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A Consumer's
Guide
to
COUNSELING and PSYCHOTHERAPY
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BY
RICHARD WADE, M.A.
To my wife, Maureen, in deepest gratitude.
TABLE OF CONTENTS
Introduction
Wise and Passive Const.IITers
Why a Therapist?
Your First Visit
Section 1
How to Choose the Best Therapist For You
, Credentials and Licenses
The Personal Touch
Section 2
Know your Rights
Th�
Confidentiality and its Exceptions
Records
Tape Recordings
�lth Insurance and the Clinical Diagmsis
Personal Conduct
Filing a Canplaint
Section 3
Types of Therapists
Psychiatrists
Licensed Psychologists
Marriage, Family and Child Counselors
Licensed Clinical Social \tbrkers
Educational Psychologists
School Psychologists
Trainees, Interns and Paraprofessionals
Pastoral Counselors
Section 4
M:xles of Therapy
Individual Counseling
Relationship Counseling
Family Therapy
Group Therapy
Section 5
Appendix
Myths and M[sconceptions About Psychotherapy
Specialists
Hotlines-Help Over the Phone
The Psychological Theories
Hospitalization
Medication
Professional Associations
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Wise and Passive Consumers
Because
people are busy wrestling with their
problems, and because they do rot have enough
infonnation to even know how to be 100re demanding,
they tend to be
passive consumers. Below is a
quick
contrast between a wise and a passive
consumer.
This applies not only to psychotherapy,
but to everything from b.J:ying breakfast cereal to
choosing an auto mechanic.
Yru may see SCXI'e of
yrurself on both sides:
A wise consumer:
asks lots of questions.
knows his or her rights.
chooses a therapist carefully.
makes legitamate complaints.
takes an active role in the therapy.
A passive consumer:
does rot ask questions.
does rot think abrut rights.
assumes the therapist is competent and appropriate.
never canplains
waits to be taken care of.
•
Being a wise consumer does rot mean that you
should go into a therapist's office or clinic with
a chip on your shoulder, expecting to find things
wrong.
It sirrply rreans yru should be aware,
infonned, and selective,
all rut of respect for
yrurself.
You might, like many people,
find a therapist
through the reccmnendation of a doctor, a friend
or a relative.
This is probably a little better
than finding one in the phone book, but don't rely
blindly
on the recorrmendation.
Use your own
ju:lgement too.
This Guide will give you SCXI'e
basic things to look for and think about in
choosing a good therapist.
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Why a Therapist?
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Everybody has problems. Anyone who tells you that
they
don't is either kidding you or kidding
themselves.
Most problems you can work rut within
yrurself,
figuring
it
out somehow.
If the
problems are a little rrore canplicated, or involve
other people, yru might ask the advice of friends
or relatives, people yru know and trust. But
s001etilres the problems are not just cooplicated,
they're painful.
Yru feel hurt, or angry, or
scared, or ashamed, or all of these.
Maybe yrur friends don't kn:>w
what
to
sugg est,
or
are
uncomfortable with these strong
feelings. Maybe yrur relatives
are involved in the problem,
and aren't nuch help. So you
look for s001eone who can be
objective' and mo will listen
carefully.
Now, a bartender or
a stranger on a bus might be
willing to do that' rut maybe
you need an objective listener
who
has SOO'le experience and
training
in
these
matters,
sareone
who has worked with
people with similar problems.
That is the role of a psychotherapist. Depending
on the problem and on the therapist, he or she
might
be
like a teacher, giving you useful
information,
or
like a referee, helping you
negotiate fairly with another person, or like a
kindly parent, comforting and encouraging you, or
like a mirror, helping you see yourself rrore
clearly, or any n:unber of other roles.
Like the
old analogy about teaching s001eone how to fish
instead of just giving them a fish, a therapist is
sareone mo will rot solve yrur problems for you,
but will help you develop the skills and personal
strength to solve them for yourself. A mark of
good therapy is that eventually yru become less
and less dependent on the therapist; the therapist
gradually works � or herself out of a job.
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It takes a long time to get all these credentials,
and
a therapist \J:to is not yet through can
practice as a trainee or intern under the guidance
and supervision of a licensed therapist.
For 100re
detailed descriptions of the
various types of
therapists and their credentials, see Section 3,
Types of Therapists.
·
·The Personal Touch
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Back
in
1967
two
psychologists, Truax and
Carkhuff,
sttxlied oow effective different kinds of
therapists
were in helping their clients get
better.
