In 2003, I had a nervous breakdown overseas. I’ve told the whole story in my memoir, As Soon As I Fell.
Part of my story is the story of some very damaging counseling that I experienced in the attempt to recover. As I look back, the red flags are clear:
- I was asked to sign away my right to confidentiality.
- When I refused, my confidentiality was breached anyway.
- I was told I had to see a specific counselor, no choices allowed.
- When I said that I didn’t like what was happening, I was told that the process was a good, helpful process.
- When I said I was angry about what was happening, I was told that the process was a good, helpful process.
- When I said that their helpful process wasn’t helpful to me–well, nobody had an answer for that.
After such a terrible counseling experience, it was terrifying to think of taking a chance on yet another counselor, but by then we needed counseling for the counseling PLUS the stuff we started out with.
Andy said this, though: “If your toilet had a leak, and you called in a plumber who didn’t fix the leak but instead created a geyser in your bathroom, you wouldn’t assume that all plumbers are incompetent. You’d just realize that this particular one was a nincompoop, and you’d find a competent plumber instead.” So, we found a competent plumber and worked on getting the leaks fixed.
So how do we steer clear of the nincompoops, and make sure we’re getting competent care in counseling?
Let me offer you some information that I wish I’d had at the time.
BASIC ETHICAL PRINCIPLES
A quick google of “ethical counseling principles” will yield these five core standards across the board:
- Autonomy: the client has freedom of choice, freedom of action
- Justice: the counselor must do what is right for the client
- Beneficence: the counseling experience must do good for the client
- Nonmaleficence: the counselor must not inflict harm or risk harm to the client
- Fidelity: the counselor must be faithful in honoring commitments to the client
Good, ethical counseling will be provided in places where your autonomy is respected, where justice is served, and where you are faithfully receiving counseling that helps you and doesn’t cause you harm.
Good, ethical counseling will respect your right to confidentiality.
Good, ethical counselors know their own limits in training and expertise and will refer you when you need help they can’t give. They won’t insist that their process is awesome when you tell them it’s painful and unhelpful to you.
GOOD THERAPEUTIC RELATIONSHIP
Research shows that therapy is more likely to be successful when there is a good therapeutic relationship, regardless of the counseling theory being used.
A good therapeutic relationship simply means that you feel safe, respected, and heard.
You and your counselor can have difficult conversations. You feel safe to say what needs to be said, and satisfied with the outcomes of those conversations.
A good therapeutic relationship is not a friendship, though. While your counselor may tell you a little about herself at times, the counseling sessions should be about YOU: your story, your pain, your processing, your way forward. You should never feel burdened by your counselor’s emotions or experiences.
If that is happening, let your counselor know what’s happening for you, and talk it through to your satisfaction. If it continues to happen after you’ve talked it through, you might want to find another counselor.
When you visit a counselor, if the relationship feels clunky and weird–or worse yet, painful–LEAVE. You are under NO OBLIGATION to the counselor.
Counseling is for YOU. It has to work for YOU.
EDUCATIONAL STANDARDS IN COUNSELING
There are many, many people out in the world offering counseling services of one type or another, with wildly varying degrees of education, training, and accountability. Here’s a quick overview of the food chain in the counseling world. (This is the US system, which you are likely to find in overseas counseling centers, most of which have been established by US-based agencies.)
A psychiatrist will be called Dr. So-and-So, and she will have the letters MD after her name. This means that she is a medical doctor who has specialized in psychiatry. Years ago, psychiatrists did therapy. These days, they prescribe medicine, and THAT IS ALL THEY DO. Now. Many of us need prescriptions. In fact, the research says that most mental illness is best treated with a combination of talk therapy and medication. Just be aware, though, that while you can get a much-needed prescription from a psychiatrist, you most likely won’t get counseling there.
A psychologist will also, confusingly, be called Dr. So-and-So, but he will have the letters PhD after his name. That means he has an academic doctoral degree in psychology (not a medical degree) and is probably a specialist in a particular area of testing or treatment. This person is a counselor, at the top of the food chain, and you will probably pay more to see him unless your insurance is truly awesome.
- Licensed Counselor
Most of the counseling work in the world gets done at this level. Licensed counselors have Masters Degrees in counseling, psychology, social work, marriage and family therapy, etc. They then go through a state-certified licensing procedure before being certified in various areas: Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), etc. There are also specializations in this category, like CSAT (Certified Sex Addiction Therapist) certification, trauma certification, and Gottman Institute certification for marriage therapy.
Different US states may have different letters for licenses that are similar. Ask your counselor what their particular letters mean.
Licensed counselors have a high degree of accountability in their training and practice because of the requirements of state licensing boards. Also, you can report a state-licensed counselor to their board if they turn out to be a terrible counselor.
- The Others
You may come across categories like Pastoral Counselor, Biblical Counselor, Lay Counselor, Life Coach. You’ll have to ask to see what kind of training process these types of counselors have been through, and what kinds of services they are able to offer. You may get really good help from counselors in these categories, and have a terrible experience with a licensed counselor. There are no guarantees! Caveat emptor, people. Ask what kind of training and licensure your counselor has.
WHAT IF IT’S BAD?
- You have the right to terminate counseling at the time of your choosing. You are under no obligation to the counselor. Shake the dust off and go.
- You have the right to report ethical concerns to the counselor’s licensing board. This information should be included in your counseling intake paperwork. If not, Google it.
- If it’s been really bad, find an ethical counselor and work through the trauma. Remember the plumber.
Here’s a YouTube animation I made a while back about finding a best-fit counselor. Basically, it’s this article in a more entertaining format. Enjoy!
(adapted from original post at www.kaybruner.com)