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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April 17, 2009 · 5:28 am

Physiology Phriday: Will I be on meds for the rest of my life?


During the course of discussing a person’s anxiety or depression, the conversation turns to the possibility of using antidepressants. Inevitably, I am asked, will I have to take them forever? Clearly, the questioner does not want to and sees the possibility of taking medication for the rest of their life to be unacceptable. So much so that many resist starting or even going to see a psychiatrist in order to consider whether they might take a medication. Rarely do they ever ask if the medications will help.

Consider for a minute why a person might ask this question. Here’s some of the reasons I think I’m asked this question:

1. Everybody is on them and they never get off (from the viewpoint that too many people take them for every little hangnail and then allow themselves to stay on the crutch forever, never solving their problem)

2. Medicines are for weak people, I’m not weak. (Not sure if the person would have the same response if their medical doctor said their thyroid wasn’t working and so they would need synthroid for the rest of their life)

3. It is only a spiritual problem. Taking the medication will solve the problem but not the spiritual problem. I’ll be avoiding the real issues.

4. I hate medicines of all kind. I hate remembering to take them and I hate their side effects.

5. I don’t think they will really work.

Can you think of other reasons? Now, antidepressants do work from a research vantage point. They are not the silver bullet. They will not make a bitter, angry, depressed person, less bitter. They may help them sleep better, improve their mood, and thus more clearly come to terms with their bitterness. Medications never block the heart from spiritual matters. Only the person who does not want to deal with spiritual matters will use them to avoid looking more deeply inside. God can be found in both suffering and comfort. Whether we will look for him is a bigger question.

So, what if you need them for the rest of your life? What if they really do make it possible to function well? Is our distaste for medicines due to their side effects or due to the fact that we have to accept that we are weak and broken people?

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April 15, 2009 · 5:37 am

Lewis on our choices impact on the self


In my CS Lewis reader, Lewis says that Christians often think about the consequences of choices either bringing reward or punishment from God. He suggests another way to look at our choices (entry for 17 March):

I would much rather say that every time you make a choice you are turning the central part of you, the part of you that chooses, into something a little different from what it was before. And taking your life as a whole, with all your innumerable choices, all your life long you are slowly turning this central thing either into a heavenly creature or into a hellish creature: either into a creature that is in harmony with God, and with other creatures, and with itself, or else into one that is in a state of war and hatred with God, and with its fellow-creatures, and with itself. (From Mere Christianity)

Does this not help us consider which creature we are forming as we make our many mindless choices every day?

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April 14, 2009 · 5:32 am

Apologies revisited: Heard a good one lately?


Public, direct, and heartfelt apologies are difficult…and rare.

I’ve written here numerous times about apologies and repentance. I find public apologies very interesting, especially by those who can afford to pay someone to help them “get it right.” Last week I listened to a public figure hold a press conference after his conviction for DUI. This person has a lot of money and access to all of the best “coaches”. And yet, his apology was all about himself. Asked what he learned? “I learned that life is full of second chances and I got one.” Now, that could mean that he realizes that he was protected from killing someone with his car. He avoided ending his career. Or, it could mean something far less than remorse. Really, his “apology” was all about himself.
 
Here’s my question to readers: Have you witnessed or experienced a “home run” apology? What made it so? What features were present? How did you know it wasn’t merely learning the right words? Did you ever think you received a real heartfelt apology only to discover later it wasn’t?

In “Machete Season” (book about Rwandan “killers”), one victim gives one requirement:

“If killers come to church to pray to God on their knees, to show us their remorse, I cannot pray either with them or against them. Real regrets are said eye to eye, not to statues of God.” (p. 163)

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April 13, 2009 · 11:11 am

Practicum Monday: The secret to a good experience


A new semester begins today and I pick up teaching again after a sabbatical. It feels good to get back in the saddle again. Practicum and Professional Orientation starts today and so my students begin their first fieldwork assignments around the region. If they are at all like I was when I first began counseling work, they will be nervous and worried about doing well and doing the right thing. But I have a secret for them. This nervousness will actually help them do well and, for the most part, mistakes in counseling often turn out to be good for both counselee and client. Counseling is more like art and less like surgery. And since counseling is relational art, the opportunity to “do over” actually provides wonderful realism to the healing.

However, there is another secret to good practicum experiences: good supervision. Good supervision makes or breaks an experience. And good supervision requires the active participation of both supervisor and supervisee.

