Creativity in Counseling

Posted on February 28, 2010

[by Leslie Vernick, DCSW, LCSW. Leslie is in private practice, Director of Christ-Centered Counseling www.leslievernick.com, and is our blogger for the month of March. This is her first blog]

I attended a workshop a while back where David Burns, author of the bestselling book Feeling Good, was teaching techniques for managing anxiety and depression. If you have a chance to hear him, go. He’s an outstanding speaker.  What I remember most and have pondered often over the years was a clinical video demonstration he showed where one of his clients, a young graduate student, was in the midst of a panic attack. She was in obvious distress, panting and crying, certain she was experiencing a heart attack. Despite Dr. Burns’s empathic responses that she was in the middle of a panic attack and not going to die, she was not convinced.

No amount of logical or rational argument calmed this woman’s body, although at some level I suppose, she did believe him at least a little bit or she would have demanded he call 911. But the truth was not sinking in as I watched her body and mind continue to be gripped by fear.

As counselors, daily we encounter these kinds of crossroad moments with our clients. They might not be struggling with panic attacks but they are struggling with embracing truth and breaking free from lies. As I watched this video, I thought to myself, how do we convince someone that the lie they so firmly believe is not true? As Christian counselors we know the truth and that the truth sets us free. Yet this woman was not freed from her panic merely by hearing Dr. Burns tell her the truth.

I’m afraid sometimes as biblical counselors, we naively think that instructing someone in correct theology or giving him or her biblical principles on how to live right, will result in a transformed heart and life. Sadly, if you’ve been counseling for any length of time, you know that most of the time, that doesn’t work.

Therefore, I was curious to see how Dr. Burns would handle this case. Instead of arguing his point or disputing this woman’s lie he got creative. He asked her to stand up. Obviously they had a good therapeutic relationship and she trusted him, so shakily she stood up while protesting that she was going to collapse on the floor. Once standing, still trembling with fear and hyperventilating, Dr. Burns asked her to start jogging in place. She resisted, but he assured her that she would not die and reminded her that she was a runner. Slowly she started jogging in place, crying that she could not do what he was asking her to do and that any minute she was surely going to fall down. He ignored her and simply told her to jog faster. While jogging in place, Dr. Burns asked his client how much she believed she was having a heart attack. She answered, “about 95%”.

“Jog faster” was Dr. Burns’s response.  Still protesting, she jogged faster and after another 15 seconds or so, Dr. Burns again asked her how much she believed she was having a heart attack.

“About 75%,” she said, still crying.

Dr. Burns said, “Jog faster”.  The woman complied and a few moments later a small smile began to creep across her face. Once more Dr. Burns asked her how much she believed she was having a heart attack. This time she started giggling, stopped jogging and sat down. She said, “I guess I couldn’t be having a heart attack and jog faster at the same time.”  Jogging helped her experience the truth.

As I’ve thought about this clinical demonstration I’ve wondered just how I might do something like this with my clients who get so stuck in their lies. What kinds of creative things can I do that will help them experience the truth so that they are free to let go of the lie?

Here’s one that provided that “ah ha” moment for one of my clients. My office is located in my home. I have a perfect set up with a walk-out basement that has a separate entrance. Outside my office I have some beautiful gardens.

 I was working with a young woman struggling with mild depression, insecurity and low self-esteem. She constantly compared herself to others and always fell short (in her own eyes). She knew the scriptures, that she was fearfully and wonderfully made, she was unique, and all the things we typically would say to help someone stuck in such lies to think differently, but nothing was really helping her to actually think differently.

So one day I invited her to take a walk with me in my garden. I asked her what she saw. She commented on the flowers, some bold and flashy like the big roses. Others more delicate and hidden like the bleeding hearts tucked under my deck.  “Which one is the best?”  I asked?

“I don’t know” she said. “They’re all beautiful in their own way.”

“You’re right. But what if the bleeding heart had compared itself to the rose?” I said. “What if it thought ‘because I’m not bold and flashy and I don’t have big flowers that people use in bouquets or give as gifts, I must not be important or as beautiful?”

My client smiled. She got it. She was not a rose, but more like a bleeding heart. She was delicate and had smaller flowers that were too fragile to pick or put in bouquets. Nevertheless, she did see that in her own way, she too could be beautiful.

Like Dr. Burns did with his audience that day, let’s share with one another some creative ways we have helped our clients experience the truth.

Using Scripture in Christian Counseling

Posted on February 21, 2010

In my mind, Christian psychology’s value comes from being able to develop a solid foundation and praxis of Christian care of souls-something that grows out of careful biblical/theological work as well as the study of human behavior. Those of us who have been talking about and doing Christian counseling for some time must admit that much of what passes as Christian counseling is either superficial Christianity (verses pasted on a theory that exists just fine without the verses) or superficial psychology (a model based on some tidbit of pop psychology research and then morphed in an exquisite but completely fictional science).

Instead of Sunday school applications (where Jesus is the answer to every question) counselors need solid examples of how to engage the Scriptures in therapeutic settings. In a recent issue of our journal, Edification (2:2), I’ve attempted to introduce some practical steps in using the bible in the therapy office. But, truth be told, many have not had good experience in seeing how one might engage the Bible in real life settings. We’re wary of the Band-Aid use of verses, the bible bullets, the superficial applications. So, it makes sense we don’t know how to engage both counseling and Scripture well.

In stark contrast to biblical superficiality, Dr. Mike Emlet has recently published CrossTalk: Where Life & Scripture Meet (2009, New Growth Press). I would encourage every Christian in the counseling world to read it. Mike’s book provides a great introduction to connecting (more of) the bible to real-life human trials and tribulations (e.g., beyond the Psalms!). Though he is a seminary professor and biblical counselor you won’t get bogged down into esoteric discussions of exegesis or genre (though you can see he understands the concepts) or finding a verse for every problem (though you can see he believes that everyone finds themselves in the pages of the bible).  Rather, Mike focuses on “redemptive dialogue” (vs. mere instruction) and how the Gospel is more than belief but the repetitive, transformative meeting with God. 

Here are three gems from the book to whet your appetite.

If you think your counseling training lacked clear teaching on how to think about Scripture and its application to everyday life (beyond timeless maxims and warnings); if you avoid using Scripture in counseling because doing so sounds trite, then I recommend you take up this book and consider how the narrative use of Scripture might enrich your counseling work.

Christian Psychology and Mindfulness

Posted on February 14, 2010

(by Philip G. Monroe. Associate professor of Counseling & Psychology at Biblical Seminary. Dr. Monroe is our blogger for the month of February and this is his third post. Dr. Monroe maintains his own blog at http://www.wisecounsel.wordpress.com/)

Christian psychology exists to promote distinctly Christian study of the nature of persons, problems and solutions. Eric Johnson, our society’s leader, has done a masterful job outlining the nature and foundation of Christian soul care in his 2007 Foundations (IVP) book. Now, the next step is for us to develop detailed conceptions of a variety of common human struggles and helpful interventions.

But Christian psychology need not re-invent the wheel. Other psychologies (e.g., secular, Buddhist, humanist, etc.) have explored common human behavior patterns in helpful ways. One such concept getting a fair amount of attention is that of “mindfulness.” I first read about mindfulness some years ago in the work of Marsha Linehan. Dr. Linehan is the main developer and researcher of Dialectical Behavior Therapy, a research supported treatment protocol for those suffering from Borderline Personality Disorder. Dr. Linehan has referred to herself as part behaviorist, part Buddhist, and part Dialectical philosopher. Her treatment consists of 4 main components, one being based on Buddhist principles of mindfulness. More recently, cognitive therapists have adopted mindfulness as an intervention in place of (or at least alongside of) the core work of challenging cognitive distortions. Since then a number of careful studies employing mindfulness as an intervention seem to indicate that the technique works-possibly even better than techniques designed to challenge or distract from anxious talk. Those who practice it see a reduction of anxious and depressive symptoms.  How might Christian psychologist think about mindfulness practice?

What is it?

Mindfulness is defined in several parallel ways. In short it is conceived of a non-judgmental, present-tense, accepting awareness. [I've blogged on mindfulness before. You can find these additional thoughts here and here]. It is the absence of judgmental attitude with an emphasis on describing rather than categorizing. It is the being focused on the present rather than the past or future. It is an attitude of openness to experience.

