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UNDERSTANDING COUNSELING
Counseling vs. Psychotherapy
The term counseling can mean many things to many people.
The simplistic definition of "giving advise
or to recommend to take action" is not exactly
the same as the process of psychotherapy nor is it intended
to be. Yet people are generally advised to get counseling
when problems arise in their daily lives. Counseling,
however, can often be the word attached to areas where
people seek advice such as financial counseling, credit
counseling, spiritual counseling, career counseling,
marital counseling, etc… but how does "counseling"
differ from "psychotherapy" or "treatment".
In general, psychotherapy is considered to be any form
of treatment for problems of an emotional nature or
for the purpose of treating mental illness in an effort
to eliminate or facilitate behavioral changes through
a relationship with a trained professional. The relationship
provides for the opportunity of removing, retarding,
modifying or eliminating negative behavior and replacing
it with positive behavior to promote positive personality
growth and development. With all that said, how are
the two different?
First, counseling generally does not require that a
professional render a clinical diagnosis which will
be explained later. Counseling may also be provided
by non-professionals and is often not regulated by state
or federal laws. Psychotherapy, however, can only be
provided by a trained professional and is often limited
to the scope of practice dictated by the professionals'
credentials and or code of ethics of the professional
organization associated with the professional. For example,
in the state of Tennessee the Law recognizes the National
Association of Social Workers (NASW) Code of Ethics
as the standard by which practicing social workers are
held accountable. To see an explanation of some of the
clinicians who use psychotherapy to treat individuals
and families, refer to the question and answer section
of the web page.
In the course of practice, the term "psychotherapy"
is often shortened to "therapy" and is often
used in context as a modifier for a specific theoretical
base used by the clinician. Examples would be: cognitive
behavioral therapy, rational-emotive therapy, solution
focused therapy, Bowen family therapy, etc… When
seeking "counseling" or treatment, one should
keep in mind that most mental health professionals are
generally trained in the same forms of treatment. Some
professionals may seek out specialized training in a
specific technique or theoretical base that they prefer.
For this reason, therapists often have the tendency
to practice from that perspective. If you have questions
about a therapist's training, you should discuss it
at the beginning of the therapeutic relationship.
Now, let me address the issue of a "clinical diagnosis".
The function of a clinical diagnosis is to help clinicians
understand their observations and concerns regarding
a specific behavior or series of behaviors and is borrowed
from the medical model used by physicians. A diagnosis
serves as a short cut method among professionals to
communicate one with another regarding their conclusions
based upon their assessment or treatment. The diagnoses
made by behavioral health clinicians are based upon
the diagnostic criteria listed in the Diagnostic
and Statistical Manual of Mental Disorders IV-TR
and are the basis by which health insurance companies
determines coverage and payment. There are understandably
some problems with the medical model format in behavioral
health. First, the diagnosis is often given based upon
the clinical presentation at the time of the assessment
and is a subjective and intuitive conclusion by the
clinician doing the assessment. Secondly, human behavior
is not the same all the time and varies per individual.
Unlike a physician diagnosing diabetes, there are not
definitive tests that are based upon physical evidence
currently available to make a diagnosis. Time, however,
does make for a more accurate diagnosis provided the
same clinician or group of clinicians observes consistencies
in behavior.
Another concern regarding health insurance coverage
that has arisen because of the overall health care crisis
in our nation is that there is no parity in health
insurance for mental and nervous disorders as there
is with medical conditions. Instead, behavioral health
services are often separate from the individual's medical
benefits at a substantial reduction in coverage. In
addition, the health insurance carriers have begun to
limit their coverage for specific diagnostic categories
which often results in a more severe diagnosis being
made in an effort to utilize the individual's health
care benefits. This practice is touted as a cost saving
measure for the companies who assist in the payment
of health care coverage but then can lead to a permanent
labeling of a chronic diagnosis that in turn limits
an individual's chances for life insurance coverage
or future health care insurance. The only way to avoid
being rated by an insurance carrier is to simply not
use your health insurance. We are now seeing a trend
to separate nervous and mental health care benefits
from substance abuse coverage as well. My advice to
all persons regarding your coverage is to check with
your insurance carrier to know both your medical and
mental/nervous and substance abuse benefits. Be sure
and check your life time limits regarding coverage as
sometimes entering substance abuse treatment even for
a couple of days in an inpatient facility may be considered
your "one lifetime" benefit for inpatient
care. We do not come with a warranty plan like automobiles
yet banks generally will require proof of insurance
to cover a car loan. Further observations regarding
the same institution is that they may or may not provide
for the treatment of depression or psychiatric disorders
for a bank employee within their own insurance coverage.
Don't be surprised by a crisis and realize you have
virtually no coverage. No one predicts life's events
or natural disasters and their effect upon You
or Your family.
Hopefully, I have addressed some of the basic facts
about counseling and psychotherapy which will aide you
in your decision making regarding what is best for you
and your family. Change is ever constant and inevitable.
Most people simply fail to fully understand the "life
cycle" of the individual and families that is common
among all of us. I love the African phrase, "It
takes a village to raise a child", because it is
so true. More importantly, as social beings, it takes
a village and interdependence among us for us to be
the most successful we can be in our own life's journey.
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