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.

Depression: It's more than "just" sadness

When is it depression?

Some people think depression and sadness are the same thing. Or depression and grief. Like you’re sad your kid made a bad choice at school and you wish he didn’t have to spend recess “on the wall.” Or you’re grieving because your aunt died, and she was your favorite, and you cry sometimes when you think about her. Those things are different from depression - not less than or better than.

Depression is more about wanting to disappear, become tiny, curl up in a corner and stay that way forever. You can’t sleep but once you do you can’t get up. At all. And you feel like this pretty much all day every day.

Your limbs feel heavy, and walking from the couch or bed to the sink for a glass of water is like moving through mud and you don’t have the energy to even think about trying it. In fact, you might actually have mud – or at least dirt – throughout the house since, with depression, it’s hard to be motivated to clean.

You CAN get stuck in sadness and develop depression. And you CAN get stuck in grief and develop depression. But generally, sadness and grief ebb and flow depending on your situation, while depression sticks around for more than a couple of weeks.

You’ve lost interest in things that used to be fun for you. You don’t socialize anymore and even Facebook takes too much energy. You used to love visiting friends but now you spend your time at home alone, and don’t even open the curtains. You used to enjoy going dancing but now you binge watch Scandal or Breaking Bad.

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Generally, sadness and grief ebb and

flow, while depression sticks around

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If you’re eating, you’re eating whatever’s easy – whether it’s healthy or not, tasty or not. Or you might be eating all the time. Boxes of cereal and milk, cartons of ice cream, bags of potato chips, supersized candy bars one after the other, or Happy Meals from drive throughs. But you’re not likely cooking nutritionally balanced meals that take planning or look and taste appealing.

You’re probably moving and talking much slower than normal for you – so much that other people might have noticed. Your parents would say you’re “dawdling,” and coworkers would call you unmotivated, but you just know you’re exhausted. And your voice has become monotone with less feeling, shorter sentences, and smaller words.

It’s likely gotten harder to concentrate and make decisions. You don’t read books anymore or watch full length TV movies, but rather flip through magazines and watch shorter shows. And if the choice is what to eat, you probably won’t eat at all. What to wear? You’ll just stay in your bathrobe.

You feel so worthless and guilty and hopeless that you wonder why you were even born, like you’re a burden to all those around you, like your existence is a mistake. You can’t imagine a better or different future.  Please, if you feel like you might hurt yourself, call the National Suicide Prevention Lifeline at 1-800-273-8255 or go to the online Lifeline Chat at http://chat.suicidepreventionlifeline.org for help.

And all of this feels like it’s gone on for an eternity and that it will never, ever be different.

That’s depression

I picture sadness and grief as bumps on an otherwise steady road of life. Depression is more of a dip, a dent (or a depression) in the road, so deep you need help to climb out.

If this sounds like you - if you think you might have depression - call me for a free consultation where we’ll discuss strategies to get you feeling better or whether you need more help. And in the meantime, click for some activities to get temporary relief.

As always, thank you for reading my post, and please share with anyone you think it might help.

Getting over getting stuck

Do you ever get working on a project or idea or maybe a complex set of tasks, and it’s so perfect for you that you whiz along, adding more, going off on side tangents to make it better, cleaner, more interesting, useful, or needed? The options are endless. And then, seemingly out of nowhere, you start to feel like you just need to hold your head in your hands and make it all go away?

You might have just sped into feeling stuck.

When it happens to me, sometimes I think I’ll just work right through, ignoring my sense of overwhelm (as if I could), and somehow get back on track. But then I just end up feeling worse. I figure it must be a common thing because there are so many metaphors for it: treading water, spinning my wheels, swimming through mud, flailing about, running in circles, getting nowhere fast. Notice each metaphor is about fast movement going nowhere. That’s exactly what it feels like.

Overwhelm feels like running in circles: Lots of action but no progress.

In my case, to break out of overwhelm, I need to stop everything. Fewer options are better. I need two things to choose from, and no more. I start with my physical sensations and ask myself: What do I need first, to drink water or breathe? And that’s it. Yes music might relax me and meditation might zen me out. But I need just two options for now. I choose water. Cold water shifts something in me more than focusing on my breathing. Maybe it shifts something in you too. No ice, no lemon, no heating for tea, just cold tap water for me.

Pick from two options

For you it might be needing to move your body physically, or smelling lavender or lemon. Anything that gives your mind a break is the right thing for you.

• Walking the dog

• Jumping jacks

• Singing or dancing

• Eating something crunchy like celery dunked in peanut butter

• Even watching a kitten video

This is usually enough to break the spell, giving space before figuring out where to go next.

