Category Archives: Law Ethics & Practice

What do therapists tell the police?

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

What will your counselor tell the police?

Short answer – Almost nothing!

For counseling to work, you need to talk about what is troubling you. For you to be able to talk like that, we professionals need to make it safe for you to do so. Enter the concept of confidentiality. What you tell your therapist is mostly confidential and may also be privileged patient psychotherapist’s communication.

There will always be someone who thinks we therapists need to protect society and tell something or other. Say you tell the therapist you are scared because you are driving without a license. Do we call the police about that?

No way. That does not happen in any place that remotely resembles a democracy or a republic, probably not in a lot of other forms of government either.

So how come the police sometimes show up at your door anyway? What did get told to them and how?

Sometimes a situation is so very dangerous that the police get notified.

Your house is on fire, the neighbor calls the fire department, and here come the police to control the crowds and traffic. I suppose some people get caught doing something illegal, like running a meth lab, because the police arrive at the fire and they find it. But the neighbor did not report you to the police, your secret slipped out because of the fire.

A similar thing happens when you tell a therapist about a very dangerous situation and we need to figuratively call the fire department.

There are certain things we just have to report, mostly to try to save lives.

I have talked about exceptions to confidentiality in a few other posts. Still, this topic continues to show up in questions and search terms. So, here is some reiteration specifically about exceptions to confidentiality and the police.

A danger to yourself is an exception to confidentiality.

If you plan to kill yourself we have to report that so you get help. This is not just a wish or thought, we should check if you are just thinking of dying, or are you planning to kill yourself and when?

We call someone to get an ambulance and take you to a psychiatric hospital. Usually, the police get called to manage the situation.

Do you get a police record for this? Generally no. Not unless you are breaking some other law, like shooting at the police when they try to take you to the hospital.

Danger to others gets reported.

If you are planning to kill someone we need to prevent that. This is not just doing something reckless. This is planning, intending to hurt others. This can get complicated. If you plan to burn the mall down while it is packed, could people die? So yes that sort of thing, in most places gets reported.

Abuse of a person that can’t protect themselves gets reported.

Child abuse, Elder abuse, disabled person abuse has to get reported. The goal here is to get the abuse to stop. But as in the care of the fire exposing your meth lab, stopping the abuse may leak out the fact that you have been committing a crime.

Sometimes these reports go to child protective services or adult protective services. In some areas, these reports go to the police department to check out.

Therapists only keep your secrets if they are your therapist.

If you see your doctor in the grocery store, don’t rely on his opinion of the produce. He is not being a doctor when you talk to him.

If the judge makes you talk to a therapist or CPS sends you to one, check if this is going to be confidential or if their report, warts, meth lab and all are going to the judge.

Even here consider the therapist is not calling the police on you. But if the judge gets the report on your mental state and you casually mentioned a couple of murders you did, the judge may be required to pass that on to the police.

So most things, even past crimes, we therapists do not report to the police. Honest, that is the last thing most of us want to do. Because once we make that call you stop trusting, stop telling us things, and then we can’t help you.

But occasionally because of something that we are required to report, some of your secrets could slip out. We do not necessarily call the police, but once we tell others to protect you or society that information is no longer strictly confidential.

When in doubt ask the therapist to tell you more about confidentiality. And if you have secrets that need to come out, let the therapist help you with the telling in the right way to the right person.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Why do therapists stop seeing you if you aren’t getting better?

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

Therapy

Therapy.
Photo courtesy of Pixabay.com

Why would a counselor stop seeing you?

Sometimes the counselor will tell the client they need to stop seeing them because the client is not getting better. Why would they do that?

There is one major reason and a few smaller ones why this might happen. Honestly most of the time this does not happen. We, counselors, want to think we can help people and sometimes we go on seeing them past the point at which we should have noticed that the client is just not getting any better. But if your therapist does say they need to stop seeing you here are some possible reasons why.

Ethics tells us not to see people we can’t help.

