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Five Ministry Storms

8/18/2020

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Growing up in a parsonage as I did, I saw  my pastor-father go through lots of good times and bad in the ministry. I recall one particular rough storm when I was about 14 years old and it stands out because I remember especially the look of fear and weariness in his face. Even though I didn't know what was going on, I knew something was wrong. I felt a bit bad for him, but not knowing the details of his pain, it left me more confused and curious than anything. Oh, and distant. Let's not forget that. 

I recall looking into his eyes one day and saying hello only to be greeted mechanically and dispassionately as if he didn't even recognize me. Fourteen year old boys don't understand things like that, and instead of concern for his mental health I only felt like he didn't love me anymore. 

We got through the worst of that storm, but not without some lingering scars. That's all history and even though I am sure God used it to sensitize me and predispose me to the life of clergy care I chose years later, I still wonder about the particular storms he endured that I never did hear about. He's in heaven now, so I will never know. But my research of clergy care over 40 years has caused me to conclude there are five broad storms that ministers endure. I've devoted my own ministry to helping ministers like my dad find peace in them. 

Burnout - Storms of Ministry Imagination 

Secrecy - Storms of Ministry Internalization 

Doubt - Storms of Ministry Idealization 

Bad Habits - Storms of Ministry Impoverization

Relational Conflicts - Storms of Ministry Isolation 


We all go through these storms, sometimes repeatedly. The details are different for everyone. But the general outlines are the same. I write about them in all my clergy resources and share my own personal as well as biblical and scientific research. 

In the middle of the storms it's easy to despair. I sometimes talk about the neural circuits of despair--the helpless, hopeless, hapless circuits in the triune brain. I saw them and their effects in my dad. I've seen them in myself and others. Tragically, I've seen some ministers never recover from them. 

Yet, as a Christian counselor, I do not believe that was God's plan for the storms. Ministry storms, like the perfect storm on the Sea of Galilee, were always a means to a greater end! God's plan for the storms is to transform us and make us the ministers he wants us to be. The pounding waves and shrieking winds of trauma are necessary to get our attention and show us our fears. We don't like them one bit and desperately want it just to be over! 

But, if we only had eyes to see, Jesus is right close by. It appears he is asleep in the stern of our "boat." And because of that we sometimes shout at him, like Peter in the storm on Galilee: "Don't you care that I'm drowning?" I've done that. So have all ministers. 

And it is then, perhaps more than at any moment in the five storms, that we are ready to learn the steps to peace. For that's what it's all about. The storms are only the means to a glorious end! 

Transforming the Storms

God wants to transform us and use the very storm to do it. 

Transforming Ministry Imaginations through Biblical Wisdom

Transforming Ministry Internalization through Biblical Confession

Transforming Ministry Idealization through Biblical Repentance

Transforming Ministry Impoverization through Biblical Shabbat Shalom

Transforming Ministry Isolation through Biblical Reconciliation 


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A Theological Basis for a Biblical Neuroscience

8/18/2020

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​Most of us who grew up in Sunday School remember the story of Noah and the flood, and of the origins of the rainbow, God’s promise never again to destroy the world with water. What is neglected in this story is the covenant message for which the rainbow was the symbolic reminder: after the chaos and disaster of unrestrained fallen humanity that triggered the flood to begin with, God established a covenant with humanity itself. That’s what the Noahic Covenant was. Though all of God’s covenant promises are connected to God’s redemptive plan for his people, there is something different about the covenant with Noah and it is directly related to this universal human application. I would argue that Noahic Covenant, as a universal covenant with humanity itself, is particularly important in the so called “second table of the law” later revealed to Moses at Sinai. Those six commands—from honor of parents to gratitude in society—represent necessary institutions in any civilized society. They do not procure eternal life. However, the closer they are followed the more shalom exists. This is precisely what God’s covenant with Noah was about also.
 
Therefore, in initiating the promise to Noah after the waters had subsided, God had more to say than where rainbows came from. Let’s consider the entire statement:
 
And God blessed Noah and his sons and said to them, ‘Be fruitful and multiple and fill the earth. The fear of you and the dread of you shall be upon every beast of the earth and upon every bird of heavens, upon everything that creeps on the ground and all the fish of the sea. Into your hand they are delivered. Every moving that lives shall be food for you. And as I gave you the green plants, I give you everything. But you shall not eat flesh with its life, that is its blood. And for your lifeblood I will require a reckoning: from every beast I will require it and from man. From his fellow man I will require a reckoning for the life of man.  Whoever sheds the blood of man,  by man’s hall his blood be shed, for God made man in his own image (9:1-6)
 
It is not inaccurate to suggest that the Noahic Covenant establishes human government (I’ll address that shortly). However, it was much broader in scope. What is established was the foundation of human institutions necessary for civilization. Government is indeed one of those. But there are others also. And they all find their origin here, in God’s promise to Noah.
 
Of particular interest to me in my sphere of life, is the “institution” of mental health counseling. I am going to argue in the pages that follow that there are universal principles for mental health in God’s covenant with Noah and the closer we adhere to them, the more civilized and “sane” our world will be.
 
The Building Blocks of Life
What does it mean to be alive? This is one of those metaquestions people have been pondering since the beginning of time. The Bible gives the definitive answer. It says that human life began when God created it. The opening words of Genesis say: “in the beginning God created the heavens and the earth” (1:1). A few verses later we read God’s account of the beginning of human life: “God breathed into Adam the breath of life and he became a living soul” (Genesis 2:7). Throughout the rest of the Bible there are references to life and breath as something given to us by God. God gives it. God also takes it away (see Job 1:21). But, what does it mean to be alive? What is life?  The Bible answers the question not in theoretical terms but practical: it shows us what life looks like, beginning with Life itself: God. However, when we examine what modern neuroscience has discovered about life, we can appreciate even more some of the theoretical framework for the truth.

Life comes in all shapes and sizes. We learned in school that the simplest forms of life are single-celled organisms like the lowly amoeba.

Amoeba is a kind of germ that can cause an illness. Even so, it’s alive. This means it’s a qualitatively different type of being than a rock or piece of glass. Though human beings have billions of cells rather than one, we are thus related to the lowly amoeba in the sense we are both alive. But does it mean to be alive?

Scientific definitions and answers differ greatly depending on prior assumptions. In the discipline of neuroscience, the question of life and what it is has special significance. I want to consider how one school of thought has answered the question. We will consider the work of Theodore Millon (1928-2014). Millon was not a Christian or creationist. In fact, he was steeped in Darwinian evolution as are most of his colleagues. Because of this, many of his conclusions are completely wrong.
I am drawn to his work, however, because he recognized that the questions of life, relationships and mental illness itself are interconnected. What Millon got get right was asking the right questions. It is also my belief that he got some answers correct as well. That’s because he was a scientist and, more importantly, because he inadvertently stumbled upon facts of our world, facts related to God’s Noahic Covenant. I’ll put all that together later.

I am not going to examine all of his views. But I do want to introduce them because, when understood in the context of God’s revelation, they give us great insight about human and relational development. 
Scientific definitions of life do not depend on the simplicity or complexity of the organism. Rather, they look at what living organisms do that non-living organisms do not. Millon considered three necessary components of life.  In Millon’s evolutionary context he believed that the first building block to appear was existence itself. He said that this basic building block is motivated by “self-enhancement” (pleasure) vs. “self-preservation” (pain). The next is adaptation. Adaptation means that living organisms are either affecting their environment (active orientation) or being affected by it (passive). Finally, a living organism has some impulse to replicate itself. In lower organisms like the amoeba this is quite mechanical, but the “higher” the organism, the more intentional and conscious it is.

I am not an evolutionist and do not agree with Millon’s Darwinian assumptions. However, as I said above, I think he was correct in identifying the three building blocks of life. The biggest difference is, God invented them and oversees their development—from the lowly single-celled amoeba to the wonder of humanity itself. I further believe God invented these building blocks based on preexistent patterns or realities. Those building blocks reflect eternal truths of what life is and, as I’ll explain later, that truth is contained in the eternal reality of a three-in-one God who, himself, is life.

Before we look at how human life reflects eternal life let’s consider in more detail Millon’s building blocks. 

