I am not sure if this counseling thing is for me….
You may have considered talking to a counselor or therapist many times but were never sure. You might have wondered what happens when you talk to someone about your fears, loneliness, and concerns. The best remedy for uncertainty is information. So let’s review some of the commonly asked questions and concerns and I will provide the best information I can on what you can expect in your first sessions.
What is the difference between a “counselor”, a “therapist”, a “psychologist”, and a “psychiatrist”? Does it matter?
The difference between a counselor and therapist is a fuzzy one at times. I use both terms as do many other professional helpers. In Kentucky, however , there are state laws about the use of certain titles such as “Licensed Professional Clinical Counselor”, “Licensed Clinical Social Worker”,” Licensed Professional Art Therapist”, and “Licensed Marriage and Family Therapist”. No one can use these titles/credentials unless they have met Kentucky legal requirements for education ad passed professional exams.
Beyond this most mental health professionals, myself included, work in a similar manner. We assist folks who are struggling with life issues to find relief and live healthy more productive lives. Licensing does require some special knowledge/expertise for each group. Marriage and Family Therapist do tend to have more experience and knowledge of working with families and couples. Professional Counselors have more exposure to education and career development. Social Worker are trained to be more tuned into social issues that may be impacting clients including economic issues and community issues/resources. Any of these professionals may give you questionnaires or other worksheets to fill out in the course of your work together. These are typically designed to help you understand yourself better and are not “psychological testing”.
Confused yet? A more important difference comes with “psychologist” and “psychiatrist”. In Kentucky a psychologist must have a doctoral degree in psychology and be licensed to practice. Psychologists perform many counseling tasks but they are also the only mental health professionals allowed to perform psychological testing such as IQ tests, psychological profiles for disability, and competency evaluations. Psychologist do not prescribe medicine or perform any kinds of medical procedures. They typically charge a higher rate than Master’s level mental health professionals.
Psychiatrist are medical doctors who have completed specialized training. Psychiatrist rarely provide counseling or talk therapy more than the time spent in managing medications (unfortunately this often due to the restrictions placed by insurance companies and other managed care systems). Psychiatrist prescribe and manage the medications prescribed for anxiety, depression, etc. No other mental health professionals are allowed to provide or give you directions on medications. Counselors and therapist may make recommendations concerning medications but you will need to consult a MD before stopping or starting any medications!
Some insurance companies will only pay for professionals with certain licenses- Licensed Psychologist, Licensed Clinical Social Workers, Licensed Marriage and Family Therapist or Licensed Professional Counselors. If you are using insurance check to see who they will allow.
Will you think I am “crazy”? Will they have me locked up?
Simple answer in both cases is “No”. As an experienced therapist I have worked with a large number of individuals, couples, families, and groups. I am continually amazed at how often people underestimate their health and strength- how often they are too critical of themselves and their efforts to cope. You may be caught in self-defeating even harmful behaviors and you recognize that this has to be addressed. In our meetings we will talk about the risks you are facing and the best options for managing these. Hospitalization is the last thing we would consider and then only if there is a clear danger of harm to yourself or others- suicidal or homicidal thoughts or urges.
If you are using insurance or an Employee Assistance Program to pay for your services, I will be required to submit a ‘diagnosis code’ from the Diagnostic and Statistical Manual (DSM-IV) in the same way a medical doctor must give a diagnosis when you see them for a cold or a sprained ankle. You will have the right to know what code was submitted and why it was chosen. The diagnosis code is in no way intended to be a judgement or a label. It is a requirement of working in a managed care environment.
You may not want to have a mental health diagnosis listed in your insurance records. The best solution in that case is to pay ‘out-of-pocket’. In this case the focus of your counseling can be kept confidential. You may choose to pay out-of-pocket even if you have insurance.
Will I be ‘drugged up’ or told I need some kind of medicine?
As a Licensed Clinical Social Worker I cannot prescribe or give you medications- only a MD/psychiatrist can do this. I will give you my best information on medications when it is appropriate. Even then you will need to consult your doctor.
That being said, if you are suffering from anxiety and/or depression there is relevant information available about using medicines to gain relief from all those symptoms that make life so difficult at times. The most relevant research shows that by comparing medication and counseling the results show almost an equal effectiveness over time- e.g. people find they feel better, have less problems with moods with medication and/or counseling. Granted this is not the last word on the subject by far- research is ongoing and medications and methods of doing counseling are changing every day. More importantly each individual is unique. There is no “one size fits all” around this question. You may have to try different things to find what works best for you.
Again- I am not a doctor nor do I play one on TV. Given that- what follows is my best experience in dealing with folks who have used medications and not used medications over the years. For better or worse most of all our medications these days work better as “shotguns” rather than “rifles”. More often than not medications will ‘hit the target’ in relieving symptoms but they also hit a lot of other areas that may not need to be hit- those ‘innocent bystanders’. This is typically what we refer to as “side effects”- dry mouth, headaches, weight gain, reduced sexual performance, etc, etc. To what degree any person is affected by side effects and/or find medicine helpful seems to a matter of individual chemistry and metabolism. There is little way to be sure before you try.
For most folks I have worked I have found a general trend as far as medications go. You are likely to find quick (but not immediate) relief from some of the most nagging symptoms of depression and anxiety- poor sleep, thoughts that you cannot turn off, crying, etc.-through taking medications. These symptoms can be relieved through counseling but the progress is typically slower. With medications most folks have reported that they feel “better” but they do not feel truly “relieved”. Counseling and work on your own to change your thinking, behavior, and emotions over time will be necessary to truly find long term relief. There are no “silver bullets” in medicine or therapy for relieving anxiety, loneliness, depression, or shyness.
Will I be asked to answer questions even if I am not comfortable doing this?
During the first meeting you will have the opportunity to decide what you would like to focus on in counseling. It will be important to give me as much information as possible in order to understand what needs to be addressed in counseling and how sessions should proceed. You can refuse to discuss certain areas if you cannot comfortably do so. I cannot guarantee, however, that progress will be made if trust cannot be established. What you share in counseling is confidential and will not be shared with anyone without your written permission except- as mentioned earlier- you report a risk of harm to self or others.
What happens in a counseling session?
When you come in for your first session you will be providing information including some written forms that will help decide what is the best direction for session. Usually we decide on one issue, fear, or concern to focus on for the next two sessions or so. You have wide range of thoughts, memories, and emotions to sort through. It is best to start small and take things slowly.
I use a variety of methods in my counseling including talk therapy, writing, drawing and painting, and practice activities- any of which you may take home and work on at your own pace. Anything you write or draw is yours to keep if you wish. I may keep a copy for the time we are working but will not keep this after you leave counseling with me.
If I start counseling does that mean I have to keep coming? What if I don’t feel comfortable?
Counseling is your choice. You can begin or end it whenever you want. Keep in mind that since you may be talking about thoughts, feelings, and memories for the first time you may find the process difficult at times. A key thing I remind folks of is that dealing with problems is uncomfortable-it always will be. However, each time you approach the problem you will likely find that it is less upsetting and it takes less time to find a solution. Coping is like bike riding- the longer you do it the better you get.
Now, sometimes a client and I will decide that we are not a good match. In those situations I will try to refer the client to another provider who may be more a specialist in the problem they need to work on. My expertise is in areas of anxiety, loneliness, depression, and shyness. I do refer clients to other providers for drug and alcohol issues or anger and domestic violence issues.
What happens to the information that gets written in my record?
Each client (or couple or family) will have a written record of their services. This record is confidential. You can make a written request to review your record and ask questions if you feel the need. I do ask that clients not ask me to appear in court on their behalf or request their records be presented in court. This is a time consuming process and distracts from providing quality services for yourself and others. If you believe you will need evidence of treatment for a court proceeding I will be happy to refer you to a specialist in for court-involved clients.