Category Archives: Counseling and Therapy

Who should treat mental illness?

Posted on by
1

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

Who should treat mental illness, where, and how should it be treated?

The mental health field is changing. A host of events and forces have intersected to influence our feelings on the proper response of society to this thing we are calling mental illness. Lots of things are happening or about to happen in this mental health field.

Here in America, the very ground underneath mental health treatment is moving.

In 1900, here in America, less than 10% of doctors had ever been to college. Until 1914 drugs were legal and you could openly buy them anywhere. As late as 1950 there were no meds to treat mental illness and those who were given a diagnosis could be tucked away first in barns and attics and later in sanitariums.

The talk therapies are just past their hundredth birthday and many people have still never been to see a therapist. Three months ago more Americans were without health care than there were those who had coverage. The few who did have health insurance here in America did not have coverage for mental illness or substance abuse. Treatment of these disorders while improving is still not on an even footing with most physical illnesses.

Less than a year ago the American Psychiatric Association released the new DSM-5 which redefined, reclassified, and altered our understanding of what is and is not a mental, emotional, or behavioral disorder. The new version of the International Classification of Diseases is due out soon which will change the field of treating mental health problems also.

This alteration in the landscape of the treatment of mental disorders is not solely confined to the United States of America. Blog readers and commenters from all over the world are asking similar questions and telling similar stories of their efforts to recover from an emotional or mental problem. They are also telling tales of less than helpful services.

The very mention of mental illness can evoke some pretty strong emotions. Some cultures, religions, and even professions still are denying the existence of such a thing as a Mental Illness.

People leave comments and they send me emails. The comments of every reader of counselorssoapbox.com are valued. Some of them I answer briefly as soon as I can. Others require longer blog posts to give them the space they call for. A few are so angry or personal I have hesitated to approve them.

Some of you have left comments or sent me emails about how we are doing things here in America and how that might differ from the way things are done in other places. I have been having an interesting ongoing conversation with Ellen in the U. K. about how they do things there. I will fill you all in on that discussion as soon as possible.

Let me offer this invitation to all of you out there to share your experiences and how the mental health delivery system works in your part of our planet. I will share my clearly limited perspective from here in Fresno, California, one of the more diverse places in this United States of America. I feel sure the view of the mental health landscape will look a lot different from other points of view.

We should be talking about how we have been treating mental illness, how we should be treating it, and how we get from where we are to where we need to be.

That discussion also implies some understanding of what “mental illness” is and how people develop a mental disorder. What a mental illness is, implies a view of what causes it, how it progresses, how to treat it. The view you take of this phenomenon also influences your view of the possibility it could be cured and if so how.

Knowing what mental illness is and what needs to be done about this leads us to the answer to my first question about who should be treating this problem.

We also have the added problem that no matter how sure we are of causes and treatments we need to know who is going to pay for these efforts. How treatment is delivered is strongly controlled by those who handle the money.

Let’s take a look at some of these questions and together see if we can find some solutions.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What is a Licensed Counselor?

Posted on by
2

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

Therapist

Counselor. 
Photo courtesy of Pixabay.com

What is a Licensed Counselor?

I wrote this in response to a question from U. K. on how our mental health system works. It has since occurred to me that one major difference between the U. S. system and those in other countries is the funding source. When you have a national health care system most of the expenditures are paid for by the government so if you get on the list and can provide services or you work for the government you get paid. The government can have some amount of control over quality.

Here in the U. S. most service is paid for by the individual directly or indirectly through the purchase of insurance. No money or insurance and you may get no services. This requires the government to regulate who can open an office and then sell medical or psychological services.

We have a licensing system for most professions so that just anyone does not open up an office and then start doing surgeries that kill people before they get sued and have to stop. The point of licensing is to control entry into a profession and ensure some minimum level of consumer protection.

Here then is the somewhat edited version of my reply to her question about how we do things in the American Mental health system.

Thanks for the comment. Interesting question. It had not occurred to me that there might be such differences in the U.K. Now I am thinking that given the number of readers of counselorssoapbox.com from countries other than the U. S. I need to say more.

Most of this has to do with our legal and governmental system. Not being either a lawyer or a politician. (We do not have separate Barristers and Solicitors but combined most of what they do into one group – lawyers who are also called Attorneys, and sometimes counselors in the sense of legal counselors.)

This whole area is a bit complicated.

Regulation of professions is left to what we call states. Each of the 50 states may have their own law or some may not require a license to practice a particular profession. So in one of our states if you graduate from a school with a degree in counseling you may be able to open an office and charge people for counseling. In another, there may be strict regulations on the quality of your degree, your internship, and your experience under another professional before you can get a license. If a state has high standards other states may accept that license. People who come from states with no or low standards will find that if they move to a state with high standards their background may not allow them to practice that profession. For example, if you become a doctor in a third world country many U. S. states will require that person to do more work and take more tests before they can become a doctor in that state. The big states like New York and California generally have the highest standards.

