So…I have some social anxiety stuff. Jack has some social anxiety stuff. We don’t like talking to people and we don’t like people talking to us. And forget large crowds!!!! He started Kindergarten a few weeks ago and he had the ambitious goal of making a friend everyday. He got two friends and decided that was enough. But hey…he talked to other kids so I am proud!!
So I’m away at school and I decided that I need to change some things about myself. If Jack can do it…I can do it. I decided to make a friend a day. Yesterday I cheated a little. I re-engaged someone that was in a previous class with me. But I sought her out and made an effort to sit at her table during lunch.
Today was a little more difficult. I tried to work up the gumption to be social…but it just wasn’t firing. We split up into dyads and did role playing. My partner had “social anxiety”…Yes Kana, that’s your sign. So I made eye contact and talked with him after the exercise. He’s actually a little famous. I won’t disclose names but he has a shiny college bowl ring!!!
So tomorrow…I’m putting myself out on a limb and asking someone to be my study partner for the CPCE. The thought of being one on one with someone studying FREAKS ME OUT. But that’s what CBT is all about and I can’t ask clients to do something I wouldn’t do myself.
So, I’m working on a paper for school and something came to me that I feel the need to blog about. The 5th chapter of John tells the story of a man who can’t walk. He is sitting at a well in Bethesda where miracles happen…and he has been sitting there patiently for 38 years. Apparently he is waiting for someone to come and hand him the miracle of feeling. When Jesus asks him if he really wants to get well, the man tells Jesus that no one will help him get to the water. He also bitterly tells Jesus that when he tries to crawl to the well on his own…someone always steps in his way. The man was blaming his inability to get healing on outside forces instead of on his own self. Jesus tells him “Pick up your mat and walk”!!! At which point he does, and he is healed.
I wonder if that man laid there for 38 years afraid of what would happen if he ever DID make it to the water? He had gotten comfortable with where he was? Was he scared of feeling again, or was he scared that if he got there, he wouldn’t be healed? Did his fear of failure cause him to project blame on those around him? Either way, Jesus did not pamper the man. He simply told him to just do it – just get up and walk. The blaming and self-pity had been wasted energy. The time he had wasted on looking for reasons WHY he wasn’t healed could have been used getting himself to the water. Fear kept the man from being made whole. Jesus knew that, just like he knows our fears and doubts. He knows that we are human. He knows that we don’t like change.
I really don’t want to be the man waiting by the well for someone else to show me the way. I don’t want to be scared of change, something peculiar, something new. I’m ready to step out of my comfort zone and into something different. I don’t want to lay in wait for everyone else to move before I try to get what God has planned for me. I want to know what it feels like to move. That man wasted 38 years!!! I want to be able to say that I tried. I may get stepped on or I may drown in the water like a paralyzed fool, but I am not going to sit around and wonder what life could have been like if I wasn’t afraid to live…to feel.
There are almost 150 classes of drugs, all of which were primarily created to be used medicinally, “by changing the biological function of target cells through chemical actions (Doweiko, 2009, p. 18).” Pharmacology is the study of how these chemicals actions affect living organisms. It includes drug composition, interactions, therapeutic capabilities, and toxicology. Counselors in the addiction and rehabilitation field must have a working knowledge of all the components of pharmacology.
One of the most important parts of pharmacology is the route of administration for a drug compound, because this affects the intensity and speed of the drug’s action. According to Doweiko (2009), there are thirteen methods of administration, with primary routes including oral and injection. Oral administration has the longest effect time because it involves breakdown of the drug compound in the stomach and intestines before absorption into the blood stream. Because of this, some abusers prefer to crush pills meant for oral administration, and inhaling them intranasally. This method provides a faster effect time because it provides the drug direct access to the blood flow in the sinus cavity, but it is somewhat “erratic (Doweiko, 2009, p. 20).” Injection involves directly depositing the drug compound into a muscle, vein, or under the skin. One benefit of this method is an almost instant effect with no interference from the gastrointestinal tract (Doweiko, 2009).
The effective dose of a drug compound is the estimated amount of the drug needed to reach desired effects for a percentage of the population. The lethal dose is the estimated amount of the drug that would kill a percentage of the population. The therapeutic index measures the difference between the effective dose and a lethal dose. The lower the therapeutic index, the smaller the margin is between the compound being effective or becoming toxic.
According to Doweiko (2009), drug compounds “must enter the body in sufficient strength to achieve the desired effect (p. 21).” The prime effect of a drug compound is the therapeutic, or medical, benefit to a disease, illness, or condition (Doweiko, 2009). The secondary, or side effect, is the undesirable results of the drug compound. Peak effect indicates when the most powerful results of the drug compound are felt. The half-life of a drug compound is an approximation of the length of time it will remain active within the body. Generally, the faster the peak effect, the shorter the half-life of the drug (Doweiko, 2009).
The bioavailability of a drug compound describes how it is absorbed, distributed, broken down, and eliminated from the body. The process of moving the drug compound from the route of administration to the sight of action is absorption. The way the drug is moved throughout the body is distribution. Biotransformation is the detoxification, or breaking down the drug compound for elimination. Elimination is the process in which the human body purges itself of the drug compound (Doweiko, 2009).
