Tag Archives: Psychology

How to evaluate a counseling model or intervention: Step four


Picking up on this series that was started last week, we come to the next-to-last step. Thus far I have suggested that whenever you are exploring the next best thing in counseling, you should

  • start with a healthy dose of suspicion about the motives and goals of the author. What are they trying to sell you?
  • Read with an open mind. Can you see what they observe about life?
  • Evaluate the author’s assumptions, worldview, etc. Be willing to be challenged!

Now we come to step four.

Step Four: Let yourself be critiqued

How might their observations and assumptions challenge your own? Sit with this a bit. Don’t worry that you will lose your faith. It never hurts to have our beliefs and values refined and challenged by our critics. Maybe some of your values are uncritically formed. How might these assumptions cause you to refine and renew your own? Can you eliminate some faulty logic?

Be willing to state some of the weaknesses within your own system of beliefs and assumptions. I wish every model builder would start with their own flaws. But, most of us are better at pointing out the speck in our brother’s eye than addressing the log in our own.

Finally, our next step will be to possibly adopt some portion of the model or intervention into our own repertoire.

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How to evaluate a counseling model or technique: Step three


In my two previous posts I suggested that the best way to evaluate “the next best thing” in counseling models or techniques is to start with a healthy dose of suspicion and then to read with an open mind as you try to enter their world and see what they see. Now, moving on to step three, I recommend that you take a look under the hood.

Step Three: Evaluate Assumptions

Whether you are considering adopting a whole model of counseling or merely a technique, you want to step back a bit and assess what assumptions and presuppositions color the author’s view of the world. If you adopt any portion of the model, you will be likely to adopt some portion of their assumptions. In evaluating assumptions, I find it best to ask yourself a few questions,

1. What presuppositiong, worldview, beliefs, etc. bleed through on their pages? Do they focus most on nature? Nurture? Individualist? Communitarian?

2. What ideas and values seem to be most prominent for this author, especially about human nature, health, healing, struggle, etc.

For some authors (especially model builders) assumptions are handed to you on a platter. When Carl Rogers said that he believed that humans had a drive to find health and wholeness, he made his assumptions quite well known. However, during the 80s and 90s, many psychologists stopped trying to build models. They hid behind “eclectic” and focused on “what works.” Well, “what works” (aka utilitarianism) is an assumption that we ought to be aware of. Many current authors have returned to try to build a better explanatory model for human flourishing. For example, Mark McMinn has penned an integrative psychotherapy model (reviewed here in past years) attempting to bring together cognitive and affective and spiritual models. Despite the return to model building, most popular trade book authors rarely discuss their own assumptions.

Still sound fuzzy? Just what are we looking for and what do we do with it once we find it? Consider these made up examples.

Author one: “…her problem? Her love tank was empty, had a huge hole in it from the way she was treated by her father.” Assumptions? You can see a little Maslow’s hierarchy of needs and a statement that present problems are the result of victimization from the past. This will surely impact the author’s ideas for treatment.

Author two: “…her problem? She struggles to connect her whole brain when processing emotions. Neural networks need to be developed and used to cool down her hypothalamus. she…” You can see here that the focus is on neural networks, possibly brain chemistry issues, and an overactive hypothalamus. You might not hear anything about will, choice, right thinking or experiencing. This client is a product of her brain. This will surely impact the author’s ideas for treatment.

Now, a word of caution. Just because we discover assumptions that we don’t agree with, it doesn’t mean we have to chuck the model or technique. Rather, we are merely trying to understand some of the straggler assumptions that might cling to the parts we buy into. I used to start all of my model evaluations with this step. However, I found that I was more likely to wholesale reject their observations if they were wrong in their assumptions. But everyone sees—even if poorly. And observations can be very helpful—even if fixated on one small aspect of life.

In our next step we will seek to let their assumptions challenge, correct, or refine our own (rather than just believing what we have always believed is airtight correct).

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How to evaluate a counseling model or technique: Step two


In my last post, I discussed the importance of evaluating the next “great” counseling method or technique with a good dose of suspicion. What is the author (or disciple) trying to sell us? Why? What is the basis of their model?

However, I do not want you to think that we ought to dispatch every counseling intervention with a snooty once-over. Rather, I want you to immediately follow-up your suspicion with an opening of your mind!

