Cognitive Biblical
Therapy Coursework
Counseling Through God’s
Transformative Word
Course 4, Chapter 20
Section 5: General Counseling Issues
Chapter 20 Aids, Abduction and Rape
Trauma is at the center of each of these issues and needs careful attention while leading a client through the process of God’s healing and redemption. When all three traumas are involved, physical, spiritual, emotional and mental healing will require deep spiritual surrender, trust and humility.
Essay Questions: Answering the section questions (red buttons) is a great way to prepare for the end of the Chapter Quiz. Chapter 20 questions require you to analyze the case study and apply both present and previous course understanding, while using common sense. The section questions will provide Dr. Wilkinson’s feedback to your answers.
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Chapter 20
Aids, Abduction and Rape
Diagnosed with AIDS
This next topic will not be much easier, because it's about the acquired immune deficiency syndrome or AIDS acquired through a gang rape after an abduction. Locate the Symptoms and Treatment Text (see Materials tab), we will be discussing Case Study 20. As you know, AIDS has a purely medical side to it. And I would suggest to you that you need to research the medical side of it.
Human Immunodeficiency Virus (HIV) damages the immune system so that the body is less able to fight infection and disease. If HIV isn't treated, it can take years before it weakens the immune system enough to become AIDS. Thanks to treatment, most people in the U.S. don't get AIDS.
HIV is spread through contact with genitals, such as during sex without a condom. This type of infection is called a sexually transmitted infection, also called an STI or an STD. HIV also is spread through contact with blood, such as when people share needles or syringes. It is also possible for a person with untreated HIV to spread the virus to a child during pregnancy, childbirth or breastfeeding.
There's no cure for HIV/AIDS. But medicines can control the infection and keep the disease from getting worse. Antiviral treatments for HIV have reduced AIDS deaths around the world. https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524
As you know, there are various ways and types of sexual relationships a person can obtain HIV/AIDS. Besides the relationships of adultery or homosexuality, your client with these medical issues should be directed to seek testing for AIDS and other sexually transmitted diseases. It's sobering for them, because they usually don't think about that when in the midst of sexual immorality. It's still very critical to seek medical testing, then treatment if needed, if the client hopes for a sense of trust, peace and willingness to re-establish a sexual relationship in a marriage or in the future. In this chapter, we will primarily focus on AIDS, Abduction and Rape as a group of traumatic events, though you may find each topic helpful when counseling a client who has experienced one of these traumas.
We will now primarily focus on clients who have been diagnosed, and under the care of a physician. It is good for you to know the symptoms, treatment and prognosis of this disease. The client may come in relatively in good health, or may be ill and dying. In the other section about illness in this course, I explain how to help clients who may either be temporarily ill, permanently disabled, or even facing death. But the issues that I want to address are more than the physical ramifications; they are the spiritual ramifications of how the client will deal with facing the diagnosis and how it was acquired. In similar cases of health limitations and decline, I have learned that their spiritual and emotional needs are impacting their quality of life and even future. The client needs to work out their understanding of it, why God allowed it, and what lies ahead for him or her. Often, they struggle with bitterness, anger, and hostility toward God, and that is our focus on this issue. How is the client coping with the issues of being abducted, raped and acquiring AIDS, and how do you work with them from a spiritual perspective?
The physical difficulties depend on the stage of the illness of the client. They may have just tested HIV positive, but not have any of the symptoms yet. It may have been lying dormant. They may be in the initial stages and under medical treatment. They may even be in some of the final stages of the illness showing the loss of weight with little to no energy. They may have had to quit their job or stop driving a car. It could be any number of things. Also, it says that they could potentially have a poor concept of God and His love. They may be experiencing a “why me” attitude, or they may be experiencing the stigma of AIDS, and be dealing with a sense of isolation, anger or fear, the loss of friends, or any number of contacts that they used to enjoy. They may be very confused by people shunning them while under treatment.
So be sure the client is receiving proper medical care to the greatest degree possible. That's going to involve a little investigation to learn about their doctor, medication, and what provision they're making for the potential that they will become more dependent upon health care. They will have issues as they continue to lose the ability to live their life without assistance.
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What is an STI and a STD? Are they similar or different? How is HIV transmitted from one person to another?
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Dr. Dan's Answer:
A Sexually Transmitted Infection and a Sexually Transmitted Disease are the same, with the difference only in the last word -- "infection" versus "disease." Human Immunodeficiency Virus (HIV) is an STD that damages the immune system so that the body is less able to fight infection and disease.
