Context: I suffer from checking and cleaning OCD. Can counseling help me to get over it?

Response: Counseling can be very effective for OCD. In particularly, a kind of therapy called Exposure Response (Ritual) Prevention Therapy is considered the 'gold standard' for the treatment of OCD. What this is, is a specific protocol that helps you build relaxation strategies and to increase the amount of time between your checking/cleaning rituals while also helping you to face any of the fears that OCD given you until those rituals and fears are no longer interfering with your life. Research has shown that this kind of therapy may even be more effective for OCD than medication, https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.162.1.151


Context: I suffer from checking and cleaning OCD. Can counseling help me to get over it?

Response: Possibly yes, and definitely worth a try.First read about different types of therapy for OCD so that you find a therapist who does the type of therapy which feels best when you read about it.


Context: I'm a teenager and I get these really intense mood swings.    My mood will be really high and I'll think of something that I want to do. When I start to make it happen I get irritated by other people if they intervene. Then if the thing I wanted to do doesn't work out, I have these tendencies to blame other people for it not working out.    Can you explain what's going on?

Response: Mood swings and getting frustrated when things don't work out is totally normal. Sometimes, we get tied to one thing we really want to do and it can feel pretty intense when that gets interrupted or doesn't work out. This said, you're coming to CounselChat and so I'm guessing this is something that is pretty intense for you and something that you are concerned about. If this is getting in the way of your life, it may be worthwhile to reach out to a therapist or doctor to get some help with this and see if there might be something more going on. While for most people frustration/mood swings is related to typical life and stress, if very intense it can be a sign of a number of challenges ranging from anxiety to a traumatic experience to something like Bipolar Disorder where a person's mood and energy might fly so high (mania) that one feels like they can do anything but often become frustrated when interrupted (note: there is a lot more to Bipolar Disorder than this and this is certainly not a diagnosis). Wish you well!


Context: I'm a teenager and I get these really intense mood swings.    My mood will be really high and I'll think of something that I want to do. When I start to make it happen I get irritated by other people if they intervene. Then if the thing I wanted to do doesn't work out, I have these tendencies to blame other people for it not working out.    Can you explain what's going on?

Response: Why do you blame other people who had nothing to do with your actions?If it is because after the fact you wish you had accepted their help, then the person who is responsible for this is you!Since you are aware of your tendencies and how the interfere with your life, try to become aware of when you do these habits.This way you can interrupt your own patterns a little bit at a time.


Context: I'm a teenager and I get these really intense mood swings.    My mood will be really high and I'll think of something that I want to do. When I start to make it happen I get irritated by other people if they intervene. Then if the thing I wanted to do doesn't work out, I have these tendencies to blame other people for it not working out.    Can you explain what's going on?

Response: Teenagers are prone to mood swings due to developmental and hormonal changes that are rapidly and intensely occurring in your body and mind - so some of this happens to many people in your stage of development. You are not at all alone.You've taken the first and very important step in regulating your moods by just identifying that you are having these intense changes instead of being completely submerged in them and unaware! The more you are able to be a witness to your emotions and thoughts, the more you can learn to manage them. Your question offers several clues for strategies that you can try - for example, identify the warning signs for becoming irritated and plan a response, such as taking a deep breath, informing the person you are becoming irritated and need some space, or find a distraction temporarily like listening to music or going for a walk. Since you are aware of blaming others for things not working out, you can proactively make a personal commitment to taking ownership or personal responsibility by just thinking about it and practicing thoughts such as "I am responsible for my efforts" and "Blame is not helpful for anyone" and other thoughts that you believe and can repeat related to this insight. When you practice thinking more rational, healthy thoughts, you are actually rewiring your brain, so practice is key!


Context: For the past four weeks, I've been having nightmares and hearing voices telling me of horrible things. They're not random voices, but rather, the voices of those I care about.

Response: Hearing voices can be a very upsetting experience to have. I want you to know that a lot of people will hear a voice at some point in their lives and that there are many things that cause voices. Oftentimes, significant stress can offset us to have symptoms like this. There also mental and physical health conditions that can do the same. I strongly encourage you to seek out help from both a doctor and a counselor to help you piece together exactly what is causing your voices. I Once you've got that down, you'll know what to work on. In the meantime, here are some strategies to cope with voices1. Lower your stress levels: Oftentimes stress makes voices worse. What can you do to lower your stress?2. Get enough Sleep: Like stress, sleep deprivation is an awful trigger for hearing voices3. Listen to Music; Music can help you focus on another sound4. Wear headphone or Earplugs5. Use Your Own Voice; If the voices are saying harsh things to you, it can be tempting to talk back and that's okay if you do. However, you cn also use your own voice through singing, whistling, or the like, which can help drown out the voices6. Remind Yourself that What the Voices Say is Not True; Sometimes it Helps to Write it Out7. Draw the Voice or Give it a Name; This can make it less scary and help get it outside of you8. Keep Track of When You Hear Voices to Identify Triggers; These are situations you can avoid while these are so distressful for you9. Be Kind to Yourself; When a Voice is Being Cruel to You it is especially important to be kind to yourself10. Remember that while hearing voices can be disturbing that it is a common experience and something that many people recover from.


Context: For the past four weeks, I've been having nightmares and hearing voices telling me of horrible things. They're not random voices, but rather, the voices of those I care about.

Response: I would recommend that you talk with a mental health professional near you about the details so you can have some really specific support for what you are going through.I don't know if you can understand when the voices are saying, but I wonder how you feel about what you are hearing? If the voices are just at night, is it possible that they are part of a nightmare or a dream? If you recall your nightmares, consider writing them down so that you can remember their content and work with a mental health professional to look for patterns.One thing that may help you while you are awake is to try to stay connected to the room you're in. For example, take time to notice your feet on the floor, hips in the chair, and shoulders against the back of the chair. You can also try mindfulness techniques, such as noticing what is around you or changing your breathing patterns. These ideas may help in the meantime prior to having more specific ideas from someone near you.Thanks for reaching out!


Context: For the past four weeks, I've been having nightmares and hearing voices telling me of horrible things. They're not random voices, but rather, the voices of those I care about.

Response: Voices and dreams could be suppressed feelings or thoughts that result from negative experiences.  Many times when people go to trough traumatic incidents or changes in their lives without being equipped to manage them and as a result they start having similar symptoms. It is helpful to find a therapist to talk to about those dreams and voices, once you get them out, you could analyze the concerns and fears that they reflect and normalize them, which will also be a good time to discuss their source, if any traumatic event has occurred in your life.  Also, I recommend to journal your dreams, especially if they keep you awake at night, and meditate after, so you could go back to sleep.   ¿Cómo puedo hacer que los sueños y las voces desaparezcan?Durante las últimas cuatro semanas he estado teniendo pesadillas y escuchando voces que me dicen cosas horribles.  No son voces que hablan al azar, pero voces de las personas que me importan.Las voces y los sueños pueden ser sentimientos supresos o pensamientos que resultan de experiencias negativas.  Muchas veces estos síntomas surgen cuando las personas pasan por situaciones traumáticas o cambios que no estaban preparados para enfrentar.  Es útil encontrar a un terapeuta con quien puedas hablar de esos sueños y voces, y aprender a normalizar el contenido de los mismos.  También sería un buen momento para discutir cualquier situación traumática que te haya ocurrido. Además te sugiero que escribas tus sueños, especialmente si te mantienen despierto  en la noche, y que medites luego de escribirlos para que puedas volver a dormir.


Context: For the past four weeks, I've been having nightmares and hearing voices telling me of horrible things. They're not random voices, but rather, the voices of those I care about.

Response: Are you in the middle of extreme emotional pressure right now?Or, is someone with whom you're close, under stress or somehow suffering?Dreams and nightmares are when our feelings and pressures we feel, try working themselves out without logic and language.Even though the nightmares are horrible, they are one way your psyche is trying to come to terms w extraordinary difficulty in your life or someone's life whom you feel greatly attached.


Context: For the past four weeks, I've been having nightmares and hearing voices telling me of horrible things. They're not random voices, but rather, the voices of those I care about.

Response: It's important to take a look inside and find out why you are experiencing these feelings. It could anything and it will change your life to know what your particular issue or trigger is. Please contact us a call with the method that is most comfortable for you.


Context: For the past four weeks, I've been having nightmares and hearing voices telling me of horrible things. They're not random voices, but rather, the voices of those I care about.

Response: Write down your nightmares and discuss them with an analyst or psychotherapist who specializes in dreams, as I do. If you are hearing voices while awake, see a doctor right away.  If the voices are strictly in your dreams, do call for therapy and talk to your caring others about what's happening.


Context: My doctor seems to think I am in danger of having one. I neglected to ask how this was different than an episode. I have been formally diagnosed with bipolar type 1.

