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The Process of Christian Counseling

By

Dr. Brian Campbell

 

 

Introduction and Background:  Once upon a time, in a far off land, I was a young student studying psychology.  Although I loved the topic of psychology and enjoyed learning, the realization that one day I would have to see a real client was ever-present in the back of my mind.  Unfortunately, deep down in my soul, I was harboring an embarrassing secret—I didn’t really know what I was doing.  I had been exposed to a lot of theories of counseling, but I didn’t really know how to “pull it all together.”

Fortunately, throughout my education, I have had the privilege of working with some brilliant mentors who helped me along the way.  My education in Britain taught me how to think independently and how to get the most out of my mentors.  My first mentor (Dr. Robert Grieve) was influential in helping me develop my “scientific mind.” 

My next mentor (Dr. Robert Hickey), taught me how to think “clinically”—to look beyond the given, and to consider deeper (less obvious) psychological constructs.  As I trained during my predoctoral internship, I would often run across situations that were downright scary.  When I didn’t know what to do, I would say to myself, “What would Bob do in this situation?”

Without knowing it, I had “internalized” the thinking style of Dr. Hickey.  At this point, I found that I was able to “think like” Dr. Grieve (the scientist) and like Dr. Hickey (the clinician).  I still wasn’t very sure of myself, but I was starting to realize the importance of learning how to think like the “giants” who were training me.

Next, came Dr. James Mulick.  Jim was my mentor during my postdoctoral fellowship.  Whereas Dr. Hickey was a radical Freudian Psychoanalyst, Dr. Mulick was a radical behaviorist.  When I arrived at Rhode Island to start my fellowship, I realized that I would now be learning an entirely different “way of thinking.”  I plunged myself into the topic of behavior modification and I “sucked the brains” of Dr. Mulick.  I wanted to learn everything I could about this new treatment paradigm and I had one of the world’s experts working side-by-side with me.  What a privilege!

I must admit, there were many times that I questioned the use of behavior modification techniques.  At one point, I remember feeling that behavior modification was too mechanistic and impersonal.  However, I soon learned that the “tools” I was acquiring actually worked, and that the results were real and tangible.  In fact, the outcomes were often truly amazing!  In subsequent years, throughout my career as a psychologist (and as a parent), I have drawn upon these skills taught to me by Dr. Mulick. 

Following my fellowship, I moved to Ft. Lauderdale to begin my career as a professor in Nova University’s clinical psychology department.  Although our program emphasized training in both psychoanalysis and behavior modification, I found myself being drawn more and more to a third treatment modality—cognitive-behavioral therapy.  The transition to the realm of “cognition” can be traced to a client I was treating in South Florida State Hospital.  We will refer to this female client as “Mary.” 

When I first saw Mary, she was shackled to a chair in the back wards of the hospital.  She was a very large woman and incredibly strong.  To some extent, she had been doing isometrics every day as she strained to get out of the restraints that bound her to her chair.  Now, Mary was a “biter.”  That’s right--she bit people.  When she was released from her chair, she would attempt to bite anyone around her.  She had already bitten off someone’s finger, and the nipple of one of the female nurses.  Mary was very scary to a 160-pound male therapist named Brian (Yikes!).

As we proceeded to treat Mary in our behavior training unit (that incorporated behavior modification techniques), I noticed that she was not responding as quickly as our other clients.  Even though our treatment center did not change from day to day, Mary did change inexplicably.  In strict behaviorism, you are taught to focus only on observable behavior (overt, as opposed to covert).  However, it was impossible to understand the changes in Mary’s behavior from day to day without considering something very important—her thinking.

You see, we finally realized that what was “driving” the changes in Mary’s behavior from one day to the next were her thoughts of “rescue and retaliation.”  One day, when her behavior was particularly troublesome and recalcitrant, I heard her mumble under her breath, “My mother is going to come and whup you.  She’ll show you.  She’ll get me out of here.”

It was then that I realized that what was driving Mary’s behavior was not what was happening around her, but what was happening inside her—in her head.  It was her thinking and what she was saying to herself that was important.  This was the area we needed to target.  Fortunately, after we started focusing on changing Mary’s thinking, we made dramatic progress.  Ah, ha! 

Of course, I knew about cognitive therapy but, until this point in time, I was mainly a strict behaviorist, and focused almost exclusively on observable behavior, as opposed to the “unobservable” realm of thinking.  It was at this juncture in my career that I decided to switch paradigms and start focusing on cognitive therapy.  Actually, I didn’t switch completely.  Instead, I focused on the marriage of the two paradigms—namely, cognitive-behavioral therapy.

The switch was not difficult.  You see, all I had to do was to use my knowledge of behavior modification (behaviorism) and apply the same principles of reinforcement and punishment to the area of “thinking.”  That is, instead of rewarding and punishing “overt behavior,” I was now focusing on rewarding and punishing “thinking.”  I had already developed the “tools of the trade.”  Now all I had to do was to switch and focus on both overt behavior and covert behavior (thinking).  Once again, the marriage of these two areas of focus is called cognitive-behavioral therapy.

Now, I really found a home in cognitive-behavioral therapy, and the tools I gained turned out to be incredibly powerful and therapeutic.  At this time in history, the entire area of cognitive-behavioral therapy was starting to blossom throughout the scientific community and the research literature was confirming the efficacy of this paradigm.  In fact, cognitive-behavioral therapy was being successfully applied to just about every type of psychological disorder you can imagine.  As many of you may know, this treatment modality is still the most effective method for treating psychological disorders.  But the story does not stop there…

Once again, as I have done throughout my life, I dove into the literature on cognitive therapy and soon mastered the techniques used to help people change their thinking.  As I garnered these skills, and was utilizing them in my private practice, I was also teaching in the university and training students.  One of my students, who happened to be a Christian, asked me one day whether or not he could do some research on the marriage of cognitive therapy and Christianity.  Wow!  What a great idea!  Why didn’t I think of that!

One of the basic tenets of cognitive therapy is that of identifying irrational or distorted beliefs that clients have adopted, challenging those thoughts or beliefs, and helping the individual arrive at a more realistic appraisal of his/her situation.  In this way, you help the individual to “restructure” his/her thinking.  It is this “cognitive restructuring” that forms a key element of cognitive therapy. 

In a very real sense, the backbone of cognitive therapy is to help bring the client to a realistic awareness of the “truth” of his/her situation, vs. the distorted view that he/she has adopted.  The irrational thinking is replaced with the more rational “truth,” through procedures such as “perspective taking” and “cognitive refutation.”  When my student suggested that we study these techniques from the perspective of Christianity, a light bulb switched on!

Wow, what a great idea!  Would it be possible to apply the biblical truths and wisdom contained in the Bible to the area of cognitive therapy?  Not surprisingly, the first thing I did was to grab my Bible and start looking for scriptures dealing with the topic of “thinking.”  To my delight, I discovered that God is very concerned about our thinking.  In fact, the very essence of cognitive therapy was right there in the scriptures:

“We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ.”
(2 Corinthians 10:4).

“Do not conform any longer to the pattern of this world, but be transformed by the renewing of your mind.”  (Romans 12:2)

I went on to find many other scriptures that related directly to thinking.  I will include a chapter from one of my books: “Godly Counsel” that deals with the topic of “healthy thinking” as it appears in the Bible (see Appendix A).  In addition, below is a brief summary of “Biblical Perspectives on Thinking.”  (By the way, the scriptures are from the NIV version of the Bible).  I will give the scripture, plus the page number on which it appears in my book entitled:  Pearls: Scriptures to live by.”

·         God is aware of everything we are thinking.  (Jeremiah 17:10; p. 155).

·         God knows what we are going to say before we speak.  (Psalm 139:4; p. 155)

·         The Lord detests the thoughts of the wicked.  (Proverbs 15:26; p. 354)

·         We are to reject impure thoughts.  They are detestable to God.  (Isaiah 55:7; p. 355)

·         We are to closely monitor what we think and believe.  (1 Timothy 4:16; p. 350)

·         We are to reject lies that run contrary to God’s truth.  (2 Corinthians 10:5; p. 351)

·         We are to get control of our thinking.  (2 Corinthians 10:5; p. 351)

·         We are to stop thinking like children.  (1 Cor. 14:11, 14:20; p. 350)

·         We are to stop dwelling on the past.  (Philippians 3:13-14; p. 350)

·         We are to change the way we think, and no longer conform to the way the world thinks.  (romans 12:2; p. 354)

·         We are to have our minds set on what the Spirit desires.  (Romans 8:5; p. 352)

·         We are to fix our thoughts on Jesus.  (Hebrews 3:1; p. 350)

Wow!  Now I was really excited!  It seemed to me that the process described in the Bible was the same basic process that was being utilized in cognitive therapy:

1.      Identify Irrational Beliefs (lies)

2.      Challenge Irrational Beliefs

3.      Replace Irrational Beliefs with the Truth

 

And the Truth, will set you free!

Over the years, my work as a Christian counselor has involved developing tools and techniques to help accomplish the tasks mentioned above.  My journey has always taken me back to the Bible as it is truly the only real source of Truth (with a capital “T”).

As my learning and growing progressed, I started using the scriptures more and more frequently in my counseling.  Unfortunately, I quickly learned that my ADHD tendencies were undermining my ability to quickly find the scriptures I needed.  Frequently, I would find myself saying, “Ahhh, wait a minute.  Let me find a scripture that relates to what you are thinking.”  At times, it seemed to take hours for me to recall the chapter and verse in order to find the scripture I was looking for.  And the more anxious I got, the more difficult the task became.  It was clear; I had to do something.

Frustrated, I decided that I would go through the Bible and find and categorize the scriptures that would be valuable in counseling.  Ultimately, this gave birth to: 
Pearls: Scriptures to live by.”  Now I was set.  The scriptures I needed for counseling were included in Pearls, and I could quickly find them under topics such as:  Anxiety; Depression; Anger, etc.

The making of Pearls was life-changing for me.  I had never studied the scriptures so intently.  I soon found myself waking up my wife in the middle of the night to read the next chapter of Pearls I had just completed.  I was like a little kid in a candy shop.  The scriptures were like food for me.  At the completion of Pearls, I realized that I had changed.  My own thinking had been renewed by the truths contained in the scriptures.

At this point, I felt much more prepared for the task of “Christian Cognitive-Behavioral Therapy.”  I ended up producing thousands of copies of Pearls and I have used it with my clients throughout my career as a Christian counselor.  I also keep a copy in the waiting room, so that my clients can look at it while they are waiting for their session.

Let me stop and tell you a somewhat humorous story about the power of God’s Holy Word.  The events were not humorous at the time they occurred, but the fact that I am writing this guidebook is evidence that I survived the event.

One day, at around the time I was working on Pearls, I was treating a difficult client named Bob.  Now Bob was a very large man and very mean looking.  He was a “born again” Christian, but this had not always been the case.  In his former life, he was a “hit man” for the Mafia.  That’s right; he killed people for a living.

Now, although Bob was a “born again” Christian, his language had not kept pace with his Christian walk (if you know what I mean?).  As I was treating him one day, he started getting very angry with his wife (who was not present).  All of a sudden, he stood up and started yelling in his old (unsaved) voice.  The expletives were reigning down like a meteor shower.  I started getting scared, and looked behind me to see if I could exit quickly (an old trick I learned while interning at the VA).  Then I had an idea.  At first, I thought it was a brilliant idea, but I wasn’t so sure as events progressed.

I remembered that I had just finished cataloging the scriptures on “Anger” that were going to be included in Pearls.  I quickly grabbed my notes and started reading the scriptures.  I think I said something like:  “Wait a minute Bob.  You need to calm down some.  Let’s look at what God has to say about anger.”

I looked down at my papers and nervously started to read…

“Do not be quickly provoked in your spirit, for anger resides in the lap of fools.”  (Ecclesiastes 7:9).  On no!  Now what had I done?  I think I just called this angry (former Mafia hit-man) a fool.  Probably not a good idea.  I was so scared, I didn’t look up.  I decided the best thing to do would be to continue to the next scripture.

Two or three scriptures later, I was feeling a little more confident.  After all, I hadn’t been killed yet, so I kept going.  But then, I came to another zinger! 

“A fool gives full vent to his anger, but a wise man keeps himself under control.”  (Proverbs 29:11).  Oh, no!  I just called him a fool again.  Do I dare look up?  No, I thought, I’ll just keep going and take my chances.  After all, I didn’t think he had a gun with him.  But this was little comfort, as I was sure he could kill me with his little finger.  Nevertheless, I pressed on…

As I read, I started taking the chance to glance up at him to look at his face to try to judge how I was doing.  To my surprise, his countenance started to change as I read God’s Word.  By the time I finished with the scriptures, something significant had happened.  He had a little smile on his face as I read out the last scripture on anger.

I put down the paper I was reading from and looked him straight in the eyes.  His smile broadened even further and he said (in a quiet and somewhat resigned voice)…”Got me!”  He sat down, and the crisis was over.  I saw first-hand the power of the Word of God.  I realized that this “tool” could “break” even the most hardened and resistant individuals. 

My experience with Bob gave me the type of experience that God wanted for me.  God showed me that mere mortals are no match for the His truth.  What an exciting day that   was for me.  Now, I must say that I don’t always use scriptures in such a direct and “in your face” way.  Nevertheless, over the years, I have always kept a copy of Pearls beside me in counseling and I refer to it often.

Let me tell you another story that illustrates the power of God’s Word.  This one involves Pearls again.  After I had 5,000 copies of Pearls printed, I noted that there was something that didn’t look right on the book cover.  It wasn’t that bad, but it did bother me a bit.  I decided to call the printer to see if anything could be done to fix the error.

The man I spoke to turned out to be a Christian also.  I told him about the error and he told me that his company would print the books again for me.  I thanked him and hung up.  I assumed that I would have to send back the books that I had already received.  Then I spoke to a Christian friend of mine.  He suggested that I call the printer back and ask him if I could keep the slightly flawed copies of Pearls.  I didn’t think that this would be possible, as it would surely “compete” with the need to re-order from the printer if I sold out of the second run of the books.

Nevertheless, I decided to call and ask.  To my surprise, when I asked him if I could keep the 5,000 copies with the minor error on the cover, he said, “Yes.”  He said that all I had to do was to promise him I would not sell the books from the original order but, instead, I could give them away for free!  All I had to do was to tear out the copyright page.  I said, “No problem.  I promise I won’t sell them.”

And that, my friends, is how I got 5,000 copies of Pearls at absolutely no cost.  But now that I had them, what was I going to do with them.  I had gone deeply in debt to publish Pearls and I wanted to get at least some of my money back.  I decided I would give some of the “free” copies away to needy clients, and I would take the others and place them in the waiting rooms of Christian counselors.  I figured that this would be good for the clients, and I could include information on the front cover about where people reading the book could purchase a copy for themselves.  Brilliant!  At least I thought so at the time.

One day, I was treating a corrections officer and I decided to give him one of the “free” copies of Pearls.  He asked for a copy, and he clearly did not have the money to purchase one of the “unflawed” copies that I was selling out of my office and on the internet.  He thanked me and left.

The next week, during his subsequent session with me, he told me he had been reading Pearls and he felt that it would be a great book for the juvenile delinquents that he was working with (remember, he was a corrections officer).  I thought for a moment, and hesitated a little.  After all, if I were to put these 5 copies into a Christian counseling waiting room, the one book that I placed could possibly result in 10 or more sales.  But then I realized that God had made the extra copies possible, and that I should honor God by giving the copies to this man for the youth he was working with.

The next week, when I saw the client again, he told me that the youths simply loved Pearls and he asked me if he could have another 10 copies this time.  I hesitated again, as my mind wrestled with whether or not I should give him another 10 copies of the “free” Pearls.  It almost felt like God was saying:  Campbell!  This is a test!”  I shook the materialistic thoughts out of my head and said, “Yeah!  Sure!  You can have another 10 copies.”  Little did I know at the time, but the next time I would see this man, I would experience something that would change my life…

As the corrections officer entered my office for his next appointment (a week later), he had someone with him.  The man approached me and shook my hand.  As he did so, he stated:  “I just wanted to thank you personally.  You see, I’m alive today because of you.”  Of course, I was shocked, as I had never met the man before.

He then proceeded to tell me…”Last weekend, I decided to kill myself.  I got some pills and tried to overdose.  However, I wasn’t successful and I woke up later on in the evening and I was still alive.  I then got a gun and was ready to kill myself.  At around that time, my friend (the corrections officer) knocked on the door and gave me a copy of your book.  I started reading it, and I couldn’t kill myself.  I’m alive today because of you.”

Of course, he was not alive because of me.  He was alive because of the power of God’s Holy Word.  No one had to say anything.  God’s Word had been more than sufficient to change his mind about suicide.  After this event occurred, I realized that my entire life may have been made meaningful by what had occurred.  I am indeed humbled to realize that there is a person alive in this world today because I was faithful in helping to bring God’s Word to him.

Choosing a Title For My Practice:

After leaving Nova University, and as I was preparing to open up my own private practice, I realized I needed to decide upon a name for my practice.  I decided to call it “New Life Christian Counseling Center.”  I thought this was a great title for my new Christian counseling practice.  However, some of my Christian counselor friends advised me that I shouldn’t use the word “Christian” in the title as I would miss out on some of the non-Christian clients who might be “turned off” by a title that included the word “Christian.” 

Fortunately for me, I didn’t listen to them.  I kept the name in order to honor my Lord and Savior.  Interestingly, God really honored this decision.  You see, third party insurances (HMOs, PPOs, etc) were taking off at that time in history.  I was on the panel of most of the insurance companies (that is, I could bill insurance companies for my services).  Well, as it turns out, I ended up getting a tremendous amount of referrals from the insurance companies.  Interestingly, the counselors who advised me to leave out the word “Christian” were not doing so well.

You see, I live in an area where there are a lot of Christians.  Most of these Christians, if they need counseling, will deliberately seek out Christian counselors.  If they have insurance, they typically call their insurance companies and request a referral to a Christian counselor.  When they do so, the insurance companies usually look down their list of providers and look for someone who seems fit the bill.  Since I was one of the few counseling centers that “advertised” as being Christian, they usually gave my name to the clients.  Bingo!  I ended up getting most of the referrals.  Once again, God honored my decision to “do the right thing” and keep His name in my practice title. 

Setting Up a Practice:  When setting up a practice, there are a few things to keep in mind.  First of all, you must make a decision as to whether or not you want to work with others or be on your own.  Working with others sounds great, but there can also be problems.

The first Christian counselor I worked with ended up having sex with one of his clients.  Yikes!  I had to run from this practice.  I ended up teaming up with another Christian counselor and we started a corporation where I owned 50% and he owned 50%.  This turned out to be a disaster also.  When you have a 50-50 corporation, it takes both signatures to sign checks and carry on business.  Both of you have equal power, and no one is really in charge.

Well, here is what happened.  I worked hard to build the practice and, at first, the other guy worked hard also.  But then something happened.  He just stopped working and there was no money coming in from “his side.”  After a while, I was working and he wasn’t.  The discrepancy built up until his side of the ledger was short $10,000.  I then refused to sign his salary check and he refused to sign for mine.  I got a lawyer from the church and tried to resolve things, but he wouldn’t budge. 

We ended up dissolving the partnership with him owing me over ten thousand dollars.  I never did get the money back.  Bottom line, do not set up a 50-50 business arrangement.  Also, be very careful choosing partners.  After these two experiences, I decided to start my own corporation and be in 100% control.  However, I did take on two employees (master’s level school psychologists) to work with me in order to help offset expenses.

By the way, I also decided to have my wife come to work for me when we started the new practice.  Now, my wife studied theoretical mathematics at the University of St. Andrews, so she is a pretty “smart cookie” when it comes to math.  And, guess what?  Not so long after she started, she found that the previous secretary had failed to bill clients properly and there was 10,000 dollars in insurance claims that had never been processed.

I hope you are getting the picture.  Be very careful about whom you choose to have as employees and/or partners in any private practice you set up. 

Choosing a Location:  The first offices I worked at took me between ½ hour to 45 minutes to get to from my house.  I had to drive on an interstate road that was highly unpredictable.  Subsequently, when I opened up my present office, I managed to find a beautiful office that is located only 2 miles from my home in Lake Mary, Fl.  When I calculated the amount of time I saved and the amount of gas I saved, I was surprised at the difference.  For example, I calculated that if you added up the time I saved in travel each day, I was saving about 160 hours per year (which is equivalent to about 4, 40-hour work weeks).  Wow!  What a difference!  The quality of my life improved significantly when I moved my offices closer to my home.

Not only that, it just so happens that I was able to find an office that had a terrific view of a beautiful lake.  This was fortunate, because I found out later that research shows that you live, on average, one year longer if you have an office with a view of nature.  Believe me, over the years, I have needed to look out my window in order to take a glimpse at God’s handiwork.  The only problems I have had with my beautiful view stems from my ADHD problems.  You can’t believe how hard it is to stay focused on your client’s problems when you have huge birds flapping their wings and diving into the lake to catch fish.  We even have bald eagles!  Yikes!  How distracting!

Making Sure It’s Quiet:  One of the most important things to think about when choosing an office is SOUND.  Many offices do not have sufficient sound-proofing and it is very difficult to conduct confidential counseling if the sound travels through the office walls.  Fortunately, for me, I was able to be involved in the construction of my current offices and I requested extra sound-proofing between the walls.  I have heavy doors and sound-proofing at the bottom of the doors (so that sound does not travel out under the door).  In addition, I was able to locate the waiting room at one end of the office space and my therapy rooms were at the opposite end.  Finally, I have Christian music playing in the waiting room to mask any sounds that might emanate up the hallway.

The Intake:  The first contact with potential clients is usually over the phone, and the first person to talk to potential clients is typically your secretary.  Fortunately for me, my wife, Claire, has served as my office manager for the past 15 years or so.  It is important that you take time to train your secretary, as there are many things that must be considered during the intake process.  If you are using a secretary, the legal and ethical responsibility rests with the therapist, who must train the secretary with regard to important things such as confidentiality and how to properly screen clients.

Confidentiality:  Secretaries need to be trained to understand that they cannot give any specific information out over the phone regarding clients.  If they make a call to a client that has already gone through the intake process, that is one thing.  But if someone calls and asks for information about someone who is in therapy—even regarding as to whether or not the person is in therapy—you must teach them not to give out personal information, or even acknowledge that the person is receiving counseling.

Be careful, as clients can be “tricky” and deceitful when trying to get information.  Often, the best thing to teach the secretary is to “take a message” and “Dr. Campbell will get back to you.  This is especially important when working with couples who are going through a divorce.  Even attorney’s will try to get information—sometimes deceitfully.

If your secretary types up your notes for you (from dictation) you must teach her the laws regarding confidentiality and that she must never divulge any information that she might have read.  Also, the secretary must never release records without your specific approval, and only then when you receive properly signed authorizations for release of records.  You can find an example of a “Release” on my internet site under “Counseling Resources.”

Screening Clients:  Although you may be tempted to accept all the clients who call your office and want counseling, you should never try to be “all things to all people.”  Know your limitations.  Although I have received more training than most people on the planet, there are still clients that I choose not to work with.

To this end, the secretary must be trained to carefully screen clients who call into the office requesting services.  As a general rule, I do not accept clients who have as their main presenting problem alcohol or drug abuse.  These problems are not easily treated in outpatient settings and, in the state of Florida, you need to be a “Certified Addictions Specialist,” to work with such clients.  Develop a referral base, and have your secretary refer such clients to appropriate inpatient treatment centers or to therapists who specialize in treating these disorders.

By the way, you can find a wide range of Christian referrals on my internet site.  For example, if you are looking for Christian inpatient treatment facilities, they are located here.  I also have links to crisis intervention programs, Christian counselors, and a host of other referral services.  I highly recommend that you take time to explore the resources on my website.  These resources should be extremely valuable to your clients.

I also have learned the hard way not to treat individuals who are involved in getting a divorce and/or who are involved in a child custody battle.  These cases can turn out to be highly emotional and very demanding on the counselor.  If you take on divorce cases, you can anticipate getting subpoenaed by lawyers and being called by irate parties (usually one spouse will be angry at you). 

With regard to child custody cases, stay clear of them altogether.  You should not be get drawn into cases where your “expert opinion” is being requested regarding custody issues.  In general, this is a highly specialized area that requires specialized training.  In Florida, the state law specifies how custody evaluations must be conducted and the level of training necessary to conduct them.  Even though I have the background and training that would allow me to undertake such evaluations, I personally would never attempt them.  In all likelihood, whatever decision you make in a custody case, someone (the aggrieved party) is going to try to sue you or make a complaint against your license to the state licensing board.

By the way, you must be careful that you do not unwittingly get “sucked into” a child custody case.  Unfortunately, people do not always tell the truth, and they often have ulterior motives.  This is why it is important to have a well-trained person manning the phones and dealing with intakes.  Your intake person needs to specifically ask whether or not the person calling is involved in a divorce proceeding and/or a child custody case.  Or, does the potential client anticipate going through a divorce in the near future that might involve children and custody issues?

You must also be careful with callers who are requesting services because of suspected child abuse.  In Florida, evaluations for child abuse are conducted by specially trained police officers.  If you, as a counselor, see the child and ask the wrong questions or break standard protocols, you may seriously compromise the child’s testimony should a court case ensue.  It is best to refer such calls to the local police, or describe to the caller why you are unable to get involved.  I have my secretary strongly recommend that the caller report any suspicion of child abuse to appropriate authorities.  I have listed telephone numbers for the Child Abuse Hotline on my internet site.

In cases of suspected child abuse, I typically tell parents that after the legal process has taken place and the police evaluation has been conducted, I will be happy to see the child and/or parents for counseling.  But only after the police evaluation has been completed and any court action has been resolved.

In addition to the categories already mentioned above, I do not see clients who are homosexual and who do not want to change their orientation back to heterosexual.  This whole area of treatment is controversial at this time.  Recently, California has passed a law that forbids all counselors from trying to help children (under 18) adjust to a heterosexual orientation (even if they were the victims of sexual abuse, and despite the fact that their parents are requesting help for their children to help reorient them back to heterosexuality).  Interestingly, the dean of Liberty University Law School is currently fighting this California law.

Client Intake:  The initial contact with a potential client is normally by telephone.  In my experience it is extremely important to have a “real person” answer the phone, rather than have an answering machine only.  If you do use an answering machine to “back up” the secretary when he/she is not available, make sure that as part of the announcement you state that:  “If this is a medical emergency, please hang up and dial 911.”

I have developed an Intake Form that the secretary/office manager can use to record important information about the potential client, including information relating to the main reason the person is seeking help.  There is also information regarding insurance coverage, etc.  In my practice, since I am able to accept insurance payment, my wife usually takes basic information and then gets back to the client once she has determined how much the client will have to pay as a co-payment, etc.  The Office Intake Form (Adult) and Office Intake Form (Child) are available for download on my internet site.

At the bottom of the Office Intake Form, there is a place for the client to sign for “Consent for Treatment.”  As part of the intake process, I have also developed a Client Handbook, that includes important information regarding consent for treatment and limits of confidentiality.  Clients must read the Handbook and sign the Consent for Treatment prior to the initiation of treatment.

After my wife screens the initial telephone contacts, she then schedules an initial appointment and sends a confirmation of the appointment (Appointment Confirmation).  In the confirmation letter, she includes information relating to the time, day, and date of the initial appointment, as well as fees for cancellation (without prior 24 hour notice).  Finally, she attaches the Client History for Adults or Client History for Children. 

If the client has an email account, Claire will send the documents by email; otherwise, she sends them out by “snail mail.”  The Client History form must be completed by the client before I see him/her for the first appointment.  If the client fails to bring the completed forms to the first appointment, then he/she must come early and complete the papers in the office.

The Client History is extremely important.  It asks the client for important background information regarding:  a description of the main reason the client is seeking treatment; current symptomatology; medical history (including current medications); marital history; sexual problems; relationship to parents; religious history, etc. 

Interestingly, the laws of the state of Florida require that you acquire a background history for each client.  They also require that you store such records safely.  Believe it or not, Florida law also requires counselors to keep a copy of the records on file for a period of seven years—even after I die!  Yikes!  Please remember to carefully study the laws of the state in which you are going to practice.

The Initial Session

During the initial interview, I have the Client History in front of me.  I have already looked over the history before the first session, but now I have it in front of me and I use as a tool for additional data collection and generating hypotheses.

During the initial meeting with the client, I am thinking about many different things.  Basically, I am trying to formulate the nature of the problem and I am developing hypotheses about what might be causing the presenting problem. 

Identifying the Presenting Problem:  I often begin the first session by asking the client what brought him/her to counseling. 

“Good afternoon, Mr//Mrs _______, please have a seat on the couch and get comfortable.  I’ve read over the information you gave me, but I wondered if you would please start out by telling me in your own words the main reason you’ve decided to come to counseling.”  (I already have an idea about this from my intake forms—which I have reviewed before the session—but I want to hear the client’s version.) 

Very often, the client is vague or unclear about the reason/s for entering counseling.  Sometimes, clients do not want to “write down” the reason for counseling on the intake forms.  They might feel that the information is too personal, they’re ashamed to admit what they have done, etc.  I gently try to “draw out” the true reasons for coming to counseling, and I take notes as we proceed if I feel that something is important and I want to remember it.

As I start to formulate the problem in my mind, and give the problem a tentative “name,” such as “anxiety,” “depression,” etc., I then proceed to get an idea of the “dimensions” or scope of the problem.

 “When did problem/s first start? 
“How long have you been experiencing these symptoms? 
“On a 1-10 scale, how would you rate your problem?”  (“1” being not too serious, “5” moderately serious, and “10” extremely serious) or, something like (“1” being almost no anxiety, “5” being a moderate or average amount of anxiety, and “10” being extreme anxiety).  You can vary this scale depending on the nature of the problem.

Symptom Checklist:  At this point, I am also hypothesizing (in my mind) about differential diagnosis.  I look over the symptom checklist that the person has marked on the Client History form and see if it looks like the person may be suffering from some type of anxiety or depression, thought disorder, etc.

Religious History:  Obviously, you will want to inquire about the client’s religious training/upbringing and information about current church attendance.  Depending upon the particular religious denomination of the client, you will have an idea about basic religious beliefs and doctrines.  In order to help with this general process, I have developed a handout to assess basic religious beliefs: “Christian Experiences and Beliefs.”

Medical History:  As I progress through the Client History, I look at the person’s medical history to see if there are any possible links between underlying medical problems/conditions and his/her presenting symptoms.  I pay special attention to past hospitalizations (especially hospitalizations for mental health issues).

Medications:  I also pay special attention to the client’s current medications—especially any psychotropic medications.  If you are not familiar with a particular medication, ask the client.  If he/she is unsure, then make sure you look it up some time after the session.  In fact, you might want to “double-check” most of the medications the client lists.  Many medications can produce side-effects (symptoms) that can present as “psychological” disorders (such as anxiety and/or depression).  You may also want to help the client check for possible drug interactions.  Here is why…

Some clients will be taking several medications when they arrive at your office, some of which may have negative side effects associated with them.  In addition, drugs may cause psychological symptoms because of drug interactions.  You might be surprised to learn that drugs can also interact with vitamins that people take.  Most medical doctors don’t take the time to check for drug interactions.  On my internet site, I have basic information about psychotropic medications as well as a link to a site where you can check out all the client’s medications and all the possible Drug Interactions.

If you note any possible drug interactions, you may want to print out your findings and give them to the client to take to his/her doctor and ask questions regarding possible problems.  Very often, clients are receiving psychotropic medications from their family doctor (as opposed to a psychiatrist).  Unfortunately, family doctors typically have limited knowledge about psychotropic medications, and limited knowledge of possible drug interactions.  In addition, they very often give “too little” of a medication and never get to the level where the medication is in the “therapeutic range.”

Here is an interesting example of the effects of drug interactions.  I was treating a woman at one point who was seriously depressed.  When she came to see me, she was taking an antidepressant.  Our therapy progressed and she seemed to be getting much better.  All of a sudden, within a week, she was having suicidal thoughts.  When I saw her, there did not seem to be any reason why she would have regressed.  Nothing unusual had happened.  

As I talked to the woman, I started asking her if she was still taking her antidepressant.  She assured me that she was, but she mentioned that it was making her constipated.  She then proceeded to tell me that she had recently started taking Metamucil to treat this problem.  Since nothing much else seemed to have changed, I decided to look up her antidepressant on the computer and check if there could be any interaction with Metamucil. 

It was not long before I came across some interesting information.  I found out that if you are taking this particular antidepressant, you should not take any type of fiber supplement, as it would interfere with the absorption of the anti-depressant.  Obviously, that is what had happened.  She went back to her psychiatrist and told him and he confirmed that this was probably the reason that her medication was no longer working as it should.  When she stopped the Metamucil, she started getting better again and we proceeded in counseling.

Bottom line, get to know some Christian psychiatrists in your vicinity and refer clients to them if you suspect that the case is medically complicated or “psychologically” complicated.  For example, if the person is diagnosed as having bipolar disorder with underlying borderline personality disorder, he/she should be seeing a psychiatrist and not a family physician.

With regard to the power of medications, I use this maxim:  “When biology meets psychology—biology wins.”  Psychotropic medications can be very powerful, and if the client is not taking the correct medication for his/her disorder, or is not receiving the dosage level of medication, it will often be very difficult to obtain any meaningful progress in counseling.

