Tag Archives: counseling

DRC/Rwanda Trip: Final Days


October 21-22, 2011, Kigali, Rwanda

Friday morning and we are up by 6 am. Have to pack this morning because we have to be out of our rooms. As soon as we finish the conference we must say our goodbyes and get to the airport. We have breakfast with Robert Briggs of the American Bible Society. He’s on his way to a United Bible Society meeting in Kenya. Our conference begins with Diane

Planning the next steps

Langberg and Carol King covering the topics of lament and grief. After their presentations, the participants practiced writing their own laments. We made time for sharing them with others. We concluded this section with a choral reading of Scriptural laments. This choral reading was compiled by Lynn MacDougall and quite moving for all. We had enough time before lunch for me to teach a bit on vicarious trauma.

After lunch, I did a short teaching on peer supervision. It is important for these caregivers to support each other and so I taught on how to do case consultations and to write-up case study/questions. After finishing this teaching, Baraka led the participants in a “What next” brainstorm. Their main recommendation was to form an association of counselor/caregivers–Rwandan Association of Christian Counseling as a place to get further support, training and to share resources. They wanted a website that would allow them to connect via social media. As they explored their current needs, many said that the number one need is ongoing mentoring. Others talked of finding ways to get paid for their work in counseling. Many spoke of the need for skills and training in dealing with drug and alcohol issues, sexuality, gender-based violence, depression, and anxiety. They asked for trainings 2 times per year. The group decided to appoint a few of the attendees to a committee to see these recommendations to completion.

We concluded our time by asking them to tell us what parts they liked the most. They liked the small group activities. They wanted these to go longer. They liked the role plays and want more. They would like PowerPoint slides (we didn’t do these but handed out outlines) and for speakers to speak slower English. We promised to send them a PDF of our talks and outlines for them to have in electronic form.

Our final activity was to hand out the certificates for real. I got the pleasure of doing this and getting a hug and a picture from each attendee. We said our goodbyes, made a quick change of clothes and headed off to the car to take us to the airport. Just as we were about to get in the car, we were given handkerchiefs each with notes and signatures from the attendees. A sweet parting gift!

Friday night at 7 pm, we boarded our plane (Brussels Air) to start the trip back home. The flight was full and our seats were all over the plane so no debriefing for us. For the next 10 hours (including a stop in Nairobi), I was jammed into a middle seat without leg room (front role of cattle class). Arriving in Brussels by 6 am, we managed to get coffee, chat a bit with each other, and buy some Belgian chocolates for the family. After a total of 28 hours of travel, we arrived back in Philadelphia, PA. 42 hours of no sleep (all day Friday and the night and then most of Saturday) but I arrived home wired and ready to tell my family about what I had seen. Funny, as I tried to tell them about my trip, I found I was having a hard time making sense of everything. I’m not sure it was just because I was tired but more because I had too many thoughts and feelings and was without words to express it all.

As I post this, I am now 1 month from the end of this trip. It is still hard to be concise about the trip. We learned much, saw much, and have ideas about how we can have an impact on future counseling training in Rwanda and the DRC. Clearly, we need to do more live vignettes for the counselor trainees. And we can impact the area by offering materials to existing schools.

I am blessed to have been able to do this work. Probably more blessed than the recipients! I couldn’t have asked for a more successful trip, better travel connections (well, unless someone has a teleporter lying around), or better travel companions. Can’t wait til the next time.

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DRC/Rwanda Trip: Day 10


October 20, 2011, Kigali, Rwanda

The second day of our conference with NGO caregivers. Today Bishop Nathan Gasatura joined us from Butare. It is always a pleasure to meet with the Bishop. We had a good lunch meeting with him where we discussed future possibilities of counseling/trauma training in his city. I learned why the national university is not in the capitol but 3 hours south in Butare. When Rwanda and Burundi were one country,

The Bishop grooves to some Gospel

the capitol was Butare and thus it made sense to have the national university there. Oh, and another reason it is good to see the Bishop is that he can really dance.

Carol King and I started this morning’s session with a short counseling vignette. I counseled Carol in order to illustrate the skills of bad listening and then good listening, stabilization, and grounding during dissociation. We then talked with them about ways to get another person’s story in bits (rather than all at once) and with their lead (rather than having the counselor pull it out of them). The role play was something that few had ever seen and we had lively discussion afterward, including why I didn’t push Carol (she played a hesitant, fearful counselee) and the issue of exploring emotion. At the end of the conference we learned our role plays were some of the most important parts of the conference.

