Tag Archives: Psychology

Gardening illustration that works for persistent problems in life


5 years ago a friend of mine asked if I wanted some purple cone flowers for my flower garden around my house.

Having admired them in other gardens, I said yes and promptly planted them in a spot next to some other flowers. Turns out they were Brown Eyed Susans, a relative of the intended flower. And, further, they spread terribly. I enjoyed them the first summer but began ripping them out the next year as they spread through the iris and choked out some other plantings.

Now, some five years later, I am still pulling these plants. They grow and spread quickly. I never let them flower but pull them as soon as I can make sure I get them and not another plan that might be right in the same spot. When I pull them I know that some little root fiber remains and so I’ll be back pulling again in a week or so.

The truth is I will never be free from these plantings. I do have some choices:

  • ignore them and let them take over the garden (BTW, they would be fine in an isolated spot surrounded by grass so they couldn’t take over another planted area)
  • be irritated that I can’t get rid of them and thus fail to see the beauty around them
  • stay vigilant but enjoy the garden
  • try shock and awe by killing everything in that spot.

I find this is much like our persistent life problems. Whether by naive choice or by something beyond our control, we develop persistent struggles with things like anxiety, depression, addictions, relational challenges, etc. While God sometimes provide miraculous removal of these struggles, we rarely find complete freedom from these kinds of struggles. We may not be in crisis mode forever, but total relaxation and assumption of no return of the problem is rare also.

So, we too have some choices:

  • be angry and bitter that the problem continues to have some place in our life
  • blame others for our problems
  • ruminate on why only we seem to have these problems
  • try shock and awe and so destroy lots of other things
  • accept the need to stay vigilant, going after the roots and shoots as soon as we notice them.

Does this illustration work for you?

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Filed under addiction, Anxiety, christian counseling, christian psychology, Christianity, counseling, Depression

Statistics and physiology: why getting it right matters


With recent advances in brain imaging and gene mapping we have significantly more data to help us understand human behavior. For example, we can see how folks with PTSD react to triggers using SPECT scans. We can understand how some folks have genetic markers that indicate a propensity for certain kinds of addictive behavior.

Enter this news story on NPR about one researcher who discovered he had the brain scan of a sociopathic killer–the very kind of people he was studying.

It is essential that we understand how to interpret these kinds of studies that often make the news. I am not an expert in brain scanning but let’s review a simple statistical principle. If you evaluate that 100% of people who have a particular problem (in this case sociopathic murder) have a particular brain scan signature, what can you say about its application to the general public? NOTHING. You cannot say, yet, that having that brain scan signature puts you at risk for becoming a murderer. What we need to know is whether or not that brain scan exists in the general public. I am willing to bet that if we did a large-scale study, we would find that 99% (maybe even higher) of those with a similar signature would NOT be killers. Thus, we cannot predict anything on the basis of the scan.

A similar (non) relationship exists between childhood abuse and becoming a child abuser. Yes, when we research pedophiles we find a high correlation between childhood sexual abuse and those who are in prison. But, when we look at the general public and victims of sexual abuse, we find that less than 1/2 of 1% go on to abuse others. Thus, abuse victims are not likely to become abusers.

However, these studies are not meaningless. In the case of the underactive frontal/orbital lobe, we do see certain features often present in individuals with ADHD: impulsivity, emotional lability, ego-centrism, lesser ability to learn from mistakes, difficulties in planning and forethought, etc. Rather than try to predict big events (like murder), we might use these kinds of studies to understand the common experiences and activity of those with a particular signature. This does not absolve people of responsibility or suggest they cannot make changes in how they operate. But, it might help us grow in understanding that what might be easy for one person may be more difficult for another. Just like we would want to give someone with dyslexia more time to read and comprehend a piece of literature, we might want to make some allowances for someone with a quiet frontal lobe.

It might mean that we understand that everyone thinks thoughts that ought not be repeated but that some have a harder time not saying it. And in the case of those “some”, we might be more willing to cut them slack even while we call them to account for saying what they say.

