Who's Qualified?
We live in the Age of Experts. We spend billions on "experts", probably two-thirds of it wasted money.
Recently, there have been warnings about "unqualified" counsellors online. "Unqualified", of course, means uncertified, as psychiatrists or clinical psychologists-- you know, the folks who gave us DSMIV and V and other forms of institutional madness. "Experts"!
There's the rub: MOST "certified" psychiatrists and psychologists are unqualified to the extent that they are part of an industry. There is no proof that in a majority of cases they do any better than just a good friend--certainly not for depression -- and a lot of evidence that they can sometimes at least make things worse. Shrink are experts in making money; not so much at helping people, or addressing the real ills of society.
Online counsellors may be better because it is easier to sort out the wheat from the chaff, as you will see at the end of this post.
Background
Most people misunderstand psychotherapy or psychiatry, both of which are framed by the concept of “mental illness” and whatever society tells us is "normal" -- products of the industrial and postindustrial ages and the atomization of human relationships. In their own way, psychotherapy is a new religion, with its own priests. Naturally, it requires ordination, which requires study of scripture -- with DSM V, the Bible.
Let us keep in mind that Freud and Jung were not "certified". None of this stuff existed before the early 20th Century, nor in the form that we understand it today since 1970. In other words, our present understanding of “counseling” is less than a half century old and evolving fast. Not so long ago, being "gay" was a mental illness. And look up drapetomania sometime
Let us say you have a problem. The death of a loved one? Loss of a job or income and anxiety about the future? A traumatic event that has left with you with PTSD”? Problems with a lover or family member such as a mother of father? Divorce or breakup?
There’s a long list.
CBT-T?
CBT or Cognitive Behavioral Therapy is a new term for a centuries-old approach to problems, which used to be known variously as commonsense or reason, with a dash of imagination --which people have always applied in a crunch.
And "crunches" is where it really matters. As interventions.
For example, studies indicate that professional “interventions” can be effective in preventing PTSD—but rarely are==and a licensed shrink may not be your best choice.
Here is an excerpt from an academic article:
Consistent with our previous review, the current findings suggest that psychological intervention offered to all individuals exposed to a traumatic event irrespective of their symptoms cannot be recommended for routine use following traumatic events. Several interventions – CBT-T, cognitive therapy without exposure, EMDR, structured writing therapy, and internet-based guided self-help – provided evidence of efficacy in reducing traumatic stress symptoms, when targeted at symptomatic individuals
EMDR is well known. It stands for “Eye Movement Desensitization and Reprocessing”
CBT-T?
In the article’s words:
CBT-T was defined as any intervention that focused on the trauma using written, imaginal or in-vivo exposure therapy with or without cognitive therapy and other cognitive behavioural techniques.
Note the words “any intervention”.
CBT is nominally the province of a licensed therapist or doctor, depending on the "school" or therapy. But they can by used by anyone because they dependent on rational and also imaginative thought -- yours -- not the therapists'.
The ancient Greeks and Romans had their own versions—the just used different terms.
As a formal approach, CBT normally takes advantage of a variety of techniques including “imaging” which may include hypnosis or guided fantasy to harness imagination to establish new neural pathways in the brain reshaping our memories of an event. Indigenous peoples have had their analogues for this for thousands of years.
Journal writing is also used, which only became common with the invention of paper.
“In vivo exposure therapy” is simply identifying activities that make you nervous, rating their severity, and then doing them starting with the easiest first, for desensitization and re-orientation. Priests and religious figures have always been good at this.
Here’s what the Emperor Marcus Aurelius wrote in his journal:
‘You have power over your mind – not outside events. Realise this, and you will find strength,’ and ‘Very little is needed for a happy life: it is within you, in your way of thinking.’
That is CBT in a nutshell. All that is new is really, really old.
Interventions
Interventions by unlicensed counselors, including phone-in services and online services often work better than visits to a psychiatrist’s office or that of a clinical psychologist simply because “professionals”, if only because they are usually more immediately available. Timing matters in real world challenges.
Psychotherapy is an industry, hugely profitable to those who sell it.
Most licensed professionals have to build up clientele – and keep a client base. They want to keep you coming. How else can they buy that new BMW? Or afford their own therapist.
Yet, the vast majority of “psychological” problems are not "illnesses" or "disorders" tied to events and coping strategies that can be resolved – IF they are EVER going to be resolved in 12 weeks or less, without the need for medication. Neurological issues that affect the mind such as psychosis or bi-polar disorder are, of course, another matter.
Unprofessional Professionals
“Professionals” are usually amateurs with a diploma who charge for what others do for free. In the case of psycho-pros, they see a lot of people--too many. Turn around is the thing .
Therapists are taught “clinical (affective) distance”, which means dulling their natural empathy and altruism. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is their Bible – an attempt to categorize “mental illnesses” as “disorders”. If you read it you will notice that almost everyone of your friends and family can be diagnosed as having a “disorder”. As I said, psychiatry has a lot in common with religions such as Christianity. We may not be all born in sin-- but we are born into "disorders".
