First counselling session - What to expect

What to expect from your first counselling session

Counselling (and psychotherapy) is a process of healing; a place where one can uncover various layers of a problem in the presence of a non-judgmental and qualified professional. Contrary to stereotype, counselling is not the same as getting advice (though most often people do find solutions to their problems when in counselling). It helps people to gain clarity about their issues and to identify potential solutions for the same.

There is a lot of ambiguity and apprehension among people when going for a counselling session for the first time. The main reason for this is lack of adequate information from reliable sources about the topic. To put your mind to rest, here is a quick guide about what to expect from your first counselling session.

In the initial session, a counsellor will typically will divide her time between the following activities:

a) Explaining how counselling works and setting ground rules

b) Understanding the client’s area of concern and background information

c) Agreeing on a set of goals

Even though part (b) takes up most of the session time, (a) and (c) are equally important, and should not be overlooked. They shape the relationship between the counsellor and client, and decide the future course of action. 

A counselling session lasts for 50-60 minutes (there might be instances when the duration would be longer, e.g. during a couples counselling session). During the initial 10-15 minutes, the counsellor will work towards making you comfortable and form a good rapport with you. She will give you a brief explanation of how counselling works or her own working style. You can use this time to ask any questions you might have about their qualifications or experience. You have every right to make an informed choice about your counsellor, so don't hesitate to ask. A counsellor is ethically bound to address any doubts you might be facing about the counselling process. 

This is also the time when the ground-rules or “contract” is discussed. This includes an assurance of confidentiality. It can also include agreeing upon the duration and frequency of sessions, session fees, terms for cancellation or rescheduling and other logistics. Some counsellors ask their clients to fill out basic information forms before the first session, while others prefer to take down this information during the first meeting. This includes information such as your age, marital status, and contact details. Depending on your area of concern, the counsellor may ask you to fill out some forms or assessments. 

Once the paperwork is out of the way, you will be asked to share the reason or concern that brings you to counselling. During this phase, your counsellor will encourage you to share your problem without inhibition. Sometimes you may not have the words to express a particular feeling or experience. Your counsellor will help you articulate these difficult emotions. She might ask you some questions to gain clarity about your situation, but will always maintain a warm, non-judgmental attitude. You have the choice of refusing to answer any questions if you feel uncomfortable doing so. 

Understanding your concern may require the counsellor to gain some information about your family, past relationships and significant life events. It may also involve sharing information about areas of your life that you have never talked about with anyone. Be mindful of the feelings that come up during the conversation. If you start to feel too uncomfortable or overwhelmed, share this with your counsellor. Remember, openness and honesty is essential for counselling to succeed. So make sure that you bring up any difficulty you might be facing in talking about various things. Avoiding or ignoring these will hamper your progress in counselling. 

When one begins to talk about emotional issues, it is quite easy to lose track of time. However, a counsellor needs to maintain time boundaries and will ideally remind you 10 minutes before the session time ends. This is essential for ensuring that the session does not end abruptly. It also leaves the counsellor with some time for summarising all that you have shared with her, and ensuring that you have been understood. 

Towards the end of the first session, your counsellor will summarise the key issues you are facing at the moment and arrive at a mutually agreed set of goals which you will work towards during the counselling process. These goals will be based on your narrative, and are not rigid or fixed. You and your counsellor can revise them at any point during counselling. 

Before the session ends, both of you would have ideally agreed on an appointment for the next session. Depending on your concern and their style of practice, the counsellor may suggest some tasks for you to undertake in the interim period till you meet again. 

Most people expect to leave the counsellor’s office with a sense of relief or accomplishment, however this is less common than believed. Don’t beat yourself up if you feel uneasy or stirred up. Counselling, like any change, needs time. Feeling unsettled and disturbed are natural responses to bringing up uncomfortable aspects of your life. This is also a sign that you are moving towards change and betterment. It is in your best interest to not get too overwhelmed by the negative feelings and discuss the discomfort with your counsellor in your next session with her. 

