Health & Wellness: Counseling & Psychotherapy

From the Grace Church Health and Wellness Committee, April 2008

The theme for April is counseling and psychotherapy. This is also National Counseling Awareness Month. A number of important issues come to mind on this topic and between the first and second editions of this newsletter for the April, we will discuss them. Such issues include but are not limited to the following:

• Reasons to seek counseling or psychotherapy,
• What you can expect the first session,
• Training and experience of your counselor or therapist,
• The actual counseling process, including length of services, termination and possible referrals to other mental health professionals,
• Confidentiality,
• Exceptions to confidentiality and
• Setback prevention.

Reasons to Seek Counseling or Psychotherapy – Reasons for seeking counseling or psychotherapy generally fall into the category of experiencing persistently mild to moderate trouble getting through the activities of daily living as a consequence of emotional or psychological pain or confusion. An additional reason to seek counseling might be severe emotional trauma secondary to, for example, the death of a parent, spouse or child or extreme anxiety secondary to, for example, the diagnosis of a life threatening, or life altering disease. Clearly, these are also times to call upon prayer but counselors or therapists can often serve as adjuncts to such prayer.

What You Can Expect the First Session? - Your first session will likely include discussion of fees, frequency of meeting and most importantly, a time for you to describe the issues or feelings that bring you to counseling as well as how things will look or feel differently when you have your last session. Discussions may also extend to the history of the problem and what, if any, other strategies you have tried on your own, or with the help of other professionals, to address the problems. Some therapists or counselors may also ask you to describe the things in your life that are going well or that you feel really good about. Such questions are built upon the assumption that you have likely developed social skills that have allowed you to experience many successes, in spite of your current array of problems, and such skills will become important building blocks for the development of future social skills.

Your Counselor – You can expect your counselor or therapist to be either a psychologist, therapist, or clinical counselor, and have advanced graduate degrees (e.g., Masters or Ph.D.). They will have taken many courses in the study of human behavior, assessment and treatment of emotional problems and have, in addition, had many hours of counseling experience under the direct supervision of mental health professionals as a students-in-training before becoming licensed. You should feel free to inquire about your counselor's background and training.

The Process of Counseling - Your experience in counseling or psychotherapy will vary depending on the counselor, what issues and background you bring to the counseling process, and the methods of helping, or professional orientation, the therapist feels most confident will be of help to you. In general, the process involves you and potentially other members of your family, speaking about issues openly and honestly, while your therapist listens to you, asks questions, clarifies points of confusion and works with you (and your family) collaboratively to address your issues. You should expect to be able to discuss with your counselor any concerns you have, whether about your problems or about the process of counseling itself. While your counselor will help you meet your goals, he or she probably will not “tell you what to do”. Rather, you will both work to identify and build upon your strengths while remaining cognizant of problematic behaviors that may have become habitual.

More than likely, your counselor will focus on improving your behavioral skills and self-confidence in dealing with the “real life” challenges that you face. Your counselor is apt to ask you to try out new and more effective behaviors in these “real life” situations and then to report back with assessments about how effective the trial behavior was. Like an effective coach, your counselor will assist you in recognizing the dynamics of interpersonal interactions with specific attention being paid to your role or contribution in how these interactions turn out. Based upon your report, then your counselor may recommend that you “tweak” your behaviors some to achieve a more desired outcome. If, for instance, your usual tendencies are to dominate conversations with friends, family and/or colleagues, your counselor may suggest that you try to listen a little bit more than you are accustomed to doing. Alternatively, let’s say that you are seeking counseling because your supervisor has received complaints from your coworkers or customers that you constantly complain about work. The following scenario might take place. To help keep track of your progress, your counselor may ask you to keep detailed written logs or diaries of the frequencies (e.g., 5 times a day) and durations (e.g., 30 minutes) of troublesome behaviors (I complained about my job to my coworker 5 times every day – for 25 minutes) and your constructive behaviors (e.g., At work, I asked for additional work after completing my customary assignments 3 times last week). Over the course of the counseling experience, one measure of progress revealed by such logs or charting might then be a gradual reduction in the frequency and duration of complaining with a corresponding increase in frequency of positive behaviors.

If you do not feel satisfied with the progress that you are making in counseling, or with any aspect of the counseling process, share your concerns with your counselor. She or he needs to know your concerns in order to be helpful to you.

Confidentiality and Exceptions – Your personal information is kept secure and confidential by your counselor. Several exceptions exist: (a) you choose to sign a release of information authorization allowing your personal information to be shared with designated others (e.g., your medical doctor); (b) personal information shared with your counselor must, by law, be shared with appropriate others if your counselor assesses that you represent an imminent and credible threat or harm to yourself or others; (c) cases of suspected child or elder abuse must also be reported, and (d) on rare instances, courts can ­order or subpoena your records.

Setback Prevention – Changing established habits is difficult. Identifying situations that “trigger” ineffective behaviors or that inhibit prosocial behaviors can be a useful tool. Often the process of rehearsing constructive solutions and/or developing a plan to address problematic situations can prevent tendencies to revert to destructive behavioral solutions.

Should you have concerns or want additional information about the material presented above, please contact your local mental health care provider, the Public Library, the Rector, or someone on the Grace Church Health and Wellness Ministry Committee (Chaired by Mrs. Florence Poyer, R.N.)

Prepared by: Walter S. Handy, Ph.D., member, Grace Church Health and Wellness Ministry Committee