There is lots and lots of “scientific” research to support this approach.
Look carefully, however, and you will see that this research, while “scientific” in methodology, designed to prove certain assumptions, it has, to date, not been able to validate even the basic efficacy of professional psychotherapy, which led to anti-psychiatry movement which began in the 60s and 70s.
We have seen one psychological theory after another overturned not in response to science but to changes in social attitudes. Masturbation was once a “sickness” -- pervert!. Lobotomies were once the most advanced therapies, until drugs arrived, to provide similar but less draconian solutions.
The Good Counselor
A good counselor, as opposed to a good clinician who is taught semi-sociopathic clinical detachment, has to have empathy.
He or she has to be strong enough to identify with your feelings, without being overwhelmed by them—to see through your eyes with being overcome by your emotions. In other words, he or she is an alter ego. Such a counselor has to be able to offer strategies – “homework” , if you like, that help you overcome your problems.
Some problems are rooted in childhood conditioning or habits of though “received” in early life, which, as habits, are heuristic, automatic, and just below consciousness. Those habits of thought, like any habit, can be overcome, or even used to create a more functional “you”.
For every person this might seem like an individual journey—but it is not. We are social animals and our identity are not singular--but multiple. Think about it, it's a different "you" at work, with Mom and Dad, and Friday Night.
As Tennyson writes.
I am a part of all that I have met;
Yet all experience is an arch wherethro'
Gleams that untravell'd world whose margin fades
For ever and forever when I move.
You are a part of not only “what” you met – your experience – but of “who” (whom) you have met. As another poet--Whitman--suggests, you contain multitudes. That leads to contradictions and it is a counselor’s task to help you resolve those contradictions when they become problems in your life.
Of course, some licensed therapists understand this. But they are few and far between and their understanding contradicts their training.
If you have a problem, shop around for advice. Keep in mind, however, that friends often have their own problems and prejudices. You must choose people who can listen and not necessarily accept everything you say as you say it -- but feel the contradictions in you. Identifying contradictions is the first step. A friend is not someone who just tries to "make you feel better"; they are someone who seeks to help you find a solution within yourself, as Marcus Aurelius would have it. They are those who can criticize directly and tell you to cut the bullshit.
The same applies to a counselor. Counseling is a relationship. Volunteer counselors can help a lot in a pinch and have literally saved a lot of lives.
The case of R
Let us take the case of R. R is 17 and was admitted to hospital after slashing his wrists. He was profoundly depressed and addicted to benzodiazepine. He is recovering well now thanks to support from others -- his grandparents, for one -- and more particularly-- the nurses in the hospital. Not the hospital clinicians -- the nurses. "They understand me", he says. Meaning they empathize with him.
Ultimately, R's addiction is physiologically not very strong, and the wrist-slashing was due to overdosing and suffering rebound depression afterwards. It was also manipulative: he wanted attention and support. HIs grandparents have given him that. My advice was for them to tell him they loved him but ultimately it was his choice to get high, now that physiological addiction had diminished -- and they weren't going to enable him. Empathy can be a double-edged sword.
For the doctors and staff psychologists he is just another "client". They get him "clean", knowing he will be back and they benefit from him coming back again .... and again....and again.
I don't think a clinical psychologist or psychiatrist is the best choice for him -- he has learned how to use the "system". In any case, in my experience, only 1 in 10 "therapists" has what it takes. His grandparents so far have done a better job.
Longer term counseling to effect real change is tough. It should identify issues, set goals and involve homework. And if you don't see improvement in real world terms in 12 weeks, something is wrong. In the end, it is the individual who chooses -- but difficult choices need support -- give'm love, tough or not.
'
Finding the Right Counsellor
Credentials mean little. This isn't rocket science. And you don't learn how to counsel people in a university course. Good counsellors are born--not made, very much like good teachers.
In this respect, compatibility means a lot; humanity means more.
Online non-certified counsellors have some advantages. And the good ones are easy to identify. They are the ones who insist on need rules and conditions.
The first session or two with an online counselor should be free, with either of you entitled to discontinue or a guarantee of refund of moneys paid after a month, if you --or they -- are not satisfied-- providing you have fulfilled all of the counselor's conditions. Online counselors do have expenses such as websites, so generally you have to pay if you find the right match.
The counsellor should outline conditions, such as homework, commitment on your part to change and growth, with a proviso that if you follow through on commitments outside the counselling session, the counsellor can discontinue services. A "growth contract" or "contract for change" is the mark of a good counsellor, indicating that they are results oriented and not just looking for lifetime flow of cash like many certified therapists. That contract needs an expiry date -- say 6 months --at which time it can be renegotiated.
COVID counseling takes both empathy and empathy. Your counselor has to learn all about you, your situation, your challenges, childhood conditioning and the like. So, a necessary component of your "contract" is open-ness and honesty. Only then can your counsellor identify issues, which you very likely cannot identify on your own--of misidentify.
Only a very few "certified" counselors offer this approach. Yes, counseling can help -- whether it's about relationships, sex, careers or work, even business.