(With the health care expansion this year the ability to bill federal programs may alter this thinking a bit.)

In California, we have 29 separate codes and the one of those that regulate counselors and other professionals is called the “Business and Professions Code (BPC.)”

In the BPC there are sections for each regulated profession. Contractors have a section, hairdressers, and so on. Doctors and nurses have their own sections also.

In the mental health field in California, we recognize a number of professions.

Psychiatrists are licensed as Medical Doctors.

Psychologists are licensed by the board of psychology

The Department of Health Care Services, Alcohol and Drug Programs licenses drug and alcohol programs but not drug counselors. So the programs have a set of standards on who they can hire.

The Board of Behavioral Sciences licenses Clinical Social Workers, Marriage and Family Therapists, and Professional Clinical Counselors.

Without a state-issued license, you may not practice a profession except in a few places specifically listed in the law as “exempt settings.”  (Schools can hire school counselors who do not have to be licensed.)

The goal of this procedure is to protect the public from people who do not have the training and skills doing work that might harm or cheat the client. This process also gives clients some redress for wrongs short of a suit in court.

The law sets out the specific things you need to do to be issued a license. And each profession has their separate list of the things they can do and the requirements to qualify to do those things.

For example:

A Professional Clinical Counselor would need to possess a Bachelor’s degree (4 years), in almost any subject, or take some remedial classes called prerequisites, to enter a master’s in counseling program. They would then need to complete and graduate from an accredited or approved Master’s program (5th and 6th-year college.)

After graduation, that person must register with the Board of Behavioral Science (BBS) who evaluated the education they have, and if it meets the board’s requirement the candidate receives an intern number.

From this point on the prospective counselor is required to be supervised by a licensed person until they receive their own license.

They must accumulate a total of 3,000 hours of supervised experience.  There are some complicated rules on what counts and what doesn’t count and how much supervision they need for each hour of client contact.

When they have accumulated those supervised hours, the applicant submits the paperwork to BBS and if this is approved they are eligible to test. In my own experience, I took first a long test on specific questions to show that I understood the process of doing therapy, the laws and the ethics, and so on. If you pass that first test you then return for a second test in which you are given stories (vignettes) and you apply your knowledge to answer questions about Howe you would work with these people.

If you pass both tests you are then sent an application for a license.

At each step of this process, you pay a fee for BBS to handle your paperwork.

Once you send in your approved application and pay the fee, if all has gone well you will be issued a license to practice Professional Clinical Counseling in California. You can then work for someone else or open your own office.

But it does not end there

Every two years you will need to complete a certain number of approved continuing education classes, and pay a fee to renew your license.

After the first two years of being licensed, you can take a class, and then you are eligible to begin supervising newly registered people.

So do things operate differently in the area in which you reside?

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

Looking for the instant cure.

Posted on by
Reply

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

Road

Road to a happy life.
Photo courtesy of Pixabay.com

Beware the promise of one and only one way to recover.

There have been a whole bunch of comments and posts recently telling us that Mental Illness and addiction are not illnesses because there is no “cure” for them. People have also left comments on some of my posts that suggest that their particular webinar or training program can cure people. There is, on the internet, always a host of posts suggesting that modern science is a fraud and that you need to adopt their particular brand of religion.

Most of these pieces contain some truth. Just enough to make them dangerous. There are also a lot of attacks on doctors, mental health programs, and most anyone who does not agree with the poster.

These comments also have included a number who report that their spouses were cheating and then they visited a particular fortune-teller or voodoo practitioner who put a spell on their wandering partner who is now all attentive and faithful. These instant cures often come with a hefty price tag. I routinely delete these comments. If you want spells there are places you can google to find them but this blog is not the place for that.

I know I opened the door on the religious posters by letting on that those clients who believe something do better in treatment. I support people’s need to have some belief system about right and wrong but there are a lot of distortions in some of these posts that are pushing their particular group as the one and only true way.

In the interest of promoting interaction and free speech, I try to approve as many comments as possible as long as those who get approved do not abuse the comment process.

Here are some of the main logical fallacies and factual errors to watch out for.

1. Confusing religiosity with religious faith.

We see a lot of people with a history of a mental or emotional illness who suddenly become fervent devotees of a particular religion. I am not talking here about a conversion experience and then being observant in practicing that religion.

Excessive religiosity includes joining small sects who have different divergent beliefs. Then the new convert, in an effort to convince themselves, becomes an ardent missionary to spread this faith. They spread this new religion mostly by insisting that anyone who does not agree with them is evil and needs to be attacked and punished.

