Dr. Phil, Weightloss and Smoking Cessation
      "Alternative Therapies" ?

Thoughts on mental health counseling, substance addiction and social work services, and continuing education choices.

~ by Richard K. Nongard, LMFT/CPFT/CCH

About two or three years ago I was walking through Wal-Mart and I noticed a display announcing Dr. Phil's book on weight loss strategies. Strolling past the book section, I kept thinking, "What the heck does Dr. Phil have to do with weightloss? Isn't he a big guy himself?" 

Upon exiting the store I suddenly had that "ah-ha" moment counselors so often seek from clients, and I realized that perhaps the most qualified person to help a client lose weight is actually a professional counselor!   
 
While some have criticized Dr. Phil for giving up the therapy office to become a television personality, he has impacted millions of supporters in the process, far more than he ever could have one-on-one. But more importantly for LPC, LCSW and LMFT type professionals, with his weight loss products, Dr. Phil has demonstrated how helping a client to lose weight exemplifies a very practical application of our skills to everyday difficulties clients face. 

We do not all need to become television stars, but we do need to be able to offer our services to a broad range of clients. To remain relevant, especially in a managed care world, counselors must move towards developing therapeutic products and solutions to every day problems affecting real people in the real world.

After all, there are only so many people with mental disorders, but a whole lot of people who could use the help of a counselor with skills in problem solving, listening, assessment and separating emotions and motivations from actions.

For example, according to the National Institute of Mental Health, 44 million Americans have an identifiable mental disorder.   

• 2.3 million have Bipolar Disorder   
• 3.3 million have OCD 
• 58 Million are addicted to tobacco products
• 127 million adults in the U.S. are overweight - 60 million are obese, and 9 million are severely obese.
  

By simply using the example of weight loss and smoking cessation, one can easily identify two lifestyle issues that the mental and behavioral health professional - who learns to apply their skills to a broader audience than therapy has traditionally offered services to - can exponentially increase the potential market for counseling services.

 
In the era of managed care and funding cutbacks, it is now more important than ever before to find these kinds of practical applications for our counseling skills. Counselors have the training and techniques necessary to not only help people recover from mental illnesses, but to also to help a broad range of individuals in a variety of other settings.    

Healthcare professionals who are able to create practical applications of the skills they possess are able to help clients feel a sense of achievement and contentment, and are also able to expand their vocational opportunities or enhance success in private practice.

The domain of counseling has traditionally been academic settings, private practice, medical and social-service oriented.  Although some counselors have found success in non-traditional environments, most counselors would never think to look at corporate, fitness or retail settings for employment and application of the skills counselors possess.

These settings are not just alternative vocational settings, but ideal opportunities for counselors and social workers to experience professional success and truly help clients in need.

Weightloss is not the only area where a clinician may find the skills they possess to be of practical value to individuals seeking lifestyle change. Smoking cessation is another area of counseling with practical applications to over 58 million Americans.

When I go to conferences on addiction treatment, I almost always see counselors smoking cigarettes during the break, but rarely are any of the seminar’s events related to cigarette addiction treatment methods. With Medicare opening the doorway to third party reimbursement to some providers of smoking cessation programs, healthcare professionals should be clamoring to offer these services and make certain that they are included in reimbursement programs.

According to a recent article in the AMHCA Advocate, counselors are more effective at smoking cessation treatment than nurses and other providers that currently are eligible for reimbursement, yet in many states, the professional counselor is still ineligible for reimbursement.   

Health and lifestyle issues such as weight-loss and smoking cessation are obvious areas of specialization where counselors can find success serving niche markets and applying their skills, but several other areas come to mind as well.  Dr. Mark Britain, an Amarillo area counselor in private practice and pilot of a 1994 aerobatic Pitts Special, provides “fear-of flying” programs to individuals, corporations and even the airlines.  

What Dr. Phil, Mark Britain and other innovative counselors have discovered is that finding solutions to practical problems, rather then simply providing open-ended talk therapy, can be financially lucrative and intrinsically rewarding.

A very poplar text in the field of counseling, Gerard Egan’s book, The Skilled Helper, impressed me early on in my career because it was solution focused. Egan’s model advocates action; action to move a client from the present scenario to the preferred scenario, and while not discounting the client’s experiences, it focuses on the tasks necessary to accomplish goals rather then the emotions or interpretations of past events.

Ever since graduate school, where I learned to provide therapy in 50 minute increments, I have been impressed with solution-focused approaches, and believe the future of counseling itself lies in selling solutions rather than trading dollars-for-hours.

I know it seems almost insignificant to offer weight loss, fear of flying or smoking cessation services compared to the seriousness of bipolar disorder, crisis intervention work or helping developmentally disordered kids achieve in academics and overcome Axis II diagnosis. At first glance, it may seem trite and simple to work in a proble-solving capacity to overcome lifestyle or everyday issues.

