Dear Ann Landers,
read your column every day and think your ad-vice is very good. That's why I hate to see you cop out and suggest "coun-seling." I've been to many counselors, ana-lysts, psychologists, etc. None of them did me any good. The fiTSt few visits they listen, look at the ceiling a lot, nod their heads and ask about your childhood. The next few visits they ask what you think should be done. After sev-eral visits they tell you to do what you think is best. This is advice? If I could depend on my own judgment why would I need them? Several months ago I called my doc-tor in the middle of the night I was desperate. I begged him to help me. Do you know what he said? "Come see me tomorrow." Finally I got smart and realized that for $50 an hour I could have a terrific vacation and it would do me a lot more good. So please, Ann, when people write for advice, give them your best shot. You might be the only one who is willing to speak out. AN ADMIRER

DEAR AD,
I "speak out" plenty, and I'll continue to do so. Many people who write for advice know what they ought to do. They just need someone to tell them to go ahead and do it. Others need a lot more than advice. They should have continuing help. And this is when I suggest counseling. I realize one's chances for getting a first-rate counselor are the same as getting a first-rate doctor, lawyer, plumber, auto mechanic or hairdresser. No better than 50-50. Psychiatry, Psychoanalysis and Psychotherapy and Other "Helpers" (The Differences) Psychiatry is the medical specialty dedicated to the study of human behavior and the treatment of conduct that is troublesome to the individual or to soci-ety. This study of human behavior includes: Genetic predispositions, which means inherited tendencies and weaknesses, birth injuries, emotional problems developed in childhood, physical problems that might influence behavior, toxicides and infections that might affect the brain and other organic factors. The character-forming influences of family, education, sexual, social and cultural experiences. How favorable physical and environmental factors can result in socially ac-ceptable "normal" behavior for some individuals and how stressful or difficult life situations can cause others to develop anxieties, irrational fears (phobias), persistent obsessions, destructive thoughts and actions, bizarre be-havior and depression with suicidal impulses, often accompanied by imagi-nary illnesses. In the treatment of such deviations, psychiatrists attempt to relieve a per-son's discomfort by developing his/her integrity, dignity and creativity. The therapy may include: Physical: Advice as to diet, exercise, rest periods, environmental or occu-pational changes, medication, surgery (when necessary for brain tumors or in similar rare instances) and other medical procedures. Psychological: (1) Re-education of the patient by encouraging him to talk freely about his innermost, often suppressed feelings and by so doing enable him to better understand himself and how he relates to others. (2) Family or group conferences during which all the parties involved, hopefully, come to realize that deviant patterns of conduct when replaced by improved be-havior give all concerned greater and more lasting satisfaction. Existential: Restoration of trust in humanity and the enjoyment of the values and beauties of life. Psychiatrists are M.D.s who have taken three years of specialized study in psychiatry after their internship. Only M.D.s may prescribe drugs. Most are not analysts. Look for one whose residency was in a university-affiliated pro-gram, who has a valid state license and who is either certified by the Ameri-can Board of Psychiatry and Neurology or "board eligible." Psychoanalysis: A qualified psychoanalyst is a psychiatrist who has been further trained in a Psychoanalytic Institute approved by the American Academy for Psychoanalysis and the American Psychoanalytic Association. This training comprises a personal analysis averaging four hourly sessions a week for four or five years of intensive study of the theories and techniques of Sigmund Freud (in advanced Institutes, also those of Alfred Adler, Carl Jung, Karen Homey, Melanie Klein, Sandor Rado, Franz Alexander and others). During the course of psychoanalytic training the student must under-take the psychoanalytic treatment of a minimum of three patients-under the supervision of an experienced analyst. Psychoanalytic Therapy: This involves the psychoanalyst talking with or listening to the patient during fifty-minute sessions, three to five times per week. These sessions cover the discussion of childhood experiences, fears and hopes. They are examined and analyzed and the patient then better under-stands who he is and why he is the way he is. This type of self-understanding enables the patient to alter his conduct in ways that make him more secure, more productive and less anxious. Psychotherapy: This is a vague term applied loosely to all methods in-tended to influence thought, feeling and behavior. Professionally these range from the expert practices of psychiatrists and psychoanalysts to the non-medical and less comprehensive but valid advice and guidance offered by academically sanctioned psychologists (M.A. or Ph.D.) as to career poten-tialities or methods of improving verbal skills, or by qualified social workers. Psychologists may have only a master's degree or may have taken addi-tional training to obtain a doctorate. Not all treat patients; some do only test-ing or research. Look for one with a state license and certification by the American Board of Examiners in Professional Psychology or with a listing in the National Register of Health Service Providers in Psychology. Social Workers do many of the same kinds of individual and group therapy that psychologists and psychiatrists do. Most work for hospitals and clinics but a few are in private practice. Look for at least a master's degree (M.S.W. or M.S.S.W.) and accreditation by the Academy of Certified Social Workers (A.C.S.W.). Pastoral Counselors are members of the clergy who have taken special training in social work or psychology, sometimes enough to qualify for de-grees in their fields. Such persons can be extremely helpful to troubled peo-ple, but untrained members of the clergy are often not effective psycho-therapists. Paraprofessionals are a mixed bag of individuals offering psychotherapy of one sort of another but without sufficient training to qualify for another title. They are usually not licensed or accredited but may have completed two-year associate degree courses to be called "mental health assistant," "psychiatric counselor," "activity therapist" or "nurse's aide." Individuals who undertake extensive treatment should be certain that they are working with qualified professional people. If there is any doubt, they should contact the American Medical Association, American Psychiatric As-sociation, the American Psychological Association or the National Associa-tion for Social Workers. The addresses can be obtained from any public li-brary with a telephone call. Be aware that any individual can call himself a therapist even though he has had no professional training or credentials. At this moment there is no law to protect the public against such practitioners. credit: Jules Masserman, M.D., Chicago, Illinois, President, American Psychi- atric Association and Professor Emeritus, Psychiatry & Neurology, Northwestern University, Chicago. Psychology {Help for Your Head-Where to Get It) The National Accreditation Association and the American Examining Board of Psychoanalysis, Inc., a group of several bodies that certifies psycho-analysts, maintains a registry of those who meet certain minimum require-ments of training and experience. The registry chiefly includes analysts who are not psychiatrists. Most are social workers. This group's national registry can be purchased for $4 by writing the or-ganization at 80 East 11th Street, New York, New York 10003. People may also call (212) 677-5455 to ask whether a given analyst is listed. Psychoanalysts whose basic training is in psychiatry and whose qualifica-tions exceed certain minimums are listed in two directories. The American Psychoanalytic Association maintains a roster of members which is available in many larger libraries. In the current directory, persons listed as "active members" have been certified as meeting a second, higher set of criteria. To learn how and whether an analyst is listed, people may call the association headquarters in New York at (212) 752-0450. The American Academy of Psychoanalysis, also headquartered in New York, has a similar roster and will answer questions about whether someone is a member at (212) 477-4250. By far the largest profession providing psychotherapy services is that of so-cial work. The largest compendium of social workers who meet certain minimum standards set by the National Association of Social Workers is the N.A.S.W. Clinical Register. Copies, which cost $25 from the association office in Washington, D.C., may be consulted in larger libraries and schools of social work. Another listing of social workers who offer psychotherapy and meet certain minimal criteria is the National Registry of Health Care Providers in Clinical Social Work. The National Registry is available for consultation in some clinics or may be purchased for $8.50 from the publishers, the Board of the National Regis-try of Health Care Providers in Clinical Social Work, 1025 Dove Run Road, Lexington, Kentucky 40502. Additional sources of information include the following: American Psychological Association will answer questions about whether and how psychologists are listed in its national directory at (202) 833-7581. A.P.A.'s national office is at 1200 17th Street, N.W., Washington, D.C. American Psychiatric Association provides similar information at (202) 232-7878. Ask for background information. Headquarters are at 1700 18th Street, N.W., Washington, D.C. American Association of Marriage and Family Counselors, 41 Central Park West, can give information on therapists specializing in this field at (212) 725-5290. American Association of Sex Educators, Counselors and Therapists, 425 East 79th Street, will provide information at (212) 535-5520. credit: Boyce Rensberger, Psychotherapy: "Finding More Shrinks to Fit," from the New York Times, Wednesday, January 18, 1978, page C-9. Barnum was right. There's a sucker born every minute. And two to take him. How do I know? Because they write to me-by the thousands. The victims, that is. "How can they be so stupid?" I ask myself. And then I answer the ques-tion. It's not merely stupidity. It's desperation and wishful thinking that wipe out all reason and common sense. I became furious at the exploitation of these good people whose only crime is ignorance and vulnerability. Here are some examples of some of the letters: