Questions and Answers

Q? Should I expect to receive advice from my counsellor

A. The answer lies in both philosophical reasons and practical reasons. Most counsellors believe that simply telling someone what to do is wrong because it would give them a sense of authority over their client that would not be justified or needed. Most adults resent being told what to do, anyway, although this may be different if they are despairing or very anxious. Giving advice would also imply that the counsellor is an expert on how people should live their lives, which is a rather bold claim. Your counsellor is more likely to be an expert on how to reflect on the problems of living, and that is a very different skill.
On a more practical level, the danger in advising people what to do is that if the advice works, the client may feel that he or she should consult the counsellor about everything. If it does not work, the client may blame the counsellor for any consequences. Most counsellors have had to face these situations at least once, when they have unwisely or accidentally strayed into advice-giving.
You may feel that if you are not going to receive any advice there is no point in seeing a counsellor. But there are ways of learning other than being told what to do. The therapy process is generally about thinking things through, and it is much more satisfying to find your own answers through the skilled questions of another person than through following the advice or instructions of that other person. The counsellor will often make suggestions, or mention ways of achieving things, or discuss strategies that he or she knows have worked for other people. But he or she should not actually advise you to do any of those things, even if you are desperate for advice. The counsellor may feel tempted to give you his or her opinion, but it probably would not help. It is your own assessment of your situation that matters most. If your feelings seem completely uncontrollable, and you are finding that a talking treatment is of little help in managing your situation, you are advised to see your GP and ask whether a mental health assessment is needed.

Q? Why does my counsellor say so little

A. Just as it is common to be concerned about something a counsellor says to you, it can also be the case that you feel a little unnerved by what he or she does not say. Often we interpret silence as a sign of discomfort, or think that the person who is looking at us but saying nothing must be thinking unpleasant thoughts about us. But it is frequently the responsibility of the counsellor to be quiet, to try to give you space and let you think through your problems. Sometimes you may not have anything to say either, and this double silence can feel very strange indeed.
We are not really used to silence in Western society. Most of the time we are surrounded by noise, and we may not realise just how much of a distraction this is until we find ourselves in a quiet room with the conversation having stopped. Sometimes this can be a very peaceful experience, and help us to relax. At other times it is intimidating, and we may feel the need to fill the space with the sound of our own voice. This is not always a bad thing, especially for a client who finds it difficult to speak or be heard in other situations such as at home or at work.
A silent counsellor may be reflecting on what you have said, but more often will be offering what is called “active listening”, a deep and welcoming kind of space for you. Not everyone is comfortable with being the centre of attention, but it should be remembered that this time is for you, and it would be wasted if the counsellor's talking gave you no opportunity to express yourself. Long silences do not always happen, but when they do it does not mean that you are failing as a client or that your counsellor is being lazy. Perhaps a few minutes' peace is just what you need.

Q? What if my counsellor trying to convince me of something, that I don't believe is true

A. A counsellor should never try to convince a client of anything. He or she may raise an issue or suggest an interpretation (possibly on several occasions), but if you are sure that it does not apply, he or she should accept that it is probably best left alone. Take the example of someone who drinks alcohol because he or she believes it helps him or her to relax, and does not want to discuss this. This may be one situation in which the refusal to discuss an issue could bring into question the usefulness of continuing with a talking treatment, but even then this can be put to the client in a friendly rather than confrontational way. Bear in mind that discussing something is not the same as agreeing with it. You are entitled to stand your ground, and to tell your counsellor that you do not find something a useful subject to talk about.
Although this is rare, it may sometimes be necessary to point out to a counsellor that his models of working, and/or the questions he asks, do not match your expectations of what would be helpful. The sessions are for your benefit, not for an over-enthusiastic counsellor to talk about the kinds of problems or issue that he or she finds most interesting.

Q? What if my counsellor tells me that we have to talk about issues that I find uncomfortable

A. No counsellor should make you talk about anything that you do not want to talk about. It is unprofessional to make these demands of a client. In fact, the counsellor would find it impossible to force you to discuss things with which you are not comfortable. In this respect, the power to make the necessary decisions lies with you.
However, sometimes a talking treatment will be effective only if you are willing to look at areas of your life that are complicated, painful or which you would rather leave alone. This does not mean that you have to go ahead against your will, but it does mean that you will have to accept the consequences of not discussing whatever the subjects are that you want to avoid. Occasionally this is a major block to progress.
For example, someone with a drink problem will not make many positive changes if he or she is unwilling to discuss alcohol. The possibility that you are missing an opportunity has to be acknowledged whenever you decide to impose these kinds of “no-go areas” on sessions. Sometimes we avoid subjects out of loyalty. Perhaps we do not want to talk about our family because we think that it is wrong to criticise the people we love. On other occasions a trauma may be too distressing to discuss in detail, or even to mention. There are many reasons why it can be easier to stay silent. You may nevertheless find it helpful to discuss the reasons why something is difficult, and you can do this without necessarily discussing the issue itself. A discussion may reassure you that the counsellor is sympathetic and will not judge you. It may be useful just for both of you to know that there are areas that have to be left untouched, because this could be an important “boundary” to agree upon. This may also leave the door open to returning to these subjects later in the therapy, when talking about them may feel less threatening or less uncomfortable.
The counsellor should never try to drag words out of you, and there is no pressure on you to walk into your first session and immediately tell me the story of your life. It may take time to get round to all the things that you want to talk about. Try to keep an open mind on what you may eventually want to discuss, but remember that you are the one in charge.

