue collagen is then laid down, knitting together the ragged edges of the wound in a repair that may not be perfect but is highly functional. (p. 94)

He goes on to say,

The healing of the emotional wounds inflicted on mind and spirit by severe violence is also a natural process.

I find his writing on this subject rather helpful. Sometimes we look passively to God to resolve our traumas, as if it were entirely up to Him. Other times we either resist what we can do or attempt what is not healthy for us. Dr. Mollica (an MD) provides many examples in his book of how the body naturally tries to heal/respond to trauma (e.g., DHEA counteracts toxicity of too much cortisol), where the system goes wrong, and what we can do about it from a therapeutic standpoint.

Dr. Mollica is right in that our bodies are designed to respond well to traumatic experiences. However, I’m pretty sure he also agrees that we are not designed to do this unassisted. The community must participate in the process. We are social beings and thus our healing must be socially situated.

Two Toxins: Emotional Memory and Poor Storytelling

Part of the problem, says Dr. Mollica, is the emotional memory system. When we experience a trauma, our cortex forms declarative memories of the event. These are where we store the “facts” (where we were, what we felt, and how these events connect to previous experiences). But there is another memory system, one he calls “emotional memory” (p. 96). Declarative memory involves the cortex and hippocampus while emotional memory involves the amygdala.

The amygdala is the fear-response command center of the brain, and it does not wait around for the conscious mind, located in the cortex, to decide if a threat is real or not. The amygdala can activate an emergency response throughout the body within milliseconds by calling the stress-response system into play.  (p. 96)

Unfortunately, traumatic events can create emotional memories in the amygdala that keep on replaying and are difficult to extinguish over time. (p. 97)

Another toxin is the re-telling of the trauma story in a way that retraumatizes the victim. Dr. Mollica, in chapter 5, describes the problem of poor storytelling. Poor storytelling evokes only the trauma, the shame, the degradation experienced. Storytelling should cause us to form images in the teller and listener’s minds. These images need to symbolize the whole person/story and not only the most damaging details. The problem is we tend to tell stories that fixate on the intense emotions and thus elicit toxic emotions and maintain the experience that the trauma is still ongoing.

Many traumatized persons are plagued by the two poles of humiliation–sadness and despair on one side, and anger and revenge on the other. (p. 122)

Assisted Self-healing?

Mollica says, “A proper clinical approach to emotional memory avoids triggering the emotions stored in the amygdala and enables the cortex to assert conscious control over the recollection of traumatic events. (p. 97)

How do you do this? With the help of a storytelling coach, a person tells their story in a factual, direct, but not grotesque way that would cause the listener to turn away. Why does this matter? Because part of the healing process is to be heard, seen, and empathized with. Fixating on the most grotesque details only enhances the emotional memory system and pushes others away. Good storytelling still tells the truth but does so in a way that reconnects people with the world, enables them to feel sadness but in community with others, and helps them see that their lives are not solely defined by the traumatic events. Further, good storytelling points to larger values that are still held and not lost due to the evil done by others. Surely trauma does shape and change us. Recovery and healing to the point of living as if the event did not happen would be to live in a world of denial and self-deception. But good storytelling reminds us that we are not ONLY defined by and/or limited to being victims. And good storytelling reminds us of God’s sustaining power that is greater than those who can only destroy bodies.

Dr. Mollica summarizes this chapter this way,

Strong emotions comprise the traumatic memories that are imprinted in the survivor’s brain. One of the mind’s key tasks after trauma is to take these strong emotions and gradually reduce them over time through good storytelling. A poor storyteller tells a toxic trauma story, unhealthy to mind and body with its focus on facts and high expressed emotions. In our society situations that demonstrate this type of storytelling are common, including superficial, sensational media reporting of tragedies and debriefing therapy by misguided mental health workers. In contrast a good storyteller is able to express tragic emotions with the artfulness of a musician playing an instrument, engaging the listener’s interest and involvement. (p. 133)

I commend to you the book. He discusses both good and bad dreams, the role of “social instruments” of healing and a call to health. Very helpful book if you are interested in international trauma recovery.

