What are you wishing for? What is on your holiday list?

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

What is on your holiday wish list this year?

As we kick off the run-up to Christmas, the stores are getting busy. There are black-whatever deals and there are wish lists for Santa, mom, dad and the government.

Watching the news this season has made me wonder whether we should be so disappointed with what we do not have or grateful for the things we do have.

Are you saying that you need a newer larger house?

No Roof.

No Roof.
Photo courtesy of Pixabay.com

OR – Do you wish your house had a roof?

Are you griping about the electricity bill?

No Power.
Photo courtesy of Pixabay.com

OR – Do you wish you had electricity?

Are you carving Chocolate?

Empty Refrigerator.
Photo courtesy of Pixabay.com

OR – Are you carving some food for your children?

Are you wishing for more time off from work?

Unemployed.
Photo courtesy of Pixabay.com

OR – Do you wish you had a job?

Maybe this season we should continue to remember the lists we made of things to be thankful for and expand our gratitude lists at a faster rate than we add to our wish lists.

Staying connected with David Joel Miller

Six David Joel Miller Books are available now!

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: Some family secrets can be deadly.

What if your family secrets put you in danger?

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?

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Sasquatch. Wandering through a hole in time, they encounter Sasquatch. Can they survive?

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

Books are now available on Amazon.

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

For videos see: Counselorssoapbox YouTube Video Channel

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking, and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders, see my Facebook author’s page, davidjoelmillerwriter.

Rules for becoming a success

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

Keys

Keys to Success.
Photo courtesy of Pixabay.com

Rules for creating a successful life.

Following a few simple rules increases the chances that you will have a successful life. Keep in mind that it is important that you have defined what success means to you. Too many people have chased success only to find that the thing they had been chasing was not what they really wanted. If you are headed towards something that you call success these are some ways to arrive at that destination.

Having goals increases success.

Knowing where you are going helps you get there. If you aim at nothing, so we are told, you will hit it. You can travel all you want but if you have no destination in mind you will never get anywhere in particular.

Sometimes wandering has its place in your life. Going out and experiencing unexpected things can add variety and excitement to your life, but sooner or later you need to develop a plan, even if that plan is to wander and collect experiences, or you will wake up one day and find that you lived your life but are unhappy with how little you have accomplished.

Having a goal in mind, a goal that is consistent with your values will keep you on track to reach what you view as success.

Enjoying the journey is a form of success.

Successful people discover that the journey is the reward. Happy people enjoy doing the thing they are doing. When you love what you do it is never work even if others pay you to pursue your love.

Sometimes the journey will be difficult, it may be rough, but if you are headed where you want to go and you enjoy doing the things you are doing, the journey will turn out to have been well worth the effort.

Take good companions with you enlarges your success.

Many hands make the load lighter. Have you heard that one? It is true. Even hard work and trying times are more manageable when you are in the company of others that share your values and goals.

For more success keep asking how this could be done better.

Life is a process of growth.  Look for better ways to do things. Especially look for easier ways to do better things. A sometimes success is easier than staying stuck in the old ways you have tried and failed.

To reach success fail early and often.

Failures and mistakes are not optional. Successful people make lots of errors. They try and they learn from the trying. Try lots of things. Discover what works, what needs more practice and also learn to eliminate those things that were not worth the effort.

Succeed more by know when to give up.

Most very successful people have tried many things before they found the one thing that made them a success. If a business is losing money, change what you are doing or end it. Same with relationships. Some friendships can be repaired and some need to be left behind.

Don’t give up on things because they are hard because others tell you that it can’t be done or because you get tired. Do give up when you decide that this is not a good idea or will not be worth the price you had to pay to accomplish this goal.

Successful people do not give up before it is time.

Don’t stop making the effort just short of the goal. Do not quit college in the last year or stop playing in the last quarter. Put in the effort to see things through to a logical conclusion.

You may not win this game this time but the lessons you learn from seeing something through to the conclusion will be valuable next time. Did not get that job you wanted? Do not stop trying. Each interview should be teaching you skills to make the next one better.

Most would be writers have books tucked away in drawers or on hard drives that never made it to publication. The ones who succeed keep writing and presumably learn from those early less-than-adequate projects. The ones who stop, they never become writers.

To succeed put in the time and the sweat.

Big successes take a big effort. Give all you have. Some people have misread this principle to mean that you have to sacrifice yourself for your goals. You need to keep your life in balance. There needs to be time for self-care, your family, and recreation.

What putting the time and sweat in means is that when you are there be there. Give totally to doing your best while you are working. When you have unbudgeted time put that in on your project.

Very successful people make commitments to themselves and they show up and do the work fully at each of the scheduled times.

To succeed stop making excuses or blaming others.

