Edwin Friedman on the search for solutions…

Consider Edwin Friedman’s counsel to leaders in book, A Failure of Nerve (Seabury Books, 2007)

In the search for the solution to any problem, questions are always more important than answers because the way one frames the question, or the problem,  already predetermines the range of answers one can conceive in response. (p. 37)

Seems true for counselors as well. How a counselor begins the exploration of a client’s problem narrows the field of answers as to the problem and solutions. Now, assumptions are always present–especially in questions. So, asking questions doesn’t keep the field of view open unless one is willing to ask questions not normally conceived. It is difficult to remember to ask questions that run counter to our initial hypotheses. And yet such questions are necessary if we are going to counsel actual individuals and not mere figments of our imaginations.

What to do with a homeless cat?

Those who know me well know that I’m not a big fan of cats. I’d much prefer a dog the size of a lab. My wife is extremely allergic so I never had to deal with them nor thought that I would. However, in the last week my boys and some other neighborhood children have discovered what appears to be a homeless cat. They have fed it and now it thinks it lives with us. It sits on our steps, tries to get in the house, and follows us like a dog might.

What to do with this skinny-as-rail cat?

My first thought was take it to the SPCA. I’m told though that euthanization is likely. My second thought is to get some other family to adopt it. I’m still in favor of this but my sons tell me “Adoption is OFF the table.” They wish to get a kitty door to allow it to come into our basement through the hatchway. My wife lobbied to have it live in our garage–where it seems to have slept recently since our forgetful boys left the side door open.

Question: Can you have an outdoor cat? In our Philly climate? Won’t we just be feeding the squirrels if we put out food?

Anybody want a cat that acts more like a dog?

Why we fail to act (sins of complicity)

In the wake of the Ft. Hood massacre we are now hearing evidence of a very troubled man–trouble that it appears many observed over the last few years of the Maj. General’s life. Some of his former teachers and supervisors took note of his strange behavior, his loner tendencies, his rages. They even mused about his possible move into psychosis. Despite these notations, they moved him on to a place they thought (so the reporting is going) he would not get into trouble. In the words of one person, where his dangerousness would be limited by the number of mental health professionals serving alongside him.

Lest we pick on the military alone, we could level charges of ignoring problems on those around Madoff, the mortgage crisis, and any other recent scandal.

The truth is this: we see things that need our attention; our voice. And yet, we often fail to act. Why? Here are some reasons:

1. We’re not sure what we are seeing or feeling. We have trouble adding up the problem
2. We don’t want to make a mistake and look foolish
3. We hesitate due to empathy
4. We don’t want to intrude on the rights of others
5. We assume someone else is more responsible
6. We don’t want to make waves, we want to avoid conflict
7. We think the person we are concerned about it will take care of it on their own
8. We deem the situation not relating to our own interests
9. We underestimate that Satan intends to deceive us into doing nothing so that evil may reign

I’ve had a couple of experiences where I didn’t act and should have–a client “playing” around with life threatening behaviors, a friend beginning an emotional affair with someone not her husband. After the fact, everything looks clear and obvious. Duh, hospitalize the client, confront the friend. And yet in both cases I acted but more slowly than I should. If there is one big reason: I think things were fine in the past and so they will be fine in the future, and so I fail to adequately assess the present.

 

 

When Sex in Marriage Doesn’t Work

Today is the first full day of the CCEF annual conference in Valley Forge, PA. The conference is entitled, “Sex Matters” and so all plenary and breakouts are on said theme. It is not too late to drop by if live in the area and want to register. I believe they will still take walk-ups.

Besides the faculty-led plenary sessions, Lauren Winner (Girl Meets God; Mudhouse Sabbath, & Real Sex) will speak on Saturday. For those of you who can’t come, CCEF sells mp3 downloads on their website.

I will be providing an hour long seminar entitled, “When Sex in Marriage Doesn’t Work” at 4 pm today. We will focus on desire, arousal, technique, and relationship problems (whether perceived, physical or emotional) couples sometimes encounter. Slides and an additional home-grown sex therapy questionnaire is available here (#16 on the list, scroll to the bottom).

