Finding a Counselor: Detailed Information

These feelings are understandable, but talking with a counselor does not mean something is wrong with you or that you are a failure. Talking with a counselor shows that you are willing to take care of yourself and find positive ways to respond to challenging situations.

Counseling is a healthy choice for people from any background or experience. When you want to find ways to manage and understand your concerns, counseling can help.

What does counseling mean?

Counseling is a service in which you receive guidance from a knowledgeable and trained person. In most cases, it involves talking with a trained professional. The goal of counseling is to learn how to relieve and manage distress about any concern. Counseling services include the following:

• Individual counseling
  The survivor talks privately, one-on-one with the counselor.
  
• Couples counseling
  Partners talk with a counselor together.
  
• Family counseling
  The entire family talks with the counselor.
  
• Group counseling
  Group of individuals with similar concerns meets together with a trained counselor. Group counseling usually examines life issues in detail. The counselor leads the members and provides guidance.
  
  Group counseling is different from a support group. A support group is also a group of individuals coming together for similar reasons, but they usually focus on one general topic, such as breast cancer. A support group is not always led by a trained counselor. Often, members of the group organize and lead these groups as a way to connect with and learn from others who are managing similar challenges.

Are counseling and therapy the same?

The terms “counseling” and “therapy” are often used to describe the same activity; however, they also have different meanings. Both counseling and therapy involve talking to a trained professional, but counseling is usually aimed at finding solutions to certain immediate problems (for example, learning how to communicate with your health care team). Therapy usually involves a more detailed look at life issues (for example, learning how to find meaning in your cancer experience).

In this document, the terms counselor and counseling are used in a general way to refer to any type of professional counseling or therapy setting. The meeting with the counselor is usually called the “counseling session.”

How do counselors help survivors?

Counselors can help survivors prevent, minimize and respond in healthy ways to the expected and unexpected stresses of survivorship. Counselors don’t solve problems for you. They provide a safe and non-judging environment where you can talk about your concerns. This is often referred to as a “counseling relationship.” The general goal for all counselors is to support and guide you as you discover ways to understand and respond to your concerns. Counselors may use a variety of approaches to help you relieve and manage distress. Below are examples of how a counselor can help you.

Counselors can help you:

• Talk about your concerns regarding cancer survivorship
• Discuss options for solving problems
• Identify action steps you can take
• Talk to your family about cancer survivorship
• Learn communication skills
• Understand your partner’s needs
• Learn about community resources
• Prevent and minimize problems
• Talk about problems that existed before cancer and are now overwhelming in your survivorship

People dealing with cancer often feel they don’t have the time, money, energy or need for counseling. So, preventable problems may develop, and small problems may become bigger. Chronic stress may remain instead of being worked through and let go.

Some survivors may not acknowledge that they could benefit from counseling. They may say, “I’m fine” or, “I don’t need any help.” They may think that seeking assistance means they are losing their independence or control over their lives.

Talking about your concerns, no matter how big or small, helps you work through them. Counseling can help you feel more confident in how you make decisions and live your life.

You don’t have to be in crisis or deeply upset to talk with a counselor. People with normal, daily challenges also benefit from talking about their concerns with a counselor.

When would survivors benefit from talking to a counselor?

As a cancer survivor, you might be experiencing many different emotions and changes in your life. These changes can affect you, your partner, family and friends. Cancer and cancer treatment create unique physical and emotional stresses for individuals and families. Sometimes the full impact is not felt until after treatment has been completed.

You may wonder how you will be able to cope with all of the changes that cancer has brought. In addition to emotional distress, you may have concerns about money, getting back to work, managing your home or managing the late-effects of your treatment. Each survivor’s needs are unique.

You may not always know exactly what you need to talk about. A counselor can help you clarify and prioritize your needs. Sometimes you need someone to help you find an answer to an immediate problem. Sometimes the need is deeper, and longer-term counseling is needed.

Survivors are often referred to support groups by their health care teams. Individual counseling can be useful for those who want support but who are uncomfortable talking in a support group.

