CCC 27-2_LR

Exploring the Complicated Relationship

The Keys to a Healthy Relationship Page 26

Christian Care Connect: Help, Hope, and the Digital World Page 10

Between Narcissism and Emotional Abuse Page 22

A Publication of the American Association of Christian Counselors

Volume 27 | Issue 2

IN THIS ISSUE

Lead Articles From the President Clinical Practice Innovative Thought & Practice Trending Now Healthy Relationships

1 10 15 18 22 26 30 34 38

Pastoral Care News & Notes Pass It On

The effects of pornography use and sexual addiction have devastated the Christian church. Studies show that the use of pornography is rampant among Christians. It affects individuals, marriages, and families. 1 Sexual addiction, often labeled the “secret sin,” thrives in isolation, fueled by guilt, shame, and silence. This pervasive issue requires a response that integrates compassion and grace with practical, evidence-based, biblical tools for recovery. NEW! SEXUAL ADDICTION RECOVERY COACHING (SARC) PROGRAM COMING SOON!

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LEAD ARTICLES However, what happens when those struggling with these issues are reluctant to seek professional help or talk to someone? The reality is that not everyone has access to or feels comfortable pursuing therapy or telling their spouse or someone they trust. That is where the need for Sexual Addiction Recovery Coaches comes in. Non-professional, trained recovery coaches are uniquely positioned to walk alongside individuals in their healing journeys, providing hope, accountability, and a biblically rooted framework for transformation. The new Sexual Addiction Recovery Coaching (SARC) Program will be available soon and is designed to meet this urgent need. Through this program, churches and ministries can train coaches to be equipped to support individuals struggling with sexual addiction and pornog raphy use—helping them break free from this dependence without taking the place of professional therapy. Who Can Benefit from the SARC Program? The SARC Program is designed for individuals who feel called to help others overcome sexual addiction in a non-professional setting. Those who have walked their own journeys are often best equipped to help others overcome their struggles. If you are a pastor, minis try leader, or simply someone with a heart for walking alongside others, this program equips you to serve as a recovery coach while recognizing the distinct role of pro fessional therapists. This program is not just designed for individual use. Churches can also use the SARC Program to complement their mental health ministry by addressing sexual addic tion and pornography use. By training a team of recovery coaches, congregations can create a place where indi viduals can find accountability, personal and spiritual growth, and transformation. Why the Need is Urgent The battle for sexual health does not stop with indi viduals—it is a fight for marriages, families, and the spiritual health of our churches and communities. The SARC Program empowers non-professional coaches to intervene early, offering a bridge to recovery before issues escalate into crisis. With the tools provided in this program, coaches can address the emotional, relational, and spiritual wounds that fuel addiction, helping clients rebuild their lives on a foundation of truth and grace. Our prayer is that this is more than a training pro gram—that it is a call to action for those who want to stand in the gap and bring hope to those battling sexual addiction. Together, we can equip the Church to respond to this crisis with love, truth, and restoration. ; Endnote 1 Over half of practicing Christians admit they use pornography. Barna. https://www.barna.com/trends/over-half-of-practicing-christians-ad mit-they-use-pornography/.

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LEAD ARTICLES

SEXUAL ADDICTION RECOVERY COACHING 101 • SARC 101: The Fight Is On: The Problem of Sexual Addiction and the Porndemic in Everyday Life | Jim Cress, M.A. • SARC 102: Understanding and Identifying Sexual Addiction, Compulsivity, and Pornography Addiction | Jason VanRuler, M.A. • SARC 103: The Secret Sin: The Role of Guilt and Shame | Jim Cress, M.A. • SARC 104: Sex on the Brain: Neurobiology of Compulsive Sexual Behavior | John Thomas, Ph.D., Ph.D. • SARC 105: Emotional Regulation, Impulsivity, and Sexual Addiction | Mike Vaughn, M.A. • SARC 106: False Intimacy and Attachment Difficulties: How Pornography Use and Sexual Addiction Impact Relationships | Tim Clinton, Ed.D., and Zach Clinton, M.A. • SARC 107: Sexual Addictions and Comorbidity of Substance Use and Mental Health Disorders | John Eklund, M.S.W. • SARC 108: Risky Sexual Behavior and Serious Mental Illness | Shannae Anderson, Ph.D. • SARC 109: The Link Between Childhood Trauma and Sexual Addiction | Shannae Anderson, Ph.D. • SARC 110: Female Sexual Addiction and Pornography Use | Crystal Renaud Day, MAPC • SARC 111: Foundations of Sexual Addiction Recovery Coaching | Jim Cress, M.A. • SARC 112: The Path to Recovery: Helping Clients Find Healing and Freedom | Jason VanRuler, M.A. SEXUAL ADDICTION RECOVERY COACHING 201 • SARC 201: The Paradox of Grace: Biblical Insights to Being Set Free | Jim Cress, M.A. • SARC 202: Building a Recovery Plan | Jason VanRuler, M.A. • SARC 203: Navigating the Client’s Discovery and Disclosure Process | Mike Vaughn, M.A. • SARC 204: Two Back to One: Healing Marriages After Porn or Betrayal | Chris Hardesty, M.A., and Elizabeth Hardesty, M.A. • SARC 205: Post-traumatic Growth for Betrayed Partners | Debbie Laaser, M.A. • SARC 206: Helping Families Heal: Support for Families of Sexual Addicts | Greg Miller, D.Min., and Beth Miller, M.A. • SARC 207: The Role of Community in Healing: Accountability and Peer Support | Greg Miller, D.Min., and Beth Miller, M.A. • SARC 208: Advanced Skills and Techniques for Sexual Addiction Recovery Coaching | Jason VanRuler, M.A., and Mike Vaughn, M.A. • SARC 209: Effective Skills for Leading and Facilitating Groups | Jason VanRuler, M.A., and Mike Vaughn, M.A. • SARC 210: Managing Transference and Countertransference | Shannae Anderson, Ph.D. • SARC 211: Building Confidence and Competency: What to Do and What Not to Do | Mercy Connors, Ph.D. • SARC 212: The Sexually Healthy Church | Joshua Broome Through this program, churches and ministries can train coaches to be equipped to support individuals struggling with sexual addiction and pornography use—helping them break free from this dependence without taking the place of professional therapy.

A PUBLICATION OF THE AMERICAN ASSOCIATION OF CHRISTIAN COUNSELORS

President: TIM CLINTON VP of Publications/Editor-in-Chief: MARK CAMPER Advertising Director: KEISHA QUEEN

Graphic Designer: AMY LEACH COLE

Published quarterly by American Association of Christian Counselors, Inc., P.O. Box 739, Forest, VA 24551. AACC is an organization of evangelical pro fessional, lay, and pastoral counselors dedicated to promoting excellence and unity in Christian counseling. To ensure the confidentiality of all individuals men tioned in case material, names and identifying informa tion have been changed. Unsolicited manuscripts and poetry are not accepted. A query letter must be sent first, describing a proposed manuscript. Unfortunately, any unsolicited manuscripts will not be returned. CHRISTIAN COUNSELING CONNECTION grants permission for any original article (not a reprint) to be photocopied for use in a local church or classroom, provided no more than 250 copies are made, are dis tributed free, and indicate CHRISTIAN COUNSELING CONNECTION as the source. Advertising deadline for display advertising is approx imately six weeks before the month of publication. Please call for exact deadline dates. All advertising must be prepaid. If you have comments or questions about the content of CCC, please direct them to the Senior Editor. The views expressed by the reviewers, authors, or advertisers do not necessarily reflect those of the American Association of Christian Counselors, and a review in this publication does not imply an endorse ment. AACC and this publication do not assume responsibility in any way for members’ or readers’ efforts to apply or utilize information, suggestions, or recommendations made by the organization, its members, publications, or other resources. All rights reserved. Copyright 2019.

AACC Member Services & Editorial Office P.O. Box 739 129 Vista Centre Dr., Suite B Forest,VA 24551

Phone: 1.800.526.8673 Email: CCC@AACC.net WWW.AACC.NET

Christian Counseling Connection 3

September 23-27, 2025 Opryland Hotel • Nashville, TN

THE WORLD’S PREMIER CHRISTIAN COUNSELING EVENT RETURNS TO NASHVILLE!

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LEAD ARTICLES

a Get Ready for the 2025 AACC “UNITED” World Conference! Anticipation is building for the 2025 AACC “UNITED” World Conference, scheduled for September 23-27 at the Gaylord Opryland Hotel in Nashville, Tennessee. This landmark event promises to unite Christian counselors, coaches, educators, and ministry leaders from across the globe for a week of professional growth, spiritual renewal, and practical training. We expect more than 7,000 attendees from across the globe, making this year’s conference one of the largest gath erings of Christian mental health professionals and coaches in history. Whether you are a first-time attendee or have participated in years past, the 2025 “United” World Conference will deliver cutting-edge workshops, dynamic wor ship experiences, and unparalleled networking opportunities. What to Expect at the 2025 World Conference

This landmark event promises to unite Christian counselors, coaches, educators, and ministry leaders from across the globe for a week of professional growth, spiritual renewal, and practical training.

This year’s event will be packed with world-class plenary sessions, practical workshops, and inspirational special events. Here is a quick look at what is on the schedule: • 8 Mental Health Learning Institute 6-hour Intensives • 50 Pre-conference Workshops • 20 Plenary Speakers • 25 Specialized Counseling and Coaching Tracks • More Than 175 Professional Workshops With topics ranging from pressing subjects like trauma-informed care and cutting-edge, evidence-based treatments to executive leadership coaching, there is something for every attendee, no matter your profession. Plus, the extensive track workshop lineup ensures attendees will find content tailored to their specific areas of interest and expertise.

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LEAD ARTICLES

Lysa TerKeurst

Curt Thompson

Tim Timberlake

Daniel Amen

Jennie Allen

Tim Clinton

Bob Goff

John Townsend

Shannae Anderson

Gary Chapman

Tyler VanderWeele

Zach Clinton

Henry Cloud

Dennis Swanberg COMEDIAN

IN CONCERT

SCAN THE CODE TO REGISTER ONLINE!

