Engaging Biblical Texts in Trauma Therapy

1. Engaging Biblical Texts in Trauma Therapy Interpreting Persons and Contexts While Promoting Interpersonal Healing Philip G. Monroe, PsyD Biblical Seminary pmonroe@biblical.edu 2009 AACC World Conference

2. www.biblical.edu

4. Complex PTSD (DESNOS) • AKA Disorders of Extreme Distress NOS:   • alterations in the regulation of affective impulses (e.g., difficulty with modulation of anger and self-destructive impulses) • alterations in attention and consciousness (e.g., amnesias and dissociative and depersonalization episodes) • alterations in self perception (e.g., chronic sense of guilt and responsibility as well as shame) • alterations in relationships with others (e.g., not being able to trust, not being able to feel intimate with people) • somatizating the problem (e.g., feeling symptoms on a somatic level without medical explanation) • alterations in systems of meaning (e.g., loss of meaning or distorted beliefs) (Some folks include a 7th characteristic: (alterations of perceptions of perpetrator(s).

5. Common trauma experiences • Intense fear, paralysis/helplessness, inability to effect any change, threat of annihilation, leading to experience of, • Loss of voice, control, connection, and meaning, resulting in, • Disorganized physical, cognitive, and emotional response system increasing, • Relational pain, distrust, self-contempt, overwhelming anxiety, evidenced as, • Running from the past, afraid of the future

6. Pause to consider: Just how does one go about building a therapeutic relationship when… All relational and therapeutic interactions will be read through the lens of danger—the danger of being abandoned or abused

7. The core problem is PAIN? • Original pain of abuse is the problem • Treatment? • Acknowledge pain • Work to release pain by • Taking control • Finding things to make you happy again • Problem with this view? • Pain is the result, not the cause…

8. The problem The way out • Powerlessness • Denial/distortion • Ambivalence • Contempt • Hypervigilance • Fixed relational style • Honest appraisal • A deep look within • Letting go of self-protection before God • Repenting of “refusals”: • To live; to trust; to feel passion • Loving others boldly One Christian Model

9. The core problem is SIN? • Sin done to the abused • What is the enemy? What are the factors that make past sexual abuse so shameful…? What must be done to lift the shroud of shame and contempt? The answer…: peer deeply into the wounded heart p. 14 • Sin done by the abused (faithlessness, refusal to be vulnerable) • If [the treatment] is to be biblical, it must insist that the image of God is central to developing a solid view of personality; that our sinfulness, not how we’ve been sinned against, is our biggest problem…p.10

10. Sin as problem, con’t • Okay so far. From a technical standpoint, Scripture seems to support this conclusion • We need to be rescued (the Exodus) • We need to be forgiven (the Cross) • So, what’s the problem? • Diagnostic focus on big picture misses the relational aspect of God’s meeting his children • Focus on what needs change rather than what is broken may unintentionally minimize the damage or the need to build healthy crisis responses • Misses the necessity for repetitive, relational work of rebuilding safety, trust, and truth

12. Using Scripture with clients? • Until recently we have had little to no guidelines for how best to use Scripture in the act and process of therapy • Instead, we’ve…

13. … • Argued over the relationship between psychology and the bible • Built biblical anthropologies • Explored how specific passages speak to particular problems • Rarely discussed bible reading as homework (comfort and reframe)

14. But we should! Christian counselors can and should use the Scriptures in counseling because: • We know where the power to change comes from • We ourselves are acquainted with them • We want to model a healthy use of the spiritual disciplines, including the use of the Bible • We want to connect hurting individuals to God

15. However, consider this… We shortchange Scripture when we use it only as a tool to • Teach, rebuke, correct • Discern • Comfort • Strengthen and encourage • Build hope • Does our use of Scripture help others meet God or learn more facts?

16. Thesis I argue that while comfort, encouragement, exhortation, hope-building, and teaching are all good things that Scripture supplies, we may miss its grand purpose of connecting individuals to God, if we: • focus on biblical anthropology (diagnostic) • focus on tools (treatment)

17. Begging the questions… • What is it about the counseling interchange that encourages change? • What role do the Scriptures play in human growth, development, change? • How might we become more effective in our use of Scripture in the therapeutic dialogue? • Role of truth-telling? • Role of experiential connection?

