Tag Archives: Psychotherapy

Will therapy work even if you don’t believe in it?

Posted on by
10

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

Therapy

Therapy.
Photo courtesy of Pixabay.com

What is therapy and how do you know if it will work for you?

Interesting question, this came in as a search term and that always gets me thinking about what was on the reader’s mind and what did they want to find. As a therapist, I believe that therapy works, sometimes, for some people, but at other times people tell me that they went for therapy and it did not help them.

Why does therapy sometimes help and sometimes not? Maybe this depends on what therapy really is. I think there are ways it works and ways it doesn’t.

Let’s try some similar questions and see if it helps understand this dilemma.

Does gravity work if you do not believe in it?

Most of us would say a conclusive yes; gravity always works, at least here on planet earth. So if therapy is a force that produces change yes it should always work regardless of whether you think it will or not.

Do cars work whether you believe in them or not? If you just hang around them, but because you do not believe in cars, you never get in one, then no for you, they will not work.

If you think that therapy is a process of change; then for it to work you will need to do some work.  If you do not do the work, your disbelief will prevent the process from taking you anywhere. Disbelief will keep you stuck where you are.

We know that you do not have to be a therapist for what you to do to be therapeutic. We even talk about therapeutic environments. So if you have supportive friends who can listen to you and help you think and talk things out, that might be therapeutic.

The most effective therapy occurs when you believe that the therapist wants to help you and you feel comfortable talking about your problems. The short answer is that counseling works best if the client believes it will. But like gravity, counseling or therapy can work for you if you just temporarily suspend your disbelief and give it a try.

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

What if you see your therapist in public?

Posted on by
1

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

Counseling and therapy

Counseling.
Photo courtesy of Pixabay.com

What should you do – What should the therapist do?

Counseling or therapy is a very special relationship. It is also very confidential. One problem is what happens if you see your therapist out in public.

Mostly what happens is up to you.

Professionals are trained to avoid saying anything or doing anything that would identify you as a client in treatment. What if we see you and you are with your wife or girlfriend? Do you want them to know you are or have been in therapy?

What if you are at work and we come into that workplace? Do you want your boss or coworkers to know you are in therapy?

Since we can’t be sure, the customary practice is to say or do nothing, just walk right on by. The professional should not do anything to identify you as a client.

You, on the other hand, are under no such obligation. If you chose to say hi then we can respond and say hi back. If you chose to introduce us it is up to you to decide how to identify us.

While we can talk with you if you initiate the conversation what we do not want to do is start another dual relationship with you.

We can shop in a store where you work; to avoid your workplace would penalize you for being our client. We do not want to ask for special discounts or deals you can’t or wouldn’t make to other customers, which would confuse the relationships and run the risk of interfering with the primary relationship, the one between therapist and client.

So if you see your therapist out in public and they do not say hi do not take this as they do not like you or they are rude. Believe that they are pretending to not know you in order to protect your confidentiality.

Thanks to the reader who asked that question.

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

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

Posted on by
7

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

Fall in love.
Photo courtesy of Pixabay.com

Unconditional Positive regard or dual relationship?

Do counselors fall in love with clients? Do they like them and if so why don’t they tell them?

The role of emotions, feelings between the counselor and the client are complicated. Learning to juggle all those factors and keep the relationship between therapist and client in bounds is something every professional has to work at.

Here are the factors in play.

1. Unconditional positive regard

This is one of those “core conditions” that counselors are taught they need to exhibit for their clients. This can be summarized as – yes I accept you the way you are, feel you have worth as a person, and have a belief in your ability to grow.

In short, the counselor is supposed to like the client as a person.  What we do not always like are the things this client is doing.

If a counselor finds themselves disliking this client, judging them or wishing they did not have to see them, those feelings are likely to get in the way of therapy. So we strive to always see the best in our clients.

2. The need to be genuine.

It does not help the client much if the therapist lies to you. If we find a particular client annoying we sometimes have to address that.

We might need to let the client know, gently if we can, that this thing they do or say, we find ourselves getting annoyed when they do that – do other people get annoyed with you when you do that? This truth-telling has to be done in a supportive way but sometimes the client needs to hear the things we see that they may be blind to.

3. Is this about the client or the counselor?

Psychoanalytically trained therapists talk a lot about transference, the times that the client relates to their therapist just like they used to relate to someone else in their life.

I am an old guy it a gray beard. Clients have told me this reminds them of their dad or grandfather. We then talk about how was their relationship with that person and how does that affect the way they relate to others in their life now.

Sometimes I see a client and they remind me of someone I went to school with. I have to ask myself, did I like that person? Does the way this client reminds me of that person from my past affect the way I treat this client. We counselors might call this countertransference, seeing the client through the counselor’s past experiences.

4. Counseling is a novel relationship.

In the therapy room, we have this close, emotionally intimate experience. We try to help the client experience emotions they may not have experienced before or have not had for a long time.

The office is a sort of laboratory to try out new ways of being and relating to people and feelings. But the relationship needs to stay in the room not get carried out into the community. We keep it confidential so we can’t become best friends and hang out at the client’s house.

5. Counselors need to avoid dual or multiple relationships.

I wrote in another post about the dangers of trying to have two relationships with a client. It can be tempting, here she is, crying and feeling really bad and looking really cute or sexy. But if the counselor lets themselves move over into that developing a romantic or friendship relationship there is a risk of messing up the therapeutic relationship.

Every year a certain number of counselors get into romantic or other dual relationships with clients. Mostly these end up badly.

The client comes in for therapy because of an emotional or mental problem. It is a short hop from trying to help the client to becoming a predator when counselors forget their need to be a helper and get into a relationship where they are getting one of their romantic needs met.

So yes, counselors do often like their clients, and sometimes some feel like they are falling in love with the client. Professionals should not talk about their feelings except to be helpful to the client and they should not act on those feelings by creating a second “dual relationship” with clients.”

The counseling relationship is a special one and the focus needs to stay on the client and their needs. The counselor needs to get their needs met at another time and place.

Thanks to the reader who asked about this for suggesting a topic for this blog post.

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

How can you tell if a therapist is Christian or non-/Christian?

Posted on by
Reply

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

Religious cemetery.
Photo courtesy of Pixabay.com

Christian or Non-Christian?

When this question turned up in the search terms for my blog I had to think about this subject for a while.

It seems like a simple question, but it is not. After a lot of mulling this over, I concluded there might be four reasons the person was typing this into a search engine. If I knew what country it came from that might help, but then maybe not. Here are my thoughts for what they are worth.

Today in America a large number, possibly the majority of people, describe themselves as “Spiritual, not Religious.” When asked for religious preference, my experience has been that the majority of people here in my area will say “Christian” despite having no particular denomination in mind and not having attended services in a long time.

So what might this searcher have in mind by asking this particular question? I thought of four possibilities and they are below.

Remember in the course of this discussion, that counselors are professionals and they want to earn a living. They may prefer to work with a particular population, but most can and do work with people of all faiths. It would be considered unethical to engage a client in counseling and then move from helping them with their problems to trying to convert them to your particular faith. But sometimes that does happen.

So why would you ask about the counselor’s religion?

1. You want a counselor that shared your religious values.

If this is the case I think the question might need to be more specific. Many counselors include in their advertising that they are or practice “Christian Counseling.” Some additionally will advertise that they specialize in working with a particular denomination.

I have seen therapists include in their ads that they work with those of a particular faith, say Seventh Day Adventists, Mormons, or from a Fundamentalist Christian perspective.

If this is your concern, I suggest that you begin your first contact with the therapist by telling them you are a member of the “X” denomination and that you would like to find a counselor who has the same beliefs as you.

Most are likely to tell you that they work with clients of all faiths and that they see nothing in their approach that should conflict with your spiritual values. If you still feel the need for a counselor of a particular faith, say so and they should be willing to make a referral.

2. You are  “Spiritual” and do not want a counselor who needs to convert you.

In this case, avoid counselors who list in their ads a particular faith and tell them upfront that being pressured in a religious way makes you uncomfortable. Can they deal with that? If they say that they believe that your problems would all be solved if you just attended their church, mosque, temple, or whatever, move on.

3. You are of a non-Christian faith and are concerned about discrimination.

Counselors have a duty to maintain confidentiality. It is not just an ethical duty but a legal one also. You would think that they would all rigorously avoid talking about clients outside the session. I wish I could tell you that no counselor ever does this. Unfortunately, some do reveal the client’s secrets.

Every semester when I teach some student comes up after class to ask me about confidentiality. Way too often they have a story to tell about how they or someone they know went to see a counselor and then what they said got out.

So if you are a member of a non-Christian faith, ask other members of your faith who they have seen and see if there is someone who is open to working with you rather than focusing on changing your religious views. This also applies if you consider yourself Christian but your particular denomination has some different beliefs or practices that others might label “a cult.”

There was a time when counselors, especially those of particular religions tried to convert every Gay person to become a heterosexual. That has largely passed, there are openly Gay therapists and there are plenty of straight counselors who work with Gay clients without trying to change them.

I think there are lots of counselors who are willing to work with clients of any and all religions.

4. You are looking to find non-Christian counselors to warn others not to see them.

This reason for me is the most dangerous. I remember a time when there was a belief that no one would vote for or do business with a Catholic because they were “Popest’s.” I think we are largely past this issue since the election of President Kennedy. I do not think we are yet past this when it comes to some other religions.

The ability to find people of another religion and then discriminate against them because of their faith is one long-enduring feature of humans.

I think this last reason to want to know, the desire to punish those of another faith, was what prompted this particular search term use. The original form of the search was how can you tell when a therapist is non-Christian.

But then maybe I am just extra suspicious having been raised in a Sunday School where we were taught that our version of Baptist was the only true Christians and that those Southern Baptists had been led astray by the devil into false beliefs. But then what do I know?

The relationship between your religion, the counselor’s religion, and the needs of both of you to talk about religion or not talk, as a part of therapy, is just one more factor that influences the relationship between you and your therapist. And counseling is all about the 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

m.

4 Ethical Loopholes strangle therapists

Posted on by
1

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

Ethical loopholes strangle.
Photo courtesy of Pixabay.com

4 Ethical Loopholes Strangle Therapists – Part 1.

Therapists who violate codes of ethics harm clients; they also may lose their licenses or ruin their carriers. Often these ethical breaches start with thinking that there might be sometimes when it is OK to make an exception to an ethical standard.

Not following ethical guidelines can harm clients. Making exceptions to ethical codes can be fatal flaws.

Therapists are taught codes of ethics in school. We take exams that include questions on laws and ethics or may even need to take a separate law and ethics exam. Every few years most of us have to take a refresher course in law and ethics. Still, people violate these guidelines. Why?

Somewhere down the line, some professionals start looking for loopholes, exceptions to those ethical requirements. When they do this, put their head through that ethical loophole, too often they can get strangled and lose their licenses or lose the trust of their clients.

Four ethical violations seem to create the most problems for clients and therapists. Most of these violations start with the professional think that while this rule is a good one there might be times when someone, not them of course, but another therapist, might do this and that would be OK. Once you have been able to picture a time when there might be an exception to this ethical rule it is likely that you will cross that boundary and try to put your head through that loophole.

Most therapists think immediately about the ethical standard that says no sex with clients. They know that if you think that might EVER be OK then you are at risk to do it. While this is huge for therapists, it may not be the ethical violation that harms the client the most.

Here are the Big 4 ethical violations in their order of harm to the client

1. Not keeping what clients say confidential.

When I get away from other professionals, out in the community this comes up more than I thought it would. Look at the list of top posts on this blog. Month after month people search for information about what is and is not kept confidential. Unfortunately, I also hear too many stories about how a therapist told that client’s story somewhere, someone recognized them from the story and this has hurt them when a family member, friend, or boss found out.

Knowing that the way counseling helps is because of the relationship and that strict confidentiality is fundamental to that confidentiality, how do so many professionals cross that line?

The first stretch through this loophole often happens innocently. Here is a HYPOTHETICAL example.

The therapist is somewhere and is asked about a particular mental health disorder. “Is there any treatment for Trichotillomania?”

“Sure there is, the therapist says. “I saw a client recently with Trichotillomania. She has suffered a trauma and began pulling out her hair uncontrollably, almost unconsciously. I treated her using treatment “X” and she got better.”

