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Counseling Sexual Minorities

In a previous post, I mentioned that a second edition of the book, Christian Counseling Ethics, has just been published. This is a book edited by Randolph Sanders, former executive director of the Christian Association for Psychological Studies (CAPS). I wanted to share a little from that book and the chapter I contributed on counseling sexual minorities. Before I do that, let me acknowledge how much I enjoyed writing this chapter, as I had a chance to work with one of my mentors, Stan Jones, and one of the grad students I had a chance to mentor, Jill Kays. Let me recommend collaboration whenever possible! It increases the chances someone will catch your blind spots, and there are always ways in which you can grow.

ChristiancounselingethicsWe first address the topic of competence by reviewing current research findings in four relevant areas. There are (1) prevalence estimates; (2) theories of etiology (causation); (3) mental health correlates (e.g., greater risk of substance use disorders); and (4) research on attempts to change orientation. We then discuss controversies and issues in treatment, including professional controversies surrounding efforts to change orientation.

The next major topic is understanding sexual minorities in the context of the multicultural movement. We discuss here recent attempts at developing counseling competency scales, as well as what we know in terms of milestone events in sexual identity development.

Next we discuss integrity and client well-being. There are a number of issues that can be discussed here, and we spend some time on the ongoing cultural and professional discussions about reorientation efforts in terms of how those efforts are seen by different stakeholders. This is also where we introduce the reader to the Sexual Identity Therapy Framework and to different ways in which Sexual Identity Therapy can be conducted to facilitate client well-being, recognizing significant differences in how people might prefer to achieve congruence between their identity/behavior and their beliefs/values.

We then turn our attention to client autonomy and self-determination. We suggest language that can be used in obtaining advanced informed consent to therapy that address sexual identity. The language provides examples for how a Christian counselor might discuss causes of sexual orientation, professional and paraprofessional options, and so on.

The last section of the chapter address value conflicts and referrals. This has become a major point of professional discussion and debate with the Julea Ward v. EMU case being recently settled out of court, as well as other major cases that have led to discussions of practice location, training, and so on. One regret is that I wish statement from The Board of Educational Affairs of the American Psychological Association (APA) had been available at the time we wrote the chapter. I had a post about that recently, and I think it would have enhanced the chapter even further.

So check out the chapter and the rest of the book. There are a number of great contributions from leading Christian psychologists and counselors on a number of important and interesting topics.

 

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Christian Counseling Ethics, 2nd Ed.

The book, Christian Counseling Ethics, has just been published in its second edition. This is a book edited by Randolph Sanders, former executive director of the Christian Association for Psychological Studies (CAPS). The opening chapters (by folks like Alan Tjeltveit, Richard Butman, and Horace Lukens) orient the reader to a Christian worldview and engagement with counseling and mental health. This is a greater challenge than it sounds like, as the book is for a broad audience and so takes up psychology, counseling, marriage and family therapy, pastoral care, and lay counseling.

ChristiancounselingethicsThe book then turns to specific populations and issues, such as couples therapy, children, those with chronic conditions, navigating multiple relationships, and working with sexual minorities. I worked with Stan Jones and Jill Kays on the chapter on sexual minorities. Other contributors here included Jennifer Ripley, Ev Worthington, Steve Sandage, Jeff Berryhill, Angela Sabates, James Jennison, and Randy Sanders.

Other chapters address some unique considerations for Christians, lay counselors, and ministry settings. These include chapters on the abuse of power (John Shackelford & Randy Sanders), business ethics (Randy Sanders), pastors and lay counseling (Bill Blackburn, Siang-Yang Tan), the military (Brad Johnson), and member care (Kelly O’Donnell).

Most of the chapters are revised, expanded versions from topics addressed in the first edition. Some are new chapters. However, given the changes in the field, even those chapters that are revised or expanded are often substantive updates. I know that material on working with sexual minorities has grown significantly since the first edition came out in 1997.

