Counseling and Treatment for Mental Health Disorders

When Should Someone Seek Counseling?

Although people may have emotional and behavioral problems, they might not seek counseling until it starts to affect their life. Some people start counseling when they have one or two problems resulting from their thoughts and behaviors. Others do not take part in treatment or counseling until symptoms are unbearable and have interfered in many areas of their lives. These areas might include their health, daily work tasks, and/or social interactions. Some clients may only seek counseling or just want medications, while usually both are recommended. This is particularly true if the emotional and behavioral symptoms are moderate to severe. Of course, it would be preferable that clients start counseling earlier. By doing so, their chance of recovery is more probable and their symptoms are not as severe. This leads to 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. But, some people are resistant to go to counseling due to the social stigma of being mentally ill. They tend to ignore or deny that they have a problem; thus, their psychological issues worsen.

Some of my clients only have one or two counseling episodes in their life due to symptoms related to a developmental issues or life problem. Then they end counseling successfully. The symptoms of these clients are usually a response to an external stressor. These might include a difficult life task or situation, a conflicted relationship, or a traumatic life event. When they have worked through their problem, they are ready to end their counseling. Some therapists call this “solution focused therapy.” However, there are those clients who have a continuing mental health illness. They need continual treatment or intermittent counseling 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 their symptoms reoccur (regression or relapse). At that time, they may also need a medication adjustment with short-term counseling. Not all clients seek counseling 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 may 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?

When someone realizes that they need counseling, there are many resources. They can find a counseling services at a community counseling center, a hospital, a treatment program at a facility, or at a private practice. My clients found my counseling services through different means. Some heard of me through family or friends. Some received a referral from their primary physician. Others found me by 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's a good idea to come to your intake appointment 15 minutes early. This way we can submit medical insurance information and 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 I'll request a release of information. This is for emergency contacts or if I need to discuss medication management issues with a prescribing physician . The purpose of the intake or evaluation is to establish a history. This allows me to assess physical, emotional, and socio-economic areas. I look for problems that have contributed to the emotional symptoms and patterned behavior. Then, I discuss the results of the evaluation with my clients to identify problematic areas and to develop goals. Periodically, I review 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. But, the frequency and length of the sessions are dependent on the severity of the symptoms. Counseling is complete when symptoms are significantly reduced, goals are met, 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. This would be performed by a psychiatrist or a psychiatric nurse who is licensed to assess and prescribe medications. In some cases, 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. 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. We also develop objectives to identify how to accomplish those goals. I use cognitive behavioral therapy (CBT) to identify symptoms related to a problem. I also use psychodynamic theory to uncover how the patterned thoughts, feelings, and behaviors developed from childhood experiences.

I then use 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 is on why the client sought counseling and the changes the client would like to achieve. 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. Another may feel the physical symptoms of anxiety like a rapid heartbeat or shortness of breath due to brain chemical imbalance. While both may be provided with coping mechanisms from counseling 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). This is 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. Cognitive symptoms include loss of concentration and memory deficits. These symptoms result in an inability to complete tasks. This 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. The completion of smaller tasks leads to positive self-thoughts and motivation to try bigger goals. By eliminating uncomfortable physical symptoms, cognitive deficits, and negative self-beliefs, and motivating clients to try new behaviors, goals can be attained. 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, many refer to this as talk therapy. This psychological model indicates that our childhood experiences and unconscious mental processes determine our thoughts, feelings, and behaviors. 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 relate to past experiences stored up in the unconscious. 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. They 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. They may use defense mechanisms to deny or minimize the significance of events and the effects on their well-being. Clients may not be aware of why they are anxious, depressed, or paranoid. But, if a mother or other significant family member provided the child with healthy nurturance, then they are more likely to have close relationships and positive self-esteem in adulthood.

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

  • Dialectical Behavior Therapy (DBT)
    DBT offers clients 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 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 as either all bad or all good. But, those 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 develops in childhood and relates to the mother-child bond. The caregiver is “good” when they meet all the infant’s needs and “bad” when they do 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 research that suggests that neglected or abused children 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, 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.)