Why Choosing A Therapist Is Difficult And Can Leave You Frustrated.

Sorry, not sorry, for spilling the beans on the industry.

If you're in the market for counselling or therapy - whether you're forced to go, or are going by your own choice, the various counsellors, techniques and styles, and price points are all over the map. It seems crazy to me that the average per hour cost of therapy is $150 per hour. Outside of counselling and personal training, I have a typical 9-5 office job. If I wanted to hire a counsellor, I'd have to work 5.7 hours of my day to afford just one hour of their day. That doesn't seem right to me at all. How are these therapists even determining their wages? Is it education, or experience, or a combination of both? Honestly, your guess is as good as mine. Often, when one therapist sets the bar high, others follow suit - often driven by greed and what they deem their time to be worth. This is just how the world works, and other professions are just as guilty of this. But that doesn't make it right. I'm just saying the facts.

Even for education and experience, there are vast differences between counsellors. Most therapists can have a mixed educational background. A bachelor's degree in Psychology, Social Work, Education, and even Nursing qualify people to practice counselling under different accreditations. That's quite the mixed bag - you could get counselling from someone primarily trained to work with kindergarteners, or draw bloodwork. Reminds me of when barbers use to also act as dentists. Counsellors can have a bachelors degree, a Master's degree, or even sometimes a Doctorate - although the Doctorate is not the qualifying degree for counselling. So, even with education you can have anywhere from 4-10 years educational differences between counsellors. Furthermore, there is no requirement that one has to practice in the field, so to speak, before working on their own. Provided a person graduates a bachelor's degree with the requirements needed to confer their degree, they can open up private practice the day after they graduate. I'd hate to be the lucky first customer. Even the terms used to describe the professional providing the service can vary from counsellor, therapist, psychotherapist, or even life coach. More or less, the term to describe oneself is not as significant as the educational background of the person providing the service. As a side note, social workers, nurses, and other regulated professionals are able to use the controlled term psychotherapist. Counsellors cannot diagnose mental health conditions, that is strictly reserved for psychologists and psychiatrists.

Now, let's say you're serious about getting counselling and you Google search your local area for a counsellor near you. The next hurdle you have to face is to scroll through all the service providers in your area - and if you live in a city chances are there are many service providers. How do you pick one, or how do you separate their differences? It's not an easy feat at all. Most describe themselves the same way and have identical websites, with similar credentials, and say they treat similar issues (usually the list of treatable conditions is quite long). If you're looking for a male counsellor, your choices drastically decreases, as the field is still dominated by women. It's pretty much a flip a coin and find out if they suit you situation. Some counsellors will offer a free consultation for 15 minutes to see if you're a good match, while others will want you to pay for a full session to find out. And if it's not a good fit, you have to shell out another $150 to the next counsellor on your list - often leading you frustrated, at a loss of funds, and having to start all over again with someone new. It's like paying $150 to each garage you take your car to when searching for someone who can fix it. At some point, you might just get defeated and think you can take care of the issue on your own, and leave a bad taste in your mouth about the local garages - it's the same with counselling. Now, I should point out that this is for fee-for service counselling providers. If you want government funded counselling, your choice of providers also diminishes, and you can face long waitlists, or be excluded from the service criteria for a variety of reasons. At this point in the counsellor searching game you might notice that you find yourself searching for the most qualified counsellor at the most reasonable price - amongst a lengthy mixed bag of candidates, or face long wait times for free state provided counselling. This is your first unwelcome hurdle, especially if you need a counsellor right away.

Next, once you've combed the list between counsellors and therapists, you might realize your search also generated results for life coaches. Now you have to figure out what to choose - therapy or coaching. I'm not going to go into every minute detail between the two, but broadly speaking, both counselling and therapy may involve looking into the past for root causes of issues, while both coaching and counselling involve focusing on the present and future. In fact, both counselling and coaching use almost the exact same techniques and tools of the trade during their sessions. I will have to say, that counselling from a social work perspective - which the vast majority of counsellors are (i.e Social Workers), shares a lot in common with counselling from a coaching perspective, and usually with less of a price tag. Perhaps the biggest difference between a counsellor and a life coach is how they market themselves. In most academic schools of counselling you learn how to do therapy, and you don't learn anything about the business world. Life coaches are taught how to market themselves - look at their websites: life coaches use motivational and emotionally charged language, they have more calls to action to begin a consultation or to subscribe to a free offer, and there is usually some err of mystery to their sites and treatment approaches - it makes you want to learn more and contact them. Life coaches also tend to use social media more effectively than counsellors, and life coaches use similar propaganda on their sites - a common narrative found on coaching sites is how they personally felt like they were not living up to their fullest potential, and found a secret way to live better - a way they want to share with you. To be honest, I like life coaches, I think that when working with people you should be forward thinking and not dwelling in the past about problems. I personally think life coaches may get a bad wrap, but that is generally because no one really knows what they are or what they do, there is some mystery to them, and they can be pretty expensive to work with.

But, this piece isn't intended to be a plug for or against life coaches, but to highlight they are one option out there. The one caveat I do have with life coaches is that anyone can take a coaching certification course and become one - and it's often run like a business where you can have higher ranking (read successful) coaches for other coaches who want to grow their businesses. You can find "master" coaches providing workshops for other coaches on how to become more prosperous - again the business focus in life coaching is stronger than in traditional counselling. The other issue is that to be a life coach, you do not need any certification or credentials - in fact, the industry is not regulated by any college or central regulating body. Anyone can call themselves a life coach, and just like in personal training - which I pick on in different blogs - certification granting companies are just a for profit business. In fact, I can create my own life coaching certification course today and start selling it and certify those who complete the course to be "certified" life coaches. Now to be fair, I will also pick on counselling. The caveat I do have with counsellors working within a psychodynamic or analytic frame work - think of Freud - is that first of all, it is theory and speculation as to the origin of problems. Second, these theories can be disproven, and are based on the counsellor's hunches at best. Third, is that at the end of the day, so what you have deducted (maybe erroneously) as to the root cause of your problem was you were not given a soother in your crib when you were an infant? What does that have to do with how you will handle problems now? It also takes away all accountability, learning, and experience that you have gone through in your life, and places the "blame" outside of your control. I think other that attachment theory, and perhaps the ego, id, and superego theories that pervade our current society, most of the rest is just garbage. Case in point about theories that ultimately cannot be proven or disproven is this: there is a real, but unpopular, theory that dinosaurs went extinct due to boredom. It is a theory and holds merit, but can't be proven or disproven, much like most psychoanalytic theories. And, the other side of these psychoanalytic therapies is that they can continue for months or years - people can see the same therapist indefinitely. It is not very economical or practical type of therapy.

The other thing you might notice is that most counselling and coaching practitioners use CBT (cognitive behaviour therapy). This is due to a large volume of research that supports this as the treatment of choice for many issues, but also because most insurance companies and funders will pay for this type of therapy. Almost every counsellor or coach will say they use CBT, and it has become almost like a marketing gimmick now - to say that you offer it. I personally don't have anything against CBT, but it's not a wonder treatment either. It's as if they (the field of psychology) found a thing that worked, and tested it for every possible situation/scenario it might work in; kind of like a best of what we have band aid treatment, and there have not been many new developments in that field since the 1960's. It's as if psychology has given up and just developed different types of band aids (larger ones, odd shaped ones, coloured ones, etc.) because they found that band aids (CBT) stops bleeding. But, sometimes to stop bleeding you may need a tourniquet or sutures, perform exploratory internal surgery, or a use whole shit load of gauze to pack the wound. So CBT, which is widely used in counselling, coaching, education, and other areas has a vast amount of research poured into it, it's been around for a while, it works better for some things than others, and is the best technique that they have available right now, since hardly anything has been developed since its inception. Has the field of psychology peaked? Come on Psychology, we need to do better. We need to start thinking outside the box for new and creative ways to treat issues other than CBT - we may discover something even better is out there, but we won't know unless we look for it. Put down the box of band aids psychology!

You know what the real kicker is - and I talked about it in my first blog - is that no matter what theoretical or educational background of the counsellor is, half of all therapeutic outcomes come from the counsellor-client relationship. If a counsellor and client click well, chances are that therapy will be a success since half of all outcomes are made from the relationship alone. The other 50% that can account for success in therapy is really mostly the client's hard work they put into therapy, and a dash of the counselling technique used. The education, training, theory, technique, etc., of the counsellor accounts for probably less than 10% of positive change - even with CBT. Basically, if you get along well with your therapist, put in the work, and believe that your will have a positive outcome (i.e counselling will work), chances are you will see some positive changes. The placebo effect, manifestation, belief, or the power of positive thinking - call it what you will, it has a profound impact in counselling, and in life in general. If you have negative beliefs about something, chances are you will act or think in ways to confirm your belief - you never give yourself a chance at success right out of the gate.

So if you're in the market for counselling, and you've overcome the stigma and embarrassment to get help, you may find yourself faced with these issues - each a barrier to getting help in themselves:

• Counselling is expensive. Is the return on investment worth it?

• What counsellor do I chose?

• What is their education and experience?

• What modality/theory does the counsellor practice from?

• Are they certified or regulated to provide their services, and if yes, by what accrediting body?

• Are you going to pick a Social Worker, counsellor, therapist, psychotherapist, or life coach?

• Where do I go for free counselling, how long is the wait list, and do I qualify to receive free counselling?

• Does my counsellor feel right for me? Will we get along?

Yikes, it's no wonder with a list of barriers and concerns like that that people shy away from counselling altogether. I think finding the right counsellor for you has less to do with the stigma of getting counselling, than it does with a lot of unknown answers for an unknown (if any) return on investment. People often wait until they needed help yesterday to start looking for a counsellor - and when they are in crisis or really need help, they are bombarded with all these factors when choosing how to get the right help.

In my practice, I use techniques that work (evidence based practices), but most importantly I keep it real - I cut through the bull shit and get right to helping clients navigate their problems. They invest a lot of money for services, and I want them to get the most for their money. I want them to have a beneficial interaction and walk away with new insights or beliefs, and tangible steps on how to reach their goals or solve their problems. When I work with clients, they know that I have formal eduction and experience in the field, and I am regulated by a professional college. My motos are "results not bullshit" and "a fresh approach to counselling" for a reason. I don't want you to waste your time or money, and I want you to move in a positive direction. I'd rather a client get value out of one to three sessions and never need to come back, than keeping them hooked for six to ten sessions and having them feel like they did not get anything out of it. I also choose to limit the issues and clientele I work with, sticking to my areas of interest, experience, and knowledge base, rather than casting a wide net and covering almost any issue I can think of, just so I don't lose a potential client or lead. Getting back to the no bullshit part - I don't pretend there's a secret recipe to what I do. I know there has been little reinventing of the wheel in decades, and I don't let client's believe that there is a patented approach to overcome their issue, that only I can teach you. I think more counsellors should take this approach.

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Thank You,

Peter J Bucciachio