Counseling Issues: A Handbook for Counselors and Psychotherapists

By George Seber

Here is a comprehensive handbook of twenty-two chapters covering all the major issues a counsellor or psychotherapist might meet in the counseling room. The book is very practical and is based on sound psychological principles. It provides a wealth of ideas for counseling and for structuring a series of counseling sessions. It is particularly accessible to the inexperienced counsellor or psychotherapist who is often looking for some guidance on a particular topic without having to read a whole book on the subject or read something more technical. The book covers basic emotional issues such as anger, shame, anxiety, stress, grief, depression, anxiety disorders, and suicide risk, and behavioural issues like addiction, phobias, and compulsive behaviours such as self-harm and obsessive compulsive disorder. There are also chapters on relationship issues such as divorce, abuse of various kinds, dysfunctional relationships, adoption, blended families, and strategies for couple counseling. There are two chapters on personality disorders. A biblical viewpoint is added at the end of each chapter for the Christian counsellor and pastor. There is an extensive list of about 500 references along with internet references throughout, providing a rich source for further reading. The chapters are mainly independent with minimum cross-referencing.

• Language: English
• Publisher: Xlibris NZ
• Release date: Feb 9, 2013
• ISBN: 9781479757404

George Seber

George Seber is an Emeritus Professor of Statistics at Auckland University, New Zealand. He is the author or coauthor of fifteen statistics books on various topics and he has received a number of awards including election as a Fellow of the Royal Society New Zealand, and the Hector medal from the Society in Information Sciences. In his later years he trained as a counsellor and has been counselling for the past ten years, with a particular interest in couple counselling.

Book preview

Copyright © 2013 by George A.F. Seber.

Library of Congress Control Number:   2012922649

ISBN:

   Hardcover   978-1-4797-5739-8

   Softcover    978-1-4797-5738-1

   Ebook         978-1-4797-5740-4

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

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700454

CONTENTS   

Preface

1   Brain Matters

1.1   Introduction

1.1.1   Mind Over Matter

1.2    Brain Structure

1.2.1    Nerve Cells

1.2.2   Brain Function

1.2.3   Memory

1.2.4   Ego States

1.2.5    Body/Mind Techniques

1.2.6    Pain Management

1.3    Personality

1.3.1    Personality Differences

1.3.2    Personality Models

1.3.3    Learning Styles

1.4    Emotions, Feelings, And Thoughts

1.4.1   Introduction

1.4.2   Emotions

1.4.3    Cognitive Processes

1.4.4   Thought Stopping

1.5    The Aging Process

1.5.1    Midlife Reassessment

1.5.2   Midlife Counseling

1.6    The Aging Brain

1.6.1    The Big News

1.6.2    Four Life Phases

1.6.3    Social Intelligence

1.7    Biblical Viewpoint

1.7.1    Metaphors

1.7.2    Positive Messages

2   Wholeness

2.1    Introduction

2.2    Physical

2.2.1    Nutrition

2.2.2    Exercise

2.2.3   Rest And Recreation

2.2.4   Sleep

2.2.5    Relaxation Techniques

2.2.6    Healthy Sexuality

2.2.7    Touch

2.3    Intellectual

2.3.1   Balance

2.3.2   Goals

2.3.3    Resilience

2.4   Emotional

2.4.1    Beliefs And Emotions

2.4.2    Identifying Feelings

2.5    Social

2.5.1    Importance Of Networks

2.5.2    Attachment Issues

2.5.3    Self-Esteem

2.5.4    Assertiveness

2.5.5    Forgiveness

2.5.6    Birth Order

2.6    Spiritual

2.6.1    Role Of Spirituality

2.6.2    Defining Spirituality

2.7.    Biblical Viewpoint

2.7.1   Who Am I?

2.7.2   Physical Wholeness

2.7.3 Mental Wholeness

2.7.4   Emotional Wholeness

2.7.5   Social Wholeness

2.7.6    Spiritual Wholeness

3   Anger

3.1    The Nature Of Anger

3.1.1    Aspects Of Anger

3.1.2   Positives And Negatives Of Anger

3.2    Expressing Anger

3.2.1    Methods Of Expression

3.2.2   Anger From Past Hurts

3.3    Some Counseling Strategies For Anger Management

3.3.1    A Management Program

3.3.2   The Reluctant Client

3.3.3   Temper

3.4   Relationships Causing Anger

3.4.1    Dealing With Our Own Anger

3.4.2    Other People’s Anger

3.5    Anger Toward God

3.6    Passive-Aggressive Anger

3.6.1    Partner Of A Passive-Aggressive Person

3.6.2    Passive-Aggressive Clients

3.7    Biblical Viewpoint

3.7.1   Anger In The Bible

3.7.2   God’s Anger

3.7.3    Effect Of Anger

4   Guilt And Shame

4.1    Introduction

4.1.1    Comparing Guilt And Shame

4.2    Guilt

4.2.1    Categories Of Guilt

4.2.2    Counseling For Guilt

4.3    Shame

4.3.1    Nature Of Shame

4.3.2    Toxic Shame

4.3.3    Shame And Intimate Relationships

4.4    Assessment Of Shame

4.5    Counseling For Toxic Shame

4.5.1   Shame From A Family System

4.5.2    Adult Shame

4.6    Biblical Viewpoint

4.6.1    Guilt

4.6.2    Shame

5   Stress

5.1    Nature Of Stress

5.1.1   Physical Effects Of Stress

5.1.2   Stress And Personality Type

5.1.3   Substances Causing Stress

5.2    Symptoms Of Stress

5.3.1    Management Skills

5.4   Counseling For Stress

5.4.1   Session Outline

5.4.2   Stress Assessment

5.4.3   Stress Reduction Methods

5.4.4   Sleep

5.4.5    Counseling Style

5.5    Biblical Viewpoint

6   Anxiety And Fear

6.1    Introduction

6.1.1   Anxiety-Related Disorders

6.1.2    Worry

6.1.3    Personality Styles

6.2    Sleep Problems And Disorders

6.2.1    Introduction

6.2.2    Strategies To Improve Sleep

6.2.3    Sleeping Pills

6.3   Counseling For Anxiety

6.3.1    Source Of Problems

6.3.2    General Strategies

6.3.3    Assessment And Strategies

6.4    Nervous Fatigue And Illness

6.4.1   Four Fatigues

6.4.2    Panic Attacks

6.4.3    Counseling For A Panic Attack

6.4.4    Hyperventilation

6.4.5   Sleep And Nervous Illness

6.4.6   Burnout

6.5   Biblical Viewpoint

6.5.1   Worry

6.5.2   Anxiety

6.5.3   Fear

7   Anxiety Disorders

7.1    Some Background

7.2    Generalized Anxiety Disorder

7.2.1 Symptoms And Diagnosis

7.2.2   Counseling Strategies For Gad

7.3    Post-Traumatic Stress Disorder

7.3.1    Introduction

7.3.2    Diagnosis And Symptoms

7.3.3    Memory Repression

7.3.4    Counseling For Trauma And Ptsd

7.4   Panic Disorder

7.4.1   Assessment Of Pd

7.4.2   Counseling For Pd

7.5    Phobias

7.5.1    Categories Of Phobias

7.5.2    Counseling For Phobias

7.6    Agoraphobia

7.6.1    Diagnosis

7.6.2    Counseling For Agoraphobia

7.7   Social Phobia

7.7.1    Criteria

7.7.2    Assessment Of Social Phobia

7.7.3    Counseling Social Phobia

7.8   Specific Phobias

7.9    Acceptance And Commitment Theory (Act)

7.10    Biblical Viewpoint

8   Compulsive Disorders

8.1   Introduction

8.2   Obsessive-Compulsive Disorder

8.2.1   Description

8.2.2    Diagnosis Of Ocd

8.2.3    Counseling For Ocd

8.2.4   Hoarding

8.3    Tic Disorder

8.3.1   Definition And Background

8.3.2   Classification Of Tics

8.3.3    Counseling For Tics

8.4   Body Dysmorphic Disorder

8.4.1    General Symptoms

8.4.2    Counseling Bdd

8.5   Self-Harm

8.5.1   The Nature Of Self-Harm

8.5.2    Why Self-Harm?

8.5.3   Counseling For Self-Harm

8.6   Eating Disorders

8.6.1    What Are They?

8.6.2   Restrictive Anorexia Nervosa

8.6.3    Bulimia Nervosa

8.6.4   Bulimic Anorexics

8.6.5   Eating Disorder Not Otherwise Specified (Ednos)

8.6.6    Binge-Eating Disorder (Bed)

8.7   Other Compulsive Actions

8.8   Biblical Viewpoint

9   Depression

9.1   Introduction

9.1.1    Basic Symptoms

9.1.2    Sleep Patterns

9.2    Causes Of Depression

9.2.1   Models Of Depression

9.2.2    Physical Causes

9.2.3   Other Causes

9.3   Classifying Depression

9.3.1   The Problem Of Classification

9.3.2   Reactive Depression

9.3.3   Major Depressive Disorder

9.3.4   Dysthymia

9.3.5    Bipolar Disorder

9.3.6   Postnatal Depression

9.3.7   Seasonal Affective Disorder (Sad)

9.3.8   Premenstrual Dysphoric Disorder (Pmdd)

9.4    Counseling Strategies For Depression

9.4.1    General Strategies

9.4.2    Cognitive Methods

9.4.3   Fifteen-Step Program

9.4.4   Counseling For Bipolar Disorder

9.5   Biblical Viewpoint

9.5.1   Spiritual Effect Of Depression

9.5.2   Biblical People And Depression

9.5.3   Some Misconceptions

9.5.4    Counseling Guidelines

9.5.5    Biblical Responses To Negative Thoughts

9.6    Appendix

10   Suicide Risk

10.1    Some Facts

10.2    Self-Preservation

10.3    Risk Assessment

10.4    Counseling For Suicide Risk

10.4.1   Uncovering Suicidal Thoughts

10.4.2    Coping With An Impossible Life

10.4.3   Some Strategies

10.5    Some Specific Suicide Factors

10.5.1   Alcohol And Drugs

10.5.2   Schizophrenia

10.5.3   Bipolar (Manic-Depressive) Disorder

10.5.4    Borderline Personality Disorder

10.5.5   Trauma

10.5.6   Suicide In The Elderly

10.6    Suicide Prevention Contracts

10.6.1   Do We Need Them?

10.6.2   Some Pitfalls Of Contracts

10.6.3    Informed Consent

10.7    Biblical Viewpoint

11   Grief And Loss

11.1   Consequence Of Loss

11.2 Death Of A Loved One

11.2.1 Overview

11.2.2   Grief Models

11.2.3    Some Metaphors

11.2.4   Significance Of Loss

11.2.5    Anger

11.3   Counseling Framework

11.3.1   Initial Sessions

11.3.2    Further Sessions

11.3.3    Some Aspects Of Grieving

11.3.4    Children’s Grief

11.3.5    Suicide And Sudden Death

11.4    Death Of A Child At Any Age

11.4.1   Miscarriage And Prenatal Deaths

11.4.2    Sudden Infant Death Syndrome

11.4.3    Loss Of A Child

11.4.4   Abortion And Grief

11.5   Job Loss

11.5.1   Introduction

11.5.2   Grief Process

11.5.3   Finding A New Job

11.6    Unresolved Grief For A Loved One

11.7    Biblical Viewpoint

11.7.1   Story Of Job

11.7.2   Death Not The End

11.7.3    Forgiveness

12   Addictions: General

12.1   Introduction

12.2    The Nature Of Addiction

12.2.1   Definition

12.2.2   Substance And Behavioral Addictions

12.2.3   Crossover Effects

12.2.4   Goals And Loss Of Control

12.3    Diagnosis Of Substance Addictions

12.4    The Aim Of An Addiction

12.5    Categories Of Addiction

12.6    Addiction Models

12.6.1   Addictive Personality

12.6.2   The Addictive Self

12.7   Counseling Methods

12.7.1   Some General Comments

12.7.2    Motivational Interviewing

Basic Principles

12.8    Biblical Viewpoint

13   Substance Addictions

13.1   Introduction

13.2   Smoking

13.2.1    Nicotine Addiction

13.2.2    Products Of Cigarette Smoke

