The story of the reluctant Blogger: blogging as the mood takes me!
Counselling and Psychotherapy: What to expect in the first sesson?
August 2016
In my experience, deciding that you need some emotional help and support is one of the hardest decisions you can make. I often feel that when someone picks up the phone, that is the most courageous part of the process – it’s a huge step in itself. But once you’ve got your first appointment, what then? What happens in a counselling/therapy session? What can you expect when you walk through the counsellor/therapist’s door?
It is usual to feel anxious when you first come to see a counsellor/therapist – anxious about what the therapist is like; what is expected of you; if it will be painful; how you might be helped; how long it will take; or even if you like the therapist! Anxiety is absolutely normal and your therapist/counsellor should be able to put you at ease straight away – assuring you that it is natural and usual to be anxious in situations that you are not used to. That is our brains way of letting us know that the situation may be unsafe – it is our body’s way of keeping us safe in an unknown situation.
Your anxiety might continue for a few sessions – to a lesser degree, but still present. Again, this is very natural: you are about to explore the most intimate details of yourself so you’ve got to trust and like the person who is sitting in front of you.
The first session is usually an ‘assessment’. The counsellor/therapist may start by asking what has brought you to their office. The client then usually describes what is bothering them in their own words. This can be anything from depression, anxiety, stress, anger issues, bereavement, marital or relationship issues, abuse in any form, work issues, sexual identity, gender issues, family or work problems - absolutely anything that is causing you emotional or psychological distress. Sometimes people seek professional help because, despite a seemingly ‘good’ life, money, etc, they just don’t feel good about themselves and they wish to explore why this might be. It is such an individual experience that it is difficult to generalise - people have very different reasons to seek therapy. In fact all the reasons why we seek professional help and support are personal and individual – as individual as you are. As I wrote in another article – there is no one counselling or psychotherapy method that works for all people all the time. So the reasons for seeing a counsellor/therapist are also individual and unique to each person.
Once you have told your therapist why you are seeking help, they may ask you why now? Has something changed in your life? Has there been a change in your circumstances? What is going on for you now? Once your have given the therapist a bit about why you are there and, the therapist is likely to ask some questions about your life, such as information about your background, current relationships, etc. This is for a number of reasons:
• in order to get some understanding of your support network
•to form a picture of your family of origin and current family
•to get a greater understanding of you - the person sitting with the therapist
These questions are usually about your birth family, your relationships with your parents, siblings or any other carer, your current family such as husband/wife/separated/divorced, children, etc.
Although the questions may often seem irrelevant to your current situation, they are important pieces of information in formulating a diagnostic picture of you. This gives the therapist an idea of how to help, how long it may take and what direction the therapy is likely to go.
During this process, you will, of course be making note of whether you like the therapist; whether you like the way they work and whether you could work together. Without actually being able to form a therapeutic relationship, the therapy/counselling will not work, however skilled or not the therapist is. For this reason, I usually end the first session by asking whether the client has any questions for me. Sometimes they do and sometimes they don’t. If not, I encourage them to ask at any time during our work together. That is a personal decision and different counsellors/therapists may work differently.
Last but not least, your therapist will discuss the terms and conditions of your work together so that you know how to get hold of them in an emergency, their cancellation policy, times when they work, etc. Different counsellors/therapists work differently, depending on the type of counselling or psychotherapy that they use. For example: some counsellors/therapists will suggest you meet once a month, others once a week and some, a few times each week. Again, ask the therapist how they work, why they work like that and remember, if you don’t like how they work, find someone else. There’s a lot of choice out there – you need to find the method and person that suits you.
Cost is also something that the counsellor/therapist may discuss at the first meeting. If you have therapy or counselling at your doctor’s surgery, then this is not an issue but if you see someone in private practice, then you will have to pay for the therapy. Medical insurance companies do sometimes pay for counselling/psychotherapy but usually only one type of therapy and for a short period of time. But it’s definitely worth asking both your provider and your therapist if they accept medical insurance.
When the first session ends, it is usual to make the next appointment. The counsellor/therapist may also ask how you feel now, at the end of the session. It is unusual to feel as anxious at the end of the session than at the beginning but if you do, it’s always important to be as honest as possible. Say how you feel and the therapist should again give you some reassuring words. This is all information and you can address it at the next appointment.
Making the decision to seek professional help for anything to do with your mental health and well-being is a brave, courageous step. In therapy, you don’t tend to talk about the things that are good in your life as they don’t need to be changed. It is the painful and difficult memories and experiences that you will be talking about - this will not always feel good but it will help.
I hope this gives you some idea of what to expect after you make that phone call. As they say, every journey begins with the first step – good luck with yours.
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2nd entry....
Counselling or Psychotherapy? What’s right for you?
30th June 2014
For those looking for professional help and support for mental health problems such as: anxiety, depression, stress, anger issues, work-related stress, sexual identity or gender, abuse, etc – where do you get help and who from? Most people know what a counsellor does but the term psychotherapy seems to have a stigma attached – is it justified and how do the two types of support differ and how are they the same? I hope that in this article, I can explain what Counselling and Psychotherapy are and how they can help.
Often the first port of call for many with depression, anxiety and other mental health issues, is their GP. GPs will sometimes refer to Counsellors/Psychotherapists. However, most people self-refer - you just pick up the phone and make the call yourself. But who are these counsellors and how do we know we are getting what we need? What does it mean to see a counsellor as opposed to a psychotherapist and where do we find them?
There are differences in the type and length of training for Counsellors and Psychotherapists. As long as the Counsellor/Psychotherapist is accredited by one of the accrediting bodies (UKCP, BACP, BPS, etc), then the differences in training matter very little as long as you find the right someone who you like and trust.
Often Counselling tends to be shorter-term and Psychotherapy tends to be longer-term – but this is a generalisation. So does this then matter? It depends on how long and in what depth you wish to work with whatever you bring. Some people wish to get to the bottom of why they feel how they feel, to make sense of their world at a profound level and to ensure that whatever bothers them does not happen again. Others may wish to get some understanding of what is going on in their lives and move on and have no wish to process their trauma or work through their pain – understanding is enough. Both are perfectly reasonable and practical.
Counselling tends to be more solution-focused: marriage counselling, bereavement counselling, etc. Because of this, Counselling may put aside other factors which are felt not to be important to help you with what you are currently feeling or experiencing. As Psychotherapy tends to be more open-ended and longer; every detail of your life may be explored in order to understand why you are having problems now at this point in your life so far… everything is seen as important. Indeed, for many, the problems they are having now, may have recurred at different times of their life. That being said, Counselling can be open-ended and Psychotherapy can be short-term and solution-focused – these are just generalisations.
The differences only matter because different people want different things. No one way of working fits for all the people all the time. Some people want to sign up for 6 sessions and talk about one thing and then go – and it works for them. Other people want to dig deeper and fully understand and explore how the crisis that made them depressed/anxious/stressed/etc, might be the result of what is going on in their life in general – events and experiences from the present and the past.
What is the most important is that you see the ‘right’ person for you. You need to find someone who you feel understands you and with whom you feel comfortable. The most important part of you getting the support you need, is the relationship you create with the Counsellor or Psychotherapist you see. Whatever theory or school of thought they follow is not as important as the relationship that you have with them.
To find a counsellor/psychotherapist look on-line, in the phone book or Yellow Pages. You can also go to the website of the accrediting bodies – United Kingdom of Counselling and Psychotherapy (UKCP), British Association of Counselling and Psychotherapy ( BACP), British Psychological Society (BPS), etc – and find someone in your area. Check the person’s credentials and make sure they have professional liability insurance.
Once you have found a few Counsellors/Psychotherapists that you like the look of on paper, phone them for a chat: find out if you like how they sound on the phone. Ask them about their training, how long have they been qualified and check their credentials and insurance. You could also ask for an initial session so you can see how they work and if you actually like them and can get on with them! Some Counsellors/Psychotherapists will offer a free initial session or half session – so ask! Given that the relationship is so central to the work, you have to like the person, feel comfortable with them and be happy to disclose some intimate details of your life with them, so the more you know about the therapist before you make the decision, the better. If you feel judged, criticised or shamed – then the relationship is not good. Be aware of how you feel in the presence of the counsellor/therapist and trust your judgement.
No one type of support or one type of method works for everyone and you, as the client, must find the person, technique and method that feels good for you. I encourage you to ask questions, check someone out and then try them out. Knowing what you want and who can best help you, means that you will find the right healing environment. It is your mental health on the line: you have every right to find the right person – for you.
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First BLOG ever....
BLOGging for Beginners
12th June 2012
My first Blog entry.... a scary event but maybe this reflects what it is like contacting a counsellor/therapist for the first time....
My own experience of the first time for therapy is knowing I needed and wanted therapy for a long time before I even had the guts to pick up the phone. My clients tell me they feel the same - that the period before you pick up the phone is the worst bit - asking for help can be very frightening. Once you take the plunge and make the phone call, it feels like such a relief - at last you have shared your pain with someone else and they have listened and taken you seriously. It's such a healing experience.....
Once you've made that first phone call, you then have to set up the first meeting! That's pretty daunting, too. But I can assure you that the first meeting is not nearly as difficult as that first phone call! In fact I usually suggest to first timers that they try a few counsellors/therapists out as you will need to find someone who you actaully like - afterall you will be telling them some of the most intimate things about yourself, often things that you have never told anyone else.
At the first meeting, we take the time to get to know one another. Obviously, I need to know a lot about you but you may have some questions for me, too. I want you to feel safe enough during our time together to talk about the things that really matter to you so you may want to know something about me and how I work.
How I usually start a session is by asking, what brings you here? Or, how can I help? I really want to know you and I try and stay curious about you and how you experience the world so that we can help you find some support for what you are going through. I hope that by the end of the first session, you will have some idea of how I work and how we are going to help you. We will also decide how long you want to work for - whether you want to work in an open-ended way or whether you would rather have a finite period in counselling/therapy. I will also go through the terms and conditions and ask you to sign this if you are happy with it. This contract sets out the terms for confidentiality, cancellations, payment, etc.
Subsequent sessions are completely led by you - you come into the sessions and just talk. I ask you to be as curious as you can about yourself, without any judgement. Easier said than done but curiousity keeps our work open and moving forwards. The more you bring to a session, the more you will get out of a session.
I'm sure there is a lot more I could say about a first session but I see that I have now completed my first BLOG entry! It was daunting when I started and now it's done. Picking up the phone for the first time is much worse but once you do it, you open yourself up to some great healing..... So trust that it will be ok and pick up the phone.
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