Short-term Care

I find it is not only possible but imperative, especially in short-term counseling, that we start solving problems in the very first session.
—Jim Smith

Short-term counseling may be short, but it’s not necessarily simple.

Jenny’s daughter was getting married, and Jenny wasn’t happy. Of course, Jenny recognized that her daughter Lynn, who was in her late twenties, was old enough to make her own decisions. Jenny also knew that Lynn was marrying a Christian young man with a good career. But Jenny still wasn’t happy.

For one thing, Lynn had announced that the wedding would take place in just two months. That gave Jenny hardly any time to plan. She had always dreamed of Lynn’s wedding as the event that would make everyone forget Prince Charles and Lady Di—a thousand guests, a lavish reception at the finest country club in Dallas. But with the event only two months away, there was no time to plan the wedding of Jenny’s dreams. The dream was scaled down to a backyard wedding with 300 guests.

Moreover, Lynn’s fiancé was not exactly everything Jenny had hoped for in a son-in-law. Before becoming a Christian, he had been involved with drugs and a wild lifestyle with the wrong kind of people. Though he had straightened out in recent years, he was a young man with an unsavory past, whereas Jenny’s daughter, Lynn, had been raised in a sheltered, white-bread, suburban environment.

When Jenny came, she was grieving her dream. “If Lynn would only wait a few more months,” she told me, “it could be such a beautiful wedding. But she says she doesn’t want a big wedding. She just wants to be married to Scott. Why are young people always in such a hurry? They have so many years to spend together, but they have to get married in a rush.”

“Parenting has its limitations,” I said. “It’s hard enough to influence the will of a toddler. But Lynn’s a full-blown adult, with the right to live her life as she pleases—and even to make a mess of her life, if that’s what she wants. You can talk to her and share your perspective, but she’s calling the shots now.”

I talked with her about the parable of the Prodigal Son, and about how Jesus packaged that parable with the stories of the lost coin and the lost sheep. She took some encouragement from these parables. “I know I need to let go, that I can’t run her life,” she said. “And I’m grateful for the fact that my relationship with Lynn is strong—even though we can both be hard-headed at times.”

We talked together for the better part of an hour. I listened carefully not only to Jenny’s expressed feelings, but also for the hidden emotions she might not even be aware of. In the end, we both agreed that she would have to do her grief work while publicly being as happy for Lynn as she could. She left my office determined to make the best of what was in her mind a very imperfect situation.

A lot was involved in that short encounter. It was not a matter of simply consoling a concerned mother. A number of skills and personal experiences helped shape how I handled that.

In fact, short-term counseling is one of the most effective ways I help people, provided I keep a few things in mind.

Short-term Versus Long-term Counseling

I need to keep in mind the difference between the purposes of short- and long-term counseling.

The goal of long-term psychotherapy is to bring about basic changes in the habits of the counselee. And this process of breaking down old patterns and installing new ones takes a great deal of time.

Short-term counseling can be a powerful and effective tool for helping people in immediate emotional and spiritual trouble. It usually involves addressing some sort of immediate crisis or event in the counselee’s life, helping people through the aftermath of a significant loss or through an important transition—jobless, grief, torn friendships, loneliness, parenting problems, marital disputes. And short-term counseling by definition is brief: four to eight weeks.

Premarital counseling is perhaps the most common situation in which pastors do short-term counseling. Premarital counseling is usually not focused on a pathology. Rather, the goal is to map out the road ahead for two people embarking on the journey of life’s second greatest commitment.

I see myself as a river guide to people who are about to take a white-water rafting trip (a pretty close approximation to marriage at times). Telling a couple, “There are some rapids two miles downstream, but the rough water won’t last long, so don’t panic,” helps steady them through the turbulent waters.

I also want to establish a relationship so that the couple will be willing to turn to me when, down the stream, things become too bumpy for them to handle themselves. And in four or five visits, such limited but important goals can be met.

Assessing the Situation

The first task, then, is to determine whether the person in my office needs short-term or long-term counseling. So, in the first counseling session, as I listen to the counselee, I ask myself a number of questions. If I answer no to most if not all of these questions, then I’m probably safe in approaching it as a short-term counseling situation.

