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Microsoft word - breaking free.docBreaking Free
Clinical Pastoral Counseling, Ph.D. Program This paper reviews the course titled, Breaking Free, and is part of the course requirements for the Ph.D. program in Clinical Christian Counseling. This course is sectioned into 30 separate modules of study, each of which will be addressed in this COMN 101 of this course is titled “Using the Bible and Relying on the Holy Spirit in Counseling”. It proposes that the Christian counselor seeks to help people who are looking for spiritual help, for truth, for purpose, and for meaning in their lives. There are various means through which the counselor embarks to achieve these goals, one of which is his knowledge and use of the Bible as a source of truth. In 2 Timothy 3:16, we are told that “All Scripture is God-breathed, and is useful for teaching, rebuking, correcting, and training in righteousness.” The Bible is pertinent for application in every area of our lives, and it serves as a guidebook for healthy living, speaking to practically every area of our lives. It speaks to basic life issues, to problems that we encounter, and it provides solutions. The Bible is useful in confronting unhealthy attitudes and behaviors, examining these in the light of Scripture, and correcting. It instructs in ways of righteousness through discipleship, spiritual growth, prayer, and through interactive use of the Bible. It is important that we use God’s truth in Scripture as a foundation upon which we provide counseling, and upon which we base all of our decisions. It is also important that we look to the work of the Holy Spirit as our guide to knowing the truth, as spoken of in John 16:13. Lastly, it is important that we let God challenge us and grow COMN 102 is titled, “Living the Life: Pursuing after God’s Heart with all Your Heart”. The essence of this section delineates the nature of true internal transformation which results from our pursuit of a loving relationship with Jesus Christ. It is one thing to seek out external transformations in our lives. These may be through a variety of means, including changes with habits, speech, personality, taste, preferences, values, and priorities. True internal transformation, however, is something entirely different. We are commanded in Romans 12:2 to not be conformed to the pattern of this world, but rather, to be transformed by the renewing of our minds. This internal (or “heart”) transformation leads to a change in our beliefs and attitudes, and ultimately to a change in our actions. Such internal transformations, directed by the power of the Holy Spirit, also bring us into a deeper relationship with God and with others. God created us to be in relationships, both with Him and with others, as reflected in Luke 10:27. One of our roles as counselors is to help connect people in damaged relationships. It is important that we understand gender differences between men and women. It is also important that we seek to focus on real change through acknowledging and understanding the problem, helping clients to connect and relate, and helping them to develop a quality relationship. As counselors, we need to realize that our highest calling is conforming to the image of God’s Son, and that this is done in the heart. COMN 103 is titled, “Breaking Free: Disaffection with God and Life and the Recovery of the Heart”. This section speaks to the struggle that we continually deal with to guard our hearts, fighting battles of spiritual warfare as we seek to grow in our relationship with God. Several elements are noted to contribute to the path of disaffection with God and life. These include those of being ambushed by the stresses and strains of life. We need to stay aware of the roles that anger, anxiety, and fear play in our lives, and whether they foster a sense of doubt in our relationship with God. We need to stay aware of our aloneness as evidenced by our emotional distance or withdrawal from relationships, as we become easy prey for the enemy when we are in such a state. As we alienate ourselves, we also tend to gravitate toward arrogance, which puts us more out of touch with God’s voice. We need to be cautious of “adulteries of the heart”, which essentially embody the spirit of idolatry. Whether these consist of work, power, sex, food, fame, etc., they are all substitutes – our attempt to look to someone or something else for fulfillment. If we are not careful, we can develop addictions as our dependency develops to fill the emptiness. Likewise, we need to stay alert and in pursuit of a loving and growing relationship with God. We need to remain vigilant in living a life of faith backed by our actions, and to maintain honesty and accountability with those we are close to. As we walk in the light and seek to remain in the light, despite what temptations may try to pull us back into darkness, we are able to experience freedom, empowerment, and the many blessings of God’s spirit. COMN 104 is titled, “When Life Doesn’t Make Sense: Facing Evil, Sin, and Suffering”. Many people struggle with the conundrum of why God allows sin and suffering in the world, when God (who is supposed to be good, and loving) is in control of everything. To understand this dilemma, we must consider that sin has been in the world since the fall of Adam and Eve. God hates sin. However, He has also given mankind free will, which brings consequences when we choose to sin. We may struggle with understanding the relationship between sin, suffering, evil, and God. Our tendency is to try to make sense of this by placing our judgment upon others, or