Tag Archives: counseling

January 2, 2014 · 5:56 am

Video: Preventing and Responding to Child Abuse in Christian Contexts


This video was shot last October during a conference in South Africa cosponsored by the World Reformed Fellowship and North West University. In it I cover these objectives:

  • Understand common practices of offenders
  • Develop policies to hinder predatory behavior
  • Avoid poor reactions to allegations known to compound injury
  • Provide care to all parties

I’m thankful to Boz Tchividjian of GRACE who allowed me to use some of his material since he could not be present to deliver it himself. If you are interested in seeing Boz’ far more eloquent work, check out videos at the GRACE site or, even better, click the link to the right of this entry and purchase the 5 hour video he and I filmed in 2012.

Link for video here. Link for accompanying slides here.

Want more resources? I encourage you to watch the other videos from this conference, especially the powerful one by Jim Gamble that should NOT BE MISSED (Thinkuknow) and another by Diane Langberg: http://wrfnet.org/resources/media

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December 18, 2013 · 1:04 pm

What is Global Trauma Recovery Institute all about? Check out this video


At the beginning of 2013, Biblical Seminary launched Global Trauma Recovery Institute to train recovery specialists here and around the world. We’re small but thus far we have taken 20 students through 120 hours of continuing education, another 15 have just begun, and we are now preparing some of those first students to travel to Rwanda to observe and participate in trauma recovery training with local caregivers. Those students we serve are from or located in three continents plus the United States. In addition, we have represented GTRI in trainings in South Africa and Rwanda this year as well as engaged Christian counselors in Romania during one of their trainings. Our hope for 2014 includes more of this kind of training as well as our first immersion trip with students. Think we are just focused on the international scene? No! The “abuse in the church” video on the right hand bar of this site was sponsored by GTRI as well.

Maybe you wonder what we do and how we handle cross cultural challenges. Check out this short 3 minute video below to see our (myself and Diane Langberg) heart for raising up capable recovery specialists here and around the world as they follow Jesus into the world.

Want to support? After viewing the video, please consider supporting us with prayer and even tax-deductible donations. If you do choose to donate, this link will bring you to a donation page. You can give to the seminary’s general fund (without their support, GTRI would NOT exist!) or you can give a specific gift to GTRI. Just note that in the comments section. Your gifts will enable us to serve more international students and to begin the formation of learning cohorts on other continents!

[Note: Link on image is broken, click here to see the video]

GTRI Video Image1

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November 19, 2013 · 1:40 pm

The power and perversity of labels


English: Photo of Paulo Freire

[Previous version published  in 2006]

That was great!

You are a liar!

We humans have powerful tendencies to label and categorize. It may be something that Adam passed on to us. Notice that Adam got to name the animals as he saw fit. I suspect that being made in the image of God provides us an innate drive to name things as they are?

But what happens when things don’t fit our categories? We either have to expand our definitions or shove square pegs into round holes.

  • The color line comes to mind. Those who are biracial face the repeated question, “What are you?” And the “one drop” rule still is holds power: one drop of African heritage blood in your recent ancestry makes you “Black” in this country.
  • How about those who don’t fit gender stereotypes. I’ve heard the pain of many who were accused of being gay because they didn’t fit someone’s image of a man or a woman. These labels were so powerful that they caused confusion. “If being a man means…(fill in the blank), then I must not be one. Maybe I’m gay.”

The Counselor’s Power to Label

Counselors hold tremendous power when as they label, especially those who represent both the counseling and the Christian worlds. We label right and wrong, righteous and unrighteous. We label idols of the heart. We want our counselees to see themselves and God in proper form. We see how distortions in labels (e.g., God doesn’t love me; I’m incapable of changing) harm and we want to provide healthier labels.

But, HOW and WHEN we label may be more important than whether our labels are actually correct. The temptation for counselors is to label too quickly, before the counselee is ready. If that happens, the counselee is passive and the counselor’s label is just one more among a chorus of opinionated acquaintances.  

Take a look at how Jesus interacts with sinners and self-proclaimed holy men. Who is he more likely to label? Who does he engage with deep questions? What are his means for helping others see themselves? Notice how the Pharisees were quick to label what was authentically Jewish and what was not. Notice that the Lord seems less interested in that and more interested connecting to others. He was not neutral about sin. However, he engages others in novel ways to show them the righteous path and their need for a savior.

