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Stirring Up the Counselling World with My Version of Counselling

April 29, 2015

People attend counselling because of distress and want relief as quickly as possible.

With traditional counselling approaches, people see the counsellor for the standard 50-minute session, one at a time, week after week. It often takes the counsellor 2 to 3 and even 4 sessions to gain enough information in order to begin being helpful. That means distress may continue at least that length of time. Even then, many therapeutic approaches have the counsellor saying very little apart from reflecting back the client’s own feelings or validating their concerns. Many people come away from this kind of experience having changed very little. While they may feel validated or supported, issues of distress can continue.

My approach to counselling is different.

Rather than coming back week after week, the first session is a long one; usually a good three hours straight. Through a structured interview process, I obtain the information necessary to understand the problem and situation as fully as possible to be helpful sooner – often on the basis of the one meeting.

At the end of that first meeting, folks are given very direct and forthright feedback. They are provided practical and direct information and guidance to help resolve matters causing the distress. They may or may not take heed of the feedback, but those that do, tend to do better than those who do not. This remains their choice. Due to the nature of this approach, remarkably, many people attend this one meeting only because it has been sufficient to address the issues for which counseling was sought.

If folks return, it is generally 3 to 6 weeks later, after they have had time to work with the feedback. Even if folks do return they are rarely seen beyond 3 or 4 times. People can improve sooner and then at less overall cost given the time to really get somewhere in our meetings.

Because of this approach, I rarely have a waiting list. I see many many people, for a short duration. This means you can be seen quickly. Again, when in distress, being seen quickly matters.

Do we tackle tough problems? Absolutely.

Because of the questions I ask directly, we address issues of abuse, drugs, alcohol, and violence, just to name a few. Connections are made between untoward childhood experiences and current life problems. Do not draw the conclusion that fewer sessions mean real issues don’t get addressed.

Whereas in traditional counseling approaches, the counselor seeks to develop something referred to as the therapeutic relationship, whereby over numerous sessions the client eventually feels comfortable enough to raise their issues on their own, in my approach, I ask directly about those experiences known to create distress so they can be discussed openly. To do this requires the counselor to be comfortable with this approach which in turn makes the client feel comfortable and safe to acknowledge those matters asked about.

By way of example, imagine going to your doctor and your doctor asking you, what do you think your diagnosis is; what do you think is the problem; what do you think you should do; how to you feel about that….

No one would want that. People expect the doctor to take your pulse, listen to your chest, look into your ears, take some blood and then tell you what is wrong and what needs to be done about it.

To add, I wouldn’t want my surgeon kicking me off the table saying we’ve run out of time and we’ll take the scalpel out next week; and I don’t want my clients to expect that when they are in distress. That is why I always set aside a good three hours for my appointments. By the way, I only bill for actual time used even though I provide up to 3 hours per meeting.

This is so different than what happens in the counseling world and no wonder many people’s experience of counseling is that it drags on and often with limited results – at least as told to me by many of the folks I see, which is not to say traditional approaches aren’t helpful overall.

But again, people attend counselling because of distress and want relief as quickly as possible.

See people beyond the standard 50-minute session. Provide time to really explore in a single meeting a person’s past and present by asking direct questions, much as a physician would do to understand the problem. Be informed on matters of abuse, violence and addictions as well as power imbalances, child development and the dynamics of relationships under different circumstances. Be helpful sooner.

If you are a therapist or counselor and would like to learn more about my approach, it would be my pleasure to discuss or provide a workshop. If you as a counselor or therapist are challenged by a particular situation with regard to a client and would like a consultation, please call.

If you are a person in a tough situation or coping with troubling behavior or feelings or relationships, it would be my pleasure to be of assistance. Expect a no nonsense approach. I would like to help you sooner.

I am Gary Direnfeld and I am a social worker.

Gary Direnfeld, MSW, RSW

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Gary Direnfeld is a social worker. Courts in Ontario, Canada, consider him an expert in social work, marital and family therapy, child development, parent-child relations and custody and access matters. Gary is the host of the TV reality show, Newlywed, Nearly Dead, parenting columnist for the Hamilton Spectator and author of Marriage Rescue: Overcoming the ten deadly sins in failing relationships. Gary maintains a private practice in Dundas Ontario, providing a range of services for people in distress. He speaks at conferences and workshops throughout North America.

If your relationship is faltering, then set it as your priority.

Read: Marriage Rescue: Overcoming ten deadly sins in failing relationships.

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  1. Your approach makes a great deal of sense to me, so thank you very much for posting it! In fact, I was thinking about similar approach to “therapy” ( I prefer the word “counseling) because in my own therapy I was sick and tired of pointless weekly reporting of events to the therapist and endlessly exploring “The Relationship”, which was not what I wanted when I was looking for help.

    So this consultation-type approach sounds right to me. One thing I would add though is to inform people from the get go about the limits of the therapist’s knowledge.

    I don’t think a comparison with a medical doctor and a comparison of the whole practice with medicine a.k.a “medical model” is valid , at least at this point in history when psycho”therapy” practice is largely based on speculative theories rather than the objective scientific data.

    Unlike medicine that deals with physical ailments, there are no objective tests in psychotherapy and, therefore, no objective “diagnosis”, no broad consensus among practitioners about the causes of mental distress let alone the methods of alleviating it, no factual knowledge of the mechanism of healing and no possibility to predict the outcomes.

    Very little in this practice is supported by well-established facts. That doesn’t mean the practice is invalid or unhelpful. It just means that we have to be honest about what counseling is and what it isn’t with those we serve because that’s the only way to obtain their truly INFORMED consent to receiving our service.

    Unlike medical doctors, our expertise is much less precise and scientifically based. It is still an expertise in the sense that a lot of information we possess can be potentially helpful to clients, but it’s not an expertise that would guarantee improvements if people heed our feedback. This has to be made clear upfront for ethical reasons and also not to imply that the reason that someone is not feeling and getting better is because they didn’t heed the therapist’s feedback. This may or may not be the case. Sometimes, it is the person who doesn’t want to make the necessary changes, other times it is the feedback that is not helpful because the therapist was unable to accurately access what’s going on.

  2. Hi Marina,

    Thank you for your comments.

    Actually there is much social science literature and knowledge in areas such as abuse, domestic violence, power imbalances, child development, drugs, alcohol, relationship dynamics, etc. From my perspective, it behooves the counselor to be familiar with a broad range of knowledge, informed by this social science literature and research. Such information can and does inform my practice.

    I appreciate your comment, “One thing I would add though is to inform people from the get go about the limits of the therapist’s knowledge.”

    I do this as part of my informed consent process with the people I serve so they have some sense of the scope and breadth of knowledge, experience and expertise I bring to their situation. I also screen all referrals by chatting on the phone to first determine that the request for service is within my span of practice.

    From my perspective, this all adds up to service more closely aligned with the client’s needs.

  3. Comment from a therapist on a Linked In group:

    Breaking out of the 50 minute hour as you describe feels refreshing . It alsoseems to address that delay in beginning the actual healing caused by those initial week-apart getting-to-know-you 50 minute sessions. Thanks for outlining an alternate model.

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