Tag Archives: Counseling

Is Behavioral health related to Behavior or Health?

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

Mental Health or Mental Illness

Mental Health or Mental Illness?
Photo courtesy of Pixabay.com

What is Behavioral Health?

The term “Behavioral health” is getting associated with anything from a place that treats mental illness to healthy lifestyles. Additional areas of concern have been added to the things the local mental health agency concerns itself with and some of the old concerns are getting eliminated. The further we stretch the term behavioral health, the more it includes, the less meaning it has.

Some consumers, who were used to going to mental health, resent the name change to Behavioral Health. They point out that they are not their behavior and that being depressed anxious etc is not a behavior. At the same time, consumers are complaining about the new “behavioral healthcare” name, a major national group, the National Council for Community Behavioral Healthcare is pushing forward with programs aimed at reducing the stigma of mental illness and informing the community about mental illness and related issues. So why the need for a name change?

You would think that Behavioral Health and Healthy Behaviors would somehow be related. There are lots of programs, blogs, and books on living and behaving in a healthy manner. Adult-onset Diabetes is highly correlated with being overweight and with having a sedentary lifestyle. So exercising is a part of healthy behaviors but not part of most Behavioral Health Departments program. We keep changing the names for a reason.

We have a tendency to avoid words that have unpleasant connotations. First, we see someone with a disability or problem. Next, we try to define what exactly is their difficulty. Defining requires a word or term. Before long the word goes from defining this person’s challenge to being a label people attach to the person, not the condition. So the term that began as a definition of an issue someone was experiencing became a negative derisive term that we can no longer say.

Consider a historical example. We discovered that given two people, both age twenty, one might be able to do advanced Calculus and another might still be struggling with basic addition. To explain this we invented the concept of I. Q. or intelligence quotation. IQ was understood as the number that resulted from dividing their mental age by their chronological age.  Let’s avoid the math and the changes in the test that measure this idea for now.

So people with a high score were called geniuses, or gifted. For people with a low score, we needed terms that described just how much lower their score was than the average.  So at first, some people used terms to describe a particular range of low scores with terms like moron or imbecile. Before long these terms moved from describing a score on a piece of paper to describing people. Calling people by those labels was offensive to them and to others and we don’t use the labels anymore.  We invented new labels.

So the new terms became Mild, Moderate, Severe, and Profound Mental Retardation. This set of terms is still in use in the most recent DSM diagnostic manual but already I notice people are uncomfortable describing anyone with these terms and we are using newer labels to avoid describing people by their IQ score.

For a long time, the same social service department that worked with the mentally ill also worked with people with lower than average IQ scores. We had places called the “X county department of mental illness and mental retardation.” Someplace changed that name to the department “FOR the mentally retarded and mentally ill,” because the first name sounded like all the employees had a mental illness or low IQ scores. Many people with a mental illness like depression or anxiety avoided going to a place for the mentally retarded because they were “not like that.” So recently we have split off the services for those with low IQ scores. They now go to special places which in my area are called “regional centers.” I expect before long all places called regional or centers will have to change their names when people find out that regional centers serve those with low IQ’s and their families. This separation creates another problem. People with low IQ scores can and do get Anxious or Depressed and they need both kinds of help.

So we have started using another term “Developmentally delayed,” which is also fuzzy because this can be applied to a lot of things besides low IQ. Eventually, we will have to stop using this term when people catch on that some “Developmentally Delayed” people have physical or learning problems and some have low IQ scores. I have written before about the trend to diagnose all people with a low IQ as having ADHD and then give them a stimulant med. We keep hoping there will be a pill that will make all people geniuses.

But our story does not end there.

Over the last few years, mental health and substance abuse programs have begun to integrate. So the mental illness label, while it did fit some substance abusers, did not fit all. And other times we find high but not universal levels of substance abuse among clients who have mental illnesses. So we started looking for a name that might be inclusive of everyone the agency was trying to serve.