Who Does the Labeling Matters

I’ve been enamored with the late Paulo Freire, a liberation theologian from Brazil. He describes how unthinking, impoverished, people become empowered when they are given the power to name things (problems, solutions). They do not, he says (in Cultural Action for Freedom), learn by being filled up with words and labels by dominant culture individuals. If this were the case, then counseling would only be a matter of memorizing the right words and phrases. No, counseling is a dialogue where the counselee is an active, creative subject in the process of change. In Learning to Question: A Pedagogy of Liberation, (by Freire and Faundez), they say,

I have the impression…that today teaching, knowledge, consists in giving answers and not asking questions.

The same could be said about counseling. It is the asking of questions that encourages us to search for answers. Without questions, we may never redefine the problem. When we counselors label (whether we are talking about DSM labels or right/wrong labels) without engaging  the client in the process, we rob them of their words.

What Can We Do?

Freire suggests a three-step dialogical model that may work also in building an effective counseling relationship: Investigate (ask exploratory questions, examine beliefs, myths, etc.), Name (code and decode, a process of un-naming and naming what is going on), and Problematize (identify problem and solutions).

Avoid the Temptation to Give the Gift of Your Knowledge

Freire says that gifts given by oppressors only perpetuate injustice. If the “gift” of your knowledge perpetuates the divide between the counselor (the healthy/wise one) and the counselee (the sick/naive one), then your gift may only serve to perpetuate their illness. This does not mean you should never speak or offer advice. But ask yourself, “does the way I speak to clients encourage and energize (all the better if in the form of a pushback) or cause passivity?

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July 31, 2013 · 1:06 pm

Treatment of complex trauma: Why mistrust of the counselor is necessary and good!


I am reading Christine Courtois and Julian Ford’s, Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach (Guilford Press, 2013). I won’t be blogging through each chapter but I do recommend it for those working with adult survivors of child sexual abuse, especially those who are new to “complex trauma.”

The first two chapters give an overview of complex trauma reactions and diagnoses. If you want to know more about complex trauma, see this post about another edited book by these two authors. Chapter three, “Preparing for Treatment of Complex Trauma” begins the meat of the book. In this chapter they take up the ever important issue of empathy, safety, and respect as foundation to therapy. They emphasize the need for,

safety within the therapeutic relationship with a therapist who is empathic and respectful yet is emotionally regulated with appropriate and defined boundaries and limitations. (54)

Challenging Counselor Safety Is Common and Good?

This empathy and trust relationship is both foundation and method of treatment (59). But while the therapist is responsible to see that at safe therapeutic relationship has been built, it requires the client to be involved in building such an environment. The truth is that the client’s role in building safety in the counseling office is by passive and active testing of limits. Most counselors tolerate suspicious questions the first or second time. But, it is important for counselors to,

being prepared to patiently and empathically respond to active or passive tests or challenges to trustworthiness as legitimate and meaningful communication that deserves a respectful reply in action as well as in words. (60, emphasis mine)

If the therapist understands and does not take mistrust as a personal affront, the therapeutic relationship can evolve gradually. The client can begin to recognize  that the therapist actually “gets” why he or she is initially skeptical, self-protective, or “realistically paranoid” and does not pressure the client to be a “happy camper” but instead works to earn trust by being honorable, reliable, and consistent. This also implies a view of the client’s initial mistrust as expectable in light of the client’s history–that is, as a strength rather than as a deficiency or pathology. (63)

Sometimes clients can present in an opposite way–to be entirely deferential and affirming the counselor before a track record can be developed. Therapists with these clients need also to be prepared to encourage a healthy level of distrust.

What is not helpful is “artificial neutrality or passive and intellectualized detachment on the part of the therapist…” (64). It is my sense that we usually do this when we are afraid of the client. Not so much afraid of being injured, but afraid of failing or being consumed by the trauma. Or, we get consumed by our own history. A healthy therapist must stay emotionally present yet aware of own internal machinations. A healthy therapist must be able to predict some of the angst that arises in treatment of complex trauma and able to prepare self and client for this inevitable distress.

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July 25, 2013 · 5:59 am

Telling Painful Memories: Recommendations for Counselors


[What is below was shared with Rwandan caregivers and counselors. It is written in simpler English and has no footnotes. Academically oriented readers will recognize the interventions come from narrative exposure therapy models for children].

Counselors invite others to tell their stories of pain, heartache, fears, and traumas so that they can find relief from their troubles. However, not every way of talking about past problems is helpful and some ways of talking can actually harm the person. So, it is important that all caregivers and counselors understand how to help others tell their difficult stories in ways that invite recovery and do not harm.