upon ourselves. Yet there are also times that we cannot assign blame, as the case with earthquakes, floods, hurricanes, or the like. Certainly Satan is involved in suffering. And yes, it is hard to “count it all joy”, as James advises us in James 1:2. But we also cannot discount the fact that God is good, and that He remains unchanged yesterday, today, and forever (Hebrews 13:8). One thing we do know is that God works all things together for good for those who love him and are called according to His purpose (Romans 8:28). We also know that God uses our brokenness, and He recycles our hurts to bring glory to His kingdom. We need to approach the concept of suffering with humility rather than with judgment, knowing that God’s strength is made perfect in our weakness (2 Corinthians 12:9). We are to follow Christ’s example, and to do our part in this world to help COMN 105 is titled, “Bondage and Spiritual Warfare: Fighting Wickedness in High Places”. Concepts of bondage and freedom are explored in relation to spiritual warfare. The Bible is full of references to these concepts, some of which include Isaiah 61:1-3, Galatians 5:1, and Romans 8:2. Spiritual warfare is characterized concisely in Ephesians 6:12, where it states that “…we do not wrestle against flesh and blood, but against principalities, against powers, against rulers of the darkness of this age, against spiritual hosts of wickedness in heavenly places.” We as counselors need to understand that bondage and freedom are rooted in several things, including our personality (as in our sinful nature from Adam, and the indwelling of the Holy Spirit). They are rooted our thoughts, feelings, and actions (as in our lie-based thinking, our adulteries of the heart, and the need for repentance and accountability). They are rooted in the body and its appetites (as in organic and biochemical problems, and chemical addictions). They are rooted in temporal systems, like hurtful or dependency-based relationships. Bondage and freedom are also rooted in supernatural systems as it relates to demonization, and the role demons play in bondage to the body, thoughts, behaviors, and relationships. As counselors, it is critical that we understand the nature of spiritual warfare as we seek to COMN 106 is titled, “Spiritual Disciplines: Taking People Closer to the Heart of God”. This section addresses the concept of spiritual life and growth. It is interesting to note that most people believe there to be a supernatural existence beyond the existence of the world in which we live. This is evident across all religions of the world, dating back to the beginning of recorded history. As Christians, we look to the life of Jesus Christ and how he lived as an example of how we are to live our lives. Spirituality in this sense refers not to legalistic religiosity, but rather to us having a meaningful and fulfilling relationship with God based in faith. In Romans 10:17, Jesus spoke to this concept by explaining that our faith-based spirituality grows as we expose ourselves to God’s Word. But as the title of this chapter implies, spirituality is a “discipline”. It must be practiced regularly – it must be tended to, weeded, and pruned like a garden, or we will not grow like we need to. We must understand the nature of spiritual growth in that there are also seasons. However, it is our responsibility to persevere in seeking the heart of God, in remaining authentic, and in responding appropriately even when times are tough. Transformation is the goal of spiritual disciplines. Jesus spoke of this in Romans 12:2, when he spoke of us being transformed by the renewing of our minds. But transformation as such implies “change”, which we as creatures of habit tend to resist. Change requires hard work, it often requires facing our fears of the unknown, it requires discipline, and among other things, it requires honesty. Paul spoke of this discipline metaphorically in Hebrews 12:1-2 when he related our spiritual growth to running a race. And so, as we develop spiritual disciplines in our lives, we receive power from God which enables us to live as He wants us to live, and to experience true freedom. We are able to do what needs to be done, when it needs to be done. Examples of spiritual disciplines include all the Fruits of the Spirit (love, joy, peace, patience, kindness, goodness, gentleness, faithfulness, and self-control), as referenced in Galatians 5:22-23. Other examples include disciplines of abstinence, and disciplines of engagement (like fellowship, self-examination, authenticity, and work of the Holy Spirit). COMN 201 is titled “Growth-Focused Brief Therapy”. More and more we find ourselves working with clients who average between three to eight sessions. Today we see that managed care capitation, economic downturn, and our culture’s desire for immediate gratification all play into this equation. As such, we as counselors need to be problem-focused, solution-focused, and growth-focused with our clients, having a clear plan with specific objectives. Counseling needs to consist of the use of sound psychological techniques along with biblical and spiritual integration, in a way that holistically incorporates body, soul (i.e., mind, will, and emotions), and spirit. Growth- Focused Brief Therapy (GFBT) shifts the focus from change (which is inevitable in one’s life) to that of growth. It shifts the focus from a client’s weaknesses to his strengths. It also shifts the focus from past to the present, from problems to possibilities, from excuses to exceptions, and from uniformity to uniqueness. Various tools are quite effective for use in this form of