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.

Good People with Bad Relationships

Do you ever wonder what causes good people to have bad relationships? There is a growing body of research giving us some distinct facts about what makes a relationship successful. The days of having a theory and writing a book then being charismatic enough to make presentations around the country are slowly diminishing. It’s being replaced with scientific measurements of perspiration, heart rate, muscle tension and ratios. 

Simply put, we can’t function when we are “charged”. In bad relationships the couple is unable to practice their marital resolution abilities. They cannot express, validate, compromise, make eye contact, and the list goes on. On a simple adrenaline test, divorced couples measure 34 percent higher during conflicts! And they wonder why they are always tired, moody and can’t get along. They are essentially physically impaired.

It’s not a difficult concept to comprehend. Do you remember your grade 10 science teacher talking about homeostasis? It was a biological concept introduced in 1932 by Physiologist, Walter Cannon. The principle is that we have a set point. When our bodies are above the set point we become deregulated. In other words we get cranky, short, will probably say things and act in ways that are unhelpful.

What is one of the set points? 100 BPM of your heart rate, “when a person’s heart rate is above 100 beats per minute (or their oxygen is below 95 percent) they can’t listen very well, they can’t empathize. They lose access to their sense of humor; they are secreting two major stress hormones: adrenaline and cortisol.”

So, what do we do? Mutually establish how you feel physically and emotionally when you are near 100 BPM’s. When you get near the “set point” or see your partner near the 100 BPM, take a time out. There are even affordable home devices to help you assess your biorhythm which helps you determine if you should go for a cup tea instead of continuing the discussion with your partner. Agree in principle first. One of the two may be more skilled than the other. Establish who that is – doesn’t matter who can do this better. We are not keeping score here! The time out/ break should be at least an hour. There is nothing wrong with 24 hours. This is what masters do.

 

Evolved Emotions

“Strong men” and “pretty women” (those who, over a period of evolution, had the most power to cause harm or withhold benefits) are most easily angered, reports psychologist Aaron Seel. He concludes that the benefit of anger is to prevent yourself from being exploited. Therefore, if you feel affronted, safety and civility are often dismissed leading us to act angrily and take action. The result of this is this anger boosts confidence, optimism, and risk taking.

So, if you fall victim to anger quickly, take some time to think about what the angry person might mistakenly think is being exploited by you. That item is the subject for you to discuss versus your own personal sense of exploitation. If it isn’t obvious, find a therapist whom you can be candid with and who will be brave enough to share an opinion.