I worked for ten-and-a-half years as a psychotherapist, nine of them licensed and one-and-a-half as a social work intern. For the last four years I have worked as a filmmaker. I have considered of late turning in my therapy license (an LCSW), and, if I were to return to the psychological helping profession, to do so as a life coach—unlicensed and outside the system. But is this wise? Others often ask me similar questions for their own career paths, and I realize the subject is complex. In the spirit of this, I wish to compare and contrast the two, from a variety of angles.
Licensure
Therapists have one, coaches don’t—or at least most coaches don’t. This of course makes it a lot easier to call oneself a coach, which is a great advantage, though it simultaneously throws open the door to wild cowboy practitioners and quacks. For these reasons, people tend to trust licensed practitioners more, even if that trust is not always, or even often, warranted. After all, the mental health field has an endless supply of licensed quacks. But at least when someone has a license there is standard of care you can expect from them. The problem is, what if many of those standards are themselves warped?
Standards of Care
One of the reasons I would like to give up my therapy license is that I do not believe in many of the standards of care of the modern mental health field. I don’t believe in pushing psych meds on people, especially vulnerable people in serious turmoil—those with so-called “biological diagnoses”—as per the modern dictums. Licensed practitioners who do not do this are considered substandard care providers and leave themselves vulnerable to all sorts of professional and legal liability. Another farcical standard of care involves forcing hospitalization or police on people who are supposedly a danger to themselves or others. What about focusing on building real healing relationships instead? And, of course, what about confidentiality here? Alas, confidentiality is only a lesser respected standard of care, which I find atrocious, because in many cases it makes therapists into agents of the state, not agents of their clients or agents of healing. Many therapists—the really good ones—secretly rebel against these standards and don’t practice them, but life coaches don’t have to get caught up in this nonsense at all. On the other hand, I could imagine the laws of the land arguing that a coach has no business seeing such “troubled” clients and penalizing him or her for unlicensed practice of psychotherapy. Coaches seem to be expected to work more with “mild” cases. But this is a farce, because in many ways therapists, especially in private practice, are also expected to turn away “the serious cases” too—and refer them to hospitals or hospital-based clinics to get drugged, or, if they’re less lucky, drugged and locked up too. What the state and the majority of the mental heath field fail to recognize, however, are the incredible numbers of people who had the most serious diagnoses and who got the most psychological help—real help, real nurturance, real interpersonal commitment, real insight—from people who weren’t even professionals at all. And many got this help from no one at all except themselves—from within.
Code of Ethics
One thing people often value about therapists is that they follow a code of ethics for personal behavior. I pretty much respect the therapeutic codes of ethics, but, at the same time, see them as pretty obvious and logical for any healing practitioner with a conscience, licensed or not. Coaches, meanwhile, are not required to follow any code of ethics except their own inner code and the law of the land, whatever that might be. To be honest, I in many ways prefer the inner code, because it allows the inner bell of truth to rule, not some list voted on by a bunch of questionable people I never met. However, this inner code might easily be exploited by coaches with less than stellar internalized ethics, allowing them to run hog-wild in taking emotional, financial, or even sexual advantage of clients. Yet therapists can and often do easily do the same. That said, clients working with licensed therapists, not coaches, have one advantage: they have more, though often still limited, recourse for reporting ethical breaches to formal licensing bodies.
Training Required
Becoming a therapist requires a lot of training, and a lot of this is bullshit—endless bureaucratic hoops, classes that can be limited or pointless or misguided, less-than-stellar or even sadistic supervisors, and a lot of expense and debt for all this “privilege.” Coaches have the advantage of being able to avoid all this and learn their trade in a much freer and more creative environment of their own making. Ultimately, though, both coaches and therapists must get the same real “training” to become good at their craft: interacting with real people in real life situations to gain real life experience. There is no substitute for that. That said, one advantage to being a therapist is that if you do your training within the system you can get referrals more easily than can most new coaches who’ve just hung out a shingle. On the other hand, if you’re a new coach with a good personal reputation or a really good private referral network, you can probably get more referrals than most new therapists in the system.
Earnings
I really don’t see a big difference here. I know several life coaches who charge more than many therapists, and I know several therapists who charge five times more than I ever charged any clients. I think high fees are one of the biggest frauds of the psychological helping profession. In general (though not always) what I have observed is that the better clinicians, be they coaches or therapists, charge LESS money, not more. They have has a deep caring for others and don’t want to exploit—and instead want to make their work as accessible as possible. But personally I think most everyone, therapist or coach, charges too much. Our society, unfortunately, encourages this.
