Category Archives: Counseling and Therapy

What will happen if I go for therapy?

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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

Can therapy help if the problem is someone else?

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

Change

Change.
Photo courtesy of Pixabay.com

Sometimes the problem is others.

Lots of times the client sits in front of us and tells the counselor that they are sure that they are not the problem. In their view, the other person, the one not in the room, is the problem. They tell me that and then they ask me to help them.

Actually many times the counselor can help in this situation.

There are two obvious possibilities here. First, it is possible that the person who has come to the office is reacting to the problems of another. If you are married to a drug addict or your child is having problems you may be right in saying that the other person needs therapy.

The other option is that the person who is telling the counselor the other person is the problem is mistaken. They have not recognized their role in creating and maintaining the occurrence they define as the issue.

The problem is you are here and the other person is not. It is hard to work on something or someone who is not there, hard but not impossible.

One way of looking at this is that this is a case of a problem in a relationship. Relationships involve one person doing something and the other person reacting or not reacting to the actions of the first person.

Both people in this relationship can be mentally healthy or they can both be seriously mentally ill. Either way, the issue that needs working on is not the individual but the way these two people are interacting. Add more people and you get a family, and as most of us suspect the majority of families are called dysfunctional by someone in them.

Think of this couple’s or family’s interactions as if it was a square dance. Each couple or family develops its own unique dance. Everyone does one thing first and then something else next. Your child does nothing, you yell, they ignore you and then you get upset and storm out and yell at your spouse, who now comes in and tells the kid to do what you said in the first place Now they kid does it, grumbling all the way and you not them become the bad person. It is you the “yeller” who is defined by the rest of the family as having an “anger management problem.”

Once the family develops a dance it becomes hard to change it. But like that square dance if one person in the square changes direction and does something different the whole square falls apart.

This time instead of yelling at your child, you turn off the electronics and then talk to them calmly. They ignore you, so now you calmly take away their entertainment. Something new has been introduced, you have changed the dance. This could end in all sorts of ways, some good and some not so good but the point is that by changing your dance steps you can force others to change theirs.

Now some of you are asking “What if the person who comes to the counseling room really is the person with the issue?”

The key here is that this person needs to understand two things.

1. What they are doing is not working.

2.  Changing others is hard work and requires them to change some of the things they have been doing.

So regardless of whose “fault”, it is. If someone in this family or couple starts the change process then the relationship will change. If you decide to try to change others by changing the way you relate to them, think this through or better yet talk this through with a professional.

Otherwise, you may change, the family may change and when you are all done you may decide you wished you had never started the change.

For tips on how to change others or more accurately induce them to change, look at the series of posts about getting someone else to change listed below.

The changing others series:

One way we get others to do more of what we want them to do and less of what we wish to avoid is a process called Behavioral Modification. Here are six posts on that topic.

Changing Others – Part One  

Changing others part two

Rewards gone wild – Changing Others Part 3

Why ignoring them doesn’t work – Or does it Part 4

Why Your Child Won’t Behave

NO, NO, NO – Learning NO!

For more on the process of change see the blog post series “What are the Stages of Change”

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 people avoid the doctor and the therapist

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

What are your reasons for avoiding getting your problems treated?

Therapist

Therapist.
Photo courtesy of Pixabay.com

The scenario is the same only the problems and the treating professional change. You have a problem, a sore that does not heal, a physical or emotional pain that won’t go away, or a troubled relationship, but you avoid getting help.

Why do people so often avoid treatment for a problem?

We see a lot of couples who come for marriage counseling, they have talked about seeing a counselor off and on for a long time. Now when they come to our offices one or both have decided it is over, past the point of repair. They say they can’t stand the pain one day longer.

Why have they waited so long? What made them think they needed to endure that pain at all? Here are some of the faulty beliefs that cause people to avoid therapy.

Talking about problems will make them worse.

Despite this fear’s prevalence, there are plenty of reasons to think just the opposite. Problems caught in the early stage may need small corrections; wait too long and they need major changes.

Admitting you have problems or challenges does not mean giving in to them. Recognizing your challenges gives you something you can work on to improve your life.

Asking for help means I am weak.