Sanders also did a nice job asking everyone to be practical. The most obvious signs of this are the appendices. Various ethical codes are reproduced in the appendix, as are sample forms for release of information, demographics, and so on. But even in the various chapters, authors made a concerted effort to make the resource more practical. In our chapter on working with sexual minorities, we added a lot of suggested language that could be used when obtaining informed consent, for instance.

This book is meaningful to me personally. The chapter I coauthored for the first edition was my first publication. When I contributed to that edition, I was a grad student working for Stan Jones at Wheaton College. It was nice to be able to return to that chapter and to update it for Christians in training today.

Having taught a course in Ethical, Legal and Professional Issues in Psychology for more than a decade, I can say that I have not found another comparable book that delves into the professional ethical issues that arise for Christians and that is written from a Christian worldview. Given that 16 years had passed since the publication of the first edition, it was definitely time for a second edition, and I think the reader will not be disappointed.

 

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The Psychology of Judgmentalism – 5

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In his work on distinguishing between healthy judgment and judgmentalism, Terry Cooper tackles the distinction between guilt and shame (Chapter 5: “Guilty Judgments vs. Shameful Judgmentalism”). This is from Table 5.1: Cooper describes guilt as specific with respect to behavior or action; shame labels oneself. Healthy guilt can focus on what can change whereas shame attacks utilizing “global generalizations” that facilitate a zero-sum perspective. Guilt leads the way to forgiving oneself, recognizing limitations and seeing “the worthwhile person underneath the unhealthy behavior”; shame “does not respond to forgiveness.” Healthy guilt can lead to disclosure to others one trusts, while shame isolates, trying to hide from both self and others. Healthy guilt can rid itself of unrealistic or unattainable standards; shame is associated with ideal or unattainable standards. Healthy guilt moves toward accepting oneself, while shame leads to self-punishment.  

 

 

 

 

For reflection: Later in the chapter, Cooper suggests that shame is “judgmentalism turned inward.” Interesting idea, right? What are your thoughts?

 
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Posted by on April 1, 2008 in Courses, Ethics

 

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Ethics and Psychotherapy – 10

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We are in the home stretch with Tjeltveit, and in Chapter 11 (“Profession and Professional Ethics”) he describes how psychotherapists are professionals, by which he means: 

 

 

When psychotherapists assert that they are professionals, they announce, they profess, they make public testimony that they possess specialized knowledge and technical skills that help people with psychological problems. (p. 255) 

 

 

More is expected of psychotherapists. This includes beneficence, because the work of the therapist is characterized by concern and service, as well as client welfare and social responsibility. It is in this chapter that Tjeltveit talks about an ethic for “moral strangers” (p. 262). He recognizes that psychotherapists work with moral strangers. Further, that psychotherapists are part of “ethical communities” that (drawing on Doherty and Cushman here) “encourage clients to consider their progressive political agendas, as do feminist therapists and therapists from particular religious communities” (p. 262). Tjeltveit says it is “appropriate only when client autonomy is preserved, clinical sensitivity employed, and informed consent obtained” (p. 262).  

 

 

 

Tjeltveit also points out a few weaknesses pointed out by others in various professional codes of ethics – as being too cautious or not validated or for failing to articulate their ethical foundations. He believes most psychotherapists draw upon even deeper ethical sources in the process of providing psychotherapy rather than rely on the minimal standards often articulated in codes of ethics.

 

For reflection: Do you agree that psychotherapists are part of ethical communities that have ethical claims that may be relevent to their clinical work? Is this best handled with sensitivity and informed consent? Should codes go “deeper” as an ethical source or is their current depth sufficient?

