A couple of weeks ago, I wrote this essay that Christian Post published today. It is a letter to church leaders and suggests 4 ways they can support positive emotional and spiritual care for their congregants.
Tag Archives: mental health
For my counselor readers, I want to let you know of a free counselor journal. Click here for free access with search capacity. It is published by NBCC and is open access to anyone who wants to try to stay current on counseling literature.
July 4. Transit day.
Today is a transit day. Breakfast of hardboiled egg, bread, and coffee. Talked with Klero of South Sudan. Discussed ideas of how to bring GTRI courses/materials and other counseling training to local areas here in Uganda and in S. Sudan. While Juba has great Internet per Klero, most people there do not have access to it. The same is true here in Uganda. I am very interested in finding a way to bring this training (videos, readings, exercises) to this region without it being in an online format as it is right now. Seems the areas of greatest interest are basic helping skills, trauma healing from the Bible Society, deeper understanding of impact of trauma and expression of PTSD across cultures, and exposure to psychopathology. My goal would be to give this material away and offer live conferencing sessions to the training mentor as needed. Then, possibly follow-up with a visit to “t0p-up” as Harriet Hill is fond of saying.
Anyone want to fund that or help me figure out how to get others to do so? (Smile)
After breakfast we made our way to a nearby Catholic college to talk with Sister Bokiambo and the dean of the counseling department, Fr Evarist Gabosya Ankwasiize. They were interested in future opportunities with shared learning (my bringing students here to engage and interact with their students and participate in joint training). I left with new ideas for this location (on the shorts of Victoria) and with the encouragement that the Bible Society might be able to begin some seminars here to improve the dialogue between Scripture engaged trauma care and traditional mental health trauma care.
After a lunch of fried fish on the shorts of Victoria, I said my good-byes to Justus and Esther at Entebbe airport. The added security was quite evident (3 bag checks and 3 metal detectors before boarding) but there were no problems. The flight to Kigali was under 1 hour on a very new Rwandair airplane. Just enough time for a Passion fruit drink from the steward. Arrived to significant upgrades to the airport.
Arrived at Solace Ministries Guesthouse, our usual haunts since 2011. Solace isn’t hotel level but I love it for many reasons: Simeon’s great cooking (he makes fantastic vegetable soups and dessert of fresh tropical fruit and ice cream tonight), my money goes to a ministry and not a behemoth corporation, the water is hot, the rooms are clean, and it is centrally located. Seems Internet is a bit upgraded since I was able to SKYPE with Kim and boys. [For a 2012 video of Solace Guesthouse, see here.]
I arrived here after the major July 4 celebrations today. Today marks the end of the 100 day mourning period and celebrates the liberation of Kigali. This is the 20th anniversary. A number of fireworks were shot off tonight, which I was told later triggered some local people into thinking the city was under attack.
Tomorrow, Lord willing, the rest of the team will arrive from the US and other points and our GTRI immersion trip will begin in earnest.
Over the next few post I plan to review similarities and differences between the ACA and AACC codes (see this post for the first in this mini-series). Today I want to look at how the two codes talk about counselors as they manage their own value systems with their clientele.
The ACA code raises the issue of values like this:
- Section A Introduction
Counselors actively attempt to understand the diverse cultural backgrounds of the clients they serve. Counselors also explore their own cultural identities and how these affect their values and beliefs about the counseling process.
- A.4.b. Personal Values
Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.
In addition, the ACA clearly states that when there are significant values differences, a counselor is NOT to make referral on the basis of values differences alone. Values clashes cannot be treated as lack of competency in a particular area of counseling.
- A.11.b. Values Within Termination and Referral
Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.
The AACC code addresses the value systems of the counselor in these sections
- ES1-010 Affirming Human Worth and Dignity
…Christian counselors express appropriate care towards any client, service-inquiring person, or anyone encountered in the course of practice or ministry, without regard to race, ethnicity, gender, sexual behavior or orientation, socioeconomic status, age, disability, marital status, education, occupation, denomination, belief system, values, or political affiliation. God’s love is unconditional and, at this level of concern, so must that be of the Christian counselor.
