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How do you know you're getting counselling?
Seems like an odd question but many people go in for counselling and psychotherapy without knowing what to expect.
If you're new to therapy, then it's important to be able to recognise what constitutes an appropriate and professional service.
Here are some common characteristics. We use the term "counselling" below, but the following is generally true for psychotherapy too.
- There should be a contract between you and the therapist
Counselling or psychotherapy involves an explicit agreement between the counsellor and the client. This means that you must consent to counselling and ought to be aware that the relationship is a counselling one. This may sound obvious but it's not unknown for people to find out after several sessions that the person they are with doesn't consider themselves to be a counsellor or psychotherapist.
Some counsellors prefer to have a verbal agreement with nothing actually in writing between you. In that case it's quite important to make sure that you have understood what's on offer. In general it's better to ask for a contract in writing, because then there is less likely to be any surprises later. Any reputable therapist should be happy to commit to a written form of contract.
The contract ought to cover issues of payment (how much and when payable), where, when and how long to meet for (typically in a specified, private location at a regular time), what the arrangements will be for cancellation and possibly holidays, and what constraints there are on confidentiality.
Typically the confidentiality agreement will have the following limitations:
- the client is not bound to confidentiality about what goes on in sessions.
- the counsellor is bound by confidentiality except for some exceptions, usually:
- if required to break confidentiality by law;
- if the counsellor has reason to believe there is a serious risk of harm to you or others;
- in meetings involving the counsellor and their supervisor (also held confidentially);
- if there are restrictions on confidentiality imposed by the organisation the counsellor works for.
As a client you should be made aware of any limits of confidentiality from the outset.
If a counsellor asks you to keep secret anything that happens between you this should ring alarm bells.
- the client is not bound to confidentiality about what goes on in sessions.
- Counselling is a psychological therapy
Whereas other forms of helping can focus on practical solutions, counselling usually focusses primarily on psychological or emotional needs and problems. So to different extents, depending on their client's situation, the counsellor:
- provides emotional support
- facilitates emotional healing
- facilitates emotional growth
Some forms of counselling, such as Cognitive-Behavioural Therapy, do have a more explicit emphasis on the development of specific skills relevant to coping with the emotional issues at hand. But beyond this, if your counsellor starts to give you practical advice or to suggest other forms of treatment such as those that address physical ailments then they may be moving out of the counselling role into another role.
- Avoids giving advice or guidance
The role of the counsellor is facilitative rather than directive, to encourage client empowerment and autonomy, and to help clients develop their own insight, clarity and self-understanding. (An exception to this is counselling for drugs and alcohol abuse, which may have more directive elements to it, especially in the early stages of recovery.)
A good rule of thumb is that if the counsellor starts giving you advice that they're no better qualified to give than your neighbour would be over the fence, then while they're doing that they're probably not counselling you. And if they charge for the service they're providing then you're not getting what you paid for. But counsellors are as human as their clients and may fall into the trap of doing so occasionally. If happens repeatedly, then think about challenging your counsellor on why they are doing so, or seek advice from a professional body such as BACP in the UK or IACP in Ireland.
- Clearly defined boundaries
Counselling places clearly agreed limits on the scope of the activity, including time and space boundaries (where, when and for how long it takes place), as well as agreed limits of confidentiality. Often this involves a regular slot, perhaps weekly, usually of a fixed duration. A common length of session is fifty minutes, which gives the practitioner time to complete the session and take any notes between hourly clients.
- Based on psychological theory
All types of counselling are based on psychological theories, although different approaches may employ different psychological models, or may make use of them in different ways. Your counsellor should be able to explain their approach and give you some information (or refer you to information) that explains what that means in practice. You can find information on some of the more common ways of working here.
- Based on listening & talking
Unlike medical treatments, counselling is a talking therapy, although sometimes this may be combined with other activities (eg. a play therapist might also use sand and toys to help a child give expression to emotional issues). Counsellors are not qualified to diagnose mental health issues or other health issues and do not prescribe drugs.
- Appropriately trained
Professional counsellors are formally trained in skills and theory so that they can practice safely and to an acceptable standard. Your counsellor should give you information about their professional qualifications if you ask. Counsellors who are registered with recognised professional bodies such as BACP in the UK or IACP in Ireland must have met certain minimum standards of qualification.
- A joint endeavour
Counselling is not passive. It works best when you and the counsellor both to commit to engaging in the process. With some other forms of helping, the helped person may be passive, or even unaware of the helping process. The comic stereotype of the client who comes week after week, year after year and simply talks, Woody Allen-like, without doing any real work to change has a grain of truth in it. Counselling and psychotherapy can be character-transforming experiences, but normally only for those who are motivated to change.
- Abides by a code of ethics and practice
Professional counsellors work to a set of ethical standards, such as the BACP Ethical Framework. People using helping skills in other roles may be bound by ethical codes, but those will relate to the responsibilities of that role (eg. teaching, nursing). Your counsellor may adhere to a different ethical code.
Ask your counsellor which code or codes they follow. It's wise to make sure that you're familiar with their ethical framework and are comfortable with it. For example, an atheist may not be comfortable with a counsellor whose ethical code has an explicitly Christian agenda behind it.
Counsellors who are members of professional bodies are usually subject to their procedures for complaints and sanctions. Check whether this is true of your counsellor. Their relevant professional body will be able to tell you whether there are any past or current complaints outstanding for that person.
- Uses the relationship
In many forms of counselling, the relationship developed between the counsellor and client is part of the process. For example, the experience of being in relationship with a counsellor who listens and responds acceptingly and empathically may help a client to grow in self-esteem and to learn to trust their own judgement. Brief therapy methods sometimes stress this less, but it is there to some extent in most forms of counselling.
The counsellor should be able to form a respectful relationship with you which puts the focus on you and your needs and should only focus explicitly on the relationship in so far as doing so may be helpful to you. The focus in counselling is primarily on the client. Where the counsellor talks about themselves or their private life, it ought to happen only sparingly, and then only where it is likely to be helpful to you.
- Avoids mixing of roles
Counsellors don't normally have contact with clients except in their role as counsellor. Typically this means that you don't know your counsellor before engaging them as such, have contact with them only in their role as counsellor, and don't continue to be in relationship with them once the counselling relationship has ended (unless you re-enter counselling with them). This is to avoid a conflict of interests, although sometimes meeting in other contexts is unavoidable, e.g. in a small community.
In particular, the role of counsellor renders inappropriate and unethical any sexual interaction, sexual intimacy or romantic relationship between themselves and their clients. If you think your counsellor is making sexual overtures towards you, or is suggesting that some form of sexualised intimacy is appropriate to your work together, seek professional advice immediately.
A counsellor might informally use their skills from day-to-day to help friends or family or in another role such as a nurse or teacher, but it is usually unsafe and unethical for a counsellor or psychotherapist to take on someone as a client who they already know from another context.
If someone you already know in another context expresses that they would be happy to be your counsellor, or if your counsellor attempts to extend your relationship past the confines of the therapeutic relationship into the realms of romance, business partnership or friendship (such as by sending you postcards, offering you a business deal, or suggesting you meet casually for coffee) then this should ring alarm bells. In this case you can seek advice from professional bodies such as BACP in the UK or IACP in Ireland.