Impact of client & counsellor culture on the therapeutic process

I have had the privilege of getting my counselling training in a country whose culture is very different from the one I grew up with. It was only when I interacted with people from diverse cultures and backgrounds that I realised the impact culture has on everything we do and think. As long as you are confined to people and places belonging to your ‘home culture’, you tend to assume cultural norms as facts. For example, putting the family or community before oneself is an integral part of a collectivist culture like India. However, assuming that this is the right thing to do for all people is an error. Similarly, a commonly held belief in predominantly white western cultures is that talking about one’s feelings makes one feel better. This again, is a cultural norm and not a universal truth, some cultures place greater value on being able to keep one’s feelings to oneself.

A counsellor needs to be sensitive to minute cultural details such as these. Recent research has focused on the need for cultural competencies as one of the core skills required in counsellors. This does not imply that a counsellor should know everything about every culture, but means that she should not base her interventions and practice on assumptions. As a practitioner of person-centred approach to counselling, I believe that the client is the expert on her life and I try not to make any assumptions about her on the basis of culture, gender or any other group that they belong to. This encourages me to be inquisitive about their life situation and ask clarifying questions whenever needed.

Social psychology research indicates that people generally prefer to associate with persons who they perceive to be similar. This similarity could be on the basis of appearance, worldview or affiliation to a group or culture. The obvious implication of these findings to the field of counselling is that clients would tend to prefer therapists who are from the same ethnicity as them. However, a meta-analysis by Cabral & Smith (2011) reports that despite client preference for counsellors from same background, ethnic matching does not improve therapeutic outcomes.

Reflecting on my prior experience with clients from diverse backgrounds, I think that positive change in a person depends a lot on the therapeutic relationship that develops between the client and the counsellor, and not on how similar they are. Considering the social psychology findings I mentioned earlier, it is natural for clients to want to work with counsellors from similar ethnicity. However, the presumption of similarity on the basis of cultural affiliations can lead to disappointment. For example, despite sharing the same nationality or ethnicity, the counsellor may be very different from the client, and vice versa.

A benefit of working therapeutically with a counsellor from a different country or community is that the counsellor can maintain an open stance of ‘not knowing’, thereby giving the client complete authority to narrate their situation with minimum risk for bias. Differences can promote insight – your counsellor may be able to suggest to you things you overlooked because of your conditioned beliefs. The most important thing is that a counsellor treats you with respect, and does not make stereotypical assumptions about you.

Seeking help..a sign of weakness or a mark of strength?

Many of my counselling clients, apart from the issues they are struggling with, have an additional difficulty: they beat themselves up for 'needing' counselling. A lot of people grapple with the guilt of not being able to 'snap out of it'. Maybe you are familiar with the feeling that you are the only one who can't deal with this problem; maybe at some point you have had the nagging thought, that you are making it worse by overthinking it. This could be worsened by the fact that there is no evident cause for how you are feeling, or that someone else in a similar situation reacted differently, or the people around you don't quite understand what's going on or how to help you.

I want to clarify this to all the people contemplating seeing a counsellor, and those who are thinking of dropping out of counselling - the fact that you decided to seek help is a mark of great strength. I am not just saying this to encourage you, I really and truly believe it. For any sort of positive change to occur, the basic pre-requisite is accepting that something needs to change or is not going as well as it could.

A lot of people live in denial that there is an issue to be addressed because it is too painful to admit otherwise. Probably you have denied this in the past too (or are still doing it). And you know that the discomfort that you feel while revealing your innermost fears sometimes feels much worse than pretending that everything is ok. Where is this feeling stemming from? Seeking help is a sign that you are accepting that something beyond your capacity is bothering you. It requires you to feel vulnerable. And that definitely is not easy.

When I say that seeking counselling or any sort of professional help is a strong positive in your favour, I mean that it is a first major hurdle crossed. It may not be an easy progress, and it may be something that takes up more time than you first imagined, but I assure you that if you persevere, you will come through it stronger and more fulfilled.

All the best! 

What to expect out of counselling

Your reason for going to a counsellor or contemplating going to a counsellor may vary from mild emotional disturbance to unbearable distress. Though the degree or nature of your problem may not be comparable to someone else’s, one thing that is common across people who seek counselling is that their situation is interfering with their life in one way or another. For most people, especially in the Indian context, the decision to see a professional for emotional troubles is a big one; often made after a lot of contemplation, and in a lot of cases, covered in a shroud of secrecy. The stigma attached to seeking therapy is a topic for another day. Today, let’s focus on what to expect out of counselling.

