The Future of Counseling

The traditional divisions in counseling have been:

  1. Remedial counseling: helping people to deal with existing problems of life.
  2. Preventative counseling: help to stop problems from getting worse or prevent them from occurring in the first place.
  3. Educative counseling: the counselor taking opportunities to teach principles of mental heath to larger groups

Recent studies indicate that the three should be reversed in the order of importance. This would take counseling to the people, rather than waiting for hurting people to come into an office. The focus is moved from individuals with problems to the community.

Counseling and Loneliness

Loneliness knows no class, race or age: it hits everyone periodically. This is the lack of meaningful contact with other people which is accompanied by sadness, discouragement, a sense of isolation, restlessness, anxiety and an intense desire to be wanted. Lonely people feel left out, unwanted or rejected, even when surrounded by others. I have sent missionaries to East Asia, where they were be in a city of 15 million people and suffered terribly from loneliness.

1. Emotional loneliness: The lack or loss of a psychologically intimate relationship with another person

2. Social loneliness: Feeling aimless, anxious or empty, even “out of it”

3. Existential loneliness: The sense of loneliness which comes from being separated from God and the person feels there is no meaning in life

The Bible and Loneliness:

1. Adam was alone and needed a helpmate

2. Adam and Eve were instructed to multiply the race

3. Adam and Eve broke fellowship with God in their sin

4. OT giants like Jacob, Moses, Job, Nehemiah, Elijah, Jeremiah and even David were lonely at times. Jesus was alone in the garden, John on the isle of Patmos, Paul in prison having been deserted by nearly everyone.

The Causes of Loneliness:

1. Social causes

  1. Technology: As government and business gets bigger, people feel less significant, smaller and not needed, and people do not develop deep satisfying relationships.
  2. Mobility: Moving around is much easier, which tears up relationship, separates families, eliminates neighborhoods or a community spirit, and people don’t risk getting close to others in fear of being hurt later.
  3. Urbanization: As people move into cities together, they really tend to withdraw from one another. There is a fear of strangers, and this leads to suspicion and withdrawal.
  4. Television: Television enhances separation both by program content and seems to promote superficiality. People view the tube and seldom engage in meaningful communication.

2. Developmental causes: Ellison mentions basic needs that must be met

  1. Attachment: People need to feel close bonds with other human beings, especially as children. Children separated from parents, divorce and even child abuse can all lead to loneliness.
  2. Acceptance: Parents communicate this to their children by touching, spending time with them, listening, disciplining, and showing affection. If children are ignored or excessively criticized they will feel worthless.
  3. Acquiring skills: We all know social misfits. They are often insensitive to the needs and attitudes of others, and they don’t know how to develop smooth interpersonal relationships. They might try to manipulate or force themselves on others which only brings more frustration and increased loneliness.

3. Psychological causes:

  1. Low self-esteem: This is the opinion we have for ourselves. If it is low we will underestimate our value and withdraw, or if it is too high we will exaggerate our value to the point of conceit. Low self-esteem will cause a person to be weak or shy, and there is a need to depend upon others. When others are not available there comes a sense of insecurity and deep loneliness.
  2. Inability to communicate: This is at the root of many if not all interpersonal problems. If one can’t communicate, there is a persistent loneliness that follows.
  3. Self-defeating attitudes: There is greater possibility for loneliness when there is intense competition, struggling for self-sufficiency, self-centeredness, criticism or intolerance for others, holding on to grudges, using other people to satisfy our own egos.
  4. Hostility: Some people are just innately angry. They seems to feel threatened, frustrated or resentful because of real or imagined injustice. This anger can turn to self-hatred, and into loneliness due to constant complaining and negative attitudes, which will drive people away from them.
  5. Fear: People are lonely because they build walls instead of bridges, which keeps other people out. These can have a fear of intimacy, rejection, or fear of being hurt.

4. Situational causes: Being single, divorced, widowed, grieving, or elderly can be lonely. Those in leadership positions, students away from home, affluent people in a financial crisis, those with deformed bodies or diseases.

5. Spiritual causes: Free will allows us to rebel against the only avenue of salvation for individuals. Existential loneliness comes when we refuse to acknowledge and confess our sin.

