Christian counseling approaches and practice

Christian Counseling

Presenting Problems

Diane seems to be undergoing many different problems that are present today because of her past. The way she was treated by her family and her husband now has gone to affect her psychologically and emotionally. The combination of post traumatic stress disorder, schizoaffective symptoms and previous satanic ritual abuse is very severe and psychological intervention is greatly required.

One of her presenting complaints is post traumatic stress disorder (PTSD) PTSD is a form of anxiety disorder that occurs as an emotional reaction to something that occurred in the patient's life. This trauma could be pain, injury, threat, or death of a loved one. (Valente, 2010) Some common examples of traumatic disorders are natural disasters, military combat or terrorist incidents. It is normal to have an adverse or a stressed response to a traumatic event. Normally, people come to back to their usual state of mind and are able to carry out their daily functions in a proper way.

On the other hand, there are some patients who are not able to recover their normal state of mind and their symptoms gradually worsen over time. Therefore, the complaints that Diane has of headache, dissociation, dizziness, and flashbacks; these are all linked to the stress and trauma that she was exposed to her entire life. Regardless of how old a person gets, they still have some sort of recollection of their time from their childhood. As a child, teen and an adult, Diane had to go through painful sexual and physical abuse. All of these events together made up the trauma that has gone to affect till now.

Another presenting complaint that Diane has is Satanic Ritual Abuse (SRA) This is a form of abuse or a ritual that has become very common in the United States since the 1980s. It has been reported that the individuals are sexually and physically abused in the context to satanic rituals. The victims of SRA often do require intense therapy and psychosocial counseling. It is problematic because these persons have been subject to the same rituals and habits ever since they are kid. Many a times, these kids go on to think that this is how their life is and they will have to deal with it their whole life.

In Diane's case, it is obvious that her childhood and teen perceptions have been deeply ingrained in her mind. Because these memories and experiences are so powerful, she still has dreams and hallucinations regarding these events. An amalgamation of the aforementioned disorders also leads to the development of schizoaffective disorder. Therefore, schizophrenic symptoms are the last complaint or notable problem that Diane is currently facing.

A study conducted by Weiss et al. (1999) stated that childhood sexual abuse is an early stressor that predisposes persons to adult-onset depression. This study concluded that the depression occurs due to the dysregulation of the hypothalamic-pituitary-adrenal axis (HPA) axis. It was also stated that women are more likely than men to get depressed because of childhood sexual abuse. It is seen that stress and trauma early in life does induce permanent changes in the regulation of hypothalamic-pituitary-adrenal axis. This therefore leads to increased vulnerability to depression and stress in adulthood. This study is one simple example of how Diane's early experiences have led to the development of this condition.

The symptoms that Diane has and the evidence that has been presented show that Diane does require crucial psychological intervention. It is true that the drugs that she is taking will help her with her condition, but she needs to be counseled in a proper way. The drugs will work better if she is psychologically treating through intervention, behavioral modifications and counseling.

The DSM-IV (American Psychiatric Association, 1994) states that PTSD can present as fearful memories and amnesia as well. In other words, where as some patients experience flashbacks of that horrendous event, others tend to completely forget what happened. From Diane's clinical presentation, it is clear that she has flashbacks and dissociative symptoms. Brewin et. al (2003) stated that the flashbacks are basically consisting of sensory details like weird visual images, sensations and other odd sounds. Along with flashbacks, these individuals experience dissociative symptoms and confusion that Diane has been experiencing. It is crucial for clinicians and psychotherapists to look into all the clinical problems that Diane is experience with. For instance, she should be treated for disturbances with memory, cognitive-affective reactions, beliefs, coping strategies, social support and attention.

Choice of treatment for Diane

Many different theories are considered when choosing to treat post traumatic stress disorder. We see that Diane is suffering from other dissociative disorders apart from PTSD. It has been stated that the way a person looks at things can go onto make a great impact on the way they feel. The major issue here is that Diane's way of life is affect and she cannot function properly. The combination of PTSD, SRA and schizoaffective disorder all show that Diane is very imbalanced intellectually, spiritually and mentally.