When looking at the pharmacology of addiction, it is vital to look at all of the components of how a substance is introduced, processed, and eliminated from the human body. The faster a drug compound can be absorbed, allowing the user reach a high, the greater the risk of abuse and addiction by the user (Doweiko, 2009). Substance abuse counselors should be knowledgeable about the pharmacology of the drugs their clients abuse in order to understand the complex nature of addiction. They must know drug benefits, side effects, risks, and symptoms in order to be most effective.
Doweiko, H. (2009). Concepts of Chemical Dependency. (8th ed). Belmont, CA: Brooks/Cole Learning.
Models of addiction define theories behind why researchers believe a person becomes physically and/or emotionally dependent on substances. Even though it is a complex and often multi-layered battle, researchers have narrowed down the root causes of addiction (Cook, 2006). The three primary models presented by Doweiko in Concepts of Chemical Dependency (2009) are medical, psychosocial, and the disease of the human spirit.
The medical model views addiction as a disease or chronic illness, stating that people are biologically predisposed to become addicts (Doweiko, 2009). According to research, addicts have a lower number of dopamine receptors. Therefore, they are
biologically vulnerable to the effects of substances that cause the release of dopamine to flow properly to these receptors (Doweiko, 2009). Once exposed to the effects, these people have a more difficult time resisting abusing the substances (Cook, 2006). One risk of the medical model is that it creates an opportunity for addicts to avoid personal responsibility for their addiction
(Jenkins, 2011). It is still unknown whether generational abuse is a genetic pattern or a learned environmental behavior.
The psychosocial model suggests that addiction is a learned behavior of an addictive personality type (Doweiko, 2009). Theorists of this model do not believe addiction is a disease because the injured party contributes to and promotes the disorder, unlike other diseases (Dowieko, 2009). Instead, they propose that people who fall into a certain category of personalities become more vulnerable to social and environmental factors that lead to substance use and abuse (Cook, 2006). These factors cause the addictive personality to seek the relief of emotional pain through addiction. One downfall of the psychosocial model is that researchers are unable to agree on exactly what personality traits predict substance abuse and addiction (Doweiko, 2009).
The disease of the human spirit model suggests that lack of purpose and connection to a greater power lead to an unending void (Doweiko, 2009). According to this model, addicts have temporarily patched the void with the abuse of substances in order to escape reality. However, no amount of chemical use can permanently fill the spiritual and emotional void. God created humanity to be in relationship with him. Therefore, there is no outside substitute or fulfillment for the empty space that is created by living outside of a relationship with Him. People suffering from addiction become focused on the substance of their abuse. They lose sight of God. According to Doweiko (2009), “spiritual growth is impossible when people view chemical use as their first
When looking at the complex nature of the beast of addiction, it is important to take in account all of the factors involved and treat the person individually, and holistically. Counselors should look at the chemical, spiritual, biological, sociological, and psychological aspects in order to gain an accurate picture of each client. Therefore, it is my belief that it is vital to examine all three models of addiction to achieve the most effective treatment for therapy.
Cook, C. (2006). Alcohol, Addiction, and Christian Ethics. London: Cambridge University Press.
Doweiko, H. (2009). Concepts of Chemical Dependency. (8th ed). Belmont, CA: Brooks/Cole Learning.
Jenkins, D. (2011). Psy.D. Addiction and Recovery: Models of Addiction. (Video Presentation).
Abuse vs Addiction
SUBS505: Abuse and the Recovery Process
When discussing substance abuse, the terms “addiction” and “abuse” are often used interchangeably. Although substance abuse and substance addiction are both potentially hazardous, they are not the same. The difference between the two terms is subtle, but it is important to those seeking to understand the complex nature of substance dependency. Addiction is always caused by substance abuse. However, abuse does not always signify a substance addiction (Pinsky, 2003).
Substance abuse is the use of a substance for purposes other than it was intended to be used. Doweiko (2009) says that abuse is “using a drug with no legitimate medical need to do so, or in excess of accepted social standards (p.13).” In cases of abuse, there is not a physical dependence on the substance. The abuse may or may not have a negative impact on the personal life of the abuser, such as financial hardships and loss of relationships. However, many times the substance is either illegal, or is being used in an illegal manner (Pinsky, 2003). This may lead to legal struggles which open doors for financial, relational, or occupational problems.
Substance addiction begins when an individual has a physical or mental dependence on the substance they have been abusing (Pinsky, 2003). They begin to be preoccupied with the using and obtaining substance, neglecting obligations and ignoring social or personal problems caused by the use of the substance. Individuals who are suffering from addiction build up a tolerance and will go though withdrawal when they are denied use of the substance (Doweiko, 2009). These individuals will have financial, personal, and/or professional struggles due to the fact that they cannot stop the substance use in spite of the negative impact it has on their personal life. They may also suffer from legal issues stemming from their addiction (Pinsky, 2003).
