Seven Clues the Counseling Industry Has Lost Its Mind
I’m playing basketball when the referee makes the worst call I’d ever seen. This particular ref was known for being terrible. I just shrugged and began calling out our next defensive formation. The ref gave me a technical foul (this is bad in basketball). While that ref had a reputation for being terrible, I had a bit of a reputation too, for being a hot head. This led me down a path to consider what basketball would be like if the refs weren’t terrible. So guess what I did. Yep, I became a ref. And 18 years later, I don’t regret it. I’ve been able to referee high school, college, and minor league pro basketball all over the country. And I love it. But I got into it because of the severe deficits I saw and hoped to become good at it in order to pave the way for other younger refs coming in.
I still ref, but that’s a side hustle. It’s my “self-care.” I’m primarily a counselor. And one of the primary reasons I got in was because of the deficits I saw in the industry. There were so many incongruencies I could see from my everyday experiences that I had to get in and figure out what was going on.
Here are seven things I’ve noticed that have gone wrong in counseling, along with my advice to professionals about how to put them right:
- Over-emotionality
- Assuming there’s a diagnosis
- The client is viewed as an annuity
- Validation at all costs
- Rumination
- Weather Man Syndrome
- Feminization
1. Over-Emotionality
The counseling industry has overemphasized the need for feeling. I’m not negating the validity of feelings. I’m suggesting that when making decisions, feelings are the last thing that should enter your mind. Rationality, practicality, who all these decisions will affect, these need to enter your mind. How you feel can help guide at times, but feelings alone are a terrible decision maker. If you make a decision based on a feeling, when the feeling changes, the decision changes with it. This explains why people who get married because of passionate desires get divorced fairly early in their marriage. They married because of a feeling. Then when that changed, their decision to be married did too. Anyone who has been married for any amount of time knows that the early feelings of infatuation in marriage go away relatively quickly.
How It Should Be
Acknowledge and address feelings. The counselor should give them their proper weight. Feelings detect, guide, and lead us to dangers to be aware of as well as opportunities to take advantage of. A counselor should hold that in juxtaposition with rationality and allow the client to experience this new perspective.
2. Assuming diagnosis
It is obvious that certain fashionable conditions are over-diagnosed (and drugs are over-prescribed for them). I’m not making light of these conditions, and I’m not suggesting they don’t exist. I’m suggesting that 14% of all boys in America between the ages of 5-17 do not ALL have ADHD. How is this diagnosis up from 9% just recently in 2015? Because it’s not actually true that more boys than ever have ADHD.
Boys are wired to run, risk, explore, and seek adventure, more so than girls. Boys are more physically active during recess: 22% as opposed to 10% for girls. And because we don’t know what to do with that, we pathologize it for 3 reasons:
- That makes the parent not feel so bad about their kid
- It helps the teacher out because she doesn’t know what to do either
- Someone receives a kickback from big pharma for recommending medication.
How It Should Be
Not everyone needs a diagnosis. It’s ok to be rambunctious, and rambunctious kids don’t need to be labeled “too hyper.” You can be socially awkward and not be labeled neurodivergent. Then there are the iatrogenic effects of diagnoses; when the act of diagnosis or treatment causes “the condition” itself. We give these kids a diagnosis, they realize they’re “not normal”, and the rumination begins. This causes more problems than the original symptom they came in with. I’ve seen it. It’s devastating. And medication should only enter the conversation as a last resort, not a first option.
3. The client is viewed as an annuity
Too many counselors are seeing too many clients for way too long. I realize that not everyone can benefit from Solution Focused Brief Therapy (SFBT), but many can. Here’s the problem—this doesn’t pay for that trip to Cabo. It only pays for a trip to Costco. I know counselors who are seeing clients who have been with them for more than 2 years. This should be rare, but it’s not.
How It Should Be
I have yet to achieve this, but my goal is to be able to tell a client on the first session approximately how many sessions this will take to achieve their stated goals, with relatively good accuracy. Clients need an end game. They need to know hope is around the corner. Bringing them in for more than a year for the same issue doesn’t provide hope. It provides the practitioner enough money for an all-inclusive vacation.
4. Validation at all costs
This one is prevalent. Counselors are encouraged to validate at all costs. The client comes in and says her family doesn’t accept her because she now identifies as a kitty cat. We are now to validate her feelings as rational, sane, and beneficial to her overall health. Nope. I can’t. I won’t be mean. I won’t be overly contrarian either. But I won’t be telling that client that her “identity” is normal and that everyone around her is nuts. Not happening.
How It Should Be
If you are my client, what I will validate is that you are hurting. I will acknowledge the confusion you must be experiencing. I will help figure out where the confusion started and provide scientific evidence for why this confusion doesn’t have to debilitate you, then help you recognize it and begin to reframe your mentality. Counselors should not be validating falsehoods for the sake of the client’s feelings.
5. Rumination
At times, a counselor will let a client ramble on about all their problems without any direction towards healing. This is not therapy. This is rumination. Problems need to be dealt with in a structured environment to move towards healing; endless rambling about problems is not healing. The client doesn’t even realize this is happening. They just come in thinking, “I’m supposed to talk about my problems, so here I go.” And the counselor just lets them deliver unfettered rumination.
How It Should Be
It is the job of the counselor to be the professional. The counselor needs to interject when discussion turns into self-indulgent rumination. This can be done without confrontation. We just turn our focus to a point the client just made. We zero in on something he said that will lead us to a core cause, and that helps us address the symptoms. Move towards healing. Not rumination.
6. Weather Man Syndrome
Counseling has become prey to Weather Man Syndrome. I can be wrong about everything I tell you and there’s little to no consequence for me. Misguided counselors end up like the proverbial weather man who gets it wrong at least half the time while everyone still treats him as an accurate authority. Iatrogenic effects are as prevalent in mental health as they are in physical health. But there are warning labels on pill bottles. Counselors don’t come with those. We call it “informed consent”, but that’s not a real warning. We as counselors can do some real damage and so many are out there just throwing noodles against the wall hoping they make enough money to afford their favorite Airbnb this fall.
How It Should Be
There should be clear warnings of the possible side effects of receiving mental health counseling/therapy. Digging up old feelings is dangerous for some. We must be careful. Talk about this up front.
7. Feminization
I could write an entire article about this alone. I’ll just say this; we have gotten to a place where the normative experience for clients is a totally feminized one. This approach alienates half of the couples who walk into our offices, particuarly for couples counseling. The wife feels great about this. The husband looks at his watch every 5 minutes hoping we get out of there before the game starts. Why?
- Women communicate to relate.
- Men communicate to exchange information.
- Women process negative emotion face to face through social communicative relation.
- Men process negative emotion side by side through action and honor, allowing them the time to form the words needed to communicate the necessary information. A man will hear bad news and go fix a lawn mower he will never use and can’t actually be fixed.
So when a couple comes in and is expected to relate face to face, it shouldn’t come as a surprise when it doesn’t work for the man. There’s more to therapy than talking face to face.
How It Should Be
When I see men, I get them to do activities with me. We throw darts, putt on green strips in the office, maybe go outside and throw football. Then they open up. We must make counseling spaces inviting for men if we expect them to begin speaking to counselors about their problems.
Conclusion
Therapy doesn’t have to be stigmatized and it doesn’t have to be experienced as distressing. For individuals who have had unsatisfactory therapeutic experiences, I encourage continued engagement with other clinicians. Maybe you haven’t found the right therapist; maybe there are more competent practitioners who are more effective. There are others like me who are willing to address patient needs with cognitive empathy, constructive challenge, evidence-based science, and common sense. The tiny handful of us still willing to say out loud that there are only two sexes get slapped with the “iconoclast” label. Fine. Say what you will. But I won’t pander or lie to clients, and neither will any professional worth the title.
Stay Classy GP!
Grainger