Wilmington NC Counseling Blog

Counseling Confidential

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There are few people that I love to watch on television more than Anthony Bourdain. He has made a living by exploring how cooking is done; its intricacies, cultural and local flavors, as well as the dirt and grime of the kitchen and those in the restaurant world. I like real things and real understandings and he can pull the veils down, cut through the smoke screens, and shatter the mirrors like no one else.

In 2000, he wrote a book called Kitchen Confidential, which for a food person is a must read. In the book he discusses the behind the scenes realities of kitchens and restaurants, the ins-and-outs of the food business ranging from how cooks and staff are treated to why you should never order fish on a Monday.

Taking inspiration from Bourdain I want to take a moment to pull back a few counseling curtains and share some behind the scenes information about how counseling works and the various kinds of counselors who are out there. To be sure, counseling is not the same everywhere and a good place to begin is by understanding what the phrase “model of practice” means.

A model of practice is a specific type of counseling. Typically, the most familiar to people are cognitive therapy and behavioral therapy, but by last count there are conservatively well over 100 recognized, researched, and prominent types of models of practice. Wow, right?

Models of practice are essentially road maps. They are usually manualized in the sense that there is a step-by-step procedure for what the counselor is supposed to do with you each session. In cooking terms, a manual is a bit like a written recipe.

And now, for some insider information; there are ongoing debates behind the scenes between counselors about which of these many models is “best,” which works the fastest, which ones counselors should learn, or not learn, and so on. It is kind of like fighting about whose meatloaf recipe is best!

The creators of these models of practice have a big stake in which counselors accept them. There are entire groups dedicated to specific models of practice and they fight with one another. Cognitive counselors say that their approach is best and fight with behavioral counselors, behavioral counselors fight with solution-focused counselors who fight with….and all of this happens behind the scenes.

You get the picture. The debates in large part come from research. Now a quick pause: If you are someone who runs from that word research as quickly as possible (and that is okay!) please skip the next two paragraphs and save yourself! For those brave souls who want to get in the water, let’s move forward.

Models of practice are usually researched and, regardless of the model, they are all generally found to be equally effective. What this means is that counseling as a whole works. It does not matter which model is used. One of the most replicated findings in counseling research can be understood in this way:

A person who goes to counseling feels better than 80% of those who have a similar problem and choose not to go to counseling.

That is a big deal! For those interested in where this information came from please see this book The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work.

Now does the practice model make a difference? There is a considerable amount of research that shows that it does not! What? How can that be? Well, research shows that it is whether you like the approach being used that matters more than the approach itself.

Let’s think of this in terms of food again. There are some foods that you like and some you don’t, right? So, if you are hungry and someone drops a big plate of fried liver in front of you then you may eat it happily (yum) or you may say to yourself, “I hate this but I am hungry so I will eat it.” After eating you will not be hungry (provided you can keep it down), but you won’t be too happy and probably won’t eat it again unless that is the only thing and you are hungry enough.

The same thing happens in counseling. If models of practice are like recipes, and they all work then it is less about which model is used and far more about which one fits you! What that means is you can have a choice: if you do not like a model of practice, you do not have to eat it.

Now for more behind the scenes information! Many agencies have supervisors who supervise their counselors and those supervisors want certain recipes followed. It is like working at McDonald’s and there are standardized recipes and those recipes need to be followed to standardize the food. If you go to McDonald’s, each customer gets pretty much the same thing. Now, I like McDonald’s! But if you don’t, then that food won’t be the best fit for you. Also, there isn’t much changing or mixing and matching.

Let’s now move away from McDonald’s and think about personal chefs and how those two are different. A personal chef will listen to you, find out what you like, and then tailor their cooking to you. In the counseling world there are counselors who are like personal chefs.

Counselors who have been around long enough to know multiple recipes, have fine-tuned cooking skills, and who recognize that the most important thing is not the recipe but whether you like the recipe. They know that all models of practice work and they are able to talk to you, and tailor counseling to you like a personal chef. How do you see things? How do you understand the problem? What makes sense to you? Do you like onions or liver, or fish, or chicken, or organic food?

Now, the VERY big difference between cooking and counseling is that in the cooking world personal chefs are expensive, but in counseling going to a personal chef is exactly the same cost as going to McDonald’s!

What? Really?

Yes, the reason is (more inside information) that the insurance companies reimburse counselors and agencies based on having a license to practice. They do not pay more for a counselor who has more experience; it is the same rate for a newly-minted counselor or a counselor who has been out there for a long time! Private-pay rates are also about the same.

So, remembering back to the beginning, do you know why Anthony Bourdain says not to order fish on a Monday? Because he knows that most fish deliveries are made mid-week and the fish on Monday is left over from the weekend. Same ideas apply here.

Counselors who tailor counseling to you and know many recipes are the same cost as those who follow strict recipes and don’t change.

I am one of those counselors who can tailor counseling to you.



Dr. Christopher Hall, PhD, LCSW
5006 Randall Pkwy
Wilmington, NC 28403

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