What is Counseling?

Counseling is a way for people who are having problems that they can't handle, can't control, or just don't know how to deal with, to find help from a trained professional. There are many types of counseling. We will deal with talk therapy. A person goes to a counselor because he/she can't find the answers to a problem. A counselor will listen to the problem and ask probing questions to get at a deeper level of what is going on. The therapist will then either explore with you ways that you can change your thinking about the issue or teach you skills so that you can correct this concern on your own.

What is the difference between counseling and therapy?

We will be using the words counseling and therapy interchangeably. There are many different kinds of counseling such as career counseling or debt counseling. There are also many types of therapy like physical therapy or gene therapy. We will be talking about the psychological types of counseling and therapy, as related to the services described in the services offered link.  To practice psychotherapy in California, the therapist must be licensed by the California Board of Behavioral Examiners.

What Education and Experience is required to get the MFT license?

In California, Marriage and Family therapists may be trained in many different styles or orientations for practicing psychotherapy. During and after their Master's level graduate level study, they must practice working with clients under master supervision, a minimum of 3,000 hours, fulfilling specific training and experience requirements in several different areas.  

After passing a written exam, and the California Board of Behavioral Examiners Oral Examination, MFT interns receive the Marriage and Family Therapy License.  The license is meant to protect consumers from untrained or incompetent psychotherapists who might do them harm.  While there is no guarantee that a particular therapist will be able to help you with your particular problem, the California State MFT license does guarantee that this therapist has taken certain classes and passed qualifying examinations, and that they maintain their knowledge base by taking continuing education programs before they can renew their license each year. 

How can psychotherapy help me?

Therapy can help alleviate emotional pain and suffering. It can teach you new skills with which you can successfully deal with the problems at hand. It can save a marriage. It can help increase your self-esteem. It can give you hope that there is a better way, or a way out. It can do all these things and more. The only thing it can't do is change you. You have to do that by yourself. You have to take the skills or new ideas and put them into practice in your life. We continually tell our clients that unless they take what they learned and put it into practice out in the world, counseling will do them no good.

What are "psychological problems and symptoms?"

Symptoms are an expression of the fact that, for some reason, we are not able to live authentic; they may look like fears, obsessions, anger, depression, or substance abuse, but they are actually the way we have found (up to now) of dealing with parts of our lives that aren't working for us. Are they the best way to deal with the challenges we face in our lives? Probably not. The purpose of therapy is to help us understand why we do what we do, and how we can create more options for getting what we need or want.

Copings are the behaviors, conscious or unconscious, we have learned (usually in our families of original, at a very young age) that allow us to survive difficult feelings. Virginia Satir identified five main coping stances: Blaming, Placating, Super-Reasonable (or Computer), Irrelevant (or Distracter), and Congruent. When discomfort in a situation gets intolerable, only the Congruent stance is able to take into account the needs of the self, the needs of the others involved and the context or facts of the situation. Yet, many of us spend our lives using obsolete coping strategies that fail to achieve our interpersonal goals. Therapy helps us to understand why we might do that, and seeks to help us identify more options towards creating new possibilities for future interactions.

Defenses are unconscious behaviors that help us avoid unpleasant feelings, such as rejection, humiliation, and other assaults to our self-esteem. They seem like they are protecting our self-esteem by maximizing our sense of being in control: a child, afraid of being left out, rejects or bullies other children; an adolescent self-medicates with drugs or alcohol rather than feel disappointment in the people who abuse him; parents rage against authority or institutions, blaming them for any problems or failures--this protects them from seeing something about their parenting or their child that may need to be addressed. These are all examples of defenses that prevent us from moving forward toward a happy fulfilling future.

A personality that begins as "defensive" can bloom into one full of symptoms -- depression, drug abuse, various anxieties, insomnia, "personality problems", even paranoia. Under "DSM Diagnosis", his health insurance claim might list Depressive Disorder, Obsessive Compulsive Personality Disorder, Conversion Disorder, Paranoid Personality Disorder (it's really called that), or several other possibilities. He may develop physical problems that relate to the tension and unconscious effort of defending his ego, instead of living his life.

So, a symptom is an outgrowth of a defense. When these defenses fail we tend to escalate our efforts. We develop new behaviors (substance use), intensify old ones (withdraw, become paranoid), or fall prey to irrational beliefs and feelings (such as phobias, panic attacks, somatic ailments). At some point these behaviors interrupt our ability to enjoy life so much they are called psychological problems or symptoms. When it becomes okay to feel the things you've been trying not to feel, when you become aware of things you've avoided, you generally feel and function better.

Why do therapists talk about the past?

Not all therapists do focus on the past! The goal of psychotherapy is to understand what happened to you, what effect it had, and how it is still affecting you, so that you can be freed to choose other behaviors and to feel better. Often, the way we deal with current challenges reflects how we have learned to deal with past experiences. The therapist is not interested in who's at fault for creating a feeling or a behavior; the truth is that it doesn't really matter if one's mother was doing the best she could, or was a vicious sadist. What matters is that the client begins to understand what he lived through, how he tried to cope with it, and how it continues to intrude in his current life. Sometimes what a client really wants is Life Coaching, where the past is less a focus than the present and future.

What Is Life Coaching And How Does It Differ From Therapy?

Both Therapy and Life Coaching are approaches that involve a supportive relationship between a client and trained professional with the mutual purpose of helping the client achieve a more fulfilling life. While therapy may focus more on insight and understanding about the source of feelings and roadblocks to achieving your dreams, coaching will focus on action.