The Supervisor: Supervisors come with a variety of skills, personality, and style. Some are quite directive and keep a tight rein on your practice attempts. Others are very hands-off, wanting you to try stuff yourself and so they respond to your questions and concerns rather than seek you out. Others are very process oriented and focus on your experience more than what you actually do.

The Supervisee: Some students come with hundreds of questions (some out of curiosity but most out of anxiety). Others want very specific directions and then try to act them out as was given. Others still want to talk about their own experiences and have a harder time recalling client responses.

Practicum students do well to prepare for supervision:

1. Before you begin, have some discussion about how the supervisor likes supervision to go? Do they have an idea about how they want you to function in it? Do they want it to happen just after your counseling experiences for the week so you can debrief? Just before so you can best remember what was decided?

2. When you bring your cases to supervision, come prepared to concisely summarize history, presenting problems, attempts to solve prior to counseling, family systems, current crises if present, work thus far in your counseling. Also, come prepared with a specific objective question you would  like to have answered. The more specific your question, the more likely you will come away with an answer.

3. Be sure to ask the supervisor to help you refine your hypotheses. This is a good opportunity to consider alternative ideas.

4. Schedule time when the supervisor can either watch you live or listen to a taping. There is NO better supervision possible. Scary? Yes. But essential if you do intend to become a good counselor

5. Be willing to ask (nicely) the why question when your supervisor gives you directives that don’t make sense. More than doing the right thing, you want to understand the critical thinking behind the right response.

6. Use your relationship with the supervisor to grow as a professional. This is one of your future colleagues. If there are conflicts between you, practice the good art of resolution. Don’t avoid and don’t attack.

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April 10, 2009 · 8:25 am

Must read: “The Other Cup” by Ray Dillard


Folks, it is “Good Friday” and if you are wondering why it is called good, you ought to read this sermonby the late Ray Dillard. CCEF offers it up for free on their homepage. If someone knows how to get a recording of it, that would be the only better option. I was present when he preached this quite a number of years ago. It is, by far, the best “Good Friday” sermon I ever heard. The cup of wrath is well-known to Christians everywhere. But there is another cup…

Ray Dillard was professor of OT at Westminster during my tenure and one of my favorites.

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April 10, 2009 · 5:49 am

Psychiatric vs. Psychological evaluations: What is the difference?


In place of my usual physiology Phriday post, I give you this…

“I think I need a psychiatric evaluation? Can you test me?” These are some of the questions I get from time to time. And they reveal an ongoing confusion about testings, assessment, evaluations, the world of psychiatry, psychology, and neurology. Interestingly, if you type in “psychiatric evaluation” into wikipedia, you actually get redirected to an entry on psychological evaluations and testing. So, let me try to differentiate a bit here:

What is a psychiatric evaluation? It is done by a psychiatrist who is a physician with special psychiatry training (courses and residencies). This evaluation is comprehensive but medical in nature. Expect the person to ask for your physical, behavioral, and cognitive histories, order blood tests or other medical exams, evaluate (by observation and interview) your mood, your reality testing, and mental status etc. Ultimately, after an extensive (and usually expensive) interview, the doctor will arrive at a psychiatric diagnosis (if appropriate) and may also recommend medicines to help with the problem–which they can prescribe. A few also provide ongoing talk therapy but most do not. Rather, they recommend you find a therapist for that part. They will follow up with med checks as needed to titrate or refine your medicines. When a person has a very difficult, complex, or lengthy history of mental health, or, when the person is needing a diagnosis for legal reasons, a psychiatrist is a good choice. They are usually gifted at extracting subtle physical and behavioral matters that may help correctly pinpoint the problem. While a person might well get anti-depressants from their regular doctor, a good psychiatrist is better able to deal with complex matters and follow you more closely to get the right compound and dosage.

Neurological Evaluation. Stating the obvious, a physician with neurological specialties and qualifications does a neurological evaluation. Neurologists specialize in…wait for it…the nervous system (brain, spinal cord, and 12 cranial nerves). A neurological evaluation includes many of the things evaluated by psychiatrists but with special attention to your motor and sensory systems, your reflexes, and similar kinds of things. You might more likely see a neurologist when you obviously have a neurological issue. Neurologists are more likely to specialize in ADHD, brain injuries, and psychiatric problems that result from dementias or other known physical problems. They are often better able to give and interpret MRIs and other imaging that might be appropriate. They will also prescribe and follow medications.

