If you've never been to therapy, you might be a little curious how it works and whether it's right for you. This two-part article outlines some of the more common questions.
There are many reasons people choose to go to counseling. The way I feel about it, it's like education, it's an investment in yourself. No matter what age you begin there are ways you can benefit. And, like education, the more you commit to the process the better your results.
Educating yourself as you embark upon your first counseling session better prepares you not only for what to expect but how you might be an active participant in your own growth.
In counseling, your first session might be the hardest...
After that, it's a piece of cake!
Okay, okay...I might be stretchin it a bit.
Seriously, I want you to be an savvy, informed customer for counseling services. Take your time to feel your way around, but note that your first counseling session is like the first day of school - you feel anxious, excited, fearful, hopeful, happy, sad, a whole range of emotions.
To understand why clients get stuck in their therapy, watch this movie for sure-fire ways to stay on track:
Open the links below to prepare for your first counseling session.
How do I decide if I need counseling?
You know, you don't need "symptoms" to go to counseling. In fact, counseling is much more than reducing anxiety or improving your mood. Some people go to learn how to relate better with others, to develop the capacity to initiate and plan more consistently, deal with money issues, or remove barriers to business and/or personal success. As you can see, there are countless reasons for starting your personal counseling.
You go because you want to make more of your life. This is how I approach counseling and why I continue to go and probably will continue to do so for the foreseeable future.
Do I have to have a "nervous breakdown" to go to counseling?
Absolutely not. As I mentioned previously, you can go to counseling to work on creating a more expansive life.
As an aside, having a "nervous breakdown" has a lot of associated meanings. It's actually a lay term that varies in severity from "I'm going to have a total meltdown if I can't find my keys" to the prospect of ending up in a straight jacket in the local psych ward.
You may not know that the phrasing "nervous breakdown'" isn't really a psychological term. Instead, in therapists' circles we refer to this condition as 'decompensating'. Generally speaking, it occurs when a person is suddenly unable to cope. They may be crying uncontrollably, feeling shaky all over, or unable to formulate their thoughts. They may very well be experiencing heightened anxiety.
You do not have to have a reason to go to counseling. Neuroscience helps us understand that we might not know why we feel the way we do.
Maybe there's a growing awareness that the way you operate in the world isn't quite working for you. Maybe you notice a joy and a lightness of spirit in others that you rarely experience within yourself. A good therapist will help you feel comfortable as you discover why you've gone into counseling.
If you get the chance, check out the definition of 'dorsal'. It explains the way the nervous system moves into conservation mode when it becomes overloaded. It's like shades of gray - your experience of the world is muted.
If this description fits you, you might consider checking out a body psychotherapist. From my experience, this type of therapist has a better understanding of what a nervous system in dorsal looks like and how to work with it.
Why would I pay someone to talk about my feelings? Wouldn't a friend do?
To understand how counseling is fundamentally different from a friendship, you will need to learn more about how counseling works. That said, here is a brief answer to that question.
This question suggests that personal counseling is a place where you go to vent your feelings or to get some advice. While counseling could indeed include these elements, the dance of attunement going on. Unlike a friend, an effective therapist knows when to pull back and when to push, when the time is right to intervene for effective change. And, it's all about you! There is none of the "give 'n take" typical of most friendships.
With repeated counseling sessions, the non-conscious parts of you -- those outside of awareness -- gradually become more conscious. This type of insight or deep knowing is typically not available in conversations with a friend.
Let me give you an example. I remember a few years ago telling a friend that I wanted to do a web site on making it cool to go to counseling. Telling her was no big deal, an everyday event.
Bringing the same subject up in my personal counseling. Well, let me tell you! I immediately felt awash in fears...thinking, this is too outrageous! I blushed and my activation jumped more than a few notches.
Without becoming aware of these fears, I would not have known that my inner world was secretly holding me back. As you will learn on this site, it is our nonconscious fears that often prevent us from realizing our passion.
How do I find a therapist?
Look for Finding a Therapist in the Choosing a Therapist section.
How much does counseling usually cost?
The short answer is that it depends on the type of counselor. Generally speaking the more education a therapist has, the more that they charge. A psychologist usually charges more than a Master's level psychotherapist for instance. And, some therapists also charge more as they become more experienced and can offer more skills in working with their clients.
Check out the article, Paying for Counseling.
How long is a typical session?
Most therapists work with what is known in the business as a "clinical hour". A clinical hour is shorter than an hour, usually 50 minutes, but it can range between 45 to 60 minutes depending upon the therapist. My guess is that 45 minutes is less common, but I once worked with an EAP where this was standard because the remaining 15 minutes was needed to complete their forms.