- ES1-120 Refusal to Participate in Harmful Actions of Clients
Within this section are paragraphs discussing the application and limits of the “do no harm” virtue to certain client behaviors deemed not to fit within the biblical framework articulated at the beginning of the ethics code. The AACC code expressed an ethic to avoid supporting or condoning (while respecting and continuing to help) in the following areas: abortion-seeking, substance abuse, violence towards others, pre or extramarital sex, homosexual/bisexual or transgender behavior, and euthanasia. On this last issue, the ACA notes that the duty to breach confidentiality may be optional (thus indicating a values insertion since in all other cases we have a duty to breach confidentiality so as to warn others or protect the life of our client).
- 1-530: Working with Persons of Different Faiths, Religions, and Values
Counselors work to understand the client’s belief system, always maintain respect for the client and strive to understand when faith and values issues are important to the client and foster values-informed client decision-making in counseling. Counselors share their own faith orientation only as a function of legitimate self-disclosure and when appropriate to client need, always maintaining a posture of humility. Christian counselors do not withhold services to anyone of a different race, ethnic group, faith, religion, denomination, or value system.
- 1-530-a: Not Imposing Values
While Christian counselors may expose clients and/or the community at large to their faith orientation, they do not impose their religious beliefs or practices on clients.
- 1-550: Action if Value Differences Interfere with Counseling
Christian counselors work to resolve problems—always in the client’s best interest—when differences between counselor and client values become too great and adversely affect the counseling process. This may include: (1) discussion of the issue as a therapeutic matter; (2) renegotiation of the counseling agreement; (3) consultation with a supervisor or trusted colleague or; as a last resort (4) referral to another counselor if the differences cannot be reduced or bridged (and then only in compliance with applicable state and federal law and/or regulatory requirements).
Differences between codes?
There are many but let me identify two. Notice that the most significant difference between the two is on the basis of the AACC code biblical/christian ethic regarding what is good and what is harmful behaviors. Both codes express the need to respect persons without regard to their beliefs, values, identities, and actions. The AACC code differentiates between imposing of values and exposing of values. What is the difference between exposing and imposing? I suspect it will be in the eye of the beholder. However, I suspect that one of the results of the ACA code is that faith and spiritual values will be less likely to be brought up by counselors since “not imposing” is more emphasized than “exploring.” There is much literature out there suggesting that the failure to explore and utilize spiritual resources actually harms clients in that it slows recovery.
Both codes address the issue of values differences between client and counselor. Both point to a path (though different) about what to do when this happens. The ACA code places pressure on the counselor to work it out while the AACC code suggests a path to resolution either with re-negotiation or referral. Which one sounds better to you?
When the difference is with a colleague?
Both ACA and AACC codes addresses differences with colleagues. In section D (Relationships with other professionals), the ACA code states,
D.1.a. Different Approaches. Counselors are respectful of approaches that are grounded in theory and/or have an empirical or scientific foundation but may differ from their own. Counselors acknowledge the expertise of other professional groups and are respectful of their practices.
The AACC codes says something similar,
1-710-a: Honorable Relations between Professional and Ministerial Colleagues. Christian counselors respect professional and ministerial colleagues, both within and outside the church. Counselors strive to understand and, wherever able, respect differing approaches to counseling, and maintain collaborative and constructive relations with other professionals serving their clients—in the client’s best interest.
The ACA code never uses the word “faith”, does suggest counselors need to address self-care (includes spirituality), and does suggest counselors seek to utilize client’s spiritual resources…”when appropriate.”
What is the difference between imagination and reality? Sometimes, not that much.
