As outlined in a previous article, there are many myths surrounding counseling. Some of those myths include ideas like only crazy people go to counseling and counseling doesn’t work and counseling is only for rich people. Once someone moves beyond those myths, there still may be some apprehension about entering counseling. Here are some things you can expect during the first counseling appointment:
1. Information on Confidentiality and Client Rights
During your first visit (possibly even prior to your first visit) the agency or counselor will give each client information about confidentiality and the client’s rights. Much of what occurs in counseling is protected by confidentiality. There are some exceptions, which the counselor will go over (if the client is a minor, if the counselor suspects a child is being abused, if a judge issues a court order for a testimony or records from the counselor). The agency will also provide information about how records are kept, how the client can view the records, what (if any) information is shared with the insurance company or client’s employer (if the client is using the employer’s Employee Assistance Program), and how the client should be treated while receiving counseling services. Once this information is reviewed, the client will be asked to sign a consent form acknowledging that he/she has reviewed and understood the information.
2. Information about the Agency, Counselor, Structure
The counselor will most likely take some time to introduce him-/herself and explain his/her approach to treatment. The counselor may explain about his/her education and any specializations/certification he/she has earned. Information about how each session will be structured (is it an hour or a 50-minute session?) and what is expected of the client (will there be homework in between sessions?) will be explained during this first session as well.
3. Questions about the Client’s Physical Health
There are many psychological symptoms that are connected to or have roots in physical issues. Depression, Bipolar Disorder, Anxiety Disorders, and Schizophrenia (and others) often involve chemical imbalances or genes that run in families. These disorders also have physical symptoms. People with depression or bipolar disorder may experience periods of sleeplessness or sleeping too much. They may also complain of eating too much or having no appetite. People experiencing anxiety disorders often report experiencing periods of heart palpitations, sweating, difficulty breathing, and chest pains. By asking about the client’s physical health history, the counselor can get an idea about the client’s general health and lifestyle and look for signs of particular disorders or problems. The client will be asked about his/her last physical exam, any medication being taken (name and dose and duration), and if the medication is being taken as directed.
4. Questions about Family History
As noted above, some psychological issues have a tendency to run in families. The counselor will ask the client about whether or not any first degree relatives (mom, dad, siblings) have been diagnosed with any mental health issues and what kind of treatment (if any) was sought.
5. Questions about Client’s Symptoms and Treatment History
During the first appointment, the counselor will want to get a good idea of what brought the client in for services and what difficulties the client is experiencing. The counselor will ask numerous questions about the client’s symptoms and complaints. This will help to guide the course of treatment. It is also necessary to determine if a diagnosis should be made, as many insurance companies, as well as Medicaid and Medicare often require a diagnosis in order to pay for services. The counselor will also ask if the client has sought treatment before. If so, the counselor will ask about the previous practitioner, what type of treatment was used, and the outcome of that treatment.
6. Questions about Client’s Coping Skills and Support System
Aside from getting to know the symptoms and treatment history of the client, the counselor will want to explore the client’s skills and support that will help during the change process. Lasting change does not occur in a vacuum and it often requires the help of others. The counselor will investigate what the client has tried on his/her own to get relief from his/her symptoms, what has worked in the past, what hasn’t worked in the past, and whether or not the client has people within his/her support network to help throughout the change process.
7. A Time for Q & A
The counselor should also give the client an opportunity to ask questions about the therapeutic process. The client should be able to ask about what to expect in terms of appointments, how to contact the counselor, how each section will be structured, and anything else that will help make the counseling relationship go smoothly. There are no dumb questions when it comes to your mental health and understanding the therapeutic process. Be sure to ask questions and be honest. That is the only way the counselor can truly help.