Later, Josh presented some material on trauma, attachment, and the impact on the brain. To make this presentation practical, we did another role play where I was the counselee and Josh the counselor. We illustrated (in a rather speeded up illustration) portions of the levels of repair: telling the story, re-framing the story (in a wider truth), re-writing the story

Josh counseling Phil

, and re-connection with others. We concluded this time by having them practice counseling each other with a focus on drawing out emotions in the story. We had another great discussion about culture and emotion as well as the cultural differences between the US and Africa (counseling as listening vs. counseling as advising and solving problems).

The evening concluded with a party and hors d’oeuvres. It was an amazing celebration where many of the women wore traditional attire. We danced (I tried), sang scripture songs, heard silly riddles, and cultural stories. Then, we concluded with a ceremony of giving out the certificates. Normally, we would do this on Friday night at the conclusion of the conference but many wanted to receive their certificate in their traditional dress and we were leaving immediately after the conference ended on Friday so we determined to do this tonight. It was a time full of celebration and joy and a wonderful reminder of one antidote to trauma–communal celebration.

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Counseling as Global Mission of the Church


A few days ago I wrote this for our seminary’s blog regarding how counseling supports the global mission of the church. If you are interested in international counseling work…you need to read this blog and follow the link I promote.

Counseling as Global Mission of the Church.

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Sneak preview: Healing Trauma in International Settings (AACC seminar)


Cascade Atrium, Gaylord Opryland Resort & Conv...

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Just completed preparing my breakout seminar for this year’s AACC World Conference at the beautiful but outlandishly expansive Opryland Hotel in Nashville (Sept 28-Oct 2). This time around I presenting with my colleague Carol King on “Healing Trauma in International Settings: Best Practices.” Carol has had some experience in Rwanda and Goma, DRC and will be with our group in October when we do trauma recovery training in Kigali. Come back to the blog on the 30th and you can see and download the slideshow we will do.

What will we be talking about? 3 main points:

  • Listen…don’t assume you already know trauma or treatment practices
  • Train…don’t do the interventions yourself (train local leaders)
  • Utilize…don’t reinvent the wheel (use existing models)

Now obviously we will be fleshing those points out. Our goal is to help prepare interested counselors to develop short and long-range intervention strategies that utilize the cultural and human resources of the people they will serve. The only way to do this well is to have a listening and collaborative/support role approach. To that end I will talk about hoe to build an effective area case map.  We end by reviewing a few models for trauma recovery (both Christian and secular).

Check back on the 30th for the full set of slides.

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Psychological rubbernecking?


One of the necessary first steps of doing international trauma work is to listen to the stories of trauma. There are two main reasons. First, it can be healing for the teller to tell their story to someone safe and caring (if those leading the story telling project follow some basic rules). Second, stories often reveal useful information that may determine future trauma recovery intervention strategies.

But let us also admit there can be a downside to getting others to tell their story, especially those who are impoverished and in great need:

  • When “helpers” or journalists helicopter in to hear the stories, the victims may not feel free to not tell their stories because of the help they hope to receive
  • Outside helpers may repeat the stories in such a way as to sensationalize or to gain more money for future trips. While some reasons to tell may be noble and good, does the retelling of the trauma put the victim at risk for retaliation?
  • Getting victims to tell their story may first raise hopes for change and then dash them if there isn’t a plan for follow-up
  • Sometimes outsiders listen only to help themselves feel better (see, we cared enough to listen) but not do anything to help

In less than one month I will be on my way to do just this kind of listening in both the DRC and Rwanda. The challenge for us is to listen and invite story-telling in ways that leaves victims with immediate help and hope and a viable plan for the future (as it pertains to what to do about their trauma).

But we face some hurdles in trying to hear the right (real) or most important stories.
1. Hearing the real stories. Sometimes stories get cleaned up in an effort to tell us what others think we want to hear. Other stories are told with a slant in order to avoid stirring up other trouble.

2. Avoiding our own biases. Some victims may be perpetrators even as they are also victims. It is easy to categorize individuals in such a way that we stop listening to the pain or the recovery. We can fail to see how victims handle temptations for revenge or how perpetrators act humanely.

3. Lost in translation. Most of the stories we will hear are going to be told to us in a language other than English. That means the story we hear may be the words of the translator rather than the victim.

There is a fine line between listening for learning or helping and listening for curiosity. It is not always clear where that line is but pray for us as we seek to listen in ways that bring health and a plan for healing. We do not want to merely rubberneck like those driving past a bad accident, looking but not providing any help.

One sign that we are listening well is that the victim not only recalls the terrible things from their past but that they also recall how they survived and have some sense of being empowered in their present and future.

