November 2, 2010 · 9:17 pm

Sexual dysfunction considered


Americans are confronted with the problem of sexual dysfunction every time they turn on the television. Seems there’s no end to the ads for products designed to improve sexual performance.

What is your response to this media blitz? Are you thankful that individuals with real problems have access to information and solutions? Or, and this is probably more likely for most, are you feeling harassed by drug company profiteering on our society that makes sexual zenith the end-all-be-all human experience.

Both are true. Despite the over-emphasis in the media, couples really do have struggles with their sex lives. And due to a number of factors (embarrassment, lack of church conversations about good sex, histories of abuse, etc.) many suffer in silence.

What follows are some common questions a good counselor will ask couples in order to uncover the nature of their problems.

Perception:

1. What is your understanding of “good enough” sex? This question explores one’s view of sex. What does it entail? Who leads? Is it planned or spontaneous? How long does it last? Is there a focus only on orgasm or penetration?

2. What shapes your overall view of sex? This question begins to explore prior experiences with sex (and abuse), shaping beliefs about meaning and purpose, and perceptions of each person’s sexual identity and feelings about their own body. The point of these perception oriented questions is to uncover differences in perceptions and meaning regarding sexual intimacy.

Relationship:

1. How are you feeling about your relationship? Sex therapy is not indicated if there are significant ongoing conflicts across the marriage relationship. Counselors need to deal with hurts and conflicts first since good sex is based on a trust relationship. It is hard to be naked with someone you do not trust.

2. How do you two talk about your sex lives and/or sex frustrations? Can you share with each other your fears and dream; what you like or don’t like? Are their affairs, abuse, or other addictions getting in the way?

Desire:

1. How would you rate your level of desire for sexual intimacy with your spouse? (High to low) What do you think accounts for this change? Has there been any changes in your level of desire? These questions begin to get at (a) the amount of desire each partner has for sexual intimacy and, (b) possible reasons for either too much or too little desire. Desire is defined as ongoing thoughts and feelings about wanting to be sexual with one’s spouse. Low desire may signal hurts, fears, and other struggles. High desire may signal addictions and/or demanding attitudes.

2. How do you feel about the differences in desire amounts? What we find is that in every couple, one wants more sex than the other. This is not a problem…unless either the one wanting more is hurt and angry about being turned down or the one wanting less feels guilty for saying no.

Arousal/Pain

1. During sex, are you able to maintain your arousal? Do you lose your erection/interest? We want to discover what if any problems begin during the arousal period. Here we may uncover medical issues (disease states, medicines, etc.) that interfere with sexual intimacy.

2. Do you experience pain during sex? Pain is a major sex killer. This may be the result of ancillary problems (e.g., a bad hip or back) or the result of poor lubrication and/or other nerve-related injuries. Some pain in women is the result of anxiety at the point of penetration. But, sadly, these women are told to push through it. Pain must be dealt with in order for them to be comfortable enough to work on anxiety.

Orgasm:

1. How do you feel about the frequency of and time to orgasm? Does it take too long or happen too quickly for you? These questions begin to uncover the possibility of problems in achieving a satisfying orgasm. Premature and delayed orgasm are real problems but sometimes we discover that the problem is one of perception. Men generally cannot thrust vigorously for more than 5 minutes without orgasming–actually most are in the 2 minute range. Women rarely orgasm from intercourse alone.

There are certainly more things to know and explore in order to help a couple solve sexual problems but these are the beginning questions most therapists will want to start with. You can find a 2009 PowerPoint presentation and accompanying questionnaire on the topic of sex therapy (When Sex in Marriage Doesn’t Work) that was part last year’s CCEF conference.

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November 1, 2010 · 10:18 am

Coming to Peace with Psychology 6


After a long hiatus I return to my summary/review of Everett Worthington’s Coming to Peace with Psychology (IVP, 2010). If you are new here just search his last name in the search bar on my blog and you can quickly catch up.

Chapter 10 is the second chapter in the last section of the book (“What Psychological Science has to Offer Theology”). This chapter covers the limitations of psychological science. Up to this point he has been lauding the value of psychological science as a marriage partner with theology. In fact, the purpose of the book is to argue for such a relationship over those who he sees as being overly critical of psychological science (due mostly, in his mind, to the anecdotal nature of psychological theory).

What does he point to as the limits of his science?

  • Despite amazing advances in psychological science, counseling hasn’t changed much (hmmm, does he consider this a limit of science or is this a complaint about practitioners?)
  • Psychological science must focus on general truths and so may not be as applicable to any one person
  • Scientists are not without bias (but then he goes on to say that given the review process, truth is a lot more likely than not)
  • Science can’t reveal the eternal (but it can reveal things of eternal value)
  • Inability to precisely predict behavior
  • No ultimate “proof” (but, probability is possible)
  • Scientist biases include “heuristics” (picking answers from an “available” list), confirmation biases, etc. which reveal our human self-serving nature.
  • Emotional experiences tend to make us more certain of our perceptions and beliefs.
  • human limitations on what we can remember, understand, perceive, do.

Notice from his list that he focuses on common human limits of knowing. This is a good start but insufficient. It treats science biases in an individualistic manner. I find this ironic given that I believe he has much awareness of family systems. In fact, systems add an additional bias–group think as example number one. Funny too that he gave very few illustrations from science of these various biases. For the most part, he illustrated them from everyday life or from theology. So, we are left with a chapter that admits to some general limits on how far psychological science can take us but no clear acknowledgment of systematic biases in the world of psychological science.

Now, let me be clear. I am not one who believes that psychological science is always biased all the time. And even when it is, there can be much to be learned from it. Nor do I believe that those within biblical studies or theology are unbiased either. But, I do think we need to recognize how specifically these biases send psychological science in some wrong directions.

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October 27, 2010 · 8:18 pm

When are fall leaves the brightest?


My perception is that a rainy, dark fall day like today makes the yellow leaves seem twice as bright as on a sunny day. The darkness of the day allows for us to take note of how the leaves are so beautiful.

I suspect this is true in life as well. When we are going through a dark time, an acquaintance we deem peripheral may begin to shine.

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October 22, 2010 · 5:07 am

Normalizing Psychiatric Problems: Pro and Con


One of the hallmarks of the Biblical Counseling movement has been the clear articulation that psychiatric problems are not different in kind from any other set of problems. This assertion is made by some for a couple of reasons:

  1. To make sure everyone knows that the bible speaks to every kind of experience. if one draws lines between “regular” anxiety and pathological anxiety, those who meet the criteria for a DSM diagnosis might think that biblical material cannot speak to their situation–that they need to go elsewhere for help. God cares for and addresses every concern.
  2. To level the playing field between professionally trained counselors and biblical counselors. If the roots of human problems are common no matter the outer expression of them, then pastors and lay counselors can understand the issues (pride, suffering, fear, despair, etc.) and walk alongside anyone. One may not need special training to help another.
  3. To communicate to the healthy that they are not different from the more obviously unhealthy. The point is to reduce stigma and promote unity.

Consider the pros and cons of this viewpoint.

Pro:

  • Reduction of stigma and ghettoization
  • Increase normalization (“so, I’m not so different from others) and similarity with the rest of humanity
  • Increase the confidence and courage of leaders to address and dialogue about all forms of suffering

Con:

  • Decrease in interest in the specific experiences of suffering thus narrowing problems down to a simplistic cause (sin?)
  • Possible over-confidence of some leaders leading to a reduction of empathy and listening to the experiences of other; failure to consider body/mind issues not specifically elaborated on in the Bible.
  • Failure to recommend outside helpers with specific expertise and training; dismissal of the need to have professional counselors who may have greater practice with certain kinds of interventions\

When I teach my Psychopathology course I want my students to see just a bit of themselves in descriptions of people with thought disorders, addictions, eating disorders and the like. I want to normalize these kinds of problems so that students don’t think of clients with the problem as somehow different from their own experiences. While I may not binge, I may be able to empathize with those who do. However, I do not want them to think their brief binge as exactly the same as someone else’s experience. Otherwise, they might assume it would be easy to “just say no” to the binge.

When I teach my Physiology course, I want my student so to see the complexity of the brain and body and thus recognize the unique forms of suffering some go through. I want them to realize just how little we understand how much the body influences our experience of the world and of self. However, I do not want them to medicalize psychiatric problems. If they did that they might believe that counseling has little influence on psychiatric disorders. They might think that biblical reflections on anxiety and depression have no place in the healing of serious problems in living.

What is your experience regarding christian leaders handling of psychiatric problems? Do you see too little normalization? Too much? Do you see minimization of psychiatric suffering?

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October 21, 2010 · 5:24 am

Reminder for Christian Counselors: We are voice, not Word


In G. Campbell Morgan‘s commentary on John, Morgan comments on John’s own recognition that he was not the foretold Christ but one who preceded the Christ and pointed to him. He says (commenting on chapter 3:22-36),

Then followed the last great statement. I have never read these final words of John without feeling their dignity and majesty. None greater ever feel from human lips. “He must increase, but I must decrease.” ….There was no unwarranted derogation of his own personality or work; but the content of the star as its lustre is lost in the rising glory of the sun.

….John the evangelist was thus showing the difference between the voice and the Word…

Surely this is what counselors must remember. Too often we want to be the sage wisdom, the Word. We want to be listened to; to be seen as wise. But, let us never forget that we are only conduit to the Word.

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October 19, 2010 · 5:46 pm

Suffering for Christ? How should we respond to discrimination due to faith?


In 1 Peter 2: 12 we are commanded to, “live such good lives among the pagans that, though they accuse you of doing wrong, they may see your good deeds and glorify God on the day he visits us.” Peter goes on to tell us that our good deeds include showing proper respect for everyone. And still later he reminds us to follow the actions of Jesus who did not retaliate when he was insulted and mistreated at the cross.

Recently, a friend was mistreated due to her faith. Actually, the mistreatment was based on assumptions rather than facts. The one doing the mistreatment made false allegations about my friend’s beliefs and attitudes. This was in a professional setting where my friend expected to be treated as any other and not singled out like this. Thankfully, the episode was brief. But what if it wasn’t? How should we respond to mistreatment for reasons of faith?

Some things we shouldn’t do:

1. Sarcasm and biting back. One of the things that bothers me in the political arena is the amount of sarcasm and belittling used against each other. Not that this behavior is new–it isn’t–but it does seem more intense than before. It would seem that the goal for liberals is to catch conservative family values defenders not living up to their standards.  And conservatives put down liberals for being open to anything and everything (except conservatives). When attacked for reasons of faith, let’s not spend our time making public comments about the missteps of our accusers.

2. Say nothing at all. Silence isn’t always wrong but it may not be right either. It can be good to overlook some mistreatment as a mercy to the attacker. Sometimes when we know someone is having a bad day or is themselves a recipient of mistreatment, we may choose to overlook hateful comments. However, saying nothing as a matter of course may also eliminate an opportunity to speak truth in love to the offending party.

What can we do?

1. Deserved or undeserved? First, we can check to see if we have brought an attack on by our own behavior. If we have, we ought to address the matter right away. If the attack is not the result of our own foolish actions, then this is not about us but about God. Hopefully, this little bit of assessment can take the personalized part of the pain out of the equation.

2. Work to understand. Where are these comments coming from? What might be revealed behind the hurtful statements about our attackers experiences? It is possible that their attack comes from a bad experience from another person of faith who did not represent well the true meaning of Christianity. We can then validate their pain even if not their expression of it.

3. Speak the truth in love via a point of contact. Look for the value that you share together. Speak to that issue first. Often, some issue of respect, justice or shared concern can be a point of contact to engage an attacker. MLK wrote a letter from his jail cell in Birmingham, AL to white evangelicals who had written to ask him to stop raising tensions via nonviolent protests. He begins with a point of contact–their shared faith, their genuine good will and sincerity regarding their concerns. He attempts to speak their language first about the necessity of prophetic voices among God’s people. Surely he moves on to accuse them of inaction and maintaining the status quo–thus not caring for all of God’s people. But he ends with invitations to dialogue more and even requests that they forgive him if he has overstated their complicity in the problem of Jim Crow. In professional worlds, we may begin with discussions of shared ethical standards. We may want to point out failures by our accusers to keep their own standards, but first we need to establish common ground.

4. Bless, do not curse. Look for ways to bless and/or encourage an accuser if at all possible. Find reason to offer mercy rather than retaliation.

5. Activate, do not withdraw. In professional settings, use the existing system well so you can to gain a hearing,  and not just for yourself. Remember, the Apostle Paul uses his Roman citizenship to seek justice against false accusers and abusers. Using his right to appeal to Caesar enabled him to speak to numerous individuals and groups that he might not otherwise have met. It was this simple act that God used to spread the Gospel to Europe and then to the whole world.

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October 18, 2010 · 11:11 am

Practicing new ways of feeling?


As you fall asleep, do you have a common thought or feeling pattern? As you wake up? In the shower? We are creatures of habit in this regard–we maintain our perceptions (of self, of the world) even in the light of contradictory information or experiences. This is why a pessimist always expects the worst and a narcissist always expects to be right. If you could categorize all your thoughts and feelings, what would your perception pattern look like? Hypervigilant? Discouraged? Embittered? Hopeful?

Now, can you change this pattern? For example, if you are not inclined to be hopeful, can you practice hopeful responses–even when things really do go south? And if you can change the pattern, what does that change look like?

Here are some of my thoughts…I would love to hear from you about what you do to practice something other than your usual way of looking at the world.

1. It is possible to re-write our narratives. How we talk to ourselves about an event either will solidify a feeling or begin to change it. For example, my wife recently had a sleepless night. She was able to use that time to talk to the Lord even while she was feeling out of sorts. In the morning, she had a positive, if also tired, way of feeling about the night.

2. Change does not look like zero experiences of an old narrative running through our head. Change looks like being able to recognize the old but also a new pattern as well. This change is not merely talking yourself out of one schema and into another. Rather, mindful awareness of threads of your experience that have been there all along get more play and so therefore become more salient over time.

3. Change isn’t permanent. Just as a professional athlete cannot go without practice, we cannot expect effortless maintenance of a new way of feeling.

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October 15, 2010 · 1:02 pm

Save the Date! March 17-19 2011


Dr. Diane Langberg and Bethany Hoang (IJM) will be doing our next Conversations with Christianity and Culture seminar March 17-19, 2011 on the topic of sexual abuse in the christian community. They will also be speaking about sex and human trafficking.

This is a free conference at Biblical Seminary. I’ll post on-line registration information here when it is available but I’m tell you this now so you get it on your calendar.  You won’t want to miss their presentations.

We expect to offer CEUs for mental health providers for the conference (probably very nominal fee) and academic credit too (in the form of ind. study) for those wanting to do some further work on the topic.

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October 12, 2010 · 4:34 pm

Skype counseling? Know of anyone doing it well?


I recently set up an acct with SKYPE to participate in an upcoming meeting. I’ve had past requests to use SKYPE in counseling people unable to come to the Philadelphia area. While I’m open to doing this (at least for brief consultations), there are a number of issues to resolve. I’m interested in hearing from readers having used it for counseling (feel free to remain anonymous). What was it like? How were confidentiality and informed consent handled? Was any mention of jurisdiction mentioned? Not sure what I mean, read on to consider these issues:

  1. Confidentiality & Privacy. Are SKYPE video conferences really private? What is the likelihood that someone can tap in?
  2. Informed Consent. Read any good Telehealth informed consent forms lately? Seems that you have to consider how to deal with crises that might be happening in another state. Insurances cannot be used. What about what files are maintained? I believe it is possible to record SKYPE calls.
  3. Jurisdiction. It is clear that licensed mental health practitioners must not practice in another jurisdiction (i.e., state) without getting licensed or approved for that jurisdiction. But what about consultations? What about Internet based interactions? Which state has jurisdiction? Some seem to think that the state of the “caller” is going to want to maintain control of the care of its citizens. Others think that informing “callers” that the point of service resides with the Counselor will be enough. Check out what they say at eCounseling.com.

This is what is known as a “Point-of-Service” issue. In our terms of service which both clients and counselors agree to upon eCounseling.com sign up, it states the following in section 5.8: 5.8 POINT-OF-SERVICE. For a client who resides outside their eCounselor’s state of residence and professional licensure, there is an important issue that should be understood by clients before counseling begins: By utilizing these counseling services, the client agrees that he or she is soliciting the services of a professional outside of his or her state of residence. By doing this, the client agrees that the “point-of-service” of counseling is to occur in the counselor’s state of residence and licensure, not the client’s. In essence, the client is using the telephone or the Internet (the “information highway”) to virtually travel to the counselor (the counselor’s state of professional practice). Hence, counselors are accountable to and agree to abide by the ethical and legal guidelines prescribed by their state of licensure and residence. By agreeing to solicit the counselor’s services, the client agrees to these terms. If you do not understand, or have any questions regarding this issue, please feel free to ask the counselor about this issue, or contact eCounseling.com support at support@ecounseling.com DISCLAIMER: The above should not be construed as legal advice. If you have questions about legality or liability, please contact a qualified legal professional.

What do you make of these issues?

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October 11, 2010 · 11:15 am

Pretense: Just how evil is it?


In Acts 5, we read the story of a couple (Ananias & Sapphira) who sold some property and gave a portion of the proceeds to their church. Seems good, right? Well, God struck them down dead on the spot.

If you have never read that story, it sounds pretty harsh judgment on someone who just gave a chunk of change to God. However, the story tells us that some others sold items and gave 100% to the church. This couple donated a percentage of the proceeds but–and here’s the kicker–intended others to think they had given it all.

Have you ever thought about how this story my apply to you? Frankly, I haven’t given it much thought. I don’t have much resources to sell and give to God. But, G. Campbell Morgan‘s thoughts on the passage bring the core of the problem to light

The Church has never been harmed or hindered by opposition from without; it has been perpetually harmed and hindered by perils from within.

Let it be carefully remembered that the sin of Ananias and Sapphira was not that of refusing to contribute….Neither was it that of refusing to give all.

Wherein then lay the sin? …The sin of Ananias and Sapphira was the sin of pretending that part was all….The sin of Ananias and Sapphira is that of attempting, by confession of the mouth, or song of the lips, to make it appear that things are, as they really are not.

Morgan right rightly points out the heart of the problem: Pretense. Or, if you prefer, hypocrisy. Pretending to be someone of character when it isn’t true; pretending to feel something when you don’t; pretending to be spiritual when not connected to God; pretending to care about someone to their face while despising them in the heart. Sounds like a spiritual form of plagiarism.

If we are honest, we pretend all the time. We smile when we are angry. We say, “that’s okay,” when we don’t mean it. Now, I should point out that there are times when we don’t feel something but we act in a way that honors what we believe. For example, I may sing praises to God at church when feeling disconnected from him. I may help my son with homework when I would rather do anything else. That is not pretense. It would be hypocrisy only if I were to present myself to others as one close to God or tell my son that I love doing homework with him.

Let us work hard to make our mouths and hearts line up–especially if we have any leadership position. Sometimes we may need to be silent rather than pretend. Other times we may need to be more vocal about what is really going on inside us.

And let us consider soberly what Morgan says about today’s church:

The Church’s administration to-day is not what it was, or there might be many dead men and women at the end of some services.

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