The month of May is known as Mental Health Awareness month. All throughout the month of May the focus will be on sharing information about ways to improve and advocate for mental health. This information will come in the form of tools to help fill your mental wellness toolbox. Some tools will be skills you can incorporate into your life while other tools may come in the form of education to increase your awareness. 

As we go through this month I will reference books and workbooks that I often recommend to many of clients. Please know that I do not receive any compensation for these recommendations. I will also welcome your recommendations as well. If there’s a resource you’ve found particularly helpful in your mental health journey, please share it with me in the comments. I may add it to my own resource list, after I’ve read it, of course.

Today, I want to shed light on the process of counseling. Many people who have never been to counseling before are often nervous, because they don’t know what to expect. So, what better way to start off Mental Health Awareness Month than by sharing with you what the process of counseling is like during an initial session? 

Assessment

One of the most common statements I hear from new clients at the initial appointment is “I’m nervous.” I get it! Coming to talk to a complete stranger about difficult experiences, thoughts, emotions, urges and sensations can be difficult, especially when you don’t know what to expect. So, just think about it as a conversation.  I cannot speak for all counselors, but my focus on the first session with a client is to establish rapport and make people feel comfortable in the space, even including the temperature of the room or if a comfort object would be helpful (pillow, blanket, or something to fidget with). I will often offer water, hot tea, and yes, coffee to clients as well. 

Much like when you visit your primary care doctor and the nurse obtains your weight, vital signs and asks why you are coming in, a very similar process happens in counseling as well. While we don’t take your blood pressure, temperature, or weight we do ask about the symptoms you are (and have been) experiencing. In other words, “What’s happening in your life that’s encouraging you to seek help?” In my practice, I always go through confidentiality, spending time discussing the particular ways confidentiality can be broken without consent. I also talk about informed consent for treatment, any medical issues I need to be aware of (medical diagnoses, food, environmental, and drug allergies) and other administrative details up front in this session. During this time I will also assess for safety issues (the presence of suicidal or homicidal thoughts, urges, actions). So, to extend the analogy, this part of the assessment process could be considered the “vitals,” because they are vitally important to understanding what you are actually consenting to when you enter into a counseling relationship. 

Next up in the initial assessment is the clinical interview. This can be structured or unstructured depending upon the mental health professional you see and the approach they use. In my office, I will ask about any pre-session change: “What’s better/ different/ improved since you called for your appointment?” Afterwards I will ask about the problem: when it began, how it’s experienced, how intense it is, and what’s happening when it’s not present. I will also ask about what you’ve tried to do that’s helped and not helped. I will ask about your specific goals for counseling: “What needs to happen during our time together for this to be helpful for you?” or “How will you know when you are ready to leave counseling and continue moving forward in your life?” I will often utilize a genogram to note specific relationship information between the client and his/her spouse, children, parents, grandparents, and so on.  

Then, what’s often included as part of an assessment is the use of screeners such as the PHQ-9 or GAD-7, which allows mental health professionals to screen for the presence of symptoms like depression (PHQ-9) and anxiety (GAD-7). These tools are not used to make a diagnosis, but do aid in gathering data regarding symptom severity. In my professional opinion, good screeners will assess symptoms in 3 specific areas: thoughts, feelings, and physical symptoms. Some common symptoms may include things like an anxious or depressed mood, aches and pains, sleep issues, energy level, racing thoughts, pressured speech, and many others. 

Finally, If there are specific concerns regarding things like ADHD, major depression, bipolar disorder or another specific mental health condition, there are assessment tools that are used to gather detailed information to determine the nature and severity of the specific issue. For example, in my office, if a new client is expressing concerns regarding attention & focus, along with problems related to executive function and emotion regulation the assessment tools used to assist with confirming or ruling out the presence of ADHD are the Conners-3, the Child Behavior Checklist, the M-PACI or MACI, along with other screeners for anxiety and depression. In addition to these specific tools, a thorough developmental history would also be part of the process of diagnosis and shared up front with clients at the initial appointment. Assessment tools like these would not be conducted during the initial assessment, because they are extremely lengthy; but, they would be explained and discussed during the first session. 

As you can see, there’s a great deal that happens during the initial counseling appointment. Sometimes it will take a few sessions to fully assess and create a clear clinical picture of what’s going on. I often tell clients that counseling is a process. Stick with it and see what happens. 

So, now that you know a little about what happens during an initial session, I hope you will feel more comfortable calling and scheduling an appointment with a counselor in your area.