If things are not going well, take the responsibility. Had a competitor with an unlimited budget opened up? Do not blame your failure on them. Look for ways to work around this or end this project and move on.

You had a great idea for a book about a boy wizard and a school for young wizards and they tell you that one has already been done? Look for some other great idea.

 Take calculated risks to succeed.

The best kind of risks to take are the ones where you go in eyes wide open, your homework done. but you see a way you can do better at this than others have done. Life has risks. You have to take chances. You can’t win if you don’t play. It helps to know if the odds are one in a billion or there is a 90% chance you can do this.

Rig the odds whenever possible. Get more education than others. Practice more hours. Develop better skills and better connections. Your support system, mentors, and your personal mental wellness all matter.

Look at things with a new set of eyes.

Do not try to succeed solely by working harder, longer and cheaper than others. Look for other options. Do something new, innovative and different.

Do not try to do and control everything – delegate, get specialists on your team.

No one has the time in life to develop skills in every aspect. Learning is great but so is recognizing when you need the help of experts. Trying to do everything yourself results in very small projects and little getting done. The most successful people know when they should do something and when they need experts.

See a lawyer, accountant, doctor or mental health professional. Do not wait for the breakdown to ask for help. Invest in education, financial soundness, and mental wellness and see how far you can go.

How is your journey to success going?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

How to have a highly productive life.

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

Productivity

Get more done.
Photo courtesy of Pixabay.com

Highly productive people, how do they do it?

1. Productive People Set Goals.

Life happens whether you are ready for it or not. Knowing where you want to end up charts your course. Productive people think about the end result they want. What will it look like when they have accomplished that goal?

2. Productive People Plan the Steps.

Goals are nice. Someday you want to own your own business or you want to be a professional athlete. What are the steps you would need to take to move that plan into reality?

Break that goal up into the steps you will need to take to get there.

What skills will you need to learn? What will you have to practice? Most importantly, what other pleasures will you need to forgo along the way. Lots of promising, talented people fade between the start and the finish because they get distracted by the pleasures of the moment and forget to do the work needed to get where they said they wanted to go.

3. Spend more time doing than planning.

Planning is needed. So is preparation. But if all you ever do is dream, the dream stays in your head and does not materialize in reality.

Once you have that goal set and know the steps to get their make sure that each and every day you are doing something, no matter how small that thing is, that will move you toward your goal.

4. Evaluate what you are doing.

The best plans do not always anticipate the changes that happen in the world. Circumstances change, plans do not work out or they need to be modified.

People with very productive lives periodically reevaluate their plans. They know what is working and what is not working. They also reevaluate that goal. Is that goal still where you should be headed?

5. Adjust plans as needed.

Be open to modifying plans when it is clear that you need to do so. Do not make frequent changes out of insecurity and doubt.

That career you planned on in high school, those occupations may not exist. Technology changes, demand changes. Your plans may need to change with the circumstances.

6. Get advice from a coach.

When you are out there doing, you can’t see the things you are doing well or the things that need improving. Top athletes work with coaches who can spot flaws in their performance.

Working with a good coach can take your efforts to a whole other level.

7. Have a plan B that flows from your plan A.

If you plan to be a professional athlete what happens if you don’t make the team? You can keep trying, but eventually, the dream meets up with reality. Even those who do reach that goal find that they can’t go on being a professional forever. What happens to you if plan A does not work out exactly the way you planned?

College athletes are well advised to get that degree and develop their other talents. After your career as an athlete, long or short, what will you do? With a degree, you can teach. Maybe coach. Your options remain open.

8. Always be looking for the next step.

Periodically you need to look off into the distance. What is the next step in your development? When you get this goal accomplished what then?

Many people set goals, achieve them and then lapse into a depression. Their one reason to exist is over. Now what?

9. Do not be easily discouraged.

In attempting anything there will be setbacks. Expect setbacks. Plan on having failures. Learn from those obstacles and perfect your skills.

Learn and practice your skills along the way and you will find that you were able to accomplish much more than you expected. Do not quit before the miracle happens and if you continue to work you are bound to experience some miracles.

10. Do not let obstacles stop you.

If one obstacle causes you to give up you will not get much done.  The more you accomplish the more the obstacles. Learn to climb over them. Sometimes you will need to change course and go around them.

An obstacle is a chance to improve what you do and how you do it not a permanent defeat.

11. Learn something new each day.

Add to your knowledge base. You never know when something you learned will turn out to be useful in the future. Do not wait till you are desperate for an idea to go looking for one.

Many innovations have been the result of taking something that a person had learned in one field and applying it to another area. Be that creative person who can synthesize and create new and novel approaches.

12. Build a team by being a team player.

Most highly productive people have a team that they can depend on that backs them up. Develop that team by being a team player. Get along with and value others around you.

