Evil Hours (David Morris): A Must-Read for Mental Health Professionals


A bit ago, I blogged on David Morris’ new book, “The Evil Hours: A Biography of Post-Traumatic Stress Disorder” and his NPR interview. [You can read my previous post here.] Having just finished reading the text, I want to highlight a few more insights about the book.

Morris does an excellent job describing his experience of trauma and then expanding to the history of PTSD and its impact, both on those going to war and those who have experienced civilian traumas. For those who wonder why Vietnam vets struggle more than WWII vets, Morris helps reveal the falseness of that belief in the beginning of chapter 5.

But the most important chapters of the book are chapters 6 through 9 where he examines therapies designed for PTSD, how research protocols designed to help us know which treatments work best may harm, how drugs and alternative interventions (e.g., yoga) may help and how to think about posttraumatic growth.

Though these chapters are his experience, I would highly recommend every MHP to read these chapters. Skip the first chapters if you must (you should not!) but these are paramount if you are going to work with traumatized individuals. Here are just a few reasons why:

  • Following protocol for therapy can harm a patient. Don’t get me wrong, research IS necessary. But when a protocol is harming a patient, it is important to make sure that research goals do not become primary over the needs of the one who is in need.
  • Prolonged Exposure, the gold standard treatment, has a HUGE drop-out rate. Somewhere around 54%. That should give us great pause. Surgery hurts. PE is like surgery but repeated opening of a wound. The dropout rate should tell us that imaginal work can re-traumatize. There are other methods that may work just a well but do less damage in the process. I think about the changes in the last 10 years for breast cancer. We are discovering that not everyone needs bilateral breast removal to survive. Not everyone needs 30 days of radiation as radiation at the time of lumpectomy may work just as well for some patients. So, we must be less fixed in our minds on treatment protocols and be considering if the patient can improve with less radical treatment options.
  • Cognitive therapies are good but over-emphasize think right = feel right. Such work could ignore the moral complexity of life, especially for those who have moral injuries.
  • The person of the therapist is more important than the treatment modality. This is not to say that the modality is of no consequence. Rather, that good interventions live or die on the capacity of the therapist to be truly human with clients.
  • Recovery must be done in community. Gutting it out alone does not work.
  • Alternatives, like yoga, works for some far better than talking, but shouldn’t be sold as a cure-all.

…yoga stands out as a uniquely effective treatment, precisely because it insists that people shut up and start listening to their bodies. Yoga works to correct the central lie of Western philosophy, which goes all the way back to Descartes, who said that the body and the mind are distinct entities that exist independent of each other. (237)

However, Morris acknowledges that yoga is, “ridiculous”, even “moronic.” Though he is also quick to say, “In the Marine Corps, we had a saying: ‘If it’s stupid but it works, then it isn’t stupid.” (238). “Placebo, wishful thinking, whatever. I’ll take the help where I can get it.” (246, discussing the mixed evidence for EMDR). Yet, be wary of proponents of any one treatment as a cure. They prey on desperate people.

The bottom line is that there is no ‘magic bullet’ for PTSD, and claims to the contrary should be taken with more than a grain of sand. (240)

  • Growth happens but not apart from ongoing trauma symptoms and changes. Too often we expect recovery to mean the removal of symptoms. But, there is no going back. Identity changes, just as it would if you lost your spouse and then got remarried. Growth needs to be observed and underlined, but not assumed to eliminate strong, continuing reminders of trauma.

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On having substantive conversations about race relations


Maybe it has always been this way, but it seems harder these days to have substantive conversations about race relations. I think the same struggle exists when you try to talk about sexual identity, gay marriage and anything else that is a hot button issue today. Does it seem that way to you?

In the realm of race relations, we have dueling images (Baltimore burning v. images of a black man being beaten by police), dueling sound bytes (Baltimore mayor portrayed as giving permission to rioters “space to destroy” property v. Franklin Graham’s “Blacks, Whites, Latinos, and everybody else, Listen up” comment) and dueling diagnoses (racist cops v. thug culture). These seem to generate much emotion and quick reaction but little in the way of deep conversation and understanding.

Who should we blame?

It is easy to lay blame at the feet of ideologically-focused cable “news” programs. Their incessant demand for sound bytes and finding “breaking” news requires that they pump up anything that might be controversial to keep the viewer on the channel. But the only reason these stations need to do this is because of the proliferation of choices from where we get our news. If the show doesn’t deliver, we’ll find our news elsewhere on the television or, more likely, online.

