Counseling is advice, instruction, or help offered by one person in order todirect the actions, thoughts, or opinions of another. The word "counseling" can be used in many ways, but often is used in the context of mental health care. Counseling involves a partnership between a client and a mental health professional who is licensed and trained to help people understand their feelings and assist them with changing their behavior. Counseling is also commonlyknown as psychotherapy.

Counseling for mental health problems is on the increase in the United States, where it's estimated that one in every five people consult with a mental health care professional at some point in their lives. According to the National Institute of Mental Health, one third of adults in the United States experience an emotional or substance abuse problem, and nearly a quarter of the adult population suffers at some point from depression or anxiety. But while oneof every three people develop some sort of mental disorder at some time during their lives, only 28% of those people seek professional help. This reluctance to get counseling is primarily due to the many misconceptions about mental health and the belief that mental health problems are somehow shameful. Inthe United States today, the stigma against mental health care is still verystrong.

Experts recommend that counseling is needed when a problem is interfering with a person's life. If a particular issue is damaging a person's relationships, or interfering with the person's ability to function in school, at work, orat home, counseling may help. ounseling may also help people who feel an overwhelming and prolonged sense of sadness and helplessness, or lack of hope intheir lives. It is probably most useful if the client's personality and lifeexperiences are the primary cause of the problem.

Counseling sessions typically last between 45 and 90 minutes. A person suffering from a mental health disorder may need only a few counseling sessions. More serious problems may require ongoing therapy for many years. There are many approaches and formats of counseling, including individual, group and family. Despite the variations, all counseling is a two-way process that works especially well when clients and their counselors communicate honestly. Researchhas shown that counseling works best when the counselor and client agree right away about what the major problems are and how counseling can help.

Both counselor and client are responsibile for establishing and maintaining agood working relationship. In the beginning, the client should establish clear goals with the therapist. After a few sessions, the client shoud feel as if the experience is a joint effort between the two.

It's normal to feel a wide range of emotions during counseling, because discussing painful or troubling experiences can unleash uncomfortable feelings. This is a positive sign indicating that the client is starting to explore thoughts and behaviors.

Counseling is available from a wide variety of health care professionals, andfrom others who have received training in counseling. However, a counselor who works very well with one individual may not be a good choice for another person. There are several ways to get referrals to qualified therapists:

  • Recommendations from close family members and friends
  • State psychological associations
  • Family doctor or other health professional
  • Church or synagogue
  • Local mental health association or community mental health center

Because anyone with or without formal training in counseling can advertise themselves as a "psychotherapist," it's important to check a person's credentials before becoming a client. A primary-care doctor often can recommend a health care professional. It's important, however, for a patient to feel comfortable with a counselor before agreeing to work together.

Those seeking counseling should make sure a professional has met state licensing requirements to be certified as either a psychiatrist, psychologist, social worker, nurse-psychotherapist or psychiatric nurse, or marriage and familytherapist.

A psychiatrist is a licensed medical doctor with additional training in the specialty of psychiatry, who is qualified to prescribe medications and make medical decisions. A "board-certified psychiatrist" is one who has completed extra training and passed national examinations.

Psychologists have completed graduate Ph.D. programs that include clinical training and internships, but they are not medical doctors. Most states requirea Ph.D. for licensing as a "psychologist" (only a few states allow master's-level graduates to call themselves psychologists). All have extensive training in psychotherapeutic techniques.

Certified social workers or licensed clinical social workers usually have completed two years of graduate work, specializing in mental health care. Some have doctoral degrees. Most states require social workers to be licensed, andto complete two years of post-graduate clinical work.

Psychiatric nurses and nurse-psychotherapists have nursing degrees and special training in mental health care, and must pass state examinations in order to practice.

Marriage and family therapists usually have completed graduate work, often inpsychology. They are licensed in some, but not all states, and usually are required to have completed at least two years of supervised clinical training.

Other types of counselors include pastoral counselors, stress management counselors, sex therapists, and hypnotherapists. Ministers, priests, and rabbis (called "pastoral counselors") serve as counselors but aren't health care professionals. There also are counseling groups, self-help groups, and support groups, which some people find useful in dealing with problems.

There is convincing evidence that most people with emotional problems who have at least several counseling sessions are far better off than untreated individuals. One major study showed that half of the patients in counseling noticeably improved after eight sessions, and 75% of them had improved by the endof six months.

Research suggests that counseling can ease depression and anxiety (especiallywhen combined with medication), and control related symptoms such as pain, fatigue and nausea. Counseling may also boost survival rates for heart and cancer patients, and have a positive effect on the body's immune system. Research increasingly supports the idea that emotional and physical health are veryclosely linked and that therapy can improve a person's overall health picture.

Mental health care may be included under a person's health insurance policy,although it is almost always covered in a much more limited way that physicalillness, with limits on number of visits per year and a fairly small lifetime maximum coverage amount. A person who doesn't have health insurance and can't afford to pay for counseling can contact a local or state agency or a mental health advocacy group to seek financial assistance. Many community mentalhealth centers offer counseling on a sliding scale based on a person's ability to pay.

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