Theodore Millon and the Essence of Living Systems

 
When Charles Darwin first explored the Galapagos Islands and began writing about the origin of species he proposed a process called “survival of the fittest.” You may recall that Darwin argued our world is a hostile place with limited resources. Only species that can endure this hostile environment and overpower the competitors for those resources will survive. Subsequent research demonstrated this survival drive is the very essence of biological life. Every cell in our bodies is wired for survival.
To the extent they adapt to the changes around them, they will survive. But if they fail to adapt they won’t. Many of those who have rejected the older static view of personality have latched on to this Darwinian concept to explain things like human personality. One theorist isTheodore Millon. He built his theory of personality on evolutionary assumptions about survival and adaptation. In fact, he suggested three dynamics that determine personality function. He called them polarities: [1]
 
Existence: The Pleasure-Pain Polarity.
The first phase, existence, concerns the maintenance of integrative phenomena, whether nuclear particle, virus, or human being, against the background of entropic decompensation. Evolutionary mechanisms derived from this stage regard life-enhancement and life-preservation. The former are concerned with orienting individuals toward enhancing survival and improvement in the quality of life; the latter with orienting individuals away from actions or environments that decrease the quality of life, or jeopardize existence itself. These may be called existential aims. At the human level of functioning such aims form, phenomenologically or metaphorically , a pleasure-pain polarity.
 
We need not adopt Millon’s evolutionary assumptions to appreciate his insight. As sentient, conscious beings we are driven by a desire to have pleasure. In its most primal form, the desire for pleasure (and to avoid pain) defines our existence. As we will see later, the Big Three Problems of Life are rooted in this desire for pleasure because we are so aware of the opposite: pain.
 
Pain is a reality in our fallen world. And when we experience or anticipate pain it seems to threaten our very existence. I reject his evolutionary assumptions but I think Millon was correct in describing the pleasure-pain polarity as a fundamental dynamic in personality. In my view, there is a pain-pleasure dynamic. But it did not develop from evolutionary dynamics. God designed it in us to motivate us to serve him. This desire was part of our original design, before the Big Three Problems of Life entered history. The reason we seek pleasure is not mere “life-enhancement” but because God made us this way. In my formulation of the Big Three, I list pain as the second one, after danger. Entire systems of the brain are devoted to addressing this problem in the mid sections of the brain.
 
Think about the three elements of the Noahic Covenant. In the first, we read: for God made man in his own image. Life exists because God made it. This is true for God’s people in all ages. It is true for those who reject even the knowledge of him. Existence in the image of our Intelligent Designer is thus, the first building block of life itself.
 
Adaptation: The Active-Passive Polarity.
To exist is but an initial survival phase. Once an integrative structure exists, it must maintain its existence through exchanges of energy and information with its environment. The second evolutionary stage relates to what is termed Modes of Adaptation; it is also framed as a two-part polarity, a passive orientation, that is a tendency to accommodate to one's ecological niche, versus an active orientation, that is a tendency to modify or intervene in one's surrounds. These modes of adaptation differ from the first phase of evolution, in that they relate to how that which exists is able to endure or continue to survive in its environment.
 
Adaptation is a central concept in evolutionary theory. This is what survival of the fittest means. Some adapt (because they are more “fit”) and others do not. In my theory, adaptation is the way we respond to the first great problem of life: danger and change. God designed this capacity of adaptation so we could manage all the threats and dangers of living in the world. To the extent a personality adapts to these changes in appropriate ways he has optimal personality function. However, if he fails to adapt (passive, rather than active in Millon’s terms) he will become increasingly fractured and disordered.
Students of the Scripture may chafe at the idea of pre-fall danger. Wasn’t danger a result of sin? How could there be some adaptive dynamic in the original creation? Perhaps we should use a different word from danger. Maybe we should just call it “change.” There could be no life without change. Change just describes different conditions and events. As we will see later, the brain defines danger is “unknown changes” and that is why danger can create so much instability. So, when God made life in its perfection they were part of a natural world in which there was change and therefore a potential of dangerous unknown change.
 
Be that as it may, we now live in a fallen world, filled with much danger and pain. Notice the second part of God’s statement to Noah. It speaks directly to the realities of daily life in our world:
 
The fear of you and the dread of you shall be upon every beast of the earth and upon every bird of heavens, upon everything that creeps on the ground and all the fish of the sea. Into your hand they are delivered. Every moving that lives shall be food for you. And as I gave you the green plants, I give you everything. But you shall not eat flesh with its life, that is its blood. And for your lifeblood I will require a reckoning: from every beast I will require it and from man. From his fellow man I will require a reckoning for the life of man.  Whoever sheds the blood of man, by man’s hall his blood be shed
 
Most Bible studies on the Noahic Covenant focus on the rainbow, possibly human government, but rarely on these important words about what life would be like. Why is so much space given to what Noah could and couldn’t eat?
 
