Timothy Miller Ph.D.

Clinical Psychologist

Frequently Asked Questions

How confidential is psychotherapy (counseling)?

Health insurance companies cause the biggest problems with confidentiality. When you authorize me to bill your health insurance company, you also authorize me to answer their questions, and most managed care companies ask many questions about mental health treatment. What happens to your privacy after the information gets to the insurance company is anybody's guess. Insurance companies routinely share information with each other, and many employers consider health records when hiring. Paying the bill yourself guarantees a very high level of privacy. Aside from the insurance company problem, information you share with me is highly confidential, though there are a few limits. Therapists must report child abuse and elder abuse. Therapists must act to prevent suicide or violence to others, even if doing so violates privacy. If you are getting counseling related to a Worker's Compensation claim, your treatment is not confidential.

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I am told I have a "chemical imbalance." If that's true, will therapy help me?

"Chemical imbalance" is a code word used by some physicians and psychiatrists. It generally refers to bipolar mood disorder (also known as manic-depressive disorder) and sometimes to recurrent major depression. Assuming the original diagnosis is correct, ideal treatment often requires long term use of psychiatric medication. However, psychotherapy can still enhance functioning and improve quality of life in these cases. There is no laboratory test for the "chemical imbalance" you have heard of, and the brain chemistry involved is still very poorly understood.

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I wonder if I was sexually abused as a young child. Would this explain my emotional problems?

"Recovered memories" is a highly controversial topic. A few therapists believe that early childhood abuse, particularly sexual abuse, is one of the most common causes of emotional problems later on in life. There is little if any scientific support for this position, and most responsible therapists (me included) take a more balanced view. Even if you were sexually abused as a very young child, you would not necessarily ever be able to remember it, and remembering it may not be necessary to solve your current problems. On the other hand, some adults have very clear memories of childhood sexual abuse or other childhood trauma. They have never forgotten it, and they have been bothered by these memories all their lives. This is obviously a very different situation. Discussing these painful memories in therapy could be very helpful.

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How can I get another person to realize that he or she needs therapy?

There's an old saying in my business. "You can't help a person who doesn't have a problem." Psychotherapy is most helpful for people who recognize that they have a problem and sincerely want to solve it. In some ways this is sad, particularly for parents whose children are self-destructing and for spouses whose partners are destroying a marriage. Still, psychotherapy is impossible unless the therapist respects the dignity and independence of the client. That means that it must be the client's responsibility to decide if he or she needs help. Children and younger teenagers sometimes represent an exception to this rule. They will sometimes reluctantly accept help if given no choice in the matter.

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What about alcohol and drug problems?

Alcohol or drug abusers who recognize they have a problem and sincerely want to solve it can often be helped by a well-trained counselor, without entering a residential program. In some cases, it eventually becomes clear that a period of residential treatment will help an alcohol or drug abuser take those first few difficult steps on the road to sobriety. I encourage clients with substance abuse problems to try Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), or to return to these organizations if they have been helpful in the past, but I do not insist. NA and AA are not for everybody. Other self-help organizations, such as Rational Recovery, can be equally helpful.

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What are your religious views?

Because many residents of this area are conservative or evangelical Christians, I often get asked this question. I prefer not to answer, for a variety of fairly obvious reasons. I will go so far as to say that my many conservative and evangelical Christian clients feel that I am respectful and knowledgeable about their religious faith. I encourage religious people to incorporate their beliefs into the process of healing and personal growth.

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Can male counselors help female clients as effectively as female counselors?

The scientists who study these things have never found that the sex of the counselor makes much of a difference for male or female clients. Some women find it hard to believe that any male can see things from a woman's point of view. In my opinion, skilled counselors can easily understand either sex's point of view, without much difficulty. The skill and personality of the counselor is much more important than his or her sex. Additionally, women who have often experienced hurt and disappointment in their relations with men may find renewed hope if they have a good experience with a male counselor. Of course, if a woman prefers a female counselor, she has a right to make that choice for herself.

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Can you help with sexual problems like impotence, premature ejaculation, or lack of sexual interest?

Many problems like this can be easily solved, particularly when they occur in relatively young and healthy people. Often, when the couple learns to talk about their sexual relationship in a relaxed and constructive way, the problem takes care of itself. In some cases, anxiety or hurt feelings are the source of the difficulty. Often, I can be helpful in such cases. Difficult, complex cases of this nature sometimes require a specialist. Long-standing problems with erectile dysfunction (impotence), particularly in older men and diabetics, respond better to medications such as Viagra or Novus than to counseling.

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How do I know whether I'm just being silly or feeling sorry for myself? In other words, when is a problem serious enough to justify counseling?

Contrary to popular belief, no one likes being miserable. It's normal to feel unhappy for a time in reaction to some unusual event or stress, and everyone makes bad decisions from time to time. If you feel miserable most of the time, even when things are going well, if you consistently make bad decisions, or if you repeatedly fail to solve important problems in your life, you are NOT being silly or feeling sorry for yourself. Think of psychotherapy as an investment in your future happiness and productivity.

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