 
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Posted by on March 31, 2008 in Courses, Ethics, Implicit Integration

 

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Ethics and Psychotherapy – 8

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In our ongoing discussion of Alan Tjeltveit’s book, Ethics and Values in Psychotherapy, we turn to Chapter 9, which is titled “Ethical Dimensions of the Goals and Outcomes of Therapy: Therapy as Means to Which (Ethics-Laden) Ends?” You have to just pause and appreciate the titles of these chapters…. Okay, Tjeltveit wants to press the issue that psychotherapy has ethical dimensions in its goals and outcomes, and that “normal” people can vary in how they are “normal,” suggesting that good outcomes or positive outcomes in psychotherapy can vary and be normal simultaneously. It is part of the heterogeneity of being “normal” (p. 208). He suggests that ideals can be evaluated based on how they affect the individual, others, and over time. They can be assessed with respect to humanity in general, therapy itself, or for a specific individual at a set point in time. Tjeltveit suggests we discuss (and choose) desired outcomes and then work toward those, selecting goals that will lead to the desired outcomes.

Tjeltveit identifies a number of unsuitable solutions when thinking about outcomes in psychotherapy. They include ignoring the outcomes; denying that any assertions can be meaningful; insisting on one and only one answer to what is best; making no universal assertions; judging an oucome on whenter it works (pragmatism); and improving psychological functioning (please note the qualifier that “improving psychological functioning” may be defined differently for different parties).  

For reflection: How about the quote on page 97: “… if the goals of therapy are based on conflicting ethical sources, and therapy’s effectiveness is evaluated in ways that vary with evaluators’ ethical ideasl, is psychotherapy (or in what sense is therapy) a coherent professional practice?

 

 

 
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Posted by on March 18, 2008 in Courses, Ethics, Implicit Integration

 

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The Psychology of Judgmentalism – 3

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Terry Cooper goes on to distinguish between critical thinking and thinking critically. He offers ten features that distinguish the two. Although I won’t cover each here, let me say at the outset that they are from Table 2.2 on page 38 of his book. He says critical thinking is a rational process, one that is capable of both affirming and correcting. It is patient and scrupulously fair, able to critique its own position. Critical thinking can avoid or refrain from emotionality and recognizes when it crosses the line and ceases to be critical (and moves into being “hypercritical”). In contrast, thinking critically is presented as an emotional process that looks to condemn and dismiss, often rushing to judgment, which involves but is not limited to blurring ideas and personalities together in its condemnation of the person rather than the idea or behavior. It is “emotional reactivity masquerading as rationality,” that is “restless until it demolishes” and sees its own process as “above criticism” (p. 38).
For Reflection: Does the distinction Cooper makes between Critical Thinking and Thinking Critically seem helpful to you? How so? In what areas have you seen these differences highlighted?
 
 

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Ethics and Psychotherapy – 7

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In Chapter Eight, which is titled “Ethical Dimensions of the Techniques, Strategies, and Processes of Therapy: Which Means to Therapeutic Ends?” Tjeltveit explores the ethical contours of what actually happens during the “50-minute hour.” These include the therapeutic relationship, specific techniques and methods, diagnosis, ways in which people change, and so on. Tjeltveit says each of these components of therapy have an ethical dimension and should be explored.

 

 

 

 

Do the ends justify the means? If so, you might be an ethical teleologist. Do you prefer to look at the means themselves? If so, you may be an ethical deontologist. Do you focus on therapist/client ethical characteristics, such as prudence? Then you may be a virtue ethicist when it comes to therapy processes. Tjeltveit then looks at five change processes: education, corrective emotional experiences, self-liberation, counterconditioning, and reevaluation. He wants psychotherapists to evaluate each of these five common change processes for their ethical dimensions. He turns his attention to overlapping aspects of the psychotherapy process, including preserving client autonomy, a non-manipulative therapist-client relationship, choice of therapy goals, and recognizing the potential influence on the client by the therapist. He distinguishes inappropriate from appropriate ethical influence, seeing a kind of paternalism as inappropriate, while informing clients of the ethical dimensions of not only therapy but also of their presenting concerns, so that they are making truly informed and autonomous decisions. 

 

 

 

 

 

For reflection: How ought psychotherapists communicate their ethical views to clients? Do both psychotherapists and clients function as ethicists?

 
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Posted by on March 11, 2008 in Courses, Ethics, Implicit Integration

 

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The Psychology of Judgmentalism – 2

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In his book Making Judgments Without Being Judgmental, Terry Cooper distinguishes healthy judgment and judgmentalism by pointing to seven key distinctives (these are from Table 2.1, p. 28). The first distinctive is that healthy judgment is characerized by concern, whereas judgmentalism does not reflect concern for others. The second distinctive is that healthy judgment trusts others until given a reason not to; judgmentalism reads the minds of others, particularly motives. Third, healthy judgment reflects tolerance such that one holds moral concepts but does so in (with) love; judgmentalism holds onto moral concepts with intolerance toward others.

The fourth distinctive Terry Cooper identifies is that healthy judgment denounces behavior or ideas but not people; judgmentalism denounces the person. The fifth distinctive is that healthy judgment is open, recognizing tensions with a person’s own posiiton, while judgmentalism is characterized by “absolute certainty” (p. 28). Sixth, healthy judgment takes time – it is reasoned over time, while judgmentalism is reflected in quick or rash decisions based often in emotion. Finally, healthy judgment is unafraid of a careful decision-making process; judgmentalism is found in unreflective thinking.

For reflection: Do these capture the essential differences between healthy judgment and judgmentalism?  Are there other distinctives that are missing from this analysis? Can you think of practical examples of any of these characteristics of either healthy judgment or judgmentalism?

 
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Posted by on February 23, 2008 in Book Reviews, Audio & Video, Courses, Ethics

 

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Ethics and Psychotherapy – 6

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We are continuing our discussion of Tjeltveit’s book, Ethics and Values in Psychotherapy. In Chapter 7 Tjeltveit discusses the “social context of psychotherapy,” that is, he locates the practice of psychotherapy in the context of how it functions within society. He discusses psychotherapy’s medical heritage including bioethics and medical ethics and the two emphases of “the idea of the professional and a focus on the individual client” (p. 132). Other influences from medicine include reductionism in the form of limiting psychotherapy’s focus to a medical focus of symptom reduction. He seems to suggest that there is much more to biopsychosocial problems than merely what is understood in terms of a “medical issue”.

The other major social context in which psychotherapy occurs is business. Psychotherapy has become a “business relationship” (p. 139) in which there is an exchange of services that occurs in the context of economics (in which resources either contribute or impeded goals being met) and limited financial resources (of third-party payors, including government, insurance companies, employers, and so on). There is a risk of a kind of “ethical reductionism” (p. 141) to the extent that businesses “consider economic considerations alone” (p. 141).

For reflection: Do you agree with Tjeltveit that psychotherapy occurs in the social contexts of its medical heritage and business? How do you see these social contexts shaping the field and the practice of psychotherapy for good or for ill?

 
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Posted by on February 21, 2008 in Courses, Ethics, Implicit Integration

 

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The Psychology of Judgmentalism

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In Ethics this spring, we are reading for our opening reflections excerpts from Terry Cooper’s Making Judgments without Being Judgmental: Nurturing a Clear Mind and a Generous Heart. A main purpose of the book is to help the reader understand the difference between judgmentalism and the capacity to make moral judgments. Practically speaking, this might entail retaining the capacity to make sounds moral judgments, which he sees as absolutely necessary, while avoiding being a judgmental person. In Chapter One he discusses some of what he sees as the psychology of being judgmental, insofar as it involves avoiding our own condition:

We may not consciously be aware that tearing down others can inflate ourselves. Yet the underlying message is something like, I wouldn’t think of doing such a thing, or I could never do that or I am shocked and aghast at such behavior. We are usually noting how utterly different we are from these people or how we would simply never sink to their level. Criticizing others is not  just an offensive move against them; it is also a defensive move to protect our own “purity.”When we are judgmental, therefore, we need other people’s faults in order to dodge our own. Stated simply, judgmental thinking is addicted to other people’s faults or destructive behavior. Judgmentalism finds its identity in what it is not. (p. 23)

 
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Posted by on February 15, 2008 in Courses, Ethics

 

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