Reasons to try counseling.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Going to see a counselor doesn’t mean you’re crazy.

People go to see counselors for a variety of problems. Just as athletes have coaches seeing a counselor can help you improve the way you are living life. Many companies now have employee assistance plans (EAPs) so that people can address life issues before they become serious problems. Counseling or therapy can be beneficial for people with serious mental illnesses, but it can also be helpful to prevent the challenges of living from becoming a mental illness. Here are some reasons you might want to see if a counselor.

Counseling can help when you are constantly upset or overwhelmed.

Life can be challenging. Some people are more resilient and able to overcome obstacles than others. Skills for living life are something you can learn. The counselor can help you with other ways to see your problems and help you to develop the skills you’ll need to cope with the challenges you’re facing.

Feeling mentally confused is a reason to see a counselor.

Confusion often brings people into counseling. You don’t know what you don’t know. You may not feel comfortable discussing your confusion with your family or your life partner. Family and friends feel the need to tell you what to do counselor can help you decide for yourself. The counselor may be able to point out other options you haven’t considered. Sometimes just talking it out with an unbiased person can help you resolve your confusion.

When you are struggling with a choice, counseling can help.

If you’re at a juncture in your life where you are going to have to decide, seeing a counselor can help you sort out the pros and cons.

If life is not fun anymore, try counseling.

Not being able to feel pleasure is a symptom of depression. It’s possible for life to stop being fun before you reach the point of depression. Re-examining what you do and don’t do and the relationships in your life can help you decide what needs to change. Having a happy life is not something other people can do for you. Aligning what you’re doing with your values and goals creates a better life, and a counselor can help you see things you should be doing you’re not and things you’re doing you shouldn’t be doing.

If you feel stuck and can’t change, counseling can help.

Lots of people make annual New Year’s resolutions, and nothing changes. Change involves a process. You need to identify where you are stuck and why. The counselor may be able to help by giving you information. Once you do decide on something about yourself you want to change, you’re going to need encouragement as you practice this new behavior. A counselor can help you through this process.

Having anxiety attacks, or worse yet panic attacks are reasons for counseling.

Anxiety and anxiety attacks have replaced depression as the largest mental health problem in America. Anxiety can manifest as physical symptoms resulting in panic attacks. A counselor can help you by teaching relaxation techniques, helping you to evaluate the way you worry about possibilities, and by helping you create a safer life. Not feeling safe in your relationships will surely increase your anxiety, and the counselor can also help you with relationship counseling.

If you are going through an overwhelming life change, consider counseling.

Changes, even positive ones, can be stressful. The counselor can help you get through the stress of life changes. You may think that what you’re feeling is unique, but the counselor can tell you how often they see this problem. Sometimes you need information, and sometimes you primarily need to be heard, your counselor can provide both.

When making a life transition consider counseling.

Life transitions can be very stressful. When you graduate from school and don’t know what to do with your life, counseling could help. People seek counseling for adjusting to a new relationship or after becoming a parent. Career changes or retirement can be stressful, and counseling can help. Anytime you’re making a change in your life situation, and you’re feeling stressed, consider seeking counseling.

Here is a list of common reasons people should seek counseling.

Have you been for counseling? Was counseling helpful? Why or why not? I’d love to hear from you. Please leave a comment.

Staying connected with David Joel Miller

Six David Joel Miller Books are available now!

Dark Family Secrets: Some family secrets can be deadly.

What if your family secrets put you in danger?

Letters from the Dead The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead?

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive?

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon.

Want the latest blog posts as they publish? Subscribe to this blog.

For videos see: Counselorssoapbox YouTube Video Channel

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter.

Advertisements

Why you shouldn’t trust psychological research.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

The Psyche

Why you shouldn’t trust psychological research.
Photo courtesy of Pixabay.com

Do not trust psychological research.

Much psychology research is unhelpful.

In writing this blog, I read a lot of research. I’m looking for ideas and suggestions for ways to be helpful to people struggling with life’s problems.

Occasionally I find some extremely well-done research that is enlightening and helpful. Much of the time, what I encounter is a lot of published studies of dubious value. Let’s look at the problems with much psychological research and why it may be less than helpful.

Most of the research is not about you or your problems.

If you are a person struggling with depression, anxiety, loneliness, or low self-esteem most psychological research will not help you. If you’re encountering memory problems, you may find a lot of studies about how rats memory works. Don’t expect a whole lot of practical help. If you’re a businessman looking for ways to convince people to buy your product, skip the psychology research and take a good look at marketing research.

For a discipline that began with the lofty idea of being the science of thinking and behavior how did it get so far off into academic research with so little value to people in distress?

Psychology research often is performed on a select group of people who are very different from the general population and predominantly different from those people who struggle with mental, emotional, and behavioral disorders. People most likely to seek treatment for problems are systematically excluded from many research studies.

A recent study I read about attitudes towards relationships which highlights this issue: this research was conducted using a convenience sample of students in a psychology class. The majority of the respondents were 18 to twenty-year-old female college students at a private 4-year college who were living at home, were unmarried, and had never been in a relationship for more than two years. While this study may tell you something about the attitude of young women who are not yet in a relationship, towards relationships it is not very applicable to working with couples who have relationship issues. Here is a highlight of the problems you may encounter when reading psychological research.

Psychological research is often conducted in fantasy land.

A lot of research is done by professors at four-year colleges. Much of this is driven by their need to create something to publish if they want to keep their jobs. The sample in the studies is often full-time students who attend during the day. Two-thirds of these students are female. This results in excluding most men, most people with full-time jobs, night students, community college students, the employed, and the unemployed, and so on.

Minorities, the elderly, and other special populations are underrepresented.

Our population is aging. Depression is common among the elderly. Repeated studies have found that minority populations are not engaged in treatment. Results of most studies will not generalize to the most impacted people.

Psychological research excludes people who are incarcerated.

Mental health and substance issues are common among incarcerated populations. Excluding those populations biases the results by underestimating the number of people with a problem and by excluding people with multiple issues.

People with substance use disorders are excluded.

The majority of people in treatment for substance use disorder also have a mental illness. At least half the people with a mental illness report a substance use disorder. Counselors working in treatment settings are primarily working with people with one or both problems. While some psychological research may include people with depression or anxiety, most exclude anyone with a diagnosable disorder.

Anyone with less than 12 years of completed education is excluded.

One result of doing psychological research on average people in academic settings is to exclude all those people who dropped out of school or failed to complete a high-school education. As our society has become more technologically focused more years of schooling has become a necessity. Excluding people who are not enrolled in college in research studies has excluded the people most likely to be seeking help in public settings.

The verbal yardsticks used in psychological research may be inaccurate.

One of the significant challenges in treating mental illness is the difficulty of communicating through words. Many clients lack a functional feelings vocabulary. When you try to use words to describe symptoms not everyone agrees on which words describe which symptoms. A great deal has been written about the “big five” psychological constructs. Those Big Five constructs were created from more than 100 different possible constructs. Introverted versus extroverted personality, doesn’t mean the same thing to everyone.

The sample size and research are often microscopic.

Grab any 10 or 20 people off the street and asked them a series of questions about their feelings, their life, and their problems and you can get radically different results. Results done at one school in one district may not reflect results you would obtain at other schools in other areas. When it comes to specific mental health issues, I have seen studies published with fewer than ten people. The chances that those ten people represent in any way millions of other people is nonexistent.

Results of many psychology experiments can’t be replicated.

Back in the 1960s, many people were “psychology majors.” The promise that psychology as a discipline could help us improve our selves, society and solve problems seemed great. Unfortunately, much of what people learned back then and since has turned out not to be accurate. Today psychology is experiencing a replication crisis — many of the things I learned in psychology classes were the results of one “landmark” famous experiment. As the years have passed, other experimenters tried to reproduce those results. Unfortunately, doing the same research more than once has produced different results.