God’s provisions are not just about having a steak dinner (meat) now with our salad (green plants)! These are concrete, symbols of the reality of a fallen world under God’s dominion. There is fear between all God’s creatures (the fear and dread of you shall be upon every beast…); even so, the interactions of the species can be managed (into your hand they are delivered…). However, this is not a blank check where anything goes. Even within God’s broad “common grace” provisions there were restrictions and “rules” of management: “But you shall not eat flesh with its life…and for your lifeblood I will require a reckoning…”
 
If we limit these words simply to eating meat we are missing the universal provision. Let me put it in more scientific terms: God was establishing for Noah the practices of the second building block of life: adaptation. How creatures would adapt to each other and how they would adapt to their environment.
 
Replication: The Self-Other Polarity.   
Finally, Millon talked about “replication strategies.” In other words, we want to propagate ourselves and our species. He terms this the “self-other polarity.”
 
Although organisms may be well-adapted to their environments, the existence of all life-forms is time-limited. To circumvent this limitation, organisms have developed  Replication Strategies, that is, ways in which to leave progeny. These strategies reflect what biologists have referred to as r- or self-propagating strategy, at one polar extreme, and K- or other-nurturing strategy, at the other extreme. Psychologically, the former strategy is disposed toward actions which maximize self-reproduction; here, organisms are egotistic, insensitive, inconsiderate, and socially uncaring; while the latter strategy is disposed toward protecting and sustaining kin or progeny; this leads to actions which are socially affiliative, intimate, caring, and solicitous.
 
Why do we develop these strategies? As a Christian, I believe our social-affiliative impulses are more than primal desires to keep the species alive! They are that but they are more. They reflect the fact we were made in God’s image.
 
Recall the third part of the Noahic Covenant: Be fruitful and multiple and fill the earth.
 
There is a beautiful symmetry between the three statements. In the Part A, we learn that God is the designer of life and he made it in his own image. In Part B, we learn about how various lives must interact with one another, especially in our fallen world. The word is “adaptation” to one another.[2]
 
God himself is a social being—three-in-one: Father, Son and Holy Spirit. Throughout the eons of eternity God demonstrated this “self-other polarity” in his own experience. We are selves but we interact with others. And in that social interaction there is a kind of replication of the self.
 
The Bible teaches that God spent the countless ages of eternity past “procreating” the Son and Holy Spirit. Scripture does not use the term “procreation” but it does use one that means the same thing. Perhaps one of the most familiar verses in the New Testament says,
 
“For God so loved the world that he gave is only begotten son, that whosoever believes in him should not perish but have everlasting life” (John 3:16) That word “begotten” is important. The Greek word is gena from which we get “gene” and “generate.” It describes the eternal generation or procreation of God’s son from the father.  Though this remains a mystery in its detail, it is nonetheless true. It is true of human life also. Life longs to replicate and propagate itself because we were made in God’s image and that’s what he does.  What better picture of the social impulse could we draw than a father “protecting and sustaining” his son? In my theory, this polarity points to the dynamic of success and validation. We experience success when we fulfill this polarity: when we not only propagate our species but when we build relationships with others that reflect the moral values of God himself.

[1] Theodore Millon http://www.millon.net/content/evo_theory.htm#element

[2] Though I will not take the time to discuss what adaptation may have involved in a pre-fallen world, even in pre-historic eternity when God himself is all that existed, I do believe that adaptation—in the sense of relational systems functioning in equilibrium and homeostasis—is essential. The Bible never uses these scientific terms, of course, but it does describe the pre-fallen and pre-historic state with the Hebrew concept of “shalom.” 
 
I mentioned above that one of the intriguing things about Millon’s theory is how he logically moves from the three polarities of life to his comprehensive system of mental illness, specifically personality disorders. Millon was first and foremost committed to personality research. Simply, he identified mental diseases and disorders as a loss of “balance” and equilibrium in the three building blocks. As I’ve emphasized, Darwinians have no good explanation for why this happens other than the obvious that it does. They have no legitimate belief about sinfulness, or a lost paradise. They have two things: building blocks and broken systems. They just don’t know why. We do, however, and that’s where our understanding of Scripture, alongside the obvious broken systems of our fallen world, creates some useful synergy. 
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This approach to scientific theory is extremely helpful for those in my field who are trying to find practical yet theologically useful treatment strategies for the broken systems of this world. Not all are equally helpful, but at least we can understand why scientists like Millon keep trying to come up with them. As a student of mental health I have read and analyzed dozens of them and am often amazed both at how much they get wrong, but also, even more surprisingly, what they inadvertently get right about the human condition.
 
