How do you prioritize what issues to address in a complex counseling situation?

I think a helpful way to think about prioritizing when faced with a complex problem as a counselor is to use an emergency room analogy. For example, just like the emergency room will immediately check a patient's breathing and circulation before anything else, the counselor will prioritize issues of safety and risk before considering other things. And in the same way that a broken bone or a cut on the forehead has a straightforward treatment plan, many counseling problems also lend themselves to straightforward goals and objectives. It's not to say that these problems are easy to address or quick to resolve, just that there's a straightforward process of care.

In contrast to the straightforward gash on the forehead, the ER requires time to sort out and decipher complex health problems like an autoimmune disease. A bunch of labs here, a handful of consultations there, testing for this, ruling out that. Complex counseling problems are similar. They too require time to investigate and sort things out. So with that picture in mind, here are four rules of thumb that I think can help you prioritize care and do that necessary exploring and deciphering work.

Rule of thumb number one: Check for safety. Just like in the ER, the first priority is to assess for safety. Is anyone in danger? Are there any immediate risks to self or others? Are there any destructive patterns that are evident?

Rule of thumb number two: One thing at a time. It's important to understand that a complex problem is usually made up of many smaller problems. And even if you and I are able to see all of the interconnected issues, we still can't prioritize and address more than one thing at a time. In this way, complex problems compel us to be patient and humble and grounded in reality.

Rule of thumb number three: Follow their lead. This is how you decide which thing to prioritize. You prioritize the door that they open. Follow the content, the topic, the concern that the person in front of you feels is most important. In doing this, you follow what is easiest for them to talk about, what they're most motivated to talk about, and what feels most pressing to talk about.

And rule of thumb number four: The good news is simple. And this is the good news: Jesus gives grace for sin and provides refuge for suffering. So even though complex problems are obviously not simple, the good news actually is. It is always relevant and always applicable. Whether that's when we're checking for safety or moving forward with one issue at a time, or you're just following their lead. There will always be opportunities to offer the refuge of Christ and the forgiveness of sins. Naturally, there will be concern and anxiety about potentially missing something important when working with complex problems and there's no substitute for experience and training and case wisdom. But these rules of thumb can help you settle into a process of navigating decision-making and prioritizing when working with a complex problem.