Examples of when survivors and their family members can benefit from counseling:

• You need support to cope with your cancer diagnosis
• Sadness, depression or anxiety interfere with your life
• You are having difficulty sleeping or managing symptoms such as pain
• Financial concerns are causing distress
• Relationship changes are causing concern or distress
• You have difficulty making decisions about treatment, work or your home
• You want to help your children understand and adjust to the changes cancer has brought to your family
• You need guidance for emotional or spiritual growth
• You want feedback as you make important decisions
• You need help coping with the uncertainty that cancer brings
• You feel confused about what’s happening or what you can do
• You feel overwhelmed by illness
• You have difficulty interacting with your health care team
• You have difficulty focusing at work
• You want to talk about your concerns with someone who is outside your circle of family and friends
• Longstanding problems unrelated to cancer become overwhelming as you manage your cancer experience
• You want to explore the meaning of your illness

What are the differences between various types of counselors?

Many different professionals offer counseling services. Some of these professionals may refer to themselves as “psychotherapists,” “therapists,” “counselors” or “mental health specialists". The professionals who are trained and licensed in most states to provide mental health/counseling services include:

Some survivors enjoy the support in an on-going relationship with a spiritual leader (such as a rabbi, pastor, priest or other faith-based leader), a relationship that may have begun before the diagnosis. Although some leaders do not have formal counseling licenses, they may be experienced in matters of concern for survivors.

How can survivors know which counselors are right for them?

Talking about your concerns with someone you just met or don’t know very well can be scary. A counselor that is a good “fit” for you will help you through any nervousness. The counselor should also be knowledgeable about and experienced in your areas of concern.

Most effective counselors will suggest meeting with you for a few sessions and then talk with you about how the counseling relationship is working. If you have any doubts or questions about the counseling relationship, you should feel comfortable talking these over with the counselor. If you do not feel comfortable, the counselor may not be a good fit for you, and you may need to find another counselor.

How much does counseling cost?

Counseling can be expensive. It is important to ask about the cost when you speak with your health care team or counselor. Ask if any free or low-cost services are available.

• Many hospitals, clinics and cancer service agencies provide social work and counseling services without a fee because they are considered an important part of the comprehensive services of the cancer program.
• Health insurance policies with mental health coverage usually pay for a set number of sessions with a licensed mental health specialist if the counseling is aimed at a specific problem such as depression or anxiety. The number of covered sessions is determined by the insurance policy and usually ranges from 6 to 20 sessions. Sometimes a co-payment is charged to the patient.
• For a private or group counseling session that is not covered by insurance, out-of-pocket fees range from about $40 to $120 per session, depending on the therapist’s credentials and local rates.
• Some mental health clinics and private counselors offer a “sliding fee scale," meaning you can ask for a reduced fee if you have limited financial resources.
• A few organizations offer limited counseling services for free over the telephone.

What if I don’t like the counselor after counseling begins?

Not every counselor or therapist is a good match. Even if a counselor has expert credentials, his or her personality or counseling approach may not fit your individual needs. Professionals, after all, are people too, with different personalities and views on life.

Consider these questions:

• Are you making progress and getting the help you need?
• Are you comfortable talking about your feelings with your counselor?
• Are you able to tell your counselor when you are uncomfortable or unsure about the counseling relationship?
• Does your counselor respond in a positive manner when you talk about your concerns?

If you don’t think you can talk with the counselor comfortably about your feelings, or if the counselor’s responses to your questions are not helpful, you should probably see a different counselor. You may feel upset and disappointed if you realize that you need to change counselors. But getting the help you need is important, and other counselors are available. Don’t give up on getting the help you need.

Sometimes in a group counseling situation, the counselor may seem to be the right person to help, but the group itself is not a good fit. Talk with the counselor to see if another group or even individual counseling might be more helpful.

Counseling is hard work. Working through problems brings up a lot of emotions and often requires a shift in how you think about the problem. The counselor’s job is to guide you through this process of understanding. As you decide if the counselor is appropriate for you, notice if it’s the topic of discussion that is causing your discomfort or if it’s the counseling relationship that needs to change.

Counseling takes time and hard work, but the benefits are worth it.

This document was produced in collaboration with:
Katherine Walsh-Burke, PhD, MSW
Licensed Independent Clinical Social Worker
Associate Professor, Springfield College