Response: I do not think there is such a thing as a psychotic seizure, however, there is something called a pseduoseizure or psychogenic non-epileptic seizure. Basically, this is when a person shows signs of a full-on seizure (such as falling and convulsing) but they are not producing brain waves consistent with a seizure. Psedoseizures tend to be brought on by high stress, emotional challenges, and trauma history. You can learn more here, https://www.ncbi.nlm.nih.gov/books/NBK441871/ Still, the best way to now what your doctor meant would be to ask them! :)


Context: My doctor seems to think I am in danger of having one. I neglected to ask how this was different than an episode. I have been formally diagnosed with bipolar type 1.

Response: The best path is to ask your doctor what s/he meant when telling you about your high risk for psychotic seizure.Your doctor knows you better than any of the therapists who write on this blog.   And, because your doctor knows your health, will likely have suggestions and advice for you regarding the seizures s/he thinks you may develop.


Context: My doctor seems to think I am in danger of having one. I neglected to ask how this was different than an episode. I have been formally diagnosed with bipolar type 1.

Response: I will admit that I'm not specifically familiar with this from my own experience.My best educated guess is that you could have a seizure during which you have some sort of symptoms similar to a hallucination (which is one of the psychotic symptoms) when you hear or see things that aren't really there.In looking briefly online, I was able to find some information here: http://www.epilepsy.com/information/professionals/about-epilepsy-seizures/psychiatric-and-behavioral-aspects/psychiatric-2It sounds like this would be a symptom in addition to an already existing seizure disorder, not a seizure disorder in addition to a mental health problem. If it is the other way around, I'm not sure how that would work. It is common with some types of seizures to have an altered state of reality during or shortly after the seizure, so that could also be related.I would suggest you talk to your physician about this directly so that if they are worried about this, you can learn more about what is making them concerned about it and what, if anything, you could do to lessen the likelihood of it or how to handle it if it does happen.


Context: Often times I find myself thinking scary thoughts and sometimes I even scare myself into thinking that something bad is going to happen to me. Once it starts, the thought continues going through my head and I can't get it out. How can I stop these thoughts?

Response: Scary thoughts can feel overwhelming at times as well as feeling quite real. I want to acknowledge how scary they can feel, but there is hope and new skills you can learn to work with these types of thoughts. The first step in working with scary or negative thoughts is to acknowledge that they are just thoughts and we can choose to follow the scary thought streams or work with cutting them off or ignoring them. I also realize that might seem really hard to do, but here's a good way to think about the brain and how thought patterns work. Thoughts arise in the mind all the time, our brain is a thought machine. Many thoughts drift by like clouds and we don't pay any attention while other thoughts arise and they trigger us in a particulate way, i.e., scary, angry, happy, sad, and when those thoughts arise we can chose to pay more attention to the thought which can lead us down that particulate thought stream that will lead to fear and anxiety. So, how do we work or stop those scary thought streams? One new skill to implement comes from the work of Rick Hansen, he wrote the book Buddha's Brain," he teaches that we need to give more energy and attention to the positive thoughts or positive memories we hold in our mind and pay less attention to the negative thoughts. Hansen asks us to imagine the brain this way, the brain is like Velcro with negative thoughts and like teflon when it comes to positive thoughts. There are reasons that our brain works this way, but I don't have time to go into all of that in this response. So, it's just important to remember we have to work at positive thinking, actually pausing throughout the day to focus on positive feelings and memories,  this will help the mind reinforce positive thought streams and help reduce negative thought streams over time. If a scary thought arises try to replace it with a happy experience for at least a couple of moments, and see if that helps reduce the negative charge connected with that scary thought.


Context: Often times I find myself thinking scary thoughts and sometimes I even scare myself into thinking that something bad is going to happen to me. Once it starts, the thought continues going through my head and I can't get it out. How can I stop these thoughts?

Response: There are some great thoughts offered by others here. I would just add that typically the most natural response to fearful thoughts is to want to stop, avoid, or get rid of them - which doesn't work if you're really caught up in a cycle of OCD or other form of anxiety. In the long run, the more effective thing to do is the harder and less intuitive option: to have those uncomfortable thoughts on purpose. This may mean writing out in detail what the worst case fear you are thinking of is, and then reading it over and over again until it becomes boring. It may also mean pausing through the course of the day to merely observe all the thoughts going on, and realizing that thoughts are merely thoughts. They are not the same as reality, and the unpleasant ones can become a lot less scary when we realize we can coexist with them without them coming true.


Context: Often times I find myself thinking scary thoughts and sometimes I even scare myself into thinking that something bad is going to happen to me. Once it starts, the thought continues going through my head and I can't get it out. How can I stop these thoughts?

Response: Such a great question! I'm so sorry you are struggling! You may be experiencing Intrusive thoughts.  These are thoughts that seem to come from no where and victimize us.  I can strongly recommend a book called "When Panic Attacks" by Dr. David Burns.  It helps you to identify the thoughts, and the help you create ways to counteract them!  There is another technique, called Thought Stopping. Thought Stopping can be as simple as saying "Stop!" loudly (if you are alone) or in your head, if you are in public.  It's a quick way to distract you from the distressing thought, and allow you to refocus.  I recommend using this technique, followed by some deep breathing, while visualizing something that helps you feel relaxed (a favorite place, a pet, etc.).  These three things in conjunction can be of great assistance. One key component in addressing anxious thinking is building the skill of relaxation.  I recommend an App called Headspace which teaches relaxation through some simple guided mediation. Super easy to do, and a great way to begin to build relaxation skills.  Plenty of sleep and reducing caffeine intake can also be things to explore. Hope this helps!


Context: Often times I find myself thinking scary thoughts and sometimes I even scare myself into thinking that something bad is going to happen to me. Once it starts, the thought continues going through my head and I can't get it out. How can I stop these thoughts?

Response: Hi there,I first want to let you know that having these thoughts is completely normal. Studies have been done that show that 80% of human thoughts are "negative" so you are not alone. I like to think of thoughts as a tornado... if you are in a tornado, you are completely consumed by it and it is nearly impossible to do anything beneficial. However, when you are, let's say, a mile away from a tornado, it is still scary but you have the option to do something that is important to you such as get shelter or make sure your family and friends are safe. When unhelpful or scary thoughts arise, we tend to start a "war" with them, which is the equivalent of jumping into the tornado. This makes the thoughts and emotions bigger and intensifies the feelings that go with them. So the question I imagine you have is "how do I get out of the tornado?" There are 3 steps to doing this:Get distance from your thoughts by adding "I am noticing I'm having the thought that...." to the front of them. For example, "I am noticing I am having the thought that something bad is going to happen to me."   The purpose of this is not to decrease your fear or get rid of the thought. These thoughts might always be there and that is okay because that is how the mind naturally works so struggling with that is a waste of time and energy. The purpose is to gain some distance from the thoughts so you don't get swept away by them. You can imagine them floating along like leaves in a stream or clouds in the sky (and often the same thought will come back again and again but that's okay... just continue to notice it with curiosity). I imagine the thoughts get in your way of doing what really matters to you so if you can get a little bit of distance, you can do things that are fulfilling and meaningful to you. Tune into your body and notice what sensations come up and where you feel them most intensely. Then breathe into them and make room for them. Our 5 main emotions are: joy, sadness, fear/anxiety, shame, and anger. ALL of these emotions are part of being human and there is no escaping them. So again, struggling with them ends up intensifying them. Instead, let them be and make a little bit of room for them. Often a side effect of this is the intensity will decrease but it might not. The purpose is to keep them from becoming more intense. Contact the present moment. Notice what is happening here and now. One way of doing this is tuning into the five senses. What are some things you hear, see, taste, smell, and feel? Another way is to notice what is happening in your body (without trying to change it). How deep are your breaths, what is happening with your heart rate, are you cold/warm, etc?Implementing these three steps can help you to refrain from getting caught up in your unhelpful thoughts. Unfortunately there is no way to get rid of thoughts or feelings completely. So the only option that works in the long run is to accept them while continuing to do what matters to you and what is fulfilling to you.I hope this helps!


Context: Often times I find myself thinking scary thoughts and sometimes I even scare myself into thinking that something bad is going to happen to me. Once it starts, the thought continues going through my head and I can't get it out. How can I stop these thoughts?

Response: I'm sorry you're going through this problem of scary thoughts in your mind.None of us are able to directly stop thoughts from coming.What is possible is to question their value, accuracy, and believability.Maybe if you examine the thoughts which upset you, you'll be able to feel better by understanding that the thoughts are not very relevant to your actual life.Also, another choice of what to do with the upsetting thoughts, is to redirect them.  When a stressful or frightening thought shows up in your mind, give it a happy resolution.   Basically, turn the fright into something pleasant or at least bearable.I hope this helps you at least a little bit!


Context: I'm a teenager, and I created a sort of imaginary friend to help me cope with stressful situations or if I'm worried or upset. She "gives me advice" and comforts me and tells me it'll be okay. I've given her a name (Solace) and created a personality for her that's like a comforting motherly figure. I know it's just my own advice and my own thoughts, but it's just that I'm thinking of them through a voice other than my own. I do this because I know I never really listen to my own advice, and I thought it would be better if it was through someone else who knew my thought process in and out, through this imaginary friend. Is this normal? Could it develop into a separate personality with time if I continue a mentality that she is her own person?

Response: Hi, I'm Amelia! You know, it does sounds like you have imagined a motherly comfort figure for yourself. Sometimes, when I have a person in my office that is very self-critical, I have him/her speak to his or herself as though he/she were speaking to a loved one. Isn't it sad that we speak to others more lovingly than we do ourselves?If you have not received empathy, nurturing, or comfort from a caregiver, it is hard to internalize empathy, nurture or comfort from the inside. There is a saying that "We have been hurt in relationships and we can heal in relationships." Healing and growth are best provided in the context of healthy relationship. How about going the next step and finding a compassionate therapist or loving mentor that could actually provide you with the comfort that you need. You deserve to be seen, heard, noticed, and valued. I am wishing my very best to you!


Context: I'm a teenager, and I created a sort of imaginary friend to help me cope with stressful situations or if I'm worried or upset. She "gives me advice" and comforts me and tells me it'll be okay. I've given her a name (Solace) and created a personality for her that's like a comforting motherly figure. I know it's just my own advice and my own thoughts, but it's just that I'm thinking of them through a voice other than my own. I do this because I know I never really listen to my own advice, and I thought it would be better if it was through someone else who knew my thought process in and out, through this imaginary friend. Is this normal? Could it develop into a separate personality with time if I continue a mentality that she is her own person?

Response: Since you are saying that you know that the thoughts are yours and your thinking of them in a different person's voice to make them easier for you to follow through on, it doesn't sound like it could develop into another personality.It may be helpful to also find other things that give you comfort and to practice telling yourself that it will be okay in your own voice. If you start to do that slowly, it may be more comfortable for you. If you're following following through with your own advice, it sounds like some part of you knows that you are making choices that you agree with.What else gives you comfort? Maybe there's a room that you like to be in when you are home or a certain outfit or color that makes you feel good. Focusing on these things may also be comforting to you.


Context: I read that you should ignore them and they have to come to a conclusion that they were wrong on their own terms. Is that correct?

Response: It is not correct because someone who is narcissistic believes they are always right.If you ignore the person, then their thinking is that there is something wrong with you.Ignoring the person to the degree this is possible in the situation or relationship, will spare you to be misunderstood further.


Context: People always judge others so rudely.

Response: I agree with you and this is emotionally painful to watch or be on the receiving side.Depending on who is the person doing this and your relationship to them, it is possible to kindly point out that the person may unnecessarily hurt someone's feelings.If you express your thoughts and give your guidance, then whatever the person does afterwards, you have the peace of knowing you tried to redirect this behavior.


Context: I've developed a really intense and unexpected attraction to An actress after seeing her in a ballet uniform while guest starring on a television show. I try, but I can't get her out of my mind. What should I do?

Response: Why not make good use of your unexpected attraction to study the features you consider attractive in someone.Attraction based on physicality is normal.  As long as you have no negative thoughts of doing harm to the person or yourself which are connected to the attraction you feel, and so long as your attraction isn't stopping you from doing your daily life responsibilities such as work, to take care of your daily needs and any responsibilities you have for other people, then eventually it will lose its power on you.


Context: I am extremely possessive in my relationships and this is hurting my friendships. How can I fix my underlying issues?

Response: Hi there. It's great you are able to realize there are other issues going on with someone who feels possessive. At the root of it is fear. Fear of losing someone, fear of being alone, fear of not being good enough. All those fears can lead to low self-esteem and feeling like you have to control other people so you don't lose them. The thing is, controlling other people only pushes them away. Vicious circle, right? What I would suggest is some cognitive therapy to change those underlying ways of thinking. You can start with this assignment. Write down all the things you think about yourself, positive and not-so-positive. Then rewrite those not-so-positive things so they are positive. For example, thinking something like, "I'm too pushy", can be rewritten as, "I'm assertive and I go after what I want." It can be hard to do since we tend to get "stuck" in our negative ways of thinking about ourselves. If you have someone you trust, you can ask for their help as well since most likely they see you differently than you see yourself.Finding a good cognitive therapist can help you further, but if that's not an option for you right now, there are lots of self-help books and websites that are out there. You've already taken the first step, so keep moving forward.


Context: I know I'm ruining my life with a lot of the decisions I make. I consistently tell myself I need to make some serious changes in my life, but I just can't seem to even though I really want to. Why can't I force myself to change?

Response: Hello, and thank you for your question. Changing unwanted behavior is one of the hardest things a person can do. I agree with Sherry that being patient with yourself is important. Here are a few things I would suggest:1. Get clear on the behaviors you really want to change, and make sure they are behaviors that CAN be changed. Sometimes we will set a goal like, "I want to be more confident" but that is hard to measure and prove to yourself that you accomplished it. Saying you are going to accept a date or go on a job interview is something you can actually do, and something that you may consider to be demonstrating confidence. Whatever your change of behavior is, make sure it is something you can actually change. 2. If you are going to give up a behavior, decide what you are going to do in place of it. So, if you are going to stop showing up late for work, then you are deciding to be on time for work and demonstrating your value of being punctual. 3. If you are going to make changes, really nail down WHY you want to make them. What is it about making these changes that is important to you as a person? For example, if you have the goal of weight loss, the reason this is important to you as a person may be because you value self-care. Knowing WHY you want to make changes is both your motivation and your compass for getting there. 4. Once you know WHY you want to make these changes, I strongly suggest setting small goals. If you set too high of goals you may not accomplish them and just feel worse. So, make the goal small, realistic, and guided by the the things you want to be as a person. 5. As Sherry mentioned, finding a counselor is sometimes a good idea if you really feel stuck. Any counselor who does work with goal-setting and motivation can probably help. Be well,Robin Landwehr, DBH, LPCC


Context: I know I'm ruining my life with a lot of the decisions I make. I consistently tell myself I need to make some serious changes in my life, but I just can't seem to even though I really want to. Why can't I force myself to change?

Response: In general the reason people aren't able to change is because the person feels a sense of fear to change.What the roots are of this fear are usually easiest to identify by talking with someone whom you trust and feel safe to talk about your inner thoughts and emotions.If you haven't got someone like this in your life, which is common, then shop around for a therapist because a therapist is someone who is professionally trained to listen in a way which helps someone know more about who they are.Be patient with yourself too.  Change sometimes feels much scarier and is more complex than simple compared with whatever you would like to change.


Context: I don't feel like myself anymore. For example, I could walk up an entire flight of stairs before realizing that my legs are moving. I feel like I’m watching my life be lived by someone else.

Response: You may be experiencing a form of dissociation called depersonalization.  People with this type of dissociation may feel disconnected from their bodies, feel that they are watching their bodies from a distance, or may not recognize their image in the mirror.  Dissociation sometimes occurs after someone experiences something traumatic.  I would suggest working with a therapist who specializes in dissociative disorders as dissociation does not typically resolve on its own.  On my website, I have some information specific to dissociation that you may find helpful.  Best of luck to you.


Context:
I was with my friends fishing by a pond. I found a frog and stabbed it with my friend's knife. I'm not sure why I did it. My friends saw me do it it and were shocked and got really mad at me.
   Now if someone brings it up I get really upset and panicked. I don't know why I feel like this. Does this mean there is something wrong with me?

Response: The good news is your awareness that being violent to animals feels out of character for you.   I'm glad you have awareness and I'm glad you are not at ease with killing frogs.Fairly likely that you were acting out aggressively toward the frog, feelings of being on the receiving side of similar type of violence.Basically, you did unto the frog what someone has or to you, feels like, has been done to you.Use your surprising finding of how strong your anger and most likely inward pain.   Reflect on your closest relationships and how these people treat you.   It is possible you feel more hurt by someone who is close to you than you ever realized.Stabbing innocent frogs is wrong.  It is understandable as a way to show you how much inner pain you probably have.It is also wrong that someone close to you hurt you.The direction to go is to recognize your pain and then decide how to go about changing what is possible on your side of that or those relationship(s).


Context: Sometimes, when I look at my pet cat, I think about how innocent he is and how somebody could hurt or kill him. It makes me sad because I love him, but I always think about how helpless he is. There've even been split-seconds where I felt almost tempted to kick him, followed by shame and guilt.

Response: A lot of different things could be happening here. Do you feel angry or sad or anxious when you think about how helpless he is? If you have not actually kicked him, then I would encourage you to look at feelings other than guilt, since you did not hurt him. What else is there?It would probably be very helpful to talk with a therapist about the specifics of this so that you can see what else is happening for you. It could be that you feel safe with your cat, so strong emotions come up because you feel safe.


Context: She was diagnosed a type one diabetic two years ago and had a very tough time dealing with it. She has an attachment issue also; her mother just moved to a much nicer home, and she gets angry and demands to go back to her prior home. We do not understand what is going on, and it is driving us crazy.

Response: There are many possible answers here. It could be that she misses friends, that she felt safe in the other house (emotionally safe and comfortable), or dozens of other things. Will she talk about it when she's not mad? You mentioned that she has an attachment issue. It could also be that she was attached to the house. It's not the same as being attached to a person, but possessions and safe places certainly mean a lot.


Context: My daughter basically freaked out out of nowhere over me saying “calm down” when she dropped her phone. Within seconds, the situation escalated to her kicking me out on the curb, saying horrifically unspeakable things, and her calling the cops on me. She seems unable to stop herself at times.

Response: Bipolar disorder has a lot of different components. If this is a one-time event, it could be that your daughter had an intense moment of anger and the phrase of asking her to "calm down" may have made her feel as though you weren't understanding what she was saying. Bipolar disorder also includes feelings of depression. When this is coupled with intense anger and acting or speaking without thinking, these can be part of bipolar disorder, but that wouldn't be the whole picture of what bipolar disorder would look like. It may be helpful to track differences that you notice in your daughter's mood and any patterns related to the times of day or what seems to lead her to be upset. Patterns are very helpful in figuring out what is happening.


Context: I've tried working out and eating fruits and vegetables, but I always seem to eat the junk in the house.

Response: I know some people do better when they don't have as much junk food in the house. This is not as tempting then. Having said that, maybe you can reward yourself with different things, such as having dessert on certain days. If you are concerned about mostly eating habits, consider seeing a nutritionist. They can help you find the balance between what it is that you really want and your goals. I'm not sure how this links to happiness for you, but hopefully looking at your choices can lead you toward your goal of being healthier.


Context: I've felt this way for two years. I feel so much better now then I did when it started, but it is still there in the back of my mind at all times.

Response: Best answer that I can give to you is that some level of de-personalization is quite normal for everyone, it will come and go throughout life, kind of like being on a roller-coaster, "here it is, then it's gone not to return for quite some time", like many things, the more that you fixate on it, the more stress it will cause you, consider it part of life, accept it, and move on, now if your having many, many ,many of these episodes or have some auditory or visual hallucination or disturbances or emotional unbalancing that accompany it than that is definitely something to look at, but for the most part nothing to worry about. Hope this helps,C


Context: It's been like a couple of years that I've been feeling like this. I don't want to self-diagnose, but I get so sad and cry and then I feel better. But then I get upset with people so quickly, and I hurt their feelings. It's this constant rollercoaster, and it's hard.

Response: Hello, and thank you for your question. Bipolar disorder is generally characterized by extreme changes in mood, ranging from mania (highs) to depression (lows). There are different types; however, so here is a website that gives you a list of symptoms for mania and depression in bipolar disorder: http://www.webmd.com/depression/guide/bipolar-disorder-manic-depression?page=2After reviewing these symptoms, if you believe you may have bipolar disorder, then you may want to see your primary care provider or a counselor. Bipolar disorder is treatable, but for many people it requires the right medication and sometimes counseling to help people make behavior changes that are important for bipolar management. For example, some people may not get regular sleep, but proper rest is important for bipolar management. A counselor may talk to you about this and other lifestyle changes that you may need to make. The good news is that many people live happy, healthy, and productive lives with bipolar disorder. So, if it turns out that you do have bipolar disorder, it doesn't mean that things can't get better. There is currently no "cure" for bipolar disorder, but with proper medication and lifestyle management, people can do quite well.Hope this was helpful. Be well.Robin J. Landwehr, DBH, LPC, NCC


Context: I just need to know if I'm really crazy or not.

Response: Do an internet research on psychosis symptoms and see if you have several of the symptoms.  If you do, seek a medical evaluation from your primary care physician.  There are great medications and psychotherapy that can help you live your life to the fullest.  There a many people who are diagnosed with psychosis and living a productive life.


Context: I start to think of an issue that doesn't even matter or something bad that happened years ago. Then, I cry, pull at my hair, plug my ears, hit myself, and throw things. In loud public places, I get on edge and start being sarcastic and moody. I have an awful fear of people leaving me (which normally ends up happening) and I feel like I'm too clingy.

Response: There is a reason you are having breakdowns. I can't agree that they happen for "no reason at all".   Finding out the reason is going to be your biggest challenge because that may require you to dig deep into your past, uncover hurtful experiences, or recognize something that would be extremely pain.  However, if you don't find professional help to carefully guide you through whatever you may confront, the symptoms mentioned will continue and may even get worse.  There is a light at the end of the road but you need some help to find the right road to get on so you can see it.


Context:
I have an ex-boyfriend who just lies about everything. He is super lazy. He lies to everyone that he has a good job, builds trust, and then start borrowing money—and large amounts too. It has come to the point where he has gone through several group of friends. He is leaving a trail behind full of friends in debt because he would put on a sob story, borrow money, then disappear. He refuses to work, so he sits at home playing games all day and either lies to his mom for money or lies to his friends. I used to think his lying was due to his drug habit, but now I'm hearing from other ex-friends of his that this started even before the drugs got into his life. He would borrow anywhere from $5,000 to $50,000 from everyone and it would all disappear. He's in debt with bills. He doesn't gamble, but he spends his money on random stuff.
   Although he has this habit of lying compulsively and spending money, he seems to be a good person. He'll always give a homeless person all his change no matter what. My brother has epilepsy and is really antisocial—my ex-boyfriend makes an actual effort to socialize with my brother. He takes him out to the movies and plays video games with him. He drives me to school and work every day and picks me up—just basically the small things that add up to the fact that he's not totally a horrible human being. Is he just simple a pathological liar or is there something that could possibly be deep down in there?

Response: It sounds like you have some ambivalent feelings towards your ex-boyfriend that are difficult to sort out. You notice that there are both desirable and undesirable things about him, and this is true of everyone to one degree or another. One question that I would have for you is, are you satisfied with your relationship with him as it currently stands? Are you happy with the boundaries between the two of you, or would you like them to be different? Negotiating through conflict and establishing different boundaries are definitely things you could work on with the help of a therapist. Another question I would have for you is, what would it mean for you to find out what motivates his behavior? Discovering the roots of such behavior is something that he would have to work on in his own therapy and not something that you and a therapist could discover without him.


Context: I noticed lately that I've been thinking a lot about death. I don't want to die, and I'm not suicidal. I just think about what would happen if I died or if someone I loved died. I imagine how sad everyone I know would be. I know it isn't worth it, and I definitely want to live and have a future. I just think about it. When I'm driving, I sometimes imagine what would happen if I just let go of the wheel and kept going.

Response: I'll respond to your speculation that if you let go of the steering wheel while driving, you'll end up quite seriously hurt, at the very least.   It is fine to play in your mind with "what ifs".   People who write horror movie scripts most likely have some terrible sounding stories and suppositions.If you trust yourself to actually not follow through with an idea that may kill you, and you recognize the difference between thinking dangerous things and doing dangerous things, then go to the next step of understanding more about your thoughts on death.Since you wonder about being missed if you die, it is possible your thoughts about death are from feeling that you are metaphysically dead to people in your life whom you wish would show more interest in you.Play around with your idea as to why you'd consider how people will feel about you if you're not in their lives.This may offer some insight as to your expectations of current relationships with others.


Context: I was never like this. Recently this year (my first year of high school), I started getting emotional for no reason.

Response: Hello Vancouver, It's really common for people to become very upset over small things sometimes. The small thing is a "trigger", and the emotions aren't so much about that event that's happening in the present; they are more connected to old events that evoked the same feeling. You've likely had too much of that feeling in your life and you've developed a sensitivity to it. Look at the small events that are triggers for you and ask yourself what same or similar emotion they evoke. If there's anger there, look underneath that. Is it powerlessness, worthlessness, hurt, shame...?  Then ask yourself when in your life you've experienced TOO much of that feeling. As a child, maybe, but not necessarily. That's the first step, and combined with empathy, compassion and self-esteem, you're starting to build what I call an emotional air conditioner. A good therapist can help you with the rest of this process and with learning ways of coping with emotions daily. I wish you the best.


Context: I am lazy. I am very aware of the problem and try to talk myself out of it all the time, but I never seem to shake the habits. I try to think of what it is doing to me and my future, but no matter what, I keep creating excuses for myself to continue the procrastination. All I'm ever left with is regrets and a low grade. I am at an all-time low in my life, and I'm not even that old. I've always been a straight-A student, but now I'm getting C's and F's, and it hurts me to know that I am way better than that. It's not even like the work is hard.

Response: Possibly laziness is not the true problem and is only what appears as the problem.Since you describe your laziness as an observable quality, I assume you've not always felt or handled yourself this way.Quite possibly and more likely, the particular conditions of your current life are not ones that are optimal for feeling good about yourself and your involvements.One suggestion is to see if there is any purpose to what you're doing in all the areas in which you see yourself acting from laziness.If you're not able to notice any good purpose, then you may be mistaking "laziness" for a significant amount of stress in your life.Stress can be opened and understood.  If stress is what underlies what appears as laziness, then you define the contributors to your stress.Not feeling enough support in your life, financial uncertainty, arguments w people who are close in your life, feeling misunderstood overall or by particular people, all are possibilities.Good luck in learning more about who you are!


Context: I am lazy. I am very aware of the problem and try to talk myself out of it all the time, but I never seem to shake the habits. I try to think of what it is doing to me and my future, but no matter what, I keep creating excuses for myself to continue the procrastination. All I'm ever left with is regrets and a low grade. I am at an all-time low in my life, and I'm not even that old. I've always been a straight-A student, but now I'm getting C's and F's, and it hurts me to know that I am way better than that. It's not even like the work is hard.

Response: I am sorry to hear that you are going through such a tough time. It sounds to me like you are suffering from depression to some degree. Have you seen a therapist or talked to anyone about your problems? If not, I would advise that you do so sooner than later so that you can learn what is causing you to be unmotivated and causing difficulty with breaking the cycle that you are in. It is also a good idea to get a medical evaluation from your doctor to rule out any medical causes for your current condition. Most often, difficult situations that life throws at us, along with an inability to think positively, and break bad habits are what cause depression. Some things you can do immediately are seek help from a professional, schedule in time every day to engage in pleasurable (or once pleasurable) activities, exercise daily, and practice thinking more positively. Set a few daily goals for yourself and write them down each morning or the night before. Achieving your goals every day will give you a sense of accomplishment and can lead to feeling more optimistic and capable. Additionally, keep a journal to write down how you are feeling and what ideas you have to help feel better. Sometimes having these ideas written down make it more real and tangible. Know that depression is most often curable but takes work and a desire to change (which you clearly have). Once you start feeling better about yourself and your life, your grades should naturally begin to improve, as you will have more motivation and energy to focus on that particular area. Best of luck to you!


Context: I never get infections or scars or anything, and it doesn't bother me if it gets filled up with blood or something, but I'm concerned.

Response: Hi Houston, The fact that you're concerned says a lot. If I was your therapist I'd ask you questions about your worries and how this is causing a problem in your life. You're causing perhaps permanent changes (damage?) to your body, and it's likely you're trying to express something...pain maybe? A therapist can help you to explore what's going on for you and how to get your needs for self-expression met in a more healthy way. Good luck!


Context: I feel that I am struggling with undiagnosed bipolar disorder, and it is making my day-to-day life extremely difficult.

Response: It sounds like you are experiencing a great deal of distress and you're wondering if it may meet a diagnosis of Bipolar disorder. There are a few different types of Bipolar diagnoses in the DSM (diagnositc and statistical manual) and the best way to find out if your experiences would meet that diagnosis would be to meet with a mental health professional. You can also look up the diagnosis online and see if what you are going through meets the criteria.One question that I would have for you is, what would it mean for you to find out that you meet the criteria for such a diagnosis? It sounds like whether or not you do, you are suffering and working with a therapist may help you get into a better place.


Context: For some reason, I look at my phone, and in no time, five hours has passed. During those five hours, I'm playing games and trying to find out how to make my phone fun to use so I don't feel like I wasted my time trying to improve my phone's performance in my life.

Response: Start by spending small amounts of time with your own thoughts and feelings.Always being focused on what a phone offers keeps people at a distance from knowing themselves.As long as you make time to spend in an activity which is not interactive the way a phone is, and instead depends only upon your actions, you will be investing time and energy into your own life.Whether by consciously considering your own interests, or doing housecleaning or chores, by devoting yourself to areas which you decide to be involved in, you will increase your knowledge of your own interests.Then, to not be so involved with your phone will be natural and easy.


Context: This is my recovery, and I don't feel that it is okay for them to ask this. They told me it is policy due to the fact that I may run into a peer there. I am a peer counselor in the small community that I grew up in. I am in recovery myself. I was asked to come work for this organization after I was two years sober (I was in treatment in this organization). I work with mental health peers and run life skill groups. I don't work with substance peers.

Response: You definitely want to make sure not to inadvertently create an inappropriate dual relationship with a client. In fact, it is not uncommon for state regulatory boards to determine that a clinician and client being in the same 12 step group is professional misconduct. You might want to consider attending a 12 step meeting that is located in a different community than the one you work in.  Another option would be to look for one-on-one or small group recovery support.


Context: This is my recovery, and I don't feel that it is okay for them to ask this. They told me it is policy due to the fact that I may run into a peer there. I am a peer counselor in the small community that I grew up in. I am in recovery myself. I was asked to come work for this organization after I was two years sober (I was in treatment in this organization). I work with mental health peers and run life skill groups. I don't work with substance peers.

Response: Hello, and thank you for your question. I know that workplaces have some latitude when it comes to requiring certain behaviors from their employees. For example, they may require you to tell them if you get into some kind of legal trouble. But this situation seems completely different. For one thing, 12 step meetings are supposed to be anonymous. I am not sure how they would know that you attended unless you or someone else told them. I agree that it seems like to cross a line. Usually each state has an office that manages complaints related to employment, such as the Department of Labor or EEOC. You may want to see which entity is in your state and contact them. It would be worth asking them to see if this is a legal practice. If it is but you still want/need to stay at this job, then you may want to look for alternate sources of support for your sobriety. There are active online support groups that would allow you to do things from the privacy of your home. SMART Recovery http://www.smartrecovery.org/ is a website that many people like. There are also online groups that specifically discuss the 12 steps. No matter what, I give you a lot of credit for doing your best to keep your sobriety and continuing to see the value in having support. Robin J. Landwehr, DBH, LPCC, NCC


Context:
I have a relative who is in his twenties. He was in a drug rehabilitation program and got kicked out for using drugs again. No one informed family that he was using drugs again. He subsequently overdosed and was found dead.
 Is their accountability of counselors, therapists or the halfway house for not reporting that he had relapsed? Is there a legal case for failing to report?

Response: I'm so sorry to hear of your loss.  This sounds like a really difficult situation for the whole family.  Since the answer to this question will depend a lot on the applicable state laws, I would suggest talking with a local attorney.  That being said, I see two competing issues here.  On the one side is the duty of confidentiality the counselors owed to your relative.  On the other side is the duty the counselors had to act reasonably to protect your relative from harm.  Generally there is not a requiremt for substance abuse treatment centers to notify family members if an adult client relapses.A local attorney will be able to provide more specific guidance on the legal obligtions and liabilities in this situation.


Context:
I have a relative who is in his twenties. He was in a drug rehabilitation program and got kicked out for using drugs again. No one informed family that he was using drugs again. He subsequently overdosed and was found dead.
 Is their accountability of counselors, therapists or the halfway house for not reporting that he had relapsed? Is there a legal case for failing to report?

Response: I am so sorry for your loss.  Generally therapists only have a duty to report self harm to ones self or others if it is expressed to them.  Often times they will not report relapses due to the fact that proper releases were not signed or patient has specifically asked them not to for fear of shaming or failure again.  I understand this may not be the answer you were hoping for.  I would encourage the family to seek therapy themselves for help coping with such a loss.


Context: What do you do when a therapist and a parent drugs a child and makes up lies in order to stop the other parent's custody visitation?

Response: This sounds like a potentially serious situation. The most important thing is to make sure the child is safe.  If you suspect that a child is (or has been) harmed, I would strongly recommend that you report your concerns to your local law enforcement or to Child Protective Services. If you don't think that a child is in danger, you can still report your suspicion of counselor misconduct to the state regulatory board.


Context: What do you do when a therapist and a parent drugs a child and makes up lies in order to stop the other parent's custody visitation?

Response: I will admit I am confused about this question. Are you the other parent in question or a concerned coworker of this therapist? Therapists do not prescribe or have access to medication. Most therapists won't even get involved in a custody battle. They know there is a good chance of their records ending up in court and that they themselves will have to testify in court. Of course, therapists are human and can make mistakes, but I find it highly unlikely that a therapist would knowingly and willingly do something like this that is such a major ethical violation. Not only are they losing their license to practice by doing this, they are going to face criminal charges and jail time. If their clinical judgment is that the other parent is a danger to the child, they don't have to resort to illegal means to try to prove this. If you have concrete proof that this has happened then there is a process in which you can file a report against the therapist with their licensure board. Every therapist is licensed in their state. There are different types of licensures so you would need to know this therapist's licensure.Most accusations from the other parent are expected in a custody situation because people do tend to get quite ugly. Don't accuse the therapist or the parent of anything just to try to make yourself look better and them look bad. Have evidence of wrongdoing before accusing them of this. If this has really happened then of course it needs to be reported, but don't try to ruin someone's career unless you are sure this occurred.


Context: They discontinued treatment for no apparent reason after they thought to diagnose me with schizophrenia.

Response: The general rule against medical abandonment says thst whenever healthcare providers discontinue treatment with you when you still need it, they are legally required to make sure that you have access to another provider of equal or higher ability.In this case, if your treatment team decided to discontinue your treatment based on a diagnosis of schizophrenia, they still will likely be required to provide you with a referral to someone who can provide you with treatment. If you haven't already done so, I'd recommend that you explicitly ask for a referral.


Context: I had a dispute with my therapist regarding an appointment cancellation. Now, she is blocking me from seeing other psychologists at the same clinic (which takes my insurance), which is also where I get my psychiatric services. There is a strict 48 hour cancellation policy, and my appointments are at 3:00 on Tuesday. I called to cancel at 4:30 the previous Friday. I was late, so we contacted my doctor to tell her that I would be out of town. She said I could do a phone in session. The thing is we do double sessions.

Response: My recommendation would be to try to talk to your therapist about this  from your description, it sounds like you have a legitimate explanation for missing your scheduled session. Maybe if you could explain that to her she would be willing to work with you. If she is not willing to consider your explanation and if she is not willing to continue working with you, she still has an ethical obligation to provide you with referral resources to another therapist.


Context: I terminated my counseling relationship with a social worker several years ago. I am now realizing that I would like to begin counseling again. The social worker’s voicemail message says that he returns calls in 24 hours, but he hasn't called me back. I called him on the weekend and made it clear that I want him to call me back. Can he just ignore me?

Response: Mental health providers should promptly return calls from current clients as well as from potential clients.  This is even true if the social worker (or counselor) is unable to make an appointment with the caller.  In that case the social worker should call you back to let you know that he is unable to schedule an appointment with you.In addition, mental health providers have an obligation to follow through with their own communication standards.  For example, if the social worker in this case has an outgoing voicemail message that promises returned calls within 24 hours, he has an obligation to follow through on that promise.All that being said, it is also worth remembering that mental health professionals are just people too. It is possible that he had an unforeseen emergency that kept him from from returning your call promptly.In the end, I agree with Sherry's advice. If you feel this social worker is not a good fit for you, you probably should trust your gut and find someone else who is a better fit.


Context: I terminated my counseling relationship with a social worker several years ago. I am now realizing that I would like to begin counseling again. The social worker’s voicemail message says that he returns calls in 24 hours, but he hasn't called me back. I called him on the weekend and made it clear that I want him to call me back. Can he just ignore me?

Response: Yes, your former social worker should return your phone call.It is the professional ethic to do so and plain human decency to do so.If he doesn't, there is nothing you can directly do about the fact of his ignoring you.There are formal complaints you can make, which you can consider doing.What matters most is receiving social work service.Stick with looking for another social worker who is willing to help you.The self-doubts you mention may be worth examining.They do not, however excuse the social worker mishandling himself.


Context: I think I have depression, anxiety, bipolar disorder, and I have anger issues. I told my mom over and over again. She told me she would get me a therapist, but she never did. I just found out that my mom can't afford a therapist for me.

Response: It can be difficult to get counseling if you don't feel supported by family members.  There might be a few options.  If you are in school, I'd recommend talking to a school counselor or school nurse.  They often will be able to help you access free or affordable counseling resources in your community.  In addition, depending on where you live, it's also often possible to call 211 for referrals to free or low cost counseling services in your area.I'd encourage you not to give up. You are on the right track.


Context: I have major depression, severe, PTSD, anxiety disorder, and personality disorder. I had an appointment with my doctor. I was very upset, and I shared with him about that particular drug.

Response: Your doctor might be required to tell your psychiatrist - especially if your doctor is concerned about your safety.It was definitely a good thing that you told your primary care physician about what is going on.  I know that must have been difficult to talk about with him.  By having that conversation, you are helping your primary care physician and your psychiatrist work together to best support your health.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: There are typically three reasons why therapy is terminated:1) Client has met therapy goals2) Client is not progressing 3) Therapist is not a good fit for clientIn order to properly assess whether therapy is helping and what progress is being made, the therapist needs to have ways of consistently checking in with clients sessions-by-session to determine what is helping, what isn't, and where the client is at in relation to their original therapy goals. When a client has met their goals, that is a good time to end counselling sessions unless the client has new goals or simply wants to check-in periodically to make sure that they are still on track (sometimes referred to as relapse prevention). When a client is not progressing, and feedback has been taken and attempts have been made to make the therapy more helpful for the client but to no avail, than it is considered unethical to continue to work with the client. In these circumstances, referring out to another therapist who may be a better fit is a good idea.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: Hello. The end of the counselor/client relationship is one of mutual respect and engagement. Counseling sessions can end for any number of reasons. Among them are the client's inability to make forward progress in therapy; the clinician's inability to help the client (for a variety of reasons); a mutually agreed upon time frame for a number of sessions to be provided; or the financial challenges of the client who decides that they need to put their resources elsewhere. In this last case, a counselor should never cancel sessions with a client simply on the basis of the client's inability to pay. That is traditionally seen as an unethical practice. Other arrangements can be made to provide care to the client, which in itself should be paramount.When the client and therapist decide that services are done, it is best if there is at least one or two more sessions to allow a case file review to occur, and to bring an appropriate psychological sense of closure to the client (and vicariously to the clinician as well, those this is perhaps not as important). This transition gives both a sense of having reached the end of a journey...rather than some abrupt departure from it. (An abrupt ending in therapy can have a varying level of impact both emotionally and psychologically on the client and therapist). Sometimes the closure of therapy is the result of a program of therapy being formally completed, in which there is a mutually known (albeit perhaps approximate) date of when that program will be finished. In this case, the client is likely feeling that impending closure and has time to prepare mentally and emotionally from a place of being the client in therapy, to a place of healing, growth and situational resolution.I have always worked in therapy with the following slogan (if you will), that I learned years ago during graduate school: "Not every therapist is good for every client, and not every client is good for every therapist." It is perhaps one of the most important guiding views I hold in working with clients. The therapeutic relationship is driven by mutuality - the desire of the client to get better at living life, and the therapist's desire to truly see the client heal and grow. When there is a block in this process from either side that prevents that synergy from occurring, the relationship that should be established may not be able to form. Or, if already formed, may at some point be unable to move forward. In these instances, referring the client to another type of service or clinician is appropriate. Usually, this can be seen pretty quickly by either party, though sometimes it is not always clear.Ultimately, the client and counselor need to work together to discover if the needs of the client (which is paramount) are being met in the therapeutic engagement with their current counselor, or if other arrangements need to be made to go elsewhere. If both are observant in this process, they can work together to maintain that sacred space and continue to reach the goals that have been set. Eventually, therapy will end, but hopefully based on the client's successful journey to the place where they wanted to go, and thus opening the next chapters of their life to a space that is more whole and brighter.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: Hopefully both the client and counselor would together decide when to terminate counseling sessions. It's really helpful for the client to leave counseling with a solid sense of what he or she has accomplished in counseling, so it can be a good idea to spend some time acknowledging that in the last session or sessions. Sometimes, however, a client has needs beyond the scope of the counselor's expertise. That's a good time for a conversation about those needs and ideas of  how best to meet them, whether by adding in care with an additional mental health professional or transferring care entirely to a new mental health provider.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: There are different reasons why a counselor may seek to terminate with a client and these will each have different processes by which the counselor will come to that decision. Here are a few examples. The counselor may determine that the client's needs are outside what the counselor is competent to be able to work with. A person may have come to the counselor talking about a particular issue but either when they first met or as counseling progressed, it may become clear that the issue is in fact something different or that there is an additional related issue. If that issue is outside the competence of the counselor, the counselor should look for alternatives, the most common of which would be to terminate and refer. Beyond clinical issues, this could also come up around particular other related facts, such as the culture of the client or linguistic issues. This could also be the choice of the counselor if they know someone that they feel would be a better match for the client's issues. Another reason for discharge (and possible referral) would be if the relationship does not seem to be a good fit. No counselor is the right person to work with everyone. If the right level of connection is not happening, the counselor will often look first at what they are doing, might talk about it with the client and ultimately will admit that things don't seem to be working to allow the desired therapeutic process to work. A similar process would be followed if the counselor determined that the client might not yet be ready for counseling as evidenced by lack of engagement such as frequent cancellations, not doing any agreed on work between sessions, showing up late or being really guarded in session. The easiest situation to decide on is when a person has met their counseling goals and have nothing new that they are working on. While this is the easiest one to determine, it is also probably the hardest one for the counselor as they may be like the client in not wanting the relationship to come to an end. However, counselors know that this is part of the process. They will also determine this by regularly reviewing the treatment plan or by sending in the sessions that the work has come to an end. This type of termination maybe final or may be with the intent that the client will return later to address other things that have been identified but for which they are not ready to move into. All of these (and other) situations involves the counselor being open to the relationship ending, to monitoring how things are going, then engaging in self reflection, possibly talking with the client and then coming to a conclusion on which the counselor  follows through.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: From the very beginning of counseling sessions I emphasize that the work will and must end at some point.In counseling there is an arc to the process. A beginning, middle and end. I am always digging, searching and exploring. There comes a point where things come to there natural ending.I always leave an opening for continuing counseling in the future. At least as a check in.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: For most:  When the money/insurance runs out.When best:  When the job is done... and you're feeling much better.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response:
To be able to identify a clear ending to a counseling relationship, we must have a clear understanding of the goals and limitations of treatment.  Usually, during the initial evaluation, I identify my client’s short term and long term therapy goals.  As therapy progress, we verify goals on a monthly to a quarterly basis, depending on the frequency of the appointments.  Once the therapy goals have been met, there is a closing session, the counseling relationship is ended, and the client can stop attending sessions.  In some cases, the client can also establish new goals and determine if I am a good fit for their therapy needs or if they need a new provider, in which case I provide multiple referrals.The counseling relationship could also end due to other factors like noncompliance= when a client is not committed to the agreed treatment process, or when the client’s or a counselor violates the counseling relationship.  Either the counselor or the client is able to end counseling.  Although, as mental health providers we need to provide a reason for terminating our therapeutic relationship and referral options, as a client no explanation is needed, a closing session is highly recommended.  ¿Cómo termina la terapia?¿Cómo un consejero decide cuando terminar las sesiones de consejería o terminar de trabajar con un paciente?Para poder determinar el final de la relación del consejero, debemos comprender las metas y parámetros de la terapia.  Usualmente durante la evaluación inicial se identifican metas a corto y largo plazo con el cliente, y se discute con el cliente como esas metas serán alcanzadas.  Durante el proceso de terapia el consejero revisa las metas mensual o trimestralmente dependiendo de la frecuencia de las citas.  Ya que las metas de terapia son alcanzadas, hay una sesión de cierre y el cliente puede terminar la terapia.   En algunos casos el cliente puede identificar nuevas metas para la terapia y determinar si el mismo consejero u otro consejero le pueden asistir.
La relación de consejería también puede terminar por no conformar o violentar los parámetros  establecidos para la terapia.   Tanto el consejero como el cliente pueden terminar la relación de terapia.  Como proveedores de salud mental los consejeros estamos obligados a proveer un razón para la conclusión del tratamiento y proveer referidos según aplique, los clientes no necesitan proveer una explicación, aunque es recomendable discutirlo en una sesión de cierre.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: It is usually time to end counseling sessions when it is clear to both the client and the counselor that therapeutic goals have been reached and enough improvement has been made that the client can continue without that support. There are exceptions to this rule, but for the most part this is when counselors begin termination. For some clients, this is an easy process that marks the achievements they have made in working through their emotions and difficulties. For some other clients, however, this is a difficult process in which they are losing a valuable support and are understandably anxious about what life will be like without the frequent meetings. Ultimately, termination is different for everyone, and there are many ways that termination can be healthy and helpful.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: As a therapist who believes in client self-determination above most other elements of the process, I want to as much as possible leave it up to the client to determine when they are finished. In the case of a termination because a client's distress has resolved, I might periodically check in with the client about how therapy has been going, and if we want to re-evaluate where we are.The more unfortunate situation would come about if I felt that I wasn't the best fit for the client. I would offer that in words, and ideas of therapists (with names) of who I thought might be a better fit and why. It still is up to the client whether to continue, however should they want to keep seeing me, a part of the work would be about that want (to see someone who professionally doesn't believe they can help as much as someone else.)I also find it perplexing when I hear a client (or on a personal level) tell me that their therapist said they "didn't need therapy." I don't know that I buy into that scenario all that much, because I do believe that yes, not everyone NEEDS therapy, but that everyone CAN benefit from therapy and I don't believe it is the therapist's job to deter someone from ever seeking out help of any kind.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: Ideally, termination should be a mutual process. It's not that the therapist kicks the client out at some point and says, "Okay, you're done." Rather, over time the client will decrease the frequency with which he/she comes to session so that it may start off as weekly, then decrease to biweekly, then perhaps once every three weeks, then once/month and so on. Throughout this process, the therapist and client should have had regular check ins about progress toward goals. If the client feels good about where he/she is in life, he/she might decide to suspend therapy for now. That being said, the therapist should make it very clear that if the client ever decided to return for "maintenance" therapy or a check in, he/she would always be welcome. There is no hard and fast rule to ending or a particular time period in which it must end. What matters most is that the client feels good about it and knows that the therapist will always be there should he/she wish to return.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: For a therapist, deciding to end counseling sessions or terminate working with a client is a thoughtful and intentional decision. One that is not entered into lightly. While there are many considerations counselors take into account, to help answer this question, I'll offer an example of two areas that counselor's take into consideration when ending counseling sessions:Does the client need different or more specialized care than the current counselor can provide? This requires the counselor to determine whether referring the client to another therapist or health care provider is needed.And, has the therapeutic relationship reached treatment goal(s)? While this question is specific to the counselor, I'd like to also add that a client, at any time, can end counseling.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: In general, I usually let the client decide when this should occur, sometimes with some clients it will be a joint agreement, but even in that case it should weigh mostly on what the client feels. In short, therapy ends when you feel your done.C


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: I will work with clients and continually review progress with them and determine if counseling is helping.  If a client appears to have less to talk about in sessions, appears more stable for a period of time and has reached therapeutic goals I will talk about termination.  Some clients however I may continue with on a monthly or bi monthly process to allow for check-ins to see how they are doing and if they need more help at that time.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: There are several reasons for a counselor to decide to end counseling.  A major reason to end counseling is if the counselor feels that he or she does not have the skills or experience to work with the client.  This may happen during the intake process or after working with the client for some time.  If the clinician feels that the client is not benefitting from the therapy, it is ethical to suggest that the client terminate the therapy.  The process of termination must not injure the client and, if necessary, the clinician may need to refer the client to other treatment modalities.  Another reason to terminate working with a client is if the client needs a higher level of care.  If the client has a crisis or is at risk of hurting himself or someone else, he or she may need a higher level of care.  In this circumstance, the clinician may need to involve outside services such as a crisis unit.  A third reason to terminate with a client is if the clinician feels that he or she cannot remain professional with the client relationship.  For example, if the issues that the client is working on bring up something significant for the clinician and the clinician feels that he is unable to separate that from the professional relationship.  In this instance, the clinician should refer the client to another therapist.  Finally, if the client has reached her goals for therapy and no longer needs treatment, the clinician and client should terminate treatment.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: Counseling ends when the client has received the maximum benefit from the therapist. Even if the therapist believes the client is not making progress, the client may feel they are improving and receiving a benefit. And the therapist may see a benefit and the client does not. It is best to have ongoing dialogue with the client to determine when termination is appropriate.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response:
Goodbyes can be hard.
Chances are most of the goodbyes you have experienced in your life have been
difficult. Saying goodbye to a therapist can be different. It can be an
opportunity to create a healthy ending in a positive relationship in your life.
If you work with a therapist who is skilled, then saying goodbye can be just as
transformative as the therapy itself. Ending therapy is also known
as “termination.” I know, “termination” doesn’t have a great ring to it!
However, it is what it is. It is an ending of the relationship as it existed.
It is reality cold and stark. Of course, when I talk to clients I don’t use the
word “termination,” I usually say “our goodbye.”  Under what circumstances does therapy usually
end? Therapy should end when a client does not need further assistance, is not
receiving any benefit from therapy, or might be harmed by continuing to work
with a particular therapist.In the best case scenario
the decision to move on from therapy and “say our goodbyes” happens when both
the therapist and the client feel like the client is ready to move on and move
up!  Ending the therapeutic relationship
should actually be worked on from the very first session. What I mean by that
is, there should be an understanding that the work we do together will have an
ending and that is a good thing because it means the client has gained the
skills to continue working on themselves independently. So the first session I
have with clients usually outlines a plan where the end goal is discussed and
we both have an understanding of the skills the client wants to learn or what
they hope to achieve. Now sometimes there are
situations where the therapist ends the relationship and the client may take
that personally, it is hard when any relationship ends and it might bring up
feelings of sadness, and fear or abandonment. Any good therapist will end the
relationship based on what is right for the client. What are some situations
where a therapist might end the relationship?If the situation the client
is dealing with is out of the therapist's scope of practice, the therapist may
end the relationship and refer the client to someone else. This is in the
client’s best interest. Another reason a therapist might end the relationship
is that the therapist is in a place in her life which prevents her from being
objective and helpful.  A therapist who
is going through a painful divorce may have difficulty working with a couple
that considering divorce. A good therapist may see that their judgement may be
clouded and want to refer the client to see someone else. This is good practice
and helps the client.If a client is actively
suicidal or actively using substances then the therapist may end the
relationship and refer out for a higher level of care. The client may need to
be hospitalized or may need an inpatient substance abuse treatment program.
Therapy may be terminated while they are being treated and may continue after
the intensive program is completed.
Ending therapy should be a
time for connection and bringing together accomplishments, or reviewing the
next important step the client needs to take. It should not be an experience of
abandonment. A skilled therapist will help a client gain a new perspective on
closure. For some clients, it may be the one time in their lives when they get
a clean ending in a healthy relationship and they get to feel a sense of
control on creating that ending. Good luck to you!


