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Choosing a counselor...
 How
do you know it’s time to find a counselor?
There are many reasons and good times, for seeking therapy, and
there’s never a wrong time. Without question, therapy is helpful when an individual is suffering severe symptoms (depression,
anxiety, grief, etc.). If you are facing life circumstances
that just seem overwhelming, that’s a great time to find a good
counselor to talk to.
Many of us seek out therapy throughout the span of
our lives, whenever we’re facing particularly difficult transitions,
or we’re just ready to take the next step in becoming who
we really want to be. Having an ongoing relationship with a skilled
counselor who knows you well and whom you trust, is like having
trusted family physician.
 Does
therapy work?
Yes.
In a good therapeutic relationship, you should experience a
very different and refreshing sense of being heard and understood.
That, in itself, can be transformative and healing. And now we have
scientific evidence to show that therapy has a positive impact on
neurophysiology – brain chemistry and wiring that is intricately
involved in our thoughts and emotional well being. If you’re
curious about the data on this question, you might want to read
“The Talking Cure: The Science behind Psychotherapy,”
by Susan C. Vaughn, M.D.
You should come away from your sessions with a clear sense of gradual
progress toward the treatment goals that you and your therapist
have agreed on. The progress varies, of course; you may experience
clarity and determination that support quick progress, and you may
face setbacks. The process is different for every individual
and every situation.
If, after a reasonable period of time (perhaps 2-3 sessions) you feel
the therapy is not helping, by all means, talk frankly with your
counselor about your concerns. The sense of not being understood
or supported in session may be the signal for an adjustment in how
you and your counselor are working together. Or it may call for
a referral to another therapist who could better meet your needs.
Feelings of discomfort often accompany the hard work of therapy,
but you should, nevertheless, feel safe and understood. And you
should be able to identify clearly how the therapy is helping you.
Talk with your therapist about your experience of the process of
your therapy, and voice any concerns you have.
 Counseling?
Therapy? Psychotherapy?
The terms “counseling” and “therapy” are
generic terms and are used by almost all in our profession. “Psychotherapy ”
is a word that is often used interchangeably with the words counseling
and therapy, but in the state of Oregon, only a licensed professional (a counselor, social worker or psychologist)
can provide “psychotherapy.” However,
if two professionals – one a professional counselor with a
master’s or doctoral level academic training and the other
a licensed psychologist – are both providing good therapy,
there is little to no discernable difference between the two. However, psychologists are uniquely able to provide comprehensive psychological testing and legal evaluations that may be requested by a physician or attorney.
Counseling is a term often used to describe short term work, perhaps
4-12 weeks, with very clear goals, usually focused on finding solutions
for current problems. Therapy or psychotherapy may be a longer
term and more insight oriented approach. The length of therapy truly
depends on the issues being addressed and the motivation of the
client. Longer term therapy is particularly helpful when the
client is dealing with severe symptoms, trauma, or enduring self
defeating beliefs or behaviors.
 Degrees
& Licenses
Not all counselors are the same. There are many different paths
of training one may take to become a therapist. There are professional counselors, who have completed master’s
level academic studies, most often in counseling or psychology,
and social workers (who hold master’s degrees in social work). Spiritual directors or counselors most often hold a Master's of Divinity degree. There are also psychiatrists
and psychiatric nurse practitioners (physicians and nurses
with extensive training in mental health who are able to prescribe
medications) and psychologists (who have completed a doctorate degree
in psychology).
We urge you to seek out a professional who has at minimum, attained
the academic training equivalent to a master’s degree (four
years of undergraduate university/college education with 2-3 years of post-graduate training
and substantial supervised clinical experience).
Oregon law urges, but does not compel, mental health professionals
to pursue licensure. Licensure provides the benefit to the therapist
of being eligible for payment through insurance companies. For the
client, licensure is assurance of the academic credential, supervised clinical experience and continuing professional education
of the therapist. A license also binds the professional to serious
penalties, up to and including loss of one's license, for failure to comply with the ethical standards prescribed
by law. For further information, visit the websites of the various
state licensing boards: Oregon Board of Licensed Professional Counselors and Therapists
Board of Psychology
(psychologists); Board of Social Workers
(social workers).
 What
are the first steps?
Your first steps in finding the right counselor will depend both
on the circumstances you face and your plan for payment. If you
are insured and have mental health benefits, your first step should
be a call to your insurance company. You will want to find out the
benefit available to you as well as whether diagnosis and pre-authorization is
required. The insurer may direct you to a website which will list
the professionals from which you may select. Other
insurance companies will have no list, but allow you to see only
licensed professionals in certain academic fields.
Whether you are using insurance benefits or choosing to
pay out of pocket (see "What does it cost?" below), a second step
will be to get on the phone (or on the web) and contact several
counselors you would like to consider. Ask questions! What
is this professional’s experience with the issues you are
facing? What methods would they use? What are their fee policies
and availability? And perhaps most important, is it possible to
meet face to face for even a few minutes to see if this is a good
match, and would there be a fee for that brief meeting or would
it be complimentary?
Pay close attention to your gut reactions to these conversations;
Do you sense the counselor is genuinely hearing and understanding
you? Is she or he respectful, courteous, open? While academic credential,
degrees and licenses are all important and practical considerations,
your intuition is important, too. Studies demonstrate that perhaps
the most important and best indicator of a successful outcome of
therapy is the rapport or "connection" between the client and the counselor. You
must be able to let down your guard and trust your therapist with
the most personal and private of your concerns. We’re often
more open and trusting with our counselors than we are with the
closest of our friends and loved ones. So – choose carefully.
 What
does it cost?
While fees to see a therapist in our community often average $70 to $150
per hour, good therapy is available in our community for
substantially less than that. The professionals in practice at Wise
Counsel & Comfort all welcome your questions about finances,
and will do their best to work with you to discount their fees,
or refer you to other qualified professionals whose fee scales are
within your means.
If you are using insurance benefits for your therapy,
ask whether a co-pay is required, and how much it is. Be sure, when
you speak with the insurer, that you ask all of your questions;
you don’t want to begin therapy and then find out a month
or two later that the services will not be paid for. If your insurance
is paying for your therapy, the therapist will communicate directly
with the insurance company about you, your needs, payment for services, and the progress of treatment.
Many, even those with insurance benefits, choose to pay out of pocket
for their counseling for a variety of reasons. One is that when counseling is paid for by an insurance company, an employe of the
insurer is ultimately the one who decides when your therapy begins, and when it is no longer medically necessary.
It’s not unusual for an insurance company to authorize about
six sessions for the average request. Paying your counselor directly ensures
that the decisions about when to begin and end therapy will be made
exclusively by you and your therapist. Another concern often
voiced is about the risk of accidental disclosure of personal information
as records are exchanged between your therapist and the insurer.
There are strict federal laws about patient confidentiality
and privacy of records - still, the fewer people who have
access to your records, the smaller the risk of accidental disclosure.
If you are paying out of pocket, your counselor will discuss the fee
with you during the initial telephone conversation or office
visit. Be frank in sharing your concerns
about the fee arrangements. It is important that the stress
of the fee not outweigh the benefit you will receive from the therapy.
 Theories,
Methods & Styles of Therapy
Many therapists have an eclectic approach in their work, tailoring
their interventions to the unique needs of each individual. All
mental health professionals with academic training of master’s
degree or above have studied a broad array of theoretical models.
Some hold firmly to a particular theoretical orientation (like psychodynamic,
gestalt or existential) or use only specific interventions (like
hypnotherapy or cognitive-behavioral strategies).
The question of which therapy is more effective is an interesting
one. Cognitive therapies tend to be slightly more statistically
effective in treatment of depression, and behavioral therapies tend
to be somewhat more helpful for individuals with severe anxiety
or phobias. Other than that, studies demonstrate time and again
that all are equally effective. The sense of “connection”
you have with your therapist is often far more important in predicting
“successful outcome,” than the theoretical orientation
or specific methods that he or she uses.
Some therapists, especially those working from a psychoanalytic
perspective, will disclose very little if any personal information
with their clients. Others are more comfortable sharing information
that is either neutral, or that they strongly feel would be helpful
to the client. The boundaries of the professional relationship
should always be defined by the client’s needs – not
the therapist’s need to share. Be cautious about continuing
in therapy with someone who seems to be talking more about their
own life than yours.
 Can
I be friends with my therapist?
No.
Healthy therapeutic relationships will have many of the signs of
any healthy relationship: trust, honesty, respect, understanding
and so forth. A relationship between therapist and client is truly
one of the most personal and emotionally intimate in our lives.
Understandably, some clients long for that
relationship to extend into life outside the therapy session. But
it must not.
First, it is almost always an ethical violation for a therapist
to engage in a “dual relationship with a client. This means
having two different kinds of relationships at the same time that
could put the client at risk. A simple example: If the therapist
hires his client to do a job, and it’s done poorly, the therapist’s
irritation would likely get in the way of the client’s therapy.
Or, if the therapist doesn’t show up to a gathering the client
has invited her to, the client may have hurt feelings that could
well interfere in the therapy. These are simple examples with very
real, very important risks. Even casual outside connections can
lead to misunderstandings that can complicate the therapy process.
But can you be friendly with your therapist? Of course, and in many
small communities it would be impractical, nearly impossible, not
to have a friendly “public” relationship with your therapist.
But don’t be surprised if you see your therapist in public
and he or she does not greet you. We work hard to guard your confidentiality
and greeting you in public might require that you answer questions
like, “Who was that?” If you haven’t shared your
counseling experience with your companion, that could put you in
an uncomfortable situation.
 A
therapist can never engage in an intimate or sexual relationship
with a client. This is, perhaps, the most severe ethical violation
a mental health professional can engage in.
A relationship between a therapist and client must have both trust
and objectivity. Sexual contact with a client destroys the therapeutic relationship.
We strongly urge you to cease contact immediately with any mental health
professional who engages in such behavior and report him/her to
the appropriate licensing boards or authorities.
 What
if I need medication?
When dealing with severe symptoms, changes in your behavior can help tremendously.
Exercise, nutrition, even laughter and spirituality can have a powerful healing effect. And working to change your thoughts, your attitudes, your beliefs,
and so forth can all work in concert to support healing.
But sometimes
it’s just not enough. If you are working on the
management of symptoms of a mental illness (depression, anxiety,
etc.), and find that after a reasonable time, perhaps 2 to 6 weeks,
the symptoms have not lightened, your counselor may suggest you
consider the option of medication. Medication doesn’t replace
therapy – it’s not an “either/or” situation.
Medication alone is rarely the answer, but it can be a helpful support
as you work hard in therapy to move toward recovery.
The referral will generally be made to a psychiatrist or psychiatric
nurse practitioner, since they are the most comprehensively trained
in the management of symptoms. On occasion, your primary care physician
may prescribe. Your counselor will ask you to sign a release giving
your permission for the counselor and prescriber to consult about
what medication would best meet your needs.
Almost always, you will experience some side effects, and these
will usually decrease over time as the benefit of the medication sets in.
But if your side effects are really bothersome, or, if after a reasonable
trial period, the medications just don’t seem to be helping,
be sure to consult with your prescriber. Some people with chronic
and serious symptoms need to be on stabilizing doses of psychiatric
medications all their lives – just like those of us with high
blood pressure or diabetes. Others benefit from a brief term with
medication, and gradually reduce the dose once we feel more stable.
 How
long does therapy last?
The average “brief” therapy is perhaps two to four months
in length. Longer term therapy can last several months, a year or
even longer. Regardless of the length, a successful course of therapy
results in a trusting relationship between the client and therapist
such that, as the years go by, it only takes a quick phone call
to re-establish the connection.
Questions?
If you have other questions about the process of finding a therapist,
please email me here and I’ll do my best to respond within
a few days. Best wishes to you in finding exactly the right therapist
who will meet your unique needs.
Be well,
Lynne Joy
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