How to Get Everything You Can From Therapy and Counseling

I have worked for a number of crisis-based agencies and as part of my role, I would take phone calls. The degree and severity of each call would vary greatly — a concerned parent; a seasoned caller who was seeking to meet their needs through the crisis line; a first-time caller experiencing life stressors and potentially contemplating suicide. There were also countless individuals seeking support for situational anxiety and depression, or someone who was in the midst of an anxiety attack needing some immediate grounding and deescalating techniques to calm them.

I worked to direct them to employ distraction and mindfulness skills, some very familiar with the skills while others wondered why I was asking them to describe the room they are in, to focus on their breathing and listen to my voice.

In all, a common denominator in many cases was the presence of therapy in their lives past or present. I would come to this question when all was calm to determine what supports they had in place. I am a big proponent in working with core strengths and capacity. Why reinvent the wheel? Why not direct these individuals to those who had a better sense of their issues and needs whenever possible? Crisis lines are not meant to be a long-term and ongoing solution.

My questions regarding therapy would consist of the focus and purpose of their experience with it. How the sessions were conducted. The length they have been in therapy and how they felt it was going. Have they been taught coping and self-management or soothing strategies? If so, are they reviewed to ensure they are still effective and useful? Do they get homework? Often the response was no.

Intrusive I know, yet as I see it necessary, for I treated callers in the same manner as those I saw in person. Once the immediate crisis was addressed, what can we do to prevent or reduce future occurrences? Rather than just pass on a few numbers or refer them back to those identified as providing support in their lives, let’s pause and see how things are going and make a plan together for when they go back to therapy.

From the perspective of a private practitioner, my intent is not to be critical of or second-guess therapy provided, or disregard an individual not using skills and other strategies developed in their counseling relationship. The basis, in my view, of helping others is to assist them to learn to develop skills and abilities to help themselves, and not create a dependence and reliance on professionals for support. I am not suggesting they will never require support or should not access crisis services and other related services in a time of need. Rather, when possible, assist those we help to pause and not always go to the default option of seeking help until first employing self-management.

People come to us for help and like any relationship, complacency is common. It’s hard for those entering into therapy or who have been there for a while to ensure they are getting their needs met. Having a safe place where you can share your intimate thoughts and feelings, be validated and heard and hopefully leave feeling better than when you went in — why shake this up?

As those providing service, our job is fundamentally to keep people on course. However, over the course of the counseling relationship, how good are we at maintaining our course and the destination identified at the beginning of treatment?

I often suggested to individuals in or entering into a counseling relationship, when possible, to take the time to prepare before the session. Jot down feelings, issue and concerns to focus on in the session. Talk about what worked or was challenging. Starting a session with questions about how you are, how things are and how your week or time since we last saw each other was, can take one in many different directions. I understand that someone paying for therapy can arguably use the time as they see fit, but it is important to have that initial connection and starting off point. If I come into therapy to discuss my anxiety, for example, then that needs to be tied and focused on each session. Seems easy enough and straightforward.

But wait a moment — as we become more comfortable in therapy, it’s easy to veer from that path. “How are you?” “Well, I lost my job, I am having relationship issues, so busy at work, I’m worried about my friend,” and the list goes on. The next sessions: “How is the job search coming? How are things in your relationship? What is happening with your friend? How are you managing at work?” There can be a consistent focus on the feelings of sadness, grief, loss, fear and so on — open-ended questions, validation and encouragement which are essential in the process — but therapy is more than just talking and listening.

Where am I going with all of this? If we don’t tie in the anxiety and continue to refer back to it as we tackle these issues, a person continues in therapy never having learned how to deal with the issue they came to address. Each example may produce varying degrees of anxiety and stress. Each opens great opportunities for cognitive behavioral interventions. Life is full of surprises and misfortunes, and building capacity to deal with these unknown is what my vision of my practice is.

As therapists, we need to drill down to ensure we provide clients with skills to cope with these issues — revisit the tools to determine what worked or what did not. My goal is to put myself out of work — a bold statement, I know. I want to help people learn to help themselves.

I do not wish to profess my infinite expertise, though what I bring comes from over two decades of working with people from children to the elderly. I have stood in people’s homes across the continuum from dilapidated and uninhabitable to palatial. I have been on the street, in the cold, alleys, shelters, hospitals, nursing homes, police stations, correctional centers and courtrooms. I have seen people in their darkest moments and returned when their aspirations and hopes for better times have gone as astray. I have witnessed things that cannot be unseen and listened to lifetimes of infinite trauma and sadness. With it, I have seen what defines strength, courage and resilience. I have watched trust and hope blossom again and felt the need to return gratitude offered for life-altering learning and change provided to me by those I have crossed paths with.

As I make the transition out on my own, my beliefs and aspirations for my own practice stem from wanting more for those I work with, as I have done throughout my career.  I want more for everyone entering into counseling or therapy.

For each of us in this profession, we are entwined. Our value and reputations are built on not only the work we do individually, yet as a whole. So, we need to hold each other accountable and build capacity for our clients in any way we can — to include giving them the knowledge and encouragement to ensure they are getting the best out of their professional supports.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741. Head here for a list of crisis centers around the world.

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Thinkstock photo via shironosov