Tag Archives: counseling

January 7, 2009 · 4:49 am

Psychology for the (Christian) Masses


So, the other night I had woke up with thistitle in my head that I couldn’t get it out of my mind. Its an academic’s kind of dream/wake state–a book idea. I wondering if you have ideas to flesh this out a bit after reading some of mine.

The title came, I think, as a result of a Miroslav Volf’s comment that consumerism, not religion, was the opiate of the people. Lightbearer provided us with the context of Karl Marx’s quote. And many of summarize his point but saying that something (religion, psychology, anything) is for “the masses.”

So, I got to thinking about the tendency among evangelicals to fall into one of two trap about psychology. Either they use it unthinkingly (cut and paste bible verses on theories without much thought) OR they reject it because psychology is unbiblical and only rank secular humanism. But, I can’t tell you the amount of conversations I’ve had about the benefits of psychological study–whether about medication, therapeutic interventions, professional ethics, etc. where it was clear that few had ever drilled down below pop psychology to understand both its value and presuppositional foundation.

So, here’s my thought. What if we developed a resource for Christians to come to that would give thoughtful, sometimes lighthearted, but always honest answers (and nonanswers when they are better) about psychology, psychotherapy, medications, psychological testing, etc.

Here’s some of the questions that tend to come up most frequently (from my memory of the last 2 months)

1. Is it wrong to take psychiatric medications for my depression? Shouldn’t I be able to either handle it or get over it using spiritual resources?

2. How do you know if the problem is demonic or psychiatric?

3. Should I ever go see a secular therapist?

4. Isn’t Mindfulness really just a Buddhist form of meditation?

5. Should I go for healing prayer for my mental health problem?

6. Isn’t ADD/ADHD just a fad?

7. Can I divorce my spouse because they refuse treatment?

8. Can pedophiles ever return to the church in a safe manner?

9. Can leaders who abuse their roles ever be restored to leadership?

I’m sure there are more. What else would YOU want to read about regarding psychology/psychotherapy from a christian perspective?   

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November 19, 2008 · 3:04 pm

Scripture and Counseling at ETS, Providence, RI


Just finished my paper presentation at the Counseling, Psychology, and Pastoral Care section meeting of the Evangelical Theological Society–meeting in frigid Providence, RI. Had the pleasure of hearing David Powlison talk about the various errors of evangelical biblical counselors and professional counselors shortchange scripture (e.g., treat it atomistically or ignore its richness altogether). He gave several case studies trying to put words to what many counselors intuitively know about the best uses of Scripture in counseling. I followed him and talked about two major problems: treating the text as a compilation of timeless truthes and missing the varied ways God is writing us into his story and the problem of either treating Scripture as a tool or a diagnostic manual–which both lead to some dangers.

I then presented one case study of what I call a narratival approach, using Scripture to meet and validate the present experience of the counselee and so make room for two things (that meeting God and seeing self may or may not change our current mental state AND that we can begin to see how God is writing a different story that we tend to imagine in our fallen states).

John Franke then gave a good talk on how a plural way of looking at Revelation supports an inerrantist model of Scripture but avoids the ONE way of articulating doctrines. He said that this way of thinking would impact counselors by: Continuing to anchor christian care in the normative foundation of Scripture, that we would resist absolutizing THE christian counseling model but find unity amongst diversity, that counseling then must be driven by wisdom and the Spirit, that counseling must be engaged in a constructive and critical dialog with secular psychology. He wants us to avoid seeing our diversity of christian counseling models as bad but facets of God’s guidance.

Well, intellectually stimulating to say the least. Now, I’m done and off to be a spectator. I’ve run into several old friends and am making some new ones as I write.

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September 3, 2008 · 1:15 pm

Biblical Counseling is too focused on big truth?


Haven’t had much time to write of late since the pressure is on for more formal writing assignments. But, in prep for a presentation in a few weeks I have been thinking about this question. Is the biblical counseling model of change too much focused on truth? Heretical thought for some I’m sure. (For those who don’t remember I consider myself both a biblical counseling and a Christian psychologist).

Let me start with some shoddy diagrams of two classic models of change.

1. Presenting problem –>Diagnosis Made–>Counselor generated insight (reality/truth) –> Corrective action (counseling as troubleshooting ways to cement corrective action outside of session). Counseling in this model focuses on truth/reality applied to counselees life outside of session. Benefit? Problem/solution focused; objective change. Drawback? Feelings and Relational activity is minimized (though not denied). The relationship is used to get to the activity of change.

