Most people enter counselling during a period of distress in their lives.  Usually every effort is made to cope until we become frustrated and feel like we’re at a dead end.  Maybe someone suggests that we should see a counsellor or a therapist, maybe we come up with this idea ourselves.  We might know of someone who benefited from it or we regularly watch Dr. Phil,  hoping we’ll pick up something important.  “Maybe counseling could help me?” you think.

If you’re curious about counselling, that’s a good sign.  Motivation has a huge role to play when it comes to making change happen.  When someone is pushed into therapy, usually by someone else, I’ve rarely seen it work.

Because distress is often high when we start counselling, it’s normal to say to the therapist, “Please tell me what to do!”  You want things to be better. Yesterday.

Advice

Advice in counselling is an interesting beast.  In some schools of therapy, it’s never given. Never.  Even if you plead with the therapist.  A common response is to turn it back to the client, or “patient” and ask about their motivation in asking that question.  Some people do really well with an approach like this or a version thereof.  And to others, it’s just plain maddening.  So maddening, there is no session two.

In other counselling approaches, there many very specific advice given for things that could improve, for example, your mood: exercise, changes to your diet, sleep hygiene guidelines, cognitive restructuring exercises, and the like.

Many therapists will not tell you what to do when it comes to major life decisions or sometimes even questions about your specific situation, working instead to assist you to develop your own solutions.  Experience has shown me that when change comes from the client, the change is always more meaningful and life-altering.

But What About…

Okay, so you’ve read what I have to say and you still want direction.  You may even say, “I don’t pay someone just to listen to me.”  You are right. Listening is rarely enough.

Common questions I hear are:

• “Can you give me some tools to help with….?”
• “What is the best way to help with…?”
• “What are the next steps?”
• “Can you give me some homework around…?”
• “I need skills, strategies.”

These are all excellent, valid questions and need to be addressed in the course of therapy.

The Importance of Understanding

And, if we go straight to these important questions right away, what can get lost is an important first step: understanding.  This is sometimes referred to in therapy as an assessment. It’s when the counsellor asks detailed questions about the circumstances and situation which brought you to counselling and also explores any relevant background information with you.

Why is Understanding Important?

• Your specific challenges are uncovered, particularly those which have made change difficult
• Your strengths and personal assets are revealed, which help mobilize the change process
• Factors that make your situation unique are identified, especially in your immediate world

In other words, the counsellor gets to know you as a unique human being and then can partner with you in making recommendations specific to you.  If advice or suggestions are offered prematurely, before the counsellor understands you or your situation, the best one can hope for is generic advice.  This is what self-help books are for!  They’re written for general audiences.  When you hire a therapist you are implicitly asking for a customized experience and in order for that to happen, the therapist has to understand, on a deeper level, why you’ve come to counselling, what you need for you to reach your goals and how meaningful change can occur in your life.

Person vs. Problem

“Person vs. Problem” is a reference to how you want to position yourself, orient yourself, ‘pilot your ship’ in the counselling process.  If advice is the main goal you hope to achieve in counselling, it’s likely you have assumed a “problem” orientation and I won’t dis that.  You may be thinking, for example:

“What is the treatment for anxiety?”

“What is the standard approach for depression?”

“What do I need to do to deal with my grief?”

“Please tell me about DBT for borderline personality disorder.”

But there is another way, and it relies initially on the suspension of advice giving: the “person” orientation to counselling.  Make no mistake: this approach is not advice-denying, unless this would undermine a client’s personal growth and goals for counselling. Advice, when given, comes from a solid understanding of the person that the counsellor is meeting with. Suggestions flow from an intimate knowledge of the situation that has brought the individual to counselling. And if counselling evolves from this perspective, there is sufficient trust, developed over time, between counsellor and counsellee to search for solutions that are truly relevant and beneficial and that any avenues can be discussed, accepted, or rejected.

And Still…

The voice of the client is an essential part of the counselling experience. If you feel at any point that you are not getting what you need out of counselling, by all means, speak up!  I cannot underscore how fruitful this kind of conversation can be. If you are willing to take responsibility for what is important to you in therapy and you have hired a counsellor who is open to, or even thrives on feedback, good things can happen!

When we are emotionally open, it is important to choose a therapist who will not misuse this vulnerability but instead, will create a safe environment where our openness can be a vehicle for our own personal growth.

When committing to counselling, it is important that we know our rights. I list here my thoughts on the matter; I may miss something or your very specific situation may not “fit” exactly with what you I’ve written. You may even disagree. Above all else, I always encourage people to use their “spidey senses,” –i.e. if something feels “off,” strange, or your intuition is raising red flags, step back and take whatever time is needed to make a decision that is right for you.

In no particular order,

You have a right to…

• Refuse to attend counselling, even if important people in your life feel that it’s necessary

• End counselling at any time, for any reason, unless you are court-mandated to attend

• Decline to work with a particular counsellor if you do not feel comfortable with her or him, or the counselling office, even if it is for reasons you are unclear about

• Request to work with a counsellor of a particular gender

• Have the content of your sessions kept strictly confidential and exceptions to confidentiality explained to you before proceeding with therapy

• Ask the counsellor questions about her or his experience, training and approach

• Refuse to answer any question the counsellor asks that you are not comfortable answering

• Provide the counsellor with feedback about your session

• Ask the counsellor questions and/or request clarification

• Have all fees and policies explained to you prior to starting the counselling process

• Have a therapist that provides you with emotional support – not the other way around. A counsellor should not share their personal problems with you. Any time a counsellor shares her or his life experience, it should be specifically related to your therapy in a way that makes sense to you and furthers your goals

• Be spared from questions that solely benefit the counsellor, for example, if you have expertise in an area or have a particular skill set which is not related to your reasons for attending therapy

• Bring a support person with you to your sessions or to refuse another person’s attendance, if requested

• Work with a counsellor that you do not know personally from elsewhere. In counsellor speak, this is called a “dual relationship.” This means that you do not choose a counsellor who is a friend, acquaintance, neighbour, family member, congregation member, employee, student, business associate, etc.

• Have a counsellor who respects your ethnicity, race, sexual orientation, gender identity, relationship status, age and religion

• Have a physically safe environment free of sexual harassment, innuendo or the expectation of a sexual relationship. Ethical counsellors never have sex or engage in sexual touching with their clients

• Have professional boundaries respected; your therapist does not initiate social contact with you outside the counselling relationship

• View your counselling file. In certain jurisdictions, information obtained from third parties may first need to be blacked out

• Ask the counsellor to make factual corrections to your counselling file

• Not have information about you released without your signed consent

• To request a second opinion

• Disagree with any diagnosis you may have received, or disagree with your counsellor’s assessment of your situation

• Have your messages returned or have been provided with information about your counsellor’s policies about between-session contact

• Request information about your progress or planning around your therapy

I wish you all an empowered therapy experience!

When many people hear ‘phone counselling’, they think Skype, FaceTime or other similar teleconferencing options. In my practice, phone counselling means phone counselling – as in ‘old school’ telephone counselling. In order to guarantee privacy and confidentiality, I do not provide counselling via Skype.

Who Benefits Most From Phone Counselling?

Phone counselling can work for a number of situations including:

Small Town Concerns

• You live in a small or remote community with no or limited access to face-to-face counselling
• You live in a small town where you know many people, including the local counsellor
• You live in a small town and value your privacy
• You do not have the money to travel to another community to receive counselling

Depression or Anxiety-Related Concerns

• Face to face contact with a counsellor feels too emotionally intense
• Leaving your home is currently overwhelming, or you worry that you will have a panic attack when you’re out
• Commuting or being in an unfamiliar environment is very stressful

Mobility Concerns

• You have a physical disability which prevents you from travelling to an appointment or attending a face-to-face appointment
• You would not be physically comfortable in an office environment
• You have physical needs that could only be met in your own home

Other Concerns

• You have limited access to childcare and can only spare the time for a phone appointment
• You are a caregiver with limited personal time
• Your work situation will not allow the time it would take to have an appointment and commute to and from that appointment
• The counsellor you have chosen to work with is from another province
• You are moving to another province and would like to continue working with the counsellor whom you have built a trusting relationship with, and who knows you well

Policies

At Willow Tree Counselling, I work with individuals living anywhere within Canada who are interested in pursuing phone counselling with me: British Columbia, Ontario, Quebec, Alberta, Manitoba, Saskatchewan, Nova Scotia, New Brunswick, Newfoundland and Labrador, Prince Edward Island, the Northwest Territories, the Yukon and Nunavut. Counselling is available in English only from my office in Vancouver, within the pacific standard time (PST) zone. As of May 2013, I am providing phone counselling on Tuesday and Wednesday mornings only. I am occasionally able to accommodate Friday mornings as well.

You will not incur long distance charges if you provide me with a valid phone number, which includes a Canadian area code. Rates for phone counselling are the same as my rates for in-person counselling and must be prepaid by PayPal or Interac e-transfer prior to your appointment time. The Fees/Funding page on my website provides the necessary PayPal links to make a payment. If you wish to pay by credit card, card payments can be made via PayPal.

Phone counselling works best with land-lines or with cell phones where there is good reception. Dropped calls, poor voice quality or reception that cuts in and out will obviously have a negative effect on your counselling experience.

Not everyone is a suitable candidate for phone counselling. If you are experiencing suicidal thoughts, psychosis, mania, are actively self-harming or are engaging in other behaviour that compromises your safety, I am not able to provide phone counselling. I am more than willing, however, to assist in directing you to in-person counselling alternatives or crisis services.

If you would like to give phone counselling a try, I welcome you to contact me so we can discuss your situation and needs further.

Introducing Intermittent Therapy

While I utilize a number of therapies in the counselling I do, cognitive behavioural therapy, solution focused therapy and psychodynamic psychotherapy, to name a few, intermittent therapy is often a feature of what I do.  As the title of this article suggests, I’d like to share my thoughts on intermittent therapy, or what I sometimes define as “counselling for the times in your life when you need it, for only as long as you need it.”

The concept of intermittent counselling or psychotherapy is seldom discussed in the academic literature, but a reference to it can be found in one of the oldest social work journals in the US, the Smith College Studies in Social Work, Vol 75, No.2 (2005), defining it as “a sequence of time-limited psychotherapies over an extended period of time” with a focus on quality counselling in the here and now which also includes a vision for the client’s future needs as well.

Counselling is Not An Option for Everyone

Now, not everyone needs counselling intermittently and for some, counselling never appeals as a life option. Some benefit from counselling for a short or sustained period of time and it never comes up again as a need in the future.  Others prefer to see a counsellor once or twice to check-in or seek clarification about a particular issue, and that’s it. This article is intended to speak to those who may benefit from counselling off and on throughout the life cycle, whether that is twice or several times.

Intermittent Therapy Checklist: Is it For You?

Let’s look at some of the characteristics of an intermittent approach to counselling:

• Counselling is Timely – You enter counselling when you are ready to accept help for a particular life situation. You are striking while the iron is hot.
• Counselling is Relevant – The counsellor explores with you what has brought you to therapy and takes your opinion seriously.  If you are there, for example, to talk about the end of a relationship, the therapist listens deeply, maintaining a focus on what you consider relevant.  The therapist may raise issues that you hadn’t thought about before, which help to broaden your view of the situation, but will not consistently pursue this if it does not make sense to you or you feel it is wrong.
• Counselling is Focused – You participate in counselling until the concern(s) that has brought you to therapy has been resolved.  For some people, this may be one or two sessions, and for others, longer-term therapy may be indicated.  At all times, however there needs to be a reason why therapy is continuing: What are your goals? What is the plan for change? Has greater understanding of the situation that brought you to counselling been achieved? Are you working to change unhealthy patterns of behaviour, etc.?
• Counselling is Healthy – I’ve said it before, both to clients and on my website, that counselling can be a healthy and helpful tool for helping us resolve issues which are causing us distress.  Humans are an interdependent beings – we all need help, whether it’s a listening ear, a vote of confidence, or someone to take away our (literal) garbage and recycling every week. Intermittent therapy respects the fact that as we change throughout the lifecycle it is common to be met with challenges which benefit from skilled help.
• Counselling has Continuity – It can be a relief to speak to the same counsellor at various points in time – someone who knows you better and better over time.  One of the hardest counselling-related issues people can face is “having to tell my story over and over to different people.” Rehashing can be hard as it can feel like it’s for the other person’s benefit each time. An intermittent-valuing counsellor also leaves the door open for future contact as counselling is viewed as a healthy option for navigating various junctures in life.
• Counselling is About Connection – Similar to the last point, the connection or ‘therapeutic fit’ between client and therapist is vital.  If it’s not there, why would a client return again?  Connection is also important because when the therapist’s interventions come from that place they are infinitely more meaningful for the client than if a client feels disconnected from the person they’re meeting with.

I’d like to write a little about loneliness, which can be particularly intense during holiday time. I’d also like to make an important distinction: loneliness is not the same as being alone.  Acute loneliness can be felt in a crowded room, unhappy family situation or even in seemingly pleasant situations, such as in the company of close friends.  And, simply the act of being alone can be a loneliness trigger for some.

