Medicalizing Counseling

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The field of counseling and psychotherapy has been dramatically influenced by the field of medicine.  While much of the medical research and approach to mental health has been very helpful, even life-saving, there have been some side-effects that has seriously corrupted the view of mental health and the healing professions that deal with psychological problems.  All psychological problems are not signs of mental illness, and not all mental illnesses require medical treatment (some do and we don’t want to minimize that).

To be clear, the problem is not the use of medicine or medical treatments to help people suffering from debilitating symptoms such as hallucinations, delusions, intractable depression, or severe anxiety.  Any time we can build a multi-disciplinary approach to complex psychological syndromes, the more likely we are to be effective.

The problem arises out of the domination of medical treatment that overshadow legitimate ways of approaching psychological distress.  For example, most clients (aka patients) who seek psychological services from a private psychologist, social worker, professional counselor, or marriage and family therapist fall into the category of the “worried well”, not the mentally ill.  This means most of them don’t have a disorder.  They have legitimate struggles and challenges in meeting the unexpected, discouraging,  and sometimes traumatic experiences in their lives that overwhelm their individual coping strategies.  They may be functioning just fine but below the level they would like to be and counseling can be of great help in getting them to optimize their opportunities and resources.

Some clients are coping with developmental transitions or challenges that all of us face in life.

Other clients who seek the help of a counseling professional are coping with developmental transitions or challenges that all of us face.  In fact these folks are the smart ones because they learned not to go it alone and have utilized the resources and wisdom of a counselor to help them succeed with greater confidence and optimism.  Parents, teenagers, the elderly, and those facing discrimination are examples of clients who are perfectly healthy and still could use the support and assistance of a counseling professional so they can not only survive but thrive in the face of life’s curve balls.  Still other clients are not even in distress, they are simply looking for support and help as they transition to a new level in their lives.  These might be executives facing a promotion, young adults launching into their careers, or stay-at-home mothers going back to work.  Nothing is awry here.  There is no diagnosis.  And yet the support and guidance of a trained professional is more effective and wise than asking one’s friends and family (who often have their own agendas).

So what is the problem here?  The fact that the health insurance industry requires a counselor to diagnose, label, and then treat the client as if they have a disorder that needs to be treated and cured rather than a life challenge that needs support.  It stigmatizes seeking help; it makes people reluctant to get a mental health diagnosis on their record; and it encourages clients to put themselves into and play the “sick” role just so they can use their insurance benefits.  More importantly, it gives the insurance company access to information that is often shared and maintained in a database to follow the person throughout life.  Or it allows the insurance company to manage (more likely restrict) the amount of care the client can receive.

So what is the solution?  It is already happening around us.  We see a growing cadre of coaches, wellness guides, spiritual mentors, and other non-licensed helpers providing the psychological services that once belonged to licensed professionals.  We also see counselors and therapists leaving insurance provider panels once they have a few years of experience so they can make a living with a cash-based practice.  Medical doctors have also begun to do the same.  Again, this shift is not problematic if you has the personal finances to fund the counseling.  What if you cannot afford to pay out-of-pocket?

If we could all pitch in and provide pro bono services, we could close the mental health gap!

This is a call to all mental health professionals to offer some pro bono or reduced fee services.  If we all pitched in and provided services to those who cannot pay, we can still maintain a lucrative practice while serving those on the lower rungs of the economic ladder.  In addition, the growth of new sliding scale fee based counseling centers is a response to this need.  Counseling centers offer different levels of service through licensed therapists, post-graduate interns, and practicum or graduate students in training, all at an affordable rate that serves populations that typically receive no service or a disservice when using their health insurance benefits.