Workers in the mental health field have long extolled the virtues of achieving balance in life. During my career, I have come to witness that the most successful people in recovery are those who strive for a more well-rounded existence. One of the most potentially enlightening tools I have come across in my work is Saakvitne and Pearlman’s Self-Care Assessment Worksheet. An old Indian proverb states that “each person is like a house with four rooms; a psychological, physical, spiritual and social- and that we should go into all four rooms everyday if only to “air them out”. Saakvitne and Pearlman’s Self-Care Assessment expounds on this idea by itemizing these various life facets and challenging clients to identify which “rooms” of their lives need more “airing out”. Group and individual sessions I have facilitated on the topic of this self-assessment are often helpful for people in determining which parts of their lives need to be addressed in order to achieve more balance and promote wellness.
Recovery is more than just quitting a drink or abstaining from drugs or adhering to a medication regimen and attending weekly psychotherapy sessions. A lot of what is most deleterious about psychological and substance disorders is that the individual’s world becomes smaller and smaller until existence becomes a lonely and desperate place inhabited by a broken shell of a once vibrant life. Gone are the hobbies one used to enjoy. Friends and family members disappear. Everyday activities that used to provide pleasure are long-forgotten memories as each day breaks bleak and grey. Money disappears, as do jobs, careers, futures. All seems to dissipate one by one until the suffering person is left with nothing but the bottle, the pipe, the needle and the damnable, unfathomable noise inside the head saying it’s all hopeless and awful and the only short-term relief is in the comfort of the very thing disintegrates us. Life becomes smaller and smaller until something stops the hemorrhaging, usually jails, institutions, death.
It doesn’t have to come to this, of course, even though the despair may have us convinced otherwise. There is help. And even though modern treatment methods are not perfect by any stretch, we have come to know a lot about the neural machinations involved in addiction. Mood and anxiety disorders, long shrouded in social stigma and thought to be completely the fault of the sufferer, fit the disease model as appropriately as any physical/medical disorder does.
A basic summation of just how psychological disorders such as depression and addiction are indeed diseases lies with the medical model, a fairly simple rubric developed shortly after the discovery of germ theory in the late 19th century, which states that for any disease there must be three criteria:
- An organ
- Defect of that organ
So let’s take diabetes. What’s the organ involved in diabetes? The pancreas. During the course of diabetes, the dysfunction of the pancreas is that it either no longer produces insulin or produces too little of it. And due to this defect, symptoms of diabetes include increased thirst, frequent urination, hunger, blurred vision, fatigue and in severe cases, amputation of a limb.
Let’s look at skin cancer. The organ, of course, is the largest organ in the body, the skin. Pathophysiology of skin cancer usually involves mutations in the DNA of skin cells beginning in the epidermis that attack the three major types of cells by forming a mass of cancer cells. Symptoms can be insidious and hard to detect due to slow onset of the disease, but may include lumps, bumps and tenderness.
So we all know that addiction is now considered a disease by most every medical institution in the world even though still today there are people who believe that it is simply the result of evil, weakness, lack of character, lack of willpower, et cetera. And a lot of this is because it has historically proven difficult to delineate the criteria for addiction fitting snugly into the disease model. The organ involved in the disease of addiction, of course, is the brain, an organ with inner-workings and intricacies which remain largely a mystery even in these modern times. This is where the argument gets tricky. Neuroscience has provided us with information regarding the numerous neurological mechanisms of interest in the study of addiction but the exact specifics as to the dysfunction of this infinitely complex machination continues to evade us. Neural areas studied in recent years include the prefrontal cortex generally, that most “human” adaptation, a relatively recent evolutionary development which is responsible for choice and decision-making, logic and imagination, although this does not even begin to tell the whole story. The mid-brain, the ancient, oldest part of the brain responsible for life functions such as thirst, hunger, libido also plays a role during the process of addiction. The limbic system, including the nucleus accumbens and the ventral tegmental area, are responsible for the brain’s reward system involving the transmission of dopamine, a neurotransmitter responsible for the sense of pleasure. Equally elusive neurostructures such as those involved in motivation, cognition, behavioral reinforcement, impulsivity and fear all represent a system so far beyond our comprehension that it defies imagination and even rudimentary understanding. And the myriad symptoms of addiction- the phenomenon of craving, continued use despite negative and potentially fatal consequences, as well as violent illness, seizures and delirium tremens and possibly even death when the drug is not registered in the bodily system. So you can see how it’s just not as simple as recognizing that a heart isn’t pumping correctly or that a pancreas isn’t producing adequate insulin or that a cancer cell is metastasizing unperturbed. It is thus little wonder why addiction was explained away in favor of fantastical ideas of demonic possession. It’s never been easy to understand addiction and will continue not to be for the foreseeable future. With mental illness you encounter the same problems when attempting to prove it a disease. Again, we’re dealing with the brain. But is it a lack of seratonin that’s to blame? A result of dysregulated dopamine output? A faulty reuptake of norepinephrine? What about just plain old laziness and attention-seeking behavior? No wonder mental illness stigma is still alive and well in the 21st Century…
But we kinda got off track there. Back to wellness and balanced life and their importance in overcoming depression, anxiety and substance use disorders. It’s not just doing one or two positive things for six months that makes for a well-realized recovery. Recovery is a lifelong process and the individuals I have seen who have been most successful are the people who do things like take a look at the self-care assessment linked in the beginning of this post and apply it to their lives. Let’s say you are working with a client who is sober at work everyday, functions well on the job, regularly attends therapy and support groups but remains alone and isolated, doesn’t exercise, sleeps and eats poorly, drinks and spends money he doesn’t have at the blackjack table until four in the morning while his wife tends to their sick child alone as he’s trying to sleep with the cocktail waitress. We should of course validate his efforts in doing the things he is doing well but also be forthright in encouraging him to address the issue of the many self-sabotaging behaviors in his social, physical, psychological and spiritual life. It’s good that he is going to meetings and to work and meeting with his therapist but even if he’s technically sober, he’s far from living life in a sober manner. A good therapist would use something like the above self-care assessment to increase the client’s insight that the behaviors he is exhibiting are just as deleterious, maybe much more so, than the ones which supposedly constitute his “real problem”.
Successful clients with whom I have worked in recovery from psych and/or substance problems usually possess a commonality of traits. They get creative with their recovery and even when they don’t feel like it, they pick up their guitar, they sign up for a public speaking class, they take it upon themselves to address their social anxiety by initiating conversation with strangers everyday, they exercise, they write, paint, draw, read, take up new hobbies, take their daily medications as directed, take on extra hours at work or get another job to avoid boredom. They join meet-ups, they adopt a pet, they plant a garden, buy a telescope, join online support rooms, take up yoga, meditate, cook healthy meals, volunteer at a nursing home, sleep eight hours every night, reconnect with family and friends, listen to new music, do sudoku puzzles, get a tennis partner, take a ballroom dancing class, et cetera, ad infinitum. They start living again, not merely existing. They force themselves into uncomfortable situations that allow them to grow and even though they are scared at first they realize they can deal with the fear and not have to reach for the bottle or to the needle or to cut themselves or to pull out their hair. They become more accepting of themselves and others and life on life’s terms. What was once a small lonely life is now expanding in every direction and the possibilities are endless. This is recovery and it will never end until we do.
Rob Gambrell, Licensed Clinical Professional Counselor
State of Maryland, license #LC6384
*(312) 972-0926 *(410) 740-8066 *email@example.com
…to all my problems today. When I am disturbed, it is because I find some person, place, thing or situation- some fact of my life- unacceptable to me, and I can find no serenity until I accept that person, place, thing or situation as being exactly the way it is supposed to be at this moment.
