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" Suppose" - an imaginative journey into the heart of psychotherapy...






What is counseling/psychotherapy?

Counseling and psychotherapy consist mainly of conversation between a counselor or psychotherapist and a person, couple, or family who want assistance in understanding and managing their lives, feelings and/or behavior.

'Counseling' and 'psychotherapy' are not identical.

Counseling is meant to assist people with problems of daily living. The counselor will help the person understand what is happening in his/her life and offer advice about changes in behavior or other approaches that may help the person get what they want. There are specialized forms of counseling tailored to specific presenting problems, such as substance abuse counseling.

Psychotherapy (‘therapy') is meant to assist people in understanding and mastering their own thoughts and feelings. Behavioral change and changes in life circumstances become possible and more probable when a person understands and obtains a degree of control or regulation of his/her own feeling states and the thoughts related to these. The therapist is trained to listen to you in a special way. S/he will give less 'advice' than reflection back to you of what s/he hears, to stimulate your own reflection about what is going on inside of you and between you and other people.

There are specialized forms of therapy, such as ‘cognitive-behavioral therapy,' ‘psychoanalytic or psychodynamic therapy,' ‘interpersonal therapy,' and others. You should ask the therapist you consult how she or he thinks people change in therapy--in other words, how the process works. (Scroll down for more...)top of page

The importance of the relationship in counseling and therapy:

Both counselors and therapists use the relationship they build with you as part of the therapeutic process. Therapists emphasize the relationship with you as the major healing influence--they expect the basic difficulties you experience with yourself or with other people to surface and be worked through in the relationship to the therapist. top of page

How do I know when a teen or preteen needs the help of a mental health professional?

With teen-agers, it is hard to know when the assistance of a professional mental health practitioner is needed because most adolescents display a broad range of symptoms that could indicate a need for professional help but often don't.

For instance, it is normal for teens to experiment with alcohol and drugs on at least a few occasions. Such experimentation may need to be addressed (with limit-setting and consequences) but does not constitute substance abuse and does not mean the teen is in need of professional help.

Another example . . . many teens decline in academics around junior high and the first year of high school. It is quite common for A and B students to start bringing home Cs and quite common for C students to come home with Ds and an occasional F. Academic decline may need to be addressed, but does not in itself mean that the teen is in need of a mental health professional's services.

In addition most teens generally test limits and break rules, especially the rules set by parents. Teens also withdraw from parents, become sullen, arrogant, verbally abusive at times, and just all around difficult to live with.

Count yourself lucky if your teen doesn't exhibit any of these symptoms, but on the other hand if your teen does, it does not necessarily mean s/he needs professional help.

You can see why it is hard to know when to seek professional help; behaviors that at any other time in life would be cause for alarm during adolescence are relatively normal and expectable.

With all of the above qualifiers in mind, we suggest getting help when you notice any disturbing behavior that persists over a long period of time.

Examples:

  • Alcohol and drug abuse (use that exceeds occasional experimentation and is interfering with the teenager's life)
  • Chronic and unremitting decline in academics (unremitting means you've tried to address the decline, to no avail)
  • Frequent truancy repeated (over a long period of time)
  • Total isolation from peers (over a long period of time)
  • Very bad self-esteem over a long period of time -- such as repeated negative statements about oneself that you feel are deep and severe
  • Repeated outright ["in your face"] defiance of rules and limits that you set
  • Any other disturbing behavior that persists over a long period of time or any behavior that seems acutely threatening, even if it only occurs once
  • Even a one-time verbal reference to wanting to hurt or kill herself/himself that feels sincerely meant and that isn't taken back when you ask, "Are you saying that you really feel like hurting/killing yourself?"
  • Any gesture (action) to seriously physically hurt/kill self or others

Parents probably ought to go to see the professional first at least one time to seek advice before perhaps unnecessarily involving the teen. The professional may be able to reassure you that things sound okay and/or may make suggestions for how to improve things without requiring individual sessions with your adolescent.

You can get help from social workers, counselors, psychologists, psychiatrists, and psychoanalysts.

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What sort of training/credentials do professional mental health practitioners typically have?

Counselors and therapists usually are trained social workers, psychologists, marriage & family therapists, or certified counselors. Those who are trained to see clients independently (without supervision or being part of an agency) are usually licensed by the State in which they function. It is perfectly appropriate for you to inquire of a counselor or therapist you are considering seeing whether this person is licensed to function as an independent health care professional. It is also possible to find out through the appropriate department of your State government whether a particular professional is licensed and in good standing.