It is easy to delude yourself, think you are, or should be superman or superwoman, able to handle everything by yourself. That is just not the way life works. Even experts consult with other experts. Two heads are better than one. Recovering people have sponsors, and in the sphere of emotional problems, counselors and therapists frequently see other professionals when they experience life problems.

People will think I am crazy or incompetent if I go for help.

No one should think that, especially not the therapist.

First off, therapy is confidential. Your counselor is not going to tell and you have the choice of telling or not telling your family and friends.

We all have times in our lives when we need to see a professional or specialist. You see a mechanic for your car repair and you see a lawyer if you have legal issues. Hopefully, you saw one or more teachers that taught you how to read.

Some people are able to do some of these things for themselves, but not many people are doctors, lawyers, and tax accountants. Everyone needs some advice now and then.

Counselors can do several things that are helpful, Give you perspective, no you are not crazy, lots of people in your circumstance would have that issue. They also can help you learn the skills you need to manage or regulate emotions.

Lots of people spend their whole life working at jobs they hate or that are low paying because they did not use the services of a career counselor to help them plan the right career for them.

People also do not seem to come in to learn how to be good parents or good spouses. They do however see their therapist when the child has problems or the marriage is in trouble.

A little early skills training or education can help you reduce life problems or navigate the things that will come along in any life.

Once I lose control, start crying or get angry I will never be able to stop.

This idea is simply not true. Given enough time people regain control. People cry and then they get “cried out” we laugh and then the laughter fades. The problem is not that a feeling will take control of you and you will never return. The issue is that you need to learn to regulate your feelings.

Regulate does not mean destroy them or eradicate them. It means learning to be able to control them, work with them, learn from them, and play with them.

Want proof that you will not be transported to crazyland if you start to cry?

Create some crying time!

Have some sadness you are afraid will overwhelm you? Set aside a time each day, 15 to 30 minutes. At this same time, each day go in a room by yourself and set a timer. For the entire time cry nonstop. Cry as hard as you can. Get that crying out!

What people find is that they are usually not able to keep up the crying for the full-time. They just do not have 30 minutes’ worth of tears in them every day, especially not every day for a week or a month.

You will also find that if you can make yourself cry on schedule, then you will be able to make yourself not cry when you want to do that.

Practice crying when you want to and not crying when you wish to not cry and you will have gone a long way towards learning to “regulate” your emotions.

If you find that regulating emotions is a special challenge for you, this does not mean that there is something wrong with you. It means that there is a skill, “Emotional Regulations Skill” that you still need to learn. A therapist, especially one trained in DBT, can help you learn to regulate your emotions.

For more on “behavioral experiments” like crying at will see the work of Milton Erickson.

I won’t be able to take the pain.

People sometimes think that if they talk about their pain then they will not be able to bear it. You will be able to take the pain of treatment a whole lot better than the pain of staying ill.

One place this fear comes from is the image of the old psychoanalyst making you go through all the sordid details of your life.

While I may be old, I do not think we need to dig up the whole garden of your life to find the weeds that are causing your pain today. A good therapist can help you work on the problem that brought you into treatment and then if you decide you can move on to working on past issues.

Working on our issues may be painful at times but once you face your demons and learn the skills to tame them they shrink like scared little kids.

The Therapist will spill my secrets.

Not likely to happen. Therapists and most counselors have a requirement to keep your secrets, that comes close to that old religious practice of things told under the seal of the confessional is not repeated by the priest.

The law protects most client-therapist conversations. The counselor can lose their license for telling even if you committed a crime.

I have written a lot of posts about what things the counselor must report (If you are suicidal, homicidal, or talk about abuse of a child, elderly person, or disabled person.)

If you have specific concerns look at those posts and if in doubt ask the counselor to tell you about confidentiality before you tell them your secrets.

They will think I am crazy and lock me up.

Extremely, I repeat an extremely low chance of this. See this post: Will they lock me up?

For more on these “therapy interfering beliefs” See the writings of the following: Aaron Beck, Judith Beck, Marsha Linehan, and Milton Erickson, to whom I am indebted for much of the inspiration for this post. Let’s hope I have not distorted their views in the retelling.

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 people are reading counselorssoapbox.com

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Counselorssoapbox.com

Why people are reading counselorssoapbox.com

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

For the last 30 days here are the top posts that brought people to counselorssoapbox .com.

In case you missed some of these top posts the links are included.

How much should you tell a therapist?

Levels or types of Borderline Personality Disorder

Do therapists have to report a crime?

Do people really forget what happened when drinking? – Blackouts

Which border is Borderline Intellectual Functioning on?

Are you a Parentified Child?

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

Reasons Counselors and Therapists Lose Licenses

About the Author – David Joel Miller

Hyperthymia, Hyperthymic Personality Disorder and Bipolar Disorder

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

That’s not what’s wrong with you!

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

Problem and problem solving

Problem-solving.

Are you sure you really know what your problem is?

There has been a disturbing trend lately in the psychotherapy business. To hear some of my colleagues talk, clients do not have a clue what is wrong with them. Worse than that, if the client did know, they are convinced the client would lie to them.

I have to question these premises. First, some fictional examples may help.

A male client goes to see their therapist. The man says he and his wife are quarreling and he is afraid their marriage will end in divorce. The therapist does a full assessment and informs the client that his problem is not his relationship. His problem is he did not have a good attachment to his mother. He needs to work through all his childhood issues of wanting more from his mother than she gave him.

The client, not conscious of psychological principles, continues to insist that he and his mother got along just fine. The client says that it is possible that all men have mother issues they need to work out before they can properly relate to a woman. What does he know about psychological principles?

So the man undergoes a long examination of his childhood and his relationship with his mother. At the end, he sees how he was not really as close to his mother as he thought.

In the meantime, his wife leaves him and files for divorce. As much as it pains this man to lose the relationship with a woman he really loves and he is also sad about losing contact with his children because the wife has moved them to another state where she lives with her parents.

Still, the man now understands how his underdeveloped relationship with his mother has resulted in his attachment issues with women and he now understands why he will never be able to make a woman happy.

Sound far-fetched? I see things like this more often than you might guess.

Second example. A woman comes to see her therapist because she has been out of work for many months. She is discouraged and getting depressed because of her employment situation and her economic troubles. I am thinking either treatment for depression or help with career counseling, but the treating therapist tells me that would be wrong.

The problem here is that this client grew up in a home with an alcoholic parent. This has left all sorts of scars on the client and the client undergoes treatment for her anger towards that alcoholic parent. The client insists that she got over that stuff a long time ago but the therapist informs this client that she is sicker than she thinks and that she will never be happy again until she gets these childhood issues treated.

The client talks with this therapist for a number of sessions, still unconvinced that she has all that big a problem with her childhood. Eventually, the therapist tells the client that this client needs to stop lying about her hatred towards her father.

Clearly, anyone who grew up with an alcoholic parent has been scarred for life and will probably never be able to work again

By the way, these are fictional composite examples so do not go thinking you know the people I am talking about. You would be wrong.

Counter-transference.

The problems these vignettes illustrate are a phenomenon known as counter-transference. The counselor who has had issues in their childhood, or has others in their life with these issues, is insistent that the client must have the issues that the counselor sees and if the client disagrees then the counselor believes the client is lying.

It can also come from a theoretical orientation that asserts that all adult problems are the result of childhood events.

A more productive approach is for the treating professional to consider that some people who had mother problems or an alcoholic parent may be having problems today because of that past, but most people really have the problem they say they have.

I try, in my practice, to always accept that the problem is what the client says the problem is. This can save a lot of time by working on that issue first and then get back to the other stuff if that still needs doing.

I also find that it saves a lot of my time and the client’s time to avoid arguing with the client. If they tell me things I take it that they believe what they are telling me. They may be mistaken but most people really do believe what they are saying.

Certainly, there are times that clients might stretch the truth. Especially if they have something to gain, like child custody or disability. In those cases, where my results will go to another person or agency I ask a lot more questions. But if the purpose of the therapy is to help the client resolve issues or cope with life problems I find it is worth the effort to start from a place of believing the client.

Most of the time the problem that needs treating is the thing the client says brought them to my office in the first place. If your provider is insistent on treating you for their issue instead of yours consider getting a second opinion.

