Hi, this is Jim. Welcome to another episode of Kitchen Table Adulting.
Today my guest is Dr. Jennifer Kahler. Dr. Kahler is a licensed
clinical psychologist. Hello, Dr. Kahler. Hi, thanks for having me on.
Thank you for joining us. Today's topic is mental health counseling.
Dr. Kahler is going to answer some questions so we can learn more
about all things related to mental health counseling. Let's start
there. What is mental health counseling? Or better yet, let's start
with what is mental health? How do you define that? Sure. Mental
health includes our emotional, psychological, and social well-being.
It encompasses three different areas of health. It affects how we
think and we feel and we act and it also determines how we handle
stress and relate to others and make healthy choices. It's an
important issue at any stage of life from one childhood to the young
adult years into the elderly. Mental health and physical health are
equally important. They're often intertwined too. If somebody is under
a great deal of stress, they are more likely to have some physical
health issues and vice-versa. It's really important to pay attention
to both one's physical health as well as one's mental health. When we
say mental health counseling, how would you describe that? Well,
that's a way to describe it. I think some of the challenges that
people have are in understanding the concept of counseling, is that
there is counseling, there's psychotherapy, there's therapy, there is
psychoanalysis. They're all different ways that people can treat their
mental health or their health needs. Counseling and psychotherapy,
also known as therapy, in shorthand, are probably the most common
terms. Mental health and counseling are terms used to talk about more
short-term issues usually, like problem solving a specific need that
someone might have. It's more shorter term, addressing mental health
needs. Psychotherapy or therapy often refers to longer-term work with
a therapist where you might be addressing longer standing issues. But
truthfully, people use the words interchangeably. Yes, I did up until
one minute ago. I'm glad I helped learn. Yeah, I learned something
today. Generically, I think if people referring to it as counseling,
although I have heard the term psychotherapy before. Well, I think
people use the word counseling a little more because it seems a little
less threatening, or it seems a little bit less pathologized. Some
people think of the word psychotherapy or therapy as like there's
something really wrong with you. Counseling is like a less threatening
term that people tend to use. But also different therapists that have
different training also use the terms differently. If you want to know
more about that, we can [inaudible 00:03:29] That's a segue into my
next question, which is the different types of counselors. Now, you
are a psychologist, but there are other types of people someone might
go to. I know one is the licensed clinical social worker, correct?
That's right. Are there others? Yes. There are licensed clinical
psychologists like myself, licensed clinical social workers. I wanted
to say a few words about the differences between them. Please. A
psychologist is somebody who has their doctorate. They either have
their PhD or their Psy.D., which is written as P-S-Y.D. They are
people who have gotten a degree after 4-6 years of graduate school
plus a year of intensive full-time internship. Training; they also do
part-time clinical training during their doctoral program. Then they
have to sit for a national licensing exam and then also get licensed
in the state that they're practicing in. Psychologists do both
psychotherapy, psychologists use that term more. They also do
psychological testing. Psychologists are the only type of mental
health professional that gets training in psychological testing.
That's IQ testing, so to speak, it's educational testing, it's
emotional, social, psychological testing. That's one thing. Social
workers complete a two-year master's degree and also extensive
clinical training and then they have to get a license in order to
practice. Social workers work in private practice. They provide
psychotherapy or counseling and they also can work in agencies such as
in a community mental health agency or work for Child Protective
Services. They can do a wide range of clinical services. Then there's
also licensed professional counselors. They also have a two-year
master's degree, usually a master's in counseling or master's in
psychology and then they also have a lot of clinical training to get a
license. Then we also have other degrees like license on marital and
family therapists. Like it says, it's a two-year degree specializing
more in working with families and couples. Those are the main degrees
that we all have in mental health. The podcast being for young adults,
how would they know which one to go to or how to navigate that?
Really, I think that if a licensed professional counselor or a
psychologist are providing psychotherapy, I think that it's really up
to an individual preference. Some clients really want to see a
psychologist, they want somebody with a doctorate. Others, that
doesn't matter to them. It matters more about what the person's
expertise is. They have extensive experience working with substance
use so they'll go and work with that person. It's really a personal
preference I think. Got you. I will say to the audience too that
should you ever pursue any mental health counseling, you don't have to
work with the first person you encounter. Anyone you're going to see
for therapy or counseling has to be a fit. You might need to go to
one, two or even three before you find someone who gets you or who
makes you feel comfortable. Is that fair? Completely agree. I think
that a lot of the progress that's made in counseling and psychotherapy
has to also do with the relationship with the therapist or the
counselor, whatever you want to call it, it's the same thing. That is
extremely important, that you feel you can be honest and you can be
open and that you trust the person that you're working with. Yeah.