However, as a marriage and family therapist, I can tell you that the majority of divorces do occur as a result of fights about money, sex and kids - not the difficulties of mental illness. In my work with the criminal justice system, I have seen clients have their probation revoked for not paying thier restitution fees - but yet they found cigarette money every week, choosing to smoke in the short-term over freedom in the long run.

Everyday lifestyle issues do compound mental illness, and ignoring the importance of these issues can mean the difference between creating therapeutically effective interventions, or not.

A therapist friend of mine called a while ago asking for my advice. She said that even though she was attending support group meetings and taking her antidepressant medication, she was still depressed and felt worse than when she started receiving counseling 5 years ago.

I listened to her story, and then asked a few questions that mental health professionals typically don’t ask. “What did you have for lunch today?”

The phone went silent for a few seconds. I had obviously caught her off guard with the odd question. Finally she muttered, “McDonald’s.”

I asked her if she was still smoking, and she said, “Yes, about one pack a day.”

I then asked her a question many would take offense to: “How much do you weigh?”

This was NOT a question she wanted to answer, but she finally said, “Around 240 lbs.”

I asked her how many miles a day she ran, and at that point she interrupted with, “Okay, okay, I see what you’re getting at.”

I was glad! When using this manner of confrontation, client insight (ah-ha!) can often save the intervention from total failure.

I went on to add, “You’re 40 years old, your lungs aren’t taking in enough oxygen, you are at least 80 pounds overweight and your heart is weak from lack of exercise. You can only function as well emotionally as you are physically. No matter how much Prozac you eat and no matter how many group and IT sessions you attend, it will be impossible for you to overcome your depression until you take care of yourself.”

In this situation, I encouraged her to stop doing what she had done for the last five years with no effect, and asked her to commit to making personal lifestyle changes, starting with a gym membership and working out with a personal trainer.   

After a few months she had quit smoking, lost several pounds, and had experienced the positive emotional impact of regular exercise on almost a daily basis.

Imagine that!  Five years of therapy talking about why she was depressed, versus only a few months of lifestyle changes - and the results were remarkable.

After this encounter, I began to wonder if replacing the couch with a treadmill in the therapy office might actually be the most effective way to truly impact clients!

Innovative approaches can focus on specific areas of client need, such as weight loss, smoking cessation and fear of flying - or on the way services are delivered. Addiction counseling has learned that not everyone gets well on the 28th day, primarily because managed care won’t pay for lengthy treatment anymore, but challenging the assumptions that wellness occurs in 50-minute increments can benefit both the therapist and the client. 

Weight loss had garnered a lot of media attention in the past few years with government studies confirming American obesity rates to be at all time highs and that obesity actually impacts the financial stability of our healthcare system. Books on weightloss, such as the South Beach Diet and the myriad of products focusing on low carb diets, have also been under scrutiny and in the news.

Yet despite this focus by the general public and the government on weight loss - some might even call it a public obsession - only a handful of mental and behavioral health counselors have begun applying their skills and services to tackle to problem of weight loss in professional settings. Many counselors do focus on eating disorder treatment, such as anorexia and bulimia, but the methods of treatment for eating disorders is quit different than helping a client to achieve weight-loss goals. Treatment of eating disorders is treatment of mental illness, but weight loss is simply behavioral in focus, without pathological labels attached.

I hope this information has been helpful to you, and that in encourages you to “think outside the box” when it comes to delivering practical mental and behavioral healthcare services.

~ Richard K. Nongard, Executive Director
Licensed Marriage and Family Therapist
Certified Personal Fitness Trainer
Certified Clinical Hypnotherapist

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NBCC, NAADAC and State Board approved online and homestudy CEU courses and intensive professional development continuing education specialty certification training programs on therapeutic weight management and tobacco cessation treatment are available for social work and counseling professionals by PeachTree Professional Education.  For complete state CE board approval listings, see our approvals page.

For more information on these Certification and CEU programs, see:
Certified Therapeutic Weight Management Specialist
Certified Tobacco Cessation Treatment Specialist

The contents of these CE/CEU/CNE course and certification programs are appropriate for use all mental health professional counseling counselors (LPC, LCPC, LPCC, MHC, RMHC, NCC), marriage and family therapy therapists (MFT, LMFT, RMFT), social work social workers (SW, LCSW, LMSW, SWA, LICSW), psychologists, psychology associates (LPA), chemical dependency substance abuse counselors (LCDC, CADC, CAD, DAC, CAAD, CSAC), nursing registered nurses (RN, CRN, LPN, LVN), and related behavioral health professionals.

Reference sources for this article:
http://www.nimh.nih.gov/publicat/numbers.cfm
http://www.obesity.org/subs/fastfacts/obesity_US.shtml

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