February 3, 2009 · 11:31 am

Improving Case Conceptualization?


For my counselor readers: What books or other helps have you encountered that improved your ability to conceptualize cases?

When we teach counseling skills we do the following (we do more than this but this is the general trajectory):

  1. Build basic helping/counseling skills (if you can’t connect with a person and build a trusting relationship, any knowledge you might have will be useless!)
  2. Expose students to a wide variety of problems (so they can understand and describe common problems in living or common pathologies–even if they are not sure of the causes of these problems)
  3. Explore human growth and development from a descriptive and biblical viewpoint (this at the same time as #2 so that they learn about common problems  and sufferings as well as what healthy and Godward lives look like in a fallen world)
  4. Teach case conceptualization (marrying client information (e.g., background info, presenting problems, attempts to solve the problems, etc.) with theoretical understanding of the person/problem/desired outcome.
  5. Build intervention repertoire during fieldwork.

#4 is the hardest, especially in a generalist program that doesn’t spend a great deal of time on theoretical models (we teach models as part of every course and our model of Christian psychology (biblical anthropology along with process oriented model) isn’t as defined as the old models (e.g., Rogers, Freud, etc.).

If you were teaching counseling to practicum students who needed help with conceptualizing cases, what resources would you turn to?

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January 30, 2009 · 5:43 pm

Personality and your soul language?


I’ve noticed that personality seems to play a significant part of helping us choose our music, our favorite writers, even our theology. Now, this is not to say that we do not have any cognitive processes involved nor that the Spirit doesn’t speak to us regardless of our personality features but consider these T/F questions:

1. I take comfort in repeating the ancient statements of faith or Lord’s prayer?

2. I take comfort in music, psalms, and other forms of writing that focus on the mystery and unknowability of God

3. I want to know the bottom line about truth.

4. I love ambiguity.

5. I love the praise and victory songs.

6. I love the dark songs that relate to the hardships of life.

Now, I suspect you might change your answers based on life experiences but some really have a habit of hanging out in one area or another. How about you?

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January 29, 2009 · 10:56 am

Are you a risk taker?


Better question: What risks do you take each and every day? Do you drive 70 in a 65 mph zone? Do you use your cell phone while driving? Do you eat without washing your hands? Do you eat foods beyond their expiration date? Do you drive after your gas gauge is below E? Do you spend money on the basis of a hoped for, but not yet received, bonus? Do you try to ride your bike across a slippery wet board, placing your assurance on your ability to keep your wheel straight and not go over the handle bars when you wipe out? Yeah, I did that last one…

It seems we take risks when the risk seems rather minimal or not all that likely. We do drive over the speed limit. We do get in cars or airplanes knowing that we could crash. We do eat without washing our hands. Why? Because we’ve done it so many times before and didn’t have a problem.

Here’s where it gets ugly. Cell phones. There are enough studies to tell us that talking on the phone is akin to driving drunk. We’d never drink and drive but most of us are quite willing to talk and drive–because we don’t feel we are risking our quality of driving.

In your Christian life, do you take spiritual risks? Engaging in private relationships with someone you fantasize about? Neglecting your devotional life? Neglecting your church life? Neglecting any other sin pattern you know you should fight to kill but rather cherish…

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January 28, 2009 · 2:01 pm

Pastor conference at Biblical: March 20, 2009


Local folks, please consider coming or inviting your pastor, pastor’s spouse, or key leaders in your church to our first ever day-long conference for ministry leaders. If God has burdened you for your leaders, consider paying for their registration. This conference will provide both encouragement for the leaders of God’s people as well as practical ideas for the challenges they face.

Here’s a flyer describing the times, costs, and speakers: pastors-health-flyer1

Here’s the link to the conference registration: http://spiritualhealth.eventbrite.com

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January 27, 2009 · 3:47 pm

Wasting Time?


If you are reading this, you are probably guilty of wasting time as there are likely hundreds of more important things you could and probably should be doing instead. But since you are here…

Wasting time is a rather subjective matter. While there are many things that we all would consider time wasters (e.g., reading junk emails from those wanting to send us their millions if only we would send them our bank acct. number) we may just as likely disagree whether or not other activities are a waste of time. For example, am I wasting time if I play video games? If I play them with my kids? Am I wasting time reading up on the daily news? making comments on FB friends’ sites? Following my favorite political blogs? Looking for just the right picture to go on my PowerPoint slides for a class? Watching a Monk episode?

How do you determine what is a waste of your precious time and what is useful? What criteria do you use? Here’s what I notice: I set an agenda most days and rarely complete even 1/2 of it. When the day is over, I routinely surmise I must have wasted time. I talked to staff, got coffee 3 times from the pot upstairs (this is NOT a waste of time as I ran up the stairs and used the stimulant to focus my train of thought), answered numerous emails, sent snail mail, edited the two blogs I moderate, got beat in a ping pong match against a student, deleted spam, worked on a chapter I’m writing, read from a new journal I received, returned calls, etc. But, I didn’t accomplish all I had on my list, so…

Notice that we often judge ourselves improperly. There are times when we should recognize time wasters and other times where we don’t do such a good job ascertaining what we really can accomplish. So, which are you? Do you overestimate what you should be able to do and therefore feel guilty for not being a superhero? Or do you tend to make excuses?

Now, get back to work, as I’ve just wasted 3 minutes of your precious work time.

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January 26, 2009 · 12:36 pm

Doing the unthinkable: Obeying Commands to do Evil


Have you ever wondered how a person could participate in a genocide? How was it that the average German citizen either explicitly or implicitly participated in the extermination of millions of Jews? Or consider the more recent genocides in Sudan, Rwanda, and the Congo. If you are honest, you’ve asked this question and have thought, “there’s just no way I would do something like that.”

Or would you? The January issue of the 2009 American Psychologist is devoted to the topic of obedience and the controversial studies by Stanley Milgram. Recall your Psych 101 class and the obedience studies in the 60s where he found that participants would be willing to shock “learners” when they made mistakes despite the learner’s protests. Shocks were administered to the point of the learner becoming non-responsive. Well, no, there wasn’t any real shocks in the study, but participants didn’t know that and agreed to obey the instructor and push buttons for increasing shock levels when the confederate learner made a mistake.

But, we’re more advanced nowadays, right? One of the authors, Jerry Burger (Santa Clara U.) modified Milgram’s study (by eliminating some of the ethical controversies in the study) and found that still obeyed the instructor to apply shocks even when the “learner” cried out and asked for it to stop–EVEN when they saw defiant participants (really, confederates) refuse to obey the instructor.

So, why do we not speak up? Why do we go along with bad ideas? What is it that happens when we know we should not go along with something but do anyway? What happens then to our conscience?

Is the problem the power of the situational factors, as some assume, that make us feel we should obey? Or is it our dislike of being in conflict that causes us to be willing to pass on conflict to another in order to stay free from it?

Consider how you have listened to off-color jokes and said nothing. Consider how you have watched someone do something inappropriate or say something inappropriate to another but decided to say nothing. While we can give ourselves a break due to the surprise and shock factor and time to consider what the best option should be, we have to admit we have times of non-action.      

I saw a recent TV show filmed at a deli where someone behind the counter made fun of individuals trying to order but lacking in English skills. It was all staged so as to see what would those waiting behind do. Would they agree with the ethnic comments? Would they stand up and demand the server stop the offensive language? Would they leave? Many did speak up, but some did not and some even participated in telling those immigrants to go back where they came from.

Fact is, we don’t like suffering and we prefer comfort. But, living in a sinful world means speaking up and taking one on the chin from time to time. Some of us have “hero” fantasies where we imagine us taking the high road, but if we are honest, we are just as likely to freeze up and go along with things we ought not.

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January 23, 2009 · 1:17 pm

The God I Don’t Understand: Chapter 6


Been blogging through Christopher Wright’s book about things that are hard to understand about the Christian God. In earlier chapters he covered things that make him uncomfortable but now he gets to the third section about the cross–something that puzzles but delights him. He begins with this thought:

As I ponder the cross, three fundamental questions sum up our struggle to understand it: Why? What? and How? Why did God ever consider sending Jesus to die on the cross? Why was it necessary from our point of view? Why was he willing to do it, from his point of view? And then, What did God actually accomplish through the death of his Son? What was it all for? And finally, How did it work? How did one man’s bleeding body stretched on two pieces of wood for six hours of torture and death on a particular Friday one spring outside a city in a remote province of the Roman Empire change everything in the universe? (p.111)

In this chapter he takes up the why and the what questions.

Why?The simple answer is “Because God Loves us.” (p. 112). But he also admits that the answer is “totally inexplicable.” Wright doesn’t believe that we can really answer the question but is convinced we can deepen our understanding traipsing through the OT. Then Wright shows what is not the OT’s answer for why God loves Israel. It is not because they are special in any shape or form. In fact they may have been the unfortunate example of “all that is worst about humanity in general.” The only way to understand why God loves us, says Wright, is to accept that it is God’s character to love. And while that states the truth, “…it doesn’t explain it.”

What? Wright points to 1 Corinthians 15:3-4 and the quick summary of what happened. He then reflects on the metaphors the Bible uses to describe what the cross does for human sinners. Metaphors used to describe the atonement cannot fully capture the “what” but neither are they lacking in reality. Wright then explores these metaphors:

1. Coming home (Eph. 2:11f)
2. Mercy (Eph. 2:3-7)
3. Redemption from slavery
4. Forgiveness
5. Reconciliation with God and other
6. Justification
7. Cleansing
8. New Life

Each of these reveal that God was doing for us what we could not do for ourselves. What is not a metaphor, says Wright, is the word “substitution.” That is, he says, is what he actually did. God accepts the penalty which belonged to us alone.

This chapter, as you may see, has less discussion of mystery and more discussion of the “what” and the “why.” Next chapter will take on some more of the mystery by exploring the “how” of the cross–how it could have such cosmic impact.

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January 22, 2009 · 5:18 am

The impact of illness on marriages


One last nugget from the book Madness on the impact of serious illness on the marriage relationships. Marya explores the impact of her bipolar disorder on her second marriage and her very devoted husband who spent two years entirely focused on caring for her. When she begins to recover, she notices that he is rather a shell of himself.

In some ways it is simpler to be married to someone who is all need and no give. It’s an enormous drain. But there is benefit too: you become the hero, the center of someone else’s existence. You are the saint. You have, in this sense, a great deal of power. You tell this person what to do, and she does it. You feed her. You hold her, You are her mother, her father, her husband, her priest. And you are never required to her on an adult level. There is never anything wrong with you; any problem is caused by her, her illness, her meds not working, her malfunctioning mind.  …

You relish your role and resent it enormously at the same time. And when your role is upset–when the patient climbs out of bed and walks on her own, makes her own food, drives her own car…–you see she now does everything wrong….And–who does she think she is?–She doesn’t always agree with you…she doesn’t need you anymore. This is unacceptable. This won’t work. (222-3)

What she describes is oh so true. Whether mental illness, disease of some other organ, or impact of an affair, one spouse picks up the slack to make life work. And so it does for a time. But when the sick one gets better, when the alcoholic gives up the bottle, when the adulterer gives up the affair and wants to renew a partnership again, the “strong” spouse often then experiences rages, resentment, distance, etc. At the just the time when a partnership is possible–the thing that the strong spouse most desired and fantasized about, they find it now difficult to allow or participate in such a partnership.

Why is this? In part it is due to comfort in one’s role and the dislike for change. It is a changed belief that the “sick” spouse is now incapable of really being a partner. In part it is due to the the hidden belief of the unfairness of the previous imbalanced relationship and the desire for some level of payback.

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January 21, 2009 · 4:17 pm

Madness revisited


Yesterday I made mention of Marya Hornbacher’s On Madness: A Bipolar Life. Nearing the end today and I continue to be taken with her capacity to illustrate the experience of mania, of using it to successfully do great things and of being drop-kicked into depression, of repeated hospitalizations, of the experience of being snowed under by medications, of chaotic and fearful thought patterns, of the impact on relationships and more.

She writes of the experience of ECT treatments and the struggle to regain her ability to think, write, relate, remember. After many treatments and lengthy hospitalizations, she reflects on her more stable mind:

Much is lost to those two year of hospitalizations. I remember very little, because madness erases memory, and so does electroshock.

…Memory is not all that’s lost to madness. There are other kinds of damage, to the people in your life, to your sense of who you are and what you can do, to your future and the choices you’ll have. But there are some things gained. The years that have followed my decision to manage my mental illness have been challenging, sometimes painful, sometimes lovely. The life I life, even the person I am, is nearly unrecognizable compared to the life I had when madness was in control. There are things in common,obviously–my mental illness hasn’t gone anywhere, and it still, to some extent, shapes my every day. But the constant effort to learn to live with it, and live well, has changed the way I see it, the way I handle it, and it’s probably changed me. (pp. 216-7)

The interesting thing is these sentences are not the last words or the “happily ever after” of the book. In fact, she goes on to tell how she unravels again and finds herself back in the hospital. Later, she confirms that it is hard to accept sanity as normal when it FEELS like failure. She desires normal to be the manic days. And then she reveals why. When her therapist asks why everything has to be perfect, why it’s okay for others to be “good enough” but not for her she says,

“It’s that your pretty good is better than my perfect”.

I suspect many of us can relate to that sentiment even if not bi-polar.

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January 20, 2009 · 5:51 am

A window into the world of bipolar disorder


As a teacher I am on the constant prowl for books, movies, pictures, etc. that give a realistic and personal view of the experience of mental illness. I picked up a great book regarding the world of the Bipolar I person: Madness: A Bipolar Life, by Marya Hornbacher (Houghton-Mifflin, 2008).

Marya tells of her life in short chapters beginning with her memories of life as a 6 or 7 year old. It is less biography and more of a sampling of her thought and emotional life. She has severe highs that last for a couple years, severe lows, and many rapid cycling from high to low in a matter of minutes. You can help but get a sense of her inner world from times in the hospital (many times at that) to impact of her medications and the ineffective care by several psychiatrists.

She is also author of “Wasted”, a book about her anorexia and successful treatment. Ironically, while on her book tour for that book she was drunk most days (trying to control her mania), impulsive in every way, and completely out of control.  

If you check out her book on Amazon, you can search inside. See if you can read pages 11-13 (search for the word “goatman”) and get a rich and painful flavor of her inner world in 1978.

If anyone here as read “Wasted” feel free to let us know what you thought of it.

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