May 4, 2009 · 1:26 pm

Practicum Monday: counseling mistakes?


I’d like to compile a list of mistakes mostly likely to be made by novicecounselors. In the past I’ve written on some of the mistakes or foolish behavior of counselors and some of you have helped contribute stories like the counselor who fell asleep during the session, the counselor who ate a meal, who tried to set the counselee up with a son or daughter, the counselor who took phone calls, etc. Most of these mistakes wouldn’t be made by the typical counselor, even one who had never counseled before.

So, what are the most common mistakes of the novice counselor? Not sure, here are some I’ve observed:

1. Failing to collect enough data during the first sessionto assess matters of suicidality or mental status. Novice counselors tend to either drill too deep on one topic (and so miss other important matters) or stay on the surface and fail to ask questions they think might embarrass the client

2. Promising too much. We want the client to have hope and we hope they don’t see us as novice, so we promise the world. Such temptations lead sometimes to offering our phone number to call at all hours, to agreeing to meet outside of sessions, too allowing sessions to go beyond the planned limit.

3. Encouraging. Beginning Christian counselors sometimes fail to let the counselee sit with their pain. Instead, they trot out verses to comfort and encourage. Often, these passages fall flat without their intended result.  

4. Writing too much. Progress notes may look like novellas. When you don’t know what is important, everything is documented.

5. Going along with the parents. Novice counselors often seen kids and their parents. It is easy to become railroaded into allowing the parents to use the session to gang up on the kids. Novice counselors have a hard time managing the parents and the kids in the same session.

What mistakes did you make? Did you experience at the hands of a novice?

When I started, I hated the question about my age (I was 24 but looked younger). I tried all sorts of creative ways to illustrate my experience and to be vague about my actual age. I’m sure I never convinced anyone. They stayed because they didn’t want to start over. I should have just said (nicely), “your right, I’m young. We can either find you another client now or we can try the following intervention and if you don’t like what I’m doing, we can find you someone else then. What would you like to do?”

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May 1, 2009 · 5:42 am

Physiology Phriday: Dieting starves your brain?


I heard a psychiatrist recently tell her depressed client that she should not go on a diet to lose weight. The client was confused. She thought that losing weight would help her with her self-esteem. She had not been exercising and had put on 15 pounds over the past 3 years. So, she asked her doctor why not. This was the explanation (paraphrased):

Exercise does provide a natural antidepressant and so I heartily encourage you to start an exercise program. However, many diets consist of decreasing foods rich in carbohydrates. Getting more protein is good but your brain needs glucose to produce neurotransmitters (e.g., serotonin) and foods rich in carbs are more easily turned into glucose. When you starve your body of glucose, your brain is the first place that starves.

Maybe this explains a bit of yo-yo dieting. The person is feeling poorly about weight, reduces foods that provide simple sugars in order to lose weight, starves their brain of serotonin (thereby creating a greater feeling of depression), and then caves to a binge in order to feel better. 

Don’t know if this supposition is true, but it might be important for those on antidepressants to make sure that they are keeping a balanced diet and exercising frequently.

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April 30, 2009 · 5:38 am

Identified by your betrayals?


This past Sunday one of our pastors, Erik Larsen, asked this question:

Are you too identified by your betrayals?

He was asking whether we form our identity around the script of being betrayed and use our experiences of being betrayed as shaping our sense of all of life. I think we could also consider whether we shape our identity around our betrayals of others?

What forms your sense of self and the world? A serious violation of your trust?A major failure? How might you begin to reconstruct your sense of self around the whole picture of who you are?

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April 29, 2009 · 5:21 am

Can your body cause you to sin, part 3


As promised, I offer you a vignette to consider as we think about the matter of culpability and involuntary sins.

Consider a 2 year old that has missed his daily nap, is hungry, and tired of being out in public. He has a meltdown. He kicks, screams, cries, refuses his mother’s comfort because he wants some object he cannot have. The good parent recognizes the child’s distress, whispers in his ear to comfort him, says “no” firmly to his kicks, and finds something for him to eat and a place to take a nap. Has the child sinned? He surely has demanded something, acted aggressively, maybe even disobeyed by going after the object after his mother said to stop. Yes, he sinned. But was it really voluntary? Well, maybe partly. But don’t we consider the circumstances and the fact that his body is not helping matters. We forgive, we overlook, we understand, we help. We do so because we know his choices are not really voluntary.

Now, we may have another reaction altogether when we see our little boy (fully rested and fed) look us in the eye and try to bite his baby brother after we just told him to stop. We know he has great voluntary control here and is in a power struggle. And we respond with appropriate discipline.

