Tag Archives: counseling

June 22, 2010 · 4:40 pm

Christian interventions in counseling


Regular readers of this blog will know that I believe that Christian counseling is not merely counseling done by Christians or merely the use of specific christian interventions. Rather, Christian counseling is founded on Christian/biblical ways of perceiving the world, the problems in it, and the goal of imaging Christ from start to finish.

However, it is good to think about the specific use of certain christian practices in counseling: meditation, prayer, bible reading and application, casting out demons, absolution, etc. How are we to think about these practices? Do they have a place in professional counseling? What are limits we ought to place on them? When should we refrain? How do we secure informed consent?

Elsewhere I have published on the guidelines we ought to consider when using Scripture in counseling. I will not repeat them here but for those who have not read that article, I do think Scripture is something that CAN be used in counseling–even OUGHT to at times. What is of more importance to me is HOW and WHEN and WHY.

Let me here consider the most commonly used practice: prayer. Here are some shaping values before we consider any practical application.

1. Prayer is talking and listening to God. It is not a technique and should not be treated as such. It is not magic. It is, from a Christian perspective, sharing one’s heart, praising, questioning, interacting with the Creator of the universe who remarkably wants to relate to me. At its heart prayer is submissive acknowledgment of God–even when praying like Job.

2. Prayer then needs to be a free act without trace of coercion. The one praying must not be coercive (you talk to God not at another person). The one being prayed for ought not feel obligated to say anything.

3. People have diverse (and not always happy) experiences regarding prayer, faith, relationship with God, etc. So, what is comforting to you may be triggering for another.

4. Prayer is intimate. Prayer often results in our setting aside defenses and becoming vulnerable and needy.

5. Prayer is power. Praying for someone gives the one praying a position of power.

So, how might a counselor consider these values and use prayer in counseling.

1. Assessment of client. What is my client’s faith tradition, experiences with prayer, history of abuse by leaders of the church, understanding of God? Have they ever felt coerced to pray, coerced by the prayers of others? Have they been publicly prayed against? Do they value prayer?

2. Assessment of self. Why am I praying for my clients (out loud)? What messages am I trying to communicate? What do my prayers reveal about my own faith?

3. Consent. Have I explained why I pray for my clients? Do they really have the right to say no?

4. Review. How are my prayers received? What impact, if any, do they have?

What does this look like for me? I don’t pray with every client. I don’t choose to start my sessions with prayer (at least the first one) until I have a better sense of my client’s experience with prayer. I work very hard not to use prayer as an effort to disarm (though I think it can do this) or to preach a message, but only to make supplication to God for healing, for care for the downtrodden. When I use imagery in prayer I make sure that it is grounded in common biblical images (God as shepherd, Christ as lamb, etc.). I never ask clients to pray but many of them choose to do so. And, I do let clients pray for me when they want to. It is part of how believers care for each other.

I do believe that prayer is extremely important but that I do not need to do it to be actively asking God for healing or guidance. I will say that when conflictual couples pray, they often find that it is hard to stay angry and embittered and pray. It can be helpful, either in reducing bitterness or by discussing bitterness and its impact.

It should not be used when clients do not want it, might be confused by it, or if it is not authentic to the counselor. It is considered good professional ethics to utilize resources from a client’s life. However, it would not be good to fake (e.g., my praying in a way that would please a member of a cult, an atheist praying as if he or she believed what she said, my talking to God even though I am no longer practicing as a Christian, etc.).

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June 18, 2010 · 10:04 am

Check out a counseling office designed just for kids


Check out this video of Julie Lowe showing off (in a good way!) her counseling office designed for counseling kids. Julie is at CCEF and an adjunct at Biblical Seminary. She is a Licensed Professional Counselor (LPC) and trained in play therapy. Here’s the link. [Link was broken, now fixed]

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June 17, 2010 · 5:41 am

Looking for summer education?


