Tag Archives: counseling

October 22, 2010 · 5:07 am

Normalizing Psychiatric Problems: Pro and Con


One of the hallmarks of the Biblical Counseling movement has been the clear articulation that psychiatric problems are not different in kind from any other set of problems. This assertion is made by some for a couple of reasons:

  1. To make sure everyone knows that the bible speaks to every kind of experience. if one draws lines between “regular” anxiety and pathological anxiety, those who meet the criteria for a DSM diagnosis might think that biblical material cannot speak to their situation–that they need to go elsewhere for help. God cares for and addresses every concern.
  2. To level the playing field between professionally trained counselors and biblical counselors. If the roots of human problems are common no matter the outer expression of them, then pastors and lay counselors can understand the issues (pride, suffering, fear, despair, etc.) and walk alongside anyone. One may not need special training to help another.
  3. To communicate to the healthy that they are not different from the more obviously unhealthy. The point is to reduce stigma and promote unity.

Consider the pros and cons of this viewpoint.

Pro:

  • Reduction of stigma and ghettoization
  • Increase normalization (“so, I’m not so different from others) and similarity with the rest of humanity
  • Increase the confidence and courage of leaders to address and dialogue about all forms of suffering

Con:

  • Decrease in interest in the specific experiences of suffering thus narrowing problems down to a simplistic cause (sin?)
  • Possible over-confidence of some leaders leading to a reduction of empathy and listening to the experiences of other; failure to consider body/mind issues not specifically elaborated on in the Bible.
  • Failure to recommend outside helpers with specific expertise and training; dismissal of the need to have professional counselors who may have greater practice with certain kinds of interventions\

When I teach my Psychopathology course I want my students to see just a bit of themselves in descriptions of people with thought disorders, addictions, eating disorders and the like. I want to normalize these kinds of problems so that students don’t think of clients with the problem as somehow different from their own experiences. While I may not binge, I may be able to empathize with those who do. However, I do not want them to think their brief binge as exactly the same as someone else’s experience. Otherwise, they might assume it would be easy to “just say no” to the binge.

When I teach my Physiology course, I want my student so to see the complexity of the brain and body and thus recognize the unique forms of suffering some go through. I want them to realize just how little we understand how much the body influences our experience of the world and of self. However, I do not want them to medicalize psychiatric problems. If they did that they might believe that counseling has little influence on psychiatric disorders. They might think that biblical reflections on anxiety and depression have no place in the healing of serious problems in living.

What is your experience regarding christian leaders handling of psychiatric problems? Do you see too little normalization? Too much? Do you see minimization of psychiatric suffering?

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October 19, 2010 · 5:46 pm

Suffering for Christ? How should we respond to discrimination due to faith?


In 1 Peter 2: 12 we are commanded to, “live such good lives among the pagans that, though they accuse you of doing wrong, they may see your good deeds and glorify God on the day he visits us.” Peter goes on to tell us that our good deeds include showing proper respect for everyone. And still later he reminds us to follow the actions of Jesus who did not retaliate when he was insulted and mistreated at the cross.

Recently, a friend was mistreated due to her faith. Actually, the mistreatment was based on assumptions rather than facts. The one doing the mistreatment made false allegations about my friend’s beliefs and attitudes. This was in a professional setting where my friend expected to be treated as any other and not singled out like this. Thankfully, the episode was brief. But what if it wasn’t? How should we respond to mistreatment for reasons of faith?

Some things we shouldn’t do:

1. Sarcasm and biting back. One of the things that bothers me in the political arena is the amount of sarcasm and belittling used against each other. Not that this behavior is new–it isn’t–but it does seem more intense than before. It would seem that the goal for liberals is to catch conservative family values defenders not living up to their standards.  And conservatives put down liberals for being open to anything and everything (except conservatives). When attacked for reasons of faith, let’s not spend our time making public comments about the missteps of our accusers.

2. Say nothing at all. Silence isn’t always wrong but it may not be right either. It can be good to overlook some mistreatment as a mercy to the attacker. Sometimes when we know someone is having a bad day or is themselves a recipient of mistreatment, we may choose to overlook hateful comments. However, saying nothing as a matter of course may also eliminate an opportunity to speak truth in love to the offending party.

What can we do?

1. Deserved or undeserved? First, we can check to see if we have brought an attack on by our own behavior. If we have, we ought to address the matter right away. If the attack is not the result of our own foolish actions, then this is not about us but about God. Hopefully, this little bit of assessment can take the personalized part of the pain out of the equation.

