Tag Archives: Psychology

November 18, 2022 · 7:21 am

Beauty in Garbage City: A Webinar Series with Dr. Diane Langberg


I want to let you know about an opportunity to engage with Dr. Diane Langberg and myself, designed especially for people helpers–mental health professionals, pastors, caregivers, and friends of those who are traumatized. Please read on if you are interested (link to register here):

The work of counseling and pastoral ministry is not “nice.” If you follow Jesus into the hard places of others’ lives, expect it to have an impact on you; to challenge your strongest held beliefs about God and the Church, your views on mental or emotional health, and your personal well-being. Join Dr. Diane Langberg and host Dr. Philip Monroe and learn from Dr. Langberg’s five decades of work with hurting people and broken systems. Listen as she talks about what has sustained her and answers your questions about what has helped her grow.

How do we continually sit with trauma and survive its impact? We will explore a specific concept during each of the three webinars:

January 15: Finding beauty means opening your eyes to the problems that are inherent as caregivers in the work of trauma. Followed by Q&A.

January 22: Embracing beauty is developing your primary helping tool: character and learning. Followed by Q&A.

January 27: Becoming beauty is applying what we have learned to trauma recovery work that leads to becoming the beauty of our Savior amid the piles of rubble and ruins we encounter every day. Followed by Q&A.

The 3 webinars will be three Sundays in a row, January 15th, 22nd, and 29th, 2:00pm-3:15pm Eastern Time. These webinars will include a Q&A portion, giving the audience an opportunity to ask Diane questions.

Cost and registration includes access to all 3 webinars. Registrants will have access to the Zoom webinar login information by January 9th, either via email or by visiting the online event page. Early Bird ticket price is $30 before December 25th, and $50 after that date.

NOTE: All three sessions will be recorded and emailed to every registered participant.

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June 30, 2017 · 5:32 am

Single session debriefing sessions? Helpful or harmful? 


I write this from Uganda having just completed a Community of Practice conference hosted by the Ugandan Bible Society. This community of practice is for bible-based trauma healing facilitators and local mental and public health experts. I presented on an update to PTSD causes, effects, and treatment. We looked at the value of Scripture engagement around the topics of trauma, loss, and recovery as well as how it fits into the larger picture of trauma counseling. 

Much of what we clinicians know and do for treatment for PTSD symptoms is based on partial research but a significant dose of “clinical judgment.” What is that? Well, it is treatment models that may have some empirical support but mostly formed over long-held assumptions in the field. One of those assumptions is that we may be able to prevent PTSD if we provide group or individual debriefing sessions soon after a traumatic experience. These debriefing sessions have been offered for decades to first responders, humanitarians, and missionaries after exposure to traumatic and tragic events. In recent years we have seen some evidence that some may not be helped but these sessions. In fact, some may even be harmed. 

The evidence of possible harm is not new. Yet, debriefing is still offered indiscriminately. We find it hard to let go what seems to work. Today I was able to read a 2006 study published in the British Journal of Psychiatry (citation below). This bit of research compared emotional debriefing, educational only debriefing, and no treatment. This study of Dutch civilians who had experienced a single episode of trauma within the last two weeks found that all three groups (emotion oriented debriefing, education only, and no treatment) saw a decrease of symptoms at 2 and 6 weeks post intervention. There was no benefit from either form of debriefing found in this study. 

In addition to no benefit, those individuals with high arounsal trauma symptoms who completed emotional debriefing showed higher rates of PTSD symptoms than the those with higher arousal who did nothing or only the educational oriented debriefing intervention. So, some forms of debriefing may actually worsen symptoms. Why? The authors surmise, 

In previous studies it has been established that high degrees of arousal in the immediate aftermath of a traumatic event are associated with an increased risk for the development of PTSD, measured both by self-report (Carlier et al, 1997; Schell et al, 2004) and physiologically by means of heart rate response (Shalev et al, 1998; Bryant et al, 2000; Zatzick et al, 2005). Encouraging highly aroused trauma survivors to express their feeling and emotions concerning the trauma might activate the sympathetic nervous system to such a degree that successful encoding of the traumatic memory is disrupted. Moreover, during an emotional debriefing session negative appraisal of one’s sense of mastery may be promoted (Weisaeth, 2000). This is assumed to keep the hyperreactive individual in a state of high arousal which may cause symptoms of PTSD to escalate rather than resolve (McCleery & Harvey, 2004). 

