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Welcome to a practical pastoral counseling site of Dr. Harold L. White

 Every pastor can be a valued and competent counselor.

Recognizing Problems

An individual is considered mentally healthy if he is in contact with reality and he is sufficiently free
of anxiety so that he is not significantly incapacitated functionally, socially, or biologically for
any extended period of time.

In contrast, an individual with clear-cut mental health problems may have lost contact with reality;
or be so filled with anxiety that he suffers significantly biologically, socially, and functionally.

Symptoms that all people have (anxiety, fear, depression, worry, guilt, body aches
and pains, etc.) increase in magnitude and occur more often in these individuals.
Their biologic functions (sleep, appetite, sex) are impaired.
Their social interaction suffers.
Other people may know that something seems wrong.
They may be functioning poorly in their jobs.

Defense mechanisms -- healthy and unhealthy ways to handle anxiety

The way anxiety is handled often determines the type of mental problems that develops.
The particular way the individual handles the anxiety is determined by defense mechanisms.
Defense mechanisms often operate on a subconscious level.
So, a person may not be immediately aware of the reason he does something.
And, if he is not careful, he may justify inappropriate behavior and even justify sin.

Some defense mechanisms are good and healthy, but others are not.

For example, the first defense mechanism is projection which can be an unhealthy
defense mechanism by which one attributes to someone else his own thoughts and feelings.
A Christian who reacts drastically to specific faults in others may actually be projecting
his own faults.

A second defense mechanism is reaction formation.
Through a reaction formation, an individual does exactly the opposite of what he would like to do.

A third defense mechanism is rationalization.
This is a defense mechanism that many use to avoid responsibility.
Not only is there a danger of rationalizing irresponsibility but it is also a sin.
Even godly people have rationalized to permit their behavior;
yet their rationalizations usually cost them.

A fourth defense mechanism is introjection.
Introjection is often used by depressed individuals to assume responsibility for events outside
their realistic control.
This explains why depressed individuals so often feel guilty when they are really guiltless.
Introjection in adults is usually unhealthy.

A fifth defense mechanism is repression.
Repression is basic to all other defense mechanisms.
Repression is the involuntary exclusion of unwanted thoughts from consciousness.
So, an unwanted thought, such as the true reason for an inappropriate behavior,
is first repressed, and then, a second defense mechanism is used such as rationalization to
justify the inappropriate behavior.

A sixth defense mechanism is suppression.
Suppression is the conscious analogue of repression.
It is the voluntary exclusion of unwanted thoughts from consciousness.

A seventh defense mechanism is compensation.
By compensation one excels in one area because he feels inferior and another.

An eighth defense mechanism is idealization and identification.
This is the overestimation of desirable traits in another.

A ninth defense mechanism is isolation.
Isolation is the splitting off of an emotion from an event or thought.
By this, many individuals with obsessive-compulsive personalities avoid being in touch
with their emotions.
They seem to endure disturbing events with only a little emotion.
Of course, the emotions are there; they are just not in touch with them.

The tenth defense mechanism is displacement.
Displacement defends the individual by shifting the emotional component of one event
to another event or person.
This explains why, when a man has a difficult day at work, he explodes at his wife the same night.
Hysterics often displace anxiety onto their bodies by developing various physical problems.

Often, how and when defense mechanisms are applied, determines whether
they are detrimental.
One can predict with a good deal of accuracy the defense mechanisms that will be used
by an individual with a particular mental problem.

For example, the hysteric will usually use denial and displacement.
The obsessive-compulsive will usually use isolation, reaction formation, undoing, and magical thinking.
The schizophrenic uses fantasy and regression.
A paranoid uses projection.
The depressed person uses introjection.

Pastors must be extremely careful when using psychiatric diagnosis, but to go to the other
extreme of not using them is equally harmful and unreasonable.

Mental problems can be broken down into 10 major categories.

These categories are: mental retardation, organic brain syndrome, psychosis
(a loss of contact with reality), neurosis, personality disorders, psychophysiological
disorders, special symptoms, behavior disorders of childhood and adolescence,
transient situational disorder (and nonspecific conditions).