Sometimes these progress to the level of distortions and invalidation anything that does not agree with their conception of reality.

One commenter reported that members of his faith, he reports being Christian, were not terrorists and do not kill people. This leaves him with the problem of explaining away the time’s people have died at the hands of people who said they were Christians in religiously motivated wars.

The easy but untruthful response to this dilemma is to say that those people were not “real Christians.” Pretty soon everyone who disagrees with this person is not a “real” Christian and whatever he says is the only truth.

This line of reasoning has also been applied to people with divergent political views who then get described as “not real Americans” etc.

A more honest answer is that people of any and all religions have been known to do things that fall short of their ideals. Good people sometimes do bad things and bad people sometimes do good things. The world is not all black and white. It also includes green and purple.

When your religion becomes mostly about forms and less about positive values you are headed in a dangerous direction.

I enjoy hearing people tell me that their faith in their higher power has improved their life. I do not enjoy reading attacks on people of other faiths in the name of spreading the truth.

2. When I say —– (word x) I mean.

Words are the way we communicate. If someone creates their own unique meaning for a word and does not let the rest of us in on that, they are off base. Use either one of the dictionary definitions, the connotative meaning that most of us understand, or create a new word to describe what you are talking about, but do not redefine existing words.

3. Defining away the problem.

One poster said Mental Illness is not a disease because doctors can not cure it and went on to say when I say – I mean. Sorry but most illnesses are not cured. Chronic illnesses like Diabetes, High Blood pressure, congestive heart failure, and so on are controlled not cured. That does not invalidate them as illnesses.

This is confusing illness with infection. If there are bacteria causing the illness it may be possible to kill all those bacteria and “cure” you of that infection. You could however still have an illness from the damage that this bacteria has done.

Just because something is missing one particular feature does not make the whole condition go away.

Just some quick thoughts. I have approved as many comments as possible. Those who contribute to the solutions are welcome. Those who spread the problems and sneak in spam or commercial pitches get deleted or banned as best I can.

I know of no one way to get an instant cure but I believe strongly that people can and do recover and that there are many ways to achieve that recovery.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Do counselors have to follow ethical codes?

Posted on by
10

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

If a therapist does not belong to a professional group do they have to follow an ethics code?

There are a lot of rules about the relationships between a client and the treating professional. There are things that the professional can do, can’t do, has to do and is required to not do. Sometimes these rules get confusing for the professional as well as the client.

Recently a situation came up in which a professional was not a member of any professional organization, so the client left that visit with the impression that this professional did not need to follow any ethics code. This report of a problem left me thinking we need to talk about some of these codes of ethics and why a professional would need to follow them and what happens if they do not belong to any organization.

Turns out there may well be a time when a mental health professional needs to follow the standards of a code of ethics even if they chose to not belong to the professional organization. More on that later in this post.

To be a mental health professional you need a license in the jurisdiction in which you intend to practice your trade. Joining a professional organization does not allow you to practice this profession. So while all professionals are encouraged to join a professional group some choose not to be members.

Here in the United States of America, the various states license the various mental health professions. Not all states license the same professions. There can be states that allow a particular profession to practice even if they do not issue a license to that profession. For example “Life Coaches” are not licensed anywhere I know. They can do all sorts of coaching on how to have a better life. What a Life coach should not do is treat a person for a mental illness if the state in which they are practicing requires that license.

This situation of when and how to follow a code of ethics is made more complicated by the multiplicity of professions and professional licenses. There are Licensed Social Workers (LCSW’s and ASW’s), Licensed Professional Clinical Counselors (LPCC’s and PCCI’s), Licensed Marriage and Family Therapists (LMFT, MFT, and MFT interns.)

Here in California, we make it even more complicated with 9 or so different registries for Registered or Certified Substance Abuse or Drug and Alcohol Counselors, each of which presumably has their own code of ethics. Here is the code of ethics for CAADE, the program in which I teach is CAADE accredited.

Recently all these registries came together to create a Uniform Code of Conduct” for California’s substance abuse counselors.

The code of ethics varies depending on your profession and the particular organization you belong to. So someone could belong to several organizations (I do), one organization or no organizations.

What if there are contradictions between the various codes of ethics? What if the professional decides to not join any group to avoid having to worry about ethical behavior? We have come up with some principles to handle those situations.

California was the last state to grant licenses to Professional Clinical Counselors. Most Licensed Professional Clinical Counselors (LPCC’s) belong to CALPCC. The exact name of the counseling professional and the specifics of what they do can vary from state to state. Many California Counselors may also be members of the American Counseling Association (ACA.) In this case, the problem was easily solved. CALPCC adopted the ACA code of ethics.  

