Category Archives: Counseling and Therapy

Should you tell that to a friend or a therapist? – Part 2

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

Talking to a Friend or therapist – part 2.

I think I misread this question the first time. My first thought after reading the question was:

“Why should a client go to a therapist they have to pay rather than just talking to a friend?” That is from the client’s point of view and describes why a client would be better off getting a professional therapist rather than relying on a friend.

I wrote a blog post about “Therapist of Friend” which is up at counselorssoapbox.com. That post got some really good comments from readers and they suggested some additional reasons they found going to a professional therapist helpful.

After rereading the question I think they were asking:

“What if your friend is also a therapist? Or as a therapist what do I say, to my friend. Do I set boundaries and keep my roles as friend and therapist separate?”

Remember some of the readers of this blog are consumers but some of the readers are professionals or aspiring professionals.

Here is my opinion of what an ethical therapist should do.

The law’s that created LMFT’s and some other therapist and counselor professions defined what professionals do as “applied psychotherapy.” We are able to bill for services provided to a client’s medical insurance. We have to keep the practice of our medical specialty separate from what we do on a non-professional friend basis.

Consider a doctor and his wife, a therapist; who go to dinner at the house of a couple who are casual friends. The friends proceed to describe some chest pains the husband has been having.

The doctor could ask a couple of follow-up questions, make a diagnosis, and whip out his prescription pad and write out a prescription. But should he? Most likely he will tell his friend you should see a doctor. That needs to be checked out and you need some tests and lab work.

Now the wife changes the subject and tells this couple all about the problems they have been having with their teenage son. What should the therapist do? Listen empathically? Ask more questions to define a diagnosis? Suggest some interventions that the parents could try? Or should this therapist, for the same reasons as the doctor, suggest politely that lots of kids these days have problems and the family might want to consider getting him some counseling? Counseling doesn’t mean he is crazy, just he may need help with some of the growing up tasks that he needs to do. And often it is hard to listen to suggestions from family members whom you want to please and you have a history with.

But wait a minute, aren’t those also reasons why the couple may not be totally honest with their therapist friend? And could you make things worse if you suggested interventions or treatment and you had an incomplete diagnosis because your “friend” left out some embarrassing details in front of their spouse and guests?

Once you learn a skill it is hard to unlearn it or know when to put it aside. If the friend had a heart attack the doctor would most likely intervene and do some emergency procedure or he might call an ambulance. The therapist would do the same if the person was suicidal. But beyond emergency situations, therapists need to put their therapist hats by the door and just be friends.

Remember no one likes a car salesman who comes to your house for dinner and spends the whole meal trying to sell them a car. No one likes a psychotherapist who is trying to psychoanalyze everyone they meet.

The difference in the relationship between a friend and a professional therapist lies in the professional’s ability to diagnose or define the problem and then institute interventions to make a change. Even professional coaches are allowed to make criticisms of the client that a friend would not be permitted.

In a past blog post, I wrote about reasons a client might want to see a professional for therapy rather than just talk to a friend. Now, look at those same reasons from the therapist’s point of view. Your liability insurance won’t cover you. They get no confidentiality or privilege. You may need to make a child protective service report on your friend. And most importantly because of dual relationships, you lose a friend.

Here is what I suggest you tell your friends who bring up problems that are in a therapist’s scope of practice.

1. This sounds like something that a counselor could help you with.

2 I make it a rule not to do therapy with friends.

3. We are not supposed to have a second relationship like a friend, with our clients and I would hate to lose you as a friend.

4. I can give you the names of some therapists who could see you if you like.

If you do other things such as coaching or teaching there is no problem in having a friend attend your class or coaching them on more effective communication but be sure that this is a separate activity from your therapy or counseling practice. And remember, in coaching or teaching you never ever give a diagnosis or conduct an intervention designed to treat a mental, emotional, or behavioral problem.

Hope that clarified the issue from the therapist’s perspective.

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 pay a therapist when you can just talk to a friend?

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

Therapist or friend – what is the difference?