therapy. These may include such things as the use of assessments, scaling questions, use of the “miracle question”, the implementation of well-formed goals (which are small, specific, positive, achievable, measurable, and observable (SSPAMO!)), and the use of homework. As such, GFBT seeks to empower the client to continue growing long after they discontinue counseling. COMN 202 is titled, “Creating a Safe Place: Listening, Empathy, and Winning Trust”. As the title implies, this section speaks to the need for us to create a safe place for our clients where trust is established and empathy is shown. It is important that we seek the heart and mind of Christ, as we know that His life exemplifies the approach we need to take in working with the suffering. In fact, we find that the quality of our relationship with Christ is more important to our success in helping people than is the repertoire of our counseling techniques. It is the power of Christ that brings true and lasting healing. And so, it is important that we as counselors seek to stay connected with Christ, and that we seek to depend on the Holy Spirit to guide the counseling session. Jesus tells us in John 16:13 that the Holy Spirit will guide us into all truth. It also says in Proverbs 3:5-6 that we are to trust and acknowledge God in all that we do, knowing that He will direct our paths. It is important that we as counselors personally experience the grace of God so that we can demonstrate (by our own witness) authentic grace with our clients. We need to apply active listening skills through our use of open-ended questions, through open body posture, through patience, and through creating a “grace space”. The combination of these facets contribute to create an environment conducive of building COMN 203 is titled “New Beginnings: Helping People Make a Fresh Start”. This section speaks to the desire that people have at times to “start over” in some aspect of their lives. This phenomenon is perhaps most evident around the beginning of the year when many people announce their New Years resolutions. In reality though, these resolutions usually get “kicked to the curb” as one finds that change is in fact difficult. Our role as counselors is in directing clients to a dramatic and healthy fresh start. It is important to assess a client’s motivation for seeking change in their lives, and to assess who or what he considers to be the source of his problems. There are several elements and issues that need clarification when working with a client on life transitions. We need to help the client understand the interplay of body, soul, and spirit in their lives. We need to help him find resolution with his developmental history, particularly as it relates to his dealing with past wounds, and finding forgiveness for those who have harmed him. We also need to help the client learn to navigate environmental issues, especially as it relates to establishing accountability with others, developing relationships, finding encouragement, and connecting with spiritual resources. We need to help the client as well with the process of brainstorming, identifying and planning new goals, and committing to actions that lead to a new beginning. COMN 204 is titled “Change Skills: Goal-Setting, Planning, and Taking Action”. This section provides a brief overview as to the process and direction that counseling sessions should take, from beginning to end. People seek out counseling because they want to implement positive changes in their lives. They may find themselves unable to deal with a situation, circumstance, or issue on their own. Or, they may long for a more meaningful, fulfilling life with caring relationships. Whatever the case is, we as counselors need to be understanding, supportive, and able to provide a positive experience for the client which will be conducive to bringing about change. The counseling process should begin with building trust and establishing a relationship with the client. Information is gathered and assessed by the counselor and goals are collaboratively set in accordance with the principle of SSPAMO from COMN 201. It is important that we also assess the client’s level of insight and commitment, as well as any potential crisis issues or legal/ethical issues. A treatment plan is developed, interventions are implemented, and referrals may be made as necessary. If at first our interventions or approaches are unsuccessful, we reevaluate, and make changes as necessary. COMN 205 is titled “Spiritual Freedom: Disarming Strongholds and Changing Habits”. This section speaks to the “meat and potatoes” of finding lasting change and true freedom in our lives. We are told in the Bible that God seeks a continuing love relationship with us. Nevertheless, it is by our own free will that we must choose to seek Him out. God will never violate our free will. As we seek out and grow in a relationship of intimacy with God consisting of conversation, communion, and consummation, we find ourselves getting healthier spiritually. God invites us into a state of spiritual freedom in which strongholds become weak, and our habits change to become ways of life which lead to righteousness. As we choose to walk in the light and remain obedient to Him, several things begin to happen. God gives us wisdom to understand what it means to surrender our lives to Him, knowing that He will meet all of our needs, and work all things together for good. We begin to find His strength in our weaknesses when we humble ourselves to offer forgiveness to those who have harmed us, and when we make amends for harm we have caused to others. We also receive a greater discernment to the ways in which God reveals Himself in our lives – all of which strengthens our faith COMN 206 is titled “Mental Illness & Character Disorders: How to Recognize and Refer Serious Problems”. This section refers to the fact that we will at times work with people who struggle with serious problems which are beyond our capacity of knowledge and experience. These people suffer from mental illnesses based out of organic causality, they may suffer from deeply ingrained personality disorders, they may experience severe depression, paranoid delusions, explosive anger, or psychotic episodes. Regardless of the issue, we need to be aware of our role, our capability, and our responsibility in acting within the best interests of the client and of society. It is important that we be able to appropriately assess the potential for harm that these people have, either toward themselves or toward others, and that we facilitate an intervention strategy if need be. This may include mobilizing legal intervention, as the case would be for someone who presented to be an imminent threat for harming himself or others. Under the Tarasoft V. Tarasoft, 1979 Supreme Court ruling, we have a duty to warn and/or protect if someone presents to us as such. This, of course, would be a last resort, in which case we would alert law enforcement, or summon the sacred cow of licensed clinicians (an LCSW), to initiate a Baker Act with the person. Short of that, our treatment options include psychopharmacology, psychotherapy, and group therapy - to be determined at the discretion of the counselor. When in doubt, though, “refer out”. COMN 301 is titled, “Depression and Mood Disorders: A Clinical Update”. This section speaks to the prevalence of depression in our society, such that it is the #1 cause of disability in the U.S. While depression and mood disorders can be easily treated, they often go misdiagnosed or untreated. Symptoms of depression include sadness, loss of interests, anxiety, irritability, fatigue, changes in appetite and sleep, problems concentrating, social avoidance, feelings of hopelessness, thoughts of suicide, and decreased sex drive. Physical symptoms of depression can also include pain syndromes, GI complaints, fatigue, and headaches. Depression can be confused with adjustment problems, bipolar disorder, organic mood disorders, ADHD, anxiety disorders, the effects of some medications, hormonal states, and traumatic brain injury. Left untreated, depression correlates with drug and alcohol abuse, work and school problems, suicide, the worsening of other medical conditions, and other psychiatric problems (like OCD and panic disorder). Depression is believed to be caused by deficits in serotonin, norepinephrine, and dopamine physiology. Adrenal gland malfunctions have also been shown to play a role with causing depression. Women are believed to experience heightened occurrences with depression, as they produce serotonin at half the rate of men, while at the same time, estrogen increases serotonin activity. This, however, presents a problem as estrogen levels drop off in a woman’s life. Treatment options include a combination of cognitive-behavioral psychotherapy with the use of antidepressant medication. Other treatments include lifestyle changes to include enough exercise, sleep, and proper diet. Light therapy may be effective for those who live in high latitudes where wintertime daylight is shortened. Electro convulsive therapy (ECT) can also be helpful in severe cases of depression. The counselor’s role in working with people suffering from depression or mood disorders is that of early identification, helping the client understand the symptoms, making responsible referrals for psychiatric management, and continuing follow-up and monitoring. COMN 302 is titled “Stress and Anxiety: Overcoming Fear, Phobias, and Panic Disorders”. This section speaks to the prevalence of anxiety in our culture, and the role that we as counselors play in directing people to overcoming and preventing fear in their everyday life. God purposed for anxiety to function in our bodies as a warning system to threats, alerting and mobilizing the body for response. Different types of anxiety (stress) include worry anxiety, fear anxiety, panic anxiety disorder, phobias, generalized anxiety disorder, and separation anxiety. These types of anxiety can be endogenous (biological), or reactive (situational). Regardless, stress affects the body by creating an over-arousal of the adrenal system. Hormones produces affect the brain’s natural tranquilizers. Over time, stress also affects the immune system, causing physical problems such as acid reflux, allergies, backache, asthma, fatigue, and migraines. Stress in the body is affected as well by substances ingested, such as caffeine, alcohol, and inhalants. With regard to treatment, the use of medication is excellent for panic anxiety disorders. Medication is also good for generalized anxiety disorder. It does not work well for obsessive- compulsive disorder, and it has no affect on phobias. COMN 303 is titled, “Freedom in Christ: Hope for the Addict, the Broken-Hearted, and the Evil-Minded”. This section speaks to the question of how we as counselors deal with matters of the heart from a Christian perspective. From a Biblical perspective, we are told that God created us with a soul and spirit in union with the body, and that our soul and spirit is in union with God when we are alive spiritually. Likewise, we are dead spiritually when we are separated from God, just as when we are born into the world. When we choose to accept Christ in our lives, we are provided a new