One problem limit – rationing emotional help

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Can you have too many problems to get help?

Ever feel like you are standing in the wrong line? You go to a place and ask for help only to be told we can’t help you with that problem you need to go someplace else. If you have a few too many problems you might get discouraged and stop trying before you found the place that could help you. You might die while waiting for help.

Systems used to be designed as if people only had one problem. You go to the specialist who handles that one thing. That almost never works, people have multiple problems.

So the system would try to sort people out by their problems. All the people with substance abuse problems go over there. You people with a mental illness you need to stand in that line. We had a line for everything. Lots of places still do.

People with co-occurring disorders, combinations of a substance use disorder and a mental health issue got used to this. You go to a treatment place for substance abuse and they tell you to go see mental health. You go to mental health and they tell you they can’t see you till you stopped using drugs. I would like to do that if only the depression and the voices in my head would shut up. So around and around you go.

So we set up a system where the mentally ill stand in line 1 and the substance abusers you stand in that line over there. The homeless go to another building and the unemployed go somewhere else. If you have a physical illness we send you to this doctor but if it is your heart you see the heart doctor and so on.

Most of us would like to think we are not like those people. We are not homeless or criminals. Until that day when you lose your job and then can’t find a new one.  If you stay out of work too long you might run out of money and have to choose between making the house payment and paying the registration and insurance on your car. But if you get stopped while driving to that job interview with no insurance or registration you might suddenly find yourself as a criminal. That might make you depressed and you might have a drink or two, maybe too many.

See how quickly these problems begin to add up. Multiple problems can be overwhelming to the person with them. They can also be too much to handle for the person who is trying to help them. I would like to help you but the agency I work for has rules and if you don’t do what I say you will not get any help.

One woman told me she was sorry for missing her therapy appointment last week, could I still please see her. Seems she was told by her welfare worker that if she did not come in that day they would cut off her welfare. The same day she got a call from the principal at the school telling her that her son was in trouble at school and if she did not come for a conference this afternoon they would be expelling her son.

Can’t understand why a kid who was sleeping on the floor at a friend of his depressed mother would be grouchy and argue with his teacher or end up in the office after talking back to that principal.

Now I don’t want to sound all negative, though some days that is more likely than others.

Some systems are making strides towards being more helpful and less territorial about controlling the clients. Substance abuse providers are offering mental health treatment and physical health facilities are providing substance abuse and mental health treatment.

Still, we have a long way to go before people who need help can get it wherever they go. As many of us have seen during this last economic downturn, anyone can be closer than they think to a whole list of problems.

SAMHSA talked for a while about the concept of “No wrong door.” That no matter which place you went, they should be able to help you and they should get you connected with the help you needed.

Then came this re-depression and we started locking doors.

Have you and yours been able to get the help you needed?

Care to share? What help have you needed? Has that help been easy to access or have you had to run from place to place and try to meet each program’s differing requirement to get services?

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

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

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

Talking to a Friend or therapist – part 2.

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

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

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

After rereading the question I think they were asking:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Best of Blog – May 2012

Counselorssoapbox.com

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

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

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

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

Best of blog for May

How much should you tell a therapist?

Are you Hyperthymic?

Why can’t we forget the painful past?

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

Is it Complex Grief, Depression, or Bereavement?

The best of blog all-time posts are

How much should you tell a therapist?

How does therapy help people?

Are you Hyperthymic?

Why can’t we forget the painful past?

Grandma is the drug connect

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

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