Counseling: Who, What, Where…And Why?

Reading this blog, you may be one of the millions of Americans who, like me, have used counseling services at some point in their lives, whether to cope more effectively with a stressful situation or relationship, navigate a loss, manage a mental illness, or to meet some other mental health or life-stress challenge. Or, you may be one of the millions of others who have never seen a counselor, but are curious about what mental health counseling is, who and what it is for, and what the differences are between types of therapies and practitioners. March being a month that is all about new life and light, I thought I’d use this month’s column to shed some light on how counseling can help support the “life” in our lives!

Countless studies have demonstrated that counseling, alone or in combination with other strategies (such as exercise, meditation, prayer, medication, energy medicine, creative activity—the list is long!), helps people to recover or suffer less from depression, anxiety and other psychological conditions, as well as to cope more effectively with transitory stressors. Even so, a common misconception persists that counseling is only for people who suffer from severe mental illness, and/or for “people who can’t solve their own problems.” Nothing could be further from the truth! In fact, the kind of person who is likely to benefit the most from counseling is actually the person who, like me, likes and expects themselves to solve their own problems, and who is generally pretty good at it…or who could be, given a chance! Between friends and family members, most of us have plenty of people in our lives who are ready and willing to offer (and for free!) opinions and advice on whatever issues we may be struggling with. What I look for instead from a professional (and what I expect from myself as one) is not someone to deliver solutions, but someone trained to listen carefully, curiously, reflectively and without bias in such a way that I can “hear myself think” more clearly, the better to find my own way. As one of my mentors put it, “our job is not to give people answers; our job is to give them really good questions!” People who go to a counselor (or send someone else to one) in hopes that the counselor will somehow “fix” them are bound to be disappointed: effective counseling is really a collaboration between client and counselor, in which both need to be actively, if differently, engaged.

So how does a person go about choosing a counselor? It’s easy to be confused by both the array of mental health professionals and types of approaches out there. Professional counseling and therapy are offered by a variety of professionals, including Clinical Psychologists, Licensed Professional Counselors, Licensed Clinical Social Workers, Licensed Marriage and Family Counselors, Psychiatric Nurse Practitioners, and Psychiatrists. With the exception of Psychiatrists, whose training and experience focuses mainly on medication-based treatments and not on counsel, all of the licensed professionals listed above receive roughly the same amount of basic training and supervised experience in order to be licensed. However, only Psychiatrists and Psychiatric Nurse Practitioners are licensed in Oregon to prescribe medication. And while there are some differences in training among the various counseling professions, there are probably more similarities than there are differences in the kind of basic knowledge and training received. In fact, more important than choosing someone from a particular discipline is making sure to choose a statelicensed professional. Licensure helps to ensure that you are seeing someone who has demonstrated that they meet certain basic training and ethical standards, and also provides consumers with recourse (for complaint and investigation) should a problem or complaint arise.

But before deciding which type of therapy you want or which therapist you want to see, it is helpful (though not essential) to identify your hopes and goals from therapy. What is it you want to change, understand better, cope with more effectively, or accept? Identifying the reason you’re seeking treatment can help you and any professional you interview to figure out together if they and their approach are likely to be a good fit for you. For instance, many treatment approaches are based on specific diagnostic disorders. Do you have a psychiatric condition such as bipolar disorder or anxiety? Are you depressed? Then you might want to find a therapist who’s been trained in certain types of behavioral therapy that studies have indicated are effective for those diagnoses. Or, are you more interested in an exploratory kind of therapy that will allow you to examine your past and present thoughts and feelings in greater depth? If that’s the case, you might be interested in finding someone who specializes in a more psychodynamic (“depth counseling”) approach.

 Once you’ve identified your hopes and goals, it’s time to start searching for a therapist. While there are many places you can go for names, two of the most effective and efficient are word-of-mouth (referrals from family, friends, or other medical professionals) , and online health professional directory web pages such as the Psychology Today Therapist Directory. Such directories have the advantage of providing a wealth of information about individual professionals, including pictures, licensure information, education, years of experience, fees, insurances accepted, therapy approach, and consumer ratings. These pages also often provide a direct link for email and phone contact. And if your health insurance includes mental health coverage, a call to your insurance company can get you a list of covered mental health providers in your area.

 After you’ve identified one or more candidates, you should feel free to request an initial consultation (many professionals offer brief ones at no charge) in order to see whether their personality, skills, and approach are likely to be a fit. This is not a time to go into detail about your specific objectives or issues so much as to ask questions which give you more information about what you can expect from the counselor you are considering. Potential questions might include: “What type of therapy do you practice?” “How will this particular therapy help me with my specific problems?” “What is your treatment philosophy?” “How long are sessions, and how frequent?” “Do you only see individuals, or do you also work with families/couples/groups?” You may also want to ask questions about their background, experience, and any confidentiality and privacy concerns you may have.

If, after this initial interview (or at any time after you’ve begun counseling) it doesn’t feel like the right fit for you, talk over your concerns with the counselor. If you are not happy with how those concerns are responded to, keep moving!

And be sure to “keep moving” in any case! After all, regular, moderate exercise is still the best antidepressant we know!