Expectations in Counseling
Hello there! It’s nice to be back on here after an unplanned break. I wanted to talk about a subject that helps set realistic expectations for counseling and can de-mystify some of the process here. A common thing I hear from clients is “I wish I could see more progress after a few sessions.” A thought I often go back to is something that one of my supervisors often reminds me of – counseling is effective for about 50% of people after 15-20 sessions (APA, 2017) which leaves a lot of room for error! So, what’s that mean for you?
Firstly, there are a ton of variables when it comes to counseling. Many symptom presentations, including those which have traits of substance abuse, trauma, or eating disorders, are often expected to take longer to see progress. This is for a lot of reasons, but the primary reasons that come to mind for me are 1) relapse in substance abuse and disordered eating are often a part of the process (my opinion, not all counselors agree on this); 2) trauma responses are reinforced by avoidance and maladaptive coping & numbing over time, which as a result, can take a long time to unlearn and replace these thoughts and behaviors; 3) it requires a lot of work on the client’s end to be successful in counseling when struggling with the above-named symptoms, especially when compounded with a comorbid (or co-occurring) disorder, such as depression, anxiety, or obsessive compulsive disorder, to name a few; and 4) most importantly, if your basic physiological and emotional needs aren’t met (eating, sleeping, having shelter, being around people who don’t cause you chronic stress), it will be hard to feel like you are able to change when your environment is not changing. Lastly, I see clients give up hope in counseling because their long-term goals aren’t met after a few sessions, yet many short-term goals have been met. Celebrate little victories! Counseling isn’t all or nothing and progress and treatment shouldn’t be viewed that way, in my opinion.
Now, if you’re thinking, ‘what if I can’t afford (or my insurance won’t cover) 20 sessions?’ you’re not alone! The fear of therapy not working keeps a lot of people from reaching out in the first place. That said, we are taught as counselors to utilize lots of treatment modalities, including some which are brief models, meaning they were created to address some of what was described above in a 6-8 session model. These sorts of models are a topic for another day, but the takeaway here is to be honest and open with your counselor. Did you call your insurance company and you know for a fact they will only cover 8 sessions, and you can’t afford to supplement after that? Tell your therapist! This helps us guide treatment from the get-go instead of a surprise come session 7 that we only have one meeting left. Likewise, if you are in it for the long haul and willing to be in therapy for as long as it takes for you to work through past traumas and current maladaptive symptoms, let them know that, too! A lot of clients are nervous to tell their therapist that they can’t afford additional sessions but keeping us in the loop is the best way to get personalized and effective treatment.
Lastly, and above all, if you don’t feel like you’re connecting or clicking with your therapist, I STRONGLY recommend finding a new one. There are likely hundreds of therapists in your area, dozens of which likely take your insurance and/or specialize in what you struggle with. So, don’t settle for someone who you get a bad vibe or feeling from. We work for you!
Thanks for joining!
Disclaimer: This blog is for informational and educational purposes, and is not to be used as a substitute for a therapeutic relationship, individualized mental healthcare, or medical healthcare.