California was the first state to licensed Marriage and Family Therapists (originally called Marriage, Family, and Child Counselors.) There are more MFT’s in California that the rest of the country combined. (LMFT, MFT, MFCC are all the same thing.)

The California Association for MFT’s (CAMFT), which has members from a bunch of other states and even some other countries, is larger, so I am told, than the American Association of Marriage and Family Therapists (AAMFT.) Both of these groups have their own codes of ethics.

The Social Workers, mostly belong to the National Association of Social Workers (NASW), which has its own code of ethics.

So now we can look at problems with which code to follow if you are members of more than one group, and what happens if the counselor tries to duck ethical behavior by not being a member of any association.

Let’s use an easy to understand example for this.

Can a counselor date and have sex with a client? If so how long do they have to wait to do the dating-sex thing?

For starters no behavioral health profession I know of thinks it is ok to have sex with a current client. That is taking advantage of a weak person and frankly sounds predatory.

The rule for substance abuse counselors is that they must wait 3 years after the client stops attending their PROGRAM (not just after no longer being their client) before they can date that former client.

Now, this substance abuse counselor decides to go on and become a professional counselor, and while in school they join a professional counseling association. The norm in these groups is that you have to wait 5 years before dating a former client.

Now say this same person decides to become a Licensed Social Worker. The rule for the NASW is the professional may NEVER get sexually involved with a former client.

So which waiting period does this person need to observe 3 years, 5 years, or never?

The rule is that you observe whichever code of ethics has a HIGHER ethical requirement. So, in this case, the answer to how long to wait would be forever.

Can this person get out of this bind by not being a member of the Social Workers Association?

Not really.

Most licensing laws require the professional to follow the customary ethics of the profession whether the professional is a member of that group or not. See if most other professionals think it is unethical then that behavior is probably illegal also.

Even if that behavior, dating or some other “dual relationship” is not outright illegal, should the professional get into that sexual relationship and then break up with that former client, they might get sued and in that case, code of ethics or not, the former client will probably win.

So the bottom line is that professionals should always adhere to the highest possible standard of ethical behavior whether they are members of a group or not.

Just not belong to a professional group does not allow you to do things the rest of the profession thinks are unethical.

Hope that helped explain this ethical issues problem. If you are not sure, you may need to contact the appropriate professional association and remember the client should be contacting an attorney or making a complaint to the appropriate licensing board if they think the professional harmed them.

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

Internet Counseling?

Posted on by
3

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

Computer

Internet.
Photo courtesy of Pixabay.com

Update – 2020.
This post was originally written in 2014. My how things have changed. The COVID pandemic has forced counselors, therapists, and educators to rethink the way we do things. In the beginning, there was a lot of resistance to working online. But when forced to do so each of these professions has developed new methods for working in a different way. Below is the post as originally written in 2014. In the near future, I will be publishing some new posts about the changes that have come about as a result of working online.

Can you get counseling or therapy while sitting at home?

There are still some big ifs, and’s, and but’s about internet or remote distance counseling. I can see some good points in favor of this approach. There is also some serious buyer beware issues.

The Internet is a new technology and so far most mental health professionals have been reluctant to adopt this one. There are some serious concerns on the part of licensing boards and professional associations about the ethics and the safety of this method.

The mental health profession has come a long way from the days when the client lay on the couch and the therapist sat behind them. In the old model, the client talked and the therapist listened. Sometimes the professional said a lot of “Um-hu’s” and “I see’s” and spent the rest of the time doodling on a pad and daydreaming. The belief was that the client if they talked long enough, might figure out the solution to why they were having this difficulty and what they should do.

This approach also presupposes that most of your problems are left over unfinished business from childhood.

Nowadays most counseling is a lot more active and focused than the old psychoanalytic model. We do more direct interventions and we have more responsibilities to keep the client and the public safe than ever before.

The preferred way to do internet counseling is via a program that lets both people see each other and talk in real-time. Emailing questions or comments is more like advice-giving. I try to answer readers’ questions on this blog in general ways but this is not therapy and is no substitute for actually sitting down and doing therapy.

Professionals who communicate with clients via emails and texts primarily use this to set appointments and confirm or change times not for doing therapy.

So is remote or internet counseling safe and is it good for the client, the professional, and the public?

Let’s look at some of the pros and cons.

Pros of distance counseling.

Internet counseling can bring help to those who live in remote areas, can’t get out of the house for physical or mental health reasons, and who just find it more convenient to seek therapy from home.

Studies suggest that distance counseling can be as effective as in-person therapy and it can be available at all sorts of times and places when a counselor might otherwise not be available.

Cons of distance counseling.

Much of what is communicated is non-verbal. From a distance, a counselor can miss those other body language messages. Some of what we do is point out the discrepancies between what the client is saying and what their body language tells us. Can’t do that if you can’t see them. Also, the tone of voice can be distorted or unrealistic over the distance.

