psychotherapist tyler ong

helping you help yourself

What is Marriage and Family Therapy?

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Psychiatrist vs. Psychologist?

Oftentimes, you might hear about “psychiatrists” as being the same as “psychologists”. In the media, for instance, many films and t.v. shows merely refer to both as “shrinks“. The term “shrink” is actually pejorative or derogatory (an insult). It refers to “head shrinkers”, which in turn referred to tribal societies who are more appropriately termed “head-hunters” since they scalp their opponents, take their heads, and shrink them as trophies of their victories. In modern society, “shrink” is used as a metaphor for people who are said to be able to “get into your mind” with the semi-sarcastic implication that they can make your head “shrink” (in reference to the tribal head-hunter analogy), or “shrink” your mental health problems. Either way, these are false assumptions. “Psychiatrist” is not the same as “psychologist” despite being mashed into the slang term above, though there are some common threads in both.

Let’s start with the similarities: 1. They are both mental health professionals along with other fields like Marriage and Family Therapists (MFT, where my primary training lies), Clinical Social Workers (CSW, this is not the same as the Philippine’s RSW), and Professional Counsellors (LPC). As such, like all mental health professions, both psychologists and psychiatrists may refer to themselves using the umbrella term “psychotherapist”. 2. Clinical psychologists (note the attached “clinical” term) and psychiatrists provide healing for people with mental health issues, specially those with diagnosable disorders.

There are however, a lot more differences between these two professions than similarities, as seen below:

Psychiatrist:

  • has an MD degree, or a Doctor of Medicine degree
  • has to go through medical school before doing a residency in Psychiatry
  • primarily performs psychopharmacology services. In other words, they primarily prescribe medications for mental disorders.
  • usually has no proper training in counselling and psychotherapy unless they belong to a specialized certification program. In the States, for instance, some psychiatrists may opt to do additional training to become certified in Behavior Therapy.
  • does not have the required qualification to deal with developmentally-anticipated issues and problems. This means that they are not able to provide counselling for problems that most people on average experience as part of the developmental life cycle. Psychiatrists usually are able to help only when problems become serious enough to become disorders. For example, while a counsellor/psychologist might be able to help with bullying in school, most psychiatrists will treat a victim of bullying as suffering from depression and anxiety and will prescribe medications to address these issues.
  • They tend to explain problems from the perspectives of chemical imbalance, social issues, and very vague general psychological concepts (for example, “due to stress”, “trauma”, or “coping” without thorough understanding of these concepts). Some older psychiatrists who got training in psychoanalysis might conceptualize cases from a psychoanalytic view.

Psychologist:

  • has at least a master’s degree. In some countries like the States, one can only be licensed as a psychologist if one has a doctoral degree. Masteral degrees refer to an additional one to three years study, specializing in a field of psychology. One can have the following:
  1. Master of Arts (MA)
  2. Master of Science (MS/ MSc)
  3. Master of Counselling (MCoun/MC)
  4. Master of Education, with a major in counselling (MEd)
  5. Master of Ministry, with a major in Pastoral counselling (MMin)

Doctoral degrees refer to an additional two to five years of study beyond the master’s degree. Doctoral degrees require the production of new knowledge that contributes to the field. This is referred to as the dissertation or doctoral project, which has to be submitted before one can graduate. One can have the following:

  1. Doctor of Philosophy, specializing in Psychology (PhD)
  2. Doctor of Psychology (PsyD)
  3. Doctor of Education, specializing in Counselling (EdD)
  4. Doctor of Ministry, specializing in Pastoral Counselling (DMin)
  • Psychology is a very VERY broad field. There are many types of psychologists. If you want counselling, assessment, and psychotherapy services, two types of psychologists can provide these for you: counselling psychologist, and clinical psychologist. A counselling psychologist technically cannot assess and treat mental disorders. The safest bet is to go to a clinical psychologists who are trained in the assessment, conceptualization (just a fancy word for EXPLAINING), and treatment of all types of psychological problems be they mental disorders or merely adjustment issues. When you meet someone who says he or she is a psychologist, don’t forget to ask what type of psychologist they are. In the Philippines, there are two other major types of psychologists: social psychologists (who usually perform research studies and teach in universities) and industrial/organizational psychologists (who perform Human Resources functions and provide specialized services for organizations such as training of employees). They cannot provide the services of a clinical psychologist! In the Philippines also, there are people who say they are “assessment psychologists”. I am unsure as to what they really are as there are no other countries that I am aware of that offer this designation.
  • Clinical psychologists perform assessment, treatment, and conceptualization of mental/psychological problems. Thus, they are trained to administer, score, and interpret psychological tests such as IQ and personality tests. They also provide counselling and psychotherapy as the main bulk of their work. Clinical psychologists cannot prescribe medications as they are not physicians. However, some states in America have started a post-doctoral training in psychopharmacology for clinical psychologists which will allow them to prescribe psychiatric drugs under the supervision of a psychiatrist. Some clinical psychologists are against this as it goes counter to how they view problems.
  • Psychologists tend to view problems from a biopsychosocial perspective. Some even view problems from a biopsychospiritual-social perspective. This means that psychologists incorporate more information about the individual and the system in which the individual functions to explain problems and treat clients.

Psychologists and psychiatrists need to work together to provide the best possible treatment for a client. This is what is called a “multi-disciplinary” approach to treatment, which means that professionals from other disciplines/fields/specializations work together for the benefit of the client. Psychologists and psychiatrists can refer with each other regarding what the diagnosis of the client they are both seeing is, and what treatment is appropriate.

In the Philippines, please be careful: psychiatrists here are not subjected to the same rigors of training as in first-world countries. In my experience, most Philippine psychiatrists I know (at least here in Cebu) do not even consider counselling as a treatment option and assess their clients haphazardly, often giving the wrong medication which could be disastrous! Some of them provide their own version of “counselling” which turns out to be nothing more than a lecture or scolding or advice giving (advice giving is not counselling/therapy).

To end on a happier note, remember that you have the power to change your life. Any mental health professional merely helps you to get whatever goal you want. Regardless of the differences, psychologists (and other mental health professionals) and psychiatrists have one overriding similarity: to help you live the way you want to live.

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What is counselling?

Counselling is first and foremost, a professional relationship.

PROFESSIONAL because:

  • there are ethics involving how one should act toward each other to prevent harm
  • the therapist as part of the relationship requires strict training
  • there are remunerations (fees) involved for services rendered which required training in the part of the therapist
  • NO other type of relationship is allowed to contaminate this existing relationship. This means that a therapist cannot have business, romantic, or friendship relationships with clients. This also means that a therapist cannot take on someone as a client IF this person is or has ever been in a business, romantic, or friendship relationship with the therapist. Therapists cannot counsel relatives and his/her own family members.

RELATIONSHIP because:

  • being in counselling involves time and effort on both sides (both therapist and client/s)
  • trust is slowly established. It is not immediate.
  • each party starts to learn new and intimate things about the other party, that is why confidentiality is very very important.

Counselling is not well-known in the Philippines. For those who have heard of counselling, they think it’s only for “crazy” people or those with mental disorders. This is not true. Sometimes we just encounter negative experiences which are too much for us to handle and we need some guidance beyond our family or friends. In fact, there are many problems that are CAUSED and MAINTAINED by our very own family and friends!

A counsellor is there to listen without judging and to help the client come to his or her conclusions and plans through various techniques. A counsellor always starts by assessing or determining what the problem is about and gets to know you better. After the counsellor knows about the problem, he or she will suggest certain plans or goals on how to proceed with treatment, and you will have a say whether you agree or not to those plans. Counselling is usually once a week for about 8 to 12 months. During this time, the counsellor will monitor progress, address whatever new issues that come up and strive to help you meet the goals set after assessment. Once all goals have been met successfully, the counsellor will initiate termination procedures by stretching the time between sessions (for example, instead of meeting once a week, it becomes once every three weeks) to help you get used to functioning by yourself. A counsellor does not want you to become dependent such that you cannot function without him or her. That’s not healthy!

Psychotherapy is what we call the type of counselling used for really hard problems such as those with diagnosed mental disorders. However, most experts have found that psychotherapy and counselling are basically the same. It’s just a matter of highfalutin words. Don’t worry about the terms. Counselling and psychotherapy are the same.

Now that you know what counselling is about, below is a list of what counselling is NOT about:

  • Counselling is not advice-giving. In fact, therapists and counsellors are forbidden by ethics to provide advice. We only provide options and suggestions.
  • Counselling is not medicine. Unlike pills and medical procedures, just going in for one session does not resolve the problem. When you take Paracetamol for example, your fever goes away. But it does not work like that in counselling. Counselling requires time for changes to occur and be maintained.
  • Counselling is not just for “crazy” people. Going in for counselling does not make you crazy. People who say these things are actually people who are ignorant of facts about counselling and have never been to a qualified professional.
  • Counselling is not useless. There are many researches that show that counselling works, and it even changes the brain and how it functions. It all matters on how the therapist “fits” with the client: the type of therapist, the type of techniques or orientation of the therapist, the type of problem, and the personality of the client. All these mix together to determine whether therapy/counselling is successful or not. Sometimes, we may not “fit” or are not “compatible” with certain people. This is the same in counselling. If you don’t feel comfortable with a counsellor, he or she may not “fit” with you and you can always move on to another. It is your right as a client.
  • Counselling is not that expensive. It actually depends on the qualifications and level of training your therapist has. These are the primary determinants of the fees of your therapist. For example, a masters-level counsellor will charge less than a doctoral-level one just because it costs more to complete a doctorate than a master’s degree. The place where you go for counselling is also a good factor. If the rent of the office of the therapist is high, expect to pay more than a therapist whose office rent is not as high. Lastly, it depends on the type of service that you are being charged with. Some types of therapy are more expensive than others due to the training required for it and the amount of time needed for the therapy to work. For example, family therapy is more expensive than individual therapy. If you are going in for psychological testing, the expense of the psychological tests which have to be ordered from abroad will have to be shouldered by you as well.

WARNING

Lastly, always be careful of people who pose as qualified therapists or counsellors. There are a lot of them here in Cebu City, and in the Philippines in general. Despite impending licensure, these people somehow “slip through the cracks” because of their connections with high-ranking people and have caused a lot of harm both to clients and to the reputation of psychology as a whole. If you are not sure about your counsellor, remember to do background investigations and ask around. Unfortunately, the Philippines does not have a reputable service that helps clients find good therapists. Many psychological organizations have been infiltrated by incompetent people who are politically-protected. Also, be aware that certain types of therapies require further training which these posers may claim to have. Always check. For example, just because a therapist has read a book about Art Therapy does not mean that he or she is now a qualified Art Therapist. He or she may use Art Therapy techniques, but can never claim to be an Art Therapist without undergoing an Art Therapy graduate program. The terms practitioners use to refer to themselves are strictly governed by numerous Codes of Ethics.

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So what is it that I do specifically?

As a clinician, I perform the following services:

  • general assessment
  • diagnosis (based on the Diagnostic and Statistical Manual of Mental Disorders)
  • treatment planning and recommendations
  • brief one-hour consultations regarding mental health issues but not leading to counselling services
  • counselling and psychotherapy
  • case consultation for other therapists

I work with the following populations/people:

  • adult (18 years above) individuals
  • couples (18 years above) whether married, living together, separated, or in the courtship process
  • families
  • elderly (60 years and above) individuals
  • children and adolescents (8 years and above only)

SERVICES:

I perform general assessment. This means that everytime a new client comes in, I ask a series of questions that might take up to two hours long to get as much information about the client as I can. This is important because without all these data, I might not be able to construct a good treatment plan or even diagnose the issue correctly. My version of the general assessment is a face-to-face question and answer format. I do not use written standardized psychological tests. The rule of thumb in practice is that standardized tests are to be used only as confirmatory evidence after a general assessment. I may use drawings as a form of assessment for certain clients like children, although these are exceptions rather than the rule.

All general assessments end with a decision whether I give a diagnosis or not. A diagnosis is merely a label, a name for your problem. Don’t be intimidated by this highly technical jargon. All it means is the name of your problem. All clinical psychologists and practicing psychotherapists/mental health professionals NEED to be trained in the Diagnostic and Statistical Manual of Mental Disorders’ (DSM) diagnosis style. DSM diagnosing is a globally accepted and expected mode of diagnosing in mental health.

Once I know your diagnosis (if you warrant one) or lack thereof, a treatment plan will be formulated tailored to your need. Basically this is a rough outline of what your goals are, and what you want to have happen as a result of our therapy. The goals will be mutually agreed upon by both myself and yourself. I might make suggestions on what I think we should be working on, but ultimately, you have the last deciding vote.

Usually, after a treatment plan is constructed, the rest of the sessions are devoted to achieving the goals that we outlined. This is called counselling and psychotherapy. I will start to perform techniques and give explanations of your problems. The way I work is from a Cognitive-behavioral Therapy perspective, mixed with a lot of Family Therapy theories and techniques. What does this mean? I focus more on your way of thinking and how this affects your behavior and feelings. I also look at how your family might be causing, contributing, or supporting your problems. Our families can offer a lot of help in times of trouble, but they can also be the ones causing our problems.

However, some people might not want to have counselling since it takes up a lot of time (usually around once or twice a week for about 8 to 12 months on average), or for other personal reasons. They might just ask for recommendations on what to do and request appointments on an intermittent basis based on their own schedule. This is what I call “consultation”. I won’t conduct counselling and psychotherapy with you, but I will be available to answer questions and offer my point of view to your issues. No treatment planning will be done for clients who opt for consultations.

I also provide hourly case consultations for my colleague-therapists who might be stuck on how to approach a problem or the ethics involved in it. I can perform individual or group consultations depending on the need of the therapist involved, and availability of a group.

POPULATION SERVED:

I offer counselling and general assessment services to individual adults, couples, elderly individuals, and families. I have the required training in all these areas. Although I am qualified to work with children, I prefer to limit my child clients to those who are 8 years old above. I screen my child clients also since I do not have the necessary equipment and space considerations for play and art therapies that are more appropriate for children in general. Counselling/therapy is not appropriate for children aged less than a year old up to 4 to 5 years of age. I also require that children come with their parents each time for sessions, and that family therapy be interspersed with child sessions. This is because of my belief that the child is embedded more deeply in family dynamics than an adult. I will not work with child clients if the parents cannot commit to this.

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