Pastoral Counseling Boundaries

According to Parent (2005) the church has been held to a high standard of ethical decision-making and is governed by laws against anyone who intends to cause harm intentionally. Following the ACA code of ethics (2005) the responsibility of the counselor is to not harm the client, consider his or her welfare, and respect the counselee. Even the AACC Code of Ethics (2004) affirmed that the counselee was not to be harmed.

When it came to boundaries Stone et al., (2004) wrote a pastor’s identity can be tainted or destroyed when boundaries are crossed and unethical decisions are made. Not only does the pastor have to deal with these issues but also it can create shockwaves through the family of the pastor, the church, and the local community along with the greater international community of believers. This study explores the idea that the pastor is not only spiritual leader but also a human being. It helps to make the reader aware of prevention and clarity in the area of ethics. Clergy may serve in a non-profit location but is still not above the law. Malpractice has plagued the church as it has the private sector.

Fain (2011) pointed out that clergy have been accused of malpractice and many pastoral counselors have been called to court for negligence or having had caused harm to others. Not only has it destroyed any practice but it has destroyed entire Christian communities as well. In the article Fain provided a number of suggestions to keep pastoral counseling liability to a minimum.

According to Banks (2002) discipline has been a major topic crossing some boundaries with giving parental advice. Although childhood discipline is an important issue for parents, it is seldom emphasized. Behavior problems are relatively common but frequently under-recognized even by physicians. Opportunities to counsel parents about safe, effective methods of discipline are therefore missed. Discipline should be instructive and age-appropriate and should include positive reinforcement for good behavior. Punishment is only one aspect of discipline and in order to be effective it must be prompt, consistent, and fair. Time-out is frequently used to correct younger children, but because it is often enforced improperly it loses its effectiveness. Corporal punishment is a controversial but common form of discipline that is less effective than some other types of punishment. Its use is linked to child and spouse abuse, as well as to future substance use, violent crime, poor self-esteem, and depression. Despite the possible negative effects of corporal punishment, it is still widely accepted in our society.

References

American Association of Christian Counselors (AACC). (2004). AACC code of ethics: The Y2004 final code. Retrieved from http://www.aacc.net/about-us/code-of-ethics/

American Counseling Association (ACA). (2005). Code of ethics and standards of practice (Rev. ed.) Alexandria, VA. Retrieved from http://www.counseling.org/resources/codeofethics/TP/home/ct2.aspx

Banks, J. B. (2002). American family physician: childhood discipline: challenges for clinicians and parents. American Family Physician. 66(8), 1447-1453. Retrieved from http://www.aafp.org/afp/2002/1015/p1447.html

Fain, C. F. (2011). Minimizing liability for church-related counseling services: clergy malpractice and first amendment religion clauses. Akron Law Review, 44(1), 221-260. Retrieved from http://www.uakron.edu/dotAsset/1820629.pdf

Parent, M. S. (2006). Boundaries and roles in ministry counseling. American Journal of Pastoral Counseling, 8(2), 1-25. doi: 10.1300/J062v08n0201

Stone, H. W., Cross, D. R., Purvis, K. B., & Young, M. J. (2004). A study of church members during times of crisis. Pastoral Psychology, 52(5), 405-421. doi: 0031-2789/04/0500-0405/0 C

Pastoral Counseling Identity

The identity of pastors as counselors was explored as Greenwald and his associates (2004) interviewed and worked with almost seventy individuals representing twelve different denominations. The purpose of this study was to get a better understanding between the care a pastor provides for others as it relates or differentiates from counseling. Greenwald (2004) provided data to clarify the difference between pastoral counselors and professional counselors. Many pastors have needed to refer counsel leaves for long–term care needs because of an adequate training. Pastoral counselors have not been viewed as professionals due to the lack of proper clinical training and education (Firmin & Tedford, 2007).

Greenwald et al. (2004) suggested that pastoral counselors pursue professional training in order to establish credibility among the greater counseling community in mental health. The correlational pastoral counselors described theological reflection as emerging after analysis of each individual client and then compartmentalizing the information gathered into a structured framework of “scriptural metaphors” (Townsend, p. 35). Unlike the formational pastor counselors that lean more towards psychotherapy this group favored the theological interpretation of any clinical experience.

Mendenhall & Ronsheim (2006) observed a pastoral counselor’s formation could greatly impact the needs of the Christian community by bridging the gap between the professional counselors and pastoral counseling. Roles have changed over the years. Today’s pastoral counselors have become greatly impacted by post–modern thought and ideas in the us reshaped the pastoral counseling context from individual eyes focused to the community context. According to Mendenhall & Ronsheim (2006) new counseling models have been developed and incorporated in meeting today’s counseling needs. Park (2006) explored the historical development of pastoral counseling as it has pertained to future endeavors. It was discovered that teaching methodologies from a historical perspective would greatly impact pastoral counselors in the future.

Further pastoral counselors pursuing training must prepare for a multifaceted education while recognizing new trends of counseling and adapting them to their present context. They further point out that methodologies that were once focused on pursuing the sacred while maintaining balance between rational and scientific discoveries that have influenced and shaped today’s contextual culture must be taken into account. Pastoral counseling must be willing to maneuver through the cultural maze while still representing the sacred and religious rather than spiritual vitality (Mendenhall & Ronsheim, 2006).

According to Parker (2006) for any pastor looking to provide counseling for church members must understand that there are roles that referred to a pastor’s identity as a counselor and boundaries that are provided for their protection and security as a clergy. Integrity and wisdom and ethical issues were explored providing literature for those in ministry over and I’m above the seminary degree. Townsend (2006) turned to research to help explain the role of pastoral counselor by having had focused on the correlation between the formation and consideration of the pastoral counselors theological interest and education.

At some point the individual must learn that the role of pastoral counselor has included a merger of clinical theory, understanding one’s view of theology, and how that has influenced the development of the pastoral counselor. This according to Frick (2010) it has been determined by the setting the individual practice. For some time counseling was looked at as a clinical program. Over the years counseling has become an intricate part of ministry in the church. Pastors are no longer spending time preparing for messages or offering care to the congregation but now are looked at or required to counsel members when needed.

References

Firmin, M. W., & Tedford, M. (2007). An assessment of pastoral counseling courses in seminaries serving evangelical baptist students. Review of Religious Research, 48(4), 420-427. Retrieved from http://www.jstor.org/stable/20447460

Frick, E. (2010). Pastoral and psychotherapeutic counseling. Christian Bioethics: Non-ecumenical Studies in Medical Morality, 16(1), 30-47. doi: 10.1093/cb/cbq005

Greenwald, C. A., Greer, J. M., Gillespie, C. K., & Greer, T. V. (2004). A Study of the Identity of Pastoral Counselors. American Journal of Pastoral Counseling, 7(4), 51-69. doi: 10.1300/J062v7n04•04

Mendenhall, C. & Ronsheim, D. M. (2006). Expanding the Context of Care: Formation from the Inside Out and the Outside In. American Journal of Pastoral Counseling Volume 8, Issue 3-4. doi:10.1300/J062v08n03_15

Park, S. (2007). An Evolving History and Methodology of Pastoral Theology, Care, and Counseling. Journal of Spirituality in Mental Health, 9(1), 5. doi: 10.1300/J515v09n01•02

Townsend, L. (2006). Theological reflection and the formation of pastoral counselors. American Journal of Pastoral Counseling, 8(3/4), 29-46 doi: 10.1300/J062v08n03̱03

Pastoral Counseling Preparation

Pastoral Counseling Preparation

In a study conducted by Firmin & Tedford (2007) over thirty evangelical Baptist seminaries were surveyed on the amount of counseling courses required or offered as electives for Master of Divinity students preparing for pastoral ministry. Most required less than two classes of training but most seminaries offered only one. The article provided a table of seminaries divided by their denomination and program. As a seminary professor Elias (2006) worked to help change the lack of counseling courses provided for seminary students. The Apostle Paul’s model of pastoral influence and care for the church in Corinth greatly influenced the development of a course offered at the seminary level.

Part of a pastor’s preparation has included self-reflection. Nolte & Dreyer (2010) explored the life of Henri Nouwen and the contributions that were made in the development of pastoral care. Part of the process of preparation has included an aspect of the pastor’s own life and how “woundedness” (p. 1) becomes part of the pastoral counselor’s formation. For now the diagnostic pastoral counselor must rely on the DSM-IV and interpret findings within the context of church setting (p. 37). This can only be accomplished if the individual understood what pastoral counseling formation entails.

Townsend (2006) defined “formation” as a framework that pastoral counselors created for themselves through experience that organized the counselor’s perceptual field and cognitive–emotional interpretive frameworks (p. 31). Townsend (2006) reported that constant comparative analysis uncovered a model that pastoral counselors used, thus correlating theological reflection and formation (p. 33). Though many of the participants unsuccessfully explained the exact model of theological reflection that was used, microanalysis determined several approaches to theological reflection: Formational Approach, Correlational Approach, Diagnostic Approach, Feminist and Liberative Models (Townsend, 2006).

The Virginia Institute of Pastoral Care (VIPCare) provided formation as an endeavor that might possibly last the pastor counselor’s life (Hill et al., 2006). Counseling theories are seen through the formation of models at the Virginia Institute of pastoral care. This institution has created a program that helps clinical pastorals using education. In addition, it prepares pastors for most chaplain services in either hospital settings or within the church.

VIPCare developed a model that has incorporated supervised training better known as Clinical Pastoral Education, C.P.E. (Hill et al., 2006). It’s training provides caregivers with the proper education to interact with those in hospitals, hospice care, military environments, just to name a few. This program helps individuals learn how to work alongside those from other cultures and other religious beliefs. As long as one’s belief does not cause harm of others. Some sort of book is at the center of most major religions. For the Christian, the Holy Bible provides inspiration and help for those in need. It is a source of hope for many who read it. It is valuable to counselors as they provide care for those in need.

C.P.E. is an interfaith program that helps prepare those called to some ministry role. It is designed to help facilitate and teach individuals with previous religious education. It is a professional program with real-life interaction between those in need of help and those giving help in a supervised environment. It also helps make the connection between spiritual and pastoral care. This program has provided those seeking to provide continuing education as part of the pastoral counselors formation where academic critics may be applied to one’s degree or certification (Hill et al., 2006).

This type of program has been geared for students interested in a ministry focused on counseling and caring for others (Hill at all, 2006). The goal is not an intellectual one but rather part in preparation in developing the pastoral counselors formational process (Hill et al., 2006). Each formation was specific to each individual and the author stressed that it could not be generalized. This self-assessment was reported to be an essential aspect of the psychotherapeutic process of being a pastoral counselor.

References

Elias, J. W. (2006). From a distance: pastoral care and theological education. Teaching Theology & Religion, 9(1), 44-52. doi: 10.1111/j.1467-9647.2006.00260.x

Firmin, M. W., & Tedford, M. (2007). An assessment of pastoral counseling courses in seminaries serving evangelical baptist students. Review of Religious Research, 48(4), 420-427. Retrieved from http://www.jstor.org/stable/20447460

Hill, H. R., Slemp, D. C., & Maloy, W. V. (2006). A model of formation: the Virginia institute of pastoral care. American Journal of Pastoral Counseling, 8(3/4), 197-207. doi: 10.1300/J062v08n03̱14

Nolte, S. P., & Dreyer, Y. (2010). The paradox of being a wounded healer: henri j.m. nouwen’s contribution to pastoral theology. Hervormde Teologiese Studies, 66(2), 1-8. doi: 10.4102/hts.v66i2.861

Townsend, L. (2006). Theological reflection and the formation of pastoral counselors. American Journal of Pastoral Counseling, 8(3/4), 29-46 doi: 10.1300/J062v08n03̱03

Pastoral Counseling Context

He comforts us in all our troubles so that we can comfort others. When they are troubled, we will be able to give them the same comfort God has given us. NLT – 2 Corinthians 1:4

Abstract

The Christian community has become known as a place where people need help. It has therefore become a place of potential counselees who may have long–term needs but look to the pastor who, if properly trained, is able to provide the most effective counsel available in the local church. This blog will explore how pastors prepare for counseling the congregation. It will explore if seminaries are providing the essential courses needed for preparing the pastor for a pastoral counseling ministry. Without seminary preparation the pastor counselor is left to learn how to care for those in crisis through experience alone. This blog’s purpose is to address pastoral needs for pastoral counselor in the local church. Subjects of discussion will be pastoral counseling context, preparation, formation, identity, and role while also taking a look at the boundaries pastoral counselors need to be aware of.

Pastoral Counseling Context

Everyone goes through crisis at some point. However this study explored a local church and worked with twenty-six individuals who had dealt with specific times of crisis. There is a need to define a crisis as it pertains to church members and also identified that a social support system is present and active in the local church. In addition, it provided for coping mechanisms and is analyzed the experiences and measured the responses (Townsend, 2006). A well-used counseling source has been used by the church is as Fletcher (2005) presented in response to Pamela Cooper–White’s book called Shared Wisdom. This article (2006) represented the presentation from the American Academy and explored an understanding or insight on how large groups interact with pastors and church consultants.

The importance of pastoral counseling to be grounded biblically enables the pastoral counseling to meet the needs of crisis within the congregation by providing spiritual guidance. Pastors provide available care when needed twenty-four hours a day and seven days a week. The local church would benefit from an article like this to help clarify or better define whom a pastoral counselor is and what the individual has to offer. It would also help the congregation better understand the boundaries and roles of the church staff.

Christians anticipate help from the pastor during times of need (Stone, et al., 2004). The pastor represents God in many if not all cases of care. Stone et al. (2004) recognized that there has been two aspects/degrees of a crisis “developmental and situational” (p. 406). According to Greenwald et al. (2004) many people have sought out pastors because they are not usually considered part of the mental health system and unlikely to diagnose the disorder in other words diagnose an individual with a mental illness. Greenwald et al., (2004) pointed out that nearly 90% of pastors used experience to counsel others. In other words just 10% of pastoral counselors surveyed were professionally trained to counsel.

In a study conducted by Stone et al. (2004) on a congregation that experienced “times of crisis” (p. 405) found that the spiritual dimension was as important emotional and physical aspects during times of crisis. Many of those who participated in the study were greatly impacted by the pastors who empathized along with those in need having had shared similar experiences (Stone et al., 2004). The study concluded that any training in “crisis intervention” (p. 420) would dramatically influence the ministry’s effectiveness.

Many in the Christian community may feel as if they needed to change something in their lives or escape the problems faced. Possibly wanting to please God much like pleasing one’s own parent that created a low self-image. They may find the church a place where they can learn to let go and allow God to fill them with his presence. The pastor counselor has served as a reminder of God and his love for his children. Understanding God’s love is one thing but accepting his grace is another. Many may feel spiritually stuck and ineffective in their interaction with others. The pastor counselor has the opportunity to provide help when all hope is lost and God feels far away.

References

Fletcher, W. (2006). Countertransference and Large Group Dynamics in the church: Reflections on Pamela Cooper-White’s, Shared wisdom: Use of the self in pastoral care and counseling. Pastoral Psychology, 55(2), 205-211. doi: 10.1007/s11089-006-0038-x

Greenwald, C. A., Greer, J. M., Gillespie, C. K., & Greer, T. V. (2004). A Study of the Identity of Pastoral Counselors. American Journal of Pastoral Counseling, 7(4), 51-69. doi: 10.1300/J062v7n04•04

Stone, H. W., Cross, D. R., Purvis, K. B., & Young, M. J. (2004). A study of church members during times of crisis. Pastoral Psychology, 52(5), 405-421. doi: 0031-2789/04/0500-0405/0 C

Townsend, L. (2006). Theological reflection and the formation of pastoral counselors. American Journal of Pastoral Counseling, 8(3/4), 29-46 doi: 10.1300/J062v08n03̱03

PTSD Conclusion

Conclusion

This blog discussed PTSD and how it affects Veterans who have suffered trauma. In this blog, PTSD was defined, symptoms were addressed, and proper treatment discussed. There is no easy fix for those who will likely deal with it the rest of his or her life. There are different theories of treatment; no one treatment will work for every Veteran. PTSD was brought to light through media exposure of the returning Veterans from the Iraq (Operation Iraqi Freedom—O.I.F.) and Afghanistan (Operation Enduring Freedom—O.E.F.) wars, but it is The Department of Veterans leading the way in treatment for post-traumatic stress. Researchers continue to research the areas of the brain that are most affected by post-traumatic stress and will continue their research as the number of Veterans suffering with it increases. The findings in this blog have indicated, that more research is needed in both understanding how the brain responds to trauma and that medical treatment along with behavioral treatment further improves the lives of Veterans and their families. With all things discussed in this paper and evidences provided, it seems that as of yet, Cognitive/Behavioral Therapy is the treatment program of choice, but could be improved when it is grounded in Scripture. For now though, it is the most effective treatment for Veterans with post-traumatic stress.

Treatment for PTSD

Treatment for PTSD

The Veteran was taught responsibility at the beginning of Basic Combat Training. Every new recruit quickly learned to take care of things or pay a painful price. Being off active duty with PTSD, the Veteran must take the responsibility to seek help. Not only for his or her own interests, but he or she owe it to the family to ask for help. “A goal of crisis counseling, as you will see, is to help the person in need accept and take responsibility.”[1] The VA is willing to help as many Veterans as it can. “The VA has been a leader in promoting quality care in the United States. The VA’s National Center for PTSD has been a recognized national leader in conducting research and promoting appropriate treatment for veterans suffering from PTSD.”[2] The VA is doing all it can to screen Veterans. Veterans will benefit from early screenings. “… even the most efficient system cannot assist those who do not seek help. The military is taking steps to overcome one of its greatest obstacles in the diagnosis and treatment of PTSD: identifying and breaking down the stigma associated with mental health wounds.”[3] Every human being will need help at some point in life. No one can deal with life alone. One individual cannot fight a war alone, that same principle applies to the mental war veterans must face.

One of the most effective ways to treat PTSD is by focusing on the Veterans thinking process and behavior. “Effective treatments already exist, and these include both cognitive and behavioral…”[4] It is successful because it focuses on the individual’s needs and provides treatment specifically suited for that person. “Cognitive-behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD.”[5] However, Veterans needing help will receive the some sort of therapy that works best for his or her needs. No treatment is effective without the individual’s willingness to get better. Finding a treatment that works for the individual takes time and trust between counselor and counselee. “Cognitive behavioral therapy helps a patient understand the traumatic event they witnessed.”[6] This process has yet to come in pill form and until that happens, patient and caregiver must be committed to the process.

There is no short cut to recovery; it is a long-term endeavor. It will take time. Just how much time will differ with each Veteran. “Therapists typically work with clients on their PTSD over a three-to-six-month period of time.”[7] As the VA makes advances in research and treatment, it must find ways to help the Veteran cope with the demands of living with PTSD. Currently, there are only so many sessions provided for care, but with more research that number could change. “The treatment program is 12 to 16 sessions long, with one-hour sessions conducted weekly until the last several sessions, which maybe conducted biweekly.”[8] With more money invested in the VA by the federal government and other organizations the care provided might change.

One factor to consider when counseling Veterans with post-traumatic stress is that they are not a number or problem needing to be fixed, but rather a person needing help. Once that is established, the counselor is able to start helping, but he or she cannot do all the work. The veteran must participate. The Veteran must commit to the process of finding an effective treatment. Participation is key to recovery. “Effective treatments exist, and these include both cognitive and behavioral, mainly exposure-based treatments.”[9] These treatments will be used until new research is discovered.

For many Veterans returning from war may find it difficult to assimilate back into society. When they are ready, they will reap the benefits of care provided for them in the long process of recovery. For Veterans seeking help, will eventually find a counselor he or she trust and that will significantly increase his or her success of recovery. “… a behavioral method involving clear and concrete goal setting is an initial clinical strategy of choice because of its ease of administration through an interpreter, general effectiveness, and aims toward activities that integrate the person into his or her community.”[10] Part of the recovery process, includes help and support from family and friends. Although the Veteran may perceive a sense of helpless, there is hope for the veteran and the family.

The VA is doing all it can do to make the transition easier for the Veteran. However, it is a slow process. It is extremely difficult for a Veteran to adjust to the demands of war and even tougher road for the family. The difference between an individual who suffers from “chronic combat stress” and those individuals dealing with other types of chronic stress is his or her perspective of the stress experienced. As the Veteran fights his or her battle within, the family must endure with them. “Angry words demoralize and embarrass both the speaker and the listener. Words that belittle, accuse, or nitpick will damage your family relationships.”[11] The entire family, including the Veteran, must learn to adapt. They must learn news way to cope with the changes.

Faith of some sort may be one of the best ways to deal stress. “Religion and spirituality” may benefit those who have experienced stress in combat and those who have experienced trauma in other areas of life. It is a major factor that the US military and the VA guarantees an individual’s First Amendment rights to practice what they believe in whatever faith group/denomination they belong to. “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof …”[12] In order to this freedom, the US military along with The Department of Veterans provide chaplains to help in time of need. Chaplains provide support and opportunities for servicemen and in women in the military and for veterans in the VA.

The federal government is committed to helping Veterans recover by providing necessary factors that contribute to his or her recovery. “Religion and spirituality may provide a framework by which many survivors of trauma construct a meaningful account of their experience and seek solace, and may provide a useful focus for intervention with trauma survivors.”[13] A few years after the birth of this nation, Congress had passed the Bill of Rights that included a number of amendments to protect the liberties of the American experience. “Freedom of religion” is one of the first guarantees of freedom.

Religion and Spirituality

The First Amendment provides certain rights for each person to practice what they believe. As long as that belief does not cause harm of others. Some sort of book is at the center of most major religions. For the Christian, the Holy Bible provides inspiration and help for those in need. It is a source of hope for many who read it. It is valuable to counselors as they provide care for those in need. “The terms “religious” and “spiritual” are both used in the clinical literature to refer to beliefs and practices to which individuals may turn for support following a traumatic event.”[14] According to the VA, they support an individual’s right to have some sort of religious practice. They encourage veterans in their decision to look to a spiritual or religious practice as a viable aspect of one’s recovery.

There are many options for a veteran to inquire about and is highly encouraged to take advantage of the available sources and individuals to help them deal with PTSD. “U.S. military personnel have several options when seeking help for mental health problems, including U.S. military chaplains, mental health practitioners embedded in operational units, counseling offered in community service programs, mental health services provided by Military Treatment Facilities (MTFs) within both specialty mental health and primary care settings.”[15] The VA provides not only medical care that would include doctors of medicine and even psychiatrists, but also offers services for mental health, chaplains, and any other organizations to help the individual. “There is a large body of anecdotal literature documenting the propensity of individuals to seek religious/spiritual comfort following a traumatic event.”[16]

The terrorist attacks of September 11, 2001 provide a recent instance of this phenomenon. “Although feelings need to be recognized and acknowledged, they are basically a product of your thinking, and they can be controlled.”[17] (Romans 12:2) Hunt “If you dwell on negative thoughts, you can turn almost anything, even good circumstances, into stress.”[18] (Philippians 4:8-9) Hunt notes, “Stress can increase your ability to endure. However, excessive pressure can break you. God, knowing you intimately, does not allow pressure beyond what you can bear. But your response is critical.”[19] Help is available to help Veterans, but ultimately it is up to the individual to seek it our. “Every crisis will carry a challenging choice. You can choose to persevere and be changed (because of love for God and for others), or you can choose to seek a way of escape.”[20] Biblically, God has demonstrated that He is able to change an individual by focusing on their heart. However, veterans must allow for it to be changed. Much of the military life requires an individual to use his or her intellect to survive on the battlefield, but recovery will require more from the heart and less on the mental processes.

Scripture Can Help

Eyrich and Hines propose, “…how indispensable Scripture is to the counseling process.”

Here is the list:

  • The Word of God is illuminating – Psalm 119:105; 130; 133; 2 Peter 1:19; 1 John 2:8.
  • The Word of God is inspired – Nehemiah 9:13; Acts 1:15; Romans 1:2; 1 Corinthians 4:35; Galatians 1:11; 1 Thessalonians 2:13; 2 Timothy 3:16; 1 Peter 1:10–12; 2 Peter 1:2–21.
  • The Word of God is instructive – Psalm 119:24, 169; Romans 15:4.
  • The Word of God is powerful – Jeremiah 23:29; Ephesians 6:17; 2 Timothy 2:8; Hebrews 4:12.
  • The Word of God is revelation – Exodus 24:4; Jeremiah 30:2; 45:1–2; Habakkuk 2:2; John 20:30; Revelation 22:18.
  • The Word of God is reliable – 1 Kings 8:56; Psalm 19:9; 105:19; Proverbs 22:19; Luke 24:44.
  • The Word of God is a safeguard – Psalm 17:4; 119:9, 11; Proverbs 3:5–6.
  • The Word of God is truth – Matthew 15:1–3; Mark 7:7–13; John 5:46–47; Acts 18:28; 28:23.
  • The Word of God is true – Psalm 33:4; 119:43, 151; Proverbs 22:20; John 17:7; Colossians 1:3–6; 2 Timothy 3:15; Revelation 19:9, 21:5.
  • The Word of God is trustworthy – Psalm 19:7; 111:7; 119:138; Revelation 22:6.[21]

Prevention

Dattilio and Freeman stated, “A goal in crisis intervention is to actively help the patient to respond to the specific negativistic perceptions or beliefs that contributed to the crisis. … This involves several steps:

  • identifying and labeling the negative emotion
  • identifying thoughts or events that triggered this feeling
  • identifying automatic thoughts that are maintaining this emotional state
  • having the patient recognize the central importance of this perception or belief
  • collecting evidence that is inconsistent with this belief
  • identifying the most persuasive evidence against the belief or perception
  • developing an alternative, more adaptive, conceptualization of the triggering event
  • assisting patients to see how their mood would shift if they were to accept this alternative viewpoint
  • developing a behavioral plan for using this information to cope with the situation.[22]

The simplest reminders can make the biggest impact. “When you first begin to experience shallow, rapid breathing … produces classic symptoms of a panic attack … as a warning signal. Using the following techniques can stop these symptoms:

  • Take slow deep, deep breaths and hold the air in your lungs for a number of seconds. Then slowly release the air.
  • Place the open end of a paper bag around your nose and mouth. Breathe normally into the bag, being sure to breathe in the same air being expelled.
  • Place a blanket or sheet totally over your head. Doing so will increase the amount of carbon dioxide being taken into your lungs and ward off the frightening symptoms produced by too little carbon dioxide in your blood.[23]

In order for true healing to take place, the Veteran must trust his or her heart. “For the sort of change to take place that is pleasing to God and has the power to truly change a person there must be a change of heart.”[24] It may be safe to say that the Veteran leaves one battle zone on active duty and to another as he or she becomes a Veteran. Exposure to war creates traumatic stress, but constant worry creates stress: either way it is still stress.

How to Rid Your Life of Worry:

  • Desire to be free of all that chokes out the will of God. (Psalm 40:8; Psalm 51:4; Mark 8:34–36; Philippians 2:13; Mark 4:19)
  • Recognize God’s presence in your life. (Colossians 3:4; Romans 8:38–39; Philippians 4:19; Isaiah 41:10; Psalm 18:2)
  • Eliminate the worry producing can’ts, should’s, must’s and have to’s. (Psalm 13:2)
  • See your worry producing situations as opportunities for character building (Philippians 1:6)
  • Cultivate contentment with prayer. (Luke 18:1; Philippians 4:11–13)
  • Thank God for … (Psalm 34:18)
  • Nourish your body with the right physical activities. (Psalm 127:2)
  • Nurture your mind with spiritual music(Psalm 28:7)
  • Commit to doing the following every day for the next four weeks:
  • Focus on living in the present—not in the past or future. (James 4:13–15)
  • Emulate the godly example of people you know. (Proverbs 13:20)
  • Ask God to direct you in performing at least one unexpected act of kindness.(Matthew 7:12)
  • Believe His promise—you have the peace of God surrounding you and the God of peace within you.(John 14:27; Matthew 6:34; Jeremiah 17:7–8).[25]

[1] H. Norman Wright. The New Guide to Crisis & Trauma Counseling (Kindle Locations 197-198). Kindle Edition.

[2] Terri Tanielian, Lisa H. Jaycox, Terry L. Schell, Grant N. Marshall, M. Audrey Burnam, Christine Eibner, Benjamin R. Karney, Lisa S. Meredith, Jeanne S. Ringel and Mary E. Vaiana. Invisible Wounds of War: Summary and Recommendations for Addressing Psychological and Cognitive Injuries. (Santa Monica, CA: RAND) Corporation, 2008): 4. http://www.rand.org/pubs/monographs/MG720z

[3] McGrane, Madeline. “Post-Traumatic Stress Disorder in the Military: The Need for Legislative Improvement of Mental Health Care for Veterans of Operation Iraqi Freedom and Operation Enduring Freedom.” Journal of Law & Health 24, no. 1 (2011):, 205.

[4] Nicholas Tarrier. “The Cognitive and Behavioral Treatment of Ptsd, What Is Known and What Is Known to Be Unknown: How Not to Fall into the Practice Gap.” Clinical Psychology: Science & Practice 17, no. 2 (2010): 140.

[5] Jessica Hamblen, Treatment of PTSD, NAT’L CTR. FOR PTSD, 1, http://www.ptsd.va.gov/public/pages/treatment-ptsd.asp

[6] McGrane. “Post-Traumatic Stress Disorder in the Military”,183-215.

[7] Monica Descamps, et al. “A Cognitive-Behavioral Treatment Program for Posttraumatic Stress Disorder in Persons with Severe Mental Illness.” American Journal Of Psychiatric Rehabilitation 7, no. 2 (May 2004): 119.

[8] Ibid., 120.

[9] Tarrier. “The Cognitive and Behavioral Treatment.” 134.

[10] Tarrier. “The Cognitive and Behavioral Treatment.” 138.

[11] Payleitner, Jay K. 52 Things Kids Need from a Dad: What Fathers Can Do to Make a Lifelong Difference. (Kindle Edition): 107.

            [12] U.S. National Archives & Records Administration. Amendment I. (College Park: MD, 1791). http://www.archives.gov/exhibits/charters/bill_of_rights_transcript.htmla

[13] The Working Group VA/DOD. 50.

[14] Ibid., 50.

[15] Tanielian, Invisible Wounds of War, 22.

            [16] The Working Group VA/DoD, 172.

[17] June Hunt, Biblical Counseling Keys on Stress Management: Beating Burnout Before It Beats You (Dallas, TX: Hope For The Heart, 2008), 3.

[18] Ibid., 2.

[19] Ibid., 2.

[20] Ibid., 4.

[21] Howard Eyrich and William Hines. Curing the Heart: A Model for Biblical Counseling. (Ross-shire, UK: Christian Focus, 2002): 40-41.

[22] Dattilio and Freeman. Cognitive-Behavioral Strategies 2-53.

            [23] Hunt, J. Biblical Counseling Keys on Fear: No Longer Afraid. (Dallas, TX: Hope For The Heart, 2008): 4.

[24] Eyrich, Curing the Heart: 45.

            [25] Hunt, J. Biblical Counseling Keys on Worry: The Joy Stealer. Dallas, TX: Hope For The Heart, 2008.

 

Symptoms of PTSD

Symptoms

Veterans returning home need help from his or her loved ones, learn to ask for help from available sources, and participate in recovery treatment.[1] Back in civilian life, Veterans may find it extremely difficult returning home. PTSD, a disorder characterized by symptoms of excessive drinking, inability to sleep, being awoken by nightmares of reoccurring events experienced, or acts of violence towards family and friends.[2] For many Veterans who have returned from war, have found it difficult to assimilate back into civilian life. “Most service members return from deployment without problems and successfully readjust to ongoing military employment or work in civilian settings.”[3] Unfortunately, those are few and far between. The VA is doing all it can do to increase that number. Here is a list of possible symptoms they look for when diagnosing veterans.

Some symptoms to watch out for include:

  • Recurring thoughts, mental images, or nightmares about the event
  • Having trouble sleeping
  • Changes in appetite
  • Experiencing anxiety and fear, especially when exposed to events or situations reminiscent of the trauma
  • Feeling on edge, being easily startled, or becoming overly alert
  • Feeling depressed or sad and having low energy
  • Experiencing memory problems, including difficulty in remembering aspects of the trauma
  • Feeling “scattered” and unable to focus on work or daily activities
  • Having difficulty making decisions
  • Feeling irritable, easily agitated, or angry and resentful
  • Feeling emotionally “numb,” withdrawn, disconnected, or different from others
  • Spontaneously crying, feeling a sense of despair and hopelessness
  • Feeling extremely protective of, or fearful for, the safety of loved ones
  • Not being able to face certain aspects of the trauma and avoiding activities, places, or even people that remind you of the event.[4]

Mental

The Veteran’s family has learned to become self–sufficient while the individual was away off to war, but find it difficult to live with those suffering for these symptoms. The world they once knew before deploying to war, have become foreign to them. One of the reasons for this is that the Veteran, once part of a team with a purpose, now must face the reality of living with a new enemy: PTSD. It is extremely important for Veterans to feel as if they are still part of a team, whether that is part of a family, community, or Veteran associations. Some Veterans “… return with mental health conditions such as post-traumatic stress disorder or major depression, and some have suffered a traumatic brain injury, such as a concussion, leaving a portion of sufferers with cognitive impairments.”[5] If the Veteran does not learn to reach out then those around him or her then others will be unsuccessful at reaching in to the individual’s life and help them transition back to civilian life. The Baker Encyclopedia of Psychology & Counseling states, “For some individuals, dissociation may occur; they become amnestic about the feelings and memories of the trauma. They also feel anger toward those who were responsible for the events, ashamed of their feelings of helplessness, and guilty about what they did or failed to do.”[6] It took the Veteran months, even years, to train for military service. Now it will take even longer to train for battle against PTSD.

Emotional

The difficulty with transitioning back to civilian life has little to do with what others see on the surface and more to do underneath it. The journey back to recovery will be a process of maneuvering emotional obstacles set before the Veteran. “Previous research has demonstrated significant impairments in daily lives, as well as linkages with suicide, homelessness, and substance abuse, even when a mental disorder is not diagnosed.”[7] “Thus, it is important to consider the full spectrum of issues related to how the OEF/OIF veterans are transitioning back into home life and how they will fare in the years to come.”[8] Such things as “suicide, homelessness, and substance abuse” are effects caused by a deep-rooted issue.

Recovery is a process that the Veteran must endure. Others can help treat the symptoms, but the individual must discover that deep-rooted issue and learn to live with it. Rarely does one find a Veteran willing to talk about what he or she experienced during war unless they find an individual or group of Veterans who have been where he or she have been before. Not only is it rare, but also almost impossible to find one that has no problems. “An individual, couple or family coming for counseling needs to know that you care about them. You demonstrate this by your warmth, understanding, acceptance and belief in their ability to change and mature.”[9] It’s a good practice to treat Veterans as people and not another statistic.

[1] Finley, Erin P. Fields of combat: understanding PTSD among veterans of Iraq and Afghanistan. (New York: Cornell University, 2011): 157.

[2] Ibid., 1.

[3] Terri Tanielian, Lisa H. Jaycox, Terry L. Schell, Grant N. Marshall, M. Audrey Burnam, Christine Eibner, Benjamin R. Karney, Lisa S. Meredith, Jeanne S. Ringel and Mary E. Vaiana. Invisible Wounds of War: Summary and Recommendations for Addressing Psychological and Cognitive Injuries. (Santa Monica, CA: RAND) Corporation, 2008):  29. http://www.rand.org/pubs/monographs/MG720z

[4] The Working Group VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. (Washington D.C. 2010): 21.

[5] Tanielian, Invisible Wounds of War 29.

[6] David G. Benner and Peter C. Hill, Baker Encyclopedia of Psychology & Counseling. (Grand Rapids, Mich.: Baker Books, 1999), 890.

[7] Ibid., 890.

[8] Tanielian, Invisible Wounds of War 3.

[9] H. Norman Wright. The New Guide to Crisis & Trauma Counseling (Kindle Locations 163-164). Kindle Edition.

Diagnosing PTSD

Diagnosing PTSD

It is a lengthy process diagnosing service men and women with PTSD. It is difficult to diagnose a Veteran with PTSD. However, the Department of Veterans (VA) has made great attempts to screen Veterans suffering with symptoms experienced by other Veterans. “Diagnostic criteria for PTSD include a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms.”[1] There is reluctance from Veterans suffering with posttraumatic stress and or depression with others around them. This cautiousness is not self-imposed, but rather a mechanism acquired from the battlefield. “…individuals with more-lengthy deployments (i.e., 12 to 15 months) and more extensive exposure to combat trauma are at greater risk of suffering from current PTSD and major depression.”[2] PTSD has become known as the most common injury associated with today’s wars. It is a debilitating injury of the brain that has gone undetected until symptoms occur.

The difficulty with the wars fought during the last decade has been their locations, number of wars simultaneously and length of deployments. “The United States military is fighting two wars halfway across the world. Many service members are serving multiple tours of duty with little time at home in between. Physical war wounds are obviously identifiable, but mental wounds are difficult to spot and need special attention.”[3] The “mental wounds” may go undetected for some time. The Veteran must learn to live with the scares from battle: both external and internal.

[1] American Psychiatric Association. Diagnostic and Statistical Manual.

[2] Tanielian, Invisible Wounds of War 13.

[3] McGrane, Madeline. “Post-Traumatic Stress Disorder in the Military: The Need for Legislative Improvement of Mental Health Care for Veterans of Operation Iraqi Freedom and Operation Enduring Freedom.” Journal of Law & Health 24, no. 1 (2011): 185.

Dealing With PTSD

but let him who boasts boast in this, that he understands and knows me, that I am the Lord who practices steadfast love, justice, and righteousness in the earth. For in these things I delight, declares the Lord. ESV – Jeremiah 9:24

Dealing with PTSD

Since the war in Iraq and Afghanistan started, the number of Veterans with diagnosed PTSD is increasing and still many more undiagnosed. The horrors of what they were exposed to are incomparable to other trauma reported with The Department of Veterans (VA). The Veterans were trained to fight, however, nothing could prepare them for the horrors of war. Just recently, PTSD has been considered a mental illness and is treatable just as any other service-connected injury would be. There is no difference between the Veterans returning from Iraq and Afghanistan and those from previous wars, except now Veterans can receive compensation and be treated for it at VA hospitals.

The US military entered a new kind of war: a faceless war. For the first time in US history, the enemy involves innocent lives for protection and hide in urban settings. Unlike the Taliban, the US military face and fight them. However, it has done so at a great cost. “Since October 2001, approximately 1.64 million U.S. troops have deployed as part of Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq).”[1] Casualties of war no longer lay lifeless on the battlefield, but instead exist with symptoms of posttraumatic stress. As many that have been diagnosed, there is a greater number go undiagnosed. It has been estimated that “…approximately 300,000 individuals currently suffer from PTSD or major depression and that 320,000 Veterans report having experienced a probable TBI during deployment.”[2] However, the undiagnosed number is much higher. With that in mind, the VA and other organizations are committed to lowering that number and help Veterans fight a new enemy called PTSD.

We need to understand that God says I am the Lord who demonstrates unfailing love. Regardless of the circumstance, God’s love will get you through it.

[1] Terri Tanielian, Lisa H. Jaycox, Terry L. Schell, Grant N. Marshall, M. Audrey Burnam, Christine Eibner, Benjamin R. Karney, Lisa S. Meredith, Jeanne S. Ringel and Mary E. Vaiana. Invisible Wounds of War: Summary and Recommendations for Addressing Psychological and Cognitive Injuries. (Santa Monica, CA: RAND) Corporation, 2008): 1. http://www.rand.org/pubs/monographs/MG720z

[2] Ibid., 12.

So What is Post Traumatic Stress Disorder – PTSD?

Bless the Lord, O my soul, and all that is within me, bless his holy name! Bless the Lord, O my soul, and forget not all his benefits, who forgives all your iniquity, who heals all your diseases ESV – Psalm 103:1–3

Definition

Hathaway, Boals, and Banks report, “To qualify for a diagnosis of posttraumatic stress disorder (PTSD), the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) requires that individuals report experiencing dominant emotions of fear, helplessness, and horror during the trauma.”[1] “In 2000, the American Psychiatric Association revised the PTSD diagnostic criteria in the fourth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).[2] Unlike previous wars, today’s media has capitalized on exposing war for what it really is or what it has been. “Recent reports and increasing media attention have prompted intense scrutiny and examination of these injuries.”[3] The terrorist’s attacks on September 11, 2001, have significantly impacted this country. According to Karner, in his article called, “Post-Traumatic Stress Disorder and Older Men: If Only Time Healed All Wounds” mentions that PTSD was first recorded in the 1980 publication of the DSM-III.[4] It set a course of military action as the United States declared war on any country connected to terrorism. For Veterans who have returned home from war, worry about the transition from the military to civilian life. Where they had once held a job before entering the military, the return home promises nothing. The once planned future has now become a dream; the future has become uncertain.

King David wrote, ...He forgives all my sins and heals all my diseases. God can forgive and heal you. Are you ready to give it all to Him?

[1] Lisa M. Hathaway, Adriel Boals, and Jonathan B. Banks. “PTSD Symptoms and Dominant Emotional Response to a Traumatic Event: An Examination of DSM-IV Criterion A2.” Anxiety, Stress & Coping 23, no. 1 (2010): 119.

[2] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Revised 4th ed. (Washington, DC: 2000). http://www.ptsd.va.gov/professional/pages/dsm-iv-tr-ptsd.asp.

[3] Terri Tanielian, Lisa H. Jaycox, Terry L. Schell, Grant N. Marshall, M. Audrey Burnam, Christine Eibner, Benjamin R. Karney, Lisa S. Meredith, Jeanne S. Ringel and Mary E. Vaiana. Invisible Wounds of War: Summary and Recommendations for Addressing Psychological and Cognitive Injuries. (Santa Monica, CA: RAND) Corporation, 2008): 1. http://www.rand.org/pubs/monographs/MG720z

[4] Tracy Xavia Karner. “Post-Traumatic Stress Disorder and Older Men: If Only Time Healed All Wounds.” Generations 32, no. 1 (2008), 82.