The ideals which have always shone before me and filled me with joy are goodness, beauty, and truth. – Albert Einstein
In order to really understand, we need to listen, not reply. We need to listen long and attentively. In order to help anybody to open his heart we have to give him time, asking only a few questions, as carefully as possible in order to help him better explain his experience. – Paul Tournier
“Running With Scissors”, an adaptation of the memoir with the same title by Augusten Burrough is a film that begins with the separation of Burrough’s parents and his mother’s quasi-narcissistic and psychotic dysfunction. Burroughs’ mother sends him off to live with her psychiatrist, whose life and practice is personified by psyco-analytic psychology. The film is a weird combination of Wes Anderson (though he’s not the director) and barbiturates, literally and figuratively. The narrative flows and is functional, but the reality of the characters only really makes sense when one applies the intrinsic determinism of radical psycho-analytic psychology and its tenacious demand for interpreting everything to find “new meaning”. What results is a strange tale of brokenness, loss, and the need for tangible and meaningful connections in the world in which we live.
Deirdre, Augusten’s mother, fantasizes about becoming a famous poet throughout the film, which reveals a greater neurosis and narcissism in her blending reality with fiction. Rarely if ever, does she appear fully grounded in the present or able to identify the needs of others above and beyond her own aspirations. The film hits its climatic arc when Deidre and her husband, Norman, get a divorce and Augusten is sent off to live with Deidre’s eccentric psychiatrist, Dr. Finch.
Dr. Finch fully embodies an extreme version of psyco-analytic psychology as a kind of life philosophy and consequently those around him seem to have adopted it as well. Dr. Finch treats Deirdre’s fantasy as a real or true extension of her “reality.” He tells her, for example, that she is a very talented poet and needs to work on her art. Deirdre soaks it in, integrating Dr. Finch’s encouragement into a full fledged pursuit towards her fantasy, which at the same time means letting go of the “guardianship” of her son. There are several other important characters to the film’s plot, however for the sake of brevity this post will remain focused on the four characters already mentioned: Augusten, his mother (Deidre), his father (Norman) and the psychiatrist, Dr Finch.
The client is ultimately Deidra, however her son Augusten receives a kind of passive therapy indirectly imposed by Dr. Finch. As Deidra delves deeper into her work as a poet she develops another relationship with a fellow poet from a women’s poetry group that Deidre leads. This group seems less of a supportive system and more of a place for Deidra to share her “expertise”. We, the audience are not given many clues about the kinds of specific counsel or tools that Dr. Finch is offering Deidre in their counseling sessions. But we can infer from the clear indicators throughout the film that Deidre is presently in therapy and Dr. Finch is aware of whatever progress or digressions that are taking place. What is puzzling is the somewhat ironic abstract commentary the film conveys about the utter uselessness of psycho-analytic psychology. The viewer may find his or her head cocked to one side while asking the question: what the hell is going on? This question is less of an obvious consequence of a narrative hobbling it’s way through Freudian symbolism and more of a poignant bullet-to-the-heart shot at how meaningless life is without boundaries, rules, and meaning.
Because of this, the number of crossed boundaries and ethical violations on behalf of Dr. Finch are numerous. The norm seems to be whatever works goes, which means the social pragmatism of Dr. Finch doesn’t even acknowledge the need for rules or ethics. The question with this film is not where did Dr. Finch cross the line? The question is, does Dr. Finch have any sort of ethical system to which he subscribes? The only time we see Dr. Finch contradict Deidre is early in the film. Deidre as was complaining about her ex-husband and speaking harshly about him in front of Augusten. Dr. Finch bluntly and directly confronted her and told her to not instill fear in her son. She listened and responded by stopping what she was doing. Unfortunately this particular scene does not give us much as to what exactly Dr. Finch wants in the moment. Perhaps keeping the situation calm and preventing anxiety was his main concern or maybe he believed Deidre was truly harming her son in that moment.
Despite our culture’s cynicism for rules, truth, and boundaries, this movie demonstrates why these things are important. Relationships are built on more than random isolated connections with people. Something else is needed for true connection to take place. People need an inner sense of where they begin and end, a kind of inner solidarity with who they are in the world. This need is intrinsic to relationship building, trust, and honesty. Take these things away and we enter a slippery slope of not challenging the false constructs of reality that are sometimes created in our minds and hearts. Take these things away from the counselor-client relationship and the very foundation for improvement, change, and inner growth becomes slippery and indiscernible. I am reminded by this film’s message that relationships require work, sacrifice, selflessness, and solidarity.
In conclusion, a perfunctory glance at the film reveals a biographical story which is jolting to our sensibilities. However, one only need to watch Augusten to see if his living situation is truly conducive to meaningful relationships and sustainable connections with others. What is helpful about the film is its contrast to what the audience would identify as stability, rest, and contentment. Yet, it cannot be assumed that clients come from backgrounds where stability, rules, and boundaries function by the same standards as the counselor. However, the film indirectly suggests that one of the greatest questions that a therapist can ask a client is: “What is your story”?
The Body Keeps the Score: Brain, Mind, and Body In The Healing of Trauma written by Bessel van der Kolk systematically demonstrates for the reader why trauma research is valuable, particularly as it relates to the client-counselor relationship. Van der Kolk begins his book with a historical perspective: As a budding psychologist he recalls his experiences working with Vietnam veterans and their struggles with PTSD. His observations about the veterans and his curiosity about what causes the symptoms to manifest in the particular ways led him towards a career of helping trauma victims through research, applied neuroscience, and investigating modern psychological approaches to healing those with trauma.
Van der Kolk writes with surprising clarity and humility as he honestly shares his thoughts and concerns regarding his approach to counseling models. Providing a careful exploration into the science of trauma, Van der Kolk shares many stories and conversations he’s had with clients regarding their trauma which helps to underscore the credibility of each part in his book. The book is divided into 5 parts: (1) The Rediscovery of Trauma. (2) This is Your Brain on Trauma. (3) The Minds of Children. (4). The Imprint of Trauma. (5) Paths to Recovery. Additionally, the book has an Appendix entitled: Consensus Proposed Criteria For Developmental Trauma Disorder, which is then followed by a section devoted to resources and further reading.
Throughout his book, van der Kolk frequently references his experience in the medical field which is quite extensive. He is the founder and director of the Trauma Center in Brookline, Massachusetts, a professor of psychiatry at Boston University, and director of the National Complex Trauma Treatment Network. In The Body Keeps The Score, van der Kolk shares his life’s work with his readers and it is a worthwhile read for lay readers, students, and professors interested in the subject of trauma and psychology.
I read this book quickly, bouncing between reading the text and listening to the audio version (on occasion doing both), yet taking time to highlight and create notes. It’s such a dense book that I think I will have to go back and re-read it as some point. I found the content insightful and certainly feel that I know much more about the symptoms of trauma victims than I did before reading this book. However, I did find that content of the book disturbing at times, particularly as Van der Kolk recounts, at times, detailed accounts of trauma stories. Though the stories provide a contextual framework for the book, I think the next time I read it, I will take breaks between the sections to allow myself some breathing space.
My point is that books like The Body Keeps The Score have a great deal to offer the Christianity community, and visa-versa, but until the scientific community is willing to lift the prevailing weapon of relativism it wields against religion, there will remain a gap between religion and science that creates a vacuum and division between the two worlds of counseling practice (pastoral and professional).
However, I have been forever altered in the way I see trauma by reading The Body Keeps the Score, but it makes me sad to think that professional counseling claims science for it’s evidence and in the same breath also claims philosophy (social constructionism) for its explanation for religious diversity. It seems there must be a middle ground, a way to bring the two groups together without scandalizing truth in the process.
Reading the book has inspired me to continue my studies in trauma treatments, particularly EMDR, yet it has also inspired me to do research into why there seems to be such skepticism amongst Christians regarding psychological and mental health problems and solutions. As mentioned above, Christians are being told (culturally) that their faith is relative, which may explain some of the push-back Christians have when it comes to psychological explanations for things like anxiety and trauma. However, there also may be other things at play, such as a lack of education in modern psychology which differs quite a bit from Freudian psycho-analysis.
In The Body Keeps the Score, the reader is invited into a history of how trauma has been viewed and treated over the last fifty years, how trauma impacts the brain and mind, and is provided with a variety of treatments backed by scientific evidence for treating trauma. The book is filled with many helpful illustrations including brain scans, which are helpful to understand the author’s perspective and well thought-out conclusions about trauma and the inner working functions of the brain. It is textbook worthy and I look forward to returning to it for further insight and guidance as I move through my professional journey as a counselor and researcher.
Van Der Kolk, B. (2015). The body keeps the score: brain, mind, and body in the healing of trauma. NY: Penguin Books.
The American Psychological Association’s (APA) code of ethics focus on the medical model and the American Counseling Association’s (ACA) code of ethics has its focus on mental health in relation to the client’s wellbeing. Both ethical codes contain a preamble, a general description of the organization’s ethical principles, and ethical standards. However, there are subtle and blatant differences between these two documents. What follows in this paper is a comparison and contrast between the APA and ACA codes of ethics with a guided focus on answering the following question: How do these ethical codes address the significance of the client-counselor relationship?
“The APA Code of Ethics” (2010) is a document with a five part ethical principles section, lettered A – E, and are as follows: “Beneficence and nonmaleficence, fidelity and responsibility, integrity, justice, and respect for people’s rights and dignity” (p. 2). Notably in the APA these ethical principles are declared as unenforceable rules, but rather they are to serve as a guide “to guide psychologists toward the highest ideals of psychology” (p. 3). In contrast, the “ACA Code of Ethics” (2014) lists six ethical principles which are as follows: “autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity” (p. 3). However, these ethical principles are provided after a list of five values creating a “conceptual basis” for the ethical principles (p.3). The ACA code (2014) derives its ethical standards on its values and principles, stating: “These principles are the foundation for ethical behavior and decision making” (p. 3). While it may be a subtle distinction, it remains noteworthy that the APA utilizes the word “guide” while the ACA code uses the word “foundation” to describe the function of the ethical principles in relation to ethical decision making; as a way to approach the ethical standards themselves.
The reason the word “foundation” is of significance, especially in contrast to the word “guide” is the overall importance being established for the ethical standards themselves. The implication being, that the word “foundation” offers a concrete recognition that they values and ethical principles within the “ACA Code of Ethics” permeate the standards in such a way that their existence can in no way be separated from their intended social pragmatism. It is not that the ends justify the means, rather it is the means that inform the ends. The emphases on a foundational system of values and principles in the “ACA Code of Ethics” communicates an overarching theme of protecting the client and making sure the counselor is clear on how, as well as why, he or she should do so.
The emphases on the client in the “ACA Code of Ethics” is substantially greater than the “APA Code of Ethics.” For example, in the ACA ethical code the words client or clients is used 293 times, as opposed to the 67 times the same words are used in the “APA Code of Ethics”. The ethical standards of the “APA Code of Ethics” are truncated by a lack of particular values (as opposed to ethical principles) that center around the client. For example, when a search is conducted for the word “counseling” in the “APA Code of Ethics” the word is used 4 times, as opposed to the 157 times the “ACA Code of Ethics” refers to it.
The terminology differences are significant because they highlight two particular paths that in some regards parallel each-other, yet have differing ultimate purposes. The APA is focused primarily on Psychology (it’s study and implications), whereas the ACA is focused on counseling (the client-counselor relationship) with an added emphases on the client’s rights. To be more specific the APA is based on a medical model, whereas the ACA is based on a wellness model. This is important for recognizing the way each of the codes approach the client-counselor relationship. The “ACA Code of Ethics” (2010) deals with “the counseling relationship” in the first section of its code, which introduces the subject as priority, upfront (p. 4). The “APA Code of Ethics” places “ethical standards” as the first section of its code (p. 5). The obvious conceptual difference is the ACA code has a cohesive platform directing the counselor in its formatting of the codes towards a client-centered approach.
Contrasting Views on “Values”
A blatant difference between the codes of the APA and the ACA regards the role of values in the counseling or therapy relationship. Section A.4.b. of the “ACA Code of Ethics” (2010) states the following:
Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature (p. 5).
Additionally, in section A.11.b in the “ACA Code of Ethics” (2010) counselors are directed to only give give a referral if their lack of knowledge in a particular subject warrants the client to see someone with more expertise on the subject. The same section also deals with values in the following: “Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors” (p. 6). The “APA Code of Ethics” is silent on the issue of “imposing values” and simply does not address the issue of making a referral based on values that are inconsistent with the client’s values. The restrictive nature of imposing values in the counseling relationship as in the “APA Code of Ethics” once again reiterates and solidifies its position on safeguarding the client from harm, neglect, and discrimination.
In the “APA Code of Ethics” referrals, (Section 1.04, b) are appropriate when there is a lack of expertise. Both the ACA and the APA codes have non-discrimination clauses, however the “ACA Code of Ethics” presents the concept that if one were to do a referral simply because of a difference in values with the client, the act of the referral itself is discriminatory.
In conclusion, both the APA and the ACA have thorough codes of ethics, however they differ with respect to the kind of emphasis given on values and the degree to which the centricity of the client’s welfare should receive. They are similar with regards to protecting the process of therapy / counseling, however the strategic formatting differences in the codes themselves reveal a visionary difference. It may be observed that the ACA code reveals a relational approach to ethical values, principals, and standards whereas the APA code particularizes its focus on the role, function, and purposes of the psychologist.
American Counseling Association. (2014). ACA code of ethics. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf
American Psychological Association (2010). APA Code of Ethics. Retrieved from https://www.apa.org/ethics/code/principles.pdf
*This post has yet to be updated for APA formatting. It’s on my long list of improvements for this site.
This is an “I Am From Poem” written for an assignment in my multiculturalism class. It’s not Shakespeare, but it captures the purpose of the poem.
I Am From Poem
I am from Appalachian hills graced with Magnolias and Balsam trees,
Blue ridge mountains and forest green hued leaves,
Sun soaked lawn chairs and balmy summers,
Rambling black bears, white squirrels, and blue fireflies.
I am from a rural town—a retirement community,
A church on every corner,
Breakfast cafes, coffee bistros, and gift shops,
A family business specializing in jeweled adornment.
I am from segregated streets: rich, poor, black, and white,
Distinct tastes: sweet tea, apple pies, and peach cobblers,
Presbyterian, but not of the frozen chosen sort,
A conservative family, rooted in Christian values.
I am from college in the Tennessee rolling valleys,
Biblical studies, theology, philosophy of religion,
Greek and Hebrew.
I am from graduate school, brick laid streets of Maryland,
Plato, Hume, Kant, Melville, and Joyce.
I am from pipe tobacco and cigarettes,
Bread pudding and Guinness beer,
Moon lit, late night conversations,
Philosophical quandaries and ethical debates,
skinny dipping and camping.
nothing and everything
quietness and loudness
crisp mornings and starlit nights
anxious and calm
plenty and destitute
full of life and ripped hearts
life and death
I am to: hope for the broken hearted, healing for the wounded
The collaborative nature of counseling involves a specific kind of interaction, unique to the counseling relationship, where the client invites the counselor to participate in their life in such a way that the client feels understood and is empowered to make decisions for their life. It is the process of understanding their problem and engaging in the narrative of their life, where the client learns through collaboration ways in which he or she may view and interact with their problem differently. When a client chooses to engage a counselor in this particular kind of relationship, it is a privilege for the counselor to be the recipient of the client’s story, or a part of their story as it relates to their problem.
As a future counselor, the author of this blog post, desires to participate in this kind of counseling relationship for three reasons: Firstly, there is joy in experiencing freedom from personal narratives or problems that hinder, suppress, or entangle our humanity—as the author of this blog post has experienced from the perspective of a client. Secondly, a counselor has the opportunity to offer hope through the collaborative framework of counseling that is a form of communicative-action. The counselor by being actively engaged with the client through the form of asking questions, identifying themes, areas of growth or change, and by offering the client encouragement, the counselor is participating in actions that communicate hope for freedom and change to the client. Thirdly, the counselor participates in the collaborative relationship with a client as a selfless agent working to demonstrate and provide a safe environment for the client to explore their story or problem without fear of being judged. As someone who cares deeply for people, the author of this paper, also finds joy in being able to create such a context for those who are wounded and struggling—in need of a respite.
Human Nature: An Existential Dilemma
Human beings live in the context of a personal narrative (individual) within a greater narrative (corporate) such as a cultural or religious narrative. Yet, confusion and anxiety ebb and flow throughout individual narratives because of changes (external or internal) introduced into an individual’s narrative—resulting in a constant examination of the individual’s structure for their narrative, which consists of the following seven aspects: beliefs, desires, values, actions, lifestyle, identity, and purpose. However, human nature is broken, struggling to align its nature with a greater corporate narrative in which an individual is living. Psychological anxiety, therefore, is a natural result of this misalignment, but not a psychological state of wellbeing—as it is merely an indicator that misalignment exists within an individual. This misalignment may include both internal and external factors, which need exploration in the counseling process.
Therefore, some reasons for entering counseling may be (1) the need to process the interruption to one’s individual narrative (i.e. divorce or a death in the family); (2) think through alternative approaches to one’s personal narrative; (3) find emotional stability; (4) re-create a personal narrative by exploring one’s options and choices for different courses of action; (5) digest the emotions and desires from events that have shaped one’s personal narrative.
The constant examination of an individual’s narrative structure is perplexed by conflicting emotions and desires, which is a result of human nature resisting itself. Exhaustion, anxiety, apathy, dread, lostness, and confusion are natural experiences flowing from an existential misalignment created by disjointed personal and corporate narratives or a disjointed narrative structure. This state of existential misalignment invites questions regarding one’s purpose and identity (two of the seven aspects of narrative structure). For example, the Danish philosopher, Soren Kierkegaard, once wrote in his journal the following:
What I really lack is to be clear in my mind what I am to do, not what I am to know, except in so far as a certain knowledge must precede every action. The thing is to understand myself, to see what God really wishes me to do: the thing is to find a truth which is true for me, to find the idea for which I can live and die. (Dru & Kierkegaard, 2003, p. 44)
Aside from Kierkegaard’s quest for a particular kind of truth, he is trying to align his personal narrative within a corporate one, which in this case is religious. This truth, if he can find it, is something he hopes will give direction to his life (purpose) and at the same time is something that illuminates his passions (identity), or to put it another way—something that gives him life and understanding. Later in the journal entry, Kierkegaard concludes, “One must know oneself before knowing anything else (γνθι σεαυτον). It is only after a man has thus understood himself inwardly, and thus has seen his way, that life acquires peace and significance….” (Dru & Kierkegaard, 2003, p. 46). The ancient greek phrase Kierkegaard attached to his conclusion is the aphorism, “know thyself”.
Understanding one’s personal narrative and the seven structural aspects listed above, creates a context for the collaborative nature of counseling whether the immediate concern is a crises, an addiction, a significant life change, or some king life struggle. The counselor and client enter the journey together—setting goals together—seeking understanding of the client’s personal narrative for the betterment of the client’s well-being.
Counseling Models Applied
Though the problem a client brings to the counseling process may be existential in nature the counseling model applied to the situation may be chosen according to the client’s needs and preferences. Two models that are easily applied to existential problems having to do with a person’s personal narrative and its seven structural aspects are existential counseling and narrative counseling. However, just as diamonds are multi-faceted things, so are problems, in which case other counseling models may be needed, such as cognitive behavior therapy or rational emotive behavior therapy.
For the sake of brevity, the remainder of this paper will be devoted to exploring how the goals of narrative therapy and rational emotive behavior therapy may be applied to the existential view of human nature outlined above.
Corey (2017) describes the therapists of narrative therapy as facilitators, whose aim is to invite clients to share and describe their experience in new and fresh language.
In doing this, they open new vistas of what is possible. This new language enables clients to develop new meanings for problematic thoughts, feelings, and behaviors (Freedman & Combs, 1996). Narrative therapy almost always includes and awareness of the impact of various aspects of dominant culture on human life (Corey, 2017, p. 384).
One of several practical applications of this goal is the process of externalization whereby the client examines the problem as something that is separate from his or her self. Practically, this may be done through writing exercises or artistic expression. A study conducted by Keeling and Bermudez (2006) indicates that when 17 participates over the course of 4 weeks practiced externalization-intervention by journaling and sculpture, the intervention helped participants express emotions, increased their awareness of personal resources and agency, helped separate problems from self, decreased symptoms and problem behaviors, and fostered a sense of empowerment (Keeling and Bermudez, 2006, p. 405).
In the magazine Psychology Today, Sherry Hamby wrote an article exploring the health benefits of emotional autobiographical storytelling. Hamby makes the following observation in her article:
Emotional, autobiographical storytelling means writing about events and people that have mattered to you in your own life–not just describing the facts of your lives [sic]. Research shows that even brief autobiographical storytelling exercises can have substantial impacts on psychological and physical health even months after the storytelling (Hamby, 2013).
Within narrative therapy, practical exercises such as journaling and personal storytelling have a natural context for the client to explore and digest. These self-reflecting opportunities give the client an option for examining his or her assumptions and expectations for how he or she perceives how life ought to function. Existentially, the client through exploring their personal narrative is guided by thoughtful and engaging questions from the counselor, which helps the client consider different ways of viewing their problem.
Rational Emotive Behavior Therapy (REBT)
“REBT is based on the assumption that cognitions, emotions, and behaviors interact significantly and have a reciprocal cause-and-effect relationship” (Corey, 2017, p. 271). This assumption fits well within the existential view described above, especially when one’s cognitions, emotions, and behaviors are recognized as fundamental elements of a person’s personal narrative. Though one’s personal narrative is less emphasized, parts of its structure are being brought to the surface for further inspection. The the primary hypothesis of REBT is that our emotions are mainly created from our beliefs, which influence the evaluations and interpretations we make and fuel the reactions we have to life situations. Through the therapeutic process, clients are taught skills that give them tools to identify and dispute irrational beliefs that have been acquired and self-constructed and are now maintained by self-indoctrination (Corey, 2017, p. 272).
As noted above misalignment occurs because human nature is broken, struggling to align its personal narrative with the greater corporate narrative in which an individual is living. This is an important principle of the existential dilemma for REBT because it is within REBT that a person is challenged to let go of faulty beliefs contributing to his or her narrative misalignment. REBT, though still within the collaborative nature of the counseling process, like narrative therapy, however REBT differs in approach. It is more direct. “REBT relies heavily on thinking, disputing, debating, challenging, interpreting, explaining, and teaching. The most efficient way to bring about lasting emotional and behavior change is for clients to change their way of thinking” (Corey, 2017, p. 276).
Though REBT is not for everyone, it is an option for exploring one’s personal narrative in such a way that it brings to light beliefs that hinder living in a healthy way. For example, a person who believes they must achieve every activity with perfection may be challenged to evaluate how and why they approach life with such a belief. Within the context of a personal narrative, this same person may be able to identify former relationships that contributed to their believing that perfection in activities is the only option. Additionally, a personal narrative would also bring to attention situations in this persons life where their beliefs had impacted their expectations and assumptions of others.
In conclusion, an existential view of human nature that is both broken and personally misaligned from a greater corporate narrative has many variational counseling approaches at its disposal for working through emotional and cognitive problems. Of the models available to the counselor, the best option is the one that fits the client and not the other way around. Yet, narrative therapy and REBT offer methods that are comfortably integrated within the existential view of human nature presented in this blog post.
Corey, G. (2017). Theory and practice of counseling and psychotherapy. Boston, MA: Cengage Learning.
Dru, A., & Kierkegaard, S. (2003). The soul of Kierkegaard: selections from his Journal. Mineola, N.Y: Dover Publications.
Hamby, S. (2013, September 03). Resilience and … 4 Benefits For Sharing Your Story. Psychology Today.
Keeling, M. L., & Bermudez, M. (2006). EXTERNALIZING PROBLEMS THROUGH ART AND WRITING: EXPERIENCES OF PROCESS AND HELPFULNESS. Journal of Marital and Family Therapy, 32(4), 405-19.