Choosing between yes or no to be insured

We have discussed the different disciplines in the mental health field in the first two articles (What is the Difference Between a Counsellor, Social Worker, Psychologist and Psychiatrist, Parts 1 and 2) So, what is a consumer to do? It’s all a bit overwhelming.

First, coverage. If you have a national Employee Family Assistance Program (EFAP), keep in mind that most Psychologists and veteran therapists do not work for the lower paying national EFAP. As well, you are generally not able to choose a specific therapist or a specific discipline with these EFAP’s, and you may only have access to sessions by telephone or email.

Alternatively, if you have access to insurance or extended health benefits (where you may have to pay up front and be reimbursed), many of these plans will only cover a Registered Psychologist. While insurance companies are slowly becoming more inclusive to disciplines other than Psychology, check your plan first. Remember, the actual registering body of the professional is the key here. Registered Psychologist or Registered Social Worker are often the only two mental health disciplines covered.  However, some employers have taken steps to include Certified Counsellors as well.  Every individual policy will have their own definition of what will be covered. As well, some require a doctor’s referral to be submitted along with your receipt, and others do not.  Again, refer to your policy details.

Getting a word of mouth therapist recommendation is a very good idea. Personally, I would be reluctant to see a therapist without a recommendation by a trusted friend. Most therapists don’t mind a brief telephone interview. Tell the therapist what you are doing and ask them questions suiting your concerns and values, beyond their profile on a website.

Remember, the purpose of your first appointment is to tell your story and further rate them. I tell my clients they need to give me at least an 80% satisfactory rating before returning. If I am seeing a couple, they each need to give an 80% grade. Couple’s counselling will fail if one gives 50% and the other gives 100%.

You will need to establish whether you are looking for a “process-” or “outcome-” based therapist. Process-based therapists are nice, kind, warm and interested in the relationship where your self-evolved insight will be helpful. Outcome-based therapists on the other hand, may have these characteristics as well, but more importantly focus on the outcome – the goal. They focus on fewer sessions with maximum outcome. Generally, it is the veteran therapists that practice the more direct approach.

Costs vary amongst disciplines. Psychiatrists and Psychiatric nurses are generally covered under medical care (as are all other public practitioners). Those of us in private practice have wide ranging rates, from under $80 per hour to $180+ per hour. The costs are generally based on 1) the therapist’s qualifications (a PhD for example, generally demands a higher hourly rate), 2) the therapist’s experience (therapists with less than 5 years’ experience generally charges a lower rate), 3) the location (therapists operating out of their homes have no little to no expenses.  An interview question for these therapists might be, where will my file be securely and safely stored until it is destroyed) and 4) the size of the practicing group (sole practitioners with no Administrative staff or overhead charge the lowest hourly rates).

You can always discontinue with a therapist if you find the relationship match (which is the most important factor of all) is not working. Admittedly, if you have seen 3 or 4 therapists and were dissatisfied with all of them, you may be looking in the wrong direction.

Best of luck with your search!


Why Do Apologies Fail?

“I am sorry”. Three very powerful words, all three wisely and commonly recommended. They can be difficult to say but nice to hear. But the well-intended apology is not fail-proof. In fact, it rarely gets the desired results of a huge genuine thank you, a hug, a “oh that was so nice of you, Excellent! good, let’s move on”. No, it is more common to be followed by a passive silence, LONG silence. Leaving you wondering if they were awestruck or just hemorrhaged. The apology can also be followed by an aggressive “What! You think those cheap three words that you always use will satisfy me, well you are CRAZY!’ It could also be followed by them stomping off, crying or the passive cold, hard stare.

“What went wrong? How can I fix this? I meant well” … Here are some tips. First your intention and sincerity, even if it was 100 percent, has absolutely nothing to do with it. Offering a peace offering to someone who is psychologically charged is largely doomed to failure. The physiology or arousal will require a minimum of 45 minutes to settle, doing it perfectly before the offended can be “rational” enough to receive, process, file and respond appropriately. Again, that is if all the stars and planets line up (hunger, thirst, sleep, hormones, pre-stress factors, circumstances, the sender having perfect body language, blood sugar levels, prior experience with apologies – and many more factors).

So why Bother? It is still the right thing to do. It is wise, however, to eliminate any expectation of a favorable response. Besides, your apology is to be UNconditional – regardless of how it is received.
Second reason it failed? There is a reasonable chance you ended the “I’m sorry” with a “but”. Qualified apologies just don’t cut it. Even saying “I’m sorry I did X but I thought you Y. Y has no value, perhaps in the debrief the day later but in that moment of the apology it has no bearing.

Third reason is you may have made a more grievous error of saying, “I’m sorry you feel this way. You took it wrong; you just didn’t X”. The worst is “I’m sorry, but you did the same last week”. The genuine apology can only refer to you not them. Remember “I” statements.

