FRUSTRATIONS of a Counselling Therapist

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This post is written to clear up some confusion. One of them is on who is trained to do therapeutic work. Another frequently asked question is what the difference is between therapy and counselling. A third confusion is the relationship between mental and physical health. A fourth one is in regards to depression and anxiety and the last topic is related to this, as I discuss the role of the class of medication that is most often prescribed for anxiety and depression.

Academic Background and Designation: Counselling-therapists may have different academic backgrounds. My background is in psychology and I specialized in counselling-therapy because most of my work is providing therapeutic services. Others may have a background in social work. Having studied psychology or social work does not make you a counsellor/therapist as this depends on how many courses and in particular practical work under supervision you have done in counselling. Many with degrees in psychology and social work who desire a career in counselling, gain these skills during professional development training after graduation. Others may have done most of their training directly in counselling. E.g studies in counselling may vary from diploma level to doctoral degrees.

Having the designation counsellor, clinical counsellor, therapeutic counsellor, psychotherapist, family/couple therapist, or anything similar, means that these mental health professionals are members of a professional counselling organization or college.

There is enormous confusion around this. There are many other professionals who offer counselling therapy, who hold membership in other professional organizations, hence their designation. It is important for clients to ensure that these professionals are indeed trained in the area they need help with. Some prefer “mental health professionals” in order to avoid exclusion of any group of professionals working in the mental health field.

Counselling or therapy or psychotherapy: The words counselling, and (psycho)therapy are used interchangeably, but some specializations in the field of therapy prefer either one or the other. E.g. Sex therapy and trauma therapy but grief counselling and couple counselling. To me, when I feel I use methods that go beyond the core ingredients of counselling; listening, understanding, validation, empathy, summarizing, supporting, encouraging…I use the words therapy. So, when working with intimacy issues and trauma, I prefer the word therapy. The combination counselling-therapist is used to end any confusion.

Physical and mental health: Most counselling therapists, do an assessment during the first session. This is after they explain the services and clients have signed a consent form. The assessment includes asking clients about their health including mental health, their life style, and the medication they take. The last part is important…as symptoms may be adverse side effects of medication. Changes made with the family doctor to medication without telling the doctor that you also work with a therapist is not effective…and not telling your therapist that you increased the doses of your meds is not helping either. Rationally, I believe that most of us know that health includes mental health. That different professionals specialize in components of your health does not mean that these parts can be seen as independent and not affecting overall health. As counsellors make the time to discuss all factors, it is important that clients include them in the team of people who look after them.

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Depression or being unhappy: When it comes to our mental health, identifying the cause of the symptoms is complicated. At the first appointment, a therapist might find out that the client works in an unhealthy (toxic) work environment, or that the client has frequent heated arguments with a spouse, or that a client is coping with an elderly parent or family member with dementia or cancer. Those stressful issues cause anxiety, anxiety often leads to sleeping and digestive symptoms, and all together an overall unhappiness and a feeling of being stuck. So, what counsellors do is looking at priorities and providing validation, support and empathy. They also teach tools to effectively solve conflict, they do couple sessions to help a couple to improve communication and to increase intimacy. They validate when clients are bullied at work and offer suggestions. Therapists spend time with a client to get to know them and to find out what is contributing to the symptoms. In many cases, the depressive symptoms are the result of situational issues…a relationship break-up, loss of a job or parenting  issues. The symptoms might be unpleasant but are perfectly normal. Having these symptoms is a good thing, as it demands our attention to do something constructive about it.

The role of Selective Serotonin Re-uptake Inhibitors (SSRIs): There seems to be a very skewed vision on what helps for people with symptoms of depression and anxiety. What I see too often is the following: A client presents with symptoms they identify as depression and anxiety and makes an appointment with a counsellor. Unfortunately, this is most often after they saw their family physician who already…prescribed them SSRIs. Most clients think erroneously that “the meds will kick in in a few days”. Many patients place an enormous believe in pills in similar ways that many patients believe that antibiotics are needed to cure an infection in a few days whether it is bacterial or viral. And…of course they feel better soon, which confirms that meds work.

Therapists are very careful to not damage a doctor-patient relationship. A good doctor-patient relationship is crucial as family doctors are the go-to person for preventative health. Therapists often refer clients to their doctor when they spot potential health issues which may be indications of diabetes, thyroid problems or heart disease.