Then you and I had agreed to explain the difference between
psychologists and psychiatrists. Yes. Thank you. I should have
mentioned that psychiatrists also do psychotherapy or counseling
sometimes too. Psychologists, as I said, have doctorates, they go to
graduate school, they do not prescribe medication. Psychiatrists are
medical doctors that went to medical school and they do a residency in
psychiatry and they do prescribe medication and some of them also
provide psychotherapy. Yeah. That actually was the part of the reason
I made the comment about shopping around for the right personalities.
The first time I ever got antidepressants when I was in grad school
years ago, I had to start with a psychiatrist to get the script and
then talk to a psychologist. The psychiatrist, I'm still angry at that
guy, he was such a jerk. That's why it's important to me to remind
people you don't have to deal with somebody you don't get along with.
Absolutely not. There are many very qualified providers out there and
it's very important to find somebody that is looking [inaudible
00:08:42]. Yes. Let's talk a little bit about the stigma around mental
health counseling. Now, to clarify for the audience, I'm currently 45
years old. This topic was not even in America's vocabulary when I was
a kid. Psychiatrist maybe, but the idea of counseling is so much more
commonplace now, which is great but it still does have some stigma or
negative connotation. I managed the mental health services for a very
large public university and this is a problem we tackle every day,
trying to encourage students to seek services from us in the
counseling center. I think it's a combination of issues that
contribute to stigma. Sometimes students believe that you only go and
seek help if things are at a level of crisis, like if they're really
serious versus getting help early on before something becomes serious.
Other people have made it cultural or familial beliefs about what it
means to address mental health needs. It's really looked down upon or
criticized by family, and so they feel unable to move forward with
that, especially young adults that do have insurance under their
parent's. Health clan will often be really hesitant to seek services
because they know that their parents will see that they have done
that, which is one of the nice things about being a college student
because most universities, like the one where I work, provides free
services and you don't use insurance for that. I hadn't even
considered that, but you're right. If under you're in mom and dad's
insurance and then they get the bill and say, what is this? What's
going on? I think as a society, we've made lots of progress in the
last 20 years about accepting mental health, although there's still
definitely some barriers to break down. One of the things that I've
felt is, I got hung up for a long time on this idea of why is there
something wrong with me that's not wrong with other people? That was
really hard for me to accept. It seems like, of course, you and I know
that the people you see in everyday life or on Facebook aren't
necessarily as well off as you think but sometimes you can get the
impression that everyone else seems happy and fine and I don't
understand why I'm the one who has this problem. But I think the same
is true for issues that would drive you to a medical doctor for pain
in your abdomen or a sprained ankle, it's just the situation you find
yourself in. I think a lot of people in any age, but definitely young
adults, well, I would say that the young adult population today, as
you pointed out, just generally has a much more open belief system
when it comes to getting help for things or asking for help, but we
still have issues with stigma. But I do think that generally speaking,
it doesn't feel good to feel different, and so that is often what
stops people from getting help because they're afraid that there's
something very wrong with them that other people don't have. In fact,
oftentimes they find out that they're not alone in something. Once
they start talking to a therapist, you can validate and support what
they're going through. Yeah. That's one of my rules for being
successful adults, is you need to realize there are very few original
mistakes or problems out there. Somebody's done it all before.
Absolutely It's really hard to be original in any aspect of life now.
This is a question I've actually wondered about myself. When we're
talking about mental health issues, I guess I'll just ask you off the
top your head, how much of this is due to life experience or trauma
versus chemical imbalance, the way you're wired, the way you were
born? That's such a good question. I think that honestly, the field of
psychiatry in the field of psychology is not an exact science. Unlike
other issues, like medical issues, where you can do a blood test and
you can see that someone's blood sugar levels are really high or
really low and therefore they're diagnosed with such and such, there's
a family history of diabetes, for example, when it comes to mental
health, it's a little bit more of a guessing game. I would say that
when you're meeting with a new therapist, that therapist should do a
really comprehensive intake at the beginning where they are asking you
a lot about your history and family history and those kinds of things.