It is considered unethical to keep seeing a client once you realize that you are not able to help them. Once the counselor realizes this, they first look at what they are doing, is there something else I could do to be helpful? Then they consider referring the client to someone else who might be able to do something differently.

Just a lack of progress on the client’s part does not mean the counselor is not being helpful. Sometimes the issues the client has may require help just to keep them stable. If the therapy sessions keep the client from getting worse and ending up in the hospital that may be a reason to continue therapy even if the client is not seeing their problems get smaller.

What would be unethical would be to keep seeing the client, taking their money or the insurance company’s money if the sessions were not helping the client.

A new problem emerges that needs special care.

Sometimes we start off seeing the client for one problem, say depression and during the process, the client starts talking about some other problem. Say the client now tells the counselor that they have a severe eating disorder they have never mentioned before.

Treating eating disorders is often considered a specialty. Not all counselors have the extra training needed to be able to help you with that. So they might need to refer you to an eating disorder specialist.

This should happen more often with clients who have a substance abuse issue. Unfortunately, some therapists are uncomfortable talking about substance use issues. They keep on working on the depression and ignore the substance use problem. The result is that the client fails to get better.

Sometimes the client wears the counselor out.

Some clients get stuck in an issue. They are angry or hurt because of something that happened in their past. What they might like to do is erase the event so it never happened. That or punish the person who harmed them.

The therapist wants to help them move on and get working on creating a new happy life. If the client is not ready to move on it can get tiring to listen to them. If the counselor runs out of steam in the listening department they should make the referral.

I do recommend to interns that if they start feeling this way they need to talk to the client about this. It is possible we professionals get impatient and try to end treatment just about the time the client is ready to make some changes.

Don’t ever stop just before the miracles happen.

If the counselor becomes impaired they shouldn’t see clients.

If the counselor gets sick, or they have a sick family member, then they can’t give helping you their full attention. Counselors who are going through a divorce or a custody battle may find they can’t give a client who reminds them of their ex their full attention.

Other professional impairments can include excessive or problematic use of substances, drug and alcohol abuse can be problems for counselors too.

You think you are not getting better but the counselor sees improvement.

Clients can start getting dependent on their therapist. Sometimes they look forward to the weekly session so much they can’t see how they can give it up. They feel they are not all better yet.

Counselors and insurance companies are not expecting you to be all better at the end of treatment. What is expected is that the symptoms will be reduced until they no longer interfere with your ability to work, have friends or family relationships.

If your symptoms seem stable, the counselor may decide that they can’t justify billing your insurance anymore and that means they need to terminate therapy with you or you will have to pay yourself.

Even in this circumstance counselors may need to revert back to point 1. When does the counselor’s seeing you become more for them, to make a profit, than for you?

Those are some of the reasons a counselor may say they have to stop seeing you, they may be others in particular cases. Hope that helps explain the process.

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Do counselors report rape?

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By David Joel Miller.

When might a counselor report a rape?

Do counselors report rape?
Photo courtesy of pixabay.

If the victim is an adult – counselors do not report rape. Rape is a crime. We do not report crimes unless there is a legal exception to confidentiality that requires us to report something. As far as I know, rape is not one of those crimes that get reported.

If the victim is an adult they should report it. We will try to help them, walk them through the process.

After seeing how rape and abuse survivors can be treated and the way reporting trauma can re-traumatize them, I can understand why they may not want their rape or abuse reported.

If the client is the perpetrator we do not report that either. It is up to the victim to report. What we should do is tell this client to stop doing that. They are ruining their lives and the life of their victim. That is if we even chose to continue to work with a rapist.

What if the victim is a child? You report the rape then, don’t you? No, not really. Not the way I understand my reporting responsibility. I do not report crimes. I do not report rape.

Wait a minute – the victim was a Child? What we do report is abuse. This is child sexual abuse. See the rape part is not what triggers the report. It is the abuse of someone with power and control over a weaker person that makes this reportable as abuse.