DINNER THEATER Katy Nichole

Micah Tyler ROCK THE BLOCK

Chris Tomlin

Meet the 2025 Keynote Speakers The 2025 plenary lineup features some of the most influ ential voices in Christian counseling and ministry leader ship. Attendees will hear from: • Dr. Daniel Amen , renowned psychiatrist and brain health expert • Lysa TerKeurst , best-selling author and speaker • Dr. Tim Clinton , AACC President and trusted leader in Christian counseling • Bob Goff , best-selling author and motivational speaker • Dr. John Townsend , leadership expert and author of Boundaries • Chris Tomlin , GRAMMY ® award-winning artist and worship leader • … more to be announced soon! From inspiring messages to practical insights, the ple nary sessions will encourage, equip, and challenge you professionally and personally. New for 2025: Expanded Learning Opportunities This year, the Mental Health Learning Institute

Intensives offer in-depth, six-hour sessions led by promi nent experts in the field. Here are some highlights: • Comprehensive Biblical-Clinical Theory of Change with Drs. David King, Ron Hawkins, and Mercy Connors • Relational and Attachment Trauma with Dr. Gary Sibcy • Sexual Compulsivity and Addiction Recovery with Jim Cress, M.A., Mike Vaughn, M.A., and Jason VanRuler, M.A. • Christ-centered Trauma Healing with Drs. Eric Johnson and Nicolene Joubert • Restoring Hope for Couples with Bob Paul, M.S., and Dr. Robert K. Burbee • Christian-based Emotion-focused Therapy for Couples with Dr. Sharon May and Linda Stewart, M.A. • The Treatment of Borderline, Histrionic Narcissism and Antisocial Personality Disorder with Drs. Shannae Anderson and David Hawkins These intensives provide a unique opportunity to dive deep into critical topics while earning Continuing Education credits.

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t 25 Counseling and Coaching Tracks The 2025 conference offers 25 specialized tracks , each curated by leading experts in their field. A few standout tracks include: • Abuse, Violence, and Trauma-informed Care • Addictions, Relapse, and Recovery • Grief and Loss, Crisis Response, and Disaster Recovery • UPDATED! Suicide, Self-harm, and Risky Behavior: Awareness, Prevention, De-escalation, and Postvention • NEW! Compulsive Behaviors: Trends, Assessments, and Effective Treatment • Sexuality, Sexual Interventions, and Sexual Health • UPDATED! Love, Intimacy, Pre-marital Counseling, and Marriage Enrichment • NEW! Marriage and Family, Parenting, Family Systems, and Therapy • Couples in Crisis, Relationship Conflict, and Marital Recovery • NEW! Youth Mental Healthcare: NextGen Issues and Interventions • UPDATED! Biblical Counseling, Theological Foundations, Chaplaincy, and Pastoral Care • Spiritual Formation, Interventions, and Discipleship • UPDATED! Mental Health Coaching, Lay Counseling, and Church-based Care • Counseling Skills, Techniques, and Empirically Supported Treatments • Clinical Assessment, Research, and Evidence based Practices • Psychiatry, Behavioral Medicine, and Collaborative Care • Mental Health, the Brain, and Neuroscience • Personality Disorders, Challenging Issues, and Complex Cases • UPDATED! Positive Psychology, Performance, and Well-being: Human Flourishing and Resilience • Christian Psychology: Theory, Practice, and Integration • Social Work: Advancements in Theory and Practice • UPDATED! Ethics and Practice Management: Advocacy, Public Policy, and Counselor Education and Supervision • UPDATED! Multicultural Counseling: Cross cultural and Global Competency • Professional Life Coaching and Consultation • Executive and Leadership Coaching and Organizational Psychology These tracks provide practical tools and techniques you can implement immediately in your practice or ministry.

LEAD ARTICLES

Special Events You Do Not Want to Miss The conference is packed with inspirational events designed to help you connect with God and your col leagues: • Opening Night Plenary: With dynamic speakers and a concert with Chris Tomlin • Rock the Block Party: A high-energy evening with comedian, Micah Tyler, and a special musical guest (ticketed event) • Dinner Theater: A night of comedy and music with special guest, Katy Nichole (ticketed event) • Light University Graduation Ceremony: Back by popular demand… the celebration of recent Light University program graduates Register Now and Save! Do not miss the Super Early Bird Registration , which ends June 30, 2025 . Rates start as low as $289, offering tremendous value for this premier Christian counseling event. Visit worldconference.net or call 800-526-8673 to secure your spot today. Take advantage of this opportunity to grow in your calling as a people helper, be re-energized, and connect with like-minded professionals from around the world. The 2025 “United” World Conference promises to be a transformative experience. Make your plans today—we look forward to seeing you in Nashville! ;

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Christian Counseling Connection 7

LEAD ARTICLES

Marriage & Family: A Christian Journal IS BACK AND BETTER THAN EVER!

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For years, Marriage & Family: A Christian Journal ( MFJ ) has been a cornerstone in integrating Christian values with the latest advancements in counseling. After a brief hiatus, this prestigious publication is making its long-awaited return, equipped with fresh perspectives, broader inclusivity, and a renewed commitment to excel lence. Grounded in the authority of Scripture and sup ported by rigorous research, MFJ is poised to become an even more vital resource for those shaping the future of Christian counseling. At its core, Marriage & Family: A Christian Journal seeks to bridge the gap between theology and psycholo gy, presenting cutting-edge research and practical appli cations through a biblically integrated lens. MFJ covers a wide range of topics, including models of marriage, trauma-informed family therapy, and interventions tai lored to vulnerable populations. Each article is designed to equip Christian counselors with evidence-based and spiritually grounded tools that provide insights directly impacting their practices. Marriage & Family’s expanded scope and heightened focus on excellence set it apart in its new iteration. With biannual issues published in May and September and a special annual issue in January, the publication guar antees a steady flow of innovative content. New themes include addressing the needs of marginalized communi