1. Friends may keep your secrets; therapists are required to keep them.

Some friends are so close you can tell them anything. Well, almost anything. Most of us have secrets which we were sure we could never tell anyone. Friends are usually friends because we have things in common. If you tell them everything can they, will they, keep the secret? What effect might their knowing the secret have on your friendship? What if you two have a falling out? Some things are just too embarrassing to tell a friend.

There are two concepts that keep a therapist from revealing secrets. Confidentiality, which means that they can’t talk about what you say unless it fits those very few exceptions like you are suicidal or talk about abuse of a child. Other than that what you say there stays there.

Also, there is what is called patient-provider privilege. That means some things may be protected even if police or lawyers come around asking questions. Friends don’t get legal protection to keep your secrets.

You are only as sick as your secrets – Friends shouldn’t have to carry some secrets

2. Friends can help you solve today’s problem – counselors can help you learn to solve your own problems.

Counselors often work with clients to help them learn skills to solve life’s problems. Friends may tell you what to do in a given situation but that does not help you with the next problem.

You want help that will help you become more independent not more dependent. Therapists are taught they should help you be independent not foster dependency.

3. Friends may not want to hurt you but sometimes you need to hear the truth.

A professional person can give you their honest opinion. You paid for it and you deserve it. Friends may be afraid to tell you the truth for fear of losing a friend.

4. Friends get tired of listening to your problems, therapists do this for a living.

Ever meet someone who was really needy. Every time you talked to them it was all about their problem of the day? When you are going through something difficult you need to talk about it. Friends can get talked out. Don’t burn out friends and damage friendships by asking friends to become very involved in your problems.

5. Friends have a good heart. They want to help with your problems. That doesn’t mean they always known how.

Therapists have many years of schooling and specific training in how to help people like you with problems. They study not only diagnosis and treatment but how to help with particular problems.
It is that kind of expertise that you need in your corner when that problem overwhelms you.

6. Friends can play the game with you, but counselors and coaches can help you improve your game.

When the team is losing all the players are going to talk to each other. They know what it feels like to lose. What they don’t always know is how to change that losing streak. That is where a new coach can come in and help turn a team around. Counselors, therapists, and professional coaches can do that for your life problems.

That does not mean you should avoid friends or peer support groups. Both are vital parts of your support system. Millions have recovered from alcoholism in A.A. But if you find that when you talk to your friends about your problem, that they don’t know how to help you or that the solutions they offer are not helping, consider that you may have a second problem, a mental health problem and seek professional help.

Those are some reasons that you might decide to see a therapist rather than talk with a friend. What if your friend is a therapist? What if you are a counselor? In the next post, I want to talk about reasons to keep that friendship and that professional relationship separate.

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

Morning Question # 1 – MFT trainee or MFTT?

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Morning Questions. (Sometimes reader question.)

A new feature for this blog. Sometimes a question or comment comes in or someone uses a search term that needs a short answer but not a post. Occasionally in the early morning, I will post answers to those questions. Here is the first one.

Morning Question # 1 – MFT trainee or MFTT?

ALWAYS – MFT Trainee. MFT Trainees are still in school. They are not yet registered or licensed. They can only work under close supervision. Both at the school they attend and the field placement they are supervised. In California, the rule is one hour of supervision for every 5 hours of client contact. Not spelling out the full word Trainee can be misleading.

For MFT interns –  who have graduated but are still accruing hours for their license the same rule applies. They should always list themselves as MFT Interns NOT MFTI. This is to avoid misrepresenting their credentials to the public.

Both trainees and interns should also tell clients who is supervising them.

Some other professions use different labels for students and unlicensed workers. For example, most social work interns have about the same experience as MFT trainees this leads to all kinds of arguments about the merits of “interns.”  For more on this label, issue see “Therapist, Counselor or Social worker?”

Is it a medical problem or a mental health problem – Axis III

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

Medical record

Diagnosis.
Photo courtesy of Pixabay.com

Which Axis does that go on?

UPDATE

Under the DSM-5 system, mental health professionals no longer separate the information onto five Axis. We do still look for this information.

Several questions have come in on the relationship between medical issues, physical symptoms, and the five-axis system of the DSM. This is the lay version of that discussion. For a full discussion, you would need to consult the APA site or the full DSM-4-TR. I see from the search terms coming into counselorssoapbox.com that there are several questions about this.

The mental health profession is focused on mental illnesses. The DSM it the “Diagnostic and Statistical Manual of Mental Disorders” for a good reason. So if the problem is medical it is outside what we are doing. If you have ANY doubt, please see a medical doctor first and get any possible physical illness or condition ruled out before seeing a therapist. The DSM, however, does not see psychical and mental disorders as two separate things even though different professions may treat different aspects.

Some mental disorders can create symptoms that are physical. People who are depressed may not be able to sleep or they may sleep excessively. Nightmares can be a symptom of PTSD. These sorts of mind-body problems can be helped by therapy. Some disorders have elements of both physical illness and learned behavior. If a mental illness is caused by a medical problem it is diagnosed as a mental illness and goes on axis I. The DSM cites a thyroid condition that results in depression as an example of this. Drug-induced hallucinations would be another.

Short answer – Mental illness goes on Axis I

(Axis II if it is long-term or hard to treat like Personality Disorders)

Some physical conditions can affect your mental health even though they are not the direct cause of the illness. If you become depressed as a result of a cancer diagnosis then the therapist and the psychiatrist would want to know about cancer when treating your depression. Medical conditions affecting your mental health show up on Axis III. Which is a sort of “oh by the way” thing for therapists.

A medical condition that “influences” your mental health – AXIS III

One reader asked about coding Pregnancy. As I see it if I were treating a client for OCD and she gets pregnant, the pregnancy does not have to be coded. If I were treating this same person for depression and anxiety as a result of a rape and now she finds out she is pregnant, well the pregnancy may now have an effect on her mental health.

Sleep disorders are especially troubling. Poor sleep can be a symptom of a mental illness as in depression. Poor sleep can cause mental illness as in a breathing problem (sleep apnea) that prevents good sleep and creates depression or irritability. Intrusive nightmares can be a sign of PTSD. They can also be causing or maintain the symptoms.

There are some sleep disorders listed in the DSM but that list is not as inclusive as the list in the International Classification of Sleep Disorders. Sometimes there is a connection and sometimes people have a mental illness and sleep disorders that may influence each other but are not directly linked.

Sleep disorders are a highly specialized area. If you have a problem with sleep I recommend that you talk with your physician and you may need a referral to a sleep specialist.

In a future blog post or two, I want to discuss some conditions that get mistaken for other things and mixed up with mental health diagnoses.

More on Sleep Paralysis, Hypnagogic Hallucinations (Hypnagogia), Hypnopompic Hallucinations, Lucid Dreaming, and their relationship to mental illness in posts to come.

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

Are people who go for counseling crazy?

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New post over at counselorfresno.com “If I go for counseling does that mean I am crazy.” If you check it out feel free to leave a comment and let me know what you think.

By David Joel Miller.

Best of Blog – May 2012

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Counselorssoapbox.com

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

Here it is – The Best of Blog Recap for May 2012 –

Thanks so much to all of you for making this another great month. I appreciate all those of you that have read the blog and especially appreciate those who have left “likes” and comments. Please feel free to leave a comment or ask a question.

I have included 5 posts since the last two in both categories were tied or very close.

Best of blog for May

How much should you tell a therapist?

Are you Hyperthymic?

Why can’t we forget the painful past?

Posttraumatic Growth (PTG) vs. Posttraumatic Stress Disorder (PTSD)

Is it Complex Grief, Depression, or Bereavement?

The best of blog all-time posts are

How much should you tell a therapist?

How does therapy help people?

Are you Hyperthymic?

Why can’t we forget the painful past?

Grandma is the drug connect

To date, there have been readers in over fifty countries. Thanks to all of you. Stay tuned for more to come.

