Considering Seeing a Counselor? Start Here!

Considering Seeing a Counselor? Start Here!

01/04/2013

If you’re considering seeing a counselor, you’re not alone. Every year millions of Americans seek counseling and many others think about it but decide not to go. I’d like to answer some of your first questions about the process of counseling, the content of counseling, and some of the logistics of counseling. If you haven’t considered attending counseling before, or if you’ve had an unsatisfactory experience, then this article may provide you with new information. If you’ve tried counseling before and it met your needs, then you may be optimistic, but still concerned about going to a new therapist, or going to your previous therapist with a new issue. This booklet can help you get organized for that next encounter. Every year I see hundreds of people who have never talked to a counselor before. Many of them report that they have mixed emotions about counseling, and thought long and hard before they decided to come. They may have negative thoughts like these:

These are all normal thoughts, and not surprising if you haven’t tried mental health counseling before. It may help to think of counseling as hiring a professional to help you, just as you hire an auto mechanic or hairstylist to help you. You’re doing the hiring, and you can fire the helper if you’re not satisfied with the service. And you should, if the service isn’t meeting your needs. You’re not telling a counselor that she will be your boss and you’re not planning to throw yourself off a cliff while hoping the counselor will save you. You’re still in charge of your life, with or without a counselor. You already hire people to give you advice about your car and your body. Maybe you also have a priest, minister, or rabbi whom you consult about your soul. A counselor is someone who has studied information about the relationship of mind and body. A counselor should be able to teach you how to improve your relationship with yourself, your family and friends, and your community. The process of counseling can give you:

I have real physical problems. How could talk to a counselor help with those?

The mind and body are intimately connected. You live through events and have thoughts and feelings that constantly affect your body in positive and negative ways. We even talk about our feelings in a physical way. We shake with fear, get a dry mouth from stage fright, blush with shame and get a sinking feeling in our stomach from guilt. We say that difficult encounters with people give us a headache. Our body comes complete with an emergency response system, the Autonomic Nervous System. When we think something is dangerous our body prepares for “fight, flight or freeze.” We aren’t born knowing what is dangerous, however. We rely on our brain, our thoughts, to tell us what and where the danger is. Even though we aren’t really expecting our boss to physically strike us, our brain tell us that when the boss is angry, we are in danger, so our bodies make preparations like tensing muscles, drying our mouth, stopping our digestive processes. All of those are real physical reactions to a real danger. Our emergency response system is wonderfully efficient, and hard to fool. You can tell yourself you aren’t nervous about an upcoming job interview, but you will probably have a dry mouth anyway, no matter what you say to yourself. In fact, not paying attention to your nervousness makes the physical problems worse. You may tell yourself you’re calm, cool and collected about an upcoming stressful event, but your emergency response system may still be ringing all the alarm bells. And because you don’t think you should be nervous or upset, you won’t act in ways to reduce your stress because you think you shouldn’t be having it in the first place! It’s hard to fix something when you don’t think it’s broken. But our bodies are really built for sudden emergencies that disappear very rapidly – like the appearance of a saber-toothed cat ahead of us that we can outrun. The emergency response is built in, but calming ourselves down after the danger has passed isn’t automatic. And what if the danger never passes? What if the boss is always angry, or always angry at you, or what if the boss is unpredictable and inconsistent? And it’s worse if you learned as a child that an angry parent meant a hurtful parent. And that’s why talk therapy can help with physical problems. Our thoughts, feelings and experiences, can cause physical problems, or make them worse. If you blush when someone tells a dirty joke, you know you’ve had a physical reaction to a mental event. If there were some reason that blushing was bad for your body and it got worse over time, you might want to learn not to have a blushing reaction. There would be two ways to go about this. (1) You could learn to consider talking or joking about sex not embarrassing, and that’s exactly the sort of learning you do in talk therapy, or (2) you could learn not to have a face-flushing reaction when you’re embarrassed, and that’s also possible in talk therapy by some mind-body methods like relaxation or biofeedback. Let’s assume you had a shoulder injury in a car crash. You have real pain from that injury, and it doesn’t seem to go away over time. How can talk therapy help with pain? Counseling helps in those same two ways. (1) You can learn to focus on the things that are stressful and bother you, and work through them mentally so you solve the unsolved issues that are causing you to tense up and make your pain worse and (2) you can reduce the pain directly by learning to relax, including even relaxing the shoulder when you’re in pain. Either or both of these methods can reduce your very real physical pain. Most people underestimate how big an effect the mind has on the body in every day life. Pain isn’t ‘all in your head’ but your head can certainly do a big job of managing it.

Is all counseling the same?

No, because all counselors are different.
There is such a thing as a good counselor. Probably most counselors are good at what they do. But you’re not just looking for a good counselor. You’re looking for a good counselor for you. You want a good fit with a counselor, and that has to do with two things, what the counselor is like and what you are like.

What happens in counseling?

Generally, you’ll fill out information about yourself first, as you would for any doctor, and you’ll receive information about the counselor. Hopefully you will learn about her employment history and some information about how she was trained and what problems she likes to work with. If you’ve ‘interviewed’ the counselor by phone first, you’ll probably have a good start on that already. In the first session, your counselor will ask you to talk about the issue that brings you in to counseling, and you’ll describe that in your own words. You’ll probably discuss it in detail with the counselor and you’ll get a chance to see how the counselor thinks about things, and how she works with you. Probably you’ll also be asked some standard background questions about your schooling, your medical history, your family and your current circumstances. You’ll probably talk about what your goals are for counseling, that is, what you want to change about yourself and about your life. Often the goals will take the form of new skills you want to learn. For example, you may want to be able to handle your mother better when she visits you, or you may want to learn to understand your past better. After the first session, you’ll probably want to talk about events from the previous week that relate to your goals or thoughts and feelings you’ve had that you want to talk over and understand better. You may want advice about how to handle specific issues in your daily life or you may want support for the progress you’ve made in achieving your goals. You won’t necessarily ‘feel good’ after each session, but you should ‘feel good about the session.’ You should feel that you were heard, that the counselor was on your side and wanted you to achieve your goals. You should think that the counselor was knowledgeable about your problem and that she was contributing to you solving it during the session. The counselor might point out things you already knew or share his or her own thoughts. Above all, you should feel hope that you can achieve your goals, if not today, at a foreseeable time in the future. Therapy ends when you decide you’ve achieved your goals. Or perhaps when you decide you’ve benefited as much from talking to this counselor as you’re likely to. If you have big ambitions and smaller resources, maybe therapy ends when your reimbursement for therapy from your insurance runs out. For some people, therapy lasts for years and involves major changes in their life circumstances or in their ways of dealing with issues. For other people, therapy lasts just a few sessions until the specific issue they talk about has been resolved. Some people see a therapist only once and leave because they didn’t think it helped them. Oddly enough, the research says that those people were helped by that single contact even though they didn’t think it was helpful!