Tag Archives: counseling

April 3, 2013 · 9:13 am

Psychopharmacology for counselors? Take a class at Biblical!


This summer, Jim Owens, PsyD will be offering a one weekend class (Aug 23-24) entitled, Essential Psychopharmacology for Counselors. Jim is a board member here at Biblical and has extensive training in psychopharmacology. In fact, he is board certified by the Prescribing Psychologist Registry. He will review traditional and alternative medicines commonly used today as well as best practices for engaging prescribers. In his course description he says,

The ever-growing use of medications, both traditional and complementary, to treat mental health problems, has both helped and harmed many people. Approximately 80% of all psychoactive medicines are prescribed or recommended by non-specialists, who frequently have little time, training or experience to accurately diagnose the person’s condition. Therefore, trained counselors and psychotherapists are in a crucial position to aid their clients in getting appropriate treatment. This involves knowing some basics regarding which available talk therapies as well as medications are most likely to be helpful for those struggling with certain problems. It is also important to know how to interact with your clients’ physician(s) and other health care providers.

Get CEs!

The course is 1 graduate credit (includes some pre and post course work) OR, 9 CE hours for counselors. Biblical is an approved provider of CES for counselors by NBCC. To read more on costs and other CE approved courses this summer, click here.

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March 19, 2013 · 5:54 am

Getting the Right Treatment for Sexual Abuse? 7 Questions to Consider


You will find the theme of sexual abuse all over the news these days, from clergy sexual abuse to teacher-student improprieties. This level of public discussion allows some victims to feel empowered to speak about past abuse. Hopefully these same individuals find the courage to seek out a counselor to address ongoing struggles with memories, shame, and self-doubt.

But will just any counselor do?

How can you know if the counselor you’ve picked is the right one? Are there questions you can ask to determine whether you are getting good care? Check out the following questions.

How does my counselor handle my disclosure of sexual abuse?

It takes great courage to tell another person about violations of body and soul. Victims fear not being believed, blamed, or worse, having their secret told to others. Thus, when a person sets aside those fears and speaks of what has been hidden, it is a great honor to be blessed with that story. Consider these questions to see how your counselor rates:

  • Does my counselor show evidence of great care for my story? Do they treat it as precious? Once you have told the story, what do they do next? While we counselors hear many tales of woe, it can be tempting to ignore sexual trauma, especially if it happened many years ago or is especially horrific. Some counselors think that past experiences should remain there. They choose to focus only on present problems. Or, counselors can dive into the story and unintentionally force the client to talk too much about the abuse before trust has been fully established.
  • Does my counselor seem in a rush to “get beyond” my abuse to forgiveness, confrontation or reconciliation? There is a place and time to talk about these matters. However, if you have just started telling your story and these topics are their prime focus, then you know that they are most interested in getting to the end of the story, the happily ever after part. The impulse to get to the end will inevitably make you feel like your abuse was a mere trifle.
  • Does my counselor seem to have an unhealthy interest in all the details of my abuse? Counselors who ignore your abuse story are not the only danger. Counselors who dive into your story with great relish may cause you to feel re-victimized. There is a time and place for telling the story in greater detail (so as to process what you have come to believe about yourself and others). Those who rush in to the gory details seem to think that all story-telling is beneficial (see this link for the difference between bad and good trauma storytelling). By the way, a counselor who offers you private access (texting, emailing, late-night phone calls, house visits) without limits and boundaries may be offering you something that is for them and NOT you.
  • Does my counselor let me set the pace of counseling? The heart of abuse is oppression and stealing voice and power (I’ve written more about that in my chapter in this book). A good therapist may unintentionally re-enact abuse when they use their position to coerce clients to meet their own agenda. A benign dictator is still an oppressor! A common question I have received from beginning counselors goes something like this, “How can I make [name] tell me about her abuse?” My answer? You should not try to force her. What happened to her was coercion. You can provide a small modicum of healing by allowing her to decide when and if she will tell you anything. “But, won’t that mean that [name] will not get better?” Yes, it means her recovery will take longer. But consider this: you are undoing her abuse experience by giving her power to decide what she does with her body, including her mouth. It is true that there will be some pushing and prodding, but it should be gentle with the client feeling that he or she has the power to say no or to slow down the process.
  • Does my counselor educate me about trauma symptoms and typical treatments? Trauma symptoms (intrusive memories, hypervigilance, attempts to avoid triggers, numbing, etc.) are not just a psychological phenomenon. The whole body has been traumatized. Your counselor should be able to talk about the effect of trauma on the brain at a lay person level. Further, your counselor should be able to tell you what we *think* we know about the biology of trauma and what we still do not know. (By the way, if they are too enamored with one particular theory or cure-all treatment…RUN).

 A quality counselor will also talk to you about the typical 3 phase model of trauma recovery. They will educate you why it is important to develop good self-care strategies and to eliminate harmful behaviors (addictions, cutting, risky behaviors) before entering into the work of processing memories. They will tell you that safety and stabilization phase (first and ongoing) is about finding ways to stay in the present and to reduce dissociation. When you do tell your story in greater detail, the effective counselor always leaves room in each session to help you leave the office well.