Till next time, David Miller, LMFT, LPCC saying “Hope you are having the happy life you deserve.”

LPC or LPCC? – Brief news update – plus the LPCC gap exam

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Is there a difference between LPC’s and LPCC’s and if so what is that difference, and how hard is the gap exam?

There have been several web searches on this topic and a couple of emails so now might be a good time to explain this. This question primarily applies to California clients and professionals.

Mental health practitioners in California are regulated by the California Board of Behavioral Sciences (BBS). They administer the laws passed by the California legislature and their rules and regulations. A recent news update from CALPCC explained the sudden appearance of multiple sets of initials for mental health clinicians.

The difference between LPC’s and LPCC’s has to do with the BBS computer system not any difference in the licenses or qualifications.

The BBS computer program only allows for three initials in front of the license number no matter what the designation of the practitioner. The correct designations are:

Licensed Professional Clinical Counselors are designated LPCC’s. Their license number begins with LPC.

Licensed Clinical Social workers are designated LCSW’s. Their license begins with LCS.

Licensed Marriage and Family Therapists are called LMFT’s. Their license number begins with MFC.

MFC is a throwback to the days when they (we) were called Marriage, Family, and Child Counselors. MFT’s are the same thing as LMFT’s since you can’t call yourself an MFT unless you are licensed. Marriage and family therapy interns and trainees should be identified as MFT interns and MFT trainees – NOT MFTI or MFTT. Both of these groups are working under the supervision of a licensed clinician.

How hard is the LPCC gap exam?

People have been asking “How hard is the LPCC gap exam?” Personally, I would say based on my experience – well that depends on whether or not you knew the answers. Since the exam is only on the differences between LCSW, LMFT, and LPCC’s, there is a lot of material to cover in a very few questions. If you graduated recently or have been studying LPCC material since graduation you should be in good shape. Some of the material was very specific so if your school covered if you were in luck. If your particular instructor did not cover an item it would have been hard to know what to study.

I would recommend a review course, though it is early for the review classes to know what to teach you. Also, study anything in the BBS booklet that looks unfamiliar. The wider your knowledge base the better you should do.

Hope this helps explain LPC’s, LPCC’s, and the gap exam.

Update on the gap exam and the changes in initials.

The period for grandfathering in as an LPCC has come and gone. No more Gap exam. Also, the new computer system fixed the initial problems. My most recent license renewal shows my licenses as LPCC and LMFT.

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

Does abuse of seniors and the disabled get reported?

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

Older people

Elderly couple.
Photo courtesy of Pixabay.com

Reporting abuse of a senior citizen or a disabled person.

Most people are well aware that child abuse and neglect get reported, but reporting abuse of other vulnerable people gets forgotten. This is a legal and an ethical question. For legal advice please consult with a lawyer or your local statue. There are lots of ifs, and’s and exceptions here. I will keep this simple.

From a California LPCC and LMFT’s point of view here are some things to think about. Every two years when we renew our licenses we have to take a refresher course on Law and Ethics, so we stay up to date and don’t forget things we are required to do. Sometimes we need to check out the fine points of the law also.

There are two types of report categories, mandatory and permitted and then there are categories of victims of abuse, children, seniors, and the disabled.

Mandated Reports.

In most places, there are groups of people called “mandated reporters.” These are people who work with a vulnerable group of people, may learn about abuse or neglect, and are required by law and ethical codes to report abuse and neglect.

In California, mental health professionals (LMFT’s LPCC’s, LCSW’s, etc.) are mandated reporters. In short, if we know or should know about some abuse or neglect, we have no choice, we have to make the call and report this.

This does not mean that we go around the neighborhood looking over fences for a crime. Mental health professionals are not the police. We don’t report crimes and as a rule, are required to keep anything the client says confidential EXCEPT that abuse and neglect stuff.

But if while doing therapy, we are told about abuse or neglect we can’t let that go. We have to make this report.

There are some iffy areas here that can vary from place to place and are open to interpretations. Cruelty to animals and domestic violence are deplorable but most of the time this does not trigger mandatory reports. Some agencies would like to expand the number of things we have to report but if the list swells beyond what is absolutely needed it keeps people from coming to their therapist and telling them things that they need help with.

