What I need to know about counselling / therapy
Why counselling?
In other cultures, at other times, I suspect that there was always a ‘counsellor’ people would go to – the medical doctor, community elder, the gentle soul at the watering hole, or someone in the family. I have heard about a tribal community that had a crying hut where people could go to cry and support each other. But in our society, people are often busy, families can be fractured, life has become complicated, and people can feel isolated and misunderstood. So we may choose to see a counsellor or therapist.
What is counselling?
Counselling is a professional activity involving a counsellor and a client in a relationship in which the counsellor uses his/her professional training and skills to help the client deal with issues in their lives and enhance their understanding of their life and relationships with others. I often see it as a search for meaning, or a bit like looking for clarity in human soup!
What should I look for in a counsellor?
Countless studies and research have shown that the most important factor in successful counselling is the therapeutic relationship – that is, you need to find a counsellor you feel comfortable with. No matter how many qualifications a person has, if you do not feel at ease and able to say what is on your mind, that person is not the right counsellor for you.
My advice: telephone your counsellor first for a brief chat. You will get an idea of whether you may feel comfortable from that first interaction.
Also ensure your counsellor is accredited with a reputable body, such as the AASW or APS. This will ensure your counsellor is accountable and bound to a code of ethics.
How many sessions will I need?
Some people come to counselling for one or two sessions. They may need to unburden themselves of something that is bothering them, get an unbiased perspective on a situation, or just talk through and problem-solve an issue.
Generally, people with emotional or psychological difficulties need a therapeutic approach that will help them identify underlying causes and patterns of thought and behaviour. Many clients attend for up to 10 sessions, particularly if they have been referred under a mental health plan by their GP. Some people engage in longer term therapy as a process of exploring self and gaining confidence and clarity in their lives.
With couple therapy it usually takes one to two sessions to identify the issues and interactions in the relationship. Some couples identify things they can do to improve their relationship. Others need a longer course of therapy. It is not unusual for couples to need between 8 and 20 sessions, weekly or fortnightly initially, and then less regularly once some progress is made.
What is the difference between a psychiatrist, psychologist, and clinical social worker?
Social workers are trained with a person-in-environment focus. They work broadly, asking about a client’s family, relationships, workplace, upbringing, culture, society, income and religion. Social workers often advocate for clients, and identify systemic issues, such as social policies, that may disadvantage individuals or groups of people. Some social workers do further training to specialize in psychological and counselling therapies.
Psychiatrists are specialist doctors who have done extensive training in mental health. They are able to prescribe medication, admit patients to hospital, and manage complex mental health conditions.
Psychologists are trained in cognitive science and human behaviour to assess psychological functioning and offer psychological strategies to overcome mental health issues and life stressors. Many undertake further training and may specialize in certain areas.
I refer clients to psychiatrists or psychologists if they need medical attention or specific psychological therapies that I do not offer. Some counsellors and psychotherapists have followed a different pathway. This does not mean they are not competent counsellors, but check that they are accredited by a professional body, such as PACFA, to ensure they have appropriate skills and adhere by a code of ethics.
Why see a clinical social worker?
The advantage of seeing a clinical social worker is that we work from a strengths-based, non-judgmental position. Clients are sometimes tired of being labelled with a diagnosis, or believe that the problems they have endured over their lives have been overlooked by the health professionals they have seen.
It is important that you are recognized for the person you are, the strengths you have, and the obstacles you have overcome.
What about the fees?
Most counsellors are paying rent for the rooms they use, pay professional association fees, and attend ongoing professional development. They have also spent many years at university, and need to earn a living.
My advice: ask up front about fees and whether the counsellor offers discounts, hardship provisions or long-term rates.
Also inquire about Medicare rebates. You may be eligible if you are referred by your GP.