Lesson 4 of 7  - optimize your relationships


Q&A About Counseling
and Therapy

By Peter K. Gerlach, MSW
Member NSRC Experts Council


The Web address of this 2-page article is https://sfhelp.org/relate/qa/counsel.htm

Updated  02-15-2015

      Clicking underlined links here will go to a place in this page or will open a new window. Other links will open  an informational popup, so please turn off your browser's popup blocker or allow popups from this nonprofit Web site. If your playback device doesn't support Javascript, the popups may not display.

      This YouTube video previews some of what you'll read in this Q&A article: The video refers to eight self-improvement lessons in this Web site: I've reduced that to seven.

      The existence and prevalence of the "mental-health industry" testifies to the widespread human need to get help in solving personal and social problems. Finding effective professional help can be a challenge

      The answers offered here come from my training and experience as a family-systems therapist working with troubled people, couples and families since 1981. I've also studied and taught effective-communication skills for over 40 years. This article answers...

  • general questions about counseling and therapy,

  • trauma-recovery questions, and...

  • relationship and family questions.

      This article assume you're familiar with...

  • the intro to this Web site and the premises underlying it

  • self-improvement Lessons 1 thru 4 (at least)

  • how to analyze and resolve most relationship problems, and...

  • how to improve communication effectiveness with adults and kids

      For perspective, see this interesting article by Dr. Richard A. Friedman "Like Drugs, Talk Therapy Can Change Brain Chemistry"

  General Questions about Counseling and Therapy

1)  What's the difference between counseling and therapy?

2What kinds of clinicians are there, and are there "best" kinds?

3)  How much does counseling cost?

4)  Typically how long does it last?

5)  What's the best way to shop for an effective clinician?

6)  What if (I think) my partner - or we both - need counseling, but s/he refuses?

7)  What is "family therapy," and when is it appropriate?

8What's required for effective marriage counseling and therapy?

9)  When is counseling or therapy appropriate for a child or teen?

10What is pastoral counseling, and when is it appropriate? 

11)  How can we tell if counseling or therapy "works"?

12When is participating in a self-help group appropriate?

13)  When is group (vs. individual) therapy appropriate?

  Questions about Trauma-recovery Therapy

      A basic premise in this Web site is that most people have inherited significant psychological ''wounds'' from their ancestors because of early-childhood trauma like abuse, neglect, and abandonment.

      These wounds significantly degrade health, thinking, communication, relationships, grieving, and parenting. They can be greatly reduced (vs. "cured") by personal awareness and informed professional help. self-improvement Lesson 1 in this  Web site gives more perspective, detail, and healing options.

14)  How can I tell if I've been "traumatized" and need professional help?

15)  How can I choose an effective wound-recovery therapist?

16)  When is grief-counseling appropriate?

17)  When is addiction-counseling appropriate?

18)  When is "anger management" therapy appropriate?

19) When is divorce mediation and/or counseling appropriate?

  Questions you Should ask about Stepfamily Counseling

      Premise: families exist to nurture - i.e. to fill the needs of their members. Because of psychological wounds and unawareness, many average families experience "stress" and "problems."

      It's increasingly acknowledged that family dysfunction is a major cause of most individual "mental health" problems. An effective antidote for this is family-life education and family therapy (above).

      Over half of American families struggle with divorce-related and stepfamily problems, which is the reason for these Q&A items: I have been a professional stepfamily therapist since 1979.

20What is "stepfamily counseling"?

21What is effective stepfamily counseling?

22)  Do typical stepfamily members need counseling more than "other people"?

23)  When should we consider professional counseling?

24)  Do counselors need special training to offer effective stepfamily help? 

25)  Is there a pattern to how stepfamily counseling usually progresses?

26)  How can I choose a qualified stepfamily clinician? Follow the link.

27)  Is it a good idea to try to get all three or more co-parents into counseling at once?

28)  What is post-divorce counseling, and when is it useful?

29)  What is pre-(re)marital counseling, and when is it useful?

30How can we select useful stepfamily books and advice? Follow the links.

31)  Can you recommend specific counselors in my/our area?

      Option - print these three Q&A pages and discuss them with other lay and professional supporters.

  If you don't see your question here, please ask!

Q1)  What's the difference between counseling and therapy?

      Professional counseling facilitates venting, expressing and clarifying feelings and needs; learning;  decision-making; and some problem-solving. It aims to help clients become wiser, more focused, grounded, aware, self confident, and motivated. Some types of professional counseling focus on specific areas like weddings, home-building, physical training, investing, spiritual growth, and financial, career, vacation, relocation, and retirement planning.

      Personal, couple, and family therapy add systematic psychological and sometimes spiritual assessment and interventions to counseling. The therapeutic process may involve the unconscious mind, the body, and the spirit or soul of participants. Generally, the various forms of therapy aim to...

  • safely resolve inner and outer impasses stressing a person, relationship, or family system;

  • release repressed emotions and awarenesses (break denials) safely,

  • restore or grow wholistic (mind + emotions + body + spirit) balance and stability,

  • stabilize or raise moods, and/or reduce excessive guilts, shame, and anxieties;

  • safely end toxic obsessions and compulsions (e.g. addictions);

  • raise clients' self-awareness, confidence, and hope,

  • improve the quality and stability of relationships and family systems; and for some...

  • help clients discover, affirm, and manifest their life purpose or mission.

      Therapy can focus on one adult or child, a relationship  (e.g. mate-mate, parent-child, sib-sib), a home, or multi-generational family, or an organization. There may be one therapist, two co-therapists, or a team of different specialists like a social worker, child psychologist, marital therapist or mediator, and a psychiatrist (MD). Therapists can work in a private practice, or a private or state-funded clinical agency.

      Different therapies use combinations of talk, sound, art and imagery, movement, massage, aromas, music, fantasy, journaling, instruction, role-plays, inner dialogs, and other means to facilitate the work. There are hundreds of different therapy models or paradigms differing in the mix of beliefs, techniques, scope, and values that their founders and practitioners believe in.

      In the last three generations, mainline Western therapists have been shifting from focusing on one person (e.g. psychoanalysis) to assessing and treating the person or couple's family system. Recently, therapists are beginning to use proven family-systems assessments and interventions to improve the functioning of individuals' inner family of personality subselves. For perspective on inner-family therapy ("parts work"), see this overview.


Q2)  What kinds of clinicians are there, and are there "best" kinds? 

      There are many kinds of counselors and therapists to choose from, and specialties within each kind. Their titles and the letters after their names can be confusing. Guidelines:

Psychiatrists are licensed medical doctors (MDs) who have had additional training in mind-body assessment and interventions. Only MDs can legally prescribe medication for "mental health" problems. Licensed pharmacists can advise on medications, fill prescriptions, and refer to psychiatrists and other healthcare providers. Some psychiatrists also have degrees in marital and/or family therapy or child pathology.

      Psychiatrists usually work with individual adults or children, and are usually the most expensive clinicians, with hourly rates over $100. Their focus can range from classic medical treatment to "non-traditional" (wholistic) work including acupuncture, therapeutic touching, light, herbs, aroma and movement therapy, spiritual work, and other practices. Many specialize in particular areas of mind-body health care. Health insurance will often offset their fees, within limits.

Psychologists are trained in individual and group behavior, but usually not in physiology and medicine. Licensed clinical psychologists provide therapy and counseling to individual adults and/or kids or groups. Typical psychologists are skilled in using a variety of non-medical tests ("instruments") to help diagnose a person's personality and problems.

      Like psychiatrists, they may specialize in one or more problem-types. Most psychologists have Master's and Ph.D. degrees. The latter may be called "doctor." They typically charge less than most psychiatrists, and may be covered by some insurance plans..

Social Workers usually have less training in instruments, no medical training (unless they work in a hospital), and more training in providing a range of community-networked services to individuals, couples, children, and their families. Licensed psychiatric and clinical social workers provide child, adult, marital, and family counseling and therapy in public and private agencies; hospital, school, and welfare departments; and private practices.

      They have Masters (MSW) or Ph.D. level (DSW) degrees, and usually need a state license to practice (LCSW - Licensed Clinical Social Worker). When proficiency and experience allow, they may also earn "ACSW" (Academy of Certified Social Workers) accreditation from the National Association of Social Workers (NASW). Clinical social worker's fees are often less than or equal to psychologists.

Licensed Marriage and Family Therapists (LMFT) and Licensed Professional Counselors (LPC) provide therapy and counseling like clinical social workers. They have no formal medical or psychological-test training, and usually get somewhat less training in providing networked social services than social workers. MFTs focus more on preventing and reducing relationship problems than other (generic) therapists. LPCs are more general. They both are usually licensed by state organizations like the other service providers.

Pastoral Counselors offer special focus on facilitating spiritual well-being and growth, in addition to non-medical counseling and therapy to persons, couples, and families. They may be affiliated with a church, an agency, a hospital, or in private practice. Some have higher-education degrees and certifications. Many have training in religion-based trauma-recovery (including grief) and marital counseling. See this and Q8 for more perspective.

Certified Family Life Educators (CFLE) provide information about the life-skills required to manage a family effectively, including parenting. They usually have masters degrees or higher, and provide expert adult and group instruction and some counseling, but usually not formal therapy. They may work with or refer to a range of local human-service professionals and organizations in their work.

Addictions Counselors have special training in assessing and guiding addicts and their families towards accepting and managing their toxic compulsions (achieving and maintaining sobriety). There are several levels of professional accreditation and licensure in most states. Many have additional professional degrees like those above. Addiction counselors may belong to one or more local and/or national associations like NAADAC.

      Addiction counselors usually work in public or private agencies specializing in inpatient and outpatient addiction treatment, including codependence. They're often members of multi-disciplinary clinical teams that work with addicts and their families. Addiction counselors are gradually accepting that addictions are not a personal "disease," but symptoms of serious family dysfunction and major childhood neglect and trauma.

      For more perspective on addictions and addiction management ("preliminary recovery"), see these articles.

Life Coaches are trained to facilitate clients (a) becoming more aware of their strengths, limitations, and personal goals, and (b) overcome some barriers to progress on the latter. Most certified coaches are rigorous about not providing therapy because they lack training and licensure to do that. So they avoid focusing on personal psychodynamics, and usually refer clients to therapists when appropriate.

+ + +

Other professional counselors and therapists specialize in helping clients manage problems with sex, grief, finances, disabilities, and occupation. They may or may not have one or more degrees in the professions above.

      Law-enforcement agencies, schools, hospitals, HMOs, and public-aid caseworkers provide family-support services that can include counseling and/or therapy.

      The best kind of counselor or therapist for a given problem is one who is trained, licensed, and experienced at diagnosing personal and relationship problems (unfilled needs) and skilled at offering cost-effective, respectful interventions that help clients improve their wholistic health in desired ways. See Q5 below.

Q3)  How much does counseling and therapy cost?

      Fees for these clinical services vary widely. Some agencies and private practitioners use a "sliding scale" for low-income clients who can't afford full-scale fees, so charges can be as low as a few dollars per hour. Full scale now ranges between (roughly) $60 to $150 per hour. Fees from licensed providers often qualify for some health-insurance coverage.

      Most Health Maintenance Organizations (HMOs), Preferred-Provider Organizations (PPOs), and managed-care organizations pay for a limited number of sessions with qualified clinicians. This cost-management limitation often hinders permanently reducing most psychological-wound (trauma-recovery)  problems unless clients can pay for extended therapy themselves.

      The easily overlooked counter-question is "How much does it cost (eventually) to not get appropriate counseling? There is no meaningful way to answer this question, other than accumulating personal pain, frustrations, disappointments, and losses over many years and looking back with hindsight and regret.

      Education is the best investment courting partners and other family adults can make to avoid such regrets and clinical costs. A high percentage of average people appear to inherit the epidemic [wounds + unawareness] cycle from their ancestors. Those that do can benefit greatly from effective personal trauma-recovery therapy, to avoid passing the toxic cycle down the generations.


Q4) Typically how long does counseling or therapy last?

      This depends on many factors. The practical answer is "It lasts until...

  • the patient or client feels the problem is solved 'well enough,' or...

