June 27, 2014 · 7:44 am

What is your response to graduation?


Tomorrow marks the end of the road for students of the 8th cohort of our MA counseling program here at Biblical. After two years of hard labor, er studying and practice, they are now set free to do other things like read for pleasure or hang with family on Monday nights. Of course, some will transition to a few final online licensure courses and others will continue to accrue supervised hours to meet licensure requirements, but the intensity of learning and the cohort life will not be the same.

In thinking about my own graduation from a cohort some 15 years ago, I remember the strange feeling of having arrived at the finish line with an empty feeling. I think that feeling came from the fact that I still had a ways to go to get licensed and to land a job.

Or maybe we put too much expectation on the acquisition of a goal, on our accomplishments. Degrees, jobs, houses, marriages, children–all good things–do not provide lasting changes in our outlook on life, our level of happiness, our perception of self. Sure, these things do provide opportunities for re-evaluation of self, the world, values, etc. But they do not exert changes. You can find people with many degrees, titles, things, who are still searching for an elusive sigh of relief, of arrival at some new constant state.

Is there a better response to graduation?

Instead of only looking for arrival or to the future, what if we use this time to see what God has done in our lives over the last two years? Like climbing a mountain, you get time at the top to stop and look out and back to see how far you travelled. During the climb your head is down trying to avoid tripping over rocks or roots. On the journey, you had to keep a steady pace for fear of quitting. But at the top you can stop and ponder. The time doesn’t last long since you will need to climb down soon. But before you go, take a look at the things God has enabled you to do. You weathered losses, had many ah-ha moments, developed courage to try rather scary things, had to admit weakness, received unexpected support, were sustained and able finish tasks that you thought unnecessary.

If you have just reached a goal like a graduation, take a minute to write down what diificulties you survived and what unexpected blessings you experienced. Look back and then write it down. Otherwise, you may forget as you climb back down the mountain.

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June 25, 2014 · 12:55 pm

My next two weeks in East Africa


Starting Monday I will be off traveling to Kampala, Uganda and then on to Rwanda for Global Trauma Recovery Institute. I welcome your prayers for myself, my students, and the attendees. In addition, Diane Langberg and myself will be leading a group of 12 Americans (10 GTRI students) on a listening/dialogue immersion trip throughout Rwanda. Some of the highlights of our trip(s) will include,

  • 2 day trauma healing community of practice in Kampala with the Bible Society of Uganda
  • 3 day trauma healing community of practice in Rwanda with the Bible Society of Rwanda
  • Afternoon mini-conference with pastors in Southern Province, Rwanda
  • Day with the newly forming Association of Christian counselors in Rwanda
  • Visits to NGOs working with trauma victims and street children
  • Church services
  • Visits to genocide memorials
  • Visit to a refugee camp
  • Numerous conversations, formal and informal over the next two weeks

I will make some attempts to update all on my trip as I go. You can follow me here and @PhilipGMonroe or @BTSCounseling. If you are interested in seeing more about the GTRI engagement model, check out this short video. And, if you would like BTS to continue doing this kind of missional work, feel free to go here and donate before the end of our fiscal year, June 30.

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June 24, 2014 · 11:28 am

Some thoughts on international trauma training


In just a few days I will be off to Uganda and then on to Rwanda to do some training with trauma healing workers in both country’s bible societies. In addition, a group of students from our Global Trauma Recovery Institute will join me in Rwanda to learn more about how to help without hurting. In light of this trip, I penned a few thoughts for those who have a heart to do something about the massive trauma needs around the world. Here’s a preview:

Trauma is a hot topic these days. We live in a world where we are aware of terrible traumas happening around the globe in real time. We hear and see tsunamis unfolding, towns being flooded when dikes are breached, mass shootings, bodies strewn about due to ethnic conflict, houses destroyed by errant bombs, and gender violence in almost every corner of the world. While humanitarian efforts to respond to the physical needs of those in trouble are not new, there is a recent push to have charity workers become “trauma informed” so they can also address spiritual and psychological distress.

Trauma is a hot topic not just because we have more evidence of it happening in real time. It is hot because we have better information about the impact of violence and abuse on the human brain, on human interactions, and on the fabric of a society (Mollica, 2006).

Christian counselors, many of whom want to provide cups of cold water to the hurting masses, undoubtedly wish to use their skills to bring hope, healing and recovery to traumatized peoples around the world. But just where should they start?

You can read the rest of my thoughts over at our faculty blog site.

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June 20, 2014 · 8:08 pm

Lies and stereotypes told by helpers hurt the cause of trauma recovery


I’ve written a piece over at the faculty blog on the shady side of bending the truth to get more attention on the problem of trauma and the need for trauma recovery. It is a common temptation for those of us who work with trauma victims, a temptation to use the stories of trauma to garner personal acclaim (“look what I am doing about the problems in the world”) and to stereotype to increase attention and funding for those who are hurting. Shaping the truth hurts the cause and hurts the victims.

Read at the above link for more.

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June 6, 2014 · 3:56 pm

When you hear “gender” what does it mean to you?


Over the last couple of days our faculty has been on retreat. At one point we watched this TEDx talk by Jackson Katz regarding the need for male leadership in response to gender-based violence. Jackson raises this issue:

What do you hear when you hear the word gender?

What do you hear when you hear the word race?

What do you hear when you hear sexual orientation?

His point is that with each of these words we tend to “hear” or imagine the minority: female, people of color, gay/lesbian/bisexual, etc. He suggests we are much less likely to think “male” in response to gender, white/Caucasian in response to race, and “heterosexual” in response to sexual orientation.

Do you agree?

If so, why is this? Jackson would say it is because the majority is always invisible and thus not included in discussions. His point is that gender-based violence becomes just a female issue due to this problem. While you might not agree with all he says, it is a worthy 0f your consideration on how it is that we ignore problems that seem to not relate to our own experience.

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May 16, 2014 · 8:41 am

Traumatic Nightmares? Two Treatment Possibilities


Many who suffer from PTSD or other traumatic reactions also experience chronic nightmares. It is bad enough to have to deal with intrusive memories and triggers during the day but being robbed of peaceful sleep can send you over the edge, both in terms of physical and emotional health. Christian counselors may be tempted to ignore these nightmares (how can you stop something you have little control over?) or overly spiritualize the content of the dream.

But we ought not neglect the problem of nightmares. It is well-known that reductions in quality of sleep make all mental illnesses worse. Nightmare sufferers understandably avoid sleep but of course this creates a vicious cycle of insomnia, anxiety, and increased avoidance strategies.

There are two intervention options (among many) that appear to have fairly robust positive data indicating helpfulness. (For detailed descriptions of these two and others including the analyses of value, see this pdf): Prazosin (medication) and Imagery Rehearsal Therapy (IRT).

Prazosin is an anti-hypertensive (alpha blocker) that may work on the problem of too much norepinephrine in PTSD patients. It seems to improve sleep length and REM time. Interestingly, beta blockers have been found to increase nightmares rather than reduce them. I am no physician and so cannot evaluate the value of this medication for clients but would encourage clients with chronic, severe and re-occurring nightmares to talk with their doctor about whether Prazosin might work for them. The studies I have reviewed primarily examined the value of this medication for veterans with extreme nightmare problems. The most significant downside to medication treatment is that it only works when the medication is taken. Stop the medication, the nightmares may come back. However, some relief may be beneficial and thus the medication then has value.

Imagery Rehearsal Therapy (IRT) is a short-term therapy that does not work on the actual content of the traumatic experience or attempt to treat PTSD. Instead, it treats nightmares as a primary sleep disorder problem. There are variations on IRT but most versions last between 4 and 6 sessions and may be delivered in individual or group formats. Sessions include education about the nature of nightmares, sleep hygiene protocols, and the imagery replacement protocol. While some of the IR protocols are done imaginally, others ask nightmare sufferers to (a) write down the details of the distressing nightmare, and (b) write a new ending to the nightmare. As Bret Moore and Barry Krakow describe, the therapist does not dictate the new outcome of the revised dream but encourage the sufferer to “change the nightmare anyway you wish” (Psychological Trauma, v. 2, 2010). The nightmare sufferer then rehearses (multiple times) the new ending and is instructed to ignore the old nightmare.

