Q1)
What's the difference between counseling and
therapy?
Professional counseling
facilitates venting, expressing and clarifying feelings and
learning; decision-making; and some problem-solving. It aims to help clients
become wiser, more focused, grounded, aware, self confident,
and motivated. Some types of professional counseling focus on specific areas
like weddings, home-building, physical training, investing,
growth, and financial, career, vacation, relocation, and retirement
planning.
Personal, couple, and family therapy add systematic psychological and
sometimes spiritual assessment and interventions to counseling. The
therapeutic process may involve the unconscious
mind, the body, and the spirit or soul of participants. Generally, the various
forms of therapy aim to...
-
safely resolve
and outer
stressing a person, relationship, or
-
release
repressed emotions and awarenesses (break
safely,
-
restore or grow wholistic (mind + emotions + body +
spirit) balance and stability,
-
stabilize or raise moods, and/or reduce excessive
and anxieties;
-
safely end toxic obsessions and compulsions
(e.g. addictions);
-
raise
clients'
confidence, and hope,
-
improve the quality and stability of
relationships and family systems; and for some...
-
help clients discover, affirm, and manifest their life purpose or
mission.
Therapy can focus on one adult or child, a
relationship (e.g. mate-mate, parent-child, sib-sib), a
home, or multi-generational family, or an organization. There may be one therapist, two co-therapists, or a team of
different specialists like a social worker, child psychologist, marital
therapist or mediator, and a psychiatrist (MD). Therapists can work in a private practice, or a private
or state-funded clinical agency.
Different therapies use combinations of
talk, sound, art and imagery,
movement, massage, aromas, music, fantasy, journaling, instruction,
role-plays, inner dialogs,
and other means to facilitate the work. There are hundreds of different therapy
models or paradigms differing in the mix of beliefs, techniques, scope, and values that their
founders and practitioners believe in.
In
the last three generations, mainline Western therapists have been shifting
from focusing on one person (e.g. psychoanalysis) to assessing and treating
the person or couple's family system. Recently, therapists are beginning to use proven
family-systems assessments and interventions to improve the functioning of
individuals'
"inner family" of
For perspective on inner-family therapy, see this overview.
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Q2) What kinds of
clinicians are there, and are there "best" kinds?
There are many
kinds of clinicians (counselors and therapists) to choose from, and specialties within each kind. Their titles and the letters
after their names can be confusing. Guidelines:
Psychiatrists are licensed medical doctors (MDs) who
have had additional training in mind-body assessment and interventions. Only
MDs can legally prescribe medication for "mental health" problems. Licensed
pharmacists can advise on
medications, fill prescriptions, and refer to psychiatrists and other healthcare providers.
Some psychiatrists also have degrees in marital and/or family therapy or
child pathology.
Psychiatrists usually work with individual adults or
children, and are usually the most expensive clinicians, with hourly rates over $100. Their focus can range from classic
medical treatment to "non-traditional"
work including acupuncture,
therapeutic touching, light, herbs, aroma and movement therapy, spiritual work,
and other practices. Many specialize in particular areas of mind-body health care.
Health insurance will often offset their fees, within limits.
Psychologists are trained in
individual and group behavior, but usually not in physiology and medicine.
Licensed clinical psychologists provide therapy and counseling to
individual adults and/or kids or groups. Typical psychologists are
skilled in using a variety of non-medical tests ("instruments") to help
diagnose a person's personality and problems. Like psychiatrists, they may
specialize in one or more problem-types. Most psychologists have Master's and Ph.D. degrees. The
latter may be called "doctor." They typically charge less than
most psychiatrists, and may be covered by some insurance plans..
Social Workers usually have less
training in instruments, no medical training (unless they work in a
hospital), and more training in
providing a range of community-networked services to individuals, couples,
children, and their
families. Licensed psychiatric
and clinical social workers provide child, adult, marital, and family
counseling and therapy in public and private agencies; hospital, school, and
welfare departments; and private practices.