The prevalent form of therapy these days is not the traditional Freudian model but the newer Behavioral and cognitive-behavioral types. My understanding of thoughts is that they are also events. Electricity moves through nerve cells and chemicals (neurotransmitters) move between cells. So every thought also involves an event and is a behavior we could see and measure. Yanking your hand out of a fire is a behavior but it is not likely to be something you think over and decide to do. So I can easily see how someone who starts out drinking can reach a point where they are dependent on alcohol. Someone who thinks about negative events in their life may become depressed. In both cases, there are behaviors going on but in neither case do I think the person is choosing to be sick.

Among children “behavioral health” diagnoses mostly include bad behavior like being very oppositional or not meeting parent’s and teacher’s requirements. So some people have started to think that people who go to “Behavioral Health” for help are just poorly behaved and need to knock it off. I can assure you they would if they could. Having a mental illness or an addiction is not fun.

People can also get knocked down by life events like losing a loved one. The ability to get back up is called resiliency. People who have trouble getting back up may need help in the form of counseling. It is hard to see how those problems are “behavioral health” problems except in terms of an event of thoughts moving around in the head. Very often clients who can’t get back up are referred to Behavioral health. They are certain they are not crazy and know they are not doing this deliberately so they tell us they don’t need to see a counselor.

I agree with them, they are not crazy, and being depressed or anxious or having another life problem does not mean you are behaving badly. But you still just might benefit from counseling. Things will get even more complicated in the future when Behavioral Health becomes more fully integrated with physical health. Negative thoughts can actually really make you sick and physical illnesses can change your mood.

Until we find a better name for the way in which we try to help people by teaching and talking – Behavioral Health just may have to do.

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

LPCC exam is behind me!

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Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

I passed! The LPCC (Licensed Professional Clinical Counselor) gap exam is behind me. Yes, I have been licensed as a Marriage and Family Therapist for some time, but becoming an LPCC has been on my “to-do list” ever since California began the process of licensing LPCC’s. So with one license why did I want another?

California is the last of the fifty states to license LPCC’s. Some states have other names for this specialty but the things we do, called scope of practice, are about the same. Social workers have been around for a long time, so have guidance counselors and psychiatrists. But the use of brief psychotherapy is a relatively new trend. Mostly this area began after WWII and really took off during the 1960s. To me, that seems like yesterday.

Professional counselors, in my opinion, are uniquely qualified to work on those immediate, day-to-day problems, like job loss, recovery from financial losses, and those other bumps on life’s road that can throw someone for a loop. I like being able to help someone decide what a happy life would look like for them and then develop a plan to create that life.

While doing all this happy life work, I need to remember that the relationship problems like partners and children are also among the things that can derail a life plan. Marriage and Family Therapists get to work on building good relationships with couples and families. That kind of relationship building and repair is important work also. So I am glad I took the LMFT training and have been privileged to work with so many families and children.  Being able to do both kinds of helping activities makes me really happy.

Thanks for letting me share about my exam pass. A few more weeks and the new license should be in my mailbox.

Sorry for the shortage of posts while I was studying for the exam. In the future, I want to write more about overcoming life’s challenges and designing the kind of life you want to live while maintaining a good set of relationships with the others in your life.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Love triangles and threesomes

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

Couple’s relationship with alcohol.
Photo courtesy of pixabay

Are you in a love triangle?

Those old love triangles are the stuff novels are made of and I expected to see a lot of them in the work I do as a Marriage and Family Therapist. Threesomes and triangles conjure up different images but the issues that turn up in the counseling session are very similar. One particular variety of this theme is especially common in my counseling practice.

The classic love triangle has love flowing around the outline but not back in the direction it came from. Usually, this is two people in a relationship when one decides they would prefer to be in another relationship. If they are married, or they have children this gets messy. The worst part of these affairs is when one partner wants out and the other wants to save the relationship. Often there are a lot of hurt feelings and when these relationships end there can be violence, depression, or self-harm. This is common but it is not the relationship with three parties I see most often.

The relationship that jumps to mind when we say threesome is more like three people involved in sex or a close love relationship presumably with the knowledge and consent of all the parties involved. I can’t tell you if this is a particularly common occurrence as I don’t do research on sexual practices but when it does lead someone to counseling, it is usually because it did not turn out to be all fun and games. When these relationships fall apart there are likely to be three or more hurt people. But this is far from the most common three-way relationship I see in counseling.

