Many years ago, I wondered “how to do counseling”. This included answering some tough questions from clients. I was fortunate to have learned from experienced therapists what was needed to reduce a client’s anxiety, depression, or some other disorder. As students in our doctoral training, we were told not to look behind ourselves for someone else to answer a client’s question. Indeed, he did not mean that we had be experts in everything, but that we had to have command of what we were taught. Therapists frequently rely on the input of peers, supervisors, specialists, and texts for guidance.
Having had the opportunity to learn from many people in a host of settings, I was able to connect the key points that make therapy effective. There are differences in individual, couple, family, and children’s therapy. I will discuss these approaches in future writings. For the integrity of this article, I want to focus on an approach to treating some common disorders that adults bring into counseling. Generally, anxiety, depression, bipolar disorder, impulse control disorders, and inattention are most common. Nevertheless, substance abuse is a significant problem that crosses the desks of all clinicians.
When a client calls for an appointment, the therapist obtains a ‘snapshot’ of the problem. An appointment is made for an assessment. The assessment should include medical, developmental, learning, emotional, intellectual, and emotional domains. The onset of the problem, its symptoms, and severity are clarified. Often times a survey, universally accepted questionnaire, or preliminary testing instrument are used at the time of assessment.
Conceptualization, or understanding of the problem, is shared with the client. Given that the therapist is correct in judgment, a path to solving the problem is shared. This should include how counseling will be provided. Coinciding with this provision, when and how often the sessions will be conducted is discussed. Measures of change, or symptom reduction, are initially identified. Potential closure of counseling is sometimes discussed with the client. This overview often gives direction to the counseling process and is reassuring for clients.
Upon this initial engagement, the therapist articulates a more specific plan to resolving the problem. The therapist should identify exactly how a client experiences his symptoms. A disorder is divided into five categories: physical symptoms and behaviors, personality traits, problem solving style, operational beliefs, and relationship style. Symptoms are identifiable under each category. A ‘configuration’, or connection between categories, is estimated with the client. Education about the causes and treatment of symptoms is provided. Specific symptoms are targeted for reduction, using cognitive and behavioral strategies. These strategies should be equivalent to “Evidenced-Based Practice Guidelines”. These are standards that therapists are taught to help clients overcome symptoms.
Usually clients have other challenges that overlap the presented issue. Problems may include marital difficulties, struggling with children or teens, job loss, financial pressures, illness in other family members, and so on. The therapist must offer “solution-based therapy’ to these problems while helping the client manage the primary identified symptoms concurrently. Psychodynamic therapy is used when long-term and severe life problems exist.
Given that this core of therapy is effective, a seventy-percent reduction in symptom severity is customary, other work is required. Identifying and countering symptom relapse and formulating an aftercare plan is needed. The aftercare plan is like a ‘check-up’. The goal is to maintain the gains from therapy and insure that the client is functioning well.
Although this article is merely a quick glimpse of the counseling process, it is important to note that the counselor’s training and ‘bed-side’ manner are to the client’s liking. Remember, there is a general way to conduct therapy, but it is how therapy is provided that defines it as “a practice of the healing arts”. Like any other healthcare professional, being comfortable with a psychotherapist is extremely important. Each person must trust their instincts with who they share many aspects of their personal life.
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