Q? If I lose my temper, will my counsellor start to dislike me

A. People often worry about the feelings of their counsellor and whether they might be upset or offended by what happens during sessions. Most counselors will attend professional supervision sessions to discuss their clients (in confidence) and to deal with anything that has come up during the course of their work. This means that they are responsible for their own state of mind, and should be able to take care of themselves. This does not mean that counsellors do not have feelings or never have strong reactions to what is said to them. Some may even be keen to tell you how they feel, whereas others will be more reserved. This usually depends on the kind of talking treatment in which they are trained. If you get very deeply in touch with your own emotions during a session, it is possible that you will feel a lot of anger or sadness. It may seem to you that showing these feelings would be “offloading” them on to your counsellor. But there is a clear difference between displaying sadness or anger about an event or a situation in which you find yourself, and acting aggressively or threateningly towards your counsellor. Getting annoyed, raising your voice, or even shouting may be perfectly acceptable if these actions are not meant to scare, to shock or threaten the counsellor.
To some extent this is a cultural issue, because some sections of society are more comfortable with emotional display, and some are less so. Counsellors may have different ideas about how feelings are best expressed, but they should be skilled enough to accept your feelings without judging you. This does not mean you have a licence to attack your counsellor verbally (and certainly not physically), but it does mean that you can expect understanding and compassion about what you say and do when overwhelmed by your emotions.
This may give the impression that big emotional scenes are normal in talking treatments. A more accurate way of looking at it would be to say that they are not at all unusual, and are neither something to be aimed for nor something of which you should be ashamed.

Q? Why do we always end a session just when we are getting somewhere

A. Most kinds of therapy and counselling operate on a timetable. Sessions are booked to last for a specific length of time, and they usually have to end on time so that both client and counsellor can keep to their day's schedule. Occasionally groups have more flexible arrangements, but this is not very common. An individual session is usually an hour in length, but sometimes the talking part of this is only 45 to 50 minutes so that the counsellor can make notes at the end, or prepare for the next client.
This fixed timetabling can be a worry to clients, who may wish the time could be more flexible. What happens if you have reached an important point in a session when your counsellor brings it to a close? The idea that you may have to leave when you are still feeling upset is can be challenging, and it may seem uncaring of the counsellor to expect this. But a skilled counsellor will keep an eye on the clock and should assist clients in managing their sessions safely, by making sure that things are not started unless there is time for them to finish. If you spot your counsellor clock-watching, give him or her the benefit of the doubt. It does not mean that he or she is bored, but instead that he or she is trying to stay conscious of how much more work can be reasonably done in the time allowed.
There is, however, another common problem with time. Many clients realise that they regularly reach a point where some really good things are being achieved, but apparently only within the last few minutes of a session. It can be a major disappointment to have to stop when you are near to taking a big step forward. There are three possibilities as to why this may happen so frequently. First, it may take a lot of time to “warm up” in a session and start to get close to the root of a problem, with the result that this happens only near the end of the hour. Second, it could be argued that subconsciously - in some part of your mind of which you are not aware – you are anxious about the issue at hand and have mixed feelings about getting too close to the truth. This could lead you to avoid raising points until it is too late to discuss them in detail.
The third possibility is that it may simply be that 50 minutes is just not long enough for you to really benefit from a particular kind of talking treatment. Different models of therapy make different demands of people, and you may need more time to work at some therapies than at others.

Q? What limits are there on physical contact between clients and counsellors

A. The first thing to say is that a sexual relationship between a counsellor and a client is expressly forbidden. The codes of conduct of the professional therapy organisations clearly condemn this, and professionals such as doctors, nurses and social workers are likely to lose their jobs if found guilty of this kind of serious offence. (In some circumstances it can even be punishable by a term in prison.) However, few guidelines are used across the board for less intimate kinds of contact Hugs, briefly holding hands, or even a kiss hello and goodbye are not uncommon with some counsellors. The experience of human warmth and affection may be thought to be very helpful, especially for people who are feeling isolated or abandoned. However, these counsellors would certainly be in the minority. Other counsellors and counsellors would see these actions as improper, because they might lead to confusion about the strictly professional nature of the therapeutic relationship.
Another important consideration (sometimes forgotten by those counsellors who like to be more physical) is that not everyone wants to be touched. It can be tempting for a counsellor to see this as a problem in and of itself, but this is a patronising attitude. Some cultures would see such touch as offensive, and many people dislike having their 'body space' invaded. It does not mean that there has to be something wrong with the person who dislikes this kind of intimacy. It may sound very odd to recommend that you ask a counsellor what his or her beliefs are in this matter. But that may be the only way to ensure that you do not find yourself in an awkward situation later on. Following a discussion, your preference should be clear to both parties.

Q? When is it time to stop

A. All talking treatments come to an end. If the decision to stop is not your own, and your experience of therapy has been a good one, this can be a real disappointment and cause a lot of anxiety. Equally, you may be struggling to decide whether to continue or stop because your experience seems to be more negative than positive. Some of the reasons why treatment ends are worth thinking through, because this could help you manage more easily what might be a worrying time.
There is no laboratory test or imaging study (e.g. like a CT or MRI scan) to measure how much progress you have made in therapy. But there is a strong movement away from endless sessions. To put it simply - setting clear goals for your therapy can be helpful in determining when it is time to stop. You might not know what the goals are at first, so it may take a little time to figure out what they are, but try to determine for yourself what exactly you are looking to change in your life, or what problems need to be solved. You could write each of these down. Then when you hit a point where you wonder if it is time to stop the therapy, take a look at these goals, and ask yourself: have they been met? If so, then I would say you have accomplished what you set out to do and therapy is no longer required. If some haven't been met, then it is not yet the right time to finish your therapy.

Q? Should I continue to see someone when it feels painful, I feel as though I'm stuck and getting nowhere

A. Being in therapy is often about challenging yourself, because trying to change your situation and the way that you think about and do things is frequently very difficult indeed. This means that you cannot always expect counselling or therapy to be an easy experience – although neither should you assume that it will definitely be painful or tiring. But if you find it very stressful or depressing, and appear to be receiving no benefits from it, it is reasonable to ask what purpose there is in continuing.
Clearly there could be many reasons why you are struggling. First and foremost, the model of therapy employed may not be suitable for your problems or may clash with your beliefs. Second, it may not be the correct time to be engaging in therapy – you may be just too tired or over-committed right now. Another reason may be that you have reached a natural finishing point, having done as much as you can at present. This does not mean that more progress could not be made later.
The sense of feeling “stuck”, as though you are on the verge of making a big step forward but cannot quite manage it is quite a common one. (This is especially true of people who have been in counselling for a long time.) Sometimes the process feels like putting together a jigsaw, making sense of the past and present with the help of interlocking ideas and experiences; it is easy to feel that a piece is missing, and to torture yourself because you cannot find it. It may help to acknowledge this openly, or even to take a holiday from therapy.
Deciding when to rest or even when to give up on your therapy is not a precise science. It can be very hard to stop doing something that has helped you. But if the experience has become too negative, it makes no sense to put yourself through suffering just for the sake of it. Therapy may be painful, but it does not have to be – the idea of "no pain, no gain" may be popular, but it is often a mistake. If you are gaining nothing from your sessions, consider whether to change the approach, to take a break, or to stop altogether.

Q? My sessions are full of conflict, and I think that this way of working just isn't for me. My counsellor and I seem to be incompatible.

A. There is a difference between realising that talking treatments can be a challenging (even painful) experience, and being willing to put up with almost any kind of frustration or discomfort in your sessions in the hope that it is doing you some good. You may be sticking it out because this counsellor is the only person in your area, and you might be unsure about what other alternatives are available. Whatever the reason for the difficulties is, talk to your counsellor about your doubts. It may be worthwhile sticking with the therapy if you are getting at least some benefits from it, even if it has its bad side.
However, if you have tried to discuss this with your counsellor and it has got you nowhere, or if it seems that you cannot do any more good work with the person right now, consider your other options. A different approach may be best for you, even if you have to wait. There is no reason to keep going with something that is not working.

Q? I have been offered a limited number of sessions, but I realise I need many more

A. A lot of therapy approaches are intended to work only for a fixed number of sessions, because they are based on a clear progression of steps that will take a predictable amount of time. Other approaches run much less to a pattern, and may work best over a long (perhaps a very long) period. But when therapy has been obtained free of charge through the NHS or through the voluntary-sector, it is usual to have a limit placed on the time available because of the pressure of waiting lists. If your model of therapy works according to a fixed number of sessions, this is not a problem. But when the type of therapy used would normally be more open-ended, you may feel that the sessions on offer come to an end just when the process is proving to be useful.
Sometimes it is best to see a limited number of sessions as a preparation for longer work, and a way for you to discover whether therapy helps you, or at least whether this type of therapy helps. On other occasions the limitation may even focus you more determinedly on the difficulties that you are experiencing so that you make sure that your efforts are directed towards the right ends. It is not always helpful to view counselling as always being about 'resolving' long-term problems over many years. Therapy may last a long time, or it may be very brief indeed, depending on what you intend to achieve.
If counseling sessions are due to end at a time that feels “too soon”, discuss this with your counsellor. Occasionally the period of support can be extended, or perhaps there are available alternatives that can be recommended. Having longer therapy is always a possibility, but it helps to think through whether it is needed and what your expectations of continuing with it would be.

Q? Why would a counsellor decide to stop seeing me

A. Sometimes a counsellor will decide that it is best to stop working with you, and this can come as a shock if you believe that you are getting on well. There could be many reasons why this needs to happen. The counsellor may decide that you have a problem about which he or she knows very little, and that it is better to recommend you see someone more skilled in that kind of problem. He or she may feel that his or her particular approach or model does not match your needs or personality. Or he or she may think he or she has given you all the help that he or she usefully can, and that it is time for you to look for a different kind of support.
Any of these situations could make you feel rejected, or even that you are a failure. But in fact knowing when not to continue is a sign of the counsellor's professionalism. If your counsellor decides to stop the therapy, the reasons should be made very clear to you, precisely so that any misunderstandings are avoided.
I will briefly mention transference and countertransference: the feelings that can develop in a client towards the counsellor (transference) and the reciprocal feelings experienced by the counsellor (countertransference). These are sometimes acknowledged and sometimes not. It is possible for a client to feel very dependent on his or her counsellor, maybe unhealthily so. It also happens that a counsellor can start to over-sympathise with a client, or to feel dominated by feelings aroused by work with the client, to the extent that he or she loses his or her balanced view of the person's situation. The counsellor's first move should be to discuss these issues with his or her supervisor so that they may be taken up appropriately and constructively in sessions. However, it may reach the point when feelings in the sessions may be so overwhelming to the client, the counsellor, or both, that ending the therapeutic relationship is for the best. In this instance, the counsellor would be responsible for recommending or handing you over to a colleague.

Q? What if my counsellor leaves and passes me on to someone else

A. As in large organisations staff are always coming and going, and counsellors employed by the NHS or large voluntary-sector projects are no exception. Lone counsellors in private practice also go through changes in their private or professional lives. It can be a shock if one day your counsellor tells you that he/she is moving away, or is going on maternity leave, or is retiring. A client's first reaction can occasionally be that he or she has made this happen by being too demanding. The reality is that it is normal for people to change jobs or move, or take time off work.
If your counsellor works alone in private practice, he or she should still try to find you alternative support or at least make some recommendations about where you can look.
Changing counsellors can be stressful, and because no two people work in exactly the same way, you are bound to make comparisons. Talking through the transition can be helpful, and bringing the new counsellor up to date should assist him or her in offering you what you need. Although a change of counsellor is not the same as stopping therapy altogether, it is a difficult process, and your reactions can show you how important the therapy may have become in your daily life.

Q? What if I run out of money before my problems are resolved

A. When you are paying for your therapy, finding the money can create a double stress. Few of us are so rich that the cost of therapy makes no impact on our finances, but if you are continuing to pay for it that probably means that you are finding the treatment helpful. So you may be anxious not only about continuing to be able to afford it, but also about what would happen if you had to stop your regular sessions.
A change in financial circumstances can sometimes be managed without too many problems. Many counsellors operate a sliding scale of charges and will accept what you can reasonably afford. This means that what you pay can be negotiated and, if necessary, renegotiated. It can also be worthwhile thinking about whether you need to attend so regularly. Maybe fortnightly would do instead of weekly, or once every three weeks instead of every fortnight. Your counsellor is entitled to have an opinion on this as well; he or she may think that once a fortnight is the minimum attendance for you to work on your difficulties, for instance. But it is always worth discussing the issue to see what arrangements can be made. Occasionally counsellors will allow you to pay them later for therapy received now. This can sound like a good idea but may create debts you cannot discharge. There is no simple answer here, but you can ask your counsellor if he or she knows of any alternative sources of support for you.
It is possible to be angry with a counsellor when he or she cannot help you reduce costs, and you may feel your counsellor does not care about you or your situation. But counsellors have bills to pay too, and sometimes genuinely cannot meet a client halfway. You will have to judge what the treatment is worth to you in relation to the money you have available. Sometimes it may be worth making sacrifices, but on other occasions your money could be better spent elsewhere. Sometimes it is actually beneficial to take a total break from therapy for a few months, especially if you have been seeing someone for a long time.