They found two things: first, half of all
the clients got better,
and half got worse.
Secondly,
they found that it didn't seem to matter
\<hat theory the therapists used, or \<hat sclx>ol
they went to. What seemed to make the difference
was three very htnan personal qualities.
The
therapists
\<hose clients got better had high
levels of empathy, warmth and genuineness.
Empathy is the ability to know \<hat another person
is going through in a personal way, to know oow it
feels.
Warmth includes caring about you and
respecting you as a person.
Genuineness rreans
being honest with you about his or her thoughts
and feelings about you, and open and accepting of
all your thoughts and feelings.
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So men you go looking for a therapist' don It just
check rut the degree on the wall. Cbeck out yrur
feelings.
Aside from the fact that you may be
nervous,
do you think yru can be comfortable
with this person? Will this person be honest with
'
you and help yru to be honest?
IX> you feel
welcorre?
fues he or she seem to care about you,
and understand at least a little of mat yru are
going thrrugh?
If
yru do not think this therapist is the right
for you, you have the right to ask for another
therapist in that agency or clinic, or for a
referral to another therapist samemere else.
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A word of caution:
Shopping around for a good therapist
is mat wise consumers do, but don't
shop around too much. If you go from
one therapist to another, again and
again,
it
could
be
that you're
avoiding
getting
deeper into your
problems.
Make your choice carefully,
then try to stick to it.
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SECTION2
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KNOW YOUR RIGHTS
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The following is a list of your rights as a
client.
They are discussed in more detail in the
sections noted in parentheses.
Ycu have the right
to krr:>w
(Fees )
the
•
cost
•
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of
therapy
BEFORE you start.
to
know
and
understand
your
therapist's
credentials. (Credentials and Licenses )
to
ask for a
(Personal Tcuch )
referral
to see your records,
them. (Records)
and
to
another
therapist.
to decide who may see
to refuse to be tape recorded. (Tape Recording)
to
krr:>w
Insurance)
your
clinical
diagnosis.
to file a complaint. (Filing a Complaint)
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(Health
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Fees
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1he cost of psychotherapy can range from less than
$10 per hour or even free at some community
clinics
to
over
$100
per
hour
for some
psychiatrists.
Some therapists charge a set fee
for their time, but many use a "sliding scale" in
which your fee is determined by your income and
ability to pay. 1he old saying, "You get \�hat you
pay for" is not always true here. Generally, the
more degrees, licences and experience a therapist
has' the higher the fee' rut it is possible for
you to find sorneone who can work well with you
without paying through the rose.
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When you call to make an appointment, ask al:xJut
the price range. Also, ask if there is a fee for
the first interview.
Some therapists charge for
the first meeting, and some do not. If they do,
you should come prepared to pay at the end of the
session.
Cllecks or cash are the usual method.
The fee should be discussed early in the first
meeting.
Be sure you understand exactly how rruch
and \Jlen you pay, as well as any ground rules,
su:h as, do you pay for meetings that you miss?
If you have health insurance,
you may be partially covered.
(See·
Health
Insurance,
later
in
this
. section. )
NOTE:
This may seem like a lot of things to remember,
especially when you 1 re concerned with the problems
that brought you in in the first place. 1he
therapist will probably explain all these things
without
you
having
to ask about them, but
remember: don 1 t be a passive consuner.
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Confidentiality and its Exceptions
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What
you
tell
ycur
counselor
nust remain
confidential or else you will not feel safe to
share very personal infonnation.
That is \lhy
state law and professional organizations like the
American
Psychiatric Association give specific
guidelines for keeping things confidential, and
makes it a counselor 's major responsibility.
It
is not, h:l'l,.-ever, air tight
The following are the
exceptions:
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Your counselor may discuss your case with another
professional
in
order
to benefit from that
person IS experience'
bJt only if it iS in your
interests.
If your counselor is an intern or a
trainee, he or she n:u.St discuss your case with his
or her supervisor, --a-licenced therapist, as part
of the training.
This is JIDst likely to your
advantage.
Different viewpoints can shed light on
things wch might be missed.
You 're getting the
expertise of two or more professionals for the
price of one. Arrong these people, the infonnation
is kept strictly confidential, EXCEPr:
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If yrur cmmselor becorres convinced that you are a
clear and immediate danger to yourself or others,
he or she is required by law to report this to the
intended victim and to the proper authorities.
This may include mental health agencies and the
police.