So, what should we do with this information? Nothing? No. But what we do should not harm, especially when we know some may be harmed. I suggest a few possible outcomes:

  1. Education about PTSD and trauma should continue. This study does not reveal harm for this intervention and given the relatively low trauma symptoms in this study (and the possibility some may have already been aware of what trauma is), education is likely to be helpful. Education is not only about trauma but also about good coping skills and activities. It does not focus on the events of the trauma experienced.
  2. Bible-based trauma healing begins not with a person’s story but looks at culture and common reactions. It normalizes pain and suffering and connects people to God and others. We do not yet have great empirical evidence (it is being collected) that such an intervention is helpful or harmful. But it appears that giving people permission to ask questions of their faith and to see that God encourages lament may still be helpful. 
  3. We need assessment of the growing movement and art oriented responses to trauma. What do these non-talk therapies add to the prevention or intervention strategies? 
  4. Debriefing or talking about a trauma that has just happened should focus less on replaying the details and more on current cognitive and affective impact with focus on resilience and boosting existing capacities. Brief assessment of arousal symptoms may well be warranted by those who promote processing trauma stories. This may be why NET, CPT and DBT oriented PE have lower drop-out rates than classic PE (prolonged exposure) therapy. 

Citation: Emotional or educational debriefing after psychological trauma (Randomised controlled trial) by MARIT SIJBRANDIJ, MIRANDA OLFF, JOHANNES B. REITSMA, INGRID V. E. CARLIER and BERTHOLD P. R. GERSONS. In BRITISH JOURNAL OF PSYCHIATRY (2006), 189, 150-155. doi: 10.1192/bjp.bp.105.021121

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November 11, 2015 · 7:00 am

Do men need sex? Wants vs. needs and the making of weak men


A bit ago, I wrote a piece challenging Michelle Duggar’s advice to her newlywed daughter about how to be sure to always be ready for sex.

“And so be available, and not just available, but be joyfully available for him. Smile and be willing to say, ‘Yes, sweetie I am here for you,’ no matter what, even though you may be exhausted and big pregnant and you may not feel like he feels. ‘I’m still here for you and I’m going to meet that need because I know it’s a need for you.’ ” (emphasis mine)

That advice, in my opinion, makes men out to need sex to such a degree that the lack of it will lead to bad things like porn and adultery. Sex is treated as the glue that holds fragile men in the marriage and the lack of it kills the marriage because men can’t function without it.

Interestingly, comments on that blog and other social media, by women, suggested that indeed sex is a need, not just a want.

Now, I just read a piece by a not-surprisingly anonymous blogger entitled, “How a husband can enjoy sex that is grudgingly given by his wife,” which argues much the same thing. While there are a million things wrong with his post, I only want to highlight the “need” language used in it. When illustrating how a wife might be allowed to (rarely) turn down her husband’s request for sex, he suggests she use this line with him,

“Honey, I know you really need it, but I am just really sick tonight, can I make it up to you tomorrow?” (bold mine)

And when he talks about the problem of the wife not wanting sex the way the husband wants,

But then we have the conundrum, women don’t always feel like having sex. Even women that have a healthy view of sex don’t always feel like having sex as much as their husbands do. (emphasis his)

One could argue that for some this is true, some men feel greater sexual desire than do their wives. But it is only a conundrum if such feelings/desires for sex are evidence of some innate need that if not met will lead to trouble.

Maybe from this quote you are not sure that this blogger believes sex is a need for men. Well, he also believes it is a need for women as well,

You need to realize that this is a physical need that you have as a man. You also need to realize that whether your wife knows it or not she needs to have sex too. Your marriage needs sex at regular intervals. If you don’t have sex with your wife at regular intervals, even sometimes when she is not in the mood but consents anyway, you will open yourself to temptation. You will find yourself becoming distant from your wife, because this is the primary way that you as man feel closeness with your wife.

But even if you realize and accept this truth that you need sex and it needs to happen even if your wife refuses to “fake it” and bury her wrong attitude then what?