The Effects of Loneliness:

1. Isolation: Often but not always.

2. Poor self-esteem: Feelings of worthlessness; failure in relationships or activities; discouragement and negative self-talk.

3. Hopelessness: This can lead to despair or even thoughts of suicide, feeling there is no way out.

4. Alcoholism and drug abuse: As a means of escape.

5. Violence: Some will express their frustrations in destructive ways

Counseling and Loneliness:

1. Admitting the problem: They might feel this admission of loneliness is the same as being a social misfit, unattractive, unable to relate to others.

2. Considering the causes: It is possible to work on the source of the problem and not just the symptoms.

3. Accepting what cannot be changed: Self-esteem can be changed, while a widow’s cannot bring back her husband.

  1. One must develop an inner life of positive interests, appreciation for what is good in life, and a sense of humor. It is more than positive thinking. It is a rejection of self-pity and a willingness to see the bright side.
  2. One must develop a lifestyle of keeping in touch. Involve yourself in play, creative activities and daily news which can keep one from a tendency to brood.
  3. One must develop a religious faith that can keep one in touch with the realities of life, seeing life in its wholeness. One will find meaning which can under-gird the individual.

4. Altering what can be changed: Watch less television, spend more time on family activities, get involved in useful church activities

  1. Developing self-esteem: People need help for them to see their strengths, abilities, gifts, and weaknesses. People spend a lifetime telling themselves that they don’t look good, are incompetent or are disliked by people. We compare ourselves with others which aids fuels our feelings of inferiority. Every person has value to God, is loved, can be forgiven, has gifts and abilities.
  2. Taking risks: It takes great courage to reach out to others, even if one has good self-esteem. It can be embarrassing or threatening.
  3. Learning skills: Many people are social cripples and need to learn basic skills of relationships.

5. Meeting the spiritual need: Jesus and me makes a majority, so why be lonely? Then one can be incorporated into the family, the body of Christ.

Preventing Loneliness:

  1. Recognize that as a believer you are adopted into the family of God.
  2. Get involved in a local body of believers or organization with whom you share beliefs.
  3. Find a mentor of someone to whom you will be accountable for growth goals and taking risks of getting out of your comfort zone.
  4. Identify and name your weaknesses, making sure to not put yourself in vulnerable positions.
  5. Rid yourself from isolating activities such as computer, television, gaming and work toward activities that force you to be in community with others.
  6. Discover your giftedness in serving others; it’s hard to be lonely when you are serving others. Visit the local homeless shelter and volunteer, there’s nothing like volunteering to put life back into perspective.

Counseling and Anxiety

Anxiety, stress, fear and tension all have different meanings yet are often used interchangeably to describe the most prevailing characteristics of human beings in this century. Rollo May called anxiety one of the most urgent problems of our day.

It is defined as inner feelings of apprehension, uneasiness, concern, worry or dread which is accompanied by heightened physical arousal. Classifications of anxiety are:

1. Acute: This comes quickly, is of high intensity, and has a short duration. If one is suddenly overwhelmed, it is usually acute.

2. Chronic: This is persistent and longer lasting, but the intensity is lower.

3. Normal: This comes when there is a real danger or situational threat. It can be recognized, managed and reduced, especially if the outward circumstances change.

4. Neurotic: This involves intense exaggerated feelings of helplessness and dread even when the danger is mild or nonexistent. It cannot be dealt with rationally because the source comes from subconscious inner conflicts.

Anxiety can vary in intensity as well: Moderate can be healthy and even desirable since it helps people avoid real dangers. High anxiety can shorten one’s attention span, make concentration difficult, adversely affect memory, hinder performance skills, interfere with problem solving, block communication, arouse panic, and even symptomatic paralysis or intense headaches.

The Bible and Anxiety:

1. Anxiety as fret or worry: (Matthew 6:25-34, Philippians 4:6-7, 1 Peter 5:7, Psalm 55:22), and we are told to avoid this type of worrying.

2. Anxiety in the form of realistic concern is not forbidden. To ignore danger is a foolish thing. (2 Corinthians 11:28, Philippians 2:20)

The Causes of Anxiety:

Sigmund Freud discusses human personality is terms of the id, ego and the superego:

  1. When he id recognizes a clear threat to the person, this is called realistic anxiety.
  2. When the id begins to get too powerful, so that it threatens to overwhelm the ego and cause the person to act with socially aggressive or sexually unacceptable behavior, this is neurotic anxiety.
  3. When the superego gets too powerful, so that the person is overwhelmed by guilt or shame, this is moral anxiety.

Anxiety Results from the Following:

1. Threat

  1. Danger: Crime, war, violent weather, unexplained illness
  2. Self-esteem: People like to look good and perform competently
  3. Separation: From significant others; or rejection
  4. Unconscious influence: Even those who reject Freud will accept that there can be certain underlying thoughts, emotions or experiences that will cause anxiety.

2. Conflict: faced with two of more pressures

  1. Approach-approach conflict: Conflict over the tendency to pursue two desirable but incompatible goals (two dinner invitations).
  2. Approach-avoidance conflict: Here is the desire both to do and to not do something. One might (grapple with a job offer with more pay and opportunity (approach), but it will bring a move and the inconvenience of a training program (avoidance).
  3. Avoidance-avoidance conflict: Here are two alternatives, both of which are unpleasant, like having pain versus having an operation to relieve the pain.

3. Fear: similar to anxiety, even though they are not identical. Fears can come in from a variety of situations. Different people are afraid of failure, the future, rejection, achieving success, intimacy, etc. These fears can build up into anxiety.

4. Unmet needs:

  1. Survival: need for continued existence
  2. Security: economic and social
  3. Sex: as an expression of love, as a sexual being
  4. Significance: to account for something, to be worthwhile
  5. Self-fulfillment: to achieve fulfilling goals
  6. Selfhood: a sense of identity

5. Individual differences: Some people are never anxious in the same anxiety producing situation for another person. Fears and phobias:

  1. Psychology: Most behavior is a result of experience or learned from parents or other significant persons. We will react as we have seen others react to similar situations.
  2. Personality: Some people are more fearful or high strung than others. Some are more sensitive, self-centered, hostile or insecure than others.
  3. Sociology: Political instability, mobility which disturbs our rootedness, shifting values, changing moral standards, religious beliefs can all cause anxiety.
  4. Physiology: The presence of disease can cause anxiety, as well as dietary imbalance, neurological malfunctioning and chemical factors.
  5. Theology: Some believers are so concerned about pleasing God that their theology cause them undo anxiety. This anxiety would then be considered a lack of faith.

The Effects of Anxiety:

1. Physical reactions: Ulcers, headaches, backaches, lack of sleep, butterflies, fatigue, loss of appetite, frequent urination, blood pressure, slow digestion, chemical changes in the blood.

2. Psychological reactions: Reduction in productivity, stifles creativity, hinders the capacity to relate to others, dulls the personality, interferes with the ability to think or remember.

3. Defensive reactions: Denial of the anxiety, blaming others for faults, rationalization, slipping into childish reactions, escape through alcohol or drugs, withdrawal into mental illness or bizarre behavior.

4. Spiritual reactions: It can drive us toward or away from God, lack of time for prayer, lack of concentration on reading the Bible, reduced interest in worship times, impatience with heaven’s seeming silence.

Counseling and Anxiety:

1. Recognize the counselor’s own anxieties: What is the situation that is making me anxious? What is it about this person that makes me anxious?

2. Demonstrate love: Love move towards others and shrinks fear, and is a demonstration of Christ (1 John 4:18, Hebrews 13:6).

3. Identify causes: One can’t simply show love and tell the client to get over their anxiety.

  1. Observation: Does he shift around, perspire or change breathing when a certain topic is discussed?
  2. Reflection: Can the client recall certain times when the anxiety is more overwhelming?
  3. Contemplation: Raise issues about the causes and get the client to dwell upon these to his own conclusion.

4. Encouraging action: The goal is not to eliminate the anxiety but to become aware of it and be able to cope with it. Help them to move through the situation rather than going around it.

5. Giving support: Anxious client get little help from impatient counselors. The helper must be calm, supportive and patient.

