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3/24/2020

MANAGING MENTAL HEALTH DURING THE CORONA VIRUS PANDEMIC

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At the time this is being written, the governor has issued a stay-at-home order for the entire State of Ohio for the next two weeks. Several other states have already done so and more are following suit. It is a very uncertain and scary time for many if not all of us. Not in recent history can we recall such a global event affecting so many and in such a dramatic fashion. The advent of this novel coronavirus is a very serious situation indeed. This is an event that affects us in every way; physically, financially, socially, emotionally, spiritually, and for some of those at high risk, existentially. The toll it can take on one's mental health is significant.

I would certainly recommend taking all necessary precautions to keep you and your family safe and follow our leader’s recommendations to socially isolate and avoid unnecessary exposure to situations that put you and others at risk. I certainly recommend that you seek additional guidance through the CDC website at https://www.cdc.gov/coronavirus/2019-nCoV/index.html where you will find a whole host of guidance and information to keep you informed and safe.

It is easy to become overwhelmed with anxiety and descend into despair when exposed to the barrage of new stories and social media exclamations related to this pandemic. Yet there are things that you can do to try to manage the anxiety and panic that has affected so many.

Talk about your thoughts and feelings. - It isn’t always easy to share when something is bothering us. It sometimes feels risky to allow our vulnerabilities to be seen by someone else. The truth is that there is a collective vulnerability right now among us all. We are all in the same soup. Yet it can be immensely therapeutic to share and relate to others as well as be understood by those closest to us when we share. In order for this to work, you need to have someone you trust with whom you can talk about and share your personal thoughts and concerns. Start with a close friend or family member who you know will not violate your trust. If you are not comfortable with this, a pastor, minister, or support group are nice alternatives.

Telehealth Services Many counselors and therapists are now offering Telehealth services in lieu of in-person appointments and these are widely being covered by most insurance companies. Some insurance companies are even waiving their cost-sharing fees for their clients on a temporary basis while the pandemic continues Counselors and therapists are very good objective listeners who are trained to not let personal bias interfere with the therapeutic process and can be very helpful in helping you arrive at solutions that you might not have tired when facing a personal problem or dilemma.

Set Limits Set limits on how much news your take in and also where you get your information. If you find yourself voraciously consuming every news story and article on this issue, now might be the time to critically think about finding something else to distract your attention. It might also be worth considering where you are receiving your information and relying on trusted sources rather than opinion columns and the random tweet without much substance. Listen and hear with a critical mind. Setting a firm limit on how much time you spend pursuing the news may also have a dramatic effect on your feelings as well as your mental health. Think of it in these terms; the more you focus on this problem and worry, (and potentially neglect other things in your life), the more it will affect your feelings and emotions, which are the single biggest influence to behavior. We feel what we think and if we spend all our time thinking about catastrophe, our natural fight or flight mechanisms will kick in and we lose focus and the potential to self-regulate. Remember, worry is about the future. The future hasn’t happened yet. So you can think of worry as fiction. It is not what is happening right now.

Meditate & Take a deep breath. Now take another…..and another. Make sure that the breath out is longer than in. Take another breath. Focus on the present moment. What is happening right now? Is there anything that is happening in this exact moment that you can link to the runaway fear and anxiety that you are experiencing? Are you safe and are you well? Are your thoughts about the future or are they here and now?. If you find yourself drifting on worrying thoughts about the future, simply acknowledge this and genly bring yourself back to the here-and-now, if only by focusing on your breath. To quote Seneca, “We suffer more in imagination than reality.”

Maintain your routine as much as possible (even if you don’t need to)
Many of us now find ourselves working from home or even temporarily out of work. As much as possible attempt to maintain a semblance of your normal routine, even if you do not have to. We sometimes find comfort in the familiar and our routine is certainly one of the most familiar things we know. Try to wake up at the same time, engage in the same behaviors and daily tasks that you do, then follow the same patterns that you usually do. The scenery may be different but if you can maintain some balance in routine, this can be reassuring.