13. Maintain your mental health.

Take care of your emotional health. Do not let things discourage you. Do not become overwhelmed with anxiety.

In the area of mental health, prevention is important. Have a support system. Learn ways to manage your stress and when those problems of life overwhelm you get help.

14. Treat your body well.

The mind depends on the body for its fuel and energy. Eat well, sleep well and play frequently. A healthy body is far more productive than an impaired one.

15. Get a support system for you non-work life

Great producers at work have good lives outside of work. Many a work problem originated at home and was brought to work. If you want a productive life do not neglect your non-work life.

16. Know your work type.

Every job has its characteristic work type. If your personality fits the job you will be more productive and happier. Happy people are more creative and productive.

Look for projects that fit your personality and try to avoid taking on projects that will make you unhappy.

Keep these productivity principles in mind and work towards becoming more productive each day. Over time you will be pleased to see how much you have gotten done and how much your life has improved as a result.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Tips for Surviving Hard Times.

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

Surviving a rough road.
Photo courtesy of Pixabay.com

How do resilient people get through the hard times?

Life is hard sometimes. People get sick, lose jobs, relationship break up. Things can get really tough. Some people get discouraged, fall into episodes of anxiety and depression. Other people are able to bounce back.

If you have depression or anxiety and it is holding you back, consider getting professional help. Resiliency, that ability to bounce back from life’s challenges is a skill that you can develop or improve. Here are some suggestions of things you can do to get through those life challenges.

1. Do not spend time thinking about how bad things are.

When you get knocked down one common reaction is to spend lots of time thinking about your set back. How did this happen? What could I do differently?

Ruminating, that endless rehashing what happened to knock you down can keep you stuck in the down position. Use this time to look for the solutions not to endlessly remind yourself how unfair things are.

Sometimes life is unfair. Sometimes things happen that should not happen. The difference between people who find their lives ruined and those who go on to overcome is all about attitude.

2. Accept that life has its ups and downs.

This is a real life. Things do not follow those storybook plots. Everyone has setbacks. People who were “instant” or “overnight” successes often spent years practicing. Many successful people failed several times before they discovered the thing that they were good at.

More than once an athlete has stumbled and fallen only to get back up and complete the race. Sometimes they were able to win despite that fall.

If you stay down you create your own defeat.

3. Do not catastrophize.

We, humans, have the ability to exaggerate things in the extreme. The student fails one test and begins to tell themselves that they will never pass another test. They will fail in school, “never” get a good job and “always” be poor.

Do not fall into “black and white thinking.” People are not either winners or losers. No one wins everything every time. One setback does not make you a loser. Slip into those mindsets and you lose out on the successes you have had.

4. View setbacks as opportunities to improve your game/

Highly resilient people look at setbacks as a lesson learned. If you fail at something you may need to change your approach or change your game.

Winners practice the skills they are deficient in. We all like to do things we are good at but those who look at their errors as chances to improve take their game to a whole nother level.

5. Start by changing yourself.

It is less painful to blame our tough times on others, on the economy, our ex or an unreasonable boss. The highly resilient person knows that spending time on why things are others faults will not change things. Most of us have tried our whole lives to make others change to suit us.

Every teen tries to change their parents. Wives try to change husbands and husbands try to change wives. You may have some small successes in getting others to change but the great lesson in life is that if you change yourself that forces others to alter the way they interact with you.

It is always easier and more productive to look at how you can alter your thinking and behavior and as a result, produce a better outcome.

6. Do not waste time insisting things be your way.

Things do not always go our way. Continuing to insist that things “must” or “should” be some particular way is a waste of your time and energy.

This does not mean that you have to accept bad or hurtful situations. Stop insisting things change and change yourself, your reaction to things and your behavior.

If you do not like the way things are going stop complaining and start taking action.

7. Sometimes not getting what you want is a good thing.

Many times in life we will not get the things we wanted. Or we get what we wanted but not when we wanted them. That just may be a good thing.

Getting one job may keep you from continuing to look and finding a better one. Often a failed romance will result in meeting someone else that is an even better match.

8. Some losses are an inherent part of the cycle of life.

Not every loss is a good thing but it may be a necessary thing. As we age we lose things. We can’t walk as well or lift as much. People, friends, and relatives leave our life. Some through death and some just drift away. These losses can be painful. They can also be an opportunity for growth.

How we handle the loss of our parents becomes a model for how our children will cope with losing us.

9. Do not confuse the journey with the destination.

Most of us do not start out life wealthy, successful and accomplished. Life is a journey. You grow and develop or you become stuck and decline. Do not despair because you are not where you want to be. Keep moving forward and you can be amazed at how things can change.

Recovering people often despair in those early days of reaching the goals they believe they should already have met. Over time they can accomplish more than they ever dreamed.