Diagnosis
In many places, therapists are required to diagnose everyone who walks into their office. As a licensed clinical social worker in New York City, I was required to do this and I didn’t like it. It’s a main reason I would not want to work as a licensed practitioner again. For starters, the diagnoses are arbitrary and not scientifically valid—having been voted on by a small group of psychiatrists who are too often entangled with the drug companies. Additionally, I have never seen a person have his or her emotional growth process enhanced by getting labeled with “Borderline Personality Disorder” or “Schizophrenia” or “Bipolar Disorder” or “OCD” or “Generalized Anxiety Disorder.” On the contrary, diagnoses tend to be disempowering, stigmatizing, and harmful—and, at best, do nothing to assist a talented therapist in helping catalyze personal growth. Instead, diagnosing gets in the way of the real work, and in many cases, especially with new therapists, seriously distracts from it. It’s scary how much people believe in these diagnoses. Coaches, thankfully, operate entirely outside of the diagnostic system. For them, diagnosis is neither necessary, nor, in fact, even allowed. But personally I think every clinician I have ever met, therapist or coach, licensed or not, DOES have some sort of diagnostic skill, in the deeper meaning of “diagnosis”: to figure out what is ailing or conflicting a person seeking help. It’s just that good clinicians don’t waste their time using simplistic psychiatric labels and instead use more human and nuanced ideas. For instance, instead of affixing the label of “Recurrent Major Depression” onto someone, they might see that the person has been extremely emotionally stuck, sad, and hopeless for a long time regarding issues of his childhood or adult trauma, and also that that trauma and the person’s replications of it have been impeding him in moving forward with his adult relationships, his self-development, and perhaps his work. This kind of diagnosis, if you want to call it that, can really provide a clinician—and a client—a real framework within which to work. And these kinds of “diagnoses” are useable by anyone—anyone, that is, with insight and creativity and humanity.
Billing Insurance Companies
Therapists, especially if they have several years of experience and a good license, can do this, and this can save clients a lot of money. However, these days more and more insurance companies are cutting costs and thus making it harder for therapists to bill them. The companies increase pointless paperwork, increase clients’ copays, reduce the number of session available per year, purposefully keep limited stables of therapists, decrease overall payments to clinicians, and often require therapists to engage in major lapses of client confidentiality not just to get paid but to justify, ludicrously, the “medical necessity for treatment.” Also, because insurance companies try to avoid payment for “less serious” therapeutic cases, therapists can feel pressured to fabricate more serious diagnoses for clients in order to insure payment, and I have no doubt that many less ethical therapists succumb to the temptation. This can potentially come back to bite clients in any number of way. Coaches, on the other hand, cannot bill insurance companies—at least none that I have heard of. More and more I see this as an advantage, and so do some therapists I respect, who no longer bill insurance companies and instead charge clients what they can realistically afford to pay.
Power within the Mental Health System
Therapists, to varying degrees, have it. From the minute they become interns they certainly have the power to harm—to hospitalize people, to pressure them to take psych meds, etc.—but also the power to help people within the system: to help them find housing, connect with certain services and even moneys, and navigate the psychiatric hospital system in order to break free of psychiatry. Therapists can also help clients by liaising on their behalf with other mental health workers, such as psychiatrists or nurse practitioners, who are helping them taper off psych drugs. Personally I found this power a valuable use of my therapeutic license, and if I returned to practice as a life coach I would miss it. Life coaches, on the other hand, are generally not taken too seriously, if taken seriously at all, within the system. I don’t see this as entirely bad, though. One thing I like about the idea of coaching is that it is a job that is unplugged from the system. This allows the focus of the work to stay right where I find it most valuable: on personal growth.
Quality of Service Provided
I think there is no definitive way to determine the quality of a clinician simply based on his role as a therapist or life coach. It’s the same thing with the letters after someone’s name, such as PsyD, LCSW, LPC, PhD, MD, or LMFT, to name a few: I find them meaningless as indicators of therapeutic quality, and too often just a marker of the clinician’s ego. Ultimately, I think the best way to determine the quality of the clinician is to get to know the quality of the person behind the role: his or her degree of maturity, altruism, compassion, empathy, wisdom, depth, experience, flexibility, commitment, creativity, humor, intelligence, and generosity. Few clinicians, be they coach or therapist, score really highly in many of these categories, though in my opinion all should. That, in part, is why I prefer therapists and coaches who are very public and detailed about their point of view. This not only shows their courage in being themselves publicly, but also gives potential clients an opportunity to see who they’re dealing with.
Conclusion
Ultimately I don’t have a good answer to this problem about which profession is better. I see advantages and disadvantages to both. Ultimately, though, I think that any good life coach is a good therapist, and any good therapist is a good life coach. So ultimately, perhaps, this whole essay is just a reflection of the insanity, fragmentation, and obsession with labeling and categorizing of our mental health system, or mental illness system, depending on your point of view.
* * * * *
Well written thoughts, among which… “the mental health field has an endless supply of licensed quacks. But at least when someone has a license there is standard of care you can expect from them. ”
I would be interested to hear Daniel Mackler’s thoughts on how the quacks (both licensed and unlicensed) can be weeded out without burning the profession of psychotherapy to the ground and starting over from scratch. As others at Mad In America have written persuasively, the track record of outcomes from psychotherapy seems just as checkered (if less immediately destructive) as that of “anti-psychotic” drugs. Published trials and observational studies are notoriously manipulated and biased in both fields. NOTHING seems trustworthy.
Where too from here, Daniel?
Sincerely,
Richard Lawhern, Ph.D.
MIA Author “It’s Not All In Your Head”.
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This problem is not just with the specialty of medicine known as psychiatry. The problem is that NOTHING seems trustworthy in the entire field of medicine period these days. Only money counts; people are not important.
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Yes and no. It’s a bit harder to fake results on cancer: patient either survives or not, cancer either shrinks or grows or stays the same. Sure, you can do some manipulation but it’s nothing compared to psychiatry when even the most “reliable” diagnosis is pure bs.
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i’m not sure how to weed out the quacks. maybe, for me, this whole mental health thing really isn’t even a field… i only refer to therapists or coaches i really trust. so it’s not about weeding out the bad ones — it’s hunting for the good ones and holding on to them!
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Hey Daniel,
You can possibly cast off the label of psychotherapist, but your going to live with the stigma for the rest of your life.
Hope you see the funny side of what I’m saying lol.
Regards
Boans
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lol.
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I do think at the end of the day if you can’t help someone in a direct sense then you’re in murky waters.
examples…
If a person is homeless, does a psychologist give them a home ?
If a person has no job, no career, does a psychologist give them one ?
No ? Then what good are they really ? A psychologist is a meta helper but is that what anyone really needs ? Or is it just a nice thing they might want ? I think you’re on the right track, life coaching sounds more direct, like there’s a goal to actually do something instead of just waffle for an hour then collect cash.
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It’s a good point, and one that Daniel didn’t fully touch on. Traditional psychotherapy was based more on insight, awareness and working through childhood fears and trauma as a way to develop healthier ways of living in the world. Some of this exploration went to ridiculous levels with meeting multiple times a week over years.
Modern therapy has shifted towards approaches that are much more oriented to accomplishing goals and changing behavior such as solution focused therapy, dialectic behavior therapy and cognitive behavior therapy that are aimed at actual achievable and measurable changes.
In many ways life coaching takes this modern tack of helping people to develop ways of living that are healthy and help the person meet challenges and ” actualize”. The “coach” is less of an authority and more of an encouraging and supportive friend who helps the person meet his or her goals in life.
A lot of the move away from depth insight oriented therapy came from a feeling that it was wasting a person’s time and money and not helping a person make achievable healthy changes in life. I think there is some merit to that argument but I do think it can be deeply valuable at times to explore the roots of fears and suffering, often rooted in early childhood dynamics…essentially….to go “deep”. By understanding these deeper shadows, a person can come to a greater understanding of their full self, and try to untangle some of the knots that have made them suffer.
Anyways…Daniel… it would be interesting to hear your thoughts on the philosophical differences between life coaching and the broad array of therapy styles.
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True, for the most part the whole idea is about pretending to be someone’s friend (like a prostitute may pretend to be your lover). The whole idea seems fake to me.
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i see good therapy as a lot more than just doing meta-help and waffling and then collecting cash. that sounds like bad therapy to me. but i also don’t see therapists as “giving” people jobs and homes — though maybe good therapy could help people, even homeless people, attain those things. i’ve seen it.
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Interesting piece Daniel. As a licensed professional counselor, I often feel that the whole system is a game, where you have to jump through hoops, spend enormous amounts of time and money to receive a degree or license…when all that really matters is the level of genuine care, empathy and authenticity a person has in connection with another person. How can that be “licensed”? Not to say that education doesn’t matter. But much of modern mental health education is steeped in the medical model.
I think you touch on some really important points such as licensed folks being beholden to diagnostic codes for billing purposes. In my practice that simply is the way to have insurance pay for the therapy. The actual diagnosis, it’s veracity and importance to therapy sessions…is zero. A diagnostic code simply will not explain the deep and complex narrative of human experience.
But on the other hand, that billing code is really essential. Very few people can afford ongoing care at 70, 100, 150 bucks an hour. But a much larger group can afford a copay of 15- 25 bucks a session. And that, sadly, is the bottom line. The system is geared to supplement licensed folks with insurance money to offer the lowest cost care to the most people.
.
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Daniel,
For my selfish self I gotta say your one talented fellow and I really enjoy your films . And I’ve never heard you say anything that didn’t make total sense . And I’d say for someone with your skill set and raw talent there is nothing you couldn’t do if you chose to pursue it . Besides you have arrived with all this at a relatively young age and G-D willing much time left . If I had the money to finance it I’d try to hire you to make a major motion picture recreating events of my life thinking it would be a blockbuster and helpful to humanity .