When looking at the difference between the terms “abuse” and “addiction” there is a similarity, but also an obvious divergence. The impact of both on society is devastating. Doweiko (2009) says that the United States is responsible for over 60% of the worlds illicit drug use, and that alcoholism is the second most common clinical diagnosis. Substance abuse and addiction are becoming frequent topics of discussion in the media and the use of illegal substances has reached an all time high (Pinsky, 2009). Because of this, it is vital that professionals wishing to enter the field of rehabilitation counseling are properly trained and educated.
Doweiko, H. (2009). Concepts of Chemical Dependency. (8th ed). Belmont, CA:
Pinsky, D. (2003). Cracked:
Putting Broken Lives Together Again. New York: Regan Books.
There are many techniques used to treat and rehabilitate addiction, but the focus of this case is the use of Psychoanalysis on a fictional character who has presumably already received detoxification treatment for the use of Vicodin. Using Psychoanalysis in addiction therapy does present a challenge. However, several new research projects promote the use of many of the foundational treatments of Psychoanalysis. It is recommended that any type of addiction therapy be coupled with group therapy, as well as with a relapse prevention plan. However, this is certainly vital when using Psychoanalysis as a recovery therapy. The combination of these therapeutic processes allow for individual healing as well as group healing and cohesion. This paper concludes that all addiction therapists must be well rounded and integrative in their approaches in order to be successful.
Psychoanalysis Case Study of Gregory House M.D.
A Conceptualization and Treatment Plan
Drug addiction is a serious issue that affects a person’s emotional, relational, and physical health. One of the reasons that addiction is so difficult to battle is that substance use reinforces itself with the perceived positive effects. However, Khantzian (2006) says that too much emphasis is placed on the pleasure principle behind drug abuse. There are more important aspects to the underlying cause of addiction, which are mostly emotional and chemical in nature (Pinsky, 2008). Khantzian (2006) describes the difficulties in an addict’s coping skills, as well as trouble engaging their environment, as primary psychological reasons for drug abuse. For this reason, Psychoanalysis can be a useful tool in treating clients with drug addiction. The objective of this form of therapy is to discover familial or relational ties related to the drug use, and formulate a healthy support system conducive to recovery (Strean, 1984).
Dr. Gregory House is a 51-year-old Caucasian male who is currently seeking addiction counseling. His drug of choice is Vicodin. The client developed his addiction after a surgery and a misdiagnosed infarction left him with “chronic leg pain.” He currently walks using a cane, and claims that he does not necessarily have an “addiction” because Vicodin use does not interfere with his work. He also says that his habitual use of Vicodin is “not a drug problem, it’s a pain problem.” Dr. House has at this time, already completed in-patient rehabilitation and detoxification. He needs consistent follow up and addiction therapy, as well as a relapse-prevention plan.
Dr. House reports that he did not come from an affectionate home environment. He states that while he loves his mother, his father has an “insane moral compass ” and he avoids contact with him. House’s father was abusive towards him as a child, and several years ago, he discovered that John House is not even his biological father. However, he is not motivated to seek a relationship with his biological father.
In his daily life, Dr. House maintains purely superficial relationships. This has caused trouble for his most recent relationship with Dr. Lisa Cuddy. Dr. House realizes that his current behavior is unpredictable and irrational. He is seriously concerned about his own mental stability. He would like to investigate his narcissistic tendencies, because he feels that this may be the primary cause in the failure of his romantic, personal, and professional relationships.
Dr. House confirms that he did not have a nurturing or supportive home environment as a child. His father was a harsh disciplinarian and his mother was distant, which prevented him from building strong attachments with either of them. He was deprived from making community attachments because of his family’s military lifestyle and frequent relocations. He often found himself in foreign countries surrounded by children with whom he could not communicate. His only solace was in learning about other cultures through archaeology. Still, House does not (openly) report that he was lonely as a child. This seems to indicate that he has had an early emotional disconnect.
Because he has disconnected himself from his emotions, Dr. House struggles to build relationships with others. It is possible that Dr. House feels unworthy of valuable relationships, or more likely, that he cannot trust anyone outside of himself to meet his own needs. His failure to bond with others only serves to validate this feeling, and is probably rooted in his early parental model. Dr. House was deprived of an emotional attachment with either of his parental caregivers. The emotional disconnect is further demonstrated by his lack of motivation to connect with the man he now knows is his biological father. His difficulty building relationships with the two men in his life may be a sign, according to Psychoanalytical theory that he has not surpassed Freud’s Oedipal psychosexual stage of development (Freud, 1914/1957). Resolution of this stage would mean that Dr. House was able to identify with either John House, or his biological father.
Dr. House may have developed a negative self-view as a child because of his lack of intimate connection with others around him. Dr. House may also be afraid of the level of intimacy that is required from any non-superficial relationships, because his parents did not model intimacy for him. However, he masks these fears with strong narcissism and grandiosity. This defense mechanism allows him to deal with negative feelings. Dr. House has been unable to make connections with women, and usually resorts to paying for sex. Whenever he is close to developing a meaningful relationship, he self-destructs with narcissism, instead of exposing any vulnerability himself. This allows him to push people away and reinforces his internalized view that they are leaving because they are unworthy of his “greatness.” His relationship with Lisa Cuddy was his most intimate, primarily because after knowing him for ten years, she was able to see through his façade.
Dr. House seems to be conflicted between his cognitive self (which says he is lonely and wants a relationship with Dr. Cuddy) and his emotional self (which tells him that women cannot be trusted and he only needs himself). His lack of attachment is rooted in his detachment from his parents, and has weakened his capacity of forming autonomy. Dr. House seems to think that he is entirely self-sufficient. If he allows someone, especially a woman, to become so close that he is emotionally attached to them, he fears that he may lose something of this artificial self–sufficiency. This idea, and its proximity to the opposite sex, should be explored in relationship to Dr. House’s mother, according to Freud’s Phallic/Oedipal stage of psychosexual development (Jones & Butman, 1991).
Dr. House’s primary issue is his addiction recovery. Dr. Drew Pinsky (2008) says that addiction is less psychological than it is biological. However, the psychological factors must not be ignored, and are key to recovery . A recent study of addiction found that there is a great capacity for using Psychoanalysis in treating addictive behavior (Khantzian, 2006). Battling addiction can be a lonely struggle. Since Dr. House has been unsuccessful in building intimate relationships, he has been unable to build effective addiction treatment supports. Effective addiction recovery treats the nature of addiction, while nurturing the client’s ability to maintain will power (Pinsky, 2008). Having proper emotional and physical stimulation helps to keep the body alert and able to fight temptations. Support is a necessary part of temptation treatment, and can make or break rehabilitation (Pinksy, 2008). By developing intimate bonds with a support system, Dr. House will be allowing himself the safety of relationship building while revealing his vulnerability. This may be a gateway for him to develop more meaningful relationships.
In psychoanalytic theory, defense mechanisms are the supports to a weakened ego (Murdock, 2009) that defend against perceived attacks. Traditional Psychoanalysis usually confronts defense mechanisms (Corey, 2008). However, Pinsky (2008) thinks it is best to provide clients in recovery with healthy ways of coping before taking away the maladaptive ones. One way to do this is to re-frame coping skills and defense mechanisms and define healthy alternatives. For instance, Dr. House has gone without the use of drugs for his chronic leg pain for a year. He does not NEED medication for pain management. His drug use at this time is strictly mask nagging inferiority feelings and vulnerability since his break up with Dr. Lisa Cuddy. According to Dr. Pinsky’s (2008) theory, it would be advisable to teach Dr. House new ways of dealing with both his perceived leg pain and his feelings of abandonment (rooted in his early parental interactions) in order to effectively treat him.
Goals for Counseling
From a Psychoanalytic perspective, the goal of treatment for Dr. House is to help him gain insight into where his fear of vulnerability comes from, and how these experiences have negatively impacted his relationship building skills. It is important to bring to consciousness any unresolved issues that are causing current struggles in relationships. Dr. House is allowing himself to be isolated, which is hindering his recovery, on many levels. Forming strong relationships in a group rehabilitation therapy setting, along with a positive therapeutic bond with the counselor, will provide Dr. House a foundation for healthy relational skills.
It is also and important goal to help Dr. House search for underlying depression or anxiety caused by his lack of emotional connection. Addicts often are ill equipped to deal with strong emotions, leaving them pre-disposed to drug abuse, and at even greater risk for relapse (Pinsky, 2008). Defense mechanisms generated by Dr. House’s emotional detachment have, for the most part, been successful in his attempt at keeping his inner-self protected. However, when Dr. House began treatment for his chronic leg pain, he found a new way of coping. Freudian psychoanalytic theory associates addiction with the oral stage, the first need-gratifying stage of development (Murdock, 2009). Khantzian and Treece (1985) add that, “Opiates were said to produce a state reminiscent of a blissful closeness and union with the mother, which resulted in avoidance of separation anxieties aroused by the adolescent dependency crisis (p. 13).” Khantzian (2006) also believes that drug and alcohol abuse act as a defensive strategy that bridges the gap between a person’s functional and defective ego, allowing them to cope.
Dr. House provides an air that he is superior, even though he uses the advice of others in solving his diagnostic cases. This grandiose personality can be especially grating on therapists. It is important to confront Dr. House on these matters, without taking too much from his fragile ego. For instance, pointing out that he was assisted in solving a certain case, but commending him on a job well done. One point that would be important in using confrontation with Dr. House is to not be affected by his narcissism and allowing it to cause counter transference, and feelings of negativity towards him. I would search my reasons behind any confrontations before hand and have an understanding of how it will benefit Dr. House.
Establishing the relationship
Considering the fragile state of Dr. House’s internalized ego, it is important that I reach out to him with acceptance and empathy. Narcissism prohibits individuals from achieving satisfaction in relationships, work, or other activities (Khantzian, 2006). He needs to see that relationships can be nurturing, even if, and especially if, an individual is broken. For this reason, Dr. House also needs to be able to forge relationships with others in his peer group and therapy group.
Khantzian (2006) says that people who struggle with their need to be acknowledged, to love and be loved, will be at risk for substance dependence. Dr. House’s drug use provides him with a synthetic validation for his narcissism. Since he began treatment and detoxification, he no longer has that artificial crutch. It is important on my part to be favorable and feed into his strengths to provide him with sincere encouragement during the initial sessions. The effects of this will hopefully be a building of mutual trust and respect. Dr. House needs to learn comfort in confiding, and the effects of being accepted, even when his attitudes are unacceptable.
Analysis of transference
One of the most important factors in the therapeutic process is the client/therapist relationship. Without it, transference cannot be assessed. In fact, Strean (1994) says that all patients “will respond to interventions in terms of the transference (p. 110)” and that the therapy model, setting, or experience of the counselor, make no difference in recovery. Because of the vital role transference plays in the healing process, I recommend that Dr. House connect with his feelings about me during our sessions, and openly confront and express them. We can then begin to match these emotions with other instances of similar feelings and their root cause.
In the Psychoanalytical therapeutic model, insight provides a look into the emotional and logical though process. The goal of insight is to find how Dr. House’s insecurities were formed and provide him with an opportunity to correctively deal with these experiences. Self-realization of past conflicts and perceptions of feelings that have been repressed will allow Dr. House to form other options for reactions, and develop other behavior patterns (Khantzian, 2006).
However, insight alone is not enough. It is vital that Dr. House makes a connection between insight and an emotional experience. Substances themselves are such strong behavior reinforcements, that patients need a strong emotional counteract-ant. This will hopefully ensure the client can counter the strong compulsion for them. Dr. House likes to solve problems. This makes him feel adequate, and feeds his need for validation. I would like to challenge him to see himself as a puzzle, and ask him to seek himself for insight on his situation.
With time and support, it is hoped that Dr. House will find meaningful relationships to be satisfying. The goal of this form of therapy is to allow Dr. House to recognize his own fear of inadequacy and how his grandiosity is interfering in his daily relationships. Dr. House needs to be validated for his strengths, but learn that weakness is acceptable, and can even be an asset. Dr. House’s self-esteem need not be threatened by his vulnerabilities. This paper concludes that addiction therapists must be well rounded and integrative in their approaches in order to be successful. Dr. Pinsky (2008) says that while addiction is “treatable” it is not “curable.” It is important that Dr. House heal his relationship patterns if he wants to treat his addiction.
Corey, G. (2008). Theory and practice of counseling and psychotherapy. Belmont, CA: Thomson Brooks/Cole.
Freud, S. (1914/1957). On narcissism: An introduction. In J. Strachey (Ed. and Trans.). The standard edition of the complete psychological works of Sigmund Freud. London: Hogarth Press.
Jones, S. L., & Butman, R. E. (1991). Modern psychotherapies: A comprehensive Christianappraisal. Downers Grove, IL: InterVarsity Press.
Khantzian, E. (2006). An ego/self theory of substance abuse. National institute of drug abuse: Theories on drug abuse: selected contemporary perspectives. 30.
Khantzian, E., and Treece, C. (1985). DSM-III diagnosis of narcotic addicts: Recent findings. Archives of General Psychiatry. 42, 11-26.
Lipowski, Z. (1984). What does the word psychosomatic really mean? A historical and semantic inquiry. Psychosomatic Medicine. 46, (2) 153-171.
Murdock, N.L. (2009). Theories of counseling and psychotherapy: A case approach. Upper Saddle River, NJ: Prentice Hall.
Pinsky, D. (2008). Cracked: Putting broken lives back together again: A doctor’s story. New York, NY: HarperCollins Publishers.
Strean, H. (1994). Essentials of psychotherapy. New York, NY: BrunnedMazel Publishers.
It is important to develop a biblically based theory of Christian counseling that integrates psychology, spirituality, and theology. This model must be flexible enough to incorporate non-believers, while attempting to gently facilitate a personal relationship with God in both believers and non-believers alike. It is the author’s intent to develop an integrative theory by using techniques proved valid by science, in conjunction with theological truth. This integrated approach will take into account personality structure, motivation, development, and worldview to devise a plan of change for clients. This process will allow the author to determine the appropriate amount of integration necessary in treating each client on an individual basis. Organizing the author’s own personal theory will improve decision making and growth. This essay will serve as a launching pad for the author to identify individual areas of strength and development.
A comprehensive personal theory of counseling should accommodate the integration of psychology, theology, and spirituality. It is important to match the client’s spirit, with the scientifically proven techniques of psychology, backed by theological truths. McMinn (1996) says that counselors who fail at integration are neglectful of their client’s needs. 1 Corinthians 12 explains that body parts each serve a purpose, but cannot function alone. Instead, they all work together in order for the body to work effectively as a whole. Because of this knowledge, I have developed my personal integrated theory of counseling based on a blend of the work of various authors.
Systems, Concentric Circles, and Personality Formation
In order to be effective, counselors should have a working knowledge of the differing personality types, as well as how behavior models work. Dr. Larry Crabb (1977) says, “Whenever we dissect an organism to examine its constituent parts, we are in danger of losing sight of the whole functioning organism (p. 87).” Personality develops throughout a lifespan, as a person grows. It is unique to each individual and is a God given gift to be used for His Glory. According to Hawkins (2006), there are five factors that counselors should look at which influence and shape the human personality. They are the core, soul, body, temporal systems, and supernatural systems, and work together concurrently and affect the entire system. Counselors must be aware of all aspects of the client in order to provide effective treatments.