The most common threesome type relationship that drives clients to counseling involves two people, sex or sexual orientation doesn’t matter here.  What does matter is that one of the parties has introduced another love object into the relationship? That love object is far and away most likely to be some form of addiction.

Falling in love with a drug.

Sherry or Jack or Bud is likely to be a constant visitor in many a relationship. Men and woman will forsake their partners to be with Crystal or Crack. And members of both sexes are likely to fall head over heels for lady luck. Addictions of all sorts become a part of a couple’s love relationships on a very frequent basis.

Some partners try to compete with the addictions intrusion in the relationship. Clearly, over time the formerly loving partner becomes alienated by the new-found love interest. Who can compete with the wiles of Ethel-nol? As the struggle for attention increases, all sorts of family dysfunction become the norm.

Many a couple has thought that the way to tame an alluring addiction is to invite them into the relationship. Turn your partner’s new love addiction into a family affair and make it a threesome. This works for a while. Life is a party that seems to never end. An addiction, whether Crystal or lady luck, is a jealous mistress and eventually she takes over and turns the whole family into her servants.

Addiction stays to console the addict long after the family, loved ones; job, and health have abandoned the house. Many an addict has given up their house to stay with their addiction.

By the time the unwary couple calls the counselor seeking treatment both partners, the relationship, jobs, and children will have been destroyed.

When addiction has become a part of the love triangle the only cure is a full divorce from the addiction before all is destroyed. Unfortunately, by the time the addict, alcoholic, or gambler leaves their best friend, their addiction, the damage may have reached the irreversible point.

The moral of our tale is that when addiction is a part of a relationship there is not much left for anyone else. The earlier you seek treatment because you are in love with an addiction the better. If someone you love has fallen head over heels for an addiction insist they end this affair before everyone suffers.

Seek help early if addiction is a participant in your relationship.

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 relationships fail – two large reasons

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

Couple drinking

Couple’s relationship with alcohol.
Photo courtesy of pixabay

Two major causes are responsible for the majority of failed relationships.

Most of the research in this area has been done by Marriage or Couples Counselors but the results of these insights are applicable to other relationships, particularly the relationship between boss and employee. The major reason for relationship failure turns out not to be the thing we most expect.

Conflicted relationships fail and they often end early.

We expect couples who fight a lot to have a bad relationship and for the relationship to fail. That does happen – sometimes but not as often as you would think.

Relationships with lots of negativity, constant conflict are likely to end fairly soon. Gottman has done a lot of research in this area and he tells us that these relationships commonly end in the first seven years, with an average length of just over five years. These relationships are easy to spot lots of obvious arguing and fights. Sometimes there is violence. The police in every town know where these couples live.

After a few years of non-stop conflict these couples part. Often they are still angry with each other and they may have to make the exchanges of the children at a supervised site.

Sadly what often happens is both parties get into new relationships and they discover that the second or eighth time is no better than the first. Gottman tells us based on his research that almost 70% of fights are about things for which there is no solution. She likes green tea and he wants black or it could be religion, politics, or any other area of preference. Much less often a couple disagrees about something where they might be able to work out a solution that makes them both happy.

In other relationships, like jobs and friendships, people who have these kinds of conflicts quit jobs, get fired, or don’t stay around long. Sometimes they have an employment history of lots of short-term jobs. They may also have an arrest record for domestic violence or bar fights. They are also likely to have over-close friendships followed by a complete rupture of that relationship.

Getting into hugely negative conflicts is not the same as being assertive though some people confuse getting there way and giving in with being assertive or being victimized.

As dramatic as unrestrained conflict may be it is not the major reason that marriages fail. It is also not, in my experience, the reason productive employees leave companies or that long-term friendships end. There is a bigger cause of failed relationships.

Relationships without love, friendship, or caring take longer to fail but eventually these couples pull apart.

In these couples, there is nothing positive between them. They have no fun together and often prefer to live the majority of their lives apart. Now I know that there was a time that couples like this stayed together till death do them part, but that was a long time ago.

