Many of us seek counselling in a state of crisis. It’s incredibly common to try everything to self-manage our situation until it becomes obvious that things are no longer personally manageable. Sometimes we’re so distressed and in the thick of it that we lose perspective and can’t even see it for ourselves, which can be frustrating to loved ones in our life.

But when we realize, or someone helps us to realize, that counselling may be the next step, we often want to act on this sense and take a step now. This can mean starting by researching and contacting a counsellor.

Particularly if we’ve never contacted a therapist before, some of us perceive that it’s similar to contacting a crisis hotline and receiving a rapid response. Is this the case? Let’s take a look.

The Initial Call

Getting Help

Similar

• Private counsellors, crisis line workers and crisis centre workers help with a variety of mental heath concerns.
• The initial contact is often made when a person is in crisis.
• The initial contact is often by phone.

Dissimilar

• Most times when contacting a crisis line or centre, the phone will be answered immediately. Alternatively, unless a person chooses to call a counselling centre or group practice that has a full-time receptionist, the potential client may receive the counsellor’s voicemail. This is often because the counsellor will have their phone turned off while in session, is using their phone, or are in a location where picking up the phone would be inappropriate/unprofessional. Also, the counsellor may not be in the office. Most solo counsellors do not have their own receptionist to answer calls or emails.
• Many crisis lines and crisis centres are open and available 24/7. Conversely, many counsellors keep office hours and may not answer messages outside of this time. This is not to shut clients out but rather to create healthy boundaries so that the therapist has adequate rest and life engagement in other areas which promote the wellbeing necessary for them to counsel effectively over the long haul. Like all human beings, therapists also have a variety of responsibilities and commitments outside of the office.
• The essence of contacting a crisis service is that clients receive mental health help quickly, ideally right when they need it. While some private therapists have no waiting list, it could still take a few days to a week to meet with the counsellor. Other private therapists have waiting lists, particularly if they are a solo counsellor who receives numerous requests for counselling. Waiting lists are common for subsidized counselling.

The Helper

Similar

• Counsellors, like crisis line workers are mental health ‘helpers.’

Dissimilar

• Clients will often have researched specific counsellors. When contacting a crisis line or crisis centre, the person who picks up the phone will vary.
• Crisis lines are typically staffed by wonderful volunteers—lay people who have taken extensive training in listening, supportive counselling and directing people to appropriate community resources. I am very proud to mention that this was how I got my start before I became a clinical social worker. Professional counsellors vary in their qualifications, a topic I have written extensively about previously.
• Many therapists also specialize in helping with particular areas such as addictions, depression, assisting with phobias, etc.

The Session Itself

Assessment

Similar

• Both counsellors and crisis line workers are listeners; in order to help effectively, they need to have a detailed sense of what is going on in the client’s situation.

Dissimilar

• Crisis workers are typically more focused on helping understand and intervene with present, pressing issues; therapists will often start with this too, although may also include more longstanding or historical issues in their assessment. Professional counsellors may also have training in specific forms of assessment such as the mental status exam. Such therapists often refer to themselves as “mental health clinicians.”

The Issues

Similar

• As people vary so widely in their life experiences, almost any issue has the potential to prompt crisis. Both counsellors and crisis line volunteers understand that there are a myriad of different reasons for why people seek help, although many counsellors specialize in helping with particular problems or issues.
• Clients may report feeling a sense of relief, or even feel drained, having talked to someone and “gotten it all out.” Conversely, whether it’s a crisis worker or a professional therapist, if the therapeutic fit is not good, clients can leave feeling disappointed, frustrated or even angry.

Dissimilar

• If client and counsellor are working together in an ongoing capacity, they will be working on particular issues over time, session to session. These issues can change and evolve but there is a sense of continuity—almost like chapters in a book—that can happen in a therapy experience. Calls to crisis lines or centres are often for a specific pressing concern. A person may call about the same issue over time but because workers rotate, they may feel like they are telling their story “all over again” each time they call.

Session Length

Differences

• When hiring a counsellor, counsellors will typically offer several timed session options, the most common being “the therapy hour” which is typically 50 minutes of counselling and 10 minutes to include things like serving tea, scheduling and washroom breaks. In contacting a crisis service, contact could be brief or more lengthy, with no time specified for the call; if the centre is busy, however, there may be a time limit communicated to the client.

Contact Over Time

Differences

• While people can and do change counsellors over their lives, if there is a good therapeutic fit, there is the tendency to continue with the same therapist, including intermittently. Crisis service workers are often working or volunteering part time and a client may not be able to talk with the same person every time. 
• When a client is able to talk to the same person over time, there is a greater likelihood that therapeutic rapport with develop over time. Of course, it is understood that sometimes rapport does not improve and could even worsen over time, or that a poor fit can be detected right from session one. However, if things progress in a positive direction, therapeutic trust and connection will deepen as will the counsellor’s knowledge of their client. Unfortunately this scenario is not consistently possible with a crisis service.

Cost

Differences

• The services provided by crisis centres are typically free, while private counselling generally comes at a cost which usually ranges from $100-$200 a session. There are many excellent lower-cost counselling services, including in Vancouver, however waiting lists can be long.

An Important Caveat

And I need to be clear here—yes, there ARE mental health situations which warrant a call to 911, attendance at a local hospital emergency department or a call to a mental health crisis service, such as the Vancouver Access and Assessment Centre at Vancouver General Hospital.

Examples of issues which require immediate attention include:

• Suicidal thoughts, particularly if they are progressing in intensity
• Hearing voices, particularly if they are telling you to hurt yourself or someone else
• Homicidal Thoughts – Thoughts or plans to kill or injure someone else
• Mania or hypomania
• Psychosis –  Loss of contact with reality

This list is not exhaustive. If you are unsure about how urgent your situation is, it is always good to check in first with a mental health professional, a family doctor/walk-in clinic or your local emergency department. Another alternative for urgent (not emergency) response is your employee assistance program, if you have an employer that provides this service as part of a benefits package.

Conclusion

It is normal to want help when you need it and it’s beautiful when counselling can be available in a timely manner. There are differences between crisis response and counselling: if the need is urgent, a call to a crisis line or centre is often a good first step.