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

CAMFT – CALPCC and the future of mental health in California

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By David Joel Miller

If you are not a Marriage and Family Therapist (LMFT) or a Professional Clinical Counselor (LPCC) you may not have heard about the commotion going on here in California.

CAMFT has for a very long time been the primary voice of MFT’s both in California and Nationally. CAMFT membership exceeds 30,000 MFTs, far more than the membership of the American Association of Marriage and Family Therapists.

While California was an early adopter of the MFT profession it was the last state to adopt the licensing of Professional Clinical Counselors.

CALPCC has become the state-wide organization for the Licensed Professional Clinical Counselors. This new sister profession is off to a dramatic start.

Some of you may be aware that I hold both licenses. I elected to become dually licensed because I feel that there are differences in the things that the two specialties do and personally I have times when I practice both professions.

Since I have two licensees I am a member of both CALPCC and CAMFT. I also have been honored to serve on the board of directors for CALPCC.

Now that there are three mental health licenses (LCSW’s MFT’s and LPCC’s) here in California we are still sorting things out. (Four if you count the registration and certification of Substance abuse counselors.)

Both the LMFT’s and the LPCC’s face challenges ahead.

MFT’s were founded on system theory and the requisite skill set includes couples or marriage counseling. Some but not all LPCC’s are trained to do marriage counseling. The challenge for MFT’s consists of maintaining that there is something different about what they do. This becomes a particular challenge as more and more MFT’s are working in county agencies with individual clients rather than seeing couples and families.

LPCC’s have specialized training that some, but not all MFT’s received, particularly in the areas of career counseling and substance abuse work. LPCC’s also have skills in working with nonverbal clients. Because LPCC’s are the newest profession there has been a reluctance to open jobs, especially in the public, governmental sector for LPCC’s even when their skill set might be a better match than an MFT’s.

Recently CAMFT’s board of directors proposed changing their bylaws so that all mental health professionals could become members. This would leave MFT’s with no organization to represent their interests and two competing organizations for LPCC’s.

Now a group of CAMFT members has succeeded in triggering a vote on the CAMFT bylaws to return CAMFT to an MFT only organization.

No less than H. Dan Smith, two-time CAMFT president, has sent out a letter in support of retaining the old bylaws to keep CAMFT an MFT only organization.

Personally, I think this is a good idea.

If you are an MFT, MFT student or intern, and plan to continue to practice Marriage and Family therapy as a specialty then I believe you should vote for the old bylaws and become or stay a member of CAMFT.

If you consider yourself a counselor and are a counseling student, PCCI (intern) or a Licensed Professional Clinical Counselor (LPCC) then I encourage you to join and support CALPCC. You might also want to like CALPCC on FaceBook.

If you are one of that group that now holds both licenses I believe you owe it to yourself to continue membership in both groups.

Recommended self-help & Counseling books

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Recommended Books.

AA big book

Alcoholics Anonymous big book.

We have had some trouble with the links to counselorfresno.com so here is a re-post of the books on self-help, counseling, and therapy. This is a work in progress so if you think of something else that warrants a listing here let me know.

Links to suggested self-help books.

Here are some books that I have found useful or that have been recommended by clients and colleagues. No book is a substitute for professional therapy but many of the things we talk about in therapy are explained in more detail in self-help books. The links will take you to the Amazon.com listing for the books.

More titles will be added as time permits. If you have suggestions for this list send them along. Leave a comment or there is a contact form available.

Self Help books

Broken Open: How Difficult Times Can Help Us Grow – Elizabeth Lesser

The story of how painful events can be the impetus for personal growth

Relationships

Men Are From Mars, Women Are From Venus

Some interesting observations about how men and women understand relationships differently. Not everything applies to everyone but you may well see large parts of your relationship behaviors depicted in this book.

Children

Windows to Our Children: A Gestalt Therapy Approach to Children and Adolescents by Violet Oaklander

Raising Good Children: From Birth Through The Teenage Years By Thomas Lickona

The Healing Power of Play: Working with Abused Children by Eliana Gill

How do people learn the difference between right and wrong and why do some people stay stuck at low levels of moral reasoning.

Alcoholism, addiction, and recovery   

The Big Book of Alcoholics Anonymous

The classic text on Alcoholism, recovery this is the book that started off the whole 12 step phenomenon.