Is there an on-going family or personal conflict going on in this person’s life? Is there a repeated pattern in this issue?
Is addiction evident in this problem?
Is there evidence of obsessive/compulsive behavior with this problem?
Is there a long-term pattern of abnormal behavior?
Is this an issue that requires a specialist?

Suppose a man comes in for counseling and says, “Pastor, I’ve had an affair. I feel shame and guilt. I feel I’ve betrayed not only my wife but my kids, my church, and my Lord as well. What can I do?” I mustn’t assume anything about this man and his affair. I have to ask questions like: Was this affair a “one night stand”? Is it an on-going relationship? Is it part of a long-term habit in which he moves from affair to affair with a succession of women?

The man who falls into sexual temptation for the first and only time during his twenty years of marriage is an entirely different case from the man who has been using sexual promiscuity as a way of building his ego or proving his masculinity or comforting himself.

Both men need to find God’s forgiveness, but the second man needs to understand what is driving him to his bed-hopping life-style. He has a problem with compulsive behavior, and he needs some long-term psychotherapeutic counseling to understand why he does what he does.

The first man needs simply to understand what led to his one fall and what steps he can take to prevent that happening again.

Another key question in the first session is Are there multigenerational issues involved? In the field of addiction, for example, some studies indicate that people can be tilted toward addictive behavior by both genetic and environmental factors.

In terms of this man’s infidelity, I might find that his problems are part of a family pattern: his father was a womanizer; his sister has been promiscuous all her adult life; his brother has been married six times. It quickly becomes apparent he was raised in a family that did not produce emotionally healthy people.

This is a very different case from the person who says, “I came from such a good family, and I’m ashamed of the way I’ve violated my upbringing.”

Sometimes, then, the answers to these questions point to hidden issues, lurking under the surface of the counselee’s awareness, like the hidden bulk of an iceberg. But sometimes it’s a simple case of “what you see is what you get.” Some problems are just a matter of bad timing, bad judgment, or poor choices. These problems can often be corrected with four or five hours of counseling.

The Pastor’s Biggest Temptation

During that first session, the pastor faces a grave temptation: to ease people’s pain.

Eloise comes in for grief counseling. Roger, her husband of over thirty years, died two weeks ago. I help her with her grief. I pray with her. I share Scripture with her and reassure her of the reality of heaven and the resurrection. I relieve her pain. I send her on her way.

And I do her a tragic disservice.

In Eloise’s case, there was more than grief to deal with. She was enmeshed with her husband Roger in an unhealthy way. She had submerged her own identity within his. She had never had a life of her own. Now she’s beginning to transfer her dependence to her son. There are major issues of codependency involved. Yet, in my eagerness to salve Eloise’s pain, I missed all these other issues. There is a malignancy growing in Eloise’s life, and I have handed her a Band-Aid.

We pastors are generally a tenderhearted lot. Sometimes we’re so anxious to get people out of their pain we make the biggest mistake of all—missing a long-term symptom while doing short-term counseling. In fact, if there is one mistake I regret more than any other in my pastoral career, it is the mistake of being too eager to move people out of their pain when it would have been better to leave them there just a little longer.

I’ve learned never to assume anything, never to jump to the conclusion that a situation only needs some prayer and some biblical reassurance. People often hide the core issues of their problems even from themselves. By letting people off the hook too quickly, we become unwitting accomplices in their denial, their compulsions, and their sins.

Another example: a single woman comes in hurting because she is sleeping around. She is embarrassed and ashamed and condemning herself. It is tempting to jump in and try to relieve her shame, offer her God’s forgiveness, and get her to stop being so hard on herself, but the question I should really be asking her is, “Why are you beating up on yourself? Why do you keep going back to this behavior you despise so much?” It would be a major mistake to rush in and give her an anesthetic before I find out where she hurts and why.

Expectations and Assignments

Assessing the problem is the key task in the first session—but it is not the only task. Once I’ve determined that counseling will be short-term, I immediately get to work.

First, I need to determine what the counselee expects to happen in our sessions.