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Filed under counseling, Psychology

Maintaining progress in counseling with short sessions


Ever felt that a 10 minute session every day might be more beneficial than a 1 hour session once a week? While a short session cannot dig very deep, it can keep a person on track. One of the frustrating things about counseling is the fact that a client may leave with direction and clarity only to return 7 to 21 days later with confusion. What seems clear in the office becomes foggy in real life. It isn’t that much different from learning a language or algebraic formulations. You think you have it then you try to apply it to a novel situation and you realize you don’t have it quite down.

The phone call session should be short, directed at problem-solving, remembering a previously learned solution, or improving hope and motivation to continue some difficult task. Consider this for marital discord. So easily conflicted couples stay cold and distant between episodes of conflict. Short sessions may help them remember to soften each day and be more inviting of non-conflict interactions.

There is some support for this kind of interaction, though not in therapy literature. The support comes from addiction quitlines. Those who call in and gain support are more likely to remain abstinent than those who try to do it on their own. Sadly, insurance companies do not support this kind of interaction (they do not cover phone sessions). They should, it would likely save money in the long run.

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

Intractable conflict in marriage


The latest American Psychologist (65:4, 2010) has an interesting article on the topic of intractable conflicts. These can be seen in families, communities or whole country disputes like found recently in Rwanda and the Congo.

The authors make this point at the outset of the article,

Conflict resolution should be easy. Conventional wisdom…has it that conflict arises when people feel their respective interests or needs are incompatible….A conflict that has become intractable should be especially easy to resolve….After all, a conflict with no ed in sight serves the interests of very few people, drains both parties’ resources, wastes energy, and diminishes human capital in service of a futile endeavor. Even a compromise solution that only partially addresses the salient needs and interests of the parties should be embraced when they realize that such a compromise represents a far better deal than pursuing a self-defeating pattern of behavior that offers them nothing but aversive outcomes with a highly uncertain prospect of goal attainment.  (p. 262)

True, but since when does logic ever beat conflict? It doesn’t and these authors know it.

As a conflict becomes a primary focus of each party’s thoughts, feelings, and actions, even factors that are irrelevant to the conflict become framed in a way that intensifies or maintains the conflict. It is as though the conflict acts like a gravity well into which the surrounding mental, behavioral, and social-structural landscape begins to slide. Once parties are trapped in such a well, escape requires tremendous will and energy and thus feels impossible. (ibid, my emphasis)

This is EXACTLY why marriage counseling is so difficult. Everything is read through the lens of “He is so controlling,” or “She won’t respect me.”

Why does this happen? On the surface, an intractable conflict might seem to be about land (e.g., Palestinians vs. Israelis) or about ideological solidarity (republicans vs. democrats) or about bald desire for power. In marriage conflict may appear to be about respect, money, or power. But these authors suggest that conflict becomes intractable because the larger system is supported by the conflict and would more or less collapse if peace were to overtake it. Attractors, they say help maintain a coherent view of the world, a way of promoting unequivocal action without hesitation. Truth be told. We like living in a black/white world where our actions are always clear to us and the bad guys are always bad. A word about power. In conflict, we use power to get what we want (via direct use or manipulation). But there are always power differences between parties. Someone always has more power. In couples, one spouse will always want more sex than the other. This isn’t a bad thing. It only becomes bad when either party refuses to accept the differences or show any capacity to be influenced by the other.

When peaceful resolutions take place, it is because a new system has been developed; a new set of values and definers of reality.

How do you implement such a change? You cannot go directly after the thing that maintains the conflict. In other words, don’t say, “You, wife, stop believing your husband doesn’t love you”; or “You, husband, start loving your wife by…” Built into the maintainers of conflict is a strain of resistance. “I know you just did something nice for me but you really are just trying to get on my good side so you can [fill in the blank], but I’m on to you!”

