What Happens During Counseling?
Posted on July 4th, 2013
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The Course of Counseling
Some of the most common questions that people ask me are: “What happens during counselling?” and “How many sessions will it take?”. In this post I would like to show an overview of the course of therapy, the key tasks, and some of the problems that are likely to happen during different stages.
For most straightforward problems such as stress, anxiety, fears, obsessive thoughts, depressed mood, and panic attacks, a course of therapy typically takes from three to six one-and-a-half-hour sessions. The number of sessions depends on the complexity of the problem and can be extended or shortened.
During the first several sessions, appointments are scheduled weekly and gradually progress to bi-weekly or monthly depending on the results you get. Follow-up sessions are scheduled after you have successfully resolved your problem to make sure that your results are stable.
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At the beginning of each session, I work together with a client to create a plan of what we are going to accomplish during the session. Creating an agenda before the session begins, ensures that we use our time most effectively. A common agenda includes prioritizing the issues, addressing any questions, and briefly discussing techniques or methods for the session. The main goal is to establish a collaborative relationship.
It is important that the counseling sessions seem relevant and helpful to you, and given that we only have a limited time in each session, it is usually helpful to decide at the beginning of the session what we will focus on. I usually have ideas about what I would like to include, but you (as a client) will often want to discuss things that have happened in the week, or thoughts that have occurred to you, and so on.
It is really important that we make time for those. It would be helpful if you would take a few minutes before each session just thinking over what you would like to include. We can then agree an agenda between us.
What’s on the agenda?
Agenda is like a map that allows us to move in the set direction to achieve your desired goals. We will discuss any issues of risk including, kids, urgent problems, possible job loss, upcoming exam, and other problems. Once we set an agenda, we will follow it as a guideline to achieve your desired results. Although, we may address other problems along the way, it is important to stick to our plan.
Brief review of the events of the past week. This is a brief review of anything that you consider to be major agenda items.
Review of the last session. If there were any problems with what we have discussed during the last session, we will review them.
Assessment of current mood. Has your mood changed since the last session? Should anything related to your mood be included on the agenda? Depending on your problem, I may give you an assessment tool or ask you a simple question like “How would you say your mood has been over the past week from 0 to 10, where 0 is as low as it could be, and 10 is absolutely fine, no problems at all?”
If you have a specific problem like anxiety, I may ask you something like How would you say your anxiety has been over the past week from 0 to 10, where 0 is no problem at all, and 10 is as bad as you can imagine?”
Review of homework. We will briefly review any assignments that you had to do before the session and address any questions or problems.
What do we talk about during the session?
While the sessions’ main topic of discussion will differ from person to person, we usually discuss symptoms such as low mood, anxiety, sleeplessness or current problems such as issues at work or relationship difficulties. While discussing your problems or symptoms, I will often help you deal with them at same time. Using a specific technique or method, I’ll help you discover a new perspective, change your feelings, gain and emotional or an intellectual insight, or work with you on a specific solution.
Homework assignment. At the end of most sessions, we will talk about specific assignments that you will need to complete at home. In a way, what happens outside of the office is more important than what happens during the counseling session. Homework assignments are based on the main topics discussed during the counseling session.
Feedback about your experience during the session.
It is very helpful for me to hear some feedback on how things have gone during the session. It may be difficult at first to tell me if things have been disappointing or if I have said something that has upset you, but as we try to work together on dealing with your problems, it is really important that you feel able to say whether things are helpful or not. Counselling is a learning experience for both, the client and the counsellor.
It is important for me to know what you think is the take-home messages from the session as well as if there was anything that I have said that is going to play on your mind, or has been unhelpful.
Progresses and Conclusion
As you progress towards resolving your problems and achieving your goals, the frequency of sessions may be reduced, perhaps moving to two-week gaps between two or three sessions, followed by perhaps a three- or four-week break before counseling ends.
At the end of our work together, it is helpful to further develop a blueprint for dealing with any problems that may occur in the future such as a relapse. This could include:1
- What has been learned during therapy
- What strategies have been most helpful
- What situations in the future may be difficult, or possibly lead to a recurrence of the problem
- Ways of responding to this, given what has been learned in counseling
- How to handle a significant problem, including if necessary a telephone review with me
Rather than having a sudden stop to counseling, I recommend to schedule a ‘booster session’ or two over the subsequent year. During this session, we can review your progress, reinforce your success at dealing with problems, check how well you were able to deal with problems that had been anticipated at previous sessions, check on reoccurrence of unhelpful patterns of thinking or behaviour, and work together to trouble-shoot if necessary.
Westbrook, D. E., Kennerley, H., & Kirk, J. (2011). An introduction to cognitive behaviour therapy: skills and applications (2nd ed.). Los Angeles: SAGE. ↩
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