May 4, 2012 · 5:48 am

Validating your client’s distrust of you


Ever had a person tell you they can’t trust you when you know they can? What was your response? if you are like most people, you notice the tendency to want to defend yourself. No, really, you can trust me. Why don’t you give me a chance? Or maybe your response isn’t one to beg but to back away and treat the person with a cool demeanor.

What should counselors do when a client doesn’t or won’t trust their intentions or motivations?Janina Fisher (see previous post) reminds us that the right responses is…acceptance validation. Especially with clients who experienced invalidation in violence and abuse. Notice that the effort to press a client to trust you or distancing from them sends the exact same message: your feelings and experiences are wrong and something to be rejected. Not surprisingly, clients feel invalidated once again.

What does validation look like?

You are right. You don’t know if you can trust me. Trusting important people meant that you got hurt in the past. So, not trusting me is understandable. So…what should we do? Validation doesn’t mean that we agree with whatever our clients say but that we find the truth and we underline it. Further, it means that we give the power back to our clients since many of them experienced being controlled.

Too often we think we know what is best for our clients and we try to indoctrinate them to our wisdom. Even when we are right, our efforts may unwittingly re-enact the stealing of power to set proper boundaries. Even when our clients want us to convince them that we are okay and worthy of trust, we ought to be careful. In everyday life we have to trust others, live with the possibility that our trust may be violated…and that we will need to respond to such violations with grace and truth. Promises to always be trustworthy perpetuate the myth that protection from all pain is possible in this life.

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May 3, 2012 · 1:59 pm

eye contact and amygdala stimulation?


I’m in the midst of a CE training by Janina Fisher–Traumatic Attachment & Affect Dysregulation–and here is something she just said (not quote…my recollection),

When you make eye contact with another, you stimulate the amgydala. The arousal of this part of the brain arouses emotions, especially those connected with desire for or fear of intimacy. The point is that eye contact stimulates the attachment system which in turn plays on our feelings about being in relationship with others.

Later, she quoted someone (named Benjamin), “To be known or recognized is immediately to experience the other’s power. The other becomes the one who can give or withhold recognition: who can see what is hidden; who can reach, conceivably even violate, the core self.”

Thus, some clients (those who are ambivalent) find our “seeing them” (via empathy) as anxiety provoking. Counselors do well to help the client notice these reactions without over-stimulating reactions (which likely would trigger fight/flight reaction).

How you feel about making eye-contact with another depends largely on (a) how you feel about that person, or (b) how you feel about yourself. Both feelings depend on prior experiences and perceptions of self and other.

Try out a few moments of eye contact, either with someone you have authority over (supervisee, child, student) or someone who has power in your life (spouse, boss, teacher). What reactions did you have? Reactions in your body, thoughts, feelings? What impulses did you have? What does this tell you about how your brain works in regard to knowing and being known?

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May 1, 2012 · 11:14 am

Disagreeing in public? Are there some best practices?


I’ve written a post over at our Biblical Seminary faculty blog about the art of disagreeing with others in public. By public I mean the kinds of conversations that take place in face-to-face with an opponent, discussions of a thinker’s position in a classroom, or the kind that take place on Internet sites (e.g., blogs like this, news sites, etc.).

Check out  my 5 tips to more loving disagreements.  Try it out with your next conflict with a friend or family member.

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April 27, 2012 · 10:50 am

Learning to get good grades or just learning? Or both?


I’m a professor and I know it is all about learning. Who cares about the grades? Right? What matters is whether or not students comprehend the material and can use it in real life. In my world, I want counseling students to understand the nature of trauma, how to recognize it and respond well to it when evident in their clients. I don’t care if they get an A or a C as long as they are competent. And, I know that some students test poorly and yet are exceptional counselors.

Yeah right, grades DO matter

But ask students and parents of school-age children, and guess what–grades do matter. Good grades get better scholarships; get parents off your back. Good grades get better internships. Good grades make teachers think you are smarter. Good grades help you feel better about yourself. Wait…those last two…are they true? Yes, even if it shouldn’t be that way and probably worth another post at some other time.

Is there a relationship between good grades and learning?

But how close are getting good grades and learning? Can you get good grades and not really learn? How many readers aced a history or statistics test years ago but now couldn’t tell you the first thing about the subject? You can memorize, recite, and forget…and get good grades. So, we know that you can teach and study to the test (notice I didn’t say learn) without learning.

And yet, let me suggest one positive relationship between getting good grades and learning. The student who learns to get good grades (but hopefully isn’t obsessed or controlled by them) has learned to

  • Decipher what the teacher is looking for and to complete assignments as required
    • Learning: decoding, organization, self-assessment, predicting time/effort needed to complete tasks
  • Get the information needed to complete an assignment
    • Learning: speed reading, efficient categorization of material
  • Deliver the information needed in an appropriate format
    • Learning: concise communication, learning to differentiate between essential and non-essential material

The real reason I’m writing this post

Okay, the real reason I am writing this post is that I just helped my teenage son take a difficult, on-line quiz that covered an inordinate amount of material. He was allowed to complete the quiz while having the material still open. However, the amount of material he had to read and understand comprised overwhelmed his ability to remember what he learned and where he learned it. So, I taught him how to read the quiz question and then go back to the multiple e-documents and use the “find” button on his web browser to find the pertinent information he needed to answer the question.

Did I help my son learn or just to get a better grade on his assignment? If he chooses to not read the material in the future but just use the search functions, is that a failure to learn well or did he learn to become efficient in work?

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April 24, 2012 · 10:32 pm

Why is some trauma complex? A helpful distinction from Judith Herman


Counselors talk about trauma as if all traumas lead to traumatic reactions. They do not. Some people have significant distress from what might be considered slight traumatic experiences (surely an oxymoron!) while others appear not have any negative or ongoing reactions to very large distressing events.

There’s another problem. We sometimes talk as if all traumatic reactions are the same. This is also not the case. While the symptoms of posttraumatic stress disorder (PTSD) are well-known to many (i.e., intrusive re-experiencing of trauma experiences, emotional numbing and other attempts of avoiding memories or triggers, and hypervigilance), you can find counseling students and practitioners who are less aware of a cousin of PTSD: Complex Trauma.

Defining Complex Trauma

I’m reading Treating complex Traumatic Stress Disorders: An Evidence-Based Guide, edited by Christine Courtois and Julian Ford (Guilford Press, 2009). This is an excellent text if you are interested in exploring the symptoms, neurobiology, and treatment protocols for complex trauma. In the foreword, Judith Herman helps the reader clarify the main difference between regular and complex trauma

These days, when I teach about complex PTSD, I always begin with the social ecology of prolonged and repeated interpersonal trauma. There are two main points to grasp here. The first is that such trauma is always embedded in a social structure that permits the abuse and exploitation of a subordinate group… The second point is that such trauma is always relational. It takes place when the victim is in a state of captivity, under the control and domination of the perpetrator. (xiv, emphases mine).

For trauma to become complex one needs to experience the trauma at the hands of those who are most perceived to control a social unit (family, community, etc.). It needs to be repeated and woven into the fabric of distorted relationships. You can see that prolonged abuses experienced as a child prior to development of an understanding of the world and of the self would have more devastating impact than an unfortunate and distressing event that happens as an adult. If I experience a horrific accident and an unexpected attack by a stranger, I would not, usually, begin to feel unsafe amongst friends and family. I would likely continue to trust them even as I might not trust the larger community. However, if I experience repeated abuse by a teacher, a parent, a relative, a church leader as a young child, I do not have the prior experiences of safety to rely on and thus, I am likely to experience all of the symptoms of PTSD and then some more.

What More Symptoms?

Courtois and Ford give a cursory description of complex trauma on the first page of the book,

…involving traumatic stressors that (1) are repetitive or prolonged; (2) involve direct harm and/or neglect and abandonment by caregivers or ostensibly responsible adults; (3) occur at developmentally vulnerable times in the victim’s life, such as early childhood; and (4) have great potential to compromise severely a child’s development.

Adding to the typical symptoms of PTSD, complex trauma victims also struggle to regulate emotions, impulses, somatic experiences, consciousness, and evidence significant distortions in views of the self and others leading to difficulty forming trust relationships and finding meaning in life and faith.

Those interested in learning more about the current thinking on complex trauma conceptualization and treatment may find this book useful. Others may wish to check out the latest articles at www.traumacenter.org, one of the leading centers in the country focused on the problem of trauma.

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April 17, 2012 · 10:11 am

3 important goals for trauma recovery


In the last week we have been discussing the best words used to describe the process of trauma recovery (see related post below). While words are important and carry much meaning, it may be more helpful to consider what recovery goals are in order for trauma victims. While we know recovery road can be long and arduous, it helps to know when we make progress and a general sense of the direction we are headed. In the days before GPS, if you went on a long car trip you probably consulted a map on several occasions in order to make sure you were headed in the right direction. So also, when you are working to get better after a traumatic experience, you want some sense you are still working on good goals. This need is especially great if the traumatic symptoms are complex and the treatment not brief (think war, genocide, child sexual abuse, etc.)

What three goals?

Esad Boskailo, as noted on p. 94 in his memoir (written and reported by Julie Lieblich) works toward these three goals that in turn support the ultimate goal: thriving (notice that the goal is not being free of symptoms, free of triggers, or back to life as if the trauma did not happen).

  • Acknowledge losses
  • Foster resiliency (i.e., build the capacity to use current coping resources)
  • Find meaning in life again

I think these do function well as helpful signposts or intermediate goals in the process of recovery from traumatic experiences. Now, I don’t believe these goals are necessarily in sequence. For some clients, they stumble on something that gives new meaning to life and thus are better able to acknowledge losses. Others get to work on building better coping mechanisms (e.g., a vet puts away items that cause him or her to dissociate, an adult victim of CSA stops cutting and develops acceptance strategies, etc.) and then can acknowledge losses.

So, in the murky water of therapy (and it surely is murky!), the trauma victim can find some comfort in activities pointing to these intermediate goals. Each day they reject self-condemnation for not being who they used to be before the trauma, they are moving toward thriving. Each day they embrace available coping resources (e.g., a friend who will call or pray), they are moving toward thriving. Each day they find one meaningful experience, they are moving toward thriving.

the how we meet these goals is, of course, the 64,000 dollar question…and not something we can set in stone. I will write on some general activities that are common in most treatment modalities in the coming days.

Related articles

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April 16, 2012 · 10:48 am

In Counseling, Who is the Teacher?


Most counselors and therapists get into the field of counseling because they want to help people. This is a good thing! Imagine if they only wanted to make money or to be the center of attention. But, underneath the goal of wanting to help people lurks an insidious goal:

being seen as wise.

Being seen as wise (notice the difference between being wise and being seen as wise) tempts us to become the teacher, the teller, the obnoxious sage.  Teaching, telling, training are all activities that may happen in counseling, but only when necessary. Truth be told, we counselors resort to teaching and telling because it gives us a job to do and makes us feel good. This is especially true when we work with the most severely traumatized people. Here someone is hurting in front of us. We can see that they are stuck. Who wouldn’t want to pull them out of the mud? Now, there may well be important teaching moments–gently instructing someone on the symptoms of trauma and/or the physiology of trauma. This might be important for the client who believes that the symptoms are really signs they are sinning and that they can just choose to stop being triggered.

In Counseling, Who is the Teacher?

“The patient is the ultimate teacher about trauma, and a good therapist is a good listener.” (Boskailo, p. 81)

While the counselor has much to offer in regard to teaching, training, and goal setting, we must remember that the client is the one teaching us about their trauma experiences and how much they can deal with at a given time. For example, Boskailo reminds us (see above link for book) that while telling the trauma story is an important part of the healing process, the “how” of telling (and the “how much”) is something each client will need to teach us. One client may need to tell and re-tell the same story each week. Another may be better helped by drawing. Still another may tell once and never again.

We counselors are the student in these kinds of matters. It is our job to listen well and learn well!

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April 13, 2012 · 11:11 am

Male Child Sexual Abuse: A Survivor Speaks Out


Most books and stories about child sexual abuse are about female victims. Given the lack of material highlighting the problem of male child sexual abuse, many victims can feel doubly isolated since it seems that no other males experienced abuse. Those looking for a story about male child abuse and rescue might find R.A. Dickey‘s new memoir a good starting point: Wherever I Wind Up: My Quest for Truth, Authenticity, and the Perfect Knuckleball (Blue Rider Press, 2012).

R.A. Dickey is on the pitching staff of the NY Mets and in this book details abuse he suffered at age 8 at the hands of a teenage female babysitter and by another neighbor, a 17 year old male. The story is about his struggles growing up, his conversion to Christianity, and his struggles to reach the big leagues after being a very promising first round draft pick. What I like about this book is that it is not a happily ever after story. Yes, many wonderful and good things happen…but so do difficult things. Losing an 800,000 dollar first contract due to an anomaly in his pitching arm, repeated attempts to make it in the big leagues, a miscarriage, the loss of his fastball. Furthermore, he tells the story in such a way that does not promote himself. He doesn’t take himself too seriously and is more than willing to admit his insecurities.

Very little is about the actual abuse. He tells a bit about the abuse and how he felt, the smells, the experience (written in the present tense), etc. He also tells about his encounter with the teen girl some years later and the experience he had trying to confront her. If you know someone who would like a realistic read on the struggles of growing up with abuse and other family heartaches and finding one’s way, this might be a good toe in the water  kind of book.

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April 12, 2012 · 5:47 am

Trauma recovery? Healing? Integration? Which words communicate a good outcome to you?


Recovery. Healing? Restoration? These words contain both information, movement, and emotion. What words do you like to use when describing the process of getting better after a traumatic experience? How do you communicate that you are better but not so much better that you have no more bad memories; that you have no more nightmares; that you are not triggered into panic when you see someone who abused you?

What words do you shy away from?

Let’s consider healing first.

I was and am being healed?

Some hear healing language as a completed task. “I have been healed.” Past tense. If I was in a wheelchair but now I walk…would I say I have been healed if I walk with a limp or need a walker to get around? Do you ever hear someone say, “I was healed, in part.” Would it be better to say I am being healed or I am recovering. Compared to Greek verb tenses, our English language doesn’t communicate well the ongoing state of something. In Greek, we can communicate a present perfect tense such as, “I was and am currently being healed” all in one verb form. But in English, we cannot communicate such an ongoing process without more words. Thus, when we use the shortcut, “I am healed,” it sounds like a finished job.

Recovery?

What about recovery? Restoration? Renewal? Recovery words are popular amongst former addicts. For them it connotes that they are no longer using but making the daily choice for sobriety. However, they recognize the danger exists of falling back into drunkenness and so they communicate that they are in a lifelong process. For some, however, recovery sounds like a failure–failure to find victory and failure to accept a new identity.  The truth is, few people outside of AA use the word recovery in every day speech. The other “r” words are more likely used in Christian circles but not so much in discussion of life after trauma.

Can you integrate trauma?

I have just finished reading Wounded I am More Awake: Finding Meaning after Terror by Julia Lieblich and Esad Boskailo (2012, Vanderbilt University Press). Julia helps tell Esad’s (a Bosnian doctor) experience of being held in 6 different concentration camps. He is now a psychiatrist in the US and works with trauma victims. However, he faced much brutality in being treated worse than one would treat an animal and so was not in good physical or psychological shape when he came to the U.S. I commend the book to those who want a basic understanding of trauma and of this thing we are trying to call healing and recovery. Listen to these quotes from Boskailo the psychiatrist,

 I can’t take away what happened” [said to another survivor]. But [I] can help [you] imagine a better future.

“You are fifty, not twenty-five. You will never be the person you were twenty-five years ago. Even if you didn’t have trauma, you would not be the same.”

What Boskailo is arguing for is integrating trauma into one’s present life. One cannot go back and recover what was lost. A trauma survivor is never going to be free from losses suffered. To do so would be to deny truth. Integration means allowing the reality of trauma and its losses while finding meaning and value to live in the present with hope and even joy. Integration requires acceptance and willingness to look for meaning and purpose.

I like the connotations of integration. But, I am not sure I like the word integration since it also doesn’t connote some level of arrival at a good enough place. What word would you use?

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April 10, 2012 · 12:21 pm

Invite your pastor (or key leader) to attend our “abuse in the church” conference, July 20-21 2012


church should be the safest place in the world! Unfortunately, it isn’t always. Even worse, when abuse does happen, the church may not always protect the victims. While this shouldn’t surprise us since the church is full of sinners, we ought always to be working to make it a place free from abuse. Is your church working to protect the congregants from abuse? Is it ready to respond to an abuse allegation?

This summer I will be co-teaching with Boz Tchividjian (Liberty Law School prof and former prosecutor) a weekend course/conference on preventing and responding to abuse in the church. We are inviting church leaders to join our MDiv and counseling students at Branch Creek Church, Harleysville, PA. The class will run Friday night, July 20 and all day Saturday, July 21, 2012. All the details you need can be found on this Abuse Course Flyer.

Would you consider personally inviting your pastor or church leader by passing on this brochure?

For non-student registrations, click here. If you want to see a syllabus, click here.

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