Part 2: My personal theoretical orientation as a counselor

Because I was asked these questions in an email over the weekend, I finally sat out and wrote my evolved theoretical orientation. As a graduate student, my theoretical orientation looked quite different because I thought of it in context to the population I served: college students working through career and learning exceptionalities, anxiety, depression, and other mood disorders. The bariatric community has had a large impact on how I see the world and what I believe is my best approach to helping others with their struggles related to obesity.

I mainly use motivational interviewing, cognitive behavioral therapy, and existential therapy. Some would consider me eclectic, but I believe that motivational interviewing is my style, cognitive behavioral is my technique, and existential therapy is my philosophy. Existential therapy is the belief that we are all essentially alone in the world, and we long to connect to make meaning of life with others, but ultimately, we must find contentment in our understanding that anxiety comes from the knowledge that our validation must come from within and not from others. However, I believe patients must consider their own ecology: the elements that make up their human existence and struggle with understanding the elements contribute to their relationship with their nourishment and physiology. If their stressors come from family, trauma, abuse, neglect (of self and others,) they must find those underlying issues and identify the impact it has on their live, and understand the behaviors resulting from those stressors.

We all are unique in our needs for therapeutic intervention. Some people do well with a family systems therapy if their issues are mainly focused on their relationships with family, others may thrive with someone who specializes in faith based counseling, if they are driven by Christian beliefs. Mental health care has been long stigmatized as a negative prescription, and so many people just want to get through the assessment process and do not want to consider the organic psyche and its condition. I could put a number on the length or number of sessions, but I truly think that depends on the issues, the willingness of the patient to discuss issues, and how dedicated to changing their thinking patterns.

Common post-op issues can often be solely the result of the weight loss itself sometimes. Dealing with new attention, emotions, body image issues, self esteem... along with the change in relationships and people around them, how to handle comments, positive and negative. Some patients will feel resentment to positive comments from some people and accept some comments from others. Everyone is unique and beautiful as they are though, wherever they are in their journey. That is what I try to continually portray to everyone I encounter. No matter where you are, pre-op, post-op, band removal, revision, pre-plastics, may never get plastics, the number one important character trait is resiliency. Overcoming the negatives and focusing on the positives while you are still working toward small, attainable and realistic goals.

Anyway, my position continues in my willingness to gladly help others find a therapist for anyone who is interested in counseling services in their area. Due to licensing board regulations, I can not provide telecounseling, so I am happy to offer peer supports online in video chat. I have been a practicing counselor intern for the last 2 years, and I have about 300 hours left until I'm licensed. I've had my Master's degree for 7 years, but I did not hold positions where I had eligible direct contact with clients. I also work with patients who have not had WLS, and specialize in ADHD/behavior disorders, anxiety, depression, bipolar disorder, autism spectrum disorders, and career counseling.

This community is, by far, where my passion lies. I see the need for knowledgeable, trained professionals to work within surgeons offices to facilitate groups on a weekly basis, identify those who may be struggling, and work with individuals on a sliding scale. There is some talk of this being a requirement in the Centers of Excellence (now MBSAQIP), though I still think that's probably 3-5 years down the road, at the least, they understand the growing need to address mental health care as a significant issue.