They have Masters (MSW) or
Ph.D. level (DSW) degrees, and usually need a state license to practice (LCSW -
Licensed Clinical Social Worker). When proficiency and experience allow,
they may also earn "ACSW" (Academy of Certified Social Workers)
accreditation from the National Association of Social Workers (NASW).
Clinical social worker's fees are often less than or equal to psychologists.
Licensed
Marriage and Family Therapists (LMFT) and
Licensed Professional Counselors (LPC) provide therapy and counseling like
clinical social workers. They have no formal medical or psychological-test
training, and usually get somewhat less training in providing networked social
services than social workers. MFTs focus more on preventing and reducing
relationship problems than other (generic) therapists. LPCs are more
general. They both are usually licensed by state organizations like the other
service providers.
Pastoral Counselors offer special
focus on facilitating spiritual well-being and growth, in addition to
"regular" non-medical counseling and therapy, to persons,
couples, and families. They may be affiliated with a church, an agency, a
hospital, or in private practice. Some have several higher-education degrees
and certifications. Many have training in religion-based trauma-recovery
(including grief) and marital counseling. See
and Q8 for more perspective.
Certified
Family Life Educators (CFLE)
provide information about the life-skills required to manage a
family effectively, including parenting. They have masters degrees or
higher, and provide expert adult and group instruction and some counseling, but usually not formal
therapy. They may work with
or refer to a range of local human-service professionals and organizations in their work.
Addictions Counselors
have special training in
assessing and guiding addicts and their families towards accepting and
managing their
(achieving and maintaining sobriety). There are several levels of
professional accreditation and licensure in most states.
Many have additional professional degrees like those above. Addiction
counselors may belong
to one or more local and/or national associations like
NAADAC.
Addiction counselors usually work in public or
private agencies specializing in inpatient and outpatient addiction
treatment, including
They're often members of multi-disciplinary clinical teams that work with
addicts and their families. Addiction counselors are gradually accepting
that addictions are not a personal "disease," but symptoms of serious
and major childhood neglect and trauma.
For more perspective on addictions
and addiction management ("preliminary recovery"), see this
series of articles in this Web site.
Life Coaches are
trained to facilitate clients (a) becoming more aware of their strengths,
limitations, and personal goals, and (b) overcome some barriers to progress
on the latter. Most certified coaches are rigorous about not providing
therapy because they lack training and licensure to do that. So they
avoid focusing on personal psychodynamics, and usually refer clients to
therapists when appropriate.
+ + +
Other professional counselors and therapists specialize in helping
clients manage problems with sex, grief, finances, and occupation. They may
or may not have one or more degrees in the professions above.
Law-enforcement agencies, schools,
hospitals, HMOs, and
public-aid caseworkers provide family-support services
that can include counseling and/or therapy.
The best kind of counselor or
therapist for a given problem is one who is trained, licensed, and
experienced at diagnosing personal and relationship problems (unfilled
needs) and skilled at offering cost-effective, respectful interventions that
help clients improve their
in desired ways. See Q5.
Q3)
How much does
counseling and therapy cost?
Fees for these clinical
services vary widely. Some agencies and
private practitioners use a "sliding scale" for
low-income clients who can't afford full-scale fees, so charges can be as low as a
few dollars per hour. Full
scale now ranges between (roughly) $60 to $140 per hour. Fees from licensed
providers often qualify for at some health-insurance coverage.
Most
Health Maintenance Organizations (HMOs), Preferred-Provider Organizations (PPOs), and managed-care organizations pay for
a limited number of sessions with qualified clinicians. This cost-management limitation often hinders
permanently reducing most psychological-wound (trauma-recovery)
problems unless clients can pay for extended therapy themselves.
The easily overlooked counter-question is "How much does it cost (eventually)
to not get appropriate counseling or therapy? There is no
meaningful way to answer this question, other than accumulating personal
pain, frustrations, disappointments, and losses over many years and looking
back with hindsight and regret.
Education is the best investment courting
partners and other family adults can make to avoid such regrets and clinical
costs. A high percentage of average Americans appear to inherit the
epidemic [wounds + unawareness]
from their ancestors. Those that do can benefit greatly from effective
personal trauma-recovery therapy, to avoid
passing the toxic cycle down the generations.
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Q4) Typically how
long does counseling or therapy last?
This depends on many factors. The practical answer is
"It lasts until...
-
the initiator feels the problem is solved, or...
-
funding runs out; or...
-
the participants' and/or
clinician's patience, stamina, and hope run out."
Most relationship and family
problems are symptoms of underlying
adult false-self
and
so periodic effective clinical help can remain a valuable investment for many years.
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Q5)
What's the best way to shop for an effective clinician?
People
who have never hired a professional counselor or therapist before may waste
considerable time, money, and energy by picking an inappropriate or
ineffective clinician. Choosing a plumber, dentist, doctor, or vehicle
mechanic is easier in a sense, because you know what service you need.
Paradoxically, the first thing you need to learn in shopping for a clinician
is "what's my problem?"
A good way to
start shopping is to do an attitude check. The best counseling or
therapy outcomes happen when clients believe "I am responsible for the
quality my life and relationships" rather than expecting someone else (a
parent, spouse, or professional) to take that responsibility. This attitude
allows you to seek a clinician who's attitude is
"If you hire me, I accept the
responsibility for helping you learn how to identify and fill your own needs
well enough."
A second vital
attitude to adopt is "I am a worthy, talented, competent person with
unarguable human rights and a valuable
life-purpose." Many of my therapy clients have been in protective denial of
a well-camouflaged attitude of
and unworthiness. This is one of up to six epidemic psychological
acquired over early years in a
environment. For perspective, meditate on these brief ideas on healthy
and
Next, do as
much self-diagnosis as you can to estimate (a) "What - specifically -
do I need, and (b) what prevents me from filling my needs now?" If you
can't evolve clear answers to those questions by mediation, journaling, and
discussion with trusted others, then select a professional who will help you
answer them before doing anything else.
The most
fundamental question you can research alone or with skilled help is
"Who am 'I' - who is causing
my thoughts, feelings, and needs ("problems") now - my
or "someone else" (other
Gain initial perspective on this by reading this background
article, and then use this
comparison and
worksheet. Then read about
in this Web site for more perspective and ways to
your true Self.
Another powerful aid to effective
self-assessment is using the premises that...
-
"all my
problems are unfilled needs (discomforts)," and...
-
"I need to
learn and fill the
that are causing my surface (secondary) needs."
Study these three "dig-down"
examples of how to do this vital self-research.
Many surface problems people
bring to clinicians involve
with or concern about other people.
Often a core root of their role or
relationship problems (unfilled needs) lies in their attitudes.
To gain perspective on this, see if this
article applies to you and/or someone you care about.
Another core
cause of most relationship "problems" is that the people involved -
specially kids - don't know how to
and
(problem-solve) effectively - they (you) don't know what they don't
know. Use this quiz to self assess your
knowledge on these vital
and then study
for practical options to "do your own therapy" (education).
A final vital
aspect of initial self-assessment is to explore whether your primary
problem/s may come from
To gain perspective on this, take this quiz,
and then review this slide presentation and
this overview of Project 5.
If you (i.e. your
dominant subselves) care enough about yourself to do these self-assessment
steps thoroly, you'll have a much clearer idea of what needs you may need
professional help and/or other support with. See
Q2
and Q10 for perspective on each of
these. If you ignore, defer, or are
half-hearted (ambivalent) at doing these self-assessment steps, you're
probably significantly
and controlled by a well-meaning, inept
Useful "Shopping Questions"
Based on the
above, vital questions to ask a potential clinician include your version of
these:
"Why did you choose this profession?"
"How long have you been practicing, and are you
licensed and accredited by state bodies and professional associations?
"How do you assess typical clients or patients -
what do you look for, and in what order?"
"Are there specific kinds of personal or
relationship problems you don't feel qualified to work on?" If so, whom
do you refer people to?"
"Do you have training and experience in doing
work?"
"Do you have training and experience in
inner-family-systems
or
"If I hire you, what do you see as your and my
main responsibilities?"
"How do you approach resolving typical
relationship problems?"
"Do you include assessing and improving
communication and grieving skills in your work?"
"Do you routinely assess for
addictions?" If so, how do you work
with typical addicts and their families?"
"What role, if any, do you see personal
playing in this work?"
(After initial assessment) "Can you recommend any
local or Web support (self-help)
groups that might help me and my family?"
If you're in a
stepfamily or may be, see this for
special questions to ask a prospective counselor or therapist. Also see
this if you're considering a stepfamily
support group
Option -
print these Q&A pages and discuss them with other lay and
professional supporters.
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Q6) What if (I
think) my partner - or we both - need counseling, but s/he refuses?
One or more of these may be true:
S/He had a painful prior
counseling experience (with you or pre-you), and
doesn't
the process to be
safe and/or productive;
Your partner's ruling
that the process
will reveal something awful about someone, your relationship, and/or
someone's family;
Your partner's
and/or
subselves feel "counseling is for crazy or sick people," and
they don't want (your partner) to
be seen as either of those;
Your partner feels that you
think
something's wrong with her or him, so some dominant subselves feel resentful
and defiant because you want to "fix" her or him (which makes you "
S/He interprets your invitation
as a disrespectful
or ultimatum ("You
must fill my needs now") rather than a respectful request
("No" is an OK response) - and s/he is protesting that;
S/He has
something against the counselor you've picked, feels left out of the
counselor-selection process; and/or feels uncomfortable about
choosing a clinician.
S/He feels you
can't financially afford
counseling now, and you disagree - a
S/He (defensively) feels
you're
the one with the problem (you're 1-down), vs. we have a
problem - so
you
should "get fixed;" and/or...
Something else.
My experience is that
trying to force or manipulate someone into going to a counselor or therapist
is a lose-lose decision because it becomes a 1-up/1-down
vs.
.
Options:
A) As with any significant personal or relationship problem,
first check to see if your
is
your
If not,
you are probably half or
more of the "counseling problem."
B)
on why you think
counseling would benefit you both; then get honest about whose needs you're most focused on filling. If it's "both of ours," then...
C) Review your personal rights, and
your views and needs clearly and simply (i.e. in less than four sentences) when (a) your partner is
clear-minded and undistracted, and (b) you each have a "two-person"
D)
(vs. critically) for
any objections like those above, and see if there's some problem you weren't
aware of. If so, use the seven
from
to try for win-win
resolution as
not
opponents;
E) Learn how to spot and resolve
and
conflicts, and
associated relationship
Then see if
"going to counseling" is a symptom of any of these three
related relationship
stressors.
F) Check your terminology. Some people (like your partner?)
find "counseling," "consulting," or "relationship tune-ups" less intimidating than "therapy."
G) Check your attitude toward your mate. If
opposing subselves feel "I love you" / "I don't like you now," these
are probably raising
your partner's confusion and anxiety.
If you don't
respect your partner,
your behavior will broadcast that no matter how you try to camouflage it
("words can lie, bodies can't"). Her or his refusal to join you may be a
response to that. Assess if something's in the way of an
(mutual respect) attitude, and
if so, take responsibility for resolving it.
H) Check your expectations of your partner. If you (or
of your personality)
expect your mate to refuse, that may be self-fulfilling.
I ) Study the re/marriage Q&A items
here and these
Refusal to go to
counseling is usually a
symptom of a
The Web address of this
three-page Q&A article is
http://sfhelp.org/qa/counsel-q.htm
General
Questions about Counseling and Therapy