by Brent Lindquist
Nine recommendations on how we can use short-term counselors more effectively in providing much-needed therapy to missionaries overseas.
In the last few years there has been increasing interest in providing on-field counseling and consulting to missionary workers. In most cases, a North American mental health professional spends one or two weeks at a counseling site. He or she does workshops or seminars, and counsels missionaries. Most of the time the outcomes have been beneficial.
However, we now see a number of weaknesses in this approach. Being both a psychologist interested in missions, and the chief executive of a mission agency, I communicate regularly with mission leaders about their needs and the quality of care available on the field. In many cases, after initial delight with the mental health professionals who travel at their own expense to offer short-term services, these executives now report some problems. Therefore, we need to consider a different model for short-term counseling overseas.
In some cases, the counselor’s workshops may not be culturally relevant. Sometimes, the brief counseling just uncovers missionaries’ problems, but doesn’t give solutions relevant to the field. Afterwards, the missions find they are more aware of their problems, but less aware of their solutions. Unfortunately, in numerous cases, they dismiss psychological explanations as irrelevant to their missionary tasks.
Mental health professionals, wanting to consult in a cross-cultural context, often do not look seriously at the dynamics of cross-cultural communication and the ethnocentrism inherent in typical Christian North American mental health work. While they may limit themselves to working with expatriate North Americans overseas, they do not account for the fact that expatriates have to adjust to a context that in many cases is quite different from what they are used to. These hidden sociolin-guistic dimensions of behavior escape the counselor.1
Standard therapist training often focuses on the individualized therapeutic process, uncovering various problems and digging beneath symptoms before providing relief. Most of us become quite good at uncovering pathology, but we take a lot more time getting to the recovery. Unfortunately, in one or two hours of therapy the counselor tends to focus on the diagnosis and does not provide important practical answers. In such cases, the missionaries are in worse shape than if they had kept their problems to themselves. Such experiences tend to reinforce the inclination of missionaries to be quiet about their problems, for fear they will be misinterpreted and hurt. Therefore, they are even less willing to get help when they are on furlough, where they may have access to more intensive forms of treatment.
In addition, a typical therapist’s training aims at empowering the client, or helping the client to advocate for himself or herself in the organization. Since most therapists do not work with their clients’ organizations, when they get overseas they tend not to pay attention to the important consequences of empowering their clients in their organizations. For example, some agency leaders have criticized me about a therapist who came to consult, but who instead stirred everyone up against the agency. (The agency may or may not have been a valid focus of such frustration or anger.) When the therapist left, the agency had a tremendously difficult time figuring out and working through issues. Sometimes I have had to apologize for mental health services to mission executives, who felt they had been burned rather deeply.
Short-term counselors need to focus on the individual in his or her agency, much as a family member within a family. Empowerment or advocacy therapy must take into account, to a stronger degree, that there are two sides to an issue, and that people still have to work together. In cases where missionaries may have been victimized earlier in life, the therapist helping to advocate or empower the client may actually revictimize the person in the context of his or her environment.
RECOMMENDATIONS
In light of these problem areas, we need to discover how we can use short-term counselors more effectively in providing much-needed therapy to missionaries overseas. Let me make nine recommendations.
1. Sensitivity to missionaries’ perceptions of the counselor’s effectiveness.The missionary community in which the short-term counselor works does not necessarily take his or her academic degrees, or past experience, as an indication of expertise. The counselor has to prove himself or herself all over gain, no matter how many letters there are after the name. Also, the missionaries’ definition of effectiveness sometimes relates less to professional accomplishments and more to personal competence and accessibility. Boundaries and time frames often need to be reconsidered. For example, the counselor will have dinner with the same people he or she works with immediately afterwards. People with very strict boundaries struggle with how to provide professional services in this new context. The therapist’s ability to be transparent and to use her or his own experience often means a great deal to a missionary who is in the middle of a crisis and needs someone else’s own experience to give him or her a sense of hope.
2. Preparation.One aspect of preparation often overlooked is cross-cultural sensitivity.2 Too often counselors make assumptions, or ignore the importance of understanding issues from a cross-cultural perspective. We need learners who will go in and ask questions first about how missionaries are working through various issues. Missionaries may think they’re North American, but they may have adapted ways of relating to each other that may be more in line with the national culture, or at least moving that way. Counselors’ failure to note this may cause their intervention ideas or strategies to be misaligned with the missionaries’ situations or styles of communication.