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The real damage done in abuse?


I’ve written before on the damage done when a community fails to respond to abuse in a justice oriented way. But here is a more succinct and apt quote by Miroslav Volf:

If no one remembers a misdeed or names it publically, it remains invisible. To the observer, its victim is not a victim and its perpetrator is not a perpetrator; both are misperceived because the suffering of the one and the violence of the other go unseen. A double injustice occurs—the first when the original deed is done and the second when it disappears. (italics mine)

Abuse victims sometimes tell us that the most significant damage to them is when community members (family, leaders, peers) fail to “see” or act justly when they hear of the abuse. It was bad enough to be sexually abused (yes, that is real damage too) but far worse to be told it didn’t happen or be told to take it for the sake of the larger community (e.g., you wouldn’t want to harm his reputation, destroy the family, cause others to fall away from Christ, etc.).

I saw this quote in the first pages of The Long Journey Home: Understanding and Ministering to the Sexually Abused, to be released soon by Resource Publications, an imprint of Wipf & Stock. I have the typeset PDF and the editor, Andrew Schmutzer, says the book will be released in August. This book (over 500 pages!) may become the place to turn for Christians seeking to understand the scourge of sexual abuse in all its ugly forms. Chapters are written by those who are expert in the social sciences, theology, and pastoral care. The line up is phenomenal. You can see the title page/table of contents (TOC Long Journey Home) to see the gamut of chapters and authors.

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Must read on preventing child abuse in christian environments


Churches should have the most effective policies in place to prevent child maltreatment. Sure, those policies aren’t fool-proof. If someone wants to abuse, they can. However, effective policies make it harder for it to happen and more likely that the response of the church to abuse results in part of the victim’s healing as opposed to further abuse.

If you are interested in reading more about what policies would be most effective…follow this link. It is written by Victor Vieth, fellow board member at GRACE and Director of the National Child Protection Training Center. This is a must read (pdf).

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“I tried that…it didn’t work”: Responding to failures in counseling


One of the things a counselor does in meeting a new client is to ask, “tell me what you have tried thus far to solve this problem.” We ask this question because we know we are not the first stop for most folks trying to solve a problem. Whether it is a parent seeking a way to manage a child’s misbehavior, a couple seeking help in changing the way they talk to each other, or an individual trying to address an ongoing anxiety problem, most people have tried and not found adequate success–which is why they come to see us.

But, let me tell you what goes through my head when I suggest a couple of options/approaches my client might try and they respond with, “I tried it…it doesn’t work.” My internal, private response?

Define try. Define work.

Now that probably sounds negative but I don’t mean it that way at all. What I mean to communicate is that I do not yet know what this person tried, for how long, and what result, if any, was achieved. What I do know is that my work is cut out for me because the client statement usually conveys a closedness to trying that particular intervention (or similar ones) again. My job is to ask questions to understand each word: try and work.

Tried it.

There are a couple of commons ways people try solutions to problems. They may try something without proper consultation. They may try something in an intermittent manner. Let me give you some examples. Parents may try a reinforcement strategy with a child but fail to find a powerful enough reinforcer to make the system work. Or, a couple may try a speaker/listener technique but revert in the middle back to a debate/invalidating mode. A couple may need to take a “time out” or break to avoid a conflict escalation but the one asking for a break may do so using it as a power move (“I’m outta here!) rather than a de-escalation attempt.

Didn’t work.

A good technique may or may not work, depending on any number of reasons. Some interventions really won’t work for a particular person or setting. However, it is important to recognize that some interventions fail to work for reasons already mentioned above and others may fail to “work” because of client expectations. For example, a parent may try a particular intervention with their child to reduce angry outbursts. Then, the parent returns to counseling the next week and tells the counselor the intervention didn’t work. Upon deeper investigation the parent does admit that the number of outbursts reduced, the duration of the outbursts shortened. Why did they feel that the intervention didn’t work? Well, last night they have a horrible blowout and very small irritating interactions each day. So, the intervention may have worked even though the parent is feeling very worn out and discouraged. Or, in the couple illustration, listening technique may enable the couple to fight less but one spouse feels that the other has a history of being self-centered and thus cannot trust the reasons they are now trying to do a better job. So, they interpret short-term success as not real or legitimate.