Results psychological research do not generalize to other populations.

The “Psychological principles” we discover in one place and at one time haven’t held true when applied somewhere else or in some other year. Experiments, particularly surveys about attitudes and issues, done in America don’t necessarily hold true in other countries. Results of studies on young, white, female, college students have in no way remain valid when applied to minorities, men, the unemployed, the mentally ill, the addicted, and so many other populations.

Mental health is about abnormal psychology.

One small branch of psychological research deals with “abnormal psychology.” The things we now call mental illness and substance use disorders are included in the field of abnormal psychology. Unfortunately, more than half of all the people in America will experience a mental health or substance use disorder. “Normal psychology” is not about normal people. The majority of normal people will experience one or more episodes of something described by “abnormal psychology.”

The next time you read about a startling new revelation from the field of psychology, you may need to take out your salt shaker. I still read a lot of that research, but I’m much more skeptical now that I was in 1966 when I thought I might want to be a psychology major.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Reasons why people avoid therapy.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Therapist

Therapist.
Photo courtesy of Pixabay.com

Why are you avoiding counseling?

Many people avoid going to the doctor as if seeing a doctor would be the cause of their illness. Avoiding counseling, in one form or another, is even more common than avoiding medical treatment.

Most people who put the effort into counseling see improvement in their lives. Here are some of the reasons people commonly say they are avoiding therapy.

Doesn’t going to therapy mean I am weak or crazy?

Not at all. Going for treatment does not mean you’re weak or giving into your symptoms. What it does say is that you are willing to face your problems. We used to think that there were two kinds of people, normal people, and the mentally ill. We now know that being mentally healthy requires more than lack of illness. The things we call mental illnesses are treatable. Facing your problems reduces their impact on your life.

The fear of being diagnosed as mentally ill is a throwback to the days when there wasn’t an effective treatment for mental illnesses. Our system of care used to be designed to try to immediately cure people. If you break a leg, a doctor can set it. When we didn’t have effective treatments for mental illness being diagnosed meant there was no hope.

Today we know that there are talk therapies which have been shown to be effective in curing some mental illnesses. Even those that can’t be cured can be made substantially better. Seeking treatment for a mental health challenge does not mean you’re weak. It says you are acting to make your mental life healthier and happier.

Talk therapy resembles coaching.

Highly successful athletes still have coaches. My view of counseling is that it should function in a similar way to coaching. The goal should be more than merely detecting what’s wrong with you. It should also entail finding solutions to your life problems so that you can have a happy, productive life.

In the same way that a baseball player or a golfer can’t see their own swing, many people can’t see the unhelpful thoughts. A counselor can help you with other ways to look at your problems and help you learn the skills to overcome life’s difficulties.

One significant difference between counseling and life coaching is the professional counselors and therapists are specially trained in diagnosing and treating mental illness. In most places, they are also licensed. While some life coaches can help you work on becoming more successful professional counselors can help you with the depression or anxiety that is interfering with your life.

You are afraid your secrets will get out.

Counselors are committed to keeping what you talk about with them confidential. Outside of a few legal exceptions, such as plans to kill yourself or others and abuse of children and the elderly, what you are going to talk to the counselor about will not leave the consulting room. Questions about what is and is not confidential and what counselors would keep confidential is one of the most common reasons people visit the counselorssoapbox.com blog. For more about confidentiality, please look at the posts under Law and Ethics.

Talking about your problems is embarrassing.

Talking about your problem could be embarrassing. During their career, counselors hear a substantial number of secrets. Chances are your counselor has heard something remarkably like what you’re about to tell them. They’ve also studied the kinds of problems to bring people to counseling.

Counselors try to approach people empathetically, being able to mentally put themselves into the client situation. They also try to practice unconditional positive regard. Regardless of your problem or what you have done in the past, the counselor wants to see the best in you and try to help you change and become a better person. It’s not the counselor’s job to judge you.

You believe your problem is beyond help.

