The initial appointment will consist of a brief client orientation and an assessment interview. During the orientation, you'll have the opportunity to tell me about your previous experiences with counseling services, if any, and what you found helpful or not helpful. I'll make sure you understand the both the importance and the limits of confidentiality in counseling and help you understand the respective roles of the counselor and the client.

During the assessment interview, I'll ask you a series of questions designed to help me better understand what you're hoping to achieve through counseling and how I might be able to help you. You willl tell me what's important to you, what's working in your life and what's not, what you wish were different. You will have the opportunity to ask questions of me. If we decide to work together, we will create a preliminary treatment plan.

In subsequent sessions, we will build on the initial assessment and start working the plan. If we identified several goals, we may start by trying to decide which are most important to you or which we should address first. We may look at your relationships, your emotional and behavioral responses to life events, what you value in life, and what you believe to be true about the world you live in. I will help you identify patterns of thought and behavior that may not be useful to you. I will help you recognize counterproductive habits and challenge maladaptive beliefs or assumptions. We will identify the strengths and resources you can draw on in pursuing your goals. We may identify episodes from your life in which you achieved the outcome you wanted, or did not, and explore them in detail to find out what lessons can be learned.

Some of this work may make you uncomfortable. You may be reluctant to discuss certain things until you achieve a certain level of comfort or safety in our work together. People don't come to counselors to discuss things that are easy or inconsequential. I will do what I can  to help put you at ease and earn your trust.

Like many counselors, I take an eclectic approach to counseling; I do not subscribe to a single theory or school of thought but instead employ a variety of theories and techniques to suit the client and the situation.

Having said that, my approach does rely heavily on the principles of Cognitive Behavior Therapy (CBT). This approach is based on exploring and understanding the interrelatedness of people's thoughts, feelings, and actions. What you think or believe can influence how you feel and what you do. How you feel can influence the your thoughts. Understanding the relationships among these components of your inner life can often be the key to changing unhealthy or counterproductive behaviors.

In some ways, CBT calls on the client to explore his or her thoughts, feelings, and behaviors much as a scientist would. You may be operating under assumptions or conclusions that are not entirely accurate, or that may have been helpful or accurate at one time in your life but that have outlived their usefulness. I may help you challenge those assumptions or conclusions and help you compile evidence that will support or refute them. Through this process, these conclusions are often revised, giving rise to new and more adaptive ways of thinking, feeling, and behaving.

In part due to my training as an artist, I frequently use metaphors and analogies in my work as a counselor. I can help you frame your problems and your efforts to resolve them in ways that make the most sense to you, to help you clarify your situation, your motivations, your mission,etc. Counseling is a creative endeavor, and I enjoy helping people discover or  develop a personally meaningful approach to their work in counseling.

In the course of my work with individuals struggling with substance abuse and dependence, I have adopted components of Motvational Interviewing and Harm Reduction into my clinical approach. Motivational Interviewing is based on the Stages of Change model and suggests specific appoaches to use with individuals depending on whether they are oblivious or resistant to making a change in their lives, considering making a change in their life, or actively working toward a change. Harm Reduction is a philosphy that works toward minimizing unhealthy behaviors to whatever extent is possible rather than rigidly focusing on total cessation as the only acceptable outcome.

Finally, it is worth noting that I am not in the business of telling people what to do, or even giving advice. My job is to help you sort out what you want to do and help you figure out whether and how to do it.

There is no minimum or maximum. I have had clients who have left their first appointment feeling enough resolution that we never had to meet again. I have had other clients with whom I have worked for 4 or 5 years with only modest progress. If you feel like you have made the changes you wanted to make, then our work is over. If I feel I have reached the limits of my ability to help you, I may refer you to someone who may be better qualified to meet your needs. The treatment plan we develop together will always include a discussion of the benefits of continuing or terminating and will always anticipate a time when our work together is over. We may set out a goal of a particular time frame measured in weeks, months, or years. We may set out a target measured in a particular number of sessions. We may base our work around a time-sensitive event, such as preparing oneself for an impending graduation or surgery or marriage proposal. We will revisit these goals periodically and revise the plan accordingly.

That said, complicated, long-standing problems can easily require two years or more of intensive work to resolve. Behavior patterns that have been reinforced for decades will probably not be changed in the course of a few sessions. Counseling is, at its root, a learning process. Some things are learned (or unlearned) more quickly than others.

Some of the variables that will help determine the length of counseling are:

• Nature of the problem-Helping a teen decide which college to attend will generally take less time than helping a teen grieve the death of a close friend. Some notoriously difficult clinical problems that require substantial time in counseling include child abuse, eating disorders, and post traumatic stress disorder.
• Duration of the problem-Generally, the sooner you recognize a problem and take care of it, the quicker the treatment and the better the outcome. When faced with a medical problem, the longer you wait to go to the doctor, the worse it gets and the farther it spreads. With passing days and weeks, minor treatment options such as a simple course of oral antibiotics becomes less likely to do the job. Eventually, only grave options remain such as hospitalization, surgery, or amputation. The longer you wait to weed the garden, the longer it will take and the harder it will be. Counseling problems are no different.
• Resources and strengths-An individual with solid relationships, a network of family, friends, teachers, and colleagues who care about them and can help them through their struggles will almost always have a better prognosis and an easier (and shorter) time in counseling than someone who has no friends, strained relationships, and no social support network. For someone who suffers from schizophrenia, for example, having a family who is willing and able to provide care and support (such as making sure they stay on ther medication) can mean the difference between living a relatively normal, productive life and living frightened and disoriented on the streets.
• Commitment-An individual who doesn't acknowledge a problem is not going to work very hard to solve it. On the other hand, someone who is highly motivated to tackle their problems is probably going to make better progress than someone with identical problems but no motivation.
• Obstacles-Some sceanrios that can slow down the pace of therapeutic change include: Uphill Battles (Family counseling with a family that includes a seriously depressed individual may not work until that individual's depression is treated separately. Treating an abused child who still resides in the abusive household is going to take longer than treating the same child who has been removed from that environment. Treating a survivor of rape or incest is going to take longer if her family denies the abuse occurred or blames her for it.) Tip of the Iceberg (A client who comes in for help with anxiety or depression may have more serious underlying problems such as an eating disorder or sexual problems they are reluctant to face or are trying to keep hidden.)
• Clinical progress-When you've made the changes you wanted to make and have gained the ability to sustain those changes without my help, there's no reason for you to continue in counseling.

Confidentiality is one of the bedrock principles of the counseling process. Counseling only works if the client feels the counseling relationship provides a safe space for sharing and exploring sensitive subjects. Entering into counseling can take courage. A certain amount of vulnerability on the part of the client is often a necessary condition for clinical progress. That vulnerability is only possible if the client trusts that the counselor will not mishandle the client's sensitive information.

Generally, the counselor will not disclose information learned in a counseling session without explicit written permission from the client.

There are, however, specific limits to the principle of confidentiality, just as there are practical limits to free speech. The State of Texas requires counselors and other helping  professionals to disclose information related to the abuse of children, the disabled, or the elderly even if the information was obtained in an otherwise confidential setting such as a counseling session. Concern for the imminent safety of the client or others (for example, a specific, credible threat of suicide or homicide) may also trigger a "breach" of confidentiality.

Counseling with minors, especially when the minor's parents are paying for the counseling services, can also raise complications with regard to confidentiality. Parents may be unwilling to consent to counseling for their teen unless they get a full briefing of the content of the sessions, while the teen may not fully participate in the process if they think, or know, that everything they say is going straight back to their parents. Treatment planning in such cases will include discussions/negotiations about the rights of the minor to confidentiality vs. the rights of the parents to know what's going on with their child.

Ask questions. Ask your friends and other people you trust if they can recommend someone. Ask potential counselors about their experience, credentials, approach, values, and the kinds of people and problems they work with. There are lots of mental health professionals in the Central Texas area. Keep looking until you find someone you feel comfortable with. It makes a real difference.