Setting the stage for homework

Counselors often give homework. For homework interventions to work, a counselor should: (a) make a very clear explanation of what should be done, when, and how often, (b) what results, if any, to note, (c) the short and long-term purpose of this intervention, and (d) follow up next week to see how the  client fared and what alterations might need to be made in the following week.

Counselors do well not to oversell the value of the intervention, admit that not all interventions work and that troubleshooting is an essential part of counseling, write down their homework requests for clients, and make sure that the homework given fits the client’s level of commitment to the process.

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Competing Models of Christian Counseling? Who is Right?


A couple of recent pieces have me thinking about (a) models of Christian counseling and, (b) the intramural conversation amongst Christians on which model is most Christian. One piece is David Powlison’s article in the Summer 2011 issue of the Westminster Today magazine (this link is to the magazine site but the current issue is not yet up). The second is by Ed Welch–a blog on Biblical Counseling Coalition website.

This is not a new topic for me. From my “About Me” page you can see that I have training in biblical counseling and also in clinical psychology. I respect the folks at CCEF who had a huge impact on my life and thought–especially that lovely editor they employ ;). While getting my PsyD I published on the historic divide between biblical counselors and Christian psychologists and the need to build bridges. I’m an associate editor for Edification, a Christian Psychology peer-reviewed journal.

All that to say, I have some thoughts on some ways we might move beyond right/wrong while still being concerned about building a clear, cogent, God-honoring model of Christian counseling.

Drop the labels

Yes, we should drop our labels. What is the difference between a Christian counselor, Christian psychologist, integrationist, or biblical counselor? These differences are as varied as the numbers of people who use them. Yes, there are probably some benefits to communicating a personal stance with one of these terms. But, for every benefit, there are probably any number of negatives, including the use of the label as a curse. “Are you that kind of biblical counselor” (whatever kind you find offensive)? “Are you a Christian who happens to be a psychologist or a Christian psychologist?”

In addition to dropping labels, we should also drop broad brush judgments. Calling Christian psychologists “syncretistic” is offensive and ill-fitting. Calling biblical counselors “psychology bashers” does not accurately portray their nuanced approach. Saying that psychology and biblical counseling is “fundamentally incompatible” (from either side of the debate) ignores the benefits that both sides gather from each other.

No labels? What then?

Facets. I’m sure there going to be problems with this idea too but let us choose to focus on facets of counseling models. For example:

  • How does Scripture shape counseling foundations and goals?
  • How do we learn from, utilize, and critique psychological constructs, data, etc?
  • How does typical human development trajectories influence our understanding of the change process?
  • How do we learn from those who do not share our epistemic foundations?
  • How do we articulate diverse counseling goals (suffering well? symptom reduction? discipleship? skill acquisition? insight?) as all working toward the common goal of glorying God and enjoying him forever.

Listen first, repent first

In Ed’s blog post (linked above on the BCC site), he captures the most essential characteristic needed if we are going to learn from each other. We ought to,

listen and enter into the world of the other person (or in this case the other counseling perspective) in such a way that the person representing the perspective says, “Yes, that’s me. You understand.”

It is a sad thing that we counselor types start with diagnosing other model builders without listening first to both the content of that model and the person behind it. We treat our fellow counselors in ways we would never treat a client. How should we listen to others? Can we see what they see? Can we see what they see that we tend to ignore? Can we see the benefits of what they do and the potential liabilities they see in our model?

Be willing to repent where you have unfairly labeled, categorized, and marginalized one who was working for Christ’s kingdom–even if you think you have been hurt more.

List own weaknesses first

Most debates, whether between thinkers or spouses, rarely succeed in winning over the other person. Why? Because we are too busy defending, explaining away, pointing out the weaknesses of the opponent to actually deal with reality.

