What to Expect In Counseling
Why Do People Go to See a Counselor?
Traditionally, people come for counseling when they have a pressing personal concern or problem, such as
• Feeling bad
• Relationship problems
• Problem behaviors
• Difficulty adjusting to new situation
• Coping with present or past events/trauma
Another reason people come for counseling is to learn and practice a new skill or to improve themselves in some way. For example,
• Stress management
• Assertiveness training
• Relationship enrichment
• Personal growth
• Finding meaning and direction in life
• Peak performance
How Long Does Counseling Last?
Each session lasts approximately 50 minutes. Generally, we meet once a week or every other week depending on the circumstances.
You and your counselor will decide together how many weeks therapy will last. You can expect to feel “finished” when enough progress has been made or your goals have been reached to your satisfaction.
Sometimes counseling can be difficult or emotionally upsetting. It may be necessary to go through a brief period of discomfort in order to get better. It’s called “growing pains.” If counseling arouses bad feelings, don’t quit! Discuss this honestly and openly with your counselor. It may be a signal that something important is just around the corner.
What is My Responsibility in Counseling?
Your role as the client is extremely important because the counselor doesn’t magically change you – rather the counselor helps you change yourself.
For counseling to work, it is your responsibility to:
• Keep and be on time for your schedule appointment
• Openly and honestly tell your story
• Think about your concerns and work on it in between sessions
• Bring active issues to each session, NOT just recount your past week or complain
• Listen carefully to your counselor’s suggestions and feedback
• Be actively involved in solving your own problems
• Be willing to try new behaviors
• Be aware of and express feelings appropriately
• Ask questions when there are things you don’t understand
• Ask for additional resources
• Honor payment arrangements
What Does the Counselor Do?
In the process of counseling, the counselor
• Listens attentively
• Accepts and respects you
• Creates an emotional safe environment
• Challenges and supports you
• Seeks to understand you
• Develop an open and honest working relationship with you
• Shares their feedback with you
• Works with your agenda and goals
• Focuses your discussion on finding resolutions to your problems
• Helps you identify your blindspots and resolve resistance to change
• Looks at your problem from multiple perspectives
• Assists you in developing new ways of being and doing things
• Maintains professional boundaries and confidentiality
Sometimes your counselor may
• Ask about your past
• Give you a referral for testing or medication
• Provide information or helpful guidance
• Suggest a resource
• Confront you about decisions and behaviors that are not taking your towards your goal
• Identify ways in which you are sabotaging yourself or causing your own problem
• Help you overcome fears of change
• Offer a tool or technique to help you
• Inquire about your dreams or fantasy life
• Teach a skill
What NOT to Expect in Counseling
Since counselors are highly trained persons, many people expect that they will tell you what to do. Unfortunately, life’s problems are not dealt with that easily or quickly.
Don’t expect your counselor to
• Give you a pat answer to a life challenge
• Treat you like a number
• Magically “cure” you in an hour
• Read your mind
• Be perfect or know everything
• Become your friend
• Keep you in therapy forever
• Judge or criticize you
• Talk about their personal life
• Make sexual advances toward you
• Prescribe medication
How Does Counseling Work?
Counseling is a collaborative effort between you and the counselor. It is your work to do. Your willingness and ability to be part of a joint effort in resolving your concerns is the most important step to feeling and being better. The counselor facilitates this process.
The job of your counselor is to assist you in finding your own solutions to your concerns. The counselor acts as a resource for you to grow into a happy, healthy, resilient and effective human being.
Counseling is both a science and an art-form. Each counselor has a unique blending of skills, training and experience which she will bring to bear for your benefit.
What is Confidentiality?
Everything that is discussed in counseling is confidential. Even the very fact that you have sought counseling is confidential. That means the counselor cannot tell anyone, including an employer, school administrator, physician, spouse/partner, family member, friend or health insurance company anything unless they have your written permission to do so.
This even applies to seeing you in a public space, if you happen to run into each other. No, your counselor is not being rude. Your counselor is protecting your confidentiality when she does not greet you or talk to you outside of the office.
Exceptions to confidentiality required by Federal and State law are:
If you pose an imminent danger to the life and limb of yourself or another person, your counselor is mandated to report this to the proper authorities to assure your safety and that of another person.
This applies to instances of
• Threats of suicide
• Threats of homicide
• Suspected or reported child abuse or neglect
• Suspected or reported elder abuse or neglect
What is Privileged Information?
“Privilege” is a question of evidence law. It gives the patient or client the right to prevent the therapist from disclosing confidential information. Privilege “belongs” to the client.
Exceptions to Privilege
• Child abuse cases
• Mental health in issue in a case. The privilege does not apply in cases in which the patient’s mental health is itself a direct legal issue. Examples include child custody cases, civil commitment hearings, hearings concerning a defendant’s competency to stand trial, and civil cases where the plaintiff seeks damages for emotional injury.
• Disputes between co-patients. The privilege does not apply in litigation between two people present at a single counseling session, e.g., if a husband and wife come for joint marriage counseling and then sue each other for divorce.
• Disputes between patient and therapist. The privilege does not apply if the patient sues the therapist for malpractice, or the therapist seeks a restraining order against a former patient, etc.
• Crime or fraud. The privilege does not apply if the patient is using the session in furtherance of an ongoing or future crime or fraud. Discussions of past crimes or wrongdoing are privileged, but not discussions of plans for future crimes or violence.
• Duty to warn. The famous 1976 case of Tarasoff v. Regents of Univ. of California established that when a therapist determines that a patient presents a serious danger of violence toward another person, the therapist must take reasonable steps to protect that person, including warning the victim and notifying the police.
If you are in need of counseling, you have several options or routes to consider:
1. Does your health insurance cover mental health benefits? I would check with your provider, and the service providers in the area to determine what benefits are covered (i.e. the number of sessions covered, co-pay / out of pocket costs). Some practitioners work on a sliding scale, meaning they can take into account your income, and work out a fee based on your income and current situation. If you find a practitioner that you like, but that doesn't accept your insurance, you can dialogue with them about this, or ask if they accept Out of Network benefits.
2. Out of Network benefits are benefits covered by your health insurance to pay for services (that may normally not have been covered). Ask your health insurance company for the specifics (i.e. what services, providers, etc are covered by these particular types of benefits, and if there are additional monetary fees you may incur). You should also check with the counselor / therapist if they do Out of Network benefits (they will give you a form(s) to fill out).
3. Medicaid (health insurance provided for low-income or no-income individuals) has coverage for mental health benefits. If you apply for this service, you can ask your social worker / the government office where you apply for this service, if they have a recommendation for a provider that accepts Medicaid. Be advised that the duration of time it may take for you to see a provider may be lengthy, if you are using Medicaid.
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