This sexual abuse does not need to be rape or intercourse. Depending on the laws of the jurisdiction all sorts of inappropriate sexual contact between an adult and a child might be reportable.

But the victim does not need to be a child to make this a reportable occurrence. If the victim is a senior citizen that is reportable in lots of places. Or if they are disabled, that abuse gets reported.

Financial abuse of the elderly, that gets reported most of the time. There are rules about when but remember it is the abuse, not the financial crime that is getting reported.

So while counselors do not report crimes, yes we do have a responsibility to protect those who can’t protect themselves by reporting abuse.

I am sure this will not be the last time a question about when a counselor will report something will turn up in the comments or my email.

The basic rule is – crimes – no report.

Abuse of a disabled person, senior citizen, or child – report.

A person intending to kill themselves or others – report.

At least that is the way things work here in California and most other places I know about. If in doubt consult a lawyer or ask your counselor about the way it works in your jurisdiction or situation.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What is a therapist? What do therapists do?

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

Therapy

Therapy.
Photo courtesy of Pixabay.com

Why this word therapy might be confusing.

When I used to tell people I was a therapist they kept giving me blank stares. I got the feeling that they did not understand what I do. Personally, I tend to call myself a counselor more often than I call myself a therapist despite the fact that I am licensed here in California as both a Marriage and Family Therapist (MFC45390) and as a Licensed Professional Clinical Counselor (LPC15.)

One intern asked me why in so many blog posts I seem to use the word counselor rather than the term therapist. I think there are two reasons, I think of myself as doing more “Counseling” and the word therapist seems to need more explanation than the word counselor to avoid misunderstandings.

Both of these words can involve activities outside mental health. Lawyers are referred to as “counselors” for example. There are other professions, financial and lifestyle workers who get to use the words counselors or therapists when appropriately attached to some other description. What we need to do is prevent the term from becoming so generic as to mislead people.

What about Substance Abuse Counselors?

Substance Abuse Counselors also do similar work but they are restricted in most places to only working on the substance use disorders. Mental health issues are outside their “scope of practice” meaning the things they can legally do.

Correctly used both counselor and therapist should be part of a license title rather than standalone names, as in Licensed Counselor, Licensed Clinical Counselor, Mental Health Counselor or Marriage and Family Therapist.

To add to the confusion many School counselors or School Psychologists are often not licensed and work on issues surrounding graduation requirements, getting into college or school behavior rather than treating mental illnesses that are more common than previously thought among school students.

So how did mental health practitioners come to use the title of therapists?

Originally this term was psychotherapists. Many mental health practitioners, Marriage, and Family Therapists, for example, practice “applied psychotherapy.” This is a reference back to the time when most mental health work was being done by psychiatrists who did some form of talk work with their “patients.” Most of this work was psychodynamic or Freudian type work. Today most therapists do briefer more directive work and do not choose to emphasize the “psycho” part of the psychotherapist name.

What about other kinds of therapists?

Two types of therapists,  occupational and physical, get confused with the psychotherapists that do mental health work.

Physical therapists, as the name implies, work on the rehabilitation of the body. So if you are in a car accident and lose a limb they could help you regain your abilities, adjust to a prosthetic limb or strengthen remaining muscles. This is my understanding and if there are physical therapists out there who would care to add to that understanding feel free to leave comments.

That same person, grieving and depressed over the loss of the limb might also see a rehab counselor who would help them with the psychological adjustment to living without that limb. That rehab counselor might also help with career counseling to find that person a new job they could do despite the loss of a body part.

In California rehab counselors as well as Career counselors might elect to get licensed as Licensed Professional Clinical Counselors providing they meet the requirements for that license.

There are also people who function as “occupational therapists.”

This one still confuses me a bit. Per the Bureau of Labor Statistics “Occupational therapists treat patients with injuries, illnesses, or disabilities through the therapeutic use of everyday activities. They help these patients develop, recover, and improve the skills needed for daily living and working.” Most occupational therapists have master’s degrees and work in the offices of physical therapists.

So when I tell someone that I am a therapist they sometimes ask if I know of an exercise that will help their shoulder mobility. No, I do not. That is not the type of therapy that I am licensed to practice.

So has that cleared up the confusion? Or have I just added another layer of mud to the waters?

The point is that you need to be sure that the type of counselor or therapist you are seeing is doing the type of work you need.

Best wishes on your journey to a happy life. (I think of myself as a happy life therapist or counselor but can’t find that listed in any of the statute books.) I do try to stay well within my scope of practice.

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What if you see your therapist in public?

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

Counseling and therapy

Counseling.
Photo courtesy of Pixabay.com

What should you do – What should the therapist do?

Counseling or therapy is a very special relationship. It is also very confidential. One problem is what happens if you see your therapist out in public.

Mostly what happens is up to you.

Professionals are trained to avoid saying anything or doing anything that would identify you as a client in treatment. What if we see you and you are with your wife or girlfriend? Do you want them to know you are or have been in therapy?

What if you are at work and we come into that workplace? Do you want your boss or coworkers to know you are in therapy?

Since we can’t be sure, the customary practice is to say or do nothing, just walk right on by. The professional should not do anything to identify you as a client.

You, on the other hand, are under no such obligation. If you chose to say hi then we can respond and say hi back. If you chose to introduce us it is up to you to decide how to identify us.

While we can talk with you if you initiate the conversation what we do not want to do is start another dual relationship with you.

We can shop in a store where you work; to avoid your workplace would penalize you for being our client. We do not want to ask for special discounts or deals you can’t or wouldn’t make to other customers, which would confuse the relationships and run the risk of interfering with the primary relationship, the one between therapist and client.

So if you see your therapist out in public and they do not say hi do not take this as they do not like you or they are rude. Believe that they are pretending to not know you in order to protect your confidentiality.

Thanks to the reader who asked that question.

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Do therapists like, fall in love with their clients? Why don’t they tell them?

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

Fall in love.
Photo courtesy of Pixabay.com

Unconditional Positive regard or dual relationship?

Do counselors fall in love with clients? Do they like them and if so why don’t they tell them?

The role of emotions, feelings between the counselor and the client are complicated. Learning to juggle all those factors and keep the relationship between therapist and client in bounds is something every professional has to work at.

Here are the factors in play.

1. Unconditional positive regard

This is one of those “core conditions” that counselors are taught they need to exhibit for their clients. This can be summarized as – yes I accept you the way you are, feel you have worth as a person, and have a belief in your ability to grow.

In short, the counselor is supposed to like the client as a person.  What we do not always like are the things this client is doing.

If a counselor finds themselves disliking this client, judging them or wishing they did not have to see them, those feelings are likely to get in the way of therapy. So we strive to always see the best in our clients.

2. The need to be genuine.

It does not help the client much if the therapist lies to you. If we find a particular client annoying we sometimes have to address that.

We might need to let the client know, gently if we can, that this thing they do or say, we find ourselves getting annoyed when they do that – do other people get annoyed with you when you do that? This truth-telling has to be done in a supportive way but sometimes the client needs to hear the things we see that they may be blind to.

3. Is this about the client or the counselor?

Psychoanalytically trained therapists talk a lot about transference, the times that the client relates to their therapist just like they used to relate to someone else in their life.

I am an old guy it a gray beard. Clients have told me this reminds them of their dad or grandfather. We then talk about how was their relationship with that person and how does that affect the way they relate to others in their life now.

Sometimes I see a client and they remind me of someone I went to school with. I have to ask myself, did I like that person? Does the way this client reminds me of that person from my past affect the way I treat this client. We counselors might call this countertransference, seeing the client through the counselor’s past experiences.

4. Counseling is a novel relationship.

In the therapy room, we have this close, emotionally intimate experience. We try to help the client experience emotions they may not have experienced before or have not had for a long time.

The office is a sort of laboratory to try out new ways of being and relating to people and feelings. But the relationship needs to stay in the room not get carried out into the community. We keep it confidential so we can’t become best friends and hang out at the client’s house.

5. Counselors need to avoid dual or multiple relationships.

I wrote in another post about the dangers of trying to have two relationships with a client. It can be tempting, here she is, crying and feeling really bad and looking really cute or sexy. But if the counselor lets themselves move over into that developing a romantic or friendship relationship there is a risk of messing up the therapeutic relationship.

Every year a certain number of counselors get into romantic or other dual relationships with clients. Mostly these end up badly.

The client comes in for therapy because of an emotional or mental problem. It is a short hop from trying to help the client to becoming a predator when counselors forget their need to be a helper and get into a relationship where they are getting one of their romantic needs met.

So yes, counselors do often like their clients, and sometimes some feel like they are falling in love with the client. Professionals should not talk about their feelings except to be helpful to the client and they should not act on those feelings by creating a second “dual relationship” with clients.”

The counseling relationship is a special one and the focus needs to stay on the client and their needs. The counselor needs to get their needs met at another time and place.

Thanks to the reader who asked about this for suggesting a topic for this blog post.

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

4 Reasons counselors don’t say they like you

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

Counseling and therapy

Counseling.
Photo courtesy of Pixabay.com

Does my counselor like me? Why won’t they say they like me?

Counselors are reluctant to tell clients they like them and for some very good reasons. Most of the time I do like the clients I work with, but there are lots of reasons I don’t say so.

1. We want the client to learn to like themselves.

Many clients report they have “low self-esteem.” As often as I hear that expression you would think it was a specific diagnosis. It isn’t.

One reason for this low self-esteem problem is that too often all of us are looking to outside things to establish our self-esteem. If you need someone, anyone, to tell you that they like you, then your self-worth is dependent on doing and saying things so they will like you. This is a risky place to be.

I do not tell the client I like them. Most of the time I do not encourage them to even worry about what other people think about them. There is a huge danger in basing your self-worth on ratings or other’s opinions.

It is worthwhile to watch and see how you are affecting others. We call this self-monitoring. If lots of people are getting irritated with you, then you may need to take a look at yourself and see what you might improve. What you do not need to do is base your self-worth on what they think. Improve what you can and accept the parts of you that you can’t change.

What I do tell a client is that I think they are worthwhile people. They are the unique them just like everyone else on earth is a unique person. They do not need to do or be anything to be worthwhile. What they need to do is to do those things that will make them happy and that they can be proud of. If they do estimable things they can feel good about themselves regardless of what others think about them.

2. Counselors should not foster dependency.

Counseling is a helping relationship. It is not helping when someone else does everything for you. Rather than doing for clients, we want to teach them to do for themselves.

Rather than being in need of a friend, which increases the risk of becoming a needy person, you should become your own best friend. Once you learn to like yourself, you will find that you are much more likable to others.

Coming every week to see your counselor for another booster shot of self-esteem is not the same thing as recovering from whatever you chose to call your problem.

3. You need to develop an outside support system.

Counselors are professional people but we can’t be there every hour of every day.  Yes, professionals are a part of a person’s support system, but we should not be the whole thing.

If you are in recovery, and who among us is not recovering from something or someone, you need a strong support system that is positive and in your corner.

There are a few people who have become conditioned to use the psychiatric hospital and professional therapists as their one and only support. They are sometimes surprised to find they do not have to go on doing that forever.

Having a positive friend you can call in the evening before bedtime or when you are feeling a little low, beats the heck out of having to call the psych hospital every night before bed for some reassurance.

Providers who create peer lines, which are places people with problems can call and talk to other peers, find there are more people who can function without needing psychiatric hospitals. Those communities that rely on hospitals to provide all the services need more hospital beds.

Peers are an important part of the recovery process.

