What to expect at your first counseling appointment

Your counseling experience will depend on a lot of different factors. One of the often overlooked factors is how one gets to the office in the first place.

Counselors work in a very wide range of settings. Some have traditional offices similar to doctors’ offices. Others, including this writer, work out of a church buildings. There are even a few who work in public places like the local park. When you schedule the appointment, get specific instructions as to where you are to go and what it looks like. Ask about parking. Get a phone number of the best person to contact if you get lost. If you have the time, ride by in advance of your appointment so you can be familiar with the area. These things will help you to feel relaxed the day of the appointment and this could greatly enhance your counseling experience.

You will want to arrive about 15 minutes early unless your counselor tells you otherwise. This gives you a few minutes to get lost and to find the entrance. Do not be surprised if you are not welcomed when you arrive. Many counselors do not have a receptionist. Counselors often book their clients back-to-back which means the counselor may only be able to greet you five minutes before the session starts. Take those few moments of waiting as an opportunity to relax.

Expect your counselor to greet you similar to how you would be greeted in any other office situation. Counselor attire varies significantly. Most will be in business casual attire. Many will attempt to match the attire of their clients. So if your counselor is dressed in a Hawaiian shirt that does not necessarily mean they do not take their job seriously.

A good counselor is warm and welcoming. If there are multiple people in the waiting room, they will likely only call you by your first name or ask if anyone is waiting for them. This is an effort to maintain your confidentiality.

Counseling offices are generally arranged for the client’s comfort. Your counselor wants you to feel relaxed, so if there is something about the room that is distracting, speak up. Most counselors would be happy to adjust the room temperature or fix a glare.

Counselors frequently spend the first few minutes of the first session on a variety of legal issues. This is important because you will need to understand fully the limitations of confidentiality, the counselor’s abilities, and the financial relationship you are entering. Ask lots of questions and do not move forward if you do not understand. Counselors may use jargon or gloss over important information because they have repeated it so many times.

Confidentiality

Confidentiality is an important part of the counseling process. In general your discussions with the counselor should be kept confidential. Details vary by jurisdiction, but there are a number of exceptions your counselor should review.

· Counselors may break confidentiality if you are suicidal. The counselor has a responsibility to make certain you are safe. If you express a desire to harm yourself, the counselor may take action to keep you alive. This could mean calling the police, a crisis intervention team, or even a family member who could take away your access to a firearm.

· Counselors may break confidentiality if you are threatening to harm someone else. It is typically referred to as “Duty to Warn.” If, for example, you threaten to kill your ex-spouse, the counselor has a duty to let that person know you are a threat. This would allow the person to seek a restraining order or otherwise avoid you. A counselor may also contact law enforcement or a hospital.

· Suspected child or elder abuse or neglect can also result in breaking confidentiality. This can be a particular tricky part of the counseling process. The counselor is bound by the law and by their personal ethics to report mistreatment of vulnerable populations. This typically means a call to Child or Adult Protective Services. Since mistreatment is often subjective, some clients are very surprised when a social worker from the county shows up on their doorstep. Clients also need to keep in mind that counselors may need to report things that happened in the distant past and counselors may not let you know that they are making the call.

· Counselors also break confidentiality with your permission. Most often this happens as part of billing your insurance company. This may also occur if you sign a written consent giving permission for the counselor to discuss issues with courts, schools, employers, family members, and the like. Sharing information can be an important part of approaching problems from a holistic viewpoint. Written consents should be very specific and only for a specific time frame.

The counselor’s credentials, abilities, and limitations

Counselors and other mental health professionals have a wide range of training and experience. In many jurisdictions they are required to inform you as to what qualifies them to be a counselor. Did they obtain a graduate degree? How many years of experience do they have? Counselors need to be clear about what they are qualified to do and what they are not.

Many counselors will fulfill the requirement to inform clients about their background prior to the session in the form of an online bio. If possible, check out your counselor online before you attend your session. This may give insight into their style and help you to feel comfortable trusting them to assist you with your needs.

Financial Obligations

It may seem out of place, but be prepared for the counselor to discuss the financial aspects of counseling before the session actually starts. If you are using insurance benefits, this may include asking for your insurance card and co-pay. If you are paying on an income based sliding scale, you may be asked for your paycheck stub. Hopefully these issues have been discussed when the appointment was made. If not, make certain you are comfortable with the financial arrangements before you are surprised with a large bill.

It is important to note that often the initial session has higher costs that the ongoing sessions. This is due to the overhead associated with starting a file and the extra time it takes for the counselor to complete paperwork.

In an age of litigation, paperwork has become an important part of establishing the formal relationship between counselor and client. Many counselors will review paperwork before your first session begins. Often paperwork is made available before the session via the internet. Remember to bring any paperwork you were asked to complete before the session. Failure to do so may take time away from your session. Other counselors suggest coming a few minutes before the appointment so paperwork can be completed.

Ask questions about what you are signing if you do not understand it. Pay particular attention to financial obligation paperwork. Many counselors charge for missed appointments and these fees are rarely covered by insurance.

The first counseling session is often more like an interview than a traditional therapy appointment. Expect a lot of questions including questions that seem foreign to the reason you came. A counselor will be looking at the whole person. There will certainly be questions about why you came, your emotional experiences, and your family background. Do not be surprised if they also ask about sleeping and eating habits, substance use, medications, religious beliefs, hobbies, career goals, support systems, education, legal history, or favorite movies. While many of these things may seem unrelated to the problem you are most concerned about, they may be important in developing a diagnosis or a course of treatment.

The first appointment should be considered as time of discovery as opposed to a time of healing. It is important for the counselor to have a thorough understanding of problem. If the counselor begin addressing the problem without understanding it, they may provide the wrong type of treatment

Case Study: John is 9 and has been treated for Oppositional Defiant Disorder for one year without much success. The counselor has been working with the child and the parent using the traditional techniques for reducing the symptoms. The counselor makes a referral to a psychologist for testing. The psychologist discovers John’s failure to follow directions is really stemming from an anxiety disorder. He’s disobeying his mother due to fear. The counselor then is able to address the anxiety and John begins making process. If the counselor had discovered the anxiety during the initial session, the course of treatment would have been very different and he may have experienced progress sooner.

All good things must come to an end. Your 45 or 50 minutes have passed. You are in the middle of an in-depth conversation when your counselor advises you that your time has ended. Though most counselors try very hard to wind down a session, often the time flies by and a small alarm clock brings the session to an abrupt end. Your counselor will likely sum up the major points of the session, assign homework or things you are to do before the next session, and schedule the next session. It is important to end on time as the next client needs to be seen on time.

Counselors vary greatly in their style. Many counselors allow clients to vent during the first session. The idea is to create a comfortable environment so that the client can express long held and deeply painful emotions which can be cathartic. Other counselors take a more direct approach. This is particularly true if the first session is part of a required evaluation by a court or other government entity. Counselors may also take this approach if they are focused on developing an accurate diagnosis or determining if an adjunct service such as a group session is appropriate.

Counseling may not look or feel like you imagined. Often our perception of counseling is based on media portrayals. For example, few counselors encourage their clients to lay down on a couch any more, but that is the image most of us have of counseling. Few counselors sit behind a desk with their credentials and diplomas on the wall. Few counselors repeatedly say, “So how did that make you feel?”

It takes a lot of courage to ask for help and follow through on getting it. Counselors bear the grunt of the responsibility for getting clients prepared for their first session, but clients can do a lot to help themselves. By asking a lot of questions and keeping an open mind, the first time client can properly prep for a rewarding and cathartic experience.