How Does Life Coaching Work?

Coaching is usually conducted over the telephone and sessions customarily last anywhere from a half-hour to forty-five minutes. You may also be given weekly "assignments" designed to assist you in staying committed to your vision and achieving your goals.  

What can I expect to pay for Therapy, Counseling or Life Coaching?

Most sessions last for 50 minutes and cost $125.  The initial session might take longer; depending upon how much paperwork can be completed in advance.  Therapy and Consulting clients pay for services as they receive them, generally by check at the end of the session.  Life Coaching clients may contract for a certain number of sessions and pay on a monthly basis.  Telephone and e-mail counseling is generally billed against a credit card account the client opens with the Gifted Development Center.

If Insurance will pay for all or part of the therapy, the therapist provides a monthly "superbill" which details information the insurance company needs in order to reimburse the client.  At this time, therapist is not on most PPO Insurance panels due to restrictions on the type and duration of therapy allowed clients.  Therapy should be individualized to reflect individual problems, resistance, and life circumstance. 

What is confidential information?

The State of California has rules concerning the confidentiality of certain disclosures. 

Psychotherapists are mandated reporters of certain dangerous behaviors; this means that if a client discusses them in session, the Therapist is required by law to make a phone and written report either to the appropriate agency or person involved.  There are other "gray" areas, where the therapist has the option to report certain dangerous behaviors or threats to self or others.  Those are reported on a case by case basis, taking into account the therapeutic issues involved.  Each of the areas of report are disclosed in the first session, and presented, in writing, to the client. 

Any other disclosures, even when requested by the client, require a signed Release of Confidential Information prior to acknowledging the person is a client.  No records or reports of any kind will be sent by electronic means unless authorized by the client, in writing, or mandated by a court subpoena. Occasionally therapists will consult with other professionals concerning treatment or legal obligations, but, unless authorized in writing, only circumstances and considerations (not names) will be included, even for that purpose.   

What Is The First Step? 

The first step is to schedule an initial consultation. During the initial phone contact you will be told the logistics of coming to the first session: directions, time, address, fees and what, if anything to bring with you. 

The first session (which generally requires two hours) will involve: 

History Taking

You will either fill out a form, or be interviewed about your life circumstances and the history of the problem. The therapist needs to get to know you or your child in order to understand the systemic dynamics as well as the personalities, challenges and resources of the client(s) involved in the treatment.  

Problem identification 

We will assess the problems or goals for which you are seeking assistance, while analyzing past efforts at solving the issue. 

Limits of Confidentiality, Fees and Logistics

Therapist will explain legal requirements of mandated reporters, and the legal Limits of Confidentiality. You will understand how much the sessions will cost, options for payment and what to do if you need to reschedule the appointment. Therapist will present you with a written explanation of these disclosures to help you make an informed consent for treatment.  

Questions and concerns 

You are always encouraged to voice any questions or concerns you may have.  During subsequent sessions, client and therapist will work together to better understand the clients wishes and goals, and how best to achieve them.  

Case formulation 

We will discuss aspects of the problem, various ways of approaching a solution, skills that will assist you and possible strategies for achieving your goals. 

Treatment selection 

There are many philosophical approaches to therapy; different ones suit different personalities and difficulties. Together we'll explore the choices for treatment and select the best fit for your individual situation.  

Treatment

Most sessions will address the problems directly or indirectly, based on the specific needs of the client, in the moment. Over time, we will follow the treatment plan, assessing progress periodically. 

When therapy has achieved the stated goals, client and therapist evaluate if the client wishes to continue therapy with new goals, or to begin the process of termination. 

Termination

This phase of the therapy occurs over a period of time, during which the client may wish to schedule less frequent sessions, or to select an end date for the therapy. Final sessions include evaluating the progress made, practicing new skills, anticipating and planning for challenges, and saying “good-bye” as a means of providing closure what has become a special relationship.  

How long does it take to go through all these phases of therapy? 

This depends upon the client, the nature of the problem, the depth of the emotional conflict or pain the client is experiencing, the theoretical approach that have been selected and the commitment of the client to achieve understanding and new purpose in their lives.  

What does successful counseling look and feel like?

Successful counseling feels like something has changed, something is different. You feel more hope and self-confidence. You are trying out new behaviors and they are working. You may notice that you are having different results from actions that in the past would not have gone so well. You might be aware of unproductive behaviors that were automatic in the past; you will suddenly have the power to continue using them, or trying out more positive ways of coping. In the end, you will always be the one to make the decision about whether therapy has been successful or not.

What do I do if it's not helping?

The first thing you do is tell your counselor. Explain what is not working and why. Discuss things that have worked in the past. It is important to reflect on what your therapist says. The reason we need counseling from time to time is that we can't see our self defeating thoughts or behaviors, or how they relate to paste experiences and the meanings we made from them; it sometimes takes an impartial observer to point out to us what is obvious to others.

How do I know when I am done?

You will feel a sense of completion and success. Most of the concerns and anxiety that brought you into therapy will have dissipated. You will have learned coping skills and new behaviors to deal with any issues that may persist. Your therapist should be able to give you feedback about your decision and discuss whether or not she feels you are ready to terminate. Ultimately the decision is in your hands.

How much does consulting cost?

The costs of consultations are based on the nature of the work involved, the costs (if travel or expenses are necessary) and the duration of the commitment.  All this will be discussed during the initial consultation, which is charged at the regular therapy rate of $125 per 50 min. session.