2. Presenting problem  –> Diagnosis Made (but may not be told) –>Counselor generated insight (NOT given) –>Introspection via counselor generated questions. Counseling in this model focuses on introspection and counselee generated insight. Benefit? No pressure to perform, feelings encouraged. Drawback? No real relationship focus as it is purely 1 way. No focus on objective change (assumed it will naturally happen).

So, model one is more cognitive. Model two is more dynamic. Both models want or respect the valuate of relationship but usually see it as a necessity to get to what really heals (truth or insight).

The biblical model is most like model one. In many respects, the focus on truth is good. We fallen creatures need constant reorientation. We are easily deceived. And yet, which truth? Notice Jesus with the woman at the well (John 4). He doesn’t start out with the biggest truth (she’s an adulterer). Notice that we often need more immediate truthes to be the focus. Peter needs the hand as he sinks, not a lecture. David needs Nathan’s story first. We learn that God doesn’t tell us all our sins right off the bat. We couldn’t take it. Do we in the biblical counseling world over-focus on the big truths of faith, trust, sin, idolatry, etc. that we miss the “smaller” truths that God is with us, that his hand is present right now in some small tangible way?

So, how about this model for change that is both solution focused AND interpersonal.

Presenting Problem –>Collaborative Diagnosis/Goal setting –> *[empathy ->validation ->here/now ->collaboration on meeting goals/objectives and responding to thoughts, feelings, behaviors] –> small habit change attempts –> post hoc insight.

In this model the primary work is in the interpersonal dynamics (the stuff in the brackets) and insight is more what happens after change takes place: “Oh, that’s what I was thinking then and this other way helped me to change that.” If this alternative model is a bit more accurate in portraying how people actually do change via God’s grace then this is my big question: how might this model change how we use the Scriptures in counseling.

Make any sense?  If anyone has artistic capability to render these diagrams I’d love to see how you’d do them.

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July 1, 2008 · 2:02 pm

Power grabs by therapists


We counselors and therapists have ways of asserting our power over our clients. Usually, we do it via subtle messages and phrases. I was reminded of this fact last week during a seminar by Paul Wachtel of CUNY. He told of a case he had of a semi paranoid and hostile client who made many complaints. After one such complaint against him, Wachtel responded with,

Isn’t it interesting that you see me as being just the way your father was

These type of insights offer pseudo-neutral “observations” that are really accusatory and given to show our intellect (but draws them away from their affective state). Further, when we are irritated and make a statement like this we are really saying that my frustration isn’t about me but is about you. I’m objective here, you are not.

When we give insights to clients we need to ask whether or not the client already understands them, will feel that we are working WITH them (not talking at them), and be motivated to do more exploration. As Wachtel stated, insights are often “implicitly adversarial” (never about us either!).

These kinds of linguistic power grabs aren’t just done by analytic oriented therapists (who might be inclined to make distant insights into clients’ unconscious). Cognitive therapists do the same by implicitly and explicitly telling clients that they are irrational and if only they could think like we therapists, they would be so much better.

Let’s not forget that the words we use with clients tell something about ourselves–maybe more than we wish they would.

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June 9, 2008 · 11:43 am

Practicum/Ethics Monday: Multiple Relationships


All counseling ethics codes address the potential problem of multiple or dual relationships (when counselors have other relationships with their clients or former clients (e.g., counseling a friend or a child of a friend, having a former client as a business partner, etc.). Some codes make it appear that dual relationships are either always or likely wrong and so should be avoided. The AACC code is a bit more liberal in that it (rightly) defines the problem as increasing the problem of exploiting or harming the client. However, this code explicitly defends the biblical nature of dual relationships since we are all brothers and sisters of the same body. Other codes have recognized that it is not possible to always avoid dual relationships. But all codes remind the counselor that it is their duty to defend the healthiness of any dual relationship. In essence, it will be “guilty until proven innocent.”

There are 3 forms of dual relationships (sexual and client; nonsexual social and client; financial and client). Not every dual relationship is with the client (e.g., a counselor has a relationship with the mother of a teen client, a client is under discipline at your large church where you provide consultation to the elders). Dual relationships may happen AFTER counseling is over (begin a friendship with a former client). Finally, it is not merely harm or exploitation that may be the negative outcome of a dual relationship. A counselor may find that a dual relationship hinders or decreases her effectiveness to provide adequate care. [See Lamb et als article in the 2004 Professional Psychology: Research & Practice (35:3), pp 248-254 for a study on these issues].

This last one is the one I want to hang out with for a bit. I had a former client who I had known and highly respected before we started counseling. At the beginning we explored the potential harm that might come from this dual relationship. Both of us deemed that we could manage the slight dual relationship. And I think we did well and the client found the counseling helpful. However, there was a period in the counseling where the client became severely depressed and suicidal. I found myself less willing to hospitalize because I had an image of this client in my head that was much more stable than was actually true. Now, I never like or want to hospitalize. Most psych hospital stays provide protection but little more in the way of healing. But, I know I would have been much quicker to pull the trigger (bad pun I guess) if I hadn’t previously formed an opinion of health before starting the counseling relationship. We should not forget the possibility of reduced effectiveness in dual relationships.