HIV is spread through contact with genitals, such as during sex without a condom. HIV also is spread through contact with blood, such as when people share needles or syringes. It is also possible for a person with untreated HIV to spread the virus to a child during pregnancy, childbirth, or breastfeeding.
Case Study - Impact of AIDS
As you see in the Treatment Text, the treatment includes evaluating their personality through the AQAL, evaluating personality through Analysis Profile. Then analyze their Biblical concepts of forgiveness, and eternal life through salvation. Also, you need to explain the concepts of grieving over loss as it applies to the client’s sense of loss of their own physical health. The number years of life yet to live, can range from 10 years to 60.
Case Study 20 is about an Active woman who has AIDS. This particular case resulted from a double tragedy. She had been walking alone on a summer's evening in her own neighborhood, when a group of men in a pickup truck came by, abducted her, and took her out to an area outside of town. She was gang-raped by the four men, one of whom was HIV positive and infected her.
She found out within a relatively short time that she had been infected. She was single, but engaged, and when her fiancé learned about this, a third tragedy happened. He withdrew from her and within just a few weeks, he broke the engagement, moved out of town, and never contacted her again. She grew up with very strong-willed parents who raised her in an extremely rigid system of discipline. Since she was strong-willed, she was rebellious against this rigid system as a pre-teen. She engaged in several power struggles and fights with her father, until she was 17, then quit school and ran away from home. She went to another town where she went back to school, enrolled and attended college. She was in her chosen career for about five years, and was doing very well. She had a lot of hope in that and felt like her life was on track to get her dreams of a family with children. Her hopes and dreams were crushed by this event. When I saw her in counseling, her fiancé left, and she lost her career position partially through prejudice, and declining health. But she wasn't extremely ill at all, looked healthy, and hadn't lost weight. But her current problem was bitterness and anger toward everything.
Assessing her Agape questionnaire scores show us, her highest scores were: D boast (18), I keep no record (15), J-K delight in evil (13), and L protect (15). Her middle scores were: B kind (10), C envy (12), E pride (10), F rude (10), M trust (11), and O perseveres (12). Her lowest scores were: A patience (8), H easily angered (9), N hopes (8), and never fails (8). She started to have some troubles with kindness and envy, also with pride and rude and selfishness. If you move to the far right, you'll see that she had trouble with being willing to trust God, and also perseveres. Her greatest problem started in the area of patience, and that was very evident in sessions. As we started talking about forgiveness and God's character, her process of thought, analysis, and getting facts were very poor. She held on to bitterness and was easily angered. She had difficulty choosing to think about, believe, and act on things that would help her move away from her bitterness and anger. She saw no good outcome, unless there was a medical breakthrough or God's healing her, she knew the end result of this would be her death, just not knowing when.
As anybody else, she had her own set of concepts about herself that weren't right, so she labeled herself as a failure. She saw herself being at fault, because she chose to go for a walk. Then she labelled God at fault, because He allowed it. She saw herself and God as failures. She had thoughts like, “If God was really God, if God really loved me, if God really cared, he would have turned the truck around. He would have told them to stop.” She explained that when it was going on, she kept crying to God to make it all stop. “Make them go away. Make this be over. Don't let this happen. Why aren't you hearing me? Why is it still happening?” Her concept of failure was tied to the instant, the situation, and she looked for a God who would give her instant feedback, instant answers, and instant understanding. She didn't see her own need to be a part of the solution.
I also showed her the results of the questionnaire and explained her personality type. Her scores show the typical pattern of an Active personality with the traditional spike that starts with a low score on patience and then a high score somewhere around envy or boastfulness. But unlike a typical Active personality, her scores are very close together from pride through easily angered, than the traditional pattern of being Active. Her passive pattern of close scores was from her past life of living with controlling parents. So, she was coming out of that Passive-active tendency, but still had, at times, that pattern, which led to her insecurity and fear. This insecurity and fear caused her to struggle with her submission to God. She would want to be submissive, she would question or think, and then she would lash out with extreme emotion of intense anger and be sarcastic with God. Rather than reason through her perceptions, or submit them to God, she would hold onto them, be rebellious and headstrong and come to wrong conclusions by distorting Scripture.
When we began to talk, the most difficult issue for her was accepting that she was going to die. So that is where I began to help her. I could not pretend like that's not the issue it is. Her case was compounded by the abduction and rapes. She had never, in her wildest dreams thought that anything like this could happen, or that her fiancé would abandon her after stating how much he loved her and how much he was committed to her. I had to focus the interpretation of the questionnaire results, her misunderstanding of the situation spiritually, and her reading into her experience the wrong concepts she held about God's character and nature in allowing this to happen.
