September 1, 2009 · 5:35 am

The waves never stop


Travelled Sunday afternoon to Ocean City, NJ. Waves were wonderful. Big enough to ride and look menacing when floating but not so big as to hurt. I rode them for a good 2 hours straight before the life guards called us out at the end of the day. Earlier, even when I thought I should probably get out the next wave beckoned me stay and ride.

Reminded me of a line in NT Wright’s book on evil. We like the beach because it lets us see the power of the ocean without having to feel it’s true strength. Something like that.

It is interesting that the wayves stay with you after you leave the beach. Ever had that feeling that you are still in the waves when lying down afterwards? I did. Reminded me that emotional waves experienced for a long time do that to a person as well. The situation is over but you still feel like you are in it.

See you later, I’ve got to go catch some more waves.

1 Comment

Filed under Uncategorized

Tagged as , ,

August 31, 2009 · 5:44 am

Disorders of Extreme Stress Not Otherwise Specified (DESNOS)


I recently scanned a book, Healing Trauma(published by Norton in 2003), and ran across a new name (for me) for the problem of complex PTSD–Disorders of Extreme Stress NOS or DESNOS.  Because many christian counselors are only marginally aware of the research on complex PTSD I’ve decided to give a brief summary here.

The following symptom presentation may be found in those with prolonged and severe personal abuse (and often starting at an early age): 

  1. alterations in the regulation of affective impulses, including difficulty with modulation of anger and being self-destructive,
  2. alterations in attention and consciousness, leading to amnesias and dissociative and depersonalization episodes,
  3. alterations in self perception, such as a chronic sense of guilt and responsibility, and chronically feeling ashamed,
  4. alterations in relationships with others, such as not being able to trust and not being able to feel intimate with people,
  5. somatizating the problem: feeling symptoms on a somatic level when medical explanations can’t be found, and
  6. alterations in systems of meaning (loss of meaning or distorted beliefs)

Some folks include a 7th characteristic: (alterations of perceptions of perpetrator(s).

Check out the this paper(44 pages long) written on the assessment and treatment of DESNOS.  Though written for psychiatrists, I found the language easy to understand. The authors do a nice job of helping counselors differentiate between Borderline Personality Disorder and DESNOS. While they recognize significant overlap between the two constellation of symptoms, DESNOS folks tend to experience less relational push/pull (less manipulative behavior) and more push behaviors coupled with more intense sadness and grief.

Counseling work falls (per this paper) into 3 categories: stabilization, trauma processing, and re-integration into their world.

4 Comments

Filed under Abuse, Anxiety, counseling, counseling science, counseling skills, Post-Traumatic Stress Disorder, Psychology

Tagged as , , , ,

August 28, 2009 · 5:18 am

The danger of “why” questions


Most thoughtful counselees want to ask “why” questions. Why do I do what I do? Why did she do what she did? Why am I the way I am? Why am I so depressed? Why isn’t my life going the way it should or seems to go for others? Counselors too ask “why” questions. Why did you blow up at her? Why is this child afraid of going to school? And closer to home, why did my client drop out of therapy?

On the surface why questions seem to want to get to the bottom of things. We assume that if we understand the nature of the problem, we’ll know how best to respond. And there is much truth in this assumption. 

But consider their danger. Some answers to the “why” are so complex that the answer to the “why” doesn’t really point to any one answer. Further, we frequently prejudge the question with implicit answers (e.g., it is because something is wrong with me…I’m a loser…God doesn’t want me to be happy…I can’t help it that I’m this way…).

Why questions also make us passive. We look for answers; we mull over the “facts.” We are less likely to become active to do something about our situation when we are in a “why…” mode.

Let me suggest a better kind of question: What questions

What is happening? What am I feeling/thinking/doing? What is it that I want? What do others want? What am I doing about my situation? What goals do my behaviors emphasize? (this is a why question that forces us to look at our behaviors and see if they match up with our stated desires) What options are before me? Be descriptive rather than interpretive. Notice that why questions jump to interpretation but seldom activate a person to do what is in their power to do.

Frequently, by asking descriptive “what” questions, we find it easier to activate the will and begin doing something about our situation. In addition, we often come to posthoc understanding of the “why” when we have some distance from the situation.

So, the next time you find yourself stuck in the “why” set of questions, stop and try to ask yourself some what questions instead. Observe the impact of distancing from the passive whys? Does it help?