Wouldn’t it be refreshing to hear a counseling model builder express his/her models weaknesses or needed growth points first before exploring the deficits of the another? “My model doesn’t yet have a good understanding of ____. Your model does so much better with that and I want to learn from you.”

Build the center

Rather than start with the differences (which do indeed exist), what if we cataloged the similarities and areas of agreement among Christian models of counseling? In addition, what if we recognized those things we might not have noticed with out the help of those outside our own community. For example, Scripture may speak a great deal about loving neighbors but a particular model of psychology may flesh out what loving a very unique population of client ought to look like. Even if Scripture is sufficient, we do not diminish it when we acknowledge we hadn’t made a particular application without our neighbor’s help.

Acknowledge differences

We will not see eye to eye. We will disagree. Let us acknowledge these where they arise. Let us make sure the differences are real and categorize them into those that are peripheral and those that are substantial. For example, David Powlison speaks about the need for a counseling/care for the soul model back in the 1950s. Despite quality practical theology and discipleship programs, he asked,

But what was the quality [in the 50s] of corporate wisdom in comprehending the dynamics of the human heart? What sustains sufferers and converts sinners? Westminster Today, 4:1 (2011), p7

Right away I ask myself, are these the only two options (sustaining, converting) for Christian counselors? Is it possible also to have the role of treating symptoms? Teaching skills? Reducing suffering? I’m fairly sure that this initial difference is not really there. I suspect David does not reject mercy ministry to reducing suffering. But in dialog, he and I might end up agreeing that some biblical counseling models fail to focus on skill intervention in their quest to address the human heart. And we would likely agree that some christian psychology models fail to address the spiritual discipline of suffering well and the need for conversion. Might we end up agreeing that we want a full-orbed model that neither diminishes nor over-promises symptom care or sanctification?

Promote each other

Finally, we do well to promote each other at our conferences and learning communities. We encourage wide-ranging reading, critical interactions (note, not criticizing), and sharpening of each other. And we commit to lovingly correcting those of our “friends” who speak ill about our neighbors. We reject the fear of defending an outsider for fear of being rejected ourselves. 

 

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“Do you know who I am?” and other self-important acts


In the last little bit we’ve been subjected to lots of signs that famous people tend to fall into the trap of self-importance (or, is it a requirement to be self-important to run for office or seek the limelight?). What signs do I refer to?

  • Taking pictures of certain body parts and emailing them to others
  • Having no apparent qualms about serial cheating while in the limelight
  • Declaring, “Do you know who I am?” and believing that if the other person did realize the importance of the person, that they would give better treatment or allow the famous person off the hook

But we too suffer from the same struggle of self-importance. While I’ve never thought someone would treat me better if they realized my greatness and I’ve never thought it would be cool to send a risqué pic of myself to someone, I have thought, “How dare you treat me this way! I deserve better than this!”

Or how about these ones:

  • inching your bumper so close to the car in front of you so that the car wanting to merge into your lane can’t.
  • cutting in line at a store because you have to get somewhere soon
  • expecting others to praise you for routine work done
  • thinking that everyone is thinking about your gaffe or your entry into a room (this may be experienced as prolonged embarrassment and desires to flee)
  • worrying about fairness about chores and whether you’re doing more than another
  • ruminating on your unsung value to your company

What other acts of self-importance are you prone to? What do they say about your sense of self? We’d like to believe that the Congressman from New York or a drunk driving actor acting oafishly are cut from a different cloth and act in ways that you and I would never consider. But, in fact the root of their foolish behavior is (a) seeking self-importance and the acclaim of others, and (b) failing to see the value of self-denial.

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Healing, recovery, restoration and other words for “getting better”


Recovered. Healed. Better. Restored. Resolved. Whole. What words do you use when describing positive change regarding traumatic events like abuse, the pain of adultery, or other like experiences? And more importantly, what do those words convey to yourself and others?