The February 2014 edition of the Monitor on Psychology (v. 45:2, p. 18) lists a brief note about a study published in Psychological Science that looks at eye pupil constriction when imagining light. Here’s the abstract from the link above (emphasis mine):
If a mental image is a rerepresentation of a perception, then properties such as luminance or brightness should also be conjured up in the image. We monitored pupil diameters with an infrared eye tracker while participants first saw and then generated mental images of shapes that varied in luminance or complexity, while looking at an empty gray background. Participants also imagined familiar scenarios (e.g., a “sunny sky” or a “dark room”) while looking at the same neutral screen. In all experiments, participants’ eye pupils dilated or constricted, respectively, in response to dark and bright imagined objects and scenarios. Shape complexity increased mental effort and pupillary sizes independently of shapes’ luminance. Because the participants were unable to voluntarily constrict their eyes’ pupils, the observed pupillary adjustments to imaginary light present a strong case for accounts of mental imagery as a process based on brain states similar to those that arise during perception.
So it seems that thinking about something causes your brain to respond as if it is really seeing. What might this mean about those who are trying to break free of addictions?
- Would imagining heroin use create observable changes in they body that would make it harder to maintain abstinence
- Would recalling sexual images create responses that make sexual addictions harder to break?
So, what is the difference between imagining an affair and actually engaging in one? From a brain perspective, maybe not that much. Certainly Jesus’ expansion of the seventh commandment suggests there isn’t a difference between the two from God’s perspective. And yet, we know that actual adultery creates more damage to more people than merely fantasizing about having an affair.
Rumination: the health killer!
I’m currently teaching students a course on psychopathology. Each week we consider a different family of problems. Thus far we have explored anxiety disorders, mood disorders (depression, mania), anger/explosive disorders and addictions. Soon we’ll look at eating disorders, trauma, and psychosis.
There is one symptom that almost every person fitting one of those above categories experiences–repetitive, negative thought patterns.
The content of the repetitive thoughts may change depending on the type of problem (i.e., anxious fears, depressive negative thoughts, illicit urges, fears of weight gain, fears of being hurt, irritability, etc.) but the heart of the problem is the vicious cycle that negative thought patterns produce.
While there are many very good ancillary mental health treatments (Did you know that daily exercise, getting a good 8 hours of sleep each night, and eating a diet rich in protein supports good mental health and may even prevent re-occurrence of prior problems?) it is essential for those of us who struggle with imagining negative events to find ways to shut down the production of rumination. Mindfulness techniques, thought-stopping, alternate focus may help to interrupt imaging bad feelings, thoughts, events and thereby interrupt the body reacting as if those bad things are indeed happening.
As a member of International Society of Traumatic Stress Studies (ISTSS), I am able to offer you a link to a free issue of their journal, Journal of Traumatic Stress.
Click this link for the February issue page with links to download individual articles. Several essays relate to PTSD treatment for veterans, at least one essay re: child maltreatment in Uganda.
I am finally getting around to read Ethan Watters’ polemic Crazy Like Us: The Globalization of American Psyche (Free Press, 2010). In this book he details the way America has exported not only its pharmaceuticals but have redefined mental health and disease. As the promotional material on the front cover says, the book “[uncovers] America’s role in homogenizing how the world defines wellness and healing.”
As I read the book, I find he is overly negative and pessimistic, even as he right points out some major bumbling when bringing Western mental health ideas to the world. And yet, consider this…
In chapter two he examines the way Western mental health providers flooded (bad pun but appropriate picture) Sri Lanka after the Tsunami to treat all the PTSD that would most definitely come to light. They “educated” the country about the symptoms of PTSD and trained caregivers and counselors to provide counseling interventions. When certain symptoms weren’t presenting widely, some helpers assumed victims must be living in denial.
Watters describes how one researcher began looking to see how Sri Lankans described symptoms of poor responses to trauma–instead of using a pre-determined set of symptoms. This researcher concluded that Sri Lankans experience trauma quite differently.
1. Sri Lankan PTSD symptoms were primarily physical in nature.
2. Sri Lankans did not identify anxiety, numbing, fear symptoms but rather identified isolation and loss of social connection as key to PTSD symptoms.
The root problem in PTSD?
So, is PTSD internal or external? Intrapsychic or social? Most Westerners think of psychopathology in terms of the individual. A sick individual will likely find their social lives eroding and less supportive. It appears Sri Lankans think of pathology in terms of social connection which when broken results in some of the physical symptoms. So, does trauma cause psychological damage which in turn harms social networks…or does trauma harm social networks which in turn causes distress?
Your answer to this question likely reveals whether you see the world as a community or a group of individuals. Or, your answer reveals whether you focus on universal human experiences or constructed human experiences.
One semi-helpful answer
My answer? Our minds, bodies, spirits and social networks are not disconnected. While distinct entities, we are far more connected than disconnected. To paraphrase the bible, if the eye is sick, the whole body is sick. Psychopathology does not reside only in one location, even if we can see it’s impact in one specific location (e.g., cells not functioning). We would not assume that seeing the destruction after a tornado would be all that is needed to find the cause of that same tornado. Whatever interventions we devise, we will not find a one-size-fits-all solution. For some, we will intervene first in the interior of their lives (medications, private counseling). For others, we will start with social reconnection.
If you read much about matters of politics and the military, you are well aware of the significant problem of PTSD in returning veterans of Iraq and Afghanistan. While only 20-30% meet criteria for PTSD, all have been forever impacted. Rightly so, the military and traumatology researchers are expending oodles of money and time trying to understand (a) ways to reduce trauma symptoms and (b) improve resilience. Thankfully, we are seeing some helpful interventions being developed. However, there is much work to be done in perfecting treatments (finding ways other than just medicating vets into a stupor), ensuring that practitioners are competent, and improving societal acceptance of PTSD as a real disorder and not just something someone can just decide not to have.
And yet, these wounded and changed warriors have something to teach us about how we see ourselves and our world. Sometimes, it takes a life-changing experience to recognize serious blind spots. Even if you haven’t served in a combat setting, you can understand a bit if you’ve gone on a mission trip and returned with a different perspective and a sense you could no longer go about life the same way.
This article is a worthy read to consider what we can learn from those who were willing to sacrifice their lives, their futures for our safety. If you are indeed thankful for a vet’s service, take a minute to read it.
Dr. Langberg and I are forming our next cohort interested in studying global trauma recovery principles and practice. If you have thought about getting such training, now might be a good time! Check out this link to our website where you can find descriptions/objectives of courses in the series as well as application materials (see links on the right of the hyper-linked page).
- CEs are NBCC approved
- Class runs November 9th to December 14th (time off for Thanksgiving)
- Workload is about 10-12 hours per week (readings, discussion boards, brief response papers)
- 4 required live 1 hour web conference to discuss material with the professors
- Focus of the class is to explore psychosocial trauma in international settings
- Want to be a Global Trauma Recovery facilitator? (wisecounsel.wordpress.com)
- Addressing Trauma in International Settings: 3 Models in Dialogue (wisecounsel.wordpress.com)
The 2013 AACC World Conference continues. Thursday, Drs Harriet Hill, Matthew Stanford, and Diane Langberg and myself will make the above titled presentation. Harriet will present an overview of the American Bible Society’s Trauma Healing Institute work of developing helpers who can help others re-engage Scripture around their traumas. That model is centered around the small but helpful book, “Healing Wounds of Trauma” (you can find this on bibles.com). Matthew’s work is the Mental Health Grace Alliance project of hope groups–structured support groups that have been tested in Bengazi IDP camps and other locations. Diane and I will describe the beginning work of the Global Trauma Recovery Institute which is designed to support the existing work by local caregivers.
Follow This slide show link for our slides.