  • When my memories are fuzzy, does my counselor urge me to try to remember? The very nature of talking about past events (whether happy or horrific) brings old memories to the surface. Inevitably, a client will recall some feature of their abuse they had not remembered for some period of time. Or, they will recall something in a very different light and as a result it will feel like a brand new memory. However, your counselor should not be intent on finding lost memories. There are two reasons for this. First, memories can be constructed. When details are vague, our minds may have ways of filling in the blanks with false ideas (However, the likelihood of constructing an entire memory of abuse ex nihilo is rather rare. In my 24 years of counseling, no abuse victims in my office ever reported having NO lasting memory of abuse. All recalled many details even if some details were not). Second, God may have a reason for keeping certain memories from you. Not everything needs to be remembered to get well.
  • What goal does my counselor seek? Counseling works best when counselee and counselor agree on goals and the means to get to those goals. Do the goals your counselor seeks make sense to you? Some goals are unrealistic and even dangerous. “Completely healed” or “as if it never happened” are unlikely and could even be dangerous in that they would make you vulnerable to re-victimization. Goals to confront, cut-off, or reconcile may be legitimate but expectations and safety plans must be reviewed ahead of time. Consider also that reconciliation may not be a good idea.

Your Questions?

I have just touched the surface on a few questions. You might have many other questions you’d like answered. Feel free to suggest questions here and I will attempt to answer some over the next few days.

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January 26, 2013 · 11:03 am

“Schizophrenic and Successful”? What are the factors in success?


This recent New York Times Opinion Page essay is written by Law Professor, Elyn Saks. She tells a bit about her diagnosis of Schizophrenia years ago and her fight against those who thought that she would not amount to much. While we shouldn’t assume that everyone who struggles with delusions and hallucinations will rise to Dr. Saks level of accomplishments, we should take note where we give in to hopelessness when someone we love receives such a similar diagnosis. Such hopelessness will surely hamper our loved one’s prognosis for recovery.

There are two important factors that predict both recovery from mental illness and future recurrence of symptoms.

  1. Acceptance of diagnosis and treatment compliance
  2. Absence of family and social stressors

These factors are found in nearly all forms of mental illness, but especially pertinent for depression, mania, and psychotic disorders. When a person accepts the existence of a problem and commits to a treatment strategy, they are likely to be more cognizant of the signs and symptoms re-appearing and therefore willing to seek additional help. When medications create irritating side effects, the committed person will either find ways to tolerate these irritations or work with their doctor to find alternative treatments.

The absence or minimization of family stress requires the family or community to not behave in ways that exacerbate the problem. The family must also accept the limitations and not act in ways that place unrealistic expectations on the patient. This of course requires a great deal of sacrifice–on top of existing grief and loss over relationships that will not be what they could be (e.g., caretaking a spouse with mania, supporting an adult child who needs a sheltered environment). This means releasing the demand for the patient to reciprocate empathy or have insight about their impact on the family. Still further, when we loved ones maintain a hopeful perspective–identifying a patient’s value, capacity, and possibility for a future–we offer that person the greatest chance for success.

For some, success may mean being able to hold down a steady cashier job. For others, success may mean staying out of the hospital. Still others may rise to Dr. Saks level of success in academia. If you have a family member who suffers with mental illness, work hard to see them beyond their illness and evaluate their current capacities (rather than by their best or worst day). Oh, and be sure to find someone to talk to. Your family member isn’t the only one who needs help coping with a difficult world!

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January 3, 2013 · 5:30 am

Good trauma telling?


In preparation for the start of our introductory Global Trauma Recovery course here at Biblical I re-read Richard Mollica’s Healing Invisible Wounds book (see previous posts about the book here and here). Mollica reminds us that there is a healing way to tell one’s trauma story…and there are destructive forms of telling the story.

Destructive forms of storytelling?

Trauma victims do need to tell their story. They need to be heard. But some forms of telling do more damage than good. Signs that the telling may not be helpful?

  • Puts victim/teller into high emotions (reliving the experience versus telling about it)
  • Overwhelms the hearer (who then disconnects thereby leaving the victim feeling more alone)
  • Focuses solely on the trauma or trauma symptoms (e.g., the degradation, shame, etc. thus maximizing paralysis and minimizing survival skills, resiliencies, and other important parts of the person’s life)

Facets of healthy trauma telling?

Mollica suggests 4 facets of good story telling

  • Factual re-telling of trauma (however not every graphic detail)
  • Identifying the cultural significance of the trauma experience
  • Gaining existential or spiritual perspective (reframe from larger perspective on self and world)
  • Identifying the teller/listener relationship forming

Notice that the storytelling is not just about what happened. It is also about the significance, looking from God’s perspective (on self, other, world, etc.) and identifying new connections, skills, resiliencies, etc.

