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Therapy and Counseling: What to Expect


Therapy and Counseling: What to Expect

Why Seek Psychotherapy?

Almost 60 million American adults suffer from a psychological disorder every year (National Institute of Mental Health, 2006). Psychotherapy (i.e., “talk therapy”) involves working collaboratively with a trained professional to reduce psychological distress and learn ways to cope with life stress.

Common Reasons Students Seek Treatment

  • Depression
  • Anxiety (worrying, panic attacks, social, phobias, test anxiety)
  • Stress
  • Eating Problems/ Body Image Issues
  • Drug or Alcohol Problems
  • Relationship Conflicts (family, roommate, romantic)
  • Couples Therapy
  • Procrastination/Lack of Motivation
  • Academic Troubles
  • Attention/Concentration Difficulties
  • Adjusting to College/Homesickness
  • Anger Management
  • Coping With the Death of a Loved One
  • Career Counseling
  • Sexual Orientation/ Sexual Concerns
  • Rape/ Sexual Assault
  • Conflict Resolution
  • Coping With Physical Illness

How Do I Know If I Should Seek Psychotherapy?

We all experience stress, depression, anxiety and other difficulties at times, and we often get over it without needing extra support. However, it is important to recognize when you should look to others for a helping hand, and below are some clues that you should probably get some help tackling your troubles.

  • You have been distressed for quite some time and you experience little to no relief from your symptoms.
  • Your distress has been interfering with your daily functioning (e.g., you can’t go to classes or work, your grades are slipping, you are avoiding or withdrawing from friends and family or it is hard for you to meet daily demands such as errands, chores, hygiene).
  • Your distress seems to be much worse than would be expected in a similar situation (e.g., after failing one test you totally withdraw from classes or you are depressed for months after the death of a loved one).
  • You have thoughts about committing suicide.
  • You feel you’re no longer in control of your behavior (e.g., excess drinking).

Services Typically Offered by College Counseling Centers

  • individual counseling
  • couples counseling
  • therapy/support groups
  • career counseling/ testing
  • psychological/personality testing
  • IQ/ learning disorder testing
  • medication treatment—sometimes available directly through your school’s counseling center or the professionals there can refer you to the appropriate resources.

What Will My First Session Be Like?

  • You should arrive at least 15 minutes before your scheduled appointment time to fill out paperwork.
  • The first visit is an information collecting session that often lasts longer than one hour.
  • This session will be conducted in an interview format.
  • The counselor conducting the interview will ask lots of questions—in order to make sure they get all the necessary information, interviewers ask many standard questions of everybody.
  • The information you provide during the first session will be used to determine what services will be most appropriate for you. At the end of the session, the counselor will share his/her impressions with you and the two of you will discuss a treatment plan.

Will the Therapist Keep the Information I Tell Them Private?

The law requires that your therapist keep your sessions confidential. This means that what you share with your counselor will be kept private and is only between you and your therapist. However, there are a few limits to the confidentiality.

  • First, your counselor is required to ensure that you and others are safe. This means that if he/she learns that you are considering hurting yourself or someone else, confidentiality must be broken.
  • He/she is also required to report any abuse/neglect of vulnerable individuals (children, elderly, disabled people).
  • In rare cases, a court of law can require the release of psychotherapy records (in this case, typically only a summary of treatment is shared, not every detail that you talked about during therapy).
  • Finally, it is common for the therapists working at college counseling centers to be supervised by a licensed psychologist. In this case, your therapist will frequently discuss your treatment with his/her supervisor. Think of this as getting “two for the price of one,” because what it means is that two people will be working on a plan to help you feel better.

One last point that is particularly relevant for college counseling center therapists: the fact that he/she even knows you is confidential information. You might run into your therapist on campus or while out with friends. He/she will not acknowledge you. This doesn’t mean that he/she is mad or doesn’t like you; it is merely to protect your privacy. Your therapist will inform you about confidentiality and his/her limits to confidentiality during your first meeting. Do not hesitate to ask questions.

What Should I Expect After the First Session?

After the information-gathering session (sometimes it will take more than one session), you will typically make an appointment to return to see a counselor (sometimes the initial interviewer and your subsequent therapist will be different people).

  • 50-minute sessions
  • Treatment is usually weekly at the beginning, and will often reduce to biweekly towards the end of treatment
  • You and your therapist will create specific goals that you will work on
  • Many therapists will assign “homework” (see below for an explanation of homework) to be completed between sessions
  • At the beginning of each session, your therapist will check-in with you about how the past week has been and your experience with the homework assignments
  • Then you will discuss issues specific to your goals for therapy and ways to accomplish those goals

Why Do I Have to Do Homework? You may be thinking “I have enough homework for my classes, why do I need to do more?” The homework assigned by your counselor is not the same as your schoolwork. You will spend approximately one hour of your week in treatment and 167 hours of each week outside of therapy. In order to make changes in your life, you will need to work on things between sessions and try applying your new knowledge and skills to your everyday life.

What can you expect for homework? Homework can be many things; it just depends on what you want to change and in what stage of treatment you are. Your therapist might give you informational readings or she might ask you to practice relaxation techniques, perform “behavioral experiments,” keep a journal or carryout self-monitoring activities.

How Long Will Therapy Last?

The duration of counseling can vary widely due to a number of factors. Some of those are: the problem you are working on, the theoretical orientation of your therapist, your preferences and practical issues such as the end of the semester, summer breaks or graduation.

Most of the time, therapy can be brief: 12 to 25 sessions. The more involved, open, committed and motivated you are to change, the quicker you will feel better. Also, regularly completing homework assignments and applying the techniques you’ve learned to your everyday life will speed up the treatment process.

Ending Treatment

Sometimes the end of treatment will be planned, for example, if you are graduating. Or, when you are feeling better, you and your counselor will determine when treatment is no longer needed. Sometimes therapy ends unexpectedly. For example, if you stop going because you become busy with schoolwork or if your therapist stops working at the counseling center (less common).

If, for any reason, you stop going to treatment, you can always resume treatment. Often, students become overwhelmed with schoolwork or other things and miss appointments or decide to stop going for awhile. They might worry that their therapist will be angry with them, and think that they cannot return to treatment. But, keep in mind that this happens frequently, and you are always welcome to receive services.