We could easily have considered a vignette of a brain injured man or a panic disordered woman. We respond to individuals based not on whether something is sinful or not but on how much voluntary control we think they have and the circumstances in play (environment, biology, understanding, etc.).

So, our bodies can cause us to sin. In the classic sense, we are guilty whether it is voluntary or not. And yet we, and God himself, varies responses to such sins based on a variety of factors. We do not ascribe innocence to those less culpable but do try to determine levels of responsibility. Thankfully, all of it is covered by the cross.

Here’s one way this might matter. I find many afraid to seek biological aids for what they determine to be spiritual problems (addictions, depression, anxiety, etc.). If we see body and soul together, then both body and soul interventions are working toward the same goal.

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April 28, 2009 · 12:20 pm

Can your body make you sin, part 2


Yesterday I posted an introduction to this topic. Today, I want to give my answer to the first question:

Is it possible that my body (against or apart from my will) might cause me to sin?

  • What is gained and/or lost if we say yes? If we say no?

My answer: Yes.

I suppose you might like some defense of this position. Okay, here’s my best shot in five minutes:

1. Nothing is done by a person apart from their cells. We mediate all worship, desire, etc. through our cells. When we do good or evil, all of us are involved.

2. Sin is not merely an act, but a disposition. All of me is tainted and not functioning as it was originally intended, including my physical body (and don’t I feel the effects of being over 40!).  The dualist position is more in danger of treating sin as only what we consciously choose.

3. I don’t have to know that I broke the law (biblical or federal) to be guilty of violating the law. I didn’t know I was speeding but I still got a ticket. In the OT, lack of intention or knowledge violating the law did not protect against impurity or guilt (e.g., Lev. 4:22; 5:3).

4. If the body is broken and under sin’s curse it stands to reason that our bodies function in ways that are out of accord with our will. If they can move without our control (e.g., Parkinsonian tremors) can they not also move in such a way that violates God’s design for us. We have scientific evidence of this. Stimulate a certain part of the brain, and you will have rageful feelings. Stimulate another part and you may have sexual thoughts. Consider, as a commenter suggested yesterday, a person with Tourettes. There is some evidence of temporary volitional control (a surgeon is able to stop a tick during an operation) but other evidence that the ticks, and in some cases, curses burst out against the conscious effort of the person.

Saying yes to this question violates our Western sensibilities:

If we accept that our bodies can act against or without the will, what do we gain or lose? I think the primary concern by many would be that somehow we will either be held culpable for sins we didn’t want to commit or claim innocence for sins we didn’t willfully commit. And this gets to our thinking patterns here in the West. We want to be only held accountable for things we did do and not held accountable for things we either didn’t do or didn’t have any control over.

It strikes us as evil to be held accountable for that which we didn’t know was wrong. I once got a ticket for making a u-turn on a Chicago city street at 11 pm when no one (but the cop!) was around. There were no signs. I wasn’t familiar with Chicago rules, was lost in an unsavory neighborhood. And yet I still got the ticket. It didn’t seem right. But I did violate the law.

Our American judicial system isn’t the only system that holds us accountable for involuntary acts. Romans teaches us that because of Adam’s sin, all are sinners. I bear the culpability for his sin (and I make plenty of my own as well). I bear the impact of his choices in my entire being. Further we see OT prophets confessing the sins of the community as if they were their own.

So, in short, I think we can answer yes to the question about whether our bodies can make us sin. They can because we (body and soul) are tainted by the Fall. It doesn’t make us more or less out of sorts with God whether our sin is chosen or involuntary. Happily, God doesn’t just forgive willful sin, he forgives sin period and makes it possible to not sin by imputing his righteousness to us.

For those still thinking about culpability, I’ll give a little vignette tomorrow to chew on.

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April 27, 2009 · 12:41 pm

Can your body make you sin?


I’ve had a small email exchange on this topic with a PhD student at another seminary and so I’m going to raise the topic here. Can your body make you sin? Obviously, I’m going to tackle this question from a Christian perspective that cares about sin and wants to think carefully about our ontology (what it means to be human).  

The major questions behind the question are (a) are we made up of 2 substances (body and soul), and (b) even if we are, does it matter when considering what causes people to do what they ought not? I am not going to even try to defend (a) but I do want us to think about (b).

Some background might help. (If you get bored with background, just scroll down to the questions below.)

1. In the Christian life sin matters. Sin is that which we do that violates God’s definition of holiness. Sin is that which fallen creatures do all the time. Thankfully, God provides a way of escape from the logical consequences of sin (grace via the cross). Despite (no, because of) this gift from God, Christians still care about eradicating sin even though it is not possible. It stands to reason, then, that it can help to discern the sources of sin in order to stop them.

2. The classic Christian view of human nature is that we are made of two substances: body and soul. We are not just our physical bodies but something intangible was imputed to us when God breathed life into Adam. Our soul allows us to worship God. The bible refers to our soul in various ways: will, heart, desires, etc. The soul is the driver of the will and therefore responsible for the moral direction of our actions. Early theologically oriented scientists (think Descartes) assumed the existence of the soul but looked to explain how the intangible soul connected to the tangible body. Now with the advances in neuroscience we have better explanatory power in describing the action of thoughts, feelings, and knowing. However, the will remains a mystery. While we can explain neural networks and what the brain does when desiring something, we cannot yet explain WHY we want or desire certain things. 

Some philosophers and theologians have attempted to deal with classic dualism by suggesting that we are only one substance. I am not capable of succinctly defending this position so I point you to Nancey Murphy and a review of her book here.  She does a masterful job defending non-reducible physicalism.

Okay, now if you think humans are made of body and soul you have these questions to consider.

  1. Is it possible that my body (against or apart from my will) might cause me to sin?
    • What is gained and/or lost if we say yes? If we say no?
  2. If it is possible, am I culpable for such sins? 
    • What is the consequences of saying yes to this question?

During this week I plan to give a feeble defense of a yes answer to both questions 1 and 2. We’ll see how this unfolds.

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April 24, 2009 · 2:16 pm

Physiology Phriday: Depressed? Check your thyroid


One of the most common mistakes made by counselors is to forget to encourage their clients to get specific medical work-ups. There are three key reasons for this problem.

1. Most clients describe their struggles with causes already in place. “I’m depressed because I have a bad marriage, because life isn’t going the way I had hoped.” We counselors accept their initial diagnosis and fail to dig further.

2. We know that counseling works. And so we help them work on their thinking, feeling, and behaviors. We do what we do best

3. When we do send someone to the doctor, we rarely get a clear answer.

Nonetheless, it is essential that your clients have had recent blood work. Case in point. Low thyroid levels often leads to experiences of confusion, mental dullness, and depression. (FYI, overactive thyroid may lead to irritability and anxiety). While there may be real counseling work to be done (everybody needs some help), it would be a tragedy to miss real mercy care (i.e., a better functioning thyroid).  

Check here for some info on hypothyroidism: http://www.endocrineweb.com/hypo1.html

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April 22, 2009 · 10:14 am

Read any good books on evil?


Have a new writing assignment on the theology of evil in sexual abuse. I’m to think theologically about this particular kind of evil. So, I want to do some reading. Any books you might recommend that discuss evil (outside of the usual ones describing the damage done by sexual abuse)?

I’ll start with NT Wright’s “Evil and the Justice of God” book, but other recommendations might be helpful as well.

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April 21, 2009 · 11:59 am

What is a competent counselor?


Today, I begin an introduction to pastoral counseling class for MDiv students with my colleague Jenn. In six short weeks we will expose them to biblical foundations of understanding people and their problems, the basic helping skills, and provide them opportunities to practice on each other.

So, what makes for a competent counselor? There is a famous book on this topic. Jay Adams focuses in his landmark, bulldozing book on the problems of secular psychology and the need for a new understanding of how people change that fits with Scripture and a confidence that all people, especially pastors, are capable of leading others to change.

Important work, but misses some of the nuances that we have now about Christian models of change. For some of my thoughts on a more robust model of counseling that I seek to impart here at Biblical, see this post from several years ago.

But I want to focus here on the talents or capabilities of the counselor. And here I list 7 factors needed to be a competent counselor

1. Spiritual maturity. Not only must the counselor know the bible, its story line, etc., they must also have understood and experienced the Gospel, show a maturing trajectory towards holiness and awareness of the diversity within the Christianity. In the words of one of my theology colleagues, they must know the difference between dogma and doctrine and opinion.

2. Self-awareness/insight. One can be spiritual mature, but not particularly insightful about the self. The competent counselor has a grasp of their own narrative (and how the Gospel story is changing it) and how it impacts past and present relationships. The competent counselor understands strengths and weaknesses and is not defensive.

3. Capable of building trusting relationships. Nothing much good comes from counsel provided by standoffish and stand-above kinds of counselors. The competent counselor is able to build trusting relationships by being interested in individuals (more so than in outcomes), able to walk in another’s shoes, cross cultural lines, and able to empower others more than tell others what to do

4. Flexibility in response styles. The competent counselor understands the need to use a variety of conversational responses depending on the needs of the client. This means sometimes questions are appropriate, other times silence. Other responses include reflections, summarizing, focusing, confronting, joining, problem-solving, self-disclosing. Counselors who only use one or two of these styles will not be able to work well with clients who find those particular styles problematic. The competent counselor is intentional in her or his choices of responses.

5. Assessment and Hypothesis skills. The competent counselor is able to move from their counselees problems and descriptions to a wider view of the person and their situation and back again. This counselor is able to pull multiple pieces of data into a cohesive understanding of the situation. In doing so she forms and tests possible hypotheses that clarify motivation for behavior as well as point to interventions. For example, is the child’s behavior merely rebellious or is it ADD or anxiety based?

6. Observation skills.The competent counselor not only understands people, their needs, solutions, and has the capacity to use multiple response styles, but also is observant regarding their own impact on the counselee. They observe subtle reactions form clients and seek to moderate their counseling style and/or gently explore the meaning of the reaction. Without these skills, the counselor blithely works toward a goal without knowing if the counselee is really following.

7. Ability to care for self. Finally, the competent counselor recognizes personal limits, boundaries and actively seeks to sustain a life of personal care. Far too many counselors confuse sacrificial giving with bypassing appropriate care for one’s own spiritual well-being. Just because one is spiritually mature one day does not mean such maturity is permanent. Neglecting personal care will likely diminish all other counselor competencies over time.

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April 20, 2009 · 11:03 am

Practicum Monday: The green counselor


No one wants to be a green counselor. “Hi, I’m an intern and you are my first counselee.” Who wants to say that? Also, no one wants to entrust their most significant problems to a green counselor. “I see you haven’t any experience, so let me expose my most tender parts to you and see what you can do.”

Houston, we have a problem.

Every counselor has to get their start somewhere just as every surgeon cuts a live human being for the first time. Young single folk counsel conflict-riddled married individuals or offer parenting advice while not yet a parent. Individuals with no history of addictions sit with folks in their 10th inpatient stay in a treatment center.

Is there any way this goes well? YES! Let me tell you why going to an intern with a good supervisor is good, even sometimes better than getting a seasoned counselor by them self.

1. You get two heads instead of one. Even if the supervisor is not in the room, you get a young, determined-to-do-it-right counselor and a supervisor on his or her toes (who loves to teach and wants nothing bad to happen) thinking about you and planning carefully. They talk about the intricacies of your situation at great depth, they consider the options, and carefully review the outcome. If you only have a seasoned counselor, they may perform better (relationship wise) in sessions, but they probably aren’t thinking as critically as they could. I can attest that I am thinking much more carefully about clients during supervision (as supervisee or supervisor) than when I am not there.

2. Book knowledge actually does help. The further a person gets away from textbooks, articles, etc. the more they rely on old knowledge. Teaching counselors and green counselors are fresh from their reading and thinking about key problems. For example, the student having just completed an ethics course will be more sensitive to boundary violations than the one who has grown accustomed to thinking they will always do the right thing. Sometimes resident doctors are more aware of subtle health issues because they are running down every article to learn and running down every symptom.  

Now surely a seasoned counselor provides many good benefits. Working with an intern or medical resident often takes longer to get to a good outcome. They just aren’t as fluid. They are still learning–learning on you. A seasoned counselor will make fewer mistakes. But if they are a humble learner, the green counselor will catch on quickly and repair any damage. Whether green or seasoned, the most dangerous character problem in counselors is arrogance and listening only to him or herself.

But the intern can manage some of this by dealing with his or her own anxiety. Confidence does actually help. It enables you to think clearly, consider options, be honest about your own weaknesses, offer the client help in finding someone else if you aren’t the right fit. It is like baseball. If you are afraid of getting hit, you’ll likely not catch or hit the ball. If you have confidence, you’ve got a better shot of catching it and/or at least making contact when hitting.

 

All that said, I have to tell you a story about my “first time.” I had just completed a 13 week internship where I counseled 2 separate clients with my supervisor in session and by myself. I could be given good grades for trying hard, but probably was too impatient to get to the good stuff of people’s problems–the stuff of repentance. In a moment of insanity my supervisor set me up as a staff counselor in a satellite center. On my first night I saw a person who said the Lord had told her I was the counselor for her but now was rethinking she had misheard. How could an 18 year old be right for her (ahem, I was all of 24!)? After trying to find out the issues, she said if I couldn’t figure it out, she definitely had misheard God. The next client was a couple. In the course of the session, the husband actually stood up and started choking his wife. I stood up–not knowing what else to do–and he fled the building.

There’s nothing like baptism by fire 🙂

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