EverythingYouWantedtoKnowAboutCounseling AfterBrainInjurybutWereAfraidtoAsk

Katy Wilder Schaaf, PhD, Lillian Flores Stevens, PhD, and Stephen Smith, PhD Department of Physical Medicine and Rehabilitation Virginia Commonwealth University Richmond, VA

Braininjurycanchangeyourlifeinmanyways.Manypeoplereportfeeling worthless,misunderstood,lonely,andfrustratedaftertheirinjury.Infact,overhalfof peoplewhohaveabraininjuryalsoexperiencedepression.Peoplewithbraininjury mightalsoexperienceanxiety,difficultycontrollingemotions,changesinrelationships withfamilyandfriends,financialstrain,anddifficultyadjustingtochangesinwork, school,orhomelife.Lifeafterabraininjurycanbeoverwhelmingforboththesurvi vorandfamilymembers. Yourdoctormayhaverecommendedcounselingorpsychotherapy*.Afterinjury, patientsoftengotomanytherapies,suchasphysicaltherapy,occupationaltherapy, speechtherapy,etc.Counselingissimplyanotherformoftherapythathelpspeople recoveremotionallyaftertheirinjury.Goingtocounselingdoesnotmeanyouare crazy;itisatoolyoucanusetohelpyoufeelbetterabout yourlifetodayandmorehopefulaboutthefuture.
*Thetermscounseling,psychotherapy,andtherapyareverysimilarandareoftenusedinter
changeably.However,atherapistvs.acounselormayhavedifferentwaysofapproachingtreatment.

FREQUENTLYASKEDQUESTIONSABOUTCOUNSELING
1. What happens when I go to counseling?
Yourexperienceincounselingwilldependontheparticularproblemsyouwanttoworkon.Thereare manydifferentwaystohelpyouaddressyourconcerns.Counselingisnotlikeamedicaldoctorvisitwhere thedoctortellsyouwhattodotofixyourproblem.Instead,youwillbeactivelyinvolvedinlearninghowto identifyandsolveyourownproblemsinthefuture.Thosewhobenefitthemostfromcounselingnotonly workontheirconcernsduringsessions,butalsoathome.

2. Can counseling help me?

Counselinghasbeenshowntobehelpfultomanypeoplewhoarerecoveringfromaninjury.Sincecounsel ingofteninvolvesdiscussingunpleasantaspectsofyourlife,youmayexperiencetemporaryuncomfortable feelingslikesadness,anger,andfrustration.However,overtime,counselingcanleadtoimprovementsin relationships,solutionstospecificproblems,anddecreasedfeelingsofdistress.Becausepersonalexperi encesvary,thereisnoguaranteedresultofcounseling.

3. Why do I need to go to counseling? I have support from family, friends and my community.
Family,friendsandcommunitycanbeexcellentsourcesofsupportandcanbethereforyouwhenyou needhelpthemost.However,atrainedcounselorcanprovideyouwithadditionalsupportthatcanaddto thehelpyoureceiveathomeorinyourcommunity.Acounselormayworkwithyoutodevelopnewskills andcopingmechanismsthathelpyoufeelbetterandmorecapableofhandlingproblemsonyourownin thefuture.Counselorsmayalsohelpyoutodiscusssituationsinwhichyouarereceivingconflictingadvice fromfriendsorfamily.

4. How do I know that what I say will be kept private?

Alllicensedmentalhealthprofessionalsarerequiredtofollowacodeofethics.Thecodeofethicsrequires thatcounselorsonlyshareinformationabouttreatmentwithpeopleauthorizedbyyou.Astheconsumer, youcansignareleaseofinformationforyourcounselortotalktootherpeople.Thereareafewexceptions whichyouandyourcounselorshoulddiscuss.Theseexceptionsinclude:(1)yourcounselorbeingcon cernedthatyouareadangertoyourselfortosomeoneelse,(2)youreportingchildabuseorneglect, (contd)

(3)youreportingelderabuseorneglect,or(4)yourrecordsbeingsubpoenaedbyacourtoflaw.Ifthese thingscomeupinsession,yourcounselorshouldtalktoyouaboutreportingthemtothenecessarypeople.

5. What is the difference between a psychologist, psychiatrist, counselor, therapist, and social worker?
Title Counselor, PsychotherapistorTherapist Generaldescription*
generaltermthatcouldrefertomanymentalhealthprofessionals providescounseling/therapy providesmentalhealthreferralifmedicationorotherservicesare

Psychiatrist

Psychologist

SocialWorker

needed hasmedicaltraining providesmedicationmanagement providesbriefcounseling typicallyschedulesappointmentslessfrequentlythanothermental healthprofessionals hasadvancedtraininginmentalhealthproblems providescounseling/therapy conductspersonality/cognitiveassessments providescounseling/therapyandreferrals providescasemanagement

*Thischartdescribeswhatatypicalpersonineachfieldmaydo. Whenyoufirstmeetwithyourcounselor,feelfreetoaskwhat typeoftrainingheorshehasandwhattypesofmentalhealthser vicesheorsheprovides.Eachmentalhealthprofessionalmayhave differentspecialties.Makesurethecounseloryoumeetwithis trainedtohelpyouwithyourspecificneedsandhaspreviousex periencewithbraininjury.

6. If I go to a counselor, will he or she try and get me to take medication?

Theonlyhealthprofessionalswhoareabletoprescribemedicationsarepsychiatrists,othermedicaldoc tors,ornursepractitioners/physiciansassistants.So,mostcounselorsarenotabletoprescribemedica tionsandwillworkwithyouonbehavioralwaystomakechangesinyourlife.Ifyouthinkthatmedication couldprovidesomeadditionalbenefit,youshouldtalkwithyourcounselorandletthemknowyourfeel ings.Yourcounselormayprovideareferraltoanotherprofessionaltodiscussmedication.Yourcounselor canalsotalkwithyouabouthowtoapproachtheappointment.

7. Will my counselor make me relive painful memories or talk about things that I dont want to talk about?
Talkingaboutproblemsisoftendifficult.Youmayexperiencetemporaryuncomfortablefeelingslikesad ness,anger,andfrustrationwhenyoudiscussunpleasantaspectsofyourlife;however,yourcounselorwill neverforceyoutotalkaboutsomethingyoudontwanttotalkabout.Youhavecompletecontrolover whatyousharewithyourcounselor.

8. How do I find a counselor?

Therearedifferentwaystofindacounselor. 1) ContacttheBrainInjuryAssociationofVirginia(18004446443)oryourlocalBrainInjuryAssociation. Theassociationcanprovideyouwithareferraltoaprofessionalintheareawhospecializesinworking withpersonswithbraininjury. 2) Ifyouhaveinsurance,youcancontactyourinsurancecompanyandrequestalistofcounselorscov eredbyyourplan 3)Talkwithyourprimarycarephysicianandrequestareferral.

9. What do I look for when trying to find a counselor?

Therearemanydifferentwaystodescribeagoodcounselor.Hereareafewthingsthatyoushouldlookfor whentryingtofindyourcounselor.Acounselorshould: Beapersonyoufeelcomfortablewith Bedependable,respectful,andunderstanding Showinterestintheissuesyoubringtotherapy Haveknowledgeandtrainingregardingyour typeofconcerns Helpyousetgoalsthatfityourlife Beopentofeedbackandquestionsyouhave Providereferralsifhe/sheisunabletohelpyou withaproblem

10. What happens if I go to counseling and dont like my counselor?

Noteverycounselorisagoodfitwitheverypatient.Ifyouareunhappywithprogressincounselingorfeel likeyourcounselorisnotagoodfitwithyou,letyourcounselorknowaboutyourconcerns.Yourcounselor maystartbytryingtoworkthroughsomeofyourconcerns.However,ifitisclearthattherelationshipwill notwork,yourcounselorshouldprovideyouwithsomereferralsforotherprofessionalswhomightbeof help.Agoodcounselorwillnotbeoffendedorupsetaboutyourdesiretofindaprofessionalwhobetter fitsyourneeds.

11. How much time does counseling take?

Lengthsofappointmenttimesvary,butatypicalcounselingappointmentis50minuteslong.Someap pointmentsmaybeshorterorlongerdependingonthepurposeofthesession.Peoplecanbeseenevery week,everyotherweek,onceamonth,oreveneverycoupleofmonths.Together,youandyourcounselor candecidehowoftenyouwillmeetbasedonyourownindividualneeds,goals,andcircumstances.The lengthoftimeyouwillstayincounselingwillvarydependingontheissuesyouareworkingonandthe strategiesyouandyourcounselorthinkwillbemostbeneficial.Somepeopleseeacounseloronlythreeor fourtimes,whereasotherpeoplemaycontinuetomeetwithorcheckinwiththeircounselorforamuch longerframeoftime.

12. How much does it cost to go to counseling?

Costvariesdependingoninsurancebenefitsandserviceprovider.Typically,ifyourinsurancecoverscounsel ing,youwouldberesponsibleforallcopaysandcoinsurance.Ifyoudonothaveinsurance,somecommunity clinicsprovidecounselingonaslidingscale.Aslidingscalefeemeansthattheamountyoupayisbasedon yourincome.Ifyoudonothaveinsuranceandareinneedofcounseling,besuretoaskabouttheslidingscale option.

13. Can I bring family members to my counseling sessions?

Youcanworkwithyourcounselortodecidewhetheritmightbehelpfultobringyourspouse,parent,chil dren,orotherclosefamilymembers.Sometimescounselingcanbeusedtoworkonproblemsindividually. Sometimesitishelpfultoincludefamilyorfriendstoworkonproblemsasagroup.Youandyourcounselor candecideonthistogether. Sometimes,peoplefeelstronglythattheirfamilybeapartoftheircounseling.Thismaybebecausethey feeltheirissuesaredirectlytiedtotheirfamilyrelationships,oritmaybebecausetheywouldlikethesup portandfeedbacktheirfamilymemberscanprovideinsession.Ifyoufeelthatyouwouldbenefitmostby havingfamilycounseling,youmaywanttoconsiderlookingforacounselorwithaspecialtyinfamilyrela tionships.CounselorsidentifiedasMarriageandFamilyTherapistsorwhohavetheinitialsMFTor LMFTaftertheirnamehavethisspecialty.

Department of Physical Medicine and Rehabilitation Virginia Commonwealth University Richmond, VA

For further information, please contact Dr. Emilie Godwin: eegodwin@vcu.edu ThisworkwassupportedbyGrants#H133A070036and#H133P040006fromtheNationalInstituteonDisabilityandRe habilitationResearch(NIDRR),OfficeofSpecialEducationandRehabilitativeServices(OSERS),DepartmentofEducation, Washington,D.C.