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: In the best case scenario, it's a mutual discussion and decision. If not,  I've had the discussion initiated both ways, by me, when I sense the client has gone has far as they want, by lack of interest in accepting or completing homework assignments, missing or cancelling appointments, usually at the last minute, lack of participation during sessions.  Client initiates by asking me pointed questions about why the need for homework assignments,, by forgetting their calendar, or their checkbook :) , by suggesting that we make appointments over longer intervals (once a week to once a month, for example).  I rarely have had to terminate a working relationship--that's why I don't charge for the first visit, so we know if we are a good fit before we start working together.  Then I periodically ask whether the client feels we are making progress, moving in the right direction, talking about the most relevant issues etc.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: In my therapy practice the decision to end therapy is mutually made together with the patient.Otherwise, the person can end up with a sense of tremendous rejection and abandonment.The way you'll both know therapy is coming to a close is that the discussion will feel lighter and move easily.The person's mood will be better, they will smile more, sit in their seat in a more relaxed way, look more at ease, take better care of their appearance.One of the ways to end therapy is to gradually decrease the frequency of the sessions.Sometimes people who are in my practice start to come each three weeks, then monthly, then every three months.This gives a sense of security, friendliness, and casualness to the therapy, and de-medicalizes it as though the person was treated for a medical symptom and the symptom stops completely one day.Talk therapy is about life and life problems usually end gradually.I end my therapy in a way which mirrors the life process in which many interaction and situation problems show their effects gradually and show different effects over time.


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: Hi there, There are a number of reasons why a therapeutic relationship might end including, but not limited to the client reaching their goals, the client reaching a place of acceptance where they wish to remain or even a breach within the relationship.  The last aspect should likely be taken to supervision in order to be fully processed.  All of these things could happen, and usually happen organically (again, except for the last example). Your question, however, was about the counselor ending treatment. This is a bit more difficult and can be very nerve-wracking.  It may be beneficial to take this with you to supervision, as well.  It's important to understand why you feel the need to end or terminate with the client, as well. Do you feel that they would be better suited for another therapist, have they achieved their goals or is it something else?In regular, open-ended sessions, I try to make a point of checking in with the clients fairly frequently. In these check-ins, I use the time to ask the client how they feel about the sessions and if there is anything they wish to focus on more astutely.  I also ask if they have any immediate goals that they would like to prioritize.  In goal-oriented sessions, I check in more frequently to ensure that both the client and I remain focused and, should they wish to shift their focus, that they recognize it is part of my responsibilities to make sure we move back to the desired goal. Often, especially in longer term therapeutic relationships, we as clinicians can see that the client has reached their goal, however they are apprehensive about ending therapy.  This is actually a great place to go with them; why would they feel unable to handle issues in their external or internal environment without you? Often, having this open discussion can increase empowerment and mastery. That said, it could also highlight other issues which the client may have been apprehensive about going into within therapy and now, as the relationship seems to be ending, feels more confident in bringing these up. In the case where the relationship is a toxic one, terminating with a client may be the best option for both of you. It's a difficult conversation, but recall that part of the role of the therapist is to model that these discomforts can be managed. I hope that this brief response can assist you going forward!


Context: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: This is a question that is very specific to each person. There are definitely some variables, but I can give you some general ideas for when counseling might end:When a client has met all of their goals, at least to a degree when they feel that they no longer need to work on them with the assistance of a counselorSometimes a decision is made that a client is no longer benefiting from counseling at a certain timeSometimes clients have to remain in counseling in order to receive medication. This depends on agency policy, but sometimes it is a requirement. If the medication is necessary and cannot be prescribed by a primary care physician, frequency of sessions is usually decreased greatlyI'm not sure why you are asking this question, but it is also something that is often discussed at the beginning of treatment. Oftentimes "discharge goals" change as treatment progresses because more is known about clients, their goals, changes in their goals, and many other things. Changes are normal, but your counselor probably has discharge goals in mind, at least generally, from the beginning. I strongly encourage you to ask about it!


Context:
My therapist is gay so there are no sexual issues here. However, my therapist for six years has made me believe that he cares about me and that we are friends. I have loaned money to him many times, and he always paid me back.
   I had a medical emergency last weekend and I was heavily medicated. I knew that this therapist came into my home and wrote down my credit card information so he could pay back what he owed me, but this therapist dropped me off and never came again. I don't know what to do.

Response: I'm sorry to hear that this has happened. Counselors are legally and ethically required to make sure that they always put the wellbeing of their clients above their own interests. In addition, counselor ethical rules, and the laws in just about every state, make it illegal for counselors to take advantage of a client financially. A counselor borrowing money from a client (even if the counselor pays it back) would usually be considered to be taking advantage of the client.There are a few options you have at this point if you can't (or don't want) to continue to try to contact him directly. You can file a complaint with your states' regulatory board and let them know what has happened.  An investigator will then look into the situation for you.  Another option would be for you to find a different counsleor who can provide you with an independent and netural point of view to help you figure out how you want to handle this situation.


Context:
My therapist is gay so there are no sexual issues here. However, my therapist for six years has made me believe that he cares about me and that we are friends. I have loaned money to him many times, and he always paid me back.
   I had a medical emergency last weekend and I was heavily medicated. I knew that this therapist came into my home and wrote down my credit card information so he could pay back what he owed me, but this therapist dropped me off and never came again. I don't know what to do.

Response: Do you want this therapist to have your credit card information?If not, then cancel the credit cards that you believe may now be accessible to this therapist.Therapists are expected to keep very clear boundaries between the therapy work and not have other relationships, such as "friend" or "money lender" with someone who is their patient.Therapists are never "friends" with their patients.Letting you believe that you are the therapist's friend, is a violation of professional ethics and almost definitely, a violation of the Consumer Protection laws in your State.Start by dropping this person as your therapist.  He has broken too many ethical standards to be worthy of offering therapy.Think over if you'd like remaining friends with this person, whom you describe as lacking integrity and stealing from you.If you need help getting back money from him, then contact the police and talk to a detective about what has happened so far.  The detective will advise according to the laws in your community and State, whether to file a police report, and what steps are necessary to utilize the Court system to get back your funds.If you'd like doing future patients who may be treated to similar ways by this therapist, a favor, go online and file a complaint with the therapist's Licensing Board.Good luck!


Context:
My therapist is gay so there are no sexual issues here. However, my therapist for six years has made me believe that he cares about me and that we are friends. I have loaned money to him many times, and he always paid me back.
   I had a medical emergency last weekend and I was heavily medicated. I knew that this therapist came into my home and wrote down my credit card information so he could pay back what he owed me, but this therapist dropped me off and never came again. I don't know what to do.

Response: Therapists, regardless of the discipline (i.e. licensed professional counselor, social worker, psychologist) are expected to put the health and well-being of the client first. Each professional discipline does have a code of ethics as well as a licensing board in each state. In order to get licensed the therapist must agree to abide by the highest standards of conduct including state, local and federal regulations in addition to the code of conduct. You do have the option of reporting this person to the appropriate licencing board in your state. The other concern is if this person has unauthorized access to your credit card. If you did not give it to him or authorize use this becomes a legal matter that you can also report to the legal authorities in your city or town. Therapy and counseling are effective because professionals gain the trust of the client. Betrayal of that trust by crossing boundaries and developing a relationship outside the therapist/client relationship is hurtful. Please know that the vast majority of counselors are highly ethical individuals who put the welfare of the client first.


Context: I just wanted to get to know one so I can hear about their college experience and the courses they took. I also wanted to know if they enjoy their job and how long they were in school.

Response: It's a great idea for you to reach out to find a psychologist to talk to if this is a field you might be interested in pursuing. Regarding the length of schooling, it generally takes 4 years of college and an additional 4 to 7 years of graduate school to earn a doctorate degree to become a psychologist. There are also other similar professions, including counseling that don't require a doctorate degree. Licensed counselors generally completed 4 years of college and an additional 2 years of graduate school. If you are thinking about a career in psychology, the local APA chapter would be a good place to start to find a local psychologist to talk to. Here's a link to the NJ APA chapter:https://www.psychologynj.org/