I am often asked for advice on how to choose a counselor. This essay is one response.
A Note on Language
I prefer the word counselor over therapist because therapist comes from therapy, which is presumably a treatment for some form of illness. As the concept of mental illness is so fraught with problems, I think counselor is a better choice. As a second note, let me briefly mention that this is a specific instance of a general problem with the use of language in psychology and psychiatry. Thomas Szasz is the master when it comes to decoding this language, and I highly recommend that everyone spend some time reading his work (www.szasz.com ); as he puts it, "Although linguistic clarification is valuable for individuals who want to think clearly, it is not useful for people whose social institutions rest on the unexamined, literal use of language" (1993, p. 1). As a quick example, consider that civil commitment really means incarceration of a citizen who has not been charged with a crime. In any event, the hard work of rehabilitating one's language is an absolute prerequisite in gaining clarity about the so-called mental health field.
This essay includes two main sections. Part 1 addresses some of the basics that come to mind in choosing a counselor. Part 2 goes into issues of structure that are vital to understand in thinking about our mental health system.
Part I The Basics
Two Initial Recommendations
My first thought about choosing a counselor is related to the above point about language. It is necessary to educate yourself. Given all the propaganda and false data, there is absolutely no substitute for intense research and investigation, most definitely outside the mainstream channels of "expert" authority on "mental health," to approach the truth.
My second recommendation is very simple. Word of mouth, from trusted sources, is the best referral. If not immediately available, effort at finding trustworthy allies, is well-spent.
The Counselor's Own Work
The huge and vital question in choosing support has to do with the personal experience of the counselor. One teacher of mine uses the term "body pilot," but however you say it, the point is that the best counselors are those who have done and are doing their own personal work. "Talking heads" who have not faced and taken responsibility for their own distresses and challenges, and moved into the realm of body and emotion, are often seriously limited in their ability to remain intelligent and at ease in the face of client distress. Counselors need to be authentic, which means being open and aware of their own inner dynamics. This sometimes means navigating challenges in the relationship between counselor and client, and greater awareness helps enormously. It also means that counselors who have done a lot of their own work tend to have more space or "slack," and are able to be in that wonderful state of relaxed confidence even in the face of intense grief or terror—this helps enormously! In the biopsychiatric climate of today's system, when the going gets hard, it is all too easy to turn to drugs and coercion out of fear and doubt. So it is fine to ask a counselor about their own personal work, as well as their work experience. It is also important to take note of their attitude and how it feels to you. Does the counselor appear at ease? Is she confident in your process? Does he seem to someone you can trust?
Perspective on a Good Life
It helps a lot to put counseling in perspective. There is plenty of theory and jargon that can make counseling sound like some kind of elaborate technical "therapy" that requires a specialized degree to understand and "practice." I think this tends to create a problematic expert dynamic that can undermine a client's power and responsibility, and distort a counselor's simple humanity. I like the Re-evaluation Counseling (www.rc.org) teaching that professional counseling is really just more of a one-way expression of what we naturally do in life; talking and listening to each other helps enormously in releasing and processing distress.
Life is big and challenging. Our society is very highly distressed; there are massive social and economic justice issues that make it hard for all of us and virtually impossible for many to have a good life. Most of this is not a counseling issue. Most of our life stresses and difficulties are not because of our flawed psyches. There is no point of nirvana or enlightenment or, heaven forbid, mental health, where all the upsets are gone and melancholy, grief, fear, anger, and challenges of love and work no longer exist. My point is that a counselor who interprets everything as your personal issue, especially one who pathologizes, is immature and unaware, and may be dangerous. I am not saying that personal work makes no sense. I am a professional counselor; I think sometimes it can be helpful. But it can be not only an imaginary panacea, but also a distraction and avoidance of facing the reality of life head on. A key aspect of psychiatric oppression is that a mental illness perspective both blames the victim and distracts all of us from taking on social and economic justice issues for the common good.
On a personal level, counseling can also enable avoidance of the challenging, but rewarding task of figuring out and moving forward with creating a good life for ourselves—authentic self-care and self-discovery, deep and rewarding relationships, meaningful study and purposeful work that contributes to the common good. It is probably wiser to look more to people like Scott and Helen Nearing (www.goodlife.org) for inspiration and guidance on how to live a good life, than to someone who sits in an office all day talking to people!