We could also blame twitter and other micro-blogs that allow us to make a point in less than 140 characters. These formats provide “data” but without context enable us to believe we have facts when we only have a single data point.

But in truth, we need to lay most of the blame at our American culture’s feet. We want sound bytes. Like fast food, we want ready-to-consume information pre-packaged and simple. And we are an increasingly angry culture, angry and feeling lost in a sea of divergent opinions. Maybe this is because the comfort we once had living in a homogenous society where everyone appeared to think and believe like us is no longer present.

What can we do?

First, let’s be honest, in some settings and with some people, we may not be able to have substantive conversations about race. The environment may not be right, the other person(s) may not be interested or able due to their pain. In these cases, let us follow the advice of Solomon and remember there is a time to keep silent (Eccl 3:7a). Of course, if  you do remain silent, remember not to gossip about it later.

When we do decide to try dialogue, let us endeavor with God’s help to do the following:

  1. Be quick (first) to listen. Our temptation is often the opposite. We have much to say and we want a hearing. Follow the admonition of James to be quick to listen, slow to speak and slow to become angry (Jas 1:19-20).
  2. Listen to the story behind the opinion. Sometimes we jump to debating facts, especially when those facts are part of the other’s experience. We may be quick to dismiss experience as anecdotal. Yet, the story of pain, confusion, and racializations are worthy of our attention because we are listening to the life and challenge of an image bearer.
  3. Give the best interpretation of what was said. When emotions run high, it is easy to react to things we hear that sound wrong to us. When trust is low, it is likely that we will provide the worst possible interpretation rather than the best. 1 Cor 13:7 reminds us that love “believes all things.” So, give the best possible interpretation of what was heard. If you aren’t sure what the person meant, ask, but do so without thinking you already know the answer. Assume your partner has truth to tell you.
  4. Avoid equalizing pain. Sometimes we fear giving credence to another’s opinions for fear of negating our own opinions. It is quite fine to acknowledge systemic abuse against one people group in one sentence without needing to equalize pain by pointing out an opposing fact (even if it is true). When we try to equalize, our dialogue partner will likely believe we have just negated their point.
  5. Avoid using some impersonal extreme case you heard to make your point. While extreme personal stories need to be listened to and cared for, we can be tempted to tell of an extreme case or fact to make our point. Remember, there are fringe stories but these fringe stories rarely tell the main problem. However, if you believe the other side is using an extreme case, don’t jump on your dialogue partner but listen for substance that you can agree with.
  6. Be willing to confess corporate sin. Both Nehemiah and Ezra confess sin that is not really their own but owned by all of Israel together. Be willing to own and confess the sins of your “people” even if they are not your own sins.
  7. Underline shared truth and shared goals. While you may disagree on most things, be on the lookout for where you can agree and highlight shared truth or goals.
  8. Finally, determine one way to move the conversation to action. Dialogue and understanding are good. Action is better when we work together. Find one thing you can do with your dialogue partner.

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Do we have a theology of trauma?


Over at the BTS faculty blog (here), you can read my post about the need for a theology of trauma. I wrote it a few days ago and coincidentally it was published today as I was listening to Dr. Robert Schreiter teach on trauma in the biblical text. He described the bible as bookended by trauma (death of Abel in Gen 4 to cosmic trauma in Revelation) and the move to read the bible through the lens of trauma.

So how would you articulate a theology? Click my link above and see if you agree/disagree.

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Making the Church a Safe Place for Trauma Victims: WRF Plenary Address


 

 Here are the slides from my plenary address given on March 26, 2015 in Sao Paulo to the World Reformed Fellowship General Assembly. #WRF2015 WRF GA 2015 Presentation

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What does recovery look like after traumatic experiences


After trauma, what does recovery look like? Is it possible to “move on?” How can you when you can never unsee or unremember what happened to you? 

Is it possible to experience joy rather than emotional pain when remembering past or ongoing hurts? If so, just what does that look and feel like for the victim? What can be expected if I am “healed”? Can I be free from the typical experience of trauma (e.g., Hopelessness, despair, anxiety, confusion, shame, anger, loss of identity, feeling stuck but the demand to act as if the trauma did not take place, and spiritual angst over the goodness and love of God)?