Regarding the treatment of PTSD, Brewin et. al (2003) went on to discuss three new theories in depth. Despite the array of theories presented in the treatment, most of the theories fell short while treating the disorder. As shown earlier, it is crucial to target all of the symptoms that the patient is having. It was concluded that Ehlers and Clark's Cognitive model is the most suitable for the treatment of Post traumatic stress disorder. This model therefore builds up on the notion that cognitive theory is the best treatment for trauma related stress and depression. Vieta (2010) also concluded that psycho education along with pharmacotherapy is very important for patients with schizoaffective disorder. Therefore, we conclude that cognitive behavioral therapy and more specifically Ehlers and Clark's Cognitive model is most suitable for Diane's treatment.

The approaches to the cognitive behavorial therapy are rooted in the fact that a person's thoughts and cognition play a very vital role in maintaining their behavioral and emotional responses to what is happening around them. Many studies have gone to say that the symptoms of PTSD get worse with the years and they should be handled well in the beginning. A reason why many other treatment regiments fail is because some symptoms of PTSD come out and persist till months later. These symptoms are listed as mental defeat (Ehlers et al., 2000) negative interpretation of the trauma (Dunmore et al., 1999) peri-traumatic dissociation, perception of permanent change in their life or in their self goals (Dunmore et.al, 1999) and many others. When keeping the Ehlers and Clark model in mind, it has been seen that late symptoms such as increase distress and negative interpretations have only been a result of the thought suppression methods that were used on patients before. (Clohessy & Ehlers, 1999) Halligan, Clark and Ehlers (2002) made use of a study to figure out how people responded after data driven and conceptual processing. It was seen that persons who were told to focus on the images and sound in the trauma film experiences more distress and PTSD symptoms than the ones who just had to notice what was going on. This study went on to conclude that the late variables that were stated before are specific to PTSD. In simpler terms, Ehlers and Clark stated that increased levels of memory disorganization were linked to data driven processing, peri traumatic disassociation, and decreased self-referent processing. Therefore, the major stress is given on cognition and this is exactly what the theory targets. This model has gone to increase the understanding of the negative symptoms that still persisted despite treatment. In early trials, this therapy has shown to be very effective in community based intervention and early intervention for PTSD. (Gillespie et.al, 2002)

Currently, it is seen that the Ehlers and Clark model puts more importance on the way stimuli are perceived during trauma. The main emphasis therefore is on the stimuli rather than on the memory that is created. This shows that the cognitive therapy used the model of autobiographical memory. This model therefore reflects the mechanism of maintaining and sustaining the treatment of PTSD. This model has gone to understand the negative appraisals and has come with cognitive factors that affect the course of this disease. It has been proved that the patient experiences decreased negative appraisals when treated through this model.

This theory is most suitable for Diane because she has a lot of other symptoms as well. Where Diane experiences flashbacks, she is also suffering from confusion and hallucinations. The emotional response theory relies heavily on suppressing the fearful memories. If we were to use this in Diane's case, her flashbacks would cease but the other symptoms would have persisted.

Cognitive therapy

There are two CBT protocols to the treatment of post traumatic stress disorder that serve to explain the way fear is processed and developed in the person. These two orientations are emotional-processing theory & learning theory. Ehlers and Clark (2000) stated three main goals for the treatment of PTSD. It is very crucial to eliminate dysfunctional behavioral and cognitive strategies, secondly it is important to take out any negative appraisals and lastly, there should be decreased re-experiences of the traumatic memory. It is important to note that the therapist should make use of all these points. Treatment would not be successful if the therapist were to rely just on the emotional processing theory and forget the other theories.

