August 13, 2009 · 9:05 am

Are you a genetic fatalist?


Definition of a genetic fatalist: If I have genetic markers for _____, then I will have _____ problem.

Maybe this doesn’t happen to you but I find that when I have conversations about a wide variety of counseling related issues, they end up hitting upon the genetic question? Whether we are discussing anxiety, depression, alcoholism, sexual identity or similar concerns, I can count on being asked,

“Do you think it is genetic?”

The questioner seems to think that if the answer is “Yes,” then the individual in question has no responsibility for the situation–or no control over what is taking place. “If my alcoholism is genetic then it wasn’t my fault.” “If my son’s sexual identity confusion is genetic then he can’t do anything about it.”

Here’s what I want to say to most of these questions:

1. Probably but we don’t really know. There are lots of researchers trying to discover genetic markers and how our genes express themselves. Some we understand really well (like eye and hair color) and others we understand less well.

But even if tomorrow we discover that your husband’s OCD is genetically based, what does that mean? Is he forever trapped in acting on his OCD?

2. Thinking about genes this way doesn’t really help us right now. We all have genetic markers for various cancers and diseases but not all of us contract the problems. Women may have markers for breast cancer but never have the disease. How can that be? It can be that way because disease states or mental health matters are multifactorial in their origination. There may be genetic markers as well as environmental insults as well as psychological stressors that all work together to either protect from the disease or cause it to get started.

So, are you a genetic fatalist? Do you give your deciding vote to genetic markers when considering responsibility and control regarding behavioral issues, mental health problems, personality?

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August 11, 2009 · 10:46 am

credentialing rant


Having spent most of yesterday trying to complete an on-line application to become an authorized, in-network provider for an insurance company, I’m fighting to remember why I started down this path.

Yes, I absolutely know it benefits clients in that they do not have to pay my entire fee out of pocket and only hope to get some money back later (if they have an out-of-network benefit). They merely have to pay a co-pay and so counseling is an affordable option.

But, being a selfish individual I’m thinking mostly about my own interests at this moment. Let me count the ways this process irritates me:

1. Collecting all my old information (addresses for pre and post docs and all education back to undergrad). Don’t they know that happened eons ago?

2. Repetitive entries. I think I entered my fax number at least 20 times.

3. Tax ids, SS ids, NPIs, etc. Numbers to find and enter correctly. I’m ready for the iris scan and probe now. My underwear size is…

4. And the real irritation is…(the previous ones really aren’t the issue as the on-line application wasn’t so bad–just time consuming)…I know that if I’m approved I get the following welcome gifts

  •  
    • Reduced income per hour
    • Delayed income (improperly rejected claims, delayed claims, claims sent to the wrong address, etc.)
    • More paperwork to fill out to beg for sessions

Whine, whine, whine. It’s all about me. So much for caring for my clients’ best interests…

Okay. I’m better now. This is a good thing and one bonus is the company collecting the information will bank it so that I can use it in the future for other insurance companies should I so choose.

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August 10, 2009 · 9:54 am

Happenings


I’m passing on a couple of items from my schedule…

1. Speaking. I’ll be speaking at Macedonia Baptist Church (Norristown, PA) on the next two Wednesdays (8/12 and 8/19) for their Summer Bible Conference (theme: Mental Health Awareness). This week will be on Sexual Addiction and the 19th will be on the topic of Anxiety.

2. School. We start late this year on 9/14. For those interested in our course offerings, check out Biblical’s site for course listings. Note that we have entry level, advanced, and post-MA courses on Monday nights. I’m teaching an on-line course (Social & Cultural Foundations of Counseling) and two face to face classes (Counseling & Physiology, Psychological Assessment). Should be fun!

3. Conference 1. The AACCis hosting it’s World Conference in Nashville Sept. 16-19. My colleague, Bryan Maier, and myself will be speaking there. On the 16th, Diane Langberg and myself will be presenting a 3 hour preconference workshop about addressing the problem of pastoral sexual abuse. Later in the week, I’ll be lecturing on the use of the Bible with trauma clients.  If you like zooy places, then come as that is the best description I have for the Opryland Hotel.

4. Conference 2. November 13-15 is the annual CCEF conference, entitled, Sex Matters. I’ll be presenting on the 14th, “When Sex in Marriage Doesn’t Work.”

5. Newly published. The latest issue of the Journal of Psychology & Christianity(v. 28:2) is just out on the topic of Theophostic Prayer Ministry and related issues. I and my George Schwab have an article in that edition: “God as healer: A Closer Look at Biblical Images of Inner Healing.” Plus, a number of the other articles site previous work that Bryan Maier and I did a few years ago where we critiqued TPM’s theological bases. 

6. In the works. I’ve just completed work on a booklet, “Sexual Addiction: When is Residential Treatment an Option?” It is intended to be an ebooklet published by a local ministry. We are researching the best way to publish such a booklet for those caught in the trap of an addiction. If any of you have any great ideas for the best way to get that out on the Internet (including issues around document delivery, sales, and pricing), I’d love to hear about it.

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Filed under "phil monroe", Anxiety, christian counseling, christian psychology, counseling, counseling skills, sexual addiction, teaching counseling

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August 6, 2009 · 5:15 am

Most common sexual dysfunction?


I’m doing some prep for a November talk at CCEF‘s annual conference which I am entitling, “When sex in marriage doesn’t work.” I’ll be giving a brief overview of how counselors can be a help to couples facing sexual dysfunction (whether biological, psychological, or relational). But in my prep today I ran across this little telephone survey result from 2002 where callers asked married men and women between the ages of 40 and 80 about their most frequently experienced sexual problem.

Any guesses yet?

For men, 26.2% reported problems with “early” ejaculation. [No definition given for “early.” Usually early or premature means earlier than he wanted.] Another 22% said the problem was ED. It is interesting that we are bombarded with ED commercials but I can’t say that I’ve ever seen PE treatments advertised in mainstream media. This is probably due to the number of baby boomers with cash seeking to turn back the hands of time.

For women? No surprises. 33% report problems with interest/desire and nearly 22% report problems with lubrication.

Did the respondents seek help? 75% had not.  Another study of men after prostate surgery reveals that those who do seek help quit soon after. Seems that while there are a number of medical and psychological interventions that can help to a degree, nothing turns back the clock to one’s twenties.

A caveat. The researchers only got a 9% response rate for their random calls. Why didn’t more participate? Did those who participated have more or less problems than those who refused?

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August 5, 2009 · 9:26 am

Options for Burned-out pastors


I am working on a talk for pastors and church leaders regarding the problem of conflict with parishioners. One of the surprises for pastors is that Kingdom work means facing attacks from those who are supposed to be on the same side. We know from work with military, NGOs, and missionaries that the most difficult aspect of personal sacrifice is not threats from outside but lack of support from supposed friends and teammates.

So, when a pastor finds him or herself in a conflicted situation and feels burned out, where might that pastor turn? There are a couple of local options for help:

1. C4ML Coaching. As a mission of Biblical Seminary, Mick Noel provides coaching regarding matters of leadership and church culture. His coaching isn’t a substitute for counseling or needed retreat but Rev. Noel is keenly aware of burn-out and church conflicts and can guide the pastor in making a plan to address leadership matters in the church. C4ML also provides opportunities for small cohorts of pastors to meet to discuss how to handle culture change in the church and wider community.

2. ServingLeaders. David Wiedis is an attorney and counselor who provides coaching, consultation, and counseling for ministry leaders. The link will connect you to his thoughts on burn-out.

3. You might consider preventing such burnout by doing some education/personal work with a new ministry called, The Identity School for Christian Ministry. Rev. Bob Miller is offering material he believes is absent from most MDiv programs but necessary for survival in the pastorate. The courses are described on the website and run for 2 days at a time.

4. Retreats. There are a number of locations that provide retreats. Use your search engine to discover these. Some are low cost, some are free if they accept your application. Some leave you alone while others provide counseling and/or coaching. While retreats are good in that they provide a break, unless there is a change in how the situation is being approached, the pastor should not expect miracles.

5. Counseling. Lastly, a good spiritual director or counselor ought to be able to guide the pastor in personal assessment, re-orienting priorities, and choosing a new response set to the difficult situation.

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Filed under Biblical Seminary, christian counseling, christian psychology, Christianity: Leaders and Leadership, church and culture, conflicts, pastoral renewal, pastors and pastoring

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August 3, 2009 · 1:04 pm

Itchy?


I have poison ivy. During the day I’m able, sort of, to distract from the constant itch. I want to scratch but I refuse to give in to the temptation. But at night, the itch seems to quadruple in strength. It screams at me: “Scratch me NOW!” And without much thought, I scratch away. Further, itches appear in other spots and I begin to wonder if I will have breakouts elsewhere. Did I touch my eye? What if it shows up there? Oh, and there’s that itch in my groin…” Certainly my mood takes a hit.

This experience got me thinking about cognitive/emotional and relational “itches” that all of us have. They may be desires, fears, beliefs, etc. During the day work enables us to set them aside for a time. But then evening arrives and with less to distract us, they come rushing at us with a vengeance. And we begin to scratch at the itch by ruminating, fantasizing that you have a different life, predicting the worst outcome, impulsively trying to get rid of the problem, or drowning with alcohol, food, or media.

What is your “itch?” Do you have mechanisms to deal with the itch without making it worse by “scratching?” How might you identify the underlying beliefs and “conversations” you have with the itch that make it much more difficult to deal with?

Soon, my poison ivy will be long gone. But many of our emotional itches never stop. Like Nash in the movie version of “A Beautiful Mind”, the itch did not go away even though he was able to distance himself from it and remind himself that he did not need to respond to it.  

This is a part of what it means to “take every thought captive.”

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July 31, 2009 · 8:46 am

The grace of restriction?


