What’s In a Name?

A common point of confusion when seeking care from a mental health professional is the difference among psychiatrists, psychologists, social workers, and counselors. While there is some overlap among the professions, here’s a quick run down of who does what and in what way.

Psychiatrists

Psychiatrists are medical doctors (M.D. or D.O) trained in the diagnosis and treatment of mental illness. They have attended medical school and are able to prescribe psychotropic drugs in the treatment of some mental disorders. Psychiatrists often have a keen eye for diagnosis, especially differential diagnosis between physical and mental illness. They are also the best resource for monitoring medication effectiveness and side effects over time. Primary care physicians may also prescribe psychotropic medications, although PCPs will generally manage medications only for patients with fairly straightforward mental health issues. More complex or long-term cases often warrant referral to a psychiatrist. Psychiatrists do not typically provide counseling aside from medication counseling.

Psychologists

Psychologists are mental health providers who have earned a doctoral degree in psychology (Ph.D. or Psy.D.). Often, psychologists are the best trained professionals to administer assessments and conduct psychological research. Many are trained in counseling psychology and also provide counseling to individuals, couples, and families. A psychologist’s expertise in counseling often varies depending on the focus of their doctoral work. Psychologists do not prescribe medication.

Social Workers

Licensed clinical social workers hold masters degrees in social work and are the most similar in training to professional counselors, with some distinctions. Traditionally, social workers have been trained in case management to assist individuals with meeting their basic needs, but social workers are also able to help individuals with personal needs via counseling. LCSWs can provide counseling services to individuals, couples, and families. They cannot prescribe medication.

Professional Counselors

A professional counselor holds a graduate degree in counseling. The training of professional counselors allows them to diagnose and treat mental disorders and relational problems in families and couples. Because the bulk of a counselor’s education derives from counseling theory and technique, the counseling process is more of a focus for professional counselors than diagnosis, assessment, or connection with resources, although a counselor is familiar with these skillsets. Professional counselors can provide counseling services to individuals, couples, and families. They cannot prescribe medication.

 

Please refer to the ACA’s Professional Counseling Fact Sheet for more information.

Advent

Many counseling practices experience a significant increase in calls around this time of year. Despite choruses of comfort and joy, the holidays often bring feelings of loneliness, stress, sadness, and relational discord. The way we are supposed to feel as depicted in commercials and movies causes us to experience dissonance when we realize how we are actually feeling in comparison. Something is amiss.

Advent Candles

We would do well to view that realization as a gift. In essence, God is shining a light on the brokenness so we can yearn for something better. And isn’t that the central idea behind Advent? We hope for that which is better. Within ourselves, we seek peace, joy, grace, love, faithfulness to win out against our frenzied, sad, self-righteousness, begrudging, and fickle hearts. Within our world, we long for Jesus’ grace to captivate our souls and for His Kingdom to restore all things. Advent is about hoping and longing for that which is better.

If you have noticed that something is amiss in you this holiday season and you long for a way of being that is better, call a counselor. Make an appointment. Don’t live another year stuck in the same patterns of thinking, behaving, and relating. God desires for you to hear His good news of grace and restoration again and again. He longs that you experience freedom from captivity and release from darkness (Isaiah 61). If you have not yet done so, carve out time to intentionally celebrate Advent and yearn for Christ’s coming- both in your life and in those among you. The Advent Project by Biola University offers one beautiful way of pilgriming through Advent that features Scripture, written reflections, music, and visual art to help engage our senses as we “earnestly contemplate the wonder and mystery of Christ’s coming to earth.”

The introduction to the afore-mentioned Advent Project reads, “The frenetic activities of the holidays tend to work us up, while the spiritual practices of Advent quietly focus our souls.” Take time this Advent to intentionally and deliberately focus your soul and consider the ways God might desire to lead you out of captivity and darkness as you prepare for a new year ahead.

Adolescents and Eating Disorders

According to the National Association of Anorexia Nervosa and Associated Disorders, nearly 95% of those who have eating disorders are between the ages of 12 and 25. For about half of those individuals, depression is a simultaneous issue.

Many people blame television, pop culture, and social media for the onset of eating disorders. Indeed, the media bears its fair share of the responsibility (check out a NYT summary of this famous research study done on Fijian adolescent girls), however, the cycle in which many adolescents find themselves caught actually has much more to do with painful emotions than media pressure.

The cycle tends to go like this: You feel uneasy (i.e. anxious, sad, bored, resentfbulimia-bigul, etc.). You desire to cover over those feelings, so you use food as the drug of choice (either abstaining or consuming) to cover those feelings. After temporary relief, you feel guilt, shame, self-hate, or hopelessness, which renews a sense of self-hatred that then emotionally predisposes you to repeat the behavior. Food is not just food, but a tool to get the release you’re seeking (Jantz & McMurray, 2002). The longer the behavior goes on, the more it is reinforced by both the body and the brain. Many adolescents lack the emotional vocabulary and other resources to cope with unpleasant emotions, leaving them with few alternatives but to continue the cycle.

