“The unexamining life is not worth living for a human being.”

~ Socrates



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Commonly Asked Questions about Counseling and Therapy.

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Why Seek Counseling?

There are many reasons to seek support from a caring, trained professional therapist.  Some include:
  • Feeling stuck or directionless in your life or career.
  • Crisis, high levels of stress, or feelings of overwhelm.
  • Long-standing psychological difficulties.
  • Unexpected/challenging life changes such as transition, divorce, or job loss.
  • Depression and/or anxiety and pervasive worry.
  • Feelings of loss and grief that have gotten in the way of living.
  • Recurrent and/or intrusive thoughts, images, memories, feelings, body sensations, flashbacks, nightmares, etc.
  • Issues surrounding self-esteem, identity, sense of self, and/or body image.
  • Unresolved childhood issues/past and present traumas, parental/sibling conflict.
  • Relationship problems.
  • Substance abuse/dependence/addiction.
  • Personal exploration/growth including self-knowledge, spiritual connection, awareness, direction, and/or meaning.

These are just a few of many reasons why people seek out therapy.  Therapy is beneficial to anyone who wants to get the most out of life by developing self-awareness, taking responsibility, and moving toward positive change. A good therapist can help foster insight, teach coping skills, and, above all, provide support and a non-judgmental listening ear when needed most.  The very question of whether you need to talk to someone may be a good sign that you will benefit from it.

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What Can I Expect From Therapy?

  • Most therapy sessions are usually about 50 minutes (although some people request 90-minutes or longer depending on need/preference). 
  • Weekly sessions are often recommended, especially at first, although people in crisis may need more than one session a week.  Some people choose to meet bi-weekly, for financial or scheduling issues, or if that is what is medically appropriate.  Whether weekly or bi-weekly, therapy can be highly effective, especially if you do your homework and spend time thinking about and applying what you learned between sessions.  
  • Homework may be assigned as part of therapy.  This usually involves practicing skills, keeping a journal, reading a relevant book/website, or doing an art project.  While you will not “get in trouble” if you do not complete your homework (no flashbacks too high school here), mental well-being can take a lot of work.  You get out of therapy the work you put into it.
  • Counseling sessions are often primarily talk, however, depending on what you are working on, we may use somatic (body) awareness exercises, mindfulness, guided imagery exercises, art, movement, play, nature encounters, and other interventions that seem appropriate.   
  • Most importantly, I AM HERE FOR YOU. I do not seek to push you in a direction you do not want to go.   You always have the right to redirect, question, or tell me “no thanks” when I suggest an intervention, and I will honor you without judgment.
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What Can Therapy Do For Me?

Sometimes a listening ear can work wonders.  Therapy is primarily about the relationship – having a non-biased, compassion, respectful someone in your corner to listen, relate, and reflect.  Therapy can also be about growth and change, and can sometimes involve being challenged (respectfully), given effective techniques and interventions, and being asked to feel feelings that can be painful and difficult (within the safety of the relationship). But through hard work and dedication, you can:
  • Develop a clearer picture of yourself, your goals, motivations, and values.
  • Improve relationship and communication skills.
  • Gain awareness into unconscious relational patterns and break them.
  • Resolve troubling issues and blocks.
  • Discover new/healthy problem solving techniques and other strategies for creating positive change.
  • Improve self-confidence and self-esteem.
  • Manage stress, anger, depression, anxiety, or other mental and emotional pressures.

For further information read: Does Talk Therapy Really Work? by F.D. Barth, (Psychology Today, 11/2010)

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Is What I Say Kept Confidential?

Counselors are bound by the ACA Code of Ethics and Standards of Practice, the Code of Ethics for the states in which they are licensed, and by HIPPA (Health Insurance Portability and Accountability Act of 1996) privacy laws to ensure protection of confidentiality within the boundaries of the client/counselor relationship. Any disclosure of your confidential information will be made only with your full written, informed consent and will be limited to a specific situations and period of time as laid out in the Release of Information that you sign.

There are some limits to confidentially.  Oregon Counseling Board Code of Ethics dictates the following exceptions:
  • Reporting suspected child/elder abuse,
  • Reporting imminent danger to the client or others,
  • Reporting information required in court proceedings or by client's insurance company or other relevant agencies,
  • Providing information concerning licensee case consultation or supervision (others bound by confidentiality),
  • Defending claims brought by the client against licensee.

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How Do I Choose a Therapist?

There are a lot of philosophies and methodologies within mental health, and several different educational tracks for therapists (counseling, social work, psychology, psychiatry, art therapy, etc).  Each has a somewhat different focus in education (i.e. counseling is focused more on the individual level whereas social work is often more focused on the societal/institutional level, psychologists often also conduct research as part of their training), but each kind of training has merit and can prepare a therapist for working with you. 

Regardless of approach, philosophy, or methodologies, research has indicated that the relationship is the primary change agent in therapy.  The primary question then becomes, "is this person someone I can work with?  Is there the ability to trust this person and build rapport?  Many clinicians, including myself, offer free or low-cost initial consultations so you can meet in person and "try them on."  This is a time for you to ask questions, explain what you are looking for, and feel into the potential of relationship.  Some things to consider and communicate on an initial session are: 

What are you looking for in therapy? 

  • What are you looking for in therapy?  Your first session may explore this a little so the therapist can get a good idea if there is a good match.  If that therapist feels they are not a good match (often because they do not specialize in the type of treatment that you want or that is recommended for what you are working on) that therapist may be able to offer other referral options.  Ethically, they must offer several choices.
  • What are your expectations of a typical session?  Knowing your expectations and communicating that with your potential therapist can be helpful.  Remember, however, that just because a therapist does not match this expectation entirely does not mean that it is not a good match, so it is important to talk to your potential therapist about it.
  • Remember, you should ALWAYS be able to talk to your therapist about any concerns you have within the relationship, even if you have seen that person for a while.  Talking about your expectations, feelings, doubts, fears, etc can help your therapist give you the best care possible.


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Kristine Nystrom, LPC, LMHC

4531 SE Belmont St. Suite 203, Portland, OR 97215

503-382-9654 kristine@newstreamscounseling.com