Dissecting a Counselor’s Brain: What’s She Really Doing?

I’m often asked what exactly I do during a counseling session. “Isn’t counseling just for people who don’t have family or friends to talk to?” The belief is that as a psychotherapist I play the role of a confidante; mostly listening, sometimes giving advice, never judging. “I can’t believe I have to pay someone to listen to me,” is another way to phrase it. So what exactly am I doing during an adult session? Here’s a behind-the-scenes look. Bart came to see me because his kids and wife “had enough of his temper.” Bart would go for weeks without raging, but then some little annoyance would happen and he spent hours yelling and breaking dishes.

I approach Bart’s temper from several different angles. Angle one: education. When we don’t recognize frustrations when they occur—no matter how trivial they seem—we can end up in this pattern of calm punctuated by surprise bursts of anger. The second angle: anger management skills. Bart and I broke his pre-outburst experiences down second by second, exploring what was happening in his thoughts, emotions, behaviors and body. Bart was surprised to notice there were many clues he’d missed. Working with me he became skilled at identifying these signals and taking a time out, which ranged from standing on the deck for a few minutes to driving to a friend’s house. The third angle: Bart’s history. Bart grew up in a household where the only acceptable feeling was anger so emotional identification was challenging. Through our conversations Bart became more proficient in recognizing a range of feelings. The fourth angle: Bart as a father. Bart and his wife desperately wanted another child and had recently experienced a devastating miscarriage. Some of his anger was part of grieving the loss of his daughter and how out of control he felt.

Literally each moment of the counseling session I am taking in the new information from Bart, plugging it into these different angles (and many more), adjusting my assessment of the situation, and deciding the most productive course of action. This constant process facilitates Bart reaching his overall goal: reduce and eliminate his rages.