In-person counselors work in the area you live in. That means that if they do something wrong you know who to complain to. Here in California, we are licensed by the California Board of Behavioral Sciences. That means we should be working with clients from California and only those from California unless we have a license from another state.

Where exactly does that person who is doing your internet counseling located? Do they have a license in your state, in another state, or anywhere for that matter?

What if you are feeling suicidal or if the client we are talking to is thinking about killing someone? If you are in an office we can make some calls and get you into a hospital or get you to a place that keeps you or the person that this client intends to kill safe?

What happens to the suicidal client if your therapist is on the internet from another country? What if they have little or no training and just decided online therapy was a way to make a lot of money?

Some state codes and some ethical guidelines require the professional who does over the internet counseling to meet with you at least once in a face to face session to make sure that they really know who you are and you can see and sign all the required forms.

If this internet counseling is arranged by a third-party, doctor, nurse, or rural government agency, that first visit may need to be conducted at one of their offices.

Information sent over the internet can be a lot less secure than the confidential setting in a therapist’s office. Make sure you understand the steps that the professional is taking to make sure your sessions stay confidential.

Right now there is a problem with those calling themselves “coaches.”  In most places, there are no licenses required to become a coach. Some “life coaches” have taken a couple of hour class on the internet on how to make money being a coach. Others may have taken much longer trainings in how to be a good coach.

What very few coaches have done is taken the training needed to work with people who have a mental, emotional, or behavioral disorder.

Here are some rules for picking a professional if you decide to work with them over the internet.

1. Make sure the person you are working with is a mental health professional who is licensed in your state.

2. Try to find someone who lives in the same part of the state you live in so that if you need to go see them at some point you can.

3. Plan to visit the counselor’s office at least once to get to know this person and to be sure this is the one you want to work with.

4. Discuss privacy concerns, confidentiality, prices, and so on.

This field is new and like any new technology, the specifics seem to be constantly changing. I expect there will be plenty of changes to this practice as well. Hope that sheds some light on the use of the internet to conduct remote or distance therapy.

Have any of you used the internet in this way? How did this work out for you? I would especially be interested in hearing from any professionals that are doing distance counseling.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What is a Therapists Scope?

Posted on by
3

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

Therapists and Counselors need to remember what is in and what is out of their “scope.”

In school, every beginning counselor is taught to pay attention to scope issues. It is not something that we talk to clients about very often. Somehow, a while out of school, a lot of professionals forget about this issue. One reason it is so hard to keep clear is that there are in fact two different “scopes.” Recently a reader commented about their therapist mentioning something as being out of their scope. That comment suggested this post.

Counselors need to remember both their scope of practice and their scope of competency.

1. Scope of practice.

Scope of practice is defined by the law in your jurisdiction. If you get an MFT license you are allowed to do some things, a Licensed Professional Counselor does certain things, an LCSW has their set of allowable things, and so on.

This gets confusing sometimes. We professionals know for example who can do certain kinds of testing and who cannot. The clients do not usually know this and may come to a professional for something that their license does not allow.

In cases like that, we should always refer clients to someone who can help.

A social work license does not allow you to cut hair, or do tax returns, for example. The Therapist or social worker may have been trained as a beautician before becoming a social worker and they may have done tax returns to help pay the cost of going to school, still that Behavioral Science license does not allow them to do those things with their therapy clients.

If a person has two different licenses, say they are lawyers and they are therapists, there are all sorts of rules about what they have to do to keep those two professions separate so as not to confuse clients as to what they are allowed to do and not do.

Every group has a code of ethics and that may influence what a professional does or does not do, but scope of practice is largely a legal issue defined by the law that permitted the licensing of that profession in the first place.

In a future post, I want to tell you about codes of ethics, who have to follow them, and why.

In many places, coaches are not licensed. That means that those who call themselves life coaches do not need to have had any training to do coaching. What the life coach should not do is treat a recognized illness like Major Depressive Disorder. They can help you with say “motivation.” But if you have low motivation because of your depression that is outside their “scope of practice.” They would need to have a license as a counselor, therapist, or social worker to treat a mental illness.

2. Scope of Competency.

To become a licensed counselor, social worker, or therapist there are certain classes everyone needs to take. The typical program at the master’s level would include about 60-semester college units. Some programs might go up to 65 units, some programs include only 45 units. Most classes are 3 units so that means about 20 classes. If they take a few 1 or 2 unit classes they might get up to say, 25 classes.

The beginning mental health professional would get a class in how to diagnose and a couple of classes in how to treat mental and emotional problems but with over 400 recognized mental, emotional, and behavioral issues in the DSM-4 no one ever gets much training in working with specific issues in their program.

