Issues - Topics of counselling conversations

When Freud first began to help people his method was dubbed 'the talking cure,' and that aspect of therapy has not changed. Counselling is a conversation - an intimate, lively, vital conversation.  Perhaps one of the thoughts which follows will begin that conversation between us . . .

Addiction

Whether you are concerned about possibly being addicted yourself or that someone important to you may be addicted, speaking to a counsellor can help. The essence of addiction is feeling compelled to engage in some behaviour while nevertheless knowing it’s harmful to oneself and/or others. Such behaviours can include drinking or drug use, gambling, sex, and disordered eating. Depression or anxiety often accompany or are masked by addiction. People typically feel shame or guilt around addiction - theirs or another’s - so it’s very important to know that I deeply respect anyone willing to examine this issue, and that respect for your dignity and choices is an essential part of how I will work with you.

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Depression

Strangely enough, depression - in which one may feel utterly hopeless - is an issue about which hope is strongly justified. Depression is very treatable, and there are many therapy ‘tools’ scientifically shown to be effective. These include medication, cognitive-behavioural therapy (changing depressive thinking and behaviour), and exploring the emotional roots of depression. Depending on your circumstances and wishes, some combination of these over time is probably most effective. The first step is having the courage to act despite the negative feelings and thoughts which depression involves.

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Anxiety

Like depression - which it often accompanies - anxiety is very common and usually amenable to treatment. Anxiety is feeling fear beyond what circumstances warrant. It takes forms like excessive worrying, phobias of various kinds, and panic attacks, and may involve excessive and detrimental avoidance of feared situations. Besides medication, cognitive-behavioural therapy is the treatment of choice: learning to stop thinking anxiety-producing thoughts and learning that anxiety diminishes when we face what we fear. Anxiety may have roots in traumatic experiences which can be addressed in therapy. As well, people who are anxious often focus on what others think of them - counselling can help modify that focus.

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Suicide

Suicide, which may or may not occur as part of depression, has been called a permanent solution to a temporary problem. Suicidal thoughts and feelings must always be taken seriously and addressed openly, and when they are it often turns out that they are part of a ‘healing crisis,’ a message to oneself (and sometimes others) that something intolerable needs to change. Because sharing one’s despair with a compassionate and accepting other is itself a step out of the darkness and isolation of suicidal thoughts or intentions, counselling is very effective in preventing suicide. And often, as hope and the will to live strengthen, a person is willing to explore and move toward the changes necessary to make that prevention permanent.

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Relationships

Good relationships are central to health and happiness, and difficulty with relationships is one of the most common reasons for seeking counselling. Conversely, the negative effect on our relationships is among the most painful aspects of such issues as addiction, anxiety, or depression. Because counselling is itself first and foremost a relationship, it functions as a sort of ‘lab’ for practicing relationship skills. This is true whether you come to improve your primary relationship in couples counselling, or come as an individual to identify and change aspects of yourself that may be getting in the way of good relationships in general, perhaps including a primary relationship.

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Couples counselling

When a primary relationship is troubled it is often because it no longer enables both partners to get some very important human needs met. We all need to be accepted, respected, trusted, and loved, to know that another will be there for us. When such needs are mutually met, the inevitable problems of partnership become manageable and secondary. When they are not, problems generate patterns of distance or conflict that not only further hamper the chances of those needs being met, but may become fixed and escalate. Unfortunately, our society often tells us that as adults we are supposed to have grown out of such needs to become self-sufficient - an empty and impossible goal. Gestalt and Person-centred counselling help couples to experience, accept, and begin to communicate these needs to their partner in ways that can powerfully and effectively transform relationship.

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Workplace and education issues

It’s been said that counselling is too good an experience to be limited to those with mental health diagnoses. Counselling is a valuable resource for exploring and resolving difficulties everyone faces from time to time at work or school. We turn to colleagues, friends, and relatives (and so we should) in these situations, but in addition to the support and wisdom these can offer, the counsellor provides objectivity, professional confidentiality, and an expertise in facilitating solutions. Because counselling will likely identify patterns of behaviour or feeling that go beyond whatever the immediate issue is, other aspects of your life are likely to improve as a sort of natural by-product!

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Personal Growth

Counselling and therapy are much more than a way to solve problems. Though many people first seek help to put right what’s wrong in their lives—perhaps one of the issues mentioned above—they often go on to find that counselling and the skills learned therein can also make better what’s already good. Others begin their counselling with the goal of self-actualization. Either way, counselling is a means of continuing personal growth. Personal growth work can range from learning the skills of listening or assertive communication, to developing increased self-awareness, to exploring the past and present in depth to change patterns of thinking, feeling, or behaving that interfere with ‘being the best that one can be.’

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Confidentiality and other counselling boundaries

Strict confidentiality is basic to effective counselling. You need to know that I do not reveal counselling conversations to anyone else.

There are just three exceptions. I may have to reveal confidential information 1) if there is a risk of serious harm to a client or someone else - suicide is one example, the possibility of child abuse is another, 2) in response to a subpoena, and 3) when I consult with a colleague. In the latter case, no identifying information is used, and in all cases the minimum information necessary is revealed.

Other important boundaries include honouring your right to set counselling goals, to understand and consent to any techniques we use, and to decide when to end counselling.

All of these boundaries are based on the principle of deep personal respect.

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