Some life problems are more difficult to treat than others. Talk therapy can help even those people with the most severe mental illnesses to improve the quality of their lives. Many people are surprised to find how much their problems are like the problems of others around them. I believe that while some mental illnesses can’t be cured, all of them can be managed. Recovery from mental illnesses just like recovery from addiction and alcoholism is possible.

You’re looking for an instant solution like medication or drugs and alcohol.

Overnight successes are often the result of years of struggle and practice. Medication can help you manage your symptoms, but it won’t eliminate all your problems. Quick fixes like drugs and alcohol can distract you from your life problems for a while, but eventually, they quit working and living with an even more serious problem called addiction.

You believe counseling will cost too much or take too much time.

Counseling for mental health challenges is often covered by insurance. Even if you had to pay out-of-pocket, you should compare the cost of getting counseling with the costs you incur trying to solve the problem with other methods.

Couples sometimes think they can fix the relationship with a romantic weekend somewhere. They spend thousands of dollars on that trip but then tell me they can’t afford to come for marriage counseling. The cost of marriage counseling is substantially less than the price of obtaining a divorce.

Compare what you will spend in time and money to get a two-year or four-year college degree. Education is an investment in yourself. If your mental or emotional problems prevent you from being successful in school or in life, all that effort and money will have been wasted. Investing in your mental health is one of your best investment opportunities.

You don’t believe your life could get any better.

When you’re deep in life’s problems, it’s hard to see how things could get better. Counselors are trained to help people overcome life’s difficulties. If you’ve lost hope, the counselor may help you get it back. If it feels like nothing you’ve done in your life has worked may be working with the counselor can help you find the things that will work.

You’re convinced the solution is moving, changing jobs, or changing partners.

It’s easy to move through life thinking that your problems are where you live. People tell me that they can only move somewhere else then they would be happy. When I asked him why they don’t do it, they give me all kinds of reasons why they must stay where they are and be miserable.

Wherever you are, whatever work you are doing and whoever you are in a relationship with you are responsible for your own feelings. Counseling can help you learn how to make the best out of where you are and how to decide when it’s time for a change.

You believe the problem is someone else.

People often believe that their problems are someone else’s fault. If that person would only change they could be happy, or maybe only less depressed and anxious. Counseling can’t change that other person, but it can help you improve your thinking and behavior. Sometimes if you change the way your living your life, the other person will change. Even when you can’t change others, you can find ways to reduce the impact they’re having on your life.

Have you been telling yourself you need to talk to somebody about your problem? What’s holding you back from finally taking responsibility for your life and seeking out the help you need to create the most effective life possible?

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, Google Play, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What if talk therapy isn’t working?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Therapist

Therapist.
Photo courtesy of Pixabay.com

What should you do if counseling doesn’t seem to be helping?

Some people come to counseling for a couple of sessions and then drop out saying that counseling doesn’t work for them.

Other people come for therapy over a very long period, and while they feel counseling is helping them, other people don’t see any change. How do you evaluate the progress you’re making in therapy?

If you don’t feel you’re getting the results, you would like to see in therapy your progress, or lack of progress should be the primary topic you talk about with your therapist. Here are some questions to ask yourself and some of the factors that impact the effectiveness of therapy.

Is your problem acute or chronic?

Some problems are acute. Something has happened, and you can tell your counselor what happened and when. Treatment for acute problems can be very brief. You decide you need to change something in your life, or you may need to accept the change which has happened. What you may need is an empathetic person you can tell about what happened you.

The problem some more chronic you’ve always been common anxiety, or you don’t ever remember being happy. Treatment for these problems is like treatment for a chronic medical problem. Managing long-term mental health problems can be like managing high blood pressure or type II diabetes.

The professional may be able to help you initially, but a significant part of the process will be your learning life skills to manage your problem over the long term.

How long have you been in therapy?

