What happens during counselling?
I’ve been a counsellor for so long that it all seems very normal and natural to listen to complete strangers tell me their deepest secrets. I do appreciate however how strange this must feel to someone who is new to counselling. I thought it would be a good idea to explain what happens during counselling in this blog post.
It can seem intimidating finding a counsellor to talk to. Often, the things that my clients tell me, haven’t been divulged to anyone else, sometimes not even their husband or wife. It can feel like a huge step to make an appointment. Taking that first step though can be the start of a very positive journey – I know it sounds like a cliche but it’s true.
Counsellors are trained to be non-judgmental and to keep your secrets. Everything that a client discusses with me is confidential apart from two exceptions:
- If they threaten to hurt/harm themselves or someone else
- If there are child protection issues involved – for example, they tell me that they are neglecting a child or hurting a child. I have a duty of care to share the above information but would discuss it with my clilent beforehand. Everything else is completely confidential so you never have to worry about anyone else finding out.
The assessment session
The first session is all about establishing rapport and creating a safe, trusting environment for a client. The first appointment is when the counsellor will do an assessment of the issues. There are a lot of questions that need to be asked for the counsellor to begin to understand what is going on for the client. A good therapist has empathy and will usually find it relatively easy to put themselves in the client’s shoes. While the client is explaining, a counsellor will be taking notes. My job as a counsellor is to fully understand what happens, when it happens and why it happens for the client. I begin to create formulation – like a ‘map’ of what happens. Counsellors often look for patterns in behaviour and we often act as a ‘mirror’ for the client. I know that I am not completely self aware (no one is) and having an objective person looking in can help to reveal missing pieces that we don’t see or aren’t fully aware of.
Future sessions of counselling
After one to three sessions, the counsellor will normally have a good idea of the problem – it could mainly be anxiety, depression, social anxiety, health anxiety, generalized anxiety, perfectionism, and so on. There are specific things to look for to help a counsellor understand the underlying issue. With Cognitive Behavioural therapy there are certain treatment protocols for different types of issues. As a counsellor becomes more experienced they are able to digress slightly from the protocol and use interventions that they know will work as a whole to help the client.
Often, as part of Cognitive Behavioural Therapy, clients are given tasks to complete inbetween sessions. This helps with continuity. I often ask clients to complete a thought diary in order to see where their focus is during the week. What we focus on (our thoughts) affects how we feel as well as our behaviour.
We may also collaborate and think up fun experiments for the client to try to challenge their current thiking and beliefs. A counsellor should feel like a positive force in yur life, someone who is championing you and who is supportive.
Counselling is all about helping a client to become their own therapist. When clients try CBT they learn how to monitor their thinking and not always believe what their thoughts tell them. They also begin to understand why certain things trigger them and upset them (often due to issues from childhood, but not always).
I like to think of myself as my clients’ cheerleader. I often use humour in sessions and try to uplift clients and instil hope. Sometimes, this will be the first time they have had someone treat them in this way.
Talking about your problems can be a huge relief for some. Just knowing someone understands can make a client feel less alone and that is before we actually do any ‘proper’ counselling work (such as active strategies and interventions).
Counsellors will follow your lead and work at your pace. A good therapist will be able to read you well and make you feel at ease.