Frequently Asked Questions about Counseling:
What is counseling?
Does the clinic take insurance?
What happens during the first appointment?
It is important to understand that your first session is not really therapy. Like all clinics, counseling starts with the intake session. It is an intake session because your therapist has to “take in” information about you and your situation in order to begin to create your individualized treatment plan. Sometimes the intake will be continued into your second session; it all depends on how much information is gathered in the first session. Your therapist will let you know if the intake needs to be continued for your second session.
Once the intake is complete, your therapist will come up with an appropriate diagnosis and create an individualized treatment plan to address your situation and work on healing. You and your therapist will go over your treatment plan, and address any questions. Then you and your therapist will sign and date the treatment plan. After the intake session is done and the treatment plan is signed, therapy begins.
How long will therapy take?
What if there is a lapse in sessions?
How does marriage counseling work?
I have a child that I think needs counseling, but I want to make sure the child doesn’t feel bad or like they are the problem. What can I do?
Working with Children and Parents in Private Practice
There can be several challenges encountered when working with children in private practice. The foremost challenge is that when we therapeutic services to a child, we actually have two clients: the child and the child’s parents. The therapy protocol I use in working with children has taken into consideration these challenges in an efficient and effective manner while creating positive growth for both parties.
When I first receive a call from parents seeking out services for their child, I always schedule the first appointment with just the parents. The reasons for this are as follows:
- To gather as much information as possible from the parents without causing the child further distress as s/he listens to someone talk about him/her in third person at a time when the child is already feeling nervous and uncomfortable
- To ask the parents questions that they can answer in full without using discretion so that I can attain the fullest picture possible from their perspective; also to acquire a full history on the child so that I can properly assess current issues
- To give the parents the chance to determine if they feel comfortable with me seeing their child prior to bringing their child into my office; also to have an opportunity to educate them on the various therapy styles, including my own.
During the first session, as well as on the first phone call with a parent, I inform parents that I require as a part of my practice a parent-only session after every fourth or fifth session with their child. This is not optional, and I need parents to commit to this protocol in order for my services to be an appropriate fit for them.
These parent-only sessions are used for checking on progress (or lack thereof) outside of my office, answering questions that parents have about the overall picture of how their child is doing, and providing parental coaching or strategies to help parents most effectively help their child. I do not use parent-only sessions to provide parents with verbatim accounting of my sessions with their child. Instead, I explain to parents the importance of their child’s confidentiality along with the limits to confidentiality with children. I also explain that when there are issues that parents need to be informed about, I will find a way to include the parents in the overall discussion, whether it come directly from the child or from me with the child’s knowledge. Obviously when there are matters of urgency, I meet with parents in a timely manner and do not wait a month to discuss these types of situations with them.
Prior to meeting with parents for their parent-only session, I ask the child if there is anything they want me to share or not share with their parents. Generally speaking, children will say there is nothing they want kept private to our sessions only. However, it gives the children the option of exercising some control over what they want shared and when (or if) they are ready to share that information. This in turn helps to continue building a trusting therapeutic relationship with the child.
When children have little or no response to my asking them what they would like to have shared, I say to the child directly: “Here is what I am thinking about sharing with your parents when I meet with them. How does that sound?” Many kids I meet with are relieved to hear my summation of their experience; more often than not, they actually want me to share what I am suggesting with their parents. Children often looked relieved that their parent will be let in on their distress, which has been so difficult for them to put into words. Yet at the same time, they are not being forced to try to explain it to their parents, which is often a relief to the children.
When I meet with kids, I do a check-in on paper at the beginning of each session where they rate on a 1 to 10 scale how various aspects of their life are going (10 being the best and 1 being the worst). My scales are blank, and I fill them in at the beginning of each session with the child. Some of the items I might list in this part of my check-in include school, home, life, and friends. The child then fills in how each aspect of their life is going in each of these areas by filling in the numbers portion of the checklist.
The second half of the check-in is another blank scale set from 1 to 10 (with 10 being the most and 1 being the least). On this scale, I fill in the blanks with four to five feeling words, then ask the child to rate them based on how they felt over the past week. For instance if I put the word “worried”, the child can identify for me if they are feeling very worried or not worried at all. I add in new feeling words as I work with them each week and help children increase their emotional language.
These check-ins are a good opportunity for children to give us a sense of how they are feeling when it can be very difficult for them to put their experiences into words. They also provide the therapist with information that is difficult for kids to discuss, thus offering an opportunity to tailor the sessions accordingly. For instance if a child ranks “friendships” as a 1, but he/she is uncomfortable discussing this, I would move on from that topic and continue to figure out how to help the child express what is feeling uncomfortable to him/her either through play therapy or talk therapy as we move forward. As we know, it is important to go at a client’s own pace.
These check-ins are helpful in monitoring progress as well as understanding areas of distress for a child. The check-ins, combined with parent-only sessions, give a much clearer picture of what a child is experiencing which is crucial to providing effective therapy services. Therapists need to have an accurate assessment of a child’s world on an ongoing basis to truly be able to help them.
This protocol addresses including parents into their child’s therapy while still building and maintaining trust from all parties involved. It is a means to answer parents’ questions without rushing them on phone calls because parents know they will always get a chance to talk more thoroughly with the therapist in the near future and get all of their questions answered on a regularly basis.
Collaborating with parents is important to a child’s well-being and making progress in therapy because we cannot impact true change while only working in our offices; there has to be a team approach that includes parents. Additionally, therapists cannot always determine if there is progress occurring from a child’s self-report; clinicians need parents to give us regular feedback on what they are seeing outside our office in order for us to know if we are making gains for children that translate into to their whole world, not just in the therapist’s office.
What ages of children are seen at the clinic?
Do you have a sliding-fee scale?
What does it mean to be a “private-practice” clinic?