What Is Counseling?
Will a counselor tell me what I should do, or give me advice?
How frequently should I expect to have sessions?
What is the length of a session?
How long should I expect to be in therapy?
Will I have homework?
What types of problems is it OK to work on in counseling?
Is counseling confidential?
Will I be diagnosed with a mental illness or disorder if I come to counseling?
Can I see a therapist who I know as a friend or an acquaintance?
I like the work I do with you and I think my child (friend, partner, sibling, or other close person) would benefit from seeing you too, is that possible?
If I am seeing you for individual counseling, can I also see you for couples and/or family counseling?
Counseling, (also known as mental health counseling, therapy, psychotherapy) is a series of private, one-on-one meetings with someone trained in a mental health or behavioral health field.
The focus of the sessions is to work on the challenges you are facing that you bring to therapy. Your licensed professional therapist may have a Master’s degree in Mental Health Counseling (LPC), Family & Marriage Counseling (LMFT), Social Work (LCSW), or be a Psychiatric Mental Health Nurse Practitioner (PMHNP). Your therapist may also have a Doctorate or Medical Degree in either Psychology (Ph.D or Psy.D), or Psychiatry (MD).
Psychiatrists and PMHNPs are the only mental health therapists who can prescribe psychiatric medications.
Most psychiatrists these days don’t do much psychotherapy, focusing instead on prescribing medications. However, a few psychiatrists still do have private practices where they do both.
There are many therapeutic techniques, each with its own name.
This plethora of names can be confusing to people looking for mental health counseling.For instance, a person may confuse counseling with psychoanalysis. Psychoanalysis is an older, form of therapy with Freudian origins, often requiring many sessions per week. There are very few pure Analysands (as psychoanalysts were originally called) practicing today as many decades of revision to this approach has yielded more updated approaches. The term psychotherapy is possibly the broadest term describing psychological therapies. It is inclusive of the many cognitive and behavioral counseling approaches as well as psychoanalytical approaches.
Regardless of which term is used to describe the therapy, mental health treatment generally refers to ongoing talk or mindfulness-based sessions designed to help you heal or shift out of difficult psychological states into preferred inner states.
The methodologies vary widely, but most counseling will involve talking about what is concerning you, to some degree, and incorporate a method of exploration into which conditions in your outer and inner life might be contributing to your distress. Then, depending on what type of counseling approach is used, particular methods for healing will be implemented.
The specific approach a therapist may take will depend upon the therapist’s training or orientation and the individual’s goals and extent of support and healing needed.
Some approaches work with your past, some less so. Some work more with tracking your thoughts and behaviors and some work more with your emotional states. Some focus on talking about the problems and trying to determine why you might be having your current experiences. Some put more focus on helping you become aware of what is happening in your subconscious. Often treatment sessions offer some combination of these. Also therapists may combine or vary their approach with different clients.
This is a tricky question to answer because I can’t speak for ALL therapists out there, but the short answer is NO! In general, the ultimate goal of therapy is to help you learn to do the inner-questioning, discovery, healing and calming for yourself. Often you will find that a counselor is specifically NOT giving you their opinion about what you should or shouldn’t do, or how to approach a situation. You may find that a therapist will offer you their general viewpoint about the range of possible options that they see open to you, or offer their general knowledge about the kind of struggle you’re going through and how some people deal with it.
Occasionally therapists do offer you their opinion about something. Some practitioners, for different reasons, may tend to be more “advice-giving” than others. One reason may simply be the personal style of the practitioner. Another reason can be the therapist’s training and methodology. When therapists do offer advice, they will usually fully disclose whether or not it is coming from their own bias, experience as a therapist, or is a generally accepted psychological or sociological “fact”.
While all of that can certainly feel similar to advice–it usually isn’t exactly. It’s purpose is to help you open to new possibilities. For the most part, therapists generally strive to work with your inner-process to help you see yourself more clearly, make friends with your inner-experiences, and from there, learn to make your own decisions.
Typically, therapy is most effective when your sessions are spaced weekly.
This gets the most traction going with the healing process and more quickly establishes the healing relationship with your therapist. Then, when you are ready, they are spaced further apart.
That being said, each individual’s needs and resources are different.
For some people in more severe distress and/or if there are a lot of big changes that are needed immediately, more sessions per week or half-day intensives are an option. For those with less financial or other resources, spacing sessions further apart may be necessary even at first.
So ultimately the spacing and the pace depends on the individual’s resources and their changing needs as their healing and self-development work progresses.
The way each individual therapist works and how their work and schedule is organized can also affect the frequency of sessions.
Generally, therapy sessions with private practitioners are 45-60 minutes depending on the therapist. But for some clients an 80-120 min. session may be more appropriate. This can depend on the individual’s processing style, goals and the method used by the counselor (e.g. clients using mindfulness-based therapies often prefer a longer session so that they go more deeply into the process and can take their time integrating the discoveries and healings.)
This varies in the extreme. Depending on a client’s goals and needs, therapy may be short–just a few sessions or it may be weekly or bi-weekly for years. Counseling progresses more quickly when you put regular time, effort and thought into your change process between sessions. This can shorten the time one needs to be in therapy. If you have a specific timeline in mind, or know you have a limit on the number of sessions you will be able to have, please let me know (or any therapist you’re starting with) at the outset. That limitation will shape the goals, expectations and therapeutic strategy involved in your brief therapy.
This too varies widely depending on the direction of change you are trying to elicit and what might be needed between sessions to move you forward at different points in your process. There are times when it is clinically important for the individual to leave the thoughts and feelings explored in the session in the counselor’s office, or to allow change to happen at its own pace. For others, it may be important that the “homework” be a simple shift in awareness, rather than add another task to their busy schedules. When appropriate, it might be more overt like interrupting an old habit and trying a new approach. At times it might be doing some reading or tracking certain experiences between sessions. For others, when they are further along in their therapeutic change process, it may mean taking bigger steps out of their comfort zone ( steps that at the beginning of therapy they might never have imagined being able to take). As you can see, if there is homework, it will be dependent on what makes sense to you and your counselor for your next steps.
The range of challenges you might come to therapy to work on can be extremely broad. They can span the gamut of any sort of Emotional, Cognitive (i.e. thoughts or learning), or Behavioral (i.e.habits) problems with the outer world or the inner world. For instance issues with your environment (outer world) could be relationship issues of any kind. This could include difficult thoughts, feelings or interactions with friends, parents, partners, co-workers, bosses, dating, school or career. They could even be problems with going out and functioning in the world at all. Challenges with your internal world could encompass your relationship with yourself. How you think and feel about yourself, your “self-talk”, self-esteem or self-criticism. They could include internal issues like perfectionism, control, motivation or procrastination issues or general mood issues like anxiety or depression. They could be behavioral compulsions or substance abuse or over-use issues. In short, anything that is going on inside of you that is causing you distress and blocking your effective functioning and self-expression in the world is appropriate to bring up in therapy.
Counseling with a Licensed Professional Counselor is very confidential. The private nature of therapy is one of the primary therapeutic elements in the process, optimizing your ability to look deep inside yourself. There are many laws and guidelines in place to keep your Private Health Information (PHI) safe. PHI includes your name, contact information, any diagnoses, session notes or any other identifying details that your therapist uses to track your work together. Technically your therapist can not even acknowledge that you are in therapy, to a person who pays for the therapy session each week, without your written permission!
That being said, there are some legal limits to confidentiality that do vary slightly from state to state. They generally have to do with issues of intervening when very particular legal situations arise or issues of harming self or others comes up. For instance most master’s level counselors are “mandated reporters”. This means that if it was discovered that either child or elder abuse was going on, support from other agencies would be called in. The specific limits of confidentiality are thoroughly explained before the counseling process starts.
The most frequent disclosure of your PHI is to your health insurance company if you are asking them to pay any portion of the fee. Insurance will not pay for services without a mental disorder diagnosis. Your records with them will contain any diagnoses for any health conditions they have ever received a claim for. They also have the right to audit my progress notes for you to make sure that the treatments are matching the diagnosis. While not a common occurrence, it is possible. While there are more and more laws tightening security for digital records, insurance claims do create an electronic trail. While this does not bother many people, private payment keeps the records most secure.
On the other hand, if you ever do want your therapist to talk to someone else (e.g. family member, other practitioners) about the fact that you are in counseling or any information about your counseling process, you would sign a “release of information” form. The form would specifically outline the purpose and limits of the information to be shared or discussed, and with whom. (Link here for more information about Individual Counseling confidentiality and for Couples Counseling confidentiality.)
The short answer is not necessarily, but only in specific private practice situations. At Self-Awareness Counseling, if you are a private pay client (i.e.funds come from a private bank account & not from an outside agency like insurance, medicare, medicaid, workman’s comp, etc.), we may have no need to specifically define the challenges you are experiencing as mental disorders. That being said, there are times when a diagnosis is helpful and required. If you are having insurance claims filed (even if submitting yourself for reimbursement), a diagnosis will be necessary and will be in your medical record.
Licensed Professional Counselors, other Licensed mental health practitioners and physicians are qualified to diagnose mental disorders. However, it is important to understand what mental health diagnoses are, and what they are useful for.
Mental Disorder diagnoses are names and descriptions of the full spectrum of emotional, cognitive and behavioral disorders as defined by a specific psychological committee. The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association is the handbook detailing the official criteria the committee has agreed upon as necessary to accurately diagnose a mental disorder. Periodically the manual is extensively reviewed, and new editions are published. The most recent edition is DSM-V. Definitions and designations of disorders can vary widely across the years. Past diagnoses should be viewed in the context of the DSM definition for the diagnosis in the edition currently in use at the time. Since the first DSM was published in 1952, the psychological field has changed or eliminated many psychiatric diagnoses.
There is also a related, but different, International Classification of Diseases (IDC), which classifies and codes the full spectrum of all health disorders. These codes for mental disorders generally correlate with a DSM diagnosis. On an insurance claim, this code tells your insurance company which disorder(s) are being treated in each therapy session.
It can be helpful to think of mental disorder diagnoses as general shorthand for communication between health practitioners, or between health practitioners and the insurance companies. Because the criteria is specific enough, they can also offer a general approach to try for treatment. It’s important to always keep in mind that the specific experiences that an individual is struggling with, in any mental health challenge, is never fully described or explained in the diagnosis. For the most part, mental disorder diagnoses simply list the signs and symptoms describing what we call a disorder, NOT the cause of the disorder.
Furthermore, in some diagnoses that we call “disorders”, as in the case of PTSD, we can also hold that rather than a “disordered” response, it is an understandable nervous system response to distressing or traumatic experience. However, it’s lasting effects result in a debilitating mental condition that severely affect an individual’s quality of life and therefore is categorized and treated as a disorder.
If we decide, for any reason, to use diagnoses in the counseling work, I will discuss my thinking about the diagnosis with you and get your input, unless there is a legal and/or logistical reason that I can’t.
It is probably best to find a therapist that you don’t know personally and/or that you have little interaction with. This is so that you can feel completely free to open up and so that your counselor has only one role in your life–to hold a therapeutic space for you. A therapist who knows you in another capacity would most likely refer you to someone else to avoid a “dual relationship”. A “dual relationship” with a client means having more than one type of relationship with a client and is generally considered unethical. However, there are situations where it might be clinically the best option and ethically sound. For instance, if you barely knew each other and had very little interaction, or if there were no other referrals in the area. A lack of referrals could occur if the therapist was a specialist, or if you were in a rural area where there were few therapists. In these situations, very clear boundaries around the therapeutic relationship would be set.
I like the work I do with you and I think my child (friend, partner, sibling, or other close person) would benefit from seeing you too, is that possible?
One of the reasons that therapy works is that you feel very confident and clear that your counselor is “yours” and that the counseling space is very private. This enables you to say anything without concern about how it would affect others close to you. Knowing that your information is safe and that information about you from other people close to you won’t influence your therapist’s relationship with you, is very freeing. So often it is best not to share an individual therapist those close to you. But this may not always be the case. If you would like to explore this possibility I can help you to identify potential problems that may arise from sharing your therapist with someone close to you and a decision can be made when all the factors are considered, that prioritizes your counseling work. If a decision is made to go ahead with your referral we would also set up a plan for how to handle any unexpected problems that might arise.
If I am seeing you for Individual Counseling, can I also see you for Couples and/or Family Counseling?
Similar to the above question, it is usually advisable to see a separate therapist for couples or family therapy.
When working with couples or families, it’s important for each individual to feel that I am supporting them equally. If a relationship with you is already established, there is already a relationship history between us that can feel exclusive to your partner or the other members coming into family counseling.
I view couples and family counseling in the following way:
I am the therapist primarily for the relationship itself between or among the people present, I am also each of their therapists, in support of their individual work regarding the relationship. For this reason, it may be important for the relationship work, that I do have individual meetings with each member of the couple or family. However, the private work with the individuals focuses on, and is in service to, the relationship work. In that way, it is not “individual therapy” per se. It may also reveal areas of individual work that would be beneficial for that person to do with their own individual therapist.
That being said, there are occasions where it is appropriate to invite others to your session.
When my clients need some support in speaking with someone close to them about an issue we are working on, with preparation, we can set a time to invite others to one or more sessions. This offers the client, and those close to them, a safe way to talk through an issue or gain understanding about something we are doing in therapy. In these cases, I am always very clear with the invitees about the focus and purpose of the session, that this is not couples or family work and that I am the client’s therapist offering this in service of the client’s growth.
For More Information:
Click on the images below (or on the right), or see the pages under the “Specializations” and “About Counseling” menus.