Counseling and Treatment for Mental Health Disorders

When Should Someone Seek Counseling?

Although people may be having emotional and behavioral problems, they usually will not seek counseling until it starts affecting their life. Some people initiate counselling when they have one or two problems resulting from their thoughts and behaviors. Others do not participate in treatment or counseling until symptoms are unbearable and have interfered in many areas of their functioning such as their health, daily work tasks, and/or social interaction in relationships at work or home. Initially, some clients may just desire medications or just seek counseling, while usually both are recommended, particularly if the emotional and behavioral symptoms are moderate to severe. Of course, it would be preferable that clients start counseling earlier so that their chance of recovery is more probable and their symptoms are not as severe. Then it would take a shorter duration of time to eliminate or reduce symptoms. Also, the probability of reoccurrence is reduced if the mental health disorder is treated upon early detection. However, some people are resistant to go to counselling due to the social stigma of being mentally ill and tend to ignore or deny that they have a problem; thus, their psychological issues worsen.

Some of my clients only have one or two counselling episodes in their life due to symptoms related to a developmental issues or life problem, and then terminate counseling successfully. The symptoms of these clients are usually a response to an external stressor, difficult life task, or situation, conflicted relationship, or traumatic life event. When they have overcome and worked through their problem, they are ready to terminate their counselling successfully. Some therapists call this “solution focused therapy.” However, there are those clients who have a continuing mental health illness and need continual treatment or intermittent counselling to manage their symptoms and life problems. Some of my clients have psychological disorders that are a result of biological causes such as abnormal brain chemistry or genetic factors.

I also have clients who are in and out of treatment and counseling. They complete one treatment episode successfully, but only return when there is a reoccurrence (regression or relapse) of symptoms. At that time, they may also need a medication adjustment with short-term counseling. Not all clients seek counselling because they are having symptoms or are having problems in their life and relationships. Some people enter counseling because they want to better themselves or their lives or they feel empty or non-fulfilled in some way. Although they are functioning well in all areas of life, they may not even know why they are unhappy or why they are not content in their relationships.

How Do I Find a Counselor?

Upon realization that counseling is needed to either resolve a problem or reduce troublesome symptoms, potential clients can find a counseling services at a community counseling center, hospital, treatment program at a facility, or private practice. My clients found my counseling services through word of mouth of family or friends, referral from their primary physician, or browsing the internet or social media.

What Should I Expect in Counseling or Psychiatric Treatment?

Upon initial contact per phone call or email, I will schedule an evaluation (intake) appointment with you. Initial admission paperwork can be completed when you arrive to your appointment. It is beneficial to come to your intake appointment 15 minutes early to submit medical insurance information and to complete the admission paperwork prior to your session. The admission paperwork consists of a consent to counseling form, a confidentiality policy, and your privacy rights. Sometimes a release of information is requested for an emergency contact or a prescribing physician to discuss medication management issues. The purpose of the intake or evaluation is to obtain a history to assess physical, emotional, and socio-economic areas to look for problems that have contribute to the emotional symptoms and patterned behavior. I discuss the results of the evaluation with my clients to identify problematic areas and to develop goals. Periodically, I review the progress for these goals with the client to assess progress, revise goals, or create new goals as old goals are accomplished. Usually the frequency of outpatient counseling sessions is once a week. However, the frequency and length of the sessions are dependent on the severity of the symptoms. Counseling is completed when symptoms are significantly reduced, goals are completed, significant life problems are resolved, and quality of life is improved.

Treatment Components

Treatment usually consists of counseling, medications, and/or referrals. When symptoms interfere with functioning, I recommend a psychiatric evaluation with a psychiatrist or a psychiatric nurse who is licensed to assess and prescribe medications. However, some clients already have a psychiatrist or would like a psychiatric referral from their primary physician. While reviewing the medical history, referrals to a specialist may be appropriate to treat physical illnesses or conditions.

Treatment Approaches and Modalities

The treatment modality that I choose for a client is dependent on their mental health disorder, the severity of their symptoms, and the cause of it/them. I usually focus on the behavioral, cognitive, and emotional symptoms that have caused the problems, as well as the client’s goals. I examine the history and experiences of the client to see how it affects their current patterned thinking and behavior. I aid the client in developing counseling goals that will enable them to accomplish their life goals, as well as objectives to identify how to accomplish them. I utilized cognitive behavioral therapy (CBT) to identify symptoms related to a problem and psychodynamic theory to uncover how the patterned thoughts, feelings, and behaviors developed from childhood experiences.

I then utilize Motivational Enhancement Therapy (MET) and Client Centered Therapy to develop goals and step-by-step objectives to make the necessary behavior-cognitive changes. The most significant focus of counseling is the reason why the client initially came into counseling and the changes the client would like to achieve to finish counseling. Clients are more likely to be successful in counseling if it is directly related to their defined individual needs and wants. A client may be having health problems, yet may want to focus on the marital relationship. Symptoms of anxiety and depression may be felt differently among clients, and have different causes. One client may have cognitive symptoms of anxiety, thinking they are not liked because of negative past experiences, while another may feel the physical symptoms of anxiety (fast heartbeat, shortness of breath, and muscle tension) due to inherited brain chemical imbalance. While both may be provided with coping mechanisms from counselling interventions, the former would benefit the most from cognitive-behavioral therapy, while the latter would benefit from medication management.

  • Cognitive Behavioral Therapy (CBT): The behaviors, thoughts, and feelings of a problem and the relationship of all three are identified in CBT techniques. Although past patterns of cognitive behavior are examined, the focus is on the symptoms in the present (or the here and now). For example, a client may be diagnosed with Generalized Anxiety Disorder (GAD) characterized by worries about most things, most of the time. Nervousness and fear of failure cause physical symptoms of racing heart, shortness of breath, and sweats, as well as cognitive symptoms of low of concentration and memory deficits. These symptoms result in an inability to complete tasks, which further reinforces feelings of inadequacy and thoughts of pending failure. The negative thoughts are connected to physical symptoms that affect cognitive functioning and, in turn, affects behavioral performance. Repeated failure reinforces negative thoughts, low motivation, depressed mood, hopelessness, and low self-esteem. Counseling interventions would consist of challenging thoughts of complete failure, relaxation exercise to reduce physical symptoms that affect cognitions, and then breaking down goals into manageable small tasks to assure success. Successful completion of smaller tasks leads to positive self-thoughts and motivation to try bigger goals. Successful goal attainment is found by eliminating the uncomfortable physical symptoms, cognitive deficits, negative self-beliefs, and promoting motivation to try new behaviors. The objective of CBT is to break the cognitive-behavioral connections and patterns to eliminate the emotional, cognitive, and behavioral symptoms.
  • Psychodynamic Approach: Whereas the focus of CBT is on current symptoms, the psychodynamic model focuses on the causes of mental health conditions. Today, this may be referred to as talk therapy. This psychological model indicates that thoughts, feelings, and behaviors are determined by our childhood experiences and unconscious mental processes. Unconscious internal forces are the mental processes that influence beliefs, emotions, and actions. Motivation, desires, and decisions are the result of unconscious memories. Emotions are from motivation rather than cognitions. Fears and anxiety are related to past experiences stored up in the unconscious, and sometimes we unknowingly and automatically adjust our behavior according to these internal forces. Events that occur in childhood can remain unconscious and cause problems in adulthood. Adult psychological problems are a result of childhood experiences and the associated feelings and behaviors. The theory indicates that our personality and behavior are predetermined and beyond one’s control (McLeod, 2017).

Clients who have been neglected, emotionally controlled, or verbally and physically abused may repeat their past victimized role in current relationships, unintentionally and unknowingly enter relationships where they are (or will be) mistreated. Unconsciously they learn to be passive, self-sacrificing, and to put the needs of others before themselves. The client may have troubled relationships because they are repeating a destructive relationship pattern from the past. The client’s symptoms may be from unresolved developmental tasks due to separation or neglect from their mother. If a mother is absent, a child will not form a secure and reliable bond due to lack of consistent emotional attachment. They will become an adult who cannot trust and form or maintain healthy, close relationships. Unconsciously, clients may not be able to accept their past abuse and use defense mechanisms to deny or minimized the significance of events and the effects on their well-being. Clients may not be aware of why they are anxious, depressed, or paranoid. However, if a mother or other significant family member provided the child with healthy nurturance, then they have a higher probability of having close relationships and positive self-esteem in adulthood.

The purpose of psychotherapy is to understand how past experiences has led to their current thoughts and behaviors, present relationship dynamics, and emotional and behavioral symptoms related to their mental health condition. It involves confronting their defense mechanisms and addressing problems in their current interpersonal functioning and applying ways to improve relationships. Psychotherapy aids clients in coping with internal stress and improving their ability to relate to others (Psychotherapy Resources, n.d.).;

  • Dialectical Behavior Therapy (DBT): provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas.
    • First, mindfulness focuses on improving an individual's ability to accept and be present in the current moment. Rather than being depressed about the past or worry about outcomes of future events, the client utilizes meditation or yoga and breathing/relaxation exercise.
    • Second, distress tolerance is developed by the client when they increase tolerance of the negative emotion, rather than trying to escape from it.
    • Third, emotion regulation is accomplished when the client learns strategies to manage and change intense feelings that are hindering functioning and relationships.
    • Fourth, interpersonal effectiveness is achieved when the clients learn to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.

DBT skills can be effective in reducing the intense emotions and dysfunction in the relationships of clients who have personality disorders. People with borderline personality disorder will see a person either all bad or all good, and the perceptions could change from bad to good and good to bad. A person with narcissistic personality disorder likes people when they make them feel good but will change their mind if they feel that they are even slightly criticized. Object relations theory describes the psychological splitting, which can be described as the mental separation of objects into "good" and "bad" parts. This thought-process is developed in childhood and related to the mother-child bond. The caregiver is “good” when all the infant’s needs are satisfied and “bad” when they are not. This is transferred to self-thoughts, and this is parallel to when the child starts to perceive good and bad parts of themselves. Children who suppress or deny the “bad” parts of themselves and the “bad” parts of the caretaker, has difficulty in adult relationships. This is consistent with the research that suggests that children who are neglected or abused are more likely to be diagnosed with borderline personality disorder or narcissistic personality disorder. If a mother satisfies the physical and emotional needs of her children, then they integrate both the good and bad of the mother as a whole and have healthy relationships in adulthood.

Therapy consists of accepting both the good and bad in themselves as well as other people, and changing the perceiving situations from “all or nothing” to more realistic and valid interpretations (Mcleod, 2017).

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013). American

Psychiatric Association.

McLeod, Saul. (2017). Simply Psychology: Psychodynamic Approach. Retrieved from

www.simplypsychology.org/psychodynamic.html (n.d.)

Psychotherapy Resources. (n.d.). What is Psychodynamic Counseling? Retrieved from https://essex-behavioural-thearapy.co.uk-article.asp?tpic+what-is-pscyhodynamic-counseling (n.d.)