Couples in these kinds of relationships describe themselves as feeling “dead.” There is nothing that the couple has in common and eventually, the relationship ends. In the workplace, these relationships are devoid of positive regard for the other party. The only things the employee hears from the boss are the complaints and the errors. The only time the employee seeks out the boss is when they have a grievance. Neither may enjoy coming to work anymore. They forget to ever have anything positive to say about each other or about the goal their organization is pursuing.

So often couples start out the relationship describing themselves as best friends, somewhere along the way they forget that the best of friendships require work and they require shared experiences. These couples are especially prone to the “empty nest syndrome” or the “we only stayed together for the sake of the kids.” Eventually, the kids grow up and move out on their own and this couple is stuck with each other. Sometimes they are able to recreate a positive relationship but often there are no feelings left to build on.

These are not the couples who are content with each other and who are comfortable whether alone or together. They are the couples who hate to be together. There is always tension in the air if they are both in the same room but the discomfort never erupts into overt hostilities. In these relationships, neither partner makes an effort to consider the other and you will never see one comfort the other in times of pain. These are empty and uncaring couples.

So there you have it, two kinds of relationships that end on the rocks. The openly hostile violent relationships may end first but the hidden dislike eventually takes its toll. Just avoiding fights is not a solution to relationship failure. Creating more positive experiences together than negative ones is the safest route to keeping the relationship intact and healthy.

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

February 2012 – Best of Blog Recap

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Counselorssoapbox.com

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

Thanks, some more to all of you that read this blog. This has been the most read month ever for the counselorssoapbox blog. Hope some of the things I have written have been helpful and thought-provoking. Feel free to comment and especially pass along the link to anyone you think might want to read this effort.

This month there were a few days with no post but when we reached the month end there were more posts than I had originally planned. We will see what the next month holds.

Here are the top read blog posts of the last month.

1. Do drugs cause mental illness?

2. How does therapy help people?

3. How many mental illnesses are there?

4. How much should you tell a therapist?

The all-time top read posts were:

1. How does therapy help people?

2. Post-Traumatic Stress Disorder – PTSD and bouncing back from adversity

3. Do drugs cause mental illness?

4. Treatment for teens risky Behavior

Over time lots of you have viewed the home page and “about the author” page also.

Thanks to all my readers new and old.

Next month we will explore some other topics and see what we come up with.

Till next time, David Miller, LMFT, NCC

Directions to happiness

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

Happy faces

Happiness.
Photo courtesy of Pixabay.com

Looking for happiness?

It is hard to find something if you don’t know where it is or what to look for. Happiness is a lot like that. Can you remember the name of your elementary school? What was the school mascot? People are able to answer questions like that all the time but they have difficulty describing things that might make them happy.

It is also helpful to know how to avoid going somewhere you do not want to go to. Besides knowing the things that might make you happy it pays to know the things that might make you sad, afraid, or mad. Most of the time we can feel sad when it is inside us but often we can’t remember or describe it even at a few minutes distance.

When asked what things make you happy or sad lots of people can’t tell me or they will list off some things, video games, or a new job to make them happy, and losing their job or not getting something they want will make them sad. Things are easier to describe than relationships and characteristics like love and acceptance. Most times those things are only symbols for the feelings we all would like to experience.

We spend so much time with ourselves, every moment of every day we are there with ourselves. Most of the time we are there but we are not present. We may be physically in our bodies but our minds, our consciousness is not home. We are avoiding feeling what we feel.

You would think that we should know all about ourselves. Most of us never take the time to really get to know ourselves, our wants and desires, until a crisis strikes.

If I asked you about your best friend, what they like what makes them happy or sad, could you tell me?

Many times the person I asked can describe in detail their friend or relatives’ favorite color, flower, movie, or place. But ask them to tell you about themselves and they are out of answers. We ask our friends these questions, talking about you and asking about the other is part of the process of getting acquainted.  Often we are afraid to take the time to get to know ourselves.