For example, a substance abuse counselor in a two-year (A.S,) program would take 36 college units in drug abuse counseling. Most licensed people LMFT’s, LPCC’s and LCSW’s will get one to three units in Substance abuse.

So if you only had a one-unit class in counseling the drug dependent, say that was a one-unit class one weekend, that person would not feel very competent in working with someone with a drug problem.

Many of us had at most a few minute’s discussion of eating disorders. Dissociative Identity Disorder and Body Dysmorphic Disorder probably were not talked about at all in a therapist’s formal training.

So while a person may be licensed as a particular mental health professional they may realize that they just do not know enough about the disorder that the client has to be able to work effectively with that client.

We call this lack of skill in a particular disorder or technique something outside the therapist’s “Scope of competency.”

Most mental health professionals will find they do more studying, read more books, and attend more trainings after graduation than they have done in their master’s level training programs. If you do not continue to study and learn, more and more things will turn up that are outside your scope of competency.

There are ways to expand your scope of competency. Get more education and training in a particular disorder or technique, work with a supervisor or consultant who is knowledgeable in the area, and do more supervised experience in that area. Some professionals do all that and over time grow their scope of competency. Others may decide that they will restrict their practice to the problems they feel competent in working on.

So if you have a relatively common problem, say depression or excess anxiety, most professional counselors can help you. But if you have a more difficult problem, substance use disorder, eating disorders or many of the trauma-related disorders you may need to seek out someone who understands and knows more about your issue.

Hope that explains the very basics of scope of practice and scope of competency.

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

Internet affairs? Internet addiction?

Posted on by
1

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

Computer

Internet addiction.
Photo courtesy of Pixabay.com

Internet affairs? Internet addiction?

The internet is affecting a lot of real-life relationships. Today’s post over at our sister blog counselorfresno.com tells the story of three ways your internet usage may doom your other relationships.

Update – the article this post originally linked to no longer exists.
For more on this topic see the posts about Affairs.

Should your therapist tell you what to do?

Posted on by
5

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

Do therapists and counselors tell people what to do?

Most counselors and therapists will tell you that they do not, under any circumstances, tell clients what to do. Frankly, I think many of my colleagues are fooling themselves more than they are fooling their clients when they say that they do not tell clients what to do.

There are good reasons to tell someone to do things and there are also good reasons to not tell people what to do. This is especially true in something as close and confidential as the counseling relationship.

Clients have told me that they get very upset with their therapists either because the therapist keeps telling them to do something that is inconsistent with their goals and beliefs or because they ask the therapist what they should do and did not get an answer.

There are three questions to examine here. Why do therapists avoid telling clients what to do? Why after saying they would never do this do they then go ahead and try to influence the client’s behavior in more subtle ways, and lastly why counselors can and should tell clients what to do.

Two reasons why the therapist should avoid telling the client what to do.

The goal of counseling is to help clients learn to solve their own problems. Telling clients what to do “fosters dependence” meaning if we make the decisions for you then you do not learn to make them for yourself.

Rather than telling you what to do the counselor should be helping you learn about yourself, what are your values and goals, and then learn how to make the choices that are right for you, not the ones that are good for the therapist.

Second, it is your life, not ours. I do not want to tell someone to get married or divorced and then have to take the blame for things that turn out badly. We are not fortune tellers and do not know what the future holds. You need to pick the outcome that is best for you. While we may have opinions, they are our opinions.

How therapists try to tell you what to do anyway.

Therapists and counselors have opinions, often strong opinions about things. We see certain things as bad for you and other things as good. Not all professionals agree on which is which.

Some marriage therapists refer to themselves as “Gorilla divorce busters.” They believe that all marriages should be saved. So if you go to them for help, no matter how badly you feel in this relationship expect this professional to try to talk you into working on the relationship and out of getting a divorce.

Some therapists take a pro one gender stance. Lots of times this is a pro-feminist stance. They seem to always align with the woman. The message is the man is the problem, get rid of that guy and things will be better.

Personally, over time my position on these gender issues has changed. Most of the time it is neither person’s fault, and if they get divorced they will each be back with a new partner. Pick a partner and you pick a set of problems. So I encourage them to learn the skills they need for a good relationship and practice this with their current partner first.

I also recognize that sometimes even if both people change, the damage they did to each other may mean that they just can’t be together.

Personally, I have worked with so many people who have a substance use disorder that I tend to think most people need to give the drugs or alcohol up. If the couple has most of their fights while drinking I tend to think we need to talk about Alcohol abuse. If the client says they do not want to quit, I go with that. But next week when they get drunk and hit each other again I may ask about that drinking thing again.