As Diane Langberg has so aptly reminded us, “Trauma is the mission field of this century.” Around the world there is much openness to talk about the impact of trauma and to use spiritual practices as part of the recovery process. In Christian language, we talk about healing the wounds of the heart and one of the best programs out there is the Trauma Healing Institute’s, Healing the Wounds of Trauma. This program is based on the strong Christian belief that God, through the work of the Holy Spirit and the Scriptures,  is in the business of healing wounded hearts. At the heart of this belief sits two important passages:

Isa 61:1-4 The Spirit of the Lord Yahweh is upon me, because Yahweh has anointed me, he has sent me to bring good news to the oppressed, to bind up the brokenhearted, to proclaim release to the captives and liberation to those who are bound, to proclaim the year of Yahweh’s favor, and our God’s day of vengeance, to comfort all those in mourning, to give for those in mourning in Zion, to give them a head wrap instead of ashes, the oil of joy instead of mourning, a garment of praise instead of a faint spirit. 

2 Cor 4: 16-18 Therefore we do not lose heart, but even if our outer person is being destroyed, yet our inner person is being renewed day after day. For our momentary light affliction is producing in us an eternal weight of glory beyond all measure and proportion, because we are not looking at what is seen, but what is not seen. For what is seen is temporary, but what is not seen is eternal.  

These two beautiful passages present a picture of recovery. Good news, release, favor, comfort, joy and beauty in place of mourning and oppression. Renewal in the face of affliction. But what does this mean in real life? Does a “double portion” instead of shame feel like to a victim of sexual trauma? What does renewal and release feel like after a natural disaster? 

Prognosis for Complete Recovery?

If you suffer a serious knee injury requiring surgery, you will need time for rehabilitation. But rehab does not necessarily mean you will recover the full range of motion you once had, or that  your knee will be entirely pain free when you are finished with physical therapy. Your prognosis for recovery depends on many factors such as age, extent of injury, physical health prior to the accident, and availability of quality care. Even with the best care provided to top athletes, recovery may not lead to return to top form. For example, an Olympic skier may be able to ski again but not at a quality that allows for competitive skiing. 

What about the prognosis for spiritual and emotional recovery? Of course, just as in the knee injury example, the answer must be “it depends.” Still, considering the two passages above, words like liberation, joy, release, and renewal shape our imagination for recovery. Do we imagine complete recovery to top spiritual and emotional form, without pain and limitation? It appears to me that we sometimes imagine emotional and spiritual healing without taking consideration the reality of broken bodies and a fallen world. We are not guaranteed a pain free life or faith without distressing questions. In fact, Paul’s beautiful words in 2 Corinthians bear this out. afflicted in every way, persecuted, perplexed, persecuted, struck down, always carrying around death, burdened, groaning and more. Yes, he also says not crushed, not despairing, not destroyed, but alive. But both must be considered together at the same time if we are indeed to imagine our prognosis. Recovery means comfort and lament, joy in mourning, perplexed while trusting, dying yet alive. 

Sprouts of Justice and Recovery?

Isaiah describes sprouts of justice and righteousness beginning in the recovery of the oppressed (Isa 61:11). As a gardener, I see sprouts as the beginning of hope. After planting seeds, the tiny sprouts give me hope for a later harvest but that hope is still tempered with the knowledge of the challenge of getting sprouts to develop into fruited plants. I have to be vigilant about bugs, weeds, and drought. I need to cultivate and fertilize or my sprouts will not turn into much. And even if I do everything right, the seed may be weak or the weather may mean I only have spindly or stunted plants that cannot bear much fruit. Yet, the sight of sprouts brings the hope that empowers us to keep at the gardening work. 

So, what are these sprouts of justice and recovery that victims of trauma may first see that encourage hope and further empowerment? Consider some of these: 

  • Capacity to Name Truth and Justice

Recovery begins when oppressed people find words to name injustices done to self and other. For example, a victim of domestic violence may become well aware of the subtle signs of verbal and emotional coercion, long before any physical violence. They become the canary in the mine, aware of poison that others may not yet sense. 

As this capacity grows beyond a mere sprout, the person may be able to speak the truth aloud, even with courage to say it to leaders. 