6. Encourage a Christian response:

  1. Rejoice (Philippians 4:4) in the midst of trouble
  2. Forbear (Philippians 4:5) graciousness in your spirit
  3. Pray (Philippians 4:6) about everything, details
  4. Think (Philippians 4:8) dwell on positive things
  5. Act (Philippians 4:9, James 1:22) put these into practice

Preventing Anxiety:

1. Trust in God: We know who holds the future

2. Learn to cope:

  1. Admit fears and insecurities when they arise
  2. Talk these over with someone else
  3. Build self-esteem
  4. Acknowledge that separation hurts
  5. Seek help from God
  6. Learn to communicate
  7. Learn some principles of relaxation
  8. Periodically evaluate your priorities, life goals and time management

Referrals in Counseling

This does not mean that the original counselor is incompetent or trying to get rid of the client. It rather shows the counselor’s desire to have the best interest of his client in mind. Counselors should be familiar with community resources and person to whom clients can be referred. After several sessions, and the person is not being helped, it could be that referral in necessary:

  1. Severe financial needs.
  2. Medical or legal advice.
  3. Severely depressed or suicidal.
  4. Demonstrations of aggressive behavior in the client.
  5. Severe emotional disturbance.
  6. Stirring feelings of dislike or sexual desires in the counselor.

Referrals include private practitioners such as physicians, lawyers, psychiatrists, community agencies in the government, or AA.

The Counselor’s Sexuality

Whenever two people work closely together towards a common goal, feelings of warmth can often arise between them. Sexual attraction between counselor and client has been called the “problem pastors don’t talk about.” Intimate details which would never be discussed between a man and a woman (not married to each other) can be discussed in a counseling session. This can be sexually arousing to both the counselor and the client. The potential for immorality tends to be greater if the client is attractive or tends to be seductive, and the counselor does not have his own sexual needs satisfied elsewhere. Ministries, effectiveness and reputations have been destroyed over this issue.

  1. Spiritual protection: Meditation on the Word of God, prayer and reliance on the Holy Spirit are all crucially important. In addition, the counselor must watch what he does with his mind. Focus on purity, truth and honor. Don’t make the mistake that, “this sort of thing can’t happen to me.”
  2. Awareness of danger signals: There are several clues that can indicate a potential shift from counseling professional to dangerous intimacy:
    1. Communication of subtle messages of a more intimate quality (smiles, raising an eyebrow, physical touches).
    2. Desire of both persons to maintain the relationship
    3. Eagerness (especially by the counselee) to divulge details of sexual experiences or fantasies.
    4. The counselor permitting himself to be manipulated by the counselee.
    5. The counselor’s recognition that he needs to see the counselee (which is a sign of going under).
    6. Increasing frustrations in the counselor’s own marriage.
    7. The lengthening of times and frequency of sessions, sometimes supplemented by phone calls.
  3. Limit setting: Once detected, the counselor can stop the sessions, make a referral, or possibly discuss these feelings with the client. Before any of this, it is best to set clear limits:
    1. Prescribe the frequency and length of sessions.
    2. Refuse to engage in long phone conversations.
    3. Discourage lengthy discussion of sexual topics.
    4. Avoid physical contact.
    5. Meet in a place, and seat yourself in a way which discourages wandering eyes or an opportunity for personal intimacy.
  4. Examining attitudes: There is nothing to be gained by denying your sexual feelings. They are quite common, but can be controlled. Remember:
    1. Social consequences: Ruined marriage, reputation, effectiveness.
    2. Professional image: This will never help your counselee, and will never advance the counselor’s professional work.
    3. Theological truth: This is sin and must be avoided, and we are responsible for our own behavior.
  5. Support group protection: A trusted confidant, accountability.
    1. Spouse: Often this is missed do to embarrassment or fear. There is also support that if a client becomes a threat to one’s marriage, there were underlying problems in the marriage long before the client came along.
    2. Trusted friend: Accountability.
    3. The client? Some may interpret this as an invitation, others may talk about this outside of the sessions which could have disastrous results.

