January 6, 2012 · 9:42 am

How to evaluate a counseling model or technique: Step three


In my two previous posts I suggested that the best way to evaluate “the next best thing” in counseling models or techniques is to start with a healthy dose of suspicion and then to read with an open mind as you try to enter their world and see what they see. Now, moving on to step three, I recommend that you take a look under the hood.

Step Three: Evaluate Assumptions

Whether you are considering adopting a whole model of counseling or merely a technique, you want to step back a bit and assess what assumptions and presuppositions color the author’s view of the world. If you adopt any portion of the model, you will be likely to adopt some portion of their assumptions. In evaluating assumptions, I find it best to ask yourself a few questions,

1. What presuppositiong, worldview, beliefs, etc. bleed through on their pages? Do they focus most on nature? Nurture? Individualist? Communitarian?

2. What ideas and values seem to be most prominent for this author, especially about human nature, health, healing, struggle, etc.

For some authors (especially model builders) assumptions are handed to you on a platter. When Carl Rogers said that he believed that humans had a drive to find health and wholeness, he made his assumptions quite well known. However, during the 80s and 90s, many psychologists stopped trying to build models. They hid behind “eclectic” and focused on “what works.” Well, “what works” (aka utilitarianism) is an assumption that we ought to be aware of. Many current authors have returned to try to build a better explanatory model for human flourishing. For example, Mark McMinn has penned an integrative psychotherapy model (reviewed here in past years) attempting to bring together cognitive and affective and spiritual models. Despite the return to model building, most popular trade book authors rarely discuss their own assumptions.

Still sound fuzzy? Just what are we looking for and what do we do with it once we find it? Consider these made up examples.

Author one: “…her problem? Her love tank was empty, had a huge hole in it from the way she was treated by her father.” Assumptions? You can see a little Maslow’s hierarchy of needs and a statement that present problems are the result of victimization from the past. This will surely impact the author’s ideas for treatment.

Author two: “…her problem? She struggles to connect her whole brain when processing emotions. Neural networks need to be developed and used to cool down her hypothalamus. she…” You can see here that the focus is on neural networks, possibly brain chemistry issues, and an overactive hypothalamus. You might not hear anything about will, choice, right thinking or experiencing. This client is a product of her brain. This will surely impact the author’s ideas for treatment.

Now, a word of caution. Just because we discover assumptions that we don’t agree with, it doesn’t mean we have to chuck the model or technique. Rather, we are merely trying to understand some of the straggler assumptions that might cling to the parts we buy into. I used to start all of my model evaluations with this step. However, I found that I was more likely to wholesale reject their observations if they were wrong in their assumptions. But everyone sees—even if poorly. And observations can be very helpful—even if fixated on one small aspect of life.

In our next step we will seek to let their assumptions challenge, correct, or refine our own (rather than just believing what we have always believed is airtight correct).

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January 4, 2012 · 5:01 am

How to evaluate a counseling model or technique: Step two


In my last post, I discussed the importance of evaluating the next “great” counseling method or technique with a good dose of suspicion. What is the author (or disciple) trying to sell us? Why? What is the basis of their model?

However, I do not want you to think that we ought to dispatch every counseling intervention with a snooty once-over. Rather, I want you to immediately follow-up your suspicion with an opening of your mind!

Step Two: Read with an Open Mind

Even the shakiest of ideas, models and techniques provide opportunities for us to grow. No matter our wisdom and intellect, we will always see life (reality) from a particular vantage point. Every human vantage point contains bias. This is why we should read outside our own disciplines and family groups. I especially encourage readers to listen to their loudest critics. They will have a point or two that we ought to take to heart.

So, find the originators of the model or technique you want to explore (often, original authors praise their ideas a bit less than their disciples do). As you read, ask these questions,

  1. What does this author observe about their world, the way it works (or doesn’t)?
  2. How do they envision the purpose and goal of life?
  3. What human problems are most significant to them?
  4. What solutions do they seek? What techniques or interventions are most prominent?

While you may disagree with their interpretations (save that for a later step), work hard to view the world through their eyes. Can you see what they see? You want to make this effort because you recognize you do not see the world entirely as it is. You see in part. Your humility here will help raise to your mind questions that you mint not thought were all that important.

Let me give you an example. In my first semester at Wheaton College (PsyD program) fresh out of the biblical counseling world of CCEF, I wrote a paper for Stanton Jones defending/critiquing a model of biblical counseling. At the end of the paper, Dr. Jones asked me to conduct a thought experiment,

Would [this] model urge medical research forward? After all, if worship is our primary end, and we can give glory to God with a serene death, why try to eradicate disease? If suffering is a human trial that gives us opportunity to glorify, should the concrete contributions to the suffering be addressed? I know this can be answered, but oh the subtleness of emphasis!

I have to tell you that these words were powerful to me at the time (and still are!). He knew I would say, “of course we should eradicate suffering.” But, in promoting the human end of enjoying God, even in suffering, I had emphasized suffering well to the point of de-emphasizing concrete helps that often come through psychological and medical research.

The goal of step two is to challenge our own assumptions to see if they need tweaking. Once we have concluded exploring the observations of the model builder, next we move to evaluating interpretations and assumptions.

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January 3, 2012 · 10:26 am

How to evaluate a new counseling model or technique: Step one


Being a professor of counseling I get lots of questions like this: “What do you think of _____ (a new or popular counseling model/intervention)? These days, I’m being asked about coaching models, neurofeedback, EMDR, EFT, brainspotting, the use of SPECT scans, the use of psychiatric medications, nutritional supplements, and the like. In past years, I might have been asked about theophostic ministry, DBT, or ECT.

To be honest, I haven’t read every counseling model to the nth degree. I know a bit about a lot of models and a whole lot about some models. So, I try to be careful not to offer too much critique on what I don’t know first hand. That said, I do think there are good ways to go about evaluating any new model and proponents’ claims of efficacy. Over the next few posts I plan to show you how I try to investigate any new (to me) model:

Step One: Start with Suspicion

What? Shouldn’t we give them a fair shake? Yes, of course. And we will. But first, I do think it is helpful to ask yourself, a few key questions about what you are being sold.

  • Who is promoting this model/intervention? What financial benefit are they seeking?
  • What claims or promises do they make about their successes? Do they seem reasonable? Overly optimistic?
  • What supporting evidence is offered? Anything other than anecdotes from the inner circle of disciples? Any empirical evidence?
  • Do supporters distance from everything that has gone on before? How do they connect to mainstream models?
  • How transparent are the authors about what is being done?

None of these questions will answer our ultimate question of the value of any new model. There are excellent new models with almost no empirical evidence. Conversely, there are those who connect their intervention to a piece of mainstream research but do so only tangentially (thereby giving the appearance of scientific support but lacking validity and reliability (i.e., much of the change your brain popular models)).

A model that starts in the popular sphere may turn out to be good. Yet, we still want to gather the data about the motives and purpose of the new model. Take coaching for example. There is good evidence that coaching techniques work. However, much of what you find in popular places (bookstores and the Internet) is about someone trying to make a buck, either to coach you or to sell you a certification to become a coach. Thus, it is important to look at “packaging” to see what we are being sold. We may well want to buy the “product” but buyers need to know that sellers don’t usually talk about the weaknesses of their product.

Watch out for those models that over-sell their results, especially in the area of “complete freedom” from suffering. These are almost always unsupported by empirical evidence and certainly do not line up with good theology. We want complete removal of mental pain. This isn’t a bad desire, but it does set us up to buy the “next best thing” without proper critical evaluation. And well-meaning friends may tempt us to try out some new technique because it worked for them.

And yet, we need to be open to the possibility that there is something new on the horizon. Truthful anecdotes still have some merit. And so, tomorrow I will suggest that step two includes “reading with an open mind.”

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January 1, 2012 · 5:22 am

Top 2011 reads at wisecounsel? Oldies rule!


WordPress sent me a synopsis of my blog’s stats (where are readers coming from, what do they read, etc.) for the year 2011. So, I thought I would look at what posts got the most attention this year. Surprisingly, of the top 12 posts, only one was written this year! Despite having an all-time readership number this year, it appears that older posts get the most attention. I can interpret this in two ways: my writing used to be better (or had more appealing titles? ) or, my writing has staying power.

Hmm. which interpretation is psychologically more appealing to me?

Anyway, here are the 12 top clicked posts in descending order (and their year first posted) of 2011. Each title is a hotlink to the post. [It doesn’t count those posts read through social networks or my homepage. Mostly this counts those posts read by clicking the right hand “top posts” list or by search engine results]

Top Posts for 365 days ending 2011-12-31

2010-12-31 to Today

Title

Year
Where is my wallet? Why we find it hard to learn some really important lessons  2007
Serious Mental Illness and faith: what to do?  2007
Psychiatric vs. Psychological evaluations: What is the difference?  2009
The art of counseling: Why interpersonal process is (almost) everything  2006
What is the proper response to Bin Laden’s death?  2011
Bonny and buxom? The answer to yesterday’s trivia  2008
Are you a humble person? 7 habits to consider  2007
How long should you keep clinical records?  2007
Frederick Douglass on American Religion  2007
Grief brings ‘wisdom through the awful grace of God’  2006
Mindfulness and meditation  2008
The practice of unlicensed counseling  2009

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December 31, 2011 · 12:38 pm

2011 the year of abuse and trauma? Or the year of speaking out?


In our 24/7 news saturated world, we are kept apprised of the traumas around the world: earthquakes, famines, nuclear catastrophes, mass murder, ethnic cleansing, rape as a tool of war. Of recent months, we have heard much about child sexual abuse. Most of what we hear has to do with abuse having taken place years before, sometimes decades ago.

Nonetheless, we could easily label 2011 as the year of abuse allegations against those who were thought to be respectful citizens. This year, the ones that got the most attention were male child sexual abuse allegations.

But I prefer to think about 2011 as the year where child sexual abuse reporting broke through the veil of secrecy. Abuse has been happening ever since our loss of Eden. And cover-ups are the norm. Maybe this year we saw a bit more willingness to speak out about past abuse. That would be a good thing if this continues.

Does it seem to you that we are having more abuse reports? Well, you are not alone in that opinion. Check out this recent Reuters reporting on the uptick of abuse calls to organizations like RAINN and the national Childhelp hotline after the Penn State and Syracuse abuse cases. RAINN reports a 54% increase in contacts and the Childhelp line reports a 20% increase.

Could there be an increase in false allegations? Sure. And every false allegation hurts not just the one being falsely accused but also every abuse victim who may not be believed. However, let us remember that when child abuse was first discussed in psychology (think Freud), it was treated as hysteria. Most allegations are true. It requires too much sacrifice of public dignity, too much loss of family relationships to have many false negatives.

An idea for 2012

How about this year we commit to child safety and prevention of abuse? 2012 as the year the church takes the lead in wholistic  care for abuse victims? This means we speak up when we see inappropriate behavior. We develop appropriate policies (and then carry them out) for all in the church, including pastors. This means we preach and teach on child protection. This means we assess our own attitudes and actions that might support child abuse (e.g., use of porn, failing to hold each other accountable, etc.). Finally, this means talking about restorative justice for victims, hope-building for victims, and care for those who abuse.

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December 30, 2011 · 5:08 pm

Baseball in December? Here’s a good read!


If you love baseball you may like Dan Barry’s recent book on the longest game ever played in professional baseball. 33 innings (in April in Rhode Island!) of Triple A baseball between the PawSox and Rochester (NY) Red Wings in 1981. Players such as Cal Ripken and Wade Boggs played in the game but the book goes beyond the play-by-play to cover the back story of many of the lesser known players, the umpire, the PawSox owner, and even the Red Wings’ radio announcers. Even if you don’t like baseball, I suspect you can find lots of human interest in the book to stay interested. Warning, the only negative is the author has to include the F word quite a few times.

While we think about the millions made in professional sports, the vast majority of players never make it to the “bigs” or only do for a few games. This book shares some of the experiences and struggles of those minor leaguers chasing dreams that never materialize–for the love of the game.

I imagine that this read was far better than actually attending the game.  Oh, and by the way, the game concluded in June (it had been suspended in the 32nd inning) with 6000 plus people in attendance. So, lots can say they attended the longest game even though almost all failed to attend the most grueling part.

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December 29, 2011 · 4:06 pm

Best Christmas ever?


My colleague, Bryan Maier, has written a great and melancholic reminder of how longing and enjoyment of Christmas mingle soon after opening of presents. You can read it here.

He speaks the truth about our inability to remember most Christmas gifts and how quickly the unwrapping process is over, leaving us with a desire for more. If your family hands out gift cards or cash, I suspect the mingled feelings are even more prominent.

What Christmas was the best you ever had? Did it have anything to do with gifts? Location? People you spent it with?

One to Remember:

My wife and I rarely give each other gifts. That is a tradition we started back when we had little money to spend. Last year I broke with tradition and gave her an early present, captured here by my sister-in-law. Squint real hard and you can see the gift on her left hand next to her wedding band. 20.5 years with me plus recovering from recent breast cancer treatment (her fight and recovery was a gift to me!) was ample reason enough for her gift–as if she needed a reason!

But even a gift of jewelry won’t always stay in the mind. This year, one of my favorite gifts was this picture that I didn’t know existed. But soon I’ll put it away and not remember how great it was to give her the ring. I’ll see the ring on her finger and won’t be moved by it. That is the way of humanity. We have short memories for joy and thankfulness but sadly, longer memories for disappointment.

May we work hard to remember the many blessings of gifts we receive each and every day. The practice of remembering blessings will be a gift to you and to others as you are less likely to be a bitter person.

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December 23, 2011 · 6:13 pm

Year-end giving opportunities for trauma recovery


Friends,

Just a few days before the end of 2011 some of you may be considering year-end charitable giving ideas. You may not 11.5 million dollars to give away (like Google did to orgs like IJM!) but every dollar counts. Below are some of my suggestions if you are looking to give to trauma recovery efforts both here and around the world. I am absolutely sure there are many more good places that are excellent choices than I list here but I include my favorites and you can feel free to add your favorites in the comments section. I also admit that the first two choices might just directly benefit the work I do.

1. Trauma Training Ministry

A. Biblical Seminary. Yes. Biblical Seminary is involved in global trauma recovery efforts. Readers here will remember my posts about our trip to the DRC and Rwanda this fall. We will be launching trauma recovery training in 2012 (continuing education and graduate studies) by the summer. Look for more info on this site. Read Biblical’s December 2011 appeal letter by me sent to Biblical’s friends and family (sorry didn’t have a pdf version with letterhead). Gifts will support training costs and research.

2. East African Trauma Recovery 

A. She’s My Sister. The American Bible Society is using Scripture to engage individuals and communities suffering through the trauma of ethnic violence, especially women having been raped in the region. Their trauma healing workshops trains pastors and local leaders to be trauma healing facilitators in their own communities and in their own language. I can attest that those who go through the trainings are both active in giving away what they received and changed by what they learn. Click the “give” button on the side and choose how many women you wish to help.

B. DOCS Hospital. A medical ministry providing needed surgeries to women with fistulas as the result of rape in the DRC. They are doing fine work there and are serving many women who cannot control their urination without the repairs being done.

3. Domestic Trauma Recovery

A. The Place of Refuge. A counseling ministry to North Philadelphians. Specializing in trauma counseling work. I have known Elizabeth Hernandez since we first met in a counseling class in 1988. She is a fine woman, expert counselor, and an upright and godly person. Donations to Refuge will absolutely extend their ministry to many abused individuals.

B. GRACE. GRACE is a ministry to educate the christian community about the scourge of sexual abuse. GRACE is also involved in providing direction for victims of abuse and in bringing light to abuse cover-ups. As a board member I can attest to the fine work GRACE does with those reaching out for help in knowing what to do in preventing and responding to abuse in Christian settings.

4. Global Recovery Efforts

A. International Justice Mission. They may have received a large donation from Google for work done in India but they are fighting for freedom and justice for enslaved peoples around the world.

Whether you choose one of these fine ministries or one of your own, consider giving to trauma recovery projects this year.

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December 22, 2011 · 5:28 pm

Calculated high risk takers: A different breed?


Some people are willing to take far more risk with their lives than most other human beings. Now, I’m not talking about the impulsive types who take uncalculated risks. I’m speaking here of those who make very considered risk. Take mountain climbers as an example. What drives a man or a woman to climb peaks such as Everest or K2 or Annapurna? Climbing mountains over 8,000 meters is a high risk endeavor. It is considered the riskiest form of sport. More people die trying in this sport than per capita in any other sport. Why are some willing to risk climbing. We cannot attribute this to impulsivity. The planning, effort and costs associated with climbing eliminate whimsical reasons. Further, opportunities to turn back in the face of increasing hardship (cold, lack of air, isolation, etc.) also eliminate those who would be adventurous but would rather not suffer much in the process.

So, if not impulsivity and if not passivity about life…then what is it that drives calculating risk takers?

I’m reading Ed Viesturs’ The Will to Climb: Obsession and Commitment and the Quest to Climb Annapurna–The World’s Deadliest Peak.  Ed Product Detailsexplores a number of climbers who are willing to spare no expense and effort to get to the top of Annapurna as well as all 14 of the 8K plus peaks. (He’s nuts enough to do all 14 without supplemental oxygen!). You get the sense that he is (a) driven, (b) willing to turn around again and again if he thinks he cannot climb safely, (c) yet willing to take far more risks than the rest of the population by being in/near danger and by pushing his body right up to the edge of the breaking point, and (d) supremely confident in his capacity to know where that breaking point is and how to stay on the right side of it.

I think he might agree with me that many of his colleagues who didn’t make it back down the mountain (more die on the way down rather than the way up) is a large dose of luck along with his will to turn back when he meets a risk too large.

As I look at this list I see that I am not that driven. I don’t get that much rush out of doing the impossible or pushing my body beyond the breaking point. I don’t like that much pain. I don’t have that much focus or drive to do just one thing either. In addition, I not that confident in my skills of making decisions on a knife’s edge nor confident in the skills of others to help me along the way (most mountain climbers put immense trust in their partners).

How about you? Do you know any calculated risk takers? Are you one? What is the difference between those who watch and those who do? How do you calculate risk?

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December 21, 2011 · 12:20 pm

Sex Offenders v. Sex Abusers: Is there a difference?


Justin Smith (Phoenix Seminary) has written a helpful chapter in The Long Journey Home: Understanding and Ministering to the Sexually Abused where he discusses the characteristics and types of sexual offenders. While we tend to lump everyone who commits a sexual offense into one (despised) category, it is better to differentiate between types of offenses and those who might commit them. More differentiation helps us (a) understand causes of abuse, and (b) treat those who commit them with more competent and compassionate care.

He believes we need to distinguish between those who have abused and those who are sexual offenders. Why? Because if 20-25% of females report abuse along with 10-20% of males, then our current stats that offenders make up 1-2% of the population cannot be accurate. The number (given that abuse is often not reported) must be higher.

If the number of perpetrators of sexual abuse is 20-50 percent of the male population, as opposed to 1-2 percent, then sexually abusive behavior is not that unusual and neither is the sexual abuser. (p. 44)

Not sure I would venture the 50% number in the above quote but the point about abusive behavior isn’t as unusual as we would like to believe.

Before we look at the differences between offenders and abusers, let Dr. Smith set the stage:

If all persons have sexual impulses and the capacity to be manipulative and potentially violent, perhaps the question should be: “Why don’t people offend”? instead of, “Why do people Offend?” “What constrains some people and fails to constrain others?” (p. 45)

Smith suggests 3 main requirements for those who abuse. First, they must disregard boundaries. They disregard social and moral prohibitions, turn off empathy and compassion for the victim, change meanings of words (to coerce), etc. Second, they disregard or deny the distress of the victim. Third, the person must struggle to regulate internal impulses.

Now to our question. Is there a useful way to differentiate offenders from abusers? Is there any value to those of us who work with those who have committed sex crimes?

Having established that sexual abuse covers a wide range of behaviors and undoubtedly involves a significant portion of the population, what can be said about sex offenders? Offenders are a subset of sexual abusers. They have not only committed sexual abuse but they have committed a specific sexual crime as defined by society.  (p. 47)

So, his primary differentiation is this: offenders are those who are caught. Abusers are those who did an offense but weren’t caught.

Now to the question: is this helpful? My answer is yes and no. Yes. When we describe the research on offenders (as Smith does) we are able to differentiate offenders in subsets: those who rape, those who are sadistic, those who offend against family members, children, or strangers. These differences do matter when considering incarceration and treatment. And likely those who get caught are different from the many who may abuse one person or who have more self-control or other factors that keep them from continuing the abusive behavior.

But the answer is also no. Because so many sexual abusers do not get caught, we can’t really say that there is much difference between an offender (one who is caught) and an abuser (one who did not get caught). I doubt it would be possible to gather a population of individuals to study them in comparison to the offenders. Who would sign up for that study?

That said, this chapter and the entire book is a great resource for those wanting more help in their quest to minister and treat survivors of sexual abuse. I am especially pleased with chapter 13 (mine!).

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