Good Storytelling Practices

Counselors who do the following can encourage healthy and safe storytelling of difficult events:

  1. Allow the client to tell their story at their own pace without pressure
  2. Allow the client not to tell a part of their story
  3. Use silence and body language to show interest
  4. Encourages the use of storytelling without words (art, dance, etc.) or with symbols
  5. Ensures the difficult stories start and end at safe points
  6. Encourages good coping skills before story telling
  7. Points out resiliency and strength in the midst of trauma
  8. Encourages the story to be told from the present rather than reliving the story

Unhelpful Practices

Here are some things that we should avoid doing when helping another tell a difficult story

  1. Frequent interruptions
  2. Forcing the person to tell their story
  3. Asking the person to relive the story
  4. Avoiding painful emotions
  5. Exhorting the person to get over the feelings; telling them how to feel
  6. Only talking about the trauma, ignoring strengths and other history
  7. Ending a session without talking about the present or a safe place

**Trigger Warning: rape, threatened violence

A Case Study With 2 Storytelling Interventions

Patience, a 13 year old girl, suffered a rape on her way to school last month. The rapist’s family paid a visit to the girl’s family and offered money as a token of penance. The girl’s father accepted the money because, “nothing can make the rape go away so we will take the money for now.” Patience was told by some family members to not tell anyone about the rape and to just act as if it never happened. However, Patience is suffering from nightmares, refuses to go to school, and sometimes falls down when she catches a glimpse of the rapist in town. Her father has threatened to beat her if she doesn’t return to school or help out with the chores at home. Her favorite aunt, a counselor/caregiver, learns about the rape and asks her to come for a visit in a nearby city.

[Warning: these two interventions are not designed to rid a person immediately of all trauma symptoms. In addition, these interventions must be used only after a counselor has formed a trusting relationship with the client.]

  1. Symbolic story telling. The aunt tells Patience that keeping a story bottled up inside can cause problems, like shaking a bottle of soda until it bursts out. Using a long piece of rope (representing her entire life) and flowers (representing positive experiences) and rocks (representing difficult experiences), the aunt directs Patience to tell her life story. They start with her first memories of her mother, father and two brothers. She tells of her going to school, the time when her mother got really sick but then got better again, the time when her cousins moved away, and the time when a boy told her he liked her. Patience noticed how she had many flowers along the rope and only a few rocks. Then, they put a large stone down on the rope representing the rape. Patience had difficulty saying much at all. She remembered being afraid, the weight of the man, the pain, and worry that her family would reject her. She remembered getting up and going to school and acting as if nothing happened. Her aunt noted that Patience was a strong girl—she had gone to school for a week before telling her mother. So, Patience placed a tiny flower next to the rock to represent that strength. After stopping for a cup of tea and some bread, the aunt asked Patience to notice how much more rope was left. This represented her future. Patience was surprised to see the rope and said that she didn’t think she would have a future now that she was spoiled. Her aunt encourages her to consider what she would like to be in her future. They continued to discuss this over the next day. By the time Patience returned home, she was able to see that she still had a future. Seeing the rapist still bothered her. However, she was able to go to school with two friends along a new path so that she would feel safe. Patience kept a drawing of the rope with the flowers and rocks and extra rope to remind her that she had a good future.
  2. Accelerated Storytelling. About six months later, Patience visited her aunt again. She was still going to school and able to do more chores (getting firewood and buying food in the market). However, she still suffered from nightmares and sometimes fell down when she heard footsteps behind her. This time, her aunt asked her to help create a “movie” of event. Before Patience was to narrate the rape, they first recounted the safety she felt at home before the rape and the safety she felt when she told her mother about the rape and was comforted. Next, her aunt asked her to identify all of the “actors” in the play: her mother, father, herself, brothers who went to school without her, classmates, teacher, and rapist. Patience then made a figurine out of paper for each actor and drew a small map of her village including the path from home to school. Then, the aunt asked her to tell her story as fast as she could from safe place to safe place and to only look at the figurines (and to move them along the map). Her aunt noted those places where Patience slowed down in the story. When she paused, the aunt asked her to try to keep moving. Once the story was complete (when she told her mother about the rape), she asked Patience to tell the story backwards as quickly as possible. Then, she instructed Patience to tell the story forwards again twice as fast. However, this time, Patience stopped part way through the story. She added one detail she had not disclosed before. She recalled that a young boy of about 5 was peering at them from behind some bushes. Her aunt encouraged her to finish the story and thanked her for her courage. Patience indicated that she was so ashamed of being seen in such a position. Again, her aunt thanked her for working so hard but asked her to tell her story forwards and backwards one more time. Patience noticed that she was less upset by the presence of the 5 year old than she had been the first time through the story.