Let me stop for a minute and tell you about drug “titration.”  As mentioned earlier, many family physicians are very conservative about the levels of medication prescribed.  They do not really understand the concept of medication “titration.”  Here is how this works. 

There is a “therapeutic window,” where the correct level of the medication is being given and the client is getting optimal effects.  A client’s medication should be gradually increased until he/she reaches the “therapeutic window.”  Unfortunately, many doctors stop short of reaching this therapeutic window.  They may increase the dosage a little, but not enough to reach an effective level.  Psychiatrists tend to do a much better job of titrating medications (compared to family physicians). 

You should also know that, as a counselor, you may need to encourage clients to continue to take their medication until the titration process is accomplished.  Many clients will want to stop taking their medication and proclaim “it isn’t working.”   Also, you may have to encourage clients to continue to take their medication even though they are having minor side-effects.  Have them check with the psychiatrist if their side-effects are severe or debilitating.  Minor side-effects, like dry mouth or constipation, can be expected (especially with antidepressants).  Most of these minor side-effects will normally “go away,” as the medication is continued.

Finally, medication can be very helpful for anxiety or depression.  However, with respect to depression, not everyone is going to respond to the first antidepressant that is prescribed.  In fact, on average, it can take up to 3 medication changes before the client finds one that works.  This can be very frustrating, as it may take 4-6 weeks for each medication to potentially “start working.” 

Previous Psychological Treatment:  Examine whether the client has received treatment in the past and by whom.  Discuss: Why?  Who?  What?  Where?  When?  How?  You may want to have the client sign a Release of Records form in order to get treatment records from therapists who have seen the client in the past.  Make sure you ask the client to describe the previous treatment and why he/she terminated. 

Personality Dysfunction:  In addition to Axis I disorders, I am also looking for information relating to possible underlying personality disorders that may be present.  This gets easier over time as you get to know the causes of personality disorders and the symptoms to look for.

            To Treat or Not To Treat:  Overall, the initial meeting with the client is a “fact finding” mission.  By the end of session, I usually have a good idea of whether I will be able to effectively help the person, or whether or not I should refer the case to someone else.  Remember, you are not all things to all people.  It is important to be aware of your limitations and know when you need to make a referral.

            Prayer During Therapy:  If my clients are Christians, I generally wait until the end of the therapy session and then ask them whether they would mind if I prayed with them.  For most of my clients, this is how I generally end all subsequent sessions.  Of course, at times I stop and pray during the session itself rather than waiting until the end.  Obviously, prayer is an important part of Christian counseling.  I often pray before the client arrives at the session, and I try to remember to pray for him/her throughout the week.  In addition, I have written some “therapeutic prayers” that I sometimes assign to clients.  

If my client is not a Christian, or is not currently attending church, or is questioning his/her faith, then I do not “force” prayer on to him/her.  I wait to get more information about the client and use my judgment as to when prayer might be appropriate (in the session). 

The Second Session:  Clinical Interview

If I decide I can be helpful to the client, I will then schedule a second appointment.  If the client is an adult, I almost always schedule the client to take the Millon Clinical Multi-axial Inventory—III (MCMI—III).  This instrument is the best available tool for differential diagnosis of Axis I and Axis II disorders.  It is especially important for identifying the presence of personality disorders.  When introducing the test, I tell the client that I want him/her to take the test because it is like doing “blood work,” only psychological.

Unfortunately, the MCMI  is only available to doctoral level psychologists, as you need to have specialized training in order to use it.  Master’s level counselors can usually refer clients to a Ph.D. level psychologist in the community to do the assessment, and then the client returns to the therapist who made the referral.  I often provide this service for local master’s level counselors.

In addition to the Millon, I also have clients complete a handout I have developed called “Parental Patterns.”  This handout consists of a list of “toxic messages” that parents communicate to children.  It is intended to help the counselor identify underlying “beliefs” that a client may have developed given the faulty messages (lies) communicated to them by their parents.

The MCMI is computer scored prior to my second session with the client so I have the scored printout in front of me when I conduct my clinical interview with the client—which takes place during the second session.  Having reviewed all the data accumulated thus far, I then interview the client and ask questions relevant to differential diagnosis.  I also obtain any additional information I may need regarding the client’s background, medical history, religious training, etc.

During the second session, I have the MCMI in front of me and I share the overall results with the client.  I read some of the text to see if the client agrees with the hypotheses generated by the assessment instrument.  The MCMI is extremely valuable to the process of differential diagnosis.

Alternatives to the MCMI-III:   If you do not have anyone who can help you by administering the MCMI-III, you will need to work carefully to ask questions that will help with differential diagnosis.  There are checklists and other tools that are available for use by master’s level counselors that will help you with differential diagnosis.

Bibliotherapy:  I always try to give clients “homework” to do during the week and prior to the next session.  Very often, I assign chapters from my books and/or books that I have cataloged in my Christian Counseling Library.  I have personally selected and listed hundreds of Christian books organized under various clinical topics.  The books can be ordered directly from the library, which connects to Amazon.com.  When people order books through my internet site, I get a small commission which helps support the expenses associated with keeping the internet site up and running.

I usually have copies of my books in my office and sell them to the clients at a reduced price.  Of course, if the client is unable to pay for them or I feel that it may be a hardship, I give them to him/her free.  (Actually, this happens more often than not, as I don’t like to charge people for my books.  I’m not good at selling things.  If God wants to punish me and put me in Hell, all he has to do is to make me a salesman).  J

In addition to my books, I also frequently recommend that clients download my audios:  Overcoming Anxiety,” and Overcoming Depression.”  These audios are available at a minimal cost and can be downloaded from my internet site (in MP3 format).  Clients can then put them on Ipods, Ipads, computers, MP3 Players, etc.  Many of my clients have told me that they listen to them in the car or at night before going to sleep.

Internet Resources:  I created my internet site, Counseling4Christians.com in order to provide clients with a wide range of internet-based Christian resources.  The site is jam-packed with resources and links to top Christian oriented websites.  I usually give my clients a business card with the internet site on it so that they will remember the website.

The internet contains the contents of most of the books I have written.  It is the home of thousands of scriptures that are valuable for Christian counseling.  Whatever the client’s problems may be, God has usually addressed it in the Bible.  You will find hundreds of clinically relevant scripture topics  together with recommended books and chapters from “Godly Counsel” and “Christlike: Walking the Walk.”

God has really blessed this website.  I am so glad, given the amount of “bad stuff” on the internet.  It was recently voted as a “Top Christian Counseling Resource” on the Internet. 

Newsletter:  I produce a Newsletter that I try to publish monthly.  I encourage clients to join my newsletter mailing list.  The newsletters focus on topics important to Christian counseling.  I encourage you to join this newsletter and recommend it to your associates.

Facebook & Blog:  Yes, I even have a Facebook site and a Blog; however, I don’t really do much with them these days.  Both of these can be reached from my website Home Page.  I also have a Google + account.  I invite you to join my Google + group, and please, please, “like me” on Facebook.  (I really don’t know what this does, but it is nice to be liked).


The Third Session:

Christian Cognitive-Behavioral Therapy 

The model I have developed for Christian counseling is detailed in a PowerPoint presentation I produced entitled:  Take Captive Every Thought.  I strongly urge you to view this presentation as a background to what follows.

Discovering Beliefs.  By the time I start the process of counseling, I have already obtained a great deal of valuable information concerning the individual’s underlying beliefs and I am starting to develop ideas about which faulty beliefs I want to tackle first—that is, I start to prioritize which of the faulty beliefs I need to focus on first.  If you start with the client’s main symptoms (such as depression), you can then trace back symptoms to the toxic messages communicated to them by their parents, school, church, the “world,” etc.

            Note:  The process of identifying and dealing with faulty beliefs is a fairly fluid process and not rigid or mechanical.

As I proceed in counseling, I develop hypotheses concerning what irrational beliefs might be driving the disordered thinking.  At the same time, I am linking the “stinky thinking” (I borrowed this from Zig Ziggler) to the emotions that are being displayed by the clients.  Remember, irrational thinking drives emotions.

As I consider the emotions the client is displaying, I am trying to “put the pieces together” and evaluate the thinking behind the emotions and the underlying beliefs that may be affecting the thinking.  I look for connections in the person’s childhood, or experiences encountered as he/she grew up.

Interestingly, I have found that certain personality disorders often have their origins in middle school—that’s right, middle school.  Young children are pretty much protected in elementary school; however, when they enter middle school they are “on their own.”  All of a sudden, they are no longer safe, and some fall prey to bullying and abuse.  If the child is particularly sensitive, then he/she can put up a “protective shield”—sort of like Star Trek.  The shield goes up, and the child pulls away from others to protect himself/herself.

The process of withdrawal and protection is often the nidus of Avoidant Personality Disorder (APD).  Personally, I am quite surprised at how many times I have traced this disorder back to middle school.  By the way, the entire school experience (including middle school) can be harmful to some children—especially if they do not “fit in” in some way.  (See Case #1)

As I progress in the process of counseling, I try to identify the “dominant” underlying belief that seems to have been toxic for the client in terms of irrational thinking and the emotions that follow.  This is what I plan to work on first, and I “attack” the faulty belief (and faulty thinking) with selected scriptures, prayer, and through gently questioning the validity of the belief.  Here’s an example:

Questioning Beliefs:  (“Thoughtbusters”) “Mr. Jones, I see from your background history that your father insulted you and called you dumb and stupid.  Do you think you believed him to some extent?  Do you think people who are wise and intelligent have to call their little children stupid?”

“You don’t sound stupid to me; you sound very articulate.  Why do you think you believed your dad?  Regardless of how your father viewed you, how do you think that God views you?  How do you think that your Dad’s intelligence compares to the Creator of the universe?  Isn’t it true that we are born with our basic intelligence and whatever intelligence we have, that’s exactly what God wanted us to have?”

Experimentation:  Another way to “break up” and individual’s faulty beliefs is to “do an experiment” and collect data that would contradict the belief.  For example, if the same man said: “Everyone at work also thinks I’m stupid,” I might tell him to do a little experiment over the next week. 

For example, I may have the man keep track each day of how many people call him stupid.  He is to keep a record of who called him stupid and how many times that this occurred.  Obviously, his “belief” was probably far from reality, and taking data that contradicts this belief may help “break up” and seriously question this assumption.

            Cognitive Refutations:   In order to refute irrational beliefs and “stinky thinking,” you can have the client develop a set of positive statements (truth statements) that counteract the irrational beliefs and thinking.  For example, you develop a list of statements (with the client’s help), such as the following:

I am fearfully and wonderfully made.
I am made in God’s image and He loves me.
Nothing is impossible with God by my side.

Typically, I will assign the initial task of generating these “positive self-statements” to the clients.  If they are unable to generate a list, then I help them during the counseling session.  I then have them put the list on a little card that they are to keep with them at all times.  These days, you can have them put them in their “smart phone.”  The point is, they should refer to them frequently throughout the day.  This is part of the process of challenging irrational beliefs that were taught to them.
           

            Changing Behavior:  Sometimes, it is possible to help individuals change faulty beliefs by helping them change their behavior.  The change in behavior “argues against” the irrational belief.

            For example, I once had a woman who came to therapy each session dressed completely in black.  Her husband had died, and she had been in mourning for over a year.  (Actually, she was clinically depressed.)  She told me that her house was a complete mess and she entirely helpless to do anything about it.  She felt overwhelmed.  Instead of asking her to go home and try to clean the entire house, I asked her if she thought she would be able to clean the coffee table off before our next session.

            Fortunately, she came to the next session and told me that she was able to accomplish the task, and she was feeling a little better.  You see, like many depressed clients, her thinking was characterized by dichotomous (black or white) thinking.  “I can’t!  I’ll never!  It’s impossible!”  The fact that she able to clean a little bit of her house strongly argued against the notion that she was “completely helpless.”

            By the way, the next session after she cleaned the coffee table, she wore a little red pendant on her black dress.  As the subsequent therapy progressed, I could gage the success of therapy by the amount of color she wore.  By the time she ended counseling, she was wearing quite colorful clothing and she was smiling quite often.

Getting the Big Picture: As you work with clients, you want to get the “big picture” of their lives.  Stand back and analyze the amount of resources the individual has at his or her disposal.  How much help can they get from others.  Can you enlist other family members to help improve compliance to the tasks you have assigned to the client?

I was trained in “eco-behavioral” analysis.  In the behavior modification world, this theoretical orientation is close to what is termed a “functional analysis” of behavior.  The process involves looking at the behavior of a person in the context of his/her environment. 

General Health Condition:  At times, you may want the client to change his/her eating habits and/or start exercising.  Exercising is great for helping reduce both anxiety and depression.  However, make sure the individual gets a physical before starting any strenuous exercise.  Helping the individual establish healthy life-long good habits can be extremely important.

Increasing Pleasurable Activities:

One of the definitions of depression is “lack of access to positive reinforcement.”  To decrease depression and increase positive feelings, it is often important to help the client identify pleasurable activities in which he/she can engage.  A handout on this topic is provided on my internet site:  Increase Pleasurable Activities.

Increasing Church Attendance and Fellowship:

Christians naturally benefit from being a part of the “fellowship of believers.”  Encourage clients to attend church regularly and to join home groups, men’s/women’s groups, bible studies, etc.  Many large churches also specialized groups such as:  divorce recovery; addiction recovery; marriage seminars; parenting seminars, etc.

The Motivaider:

One of the tools I frequently use with clients is called the “Motivaider.”  I use this tool in conjunction with a procedure called “cue-controlled relaxation.”  The Motivaider resembles a pager (in the old days).  You can set the device to vibrate on a schedule (for example, every 8 minutes).  When the device “goes off,” the client is taught to take a slow deep breath.  Slow deep breathing is completely incompatible with anxiety.  This represents the “behavioral” part of the cognitive-behavioral procedure.