The best part is that after I’m done, Biblical Seminary is hosting a pizza party for current students and alums (5:30p) at our information table.

On-line counseling courses through Biblical Seminary

Those interested in taking an on-line, graduate-level counseling course might wish to consider this new joint offering from my school, Biblical Seminary, and the Christian Counseling & Educational Foundation (CCEF).

Counseling in the Local Church (2 credits)

The course is taught by Dr. Tim Lane, Director of CCEF and runs from 1/18/2010 to 3/19/2010. It is completely on-line with mp3 lectures, assignments, and threaded discussions with others in the class. You can register here for this class. If you have Internet access and an undergraduate degree, you can take this class.

Later in Spring 2010 we will offer David Powlison’s Dynamics of Biblical Change.

CCEF started Biblical’s counseling program back in the mid 80s and has continued to lend their faculty to courses here and there at Biblical. They have been offering on-line and residential courses (non-accredited credits) for 25 years. In my personal opinion, our joint venture brings together quality biblical counseling and theological expertise with practical and professional counseling expertise!

Now, we have a chance to work together to provide on-line students with quality teaching from CCEF but now for academic credit. (You must have an undergraduate degree already)

What can you do with these credits? Well, for one, you could apply them to a number of Master’s degrees at Biblical. They could count as elective credits in our MA Ministry, MDiv, or MA Counseling program. Second, you might seek to have them transferred to your own local graduate school program. Biblical Seminary is ATS and Middle-States accredited and so will be considered a legitimate institution. However, you should know that every school sets its own polices regarding transfer of credits. Usually they look to see if the course fulfills a course they would have required in their own program. Remember that it is up to you to find out if they will transfer.

Or, you can just take them because you want to be enriched! We’d love to have you as a student!

Stress & Christian mindfulness, part 2

In the last post I reviewed some simple definitions of mindfulness, including some of the Buddhist ideas behind a version of mindfulness. In this post I want to consider how mindfulness, when reconsidered in the light of Christian thought, can be a valuable part of counseling practice.

A thought about mindfulness and the brain

Let me detour to one more thought about biology and mindfulness. What happens in the brain when a person is practicing mindfulness? Thought and feeling patterns result in neural activity in the brain (or is it the other way around?). Repeated neural activity creates stronger connections between neurons (increased synaptic activity and denser connections with neurons in the same neighborhood. Repeated activity leads to greater blood flow and activation in particular regions of the brain. Neuroscientists call this neuroplasticity.

Thus affective and cognitive patterns can indeed change your brain. Think about this. What patterns of thought do you engage in on a repetitive basis? Do you have a habit of fantasizing? Mulling over bitter or jealous thoughts? While some of these may come naturally to you, what you do with them may actually change or strengthen neural connections in the brain–for better or for worse.

Is mindfulness healthy or relativistic?

Mindfulness, no matter whether you take a religious, consciousness, or relational approach to it, includes the stepping back from shoulds, oughts, and other judgments. One might think that this would be dangerous for Christians. Within Christianity, there are rights and wrongs, truth and lie, righteousness and unrighteousness. The Bible is, among other things, the single guide for Christians to determine how to live for God. SO, it begs the question whether Christians should be wary of anything that seems to let go of shoulds and oughts?

Another view of shoulds and oughts

In my experience, those suffering from anxiety and depression suffer from a disorder of judgments. They are flooded by shoulds and oughts. Their self-talk does not seem to come from the Lord but are already laced with prejudice. “You should have been more vigilant against danger AND you weren’t. You’re a failure.” “You shouldn’t be rebellious BUT you are always a screw-up.” “I shouldn’t have to suffer this way AND God must not care for me.” Notice that most of these forms of judgment are careful consideration of the facts and experiences but well-formed opinions that may be based on only a smidgen of the actual events in their present circumstances.  Notice that these forms of ruminative thinking come in disguise as careful, logical thinking. They are not. What they are narratives–well-practiced narratives–that have an already formed conclusion that we repeat regardless of the actual facts of our lives.

Mindfulness, then, is stepping back from these narratives. Mindfulness is a practiced discipline of just noticing and describing events so as to process them more carefully instead of automatically repeated a script or mantra. Mindfulness provides the opportunity to discover “what is” rather than compound suffering by focusing on what we just assume. Consider Dan Siegel (The Mindful Brain, p. 77)

When the mind grasps onto preconceived ideas it creates a tension within the mind between what is and what “should be.” This tension creates stress and leads to suffering.”

While I’m sure I would vigorously disagree with Siegel on what a preconceived idea is, on what can be healthy “should be’s”, and much more, he has a point worth considering. Have you ever engaged in a fantasy conflictual conversation with someone you are about to meet. You play out yourself winning, being mistreated, standing up for what is right, and so on. Notice how such conversations aren’t useful. They only increase your level of stress because your brain responds to the inner drama as if it were really happening, when it has yet to happen. In this way, Siegel is right. We create tension that leads to suffering.

Using mindfulness in Christian Counseling

I’m running out of room here and won’t be able to do justice, in this post, to the most practical part of mindfulness. [Isn't that just like us academics. We spend all our time pointing out problems but we never solve anything!]. Mindful practice may include time practicing being present in one’s surroundings. The counselor may encourage clients to take in their surroundings. While many thoughts may race through the brain, the mindful person may choose to not follow them but “drink in” the creation beauty around them–things growing, art, or anything that is a delight to the senses. This form of discipline must be practiced in de-stressed times so that it will be available during a crisis–just like a basketball player practices free-throws over and over so as to make the shot when there is only 1 second left on the clock.

Such work is the work of taking every thought captive. and resting (a la Psalms 131) without grasping after things “too wonderful” for us.

Stress & Christian mindfulness, part 1

I’ve written about mindfulness in the past and based on numbers of folks coming to my blog looking for information about Christianity and mindfulness, I thought I might write just a bit more here. My intention is to write in two parts. Part 1 will cover some basics about stress and the idea of mindfulness. Part 2 will explore how Christian counselors might think critically about the topic and consider its use in their practice.

If this is not a term you are familiar with, you may wish to explore the goodly number of books in your local store discussing the topic. Why the interest? There is clear evidence that mindfulness has positive health benefits by reducing our stress responses to the chaos in our lives. Mindful individuals appear to have greater amounts of patience, able to avoid impulsive responses to stress, process rather than react to emotions, have greater capacities to be curious, open, accepting, and loving.

Stress and your body

It is well-known that small amounts of stress activate the body but larger amounts make us sick. But, did you know that the same biological response system that fights viral intruders activates with high levels of stress? Your immune system works in this manner (okay, my simplistic rendition): Your body senses an intruder. The microphages that come in contact with a virus act like little ants sending messages to their buddies to come and defend the colony. One of the messenger chemicals is interleukin-1. Your resulting fever is evidence that the body is working. But to work this hard, other bodily systems get such down. Your stomach and intestines stop or slow down their contractions, you lose your appetite, sexual drive, you have difficulty thinking clearly. These sick symptoms are more likely the result of your body’s defense mode than the virus that has intruded.

The SAME thing happens with high stress. Your pleasures centers shut down to conserve energy. Such activity decreases clarity of thought and pleasure and thus increases experiences of depression and anxiety. See how a vicious cycle of stress/distress leads to greater symptoms of depression/anxiety–a vicious cycle!

What is mindfulness?

Well, it depends upon who you ask. Definitions range from Buddhist forms of meditation, to being present in the moment, to being aware, to centering prayer, to having a nonjudgmental stance. So, for some it is a religious activity. For others it is a form of consciousness. And still others describe it as a relational “attunement” (e.g., a mother’s awareness of the meaning of her infant’s needs even before the cry; a service dog who picks up subtle clues that it’s owner is about to have a seizure). The truth is that each one of these fragments of definitions captures a little bit of what one observes in someone who is able to, in the moment, stand back from the chaos in their life and not react to it. Such people seem to be alert (not dissociated) to the moment, are being in the moment rather than reacting and doing something, are more likely to be describing events, feelings, perceptions, etc. rather than judging them.