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July 3, 2013 · 5:18 am

Tuza 2.0: Day Three


[June 25, 2013: Kigali to Kibuye]

Our day started with devotions with IJM staff at their office in Kigali. After devotions we met with the social work staff on a beautiful balcony overlooking the city to hear about their work with victims, the process of getting information to determine View from IJMif they could take the legal case and the counseling they could offer. IJM offers TF-CBT informed therapy for parents and child victims. You could hear the heartache as the counselors can only offer counseling to those whose cases IJM agrees to investigate and work for prosecution. They do what they can in those cases where abuse has happened but lack necessary evidence for courts. Unfortunately, there are few options for referral.

After IJM we proceeded to go to Ndera Psychiatric Hospital. As the ONLY psychiatric inpatient facility in the country of 11 million people, they about 350 beds. Do the math! About half of their patients are those with serious seizure disorders. Those in the crisis units have severe psychotic and disruptive behaviors. We saw one man who was stark naked. When asked about census, we discovered that while they have 60 or so beds for men in crisis, their current census is 78. Meaning, men share cots for sleeping!

We visited the stabilization units for men and women, the pharmacy, and kids ward [Picture below is of the daily schedule for kids in picture form]. It seemed that the hospital has a fewkid schedule more medications available to use since our last visit in 2009. Then, they only had access to Haldol. Now, they have some atypicals like Risperadone. Most stay at the hospital for about 3 weeks, though we were told that someone was in the crisis unit since 2001!

After the hospital, we intended to take a trip to one of the church memorials in Nyamata. However, we were running late so we returned to Solace for lunch and discussions with Bishop Alexis, an Anglican Bishop. Bishop has been engaging with us since 2009 for counseling help. He suggested that we come next time with a plan to engage key principles for a country-wide  response so that we avoid overlap.

By 3pm, we were on our way to Centre Bethanie on Lake Kivu in Kibuye. Our bus was packed with people and luggage. The road from Kigali to Kibuye has more twists, turns and vistas than you can possibly imagine. Lovely drive, though long. Finally, we arrived 3 hours later (after dark) to the conference center. Dinner was served in the restaurant (open sides to the lake!).

Today was a full day in many ways. One fun item: I received an African shirt from other team members. Wore it with pride today. One serious item: on our trip to Kibuye, I sat next to a man who told me his genocide story. Lost wife and 2 children. Survived hiding in the reeds for over a month. He told me how the Lord spoke to him about forgiving his family’s killers and how now he is doing reconciliation work with victims and perpetrators. I am amazed at his strength and struggles.

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June 28, 2013 · 3:33 am

Tuza 2.0: Day One


We arrived last night in Kigali after 24 hours of traveling. Yet, Solace Ministries Guest house provided an excellent rest (and a great meal).

Today, we started with church on Ndera hill. Well, actually we started with breakfast, my favorite meal in Rwanda: fruit, croissants, and coffee…with a view hard to beat. Church consisted of excellent singing, dancing ( the spirit can move my feet when I am here), testimonies, and choirs. Then, I preached from Jeremiah 29 about prospering in exile. Being translated is a different experience.

3.5 hours in total. It passes like an instant despite the hard benches. I imagine we could learn from Rwandans something about doing church.

After church we went to an elder’s home for lunch and then on to Baraka’s house for a visit. Got to get in her banana grove to see the trees up close and personal. After visiting with her, she took us to a residential home for street boys. 124 in residence. The young man showing us around is one of their first graduates. Fine young man. Many of the boys were on the street due to family violence or substance abuse. The organization has just hired a counselor ( herself a former orphan) just out of school. She has been working for 3 months to assess each child’s needs and to determine which ones will get services. She has no resources and said she greatly desires more training. While we were there we watched some outsiders teach the boys break dancing moves.

The day is ending back at Solace with a jam packed day on tap for tomorrow.

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June 18, 2013 · 9:57 am

Dr. Langberg on Dissociation (part II): DID, Principles and Cautions


Over at my other site, www.globaltraumarecovery.org, we now have part II of Dr. Langberg’s talk (March 2013) on dissociation. This video covers the concepts of Dissociative Identity Disorder (DID) and complex trauma. She ends with 10 principles and cautions for therapists working with clients who dissociate and/or who present with alternate personalities and identities.

