February 25, 2008 · 9:32 pm

Science Monday? Studies in Internet and Pornography addiction


I think I wrote about this last year….search APA journals for literature on Internet addiction and Pornography addiction and what do you find? Not much (1st set of terms) and nothing (2nd set of terms). Search all of PsychInfo to include all of psych journals and you find a few: several published in christian journals and several in marriage and family journals. But all in all, very little.

I guess they don’t have the stomach to address these ills. They don’t even try to debunk them as social or cultural anomalies.

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February 22, 2008 · 5:34 am

God’s problem? Can we Christians sufficiently answer why we suffer?


I heard a great interview on “Fresh Air” with author Bart Erhman, professor of religion from UNC regarding his new book: God’s problem: How the Bible fails to answer our most important question–why we suffer. While I completely disagree with his conclusions, you have to admit this guy talks much about the bible in ways we evangelicals would. But he draws opposite conclusions. Listen here.

Dr. Ehrman is an interesting character: becomes born again at 16, is part of Youth for Christ, attends Moody Bible Institute, and gets his doctor of theology at Princeton Seminary. However, he now says he is agnostic. Why? He sees no satisfactory answer to the problem of suffering. In the interview he describes three common Christian answers, all based in the text. The classic answer says that we suffer because of human choices. There are variations of this view. Simply put, the righteous are blessed and the unrighteous will suffer. Dr. Ehrman points to the OT prophets for this view. He finds this unsatisfactory because it doesn’t answer the problem of what causes Tsunamis. [He doesn’t address in this interview how he handles the argument that while suffering may not come in a 1:1 correlation (sin:suffering), no one is righteous and no one gets to say, “not fair.”] He describes a second view as God is mysterious and doesn’t have to answer (e.g., Job). Finally, he describes Jesus’ view as an apocalyptic view suggesting that suffering is caused by principalities and powers which will be defeated at the end times.

Two questions I’d like to ask Dr. Ehrman:

1. Since agnosticism doesn’t claim a full answer to why there is suffering (or why we should do anything to stop it as Dr. Ehrman believes) why does faith in God have to answer it as well? Since one view allows for mystery, why can’t God not clarify every answer?
2. He sees God putting his thumb on Job and squishing him with his final question to Job. “Were you there when I created the universe.” I guess he sees God’s answer as, “then, shut up.” But is that really the message of Job? If it was, why does God not take Job to task in the 40 or so chapters where he rants and raves?

 Dr. Ehrman likes the book of Ecclesiastes. He likes it because he thinks the answer in it is, “live as best you can.” I think Dr. Ehrman needs to re-read the book because it says, “fear God, and live as best you can.” (Phil’s translation)

 I encourage you to listen to the interview. Then afterwards, try Tim Keller’s new book, The Reason for God: Belief in the age of Skepticism. In answer to my title? Can we answer sufficiently? Yes. Can we answer all that we wish we could know? No. But funny, learning what we wish we could know might not be so good (like learning the day you are going to die).

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February 21, 2008 · 12:01 pm

Every city needs a Bill Krispin


On Tuesday night I attended a talk given by Bill Krispin entitled, “How the World has Changed in my Years of Ministry Service (1966-2008). Bill is recently retired as executive director of Citynet. Before that he was longtime leader of the Center for Urban Theological Studies (CUTS). Functionally, he is part pastor and part sociologist. He knows Philadelphia streets, neighborhoods, and churches like no other. He keeps us up to date with what is happening now instead of focusing on what happened five years ago.

He covered the shift in demographics (world, US, and Philly population shifts; how suburbs and urban areas changed; the loss of the intergenerational church), the emerging generation (18-34 year olds), changes in bible translations (and the effect of dividing the church), how charismatic movements changed the ministry from professionals to laity, changes in thinking about mission (e.g., how a small Dominican church here plants multiple churches in the DR at extremely low cost), rediscovery of a wholistic gospel (reuniting word and deed), and the decline of denominationalism. Oh, he also talked about the changes in theological education (that individuals come for training not for credentials) and that an apprenticeship model makes more sense now.

I recommend you check back with the link above to find the audio/video since they said it would be up on the site soon.

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February 20, 2008 · 12:32 pm

Integrative Psychotherapy VI: Assessment and Conceptualization


In chapter 6 of Integrative Psychotherapy: Toward a Comprehensive Christian Approach, McMinn and Campbell take up the matter of case conceptualization. Thus far they have been discussing the foundations and features of their therapy model. Just before going into deeper looks and clinical applications of their 3 domains, they stop to look at the concept of assessment and case planning. Why does case planning matter?