The good news about eating disorders is that decreasing those unpleasant feelings and helping an individual find a sense of security and calm can take away the urgent need to cover unpleasant feelings. This very action interrupts the cycle and allows space for the development of healthy coping behaviors to help with those unpleasant emotions that all of us experience. This process takes time, especially when considering how long it took these patterns to develop and take root, but it is possible.

If you know someone struggling with an eating disorder, contacting a therapist is a wise first step. The text mentioned above (Hope, Help, and Healing for Eating Disorders by Gregory Jantz and Ann McMurray) is also a helpful resource.

Deep Breathing: Pearl of Wisdom or Old Wives Tale?

You’ve heard it a hundred times: “calm down, take a deep breath” as well-meaning advice on how to handle stress. But does it actually work? And if so, how?

Nervous System GraphicIt’s all a part of the miraculous design of the human body. Our autonomic nervous system consists of two parts: the sympathetic and parasympathetic nervous systems. The sympathetic nervous system orchestrates all of our fight or flight reflexes. Think rapid breathing and the adrenaline you associate with stress. Conversely, the parasympathetic nervous system is initiated by slow, deep- again I say- slow breathing. This calms us down.

Essentially, you can think of the sympathetic nervous system as the gas, the parasympathetic nervous system as the brake. Just like when driving a car, you can’t pump the gas and brake simultaneously, so guiding yourself to take intentional, deep breaths forces your body to slow down and therefore, calm down. While this is happening, your sense of stress and anxiety is automatically suppressed.

In addition to the immediate benefits of decreasing stress and mitigating anxiety, deep breathing is also associated with more far-reaching health benefits. Some research suggests it can offer positive effects on everything from asthma to blood pressure, the immune system to digestion, with some data even implicating an impact on the expression of individual genes.

There’s nothing fancy to it. Breathe in through your nose. Make the breath in last a second longer than you think it should. Pause here as if you are arriving at the initial crest of a rollercoaster. Then, breathe out through your mouth. If you have the benefit of some solitude, let yourself verbally exhale along the way, making a swooshing sound. Allow your shoulders and fists to follow the lead of your breath, tensing as you breathe in and relaxing as you breathe out. You can even make the experience meditative by repeating a phrase from Scripture or ancient liturgy. Lord Jesus, have mercy on me, a sinner.  I am the vine, you are the branches. The Lord is compassionate and gracious, slow to anger, abounding in love. Change emphases where appropriate to help you reflect on truth and soak it in. You could even try incorporating your body into this exercise in other ways. In Celebration of Discipline, Richard Foster describes a technique he calls “palms up, palms down.” While sitting, breathe in with your palms down as you consider an attribute of God’s character and grace. Then move your hands so that your palms are facing up as you slowly breathe out. As you do, make a conscious effort to release specific worries, fears, and sins to the lordship of Christ.

Though deep breathing as a solution to stress and anxiety may sound trite, theological anthropology supports its basic suppositions and science proves its efficacy. Though distinct from one another, our bodies and souls are valued aspects of our personhood and intricately connected to one another. My hunch is that if you give this practice a shot, your experience will add another level of validation. Don’t knock it till you try it!

A Vision for Christian Counseling

ChristianCounseling640x360If you are looking for counseling, you might be wondering what is exactly meant by the term “Christian counseling.” There are some obvious implications, namely that the counselor herself is a Christian and secondarily that the counseling will involve some Christian themes and Christian ethics, but otherwise the phrase can be somewhat ambiguous. What type of counseling is implied by the phrase? What origins does this form of counseling claim? What are the goals of Christian counseling? What actually happens in the room with a “Christian counselor?” How is that different from what may happen in the counseling room with a professional counselor who doesn’t ascribe to the same belief system, or to someone who describes himself as a “biblical counselor?”

I’d like to devote this post to answering the first two questions, which are the more theoretical components to the larger question “What is Christian counseling?”

In its simplest form, Christian counseling applies the truths of Christian theology and the truths of psychology to people’s problems. Because our suffering and struggling often holds spiritual, emotional, behavioral, and biological origins, the solutions to our issues are derived from all of these disciplines. We would do clients a disservice to see problems in a singular way as purely spiritual or purely biological. Compartmentalizing aspects of our humanity as either sacred or secular is an unrealistic way of understanding the human condition. Instead, we are multi-faceted creatures and thus, a multi-faceted approach is required. This does not imply that God is left out of some areas while He is incorporated in others. Rather, if all things are from him, through him, and to him” (Romans 11:36), He is just as present in the application of psychological tools for healing as He is in the articulation of biblical truth. In Christian counseling, there is a belief that all truth is God’s truth, including the truths contained in Scripture and the truths present in the world God so sovereignly created. I am borrowing from David Entwistle’s Integrative Approaches to Psychology and Christianity here when he comments

“If we understand that all of what God created was good, then we must avoid creating an artificial separation between that which is sacred and every facet of life” (p. 9-10).

So the key word for anyone who self-designates as a Christian counselor is “integration.” In Christian counseling, there is a conscious effort to integrate the insights of rigorous psychological science with the timeless truths of the Bible and basic tenets of Christian theology, both in how we understand people and how we understand problems and their solutions. According to Stanton L. Jones (2010) in Psychology and Christianity: Five Views,

“Integration means approaching the discipline and profession of psychology with a commitment to having one’s Christian convictions shape every aspect of one’s work. Because Scripture and the accumulated wisdom of the church in theology leave many areas of uncertainty in understanding and helping humanity, we approach psychology expecting that we can learn and grow through our engagement with it. Because all psychology is infused and shaped by metaphysical and moral presuppositions, we also expect that we may need to modify and reshape what we learn from psychology in light of our Christian beliefs” (p. 125-126).

In this way, Christian counseling derives its origins from God’s word as well as evidence-based practices that have been proven effective for those struggling with all manner of problematic behaviors, faulty thinking, out-of-control emotions, etc.

Now for the last question: Toward what ends? The goal of Christian counseling is to partner with God in His work of bringing restoration and healing to all areas of a client’s life as we move toward the new heaven and new earth waiting for us (Revelation 21). It is holistic and follows God’s vision of restoring every facet of creation: mind, body, soul. This is God’s Kingdom coming to bear on earth. Christian counseling is not merely interested in making a client feel better, although this is helpful and often happens. On the other hand, the profession is not focused only on helping a client grow in their Christian faith, although this is beautiful and often occurs alongside other forms of growth. Instead, the goal is to see authentic healing in the deepest areas of our being; to see broken responses, ways of thinking and relating, patterns, etc. restored to what God originally intended them to be. This is the vision of Christian counseling.

Good Reads: The Gift of Therapy

Gift of TherapyOne of the best books I suggest to people curious about therapy and young therapists alike is Irvin Yalom’s 2009 The gift of therapy: An open letter to a new generation of therapists and their patients. In it, Yalom offers words of guidance to the next generation of therapists in 85 compact, yet meaningful chapters. Topics vary widely, but Yalom’s central ideas include the importance of using the “here-and-now” as a major component of therapy and the subsequent importance of the therapist’s own personal journey and psychological health. Whether it is entertaining the possibility of conducting a home visit or the use of touch in session, Yalom insists that the intimacy and authenticity of the client-counselor relationship is essential to successful therapy. In sum, Yalom is vigilant in his insistence on the preservation of humanity in the client-counselor relationship; holding fast to the notion that counselors avoid the illusion that they can or should be blank slates or that clients can be conceptualized predominantly by their diagnosis and only secondarily as people.

Yalom gives attention to several unique aspects of therapy, such as how to leverage a client’s experience with death (either the death of a significant other or one’s own pending death) in order to help the client seek meaning in life. Yalom also suggests how to use dreams in session and how to approach a client who is resistant to making decisions. Yalom shares his thoughts on appropriate ways therapists can self-disclose and provide honest feedback to clients in session. Practical attention is allotted to the development of fundamental healthy habits, such as timely note-taking and scheduling clients with adequate note-taking and preparation time in between sessions. Overall, The Gift of Therapy may be a better resource for therapists-in-training than any textbook or counseling manual available today. Yalom’s forthright and frank tone is engaging while his insistence on leveraging the client-counselor relationship and the “here-and-now” of the moment with clients is compelling. Yalom is able to conceptualize therapy as an authentic, bold, and transformative reality, something that the budding therapist idealistically hopes it can be, but by the end of the book, also believes it can be.

The Art and Science of Counseling

art-and-science1

It’s been said that counseling is both art and science. Indeed, walking with people through pain and suffering combines the finesse and intuition of a seasoned craftsman with the ardor and precision of a rigorous practitioner. I find that this aphorism resonates with many counselors, and my hunch is that it does so because of the way it speaks to how God is at work in our lives. He reveals Himself to us as the Potter, the Master Sculptor, the One who cultivates beauty from ashes. Yet at other times, our senses are heightened to the brilliance of his meticulous sovereignty at work. We stand amazed at his genius. His work is both art and science.

The fruitful counselor grasps this balance as she partners with God in his restorative work in clients’ lives. There is a particular quality to skillful counseling that can neither be described nor taught. It is art in its truest form- intuitive, creative, perceiving what is and what could be. Yet there is also the rigor of good science- the commitment to following what God has revealed to be empirically true about the way the human mind, soul, heart, and body interact, change, and flourish.

My prayer is that my work would reflect this delicate balance and its fruit would honor the One who artfully and brilliantly knit us together and loves us despite the ways we have fallen apart.