WHAT IS THE EXPERIENCE OF COUNSELING LIKE?
Everyone has images of what counseling is like, even those who have never attended a session. People's images are created from blending information from movies, television, books, friends and family, along with their own fantasies. Therefore, their conceptualization of counseling is most likely to be part-truth and part-fiction. This writing is intended to help bring them to a more realistic understanding of the process of counseling and a client's experience.
Counseling is, foremost, a relationship. It is this relationship that heals. It is not the knowledge, wisdom, techniques, etc., that heal, but all of these things in the context of a meaningful relationship. Throughout the counseling process, regardless of the counselor's approach, the therapeutic relationship between counselor and client is a central component in the healing process. Without a mutually trustworthy, respecting and caring relationship, a client will not be able to work through the stages of counseling, but will terminate prematurely. The importance of a relationship is not unfamiliar to us as Christians. We understand that the healing we experience from God after we are saved is based upon the relationship we have with Jesus Christ. In the context of our relationship to God, we experience forgiveness, reconciliation, peace and love, for example. The key relational dynamics of safety, acceptance, respect, understanding, trust and commitment are essential ingredients for a positive treatment outcome.
The length of treatment can be a single session, a few brief sessions, or up to many years of intensive work. A single session or two is often for those looking for consultation. They seek understanding about something fairly simple or to secure some direction for a particular non-crisis problem. Brief counseling, from a few sessions to about 20 sessions, is geared for those whose conflicts or problems are not severe, but they need more time to process information and make changes. Clients who receive years of treatment, usually have more serious disorders, such as chronic depression or personality disorders. The length of treatment is also dependent upon factors, such as the type and number of treatment goals and the orientation of the counselor. Cognitive and behavioral treatment can be brief. Analytic counseling is most often long-term treatment, meaning more than a year. That may seem like a long time, but the reality is, it is relatively short in comparison to the years a person has been developing his or her personality, view of life, etc. One year of in office counseling time is equivalent to approximately one week of full-time work.
A person considering entering counseling often will question if it is necessary and if it is morally okay for a Christian to go to counseling. Additional factors that influence one's decision include fear of facing pain, thinking he or she should rely exclusively upon God, financial issues and questions such as, "Who can I trust?" Most commonly, a person calls to make an appointment when his or her pain and feelings are out of control. Some persons decide to begin counseling when they are aware of problems and before the problems reach a crisis point. When a client calls for a first appointment, he or she may experience some relief in knowing he or she is going to get some help. On the other hand, some experience a mild increase in anxiety, particularly if this is his or her first time. This is normal, and the anxiety usually diminishes during the first session.
The following stages of counseling are common to all counseling processes, although the actual content, methods and timing are different, due in part to the differences in a counselor's theory and the goals of treatment. This presentation of the stages of counseling is not intended to be exhaustive, but to provide a brief and simply way of understanding a rather complex process. The stages of counseling include evaluation, working through and termination.
The first stage of counseling is evaluation. During the first session, the counselor and client get acquainted with each other and discuss the problems presented by the client. This session also consists of a mutual evaluation of one another. Answers are sought to questions, such as: "Does the counselor and client feel comfortable enough with each other to be able to work together?" "What are the presenting and possible underlying problems and symptoms?" "Is counseling warranted for the problems presented?" and "Does counseling have something to offer the client to help remedy his or her problems?" If the answers to these questions are, "Yes," then a mutual decision is made to continue counseling. Often, a secondary evaluation process is next on the agenda. This evaluation may include some psychological testing and/or interviews where an in depth history of the client is taken. This essential information helps the counselor understand the client's personality, factors that have influenced his or her development, how to approach or work with the client and what treatment goals should be set, as well as other factors that aid in treatment planning.
The second stage is one of working through, where the majority of counseling time is devoted. Working through is done in individual, couple, family and/or group counseling. Counselors, who are analytical or insight-oriented in their treatment, will engage in clarification of issues and ongoing analyzation and interpretation of conscious and unconscious material, such as dreams, experiences, thoughts, feelings and behaviors. The most common goal of analytical treatment is to integrate back into consciousness those painful and unwanted thoughts, feelings and behaviors that were cut off from consciousness. The client releases pent-up emotions such as anxiety, develops insight and gains self-understanding, which lead to change.
Other common therapies that utilize a working through stage include behavioral therapy (primarily treating physiological or psychological symptoms, e.g., anger), cognitive therapy (primarily remedying faulty beliefs) and systems (primarily changing the social system in which the client is experiencing difficulty). To illustrate the working through in behavioral therapy, if a person is fearful of insects, he or she may be exposed to insects in-vivo (live) and/or through imagination, until he or she has gained control over or alleviated his or her fear. Cognitive therapy seeks to confront a client's irrational thoughts, such as, "No one cares for me!" The counselor will challenge the client regarding the belief. The goal here is to replace the faulty thought with one that is realistic or true. In the systems approach to treatment, realignment of relationships is a focal point. For example, a child triangulated in a marital relationship will become the center of marital communication and conflict. The counselor will seek to remove the child from between the couple and help the couple resolve the problems between themselves.
The final stage of counseling is termination. When a client has accomplished the goals mutually set by himself or herself and the counselor during evaluation, he or she is ready to end counseling. However, termination is a process. It is not often a one-session discussion. Most clients have established a bond of trust and safety with his or her counselor. Ending that relationship most often includes a letting go process and some grief. Termination can take a couple of sessions, or in long-term treatment, consisting of a few years, it can take up to two or three months.