Because we have to make this report and others, we are supposed to inform our clients of the things that we must report. This along with fees and other stuff like that is called “informed consent.” You can’t very well consent if you have not been informed, can you?  Remember in most counseling settings, the abuse gets reported, like it or not and neither you nor the counselor has a choice in this.

Permitted reports.

Any member of the public can report abuse at any time. Permitted reports can be anonymous. The reporting person is supposed to be kept confidential but sometimes people do things they are not supposed to do like tell the person involved who reported them.

My understanding of this is – if I am a mandated reporter, I can’t make an anonymous report. Some of my colleagues have argued with me about this. But the first thing they ask me on the phone is “are you a mandated reporter?” Once I say yes I can’t very well try to make an anonymous report. Besides if I am required to do this I want a record that I did it. It took a lot of work to get these licenses and I want to keep them.

One difference between mandated and permitted reports may be that mandated reporters have lots of protection if they make a report, whether it turns out to be true or not. We don’t investigate people. We report it once and unless we learn more down the road we are done.

People who make Permitted reports get in a lot of trouble for making too many unsubstantiated reports. In divorce cases, there is this temptation to think your ex should never be allowed to see these kids again. He cheated on you, right? Cheating on a spouse is most likely not abuse of the child. If you make daily reports on your ex, pretty soon the authorities stop listening to you and they may even come after you for false reporting.

So the people who might get abused or neglected are Children, the elderly (seniors), and the disabled.

Child abuse and neglect are the most common by far.

Remember abuse is really bad stuff, not just stuff we don’t like such as strict parents. Lots of parents want their 17-year-old daughter’s 18-year-old boyfriend arrested for them having sex. That may be statutory rape, a crime, but it is not generally child sexual abuse. Counselors don’t report crimes they report abuse or neglect, which just happens to be a crime also.

If that 18-year-old boy is having sex with your eleven-year-old daughter that is pretty much child sexual abuse everywhere and that will get reported to the proper authorities in a heartbeat.

Abuse or neglect of Senior citizens and the disabled are also reported.

It is probably a mandated report if you are a mandated reporter. For sure it is here in California. These are classes of people who because of their age or disability cannot fully take care of and or protect themselves. Society steps in to take care of them.

Besides the types of abuse that apply to children, another type of abuse is common when it comes to the elderly and the disabled, financial abuse.

Now some seniors choose to have relatives live with them or give those relatives gifts. But if that other person does not care for the elderly person and bullies them or cheats them out of the money then it may be a crime. It may also be elder or disabled person abuse.

One warning here

Some people come to therapists and tell us tales of people being abused but they don’t want to get involved or make the report. All that second-hand information may not meet the criteria for a “mandated report.”  Calling a therapist to tell them about your suspicions will not help the person. The therapist can’t go out and investigate. If you think someone is being abused, you should be the one making the report.

Hope this helped to get you thinking about the problem of abuse and neglect in our society and the role of the mandated reporter and the possibility that abuse and neglect could include senior citizens and the disabled.

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

Therapist, Counselor or Social Worker?

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

LPCC, LMFT, or Social Worker?

Recently a number of people have asked me about the different mental health professions and which they should go to see. Students in my Substance Abuse Counseling classes also ask me about which career they should pursue. It might be helpful to talk about where these professions came from, what they do, and why you would choose to see or become one of these professionals. Many professionals in these fields are in recovery also and they often make excellent helpers.

Here is a brief explanation of my point of view on the subject. Remember that I am licensed as both a Licensed Professional Clinical Counselor (LPCC) and a Licensed Marriage and Family Therapist (LMFT), have taken classes in the Psychology Doctorate program but am a long way from finishing that one and that these are just my opinions.

The titles and what they are allowed to do depend on your jurisdiction.

