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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Filed under christian psychology, Christianity, counseling, counseling science, Psychology, Uncategorized

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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Filed under arousal, Post-Traumatic Stress Disorder, Psychology, ptsd, trauma

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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Filed under Abuse, christian counseling, christian psychology, Christianity, counseling, Psychology, ptsd, trauma

Theological reasons to not use corporal punishment?


Victor Vieth has published an essay looking at the use of the bible to validate corporal punishment. What makes this essay interesting is not that he is arguing against the use of physical punishment but that he is writing to child protective services officials on how to respond to those who believe it is okay. I encourage you to read the full text here.

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Does spiritual maturity reduce spiritual distress?


I’ve posted another blog over at the BTS faculty blog site musing whether spiritual maturity leads to less or more spiritual distress. See if you agree. Post here.

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Trauma and Healing: Faith Communities Respond


Today I will be presenting at the 8th annual Faith and Spiritual Affairs conference put on the Philadelphia Department of Behavioral Health (DBHIDS). The conference theme, and the title of my talk is: Trauma and Healing: Faith Communities Respond. Here are the slides from that talk: DBHIDS Presentation

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David Brooks on Suffering


Over at the BTS faculty blog, I’ve written a short post pointing to David Brook’s recent Op Ed pieces on suffering. He has been writing quite a bit on the topic lately. I think you will find his nuanced thinking quite useful and theologically rich.

You can read my post here.

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On Resilience


From the recent ABS Community of Practice: my talk on resilience to trauma healing specialists.

<p><a href=”http://vimeo.com/90045325″>Philip G. Monroe – COP 2014</a> from <a href=”http://vimeo.com/americanbible”>American Bible Society</a> on <a href=”https://vimeo.com”>Vimeo</a&gt;.</p>

 

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Filed under "phil monroe", Abuse, christian counseling, christian psychology, Post-Traumatic Stress Disorder, trauma, Uncategorized

New Pennsylvania Mandated Reporting Bills Signed Into Law


My local newspaper informs me that Governor Corbett signed into law HB 431 436 and SB 21 and 33 into law today. The paper reports what this means:

“Senate Bill 21 ensures that virtually anyone who works with children in a professional or volunteer capacity, including school personnel, personnel at colleges and universities, youth sports coaches, child care providers, religious leaders, physicians and other health care workers, social services workers, law enforcement officers, librarians, emergency medical service providers and employees and independent contractors for each of those entities are required to report suspected child abuse.

“House Bill 436,” Stephens continued, “adds attorneys for organizations caring for children to this list of reporters, while preserving the attorney client privilege, bringing Pennsylvania in line with a majority of states across the U.S.”

So, anyone who works with or volunteers with children is now considered a mandatory reporter. Attorneys who work for those organizations who serve children cannot keep quiet when child abuse is reported to them. Mental health and other health professionals continue to be mandated reporters when potentially abused children present to them or their colleagues.

Besides expanding who is mandated to report suspected child abuse, HB431 also now requires evidence of 3 hours of training on child abuse recognition and reporting for all seeking PA licenses AND evidence of 2 hours of continuing education on the same subject for all who seek to renew their PA licenses. 30 CE hours are still the minimum required per licensing period, but now 2 of those 30 must be about child abuse recognition and reporting. Not sure if that means the existing mandate to take at least 3 hours in ethics will be on top of the 2 for child abuse reporting or if the 2 for child abuse reporting will count towards the 3 in ethics.

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Filed under Abuse, counseling, counseling and the law, ethics, Psychology

Comparing ACA and AACC ethics codes: Multiple Relationships


Continuing our review of the ACA and the AACC codes for counselors, let’s take a look at how both codes address the matter of multiple or dual relationships. (See first and second posts about comparing the ACA and AACC code of ethics for counselors and mental health professionals.)

Multiple or dual relationships between counselor and client (or client’s family) are those that combine the professional relationship with one of another sort. If a counselor of a client is also that client’s pastor, that would be a multiple relationship. Other types could combine counselor and friend, counselor and business partner, counselor and employer, and increasingly possible, counselor and social media “friend.” Both codes are concerned about the formation of dual relationships because they become fertile ground for counselor judgment bias and harm to the client. Both see that once a counseling relationship has been formed, that relationship ought to be clear take priority over all others.

The ACA code of ethics prohibits outright the following dual relationships:

  1. Counselor and sexual partner: Counselors may not have sex with clients or their family members
  2. Counselors may not start counseling work with former sexual partners
  3. Counselors must wait at least 5 years before engaging in sexual activity with former clients (and even then may be prohibited)
  4. Counselors may not provide services to friends and family
  5. Counselors are prohibited from engaging in personal virtual relationships (social media) with current clients

Beyond the sexual arena, the ACA code warns counselors to avoid dual relationships or “extending the boundary” of the counselor or supervisor relationship

Counselors avoid entering into nonprofessional relationships with former clients, their romantic partners, or their family members when the interaction is potentially harmful to the client. This applies to both in-person and electronic interactions or relationships. (A.6.e)

When a counselor agrees to provide counseling services to two or more persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person. If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from roles appropriately. (A.8)

So, notice the focus: avoid “extending the boundary” or what we used to call forming multiple relationships with current or former counselees or their family members. Document when you do so to illustrate informed consent, limiting of potential harm, and efforts made to rectify harm when it unintentionally happens

What about the AACC code?  It begins (ES1-140) with these paragraphs,

Dual relationships involve the breakdown of proper professional or ministerial boundaries. A dual relationship exists when two or more roles are mixed in a manner that can harm the counseling relationship and/or the therapeutic process. This includes counseling, as well as personal, fraternal, business, financial, or sexual and romantic relationships. Not all dual relationships are necessarily unethical—it is client exploitation that is wrong, not the dual relationship in and of itself. However, it remains the responsibility of the counselor to monitor and evaluate any potential harm to clients. (emphasis mine)

While in a counseling relationship, or when counseling relationships become imminent, or for an appropriate time after the termination of counseling, Christian counselors do not engage in dual relationships with clients. Some dual relationships are always avoided—sexual or romantic relations, and counseling close friends, family members, employees, business partners/associates or supervisees. Other dual relationships should be presumed as potentially troublesome and avoided wherever possible. (emphasis mine)

The AACC code then prohibits counseling relationships with family and close friends and warns against those “best avoided” (e.g., business associates, club members, etc.). Finally the code addresses counseling relationships within the church,

Christian counselors do not provide counseling to fellow church members with whom they have close personal, business, or shared ministry relations. Dual relationships with any other church members who are clients are potentially troublesome and best avoided, otherwise requiring justification. Pastors and church staff helpers should take all reasonable precautions to limit the adverse impact of any dual relationships. (ES-140-f)

This wording marks a change from the previous AACC code where dual relationships were more positively addressed. The old rule stated this, “Based on an absolute application that harms membership bonds in the Body of Christ, we oppose the ethical-legal view that all dual relationships are per se harmful and therefore invalid on their face.  Many dual relations are wrong and indefensible, but some dual relationships are worthwhile and defensible.”

Agreements? Disagreements? Both codes ban the ending of counseling relationships for the purpose of changing the professional relationship to different relationship, or to engage in sexual activity with a client or a member of the client’s family. The AACC codes requires 3 years before marrying a former client (assuming all other concerns raised are not an issue) whereas the ACA code requires 5 years before engaging in an intimate relationship. The ACA code as extensive concerns about the teacher/student relationship as well as the supervisor/supervisee relationship. The AACC code says little about these (though some can be inferred). The biggest difference, however, is found in the stronger language banning dual relationships in the ACA code where the AACC code warns against possible harm but leaves the door open as long as the counselor knows they have to prove no harm happened and informed consent.

 

 

 

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