 How should we respond to it?

The Christian therapist might rightly have some concerns about mindfulness. Buddhist beliefs about the goal of eliminating desire do not comport with Christian theology. Further, Christians are called to judge between right and wrong. Clearly, relativism isn’t part of Christian doctrine. However, are there facets of the practice that do comport with Christian foundations of soul care? Some integrative counseling models might include mindfulness from a purely utilitarian standpoint: it can be described without emphasizing Buddhist foundations. However, a better process would be to develop a foundation for consciousness and awareness of one’s surroundings using Biblical principles and Christian tradition.

Building a Christian psychology of mindfulness?

A Christian psychology of mindfulness might start by identifying the problem of distorted thoughts, perceptions and judgments and their genesis in the mind and heart. Second, the model of mindfulness might articulate the proper cognitive and attitudinal engagement in an unpredictable and frightening world.

The study of Buddhist mindfulness may encourage the Christian psychologist to re-investigate similar concepts from early Christian writings. For example, one might consider those spiritual disciplines designed to center one’s mind in Christ or to be “watchful” of thoughts. For example, IVP is preparing to release a new book entitled, Life in the Spirit: Spiritual Formation in Theological Perspective. In this book, James Wilhoit (Wheaton College) has a chapter on centering prayer. Building on the writings of Christian forbearers, he depicts a prayerful stance of observing the thoughts. The goal is not emptying the mind but maintaining conscious connection with the Spirit. Such activity opposes “what if” or “if only” kinds of hypervigilant thinking-thinking accompanying depression and anxiety and which hinders contentment.

In a recent phone conversation, Jim Wilhoit described the concept of watchfulness as an “intentional construal of the world” from God’s perspective. In my thinking, this form of mindfulness does not grasp after logical constructions (e.g., Psalm 131) but observes (a) the world as God sees it, and (b) the common but distorted scripts used as substitutes.

While I have not articulated a clear picture of a Christian psychology of the mind, I hope that my ramblings may encourage someone to build a rich model of mindfulness from our Christian tradition that avoids conceiving of the mind as only a logical instrument to talk ourselves out of feelings and perceptions.

Do No Harm

Posted on February 7, 2010

(by Philip G. Monroe. Associate professor of Counseling & Psychology at Biblical Seminary. Dr. Monroe is our blogger for the month of February and this is his second post. Dr. Monroe maintains his own blog at http://www.wisecounsel.wordpress.com/)

Every counseling ethics code in existence includes this principle: Do no harm. This maxim is drilled into the heads of counseling students (and any other medical professional as well). Our work should help, not hurt. Who could disagree?

But pause for a minute and consider how you might evaluate whether an intervention helps or harms. What criteria will you use? From what vantage point will you evaluate the criteria you choose? If a medical treatment extends life for an ill patient that would seem good-unless it keeps them alive and in a vegetative state with no possibility of recovery. Some would then wonder if the treatment was indeed best. Or, is it harmful if marriage counseling encourages truthfulness between spouses leading to the revelation of a terrible betrayal leading on to divorce and financial ruin? If honesty is your criteria for helpfulness, then the intervention is sad but helpful. If stability is your criteria, then such counseling is harmful. We could go on and on. Do we use client interpretation of whether treatment is helpful or counselor observation? Do we consider the difference between short and long term evaluation? And importantly for Christians, do we consider only statistical analyses or do we also consider biblical categories (e.g., intervention “A” leads to increased positive affect but encourages clients to pray to another deity).

Despite the muddy water I just churned up, I want to argue that Christian psychology is well poised to help Christian counselors provide treatment that does not harm. This society includes some of the best philosophers, theologians, sociologists, clinicians, and researchers of our day. These members are interested in looking at how people grow and change, how the bible connects with everyday life, common human struggles and effective interventions, etc.

How then do we go about refining our practices and avoiding harm? Let me suggest some steps we might take:

That would be a good start. Now, I’m not under some delusion that we will agree completely on any one of these issues. But, clarifying agreement, identifying disagreement might bring our work into better focus. I suspect we will find much that ought to be fixed and a sadly needed increase in Christian counselor humility.

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