Frequently Asked Questions
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 a 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 master's 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.
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 a 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 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.
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 relationships 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.
Preventing relapse to substance use is mainly a matter of becoming aware of the triggers to relapse and either finding ways to avoid or cope with them. Triggers can be external, for example, being in places where substances are being used. Stress of any kind (job stress, financial stress, arguments with important people) can also be an external trigger. Triggers can also be internal such as craving, depressed mood, anxiety, hunger or fatigue. The key is to anticipate triggers ahead of time so they don’t come as a surprise and use a plan or coping strategy to deal with the triggers. Usually, professional help is needed to gain awareness of and plans to deal with triggers to relapse. There are also very good medications for alcohol, opioid and tobacco use disorders that effectively reduce craving and can help prevent relapse.
Counselor told me I need to quit alcohol completely for at least 90 days before getting help for my mental illness. Is this the only way?
It is common for people with alcohol use disorder to have other psychiatric disorders like post-traumatic stress disorder, depression, bipolar disorder, or anxiety disorders. It is often difficult to determine if the other psychiatric disorder is caused or worsened by alcohol use or whether the other disorder exists without alcohol use. If possible, it is ideal to be able to stop the alcohol use totally for a period of three to six weeks to help determine how much the alcohol might be contributing to the psychiatric symptoms. It is not usually necessary to stop for as long as 90 days. In many cases, the symptoms will substantially improve after stopping the alcohol. If the psychiatric symptoms do not improve with stopping alcohol, they will need specific treatment with medication and psychotherapy. For people who cannot stop the alcohol, it sometimes makes sense to go ahead and try treating the other psychiatric symptoms with medication and psychotherapy even while some alcohol use is still occurring, with the hope that treating the psychiatric symptoms will make it easier to cut down on or completely stop alcohol use.
Drug addiction is not a choice but a disease. Taking a drug the first time or first few times may involve a conscious decision, but the drug eventually creates changes in the mind and body of an addict that affect his or her ability to resist. The psychological desire and physical craving for the substance eventually override the person’s self-control.
Addiction is a chronic disease. Recovery is an ongoing process that involves the daily management of that disease. Neither relapses nor multiple episodes of treatment are uncommon. Relapsing does not mean that the addict cannot achieve a lasting recovery; it’s just an indication that treatment needs to be managed more closely. Perhaps a different type of treatment or additional therapy needs to be implemented. As long as an individual is willing and ready to work toward a substance-free life, there is hope for long-term recovery.
Drug-induced changes in the structure and function of the brain may be long-lasting. The degree of damage to the brain and the potential for that damage to be reversed depending on the specific drug (or drugs) that an individual has taken. In general, the longer a person has abused a drug, the more the drug has altered the brain. It’s also possible that a persistent alteration in the brain is a factor in relapses that occur after a lengthy period of abstinence. Although undergoing treatment for chemical dependency may not reverse all of the physical effects of using the drug, many positive changes are likely.
Recovery from drug or alcohol abuse involves stopping the drug use and ongoing abstinence from the drug. Detoxification is the first step, but a lasting recovery usually requires behavior changes beyond merely stopping drug use. Also important is replacing negative habits with healthy ones, learning new coping skills for stressful experiences, and developing new ways of relating to family and friends.
Addiction is a chronic disorder. As is the case with other chronic health problems, the goal is the long-term successful management of the disorder. Research has shown that prolonged abstinence from drugs can lead to partial recovery from some of the effects on the body and brain. However, there are many factors at play in creating the addition, and ongoing management of some of those may be necessary for maintaining a successful recovery.