Dr. Diane Langberg now has her own website. Check out www.dianelangberg.com for more information about her speaking (both schedule and available audios–both free and for purchase) and her counseling practice. You can see a list of her associates and their specialties. Her resources page has lots of good book, article, and website suggestions regarding a wide variety of issues.
Tag Archives: Psychology
Diane Langberg on the web
Filed under Abuse, christian counseling, christian psychology, Christianity, counseling
AACC revisited
Not much time today for any significant posting on psychological assessment and/or the AACC world conference I’ve just returned from. 5 Days away from home leaves way too much other stuff to do!
However, here’s one small reaction question I pondered on the plane ride home: Which is better: a conference where I agree with most speakers, OR, one where there is wide diversity and quality of work (and some work that is downright bogus)?
I attend two different counseling conferences. One really scrutinizes speakers and makes sure they are in agreement with the organizing agency. The other seems to let any counselor teach if they can write a decent proposal and outcomes statement. The first one protects from outrageous presentations but most likely limits new voices and/or progressive ideas. The second one gives many ideas an opportunity but the listener bears the responsibility to figure out whether the speaker has any basis for their opinion.
Now, I don’t know this for sure, but I’m guessing the first one suffers from highly critical followers who make sure that no speaker ventures too far from home. And I also guessing that the second group has a large following that does not discern truth from simplistic pop psychology.
So, which is better? The first one rarely ruffles my feathers. The second one has speakers that make me want to scream but also exposes me to new ideas and research.
As I said, I’m not sure which I prefer. Both tempt me to have arrogant thoughts…which reveals more about me I suppose.
Share this:
Psych assessment and the new semester
And so we begin the new semester today. I’m teaching Psychological Assessment tonight to our advanced professional counseling students (recent grads looking to complete licensure courses). Psych assessment covers a wide variety of formal and informal assessment techniques for counselors. Among them are the use and interpretation of psychological tests. It is my experience that most people with superficial exposure to psychological tests have one of two responses
1. Inordinate value of testing and what it can do
2. Inordinate suspicion of testing and what it can do
Most of these responses come from quick reactions to some personal exposure to tests. Those who give too much value to tests may have taken a test and had it “nail” them. For instance, someone takes the Myers-Briggs (MBTI), finds out they are an INTJ and that it explains why they nearly lose their mind around their boss who is an ESFP. Those who are suspicious of testing often have had a bad experience of testing (test mis-use, a negative evaluation or they have had a course that exposes them to the weaknesses of some test construction and research.
The truth is that tests do have both limits (some way more than others) and value. Never underestimate the power to abuse a test or the data that comes from one. A relative of mine once was turned down from a job because some wacko decided he had repressed issues from a simple drawing.
However, those who say that they can get all they need from a clinical interview fail to recognize the value of learning how one functions in comparison to a large sample of peers. And several data points like that can really flesh out a personality or learning profile.
I’d be curious to hear reader’s experiences with testing (their administration and/or interpretation). Did you have a positive or negative experience and why?
Share this:
Filed under christian psychology, counseling, counseling science, Psychology
ICAT as a new therapy model?
Take any psychotherapies class and you will get your usual dose of the classic models built on grand schemes attempting to explain the meaning of life and human behavior: psychoanalysis (and later versions of object relations), humanist/client-centered, behaviorism, cognitive (and later combinations of the two), and various forms of family systems models. Students in advanced courses may learn a bit about various combinations of these models but usually such classes leave learners picking and choosing a theoretical home–or becoming eclectic by trying to take parts of each model.
But nowadays, models are built not to explain the meaning of life but to show “what works” in therapy. Sometimes model builders stumble onto a technique and then attempt to provide evidence how and why such interventions work. For example, I would classify Les Greenberg’s EFT, Francine Shapiro’s EMDR and Marsha Linehan’s DBT (though DBT has much more robust evidence supporting and has validity whereas Shapiro’s techniques have reliability but lack validity in my mind) as these kinds of models.
Now comes another model to try to capitalize on a number of proven techniques: Integrative Cognitive Affective Therapy. Right now, it seems to be used and studied for the treatment of Bulimia. But, I expect to see it grow over the years to any number of problems (just as DBT is not just used for Borderline Personality Disorder anymore).
What is ICAT? It is an attempt to improve upon the weaknesses of Cognitive-Behavioral Therapy (CBT) while maintaining the robust empirical power of the model. What are CBT’s weaknesses? Stephen Wonderlich says they are “1) a limited view of emotional responding; 2) inadequate consideration of interpersonal factors; 3) insufficient attention to therapist-client relationship; and 4) overemphasis on conscious-controlled cognitive processing.”*
ICAT attempts to improve on CBT by paying very careful attention to emotion, mindfulness, and other aspects of a person’s experience of self and world. Again, Wonderlich describes ICAT as “a collection of interventions drawn from an array of cognitive behavioral and emotion-focused therapies and based on a testable theoretical model…”
ICAT for Bulimia exists in a 21 session form as of now. It focuses on experiencing and identifying key emotions involved in the Bulimic process, making initial changes to eating habits, developing alternative coping mechanisms to deal with distressing emotions, dealing properly with desires, practicing self-regulation and challenging discrepancies between ideal and actual self. What makes it different from CBT is its focus on emotion and collaborative work between patient and counselor.
In many ways, it seems to adapt other model’s focus on validation, affect, mindfulness, and distress tolerance. Over and over it appears that understanding and addressing subtle emotional interpretations of life are the building blocks to changing pathological behaviors.This is not the first attempt to build an affective version of CBT. Some attempted to talk about constructivist CBT but that did not take hold. I suspect this model has a better chance at catching on.
*Wonderlich, Stephen (Summer, 2009). “An introduction to Integrative Cognitive Affective Therapy for Bulimia Nervosa” Perspectives: A Professional Journal of the Renfrew Center Foundation, pp 1-5.
Share this:
Filed under counseling, counseling science, counseling skills, Psychology
Case consultation by videoconference?
For my counselor readers…how interested would you be in participating in videoconferenced case consultations with an expert in your field for the purpose of discussing client cases with that expert? Bear in mind that this kind of activity would have to meet ethical guidelines (e.g., no identifying information about any clients could be revealed, clear distinction that this is consultation and not supervision, etc.), but would you be interested? Would something like this reduce your sense of isolation? Consider answering the following questions:
1. Would you be interested in getting consultation for some of your cases via videoconference (private video exchange with an expert, such as skype or other service)?
2. Would you still be interested if the videoconference was a group of no more than 4 (and everyone got to present something)? If it was a group of about 10 and not everyone got to present but all got to participate in the discussion)
3. Would you be willing to pay for such a consultation?
4. If yes to above questions, how frequently would you think you might use this type of service? Monthly? Quarterly? Other?
5. Finally, what questions or concerns does this idea raise for you?
Share this:
The APA on identity therapy and conversion therapy
[Let me wade into something that tends to fire up lots of feelings and lead to controversy. And let me ask all to be civil. Civility seems to be the first thing that disappears when we discuss matters near and dear to our hearts. But let us be different and listen to each other rather than talk at or past each other. As James tells us, let us be quick to listen and slow to speak.]
In recent days media outlets have picked up the story of the American Psychological Association’s release of a report and declaration of their official stance on reparative or conversion therapies for individuals seeking to change their sexual orientation. You can read their press release and find their 100 page research review here. Being a member of the organization, knowing a few of the players in the research side of things, and knowing how easy it is to get caught up in debate and miss some of the finer points, I thought I might make a few comments that may not make it to the public eye.
1. Researchers are beginning to distinguish between sexual identity and orientation. This is a good thing. I dare say that the public lags far behind on this matter. Separating these two different aspects of sexuality allows for individuals to consider and interpret their sexual feelings in accord with their beliefs and NOT as how either the minority or majority of the world tells them to define themselves. This is akin to biracial people determining how they want to self-identify rather than be forced to say they are black or white. Consider the following quote by one of the players (whom I don’t know),
The distinction between orientation and identity (or attraction and identity as we often describe it here) is key, in my view, in order for us to understand the experience of those who say they have changed while at the same time experiencing same-sex attraction….I hope we can agree that sexual attraction patterns may be one thing while meaning making aspects may lead two people with the same attraction pattern to identity in disparate ways. (emphasis mine; from http://www.crosswalk.com/blogs/EWThrockmorton/11607271/)
If I understand the relationship between identity and orientation, it would seem that one forms identity from a variety of “data” which leads to an orientation. This is true outside of sexual identity. A number of factors come together for a person to see themself in a particular way (this may include biology, family, life experiences, key “flashbulb” moments, etc) and in cementing that particular identity they develop an orientation towards the world. SO, this may explain why trying to change orientation has little positive effect. Until the person reviews, explores, and reconsiders their identity (something that happens in nearly every counselee I’ve ever worked with) and begins to practice another way of seeing self, not much is going to change in attraction and orientation. Further, what may change is one’s sense of importance (and therefore meaning) of various parts of themself. When my clients explore their identity, it is rare they come to understand that they were completely mis-perceiving their feelings or experiences. Rather, they begin to see those experiences and feelings from a different vantage point.
2. Change. What constitutes change is still up in the air. Ask a depressed person if they have changed even if they are only 50% less depressed and they will say likely say yes. Ask someone else and they may say “no, I’m still depressed.” In the realm of sexual orientation, however, many see orientation as all/nothing. All same sex or all opposite sex orientation. Many will tell you this is just not their particular experience. So, IF someone wanted to change their direction of sexual attraction, what standard would they use to determine if change had taken place? Would 50% change be good? Who would decide this?
There is another analogous scenario in psychology. Should psychologists provide weight loss treatment? Given that an extremely large portion of those who lose weight gain it back and more, many have felt it unethical for a psychologist to offer weight loss therapies when they know that success is extremely low. So, how long do you need to keep the weight off to make a treatment worthwhile? How much do you need to lose? Who decides?
My gut feel is that the APA is not accurate in saying that there isn’t evidence that individuals can change. There is some evidence. Not complete change, but let us not deny what is there. Neither are they accurate about their reporting of harm. Harm reports are difficult to objectify. The best research will show you that some are harmed and some are not. Instead of assuming harm, let us evaluate more closely how some are harmed and how some are helped. Just as one might do with the weight loss scenario.
3. APA makes an attempt to make room for the work of helping one to find congruence between faith commitments and sexual feelings. This is also a good thing. Now, just how a psychologist does this matters greatly. Does he or she evangelize here? By that I mean (a) encourage a client to choose a different faith or change it to fit one’s sexual feelings, or (b) encourage a client to deny feelings and deny the suffering one might have by choosing not to act on a desire? My personal opininon is that option c (stay neutral) does not exist and is not possible. So, where does that leave us? Informing clients of our personal positions and yet not attempting to force individuals into our view of the situation. In other words, truthful but humble without being demanding.
This is a divisive topic. Do individuals seeking to change their sexual orientation have the right to try to do so with the help of psychologists? Is change possible? Desirable? Damaging? And of course in trying to answer these questions you have a number of players on each side–each reading the “evidence” the way they would like to see it. You have those who have personal experiences in one direction or another. You have those with political or philosophical agendas. And, on top of that, you have media players interested in creating controversy where they can. I observed this last one myself where a local talk show host did his level best to create differences between two parties that weren’t disagreeing with each other as much he wanted them to.
So, what do you make of the difference between identity and orientation? Is it meaningful? How do we speak of change? Can we admit that it happens for some and not for others no matter our personal opinion whether change is good or not? And finally, can we avoid the “what if…” tendency in our conversations so that we deal with what is happening and not what we fear might happen?
Share this:
Filed under APA, Christianity, counseling science, ethics, homosexuality, Psychology, sexual identity, sexuality, Uncategorized
Are you a genetic fatalist?
Definition of a genetic fatalist: If I have genetic markers for _____, then I will have _____ problem.
Maybe this doesn’t happen to you but I find that when I have conversations about a wide variety of counseling related issues, they end up hitting upon the genetic question? Whether we are discussing anxiety, depression, alcoholism, sexual identity or similar concerns, I can count on being asked,
“Do you think it is genetic?”
The questioner seems to think that if the answer is “Yes,” then the individual in question has no responsibility for the situation–or no control over what is taking place. “If my alcoholism is genetic then it wasn’t my fault.” “If my son’s sexual identity confusion is genetic then he can’t do anything about it.”
Here’s what I want to say to most of these questions:
1. Probably but we don’t really know. There are lots of researchers trying to discover genetic markers and how our genes express themselves. Some we understand really well (like eye and hair color) and others we understand less well.
But even if tomorrow we discover that your husband’s OCD is genetically based, what does that mean? Is he forever trapped in acting on his OCD?
2. Thinking about genes this way doesn’t really help us right now. We all have genetic markers for various cancers and diseases but not all of us contract the problems. Women may have markers for breast cancer but never have the disease. How can that be? It can be that way because disease states or mental health matters are multifactorial in their origination. There may be genetic markers as well as environmental insults as well as psychological stressors that all work together to either protect from the disease or cause it to get started.
So, are you a genetic fatalist? Do you give your deciding vote to genetic markers when considering responsibility and control regarding behavioral issues, mental health problems, personality?
Share this:
Filed under christian psychology, counseling, News and politics, personality, Psychology
credentialing rant
Having spent most of yesterday trying to complete an on-line application to become an authorized, in-network provider for an insurance company, I’m fighting to remember why I started down this path.
Yes, I absolutely know it benefits clients in that they do not have to pay my entire fee out of pocket and only hope to get some money back later (if they have an out-of-network benefit). They merely have to pay a co-pay and so counseling is an affordable option.
But, being a selfish individual I’m thinking mostly about my own interests at this moment. Let me count the ways this process irritates me:
1. Collecting all my old information (addresses for pre and post docs and all education back to undergrad). Don’t they know that happened eons ago?
2. Repetitive entries. I think I entered my fax number at least 20 times.
3. Tax ids, SS ids, NPIs, etc. Numbers to find and enter correctly. I’m ready for the iris scan and probe now. My underwear size is…
4. And the real irritation is…(the previous ones really aren’t the issue as the on-line application wasn’t so bad–just time consuming)…I know that if I’m approved I get the following welcome gifts
-
- Reduced income per hour
- Delayed income (improperly rejected claims, delayed claims, claims sent to the wrong address, etc.)
- More paperwork to fill out to beg for sessions
Whine, whine, whine. It’s all about me. So much for caring for my clients’ best interests…
Okay. I’m better now. This is a good thing and one bonus is the company collecting the information will bank it so that I can use it in the future for other insurance companies should I so choose.
Share this:
Filed under christian psychology, Psychology
The grace of restriction?
I admit it, I hate restrictions. I like the freedom to do what I want. When someone tells me I can’t do something, I want to do it all the more. Have you ever wanted to NOT “keep off the grass” just because the sign was there? Or, have you thought you should be able to handle saying no to a great temptation all by yourself?
In working with men who have done things that have caused their loved ones or church community to trust them less, I sometimes see significant push back when it comes to natural consequences or restrictions put in place to protect the man from himself. These push backs come in the form of
- But I said I was sorry. Why won’t you forgive me?
- You don’t believe in grace. If you did you wouldn’t keep me from having free access to the church (said by a convicted sex offender)
- I shouldn’t have to have someone checking up on me or controlling my Internet access. If I don’t control myself and say no, then I’ll never learn to do it myself.
This last one is a bit murky. On the surface, the man is accurate. If he doesn’t learn to manage his own impulses, the moment he isn’t under restriction, he’s likely to act out. But here is the deeper issue. He doesn’t want restrictions because he sees them as painful reminders of his past transgressions.
Let me suggest that grace comes in the form of limits and restrictions. A man who abused his power as public school teacher and sexualized a child has served his time. He loves children and “only” offended once. He wants to work with kids in his church and is angry that the church has said no. “But I’m gifted with helping troubled children and I’ve had 15 years of great reports and plenty of parents who tell me they would trust me with their children. Why can’t I do what God made me to do?”
Now, there may be some explanation as to how this man might not ever be a threat again. And yet, might he also realize that restrictions from certain populations of people might actually be a grace to him–a freedom from temptation, from deception, from stresses that formerly led him down a path of fantasy and rumination about being a hero to children?
I haven’t worked this out fully in my head but I do think there can be much grace in restriction. I certainly see my children receiving a grace from not being allowed to watch certain shows or have unfiltered Internet access.
What grace have you received from a restriction? Was it both a blessing and a suffering?
Share this:
Filed under christian psychology, Christianity, counseling, deception, Psychology
Did Paul struggle with past memories?
On Sunday Steve Light preached from Acts regarding the conversion of the Apostle Paul. Prior to his conversion he was known to be one seeking the death of Jewish followers of Jesus. He witnessed and may have provided support for the stoning of Stephen. Upon his conversion those Christians in his circles were wary of whether he was a changed man or merely using it as a ploy to disrupt new churches. These folks had visceral reactions to such a person because they had likely experienced great suffering and distress by Paul’s hand.
Today, Christians generally think positive thoughts about Paul. He is the human author of most of the NT. His words give instruction, comfort, rebuke. We know he was a former violent man but we don’t experience him that way.
SO, here’s my question. Do you think Paul suffered from unwanted or painful memories of past actions? How did it impact him? We know very little about this from Scripture. Yes, Paul admits his past. He thanks God for unmerited grace and favor. But, he doesn’t address the existence of memories.
My thought? I think it is very human to remember shameful acts we have done. In fact, let me be bold enough to say we must remember them if we are to be human. The bigger question is rather HOW we remember them? Volf’s The End of Memory (which I have blogged through here some time ago) is instructive in answering this question.
How do you remember shameful images or memories of your past? Do they hold you back from relationships? Do they keep you paralyzed? Are you constantly trying to better yourself to make up for the past?
Share this:
Filed under Biblical Reflection, christian counseling, Christianity, memory, Psychology, sin
Musings on Faith and Psychology 