Counseling lifeline.

Byline: RICK FRIEDRICH and LAURA TAMKIN For The Register-Guard

CAROL CAME IN to the Center for Community Counseling for psychotherapy. She reported symptoms of daily tearfulness, a feeling of hollowness and recurring distressing images of ending her own life.

Carol is 49 years old, has a low income and is divorced from a husband who was verbally abusive over their 10 years of marriage. Her two grown children live in the Northwest. She had relocated to Eugene to live closer to her only sibling a few months before we saw her for counseling. She had tried an anti-depressant, but after having a bad reaction to one she was leery of taking medications. She had no health insurance at all when she called our office. She now has health insurance through her job, but not for mental health treatment.

The psychotherapy available through the Center for Community Counseling, formerly the Aslan Counseling Center, is provided by clinicians who have at least a master's degree. These clinicians volunteer their time, thus allowing the average fee per counseling session to be as low as $9 (compared to $50 to $150 for most private counseling). Clients can participate in counseling for as long as they need to resolve their difficulties.

Last year our volunteer therapists and supervisors donated 3,123 hours of counseling and supervision on behalf of our clients. At an average rate of $70 an hour (which is probably low), that is an in-kind contribution of more than $218,000 a year. This allows us to provide $2.70 worth of services for every dollar donated. Because our client fees are low, the CCC depends on donations and grants, which are difficult to obtain in the current climate. We have a great deal of loyalty from the mental health clinicians in this community. We will survive as long as we have the volunteers willing to see our clients, but it is a struggle at times.

This service is crucial for Carol and many others. Her lack of mental health coverage is not unusual. Nationally, more than 40 million Americans lack health insurance altogether; in Lane County, the number is greater than 28,000. Many more people lack adequate mental health benefits, even if they do have health insurance, due to a lack of parity between coverage for physical and mental illnesses. This disparity in coverage reflects the continuing discrimination against and stigmatization of those with mental disorders.

Lisa was referred for counseling by a local agency that offers support to parents of infants and young children. Lisa's biological parents were unable to raise her because of their drug and alcohol addictions. She witnessed many scenes of domestic violence before her aunt and uncle became her guardians at age 6.

She has been very angry and emotionally overwhelmed since the recent death of her uncle. She is a 22-year-old married pre-nursing student. The strain of caring for her 1-year-old and grieving the loss of her uncle have stretched her internal resources to the limit. She is uncertain about her parenting abilities and her capacity to be a partner to her husband. She doesn't know why she feels so angry.

Lisa wants a chance to make sense of what happened in her family, to look at how her childhood has affected her life, and to learn to be a good mother to her little one. She also wants to graduate from college, which would be a first in her family.

Lisa has seen her family practice doctor and is being treated with an anti-depressant, which has alleviated some of her symptoms, and yet her emotional turmoil continues. Lisa has no insurance for mental health treatment.

The majority of visits to primary care physicians are motivated by underlying psychological issues and psychosocial stressors, although the complaints presented may be of a physical nature. The prevalence of current mental disorders in the general population is estimated to be about 20 percent, but that estimate is probably low. The lifetime prevalence - that is, the proportion of the population that has ever had a mental illness - may range to 40 percent or higher. Conservatively, that is one in three people; that means we all have family or friends who will need mental health treatment at some time in their lives.

While psychotropic medications can be extremely helpful for a wide range of symptoms and disorders, they cannot and should not be expected to substitute for the healing potential of a psychotherapeutic relationship. People often need the privacy and security of a trusting relationship with a therapist to face the pain or shame or fear in their lives, past or present, and to grow beyond these wounds. This cannot be accomplished with a pill, nor can it be mandated to occur in 10 sessions or less.

Lisa and Carol are two of the 125 clients being seen for therapy at the Center for Community Counseling. All of the clients have low incomes and lack adequate health insurance, though they are often working or in school.

Ninety-eight percent of the clients were abused as children, and many struggle with violence in their adult relationships. The legacy of untreated child abuse and neglect includes depression, low self-esteem, alcohol or drug addiction, the inability to reach one's potential in the work world, difficulty coping with the challenges of raising children - and, unfortunately, revisiting the pain of abandonment and terror of abuse upon the next generation.

Mental health treatment is effective, and therefore essential. Psychotherapy is life-changing and sometimes life-saving for those who stick with it. Post-treatment self-evaluations from clients at the Center for Community Counseling indicate that 98 percent of clients have improved self-esteem, 95 percent relate better with their friends and families, 90 percent have improved relationships with their children, and 90 percent are more employable. This is what can occur, but people must have access to treatment.

Carol and Lisa were fortunate to have the services available when they were in crisis and unable to cope. Carol continues to work at her full-time job with much less anxiety now than when first seen. She no longer has thoughts about ending her life. Lisa has just begun the process of finding hope and safety within the therapeutic alliance she is building with her therapist. She is feeling the relief that comes from giving voice to her story.

Rick Friedrich, M.D., is a psychiatrist and president of the board of the Community Counseling Center. Laura Tamkin, M.A., is a mental health therapist and member of the board of the center.