My school, Biblical Seminary, has a variety of summer classes, from on-site intensives to weekend only to totally on-line. Click the link if you are trying to figure out what enrichment you will pursue this summer. The page that pops up will list both classes and free events. Those of you looking for counseling CEUs may be able to get credit too!

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June 16, 2010 · 9:21 am

Ethical blunders: Root causes?


Finishing up the Ethics course in the next week. There are two kinds of ethical errors in counseling: conscious violations of ethical practice and blunders.

Forrest Gump’s quotable line, “Stupid is as stupid does,” is ringing in my head as I write this post. We do stupid stuff–stupid as in without thinking. Most of our blunders are just that–things we never intended but did absent forethought. Example? Oh, I don’t know, like walking through a dark room while talking on a cell phone and resulting in a face plant over an unseen chair. That kind of thing…and the real reason why I’m hearing Gump in my head.

We all go through parts of our life in unthinking auto-pilot. Consider the equivalent in counseling: Starting a first session but forgetting to cover informed consent because you are focused on helping the person in front of you. Or, handing out personal contact information because the client asked nicely (but never considering ulterior motives). Or, calling back a spouse of one of your clients and discussing issues but failing to remember you do not have a release to speak to them. These are some of the unthinking blunders we may make.

Are there root causes to blunders? Try on some of these:

1. Naiveté. Taking the comments of others without considering context or motives. I am not suggesting that good counselors need to be suspicious. Rather, we need to be realistic, critical thinkers who employ wisdom. We need to consider motives, consequences, impact, etc. We need to think beyond the immediate moment.

2. Reactivity. Some of us are just more reactive or instinctive driven. This may be personality driven. However, it may also indicate that we are being driven by unexamined desires (e.g., “I want this person to like me”; “I want to defend myself from an accusation”).

3. Over-confidence. Sometimes our blunders come from overconfidence. We’ve all heard the evidence that talking on the cell phone while driving raises our risks of having an accident. But most of us do it anyway. Why? We don’t think or perceive ourselves as compromised. We consider ourselves better than the rest. Sometimes, blunders in counseling come from an unsupported confidence in self–I will act right because I am an ethical person.  When we are overconfident we have placed our trust in something that may be good but not right in a particular situation.

4. Fear. Yes, fear. It can lock us up causing us to stop using our training and intellectual capacity. This is the counseling version of driving right into the thing you were trying to avoid. Fear paralyzes.

5. Group think. Group think happens when we stop asking questions and as a whole foreclose on other hypotheses. An agency may create this problem by how it manages staff meetings, supervision. As a group we may become comfortable with an ethical breach in such a way that it becomes normal–unseen.

Can you think of other root causes of unthinking ethical blunders?

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June 15, 2010 · 5:54 am

Gain: Ethical boundaries relating to client gifts


[note: I found this document in my Ethics course files. I think I wrote this some time ago…but I don’t remember. It is possible that I received a WORD document with this in it from someone else. If so, I apologize for posting without acknowledging the source. Ah, the joys of aging.]

Professional counseling is founded on the assumption of the patient/practitioner relationship. The practitioner/expert provides a needed and appropriate service and the patient pays a reasonable fee—or their insurance company does for them. However, the extremely personal nature of counseling work often creates strong feelings between client and therapist and consequently the client may wish to bring a token gift signifying their thankfulness for a job well done.

Gifts beyond the token category provide therapists with “gain” and likely disrupt the fee/service relationship mentioned in the previous paragraph. While gain may not cause actual harm and may be unavoidable, the wise counselor remains aware of possible sources of gain and their consequences.

Consider the following examples and check whether you think they may be problematic:

  • A Board member of the counseling center offers one of the counselors tickets to a ball game
  • A Client offers his private counselor tickets to a ball game.
  • A student offers her teacher tickets to a ball game

Should the counselor in any of these scenarios accept the tickets? Does the cost of the gift or the wealth of the person giving a gift matter? Would it change your answer if the gift were a week’s stay at a beach house? Does it matter if the student is currently in a class with the teacher or not?

Gifts are a form of gain. Others may come in other forms of benefit for the counselor. If the counselee owns a publishing company, should the counselor accept an offer to have him or her publish his next book? If the counselor has a non-profit ministry, should he or she accept client gifts to that ministry? If a client offers to sit for a testimonial ad for the counselor’s new technique, should the counselor accept?

Gifts, though, represent expressions of thankfulness and thus a policy of rejecting all gifts may bring harm to the counseling relationship.

Wise Counselors explore with their clients any possibilities of gain and their potential consequences. Counselors consider how gains may harm the client or create an indebtedness that in the future clouds clinical judgment. For example, counselors do not accept gifts or fee sharing from treatment facilities in return for referrals. On the other hand, a cup of coffee brought to the session likely is just a cup of coffee, a friendly gesture. Christmas cookies are a small but personal thank you for a job well done. But, don’t assume that small gifts can not produce a quid pro quo (this for that) interaction. So, back to our first line in this paragraph. Take the time to explore the meaning of an offered gift and be willing to talk about it with clients.

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June 13, 2010 · 5:37 pm

Ethics training without tears?


I once saw a title of a text, “Statistics without tears.” Few people are in tears in my Ethics class but most have looks of fear. Thus, my question. Is it possible to teach ethics to counselors without incurring fear?

Counselors, by nature, want to do what is right for their clients. They want to solve problems. They also want to avoid harming clients AND facing lawsuits or licensing board complaints. So, you can understand that my students take great interest in a course where we discuss standards of care and the bases for ethical practice.

I try to focus on the underlying values that guide counselor behavior. I try to remind students that suicide and lawsuits are extremely rare (as long as you aren’t trying to do things that are controversial or fail to consider the wise counsel of supervisors). But, bottom line, you have to discuss practical cases where errors matter–breaches of confidentiality, failure to warn or protect in the face of imminent harm, dual relationships, practicing outside of competency, etc. It is these vignettes that raise our fears.

I’ve tried to reduce student fears but in the end some fear is good. Fear that leads us to be careful, to ask for supervision, to double-check our motives may not be a bad thing. When fear paralyzes or leads to self-protection alone, then it is not helpful.

In the end, we must trust that God will not abandon us, even if we make mistakes. We must remember that humility will take us a long way and that every path we take has risk associated with it. Our job is to remain learners as we walk with others in their difficulty. As soon as we stop asking good questions about our clients or about our actions, we now enter risky practice.

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June 8, 2010 · 2:01 pm

Minimal Brain Damage?


I’m thinking about brain injuries today. On Sunday one of my son’s teammates got carted off the diamond after falling on his head while trying to make a play. Though scary, it seems he did not sustain an injury other than a headache. At least that what the initial scans suggest. Then today I heard a story on NPR about brain injuries of soldiers experiencing a “concussive” event–those who survived roadside bombs. These soldiers may not have been pierced by shrapnel and may not have had their heads slam into something (two obvious causes of TBI) but may have experienced injury from the impulse of the blast of energy hitting their brain. Pro Publica explains the injury and has the larger story about the many soldiers who fail to be properly diagnosed and treated in military care centers.

It stands to reason why this would happen. Minor brain damage is hard to quantify. Brain scans may not pick up these minor changes. The person isn’t missing a limb which visually reminds others of injuries. Some of the symptoms are similar to other mental health problems and so providers may wonder whether injuries are physiological or psychological.

Some of you have been around long enough to remember MBD or minimal brain dysfunction. This was a term used in the 1960s for a wide variety of problems that now go under the name of ADHD. MBD was a way of signaling that something wasn’t right in the brain even though no one could actually pin point where the problem lay. At this point we may not have ways to identify damage to cells (rather than whole structures) and cell communication and so much use the term concussion or minor TBI (mTBI).