10. See the good in your current situation.

Not working right now? Does this mean that you can spend more time with your children or spouse? Not in a relationship at this time? This may be your one and only time in life to learn who you are and to have time just for yourself.

11.  Notice the small pleasures.

If you are crying because you do not have a rose garden you miss the pleasure from the one flower you do have. Enjoy your friends, your family, and your leisure. Relish what you can buy rather than bemoan that you can’t afford the best or the most expensive.

12. Love and accept yourself.

You are a worthwhile person simply because you are you. Do not despair because you compare yourself to someone else. There are always other’s with more. Remember that they may also be unhappy and struggling. Do not envy what others have unless you know what they had to give up and go through to get there.

If you really know what sacrifices that other person had to make to get where they are you might not want to make those efforts.

13. Give yourself credit for the things you accomplish.

One sure way to stay stuck in failure is to attend only to your errors. Whatever you focus on you get more of and eventually if you keep looking for the failure your brain will create more disappointments.

To build resilience, to really improve your ability to bounce back from adversity, learn to give yourself a round of applause for each and everything you accomplish.

Cumulatively a string of small victories can add up to a major victory. Anything you accomplish is a win. Make sure you mark those things you do well down and hold onto those memories so they can carry you through the hard times.

14. Aim high but be happy with all your accomplishments.

We humans have a decided tendency to be unrealistic in our expectations. Some of us aim so low that we never miss the mark. The trouble with aiming at nothing is that is precisely what you hit – nothing.

Other of us aim so high that no one, not even a superhuman could reach that mark. Then when we fail to hit that sky-high mark we alibi our failure by saying – well what did you expect.

Resilient people aim high but are pleased with whatever accomplishments they achieve. Practice these ways to cope in times of stress.

What other techniques have you found that help you bounce back when life knocks you down?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Emotional healing takes several tries

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

Emotional healing.
Photo courtesy of Pixabay.com

Emotional Healing.

Some pain and trauma are just too intense to get past the first time around.

Getting over things is a process. Some things need time to heal. It is hard for others to sit and watch you suffer but sometimes you just need that space to get past it. What you can’t do is pretend it never happened and hope the pain will go away.

People come for counseling and they expect the pain to end right away. It can’t always happen that way. We find that pain, from trauma or grief and loss, take time and repeated attempts to get better.

Clients who have suffered a severe loss, someone close to them has died, find it hard to talk about that person at first. In the beginning, it is mostly about the pain of the loss and the tears.

Over time, the process of recovery is like the way you might peel an onion. You strip away an outer layer and then you cry. Then as your tears dry you strip away another layer. Eventually, you reach the core.

In the early stages of grief, all you can feel is the pain. What can happen if you keep working on the process is that with time you can let the pain recede and begin to remember the good things, the treasured memories, you have of that person.

People mean well when they tell you to just get over it but what they often do not understand is that getting over it is a process, not a destination. Some things in life we never get over, not completely, but we can reach a place of peace with what happened.

In counseling, we find that to push the client to talk about things before they are ready can cause more trauma rather than aid healing. Some clients come for a while, go as far as they can, and then go off to live their lives for a while. Some find that they need to return to continue or finish the process. Others have the drive to get the painful part over with as soon as possible. You may find that the pain keeps reminding you that help is needed and you can’t let it go until you finish the project.

Either way I hope that if you are feeling the pain of a loss, a death, a trauma, a life disappointment, that you will find someone to work with on this issue that helps you move through the pain by leading you along not by forcing you to go faster than you are ready to go.

Therapy should heal the emotions not create new wounds.

If you are only part way along in your healing process, keep moving forward and know that eventually, you can reach a point of finding the meaning in the loss. Not having someone now should not take all those happy memories from you. Having suffered a terrible trauma need not rob you of your future.

The road of recovery can be difficult, but recovery is worth the effort.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Does smoking cause mental illness?

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

Does smoking cause mental illness?
Photo courtesy of Pixabay.com

The evidence is starting to pile up that smoking may be a cause of some mental illnesses.

We have known for some time now that the mentally ill were heavy smokers. Those with psychosis, schizophrenia, in particular, are frequently two pack a day or more smokers.

We also have seen studies that report from 44% to over 50% of the cigarettes consumed in America are consumed by those with a mental, emotional or behavioral disorder. Alcoholics and Drug Addicts are frequently heavy smokers.

Fully one in three adult smokers has some form of mental illness.

What most researchers have been reluctant to conclude is that smoking may be the cause of some of these mental illnesses. That is beginning to change.

One problem with the past studies has been the way the samples were drawn. A survey of the population can tell you how many people have a mental illness and how many smoked, but not which caused which or were they both caused by some third factor like poverty or trauma.