She was destroyed by the unfairness of her suffering and losing her dreams for the future. The issue I came to with this client was facing the whole fact of what had happened. There was going to be the potential reality that she would die earlier than what she would normally have as a normal lifespan. Then along the way, there was going to be a degree of suffering that wasn't fair and that she shouldn't have experienced. Her reaction wasn't good, and I wasn't able to help her.
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A person with the AIDS virus may have become infected through many different avenues. What types of thoughts, emotions, or attitudes towards God and others do you think that this person will be experiencing in relation to how he or she has become infected?
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Dr. Dan's Answer:
The client may be feeling wronged by God, that God does not care or is indifferent to the client, angry or violent towards the one or ones that infected him or her, closed to all relationships or people, frustrated, hopeless, or suicidal.
Defensive Resistance
Her defensive demeanor was based upon her fear and insecurity, as discussed in the last section, where her scores clustered from E Pride to H Easily Angered, in a Passive-active manner. This pattern will almost always relate to someone’s difficulty trusting God, which gives them the reassurance they are a victim and God is not good to them. If a person uses the process of patience and senses God’s peace rather than fear and neediness, let them know their peace is most likely from the Holy Spirit. Reaching out to God, using the process of patience is their ticket to peace and freedom from being a victim, like living with controlling parents. God’s peace is freedom from her former reality, which can ground her to live in her present reality.
Later I will talk about illness, explaining how a client who lost her eyesight from diabetes and felt abandoned by God, came to me because she didn’t know how to die. She also had hopes of marriage and a family that were lost. In her case, she was willing to learn and change. In the end, she got a lot of help. We counseled over the phone because she couldn't get out of the house. Later, she was able to testify in her church about how good God was and how he had given her peace. It triggered a tremendous outpour from the congregation of their own needs and emotions. She was at the altar in her wheelchair, and most of the church came up to pray. She called to tell me that she could not believe how God had used her. And she said, I actually rejoice in the fact that God allowed me to become ill, so that He can use me to help others. I can pray for them and be an example of what dependence on him is like.
Going back to the initial AIDS case study (20), one of the most difficult things I had to try to do with this client was to focus on the bitterness that she felt very justified in, and her anger even toward me. She asked, “What would you do if you were me? How can you tell me you would have this ‘holier than thou’ attitude?” Can you see some of her selfishness, plotting against her own life or being easily angered, provoking herself or others into a sense of fear and being hopeless? She clung to that bitter attitude and would not let it go.
When I would confront her, and I'd say, “Have you worked through the steps of patience? Have you asked the Holy Spirit to check yourself to see if your concepts are true, if your attitudes are valid, if you're helping yourself or hurting yourself? What has God told you?” She wouldn't do that. She kept her sense of failure and hopelessness, while provoking herself to be upset and angry. She stayed proud and rude. All of these conditional, emotional reactions were her means to cope and protect herself, trapped in her victimhood.
I think pride was the major issue. In looking at her background, I found that she almost constantly had trouble with people and authority. She was always in and out of work. She'd had trouble getting along with her parents, then even into her college days, she still had some of those difficulties. The other physical problems weren't related to AIDS, but poor health habits in eating, sleeping, and poor health care. These were caused by the same issue of pride and rebelliousness against making choices that support good health.
As it turned out, in this case, that the symptoms of the problem of AIDS, something she obviously did not want and didn't ask for, revealed this underlying problem of pride that made dealing with the problem the AIDS much more difficult and just about impossible. She stayed very bitter and very broken, because of that thread of rebelliousness that ran through everything. This might seem silly in a sense, to mention this, but one type of evidence of pride and rebelliousness in a client toward you as a counselor will be their payment for their sessions. This client quit sessions, but didn't talk to me about it and owed money that I eventually wrote off as bad debt. I don't say that to condemn her. If a person has this rebellious attitude, it will manifest itself in many ways. When I tried to discuss the material, she didn't want to take time to read it. She dismissed it, because she felt that it wasn't good material, even though in the initial stages, she thought it was just excellent, and felt very eager to get into it and to find answers, and was very excited about it.
Fully answer the following question from the content you just read and submit your answer to find your score and Dr. Dan's answer to the question.
When an Active personality type looks like a Passive-active person's scores that cluster from E Pride through H Easily Angered, what may be the reason?
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Dr. Dan's Answer:
This pattern potentially comes from their past life of living with controlling parents or a controlling husband. Coming out of a Passive-active tendency, there will be a tendency toward putting their security in God, grounded in God's Word through experiences of surrender to God.
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According to the text in Chapter 20, what can a disease, disability, or physical condition reveal in a person's heart?
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Dr. Dan's Answer:
Various conditions of "what love is not" -- like pride -- can be revealed as an underlying condition in the heart when experiencing any type of physical or medical condition, though also in a problematic relationship, addiction, etc.
This can also potentially reveal what is behind a client who does not pay their counseling bill or refuses to attend counseling.
Responding to Fears and Defensive Accusations
I know there are a lot of other issues that can be involved such as immoral sexuality, homosexual or lesbian issues. But the biggest issue is going to be a spiritual issue, God's goodness, and the client accepting the basic facts of sin of humans who brought sin into the world, not God. In fact, God made a way for that sin to be dealt with permanently; that's through the Gospel, the sacrifice of his one and only Son, giving salvation and the forgiveness of sins. And then God gave us a way to deal with all these difficult life issues through the Holy Spirit, the Scripture and spiritual transformation. And that's the core issue. If the person is bitter or angry at somebody else, hopeless, afraid of death, frightened by the degeneration of their body and mind, inability to work, or have relationships, there has to be a deepening relationship to God. Only through this relationship to God, can a person get strength from God through Christ to endure the suffering and death from a fatal disease.
You may be accused of not understanding the client’s problem, because you are not suffering as they are, but you still face death and the unknown part of it. Because we are human, we have our own faith challenges. To help them, share about your own places of struggle, and how God has helped you as you've been patient, confronting your own rebelliousness. Describe your own struggles with defensive reactions (denial, anger, suppression, blame, etc.) as a way to survive loss, fears or possible traumas. Then how you were able to be submissive to God in the struggle. Do that through both personal examples and the studies on First Corinthians 13, and the process of patience.
In some case, you will find this same crisis point, and the client has to make a decision. They have to make a decision to stop being adulterous, to stop being a gambling addict, to give up substances, to give up a cruel and vicious tongue, sarcasm, pride, selfishness. So don't see AIDS as something other than another symptom of sin, whether it's somebody else's sin that was fostered on the client, as in this case, or it was a willful decision to be involved in a homosexual or lesbian lifestyle, or commit adultery. The person has been caught in their sin, and may have lost their family. The wife may now have AIDS, and she's bitter and angry. You've got them both in your office, and all they see is hopelessness and despair. The certainty of death is difficult.
If you have fear of counseling with somebody and being infected yourself with AIDS, you need to look at the medical information for more guidance on that. You have to have your own sense of peace and stability by learning how AIDS is transmitted. It's more sexually transmitted disease, and through a blood transfusion. But make sure you settle that issue within yourself so that you don't have fear, because if you do, you will appear to be a phony or a hypocrite. So, you have to make sure that that's settled. That's an issue you've thought about, prayed about, gotten facts about, confronted yourself about, through patience, talked to the Holy Spirit and surrendered your own bias or prejudice.
I can remember in another situation, I shook the hand of a fellow in a prison, who had accepted the Lord about three weeks prior. And as I left, I asked my co-minister, “What did he do?” And he said, “Well, you know the hand you shook?” And I said, “Yes.” And he said, “Well, about three weeks ago, that hand and the other one put itself around his father-in-law's throat and killed him by strangulation. He then dragged him down to the river, tied cinder blocks around him, and threw him in!” I remember that that same sense of emotion and fear rushed through me as I thought about that the hand of the man had just killed somebody about three weeks ago. Now he professed Christ, and his witness seemed true, because I would have never thought that he had murdered someone. But the problem wasn't his, it was mine: and the problem (fear, apprehension) won't be the client's, it'll be yours.
So, you need to have settled spiritually anything at all that's going to get in the way of your being a true, clear witness and image of this love that you're telling the client that comes from God. This power of God’s love will give them a sense of peace and stability as they deal with AIDS, and those they have infected. Even if they are the victim such as this case, you still have to make sure that you're able to work with a client. If you're not settled or confident, don't take the case, but refer them to somebody else who you have confidence in. Because when you work with someone who is dying, you need to be sure you know God. That He is good and trustworthy, because you are asking them to know a God who will walk with them “through the valley of the shadow of death without fear of evil”, because God will be “your rod and your staff, and he will comfort you.” You know that because you've walked through your own valleys, tough places, and hard times where you had to depend on God. He has revealed to you that He's dependable.
Copyright 1987, 1990, 1993 by Daniel D. Wilkinson. All rights reserved. For more information concerning this material, write to:
The Biblical Christian Counseling Ministries, Inc., 2730 Radcliffe Dr., Florissant, MO 63031.
Any reproduction of this material without the express written consent of the author is prohibited. Printed in the U.S.A..
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When a client accuses you of not understanding or being self-righteous, how would you respond?
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