What is it like to have counselling?

Many people are nervous about booking their first counselling session. It can be a big step, and there may be dozens of questions whizzing through your head. It's perfectly normal to feel like this. Every counselling session with every therapist is different, but this article should give you a general idea about what it's like to go for counselling in the UK.

You may be thinking of images from the media. Perhaps a couch, or a very clinical and sterile environment? Neither of these are likely to be the case. Most therapy sessions take place with both the counsellor and client sitting on comfortable chairs in a welcoming room. This may be in a counselling agency, health centre, community centre or even in the therapist's home. It should never be in a public place where other people can see or hear you. Alternatively, many counsellors offer sessions over Skype so you don't even need to leave your home in order to access therapy.

During your first session your counsellor will discuss the contract with you which will form the basis of your therapeutic relationship if you decide to continue. You may agree to work together for a certain number of sessions, or leave it open-ended. In most cases you will probably meet weekly for around one hour at a time. Being on time is really important for both the counsellor and the client. Counsellors are working to set time boundaries so if you're late they will probably still have to finish the session at the expected time, rather than allowing you to run over. It could be that they are seeing another client after you and they can't be late for their next session.

Your counsellor will explain that everything you tell them is confidential with a few exceptions. In most cases these will include serious harm to yourself or another. They're not talking about self-harm here; this means that if you're suicidal or you have plans to go and kill someone then the counsellor can't keep that a secret and will have to get help. Professional bodies require counsellors to have what's known as supervision. This isn't someone watching or a manager standing over you at work. It means that they discuss their cases (without mentioning clients' names) with another experienced counsellor to check that they're working in the best way for you and that they haven't overlooked anything important which could help the counselling process move forward. Lastly, it's possible for a judge to issue a court order demanding that a counsellor testify because the judge believes a defendant has divulged important evidence in a criminal case to their counsellor. It's extremely rare but it does happen. If a counsellor refused to give evidence then they could be found in contempt of court and sent to prison. Everything else is totally confidential. Your counsellor isn't going to tell your family or friends what you've said or discuss their clients with their mates down the pub. If they did then their professional body could kick them out and they wouldn't be working as a counsellor for very long.

The therapeutic relationship is a very boundaried one. It's not a chat and it's not a friendship. Counsellors are not allowed to have friendships or relationships with their clients, and counsellors can't take on friends or family as clients. The focus should be totally on you as the client and the time will be spent working on what you want to discuss. You may know exactly what it is you want to talk about, or you may be feeling generally down or directionless and want your counsellor to help you pin down which issues it would be useful to work on. Counsellors value their clients' autonomy and will provide a supportive, non-judgemental environment in order to help you make decisions for yourself. You are the expert in your own life and what may be the right choice for the counsellor would not necessarily be the right choice for you. Therefore they will never give you advice or tell you what to do. Instead they provide the space for you to talk through situations and options and come to your own conclusions.

Exactly what happens in a counselling session will depend on the form of therapy you have chosen. The focus will usually be on you speaking, but there are lots of different options. You may have heard of art, music or drama therapy. If you have chosen to have counselling which is based on talking, it can still take many different forms. I am training to offer integrative counselling, which means I use the techniques and theories which are most likely to work for you and your problems. Many other counsellors only work with one mode whatever the issue. This may suit some people but not others because we are all different and we all respond to different things in different ways. You can find out about some of the different types of counselling here and here. You can also choose to see a counsellor who specialises in a particular area such as addiction, trauma, bereavement, domestic abuse or couples counselling if you feel that would suit you best. Counsellors cannot diagnose you with a mental health condition or prescribe medication.

An introductory session is a good time to decide whether or not you've made the right choice of counsellor and technique. Some counsellors offer these free or half price, while others charge their usual rate. Studies show that the most important thing in determining whether counselling will be effective is whether you - the client - want to change. If you don't then your counselling will not be effective, whatever type you choose. The second most important thing is your relationship with your counsellor. You need to feel safe revealing things to your counsellor, and to trust that they will respond with empathy and non-judgement. You need to have confidence that they have the right qualifications and experience to help you, and that they work in a way which you feel comfortable with. The counselling relationship will develop over many sessions and it can be difficult to tell in the first session, especially if it's your first experience of counselling. However, if you take an immediate dislike to your counsellor or you find them untrustworthy or unprofessional or don't like the way they conduct the session then you will be able to find another therapist who is a better fit for you.

You may want to see a therapist who has experienced a particular problem first hand so they will understand you. This is a natural assumption, but it's something counsellors are very cautious about. Counselling works on empathy - the counsellor really listens to what you are saying and tries to place themselves in your shoes and understand the world from your point of view. If they have experienced the same problem in their own life then this can block empathy and instead lead to identification. The counsellor will have to work hard to avoid making assumptions based on their own experience, because everyone feels and experiences differently. For example, you may have come to counselling because you're going through a divorce which is causing you a lot of pain. If the counsellor got divorced and saw it as a liberating experience and the best decision they ever made then there is the potential for their own experience to get in the way if it is not carefully handled. It's perfectly possible for someone who has been through the same thing as you to empathise, but it could well be a lot harder than you think.

The reason you have come for counselling will have a big impact on your experience of counselling. Some people want basic support with a life issue and may have six sessions or fewer. Others will have deep trauma to come to terms with and may spend many months or years in therapy. You may spend a lot of your time in tears. You may want to rant. You may want to sit in periods of reflective silence. Others may spend their session logically assessing the way they respond to negative situations and coming up with more positive responses to these. You may go deep into your childhood and discuss events which profoundly affected you. You may spend a lot of time laughing. There is no right or wrong. Whatever your reason for going, your counselling sessions should be demanding - and quite probably uncomfortable. You will be doing a lot of self-examination, and as a non-perfect human being you probably won't like some of what you come across. Your counsellor should hold the space and allow you to undertake this work safely. You will probably do a lot of thinking and reflecting between sessions, and some types of therapy will even introduce homework for you to try out in your own time.

Endings are important in counselling. You will hopefully have built a strong therapeutic relationship with your counsellor, and it can be difficult to let that go. It may be that you are able to agree that you can contact your counsellor to book further sessions if you would like more help in future, or the agency may have a strict limit on the number of sessions available. Your counsellor is likely to discuss the ending with you during your work together, and they should signpost you to other modes of support if you want these.

Ultimately, everyone's experience of counselling is unique. If you think you would benefit then it's well worth spending a bit of time reading the websites of local or Skype counsellors and choosing one who fits with your outlook on life (just make sure you check they are properly qualified). Counsellors are as varied as the rest of humanity!

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See also >> If you want good advice, don't ask a counsellor.