One particularly convincing study was done in Norway (Petersen et al. 2008.) They have good data on who was treated for what and why. This study was able to follow a large sample of youth beginning at age 13 and lasting 13 years until they were 27. They looked at who smoked at age 13, when they started and the results. They were also able to follow the person’s health and mental health treatment.

This longitudinal study allowed them to compare those who had a mental illness at age 13 with those who did not and those who smoked at age 13 with those who did not. Their data tells us that those with an early onset of mental illness were at high risk to become daily smokers with a nicotine dependency.

What was more startling was that those who had no mental health diagnosis at age 13 and smoked were more likely to develop a mental illness. The smoking appears to have preceded the development of the mental illness. Even more, evidence that a mental health issue is caused by not is the cause of, smoking was found in the effects of levels of nicotine dependency.

Those youth who were heavy smokers (nicotine dependent) developed more mental health problems regardless of the age at which they first started smoking. Someone who became a heavy smoker at age 20 with no history of mental illness was at high risk to have a mental illness at age 27.

Further evidence of the connection between smoking tobacco and mental illness comes from a study from South Australia (Bowden et al., 2001) which found that the more severe the level of mental illness the more likely the person was to smoke. The most seriously mentally ill had a smoking rate in excess of 51%.

This leads to the inescapable conclusion that smoking increases the risk of developing a mental illness in addition to the physical ones we already knew about.

How might smoking be increasing these risks?

One way smoking may increase the risk of developing a mental illness is Nicotine’s effect on the serotonin regulation in the brain. Nicotine impairs the serotonin function of the brain. Low serotonin has been postulated to be a major factor in Major Depressive Disorder. Selective Serotonin Reuptake Inhibitors (SSRI’s) that slow the breakdown of Serotonin and thereby increase the levels of serotonin in the brain are commonly used to treat depression. One antidepressant is also currently being marketed to help people stop smoking.

But there is more.

Smoking reduces the levels of oxygen in the bloodstream and the brain. This reduced oxygen is a factor in the presence of chronic pain and now appears to also be a factor in increasing depression and anxiety.

Social factors may also account for some of the difference in depression in non-smokers versus smokers. With societies shift to preferring nonsmokers, there are restrictions on smoking in public places. Smokers are finding it harder to get jobs and to be able to get off duty during the work day to smoke.

Not having a job, having few social friends and being socially undesirable all add to the reasons a smoker is more likely to be depressed than a nonsmoker.

In future posts, we will explore the connection between smoking and specific mental illnesses and look at how and when you should quit if you want to maximize your mental wellness.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Who should treat mental illness?

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

Who should treat mental illness, where and how should it be treated?

The mental health field is changing. A host of events and forces have intersected to influence our feelings on the proper response of society to this thing we are calling mental illness. Lots of things are happening or about to happen in this mental health field.

Here in America, the very ground underneath mental health treatment is moving.

In 1900, here in America, less than 10% of doctors had ever been to college. Until 1914 drugs were legal and you could openly buy them anywhere. As late as 1950 there were no meds to treat mental illness and those who were given a diagnosis could be tucked away first in barns and attics and later in sanitariums.

The talk therapies are just past their hundredth birthday and many people have still never been to see a therapist. Three months ago more Americans were without health care than there were those who had coverage. The few who did have health insurance here in America did not have coverage for mental illness or substance abuse. Treatment of these disorders while improving is still not on an even footing with most physical illnesses.

Less than a year ago the American Psychiatric Association released the new DSM-5 which redefined, reclassified and altered our understanding of what is and is not a mental, emotional or behavioral disorder. The new version of the International Classification of Diseases is due out soon which will change the field of treating mental health problems also.

This alteration in the landscape of the treatment of mental disorders is not solely confined to the United States of America. Blog readers and commenters from all over the world are asking similar questions and telling similar stories of their efforts to recover from an emotional or mental problem. They are also telling tales of less than helpful services.

The very mention of mental illness can evoke some pretty strong emotions. Some cultures, religions and even professions still are denying the existence of such a thing as a Mental Illness.

People leave comments and they send me emails. The comments of every reader of counselorssoapbox.com are valued. Some of them I answer briefly as soon as I can. Others require longer blog posts to give them the space they call for. A few are so angry or personal I have hesitated to approve them.

Some of you have left comments or sent me emails about how we are doing things here in America and how that might differ from the way things are done in other places. I have been having an interesting ongoing conversation with Ellen in the U. K. about how they do things there. I will fill you all in on that discussion as soon as possible.

Let me offer this invitation to all of you out there to share your experiences and how the mental health delivery system works in your part of our planet. I will share my clearly limited perspective from here in Fresno, California, one of the more diverse places in this United States of America. I feel sure the view of the mental health landscape will look a lot different from other points of view.

We should be talking about how we have been treating mental illness, how we should be treating it and how we get from where we are to where we need to be.

That discussion also implies some understanding of what “mental illness” is and how people develop a mental disorder. What a mental illness is, implies a view of what causes it, how it progresses, how to treat it. The view you take of this phenomenon also influences your view of the possibility it could be cured and if so how.

Knowing what mental illness is and what needs to be done about this leads us to the answer to my first question about who should be treating this problem.

We also have the added problem that no matter how sure we are of causes and treatments we need to know who is going to pay for these efforts. How treatment is delivered is strongly controlled by those who handle the money.

Let’s take a look at some of these questions and together see if we can find some solutions.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is a Licensed Counselor?

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

Therapist

Counselor. 
Photo courtesy of Pixabay.com

What is a Licensed Counselor?

I wrote this in response to a question from U. K. on how our mental health system works. It has since occurred to me that one major difference between the U. S. system and those in other countries is the funding source. When you have a national health care system most of the expenditures are paid for by the government so if you get on the list and can provide services or you work for the government you get paid. The government can have some amount of control over quality.

Here in the U. S. most service is paid for by the individual directly or indirectly through the purchase of insurance. No money or insurance and you may get no services. This requires the government to regulate who can open an office and then sell medical or psychological services.

We have a licensing system for most professions so that just anyone does not open up an office and then start doing surgeries which kill people before they get sued and have to stop. The point of licensing is to control entry into a profession and ensure some minimum level of consumer protection.

Here then is the somewhat edited version of my reply to her question about how we do things in the American Mental health system.

Thanks for the comment. Interesting question. It had not occurred to me that there might be such differences on the U.K. Now I am thinking that given the number of readers of counselorssoapbox.com from countries other than the U. S.

Most of this has to do with our legal and governmental system. Not being either a lawyer or a politician. (We do not have separate Barristers and Solicitors but combined most of what they do into one group – lawyers who are also called Attorneys, and sometimes counselors in the sense of legal counselors.)

This whole area is a bit complicated.

Regulation of professions is left to what we call states. Each of the 50 states may have their own law or some may not require a license to practice a particular profession. So in one of our states if you graduate from a school with a degree in counseling you may be able to open an office and charge people for counseling. In another, there may be strict regulations on the quality of your degree, your internship and your experience under another professional before you can get a license. If a state has high standards other states may accept that license. People who come from states with no or low standards will find that if they move to a state with high standards their background may not allow them to practice that profession. For example, if you became a doctor in a third world country many U. S. states will require that person to do more work and take more tests before they can become a doctor in that state. The big states like New York and California generally have the highest standards.

(With the health care expansion this year the ability to bill federal programs may alter this thinking a bit.)

In California, we have 29 separate codes and the one of those that regulates counselors and other professionals is called the “Business and Professions Code (BPC.)”

In the BPC there are sections for each regulated profession. Contractors have a section, hairdressers and so on. Doctors and nurses have their own section also.

In the mental health field in California, we recognize a number of professions.

Psychiatrists are licensed as Medical Doctors.

Psychologists are licensed by the board of psychology

The Department of Health Care Services, Alcohol and Drug Programs licenses drug and alcohol programs but not drug counselors. So the programs have a set of standards on who they can hire.

The Board of Behavioral Sciences licenses Clinical Social Workers, Marriage and Family Therapists and Professional Clinical Counselors.

Without a state-issued license, you may not practice a profession except in a few places specifically listed in the law as “exempt settings.”  (Schools can hire school counselors who do not have to be licensed.)

The goal of this procedure is to protect the public from people who do not have the training and skills doing work that might harm or cheat the client. This process also gives clients some redress for wrongs short of a suit in court.

The law sets out the specific things you need to do to be issued a license. And each profession has their separate list of the things they can do and the requirements to qualify to do those things.

For example:

A Professional Clinical Counselor would need to possess a Bachelor’s degree (4 years), in most any subject, or take some remedial classes called prerequisites, to enter a masters in counseling program. They would then need to complete and graduate from an accredited or approved Master’s program (5th and 6th-year college.)

After graduation, that person must register with the Board of Behavioral Science (BBS) who evaluated the education they have and if it meets the board’s requirement the candidate receives an intern number.

From this point on the prospective counselor is required to be supervised by a licensed person until they receive their own license.

They must accumulate a total of 3,000 hours of supervised experience.  There are some complicated rules on what counts and what doesn’t count and how much supervision they need for each hour of client contact.

When they have accumulated those supervised hours, the applicant submits the paperwork to BBS and if this is approved they are eligible to test. In my own experience, I took first a long test on specific questions to show that I understood the process of doing therapy, the laws and the ethics and so on. If you pass that first test you then return for a second test in which you are given stories (vignettes) and you apply your knowledge to answer questions about Howe you would work with these people.