Preparation also includes being clear—to the point of getting things in writing from the mission agency—about exactly what is expected. All too often, “Oh, yeah, there’s one more thing we’d like you to do,” hits counselors with a great problem but no resources or time to take care of it. Unfortunately, short-term therapists will more often be remembered for their failures rather than their successes.
3. Ombudsman vs. advocate. Seeing missionaries simply as an individual, or as a family, causes short-term counselors to make unfortunate mistakes. Their role as advocate is important, and they need to advocate for their clients to help them to understand and work through their problems and difficulties. However, to advocate without taking into account the needs of the mission board can cause greater problems for the client and may actually jeopardize the missionary’s position. Therefore, perhaps it’s wiser for the counselor to assume the role of ombudsman and provide mutual regard for both positions. That way the counselor can help the missionaries make peace with all of their circumstances. This is not an easy approach.
4. Solution-focused rather than problem-focused. The short-term therapist needs to build success into the brief time available. This means using the time to reinforce what has been done right, and to give direction toward doing more things right. That way the therapy assumes a more hopeful, encouraging stance.3
5. Focusing on brief diagnosis. Since the counselor may have only one or two hours to work with a person or a family, that time could well be spent gathering data, leaving only a brief time at the end to offer solutions. This could leave people quite frustrated, disappointed, and discouraged. Instead, the counselor should focus on where they see themselves, what’s going on with them, and then give them some strategies to follow. In many respects, when people have even a single success, or a feeling that they have accomplished something, this energizes them to do more work on their own without therapy.
6. Diagnosing.Avoid revealing diagnoses to others in the missions community. A flippant comment made to a field director may, for a long time, label the missionary as a problem person. That label will stick, even in the face of understood confidentiality.
7. Follow-up. It is much better for a counselor to develop a longer term relationship with a mission board, and focus on a specific field, than to bounce around to many different fields. This allows the counselor to return and provide his or her own follow-up over time on an intermittent basis. It also helps the missionaries to feel there is at least one person who is really concerned about them. Too often, member care simply means one counselor going all over the place and never really deepening any relationships.
I have relationships with people that span 12 years. I see them every two to four years for single-session therapy. In most cases, they highly value my time with them because they see me as someone who knows them. They don’t have to spend a lot of time telling me what’s going on, or rehashing their background.
Lacking such follow-up, we must emphasize to missionaries seeking help the importance of some kind of follow-up. Frequent communication will help, as well as support groups focused on their problems.
8. Normalizing. Many personal problems are reasonable responses to developmental stages. Normal people react to stress and strain. Counselors can help missionaries see their responses as normal reactions to abnormal situations, thus empowering them to develop positive coping strategies.
9. Be yourself; don’t be a “professional.” This gets back to a previous point, but it’s a good conclusion. People remember the funniest things. They may not remember how concise and clear the counselor’s outlines were. But they will remember the practical aspects of what the therapist said, and how it applied to their lives. They will remember what the counselor did on her or his time off.
If missionaries remember the counselor as a someone who is personable, approachable, caring, and transparent, then they will remember more of the other kernels of wisdom the counselor presented. In many of the mission boards with which I work, I am known as the “Shrink from Link.” Although some professionals have been quite offended by that title, I look at it as a term of endearment, because it signifies that my philosophy and goals are being reached. I want to be seen as a relatively normal person who is a helpful resource. Not a bad goal, I think.
Endnotes
1. Brent Lindquist, “Missionary Support Centers,” Missionary Care: Counting the Cost for World Evangelization (Pasadena: William Carey Library 1992).
2. Ibid.
3. B. Furman and T. Ahola, Solution Talk: Hosting Therapeutic Conversations (New York: W.W. Norton, 1992).
Other Sources
T. Kreilkamp, Time Limited Intermittent Therapy with Children and Families (New York: Bruner-Mazel, 1989).
J. Powell, “Short-term Missionary Counseling,” Missionary Care: Counting the Cost for World Evangelization (Pasadena: William Carey Library, 1992).
M. Talmon, Single Session Therapy (San Francisco: Jossey-Bass, 1990).
J. Walker and J. Peller, Becoming Solution Focused in Brief Therapy (New York: Bruner-Mazel, 1992).
F. White, in Missionary Care: Counting the Cost for World Evangelization (Pasadena: William Carey Library, 1992).
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