Let me take this one step further. You may have a client who shares your same faith or doctrinal positions, graduated from the same school (but a different time). Any of these connections MIGHT cause you to be less effective in your work because of bias, groupthink, etc. These are not reasons to NOT counsel them but things to keep in mind. Reduced effectiveness because of dual relationships should not be neglected just because we are too busy talking about the rare counselor who decides to have sex with his clients.

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June 2, 2008 · 5:24 am

Practicum and Ethics Monday: Deficient Trainees


Since both of these classes are in progress here at Biblical, I thought I’d bring up a rather touchy subject: impaired students. Ruth Palmer, Gwen White, and Walter Chung (a Biblical grad!) all of Eastern University have recently published an article in the Journal of Psychology and Christianity(2007, 27:1, 30-40) entitled, “Deficient Trainees: Gatekeeping in Christian Practitioner Programs.”

Palmer et al surveyed profs in master’s level counseling related departments at Christian colleges and universities to find out, 1. what percentages of students were perceived by the profs to be professionally deficient, to have received help or dismissal. 2. Whether or not the schools have formal gatekeeping procedures. 3. Whether senior level faculty and junior level faculty perceive the pressures of dealing with impaired students differently, and in part, 4. Whether views on grace, calling, and gifting have any effect on how faculty respond to deficient students.  Their study replicates one done on secular campuses.

Before I mention the results, it would be good to consider why this is important.

1. Because faculty are obligated to protect the public. The authors quote from the ACA code of ethics, “Counselor educators, throughout on-going evaluation and appraisal, are aware of and address the inability of some students to achieve counseling competencies” (ACA, 2005, Section F.9.b) (p. 31). This is a relatively new topic amongst programs. Previously, we merely taught our students but it was up to licensing boards to weed out incompetency. Not so any longer. And rightly so is this change. We have an obligation to remediate problems before sending folks to their fieldwork sites. When we bless a student with an internship, we are saying they are ready to work at an entry level. When we find students with significant relational, behavioral, motivational problems prior to graduation, the authors remind us that the data are “strongly linked to subsequent poor performance in clinical work. (p. 31)

2. Counseling programs tend to attract people who are working out their problems. In fact, the authors point to a study that reported first year counseling students showing more severity of problems on MMPI scales. (This may be partially explained away by the common tendency of students to think they have all the disorders of the DSM). While this isn’t necessarily a bad thing (could mean that students are more likely to be cognizant and empathetic to the trials of life), it becomes a problem when said students are either unaware of the extent of the problems, unwilling to work on these problems, or so overwhelmed in the moment as to not have the capacities to deal properly with the problem. I find most students very committed to personal growth and change. There are those, however, who are so desirous of the prestige of the position or of looking good that they cannot bear to admit their flaws. The authors point out the crux of the problem. “…there is a tendency of impaired students to resist submitting to ‘the very therapeutic process through which they wish to lead others,’… (p. 31)

3. Finally, turning a blind eye to student problems and/or mismatch in skill/profession/calling is akin to walking around the man and left to die on the side of the Jericho road (Luke 10).

Results of the study? The authors got responses only from 1/3 of the surveyed professors (the surveyees should be ashamed at their lack of cooperation with this important study! They ought to know better having all been through programs that value the research question). But from respondents they found,

  • Faculty of CCCU estimate an avg. of 10.9% of impaired students in their program (SD=9.89; I would have liked to see the modal response since the range was from 0% to 50%!! reported). This fits with the prior secular program survey.
  • Interventions with these impaired students only happens about 50% of the time (again a big SD with response rates ranging from 0% – 100% (yeah, right!)). 38% of faculty reported interventions less than 20% of the time.
  • What are some of the bigger reasons for not addressing these matters formally? Fears of lawsuits, institutional pressures (we need students to survive!), fear of poor teaching evals by junior faculty, and inadequate administrative support.
  • They suggest the need to have departments talk regularly about policies, students, and the need to follow-up with potential or actual problems.

Do we ever have impaired students at Biblical? Of course. But I am determined at dept chair to help those in need find help. I remember being a student at another seminary and seeing those that EVERYBODY knew should never be a pastor or a counselor and yet NOBODY (student or teacher) said a word. So, we have 6, 12, and 18 month evals collecting data from the student, profs of each class, peers, mentors, and supervisors to help catch a remediate problems when they exist and to encourage on-going personal growth even when they don’t exist. It still surprises me when I find counseling students balking about getting some of their own counseling. We really do want to be the one who has it together, don’t we. Me included.