Check out the video here. If you missed the first video or want to find other free resources, click around on that website.

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May 7, 2013 · 5:10 am

Of dogs and addictions


Our six-year-old cocker spaniel has learned a new trick. After having lived with us for over 1.5 years, she has figured out that she can open the pull-out cabinet drawer that contains our trash. This only happens when we leave her penned in the kitchen. I suspect we left some wonderful smelling meat scraps in it one night and the desire enabled some higher level problem-solving skills (she’s not the brightest dog in the world). Now that she has learned how to do this, we’ve taken to bungy cording the drawer. A few nights ago, we forgot and came home to a mess of coffee grounds and torn up trash all over the floor.

Interestingly, our dog responds in quite a predictable manner. Normally, when we come home, she is at the door to greet us by dancing around and putting her front paws on our legs. But each time we have come home to a mess she has made, we see her cowering and ready to bolt. The last time we came home to this mess, she squeezed out the door before we could get into the house so she could run away. No, we don’t beat her. She knows she has done wrong.

I’ve wondered what goes on in her head during the time she is into the trash. Does she know it is wrong? When does she start feeling bad. The moment we arrive? Has she been cowering and feeling guilty as soon as she spreads trash around? One more funny behavior: when we send her to her crate (in the basement) for a time out, she goes right away. But then, after a bit, we see her outside of her crate but sitting patiently. Then, she’s at the bottom of the stairs looking to see if we will let her up. Then, her front paws on the first step, waiting in anticipation that we’ll say all’s forgiven.

And this relates to addictions how?

Most individuals who struggle with an addiction have the strong feeling of guilt even as they partake. Guilt rarely is enough to stop us from acting out. Even knowing that we may well be caught does not stop us as much as you might think it would. The desire to have what is right at our fingertips can easily overwhelm all sensibilities and logic–that will race back to us as soon as we finish partaking or as soon as someone finds out. Our initial response may include running away. Guilt and shame prevail for a time and then we creep back into life hoping that the troubles we have caused will blow over and life will return to normal.

Of course, we are not dogs and so we must use the gifts God has given us (a brain capable of higher order planning, the Spirit) to learn from our mistakes and misdeeds. We can

  • remove ourselves from proximity to the addictive agent
  • plan for accountability, especially during vulnerable times
  • examine the roots, shoots, and fruits of our addictions with a trusted friend/counselor
  • remind ourselves of the power to say no and the foolish, false promises of addiction

For more of what I have written about addictions and interventions search the word in the seach box at the top of this page.

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April 17, 2013 · 9:14 am

The “End of Worry” in a dangerous world?


In light of the recent bombing in Boston, I thought I would use today’s post as a timely book note. Will van der Hart (Anglican vicar) and Rob Waller (Psychiatrist) have written a small but helpful book entitled, The End of Worry: Why We Worry and How to Stop (2011, Howard Books). What makes this book interesting is the fact that Will freely discusses his own struggle with worry, made more evident after the 2005 bombings in his city of London. While the bombings were the final straw to panic attacks, Will also explores some of the early roots of worry in his life.

If you struggle with worry, there are several reasons why this little book might be a comfort to you.

  1. The authors write as if they know worry and fear.
  2. It is not, as they say, “triumphalistic.” Meaning, they do not believe the right beliefs/prayers/faith will automatically solve the problem
  3. Worry is portrayed not only as a spiritual problem but also explored through lenses of psychology, biology, and habit formation.
  4. It is written to the worrier, not about the worrier
  5. Each chapter gives you opportunity to engage in a few key exercises
  6. They differentiate between solvable worry and floating worry (and the tyranny of the “what ifs…”)
  7. Their solutions are practical but do not pretend to be simplistic. In fact, they devote some space to the notion that you should “stop trying not to worry.” Sound radical?
  8. A number of their solutions are helpful for those who ruminate (OCD, scrupulosity)

The book sits firmly in the cognitive behavioral model of intervention. Therefore, much of it encourages readers to explore belief systems about self and world and to begin challenging faulty thinking and to work to replace with more appropriate cognitions, meditations, and self-talk. CBT is not the only therapeutic model but offers anxious people something to do.

If you would like to work through a book that describes the process of worry and perfectionism and then gives you some ideas to examine and change your own struggle, this might be the book for you.

*I received a free copy of this book without any obligation to write this post.

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