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Getting started in counseling: (continued)
... that I don’t have a “program” or a sequence of exercises I am going to put you through. Rather my effort is to assist you as you find your way to the issues that will be most fruitful for us to be discussing. Broadly speaking, here are some activities that take place in counseling:
Many patients want to talk about a relationship or a work situation that may be troubling them. I help them gain clarity in how they want to understand the situation and how they prefer to proceed. We may each participate more or less equally in this conversation.
Some patients want a “witness.” In other words, these patients may prefer me to speak less. Their goal is simply to have somebody know what they are going through. They may not be looking for my input as much as they are just wanting to be heard and understood, and to feel “real,” as they sometimes put it. In such circumstances, I am likely to speak less, to be a listener and a witness.
With some patients, I feel as though I am a little bit in the role of parent (I am older than most patients), sibling, or close friend. The reality is that many people in Tampa are far from family; others may have families that are untrustworthy, or even just lacking in objectivity. Some people have limited support all-around. I am happy to help people feel they are not "in it" all by themselves.
Some patients are here to make a decision. In these cases, some patients respond best if I take a “devil’s advocate” position, helping them to see both sides of the situation. Other patients may be looking for simple support, an endorsement of their thinking. I do my best to provide that, and usually it works out very well. But I am as likely as not to speak my piece, gently, if I am having trouble seeing it my patient’s way.
Some patients need to talk about historical events. These may be situations from childhood where they were subjected to family members who hurt or neglected them, experiences of chronic bullying (the impact of which may be astonishingly persistent), or other traumas. In such cases, my activity may be to help the individual clarify the details and organize the memories in order to stifle the echoes of these experiences or to recommend something more active to address them.
Some patients want direction. In other words, these individuals or couples expect me to take the lead, to give advice, to prescribe activities, or to recommend reading. This of course is much more common in couples and marital counseling, where I agree that my role most often is to take the lead and to be explicitly directive.
Some patients are dealing with specific emotional concerns such as a variety of difficulties with anxiety, depression, mood swings, troubles with insight or judgement, or a variety of other psychiatric challenges. Some of these struggles are relatively short-term, but other times they may be lifelong and exhausting. Some of these patients simply want a better understanding of what is going on with them. Others are looking for specific strategies to reduce specific symptoms. Others want to discuss medications -- choices, impacts, and side effects. Still others just want to talk over what they are going through with someone who is experienced and knowledgeable about their particular difficulties.
Some patients arrive in some kind of existential crisis. This may pertain to the death of someone they were close to, their own mortality, or a struggle to make sense of this life and this world. Sometimes it is a religious conflict or insight. These conversations may be collaborative and speculative, without a particular goal or end point.
So these are some of the categories that come to mind as I compose this. There are many, many other cases-- truly every individual and couple and circumstance is unique and complex and important. I feel honored to be trusted by my patients -- I will do whatever I can to “be where you are” and provide what you need.