But if its one of the 2 choices you mention ( maybe you just use them as illustrations to make your very important insights available to all) I hope you are not offended if I offer a suggestion out of solidarity and gratitude for the work you have done for the psychiatrically oppressed . As Call said to Gus or some other character somewhere in the series Lonesome Dove “Commendable Behavior”. Anyway’s if you choose life coach my lived experience tell’s me if you took the time to learn the skill and art of energy healing , specifically YuenMethod.com and could learn it preferably from Kam Yuen himself the developer of the system as I have done ,you would find quite a positive directional shift in all that you speak of or do beyond what you expect actually in whatever you choose to do . See YuenMethod.com I learned from him , I’ve watched him work in person on 600 some people including myself and know what he does is for real. I can’t think of a better skill for a life coach to have in their back pocket besides what you already have . Guaranteed it would be awesome . If you have learned this skill and are not satisfied it makes you a more effective better life coach or whatever I will reimburse you at the rate of $50 a month for expenses incurred . I feel in making this suggestion to you in the long run I’m doing something that will help suffering humanity.
Besides I’ve got original ways to help with extreme states in a “first do no harm free choice fashion ” I believe would be easily adaptable to many of the settings you’ve seen or worked in . I’ll share them with you freely if you are interested .
Sincerely and in Solidarity,
Fred
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Daniel, I made this transition, similar to what you’re talking about. Although much earlier on in my career than what you describe, I defected before taking the exam, in the middle of my MFT internship. I had healing of my own to do, and I could tell that my issues were interfering with my work with clients, so I took time off to do this. I turned to the system for support, which is where I WOKE UP.
What I realized was that it was not so much my issues, but that of the environment that I was in, and these stigmatizing power dynamics. I had felt that this therapy thing had become more about power, rigid boundaries, and ‘othering,’ rather than being authentically about healing, personal growth, and true compassion. I found it politically and financially motivated, pure and simple. I became very disillusioned with the field, but still felt the call to be of support to others. I had done very well in my training and internship, and I knew I cleared out my own stuff, I could get back on track in a much more neutral and fully present way with clients.
Thanks to the rude awakening I got going through the mental health system and its many tangents, I took a journey of personal transformation before it became clear to me how to make this best work for myself, and that’s where I got all my clarity about this path. Of course, this was after falling into a lot of confusion and feeling resistance, from both inside and outside, that led to a great deal of soul-searching and learning about who I am as spirit, what my path and life journey are all about, and how this all worked integrally in the human realm–to heal, grow, manifest, etc.
Along the way, I became certified in a variety of healing modalities which gave me legitimacy, including becoming ordained as minister–not in a religious program, I’m non-denominational and continue to identify with my Jewish roots, but as the result of doing spiritual energy work specifically for the purpose of healing the spirit and psyche. That was the best healing and training I ever got, plus it’s my legal claim to do spiritual counseling.
I’ve been called a ‘life coach,’ but I reject it, because I am not comfortable with it. We’re all learning as we go along, regardless of the roles we play. I call myself a ‘healer’ because what I do is for the intention of healing and shifting perspectives for the purpose of personal growth and evolution. Plus, I only had the courage to start my practice when I considered that I had done my own self-healing, as this is what I teach and how I support others. Others have called me a teacher or spiritual guide. Doesn’t matter to me, the work is the same, and I’m off the grid, legitimate and free.
You bring up excellent and highly relevant points about the logistics of this, vis a vis the mainstream establishment. I had to be extremely creative and take leaps of faith, while keeping that faith. I also had to let go of the old paradigm altogether, meaning that I had to go into this with a beginners mind. It would have been impossible to make this shift without being fluid in my perspective, not hanging on to familiar meanings and attachment to the past and what I had learned, but to allow a new and fresh perspective emerge. It took time, trust, and flexibility, but it’s worked out really great for me, I found exactly what I wanted, from the perspective which fits me perfectly, so I feel fully in my integrity.
There’s a lot to address here which could be messy and easily misunderstood in a forum like this, so feel free to contact me if you want to know more. http://www.embodycalm.com/Contact.html
Either way, best wishes with these shifts you are looking to make! Personally, I feel this is the way to go. Detaching from a system altogether disempowers that system. Creating a new, better, and effective way to do things will make it obsolete.
Alex.
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thanks Alex.
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Alex, so well said.
Fred
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Thanks, Fred, I always appreciate your kind words.
Alex.
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“confidentiality is only a lesser respected standard of care, which I find atrocious, because in many cases it makes therapists into agents of the state”
I agree 100%. That is why the most helpful advice on dealing with people in the system is one from the Millenium saga: just don’t talk to them at all.
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http://www.theonion.com/articles/glaxosmithkline-releases-new-drug-to-treat-people,36585/?utm_source=Facebook&utm_medium=SocialMarketing&utm_campaign=LinkPreview:1:Default
HaHa! Anyway, congratulations for seeing yourself as the individual you are. Yesterday, I told my best Soulmate and Psychiatric Survivor. “I just love a movie that makes fun of psychiatry, because there is nothing I find more gut wrenchingly funny and everyone loves it.”
https://www.youtube.com/watch?v=NV40bc6yA7c
Daniel,
I also think that Nothing Is Funnier Than To Make Jokes About Psychiatry & Psychiatrists. Especially if you are Fighting For Survival From Day To Day, And Minute To Minute Because Of Psychiatry.
The Psychiatrist that I had most of the time was like many other people in this world. Somehow, he went down a wrong path from which there was no return without First Doing Harm. My Psychiatrist was a man who tried to be a humanitarian.
I think it caused my Psychiatrist a great deal of stress to “Have” to do a many things or loose his job, in The Hospital where I stayed. Anyhow, he believed he was doing his best, He said, “I would loose everything if my fellow colegues really knew what I think. I Believe That A lot of people get into the field of Psychiatry ( : [ ) X , for all Well Meaning Reasons. But it’s a very bad profession in my opinion. I will say this, one Psychiatrist (Was Different From The Rest) Saved My Life So Many Times. He Was A Man Of “Ethics”. He would say, “That means there are things I refuse to do if I believe it’s unethical.” He also admitted many other things like, “He Could Be Sitting In My Chair Just As Easily As He Was Sitting In His”. Or, “If my fellow Psychiatrists Really Knew What I was thinking most of the time, I’d loose my position as a Psychiatrist, but I have an Edge Over Them.” “What is it”, I asked. “Education,and Reputation.”, “Reputation for what”? “Reputation For Having More Money, And Power. Also, I work here for free, and without me, this hospital wouldn’t exist.”
My first hospitalization was at 23. My second was at 26, after my daughter was born. But as soon as Services For Children And Families had taken my children for No Reason, I spent the next 15 years of in the Hospital I went to, than out of it. This particular Psychiatrist took care of me. The norm is that they rotate psychiatrists with patients. But I Made A Deal With The Devil. And this Psychiatrist would be mine, Lucky for ME. Reason 1 why i’m still alive today at 49.
I Encourage You to Reach For Your Golden Ring, “Because You Can”, If You Do It. Why Not, You’ll Feel Better. Even the Best Psychiatrists are Miserable Because even when they believe their ethics are so strong, they watch the enthics go out the window, over and over again, with this crazy look in their eyes. Then, it’s business as usual.
DO WHAT MAKES “YOU” HAPPY, and Make EVERYONE Else Happier. Isn’t That The Reason We’re SO MAD IN AMERICA? Because we’re Allowed to do what WE ARE ABLE TO DO, AND WE’RE NOT DOING WHAT WE WOULD LOVE TO DO?
I Hope You are successful at all of your Endeavors Because You Have ETHICS. ~Sarah
Now I Take A Nap, Then I’ll Weave A Basket, Then I’ll Drop my Blow Dryer into the Tub. Then I’ll Draw With Crayons (a Pretty Picture). Just For To FORCE myself to (fit the mold) whatever it is?
Please Send Nurse Ratchet in with 2 cc’s of Haloperidol SO I CAN TAKE A NAP!!!
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Or These,
https://www.youtube.com/watch?v=G0yU-YJ6sjY&list=PL7A9200584AE4CFC1&index=1
The thing I Liked about hospitalization the most, was I loved to be with the other patients who were in there.
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Hi Daniel.
I don’t have any good answers to the question you pose above, although I have seen and experienced this issue from many sides and think of it often. I was an LISW-S in the state of Ohio for a number of years. My agency practice included a number of tasks that I will probably have to answer for at some point, the most horrifying of these being writing seclusion and restraint programs for individuals who are differently abled with regard to cognitive functioning (commonly referenced as “intellectually and developmentally disabled” in current, politically correct, clinical language). As another writer notes above, you can stop being a clinician; but, you can never escape the stigma. Any stigma I carry for the horrific oppression I was responsible for perpetrating on this already completely marginalized population is well deserved.
In your essay, you talk about the relative limitations and advantages of both clinical practice and life coaching. I have one point that I want to add to your discussion. If you are a clinician, and you are “out” as a consumer/survivor/ex-patient, you will become a target for your colleagues. Not maybe, eventually. Definitely. And sooner rather than later. All of the expensive and time consuming licensure that you have worked for will be jeopardized. This feels completely wrong, I know. I thought the same thing a dozen or so years ago when I returned to work from a psychiatric hospitalization. I thought, “Well, I work in the field of mental health. My colleagues will understand. I will have a better understanding of those I serve. Surely I will be treated kindly and my knowledge will be valuable.” Wrong.
