Therapy 101

Your First Counseling Session - Part A

First Things First

If you've never been to therapy, you might be a little curious how it works and whether it's right for you. This two-part article outlines some of the more common questions.

There are many reasons people choose to go to counseling. The way I feel about it, it's like education, it's an investment in yourself. No matter what age you begin there are ways you can benefit. And, like education, the more you commit to the process the better your results.

Educating yourself as you embark upon your first counseling session better prepares you not only for what to expect but how you might be an active participant in your own growth.

How do I decide if I need counseling?

You know, you don't need "symptoms" to go to counseling. In fact, counseling is much more than reducing anxiety or improving your mood. Some people go to learn how to relate better with others, to develop the capacity to initiate and plan more consistently, deal with money issues, or remove barriers to business and/or personal success. As you can see, there are countless reasons for starting your personal counseling.

You go because you want to make more of your life. This is how I approach counseling and why I continue to go and probably will continue to do so for the foreseeable future.

Do I have to have a "nervous breakdown" to go to counseling?

Absolutely not. As I mentioned previously, you can go to counseling to work on creating a more expansive life.

As an aside, having a "nervous breakdown" has a lot of associated meanings. It's actually a lay term that varies in severity from "I'm going to have a total meltdown if I can't find my keys" to the prospect of ending up in a straight jacket in the local psych ward.stressed-smiley.jpg

You may not know that the phrasing "nervous breakdown'" isn't really a psychological term. Instead, in therapists' circles we refer to this condition as 'decompensating'. Generally speaking, it occurs when a person is suddenly unable to cope. They may be crying uncontrollably, feeling shaky all over, or unable to formulate their thoughts. They may very well be experiencing heightened anxiety.


You do not have to have a reason to go to counseling. Neuroscience helps us understand that we might not know why we feel the way we do.

Maybe there's a growing awareness that the way you operate in the world isn't quite working for you. Maybe you notice a joy and a lightness of spirit in others that you rarely experience within yourself. A good therapist will help you feel comfortable as you discover why you've gone into counseling.

Related topic:

If you get the chance, check out the definition of 'dorsal'. It explains the way the nervous system moves into conservation mode when it becomes overloaded. It's like shades of gray - your experience of the world is muted.

If this description fits you, you might consider checking out a body psychotherapist. From my experience, this type of therapist has a better understanding of what a nervous system in dorsal looks like and how to work with it.

Why would I pay someone to talk about my feelings? Wouldn't a friend do?

To understand how counseling is fundamentally different from a friendship, you will need to learn more about how counseling works. That said, here is a brief answer to that question.

This question suggests that personal counseling is a place where you go to vent your feelings or to get some advice. While counseling could indeed include these elements, the dance of attunement going on. Unlike a friend, an effective therapist knows when to pull back and when to push, when the time is right to intervene for effective change. And, it's all about you! There is none of the "give 'n take" typical of most friendships.

With repeated counseling sessions, the non-conscious parts of you -- those outside of awareness -- gradually become more conscious. This type of insight or deep knowing is typically not available in conversations with a friend.

Let me give you an example. I remember a few years ago telling a friend that I wanted to do a web site on making it cool to go to counseling. Telling her was no big deal, an everyday event.

Bringing the same subject up in my personal counseling. Well, let me tell you! I immediately felt awash in fears...thinking, this is too outrageous! I blushed and my activation jumped more than a few notches.

Without becoming aware of these fears, I would not have known that my inner world was secretly holding me back. As you will learn on this site, it is our nonconscious fears that often prevent us from realizing our passion.

How do I find a therapist?

Look for Finding a Therapist in the Choosing a Therapist section.

What types of therapists are there?

You'll find an outline on the types of therapists in  What is a psychotherapist? It's in the section, Choosing a Therapist.

By the way, you might find my movie on the different ways people can get stuck in their therapy. In it, I explain the kinds of tools that are useful for staying on track.

How much does counseling usually cost?

The short answer is that it depends on the type of counselor. Generally speaking the more education a therapist has, the more that they charge. A psychologist usually charges more than a Master's level psychotherapist for instance. And, some therapists also charge more as they become more experienced and can offer more skills in working with their clients.

Check out the article, Paying for Counseling.

Do I need a note from my doctor to get a referral?

In some countries and with some medical insurance plans it is necessary to get a doctor's referral i.e. your counseling can be covered by a third party payer as with an HMO (USA) or an extended health plan (Canada). Ordinarily, if you are willing to pay out of pocket, you can self-refer i.e. you can call up and make an appointment with a therapist in private practice.

If you interested in lasting change you must make a commitment to yourself to to the distance. Unfortunately, most plans cover only a few sessions (6-10) and in some cases they drastically restrict your access to a wider choice of therapists.

I often suggest using your insurance-covered sessions for choosing a therapist for longer-term work. You can learn a lot from meeting with different therapists. Not only do you become familiar with a variety of techniques, you also learn about yourself. Chances are a variety of therapists will bring out different aspects of your personality.

How long is a typical session?

Most therapists work with what is known in the business as a "clinical hour". A clinical hour is shorter than an hour, usually 50 minutes, but it can range between 45 to 60 minutes depending upon the therapist. My guess is that 45 minutes is less common, but I once worked with an EAP where this was standard because the remaining 15 minutes was needed to complete their forms.

Some therapists are open to scheduling longer sessions. I have held longer sessions for out-of-towners for example. Longer sessions are not unusual for couples or family therapy.

Can I expect a free half-hour session?

Some therapists offer this and others don't. While it's natural for you to want to get a sense of someone, especially for personal counseling, choosing a therapist isn't like finding an expert lawyer or accountant. You are developing a relationship with this person and that relationship is essential to the success of your work.

Research indicates that factors related to the therapeutic relationship account for at least 40% of positive client change. Finding someone you feel comfortable with will increase the chances of this happening for you.

As far as I'm concerned (and I know that I am not alone), 30 minutes isn't normally sufficient for making such an important decision. As well, I often wonder if a "free" half hour sets up a devaluation (albeit, largely an unconscious one) of the clinical framework and therapist's time.

What is the difference between short-term and long-term counseling?

There is no clear distinction.

Short term is 'generally speaking' more directed to problem solving and crisis management, i.e., I need to find a home for my ailing mother.

When counseling moves into character change or resolving historical issues, we refer to it as long-term counselling or psychotherapy.

In terms of frequency, some consider short-term as 3 to 4 sessions. However, in therapists' circles, short-term varies depending upon whom you talk to and can range between 12 and 24 sessions. Long-term is frequently longer! smiley-wink.gif

Reviewed by: Dr. Carole Gaato

next-page-ico.gifNext: Counseling - Your First Session - Part B.
What is a psychotherapist?


Need to chat with someone now?
Live therapists available 24/7.

How did you like this page?

Don't lose track! Add to your FAV bookmarks:

Counseling Home  •  Approaches to Counseling  •  Words of Encouragement
What is emotional health?  •  Anxiety Attack  •  Depression Signs
How does the brain work?  •  List of Counseling Theories  •  Carl Rogers Person Centered Approach
Emotional bucket reached it's max? Click here.

kids in counseling

You and 15 others are currently browsing this site.

Now, doesn't be gittin' yer knickers in a knot. Therapy ain't sech a big deal.