Psychological Evaluation, AKA testing, psych assessment. These are offered, mostly, by doctoral level psychologists. These evaluations will cover much of the same history, mental status, and provide diagnoses when appropriate. Interviews, just like the previous two options, are essential. However, what sets psychological evaluation apart is its use of standardized tests. These may be paper and pencil or electronic. They may be filled out by the client or by family members. The results provide a snapshot of behavior, or cognitive functioning, or mood by contrasting the individual results against a peer group. For example, a child may complete a computerized test to assess attention span. The results are compared to thousands of children taking this test who either are “non ADHD” and or ADHD. A good psychologist collects data from multiple data points (test data, interviews by client and maybe family, observations, etc.) and uses that data to make interpretations and recommendations for ongoing care. Usually, the best psychological evaluations begin with a very objective, specific question. Just throwing a bunch of tests at a person to “see what comes up” isn’t all that helpful. Just because something pops up doesn’t mean it is meaningful.

It is true that masters level therapists (licensed or not) give and interpret some tests. But most of the best tests can only be given and interpreted by doctoral level, licensed psychologists.

There are other types of evaluations. Neuropsychologists are doctoral psychologists with specialized training and help pinpoint brain injury, unravel more complex learning disabilities, etc. Neuropsychiatric evaluations are done by another similar but slightly different professional. You can check out their interesting history on this wikipedia page.

So, how do you choose what is best for you? Answer a few questions.

1. What do I really want to know when it is all said and done? What might help me decide how to proceed? The more specific you are, the more likely you can get the answer you want.

2. Do I think I need to focus more on physical options or behavioral options?

3. Do I think I’m likely to need medications? The physician types are better. Psychologists cannot prescribe meds (unless you live in Hawaii or are in the military).

4. If I am given a diagnosis, what do I need it for? Both doctoral level psychologists and psychiatrists are capable of giving you diagnoses. However, some people or systems value one opinion over another. Figure out if it matters for your purposes.

5. Am I looking for specific behavioral/relational suggestions? Then psychological evaluations are more appropriate.

6. Am I looking to form an ongoing therapeutic talk based relationship? See the psychologist.

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April 9, 2009 · 5:30 am

Final thoughts on roots of evil


Well not really. Just that I posted on Tuesday that I would add a few more thoughts on this topic. On Sunday, Terry Traylor preached on the last verse of Judges and the first part of Matthew 21. You can hear it here. In his sermon he gave a nice summary of the book of Judges and the cycle we find in it:

1. The people stop dealing with sin, begin to flirt with it
2. God gives them over to their desires. He lets them have what they demand.
3. The people slowly recognize the problem, take a long time to do something about it, but finally call to the Lord for help.
4. God raises up a protector/deliverer.
5. God provides a period or rest and safety

Unfortunately, the cycle repeats itself. Except for one small problem: the cycle is broken when the people fail to cry out to God for help but keep going on their way. We could call it the “butterfly effect.” When the people fail to get rid of the idols but accept forms of syncretism, then it allows temple workers (Levites) to make it okay to have a concubine in the first place. He doesn’t protect her when some rapists come his way. He shows her no concern after her rape. She dies and he doesn’t give her the decency of a burial but sends her body parts to the 12 tribes and tells only the part that makes others look bad. And ultimately this butterfly effect ends with thousands dead in a civil war and innocent women stolen and subjected to forced marriages. All because everyone did right in their own eyes.

It would seem that this is part of the problem in Rwanda. You have a rather religious/Christian population that flirts with hatred and jealousy of the other, turns a blind eye to neighbors doing violence to others and ends up with civil strife and genocide.

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April 8, 2009 · 5:16 am

Ramp up your helping skills!


Biblical Seminary is offering community education (non-degree) for those not able or not eligible for graduate education. It is a way to get a taste of what we do here. Starting next Monday night, Jenn Zuck (one of our counseling adjuncts) will be teaching an introductory counseling skills class for 6 weeks. If you’ve wanted to ramp up your listening and helping skills, wanted to see what we teach counseling students, or just wanted to improve your family relationships, you should enroll in this course.

By the way, the course isn’t just for your head. You will practice some new skills and you will find that your spiritual life will also be enriched.

Here’s the link for more info (flyer and syllabus): http://www.biblical.edu/pages/embark/about-us-upcoming-eventstest.htm

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