MemphisCounselor

What do counselors do?

What is the difference between a mental health
counselor, a pastoral counselor, a clinical social worker, a
psychologist, and a psychiatrist?

How do I choose a therapist?

What is a psychotherapist?

What is a psychoanalyst?

What is a life coach? How do they differ from
the above mental health professionals?

What sorts of issues do psychotherapists
deal with?

If I see a counselor
for a physical problem, doesn’t that mean it was
just “all in my head”?

Which is better, medication or talk
therapy?

How much do therapists charge?

Is everything I discuss in therapy confidential?

I should always use insurance, if I have
it, to pay for treatment, right?

How long does therapy last?

So what is your approach to
therapy?

What happens in therapy?

What do counselors do?

The term counselor is now being used for anything from a
financial planner to a personal trainer, and of course, the term
has long been used for attorneys. However, the term counseling usually refers to rehab counselors, school
counselors, mental health counselors, and college counselors.
Counseling programs generally provide the same training to all
these professionals, but add specialty training for the chosen
area. This site will particularly relate to mental health
counselors, who are specifically trained in assessment,
diagnosis, and treatment of mental illness, as well as being
trained in psychotherapy, group work, career counseling, etc.
Additional special training may include couples and/or family
counseling, gay/lesbian/bisexual/transgendered issues,
multicultural counseling, and so forth, and training in certain
techniques, such as eye motion desensitization and reprocessing
(EMDR), hypnotherapy, trauma work, and so forth.

What is the difference between a mental health counselor, a
pastoral counselor, a clinical social worker, a psychologist, and
a psychiatrist?

In Tennessee, as in most states, all of these health
professionals are licensed by the state, and are held accountable
to its laws. They are also bound by the ethical guidelines of
their profession.

Psychiatrists are the only ones with a medical degree,
and thus the only they can prescribe medications. Training in
talk therapy is limited, and n this area of the country, they
usually do not provide talk therapy. Other professionals often
collaborate with the client’s M.D. to provide medications
asneeded.

Pastoral Counselor – In Tennessee, to be a licensed
pastoral counselor, the therapist must have the equivalent of a
Masters in Divinity and a Masters in Pastoral Counseling, with
training in mental health diagnosis and treatment.

Licensed Clinical Social Worker – The training of these
therapists is especially strong in linking clients to community
and institutional resources necessary to meet their
needs. This is usually a masters level
therapist.

Licensed Professional Counselor – Usually a masters level
therapist. In Tennessee, if this person is licensed to treat
psychological pathology, they must be additionally licensed as a
Mental Health Service Provider, designated LPC/MHSP.

Psychologists – These are
doctoral level therapists. Usually, the degree is a Ph.D., but
may be a Psy.D. There are counseling psychologists and clinical
psychologists. Psy.D. and counseling psychologist
training emphasizes therapy more than clinical Ph.D. programs,
which emphasize research.

MS’s, Counselors, and Interns – All of the above
professionals require state licenses to use these titles. In
order to be licensed, the required degree must first be obtained.
The degree requires a period of internship, during which the
student works as a professional under site and academic
supervision. After graduation, the graduate is required to take
state licensing exams, and then is required to practice under
approved supervision for a period of time, usually two or more
years. This is similar to residency for medical doctors. Titles
for these individuals may include MS (Master of Science), NCC
(Nationally Certified Counselor), MSW (Master of Social Work),
Intern, Counselor, etc.

How do I choose a therapist?

This is the key question, and the answer is simpler than one
might suppose, given the plethora of titles above.

First, if the client is hearing voices or
delusional,or bipolar disorder is suspected, start
with a psychiatrist. Medication is usually a first
line treatment for these disorders.

If the issue is primarily religious or spiritual in
nature, you might consider a pastoral counselor. If it is likely
that you will need the services of multiple community agencies
and resources, you might consider an LCSW. Expecially with
religious and spiritual issues, if using another professional,
inquire about specialized training they may have with these
issues. Many, but not all, counselors and
psychologists are trained in this area. No therapist should push his or her
religious views or values on you, but should help you work
through your own journey.

However, the main thing is this; it is widely
supported by research that the key component of successful
therapy is the relationship between the therapist and the client.
Therefore, although length of
training, degrees, and licensure are important, they
mean nothing unless you have a good trusting relationship with
the therapist and you are comfortable with him or
her.

Therefore, the best bet is to just pick a counselor, LCSW, or
psychologist, or get a referral from a friend or your medical
doctor. Then, try him or her out. If you do not feel
a connection with the therapist, talk to them about it. If it
does not work out, or the therapist cannot refer you to a
professional that fits your needs better, try a different
therapist.

Another approach to consider is to think of the
therapist as your general mental health practitioner.
For example, a mental health counselor is
trained to assess the gamut of mental health issues
and to refer you to the proper specialist at the appropriate
time, much like your family doctor does.

What is a psychotherapist?

Also known as “talk therapy”, psychotherapy is the art
and science of preventing, reducing the distress/impairment from,
and eliminating problems of thought, feeling, and behavior. This
also includes problems of relationship to others and to the
environment. Any of the above professionals would be considered a
psychotherapist when engaged in talk therapy with a client.
Psychotherapists also differ in their theoretical orientation and
the techniques that they use. The main theoretical approaches
are:

1. Psychoanalytic – This is the
   original approach of Freud. In more modern times, various similar approaches
   fall under the heading of psychodynamic therapy. Very specialized training is
   required for this approach, and psychoanalysts are almost always, if not
   always, psychiatrists. Treatment is generally long term, often years. However,
   certain disorders, particularly pathological personality disorders, requires
   years to resolve under any therapeutic approach. The focus is on the past, the
   unconscious, internal conflict, sexuality, and therapy is insight oriented.
   Research results on the effectiveness of psychoanalytic approaches have been
   mixed.
2. Behavioral – Behaviorists believe
   that all behavior results from conditioning and learning. Therapy focuses on
   changing the contingencies (rewards and punishments) surrounding the behavior
   to be changed, and in learning better coping mechanisms via observing others
   (modeling), learning, and rehearsal. A strict behaviorist gives no credence to
   the influence of cognitive aspects such as thought, reason, motivation, plans
   for the future, etc. Everything has to do with avoidance of pain and pursuit
   of reward.
3. Humanistic – The primary figure
   here is Carl Rogers, who stated that the primary means of therapy are
   unconditional positive regard, genuineness, and empathic understanding. It is
   assumed that the client has the answers and simply needs the therapist to
   listen and reflect empathically for the client to find his or her own answers.
4. Cognitive – This approach is based
   on the idea that the client has dysfunctional thoughts or learned patterns
   that are causing dysfunctional emotions and behavior. Restructure of these
   dysfunctional thoughts and patterns is the objective.

There are many other approaches, including existential therapy,
feminist therapy, etc. However, it is probably easy to see that
each approach has its positive side, especially if match to the
person and the problem at hand. The humanistic approach is widely
considered to be a necessary, but perhaps not sufficient, part of
all therapy. Many therapists today consider themselves to be eclectic or integrative, and utilize these and other
theories and techniques as determined by the client’s
situation.

What is a psychoanalyst?

This is a professional who practices primarily with a
psychoanalytic approach.

What is a life coach? How do they differ from the above
mental health professionals?

Life coaches or executive coaches help people become more
effective in their lives and/or careers. However, there is no
common set of training or certification. Anyone can call
him/herself a life coach. There is no legal restriction on the
use of these titles.

What sorts of issues do psychotherapists deal with?

In short, anything that is causing you distress or impairment in
personal, family, social, or occupational function is a likely
candidate for psychotherapy. Even physical problems, which should
first be treated by a medical doctor, can have negative effects
that can be relieved with psychotherapy. The types of issues can
be broken down into categories:

1. Pathological – These are the
   issues found in the Diagnostic and Statistical Manual of Mental Disorders
   (DSM-IV).
   1. Disorders that are generally physical in cause: Retardation,
      learning, Delirium/dementia/memory, motor skills, communication, pervasive
      developmental, and tic disorders.
   2. Disorders that can have physical/psychological causes and
      effects: Anxiety, depression,
      sexual/gender, sleep, impulse, eating, dissociative, personality, substance
      abuse/dependence, attention deficit, disruptive behavior, elimination,
      psychotic (schizophrenia, etc.) and special childhood disorders (separation
      anxiety, reactive attachment disorder, etc.).
   3. Physical problems resulting from psychological causes
   4. Psychological problems resulting from a medical condition
   5. Psychological problems resulting from substance or
      medication use
2. Sub-clinical pathology – Many
   times, a client may have a problem listed above, but not to such an extent as
   to warrant a diagnosis of pathology. For example, a client might be depressed,
   but not meet all the criteria for a major depressive disorder, or a client may
   have certain personality traits that they would like to change, but not have a
   personality disorder.
3. Adjustment – These are problems in
   adjusting to life changes.
4. Personal Growth – Perhaps the
   client feels as if they are not growing, or are having difficulty in growing
   in certain areas of his/her life.
5. Dysfunctional patterns of thought
   or behavior.
6. Stuck – In a sense, most
   psychological problems involve being “stuck”; whether stuck in an emotional
   state, stuck relative to how to solve a problem, and so forth.
7. Behavioral – These include what we
   normally think of as behavior problems in children or adolescents, but also
   include adult habits, dysfunctional patterns of behavior, and so forth.
8. Academic problems
9. Occupational issues (career,
   interpersonal, etc.) – These include problems in the workplace, but can also
   include help in career decision-making. Counselors generally have specialized
   training in career counseling.
10. Phase of Life issues- Puberty,
    adolescence, early adulthood, mid-life, empty nest, retirement, menopause,
    aging, . . . all of these and others are natural phases of life that present
    new challneges to the individual.
11. Identity issues: Answering the
    question “Who am I” can be a lifelong process, as the answer changes as we
    grow through different stages of career, moral, sexual, existential, and
    social development.
12. Religious or spiritual issues-
    Another area for growth over the lifespan is in the areas of spirituality and
    faith.
13. Acculturation – For people who
    move from one culture to another, there are developmental stages as the person
    determines how much of the new culture to adopt and how much of the old
    culture to retain. Usually we think of these issues relative to immigrants,
    but they can also exist in biracial relationships, changing religions,
    changing sexual orientation, etc.
14. Relational problems
    1. Interpersonal
    2. Marriage
    3. Family
15. Situational problems – A situation
    that requires problem solving or coping, and the client experiences a lack of
    alternatives or coping skills.
16. Environmental problems – Many
    problems that might have been thought of as personal psychological problems in
    the past are now recognized as being caused by the environment. Poverty,
    abuse, lack of educational opportunities, trauma, racism, oppression, refugee
    status, crime, and so forth can have a profound negative effect on mental
    health.
17. Crisis – This occurs when a
    person’s inability to cope with current problems results in behavioral,
    emotional, and cognitive deterioration that requires immediate help.
18. Trauma or abuse/neglect – Both in
    the present, and from the past.

If I see a counselor for a physical problem, doesn’t that
mean if was “just all in my head”?

Science, in recent years, has come to understand that the
boundary between the physical body and the mind is an artificial
one. From this realization has been born research institutes such
as The Mind-Body Medical
Institute founded by Harvard Medical School
professor Dr. Herbert Benson, which study the mind and body as a
hoistic unit. With this understanding, phrases such as “it
is all in your head” and “it is only stress”
become meaningless. Mind affects body and body affects mind. We
now know that chemical creation even at the gene level is
controlled by the brain, and that what used to be considered
“brain chemicals” such as neurotransmitters, are found
throughout the body. Whether the source is psychological or
physical makes no difference to the person suffering the distress
. . . they just want it to get better.

Which is better, medication or talk therapy?

This depends on the problem or illness and the severity of it.
Your therapist will know the best course to take. Sometimes, the
best treatment includes both, together or one after the other.
What is best is usually defined by research
studies. Even when medication is required, concurrent
talk therapy often is often more effective in preventing relapse,
and helps ensure medication compliance. Medications, over time,
may become less effective as the body adapts to them, and
the adaptation is not always a positive one. If talk
therapy can minimize or eliminate the need for medication, that
is probably best. All that being said, there are some excellent
medications available now for dealing with a variety of issues.
Interestingly, both medication and talk therapy have been shown
to create similar changes in the brain.

