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Counseling: Who Gets It? For What? Who Doesn't? Why Not?

Trends and barriers to getting folks the counseling they need.

Linda McKinzie, executive director of Denver’s Maria Droste Counseling Center has joined me in writing this joint blogpost. Maria Droste offers affordable mental health services in Denver, Colorado.

For what do folks seek help?

The pie chart above shows what kinds of emotional problems led over 1500 folks last year (2012) to seek help from Maria Droste's 30 or more counselors.

Maria Droste's analysis indicated that anxiety and depression together accounted for the primary troubles of almost 40% of people who sought help. What triggered their anxious, stressed and depressed feelings? The something going wrong in their lives, MDCC’s staff believes, has often included long-term or chronic unemployment.

When people face a life problem, which usually is about the work or the love aspects of their lives, they typically first feel anxious. Looking ahead they feel uncertain about what if anything they can do about the problem.

After a period of anxiety, which they may refer to as stress, people become at increasing risk for feeling angry, blaming others for their dilemma, for depression with hopelessness about finding solutions, or for self-injurious habits like drinking and smoking, and for relationship problems.

Note that the two biggest reasons people seek help are depression and relationship troubles. That should be a heads up for therapists and therapy training programs, most of which do not have adequate training in marriage counseling.

It’s probably a bad sign that there’s twice as many folks seeking help for depression as for anxiety. Depression suggests that folks are giving up on finding a fix. This disproportion could indicate that people wait out their difficulties while they are anxious rather than seeking help in response to this initial distressed feeling.

For many folks, it’s only when they have fallen into a dark hole of hopelessness that they finally feel so bad that they reach out for professional mental health services. Better late than never, and yet that’s sad because often it’s easier for folks to find solutions to their problems when they are still feeling anxious than after they’ve given up.

Intake workers at Maria Droste noted another unexpected factor when they looked at these statistics for the past year’s intake records. They noticed an increase in calls about relationship issues.

Claudia Gray, Maria Droste Intake Manager, said, “This year in particular, we had a lot of people requesting couples and family therapy for a variety of reasons.”

One of those reasons Gray speculates, has been the country’s economic downturn. “If couples are already struggling with insufficient communication skills for talking over their difficulties cooperatively and productively, and then you add the stress and struggle of economic and financial worries, weaknesses in communication become more pronounced. Couples seek out counseling to help them find better ways to communicate with each other.”

If instead of getting help spouses either get mad at each other or go silent lest they fight, difficult financial realities chronically hang over the family and at the same time make living together increasingly difficult.

Another reason for increases in requests for couple or family therapy (treatment that focuses also on problems the children are having) is that in a bad economy couples can’t afford to buy new things when something breaks…and that applies as well to marriage.

On the other hand, if there’s no money in the bank for splitting up into two houses, never mind all the legal costs of a divorce getting help as a couple looks far more attractive.

Sue Kamler, Director of Maria Droste's intake services, added that the calls coming in last year also seemed to be more complex. “For example, when someone called in saying they were experiencing depression and anxiety, during the assessment process we often discovered a history of childhood abuse or domestic violence. The depression and anxiety needed treatment, and at the same time it was important also to address their earlier issues of loss or abuse.”

Why don’t more folks reach out for the help they need?

Ms. McKinzie offers the following explanations for why many people delay seeking help or never look at all for a counselor to talk with

“Mental health is talked about more now than ever before. With the high profile media coverage of the shootings in Aurora and at Sandy Hook elementary school, mental health is now the subject of discussions at national, state, and community levels. Yet only a small proportion of the people who would benefit from counseling actually seek it out.

“One major reason that many people, especially men, do not seek help and therefore needlessly suffer for long periods of time from emotional pain, anxiety, excessive anger, old resentments and depression, is their perceived stigma associated with receiving mental health care. They regard getting help as embarrassing, something others do but not themselves. Better to grin and bear it than to admit that they need help.

“Another concern is expense. Only one of the costs of meeting with a counselor is paying for the sessions, which insurance may or may not help to cover. In addition, missing time at work for weekly daytime therapy sessions can be costly in terms of not getting work done, docked pay, and supervisor disapproval. Evening and weekend sessions may require payment for babysitters.

“Finally, there is a documented shortage of affordable mental health care in our community. This has been true since Maria Droste Counseling Center was founded in 1989, and it continues to be true today. If everyone who genuinely needs mental health help were to seek it, there would be far too few therapists to meet the challenge.

“Mental health is fundamental to physical health as well as to experiencing life’s most positive blessings such as happiness, gratitude and supportive loving relationships. This was one of the key messages in the first-ever Surgeon General’s report on the topic of mental health and mental illness released way back in 1999. Now, 15 years later, we still have far to go in terms of getting mental health help to all who need it.”

What can give us hope?

Fortunately, there are options for folks who are feeling that they just have to grin and bear it, don’t know where to turn, fear they can’t afford help, or don’t feel comfortable opening up to a stranger.

To me, one of the most exciting new trends in our internet age has been the offering of SKYPE, phone and web-based mental health services.

In addition, many communities have facilities like Maria Droste Counseling Center. Maria Droste has striven for more than two decades to provide private counseling options for under-served populations. A third of the adults, children and families that utilize their services lack health insurance, have insurance that does not provide for mental health counseling, or earn insufficient income to access counseling in the private sector. Maria Droste's core mission is to serve these folks.

One of the appealing aspects to me of Maria Droste is that this privately funded organization offers a model of how old-fashioned charitable giving plus pay-what-you-can does such a super job of providing for the needs of modest, low and no-income folks. I worry about much Americans depend on Uncle Sam instead of family, friends and charitable giving for care when things go wrong in life. Uncle Sam may often be a nice guy, but he also is often slow to respond to folks in need, expensive to pay for in terms of huge taxes and our country’s increasing debt, and tends to be more bureaucratic than imaginative in his ways of helping out. Maria Droste's model by contrast offers immediate services that are affordable, high quality, and creative in responding to changing community needs.

The bottom line

Services are available far more broadly and less expensively than many might think. If you are feeling down and out, mad or stressed, do consider giving mental health services a try!


Clinical psychologist Susan Heitler, Ph.D. specializes in marriage counseling. She and her adult children have built a fun interative website that offers couples an online alternative to couples therapy for less cost per month than a dinner out.

Dr. Heitler's latest book offers a preliminary step for easing emotional distress. Prescriptions Without Pills offers strategies for relieving depression, anger, anxiety and more. Check it out!

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