|
|
Answers to Common Questions Asked by People
Considering Counseling/Therapy:
- What good does talking do?
When it comes
to seeking help for personal problems, talking isn't really
'just talking.' In psychotherapy it is a unique means by
which we share,
(re-)experience, and 'process' many thoughts and feelings.
These in turn may
be associated subconsciously with a much larger reservoir of
emotions and memories, many long-forgotten, that are playing
a role in the current situation.
These may include "irrational" or contradictory thoughts
or behaviors, patterns
of self-defeat or failure, or of "messy relationships that
don't work out", etc.
The therapist provides a particular kind of listening,
reflecting, and responding to you that, together, are
intended to help you understand yourself and the things
troubling you in a new way. You come to feel "unstuck" and
more empowered to handle your life more effectively in the
future. While past events cannot themselves be changed,
their impact on us, and our reaction to them, can be
altered.
|
- What is the difference between "counseling" and
"psychotherapy"?
These terms don't really have technical definitions
because they are used loosely in conversation and can mean
different things in different contexts. In many settings the
terms are used interchangeably.
For the resolution of specific kinds of problems for which a
highly focused
psychoeducational approach may be most useful, some people in the mental health
field have recently developed a "life coaching" format for some
situations. Most coaching skills are actually the
traditional skills of the social work profession. Insurance plans do not, however, cover
"coaching" since a diagnosis does not apply.
|
- What is the difference between a "psychotherapist"
and a "psychiatrist"?
"Psychotherapist" is a non-technical term referring to a
mental health professional who uses primarily "talking
treatment" to explore and understand
emotional/psychological concerns. The New York
State-licensed psychotherapist has been trained in one of
three disciplines: clinical psychology, clinical social
work, and psychiatry.
Generally speaking, clinical psychologists are
especially knowledgeable
about various areas of research and about cognitive/learning
and attention deficit problems. These may in some cases
require special knowledge in
neurological and other medically- related fields. The
particular specialty
associated with clinical psychology is psychological or
neuropsychological testing
which works as
a kind of "xray" into the functioning of the mind
& the personality.
Testing helps clarify
diagnosis which, in turn, can provide a basis for their
recommending the
modality(ies) of treatment or other interventions that may
be needed. Licensed clinical psychologists in NY have
one of two degrees: PhD or PsyD.
The clinical social worker comes originally from a
tradition of focused short
term treatment with specified goals and ready utilization,
if needed, of a broad range of ancillary services. The
clinical social worker (to be distinguished from all other
"social workers") also has training and experience in
addressing a broad range of emotional problems. In addition
to the treatment of individuals and couples, clinical social
work has traditionally specialized in the treatment of
families. Many clinical social workers have had a good deal
of advanced clinical training in psychotherapy,
psychoanalysis, DBT, cognitive-behavioral approaches among
others. In New York State the most advanced
credentials in clinical social work are the LCSW (Licensed
Clinical Social Worker) and the BCD (Board Certified
Diplomate).
The psychiatrist is a medical doctor with specific,
advanced training in
psychiatric and neurological disorders, medical symptoms or
illnesses that
likely have a psychological component, and in prescribing
medication for
certain psychological problems such as disabling anxiety and
depression.
It is mainly the psychiatrist's knowledge of medicine and
psychopharmacology (medication) that
distinguishes her/him from other psychotherapists.
Regardless of their discipline (PhD, PsyD, LCSW, MD), experienced psychotherapists generally practice a
combination of skills and
approaches that they have learned from their training
and clinical experience,
typically in collaboration with the other mental health
disciplines.
|
- What is meant by the term "mental illness"? Does
seeing a therapist mean I have a "mental illness"?
No, seeing a psychotherapist does not imply a "mental
illness." This term generally refers to the severest
and most debilitating disorders or
illnesses of the
mind characterized by a significant inability to
distinguish reality from
unreality, as occurs with delusions and hallucinations, or
severe mood
disabilities that leave the person "out of control". Many of
the mental
illnesses can be very successfully treated with psychiatric
medications. But
people with "mental illness" are a relatively small
minority, while most people experience varying
degrees and types
of life-transitional or relationship issues, concerns about
symptoms, various emotional conflicts and losses. In
addition to influences such as culture and, for some
illnesses and personality disorders, suspected genetic
factors, many struggles come out of the "human condition".
|
- How confidential is the information that I give
the therapist?
A licensed mental health professional observes strict
standards of
confidentiality which means that nothing whatever, including
the simple fact
that the person has consulted the therapist or is in
treatment, can be
disclosed to anyone or any party without the person's signed
consent. The
only exception to the fixed rule on complete
confidentiality would be in the
rare instance that a client's life, or someone elses' life,
is in imminent
danger. (This one exception is NYS law.)
However, claims procedures within all of managed care
contradict the stated intentions of HIPAA regulations on
privacy. I discuss this with any patient wishing to
use her/his insurance benefits, and no information about a
person I am treating is ever entered into a computer.
|
- What is meant by "different forms of depression"?
Depression is manifest in many different ways. These differences are
determined by variations in the person's personality, culture,
earlier
history, and current place in the life cycle, as well as by
biological or
genetic factors. A depression may be the main problem to be
addressed,
or it may be part of another medical or psychiatric illness.
Examples of
these are bipolar disorder, post-traumatic stress disorder, and
chronic
fatigue syndrome. If a person has had an earlier experience with
depression, sometimes it can help clarify the nature and diagnosis of a current
depression.
It often comes as a surprise when people learn that there are
several different kinds of depression and that each may require a
different treatment approach. In fact, it is important that a
"depressed" person learn from the psychotherapist her/his own form
of depression and the treatment indicated. Sometimes
there can be more than one kind of depression at the same time, or
different forms at different times in their life. This is why
the evaluation of depression can be so complicated. Unlike
medications for common forms of anxiety or problems with sleep, I
usually prefer that anti-depressant medication(s) be prescribed
by a psychiatrist or psychiatric nurse practitioner rather than a
primary care physician.
Depending on the severity and nature of the symptoms, psychotherapy
can
be the treatment of choice, especially at the outset. However
sometimes
antidepressant medication needs to be considered either in the very
beginning or at a later time in treatment. The therapist can make a
recommendation but the decision to take or not take medication is
always
the patient's.
- Does psychotherapy make you dependent on it?
Psychotherapy does not "make you dependent". Concerns about
needing therapy in the sense of "allowing oneself" to become "stuck"
in it come from within the person's own personality and it is an
important part of the treatment to understand the meanings and
origins of these concerns. Actually, the goal of psychotherapy
is to resolve the difficulties that bring a person into treatment,
and to develop greater understanding of her/his feelings and
behaviors, so that the person can live a freer and more gratifying
life without treatment.
- Is there anything I should do to prepare for my initial
consultation?
The only thing it would be helpful for you to do prior to meeting
the therapist is to review carefully your insurance coverage for
mental health benefits, e.g., benefit limits, whether there is
coverage for out-of-network providers, the amount of your co-pay,
any deductible, etc. This will save you a good bit of time in
the initial visits with the therapist.
- Can you be required to go into treatment?
Occasionally someone with "unresolved problems" is "forced" to go
into treatment in order to keep their job or stay in school, for
example. Typically a kind of surveillance is set up, such as
requiring the therapist to confirm intermittently that the
appointments have been kept. This is "policy" in several contexts,
e.g.,employers, school administrators, and court judges.
There is a good deal of naivete in this practice, for several
reasons. First, "requiring" either the client or the therapist to do
anything automatically undermines the treatment because there is a
conflicting agenda other than fully-confidential self-examination.
Only a consultation or evaluation can be mandated, but this is not
treatment, and it is essential to maintain this distinction. Also,
people for whom treatment has been mandated often keep appointments
only to appear to be in compliance with the order, while the real
goals of therapy are avoided. The ony way to determine whether there
has been authentic change in a person's attitudes, behaviors, and
self-control is to require a followup evaluation with a qualified
mental health consultant (not the therapist). This can be required
at a future time, such as when the person wants to return to work or
school, or wants their parenting rights restored.
|
