Follow Up: OK, So I Need to Be in Counseling ... Now What?

by Johnny LaLonde

Even if you recognize a need to be in therapy or want to be, for many people those first steps can be daunting. How to find a therapist, what to expect during your first session and what the counseling process will look like are all challenging questions. To help demystify this process, here are answers to five frequently asked questions about counseling. This piece will focus on some of the mechanics of initiating therapy; for more information on what to expect from counseling and why it’s beneficial for everyone (whether you think you need it or not), read this previous post.

What should I be looking for in a counselor?
There is a huge amount of diversity in how counselors view the therapy process. On one end of the spectrum you will find therapists who see clients for 3-5 sessions and primarily focus on their thoughts and behaviors. Traveling deeper along that spectrum you will find counselors who acknowledge the impact of emotions, history and personality. Moving even deeper will bring you to a place that acknowledges the depth of the human soul. These counselors wield a perspective which views the external in terms of the deep internal.

As with other Christian things, counseling should not be characterized by tips and tricks that are linked to scripture. Rather, good counseling should be an invitation to depth. So, what does that mean for your selection of a counselor? It means you want a professional who recognizes the hard work involved in exploring the depths of the human soul. It means finding a therapist who will honor your request for a behavioral fix, while inviting you to much more. It means finding a counselor who is acquainted with pain and grief and can sit calmly in the presence of your pain.

This is not an easy thing to find. Our culture is therapy rich and depth poor. We have plenty of self-help books, therapeutic television shows and New Year’s resolutions. We are not lacking in people willing to offer us a solution to our problems. But we are lacking in people who are willing to sit with us in our disappointment, to lament with us. To walk with us as we pursue our true self.

Many walk away from counseling frustrated and disappointed. They were offered quick fixes from a narrow view of the human experience. Our counseling center regularly sees clients who report their surprise to us. Having previously tried counseling, they are surprised by how much depth they possess. They talk about being asked questions they have never been asked before. They talk about seeing themselves in a new light and understanding their relationships in a new way. They speak of meeting their true self and in turn, experiencing God in a fresh way. They are speaking about the difference between surface level fixes and a deep soul journey

So, how do I find a good counselor?
Therapy is driven by two main referral sources: insurance and word-of-mouth. If possible, you should always find your therapist through a word of mouth recommendation. Ask friends, pastors, or family members if they have seen a counselor and what their experience was like. Try to find a recommendation that can give you a sense for what the therapist is like. Not every counselor is a good fit for every client. You may need to try a couple counselors out before you settle on one. Obviously, you can always do a Google search, but another source for finding counselors is through professional groups like the American Association of Christian Counselors or the American Counseling Association Christian Counseling Resource Directory is another great option. These avenues will get you pointed in the right direction but are no replacement for first hand experience.

Don’t be afraid to ask the counselor a few questions yourself during the first visit. You aren’t bound to the counselor forever just because you’ve visited once, so take some time during the initial session or two to make sure the relationship is a good one. Here are a few questions you might ask during your first session:

How long have you been counseling?
How do you believe people change?
Why did you become a counselor?
Have you been to counseling yourself?
Where did you go to graduate school?
What other certifications do you have?
What specializations do you have?
What have you done to develop your specialization?

You can also feel free to ask some personal questions about your counselor. While therapy is not about exploring the life of your counselor, it can be helpful to know a little bit about the person you are sitting with. We are often asked questions like:

Are you married?
Do you have kids?
Do you have any pets?
What is your favorite book?

How much does counseling cost … and what if I can’t afford it?
The cost associated with counseling is another area of the process where information is a must. Here is the bare bones information you need to have about the cost of counseling. First, you can expect to pay anywhere from $45 to $200 per session. That is a big variance that can come as a surprise to would-be clients. As with all things, you do get what you pay for. The hourly rate for counselors increases as they gain more experience, develop professionally and earn a solid professional reputation.

For many, the cost of counseling feel can like too much. There are a few options that can help.

Many counselors operate on a sliding scale. Basically, your fee for counseling will be proportional to your earned income. This is something you’ll want to talk to the counselor about before you schedule your first appointment.

Churches will often set money aside to assist congregants with the cost of counseling. Have a conversation with one of your pastors to see if the church can offer you assistance. This usually comes in the form of the church agreeing to pay part of the fee for a set number of sessions.

Some churches or ministries offer or are associated with a counseling center. Often these counselors are subsidized or fully paid for by the church and the cost can be less.

Consider asking friends or family members to assist you with the cost.

Finally, insurance. It can be hard enough to find a good Christian counselor through a solid word-of-mouth reference. Expecting that counselor to also be on your insurance is unlikely. But, there is good news. Insurance companies are growing increasingly accommodating toward mental health services. Many insurance plans now allow for coverage of mental health counseling by an “out of network provider.” These plans will cover a percentage of a set number of sessions. Typically, this number ranges anywhere from 20 to 40 sessions or more. It is worth a call to your insurance company to inquire about your benefits in this area.

What can I expect during my first session?
The first session of counseling can be a nerve-wracking experience. It’s hard to know exactly what’s going to happen. What will the counselor do or say? What is the client supposed to do?

First, do not expect anything earth shattering during your first session. Your counselor does not know you or the thing you would like to talk about and they are not magicians.

Here are some things you should expect. Some of them are practical and some are not.

First, there is paperwork associated with going to counseling. Many counselors like to have an intake form filled out that does a general survey of your life. This gives them a quick overview of the possible areas that are being impacted by your decision to see a counselor. All counselors are required to provide you with a summary of the HIPPA privacy policy. This is the same with all health care providers. Many counselors will have a document ready to be signed stating you have received this summary. A counselor may have a policies form they provide for you. This gives you an idea of what is expected of you in terms of scheduling appointments and canceling appointments. Finally, all counselors should provide you with and talk you through an informed consent document. This is a standard item given to people when they choose to come to counseling. It lets you know what your rights are as a client. It will also highlight for you any areas under state law that require a counselor to break confidentiality.

Your counselor may ask you if you have any questions for them about the counseling process. Feel free to ask whatever comes to your mind. You have a right to be informed about what is happening during your counseling.

After the formalities are taken care of, you can begin to discuss whatever it is that brought you to counseling. This part is up to you. You start wherever you need to. This may take the remainder of the session and it’s fine if that happens. Often, clients feel relieved just to begin talking things out and getting things in the open. Your counselor will interject and ask clarifying questions or collect details that stand out. At the end of your session, your counselor will probably talk to you about scheduling another appointment.

Above all, you should expect to be listened to during your first session. No matter how experienced or amazing your counselor is, there is no way for them to know exactly what you have experienced. It is important for them to listen to you to get a sense of what you are dealing with.

How Long Should Counseling Last?
It would be wonderful if there was a formula for determining exactly how long counseling should last. Unfortunately, there are a number of factors that can influence the length of time necessary for counseling.

First, it depends on the severity of the issue being discussed. If it’s a problem like marital communication or career counseling or premarital counseling, then it is likely counseling will last for a shorter amount of time—perhaps even as short as 4 or 5 sessions. If for example, it’s an addiction, abuse or emotional issue, it may last significantly longer—a year or more.

Second, it will depend upon the type of counselor you are seeing. There are modalities of counseling which believe counseling should never last more than 10 sessions. There are others that see counseling as a problem solving tool as well as a personal development tool. For these approaches, counseling can last as long as the client is growing, benefiting and interested in continuing. The brand of counseling we utilize at City Church honors the short term needs while primarily focusing on deep transformation.

It is appropriate for you to ask your counselor how long they feel counseling should last. It may take them a few sessions to get an accurate feel of where you are and how long the process will last. However, they should be able to give you some indication based upon the goals you have set. In the end, it’s really up to you. Some people find that being in counseling is like preventative medicine for their relational health. It allows them a venue to examine themselves and to grow and develop. Others want a particular problem to subside and when that has been accomplished, counseling is over for them. Just remember that true transformation takes time and investment.

Johnny LaLonde is a licensed therapist with specializations in group work and addictions at City Church San Francisco, where he supervises new therapists, teaches classes for lay counselors, and directs support and therapeutic groups.

Editor's Note: Image by Seier + Seier.

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