The authors say, and I agree, that, “Attempts to challenge directly the validity or practicality of an attractor for intractable conflict are therefore often doomed to fail and in fact are likely to intensify people’s beliefs and energize their response tendencies.” (p. 273)

Again, how do we deal with these longstanding conflicts? How do we stop seeing the problem as a simple equation (you stink and I’m great) to something more complex (we’re both broken and here’s what I can do to make things better)?

1. Force self to step back to see the complexity of the situation. This sometimes happens when something blows our mind (we act in a way we THOUGHT we never would). To do this we have to believe that the simple answer is easy but ALWAYS wrong and desire to have a more nuanced view of self and other

2. Go back to see previous unity. So, a couple might go back to remember their first love. What affinities did they once have? Can they recover them? Some couples can. From here, they may find the power to fix problems that seem just a wee bit smaller because of a more powerful unifying narrative that was forgotten.

3. Focus on who we want to be in the midst of trials and tribulations. What kind of person do I want to be (that God empowers me to be) come what may?

Notice that only #2 has to work towards maintaining the marriage and living in close quarters. One can develop a more complex and realistic view of the problem (#1) or focus on character development (#3) and still choose to end a violent or destructive relationship. Both also require that we value something greater than self-interest. From a Christian point of view, love must be the reason for all three options–a love given to us by God alone.

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Filed under christian counseling, Cognitive biases, conflicts, counseling skills, Desires, marriage, Psychology, Relationships, Uncategorized

Changing Your Narrative in Counseling?


If you have gone to counseling, then you probably wanted something to change in you or something connected to your life. If you have counseled someone or been their wise friend, you also wanted something to change. There are a variety of ways to try to calculate or observe change. Is there a reduction of unwanted behavior or an increase of hoped for behavior? Is there a change in affective or perceptual change (i.e., do I feel better or have more hope?)? Is there more insight? More acceptance of what cannot be changed? Greater responsibility taking for what can be changed? Is there greater congruence between faith and practice, head and heart?

While everyone (counselor, counselee, insurance company) wants objective evidence of positive change to prove that counseling was worth the cost and effort, the most powerful and most valuable change gets little attention. What is that change? Script or narrative change. We all live by a storyline. We use that story line to make sense of our world and of ourselves. However realistic we think we are, we never really use all the data to determine our reality. Rather, we use scripts to fill in blanks and supply us with the “truth.” Don’t think this is true? Just examine the common fights of a couple. Most likely you can remove the content of the fight and you will find an enduring pattern of feelings and perceptions about self and other in each spouse.

How did we get these scripts? We have experiences of self in the world? We make interpretations of what we experience. Others communicate interpretations for us. But we are not blank slates, we come to these experiences with a distorted imago dei–a God-given image and agency that is both active and yet distorted due to Sin.

So, how does counseling change a script or life narrative? There are a couple of options. You can begin with behavior change. Changes in behavior may cause someone to re-evaluate view of self and other. For example, a person may move from “I can’t” to “I can” based on the evidence in behavior change. You can begin with insight. What is my dominant life narrative and is that really accurate or is there a better one to live by? You can begin with relationship. This form of intervention is less clear but probably more powerful than the first two. By focusing on the “here and now” you are having an impact on narrative as it plays out in the moment. In opposition to insight which pulls narratives apart, this form of intervention is predominantly an experience that shapes the narrative in a more implicit fashion. In other words, we realize the change sometime after the fact.

What you cannot do is exhort someone into a new script. When we try (and we do sure try: “Don’t be afraid of ____ …It isn’t that bad…”), we fail. Even if the counselee “buys” the new script, they have only listened to you say it. They have not yet written it on their heart. Passive acceptance ought not be mistaken for real change. In fact, sometimes hearing the needed change over and over only makes the person more resistant to it. A change in script must be practiced and owned for it to become real. That is why an addict may well become sober by accepting the limits imposed by others and still yet remain an addict at heart.