2. Work to understand. Where are these comments coming from? What might be revealed behind the hurtful statements about our attackers experiences? It is possible that their attack comes from a bad experience from another person of faith who did not represent well the true meaning of Christianity. We can then validate their pain even if not their expression of it.

3. Speak the truth in love via a point of contact. Look for the value that you share together. Speak to that issue first. Often, some issue of respect, justice or shared concern can be a point of contact to engage an attacker. MLK wrote a letter from his jail cell in Birmingham, AL to white evangelicals who had written to ask him to stop raising tensions via nonviolent protests. He begins with a point of contact–their shared faith, their genuine good will and sincerity regarding their concerns. He attempts to speak their language first about the necessity of prophetic voices among God’s people. Surely he moves on to accuse them of inaction and maintaining the status quo–thus not caring for all of God’s people. But he ends with invitations to dialogue more and even requests that they forgive him if he has overstated their complicity in the problem of Jim Crow. In professional worlds, we may begin with discussions of shared ethical standards. We may want to point out failures by our accusers to keep their own standards, but first we need to establish common ground.

4. Bless, do not curse. Look for ways to bless and/or encourage an accuser if at all possible. Find reason to offer mercy rather than retaliation.

5. Activate, do not withdraw. In professional settings, use the existing system well so you can to gain a hearing,  and not just for yourself. Remember, the Apostle Paul uses his Roman citizenship to seek justice against false accusers and abusers. Using his right to appeal to Caesar enabled him to speak to numerous individuals and groups that he might not otherwise have met. It was this simple act that God used to spread the Gospel to Europe and then to the whole world.

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October 1, 2010 · 10:48 pm

Preaching to the 20%?


I’m representing Biblical Seminary this weekend at the Shepherd Press Marriage & Family conference being held in Harrisburg. Dave Harvey opened the conference with a very good sermon on showing mercy and kindness to family members. He stressed the importance of Luke 6:36 and the need to show mercy to sinners just as God does for us. This goes against our typical human desires for revenge or at least punishment for the misdeeds of others.

But, without taking anything away from the good sermon I found myself asking this question. How would ______ hear the call to have mercy on a sinner spouse. ______ represents a person I know who has been emotionally and financially abused by her husband. She finally was able to bring truth to light and has a reprieve from his sin while he is living with his parents. However, she faces strong pressure by others to reconcile (despite little evidence of true repentance in the husband).  Knowing what I know about this woman, I suspect she would feel more pressure to have mercy and allow her husband to return to the home.

I think most sermons really preach to the 80%. 80% hear this and recognize that mercy may be shown in numerous ways. Even allowing truth to come to light is an act of mercy. Mercy may be treating someone better than they deserve but may not mean playing the part of the fool and thinking that a few tears and words are enough. But what of the 20% who are weighed down with guilt and assume that a general principle must be applied in a very black/white manner? How do we care for them when exhorting all Christians on to the Gospel saturated life?

I want to reiterate that I think Dave Harvey did a good job. I do think that it may be too easy for the rest of us to assume that the more vulnerable among us will be able to nuance the big virtues of the Christian faith; that they will know that to emphasize one (e.g., truth-telling) does not mean a rejection of another (e.g., forgiveness).

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August 30, 2010 · 2:27 pm

When is residential treatment an option for you or someone you love?


Harvest USA, a local Philadelphia ministry,  is just about ready to unveil a new booklet that will be available for purchase via download. I wrote this last year after trying to help someone consider whether or not residential care was necessary to address an ongoing battle with sexual addiction.  They sent me an advance hard copy to preview and so I’ve included a pic of the front page on this post. Sorry, I couldn’t provide a better, color shot.

As you might expect, when a sexual addiction is discovered, confusion reigns among the addict and the family. What should they do? What does it mean? Where can he/she go to get help? Strong emotions and the nature of the crisis may lead to quick decisions. Whereas one family wants to find the best, most intensive solution, another family may try to solve the problem “in-house” with accountability from the pastor.

This is a short booklet designed to help the reader cut through some of the confusion and answer 8 key questions to help them decide whether it is necessary to seek treatment in a residency setting. The booklet concludes with a list of books and short-term and residential programs around the country.

I’ll let you know when the e-version is available for download.