Nothing, absolutely nothing happens in God’s world by mistake. Until I could accept my alcoholism, I could not stay sober; unless I accept life completely on life’s terms, I cannot be happy. I need to concentrate not so much on what needs to be changed in the world as on what needs to be changed in me and in my attitudes.”
The Big Book of Alcoholics Anonymous, page 417.
The world is 4.5 billion years old by most accounts. I didn’t come along until the late 1970s. To expect that the world will change to fit my needs, my wants, my expectations is more than childish, it is insane. Yet, during some of my weaker moments, I am assured that my needs, my wants and my expectations are The Most Important Thing In The World. I come back to this quote from the Big Book of Alcoholics Anonymous many times to remind myself of the importance of acceptance. Of not only myself and all my faults and flaws, but other people and the world around me. “Life on life’s terms”, not on my terms. I do believe that the importance of acceptance cannot be overstated when applied to recovery from mental health and substance use disorders.
You may have been fortunate enough to read the book Man’s Search for Meaning by Viktor Frankl. Frankl and his entire family were imprisoned at Auschwitz, where his mother and brother were murdered in front of him. His wife was transferred to another concentration camp and ultimately met the same fate. Very few things in this world could have been more horrific and unspeakable than his experiences during those three years of hell. He eventually was liberated by American soldiers at Turkheim in April of 1945 with scars psychological and physical that we can’t even begin to imagine. Upon returning to Vienna following the war, Frankl developed the tenets of what would eventually become the theoretical orientation of “logotherapy”, which is essentially existential analysis which posits the importance of deriving meaning from life using acceptance, forgiveness, logic and reason. Frankl said that whatever happens to an individual, he or she always has the choice to decide how they perceive and process it.
Even in the face of some of the most deplorable conditions humanity has ever experienced it is possible to find meaning in the tragedy and suffering that spares no one alive. Frankl is quoted as saying, “what is to give light must endure burning”. We always have a choice as to what and how we believe. Sometimes those of us who have suffered the most are the most capable of harnessing all that unfathomable pain, anger and despair and use it to transcend the evil and the unjust. Carl Jung, the famous psychoanalyst described the archetype of the “wounded healer”, the idea being that those who have been deeply wounded are often the most capable of helping others overcome wounds of their own. It is estimated that more than 70% of people in the helping professions were compelled to enter their chosen field as a result of their own wounds and to help other people heal from theirs. I am no different in this regard, and it serves as a great asset for me in helping clients that are enduring some of the same suffering I have experienced. There is a line in the chapter on acceptance, beginning on page 417 of the Big Book of AA, in which a man writes, “I used to believe that my alcoholism is the worst thing that ever happened to me. But now I am certain that it is the best thing” because if he did not have this experience of tremendous suffering he would not be able to take on all that darkness and turn it into light.
At the heart of all this is acceptance. If I can accept more of myself, others and the world around me, I’m just in a better position to be happy and I also need to accept that I can’t be happy all the time. Sometimes I can just be ok and that’s ok. We can’t change most of what happens in life. A lot of things in life are unfair and unjust. Even though we can’t change these realities we can work to accept more of ourselves, our lives and the challenges they present. We all can find meaning even in the pitch-blackest darkness and the most smothering despair and it all starts with acceptance.
ROB GAMBRELL is credentialed by the State of Maryland Department of Health & Mental Hygiene as a Licensed Clinical Professional Counselor (LCPC). Mr. Gambrell specializes in helping clients with co-occuring mental health and substance use issues. If you or someone you know needs help please call to set up an initial assessment session during which myself or a colleague will be able to assess your needs at this time.
Alcoholics Anonymous (AA) and Narcotics Anonymous(NA) have a powerful presence all over the State of Maryland and you can reach a representative from one of the ten AA intergroups by first accessing their website, marylandaa.org/find-a-meeting/.
*If you are considering becoming abstinent in both alcohol and other drugs, you could be in danger of suffering immensely painful withdrawal symptoms that can lead to vomiting, shaky hands, hallucinations and in some severe cases, death. If you are experiencing such symptoms please go to the nearest hospital emergency room to undergo a safe medical detox process.
Rob Gambrell, Licensed Clinical Professional Counselor
State of Maryland Professional License Number LC6384
If you’ve done some research on counseling and theoretical orientations counselors use, you’ve probably heard the term Cognitive Behavioral Therapy, (CBT). While this sounds really fancy and technical, it’s not. CBT is essentially about maintaining better control over the ways in which we think about ourselves, others and the world around us. If we are able to modify our thinking habits to serve us rather than hinder us, we are just in a better position to adjust to the realities of life. Any therapist worth his/her salt will tell you that they rely heavily on CBT because it has been proven to be the most efficacious, valid and reliable treatment application in the last half-century for anxiety and mood disorders and substance use disorders as well.
Our emotions and our behavior all come from the ways that we think. With everything that ever happens to us, we always have the ability to choose how we will think about it. Two people can experience the exact same situation and come away with completely different beliefs and perceptions about what happened. We create our own reality by the thoughts we select and over time, we may get into some thinking habits that sabotage our well-being. As the saying goes, “the mind can be a great servant or a terrible master”.
Imagine the driver of the car next to you cuts you off in traffic. What do you believe about what just happened? You have countless choices here. Some of us may choose to think, “who does this guy think he is? He’s trying to kill me!” and as a result, we’ll probably get angry and just maybe we’ll use a choice gesture and/or call him everything but a swell guy and in some extreme cases like some of the ones you’d see on an MSNBC cop show, we may follow him to the next exit, honking the horn like mad and do something that may put us in jail or worse. That would all be the consequence of first thinking, “this guy is an #%$ and he’s personally doing this to me which is unfair and disrespectful”. Now, what if the same scenario happens. Guy cuts us off in traffic. But this time, we choose to believe that he’s taking his sick puppy to the vet. Maybe he just didn’t see us. Maybe he’s so anxious about his poor little dog that he’s driving a little too fast and carelessly. Maybe he’s in a way more legitimate hurry than we are. It’s all simply what we choose to believe. But this particular choice, this particular way of thinking certainly doesn’t end in a mug shot or court fines or getting into a fight that will be broadcast for everyone you know to see on Youtube. Same situations, two completely different cognitive processes.
Here’s a list of some common errors we make with our thinking. I’ve never showed this to a client without them admitting that they find themselves engaged in such thought patterns many times a day. We all do it. We all make mistakes sometimes with the ways that we think, which leads to emotions, behavior and ultimately, the consequences of that behavior. My theoretical orientation in the therapeutic process relies heavily upon helping you identify, reframe and dispute some of these common thinking errors and help you to get into better, healthier cognitive habits. True change is attainable if we are able to modify the ways in which we write our life stories.
Rob Gambrell is a Licensed Clinical Professional Counselor (LCPC) in the State of Maryland specializing in mood, anxiety and substance use disorders.
(312) 972-0926 (cell)
(410) 740-8066 (office)
People may put off going to therapy for many years despite a lot of evidence pointing them in that direction. I’ve heard all kinds of excuses for not getting help in therapy and maybe these sound a little familiar to you.
- “I’m not crazy so I don’t need therapy”- I rarely see anyone sitting in my office that could qualify as crazy, although I’m not sure what would constitute such a label in the first place. Most people with whom I work are high-functioning people who have strengths and weaknesses just like everyone else. Some people may feel “stuck” or “trapped” or they may have tried various methods to address certain problems but have failed or have not achieved the results they want. Asking for help is a sign of maturity. We all have faults, some are more interested in facing them and working through them than others.
- “I can just talk to a friend”– Humans are social creatures. We all need the social support that good, trusted friends provide. However, well-trained counselors provide an unbiased, non-judgmental therapeutic approach and are adept in the art of active listening. We are not generally in the business of giving advice like friends are wont to do, but rather our goal is to work with you in guiding you toward achieving your identified goals from an objective, non-judgmental perspective that keeps everything you say in complete confidence. Yes, you are “paying for someone to listen to you” but it goes way beyond that. Friendship, unlike counseling, involves mutual interest and exchange while therapy is all about you. This is your chance to help yourself, to do something positive for you, and I’d like to help you in doing so.
- “If I talk about my problems, it will just make them worse”- When we bottle our problems up, we may think we’re dealing with our problems but really we are just suppressing them. It helps to get it out there and deal with it. Therapy is not about getting over our problems, but getting through them. Talking about them with a trained mental health professional not only helps to lessen psychic pain but provides us with an avenue for exploring options and choices in working on our problems.
- “I don’t really have any problems to talk about”– Some days, there may not be much to talk about. Everything’s ok and there’s not much on your mind. That’s expected. I’m not gonna keep you in the office for an hour asking you inane questions just for the sake of needling you into taking about something. But usually, what I find is that these times are often great opportunities to discuss other matters that don’t seem related to the identified treatment plan, but end up providing wonderful insight. You get out of counseling what you put into it, and I have found that those who realize the best results are usually the ones who are willing to put in the most effort. Sometimes, just sitting down with a mental health professional and discussing seemingly frivolous things can result in better understanding of ourselves, others and the world around us. It’s ok if you think you can’t think of anything to talk about before you come in.
“I don’t need to go get my head shrunk”– A long time ago, Freudian Psychoanalysis was the treatment approach du jour, and with it came the stereotypical guy with a pipe taking notes as his patient stretched out in the supine position facing away from the therapist talking about his relationship with his mother. This is definitely not what modern therapy looks like. We’re not in the business of shrinking heads. On the contrary, I’ve often seen minds expand during the course of the therapeutic process as people come to new insights and realizations about who they are and how they are able to change their lives for the better.
- “Men aren’t supposed to talk about touchy-feely stuff”– Says who? A lot of the thinking behind this is a holdover from the supposed “good old days”, when all men were like John Wayne and boys walked to school in the snow uphill both ways. Men live in a different world now and studies have shown that men who talk about their problems rather than bottle it up are healthier and have a longer life expectancy. Why hold it all in?
- “I went to counseling before and it sucked”– Counseling is like any relationship in that sometimes people just don’t click together. Doesn’t mean someone is good or bad or right or wrong, it just happens that way sometimes. And admittedly, like most professions there are good practitioners and not-so-good practitioners. Some therapists just sit there and nod their head until you want to yell at them, “HELP!” while some want to tell you to be a warrior and “man up” and remind you that there are starving people in Africa so what makes you think you have problems? People who like their doctor are less likely to sue them and I think that people who like their therapist are more likely to be engaged in and amenable to the treatment process. Find someone who you click with and be open to a new experience. I schedule clients for four consecutive weekly sessions and by the end of a month, we will have a pretty good idea if we are working well together and if you want to continue with me. Most clients choose to stay on with me and on the rare occasions they don’t, I won’t get my feelings hurt, I promise, and I’ll be able to find a colleague who may be better suited to meet your own individual needs.
- “People will find out I’m going to counseling and think I’m crazy”– Well, first of all, there’s that word “crazy” again and if the truth were known, we’re all probably a little crazy in our own way. Anyway, no need to worry about others somehow finding out you are in therapy because of the strictures of confidentiality between therapist and client by which I abide absolutely. Nothing you say during our work together, unless you deem yourself to be a direct and immediate threat to yourself or to others, leaves the four walls of my office unless you sign a release of information that gives me the right to do so. And even on the off-chance that you see me at Whole Foods while you are shopping with your friends who don’t know you are in treatment, I will not even stop to say hello unless you say hello first and even then I would never presume to bring up the nature of our relationship among others. So don’t think I’m rude if I don’t say hello to you out in public, I’m just being ethical.
Rob Gambrell is a Licensed Clinical Professional Counselor (LCPC) in the State of Maryland specializing in men’s issues as well as treating mood, anxiety and substance use disorders.
(312) 972-0926 (cell)
Sometimes the signs are clear and obvious why someone chooses to seek therapy. An incapacitating drinking problem after you’ve worked through the denial that kept you from getting help in the first place, serious interpersonal consequences of the highs and lows of bipolar disorder, grief in the wake of a loved one’s death or depressive episodes so abysmal that suicide seems preferable to going on in such tremendous pain. At other times, it’s difficult for us to realize that maybe we need to see somebody about this. Below are some signs that it may be time to get the help we need:
- Headaches, backaches, stomach aches. Psychological issues can manifest in the form of these physical issues and stress can affect our body in myriad ways. I’ve had many clients tell me that once their mood improved and they were better able to cope with the stress of everyday life, they no longer had back/stomach pain or migraines. There truly is a mind-body connection.
- Strained relationships. With our co-workers, friends, spouses, children, our parents. Our emotional state affects others more than we may realize and those closest to us often notice these changes first. Sometimes these issues are left unspoken until they become very problematic. By listening to the concerns others have for our well-being and not ignoring it or being defensive or dismissive, we can get a grasp on the issue before it becomes a much bigger problem. If we’re taking care of ourselves, as we get better those around us get better, too.
- Using substances/behaviors to cope. Drugs and alcohol are often seductive ways to allow us to escape from our problems and/or uncomfortable emotions. So are gambling, sex, pornography, eating and a number of other things that in desperate times, seem like a way out. Problems is of course, they may become relied upon as the primary coping mechanism and may be addictive and ultimately, add to our problems instead of assuage them. Sometimes we may not even realize how much we depend on a given substance and/or behavior to help us through tough times. We may look up the criteria for alcoholism on WebMD and think to ourselves that because we don’t meet every single symptom of problem drinking, that we don’t need help. We rationalize our use and/or behavior and minimize the consequences that result because we need that escape. Chances are that if we think our problem might be an issue, it’s probably a good sign that it is indeed, an issue. I’ve never met a person who didn’t have a problem with alcohol who has to stay sober for a few days just to test his ability to be sober for a given period of time. If his or her drinking was not a problem they wouldn’t have to “test” themselves to see if it was a problem or not in the first place.
- Lingering effects from a traumatic event. Many people who have suffered traumatic experiences may indeed go for a long time without experiencing any psychological disturbances. However, the trauma could be operating at a level underneath our ability to detect it. Nightmares, trouble sleeping, an exaggerated startle response, self-destructive behavior and nagging feelings of tension may easily be written off as a one-off, especially if the trauma we experienced was so long ago that we couldn’t possibly believe we are still dealing with it. Sometimes our conscious believes we’ve long moved past something that our subconscious is still dealing with.
- Experiencing emotions intensely. Everybody gets down sometimes, but when it begins to affect our productivity or our ability to function, we may need to look deeper into the problem. Everyone gets angry, but if the anger becomes something that results in adverse consequences- legally, interpersonally, financially- then we probably need see someone about it.
- Feelings of being trapped, stuck, helpless or hopeless. Every one of these feelings can be smothering and overwhelming, but it doesn’t have to get to the point that it completely derails you. We have feelings for a reason and often when we feel trapped or stuck, it may be our own way of motivating ourselves to do something about it. Paying attention to these feelings and doing something about them sooner rather than later may keep a bad thing from getting much much worse.
- You’re avoiding things. Withdrawing from activities you once enjoyed, no longer pursuing hobbies, staying home weekend after weekend, isolating, not calling your friends back. These all may be symptoms of deeper issues that should be addressed in therapy.
- You are human. Even if you always have a clean bill of health after visiting your primary care doc, you still get regular check-ups. Addressing your mental health should be no different. Life is full of challenges and stress and by growing as a person we are better able to be well-adjusted to the realities of life. We always have a chance to grow and evolve and therapy is just one more tool we can use to help us achieve continued wellness.
Rob Gambrell is a Licensed Clinical Professional Counselor (LCPC) in the State of Maryland, County of Howard, specializing in men’s issues and dual-diagnosis (Substance use and co-occurring mental health disorders).
(312) 972-0926 (cell)
(410) 740-8066 (office)
Now that you’ve decided that you want to get help, how do you go about it? A simple Google search for say, “therapist anxiety columbia maryland” will yield countless addresses and phone numbers for mental health agencies public and private and a variety of mental health professionals with myriad weird letters after their names like LCPC, LCSW, LCMFT, APRN and CRNP-PMH, among others. What do all these letters mean and how do you know if the people possessing them are any good at what they do? Like every business, there are good practitioners, not-so-good practitioners and some who after meeting them, you wonder how they ever tricked a state or professional board to license them for anything. The mental health business has its share of people who got into the profession for the wrong reasons as well as people who burned out their last gallon of compassion and competence years ago. However, there are some really good ones out there but they are often hard to find.
I’m not going to make a list of the things you should look out for in determining what constitutes good therapy because as luck would have it, this list is called “50 Signs of Good Therapy” and was written by someone at goodtherapy.org. But here’s a little primer on what all those letters mean anyway:
LCPC- Licensed Clinical Professional Counselor- This is someone who has a Master’s degree in something like Clinical Mental Health Counseling, Rehabilitation Counseling or Counseling Psychology, and has been licensed by a specific state’s Department of Health and Mental Hygiene after completing 3,000 hours of supervised practice and passing necessary licensure exam(s). Individuals with this licensure designation offer psychotherapy in individual, family and group settings and are not authorized to prescribe medications.
LCSW- Licensed Clinical Social Worker– This license is for providers who have a Master’s degree in Social Work and have completed training similar to that of the LCPC but with more of an emphasis on social work directives such as assisting clients in navigating social programs and advocating on behalf of clients in legal situations, custody, housing and child welfare issues, etc. They are also not authorized to prescribe medications.
Psychologist– Sometimes Licensed Clinical Psychologist (LCP), PsyD or PhD. Practitioners that have obtained a doctorate and are similarly trained in psychotherapy as the aforementioned two, although in most psychology doctoral programs there is more emphasis placed on statistical research and the administration and assessment of personality tests and depression inventories, etc. The license holder is also not authorized to prescribe medication.
Psychiatric Mental Health Nurse Practitioner (PMHNP)– Are trained to provide a wide range of mental health services to patients and families in a variety of settings. PMHNPs diagnose and prescribe medications for patients who have psychiatric disorders, medical organic brain disorders or substance abuse problems. These practitioners have a focus on psychiatric diagnosis, including the differential diagnosis of medical disorders with psychiatric symptoms, with comparatively more emphasis on medication treatment than on psychotherapy.
Psychiatrist- Physician who specializes in medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are medical doctors, unlike psychologists, and must evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments, or strictly psychiatric. Psychiatrists work with you in a rather controlled trial-and-error manner in getting you on the best medication regimen for you. A lot of times patients have a difficult time handling side effects, but most are minimal and shouldn’t be all that worrisome. Your psychiatrist will go over any possible drug/food interactions as well as contraindications like the fact that it’s not advisable to take benzodiazepines while eating grapefruit because of an enzyme that potentiates (makes stronger) the effects of the drug. Good tip: if you know of a blood relative who has similar issues and has had a positive response to a certain drug, tell the psychiatrist because due to a lot of genetic influence, he may choose to start you on that particular drug which could quite drastically effect the trial period with medications. And remember, there are many misconceptions about anti-depressants and other drugs, so please read as much as you can about the drugs you are putting into your body and have a lot of questions for the psychiatrist and pharmacist.
Hope this clears up some confusion in deciding between all the options you may have for mental health treatment. You may have to meet with several clinicians before finding the one that is most capable to meet your needs. Take what you’ve learned from the list of 50 signs of good therapy and when meeting with a prospective therapist ask questions to discern more about theoretical orientation, ethics, treatment planning, training, experience, etc. Also, ask around. A lot of people are in therapy these days and some of your friends and trusted associates may be able to refer you to a good counselor that can help you. Feel free to contact me if you need any other assistance with this process and good luck!
Rob Gambrell, LCPC
(312) 972-0926 (cell)
(410) 740-8066 (office)
In this December, 2012 article in Counseling Today, some of the helping professions’ educators and practitioners weigh in on what traits make for an effective therapist. When shopping around for a counselor, consider whether or not they possess such qualities. Here are some excerpts of how several professionals in the behavioral health field answer the titular question, “what makes a great counselor?”
Bradley T. Erford, president of the American Counseling Association and a professor in the school counseling program at Loyola University Maryland:
Masterfully developing the therapeutic alliance, instilling hope, quickly centering on achievable objectives, judiciously selecting evidence-based practices, maximizing out-of-session change opportunities, and facilitating treatment adherence and follow-up to make sure treatment gains are maintained long after termination.
Marcheta Evans, associate dean of the College of Education and Human Development at the downtown campus of the University of Texas at San Antonio and a past president of the American Counseling Association:
A person who is totally committed to the clients they are serving. They realize they must be engaged in continued growth professionally and personally. They have the ability to see beyond the spoken word and connect what is truly happening in a client’s life. A great counselor is someone who enjoys helping those they serve to become empowered by teaching their clients to become life problem-solvers. Ultimately, a great counselor works themselves out of a job with a client by helping [that client] to learn to navigate life on their own with maybe periodic mental health check-ups.
Samuel Gladding, professor and chair of the Department of Counseling at Wake Forest University and a past president of the American Counseling Association:
A willingness to listen carefully, form and maintain a strong therapeutic relationship, empathize, be persistent energy and work with clients on mutually agreed upon goals are essential qualities of a great counselor. If the counselor is truly a wounded healer, he or she may well go beyond what would be considered exemplary practice because of increased sensitivity and understanding of what it feels like to be hurt and what it takes to heal.
Gerald Juhnke, professor in the Department of Counseling at the University of Texas at San Antonio:
A passion to help others. They demonstrate respect for those they serve and understand their roles within the counseling process. Concomitantly, great counselors understand themselves. They know their core values and beliefs, and they accurately anticipate how their core values and beliefs influence the counseling process. Likewise, superior counselors have appropriate fun and utilize benevolent and kind humor. They understand the critical need for balance within their clients’ lives as well as their own. Finally, great counselors exhibit a degree of tenacity that promotes continued client engagement even when the counseling process becomes challenging.
Don W. Locke, dean of the School of Education at Mississippi College and past president of The American Counseling Association:
The underlying quality that supports great counselors is the genuineness they can convey both in how they respond to the client and how they view themselves and others.
Mark Pope, professor and chair of the Department of Counseling and Family Therapy at the University of Missouri-St. Louis, and a past president of ACA:
A passion for helping others. We can teach knowledge and skills, but we can’t teach this passion. Also, being a great client. Great counselors really learn to be a great counselor by first being a great client.
Jane Webber, associate professor in the counseling program at New Jersey City University:
Unconditional respect, authenticity, empathy and compassion. Great counselors build a safe therapeutic alliance where I feel connected, affirmed and validated. They are a witness and a partner, walking with me on my journey, empowering me to share my deepest feelings and to take risks to change.