Practice Areas/Boundaries

The NPCA now recognizes two kinds of philosophical practitioners: (1) philosophical counselors and (2) philosophical consultants.

1. Philosophical Counselors

a.) In addition to training/certification in a modality of philosophical practice that is recognized by the NPCA, such as Logic-Based Therapy (LBT), philosophical counselors hold a minimum of a Masters degree in a mental health area from a recognized graduate program, and are licensed in the state in which they practice. This includes (but is not limited to) licensed mental health counselors, licensed professional counselors, licensed clinical social workers, clinical psychologists, and marriage and family counselors.

b.) Philosophical counselors may apply their training in philosophical practice to the range of mental disorders ordinarily addressed by licensed mental health practitioners (See list of mental disorders provided below under “Referral Indications for Philosophical Consultants.”)

c.) Philosophical counselors may wish to practice distance counseling, for example, online. In some cases they may seek to practice across state lines. Because the NPCA requires that certified philosophical counselors be licensed mental health practitioners in the states in which they practice, philosophical counselors who seek to address mental disorders through distance counseling across state lines must be appropriately licensed in the states across which they practice. However, philosophical counselors who are not so licensed in states across which they seek to practice may practice exclusively as philosophical consultants pursuant to the NPCA practice standards that apply to philosophical consultants (see below). In such cases, as part of informed consent, philosophical counselors must explain to clients the difference between philosophical consultation and mental health counseling, and agree that the relationship will be restricted to consultation.

2. Philosophical Consultants

a.) In addition to training/certification in a modality of philosophical practice that is recognized by the NPCA, such as Logic-Based Therapy (LBT), philosophical consultants hold a minimum of a Masters degree in philosophy from a recognized graduate program.

b.) Philosophical consultants help their clients deal with many kinds of problems of living that people confront in the course of everyday life. These include but are not limited to:

Sample Problems Addressed by Philosophical Consultants

  • Moral issues
  • Values disagreements
  • Political issues and disagreements
  • Writers block
  • Time management issues
  • Procrastination
  • Career issues
  • Job loss
  • Problems with coworkers
  • Disability issues
  • Financial issues
  • Retirement
  • Aging
  • End of life issues
  • Midlife issues
  • Adult children of aging parents
  • Problems with family
  • Family planning issues
  • In-law issues
  • Breakups and divorce
  • Parenting issues
  • Becoming a parent
  • Sibling rivalry
  • Finding out one is adopted
  • Falling in and out of love
  • Loss of a family member
  • Loss of a pet
  • Friendship issues
  • Peer pressure
  • Academic or school-related issues
  • Rejection
  • Discrimination
  • Religion and race-related issues
  • Entertainment-related issues
  • Technology-related issues

c.) However, philosophical consultants do not address mental disorders. They refer such matters to licensed mental health professionals, including NPCA-recognized philosophical counselors. Philosophical consultants such as LBT practitioners, facilitate clients’ examination of their reasoning concerning such matters as the abovementioned, and teach critical thinking skills (see also discussion of philosophical practice). Sessions are directed at particular problems of living and end when the particular problem is addressed.

Referral Indications for Philosophical Consultants

d.) The following is a list of indications, based on the Diagnostic and Statistical Manual of Mental Disorders,[1] for which referral to a licensed mental health professional should be made.  The satisfaction of any single bulleted item in any of the given disorder categories is grounds for referral:

Neurodevelopmental Disorders

  • Enduring pattern of inattention and/or hyperactivity-impulsivity that is inconsistent with developmental level, which significantly impairs a major area of functioning such as social, academic, or occupational;
  • Developmental deficits in capacity for social-emotional communication/interaction including non-verbal communication/interaction, and in forming and maintaining interpersonal relationships.

Psychotic Disorders

  • Hallucinations;
  • Delusions;
  • Disorganized thinking or speech (loose associations, tangents, incoherence);
  • Catatonic behavior and other abnormal motor behavior.

