Frequently Asked Questions:
1. What makes a problem serious enough for me to seek counseling?
Typically, a problem becomes “Diagnosable” when it effects your job/career/occupation or your social/familial situation enough to cause you significant distress. This criteria, however, is very individual and many people differ on “how bad is bad enough?” Basically, you don’t really have to be that bad to seek help. By the way, many folks like to come to counseling in order to enhance their marriage, family and/or life. Good counseling, utilizing a lot of common sense, practical advice and effective techniques, will never hurt and it almost always helps any commonly encountered life issue. Remember: “An ounce of prevention is worth a pound of cure.” If we advocate “preventive medicine” why would it be unusual to advocate “preventive counseling?”
2. Are all counselors the same…and what makes a “good” counselor “good?”
This is a very relevant question, especially for those who have not had previous counseling experience. Basically RESULTS become the deciding factor, not only for counseling, but for pretty much any profession. I like to say in jest…”I’m like Vidal Sassoon-when you look good-we look good!” At FCBH we are not “Head Nodders” who simply reflect what you are feeling back to you, or ask redundant, non-directive questions that you already know. A directive, active “coaching” style that collaborates with each individual seems to be not only popular but much more effective. In addition, top-notch training, staying abreast with the latest empirically-based research and techniques, as well as listening to the client, all become essential to an effective counseling relationship. Every person that walks through that door is unique. By the way, “If It Works-Don’t Fix it!” Good counselors start with the most simple-common sense approach (The Law of Parsimony)…and they take it from there. Oh yea, and they “practice what they preach!” Believe me; if a counselor’s life, kids and/or relationships are screwed up, they have no right helping you with yours. Oh yea, trust your “guts” when it comes to finding a good counselor, ask questions, and remember that you are the consumer.
3. How can you tell if a person is addicted to something?
This is a great question about an often misunderstood diagnosis or label. Addictions can take many forms including, but not limited to: Alcohol, Drugs, Eating, Gambling, Sex, Spending and Work. In all the years I have been working successfully with addicts, in both inpatient and outpatient settings, I have been able to narrow this down to three criteria, simple to understand and easy to see:
· Loss of Control
…of either the “usage” or the behavior around the usage. If referring to Alcohol, for example, one might reference the old saying, “the man takes the drink-the drink takes the drink-the drink takes the man.” Breaking your own “rules” around limiting the usage, or acting in ways you normally would not act around it, are typical examples of loss of control-and it certainly does not have to happen each and every time.
· It Takes Priority
If you think about something that is very important to you, how would I know it is so? Would you spend time, money and/or interest around it? Would you hang out with others who are like-minded, or sacrifice for it? Basically I would see by your actions that something has become somewhat of a preoccupation for you, whether you acknowledge it as such or not-your actions give it away.
· Using Despite Negative Consequences
If I asked a typical problem drinker, or a compulsive eater to “list all the ways alcohol/binging has helped you and/or your family…” I’d probably be met with a blank stare. On the other hand, if I asked them to now “list all the ways alcohol/over eating has hurt you or others,” the list would undoubtedly be quite extensive. “Doctor it hurts when I do this…” “Well, then don’t do that!”…but the addict does it anyway.
4. How can I tell if I’m depressed?
Many people confuse depression with sadness. Sadness is part of the normal “ups and downs” of life, and moods can change-some more profoundly in some folks than in others. When someone cannot seem to get out of a “down” mood for extended periods of time, starts to lose enjoyment for things (anhedonia), has changes in appetite (eating much more or much less than usual), experiences sleeping irregularities (too much or too little) and generally feels tired more often than not, it may be time to seek help for depression. Unfortunately many physicians seem to view depression as “drug depletion” (just kidding-not really) and it is rare to find a doctor who advises counseling prior to prescribing psychotropic medication. Dr. Peter Breggens (a board certified psychiatrist), in his book Medication Madness, clearly explains the ‘down’ side of most psychotropics. Maybe not enough physicians have been exposed to effective counselors…Either way, counseling, especially non-traditional, Cognitive-Behavior Therapy-like approaches really do work! And, just as an aside, regular aerobic activity can go a long way in helping reverse depressive symptoms when it is coupled with effective counseling. It is just silly to go right for the meds without trying counseling first. Besides, medication may relieve some symptoms temporarily, but they often “poop out”, develop dependence, frequently have unpleasant side effects and ultimately do not teach you anything different about coping.
5. What is the difference between a Psychiatrist, Psychologist, Marriage and Family Therapist, Social Worker, Counselor, Psychotherapist or Analyst? *
Many requirements differ from state to state, but the terms ”Psychiatrist” and “Psychologist” are legal terms in just about every state. Both must be doctors; a Psychiatrist (who is a Medical Doctor) usually only prescribes psychotropic medication and rarely does the “talking therapy” with which we are familiar. Psychologists usually possess a doctorate and must be licensed to call themselves a “Psychologist”…although I often come across those who violate this law. There are some states in which properly trained and certified Psychologists can prescribe medication, but they typically do not. They typically provide testing and/or talking therapy. Social Workers need only possess a Master’s Degree (MSW) as do the various other counselors. The terms “Counselor,” “Therapist” and /or “Psychotherapist” are not typically legal terms in many states and may refer to any and/or all of the specialties within counseling.
An “Analyst,” which is a licensable term in New York, practices psychoanalysis-the non-directive Freudian-type of talking therapy that many people associate with a couch, a note pad…and a German-speaking fellow with a beard who states, “tell me more about your mother…”; sometimes “a cigar is just a cigar.” A Marriage and Family Therapist does just that-marriage and family therapy, and usually views most presenting problems from a “systemic” or family-interactive/dynamic perspective. Certifications differ widely from licenses. The term “Certification” is not as widely monitored or controlled, and a certification can be awarded by various organizations for many and varied reasons. Keep in mind that, although a state Licensing Board can be called upon to help assure ethical services relevant to a licensed practitioner, there is no guarantee that possessing a license or a particular certification assures quality. Again, trust your guts, and use common sense when deciding upon or evaluating counseling services. Overall, a “licensed” person may ultimately only enhance the prospect of getting insurance to reimburse you for services…the quality of those services is something for you to decide.
6. What makes something “Traumatic,” and how is it best treated?
Trauma is essentially determined by frequency, duration and intensity of an extremely upsetting event (or events) that are perceived to be life-threatening. Ultimately, it is our perception or interpretation of something that potentially determines whether or not an event is considered “trauma” to us.
Trauma can remain lodged within our mind, sort of like a log jam in a river, and symptoms such as reactivity, misperceptions, physical ailments, flashbacks, and re-experiencing similar emotions, can all “flood” in upon someone who has been traumatized. These symptoms can last for years and even worsen with time if left untreated-or if treated by a counselor who is inept. A simple nodding of the head, talking about one’s “feelings” and reiterating the event over-and-over again only makes it worse, and it could eventually turn in to Post-Traumatic Stress Disorder (PTSD).
Eye-Movement Desensitization and Reprocessing (EMDR) is the most effective, quickest treatment of trauma. There are, of course, many other techniques and approaches but EMDR has proven to be quite remarkable. Within just a couple of sessions of EMDR, clients have been astounded by the symptom relief, clear-thinking and resolution of what they were told by previous therapists would either never happen…or would take years of therapy to accomplish. By the way, if you exercise aerobically for an extended period of time, drink lots of water, and eat some complex carbohydrates within the first 48 hours of the trauma, the physical and psychological impact of the event can be decreased by 50%!
7. What is “Hypnosis,” and how can it be used?
The term “hypnosis” is derived from the Greek word “Hypnos,” meaning “sleep.” This is actually a misunderstanding of the phenomena. Whether induced through a relaxation-type technique, or brought about by more authoritarian methods (such as in stage shows) hypnosis simply produces a natural state in which someone is more suggestible. Nobody can be hypnotized who does not want to be. Approximately 20% of the population enters a ‘light’ trance; 60% will be able to enter a moderate depth, and another 20% are able to go into a very deep state of hypnotic trance (they’re the ones you want to pick for the stage show). The depth of trance one enters simply determines or facilitates how easy it is to arrive at your goals (such as smoking cessation). Naturally, the deeper you go-the easier it will be to, say, stop smoking (I have an approximate 85% success rate using one session only). Hypnosis is much more of an ‘art’ than a science, and skills/abilities of the Hypnotist can differ significantly from one practitioner to another. By the way, you do not come under someone else’s power or control when you are hypnotized, and a hypnotized person will not do something in which they morally object-regardless of what television depicts.
Hypnosis can be a useful technique to help eliminate smoking, enhance habit control, promote relaxation, and facilitate many other treatment goals as either an adjunct or as a primary modality of counseling.
8. When is medication necessary?
I am not a physician, so I cannot give you prescription advice per se. I can, however, let you know that it is the rare physician who does not almost always prescribe medication first. This is unfortunate. In my book, Joe and the CEO:A common sense approach to changing your mind, I review a landmark study in which they identified clinically depressed individuals by using Positron Emission Tomography (PET) scans. Blood flow was found to be lacking in certain parts of the brains of depressed people. After four to six weeks of anti-depressant medication, the blood flow changed in their brains, and they felt less depressed. Of course they never really acquired any new coping skills, and they were typically dependent on medication in order to ward off the depression…maybe. The same group of classified depressed folks was given good Cognitive Behavior Therapy (CBT) after their brains showed the very same problems in blood flow (via PET). Following their talking therapy (4-6 weeks), the blood flow changes were exactly the same as those who were prescribed meds! The mind-body connection is marvelous.
I am not saying that psychotropic medication is never necessary. I would say, however, that it should usually be considered the last resort after other interventions have failed or produced minimal results. Severe psychoses (usually involving hallucinations and/or delusions), or extreme cases of severe mental illness may be the exception to the rule.
9. How do I know if I have a “phobia,” and if so, how can it be successfully treated?
A “phobia” is an irrational fear. A reasonable fear, that is based on a realistic concern or fear of a very real subject/situation, such as falling into shark infested waters while bleeding, is not at stake here. Phobias involve a significant overreaction, such as becoming pale, short of breath and trembling when seeing a spider on the other side of the room. Typically, people tend to rigorously avoid the situation or object of their phobia, thereby expanding their fear. Systematic desensitization, CBT, EMDR, hypnosis (or a combination thereof ) and other techniques have been found to be very effective in treating phobias within a relatively short time. Again, psychotropic medication should be utilized as a last resort when all else has failed.
10. If we need marriage counseling what can I expect?
Marriage/couple’s counseling is truly an art form, and an inept counselor can often do more harm than good. It is important to have a good “fit” when choosing a counselor. Achieving and/or maintaining a balance, so that the counselor does not become “triangulated” between the couple, is sometimes tricky business. Couples most frequently identify “lack of communication” as one of the first presenting problems. Good marriage counseling will almost always be beneficial-regardless of ultimate outcome. There are times for each person to “vent,” but a structured, “coaching” approach seems to be much more popular and cost-effective-“…and I’m cheaper than a lawyer.”
Following a “get-to-know-ya’” information gathering session, there is a review of the presenting problem from each partner’s perspective. A brief family of origin (Genogram) is developed, as well as guidelines for conflict negotiation, structured exercises, and sometimes “homework assignments.” In some cases, each partner can briefly be seen individually, or in addition to, the scheduled couple’s sessions. Positive results are usually experienced within the first few sessions, and appointments are often spread out as the counseling progresses. Divorces have been avoided, marriages have been healed, parents have been empowered and families have been saved-good marriage/couple’s counseling works!
11. What is “biofeedback,” and how is it used in counseling?
“Biofeedback” is a term used when a client is hooked up to any of various devices that “feed back” what their body is doing; for example, blood pressure, heart rate, skin temperature, EEG, EKG, Skin Conductance Activity (SCA) and Surface Electromyography (EMG) are all popular modalities used in biofeedback sessions. There is also a device that allows you to see how you are breathing, which is essential in acquiring certain skills. These sensitive machines allow the client to see and/or hear what their body is doing in a way that, without the machines, would be very unlikely to know. Through the use of these instruments, clients can modify their blood pressure, skin temperature, brain waves, muscle tone and various other mind-body phenomena. I like to incorporate biofeedback instruments when teaching relaxation skills, monitoring bodily responses to counseling goals and/or coaching a client to “listen” to their body when learning to “be still.” The Biofeedback Certification Institute of America (B.C.I.A.) is the most professional certifying organization in the country, but a counselor does not necessarily have to be BCIA certified to be competent in the use of biofeedback. There is no license, per se, specifically for biofeedback at this time. I have seen many clients avoid the use of medication and/or wean themselves off psychotropics by developing skills and strategies through biofeedback training.
12. How does stress affect me and what are some effective stress management techniques?
“Stress” has been defined by experts, such as Dr. Hans Selye, as “…the arousal of an individual’s mind and body in response to demands or changes made upon them.” Understand that stress can be non-specific, that is, it can be ‘positive’ (eustress) such as riding a roller coaster or winning the lottery, or it can be ‘negative’ (distress) such as getting divorced or being convicted of a crime, but the impact upon us is basically the same. It can come in the form of intense, “burst” stress (with a ‘fight-or-flight’ response), or it can present itself as a nagging, daily hassle type of pain-in the-neck stress that can create cumulative mind-body problems. Gastro-intestinal symptoms, headaches, back pain, mood-swings and a host of other issues typically manifest themselves when ongoing stress is not addressed. Untreated stress can not only impact upon your quality of life-it literally makes you sick.
Proper diet, incorporating B Complex vitamins, aerobic exercise, biofeedback, CBT, relaxation training, as well as a host of other interventions, are usually quite effective in converting ‘distress’ into ‘eustress’ and eventually reducing the negative impact it can have. In some cases, a modification of environmental factors may be necessary. What works great for one person may do relatively little for another, so I prefer the ‘shotgun’ approach in order to find the techniques and strategies best suited for you. It is unfortunate that so many people run to the pills immediately when stress management techniques can be so much healthier. I actually completed my doctoral dissertation on this very topic, so I certainly have some real expertise here. It sometimes takes a little practice, discipline and ‘stick-to-itiveness’ to acquire stress management skills…but it is well worth it in the end and you will get results.
13. Are the things I discuss in a counseling session private?
Yes. In every state, the topics, content and information brought up in any counseling session are protected by law (HIPPA guidelines). Having a very confidential setting assures that you can be “safe” in bringing up anything relevant to your situation. Any ethical counselor will review the guidelines for confidentiality, as well as other relevant ‘consumer protection’ information, including fees and payment for services, within the initial session. The counselor’s background, education, experience, training and credentials should also be ‘fair game’ for discussion should you choose to ask. I think there was a popular commercial where Sy Sims states “The educated consumer is our best customer.” Remember you are the consumer, and you have a right to know whatever you deem important-full consent. An ethical counselor will also clearly explain the limits of counseling as well as any exceptions to confidentiality before your treatment begins. By the way, you should know that, in addition to your specific written permission for the counselor to talk to someone outside the counseling setting, being truly a danger to yourself or someone else, or cases of significant child abuse, may require the counselor to go outside the privacy of the session. Again, these exceptions should be reviewed and clearly understood by anyone engaging in treatment before you embark on your counseling journey.
14. If I have a temper problem, does “anger management” work?
Everybody has “moments”, from time to time, when their temper can get the best of them. If you have a heartbeat, and an opinion, you will be angry once in awhile. In addition, you cannot control what type of temperament you have. Anger and/or temperament are not the problem-it’s how it is expressed. Family of origin role models (or lack thereof) can be a significant influence on what you learned about the expression of anger. That being said, common sense and practical, hands-on (no pun intended) education, counseling and management techniques become the best way to address and modify destructive, toxic, inappropriate and sometimes abusive expressions of anger. Sometimes individuals simply need a few sessions of education and/or training in anger management skills. Poor anger management skills can result in destroyed relationships, legal problems and even physical issues; that’s right, anger problems have been found to actually cause heart problems over time. You cannot get rid of a habit (try to ‘not think about swallowing’…LOL) but you can replace it. Telling yourself to “not get angry” is ridiculous and frustrating. Learning to replace your ineffective anger strategies with effective alternatives can be helpful. Again, CBT, biofeedback, clinical hypnosis and other interventions are the key to redirecting (sublimating) and replacing “…doing the same thing over and over-expecting different results.” Sometimes ferreting out the hurt, fear and/or frustration leading to anger can also be of assistance. Overall, each case is rather unique but many of the remedies found effective for so many people can save you untold trouble in the long run-and it can be extremely gratifying to develop the self control, skills and confidence gained with practical anger management.
15. If I suffer from anxiety or panic attacks, is there help for me that does not necessarily involve medication?
Yes. Many strategies addressing “hypervigilance” can be utilized when dealing with anxiety. Sometimes understanding and replacing cues or dysfunctional beliefs leading to over-reactivity and anxiety/panic can be part of the solution. When combined with more physiological techniques and strategies, such as self-hypnosis, biofeedback, relaxation and breath control, many people have been able to get a handle on their anxiety and panic without the use of psychotropics or costly and unnecessary ER visits.16. Can you help a person who needs help but does not want it, such as an alcoholic in denial?
Yes. This is called an INTERVENTION, and when performed correctly, it can prove effective. If performed incorrectly, it can lead to an “inoculation” effect that may eliminate chances for a future successful intervention. Dr. DeYoung has successfully orchestrated many interventions. Approximately 85% of people who did not initially want help, and who thought they did not have a problem, will go directly to an inpatient facility after an intervention; another 10% will agree to an alternative program, and others will usually get help ‘down the road’ following the impact of a well-done intervention.Dr DeYoung no longer maintains a professional license in Pennsylvania, but he is licensed and credentialed in New York. If the particular services of a PA licensed psychologist or psychiatrist are necessary, an appropriate referral will be made.