The Counselor’s Burnout

We would think that the field of counseling would offer a lifetime of satisfaction and vocational fulfilment. But it is hard work that is emotionally draining and very stressful. Contributing to this are the feelings of futility, powerlessness, fatigue, cynicism, apathy, irritability and frustration. To help prevent burnout, we can utilize these ideas:

  1. Spiritual strength that comes from regular periods of prayer and meditation on the Scriptures.
  2. Support from a few others who accept us for who we are and not what we do. We all need a person to whom we can cry if we need to, a person who we can trust.
  3. Solitude: take time off from the demands of people. Jesus did.
  4. Share the load by training a few capable leaders to be sensitive lay counselors and burden bearers.

If you are burned out already, take the phone off the hook and get away for a time of re-evaluation. Consider your leisure activities. How can you lighten your load and add self-fulfillment and relaxation? We are beings who need both work and rest and play. Otherwise life will become boring and routine.

Homework in Counseling

Each person has a special way of learning. Some people learn best by hearing (listening to the words of others), some people learn best by seeing (reading books, watching movies, looking at diagrams), while still others learn best by doing (completing projects, participating in role plays, or acting out their feelings).

One session in your office is separated by 167 other hours filled with other activities. Homework assignments are essential to enabling people to extend their learning beyond the counseling sessions and permit seeing and doing in addition to hearing. The word “homework” usually sends a red flag so “task agreement” might be a better term for the client to gain addition information, develop and practice new skills, eliminate harmful behavior, or test what he has learned in counseling.

Some assignments can be: giving one compliment to your wife each day, read a chapter a day in the Bible, spend time with a specific relative, keeping a record of time-use, or making a list of one’s values and priorities. There are basically five types of homework task agreements:

  1. Testing: questionnaires, sentence completion forms, standardized tests, writing assignments, listing life goals; then brought in for discussion.
  2. Discussion and study guides: Sometime these appear in the appendixes of books, but entire volumes have been written to guide home or small group discussions.
  3. Behavior assignments: The person can be encouraged to change their actions in small and important ways between sessions: saying “thank you,” giving periodic compliments, not complaining about an annoying practice by your spouse, getting to work on time.
  4. Reading: Books and articles contain helpful information which can supplement the counseling sessions. There is the danger that the counselee might misinterpret the information or pull it out of context. It is almost impossible to screen all the resources available.
  5. Recordings: Music therapy (the use of music to help people with their problems) is at least as old as David and Saul.

The Counselor’s Vulnerability

Not every client will be honest and cooperative, and some will be deceptive and manipulative and have a desire to frustrate the counselor. There are two major ways people will attempt to frustrate the counselor:

  1. Manipulation: Some people are masters of getting their own way by controlling others. Sessions might lengthen and become more frequent; one counselor even began to running errands, making phone calls and giving small loans for the counselee, who consistently expressed gratitude and mournfully asked for more. These people have made manipulation a way of life. The counselor must ask, “Am I being manipulated?” “Am I going beyond my responsibilities as a counselor?” “What does the counselee expect from me, or really want?” One must deal with the manipulation and expect their denial of it, then restructure the counseling in a way that prevents this manipulation and exploitation of the counselor in the future.
  2. Resistance: Many people want quick relief, and when they discover it will take time and commitment on their part, they begin to resist. Resistance is a problem that often requires in-depth professional counseling. When a counselor begins to work, a client’s psychological defences are threatened and this leads to anger, anxiety and non-cooperation. When clients are fairly well-adjusted, this resistance can be discussed gently and openly. The client needs to know that he (not the counselor) is ultimately responsible for his improvement.

Crisis Intervention

There are several goals in crisis counseling:

  1. To help the person cope effectively with the crisis situation to his usual level of functioning.
  2. To decrease anxiety, apprehension and other insecurities that may persist after the crisis has passed.
  3. To teach crisis-solving techniques so the person is better prepared to anticipate and deal with future crises.
  4. To consider biblical teachings about crises so the person learns from the crisis and grows as a result.

The counselor can make a difference during a crisis in several ways:

  1. Make contact: People in a crisis don’t always seek a counselor, so more often we must go to them to show support, warmth, understanding and genuine interest. The person make drift into daydreaming, and eye contact can bring them back to reality. Touching can give reassurance, but one must be cautioned that a hug or hand holding can be interpreted with sexual overtones. Remember to ask about your own motivation for touching. Is it something that can give comfort to your counselee in their crisis?
  2. Reduce anxiety: The counselor’s calm, relaxed manner can help reduce anxiety in the client, especially when the calmness is accompanied by reassurance. Remind the client that there ARE ways to deal with this situation. State your approval of something done effectively. Encourage taking deep breaths, relaxing of muscles, using comforting verses from the Bible as well.
  3. Focus on issues: There are at times a mass of confusing facts and one can be overwhelmed. Which are the real problems and the ones on which need to be worked on first. Focus on the present and not on the possibilities of the future.
  4. Evaluate available resources:
    1. The counselor’s willing to help.
    2. The spiritual resources we have in Christ.
    3. The client’s personal resources: Intellect, skills, past experiences, motivation.
    4. Interpersonal resources: Friends, family.
    5. Tangible help: Medical, legal, psychological, financial and community.
  5. Plan intervention: Deciding on a course of action is very helpful, “What do we do now?” How realistic is the plan? What should be done first? Our goal is not to put more pressure on the client to make these decisions, but also we don’t want them to become dependent on someone else to solve the problem.
  6. Encourage action: It is possible to decide on the plan and be afraid to move out in faith to get it all going. Taking action involves some risk. There is the possibility of failure or later regret. There are some crises that will never be resolved even with action taken: death, terminal illness, failure to get the promotion. They will need help to face the situation honestly and adjust to the reality of it.
  7. Instill hope: This can bring relief from the suffering. It is based on the belief that things will be better in the future. The Christian counselor does this through:
    1. Sharing of Scriptural truth, stimulating faith in God.
    2. Help them to examine their self-defeating logic, like “Ill never get better” and “Nothing can get worse.” These should be gently challenged.
    3. You can get the counselee moving and doing something, even if it is minimal activity can bring hope in the steps toward the goal.
  8. Environmental intervention: Encouraging others to pray, give money or supplies, give practical help or otherwise assist. The client might feel embarrassed by the attention, or threatened by the implication that they need help. They might even become angry with the counselor.
  9. Follow-up: Crisis counseling in short-lived. The time moves on, and we wonder if anything has been learned? Will the next crisis be handled effectively? Is the person getting along satisfactorily?

The Crisis in Counseling

A crisis is an event or situation that threatens our psychological equilibrium. They are expected or unexpected, real or imagined, actual (as a loved one has died) or potential (as is appears that a loved one might die). Someone has noted that the Chinese word for crisis is made up of two characters: one means “danger” and the other “opportunity.”

  1. Danger: This is because it threatens to overwhelm the person. It involves the sudden shift of roles, or a significant loss. Due to the intensity of the situation, the customary methods of handling stress no longer work, which leads to frustration and bewilderment, anxiety, anger, discouragement, sorrow or guilt.
  2. Opportunity: Counseling offers a chance to grow, change and develop better ways of coping.

The Bible and Crises Types:

Much of the Bible is concerned with people in crises: Adam, Eve, Cain, Noah, Abraham, Isaac, Joseph, Moses, Samson, Saul, David, Elijah, Daniel and on and on. Several letters were written to help people going through crises. There can be identified three types of crises:

  1. Accidental or situational crises: Sudden threat or unexpected loss occurs (death, pregnancy, social disruptions like war or economic depression, loss of a house or savings, sudden loss of respect or status).
  2. Developmental crises: Occurs in the course of normal human development (start in a new school, going away to college, adjusting to marriage then parenthood, handling criticism, facing retirement, declining health).
  3. Existential crises: The are changes in self-perception, which can be denied temporarily but must eventually be faced realistically. They overlap the above but come when we are forced to face such disturbing truths:
    1. I’m a failure.
    2. I’m too old to reach my goals.
    3. I’ve been passed over for the promotion, again.
    4. Now I’m a widow, single again.
    5. My life has no purpose or meaning.
    6. My illness in incurable.
    7. My house and possession were destroyed in the fire.
    8. I’ve been rejected because of my skin color.

Think of Elijah’s great victory at Carmel and then his emotional state afterwards; Jonah and his thoughts; the calamities of Job.