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Narrative therapy and emotion 1


This month, Richard Smith and I are teaching an on-line class entitled, Christian Counseling in Postmodern Culture. Dr. Smith is managing the culture side of things in this class and has students thinking about the impact of consumerism, the “empty” self of the modern era, and “infantilist ethos” (from Barber’s 2008 Consumed)

This week Dr. Smith gave the class this quote:

At heart postmodernity [is] the same anthropology: both see humans as primarily units of consumption for whom choice is the defining characteristic… The difference between modernity and postmodernity is not that great looked at in this way: The cult of the autonomous ego, an endlessly acquisitive conqueror and pioneer devolved into a commodious individualism characterized by an unencumbered enjoyment of consumption goods and commodities.  (Brian Walsh and Sylvia Keesmaat).

A mouthful? Boil it down to this…postmodernist philosophy is very much concerned about the self. Not all that new. Now, postmodernism is much more than that and NOT all bad. But my point here is this: a counselor working in this culture must be able to connect with the client and help them construct/reconstruct their story rather than just give them lists of universal truisms to apprehend. Not that there isn’t universal truth but that the approach to them must  done in a dialogical and storying manner.

Enter narrative therapy.

Thus, I intend to blog a bit on this topic during the rest of August by summarizing and commenting on Working with Narrative in Emotion-Focused Therapy: Changing Stories, Healing Lives, by Lynne E Angus and Leslie S. Greenberg (APA, 2011).

Chapter one begins with this statement:

Being human involves creating meaning and using language to shape personal experiences into stories, or narratives. (p 3)

Do you agree? I would argue there is much truth in this. We shape our sense of self from our retelling of our experiences (both in words and in unspoken thoughts/emotions). But, we do not re-tell all of our experiences. Rather, we collect some and ignore others. Part of counseling is to dialog with the clients about how they shape their own narrative.

The authors then make this statement about the work of counseling,

As therapists, it is when we listen carefully to our clients’ most important stories that we gain access to how people are attempting to make sense of themselves in the context of their social worlds. In this way, psychotherapy is a specialized discursive activity designed to help clients shape a desired future and reconstruct a more compassionate and sustaining narrative account of the past. (p. 3-4)

Here they are telling us that our stories we tell are shaped by our emotions and at the same time make sense of our emotions.

What is EFT? It is a therapy that sees emotions as “centrally important in the experience of the self.” (p. 6). It was developed (principally by Les Greenberg) out of humanistic and Rogerian ideas of self-actualization and of counselor activities of being with, following the client and guiding. Throw in some F. Perl’s empty chair techniques as well. EFT focuses on emotions. Adaptive emotions are “the most fundamental, direct, initial, and rapid reactions to a situation…” (p. 7). Maladaptive emotions “…usually involve overlearned responses based on previous, often traumatic, experiences.” By this they mean emotions such as shame and abandonment sadness. They define secondary emotions as those reactions that are intended to protect the primary or most vulnerable emotions. Finally, they define instrumental emotions as those expressed for a motivation to achieve an aim.

Why the focus on emotion? Because they seek the goal of being emotionally congruent and adaptive. In this book, they focus on empathic attunement and changing client narratives.

How? Clients identify, experience, explore, story, make sense of, and flexibly manage their emotions (their words). Therapists notice “meaning markers” that reveal client confusion or conflict with the self.

This book will explore the narrative approach to EFT. “Critical life events must be described, reexperiences emotionally, and restoried before the trauma or damaged relationship can heal. New meanings must emerge that coherently account for the circumstances of what happened and how the narrator experienced it…” (p. 11)

Finally, they say,

…no form of psychotherapy is likely to have a big impact on basic temperament traits, but a client’s specific strategies, adaptations, and their internalized life narratives (i.e., macronarratives) have as much impact on behavior as do dispositional traits. (p. 13)

That is an interesting quote and puts the act of storying as more important than disposition.

So, what we will look at in the remaining 7 chapters is how the authors help facilitate new meanings and change their own narrative. The question for us is whether or not the narrative or re-storying approach to therapy is (a) effective in remediating problems, and (b) fits with Christian faith.

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Shepherding Survivors of Sexual Abuse • EFCA Today


 

 

 

 

 

 

 

 

 

 

Shepherding Survivors of Sexual Abuse • EFCA Today.

Click the above link for a good read: 6 myths about shepherding sexual abuse survivors. Written by Andrew Schmutzer, OT prof at Moody and editor of the forthcoming multiauthored The Long Journey Home: Understanding and Ministering to the Sexually Abused (Wipf and Stock).

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Heal thyself? Do we have the capacity?