California was the last of the 50 United States of America (North America) to license Professional Clinical Counselors. Substance abuse counselors in California are registered or certified not licensed and in some states, there are no requirements other than getting hired to do the work. Educational requirements and licensing rules can vary widely and have changed over the years.

These titles and what they may legally do vary from place to place. Check with your appropriate state or national agency to see what the regulations are in your location. Consumer protection agencies can sometimes tell you what the rules are in your locality.

Licenses, Job titles, and Educational degrees are not the same things.

Agencies hire people to work in a particular field. Not everyone who works in a social work agency has either an educational degree or a license in social work. Someone who processes welfare applications or inspects homes for child abuse or neglect may be called a social worker. Sometimes these workers have a degree in the field but not always. This depends on the rules of this agency.

If you are looking for work and have not yet finished your education there are far more entry-level positions for doing social work than any other of the behavioral health professions. There are two-year degrees (AA or AS) in social work and Substance abuse counseling but not much else in the Mental Health field. There are also many social work bachelor degrees that qualify you to work in the field but not to be a clinical social worker.

There is a large difference between a “social worker,” someone with a master’s degree in social work (MSW) and a Licensed Clinical Social Worker (LCSW.) To be an LCSW you would need to complete a master’s degree, complete a number of hours of supervised experience, and pass a test. LCSW’s spend a lot more time working with clients and some specialize in therapy around certain issues, such as foster family and abused or neglected children.

All of the licensed professions also have beginner categories of learners who are being trained and supervised by licensed people.

So what are the primary types of behavior health specialists?

They would be Social Workers, Marriage and Family Therapists, Clinical Counselors, psychologists, and Psychiatrists. Here is my oversimplified description of what each profession does. Let’s take a short look at a scenario that might show us how all these professions may interact with one family.

Police are called to the home where a domestic disturbance is in progress. The adults are both drunk and they are fighting. The kids are scared and under the bed. Parents are out of work and about to be evicted. Mom has a history of depression. Both parents are yelling about wanting a divorce.

So what does each profession do?

Social Workers (LCSW’s or beginners are called ASW)

They might be called to the scene. They will evaluate the home and maybe take the children into custody and place them in foster care. Once the parents are released from jail for the domestic violence charges the social worker might meet with the mother, get her in a battered woman’s shelter, arrange for both adults to attend substance abuse treatment, and enroll them in domestic violence counseling. A Licensed Clinical Social Worker could be assigned to work with the children to see if they have PTSD and need treatment for the effects of living in a violent home.

While an LCSW may do long-term therapy, they are specially trained in policy and referrals. They are likely to be running programs, deciding to leave the kids, or take them and making referrals to long-term treatment.

DV and substance abuse counselors

These professionals often have a short-term, two-year, or less training in their specialty. They are limited to working on one problem only and most often they must work for a licensed agency or under the supervision of a licensed person.

Parents may be required to complete a Substance abuse program and or Domestic Violence or anger management groups before the kids are returned to the home.

Once the parents stop drinking and they have learned how to control their anger, or not get angry in the first place they may decide to try to get back together.

Marriage and Family Therapists

Marriage and Family Therapists (LMFT’s, or MFT’s if they are licensed and beginners are called MFT interns or MFT trainees.)

MFT’s work from a systems approach that says that all humans have relationships and relationships are like dances. If one person changes, the others may change, and then the dance changes. So they would with couples or families on better communication and having a good relationship.  They most often work with the couple or the whole family at once. If they work with one person it is most often about that client’s learning skills to improve their relationship.

They might also have to tackle working with mom on how her depression or dad’s unemployment is affecting the kids and the family.

All the Marriage and Family Therapist programs I know of are 45-60 unit masters degrees. MFT’s often have bachelor’s degrees in all sorts of things unrelated to therapy. They frequently have had some life experiences that pointed them in this direction.

Professional Clinical Counselors (LPC or LPCC in California)

These counselors are specifically trained in mental health and problems solving. They might work with mom on changing her long-standing depression or they might work with dad on how to find a new job.

Should the marriage counseling fail they might also work on meditation and working out custody arraignments.

