Tag Archives: mental health

Want to be a Global Trauma Recovery facilitator?


Our Global Trauma Recovery Institute is gearing up to start our 2nd continuing education cohort in November for those who want training to become culturally savvy trauma recovery specialists. If you have been wanting to understand and address the issues of trauma that exist here and around the world, have graduate education in a counseling related field (or are involved in similar kind of work) and are able to complete both online and on campus training, then please check out our other site: www.globaltraumarecovery.org. This flyer will give you the nuts and bolts of our 3 course series (times, locations, and costs). This link will bring you to the course abstract downloads so you can see what you will be learning.

The first course begins November 9 and is fully on-line. We are NBCC approved provider of continuing education in mental health and counseling.

Who are the teachers? Diane Langberg, PhD and myself.

 

Check us out!

GTRI - First Graduating Class

Cohort One

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Why counseling? To be fixed or found?


Chuck DeGroat and Johnny LaLonde have written a post that some might find helpful when considering therapy or counseling (I use these words interchangeably). At some point in our lives, we all feel like life is getting out of control. We need help. We begin to wonder if there isn’t someone out there who can help us. But, even as we think these thoughts, we may also think, “what is the point? How can therapy fix this problem?”

Well, to give a partial answer, check out this first post over at Q Ideas. The authors argue that we should all be in therapy. However, they suggest that the purpose of such counseling is not so much to fix our problems but to understand ourselves, to admit our weaknesses, to be “found” or known. Now, these may sound like things that only wealthy people have the time to do. And yet, I would argue that in our isolated, individualized society, the normal communal means of being understood, supported, known, etc. are not often present in our lives.

Three paragraphs in this first post jump out for attention:

Don’t I go to therapy to get fixed? Believe it or not, I don’t advocate therapy because it fixes people. Now, while some forms of therapy help people get past difficulties that stifle them (e.g. panic attacks, major depression, bipolar symptoms), Christians should recognize there is always a deeper and more transformative purpose to counsel and care.

This was the ancient art called curam animarum—the care of souls. And the wisest therapists will foster this process. Now, the vast majority of clinicians practicing today have been trained in fix-it strategies—cognitive and behavioral solution-based processes which are aimed at quick, painless fixes. This is what sells. This is what insurance tends to pay for. But there is a profound difference here—fix-it strategies try to remove pain while deep soul care attempts to learn from it. Sometimes in the process we are afforded the mercy of pain relief. But it is not the goal. And so I counsel people to search carefully, to interview therapists, to ask many good questions.

And then this reflection:

But at the same time, I’m not convinced Christian therapists do this as well as secular therapists at times. Let me explain. Many settle for what Dietrich Bonhoeffer called “cheap grace,” a quick fix approach which stands in stark contrast to the “costly grace” of searching and knowing ourselves, through exploring our stories and examining our motives. This kind of care is, indeed, much more rare. Christian counseling which is reduced to mere Bible memorization, or repentance or a behavioral regimen misses the point.

Fixed and found?

I imagine that the authors would agree that both are possible. Therapy can lead to being fixed and found, to find relief and care for the soul. Therapies that ignore the need for immediate mercy and relief are of little value. I once talked to someone who had just completed a decade of psychoanalysis (3 sessions per week!). His therapist, a well-known analyst had just released him as having completed analysis. My new friend was looking for a therapist to deal with his longstanding panic disorder. I have also seen Christian counselors who have so emphasized discipleship that they paid little attention to easy helps for their addict clients. On the flip side, simple behavior change (now that is an oxymoron!) may provide some relief but miss insight into self and what God is up to in the world. In seeking only relief, we miss out on deepening our relationships with God and others. A superficial life lived may hurt lest, but is it worth living? 

Note at the bottom of the post there is a link to another post about how to choose a counselor. If you are looking for one, consider one who can have difficult conversations with you, one who does not over-simplify the problem, one who cares about your growing relationship with Christ, one who can provide ideas to bring immediate relief, and best of all, one who listens more than talks.

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Filed under biblical counseling, christian counseling, christian psychology, counseling, counseling skills, Psychology

When trauma isn’t “post”?


Over the last year or so I have been doing some thinking about those experiencing ongoing trauma. We talk of PTSD, Post-traumatic Stress Disorder, as a set of symptoms experienced after a traumatic event or time. But some people continue to live in ongoing trauma. I’m reading James Fergusson’s The World’s Most Dangerous Place: Inside the Outlaw State of Somalia. Early in the book, he talks of seeing “Sister Mary, a warm-hearted big-bosomed Ugandan in combat fatigues, dispensing medicines from a table in the ruins of the villa’s kitchen.” (p. 45). Sister Mary explains that there are two medical problems she sees. The one she treats most often is diarrhea. But, she says, the other problem she could not treat,

The people here are stressed, she explained. They are traumatized. They do not know where to turn.

You talk a lot in the West about PTSD-Post-Traumatic Stress Disorder…but for these people there is no “post”. The trauma never ends.

What can people do when trauma isn’t post? Do they have to wait until the traumatic experience is in the past in order to deal with it? What can we do for others who remain in precarious and life-threatening situations? A friend raised this question when working with a group of refugees in a UN temporary camp. Some of the suggestions that were given this friend

1. Helping refugees find some way to hang on to small measures of empowerment: set up classes for children, build huts for those who are just arriving, develop “positions” for adults to fill so the camp runs smoothly and has a modicum of safety.

2. Reinstate religious and cultural traditions where possible

3. Practice corporate lament along with other worship activities

4. Allow people to tell as much story as they wish, whether by voice or artistic rendering

Notice that these are finding ways to cope by (a) making the moment better and (b) bearing witness, even if they can do nothing about the crisis. When a person feels some level of ability to respond to a difficult situation, that person often experiences less trauma than those who are unable to express any agency. Further, when they feel that they matter to others (someone listened to whatever they had to say), they tend to have less long-lasting PTSD symptoms.

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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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Filed under Abuse, counseling science, counseling skills, Post-Traumatic Stress Disorder, Psychology, ptsd

How do trauma symptoms pass to the next generation?


As a clinician, I have had anecdotal experiences that the trauma experienced by a parent is passed on to a child who presents with many trauma symptoms despite not having experienced the initial trauma. We have witnessed what looks like this kind of transmission in places like Rwanda where children born after the genocide seem to experience many of the same symptoms of their parents.

Thus far, the data about generational transmission has been mixed. Looking at 2nd and 3rd generations of holocaust survivors, some research indicates that later generations can be affected; some research indicates no secondary traumatization. The problem with this research is that much is focused on the content of transmitted symptoms rather than the process. In the latest issue of Psychological Trauma (v. 5:4, 384-391), Lotem Giladi and Terece Bell have published a study looking at both content and process of trauma symptom transmission (“Protective Factors for Intergenerational Transmission of Trauma Among Second and Third Generation Holocaust Survivors”). The authors hope to have a clearer picture of risk and protector factors. As they say,

“The research question was not whether 2G and 3G experienced greater psychopathology than controls, but rather why some of them still carry some Holocaust-related psychological distress whereas others do not.” (384)

These researchers tested whether psychological concepts of differentiation of self (a Bowen concept indicating the ability to balance need for connectedness with family and need for being a separate self) and family communication (a previous study indicated that 2G holocaust survivors suppressed communication of negative emotion around their parents).

What did they find? 2G and 3G both showed greater levels of secondary trauma than controls (though all amounts of STS were in normal range) and surprisingly, the 3G group did not show less secondary trauma than did the 2G group. Indeed, greater differentiation of the self and better family communication among the generations of holocaust survivors positively correlated with  few secondary trauma symptoms.

So, how do trauma symptoms get transmitted to the next generation? We do not really know yet but one possible answer is that trauma tends to influence emotion regulation, anxiety regulation, and thus decreased self-soothing behaviors. This may get passed on to the next generation via suppressed negative feelings (children who do not want to make matters worse) and identification with the parent’s distress (and partially responsible for it).

For those readers who might wonder if their own trauma is causing secondary trauma in children, consider these things:

  • Most of the 2G and 3G holocaust survivor families are not terribly harmed. Most do well. So, it is not a given that your family is being harmed by your trauma symptoms
  • Open communication about the trauma symptoms and impact on family (without laying blame!) is likely helpful. Also communicate how coping with trauma symptoms can also teach a family some positive lessons as well (patience, gentleness, boundaries, etc.)

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Filed under Abuse, Post-Traumatic Stress Disorder, Psychology, Uncategorized

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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Filed under Abuse, christian counseling, christian psychology, counseling, counseling science, counseling skills, Psychology

Dissociation: What is it? What can be done?


For those of you who love or are helping PTSD or complex trauma victims, you may find this video link helpful. Dr. Diane Langberg (after an introduction by me) explores the experience and process of dissociation, or “leaving” the present. She discusses why it happens and what is going on when a person dissociates. At the end of the video, she explores a few helpful ideas for helping to ground the individual in the present.