identity, and we begin to be transformed from the inside out as we grow spiritually in our relationship with God. Though we live in a world of flesh patterns, temptations, and strongholds, we seek to not be conformed to the patterns of the world, but rather, to be transformed by the renewing of our minds in Christ (Romans 12:2). We find that Biblical faith leads to wholeness, with the presence of God in our lives affecting both our physical being and our thoughts. Cognitive Therapy, from this perspective, holds that if what we believe does not reflect the truth, then what we feel does not conform to reality. We must contend with the fact that we experience spiritual battles in our mind on a daily basis, and that we must take every thought captive, and bring it into obedience with the mind of Christ (2 Corinthians 10:5). This relates to anxiety and the mental strongholds that surround many of our hurts, habits, and hang-ups. The bottom line is that the presence of Christ in our lives and His truth will set us free if we choose to embrace it, stay in the COMN 304 is titled “Helping Others with Alcohol, Substance Abuse, and Addiction Problems”. This section speaks to the adverse effects that alcohol and drugs have in our culture, and the need we have as counselors to deal with this problem. Among the different types of substance use and abuse are the use of narcotics, stimulants, depressants, hallucinogens, inhalants, alcohol, and marijuana. Other addictions include compulsive emotional overeating and eating disorders, sexual addiction, and gambling (among other types of “adrenaline-junkie” thrill seeking addictions). The commonality that all of these addictions have is that they are shame-based, and they lead to isolation, death, and destruction. Most, if not all, addictions tend to be progressive, requiring greater frequency and intensity of use over time to achieve the same desired effect. All addictions tend to be self-medicating attempts to fill voids from unmet needs in our lives. Addictions also provide (at least by appearance) a means for escaping from pain which arises from these voids. The truth is that no substance or counterfeit can effectively fill these voids in our lives. It is like trying to fit a square peg in a round hole. It is only God who can truly and effectively meet our needs, fill the voids, and heal the pain in our lives. As counselors, it is important to understand that addiction is a family issue requiring intervention, as opposed to the typical codependent dance of enabling which tends to exist in addictive families. We need to encourage treatment as soon as possible, to include not only detox (if necessary), but also involvement in a Christ-centered 12-step program. Granted, there are many secular 12-step programs available today which recognize the need for a “higher power”. However, as we know, there is only one Higher Power, and that is Jesus Christ. I have a particular affinity toward a particular 12-step program known as Celebrate Recovery (CR), which has played an important part in my own recovery and healing from sexual addiction. What I like about CR is that it is not limited in its focus to only people who struggle with alcohol or chemical dependency. Rather, the program welcomes anyone who struggles with hurts, habits, or hang-ups in their lives, and it looks to Christ as the real source of all healing. CR is based on the 12 steps of Alcoholics Anonymous, with the corresponding 8 Principles, based on the Beatitudes. People who attend CR come to realize that they are not alone, that they are in a safe place where they will not be judged, and where anonymity and confidentiality are held in the highest regard. I believe that CR is the fastest growing recovery program in the world, now involved with over 30,000 churches in America, and in over 30 different countries. It is also the fastest growing recovery program in American prisons today, with success rates so astounding that not even atheists can deny its effectiveness. In a 1999 study of 1000 inmates who completed the “CR Inside” 12-step program during their prison time, outcome measures showed that only 7.8% of this sample population re- offended, compared to 78% of the general population released which re-offended. I cannot speak highly enough about the effectiveness of Celebrate Recovery in helping people who struggle with addictions, as I know that it is anointed by God. In fact, I refer many of my clients to CR as an adjunctive form of treatment. COMN 305 is titled “Overcoming Gambling, Spending, and Credit Abuse”. This section speaks to the progressive nature of compulsive gambling, the individuals at risk, and effective ways to divert a gambler from the path of personal destruction. Like many other addictions, compulsive gambling is a progressive behavior involving an uncontrollable preoccupation with the urge to gamble, which compromises family, occupational, and other pursuits. It does not help that our culture also condones such irresponsible behavior as by extending credit to unqualified applicants (which contributed significantly to the real estate crash and our current recession/depression), by our state- run lotteries, dog track and horse racing, Internet gambling, and by the prevalence of casinos where legal – just to name a few. Gabling has become a huge money-making venture in our commercialized culture. As such, its allure has become increasingly more appealing and normalized, to the point that some casinos call themselves “family-friendly gaming resorts”. Gamblers tend to engage in this compulsive activity for a variety of reasons, to include gambling for