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August 23, 2010 · 9:05 am

Integrating Faith and Psychology: Book Notes


IVP just sent me a new (free!) book, Integrating Faith and Psychology: Twelve Psychologists Tell Their Stories (2010), edited by Glendon L Moriarty and with a foreword by Gary Collins. I’m looking forward to reading it. Each chapter is by a different psychologist and tells more of a personal story on how they came to the work they do and how their faith matured along the way. This is not a theory driven book but a group of narratives. While I very much appreciate theories of how psychology and Christianity function together, narratives sometimes provide a window into a more living integration. I might disagree with a theory but appreciate the heart behind it. Each author describes their development as a person and a professional, points to mentoring along the way, addresses key personal and philosophical tension points, mentions their experience with spiritual disciplines, and concludes with a personal letter in order to share key wise advice to those interested in the integrative  process.

I’m especially interested in reading several chapters written by those I know more closely than others: Mark McMinn and J. Derek McNeil (former professors), Jennifer Ripley, Siang-Yang Tan, Everett Worthington, Bill Hathaway (people I’ve met at conferences and whose work I appreciate), and Mark Yarhouse (influential scholar and fellow student at Wheaton College).

The foreword by Gary Collins gives a tiny window into the tensions he experienced between evangelical-fundamentalists and the profession of psychology. He first felt the tension of psychology colleagues who looked down on him for being a Christian. There were leading scholars of his day who felt that religion was the cause of most psychopathology. He notes that this view has shifted greatly and there is now much openness to spirituality within psychology (though I hasten to add this openness isn’t always felt in the Northeast United States). He then briefly mentions Jay Adams, Competent to Counsel, and the attacks he received from those Christians suspicious of psychology’s secular humanism.

I find his foreword less than helpful only in that it can only stereotype the conflict in 7 short pages (what else could he do?). But he does conclude by saying that not all the critical statements (about the integrative agenda) made by Christians were wrong and in fact many help to refine the work of Christian psychology. He lists quite a few names of those who have worked hard to build a psychology on biblical foundations. Nearing the end, he comments on a shift that happens somewhere in the late 80s and early 90s. “The integration movement began the shift to a younger, more pragmatic, less theoretical generation.” (p. 14).

I will blog here on a couple of the chapters as I make my way through the book. I’ll be looking for interesting historical threads that help me better understand some of the prominent leaders of the integrative movement.

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August 16, 2010 · 10:33 am

Counseling those with chronic conditions


My friends and colleagues here at Biblical Seminary–Jenn Zuck and Bonnie Steich–are teaching a class this weekend about the role of counseling in helping those with chronic conditions. Need CEUs anyone? Info here.

This is such an important issue given our increase in capacity to manage or maintain life with chronic conditions. Some cancers now are more like chronic conditions. HIV can be a chronic condition. And of course there are the more well-known problems such as MS, chronic fatigue, fibromyalgia, neuropathy, diabetes, liver dysfunction, etc.

How do you respond to those who seem to be struggling with a long-term condition? Especially when the condition is vague and not visible to the eye? Do you get worn out comforting that person?

I just read a study where they assessed whether major life events or daily hassles were more negatively impacting chronic pain conditions. It turns out that daily hassles increase chronic conditions symptoms far more than do major life stressors. It makes sense but also challenges us to consider how we might overlook the “normal” life of counselees and secretly want them to stop their whining and complaining about how hard it is to …

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July 27, 2010 · 5:54 am

When helping harms


Just before vacation I caught a PBS television show on how economic development (funded by international aid) often ends up hurting while trying to help. Here’s a link to the documentary website. The show covers two areas of Kenya and the pros/cons of trying to raise the living standards of those who live there.

This is not a new problem and reminds me again that there is a book I need to read (When helping hurts).

As a counselor who has traveled to Africa to try to help, I am very interested in finding appropriate methods to provide emotional support and care to traumatized peoples. What are some of the ways we counselors might unintentionally hurt those we want to help?

1. Pressuring clients to do something we think is important (e.g., stand up for yourself, say no to a violent spouse, speak the truth about your abuse, etc.) without considering the consequences. I once read about some African women who sought counseling for rape. Problem was that by going to the rape counseling center, they communicated to their village that they had been raped–and were later killed for being defiled.

2. Assuming that counseling can only be done by licensed professionals. We could train counselors in another country but if these folks couldn’t get paid to counsel because their clients are all subsistence farmers, we have only created additional frustrated individuals.

3. Similar to the last point, if the trainers are all westerners, then they will likely fail to understand culture specific resources/challenges and may reinforce the assumption that only westerners are competent to provide the care.

What are some other ways you have seen western counselors unintentionally harm the helpee?

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July 12, 2010 · 1:48 pm

Emotional Arousal: Too much or too little?


I am doing some prep for my upcoming class on the treatment of Borderline Personality Disorder (BPD). [Links: summer institute brochure, and CEU information for LPCs] Many theorize that BPD is really a problem of emotional (over) sensitivity resulting from a combination of psychological factors (trauma, loss, attachment injuries, or chronic invalidation) and biological predispositions (high base-line emotional experiences, slow return to baseline once activated, and chronic and inappropriate scanning environment for danger).

If a person is prone to intense emotional experiences, they are likely to get the message that their emotional expression is out of line. Thus, they may either try to avoid emotions (leaving them less aware of how they feel and maybe more likely to be taken advantage of) or give in and respond out of their full expression (leaving them less likely to be able to solve the problem given their high state of arousal).

Are you a person of high emotional arousal? Do you know or live with one? Do you struggle with thinking that high arousal is wrong? Theoretically, most of us do not think strong emotions are wrong. But practically those who experience their own intense emotions and those who live with them do think they are wrong. “I shouldn’t feel this way…she shouldn’t feel that way.”

Counselors do not seek the goal of eliminating or even tempering emotions. What they seek is to avoid the “why” or “because” that often follows the strong feelings. It appears that the big problem is not the feelings but the beliefs and interpretations that one holds during and after the emotional experience. I feel this way because…(I’m stupid, a loser) or because…(others hate me) leads to cementing emotions and beliefs together in such a way that lead to more easily experiencing invalidation.

Looking to get into this a whole lot more in a few weeks (July 30-31)!

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July 10, 2010 · 11:09 am

Gardening illustration that works for persistent problems in life


5 years ago a friend of mine asked if I wanted some purple cone flowers for my flower garden around my house.

Having admired them in other gardens, I said yes and promptly planted them in a spot next to some other flowers. Turns out they were Brown Eyed Susans, a relative of the intended flower. And, further, they spread terribly. I enjoyed them the first summer but began ripping them out the next year as they spread through the iris and choked out some other plantings.

Now, some five years later, I am still pulling these plants. They grow and spread quickly. I never let them flower but pull them as soon as I can make sure I get them and not another plan that might be right in the same spot. When I pull them I know that some little root fiber remains and so I’ll be back pulling again in a week or so.

The truth is I will never be free from these plantings. I do have some choices:

  • ignore them and let them take over the garden (BTW, they would be fine in an isolated spot surrounded by grass so they couldn’t take over another planted area)
  • be irritated that I can’t get rid of them and thus fail to see the beauty around them
  • stay vigilant but enjoy the garden
  • try shock and awe by killing everything in that spot.

I find this is much like our persistent life problems. Whether by naive choice or by something beyond our control, we develop persistent struggles with things like anxiety, depression, addictions, relational challenges, etc. While God sometimes provide miraculous removal of these struggles, we rarely find complete freedom from these kinds of struggles. We may not be in crisis mode forever, but total relaxation and assumption of no return of the problem is rare also.

So, we too have some choices:

  • be angry and bitter that the problem continues to have some place in our life
  • blame others for our problems
  • ruminate on why only we seem to have these problems
  • try shock and awe and so destroy lots of other things
  • accept the need to stay vigilant, going after the roots and shoots as soon as we notice them.

Does this illustration work for you?

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July 2, 2010 · 11:17 am

Does porn use give a Christian grounds for divorce?


Brad Hambrick, a counselor in Georgia, has written an article exploring whether or not pornography use might provide grounds for divorce. It is a worthy read. His final answer is a qualified no but includes a lot of other helpful thoughts about the experience and what repentance ought to look like. Too often we get caught up in a yes/no focus to this question and miss significant issues. Seems there are several questions that need to be answered,

1. Is porn use a form of adultery given Jesus’ equating lust and adultery?

2. Does failure to repent or repetitive acts such porn use destroy the covenant so that it is impossible to live at peace with a spouse? In this case, the question is less about porn and more about refusal to honor a covenant. David Instone-Brewer writes about this from a NT perspective on the OT. I blogged about his thoughts some time ago and you can search “divorce” on this blog and find multiple entries.  Instead of divorce, we could insert repetitive gambling away family income, repetitive risky behaviors.

3. What would be evidence of repentance? Does any relapse equate to total failure? How many relapses equal refusal to repent?

Rather than just focus on the “big” question, it might be helpful to ask more immediate concerns. Does the porn user agree to utter transparency? Are they demanding something in return for their abstinence? Are they still trying to control their treatment?

For those who follow the link, I’d be curious your response. Read it from a user’s perspective and also of the victim spouse.

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