When you’re in pain, whether it’s emotional or physical, you want it to stop. Go to the doctor he can give you pain meds, or he can look for an underlying cause and treat that issue. If you have gone to therapy for a while but aren’t feeling better discuss with your counselor how long treating your condition should take. Many people have unrealistic expectations for talk therapy.

Treating emotional problems is a process. How long this process will take depends on your specific diagnosis and your personal characteristics.

How good is your relationship with your therapist?

Most of talk therapy is done through conversation. The best predictor of success in treatment is the relationship you have with your counselor. If you feel uncomfortable discussing certain things with that therapist those unsaid things could be holding back your progress. Ask yourself if the problem is your difficulty in talking about what you need to deal with or in your lack of trust of the counselor. Not every counselor is a good fit for every client. If you have been working together for a long time and don’t see progress, you may need to try working with a different therapist.

Are there some problems you’ve avoided discussing?

The issues you don’t deal with are the ones likely to be keeping you sick. Sometimes people go to counseling and talk about the surface day-to-day events. Every time you go you feel a little better. But if you never get down to the real core of your issues, each session is like a Band-Aid placed on a deep wound.

Therapy can involve treating deep emotional pain. Looking at your core issues can be uncomfortable. The process can be like peeling an onion. You go as deep as you can and then you cry little. When you have process that material fully you go a little deeper. Over time you can heal all these deep wounds.

Are you working on your problem between sessions?

Your problems are with you between sessions. Talk therapy can be very instrumental in healing past wounds are in clarifying values and goals. For things to change in your life, you need to start making changes. For every one-hour a week of therapy, there will be 167 other hours when you’re not in therapy.

If your counselor is teaching new skills in session, you need to practice those skills outside of the therapy hour. The students who learn most in school not only attend class but also do homework outside of class. You can’t become a great musician by taking a weekly lesson. You need to practice your music between lessons. As you learn new emotional skills, you need to practice those skills between therapy sessions.

You’ll make more progress if you have clear therapy goals.

When reason people don’t make good progress in the therapy is fuzzy goals. Think about your goals for treatment. Discuss these goals with your counselor and make sure the counselor is working towards the same goals.

Consider adding medication to talk therapy.

Medication has not been shown to cure any mental or emotional illness, but medication can be very effective at managing symptoms so that you’re able to work on the causes. I’ve had lots of clients tell me they don’t want to take medication because they don’t want to become dependent on drugs. Unfortunately, many of those same clients are using alcohol, marijuana, gambling, or sexual addictions as ways to manage their problem. Newer psychiatric medications are much safer than the medicines that were available in the past. Discuss medication with your medical doctor and your mental health provider. Medication and therapy together are often more effective than either separately.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, Google Play, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

The difference in mental health services for youth and adults.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Children

Children’s mental health.
Photo courtesy of Pixabay.com

One size does not fit all.

Children

Children.
Photo courtesy of Pixabay.com

When it comes to mental health services what’s needed and what’s actually provided can vary tremendously. Treatment for each client should be individualized.

Therapy for children needs to be appropriate for both their age and their developmental stage. There are also some differences in the way the counselor or therapist may need to approach treatment. In selecting a therapist, it’s important to find someone with both the training and experience required to work with the person receiving services. Here are some of the differences between mental health services for youth and adults.

The therapist needs to speak the same “language” as the child.

Children don’t have the vocabulary to describe feelings. Children often express themselves by actions rather than words. For very young children therapy is best done through speaking the language of “play.” How a child expresses themselves through action will change as they age.

What’s appropriate for a baby to say at age six months will be very different from what they should be saying at five years. The same is true of their behaviors and the way in which they play.

The therapist needs to consider “who is the client?”

Children are usually referred to therapy because an adult has either recognized the problem or is afraid the child may develop a problem. The counselor must consider whether the reason this child is in therapy is because the child is doing something an adult doesn’t want them to do or because they aren’t doing something the adult wants them to do.

More than one female single parent has brought their male offspring in for counseling because they did not want that child to “be just like their father.” In these cases, often the father was either physically abusive, drug-addicted, or engaged in criminal activity. Unfortunately, being told repeatedly that you are “just like your father” can be extremely damaging to the child’s development.