What is probably most controversial in this blog is that he advises men to go ahead with sex when a wife is giving sex in a grudging way. He recommends that a husband not look at his wife’s face but focus on her body. You see, sex is such a need, it would be best to just muscle through it, don’t look at her face, so you can fulfill that need. Really!

Is it a need? Is it a want?

So is sex a need? Even if you believe it is a duty to provide sex to your spouse, does that make it a need equivalent to, “if I don’t get oxygen, I will die”?  Will the absence of it lead to bad things? It seems that some have  bought into this little formula: SEXUAL DESIRE = NEED. UNMET NEED = DANGER that will lead to  temptation, straying, or some such pathology.

What do we do with single men who want to be married? Is God unkind to them?

I think our troubles begin this way: We often baptize desires as needs, expect needs to be fulfilled, are angry when they are not, make demands of others to fulfill our wants and excuse ourselves when we use illicit means to get what we want (either by outright force, manipulation, or secrecy).

Notice here the author conflates desire with need. Yes, many men and women desire sexual activity. We are designed for it so it is not surprising when we like it and want more of it. But it is also designed to be used to connect us with our spouses. And when it is used to only fulfill one person’s needs, then it is not being used as designed.

And when we see it as a need, we are encouraging men to see themselves as weak and incapable of living without sex.

Further, arguing backwards does not make it a need. For example, you could show that those in sexless marriages are more likely to cheat (example; I don’t know if this is true or not). This information still does not make sex a need. At best it can only tell us it is a powerful want.

Consider for a minute how we might respond to these two different equations:

  • Sex as basic need + unmet need = ???
  • Sex as powerful want + unmet want = ???

How would you conclude these two equations? The first is more likely to focus on ensuring the spouse is not selfishly withholding such a basic need. The second is more likely to be concluded by addressing the one who has the want and how they plan to address that want.

A Better Equation

Maybe this is a more accurate equation: Sex as a powerful want + partially unmet wants + brokenness (bodies, relationships, desires) = grief over losses + opportunity to rely on Holy Spirit + pursuit of loving our spouses more than ourselves. This equation better acknowledges wants, sadness the happens when wants are not met, the reality of broken wants and broken bodies but also points to a better goal of reliance on God and the focus of love more than getting something.

It is painful to have unmet wants/desires. Those desires do not have to be wrong (though we are never fully right either). But our wants are always given to God and made secondary to our command to love the other well. Yes, part of loving the other may be talking about desires and hurts. But surely let us get rid of the idea that failing to have sex leaves men or women in some greater danger than those who have sex as much as they want.

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October 31, 2015 · 11:23 am

Should you get a doctorate in counseling or psychology?


Over at the BTS faculty blog, I’ve written about the pros and cons of getting a doctorate in a mental health field. Of course, I focus on what I know and play to my biases. You can read that post here.

That post is missing a link in the first paragraph. Here’s the link to the APA book.

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September 25, 2015 · 6:00 am

Useful Book on Narcissism


Craig Malkin of Harvard Medical School has written a popular, easy to read book on the topic of narcissism and its opposite end of the spectrum, “echoists.” Rethinking Narcissism: The Bad–And Surprisingly Good–About Feeling Special (Harper, 2015) is worth your read if you think you might be on the spectrum or if you live with someone who does.

In the beginning he sets out to destroy the myth that narcissism is always destructive and that all narcissists act the same. To help describe the continuum of egocentrism Malkin defines the low side as “echoists,” those who have too little of it who feel special in becoming invisible to others only known for the help they offer to others. Further, he also describes narcissism as something that may ebb and flow, rather than a consistent trait. Malkin describes the continuum well with many real life examples. With a better understanding of the spectrum, it may help us look more closely at less pathological forms of egocentrism and be less likely to lump everyone together.

Worried that you might be a narcissist? Want to see where you fall on the spectrum? Try out his assessment tool.

In his book he describes the root causes and the experience of being around subtle and extreme forms. Unlike other researchers, he outlines ways that egocentric people can grow empathy toward others. This idea flies in the face of conventional wisdom that a narcissist can never change,

The problem is we’ve all had it drummed into our heads that narcissist can’t change. They think they’re perfect just the way they are, the argument goes, so why should they even try? But unquestioningly accepting this idea backs us into an impossibly tight corner….We’ll fall silent or vent our anger, or…we’ll try a little of each. And none of these reactions will make the relationship any healthier

When we withdraw, by swallowing our words or walking on eggshells, we only strengthen people’s narcissism. In fact, echoists and narcissists often pair up to create a “love” that’s toxic to them both.

What can we do? For those who are not extreme narcissists, one way to encourage growth is to validate their experiences even while we say “ouch” letting them know we are hurt. Too often our anger or our silence is the primary response. While validation and pointing out our pain is not a guaranteed solution, combining validation plus vulnerability can enable some to experience compassion for self and other at the same time.

Check out the book!

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January 27, 2015 · 1:49 pm

How labels we use reveal self-deception


 

Someone sent me one of Ken Pope’s summaries of a recent essay about the differences in research findings when asking men if they have ever used force and held someone down during sex versus asking them if they had ever raped another person. You can read the original research he was discussing here, which is by some researchers at the University of North Dakota.

No, I’m not a rapist, but I have used force to make someone to have sex.

Let that previous line sink in a bit.  We’ll discuss it in a minute. But first, you might not want to read the article so let me tell you what the authors were interested in knowing. They wanted to know if there were differences between men who are hostile towards women and accept the label of rape and those who have used force but deny the label.

This allows us to test whether there are differences in men who do not identify with the “rape” label on sexual aggression surveys, although they have committed acts that would be defined as rape. Men who admit intentions to force women to have sexual intercourse only, but do not believe that this act constitutes rape, might not be primarily motivated by a desire to retaliate and overpower women. Their behavior could be guided by other factors in line with stereotypically masculine gender roles such as having a high desire for sexual activity, viewing sexuality as a competition and a way to gain respect among peers, and lacking consideration for women or viewing them as sexual objects. Therefore, we hypothesize that men do not endorse any intentions for sexual aggression will differ from the other two groups of men primarily on a dimension characterized by hostility toward women as the strongest loading factor. (emphasis mine)

What did they find?

As hypothesized, a sizable number of participants indicated that they might use force to obtain intercourse, but would not rape a woman. Men who indicate intentions to use force but deny intentions to rape exhibit a unique disposition featuring an inverse construct of hostility toward women but high levels of callous sexual attitudes (Check 1985). Given that hostility toward women involves resentment, bitterness, rejection sensitivity, and paranoia about women’s motives, we consider the inverse of hostility toward women in men that intend to use force to be indicative of an affable, trusting, and nonreactive affect toward women. When combined with callous sexual attitudes, we interpret this function as representing personality characteristics that might lend themselves to allowing men to not perceive his actions as rape and may even view the forced intercourse as an achievement. The primary motivation in this case could be sexual gratification, accomplishment, and/or perceived compliance with stereotypical masculine gender norms. The use of force in these cases might be seen as an acceptable mean to reach one’s goal, or the woman’s “no” is perceived as a token resistance consistent with stereotypical gender norms. While the ultimate outcome of either act constitutes rape, this pattern of results suggests that there might be different types of offenders with potential differences in underlying motivation, cognition, and/or personality traits.

So, not every rapist does so for the same motives (and therefore our interventions will need to be different). Some knowingly rape and are not self-deceived about their actions. Others who are willing to acknowledge “forceful intercourse” group reveal deceptions  (probably both in view of self and other) that enable rape to be considered something less than it really is.

Labels and what they may reveal

What labels do you use and what do they reveal about yourself and your proclivity to self-deceive? Here are some examples

  • I exercise (once in a great while)
  • I stand up for myself (I attack anyone who disagrees with me)
  • I used to struggle with porn (well, I look about once a month but I don’t think I will do it again)
  • I eat healthy (I’m obsessed with food labels)
  • I am good at doing my taxes (I underreport income)
  • I’m a Christian (I go to church but never really talk to God)
  • Let’s just call it sin rather than abuse (because I won’t accept my actions are abusive)
  • I need (I want/demand)

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September 16, 2014 · 9:27 pm

Institutional betrayal: Secret ingredient to PTSD


We live in the world where human frailty and pathology is viewed in individual terms. When we see sickness we imagine that the person must have some weakness in biology, faith, or behavior. Rarely do we think about the role the system or community has played in the development of that person’s pathology. This is true when we think about a person diagnosed with PTSD. We therapists hypothesize about individual factors (personality factors, early childhood experiences (a slight nod to external causes) and neurobiological risk factors) and situation factors (the frequency, duration, and intensity of overwhelming trauma events) when we try to answer the “why” of the development of PTSD in a person.

The problem with this kind of thinking is that it fails to take into consideration of known research that suggests that environmental response to an individual’s trauma experiences may be a determining factor in whether PTSD or chronic traumatic reactions form.

In the most recent American Psychologist (2014, 69:6, 575-587), Carly Parnitzke Smith and Jennifer Freyd write about the concept of institutional betrayal. Traumatologists recognize Freyd’s name as the researcher who developed “betrayal trauma theory”, pointing to the especially toxic form of PTSD caused by those who were supposed to be safe and protective. These begin to examine “institutional action and inaction that exacerbate the impact of traumatic experiences…”

How can an institution betray a victim?

When a person trusts that a system designed to defend, respond, protect, or seek justice will do its job after an interpersonal trauma, and when that system either chooses not to respond (omission) or worse, chooses to lay blame at the feet of the victim (commission), institutional betrayal occurs. Examples include law enforcement accusing rape victims of “asking for it” with their clothing, church leaders allowing offender clergy to “leave with their reputations” or refusal to investigate a case of date rape when the reported offender is an important leader in the community.

In summarizing a couple of studies, Smith and Freyd point out that institutional betrayal after a trauma experience leads to higher rates of dissociation, sexual problems, and health difficulties. This is even more likely when the trauma takes place in an environment where protection of the members is trumpeted (i.e., church or military).

What are the common characteristics of betraying institutions?

Smith and Freyd note several characteristics found in institutions at greater risk for betraying members.

  • membership requirements to define in group identity. This produces a need for members to act in ways to maintain such an identity
  • Prestige (both leaders and institutions). Prestige produces both trust and fear, dependency and power
  • Priorities. “Institutional betrayal may remain unchecked when performance or reputation is valued over, or divorced from the well-being of members.” As the authors note, maintaining reputation as a priority will lead to neglect or attack of those who challenge reputation
  • Institutional denial. Blame a few bad apples, avoid institutional blame or responsibility

Those institutions that do make efforts to prevent abuse within its community may still yet fail to respond well. They may fail to use adequate screening procedures, normalize abuse, fail to utilize or follow appropriate response procedures, punish whistleblowers, and aid cover-ups.

What to do?

Smith and Freyd argue that transparency (about past actions/failures to act as well as power structures) and priority to protect the well-being of all members will move institutions away from the risk of betraying individual members. I would argue that the shift to protect moves from the institution as a whole to protection of the most vulnerable.

Let me recommend a few resources that have appeared here in the past:

  1. Diane Langberg’s 5 part video about narcissistic leaders and the institutions they lead. She too describes systemic narcissism.
  2. Why some spiritual leaders abuse (and systems allow it)
  3. Narcissistic systems
  4. Resources to combat narcissism one person at a time

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August 19, 2014 · 12:10 pm

Why Oppressed People May Not Jump At Chance For Freedom


Ever wonder why those who experience systematic abuse and violence don’t jump when they get a chance for freedom? Consider the abused teen choosing not to reveal the abuse to an inquiring teacher but rather stays in the abusive home in silence. Consider the victim who refuses the help of a friend in order to leave a domestically violent spouse. What is the psychology that supports these responses to oppression?

Brilliant Mhlanga has written a short memoir of his experience of being from an oppressed people group in Zimbabwe. Under the guise of “independence” his people and his family suffered tremendous violence. Family members were raped and murdered in grisly fashion. He labels what happens a genocide (from 1980-1987).

Here’s how he describes the impact of this systematic oppression (emphasis mine, British spellings his)

The psychology of oppression, then, becomes a phenomenon derived from the state where the oppressed, given their existential experience, adopt the attitude of ‘adhesion’ to the oppressor (ibid: 45). Freire adds that under these circumstances the oppressed cannot consider their situation clearly and objectively in a bid to discover themselves outside the spectacles of their oppressor. As discussed earlier, the oppressed rationalise and internalise their suffering. Their state of mental warping makes them appear as walking symbols of conformity. Such conformity makes them reject their enlightened brethren whom they tend to perceive as ‘trouble makers’. To them anyone who advocates change of their state of being is likely to bring them more trouble, as they cannot know the likely outcome. They fear change. This is the state of people who have lost a sense of hope in their full potential without the help of the oppressor.

Notice some of the features of the oppressed:

  • Identity tied to oppressor
  • Belief that one cannot exist outside this relationship (fear of being in relationship, fear of not being in relationship)
  • Internalize suffering (blame self)
  • See those who would fight for their freedom as dangerous (the devil you know may be better than the one you don’t know)
  • Reject change as dangerous

Now these features are not found in everyone who is abused but they are worth noting. Those who would want to help the oppressed must consider these challenges and develop interventions that do not automatically trigger the fear reactions. This might include,

  • Identifying self-blame and raising doubts
  • Giving freedom to control response to oppressor (not coercing leaving oppressor)
  • Identifying possible future
  • Validate change as scary

Quote: Mhlanga, B. (2009) On the psychology of oppression: Blame me on history! Critical Arts, 23:1,106 — 112

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August 12, 2014 · 12:11 pm

Brooks on journaling about emotions


Friend Jeff McMullen pointed out a recent David Brooks op ed in the New York Times. (Read it here). While I’m not sure I agree fully with his journaling/not journaling point he says something very important about the timing of writing one’s emotions after a traumatic event. He says,

When people examine themselves from too close, they often end up ruminating or oversimplifying. Rumination is like that middle-of-the-night thinking — when the rest of the world is hidden by darkness and the mind descends into a spiral of endless reaction to itself. People have repetitive thoughts, but don’t take action. Depressed ruminators end up making themselves more depressed.

Then later, this important distinction between immediate processing of emotions and later processing,

We are better self-perceivers if we can create distance and see the general contours of our emergent system selves — rather than trying to unpack constituent parts. This can be done in several ways.

First, you can distance yourself by time. A program called Critical Incident Stress Debriefing had victims of trauma write down their emotions right after the event. (The idea was they shouldn’t bottle up their feelings.) But people who did so suffered more post-traumatic stress and were more depressed in the ensuing weeks. Their intimate reflections impeded healing and froze the pain. But people who write about trauma later on can place a broader perspective on things. Their lives are improved by the exercise.

David points to some research that exists that suggest CISD is unhelpful for some participants. Some are made worse. Yet, narrating one’s trauma in the broader context of a life tend to see a reduction of symptoms. The difference seems to be whether the focus in on life or mostly on the trauma. Trauma in perspective is the goal. Just reviewing trauma may in fact strengthen the traumatic reaction rather than weaken it.

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June 25, 2014 · 12:55 pm

My next two weeks in East Africa


Starting Monday I will be off traveling to Kampala, Uganda and then on to Rwanda for Global Trauma Recovery Institute. I welcome your prayers for myself, my students, and the attendees. In addition, Diane Langberg and myself will be leading a group of 12 Americans (10 GTRI students) on a listening/dialogue immersion trip throughout Rwanda. Some of the highlights of our trip(s) will include,

  • 2 day trauma healing community of practice in Kampala with the Bible Society of Uganda
  • 3 day trauma healing community of practice in Rwanda with the Bible Society of Rwanda
  • Afternoon mini-conference with pastors in Southern Province, Rwanda
  • Day with the newly forming Association of Christian counselors in Rwanda
  • Visits to NGOs working with trauma victims and street children
  • Church services
  • Visits to genocide memorials
  • Visit to a refugee camp
  • Numerous conversations, formal and informal over the next two weeks

I will make some attempts to update all on my trip as I go. You can follow me here and @PhilipGMonroe or @BTSCounseling. If you are interested in seeing more about the GTRI engagement model, check out this short video. And, if you would like BTS to continue doing this kind of missional work, feel free to go here and donate before the end of our fiscal year, June 30.

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