Finding a Counselor

Survivors often face many different emotions and life changes during their cancer experience. Working through these challenges is sometimes easier with the help of a professional counselor. A counselor will listen to you and help you understand your cancer experience and the emotions you are feeling.

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Finding a Counselor: Detailed Information

Survivorship is about taking care of both your physical and emotional health. It's about taking care of the whole person — body, mind and spirit. Some survivors think that because cancer is a physical disease, they don't need help with emotions. So much attention is placed on the physical recovery from cancer and its long-term effects that emotional concerns are often overlooked. Survivors may worry that seeing a counselor means they are weak, mentally ill or a failure at solving their own problems.

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

Finding a Counselor: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

Talk to your family and health care team.

Discuss your needs with your family and health care team. This helps you clarify your needs and decide what kind of counseling is best for you. You may decide that couples or family counseling is the best option.

Choosing the right professional

Look for a counselor who is experienced in survivorship issues. Some counselors may not know about cancer survivors’ special concerns.

Interview a few counselors, if possible, before you choose one. Let the counselor know what you want to talk about and then ask if s/he can help you with those issues.

Interviewing the counselor

• Describe your situation briefly. Be specific and honest about your needs.
• Tell the counselor what you want to accomplish with counseling.
  
  Examples:
  
  • "I want to find ways to talk to my family about my fatigue."
  • "I need help with depression."
  • "My partner and I have not been very close since my treatment ended."
  Ask:
  • Can you help me with this?
• Ask whether individual, couples, family or group counseling would be best for you.
• Ask the counselor to explain his or her professional degrees and training.
• Ask about the counselor's knowledge.
Examples:

• "Do you have experience working with cancer survivorship?"
• "Do you have experience with my particular kind of cancer?"
• If the counselor is not knowledgeable about your areas of concern, ask if s/he can refer you to someone who has this knowledge and experience.
• Ask about the approaches s/he will use to help you. If s/he describes therapy with counseling terms that are unfamiliar to you, ask for explanations.
Example:
• "What approaches would you use to help me?"
• Discuss costs and billing arrangements. Ask if the counselor has a set fee or sliding fee (a reduced fee). Discuss whether your insurance will cover the costs.
• Discuss the counselor’s availability.
Ask:

• "Can you see me right away?"
• "How often do you want to see me?"
• "How many sessions do you think we will have?"

Finding a counselor

• Ask your health care team for recommendations. Many hospitals and clinics include social workers or other mental health specialists as part of their team. They work closely with the other team members and often without an extra fee.
• If your hospital or clinic cannot help you, you may be referred to a private counselor in your community or to a local family service or cancer service agency. Ask for several referrals, if possible, so you can interview the counselors and find one who meets your needs.
• Support groups are also a good place to get referrals for counselors from other survivors.
• Some cancer organizations and counseling associations provide information and referrals over the Internet.
• Look in your telephone book for local counselors.
• See Additional Resources for a list of resources.

The counseling session

• Prepare for your counseling session by writing down what you would like to talk about.
• Be honest with the counselor.
• Be prepared to ask questions or take notes.
• Set goals together.
• If you feel uncomfortable with the counseling experience in any way, tell your counselor. If your discomfort continues, see a different counselor.

It's okay to tell your counselor that you do not think the counseling relationship is working and that you want to find another counselor.

Finding a Counselor: Additional Resources

The resources listed below provide more detailed information and support services to help you with finding a counselor. Please read the Detailed Information and Suggestions document for more information and questions to ask.

Click a resource for more information:

• National Register of Health Service Providers in Psychology
• American Psychosocial Oncology Society (APOS)
• American Association for Marriage and Family Therapy
• American Psychological Association Help Center
• AMC Cancer Information and Counseling Line
• LIVESTRONG SurvivorCare Program

National Register of Health Service Providers in Psychology
www.findapsychologist.org

The National Register of Health Service Providers in Psychology sponsors this free psychologist referral Web site to promote consumer access to more than 12,000 professionally screened psychologists in the United States and Canada. This site also contains frequently asked questions about getting help, web links and resources on behavioral healthcare issues for consumers.

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American Psychosocial Oncology Society (APOS)
www.apos-society.org

The American Psychosocial Oncology Society is dedicated to advancing the science and practice of psychosocial care for people with cancer while striving to ensure that all people with cancer have access to psychosocial services as a part of quality cancer care.  APOS provides mental health care referrals to survivors, caregivers and advocates. You can obtain referrals for local counseling and support services throughout the United States. If no services are available in your community, a professionally trained Helpline staff member will provide crisis counseling over the phone. To access this service, call the toll-free number. If you leave a message after hours, include your name, phone number, survivor's cancer diagnosis and survivor's city and state of residence. You should receive a call from an APOS member within two business days. The site also has links to other organizations and a list of suggested books.

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American Association for Marriage and Family Therapy
www.aamft.org

The American Association for Marriage and Family Therapy provides a searchable database for locating licensed marriage and family therapists. This Web site also has information about a variety of emotional concerns, including chronic illness, caregiving, bereavement and loss, and more. Descriptions of related books, audio tapes and articles are also available.

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American Psychological Association Help Center
www.apahelpcenter.org

The American Psychological Association (APA) has an online help center that offers consumers free information, facts, and tips about mental health issues. The APA Help Center provides a variety of brochures and online information about a wide range of emotional concerns, including chronic illness, stress, mind-body health, resilience, and issues including managed care and health insurance. The site also includes a psychologist locator service and a toll-free number to obtain contact information about psychologists in your area. Some information is available in Spanish.

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AMC Cancer Information and Counseling Line
www.uccc.info

This counseling line is staffed by trained professional counselors who can talk to you about your concerns. In addition, they provide medical information, resource referrals and emotional support through short-term counseling at no charge. Services are available to survivors, caregivers, family members, or anyone with questions about cancer. This service is operated by the AMC Cancer Research Center, affiliated with the University of Colorado Cancer Center. The Web site has additional information about a variety of cancer topics, as well as links to other cancer sites.

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LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare

LIVESTRONG SurvivorCare offers assistance to all cancer survivors, including the person diagnosed, caregivers, family and friends. The program provides education, information about treatment options and new treatments in development, counseling services and assistance with financial, employment or insurance issues. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations, including CancerCare, Patient Advocate Foundation and EmergingMed.

The LIVESTRONG Survivorship Notebook is a tool that can help you organize and guide your cancer experience. The portable, three-ring binder contains a variety of information covering a full range of physical, emotional and practical survivorship topics. You may order a free LIVESTRONG Survivorship Notebook at www.livestrong.org/notebook. Shipping and handling charges will apply.

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