Worse than missing the diagnosis is not having great solutions to deal with the wide variety of symptoms. Our best solution for civilian sports related concussions is to avoid having a second, even minor, head bump. We do so by banning participation in sports for a couple of weeks. It is often these second or third bumps that do the worst of the damage. But I suspect that having a soldier sit in Iraq for a couple of weeks after being dazed by a blast will not be anyone’s desire.

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June 2, 2010 · 5:41 am

Criticizing Christian Counseling Models


Critical thinking and evaluation of what goes for “Christian” has always been a part of the Christian faith. This past Sunday my pastor preached on Colossians 2:13-19 and in the midst of the sermon he made this brief remark about Paul’s list of characteristics of those who have “false ideas about ‘righteousness’ and salvation”–in other words, those who use their critical evaluation skills to destroy others (rather than build up) or to build their own kingdoms.

Based on Paul’s list, he said these leaders tend to (a) be quick to pass judgment about the views of others, (b) equally quick to dismiss their opponents, (c) and likely to claim a vision or something special on which to base their own beliefs. He added that these leaders commonly hide their views under a veneer of humility.

In the counseling world, we have had many of these thought “leaders.” These are those who have a grain of truth as they point out the flaws in the views of others, who refuse to accept any critique of their own position and claim to have a purer view of the Bible (though never once really articulating it as a positive position).

But is there a place for critiquing others’ models? If so, how do you tell the difference between a false critique and a necessary critique? Try some of these questions:

  1. Are the critique overly personal? Does the writer give the benefit of the doubt or choose to read the one being critiqued in the worst possible light? If you finish a critique and it seems like the author was making fun of their opponent or making outlandish statements about the intentions or consequences of ideas–then they probably fail the test of constructive criticism and love for all.
  2. Does the one doing the critique identify where the author has spoken truthfully? If not, then the critique is not balanced.
  3. Does the critic offer an alternative after making statements of judgment? If not, then it is likely that the critic isn’t really looking for solutions but merely wants to be destructive.

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June 1, 2010 · 8:40 am

Maintaining progress in counseling with short sessions


Ever felt that a 10 minute session every day might be more beneficial than a 1 hour session once a week? While a short session cannot dig very deep, it can keep a person on track. One of the frustrating things about counseling is the fact that a client may leave with direction and clarity only to return 7 to 21 days later with confusion. What seems clear in the office becomes foggy in real life. It isn’t that much different from learning a language or algebraic formulations. You think you have it then you try to apply it to a novel situation and you realize you don’t have it quite down.

The phone call session should be short, directed at problem-solving, remembering a previously learned solution, or improving hope and motivation to continue some difficult task. Consider this for marital discord. So easily conflicted couples stay cold and distant between episodes of conflict. Short sessions may help them remember to soften each day and be more inviting of non-conflict interactions.

There is some support for this kind of interaction, though not in therapy literature. The support comes from addiction quitlines. Those who call in and gain support are more likely to remain abstinent than those who try to do it on their own. Sadly, insurance companies do not support this kind of interaction (they do not cover phone sessions). They should, it would likely save money in the long run.

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May 28, 2010 · 8:38 am

insomnia and suicidality


Counselors need to keep regular watch over the insomnia of their clients. Untreated or unresolved insomnia predicts poor recovery and lesser benefit from therapy. It ought not be treated as a secondary problem. But a recent abstract sent to me via email suggests that insomnia may also be a significant factor in suicidal ideation and action. Some researchers at Wake Forest followed 60 adults with both insomnia and major depression for 9 weeks. All received antidepressants but some received a sleep aid as well. Both were assessed by using the Hamilton Depression Scale and an insomnia severity scale.

Their findings suggest that insomnia is a factor in suicidal ideation independent of depression or lack of pleasure. Insomnia leads to more intense suicidal thoughts. Thus, counselors ought to redouble their efforts to ask about insomnia, to track it and to especially follow-up with questions about suicidal ideation or plans when complaints of insomnia increase.

Interested readers may find the abstract of the research here.

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