In Dan Siegel’s The Mindful Brain (W.W. Norton, 2007), he lists a number of component parts to mindfulness:

• Intention (rather than reactive), attention (aware), attitude (open, curious, non-judgmental)
• Nonreactive to inner experiences (I notice my inner experience, but I am not merely my inner experience)
• Observation, noticing, describing, labeling
• Attending to sensations; acting with awareness
• Either focused attention on the present or merely noticing all that passes through the mind

What about the Buddhist part?

There are two terms you’ll find when reading up on Buddhist meditation: vipassana (insight, clear thinking), samatha (concentration or tranquility). I’m not a Buddhist scholar but I do believe I’m in the ballpark about these next bullet points:

• The goal is to get beyond (ab0ve) the experience of good and evil; of pleasure and pain to a higher level of experience
• The goal is personal transformation and character development; awareness leading to the drying up of demands (desires?)

It is important to point out that Buddhism is not the only religion that espouses meditational practices. Christianity, from the beginning of the Church, has promoted the concept of meditation, albeit in significantly different form and purpose.

How ought we Christians to think about it?

Some might suggest that engaging in practices that encourage openness, neutrality (which is a misrepresentation of Buddhist practices) open oneself up to the occult. Others might be suspicious of hidden, subtle belief systems (personal transformation vs. Spirit-led transformation). These are legitimate questions. And yet I contend that we do not need to reject these concerns to acknowledge that God has given all humans the capacity to observe and grasp concepts that are true and right–even if we might staunchly disagree with their personal philosophies. This does not mean we take a concept into our life and practices without considerable critical thinking, but it does mean we are open to learning something that our own tradition has lost, ignored, or deemed unnecessary to healthy living.  I’ll attempt to do just that in the next post.

Thinking about moral responsibility and agency in TBI

Tonight I will assigned my Counseling & Physiology students a response paper to the following case study. As you read this fictional case, consider how you might answer these two questions:

1. What are the spiritual issues in this case and how do you consider Tim’s limitations in considering these spiritual issues? What is his personal accountability in light of his functional limitations and injury?
2. How might you advise Tim’s wife and pastor as they struggle to understand and respond to Tim’s inappropriate behavior?

Tim is a 34-year-old, married man and deacon in his church. Prior to a serious car accident 2 years ago, Tim was a successful general contractor generating income over $200,000 a year. 2 years ago, Tim suffered a traumatic brain injury when a drunk driver, traveling at a very high rate of speed, slammed into his vehicle. Damage to his brain was located in the frontal and temporal lobes. Tim spent a total of six months in the hospital and in rehab. Initially, He was in a coma for 3 weeks and not expected to recover. However, he did emerge from unconsciousness and with rehab regained his capacities to walk and talk. His memory is mostly intact, missing only the week prior to the accident and the five weeks post accident. He seems to be able to form new memories but complains that he has to write everything down or he will forget tasks. He also complains that it is hard for him to find words. His friends notice that his speech is slower now. He is oriented to person, place, and time.

Tim’s wife and pastor ask you to meet with him. Tim complies. In session he is affable, talkative, but unsure why others think he needs counseling. He notes that he works hard every day, uses his daily contacts in business to talk about God’s miraculous work in his life. He admits that he smokes now and should quit but that shouldn’t be reason enough to warrant counseling. He signs a release to talk to his wife and pastor.

You learn from his wife that Tim has numerous problems that did not exist prior to the accident. Most notably: he doesn’t complete work; fails to bill clients properly; seems to over-estimate what he can complete; work done does not meet his pre-accident quality; he is easily angered and even aggressive; he curses and smokes 2-3 packs per day (none prior to accident); he drinks; he spends beyond his means; he has periods of deep depression; he engages in foul language about sex; is demanding of sexual activity with his wife (but cannot perform since the accident); he flirts with other women.

Tim refuses to return for further appointments. His wife and pastor come to you to discuss options and how to think about Tim’s behavior. The church board has removed Tim from his diaconal position this week and is likely to initiate church discipline after it was discovered that he made a sexual comment to an 18-year-old girl (he commented (spoke admiringly) about her breast size).

Orbinski on humanitarianism, dignity, and hope

 

Two days ago I had the privilege of meeting and hearing Dr. James Orbinski at the 2009 Frobese Day, an educational conference held at Abington Memorial Hospital each year. Dr. Orbinski is the former head of Medicins Sans Frontiers (Drs without Borders), current head of Dignitas, professor at U. of Toronto, author of An Imperfect Offering, and central figure in the documentary, Triage. Of interest to me was his work in Rwanda during the genocide.

On a personal note, I found him very engaging. When I was introduced to him, he didn’t do the usual handshake and move on. He really engaged me about Rwanda and what work we did and plan to do there and gave a number of encouraging comments that went above and beyond the call of duty. I guess that is one of the characteristics you need if you are a person who goes into distressed areas. You need to connect to the people, figure out what they need and what can be done, and then do it.

First, an assortment of observations presented:

• There are about 6.8 billion people in the world. Some 3.8 billion, or about half, subsist on less than 2 dollars a day
• 1.1 billion go to bed hungry each night. This number grows by about 100 million each year
• Nearly all famines are the function of political conflict rather than acts of nature
• There has been a 24% increase in food prices in impoverished areas. One of the key causes is the increase of developing biofuel. Food is more valuable if it can be made into fuel.
• The World Food Bank is begging for about 23 billion dollars to feed this number of poor. It can’t get it. But, 13 TRILLION dollars has been recently expended to prop up a collapsing international economy.
• In 2000, it cost 15,000 (a year, I think) to provide an individual in Africa the antiretroviral meds needed to survive. Today, with political pressure, it costs 99 dollars
• The drug companies say that it costs 1.6 billion dollars to bring a drug from a new chemical to market (through research & Development). While they do not reveal how it costs this much, it is clear that part of the costs they factor in is the income they expect to make on the drug. So, if you expect to make 10% on your investment, can you really consider that a cost to develop a drug. Apparently, they do
• A recent nonprofit just released three new drugs dealing with neglected diseases in Africa. The costs to bring these drugs to the market was 100 to 300 million dollars. And, the companies selling them are indeed making a profit

A couple of his key ideas:

• Dignity cannot be granted; it must be acknowledged via engaged collaboration and solidarity
• Solidarity is not pity but active compassion
• Hope is not some naive utopian dream, it is “what we do”
• We all need to be political. The first act of politics: speak the truth; The second act: listen
• The worst form of suffering is suffering alone
• We must see it, acknowledge it, give voice to the voiceless and thus allow for dignity even if we cannot solve it
• Optimism and Hope are two distinct concept. Optimism is confidence that one’s actions will work for the best. Hope is confidence that the action you are about to undertake is the RIGHT one no matter the outcome
• We need those with daring ideas, with visions of possibilities. That is all there is. Hope, is in his estimation, in himself–that he will do the right thing.

While I do not agree with his definition of hope, I do agree that we need more people to move from insight (that a problem exists) to action (that I can do something of value in a hopeless situation). Folks like Orbinski certainly put many of us to shame.

Characteristics of Ego driven leaders

Here’s a link to a blog post on sniffing out ego driven leaders (teachers, pastors, future employees, etc.) you might find helpful. Cavman, a thoughtful pastor, lists a set of characteristics about ego driven individuals that he gleaned from a book by Roger Parrott. He, Cavman, writes,

He [Parrott] offers some of the signs that a person is probably driven by ego (getting attention) rather than ambition (advances in the kingdom).

• Live Flamboyantly- drawn to lavishness in things and people.
• Inflate Vision- consistently over-promise and under-deliver.
• Act Invincible- winning is more important than what is prudent and wise.
• Ignore Critics- discredit or ignore those with different ideas, or who offer constructive criticism.
• Crave Adrenaline- gain energy in flagrant risk.
• Exaggerate Actions- exhaust rather than equip their staff.
• Become Sensitive- very thin-skinned, they either attack or isolate.
• Attract Groupies- people who will not/cannot challenge them.  They feed their attention addiction.
• Demand Appreciation- like a drug addict.
• Require Empathy- without offering empathy.
• Listen Poorly- they don’t want instruction, correction or good ideas.
• Enjoy Competition- gaining attention by prevailing over others.
• Control Obsessively- uncomfortable when they are not in control.
• Ignore Boundaries- they assume they are better than others, and not subject to the same rules.