Some therapists are open to scheduling longer sessions. I have held longer sessions for out-of-towners for example. Longer sessions are not unusual for couples or family therapy.
Can I expect a free half-hour session?
Some therapists offer this and others don't. While it's natural for you to want to get a sense of someone, especially for personal counseling, choosing a therapist isn't like finding an expert lawyer or accountant. You are developing a relationship with this person and that relationship is essential to the success of your work.
Research indicates that factors related to the therapeutic relationship account for at least 40% of positive client change. Finding someone you feel comfortable with will increase the chances of this happening for you.
As far as I'm concerned (and I know that I am not alone), 30 minutes isn't normally sufficient for making such an important decision. As well, I often wonder if a "free" half hour sets up a devaluation (albeit, largely an unconscious one) of the clinical framework and therapist's time.
What is the difference between short-term and long-term counseling?
There is no clear distinction.
Short term is 'generally speaking' more directed to problem solving and crisis management, i.e., I need to find a home for my ailing mother.
When counseling moves into character change or resolving historical issues, we refer to it as long-term counselling or psychotherapy.
In terms of frequency, some consider short-term as 3 to 4 sessions. However, in therapists' circles, short-term varies depending upon whom you talk to and can range between 12 and 24 sessions. Long-term is frequently longer!
I don't know much about counseling. What can I expect?
There are several expectations that all therapists should meet. For instance, you can expect to be warmly greeted in a respectful manner at the arranged time of your appointment. You would also be encouraged to address your reason for coming.
All therapists will explain other important matters. For instance, in the first counseling session you should be advised about issues related to confidentiality, office policies (e.g. what happens if you "late cancel" or "no show"), fees and/or sliding scale options (if it hasn't been discussed over the phone before), and the treatment that the therapist uses. You may also be informed of the considerations and risks related to specific treatments.
No one therapist can meet the needs of all clients. If you or the therapist feels that the particular approach is not suited to your needs, the therapist must direct you to alternative resources. If, as your counseling proceeds, you feel her approach is not working for you, you should bring this to her attention—although she may or may not be able to accommodate you.
I've never been to counseling. Am I just supposed to talk about myself?
You may have heard counseling called "talk therapy" but these days there is more than talking involved in many approaches. For instance, I often teach clients an easy grounding technique to help them feel more comfortable in their first session.
Nevertheless, your first counseling session will involve discussion on what you hope to achieve, so a plan of action can be formulated. Depending on their approach, some therapists will want to know more details than others. The therapist may prefer to get the "big picture" of your life so they have a context in which to consider your goals. Others may want to focus on a very specific problem area. It depends on why you came to counseling.
The reason you are going to counseling is likely emotionally charged, so it is best not to go into all the details in the first session. A general description of your problem will be sufficient until you and your therapist know each other and are addressing specific issues.
As you will learn on this site, our understanding of the nervous system suggests that change occurs through modifications in the right brain , the seat of our emotions. In speaking of an event in a way that is disconnected from your feelings you are still using your left brain (i.e. your thinking brain) and are thus at arm's length from where relevant change occurs.
Until the relationship with your therapist is established you may find it difficult to feel deeper emotions in relation to the reason you came. This is a common human trait. We feel vulnerable until we come to trust the other person. This self-protection is a good thing.
Like any relationship the therapeutic alliance takes time to develop. As you begin to feel comfortable with your therapist you will naturally find yourself sharing more details as your work continues.
My Personal Musings
For those whose emotions are often overwhelming, it is important to establish a secure, safe connection with the therapist (i.e. it helps to contain the emotions that surface). While we may feel relieved after an explosive discharge of emotion, it is not an effective way for your nervous system to learn to self regulate your emotions.
What kinds of questions can I ask of my therapist?
You have the right to ask any question about what happens in counseling, including questions about the kind of treatment you're getting. You can also ask about your therapist's training, their experience, their continuing education, and their ongoing supervision.
And of course, a few will be tempted to pose the not always rhetorical question…“how much more do I have to pay before I'm better”?
Recovery time is actually very difficult to predict. Read more about this subject in Paying for Counseling .
How do I tell whether I have a good therapist?
"It's pretty hard to tell in the first counseling session, but the most important thing is to trust your intuition. If the connection feels good, you're halfway there.
How do I address my therapist?
A power differential is usually implied whenever we refer to someone as "Ms", "Mr" or Dr., while they refer to us using our first names.
There are some doctoral level therapists who refer to themselves as "Dr. So and So" and for some clients this is what they want and expect. They may need to feel that the therapist knows more than they and that he or she is in charge; using this form of address gives them that assurance.
Also consider that a therapist referring to herself or himself as “Dr.” does not guarantee professional competence. You will have to judge this for yourself.
Some therapists try to eliminate the power differential by always using their first name. Feminist therapists, for example, have always been sensitive of this; for them, diffusing the power differential is part of the treatment.
Speaking as a Therapist
In my practice I usually return a new client phone inquiry with “Dr. LaCombe speaking”, since they often won't recognize my name otherwise. However I soon make it clear that "Suzanne" is completely acceptable too; this gives clients the option.
Yet I don't object if they want to refer to me as "Dr. LaCombe". However, if they continue their counseling there usually comes a time when they no longer feel the need for this formality.
Keep in mind that some therapists believe using a formal title is part of maintaining a secure frame…and no, it's not about them being "stuffy".
When I go to counseling am I a "patient" or a "client"?
It depends to a large degree on which country you live in and how psychotherapists are related to the medical profession. In Canada we usually use the term "client" when talking about private practice but would be likely to say "patient" if working in a hospital or medical clinic.
In the USA, where many of the services of a psychotherapist are delivered through HMO's, the usual term is "patients" In this case, counseling is more associated with the medical model.
My Personal Musings
When it comes down to it, it's only semantics. That is, whether you are called a "patient" or a "client" your nervous system responds the same way. Emotional ill health and illness are inextricably tied together. This site was created in part to highlight the neuroscience research that confirms this relationship.
How often should I go to counseling?
Unless I feel the client can benefit from more frequent counseling sessions (i.e. two or three times a week), I usually recommend once a week for the first five or six weeks, and then reconsider the question at that time. This should give you sufficient time to establish a working relationship with your therapist.
Every practice will vary, but most of my clients come once a week and the rest twice a week. As clients approach the conclusion of their work I'll see them less frequently.
Family and couples therapy are often less frequent than once a week, although don't be surprised if the therapist recommends counseling on at least a weekly basis at the beginning.
My Personal Musings
If you want to resolve an enduring emotional problem or a lifelong pattern I personally think that seeing your therapist less than weekly is stretching the limits of what counseling can do. You could still benefit from less frequent sessions but don't be surprised or blame "counseling" (or yourself) if progress is slow.
As well, if your life tends to be tumultuous (i.e. you are frequently embroiled in a crisis), counseling sessions once every two weeks will be less likely to progress quickly. You'd find that your counseling would be so focused on 'catching up' that it would be difficult to deal with the underlying patterns.
Do I have to relive everything from my past?
Not at all! In fact there are several therapeutic approaches (e.g. Gestalt Therapy, AEDP) that focus on emotional states as they are experienced in the present. I use a form of body psychotherapy called, Self-Regulation Therapy and the work entails feeling the past only as it is experienced in the present.
There's no need to "relive" everything from the past because the past is always with us. Our deepest attitudes and prejudices about others and ourselves were formed very early in life and we carry them still. Patterns of feeling and action were encoded by our neuropathways into an emotional template. This template was then modified and hardened by all our experiences since then.
That is, our reactions to today's events are a function of what has been laid down in that template over the years. It unconsciously determines our emotional behavior and will continue to do so until we somehow induce changes in it. The brain's plasticity makes changes possible in counseling.
So when issues that we have encountered in the past surface in the present, we'll tend to react the same way now as we did then, especially when intense activation is triggered.
Personal relationships are a good example of this phenomenon. We need only examine how we feel and behave with people today to glimpse the underlying features of the emotional template that underlies our conscious life.
Speaking as a Therapist
As your counseling proceeds, it is not unusual for snippets of past events to surface. As a rule I trust the wisdom of the moment. I believe that whatever arises in the moment between the client and myself, whether related to past experiences or not, is potentially an opportunity for a therapeutic shift.
Ultimately it's not what your past has been but what your future will be that excites me as a therapist.
Do I need a note from my doctor to get a referral?
The short answer is "for as long as you are making changes". Keep in mind that some changes are small but important nonetheless e.g. "I'm a little more comfortable in talking about myself to a complete stranger" or "I no longer worry what I'm supposed to say when I think of my next session".
It's ultimately your choice--it depends on what results you want to achieve and how deep-seated your problems are. Personally speaking, I don't intend to stop my ongoing counseling any time soon.
Research suggests that on average, the longer you go to counseling the more satisfied you'll be with it. (Engler & Goleman, 1992)
By the way, unless your problem is very specific, a single counseling session isn't going to do much. Although there is a treatment known as "brief therapy", there is no such thing as "instant therapy"!