  • funding runs out; or...

  • the participants' and/or clinician's patience, stamina, and hope run out."

Most relationship and family problems are symptoms of underlying adult psychological wounds and unawareness, so periodic effective clinical help can remain a valuable investment for many years.


Q5)  What's the best way to shop for an effective clinician?

      People who have never hired a professional counselor or therapist before may waste considerable time, money, and energy by picking an ineffective clinician. Choosing a plumber, dentist, doctor, or mechanic is easier in a sense, because you know what service you need. Paradoxically, the first thing you need to learn in shopping for a clinician is "what's my problem?"

      A good way to start shopping is to do an attitude check. The best counseling or therapy out-comes happen when clients believe "I am responsible for the quality my life and relationships" rather than expecting someone else (a parent, spouse, or professional) to take that responsibility. This attitude allows you to seek a clinician who's attitude is "If you hire me, I accept the responsibility for helping you learn how to identify and fill your own needs well enough."

      A second vital attitude to adopt is "I am a worthy, talented, competent person with unarguable human rights and a valuable life-purpose." Many of my therapy clients have been in protective denial of a well-camouflaged attitude of shame and unworthiness. This is one of up to six psychological wounds acquired in early childhood from abandonment, neglect, and abuse ("trauma"). For perspective, meditate on these brief ideas on healthy self love and pride.

      Next, identify (a) "What - specifically - do I need, and (b) what prevents me from filling my needs now?" If you can't evolve clear answers to those questions by mediation, journaling, and discussion with trusted others, then select a professional who will help you answer them before doing anything else.

      The most fundamental question you can research alone or with skilled help is "Who is causing my thoughts, feelings, and needs ("problems") now - my true Self or "someone else" (other personality subselves)? Gain initial perspective on this by reading this background article, and then use this comparison and this worksheet. Then study Lesson 1 in this nonprofit Web site for more perspective and ways to empower your true Self.

      Another powerful aid to effective self-assessment is using the premises that...

  • "all my problems are unfilled needs (discomforts)," and...

  • "I need to learn and fill the primary needs that are causing my surface (secondary) needs."

Study these three "dig-down" examples of how to do this vital self-research.

      Many surface problems that people bring to clinicians involve frustration with - or concern about - other people. Often a core root of their role or relationship problems (unfilled needs) lies in their attitudes. To gain perspective on this, see if this article applies to you and/or someone you care about.

      Another core cause of most relationship "problems" is that the people involved - specially kids - don't know how to think and communicate (problem-solve) effectively - they (you) don't know what they don't know. Use this quiz to self assess your knowledge on these vital skills, and then study Lesson 2 for practical options to "do your own therapy" (education).

      A final vital aspect of initial self-assessment is to explore whether your primary problem/s may come from incomplete grief. To gain perspective on this, take this quiz, and then scan self-improvement Lesson 3.

      If you (i.e. your dominant subselves) care enough about yourself to do these self-assessment steps thoroly, you'll have a much clearer idea of what needs you may need professional help with. See Q2 and Q12 for perspective on each of these. If you ignore, defer, or are half-hearted (ambivalent) at doing these self-assessment steps, you're probably significantly wounded and controlled by a well-meaning false self.

  Useful "Shopping Questions"

      Based on the above, vital questions to ask a potential counselor or therapist include your version of these:

"Why did you choose this profession?"

"How long have you been practicing, and are you licensed and accredited by state bodies and professional associations?

"How do you assess typical clients or patients - what do you look for, and in what order?"

"Are there specific kinds of personal or relationship problems you don't feel qualified to work on?" If so, whom do you refer people to?"

"Do you have training and experience in doing family-systems work?"

"Do you have training and experience in inner-family-systems or parts work?

"If I hire you, what do you see as your and my main responsibilities?"

"How do you approach resolving typical relationship problems?"

"Do you include assessing and improving communication and grieving skills in your work?"

"Do you routinely assess for addictions?" If so, how do you work with typical addicts and their families?"

"What role, if any, do you see personal spirituality playing in this work?"

(After initial assessment) "Can you recommend any local or Web support (self-help) groups that might help me and my family?"

        If you're in a stepfamily or may be, see this for special questions to ask a prospective counselor or therapist. Also see this if you're considering a stepfamily support group


Q6)  What if I think my partner - or we both - need counseling, but s/he refuses?

      One or more of these may be true:

S/He had a painful prior counseling experience (with you or pre-you), and doesn't trust the process to be safe and/or productive;

Your partner's ruling subselves fear that the process will reveal something awful about someone, your relationship, and/or someone's family;

Your partner's shamed and/or fearful subselves feel "counseling is for crazy or sick people," and they don't want (your partner) to be seen as either of those;

Your partner feels that you think something's wrong with her or him, so some dominant subselves feel resentful and defiant because you want to "fix" her or him (which makes you ''1-up'');

S/He interprets your invitation as a disrespectful demand or ultimatum ("You must fill my needs now") rather than a respectful request ("No" is an OK response) - and s/he is protesting that;

S/He has something against the counselor you've picked, feels left out of the counselor-selection process; and/or feels uncomfortable about choosing a clinician.

S/He feels you can't financially afford counseling now, and you disagree - a values conflict;

S/He (defensively) feels you're the one with the problem (you're 1-down), vs. we have a problem - so you should "get fixed;" and/or...

Something else.

      My experience is that trying to force or manipulate someone into going to a counselor or therapist is a lose-lose decision because it becomes a 1-up/1-down power struggle vs. win-win problem solving. 


1)  As with any significant personal or relationship problem, first check to see if your Self is leading your personality. If not, you are probably half or more of the "counseling problem."

2)  Get clear on why you think counseling would benefit you both; then get honest about whose needs you're most focused on filling. If it's "both of ours," then...

3)  Review your personal rights, and assert your views and needs clearly and simply (i.e. in less than four sentences) when (a) your partner is clear-minded and undistracted, and (b) you each have a "two-person" awareness bubble;

4)   Listen empathically (vs. critically) for any objections like those above, and see if there's some problem you weren't aware of. If so, use the seven communication skills from Lesson 2 to try for win-win resolution as mutually-respectful teammates, not opponents;

5)  Learn how to spot and resolve values and loyalty conflicts, and associated relationship triangles. Then see if "going to counseling" is a symptom of any of these three common relationship stressors. See this for options.

6)  Check your terminology. Some people (like your partner?) find "counseling," "consulting," or "relationship tune-ups" less intimidating or stigmat5izing than "therapy."

7)  Check your attitude toward your mate. If opposing subselves feel "I love you" / "I don't like you now," these double messages are probably raising your partner's confusion and anxiety. See Lesson 1.

      If you don't respect your partner, your behavior will broadcast that no matter how you try to camouflage it ("words can lie, bodies can't"). Her or his refusal to join you may be a response to that. Assess if something's in the way of a genuine mutual-respect attitude. If  so, take responsibility for resolving it.

Option 8)  Check your expectations of your partner. If your subselves expect your mate to refuse, that may be self-fulfilling.

9)  Study the marriage Q&A items here and these articles. Refusal to go to counseling is usually a symptom of a deeper personal, marital, and/or family problem, starting with psychological wounds and unawareness.

10)  Check yourself for black/white ("bi-polar") thinking - "Either you go with me, or you won't." There are always more than two options - e.g. maybe s/he'll go in a month, three, months, or after you've been to several sessions. Bipolar thinking is often a sign of false-self dominance.

11)  Check to see if you're stuck in a " Be spontaneous!" paradox - e.g. "I want you to want to go to counseling with me." That's something that can only be granted spontaneously, not demanded. Finally...

12)  Keep these timeless guidelines in mind, and use them when you're confused, overwhelmed, and/or discouraged...

      If you try options like these and still don't feel satisfied, listen to your inner voice carefully, and trust it. If it feels right, go to counseling yourself, and try identifying your primary needs (discomforts), vs. complaining about your mate.

      Coach yourself to be self-aware and try to avoid manipulating, hinting, threatening, arguing, power-struggling, mind reading, catastrophizing, whining, explaining, and demanding. Those are all lose-lose relationship choices, long term!


Answers about counseling continue on p. 2

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