Why am I thinking about this? Soon, I will begin teaching an on-line summer class called “Healing Trauma in International Settings.” To be honest, I’m a little uncomfortable with the title I chose. Words matter and “Healing” conveys a message. Imagine replacing “healing trauma” with

Trauma treatment

Trauma recovery

Trauma care

Now, maybe I’m being overly sensitive but consider some of these other kinds of problems we face

  • You break your tibia during an aggressive move on the basketball court. Your leg heals and you go back to your basketball playing. Here we use healing to denote that you regained your former capacity to play sports. You are back to normal or near normal.
  • You cut your finger while slicing vegetables. You go to the hospital to get stitches. While you have a scar, your finger heals and you use it again. In time you have only a slight scar to remind you of that day.
  • Your house sustains a fire. You lose belongings. Your insurance company restores your house and replaces your possessions.
  • Your car is stolen. The police recover it and return it to you (with fuzzy dice attached)
  • You have a protracted conflict with a family member. At some point, you have a heart to heart and resolve your differences.

My examples all convey a resolution of a problem where the problem recedes, maybe even disappears. But what about trauma? Is there a form of resolution and healing of rape or sexual abuse or domestic violence where the memories disappear? Should there be? Wouldn’t forgetting these experiences place the person in danger of living in unreality and, in some cases, at risk of re-injury? Here are some important questions:

  • What does healing from an affair look like? How do you know you have “recovered”? What symptoms or experiences would remain?
  • What does healing from a rape look like? What would be expected if you “pretty well recovered”? What is to be expected to not change?

As a counselor I do not want to under or over-sell the recovery process. Victims do find tremendous healing but to assume all vestiges of a traumatic experience go away would be false. Unfortunately, we who have not been traumatized sometimes expect the kind of recovery where victims go back to a way of life and thinking as if the trauma never happened.

If we are honest, we wish to live in a world without lasting consequences from sin and suffering.

We want people to “get over” their pain and go back to a way of life as if it never happened. It would be like asking a person who lost a leg to hope they will run exactly like they did before losing the leg. Indeed, they may run again. But never as fast and never as easy. There will be a stump to care for, a hip to learn new motion, phantom pains to re-interpret, and limits to accept.

This world of limits is one God wants us to live in and one we detest. Our first parents saw the limits of their wisdom and desired to get wisdom on their own. We too love the happily ever after story where humans obtain health and healing apart from limitations. We tell the stories of miraculous healing as if we no longer live in a broken world.

Let us endeavor to tell true stories of healing that glorify God and remind us that we depend upon him for every breath.

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Introduction to Healing Trauma course


Starting July1 I will be teaching an on-line course, Healing Trauma in International Settings. Here’s the introductory video for students to watch during week one that tells what I plan to have them do during the course. Don’t worry, most of the course ISN’T watching me talk. You can see the full syllabus here.

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On apology, again


Will Harold Camping apologize for his antics? What would you like him to say if he did?

One of the hardest things for us to do is to make a clear, direct, no-blinking apology when we have erred. Consider how many times you’ve heard such an apology, especially if the error was intentional (e.g., lying, deception, stealing, and other trust-breaking activities). Mistakes (the real ones) are quite easy to apologize for. For example, I broke the arm of one of my son’s friend by accident. I felt terrible and apologized many times over. I made no excuses for it.

Funny thing: the more guilt we actually own for an error, the less likely we will be willing to own it. We’ve all heard and even made some of these “apologies.” Mistakes were made, I did but you did worse, I’m sorry IF I might have hurt you, I was tired…

So, here’s the apology I’d like Camping to make:

I was wrong to try to guess the date of the return of Christ because the Bible clearly states that “no man knoweth the day or the hour.” Not only did I choose to ignore that verse but I also abandoned the plain teaching of Scripture and the common interpretations of passages down through the ages. Instead, I sought to convince people that I was someone smarter than everyone else. It is not surprising I rejected the good teachings of others since, in my arrogance, I left the church back in the 80s. While some might not know the teaching of the bible, I do. Failing to submit myself to a local community is forbidden by the Scriptures. A teacher is held to a higher standard and so I am responsible for encouraging foolish decisions of others who sit under me. I also apologize for encouraging cynicism and disbelief in the Bible all because I taught that there is a secret code in the Bible. In light of God’s mercy to me I ask for your forgiveness. As a sign of my repentance I promise to cease preaching and teaching. I promise to submit myself to those who can disciple me. Further, I will sell my assets and search to pay back all those who listened to me and spent their hard-earned monies to support my delusions.