Step Two: Read with an Open Mind

Even the shakiest of ideas, models and techniques provide opportunities for us to grow. No matter our wisdom and intellect, we will always see life (reality) from a particular vantage point. Every human vantage point contains bias. This is why we should read outside our own disciplines and family groups. I especially encourage readers to listen to their loudest critics. They will have a point or two that we ought to take to heart.

So, find the originators of the model or technique you want to explore (often, original authors praise their ideas a bit less than their disciples do). As you read, ask these questions,

  1. What does this author observe about their world, the way it works (or doesn’t)?
  2. How do they envision the purpose and goal of life?
  3. What human problems are most significant to them?
  4. What solutions do they seek? What techniques or interventions are most prominent?

While you may disagree with their interpretations (save that for a later step), work hard to view the world through their eyes. Can you see what they see? You want to make this effort because you recognize you do not see the world entirely as it is. You see in part. Your humility here will help raise to your mind questions that you mint not thought were all that important.

Let me give you an example. In my first semester at Wheaton College (PsyD program) fresh out of the biblical counseling world of CCEF, I wrote a paper for Stanton Jones defending/critiquing a model of biblical counseling. At the end of the paper, Dr. Jones asked me to conduct a thought experiment,

Would [this] model urge medical research forward? After all, if worship is our primary end, and we can give glory to God with a serene death, why try to eradicate disease? If suffering is a human trial that gives us opportunity to glorify, should the concrete contributions to the suffering be addressed? I know this can be answered, but oh the subtleness of emphasis!

I have to tell you that these words were powerful to me at the time (and still are!). He knew I would say, “of course we should eradicate suffering.” But, in promoting the human end of enjoying God, even in suffering, I had emphasized suffering well to the point of de-emphasizing concrete helps that often come through psychological and medical research.

The goal of step two is to challenge our own assumptions to see if they need tweaking. Once we have concluded exploring the observations of the model builder, next we move to evaluating interpretations and assumptions.

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How to evaluate a new counseling model or technique: Step one


Being a professor of counseling I get lots of questions like this: “What do you think of _____ (a new or popular counseling model/intervention)? These days, I’m being asked about coaching models, neurofeedback, EMDR, EFT, brainspotting, the use of SPECT scans, the use of psychiatric medications, nutritional supplements, and the like. In past years, I might have been asked about theophostic ministry, DBT, or ECT.

To be honest, I haven’t read every counseling model to the nth degree. I know a bit about a lot of models and a whole lot about some models. So, I try to be careful not to offer too much critique on what I don’t know first hand. That said, I do think there are good ways to go about evaluating any new model and proponents’ claims of efficacy. Over the next few posts I plan to show you how I try to investigate any new (to me) model:

Step One: Start with Suspicion

What? Shouldn’t we give them a fair shake? Yes, of course. And we will. But first, I do think it is helpful to ask yourself, a few key questions about what you are being sold.

  • Who is promoting this model/intervention? What financial benefit are they seeking?
  • What claims or promises do they make about their successes? Do they seem reasonable? Overly optimistic?
  • What supporting evidence is offered? Anything other than anecdotes from the inner circle of disciples? Any empirical evidence?
  • Do supporters distance from everything that has gone on before? How do they connect to mainstream models?
  • How transparent are the authors about what is being done?

None of these questions will answer our ultimate question of the value of any new model. There are excellent new models with almost no empirical evidence. Conversely, there are those who connect their intervention to a piece of mainstream research but do so only tangentially (thereby giving the appearance of scientific support but lacking validity and reliability (i.e., much of the change your brain popular models)).

A model that starts in the popular sphere may turn out to be good. Yet, we still want to gather the data about the motives and purpose of the new model. Take coaching for example. There is good evidence that coaching techniques work. However, much of what you find in popular places (bookstores and the Internet) is about someone trying to make a buck, either to coach you or to sell you a certification to become a coach. Thus, it is important to look at “packaging” to see what we are being sold. We may well want to buy the “product” but buyers need to know that sellers don’t usually talk about the weaknesses of their product.

Watch out for those models that over-sell their results, especially in the area of “complete freedom” from suffering. These are almost always unsupported by empirical evidence and certainly do not line up with good theology. We want complete removal of mental pain. This isn’t a bad desire, but it does set us up to buy the “next best thing” without proper critical evaluation. And well-meaning friends may tempt us to try out some new technique because it worked for them.

And yet, we need to be open to the possibility that there is something new on the horizon. Truthful anecdotes still have some merit. And so, tomorrow I will suggest that step two includes “reading with an open mind.”

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Stopping seasonal high anxieties: Some strategies and a better goal


For most people, anxiety is a looped internal conversation. It just keeps starting over even when we don’t want to listen to it anymore.

The Christmas season we’re in can make anyone quite anxious. (Don’t think so, watch this fun video to remind you why.) Those of us naturally anxious and ruminative find the added responsibilities, family stresses, and disappointments just adding fuel to the fire. You try to take a moment to rest but all you can do is think about what is yet to be done or what you tried to do but failed. You pray but before you finish you are back to your worries. You distract yourself but the looped fears keep running in the background.

What helps you decrease your anxieties and repetitive worries? Can you really suppress them? Or should you have another goal in mind than just trying to shut them down? Are there any practical strategies that work?

Practical Strategies?

Daniel Wegner gave a short award address on this topic at the 2011 APA convention (now found in v. 66:8 of the American Psychologist, pp 671-680). In the address he tells us what we already know. It is hard to suppress thoughts in a direct manner (e.g., I won’t think about how much work I have to do). So, Wegner focuses on indirect strategies. Here is a sample of strategies with empirical support:

  • focused distraction
    • pre-planned alternative topic to think about when the rumination starts. Benefit? Avoids mind wandering which will more quickly return to the anxiety. Example: Every time I think about the conflict at work I will focus on a comforting favorite verse or an upcoming happy occasion.
  • Stress and load avoidance
    • Overall reduction of stress helps reduce unwanted/anxious thoughts. Focused distraction helps only to a point. Overwork which may provide some distraction will increase anxious thoughts over time.
  • Thought postponement
    • Choosing to postpone anxiety to a set time can work to reduce the amount of rumination experienced.  Example: I’ll spend time worrying about my visiting in-laws at 4:30 pm.
  • Acceptance
    • Instead of fighting and arguing with fears some find it helpful to observe fears without taking action. There is some evidence that those who accept the occurrence of unwanted thoughts have less distress than those who fight the thoughts.

Wegner goes on to mention other strategies (i.e., planned exposure, mindfulness, focused breathing, self-affirmation, hypnosis, and journaling) for reducing unwanted thoughts.

 A Different Goal?

What if the goal isn’t to remove or end unwanted thoughts and anxieties but to cope with them and not to be dragged along by them? Does this sound like failure to trust God? Failure to be at peace? if the goal is to trust God in the midst of uncertainty and anxiety, what would that look like? How would you know that you were doing well? To do this we would need to give up on the goal of having an absence of anxiety and to reimagine peace as something one can have in the midst of angst. After all, we are not seeking to be absent from this world but to live in the world that is full of chaos and uncertainty.

Here are two goals you might consider:

  • Being okay with things not done to perfection and with the disappointment of others who have come to expect perfection from you
  • Experiencing anxious thoughts as normal and yet savoring moments of rest when they present themselves
  • Using one strategy for anxiety reduction each day

So, how do you measure your seasonal high anxieties and what goal do you seek to reach during this Christmas season?

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Counseling as Global Mission of the Church


A few days ago I wrote this for our seminary’s blog regarding how counseling supports the global mission of the church. If you are interested in international counseling work…you need to read this blog and follow the link I promote.

Counseling as Global Mission of the Church.

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Sneak preview: Healing Trauma in International Settings (AACC seminar)


Cascade Atrium, Gaylord Opryland Resort & Conv...

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Just completed preparing my breakout seminar for this year’s AACC World Conference at the beautiful but outlandishly expansive Opryland Hotel in Nashville (Sept 28-Oct 2). This time around I presenting with my colleague Carol King on “Healing Trauma in International Settings: Best Practices.” Carol has had some experience in Rwanda and Goma, DRC and will be with our group in October when we do trauma recovery training in Kigali. Come back to the blog on the 30th and you can see and download the slideshow we will do.

What will we be talking about? 3 main points:

  • Listen…don’t assume you already know trauma or treatment practices
  • Train…don’t do the interventions yourself (train local leaders)
  • Utilize…don’t reinvent the wheel (use existing models)

Now obviously we will be fleshing those points out. Our goal is to help prepare interested counselors to develop short and long-range intervention strategies that utilize the cultural and human resources of the people they will serve. The only way to do this well is to have a listening and collaborative/support role approach. To that end I will talk about hoe to build an effective area case map.  We end by reviewing a few models for trauma recovery (both Christian and secular).

Check back on the 30th for the full set of slides.

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Narrative therapy and emotion 1


This month, Richard Smith and I are teaching an on-line class entitled, Christian Counseling in Postmodern Culture. Dr. Smith is managing the culture side of things in this class and has students thinking about the impact of consumerism, the “empty” self of the modern era, and “infantilist ethos” (from Barber’s 2008 Consumed)

This week Dr. Smith gave the class this quote:

At heart postmodernity [is] the same anthropology: both see humans as primarily units of consumption for whom choice is the defining characteristic… The difference between modernity and postmodernity is not that great looked at in this way: The cult of the autonomous ego, an endlessly acquisitive conqueror and pioneer devolved into a commodious individualism characterized by an unencumbered enjoyment of consumption goods and commodities.  (Brian Walsh and Sylvia Keesmaat).

A mouthful? Boil it down to this…postmodernist philosophy is very much concerned about the self. Not all that new. Now, postmodernism is much more than that and NOT all bad. But my point here is this: a counselor working in this culture must be able to connect with the client and help them construct/reconstruct their story rather than just give them lists of universal truisms to apprehend. Not that there isn’t universal truth but that the approach to them must  done in a dialogical and storying manner.

Enter narrative therapy.

Thus, I intend to blog a bit on this topic during the rest of August by summarizing and commenting on Working with Narrative in Emotion-Focused Therapy: Changing Stories, Healing Lives, by Lynne E Angus and Leslie S. Greenberg (APA, 2011).

Chapter one begins with this statement:

Being human involves creating meaning and using language to shape personal experiences into stories, or narratives. (p 3)

Do you agree? I would argue there is much truth in this. We shape our sense of self from our retelling of our experiences (both in words and in unspoken thoughts/emotions). But, we do not re-tell all of our experiences. Rather, we collect some and ignore others. Part of counseling is to dialog with the clients about how they shape their own narrative.

The authors then make this statement about the work of counseling,

As therapists, it is when we listen carefully to our clients’ most important stories that we gain access to how people are attempting to make sense of themselves in the context of their social worlds. In this way, psychotherapy is a specialized discursive activity designed to help clients shape a desired future and reconstruct a more compassionate and sustaining narrative account of the past. (p. 3-4)

Here they are telling us that our stories we tell are shaped by our emotions and at the same time make sense of our emotions.

What is EFT? It is a therapy that sees emotions as “centrally important in the experience of the self.” (p. 6). It was developed (principally by Les Greenberg) out of humanistic and Rogerian ideas of self-actualization and of counselor activities of being with, following the client and guiding. Throw in some F. Perl’s empty chair techniques as well. EFT focuses on emotions. Adaptive emotions are “the most fundamental, direct, initial, and rapid reactions to a situation…” (p. 7). Maladaptive emotions “…usually involve overlearned responses based on previous, often traumatic, experiences.” By this they mean emotions such as shame and abandonment sadness. They define secondary emotions as those reactions that are intended to protect the primary or most vulnerable emotions. Finally, they define instrumental emotions as those expressed for a motivation to achieve an aim.

Why the focus on emotion? Because they seek the goal of being emotionally congruent and adaptive. In this book, they focus on empathic attunement and changing client narratives.

How? Clients identify, experience, explore, story, make sense of, and flexibly manage their emotions (their words). Therapists notice “meaning markers” that reveal client confusion or conflict with the self.

This book will explore the narrative approach to EFT. “Critical life events must be described, reexperiences emotionally, and restoried before the trauma or damaged relationship can heal. New meanings must emerge that coherently account for the circumstances of what happened and how the narrator experienced it…” (p. 11)

Finally, they say,

…no form of psychotherapy is likely to have a big impact on basic temperament traits, but a client’s specific strategies, adaptations, and their internalized life narratives (i.e., macronarratives) have as much impact on behavior as do dispositional traits. (p. 13)

That is an interesting quote and puts the act of storying as more important than disposition.

So, what we will look at in the remaining 7 chapters is how the authors help facilitate new meanings and change their own narrative. The question for us is whether or not the narrative or re-storying approach to therapy is (a) effective in remediating problems, and (b) fits with Christian faith.

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The real damage done in abuse?


I’ve written before on the damage done when a community fails to respond to abuse in a justice oriented way. But here is a more succinct and apt quote by Miroslav Volf:

If no one remembers a misdeed or names it publically, it remains invisible. To the observer, its victim is not a victim and its perpetrator is not a perpetrator; both are misperceived because the suffering of the one and the violence of the other go unseen. A double injustice occurs—the first when the original deed is done and the second when it disappears. (italics mine)

Abuse victims sometimes tell us that the most significant damage to them is when community members (family, leaders, peers) fail to “see” or act justly when they hear of the abuse. It was bad enough to be sexually abused (yes, that is real damage too) but far worse to be told it didn’t happen or be told to take it for the sake of the larger community (e.g., you wouldn’t want to harm his reputation, destroy the family, cause others to fall away from Christ, etc.).

I saw this quote in the first pages of The Long Journey Home: Understanding and Ministering to the Sexually Abused, to be released soon by Resource Publications, an imprint of Wipf & Stock. I have the typeset PDF and the editor, Andrew Schmutzer, says the book will be released in August. This book (over 500 pages!) may become the place to turn for Christians seeking to understand the scourge of sexual abuse in all its ugly forms. Chapters are written by those who are expert in the social sciences, theology, and pastoral care. The line up is phenomenal. You can see the title page/table of contents (TOC Long Journey Home) to see the gamut of chapters and authors.

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“I tried that…it didn’t work”: Responding to failures in counseling


One of the things a counselor does in meeting a new client is to ask, “tell me what you have tried thus far to solve this problem.” We ask this question because we know we are not the first stop for most folks trying to solve a problem. Whether it is a parent seeking a way to manage a child’s misbehavior, a couple seeking help in changing the way they talk to each other, or an individual trying to address an ongoing anxiety problem, most people have tried and not found adequate success–which is why they come to see us.

But, let me tell you what goes through my head when I suggest a couple of options/approaches my client might try and they respond with, “I tried it…it doesn’t work.” My internal, private response?

Define try. Define work.

Now that probably sounds negative but I don’t mean it that way at all. What I mean to communicate is that I do not yet know what this person tried, for how long, and what result, if any, was achieved. What I do know is that my work is cut out for me because the client statement usually conveys a closedness to trying that particular intervention (or similar ones) again. My job is to ask questions to understand each word: try and work.

Tried it.

There are a couple of commons ways people try solutions to problems. They may try something without proper consultation. They may try something in an intermittent manner. Let me give you some examples. Parents may try a reinforcement strategy with a child but fail to find a powerful enough reinforcer to make the system work. Or, a couple may try a speaker/listener technique but revert in the middle back to a debate/invalidating mode. A couple may need to take a “time out” or break to avoid a conflict escalation but the one asking for a break may do so using it as a power move (“I’m outta here!) rather than a de-escalation attempt.

Didn’t work.

A good technique may or may not work, depending on any number of reasons. Some interventions really won’t work for a particular person or setting. However, it is important to recognize that some interventions fail to work for reasons already mentioned above and others may fail to “work” because of client expectations. For example, a parent may try a particular intervention with their child to reduce angry outbursts. Then, the parent returns to counseling the next week and tells the counselor the intervention didn’t work. Upon deeper investigation the parent does admit that the number of outbursts reduced, the duration of the outbursts shortened. Why did they feel that the intervention didn’t work? Well, last night they have a horrible blowout and very small irritating interactions each day. So, the intervention may have worked even though the parent is feeling very worn out and discouraged. Or, in the couple illustration, listening technique may enable the couple to fight less but one spouse feels that the other has a history of being self-centered and thus cannot trust the reasons they are now trying to do a better job. So, they interpret short-term success as not real or legitimate.

Setting the stage for homework

Counselors often give homework. For homework interventions to work, a counselor should: (a) make a very clear explanation of what should be done, when, and how often, (b) what results, if any, to note, (c) the short and long-term purpose of this intervention, and (d) follow up next week to see how the  client fared and what alterations might need to be made in the following week.

Counselors do well not to oversell the value of the intervention, admit that not all interventions work and that troubleshooting is an essential part of counseling, write down their homework requests for clients, and make sure that the homework given fits the client’s level of commitment to the process.

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