Would you want you for a best friend? Lots of people in therapy will say no. I tell them that they need to be their own best friend. How can others treat you better than you treat yourself?

So the first step on the road to happiness is getting to know you. Seeing you realistically but still being able to accept you with all the faults. We often can accept a friend with warts and all but let us be one hair less than perfect and we can judge ourselves unmercifully. Learn to accept yourself.

One question I ask kids is if they were that person in the Aladdin’s lamp story and they found that lamp, what would their three wishes be? Some kids give me a list of things video games and new sneakers. Other kids say they want their parents to stop fighting or to still be together.  Wishes like this tell me about what is really important. What do you think you would wish for?

How might having three magic wishes reveal what you truly value and what direction you need to go to find your happy life?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What do you do if therapy is not helping?

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Counseling not working?

So you have been going to therapy for a while now and things are just not getting better what should you do now? Here are a few suggestions.

Talk to the counselor about your progress.

Sometimes you may think nothing is changing, you may be too close to your problems and in so much pain that you don’t see the progress you have made. Reviewing what has happened so far in counseling can help you gain perspective. Some problems are more difficult to solve than others. Consider where you started from in evaluating your progress. Sometimes, for some people, the light just comes on but other people find lifelong problems take time to work through.

Clarify your objectives.

You also want to discuss your objectives with your provider.  If your provider is working on one issue but you really feel that you need to solve something else you need to tell them. If your goals are unclear then it is not surprising you are not seeing progress. When therapy started you may have been in so much pain all you wanted was for the hurt to stop. Often in the early stages of change, we are very unclear about what we want to have change. As the process progresses you may decide on a goal or you may want to change your goal. Is it possible your goal changed without you noticing?

Consider what you are doing in the hours outside of therapy.

There are 168 hours a week; you only spend one or two of those in therapy.  If you come to the counselor’s office, talk about change but the rest of the week you live your life the same old way, you are not likely to make much progress. Are you working on improving your lifestyle? Have you cut down on drugs and alcohol? Should you cut them out altogether? Do you get enough sleep? Do you eat well and exercise? An hour a week talking about your stress will not do much if you continue to live a stressful life. Has your counselor suggested homework? Have you done it? If they did not suggest homework consider asking them why not? If you didn’t do the action steps ask yourself why not.

 Reevaluate your motivation to change.

Are you interested in changing? Did you come to therapy hoping that the counselor could help you change someone else? Specifically, what do you want to change? Or do you really want anything to change? If you don’t what change, then what do you want from being in counseling?

Are there other helpful things you could add to therapy?

Consider adding self-help groups, reading self-help books, and working on developing or improving your support system. Support groups of others who are struggling with the same issue are extremely powerful. Learn from those who are farther along in their journey. Self-help books are full of ideas that might be just what you need. Ask your counselor to recommend some books or groups that might aid in achieving your goals. Take the good and uplifting from where ever you can get it. Do you have a religious or spiritual belief? Are you practicing that belief?

Consider adding medication.

Many people come to counseling resistant to medication. Medications are not a magic cure-all but for some conditions, they are helpful, for some they are essential. Possibly the help you get from a medication may be just the thing you need to get that initial progress into motion.

Reexamine the relationship between yourself and the therapist.

The major predictor of success in a counseling relationship is your belief in the counselor’s ability to help you. If you have any doubts about that consider why you have doubts about this relationship. Do you lack trust? Do you not feel heard?  Consider talking with your provider about your doubts. Then if you still feel that this relationship is not helping consider seeing someone else. There are times when even the best therapist might decide that they are not helping a client. The ethical thing for a provider to do if they are unable to be helpful is to refer that client to someone else that has more expertise or is a better fit for that client.

Here is hoping that you are finding the things you need to help you along your journey to the life you truly want and deserve.

For more on this subject see:

5 Rules for Picking the Right Therapist

How to Spot a Bad Therapist

Reasons Counselors and Therapists lose licenses 

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

Today was another “Mental Health First Aid” training

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Counselorssoapbox.com

This is one of my favorite trainings to conduct. It runs two days, 12 hours full of information on what to do if you or someone you meet is experiencing a mental health issue.

Tonight’s post will be short. I hope to get a new blog post written tomorrow. If you are anywhere near Central California and are interested in this training contact me. There are a number of certified trainers and the full list of trainers is available from Mental Health First Aid USA. Below is a description of the training I had posted a while back. If you did not see that post here is the info. If you did see it – well some things may be worth repeating.

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Mental Health First Aid (MHFA) is a great new training. If you are not familiar with this training you should check it out. Designed for the non-professional, it teaches you how to react and how to be helpful if you encounter someone who is having a mental health crisis. Created in Australia the program has now come to the United States. The two-day, twelve-hour interactive class covers the major kinds of mental illnesses and how to help a friend, family member, or someone you might meet who is experiencing mental health problems. Sponsored by the Maryland Department of Health and Mental Hygiene, Missouri Department of Mental Health, and The National Council for Community Behavioral Healthcare there are now certified trainers throughout the United States.

Here in California’s central valley, there are over a hundred certified trainers. Certified trainers in Fresno have put on numerous trainings over the last year. I became so enthusiastic about this program that I took the training and became a certified trainer. So far I and a co-facilitator have completed three trainings (now at 5.) All of our trainings were enjoyable to do and well attended. In the coming year, we plan to offer the training at least three more times. We are currently looking for a larger room or a sponsoring agency. If you want more information on my trainings please email me or watch this blog for posts on upcoming trainings.

If you are not near Fresno, California, you can check the Mental Health First Aid USA website at http://www.mentalhealthfirstaid.org/cs/program_overview/ for a listing of courses in your area. The training comes with a detailed book for reference after the class. So whether we see you in one of our trainings here in Fresno, or you take it from another trainer, this is one class well worth taking.

Thanks to all of you who are reading this blog, subscribing, and passing it on.

Have a happy life. David Miller, LMFT, NCC

More child sexual predators?

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Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Have you lost track of the number of reports in the news of people abusing children? I know I have. One topic of discussion around the water coolers and in the media these days is the number of these reports and the number of times the thing we fear most, turns out to be true. Which makes one wonder- is there more child abuse, especially child sexual abuse, going on these days?

We are correct to distrust reports of more – or fewer predictors these days. More people being arrested does not mean more incidents. It is very likely that children have been victimized since time began, which is not to excuse it, just to say we can’t be sure there is more going on now. But the number, frequency, and severity of children being abused are beyond troubling.

With children, professionals like myself are what is called “mandated reporters” which means if we know or reasonably suspect someone is harming a child we are required to report this. From the number of adults who end up in therapy as a result of being victims of sexual abuse, it seems clear that this has been going on largely overlooked for a long time. Mostly we don’t like to think that someone who is working with children might be harming them. The stranger molester is very rare, most of the time the person harming kids is someone that is close to them and is respected by the community.

Beyond the pain of the first abuse, most adult victims will tell you the most painful part of being a victim was the number of adults who dismissed the claim or covered up for the perpetrator. I read that one child victim was punished for “making stories up” about his abuser. Years later we find out that this victim was telling the truth but was intimidated by adults into silence.

The shocking thing about so many of these reports of an adult sexually abusing a child is not just that the incidents are occurring but that the activities have gone on for so long, involved so many children and the perpetrator was allowed so much access to children. There may be some societal changes that account for this.

We live in a more anonymous society than ever before. This is the first time in the history of the world that the majority of people on earth live in large cities instead of rural communities. In the small town, there was always someone who was considered “weird” and the children were told to avoid them. This may not have protected anyone. Kids back then disappeared and things happened to them on the way home from school but we felt safer then, thinking that by avoiding certain people we were keeping kids safe. Today we have little idea who lives next door let alone on the next block.  We also know very little about public figures like the teacher, pastor, or priest.

Some people think that putting lists of child predators online will help reduce children being victimized. This process has proved inefficient in practice. I was at a county fair a while back. It was a relatively small county. The local police had a map in their booth with pins showing the location of registered sex offenders. In this one small town, there was no street that did not have a pin within a block or two. The sex offenders we know about are everywhere. What about the ones we won’t know about for years to come?

There is some likelihood that in times past most predators were solitary creatures. They were afraid to let anyone know their secret. That reduced their ability to abuse children and may have limited the number of victims. You don’t share secrets in a small town where if one person found out your secret everyone might be out to get you.

There was also a lot more social disapproval of people who might be abusing a child especially sexually. There were and still are families in which child sexual abuse is a family tradition. Older relatives abuse children and the parents who were abused themselves cover it up. More than once an adult has cried while talking about their child’s victimization and then they told me they had been a victim themselves, sometimes the adult was molested by the same uncle or cousin that had now molested their child.

In addition to the reduced social disapproval, these days it has become easier for predators to find others who approve of their behavior. They are able to connect via the internet and other electronic media. Children who don’t understand victimization, we all think things won’t happen to us when we are young, put themselves in risky online situations.

The increase in pornography and sexually explicit materials makes deviant behaviors look more normal. A few years back people who wanted sexually explicit materials had to go to a particular store and buy something that was kept under the counter. By today’s standards, most of that stuff was pretty mild. Today situation comedies have more sexual content and more violence than the girly magazines used to portray. Violence and sexual content are a lot more interesting to watch most of the time than normal behavior. If you watch a lot of violence or sex it is easy to get a distorted view of reality and think that things are normal that in times past were clearly off-limits.

The widespread abuse of stimulants has added to the problem of inappropriate sexual behavior, especially the increase in hypersexuality. Meth users report that under the influence they felt extreme sexual urges and participated in sexual acts that when off drugs they would never have considered. Much, but not all child sexual abuse is reported to be connected with drug abuse.

If it were possible to put aside the emotional cost of child mistreatment, which is not possible for most of us, there is still a huge monetary cost to society. According to the CDC, a single year of child abuse costs society over $200,000 in additional lifetime treatment costs. That is more than the cost of a stroke or most physical diseases. More years of abuse means more pain and more expense. We also know from studies of PTSD that the sooner someone gets treatment the less likelihood there will be a severe permanent disability. This makes the early detection and treatment of abused children all the more important.

So this blog post is running long.

The point of all this is that there may not be any more people who are having urges to sexually abuse children now than in times past. What we are seeing now are more cases involving people we all thought we could trust. There are societal factors that may be reducing the inhibitions of people who have these urges. These incidents can make us start to fear and distrust everyone. Some of these cases involve large numbers of victims and have gone on over long periods of time. Being a victim of abuse causes lifelong suffering and we as a society need to do more to prevent and treat these victims. The questions before us are how to prevent or reduce the number of these incidents and do we as a culture have the will to use resources to heal the victims?

Any thoughts on this?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

How much should you tell a therapist?

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

Whispering secret

Keeping your secrets?
Photo courtesy of Pixabay.com

Do you wonder how much you should tell your therapist? What is it ok to talk about and what should you keep to yourself? Here are some guidelines.

1. The more you are able to talk about with your therapist the more likely the process is to help you.

If you feel the need to hold back on something you need to ask yourself why. Consider if this is something that might really affect your life or is it just embarrassing. You shouldn’t be embarrassed to talk with your counselor. They have probably heard it all before so they are not likely to be surprised. Their goal is or should be, to be helpful. They can’t really help you if you won’t tell them things that are bothering you.

2. Ask them about confidentiality

When you first came to meet the counselor they should have covered the rules and the limits of confidentiality. Some things are confidential, meaning the therapist won’t tell anyone else, some things are not. When you meet your counselor for the first time there is so much on your mind that you may not have understood it all. If you signed a copy of a confidentiality policy you should have received a copy. This is a part of the “informed consent” they are supposed to do. If you have any doubts about this ask them.

There are certain things that counselors can’t keep secret. By law, most counselors are required to report child abuse and the abuse of elderly or disabled people. If you have done something like that or know about someone who was abused, the counselor can help you by working on the reasons you acted that way. They should try to help you change. They can help you with the process of admitting what happened and helping the victim get treatment. If you were the victim of abuse when you were a child most counselors will not have to report that unless the abuser is still around and might be abusing someone else.

