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The Reflective Eclectic

I’ve written hundreds of articles on mental health and relationships. My latest are published in Substack, in a weekly newsletter, The Reflective Eclectic.

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A therapist not trained in Person-Centered Therapy is like a musician who never learned his scales, basic skills for his profession. But, going to a therapist who only practices Person-Centered Therapy is like listening to a musician practicing scales. It gets pretty tedious and you wonder if it’ll ever go anywhere.

Carl Rogers, who developed Person-Centered Therapy, likened therapy to growing a plant. When you provide the right kind of soil, the right amount of sunlight, and the right amount of water, plants grow themselves.

Rogers said there are three things needed to help people grow: empathy, acceptance, and sincerity.

How to Escape the Identity Trap

My client was a young, black woman, anxious about fitting in to her new job, and worried that she’d never find anyone to love, with so few eligible black men available. I wondered why she was seeing me. I am a licensed counselor, but I am not, nor have I ever been a black woman. I was young once, but I’m not young now. I’ve started new jobs, but I haven’t been her, starting her new job. I’ve had my days when I thought I’d always be alone, but it was for different reasons. Why would she think I would understand her, much less say what her problem was, and have a good idea of what to do? And yet, as a therapist, I was called upon to empathize, diagnose, and treat someone with a different lived experience.

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Why I Don’t Specialize in Anything

As a therapist, I could’ve had a specialty; but I wouldn’t be the kind of therapist I am.

I did some post grad work in family therapy and some more in substance abuse. I sought for ways to address the desire my clients had to quit using tobacco back in the days when few others were doing so. I ran therapy groups for sex offenders. For more than thirty years I had a caseload full of victims of trauma, depression, bipolar disorder, and anxiety disorder. I sought clients with borderline personality disorder, when most thought they were untreatable. I could have specialized in any one of these conditions and turned away clients without them, but I’ve always resisted specializing in anything.

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Announcing My New Substack

I’m Keith Wilson, a psychotherapist in private practice and writer of novels, short stories, poems, self help books, and hundreds of articles focused on mental health, relationships, philosophy, and the practice of psychotherapy.

I’m awed by everything a psychology of depth, insight and relationship has to offer and want to share it all in thoughtful, accessible writing. I’m looking for readers who are curious about the human mind and its capacity to adapt and love.

I intend to send an email out no more than once a week, containing re-published articles that have been buried in the archives of my blog. These will be available to all subscribers. Those who support my work with a paid subscription will have access to new articles as they are released.

Originally published at https://keithwilsoncounseling.substack.com.

While You’ve Been Collecting Tokens at Your Meeting, Your Addiction Has Been Doing Pushups in the Dark

While You’ve Been Collecting Tokens at Your Meeting, Your Addiction Has Been Pumping Iron in the Parking Lot

So, you’ve stopped drinking or drugging. The addiction seems to have gone away.

Has it, really?

Addiction takes cover sometimes when it feels threatened. It’ll hide in the bushes and come roaring out when you least suspect it. Make no mistake, addiction is cunning, baffling, and very, very patient. While you’ve been collecting tokens at your meeting, your addiction has been pumping iron in the parking lot.

Addiction prefers the dark. It likes to perform its dirty deeds in secret. The night belongs to Michelob. However, addiction is rarely ever a real secret. It’s kidding you when you believe it leaves no trace. You can tell when addiction is still afoot if you are willing to read the signs.

These are the signs:

You haven’t done the things promised for your recovery

If the problem behavior is gone, but you still haven’t been to see a therapist, attended meetings, written that letter of apology, changed associates, or done any of the things you promised, then the addiction is just hoping you won’t notice.

The behavioral changes have been minor

The more serious the addiction has been, the more excited you’ll be when there’s been a slight improvement.

You were drinking every day, now you’re thrilled that you cut down to once a week. You used to put your whole paycheck into your arm, now you’re just chipping a little. The underlying attitudes towards drinking and drugging have not changed; the only thing changed is the frequency and severity.

When gardeners trim bushes back a little, they call it pruning; it doesn’t destroy the bush, it makes it grow more. The same thing happens when only minor changes are accomplished. You wouldn’t be satisfied with your surgeon if you had a mastectomy and he left some cancer behind, so don’t fool yourself by minor behavioral changes.

Your thinking has not changed

If the rationalizations that have justified the addiction are still in evidence, then nothing has not gone away. You used to say you needed to drink, so you drank. Now, you don’t drink, but you still say you need to. Guess what? You’ll drink again. If the madness was truly gone, you’d no longer believe you needed it.

No fence has been built

It is not enough just to change the problem behavior to recover from addiction. You also have to know the route that it takes before it arrives. You need to put up a gate and shut out behavior that, in itself, is not problematic, but leads up to the problem.

Relapse comes masquerading as something harmless so that you will not see it coming. If its powdered cocaine you’re addicted to, there’s nothing wrong with having a glass of wine at dinner or a pain medication that was prescribed by your doctor, right? No, not at all, except for where that leads, for you.

Authentic recovery means that you see through all the disguises.

You minimize your history

If the story you tell about your addiction differs significantly from your partner’s, then it’s still lurking about. If you talk about it only in terms of your suffering and leave out how it affected others, then you’ve not incorporated other points of view into your own. Your limited perspective is still all you have. You have an incomplete appreciation of the costs of your choices. You should be able to tell your partner’s side of the story as well as your own.

You’re withdrawn

If your partner complains that you’re virtually unreachable, emotionally inaccessible, or sexually uninterested, then relapse is waiting for its chance to strike. It doesn’t want people to ask too many questions, know too much, or get too close.

You’re always angry

You may be blaming other people for calling out your addiction and challenging it. you may be using anger as a way to keep others away, off balance, and uninformed. You may still be taking sides with it, against anyone who cares.

Your partner is working harder at your recovery than you are

Your partner has been on you like white on rice. Ever since you had that relapse, she’s been monitoring your phone for drug dealers, checking your whereabouts, scanning your emails, opening your letters. She doesn’t let you go anywhere without her. She scrutinizes your eyes whenever you come home at night. She’s gone to more Al-Anon meetings than you’ve attended AA. She found a therapist for you, set up the appointment, brought you to every session, paid, and did the homework assignments. Your partner is working harder than you are.

If you have not taken responsibility for change, then you will not make the right choices the moment your partner’s back is turned.

You say everything is changed

You’re not the one to judge whether anything has changed. When your addiction fools people, it fools you first.

You want to move on and not get stuck in the past

That’s the addiction talking, trying to convince you to not learn from the past. Truly recovering people remind themselves of the past regularly, so that they’ll not repeat it.

You want credit for improvements

An adult straightens the house every day. He scrubs the toilets when they need it and mops the floor when it’s dirty. He doesn’t expect a medal for it. He just does it because it needs doing.

A toddler tickles the furniture with a feather duster once in a while and everyone will fall all over him, saying he was very helpful. That’s what they do for a child. Are you a child?

When madness takes over: the less you do, the more credit you think you deserve.

In a healthy world: you don’t earn special points for doing what you should have been doing all along.

It’s still all about you

Not only have you stopped the problematic behavior, but you’ve been going to therapy, attending AA, writing in your journal, and getting in touch with your feelings. These are all good things, but you’re still as self-involved as ever.

Real change means taking action towards becoming more loving, generous, caring, and empathetic towards others.

There are no signs

You looked over this list and you did not find a single thing that indicates relapse may be lurking. There seem to be no signs. Well, that’s your sign. If you aren’t seeing signs, then you’re fooling yourself. There are always signs.

The road to recovery is the same road as the road to ruin; you’re just traveling in a different direction. You pass by the same markers as when you were heading to ruin. You should be seeing them now and recognizing them for what they are. You should also be seeing some signs that indicate you are heading in the right direction. You should be seeing meaningful change.

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Why Ask Why?

Sooner or later, if you come to me for therapy, I’ll ask you to put, in a single sentence, your objective in seeing me. I ask this because I want to know how to be successful. I also want you to define your goal. The most common answer I get is something like, “I want to know why I am the way I am.” In other words, why do I drink more than I should, why can’t I get the courage to leave my husband, or why am I so depressed, so anxious, or so angry?

I used to be surprised by this, especially if it came after a long, intense description of how unhappy they were. Wouldn’t they rather know how to stop drinking, how to be less depressed, anxious, angry, or how to leave their husband. Why ask why?

The insurance company which may be paying for most of your therapy would rather you asked how than why. How can be answered in a few sessions. I could teach you the principles of relapse prevention, symptom management, cognitive behavioral therapy, dialectical behavioral therapy, mindfulness meditation, relaxation, conflict resolution, or refer you to a divorce lawyer without even getting to know you. I may not need much training or be especially skilled or wise to teach you how. It could all come from a book or a YouTube video. In fact, you might not even need to see me at all: you can buy the book or stream the video and save your insurance company a lot of money. Why is a harder question, one that cannot be answered in brief therapy.

Psychotherapy researchers would rather you asked how than why. When you ask how, success or failure can be more easily measured. Either you stop drinking or you don’t, you get up out of bed or you don’t, you get on that plane or you don’t, you bust another hole in the wall or you don’t, you get a divorce or you don’t. When you ask why, we can never be sure we’ve gotten the true answer. Are you the way you are because of early weaning, genetic determinants, cultural influences, racism, sexism, peer pressure, individual choice, or sheer laziness? The answer is probably yes, all of them to some degree, and more. But, even if we get an answer, how will we know when we find it? Psychotherapy researchers have no patience for that. It’s publish or perish for them. Consequently, no therapy that asks why will ever be listed as “evidence-based” therapy in the way they often define it. Insight-oriented theories cannot easily be falsified, confounding variables cannot easily be eliminated, and results cannot easily be measured. Psychotherapy researchers would rather do what’s easy.

Employers of therapists, those big head-shrinking conglomerates like I used to work for, would rather you asked how than why. They can hire less experienced therapists, pay them poorly, and be assured of a standardized product if the focus is on how, rather than why. They’ll be on good terms with insurance companies and be able to point to statistics of success. They’ll keep you moving into brief treatment, out of treatment, and often back into treatment with a new therapist so that your brand loyalty is with the clinic at large, not with an individual clinician. With how, you are just another widget, in for standardized repairs. When you ask why, there is no way you can be treated in any way other than as a complex, unique individual.

Given these difficulties, why do people ask their therapists why, when they could be asking how? Why would a therapist entertain why as a question? Are there any good reasons?

You want to have a name to call the problem
In many cases, people haven’t recognized that their misery fits a particular pattern. They want a reason they are unhappy. If I see a pattern and tell them they’re unhappy because they are an untreated alcoholic, or because they’re depressed, anxious, don’t know what to do with their anger, or are in a bad marriage, that might be all they need to know. Having a label gives them the ability to find others who have the same problem and learn from them.

Of course, why is a question that only leads to more why questions. If I say that you can’t get up in the morning because you’re depressed, you can Google it and get all kinds of tips to deal with depression. You can go to your doctor and know what drug to ask for. You can take solace that you are not just lazy but have a treatable disease. But it’s only a matter of time before you ask why you are depressed. What causes your depression and why do you have it when others don’t? Why is a question that goes all the way down and never ends.

You just need to tell the story of your problem, but you can’t find anyone who will listen
You can live with all kinds of things — depression, anxiety, a shot liver, a bad marriage — if you have a good reason to do so. Often, you aren’t really interested in changing anything so much as gaining the dignity you get when you find the meaning in it. Most times, when you try to tell the story of your problem, people try to fix it, when all you may want is for them to bear witness to the sacrifice you are making. If you come to see me and all I want to talk about is how to fix the problem, then I’ve done the same thing. If you want to talk about why, I’d better be listening.

You don’t want to change anything yet; you just want to understand it
You figure it might be better to understand your problem before you try to change it. You know that every problem was once a solution to something else. It’s better to study the source of the problem than tear into it and start changing things willy-nilly without knowing how everything is connected.

The woman who wants to know why she doesn’t have the courage to leave her husband should probably ask why long before she asks how. If she doesn’t know the part she plays in her marital problems, she’ll just leave that one relationship, only to end up in another just like it.

If you knew why, then you’d know how
In many cases, asking why is the same as asking how. If your car doesn’t start and you know the reason is a dead battery, then getting a new battery is how you fix it. If you can’t get going in the morning and you know the reason is that you hate your job, then you know that if you got a better job, you will look forward to starting the day.

You believe that why is the answer I can give. You don’t think I can tell you how
You’ve heard about shrinks before. You’ve seen them on TV. You’ve been to one a few times. We strike you as academic types, inhabiting an ivory tower, far removed from the hurley-burley of actual life. We’re given to endlessly analyzing things, going back to childhood to find first causes. Moreover, you want to be a good patient. You want to have an objective that would please me, something that permits me to ask about your childhood, since that’s what I want to know anyway.

I have to admit that many of the stereotypes about therapists are true. We are largely an impractical bunch. We seldom have a payroll to meet. When we’re asked to be accountable, we raise an unholy ruckus. Our walls are lined with diplomas and books. Some of us actually write books, so I think it’s fair to say we are book people. We ask a lot about history. We’re obsessed by context.

Moreover, we can’t answer how your problem is going to change because we don’t know what it will take to change. Many of our interventions are hit or miss, our suggestions are misunderstood, our recommendations are ignored. We haven’t studied success like we’ve studied problems. When patients are successful, they leave, so we often don’t know what worked, or even if anything worked.

Why is the sound ambivalence makes
Often people who are not ready to do something about their problem will engage in stalling tactics, like asking why instead of how. That’s fine with me. You must be ready for change before change will truly occur. It’s boring to talk about how to make a change if you are not ready to make the change, so we can talk about why. Talking about why keeps you focused on the problem while you work through your ambivalence towards change.

Let’s take the guy who must stop drinking. There’s no real point in developing a plan to stop drinking when he still does not have the motivation to do so. But it is OK with me if he comes to therapy to ask why he drinks. That will occupy us while he sorts it out. It could sound like he’s looking for an excuse to drink, except that, in asking why he drinks, he’s also asking why he doesn’t stop. Asking why he doesn’t stop drinking is as good a question as asking why he drinks at all, and it is a question that lets him imagine a life without drinking.

So, you see, there are lots of good reasons to ask why, rather than how. I’ve come to accept why as an answer when I ask about goals and objectives. Now, if insurance companies, researchers, and employers of therapists could be more accepting of why, then clients would get the kind of care they want and need. They won’t have to keep coming back when only asking how doesn’t work for them.

The Shrink’s Links: Journaling

Writing a journal has been a big part of my own life ever since I began to examine the inside of my head. I’ve used it to express how I felt when I couldn’t express it anywhere else. It’s been a way I can pin down rushing thoughts and wayward feelings. I’ve sorted through choices and experimented with alternate points of view in my journals. I’ve used some parts of my journals in these blog posts and my novels.

I often recommend journaling to clients. They often want some tips on how to journal and I’ve meant to write a post about it; but then I came across a post by a subscriber to this blog. She has her own blog, elizablooms. Her article, The Ultimate Guide to Journaling for Mental Health is the ultimate guide, as good as any I might write.

Image by Jay-r Alvarez, Pexels

The Shrink’s Links: A Guide for Students With Mental Health Disorders

Going to college can be a challenging experience for anyone, but for students with mental health problems, it can be even more difficult. From dealing with the stress of coursework to navigating social situations, college life can exacerbate mental health issues. However, there are resources available to help students with mental health disorders succeed in their academic pursuits.

One such resource is the online college guide created by Intelligent.com specifically for students with mental health issues. This guide offers a wealth of information and resources to help these students navigate the challenges of college life. It’s packed with information to give students ways to succeed in their academic pursuits, including tips for managing stress and anxiety, strategies for staying organized and focused, and advice on how to communicate with professors and peers about mental health issues. The guide is useful for both online and traditional college students, and educators can also use it to better support students with mental health disorders.

Can You See a Therapist for Couple’s Counseling Who You’re Already Seeing for Individual Counseling?

When I’m working with you in individual counseling towards one goal, can you start couple’s counseling with me and your partner, towards a different goal? It seems like having only one therapist do both would be more convenient, but many therapists flat out refuse because of the complications that may ensue. Some believe it’s unethical, but is it right to send people away when you can help them? Moreover, making that decision for clients is patronizing. Wouldn’t it be better to treat clients as competent adults, discuss the pros and cons, and decide together on a case-by-case basis?

First, why do some believe it’s unethical? They’d point to provisions in most ethical codes, like the one New York State has for mental health counselors, that warn us to “avoid the dangers of dual relationships when relating to patients in more than one context…” In other words, it’s best to have only one relationship with a client at a time. If I already have a relationship with you in your individual therapy towards one goal, they say we would be adding a second if I also saw you in marriage counseling, to help you towards another. They say we would also be adding a second relationship if you were my server when I came to your restaurant, if I hired you to do my taxes, if our kids were on the same baseball team, or if you read one of my books. This rule can be taken to absurd lengths and, for therapists who live and work in a small town, it’s impossible to follow.

A dual relationship is obviously unethical when the therapist is doing something egregious like having a sexual relationship with a client or coercing clients to pay for extra services. That’s the kind of thing ethics codes are trying to address. But just where can we draw the line between the truly dangerous and the picayune?

I have a seventeen step process towards ethical decision making that should shift out frivolous considerations and show us the ones we should worry about. I got it from the sixth edition of Ethics in Psychotherapy and Counseling, by Pope, Vasquez, Chavez-Dueñas, and Adames. Let’s take one scenario and put it through the seventeen steps.

1. State the question, dilemma, or concern as clearly as possible.

Mark (not his real name), who I’ve been seeing individually for a couple of months for his alcoholism, is having problems in his marriage and wants his wife, Suzy (also not a real name), to join us for marriage counseling to help them communicate better, while he continues to see me for his alcohol use. He’s skeptical that he would find another counselor he trusts, for he’s had problems with that in the past and assumes it would be better to have someone already familiar with him to address this second issue.

It’s very common to meet with partners in substance abuse treatment, with the focus on substance abuse. In marriage counseling, it’s very common to find one or more partners who abuse substances, when the focus is on improving communication. But can I be effective when the focus is on two goals?

2. Anticipate who will be affected by the decision.

Suzy will be meeting me for the first time, while Mark already knows me well. She may feel out of place in my office and assume I’d side with him. If I don’t, then Mark may feel betrayed by me.

There may also be a problem with confidentiality. My individual sessions with Mark need to be private for them to be effective. What if Mark discloses something he wants to keep from Suzy? The goal in marriage counseling is to open up communication. That hardly seems to jibe when Mark and I collude to withhold information from her.

Then there’s the problem of mission creep. Will we end up talking about Mark’s alcohol use in marriage counseling and communication issues in individual, where we are least likely to effectively address them?

3. Figure out who, if anyone, is the client.

Up until now, Mark has been the client in his individual sessions. He pays for them and decides his treatment goals with me. The moment I meet Suzy, there’s a risk that her concerns may start to direct his individual therapy, making her the real client there, even if she’s not in the room.

In marriage counseling, neither Mark nor Suzy is the client alone. Their relationship is the client. Treatment goals should be decided together. Ideally, no one person would pay for it, set up appointments, or do most of the talking in sessions, but often one partner does it all, making the other person a client in name only.

4. Assess whether my areas of competence—and of missing knowledge, skills, experience, or expertise—are a good fit for this situation.

Substance abuse treatment is well within my area of competence. I have special training in that field and decades of experience. I also have had special training in marriage and family therapy. I wrote a book on communication and another on reconciliation. While my experience with marriage counseling is not as extensive as it is with substance abuse, I still have more experience than most other therapists they would find.

If Mark had asked for something different, like providing therapy for his seven year old son, I wouldn’t be a good fit. Although I’ve had some training in it, it’s been a long time since I did therapy with a child.

5. Review relevant formal ethical standards.

The most relevant ethical standard is the injunction to avoid dual relationships, as I’ve already discussed. But the argument could be made that being a marriage counselor and substance abuse counselor are not two different roles, but different parts of the same one. In that case, the relevant standards would be around treatment planning. The only thing the New York State Office of Professions says about treatment planning is that I should be appropriately trained to implement the treatment plan. The American Counseling Association (ACA) says more. It says I need to work jointly with my client to devise a plan that offers a reasonable promise of success, consistent with the abilities, temperament, developmental level, and circumstances of the client.

6. Review relevant legal standards.

The ACA Code of Ethics is a good reference point, but it has no legal authority over me. Legally, I only need to worry about the standards set by the New York State Office of Professions. Both treatment for alcoholism and marriage counseling are within the scope of practice for licensed mental health counselors in New York State. Regulations also say I should avoid dual relationships. I could be sued or lose my license if I don’t, but it’s highly doubtful I would over any but the most egregious errors.

7. Review the relevant research and theory.

There’s a large body of knowledge called systems theory which is relevant. One of its principles is that individual problems like alcoholism cannot be separated from marital issues, such as communication. Under systems theory I wouldn’t even try to treat someone solely by individual therapy or solely by marriage counseling or even to focus solely on addiction or solely on communication. Everything’s connected.

One evidence-based treatment model that comes out of systems theory is Integrative Behavioral Couple Therapy. IBCT explicitly integrates the symptom reduction work done in individual therapy with the opening up communication work of couples’ counseling.

8. Consider whether personal feelings, biases, or self-interest might affect our ethical judgment.

My strongest bias is in favor of systems theory. I have an aversion to arbitrary distinctions. Before Mark and Suzy came along, I developed an innovative program that integrated mental health and substance abuse treatment, two types of treatment that are sometimes incompatible. Therefore, I’m predisposed to rising to the challenge of finding how things can fit together.

I’m also inclined to go with Mark’s proposal because I would like to please my client who’s asking me to do this. You could say it’s in my self-interest to keep all Mark’s counseling business to myself, but, believe me, I’ve got plenty of work. The counseling business is different from many others in that there’s a limit to how much you can take.

Mark has a bias towards seeing me for marriage counseling because he’s learned to trust me and won’t have to repeat his whole story to a new therapist. We don’t know how Suzy feels about this arrangement, though. We’d need to fill her in on all the pros and cons and get her opinion.

9. Consider whether social, cultural, religious, or similar factors affect the situation and the search for the best response.

It was hard for Mark to go to therapy at first. Talking about his feelings does not come naturally to him and he’s had some bad experiences. Therefore, it might be hard for him to start seeing a therapist he doesn’t know. While I don’t know much about Suzy’s culture or religious background, I do know she’s a woman. I might assume she’s more adaptable socially, as women often are. However, I should not take her for granted. That would not be a good start if I do work with her in any way.

10. Consider consultation

I have a number of colleagues I consult on ethical issues and have talked about the issue of combining treatment modalities with them. Some of them would not agree to this request if asked of them, either because they don’t think it’s ethical or they’re not qualified to do it. Others would agree to it, either because they’ve used something like the seventeen steps, or because they just do what feels right.

The idea of consultation is not to see if everyone agrees with me. The idea is to solicit multiple points of view, so I can consider things I haven’t thought of. The decision about what to do must always rest between the therapist and clients, not a committee that has never met them.

11. Develop alternative courses of action.

The alternatives are:

Try marriage counseling as well as individual, just as Mark proposed.
Have them see Suzy’s therapist for marriage counseling, if she has one.
Have them find a whole new therapist for marriage counseling.
Not do any marriage counseling at all.
Pause Mark’s individual therapy while we address the communication issues.

12. Think through the alternative courses of action. What are the risks with each?

If we tried marriage counseling as well as individual – The worst that could happen would be for Mark to get offended by me and stop going to both. Suzy might not engage because she assumes I’m biased. We might allow the focus of treatment to drift.

If Mark and Suzy were to see Suzy’s therapist – They’d run the same risks with Suzy’s therapist as they do with me. I would not be able to fully integrate the addiction work with the communication work.

If they did not get any marriage counseling – They may continue to struggle with communication and Mark would relapse with his alcoholism to deal with the pain of a bad marriage or divorce.

If they go to a new therapist to do marriage counseling – There’s a greater chance that an unknown counselor would be a bad fit than a known one. I would not be able to fully integrate the addiction work with the communication work.

If we pause Mark’s individual therapy while we do marriage counseling – We might get distracted from Mark’s recovery, leading to relapse. Mark still might get offended by how differently I relate to him in marriage counseling and stop coming. Suzy still might not engage because she assumes I’m biased. However, Mark would have fewer appointments to keep each week and it would save him the expense.

13. Try to adopt the perspective of each person who will be affected

The person most affected would be Suzy, and she’s the one person who has not yet been part of the decision making. We obviously need to talk to her before doing anything.

14. Decide what to do, review or reconsider it, and take action.

In this case, we decided that I would see Suzy for an individual session to get to know her and give her a chance to see if she feels comfortable with working with me. She was, so I proposed to start marriage counseling with the understanding that I would still be seeing Mark individually for confidential sessions. I explained that I’d keep those confidences, not because I think it’s a great idea for couples to have secrets from one another, but because individuals need a safe place to process their feelings and make confessions before putting them out to anyone who might have a strong reaction. I gave Suzy the same access to seeing me for confidential individual sessions if she needed to. She agreed to this plan, but never asked for any more individual sessions.

If Mark objected to doubling the number of appointments he must make, I was prepared to suspend his substance abuse treatment with the understanding that we will need to resume it if he relapses. As it was, he never complained about having to meet twice as often.

If they had decided to see someone else for marriage counseling, I was prepared to urge them to give me permission to talk with that therapist so that we would not be at cross purposes and so Mark does not have to repeat his whole story.

15. Document the process and assess the results.

I asked Mark and Suzy to read and sign a contract for each type of treatment. I wrote summaries of each session, no matter what type, and sent them to whoever participated. I repeatedly asked for feedback on how they thought it was going, so that we could talk about any problems that might come up.

16. Assume personal responsibility for the consequences.

In this case, we went ahead with marriage counseling to improve communication, as well as individual counseling for Mark’s alcoholism. It was very hard to keep them separate because Mark’s alcoholism, and Suzy’s bitterness towards it, played a leading role in the communication issues. It was like alcoholism was a third party in their marriage, like a stepchild that Mark brought in, and Suzy never learned to relate to.

Just as alcoholism invaded the marriage counseling, communication problems invaded the individual sessions. I often found myself coaching Mark on how to relate to Suzy better. Suzy could have used some private coaching sessions, as well; but she thought the problem was Mark’s alcoholism, so he should handle it.

In the end, we never achieved the goals set for marriage counseling. They remained cold and distant to one another and lost the enthusiasm for coming. Mark kept up his individual sessions and successfully sustained sobriety. I’m not sorry we tried it, though. I don’t think the outcome would have been any different if they saw a different therapist for marriage counseling. The two sets of problems really needed to be addressed together and it’s almost impossible to do so between two therapists who aren’t in the same practice. If I had to change anything, I’d insist on seeing Suzy for individual therapy more, making it an even more complex arrangement, for she was bringing her own baggage we never got a chance to unpack.

17. Consider implications for preparation, planning, and prevention

This question of seeing individual clients for marriage counseling, comes up so frequently, I decided to write an article about it, so the seventeen step process would be there for clients and therapists to read before making a decision to do it. Your case may be different from Mark and Suzy’s, but you now have a general idea about how to make tough ethical decisions and learn from them.

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I have written hundreds of articles on mental health and relationships. The latest are published in a weekly Substack newsletter, The Reflective Eclectic.

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Most Recent Articles

Thorny Issues I’ve Written About

I’ve been a counselor for more than 35 years in a variety of settings; I’ve heard everything. There are a few issues, though, that are so common, that I have a lot to say about them.

Addiction

Are you looking for hassle free help for addiction?

Anger

Truly powerful people have no need for violence

Anxiety

You can avoid anxiety or face it. I can face it with you, if that’s what you must do.

Depression and grief

Depression and grief represent a call to realign values as much as a sadness or lack of motivation

Improve Your Relationship

What kind of relationship do you want?

Trauma

If you had awful things happen to you, you might have put it away in a mental closet so that you could deal with it later. Perhaps it’s time to clean the closet.