Understanding Loneliness

Loneliness is sometimes defined as what the Merriam Webster Dictionary describes as feeling “cut off from others: solitary.”

The experience of loneliness is also affected by factors such as:

• A preexisting psychological state such as anxiety, depression or stress
• Loss – grieving the loss of someone who has passed away and whose absence is acutely felt during the holidays
• An unresolved personal situation in one’s life, including unresolved conflicts with family members or friends
• Expectations that one has about the holiday season that are not being met
• Geographical distance from loved ones or one’s home (homesickness)
• Isolative or ‘loner’ lifestyle

Coping With Loneliness

What relieves loneliness?  There is no one-size-fits-all solution, as people’s needs are different; feel free to mix and match the following options to create a strategy that’s right for you.  Of course, you may have other solutions not listed here, that work for you.

• Help Others – Before grimacing at the seeming cliche of it all, I can’t emphasize enough the value that helping others can bring, both to the recipient and yourself.  And this is a strategy that works best when one extends it throughout the year, not just the holiday season.  Some people like to help in ways where they can use specific skills they have such as making quilts for premature babies, while others like to help in ways they’ve never done before, taking them out of their comfort zone, in a manner that challenges and refreshes them.  For those in the Vancouver area, Volunteer Vancouver posts formal volunteer opportunities.  Asking around in your community, or offering help when you see it, such as shoveling an elderly neighbour’s walkway, are options which are just as valuable.
• Make Time for People You Care About – I’m not talking here about the people you feel you should be seeing (and may actually have to see).  Rather, I’m referring to those you would really like and want to get together with. People can be busy over the holidays but with a little planning, or even spontaneity, such get-togethers can happen.  They may even be part of your regular routine, such as a men’s group or a close-knit book club.
• Do What You Want to Do – Allow yourself a day for yourself, or more, if possible.  For some, that day is Christmas Day, when everyone else seems to have something better to do.  You may be alone, or not, so strategies will differ.  Allow yourself the permission to be creative: if knitting for 5 hours and subsisting on a bag of cheesies is your thing, go for it!  Again, barring any other important responsibilities in your life, the emphasis is on what you want to do, not what you think you should do.
• Schedule Something Specific – plan events that you would like to partake in over the holidays, be it a play, craft show or a cookie making party.
• Organize a Group Activity – Take the initiative to organize a get together, be it a dinner, snowshoeing day or anything in between!
• Ask for Support – Talk with close friends, family, a priest or minister, or a counselor (or other helping professional).  Take an inventory beforehand about who is in your corner, so you’re prepared.
• Express Yourself – Release emotions in a meaningful and healthy way: writing/journaling, creating art/crafting and playing music are all examples of this.
• Get together with out-of-towners – a good friend of mine likes to organize a dinner for anyone who can’t visit loved ones over the holidays – people from various parts of the country who live in Vancouver come together for a lovely meal, all with a common bond.

Whatever strategy you choose, the key is to treat yourself compassionately and kindly.  While many good options exist to stretch oneself emotionally in ways that can greatly benefit ourselves and others, this can be a very difficult time of year.

I’m passionate about the importance of finding a counsellor who is right for you.  Making that choice, however can get extra-confusing when we’re trying to decipher what all the letters behind counsellors’ names mean.

I thus present a humble guide to helping you crack the code and better understand a counsellor’s credentials.  I welcome corrections from mental health professionals if  anything is in error.  I also note that in this article I’ll be referring to the most common credentials seen in Vancouver, British Columbia, the city I’m from and where I have my counselling and psychotherapy practice.  This is by no means an exhaustive list.

A Note About Counselling and Psychotherapy

Many people don’t realize that the terms “counsellor”, “therapist” and “psychotherapist” are not regulated in British Columbia.  This means that anyone can refer to themselves this way, even if they have no credentials.  It really is a situation of buyer beware.

The Degree

In most (but not all) cases the first letters you see will refer to the counsellor’s degree.  In many instances the therapist will have a minimum of a master’s degree in counselling psychology or social work with a minority of folks possessing a bachelor’s degree.  Some will have no degree at all, but may (or may not) have a counselling-related diploma.  Psychologists in British Columbia typically have a doctoral degree in psychology.