ties and exploring the intersection of individual therapy and family systems. MFJ also introduces a more robust peer-review process, emphasizing clarity, practical implications, and methodological rigor. The return of this journal signals an open invitation to scholars, clinicians, and researchers to contribute to this growing body of knowledge. Whether sharing ground breaking research, refining therapeutic models, or propos ing fresh approaches to pastoral care, MFJ welcomes sub missions that advance the field of Christian counseling. Aspiring authors are encouraged to explore this opportu nity to shape the discipline in theory and practice. As MFJ re-enters the academic and clinical land scape, it stands as a testament to the power of collabo ration, faith, and the pursuit of truth. With its renewed focus and expanded vision, the journal is back and better than ever! It is ready to inspire, inform, and transform the understanding and support of marriages and fami lies within Christian counseling. ;

To learn more about the requirements and how to submit an article for publication consideration, please visit: https://acrobat.adobe.com/id/urn:aaid:sc:VA6C2:9feaaeed 3340-4dc3-9b35-33e5181b0333.

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FROM THE PRESIDENT

CHRISTIAN CARE CONNECT: HELP, HOPE, AND THE DIGITAL WORLD Tim Clinton, Ed.D., LPC, LMFT m More than 30 years ago, I envisioned using technology and the Internet to pro vide counseling and resources to individuals seeking help and hope for their pain. This dream led AACC to pioneer and launch a website called eCounseling. com, an initiative to connect Christian counselors across the U.S. and abroad with people in need. While we were ahead of our time in concept, the resourc es and technology of the late 90s and early 2000s were limited. Platforms like BetterHelp and Talkspace did not exist, and the world had not yet grappled with privacy and compliance concerns, such as the Health Insurance Portability and Accountability Act (HIPAA) regulations that now shape online therapy.

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FROM THE PRESIDENT

Fast forward to today. The world of mental healthcare has changed in incredible ways. As terrible as the COVID-19 pandemic was, the lockdowns and restrictions forced us to rethink how we provided care and by what method clients accessed support. As a result, telehealth became a lifeline for many, making it easier for people to connect with mental health profes sionals no matter where they are located. This shift has opened doors and expanded the reach of care like never before. We now have the tools, plat forms, and technological advances to make the dream I had more than three decades ago a reality in ways I could have only imagined back then. Something we have said around our offices for years is, “While asking for help is hard, finding it shouldn’t be.” This belief is foundational to every thing we do. Our God-given vision as an organization goes beyond training Christian mental health professionals and coaches. Our ultimate hope is to connect individuals in need with compassionate, professional caregivers ready to help and support them along their journeys. Introducing Christian Care Connect (CCC) After years of hard work and dedication, I am thrilled to announce the offi cial launch of Christian Care Connect ( CCC ), AACC’s new premier mental health provider referral network. This launch represents a culmination of years of prayer, planning, and a deep desire to make mental healthcare more accessible, particularly for Christians seeking faith-aligned resources. I am so proud of our team! The following are some of the unique features that set CCC apart from other referral networks: Provider Database. CCC provides a comprehensive database where indi viduals can easily search for Christian counselors, coaches, clinics, church es, treatment centers, and support groups. Using a zip-code search tool, people can quickly find professionals in their local area, ensuring they can access care that is both convenient and aligned with their faith. Mental Health Check-up Assessments. For clients who may not know where to start, CCC offers a variety of self-assessment tools. These assess ments are designed to provide insight into emotional and psychological well-being. While not a substitute for a clinical diagnosis, these tools serve as a starting point to guide individuals toward the appropriate level of care and support they may need. Self-help Resources and Blogs. CCC includes a growing collection of self help blogging resources that cover common symptoms and provide a deeper understanding of topics such as depression, anxiety, and more. Whether individuals seek tips on managing stress, improving relationships, or deep ening their faith, our blog is a valuable resource. Beyond Mental Healthcare While mental healthcare is at the core of AACC and Christian Care Connect, the vision does not stop there. We believe CCC has the potential to grow into something even more significant. We envision CCC encompassing not just mental health services but also Christian coaching, medical services, and other areas of care that connect people with Christian providers. The goal is to create a massive list of support options for Christians in every season of life, whether they are facing personal challenges, looking to grow in their faith, or navigating health and wellness concerns. Why Join the CCC Network? I want to extend a personal invitation to our current and aspiring members. By joining the CCC network, you become part of a movement transforming how Christians access care and connect with professionals who share their values. Whether you are a counselor, coach, pastor, or leader in the faith

The goal is to create a massive list of support options for Christians in every season of life, whether they are facing personal challenges, looking to grow in their faith, or navigating health and wellness concerns.