If you reveal any knowledge of abJse to a child or
minor,
your counselor must report it to the
Department of Public Social Services, and to the
police.
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Records
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Your therapist may keep some kind of recon:ls of
your case, including forms you fill out at the
first visit, the results of psychological tests,
as weLl as rotes about you and your progress, and
any tape recon:lings.
( see below) These notes may
be sketchy or very detailed. Both California law
and professional organizations require therapists
to
guard their recon:ls carefully.
While the
actual records are the property of the therapist,
the infonnation on them belongs to you.
You have
the right to see your records, and the right to
decide who else may or may rot see them. For the
exceptions to this, see "Confidentiality," on the
previous page.
Tape Recordings
Some therapists like to use tape recon:lings of the
counseling
sessions
in order to study their
interaction with their clients and to consult with
other therapists.
The tapes are govenened by the
same strict rules of confidentiality.
If your
therapist wants to record your sessions, he or she
must ask your permission first.
If you feel
tmeomfortable with this, talk it over. You have
the right to refuse.
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Health Insurance
and the Clinical Diagnosis
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If you have health insurance, your policy may
cover you at least in part for a limited number of
therapy sessions.
A few years ago, rost insurance
conpan:ies
\\OUI.d
only pay for treatment from
psychiatrists,
if
at
all.
Recently,
many
corrpanie s have expanded their coverage to include
other professional therapists, such as Marriage,
Family and Child Counselors. Read your policy or
call your insurance company and ask row rruch they
cover you, and v.hat kinds of therapists they
cover.
Also, make sur� your therapist will accept
insurance.
Most insurance companies require the therapist to
give them an official diagnosis of v.hat you are
getting therapy for.
This will come fran a l:x::>ok
called the Diagnostic and Statistical Manual of
Mmtal Disorders, Third Edition, or DSM-III. Your
therapist will give only a title and number for
your
diagnosis,
such as
300. 02, ''Generalized
Anxiety Disorder." No details about your problems
may be described.
However, the diagnosis might
say
enough
for you to feel embarassed, for
instance,
303.9x, "Alcohol Dependence," or 312.32,
"Kleptomania."
The diagnosis will go into your
files
at
the
insurance
company.
Insurance
companies are generally careful with confidential
infonnation, rut are rot necessarily as discreet
as your therapist.
If you have second thoughts
about having one of these labels on permanent
record, talk it over with your therapist. You
have the right to know the diagnosis before it is
sent to the insurance company.
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Personal Conduct
Aside
from
these
professional matters,
your
therapist is strictly bound by both state laws and
rules of the various boards and associations to
hold to high standards of personal conduct during
his
or
her practice.
Generally,
this IlEans
respect for yoo as a person and as a client. Two
specific points which should be emphasized are:
Personal
or
social
relationships
between
therapists and clients outside the therapeutic
relationship are strongly discouraged.
A dual
relationship
like
this
is
thought
to
be
destructive to the therapy.
Sexual relations between therapists and clients
are strictly forbidden by state laws governing
psychotherapists
and
professional
every
association in psychotherapy as being extremely
destructlve to the therapy, to the client, and in
the end, to the therapist's career.
It is grounds
for taking away the therapist's license.
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Filing a Complaint
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Most
psychotherapists are highly professional,
ethical people. Occasionally, they rmke mistakes.
As in any profession, on rare occasions you get a
real l::ad apple.
If your therapist has simply not been able to help
you with the problems you presented, that is not
really a legitirmte complaint, because so much of
it depends on you. 'That is rore a reason to just
find another therapist.
However, if during the course of your therapy,
your
therapist seriously breaks any of these
ethical, professional or personal rules, you can
arrl should file a complaint.
This is for your
sake, for the sake of the clients who will COI'T'e
after you, and for the sake of the profession as a
whole.
Maybe your therapist has been very helpful in
every other way, and you hesitate in causing
trouble.
It would be very sad if you were to
leave therapy or continue in therapy feeling that
you had been victimized and did not fight l::ack.
If you're not sure v.hat to do, perhaps asking the
advice of one or t� other therapists W:lo do not
know yours might help.
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Telephone calls are good for getting information
arrl advice, but if you want results , put your
complaint in a letter.
In it, describe your
complaint briefly ana clearly' and include your
narre
and
address, your therapist' s narre and
business address, what kind of therapist, and try
to include his or her professional license number.
This is on the license, and may also be on the
business cards and advertisements. Your complaint
will
be
investigated
as
confidentially
as
possible, rut yru are increasing the nunber of
people who must discuss your case and complaint.