A similar problem happens when male parents are raising female children and, in their effort, to prevent their daughters developing sexuality, they continually accuse the daughter of promiscuity “just like your mother.”

In cases like these, where a parent is projecting their own issues and negative life experiences on to their children, the counselor tries to help the child develop the skills to make their own healthy choices. Frequently, what needs to happen is for the parent to get into therapy for their issues and for help in becoming a more effective parent.

The counselor will at most see the child for an hour a week, while the parent will provide the care for that child for 167 other hours each week.

Lifespan development issues are important.

If a child isn’t hitting their developmental milestones, walking, talking, learning schoolwork and appropriate behavior on time, this warrants a referral to medical or mental health professionals. Unfortunately, many parents have unrealistic expectations for their child. Parents often push their children to do things that they are not developmentally ready for. I’ve had parents request that their child be assessed for ADHD because the child was getting B grades instead of straight A’s.

Children may be afraid to tell the truth.

While the child is often the one identified as having the problem, it’s entirely possible the problem is with the home situation. Children who grow up in a home where parents have frequent violent fights may be awake all night. When they go to school, they can’t concentrate because of their lack of sleep and their fears about what is going on at home while they’re at school. If they witnessed domestic violence, they might learn to use hitting as a way to get what they want.

While the child is referred for assessment for attention problems the real issue may lie with the parents. Children are afraid to report problems at home for fear that their parents will punish them or that they may be taken away from their parents.

Many children are taught not to talk to strangers and to never talk about families “business” outside the family. Children from lower socioeconomic status homes may be embarrassed. Children may have been instructed not to talk about parents who are engaged in illegal activity, or they may be reluctant to talk about having a parent or caregiver who is incarcerated.

Many problems are not identified until the child gets older.

I see many files for teenagers in which they were treated in the early grades for developmental issues. Later they were treated for attention deficits. In middle school and high school, they may have been treated for bad behavior. It’s not until late high school or college that some of these clients are diagnosed with severe depression.

It’s important that anyone working with children not write off poor attention and behavioral problems as a result of “bad child” diagnoses. A specialist in child developmental issues should be looking for serious mental health issues such as anxiety disorders and depression.

Children may need help in developing life skills.

Counselors working the children must be careful not to think that it’s the child who has the problem. Sometimes what the child needs are the skills to cope with a dysfunctional family and a challenging world. Social skills are tough for some children to develop. The majority of adults who develop anxiety disorders had the symptoms by the end of middle school.

Counselors may need to normalize the challenges of growing up. Most children go through a stage of feeling insecure and worrying about whether they measure up. Helping the young client through the transition periods can reduce or possibly even prevent the development of anxiety disorders, eating disorders, and other mental health problems that are the result of judging themselves in overly negative ways.

These are some of the major differences between working with children and adults. The techniques and materials the counselor uses are also likely to be different. Please feel free to leave additional questions or comments.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, Google Play, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Assessment – a core drug counselor function.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Assessment doesn’t mean the same thing to everyone.

Anytime counselors get together you’re likely to hear the word assessment.

Unfortunately, it means so many different things to so many different counseling specialties it’s as if we are not speaking the same language.

There are two primary ways that the word assessment is used. One is to describe the form the counselor fills out during the initial part of treatment.

The other meaning of the word assessment is the ongoing process counselors use to try to identify the client’s problem and find ways to be helpful.

Assessment may mean the assessment form.

Often a form is completed either during the initial intake of very soon after that. The information is gathered on this form should be used to develop a treatment plan, part of the next core drug counselor function designing a comprehensive recovery plan. It’s common to hear counselors referred to filling out this form as “doing an assessment.” If you use an assessment form that should be thought of as a tool you use to gather the information you need to assess the client’s issues.

One danger of relying too heavily on a particular form is that the process of filling out the form can turn into an interrogation of the client rather than a conversation. One simple way to tell a good assessment from a poorly done one, especially in the drug counseling field, is to look at the bottom of the page for the comments. Anything the client says that’s out of the ordinary should call for follow-up questions to get more information. Under the pressure of a lot of work to do it’s easy for the staff member doing the initial intake and assessment to rush through the form and get only surface information.

Assessment in substance abuse counseling is very different from the type of assessment done in mental health settings. In a mental health setting, the goal is to collect enough information to rule in or out various diagnoses and then to design a treatment plan to treat that illness. The various license types are likely to have been trained in very different ways of doing an assessment. How the assessment is done also varies with the setting. Therapists working for a public agency are likely to have a specific form they must fill in. In private practice, they’re more likely to use a more conversational approach to assessment.

Clinical psychologists do a great deal of testing and often have the clients fill out a large quantity of paper and pencil “assessment instruments.” Clinical counselors are likely to use a very limited number of brief screening tools. In California licensed professional clinical counselors are limited by the licensing law to using only a couple of instruments and then only for diagnosing. Mental health counselors and therapists are generally not allowed to do testing and report the results to outside parties. Marriage and family therapists, of course, emphasize assessing the client’s relationships and the connections between their “presenting problem” and their relationships with family, friends, and the people they interact with in the work setting.

Drug counselors are assessing the client’s drug use and its consequences.

Drug counselor should limit their scope of practice to working on the client’s issues as they relate to substance use disorders. They can be some fuzziness around the edges of their scope of practice. The assessing drug counselor needs to develop a picture of the client’s drug use, both current and past. Many clients abused multiple substances at various times in their life. The drug counselor is assessing for what drugs the client has used recently and what drugs they used in the past that they may be at risk to resume using.

The drug counselor also assesses all the various aspects of the client’s life to see how problems in other areas may have influenced the client’s drug use and how that drug use may have affected all those other parts of the client’s life.

There are two primary assessment tools I’ve seen used in drug and alcohol counseling, although individual programs may design their own written tools drawing on either or both models.

Assessment using the biopsychosocial-spiritual model.

The biopsychosocial assessment understands the healthy, or recovered life as requiring balance in all the various aspects of the person’s life. Drug and alcohol use has probably bent the wheel of life completely out of balance. Assessing all these various areas of the client’s life helps to develop not only a treatment plan for the current substance use disorder but a recovery plan for the client putting their lives back in balance.

The Addiction Severity Index or ASI.

The ASI is a widely used assessment tool for drug and alcohol counseling. The ASI is a copyrighted instrument with both paper and electronic online versions available. Students can look at an online sample by searching for the Addiction Severity Index – training edition.

American Society of Addiction Medicine Patient Placement Criteria (ASAM.)

This is another assessment tool which may or may not be used during intake. The goal of the American Society of Addiction Medicine Patient Placement Criteria (ASAM) is to create objective criteria for how much and what kind of treatment a client might need.

These criteria have various levels ranging from a high of long-term residential treatment to a low of psychoeducation. Programs which plan to bill medical insurance are likely to need to complete this measure to justify the level and intensity of treatment for insurance reimbursement.

For more on the drug counselor domains and the core functions see John W. Herdman’s book Global Criteria; the 12 Core Functions of the Substance Abuse Counselor

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Intake – a core drug counselor function.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Intake involves a lot of paperwork.

Counseling

Counseling.
Photo courtesy of Pixabay.com

Getting a client signed up for a drug treatment program involves a lot of paperwork that needs to be completed before the counseling can begin. Drug counselors need to know how to do this function, although the exact paperwork they will have to do can vary a great deal from program to program. Many treatment agencies now use computerized systems. As the counseling field shifts towards more electronic records, more of the intake paperwork will end up on the computer. Some systems now include electronic signature pads that will capture the client signature onto the electronic file.