The Heroic Client
Barry Duncan and Scott Miller wrote the book, The Heroic Client, and have devoted a lot of their professional energy to the removal of the counselor from center hero stage, and the proper placement of client as the hero of his or her own life, including counseling. They summarize the counseling outcome research, showing four factors of change that contribute to a positive outcome. The first and most significant are client factors, which are "extratherapeutic," meaning they operate independently of the counseling relationship. 40% of improvement during counseling is due to client factors such as persistence, openness, a supportive grandfather, or getting a new job. As the authors put it, "neither guru therapists nor their carefully acquired silver bullets are the defining factors of change" (2000, p. 57).
The next most significant change factor, accounting for 30% of the difference in outcomes, is the relationship, as rated by the client. The alliance between counselor and client is more predictive that diagnosis or counseling method or "therapist" or anything else—not the theory or method, but the relationship. One thing this means is that the counselor accepts client goals without reformulating them to a pet theory, and that the counseling is guided accordingly.
The third factor, expectancy and placebo accounts for about 15% of the outcomes. This is about confidence and hope, and a client’s perception of the credibility of the counselor and her approach.
Last, again contributing to 15% of change, are the model and technique factors. These are the unique beliefs and practices of specific counseling theories. So the theory and techniques play a role, but a relatively minor one. It is much more important to be flexible and adjust according to the client's goals, and to what works, than to cling to a set method. Good counseling is not about models or the perfect counselor. People go through stuff in life, their life, and can sometimes use a counselor's support.
When it comes to the nitty gritty, a good idea is to go ahead and get basic policy parameters. Where do they work? How long is a session? What do they charge? Is there any flexibility in time and money? That kind of thing. Then there is the actual counseling.
Views on Counseling
Once put into perspective, the actuality of counseling is quite simple. It is something that we do naturally. We are born to cry when hurt or sad, and to tantrum when upset or frustrated. And we are oriented to listen and respond supportively to our crying babies. We talk and listen with our friends and family as we vent our daily challenges and upsets. We even have built-in ways of discharging and working through trauma. This is counseling, and one grassroots group (www.rc.org) has created a community of re-evaluation counselors to support and encourage this process among peers. In any event, I think professional counseling may be helpfully seen as a one-way version of this natural co-counseling process of exchange by talking and listening. The RC theory is very simple. The starting assumption is that wee humans are inherently intelligent, zestful and loving. When we are physically or emotionally hurt, however, we experience distress that interferes with our thinking and relating, and we tend to think less well and get a bit mean-spirited, unkind or withdrawn. The good news is that we have a built-in way of restoring ourselves, and that is by expressing our thoughts and emotions—crying, storming in anger and shaking with fear are some of the ways we naturally release or discharge distress. A good counselor is someone who allows, supports and encourages this process. So expression is huge, and "falling apart" is alright.
As Janet Foner, Mental Health Liberation Reference Person for the RC community put it:
There is no such thing as "going crazy."
You can't "lose your mind."
What is "mental illness" really? It's a very long "session" seeking discharge or having lots of discharge, without a counselor.
Consider putting to rest the notion of needing an expert, and be choosy if you decide to use a professional. There are good ones out there, and I list a few resources in the reference section.
RC is one basic, simple theory that I find valuable, but there are many theories of counseling. Other favorites of mine include Arny Mindell's process work (www.aamindell.net), and certain experiential psychodynamic and transpersonal approaches. What they have in common for me is trust in a natural process of growth, recovery and re-emergence for people. As noted earlier, the evidence suggests that a particular theory is not the key to positive results.
A good counselor is someone who sees you as an individual and who trusts and supports and respects your goals, your intentions, your process. A good counselor does not presume to know what is best for you. They convey an attitude of relaxed confidence, but are authentic when something else comes up. They are not afraid or shy about supporting you to confront distress, but they are not desperate or urgent about it. They ask permission, they may make suggestions, mostly they try to support and encourage your natural process of self-discovery and recovery. They stand guard and provide safety while you can let down your guard and dive into your process.
Good counselors try to be fully present and authentic. It is not the counselor's session to work on his or her stuff, but it is a relational experience and so I think it is important for a counselor to be real and not too rigidly bound in an "expert professional" role. Trust your experience on this; talk about it with your counselor as seems right for you, but don't hesitate to discontinue if you feel unsupported or that your counselor is projecting their own agenda or distress into the sessions. This is most likely going to be an issue when things get hard, and sorting it out can be difficult. You may be in your fear and distress, the counselor may be in their fear, it is sometimes hard to sort out. At the very least, the counselor ought to be willing to talk to you about it, and to look at himself. He should also be supportive of your talking with other people about it, maybe even consulting another counselor. It is your process that is important here, not the counselor's ego.
I highly recommend Oriah Mountain Dreamer's incredible poem, The Invitation (www.oriahmountaindreamer.com), as a reference point in choosing a relationship; here is one stanza:
It doesn't interest me
who you know
or how you came to be here.
I want to know if you will stand
in the centre of the fire
and not shrink back.
Self-education is important, and word of mouth is usually the best referral guide. Beyond that, it is a good idea to ask a few preliminary questions. This can be done over the phone; also many counselors offer upon request a free 20 or 30 minutes to meet and do a brief interview.
There is no right or wrong way to do this. Here are a few thoughts about questions.
What are your basic policies and fees? Any flexibility on those?
What are your guiding principles?
How do you see counseling and personal growth and transformation?
What is your training?
What are your guiding theories?
What kind of personal work have you done? What kind of work are you doing now?
What do you think about biological psychiatry? About psychiatric drugs? About withdrawal from psychiatric drugs?
What are your privacy policies?
Anything else that you want to know, that is significant for you!
Here is what I recommend on beginning counseling. Once a decision is made to have an initial session, go for it. Many times, a client actually only wants or needs one session, and that's it. If there is a need or desire for more work, if it feels right, and the counselor seems like someone you can trust and work with, then I recommend you commit to 3 or 4 sessions. By that time, you will have an experience you can evaluate and see if this is really helping to meet your goals. Then you can go from there. You're the boss.
Part II On Structure
In this section, I want to lay out a few structural issues about our mental health system that are vital to understand. The structure of our "mental health system" is severely misguided, distorted and dangerous. As a result, many people have lost hope in finding a good counselor; one man asserted to me just yesterday that 99.5% of "therapists" were bad, and asked whether I agreed. This is an extreme statement, but of course extreme does not mean false. In this case I think it as at least a small exaggeration—there are good counselors out there. Nevertheless it is true that a large percentage of mental health professionals do more harm than good, and psychiatry as a whole is exceedingly dangerous. So we must address structure to approach clarity.
It is worth noting right up front that psychology and psychiatry are focused on individuals, and there is a very strong argument to be made that this emphasis has serious drawbacks. It is beyond the scope of this paper, but there is a robust theoretical and practical domain of family and systems work that cogently argues, and often demonstrates, that the best way to help people is to work with their families and other community systems in which they are engaged. The range of these ideas runs from direct family counseling to social economic policies and practices such as those that provide jobs and housing. Real improvements in job and housing opportunities for citizens would have way greater impact on the lives of people who get caught up in our mental health system than any kind of "treatment" program.
Most crucial to see is that psychiatry is rooted in coercion. It has long been decided that it is necessary, right and proper to coerce citizens who are deemed mentally ill. Well over a million (Lee Coleman estimated 1.5 to 2 million (Citizens Commission on Human Rights International, 2005).
United States citizens are incarcerated and forcibly treated—almost always with toxic brain-damaging drugs, sometimes with brain-damaging electroshock. All forms of oppression are justified by claims to virtue—the argument for coercion in psychiatry is that these citizens are sick and incompetent, and that such "treatment" is for their own good. This cloak of benevolence hides the truth of deprivation of liberty and freedom of mind and body of citizens who certainly have not been afforded the due process rights given in the penal system.
Furthermore, as long as overt coercion, in the form of "involuntary commitment and treatment" is an integral part of the system, there can not be truly voluntary participation in that system. Countless so-called voluntary "patients" are really there because of overt threats of coercion or covert pressure. Very many have discovered, to their dismay and disillusionment, that once in the system, "voluntary" is simply a word that means, "As long as you agree that you are 'mentally ill' and that our 'recommended' treatment is best for you, you are voluntary." "Noncooperation" very often leads to a judgment of "incompetence" and court-ordered coercion.
There are many faces of this charade, but most common is a result of the societal and professional ethic that judges suicidal ideation as prima facie evidence of insanity and need for coercion. This results in massive violation of liberty interests. Regrettably, it also seriously aborts the possibility of real change as fundamental conditions of transformation—safety, free choice, acceptance and expression of distressing thoughts and emotions—are inhibited.
Private and Public
A private system requires exchange—usually professional attention for money—and is often prohibitive for people. For many others, it is not prohibitive, but seen as not so valuable. This is, of course, a valid choice as either a financial or substantive decision. Often, however, there is a trust and dependency on the private health insurance company's decisions about who they will pay to provide services to their customer. This dependency often overrides genuine discernment as consideration of the beliefs and qualities of individual services is secondary or even irrelevant, and the only question is who the insurance will pay.
When insurance, or any third party, is involved, some degree of privacy is by definition compromised. While it is at least in theory possible to find a private counselor who truly honors the word private, it is difficult to find one who deliberately eschews, for example, the professional ethic that "obliges" the counselor to become coercive in the face of a conversation about suicide.
In the private system, one can also find, albeit with difficulty, counselors who reject the mental health system model of biological psychiatry. In the public system, that is mostly impossible because one has to at least accept the model and resultant practices to even be employed. So one very important thing to know in choosing a counselor is where they stand on biopsychiatric theory and practice.
Modeled after the practice of medicine, biopsychiatry has all the trappings of language that we associate with scientific medicine. Biopsychiatry has the language, but not the science (Breeding, 2000). The basic assumptions of biopsychiatry are as follows:
- Adjustment to society is good.
- Failure to adjust is the result of "mental illness."
- "Mental illness" (Depression, schizophrenia, bipolar disorder, etc.) is a medical disease.
- "Mental illness" is the result of biological and/or genetic defects.
- "Mental illness" is chronic, progressive, and basically incurable.
- "Mental illness" can (and must) be controlled primarily by drugs; secondarily, and for really severe "mental illness," by electroshock.
- People with "mental illness" are irrational, and unable to make responsible decisions for themselves; therefore, coercion is necessary and justified.
The primary pillars of biopsychiatry are the chemical imbalance theory and the bad gene theory (Colbert, 1996). Neither is scientifically validated. To understand psychiatry today, it is necessary to be very clear that it is not about medicine; it is really about social control.
The application of this theory in the form of psychiatric drugs has become ubiquitous, with millions upon millions of adults and children of all ages taking billions upon billions of dollars worth of various psychotropic drugs. The resulting carnage in physical, emotional and mental damage and dysfunction is sufficient to justify my attorney friend's coining of the term pharmacaust. The bottom line can be summarized from Robert Whitaker's excellent new book, Anatomy of an Epidemic, which is a thorough and up-to-date review of the scientific literature on various classes of psychiatric drugs:
- Scientific research fails to validate biopsychiatric theory;
- Psychiatric drugs generally do not work any better than placebo;
- Psychiatric drugs are very damaging, creating all kinds of real biological damage and disease;
- Use of psychiatric drugs makes positive growth and transformation less likely;
- Use of psychiatric drugs is largely responsible for the fact that approximately 1 in 50 adult Americans are now on permanent disability due to "mental illness;" hence the book title, Anatomy of an Epidemic.
A client needs to know whether a counselor is going to support an adventure of personal growth and self-discovery or interpret their life challenges and distresses—their patterns of thought and behavior and relationships—as symptoms caused by brain disease. The latter leads to drugs, especially when the going gets at all tough and uncertain, where fear is present.
On Withdrawal from Psychiatric Drugs
Biopsychiatry is ubiquitous, and tens of millions of United States citizens of all ages are taking various psychotropic drugs, and various combinations of such drugs. As just mentioned, the drugs cause untold damage and they tend not to work. So it is understandable that a very many people want to get off them. Given that these drugs are highly addictive, and that withdrawal reactions are often intense and difficult. I and others have written at length on the subject of withdrawal, but here I just want to emphasize that, if this is an issue for you, be sure and find a counselor who will truly support you in your decision. One vital understanding a counselor absolutely needs to have is that there can be many difficult physical and mental symptoms of withdrawal; it is amazing and troubling how even doctors often fail to recognize withdrawal, and instead misinterpret withdrawal symptoms as evidence of an alleged "mental illness." The main general recommendation is to withdraw gently and gradually. On an emotional level, emotions of fear, shame and hopelessness tend to be the greatest challenges (Breeding, 1998). It can be very helpful to have a counselor who provides a little hope in knowing that it is possible to withdraw and live well off the drugs. Regarding fear, I cannot say enough about this bugaboo. In this case, a counselor who knows about fear, who can be relaxed and supportive as you work on your fear, and who is confident that you can get through it can be a huge help. My book, The Necessity of Madness, has a chapter on withdrawal. Peter Breggin is an important voice challenging biopsychiatry; the book he co-authored with David Cohen, Your Drug May Be Your Problem, is a good one for this subject.