Narrative changes usually take time. It is possible for powerful experiences to create instant change in our view of self and other. Certainly conversion experiences are evidence of massive script changes. Many of us have had powerful “a-ha” moments that also change our perception of self and the world. But most of our script changes happen via the drip method–water dripping on rock does indeed make changes when viewed over the long haul. When we look back on our lives, we often note places where we have indeed changed–sometimes for the better, sometimes not.

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For more on intervention points in counseling, check out this post I wrote 2 years ago. I tried my hand at illustrating both the script and the intervention points.

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

Decisions by the numbers or by the gut?


We all make decisions every day. And most of us like to think that our decisions are based on adequate data. We consider going to college or grad school. Which school has the best degree, best profs? Which will give be the best options post graduation? We consider getting married. Will ____ be a good spouse? We consider buying a car. Should I buy a Toyota because their history of longevity and safety are well documented or do I skip them because of the gas pedal situation? We consider which counselor to use for our problems. Do I choose a christian or someone who is board certified (I know, I know, they can be both)?

We make decisions all the time but they are NEVER based on enough data. This is where faith or our gut is involved. For example, I didn’t know my wife would be the best wife to have. Well, I’ll tell you I did but I didn’t.

What I am aware of is how we have so much more data available to us these days to make our decisions. At times, the data can be helpful but it can also deceive us into thinking that we have more control over the outcome.

Consider these counseling related examples:

1. Home Sleep study devices. I saw an ad for a radio alarm clock sized device that records your time to sleep, your REM time, your number of awakenings and your wake point. Assuming the device works, you can really track your sleep in a much more accurate way (rather than just going by how it felt). There might be some benefit to this, especially if it helped you be more consistent in your bedtime rituals. But, data doesn’t stop anxiety nor does it alter sleep apnea.

2. Scales. I have a new scale at home that gives me all sorts of data. So, I weigh myself more frequently just to see what changes. Of course, it has yet to change my eating habits nor really tell me much that I didn’t already know.

3. Pop Psych treatments. I suppose some will challenge me here on this category. But there are a number of popular forms of treatments or assessments out there that purport to pinpoint your problem, remove your problem, or illustrate the healing you just received. Each of these forms of treatment have stories, anecdotes, even statistical data. But few have been researched in controlled studies. So, the data may be accurate and yet meaningless to you at the same time. These interventions may well be useful but often the promise outstrips what is really known at the present time.

I might sound like I’m down on data. I’m not at all. We have some wonderful tools now to track information. Data can give us direction. But, in the end, we have to decide and there are other kinds of “data” that we use to make these decisions: feelings, recent experiences (our own or others), first reactions, amount of energy, hope, etc. Let us not deceive ourselves that we truly live by the numbers.

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Filed under Cognitive biases, Psychology, Uncategorized

Book Note: Linkages between stress, inflammation, and mental illness


I am in the process of clearing my desk of semester debris. Well, truth be told, I am in the process of clearing a portion of my desk from said debris. The rest will have to wait. In the process, I came across a book I’ve been meaning to read since the dept. purchased it for me: The Psychoneuroimmunology of Chronic Disease: Exploring the Links Between Inflammation, Stress, and Illness (APA, 2010).

Before you all stop reading, it really is an important work! You should care if you are someone experiencing high levels of stress or if you counsel those who do. AND, there IS an answer (you won’t like it!) that can help given at the end of this post.

Yes, it is very technical. You can’t skim this book easily unless you read only the chapter summaries (not a bad idea!). However, I find it very interesting to read about how well-connected (too well!) our minds are with our bodies. Here are a couple of book highlights

1. Chapter one: Stress activates primary and secondary responses that may actually increase our vulnerability to disease. Secondary? Examples given include alcohol abuse, poor diet, non-compliance with treatments. Primary? Your body does a couple of things in reaction to stress. First, your sympathetic system starts looking for inflammation. Immune cells look for an injury. You have more glucose available to burn and cortisol increases which also works to activate anti-inflammatory responses. Inflammation is the problem (a “rapid and nonspecific response to danger”). Too much inflammation? damaged tissue. Too much anti-inflammatory response? Damaged tissue. Those with depression may have become less sensitive to cortisol and so end up with lots of non-specific inflammation. Maybe this is why depression hurts so much!

2. Chapter 3: Poor sleep has serious health consequences, especially concerning chronic diseases. One study indicates that disordered sleep has a direct link to type 2 diabetes, independent of age and body size. Individuals with sleep apneas have a greater production of inflammatory bio-markers. Women may be at greater risk for cardiovascular diseases due to sleep problems than men. One problem (sleep problems) begets the other (inflammation) which creates a vicious cycle.

3. Chapter 4: “Western diets typically contain an abundance of proinflammatory omega-6 fatty acids and are low in anti-inflammatory omega-3s.” (p. 96). In other words, dietary fish oil helps promote healing and may lower symptoms due to inflammatory diseases. More fish oil, less vegetable oil.

4. Chapter 5: Links between stress, depression, PTSD, hostility and inflammation. Each of these things increases inflammation, increases sleep disorders which in turn…(you get the picture).

Okay, does anything help l0wer stress and increase healthy immune system functioning? This is the answer I promised at the top of this post. Are you ready? It is so simple you will hate it!* (that will be something to explore at a later date–why do we resist the things we CAN do to help our situation?)

1. Diet. Having a better (lower) ratio of Omega-6s to Omega-3s (more cold water fatty fish) seem to lower rates of depression. Higher Omega-3 consumption predicts lower suicidality, lower depression, and bipolar disease. It appears these amino acids help stop the overactive inflammatory response caused by repeated stress.

2. Exercise. It will initially raise inflammation markers (hence why many with RA feel that any exercise creates more pain), but later lower it if continued on a regular basis.

3. Counseling. Cognitive-Behavioral social support interventions have shown to reduce the inflammation effect by lowering stress. be effective in doing just that.

So, encourage your stressed clients or friends (even better, do it with them) to eat well, exercise (just walk!) and seek social support. In doing so, they will find relief from inflammation and the effects on the mind and body. I guess it is time for me to get up from this desk, skip the doughnut, and walk up to the library for a bit of exercise. On the way, I should stop by a colleague’s desk and get him to come with.

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*Simple? Yes. Quick fix? No. Sure bet to solve all our problems? Absolutely no.

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Filed under counseling, counseling science, counseling skills, Depression, Psychology

The good and bad of new diagnoses


A draft of the next edition of the Diagnostic & Statistical Manual (DSM-V) has been posted to their website and open for comments by users. The website breaks out the changes being considered in categories so it is easy to find your area of interest.  The final edition isn’t expected until 2013.

Diagnostic changes can be a help and a problem at the same time. When DSM IV removed Multiple Personality Disorder in favor of multiple diagnoses for clarifying dissociative symptoms, that helped clinicians be more descriptive of their client’s struggles. In this new proposal, they plan on eliminating Asperger’s Disorder and subsuming a number of diagnoses (Retts, PDD, etc.) into one diagnosis: Autistic Disorder. I would think this would not be helpful as it reduces specificity.

How about this new entry: Temper Dysregulation Disorder with Dysphoria? A new diagnosis for children? I think it may help in that it might hinder the ever popular “bi-polar” label given too quickly to children (and accompanied with serious meds). On the other hand, it probably will make quite a few roll their eyes. The label doesn’t have that ringing medical sound to it. Not that I’m disparaging the symptoms it tends to cover. There are children who mood is so easily dysregulated, whose reaction to frustrations are way over the top. These children tend to be impulsive to boot. Something isn’t right, but what best identifies their struggles; the etiology of their problems?

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Filed under christian counseling, Psychology

Blogging this month for the Society of Christian Psychology


This month (really, the 4 Mondays of February), I’ll be the guest blogger at the Society for Christian Psychology’s site. You can find it at www.christianpsych.org or from my links on this page. Here’s a tease from my first post:

Should Christian Psychology become a Profession?

Right now, in the Commonwealth of Pennsylvania, lawmakers are considering a bill that would place more restrictions on who can provide counsel. Currently, the state has a number of mental health credentials. Among those is the Licensed Professional Counselor credential for those with a requisite master’s degree and post graduate supervised practice. If passed, the new bill will not only protect the title of “Professional Counselor” but also the practice of professional counseling. Per the law, one may not “style” themselves as a counselor unless they are licensed as such.

Who does this effect? This will especially impact the many Christian counselors who are not licensed but practice a form of counseling (aka biblical counseling, Christian counseling, etc.). While these counselors do not provide diagnoses or bill insurances they do collect fees, keep progress notes, maintain confidentiality, and provide counsel for those struggling with issues such as anxiety, anger, depression, marital conflict and the like. So, the 64 million dollar question: Do these unlicensed Christian counselors “style” themselves as professional counselors? And who decides the line between the two? As an aside, the bill does contain an exemption for pastoral counselors. Pennsylvania does not yet define that title but in other locales that title is reserved for those ordained, trained in a pastoral counseling graduate program, and doing work in church-related institutions.

Here’s where the bill gets interesting. It describes what typifies a profession that might overlap with counseling but have a separate (and thus exempted) identity and practice. Here are some of the criteria they might use to discern a separate profession (note my bolded text to emphasize interesting details):

[For the rest of this post, click here.

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Filed under biblical counseling, christian counseling, christian psychology, Christianity, counseling, counseling and the law

Harmful counseling?


This month’s edition of American Psychologist has several interesting articles about the negative effects of therapy. The article by David Barlow, “Negative effects from psychological treatments”, provides a good overview of the effectiveness research controversies. But instead of focusing on how best to collect data about the benefits of a treatment, he gives some attention to looking more clearly at who benefits from a treatment and who is made worse (using dismantling type studies).

The next article (by authors Dimidjian and Hollon) gets at the definition of harm. Defining harm is rather complex. That a client may not get better from a treatment or may get worse during a treatment is not necessarily evidence that the treatment caused harm. And true to form, we have to accept that some treatments may both harm and help (they give the illustration of a nursing mother on medications: it may help her and yet harm her baby). Or, a treatment may make someone worse at first but then help them later on. Or, the treatment may be just fine but the practitioner may use it in a way that is good or bad. Finally, a treatment may be thought of as harming a patient when in fact what is seen is the normal trajectory of the disease.

So, how do you get at understanding whether a counseling treatment harms? They offer a number of methods for research which I won’t get into here.

Finally, the last article covers training implications (Castonguay et al). They cite therapists’ frequent underestimation of treatment failure and client deterioration. Looks like about 5-10% of clients get worse in treatment. If one wants to train counselors to avoid more failure how might one do that? Castonguay et al suggest that one do so by beefing up (a) proper therapy skills, and (b) skills to identify potentially harmful treatments. On p. 45 the authors include a table of training recommendations, which include

  • expose trainees to list of potentially harmful treatments
  • help trainees monitor change and deterioration
  • enhance relationship skills
  • learn and practice interventions that are empirically supported
  • prevent and repair a variety of relational pitfalls
  • adjust treatment choice, expectations, etc. based on client characteristics
  • Address trainee’s issues (anxiety, hostility, defensiveness, naiveté, etc.) that may hinder counseling

Every counselor fears harming another; fears not helping enough. And it is often unclear whether our work is having its intended impact in the moment. However, there are things we can do to keep the communication lines open and thus listen to our clients about what is helping or not helping. This is what keeps us on our toes. What works for one person harms another. We must not get wedded to one way of helping.

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Filed under christian counseling, counseling, counseling science, Psychology