Alcoholics Anonymous from The Anonymous Press

At 99 cents this is such a bargain. This edition needed a separate listing. No Kindle reader? No Problem, if you have a computer you can download a free Kindle reader.

Theory and counseling techniques

These books are recommended for professionals, interns, and students. They may also be of interest to some clients or consumers.

Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward

Schizophrenia: Cognitive Theory, Research, and Therapy – Aaron Beck

Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D.– Jay Halley

The story of Milton Erickson’s very unusual and very effective way of conducting therapy.

Need a Kindle? Here is one for $69

Kindle, 6″ E Ink Display, Wi-Fi – Includes Special Offers (Black)

“Counselorssoapbox and counselorfresno.com are participants in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.” We recommend only books we think are good and maybe occasionally make a buck.

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 are evidence based practices?

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Update on the national registry of evidence-based programs and practices, 2/19/18.

SAMHS recently sent out a press release saying please disregard the National Registry of Evidence-based Programs and Practices.

The new administration questions whether some of these programs and practices listed there were added without much real evidence. The original post follows.

What are evidence-based practices?

How many evidenced-based practices are there anyway and why should you care? Should you care if your counselor or therapist is using an evidence-based practice, and what are those things anyway?

The talking cure and case studies.

In the beginning of psychotherapy, it came as a shock that just talking could help someone. Freud came up with a whole lot of ideas about how and why things were creating problems for clients. If you see early childhood sexual conflicts and the unconscious as the source of the patient’s issues you go in one direction.

So as the practice of psychotherapy grew, those practitioners, often called analysts, started trying all sorts of interventions. Some worked and some didn’t and often we had no idea what worked, for whom, and when.

Analytical psychotherapists started writing up case studies about clients they had treated. Then other psychotherapists tried similar interventions and often got different results.

How are we to know what works when? Is it the characteristics of the psychotherapist, the client or the intervention that is causing the results we see?

When someone else pays they care if your treatment is working.

If you are paying for your treatment then you can see whomever you want, but as there became more government and insurance funding we need a way to check and see if what others are paying for is really worth the money.

Some therapists, particularly Cognitive-Behavioral Therapists, believed that if a technique is valid then it should work most of the time and no matter who did the technique. That notion has spurred a lot of research.

What we find is that the larger the group in the study the more reliable the results of the study, all other things being equal. So more and more theories have been studied in larger and larger trials. We are starting to see that some interventions work most of the time, for most people, when the therapist does them correctly.

One way to further this process has been to create a “National Registry of Evidence-Based Practices.” New interventions, treatment manuals, etc. are registered here and as the research is conducted it gets added to this database.

SAMHSA (Substance Abuse and Mental Health Services Administration created a National Registry of Evidence-based Programs and Practices.  

Currently, the registry contains listings for over 300 different programs and practices that are registered and for which reports and evaluations are available. Some of these treatments are much better than others. Some treatments have a few or only one study showing they worked. Other treatments have hundreds of studies and thousands of clients and are much more recognized as worth the cost.

Over time we should be able to see what works and what does not. Understand that no treatment or intervention is guaranteed to cure every client every time. But some treatments are clearly worth their costs and others are rarely of value.

Also, consider that it matters who did the research and how many people were in the sample. A study of two friends does not mean as much as a study of 10,000 randomly selected clients. Not every counselor has the same level of skill. So in evidence-based practices, it would be reasonable to emphasize treatments that are “manualized,” meaning that there is an instruction book and we can see if the therapist is actually giving the client the treatment that is prescribed by a particular evidence-based practice.

While not all evidence-based practices are equal and some of those on our current list are sure to fade away with time, this system of asking practitioners to prove that what they are doing for or with clients is beneficial to those clients is certainly a huge step forward.

A program or practice inclusion does not necessarily mean that a practice works or that it will work all the time with every client. What it does mean is that these programs and practices have documentation to tell others how they should be conducted and research to document when and where they have been effective or not effective.

SAMHSA notes that “NREPP is not an exhaustive list of interventions, and inclusion in the registry does not constitute an endorsement.”

Whatever the drawbacks having a place where providers can go to look for programs and practices that may be helpful in designing treatment programs is hugely helpful in moving the mental health and substance abuse professions forward.