Different kinds of psychotherapists are governed
by different agencies.
For a list of where to
send
your
letter,
see Section 3, Types of
Therapists.
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SECTION3
TYPES OF THERAPISTS
Only the following kinds of professionals can
practice
"psychotherapy",
and
their
basic
qualifications are briefly described here. If you
want to get further information or want to file a
canplaint, the addresses and phone rn.unbers of the
proper agencies are listed after each description.
See also "Professional Associations" in the last
section of this Guide.
Psychiatrist (Licensed M. D.)
Psychologist (Licensed Ph. D. )
Marriage, Family and Child Counselor
Licensed Clinical Social Worker
Educational Psychologist
School Psychologist
Trainee, Intern, Paraprofessional
Pastoral Counselor
Psychiatrists
All
Psychiatrists
are medical doctors.
Only
M.D. 's
can
prescribe
drugs
for
use
in
psychotherapy.
Their practice can range from
simple counseling of normal people to treatment of
severely disturbed or insane people.
The basic requirements for Psychiatrists are:
1. Graduation from a four year accredited medical
school.
2. A one year internship.
3. Passing an examination for a state license
given
by
the
Board
of
Medical
Quality
Assurance.
4.
A
three year residency in a psychiatric
hospital. (optional)
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As long as they can pass the state psychiatric
license examination, rredical doctors do not have
to have any specialized training in psychiatry in
order to practice it, but rrnst do. In order to
belong to a professional society like the American
Psychiatric Association, they ITP.JSt have that three
year residency.
For information or complaints write:
Board of M2dical Q..Jality Assurance
1430 lb� Ave.
Sacrarrento, CA. 95825
Telephone (916) 920-6383
or:
Board of M2dical Q..Jality Assurance
8939 S. Sepulveda Blvd. Suite 520
Los Angeles CA. 90045
TelephOne (213) 641-8100
Licensed Psychologists
Not all Psychologists are therapists. Sorre are
scientists me stu:ly the ways people behave. If
they want to practice psychotherapy, they nust get
the state license.
With that, they can work with
the sane wide variety of people as psychiatrists,
but they cannot prescribe drugs.
The
basic
license are:
requirerrents
for
the
Psychologist
1.
A Doctorate (Ph. D. ) degree in Psychology,
Educational Psychology, or the like.
2. 3, 000 hours of experience in counseling people,
discussing their cases, writing asessrrents, and
attending trainings, lectures, and seminars, all
under the supervision of licensed psychologists or
psychiatrists.
3. Passing a written and an oral examination given
by the California Board of M2dical Examiners.
For information or complaints write:
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Psychology Examining Committee
Board
of
Medical Exarrdners
california
1020 N Street
Sacramento, CA. 95814
Telephone (916) 920-6383
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of
the
State
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Marriage, Family and Child Counselors
Generally, MFCC ' s work with relationships, like
those between spouses, or parents and children,
and often see couples or whole families all at
ore e.
They also often work with individuals, but the
errphasis
is on their relationships, past and
present.
The
basic requirements
license are:
for
a
California
MFCC
1. A two-year Master's degree from an accredited
school,
college or university
in counseling,
psychology, or social work.
2.
Various
extra
classes in counseling and
psychology required by the California Board of
Behavioral Science Examiners.
3. 3,000 hours of experience in counseling people,
discussing their cases, writing asessments, and
attending trainings, lectures, and seminars,
all under the supervision of licensed MFOC's,
Psychologists or Psychiatrists.
4. Passing a written and an oral examination given
Behavioral Science
by the California Board of
Examiners.
For infonnation or complaints write:
Board of Behavioral Science Examiners
1020 N Street
Sacramento, CA. 95814
Telephone: (916) 445-4933
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Licensed Clinical Social Workers
LCSW's generally work with a person's relationship
to
society.
They
have knowledge of social
resources as well as counseling and psychotherapy,
am help individuals' families and groups create
better relationships with each other and their
society.
The basic requirements
Social \-brker are:
for
a
Licensed Clinical
1. A Master's degree in Sociology, Social Work or
the eq..tivalent
2. 3, 200 hours of supervised experience, similar
to the hours for the MFCC's.
3. Passing a written and an oral examination given
by the California Board of Behavioral Science
Examiners
•
•
For infonnation or ccxnplaints , write:
Board
of
Behavioral
address above. )
·
Science
Examiners,
(see
Educational Psychologists
School Psychologists
Educational Psychologists generally help students
with problems in school.