Mollica gives these questions for counselors, family, and pastors to help guide a better story. I find them very helpful if one accepts the caveat that they are not all asked in one sitting nor would we demand articulate answers from victims:

  1. What traumatic events have happened?
  2. How are your body and mind repairing the injuries sustained from those events?
  3. What have you done in your daily life to help yourself recover?
  4. What justice do you require from society to support your personal healing?

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December 21, 2012 · 10:54 am

Diane Langberg on Lessons for Counselors


Back in November, Diane Langberg presented 10 things that counseling students might not normally hear about during their academic training. Click here for the video.

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December 17, 2012 · 5:15 am

Diane Langberg on Listening to Trauma


Here’s video of Dr. Diane Langberg musing about what she has learned from listening to trauma over the years. (link here) She made this presentation as a part of a larger evening of trauma counseling training at Biblical Seminary, November 12, 2012.

Enjoy. More to come soon.

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December 5, 2012 · 10:27 am

Side effects of Counseling?


Next Monday is the last night of my Counseling & Physiology class (well, last night for the students as I have a boatload of papers to read and grade). As you might imagine, we spend a bit of time talking about psychotropic medications, their value, and probable side effects. Most students fall into one of two categories. Either they have personal and (largely) positive experiences with medications or they have concerns about side effects and observe the tendency of our culture to over-medicate.

But, it would probably be good for me to remind students that there are side effects to counseling or therapy as well. Most clinicians are trained to inform their first time clients that things sometimes get worse before they get better. Counseling requires that you attend to your problems, problems that you may have been in denial about. Talking about painful things usually means you think about them more outside of the hour with the counselor. In addition, you may find that the problem you entered with was only the tip of the iceberg. Or, you may find that the work to be done in therapy is much harder and slower than you thought, or the solution much different than you imagined.

There are a few other side effects that are worth pointing out.

  • You may discover you aren’t the righteous victim you thought you were; that you need more grace and mercy than you want to admit
  • You may discover you have bigger blind spots leading to new areas  to die to self
  • You may discover that others can love you despite your flaws
  • You may discover the joy of accepting some things you thought not possible to accept
  • You may discover better goals than the goal of getting beyond your troubles
  • You may discover strengths you didn’t know you had; success with new habits you had previously believed beyond you

Yes, counselors ought to talk to their clients about the side effects of proceeding in therapy (both general and specific to the particular intervention). Not to have this conversation is to not serve the client well. They need to know what they can expect from you and what other options they might choose. Of course, we also should discuss the side effect of doing nothing at all.

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November 28, 2012 · 5:05 am

One Definition of Christian Psychology


At a recent conference, Diane Langberg submitted the following definition of Christian Psychology. I present it below, verbatim, for your consideration. In some ways she doesn’t say anything new. However, it is quite different from our usual definitions.

Let me explain my seeming contradiction by first giving you C. Stephen Evans definition of Christian psychology,

 [It is] psychology which is done to further the kingdom of God, carried out by citizens of that kingdom whose character and convictions reflect their citizenship in that kingdom… (p. 132)

As you would expect, Dr. Evans offers a philosophically astute definition.

Or, consider Eric Johnson’s tome, Foundations for Soul Care: A Christian Psychology Proposal. In this book of 700 plus pages, he explicates a Christian psychology framework as doxological, semiodiscursive, dialogical, canonical, and psychological approach to soul repair. If you are looking for a theologically and epistemologically rich entry point to Christian psychology, I can’t point you to a better place than this book.

Like these two examples, many of our current definitions focus on matters of epistemology, theology, and psychology. Many definitions also emphasize the work of critical evaluation of existing psychological theory and research.

Now turn to Dr. Langberg’s definition. Notice how she emphasizes the character, the preparation, and actions of the counselor. Notice further that the focus on outcomes is bidirectional–on counselee and counselor.

Christian psychology as practiced in the counseling relationship is a servant of God, steeped in the Word of God, loving and obeying God in public and in private, sitting across from a suffering sinner at a vulnerable crossroad in his/her life and bringing all of the knowledge and wisdom and truth and love available to that person while remaining dependent on the Spirit of God hour by hour. That work, no matter what you call it, will be used by God to change us into His likeness; that work will result in His redemptive work in the life sitting before us; that work will bring glory to His great Name.

What I take from Dr. Langberg’s definition is an emphasis on action, the Spirit’s work and the counselor’s work (in self and other). While the epistemological definitions are necessary if we are going to think critically about our work, so to is this action-oriented definition. It reminds us that for all our thinking and theorizing, it is God’s work in our private and public lives that is used to bring healing and hope to others.

Your thoughts?

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November 6, 2012 · 5:42 am

The purpose of retreats in counselor education?


I have another post over at the Biblical Seminary faculty blog describing three reasons why we require our counseling students to attend our program retreat each fall.

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September 23, 2012 · 5:03 pm

Biblical Seminary and global trauma recovery?


I have a short blog post over at Biblical Seminary’s faculty post explaining why the seminary is interested in global trauma recovery. You can check it out here.

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