I can think of a bunch of other issues that turn up in counseling that might prompt a counselor who has strong opinions to try to influence their client even after that professional says they never tell their clients what to do. Abortion, Homosexuality, and other sexual behaviors all may evoke that behavior in the therapist.

When should a counselor tell a client what to do?

I think, and I may well be in the minority on this, that there are times the counselor may need to tell the client what to do. I usually do this more in the way of providing information or making suggestions, but the point is clear that I think this is what the client should do.

When might a counselor do that? Mostly when I have some information that the client needs and the client does not have that information, some of this borders on social work. I do not do that but I do clinical counseling and there are similarities.

If the client does not have a job, I might do some testing, talk about their job history, and which was their favorite job, and then I might suggest some careers that would be good for the client. I might also suggest some websites to visit and some ways to revise their resume.

If the client is homeless I might suggest some places to go for housing. I might also revisit the drinking problems and suggest that if they stay sober their housing opportunities increase.

When doing Cognitive Behavioral therapy I may give homework. We sometimes call this “conducting behavioral experiments.” I ask the client to do something and then in the next session we talk about how that went. If they did not do the experiment we talk about what got in the way of doing this exercise.

Most of this “advice-giving” is done when the client is trying to adjust to a change in their life and they just do not know where to go or what to do. This “telling” also works best when it is done in the form of suggestions and the client is free to do or not do these things. Either way, I am willing to keep seeing the client and together we work on finding the solution to their problems that work best for them.

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

Is money keeping you from getting emotional help?

Posted on by
1

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

Cash

Money.
Photo courtesy of Pixabay.com

Is the cost keeping you from getting help?

No doubt that therapy does cost and it would be easy to tell yourself that you can’t afford it. Most people who do check it out find that the costs of therapy can be a lot less than they thought and that the cost of avoiding it can be way more than what the therapy would have cost in the first place.

You may be surprised to find how affordable some kinds of counseling can be. Going for therapy may actually be cheaper than not going. There are some ways to get the cost of seeing a therapist down in the same way you can shop for other things and find ways to save. More on that later.

Some hypothetical examples may help explain this cost versus benefits problem.

The cost of relationship counseling.

A couple is having problems in their relationship. They try to fix this by going on a few date nights.  She gets her hair done. He buys tickets to a show and they go to dinner. During the date night, they get into an argument and go home mad at each other. The fight carries over and neither gets much sleep. They have spent a lot of money and their relationship is in worse shape than before.

Note in this example that the hairdresser’s hourly rate may well be higher than the psychotherapists. The auto mechanic and the guy who does your taxes all charge as much or more than the therapist. Also, dinner and tickets will easily cost more than a visit to the therapist.

Another couple, same problem, went away for the weekend to the coast or it could be the casino. Someone drank too much or gambled too much, they fought and the result is a lot of money spent and no improvement in the relationship.

When you compare the cost of therapy with a lot of the ways couples go about avoiding therapy the avoidance is a lot more expensive.

This is not to mention that the hourly rate of the divorce and child custody lawyers will top all the other professionals I have mentioned so far.

Why then do people avoid the work of repairing relationships or themselves and then have to spend the large sums for lawyers to end these relationships?

Counseling for substance problems.

Seeing a professional to explore your drinking and other substance use problems, to see why you are overdoing things and reduce or quit that behavior is a whole lot cheaper than the cost of the DUI. But people put off the cost of repairing themselves or their relationship until they hit the wall and are required to do a program or go to counseling in order to avoid jail or loss of their children.

How might you make therapy more affordable?

Often seeing a counselor for psychotherapy costs a lot less than people think. The days of going to your analyst weekly for years have been replaced by a lot of counselors that do very brief therapy.

The average client going to a private therapist goes for about 6 sessions. The usual and customary rate for these sessions depends on the therapist and also on what they pay for their office and other expenses. I have seen figures from $50 per hour to $200 per hour.

Figure the middle figure ($100 per hour) and would it be worth $600 to repair your marriage, avoid a DUI, or keep your child from getting expelled from school?

But there may be a bargain in the making. Some of you have health insurance. The cost to you, if your plan covers your problem, will be a co-pay of say $20 per session. That brings the cost of the typical therapy program down to $120. That sounds doable for a lot more of you.

Under the new laws, this started way before the current Affordable Health Care Act (Obama Care), private insurance companies are supposed to provide the same benefits for mental health and substance abuse that they do for physical health coverage. This is referred to as Parity.

So in the future, more people are going to find that they can see a therapist at very little out-of-pocket costs if they are just willing to pick one that is on their insurance company’s in-network list. This means that the therapist has signed a contract with the insurance company to see their clients.

But there is more, therapy may be FREE!

Many of you will have an EAP (Employee Assistance Plan) at work. This plan probably includes seeing a therapist – for FREE! I am on some of these panels and I like doing this kind of work.

