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Welcome to CombatCounselor Chronicle, an E-zine dedicated to giving you the most current, pertinent information on cognitive behavioral therapy (CBT) and mindfulness-based CBT available.

Chris Sorrentino, a.k.a CombatCounselor, is a leader and expert in cognitive behavioral therapy. He combines 30 years of experience in psychology with the discipline from having served as a U.S. Air Force officer for 20 years, 4 of those in combat zones, retiring as a lieutenant colonel in 2005.

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Friday, April 4, 2014

Introduction to Body-Mind-Behavior Therapy (BMBT)

Many of us have suffer from anxiety or depression, yet are still looking for a solution. Whatever you have been doing must not be working or you would not still be looking for answers.

Maybe you have been looking in the wrong places! Maybe you have been focusing on changing the "content" of your life (words, thoughts, emotions) instead of the "context", the part you actually have control over when it comes to internal problems (e.g. cognition...your thoughts).

In my upcoming book, "Get Off Your Buts And Live A Value-Driven Life ... That's A Freakin' Order!", I explain my proprietary approach to psychotherapy, integrating traditional cognitive behavioral therapy (CBT) with mindfulness-based CBT, called Body-Mind-Behavior Therapy (BMBT).

In BMBT, we focus first on what your BODY is telling us in terms of proper exercise, diet, and sleep as well as those internal sensations that "set-off" your anxiety or depression. Next, we focus on the MIND, teaching you how to be mindful in the present moment, accepting thoughts and emotions, and changing the "context" of how you relate to your thoughts rather than changing the thoughts themselves. Finally, BEHAVIOR becomes the target by clarifying your values, setting achievable goals, and making a commitment to taking action toward achieving those goals.

The result of BMBT is not another "quick fix", but a new way of life where you are mindful of the moment and ACT based on your values, rather than avoiding the things that you fear or make you sad.

Visit and SUBSCRIBE to my POPULAR YouTube channel, The CombatCounselor Channel, and  send me a message, telling me about your problem, what you have tried to do to fix it, and what result you would like to achieve:

Or SUBSCRIBE to the CombatCounselor Channel on Spreecast:

You may be one of the lucky viewers who has their issue addressed personally by CombatCounselor.

Good luck!

acceptance, ACT, anxiety, are, avoidance, cognitive behavioral therapy, CBT, acceptance and commitment therapy, combatcounselor, DBT, depression, journey, ACT, mental health, ptsd, mindfulness

Monday, March 31, 2014

Is a Smaller Amygdala The Cause Or An Effect of PTSD?

PTSD Linked to Smaller Brain Area That Helps Regulate Fear

In an recent article by Janice Wood, researchers at Duke University and the Durham VA Medical Center discovered that combat veterans with post traumatic stress disorder (PTSD) are more likel to have a significantly smaller amygdala than those without PTSD. The amygdala is a small structure in the brain which regulates emotions, in this case fear and anxiety, with anxiety literally being  "the fear of fear".

Wood states that "their study provides evidence that smaller amygdala volume is associated with PTSD, regardless of the severity of trauma. But, they add, it’s not clear whether the physiological difference was caused by a traumatic event, or whether PTSD develops more readily in people who naturally have smaller amygdalas."

“Researchers found 20 years ago that there were changes in volume of the hippocampus associated with PTSD, but the amygdala is more relevant to the disorder,” said Rajendra A. Morey, M.D., M.S., assistant professor at Duke and lead author of the study.

Morey noted that studies in animals have established the amygdala’s role in regulating fear, anxiety and stress responses, but its effect on human behavior is less well known. “It’s associated with how fear is processed, especially abnormal fear processing,” he said. “So it makes sense to look at the structure of the amygdala.”

The researchers recruited 200 combat veterans who served in Iraq and Afghanistan after Sept. 11, 2001; half had PTSD and the other half had been exposed to trauma, but did not developed PTSD. Amygdala and hippocampus volumes were computed from MRI scans of all 200.

The researchers found significant evidence that PTSD was associated with smaller volume in both the left and right amygdala, and confirmed previous studies linking the disorder to a smaller left hippocampus. The researchers emphasize that the differences in brain volumes were not due to the extent of depression, substance abuse, trauma load or PTSD severity, factors they took into account in their statistical model.