Bipolar and Depressive Disorders

  • Manic episodes;
  • Suicidal ideation (contemplating committing suicide) along with one or more of the following:
    • Specific plan;
    • Expression of intention
    • Past history of suicide attempts or threats
    • Family history of suicide
    • History of psychiatric diagnosis or commitment to inpatient facility;
    • Other serious health problems—perceived or actual
    • hopelessness,
    • self-damning
    • alcohol / substance abuse
    • history of trauma / abuse
    • cultural / religious/ personal acceptance of suicide
    • recent loss – relationship, financial
    • Access to lethal means
    • Impulsivity/aggressiveness
    • knowing others who have committed or attempted suicide
    • lack of support system, single or living alone
    • elderly or young adult male
  • Sadness, emptiness, or irritable mood most of the day, on most days, which significantly impairs day-to-day activities ongoing for at least one year;
  • Sadness, emptiness, hopelessness, or irritable mood, most of the day, on most days; and/or loss of interest or pleasure in all or most activities, most of the day, on most days; causing significant distress or impairment in social, occupational or other major areas of functioning; including at least five of the following changes:
    • Sadness, emptiness, hopelessness, or irritable mood, most of the day, on most days;
    • Loss of interest or pleasure in all or most activities, most of the day, on most days;
    • Significant otherwise unexplained weight loss/gain or decrease/increase in appetite;
    • Insomnia, excessive daytime sleepiness
    • Psychomotor agitation (e.g., fidgeting, purposeless leg movements, or pacing) or psychomotor retardation (e.g., slowed speech or walking)
    • Chronic fatigue or energy loss
    • Persistent feelings of worthlessness or inappropriate guilt
    • Diminished ability to think clearly, concentrate, or make decisions
    • Recurring suicidal ideation without a specific plan; with a suicide attempt; or with a specific plan.
  • Chronic, severe, persistent irritability, including frequent temper outbursts and a tendency to be angry;
  • Mood swings tending to occur during menstrual cycle.

Anxiety Disorders

  • Phobias – persistent, ongoing, exaggerated, intense fear or anxiety about a specific sort of object (e.g. snakes) or situation (e.g. heights);
  • Panic attacks –sudden intense fear peaking in minutes characterized by changes such as pounding heart and feeling unable to breath;
  • Ongoing, day-to-day, excessive anxiety or worry about a number of different activities or events, which causes significant distress in social, occupational or other major areas of functioning.

Obsessive-Compulsive Disorders

  • Obsessions – repetitive, persistent, intrusive, unwanted thoughts, which interferes with or causes significant distress in social, occupational or other major areas of functioning;
  • Compulsions – repetitive behavior or mental activities one feels driven to engage in, having no real connection to what it is intended to guard against, which interferes with or causes significant distress in social, occupational or other major areas of functioning;
  • Preoccupation with perceived bodily defects, which interferes with daily functioning;
  • Hoarding – ongoing difficulty getting rid of things regardless of their actual worth such that clutter prevents room use, and causes distress in day to day living.

Trauma and Stress Disorders

  • Flashbacks; nightmares; or intrusive, unwanted, distressing memories or thoughts about an event involving death, destruction, injury, or sexual violence.

Dissociative Disorders

  • Dissociative identity – taking on two or more identities;
  • Dissociative Amnesia—inability to recall specific events during a specified period of time, including periods of travel or wandering (so-called “dissociative fugue”); or general inability to recall personal identity or life history;
  • Depersonalization – sense of being an outside observer of oneself
  • Derealization – sense of unreality of one’s surrounding environment.

Somatic Symptom Disorders

  • Distress about perceived or possible somatic (bodily) pains or health problems.

Feeding and Eating Disorders

  • Purging, overeating, bingeing, self-starvation, poor appetite, or persistent eating of non-food substances.

Elimination Disorders

  • Elimination problems –bedwetting or clothes wetting; defecating in clothes or on floor.

Sleep-Wake Disorders

  • Insomnia; excessive sleepiness or sleeping; breathing problems; sleepwalking; nightmares; sleep-talking; leg discomfort; or other sleep-related problems.
  • Fatigue or loss of energy.

Sexual Dysfunctions

  • Sexual problems – ejaculation, erections, arousal, penetration, low sex drive, or related problems;
  • Distress about one’s gender.

Disruptive, Impulse-Control, and Conduct Disorders

  • Persistent pattern of:
    • verbal aggression or outbursts;
    • physically violent behavior, including threats or destruction of property;
    • fire setting;
    • torturing animals;
    • lack of conscience or remorse, i.e., seeing people as objects/pawns.

Substance –Related and Addictive Disorders

  • Alcohol, caffeine, cannabis, hallucinogens, opioids, sedatives, hypnotics, anti-anxiolytics, stimulants, tobacco, gambling.

Neurocognitive Disorders

  • Neurocognitive decline – Delirium, Alzheimers, Dementia, and other brain diseases.

Personality Disorders

  • Enduring, deeply engrained pattern of maladaptive and inflexible behavior and thinking across a broad spectrum of areas of living, which interferes with or causes significant distress in social, occupational or other major areas of functioning, including:
    • paranoid ideation;
    • social detachment;
    • instability of interpersonal relationships, self image, and affect;
    • grandiosity;
    • inability to empathize;
    • social inhibition;
    • submissiveness;
    • fear of separation;
    • preoccupation with orderliness.

Paraphilias

  • Voyeurism, exhibitionism, frotteurism, sexual sadism or masochism, pedophilia, fetishism, transvestism.

e.) Philosophical consultants accordingly establish and maintain a referral network of licensed mental health professionals.

f.) Philosophical consultants whose case falls into a gray area or who have questions about whether the given case falls under any of the above disorder categories should consult a licensed mental health professional.

[1] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, DSM-5 (Washington, D.C.: American Psychiatric Publishing, 2013).