Medicating for depression remains controversial. What we require is a sound consistent and honest overview of what these meds might do. Patients deserve to know all common adverse effects. These are serious and cannot be minimized. E.g. if a considerable group of patients report adverse side effects such as headaches, nausea, insomnia!, nervousness and ejaculation disorders, among others, we need to consider carefully whether the potential benefits are indeed outweighing the costs.

I often hear from my clients that the meds do something. I am sure they do…as there would not be adverse side effects if they did not. Clients tell me they know when they skipped a tablet, as they feel not well. These however, are withdrawal symptoms. Do SSRIs work for depression?

SSRIs seems to have a calming or numbing effect, which may offer a relieve to those with panic attacks and high anxiety. Whether the SSRIs work for depression is not easy to answer as before we ask ourselves what works for depression, we need to clearly identify what the presenting symptoms are and when these started and we need to obtain more background information from our clients. What I do know is that pills do not make you a better listener or a more thoughtful lover. Pills do not help you to set boundaries and to become more assertive. Pills are not helping you to make friends, or to be a better parent. Pills do not prepare you for illness, a loved one’s death, and other major adjustments and they do not help you to grieve. Pills do not cure your spending and drinking habits. Pills are not helping you to re-evaluate whether you are in the right job.

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Pills are no substitute for Trauma Therapy. Counselling therapists make time for their clients and therapy is only helpful when clients equally value their therapists’ efforts and stick with the therapy.

It is so incredibly frustrating when I hear that clients report to their family doctor or psychiatrist that the pills must work as they feel better, without mentioning all the work they did with their therapist. It is equally frustrating when I hear of a client having had a setback and rather than talking to their therapist speak with a family doctor who increases the doses of the meds.

Challenges and setbacks are normal and help us to grow…and reducing the stigma of mental health issues includes at least equally valuing the work you do with your therapist. Therapy is not an add-on, it is the main ingredient!

Comments and questions are welcome!

4 thoughts on “FRUSTRATIONS of a Counselling Therapist

  1. This was very helpful, Elizabeth. I know that I’ve no doubt used both counseling and therapy incorrectly for years. I appreciate your explaining the differences, plus the stages towards certification. One thing I’ve often wondered about, though, is when I see religious therapies, “Christian counseling,” etc. being advertised or listed. To your knowledge are they accredited at all? – Marty

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  2. Hi Marty,

    Thank you for your question.
    It is a complicated question as there are so many terms used and they all have a different meaning.

    Accreditation is a process of identifying whether educational programs meet the standards of the profession, in order for the graduates to be eligible for certification. Having studied at an accredited institution does not make you a certified/licensed professional (yet).

    Certification is a marker of professional expertise and often provided by professional organizations.

    Regulation is another term which refers to a professional being regulated (In Canada 5 provinces have regulated the profession of counselling/psychotherapy). This means that not everyone can refer to themselves as a counsellor in Canada anymore, as they need to be certified and hold membership in a regulatory body.

    Licensure (US) is a credential provided by the government (You often find certification/licensure but there is a difference in meaning).

    All of these: accreditation, certification, regulation and licensure are put in place to ensure quality services, but in the end only competency guarantees that a service is offered by a competent professional (who is effective) and that is not easy to assess. Supervisors can do this…but without the help of client feedback, it remains a process based on expectations and assumptions.

    Many Christian counsellors meet the standards as described above, but it depends on where somewhere practices. If a person practices in a country, state or province where counselling is not regulated, than they may not have a degree from an accredited institution and may not be a member of a professional organisation. This means that they might not be aware of the diverse codes of ethics and codes of conduct and it also means that when their clients are not treated well, these clients will find it hard to make a complaint as the person is not listed as a member of a professional organisation or regulatory body and very likely also has no professional indemnity insurance.

    For anyone seeking professional (mental) help it is always good to find out whether these service providers are a certified or registered member of a professional organisation in good standing, regardless of what (post-nominal) letters appear after a person’s name.

    I hope this is a bit helpful rather than more confusing…

    Elisabeth

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    1. Good grief, I’m so sorry for only seeing your response now, Elizabeth! WordPress for some reason never sent me a notification that you responded. Thank you so much for explaining the certification and licensing processes. That does help clarify.

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