PTSD strikes nearly 14 percent of combat veterans serving in Iraq and Afghanistan, according to the Department of Veterans Affairs. PTSD also is estimated to affect 6.8 percent of adults in the general population who have suffered abuse, crimes and other traumas.
“The next step is to try to figure out whether a smaller amygdala is the consequence of a trauma, or a vulnerability that makes people get PTSD,” Morey said.
He said the study showed that amygdala volume does not appear to be affected by the severity, frequency or duration of trauma, indicating that these factors do not cause the amygdala to shrink. It appears more likely, according to the researchers, that people with measurably smaller amygdala to begin with are susceptible to PTSD, but more studies are needed to make that determination.

Morey said he and colleagues are exploring that question, and are intrigued by evidence from their study that suggests people may have a propensity for developing PTSD based on inherently smaller amygdala volume.
“This is one piece in a bigger puzzle to understanding why some people develop PTSD and others do not,” Morey said. “We are getting closer to that answer.”
Funding for the study, which was published in the journal Archives of General Psychiatry, came from the U.S. Department of Veterans Affairs and the National Institutes of Health.

Friday, March 21, 2014


According to an article in your March 24, 2014 issue, George W, Bush and Army General Chiarelli, well respected  psychologists and scientists?, believe and profess that removing the word "disorder" from post-traumatic stress disorder (PTSD) is going to single-handedly end the military and veteran mental health and PTSD stigmas. Sorry boys, don't be ignorant ... ain't gonna happen!

President Bush's endorsement of this half-baked idea is as sound as my abilities in brain surgery and General Chiarelli's influence and support would be better utilized by focusing on the real causes of the stigmas, lack of confidentiality in military mental health, the macho bravado and ignorance endemic in the military, and the inaccurate portrayal of veterans and military members in the media.

PTS Without "Disorder" WILL NOT END THESE STIGMAS gentlemen. Use your clout to attack their real causes before more American heroes decide suicide is a better alternative than seeking treatment, risking security clearance and career, or being called a wimp. 

As a licensed professional counselor with 23+ years of experience treating military and veterans with anxiety (including PTSD) and depression, a retired military officer, and disabled veteran, I have written and advocated extensively on this topic. Specifically, my article THE STIGMAS KILLING AMERICAN HEROES. and two White House Petitions asking President Obama to address the stigmas, which garnered a whopping 70 signatures each out of the tens of thousands who heard my pleas, outlined clear, tangible courses of action. I have also written to Air Force Times on numerous occasions regarding this exact topic, but was ignored. But who can blame you when you have such authoritative experts in psychology and military/veteran mental health as President Bush and General Chiarelli?

C.T. Sorrentino, LtCol, USAF (Ret)
aka CombatCounselor
Lawrence, KS

Sunday, March 2, 2014

Psychology Today's "Dear Abby" Unethical in Advice to Reader

Letter to the Editor: T

In regard to her column in the April 2014 issue of Psychology Today, Hara Estroff Marano was out-of-line. The reader asked for help in getting "the spark" back in her relationship with a man she obviously loves. Ms. Marano was not only incompetent and unprofessional in her response, she was unethical. I'm not sure what her qualifications are, but based on previous columns and this, she apparently does not answer to a code of ethics.

Her judgmental "advice", something a licensed clinician who adheres to a code of ethics would never offer, was appalling. Take a six-month break, date other people, better qualities? This poor woman has the values and motivation most people should emulate, loyalty and respect toward the man she loves, and all the "fraud" you apparently allow to dole out advice in your magazine can do is recommend bailing on the relationship? 

Ms. Marano obviously does not know any better, but you as editor of such a popular and influential national publication should know better than to allow this type of garbage to be published. Shame on you.

C.T. Sorrentino, LtCol, USAF (Ret)


aka CombatCounselor

Tuesday, February 18, 2014

"Thank You for Your Service"? Put Your Money Where Your Mouth Is!