Some of this paperwork part can be done by office staff. Larger drug treatment programs may have one person assigned to do the intake paperwork. There are some advantages to having the primary counselor, the one the client will see the client throughout treatment, do the intake. When the client first comes into drug treatment, they are likely to be anxious and uncertain. Developing a relationship, establishing rapport, is an essential part of what staff at a drug treatment program must do. It’s easier to build up a rapport when the client sees the same person throughout treatment.

Informed consent is a required part of treatment.

Informed consent is not a separate specific drug counselor function, but it should be incorporated into all the intake paperwork as part of the legal and ethical responsibilities of a counselor. Fees need to be discussed during the first session the staff spends with the client.

Limits of confidentiality and the exceptions to them need to be explained to the client. What information will the program keep confidential and what information might be disclosed. Drug counseling has an extremely high requirement for confidentiality. Drug counselors should not even confirm or deny that someone is in their program.

Drug counselors are mandated reporters who must report clients who are a danger to themselves or others. They also are required to report abuse of the child, an elderly, or a disabled person. In some jurisdictions, they may be required to report clients who view child pornography. All these exceptions to confidentiality need to be explained to the client during the intake process.

Because so many clients are referred to drug treatment by the criminal justice system, parole probation, or the courts, more of the client’s information may be divulged than might happen in mental health counseling.

As part of the evidence that you did informed consent, the client will be required to sign a form called either a consent for treatment or a treatment agreement.

Consent to release information forms.

If any information about a client will be released to an outside party, a specific form called a consent for release of information should be filled out and signed by the client. These forms are often referred to by counselors as “releases.” Most releases can be revoked by the client, which must be done in writing if they decide they want the drug program stop releasing information. One exception to this right to revoke consent to release information is the “criminal justice consent form.”

If the criminal justice system has sent a client to your program, they will require information about that client. If the client does not wish to sign a release of information, you will not be able to admit that client to your program. Clients who attend a drug treatment program without signing a release for the criminal justice system will not have met their legal requirements for a court-mandated program.

Financial forms are part of drug counseling intakes.

For most programs, someone is paying for treatment. If it’s insurance, then there will be insurance forms to fill out. If the treatment is paid for by the criminal justice system or the child protective services, there will be other forms they will need to fill out. Clients who self-pay will still need to fill out a financial agreement.   Some programs have a sliding scale fee agreement for low-income clients. Providing financial information and filling out additional forms may be a part of qualifying for these reduced fees.

HIPPA notice of privacy practices.

Almost all programs nowadays are “covered entities” and must follow the HIPPA regulations. The counselor needs to give the client a notice of privacy practices and have the client sign a form saying they received this information.

Demographic information.

Clients need to provide the program with their demographic information. You need to know who it is you’re working with. It’s good practice to have an address and phone number for this client. This form might also next of kin.

Consent to follow-up.

Some programs do follow-up studies to see how effective their treatment is. Studying the results of treatment may be a condition of receiving funding from grants or contracts with governmental agencies. It’s a good practice to have written permission to follow-up, signed at the time of intake. You should also make sure you know how you are allowed to contact the client. If the phone number they gave you is a work phone, they may not want you calling there for follow-up.

Program rules or expectations.

During the intake, the counselor may give the client rules, a form about client rights and responsibilities and other information about the program. Some programs do this after the intake as part of a separate step referred to as the core function of orientation. More about orientation in an upcoming post.

There are a wide variety of other forms used by various treatment programs. Most of these forms have been created by the individual treatment program.

Assessment may take place during intake.

Assessment means different things in different contexts. Assessment is considered a separate drug counselor function and it’s a skill that counselors need to learn and to practice. Assessment may take place during the initial intake. Some programs will schedule a separate appointment for the assessment. Assessment functions as the bridge between the first domain which involves getting clients into treatment, and the second domain which is the work the counselor will do in creating a comprehensive recovery plan.

In our next installment of this “what do drug counselors do and how do they do it” series we will look at the core counselor function of assessment.

For more on the drug counselor domains and the core functions see John W. Herdman’s book Global Criteria; the 12 Core Functions of the Substance Abuse Counselor

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.