They know how to give
am
interpret
tests
which
measure learning
ability, to advise students about classes and
career goals and to counsel students and their
families about problems Which may interfere with
their perfonnance in school.
The
basic
requirements
Educational Psychologist are:
for
the
Licensed
1. A Master's degree in Pupil Personnel Services,
Educational Psychology, or a related subject.
2. A School Psychologist Credential
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3.
Three
years
working
experience
as
a
credentialed school psychologist.
4. Passing a written and an oral examination given
by the Board of Behavioral Science EKaminers.
School
psychologists
work
within the school
system, While licensed Educational Psychologists
can have a private practice. For infonnation or
complaints
about school psychologists, contact
yrur local school board.
For infonnation or complaints
Psychologists, write:
Board
of
Behavioral
address above. )
Science
about Educational
Examiners,
(see
Paraprofessionals
It obviously takes a long time to get these
degrees and licenses, and therapists who are not
yet through the process are called trainees or
interns.
Trainees
are
enroled in a degree
program, but have rot yet graduated.
Interns have
recieved their degree, but are still corrpleting
the hour requirements for the license. The fee
for \<I.'Orking with a trainee or intern is usually
far lo�r than a fully licensed therapist, and so
they are the most common source of counseling for
people with limited incomes.
"Paraprofessional"
means
"sort
of
like
a
professional. "
People � are trained to do a
specific limited service,
like listening on a
hotline or managing groups of ahlsed children are
paraprofessionals.
They
are
not
really
therapists,
but
they are trained to do one
therapeutic thing.
For rrore infonnation or complaints write:
Science
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Trainees, Interns and
Boaro
of
Behavioral
address above.)
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(see
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Past oral Counselors
Ordained clergymen or clergywanen of any religion
can
practice
psychotherapy as part of their
While they may have sone, they
assigned duties.
are
not
required
to
have
any license or
psychological
training.
They
may
couns el
irnividuals,
families or groups, but may not
administer psyChological tests or drugs.
Religion
may or may not be an important part of the
therapy.
If you have any cooplaints about the
ca.ms elor,
you will have to take them to the
authorities of the religion. The laws pertaining
to pastoral counseling are not very clear or
canplete.
For more information write:
Arrerican Association of Pastoral Cotmselors
3000 Conneticut Ave. N. W.
Washington, D.C. 20008
Telephone (202) 385-6967
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SECTION4
MODES OF THERAPY
Psychotherapy is offered in rmny different ways,
called modes.
The modes are like vehicles on a
road.
'There are motorcycles, llhich carry one or
t:\\0 people, cars, carrying a few more, am busses,
They all get
which carry large runbers of people.
where
they're
going,
and each has its own
different advantages.
INDIVIDUAL COONSELIN:; is where you work alone with
the therapist.
Its advantage is that you can deal
with very personal things that you would hesitate
to share with others,
am you can work on rmny
things, because the whole sessions are devoted to
yoo.
RElATIONSHIP CCl.JT\SELING can be done individually,
but it probably rmkes more sense to have both
people in the relationship present, such as you
arrl
your spouse.
Its advantage is that the
therapist can see directly how you and the other
person ccmnunicate
(or fail to) and can help you
learn better ways of settling your differences am
being together.
FAMILY TIIERA.P'{ includes both parents and all the
children.
If other people, such as grandparents,
ex-spouses,
step parents or step children live
with the family or are important in the family
life,
they also are often included, provided they
agree
to
come.
Its advantage is that the
therapist can directly experience the complicated
ways the llhole family works. tvbst psychological
problems have their roots in family life, arrl the
therapist helps the family to become strong and
stable, llhile at the same time allows each member,
young or old, to grow as an individual.
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GROOP
THERAPY involves
individuals or couples
meeting as a group of usually four to ten people,
led by one or two therapists.
Its advantage is
that as a little slice of society, the therapist
arrl the other naribers can help you to see how you
behave with other people; the ways that \\Xn:k for
you and the ways that don't.
Often people in a
group are relieved to find that other people have
similar problems.
Because of this, groups often
form
to
work on specific problems,
such as
eating disorders, or grief over a lost
alcoholism,
loved one.
<Xle other important advantage of group
therapy
is
that it is usually cheaper than
irrlividual couns eling.
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SECTION5
APPENDIX
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Myths and Misconceptions
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About Psychotherapy
There are a fll.l'l'ber of ideas about psychotherapy
floating
arOI.liKI
which
really
need
to
be
challenged.
1hese are sorre argurrent s against
them.
If any of these or other ideas are on your
mind, it might help to share them with your
therapist.
1.
"fuly
\\leak
psychotherapists. ''
or
crazy
people
go
to
This is the IlDSt corrmon and IlDSt damaging myth.
It's puzzling how easily we can talk about our
physical problems, yet mental problems are often a
srurce of great shame in ourselves and suspicion
in others. A large part of your life, of '\\hat you
are is rental, and part is physical. So part of
what needs taking care of is rental. If yru're
only willing to take care of the physical side of
yrur life, then you may only be partly healthy.
It is not weakness to gp to a therapist for
personal problerns any more than it is weakness to
go to a dentist for a toothache.
It hurts, and so
yru gp to the proper specialist in order to take
care of it.
Many people Who go to psychotherapists are afraid
that they are gping crazy. Most of them find out
they're not. You may have sCJTJe crazyness going on
in your life, as we all do, but thB.td oesn't Irean
yru 're a nut.
24
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"Therapists have it all together.
problans."
2.
They have no
It makes
Don't put yrur therapist on a pedestal.
it harder to reach you.
Therapists are human
beings.
'!hat is the most valuable thing they have
to offer you. They know \\bat it means to hurt and
to be afraid.
An::l it isn't all in the past for
them either.
Therapists continue to have problems
fran time to time, and the best ones see their o-wn
therapists regularly.
3. ''The therapist will solve all yrur problems and
tell you exactly \\bat you should do."
If
only it could be that sinple. The therapist
help yru see things ntrre clearly, give you
useful information,
help yru resolve conflicts
within
yourself
or
your
relationships
and
encrurage yru to take steps to change things, but
it will be � who does all the \\Urk.
An::l it will
be
.�
wfi() can
take
credit for all the
inprovement.
Instead
of
some one
'lf.bo fixes
the therapist is more like a
everything for yru,
tool which you use to repair parts of your life,
arx:l build new parts.
can
4. ''The therapist must have had the same problems
in order to be able to help yru."
Well,
it helps, rut it isn't absolutely recessary.
For instance,
your therapist rm.y not have ever
attenpted
suicide,
but
probably
knows �t
hopelessness feels like.
If the therapist can be
in touch with his or her own feelings collected
thrrugh life, and use them to know \\bat yru're
going
through, that is called empathy.
(see
Personal Truch, Section 1. )
Your therapist rm.y be
yCR..Jr�ger or older than yru, or be of a different
sex,
race or other background, but there can still
be empathy.
.
25
l
Specialists
may specialize, working with
therapists
Sane
as
such
problems
particicular
with
people
or sexual
disorders,
eating
or
alcoholism,
Or they may specialize in a certain
problems.
kim of therapy, such as Art Therapy, or Stress
Management, or one of the rrodes, like Family
There are specialists for just about
Therapy.
every problem, and there is an amazing variety of
special therapies.
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CAUTION:
Sane of these therapies are very well
\\bile
respected,
and
established
If
are rather far-fetched.
others
yru 're considering a "therapy" that
sounds a little wierd, contact one of
the state agencies listed in Section
3, and ask if it is a questionable
practice.
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·
Clients usually find legitimate specialists by
being referred to them by therapists with a rrore
general practice.
There are no legal requirements for extra training
experience in most of these specialties.
or
Licences require general knowledge. Man y of these
have private
therapies
or
problems
special
organizations \lhich will certify a therapist if he
or she gets a required amount of extra training
arrl experience.
If you are referred to a specialist, ask \\hat
extra training or experience he or she has in that
area.
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Hotlines - Help Over the Phone
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''fbtline" has bee� the infonnal general term for
services wch offer help, advice or comfort over
They go by many narres; to keep it
the telephone.
brief here, they're all called ''hotlines "
•
Hotlines are generally for helping people mo are
in a crisis, that is, an irnrediate problem mich
is so frightening or upsetting that they do not
think they can handle it by themselves. A crisis
is a short term problem, lasting no roore than a
few v.eeks.
This can range from having a bad
argt..mt
m
with your best frierrl, to having thoughts
arrl feelings about comnitting suicide. Hotline
listeners usually help the caller to calm down,
sort out sorre useful alternatives, and encourage
the caller to get sare help.