My suggestion to you is to ask the counselor about their procedures before you tell them something you might regret. This will give them a chance to explain the rules of their profession and the laws in their jurisdiction. Consider that even if there are consequences to you for telling it still may be worth doing. They say we are only as sick as our secrets.

If you are suicidal counselors are supposed to report this. Not to hurt you or take away your will but to try to save your life. Most times the client will report afterward that they were glad someone cared enough to prevent their suicide.

In most places, the relationship between a patient and their therapist is protected by law. So outside of specific things they must report, like child abuse, therapists are not supposed to disclose other things you talk about. They are not police investigators and they don’t have to report most crimes.

3. How much do you trust them?

The whole process of therapy depends on the trust between you and your counselor. Despite all the laws requiring therapists to keep things confidential, some people are not trustworthy. If you don’t feel you can trust your therapist– don’t tell them your secrets until you have resolved that issue. Now some of you have “trust issues.” You have trouble trusting anyone. Working with a counselor to learn to be more trusting should help that. So start by telling the counselor a small thing and see how that feels. You can work on the bigger things later on.

When I first started in this field I went to see a therapist. We are all supposed to have that experience if we want to understand how it feels for the client. The therapist should also work out their own issues in their own therapy, not in sessions with clients. I asked the therapist I was seeing if what we talked about was confidential. Their response was to ask me what I meant by confidential. They never did answer my question. So I avoided talking to that therapist about anything which might reflect on my future career. The lesson I learned was that if my therapist would not give me a straight answer to my questions I did not feel like trusting them. I make an effort to never do that to one of my clients.

P. S. I did eventually find someone I did trust to talk to about those issues and everything worked out just fine.

4. What is the consequence of this getting out?

If you might be embarrassed by a revelation say that you had a crush on some movie star when you were eight, even if the therapist did slip and tell your family you might be embarrassed, you might never trust that counselor again, but your life should not be ruined. If you cheated on your taxes or your wife and now feel guilty, having that revealed might be life-changing. Think long about telling your therapist where you buried the body unless you need them to help you confess that to the police and clear your soul. While therapists are not supposed to violate confidentiality and tell about client’s past crimes sometimes it happens. When this happens the therapist loses their license and the client gets to feel really happy about that the whole time they are in prison. Neither of those outcomes is what therapy is supposed to be about.

The point of requiring therapists to keep client’s secrets and to tell them upfront what will and won’t be kept secret is to make it possible for them to discuss their problems without fear of reading about their issues in the local paper. Without that level of trust, most therapy would not be helpful. This is similar to doctor-patient or lawyer-client privilege.

5. Who do they work for?

If you want your counselor to keep the secrets you tell them within legal limits, then you need to hire and pay them.
If you visit a court-appointed therapist or one at the school or CPS they are working for the agency that referred you. They may have a duty to tell the court, CPS, or the school what they think and what you said. They should be clear about this when you go to see them but if they are not – be careful and ask about confidentiality before you “spill the beans.”

6. Do they have a no secrets policy?

Some therapists, Marriage and Family Therapists, and those working with children may have a no secrets policy. When I work with a couple I don’t want to be working on saving the marriage if I know that one of the parties is having an affair. I might tell both parties that I can’t keep secrets from the other partner if we are to work on improving the relationship.

This is a big issue when we work with children. Some parents want us to find out all the kid’s secrets. This does not work. After we tell the parent the first secret the child decides to never be honest again. This may require some balancing.

If an eight-year-old tells me they snuck a sip of dad’s beer or took some cigarette from a store and tried one, I don’t feel the need to tell the parent. I want to find out why the kid is doing this and work on that issue. What if the kid is injecting heroin into his arm? I think I should tell the parent that. So if it is life-threatening I will tell the parent. I have covered this policy when I first start seeing the kid so he knows if it is life-threatening or really scary stuff I plan to help him tell his parent but I can’t keep that secret. I do say that little stuff, the kind of stuff most kids do. That can stay just between us.

So there you have some guidelines for what to share with your counselor and when. Hope that was helpful.

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