Back to the larger project (no looking at tangents at this point) or a bigger, more impactful break? Again, just two options. If I’m still feeling stuck and overwhelmed I try really hard to accept that and give myself what I need. I can close my eyes and just check in with my emotions, physical sensations, and try to notice what my body and mind are trying to tell me.

Messengers

Do I feel tightness anywhere? Frustration or dis-ease?

A friend once told me that emotions are just messengers trying to get us to pay attention to something we need. I believe it.

If I truly feel relieved after my break, I’ll go back to the project. But I try to remember we are, each of us, the only person who knows what’s going on with our own body and our own emotions. We need check in periodically, to give ourselves permission to do something else if the feeling of overwhelm comes back, and to continue on when we’re ready.

Like walking a stone path

Back to the project or idea or task, you can look at it with fresh eyes. Mapping it out, making an outline or sketch, or listing components can help. That makes a visible path, without tangents, and also helps make the project more concrete and less abstract in your mind. There’s time later, there’s always time, to revise the plan. But getting it out on paper feels like forward movement. It’s progress. And when you have forward movement, overwhelm turns to satisfaction and a sense of accomplishment.

What do you do when you feel overwhelmed or stuck? Post below or email me at robin@balanceinsight.com

Thanks for reading.

To Hide or to Run: Tools to Help with Decision Making in a World with Too Many Choices

Did you ever play hide and seek, outside in the neighborhood, after dark? My cousins were the best at surrounding the good hiding spaces, causing me to freeze, leaning toward the corner of the garage – nope, Kathy’s there, leaning toward the cave under the stairs – nope Pam’s there. As a child I’d think: what’s keeping me from just grabbing a spot and hiding? Well here it is: to make one choice was to leave behind other, possibly better options. Worse, the number of hiding spots felt infinite, so any one choice eliminated an infinite number of potentially better choices. Now, don’t get me wrong, I know the difference between hiding spots at age 8 and where to move, where to work, whether to have children, who to reach out to at age 30 or 40 or 50.

Some people list pros and cons on a T-chart. That’s one way as long as the items on each side have equal weight and value. I tend to pick apart the items into smaller parts, taking lots of time making sure the smaller items are relatively equal.

Some people research and gather information from the internet, friends, and professionals, mull it all about and synthesize things into the one best choice. I try this one often. If nothing else, I enjoy learning more about possibilities. That said, I have a hard time making an actual decision.

Another thing I try is flipping a coin. Even for major decisions. Wait, hear me out. Say, for example I am trying to decide whether to move to Hawaii or stay in Oregon. I researched in a huge way, read books about the different islands, talked to friends I trust, and made a lengthy list of pros (all about beaches and sunshine) and cons (many more – pet quarantine, leaving jobs, no family or friends there, etc.).

In the end I flipped a coin. Heads, we’d live on an island; tails, we’d stay in Oregon. Now this is the beauty of coin flips: it’s a coin, not a judge or The Price Is Right. I flipped tails. My reaction was on of disappointment, sadness, “why not’s,” and “but I want to’s.” Coin flipping lets me gauge my reaction to the coin outcome and my decision becomes clear.

Another decision making tool I use, especially for decisions with more than two options, is eeny meeny miney moe. Yes, the childhood game. There are a couple of ways to do this. I like to touch a photo of each option or have some item that symbolizes each option and touch them as I go around, one touch and one word for each option.

• Eeny (go to Hawaii this year), meeny (stay in Oregon), miney (move to Hawaii after retirement), moe (move to Florida instead),

• catcha (go to Hawaii this year), piggy (stay in Oregon), by the (move to Hawaii after retirement), toe (move to Florida instead),

• if he (go to Hawaii this year), hollers (stay in Oregon), let him (move to Hawaii after retirement), go (move to Florida instead),

• Eeny (go to Hawaii this year), meeny (stay in Oregon), miney (move to Hawaii after retirement), moe (move to Florida instead).

If I land on Florida and I don’t want to move there, I toss that out and start again with just 3 choices. If I want Florida in, I cheat and decide that means I win and get to go to Florida. Either way I’m tricking my brain into making decisions.

Decisional Balance

For a broader, deeper, and visually relevant decision making method, I like the Decisional Balance Activity. It’s a grid that works a bit like the T-chart, but it includes scales of how important the choice (change) is and how certain you are that you can make the choice (change). It looks something like the graphic (click to enlarge, and thank you Miller and Rollnick).

How do you make decisions? Try one of these and let me know what works for you. Add others if you have ‘em. Thanks! We all need a little help with choices.