So far so good. But the therapist wants to sound great, impress this person, and get more referrals. He or she is thinking maybe I should become the authority on treating trichotillomania in this town. So they go on to tell more.

This was a tough case you know. Her family is very influential in this town. Her father is a prominent politician in this town and he did not want this getting out in his district or it might affect his reelection campaign. That district on the “X” side of town is awful conservative.

Is there a problem now? Sure there is. This is way too much information and has identified that client to anyone who thinks about this for over 5 seconds.

One little story – what harm?

But the next time the story gets more elaborate and before long this clinician is talking about their clients all over. They even decide to warn their church group about that sexual offender that has moved in on the same block as the church. What harm can there be in helping people keep their children safe?

The harm comes first because they have violated that client’s trust and eventually someone will find out and then it turns major. The harm may also include attacks on that client. Sometimes that registered sex offender, the one that the counselor warned people about, what he did was when he was 18 he had sex with his 17-year-old girlfriend and her parents pressed charges. This couple since has gotten married but he could still turn up on a list of sexual offenders.

If this therapist has a private practice and people find out about this they may just stop going to see them. But if the clients are low-income and have to go to a government-funded clinic they may not be allowed to change therapists. They may just stop coming and they will be counted, not as victims of the system but as treatment failures and drop-outs.

You would think a profession like counseling would police itself. Not usually. The complaint in this situation is most effective if it comes from the client. But then the client already afraid because of the harm done to them, that registered sex offender or Muslim may be getting death threats at this point, probably just wants to escape the system.

Other professionals may hesitate to report this. It is their word against the others. Whistleblowers can and do get punished. Also because this happened to a client there may be minimal ways that this can be reported by another counselor without violating this client’s confidentiality again. All of these are ethical and practical concerns.

Oh my! I am past 900 words and have only talked about one of four ways ethical boundary violations hurt clients.

One caution here – Ethical guidelines are just that “Guidelines” not hard and fast rules. So any professional, at any point, is in danger and may have a problem with something. What I am talking about here are the big problems and the professionals who repeatedly break these ethical principles.

In the future, I want to talk about other ethical problems also. My plan is to talk about one of these problems each Friday for the next three weeks. This post was mainly aimed at counselors and would-be counselors, but then I thought others might be interested in the ethical dilemmas we confront.

Here are ethical issues number two, three, and four.

2. Thinking that it is OK to party a little. If you just chip on the weekends how can that hurt clients?

3. Dual Relationships, hiring clients to work for you, getting them to loan you money or loaning them money, especially getting into investments together.

4. Falling in love and getting into sexual relationships with clients. We all want to believe in Snow White and Prince Charming but if a therapist falls in love with a client who came to him with a mental illness, this may turn out more like a sexual predator than a prince.

Let’s look at these three problems over the next three weeks.

Since we are over on words today I will skip the links to other stuff, you know where to find me. Check the categories to the right for more on other mental health and substance abuse issues.

David Joel Miller, LMFT, LPCC

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

What if your Therapist loses their cool?

Posted on by
7

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

Therapy

Therapy.
Photo courtesy of Pixabay.com

What should you do if the therapist loses their cool with you in the session?

It was interesting to me that more than one search term included this idea of a counselor or therapist losing their composure with a client. Here are some basic thoughts.

Counselors like clients are people and sometimes they do things they later wish they hadn’t done. The way this gets handled depends on how far off the track the counselor has gotten.

Sometimes it’s the counselor that is inappropriate, sometimes it is the client.

If the counselor feels their buttons getting pushed, they are getting upset; this is most likely about the counselor. We, professionals, are all taught that in those situations we should get counseling for our issues, talk with our supervisor, or do other things to work on ourselves. What we should not do is take our problems out on the client. If we are unable to deal with our stuff and work with this client we owe it to the client to transfer them to someone who can.

Sometimes this thing that is upsetting us can be useful material for the counseling session. One way your therapist might handle this is to tell you that what you are doing or saying is getting them upset and then ask you “Do other people in your life also get upset when you do this?” This approach can be useful to the client to let them see how their behavior and statements are affecting others around them.

Talking about this issue is only useful before the counselor loses their cool.

If the counselor gets physical with the client and the client has not been physical first, that is not OK.  Counselors can be disciplined or even lose their licenses for acting inappropriately with clients. Yelling, cursing and other hurtful statements and behaviors are also not acceptable. These things are rare, or so I would like to believe, but yes they can happen.

Both parties in the relationship should always feel safe. If the counselor feels physically threatened then there needs to be some intervention to make them feel safe. Sometimes there is just a bad fit between the two people and the relationship needs to be changed.

The results of counseling are almost exclusively dependent on the relationship between the counselor and the client. Anything that damages this relationship harms the client’s progress. Counselors sometimes need to balance the need to maintain a helpful relationship with the need to tell the client the truth about how the things they say and do are affecting others.

Occasionally the counselor has done nothing wrong but the client does not like hearing what the counselor says and they become threatening or even physically violent.

Having an emotional or mental illness is no excuse for acting out and becoming physical with someone. If the client does that then the counselor may need to call the police and have that client arrested. We don’t like to do that, we use all our skills to de-escalate the situation and prevent the need for law enforcement, but sometimes it has to be done.

So if you have been in a situation with a professional who lost their cool with you, think carefully about was this about you or about them. If it was about you, while the behavior was not OK you can learn from it. If it was about them then it is probably time to change counselors.

If the prospect of changing providers is overwhelming take a look at a previous post here on counselorssoapbox.com where I talked about how to fire a counselor.

If this provider is not meeting your needs, is making you worse instead of better, you need to advocate for yourself and find someone who can help you.

Here is hoping that this helps those of you who feel that your clinician has lost their cool with you. If this has happened to you and you can share the event without harm to you consider telling the rest of us about your experience and how you have resolved this or are trying to resolve it.

Here is wishing you a speedy recovery and a happy life.

David Joel Miller, LMFT, LPCC

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

How do you fire a psychologist or counselor?

Posted on by
14

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

Therapy

Therapy.
Photo courtesy of Pixabay.com

Is it hard to say goodbye to your therapist?

There are several reasons you should say goodbye to a counselor and a few reasons you shouldn’t  Let’s look at these reasons first and then the how second.

Times you should stop seeing the therapist

1. If you have made the progress you need to make.

In managed care, we draw up a treatment plan. The goal is not a complete elimination of the symptoms. That would keep even normal humans in treatment forever. The goal of treatment should be to reduce the symptoms to a manageable level and to teach the client to be able to manage those symptoms in the future.

If your symptoms are under control and you feel you have the tools to live life without staying in therapy, you may be ready to move on. Ending this episode of therapy does not mean that you will never return to therapy with this or another counselor. It means that right now you don’t have a need to keep going to therapy.

2. If you are making NO progress.

Ethically a counselor should stop seeing you and refer you to someone else if they can’t help you. Sometimes we counselors want so much to be helpful it is hard to see when we are not the one that can help this client.

You’re bringing up the idea of ending therapy may come as a relief for your counselor who has been trying to think of a good way to tell you that you need to see someone else. Therapists do not want to abandon clients in need and it is hard for them to stop trying.

Sometimes a self-help group, peer counseling, or a friend support system is what you need just now.

Reasons you shouldn’t stop seeing this counselor

1. It is getting painful or difficult to talk about your problems.

Quitting therapy when the work gets hard or painful is a sure way to stay in your problem. When the work gets hard it is tempting to blame the therapist and change. It takes time for the new counselor to get to know you and you can put off really facing the issue for a while. This makes moving from one therapist to another tempting. Eventually, that issue will come up again and the pain is back.

Running from problems has kept a lot of people sick. Sometimes we use drugs and alcohol or romantic encounters. Other times people just change counselors. Either way, evading your issues will not get you better.

2. There will be negative consequences if you stop.

If you were court-ordered or need to complete the sessions to get your license back then stopping is a really bad idea.

If you are facing consequences as a result of stopping, think carefully before you do so. This probably means there are things about yourself you do not want to face.

How do you stop therapy?

There are oh so many ways but a few are more recommended than others. Counseling is all about the relationship and if you have been together with this counselor for any length of time you should have a good enough relationship to talk with them about this.

Most counseling relationships do not go one forever. Eventually, there will be a “termination stage,” to your counseling that involves the counselor preparing you to stop coming. If you bring this up the counselor should be willing to talk about where you are in the process, what else they think you need to accomplish and how you two will go about ending the counseling relationship.

If you have given this a try and the relationship is not working you owe it to yourself to tell the counselor that. Sometimes that discussion will result in taking a new approach and you will begin to make the progress you need to make.

With an independent private practice counselor, this can be as simple as saying no to another appointment and calling around to make an appointment elsewhere. If you have insurance that is paying for the treatment you should talk with your insurance provider about who else can see you and be prepared to give some reason why you need this change.

If you go to a large agency they may have rules and procedures for therapist changes. You need to ask how you go about doing this. While you may need to talk with a supervisor or administration about your desire to change you should always think of this as advocating for yourself and for the care you need.

If you find this especially difficult look for a case manager or patients advocate that can help you with the process.

Making progress in counseling is about finding a provider that you can develop a good working relationship with and then about doing work. Here is wishing you the best on your process of recovery.

David Joel Miller, LMFT, LPCC

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 your therapist cancels?

Posted on by
16

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

What do you do if your therapist cancels?
Photo courtesy of Pixabay.com

How should you respond to an unavailable professional?

One thing that counselors are supposed to avoid is “creating dependence” on the part of their clients. Our goal should not be to tell the client what to do but to help them learn what they need to learn to get through life. But many clients come to expect that they will get to see their therapist at a given time and place and they are likely to experience extra life difficulties when the counselor they are used to seeing is not available.

Some simple cases first.

The counselor is just not in the office today.

This problem is especially difficult for clients who have “trust issues.”
One thing counselors try to do is engage in a “corrective emotional experience.” You did not learn some things, emotional lessons, because the people you lived with did not teach you correctly or because when they did, you got the lesson wrong.

If when you needed a caregiver they were unavailable or abusive, you grew up insecure. Now to have your therapist do this to you is extra traumatic. Why does this happen and what should you do about it?

Begin by thinking about the counselor; this is probably about them not you. Counselors are real people and real people have lives. Unless you live with them, and then they should not be doing therapy on you, there will be times they will not be available. Your regular counselor may be on vacation, out sick, or may have had a family emergency.

This plays out differently in private practice than in a large agency. In private practice, the counselor does not get paid if they do not see clients. They have a lot of financial incentive to see you. They also do not routinely have co-workers who can cover for them when they are out. So they will make an extra effort to be there or to reschedule your appointment.

In an agency, you are the client of that agency not necessarily of that particular counselor. When one person is out sick then someone else should call you and reschedule or you may get assigned a new person to see you.

As much as administrators want high productivity, meaning keep everyone busy as much as they can, too many changes of provider are not good for a client. You see someone and then after telling them your secrets, they are out sick the next week. Do you really want to repeat your whole life story to a new person?

In an agency, people go on vacation, get transferred to a new department, move or change workplaces and sometimes they retire or die. The agency should arrange for you to see someone else.

In private practice, your therapist should make a plan for who you can talk to and who you will see if they are not available. If they are no longer available you can choose to find someone else.

What if you are in crisis?

Relying on seeing your counselor when you are in crisis is a bad idea. Most counselors either have a recording or an answering person who will tell you that if you are in a crisis situation you need to call your local emergency number first. In my area, this would be 911.

There may also be talk lines or crisis lines in your area. Sometimes there are peer support lines or “warm lines” that are very useful if this is not a full-fledged emergency.

In a crisis, the counselor can’t always be there and even if they were at some point this needs to move from their office to a place where you can be stabilized.

What if you have a problem, it is not a crisis but it is getting to you, you just need to talk?

Some therapists are able to take a few calls from clients when they are having difficulties. They can’t take every call, from every client, every day, or they become a phone counselor.

Consider if you can wait till the next appointment, does this conversation need to happen now? Also, consider if this is a crisis situation? Now if it is not a life and death situation and you have tried all the tools you have been taught to cope with this problem then this may be a time for using your “support system.”

One thing your counselor should be moving towards from the very first session is called termination. That is the point when you can manage your life, problems, and all, without needing to come to see a professional every week.

There are some people who do need lots of help; they may even need weekly sessions for a long time in order to keep them stable and out of a psychiatric hospital. But even then the provider should be trying to get that client to a place of needing professionals less and less.

The fastest way to take control of your recovery is to develop a personal support system.

That support system may be other recovering people or a support group meeting. For recovering alcoholics and addicts this may include a 12 step group meeting. It may also include family members, friends, or romantic partners. Sometimes this includes online support groups, which is fine as long as they are about recovery and not about other ways to keep your disease.

So at times, your provider is not available and you have determined that this is not an emergency, call or visit your support system.

Lastly, if your provider keeps canceling and rescheduling, consider whether you need to change providers. This is easier for people seeing private practice providers. They vote with their feet. If they don’t get what they need from the person they are seeing they make an appointment with someone else.

In an agency setting, you may need to talk this out with your counselor, their supervisor or request a transfer to a different clinician.

There is a lot more I could say on this subject but this is getting long so, for now, I need to close.

Here is hoping that this helped those of you who have been asking search engines about what to do if your counselor is not available.

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

Must psychologist report patient planning a crime

Posted on by
1

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

More about when the therapist breaks confidentiality Reader Question #1

Please with crime scene tape

Do therapists have to report a crime?
Picture courtesy of pixabay

Most of the time therapists, counselors, and psychologists do not report past crimes. If the crime may occur in the future, then we have a problem. How does the treating professional balance the duty to protect the public with the need to maintain a trusting relationship with the client?

In past posts, I talked about some of the standard exceptions to confidentiality. Things like child abuse or an intent to harm themselves or others. If the client tells me about a plan, to harm or otherwise abuse a child, or kill their partner and them themselves, I feel both ethically and legally bound to intervene and try to stop this. How I go about intervening may be a matter of my best “clinical judgment.”

But this planning a crime issue, that is tricky.

One thing every professional should do is have a place they can go to for legal and ethical advice. This is one of the reasons I am a member of both CALPCC (California Associations for Licensed Professional Clinical Counselors) and CAMFT (California Association of Marriage and Family Therapists.) Professional associations often offer services to answer or refer you to answers for ethical and legal questions. CAMFT has lawyers on staff who can answer these kinds of questions if you are a member.

So a counselor who is presented with this situation may well consult with a legal or ethical adviser. While doing this consultation they would use the minimum amount of information needed to get an answer. They should not give the client’s name or identifying info but only the nature of the crime the client says they might commit and then ask if they legally or ethically need to make any kind of report.

I mentioned also that it matters who is paying this counselor. If you go to a government psychologist and are planning on cheating disability by lying about your symptoms, that professional is working for the government and will report your effort as fraud. The point of the interview is to see if you are disabled. Even if your treating clinician does not disclose something you said they will not lie by leaving out things that would affect the decision someone else is making.

So what kinds of crimes can I think of that might need to be reported?

If my client was thinking of burning down a building or planting a bomb, I might need to report that and warn people near that building because of the high risk that someone would be hurt. If they were planning to set a fire and they shoot first responders, I feel that this is absolutely reportable.

We do encourage clients to talk with us about anything and everything so we can help them and I would want to try to help my client find other ways to accomplish their goals without committing a crime.

Generally, financial type crimes, writing bad checks, or cheating on your taxes, we don’t have to report clients for that. But we do want to work with them on why that lifestyle may lead to worse things. What a counselor should not do is help the client plan ways to get away with a crime.

One last exception to confidentiality no one ever seems to talk about is if the client is a terrorist. If they are plotting a terrorist attack, even if no person is likely to be harmed, the treating professional may be required to divulge that information. Homeland security can require treating professionals to disclose certain things.

But honestly, this is not a big problem for counselors; suicide bombers probably do not see therapists. Around here we aren’t likely to hear about any Homeland security related issues. There are not many terrorist attacks on cattle feedlots or vegetable growers.

Yes, I live in California, but remember that a large part of this state is a long way from the ocean.

Not sure that really answered the question, but I know that the worry about how much to tell and how much you need to hold back from your counselor is on a lot of client’s minds. If you can’t trust your therapist it is hard for them to be able to help you.

When in doubt ask the person you are seeing and judge by their answer if they will try to help you while staying inside the law and ethical guidelines.

This has been a general discussion of legal and ethical issues involved in a client and counselor discussing the client’s plan to commit a crime. Remember I am a counselor, not a lawyer and legal issues vary from jurisdiction to jurisdiction. For your specific situation, you may need to talk to a lawyer.

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

How does my therapist know that? Isn’t counseling confidential?

Posted on by
5

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

Is counseling confidential?
Picture courtesy of pixabay.

Did my last therapist tell?

This comes up a lot when people move from provider to provider. It especially happens when you see multiple people in the same agency. No not everything you told your old therapist will be kept secret from your new one. WHY?

Laws about confidentiality make a distinction between “Use” and “Disclosure” of information. If you are in the hospital anyone who is treating you needs to be able to look at your record and see what medications you are on, what procedures you have had, and what allergies you may have. Anyone who treats you in the future at that agency probably has the right to look at your old record and see what was done to you. The same applies to psychotherapy.

Everyone at the hospital does not get to look at anyone’s medical record just because they want to see it. The only reason to access a medical record should be for the purpose of treatment. People have gotten fired for looking up someone’s medical record just because they were curious. Even looking in medical records to see if a famous or infamous person was treated at your hospital can get you fired. But if you are treating a client you may need to know what is in their record.

Psychotherapists do and can share records and that is considered “use” not “disclosure.” Laws about confidentiality primarily relate to disclosure. Some of this has to do with law, for that see a lawyer. As a therapist though, I find this is an important issue to many of my clients and they need to understand how our system works.

It is considered good practice to separate psychotherapy notes from your general medical file. Everyone who treats you in the emergency room for an accident does not need to know about your marital problems.

We also don’t need a list of the names you or your spouse call each other. What the counselor wants to know is that you two are having conflicts and that you resort to name-calling with each other rather than problem-solving. One or two examples will suffice here. Long transcripts of the argument might be interesting in a movie script but they don’t need to be in psychotherapy notes.

Clients sometimes move from therapist to therapist. Sometimes clients want a new counselor, some therapists are known to “fire” clients for a variety of reasons. Ethically we should suggest a change of provider if we feel that we are not able to help a client. If your counselor retires, you may be assigned a new one.

When the client changes therapist, we do not, as a rule, start a new file. Would you want to go through all those tests and lab work every time you saw a different doctor? Same with taking a life history. It should be in your chart. The new provider should review your chart so they should have some knowledge of what your last therapist was treating you for and why.

Charts are needed to provide continuity of care as well as other reasons. Clients have told me they resent that the new therapist knows things they had not told them. They probably read this in the chart though they may have been briefed on the case by the last provider also. If the file moved to a new agency there probably was a release of information but at the same agency, the old paperwork still applies.

Personally, I like to meet the client first and form my own opinion about them, then review the chart. The risk is that the client will have to tell me something they just told the other counselor last week. The benefit is that in telling me again they may say something they did not say last time or I may ask a different question. A fresh set of eyes can sometimes see something new.

More than once after doing a new assessment I looked at the file and can see why the last counselor came up with the diagnosis they did, but having new facts I don’t necessarily agree with that opinion.

So yes, the new therapist may know something you did not tell them. That they were filled in by your previous provider is not a violation of confidentiality. Did you really want to have to retell your whole life history to a new person before getting down to the work of solving life’s problems?

The bigger question is why you would want to hide things from the therapist you are seeing now?  They will have trouble helping you if you don’t tell them what the situation really is.

The most important person for you to trust and get honest with is you. Some clients hide things from their counselor because they don’t want to face the fact that they have a particular problem.

The results of counseling are mostly about the relationship. We try to spend time upfront getting to know clients and building trust. Some clients have more trust issues than others. If you are not sure you trust your therapist, ask them questions. The names of their kids and their spouse are not important but their views on how to raise a child or have a good relationship might matter to you.

You should be able to rely on your provider to maintaining your confidentiality and not disclosing your information to someone who has no reason to know. Don’t expect one doctor or therapist to try to hide your symptoms from another professional who is treating you.

The bottom line? If you want help in recovering from your issues, whatever they are, you need to get honest with yourself and your counselor or find a provider you feel you can trust.

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