Text Box: Counseling Complexities—What Can Happen?
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   The issue of how long the treatment process takes is difficult to answer.  No matter how well the treatment plan assesses, diagnoses, and specifies the number of sessions needed, there are many other considerations:

 

 Some mental illnesses are harder to treat than others. 

Example: a person who has phobic symptoms when crossing the street may be easier to treat than a person who cannot stop drinking, taking drugs, or who cannot stop viewing pornography. 

 

 Various methods are used by different professionals. 

Example: some professionals use behavioral treatment methods focusing on what people do (or don’t do) while other professionals use psychoanalytic methods focusing on the formative parental relationships. Hypnosis and online digital therapy services occur in different settings (hypnosis may be one time, in the office, online therapy may be self directed with clients self scheduling).

 

 People respond to treatment differently. 

Example: one person who is dealing with memories from child abuse might rapidly address the recall whereas another person might resist any topic that remotely addresses memories.

 

 One problem might expose other problems. 

Example: a mother might bring her child in for what she thinks is an attention deficit disorder and during treatment it is learned that the focusing problem is linked to the domestic violence in the home.

 

 Expectations of treatment delays recovery.

Example: a man seeks counseling to “talk about marriage problems” and when depression medication is suggested he refuses to see the doctor, psychiatrist, or ARNP—the marital problems continue for months until finally he begins medication therapy.

 

 Clients want services; professionals refuse termination.

Example: a couple brings their child to counseling certain that the child has a mental disorder.  The mental health professional has determined that the child is functioning within normal developmental milestones but continues to see the child anyway.

 

 Many other variables impact the process of treatment. 

Example: age, emotional development, physical considerations, culture, spiritual beliefs, and the environment all play a role in how treatment will progress.  A competent mental health professional can most adequately address such variables.

 

  To understand these, and many other, variables it is helpful to understand the Person in Environment (PIE) perspective.

 

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Text Box: Kurt LaRose, LCSW, LICSW

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