Likely, however, he will do what most of us do with our apologies: excuse, blameshift, try to use other lies to make ourselves seem like truth-tellers or victims, etc.

Interested in reading other posts on the art and act of apology? See my first one here. You can also search the word “apology” in the search engine to the right of this post. There you will find several other posts on the topic, especially why it is so hard for us to apologize.

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What is the difference between a trial and a stressor?


Words matter. The words you use to describe an event really do shape how you will view it and how you will respond to it. For counselors, the words they use to conceptualize a client/case will shape how they see clients and how they will attempt to intervene. This is why I take considerable time in my Practicum class to practice case conceptualization.

Most beginning counselors are good at collecting information. But, for most, that data might well be a hopelessly knotted  ball of twine.  Where to start pulling? How do we make sense of the various pieces of data? And since data never comes to us uninterpreted, which “data” do we tend to gravitate to? Behaviors? Family history? Motivations? Biology? Environment? Client beliefs? But even more confusing are the words we use to describe these sectors of life–and the meaning they convey!

Stressor v. Trial?

Here’s how language influences case conceptualization. Your client experiences long-term family discord due to an adult child with schizophrenia. The family member routinely goes off medications and the police have to be called in order to transport him or her to the hospital after threatening self-harm. Your client comes to counseling to seek support for handling this difficult situation. As you can imagine, the client feels alone, worn down, and wondering how to keep going despite no sense that the situation will get better any time soon.

What do you imagine might be the impact of calling this family situation a trial? And how might you view it differently if you called it a stressor. Notice any differences? Benefits of each? Drawbacks of either? In your mind, are they equivalent? (See Eric Johnson’s brief discussion of these two words and their similarities/differences in regard to Christian psychology in his Foundations for Soul Care, p. 240)

Here is my thinking. Within Christian tradition, a “trial” signifies a difficult time or season but from a spiritual or divine perspective. It conveys a purpose–a testing or proofing of one’s faith. We tend to view trials (or desire to at least) from an eternal point of view, “testing of your faith produces perseverance…”  (Jas 1:3). Notice that while “trial” does signify difficulty, the focus is largely on the purpose it serves.

On the other hand, a “stressor” is something that causes stress or distress in a person’s life. Notice that this word carries no sense of eternity, divine value or purpose. It merely describes a facet of life that is troubling a person’s life.

Imagine with me a counselor who uses “trial” to describe the distress in the life of the client mentioned above. How do you expect that might shape the counselor’s view of the situation and thus response sets to that client? Would our counselor be more likely to view the trial as something to endure, more likely to engage in spiritual conversations so as to find comfort and peace in the middle of the storm? Would their conversations tend toward the hope of heaven? Is it possible that using the language of trials might cause a counselor to ignore the real-time experience of distress?

Now imagine the counselor who uses “stressor” to describe the same distress. Would this counselor be more likely to discuss in detail the physical, psychological impact of living with a mentally ill and unstable family member? Would this counselor then be more focused on finding ways to decrease the moment-by-moment stress levels? Is it possible that using the language of stressor might cause a counselor to ignore an eternal perspective?

Hopefully, you can see the value of both word meanings and the interventions described. It is possible to use the language of trials and focus in on the details of how that trial impacts the client. And it is possible to use the language of stressors and keep in mind an eternal perspective. Whatever language, the interventions off stress education and reduction and hope building are necessary interventions.

If you are a counselor or counseling student, observe the language you use to describe your clients and their lives. How does that language influence your view of them and the interventions you might use with them?

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