There is much more that can be said about this process, but I’d like to conclude with three general observations about using the Noahic Covenant as the framework for counseling and mental health. These are not observations specific to the work of Theodore Millon but could just as accurately be said of anyone from Freud to Napoleon Hill.
 
  • Existence: The creation of human life in God’s image means there is design and that when scientists study it they are always going to see complexity and order reflecting that design.
 
  • Adaptation: Astute scientists who study design, either on a micro or macro level can also see patterns and systems. Another scientist who has influenced my own research was Ludwig von Bertlanffy who wrote General System Theory, one of the foundational theories for all mechanical and biological systems. System theory itself could be adequately summarized by one word: adaptation without destruction. When any system adapts effectively (according to design) it continues. When it does not it is destroyed. In this observation I think we see the scientific task set out clearly: observation, interpretation and application. Regardless of Darwinian assumptions or not, there are always going to be data of value to Christian therapists if we know how to use it properly.
 
  • Procreation: Though godless science has no compelling explanation for why life reproduces itself, they do generally acknowledge that the very procreation demonstrates a “value” of life and as soon as they admit to value they have presumed some form of morality. The moral law of God is obviously the definitive and authoritative standard of morality. Even so, all other moral codes at some point reflect those eternal truths. Therefore, even the atheist scientist father can “love” his children. If we would derive any benefit from Millon’s third building block I think it is here in its rustic morality which, as inconsistent as it often is, whispers and even shouts the existence and purpose of God. If it is true that the “heavens declare the glory of God and the firmament shows his handiwork,” how true also is it that Millon’s scientific research declares the glory of God and his personality theory shows God’s handiwork”—at least for those with eyes to see it. 



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The Neuroscience of a Pandemic

7/25/2020

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Everyone has a story or three about the COVID Pandemic and how it impacted our lives. There may be some funny stories in the mix, but for most people, the best summary of the Year 2020 will be, “I’m glad that’s over…”

As a mental health professional I’m particularly focused on how all this is affecting our thoughts, fears and habits. Don’t for a minute imagine that the consequences will be over soon. In fact, I’ve heard some of my colleagues speculate that the mental health pandemic, in the wake  of COVID-19, may be more destructive than the virus itself. But, that’s another topic. Right now, I want to consider a particular aspect of this ordeal I will term, Pandemic Trauma. Not to be nerdy, but I will abbreviate it for this article as PT. I’m going to argue, based on a neurological principle called Associative Learning, that the long term consequences of this global pandemic will be felt for a generation, regardless of how or if a COVID vaccine is forthcoming.

Let’s first of all make sure we understand Associative Learning. Back in the 1960s, a scientist named Donald Hebb rocked the neurological world with a simple but thought-shifting statement: “neurons that fire together, wire together.” By neurons, he was describing those tiny brain cells that we never see but are always involved in everything we do. The simple version of what is called Hebbian Theory was that if two or more brain cells are activated at or about the same time, a neural connection is actually established between the two cells and so, in the future, when one fires, the other fires as well. Hence, “neurons that fire together, wire together.” I don’t want to get lost in the weeds here, so let me just summarize the significance of Hebbian Theory. It’s the neurological basis for all learning, but also for habit formation. We’ve all experienced it every day of our lives. The clock chimes twelve noon. The neurons in the ear are activated. We hear the clock. But, “mysteriously”, some other neurons are activated at the same time: those in the stomach that make us hungry! “I’m starving. It must be time for lunch.” Neurons that fire together, wire together. This is what Associative Learning is.

That’s just a simple example but I could repeat them for hours! Now, there are some neural activations that are stronger than others. Again, the scientific explanations for all that would get ponderous, so let me just talk about one type of neural activation pattern that happens to be very strong: fear. When particular brain cells fire in a fearful or traumatic experience in our lives, those associations are typically stronger than ever. What that means practically is, we can relive a particular trauma based on Hebbian Theory, even though we’re not dealing with it right now.