The client comes in for marriage counseling, anger issues, or substance abuse. The EAP usually has a checklist of what we are going to work on. The client gets 5-6 or 12 sessions at NO CHARGE! We agree upfront to try in those few sessions to find a way to reduce this client’s issues to a manageable level.

What if you have no job, no health insurance, and no EAP? Say you also know that you cannot pay $600 cash without giving up eating. This means that you have no extra money for hair appointments or trips and nights out. (Otherwise, we are talking about your priorities and that you don’t want to spend money on therapy not that you really can’t.)

There is a bunch of ways that you can get very low or no-cost counseling.

For more on those kinds of services see the counselorssoapbox post –

10 ways to get emotional help without money

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What will happen if I go for therapy?

Posted on by
Reply

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

Therapy

Therapy.
Photo courtesy of Pixabay.com

Therapy can be pretty scary if you don’t know what to expect.

Whether it is your first time seeing a therapist or just your first time seeing this particular one you are probably wondering what to expect. The process of seeking professional help for emotional, mental, or behavior problems can make you so anxious some people do not make it to the appointment. Some folks never make the call in the first place.

You probably have one set of concerns on your mind. You know why you are thinking about therapy or at least who told you to go for therapy. The therapist often does not know these things about you.

The therapist has a whole other set of worries on their mind. In the interest of demystifying the whole process, let me try to explain what is happening here and why. To do this we may need to do some head-hopping between your thoughts and what is going on in the therapist’s mind.

In larger practices, you may have to come in beforehand and fill out paperwork. That helps relieve some of the therapist’s anxieties but not yours. In smaller practices, this may all get done at the first visit.

The therapist will want to know who they are supposed to be treating. We call this the “unit of treatment.”

Sometimes the person in front of the therapist wants help for themselves. Sometimes they are here because a family member needs help or they need help coping with that other person. Just because a couple shows up does not mean they want marriage therapy. One may need help and the other is being supportive or they may need help telling the kids about the divorce.

So the therapist asks what brings you to therapy. Who will be receiving the counseling and what you want to accomplish by being in therapy?

Once the therapist knows who they are treating they need to go through a bunch of stuff we call “informed consent.” You may or may not care about this stuff but we care.

First, the therapist has to tell you about exceptions to confidentiality. Yes, therapists want to keep your secrets and most of the time most of them do. But there are those pesky exceptions to confidentiality, the things the law says the therapist is not allowed to keep to themselves.

Look back over the last year and the posts about exceptions to confidentiality and what secrets the therapist can and cannot keep are the perennial top read posts.  Shortlist is 1. Danger to self or suicidal, 2 Danger to others, homicidal 3 Gravely disabled, unable to feed and clothe yourself. 4. If you enter your mental status into the court record then the judge can order the therapist to testify about what you said. 5. If you sue the therapist and say they did a bad job, they get to show the judge and jury your record and what you said at the time.

The other thing the therapist is thinking about is how much will you be paying and who is paying the bill. By law, in most places, they must tell you if they take insurance or not and either way how much each session will cost you.

The next thing the therapist is likely to do is an “assessment” of some sort, they need to know what the problem is that they will be treating you for. This identified problem can change over time but your treatment should aim at changing something.

The client may come in saying they are having conflicts with their partner. Later in this first session, they might say they have an “anger management” problem. We want to know how bad that problem is and what might be causing it. In the course of the assessment, if they say that they and their partner fight a lot, the therapist wants to know if this is domestic violence. We also would be asking how much alcohol they drink and what drugs they use.

This is not about being judgmental. It is about seeing what the problems are and how it needs to be treated.

Therapists, especially those paid or reimbursed by insurance will also probably need to create a treatment plan for what they will do and how you and they will know if you are getting better.

Different schools of therapy may proceed differently through these items. Some therapists like to let you do most of the talking, to talk it out. They feel that you already know the answer but you have no one you trust to listen. Other professionals will be looking for things you need and make referrals. They may even give you homework assignments.

If you came in saying that the problem is you are depressed because of your poor relationship with your partner we probably will work on that for a while. Later on, you may find that this relationship is a copy of the one you had with your parents or your parents had with their partners. At that point, we might shift to working on things from childhood.  All the while, as the focus of the session shifts, the therapist is thinking and working on how do we connect this back to the depression. How can a better awareness of where your depression comes from help you reduce the things that are maintaining that depression?

Some problems have quick solutions. Others take a lot longer. Some people may need to stay in therapy for a long time to avoid getting worse and ending up in a psychiatric hospital. Whatever your needs, the therapist should be working towards a thing called termination, the time when you will not need to come to see them anymore.

Those are the things that are likely to happen in the first session. From there the process moves to finding ways to help you get the result you want.

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