Lived experience is still treated as a ticket to unemployment in many mainstream clinical settings. I returned to work, and immediately, another clinical person with my same first name began referring to us as “crazy Sharon” and “regular Sharon”. I went to a staff meeting of the department I supervised and was ready to run the meeting. Imagine my surprise to find that a junior clinician, many years younger and more inexperienced than I, had been promoted to my position while I was on leave. I had been demoted back to direct service. This was never discussed with me by administration. The Human Resources Director told me my supervisor stated I requested the change. To this day, I don’t know which of them was lying. Both serve as examples of the abusive hierarchy that you mention existing in much of agency work. It is very unfortunate that I was not in a good place to exercise my rights in that situation. I was also not in a good place to look for another job and remained in this abusive situation for a few more years. This agency, Blick Clinic, Inc., continues to operate in Akron, Ohio and continues to crank out seclusion and restraint plans for already oppressed individuals.
Some years later, I left agency work and formed my own practice as a dissident clinician. Many people who came to me had experienced abuse in the mainstream system. I was openly critical of local mental health boards and related programs and continued to be a target of discrimination by my former colleagues. Eventually, one of them (I presume) filed a complaint with the Ohio Counselor, Social Worker and Marriage and Family Therapist Board. The board initiated an investigation and basically asked me to prove I was not impaired to practice. I told them to fuck off. Subsequently, the board barred me from ever practicing as a clinician in the state of Ohio again. It felt like no big loss, honestly. In retrospect, I believe that the actions of this board were another symptom of the discrimination that faces clinicians who are “out” as consumers/survivors/ex-patients. I believe it was probably illegal.
In further retrospect, I see that the debacle with my clinical license was partially a sick drama that I created for myself because I did not WANT to be any part of that system any longer. I feel somewhat disappointed in myself that I did not own my power and simply walk away when I knew for sure, inside of myself, that I hated that system and needed to become an Activist and critic of the system. As I state at the beginning of this comment, I don’t know the answer to whether or not it is the right thing for you to walk away from your clinical credentials, Daniel. But I hope you make this decision on your terms, fully informed, with the dignity that you (and all of us) deserve.
Best regards,
Sharon Cretsinger, XLISW
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This Too,
https://www.youtube.com/watch?v=nOEDMr2lPao
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Daniel
Interesting blog. After 21 years (still working) as a therapist/counselor in a community mental health clinic I would make the following comments:
1) Whether working as a therapist or life coach in today’s world, if you don’t become educated about what is wrong with Biological Psychiatry and its complete takeover with the medical model you will not be able to offer much help to people and will probably end up harming them.
2) Working both inside and outside the system is a daily battle to avoid allowing yourself to get stuck on the often deadly “path of least resistance.” That is a path that both follows and reinforces an oppressive status quo.
3) Once educated about the criminal nature of Biological Psychiatry and its medical model you cannot help people or do positive work inside the system unless you are constantly pushing up against and challenging the status quo, and also taking calculated risks that may very well lead to you getting fired.
4) Whether inside or outside the system if we do not take our knowledge of the crimes of Biological Psychiatry to the level of building and supporting mass direct action targeting the system, then we are limiting our effect on social change and foregoing our historical responsibilities as truly moral human beings.
Richard
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Well said, Richard. And I concur. Many in the “mental health” field seem to have fallen under a collective delusion that diagnoses are actual entities and that biological psychiatry and the medical model are the only way to help individuals. Sadly, many in the profession seem unwilling to take a stand and risk being fired. And it is tiring always challenging the status quo.
In regards to your decision, Daniel. You already know enough to serve and to help people heal. People will pay for what you have to offer regardless of your credentials if you serve them and help them accomplish what they want to accomplish. In my opinion, you’ll experience more freedom and less stress with less restrictions by serving others as a coach – a talented, committed, highly trained coach – rather than a cog in the industrial mental sickness machine. Breaking free is stressful, it comes with a cost (peer skepticism and perhaps rejection, smaller pool of clients initially perhaps) but you will be free to serve as you best see fit.
Trepidation about the decision is understandable. However, don’t let it paralyze you. The mental health system is a socially constructed game. And there is tremendous power, relief, and freedom in realizing you don’t need to play that game. In fact, you can create a new one — and still leverage your knowledge, expertise, and compassion to serve. And in your new game, you get the freedom to be your authentic self.
Just my two cents…
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The best therapeutic relationship I ever had was when I took mandolin lessons. I was in a horrible place mentally and emotionally, and going through appointments and checklists with professionals was nothing but an exacerbating ordeal. The lessons gave me something to focus on other than my misery and problems. I went once a week, but had something to do and focus on every day, practice. I could practice as much or as little as I liked. I could cancel whenever I liked, but rarely did out of courtesy, and never did without notice. My teacher always asked me how I was and how my week had been. Sometimes we spent ten minutes or so talking about my week or my problems, and they might mention their own. They always remembered what we had talked about the week before, and sometimes asked me about something I had mentioned the week before. The lesson was half an hour, which was not too much time for me to handle. Going to the office of a professional and sitting in the crowded chaotic waiting room for up to three hours was too much for me to handle. I think the most important thing was that my teacher was a good, affable person and also had the freedom to do as they liked and felt best for the lesson. A few lessons in they mentioned I looked nervous, and I admitted the fact that their office was tiny, up two narrow stairways and down three narrow hallways was causing me to panic. They pointed out the fire escape stairwell was right outside the door and I said, I know, I tried it and it’s locked. They checked and said, You’re right, now I’m going to panic. The funny thing was I did mention my diagnoses and it didn’t change anything. No emotion or problem I ever mentioned was diagnosed or labeled as abnormal. We just spoke about them briefly and they expressed compassion or perhaps a suggestion briefly. My completely reasonable concern about the fire escape wasn’t due to paranoia or delusions of persecution. After talking about something that was a bit off once I mentioned that they must think I was incredibly odd, and they just said, Not at all, you wouldn’t believe some of the things the people who sit in that chair have said to me, especially the teenagers. Also I just enjoyed myself, and enjoyed the practice. I took lessons for about a year, as I had planned. There was an expense involved, but I very much felt I got my money’s worth, which I can’t say for any mental health professional who treated me, ever (not that I would think good mental health care wasn’t worth the money.) I also had a good experience talking to a very kind and helpful local police officer. They gave me a lot of advice about a particular problem I was having, and because what I was doing about this problem wasn’t working I followed that advice, although my instincts were practically screaming against it. It was (so it seemed to me) miraculously helpful, and led to very positive changes in my life. If I had chosen to take it up with a mental health professional I might have spent years wallowing in misery about it. I think I spoke to the officer and a friend of his who also helped for a total of two hours. Then I arduously sucked it up and tried what they suggested. They didn’t ask for my life story (although they listened seriously as I blabbed it at them,) they didn’t pathologize, patronize or laugh at me, and they didn’t believe patching on a simple solution and getting on with my life was somehow a bad move.
Anyway this is a good article and it got me thinking. I’m not sure what the answer is, but it seems like it would be very, very difficult to make a living as a life coach. I wonder if it is impossible to work as both at once?
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Keep going this route, Daniel, it looks right and leads to wondering for good reasons about what needs done. You are that outspoken practitioner you say to be.
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“…ultimately, perhaps, this whole essay is just a reflection of the insanity, fragmentation, and obsession with labeling and categorizing of our mental health system, or mental illness system, depending on your point of view.”
Daniel,
Another fine blog post that reads well — except as you get to your very last sentence (imo). Of course, it’s possible I’m misreading you, in those concluding lines, but you seem to express doubts as to whether there would really be much difference, after all, were you to hand in your State-sanctioned credentials and then put up a shingle, advertising yourself as an unlicensed personal coach (as opposed to a licensed psychotherapist).
Prior to that point, your blog regards your psychotherapist’s licensing, so you are openly pondering, in clear/concise terms, an array of very real and potentially insurmountable issues for any would be licensed therapist who is totally awake to the realities of psych-survivor issues (as you are awake to them); and, moreover, you possesses an awakened conscience.
Hence, throughout the brunt of your blog post, you’re addressing consequential issues, pertaining to what are increasingly intractable problems throughout the system, issues that can’t help but plague the all conscious professionals now striving to earn a living as licensed ‘mental health’ pros…
That’s not to say I think I know what’s best for you (but, I will say I do appreciate Richard D. Lewis’s four points of advice, in his comment on October 7, 2014 at 9:58 pm and also Alex’s advice in his comment on October 7, 2014 at 12:06 pm… oh, and also Sharon Cretsinger’s October 7, 2014 at 7:48 pm comment is very powerful and moving, but it doesn’t necessarily apply to you, as it seems to me, from my limited readings of your online offerings, you aren’t a psych-survivor).
Anyway, I think you’re getting a lot experienced advice on this page, you’d do well to take many of the comments to heart, and though I’d not want such a ‘mh’ license of any kind, that’s just me; I’d not judge you for keeping yours, because…
I think there are really are (rare) individuals who do far more good than harm working in the ‘mh’ system (of course, they are those who are willing to buck the system, from within, as Richard D. Lewis describes); I know there are a number of such individuals who are associated with MIA, as bloggers and commenters; but, I just know that I personally would never choose to work (note even for a moment) in any way that ever required me to seemingly affirm for anyone the supposed reality of his or her psychiatric so-called “diagnosis” or “diagnoses” (committee-approved label/s).
To encourage people to go on believing in those totally pseudo scientific ‘diagnoses’ — suggesting they and/or others whom they know should or can be well described as “mentally-ill” or “-disordered” makes no sense whatsoever to me. To prop up the medical model in that way would be contrary to every bone and ligament in my body.
(Of course, there are folk with verifiable neurological disorders who some therapists may address in the course of developing a career.)
In any case, it’s more than obvious from reading your words, you are a man with considerable integrity, so I’m quite sure you’ll make the best possible choice, that’s in accord with your Path (and your conscience).
Respectfully,
Jonah
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Therapist or life coach – nah mate, neither. Good Friend is what I want.
On a more serious side, the problem isn’t so much the name of the job it is how the mental health system is organised, paid for, and what it’s aims are.
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Great point followed by a good one :).
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I’ll say a bit more about how the mental health system is orgainsed.
In the Western Lapland Open Dialogue System, which Daniel made an excellent film about, there are various workers who do the same job. They are psychiatrists, counsellors, nurses, social workers. If I have it right they visit people’s homes in teams, and with the agreement of the people who live there. They conduct conversations based on the idea of trying to understand what happened to drive the person mad, why they are acting the way they are and to help all the people in the person life understand each other bit more. They do it until the person is not distresed and can get on with thier life. If that doesn’t work they try drugs and other things.
In the UK you can get a referal to Individual Access to Psychological Therapies by phoning up a local service provider. It is free. You might get up to 20 weeks of really good counseling or you might get six weeks of really shoddy CBT. It depends on what the local service has been commissiond to do. If you have a diagnosis of psychosis or are are talking odd you might be excluded from the service.
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Therapist Or Life Coach? Why Not Friend? You Must Have Heard Me and Casper before we fell asleep. We both read this article and came to the EXACT SAME CONCLUSION TOGETHER AS YOU SAY, ~FRIEND!!!!!!!!!
I Think Your Statement Is So Profound That It Could Escape Someone Very Easily. You Say 1000 words in just 1 word “FRIEND”.
Who Doesn’t Need A REAL FRIEND?
Who Forgets A REAL FRIEND?
FRIENDS A PLENTY – “1 IN 20”. In Essence, If You Believe 20 People Are Your Friends Maybe One Is Your Friend If You’re Lucky. This Excludes FB lol.
https://www.youtube.com/watch?v=ZtSJu6OHe_U&list=RDZtSJu6OHe_U
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Daniel –
Loved reading this post. So thoughtful and concise. There are so few black or whites in this world, but teasing out how to find your way through the weeds is essential. I almost went for my LCSW years ago but backed off because the paradigm felt so oriented in pathology.
I love that you’ve gone the filmmaker route. Any chance you’re selling DVD’s? I’m on the West Coast but would love to have some house parties or try to connect the art houses here with this kind of work.
Regardless, I’m glad you’re part of this community. Keep up the lovely work.
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somewhat relevant:
https://www.youtube.com/watch?v=Pr9ruvxA3K4&list=PL7A9200584AE4CFC1&index=8
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Therapist…..”.I don’t know how you can say this is a fascist state”.
Life Coach…”.I’ll guide you on how to fulfill your dreams of freedom in this fascist state.”
Massage parlor owner…… “Let me introduce you to Angela.”
Which one would you chose ?
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Daniel, As a long term 40+ years) mental health professional with a counseling psychology Masters, certified as a hypnotherapist and an NLP practitioner. In 1983 I realized that most of what I was doing in my private practice in Hollywood, CA was teaching self-confidence, self-esteem and other life skills and coaching folks as they developed them. So I invented a label for what I was doing, “Life Coaching.” My ads said. “You have a coach for the gym, a coach for your acting and performing, so how about a coach for the rest of your life?”
Because I was operating in that area of counseling and then later on, working extensively with street kids, I never thought I would need to be licensed. It one point I had accumulated all the hours for licencing and decided taking the test was a waste of time. I also knew that I would not be able to do the innovative work I was doing with the licencing restraints that you discussed, so I never got licensed.
Flash forward to the present. At a time when I ought to be running programs and agencies, I can’t even get a job as a counselor without that license. My advice is keep your license and just do the coaching work you want to do. As long as you draw clear boundaries with your clients as to what you consider to be therapy don’t go there with them, you will probably be OK. There are lots of licensed folks that are practicing as Life Coaches. Keep that license just in case some time in the future you would like to be running a program.
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After my training in hypnosis, I adopted the term life coach because of the stigma on being hypnotized. It is a lot of work to market my services and convince people I can help them quit smoking or manage unwanted habits. The life coaching world is oversaturated with influencers and so I have decided to pursue my LCSW so I can help the people who can’t afford the hourly rate of life coach..
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