thrill, money, recognition, control, or connection. They fall into an addictive cycle which involves a winning phase, losing phase, and desperation (shame-based) phase. Along with this activity also come the allures of alcohol, drugs, and sex. Some gamblers in the throes of desperation may as well resort to stealing to foster their addiction. As counselors, we need to be able to recognize this addiction, properly assess, and provide help for the compulsive gambler. Like with other addictions, gambling affects the entire family, and must be addressed by intervention and involvement in a Christ-centered 12-step program. COMN 306 is titled “Emotional Overeating: The Truth About Dieting and Weight Control”. This section speaks to the prevalence of emotional overeating in our society today, as evidenced by the majority of Americans being clinically obese (at least 20 pounds overweight). There is a significant connection between food and mood, which speaks to the nature of “appetite” versus true hunger. Compulsive overeating often has a connection with emotional suppression, relationship change, lack of self-worth, and need to fill emptiness in our lives. In this sense, compulsive emotional overeating becomes an addiction aimed at changing moods, solving stress, dealing with boredom, and bringing comfort. Like other addictions, compulsive overeating can be characterized by the addiction cycle of preoccupation, ritual, acting out (indulgence), and despair. We need to understand these issues and offer help from a Biblical perspective involving faith, surrender, sacrifice, and servitude. Accountability and support groups, as available with Celebrate Recovery, are also a vital source of help for people who struggle with COMN 401 is titled “Eating Disorders: Diagnosis, Treatment, and Referral with Anorexia and Bulimia”. This section speaks to prevalence of eating disorders (namely anorexia and bulimia) in our society, with as many as one in ten women suffering from them. Eating disorders are often complex and involve many different issues. And while they often start with what appears to be harmless dieting, they can become life- threatening. We need to be able to recognize the signs of eating disorders. These include extreme or rapid weight loss, intense fear of being overweight, preoccupation with food and dieting, unusual eating habits, frequent bathroom usage, social withdrawal and mood changes, increased use of substances like caffeine, diet products, and laxatives, wearing baggy, full-covering clothing, missing food items or empty containers, health problems (especially digestive), and hyperactivity or over-examining. Eating disorders are an unhealthy, irrational way to meet needs for love, acceptance, and identity. Treatment implications need to involve the body, soul, spirit, socialization, family, and personal forgiveness and responsibility. Our media influences portray an unhealthy, unrealistic perspective of body image, so it is important that we challenge the media. We need to examine our personal attitudes about food, examine our beliefs and prejudices about weight gain and appearance, and examine our attitudes about ourselves, our relationships, COMN 402 is titled “Complicated Grief and Mourning and Crisis and Trauma”. This section speaks to the differences between normal and complicated (abnormal) grief and mourning. Grief is a normal emotional response to death or loss of a loved one, or to the experience of trauma. Although people have conventionally focused on grief as being the emotional response to loss, it also has physical, cognitive, behavioral, social, and spiritual dimensions. According to Kubler-Ross, there are five stages of the grieving process, which include denial, anger, bargaining, depression, and acceptance. Problems occur when a person does not successfully navigate through these stages, and gets stuck. As counselors, we will work with people who struggle with unresolved grief, or who are in the midst of dealing with trauma and crisis. We must help them to talk about what happened and what they are feeling, and help them to normalize what they are going through. We must also apply a theology of suffering in our work with the grieving. Suffering is normal and inevitable in our lives. And God uses suffering for our good, to conform us to the likeness of His Son, who paid the ultimate price in suffering for us. COMN 403 is titled “Helping Distressed Couples: Anger, Conflict, and Dissatisfaction in Marriage”. This section speaks to the prevalence of marital problems in our society today, relative to couples’ difficulties with effective communication and expression of anger. In the Bible, we see that God intended for people to be in relationship with each other. Marriage is also intended to reflect the love that Christ has for the church. The problem is that we live in a fast-paced fallen world full of stress, satanic assault, scripts from our past, and sin and selfishness. Combine this with communication problems we often experience, as well as with problems effectively expressing anger, and we have a recipe for disaffection in marriage. We as counselors need to help married couples to improve the quality of their communication, the methods of which are all based in biblical truth. We need to help each to become better listeners, to reflect on and think about what is being spoken, to be sensitive and respectful of the other spouse, to speak the truth in love, to not fight or respond in anger, and to confess, COMN 404 is titled “Families in Crisis: Hopeless Parents and Angry/Defiant Children”. This section speaks to the prevalence of defiance with many of our children today. They may exhibit characteristics of negativity, hostility, tendencies toward blaming, arguing, being spiteful, vindictive, easily annoyed by others, and engaging in temper tantrums. In the Bible, we can find many scriptural references to the importance of love, attachment, and discipline in raising and parenting children. Unfortunately, children exhibiting these aforementioned characteristics often grow up in homes where parents are either disengaged emotionally, or are physically absent. Angry and defiant children in actuality need to feel a sense of attachment and closeness with their parents. They need to feel that it is safe for them to explore and experience the world around them. Without such, separation for them fosters a sense of anxiety and anger, and they perceive loss of a relationship. It is important for parents to understand that rules without relationship lead to rebellion. As counselors, we need to help parents learn to rekindle their attachments and relationships with their children through the use of floor time and special time, through demonstrating empathy, engaging them with problem solving, and establishing and enforcing healthy boundaries in love. COMN 405 is titled “Aging and Elderly Parents: Health Problems, Dementias, and Disabilities”. This section speaks to implications of old age, and the effects of care- giving on the family system. It is important to realize that quality of life issues become a greater issue of concern for the elderly as their life expectancy increases. They must contend with issues of memory impairment, dementia, mood disorders like anxiety and depression, Social Breakdown Syndrome, and an increased risk for suicide. We as counselors can provide care for the elderly by involving caregivers and family, addressing role changes in the family, and by helping to assess strengths and weaknesses of the primary caregiver. We can also help to strengthen the elder’s resiliency through the use of their faith, positive memories, and favorite activities. We will need to assist families with care options, helping them to identify resources in the community, and showing them how to maintain family bonds during life changes. COMN 406 it titled “Blended Families: Helping Yours, Mine, and Ours Become a Family”. This section speaks to the prevalence of stepfamilies in our society today, their unique dynamics, and inherent stressors which affect them. Stepfamily life can be difficult for both the new marriage and the children of each spouse. The children often struggle with insider/outsider dynamics, loyalty issues, and loss issues. The parents and step-parents also struggle with their roles, which require unity, reframing of roles for the children, and an evolution of the step-parent role. It is recommended that stepfamilies be allowed to adjust slowly, comparable to the metaphor of using a crock pot to cook a roast (over time with low heat), versus “forcing” the family to blend. It is important that the counselor provide pre-stepfamily counseling to address several issues. The couple needs to think critically about their relationship, and what is in the best interests of both them and their children. They need to be encouraged to slow down. They and their children need to grieve their past losses. As well, they all need to be educated on the reality of stepfamily living, using the “crock pot” perspective. COMN 501 is titled, “Chronically Troubled Relationships: Everybody Has at Least One”. This section speaks to the population of people we refer to as “difficult”, or more specifically, those people who suffer from personality disorders or traits. These people tend to struggle with beliefs and behavior patterns which have over time become deeply ingrained within their sense of identity. It is theorized that people with personality disorders, or pervasive developmental disorders, experienced disruptions with their early attachments which affects them later in life. These experiences affect them psychologically, emotionally, socially, and spiritually. Personality disorders as discussed in this section include paranoid, narcissistic, dependent, histrionic, and obsessive- compulsive types. There are also borderline and antisocial types within the realm of Cluster B personality disorders in the DSM-IV. Each of these disorders can be challenging, and potentially exhausting to work with. We as counselors need to work with these people particularly with regard to improving their social skills, challenging and correcting distortions about themselves and God, and teaching empathy. We also need to be able to recognize when we are in over our heads, and be able to appropriately COMN 502 is titled “Developing an Effective Lay Helping and Supervision Ministry”. This section speaks to the importance of developing lay helping ministries within the church, as lay helpers have been found in most research studies to be as effective as professional counselors. Several steps must be taken when establishing lay helping/counseling programs, whether they are intended to be informal/spontaneous, informal/organized, or formal/organized models. An appropriate plan of action needs to be developed within the church which includes assimilating support, and screening helpers for the ministry. Helpers and lay counselors need to be provided with adequate training, and programs developed where these helpers can be used. Lastly, a formal, organized lay helping or counseling center needs to be set up at the church, with ongoing supervision and advanced training provided for the helpers/counselors. The professional counselor should be involved in training and supervising lay helpers, educating, consulting, and both conducting and evaluating outcome measures. He should serve on the board of directors or advisors of lay helping, and as well should serve as a referral source when professional counseling is needed. COMN 503 is titled “Dynamic Small Groups and Spiritual Care Teams in Church- Based Counseling”. This section speaks to the incredible potential of groups in lay helper/counseling ministries. Group approaches tend to be more efficient, more effective, more economical, and more experientially appealing as compared to individual counseling. Groups provide the capacity to rekindle hope, they provide relief of universality (or the notion that we are not alone with our struggles), and they allow for experiential learning. There are different group models, depending on the purpose and intent of the group. Among those is the Wagon Wheel model, where the leader is the central helper. In the Interpersonal Process model, the leader guides members to address one another. In the Support Group model, members help one another from experience. And in the Psycho-educational Group model, information and support are shared. Groups tend to be very helpful for members because they exemplify social and relational dynamics, allowing them to work out issues in a safe, facilitated environment. COMN 504 is titled “Preventing Compassion Fatigue: Self-Care for Caregivers”. This section speaks to the propensity for fatigue and burnout among caregivers if they do not take care of themselves. Truly, if caregivers are going to be effective in helping others, they must first understand how to properly manage their own stress. We must be able and willing to assess the level of stress we are experiencing, and ask ourselves whether the ministry is causing stress for us, or whether it is “revealing” the stress already existent in our lives. It is important that we understand the foundation blocks for stress and burnout, which include role ambiguity, role conflict, role overload, role inconsequentiality, role isolation, and role rigidity. As a means of promoting continuity of self-care, it is important that we not personalize everything. We must remember that God is our first love, as He has called us to be with Him (Mark 3:14). We must learn to rest, and to be silent and still. We must learn to triage and prioritize our daily schedule, and learn to have realistic expectations. We need to learn to delegate wherever, whenever, and however appropriate. And lastly, we need to be accountable to someone. COMN 505 is titled “Boundaries and Violations I: Confidentiality, Consultation, and Referral”. This section speaks to the requirement for helpers and counselors to maintain confidentiality, and the specific conditions under which confidentiality may be breached. It is our responsibility to inform the client that what they share will be held as confidential, with exception to any information disclosed that they present to be a danger to themselves or others. Another exception to confidentiality would be if the court subpoenaed counseling records as party to a case involving the client, or if the client’s insurance requested a consultation report. The only other exceptions to confidentiality may involve case supervision, where both the counselor and supervisor are bound by the same rules of confidentiality. For all of the aforementioned cases, it would be wise for the counselor to obtain a authorization from the client, which (oh, by the way) can also be part of the client’s consent for treatment. Beyond these limits, it is necessary to obtain a signed authorization to release confidential information to a specific party for a specific reason. HIPPA is the governing federal law which regulates the disclosure, storage, and administration of confidential information. COMN 506 is titled “Boundaries and Violations II: Dealing with Seductive, Suicidal, and Dangerous People”. This section speaks to our need as counselors to establish ethical boundaries when dealing with such people, as well as our need to identify dangerous people, and implement effective intervention strategies. It is recommended that we safeguard against sexual temptation with clients by never counseling a member of the opposite sex alone (although that does not work very well in my practice). We are to presume that we are vulnerable, and to develop accountability; and to consult with such accountability when tempted. If necessary, we are advised to refer the client elsewhere, or to meet with them in a different setting. The bottom line to dealing with suicidal or homicidal people is that we are breach confidentiality if we consider them to be a threat to themselves or others, regardless of any resulting lack of trust. I say, “better safe than sorry”. Among other things, if we do not feel comfortable with a client because we feel unsafe, that should be a clue that we should refer the client In conclusion, I found these modules to be very helpful as a means of reviewing many of the components central to counseling. I liked the format of there being 30 lectures on DVD, supplemented by an outline review of each, along with the requirement of written reviews for each module. Granted, this course required some work, but I also
**********************************************************************AkdÄ Newsletter 2003-033Die Arzneimittelkommission der deutschen Ärzteschaft informiert:**********************************************************************NEUE DATEN ZU HORMONTHERAPIE IN DEN WECHSELJAHREN UND BRUSTKREBS: DIEBRITISCHE "MILLION WOMEN STUDY"Eine große prospektive bevölkerungsbasierte Kohortenstudie