Sunday, May 18, 2008

Counseling Resource Recommendations

Counseling resource recommendations are hard for me to make without a sense of what skill level the person has. As a general rule of thumb, however, the very first thing to bear in mind is that we ought not to enter into a counseling relationship that is beyond our comfort level. So for example, even if I'm comfortable and competent (different things by the way, the former not being in anyway a predictor of the latter) in a therapeutic setting deal with this or that issue, I often find that I need to refer the person to a therapist who has more time and access to greater social service resources then I do in a parish.

What I'm getting at is this: The best resource we have in counseling is a sense of our own personal and technical limitations.

What studies that have been done on the effectiveness of counseling relationships suggest that the quality of the relationship between counselor and client is what is most important. Second on the list are the personal internal and social resources of the client. The specific therapeutic orientation and skill set of the counselor is relatively low down on the list of predictors for a successful counseling relationship. This doesn't mean professional competence is unimportant, only that it is not the primary predictor of success.

So, looking at the first element, the relationship between counselor and client, you might want to read Adrian van Kaam's The Art of Existential Counseling: A New Perspective in Psychotherapy. I have found this and a number of van Kaam's books to be very helpful and very accessible. You also might want to look at Dynamics of Spiritual Direction
also by van Kaam. The Art of Spiritual Guidance by Carolyn Gratton might also be of use to you. (Having studied with both authors I can testify to both their professional competency and commitment to Christ.)

As for the second element, before getting involved in any type of ongoing counseling relationship, it is important to have a sense both of the person's internal, moral strength as we well as what kind of social support they have to encourage and sustain change. People without these internal and social resources are generally not good candidates for counseling, at least without enlisting significant support from social services. In a parish setting we simply can't work with people who lack these personal and social resources. Again, this isn't a reflection on our commitment to Christ or His People, but rather of the whole range of resources we can bring to bear.

BUT, even if I cannot enter into a formal counseling relationship with someone, I certainly can refer them to a professional therapist and commit to being a support for them as they go through counseling. This works most effectively if I have a pre-existing professional relationship with area therapists (and this is one of the things on my "to do" list when I come to a new parish) who can act as potential partners when I refer folks. Also a relationship with a therapist is good to help me get a sense of when people bring me things about which I'm not in a position to help them.

Two resources that address the technical aspects of counseling that you might find helpful are Basic Types of Pastoral Care and Counseling: Resources for the Ministry of Healing and Growth by Howard John Clinebell and A Minister's Handbook of Mental Disorders by Joseph W. Ciarrocchi. Together these will give you a sense of the therapeutic lay of the land and help you recognize when you are passing from a spiritual/pastoral matters to more psychological/mental health issues.

In my own ministry I have some general rules that I follow.

First, I divide my counseling ministry into three basic areas:

  1. PASTORAL counseling for those who are still functional (i.e., can love and work successfully) and whose basic concern is to find meaning in Christ for themselves or their life.
  2. PSYCHOLOGICAL counseling is for those who are not able to function or only marginally functional. As a rule, these I refer to a professional therapist though I do try and offer what pastoral support I can give and they can receive.
  3. POLICE matters pertain to anything criminal. Here all I can really do is support the victim in making the best of the situation they find themselves in. As for perpetrators, these folks I encourage to turn themselves in. Any instance of actual or threatened physical violence is a police matter.

Second, I need to realize that I can't deal with every person who comes to me looking for help. While some times what they bring me are outside my area of technical competence, generally and for most part the issue is one of time management. I have limits on my time and energy. If I spend several hours in a series of high stress counseling sessions (which sometimes happens), I'm useless for much of anything else for DAYS.

Third, counseling in a parish setting is often crisis oriented--clergy are good first responders, but we are not in a situation to do long term, or even short term, counseling. The further we get from a pastoral relationship the more danger we are in of malpractice, malfeasance, misconduct or personal burn out.

Fourth, when in doubt about my abilities or if I don't have the time/energy to help someone I refer them to a professional therapist. Yes, this comes with a commitment to support them in therapy—but as their priest who will help them bear the cross of mental illness.

Fifth things which are clearly PSYCHOPATHOLOGICAL (e.g., depression, schizophrenia, bipolar disorder) I refer to a clinical psychologist. Pastoral support here means checking in with the person from time to time and seeing how they're doing. Oh, yes, I also will ask them about medication usage--basically, "Are you taking your medication(s)?"

Sixth, PHYSICAL VIOLENCE (either ACTUAL or THREATENED) is NEVER something that I work with as the primary caregiver. Instance of physical violence, like all crimes, are POLICE MATTERS. Yes there is a pastoral dimension to say domestic violence, but it is fundamentally a legal matter and I need to respect that even if my parishioner is not willing to report the crime.

Finally, I think one of the best things I have ever done for my own counseling ministry was to be in therapy. I have seen a therapist several times in my life. The old psychoanalytic model (now increasingly ignored) was clear: You must undergo analysis to become do psychoanalysis. Being in counseling has been most helpful for me learning what my limits are.

Let me know if the above is of any help to you. Of course you can always invite me to come and speak and do a clergy training workshop.

In Christ,

+Fr Gregory