There was a time not that long ago when each place was doing their own thing sometimes with good and sometimes with poor results. We now have better ways of establishing that the treatment provided is generally effective in treating a particular condition.

Some of the programs included in the registry are expensive to get trained and certified and others are free or nearly so. Clearly, some practices were listed by their originators to sell more books and trainings; others are listed because the developer wants people to try them and to promote research. A few of the programs were developed by SAMSA or other government programs and the materials are all available to download for free.

A quick scan of the list came up with some treatments worth looking into.

Brief Marijuana Dependence Counseling

Mental Health First Aid

Seeking Safety

Take a look, and let me know what other Evidenced Based Practices you find interesting.

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

When talk therapy fails – other learning styles

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

Lessons of childhood

Child learning.
Photo courtesy of Pixabay.com

Not everyone learns things the same way.

Therapy is often conducted as if everyone learned in one way and only one way. In traditional therapy, we copy Freud, the client talks and the therapist listens. Eventually, the client says something, and then hearing their own voice they have this insight moment and suddenly they know what is wrong and what to do.

If only it was that simple. Sometimes just talking does not help everyone.

Several other methods of counseling have been developed to help those who learn or communicate best in another way. Unfortunately, those other styles of therapy do not always get the respect they deserve.

The three learning styles and therapy.

Some people are good at learning by listening to verbal directions. Verbal learns can reach decisions from listening to themselves talk things out.  Some people learn best by seeing things, they are visual learners. Some people need to be guided through the motions to learn. We call that kinesthetic learning. Some people learn best through a combination of methods.

While talk therapy may work well for verbal learners it is not always equally helpful if you have a different learning style.

Some people can’t find the words.

What if you can’t find the words to describe how you feel? There are a variety of reasons why someone would not be able to communicate about their experiences or feelings in words.

Young children may have been the victims of abuse or neglect; they may have grief or loss that is troubling them. What they do not have is the words to talk about those problems. That does not imply that a nonverbal person is not troubled by their problems.

People with a disorder on the autism spectrum may not be adept at verbal communication. Those who dissociate or are disconnected from their feelings have the same issue.

One method of working on those issues is to employ art therapy.  Art therapy does not mean the therapist and the client sit around and color or draw pictures. There is a reason for the art and it is therapeutic. The child who could not explain something bad that has happened to them can often draw a picture of that experience or of the feeling that event created. Once the picture has been drawn they can begin to describe the things they pictured. Amazing insights can develop as a result of using visual methods to supplement the client’s vocabulary.

Sometimes you can express yourself best by moving.

kinesthetic learners need to move and feel the situation.  One technique that I have used in a group setting is to have a client who is unable to describe how they feel about their family create a “family sculpture.” They make up a list of family members that we display on a whiteboard. Then other clients are asked to play the roles of those family members and positioned around the room. The client tells each “family member” where to stand.

The group then asks the client why each person is standing where they are. Clients discover that they always felt that one person was closer to them than another or that two family members stay apart from the rest and excluded them. This becomes a topic to talk about and sometimes exercises to do at home to improve relationships with those family members they saw as distant from them.

Other clients may find dance therapy or physical activity to be helpful in learning to understand and regulate their behavior.

Why other therapies?

The intent here is not just to engage in fun activities with clients as therapeutic as that can be, but to help the client to grasp their thinking, feeling, and behavioral issues in a way that fits their essential learning style.

To apply these alternative therapeutic modalities the clinical counselor needs to be trained in assessment and diagnosis of mental, emotional, and behavioral disorders.

For more on Clinical Counselors and the things you do please look at past posts on LPCC’s and check out the CALPCC (California Association for Licensed Professional Clinical Counselors. website.

Two books that I find especially helpful in working with young children or less verbal adults are:

Windows to Our Children: A Gestalt Therapy Approach to Children and Adolescents by Violet Oaklander

The Healing Power of Play: Working with Abused Children by Eliana Gill

For the full list of recommended books check out the listings over on counselorfresno.com at Recommended Books 

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

13 things your counselor should know – part 2

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

In a previous post, we talked about the first 6 things that a Professional Clinical Counselor should know. Today the rest of that list.

