Category Archives: Counseling and Therapy

Where did the LPCC Gap exam go?

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

About the grandfathering test for Licensed Professional Clinical Counselors.

Both CALPCC and CAMFT have reported that the California Board of Behavioral Sciences has stopped administering the Gap exam for those wishing to grandfather in as LPCC’s.

The information I have heard is that the testing company has notified potential candidates for the exam that BBS has temporarily stopped the test.

At this point, we do not know why or when the exam will be resumed.

My suggestion for those who plan to take the exam is to keep reviewing those things that were listed as inside the LPCC’s scope of practice. Especially focus on those things that were not emphasized in you testing for the LMFT or LCSW.

Let us hope this will be a short delay and that BBS will announce something soon. For more on this, I would encourage all potential LPCC’s and PCC Interns to join CALPCC and make use of the latest news and information in the member’s only area. If you are already a member of CAMFT, I encourage you to continue your membership in CAMFT as I have done.

The Mental Health Field needs all the advocates it can get.

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LPCC’s PCCI’s and Medi-Cal – News update from CALPCC

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

LPCC’s PCCI’s and Medi-Cal – News update from CALPCC

CALPCC the state-wide association for LPCC’s and PCC interns today released a news update confirming that LPCC’s and PCCI’s will be able to bill Medi-Cal here in California. This greatly increases the job opportunities for this new mental health profession.

Professional Clinician Counselors in California will be able to see adults and children. If they wish to see couples or families they will need to have had specific training in family therapy.

This SPA (state plan amendment) was signed in December 2012 with an effective date of July 1, 2012. The result of this SPA is that Professional Clinician Counselors will be able to bill Medi-Cal during the current fiscal year.

For more information please check the CALPCC website. Those of you who plan to practice as Professional Clinician Counselors in California should plan to join CALPCC if you have not already done so.

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Why the therapist doesn’t care about your problems- unit of treatment

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Does it feel like the therapist only cares about the other person?

Sometimes you go for therapy, with a person you think of as “your therapist” only to find they don’t really want to talk about you or your problems. They are only interested in your family member’s problems. What is going on here?

One problem for therapists is defining the “unit of treatment.” A good therapist will try to explain this to you at the beginning, but sometimes they don’t, and sometimes in the crisis of the moment you don’t get the details. Let me explain a couple of situations where this may be occurring.

When one member of the family has been seeing a counselor and now they want the counselor to help them with their relationship with another family member. Let’s say the client is a twenty-something woman and she has conflicts with her mother.

Mom gets invited to the next session. Mom wants to talk about how difficult it is getting along with her daughter and how she had to raise the daughter all by herself and now mom’s depression has been interfering with her life. Mom would like more respect and caring from her daughter.

The therapist does not want to hear about mom’s history of problems with depression, her hard life, and all the times the daughter disrespected her mother. The therapist wants to talk about their last fight and how mom could better support her daughter by being more understanding of the daughter’s mental health problems. What has gone wrong here?

The therapist is the DAUGHTERS therapist.

The unit of treatment is the DAUGHTER. They are not going to spend time on mom’s problems. If mom needs therapy then she needs to get her own therapist.

In this situation, Mom is a guest in the daughter’s therapy session. This can sometimes be referred to as a collateral session. A collateral session is all about how the guest can help the identified patient. If you ever get this kind of invite you should ask some questions. Is this for both of you to work out problems or are you only there so that the other party can tell you why you hurt them and they are expected you to do something to help them?

As a guest, you do not get confidentiality. You are not the therapist’s client and if you disclose that time you did something wrong you may get reported even if this is not a mandated reportable situation. Also if the daughter has told the therapist about things she has done in the past to the mother, like steal her money and forge her signature, the therapist can’t break confidentiality and tell mom.

Another situation that causes a lot of confusion is when a person is being seen for individual therapy and then asks their partner to join this. Say the woman above now wants to do some sessions with her husband.

Is this a request to stop individual therapy and begin couples therapy? Or is this an effort to bring the partner in to learn how to be more supportive and helpful to the wife?

This is an awful situation for a lot of men. They have talked with me in individual sessions repeatedly about how they went to a session with the wife and felt bushwhacked. The therapist, sometimes with a very feminist point of view, spent the session telling the husband how it was his fault, that all women are oppressed by their husbands and he is to blame for their marital problems.

Now any good marriage therapist knows or should know, that taking sides is likely to make the conflict between the partner’s worse and is not going to help the relationship. We should always be neutral. But if you have spent months listening to a client tell you all the awful things their spouse does to them, it is very tempting to turn this into a “heart to heart talk” by creating a safe place for your client to tell their spouse off.

This kind of session usually ends up in a blowout argument and possible violence or an end to the relationship. Counselors who do this sort of work should warn their clients to come in separate cars because after beating up on one of the partners there is no way that person is likely to give in say it was all my fault and go home to do as told.

If you go to a session with your partner’s therapist and this is not to begin couples therapy, expect it to be ALL about them and not you. A few therapists can handle this well and help the couple or family work some things out, but just who is here for treatment should be clarified at the start of the session.

The last example I will give is the parent, usually mom, who takes the child for therapy. They expect the therapist to help them cope with raising this defiant, belligerent child. What happens is that the session becomes all about how mom can be a better more nurturing parent and what the developmental needs of the child are at this age. She is instructed to spend more time reading to her child, help him with his homework, and make sure to walk him to and from school to increase his sense of security. The sessions are all about the child.

Never mind that mom does not sleep nights because of the nightmares from the abusive violent relationship or that dad is away in prison for what he did to mom and child. Mom also wants help with how she as a single parent is supposed to work two jobs to support her kids and still do all this with the identified patient child. As much as she loves this child and knows he needs her attention she has three others who also need attention. What has gone wrong here?

The unit of treatment is the child, not the family.

Mom gets only the help that relates to her ability to help her son. Now sometimes the therapist will shift the focus and start helping mom. The risk then is that the therapist will side with mom and spend the sessions beating up on the child, telling him he is a bad person and that everything is his fault. A good therapist will balance all these needs and help the whole family but this is a difficult task.

There are a whole lot more issues around children in therapy we need to look at. Can they consent, do they get confidentiality, and if so how much? Can an 8-year-old really consent to treatment? Is telling him he is the bad child an institutionalized form of child abuse?  And do we sometimes abuse the parent to make the child feel better? This post is running long and I need to leave those issues for other posts.

My conclusion is that there are good therapists who do a great job and not so good therapists who don’t do a good job of juggling these issues. Any time more than one person walks into a consulting room there are conflicts about whom we are helping and how we should be with the others.

Have you ever been to a therapist who just didn’t seem to care about your problems?

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

Can an LPCC practice privately? Reader Question # 2

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

So now LPCC’s are licensed – where can they work?

In California, an LPCC can practice privately if – and only if, they are licensed here in California. So far the only people who meet this requirement are those who already had another license (LMFT or LCSW) here in California and who took the Gap exam to qualify for the LPCC license also. People who were licensed as a Professional Counselor in other states and moved here are beginning to qualify to take exams and become California licensed LPCC’s.

LPCC’s have a special role in working in career counseling, mediation, and a few other areas that are somewhat different from other mental health professions. LPCC’s should not treat children, families, or couples unless they have had additional training in those areas similar to the training LMFT’s receive.

Interns of any license (MFT interns, ASW, and PCC interns) are not allowed to have their own practice and must work under another licensed person. In a for-profit practice, the intern can only work for a limited period (6 years) while gathering supervised hours and testing. Interns and associates who work in governmental settings or other “exempt” settings may be able to work longer than the 6 year period their first intern number is good for.

Because of quality concerns, I expect most employers to limit the time interns who work for them have to get licensed and still work seeing clients.

Some people are attempting to get around this licensing requirement by calling themselves Life Coaches, a profession that to the best of my knowledge is currently not licensed or regulated. If the client’s issue relates to anything that may be caused by a mental, emotional, or behavioral disorder then the client should be seen by a licensed mental health professional. Coaches should restrict their practice to clients who do not have a mental illness but want help in accomplishing more in life.

The more promotional material I read and view online from coaches the more nervous I am that they may be stepping outside their scope of competency as well as their scope of practice.