Focus more on what you can control (less on what you cannot)
When facing a situation such as the coronavirus that is affecting the entire world, one can easily feel helpless and become victim to despair. A very good antidote to this is to focus on what you can control rather than what you cannot control. If you find yourself at home, focus on what you have been putting off doing around the house. Systematically go room by room and do a thorough spring cleaning. If your work schedule has been greatly diminished or suspended completely, plan for what you were going to do after this pandemic has passed. Shrot or long-term planning in the face of anxiety can be a great antidote to reduce anxiety. Actually,t planning inhibits worry. The opposite is also true and worry can detract from goal directed thinking and behavior. The brain has a capacity of only engaging in one or the other. Try planning and problem-solving instead of worrying.

Accept what you can’t control (including your feelings)
Once you have thoroughly exhausted all the planning and problem-solving that you can do and have exhausted any other ideas about what you can control, the only other thing that you can do is accept what you cannot control. Accept the situation and/or accept your feelings. Telling yourself that you don't want to be afraid is an exercise in futility. Anxiety is like a paradox. The more you don’t want it, the more you will have it. Accepting the anxiety, normalizing it if you will, has the potential for at least reducing some of the fear and panic you experience. Let's face it we are all in the same soup. Being afraid for yourself and your loved ones in the face of this pandemic is entirely normal. You are in good company because most others feel the same way. Accept what is normal.

Healthy distractions
The brain is a funny thing. We do not hold divided attention very well. If you want to continue to focus on the pandemic and continue to voraciously read the plethora of news articles, factoids, and opinion columns on the subject, you will have more than enough fuel to sustain your anxiety for a very long time. However, there are other sources that you might find more desirable for your state of mind and mental health. You may have been putting off those projects in the yard or around the house. Do you need to create a budget, balance the checkbook, organize the closet or junk room? Maybe you and your family can put together an all-in family activity or dinner where everyone gets to contribute and engage. If you are isolated, most video apps are well suited to you connecting with friends and family over long distances. Now is a chance to connect when many of us were “too busy” to do it before now. How creative you can be and coming up with your own ideas to find something meaningful to you is only limited by your imagination.

Practice Gratitude
This is one of my favorites. Feeling and experiencing the negative barrage of thoughts and feelings can be quite heavy sometimes. When I catch myself delving into my darkest thoughts, I do a little exercise. This can be more effective if you write down or verbalize it aloud. Either way begin to contemplate everything that you can possibly think of for which you are grateful in that moment. The more gratitude that you experience the less despair or negative thinking will invade your thoughts. Gratitude is a powerful tool to modify negative thinking and to lift you from anxiety and despair. You can be grateful for family, friends, health, a sunny day, the ability to take a walk outside, the companionship of a favorite pet, for children, for parents, for a well stocked pantry, for a moment of peace and quite, for a good book, a joke; the list is endless.

Get outside and enjoy nature - The stay-at-home order doesn’t restrict you from going outside as long as you are asymptomatic and adhering to social distancing guidelines. Go on a nature hike. Visit a park. When doing so, observe the moment and the elements of nature you experience. Take a moment to recognize the impact it has on your thinking and mood. No, don’t pick up your phone to answer that text or email. It can wait. Unplug and allow Mother Nature, one of the most accessible abundant resources around to work her magic on your disposition and mood. Nature can be energizing, it can be calming, it can be meditative, and it certainly can be therapeutic. Take advantage of all she has to offer.

Stay connected. We are social creatures. Our options to connect with others have been greatly limited due to “stay-at-home” orders and social distancing. Loneliness can make coping with anxiety and even physical illness more difficult. It can be very impactful to one’s mental health. This pandemic will not last forever. In the meantime, we have to find other more creative ways to connect. If we aren’t connected, if we don’t have at least one meaningful relationship that we nurture and work at, we aren’t grounding ourselves, and we can become down and isolated. Isolation can often lead to, or be the result of depression. Now is the time to reach out and connect with friends and family any way you safely can. There are many options in our age of technology. What’s holding you back? Friends and family know us best and can be great sources of support when we need them most. When we are mentally healthy our physical health and fortitude to fight illness and infection is strengthened. It is also OK to seek out new people on social forums on the internet. Just use a critical mind before joining a group that might be more toxic than helpful.

Other things you can do to promote better mental health during a crisis.

Everything in moderation

Healthy eating
Exercise
Sleep
Limit use of or avoid alcohol or other substances

There are certainly many things that you can do besides those listed above to maintain good mental health. If there is something that works for you, please feel free to share and post a comment.

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1/17/2018

Why Change Can Be So Hard

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It is now 2018 and the start of a new year. For many of us, it represents a time to look back on a year of accomplishments and success. It also allows us to reflect on things we wish we could have accomplished yet maybe we fell short in some way.   We may look toward the next 12 months as an opportunity to move past the barriers that prevented us from making the changes we wanted to make in the previous year. This new year will be different, right? This year will be better? You will be better?   Maybe this sounds familiar to you?   Are you contemplating making some changes for yourself in the New Year? Is this how you remember thinking last year, and maybe the year before that? Reflecting back on failed New Year’s resolutions is enough to make the most motivated person give up before they start in their attempts at change.
Change can be very difficult. Resistance to change is very common, even though that person recognizes that change can be very beneficial to them.   It is one reason that as a counselor I tend to not be heavy on advice-giving when with a client. I recognize that for every miraculous and truly spectacular solution I provide to a client (in my humble opinion), I am likely to be met with an equally rational and well-considered problem with any solution that I am able to conjure.    Why? This is largely because people can be strongly resistant to change, even when they see the benefits of change. There are many reasons for this.

Defining the Problem Identifying the problem that requires change is the first step to making a change for yourself. However, if you don’t know what the problem is, or if you falsely identify the change that needs to take place, positive change may be doomed from the start. The overworked, underpaid, heavily drinking husband might think that a six-pack per/day is just what he needs to cope with the stress of everyday life. He might think that, “If my wife would just leave me alone in the evening and stop complaining about my drinking, everything will be fine!” The person that works out aggressively every day for 2 or more hours a day in order to achieve their fitness goals and lose weight may not achieve the goals that they want if they continue to eat ravenously after every workout or when they eat to mask painful feelings.   The mother that knows that yelling at her children is hurting her relationship with them may show some insight into this unhelpful behavior until she begins to justify this behavior by thinking “My children are simply hard-headed and this is the only thing that works.”   She misses the possibility that yelling at them may contribute to resentful feelings they experience that influences oppositional behavior. Sometimes we are not always as insightful about our own behaviors that require change until we hear enough complaints or concerns from friends or loved ones and it eventually sinks in that the problem is within ourselves, not external to us.

Old Habits    The old adage, “Old habits die hard.” is real!     Isaac Newton knew this. “An object in motion tends to stay in motion.”    We are creatures of routine and habit.   It is often hard to break from that routine.   There is a ton of research that shows that in order for a behavior to become a habit, it requires that behavior to be repeated, consistently, generally over a long period of time.   The time it takes for a behavior to become a habit varies widely and is largely dependent upon the behavior.    The more complex the behavior, the longer it takes for the behavior to become routine.   For example, in the book by Jeremy Dean, “Making Habits, Breaking Habits”, it was suggested that if you wanted to routinely drink a glass of water after breakfast every morning, it took approximately 3 weeks. If you wanted to do 50 sit-ups in the morning, this could take up to two months before it becomes a habit. More complex behaviors can take nearly a year before they can become a habit. While old habits are hard to break, it appears that forming new ones can be just as formidable.

Ambivalence   According to Google’s dictionary, ambivalence “is the state of having mixed feelings or contradictory ideas about something or someone.”   I like to think of ambivalence as holding two seemingly opposing ideas in your mind at the same time.    For example, “I want that nice big piece of chocolate cake.” while simultaneously telling yourself that “I know it is not good for me and I really shouldn’t eat it.” Ambivalence is also very prevalent in the world of addiction.   “I want a drink.” vs. “I want to quit drinking.”    In reality, we tend to gravitate toward those behaviors that are harmful to us if we perceive some benefit from them, as long as that benefit is perceived as greater than any cost or consequence we experience from the behavior. It is only when the consequence is perceived to be greater than the benefit of that behavior that we even contemplate change.   Weighing short term consequences against long term benefits of change, (or long term consequences of not changing), can help one push through ambivalence and move toward change.
Fear   This can take the form of lack of confidence in oneself.   “I’m not good enough.” “I don’t have what it takes to make this happen for me.   Negative emotions are powerful motivators, but they often motivate us in the wrong direction. According to one study by McGregor & Elliot, http://journals.sagepub.com/doi/abs/10.1177/0146167204271420   their results, “demonstrated that individuals high in fear of failure reported greater shame upon a perceived failure experience than those low in fear of failure.”    Taken another way, if you have experienced failure in the past, (pretty much all of us), and have a high sense of fear of failure, this can have a dramatic influence in making any further attempts at change.   It would not be difficult to assume that those that have a high fear of failure also experience poor self confidence. “ I’m not good enough.”   “I have little control or influence over what happens to me.” It is my experience that those individuals that struggle with poor self-confidence tend to gravitate toward more negative thoughts and feelings that lead to discounting or ignoring any evidence to the contrary.   Thus the person tends to exhibit thinking fallacies or cognitive distortions. “I always fail.”   “I’m totally worthless” “Nothing good ever happens to me.”   Thoughts influence feelings.   The person that exhibits strong tendencies to think negatively about themselves will experience shame, fear, guilt, and self-loathing.   Those feelings then influence that person’s behavior, and a sense of being helpless to change.   Can you imagine how a person will respond to a desire to change if they experience this kind of negative thinking? Fear to take risks is what prevents us from moving forward. The famous author J. K Rowling once said,   “Failure is so important. We speak about success all the time. It is the ability to resist failure or use failure that often leads to greater success. I've met people who don't want to try for fear of failing.”

Need for Immediate Gratification Let’s face it, we live in a world where results are expected right away.   We seem to be running short on time in our increasingly busy lives; and in our frenzied lives, if we run into obstacles that impede us in our goals, we make a judgment call about whether or not we are wasting our time, and may abandon our attempts.   Other times we may just get impatient, and if it doesn’t work as quickly as we would like, or as easily as we would want, we simply abandon our efforts and cling to a likely irrational belief that “it will never work!” “Why try?”   “No human ever became interesting by not failing. The more you fail and recover and improve, the better you are as a person. Ever meet someone who’s always had everything work out for them with zero struggle? They usually have the depth of a puddle. Or they don’t exist.” - Chris Hardwick

I must be perfect Perfectionistic thinking is another kind of distorted thinking that may prevent someone from achieving their goals. A perfectionist on the one hand can work very hard toward their ambitions.   Yet, for many, this kind of thinking can also contribute to an irrational sense of failure. “If I don’t do it perfectly than I have failed.”   A sense of failure often prevents you from persisting in your attempts at success.   For a perfectionist, there is no “good enough.”    It either has to be perfect or there is no success. Someone once said to me, “Don’t make Perfect the enemy of Good.”   Sometimes Good, is good enough!
Unmet needs & emotional pain In order to solve a problem, work toward change, you must first understand what the problem is before applying the correct solution (or solutions). For many, I find that unmet needs and emotional pain is the crux for their inability to change.   One might tell themselves, “I can’t stop drinking because I’m not strong enough.”   “Alcohol gives me what I need and helps relieve stress/anxiety/pain.”    So often I experience clients in emotional pain, struggling with change because they have experienced so much emotional pain or adversity, that they continue to engage in unwanted behavior because it fills an emotional need, or masks emotional pain.   Often that behavior is a way to avoid a feeling.   “I’m too stressed. I need a cigarette.”   “It's been a rough day, a pint of Mint Chocolate Chip is just what I NEED right now.”    Those that avoid emotional pain by engaging in harmful behaviors don’t lessen their emotional pain, they only prolong and potentially compound it. The often develop unhealthy habits that lead to other consequences, thereby increasing their emotional pain.   While we all have feelings, we are not defined by them. We have feelings however we are not our feelings.    Feelings are fleeting. They come and go.   The first step to managing emotional pain is not to avoid it, but to allow yourself permission to be sad, hurt, angry, frustrated, or unhappy.   Many people, while in the midst of a powerful emotional experience, fail to recognize that “This too shall pass.”   They simply tell themselves that their experience in the moment is intolerable, and they want it gone as quickly as possible, thereby resorting to some vice that numbs their experience, rather than confronting and working through their feelings.   You have the RIGHT to feel.   Give yourself permission to do so, so that change can happen for you.

If you are thinking about making some changes, or have set some New Year’s resolutions this year, I encourage you to read my blog I wrote a couple of years ago, I Challenge you to NOT Make Any New Year’s Resolutions This Year - Success in Achieving Your Goals.

I wish you much success in the new year!

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5/5/2017

How to Find and Choose the Right Counselor for You. Questions to ask when interviewing a new therapist.

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Finding the right counselor or therapist for you can seem like a very difficult and pain-staking task.     There are many considerations one must think about when selecting a counselor. To that end, some of these questions might help a person find the right therapist for them.

Can you describe to me how a typical counseling session would go? What is the process of counseling?    This is typically referred to as “informed consent”.   This, in my opinion, should be a top priority your therapist should discuss with you before entering into any counseling agreement.   This is usually a form your therapist has you read before signing a consent to treat agreement. However, it is also good to have this summarized verbally to you in person as well. In fact, the governing board in Ohio, (Ohio Counselor, Social Worker, & Marriage & Family Therapist Board), makes informed consent a requirement, as stated in the Ohio Administrative Code for Standards of Ethical Practice for counselors.   Informed consent should include, but not be limited to: Potential benefits/risks of counseling.   Fees. What happens in case of emergencies? Confidentiality.   How long does counseling last?   Who decides when counseling is no longer needed?   What if I want to discontinue counseling for now and come back later?

What are your areas of specialty?   An important question to start asking any potential therapist when seeking the right therapist for you.   It is also good to ask how many years of experience or what kinds of training they may have in their professed areas of specialty.    While a therapist’s personality is very important in finding a counselor of “best fit” for you, I’m sure you can agree that you would like to work with someone that is qualified to address the problems or concerns you bring to the therapeutic process.   There are many ways to measure this, including years of experience, areas of formalized training, and quite simply, how much does the therapist you are interviewing seem genuinely interested in you?

What kinds of clients do you most enjoy working with? More important than areas of specialty, you might want to ask your therapist what kinds of people they most enjoy working with, and why?   This might generate a more honest and thought through response.

Describe to me your approach to counseling.    You have a right to know from what theoretical framework your counselor typically works.   Is it psychodynamic - which can potentially mean years of long-term insight oriented therapy, Solution-focused brief therapy - which may mean 6-10 sessions of a very specific focus, Cognitive Behavioral - which explores the relationship between thoughts, feelings, and behavior and seeks to correct potential thinking errors or irrational thoughts, or perhaps a person-centered approach, which largely allows the client wide latitude to choose the agenda, content, course, duration, frequency, and other aspects of the counseling process? If your counselor prefers to answer this question with a response of “I’m eclectic”, be careful.   This can be a catch all phrase from someone who may be less trained to address specific mental health concerns.   While an “eclectic approach” is certainly a valid approach for very experienced counselors, a potential client can respond to a therapist who professes to use this approach by asking, “How would you use an eclectic approach to help me with my problems?”

What is your privacy policy and how do you ensure my privacy is maintained? This is also something that should be discussed in the area of “informed consent” and the limits thereof.   Records should be stored safely and in such a way that would reasonably minimize unauthorized access.   The therapist should also talk to you about exceptions to confidentiality, duty to warn/duty to protect, and obligations of reporting when abuse/neglect/endangerment issues are raised during the counseling session.   When a therapist contacts you, you have a right to request how you are contacted and by what means, either by phone, mail, email, or other electronic means, and the therapist must inform you of the steps they take to ensure your privacy is maintained as much as possible.

What is your cancellation / no-show policy?   Most therapists do not like it when you cancel at the last minute.   Worse yet, if you do not show for an appointment, that is akin to you showing up for work and then not getting paid for it. It is always important to ask this question of any therapist as there are generally fees associated with appointments cancelled less than 24 hours from the scheduled time, or no-shows. These can range from a percentage of the fees to the entire cost of the session.    More important to note is that there are few things that can spoil a therapeutic relationship faster than a person who frequently cancels, reschedules, or fails to show for scheduled appointments, which may result in the therapist refusing to schedule any further appointments and referring you elsewhere.   Cancellation policies can usually be found in Informed Consent.

What are your fees? Do you accept a sliding fee scale?   This is nearly always a question that is asked of me, and if it isn’t, I make it a point to be as transparent as possible, as there should be no surprises in this area when it comes to counseling.   Some therapists may charge higher fees than average as they have developed a niche specialty of their practice.   For these therapists that charge a higher fee, (anything approaching $200/hour or more), you should have similar high expectations as to the quality of services and potential outcome.   Conversely, a therapist that charges a very low fee, ($50 or less), may generate correspondingly low expectations from their clients.    When it comes to quality services, sometimes the old adages of “Buyer beware!”   and “You get what you pay for!” come to mind.   In my experience, most therapists of reasonable experience and quality charge between $90 and $150 /hour.   A therapist should be able to provide you with a complete list of their fees, including in-person and phone time, when appropriate.

Do you accept my insurance?    To be frank, working with insurance companies is becoming more challenging for all types of health care providers. Some insurance companies have been closed to new providers for many years. (You may have also experienced the consequence of this when you call therapists in your insurance network who have long wait times before they can schedule their first appointment.)   Some providers may choose to only work with self-pay clients, largely due to a history of unpaid claims and lots of administrative time spent chasing down those claims. Or, as is becoming more of a reality, contract rates for some insurance companies may not be keeping pace with inflation and expenses required to run a practice.   As a provider, it can be a big headache. As the insured client, it can equally frustrating and you may feel you are stuck in the middle.   Just recently in my area, a very large provider network and hospital discontinued their in-network status with a very large insurance company over a contractual dispute. This is a very big deal and received lots of media attention by the local TV networks. It essentially means that consumers seeking medical attention through this provider network and hospital will be treated as out of network and subject to higher deductibles & co-pays, provided those consumers even have out of network benefits.    Whomever you choose as a therapist, it is an important discussion to have with any provider and how they approach these insurance challenges. If that therapist is not contracted with your insurance company, the conversation should not stop there.   The therapist may be willing to work with you on an out-of-network basis where you may still be able to utilize your insurance.   This is a good option if you are not able to find an in-network provider that can see you in a timely manner.   While insurance is important, it should not be the only factor in choosing a quality therapist, or other health-care provider for that matter.

What specialized training do you have? How many years of experience?    What are your credentials? Training is important. A therapist should at least be able to tell you any specialized formal training or years of experience they may have in a particular area.   It may also be worth asking to what degree do they see themselves as successful in working with a particular kind of problem?    Maybe they can anecdotally talk about a success story or two.   This may give you more insight as to how successful they truly are at working with a particular mental health issue.

How many years have you been providing direct counseling services?    Many therapists can be eclectic in their experience.   While some may have been licensed for 20+ years, maybe they have only provided direct services for a fraction of those years, while the majority of that time was spent in an administrative position.    This is not necessarily a bad thing as they may have been selected to fulfill a supervisory role with other therapists, which speaks to the provider’s expertise being valued as a resource to other therapists.

Have you ever supervised other therapists?    If your therapist has supervised other therapists, this may be indicative of someone who’s expertise is recognized by other providers as of sound quality, and with several years of experience under their belt.   Someone with a supervisory designation to their title, (represented by an “S” that follows their credentials), is recognized by the state as someone who is qualified to supervise therapists in training to become licensed therapists.   While it is only one of many potential indicators of a quality therapist, it is a good one to make note of.

How long are your sessions?    Can you do video or tele-conferencing?   Sessions can range widely from a 30-minute session to a 45, 50, 55, or 60 minute hour. Some therapists offer over the phone sessions.   With the advent of new technology, some therapists also provide virtual counseling through the use of apps such as Skype, or Face Time.   While the convenience of these new technologies cannot be ignored, it also becomes more difficult for a therapist to ensure confidentiality if the counseling session occurs over the world-wide web. Regardless, getting this question out early when interviewing a potential therapist may alleviate misunderstandings and disappointments later as to what you can expect.

How many sessions on average do you see your clients before the end of treatment? How many sessions do you estimate I will need?   Depending on the therapist’s theoretical orientation, this can vary widely.    This can mean as few as 6 sessions for a Solution-Focused Brief Therapy orientation, or many years for a psychodynamic approach.   This is an important question to ask I’m sure you will agree. And while no therapist can accurately predict exactly how long you will need counseling, or how many sessions, they should at least be able to give you a ball-park estimate and then be able to tell you later why it may be longer or shorter than originally thought.

How would I reach you in case of emergencies?   In case of crises, which are likely to occur on occasion, a therapist should be able to tell you how to reach them in case of emergencies, or who to contact if they are unavailable.

How many clients do you typically see in a day or week?    This can be a nice way of knowing if your therapist is seeing too many clients.   On average, if a therapist sees 25 clients in a week, that means an average of 5 clients per day.   That also potentially means an additional 20-30 minutes of writing, documenting, reviewing, and preparing for each client.   If you also consider if that therapist does their own invoicing and administrative overhead, you are quickly into the 40 hours of work range.   A therapist that sees more than 30 clients per week may start to approach burnout, which can lead to “compassion fatigue”.    A therapist that provides services at a greatly discounted rate might find themselves in need of seeing more clients to offset any revenue shortfalls, thereby making them more susceptible to burnout or compassion fatigue, which should be a consideration when you ask a therapist about their fees.   Another direct question to ask any therapist is how they manage compassion fatigue which can provide you insight as to how the therapist takes care of him or herself.

Do you provide spiritual counseling?   Some therapists do utilize spiritual-based methods in their counseling approach.    If you find that you are looking for spiritual guidance to address your counseling needs, this becomes a very important question to ask.    Most faith-based leaders offer some counseling in their areas of expertise.     This becomes an equally important question to ask if you find that a spiritual based approach does not suit your lifestyle.    I’m sure you would agree that a Christian-based counselor may not be reasonably good fit for someone who considers themselves agnostic or atheist, or vice versa.

What are the ages with whom you typically work?    This question seems obvious but is often neglected when interviewing a potential counselor.   You probably would not want a 7 year-old trauma victim to see a counselor who largely works with 20-50 year old adults.

Do you prescribe medications?   Do you see medications as necessary in treating my problems?    Counselors do not prescribe, nor should they recommend medications for any of their clients as they are not trained or qualified to do so.    However, counselors should have reasonable training in the various pharmacological approaches to different mental health concerns and should be able to refer you to a medical doctor or psychiatrist if they believe such a referral would be beneficial to the client.

How do you track progress in treatment?    Treatment planning should occur at the very first meeting you have with your therapist, and goals should be addressed in every session thereafter.   In my experience, my clients generally report greater satisfaction with the counseling process the more specific they can be with their treatment goals.   These treatment goals should be reviewed during each session, and in theory, should frame the content of your sessions, and should match the agenda you bring to each session. During the course of counseling, new issues may arise, and are opportunities to add to or modify your individualized treatment plan.

Are you friends with any of your clients?      In every state in the union, counselors are strictly prohibited to have any other kind of personal relationship with their clients.   In the state of Ohio, there are strict rules for therapists not to enter into any kind of “dual role” relationship with their clients.    This would include “friending” any client in a social media format.

What other things can I be doing to help me with my problems, in addition to counseling? Sometimes a therapist may not be able to schedule you right away to begin helping you with the problem for which you are seeking counseling.    In this case, the therapist might be able to point you to recommended readings, articles, or other ways that you might be able to being addressing your problem even before any formal sessions take place.

Who does most of the talking in session?     How much advice can I expect from you?
There are as many different kinds of therapists as there probably are personalities in the world.    There is research to show that finding a therapist that best fits and complements your personality can have a significant impact on the outcome of the counseling process and your satisfaction with therapy.    Some therapists present a more authoritative, psycho-educational approach that some clients find appealing.   In these sessions, the therapist may do as much, or more of the talking, than the client.    Other therapists take a more person-centered or non-directive approach and largely let the client set the agenda, while the counselor actively listens and asks evocative questions to help guide the session.    There are varying degrees of approaches in between.     Whatever your preference, the more information you can glean from the therapist in an initial over-the-phone consultation, the better informed you can be in making a choice with a positive outcome for yourself. In my experience, clients that perceive an equal partnership in the therapeutic process typically derive greater satisfaction from it.

Under what circumstances do you let a client know that you think counseling is not working for them and how do you do this?    Counseling may not benefit everyone.    If the therapist perceives the client may not be benefiting from counseling, or is simply stuck, it is incumbent on the therapist to inform the client of this and have a meaningful conversation about it.    Many times, this can overcome a therapeutic impasse and help the client move forward in their counseling goals.   At other times, this may lead to a referral to another professional or service where greater expertise or specialty may be needed.

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How to Find and Choose the Right Counselor for You. Questions to ask when interviewing a new therapist.

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