Ehlers & Clark (2000) emphasized on the fact that individuals who suffer from prolong PTSD do not consider the trauma limited by time. In other words, even though the trauma had occurred way back, they still think that they can be harmed and that their life is in danger. Therefore, a major purpose in this therapy is to remind and restate that what happened in the past is over now.

The learning theories state that the environmental cues that bring back fear and memory associated with the event should be removed. Wolpe (1976) emphasized that a person should avoid traumatic memory and any trigger that will activate or reinforce those memories. It is important to see and observe what conditions can trigger fear in that person. A patient of PTSD can view being in an elevator alone as a dangerous situation due to an assault that could have occurred in an elevator before.

Therefore, when working through this theory, it is important for the person to take on an avoidant behavior that keeps away from these sorts of triggers. Another basis through which PTSD patients are treated is the way they cognitively and emotionally process something that has occurred. (Clark & Ehlers, 2004) As mentioned earlier, a PTSD is considered persistent if the individual recalls and experiences a bad event just as he experienced it the first time it happened. Therefore, we see that the major purpose is to teach the patients how to pinpoint, evaluate and reframe the cognitions that are linked to the trauma. This will consequently contribute and avoid the bad emotions and any reactions that were linked with the trauma.

Patients who are suffering from PTSD always go on to render themselves very weak and incompetent. Their past experiences have shattered their defensive ability and they think that they cannot fight anymore. Along with that feeling, these patients feel that the world is a very bad place and that everything bad will happen to them. They do not have any good hopes and feelings about the world.

The goal of therapy for PTSD patients is that they need to be taught strategies that will help them cope with their stress. These clients need to identify and restructure their beliefs and their thoughts about what happened to them. Another thing that is crucial in this therapy is evaluating the negative and irrational cognitions through validity and functionality. In other words, the patient and therapist can talk about the chances of something bad happening to them. The patient can be convinced with evidence, and this will work to change his thoughts and reframe the irrational thoughts that he has been having. In other words, the major goal over here is to give rise to more rational, balanced and functional perceptions of the world, the future and of the person himself. It is very important for the therapist to see how the person feels about himself.

Our patient Diane was also suffering from dissociative symptoms. Morrison (2009) has stated that cognitive therapies have been used to treat people with schizoaffective disorder. Schizoaffective disorder is a disorder that causes the person to lose touch from reality and have mood issues. It is apparent that Diane has never had a healthy relationship with many people. Going through a traumatic childhood, she needed comfort and securities form her husband. Schizoaffective order could have been a result of these experiences or they could be due to the medicines she is taking. This shows that Diane is in need of counseling and therapy along with medications. The hallucinations that Diane is having is just exacerbating her symptoms. Increased trauma has caused Diane to lose touch with reality and has resulted in these symptoms. The satanic ritual abuse (SRA) that Diane went through just added on the traumatic experiences that she has had. It is not clear whether Diane is in favor of these rituals but it was seen that she never tried to stop them. This aspect of Diane's condition can be healed better through the spiritual and emotional ways that will be discussed below. This was inflicted upon Diane as part of religion. It is quite clear that Diane needs to be strong and stable before she can re connect to her spiritual and less violent side of religion.

Cognitive therapies basically help the person smoothly move from their current state of mind to a better one. A very important point to notice is that cognitive therapies slowly transition and alter the person's thinking. In contrast to medications, these patients therefore do not experience sudden spikes and falls in their moods.

Religious insight into cognitive approach to PTSD

When therapists are utilizing cognitive therapies to treat disorders like PTSD and schizophrenia, religious and spiritual beliefs should be considered a great deal. Many people have their set of beliefs that they will continue believing no matter what happens. Park (2005) emphasized that people have used and relied on religion to define whatever happens in their life. It should be noted that people can use religion in varying ways. A therapist should establish a good relationship with the patient so he tells about his religious orientation. If a person is adherent to maladaptive beliefs, no amount of psychological therapy will make a difference to their condition.