What should I talk about in counselling? Part 1 of 3: The presenting problem

What should I talk about in counselling?

What should I talk about in counselling? This question is asked by every single individual (or couple) who considers asking a professional for assistance – and few find it an easy question to answer. Even those who feel they have a readily identifiable issue or concern will still have questions about what aspects of it to discuss, and may be uncertain as to the best way to approach it. This series of blogs will discuss this question in some depth, and hopefully provide a solid overview of how any individual considering a therapeutic endeavour can answer that question for themselves and get the most out of their counselling experience. This is the first in a 3 part series of blogs entitled “What should I talk about in counselling?” and in it I will discuss the nature of the top-line issue(s) that usually bring(s) about the final decision to contact a therapist. This is something therapists call: The presenting problem.

The term “The presenting problem”, refers to that final last straw issue or life event that ultimately brings someone into a therapeutic endeavour. It is the issue that any given person who meets with a therapist or counsellor for a first session states as the reason they are there. For some it may be that they have suffered a bereavement, others may have discovered their partner has had an affair and still others find they are struggling with some sort of anxiety or compulsive behaviour. The truth of it though, is that having met with many hundreds of individuals over the last 20 years of practice, a “presenting problem” can literally be anything. What is important is that your therapist understands that nobody exists in a bubble consisting only of their top-line presenting problems, while at the same time they are not so arrogant as to minimalise the importance of yours and instantly try to dig deeper. The fact is, life is complicated and life’s problems often have several layers. A professional therapist knows this, and knows that there is likely to be more to it than meets the eye, but a good therapist also knows that it is not their place to believe they know you better than you, nor is it their job to pry information out of you to get to what they believe is the full story.

Good therapists are able to find the balance between accepting the full validity and impact of any presenting problem, whilst also quietly understanding that there are likely to be additional contributing factors running alongside it – but also know how to allow those other factors to come out naturally, at the right pace and time for you. Even then however, it is critical that no therapist sit with a client thinking to themselves, “Yes yes, I know that this is reason you’re claiming to be here, but I also know there is a lot more to it than you are telling me, and I’m sure we’ll get to in a minute”. Frankly, any therapist who does have that thought process, shouldn’t be practicing.

So how does this answer the question: What should I talk about in counselling? Well, quite honestly, my suggestion at this stage is: Please try not to worry to much about that question right now. I know that this is a big ask and sounds counter-intuitive, but I promise that the rest of this blog series will explain why I’m saying this. In my opinion the questions that are far more important to be thinking about as you attend your first session are: “Do I feel comfortable and safe with this therapist?” and “Do they feel genuine and trustworthy?”. My continuing experience is that these gut feeling questions are the single most important factor in helping people who have just begun a therapeutic endeavour to discover what to talk about in counselling. I say this because if you do feel comfortable and safe, and if you do feel your therapist can be trusted and is genuine, then the things you want to talk about will come out naturally, all by themselves.

Having said that, by all means tell your therapist about your presenting problem, but also use that time to suss out those other important feelings about the professional you are sitting with. Beyond that, listen to your gut. If you feel safe, and you feel you can trust your therapist, you will quickly wonder why you ever worried about what to talk about in counselling in the first place. This leads us nicely to the next blog in this series: Feeling safe and comfortable with your therapist