Note to Family
Although it may seem obvious as I point it out, we often fall prey to the illusion of individualism, and do not think enough about the effects of all this on friends and loved ones, especially the family of a person getting "mental health services." It is one thing to become a client making a private agreement with a counselor for support or discussing and working on whatever. It is an entirely other matter to be an "identified patient" who has a "mental illness" and needs "treatment." The latter tends to activate coercion, which as mentioned earlier, destroys the possibility of real help, but is also very destructive to personal relationships, creating dependency, resentment, distrust, etc. The turning of a family member into a damaged and disabled "chronic mental patient" has profound effects on a family, and they are not good. Groups like the National Alliance on Mental Illness (NAMI), seen ostensibly as support for family of people with "mental illness," are largely funded with corporate pharmaceutical money and tend to be true believers in biopsychaitry. The main message is that the patient needs to accept their illness and take their medicine (Colbert, 2009).
This attitude is supposed to provide hope and absolution—hope that there is help by medicine, and absolution that you are not responsible since mental illness is a brain disease. This is really a false hope as is clear by the epidemic of deterioration and disability caused by the practice of psychiatry; remember that people who stay or get off the drugs tend to have much better outcomes. The absolution is also false. Not only is it based on a faulty premise—the chemical imbalance theory—however you want to explain life and relationship challenges and distress, they do not happen in isolation. There is always relationship! The way out is not to wash our hands of responsibility anymore than it is to collapse in self-blame and guilt. A useful saying for personal work is that "the way out is through," and this applies to relationships as well. A deep address of family is beyond the scope of this essay, but I will mention two references. Some of the very best outcomes for dealing with even most serious "mental illness," so-called schizophrenia, are apparently found in certain areas of Finland where a systematic community and family-based approach has had outstanding results, both for individual recovery and in dramatically lowering incidence in the area (reported in Robert Whitaker's Anatomy of an Epidemic). Second, A Way Out of Madness, by Daniel Mackler and Matthew Morrissey, is written with advice and stories for people dealing with their families, but would also be very good for anyone who has family members who want or are judged as needing help.
While the focus of this paper is on adults seeking a counselor for themselves, the basic ideas I present also apply to families seeking counseling for themselves and their children—the same pitfalls, the same need to ask questions and find a good counselor. As the drugs are especially dangerous for children, that part is if anything even more important. My website, www.wildestcolts.com, and my books, The Wildest Colts Make the Best Horses (2007) and True Nature and Great Misunderstandings (2003) provide guidance for parents.
Breeding, J. (1998) "Drug Withdrawal and Emotional Recovery." The Rights Tenet, published by the National Association for Rights Protection and Advocacy. May be read at www.wildestcolts.com/psych_opp/b-psychiatric_drugs/5-drug_wd.html.
Breeding, J. (2000) The Necessity of Madness. London: Chipmunka Publishing.
Breeding, J. (2007) The Wildest Colts Make the Best Horses. 3rd Edition. London: Chipmunka Publishing.
Breeding, J. (2003) True Nature and Great Misunderstandings: How We Care For Our Children According To Our Understanding. Eakin Press.
Breggin, P. & Cohen, D. (2007) Your Drug May Be Your Problem. Cambridge,MA: Perseus.
Citizens Commission on Human Rights International (2005). Involuntary Commitment. Retrieved March 1, 2006, from http://www.newcriminologist.co.uk/news.asp?id=-1919147788.
Colbert, T. (1996) Broken Brains or Wounded Hearts. Santa Ana, CA: Kevco Publishing.
Colbert, T. (2009) "NAMI parent's false hope: blindly disabling children for life." http://bipolarblast.wordpress.com/2009/04/26/nami-parents-false-hope/
Duncan, B. & Miller, S. (2000) The Heroic Client. San Francisco: Josey-Bass.
Mackler, D. & Morrissey, M. (2010) A Way Out of Madness. Bloomington, IN: AuthorHouse.
Szasz, T. (1993) A Lexicon of Lunacy. New Brunswick, NJH: Transaction Publishers.
Whitaker, R. (2010) Anatomy of an Epidemic. NY: Crown Publishers.
A Few Resources
This is my personal website with a lot of resources—written, audio, video and links—that you might find helpful.
There are a lot of great psychologists out there. A few fellow psychologists that I like are Ty Colbert (www.transtherapy.org/Board.htm), Al Galves (www.algalves.com), Seth Farber (www.sethhfarber.com), and Bruce Levine (www.brucelevine.net).
Here are some organizational websites that provide excellent information and referrals: