Confidentiality is an important part of counselling that helps to ensure safety in the counselling process. The specifics of it are reviewed in detail as part of the informed consent process so you understand exactly how it works. Confidentially basically ensures the privacy of what is shared in terms of what is documented, how it is stored, and if and how it is disclosed with your consent. 

Everything is confidential with a few exceptions, including through the duty to warn and protect if you are at risk of harming yourself or someone else, if there is abuse of children or vulnerable adults, or if there is a court order legally requiring information or documents.  

The flow of each session varies depending on the phases of recovery and can involve a number of things to move you forward such as:

• Checking in and reviewing or determining the session’s specific focus.
• Listening to your concerns and allowing you to express your thoughts and feelings.
• Supporting your identification of problematic thoughts, feelings, behaviors, or circumstances.
• Asking questions or giving exercises to prompt self-awareness and insight.
• Conducting assessments to measure your progress.
• Providing relevant psychoeducational information or handouts.
• Helping you identify your strengths and resources and notice progress.
• Using interventions to stabilize things, release things, reimagine things, and practice things.
• Suggesting some reading or writing assignments to help you gain insight into your concern.
• Giving a homework assignment to be completed between therapy sessions.
• Assisting you to develop plans for managing or overcoming the obstacles to your well-being.

Fear of further overwhelm or being overtaken by painful feelings is one of the major reasons people don’t go or put off counselling that would help them recover.

Safety is one of the most important aspects of counselling, especially for toxic stress, trauma, and complex trauma whereby the nervous system is already feeling “unsafe”. This means that the process and pace of everything, particularly during the first phase of stabilization works to restore that safety.

Nothing painful is opened up until there is some stabilization in the system and you have learned some practices to be able to keep yourself in, or quickly return to a state of safety and stabilization. And even then, there is great deliberateness in ensuring that any painful experiences are moved through in small doses (not all at once) that won’t overwhelm.  This approach also helps to build something called distress tolerance, which is an important skill in life. 

Counselling certainly benefits from your honest expression of what you are thinking and feeling and what is affecting you. It’s hard for a counsellor to support you fully and properly without knowing the big picture of what’s happened.

Processing of traumatic material is part of recovery for trauma and complex trauma. Because of the nature of trauma, these experiences were not encoded and integrated in the brain or in your story at the time of their occurrence. But, it is not necessary to verbally share the details of the story in order to process and consolidate the experiences. There are numerous nonverbal ways to work with the experiences that are just as effective. You don’t have to tell the story unless you want to and believe it would be beneficial. 

It’s important that people pay for counselling to signify the investment in themselves, their commitment to the process, and the extensive training and support of the counsellor.

Counselling can seem expensive when added up over time, but its benefits in support and helping people to resolve what are often significant issues generally outweigh the expense. 

Generally, the costs of counselling have been rising along with everything else. I intentionally keep my rate on the low end ($110/session) to make it more accessible especially for those with no or limited health insurance benefits. Beyond that, I also offer a sliding scale that further reduces the cost.  

I don’t use specific financial cutoffs for the sliding scale, but prefer to have a conversation during the consultation process or the first session to determine what session rate makes the most sense given people’s ability to pay within their income and circumstances but that also feels appropriate. 

The recommended frequency of session varies by the phase of recovery. In the earlier phases where stabilization is being established and processing is happening it is helpful to have sessions every 1-2 weeks, but this can stretch to every 2-4 weeks in the development and moving forward phases.  

The overall length of counselling is variable based on client motivation, number and severity of issues to resolve, and effort with homework and practicing new skills outside of therapy sessions.

Many people with toxic stress or trauma feel they have obtained the improvement they were looking for in 8-12 sessions. For some it is fewer and for others longer.

With complex trauma, people often approach counselling in parts. Over the course of a number of years, they engage in multiple rounds of counselling with gaps to integrate in between. In each round, they focus on addressing one or more aspects of the complex trauma and how its affecting them and their lives.

For example, in the first round stabilization would be brought into the nervous system including learning to identify and work with triggers and one or two significant trauma(s) might be processed. In the next round, issues of self identity and leadership might be focused on along with processing a few more significant trauma(s). In the following round, insecure attachment and relationship issues might be explored while another couple of significant trauma(s) are processed. Etc.