The term _psychotherapy_ is often used to imply more advanced professional training, whereas counseling is something individuals with more modest academic credentials may practice. Whether a professional is called a counselor or a therapist has to do with his or her level of training, with the setting in which services are offered, and, to a certain degree, with that person's theoretical orientation. {32} In practice, these differences in outlook frequently amount to differences in _emphasis_ rather than approach. In this book, I will speak of counseling and psychotherapy interchangeably unless there is a need to be especially restrictive. THERAPY: THE ART OF CHANGE HOW WE ARE ABLE TO CHANGE We are what we do ... and may do what we choose. Allen Wheelis, _How People Change_ Freud identified five causes of personality development: * growth and maturation * frustration * conflict * inadequacy * anxiety By the time we become adults, most of us have developed sets of defenses to enable us to cope with everyday problems _in spite of_ feelings of frustration, conflict, inadequacy, and anxiety. But as these feelings become more pronounced, when we encounter situations that intensify these feelings, we must put more and more energy into our defenses. They allow us to continue living and acting in habitual ways, usually by hiding, by denying, and sometimes by distorting our perceptions of reality. Facing the inadequacies of a marriage, the unrewarding nature of a job, the extent of conflicts with a child, or difficulties relating to friends can cause intense anxiety. So, to avoid this anxiety, we frequently "defend against" these realizations: we try to uphold the belief that our marriages are just fine, that things are OK between us and our children, that our jobs are at least tolerable--that, in spite of some problems "here and there," we can get along all right. We do, in short, try to see our lives through rose-tinted glasses. We continue to do this until our negative feelings become too strong, until we have expended so much energy to maintain our defenses that we are _emotionally exhausted_. If we reach such a state of real depletion, and our defenses can no longer hold against the building pressure of our feelings, the result is {33} _nervous breakdown_. This is the layman's name for a variety of psychological conditions that develop due to _a burned-out emotional fuse_. A fuse is a protective device that prevents an overload of electricity. Our defense mechanisms are analogous devices that protect us against emotional overload. When an emotional fuse burns out, it is often because we have maintained defenses too long in the face of increasing inner frustration and pain. The result may involve severe depression, incapacitating anxiety, or serious withdrawal.