Sound goofy? How is it that a person can just decide to have a different dream? However, the evidence that this therapy works is quite robust. Numerous studies with veterans and civilians indicates it is effective in reducing unwanted nightmares. Most treatment protocols suggest starting with nightmares with content unrelated to actual traumatic events.

Thus, Christian counselors ought to review these two treatments and consider learning the IRT protocol to bring relief to chronic nightmare sufferers.

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May 12, 2014 · 12:58 pm

Counselors talking about themselves? Additional thoughts


Last week I described some research supporting counselor self-disclosures, research that suggests clients appreciate disclosures revealing (a) similarities between counselor and client, and (b) vulnerabilities or personal emotions. While this research flies in the face of conventional wisdom in most counselor training programs, I cautioned counselors to ask some questions first before talking too much about self. With this post, I would like to press the caution just a bit more.

Why do counselors talk about themselves?

Why do counselors talk about their personal life with clients? Read the following numbered list to see some of the main reasons (and the sub-points in italics as illustrations of that reason). Then, consider the bracketed sub point as an alternative to self-disclosure.

  1. We want to put clients at ease and we think knowing something about ourselves might help
    • I can see you are anxious about whether taking antidepressants is appropriate for faithful Christians. I take them and it has only helped my faith.
      • [You’re not alone with that question so let’s explore the pros and cons to taking an antidepressant. Why don’t you start by telling me the reasons you’ve heard or thought about for not taking Prozac?]
  2. We believe our personal history will help a client understand, accept, or challenge something about their struggle
    • I know this treatment for panic disorder is difficult for you but I can tell you it works. It worked for me.
  3. We want to please an inquiring client
    • Yes, I am married and I have 2 children.
      • [Sure, I don’t mind telling you who is in my family, but could you first tell me why that is an important question for you?]
  4. We want to earn their respect and believe that our history will help
    • Well, for starters, I want you to read my book. It is now in its second edition and has been translated into 4 languages. I think you will find it very helpful for your problem.
      • [I’d like for you to start reading about your problem. There are a couple of books out there that I think you might find helpful, including one I wrote. But, feel free to look these over on Amazon and choose the one that seems right for you.]
  5. We like talking about ourselves; our personal stories seem difficult to avoid
    • You and I have a lot in common. My wife has the same problems as your husband. So, I know how lonely you must feel. We’ve tried…
      • [Though you are not saying so, I wonder if you feel lonely in your marriage.]
  6. We see the relationship more like a friendship with mutual sharing
    • I’m so glad to see you today. You are a bright light in a dull day. I look forward to our stimulating conversations. Just yesterday I was thinking about you and wishing to have coffee with you to discuss your career future. 
  7. We want to be seen as human rather than just professional
    • Yes, it has been a stressful day. I could use a back rub after all these sessions today.
      • [You know, some days are harder than others, but I’m curious why you asked this today?]
  8. We want the client to help us in some way
    • I was thinking about your need to work and my need to have someone edit my website. Or, I’m headed out on a mission trip next month. Well, I am if I can get enough donations. I’m about $1000 short thus far but I know God will come through.
      • [neither of these need to be said!]

Is it necessary? Is it helpful?

While self-disclosures may improve client perceptions of counselors, I suspect that empathic, client-centered therapists evoke these same feelings by asking good questions making observant reflections yet still minimizing disclosures, especially those where we initiate them and those that force the conversation to our personal history. There are some disclosures that are in response to client questions (e.g., have you ever struggled with addictions? Are you married? Do you believe in medications? Are you angry with me?) that warrant an answer. When giving this answer, work hard at keeping it brief and returning to the client’s story.

Don’t forget about social media self-disclosures

Clients sometimes “hear” our disclosures through social media. Imagine a client reading, “Well, that was a difficult session, glad I’m done for the day” having been that counselor’s last appointment! Blogs (like this!), Twitter, Facebook, and Instagram can be forms of self-disclosure. Be wary of these. Conventional wisdom says to avoid social media contacts with most clients so as to avoid harm to the counseling relationship. While we need not require an outright ban of these connections, a thoughtful counselor will review connections via social media for potential harm.

Be human

Despite these efforts to avoid letting our selves intrude too far into the session, sometimes life gets in the way. A counselor has a health or a family crisis. Clients have ways of finding this out and often want to ask how things are going. Here it is appropriate to say something brief, thank them for their concern and then start the session. In other situations a client discovers a shared passion for food, a sporting team, a connection through mutual friends. Enjoy these connections, acknowledge them, but be sure not to linger there during the session proper. We are, after all human. Don’t be surprised when counselor and client humanness come into contact.

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May 9, 2014 · 10:36 am

Should therapists talk about themselves to clients? Surprising information


How do you feel when your counselor begins to self-disclose during a session? When they do, is it helpful or a lapse in their judgment?

This is a common conversation in counselor training programs. Generally, most models of counseling and therapy discourage counselor-self-disclosure; some models do so more than others. The reasons for discouraging counselor self-disclosure vary from breaking the unconscious projection (analytic) to just confusing clients because we change the subject from client to counselor.

But a recent article in the April 2014 Journal of Counseling Psychology, suggests that self-disclosure might actually help more than we think. Henretty, Currier, Berman, and Levitt completed a meta-analytic review of 53 studies examining counselor self-disclosure versus non disclosure. And “overall” they found that clients have favorable perceptions of disclosing counselors.

Why? It appears that when a client perceives great affinity/similarity with a counselor, they rate that counselor higher. Also, when a counselor reveals something difficult or painful (a vulnerability?), it makes them more human to their clients. Some examples of this negative valence might include, “when you said that, I felt really sad.” Or, “Let’s talk about your anxiety, having suffering with it some years ago, I suspect you…”

Not so fast!

So revealing similarities with clients and being human make clients feel more similar and possibly more understood. This makes sense. Client/Counselor matching seems to correlate with better outcomes. However, before counselors go talking about themselves they ought to consider a few things.

  1. Why am I doing this? Is what I have to say for them or really for me? (Too often, we speak to talk about self)
  2. Is what I say really going to keep my clients focused on themselves or distract them to my story?
  3. Am I sure that what I say will show similarity? The truth is that we *think* we have a similar story but the times we are sure we know what our clients are feeling we are most likely to stop listening and then miss the client.
  4. How often do I do it?

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May 5, 2014 · 9:49 am

Does yoga decrease PTSD symptoms?


The lead article in the most recent issue of Journal of Traumatic Stress (27:2, 2014) presents a small randomized control trial pitting yoga interventions (12 sessions) against “assessment control” (i.e. assessment plus no treatment). The authors suggest this is the first randomized control trial for yoga interventions, something needed since there is significant anecdotal and quasi-research evidence that yoga reduces trauma symptoms. It is purported to work for several reasons: improved breath-control, improved mind-body awareness/mindfulness, and improved stress resiliency.

What did they find?

The answer to the title question: yes, but not more than controls. Some improvement is noted in the Yoga intervention group: reduction of re-experiencing symptoms and reduction of hyperarousal symptoms. However, the same reductions are also noted in the assessment control group. You might wonder why. The authors suggest that the control group found benefit in tracking their symptoms each week. Thus, self-monitoring may help improve well-being, especially if the person also is accepting and normalizing symptom expression of PTSD. Thus, both groups may have received the same intervention: self-awareness, self-monitoring, and self-acceptance.

Now, this trial was rather small, just 38 in total. With a larger study, researchers might find more power to their intervention. Why keep trying? Yoga is (a) low-cost, (b) not particularly taxing from an emotional standpoint (thus few drop-outs when compared to something like Prolonged Exposure), and (c) something that helps sufferers stay attuned to their body.

 

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April 29, 2014 · 12:39 pm

Urban trauma or bad kids?


Psychiatrist Michael Lyles gives an excellent presentation on the nature of urban trauma at the 2014 ABS Community of Practice. He points out how much of what gets labeled as uncaring violence is better seen through the lens of urban trauma reactions. In addition, he discusses the response of the church. Not to be missed!

Michael Lyles – COP 2014 from American Bible Society on Vimeo.

After his presentation, Police chaplain and urban pastor Rev. Luis Centano gave this response regarding trauma in the city of Philadelphia.

Rev. Luis Centeno – COP 2014 from American Bible Society on Vimeo.

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