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Global Trauma Recovery Intensive: Day 1


20 students along with myself and Dr. Diane Langberg just finished a 3 day marathon together at Biblical’s Hatfield campus. This inaugural cohort has been studying together via our e-campus since January. We’ve read books, articles, watched slides shows, and discussed a wide variety of topics (e.g., the psychological, social, spiritual, biological impact of trauma, shame, culture, strengths-based listening skills, and faith and psychological intervention strategies). At this meeting, we continued to consider how to listen andGTRI - First Graduating Class respond to traumatized individuals in places other than our own.

Morning Session: Romania

Our morning consisted of a live engagement (thank you Google Hangout!) with mental health practitioners in Romania. Dr. Ileana Radu and Stefana Racorean hosted the meeting. The Romanian contingent consisted of mental health therapists, psychiatrists, and Christian leaders. As part of their conference, they took time out to ask us questions about trauma, trauma recovery interventions, and integration of psychology and Christian faith practices. In return, we asked them about the mental health scene in Romania, the most common forms of trauma and intervention models in their practices. From our conversations, it appears that they experience a significant divide between secular mental health models or “bible only or prayer only” models.

The conversation bolstered our students understanding of Romanian culture and put a human face to what they had read about regarding torture trauma resulting from pre-revolution days in that country. In addition, students had the opportunity to discuss a couple of PTSD cases written up by mental health practitioners in the conference.

The entire conversation and connection (bridge, according to our new Romanian friends) was the result of Dr. Langberg’s inability to travel to Romania in April. She was to be their keynote speaker but due to the death of her mother, she was unable to attend. The conference was rescheduled and Dr. Langberg spoke via SKYPE and previously recorded DVDs.

Afternoon Session: North Philadelphia

Elizabeth Hernandez, executive director and founder of Place of Refuge, led our afternoon session by giGTRI - appendix photoving us a window into the trauma work going in North Philadelphia among the latino population. She shared with us some of the groundbreaking work they are doing with low-income population who have experienced many traumas. The class also engaged around the matter of syncretism (Catholic faith practices mixed with witchcraft and other superstitions) and how faith-based counseling services are delivered.

We ended the day with some brief use of video to “listen” to trauma stories in Eastern Europe and the US. After these engagements, we had our students explore writing their own laments as means to connect with God and concluded with a corporate lament. The purpose of lament is to confess (one’s own sin or the sins of others!), converse with God and others, question God about what we see that is not the way it is supposed to be, and by questioning acknowledge hope in God that he is in the process of redeeming and rescuing a broken world. Lament is not a tool to get better but to connect to each other and to talk to God about our suffering.

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Filed under Abuse, Biblical Seminary, christian counseling, christian psychology, counseling, counseling skills, Diane Langberg, Post-Traumatic Stress Disorder, trauma, Uncategorized

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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Filed under Anxiety, christian counseling, Cognitive biases, Good Books, Uncategorized

Suicide education and prevention in the church


Suicide is in the news these days. Military suicides are off the charts. Bullied teens are in the news this week along with a nationally known pastor’s son. Suicide is an important topic! We need to talk about why, for some, suicidal thoughts (fairly common across the population) become plans and actions. We need to explore what helps reduce suicide as a desirable option. We need to talk about how to care for those left after the horror of suicide.

But here’s a question: Have you ever heard a sermon or a Sunday School lesson on the topic of suicide?

I can’t say that I have.

This week I was sent a survey about graduate theological education and suicide assessment and prevention training. Our counseling students get a bit of education on suicide assessment in a couple different courses. They read an article or two on the topic. Not really enough but our challenge is to know what to cut in order to fit more suicide material into the program.

The result is that most learn in the middle of a crisis. Not really the best plan.

If you are looking for materials, let me point you to a few:

1. National Action Alliance for Suicide Prevention.

2. CCEF. Use their search tool to find their resources in this packed website (some free, some cost a bit). Jeff Black’s article on understanding suicide is helpful. There are several blogs that are free.

3. Al Hsu’s book, “Grieving a Suicide.”

4. American Foundation For Suicide Prevention.

If you google suicide and christian, you will notice that the vast majority of material is about whether or not suicided individuals can still go to heaven. While this is an important question, it appears that we have spent more time on this topic than on that of prevention and intervention.

Maybe we can do a bit better than this? Let’s commit to talking about it rather than being afraid.

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Filed under Depression, Psychology