For me, that explains why, for so many years of my life, I had a paralyzing fear of hospitals. As a little boy of three, I had hernia surgery and, though I have very little conscious memory of the event itself, my mother tells the story of my emotional state through the ordeal and how traumatic it was, particularly since, in those days, I had to be left alone for much of the time (with my own “Nurse Ratchet”, but that’s another story too!).

What is important to understand is that in those confusing and terrorizing events neural activation patterns were formed that included not only the feelings of fear but the location and sensory data that was stored away in some dark scary cellar of my childish imagination. For years thereafter, when I would go into a hospital to visit someone, those old patterns were reactivated and I essentially relived the hernia surgery and Nurse Ratchet herself. And this noteworthy, I had very little conscious awareness of why.

I remember vividly when this all came into my conscious awareness. I was now a young pastor in my first church. I was making a hospital call to a family with a young boy on life support. The experience activated those old Hebbian patterns in a paralyzing, mind-spinning assault. I nearly fainted.

Now, let me make the connection of Hebbian Theory to PT—Pandemic Trauma. Tens of thousands of us have been touched by the physical consequences of the virus, either through the death of a loved one or the impact of the disease itself. But I would say that number pails in comparison to the hundreds of thousands—perhaps millions—who have been emotionally traumatized by the nonstop assault of fear and confusion to which we have been subjected through the months. Even those who had no direct experience with the disease were exposed to the fears and anxieties that have attended the pandemic. I say this, not in any political way, but when the entire world (not an exaggeration) is being subjected to this daily fear assault, imagine the Associative Learning and Hebbian patterns that are being hardwired into our very brains? And to make it even more serious, remember that most Associative Learning is nonconscious. It’s real. But we don’t even realize it’s going on.

I could say more about how this kind of trauma scars us. In fact, I could even argue that the biological impact on entire populations is likely to be generational. I can’t take time to explore the science. But you’ve heard of the human genome—the system of genes that determines our physical traits. We inherit this from our parents. Did you know, however that recently scientists have discovered another system called the “epigenome?” It explains why, even within genetic systems (like a family, where all children inherit the same genetic material) there are differences between individual members. In fact, some studies suggest that epigenetics involve the emotional control systems as well, and may explain why some people in a family have a mental illness but others do not. Indeed, there is evidence from trauma survivors (such as Jews in WWII concentration camps) that epigenetic changes in the camp were passed along to their ancestors even though they were never in one!

Let’s consider what that might mean for our current pandemic. It won’t impact everyone the same way, but we can certainly say that the combination of Associative Learning and epigenetic transmission, will leave scars for many years to come.

​I have no doubt painted a very bleak picture! It is indeed the “bad news” of COVID-19. However, as a biblical neuroscientist and Christian counselor, I am always delighted to follow up the bad news with the good news! And there is good news. The good news is not that masks or social distancing or even a vaccine will save us all. Even those developments would probably be insufficient to undo the traumatic activation patterns in those hardest hit. No, the good news is that Hebbian Theory can also be applied to renewed thoughts and transformed emotions. Inserting new ones on a regular basis means new neural activation patterns can be established. New thoughts and feelings that “fire together wire together” also.  What this means for us is that we can change the way we think and feel about COVID. We can even change the way we think and feel about the fears and anxieties that have traumatized us. It won’t happen by itself. But there are practical ways to do it. It’s what I do in my counseling practice with others; it’s why I’ve written so many resources to share on my website; and perhaps most importantly for me, it’s what I myself have learned to do with my own pandemic trauma. 
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5 Reasons You Probably Don't Want Online Counseling

7/24/2020

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I’ve heard people say online counseling doesn’t work.
I’ve heard it too—for many years now. In fact, when I got my counseling degree (about 15 years ago) my professors took all of two minutes to dismiss it as “something that will never catch on…” I guess they didn’t anticipate COVID-19. To the larger question, though: does it work? Have there been any scientific studies to actually provide evidence about that?  I cannot go into great detail but here are three recent studies: [1]

​A 2014 study published in The Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
A 2018 study published in The Journal of Psychological Disorders found that online cognitive behavioral therapy is, "effective, acceptable, and practical health care." The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
A 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.
I could go on with recent research but you get the point. The claim that online counseling doesn’t work is not true. No doubt there have been many who practiced it poorly and even unethically, but that doesn’t mean the method itself is the problem.

I don’t want my personal problems on the internet!
Most of us hear stories all the time of identity theft, of foreign hackers in data bases and social media abuse. Maybe you’ve even been warned, “if you put it on the internet, everyone can see it.” Why would anyone even think about sharing their deepest and often darkest secrets in such a venue? Let’s think about this fear, however. Let’s consider that the actual issue is the security of our information and how protected it is, not just the way it is communicated.  So, if online counseling is not digitally secure, it is very correct to worry that anyone could find it.
It is for this reason that special online technologies have been devised. Your mental health is not the only kind of privileged information out there. Consider what banks and financial firms have to protect—not to mention hospitals and insurance companies. Because information security is so important, I’ve developed a whitepaper on the key legal, ethical and practical considerations for online counseling, titled, Protecting Personal Information in Online Counseling.

I want to be with a real counselor not a digital one!
This is probably the problem that ranks highest for me—both as a counselor and even at times a client. You get my point, I’m sure. I was thinking about my birthday during COVID-19. If you asked me last year would I rather have a “real” party with family and friends in the room or a virtual party on Zoom, there would have been no contest! But since my birthday came at the height of the stay-at-home order, that was not an option. And, to be honest with you, I was just happy to have them all in the Zoom gallery that day.
I think this is very comparable to real vs. digital counseling. While most everyone would prefer face-to-face, there are many times circumstances will not permit it and digital options are better than none at all.  To make online counseling effective it has to be conducted correctly and respectful of the unique challenges of the medium. I’ll talk about trust in a moment, but let me say here that an effective online experience requires some additional skills not always utilized in face-to-face sessions. For example, both counselor and client need to take more time to communicate clearly and then verify that the other person understands. In my online practice I have adopted some technological features to expedite that, including the use of feedback buttons. I will frequently ask the client to use the buttons and scales to give honest nonverbal feedback during our meetings.

How can I trust a counselor I have never met in person?
Whether you realize it or not, you rely two or three times as much on what a counselor does not say than what he or she does. That is true of the counselor and you also. It’s because we depend so much on what experts call “nonverbal communication.” In other words, we communicate and understand by such nonverbal cues as facial expressions, posture, tone of voice, and other subtle messages. Most of the time we are not even aware we are doing it. I say it this way, 70-80% of conversation is not what we say but who we are. What happens to conversation when we are doing it on a computer screen instead of in an office? This is especially true when we’re trying to determine if we can trust someone. We rely more on these nonverbal cues than even their words.
All this internet stuff stresses me out. I don’t really understand how it works.
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During the height of the COVID lockdown I was involved in daily Zoom meetings often lasting several hours. Like the others, I was just sitting in my home office! I hadn’t driven anywhere in my car for a couple weeks and the only people I saw in person were my wife and daughter. So, why, after a Zoom meeting was I so exhausted! I coined the term “Zoom Fatigue” to describe it. Especially in the early days of the pandemic we were being pommeled with fear and bad news every day. I remember my first trip to the bank to make a deposit, worrying about even touching the deposit slip after the teller gave it to me. In other words, there was a lot of stress brought on by all the unknowns. I also remember my first time hosting a Zoom meeting. I had attended them before but never hosted. And some of the people who were attending couldn’t get into the meeting. I found that enormously stressful.
This is the thing: if you are not real comfortable with digital technology anyway, the thought of doing counseling online seems more stressful than just doing nothing. I understand that, believe me. There are lots of biological and psychological reasons I could give you why we react this way, but all I will say now is, “I get it!” However, that reason is not a good excuse, simply because the stress that is burdening you enough to need counseling to begin with is much, much worse than the “internet stuff.” To accommodate online clients who get easily confused or frustrated by all the unknowns of the media I have instituted certain procedures during online sessions—such as talking on the telephone first if necessary so we can talk about how to get into the online appointment not just try to figure it out themselves.


[1] Retrieved at https://www.psychologytoday.com/us/blog/what-mentally-strong-people-dont-do/201911/does-online-therapy-work
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J.E. Rose, LPC

Jim Rose is an ordained minister, licensed professional counselor and the director of Fortress Institute. 

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    J.E. Rose, LPC

    Jim Rose is an ordained minister, licensed professional counselor, and director of Fortress Institute. 

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