7. Counselors know the principles of the diagnostic process.

What would you think of a doctor who sent all his patients for cancer chemotherapy first and then checked to see what was wrong later? You wouldn’t want to be treated for something you did not have, would you?

That is why diagnosis is so very important. It is also controversial and sometimes the diagnosis on a client’s file is flat wrong. I have written in previous posts about why we professionals may get it wrong and there is room for improvement but one thing a good counselor is to be able to do is to diagnose.

We may change that diagnosis over time. You may turn out to have more than one problem or we may treat the thing that looks the worse first, then move on to another thing.

However it is done, a good counselor needs to be able to diagnose and they need to be able to explain that diagnoses to their client. The diagnosis drives the treatment. We should treat the problem and leave the other things in the client’s life alone unless they want to change them.

8. Counselors know about research and evaluation.

Counselors need to know how to read research and understand the information. Some stuff looks good on paper but does not work when we try it on clients.

I read a lot of research in preparing to write this blog. I will not say I “get” it all. But I can spot some really suspicious research.

Recently I looked up a new counseling theory; there are over 300 of those and counting. This new therapy had one study done by the author of the book on this new system and then his study included only 5 or 6 of his patients.

I do not call that evidence.

See why professional clinical counselors need to know how to evaluate research? Would you want them trying out something on you that might not work or might even harm you?

9. Counselors know professional orientation, ethics, and laws in counseling.

Interesting that the law that created Licensed Professional Clinical Counselors lumped all three of these things together. In another context, this might be three separate things.

What this is telling the prospective clinical counselor is that they should know about their profession and presumably related professions. Who does what, when, and why?

It is always really important to understand a little about the law. It is recommended that counselors have lawyers rather than trying to memorize all the things in applicable laws.

Clinical counselors also need training in ethics. Not that ethical principles are hard and fast rules, but the code of ethics for a profession are general guidelines for how to conduct yourself.

The big ones as you may have gathered from my past posts on ethics are avoiding things that would harm clients. You can read more about this topic by clicking on the law and ethics category in the list of categories to the right.

10. Counselors should know about psychopharmacology.

Professional Clinical Counselors do not prescribe medication here in California or anywhere else that I know of. That is fine with me, as I think that if you are prescribing meds you need to have attended a medical school and know about medicine.

Still, we Profession Counselors see a lot of people who are taking meds, psychiatric or others. We need to have an awareness of what the meds are that clients are taking, are they complying with their doctor’s instructions, and so on.

Some medication that is prescribed for physical health issues can cause symptoms that might be mistaken for a mental health condition. We need to know when to refer clients to an MD and when to send them back so their primary care doctor might be able to take another look at the meds they take and the side effects they are experiencing.

11. Addictions Counseling.

Clinical counselors are supposed to have knowledge about the field of substance abuse. In the future, I expect to see more LPCC’s working in the substance abuse areas. I say supposed to because while LPCC’s have some training in substance use disorders. Some is just not enough.

It is amazing how little training in substance use disorders mental health professionals get. A standard MFT program might include a one weekend class, Friday evening and all day Saturday.

Contrast this with 36 units, eleven full semester classes on substance abuse and related problems, which are included in the CAADE Drug and Alcohol counseling curriculum which I teach over at FCC.

More training is needed but look to LPCC’s as the branch of the mental health field that combines mental health treatment with substance use disorder treatment in the future.

12. Crisis or trauma counseling.

Would you believe that there are mental health professionals that are uncomfortable handling a crisis? Sorry, you other professionals. I do not have time to wait around to make a referral to a program when someone is suicidal. (I know most of you don’t do that either.)

Crisis and trauma are huge parts of what brings people to counseling.

Stress, acute or chronic is a significant factor affecting mental health. Professional clinical counselors are trained to help clients with issues in these areas.

13. Advanced counseling and psychotherapeutic theories and techniques.

Beyond the basics, there are times when you may need tools in your counselor’s toolbox beyond the everyday ones.

This concludes part two of the discussion of the 13 things every Professional Clinical Counselor should know and understand. As I tell my students, these things probably will be on the test.

For more on Professional Clinical Counselors, LPCC’s and PCCI’s check out the CALPCC website.

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel