January 22, 2010 · 11:53 am

Update on PA HB 1250


Posted previously here about the bill proposed to go to the PA legislature that will change the Licensed Professional Counselor credential from a title act to a practice act. This would further restrict non-licensed counselors from “styling” themselves as a licensed counselor, from offering the services of a counselor. Already one cannot call themselves a professional counselor or similar titles. But these changes would eliminate many from practicing. This bill (see here for bill with highlighted changes. Go to page 10 to see most pertinent changes and list of exempted individuals) is being voted on by the committee on 1/27.

Note that the exempted parties include “pastoral counselors”. In PA they are not defined. However, in other states they are defined and licensed. Thus, who will determine who is a pastoral counselor and what to do with the overlap between the two? In other states, a pastoral counselor must be ordained and trained in pastoral counseling. Also, psychologists supervising unlicensed people with counseling degrees may be exempted but there is still fuzziness in the law.

It all comes down to the definition of “styling.” See this quote from page 10:

Only individuals who have received licenses as licensed professional counselors under this act may style themselves as licensed professional counselors and use the letters “L.P.C.” in connection with their names. It shall be unlawful for an individual to style oneself as a licensed professional counselor, advertise or offer to engage in the practice of professional counselor counseling or use any words or symbols indicating or tending to indicate that the individual is a licensed professional counselor without holding a license in good standing under this act.

Section 3.  The act is amended by adding a section to read:

Section 16.4  Unlicensed practice prohibited.

No person shall engage in the practice of as a licensed social work worker, licensed clinical social work worker, licensed marriage and family therapy therapist or licensed professional counseling counselor in this Commonwealth unless the person holds a valid license to do so as provided in this act. The provisions of this section shall not apply to the following persons:

If you are in PA and one of these representatives (scroll down for the list) are from your district, you may wish to register you opinion on the matter.

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January 20, 2010 · 3:09 pm

Harmful counseling?


This month’s edition of American Psychologist has several interesting articles about the negative effects of therapy. The article by David Barlow, “Negative effects from psychological treatments”, provides a good overview of the effectiveness research controversies. But instead of focusing on how best to collect data about the benefits of a treatment, he gives some attention to looking more clearly at who benefits from a treatment and who is made worse (using dismantling type studies).

The next article (by authors Dimidjian and Hollon) gets at the definition of harm. Defining harm is rather complex. That a client may not get better from a treatment or may get worse during a treatment is not necessarily evidence that the treatment caused harm. And true to form, we have to accept that some treatments may both harm and help (they give the illustration of a nursing mother on medications: it may help her and yet harm her baby). Or, a treatment may make someone worse at first but then help them later on. Or, the treatment may be just fine but the practitioner may use it in a way that is good or bad. Finally, a treatment may be thought of as harming a patient when in fact what is seen is the normal trajectory of the disease.

So, how do you get at understanding whether a counseling treatment harms? They offer a number of methods for research which I won’t get into here.

Finally, the last article covers training implications (Castonguay et al). They cite therapists’ frequent underestimation of treatment failure and client deterioration. Looks like about 5-10% of clients get worse in treatment. If one wants to train counselors to avoid more failure how might one do that? Castonguay et al suggest that one do so by beefing up (a) proper therapy skills, and (b) skills to identify potentially harmful treatments. On p. 45 the authors include a table of training recommendations, which include

  • expose trainees to list of potentially harmful treatments
  • help trainees monitor change and deterioration
  • enhance relationship skills
  • learn and practice interventions that are empirically supported
  • prevent and repair a variety of relational pitfalls
  • adjust treatment choice, expectations, etc. based on client characteristics
  • Address trainee’s issues (anxiety, hostility, defensiveness, naiveté, etc.) that may hinder counseling

Every counselor fears harming another; fears not helping enough. And it is often unclear whether our work is having its intended impact in the moment. However, there are things we can do to keep the communication lines open and thus listen to our clients about what is helping or not helping. This is what keeps us on our toes. What works for one person harms another. We must not get wedded to one way of helping.

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January 18, 2010 · 10:54 am

Counseling skills help pastors cope?


A couple of people sent me links to a recent news item out of Britain concerning the value of teaching counseling skills to pastors. Researchers there found that pastors who do a lot of emotion laden work with parishioners bear a heavy load (pretty obvious so it is nice to see that research doesn’t say otherwise). Those pastors with counseling skills training seem to cope better with the distress. I’ve not seen any in-depth description of the study so I can’t comment on why this might be the case. It could be that pastors with counseling training are more self-aware. It could be they are more positive on the benefits of talk therapy and so utilize it for themselves. It could be they feel more effective in their counseling work and therefore feel less helpless.

Whatever the case, I’m happy that it supports my coursework teaching counseling skills to pastors.

Read about the research:  CT’s news blurb, Medical News blurb

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January 14, 2010 · 5:00 am

Free Career Clinic at Biblical Seminary!


Mark it down! Monday, February 8 is Biblical’s annual free career clinic and it is open to the public? Need a jump-start to finding a new career? Want some advice on your resumé? Pam Smith and Debra Franke oversee recent MA grads (and now students in our postgrad Career Counseling class) in the clinic. Each year we get rave reviews for this. The students are well-trained AND you get 2 heads (the supervisor and the student) helping you come up with some new ideas.

Check out this Career Clinic Flyer 2010 (2) and call 215.368.5000, x106 to reserve a spot. I imagine that they will be glad to do phone appointments if you live outside of our region.

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January 13, 2010 · 5:28 am

Follow-up on expressing vulnerable feelings to a loved one


Yesterday I commented on a series of studies indicating that expressing insecurities to a romantic partner might lead to perpetuating them (because of our impressions of our vulnerabilities, what we think they think of us, and our suspicions that they don’t really care). Today, I want to list the major findings of the 5 studies. See what you think of these interpretations of the data:

  • “Study 1 demonstrated that people believe expressions of regard toward interpersonally insecure and vulnerable others are relatively inauthentic.” (p. 436).
  • “Studies 2A, 2B, and 4 suggest that, when people believe they have expressed vulnerabilities to a romantic partner or friend, they believe they are viewed especially vulnerable, which in turn predicts their suspicion regarding the authenticity of the other’s expressions of positive regard and acceptance.” (ibid)
  • “Study 4 suggests that this process can operate independently of the partner’s appraisals of vulnerability and reported authenticity.” (ibid)
  • Study 5 seems to show that when subjects appraise themselves as vulnerable they doubt a new acquaintance’s expressions of pleasure (even though the new person didn’t see the subject as vulnerable.
  • Studies 3 and 4 seem to indicate that when you have doubts about your partner’s authentic expression of love, you then perceive acts of caring in a more pessimistic manner. “In particular, authenticity doubts may result in a downward estimation of the partner’s true regard and acceptance, as expressions of positive are presumed to be exaggerated and clandestine rejection can be inferred from the partner’s presumed cautious orientation.” (ibid)

SO, do you think those who express vulnerabilities then are only placated and thus receive inauthentic expressions of kindness? Have you experienced yourself devaluing objective kind acts by re-interpreting them through a lens of pessimism? “He’s only doing that because he wants me to let him have his way.” Now, that could be true, but if you find yourself regularly dismissing acts of caring then you might want to explore where your assumptions are coming from.

What should we do? We should express our insecurities and then seek to listen to our loved one with the best possible interpretation and seek to be specific and concrete in pointing out how their actions/attitudes impact us. If we are the one listening to a loved one tell us that they are not feeling secure, then we ought to express warmth, concern, etc. Put off the defensiveness and put yourself in their shoes. If you were worried, you would want another to comfort and care for you–not call you an idiot for thinking that way.

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January 12, 2010 · 5:06 am

Perpetuating vulnerable feelings?


Feel unsure of your mate’s love for you? Should you tell them that you are not feeling safe or secure in the relationship? When you tell them (accuse them of not caring?) and they profess their love for you, what will tell you that you can believe their promises? What will tell you to doubt their words?

Two Yale University psychologists (E. Lemay, Jr and M. Clark) explore this problem in 2008 in their “Walking on Eggshells: How Expressing Relationship Insecurities Perpetuates Them” (Journal of Personality & Social Psychology, v95, 420-441).

Their study is fairly long (5 studies in fact). But here are some key points.

When people feel insecure about a partner’s regard and acceptance, they often judge their own prior behavior as having communicated insecurity and emotional vulnerability to the partner. Consequently, they come to believe that they are viewed as especially insecure and vulnerable. Then, due to shared beliefs that people walk on eggshells around insecure, vulnerable others, such reflected appraisals of vulnerability elicit doubts about the authenticity of the partner’s expressions of regard and acceptance. Once authenticity is doubted, positive expressions are discounted, negative expressions are augmented, and hidden negative regard is inferred even when partners are accepting and actually hold positive regard. (p. 436)

What they are saying is that our own anxiety fuels are belief that they know we are vulnerable and are tiptoeing around us and that we doubt they love us and then we read their actions through a lens that denies the evidence of love and declares their love to be inauthentic. Which of course, we then share with them. Repeat this action and sooner or later they don’t want to be declared a liar anymore and distance from us thereby proving our deepest fears of abandonment.

In short, anticipated rejection leads to presumption that it has happened and that any activity countering that presumption is rejected and re-read through the lens of rejection. Because that is what we believe happens to weak people–they are abandoned.

So, should we keep our fears to ourself? No say the researchers. Then what should be done? The researchers say only a little on this (since it is not the focus of their research here). But, challenging cognitive distortions are at the top their list? What distortions in particular? Believing that others see you as weak as you feel; challenging the interpretations of another’s motivation. Also in their suggestions is practicing reading the commitment of the mate to the relationship by re-appraising and collecting the evidence of authentic responses from that mate.

The next time you feel the need to express your fears that your mate doesn’t really love you check to see whether your insecurity isn’t already telling you the answer you fear and rejecting evidence to the contrary. Dig a little and you may be able to find evidence that shows they love you. Then, be specific and tell them one concrete thing you would like to see changed, something that bothers you. Do it in love so as to not trigger their fears that you do not love them. Be wary of listening too much to your fears!

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January 11, 2010 · 2:02 pm

Psychiatric labeling: The problem isn’t the label


Christians tend to have some strong feelings about counseling, psychology, psychiatry and similar terms. Come to think of it, most people, regardless of faith, have strong feelings about these topics. Experiences dictate much of these reactions. Experiences, such as:

  • experiencing or hearing of a mental health representative (mhp) belittling Christianity
  • experiencing or hearing of an arrogant, controlling, or completely incompetent mhp
  • experiencing or hearing of a positive experience where someone found relief or change or insight
  • feeling either helped or stigmatized by a received diagnosis or a use of medication

In psychopathology class tonight, we will explore the background behind psychiatric classifications. How did we get the Diagnostic and Statistical Manual? What are its underpinnings? There are a couple of common concerns about the DSM

  • It purports to be atheoretical and descriptive only
  • Diagnoses suggest objective and distinct “things”
  • It medicalizes problems in living
  • Under one diagnosis (e.g., depression) you can have such wide variety of symptoms
  • Therapists have sizeable disagreements on diagnoses so are they all that helpful?
  • It is leveraged by insurance in ways that make it a liability
  • It doesn’t address matters of the heart or spirit
  • It has political overtones
  • It treats most problems in an individualistic fashion without account for family systems

Every one of these concerns has merit. However, the biggest problem I have is not with the DSM itself but with many of its users. The complaints that are raised about the DSM usually come from someone mis-using the DSM.

Remember the simple explanation of a problem almost always distorts it. Thus, the simplistic use of diagnostic labels almost always does damage.

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January 8, 2010 · 10:00 am

Are you bringing your friends’ mood down? Why your happiness matters


Did you know that your friends’ friends’ friends can effect your happiness? So says researchers looking at the longitudinal Framingham Heart Study started in 1948.  The previous link is to a research publication on the topic. If you are happy, you likely increase the happiness of those in your social network–even if they do not have direct contact with you. You make your friends happy who in turn make their friends happier…if they live in closer proximity to each other.

Of course this study begs some questions. Does unhappiness make others more unhappy or do unhappy people merely lose their friends? The study looks at positive emotions. What are the differences between positive emotions and happiness? Would the same effect exist if studying contentment? peace? Or, are we really studying the ability of folks to buck up in social networks? Those that do not are on the periphery and therefore more unhappy. Finally, Framingham is a relatively affluent small city. Would the same effect exist in N. Philly?

But, it does raise some good challenges for us. In the midst of suffering (and there seems to be more and more of it in my social spheres!) are there ways that we need to be working to raise our positive affect? Intentionally seeking to think and talk about the good and not just the bad? Have a friend with cancer? How do you make sure to include conversations about beauty, joy, pleasure? Is your church in a funk? Are you stressed at work or school? Listen to your conversations with others. Do they dwell on the negative? Are their positives that you are neglecting to discuss and notice?

Surely you should not be a “pollyanna.” This is not an invitation to denial nor a rebuke of those who find themselves groaning under a burden. But, try laughing a little more heartily. It might cheer your friends up.

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January 7, 2010 · 5:33 pm

Accepting our part of the problem


Notice how hard it is to own our own stuff? Especially when the other person is the bigger problem? Consider the following conversation:

Speaker A: He’s such a jerk! I never want to talk to him again.

Speaker B: What happened?

Speaker A: He never told me that the assignment was due today or that it had to be done up professional. He just yelled at me when I asked him a question and told me I was going to get written up and reported to _____.

Speaker B: Wow that was so unlike him. He must have had something that was bothering him. Aren’t your assignments listed for you ahead of time?

Speaker A: Yeah, they are listed, but I wasn’t there when they put them up and because I have so much to do I couldn’t check what was listed and anyway he should tell me or at least cut me some slack since I work my butt off for him.

Without considering the wrongs or the mistakes of leader (which may be numerous!), notice that speaker A doesn’t tell you that he/she has a habit of forgetting to look at the assignment list nor that when the unnamed “he” called speaker A on messing up, speaker A then spoke in sarcastic and demeaning and defensive tones.

