Download Engaging Biblical Texts in Therapy

Engaging Biblical Texts in Trauma
Therapy
Interpreting Persons and Contexts While
Promoting Interpersonal Healing
Philip G. Monroe, PsyD
Biblical Seminary
[email protected]
2009 AACC World Conference
www.biblical.edu
Review
Problem
Application
• Challenges related to complex PTSD or DESNOS
• Best practices for the use of Scripture in
counseling
• Diagnostic vs. process use of Scripture (truth vs.
relational uses)
• Application to counseling work with adult
survivors of sexual abuse
Complex PTSD (DESNOS)

1.
AKA Disorders of Extreme Distress NOS:
alterations in the regulation of affective impulses
(e.g., difficulty with modulation of anger and self-destructive impulses)
2.
alterations in attention and consciousness
(e.g., amnesias and dissociative and depersonalization episodes)
3.
alterations in self perception
(e.g., chronic sense of guilt and responsibility as well as shame)
4.
alterations in relationships with others
(e.g., not being able to trust, not being able to feel intimate with people)
5.
somatizating the problem
(e.g., feeling symptoms on a somatic level without medical explanation)
6.
alterations in systems of meaning
(e.g., loss of meaning or distorted beliefs)
(Some folks include a 7th characteristic: (alterations of perceptions of
perpetrator(s).
Common trauma experiences
Intense fear, paralysis/helplessness, inability
to effect any change, threat of annihilation,
leading to experience of,
 Loss of voice, control, connection, and
meaning, resulting in,
 Disorganized physical, cognitive, and
emotional response system increasing,
 Relational pain, distrust, self-contempt,
overwhelming anxiety, evidenced as,
 Running from the past, afraid of the future

Pause to consider:
Just how does one go about building a
therapeutic relationship when…
All relational and therapeutic interactions
will be read through the lens of danger—
the danger of being abandoned or abused
The core problem is PAIN?
Original pain of abuse is the problem
 Treatment?

◦ Acknowledge pain
◦ Work to release pain by
 Taking control
 Finding things to make you happy again

Problem with this view?
◦ Pain is the result, not the cause…
The problem
The way out
Powerlessness
 Denial/distortion
 Ambivalence
 Contempt
 Hypervigilance
 Fixed relational style

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Honest appraisal
 A deep look within
 Letting go of selfprotection before God
 Repenting of “refusals”:
◦ To live; to trust; to feel passion

Loving others boldly
One Christian Model
The core problem is SIN?

Sin done to the abused
◦ What is the enemy? What are the factors that make
past sexual abuse so shameful…? What must be
done to lift the shroud of shame and contempt? The
answer…: peer deeply into the wounded heart p. 14

Sin done by the abused (faithlessness, refusal
to be vulnerable)
◦ If [the treatment] is to be biblical, it must insist that
the image of God is central to developing a solid view
of personality; that our sinfulness, not how we’ve been
sinned against, is our biggest problem… p.10
Sin as problem, con’t

Okay so far. From a technical standpoint,
Scripture seems to support this conclusion
◦ We need to be rescued (the Exodus)
◦ We need to be forgiven (the Cross)

So, what’s the problem?
◦ Diagnostic focus on big picture misses the relational
aspect of God’s meeting his children
◦ Focus on what needs change rather than what is
broken may unintentionally minimize the damage or
the need to build healthy crisis responses
◦ Misses the necessity for repetitive, relational work of
rebuilding safety, trust, and truth
Review
Problem
Application
• Challenges related to complex PTSD or DESNOS
• Best practices for the use of Scripture in
counseling
• Diagnostic vs. process use of Scripture (truth vs.
relational uses)
• Application of best practices counseling adult
survivors of sexual abuse
Using Scripture with clients?
Until recently we have had little to no
guidelines for how best to use Scripture
in the act and process of therapy
 Instead, we’ve…

…
Argued over the relationship between
psychology and the bible
 Built biblical anthropologies
 Explored how specific passages speak
to particular problems
 Rarely discussed bible reading as
homework (comfort and reframe)

But we should!
Christian counselors can and should use the
Scriptures in counseling because:
 We know where the power to change
comes from
 We ourselves are acquainted with them
 We want to model a healthy use of the
spiritual disciplines, including the use of the
Bible
 We want to connect hurting individuals to
God
However, consider this…
We shortchange Scripture when we use it
only as a tool to
◦
◦
◦
◦
◦

Teach, rebuke, correct
Discern
Comfort
Strengthen and encourage
Build hope
Does our use of Scripture help others
meet God or learn more facts?
Thesis
I argue that while comfort,
encouragement, exhortation, hopebuilding, and teaching are all good things
that Scripture supplies, we may miss its
grand purpose of connecting individuals
to God, if we:
◦ focus on biblical anthropology (diagnostic)
◦ focus on tools (treatment)
Begging the questions…
What is it about the counseling
interchange that encourages change?
 What role do the Scriptures play in
human growth, development, change?
 How might we become more effective in
our use of Scripture in the therapeutic
dialogue?

◦ Role of truth-telling?
◦ Role of experiential connection?
Guidelines for the Effective use of the
Bible in Counseling

Edification, 2:2, 2008 (pp 53-61)
◦ Without guidelines we may overestimate the
value of Scriptural interventions
◦ Disconnect is more likely
◦ Future interventions may be hindered
◦ If change is mediated through healing
relationships then we must pursue a relational
use of the Scriptures
Maturity
The Christian Life
Guidelines, con’t

In the absence of empirically supported
guidelines…pay attention to
◦ Personal and professional competencies
◦ Assessment




Client experience and understanding
Intended purpose (and later result)
Contextual matters
Impact on the therapeutic relationship
◦ Informed consent
The Problem
Technical accuracy ≠ counseling strategy
(exegesis ≠ application)
 Idolatry of “getting to the bottom” of the
heart? Misses other truths?
 Diagnostic or tool approach to Scripture
undermines its relational and dialogical
fabric

Consider this criticism
…evangelical preaching [use of the Bible?]
underwrites the myth that the isolated self can
transform its own self through its own rational
powers with the help of the Spirit…
David Fitch, The Great Giveaway, p. 133
Text as object?
The text becomes an object in the hands of the
preacher as it is broken down into three points to
be given out as something the listener can use.
Once the sermon is given, the text becomes an
object to be consumed by the parishioner, who in
turn listens, analyzes, takes notes, and goes out to
be a doer of the information just heard, which
consequently distances the listener from
the text.
p. 137, The Great Giveaway
And the problem is?
As the…applications pile up and the
parishioner loses ground week to week, ever
hurrying to catch up with last Sunday’s
application point, frustration is the result.
p. 140, The Great Giveaway
This relates to counseling how?

Our stance and use of Scripture influences
client disclosure.
◦ Diagnostic or intervention uses may lead to
either objectifying text or persons

Use of Scriptures in counseling should
facilitate opportunities to deepen horizontal
and vertical relationships
◦ “…how the patient talks about events…depends
on the relational context in which the events are
described.”
Paul Wachtel in Relational Psychotherapy, p. 18
Application

How do we connect adult survivors of
sexual abuse to God via the Scriptures?
◦ What are the common problems?
◦ What are common clinical responses?
◦ What truths/experiences do we think work
well with those problems
True but therapeutic?
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The sexually abused person often carries contempt as
an antidote to the bite of pleasure (p. 65)
A sexually abused person often forfeits the
experience of pain by a process of splitting, denial…
(p. 104)
Distorted judgment is seen more often than not in
the arena of relationships (p. 107)
Hypervigilance often masks a deep strain of
suspiciousness. (p. 118)
Patterns of distorting facts and conclusions in one’s
own mind lead eventually to the necessity of deceiving
others. (p. 120)
How heard?
◦
◦
◦
◦

I’m even worse than I thought.
See I did create much, if not all, of my mess
So you’re saying I refuse to trust God?
I am rebellious, just like my father said I was
Why? Because survivors have difficulty
contextualizing competing truths due to
relational factors
What if…
The core problem of abuse is relational
anxiety (which is painful and leads to
sinful responses)?
 We consider how God meets anxious
people?

◦ See works by Judith Hermann and Diane Langberg
Quick case study: Sara
28 yo married woman, SS teacher
 Sexual aversion for 3 years after
difficulties starting on their honeymoon
 History of sig. child sexual abuse
 Strong Christian, fears being rejected by
God because of fear
 Sessions filled with both self-contempt
and fear of counselor

Trauma therapy in context
Phase 1: stabilization
 Phase 2: trauma processing*
 Phase 3: Re-integration

*Our focus today
Review the Guidelines

Personal competency
◦ Counseling push/pull style personalities?
◦ Response to pervasive core fears?
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Assessment
◦
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Client experience (“voice” of Scripture?)
Intended purpose (and later result)
Contextual matters (how does she hear you?)
Impact on the therapeutic relationship
Sara meets Scriptures

Assessment
◦ Fear of fear, fear of failure, fear of rejection by
God and others
◦ Obsessional reading of some passages: usually
with condemnatory voice. “I shouldn’t be
afraid. I shouldn’t withhold.”
◦ Hears counselor insights as condemnation;
believes counselor is “tired” of her
◦ Wants to get to the bottom of things and
demands Scripture reading in session
Sara meets the Scriptures

Intervention 1
◦ Brief description of plan to look at the “voice” of
Jesus in Luke 11 and 12
 Reads Luke 12:4-32
 What voice do you hear?
 Reads Luke 11:39-44
 What voice? Difference with ch. 12?
 Whose voice sounded like that for you?
 Mother? Father? First pastor?
 What if you heard “little sheep…” with compassion?
◦ Noticing the propensity for judgment
 Anxiety described as judgment disorder
 Use of here/now to explore fears of my judgment
 Homework to journal on voice in 12:32
Sara meets the Scriptures

Intervention 2: HW to read John 4
◦ Jesus’ response to a known adulterer?
◦ Notice his voice? Try it several different ways
Counselor evaluation time
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Which truth is needed now?
Goals? Description first rather than evaluation
◦ Description (and not judgment) leads to insight
◦ Context and impact of interventions

Attend to the relational context/atmosphere
◦ Build a foundation of trust when trust is scary by…
◦ Simple words, transparency, integrity, and clear goals
and

Avoid the diagnostic use of Scripture whenever
possible until the foundation of God’s perspective
on abuse is firm
For slides:
www.wisecounsel.wordpress.com