The 10 most common questions I get asked about counseling

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.

What questions do you have? Email me and I'll answer in another blog post.

Saying NO: 4 Steps to Telling Your Mother No

Like many women of a certain age, we’ve moved past being a rebellious daughter and into being a mother in our own families. We tell our children no when they ask for unreasonable or unhealthy things. We tell our partners no when they have unrealistic expectations. We even tell our best friends no when we need more time with our children and partners. Why, then, is it so difficult to say no to our mothers or fathers or other members in our family of origin?

In some cases, we feel obligated to go along with our parents’ requests, no matter the cost to us. She raised us, changed our diapers, protected us from mean neighbor kids, and took us out for ice cream after the dentist. We feel we owe her our allegiance.

In other cases, we feel obligated since she put us first, no matter the cost to them. Maybe they left our hometown and their friends to move us closer to a better school. Or, she skipped work, again, left early, again, and jeopardized their job each time we threw up at school. We feel we owe her our undying loyalty.

But, sometimes, we comply with her demands because we recognize her power to hurt us, even as the grownups we are. We know from experience she can turn our siblings against us, disinvite us to family holidays, or simply send a nasty email that feels like banishment. We feel we need them to survive.

Regardless of our reason for saying no, it can feel impossible. Good news: you can learn to say no, stick with your no, and feel better for it.

1. First, get clear with yourself that you want to say no. It’s important to you. You feel it in your gut and it matters.
   

2. Second, phrase it in the affirmative to yourself. No, I will not cancel my trip to Greece because you want me with you during the anniversary of your divorce becomes “I have a vacation planned and I’m going to Greece.”
   

3. Third, practice and be a broken record. Don’t scatter about trying to put out other fires. “I’m going on vacation to Greece next month.” But I need you. “I’m going on vacation to Greece next month.” You’re so selfish. “I’m going on vacation to Greece next month.” Your sister wouldn’t go away when I needed her. “I’m going on vacation to Greece next month.” Rinse and repeat. If you need to, you can add an "I love you" in there but stick to the main message and don’t get sucked in to answering the little accusations and manipulations.
   

4. And fourth, reward yourself for your bravery, for taking your needs seriously, and for being a role model for your own children. Before long, your kids will need to learn to say no to you. You can start teaching them, by example, now.

Family relationships can be a source of support, affection, and learning, but without boundaries and saying no when you need to can lead to energy loss, distress, and anxiety. If you're having a hard time saying no or keeping boundaries and want to improve your relationships, call or email to schedule a free telephone consultation where you'll get some ideas and learn if maybe you want more help.

When feelings feel physical

 “It’s all in your head.”

“You need to get over it.”

 “Just ignore it and move on.”

How often do we say this to people who feel depressed or anxious?

Well, we’ve all heard of people heading for the Emergency Room with chest pain and learning it was a panic attack. This is because panic has a profoundly physical part of it that can make it hard to function. Imagine how hard would be to ignore severe chest pain. This is what’s being asked when folks tell people with anxiety and panic to just get over it. Many feelings and mental health disruptions can show up as physical health issues. Check with your doctor to rule out things like heart attacks, stomach ulcers, and brain or neurological problems, of course, but once those are ruled out, look for a mood or psychological issue (feelings or thoughts) that could be helped with counseling.

Imagine, or maybe you’ve already felt it, the amount of pain involved to send you to the hospital. All the parts of us are connected so it makes sense that depression, anxiety, and trauma can cause physical symptoms. If you get frequent stomach aches, headaches, or even just feel unwell or less healthy, this can be due to either a physical injury or illness, or a mental one.

Not sure about the connection between psychological and physical feelings? Try this little experiment: Bring something to mind that makes you feel angry – a memory, assumption, future meeting with someone. Sit with that thought or memory for a few minutes and notice if there’s a place in your body that feels pain or other physical sensations. For me, it’s my head. If I’m really angry my head sometimes aches. I know, most of us get headaches on occasion. I’m not saying they are always due to anger or other emotion - but sometimes mine are.

Now bring up a memory or future event that causes you fear. Where do you feel it in your body. Some people feel heavy limbs, stomach aches, or a sore throat.

Now try it with sadness, again sitting with the thought or memory for a few minutes. Pay attention to your body and where your sadness lives. Do you feel a heavy chest, a sharp stomach ache, something else?

And lastly, think of something or some time you felt joy. The kind of joy that has you jumping, clapping, and maybe even crying for its beauty. How does your body feel? Hollow? Full? Loose? My arms and legs get almost floaty, they become so light.

Bonus, you can try this with other positive feelings to help you improve your mood. Recall something terrific (calming, or safe, or happy), including sounds and smells. Keep it in your mind for more than a few minutes. It really works!

It seems that some pains may truly be in our head, but that’s not a bad thing. If you have unresolved pain, and your doctor can find nothing physically wrong, call me to talk about whether you might want more help. 

Related posts: Where do you hold stress, Mad as hell, Finding the right therapist (anywhere)

How to get the most out of counseling - 5 ways

Let’s start by telling the truth: counseling is a large investment of your time and money. Living in the Issaquah area is expensive enough and commuting to work is long enough – no need to throw away time and money. And by the time you start counseling, you’ve probably been suffering long enough that you’re really ready for things to be better. Since your time and money are being spent, here are some ways to make sure to get the most out of it.

1. Make sure you connect

Do your homework when picking a counselor. Ask people you trust, like friends, family, doctors, for names of counselors they know and trust. Look online. As you read counselors’ web sites and blog posts, watch their videos, you’ll begin to get a sense of them. When you’re ready, contact a few counselors and ask for a consultation. During the consultation, you’ll learn more about how they work and they’ll learn about you. Both you and the counselors will be able to tell if you are a good fit for one another.

In sessions, pay attention to whether and how well you connect. Keep an eye out for how well the counselor seems to “get you.” Are they empathetic, can you get to know them enough to feel like you have some things in common or that they are a bit like you? Does the counselor seem to pay attention to you?

2. Come regularly.

Just like with exercising at the same consistent time of day, you will start to become accustomed to a certain day of the week being yours to share, get care, learn, grow, and heal. You can look forward to it. If you miss weeks in between, sessions are spent catching up instead If you start and end on time, you’ll get your full time. Especially if your counselor is using a method that has a bit of a plan to it, like EMDR, there is a lead in, work, and an easing out. When sessions are cut short, the needed parts might not happen, or might not give the full effect or benefit.

3. Do your homework.

If you have homework, try your best to do it. If you’ve said yes to accepting it, you’re saying yes to saving some money and time – it’s not being completed in session, but reviewed and digested in session. If you don’t want homework, it’s OK to say that (see below – telling your counselor if something’s not working. If you don’t have time or would rather keep counseling in the counseling office – not that I’m recommending that (trying things out, practicing, at home is a great way to progress) – just say so.

4. Share even if you’re scared

It can be scary sharing intimate details with someone. That’s why it’s so important to find a counselor you connect with and can trust. But the more you can tell them about yourself and your history and your needs, the better able they are to incorporate those things into the therapy and help you process them and heal.

And 5. Tell your counselor if something’s not working.

Counselors are human beings. Just like you, we have grief, moves, children, hobbies, demeanors, etc. If something we’re doing isn’t working for you, you’re paying in money and time without benefit. Please please tell your counselor if you need them to hold you accountable, not push you so hard, change your schedule, work on different goals, or if you’re just having a day when you need to just “be” and not work on anything. We all need those days. I’m of the opinion that you know you best. I know human nature and development, psychology, family systems, and counseling but you know you.

So now I put it to you.

Pick one of these things to start with. And try it out with your counselor. If you want, you can even tell them I said to. Then post below or email me at robin@balanceinsight.com with how it went. Thanks for reading.

How to feel better when you're depressed

Have you ever felt so sad you couldn't leave your bed? Make something to eat? Here are some ways to feel better, fast. If you feel you might have depression, try one or several of these.

1. Accept – Recognize your symptoms of insomnia or exhaustion, irritability and withdrawal, isolating, eating too much or having no appetite can be symptoms of depression. Depression is nothing to be ashamed of, in fact it’s quite common. According to the Centers for Disease Control and Prevention (CDC) 8% of people 12 and older suffer from depression. Accept.

2. Move – This one is hard because being depressed means you don’t want to move, don’t want to go anywhere, and maybe don’t want to get out of bed. If you can make yourself move your muscles every so often, even if it’s to walk from your couch to the refrigerator, you will feel better. Move.

3. Eat – Eat small healthy meals or snacks whether you’re hungry or not. Depression commonly affects appetite. Some of us eat comfort food and lots of it, while others would rather eat nothing at all. Eating a small healthy mix like an egg, and apple, and toast puts something good in your stomach, staves off hunger, and helps keep your blood sugar where it needs to be. Eat.

4. Argue – Identify the thought or belief that’s perpetuating your feelings and consciously dispute it. Argue with yourself. If you’re feeling down because you feel other people don’t understand you, tell yourself with resoluteness, “Shawn understands me.” If you’re sad because your partner left and you feel like you’ll never be OK without her, tell yourself, “I miss her but I was OK before her and I will be OK after her.” Argue.

5. Pet – If you have a cat, dog, or other household animal, or have access to visit one, spend time petting them. Research shows that petting an animal releases endorphins, the body’s natural opiates responsible for feeling good. Pet.

6. Seek a qualified therapist to talk to. A good therapist can help you experience relief in as little as 1 session, so long as you dig in and do the work. Many therapists specialize in treating people with depression. Seek.