Is there such a concept as “prevention” in
psychotherapy?

Yes, there are three phases of prevention. Primary prevention is
aimed at preventing the occurrence of a problem and usually
involved education. Secondary prevention involves symptom
reduction and/or elimination, and tertiary prevention aims to
reduce the long-term effects of the psychological problem, which
may extend to the family, social network, and workplace.

How much do therapists charge?

That varies by location in the country and the credentials of
the therapist. Doctoral level therapists will generally charge
more than masters level therapists. Also, many therapists use a
sliding scale, whereby fees are based on income. Fees are per
session and based on a 50 minute session.

Is everything I discuss in a therapy session
confidential?

Basically, yes. Of course, there are always exceptions! A court
can order a therapist to turn over confidential records, and the
ethical therapist would be forced to comply under protest. The
law also dictates that if the therapist becomes aware of child or
elder abuse, or if the client presents a serious threat to
him/herself or others, then it must be reported. The ethical
therapist will use good judgement, break confidentiality only if
required, and inform the client before doing so.

I should always use insurance, if I have it, to pay for
treatment, right?

“Always” is such a big word! At first glance, this
might seem to be a no-brainer. However, there are some facts
about our current healthcare system that might lead you to
reconsider:

• Personality disorders are typically not covered by insurance
  due to the length of time required to resolve the problem.
  Instead, the insurance company will pay for the problems that arise from the personality disorder, such as
  depression, anxiety, psychosis, etc. This results in correcting symptoms, but
  not the root cause.
• Insurance companies require a DSM-IV diagnosis before they
  will pay. Many clients do not meet all the criteria for a full diagnosis, but
  may get the diagnosis anyway just so insurance will pay.
• A diagnosis can show up later in life in negative ways; for
  instance, disqualification for certain jobs/careers and higher insurance
  rates. This is particularly unfortunate when the diagnosis was incorrect to
  begin with.
• As you can tell from the long list above, many issues that
  clients bring to therapy do not meet the criteria for a diagnosis of
  pathology. Given the possible consequences of such a diagnosis, one must weigh
  the pro’s and con’s of using insurance.

How long does therapy last?

Of course, that depends on the nature of the client’s goals.
However, the average number of sessions, according to research,
is about fifteen. Averages can be deceiving though. Some people
will be in treatment for years, and some problems are resolved in
two or three sessions.

So what is your approach to therapy?

I like to look at the client’s issues from the perspective of
a number of theories and find the explanation that provides the
best fit. What the client thinks about that fit is critical, as
therapy needs to be collaborative, from diagnosis through final
solution. Personally, I always feel that I do better making
personal changes when I have some insight as to the cause, but
this approach is not for everyone. In any case, exploration of
the past is useful mainly for processing old emotions and
understanding the present. Insight alone is usually not
sufficient to resolve a present day problem.

Although client’s are not responsible for the cause of any
problem, they do have to take responsibility for the solution. My
job is to help the client get through the healing process as
quickly, easily, and thoroughly as possible.

I do believe that medication provides the best answer for some
problems, and part of the solution for some other issues. I will
be glad to work with your medical doctor or to provide a
psychiatric referral as required. The art and science of healing
changes daily. I enjoy chasing down the latest research relative
to client’s issues when needed. In short, my approach to
therapy is client-centered while being action-oriented.

What happens in therapy?

My goal during the first part of therapy will be to come to
understand you, the change you wish to make, and how the problem
currently, and the change will, affect(s) your life. Working
together, we will try to find the highest priority area to work
on, perhaps one that will have multiple positive results and that
will deal with the issue(s) at root cause. That will provide our
treatment goal. We will then consider various alternatives for
treatment, put together a plan, and implement the plan. Of
course, the stages do not always happen in this order and this
neatly. We may revise our definition of the problem, or our
treatment plan, along the way, taking whatever path
appears to be the most beneficial. Depending on the issue being
addressed and your preferences, there may be homework assignments
so that you can make more rapid progress.

However, in all ways, therapy is about you . . . your values, your identity, your view of how the world works, your growth, your goals, your wants and needs. My goal is to
help you along your journey.