November 12, 2009 · 3:33 am

On-line counseling courses through Biblical Seminary


Those interested in taking an on-line, graduate-level counseling course might wish to consider this new joint offering from my school, Biblical Seminary, and the Christian Counseling & Educational Foundation (CCEF).

Counseling in the Local Church (2 credits)

The course is taught by Dr. Tim Lane, Director of CCEF and runs from 1/18/2010 to 3/19/2010. It is completely on-line with mp3 lectures, assignments, and threaded discussions with others in the class. You can register here for this class. If you have Internet access and an undergraduate degree, you can take this class.

Later in Spring 2010 we will offer David Powlison’s Dynamics of Biblical Change.

CCEF started Biblical’s counseling program back in the mid 80s and has continued to lend their faculty to courses here and there at Biblical. They have been offering on-line and residential courses (non-accredited credits) for 25 years. In my personal opinion, our joint venture brings together quality biblical counseling and theological expertise with practical and professional counseling expertise!

Now, we have a chance to work together to provide on-line students with quality teaching from CCEF but now for academic credit. (You must have an undergraduate degree already)

What can you do with these credits? Well, for one, you could apply them to a number of Master’s degrees at Biblical. They could count as elective credits in our MA Ministry, MDiv, or MA Counseling program. Second, you might seek to have them transferred to your own local graduate school program. Biblical Seminary is ATS and Middle-States accredited and so will be considered a legitimate institution. However, you should know that every school sets its own polices regarding transfer of credits. Usually they look to see if the course fulfills a course they would have required in their own program. Remember that it is up to you to find out if they will transfer.

Or, you can just take them because you want to be enriched! We’d love to have you as a student!

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November 11, 2009 · 5:59 am

Stress & Christian mindfulness, part 2


In the last post I reviewed some simple definitions of mindfulness, including some of the Buddhist ideas behind a version of mindfulness. In this post I want to consider how mindfulness, when reconsidered in the light of Christian thought, can be a valuable part of counseling practice.

A thought about mindfulness and the brain

Let me detour to one more thought about biology and mindfulness. What happens in the brain when a person is practicing mindfulness? Thought and feeling patterns result in neural activity in the brain (or is it the other way around?). Repeated neural activity creates stronger connections between neurons (increased synaptic activity and denser connections with neurons in the same neighborhood. Repeated activity leads to greater blood flow and activation in particular regions of the brain. Neuroscientists call this neuroplasticity.

Thus affective and cognitive patterns can indeed change your brain. Think about this. What patterns of thought do you engage in on a repetitive basis? Do you have a habit of fantasizing? Mulling over bitter or jealous thoughts? While some of these may come naturally to you, what you do with them may actually change or strengthen neural connections in the brain–for better or for worse.

Is mindfulness healthy or relativistic?

Mindfulness, no matter whether you take a religious, consciousness, or relational approach to it, includes the stepping back from shoulds, oughts, and other judgments. One might think that this would be dangerous for Christians. Within Christianity, there are rights and wrongs, truth and lie, righteousness and unrighteousness. The Bible is, among other things, the single guide for Christians to determine how to live for God. SO, it begs the question whether Christians should be wary of anything that seems to let go of shoulds and oughts?

Another view of shoulds and oughts

In my experience, those suffering from anxiety and depression suffer from a disorder of judgments. They are flooded by shoulds and oughts. Their self-talk does not seem to come from the Lord but are already laced with prejudice. “You should have been more vigilant against danger AND you weren’t. You’re a failure.” “You shouldn’t be rebellious BUT you are always a screw-up.” “I shouldn’t have to suffer this way AND God must not care for me.” Notice that most of these forms of judgment are careful consideration of the facts and experiences but well-formed opinions that may be based on only a smidgen of the actual events in their present circumstances.  Notice that these forms of ruminative thinking come in disguise as careful, logical thinking. They are not. What they are narratives–well-practiced narratives–that have an already formed conclusion that we repeat regardless of the actual facts of our lives.

Mindfulness, then, is stepping back from these narratives. Mindfulness is a practiced discipline of just noticing and describing events so as to process them more carefully instead of automatically repeated a script or mantra. Mindfulness provides the opportunity to discover “what is” rather than compound suffering by focusing on what we just assume. Consider Dan Siegel (The Mindful Brain, p. 77)

When the mind grasps onto preconceived ideas it creates a tension within the mind between what is and what “should be.” This tension creates stress and leads to suffering.”

While I’m sure I would vigorously disagree with Siegel on what a preconceived idea is, on what can be healthy “should be’s”, and much more, he has a point worth considering. Have you ever engaged in a fantasy conflictual conversation with someone you are about to meet. You play out yourself winning, being mistreated, standing up for what is right, and so on. Notice how such conversations aren’t useful. They only increase your level of stress because your brain responds to the inner drama as if it were really happening, when it has yet to happen. In this way, Siegel is right. We create tension that leads to suffering.

Using mindfulness in Christian Counseling

I’m running out of room here and won’t be able to do justice, in this post, to the most practical part of mindfulness. [Isn’t that just like us academics. We spend all our time pointing out problems but we never solve anything!]. Mindful practice may include time practicing being present in one’s surroundings. The counselor may encourage clients to take in their surroundings. While many thoughts may race through the brain, the mindful person may choose to not follow them but “drink in” the creation beauty around them–things growing, art, or anything that is a delight to the senses. This form of discipline must be practiced in de-stressed times so that it will be available during a crisis–just like a basketball player practices free-throws over and over so as to make the shot when there is only 1 second left on the clock.

Such work is the work of taking every thought captive. and resting (a la Psalms 131) without grasping after things “too wonderful” for us.

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November 10, 2009 · 5:25 am

Stress & Christian mindfulness, part 1


I’ve written about mindfulness in the past and based on numbers of folks coming to my blog looking for information about Christianity and mindfulness, I thought I might write just a bit more here. My intention is to write in two parts. Part 1 will cover some basics about stress and the idea of mindfulness. Part 2 will explore how Christian counselors might think critically about the topic and consider its use in their practice.

If this is not a term you are familiar with, you may wish to explore the goodly number of books in your local store discussing the topic. Why the interest? There is clear evidence that mindfulness has positive health benefits by reducing our stress responses to the chaos in our lives. Mindful individuals appear to have greater amounts of patience, able to avoid impulsive responses to stress, process rather than react to emotions, have greater capacities to be curious, open, accepting, and loving.

Stress and your body

It is well-known that small amounts of stress activate the body but larger amounts make us sick. But, did you know that the same biological response system that fights viral intruders activates with high levels of stress? Your immune system works in this manner (okay, my simplistic rendition): Your body senses an intruder. The microphages that come in contact with a virus act like little ants sending messages to their buddies to come and defend the colony. One of the messenger chemicals is interleukin-1. Your resulting fever is evidence that the body is working. But to work this hard, other bodily systems get such down. Your stomach and intestines stop or slow down their contractions, you lose your appetite, sexual drive, you have difficulty thinking clearly. These sick symptoms are more likely the result of your body’s defense mode than the virus that has intruded.

The SAME thing happens with high stress. Your pleasures centers shut down to conserve energy. Such activity decreases clarity of thought and pleasure and thus increases experiences of depression and anxiety. See how a vicious cycle of stress/distress leads to greater symptoms of depression/anxiety–a vicious cycle!

What is mindfulness?

Well, it depends upon who you ask. Definitions range from Buddhist forms of meditation, to being present in the moment, to being aware, to centering prayer, to having a nonjudgmental stance. So, for some it is a religious activity. For others it is a form of consciousness. And still others describe it as a relational “attunement” (e.g., a mother’s awareness of the meaning of her infant’s needs even before the cry; a service dog who picks up subtle clues that it’s owner is about to have a seizure). The truth is that each one of these fragments of definitions captures a little bit of what one observes in someone who is able to, in the moment, stand back from the chaos in their life and not react to it. Such people seem to be alert (not dissociated) to the moment, are being in the moment rather than reacting and doing something, are more likely to be describing events, feelings, perceptions, etc. rather than judging them.

In Dan Siegel’s The Mindful Brain (W.W. Norton, 2007), he lists a number of component parts to mindfulness:

  • Intention (rather than reactive), attention (aware), attitude (open, curious, non-judgmental)
  • Nonreactive to inner experiences (I notice my inner experience, but I am not merely my inner experience)
  • Observation, noticing, describing, labeling
  • Attending to sensations; acting with awareness
  • Either focused attention on the present or merely noticing all that passes through the mind

What about the Buddhist part?

There are two terms you’ll find when reading up on Buddhist meditation: vipassana (insight, clear thinking), samatha (concentration or tranquility). I’m not a Buddhist scholar but I do believe I’m in the ballpark about these next bullet points:

  • The goal is to get beyond (ab0ve) the experience of good and evil; of pleasure and pain to a higher level of experience
  • The goal is personal transformation and character development; awareness leading to the drying up of demands (desires?)

It is important to point out that Buddhism is not the only religion that espouses meditational practices. Christianity, from the beginning of the Church, has promoted the concept of meditation, albeit in significantly different form and purpose.

How ought we Christians to think about it?

Some might suggest that engaging in practices that encourage openness, neutrality (which is a misrepresentation of Buddhist practices) open oneself up to the occult. Others might be suspicious of hidden, subtle belief systems (personal transformation vs. Spirit-led transformation). These are legitimate questions. And yet I contend that we do not need to reject these concerns to acknowledge that God has given all humans the capacity to observe and grasp concepts that are true and right–even if we might staunchly disagree with their personal philosophies. This does not mean we take a concept into our life and practices without considerable critical thinking, but it does mean we are open to learning something that our own tradition has lost, ignored, or deemed unnecessary to healthy living.  I’ll attempt to do just that in the next post.

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November 9, 2009 · 5:44 am

Thinking about moral responsibility and agency in TBI


Tonight I will assigned my Counseling & Physiology students a response paper to the following case study. As you read this fictional case, consider how you might answer these two questions:

  1. What are the spiritual issues in this case and how do you consider Tim’s limitations in considering these spiritual issues? What is his personal accountability in light of his functional limitations and injury?
  2. How might you advise Tim’s wife and pastor as they struggle to understand and respond to Tim’s inappropriate behavior?

Tim is a 34-year-old, married man and deacon in his church. Prior to a serious car accident 2 years ago, Tim was a successful general contractor generating income over $200,000 a year. 2 years ago, Tim suffered a traumatic brain injury when a drunk driver, traveling at a very high rate of speed, slammed into his vehicle. Damage to his brain was located in the frontal and temporal lobes. Tim spent a total of six months in the hospital and in rehab. Initially, He was in a coma for 3 weeks and not expected to recover. However, he did emerge from unconsciousness and with rehab regained his capacities to walk and talk. His memory is mostly intact, missing only the week prior to the accident and the five weeks post accident. He seems to be able to form new memories but complains that he has to write everything down or he will forget tasks. He also complains that it is hard for him to find words. His friends notice that his speech is slower now. He is oriented to person, place, and time.

Tim’s wife and pastor ask you to meet with him. Tim complies. In session he is affable, talkative, but unsure why others think he needs counseling. He notes that he works hard every day, uses his daily contacts in business to talk about God’s miraculous work in his life. He admits that he smokes now and should quit but that shouldn’t be reason enough to warrant counseling. He signs a release to talk to his wife and pastor.

You learn from his wife that Tim has numerous problems that did not exist prior to the accident. Most notably: he doesn’t complete work; fails to bill clients properly; seems to over-estimate what he can complete; work done does not meet his pre-accident quality; he is easily angered and even aggressive; he curses and smokes 2-3 packs per day (none prior to accident); he drinks; he spends beyond his means; he has periods of deep depression; he engages in foul language about sex; is demanding of sexual activity with his wife (but cannot perform since the accident); he flirts with other women.

Tim refuses to return for further appointments. His wife and pastor come to you to discuss options and how to think about Tim’s behavior. The church board has removed Tim from his diaconal position this week and is likely to initiate church discipline after it was discovered that he made a sexual comment to an 18-year-old girl (he commented (spoke admiringly) about her breast size).

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November 6, 2009 · 9:59 am

Orbinski on humanitarianism, dignity, and hope


 

Two days ago I had the privilege of meeting and hearing Dr. James Orbinski at the 2009 Frobese Day, an educational conference held at Abington Memorial Hospital each year. Dr. Orbinski is the former head of Medicins Sans Frontiers (Drs without Borders), current head of Dignitas, professor at U. of Toronto, author of An Imperfect Offering, and central figure in the documentary, Triage. Of interest to me was his work in Rwanda during the genocide.

On a personal note, I found him very engaging. When I was introduced to him, he didn’t do the usual handshake and move on. He really engaged me about Rwanda and what work we did and plan to do there and gave a number of encouraging comments that went above and beyond the call of duty. I guess that is one of the characteristics you need if you are a person who goes into distressed areas. You need to connect to the people, figure out what they need and what can be done, and then do it.

First, an assortment of observations presented:

  • There are about 6.8 billion people in the world. Some 3.8 billion, or about half, subsist on less than 2 dollars a day
  • 1.1 billion go to bed hungry each night. This number grows by about 100 million each year
  • Nearly all famines are the function of political conflict rather than acts of nature
  • There has been a 24% increase in food prices in impoverished areas. One of the key causes is the increase of developing biofuel. Food is more valuable if it can be made into fuel.
  • The World Food Bank is begging for about 23 billion dollars to feed this number of poor. It can’t get it. But, 13 TRILLION dollars has been recently expended to prop up a collapsing international economy.
  • In 2000, it cost 15,000 (a year, I think) to provide an individual in Africa the antiretroviral meds needed to survive. Today, with political pressure, it costs 99 dollars
  • The drug companies say that it costs 1.6 billion dollars to bring a drug from a new chemical to market (through research & Development). While they do not reveal how it costs this much, it is clear that part of the costs they factor in is the income they expect to make on the drug. So, if you expect to make 10% on your investment, can you really consider that a cost to develop a drug. Apparently, they do
  • A recent nonprofit just released three new drugs dealing with neglected diseases in Africa. The costs to bring these drugs to the market was 100 to 300 million dollars. And, the companies selling them are indeed making a profit

A couple of his key ideas:

  • Dignity cannot be granted; it must be acknowledged via engaged collaboration and solidarity
  • Solidarity is not pity but active compassion
  • Hope is not some naive utopian dream, it is “what we do”
  • We all need to be political. The first act of politics: speak the truth; The second act: listen
  • The worst form of suffering is suffering alone
  • We must see it, acknowledge it, give voice to the voiceless and thus allow for dignity even if we cannot solve it
  • Optimism and Hope are two distinct concept. Optimism is confidence that one’s actions will work for the best. Hope is confidence that the action you are about to undertake is the RIGHT one no matter the outcome
  • We need those with daring ideas, with visions of possibilities. That is all there is. Hope, is in his estimation, in himself–that he will do the right thing.

While I do not agree with his definition of hope, I do agree that we need more people to move from insight (that a problem exists) to action (that I can do something of value in a hopeless situation). Folks like Orbinski certainly put many of us to shame.

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November 5, 2009 · 10:18 am

Characteristics of Ego driven leaders


Here’s a link to a blog post on sniffing out ego driven leaders (teachers, pastors, future employees, etc.) you might find helpful. Cavman, a thoughtful pastor, lists a set of characteristics about ego driven individuals that he gleaned from a book by Roger Parrott. He, Cavman, writes,

He [Parrott] offers some of the signs that a person is probably driven by ego (getting attention) rather than ambition (advances in the kingdom).

  • Live Flamboyantly– drawn to lavishness in things and people.
  • Inflate Vision– consistently over-promise and under-deliver.
  • Act Invincible- winning is more important than what is prudent and wise.
  • Ignore Critics– discredit or ignore those with different ideas, or who offer constructive criticism.
  • Crave Adrenaline– gain energy in flagrant risk.
  • Exaggerate Actions– exhaust rather than equip their staff.
  • Become Sensitive– very thin-skinned, they either attack or isolate.
  • Attract Groupies– people who will not/cannot challenge them.  They feed their attention addiction.
  • Demand Appreciation– like a drug addict.
  • Require Empathy– without offering empathy.
  • Listen Poorly– they don’t want instruction, correction or good ideas.
  • Enjoy Competition– gaining attention by prevailing over others.
  • Control Obsessively– uncomfortable when they are not in control.
  • Ignore Boundaries– they assume they are better than others, and not subject to the same rules.

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November 4, 2009 · 5:47 am

James Orbinski


Today I’ll be attending a couple of seminars by James Orbinski at Abington Hospital. Orbinski is the author of An Imperfect Offering which details his crisis medical work in Rwanda, Somalia, and other countries as a Doctors without Borders doc. He also has a DVD on the same topic called Triage.

What I’m most excited about is that I’ve been invited to his “Grand Rounds” seminar with the current family physician residents at AMH. That should be fun!