Lastly, there is an inverse relationship between being convinced you are right or faultless and the effectiveness of the apology. If people estimate that you think you are still right, the apology will be rejected. The more you think you were right, the more your apology will be regarded as synthetic – “faux leather”. And this air of “right” will be detected, guaranteed.

Part 2 of 2: What is the difference between a Counsellor, Social Worker, Psychologist, and a Psychiatrist?

In Part I, we distinguished Psychiatry – the medical model of the helping professions. In Part II, we will attempt to differentiate Psychologists, Social Workers, and Counsellors.

First, to be fully accurate, the research shows no difference in outcome for any of the disciplines or the model, philosophy or approach used by the practitioner. In other words, the Psychologist may be held in higher regard than a Social Worker or Counsellors but there is no research to support their greater effectiveness.

Admittedly, Psychologists are arguably held to a higher standard of care than the titles Social Worker and Counsellors. Using the title of Psychologist requires considerably more training and arduous comprehensive exams, plus an oral examination. The Social Work title can be used with a two-year diploma, an undergraduate or graduate degree. The title “Counsellor” is generic. As such, anyone can use the title with no training at all. A Canadian Certified Counsellor (CCC) status does require a minimum of a Masters Degree and the Association does have the right to certify, advise and discipline its members. So, a CCC may well have more training than a Registered Social Worker (RSW).

As with most disciplines, there are different types of Social Workers and Psychologists. A community Social Worker or an Administrative Social Worker would have no counselling training. Similarly, an Assessment Psychologist may have little counselling training.

So, indeed, it is buyer beware. First, ensure the person you are seeing is registered with any of these three bodies: Saskatchewan College of Psychologists, Saskatchewan Association of Social Workers or the Canadian Counselling and Psychotherapy Association. If not, you may be advised to continue looking for an accredited therapist. Second, check both the level of degree and the type of experience the therapist has before booking that initial appointment. A minimum of a Master’s Degree is recommended. Now, the question of the actual difference between the two disciplines is that Social Workers (like the name implies) have a broad social vision of the client. The Social Worker considers both the person and the environment to understand and treat the client. They cast a wider net to include family, family of origin, work, community and all variables in a person’s suffering. It is not that the Psychologist or Certified Counsellor neglects to consider these areas but it would be a matter of weighting. They may think that these external influences are factors but the weight of the responsibility rests largely/exclusively with the client. The Social Worker would regard the 5 factors worth 20% each in the foundations and functioning of the individual.

There can be considerable tension between the disciplines. The Psychiatrist who argues in the value of Pharmacology, the Psychologist who argues the value of individual responsibility, the Social Worker who argues the impact of an entire system, and the Certified Counsellor who may be more general.

The truth is, all four are correct and valuable depending on the case itself.

What is the difference between a Counsellor, Social Worker, Psychologist, and a Psychiatrist? (Part 1 of 2)

Good question! Most people cannot distinguish between these disciplines. Regulatory bodies require each discipline to carefully represent themselves accurately.

First, let’s distinguish Psychiatry from counsellors, Social Workers or Psychologists.   A Psychiatrist is a medical physician who is a specialist in the treatments and medicines for the mind. This is the only discipline (of those referenced here) that can prescribe medication. A General Practitioner/Physician/Doctor must make a referral for you to see a Psychiatrist.   Only a Psychiatrist/GP/Physician or other medical Physician can prescribe medications. Their training largely follows a medical treatment model.  As such, Psychiatry appointments are generally shorter in length, as they listen for symptoms that would give them cause to prescribe or adjust a medication. Your Pharmacist may know more about the drug in question so you should consult with that discipline if your Psychiatrist prescribes a medication.

There are relatively few Psychiatrists in Canada who see patients for a full hour for what is basically called “talk therapy” (involving no medication). In other words, the Hollywood version of a Psychiatrist is a bit misleading.

Now to confuse matters further, a Registered Psychiatric Nurse (who would have 2-4 years of academic training) may also be involved.  The nurse monitors the symptoms and medication, offers some general talk therapy and works in concert (as a team member) with the Psychiatrist in a public practice setting (hospital or outpatient clinic).

Wait times are generally several months, though most times your Physician may have already started some pharmaceutical intervention for the Psychiatrist to adjust.

This leaves the non-medical/Pharmacological disciplines of Psychology, Social Work and generic “Counsellor”. In Saskatchewan, anyone can use the title of counsellor, therapist, mental health worker or a host of other labels. No training, licensing, or regulation is required.  Occasionally you may see an allied degree (like a nurse or teacher) use the title of counsellor and represent a degree other than Social Work or Psychology.   It is generally a good idea to look carefully into these services. The greatest issue (besides the obvious) is that they may not be accountable to any regulating body if you were to have a claim against them.  In addition, the counsellor may not be insured at all, or their insurance may be very limited (and prohibitive).  This is not to say they are not good at what they do.  Some people with little to no training or allied training have a gift.

What does Science Say About forgiving?

Should you first forgive yourself or your partner after a dispute or conflict? Common sense would indicate that we must always forgive our partner. That would be the standard practice of instruction by our families, our church, and our therapists.

However common this common advice is, it is wrong. An article published in the Journal of Family Psychology 2013 discovered, that out of 168 couples, satisfaction was higher for both partners when the offender has less negative thoughts and feelings towards themselves. Albert Ellis, the Psychologist, who developed Rational Emotive Behavior Therapy, spoke of unconditional self-acceptance as being an essential component of all human and loving relationships. Little did he know just how right he was! His argument at the time was before you can unconditionally accept someone else for their shortcomings you have to be able to do this for yourself first. Now, remember: Unconditionally. That means regardless. No terms, no buts, ifs, or “it’s just that”.

To be clear, this does not mean that your partner has to accept you first. No, you have to accept the fact that you have been harsh, critical, negative, and perhaps a plain bonehead. This, of course, requires taking an inventory of yourself before you take critical inventory of your partner. A good question to ask yourself “is there anything that I may have either done (commission) or not done (omission) to cause, contribute or exacerbate (make worse) the situation that I/we are in?”

This is where the researchers say we really require USA – Unconditional Self-Acceptance for our part. It is kind of obvious when you think about it. First take the log out of our eye before attempting to take the speck out of our brother’s eye, as instructed in the Bible. To do this requires taking stock, taking inventory, of our commission or omission. Once you have discerned what that may be, it is always a good idea to check it out with your partner. “Is there a chance that my (specify your behavior) may have caused, contributed, or exacerbated this? “Now this is where the researchers say we need to practice our USA. Something like “I can accept myself just as I am for my part of this conflict”.

Failure to do so jeopardizes self-responsibility, self-correction, and the seeking of forgiveness. The blame game continues to no avail, the tensions mount and resentments are fueled. Doing this will cause one of two things: either our partner will say “yes, that’s what it was” or report it was not what you had estimated but another aspect. Either way, you are ahead because now you know what you are dealing with. The added benefit is that if you get it right, your partner is very impressed. And even if you don’t get it, you have still demonstrated an empathic attempt, which generally does wonders for softening things up. Now, be reminded, this is why you have to use the USA method. There may be a bridge of time from 1 to 10 minutes while your partner continues to unload. They may not receive your approach as understandingly as we would hope. At worst, they may continue digging or using barbs to re-engage you. But if your USA is high, it will have no effect because you are able to accept the bad (and maybe even nasty) things that are being said about you.

Here is the real plus. There’s a reasonable chance that after the conflict is said and done, and your partner has gone to another room, he or she will be taking inventory of how well you handled this — and perhaps how dreadfully they have. This may cause another discussion where they are seeking forgiveness for their bad behavior. Even if they don’t, doing this enough times models exemplary high-quality relationships. The fact is, the chances of them eventually getting it goes up with good, not bad modeling. But the research says it all starts with your USA.

PPC has several Rational Emotive Behavior (REBT) therapists with whom you could check this out personally.

How Are They Staying Together?

There are dozens, if not hundreds, perhaps thousands of reasons why relationships flourish or fail. And the research to explain these factors is accumulating.

As Lisa Neff, Professor at the University of Texas found in a 2013 issue of Journal of Personality and Social Psychology. High “Dispositional Optimism” is a factor for flourishing, Disposition is your natural state, attitude. How you learn how people would predict you to respond. Optimism is a term encompassing positivity, optimism, and hope.

When Lisa Neff and her co-authors researched first-year newlyweds, the dispositional optimists reported a more stable well-being and were more suited to conflict management. By contrast, the relationship optimists remain positive as a condition of the quality of the relationship at any moment. The well-being of this group declined to display poorer problem solving, avoided touchy discussions and suppressed their own desires. In other words, having arguably high expectations lead to greater disappointment or discouragement with inevitable minor conflicts.

So what is the lesson? We all know this… optimism is always better! Agreed. And you may be part of the population that is not a natural optimist but you may want to lower your expectations, standards, requirements, and imperatives when conflict and disagreements arise. Failure to do so, especially over decades, can cause irreversible damage.  

I am reminded by my deceased father. He had dispositional optimism (a trait not carried genetically to his son). He also had hardships, not least of which the loss of his wife, my mother, at an early age. Regardless, aside from positive emotions of joy or happiness, he had only two ways of expressing a negative experience. If it was minor he dismissed it, if it was moderate he would say “that was disappointing”, and if it was major he would say “well, that was a real disappointment”. His way of regarding things this way prevented damaging anger, lingering hurt or festering depression.