“Assessment is the task of systematically observing what signs and symptoms a client experiences. These signs and symptoms are then understood through a particular theoretical grid, resulting in a case conceptualization (a framework for understanding the symptoms). Case conceptualization is an effort to understand the cause of the symptoms, the role the symptoms play in the person’s experience and treatment strategies to help the person improve.” (p. 145)  The authors acknowledge that this task of assessment and conceptualization are neither linear nor without bias. As they say, the very questions one asks determines to some degree the data one gets and how one interprets that data.

They pose 3 questions for the Christian counselor. Is evaluation acceptable for Christians? Isn’t Christian assessment mostly a matter of identifying sin? How is Christian evaluation unique? I’ll dispense with the first two assuming we agree the answers are in order: yes. no, not only. How is Christian evaluation unique? It doesn’t settle for simplistic biological, behavioral, or volitional explanations of symptom manifestations. That probably isn’t unique. What is unique then? The starting point about human nature.

The rest of the chapter describes key assessment and conceptualization practices. Collect data from multiple sources. Make a diagnosis (they describe the benefits and drawbacks of making a DSM diagnosis and how it is the start of assessment, not the end). Consider etiology (predisposing, precipitating, and perpetuating factors). Consider client factors (client perceptions, expectations, ability to work with a therapist, additional strengths and resources). The authors also want IP counselors to assess the specific areas of maladaptive thoughts, schemas, and interpersonal relationships. They provide sample lines of questions to explore each area. Finally, they suggest that the counselor consider whether the data they collect in each of the above assessment areas is likely to facilitate or inhibit therapy. This action may guide clinicians as to where to start (if at all) and what kinds of goals might remove a specific therapy interfering behavior

My thoughts? I like this chapter. It provides a concise reminder to the beginning counselor regarding the basic data they should collect. It does remind us that our interpretive grids impact the data we get and the interpretations we make. We are not so objective. In light of that, I do wonder whether the DSM diagnosis is a good place to start. By starting there does not the clinician tempt herself to think only in light of classic psychiatric models. I would rather see the diagnosis happen at the end. In this way, the clinician can report to the client whether it is helpful to consider the diagnosis. For example, a child may look ADHD, but by collecting the other data, it may be clear that the child has a primary trauma or anxiety type problem.

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February 19, 2008 · 1:14 pm

Do you say more than you mean to?


We all are guilty of saying one thing while hiding (or trying to) our true feelings or intent. We do this for a variety of reasons. We fear conflict. We don’t want to hurt another. We don’t want to be seen as petty. We want to manipulate. Bottom line, we do image management.

But, I suspect that we leave more telltale signs as to our true feelings/beliefs than we realize. Consider these examples:

1. An interviewee badmouths a previous employer to a prospective employer and at the same time describing their own gifts. Here the individual thinks they are showing how they are better than their prior employer but really reveals arrogance and narcissism. I watched this happen recently (not at Biblical). The poor guy thought he was acing his new interview but kept on digging a deeper hole for himself.

2. A person says they are fine (after a possible conflict with a friend) and then looks down and away. Here the individual may be saying several things (I’m embarrassed, I’m not fine, I just want this to go away…) but they are rarely saying, “I’m fine.”

3. Or how about that line some of us said in our teen years, “Let’s be friends” (to a former boy/girlfriend). Here, we meant, “please let’s not make this harder than it has to be.”

What body language messages do you notice that convey to you a message that isn’t being stated? Where do you think you are fooling another? 

Just recently, I congratulated someone on a job that I thought they had worked hard on. The person immediately stated that it hadn’t gone well (correcting my assumption) and yet, they were fine with the outcome. I appreciated the spontaneous and honest response rather than the usual nicety-laden conversation that would have meant nothing to either of us. 

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February 18, 2008 · 3:45 pm

Suppressed Anger enhances pain perception?


Today in Psychopathology we will be discussing the problem of problem anger. In doing some additional research I found that there has been a fair amount of literature produced on the topic of angry emotions and a good amount in the last year or so.

We know that chronic anger has significant impact on the body and may influence certain disease states such as high blood pressure, atrial fibrillation, etc. But, Quartana & Burns (Rosalind Franklin University of Medicine & Science, Chicago) investigated the relationship between anger suppression and increased pain sensitivity. Here’s how they explore the possible connection:

1. They asked 209 healthy and pain-free college students to perform a mental arithmetic task (serial sevens). While doing the task, some were harassed (made angry) and some were told to express their feelings, to suppress their experience and/or expression of their feelings, etc.

2. After the task, they had to put their non-dominant hand into a bucket of ice until they reached the point where they could not tolerate pain any further.

What did they find? Well, first they found that 32% kept their hand in the water so long as to be not helpful in their research. But, they also found that, “Participants who attempted to suppress either experiential or expressive aspects of emotion during anger provocation reported greater pain in response to subsequent pain induction than did participants who suppressed during anxiety induction and those instructed not to suppress, irrespective of emotion-induction condition.” They also found, “Participants who suppressed anger not only reported the greatest pain severity, but also described the quality of the pain as more physically hurtful (e.g., throbbing) than their counterparts who suppressed anxiety or those who experienced angerbut did not engage in effortful suppression. More important, those who suppressed anger also described their pain as annoying and irritating to a greater extent than those who suppressed anxiety.”

This makes sense. When I’m angry, everything becomes an irritant.

Does this suggest that to be more healthy we should be more free with our anger by giving vent to it? Not necessarily so. It does mean that those who hold it in (become embittered?) may become quite sensitive to perceptions of pain–that is, notice all the other things wrong with the world. But anger expression isn’t necessarily the opposite of suppression. Rather, honest self-evaluation, bringing our anger to the Lord, remembering that He is our vindicator may be more important than outward expressions of our anger.

Biblio: Emotion, 7:2, pp 400-414 (2007).

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February 14, 2008 · 6:35 pm

What defines you? Ashes or Stones of Remembrance?


The Israelites were told to pile up stones as a reminder to their children that the Lord had done an amazing work. These stone of remembrance provide a reminder during hard times that God is near and active. Sometimes we also have the reverse: ashes. Ashes that remind us of a painful time, a failure, a grief/loss, a violent moment. It is easier to see the ashes and allow those ashes to completely define us.

A friend of mine told me of a “Dr. Phil” episode where he was talking to a woman who has lost her daughter at 18 and had never recovered despite many years passing. He asked her whether she would only define her life by her daughter’s death-thereby implicitly denying the 18 years of her life. Pretty good for Dr. Phil.

Without taking more than 20 seconds to think of the answer, what “stone” or “ash” do you most easily use to define your life?

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February 13, 2008 · 12:35 pm

Integrative Psychotherapy V


Now here in chapter 4 of Integrative Psychotherapy, McMinn and Campbell are starting to map out their 3 domained model of persons and psychotherapy. As an aside, the next chapter will cover how to do assessment and case conceptualization within this model and the remaining 6 chapters (excluding the conclusion) will be spent exploring each domain and how to apply the concepts into practice (2 chapters per domain). Should be a fun ride.

If you will recall from their chapter 1, they imagine the imago dei as a good rubric of the nature of persons and as best described by its functional, structural, and relational aspects (i.e., behavior, cognitive/moral, and relational aspects). They note that most therapy models tend to address one of these 3 domains problems: cognitions and challenging distorted thinking/acting, schema or insight-oriented work, and relational/experiential work. Instead of separating these domains, McMinn and Campbell define them as necessary and interconnected. “A person engages in functional behavior because of certain structural capacities, and similarly, relationships influence a person’s [behaviors and schemas].” (p. 115)

I think the best way to understand the interconnected parts of their model is to see it. Page 136 offers a nice illustration (Thanks Mark for making this available.). Note how behaviors, thoughts and feelings are influenced by situations but also arise out of core beliefs/schema and relational experiences. Note also the dark arrows depict the common path of influence but that feed-back loops are in play as well. Though I wish they gave more detail here how the domains interrelate (that would be a very fat personality text!), they do a fine job illustrating what they mean by discussing the case of “James,” a man who suffers with anxiety and things his value comes from meeting others’ expectations.

Domain 1 (Functional/behavioral) lends itself to symptom reduction and skill-building activities (the heart of cognitive-behavioral therapy). A counselor might address how James might learn so anxiety reduction techniques. But stopping here leaves James and the counselor wanting more. Why does James view himself and the world this way? Where do these distorted views come from? McMinn and Campbell recognize that these views are very hard to disrupt because they are so well-engrained through experiences. Domain 2 (Structural) then looks deeper to settled core beliefs using insight-oriented techniques to expose unconscious schemas that might uncover how these schemas got started (we learn, among other things, that James’ father was harsh and that he made some understandable but problematic choices/interpretations that now lock him in a pattern of perceiving himself as a failure–even though this view violates his own Christian belief).

Domain 3 (Relational). IP recognizes that formative relationships shape our schemas AND that the formative relationship between client and counselor provides experiences to shape and reshape our experience of self, other, and God, mirroring the incarnation of Christ.

Throughout this chapter the authors show how the IP 3 domain model is similar and different from standard CT. Yes CT is interested in reducing distorted thinking and building life skills. But IP also values insight and experiential aspects to therapy and provide additional opportunities to expose settled core beliefs (See p. 132 for a great chart illustrating how IP stands as a bridge between CT and insight-oriented models). IP attempts to show how the interconnections of situations, past experiences, developed core beliefs, habits, etc. illustrate both determinism (stuff outside us shapes us significantly) AND human agency (our choices also shape us). They also explain that classic CT has not done a good job explaining how relationships, motivation, emotions and culture play in person development. Further IP is not merely CT with some additions because it is built on a Christian view of persons (creation, fall, redemption, imago dei, etc.)

MY THOUGHTS AND ONE QUESTION: Now, we are getting into the meat of their model. It is good to hear their theoretical foundations in previous chapters but now McMinn and Campbell show us how they see how humans develop. While acknowledging the Fall, here’s what I see about their view:

1. Humans are intrinsically motivated to move toward God and long for a proper relationship to God, others, and creation.
2. The fall brings misery, brokenness, and difficulty (our fundamental problem is broken relationships)
3. Fallen humans are ripe for cognitive distortion.
4. When good longings (see pt. 2) are not met, we make bad but understandable choices (even adaptive at the time) and interpretations which lead to formative experiences that we interpret in distorted ways which in turn lead to more cognitive, moral/schema, and relational problems.

Classic Reformed theology suggests we NOT ONLY inherit a broken world, we also inherit Adam and Eve’s desire to be on par with God. We have an intrinsic motivation to be God and our denial of God comes out of this motivation (Rom 1). So here’s my question (in 2 parts):

1. Do we begin with good longings that we attempt to meet in naive and foolish ways (a la James in chapter 4), OR do we begin at birth to read things in distorted ways because we are looking to be our own God? Or both
2. Does this distinction matter? How would it impact our therapy model or application?

Calvin seems to support both ideas. He says our heart are idol factories AND he says our problem is not so much what we want/desire, but how much we want it. Notice that if you emphasize the “bad response to a bad situation” then it might end up dismissing personal culpability. However, if you emphasize the “bad heart seeks self promotion” then it might end up missing the all important influence passed on from a broken world and thereby blaming people for being sinned against.

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February 12, 2008 · 5:06 am

Good questions when dealing with counseling crises


I’m doing a training with a local counseling center today about dealing with chronic crises and short-term crises. I have a list of questions I think we outpatient counselors ought to ask ourselves in order to keep from missing key helps for those we serve:

1. What supports (family, professional, church) really exist? Which of these are stressors?
2. Am I the primary or only provider? Why? What do I need to do to eliminate this problem?
3. Have I expressly recommend/required other team members. Have I communicated with those already on the team (assuming releases to do so)
4. Have I sought supervision?
5. What course of treatment might this person receive at another center? What is my rationale for why I am or am not following that course?
6.  What plans have I devised, with the client’s cooperation, to implement during the crises? Am I responding to motivation breaches
7. What impediments exist that block optimal functioning? What impediments hinder counseling?
8. Do my goals reflect the need to address impediments first? Have I triaged goals and objectives?
9. Do my feelings for the client hinder my ability to care for them well? Would I treat a new client differently?

These are not all of the questions I think we should ask, but these may help us focus our attention on important matters that have escaped our notice.

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February 11, 2008 · 11:52 am

Ancedotal Science Monday: Anxiety–Depression–Anger


Today, my psychopathology class will explore the problem of depression. Last week we looked at anxiety and next week, we take a shot at understanding the roots of anger. Here’s my thought for today: these three emotional states are not different animals but three manifestations of the same problem.

There is some psychological research and writing suggesting that anxiety and depression either highly overlap or are two ends of the continuum. Further, we understand that the same SSRI antidepressants seem to alleviate both anxiety and depressive symptoms. I would like to suggest that we consider that they do exist on a continuum and anger as the center point.

Consider these simple definitions for our Anxiety–Anger–Depression continuum:

Anxiety: Manifestations of mood revealing a deep sense that something is not right in the world and hope in activating in someway to forestall the danger.

Depression: Manifestations of mood revealing a deep sense that something is not right in the world and hopeless to forestall the danger.

Anger: Manifestations of mood revealing a deep sense that something is not right in the world and frustrated that others aren’t doing something to forestall the danger. 

How might this change our approach to these problems? Not sure it would. However, all of us have some experience with at least one of these three manifestations and so therefore we can better relate to those who experience one of the other two manifestations.

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