What You Need to Know When Seeking Couple's Therapy or Family Counseling

A Counselor’s or Psychologist’s effectiveness in doing psychotherapy lies in their training and field of expertise, as well as skills and years of experience.  It is important to realize that having a degree in psychology or counseling does not make one a competent counselor or psychotherapist. 

Four reasons why it is good to seek the help of a professional counselor or psychotherapist

1)     They are objective and can provide an objective perspective on issues that you are having difficulty discussing with each other.

2)      They are trained to provide safety and create an environment so every person in the room feels comfortable to honestly tell how they see the situation and feel about being in this difficult situation.

3)      They are trained to see the dysfunctional dynamics in relationships.  They know how to restructure  communication and how to disseminate power among each member of the family. 

4)      They also help in making sure that each one is heard and listened to by the members of the family.  When each one can speak truthfully and be listened to without being criticized and judged, then your family members will begin to feel loved and respected in the family.

Just make sure to follow through on your program.  Often people will see an improvement after 1 or 2 sessions and then decide they do not need to come back.  This is not wise and can sabotage the counseling.  It takes time and discipline to restructure dysfunctional relationships.  Not following through for change because the intensity of the moment has passed is another dysfunctional pattern.  Establishing trust is not easy.  Trust grows when you give your therapist a chance to work with you and faithfully attend your weekly counseling sessions.  Give yourself time to grow and change (at least 12 sessions).  Then reevaluate whether your goals have been met and whether there is further need for  counseling.

To make counseling work for your family, you must define a specific goal what you want to accomplish in your time together. 

Commit to finish the agreed number of sessions (unless you feel that you are not really going anywhere).  Sometimes it takes up to the 3^rd session to have a comprehensive assessment of the situation of your family.  So do not give up right away.  If you do not get what you expected, discuss it with the counselor.  If it is still not achieving your goal by the 6th session, that would be a fair time to decide that this specific counselor may not be the right person for you. 

Do not decide right away to change counselors based on the fact that the counseling is uncomfortable for you.  While you are uncomfortable, it may be helping other family members.  So stick with it for their sake.  Later you will realize that not all pain is harmful.  Some pain and discomfort might be needed to feel better and become a better person – and a better family.

Yes, bringing another person who is neutral and skilled to help provide safety for each of your family members and to allow each person to be honest to each other about what they think and feel about a specific situation or how they feel about being in the family and what they can do to help achieve the goal of the family is very important in changing the family dynamics as well as changing the culture of your home.  Changing is very uncomfortable, so at first you might feel that things are getting worse because you are actually being a lot more truthful to one another.  You may find that there are so many issues that have been hidden, and now each person is bringing what is bothering them into awareness.  But persevering in counseling can bring a real change of lifestyle and family culture that can bring long-term happiness and enjoyment of the relationships.

Daniel Siegel on the Triangle of Well-Being

Dr. Siegel introduces a case where a young girl has come to him for psychotherapy because she is no longer speaking in school.  

In this lecture, Dr. Daniel Siegel discusses the function of the middle prefrontal cortex.  There are 9 functions of the body that are controlled in that area. 

1. Regulating your body.
2. Attuning to other people
3. Providing emotional balance
4. Extinguishing fear from learned events like traumas
5. Providing the ability to pause before you act
6. Empathy
7. Insight – (Where you are now, where you’ve been in the past, where you’re going in the future)
8. Morality 

• These first 8 functions are developed in children through secure attachment with their parents

9. Intuition – having access to the processes of the body

• The 9^th function is developed through the ancient practice of mindfulness (for Christians this is prayer, self-reflection and meditation) 

According to Dr. Siegel, 3 entities go into a triangle of well-being:

1. Relationships
2. Brain – extended nervous system
3. Mind

The proper care and development of each of these 3 entities is absolutely necessary for an individual to grow into healthy adulthood.   All 3 of these are separate, but interdependent.  They can impact and be impacted by the others.  Though behaviorists would argue that the mind is only the activity of the brain, it has become more clear through research that the mind can impact the formation and structure of the brain.  Development of these 3 is critical in child development, but there is always opportunity for growth and change.  Because of neuroplasticity, even ‘hardened’ and ‘traumatized’ adults can grow and change though it is not an easy or natural process as it can be in child development.

One application of Philippians 4:8 “Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things.”  is that by meditating and concentrating on things that are good, we can reconfigure our brains from the dysfunctional neural pathways created by traumatic experiences.

In the video, Dr. Siegel uses his hand to model the structure of the brain.  Because of its location, the middle prefrontal cortex links the cortex, brain stem, the body proper, limbic area, the neo-cortex and the signals from other people’s nervous systems.  This area of the brain coordinates all of these areas and integrates them as differentiated parts into an integrated whole.

Dr. Siegel proposes that shaping toward mental health is shaping toward integration.  Before integration, we must promote differentiation in relationships, differentiation in our mental experience and differentiation in our nervous system.  Then we must shape toward connecting these differentiated components to create more complex yet harmonious ways of functioning (integration).

Some nice food for thought for parents and educators:  Dr. Siegel suggests that the 4^th R (in addition to Reading, wRiting and aRithmetic) in education should be Reflection.  He adds Relationships and Resilience as the 5^th and 6^th R’s needed for children to grow into mental health.

Questions for Discussion:

1. What impact did the accident have on the mother’s personality?
2. What impact did the mother’s personality change have on her daughter?
3. Providing emotional balance takes place in the middle prefrontal cortex.  What does emotional balance look like?  How can you tell if someone is emotionally balanced?
4. What does attunement look like?  What are some differences between an individual who is attuned to others and someone who is not?
5. What does the brain require for healthy growth?
6. What is the meaning of neuroplasticity?  Why is neuroplasticity important for mental health workers assisting those who have suffered serious trauma?

Going Deeper:

1. By understanding neuroplasticity, how can we help a child whose mother has lost the ability to attune?
2. How can the mother develop new neural pathways even though she has damage to the middle prefrontal cortex?   Is this an easy process?
3. In his definition of mental health, Dr. Siegel says that we need differentiation before integration.  Why do you think that is?

Common Counseling Mistakes (part 1)

Counseling is a learning process where an objective and empathic listener provides unconditional acceptance and confidentiality that allows the hurting person to have space, time, and safety to examine personal issues, grieve over their losses, and embrace private pain.  It is also a place where defenses are challenged, maladaptive belief systems are examined and opportunities are provided for corrective emotional experiences.  The counselee is encouraged to take responsibility for his or her own behavior and is helped to make better decisions that would bring more fullness of life.  The goal of counseling is to help the counselee become what he or she is potentially capable of becoming.

While at Alliance Graduate School of Counseling, I had the privilege of studying under Dr. John Cheydleur.  In his book Called to Counsel* (Tyndale, 1999), Dr. Cheydleur addresses 12 specific counseling mistakes that lay counselors and non-professional Christian counselors tend to make.  He also suggests ways to avoid or correct these mistakes.  I will summarize his 12 points here:

1.  Patronizing or Cliché Responses 

A cliché response is a stereotypical expression that has lost its original meaning and impact through overuse.  

Example: 

Counselee:  I really struggle with my work.  I feel like I give all my time and energy, but I just don’t feel that my boss cares about me and my family.

Counselor:  I think you are just too discouraged – you have to keep in mind that sweet is the pleasure after pain.

A patronizing response is an attempt to encourage the counselee by emphasizing the positive.  It puts the counselee higher than he is or higher than what he thinks he can achieve.  The problem is that this is not how he sees himself at that moment (even though what the counselor sees or has observed may be true.) 

Example:

Counselee:  I want to quit my job.  It is very difficult; I don’t think I can bear the pressure they are putting on me.

Counselor:  I know it is difficult, but you can do it.  Don’t you remember you were able to complete the project that no one else at your job could do? 

Explanation:  On the cognitive level these responses makes sense to the well-meaning counselor.  However, psychologically the counselee gets confused because of the incongruence of how others perceive him and how he actually feels deep inside.  For the counselee, it deepens his struggle.  Some counselees would learn to hide by riding on to the encouraging comment and keeping a mask that shows that he is strong enough to face the challenges of life instead of admitting his insecurities and fears.

On a superficial level, these responses seem caring of the counselor, but on a psychological level, they are an attempt to control and limit the counselee’s feeling and expression of painful emotions.  Because of the inability of the counselor to understand how to help the person go deeper in examining the problem, they cut the counselee from the opportunity to express him or herself that could bring some emotional healing.

How to correct these mistakes: 

Instead of cutting the person off with patronizing or cliché responses, let the person talk.  And show that you care by reflecting not only the content, but also the emotion with which the person is struggling.

2.  Questions and Probes Too Soon

In good counseling practice, the counselee needs to be able to hear what he feels and thinks about his situation.  By bombarding the client with too many questions (probes), the counselor appears to be an expert on an awareness level, but on the psychological level, the counselor is very controlling and overly anxious.  By stacking questions, the counselor prevents the client from discussing areas that are important to him.  Another problem that arises from asking too many questions is that the counselor might lead the counseling in the direction the client is not yet ready to face. Probing too soon also inappropriately narrows the focus of the interview.

How to correct this mistake: 

Instead of asking so many questions, the counselor should:

·         Pay attention and listen

·         Slow down and allow the client to talk freely

·         Reflect and clarify statements to keep on track with the counselee’s process.

3. Giving Advice Instead of Lending Information

A major mistake commonly made by new or untrained counselors is to confuse the necessary process of introducing new information to the client with the negative process of giving advice.

When we give advice, we assume the role of an expert. (i.e.  “Follow what I say because I know what is best for you.”)  We assume (incorrectly) that we completely understand the person, his feelings, fears, hesitations, the nature of his struggle, and the obstacles he will face when following through with our advice. 

Reasons why counselors should NOT give advice:

·         Most of the time when receiving advice the person feels coerced to follow you and may come to resent you for making him do certain things. 

