When Stan presented himself for his first session with the counsellor he’d been referred to after the consultation, he was asked to complete a general information form, and was offered a paper that said, “Informed Consent.” The receptionist told him, “Read this over but don’t sign it yet. Your counsellor will go over it with you first.”
Just as he was finishing reading, a woman stepped into the reception area and introduced herself. “Come with me?” she asked.
Stan followed her to an office that, to his surprise, looked and felt like a comfortable sitting room. She indicated he should sit where he chose, and Stan picked an armchair in the corner. As he waited for the counsellor to settle in her chair, he looked around the room, observing travel photos and mementos, and to his amusement, tucked here and there among the plants and books, what looked like quirky chickens.
“Did you read over the Informed Consent, Stan?”
“I did, yes.”
“Do you have any questions about it?”
Stan cleared his throat. “I’m wondering what would cause you to breach confidentiality. I mean, how bad does the situation have to be before you report? And whom do you tell?”
“That’s a fair question, Stan. I am a ‘Duty-to-report’ professional, so when I believe there’s a credible threat of harm to Self or others, I have to report. I don’t report third party information, though. It has to be a clear threat in which you play a personal and central role. Does that make sense?”
“Kind of. What’s ‘third party information’ mean?”
“It’s like gossip. You’re telling me about what someone else said, or what you believe about a situation without having direct, first-hand involvement. The legal profession calls this kind of information ‘hearsay’ and it’s not legally actionable.”
“Okay. I get it. To breach confidentiality, harm has to involve me directly?”
“Okay. I’m clear. You’re not going to report anything from these sessions except for very specific circumstances.”
“Right. If your questions are all answered, then you can sign the consent, and I’ll sign it, and we’ll give you a copy after this session.” Stan signed the form and handed it to the counsellor, who also signed it and set it aside.
She picked up a clipboard. “This session is a clinical interview to gain some understanding of the history of the problem, and also to collect information about you that’s important to solving the struggle you’re having. It’s the only time where I’ll take notes in session. When we’re done with the interview, I’ll teach you some strategies you can practice which will could help you manage the panic attacks.”
Stan shrugged. “I don’t have any idea what’s supposed to happen in a session, so you can take notes or whatever. I’m hoping I can go away from today with something tangible to do.”
She smiled. “For sure you will have something tangible you can do when you leave. Let’s get started.”
About an hour later, Stan took a deep breath and said, “Wow. I had no idea all that information was relevant to panic attacks.”
“It’s all relevant. Our histories are directly connected to our current circumstances.”
“I’m surprised actually,” Stan said slowly. “I’ve never put my history together all at one time. There are things I’ve never considered that appear to be really significant. Especially now that I know that anxiety is often generational.”
“It is, that’s true. Those significant things are what we’ll explore in coming sessions. Now, I’m going to teach you some ways to gain control of your anxiety in the moment.”
“Finally!” Stan responded with a smile.
“I’m going to teach you Box Breathing and a couple of distraction techniques. I think our trauma specialist that you saw for the consultation explained to you how practicing in between sessions is the key to successful therapy?”
“She did, and I’m prepared to practice hard,” Stan grinned. “Show me what to do and I’m all over the ‘practice’ part.”
“Groovy. Practice the breathing when you’re not panicking. Every time you’re doing something that allows you to practice, do. Five rounds at least. If you’re doing it correctly, after about day 2 you’ll have sore abdominal muscles because most people don’t breathe properly. Keep practicing and it will go away.”
“Got it. I’ll do it,” Stan said firmly.
Thirty minutes later, Stan left his first counselling session feeling encouraged and determined to practice. She’d promised to send him the instructions by email, and he was feeling hopeful that things could be different. He was already looking forward to his next session.
Follow the Story of Stan as he moves through the process of therapy to deal with his anxiety. Look for The Story of Stan - Session 2