  --This information is developed in detail by Frank B. Minirth in his book,
    Christians Psychiatry.

Personality Traits And Disorders

All individuals have certain personality traits.
Most people have a spread of different personality traits with perhaps a predominance of one.
This is healthy.
On the contrary, one particular personality trait may lead into a personality disorder.
This is not healthy.

A personality disorder is characterized by: being lifelong, manifesting a particular
life-style (mentally unhealthy and maladaptive), and by the excessive use of certain
predictable defense mechanisms in order to handle anxiety.
When a person carries a trait to an extreme, it becomes a disorder.

Below are some descriptions of personality disorders.

Hysterical Personality
This is the emotional individual.
The diagnostic manual for psychiatry uses ten terms to describe an hysterical personality.
They are excitability, emotional instability, over reactivity, self-dramatization,
attention seeking, seductive, immature, self-centered, vain, and dependent.

An individual with an hysterical personality develops a life-style early in life characterized
by self-centeredness, manipulation, and seduction.
This life-style has persisted with the person throughout life.
An individual with hysterical traits is usually attractive, likable, and has a winning personality.

Obsessive-Compulsive Personality
The perfectionistic individual is characterized as being perfectionistic, being intellectual,
and having oppositional thinking.

First, these individuals are perfectionistic in many ways.
They do their jobs and do them well.
In fact, they work too hard, are too dutiful, are too conscientious, and are unable to relax.
They are neat, clean, orderly, and meticulous.
They are concerned with details in their work.
They never feel they have done enough.

Secondly, these individuals are intellectual.
They are concerned with facts, not feelings.
In fact, they have trouble expressing how they really feel but are great
at intellectualization.
They seem cold, formal, and rigid.
They could argue at length on how many angels could sit on the head of a needle.
They are logical, rational, and cautious, but are lacking in flexibility.

These individuals also tend to be oppositional in their thinking, which can make therapy difficult.
If someone said, " Yes," on a subject, they would tend to think, " No."
And the reverse would also be true.
This complicates their problems with authority.

On the one hand, they have a need to conform and usually seem overly meek and compliant,
but on the other hand, they resent this.
Since they tend to always disagree, the problem with authority is further complicated.
Finally, because they split hairs and cling to tiny distinctions, their problem
with authority is accentuated.

Most successful people have some of the above traits.
However, if extended from a trait into a personality disorder, the trait can control an individual.

Paranoid Personality
This is the suspicious individual.
These individuals are characterized by being overly suspicious.
They do not trust others.
Actually, they may have evil motives which they cannot admit to themselves,
so they project them onto other people.
So, if they feel hatred toward someone, they feel that that person does not like them.
We dislike in others that which is often present in ourselves.
These traits do make a person sensitive and discerning, and this can be helpful,
if not carried too far.

Cyclothymic Personality
This is the moody person.
These individuals are characterized by being either depressed, elated, or alternating
between the two.
When these individuals are feeling high, they have a bubbly personality, and are outgoing and likable.
They have a tremendous amount of energy and can be very successful.
They can do a dozen things at once.
When these individuals are feeling low, they are sad, blue, and feel hopeless and helpless.

Schizoid Personality
This person is a loner.
These individuals are characterized by being shy and socially regressed and withdrawn.
They would often rather be alone, and may seem to be caught up in their own thoughts,
daydreams, and fantasies.

Explosive Personality
This person is explosive.
These individuals are emotionally explosive when provoked.
They have outbursts of temper and may become violent.
These individuals are usually likable who have good personalities until they are put
under emotional pressure.

Antisocial Personality
This is the criminal.
These individuals are characterized by a lack of conscience, or, at least,
an impairment in this area.
So, they do not feel guilt for wrongdoings.
Furthermore, even though they may go through repeated conflicts with the law,
they do not seem to learn from experience.
These individuals are likable and have winning personalities.

In addition, they are manipulative so they are good at conning people.
These individuals feel little responsibility toward anyone but themselves.
They feel they are "OK" but that everyone else is not "OK."
They are more likely to resist the gospel than any other one group.

Passive-Aggressive Personality
These individuals are characterized by often being very passive in their
responses to others.
They have learned to accomplish their desired ends by passive means.
They may be stubborn, pout, put things off, be late, and use various other
passive-aggressive techniques.

Inadequate Personality
These individuals are characterized by just being generally inadequate.
Often they are socially inadequate and have problems dealing effectively with others
in interpersonal relationships.
They are inadequate in handling stress.

Asthenic personality
This is the fatigued individual.
These individuals are characterized by being generally weak and fatigued.
They have low energy levels.
They may have various body aches and pains.

All the above information concerning personality traits and disorders is perhaps
most useful in marriage counseling.
Numerous combinations could be formed.

One of the most common types of marriages is the obsessive-compulsive man
who is dutiful, conscientious, concerned, and has a strict conscience.
He is attracted to a female who is somewhat the opposite of him in many ways.
She is emotional, excitable, dramatic, theatrical, and seductive.
He finds this dramatic, emotional, seductive nature pleasant at first.
She arouses pleasurable emotions in him.

Likewise, she is attracted to him since he has many opposite traits than she.
She likes his non-emotional, stable, logical, father-figure image.
Each finds in the other what he lacks. 
(this is symbiosis -- meaning that it takes two to make one.)

He lacks emotions.
She arouses this in him.
She lacks logic and stability.
She likes the apparent stability she finds in him.
Thus, while they can really complement each other (since he can't feel and she can think),
they may begin to become irritated with each other.
He may grow tired of her dramatics, and she may grow tired of his cold logic.
If both are relatively immature, the stage is set for a lifelong battle
of conflicting personality traits.

The second type of marriage is the passive-aggressive husband married
to the passive, aggressive wife.
Both are passive and immature.
Both want to receive more than they give.
Both are overly dependent.
Neither is able to understand the needs of the other because they are so self-centered.

A third type of marriage is based on a neurotic attraction is the passive husband
and the dominant wife.
Each feels a neurotic need for the other.
He has a need for someone to lead, to be in charge, and to dominate.
She has a need to lead, to be in charge, and to dominate.

Conflicts arise because he is inwardly hostile at being dominated, and she is frustrated
by not having her own dependency needs met.
This is also a parent-child type interaction, but here she is the parent and he is the child.

A fourth type of marriage is that of the paranoid husband and the depressive wife.
This is the sadomasochistic type relationship.
He is jealous, hostile, angry, and has a need to hurt others.
She is prone to depression, has a low self-image, and readily accepts blame.
In short, she has a need to be hurt.

His main defense mechanism is projection by which he attributes his own
shortcomings to her.
Her main defense mechanism is introjection by which she assumes blame
for things she didn't do.

Often, the female in this relationship had critical, demanding parents.
She subconsciously sought out the same time of parental figure in the man she married.
Accepting blame became a way of life.

A fifth of type of marriage is the paranoid wife and the depressive husband.
It's just the opposite of number four above.

A sixth type of relationship is the asthenic wife and the obsessive-compulsive husband.
She is sick (both mentally and physically), and has an need for someone to
totally take care of her.
He feels inadequate in the world and has a need to take care of someone
who is weaker than he is.

Conflicts arise because she begins to resent being totally dependent on someone else,
and he begins to resent the drain he feels from her continuing sickness.

A seventh type of marital relationship is that of the obsessive-compulsive husband
and the obsessive-compulsive wife.
Both may be overly perfectionistic, demanding, and critical.
Because they can hardly live with themselves, they may have difficulty with each other.
Of course, if they are relatively healthy with their obsessive-compulsiveness,
they can have a very orderly marriage.

Minirth deals with the technique of counseling in another chapter, but it should be said
that the marriage counselor has various roles.

He is a listener.
He is an observer of communication patterns.
He is one who confronts and points out games and detrimental defense mechanisms. 
He helps the couple gain insight into their personality types.
He helps them to formulate a specific plan of action to deal with their problems.

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