In addition to slow deep breathing, I help the client “re-program cognitively, by utilizing a “cognitive refutation.”  For example, many Christians need to “let go” and turn everything over to God.  In these instances, many clients use the expression, “Let go (while breathing in) and Let God (while breathing out). 

Clients can wear the Motivaider throughout their day, and practice slow deep breathing and cognitive restructuring.  It is a very powerful tool.

Subsequent Sessions:

Typically, my counseling work with clients involves around 10 therapy sessions.  However, I see some individuals for a much longer period of time.  In fact, I have been counseling one woman for over 20 years.  She was a victim of extreme sexual abuse as a child and suffers from paranoid schizophrenia.  My work with her has helped her to stay out of psychiatric hospitals for this entire time.  She is a wonderful Christian woman who has learned to trust me over time and I am her “sounding board” for reality.  She cannot talk to her husband as openly as she can talk to me.  She has gradually, over time, dropped the belief that her auditory and visual hallucinations are “real.”  We are even able to laugh at times about her “crazy” thinking.  She doesn’t fear the world nearly as much and, most importantly, she has learned to trust God.

Non-Christian Counseling Problems:

There are some problems that I deal with that do not involve a Christian framework—at least directly.  For example, I teach parents how to train their babies to sleep through the night.  I teach parents about ADHD and ways to handle behavioral problems (using behavior modification techniques).  I teach parents how to toilet train their children.  I teach parents how use timeout and other behavior modification techniques.

Also, when I deal with disorders such as panic disorder, I focus a lot on the fact that this is more a physical/brain problem than it is “lack of faith.”  I do a lot of teaching about the autonomic nervous system and how it works.  I normalize the problems so that clients don’t think they are going craze or losing their minds.

 

Case Studies

Case 1:  I recently saw a young boy named John, age 17, who presented with symptoms of ADHD and behavior problems at home.  He was a very diminutive young boy, who looked much younger than his actual age.  (If you are small in stature, and you are a boy, this creates major problems in school).  This young boy was adopted as a baby and was being raised by older Christian parents.  In effect, he was an “only child” as the biological children of the parents who adopted him were already adults and had moved out of the house.

Parents informed me that John was not getting along very well at the Christian school he was attending.  I had previously seen this young man when he was 12 years old because of problems with attention underperformance in school.  I had one of my associates, a school psychologist, give the boy a psycho-educational evaluation to determine the boy’s IQ and to identify any potential learning disabilities.  I had already administered the Behavior Assessment System for Children (BASC), interviewed the parents, and interviewed the child.  The BASC indicated the potential presence of ADHD, and my clinical judgment also aroused this suspicion.

The psycho-educational testing revealed that the young boy was functioning in the “Gifted” range of intellectual functioning (IQ=134).  Apart from his ADHD, there were no indications of any specific learning disabilities.  Unfortunately, ADHD combined with this young boy’s social awkwardness at being “small and baby-faced,” were a devastating combination in his school experience.

Although he was probably smarter than his teacher and certainly smarter than most of the kids in his class, he was unable to perform because of his difficulties paying attention and his distractibility.  He was also overactive and had difficult staying in his seat and following directions.  These problems can be all-the-more devastating when children with these conditions attend a Christian school—which can focus rigidly on rules, respect, paying attention, and following directions.

Not surprisingly, John had spent most of his days in school “getting into trouble” for breaking this or that rule.  If you weighed up the “positives” versus the “negatives” that her received, the ledger was definitely on the negative side.  Over the years, he withdrew from the teachers (who were mainly a source of punishment) and the other children (who made fun of him).  The only attention he got was for being the “class clown.” 

By the time John reached my office again at the age of 17, his fragile sense of self had been beaten down.  He viewed his teachers as punishing and God (represented by the teachers) as punishing.  He also had withdrawn from his family who, to some extent, were considered religious extremists.  He had announced to them that after he turned 18 and graduated, he would never go to church again.

At this point, I tested John using the Millon Adolsecent Clinic Interview (MACI) and found that he was suffering from Dysthymic Disorder.  One of the cardinal features of this disorder (as opposed to Major Depression), is “low self-esteem.”  It is difficult to feel good about yourself if people treat you like a “freak” because of the body God gave you, and “dumb” or “stupid,” because of the ADHD.

At this point in his life, my approach with him was not to lecture him or teach him about God’s love.  I simply “came along side” him and showed him care and concern for his situation.  Since I also have ADHD, it was easy to talk to him about the difficulties associated with this disorder.  The fact that I could reveal my own difficulties was refreshing to him and he didn’t feel so “alone.”  The fact that I was a “doctor” also gave him hope that he could some day overcome his problems and still be successful.

I also was able to identify with him with regards to his “looks.”  I assured him that I was a total “geek” when I was young and I wore glasses that were about ½ inch thick (which is true).  I did so many stupid things, I was well known in my school and neighborhood as being “absent minded.”  (The stigma carried on with me, even into my teaching years at Nova University).

Eventually, this young man was able to talk with me freely in counseling and we learned to laugh a lot about life.  I was able to help him put things in perspective, and I emphasized to him that he would soon be making decisions for his own life.  He started taking a psycho-stimulant, and started doing much better in school (academically).  I assured him that things would only get better and that he would do great in college (given how much intelligence God had given him).

I didn’t lecture him or quote Bible passages to him.  Scriptures had become aversive to him as they always pointed out what he was “not doing right.”  Instead of lecturing, I tried to show him God’s love and acceptance of him (even with his “differences”).  We bonded, and he started to see me as a “nice guy” who he could talk to and not be judged every second. 

In subsequent sessions, I worked with him on identifying what he wanted to major in when he went to college.  I kept looking “forward” with him, and assured him that his adolescent years would soon fade, and he would eventually grow out of “youthful” appearance.  Given his intelligence, we decided that something in information technology would be a good starting point for him in college. 

Over time, John’s depression started to lift.  He was now convinced that he was very intelligent and that he was going to be able to make his way in life.  He now had HOPE and a sense of future.  I believe that God put this young man in my path so that I could show him the kind of love unconditional love that God shows for us.  I did not have to beat him over the head with scriptures, I just had to live out the scriptures in my life.

Finally, if God did not use me for healing some of the hurts of this young man, I feel certain that he was well on his way to developing Avoidant Personality Disorder.  He had already “put up a shield” to protect himself from the hurt of others.  He never really felt safe from judgment.  With me, at least for a little while, he was able to put down the shield.  I pray that other people of God will also accept him without continual judgment.  (By the way, I have a sneaky feeling that this young man will get in touch with me when he goes to college this next fall).

(Dr. Campbell's Chapter on "Thinking" is not included in this Online Version)