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Q11) How can we tell if
counseling or therapy "works"?
Well-chosen, effective individual, couple, or group
counseling or therapy aims to do one or more of these: help participants...
-
clarify and
rank-order
("problems") and
options;
-
clarify and affirm perceptions,
roles, and strategies;
-
want
to learn and apply relevant new
-
dissolve
impasses respectfully;
-
facilitate
and growth,
-
facilitate
effective
and
and...
-
lend
temporary emotional, spiritual, and social
in times of special
need.
Each client person brings a unique array of surface and
to the work.
Guideline: if all people affected by the initial ("presenting") problems feel
consistently "better" when counseling ends, it probably "worked." If
some people feel better and others don't, it worked "partially." If
everyone is dissatisfied or frustrated, something about the counseling "didn't
work." Be alert for protective
trying to avoid
fear,
or loss by trying
to give responsibility to a stranger (e.g. a clinician) or someone else.
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Q12)
When is participating in a self-help group appropriate?
The number and
range of self-help groups in most cities and towns testifies to how widely
needed they are. Typical self-help (or mutual-help) groups strive to fill
participants' needs for...
-
empathy,
encouragement, and inspiration;
-
belonging,
acceptance, socializing, and concern; and...
-
relevant
information and effective suggestions.
Group leadership may be professional, but is often one or more devoted lay
people or couples with enthusiasm, dedication, and commitment, but modest or no training. The most helpful groups offer
a consistent, balanced, flexible format to intentionally meet the needs
above.
They usually meet regularly in a comfortable, accessible setting, are
financially self-supporting or sponsored, and have a clear charter (mission
statement), and a framework of policies and rules (e.g. "start and
stop on time, and no smoking, gossiping, interrupting, or swearing.")
Groups may be local, or affiliated with similar groups in the region or
nation - e.g. any of the "12 step
Anonymous" groups for addicted persons and families, "Compassionate
Friends," for grieving parents, "Parents Without Partners" for single
parents, and Rainbows for members of
divorcing and bereaved families. Some groups are for people with physical problems, and others focus
on emotional, spiritual, or relationship, concerns.
Typical support groups are much less expensive than professional counseling
or therapy. They can help fill some needs effectively, but usually can't
provide the assessments, wisdom, and strategic interventions that trained
and experienced clinicians can. Much advice in typical lay-led groups is "common
sense" suggestions to surface problems, which often don't
acknowledge or satisfy the unfilled
Options: do some preliminary self-assessment to decide specifically what
you need - e.g. "I need to stop exploding at my family members, and
feeling so guilty and frustrated with them and myself." Then ask in your
community if their are groups available that focus on similar needs - e.g.
an "anger management" group.
If so, (a) ask if people you know have any information about the group
(helpful or not?), and/or (b) go to at least three meetings with an open
mind to get a feel for the people and process. If one group doesn't suit
you, don't write off all similar groups, because each has it's own unique
character.
Most common personal problems have several Internet sites devoted to people
with similar needs. Many offer free "chat rooms" or "forums" - i.e. online support
groups. When there is no physical group to attend (e.g. in a rural
area), this can be a real help - despite lacking the visual communication
and social interaction that "real" groups offer (e.g. group hugs)
If you try out one or more groups and find your needs aren't being met well
enough, then consider individual or group counseling or therapy. After
assessing you, a veteran clinician should be able to advise you on the
usefulness and availability of relevant community and/or Web groups.
For more perspective, see this
series of articles on effective support
groups for co-parents. Much in these articles applies to any
self-help group. Also review the answer to
Q1.
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Q13)
When is Group Therapy Appropriate?
Well-run
professionally-led group
therapy offers several advantages compared to individual work. Each person
can get nonverbal and probably verbal feedback from several people, not just
one. Hearing other people talk about their situation and coping strategies
can help to...
-
put your own
situation into perspective ("Ah - I guess I'm not alone with this
problem"); and...
-
reveal
resources and options that you wouldn't have thought of alone or with a
counselor. And for many,
-
to a group (being known, accepted, and valued) can be very satisfying
- specially to socially isolated people.
Other benefits:
Professionals running groups can observe each person's way of interacting
directly, rather than relying on clients' subjectively descriptions. They
also have some useful intervention options that they can't do in 1-on-1
clinical work - e.g. group role plays. A reality is that some skilled
therapists may not be effective group leaders, and vice versa. A final
consideration: typical group therapy is less expensive, since the
clinician's fee for each meeting is split up among several people.
Three options to choose from are
to use:
-
individual
or group counseling or therapy only,
-
individual and group counseling concurrently, and
use...
-
individual and group counseling
at separate times.
The best choice
depends on a client's personality, problem/s, past experience, finances,
other supports, and the availability of appropriate professional help.
In my
experience, individual and group therapy in some combination is most
apt to yield long-term satisfaction. Trying a group is guaranteed to
teach you something useful about yourself and the process - if you're
Note the difference between a
therapy group (usually led by a professional, and focusing more
deeply on people's issues) and a
self-help group (usually
led by a lay person or couple, and staying more superficial). Each can be
helpful, depending on a participant's mix of
For more perspective on family therapy, see the answer to
Q7
above.
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Answers to Trauma-recovery Therapy Questions
Q14)
How can I tell if I've been "traumatized" and need professional help?
Let's define a
trauma as "a sudden or expected event that causes someone (a) psychological
upset and/or (b) physical injury that (c) significantly reduces their
ability to function normally. Significantly is a subjective judgment.
For most people,
trauma and traumatized are emotionally provocative ("hand-grenade")
terms like sick, diseased, raped, and "mentally ill." This unpleasant
association causes some people to discount or deny the personal effects of a
traumatic event, and to ignore, avoid, or defer appropriate self-care.
Many people find psychological injuries in themselves and loved ones to be much harder to
assess and admit than physical ones - e.g. admitting a broken arm from
a car crash but denying related depression, guilts, frustrations, and anxieties. Also,
some psychological traumas happen over months or years - e.g. growing up in
a
environment. These realities can make it hard to answer "Have I (or has someone
I care about) been traumatized?" accurately.
From
29 years'
clinical experience with over 1,000 average American adults, I propose that
three more relevant - and measurable - questions are:
-
do I have
significant
symptoms of "Post Traumatic Stress Disorder (PTSD)?"
-
do I have
of
significant psychological
and...
-
do I have
of significant unfinished grief? (because some
can be traumatic)
If you get
anything other than a solid "No" on any of these questions, you may benefit
from hiring a qualified professional to check your trauma-assessment and advise you on
appropriate self-care options - including some type of counseling or
therapy. Shop for qualified trauma-recovery and grief clinicians - see the
answers to Q1 and
Q5.
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Q15)
How can I choose an effective wound-recovery therapist?
I suggest you
study these slides or this
five-page article first, to gain useful
perspective for what follows.
This question
presumes that you (a) accept the idea of psychological
and (b) believe such wounds can be
(vs. "cured"). If so, then the first step in getting effective help is to
find an experienced clinician who believes the same thing, and is
professionally devoted to wound-reduction. The next step is to agree on what
wounds you want to reduce, specifically - e.g. "I want to stop living a
life, and grow my self esteem and self confidence."
I am an
experienced wound-reduction
therapist, and am biased about answering this question. My experience and
research since 1979 strongly suggests that most (all?) common forms of "mental illness"
are symptoms of one cause: false self dominance, or a
I have seen
or inner-family therapy succeed at reducing psychological wounds often enough
to recommend it as the therapy of choice. Other
types of therapy can also be effective. To see if there is a "parts work"
therapist near you, see
this.
Since the advent
of family-systems therapy (Q7) in the 1950s, there is
increasing agreement that growing up in a "dysfunctional"
family promotes most psychological and relationship "problems." There is much
less agreement on the nature of such problems (called "wounds" here) and
how to reduce them effectively. If you can't find an acceptable
parts-work therapist, I recommend investigating clinicians experienced with
these types of therapy:
-
Post-traumatic Stress Disorder (PTSD) treatment
-
Voice Dialog
-
Psychosynthesis
-
Theophostic
- this healing technique has special appeal to lay and clinical people with a
strong Christian faith; and...
-
EMDR (Eye Movement Desensitization and Reprocessing)
- augments and/or replaces traditional "talk therapies" to help
many survivors permanently reduce psychological wounds from major life
traumas.
Other therapists promote various ways to "heal from toxic
parents," nurture your "Inner Child," (singular), and "Let Go of the Past." Each
has unique benefits and limitations that depend on the clinician's
personality, style, wisdom, and wholistic health, as well as the brand of
counseling or therapy they offer.
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Q16)
When is grief-counseling appropriate?
Premise:
grief is a natural
process which allows eventually accepting major life
(any broken bond, not just deaths) and resuming normal life activities. Many
people bearing significant
from childhood and/or who were not raised in a
family are hindered or blocked in healthy mourning. For some, this is
because they're unable to form healthy
with other people.
Incomplete grief
produces common behavioral
and can promote significant psycholog-ical, relationship, and medical
problems. So the answer is: "Grief counseling is appropriate when you
(or someone) have too many of these symptoms that interfere with productive
living."
I suspect that
what is often labeled as "clinical depression" is really a combination of
psychological wounds and blocked grief. Implication - if you or
another person is "too depressed too often," explore the possibility that
effective grief counseling is more useful than anti-depression medication.
Such medica-tions may reduce the symptoms, but not the underlying
causes.
Some counselors and therapists
specialize in assessing for
incomplete grief and freeing it up. For better perspective on hiring such a
helper, first study these
slides or this article.
I suggest you learn the ideas in this quiz before
starting to shop for professional help. Searching the Web for "grief
counselors" will bring you many useful choices.
My experience is
that three factors can hinder healthy grieving: (a) psychological
and (b)
and (c) living in a family and/or working in a social environment that
normal mourning. This suggests that a competent grief clinician will assess
all three factors and offer appropriate interventions.
For more
perspective and options on healthy grieving, see these
Project 5 articles.
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Q17)
When is addiction-counseling appropriate?
Premises:
true addictions are reflexive (vs. intentional) attempts to medicate
intolerable
For perspective
on this,
please read this series of articles and return.
A simplistic
answer to this question is "Addiction counseling is appropriate when you feel you have - or may
have - a compulsion that degrades your health and life." A wiser answer is
"When someone in your family may have - or has - any of the
of addiction." This is a better response because
true addictions are not a
disease -
they're a symptom of (a) a
family, and (b) adult
and psychological
Some substance addictions do have physiological component - e.g. bodily
"cravings" for nicotine, heroine, and fatty "comfort" foods.
From this view,
the best way to answer this question in your unique situation is to (a)
learn addiction
The Web address of this
three-page article is
http://sfhelp.org/qa/counsel-q.htm