PhD – Doctor of Philosophy.   As noted, psychologists typcially have a PhD in psychology.  A smaller number of social workers also have PhDs (usually university instructors). Unless they are a registered psychologist, it’s important to ask the counseling professional what their PhD is in as it could vary from Anthropology to Zoology!  Just because it sounds impressive, doesn’t guarantee that their PhD is relevant to what you need.

MSW – Master of Social Work- A master’s program which varies from 1-2 years in duration following the completion of a bachelor’s degree.  MSW students have the option of concentrating their studies in counselling and psychotherapy although not all do.  It’s good to ask!

MA – Master of Arts – This is a common master’s degree for clinical counsellors in Vancouver.  Many have an MA in Counselling Psychology.  Still, it’s important to ask “what is your MA in?”

M.Ed – Master of Education – Some counsellors have chosen to pursue their counselling psychology training in the faculty of education.  Like the MA, this is a very reputable degree.

MC – Master of Counselling, offered by some Canadian and international universities.

BA - Bachelor of Arts. Many counsellors will have a bachelor’s degree but have often pursued Master’s level training following their BA.

BSc. – Bachelor of Science – a smaller number of therapists have pursued a BSc in psychology; such degrees may have more emphasis on science and math coursework.  University programs vary.  Again, it’s good to ask the counsellor what their BSc is in.

A number of community and private colleges also offer diplomas in counselling, usually 1-2 years in duration.

Professional Designations

R.Psych – Registered Psychologist. Psychologists must pass a rigorous examination as well as meeting other educational and procedural requirements. See the BC College of Psychologists for further details.

RSW – Registered Social Worker. A designation available to social workers with Bachelor’s, Master’s and Doctoral degrees in social work, providing they also meet other professional standards. All RSWs are members of the BC College of Social Workers.

RCSW – Registered Clinical Social Worker (In the US, this designation is known as Licensed Clinical Social Worker, or LCSW).  This is a separate class of Registered Social Worker which also requires the social worker to have extensive clinical experience and coursework and to pass a national board exam. RCSWs are also members of the BC College of Social Workers.

RCC - Registered Clinical Counsellor. This is a common counselling designation in BC. Open to practitioners with counselling-related master’s degrees and meeting other clinical standards. RCCs are members of the BC Association of Clinical Counsellors.

CCC – Canadian Certified Counsellor. A Canada-wide designation that counsellors with varied counselling education backgrounds may be eligible for. Its regulatory body also requires the counsellor to meet other professional standards.

RPC – Registered Professional Counsellor. Sometimes described as an experienced-based, rather than a degree-based designation as no specific counselling education is necessarily required, although many of its members may have a diploma in the field, or other counselling credentials. The counsellor meets the RPC requirement according to the number of supervised years in the field, as well as other requirements. Some RPCs are referred to as master practitioners of counselling; this term is not equivalent to a master’s degree.

RMFT – Registered Marriage and Family Therapist.   These therapists have extensive experience and training in couples and family therapy.

Other Questions

What is the difference between counsellors who belong to a college vs. an association?

When your health professional is a member of a college, the college’s mandate is to serve and protect the public interest by regulating the practice of the profession and governing its members.  Colleges also have particular legislation, defining their member’s scope of practice, that members are required to abide by. The mandate of an association is typically to represent the “voice” of a profession.

Which designations will my extended health plan cover?

Some workplace extended health plans will provide coverage for counselling benefits, while others will not.  For those who do, Registered Psychologists are the most commonly covered counselling professionals, while other plans cover Registered Social Workers or Registered Clinical Counsellors (usually not both) and a minority of other credentials.  It’s always very important to check with your HR department which counselling providers you are covered for, as plans differ so widely depending on what your employer has paid for / the plan they have selected.  It is also important to check your yearly maximum so you can decide how many sessions will actually be covered.

Getting the News

As you can imagine, I’ve known about the move for several months; news that started as a rumour and became definitive more recently.  I knew it was for real when I saw the request for redevelopment sign posted on the exterior.

At first, just the mere whisper of a rumour hit me like a ton of bricks.  Many of my current clients will attest to the fact that I was very happy in my cozy little space.  When I heard that I might have to move I was…discombobulated.  I had spent the last three years of my counselling practice here; it was where I started Willow Tree Counselling.  First ‘homes’ have a way of feeling special.

Some Self-Reflection

When I reflected on my feelings–shock, sadness, wistfulness, annoyance, anxiety–I realized that I had created my own little world inside my counselling space, a world where I operated under the (unconscious) assumption that my universe was not subject to change.  I could be happy in my counselling office forevermore.  I came to the understanding that it was not much of a leap between 1271 Howe street and a fairy tale that I had created in my mind.

I thought about all the other situations where I’ve lived my life as if the situation would be permanent and it was a cause for pause: those situations are not actually permanent either, even if I live my life as if they were.

Time to Deal

So, what’s a counsellor to do?  I came up with what seemed to be my only viable option: roll with it.  And this is where my Willow Tree analogy comes in: the willow’s branches flex with the conditions of life and snap when we get rigid about situations.  I decided that if I wanted to minimize my suffering, I had better accept.  There’s nothing I can do about the fact that 1271 Howe Street will be reduced to a pile of rubble sometime in the New Year.  It’s beyond my control.  I then focused what was in my control such as finding an office in Downtown Vancouver and creating a safe, confidential space. And honestly, there were times when I wasn’t too accepting–times like, for example, when I discovered that my venerable blue couch was half an inch too long to fit in my new office and that I had to buy new furniture…fast.  But there is a lesson in the anxiety too: use it to motivate, and roll with it at the same time too.  It’s easy to accept mildly uncomfortable feelings and a greater challenge to accept the ones that ain’t so pretty.  For me, anxiety falls into the latter category.

And, I must continue to accept the little imperfections: going to the washroom door and not remembering the code, figuring out how to make tea efficiently with higher overhead cabinets, etc.  A metaphor for daily life, really.

And none of this diminishes the excitement at being able to invite clients to my new counselling room.  I hope that you will enjoy it as much as I have enjoyed creating the space.

Thank you to all clients: past, present and future.

I can’t count the amount of times I’ve heard people devalue the contribution of listening, be it to a friend, colleague, partner or other family member.  The comment I often hear is “I just wish I could do something.”  My response is, “You are.”

There are a number of definitions of listening available in print or online.  My favourite, from writer Richard Nordquist suggests that listening is “The active process of receiving and responding to spoken (and sometimes unspoken) messages.”

Before getting to the meat and potatoes of how to be a better listener, let’s look at some listening myths and facts.

Myths and Facts

Myth: Listening is a passive endeavour; we are merely blank slates or receptacles for information.

Fact: When we truly listen, we focus on and attempt to comprehend what is being expressed. This is an active process!

Myth: We listen solely with our ears.

Fact: Listening also involves our powers of observation, and in some cases, touch and smell.

Myth: Listening is just about hearing words.

Fact: How words are being expressed is often just as important as the words that are chosen.  Tone of voice is huge, as is body language, eye contact and other forms of non-verbal communication.

Myth: Counsellors, therapists or other helping professionals are the best listeners.

Fact: Counsellors may have had more training, but there is tremendous value when someone important to you truly listens to what you are saying.

Myth: Listening is a time and energy suck.

Fact: Not if you choose your friends wisely. And when you can’t choose other relationships such as family members or co-  workers, it’s important to know your limits.  Adopting healthy emotional boundaries is key!

Myth: Listening diminishes our power in relationships. We never will get our point across.

Fact: We make our point a lot more effectively when we are engaged, when we understand what is being discussed.  Otherwise, we risk coming across as a blowhard.

How to Be a Better Listener

 Do’s:

1. Prioritize understanding over advice.  Offering another the opportunity to express an emotional burden, explain a situation, or speak about something close to their heart is a gift.  Often the value for the other party is in the expression of what is on his or her mind.  Advice is sometimes warranted, especially if requested, but can feel abrupt if it is offered prematurely and/or if one’s understanding of the situation is incomplete.
2. Take care of your own emotional needs.  It’s difficult to listen when one is consumed with one’s own emotional burden or stress.  Come back when you can truly be emotionally present.
3. Set the scene.  Turn off all devices, television, music etc.  No one feels like a priority to you if your attention is elsewhere.
4. Be rested.  Listening is much easier when you are.
5. Time it right.  Choose a time when you’re less likely to be interrupted and are not occupied with something else.  Don’t commit to listening if you are in a hurry or don’t otherwise have the time.
6. Ask questions.  Showing appropriate curiosity can help you to feel more engaged in what is being said and the other person feels like their thoughts and or feelings are valued by you.  Asking clarifying questions also enriches our understanding of what is being expressed.
7. Make the occasional rephrasing comment.  Your feedback, if accurate, shows that you were listening.  For example, “It sounds like you were really bummed out when Mary failed to show at the game.”
8. When your mind wanders off, bring it back.  Repeat as needed. People’s minds can drift off if you’re tired, preoccupied, bored, or for a host of other reasons.  You may need to limit the time you are available to listen.
9. Remember the power of nonverbal communication in conveying listening: eye contact, nodding, an open posture, even “mm-hmm.”

Don’ts:

1. Don’t pretend to listen.  This is a habit some of us get into if we think we can get away with it, such as when we’re on the phone.  We may doodle, surf the Internet, do our nails or text at the same time.  People know when you’re not listening.
2. Avoid platitudes.  Examples include, “I understand,” “If there’s anything I can do…”, “I know exactly how you’re feeling.” Anything that feels like a cliche probably is.
3. Don’t derail the conversation by launching into a soliloquy about yourself or someone else you know.  This can sometimes happen when we over-relate to what someone is saying.  Unfortunately, this can have the unintended effect of making the other feel that what they are saying is not important to you.
4. Avoid playing armchair psychologist.  It’s condescending.
5. Listening when you’re overwhelmed with emotion is next to useless.  Heated arguments are a particularly poor time to try to listen.  Take a break and come back to the conversation when you’re calm.

I’ve long been interested in the potential challenges that health practitioners face in coming for counselling and psychotherapy.  In fact, I recently wrote about my experience being counselled.

It’s rewarding to work with such an insightful, sensitive and reflective group of people. But when you help people for a living, it can be difficult to ask for help.

Themes

While we all come from diverse backgrounds and experiences, there are themes that I’ve noticed which commonly arise when health professionals seek counselling. Many of these issues aren’t distinct, but mix and meld with one another.

Loss of Control – Many of us are accustomed to being “in charge” when it comes to helping clients and patients.  Generally, we are used to assessing health-related situations and providing an appropriate response or intervention. Many of us have specific ways of doing this, particular to our profession and accumulated wisdom.  We may even feel quite comfortable in this.  When we find ourselves in the client’s chair, we may feel uneasy, apprehensive or even discombobulated.

Stigma – There is an idea floating around that we should be able to solve our own problems: we’re professional helpers after all! When we combine this idea with societal beliefs that asking for counselling or therapy is somehow a sign of “weakness,” our own sense of embarrassment or self-reproach can multiply.

Devaluation of Self Care – Caring for ourselves may be the last thing on our list, below the care we give to our family members, friends and clients. There may not seem to be enough time in the day or doing something active to promote wellness may seem like too much energy. Or maybe we’re so caught up in helping others that we forget about ourselves.

Putting Things Into Practice – You might even have written the book on it. It’s more painful to know what you “should” be doing, bringing new meaning to the adage “ignorance is bliss.”  Sometimes we may even feel like a fraud, advising clients to make healthy choices that we can’t make for ourselves.

Confidentiality / Anonymity – You choose a counsellor that you do not know professionally but then wonder whether you could run into them again.  Or you wonder whether a colleague may know your counsellor.  If you’re a counsellor or social worker especially, the world may feel just a little too small.

My Approach

Collaboration – It’s the cornerstone of my therapy practice.  I trust what clients tell me about their reasons for coming for counselling and see it as my role to work with you to find a way through your difficulties.  And your experience as a helper is always factored in.  Shared wisdom can be a powerful thing.

Acknowledge the Process – I don’t pretend everything’s easy peasy, if it’s not.  It can feel pretty awkward for health professionals to be attending counselling, sometimes even more so for counsellors. I like to bring this up and we either continue with this conversation–or not–depending on whether you think it’s relevant.

Needing Counselling is Normal and Healthy – I really feel strongly about this.  I’m a big believer in intermittent therapy, or ‘counselling when you need it.’  If your initial reasons for coming for counselling have been addressed and you feel you’re doing well, I believe you!  And, if you need to come back in the future, for the same or different issue, I welcome you!

Offer Empathy – I’ve been through counselling before and remember the vulnerability that can come with “being a client”.  I’m sensitive to this and if there’s anything that I can do to make you feel more comfortable, please let me know.

Confidentiality – I understand that there is always the possiblity, especially with mental health professionals, that we may run into one another professionally.  I never approach current or former clients in public settings and if you choose to acknowledge me, I keep the conversation brief and non-specific. And I’ll never ask how you are doing (even though inside I’m hoping you’re doing well).

Practicality – I offer a practical approach if you are having trouble moving past theoretical concepts and making meaningful change. I believe that those who achieve most in therapy are working at what we talk about inside the session, outside of the session.  I offer follow-through for those who want this and encouragement for those who want to work at this more independently.   Give me a call or drop me a line if you would like to get started!

Sometimes this takes one session, often more like 6-12, and occasionally this process is a longer-term one.  Ultimately, however, my goal is the same.

So, in other words, firing your therapist is a healthy step at the end of the counselling process and there are times when you may find it necessary to fire your counselor prematurely if you feel the counseling is not helpful.

Know Your Rights

Beware of any counsellor who tells you that the counselling process is indefinite, that you may never get better or that you will always need them in your lives.  You may have even had the unfortunate experience of trying to conclude counselling only to be told that by stopping you were “avoiding your issues” or “sabotaging” your therapy.  Maybe you are avoiding or sabotaging–possibly missing the chance to grow emotionally–but even if this were true, it’s your right and your choice.  It’s my belief that clients have the right to quit counselling at any time, for any reason and yes, by doing so, some issues may remain unaddressed or unresolved.

Talk Strategy

To help you get the most out of your counselling experience, communicate with your therapist about what is important for you to talk about any changes that you would like to make in your life. What are your goals? Put forth any ideas you may have about how to work towards them and get your counsellor’s input too.

Together, come up with a plan on how to get there.  Are there things that you can do outside the sessions to carry on with your therapy and bring it into your life?

Have a discussion with your counsellor about how you will know that progress is being made.  In my practice I use an outcome rating questionnaire which helps to ensure that we are on-track with therapy and that it is leading somewhere.  Other signs of progress include:

• You think about your counselling in between sessions and see connections between topics you’ve discussed in counselling and yourself.
• Your newfound knowledge and self-understanding changes some of the choices you make in your life, big and small.
• The issue(s) that you came to counselling for is feeling resolved, or is being addressed in a meaningful way.
• You forget that you have an upcoming counselling appointment until you receive the reminder from your therapist.
• The general quality of your world is changing: better people, better relationships, better opportunities, better options.  You also see evidence of positive change.
• You feel shocked when you reflect on what your life used to be like and how far you’ve come.
• While you may be nervous about leaving counselling, you are feeling empowered to make changes on your own, or maintain the gains that you’ve made in therapy. You can problem solve bumps along the way.
• You come into a session and you feel like you don’t have anything to say.
• You take ownership for the progress you’ve made.

Saying Goodbye

This can happen for several reasons:

• Dissatisfaction: you are unhappy with your therapist or your therapy experience
• Circumstantial: you or your therapist is moving away, you have gone through a major life transition, or other life circumstances are getting in the way of you being able to attend appointments
• Therapy has been successful: you’re feeling better and your reasons for coming for therapy have been resolved or adequately addressed.

How To Say Goodbye…When You’re Dissatisfied

Most people will cancel their next appointment or fail to show up.  Often a reason is not provided to the therapist.

Clients should not feel obligated to provide a reason to the counsellor, although when you do, several things could potentially occur:

• You have a fruitful discussion which helps you to resolve issues in a meaningful way.  Sometimes this results in you continuing with the counsellor, sometimes not.
• The therapist listens to your feedback and ultimately makes changes in their practice that could benefit future clients.
• You feel relieved to have expressed unresolved concerns.
• Yes, there is the potential that the therapist could become defensive or blame you for your negative experience.  If so, it’s definitely time to find a new counsellor!

If you do not want to return to therapy, please cancel any follow-up appointments you may have.  It wastes the therapist’s time when a client does not show up for a scheduled appointment and prevents other clients from using this time.  Even though I’ve discussed the potential merits of giving the therapist feedback, this is not necessary.  Stating “I need to cancel my next appointment” is enough.  If the therapist asks if you would like to reschedule, “not at this time” is a perfectly acceptable response.  If you fear conflict, use email instead.

How to Say Goodbye…When You’re Happy as a Clam

Whenever possible, it’s great to schedule a final session, even if you’re feeling good to go.  This is beneficial in several ways:

• You and your counsellor review and consolidate your gains; it’s encouraging to see how far you’ve come!
• You have the opportunity to discuss what worked well in your counselling experience, and any aspects of the therapy that weren’t helpful.
• You discuss a plan for the future: specifically how you will stay well and what to do if you hit a snag along the way.

Endings, like beginnings, are very important and are a process that should start as soon as the therapy begins.