That can help inform the therapist's understanding of what you might
be dealing with. For example, if you share that both your mother and
father had struggled with depression or that there's a lot of anxiety
in your family, or that your sister takes anti-depressant for this or
that, that's just helpful information, I think for the clinician to
have, but it doesn't necessarily mean that you will have the same
thing. But if you have a strong family history of mental health
issues, it's more likely that you may develop those same issues and so
it's really good to pay attention to any symptoms and get help
earlier. But then some people are in counseling for things that
happened in life. I think trauma is the one that comes to mind where
it's not anything in the way you're wired. It's just something really
bad happened to you. What are some examples that young adults might
experience? Certainly trauma is something, and a lot of times, young
adults who have experienced trauma in their childhood don't really
feel able to start looking at that until they've left their home and
they're in a different environment. We do see a lot of young adults
coming in, and college students coming in for services to address
common issues they were never really able to do before when they were
living at home, for example. Other issues that I think are really
common in the age group are just anxiety and depression, but also
relationship issues. Identity issues are really big and adjustment
issues. What does adjustment issues mean? Well, adjusting to a new
environment, adjusting to being on your own, adjusting to living in a
new place, adjusting to sharing space with others that maybe you
haven't had to do before, possibly. But it's identity issues,
relationship issues, those kinds of things are pretty big in those age
group. On the subject of trauma, and this is just what I've observed
in life, that ranges quite a bit from things that are truly violent
trauma like you witnessed a family member being killed to things that
might not seem like traumatic events but still have a big impact on
you. Absolutely. I can't think of a good example right now. Does
anything come to mind? It happens to be my specialty area, is complex
trauma, so I can definitely speak to it. I think that we as a society
tend to think that it's like you just said, something really violent,
awful happens to someone, then surely they'll have a trauma reaction.
Although develop post-traumatic stress disorder. Like a car accident
or they witnessed a murder or something like that. They've been
sexually assaulted. But other kinds of trauma can also have really
lasting effects on someone. For example, growing up in a home with an
alcoholic parent or a parent that was always absent. Witnessing
domestic violence growing up, even if the person wasn't on the
receiving end of it, but they saw it a lot, the way that it affects
people, each person is different, but one of the ways is it really
affects that person's sense of what it's like to be in a relationship
with somebody, trusting others, oftentimes it can affect their sense
of self-esteem and identity, and feeling safe with people,so it can
have different effects. Yeah, there's a lot there. We could do a whole
podcast just on trauma. I think we'll bring you back for the trauma
podcast. That's an area I know well. I'd be happy to talk more about
it. I actually didn't didn't realize there were so many facets to it.
But I don't think and one thing from my perspective, the definition of
trauma is unique for each person, I think, in the sense that somebody
could witness a single act of violence in their household growing up
and not think twice about it or not really be affected and then some
people can witness somebody eluding the violence in the household and
have a very deep reaction. Absolutely, I mean, I think, that's one of
the interesting things about treating trauma is understanding the
impact that events have had on that person. So on things that are
significant are like protective factors like did this person if home
didn't feel that safe, did they have any other safe people or places
in their lives growing up? Sometimes that can mitigate some of the
severity of the trauma response. But I was also going to say that
there are other kinds of traumatic experiences growing up. Bullying,
being bullied can lead a lot of kids to experience a lot of trauma
symptoms and as adults not trust other people and not feel safe with
people. Growing up in a situation where you have food insecurity,
where you don't really ever know exactly if you're going to get your
next meal. Those kinds of things can also really have a strong impact
and be traumatic in a different way than we would normally understand
it. Okay, Thank you for that. I know there's no easy answer to this,
but what should somebody expect from counseling? I have a feeling for
most young adults, somebody's going to nudge you there rather than you
finding your way to counseling on your own. But let's say somebody
finally walk through your door, what should they expect? Well, I guess
the first thing is it's not a one visit and you're done. This is not
getting a tooth polled situation. You not have a magic one. Yes. Okay.
I wish I did, frankly, I'd use it if I could on people. Absolutely. I
think I got to say there's the pre-COVID and the current [LAUGHTER]
pandemic answers to what you'd expect in counseling because they're
very different. We can talk, if you want to, about virtual counseling
versus in a normal world what you'd expect. In a normal world, you'd
make an appointment with the provider and they either would ask you to
fill out paperwork ahead of time by emailing it to you. I don't think
people fax anymore. But emailing it to you and having you complete it
or completing online in like a portal that they might have. Or they
might ask you to come to their offices and sit in their waiting room
where you will find some forms to fill out and it's arrives like 15
minutes before your appointment like you would at a medical
appointment. You would expect when you go into the counseling office
or the therapy office that it would be a very quiet space, a space
that feels very confidential, the door will be closed. There are
usually a lot of, counselors have what we call white noise machines.
They're some machines outside their office door just for extra privacy
to make sure that nobody could hear anything what was said. A lot of
times a counselor's office looks like a living room [LAUGHTER] where
you have a couch and some comfortable chairs and usually there's some
nice art and a desk. Usually you'll sit across from a counselor
wherever you feel comfortable chair or a couch. Usually in the first
session the counselor will start to ask questions about what brought
you there, trying to get a sense of what you might need and get some
background information from you. Remind you a little bit about
confidentiality, that what you're talking about is confidential unless
you sign a release information, some of those intricate things. The
hope is that at the end of the procession, you might have a sense if
this person is a good fit for you, if this counselor is somebody you'd
want to come back to or not and maybe start to get a sense of what you
might work on if you are going to be working with this person in
therapy or counseling. That can sometimes take a couple of sessions to
figure out. I usually encourage people to give it like three sessions
because it's hard to start talking to a stranger. If after three
sessions you're not really feeling like it's a fit, you're not feeling
comfortable with the person still, then I would suggest letting that
person know that you think it's not a good fit, which is okay to share
with someone and you know like what grounds more. That's something a
young person would probably hesitate to do. [OVERLAPPING] I know. I've
had that conversation with so many people. It's really not a personal
offense. I as a therapist know that I am not the right fit for
everyone and I don't expect every single client to feel that way about
me. I really, I'm invested in helping clients figure out who would be
a good fit. Sometimes if I'm not the best fit, maybe I don't think I
have the right expertise for what this person's bringing to me. I will
help them find another therapists. So I'll reach out to some
colleagues that I know. I've done that many times if it's appropriate.
Okay. I know that there is no normal, but in terms of duration, I
would imagine that some people are going to go maybe once a week for
eight or ten weeks. And some people I know some people who have been
seeing a therapist regularly for seven years. Yes, totally correct.
There are people that seek therapy or counseling as the time each week
that they take care of themselves. They stop and it's self-care. So
they are committed for the long haul. There are people that will go
for 10 years while still seeing a therapist or longer. There are
people who need to see a therapist long-term because of the extent of
the issues that they're dealing with, especially when we're talking
about trauma. Sometimes some trauma histories do require longer-term
therapy. I often say to my clients, it didn't happen overnight and
it's not going to go away every night. It's a longer-term work.
Sometimes people need to be seen twice a week in the beginning if
they're coming in and some kind of crisis. Then go down to once a
week. But then there are people that just need, like you said, eight
to 10 sessions to address a particular issue and then they're okay or
they just go back periodically to see that therapist. Okay. You've
mentioned crisis. Now, as a lay person, when I think of crisis I
immediately think of somebody who might be suicidal, but I'm sure
there are more examples of crisis like people who just can't function
through the day. What else meets the definition of crisis? Well,
definitely you're right, like safety issues. So someone who's dealing
with suicidal thoughts, somebody who maybe is struggling with self
harming thoughts like self injuring because they're in distress.
Sometimes people have thoughts of hurting others, that would be a
crisis. But not all crises are at that level. Sometimes it's that they
are going through a breakup and there are really having a hard time
getting out of bed and functioning. They really need to be seen more
than just once a week in the beginning to just to start to get over
that hump of what they're struggling with. Or it could they're dealing
with a sudden job loss, which is frankly a grieving process when you
suddenly lose a job and they're so overwhelmed with where to go that
they really needed somebody to work with them more than once a week. I
think as a therapist, when I'm making that decision about twice a week
or once a week just for that first part of the work together, I'm
usually thinking to myself, how much is this issue impacting this
person's ability to function? How symptomatic are they? How hard is it
for them,? What's going on in terms of their everyday functioning?
Let's talk a little bit about different forms of counseling, and I
guess now in COVID times Zoom is all the rage. In person probably is
preferable. This was a huge debate when the pandemic started up and a
lot of therapists were really scrambling to figure out what to do. I
would say, in order of preference, absolutely in-person is the best
possible way to provide and receive counseling. Number 1, you are in a
quiet confidential space. There's something to be said for driving or
walking, or whatever to your therapist office, sitting in a waiting
room having a little bit of space from your normal world, going into
an office talking about your stuff, leaving, that kind of thing. But
also on Zoom and on the phone, a clinician just misses body language.
That's a great point. Yeah. For example, if I have a client that has
an eating disorder. I have no idea what they look like from the neck
down. There are things like that, that is important. But also things
like a client that's fidgeting or really anxious. You miss that stuff
with body language. That's why in-person is preferable and I don't
know any therapists that are providing in-person right now. The second
one and I'm so grateful in 2020 that we have virtual template
platforms or telehealth is like Zoom. There are a lot of other
platforms that are used and it's always really important to make sure
they're encrypted. We do that at the university. We always have to
make sure that this person is in there confidential space and we say
to them, "Are you in a private space?" It's amazing someone says,
"We'll try to have a therapy session,'' and the roommate is in the
room. So we'll say, "Sounds like this might not be the best time." The
bottom line I'm going to break up with is sitting next to me, but
let's go ahead and talk. We've had clients that are taking virtual
classes from home and they share a bedroom of a younger sibling. It is
hard to find a space, so we try to problem solve our clients at the
university. We've had people do therapy from their car. We also do
offer an opportunity for students to come in and use one of our
telehealth offices where they're on the computer with a clinician in a
different space. But at least it's a private space, and then the last
one would be phone. Phone is really not great because I have no idea
if somebody is crying, smiling, frowning, distracted, like what's
going on on the phone. But it is something that sometimes we have to
use especially like Internet goes down, or there's a bad connection,
something like that. Most of all we've talked about there been
individual counseling, but there is group counseling? Yeah. Can you
give us one or two examples of when a group setting makes more sense?
Yeah. Groups are amazing. I know that they can be intimidating. But if
anybody listening ever has an opportunity to be a part of a group, I
really would recommend it. We offer groups, for example called
Understanding Yourself and Others, USO we call it. Basically, it is a
group of same age students that want to have a better understanding of
themselves in relationship to others. What it's like to be in a group,
people getting feedback from people about topics in an honest and
safe, and confidential setting and this is run usually by two
therapists. Talking about relationships, identity stuff with others
that are in the same cohort or age group. Then there are other groups
that are more skills-based or specific. A group that's maybe just for
people who are struggling with substance use. The topic is how to stay
clean and sober. There's a support group in that way. There's lots of
different groups out there. We run some of our most popular groups
here for our LGBTQ community or lesbian, gay, bisexual, trans
community on campus. Okay. We probably can't fully answer this, but
for people who don't have insurance is there usually an option in the
community? That is always challenging. We deal with this a lot too.
Depending on your community, there are people that live in more urban
areas that have more resources and options and then if you're in a
more rural area, it is always harder to find those services. So if
you're in a more rural area, often times you might want to contact
your community, mental health agency, usually through the county.
They'll offer some services like to the department of mental health or
the department of [inaudible 00:30:40] health. But I also want to
recommend, because a lot of people don't even think about it. If you
are near a local university, a lot of times the university will have a
community clinic that's run by their graduate program in psychology or
counseling and that's a place where those students are getting
training on providing free services under the supervision of a
licensed clinician. That can often be a really good option too. Okay.
If you are absolutely clueless, start with, ''Free medical clinic near
me. Call them and ask for a reference to a mental health or
something.'' They'll know. Right. Also I wanted to mention, since we
talked about trauma. If somebody is needing support for sexual
assault, there are rape crisis centers the offer free services and
usually some very good treatments for that too. Excellent
recommendation. Well, let me just ask one final question. Thinking
about all the things that are relevant to being an adult. What is
something you wish you had figured out before you turned 25? I wish
that I knew or thought more about saving for retirement. It seems so
far away when I was that age, but comes really quickly. It still does.
Okay. When did you get serious about that? Really, not until I had
kids in my 30s. Did I start really thinking, "Gosh, I really should be
planning a little bit more." Those earlier years when you don't have
kids or dependents, it's a great time to start saving if you have the
ability to do that. It is never too early to start saving, I agree.
All right, Dr. Kahler. Thank you so much for your time and I will skip
coordinate with you to have you back to do an episode about trauma.
Thanks so much, Jim. That concludes today's episode. I hope you
enjoyed it. If you have any follow-up questions, you can email me at
askjimkta@gmail.com or for more information, check out
kitchentableadulting.com.