The laws may vary in other jurisdictions but the legal and ethical principles to stay within your scope of practice and scope of competency should be the same everywhere.

Thanks for that question.

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

Must psychologist report patient planning a crime

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

More about when the therapist breaks confidentiality Reader Question #1

Please with crime scene tape

Do therapists have to report a crime?
Picture courtesy of pixabay

Most of the time therapists, counselors, and psychologists do not report past crimes. If the crime may occur in the future, then we have a problem. How does the treating professional balance the duty to protect the public with the need to maintain a trusting relationship with the client?

In past posts, I talked about some of the standard exceptions to confidentiality. Things like child abuse or an intent to harm themselves or others. If the client tells me about a plan, to harm or otherwise abuse a child, or kill their partner and them themselves, I feel both ethically and legally bound to intervene and try to stop this. How I go about intervening may be a matter of my best “clinical judgment.”

But this planning a crime issue, that is tricky.

One thing every professional should do is have a place they can go to for legal and ethical advice. This is one of the reasons I am a member of both CALPCC (California Associations for Licensed Professional Clinical Counselors) and CAMFT (California Association of Marriage and Family Therapists.) Professional associations often offer services to answer or refer you to answers for ethical and legal questions. CAMFT has lawyers on staff who can answer these kinds of questions if you are a member.

So a counselor who is presented with this situation may well consult with a legal or ethical adviser. While doing this consultation they would use the minimum amount of information needed to get an answer. They should not give the client’s name or identifying info but only the nature of the crime the client says they might commit and then ask if they legally or ethically need to make any kind of report.

I mentioned also that it matters who is paying this counselor. If you go to a government psychologist and are planning on cheating disability by lying about your symptoms, that professional is working for the government and will report your effort as fraud. The point of the interview is to see if you are disabled. Even if your treating clinician does not disclose something you said they will not lie by leaving out things that would affect the decision someone else is making.

So what kinds of crimes can I think of that might need to be reported?

If my client was thinking of burning down a building or planting a bomb, I might need to report that and warn people near that building because of the high risk that someone would be hurt. If they were planning to set a fire and they shoot first responders, I feel that this is absolutely reportable.

We do encourage clients to talk with us about anything and everything so we can help them and I would want to try to help my client find other ways to accomplish their goals without committing a crime.

Generally, financial type crimes, writing bad checks, or cheating on your taxes, we don’t have to report clients for that. But we do want to work with them on why that lifestyle may lead to worse things. What a counselor should not do is help the client plan ways to get away with a crime.

One last exception to confidentiality no one ever seems to talk about is if the client is a terrorist. If they are plotting a terrorist attack, even if no person is likely to be harmed, the treating professional may be required to divulge that information. Homeland security can require treating professionals to disclose certain things.

But honestly, this is not a big problem for counselors; suicide bombers probably do not see therapists. Around here we aren’t likely to hear about any Homeland security related issues. There are not many terrorist attacks on cattle feedlots or vegetable growers.

Yes, I live in California, but remember that a large part of this state is a long way from the ocean.

Not sure that really answered the question, but I know that the worry about how much to tell and how much you need to hold back from your counselor is on a lot of client’s minds. If you can’t trust your therapist it is hard for them to be able to help you.

When in doubt ask the person you are seeing and judge by their answer if they will try to help you while staying inside the law and ethical guidelines.

This has been a general discussion of legal and ethical issues involved in a client and counselor discussing the client’s plan to commit a crime. Remember I am a counselor, not a lawyer and legal issues vary from jurisdiction to jurisdiction. For your specific situation, you may need to talk to a lawyer.

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

The question why? – In therapy

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

The question why in therapy.
Photo courtesy of Pixabay.com

Does it help to know why?

More than half the time in most therapy sessions is spent on the question of why? Most of the time the focus of the why question, is not on the client but on some other person in their life. Clients spend a good deal of time asking me why their partner did this or that, why did their parents do something, and so on.

It would be reassuring to know why. Most of us think if we just knew “why” then we could prevent something bad from happening. The great illusion of most relationships is that we can somehow control the behavior of others. Most of the time we can’t control the others in our lives, and except for teaching our children good behavior, controlling others is probably not healthy.