Unless they specifically say so, hotlines are not
for ongoing counseling because it is usually very
hard to do this well over the phone. If the
caller needs this, the rotlines roos t often will
give the caller one or roore referrals, that is,
the narre and phone rn.mber of a therapist or agency
mich can give the caller \\bat he or she needs.
Even if you're not facing a crisis, a hotline can
be a source of information and referrals for
cnmseling mich fits your particular problems and
yror incorre.
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Hotlines
are often specialized for particular
needs.
Some are for preventing suicide, others
are for runaway children, or for battered wanen .
There are hotlines for alcohol or drug problems,
lcnely people, people needing shelter, renter's
problems, and job seekers, to list just a few. To
find a
hotline, look in the phone book under
''hotline,"
"crisis
intervention," or ask the
operator.
Most hotlines have references to other
hotlines, so if W:lat you find isn't exactly W:lat
you want, call and ask for a referral.
A
referral
is
Remember:
guarantee of quality service.
to you to choose wi �ely!
a
not
It's up
The Psychological Theories
of
methods
and
theories
many
are
There
to
like
theorists
sonetimes
and
psyc hotherapy,
This
rest.
the
than
better
is
claim that theirs
kind of debate is really beside the point, because
it doesn 1 t seem to matter \thich theory is used as
(see
�T��.X;h as 't\hat kind of a person is using it.
may
s
therapist
Often
1)
Section
Personal Tcuch,
use
may
but
others,
than
more
prefer one theory
you're
problems
the
on
depending
parts of several
The various theories are too complicated
facing.
If you are
to describe here with any fairness.
uses,
therapist
your
theory
't\hat
in
interested
academic
long
a
into
getting
avoid
BUT:
just ask.
discussion; W:lat you're there for is to talk about
you
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r
f
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Hospitalization
Mental
hospitals
are for people Who are so
severely upset, disturbed or unable to take care
of
themselves
that
they
need a controlled
ert\Tirorarent,
lots
of
attention and possibly
medication.
This is a very scary subject to rrost
people, partly because of the loss of freedan and
ccntrol over cne' s life, and partly because of
stories
of
madhouses
and maniacs, and news
scandals
of
abuse
and
neglect
in
mental
institutions.
Fortunately, these incidents are
rare' rut both the patient and his or her loved
o�s should be watchful of the treatment and
mindful of their rights; the basic ones are listed
below.
There are a number of ways a person may be
admitted
to
a
psychiatric
hospital or the
psychiatric ward of a general hospital:
1. He or she may request admission.
This is
actually
very
coom:m.
A frequent reason is
wanting to get treatment for addiction to drugs or
alcohol·.
2. A licensed psychiatrist, psychologist, police
officer or judge has reasonable cause to believe
that the person is a danger to self or others, or
is unable to take proper care of him or her self.
In this case, the person may be held involuntarily
in the hospital for observation for up to 72
hrurs.
After that time he or she III.JSt have an
evaluation by the psychiatric staff. The patient
may then be released, or if he or she still seems
a
danger
to
self
or
others may be held
involuntarily for up to 14 days, depending on the
problem.
Then another evaluation rrust be held.
The laws and regulations governing all this are
too cooplicated to cover here, rut the patient or
his or her family have the right to have it all
explained to them by the hospital authorities.
Both the voluntary and involuntary patient also
have these rights under California law:
29
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1. To wear his or her own clothes; to keep and use
his
or her own personal posessions including
toilet articles;
and to keep and be allowed to
spend a reasonable sun of his or her own money for
canteen expenses and small purchases.
2. To have access to individual storage space for
his or her private use.
3. To see visitors each day.
4. To have reasonable access to telephones , both
to make and receive confidential calls.
5. To have reasonable access to letter writing
materials,
including stanps,
and to send and
receive unopened mail.
6. To refuse shock treatment.
7. To refuse lobotomy.
8. Other rights as specified by regulations.
The hospital staff may only deny any of these
rights for a good reason, which must be entered
into the patient 's treatment record. This list
must be posted where the patient can read it.
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Medication
Only a Psychiatrist or another Medical Doctor can
prescribe drugs for use in psychotherapy. Many of
the drugs used in psychiatry are addictive or have
bad side effects. Both yru a:rd the doctor should
be very careful in their use. They are called
"psychoactive" or "psychotropic" drugs, meaning
they affect your thinking, eootions or IOOOd .
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If you take any other medicines, drink alcohol or
take drugs, let the doctor krow. Mixing these
things can be very VERY dangerrus !