In marital counseling, for example, I ask both the husband and the wife each to summarize the problem as they see it. Then I ask how each would like their marriage to be different. That tells me what they expect (or at least hope) to achieve in counseling. Sometimes I’ll write those expectations on the blackboard so that we can fix the goal firmly in our minds.

Then I set a contract with the couple for a counseling term of between four to eight sessions. At the end of that term, we can determine together whether we want to renew the contract for another four to eight weeks.

Having a definite time frame tends to focus everyone’s mind on the task at hand. It also eases the counselee’s anxiety: Many people are apprehensive about counseling because they fear it may go on forever, draining their time and resources without ever achieving closure. Short-term counseling should take place within limits that are agreed upon at the outset.

In short-term counseling, my goal is to help counselees understand (1) why they do what they do, (2) what they would like to do differently, and (3) how to do things differently. Assignments move us more quickly to that last goal; so by the end of the first session, I usually assign projects during the week.

Giving the counselee an assignment is especially important in short-term counseling, because we have only a limited number of 50-minute sessions to get the problem out in the open and resolve or manage it. Assignments help both the counselor and counselee “cut to the chase” and quickly expose the issue. I use three types:

• Readings. If the counselee needs to understand better his childhood, for instance, I may assign a book that describes various parenting styles and the kinds of problems those styles often engender in adult life. The counselee can read that book at home and get insight into whether he was over-indulged, over-corrected, neglected, driven toward over-perfectionism, and the like. The next time we get together, the counselee has already progressed a few miles down the road toward understanding his problem.

• Journaling. A journal forces a person to consciously reflect on her choices and feelings. Sometimes I ask a counselee to record her self-talk during the day: Am I down on myself—or my own best encourager? Am I upbeat about the future—or a defeatist? A journal gives us a record of moods and attitudes, almost like an emotional electrocardiogram.

Some people, particularly those who are in an addictive cycle, journal almost hourly. (Although most compulsions require long-term counseling, some can be dealt with effectively in four or five weeks.) They carry a pad or a book with them and record their thoughts, feelings, temptations and compulsions, and the things that worked (or didn’t work) in dealing with those temptations and compulsions. It’s a way of forcing themselves to live consciously, reflectively, and volitionally instead of merely drifting through life on the autopilot of their destructive habits.

• Homework. These are tasks I ask people to undertake to help them grapple with their problems.

In counseling couples filled with anger and resentment against one another, for instance, I might try to find small ways to reverse that hostility and immediately get things moving in the right direction.

For example, I’ll tell the husband that he has to do something very special for his wife at least once a day until our next session. He has to write it down on a list that he will bring to the next counseling session. But he’s not allowed to announce to his partner, “Here’s your goody for the day.” The wife has to do the same.

This assignment does several things. It gets each partner focused on the needs of the other. It begins a pattern of kindness toward each other; often, kind feelings will follow kind acts, and healing will begin to take place. It also gives the couple hope. They begin to think. Maybe we’re not doomed to divorce after all. Maybe there’s just a chance we can work this thing out.

Without such an assignment, the couple would come in and dump their hostility on my office floor, then leave feeling as angry and bitter as when they came. When couples are in conflict, it’s vitally important to get the healing started as soon as possible.

• Writing. This is a little different than journaling in that I pose a number of questions and ask the counselee to come to the next session prepared to discuss the answers to these questions. For example:

—What was the warmest room in the house, emotionally speaking, when you were growing up?

—Think of your mother. What are some key words that come to mind when you think of your mother?

—Think of your father. What are some key words that come to mind when you think of your father?

—How did your parents feel about money?

—How did your parents feel about sex?

—Who was the chief disciplinarian in your home? How did that person feel about the disciplinary role?

These questions get at much of the same information I would otherwise seek in the counseling hour, but I’m able to progress with the counselee much more quickly by giving these questions as a writing assignment.

While some therapists believe that the first counseling session should be spent just gathering information, I find it is not only possible but imperative, especially in short-term counseling, that we start exploring solutions in the first session. I want to build hope in the very first hour, and assignments are one of the tools for building hope. Assignments give counselees a sense that they’re already moving forward, the process is in motion, and insights are beginning to surface.