Knowing the structural aspects of the personality is imperative for understanding how to effectively help people in need. Crabb (1977) says that human personality is composed of two parts, the physical and personal. “The body belongs to the physical side and the spirit and soul to the personal (p. 88).” However, Hawkins’ model is more comprehensive and takes into account all of the systems that effect the personality. He proposes the personality is comprised of several systems of circles.
The heart, mind, and soul are the core of a person, and are where life abounds (Hawkins, 2006). According to Genesis 1:27, man is made in the image of God. At our core we are unique individuals, with different talents, dreams, and abilities. However, sin and selfishness are also a part of the first system, or core, of personality (Hawkins, 2006). It is the goal of Christian counselors to help clients seek to become more like God. Crabb (1977) says that the Holy Spirit can guide clients through a transformation of their personality. “Therefore if any man be in Christ, he is a new creature: old things are passed away; behold all things are become new… (2 Corinthians 5:17).” Personality development in a Christian occurs when God becomes the focus of an individual’s thoughts and behaviors. An accurate sense of self, and the need for God, replaces self-sufficiency (McMinn, 1996) and faulty beliefs from childhood (Crabb, 1977).
Counselors can help clients make core changes by reshaping unhealthy behaviors. This primarily includes the thoughts and emotions of the heart and soul (Hawkins, 2006). One way that counselors can help clients overcome irrational thoughts and emotions is to use Crabb’s (1977) seven stages of counseling. Crabb (1977) says counselors should help clients identify problem feelings, behaviors, and thinking. Then, clients should commit themselves to change with biblical actions and thinking. Jay Adams (1986) rejects the claim that truth has to make one feel good about his or herself. Adams stands by the biblically based notion that: “all have sinned and fall short of the glory of God.” It is necessary both as a Christian coming to faith, and as the broken one coming for healing, to know that change is needed because old behaviors were not working.
The body is also a part of the first concentric circle (Hawkins, 2006). Anderson (2000) says that environment plays a vital role in a person’s emotional wellbeing. Understanding the affects that poor physical health can have on mood and cognition is a key indicator of counselor proficiency. Emotional problems can have physical consequences (Hart, 1999). Chemical reactions, caused by anxiety, worry, and stress, can have a negative effect on brain functions. Dr. Hart (1999) says unhealthy stress and a fast paced environment are the root cause of anxiety and have very physical ramifications. He suggests that humans were not made to withstand the high demands and activity that is common among American society. He adds that a panic attack can sometimes serve as a warning that a person might be “living too fast, too hassled, and too stressed-out (p. 5).”
God designed people to be in relationship with one another. “People just don’t have relationships; they are relational (Wilson, 2001, p. 77).” The Bible is full of stories about what Hawkins (2006) calls temporal systems, or relationships. Looking at client temporal systems is a vital part of client healing. These include friends, family members, communities, co-workers, and church members. Dr. Cloud and Dr. Townsend (1999) make it clear that it is personal reactions to events that cause relationship breakdown.
Counselors must help clients learn what part of each system that they are responsible for and set healthy boundaries, or property lines, in order to protect themselves (Cloud & Townsend, 1999). There are several types of healthy boundaries, which include language, integrity, consequences, emotional or physical separation, and time. Cloud and Townsend (1999) further clarify that a boundary is a means to help us decide where another person’s power begins and ends, but not as a means to control another person. This is the way God designed healthy, temporal relationships.
Finally, there is the supernatural systems circle (Hawkins, 2006). ”In The Bondage Breaker, Dr. Neil Anderson (2000) claims that, “some problems are physiological and some are spiritual (p. 21). He describes the forces at work on the formation of human personality, and the affect Satan has on temperament. Anderson (2000) says that a sinful lifestyle provides the enemy an open door to do his work.
Components of Mental Illness
There are many things that cause or contribute to a client’s mental illness. A breakdown in any one of the concentric circles can provide the foundation for a psychiatric disorder (Hawkins 2006). Mental health can also be affected by biological, cognitive, emotional, spiritual, and lifestyle dynamics.
Biological factors that affect mental health include genetics and chemistry. For instance, Hart (1999) says that genetics sometimes play an important role in anxiety caused by stress. He suggests that people who run on adrenaline “inherit a large part of this tendency rather than develop it later in life (p. 55).” While genetics can influence the impact of stress, chemical imbalances are to blame for most cases of depression and anxiety. According to Hart (1999), chemical imbalances are also to blame for disorders such as schizophrenia. Some other illnesses, such as addiction, can be biochemical in nature (Wilson, 2001).
Backus & Chapian (2000) state that another cause of mental illness is cognition, or the way a person interprets events that happen to them. In fact, they add that flawed cognition is the cause of most mental illnesses. Instead of actual events, it is the client’s interpretation of the events, which causes them distress (Backus & Chapian, 2000). They claim that, “Wrong thinking produces wrong emotions, wrong reactions, wrong behavior—and unhappiness (p. 222).”
Anderson (2000) warns that Satan can manipulate our thoughts, and knows that “if he can control your thoughts, he can control your life (p. 61).” For this reason, it is important that counselors look for faulty thought patterns and work with the client to replace them with truth. Since behavior is affected by cognitions, interventions need to be based on the level of how much faulty beliefs are guiding a client’s inappropriate behavior (Backus and Chapian, 2000). They state that the best way to help clients see past wrong thinking is to train them to put thoughts in the proper prospective, with what they term “Misbelief Therapy.”
McMinn (1996) defines mental health as having an awareness of self that is reflective of the truth. Dr. Sandra Wilson (2001) suggests that the way for clients to find the truth about who they are is to use scripture to validate their worth in Christ. Hart (1999) adds that people should use positive self-talk in order to promote truth. Dr. Wilson (2001) suggests the way to promote truth is to identify key issues, apply truth to them, decide what steps to take next, and put it into practice. When clients have an awareness of how their misconceptions can affect their attitude and outlook, they will work harder to take control of those thought patterns. Dr. Wilson (20001) puts it this way, “new choices + consistent practice = change (p. 87).”
Clients can also have emotional scars that stem from their temporal systems, or the hurts of others. Backus and Chapian (2000) say that Satan uses relational deceptions to keep God’s children from building healthy temporal systems. The most common deceptions include: trying to win the approval of others, having the attitude of a victim, manipulation, beliefs about being needed, and old habits or behaviors. Anderson (2000) claims that the sources of unhealthy emotions are defense mechanisms such as denial, regression, projection, rationalization, and fantasy. Use of these defense mechanisms can cause hurtful behaviors in ourselves, as well as others. In her book, Hurt People Hurt People, Dr. Sandra Wilson (2001) says that emotional wounds cause people to wound others. She feels that this cycle is strongest between parents and their children, stating that parents often unknowingly repeat the same hurtful patterns that they experienced as children. Until clients learn to find their worth in Christ, and not in these temporal relationships, they are doomed to repeat this cycle.
A final way that mental health can be compromised is by sin. Jay Adams (1986) says that counselors who dismiss the affects of sin are being neglectful. Sin infiltrated human nature when Adam and Eve were disobedient in the Garden of Eden. Since that time, Satan has used our human vulnerabilities to prey on God’s children. Anderson (2000) says that the loss of control happens gradually and leads to the emotional bondage of God’s children. According to Wilson (2001), food, comfort, sex, and rest are areas of weakness that Satan preys on. She adds that these are the roots of many mental health issues, and succumbing to these temptations lead to destruction. Satan is working in deception, and only God’s truth can break his power.
It is important for counselors to know their clients inside and out according to the systems approach outlined by Hawkins (2006). This allows them to reach clients on a level that is most effective for their personality types. Clients may need emotional, spiritual, physical, or cognitive based approaches, according to their differing needs (Hawkins, 2006). Client weaknesses must be looked at as well, in order to find the sources of any hurts, scars, sin, imbalances, or misconceptions.
Integrated Personal Theory
McMinn (1996) defines the ability to contemplate and utilize a blend of theories at once as multi-tasking. My integrated personal theory of counseling includes the ability to multi-task with clients in a way that accommodates the entirety of their lives. I feel the way to do this is by using techniques that have been proved valid by science, in conjunction with theological truth. It is important for me to develop a biblically based model of counseling that integrates psychology, spirituality, and theology that is also flexible enough to incorporate non-believers.
It is my professional goal to gently facilitate a personal relationship with God in both believers and non-believers. I will strive to seek treatment methods that can be tailored to individual needs, such as Hart’s (1999) method to break the worry habit, Hawkins’ (2006) concentric circles model, Adams (1986) teaching in the milieu, and Anderson’s (2000) steps to freedom. This integrated approach will take into account personality structure, motivation, development, and worldview to devise a plan of change for clients. I feel my personal method will allow me to determine the appropriate amount of integration necessary in treating each client on an individual basis.
Creating an environment that is conducive to healing is a key factor in the therapeutic process. Dr. Larry Crabb (1977) says that the best way to assist clients in identifying problem feelings is to create an atmosphere of acceptance and genuine empathy. The best way to do this is by creating an inviting space and using body language that is open and receptive (McMinn, 1996). Counselors should also use limited self-disclosure, humor, empathy, and modeling in order to build a positive report. Clients will feel removed from the threat of being judged and trust will be established, allowing the client the freedom to look at themselves honestly (Crabb, 1977). According to Dr. Wilson (2001), this is a very important step in a helping a client find motivation to create change for themselves.
Finding what motivates clients to make change is a task all counselors must face. Neil Anderson (2000) says that while we are born into the world physically alive, we are spiritually dead. Man begins to seek his purpose outside of God, with pride, greed, and envy – leading to spiritual bondage. It has been my experience that people make successful change when the old way is not working for them any longer. I believe this is where clients, and Christians in general, are when Jesus lovingly meets them and says, “Come to me, all you who are weary and burdened, and I will give you rest (Matthew 11:28).” Clients have the choice to fight the exhaustion and struggle that the old way has brought, or they can accept Jesus’ invitation. Cloud and Townsend (1999) expound on this by saying, “We must be free to say no, before we can wholeheartedly say yes (p. 49).”
