What Does a Counseling Appointment Look Like?
Updated: Nov 4, 2020
If you have ever considered seeing a counselor, but you weren't sure what that involves, join me as I talk with Sarah Easterly, Licensed Professional Counselor. We walk through the counseling process from start to finish.
Q. Are there any questions a person should ask the counselor to see if the counselor is a good fit for them BEFORE they schedule an appointment?
A. A great way to begin is by seeing what a therapist has written on their bio or speaking with them on the phone to see what types of clients they usually work with and what model or modality they use. I personally like therapists who have a favorite model or theory they work from as opposed to a primarily “eclectic” approach. For example, I am trained in Cognitive Behaviorial Therapy (CBT), but I don’t find that model to address body-based symptoms of trauma and stress. So, I am an attachment theorist and mainly use Emotionally Focused Therapy. That is my personal preference – I appreciate a mental health professional who is deeply learned and skilled in one or two areas rather than trying to know all possible approaches. If it is important to you to see someone who shares the same faith as you, those are reasonable questions to ask during an initial phone conversation. Some therapists will provide a 10-15 minute phone call or perhaps an email in order to help a new prospective client decide if they’d like to schedule an initial appointment. Others may not be able to provide this service, but it is always reasonable to ask. This call may give you peace of mind regarding the tone and feeling of the counselor or, it may clarify that this isn’t a good fit in which case you can ask them for referral options (names of other therapists who may fit better what you are looking for). Most counselors will offer this, but again, it is always reasonable to ask.
Q. What can a person expect at their first appointment with a counselor?
A. Much of the first appointment will be going over informed consent (what it means to be in therapy, therapist’s qualifications, limits of confidentiality, cancellation policies, fees, etc). Expect a packet of paper work and to sign or initial a few times on the various forms. It’s always a good idea to read over and fill out the forms beforehand, and receive answers to any questions you have before signing the forms. After all those items have been taken care of, then the counselor will shift into reviewing the personal information you’ve filled out and start the process of hearing your story and start to clarify your goals. Expect goal setting to take a couple of sessions. You should leave your first session feeling heard, honored, and cared for by a counselor who is invested in your personal journey and who has a few ideas on what they can contribute to helping you reach your goals. You likely will not have gone into depth on everything you want the counselor to know and to help you with, but the process should be well on its way. You may leave with homework to write down your goals and bring those to the next session. It can take 2-3 sessions to decide if the counselor is a good fit, but you should have a pretty good idea by the end of that first session if their style and skill set is what you are comfortable with.
Q. What can a person expect at their continued appointments with a counselor?
A. You should expect to attend sessions every week to every other week depending on your resources and severity of symptoms. Less often than that is difficult to gain momentum. It is possible, just more difficult. You should expect after two or three sessions to feel increasingly more comfortable with your counselor and able to envision opening up to that counselor with the burdens you carry around with you. It is possible (and fairly likely) that things will get worse before they get better (I’ll go into depth about that in a later question). The therapist may utilize homework assignments. You should expect your therapist to honor the time commitments you make when you schedule your time slot. You should expect their full attention and emotional engagement. You should expect to have your experience honored and to feel cared for in the session. It is very common to cry in session. As a counselor, this is an honoring thing that I could provide a safe place for a client to express their pain, fear, anger etc. Although very normal, there is no need to feel like you ever need to apologize for emotion expressed in session. You should expect to know the process you are walking through, this should be clearly communicated and tracked: are we getting closer to the goal by the work we’ve done in this session? The answer should be a clear “Yes” and if it isn’t, please ask your therapist about this. If any of these things are NOT happening, bring them up with your therapist. If nothing changes, then ask your therapist for a referral. We are ethically bound to make a good referral for any client wanting one. As a counselor, I never want to stand in the way of a client’s progress or goals and I am grateful for the opportunity to help a client find a better fit on their own journey. Not every counselor is a good fit for every client. That is ok. It does not have to mean that either one has failed.
Q. Could there be “homework” or things that need to be done outside of the counseling sessions?
A. Yes! Think of this like working out. If you only ever went to the gym once a week and never did anything else outside of that, you’d be hard pressed to see much improvement. If you are ever given homework that feels like too much or is confusing, let your counselor know! Homework could look like writing, reading, or practicing skills learned in session.
Q. Just like with anything in life, we can’t be passive participants. What does a person need to contribute to each counseling session to get the best results?
A. The best contribution is to be as honest as possible and to the best you are able, do any homework. But, honestly, showing up and being authentic is huge. Taking a notebook to jot down some thoughts, quotes, insights or questions can be invaluable for continuing to think through the session. Being open to trying out, testing, or just being mindful of your therapy work in your day-to-day life can be one of the biggest predictors of success. While some clients respond to therapy with a flurry of energetic change, others are working incredibly hard to simply show up for a session. Both types of clients (and any type in between) are excellent candidates for therapy. If the most you can do is show up and be honest with a skilled, compassionate helper, you are giving yourself a huge blessing – someone focused on you, with eyes to see a future for you and with a patient, caring spirit. This helps. Enormously.
Q. What benefits can a person hope for as a result of participating in counseling?
A. Benefits will depend on goals. But, in general, a person can hope for more insight and understanding for the way they are and how they experience the world, themselves and others. They can hope – expect – a decrease in the symptoms which brought them into counseling (ie less anxiety, depression, hopelessness, loneliness, shame.) They can hope to feel more connected to themselves and potentially their loved ones. Most clients report feelings of clarity, hope, connection, love, and joy at the end of therapy.
Q. Is seeing a counselor a “once and done” type of thing?
A. It can be that a person only ever goes to a therapist for one season in their life. My experience, though, is that for many, going to counseling becomes an option when that feeling of “the walls are closing in” or “breaking point” happens with one new life trigger or another. After experiencing success and relief in one difficult season, when another comes along, clients are more likely to return because it works! Also, clients may see their therapist to check in. Many clients will see the same counselor at different points along their life unless a move or a specific need brings that client to a new therapist.
Q. If someone wants to find a counselor, where would you suggest they begin?
A. My favorite place would be with someone who you know has been in counseling that they, themselves, have found successful. A simple google search, asking your insurance provider, or checking out Psychology Today are all options for coming up with a list. But, knowing someone who has benefited from a specific therapist will go a long way to vouching for that therapist’s approach. It can also be good to check out the counselor’s webpage if they have one and read their bio or any blogs. This will also help you get a sense of who they are as a person and as a professional.
Q. Is there anyone who would not be a good candidate for counseling?
A. Someone who is at imminent risk of hurting themselves or others should not wait to get an appointment with a counselor, but should proceed to their nearest emergency room. If someone is not able to provide for themselves or have provided for them the basic necessities of food, clothing and shelter, they should use community resources to acquire these basic needs first. All others, to my mind, would be good candidates for therapy.
Q. Are there any risks involved in counseling?
A. Yes. There is the risk that things get worse before they get better. My analogy is that counseling can be like cleaning out your closet after putting lots of leftovers in there (instead of in the fridge). We are going to need to pop the lids and start cleaning. That process can feel overwhelming at times. The middle of therapy – when your fears or vulnerabilities feel particularly loud – is not the time to stop. We can’t go around, under or over. The only way is through. (Of course, if you do not wish to do deeper level work of old wounds or trauma or beliefs about yourself or others, simply make those boundaries clear to your counselor. He or she should honor those boundaries and address what you wish to address. It is common in short term therapy to do this.) And, there is risk in doing personal growth if those with whom you are in close relationship are not open to their own growth. Often when we start to change our own patterns or ways of being, the momentum of our everyday life may push back. This can look like friends or family protesting when we start setting healthy boundaries if we did not have those boundaries prior to counseling. This can stress the relationship as that person now needs to decide how to shift in this new normal. These can be big growing pains and it is not guaranteed that every friend or family member will choose to grow with you. If they do, then very often we experience the gift of giving and receiving love and relationship in more healthy and whole-hearted ways.
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Wow! Lots of GREAT information here to help YOU decide if you want to pursue counseling to work on your emotional health. If you are working on YOUR whole body wellness, remember that emotional wellness is part of that whole. I encourage you to work on this part of YOU! You are welcome to reach out to me regarding counseling. I am happy to share my experiences in this area with you.
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