This is a fictional account. And yet we all struggle with saying, “I didn’t like how he treated me but to be fair, I keep forgetting to do what he asked.” “I wish he didn’t yell at me in front of everyone, but I have to admit I was goofing off and talking when I shouldn’t.” If I yell at my kids it is because I was tired or they deserved it. If I speed, it was because I was late. If I’m late it was because of bad traffic. If I didn’t finish my writing assignment it was because of some last-minute crisis. Notice how we take truths and turn them into defenses and thus avoid any blame at all.

What if you are only 10% of the blame for a conflict and your child/spouse/coworker/parent is to blame for the other 90%? Do you find it hard to say, “You know, when we were fighting yesterday, I said _________ and that was hurtful and wrong. Will you forgive me?” Do you find it hard to stop at the end of the sentence without adding, “but you….”

I do. So do my clients and my kids. We seem to think that if we acknowledge our part we let the other party off the hook. In fact, most frequently, when we own our part, the other party is MORE likely to own their stuff too.

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January 6, 2010 · 11:33 am

Some thoughts on “This Emotional Life”


Caught part II of a 3 part, 6 hour, series on PBS last night. This Emotional Life, moderated by Dr. Dan Gilbert. I recommend you check out, at minimum their website but if you get a chance, tonight your local pbs station may air the 3rd part. The website includes lots of info about the various topics, individuals interviewed, and the whole first episode (which I have yet to watch). The series focuses on love and family relationships and attachment (#1), negative emotions such as anger, fear, and depression (#2), and happiness (#3).

Now, there are a number of irritations I have about the program but the good outweighs the bad. What don’t I like?  I don’t like the way they say, “Science says…” and then do not discriminate between data and interpretation of said data. I don’t like the repetitive evolutionary comments. For example, “the newer part of your brain can’t communicate with the older part” assumes that because we have a cerebral cortex and animals don’t have as well-developed cortexes, that part of our brain is “newer.” Further, the view of humanity in episode 2 seems to be that of the human physical robot. There is no space for the spiritual. One quote from the episode, “Mental illness is nothing less than a physical illness that has psychological consequences.” It is as if emotions are only chemical.

But these small problems can be easily forgiven. Here’s what I like from episode 2:

  • The honest admissions of struggles of celebrities (e.g., Katie Couric’s admission she has intrusive thoughts of jumping off high balconies, Chevy Chase’s admission of depression, etc.)
  • The gripping stories of struggler’s with anger, anxiety, and depression (especially two vet’s struggle with PTSD) and the significant impact of the struggles on the other family members
  • You really get a window into their interactions with their therapists. Lots of good video that is rare to see!
  • The scientific discoveries relating to the brain and the experiences of these negative emotions. For example:
    • Stress hormones seem to strengthen memory formation. Thus traumatic experiences likely etch bad memories much deeper than other memories.
    • Re-appraisal (neutral re-evaluation) of events where you experience negative emotions supports more control of these emotions whereas rumination causes us to be more reactive
    • Prolonged exposure therapy (telling, retelling and retelling again) for PTSD patients seems to have significant positive benefits (though it defies logic–most people want to get away from their bad memories)
    • Depressed individuals tend to have reduced hippocampus volume. Antidepressants and ECT seem not merely to change brain chemistry but actually increase cell growth. Depression actually seems to change the brain and antidepressant use stops hippocampus shrinkage

A couple of other interesting tidbits:

  • Emotion regulation: not trying to turn off emotion but tools to change the course of emotion
  • “Don’t believe everything you think.” But, we tend to nonetheless
  • Struggling with overwhelming anxiety? Accept that you have these feelings (crying, tension, fear), accept that they are physiological experiences, avoid labeling them as awful. You will have scary thoughts and you can live with them
  • “What is the worst thing that could happen right now?” I might cry. “And what if you do?” That would be bad. By accepting these emotions you can distance from the meaning you are applying to them.
  • There are biological indicators in those who are highly reactive to stress. These folks can’t help their reaction but they can recognize their tendencies and respond differently to them.
  • Untreated mental illness is harder to treat if left untreated for long periods of time.
  • Richard Lewis on the benefits of therapy and getting to talk about things he never talked about with anyone: “Maybe for the time I left her (his therapist) office til I got in my car I was floating on air”. Hmm, is that worth the 150 dollars he probably paid?

Finally, I leave you with this. Perceptions of progress, or lack thereof, have a huge impact on your perceptions of happiness. One young girl thought her ECT would help sooner than it did. When it did not, she crashed even worse. Even more than our physiology of emotions, our perceptions of our well-being and our progress often dictate our beliefs about ourselves and our futures.

If you saw it, what did you think?

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