If you pass both tests you are then sent an application for a license.

At each step of this process, you pay a fee for BBS to handle your paperwork.

Once you send in your approved application and pay the fee, if all has gone well you will be issued a license to practice Professional Clinical Counseling in California. You can then work for someone else or open your own office.

But it does not end there

Every two years you will need to complete a certain number of approved continuing education classes, and pay a fee to renew your license.

After the first two years of being licensed, you can take a class and then you are eligible to begin supervising newly registered people.

So do things operate differently in the area in which you reside?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Do counselors have to follow ethical codes?

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

If a therapist does not belong to a professional group do they have to follow an ethics code?

There are a lot of rules about the relationships between a client and the treating professional. There are things that the professional can do, can’t do, has to do and is required to not do. Sometimes these rules get confusing for the professional as well as the client.

Recently a situation came up in which a professional was not a member of any professional organization, so the client left that visit with the impression that this professional did not need to follow any ethics code. This report of a problem left me thinking we need to talk about some of these codes of ethics and why a professional would need to follow them and what happens if they do not belong to any organization.

Turns out there may well be a time when a mental health professional needs to follow the standards of a code of ethics even if they chose to not belong to the professional organization. More on that later in this post.

To be a mental health professional you need a license in the jurisdiction in which you intend to practice your trade. Joining a professional organization does not allow to practice this profession. So while all professionals are encouraged to join a professional group some choose not to be members.

Here in the United States of America, the various states license the various mental health professions. Not all states license the same professions. There can be states that allow a particular profession to practice even if they do not issue a license to that profession. For example “Life Coaches” are not licensed anywhere I know. They can do all sorts of coaching on how to have a better life. What a Life coach should not do is treat a person for a mental illness if the state in which they are practicing requires that license.

This situation of when and how to follow a code of ethics is made more complicated by the multiplicity of professions and professional licenses. There are Licensed Social Workers (LCSW’s and ASW’s), Licensed Professional Clinical Counselors (LPCC’s and PCCI’s), Licensed Marriage and Family Therapists (LMFT, MFT, and MFT interns.)

Here in California, we make it even more complicated with 9 or so different registries for Registered or Certified Substance Abuse or Drug and Alcohol Counselors, each of which presumably has their own code of ethics. Here is the code of ethics for CAADE, the program in which I teach is CAADE accredited.

Recently all these registries came together to create a Uniform Code of Conduct” for California’s substance abuse counselors.

The code of ethics varies depending on your profession and the particular organization you belong to. So someone could belong to several organizations (I do), one organization or no organizations.

What if there are contradictions between the various codes of ethics? What if the professional decides to not join any group to avoid having to worry about ethical behavior? We have come up with some principles to handle those situations.

California was the last state to grant licenses to Professional Clinical Counselors. Most Licensed Professional Clinical Counselors (LPCC’s) belong to CALPCC. The exact name of the counseling professional and the specifics of what they do can vary from state to state. Many California Counselors may also be members of the American Counseling Association (ACA.) In this case, the problem was easily solved. CALPCC adopted the ACA code of ethics.  

California was the first state to licensed Marriage and Family Therapists (originally called Marriage, Family and Child Counselors.) There are more MFT’s in California that the rest of the country combined. (LMFT, MFT, MFCC are all the same thing.)

The California Association for MFT’s (CAMFT), which has members from a bunch of other states and even some other countries, is larger, so I am told, than the American Association of Marriage and Family Therapists (AAMFT.) Both of these groups have their own codes of ethics.

The Social Workers, mostly belong to the National Association of Social Workers (NASW), which has its own code of ethics.

So now we can look at problems with which code to follow if you are members of more than one group, and what happens if the counselor tries to duck ethical behavior by not being a member of any association.

Let’s use an easy to understand example for this.

Can a counselor date and have sex with a client? If so how long do they have to wait to do the dating-sex thing?

For starters no behavioral health profession I know of thinks it is ok to have sex with a current client. That is taking advantage of a weak person and frankly sounds predatory.

The rule for substance abuse counselors is that they must wait 3 years after the client stops attending their PROGRAM (not just after no longer being their client) before they can date that former client.

Now, this substance abuse counselor decides to go on and become a professional counselor and while in school they join a professional counseling association. The norm in these groups is that you have to wait 5 years before dating a former client.

Now say this same person decides to become a Licensed Social Worker. The rule for the NASW is the professional may NEVER get sexually involved with a former client.

So which waiting period does this person need to observe 3 years, 5 years or never?

The rule is that you observe whichever code of ethics has the HIGHER ethical requirement. So, in this case, the answer to how long to wait would be forever.

Can this person get out of this bind by not being a member of the Social Workers Association?

Not really.

Most licensing laws require the professional to follow the customary ethics of the profession whether the professional is a member of that group or not. See if most other professionals think it is unethical then that behavior is probably illegal also.

Even if that behavior, dating or some other “dual relationship” is not outright illegal, should the professional get into that sexual relationship and then break up with that former client, they might get sued and in that case, code of ethics or not, the former client will probably win.

So the bottom line is that professional should always adhere to the highest possible standard of ethical behavior whether they are members of a group or not.

Just not belong to a professional group does not allow you to do things the rest of the profession thinks are unethical.

Hope that helped explain this ethical issues problem. If you are not sure, you may need to contact the appropriate professional association and remember the client should be contacting an attorney or making a complaint to the appropriate licensing board if they think the professional harmed them.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is a Therapists Scope?

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

Therapists and Counselors need to remember what is in and what is out of their “scope.”

In school, every beginning counselor is taught to pay attention to scope issues. It is not something that we talk to clients about very often. Somehow, a while out of school, a lot of professionals forget about this issue. One reason it is so hard to keep clear is that there are in fact two different “scopes.” Recently a reader commented about their therapist mentioning something as being out of their scope. That comment suggested this post.

Counselors need to remember both their scope of practice and their scope of competency.

1. Scope of practice.

Scope of practice is defined by the law in your jurisdiction. If you get an MFT license you are allowed to do some things, a Licensed Professional Counselor does certain things, an LCSW has their set of allowable things and so on.

This gets confusing sometimes. We professionals know for example who can do certain kinds of testing and who cannot. The clients do not usually know this and may come to a professional for something that their license does not allow.

In cases like that, we should always refer clients to someone who can help.

A social work license does not allow you to cut hair, or do tax returns, for example. The Therapist or social worker may have been trained as a beautician before becoming a social worker and they may have done tax returns to help pay the cost of going to school, still that Behavioral Science license does not allow them to do those things with their therapy clients.

If a person has two different licenses, say they are lawyers and they are therapists, there are all sorts of rules about what they have to do to keep those two professions separate so as not to confuse clients as to what they are allowed to do and not do.

Every group has a code of ethics and that may influence what a professional does or does not do, but scope of practice is largely a legal issue defined by the law that permitted the licensing of that profession in the first place.

In a future post, I want to tell you about codes of ethics, who has to follow them and why.

In many places, coaches are not licensed. That means that those who call themselves life coaches do not need to have had any training to do coaching. What the life coach should not do is treat a recognized illness like Major Depressive Disorder. They can help you with say “motivation.” But if you have low motivation because of your depression that is outside their “scope of practice.” They would need to have a license as a counselor, therapist or social worker to treat a mental illness.

2. Scope of Competency.

To become a licensed counselor, social worker or therapist there are certain classes everyone needs to take. The typical program at the master’s level would include about 60-semester college units. Some programs might go up to 65 units, some programs include only 45 units. Most classes are 3 units so that means about 20 classes. If they take a few 1 or 2 unit classes they might get up to say, 25 classes.

The beginning mental health professional would get a class in how to diagnose and a couple of classes in how to treat mental and emotional problems but with over 400 recognized mental, emotional and behavioral issues in the DSM-4 no one ever gets much training in working with specific issues in their program.

For example, a substance abuse counselor in a two-year (A.S,) program would take 36 college units in drug abuse counseling. Most licensed people LMFT’s, LPCC’s and LCSW’s will get one to three units in Substance abuse.

So if you only had a one unit class in counseling the drug dependent, say that was a one unit class one weekend, that person would not feel very competent in working with someone with a drug problem.

Many of us had at most a few minutes discussion of eating disorders and Dissociative Identity Disorder and Body Dysmorphic Disorder probably were not talked about at all in a therapist’s formal training.

So while a person may be licensed as a particular mental health professional they may realize that they just do not know enough about the disorder that the client has to be able to work effectively with that client.

We call this lack of skill in a particular disorder or technique something outside the therapists “Scope of competency.”

Most mental health professionals will find they do more studying, read more books and attend more trainings after graduation than they have done in their master’s level training programs. If you do not continue to study and learn, more and more things will turn up that are outside your scope of competency.

There are ways to expand your scope of competency. Get more education and training in a particular disorder or technique, work with a supervisor or consultant who is knowledgeable in the area and do more supervised experience in that area. Some professionals do all that and over time grow their scope of competency. Others may decide that they will restrict their practice to the problems they feel competent in working on.

So if you have a relatively common problem, say depression or excess anxiety, most professional counselors can help you. But if you have a more difficult problem, substance use disorder, eating disorders or many of the trauma-related disorders you may need to seek out someone who understands and knows more about your issue.

Hope that explains the very basics of scope of practice and scope of competency.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.