If yru have
any nedication left over frcm an old prescription,
yru should probably discuss it with a doctor or a
psychiatrist before you start taking it again.
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yru are given a prescription, yru
as a wise consumer should ask the
doctor to explain carefully why you
should take it, to.bat it will do to
you, to.bat side effects there may be,
am how long he or she expects you to
need to take it.
A \\Ord about side effects:
W:latever a drug does
to you is the effect, and that may be many things.
We tend to call the part we want the "effect," and
the part we don't want the "side effect," sort of
trying to p.15h it over to the side. Sane people
will have some side effects, others will have
nate.
Renember, the whole effect is inportant.
Don't ignore what we 1 d like to keep to the "side."
If yru experience any effect that you don't like
or don't understand, tell your doctor immediately.
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'The
drugs
roos t
corrm:mly
prescribed
psychiatrists fall into four groups.
They are:
by
Antianxiety drugs, or Minor Tranquilizers
'These
are used to treat anxiety,
or nervous
tension.
Valium and Libriun are very corrm:m
examples.
These drugs are intended to help you
relax, both physically and rrentally.
They can
also
cause
you to becoroo drowsy,
depressed,
coofused, nauseated, or dizzy, or have less comron
side effects.
They can be physically addictive,
am withdrawal symptoms can include loss of sleep,
depression, loss of appetite, and roor e anxiety.
Sedatives, or sleeping pills
These of course, are intended to help yru sleep.
The m:>st corrm:m side effect is the tn:"ge to take
larger
amounts,
and
this leads to physical
addiction.
Taking too many at ooce or with
alcohol can be fatal.
Suddenly stopping after
taking sleeping pills for a long time can cause
tension, sleeplessness or even seizures.
If you
have been taking sleeping pills for soroo time, you
should "taper off" gradually under close watch by
a doctor.
Antidepressants or stimulants, ''uppers"
Depression isn't really sadness, although it looks
like
sadness.
It's roore a lowering of all
feelings and activities to a very low level.
It
has specific symptoms and is thought of as a
mental d isorder.
In bad cases, psychiatrists try
to pull their patients rut of depression with
these drugs.
Elavil is a popular type.
The roost
carmon side effects include dry roouth, bltn:"red
vision,
restlessness,
dizziness,
tremor,
tenseness,
loss of sleep and confusion.
SUdden
withdrawal symptoms can be mild to severe.
32
Antipsychotic drugs, or Major Tranquilizers
These are very powerful drugs used to control
symptoms of psychotic patients, or people Who are
extremely upset or agitated for some other reason.
They slow down thinking, and blunt the erootions.
Thorazine and Mellaril have become well known in
include
effects
side
The
group.
this
restlessness, trembling of the hands or face,
sl:uffling walk, l�red sex drive, seizures, and a
pennanent, incurable twitching of the toungue,
face and eyes, or hands and anns, called 'Tardive
Often other drugs are prescribed
Dyskinesia."
along with these drugs to try to catm.teract the
Of course, these have their own
side effects
side effects.
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Professional Associations
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There are private associations for the different
They help to promote the
kinds of therapists.
interest of their rrembers, as well as to keep them
The associations listed here all have
in line.
codes of ethics and professional standards which
their rrembers lll.lSt follow. For rore information
or to make a coinplaint, you may also want to write
to one of these organizations, especially if your
They may have local
fs a member.
therapist
chapters in your area. You can also use them to
find a therapist, by asking for referrals in your
area.
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Arrerican Psychiatric Association
1400 K Street, N. W.
Washington, D.C. 20005
·Telephone (202) 682-6000
Arrerican Psychological Association
1200 Seventeenth Street, N.W.
Washington, D.C. 20036
Telephone (202) 833-7600
Arrerican Psychoanalytic Association
One E. 57th Street
New York, NY. 10022
Telephone (212) 752-0450
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American
Association
Developrn:!nt
5999 Stevenson Ave.
Alexandria, VA. 22304
Telephone (703) 823-9800
for
Counseling
American
Association
for Marriage
Therapy
1000 Conneticut Ave. N.W. No. 4D7
Washington, D.C. 20036
Telephone (202) 429-1825
and
National Association of Social \ok:>rkers
7981 Eastern Ave.
Silver Spring, MD. 20910
Telephone (301) 565-0333
American Association of Pastoral Counselors
3000 Conneticut Ave. N.W.
Washington, D.C. 20008
Telephone (202) 385-6967
34
and
Family