The questions we should be asking are not about others. More helpful questions are the ones we ask about ourselves. What do I really want out of life, what are my values? How much am I willing to invest in reaching my goals? Can I accept this situation? What am I willing to do to change?

Sometimes we focus on others to avoid looking at ourselves. It is easy to upset yourself about things happening in the next apartment, across the street, or across the country.  Looking at what is happening in your own life is more productive. It is also more challenging.

People like to vent about their partner, their boss, or their children. It would be easy to devote a lot of therapy time to talking about others. Conversations between friends often turn to talking about others. We call that practice gossiping. It is easy to do. We may even think that by discussing others, we can gain some insight into the situation, some way to improve our outcomes.

One thing we tell clients in therapy is that it is not productive to talk about people who are not in the room. Taking about your conflicts with your partner may make you feel better, temporarily, but it won’t change the situation. There are two ways to improve this relationship situation, get the other person in the therapy room, or change yourself.

Marriage, Child, and Family Therapist’s work from a “systems” perspective, to change a family situation it helps to get all the people involved in the room. Often the “identified patient” is not the one with the problem. Let’s look at some examples of this situation.

The mother comes in with her teenage child. The child has a severe weight problem. The child has become depressed as a result of being overweight. Despite mom’s best efforts to put this teen on a diet, make them exercise; the teen continues to gain weight. The teen comes to therapy; they don’t want to talk about their weight. What is on their mind is the way their parents have been fighting and every time they go to visit Grandma, she runs mom down the whole visit.

Turns out that because of the marital conflict, every time dad takes this teen out they stop somewhere for something to eat. Dad always says “don’t tell your mother, she is way too hard on you,” which the teen tries to respect.

When the teen visits grandma, she does the same thing, makes excuses for why the teen does not need to lose weight, and rewards the teen with food treats. Grandma does not like her daughter-in-law and gets even with her by being the teens “friend” and sabotaging the mother’s plans for the teen to lose weight.

Working with the teen around weight loss may not be very effective. One approach is to get the whole family together at once and talk about how they are all colluding to use the teen’s weight as a way to try to control or get even with other family members.

Sometimes we can’t get the whole family to therapy. We have to work with the teen on what they really want. If the teen is impacted by this weight issue, we may need to help them to learn how to say no to dad and grandma’s efforts to sabotage their diet. Some teens can’t resist the family dance and are stuck.

Boys escape this family dance by joining the military or running away from home. Girls try to escape by getting pregnant, moving in with a man, or some other way of having to leave the family. Both genders may also use drugs and alcohol to escape intolerable conflicts.

Another situation that results in a lot of talk about a person who is not in the room is the spouse of the alcoholic or addict. They are likely to want to spend a lot of time on how to make their partner stop or on what they did to make them drink and use.

The spouse did nothing to make their partner abuse substances.  A bad relationship may have contributed, but it is not the cause. People drink and use to change the way they feel. Eventually, they lose the ability to cope without the substances. Some people can use and drink a little or even drink a lot and then stop when they want. Other people find that when they try to stop, they can’t. We consider this an example of the disease of addiction.

There is not much the non-using partner can do to stop the other person’s substance abuse.  They have a choice. End the relationship, say that this is more than you signed on for and you are done, or you can accept that the other person is the way they are and go on from there. Spending time talking about the person who is not in the room is not helpful here either.

Do you spend a lot of time asking why others do what they do? How much time have you spent looking at yourself? What do you really want? What can you accept or not accept?

Don’t waste time on the why; work on the “what and how” of the changes you need to make to have a happy future.

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

How does my therapist know that? Isn’t counseling confidential?

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

Is counseling confidential?
Picture courtesy of pixabay.

Did my last therapist tell?

This comes up a lot when people move from provider to provider. It especially happens when you see multiple people in the same agency. No not everything you told your old therapist will be kept secret from your new one. WHY?

Laws about confidentiality make a distinction between “Use” and “Disclosure” of information. If you are in the hospital anyone who is treating you needs to be able to look at your record and see what medications you are on, what procedures you have had, and what allergies you may have. Anyone who treats you in the future at that agency probably has the right to look at your old record and see what was done to you. The same applies to psychotherapy.

Everyone at the hospital does not get to look at anyone’s medical record just because they want to see it. The only reason to access a medical record should be for the purpose of treatment. People have gotten fired for looking up someone’s medical record just because they were curious. Even looking in medical records to see if a famous or infamous person was treated at your hospital can get you fired. But if you are treating a client you may need to know what is in their record.

Psychotherapists do and can share records and that is considered “use” not “disclosure.” Laws about confidentiality primarily relate to disclosure. Some of this has to do with law, for that see a lawyer. As a therapist though, I find this is an important issue to many of my clients and they need to understand how our system works.

It is considered good practice to separate psychotherapy notes from your general medical file. Everyone who treats you in the emergency room for an accident does not need to know about your marital problems.

We also don’t need a list of the names you or your spouse call each other. What the counselor wants to know is that you two are having conflicts and that you resort to name-calling with each other rather than problem-solving. One or two examples will suffice here. Long transcripts of the argument might be interesting in a movie script but they don’t need to be in psychotherapy notes.

Clients sometimes move from therapist to therapist. Sometimes clients want a new counselor, some therapists are known to “fire” clients for a variety of reasons. Ethically we should suggest a change of provider if we feel that we are not able to help a client. If your counselor retires, you may be assigned a new one.

When the client changes therapist, we do not, as a rule, start a new file. Would you want to go through all those tests and lab work every time you saw a different doctor? Same with taking a life history. It should be in your chart. The new provider should review your chart so they should have some knowledge of what your last therapist was treating you for and why.

Charts are needed to provide continuity of care as well as other reasons. Clients have told me they resent that the new therapist knows things they had not told them. They probably read this in the chart though they may have been briefed on the case by the last provider also. If the file moved to a new agency there probably was a release of information but at the same agency, the old paperwork still applies.

Personally, I like to meet the client first and form my own opinion about them, then review the chart. The risk is that the client will have to tell me something they just told the other counselor last week. The benefit is that in telling me again they may say something they did not say last time or I may ask a different question. A fresh set of eyes can sometimes see something new.

More than once after doing a new assessment I looked at the file and can see why the last counselor came up with the diagnosis they did, but having new facts I don’t necessarily agree with that opinion.

So yes, the new therapist may know something you did not tell them. That they were filled in by your previous provider is not a violation of confidentiality. Did you really want to have to retell your whole life history to a new person before getting down to the work of solving life’s problems?

The bigger question is why you would want to hide things from the therapist you are seeing now?  They will have trouble helping you if you don’t tell them what the situation really is.

The most important person for you to trust and get honest with is you. Some clients hide things from their counselor because they don’t want to face the fact that they have a particular problem.

The results of counseling are mostly about the relationship. We try to spend time upfront getting to know clients and building trust. Some clients have more trust issues than others. If you are not sure you trust your therapist, ask them questions. The names of their kids and their spouse are not important but their views on how to raise a child or have a good relationship might matter to you.

You should be able to rely on your provider to maintaining your confidentiality and not disclosing your information to someone who has no reason to know. Don’t expect one doctor or therapist to try to hide your symptoms from another professional who is treating you.

The bottom line? If you want help in recovering from your issues, whatever they are, you need to get honest with yourself and your counselor or find a provider you feel you can trust.

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

The question why? – In therapy

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

The question why in therapy.
Photo courtesy of Pixabay.com

Does it help to know why?

More than half the time in most therapy sessions is spent on the question why? Most of the time the focus of the why question, is not on the client but on some other person in their life. Clients spend a good deal of time asking me why their partner did this or that, why did their parents do something, and so on.

It would be reassuring to know why. Most of us think if we just knew why then we could prevent something bad from happening. The great illusion of most relationships is that we can somehow control the behavior of others. Most of the time we can’t control the others in our life, and except for teaching our children good behavior, controlling others is probably not healthy.

The questions we should be asking are not about others. More helpful questions are the ones we ask about ourselves. What do I really want out of life, what are my values? How much am I willing to invest in reaching my goals? Can I accept this situation? What am I willing to do to change?