A February 18, 2014 Facebook post by The Duffel Blog proves that a picture CAN in-fact be worth a thousand words:

As I have been saying for a long time, words are easy, actions are more challenging and appreciated. I have sponsored two White House Petitions in the last two years asking the public to sign and support action by Obama in reducing the staggering rates of PTSD and suicide in the military and among Veterans. The petitions needed 10,000+ signatures for POTUS to take action, BUT LESS THAN 70, that is SEVENTY, people took the time (5 minutes) to read and sign the petitions!

I've also been struggling to start a non-profit for Vets with PTSD, aptly named Help4VetsPTSD, but am considering throwing in the towel due to lack of support and funding. 

BOTTOM LINE: Please stop "thanking" us for our service. Instead, please PUT YOUR MONEY (OR SIGNATURE) WHERE YOUR MOUTH IS and support military and Veteran charities and non-profits.

Thank you,

CombatCounselor ... OUT!

Photo courtesy of The Duffel Blog, posted 2/18/2014 on Facebook 

Sunday, January 19, 2014

#BringBoweHome ... Seeking the Release of Sgt Bowe Bergdahl (USA)


Army Sergeant Bowe Bergdahl was captured on June 30th, 2009 while on patrol near the town of Yahya Khel in the Paktika Province in Southeast Afghanistan and near the border with Pakistan.

Bowe recently received national media attention after this video was exposed:

For more background on his capture and efforts for his release, read more here:

This young man has been in captivity for nearly 5 years, but have you heard much, if anything, about him? Probably not. Why is our government and the media covering this up and what are they doing to ensure his safe release or recovery?

You and your family members are home, safe, and secure, but Sgt Bowe Bergdahl's family has been worrying about their son, brother, and grandson for nearly five years ... PLEASE SIGN THIS WHITE HOUSE PETITION, endorsed by Bowe's father Bob on Twitter:

Let's help #BringBoweHome soon and safely!

Key Words: sgt, Bowe, Bergdahl, bob, US, Army, Afghanistan, patrol, capture, captured, captivity, Taliban, Pakistan, Navy, SEALS, CombatCounselor, combat, counselor

Copyright 2013 - CombatCounselor and 3rd Wave Media Group, LLC - All Rights Resreved

Wednesday, January 15, 2014

Letter to Joe Biden: Attack on Military Retiree COLAs and DisabledVet-Owned Business

January 15, 2014

Dear Vice-President Biden,

I am a retired Air Force lieutenant colonel, 80% disabled Veteran, and service-disabled veteran-owned small business owner. I am tired of this administration's anti-Veteran/military agenda and lack of concern and response to whistleblower retaliation against me by the Department of Interior.

The fact that military retiree COLAs were targeted for 1% per year reduction until age 62 is wrong! Your retirement, the retirements of Congress, and the retirement of DoD civilians like Sharon Hallinan, the Department of Interior contracting officer who retaliated against me and ruined my business, we're not targeted, but those of us who defended our country for 20+ years were?

Why are the millions of dollars being wasted by Government agencies and contractors each year not targeted BEFORE the pensions of the brave men and women who dedicated their lives to our Nation's freedom?

I was targeted for whistleblower retaliation by the Department of Interior after reporting gross fraud, waste, and abuse in the Military Family Life Consultant (MFLC) program in the tens of millions of dollars annually. I complained to the Department of Interior Contracting Officer, Interior Business Center, in January of last year and two days later my $50K MFLC contract was cancelled. Not only did I lose much needed income, she fabricated lies, defaming my character and ruining the reputation of my business, leading to my business being ruined and the loss of our home and half of our possessions.

I filed complaints with the DoI and DoD IGs, but was ignored. My Congressman, Sam Graves, and Senators Blunt and McCaskill blew me off as did your boss President Obama. 

How is it that military retires are the FIRST ONES TARGETED when it comes time to reduce spending? Why are government agencies and contractors allowed to defraud our Government and taxpayers, wasting hundreds of millions of dollars each year with impunity? How can a Government agency get away with illegally canceling a contract and ruining a service-disabled veteran-owned small business? I will continue to pursue this until those responsible are held accountable and am contacting you because I believe you are one of the few in Washington with the INTEGRITY and persistence to take action. I hope I am right Mr. Vice-President.

God bless you, your family, and our United States of America!

Chris Sorrentino,  LtCol, USAF (Ret)

Submitted via the White House app and website at 4:30 pm (CST) on 1/15/2014

PostScript: Representative Paul Ryan (R - WI) and Senator Patty Murray (D - WA) initiated the bill in Congress and IN ALL LIKELIHOOD NEVER SERVED A DAY IN UNIFORM. I HIGHLY RECOMMEND that both Rep. Ryan and Senator Murray NOT BE RE-ELECTED OR ELECTED TO A HIGHER OFFICE due to their contempt for our military and Veterans and the cowardly act of reducing retiree entitlements BEFORE addressing far bigger problems such as the GROSS FRAUD and WASTE endemic in government and government contracting.

These cowards in Congress, the White House, and Pentagon whom break promises made to our military and Veterans insist that these changes "enhance readiness" WHEN IN- FACT READINESS WILL BE NEGATIVELY IMPACTED LONG-TERM! Potential recruits will choose not to serve in the military due to the broken and empty promises made to those who patriotically served before them ONLY TO HAVE EARNED BENEFITS AND ENTITLEMENTS  REDUCED OR REVOKED. 

Our military men and women have sacrificed life, limb, and family through over 12 years of combat only TO BE THE FIRST GROUP TARGETED when it comes time to reduce spending. "Thank you for your service"? ... You cannot be serious.

Key Words: resolution,Graves,retiree,McCaskill,disabled,joe,Biden,INTEGRITY,government,veteran,COLA,abuse,Congress,interior,Vice-president,Blunt,contractor,waste,budget,fraud

Thursday, January 9, 2014

Are You Really Cutting Military Retiree COLAs?

Congress recently voted to cut the Cost of Living Adjustment (COLA) for military retirees by 1% per year in order to help balance the budget. That's right ... military retirees, those of us who risked life and limb to PROTECT YOUR FREEDOM for 20+ years are THE FIRST ONES CONGRESS GOES AFTER WHEN CUTS ARE NEEDED! They do not eliminate the BILLIONS OF DOLLARS WASTED ANNUALLY BY GOVERNMENT EMPLOYEES AND CONTRACTORS ... No, they ignore the gross fraud, waste, and abuse happening each and every day and go after military retirees!

Here is the letter I sent to my congresswoman and senator:

Chris Sorrentino LtCol 
Lawrence, KS

January 4, 2014 

Congresswoman Jenkins: 

I'm writing to ask you to repeal a provision (Sec. 403) within the Bipartisan Budget Act (H. J. Res 59) that significantly cuts retirement benefits for current and future military retirees. Section 403 cuts the annual Cost of Living Adjustment (COLA) for uniformed service retirees by 1 percentage point each year until age 62. 

The cuts will have a devastating and long-lasting impact. By age 62 retirees who serve a 20 year career would lose nearly 20 percent of their retirement pay purchasing power. 

I support a long-term budget deal, but this agreement places a disproportionate burden on the backs of the men and women who have already sacrificed so much for our nation. No other group was asked to take such a cut. 

Many members of Congress have stated they would take this up immediately upon their return in January. Help lead this charge - take action to repeal this provision that breaks faith with current and future military retirees, and threatens long term readiness and retention in the uniformed services. 


Chris Sorrentino, LtCol, USAF (Ret) 

Here is the response I received from my congresswoman on 1/9/2014:

Dear Mr. LtCol:

     Thank you for contacting me regarding veterans benefits. As your representative in Washington, I value your thoughts and concerns.

     The Second District is home to some of the best and brightest in the Armed Forces. From Fort Leavenworth to Forbes Field, and the over 7,500 National Guard Members and over 4,000 members of the Reserve, Eastern Kansans are proud of its strong military presence. This means we also have a proud, distinguished population of veterans, and I am committed to making sure these veterans are honored and receive the benefits they have rightly earned.

     I am proud of legislation I have authored and supported for veterans. In July, I authored an amendment to H.R. 2610, the Transportation, Housing and Urban Development, and Related Agencies Appropriations Act of 2014 to ensure the Department of Housing and Urban Development - Veterans Affairs Supportive Housing (HUD-VASH) program serves homeless veterans in the best way possible. I am an original cosponsor of the Expedited Hiring for VA Trained Psychiatrists Act, which would create a fast-track, hiring process for psychiatrists who train at Veterans Affairs facilities. The legislation aims to reduce the wait times for veterans seeking to access mental health services by reducing the time it takes to fill these critical positions.

     Recently, I voted in favor of H.J.Res.59, the Continuing Appropriations Resolution, 2014, for several reasons. First, it prevents another disastrous government shutdown, which the VFW and other veterans organizations warned would be catastrophic for veterans who rely on their benefits. The budget deal also provided the Department of Defense (DoD) $32 billion in sequester relief, another issue the VFW called on Congress to address.  According to the legislation, no military retiree over the age of 62 will be effected in any way. However, working-age military retirees will see their annual cost-of-living adjustment reduced by 1 percent starting in January 2016. This affects those who are still of working age, and who likely have another paycheck. However, when they reach 62, their retired pay will revert back to the full rate of inflation, and they have full inflation protection going forward.

     To be clear, while I would have preferred this particular provision not be included in the legislation, I believe it is the best of the likely options before us; this agreement, another shutdown or continue with sequestration, which mandated an additional $20 Billion cut to the DoD next year, likely resulting significant furloughs.  Our nation’s massive deficit requires that we make concessions and work with the President and the Democrat-controlled Senate to bridge an agreement and avoid another government shutdown. While far from ideal, I believe that is what this budget agreement does.

     Thank you again for contacting me. Please never hesitate to call, email, or write if you have any issues or concerns on your mind. Also feel free to visit my website at where you can see what I have been up to and sign up for my weekly newsletter.
          I hope you have a blessed Holiday Season and a Merry Christmas.


Lynn Jenkins, CPA
Member of Congress

Privacy Statement

Congresswoman Jenkins appreciates the opportunity to communicate with you via e-mail.

Here is my response sent to Congresswoman Jenkins 1/9/2014:

Dear Congresswoman Jenkins,

You voted in favor of H.J.Res.59, the Continuing Appropriations Resolution, 2014, for the following reasons: First, it prevents another disastrous government shutdown, which the VFW and other veterans organizations warned would be catastrophic for veterans who rely on their benefits. The budget deal also provided the Department of Defense (DoD) $32 billion in sequester relief, another issue the VFW called on Congress to address. According to the legislation, no military retiree over the age of 62 will be effected in any way. However, working-age military retirees will see their annual cost-of-living adjustment reduced by 1 percent starting in January 2016. This affects those who are still of working age, and who likely have another paycheck. However, when they reach 62, their retired pay will revert back to the full rate of inflation, and they have full inflation protection going forward.

You are grossly ignorant if you believe cutting retiree benefits is the FIRST way we should balance the budget. I have personally witnessed gross fraud, waste, and abuse in government spending and contracting in the BILLION$ ANNUALLY ma'am.

When I reported the gross fraud, waste, and abuse last January, my $50,000 government contract was illegally cancelled two days later and my business was ruined by the government employee who I reported to when she made false allegations against me and my service-disabled veteran-owned small business. My business was ruined, we lost our home, and were forced to sell half of our possessions because I tried to save the government BILLION$.

I am 57 years-old and don't have an income other than my pension and VA disability, and you think that's OK? You believe that those who served their country for 20 years and risked life and limb for YOUR FREEDOM MADAM should be the first ones to have our COLA's garnished, reducing our lifetime benefits by tens of thousands of dollars? Seriously? MAYBE YOUR COLA AND THE COLA OF THE DEPARTMENT OF INTERIOR CONTRACTING OFFICER (SHARON HALLINAN) WHO RETALIATED AGAINST ME SHOULD BE REDUCED BEFORE MINE?

You are living in a glass house madam, are completely ignorant if you believe that garbage in the letter you sent me, and I will do everything in my power to ensure you are not re-elected because there are far too many ignorant people already in Washington DC! Sincerely, Chris Sorrentino, LtCol, USAF (Ret)


I would like a response



Saturday, December 21, 2013

Billion$ Wasted on Fraudulent Contractors Annually and CONGRESS TAKES FROM MILITARY RETIREES?

Tuesday, December 17, 2013

Is The Voice's Will Champlin Just Shy or Is There More To It?

Is Will Champlin, the very talented contestant and finalist on this season’s NBC’s The Voice, just very shy or does he possibly struggle with what has been referred to until recently as Asperger’s Syndrome? Could NBC, The Voice, or Will himself be waiting until the season is over to make an announcement, not wanting to influence fan voting either positively or negatively?

As a licensed professional counselor with over 30 years experience as a clinician and experience working with and treating those with one form of autism or another, I would personally not be surprised. If Will did have Asperger’s Disorder (now referred to as Autism Spectrum Disorder in the new DSM-V) or another form of autism, all I could say is OUTSTANDING! Not because I would ever wish something as debilitating as autism on anyone, but because Will would make an excellent ambassador and role model for those individuals and families struggling with autism and other mental health concerns. That would be something that could potentially have a massive impact on the elimination of the many negative stigmas surrounding not just autism, but all mental disorders, something I have personally been fighting very hard to achieve.

I am not going to detail the differences between DSM-IV-TR and DSM-V diagnoses here as that would take many pages and is not really relevant to this discussion. Let it suffice to say that whether we call it “Asperger’s Disorder” or “Autism Spectrum Disorder” is not important because they are both merely diagnoses, labels we as clinicians are often mandated to provide and do not define who a person is.

Will Champlin appears to be an extremely quiet person and smiles are few and far between, both symptoms of what we used to call Asperger’s and other Autism Spectrum Disorders. In-fact, Carson Daly commented for the first time just last week that it was nice to see Will finally smiling. 

Will appears rather uncomfortable on stage with difficulty making eye contact. Another thing that has stood out is Will’s unwillingness, inability, or lack of comfortableness touching others. Most, if not all Voice contestants hug or otherwise touch Carson Daly after a performance or when greeting others, including their coaches and other contestants, but Will does not. 

I have seen Carson deliberately not touch Will in those situations and last week, while the very talented (and probable winner of this season’s show) Tessanne Chin and James Wolpert (who was eliminated last week), Adam Levine’s two other finalists, were holding each other tightly while waiting for the announcement of whom would be moving on to the #VoiceFinale, Will Champlin stood alone and emotionless. These are symptoms of the Autism Spectrum Disorders, a very few symptoms of a very complex set of criteria we use to make diagnoses.

I do not know Will Champlin and do not have enough information to make a diagnosis, nor should I as it would be unethical. Maybe he is just a very shy person, maybe he struggles with autism, maybe I am way off base. All I am saying is that based on the behaviors I have witnessed during this season of The Voice, he could be one of the millions of people who struggle with the developmental disorder we refer to as “autism”. 

Autism comes in many forms and varies wildly in severity, as do all of what we in the profession call “mental disorders”. Whether Will Champlin has a diagnosable disorder or not cannot and will not be determined here nor would it define him. However, if he does, he could become the face of Asperger’s, Autism Spectrum Disorder, or whatever label we as humans feel the need to put on people with symptoms of social discomfort, and Will could bring awareness to the struggles the millions of people with mental health issues suffer through each and every day.

I have written extensively about the stigmas surrounding mental disorders such as PTSD, anxiety, and depression, both in general and specifically in the military. My goal here is to help eliminate those stigmas and the many misconceptions the public has regarding mental disorders and mental health treatment. 

The winner of this season’s The Voice has not been announced as I write this and believe Tessanne Chin will likely win. But I am pulling for Will Champlin mostly because I believe a person suffering from the socially uncomfortable emotions and behaviors such as those I have witnessed in Will this season can and should succeed on the Voice and in life. 

Good luck Will!

Key Words: NBC, television, The Voice, voice, Will Champlin, Carson Daly, show TV, singing, song, talent, Asperger's, autism, spectrum, disorder, CombatCounselor, combat, counselor, psychology, therapy

Copyright 2013 - CombatCounselor and 3rd Wave Media Group, LLC - All Rights Reserved

Thursday, November 14, 2013

CombatCounselor Q&A


PenePan @PenePan
11/13/13 Once immersed in therapy how to judge if ur pain and anguish is therapeutic or just painful/therapist not a good fit?

ANSWER: Facing and enduring painful #thoughts and #emotions is part of #therapy. If you continue to get worse, something's wrong.  There's normally a #HoneymoonEffect followed by a short downturn, then gradual improvement with minor set-backs from time to time. If you don't see gradual improvement over 3-4 consecutive sessions, it may be time to find a new therapist !

Here's an article on finding a good therapist: 

This article tells you everything you need to know AND ASK when looking for a TRUE COGNITIVE BEHAVIORAL THERAPIST:

C.T. Sorrentino, LtCol, USAF (Ret)
aka CombatCounselor

Key Words: The rap question answer pain anguish twitter Facebook combat counselor CombatCounselor psychology psychotherapy blogger emotion thought mindfulness

Saturday, October 12, 2013

Online Therapy: Boon or Bust?

In a modern world with technology making it easier and easier to communicate across the street or around the planet, we as psychotherapists face uncharted ground and ethically borderline situations when communicating with clients. I see people who call themselves "therapists" on Twitter and other social networking sites offering therapy via email and Skype (to name just two potential platforms) ... AND THAT CONCERNS ME!

Based on my experience, education, and knowledge of clinical ethical standards for our profession, email is "dodgy" to say the least, offering little protection for confidential communications. Skype therapy has been challenged by licensing boards and professional ethical standards (National Board of Certified Counselors, American Counseling Association, American Mental Health Counselors Association) based on state of licensure, with restrictions on whom licensed clinicians can see, particularly concerning domicile of both parties.

In Missouri and Colorado, two states in which I am licensed, licensed professional counselors (LPC) like myself ARE NOT ALLOWED to see clients outside of our state, even if it happens to be over the internet. The reasons for this are numerous, but, most importantly, the well being of our clients should be utmost in our minds. We cannot travel across state lines to see clients and, therefore, cannot travel virtually cross state lines via the internet either.

There are situations where it may be advantageous to see clients remotely, especially when a client is housebound or in geographically remote areas where face-to-face visits would be cost or time prohibitive. Otherwise, it is ALMOST ALWAYS IN THE CLIENTS BEST INTEREST to meet in person. 

Research on language has indicated that a majority of human communication is "non-verbal" with estimates ranging from 70 to 90 percent. Body language is one non-verbal mode of commuication where context is critical in understanding what is being communicated. Electronic commuications do not allow us to experience body language when discussing sensitive and often complex personal experience as is necessary when performing psychotherapy. Intonation is another non-verbal cue we use to determine what exactly is being communicated, a phenomena that is severely restricted, particularly in written communication.

Confidentiality is of utmost concern when working with clients and electronic commuications are not secure, allowing for potential exposure of extremely sensitive experiences, thoughts, and emotions. Would you want the NSA listening in on your therapy season?  I know I do not!

The individuals performing "Skype Therapy" are many times unlicensed, a fact that can easily be manipulated on websites, blogs, and social networking sites. Few understand that WE MUST BE LICSENED in the state in which we practice in order to offer psychotherapy to the public. Licensure involves AT LEAST a masters degree in psychology or counsleng, and in some cases a doctorate (PhD or PsyD) degree from an accredited institution of higher learning. On top of the degree, practicums, supervision, and post-graduate experience totaling in the thousands of hours (3,000 and up in most states) are required in addition to passing a national exam in order to become licensed. People have been "hanging shingles" for many years without proper training, education, and licensure, so why would things be any different today? 

I have preached about unlicensed and other unqualified individuals (can you say "life coach?) elsewhere in this blog, so I will not elaborate here. It will suffice to say that being "certified" is not enough. I, for example, am a National Certfied Counselor (NBCC - since 1991), but I am AND MUST BE licensed in the state in which I practice in order to LEGALLY PERFORM PSYCHOTHERAY. 

As I have also mentioned in other articles, YOU MUST CHECK AN INDIVIDUALS LICENSE BEFORE INITIATNG THERAPY WITH THE STATE REGULATORY AGENCY COVERING PSYCHOTHERAPISTS IN YOUR AREA. Then, and only then, should you consider undergoing treatment, whether it is face-to-face or over the internet. I would recommend face-to-face treatment in all but the most austere or complex situations.