These three professions, LMFT, LCSW, and LPCC despite having differences in training may do very similar things. Beyond the basic degree or license, they are required to take continuing education classes each year. Some professional counselors or therapists specialize in a particular issue, some are generalists. If clients only had one problem we could all get really specialized but most people have multiple problems and so over time a counselor learns to work with clients on many issues.

Psychiatrists.

Psychiatrists are medical doctors with additional training in psychiatric medicines. Child Psychiatrists are even more specialized and unfortunately, there are never enough of these professionals. Because of the high demand for their services they are very busy. Most psychiatrists see clients for an initial “assessment” which is a medical assessment and very different from the counseling assessments we therapists do. After that first appointment, most psychiatrists will be seeing clients for a ten to fifteen-minute med check appointment every month or even every few months. They are looking for side effects of the medication and to see if they need to change meds or doses.

Psychiatrists generally do not have the time to spend talking with clients that are required for therapy. Most often they oversee the meds and refer the clients to see a counselor or therapist to work on the thought and behavior parts of the problem.

In our example of the couple above, the Social worker, therapist or counselor might refer the mother to a psychiatrist if the depression was severe. Some clients are so affected by their disorder that they can’t benefit from therapy until they are on medication. Some conditions are the result of changes in the brain and that person may need medication for the rest of their life. Meds may stabilize them but they will often need counseling for other problems like relationships and careers.

Psychologists.

This is a doctor’s level degree. I completed 6 units in this program before deciding that I did not have time for another degree and license. What their training appears to be directed towards are long-term problems. They can spend a lot of time studying, testing, and personality structure.

Many psychologists work with clients over the long-term on problems that are slow to change. They are also likely to be called upon to do evaluations for court or disability insurance.

In the example of the couple above the man might be court-ordered to see a psychiatrist who will determine if he should be allowed back around the family. The wife might be evaluated if she puts in for long-term disability saying she is so depressed or traumatized that she is unable to work.

So there you have it, a brief oversimplified outline of what the larger professions in the mental health field do. Whether you are a client or an aspiring professional you need to pick the profession that will be a good fit for you.

Licensed Professional Clinical Counselor (LPCC), Marriage and Family Therapists (LMFT), Social Workers, Psychiatrists, and Psychologists which is the right fit for you?

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

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For videos, see: Counselorssoapbox YouTube Video Channel

Licensed Professional Clinical Counselors (LPCC) Update

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

More about LPCC’s and LMFT’s.

Interest in California’s Licensed Professional Clinical Counselor (LPCC) program is noticeable on the Web. I was surprised that a couple of short, mostly personal posts about the LPCC license received as many hits as they did. I realize now that I also forgot to mention CALPCC, the organization for LPCC’s. Briefly, this is a counseling specialty that is now licensed in all 50 states. Surprisingly enough California was the last of the 50 U. S. States to license LPCC’s.

Had this been an option when I enrolled in my degree program, it is the one I would have chosen. I am glad that I took the training as a Marriage and Family Therapist now that I have done it. But now that LPCC’s are licensed I completed my original plan and took that exam and became licensed as an LPCC also.

The posts about LPCC’s can be found at LPCC exam is behind me!

Licensed Professional Clinical Counselors (LPCC) in California

Some of the searches were about study courses for the exam and about pass rates. Since my license issued 4/17/2012 is number 15, it would appear that so far about one person per week is getting through the Gap exam which is being given to LMFT’s and LCSW’s who chose to test for the LPCC license also.

I feel sure that there will be study classes for this exam offered by the same companies that offer study classes for the LMFT and LCSW exams. Only time will tell how useful those classes will be.

For more information on the California, LPCC license check out the information at the Board of Behavioral Sciences website.

LMFT’s who are choosing to take the gap exam and become licensed as both MFT’s and LPCC’s should already know about the California Association of Marriage and Family Therapists – CAMFT

For information on CALPCC – the organization for LPCC’s see:

Questions and comments about Counseling, Therapy, LMFT’s, LPCC’s and recovery and resiliency are always welcome.

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