13.2.3    Health Aspects

13.2.4    Motivation To Stop

13.2.5   Counseling Process

13.3   Alcohol

13.3.1    Physical And Social Effects

13.3.2    Alcohol Assessment

13.3.3    Counseling Strategies

13.3.4    Harm Reduction

13.4    Other Drugs

13.4.1   Stimulants

13.4.2   Opioids

13.4.3    Cannabis

13.4.4   Hallucinogens

13.4.5   Party Drugs

13.5    Biblical Viewpoint

14   Addictions: Behavioral

14.1   General Comments

14.2   Gambling

14.2.1    When Is It Addictive?

14.2.2    Assessment

14.2.3    Understanding Chance

14.2.4   Counseling Strategies For Gambling

14.3   Sexual Addictions

14.3.1   What Is Sexual Addiction?

14.3.2    Role Of Pornography

14.3.3    Counseling For Sexual Addiction

14.3.4    Sexual Anorexia

14.4    Internet And Electronic Device Addiction

14.4.1    Diagnosis And Assessment

14.4.2    Counseling For Internet Addiction

14.5    Relationship Addiction

14.5.1   Recognizing Relationship Addiction

14.5.2   Counseling For Relationship Addiction

14.6    Workaholism

14.6.1   The Nature Of Workaholism

14.6.2   Counseling Strategies For Workaholism

14.7   Compulsive Eating

14.7.1    Relationship With Food

14.7.2   Assessment

14.7.3   Counseling For Compulsive Eating

14.7.4    Relapse Prevention

14.8    Biblical Viewpoint

14.8.1    Gambling

14.8.2    Sexual Addiction

14.8.3   Workaholism

14.8.4   Religious Addiction

15   Adults Abused As Children

15.1   Introduction

15.2    Sexual Abuse

15.2.1    What Is It?

15.2.2    Stages Of Abuse

15.2.3    Effects Of Sexual Abuse

15.2.4    Counseling Strategies

15.3    Physical Abuse

15.4    Psychological Abuse

15.4.1    Effects Of Divorce, Legal Or Emotional

15.4.2    Adult Children Of Alcoholics

15.5    Biblical Viewpoint

15.5.1 Child Abuse

16   Abused Adults

16.1    Introduction

16.1.1   Control

16.1.2   Counseling The Controller

16.2    Physical Abuse

16.2.1    Prevalence

16.2.2    Men’s Violence Against Women

16.2.3   Women’s Violence Against Men

16.2.4   Counseling For Physical Abuse

16.3    Adult Sexual Abuse

16.3.1    Rape

16.4    Psychological Abuse

16.5    Why People Stay With Abusive Partners

16.5.1    Abusive Men

16.5.2    Abusive Women

16.6    Abuse Of The Elderly

16.7    Spiritual Abuse

16.7.1    Defining Spiritual Abuse

16.7.2   Recognizing An Abusive System

16.7.3    Hallmarks Of A Spiritually Abused Person

16.7.4   Why Stay?

16.7.5   Counseling For Spiritual Abuse

16.8    Biblical Viewpoint

16.8.1    Control Issues

16.8.2    Partner Abuse

16.8.3    Spiritual Abuse And The Bible

17   Dysfunctional Relationships

17.1   Introduction

17.2   General Boundaries

17.2.1   Nature Of Boundaries

17.2.2    Some Boundary Principles

17.2.3    Recognizing Unhealthy Boundaries

17.2.4    Counseling For Boundary Issues

17.3    Particular Boundaries

17.3.1    Boundary Checklist

17.3.2   Boundaries With Self

17.3.3   Boundaries And Partners

17.3.4    Boundaries And Family

17.3.5    Boundaries And Friends

17.3.6   Resistance To Boundaries

17.4    Codependency

17.4.1    Definition And Nature Of Codependency

17.4.3    Counseling For Codependency

17.5    Biblical Viewpoint

17.5.1    Boundaries

17.5.2   Codependency

18   Divorce

18.1    General Comments

18.1.1   Grief From Divorce

18.1.2   Attachment Issues

18.1.3    Narcissistic Injury

18.2   The Fall-Out From Divorce

18.2.1   Family And Friends

18.2.2   Telling The Children

18.2.3    Effect On The Children

18.3   Parenting And Divorce

18.4    Looking Back

18.4.1   Reasons For Breakdown

18.5    Forgiveness

18.6   Biblical Perspective

19   Couple Relationship Counseling

19.1   Introduction

19.1.1   Who Should Come To Counseling?

19.2    Models For Counseling

19.2.1   Life-Cycle Models

19.2.2 Psychoanalytic Models

19.2.3    Imago Model

19.2.4    Cohabitation

19.3    General Problem Areas

19.3.1    Couple Issues

19.3.2   Intra-Personal Problems

19.3.3    Inter-Personal Problems

19.3.4   Environmental Problems

19.4    Some Specific Issues

19.4.1   Forgiveness

19.4.2    An Affair

19.4.3    Sexual Problems

Some Myths

19.5    Counseling Structure

19.5.1   Some General Principles

19.5.2   Setting The Scene

19.5.3   First Session

19.5.4    Other Sessions

19.5.5   Some Dos And Don’ts Of Evaluation

19.6   Couple Communication Skills

19.6.1   Conversing

19.6.2   Art Of Listening

19.6.3   Feelings Contract

19.6.4   Conflict And Disagreement

19.6.5    Love Languages

19.6.6   Role Of Birth Order

19.7    Some Miscellaneous Interventions

19.8    Couple Exercises

19.9    Biblical Viewpoint

19.9.1    Marriage Model

19.9.2   What Is Love?

19.9.3   Who Is In Charge?

19.9.4    Love And Respect

19.9.5   Adultery

20   Blended Families

20.1   Introduction

20.2    Stepfamilies From Remarriage And Divorce

20.2.1    Some Problem Areas

20.2.2   Counseling And Blended Families

20.3    Stepfamilies From Cohabitation

20.4    Blended Families With Same Sex Parents

20.5    Adopted Children

20.5.1    How Well Do Adopted Children Do?

20.5.2   Open Adoption

20.5.3   Single Parent Adoption

20.6    The Adult Triad

20.6.1    Fathers

20.6.2   Adults Adopted As Children

20.6.3    Adoptive Mothers

20.6.4    Birth Mother

20.7    Biblical Viewpoint

20.7.1   Blended Families

20.7.2   Adoption

21   Personality Disorders: General Concepts

21.1   Introduction

21.2   General Psychological Assessment

21.2.1    Gathering Information

21.2.2   Baatomi Assessment

21.3    Indications Of A Personality Disorder

21.4    Categories Of Personality Disorders

21.4.1    Cluster A

21.4.2    Cluster B

21.4.3   Cluster C

21.4.4   Other Disorders

21.4.5    Treatability

21.5    Defense Mechanisms

21.6    Biblical Viewpoint

22   Personality Disorders: Counseling

22.1    General Counseling Strategies

22.2    Cluster A

22.2.1    Paranoid Pd

22.2.2    Schizoid Pd

22.2.3    Schizotypal Pd

22.3    Cluster B

22.3.1    Antisocial Pd

22.3.2    Borderline Pd

22.3.3    Histrionic Pd

22.3.4    Narcissistic Pd

22.4   Cluster C

22.4.1    Avoidant Pd

22.4.2   Dependent Pd

22.4.3   Obsessive-Compulsive Pd

22.5    Other Disorders

22.5.1    Depressive Pd

22.5.2    Negativistic (Passive-Aggressive) Pd

22.5.3    Masochistic (Self-Defeating) Pd

22.5.4   Sadistic Pd

22.6    Biblical Viewpoint

References

Endnotes

PREFACE

The aim of this book is to provide a handy look-up reference. It focuses on providing information as well as techniques and counseling ideas for dealing with a variety of psychological problems and issues that an inexperienced therapist might encounter in the counseling room. I hope that the book will also be useful for the more experienced therapist, especially for some of the more difficult counseling issues. It is assumed throughout this book that the therapist is in regular professional supervision. In New Zealand, as in most countries, such supervision is a standard requirement for all therapeutic practice.

This book is not an in-depth psychological book nor a self-help book (though some may find it useful in the latter case), but along with the references and extensive bibliography will I believe be a useful resource. I am well aware that a string of techniques is not counseling as therapy needs to be anchored to sound psychological principles, which I have endeavored to endorse throughout. I therefore assume that the reader has at least a basic knowledge of psychotherapy and counseling methods as well as familiarity with the terminology used. In the latter case I try to explain all terms used as I proceed. Throughout the book I endeavor to give some prevalence statistics. Data on any particular topic can vary a great deal and may not be current or very accurate. However, my aim is not for data accuracy but rather to provide a very rough idea of prevalence for the therapist’s interest.

Before proceeding further I want to clarify something about terminology. Some people distinguish between a psychotherapist and a counselor, while others use the words interchangeably. It does depend to some extent on the country, for example psychotherapist is used in the U.S. and counselor in the U.K. A distinction is made in New Zealand because of differing qualifications. As I do not wish to enter into this debate, I have titled this book accordingly and I shall use the generic term therapist to represent both groups. A therapist in this book is simply someone who does counseling.

I want to say something about what led me to write such a book. I began my training as a therapist rather late in life having had a long career as a professor of statistics and mathematical author. The journey into counseling in my later years was for me a real challenge, not only in writing assignments in a completely different field, but also in undergoing exercises about self-awareness. I found that I had to be able to change from a person who told people what to do and how to solve their problems into a person who listened and helped people solve their own problems! Preparing a wide variety of assignments opened the door to the extensive literature on the subject and helped me to appreciate the existence of several hundred therapies or methods of counseling that are available. Reading books like Sexton et al. (1997) and McLeod (1998) from my statistical perspective helped me to realize the difficulty of trying to compare the effectiveness of various counseling methods and interventions and to appreciate that more than one method could be used in any specific counseling session. However, there are specific situations when certain methods tend to be favored, for example, cognitive behavioral therapy for depression and motivational interviewing for addictions. The key element of any counseling is the therapist/client relationship, which is more important than the method used—something I always try to remember.

When I began counseling as part of my training, I often wanted to get some background on a particular issue, for example, anger, and find strategies for approaching this issue. I found two sources to help me; one consisted of books on therapies that I looked through for hints on anger management, and the second was reading books just on anger. Neither source I found completely satisfactory as they both required considerable time in searching for suitable strategies. Although I benefitted from the reading as my custom is to take notes, I had limited time available to read whole books. More recently I have found the internet to be a wonderful resource. Now, some years down the track, I want to remedy the situation that I found then by writing a different kind of counseling book, namely one which focuses on issues and techniques, rather than on therapies. One danger in this approach is that of repetition, as one method can be applied to a variety of issues so that some repetition is unavoidable.

Writing such a book opened up some challenges for me. First, I faced the challenge of a multitude of psychological issues: Which ones should I leave out? Clearly some strategies could be applied quite generally, as in the case of addiction, but they often need to be adapted specifically. For example, individual addictions such as alcoholism, smoking, an averseness to needles, and gambling are all very different. Some topics I have deliberately omitted because of space are family counseling, counseling children, counseling parents with problem children, and some specialized topics within each chapter. Given the perverseness of human nature and the variety of human predicaments, I have no doubt omitted one of your favorite issues! Please let me know of any topic which you would have liked to have been covered (e-mail: [e-mail] or [e-mail]).

I have also considered some topics that should be dealt with by an experienced therapist such as, for example, eating disorders, self-harm, and personality disorders. However, it is important for an inexperienced therapist to be able to recognize when such an issue arises so that they can at least refer these clients on to more competent therapists. In trying to cover such a wide field, a related problem I am keenly aware of is oversimplification; for example how does one deal with a subject like depression in a single chapter. As I have had to be selective, one answer is through the references to further reading. My choice of references has been largely determined by what is available from local university libraries (including electronic books) and what books I own myself. Sometimes I have had to make do with a less than recent edition. The internet is also a great source of information and I make frequent references to web sites, though one has to be careful to refer to only authoritative sources.

A second challenge that I met I have already alluded to, namely that we can use more than one method to deal with an issue. We all have our favorite approaches even if our style is eclectic, for example, cognitive behavior therapy, transactional analysis, and narrative therapy are all quite different in the way they deal with client problems. Although I have tried to keep in mind the various approaches in writing this book, some techniques or ideas will need to be adapted to your own favorite counseling style.

A third challenge in covering so many counseling issues is that many of the topics overlap. For example, anxiety, anxiety disorders, stress, and phobias overlap, and sleep problems turn up in various places. The therapist often finds that a client has more than one type of problem (comorbidity). I endeavor to get round these difficulties through cross-referencing.

A fourth challenge was how to cater for the reader who is a Christian therapist. As many biblical principles make authentic psychological sense, I have added a brief section entitled Biblical Viewpoint at the end of each chapter that endeavors to comment on the material in just that chapter from a biblical perspective. The spiritual is very important in counseling and I am well aware of different world views in dealing with the religious as opposed to the spiritual—a controversial subject. I have endeavored to keep to basic ideas about spirituality, but there will be those who feel I am not biblical enough while others will ignore this add-on section. I believe that my book will be a useful addition to a pastor’s bookshelves.

The first two chapters are general introductions that I will refer back to in later chapters, when needed. In Chapter 1 I give some aspects of physiology and brain function to provide a background for thoughts, emotions, behavior, and mind-body interactions. The effect of aging is also mentioned. Chapter 2 is a large chapter about wholeness in the various areas of our lives, namely the physical, mental, emotional, social, and spiritual areas. Topics like the sleep process, relaxation techniques, attachment, assertiveness, self-esteem, and forgiveness are included for later reference. In Chapters 3-6 I refer to issues relating to the common emotions of anger, guilt and shame, stress, and anxiety and fear. The so-called Axis I disorders, like anxiety disorders, phobias, and trauma are in Chapter 7 with compulsive type disorders in Chapter 8. Depression in its various forms is discussed in Chapter 9 while the related topic of suicide risk follows in Chapter 10. Grief and loss are considered in detail in Chapter 11, where the focus is on a variety of losses that one can meet. Addictions are the subject of the next three chapters 12-14 including general addiction counseling, and substance and behavioral addictions. The next two chapters are about abuse; Chapter 15 focussing on adults abused as children and Chapter 16 dealing with adults and various forms of adult abuse. The four chapters 17-20 deal with relationship issues, namely dysfunctional relationships, divorce, couple counseling, and blended families (including adoption). The book concludes with two chapters that deal with personality disorders.

In conclusion, there are several people I wish to thank. My special thanks go to Brian McStay, my supervisor and friend, who has continually encouraged me in the writing of this book and has given me time from his busy schedule to read a first draft of this book and provide valuable comments. I also thank Siobhan Whiting for reading some of the earlier chapters and providing helpful input. I am very grateful to Amy Hendrickson for the use of her Latex electronic package and her technical assistance. Last, but certainly not least, I am most grateful to my wife Jean for her patience and long suffering support while I wrote a book of this size.

GEORGE A. F. SEBER

Auckland, New Zealand

January 2013

CHAPTER 1

BRAIN MATTERS

1.1   INTRODUCTION

I decided to start this book where it all begins—in the brain. With modern developments in brain physiology we are beginning to find that many psychological problems have a physiological basis. We also find that the brain is an organ capable of changing and adapting itself in remarkable ways—described as brain plasticity.¹ The brain has a capacity to reorganize itself and find new ways to perform lost functions. Richard Faull, a neuroscientist at Auckland University, New Zealand, provided first evidence that the diseased human brain can repair itself by the generation of new brain cells. This new knowledge about the brain has been particularly helpful with, for example, stroke victims using constraint induced movement.² The brain’s plasticity provides a reason why a person gets locked into a particular behavior (e.g., obsessive compulsive disorder, pornography); the structure of the brain becomes altered. Doige says: The plastic paradox is that the same neuroplastic properties that allow us to change our brains and produce more flexible behaviors can also allow us to produce more rigid ones.³ The key is to help the brain reorganize itself again; an idea that has considerable repercussions for the future of counseling and treating people with, for example, compulsive psychological problems.⁴

In this chapter I wish to consider a number of topics about the human brain to provide some background to when they merge later in this book. I will address some relevant aspects of brain structure, function, and memory, ego states, and body/mind techniques as they relate to counseling. This is followed by a discussion on personality, and the connections between emotions, feelings, and thoughts as they too relate to counseling. The chapter finishes with an extensive section on the aging process, including midlife reassessment and aspects of the aging brain that can be helpfully used in counseling older people. I conclude with a biblical viewpoint of this topic.

In future chapters I shall consider a number of disorders that have their origin in brain function. Psychological problems can be categorized by, for example, the Diagnostic and Statistical Manual of Mental Disorders (DSM) as Axis I, II, III, IV, and V disorders. Axis I refers to depression, anxiety disorders, compulsive disorders, phobias, and addictions, Axis II to personality disorders, Axis III to medical conditions, Axis IV to current stressful events, and Axis V to functioning.⁵ Although all five categories are generally covered in this book, my chapter divisions will be different. It should be noted that there are some problems with the DSM mentioned in the report of the American Psychiatric Association planning committee for DSM-V. For example:

The goal of validating these syndromes and discovering common etiologies has remained elusive. Despite many proposed candidates, not one laboratory marker has been found to be specific in identifying any of the DSM-defined syndromes. ⁶

What is more concerning is the following comment:

Epidemiological and clinical studies have shown that extremely high rates of comorbidities among disorders, undermining the hypothesis that the syndromes represent distinct etiologies. Furthermore, epidemiological studies have shown a high degree of short-term diagnostic instability for many disorders. With regard to treatment, lack of specificity is the rule rather than the exception. ⁷

Referring to the DSM system, Elfert and Rorsyth (2005: 7-8) note that: The ‘comorbidity’ rates among disorders are so high as to challenge the basic definitional integrity of the entire system, and A syndrome focus has led us to develop treatment approaches that over emphasize symptom reduction and downplay functional and positive markers of psychological health. There is a tendency to view distressing states of mind as signs of disorder and disease but this does seem to work very well. There is a strong focus on disease models.

1.1.1   Mind over Matter

We are all aware of how our minds affect our bodies. Our psychological health can affect our physical health and the physical effects can linger on well after the psychological problems have gone. For example, reactive depression can set in after we experience a significant loss in our lives. Stress can also affect us physically in many ways. Ailments arising from psychological sources are referred as psychosomatic illnesses⁸ and are due to complex mind/body/spirit interactions as well as the interaction between heredity and environment. So often people express their pain in bodily symptoms. Terrifying physical symptoms can occur with panic attacks (Section 6.4.2) and post traumatic stress disorder or PTSD (Section 7.3). Addictions are related to substances produced in the brain called neurotransmitters. For example, the so-called reward system of the brain is involved with the neurotransmitter dopamine.

Given this brief selection of body-mind interactions, I felt it would be appropriate to discuss some physiology of the brain as a prelude to discussing psychological issues. As this is a complex and, at times, a controversial subject, I will be giving only a brief and rather simplified overview of some aspects of brain physiology and related topics.⁹ Some aspects are technical, but they can help us understand some of the theory behind counseling.

1.2    BRAIN STRUCTURE

1.2.1    Nerve Cells

Nerve cells or neurons are electrically excited cells that process and transmit information and are the core components of the brain, spinal chord, and peripheral nerves. Extending out of each neuron like branches of a tree are a large number of dendrites,¹⁰ each covered with small knobs called dendritic spines that increase the number of possible interconnections. Many neurons have just a single nerve fiber called an axon that carries primary messages away from the body of the cell or soma to another neuron, muscle cell, or cells in some other organ. Most axons divide many times and the branches connect with other neurons via their dendrites. The axons are in effect the primary transmission lines of the nervous system and, as bundles, help make up nerves. At the ends of the axon branches there are so-called terminal buttons each followed by a gap called a synapse, which is chemical in nature. When an electrical message hits the synapse it is transported across the gap by a chemical called a neurotransmitter on route to the next neuron; such messages generally move in one direction only. Thus each neurotransmitter is like a key that fits into a special lock called a receptor and when a neurotransmitter finds its receptor it activates the receptor’s nerve cell.

It has been estimated that the brain has approximately 100 billion neurons¹¹ and each neuron has on average 7,000 synaptic connections to other neurons.¹² Different synapses have different neurotransmitters and it is these substances that have a major effect on how the brain functions and on our emotions. One transmitter, for example, that is involved in many functions, including muscle movement, breathing, heart rate, learning, and memory is acetylcholine. An important group of common neurotransmitters called monamines include dopamine, adrenaline (epinephrine), noradrenaline (norepinephrine), serotonin, and melatonin.¹³ The names in brackets are alternative names used in the U.S. Dopamine plays an important role in addictions,¹⁴ adrenaline and noradrenaline are involved in stress, serotonin is associated with the feeling of well being and its lack can lead to depression, and melatonin plays an important role in sleep. These substances will be discussed specifically elsewhere in relation to therapy. In general, every addictive drug mimics or blocks some neurotransmitter.¹⁵

1.2.2   Brain Function

There are several key areas of our brain that relate to how we react to situations. The first has been called our emotional brain and has been described as being located in the limbic system that includes two important areas, namely the amygdala ¹⁶ and the hippocampus.¹⁷ However, this location has been called into question as the brain is much more complicated and LeDoux believes that the concept of the limbic system should be abolished.¹⁸ The second key area is the neocortex, our thinking brain. It is part of the cerebral cortex, the outermost layer of the brain (commonly called the grey matter because of its color), that is the source of our rational thinking and is where most of the memory is stored. The amygdala performs a primary role in the processing and memory of emotional reactions, for example trauma, and it is discussed in more detail in Sections 1.2.3 and 1.4.2 below. Another concept that has been criticized by LeDoux is the evolutionary idea of an old and new part of the cortex.

The view that the brain is divided into thinking and feeling parts, which has received a lot of past support is now being criticized as being too simplistic. Lazarus¹⁹ maintains that we only have one mind, not two, that combines both thought and feeling; Damasio²⁰ says a similar thing, but in more technical language. As Baker comments, Emotions and cognition both develop together as mutually interacting systems. The two become fused as part of our total experience.²¹ Greenberg²² uses the metaphor of two selves—one drives cognition and the other, which is more automatic, drives emotions. These two selves don’t necessarily get along and one goal of therapy is to integrate the two; the integration of head and heart.

Two Hemispheres

The brain is divided into two hemispheres, and the communication between them takes place through the corpus callosum. The left hemisphere controls the right half of the body and is more about doing so that it involves reasoning and the logical, mathematical, and language based skills. The right hemisphere controls the left half of the body and is more about being so that it involves comprehension, imagination, creativity, insight, and relaxation. The way they work together is interesting. For example, the left side hears the words, whereas the right side appreciates the moral or metaphor of the story and the punch line of jokes. The left side reads the music score, while the right side determines the pitch and quality of the tones. The left brain assesses facts and the right brain appears to be more concerned with moral values.

Gender Brain Differences

There are some differences in male and female brains, the result of different testosterone levels. A clear difference is the size with the male human brain being on average, larger; however in females, who generally do not have as high a testosterone level, the corpus callosum is proportionally larger. This means that the effect of testosterone is a greater overall brain volume, but a decreased connection between the hemispheres.²³

1.2.3   Memory

The good news is that we never run out of memory, as there are no known limits for memory storage. Our brain’s memory is essentially limitless! We tend to think of memory as two types. The first is short term, which is better described as working memory, where we temporarily keep information required for a task at hand. This is limited and temporary. To retain such memories they need to be transferred to long-term memory. This is not a single storage location as long-term memories are distributed right throughout the brain, and different parts are devoted to different types of memory functions.²⁴

Long-term Memory

Long-term memory comes in two broad types (alternative names in brackets): declarative (explicit) and procedural (implicit or non-declarative), which acquire and store different kinds of information for long periods of time.²⁵ Explicit or conscious memory is where we store how-to information like driving a car or playing a musical instrument. Some explicit memories, called semantic memories, are facts about the world, while others are more image-based and represent scenes or episodes from our experience (episodic memories). Here the recall is intentional and conscious, and information stored in explicit memory is about a specific event that happened at a specific time and place. In forming and storing explicit memories, associations are made with previous related stimuli or experiences so that they can be remembered and recalled. On the other hand, implicit memory refers to remembering that occurs without effort or conscious awareness and usually relates to habits and skills, like riding a bike. It is best demonstrated when performance is improved on a task. We note that the hippocampus in the brain seems to play a critical role in storing information in our long-term memories. High levels of stress hormones in the bloodstream may shrink the hippocampus and reduce its performance.²⁶

Implicit or unconscious memories play a role in alerting us to dangerous or threatening situations and are created through fear conditioning. We may be aware that the fear is there, but we don’t have control over its occurrence or have access to its workings. Implicit memories cannot be looked up or remembered in order to use them for actions and reasoning. These memories are linked to the amygdala system. The conscious explicit memory of the fear response, namely the set of unemotional facts relating to the response that generally occurs at the same time, has been called the memory of the emotion, while the unconscious implicit memory of the emotional response can be termed the emotional memory.²⁷ Sometimes these two systems don’t communicate as for example with people who have not recovered emotionally from a traumatic event. The resolution of the trauma involves integrating these two memory systems.

Amygdala in Action

In general, when we have an emotional situation, the amygdala system gives rise to an implicit emotional memory and the hippocampal system gives rise to an explicit memory about the emotional situation. The current arousal from the amygdala combined with the explicit memory of past emotions can reinforce fear conditioning,²⁸ thus making various disorders such as phobias difficult to deal with. Furthermore, when the amygdala system is activated, it turns on all sorts of body systems such as the autonomic nervous system, which in turn activates the adrenal gland that releases adrenaline into the bloodstream. This adrenaline ends up influencing various parts of the brain including the hippocampus, thus strengthening the explicit memories created there so that such memories are stronger than explicit memories of unemotional situations.

If a person faces prolonged stress or trauma, the hippocampus can be damaged, thus explaining why some traumatic events may not be easily recalled. In the case of child abuse, the problem is compounded by the fact that the amygdala matures in a child before the hippocampus.

Memory Association

It should be noted that the brain doesn’t store a photographic record of our life that we can access at will. In fact most of our stream of consciousness passes through our brains unpreserved. The key idea is that memory is a phenomenon of association so that the more links we can make in our brain with a particular item the better we will remember it. We can remember a name better if we can also link that person with other items of information about them. Although working memory and and the episodic form of declarative memory can decline over time, semantic and procedural memories are quite stable. However, the ability to lay down new memories can be improved with mental exercise. By making lists and using mnemonic tricks, for example, we can augment our more vulnerable working memory. Memoirs, scrapbooks, photos, and so forth, can also be helpful.

Linked with the memory are the important concepts of fluid intelligence and crystallized intelligence. Fluid intelligence is on-the-spot reasoning ability that does not depend completely on prior learning. It is the sort of native intelligence that IQ tests sometimes strive to measure. Crystallized intelligence is what we accumulate throughout life and arises out of experience. Many studies have shown that fluid intelligence slowly declines with age, but crystallized intelligence often improves and expands. We can learn new skills as we get older.

Information from an event is slowly assimilated into long-term memory over time until it reaches a relatively permanent state.²⁹ During this consolidation period, the memory can be modulated by the amygdala. For example, emotional arousal following an event can increase the strength of the memory of that event, the greater the arousal the stronger the memory. We see this in the persistence of traumatic memories.

1.2.4   Ego States

Through brain activity, neurons connect up together to form a neural network that relates to a particular state of mind.³⁰ If an overwhelming trauma occurs or a particular (positive or negative) state of mind is repeated, the state of mind engendered in both cases becomes engrained in a single network called an ego state that we can describe as a part of self with a point of view.³¹ Berne defined an ego state as a consistent pattern of feeling and experience directly related to a corresponding consistent pattern of behavior.³² For example, with certain events one can consistently experience uncomfortable childhood memories and then feel panicky; experience and feelings consistently occur together.

Ego states reflect positive or negative experiences depending on caregiver-child interactions and can change with time, generally becoming more engrained (for better or worse) as new events are interpreted in the light of past experience. Those positive parts tend to live in the present while negative wounded parts due to painful experiences such as childhood neglect or abuse remain stuck in the past. These states vary in complexity. For example, a single event can give rise to several states, or a single state can include a large area of one’s life making up many events (e.g., recreation). Our parts of self can disagree, leading to ambivalence (i.e., Shall I or shall I not…), which we all experience. The stuck-child part can conflict with an adult part. Child ego states can form to mimic other people, called introjects, and these can have a profound impact on the adult later. For example, life events can trigger a child ego state causing an adult to act inappropriately.

Various ego-state therapies have been developed and some are briefly described below:

1.   Transactional analysis or TA (with Parent, Adult, and Child, or PAC states) was developed by Eric Berne (1961).³³ Two key ideas of this method are the PAC model and the life-script.

2.   Ego-state therapy, generally regarded as being attributed to John G. Watkins, utilizes family and group-therapy techniques along with hypnosis for the resolution of conflicts between the different ego states that constitutes a family of self within a single individual.³⁴

3.   Inner-child therapies became popular in the late 1980’s and are aimed at finding healthy ways to heal the wounded inner child by nurturing child ego states. There are a number of writers associated with this development such as Bradshaw (1990), Napier (1993), Paul (1992), and others.³⁵

4.   Eye Movement Desentization and Reprocessing (EMDR) was developed by Francine Shapiro in the early 1990’s³⁶ and it is described in the following section.

5.   Developmental Needs Meeting Strategy (DNMS) was developed by Shirley Jean Schmidt.³⁷ It uses the nurturing and protective adult parts of self along with the spiritual core self to deal with introjected caregivers (stuck ego states that mimic significant childhood role models) and child reactive parts.

Ego-state methods need to be carried out with care as they can lead to creating even more parts of self and an increasing ego-state isolation, especially if a person has dissociation problems.

1.2.5    Body/Mind Techniques

There are a number of techniques that seem somewhat strange when first encountered. I mention them because they indicate certain subtle connections between mind and body that open up new possibilities in counseling.