·         Some counselees actually like this because they are so dependent on other people thinking for their lives that they don’t want to take time to ponder it on their own.  Through advice giving, the counselor can just reinforce their tendency to not own their own thoughts and feelings in a way that is required to make a personal decision.  The counselor can empower them to blame others for their lives.  Later you hear them say, “I just followed your advice.  Look what happened…”  (and they are implying, “How do you feel now? You made a mess of my situation.”)

·         Others will listen to the advice of the counselor, but will not do it.  When asked why, they will present an alibi, like what if it will not work?

How to correct this mistake: 

·         Evaluate the receptivity of the client before giving new information.

·         Avoid using “you should” statements.

·         Always try to give the counselee two or three alternatives so that he has to choose for himself what he thinks is the best alternative.

·         It is always good to process the counselee to see their perspective on the issue.

I will be discussing other common counseling mistakes in upcoming posts  . . .

*Cheydleur, John R. 1999. Called to Counsel. Wheaton. Illinois: Tyndale

Common Counseling Mistakes (Part 3)

Information in this post comes from Dr. John Cheydleur's book Called to Counsel, in which he describes 12 Common Counseling Mistakes that lay counselors and nonprofessional Christian Counselors tend to make. (Used with permission)

5. Poor Challenging Skills
The counseling process needs to reach the action-planning stage in order to make significant impact on the counselee’s life.  It is very comfortable for counselees to stay in the exploration or insight stages where they talk about the people or situations that are bothering them, but not yet looking at their personal contribution to the problem. The counselor needs to look deeply into the motives behind the behaviors of the counselees and examine the factors that can sabotage them from following through with their plans for change.  Then the counselor can appropriately challenge the counselee to take bigger risks, set narrower boundaries and establish specific goals to address the issues that are troubling him.

How to avoid this mistake:

• Avoid yes or no questions, irrelevant comments, and inappropriate emphasis on secondary issues.
• Ask appropriate, precise, accurate, timely questions.
• Slowly direct the counselee to decide for himself and take responsibility for his problem.           (Be careful not to fall into the trap of premature plans.)

6.  Superficial Decisions

This happens when the counselor asks the counselee to make decisions toward the beginning of the counseling session before the problem has been thoroughly explored. The decision may be the "right thing" to do, but the counselee has not processed their emotions and weighed their options, so they will still have many adverse emotions when trying to implement the decision, and likely will not persevere in the decision. 

Example:   

A counselee is a very good worker, but his boss is quite abusive.  During counseling he decides to confront his boss.  However, he has not taken time to process his emotions.  When he confronts his boss, he is overwhelmed with emotion (for different people, it may be different emotions: fear, anger, breaking down or appeasing) and does not state his problem clearly.  The boss does not get the point and continues to look down on him and not treat him well.

How to avoid this mistake:

Do not ask the counselee to make decisions early in the counseling process.  Instead explore the problem and look at other factors that caused this problem to arise:  Who are the people involved?  When did this specific problem begin?  How did this problem affect the counselee’s functioning level?  Look at how the person perceives the problem, his subjective distress, and his coping skills. 

7. Artificial Action Plans

Sometimes the counselee may simply choose the accepted course of behavior as an action plan without getting to the root cause.  He is just trying to appease.  The counselor may tend to push the client to make a decision or create an action plan too soon in the counseling process, before emotions and values are sufficiently explored and clarified.  Sometimes a counselor stays on the superficial level of the problem without looking at the core issues.  When the counselor focuses only on the presenting problem, he may be treating only the symptoms instead of treating the real cause of the problem or dysfunctional behavior. 

Example: 
A client says that his boss is abusive.  After talking with his counselor.  He decides to set a meeting with his boss and bring up the matter.  He has decided he will take the risk of confronting his boss and has plans to accept a lower paying job if his boss fires him.  However, the counseling never got to the root of the issue that the counselee is quite irresponsible at work.  He has a pattern of poor performance and his personal life has been interfering with his work performance.  But there is nothing in the action plan to address that.

How to avoid this mistake:

• Explore the counselee’s emotions and values, not just the content of the current problem 
• Compare and contrast the counselee’s values with Scripture.
• Brainstorm with the counselee in order to create a wide number of options and possibilities.
• Prune and organize all of these ideas to end up with a functional set of behavioral goals and programs to accomplish these goals. 
• Work as a coach, helping the counselee to create a realistic action plan based on values you can support and to which the counselee is committed.

8.  Overlooking Accountability

Sometimes there is an assumption that after the counseling that everything will be all right.  The counselee went away feeling relieved and having good advice to follow.  However, the chances of the counselee resolving the problem without some kind of followup and accounability are slim.

Explanation:  In short-term pastoral counseling, the selection and commitment to an accountability partner is very important.  This step supports, reinforces, and maintains the new decision and the actions that go with it.  Accountability to you as the pastoral counselor is not enough.  

How to avoid this mistake:

Each counselee’s decision and plans should be: 

• Clearly endorsed by the client
• Submitted by the client to God in prayer
• Communicated to at least one other significant individual who can serve as an accountability partner