18. Guidelines for the Effective use of the Bible in Counseling • Edification, 2:2, 2008 (pp 53-61) • Without guidelines we may overestimate the value of Scriptural interventions • Disconnect is more likely • Future interventions may be hindered • If change is mediated through healing relationships then we must pursue a relational use of the Scriptures

19. Maturity The Christian Life

20. Guidelines, con’t • In the absence of empirically supported guidelines…pay attention to • Personal and professional competencies • Assessment • Client experience and understanding • Intended purpose (and later result) • Contextual matters • Impact on the therapeutic relationship • Informed consent

21. The Problem • Technical accuracy ≠ counseling strategy (exegesis ≠ application) • Idolatry of “getting to the bottom” of the heart? Misses other truths? • Diagnostic or tool approach to Scripture undermines its relational and dialogical fabric

22. Consider this criticism …evangelical preaching [use of the Bible?] underwrites the myth that the isolated self can transform its own self through its own rational powers with the help of the Spirit… David Fitch, The Great Giveaway, p. 133

23. Text as object? The text becomes an object in the hands of the preacher as it is broken down into three points to be given out as something the listener can use. Once the sermon is given, the text becomes an object to be consumed by the parishioner, who in turn listens, analyzes, takes notes, and goes out to be a doer of the information just heard, which consequently distances the listener from the text. p. 137, The Great Giveaway

24. And the problem is? As the…applications pile up and the parishioner loses ground week to week, ever hurrying to catch up with last Sunday’s application point, frustration is the result. p. 140, The Great Giveaway

25. This relates to counseling how? • Our stance and use of Scripture influences client disclosure. • Diagnostic or intervention uses may lead to either objectifying text or persons • Use of Scriptures in counseling should facilitate opportunities to deepen horizontal and vertical relationships • “…how the patient talks about events…depends on the relational context in which the events are described.” Paul Wachtel in Relational Psychotherapy, p. 18

26. Application • How do we connect adult survivors of sexual abuse to God via the Scriptures? • What are the common problems? • What are common clinical responses? • What truths/experiences do we think work well with those problems

27. True but therapeutic? • The sexually abused person often carries contempt as an antidote to the bite of pleasure (p. 65) • A sexually abused person often forfeits the experience of pain by a process of splitting, denial… (p. 104) • Distorted judgment is seen more often than not in the arena of relationships (p. 107) • Hypervigilance often masks a deep strain of suspiciousness. (p. 118) • Patterns of distorting facts and conclusions in one’s own mind lead eventually to the necessity of deceiving others. (p. 120)

28. How heard? • I’m even worse than I thought. • See I did create much, if not all, of my mess • So you’re saying I refuse to trust God? • I am rebellious, just like my father said I was • Why? Because survivors have difficulty contextualizing competing truths due to relational factors

29. What if… • The core problem of abuse is relational anxiety (which is painful and leads to sinful responses)? • We consider how God meets anxious people? • See works by Judith Hermann and Diane Langberg

30. Quick case study: Sara • 28 yo married woman, SS teacher • Sexual aversion for 3 years after difficulties starting on their honeymoon • History of sig. child sexual abuse • Strong Christian, fears being rejected by God because of fear • Sessions filled with both self-contempt and fear of counselor

31. Trauma therapy in context • Phase 1: stabilization • Phase 2: trauma processing* • Phase 3: Re-integration *Our focus today

32. Review the Guidelines • Personal competency • Counseling push/pull style personalities? • Response to pervasive core fears? • Assessment • Client experience (“voice” of Scripture?) • Intended purpose (and later result) • Contextual matters (how does she hear you?) • Impact on the therapeutic relationship

33. Sara meets Scriptures • Assessment • Fear of fear, fear of failure, fear of rejection by God and others • Obsessional reading of some passages: usually with condemnatory voice. “I shouldn’t be afraid. I shouldn’t withhold.” • Hears counselor insights as condemnation; believes counselor is “tired” of her • Wants to get to the bottom of things and demands Scripture reading in session

34. Sara meets the Scriptures • Intervention 1 • Brief description of plan to look at the “voice” of Jesus in Luke 11 and 12 • Reads Luke 12:4-32 • What voice do you hear? • Reads Luke 11:39-44 • What voice? Difference with ch. 12? • Whose voice sounded like that for you? • Mother? Father? First pastor? • What if you heard “little sheep…” with compassion? • Noticing the propensity for judgment • Anxiety described as judgment disorder • Use of here/now to explore fears of my judgment • Homework to journal on voice in 12:32

35. Sara meets the Scriptures • Intervention 2: HW to read John 4 • Jesus’ response to a known adulterer? • Notice his voice? Try it several different ways

36. Counselor evaluation time • Which truth is needed now? • Goals? Description first rather than evaluation • Description (and not judgment) leads to insight • Context and impact of interventions • Attend to the relational context/atmosphere • Build a foundation of trust when trust is scary by… • Simple words, transparency, integrity, and clear goals and • Avoid the diagnostic use of Scripture whenever possible until the foundation of God’s perspective on abuse is firm

37. For slides:www.wisecounsel.wordpress.com