I agree with Crabb (1977) that creating self-motivated change in a client’s needs, behaviors, ideas, beliefs, or personality is the main goal of the healing process. All of my education and experiences have provided me with techniques that a centered around assisting clients in reaching the point of change. Real, lasting, and valid change must change the heart of a client to make them want to become more like God.
It is important that counselors provide clients with the tools necessary to sustain lasting change (Adams, 1986). When client’s motivation changes from finding their own purpose, to finding God’s purpose, they find the maturing guidance of the Holy Spirit, which resides in their core (Hawkins, 2006). McMinn (1996) advises counselors to use prayer and scripture in order to help clients to make a connection with Biblical truth. This is modeling for clients another tool that they can use to seek and make changes, long after therapy has ended.
Once clients have reached a level of positive self-motivated change, they should begin to seek participation in healing relationships “with God and others (McMinn, 1996, p. 59).” This fits in with Hawkins (2006) temporal systems. The goal at this stage of Christian counseling should be a steady progress of becoming more Christ like. I feel it is important to teach clients models for setting healthy boundaries, so that they do not continue to allow themselves to by hurt by others or build resentments. Dr. Hawkins (2006) says that people are not alone, but are “constantly swimming in a sea of influences (Week one, step five).” It is the counselor’s job to work with clients to ensure they have a healthy temporal system.
Humans face challenges that are physical as well as spiritual. A headache can cause slower cognition, as well as emotional turmoil. Because of this, it is vital that counselors make sure that clients are healthy when they are doing a general assessment (Hart, 1999). Healthy clients are those who can function on all levels and maintain balance by utilizing healthy coping mechanisms. In order for clients to reach overall mental and physical health, they must strive for positive personal growth. Dr. Wilson says, “as long as we’re shuffling, or stumbling, in a new, healthier, more truthful direction, we’re making positive progress (p. 233).” There are many practical and healthy ways of dealing with life. Dr. Hart’s (1999) goal in The Anxiety Cure is to provide individuals with alternative methods of coping, which include learning to use the body’s natural tranquilizers, and reorganizing a hectic lifestyle. He encourages anxiety sufferers to “create a tranquil life in the midst of an anxious world (p.4).”
Christian Counselors need to have an understanding of their own worldview because it affects treatment and the progression of the healing process (McMinn, 1996). I value my relationship with Christ and have a Biblical worldview. All client issues will be reviewed from a Scriptural standpoint. It is my belief that any issues which are not addressed specifically in God’s word must be compared in light of Scripture. This will prepare me to wage a professional war with dysfunction and mental illness in the children of God, with a goal to restore client relationships with God, allowing them to find their identities in Him.
Adams (1986) says that scripture is inerrant and totally sufficient in providing the wisdom for counselors. I believe that this is still true, even for those who do not believe in Jesus as their personal savior. When dealing with clients who are non-believers, I will offer prayer and guidance without forcing my worldview on them. In fact, I view this as a challenge to build trust, and perhaps later have the chance to share the Good News. St. Francis of Assisi said, “Preach the Gospel at all times and when necessary use words.” I believe this applies to counseling. The nature of counseling is very interpersonal and because of this it is a great platform for transformation.
The unification of psychology, spirituality, and theology in counseling allows professionals to look at all of the aspects of human behavior when making client assessments (McMinn, 1996). Psychology provides scientifically proven theories and techniques. Spirituality provides a need for change, guidance, and hope. Theology provides a lens through which theories and techniques should be judged. In creating my personal integrated counseling theory, I pondered over which aspect was most important. I agree with Crabb (1977) that “psychology must come under the authority of Scripture (p. 49).” However, there is a risk of using personal interpretation of Scripture, instead of the way God intended. Because of this, I think it is important to utilize the guidance of the Holy Spirit. Christian counselors who are able to use the three disciplines in McMinn’s (1996) multi-tasking model will have the most comprehensive strategy for helping client’s to change.
Adams, J. E. (1986). How to help people change: The four-step biblical process. Grand Rapids, MI: Zondervan.
Anderson, N. T. (2006). The bondage breaker. Eugene, OR: Harvest House Publishers.
Assisi, F. (2011). Thinkexist. Retrieved from http://thinkexist.com/quotation/preach_the_gospel_at_all_times_and_when_necessary/219332.html
Backus, W. & Chapian, M. (2000). Telling yourself the truth: Find your way out of depression, anxiety, fear, anger, and other common problems by applying the principles of misbelief therapy. Minneapolis, MN: Bethany House Publishers.
Cloud, H. & Townsend, J. (1999). Boundaries in Marriage. Grand Rapids, MI: Zondervan.
Crabb, L. (1986). Effective biblical counseling: A model for helping caring Christians become capable counselors. Grand Rapids, MI: Zondervan.
Hart, A. D. (2001). The anxiety cure. Nashville, TN: Thomas Nelson.
Hawkins, R. (2006). Hawkins’ model for guiding the counseling process. Lynchburg, VA: Liberty University, Counseling Department.
McMinn, M. (1996). Psychology, theology and spirituality in Christian counseling. Wheaton, IL: Tyndale House Publishers, Inc.
Wilson, S. (2001). Hurt people hurt people: Hope and healing for yourself and your relationships. Grand Rapids, MI: Discovery House Publishers.