Intentions

In the first session, I try to find out what help the counselee expects to receive from me. In the second, I try to discover what counselees intend to bring to the process themselves. The second session has to answer this question: How serious is the counselee?

I assess the counselee’s seriousness by asking how he or she did with the assignment I gave in the first session.

If the counselee has read or journaled or done homework as I assigned and returns to the second session brimming with insights and understanding, then I have a pretty good idea that the counselee’s intentions are sincere. The counselee is prepared to work, and so we continue.

But sometimes counselees haven’t done the assignment—”I just didn’t have time,” they’ll say. Then it’s time for me to explore a little and respond according to what I discover. The main reasons for not completing assignments are these:

• Sloth. After a little discussion, I sometimes sense the counselee is just lazy. So I’ll respond, “Are you really serious about what we’re doing here? Is this a priority in your life or are we just kidding each other? Are you being honest with me and with yourself about your commitment to wholeness?” Often that awakes them, and they begin taking their problems more seriously.

• Looking for magic solutions. Some people come and nearly expect me to wave a magic wand over them and make their problems go away. Such people need to have a bucket of cold reality splashed in their faces. I sometimes ask, “Do you realize that marriage takes work? Or do you expect me to do all the work for you?”

If a couple says to me, “We just want to feel good, to have those passionate feelings we had when we were first married,” I’ll reply, “Well, gee, last week I accidentally sat on my magic wand and broke it.”

In fact, a counselor friend of mine has an actual wand—a stick with glitter and stars on it—that he pulls out and waves over people when they make such statements, just to show them how ludicrous their expectations are.

• Avoidance of pain. Sometimes people seek an anesthetic for the symptoms not a cure for the disease.

Some people, for instance, are desperately lonely. They come for counseling because they view the pastor as a genial father or caring friend. They tend to avoid the homework assignments because those assignments make them face the pain of their loneliness.

Often, such people are difficult to keep in therapy. The moment you are able to soothe their pain to a point where they can stand it, they disappear. They were never really there to make changes in their habits and their attitudes. They just came in to get their level of pain down to a tolerable threshold. If you confront their pain too boldly, they’ll feel threatened and drop out.

Such people, then, need to be dealt with gently but still directly: “I’m concerned that you didn’t do your assignment. I imagine it was painful to deal with, but unless you’re willing to do the assignments, it’s not going to do much good to continue to see me.”

• Outright resistance. Some counselees display anger or irritation with the assignment: “This assignment was stupid! I came here to feel better, not to get loaded down with a lot of ridiculous home-work. I’m not in the seventh grade, for crying out loud!”

In such cases, I try to find out who else they’ve been resisting and who I represent to them—mother, father, spouse?

In any event, strong resistance to homework assignments tells me that the counselee’s defense mechanisms have kicked in—and that’s a clue that deep, long-term emotional forces are at work in the counselee’s issues, and that usually means referral.

These people too must be handled gently: “You know, I asked you to do some very simple things for your own insight and benefit, and you appear to be very resistant to doing them. I sense your resistance is actually part of the problem. I sense that your issues are going to require some long-term help, so I would like to refer you to someone who is very good at helping people with these kinds of issues.”

I’m available to help people in any way I can—to identify and clarify their issues. But I don’t heal anybody. God and the counselee must do the work of healing. If counselees are willing to work, change will take place. If not, I can’t do the work for them. People have to solve their own problems.

Closure

Howard is a successful attorney. Several years ago, he sat in my office with his wife June, weeping and moaning and calling himself “a failure.” His salary could have fed, clothed, and housed five median-income families in my church, yet he and his wife were drowning in debt and headed for bankruptcy court. They had no idea where their money went, so in one of our early sessions, I gave them the assignment of making out a budget.

The next week they came to my office, and I asked to see the budget. They hemmed and hawed and made this and that excuse. So I grabbed a pad of paper and said, “Look, this is not brain surgery. It’s just a family budget. I’m getting the sense that the two of you just don’t want to deal with reality. So we’re going to draw up a budget right now. Howard, how much do you make?”

“A hundred-fifty K.”

