Finding a Counselor

Survivors often face many different emotions and life changes during their cancer experience. Working through these challenges is sometimes easier with the help of a professional counselor. A counselor will listen to you and help you understand your cancer experience and the emotions you are feeling.

Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources.

Survivorship is about taking care of the whole person including your body, mind and spirit. It involves taking care of both your physical and emotional health. Some survivors may think that, because cancer is a physical disease, they should not need help with emotional challenges. Emotional concerns are often overlooked because so much attention is placed on the physical recovery from cancer and its long-term effects.

Counseling is a healthy choice for people from any background or experience. When you want to find ways to manage and understand your concerns, counseling can help. In some cases, an individual may have concerns that seeing a counselor means they are weak, mentally ill, or a failure at solving their own problems. However, talking with a counselor does not mean something is wrong with you or that you are a failure. Instead, talking with a counselor is often a sign that you are willing to take care of yourself and find healthy ways to respond to challenging situations.

Is there a difference between counseling and therapy?

The terms "counseling" and "therapy" have different meanings, but are often used to describe the same activity. Both counseling and therapy involve talking with a trained professional—many are also licensed by the state in which they work.

• Counseling is the process by which a counselor helps an individual understand and solve problems to help him or her cope with mental or emotional stressors. For example, counseling generally works to find solutions to specific immediate problems such as learning how to positively communicate in relationships with others.
• Therapy usually involves talking about your situation in order to gain more understanding about issues such as mood, feelings, behavior, and ways of thinking. For example, therapy can help you learn how to find meaning in your cancer experience.

In this document, the terms counselor and counseling are used in a general way to refer to any type of professional counseling or therapy setting. The meeting with the counselor is usually called the "counseling session."

How can a survivor benefit by talking with a counselor?

Cancer and treatment can create unique challenges for survivors and their loved ones. In some cases, the full impact may not be felt until after treatment has been completed. Some survivors may begin to wonder how to cope with challenges such as physical changes, emotional issues, or concerns about practical issues like finances, insurance or employment issues. Others may want to discuss concerns with someone who is outside the circle of family and friends

Some survivors may find it difficult to admit to themselves or others that they could benefit from counseling. They may think that seeking assistance means that they could lose their independence or lose further control over their lives. However, talking about concerns, no matter how big or small, can help you work through them more quickly.

There does not have to be a crisis to talk with a counselor. Counseling can help to make decisions, build self-esteem, and deal with stress. Even those who only have concerns about general daily challenges can benefit from talking with a counselor to clarify and prioritize needs or find an answer to an immediate problem. When there are more serious issues, there may be a need for longer-term counseling.

The following are examples of concerns that could be addressed during counseling sessions:

• Coping with a cancer diagnosis
• Emotions such as sadness, depression or anxiety
• Difficulty sleeping
• Challenges managing symptoms such as pain
• Financial issues
• Relationship changes
• Difficulty making decisions about treatment, work or home
• Helping children to understand and adjust
• Spiritual issues
• Decision-making process
• Communicating with a health care team member
• Employment issues
• Longstanding problems unrelated to cancer
• Desire to find meaning in this illness

What types of counseling services are available?

Counseling is a service in which you receive guidance with emotional and practical concerns from a knowledgeable and trained person. In most cases, it involves talking with a trained professional. The goal of counseling is to learn how to relieve and manage distress about any concern.

Counseling may be provided in a variety of settings including:

• Individual counseling - Talking and sharing privately, one-on-one with the counselor. Individual counseling can be useful for those who want support but who are uncomfortable talking in groups.
• Couples counseling - Partners talk with a counselor together.
• Family counseling - The entire family talks with the counselor.
• Group counseling - A group of individuals with similar concerns meets together with a trained counselor who provides guidance.
• Support group sessions - A group of individuals that come together for similar reasons. These groups usually focus on one general topic such as cancer survivorship. Support groups are not always led by a trained counselor. Often, members of the group organize and lead these groups as a way to connect with and learn from others who are managing similar challenges. Survivors are often referred to support groups by their health care teams.

What types of counseling professionals are available?

Many different professionals offer counseling services. Some of them may refer to themselves as "psychotherapists," "therapists," "counselors," or "mental health specialists." The professionals who are trained and licensed in most states to provide counseling services include:

You may have concerns about talking openly with someone you have just met or may not know well. However, the right counselor will help you through any nervousness. Most effective counselors will suggest meeting with you for a few sessions and then talking with you about how the counseling relationship is working. If you have any doubts or questions, you should feel at ease talking these over with the counselor. If you do not feel comfortable, the counselor may not be a good fit for you. In some cases, you may need to find another counselor.

Some people find support through a faith-based relationship with a spiritual leader such as a rabbi, pastor, priest or hospital chaplain. This may be a relationship that existed before the diagnosis or one that begins after. Although some may not have formal counseling licenses, they may be experienced and provide support in matters that are of concern to some survivors.

How can a survivor find a counselor?

If you are interested in working with a counselor, ask your health care team for recommendations. Many hospitals and clinics include social workers or other mental health specialists as part of their team. They work closely with the other team members, often without an extra fee.

If your hospital or clinic cannot help you, you may be referred to a private counselor in your community or to a local family service or nonprofit cancer organization. Ask for several referrals, if possible, so you can interview the counselors and find the one who best meets your needs.

Support groups are also a good place to get referrals for counselors from other survivors. In addition, some cancer organizations and counseling associations provide information and referrals.

Look for a counselor who is experienced with cancer survivorship issues. If possible interview a few counselors before you choose one. Let the counselor know what you want to talk about and then ask if he or she can help you with those issues. If the counselor is not knowledgeable about your areas of concern, ask if you can be referred to someone who has this knowledge and experience.

How much does counseling cost?

It is important to ask about the cost when you speak with a counselor. Because counseling can be expensive, you may want to ask if any free or low-cost services are available.

Assistance with costs for counseling services may come from sources such as the following:

• Many hospitals, clinics and nonprofit cancer organizations provide social work or counseling services without a fee because they are considered an important part of the comprehensive services of the cancer program.
• Health insurance policies with mental health coverage usually pay for a specific number of sessions per year with a licensed mental health specialist if the counseling is aimed at a specific problem such as depression or anxiety. The number of covered sessions is determined by the insurance policy and usually ranges from 6 to 20 sessions. Sometimes a co-payment is charged to the patient.
• Some mental health clinics and private counselors offer a "sliding fee scale," meaning you can ask for a reduced fee if you have limited financial resources.
• A few organizations offer free limited counseling services over the telephone.
• A private or group counseling session that is not covered by insurance may charge out-of-pocket fees ranging from about $40 to $120 per session, depending on the therapist's credentials and local rates.

What if I am not comfortable with the counseling style?

Not every counselor or therapist is a good match. Even if a counselor has expert credentials, his or her personality or counseling approach may not fit your individual needs. Sometimes counselors and their clients have very different personalities and views on life.

In a group counseling situation, it is possible that the counselor may seem to be the right person to help, but the group itself is not a good fit. If this happens, talk with the counselor to see if another group exists or if individual counseling might be more helpful.

Ask yourself questions such as the following to decide if the counseling relationship is working for you:

• Are you making progress and getting the help you need?
• Are you comfortable sharing your thoughts and feelings with your counselor?
• Are you able to tell your counselor when you are uncomfortable or unsure about the counseling relationship?
• Does your counselor respond in a positive manner when you talk about your concerns?

You may want to find another counselor if you cannot comfortably talk with the counselor about your feelings or if the counselor's responses to your questions are not helpful. As you decide if the counselor is appropriate for you, check to see if it is the topic of discussion that is causing your discomfort or if it is the counseling relationship that needs to change. Finding the right counselor and getting the help you need is what is important.

Sometimes, people dealing with cancer may feel that they do not have the time, money, energy, or need for counseling. For this reason, preventable problems may develop, and small problems may become bigger. Chronic stress may remain and build instead of being worked through and released.

Working through problems may bring up a variety of emotions. It often requires a shift in how you think about situations. The counselor's job is to guide you through this process. The counseling process may take time, but it is likely to require much less time than if you had tried to do the work by yourself. You will find that the benefits are well worth the effort.

This document was produced in collaboration with:

Katherine Walsh-Burke, PhD, MSW
Licensed Independent Clinical Social Worker
Associate Professor, Springfield College

Works Cited

Institute of Medicine, National Research Counsel. Meeting psychosocial needs of women with breast cancer. Washington, D.C.: National Academies Press, 2004. Holland, Jimmie, ed. Psycho-Oncology. New York: Oxford University Press, 1998.

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Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

• Decide ahead what you would like your counselor to help you with.
  
  
  • Counselors can help survivors prevent, minimize, and respond in healthy ways to the expected and unexpected stressors that may occur during the experience of cancer survivorship.
  • A counselor will not solve your problems for you. However, he or she should provide a safe and non-judgmental environment where you can talk about your concerns.
  • The counselor will guide you through a process of learning and finding solutions and ways to deal with challenges. This is often referred to as a "counseling relationship."
• Consider whether the counseling sessions are helping.

  The general goal for all counselors is to provide support and guidance as you discover ways to understand and respond to your concerns. Counselors may use a variety of approaches to help relieve and manage distress.

  A counselor may be able to help you:

  • Talk about your concerns regarding cancer survivorship
  • Discuss options for solving problems
  • Identify action steps you can take
  • Talk to your family about cancer-related issues
  • Learn communication skills
  • Understand your partner's needs
  • Learn about quality community resources
  • Prevent and minimize problems
  • Talk about problems
• Discuss your need for support and guidance with your family and health care team.
• Look for a counselor who is experienced with cancer survivorship issues.
• Interview a few counselors, if possible, before you choose one.
  
  
  Let the counselor know what you want to talk about and then ask if s/he can help you with those issues. For example:
  
  
  • "I want to find ways to talk to my family about my fatigue."
  • "I need help with depression."
  • "My partner and I have not been very close since treatment ended."
• If the counselor is not knowledgeable about your areas of concern, ask if you can be referred to someone who has this knowledge and experience. Ask questions such as:
  
  
  • Would individual, couple, family or group counseling be best for me?
  • What professional degrees and training do you have?
  • Do you have experience working with cancer survivorship?
  • Do you have experience with my particular kind of cancer?
  • What types of counseling methods do you use?
• Find out if the counselor has a set fee or sliding fee (a reduced fee) and discuss whether your insurance will cover the costs.

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Additional Resources

The resources listed below provide more detailed information and support services to help you with finding a counselor. Please read the Detailed Information and Suggestions document for more information and questions to ask.

Online: Complete an intake form through the LIVESTRONG website.
Phone: 1.855.220.7777 (English and Spanish)
Navigators are available for calls Monday through Friday, 9 a.m. to 5 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about fertility risks and preservation options, treatment choices, health literacy and matching to clinical trials. Emotional support services, peer-to-peer matching and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG has partnered with several organizations including Imerman Angels, Navigate Cancer Foundation, Patient Advocate Foundation and EmergingMed.

American Association for Marriage and Family Therapy
www.aamft.org

Email: Send email through the website.
Phone: 1-703-838-9808

The American Association for Marriage and Family Therapy provides a searchable database for locating licensed marriage and family therapists. This website also has information about a variety of emotional concerns, including chronic illness, caregiving, bereavement and loss. Descriptions of related books, audio tapes and articles are also available.

American Psychological Association Help Center
www.apahelpcenter.org

Email: Helping@apa.org
Phone: 1-800-964-2000

The American Psychological Association (APA) has an online help center that offers consumers free information, facts, and tips about mental health issues. The APA Help Center provides a variety of brochures and online information about a wide range of emotional concerns, including chronic illness, stress, mind-body health, resilience, and issues including managed care and health insurance. The site also includes a psychologist locator service and a toll-free number to obtain contact information about psychologists in your area. Some information is available in Spanish.

American Psychosocial Oncology Society (APOS)
www.apos-society.org

Phone: 1-866-276-7443
Voicemail is available after hours. Messages will be returned within 24 to 48 hours.

APOS works to ensure that all people with cancer have access to psychosocial services as a part of quality cancer care. They provide mental health care referrals to local counseling and support services throughout the United States. If no services are available in your community, a professionally trained Helpline staff member will provide crisis counseling over the phone. To use this service, call the toll-free number.

National Register of Health Service Providers in Psychology
www.findapsychologist.org

Email: search@findapsychologist.org
Phone: 1-202-783-7663

The National Register of Health Service Providers in Psychology sponsors this free psychologist referral website to promote consumer access to more than 12,000 professionally screened psychologists in the United States and Canada. This site also contains frequently asked questions about getting help, web links and resources on behavioral health care issues for consumers.

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