Christian Counseling Connection 11

FROM THE PRESIDENT

f community, your participation matters. Together, we can extend the reach of Christian care, offering a safe and unique place for help and hope to individuals and families who need it most. Every day, we hear from churches and individuals searching for nearby Christian mental healthcare, and they are counting on someone like you to step in and help. With this increasing demand for biblically-based resources and care, CCC offers providers a way to grow their practices and ministries while serving others meaningfully. A Vision for the Future For our team, the launch of Christian Care Connect is more than just a new horizon of helping stem the tide of today’s mental health disaster—it is the realization of a dream and the beginning of a new chapter to make Christian mental healthcare more accessible than ever before. My hope is that CCC will become a trusted resource for Christians everywhere, helping them find the support they need when they need it most. And as we dream for the future, let’s not limit what God can do through this platform. Let’s imagine a world where CCC becomes a central hub for any type of care—men tal health, coaching, medical, and beyond that meets people at their point of need and points them to the ulti mate source of hope and healing, Jesus Christ. In the words of Ephesians 3:20 (NIV), God can do “… immeasurably more than all we ask or imagine, according to his power that is at work within us.” Together, we can step into this calling and make a massive difference in the lives of those seeking help and hope. ;

Tim Clinton, Ed.D., LPC, LMFT, BCP CC, is president of AACC, the world’s largest and most diverse Christian counseling association. He is also Exec utive Director of the Global Center for Mental Health, Addiction, and Recovery and Professor Emeritus at Liberty Uni versity. Dr. Clinton served as co-host of Dr. James Dobson’s Family Talk, heard on more than 1,400 radio outlets dai ly, and now hosts a weekend television program, The Road Forward, seen on Real America’s Voice News streaming service and numerous platforms. He and his son, Zach, launched a new daily meditative prayer podcast on pray.com for mental health and relationships. Dr. Clinton has been married for 43 years to his wife, Julie, and they have two children and two granddaughters.

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Proven Emotional Management Tools to Get Up-and-Down Feelings Under Control with Science and Scripture

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Perfect for the everyday person struggling with their emotions. They’ll learn how to: • Handle emotional overwhelm, overthinking, and avoidance • Acknowledge feelings without judgment • Process emotions through God’s clarifying lens of truth • Courageously choose a Scriptural response Not only will the book help them understand what they are feeling, but they’ll also learn a 3-step method to understand how to partner with God to manage their feelings, strengthen their faith, and have more peace.

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Christian Counseling Connection 13

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CLINICAL PRACTICE

Compassion in Christ-centered Counseling from the Society for Christian Psychology CHRISTIAN PSYCH NOTES Nicolene L. Joubert, Ph.D.

t Introduction The Latin origin of the word fatigue ( fatigare ) means “to be weary,” “to tire out,” or from the pre-Latin adjective “fati-agos” meaning “driving to the point of breakdown.” Several verses in the Bible refer to being tired and weary and God’s promise to give us rest. For example, Jeremiah 31:25 (AMP) states: “For I [fully] satisfy the weary soul, and I replenish every languishing and sorrowful person.” And Matthew 11:28-30 (NASB): “Come to Me, all who are weary and burdened, and I will give you rest. Take My yoke upon you and learn from Me, for I am gentle and humble in heart, and you will find rest for your souls . For My yoke is comfortable, and My burden is light.” In Genesis 25:29, Esau is described as “exhausted” after hunting and being without food for a couple of days. In his exhaustion, he made a life-changing decision with

severe consequences. The lesson in this event is that our ability to make wise and rational decisions is affect ed when we are fatigued. Our ability to have and show compassion is also affected, especially in ministries or careers where compassion plays a critical role, such as caring for the sick or counseling traumatized people. Cognitively, emotionally, and behaviorally, exhaustion affects us negatively. Compassion Fatigue Compassion is a noun of action borrowed from French that historically was used to refer to the action of suf fering with someone or to have pity. The first part of the word, com , means together, and patio means pity (Oxford, English Dictionary, 2023). Thus, the ability or capacity to share the painful feelings of another in a

Christian Counseling Connection 15

c CLINICAL PRACTICE practical manner. Becoming physically tired or mentally exhausted will affect one’s capacity to do compassion. It will negatively impact the qual ity of care given to a suffering person who requires compassion daily. The term compassion fatigue (CF) was coined by Figley (1995) to describe the acute onset of personal suffering that stems from the intense sharing of someone else’s painful emotions. This phenomenon of emo tional distress results from caring for a traumatized victim rather than from exposure to the trauma itself. It stems from working in traumatic sit uations or witnessing others’ distress (Cocker and Joss, 2016). The contin uous experience of the internal conflict between empathy and suffering leads to a psychological response of distress and eventually to CF. The daily exposure to traumatic information causes a risk of developing CF, which would reduce the quality of care people provide. In addition, it can lead to the development of more debilitating conditions, such as depres sion and anxiety. Signs and Symptoms of Compassion Fatigue Caregivers and counselors who develop CF are impacted in several ways. They become irritable and angry and lose their ability to find joy and satisfaction in their work. They find excuses to stay away from their patients/clients and avoid traumatized individuals. These symptoms intensify when traumatic material is extreme and graphically presented. CF impacts the decision-making ability of caregivers, counselors, and clergy. Pastoral counselors may develop CF, which may affect their ability to provide hope and spiritual support to congregants. Because compas sionate care addresses the counselee’s need for connection and relation ships, it is based on active and emphatic listening. Furthermore, coun selees need counselors and caregivers to understand their perspective of a traumatic experience. CF reduces the ability to provide this quality of emotional and cognitive care. Social-Neuro Science and Self-care The role of empathy and compassion is key in providing well-thought out, effective care for traumatized individuals on a continuous basis. In a Christian context, any form of care should meet biblical requirements, which entail the expression of agape love and the maintenance of healthy connections and fellowship with traumatized individuals. Neurological social science and self-care strategies have been found to offer some key concepts that could be helpful in this regard, such as the role of honest and accurate communication, realistic expectations, and self-awareness. According to neuroscience, two distinct empathy-related pathways exist: 1) socio-affective (empathy), and 2) socio-cognitive (compassion). These two pathways are related but differ on a neural level as each acti vates different independent brain networks. Empath-related means that we “feel with others” but recognize that the emotions are external to our selves. Compassion-related means that we feel for others who are in pain and have a warm and emphatic concern, but we also understand their perspective and intentions. This pathway results in pro-social behavior, the motivation to act and relieve people’s pain, and advocate for social justice. Self-awareness is the ability to distinguish between our emotional and mental states and those of others. It is important for developing effective self-care strategies (Figley, 2002). This leads us to the question of prevention. How could CF be prevented and compassion satisfaction (CS) increased? Compassion satisfaction has been shown to be an inter nal positive experience that would form a shield against CF.

