Counseling, if you've never been, can feel scary to consider.
People often wait until their feelings or problems cause them to have more pain than joy in their life before calling for help. One reason for that is they don't know what to expect from psychotherapy. So here are some of the most common questions they ask and how I answer.
1. Is here something wrong with me?
The short answer is no. There is likely nothing “wrong” with you.
People seek out counseling for a variety of reasons. Some want help with productivity at work. Some want to feel happier. Some want to learn why they do certain things or think certain ways. Some want help with decision-making. Some want help smoothing out a relationship. I like to compare counseling and psychotherapy to any other healthy change. If you want to build up your stamina, you might take up jogging or other aerobic exercise. If you want to create art, you might take a class. If you want to feel closer to your partner, you might schedule date nights. And, yes, if you want to learn why you get stomachaches and headaches after a fight, you might come see me.
2. How do I know if counseling will work?
The short answer is if you want to learn, change, or practice something about yourself, if will work.
The longer answer is that different people fit better with different types of counselors – male or female, spiritual or secular, client centered or theory oriented. Therapy will work best if your counselor is one with whom you fit well. In fact, research shows the relationship between client and counselor is at least as great a predictor of the success of therapy as any other aspect, including the type of therapy (EMDR, solution-focused, CBT, or other) and the therapist’s education level (Norcross, 2011).
The other piece, though, is that if you want your counseling to change someone else, it’s not that simple. You can only change you. Your therapy can change the way you interact with others, which could change their behavior, but it’s not a straight line from your therapy to their change.
3. How do I know if it’s working?
If you are meeting goals you set, or making progress toward meeting goals you set, it's working.
A good therapist will work with you to set goals. What do you want from counseling? Where do you hope to be in 3 months, 6 months, a year? Some counselors use “the miracle question:" Say you went to sleep one night, and while you were sleeping, a miracle happened to make your life exactly how you want it. But, you were asleep so you didn’t know that miracle had happened. The only way you would know is by what you saw, heard, did, or felt when you woke up. What would you notice that was different?
Then you take time every month or couple of months to review your goals. Are you getting closer to getting the job you want? Are you yelling at your spouse less and feeling closer? Are you feeling lighter, freer, more confident? If the answer is yes, counseling is working.
If the answer is no, a good therapist will help you by changing up the focus or frequency of counseling, learning whether goals set are attainable as is or need to be broken down, or if there is some other reason for lack of progress meeting them.
4. What happens if it’s not working?
Short answer: We shake it up.
Longer answer: In addition to the last paragraph in number 3 above, your counselor, with your agreement, might suggest adding in some EMDR, play therapy, art therapy, narrative therapy, or other method to mix it up a bit. I might add homework or reading assignments for the time between sessions.
And one other thing. You and your counselor might look at your relationship. Have you built trust, warmth, and mutual respect? See number 2 above.
5. Do I have to tell you everything?
Nope.
You don’t need to tell what you don’t want to tell. If you and your counselor allow your story to naturally unfold, in its own time, your relationship (see how I did that) will become more solid, trusting, and therapeutic than if you run down a long list of events from your life. Your counselor will have given you forms to sign that define the limit of what they will do with the information you give. That said, the more open you can be, over time, the more help you will receive.
6. How long will it take?
I’m not sure yet.
Because every person is unique, and every issue affecting every person is unique, it’s impossible to know how much time is needed to resolve problems. However, you should know by the fourth or fifth weekly session if counseling is helping. If counseling is every two weeks, of course, progress will be cut by more than half. This is because we spend more time catching up instead of just continuing on from last session. So at the rate of every two weeks, it will probably take more than twice as long to see complete healing and achieve your goals.
Just like when you take a class, if you go every week, you have 6 days to practice and/or forget what you learned. If you attend every other week, there is more time for other competing forces to get you sidetracked. Understand that some therapists and clients work even better in longer sessions though. The best way to figure out what will work best for you and how long that will take is by goal setting (see above), monitoring progress made toward your goals (again, above), and communicating with your therapist along the way.
7. How does it end?
By termination.
Termination is the word therapists use to describe the end of therapy. Shortly after beginning therapy, a good therapist will start planning for termination. Not because they want to be rid of you, but because no one deserves to have to be in therapy forever. The way to plan for termination is by reviewing the goals (again with the goals), and progress made. If you come to a therapist like me, for anxiety, you don’t want to keep on coming to me for years, with that same level of anxiety. That means something’s not working and we need to change something up (number 4 above).
When your stated goals are close to being met, or you are satisfied with your progress you are making toward them, you and I will talk about next steps. That could look like ending therapy, adding new goals, coming less often, or something else that suits your needs. We’ll review your progress, how far you’ve come, and all your tools and strengths you have acquired to help with any future needs you might have. I will also tell you it’s OK to call and come back some later time if you feel the need. We might have a celebration if that’s something you want. Or we might have a quiet goodbye with the knowledge that you are now stronger or you were always strong but now you know it. Let me say again, you deserve to have a finish point for the current issues.
Another way it can end, although this is less ideal, is for you to just stop coming. You are the client and you may choose to end therapy at any time, of course. The reason it isn’t ideal is that there is no wrapping up, reviewing strengths and supports, no sending off, or setting off with your bag of tools. Goodbyes can be hard but they are important, part of the cycle of life, and good learning.
8. I just want someone to tell me what to do. Why won’t you do that?
Some therapists will. I won’t and here’s why.
I don’t tell clients what to do because, no matter how much you may want it, I’m not the one who is hurt if it doesn’t turn out the way I think it will. I’m not the one who feels your pain (although I will likely feel pain for you). Also, I believe you have the answers inside you. You’ve already done something that worked in a different situation. I’m here to show it to you, help you rediscover what’s inside.
I will help you see options, learn about potential pitfalls and advantages, consider impacts and ripple effects. Like it or hate it, you have free will. And I will support your choices and the learning that comes from those choices.
9. What do you do with the information you learn about me?
I keep it private and use it to understand you better.
State and federal confidentiality laws, the Health Information Portability and Accountability Act (HIPAA), and the National Association of Social Work Ethics prevent me from sharing your information. There are exceptions in a few circumstances like abuse of a child or fragile adult, threats to self or others, and to provide for coordination of care in emergencies. Then I share the minimum amount possible.
“Mostly, the information, your story, that you choose to share with me, I hold sacred because it is a piece of you. I value your information the way I value you. It is a gift that helps me determine how to work with you, what might help you, what to avoid until you get stronger.”
10. My husband, partner, parent, child needs counseling. What should I do?
Ask them if they would like to talk to someone.
You know your husband, partner, parent, child. If you believe they will be reluctant to come to therapy alone, you might ask them to come with you. You might start the conversation slowly, by simply noticing aloud that they seem less happy than usual, more stressed, are having trouble sleeping, or whatever is true for them and for you. You might give them this article to read, and ask if they’d like to call me with questions or for a free telephone consultation. You can show them my web site www.balanceinsight.com
And you might remind them that what they tell me is confidential (see number 9 above). Just like what you tell me. Therapy is a safe place.