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November 3, 2009 · 5:38 am

Philip Cushman’s prophetic words


One of my all-time favorite books is Philip Cushman’s Constructing the Self, Constructing America: A Cultural History of Psychotherapy. In this 1995 book he details the social constructed nature of psychotherapy. My Social & Cultural Foundations class is reading a summation of this book published in article form and so I picked the book back up and read through some of my more favorite parts.Here’s some of my choice quotes from the beginning:

“When social artifacts or institutions are taken for granted it usually means that they have developed functions in the society that are so integral to the culture that they are indispensable, unacknowledged, and finally invisible.” (p. 1)

“It [psychotherapy] is thought of as a scientific practice, yet it is anything but standardized or empirical, and it has not yet developed a disciplinewide consensus about how to think about patients or what to do with them. It is thought of as a medical practice, yet it has an enormous social and political impact.” (p. 2)

“…in order to understand American psychotherapy, we must study the world into which it was born and in which it currently resides.” (p. 4)

“Origin myths describe the origins of the discipline in such a way as to demonstrate the discipline’s utility for those in positions of power. This means that mainstream historians will shy away from portraying psychology as critical of the status quo and will avoid including within their work a critical exploration of the sociopolitical frame of reference in which the discipline is embedded.” (p. 5)

“…I will argue that the current configuration of the self is the empty self. The empty self is a way of being human; it is characterized by a pervasive sense of personal emptiness and is committed to the values of self-liberation through consumption. The empty self is the perfect complement to an economy that must stave off economic stagnation by arranging for the continual purchase and consumption of surplus goods. Psychotherapy is the profession responsible for treating the unfortunate personal effects of the empty self without disrupting the economic arrangements of consumerism. Psychotherapy is permeated by the philosophy of self-contained individualism, exists within the framework of consumerism, speaks the language of self-liberation, and thereby unknowingly reproduces some of the ills it is responsible for healing.” P. 6

Now, soon after 2000, Cushman wrote about the transition from the empty self to the “multiple self.” By this he was not talking about MPD or DID. He felt that the younger generation was no longer looking to find their true self in therapy but to maintain a fragmented self in a chaotic world. In this sense, “who am I at church, work, school, friends, dating, etc. and how can I keep all my pieces from crashing down altogether.”

But, it is interesting to read his view of psychotherapy as supporting the consumeristic economy (even encouraging it). I wonder how our current economic woes will impact the world of therapy….

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November 2, 2009 · 11:40 am

Technoethics?


At September’s AACC conference I attended a presentation entitled, “Technoethics” by Jana Vanderslice, a psychologist from Texas. She got me thinking about the use of e-mail and other Internet-based technologies with counselees. Here are some of the issues:

1. E-mail. Do you have a policy about your use of e-mail with counselees? Do you inform them about the limits or possible problems that might be encountered? Problems such as security and confidentiality, whether or not you will read them “in time”, what becomes of them (printed out and kept in a file?), whether or not you provide brief counseling through e-mail and possible charges, etc. Dr. Vanderslice suggests having a start to the email that says, “Confidential! This is not meant to take the place of in person consultation…”

2. If you do e-mail counseling, do you (a) know who you are emailing? What data do you collect from the person you provide email counseling to? And (b), do you think about how your email may sound if it is printed off and/or forwarded to others. You should assume that your electronic communications may be passed on. Further, if you have regular e-mail contact, how will you deal with the nature of always being at the beck and call of clientele?

3. Your Social networking accts. Do you use twitter? Do you have a Facebook or MySpace account or the like? Do you “friend” your clients? Do you have anything personal on the web you’d rather your clients didn’t see? This becomes a form of self-disclosure. There may be things revealed about yourself on-line that you would never reveal to a client. Remember, if the client is in the same Facebook network, they can likely see more of you than you might realize.

4. Google searches. Similarly, it might be worth your while to search yourself and see what is out there. Did you know that there are “rate my counselor” type sites out there? Many of these exist to help you find healthcare providers in your area, but include ratings by current or former clients. Do you know what others are saying about you?

5. IT and other providers. Who has access to your accounts and computer? Does your IT dept (if you are in a larger organization) know to honor HIPAA regulations? If you use a vendor (e.g., Geek Squad), they need to sign an agreement to maintain the privacy of the clientele data on your email or database. Can you encrypt email and/or WORD documents?

Can you think of other technoethics issues?

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October 29, 2009 · 8:40 am

Your opportunity to help asylum seekers


For my licensed mental health readers, you might be interested in checking out Physicians For Human Rights (PHR) an organization that helps asylum seekers get proper evaluation as part of determining their application for asylum. PHR has an “Asylum Network” that you can join for free and be contacted if there is a case in your area. These are usually pro bono cases. PHR also provides an extensive guide for those doing psychological evaluations of torture and/or persecution on the website. If you are looking for something exciting to do, I would think this would be a good choice–an opportunity to immerse yourself in another’s world and to care for the “alien” among us in obedience to God. My friend who does this says that you are not required to take cases offered to you and that you determine how many cases you might want to do in a year’s time.

Check them out! I plan to join.

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