On Resilience


From the recent ABS Community of Practice: my talk on resilience to trauma healing specialists.

<p><a href=”http://vimeo.com/90045325″>Philip G. Monroe – COP 2014</a> from <a href=”http://vimeo.com/americanbible”>American Bible Society</a> on <a href=”https://vimeo.com”>Vimeo</a&gt;.</p>

 

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New Pennsylvania Mandated Reporting Bills Signed Into Law


My local newspaper informs me that Governor Corbett signed into law HB 431 436 and SB 21 and 33 into law today. The paper reports what this means:

“Senate Bill 21 ensures that virtually anyone who works with children in a professional or volunteer capacity, including school personnel, personnel at colleges and universities, youth sports coaches, child care providers, religious leaders, physicians and other health care workers, social services workers, law enforcement officers, librarians, emergency medical service providers and employees and independent contractors for each of those entities are required to report suspected child abuse.

“House Bill 436,” Stephens continued, “adds attorneys for organizations caring for children to this list of reporters, while preserving the attorney client privilege, bringing Pennsylvania in line with a majority of states across the U.S.”

So, anyone who works with or volunteers with children is now considered a mandatory reporter. Attorneys who work for those organizations who serve children cannot keep quiet when child abuse is reported to them. Mental health and other health professionals continue to be mandated reporters when potentially abused children present to them or their colleagues.

Besides expanding who is mandated to report suspected child abuse, HB431 also now requires evidence of 3 hours of training on child abuse recognition and reporting for all seeking PA licenses AND evidence of 2 hours of continuing education on the same subject for all who seek to renew their PA licenses. 30 CE hours are still the minimum required per licensing period, but now 2 of those 30 must be about child abuse recognition and reporting. Not sure if that means the existing mandate to take at least 3 hours in ethics will be on top of the 2 for child abuse reporting or if the 2 for child abuse reporting will count towards the 3 in ethics.

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Comparing ACA and AACC ethics codes: Multiple Relationships


Continuing our review of the ACA and the AACC codes for counselors, let’s take a look at how both codes address the matter of multiple or dual relationships. (See first and second posts about comparing the ACA and AACC code of ethics for counselors and mental health professionals.)

Multiple or dual relationships between counselor and client (or client’s family) are those that combine the professional relationship with one of another sort. If a counselor of a client is also that client’s pastor, that would be a multiple relationship. Other types could combine counselor and friend, counselor and business partner, counselor and employer, and increasingly possible, counselor and social media “friend.” Both codes are concerned about the formation of dual relationships because they become fertile ground for counselor judgment bias and harm to the client. Both see that once a counseling relationship has been formed, that relationship ought to be clear take priority over all others.

The ACA code of ethics prohibits outright the following dual relationships:

  1. Counselor and sexual partner: Counselors may not have sex with clients or their family members
  2. Counselors may not start counseling work with former sexual partners
  3. Counselors must wait at least 5 years before engaging in sexual activity with former clients (and even then may be prohibited)
  4. Counselors may not provide services to friends and family
  5. Counselors are prohibited from engaging in personal virtual relationships (social media) with current clients

Beyond the sexual arena, the ACA code warns counselors to avoid dual relationships or “extending the boundary” of the counselor or supervisor relationship

Counselors avoid entering into nonprofessional relationships with former clients, their romantic partners, or their family members when the interaction is potentially harmful to the client. This applies to both in-person and electronic interactions or relationships. (A.6.e)

When a counselor agrees to provide counseling services to two or more persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person. If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from roles appropriately. (A.8)

So, notice the focus: avoid “extending the boundary” or what we used to call forming multiple relationships with current or former counselees or their family members. Document when you do so to illustrate informed consent, limiting of potential harm, and efforts made to rectify harm when it unintentionally happens

What about the AACC code?  It begins (ES1-140) with these paragraphs,

Dual relationships involve the breakdown of proper professional or ministerial boundaries. A dual relationship exists when two or more roles are mixed in a manner that can harm the counseling relationship and/or the therapeutic process. This includes counseling, as well as personal, fraternal, business, financial, or sexual and romantic relationships. Not all dual relationships are necessarily unethical—it is client exploitation that is wrong, not the dual relationship in and of itself. However, it remains the responsibility of the counselor to monitor and evaluate any potential harm to clients. (emphasis mine)

While in a counseling relationship, or when counseling relationships become imminent, or for an appropriate time after the termination of counseling, Christian counselors do not engage in dual relationships with clients. Some dual relationships are always avoided—sexual or romantic relations, and counseling close friends, family members, employees, business partners/associates or supervisees. Other dual relationships should be presumed as potentially troublesome and avoided wherever possible. (emphasis mine)

The AACC code then prohibits counseling relationships with family and close friends and warns against those “best avoided” (e.g., business associates, club members, etc.). Finally the code addresses counseling relationships within the church,

Christian counselors do not provide counseling to fellow church members with whom they have close personal, business, or shared ministry relations. Dual relationships with any other church members who are clients are potentially troublesome and best avoided, otherwise requiring justification. Pastors and church staff helpers should take all reasonable precautions to limit the adverse impact of any dual relationships. (ES-140-f)

This wording marks a change from the previous AACC code where dual relationships were more positively addressed. The old rule stated this, “Based on an absolute application that harms membership bonds in the Body of Christ, we oppose the ethical-legal view that all dual relationships are per se harmful and therefore invalid on their face.  Many dual relations are wrong and indefensible, but some dual relationships are worthwhile and defensible.”

Agreements? Disagreements? Both codes ban the ending of counseling relationships for the purpose of changing the professional relationship to different relationship, or to engage in sexual activity with a client or a member of the client’s family. The AACC codes requires 3 years before marrying a former client (assuming all other concerns raised are not an issue) whereas the ACA code requires 5 years before engaging in an intimate relationship. The ACA code as extensive concerns about the teacher/student relationship as well as the supervisor/supervisee relationship. The AACC code says little about these (though some can be inferred). The biggest difference, however, is found in the stronger language banning dual relationships in the ACA code where the AACC code warns against possible harm but leaves the door open as long as the counselor knows they have to prove no harm happened and informed consent.

 

 

 

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Free CEs! faith and trauma in the public sphere


On April 23, 2014, I will be the keynote speaker for the 8th annual Faith & Spiritual Affairs Conference put on the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). The conference theme: Trauma and Healing: Faith Communities Respond. My particular talk is geared to illustrate the necessity of engaging the faith community in trauma recovery efforts. Trauma almost always challenges a person’s faith and when mental health professionals do not pay attention to spiritual matters, treatment will likely stall. I will highlight several faith founded trauma recovery interventions being used today in church settings. 

The conference is free to all who register. But registrations are limited. Held at the Philadelphia Convention center. The breakout speakers list includes the Director of Place of Refuge, Dr. Elizabeth Hernandez.

To register click here. NOTE: enter fsac2014 as the redemption code to get into the conference website. CEs provided for SW and PC. Biblical Seminary, an NBCC approved provider, is the co-sponsor to offer counseling CEs. Other CE providers offering CEs as well.

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Comparing ACA and AACC ethics codes: Addressing counselor values impact


Over the next few post I plan to review similarities and differences between the ACA and AACC codes (see this post for the first in this mini-series). Today I want to look at how the two codes talk about counselors as they manage their own value systems with their clientele.

The ACA code raises the issue of values like this:

  • Section A Introduction

Counselors actively attempt to understand the diverse cultural backgrounds of the clients they serve. Counselors also explore their own cultural identities and how these affect their values and beliefs about the counseling process.

  • A.4.b. Personal Values

Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

In addition, the ACA clearly states that when there are significant values differences, a counselor is NOT to make referral on the basis of values differences alone. Values clashes cannot be treated as lack of competency in a particular area of counseling.

  • A.11.b. Values Within Termination and Referral

Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

The AACC code addresses the value systems of the counselor in these sections

  • ES1-010 Affirming Human Worth and Dignity

…Christian counselors express appropriate care towards any client, service-inquiring person, or anyone encountered in the course of practice or ministry, without regard to race, ethnicity, gender, sexual behavior or orientation, socioeconomic status, age, disability, marital status, education, occupation, denomination, belief system, values, or political affiliation. God’s love is unconditional and, at this level of concern, so must that be of the Christian counselor.

  • ES1-120 Refusal to Participate in Harmful Actions of Clients

Within this section are paragraphs discussing the application and limits of the “do no harm” virtue to certain client behaviors deemed not to fit within the biblical framework articulated at the beginning of the ethics code. The AACC code expressed an ethic to avoid supporting or condoning (while respecting and continuing to help) in the following areas: abortion-seeking, substance abuse, violence towards others, pre or extramarital sex, homosexual/bisexual or transgender behavior, and euthanasia. On this last issue, the ACA notes that the duty to breach confidentiality may be optional (thus indicating a values insertion since in all other cases we have a duty to breach confidentiality so as to warn others or protect the life of our client).

  • 1-530: Working with Persons of Different Faiths, Religions, and Values

Counselors work to understand the client’s belief system, always maintain respect for the client and strive to understand when faith and values issues are important to the client and foster values-informed client decision-making in counseling. Counselors share their own faith orientation only as a function of legitimate self-disclosure and when appropriate to client need, always maintaining a posture of humility. Christian counselors do not withhold services to anyone of a different race, ethnic group, faith, religion, denomination, or value system.

  • 1-530-a: Not Imposing Values

While Christian counselors may expose clients and/or the community at large to their faith orientation, they do not impose their religious beliefs or practices on clients.

  • 1-550: Action if Value Differences Interfere with Counseling

Christian counselors work to resolve problems—always in the client’s best interest—when differences between counselor and client values become too great and adversely affect the counseling process. This may include: (1) discussion of the issue as a therapeutic matter; (2) renegotiation of the counseling agreement; (3) consultation with a supervisor or trusted colleague or; as a last resort (4) referral to another counselor if the differences cannot be reduced or bridged (and then only in compliance with applicable state and federal law and/or regulatory requirements).

Differences between codes?

There are many but let me identify two. Notice that the most significant difference between the two is on the basis of the AACC code biblical/christian ethic regarding what is good and what is harmful behaviors. Both codes express the need to respect persons without regard to their beliefs, values, identities, and actions. The AACC code differentiates between imposing of values and exposing of values. What is the difference between exposing and imposing? I suspect it will be in the eye of the beholder. However, I suspect that one of the results of the ACA code is that faith and spiritual values will be less likely to be brought up by counselors since “not imposing” is more emphasized than “exploring.” There is much literature out there suggesting that the failure to explore and utilize spiritual resources actually harms clients in that it slows recovery.

Both codes address the issue of values differences between client and counselor. Both point to a path (though different) about what to do when this happens. The ACA code places pressure on the counselor to work it out while the AACC code suggests a path to resolution either with re-negotiation or referral. Which one sounds better to you?

When the difference is with a colleague? 

Both ACA and AACC codes addresses differences with colleagues. In section D (Relationships with other professionals), the ACA code states,

D.1.a. Different Approaches. Counselors are respectful of approaches that are grounded in theory and/or have an empirical or scientific foundation but may differ from their own. Counselors acknowledge the expertise of other professional groups and are respectful of their practices.

The AACC codes says something similar,

1-710-a: Honorable Relations between Professional and Ministerial Colleagues. Christian counselors respect professional and ministerial colleagues, both within and outside the church. Counselors strive to understand and, wherever able, respect differing approaches to counseling, and maintain collaborative and constructive relations with other professionals serving their clients—in the client’s best interest.

Fun facts

The ACA code never uses the word “faith”, does suggest counselors need to address self-care (includes spirituality), and does suggest counselors seek to utilize client’s spiritual resources…”when appropriate.”

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New Ethics Codes for Counselors


Both the American Counseling Association (ACA) and the American Association of Christian Counselors (AACC) have published 2014 editions of their codes of ethics (links above to pdf of codes). Given these new documents, I highly encourage all Christian counselors (both professional and pastoral/lay) to review these two codes. Even if you do not belong to either the ACA or the AACC, you should spend some time with these documents. Here’s why:

  • The codes represent the current thinking of the ACA and the AACC about best practices for counselors. Even if you disagree, you need to know where you diverge (both for integrity sake with clients and for protection from unnecessary risk)
  • It is easy to become sloppy about ethical matters. We tend to believe what we do is good. Reviewing our practice habits against a standard can reveal slippage
  • It can be helpful to clients to know what code of ethics you subscribe to. Reading codes can help you determine which code you subscribe to and your reasons for doing so

Comparing Values and Principles

The following chart shows similarities and differences regarding the bases for ethics codes. It is worth reviewing these to see how they compare and contrast. In the next post, I will compare a few specific standards.

Content AACC ACA
Mission 1. help advance the central mission of the AACC—to bring honor to Jesus Christ and promote excellence and unity in Christian counseling;

2. promote the welfare and protect the dignity and fundamental rights of all individuals, families, groups, churches, schools, agencies, ministries, and other organizations with whom Christian counselors work;

3. provide standards of ethical conduct in Christian counseling that are to be advocated and applied by the AACC and the IBCC, and are respected by other professionals and institutions; and

4. provide an ethical framework from which to work in order to assure the dignity and care of every individual who seeks and receives services.

1. enhancing human development throughout the life span;

2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts;

3. promoting social justice;

4. safeguarding the integrity of the counselor–client relationship; and

5. practicing in a competent and ethical manner.

Principles Compassion in Christian Counseling – A Call to Servanthood Competence in Christian Counseling – A Call to ExcellenceConsent in Christian Counseling – A Call to Integrity

Confidentiality in Christian Counseling – A Call to Trustworthiness

Cultural Regard in Christian Counseling – A Call to Dignity

Case Management in Christian Counseling – A Call to Soundness

Collegiality in Christian Counseling – A Call to Relationship

Community Presence in Christian Counseling – A Call to Humility

autonomy, or fostering the right to control the direction of one’s life;nonmaleficence, or avoiding actions that cause harm;beneficence, or working for the good of the individual and society by promoting mental health and well-being;justice, or treating individuals equitably and fostering fairness and equality;

fidelity, or honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in professional relationships; and

veracity, or dealing truthfully with individuals with whom counselors come into professional contact.

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GTRI featured in an online, free journal


Our Global Trauma Recovery Institute is featured in the most recent issue of the EMCAPP Journal for Christian Psychology Around the World. Pages 172-211 include an overview of GTRI, two essays by Diane Langberg (The Role of Christ in Psychology; Living to Trauma Memories) and one by me (Telling Trauma Stories: What Helps, What Hurts).

The journal also contains an essay by Edward Welch (www.ccef.org) where he muses his development as a biblical counselor, explores the matter of emotions and some of the stereotypes of biblical counseling. The journal also includes a large number of essays about Paul Vitz as well as a number about the Society of christian Psychology.

Take a look!

 

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Whose eyes do you see when you look at the suffering?


A friend of mine has written the most exquisite Lenten devotional based on the passage in Mark about the evening of anguish spend alone in the garden.

I commend it to you here.

Why do we suffer? Why is it not removed? This we cannot say. But we can say, as Josh says, that in suffering we see the eyes of Jesus. It is difficult to keep both the depth of our suffering and a sovereign God in sight at the same time. But Josh shows us how without fancy theological argument.

Read it.

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The Power Behind Domestic and Political Dictatorships


The quote by Anjan Sundaram in Stringer continues to rattle in my head. I mentioned him here when I spoke about the power of small-time tyranny–that it lasts only when those close to the dictator look the other way.

Here’s the quote as he talks about being the victim of the dictator’s myth:

It startles me how steadfastly I believed, growing up, that our dictator was just, good and wise. I was never told anything to the contrary. … the indoctrination that holds up the dictator as a savior, a sage, as all-powerful. Until recently this myth usually invoked God, a divine right to power. These days dictators have less need for mysticism: they us the tools of liberty–elections, business, schools, art, the media. The successful dictator creates at once a terror of his presence and a fear of his loss. (p. 61-2)

Terror of presence, fear of absence. Sounds similar to the experience of victims of domestic abuse. Afraid of being hit, afraid of being abandoned. In order to have someone excuse violent and abusive behavior of a dictator, you have to believe that you need them, that what they do is necessary or acceptable in light of a worse outcome. While Sundaram may be right that dictators speak less of divine right, I suspect many religious abusive husbands use a variant on divine right to excuse lording it over their wives. And abusive wives can claim that their husband’s (supposed) failure to lead gives rights to engage in verbal abuse.

What is the power behind a dictator? Myth. Pay no attention to the man behind the curtain. 

True power does not grasp its right but willingly gives up power for the sake of others.  Philippians 2 gives us this clear picture.

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Mapping urban domestic trauma


Our community of practice continues with a presentation by Michael Lyles, MD who presented on the problem of trauma in urban settings. He pointed out how we often think about violence and the connection with trauma in international settings but fail to connect the two in American urban settings. We see angry young men and women who seem calloused and do not value life. Yet, often what is happening is that we have hypervigilant individuals who choose to manage their trauma reactions by being alert and on edge and ready to attack before being attacked. When you bring together poverty, violence and a traumatized population, you develop a chronically meeting most criteria for PTSD but never getting diagnosed.

One study mentioned a few statistics about violence prevalence. 55% of urban children have experienced sexual abuse (compare that to 15 to 15% of US population); 39% have witnessed domestic violence. 27% experienced physical abuse.

To highlight the problem he pointed out a 2o12 Philly Magazine report on trauma in our city. Between 2001 and 2012, more than 18,000 people were shot. During that time some 3800 murders. He noted that suicide rates run about 20% and that number goes even higher when you include “academic suicide”–dropping out of life. In addition, he pointed to the connections between trauma and adrenal overload, hypertension, diabetes, and other physical illness. He also pointed to the scarring that takes place in the amygdala.

He noted a good book to consider: John Rich, MD (Drexel University) Wrong Place, Wrong Time: Trauma and Violence in Lives of Young Black Men.

He ended his presentation considering the role of “Chief Musician” as found in the Psalms. These are folks who listen to the story, don’t debate it, set it to words/music that are appropriate.

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