Counseling Questionnaire
Please ask and answer the following ten questions for your loved one in order to make an "educated guess" as to what level of professional counseling would probably be best for him or her.
There are basically three levels of professional counseling care, with modifications of each: HOSPITAL, DAY PROGRAM and OUTPATIENT COUNSELING.
1. Is your loved one so suicidal that he or she cannot promise honestly not to commit suicide?
Your loved one may require a few days in the hospital somewhere on a psychiatry unit where he will be protected from himself. Antidepressant medications can be started, and he will be released usually when he is no longer committed to suicide. Most hospital programs offer very little counseling, mostly temporary protection.
2. Is your loved one abusing drugs or alcohol so heavily that abruptly stopping would endanger his life?
Many drug addicts or alcoholics go into delirium tremens (DT's) if they quit abusing abruptly and don't take meds to help them withdraw. About 50% of alcoholics who go untreated for their DT's (seeing imaginary bugs crawling on their bodies, etc.) die from it. Less than ten percent of those who are medically treated for withdrawal from DT's die from the DT's (usually from swelling of the brain). The Meier Clinics do not currently hospitalize anyone for any reason, but we will be happy to help you find a hospital or a drug/alcohol treatment center if you call 1-888-7-CLINIC. Following a person's release from a drug and alcohol treatment facility, we recommend follow-up care either in one of our Day Programs (Where we have staff who work with addictive behavior), or in one of our outpatient clinics.
3. Is your loved one so psychotic (grossly delusional) that he would be uncooperative with regular counseling and/or medication suggestions?
If your loved one is grossly delusional, hospitalization would be recommended by us, even though we do not do this ourselves. If your loved one is mildly delusional and cooperative, we would prefer that he or she be treated in one of our Day Programs where a psychiatrist can adjust anti-psychotic medications daily to bring that loved one back in touch with reality as soon as possible, which can take anywhere from one hour to several weeks, depending on the quality of response to the appropriate medications.
People who have inherited various degrees of Bipolar Disorder (Mood Swings from mania or hypomania to depressions) need to take their meds the rest of their lives, and require a combination of a mood stabilizing medication with an antidepressant. An antidepressant by itself will not take away all the symptoms of bipolar disorder, and can often even make it worse for awhile, so proper diagnosis and treatment is vital.
Most bipolar disorders are never properly diagnosed, and seventy percent of bipolars end up addicted to illegal drugs or alcohol to compensate for the symptoms. Twenty percent of bipolars die of suicide. But when properly treated, people with bipolar can live a very normal life, and many are very successful and own their own businesses because they are very energetic and creative people (Winstin Churchill, Van Gogh, etc.). We treat the vast majority of our bipolar patients initially in our three week Day Program, followed by lifelong medication follow-up (usually fifteen minutes every three months) and occasional outpatient counseling.
NOTE: At the Meier Clinics try to avoid hospitalization whenever possible, unless absolutely necessary for the safety of the client. The preferred level of care is called Day Program Care (insurance policies usually cover this under "Day Hospital" or "Intensive Outpatient Care." The Meier Clinics specialize in Day Program Care and have Day Programs in various locations throughout the United States . I (Paul Meier, M.D.) personally evaluate patients who come to the Dallas Day Program, and I see each patient who is there every day, five days a week, for an average stay of three weeks. We have the same excellent level of care at all of our Day Programs. The person comes and stays in a motel near the counseling facility (or stays at home nights if we have a Day Program in their home town). But the person comes to the outpatient counseling facility for about seven hours a day, five days a week, for three weeks (varies). We do primarily group therapy and educational therapy, but also individual therapy and psychiatric oversight for medication needs, if any. Six months to a year of outpatient counseling is "crammed" into three weeks in order to help your loved one get well (or significantly improved) quicker, so he or she can resume a normal routine at work or at home and feel better sooner.
4. Do you have a loved one who has tried outpatient counseling but has still not gotten over his or her depression or anxiety?
Reply: Most people improve significantly after six months to a year of weekly outpatient counseling, but this is a slow but steady process. If your loved one has tried outpatient therapy and has not significantly improved for any variety of reasons, or if your loved one doesn't want to wait six months to a year to recover from depression or anxiety, then a three-week intensive Day Program would be the logical choice because of the intensive digging and probing into root causes plus the psychiatric evaluation for possible genetic tendencies toward depression, anxiety, perfectionism, addictive tendencies, ADHD, bipolar spectrum disorders (genetic mood swings), psychoses, hypothyroidism (which tends to keep one stuck in depression until treated)--all of which can be helped significantly with the proper combination of modern medications and appropriate counseling and education.
5. Is your loved one too depressed, too anxious, or too hypomanic to function at this time at home or at work?
Whenever someone is too depressed or anxious or hypomanic (racing thoughts, insomnia, restless, irritable, grandiose, impulsive, etc.) to function safely and adequately at work or at home, then Day Program Care will probably get him well enough to become functional again within a few weeks rather than the few months or longer that professional outpatient counseling would typically require to get him or her functional again.
6. Is your loved one on the edge of losing touch with reality?
Proper medications are a must for individuals who are losing touch with reality, a phenomenon which happens to one out of every 33 Americans some time in their lives. If your loved one is on the edge, but still able to reason and carry on a relatively normal conversation, then Day Program is the treatment of choice, usually with a friend or relative staying with him nights in his motel room. After the first week of treatment, the psychosis is often gone, and the more in-depth counseling becomes intensified to figure out root causes (other than genetic tendencies) for the psychotic depression or other psychosis. There is usually a dramatic improvement after three weeks of this level of care.
7. Does your loved one have bulimia (compulsive vomiting for weight control) and/or anorexia (losing weight lower than 15% below the recommended weight for that person's height and frame)?
Bulimia and anorexia are both life threatening (bulimia from loss of electrolytes in the vomit, causing heart failure and other physical failures; anorexia has a 15% death rate if left untreated from damage to organs from starvation). Therefore, a medical or psychiatric exam should be the first step to assess whether inpatient hospitalization is required (if there is immediate danger of death), or Day Program Care can be started immediately. Day Program is the most likely place your bulimic or anorexic loved one will receive adequate insight-oriented therapy for hours at a time to look for root causes of these symptoms (such as over-enmeshment with a kind but overindulgent mother or a marital situation the client would like to symbolically "vomit up.") Outpatient therapy is too slow for someone with a life-threatening problem like bulimia or anorexia, and people with eating disorders tend to be very secretive, requiring the intensity of the Day Program Care to dig out the root causes. If hospitalization is required first, we still recommend Day Program Care as soon as your loved one leaves the hospital.
OUTPATIENT COUNSELING:
8. Do you know a loved one who is still functioning adequately at home or at work, but is in obvious emotional pain from depression, anxiety, or relational stressors.
When someone you love is in any kind of pain from any cause, of course you want that pain to go away as soon as possible. But you don't want your loved one to relieve that pain with illegal drugs, or suicide, or any quack treatments. For physical pain, non-addicting meds can be given my a local physician. For emotional or spiritual pain, Christian counseling by a trained, professional Christian counselor is the best and quickest way for your loved one to get rid of that pain (except for Day Program treatment, which is the very quickest way but not always feasible because of the expense or time away from work).
An outpatient counselor typically sees his or her clients once or twice a week for anywhere from three months to several years of outpatient counseling, depending on a host of factors. For relational problems, a marriage and family counselor or someone who specializes in that particular type of relational stress (sexual abuse recovery, post-traumatic stress disorders, etc.) would be the most logical choice. You don't want your family physician to remove a brain tumor do you? By the same token, you don't go see a brain surgeon to treat your influenza either. You see a good car mechanic for your car breakdowns, a good family doctor for your normal physical illnesses, and a brain surgeon for your brain tumor. Likewise, see an outpatient counselor who has expertise in your particular type of emotional or spiritual problem.
PASTORAL COUNSELING, PRAYER PARTNERS AND SUPPORT GROUPS:
Every single Christian should have a prayer partner to be accountable to. We all have struggles of one kind or another. The Apostle James said that we all fail in many ways, and that confessing our faults to one another promotes healing (see James 5:16 , for example). The New Testament is filled with "one-another" passages, like love one another, speak the truth in love to one another, confess to one another, confront one another, weep with one another, rejoice with one another, etc. God made people who need people, and that's the only kind of people God made. That's why a healthy local church is one of the most important decisions we can possibly make, and especially breaking into small groups (mini-churches, bible-study groups, support groups, AA, discipleship groups, and just groups of great friends).
Does my loved one need to be in some sort of support group?
Everyone needs to be in some form of support group. Psalm 68 says that God takes the lonely and places all of us in a "family."
FINAL COMMENT: Other things that can help all of us to enjoy better physical, emotional and spiritual health include such common sense things as regular physical exams, checking especially for thyroid levels (many people are chronically depressed because their thyroid levels are low and they never get them checked and they get years of counseling and medications and still do not recover and never will until they get on thyroid medications, at which time they finally recover from years of unnecessary depression). And because of the way our foods are processed today, we also recommend that everyone take a good vitamin supply daily. It is also important for every human being to exercise a minimum of thirty minutes a day, three days a week, which produces endorphins that help us feel better. Laughter also releases endorphins, which is why the Bible tells us that laughter does good, like a medicine.