5 Comments

Filed under Anxiety, christian counseling, christian psychology, counseling, counseling skills, Psychology

Tagged as , ,

August 25, 2009 · 5:51 am

Laughing at stupidity?


Here’s one more line from David Goneau’s sermon (not quoted):

Why do we laugh at Elaine’s dancing on Seinfeld or any one of the idiotic characters on The Office? Isn’t because these characters are so obviously out of step with social acceptability?

What we laugh at reveals what we value most: acceptability.

Hmm. I think he may be right. We want to make sure we do not fall out of step with what is considered acceptable. I sometimes have to turn off The Office because it is so outrageous and I can’t stand the embarrassment–even though I know it is just a show. Not sure what that says about me…

2 Comments

Filed under Uncategorized

August 24, 2009 · 8:35 am

Two ways to look at suffering


Yesterday, one of our pastors, David Goneau, preached on Acts 13 and made the following point: “Jesus’ Lordship advances through suffering.” His point was that through the book of Acts one cannot miss that the message of Christianity spread through the starter soil of opposition. Consider the cross, Stephen, Peter, Paul, James, etc.

So, there are at least two ways to look at our own suffering and hardships:

1. Not the way it is supposed to be. We rail against trauma, suffering, pain, death, hate, illness and much more because it is not the original design and we know it. Brokenness is something to be fought against; to be resisted at all cost.

2. The starter soil for our maturity. Who hasn’t had the experience of coming through a time of hardship with maturity that we wouldn’t want to give up? Haven’t we heard of those who raise children with disabilities say, “I wouldn’t have asked for this but I wouldn’t go back and change a thing.” Like some seeds that need to be frozen before they can bloom, we need certain forms of stressors to grow in maturity. (Consider the character of one who has nothing but luxury and never has to work!)

Is it hard to hold these two truthes at the same time? Yes! And followers of Jesus look for the day when their maturity will be complete and suffering will be no more–when Christ establishes his kingdom once and forever. Until then, we must try to hold on to both thoughts–to work against suffering everywhere (justice work) and yet allow what suffering we do experience to build character while we look for our relief.

2 Comments

Filed under Mindfulness

Tagged as ,

August 21, 2009 · 8:46 am

Case consultation by videoconference?


For my counselor readers…how interested would you be in participating in videoconferenced case consultations with an expert in your field for the purpose of discussing client cases with that expert? Bear in mind that this kind of activity would have to meet ethical guidelines (e.g., no identifying information about any clients could be revealed, clear distinction that this is consultation and not supervision, etc.), but would you be interested? Would something like this reduce your sense of isolation?  Consider answering the following questions:

1. Would you be interested in getting consultation for some of your cases via videoconference (private video exchange with an expert, such as skype or other service)?

2. Would you still be interested if the videoconference was a group of no more than 4 (and everyone got to present something)? If it was a group of about 10 and not everyone got to present but all got to participate in the discussion)

3. Would you be willing to pay for such a consultation? 

4. If yes to above questions, how frequently would you think you might use this type of service? Monthly? Quarterly? Other?

5. Finally, what questions or concerns does this idea raise for you?

1 Comment

Filed under biblical counseling, christian counseling, christian psychology, counseling, counseling skills, Psychology

Tagged as , , ,

August 20, 2009 · 5:23 am

Be Anxious for Nothing???


Posted slides on my “Articles, Slides…” page (#13 on the list) from the talk I gave last night at Macedonia Baptist Church. Talk entitled: Be Anxious for Nothing??? Dealing with Anxiety in a Frightening World.

1 Comment

Filed under Anxiety, biblical counseling, Biblical Reflection, christian counseling, christian psychology, counseling

Tagged as ,

August 19, 2009 · 9:51 am

Apologies revisited and moral outrage


The matter of Michael Vick and his return to the NFL cannot be escaped–especially when you live in Philadelphia Eagle territory. Seems the media cannot get enough of him: Can he be forgiven? Is he truly sorry? Has he paid his debt? Should he get a second chance?

I care little about these matters but would like to make two observations.