4. There is a danger of developing a second or dual relationship.

The counseling relationship is special. It should not get mixed up with any other relationship. Counselors who forget those boundaries are at risk to get into friendship, financial or even romantic relationships with their clients. That is very likely to harm the client.

If someone says they like you there is that natural tendency to say you like them back. For a week or vulnerable person, there is the risk of trying to feel that way even if that is not how you really feel. The net result is an unwanted unprofessional relationship.

These second or dual relationships harm clients and they can cost counselors their licenses. Best to avoid this from the start.

Hope that explains this odd behavior we counselors feel obligated to observe with our clients.

David Joel Miller, LMFT, LPCC

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Why love and counseling don’t mix – ethical Loophole 4

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

Falling in love in recovery.
Photo courtesy of Pixabay.com

This time love is not the answer.

We thoroughly enjoy our romance. Everyone can connect with the story of Cinderella and the price, wouldn’t it be nice if every commoner girl could find and marry her prince charming?

There is a whole category of books devoted to romance. There are plenty of films that script out the story of someone who finally meets this wonderful person who makes their life complete, and they live happily ever after. It is when we try to bring that fantasy into the real world that things go wrong.

Men, particularly older men have this fantasy, that should some woman, usually, a beautiful younger woman, enter their life, they will have wild passionate sex and live happily ever after. As long as this stays in the world of fiction this may cause few problems.

When these fantasies make their way into the counseling room this looks less like a flowery romance and more like a fatal car crash viewed in slow motion.

It is not unusual for a client to find they are falling in love with their therapist. They may be weak, vulnerable, and needing love and affection. Clinicians are taught to be aware of this and to work on helping the client learn to love again without taking unfair advantage of the client and becoming that new romantic partner.

Some codes of ethics say that a therapist or counselor should never date or become romantically involved. Some set limits, 2 years, five years, or more. The thought here is that after many years of not being in a professional relationship, then should you meet a former client on a cruise or at a school function you might establish a relationship. Even here the counselor is supposed to make a note in the chart indicating they thought about this, that enough time has passed and they believe this will not harm the client.

This is critical; will falling in love with former client harm them? By the way, ending therapy and giving the client a love letter saying call me in two years on date X and then we can date. That is just as bad as starting up the relationship while the counselor is still seeing them.

Given all these warnings why do counselors still engage in romantic and sexual relationships with clients?

Every time the new professional magazine arrives we see a list of professionals whose licenses have been suspended or revoked. Counselors who started using drugs or abused alcohol is always a big one. But right up there, sometimes in first place, are the reports of therapists that engaged in sex with a client.

Why does this happen? What is the ethical loophole that people stick their heads through that ends up strangling them?

Frequently this ethics issue begins with the counselor entertaining the notion that yes sometimes it is possible to fall in love with a client and live happier ever after. No, they would not do it, but they can see how it might be all right sometimes for some counselors and clients.

This can also start with the idea that it is possible for a counselor to develop an outside social relationship or friendship, without it becoming sexual. Sometimes it starts with attending a social event, going to a movie or having dinner together. There are all the usual excuses, the client needs to feel safe going out, we are helping them learn to make friends or socialize.

But having once said that it may be OK to have some dual relationship with a client that sometimes it might be OK for some counselors and clients to fall in love and have a romantic sexual relationship, it becomes possible that this time, they and this client, that is one of those exceptions to the rule.

Once we start making exceptions, looking for loopholes, sooner or later we are at risk to put our heads through that hole. Why should we care if an occasional therapist has sex with a client, maybe the code of ethics is too strict?

We should care because those relationships are inherently unequal and have a serious potential to harm the weaker party, commonly this weaker person is the client.

Falling in love with a client, that one is always a bad idea. Beware the tendency to look for loopholes. Many an unwary counselor has tried to put their head through this one and ended up hung.

David Joel Miller, LMFT, LPCC

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Money and Friendships can cost you – ethical loophole #3

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

Ethics

Ethical loopholes strangle.
Photo courtesy of Pixabay.com

Dual relationships get a lot of counselors and clients into trouble.