“Good. Now that puts you in the 28 percent bracket, so let’s just take off $42,000 for Uncle Sam. That leaves $108,000.”

“Well, I have to pay my own Social Security,” he said, and I figured that in. “And there’s my pension,” he added, and I subtracted a little more. He spoke and I wrote until we had whittled his income down to about $94,000 of disposable income. We divided that by 12, which came out to about $7,800 for Howard and June to spend each month. Then we added up all their fixed costs for each month, and those figures totaled $8,500. We discovered that they were hemorrhaging at a rate of $700 a month.

“Now you can see,” I said, “why you are going in the hole to the tune of $700 dollars a month—a total of over $8,000 a year.”

“But I make $150,000 dollars a year!” Howard protested.

“Howard,” I said, “you don’t make $150,000. You make less than $8,000 a month.”

Then I saw a light come on in Howard’s eyes—and June’s. “I think I finally understand,” said June. “I’ve been thinking Howard makes $150,000, and that anyone making that kind of money is entitled to a certain kind of lifestyle. I never looked at it in terms of finite numbers before.”

As we continued talking, it became clear that a large part of the problem was that June had been treating credit cards as a source of unlimited wealth. She had been raised in an extremely affluent environment, and she had always used her father’s credit cards as a kind of magical money tree that paid all the bills. She had never in her life had to think in terms of a limited amount of income. Sitting in my office with the facts staring her in the face, she frowned and said, “I really have to deal with this.”

I said, “Yes, you do. We have worked out a budget of so-called “fixed” expenses that exceeds your spendable income. But I have a feeling a lot of these fixed expenses are really optional. The two of you can live on the money Howard makes. Ninety-five percent of the people in this country live on considerably less. But you are going to have to make those choices. You are going to have to eliminate many of those expenses so that you can get to a point where you are living on a thousand or two less than you make each month and start paying off your debts.”

I could see that my words were painful to them, and they were exhibiting some resistance. I added, “If you choose to live in reality, it will take you only about five years to get out of the fix you are in. But if you choose not to live in reality, if you clutch the illusion that you are making $150,000 a year, you will be filing Chapter Seven within twelve months. It’s your call. I’m not going to come to your house every month and lecture you and help you pay your bills. You have the ability to put your financial house in order. Only you can decide to do that.”

At that point, our hour was over. I had done all I could. We had uncovered the facts and recorded those facts on paper. They had a copy of the budget, and I kept a copy for my records, so we wouldn’t have to go over it again in the future. They knew what they had to do.

We had reached a point of closure.

Closure doesn’t mean happily ever after. It doesn’t mean the problems are all wrapped up and tied with a bow. Closure means that insights have surfaced, choices have been clarified, and the counselee can now see the road to wholeness. Whether the counselee chooses to walk that road or not is up to the counselee, not the pastor.

When I get to the end of a course of counseling, I ask the counselee:

What has been helpful to you?
Where have we gotten?
How have your hopes and expectations been met? And how have we failed to meet them?
What changes have you made in your life as a result of these counseling visits?

The final session is a time to summarize the past and look to the future. It is also a time when I let the counselee know that the door is open if he or she ever needs a return session. “This issue may resurface in the future,” I say. “If you want to come back and talk with me, you are welcome to do so.”

It is also a time to point the counselee to additional resources that will keep the healing process going—books, tape series, an adult Christian education class on Sunday mornings, or support groups and organizations such as Alanon or Alateen. I also pray with the counselee—a prayer that affirms the counselee’s desire for continued healing and that asks for God’s grace for the road ahead.

The rewards and satisfactions of short-term counseling don’t become apparent in the short term. Rather, these rewards and satisfactions are like diamonds embedded in layers of time, in the bedrock of relationships.

Wholeness is not a destination. It’s a journey. In this life we never arrive; we’re always in process. Everyone in my congregation is in process. I am in process. Life is a process. We face our struggles one at a time, day by day, and only at the end of a year or ten years or twenty can we see the progress we’ve made.

So I can’t always see results at the end of a four-week or eight-week course of counseling. But when over the years, I see individuals, couples, and families growing strong, their relationships knitting together, their kids maturing free of addiction and shame —that’s rewarding.