1. Is there something wrong with me?
The short answer is no. There is likely nothing “wrong” with you.
People seek out counseling for a variety of reasons. Some want help with productivity at work. Some want to feel happier. Some want to learn why they do certain things or think certain ways. Some want help with decision-making. Some want help smoothing out a relationship. I like to compare counseling and psychotherapy to any other healthy change. If you want to build up your stamina, you might take up jogging or other aerobic exercise. If you want to create art, you might take a class. If you want to feel closer to your partner, you might schedule date nights. And, yes, if you want to learn why you get stomachaches, you might see a doctor.
2. How do I know if counseling will work?
The short answer is if you want to learn, change, or practice something about yourself, if will work.
The longer answer is different people fit better with different types of counselors – male or female, spiritual or secular, client centered or theory oriented. Therapy will work best if your counselor is one with whom you fit well. In fact, research shows the relationship between client and counselor is at least as great a predictor of the success of therapy as any other variable, including the type of therapy provided and the therapist’s education level (Norcross, 2011).
The other piece, though, is that if you want your counseling to change someone else, it’s not that simple. You can only change you. Your therapy can change the way you interact with others, which could change their behavior, but it’s not a straight line from your therapy to their change.
3. How do I know if it’s working?
You are meeting goals you set, or making progress toward meeting goals you set.
A good therapist will work with you to set goals. What do you want from counseling? Where do you hope to be in 3 months, 6 months, and a year? Some counselors use “the miracle question:” Say you went to sleep one night, and while you were sleeping, a miracle happened to make your life exactly how you want it. But, you were asleep so you didn’t know that miracle had happened. The only way you would know is by what you saw, heard, did, or felt when you woke up. What would you notice that was different?
Then you take time every month or couple of months to look at those goals. Are you getting closer to getting the job you want? Are you yelling at your spouse less and feeling closer? Are you feeling lighter, freer, and more confident? If the answer is yes, counseling is working.
If the answer is no, a good therapist will help you with changing up the focus or frequency of counseling, learning whether goals set are attainable or need to be broken down, or if there is some other reason for lack of progress meeting them.
4. What happens if it’s not working?
Short answer: We shake it up.
Longer answer: In addition to the last paragraph in number 3 above, your counselor, with your agreement, might suggest adding in some EMDR, play therapy, art therapy, narrative therapy, or other method to mix it up a bit. S/he might add homework or reading assignments for the time between sessions.
And one other thing. You and your counselor might look at your relationship. Have you built trust, warmth, and mutual respect? See number 2 above.
5. Do I have to tell you everything?
You don’t need to tell what you don’t want to tell. If you and your counselor allow your story to naturally unfold, in its own time, your relationship (see how I did that) will become more solid, trusting, and therapeutic than if you run down a long list of events from your life. Your counselor will have given you forms to sign that define the limit of what they will do with the information you give. That said, the more open you can be, over time, the more help you will receive.
6. How long will it take?
I’m not sure yet.
Because every person is unique, and every issue affecting a single person is unique, it’s impossible to know how much time is needed to resolve problems. However, you should know by the fourth or fifth weekly session if counseling is helping. If counseling is every two weeks, of course, progress will likely be cut in half. So it might take double the time to see complete healing or achieving your goals.
Just like when you take a class, if you go every week, you have 6 days to practice and/or forget what you learned. If you attend every other week, there is more time for other competing forces to get you sidetracked. Understand that some therapists and clients work even better in longer sessions though. The best way to figure out what will work best for you and how long that will take is by goal setting (see above), monitoring progress made toward your goals (again, above), and communicating with your therapist along the way.
7. Do you prescribe medications?
However, we can refer you to a psychiatrist or psychiatric nurse practitioner who can prescribe the medication. We will coordinate between each provider and make sure that the necessary communication happens between therapy and medication management.
8. What do you do with the information you learn about us?
I keep it private and use it to understand you better.
State and federal confidentiality laws, the Health Information Portability and Accountability Act (HIPAA), and our Ethics Agencies prevent us from sharing your information. There are exceptions in a few circumstances like abuse of a child or fragile adult, threats to self or others, and to provide for coordination of care in emergencies. Then I share the minimum amount possible.
Mostly, the information, your story, that you choose to share with us, I hold sacred because it is a piece of you. I value your information the way I value you. It is a gift that helps us determine how to work with you, what might help you, what to avoid until you get stronger.
9.What if I need to cancel my counseling session?
24 Hours prior to the session
In an effort to accommodate as many clients as possible during the limited time available during a given week, it is necessary to have a cancellation policy that is fair and reasonable for all concerned. It is in the spirit of showing respect for each other that the following policy was created. To avoid being charged the full price of your scheduled session(s), cancellations must be made 24-hours in advance, i.e., Friday appointments must be canceled by Thursday. Monday appointments must be canceled by Sunday. By providing this notice you are also helping other clients have sufficient time to respond to new appointment opportunities. There is no charge in the case of illness, injury, extreme weather, or family emergency.
10. My husband, partner, parent, child needs counseling. What should I do?
Ask them if they would like to talk to someone.
You know your husband, partner, parent, and child. If you believe they will be reluctant to come to therapy alone, you might ask them to come with you. You might start the conversation slowly, by simply noticing aloud that they seem less happy than usual, more stressed, are having trouble sleeping, or whatever is true for them and for you. You might give them this article to read, and ask if they’d like to call us. You can show them our website.
And you might remind them that what they tell us is confidential. Just like what you tell us. Therapy is a safe place.
11. Do you accept credit cards?
Yes, VISA, Mastercard, HSA/FSA (with credit logo) are accepted.
12. Do you accept insurance? What are my options?
No, however, you may contact your insurance provider to see if you can be reimbursed for therapy with “out-of-network” benefits for “outpatient mental health services.” We can provide you with a statement to submit to your insurance. It also may be possible to deduct qualified health expenses from your taxes, so check with your tax preparer.
13. What do I need to know about insurance?
Can be more harmful than good.
Insurance companies require that they decide what our goals should be, how long you get to be in therapy, and what your options are. They also require a diagnosis to authorize treatment to prove “medical necessity.” This diagnosis is in your file, and can follow you around and interfere with your ability to get insurance in the future. It stop you from get jobs with the government or military. If a diagnosis is warranted, it should be private and up to you to share at your discretion. Ethically, we cannot justify providing a third party insurance company with as much information as they require to justify paying for services.
14. Why does therapy cost so much?
Huge question - long answer - here we go.
It may seem like therapists charge a lot of money, but believe me, the vast majority do not become wealthy from their private practices. Let me tell you why that is, and about the high cost of therapy.
Like anyone who works independently, therapist’s fees pay for office space, office supplies, advertising, websites, continuing education, outside consultations, medical and malpractice insurance, and vacation time. While companies commonly supply these accoutrements and provisions for employed professionals, those of us in private practice supply them for ourselves. This is why we will refer agency settings to people who need therapy at very low fees.
For most therapists a full time practice is 18-25 contact hours with clients each week. This is also true of therapists who are employed by organizations. The rest of our time we are marketing and promoting our practice, doing essential administrative work, and keeping up with new information through study, professional/peer consultations with other professionals, seminars and conferences. We are only paid for our contact hours with clients; we do not get paid for any of these other responsibilities necessary for maintaining our practice and license.