So, strive for an optimistic state. Find and list the things you are grateful for that he/she has (or do not have for that matter). When all else fails, change your expectations to preferences. That will keep you from anger to disappointment. 

Do you suffer from Anxiety?

A June 2013 issue of The Journal of Clinical Psychology revealed a strong link of anxiety, depression, and panic disorder to one common item: uncertainty.

It is common to feel fear and panic before exhilaration before an adrenaline rushing activity, such as bungee jumping, because you are reciting questions out of the fear of the unknown. Will I get hurt? Will the rope hold? Will I hit myself on the bottom? Can I do this? This is especially common if you have never done something before as your questions cannot be answered until you’ve done it. Consequently, on the way to anxiety you pass through uncertainty.

Using questions when feeling anxious will, by definition, increase anxiety. The questions are often unanswerable forcing our brain to race around attempting to find some definitive statement to achieve balance. If you brain can’t achieve this, the brain moves even faster in it’s frantic attempt to latch on to some conclusion. Failure to reach this conclusion generates a false negative that there is no answer (or neurological file) which multiplies the anxiety again. This is what is referred to as Secondary Anxiety: anxiety over anxiety.

In today’s daily life we don’t bungee jump but we do ask questions and lots of them. What will happen if? What would I do if _? What if _? When will_? This results in examine checking, planning and reassurance. Furthermore it is the gateway to rumination and avoidance.

What is the trick? Take some time to Google Bob Newhart’s comedy skit “Just Stop It”. It is unrelated to anxiety (yet funny). We have to stop using questions and firmly and aggressively recite statements. I can do this! Yeah it will be hard, not too hard though. I have done this before. It has always left in the past.  First ensure they are true and believable and reference you and not others.

Which is the best motivator? Envy or Admiration?

Have you ever wondered which is the best motivator – envy or admiration? Sadly, research psychologists at Van de Den at Tilbert University report that it is envy. Their research found that when we envy someone, our persistence on a creative task improves. They also found that we try to emulate the person that we envy.  Benevolent, well-meaning, envy was found to be creative, and motivated those studied to perform our tasks more creatively. Malevolent envy, however, was found to be destructive in those studied.

Using these findings we can examine our own envy: it’s been found that your own envy might be a good thing. We must first check to see if it is rooted in benevolence, or with good intentions. We do not want it to be rooted in negative meaning. If you are unsure where your envy is rooted, a check in with a therapist will help you examine your motivation and how to move forward.

How Much Can You Get Away With?

The Gottman’s, pioneers in the field of marital research, have found that a couple may be able to exchange two hostile messages in 15 minutes but that will exceed a healthy set point. Our relationship breaker flips and there is no power left to constructively resolve a conflict if over that point.

One of the Gottman’s pieces of research discovered that during conflict interactions, a positive to negative affect ratio of 5-1 or higher is healthy. That is the average ratio in a stable, happy couple. By contrast if the positive to negative ratio during conflict is one to one or less that would be unhealthy and need to be characterized by the term “disaster”. These people would be high probabilities of divorce.

Practically speaking, when my wife approaches me about an item on “my banquet of short-comings”; Gottman’s recommends that, her success will be dependent on her finding things that she can say or do to keep me constructively engaged. If she is making the “complaint”, that initial responsibility of delivering it well is hers. She may make a comment on my caliber of my dress code. She may give me an affectionate touch, a teasing remark, she may express appreciation for how good our communication is (is that four?) then say “sweetheart, my love, do you know what would be really helpful for me? If you could…” and away we go, hopefully to a conclusion.

Some say this is manipulating. Some say it is pathetic. Some say it is childish. Masters smile and hold hands. They don’t care as long as it is respectful, kind and forward moving. They do not tie their ego or pride to the process. They can maturely delay their immediate gratification for the longer term goal of relational well-being. They do not even consider the idea of manipulation or being “whipped” because they have developed an auto-trust from years of practice.


What to do after a Relationship Fight?

The June 2013 issue of Journal of Social and Clinical Psychology reports that in a study of 953 couples, most want to disengage or meaningfully engage after a fight. Disengage is to leave the room or the house to avoid. Meaningful engage means to talk it out, what some call re-hash.

But which do I do? Individuals fully neglect which ones, can you guess it? It is obvious, engagement. Actively show investment, communication and affection; NOT an apology. Did you get that?

How often have we heard “I apologized, what does he/she expect!” Apologies are indeed helpful but “engagement” is rated first, then an apology second is what Masters do. Disasters on the other hand just keep fighting or disengage.

So, when should I disengage? Firstly, when there is a threat whether it is physical or emotional. Ones perceived safety always trumps communication. Secondly, blamefulness or criticism is a dead losing proposition.  This is also a time when disengagement or differing is the best idea. Environment is a third criticism for disengagement. If children are present it would be wise to disengage.