at your side: during counseling

how do I ask how it’s going?

It can be hard to figure out how to ask your friend how counseling is going without sounding like you’re checking up on them and policing their behavior. Here are some ways to finesse the situation.

1. Ask if they’d like you to check in
   It’s simple. It’s direct. And even if they say no at the moment, let them know they can change their mind anytime.
2. Tell them you’re going to check in
   This is basically the same thing as asking, except it’s for your friends who you know won’t want to be an imposition. “I’m going to keep checking in about how things are going at counseling. Just let me know if I’m getting on your nerves.”
3. Open with a safe question asked in a safe place
   When you check in, try to start with an easy opener question. “Hey, how was your first trip to counseling? Was it like you thought it would be?” As always, have the conversation in a place where you’ll have a little privacy.
4. Reinforce your desire to understand
   As you ask deeper and deeper questions, reinforce that you’re doing it so that you can better understand what they’re going through. Your friend doesn’t want to think you’re feeding off the drama of it, so reassure them you’re not. It also helps to drop in a qualifier phrase like, “You don’t have to answer this if you don’t want to…” every once in awhile to soften your prying.

when they stop going to counseling

People stop going to counseling for a million different reasons, from not feeling comfortable with their counselor to running out of free or covered sessions, to completing their course of needed treatment and every reason in between. Here are some tips for when they stop going.

1. Be there and open
   We can’t emphasize enough how important it is to keep the door open for your friends. Regardless of why they’ve stopped going to counseling, maintain that openness and recognition that you know their journey will continue and you will be there to help understand.
2. Pry delicately
   Sometimes it’s going to take a little bit of prying to figure out why they’ve stopped going unless they’ve successfully completed counseling or hit a session limit. The other, more personal reasons for discontinuing require persistent, innocuous questioning. Questions like, “How are things going with your counselor? Are you clicking?” or “What’s it like having to fit your counseling appointments into your daily life?” might be good starters.
3. Reaffirm their courage and persistence
   Regardless of why they discontinued, let them know how glad you are they had the courage to seek help. If you admire that courage, tell them so. Positive reinforcement goes a long way.
4. If they didn’t click with their counselor…
   Take their word for it. They know better than you what they need in a counselor. So, if it wasn’t working for them, it wasn’t working for them. Accept that truth and help them seek other options. A lot of people have to see several different counselors before they find someone who works well with them. Fit is important and it’s normal not to end up with the right person on the first try. Just in the same way you wouldn’t expect to marry the first person you dated. It can be discouraging, however, to come to this realization.Mostly, you and your friend should just remember that it’s a good idea to find another counselor if it’s not working out. They won’t hurt their counselor’s feelings. Rest assured there is someone on a waitlist who will benefit more from those sessions with that counselor, and the fact that it’s not working for your friend is the only fact that truly matters.Finding a new therapist can be exhausting, though. As a friend, the most helpful thing you can do is proceed to #5.
5. Give them alternatives
   Many people in distress find it hard enough to seek help the first time. But if they don’t like their counselor or they are in some other way dissatisfied with their first experience, it’s that much harder to muster the energy and hope necessary to try again. As a friend, do as much as you can to push them toward a fresh start.Maybe you want to plan a night in with your friend to look through Psychology Today’s database of providers – it allows you to see their picture, read about their specialty areas and approach to work, note what insurance they take, and more. Once you have a list of options, sit down with your friend, express your willingness to help, and help them call to set up a next initial appointment. You might even offer to go with them if you both feel comfortable with that.
6. Help with payment
   If your friend is covered by an insurance plan, help them find the mental health section of their policy and check to see whether preauthorization for mental health treatment is required. Some insurance companies bury preauthorization requirements in their policies as a way to create a loophole for paying for a consumer’s mental health and addiction treatment.After the passage of the Affordable Care Act (ACA), most insurance providers should have abolished lifetime limits on mental health and substance abuse treatment coverages. Yet, some people have to leave outpatient treatment because they don’t have insurance or because their insurance provider is not ACA compliant.If a friend can no longer afford treatment or has run out of covered outpatient treatment time, Mental Health America offers a guide that links to other local, state, and national resources. Another option is the Partnership for Prescription Assistance

discussing disclosure

When your friend changes their routines in order to accommodate counseling appointments, they might feel the need to make a decision about who they’re going to tell and who they’d like to keep at arm’s length. Here are some tips for guiding the conversation.

1. Who else do they want to know?
   Help them develop a list of people who they’d like to tell about their struggle, what their goals are in telling them, and how they expect that person to respond. This will help both of you understand who would be safe to approach and able to provide positive benefit to your friend’s treatment and recovery process.
2. How should they share?
   Figure out the best method of telling the story given the outlets they have available. Face-to-face is often best, but it isn’t always possible. Phone calls can be good, too. If they want to write it, encourage an email over a text and remind them that communicating tone is going to be just as important as the facts of the story.
3. Who do they not want to tell and how can you help them keep it private?
   People get to disclose their mental health struggle in their own time to the people they choose. It’s not up to anyone else to out them unless requested to do so by their friend. If there needs to be a cover story, make sure they’re consistent, and do your best not to say anything that would out them against their wishes.
4. Maintaining trust: Not outing them
   A big part of maintaining your friend’s trust around disclosure is demonstrating that you won’t out them. Try to resist doing so at all costs; even if your only answer can be, “I don’t know. Maybe you should ask them.”