Tag Archives: Psychotherapy

Should your therapist tell you what to do?

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

Do therapists and counselors tell people what to do?

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

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

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

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

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

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

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

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

How therapists try to tell you what to do anyway.

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

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

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

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

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

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

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

When should a counselor tell a client what to do?

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

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

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

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Is money keeping you from getting emotional help?

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

Cash

Money.
Photo courtesy of Pixabay.com

Is the cost keeping you from getting help?

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

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

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

The cost of relationship counseling.

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

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

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

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

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

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

Counseling for substance problems.

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

How might you make therapy more affordable?

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

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

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

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

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

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

But there is more, therapy may be FREE!

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

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

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

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

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

10 ways to get emotional help without money

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What will happen if I go for therapy?

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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 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

Top counselorssoapbox.com posts for Sept 2013

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Counselorssoapbox.com

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

Well, the month is not quite over but here they are the most-read posts on counselorssoapbox.com for the last 30 days, just in case you missed one.

How much should you tell a therapist?                     

Levels or types of Borderline Personality Disorder               

Do therapists have to report a crime?            

Hyperthymia, Hyperthymic Personality Disorder and Bipolar Disorder                   

Do people really forget what happened when drinking? – Blackouts                       

Which border is Borderline Intellectual Functioning on?                  

Reasons Counselors and Therapists Lose Licenses               

Are you Hyperthymic?                      

6 ways to recover from Complex Trauma or Complex PTSD                       

Is nicotine a stimulant or a depressant?                     

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

Can you force a teenager to go for therapy? 

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 you talk to your therapist on the internet? Online dual relationships

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Online dual relationships.

Computer

Internet.
Photo courtesy of Pixabay.com

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

Update.
This is an older post from 2013. As a Rural result of the COVID pandemic counselors and therapists have had to learn to do a lot more online, distance counseling work. This post reflects the thinking back in 2013 but I feel sure the use of the Internet in counseling will continue to grow, and change in the future.

Has the internet changed relationships between clients and therapists?

A member of an online group to which I belong sent in this question

“Is it ever proper for a life coach or therapist to invite their clients to an online group, or for a client and therapist to be in the same group, or work on online projects together?  Can that cause a lot of problems?”

How this affects life coaches and how it might affect therapists and counselors are miles apart.

This is a problematic area for therapists and counselors. We are taught to avoid “Dual relationships” with clients. Some of these issues are pretty clear, dating, sex, borrowing money, and so on. Some dual relationships are easy to see and clearly, can cause problems.

The goal of avoiding dual relationships is to avoid harming the client, once you see the client outside the office there are risks for the client and the therapist.

We do not want to do or say things outside the office that identify this client as a patient in a mental health treatment setting. Sometimes there is just no way of avoiding the client when we are out in the community, so in those settings, most therapists will not say anything to the client and wait for them to say something first. That way they do not identify this person as a patient.

The smaller the town the more the risk of a second relationship. I live in Fresno; my clients live in Fresno, so far no problem. They shop at the same grocery store as I do.  I do not need to stop shopping there but I do need to not make the first move to say hi and especially we do not talk about their therapy in the store.

Then let’s say I go visit a new church. I run into a client there. Now can I talk to them? Maybe. I do not think I need to avoid churches or schools or civic organizations because my client might attend. What I do need to avoid is getting into a close friendship relationship with a client.

What happens when we both belong to a local group, say, NAMI and then we end up on a committee together? This may begin to create problems. I need to remember what they said in therapy and keep that separate from what they told me at the group meeting.

In that kind of situation, I might consider not being on the committee or ending therapy with the client so we do not have two separate relationships going. At this point, no matter what I do there are ethical implications. Dropping a client to be on the committee is a problem, being on together is a problem, telling the client they can’t be in this group is a huge problem.

Therapists need to consult.

Once these problems begin, or that possibility crops up, we therapists should get an opinion from our colleagues, maybe from a lawyer, and we may talk this over with the client.

Some therapists try to avoid these things by not joining or attending meetings, but you can only go so far with that before you give up your right to have a life.

Some therapists have tried to avoid these problems by not being online or having a social media account. While this may prevent some problems it can create others.

The hard part is keeping all your separate roles or “hats” separate.

Lots of therapists teach classes. We may see current or former clients there. I do trainings, Mental Health First Aid for example. Good chance that a former or current clients could show up there. I do not cancel the class or throw the client out of the training because they have seen me for therapy, but it can be a challenge if they start asking questions and I know this is an issue we have worked on in therapy.

The internet has changed all that.

Millions of people all over the world are now connected. I can run into clients current and former and not even know it. So we need to work on making sure that while we all engage in those activates nothing I do might harm any client’s current past or even a potential future client.

So here are some suggestions for both therapists and counselors and clients on the multiple relationships that can form on the internet. Let’s get specific with this reader’s questions.

Is it ever proper for a life coach or therapist to invite their clients to an online group?

Therapists should not be maintaining email lists of clients and then start mailing anything to them. If they happen to subscribe to my blog or a list of trainings or classes I treat them just like any other subscribers, not like clients.

For a client and therapist to be in the same group or work on online projects together? 

If they join a group and I join, so be it. I do not suggest this as a rule but if they are interested in homelessness and so am I, then I might give them the information about an online group. What they do with that web address is up to them.

Working together on an online project sounds like something I would not do until a lot of time had elapsed between them being a client and the project. If I had a client who was a web designer I would not pull out his file and call him for some help on my website.

If someone who worked with me got a list of designers and called him, then next session I would need to discuss this with him and we would need to decide if we were going to end therapy or he would not be able to also be working for me.

Can multiple relationships cause a lot of problems?

Yes having multiple relationships can cause lots of problems. I do not let that keep me from writing a blog or teaching classes but I am always looking out for these possible conflicts and avoiding them whenever I can.

Therapists and clients do run into each other, in the community and on the internet. The rules are essentially the same.

Do not get into a second relationship that will harm the client. Do not do things to identify them as clients or to violate their confidentiality and treat you various roles professionally and appropriately.

About life coaches.

There is no licensing for life coaches that I know of. Some have taken classes, anything from a one hour webinar on up. Some join coaching associations and they may or may not have codes of ethics. But coaches do not get confidentiality and you get no privilege in talking to them. They can say and do what they want and they may engage in all sorts of multiple relationships. If they hurt you really badly you have to sue them. It is common for coaches to keep mailing lists of former clients and to keep trying to sell you things and they can use your name or story in their materials or trainings. While there are some good coaches out there, coaching is not meant to help you with emotional problems that might include a mental illness.

I am sure that this will not be the last time we need to look at how the internet, blogs, and social media are changing relationships and how that might affect clients and therapists, but at least it is a start.

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 therapists tell the police?

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

What will your counselor tell the police?

Short answer – Almost nothing!

For counseling to work, you need to talk about what is troubling you. For you to be able to talk like that, we professionals need to make it safe for you to do so. Enter the concept of confidentiality. What you tell your therapist is mostly confidential and may also be privileged patient psychotherapist’s communication.

There will always be someone who thinks we therapists need to protect society and tell something or other. Say you tell the therapist you are scared because you are driving without a license. Do we call the police about that?

No way. That does not happen in any place that remotely resembles a democracy or a republic, probably not in a lot of other forms of government either.

So how come the police sometimes show up at your door anyway? What did get told to them and how?

Sometimes a situation is so very dangerous that the police get notified.

Your house is on fire, the neighbor calls the fire department, and here come the police to control the crowds and traffic. I suppose some people get caught doing something illegal, like running a meth lab, because the police arrive at the fire and they find it. But the neighbor did not report you to the police, your secret slipped out because of the fire.

A similar thing happens when you tell a therapist about a very dangerous situation and we need to figuratively call the fire department.

There are certain things we just have to report, mostly to try to save lives.

I have talked about exceptions to confidentiality in a few other posts. Still, this topic continues to show up in questions and search terms. So, here is some reiteration specifically about exceptions to confidentiality and the police.

A danger to yourself is an exception to confidentiality.

If you plan to kill yourself we have to report that so you get help. This is not just a wish or thought, we should check if you are just thinking of dying, or are you planning to kill yourself and when?

We call someone to get an ambulance and take you to a psychiatric hospital. Usually, the police get called to manage the situation.

Do you get a police record for this? Generally no. Not unless you are breaking some other law, like shooting at the police when they try to take you to the hospital.

Danger to others gets reported.

If you are planning to kill someone we need to prevent that. This is not just doing something reckless. This is planning, intending to hurt others. This can get complicated. If you plan to burn the mall down while it is packed, could people die? So yes that sort of thing, in most places gets reported.

Abuse of a person that can’t protect themselves gets reported.

Child abuse, Elder abuse, disabled person abuse has to get reported. The goal here is to get the abuse to stop. But as in the care of the fire exposing your meth lab, stopping the abuse may leak out the fact that you have been committing a crime.

Sometimes these reports go to child protective services or adult protective services. In some areas, these reports go to the police department to check out.

Therapists only keep your secrets if they are your therapist.

If you see your doctor in the grocery store, don’t rely on his opinion of the produce. He is not being a doctor when you talk to him.

If the judge makes you talk to a therapist or CPS sends you to one, check if this is going to be confidential or if their report, warts, meth lab and all are going to the judge.

Even here consider the therapist is not calling the police on you. But if the judge gets the report on your mental state and you casually mentioned a couple of murders you did, the judge may be required to pass that on to the police.

So most things, even past crimes, we therapists do not report to the police. Honest, that is the last thing most of us want to do. Because once we make that call you stop trusting, stop telling us things, and then we can’t help you.

But occasionally because of something that we are required to report, some of your secrets could slip out. We do not necessarily call the police, but once we tell others to protect you or society that information is no longer strictly confidential.

When in doubt ask the therapist to tell you more about confidentiality. And if you have secrets that need to come out, let the therapist help you with the telling in the right way to the right person.

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 your daughter’s therapist be talking to you?

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

child

Child.
Photo courtesy of Pixabay.com

When should your child’s therapist include you in the conversation?

Sometimes the therapist should be talking to the parent and sometimes not.  Which is which and what factors are in play?

The child’s age.

If your child is 4 then yes, most of the time the therapist should actively engage you in the conversation and in participating in the process of therapy. You need to be a part of what is going on. You are with the child 24 /7 and you will need to do things to maintain any progress that is made in therapy. Mostly, if the child is young, the parent needs to be involved. Most of the work will focus on helping the parent to manage this child’s symptoms in the home environment.

When your child is older will the therapist talk to you?

What if your child is 44? Sorry folks, I know that you parents think of this person as your child, you care about them and want to help them. But once they pass 18 they get privacy and confidentiality. Unless they are severely disabled and you are their only caregiver it is unlikely you will be included in the conversation at all. Even then most of the conversation will stay confidential between the client and therapist. Your child will need to tell you what you want to know or you will not get the information.

Between four and 18 years of age the “including parents” part gets iffier. The older the child the less that parent will be included in the therapy.

The more the parent pushes to know every detail of what the child is saying in therapy the more this intrusion can interfere with making progress. As the parent pushes more to control the therapy we therapists also get progressively more suspicious.

I love it when the parent cares about their child and wants them to get well. But the parent who insists on being present at every session and wants to know everything that the child says and the therapist does – what is up with that?

Is the parent the solution to the child’s problem or the cause?

Most therapists have stories of parents who seemed overly interested in what their child said in therapy. One reason this happens is that the parent is the cause of the problem.

Parents who are abusing their children are afraid the child might talk about that abuse. Some parents have their own secrets they want to hide, drug use, alcoholism, criminal activity, all manner of things.

Even if the parent is not the proximate cause of the problem, the family’s situation may be what is making this child depressed. Most parents want the conversation focused on the child and they do not want any discussion of the domestic violence or other problem behaviors that take place at home. Some parents do not want the therapist to find out that one parent has been missing for a few years in prison or that there has been a whole string of step-parents.

When parents are present, or when the child thinks the parent will hear what they say, they don’t talk about the embarrassing things.

Most kids do not talk about the pressures to have sex or the urges when parents are present. They know what their parents have told them about drugs, alcohol, and sex. They also know what the parents are doing in these areas and that what parents say and do are often at odds. So lots of embarrassing things get left out of conversations when the parent is present in the therapy room.

The fear that the parent will disapprove or the risk of embarrassment should the parent know what is going on might keep the child from talking about things that really need to be discussed.

Even that fear of failing algebra may not get talked about with mom in the room. The kid knows mom will just rag on them to study more rather than hear that this fear of failing algebra is giving them test anxiety and making it harder to finish the test.

Therapists help families through role changes.

During those late teen years, the parent’s role moves from protecting the child to teaching them how to make choices and learn from their mistakes. Parents, if your teen’s problems are severe enough to need the services of a professional then you probably will not be involved in the discussion until the teen has worked the problem out.

One thing a therapist should do is help the teen work up the courage to tell their parents what is wrong. Sometimes we even facilitate the teen telling the parents embarrassing things.

Many a child is surprised to find that when they do work up their courage and tell the parent this secret, the parent is more understanding and supportive than the teen expected.

Lots of problems could be worked out if a family could just talk about the issues in a supportive; “we are all in this together” atmosphere. But for family’s who can’t do this or have lost the ability to talk with each other, there are professionals that can help.

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