As naming capacity grows, it moves from awareness of personal risk to capacity to notice and care for the injustices others experience

  • Accepting weaknesses without hopelessness

Part of recovery requires honest reflection of the damage done. Signs of recovery include the ability to recognize limitations and working within capacity without self-hatred (though there may be lament for losses of previously held abilities). When we truly accept the “new normal” we then can stop evaluating daily life from the perspective of who we used to be

As we accept our limits, we can then begin to see the opportunities we do have even within our limitations

  • Identify resilience and new capacities in the midst of struggle

There may be new capacities we never observed before (e.g., the capacity to speak up to power, the ability to withstand rejection, increased empathy for the pain of others). We now notice these resiliences and growth as they stand on their own

Though we will not call the suffering good, we will be able to identify blessings that we have received in spite of and as a result of the trauma experienced 

Be Careful Not to Damage the Sprouts

For those who are not attempting the impossible, to “move on” from trauma and abuse, it is good to remember that sprouts are tender and can be easily damaged with too much interference. You may need to leave a few weeds you see near the fledgling plants so as not to disturb their roots or bruise the green shoots. How do we do this to the sprouts of recovery? We may unintentional limit growth by questioning why the person learning to speak the truth isn’t doing it in a even-tempered manner. Sadly, too often those in domestically violent marriages are told to stop being so dramatic and to calm down when they begin to speak about the truth of the violence they have experienced. Or, we can point out the sins of the victim as if somehow their responsive sins eliminate their right to speak up about the trauma they experienced. Or, we can hear someone accepting brokenness and accuse them of not trusting God for complete healing. 

Nurture recovery as you would a tender plant. It is a scandalous act of grace! By paying attention to safety needs, by bearing witness to trauma, by being willing to lament and to stay connected, we provide a greenhouse for such plants to grow into levels of recovery never before dreamed of. 

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Filed under Abuse, biblical counseling, christian counseling, christian psychology, Christianity, counseling skills, pastors and pastoring, Post-Traumatic Stress Disorder, ptsd

Thinking about offering SKYPE counseling? Think twice!


There has been a lot of focus on telepsychology over the last decade. What started out being about counseling over the phone has morphed to counseling via the video chat, text chat, instant message, social media, and even in virtual settings with avatars.

At times it seems like the wild west, that anything goes without regulation.

But now, more counseling related associations have developed standards for telehealthcare delivery. And licensing boards are also beginning to restrict who can offer telecounseling. Did you know that Georgia only allows Georgia licensed mental health providers to provide telecounseling to its citizens?

Ken Pope has an excellent website listing many resources you will need as you consider what you might be allowed to do. He lists standards of care, recent professional articles, and links to state boards who are beginning to regulate telepsychology. I encourage anyone who currently practices “Skype” counseling (BTW, SKYPE is not HIPPA compliant), to become informed.

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Making the Church a Safe Place For Victims of Trauma


Free resource available here (filmed October 2013). (Overlook that maniacal looking pose from the image below)

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Online Trauma-related (Cheap!) Continuing Education at BTS


[Note: the video-based training described below is available to anyone for free. The information below is for those interested in purchasing continuing education credits after watching the video. If any of the titles interest you, click the link below and start watching right away!

BTS is an NBCC approved continuing education provider. Just in time for those looking for last-minute CEs before renewing their LCSW or LPC this month, please check out our new online offerings. We offer three new trainings:

  1. Narcissism and the System it Breeds, By Diane Langberg, PhD
  2. Understanding and Responding to Dissociation, By Diane Langberg, PhD
  3. Making the Church a Safe Place for Trauma Victims, By Philip Monroe, PsyD

The videos are free for anyone to watch. If you desire CE certificate, the cost is quite nominal in comparison to the usual going rate. Check out the abstract and objectives and follow the links to pay for your CE quiz. Watch the videos, complete the quiz, and we will email you a certificate you can use to claim on your license renewal form.

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Filed under Biblical Seminary, continuing education, counseling, Counselors, trauma

Free Counseling Journal For Counselors


For my counselor readers, I want to let you know of a free counselor journal. Click here for free access with search capacity. It is published by NBCC and is open access to anyone who wants to try to stay current on counseling literature.

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From Protest to Process: Law Enforcement, Race, Trauma, and the Church


In the wake of Ferguson, NYC and many other struggles regarding race and law enforcement, BTS is hosting a free seminar on February 23, 2015 at Temple University to hear community leaders, law enforcement, and mental health discuss some of the struggles and look for ways the church can be a healing force. The hidden matter of urban forms of trauma and impact on the conflict will be the highlight of the night.

Here’s why you should sign up now!

  1. It is Free!
  2. Great speakers: Former Commissioner of Philadelphia Police, Sylvester Johnson, Mike Majors, community leader, Rev. Desiree Guyton, LPC, Dr. Shannon Mason, and Dr. Dan Williams. There may be even more!
  3. Opportunity to ask questions
  4. Though free, space IS limited.

Sometimes we complain and feel the conversation isn’t going in the right direction to solve these complex problems.  I encourage you to be a part of the solution.

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