The daily exposure to traumatic information causes a risk of developing CF, which would reduce the quality of care people provide. In addition, it can lead to the development of more debilitating conditions, such as depression and anxiety.

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CLINICAL PRACTICE

exposure to the trauma of victims. It does not reduce or remove painful or negative emotions but provides resil ience and the ability to continue expressing empathy and compassion. The ethical component of compas sion is based on the virtue of benevolence. A virtuous approach to serving those suffering could strengthen one’s capacity to have empathy and compassion. It aligns with biblical teachings and the example of the life and work of Jesus Christ on earth. Thus, implementing training programs to teach and practice biblical virtues would increase compassion and empathy. It would enhance the capacity to experience CS, an oppositional internal force against CF that could sustain one’s capacity to show and act with compassion. The seven biblical virtues are faith, justice, pru dence, hope, temperance, fortitude, and charity. Faith is the foundation of all other virtues. Faith is the belief that each person carries the image of God, as humans are created in His image. Justice is based on God’s love for the world and not prejudice. John 3:16-17 (NASB): “For God so loved the world, that He gave His only Son, so that everyone who believes in Him will not perish, but have eternal life. For God did not send the Son into the world to judge the world, but so that the world might be saved through Him.” Prudence is the wisdom to make the right choices, hope is to believe in what we cannot see based on faith (Hebrews 11:1), temperance is the ability to set boundaries and practice constraints, fortitude is to persevere, and charity is the greatest of all virtues and an expression of agape love. A biblical principle that we should follow to increase compassion is to keep in mind that charity is not only giving what is surplus but also giving of ourselves. Christ said in John 13:34 (NASB), “… that you love one another; just as I have loved you, that you also love one another.” ; Nicolene L. Joubert, Ph.D., is a

Compassion Fatigue and Compassion Satisfaction As previously mentioned, the risk of developing CF and the consequences of reduced empathy and compassion prompt us to take note of the increasing evidence that compassion can be taught. Some key components have been identified for compassion training (i.e., self-com passion, psychological flexibility, compassionate prac tice, and compassionate leadership in healthcare or counseling ministry cultures). Compassion training could increase the capacity to regulate emotions and build resilience. It can strengthen altruistic behavior and lead to better coping skills and an increased ability to have self-compassion. Compassion training increases activation in the brain areas associated with love, posi tive emotions, and reward. Self-care strategies include setting healthy bound aries and developing self-compassion. A key factor is to be kind to oneself and recognize common humanity or feeling connected to others who consider themselves inadequate because of mistakes. The connection means sharing experiences rather than isolating oneself. Connecting to Christ and His deep love and compassion for the world forms the foundation for connecting to oth ers in a shared space. Meditation on God’s Word and His acts of kindness and love would ease emotional distress and alleviate self-judgment. This would increase com passion satisfaction. A Biblical Response Compassion satisfaction is associated with a positive work experience despite difficult circumstances of

Counseling Psychologist and an Adjunct Professor of Psychology and Christian Counseling at Houston Christian University in Texas.

References Cocker, F., & Joss, N. (2016). Compassion fatigue among healthcare, emergency and community service workers: A systematic review. International Journal of Environmental Research and Public Health, 13 (6), 618. https://doi.org/10.3390/ijerph13060618. Figley, C.R. (1995). Compassion fatigue: Coping with secondary trau matic stress disorder in those who treat the traumatized. Figley, C.R. (2002). Compassion fatigue: Psychotherapists’ chronic lack of self-care. Journal of Clinical Psychology, 58 (11), 1433-1441. Oxford English Dictionary, s.v. “compassion (n.), etymology,” September 2023, https://doi.org/10.1093/OED/3741965505.

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f For many caregivers, be they pastors, clinicians, or coaches, the command is clear: Nothing is to impede people from coming to Jesus. No problem is too significant, no hole too deep, no issue that the Gospel cannot touch. A second idea is quick to follow: “To the weak I became weak, to win the weak. I have become all things to all people so that by all possible means I might save some” (1 Corinthians 9:22, NIV). This verse places the expectation that the caregiver is “the one.” The one who takes the call, makes the connection, and introduces the Gospel to the hurting. The image of a battlefield foxhole with a chaplain gripping a wounded soldier’s hand illustrates the caregiver’s role. The one who will go where angels fear to tread. James Sells, Ph.D., Diane Chandler, Ph.D., and Jennifer Ripley, Ph.D. FIRST STEPS IN ATTENDING TO FAMILIES IN CRISIS “For I am convinced that neither death nor life… will be able to separate us from the love of God that is in Christ Jesus our Lord.” – Romans 8:38-39, NIV

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INNOVATIVE THOUGHT & PRACTICE

Many sessions with families are like the “fog of war”—chaotic and explo sive. Emotions can be hot. Harsh words declared. People can leave angry! There is good reason to withdraw from the battlefield and focus on sermon preparation or next year’s budget. No one screams. No one slams doors. Their crisis creates a caregiver crisis. However, caregivers faithfully, even eagerly, follow where they are called. And that calling frequently carries them into very difficult places beyond seminary preparation and job description. So, when a mom or dad makes the call, you answer. The call may sound something like, “You don’t know me… I’ve never been to your church before, but I drive by it every day on my way to work. Taylor and Ramon, who attend your church, live across the street. They gave me your name and said you could help. My family is in a crisis. Will you see us?” The answer is going to be “yes.” Oh, you will ask some questions regarding details, such as who is involved and a brief history. You need to ensure this is not an imminent threat to health and safety. And then you say, “Let’s meet and talk….” Once a caregiver says yes to caring, yes to receiving, yes to lis tening, another question must be answered, and often with a slight degree of anxiety—even panic. “What do I do next?” We have gathered the accumulated wisdom of some of the best mental health and pastoral experts to answer this question. To 18 Christian author ities, we gave the question: “What would you say to a caregiver if you were to be asked, “A family who is addressing __________ will be in my office in one hour. What do I do?” We invited these authors to write a response to what every caregiver needs to know and do when faced with a family care crisis. Their responses are compiled in our book, Ministering to Families in Crisis: The Essential Guide for Nurturing Mental and Emotional Health (IVP, 2024). A few of the crises addressed in the book include an LBGTQ+ identity in a child or spouse, severe mental illness, challenges from blended families, violence and abuse, addiction, financial crisis, attending to the elderly, and racial trauma. Each chapter presents challenges that the caregiver must navigate. The goal of assisting families in crisis is to develop a biblically supported approach. Those ministering in crisis situations are to offer hope, courage, and safety, conveying that family members are not alone. Following, we pro vide short explanations and invite you to explore the details of the accumu lated wisdom of these expert book chapter authors. Hope. First Thessalonians 4:13 (NIV) declares, “… so that you do not grieve like the rest of mankind, who have no hope.” Family members are often pulled into the cauldron of crisis. They desire to relieve, solve, and heal right now. Their need for grief relief is immediate. Paul’s words suggest the situations we find ourselves in often result in grief. Disillusioning grief. Yet, hope abides where we are to fix our gaze. Hope must be placed so close that everything seen must be seen through it. Caregivers can help families declare, “I can’t yet see how this will work out, what our outcomes will be, or where we are going, but I will trust God and have confidence in that outcome.” Courage. Vincent van Gogh is credited with saying, “The fishermen know that the sea is dangerous and the storm terrible, but they have never found these dangers sufficient reason for remaining ashore.” 1 Courageous caregiv ers meet with family members who face complicated and vital dilemmas. And don’t blink. Your courage creates courage. It declares you are not afraid of “it”—that issue or concern which might be too painful for thought or dis cussion. Caregivers are the primary “first stop” for most as they experience pain. Caregivers can help families with all of the “next step” decisions. Act as Jesus, who said, “… permit the little children… to come to Me…” (Matthew 19:14, BLB) even if you are not a child expert!

Those ministering in crisis situations are to offer hope, courage, and safety, conveying that family members are not alone.

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INNOVATIVE THOUGHT & PRACTICE

Safety. Families come to ministry leaders because of pain, threat, or danger. Creating spiritual, physical, emotional, and relational safety permits clear thinking and planning. Decisions made by families under stress are usually poor choices. However, caregivers who create immediate security permit all to think creatively, col laboratively, and toward a long-term conclusion. Stress, duress, elevated defenses, and reactivity contradict efforts to form good plans and lasting solutions. For example, the first meeting may have a history of events and circumstances coming to a crescendo in the office. Slow the music down! In an initial meeting, every thing will not be fixed, set right, or even understood. Safety creation does not mean anyone should “sweep things under the rug” and pretend, deny, or delay. Instead, safety permits people to obtain internal order and prepare the brain to listen, learn, and select from alternatives. “Safety first” was a good idea in kindergar ten. It is also suitable for those in ministry. Pastoral care for families is usually the starting point, not the final destination. Pastors can become co-travel ers as families address their specific crises, share details, and embrace learning that leads to spiritual, personal, and relational transformation. ;

James N. Sells, Ph.D., is a licensed psychologist, professor of counseling, and a Hughes Professor of Christian Thought and Mental Health at Regent University, where he also co-directs the Charis Institute. He is the co-author of Ministering to Families in Crisis, Beyond the Clinical Hour, and Family Therapies: A Christian Appraisal. Diane J. Chandler, Ph.D., is an associ ate professor of spiritual formation and leadership at Regent University. She is co-author of Ministering to Families in Crisis and author of Christian Spiritual Formation. Jennifer S. Ripley, Ph.D., is a licensed psychologist, professor of psychology, and a Hughes Professor of Christian Thought and Mental Health at Regent University, where she also co-directs the Charis Institute. She is the co-author of Ministering to Families in Crisis and Couple Therapy: A New Hope-Focused Approach.

Endnote 1 Vincent van Gogh quotes. Vincent van Gogh. (n.d.). https://www.vin centvangogh.org/quotes.jsp.

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EXPLORING THE COMPLICATED RELATIONSHIP BETWEEN NARCISSISM AND EMOTIONAL ABUSE

David Hawkins, M.B.A., M.S.W., M.A., Ph.D.

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I believe we have overused the terms “narcissism,” “narcissist,” and “abuser.” These words are often used interchangeably and subsequently have lost much of their meaning. We are too quick to say someone is “narcissistic” and blur the lines between narcissism, emotional abuse, and other forms of abuse. It is time to clear this up. I am indebted to Lundy Bancroft, author of the popular book, Why Does He Do That? In side the Minds of Angry and Controlling Men , who began the discussion about the difference between narcissism and emotional abuse. He has led the way in helping us understand these complicated issues.

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NARCISSISM IS A MENTAL HEALTH AND DIAGNOSTIC CONDITION MARKED BY PROFOUND SELFISHNESS, A SENSE OF ENTITLEMENT, A NEED FOR ADMIRATION, AND A LACK OF EMPATHY. EMOTIONAL ABUSE, IN CONTRAST, IS A BEHAVIOR. EMOTIONAL ABUSERS ARE OFTEN NOT GRANDIOSE, DO NOT SEEK ATTENTION, AND CAUSE THEIR HARM BEHIND CLOSED DOORS.

Third, narcissists treat many people with disdain, while emotional abusers often focus their disdain on one person, frequently their mate . Again, we should examine the secre tiveness of harm being caused to countless women behind the facade of propriety. Fourth, narcissists exploit others in their lives, not only intimate partners . Bancroft says, “The narcissist fools a lot of people—as the abuser does—but there are at least a few people who hate his guts because of what he’s done to them. If the only people who know the truth about what the guy is really like are his past partners, he’s a straight-up abuser.” 3 Narcissism tends to be blatant, while emotional abuse occurs mainly behind closed doors. Finally, abusers can have significant relationships in which he (or she) is not abusive . An inspection of their life reveals the possibility of many “normal” relationships. Narcissists, however, have caused harm to many people. Implications Research suggests that the diagnosis of narcissistic person ality disorder (NPD) is extremely rare. Narcissistic ten dencies, however, are not rare, and their implications are just as concerning. We will, however, never truly know its true incidence because those with this disorder are very unlikely to seek treatment. On the other hand, we know that emotional abuse is rampant. Society is riddled with people selfishly taking advantage of others, seeking to meet their own needs. There are many “Dr. Jekyll-Mr. Hydes” in hiding. Because both perpetrators and victims often hide emotional abuse, it, too, is sadly underreported. Victims of abuse are usually embarrassed, ashamed, and frightened to speak up about the horrific harm occurring in their lives. The Church has thankfully begun to speak out about the impact of emo tional abuse and offer help to victims. Therapeutic Considerations What does all of this mean for clinicians and people help ers? That depends on who you believe when considering treatment. If you rely on social media, they say that anyone with narcissism/ emotional abuse is untreatable. However, suppose you think we have confused the issues of narcis sism, narcissistic tendencies, and emotional abuse. In that case, you will find, as I have, that given the proper focus, accountability, and rigorous treatment, intervention of emotional abuse is possible. Some will undoubtedly be skeptical. However, I believe that change is possible with in-depth, rigorous, issue-spe cific counseling. We at the Marriage Recovery Center have

n It is important to remember that narcissism, at least in the psychological sense, refers to personality—someone with a shattered sense of self who takes advantage of others in a compensatory way. These individuals are often incapa ble of taking responsibility for their actions and are insen sitive to the pain they cause others. They typically have a grandiose sense of self to compensate for inner fragility. Narcissism is a mental health and diagnostic condition marked by profound selfishness, a sense of entitlement, a need for admiration, and a lack of empathy. Emotional abuse, in contrast, is a behavior. Emotional abusers are often not grandiose, do not seek attention, and cause their harm behind closed doors. Emotional abuse has been defined as intentional actions taken against another that negatively impact their victim’s emotional well-being, like verbal abuse, intimidation, humiliation, and excessive control. More Distinctions There are several additional distinctions to help us think about and understand narcissism and emotional abuse in more realistic and practical ways. First, narcissism is thought to be rooted in childhood wounds, whereas emotional abuse is understood to be a learned behavior. If true, we must focus on current behav ior and attitudes promoting existing power and control. Second, narcissism is considered to be a character issue, a personality disorder at its extreme, whereas emotion al abuse is primarily a conscious choice for dealing with challenges . Again, if this is true, we would do well to stay focused on encouraging ownership and responsibility for harmful actions. Bancroft notes, “Abusiveness can look a lot like nar cissism. They (abusers) refuse to be accountable for their actions; they turn on the charm when they have a goal in mind and want people on their side to help them get there; and they’re comfortable lying. They think the problem resides not in them but in other people—specifically, women they’ve been involved with.” 1 I agree with much of what Bancroft says, emphasizing that there is a difference between narcissists and abusers. I agree that abusers shift responsibility onto their victims, especially women. Bancroft goes on to say, “Abusiveness is different in crucial ways. Abusers don’t have any particular similarities in their childhood emotional injuries, whereas narcissists do. Abusers can hide their abusiveness from the public for a lifetime and no one other than their intimate partners and children will know the truth; whereas narcissists leave a trail of enemies behind them.” 2

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