• First and foremost, counselling provides you with a warm, safe and confidential setting, where you can explore your concerns in the presence of a non-judgmental, qualified professional. Since this person (your counsellor) is an objective outsider, he/she does not have any personal agenda while understanding what you share. Your perspective is the only one they know.

• Counselling usually happens over a period of weekly sessions. The number of sessions or the period of time required will vary from person to person. It is difficult to give an exact number at the beginning of counselling. I find it a useful practice to schedule a ‘review’ session after 4 or 5 counselling sessions. This gives both the client and the counsellor an opportunity to look at the way things are progressing, and take into account what is working and what isn’t. Depending on the severity of the problem, a more realistic estimate of further sessions required can be made.

• Being open and honest during counselling will lead to clearer understanding of yourself and your context. Counsellors are trained to listen with empathy, but that’s not all they do. They will help you to read between the lines of your own words, giving you a better insight into yourself and the situation you are in.

• The counselling relationship is the cornerstone of any change you wish to see. You can make the most of your counselling experience if you actively engage in the process, rather than passively expecting advice. If there is anything about your counsellor that is bothering you, communicate it openly. A qualified counsellor will be able to consider your feedback in a positive manner and help you understand your misgivings better. Someone who seems rigid or judgmental towards you may not be best suited to address your needs. 

• Most counsellors will work collaboratively with you towards identifying therapy goals. Your counsellor should be able to help you to formulate realistic achievable targets. These goals are open to revision and modification, depending on your progress.

• Many a times, we unknowingly indulge in practices that are detrimental to our own betterment. For instance, a person who has had a string of bad relationships may be unconsciously choosing partners who are abusive, thereby maintaining the pattern. Counselling gives you an opportunity to identify any patterns or recurrent behaviours that may be maintaining the crisis situation. With the help of your counsellor, you can become more aware of your behaviours and learn ways to modify them.

• Counselling also involves some risk. Sometimes, clients experience an emotional upheaval – things that you didn’t think as relevant to your current problem or were not prepared to talk about, might come up. Some painful memories, which you had put away, may resurface. In addition, the changes you are beginning to experience may not be well received by the people in your life. However, these risks can be dealt with if you honestly discuss with your counsellor about how you are feeling. Working through these difficult feelings often leads to considerable personal growth and progress for the client.

• Sometimes, the ‘problems’ we take to counselling may be beyond its scope, or may require the assistance of another professional. For example, through the course of a few sessions a counsellor may suspect that your mood swings may be related to a clinical condition, or that your lack of appetite may need a doctor’s attention. In such a scenario, a counsellor refers the client to psychiatrist or a general physician, as required. There are many instances where a person benefits from continuing psychotherapy in addition to medical aid.

• A structured ending is perhaps the least talked about aspect of counselling. Considering the amount of time and money you invest in counselling, it is natural to want to ‘stop’ once things seem a little better. Many a times people may stop therapy quite suddenly, fearing that if they told the counsellor they wanted to stop, he/she may not ‘allow’ it. This couldn’t be further from the truth. A professional counsellor will never extend therapy beyond the required period of time. Also, as a client, you have complete authority to bring counselling to an end whenever you want to. However, it is in your best interest if you do this in a structured manner rather than quitting abruptly. A planned ending session will give you an opportunity to process your learning and progress and to give you a sense of closure.

If you have any queries or doubts about what to expect from counselling please feel free to contact me on aditikdcounsellor@gmail.com

Coming Out

Here's a link to my article about "coming out" on the Talk it Over website...

http://www.talkitover.in/romantic-relationships/coming-out-acknowledging-your-sexual-orientation-to-others/

Asha is a well-educated, independent young woman of 25. She lives with her parents and younger brother. Around the age of 15, she first discovered that she felt emotionally and sexually attracted to girls. Despite the initial turmoil, she has grown comfortable with her sexual identity and considers it to be a valuable part of herself. She has come out to a few of her friends. However, she hasn’t been able to come out to her parents yet, who she considers strict and conservative. She worries that they will hate her if she tells them that she is gay. But she can’t stand keeping it a secret anymore. Also, there is talk of finding a suitable groom for her.
What would you do if you were in Asha’s place? How would you deal with the situation?

Coming out – what does it mean?

According to the American Psychiatric Association (APA), coming out is the process of acknowledging and accepting one’s own sexual orientation as gay, lesbian or bisexual (LGB). Sexual minorities are not limited to lesbian gay and bisexual. This article however focuses on coming out experiences of individuals who identify themselves as LGB. It also includes the process of disclosing one’s sexual orientation to others. Unlike the stereotypical view, coming out to others is not a one-time thing. It may occur on numerous occasions when a person identifies him/herself as LGB to friends, family and significant others.

Coming out experiences are unique to each individual, and even though it is a challenging process, many people find it to be an empowering and enriching experience. With adequate support, it can prove to be a very positive experience. This article will familiarize you with the basics of coming out, its possible outcomes and how to prepare for them.

What does it feel like?

Coming out to yourself usually (though not always) takes place during adolescence – when you are at a stage of growing awareness regarding sexuality and identity. The process is neither unidirectional nor uniform. Each individual’s coming out experience is unique. However, most often it begins with a sense of being different. It may take weeks, months or even years for individuals to come to terms with this feeling. During this stage, feeling confused, unsure, angry, guilty, and even wanting to punish yourself are normal.

You might find your head crowded with questions such as:

• ‘Is it just a phase?’
• Why am I not attracted to the opposite sex?’
• ‘Am I abnormal?’
• ‘Is this wrong?’
• ‘How will I tell my friends/family?’
• ‘What will they say?’
• ‘Will I be teased/bullied if I tell people I am gay?’

A large part of overcoming the negative thoughts and feelings includes challenging your own homophobic assumptions and dealing with the denial. The difficulty in coming out to yourself is increased when you see stereotypes and prejudices about LGB people all around you. However, once you come to terms with your sexuality, you will feel good about accepting yourself and this will lay the foundation for building a healthy self-concept as well as healthier relationships. During this process, you must ensure that you are not being too hard on yourself. Some people find it useful to read more about other people’s coming out experiences. Others prefer joining online communities and interacting with people who have dealt with similar situations. Talking to a counsellor also proves beneficial when there is a lot of turmoil within you. Being aware of and accessing the available resources is essential.

Why come out?

Considering the discrimination and difficulties faced by LGB people, do you wonder why people come out at all? Wouldn’t life be simpler if you just pretended to be straight? The answer is, no. Even though social circumstances for an LGB person may seem bleak, living a lie is often much more difficult.

Research (LaSala, 2000) suggests that coming out is psychologically healthier than living in the closet. Your reasons for coming out could be varied; you might want support because of the overwhelming feelings or simply because you don’t want to hide it anymore. Whatever your reasons may be, coming out often eventually leads to more honest and stable relationships. Being open about oneself with others makes you better equipped to access social support, which is important for your psychological well-being.

Coming out to your family and friends

Who you tell first and how much you share with them is entirely your decision. Here are a few things to keep in mind while coming out to your loved ones:

• Each person’s family and social circle are different. Hence, there is no one full proof way of coming out. It helps to identify one person in your family or friends circle whom you trust, and share with them. Slowly you can share with the others
• Try to imagine and prepare for the reactions you might get from your parents, siblings or friends
• It is best if you come out when you are in a calm state of mind, and have enough time to say what you have to say. Coming out when you are angry or upset is not a good idea
• Some people find it helpful to mentally rehearse how they will tell their loved ones. You could say that you want to tell them because this is an important part of who you are and you trust that they will accept you for it. You might want to tell them what made you keep it a secret till now. Sharing your fears and apprehensions will help them to see what you are going through
• Be prepared for negative reactions. Some people may be surprisingly supportive and understanding; conversely, they might also show shock, anger or disbelief when you first tell them
• Remember that it took you time to accept your sexual identity. Give them time too. Their first reaction isn’t necessarily their final reaction. Once they have had time to process it, they might be more supportive
• Sometimes people say hurtful things when they are angry. Try not to take these to heart>/li>
• Parents might typically worry about what others will say or think. They might not know much about being LGB. Encourage them to ask you questions and be open in answering them

Many times, people hesitate to come out because they fear discrimination. Some people come out to a select group of people while still others decide to be very open about being LGB. The choice is yours to make. Before coming out, weigh your personal pros and cons. Will your safety be compromised? Will it mean losing more than you are willing to give up? Do you have adequate means to support yourself in case your family decides not to?

The norms of certain families and cultures might make it very difficult for them to accept an LGB person. Do not feel compelled to do anything that does not feel right for you. Consider whether hiding your sexual identity is more or less stressful than being open about it.