1. On apologies (again). I’ve written here numerous times regarding the good and the bad about the art of apology and what one reveals about the person making said apology (use the search engine above to find them). But let me highlight one thing about Vick’s recent comments regarding his awakening to the evils of dogfighting. The following appeared in a recent USA Today,

During his interview with Brown, Vick summed up why many sports figures lie through their teeth when caught red-handed in personal or criminal scandals. They’re — what else? — terrified of losing their multimillion-dollar salaries and endorsements. “I was scared. I knew my career was in jeopardy. I knew I had an endorsement with Nike — and I knew it was going to be a big letdown. I felt the guilt and I knew I was guilty, and I knew what I had done. And, not knowing at the time that, you know, actually telling the truth may have been better than, you know, not being honest. And it backfired on me.”

Notice his answer reflects the same root problem that got him into the problem behavior–SELF. His reason for truth telling is because it would have been better for him. “What is best for me” thinking is one of humanity’s main problems.

2. Moral Outrage. Is anyone else surprised at the level of public outrage about Vick? He is not an elected official charged with leading us? He is not anything but a professional football player. Why is there so much outrage about the evils of dogfighting and so little outrage for other evils (abortion, porn use, child abuse, poverty, obesity, etc.)? Here I think NT Wright is instructive. In his book, Evil and the Justice of God(IVP, 2006), Wright suggests that most of the western world (a) ignores evil unless it hits us personally, (b) is surprised when it does, and (c) responds in “immature and dangerous ways as a result.” (p. 24). To point c he says,

Having decreed that almost all sexual activity is good and right and commendable, we are all the more shrill about the one remaining taboo, pedophilia. It’s as though all the moral indignation which ought to be spread more evenly and thoughtfully across many spheres of activity has all been funneled on to this one crime.” (p. 27)

Well, maybe we should add animal cruelty to the list of greatest evils.

He goes on to remind us,

Lashing out at something you simply know by intuition is wrong may be better than tolerating it. But it is hardly the way to build a stable moral society.” (p. 27)

1 Comment

Filed under Abuse, News and politics

Tagged as , ,

August 18, 2009 · 7:35 am

Cultural sensitivity or watered down


Having been in meetings yesterday and today about our next steps regarding counseling training in Rwanda, I’m wrestling with the best way to address cultural differences in whatever training we do. And specifically I’m wrestling with a particular dilemma forming in my mind:

Teach what we know about counseling NOW but be unaware of subtle but important cultural differences vs. listen, learn, and teach LATER what we know (but in culturally relevent terms)

It is not the first time that I have been asked to do something sooner rather than later with these words. “Don’t worry about the cultural relevance. We’ll tell you when something doesn’t work or our students will do the application to their own situations. If you try to be culturally sensitive, it will end up being watered down. We want our students to get the best education, something that the US would recognize.”

Why do I struggle with this request? Well, in my head it sounds like, “hey, come bring your colonialistic methods of evangelism and we’ll handle it.” I struggle with it because I know American counseling culture has significant problems with it. And, I struggle with it because I know that some students (this is a universal truth!) are really good at critical thinking while others blindly ape what we say without much thought at all. AND YET, I know that waiting until I’m culturally aware enough to teach means I wouldn’t do so for a very long time.  

So, part of my struggle is not wanting to look like a culture boob by just assuming that what I teach US students is what Rwandans would need. I suspect the answer is (a) being courageous enough to risk looking like a fool, but (b) flexible enough to change on a dime when I am aware of a disconnect.

Hmmm. I may have a problem with both.

3 Comments

Filed under christian counseling, christian psychology, counseling skills, Cultural Anthropology, Psychology

Tagged as , ,

August 17, 2009 · 11:59 am

The APA on identity therapy and conversion therapy


[Let me wade into something that tends to fire up lots of feelings and lead to controversy. And let me ask all to be civil. Civility seems to be the first thing that disappears when we discuss matters near and dear to our hearts. But let us be different and listen to each other rather than talk at or past each other. As James tells us, let us be quick to listen and slow to speak.]

In recent days media outlets have picked up the story of the American Psychological Association’s release of a report and declaration of their official stance on reparative or conversion therapies for individuals seeking to change their sexual orientation. You can read their press release and find their 100 page research review here. Being a member of the organization, knowing a few of the players in the research side of things, and knowing how easy it is to get caught up in debate and miss some of the finer points, I thought I might make a few comments that may not make it to the public eye.

1. Researchers are beginning to distinguish between sexual identity and orientation. This is a good thing. I dare say that the public lags far behind on this matter. Separating these two different aspects of sexuality allows for individuals to consider and interpret their sexual feelings in accord with their beliefs and NOT as how either the minority or majority of the world tells them to define themselves. This is akin to biracial people determining how they want to self-identify rather than be forced to say they are black or white.  Consider the following quote by one of the players (whom  I don’t know),

The distinction between orientation and identity (or attraction and identity as we often describe it here) is key, in my view, in order for us to understand the experience of those who say they have changed while at the same time experiencing same-sex attraction….I hope we can agree that sexual attraction patterns may be one thing while meaning making aspects may lead two people with the same attraction pattern to identity in disparate ways. (emphasis mine; from http://www.crosswalk.com/blogs/EWThrockmorton/11607271/)

If I understand the relationship between identity and orientation, it would seem that one forms identity from a variety of “data” which leads to an orientation. This is true outside of sexual identity. A number of factors come together for a person to see themself in a particular way (this may include biology, family, life experiences, key “flashbulb” moments, etc) and in cementing that particular identity they develop an orientation towards the world. SO, this may explain why trying to change orientation has little positive effect. Until the person reviews, explores, and reconsiders their identity (something that happens in nearly every counselee I’ve ever worked with) and begins to practice another way of seeing self, not much is going to change in attraction and orientation. Further, what may change is one’s sense of importance (and therefore meaning) of various parts of themself. When my clients explore their identity, it is rare they come to understand that they were completely mis-perceiving their feelings or experiences. Rather, they begin to see those experiences and feelings from a different vantage point.  

2. Change. What constitutes change is still up in the air. Ask a depressed person if they have changed even if they are only 50% less depressed and they will say likely say yes. Ask someone else and they may say “no,  I’m still depressed.” In the realm of sexual orientation, however, many see orientation as all/nothing. All same sex or all opposite sex orientation. Many will tell you this is just not their particular experience. So, IF someone wanted to change their direction of sexual attraction, what standard would they use to determine if change had taken place? Would 50% change be good? Who would decide this?

There is another analogous scenario in psychology. Should psychologists provide weight loss treatment? Given that an extremely large portion of those who lose weight gain it back and more, many have felt it unethical for a psychologist to offer weight loss therapies when they know that success is extremely low. So, how long do you need to keep the weight off to make a treatment worthwhile? How much do you need to lose? Who decides?

My gut feel is that the APA is not accurate in saying that there isn’t evidence that individuals can change. There is some evidence. Not complete change, but let us not deny what is there. Neither are they accurate about their reporting of harm. Harm reports are difficult to objectify. The best research will show you that some are harmed and some are not. Instead of assuming harm, let us evaluate more closely how some are harmed and how some are helped. Just as one might do with the weight loss scenario.  

3.  APA makes an attempt to make room for the work of helping one to find congruence between faith commitments and sexual feelings. This is also a good thing. Now, just how a psychologist does this matters greatly. Does he or she evangelize here? By that I mean (a) encourage a client to choose a different faith or change it to fit one’s sexual feelings, or (b) encourage a client to deny feelings and deny the suffering one might have by choosing not to act on a desire? My personal opininon is that option c (stay neutral) does not exist and is not possible. So, where does that leave us? Informing clients of our personal positions and yet not attempting to force individuals into our view of the situation. In other words, truthful but humble without being demanding.   

This is a divisive topic. Do individuals seeking to change their sexual orientation have the right to try to do so with the help of psychologists? Is change possible? Desirable? Damaging? And of course in trying to answer these questions you have a number of players on each side–each reading the “evidence” the way they would like to see it. You have those who have personal experiences in one direction or another. You have those with political or philosophical agendas. And, on top of that, you have media players interested in creating controversy where they can. I observed this last one myself where a local talk show host did his level best to create differences between two parties that weren’t disagreeing with each other as much he wanted them to.

So, what do you make of the difference between identity and orientation? Is it meaningful? How do we speak of change? Can we admit that it happens for some and not for others no matter our personal opinion whether change is good or not? And finally, can we avoid the “what if…” tendency in our conversations so that we deal with what is happening and not what we fear might happen?

7 Comments

Filed under APA, Christianity, counseling science, ethics, homosexuality, Psychology, sexual identity, sexuality, Uncategorized

Tagged as , , ,