Those who follow the Christian faith wholeheartedly believe that God is the “great physician” and eschew the belief that humans heal themselves. As a result of this belief, Christians sometimes react rather strongly to humanistic language of “self-healing.”

But before you do, consider this: if we assume that God is indeed the creator of all things, then we must also assume he puts into place the many corrective features found in the body. The liver and kidneys remove toxins from the body; blood clots when we cut ourselves; we sneeze to get rid of irritants; we sleep to rejuvenate what has become run down. In better words, Richard Mollica says,

This force, called self-healing, is one of the human organism’s natural responses to psychological illness and injury. The elaborate process of self-repair is clearly seen in the way physical wounds heal. At the moment of injury, blood vessels contract to staunch bleeding. Chemical messengers pour into the tissue, signalling a multitude of specialized cells to begin the inflammation process. White blood cells migrate into the wound within twenty-four hours, killing bacteria and triggering a process of cleansing and tissue repair. A matrix of connective tissue collagen is then laid down, knitting together the ragged edges of the wound in a repair that may not be perfect but is highly functional. (p. 94)

He goes on to say,

The healing of the emotional wounds inflicted on mind and spirit by severe violence is also a natural process.

I find his writing on this subject rather helpful. Sometimes we look passively to God to resolve our traumas, as if it were entirely up to Him. Other times we either resist what we can do or attempt what is not healthy for us. Dr. Mollica (an MD) provides many examples in his book of how the body naturally tries to heal/respond to trauma (e.g., DHEA counteracts toxicity of too much cortisol), where the system goes wrong, and what we can do about it from a therapeutic standpoint.

Dr. Mollica is right in that our bodies are designed to respond well to traumatic experiences. However, I’m pretty sure he also agrees that we are not designed to do this unassisted. The community must participate in the process. We are social beings and thus our healing must be socially situated.

Two Toxins: Emotional Memory and Poor Storytelling

Part of the problem, says Dr. Mollica, is the emotional memory system. When we experience a trauma, our cortex forms declarative memories of the event. These are where we store the “facts” (where we were, what we felt, and how these events connect to previous experiences). But there is another memory system, one he calls “emotional memory” (p. 96). Declarative memory involves the cortex and hippocampus while emotional memory involves the amygdala.

The amygdala is the fear-response command center of the brain, and it does not wait around for the conscious mind, located in the cortex, to decide if a threat is real or not. The amygdala can activate an emergency response throughout the body within milliseconds by calling the stress-response system into play.  (p. 96)

Unfortunately, traumatic events can create emotional memories in the amygdala that keep on replaying and are difficult to extinguish over time. (p. 97)

Another toxin is the re-telling of the trauma story in a way that retraumatizes the victim. Dr. Mollica, in chapter 5, describes the problem of poor storytelling. Poor storytelling evokes only the trauma, the shame, the degradation experienced. Storytelling should cause us to form images in the teller and listener’s minds. These images need to symbolize the whole person/story and not only the most damaging details. The problem is we tend to tell stories that fixate on the intense emotions and thus elicit toxic emotions and maintain the experience that the trauma is still ongoing.

Many traumatized persons are plagued by the two poles of humiliation–sadness and despair on one side, and anger and revenge on the other. (p. 122)

Assisted Self-healing?

Mollica says, “A proper clinical approach to emotional memory avoids triggering the emotions stored in the amygdala and enables the cortex to assert conscious control over the recollection of traumatic events. (p. 97)

How do you do this? With the help of a storytelling coach, a person tells their story in a factual, direct, but not grotesque way that would cause the listener to turn away. Why does this matter? Because part of the healing process is to be heard, seen, and empathized with. Fixating on the most grotesque details only enhances the emotional memory system and pushes others away. Good storytelling still tells the truth but does so in a way that reconnects people with the world, enables them to feel sadness but in community with others, and helps them see that their lives are not solely defined by the traumatic events. Further, good storytelling points to larger values that are still held and not lost due to the evil done by others. Surely trauma does shape and change us. Recovery and healing to the point of living as if the event did not happen would be to live in a world of denial and self-deception. But good storytelling reminds us that we are not ONLY defined by and/or limited to being victims. And good storytelling reminds us of God’s sustaining power that is greater than those who can only destroy bodies.

Dr. Mollica summarizes this chapter this way,

Strong emotions comprise the traumatic memories that are imprinted in the survivor’s brain. One of the mind’s key tasks after trauma is to take these strong emotions and gradually reduce them over time through good storytelling. A poor storyteller tells a toxic trauma story, unhealthy to mind and body with its focus on facts and high expressed emotions. In our society situations that demonstrate this type of storytelling are common, including superficial, sensational media reporting of tragedies and debriefing therapy by misguided mental health workers. In contrast a good storyteller is able to express tragic emotions with the artfulness of a musician playing an instrument, engaging the listener’s interest and involvement. (p. 133)

I commend to you the book. He discusses both good and bad dreams, the role of “social instruments” of healing and a call to health. Very helpful book if you are interested in international trauma recovery.

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The real damage done in abuse?


I’ve written before on the damage done when a community fails to respond to abuse in a justice oriented way. But here is a more succinct and apt quote by Miroslav Volf:

If no one remembers a misdeed or names it publically, it remains invisible. To the observer, its victim is not a victim and its perpetrator is not a perpetrator; both are misperceived because the suffering of the one and the violence of the other go unseen. A double injustice occurs—the first when the original deed is done and the second when it disappears. (italics mine)

Abuse victims sometimes tell us that the most significant damage to them is when community members (family, leaders, peers) fail to “see” or act justly when they hear of the abuse. It was bad enough to be sexually abused (yes, that is real damage too) but far worse to be told it didn’t happen or be told to take it for the sake of the larger community (e.g., you wouldn’t want to harm his reputation, destroy the family, cause others to fall away from Christ, etc.).

I saw this quote in the first pages of The Long Journey Home: Understanding and Ministering to the Sexually Abused, to be released soon by Resource Publications, an imprint of Wipf & Stock. I have the typeset PDF and the editor, Andrew Schmutzer, says the book will be released in August. This book (over 500 pages!) may become the place to turn for Christians seeking to understand the scourge of sexual abuse in all its ugly forms. Chapters are written by those who are expert in the social sciences, theology, and pastoral care. The line up is phenomenal. You can see the title page/table of contents (TOC Long Journey Home) to see the gamut of chapters and authors.

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“I tried that…it didn’t work”: Responding to failures in counseling


One of the things a counselor does in meeting a new client is to ask, “tell me what you have tried thus far to solve this problem.” We ask this question because we know we are not the first stop for most folks trying to solve a problem. Whether it is a parent seeking a way to manage a child’s misbehavior, a couple seeking help in changing the way they talk to each other, or an individual trying to address an ongoing anxiety problem, most people have tried and not found adequate success–which is why they come to see us.

But, let me tell you what goes through my head when I suggest a couple of options/approaches my client might try and they respond with, “I tried it…it doesn’t work.” My internal, private response?

Define try. Define work.

Now that probably sounds negative but I don’t mean it that way at all. What I mean to communicate is that I do not yet know what this person tried, for how long, and what result, if any, was achieved. What I do know is that my work is cut out for me because the client statement usually conveys a closedness to trying that particular intervention (or similar ones) again. My job is to ask questions to understand each word: try and work.

Tried it.

There are a couple of commons ways people try solutions to problems. They may try something without proper consultation. They may try something in an intermittent manner. Let me give you some examples. Parents may try a reinforcement strategy with a child but fail to find a powerful enough reinforcer to make the system work. Or, a couple may try a speaker/listener technique but revert in the middle back to a debate/invalidating mode. A couple may need to take a “time out” or break to avoid a conflict escalation but the one asking for a break may do so using it as a power move (“I’m outta here!) rather than a de-escalation attempt.

Didn’t work.

A good technique may or may not work, depending on any number of reasons. Some interventions really won’t work for a particular person or setting. However, it is important to recognize that some interventions fail to work for reasons already mentioned above and others may fail to “work” because of client expectations. For example, a parent may try a particular intervention with their child to reduce angry outbursts. Then, the parent returns to counseling the next week and tells the counselor the intervention didn’t work. Upon deeper investigation the parent does admit that the number of outbursts reduced, the duration of the outbursts shortened. Why did they feel that the intervention didn’t work? Well, last night they have a horrible blowout and very small irritating interactions each day. So, the intervention may have worked even though the parent is feeling very worn out and discouraged. Or, in the couple illustration, listening technique may enable the couple to fight less but one spouse feels that the other has a history of being self-centered and thus cannot trust the reasons they are now trying to do a better job. So, they interpret short-term success as not real or legitimate.

Setting the stage for homework

Counselors often give homework. For homework interventions to work, a counselor should: (a) make a very clear explanation of what should be done, when, and how often, (b) what results, if any, to note, (c) the short and long-term purpose of this intervention, and (d) follow up next week to see how the  client fared and what alterations might need to be made in the following week.

Counselors do well not to oversell the value of the intervention, admit that not all interventions work and that troubleshooting is an essential part of counseling, write down their homework requests for clients, and make sure that the homework given fits the client’s level of commitment to the process.

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