Sometimes we focus on others to avoid looking at ourselves. It is easy to upset yourself about things happening in the next apartment, across the street, or across the country. Looking at what is happening in your own life is more productive. It is also more challenging.

People like to vent about their partner, their boss, or their children. It would be easy to devote a lot of therapy time to talking about others. Conversations between friends often turn to talking about others. We call that practice gossiping. It is easy to do. We may even think that by discussing others we can gain some insight into the situation, some way to improve our outcomes.

One thing we tell clients in therapy is that it is not productive to talk about people who are not in the room. Taking about your conflicts with your partner may make you feel better, temporarily, but it won’t change the situation. There are two ways to improve this relationship situation, get the other person in the therapy room, or change yourself.

Marriage, Child, and Family Therapist’s work from a “systems” perspective, to change a family situation it helps to get all the people involved in the room. Often the “identified patient” is not the one with the problem. Let’s look at some examples of this situation.

Mother comes in with her teenage child. The child has a severe weight problem. The child has become depressed as a result of being overweight. Despite mom’s best efforts to put this teen on a diet, make them exercise; the teen continues to gain weight. The teen comes to therapy; they don’t want to talk about their weight. What is on their mind is the way their parents have been fighting and every time they go to visit grandma, she runs mom down the whole visit.

Turns out that because of the marital conflict, every time dad takes this teen out they stop somewhere for something to eat. Dad always says “don’t tell your mother, she is way too hard on you,” which the teen tries to respect.

When the teen visits grandma she does the same thing, makes excuses for why the teen does not need to lose weight, and rewards the teen with food treats. Grandma does not like her daughter-in-law and gets even with her by being the teens “friend” and sabotaging the mother’s plans for the teen to lose weight.

Working with the teen around weight loss may not be very effective. One approach is to get the whole family together at once and talk about how they are all colluding to use the teen’s weight as a way to try to control or get even with other family members.

Sometimes we can’t get the whole family to therapy. We have to work with the teen on what they really want. If the teen is impacted by this weight issue we may need to help them to learn how to say no to dad and grandma’s efforts to sabotage their diet. Some teens can’t resist the family dance and are stuck.

Boys escape this family dance by joining the military or running away from home. Girls try to escape by getting pregnant, moving in with a man, or some other way of having to leave the family. Both genders may also use drugs and alcohol to escape the intolerable conflicts.

Another situation that results in a lot of talk about a person who is not in the room is the spouse of the alcoholic or addict. They are likely to want to spend a lot of time on how to make their partner stop or on what they did to make them drink and use.

The spouse did nothing to make their partner abuse substances.  A bad relationship may have contributed but it is not the cause. People drink and use to change the way they feel, eventually they lose the ability to cope without the substances. Some people can use and drink a little or even drink a lot and then stop when they want. Other people find that when they try to stop they can’t. We consider this an example of the disease of addiction.

There is not much the non-using partner can do to stop the other person’s substance abuse.  They have a choice. End the relationship, say that this is more than they signed on for and they are done, or they can accept that the other person is the way they are and go on from there. Spending time talking about the person who is not in the room is not helpful here either.

Do you spend a lot of time asking why others do what they do? How much time have you spent in looking at yourself? What do you really want? What can you accept or not accept?

Don’t waste time on the why; work on the “what and how” of the changes you need to make to have a happy future.

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

Ca. Professional Counselors – CALPCC and LPCC’s

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

October CALPCC board meeting.

This year California became the 50th state to license Professional Counselors. The official designation in California is “Licensed Professional Clinical Counselor” LPCC for short. Other states had some form of professional counselor’s licensure before California, so we are still finding our way as this profession matures and adapts to California.

CALPCC, a non-profit organization, is the statewide organization for this new profession. Last weekend was the annual “retreat” for CALPCC’s board of directors which I was able to attend.

CALPCC has seen fit to appoint me to that board to fill out an open board member term. I am excited about this opportunity.

Some short recaps of what we talked about are below. Remember that as a new board member these are my impressions and that I can’t speak officially for the board. So any sentiments expressed are purely my own. Here are some of the questions that came up.

1. Why are Marriage and Family Therapists (MFT’s or LMFT’s) becoming LPCC’s also?

At least 4 of the CALPCC board members, myself included, are also licensed as LMFT’s so there was some discussion of why LMFT’s might want to also become LPCC’s.

My belief is that there are things that each profession does that the other does not do and to best serve my clients I needed to be trained in both areas.

Most LMFT’s work with couples, families, and sometimes children. Since I see some children, couples, and families I need to stay licensed, active and up to date in the LMFT field.

Much of my private practice is in individual counseling, particularly something I loosely call “men’s issues.”  LPCC’s are specially trained in things like career counseling and mediation. Sometimes this shades over into the area of life coaching. I approach these issues by trying to help clients solve problems that are causing social or occupational problems or interfering with having a happy life.

2. Why should someone join CALPCC?

Lots of counselors are already members of one or more professional therapist or counselor organizations. They asked why they should join another group.

My view is that if I was solely an LMFT I would need to belong to the one or two organizations in that field. Since I am also an LPCC I felt the need to join the organization that is specific to LPCC’s, which would be CALPCC. I chose to be a member of organizations in both fields and would recommend that to other people who are dually licensed.

3. What are the benefits of being a member of CALPCC?

CALPCC maintains a website. There is information on the website for anyone who is interested in the new Professional Clinical Counselor profession. There is also a member’s only area with additional information that is useful to LPCC’s that may not be of interest to non-counselors. Other professional associations also use this member’s only format for some of their website content to encourage those who use the resources to help pay the cost.

I recommend that if you are licensed or seeking licensure as an LPCC, you want to be a member of CALPCC and get access to the members-only content on the website.

4. Can LPCC’s bill Medi-Cal?

Not yet, but we believe this is coming and coming soon. At this point, there are only a few LPCC’s licensed in California. The last license number I heard was about LPC200. Those who are getting licensed now are people with previous other licenses who are getting a second license.

We were told that there is a huge pile of applications for the LPCC license that were mailed on the last day of 2011. BBS will be working on that pile for a while. By the time those licenses are completed and the BBS moves to issuing new licenses to people who did not have a previous license we hope that the Medi-Cal approval will be completed.

There are other federally funded programs in which LPCC’s are already being hired.

5. Can LPCC’s open a private practice and take private insurance?

Yes, they can. Who the insurance company place on their panel is up to each individual insurance company. I am on several panels and each one that I have looked at will take LPCC’s.

That does not mean that if you are newly licensed as an LPCC the insurance company will automatically add you.  Most insurance companies want to know they are sending their customers to someone who is reliable. They require providers to have a certain length of time in the profession before they add you to their panel. They also look to see if they have too many or too few counselors on their list for your area.

This is not insurance companies picking on the new LPCC profession. These rules have also been applied to existing LMFT’s and LCSW’s.

Most insurance companies I have looked at require you to have been licensed for 2 to 5 or even 6 years before they will consider you for their panel unless you have a particular skill they need on their list. So if you speak Russian and Swahili you may get on insurance panels sooner.

6. Should students join CALPCC now or wait till graduation?

I recommend that you join while still in school and read the members-only updates while you are preparing for your exams. This keeps you up to date on the latest events and trainings in your field.

Also – the CALPCC student member price is VERY reasonable.

Consider that the really good counselors and therapists do not stop learning when they graduate. If you want to be the best possible therapist or counselor you can be, stay active and up to date in your field.

If you are a client or an out of California professional forgive the very California LPCC specific post. The last two weeks have been extra busy for me. Shortly I will return to my posts on recovery, resiliency, and having a happy life.

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

Articles about anger, behavior and children.

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

Happy family

Parenting.

More resources for parents – single or coupled.

Some additional resources I wanted to make you aware of. Some of you may remember that I was interviewed for an article about managing anger during a custody dispute. That article and several others on children’s anger and behavior issues are available at the same website.

They also have a new Checklist for parents on child behavioral problems and while it is not a diagnostic tool it can suggest times when you should seek professional help for a child’s behavioral issues.

Just returned from the California Association for Licensed Professional Clinical Counselor (CALPCC) board meeting. More on that meeting and the new (in California) profession of Professional Clinical Counseling as soon as I can get the posts written.