Remember, you do not need to be apologetic or ashamed about who you are. Talking to a counsellor in a non-judgmental, safe and professional environment has been helpful for many people grappling with the coming out crisis. You could speak to a counsellor about your thoughts and feelings to gain clarity about what you want to do.

References:

• LaSala (2000) Lesbians, Gay Men, and Their Parents:Family Therapy for the Coming-Out Crisis. Family Process, Vol. 39, No. 1.
• Revel & Riot, Resources, Coming out http://www.revelandriot.com/resources/coming-out/
• American psychiatric association website (2014) LGBT Sexual orientation http://www.psychiatry.org/lgbt-sexual-orientation/
• AVERTing HIV and AIDS (2014) http://www.avert.org/coming-out.htm/
• Stonewall (2014) http://www.stonewall.org.uk/at_home/coming_out/
• FFLAG (2012) How do I tell my parents http://www.fflag.org.uk/images/pdf/parents2012.pdf
• American Psychiatric Association brochure (2008) Answers to Your Questions
  For a Better Understanding of Sexual Orientation & Homosexuality

Boundaries in counselling

In my previous article, I described counselling as "a process of healing, which is defined by certain boundaries". To understand what counselling is, and how it works, it is important to know the meaning of boundaries. Literally speaking, they are limits which are mutually agreed upon, in order to ensure the safety and well-being of both clients and counsellors.

Boundaries are behaviour patterns that are agreed upon between a client and counsellor (for example, beginning each session at a pre-decided time). Such boundaries help to give a structure to the relationship. They ensure the smooth running of the process. Some boundaries are implicit. Such as refraining from a romantic or sexual relationship with a client. Others are discussed with the client and can be negotiated. Laying down and respecting boundaries are core aspects of a successful counselling relationship.

In any counselling setup, it is the responsibility of the counsellor to uphold the safety and well-being of their clients. A lot of times, people come to counselling because there is some sort of chaos or disorder in their lives. In the process of finding meaning in this chaos, it is important to have some sort of structure to hold you up. Boundaries are this support net. In this sense, they have both structural and functional value. Open discussion of expected patterns and behaviours allows you, as a client, to feel a sense of security.

To read more about boundaries click here.

What is counselling?

What is Counselling? (Photo source: Pixabay)

What is counselling? Quite simply, it is a process of healing, which is defined by certain boundaries. Contrary to stereotype, it isn’t a place to get advice (though most often people do find solutions to their problems when in counselling). It is a place to uncover the layers of your problem with the help of a warm, non-judgmental professional. 

The question I face most often is: why do you need a counsellor when you have family and friends you can speak to? Coming from people raised in a culture of close-knit social contact, it’s a pretty valid query. However, it is this very nature of our society that makes counselling – in its real sense – a necessity.

In my understanding, counselling is a relationship, a space that is defined as being safe and confidential, where the boundaries are well defined. Most importantly, the counsellor – being an objective stranger – does not feel pressurised to “fix things” or “make it better”. This might seem like a trivial thing, or even a negative point to some of you. Believe me, it isn’t. I, for one, have been more frustrated about my problems after talking about it than I was before, on more than one occasion. Quite naturally, if I’m miserable, the people who care for me want my misery to end. So instead of just hearing me out…instead of letting me vent, I find them joining in my rant. I empathise with that need to support by joining; I do it myself so often!

Your counsellor is not your friend. He or she is a professional whose job is to facilitate you to find a way through your mess. And in doing so, they extend an unconditional acceptance of you as a person. They may challenge your habits and behaviours, but never doubt the person you are. They believe in your potential to excel, and communicate it too.

I can’t begin to describe how liberating it is to speak your mind without trying to mould it to suit the listener. For me, the most important thing about counselling is this opportunity to say out loud, things you are scared of even saying in your head. It is the first step to finding your way out (or ‘in’…whichever it is that you are looking for)…a pre-requisite to recovery.

Counselling is for everyone. And I don’t mean it in a marketing-sorta-way. Everybody faces emotional turmoil at various times in his or her life. A lot of times, you feel equipped to handle it yourself. There may even be times when you feel too overwhelmed to cope. The latter might require you to experience a longer-term, more intense counselling relationship, but in both instances, counselling will prove to be useful.