Alternating Bilateral Stimulation (ABS)

ABS refers to a method of stimulating both sides of the brain by applying alternating stimuli of various kinds. This was first introduced as part of a method of psychotherapy called Eye Movement Desensitization and Reprocessing (EMDR), already mentioned above. Clients were asked to move their eyes rapidly back and forth (e.g., tracking the therapist’s fingers as they are moved from side to side) while they concentrated on disturbing or upsetting emotional material.

Other forms of stimulation have since been introduced, a popular choice being alternating bilateral tactile stimulation where the therapist taps the client’s knees, hands, or feet, or the client uses an electronic device where two hand-held pulsars vibrate in an alternating fashion.³⁸ Some clients prefer auditory ABS using a headset that provides beeping sounds or music patterns alternately to each ear. Clients can also tap their own knees.

The idea behind ABS is that the alternating movement is thought to affect the way the memory is accessed and treated so that any disturbing affect is neutralized by desensitization and reprocessing. It enables clients to get fully in touch with their memories and accompanying feelings, so care is needed in using ABS or EMDR as feelings are intensified. The method should therefore be used only by personnel trained in its use.

ABS seems to be particularly useful in dealing with trauma, especially single incident events (e.g., seeing horrendous accidents and acts of violence), post traumatic stress disorder, and childhood abuse.³⁹ However, it has been used in many other areas as well.⁴⁰ In dealing with adults who suffered as children, EMDR can be combined with ego state ideas as it activates the child part.⁴¹ An important feature of ABS is that it also helps strengthen positive beliefs about self, which is the basis for its use in both EMDR and DNMS (mentioned in the previous section).

We now consider some body/mind methods based on tapping certain parts of the body.

Tapping Techniques

There is an unconventional technique called thought field therapy (TFT) for dealing with emotional problems that involves tapping with the fingertips at the end points of the body’s so-called energy meridians. The theory behind the method is that the cause of all negative emotions is a disruption in the body’s energy system that is fixed by tapping.⁴² A similar method based on the same principles has joined forces with TFT called emotional freedom technique (EFT), where EFT is an emotional version of acupuncture.⁴³ At the time of writing this there seems to be a need for further well-designed scientific studies on the usefulness of these methods.⁴⁴ One complicating factor pointed out by some skeptics is the possible existence of a placebo effect. However, there is anecdotal evidence that people have been helped by these methods. They have been used, for example, to deal with traumatic thoughts and uncomfortable emotions. For further details see, for example, Bender, Britt, and Diepold (2004).

1.2.6    Pain Management

I want to say something about pain management as pain can have a serious effect on our well-being.⁴⁵ Alternating Bilateral Stimulation, described above, has been used to help a person cope better with chronic pain.⁴⁶ An interesting aspect of pain is that there is a so-called pain gateway that can be used to ameliorate its effects. An unpleasant stimulus like a cut or sting, is detected by peripheral nerves in that area sending a signal to the spinal chord. The signal is then sent to the brain via a gateway and the brain then relays the message of pain to the effected area. In the spinal chord there are specialized nerves acting like gatekeepers that sort the signals according to their severity. For a life threatening signal, the gate is wide open and the signal follows an express route to the brain. For a weak signal (e.g., scratch), the gate may be partially closed or completely closed. However, the brain can work in reverse and close the gate by sending an inhibitory message back down. Pain management is using distraction to close the gate as much as possible, minimizing the signal to the brain.

There are three factors involved in the opening and closing of the gate; physical, emotional, and mental conditions.

Open

(a)   Physical conditions.

•   the extent of the injury

•   any inappropriate physical activity to stir up other nerves

(b)   Emotional conditions.

•   anxiety or worry

•   tension

•   depression

(c)   Mental conditions.

•   focusing on the pain

•   boredom

•   catastrophizing (e.g., I am not going to get better, or Life is not not worth living)

Closed

(a)   Physical conditions.

•   medications

•   counter stimulations (e.g., heat, cold, massage)

(b)   Emotional conditions.

•   positive emotions (e.g., self assurance, good information about what has happened)

•   relaxation exercise

•   rest

(c)   Mental conditions.

•   intense concentration as a distraction

•   involvement and interest in life activities

Using up all our attention with distracting thoughts or activities is one key to pain management. The aim is to involve all our senses. Some distracting thoughts and activities are:

•   pleasant peaceful image, dramatized image incorporating pain as part of the script (e.g., an escape), or a neutral image (e.g., plans for the weekend)

•   focusing on the environment instead of our body (e.g., reorganize the house, study, or garden)

•   rhythmic activity (e.g., counting, singing, playing a musical instrument)

•   solving problems (e.g., mathematics, chess, crosswords)

Finally I want to briefly mention the so-called phantom limb phenomenon where a person feels a pain in a limb that is no longer there, having been amputated. Various explanations have been put forward⁴⁷ and a recent one is the idea already alluded to at the beginning of this chapter that it is because of the brain’s plasticity.⁴⁸ There are exercises available to help a person with this pain or sensation problem.

1.3    PERSONALITY

1.3.1    Personality Differences

We all think and behave differently because we are different genetically and we are molded by different life experiences. Personality can be defined as a dynamic and organized set of characteristics possessed by a person that uniquely influences his or her thinking, motivation, and behavior.⁴⁹ The word personality originates from the Greek persona, which means mask, and in ancient theatre it originally referred to a mask that typified a character rather than disguising the character. True personality is the person behind the mask he or she wears.

Since personality is such a broad and difficult concept, it is perhaps not surprising that there are a number of different models that endeavor to categorize personality.⁵⁰ We meet terms like temperament, traits, and types, which sometimes overlap in their meaning.⁵¹ Temperament has been defined as a person’s characteristic way of approaching and reacting to people and situations⁵² and focuses on not what people do but how they go about doing it. It is largely inherited and tends to be fairly stable throughout life;⁵³ it has been described as the part of personality that is genetically based. Personality also has a certain stability, but it is molded by circumstances and environment.

1.3.2    Personality Models

One of the earliest personality models, dating from Hippocrates in ancient Greece, consists of the categories choleric, sanguine, phlegmatic, and melancholic. This model has been revived by LaHaye (1988) and Littauer (1992; she uses the terms powerful, popular, peaceful, and perfect).⁵⁴ Another model uses the categories of lion, beaver, otter, and golden retriever.⁵⁵ A questionnaire along with details for this model is available on the internet.⁵⁶

One other model that has been quite popular is the Type A and Type B personality model, where a Type A person has characteristics like impatience, excessive time consciousness, being unable to relax, and needing to be on the go. Type B people, however, are patient, easy going, and relaxed.⁵⁷ A test for type A or B is given on the internet.⁵⁸ In using such models, and I am uncertain about the statistical validity of some questionnaires, they can be useful in a relative fashion for determining the difference in say the personality profiles of members of a couple, as well as quickly providing some inside knowledge on an individual client. Many people have found some of the models mentioned above very helpful.

One popular traits model called the Big Five has a five-factor model consisting of factors that seem to underlie five groups of associated traits, and generally persist regardless of language and culture.⁵⁹ They are: (1) Openness to experience, (2) Conscientiousness, (3) Extraversion, (4) Agreeableness, and (5) Neuroticism (with acronym OCEAN).⁶⁰ A popular personality test based on the Briggs-Meyers test uses four types based on the typology model of Jung involvi-ing the pairs Extraversion/Introversion, Sensing/iNtuition, Thinking/Feeling, and Judging/Perceiving, giving 16 possible categories, for example ENFJ.⁶¹

There is one personality trait called alexithymia⁶² that varies in severity from person to person. It includes difficulty in identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal as well as difficulty in understanding other people’s feelings. Alexithymia places individuals at risk for other medical and psychiatric disorders while reducing the likelihood that these individuals will respond to conventional treatments for the other conditions. It is frequently comorbid with other disorders and overlaps with Asperger’s syndrome.

1.3.3    Learning Styles

Another area where we can differ is in our primary way of receiving or giving information. We can be one of three types of people, namely visual, auditory, or kinesthetic/tactile (i.e., seeing, hearing, and handling). Although we can do all three, one tends to dominate, which determines our learning style.⁶³ The visual person says, Do you get the picture?; the auditory person says, Do you hear what I am saying; and the kinesthetic person says, Do you grasp what I am saying? Sturt and Sturt⁶⁴ note that there are other clues about their style such as the profession or recreation they are attracted to. Their movements also differ when asked a question. For example, the visual person will usually look up before answering (just a slight flicker of the eyes), the auditory person will look to the side, and the kinesthetic will look down. Information about learning styles may or may not be useful in counseling a client. However, body language will sometimes give useful cues.⁶⁵

1.4    EMOTIONS, FEELINGS, AND THOUGHTS

1.4.1   Introduction

This whole subject is a difficult one as there isn’t agreement in the literature on the relationships between all three of the above concepts and how they interact. There is little agreement as to the nature of an emotion, and emotions are notoriously difficult to verbalize.⁶⁶ Part of the problem is that we don’t fully understand the nature of consciousness and how it occurs.⁶⁷ It seems that emotions can be regarded as unconscious processes that may give rise to conscious content and feelings; the memory is also involved. However, because of lack of clarity in the literature, I shall not enter into the debate but simply use the words feelings and (conscious) emotions interchangeably.

1.4.2   Emotions

As noted at the beginning of Section 1.2.2, the so-called limbic system making up certain parts of the the brain has been described as the source of emotions in the brain, that is the emotional brain. However, LeDoux⁶⁸ maintains that it is not just this traditional system that is involved in emotions but that different brain networks are also involved with different emotions. There are some cognitive processes that LeDoux⁶⁹ refers to as the cognitive unconscious whereby the brain does things like analyze the physical properties of a stimulus, help us play a ball game (e.g., table tennis), or help us to talk reasonably grammatically without awareness on our part. Also, the emotional meaning of a stimulus can begin to be appraised by the brain before the perceptual systems have fully processed the stimulus so that the brain can know something is good or bad before it knows exactly what it is.⁷⁰

From the above we see that much of brain processing is unconscious. What is perhaps more important however from a counseling point of view is whether a thought or an emotion comes first. The answer seems to be that either can be first, depending on the circumstances, and we begin by considering the relationship between the two. One aspect of this begins with the amygdala that is linked to our survival mechanism. It is part of the brain that initiates fight, flight, or fright responses in the face of danger and is deeply involved in responding to traumatic events. Sensory signals from the skin, ears, and eyes are received and processed by the thalamus.⁷¹ One part of the information is sent to the amygdala while the major part is sent by a much slower route to the neocortex, our thinking brain, for an appropriate and meaningful response. If the response from the neocortex is emotional, a signal goes to the amygdala to activate the emotional centers.

If the amygdala senses danger, it sounds the alarm and stirs the body into readiness for action before there has been any thinking and, soon after, the neocortex conveys a response to the amygdala. For example, if I see a projectile heading towards me I instinctively duck, or if I see a stick in my path that looks like a snake I take evasive action, but then I realize it is just a stick and begin to calm down. In addition to the fear aspect, which is closely linked to anxiety, there are times when we are swamped with feelings, apparently without cognition. The reason for this is that the connections from the cortical areas to the amygdala are far weaker than the connections from the amygdala to the cortex so that our conscious thoughts can get invaded by emotional information. The rapid response by the amygdala can, in some cases, be lifesaving while in others integration with the cortex is better. According to LeDoux,⁷² we have little direct control over emotional reactions and it is futile to fake an emotion.

Role of Memory

Memory plays a critical role in traumatic situations. During such a situation, LeDoux⁷³ notes that conscious memories are laid down by a system involving the hippocampus and related cortical areas, and unconscious memories established by fear conditioning mechanisms operating through an amygdala-based system. If a stimulus happens that was present with the initial trauma, both systems have the potential to retrieve memories of the event. The amygdala’s emotional memories tend to be deeply ingrained and underly anxiety disorders. We see then that one memory system stores conscious information about events, while another stores the emotional memories. In counseling it can be a matter of helping clients to use their cortex to control the amygdala and ameliorate those memories. Cognitive processing endeavors to help us make sense of an emotion or regulate it.

One model that is used to describe a response to a stimulus is the SIR (stimulus, image, response) model that follows the pattern stimulus → image → response. For example, whenever Joan walks into a crowded room she feels anxious. It transpires that she always has an image of herself fainting in a crowded environment as many years ago this happened to her. It is not the crowded room that causes the anxiety but the embarrassing image of her sprawled on the floor in front of everybody. A more general model is the SOR model where O is for organism and it represents an input from variety of processes from a person such as thoughts, beliefs, motivation, and so forth.

Basic Emotions

Are there such things as basic emotions? As might be expected, there seems to be no clear consensus as to what might be on a basic list.⁷⁴ However, given the variations in word meaning, the different lists available have a great deal in common and generally include anger, happiness, sadness, and fear (sometimes referred to as mad, glad, sad, and bad) or close relatives of these emotions. For example, Greenberg⁷⁵ found the emotions of anger, sadness, fear, and shame among the most important in therapy. Ekman⁷⁶ has given some evidence that certain emotions including anger, disgust, fear, joy, sadness, and surprise have universal facial expressions. For example, an angry face is recognizable in any culture.⁷⁷ He pointed out that universal facial expressions can be regulated by what he calls display rules that refer to modifications by learning and culture.⁷⁸ However, the role of culture and language in formulating emotions is not straightforward and some of these difficulties are discussed by Prinz.⁷⁹

The above basic emotions are also referred to as primary emotions and generally are felt first as a first response to a situation. These tend to followed by so-called secondary emotions which, confusingly, can also be other primary emotions. Such emotions can be reactions to the primary emotions or to thoughts about them, and clients find them troublesome, wanting to get rid of them.⁸⁰ They also cause problems for the therapist as they can obscure what is happening deep down with a client (e.g., depression or anxiety can hide anger, anger can hide fear, and so forth). According to Greenberg,⁸¹ primary feelings feel right even if painful, while secondary emotions are more disturbing and puzzling. A key aspect of therapy is for a client to name and experience a disturbing emotion and determine whether or not that emotion is primary—but more below. The only way to get rid of a problem emotion (e.g., fear) is to experience it first before it can be changed.

Emotional Processing

When it comes to isolated small or large disturbing emotional experiences, they are generally satisfactorily dealt with and the accompanying distress dissolved. This process by which emotional disturbances are absorbed or decline so that they no longer interfere with normal living is