I admit it, I hate restrictions. I like the freedom to do what I want. When someone tells me I can’t do something, I want to do it all the more. Have you ever wanted to NOT “keep off the grass” just because the sign was there? Or, have you thought you should be able to handle saying no to a great temptation all by yourself?

In working with men who have done things that have caused their loved ones or church community to trust them less, I sometimes see significant push back when it comes to natural consequences or restrictions put in place to protect the man from himself.  These push backs come in the form of

  • But I said I was sorry. Why won’t you forgive me?
  • You don’t believe in grace. If you did you wouldn’t keep me from having free access to the church (said by a convicted sex offender)
  • I shouldn’t have to have someone checking up on me or controlling my Internet access. If I don’t control myself and say no, then I’ll never learn to do it myself.

This last one is a bit murky. On the surface, the man is accurate. If he doesn’t learn to manage his own impulses, the moment he isn’t under restriction, he’s likely to act out. But here is the deeper issue. He doesn’t want restrictions because he sees them as painful reminders of his past transgressions.

Let me suggest that grace comes in the form of limits and restrictions. A man who abused his power as public school teacher and sexualized a child has served his time. He loves children and “only” offended once. He wants to work with kids in his church and is angry that the church has said no. “But I’m gifted with helping troubled children and I’ve had 15 years of great reports and plenty of parents who tell me they would trust me with their children. Why can’t I do what God made me to do?”

Now, there may be some explanation as to how this man might not ever be a threat again. And yet, might he also realize that restrictions from certain populations of people might actually be a grace to him–a freedom from temptation, from deception, from stresses that formerly led him down a path of fantasy and rumination about being a hero to children?

I haven’t worked this out fully in my head but I do think there can be much grace in restriction. I certainly see my children receiving a grace from not being allowed to watch certain shows or have unfiltered Internet access.

What grace have you received from a restriction? Was it both a blessing and a suffering?

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July 28, 2009 · 9:39 am

Rwandan coffee


I was sent this link to a video for “Hope for a Thousand Hills” by one of my travelmates. This is a ministry based in New Jersey that is trying to restore a coffee plantation in Western Rwanda. In doing so they are trying to enable restoration of the people.

I can attest that Rwandan coffee is some of the best I have ever drunk. While there I purchased two different types and both were smooth yet full bodied. If you are a coffee lover, I highly recommend trying some if you can. If you just want to support a ministry in Rwanda, then the ministry above is worth your review.

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July 26, 2009 · 8:52 pm

What should Christian counseling look like?


 I posted this little item for my last guest blog at www.christianpsych.orgfor the month of July. In it I mention “Christian Counseling: An Introduction” by Malony and Augsburger (2007).

And no, I don’t say what it should look like–merely a comment that we still need to figure out how we handle the faith/science dichotomy that we’ve been handed all these years.

Those who have been around wisecounsel for a while will remember I blogged through each chapter. If you are interested in seeing those posts, just use the search engine on this page to find posts mentioning Malony.

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July 23, 2009 · 4:54 pm

Healing experience of Peter?


Yesterday’s commment about Paul and possible suffering he might have experienced from intrusive memories of past murderous actions got some fun dialogue going here and on Fb. So, in light of the summer doldrums, let’s try another provocative thought. While neither this one nor the yesterday’s musing is based on the actual text (rather they are musings about the personal experience of two apostles), I think they are still fun to consider.

*in chapter 18 of John, the story of Peter’s thrice denial of Jesus is told to us. We are told he is warming himself around a communal fire during this episode. Fast forward to chapter 21. Jesus is now resurrected, has met with the disciples in Jerusalem and now meets the disciples in Galilee after a night of fishing on the Lake. Verse 9 tells us that when the disciples landed and saw Jesus, he was standing beside a charcoal fire cooking fish. What transpires next is Jesus thrice asking Peter if he loved him followed by the command to feed and care for “my sheep.”

Is it purposeful that the only two times in the book of John that charcoal fires are mentioned are these two? What memories does it evoke in Peter as he sees Jesus by it and smells the fire. Does it trigger a way of shame? Had they yet to talk about his denials? Was Peter hanging back? Was Jesus three questions intended to undo the damage done by Peter’s 3 denials?

Clearly, we can say that Jesus’ questions hurt Peter (the text tells us this) but we don’t know the nature of that hurt. What we do know is that humans often carry with them visceral reactions to triggers that bring them back to shameful past events. We don’t know that is what happened to Peter but it might well have.

We can also say that sometimes it is appropriate to have symbolic healing experiences that help commemorate and change our experience of something. I would caution those too enthused with ushering in healing with half-baked re-experiencing moments. And yet, I suspect we all have had some postive, even painful experience that resolved a negative experience from the past.

*This idea did not originate from me. I heard a pastor begin a sermon on this passage by remembering his own traumatic experience (bike accident) and how he physically remembered that accident when his young children were biking. He then mused about Peter’s reactions with Jesus in this passage. He did not suggest the text tells us much here but it was worthwhile considering how we respond when facing memories of past negative and shameful events.

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