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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October 27, 2009 · 5:48 am

Dichotomy vs. Trichotomy?


In the world of Christian counseling past, thinkers (philosophers, theologians, model builders) pondered whether it would be good to consider humanity in two parts (body/soul) or three parts (body/soul/spirit or psyche). These days I can’t recall anyone even raising this as an issue that competent counselors should consider. This absences does beg the question(s): Is pondering the substances of humanity not particularly needed anymore? Is it that our academic predecessors already answered the question?

I’m not sure but I lean to the first reason–most people think this isn’t particularly relevant to their work counseling others. I tend to agree with caveats. When I sit with someone, I try to consider their whole being. We can’t possibly discuss their body without considering their mind. We can’t possibly talk about spiritual matters without using the body. I can just imagine this. “Now, let’s discuss your stomach pain, but we will not consider your thoughts or your spiritual well-being in this part of the conversation…[room goes silent]”

And yet many counselors continue to function like this in implicit ways. The counseling professional who feels incompetent to talk about faith matters (or that it somehow violates ethics) may choose to ignore spiritual matters (e.g., “I deal with only the psyche and I leave faith matters to the pastor). Well-intended, but in denial of the whole person in front of them. Then there are those counselors who see themselves as only dealing with faith or spiritual matters; matters of the will. These counselors may implicitly neglect, even reject, the role of the body in counseling concerns.

We counselors need to consider whether we tend to neglect a part of the person in front of us when we ignore body or spirit issues. Thus, it can be helpful to examine our practical theology of persons. Note I didn’t answer the question in the title. There are a good many who do a fine job debunking the trichotomy position. However, a practical monism likely works better in the session–that the whole person in front of me functions as a unity that cannot nor should not be divided into pieces.

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October 26, 2009 · 9:13 am

PTSD and surgery mortality rates


Today I begin “Counseling & Physiology”, a crash course (6 weeks!) for my students to explore the mind/body connections and how counselors pay attention to the body even if not their primary focus.

Last week I saw this news item on my Medscape.com feed: “Veterans with PTSD twice as likely to die after surgery”

Here are some of the highlights from a research study done at the San Francisco VA and UC San Francisco:

  1. 10 year retrospective study of 1792 vets (ending in 2008). 7.8% had established dx of PTSD. On average vets with PTSD were 7 years younger than those without the diagnosis (you would think then, younger = higher survival rates). Surgeries studied were elective surgeries.
  2. 25% increase in mortality 1 year post surgery for vets with PTSD, even if surgery happens years after getting out of the service
  3. Mortality rates for these vets were higher than those with Diabetes
  4. PTSD is an independent risk factor for mortality
  5. DX of PTSD was associated with increased cardiac issues (may point to why the mortality rates are higher

Sobering research if you ask me. Let us not become lazy in our thinking. Emotional problems such as severe depression and anxiety (which PTSD tends to bring both together) have a substantial impact on the entire person, affecting every part of the person from cells to spirit. Neither let us believe that if the cells are involved in such a disorder that there is nothing that counselors can do. Clients can learn to manage and even defeat some of the symptoms of PTSD by taking control of their thought life.

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October 23, 2009 · 1:51 pm

The practice of unlicensed counseling


The practice of counseling, therapy, psychotherapy and other related terms is restricted to those with proper licensing in most, if not all, US states. Makes sense on most levels, right? You wouldn’t want to go to an unlicensed doctor for your appendectomy. In opposition to Holiday Inn’s ads, you wouldn’t want just anybody doing professional work on you. License control is supposed to protect the public from harm. Bad docs and bad therapists should lose their license and not be allowed to practice.

But with counseling and therapy, it gets a bit sticky. Lots of different professions do similar activities. Unlike surgeons, you have people from widely divergent schools of thought and training doing very similar things. LCSWs, LSWs, LMFTs, Psychologists, Psychiatrists, LPCs all do talk therapy. They all diagnose and intervene per their view of what is wrong and what needs to change (thoughts, behaviors. feelings, etc.).

And it gets stickier. Pastors, clergy, and religiously trained individuals do many of these as well. While they may not give DSM or ICD9 diagnoses and bill insurance companies, they do talk therapy with people who are depressed, anxious, angry, on the verge of divorce–just like all of those licensed people above.  In my world, there are pastoral counselors, biblical counselors, pastors who counsel, christian counselors, etc. Most of these in PA are not licensed by any body. (In PA we don’t have a pastoral counselor license as some states do.)

In an effort to tighten controls, there is a state effort underfoot (HB 1250) to tighten who can practice as a counselor. There were already controls but now the new bill would disallow someone like myself to hire or supervise an unlicensed (but in my opinion competent) person UNLESS they were actively in the process of becoming licensed.

Why does this matter?

1. There are many competent people doing counseling related work that are not licensed (nor could they be since their training is of a religious or pastoral nature). Should the state control these individuals? Right now they haven’t been actively going after these folk. The law will continue to remain vague: Here’s the restriction for LPC practice:

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 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. [underline indicates new change in this paragraph]

Who decides what “engage in the practice of…or use any words…” constitutes? Obviously, one cannot intentionally lie but does the term therapy indicate a license?

2. There are many who provide pastoral care who are not ordained clergy. They have graduated from seminary-based programs that are not professional counseling programs. Yes, the current standard makes clear that it does not seek to limit the work of those acting under the legal auspices of a religious institution (i.e., are ordained by the church). But, should the state regulate those who provide biblical counsel but are not ordained? As long as these individuals make clear (informed consent) what it is they do and what they do not do, shouldn’t they be able to make a living? Research indicates that lay people can have tremendous success in helping those with depression and anxiety.

I’m all for protecting the public. But while licenses limit who gets to perform certain duties, it does not eliminate unethical or harmful practice. Further, much of psychotherapy is art as well as science. Artists can learn their trade in a variety of locations. What we need to do is to make sure the public can clearly identify the kind of counseling (and limits of) each counselor does. Second, those who provide biblical counseling ought to have some authoritative body. It would be great if they were recognized and “licensed” by denominations or organizations (e.g. the AACC who is trying to do this).

But I would hate to see the many seasoned, unlicensed counselors lose their ability to ply their trade.

That raises a question of analogy. Can anyone make a legal living cutting hair for a fee without a license?

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October 22, 2009 · 5:00 am

Remembering Little Albert


The latest issue of American Psychologist has a very interesting story about the search for John Watson’s baby Albert. Remember from your Psych 101 class that John Watson, a behaviorist at Johns Hopkins in the 1920s, attempted to condition the infant to be afraid of white rats by pairing scary sounds with the presentation of the rat. Most every history of psychology tells the story how his condition fear generalized to other furry objects.

For a couple of generations the story ended there. Myths held that the mother took the child away out of her anger; that Watson later deconditioned him. Neither are true. But these researchers decided to spend a great deal of time and energy seeing if they could discover who he was. With Watson burning his own notes before his death, they didn’t have much to go on.

I won’t relay all the details here but suffice it to say they likely discovered who Albert was (Douglas Merritte) and who his mother was (Arvilla, a wet nurse who lived/worked at the university as a wet nurse after becoming pregnant out-of-wedlock for the second time).

Sadly, the boy died before he turned seven (unclear but maybe due to meningitis). So, we haven’t any knowledge of the impact of Watson’s research on him.

What I find amazing is that it was considered ethical to seek and reveal this information in today’s American Psychologist. We are called to provide the highest standards in clinical and research settings, which include anonymity. Why was it okay to reveal this information now when the person in question isn’t able to determine whether he would want this information released. Maybe existing relatives helping with the search gave permission.

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October 21, 2009 · 9:20 am

A friend sent me a book review of Philip Zimbardo’s The Lucifer Effect by a therapist and former educator named Stephen Prichard, MDiv. In the review Prichard picks out a quote that Zimbardo uses (by C.P. Snow in Either/Or). Got that? Prichard quotes Zimbardo who is quoting Snow…

“When you think of the long and gloomy history of man, you will find far more hideous crimes have been committed in the name of obedience than have been committed in the name of rebellion”.

My friend connected this quote to some of my thoughts on Rwanda. There, a genocide was committed under the guise of obeying the government.

I like this quote even though I am not sure of Snow’s context or meaning. Of course, all crimes are rebellion–rebellion from God’s decree. But still, we use obedience (either by demand or by denial) to excuse bad behavior and our responsibility in it.

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Filed under Abuse, Cognitive biases, Cultural Anthropology, Great Quotes

October 20, 2009 · 9:12 am

Diane Langberg on the web


Dr. Diane Langberg now has her own website. Check out www.dianelangberg.com for more information about her speaking (both schedule and available audios–both free and for purchase) and her counseling practice. You can see a list of her associates and their specialties. Her resources page has lots of good book, article, and website suggestions regarding a wide variety of issues.

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October 19, 2009 · 3:12 pm

Theological thoughts on intersex and gender


For those in the Philly area, you are invited to come to Biblical to hear a guest lecturer speak on the subject of intersex. Megan De Franza will be guest lecturing in an MDiv theology class, Tuesday, November 3rd, starting at 6 pm. She is a doctoral student at Marquette University and writing her dissertation on the topic of gender and how Christian theology might address “intersex” (formerly known as hermaphrodism). As many as 1:2200 births result in a form of intersex (anywhere from ambiguous external genitalia to more hidden gender anomalies).

Is there room for a third gender? Megan will explore Jesus’ teaching in Matthew 19 about marriage and eunuchs and consider if this relates to the subject.

No charge (but I’m sure someone would take a check if you felt so inclined).

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