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May 26, 2008 · 5:20 am

Top 10 Counselor Nightmares


No classes today because of the holiday. Next week, we’ll be discussing the perils and pitfalls of being a counselor. In partial jest here’s my “top 10” counselor nightmares. A few of these happened to me, some happened to my friends and others are just fears: 

10. Someone from your past shows up as a counselee or at a seminar you give and they know all your immaturities

9. You run into a counselee from a couple of years ago and although they are grateful for your help,  you don’t remember ever meeting them before

8. Spending the whole hour with a new client and your fly was down and open the whole time

7. Same as 8 but you passed gas

6. Its time to pray at the end of the session and as you go to pray for them you can’t remember their name and so you have to pray for your “brother” instead.

5. You worked really hard helping a resistant client learn something and then they come in and tell you that their aunt told them this amazing thing (the thing you have been trying to tell them for 6 months) and now they wonder why you didn’t help them.

4. You come to the waiting room only to find you double booked by mistake.

3. You’re at the hospital having a colonoscopy and you find out the nurse assisting is your client who probably hates you

2. You fall asleep in session for a few minutes and wake up wondering how long it has been and whether they noticed or not (they did!)

1. Subpoena and/or call from the licensing board

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May 19, 2008 · 10:05 am

Practicum Monday: Premature Termination in Counseling


Today in Practicum class we discuss matters around ending treatment or counseling relationships with our counselees. The one that causes interns most consternation is the premature termination by clients after only one session. The trainee is left to wonder why. “Did I fail to connect? Did I say something to offend them? What did I do wrong? Did they figure out I don’t know what I’m doing?” Usually, they report feeling like a failure. Here’s a secret: even experienced therapists feel this at times as well.

Well, let’s start with the murky data. Brogan, Prochaska & Prochaska (v. 36 (1999) of Psychotherapy: Theory, Research, Practice & Training, 105-113) report that various studies reveal a premature termination after just one session stands somewhere between 20 and 57%. Some 30-60% drop out before the counselor thinks they should. And a meta-analytic study (of 125 studies) reports a premature dropout rate of 47%. Even though our research in this area is still weak (we don’t really know what factors to use to report premature dropout), the numbers are pretty high.

So, why do people stop counseling before they should? Why do our clients not return? We really don’t know as much as we would like. We do know that individuals in certain demographics are more likely (lower SES, lower education, minority status) to drop out. But even here, we don’t really know why. Is it client-counselor mismatch? Lack of understanding of the process of counseling? Lack of hope?

We do know that several factors do NOT seem to relate to premature termination (therapy mode, setting, and ages of clients).

While our research is still cloudy, it makes sense to consider the combination of client factors (motivation for personal growth, ability to have insight), environmental factors (financial status, family support or detraction, cultural support), and counselor factors (capacity to empathize and connect with the client’s perceptions, diagnostic and listening skills).

Trainees can ask these questions in their postmortems:

1. Did we share an understanding of the type and severity of the problems?
2. Did I give evidence that I understand their experience (beyond saying so)?
3. Did I give some evidence of the path forward and hope for the future without overselling it?
4. Did I acknowledge potential pit-falls, hopelessness, fear?
5. Was my client the “customer” or was someone else demanding it (e.g. parent)?   

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March 14, 2008 · 12:06 pm

Note-taking in sessions?


Counselors have vastly differing styles of counseling. Some choose to be directive, others are remain passive even when the client wants them to give advice. We are different because of our varying theories and personalities. But I always assumed that most counselors do not take notes during sessions unless needing to record very specific details (say taking a family genogram or collecting details for a psychological report). But after having conversations in several different locations I learn that many write during the session. They write down key client phrases and other things that they wish to come back to and explore at a later date.

I’m curious about your experiences–either as a counselor or counselee. Was there note-taking going on during the session and was it helpful (for both)? Did it cause problems?

I don’t take notes in session so that I can stay engaged in good dialogue with my clientele. I don’t want to miss subtle details and I don’t want to break up the work by taking a note. It seems to me that if I take a note during the session, the client waits for me to do so and then they move out of an experience to only describing an experience–and so distance themselves from their feelings and thus any insight or intervention is also distant.

What do you think?

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February 8, 2008 · 10:00 am

The difference between counseling and discipleship?


Is there a difference between counseling and discipleship? If so, how would you articulate the difference? Is it merely a matter of intensity (counseling being more focused and intense)? I’m interested in your opinions as to (a) whether there is a difference, and (b) what that difference is.

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