A licensed mental health professional ought to have earned at least a master's degree in his/her field: an MSW (Master of Social Work), MA or MS in a specific field (such as counseling), or master's degree in a related field. Clinical psychologists usually have earned a doctorate--a PsyD (Doctor of Psychology) or a PhD in psychology. School psychologists practice with a master's degree. It is appropriate for you to ask a counselor or therapist for information about their academic degree(s). (Scroll down for more...)

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What if I need or want medication?

Social workers, psychologists, or other counselors/therapists are not currently able to prescribe medication (such as antidepressants or anti-anxiety drugs). Only MD's can prescribe medication. Often counselors and therapists have a relationship with one or more psychiatrists (MD's with training in mental disorders) who diagnose and prescribe medications for those clients of the counselors/therapists who require or who would benefit from them.

Psychiatrists are MD's specifically trained in diagnosis and medical treatment of mental disorders, such as depression, phobias, compulsive disorders, anxiety disorders, bipolar disorder (manic-depression), schizophrenia, etc. Some psychiatrists have also been trained in psychotherapy; many more-recently-trained psychiatrists specialize in medication and do little psychotherapy. (Scroll down for more...)

Psychoanalysts are experts in psychotherapy. A psychoanalyst who is also an MD can prescribe medication when it is appropriate. But many psychoanalysts are not MD's. They are therapists who have several years' intensive training in psychoanalysis, a specific form of intensive treatment for people with a wide range of problems or symptoms. Psychoanalysis is a specialized, intensive therapy that usually requires a commitment on the part of the patient to attend sessions several times a week (four times a week is typical). Analysis is usually also a longer-term form of therapy.

 

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How do I choose a mental health professional?

Given that you've found someone duly credentialed and licensed to practice as a mental health professional, the single most important further ‘ingredient' to consider is your experience of ‘fit,' of the emotional chemistry between you (and between your adolescent) and the practitioner. You may want to give yourself and your adolescent two or three sessions with a practitioner before making up your mind if s/he feels right for you. Ask yourself/your adolescent these questions after the first one, two, or three sessions with the person you're considering:

  • Does this practitioner listen to me?
  • Does this person give me his/her full attention?
    [Note: counselors or therapists should not be talking about themselves--except in answer to your questions--nor taking telephone calls--except for emergencies--or conferring with other people during their time with you]
  • How does this person seem to think that my seeing them can be helpful to me--what will be the process of the counseling or therapy? Do their ideas about this make sense to me?
  • Do I have a feeling that I may be able to develop trust with this person?
  • Do I have a sense that maybe this person can come to understand me? (Scroll down for more...)

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How do I know whether to consult a counselor/therapist or a psychiatrist or a psychoanalyst?

If you or the adolescent you are concerned about are experiencing mild to moderate problems in daily living or are having mild to moderate trouble with disturbing feeling states (depressed, sad, lonely, anxious, afraid, confused), you should first check out your (or your adolescent's) physical health. Many times physical factors contribute to mental or emotional discomfort. Assuming that you are physically healthy, then you may appropriately seek a counselor or therapist with a master's degree (or a clinical psychologist with a doctoral degree) for advice about what you can do to improve your/your adolescent's life or make yourself/your adolescent feel better.

If you or the adolescent you are concerned about are experiencing severe problems (not eating for a long period of time, can't sleep or sleeps all the time for an extended duration, not working/attending school over a long period of time or a drastic and continued change in academic achievement, drastic and continued changes in other behavior, visual or auditory perception disturbed, frequent or continuous suicidal or homicidal thoughts or gestures), you may still wish to start with a social worker, counselor, or psychologist. The therapist or counselor may refer you to a psychiatrist (MD with training in diagnosing and medicating mental/emotional disorders) for diagnostic consult and to consider the utility of medication. (Scroll down for more...)

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What is psychoanalysis?

Psychoanalysis is a specialized form of intensive psychotherapy that requires a deep commitment on the part of both psychoanalyst and client to remain in the analytic process for as long as it takes for the client to understand and learn how to manage his/her own feelings and thoughts and behaviors. A psychoanalyst has been trained in a psychoanalytic institute--usually for four years in academic courses and for several years in supervised psychoanalysis of clients. A psychoanalyst is also required to undergo his/her own psychoanalysis while in training. Psychoanalysis is the only one of the mental health disciplines that routinely requires practitioners to undergo the procedure they are learning to practice. Typically psychoanalysis requires a commitment to four times a week (or more) sessions. The frequency of sessions is intended to establish a profound relationship between psychoanalyst and client--it is this relationship that is expected to be the major healing influence.

Institutes for Psychoanalysis in major cities often offer psychoanalytic treatment at reduced fees through Clinic programs. (See the Chicago Institute for Psychoanalysis in the Parenting Adolescents Therapeutic Resource Directory, for instance.)

Specialized forms of psychoanalysis include Jungian analysis, classical psychoanaysis (based closely on the work of Sigmund Freud), interpersonal analysis, Self Psychological psychoanalysis, and others.

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This page updated 2/4/08. Copyright © 2008 Karen Martin and Jean Walbridge, dba Parenting Adolescents. All rights reserved.

 

SUPPOSE...

Reflections on Psychotherapy, by Jean Walbridge

Copyright © Karen Martin and Jean Walbridge, dba Parenting Adolescents, 2008. All rights reserved.

Suppose you could go to a place once or twice a week where for about an hour you have somebody's complete, skilled, undisturbed, non-judgmental attention as you attempt to relax and talk about anything that comes to mind:
the weather, if you like;
how your shoes hurt;
why it was hard to get up this morning;
whether it's stupid to feel happy because the kid at the bakery smiled at you as he handed you your coffee;
your worries about losing money;
your worries about making money;
your sister;
whether the clock on your desk has been changed by somebody so it runs five minutes slow, making you late for all your appointments;
how you dreamed of going to a wedding in the woods; whether your left arm is actually shorter than your right or if it's just your imagination;
why your mother loved your brother more than she loved you;
why your father was sexual with you;
that it feels that other people have been more fortunate than you and how you can't get over how angry you feel about it;
that you are convinced that you are really unattractive and sure that no one could really ever fall in love with you; why you feel like beating or abandoning your children;
why you feel so anxious when you are alone that you would rather be in a relationship with someone who emotionally or physically abuses you than to have no relationship at all.

Suppose further, that the listener's attention is rapt. His or her total task is to listen - to you, only to you, as you speak or as you are silent - to listen to what you are saying with your words or with your silence in order to understand your meanings more deeply than you understand them yourself.

In fact, it is this kind of listening that gradually permits you to begin to listen to yourself in a way you probably never listened before and to understand what you're saying and why you are saying it. This kind of listening puts you in touch with what you hope for, what you dream of, what you fear, and what you know. This kind of listening perhaps lets you come to know who you are...deeply...for the first time in your life.

Suppose further, that there is no tit-for-tat: just for once it is always your turn: your listener never needs you to be there for him or her, although will supply comments on demand--which are always honest and kind.

Suppose that from time to time you test your listener's attention and recall: you say something that you've said before and listen to the listener's response - does he or she recognize the repetition, remember the incident, know the name? And suppose that, often enough for you to begin to trust him or her, your listener passes the test.

In time you begin to create a more serious test: the contract between you and the listener is that everything you say will be held in confidence. But one day you tell something outrageous - something you've never told anybody. You wait to see whether the listener will be shocked, repelled, frightened - and even if the listener passes this part of the test, you wait to see what else might happen: having confessed, will you be punished? And will what you told really be held in confidence, or will you see it rebound somewhere?

What is the effect of confession without either absolution or judgment? What is the effect of confession responded to with understanding, as if the listener could put him or herself in your shoes, as if your "worst thing" is not just forgivable, but understandable, human?

Can you imagine how you would begin to feel about this listener, and how in turn you would begin to feel about yourself? Can you imagine how such an experience might change your life?

I hope so. Immersion in this kind of relationship for most people is transformative. It can change our lives. And for those of us who are "broken" due to childhood trauma or due to present day misfortunes or tragedies of major proportions, this kind of healing relationship and work "saves our lives." This is psychotherapy at its best.

So go ahead--find a psychotherapist who can engage with you in the work of healing your Self. See the articles in "About Getting Help" for assistance in finding one.

Copyright © Karen Martin and Jean Walbridge, dba Parenting Adolescents, 2008. All rights reserved.

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This page updated 2/4/08.