Having multiple relationships can mess up therapy.

The big obvious one is sex, we will talk about that one later, but there are a bunch of other dual or “multiple” relationships that can cause problems. Here are some examples.

The client doesn’t have money to feed her kids; can I pay her to clean my house?

This sounds harmless enough. Counselors want to help people, that is why they became a counselor in the first place. So they might try to help out. Maybe give the client a little money. What about bus fare home? What about hiring the client to do a part-time job around the house? All this sounds good until it goes wrong.

You give that client bus fare once. They tell some friends who all ask you for bus fare. You have to start saying no. Now you have to tell that first client no. Then they all complain to your boss. Why does client X get bus fare and I don’t? Why did you give it to me and then take it away when I did not do what you wanted? See how that good deed can come back to get you?

What about paying them to help you? They could mow the lawn or clean your house. What if the lawnmower goes missing right after they cut that lawn? What do you do if your jewelry is missing? Can you make a police report on a client? Doesn’t that violate confidentiality? How can you explain that away?

The client is new to the city and does not have any friends. The counselor invites them, to attend church with them. The counselor goes and picks the client up and takes them to church. What could be wrong with that?

You are their therapist; you have power over their life. They are in a weak vulnerable position and you tell them they need to attend church and you are taking them to yours. Can they really say no? Will you withdraw care, stop seeing them if they say no?

What if their religious or spiritual tradition is one you do not approve of? Will you pressure them to convert? What if they consider your religion a “cult” will they be able to say no?

Think this doesn’t happen? Clients tell me, they have been told that their child protective services worker wants to be sure that their children are being raised in a “good Christian home.”  Does that constitute bias? Can the client say anything if they risk having their children taken away or if they have a mental health issue or substance abuse problems? Could those problems be used against them?

Revealing your religious preference to a provider can result in discrimination, loss of jobs, denial of promotion, or even make you the victim of physical violence. That’s why in this day and age members of some religious traditions still need to use the “decline to state” response to the question about religious preference.

I am not saying that all discussions of religious or spiritual values should be off the table in therapy. People with a spiritual connection do better in recovery. What is a problem is when the therapist crosses the line from listening to the client about what the client believes to doing a sales pitch or enabling the client to follow the counselor’s religion.

Encouraging them to practice a religious or spiritual tradition is a yes. Telling them they need to come to Zoroaster is a no.

Counselors do not have to stop going to church or another religious gathering place because their client attends, but they need to be very careful about transporting or arranging to meet clients there. It is probably an ethical boundary violation to be seeing someone in therapy that you also sit in a religious service and socialize with.

Wow! That new client just told me about this great money-making deal.

Money and client relationships, what a dangerous mix. Yes, we have to think about money. We need to get paid. But when we start thinking about money or other things first this can be a trap.

Investing money in a client’s business or investment opportunity or asking them to invest in one of yours, these are all bad ideas.

Lending money to your therapist is an absolute NO! If your counselor asks to borrow money run as fast as you can. Consider lodging a complaint on your way out to the appropriate person.

Think also about insider trading issues. Do you want to end up in court because you made an investment based on a tip from a client? Clients, do you want your therapist testifying in court about your therapy session and how this investment idea came up in the first place?

All of these ethics issues can start with just that little finger through the ethical loophole. Giving someone bus fare out of your own pocket, paying them a few bucks to mow their lawn, becoming involved in their religious or social activities, all of these can lead to trouble.

Client, I know that you may like your therapist, want to do something nice but remember that their ethics code like a priest vow of poverty may preclude them from accepting gifts, stock tips or other offers by you to do things for them.

For me, as a therapist, the best gift a client can give me is to tell me that something we did in session has helped them have the happy life they want. Hearing that I have been able to help, that makes my day.

Sorry if we can’t hang out or attend some social events together. I like you as a person but I respect our professional relationship and you as a client too much to mess this up by getting into another dual relationship with a client.

Next Friday ethics part 4 – the bad news for all you romantics at heart. Why falling in love with clients or your therapist so often ends so very badly.

David Joel Miller, LMFT, LPCC

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What’s the big deal if a therapist smokes a little dope? Ethical Loopholes Part 2

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

Cannabis

Marijuana’s effects. 
Photo courtesy of Pixabay.com

What if your counselor does drugs when they are off work?

The series on “Ethical loopholes and why these can strangle you” started in a previous post (last Friday) when I talked about the dangers of counselors talking too much about their clients and then violating confidentiality, this is a violation of most codes of ethics and illegal in most places. I also said there are three other ethical problems for counselors that may be affecting their clients. Here is part two – Counselors who are impaired by drug or alcohol use.

Is it OK to be a casual drug user? Can you just chip a little? Even if someone has a drug problem, should that keep them from working a job?

I think this depends on what that job is and for counselors and therapists, this should be a no.

There are times when working with a client that I do not focus first and exclusively on getting that client to stop drug use. When working with a suicidally depressed client, this is not the time to talk stop smoking, or even about giving up weed.

That is the old approach and it did not work. We used to tell the mentally ill that they had to stop all drugs for 30 days before they could get mental health treatment. Clinicians did not want to diagnose clients until they had a period of sobriety. So they referred them to substance abuse treatment first. The substance abuse treatment provider then refused them saying they were too mentally ill for drug treatment until they got their mental health symptoms under control So the client got ping-ponged back and forth.

The new process is to treat both problems at once and to “meet the client where they are” so if they are not ready or do not want to quit we work on the things they do want to change. So far I am good with this. I believe that any clinician worth their salt substitute can do an adequate assessment on someone who is using, you may have to catch them at a lucid moment but it can be done.

So we help clients work on what they want to work on. But here is where there is a two-part ethical trap.

In being willing to work with clients who are still using we can cross the line into saying that their drug use is OK and that they are entitled to keep doing it. I think we let the client down when we do not at some point mention that their drug use may be causing some of their mental health symptoms and encourage them to stop.

This danger, that accepting their drug use and working with them as they are can turn into advocating for their right to continue to abuse substances.

I am not an advocate of trying to help an airline pilot control their recreational drug use or alcoholism and still keep flying.

The ethical problem for counselors.

Once you begin to advocate for your client’s right to keep getting high and working it is a short hop to thinking that it is OK for the therapist to use and get drunk as long as they do it on their own time.

At what point does this “harm reduction” philosophy move over into it is OK for the therapist to use?

Can you smoke the night before and sleep it off? What if you come to work and are high? What if you come to work and have a hangover?

It is my belief that counselors who started out advocating for the client’s right to keep using can cross the line into being impaired by drugs and alcohol on a regular basis.

Those therapists do not usually get caught because they come to work impaired. They can often hide that. But every time I get my professional magazine it seems like there are more listings for therapists, psychologists, and counselors who got arrested did something violent or delusion while under the influence.

Guess what? Licensing boards do not say “He was off work so the DUI does not count.” Impaired professionals get their licenses suspended or revoked.

Starting to make exceptions for when it is OK to keep on drinking and using includes the risk that the professional will pick up.

I cannot tell you how many times I have seen substance abuse counselor’s crash and burn when they picked up again.

Therapists seem to be able to hide it a lot longer but once they stick their head through that ethical loophole and think that it is OK to abuse substances occasionally when they are off work, then becoming an impaired professional is just around the corner.

Oh my, the word counter is blinking at me again. Seems I have gotten worked up and written more words about this ethical issue than I had planned.

In a future post the dangers of counselors and therapists making exceptions to the “dual relationship” principle.  Getting to be friends with clients and doing things other than therapy with them can hurt clients and therapists. We also need to talk about that sex with counselor thing but we have saved that for last. See you again next time.

David Joel Miller, LMFT, LPCC

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel