Okay, what I’m about to say isn’t completely true, but hyperbole aside, I think my point is still valid…
Who is most dangerous? The one who believes him or herself to be powerless but want just a little power to be seen, known, heard, etc. When we feel powerless we do not believe our reactions to others to be anything but a trifle. So, we do not see our impact on others. And so we excuse our rantings as nothing more than a cry to be heard.
Filed under Uncategorized
Is there a difference between counseling and discipleship? If so, how would you articulate the difference? Is it merely a matter of intensity (counseling being more focused and intense)? I’m interested in your opinions as to (a) whether there is a difference, and (b) what that difference is.
Filed under christian counseling
Recently read Proverbs 30 and see how it could be “translated” to today as a prayer model.
1. Reminder of who I am and am not (v 2-4)
“I am the most ignorant of men…I have not learned wisdom, nor have I knowledge of the Holy One.” “Who has gone up to heave and come down? Who has gathered up the wind in the hollow of his hands?”
2. Reminder to not mess with God’s Word (v. 5-6)
3. Prayer to God for mercy and protection (v. 7-9)
…keep falsehood and lies far from me; give me neither poverty nor riches, but give me only my daily bread. Otherwise, I may have too much and disown you and say, “who is the lord?” Or I may become poor and steal, and so dishonor the name of the Lord.
4. Numerous reminders of the reality of how this broken world is, various examples of pain and a final reminder that fools who exalt them self come to strife, just like “twisting the nose produces blood.”
Certainly, this isn’t all that we need to pray, but I think it helpful none the less.
Filed under Biblical Reflection
In chapter 3 of Integrative Psychotherapy, McMinn and Campbell provide a nice overview of a significant portion of their theoretical foundation–Cognitive therapy. They begin by discussing the so-called cognitive revolution in the 1960s (over against mechanistic behaviorism and the prior king, psychoanalysis). They remind us how this revolution continues to shape the landscape of mental health (empirically-validated treatments, short-term therapy, self-help books, etc.).
Going into more detail, McMinn and Campbell divide Cognitive therapies into 2 broad categories: Semantic Cognitive Therapy (SCT) and Constructivist Cognitive Therapy (CCT). What is the main difference between the two? SCT’s premise is that people attribute feelings to the events/circumstances in their life, but only simplistically–overlooking their interpretive thoughts about the situation. The authors provide this common diagram: Events -> Thoughts -> Feelings. SCT is designed to help folks critique their thought patterns and evaluate their rationality. Once this happens, it is supposed that individuals will then have more control over their feelings. They mention Albert Ellis’ REBT model: Activiating event -> Belief -> Consequential emotion. This leads to his treatment: Disputing irrational beliefs -> revised cognitive Effect. They also mention Aaron Beck’s additions to SCT in his description of Core Beliefs that color one’s view of the world and self and are highly resistant to change. While there are some benefits to SCT (revealing our tendencies to assume the worst, making mountains out of molehills) McMinn and Campbell find this model to oversimplify “the complexities of human change.” (p. 85).
CCT began to develop in the later 80s and 90s, per the authors, to address the problem of linearity in SCT. Instead of merely assuming that we react to events, CCT recognizes that how we shape events and feelings can also shape interpretations. “Our beliefs do not simply reflect a passive understanding or misunderstanding of reality; they actually change reality…” (p. 86). From this point, the authors go into a sidebar apology on constructivist philosophy, but not radical constructionism. “One can still believe in external authority and truth while acknowledging that human processes influence the actual events of everyday life.” Also, “Christians can and should accept the premise that personal values and perceptions of reality end up changing reality itself.” (p. 87) Unfortunately, CCT sputters and fades because of a new focus on Empirically Validated Therapies which are based on SCT models.
The remaining 20 pages of the chapter provide the authors’ critique of the the CT foundations and model. On the plus side, they see how CT has a lot of commonsense to it, has clear goals/objectives in focus, is time-limited, and supported by scientific research. As a model it does not have a deterministic mindset. Rather, CT believes in at least partial human agency–you can change how you think, see, feel, etc. You are not merely robotically determined by your past. On the negative side, they acknowledge that CT is rather disconnected from well thought out foundations. They call it a practical response to the frustration of analytic models. CT is, in their words, free-floating interventions without the foundation of a good theory. Further, they point out several false premises within CT and support with examples to the contrary: healthy people think rationally, cognitive errors are usually negative, healthy, rational people eliminate negative emotion, thoughts come before feelings, and we are motivated to be more rational. Finally, they charge CT with being “pragmatic rationalism” (I’d call it pragmatic modernistic rationalism) and point out the problem that it doesn’t deal well (at least as originally designed) with the importance of feelings, relationships, culture, fallen human condition, values, etc. in the process of change. They also point out that some of the Christian versions of CT fall into some of these false premises as well. “The Christian narrative is not primarily about correcting sloppy or ineffectual thinking. We are not taught in Scripture that the path to wholeness is found in better thinking. The bible is a narrative about humans being created for relationship with God and one another, struggling because those relationships are now tainted by the devastating effects of sin, and living with the hope of creation restored.” (p. 109).
My thoughts: I’m glad to see they critiqued the problems in CT. In fact, they did it so well, I’m surprised they didn’t do much more to defend why they keep it rather than looking for an entirely new model. Maybe that will get explained in the next chapters. They avoid the simplistic view that CT is similar to the put off/put on message of the bible. I’m glad they presented the material in the SCT vs. CCT description. I did wonder why CCT didn’t take off given its affinity with postmodern philosophies of science. I would quibble with their bible passages used to defend a chastened constructivism. I have no problems defending a form of social constructionism. But, the passages picked from 1 Peter have more to do about the fact that we influence others than about whether our assumptions about the world construct a portion of reality. I would have liked to see them build a more christian or theological model for CCT and relating it to emotions and narratival therapies. I understand the chapter was already getting long but I would have also like to see them connect the dots in other therapies that have cognitive features (e.g., emotion-focused therapy, Mindfulness, etc.).
Filed under book reviews, christian psychology, Uncategorized
I’m all for a good reason to celebrate with food. Today is Fat Tuesday, Shrove Tuesday, Fastnacht Day (donut day for the Penna. Dutch), or Mardi Gras–depending on where you come from. But there is something crass about celebrating because you are about to go into a period of fasting from tasty things. “Let’s see, I have to be good for the next 40 days, so we’ll party and sin with abandon just before.” It is interesting to me that in Islam, Ramadan is really a period of feasting even though it is known for its fasts. According to my Sunday School teacher Kerry, the daytime fast does exist, but the feasting each night is like Christmas. You feast in order to fast.
I wonder if this is like some I know who struggle with addictions. They are good the week before they see their counselor, but then they “fall off the wagon”right after because they won’t see their therapist for another 3 weeks.
What does this reveal about the human heart? We’ll make up just about any excuse to overindulge–especially if we won’t be found out or we think everyone is doing it.
Filed under Cultural Anthropology
I’m feeling a bit left out here in good ole Pennsylvania. Millions are on the verge of clarifying the likely Republican candidate for president and sharpening the fight for the democratic ticket. But we here in PA are sitting on the sidelines and by the time it comes around for our primary, it won’t likely matter. So enjoy your voting privileges if you live in one of the Super Tuesday states–and vote your conscience. I know some vote for who they think can win, but that defeats the purpose. Vote for the person who you think is the best candidate and leave the rest to God.
On a similar note, did you see/hear the Obama “Yes, we can” video? Moving. Not as moving as an MLK speech and would have been better if it were average people in the video and not stars, but pretty good. Here’s the link if you are interested: http://www.youtube.com/watch?v=jjXyqcx-mYY
Filed under News and politics
Today in Psychopathology class we will be studying the anxiety disorders. In preparing for the class, I happened on an 2001 article by Huppert, Bufka, Barlow, Gorman, Shear, & Woods in the Journal of Consulting and Clinical Psychology (v. 69, pp747-755). FYI, David Barlow is a well-known anxiety researcher in the Boston area.
These authors researched how various therapist characteristics influence outcome in CBT for anxiety disorders. While CBT has been found to be effective in treating anxiety, does it matter much what therapist you get?
What therapist characteristics were not found to be all that meaningful to outcome? Gender, age, and theoretical orientation did not seem to make any difference. The fact that theoretical orientation didn’t make much difference is quite interesting. This suggests that expertise in CBT may not matter as much as one might think. Anybody with a manual and a willingness to follow it can do it well enough–maybe.
So what counselor characteristics do increase successful outcome for anxiety treatment? Experience. The more experienced therapists had clients who had less anxiety after treatment. Experience (number of years as a therapist) matters quite a bit. The authors did not find that experienced therapists were more apt to follow the treatment protocol as there were no differences between experienced and inexperienced therapists as far how they did in following the protocol.
So, what does experience mean? We’re not really sure but it probably has something to do with therapist flexibility while continuing to adhere to the treatment protocol. Those who followed the protocol but were more rigid may have communicated that rigidity to their patients and missed key interpersonal processes. This study didn’t explore this issue but I surmise that is part of the issue.
One funny finding was that more experienced therapists suffered the same drop-out rate as did the more inexperienced therapists. And yet, those who stayed in treatment had much lower anxiety when they were seen by the experienced therapists. So, just because you go to an experienced therapist, don’t assume that everything will go well. No, you have to want to be there and be willing to do the hard work. Also, you just may not click with the counselor.
Most of us counselors want to be skilled and have cool techniques. But once again we find that relationships matter more than technique.
Filed under Anxiety, counseling, counseling science
In preparation for some training I’m doing today, I came across an article published by Karen Chicca Enyedy and her colleagues regarding the types of phenomena that hinder effective group supervision for counselors. In analyzing the data, they suggest that group supervision may fail as a result of 5 separate clusters of problems. You will note that these problems exist in any group, whether bible study, therapy group or group supervision.
1. Between-member problems. (e.g., conflict, griping, competition attitudes, story-telling that hinders supervision)
2. Problems with the supervisor. (e.g., lack of focus, being overly critical of others, dominating conversation, lateness, going on tangents, rigidity, not allowing other theoretical perspectives, using supervision for personal issues)
3. Supervisee anxiety (e.g., feeling unsafe, unsure, inability to be transparent)
4. Logistical problems (e.g., room size, supervisor illness)
5. Poor time management (e.g., not being able to bring up cases).
While these problems are not surprising, they provide a good reminder of the ways we can care for each other by all observing the group dynamic and being willing to address personal and interpersonal matters as they come up. Too often we are hesitant and then the dynamics become cemented and difficult to change. While we supervisors must take stock of what we do, acknowledge weaknesses, and avoid defensiveness, students also must take responsibility for communicating their concerns in a timely fashion.
Biblio: Hindering Phenomena in Group Supervision: Implications for Practice. Professional Psychology: Research & Practice, 34, 312-317.
Filed under counseling science
About every 2 or 3 months I get mail from individuals who must get my contact info off of websites. This mail is not usually personal, though it was when we were advertising for a new counseling professor. There are several similarities to these pieces of mail:
1. The end of the world is at hand. The planet is about to crash or the world will come to an end (and they include very complex and detailed reasons from political news, astronomy, and biblical data as to why they know this about to happen now.
2. They write extremely complex sentence structures that have no meaning. You can define each word, comprehend a phrase, but it may not have much connection to the prior phrase. For example: “certain celestial & terrestrial transactional events due for occurrence in the prophetic year xxxx per the present solar calender in extension, strictly as timed in the book of XXXXX.”
3. Neologisms. Word or words that are newly created by the author. For example: angular separation; inter steller emigration purposes.
4. Persecution. The writer is being mistreated or persecuted for their knowledge.
5. Clip art/cut and paste. The writer uses multiple type-faces, colors, clip-art, and cut and pastes quotes from other sources to bolster the letter
6. Many pages. Most of these mailings have double digit pages.
These letters always break my heart. I can sense the torture they must endure because of the rate and power of their racing thoughts. Imagine knowing the world was going to blow up and everybody ignores you or calls you crazy.
Filed under Uncategorized
In chapter two of Integrative Psychotherapy, McMinn and Campbell attempt to set our their foundation for psychotherapy. You’ll remember that in the last chapter they articulated their theological foundation. This chapter nicely divides into two parts: (a) A defense of the science of psychotherapy, and (b) a summary of what is “known” about the what works, when, and why.
They begin the chapter by admitting that there are many competing and dispirit theories/models of psychotherapy–many which have never been tested through empirical means despite lofty claims. They also acknowledge that many Conservative Christians have cherry picked certain studies that show that psychotherapy is ineffective and ignored many others that say the opposite. In other words, anyone can find a stat to prove whatever they want.
McMinn and Campbell remind their readers that they intend to build a Christian Psychotherapy model built on a robust Christian worldview and fleshed out with scientific methods to tell us, “what works, whey, and why” (p. 56). They lament that since both scientists and theologians aren’t known for their humility, a robust Christian psychotherapy model has not really been built. Collective wisdom is needed to accomplish the goal.
Then the authors turn to some of the details about the science of psychotherapy? Is it really effective? They summarize some of the effectiveness and efficacy studies (these are different: effectiveness: client survey; efficacy: lab studies of very specific interventions on one particular problem). Back in the 1950s Hans Eysenck published a number of studies reporting, “there was no research evidence to support the effectiveness of psychotherapy compared to no-treatment control groups” (p. 57). By 1980, however, there was ample evidence to the contrary. In fact, McMinn and Campbell report, “that the average effect size for psychotherapy is .82 indicating that the average treated is less symptomatic than 80% of untreated persons” (p. 58). They then compare that number with the effect size of certain medications on psychiatric problems (stimulants for ADHD: .91, SSRIs for Depression: .50, Atypical Antipsychotics for Schizophrenia: .25).
Does any one model work better than another? The authors report the oft-heard conclusion: no one model seems more effective than another. And yet, at the end of this chapter they state their preference for Cognitive theory models (due to the research published about cognitive techniques) joined to aspects of client-centered models and other aspects of psychotherapy research. In olden days, we called this eclectic. They do not call it that, most likely due to the negative connotations associated with the word (it has often been used to cover up the lack of theoretical awareness of the clinician using the term).
Before they end the chapter, they consider whether length of treatment matters. They do not really do much with this question other than to point out that most therapeutic courses are much shorter these days. They also consider the question whether therapy benefits last. Again, they don’t cite the literature but state the that certain factors will make it more or less likely for the benefits to last.
They speak briefly about two more important matters in the consideration of the effectiveness of psychotherapy: (a) recognizing that common threads of the change process (insight, affective experience, stages of change, behavioral change, etc.) and point to the works of Prochaska and DiClemente, and (b) common factors in all models of therapy that seem to account for success. They cite date regarding these factors (and the percentages the factor accounts for for therapy outcome) as
My thoughts on this chapter. Nothing out of the ordinary here. The chapter follows conventional wisdom about the science of therapy. The reader who wants to go deeper can look look at their bibliography and dig pretty deep. The reality is that though we think we know a number of things, the research on psychotherapy is complex and sometimes controversial. This is not to say that we know nothing. But we do have a long way to go. I might have liked to see some more discussion on what we as yet do not know but really want to. Further, I would have also liked a short discussion of philosophy of science. Why? Just as we need to be tentative about some of our theological underpinnings, so we ought to be a bit tentative about the modernist underpinnings of psychological research. I don’t think they are overstating their case yet, but the reader may view these two disciplines (theology and psychology) as one having only theory and the other only fact.
I do hope that they will take a look at the presuppositions of cognitive theory in the next chapter. How does that model influence what they see?
Musings on Faith and Psychology 