Counseling

Counseling is designed to help people respond to challenges and the associated emotions in healthy ways. Counselors cannot always solve problems, but they provide a safe environment for people with cancer to talk about their concerns. Because counselors are removed from the situation, they provide a helpful, outside perspective.

When to seek counseling

Although it's normal to experience emotional distress while living with cancer, it's important to seek professional help when the distress is long lasting and interferes with your ability to carry out daily activities. However, you may find counseling helpful even if your level of distress is not severe. Living with cancer is an enormous challenge for everyone, and even a few counseling sessions are likely to be helpful.

How counseling helps

Counseling often helps people with cancer and those who care about them. Some goals are to:

  • Learn ways to cope with a cancer diagnosis, feel less overwhelmed and more in control
  • Explore the meaning of the cancer experience
  • Manage difficult feelings, such as depression and anxiety
  • Manage cancer symptoms and treatment side effects, such as pain and fatigue
  • Learn how to communicate effectively with the health care team
  • Address relationship issues and financial concerns that are causing distress
  • Explore options and get feedback about important decisions
  • Consider professional or workplace issues and strategies
  • Talk about concerns you may have about what comes next after finishing treatment
  • Learn how to help your family understand and adjust to changes in routine as a result of a cancer diagnosis
  • Explore and resolve cancer-related sexuality issues 

Types of counseling

The type of counseling you choose may depend on your specific needs, personal preferences, and financial resources. The options include the following:

Individual counseling. This provides a one-on-one interaction with a counselor to talk about troubling circumstances, thoughts, and feelings. The counselor will listen attentively, express caring concern, ask questions, and offer feedback.

Couples or family counseling. When meeting with a couple or with multiple family members, a counselor listens objectively to all participants and helps identify how specific thoughts and behaviors may be contributing to conflict. Family members learn new ways to support one another during stressful times.

Group counseling. A group of individuals with similar concerns may meet together with a counselor who leads the discussion and provides support and guidance. Individuals learn from both the counselor’s insights and the perspectives of the other members of the group.

Types of counselors

In most cases, mental health professionals must complete specialized training and pass a state examination before becoming a licensed counselor. The following individuals are qualified to provide counseling services.

Psychiatrists. These are medical doctors who specialize in the diagnosis and treatment of mental disorders. In addition to providing counseling, psychiatrists can prescribe medications to treat mental disorders and emotional problems. 

Psychologists. These professionals have a doctoral degree and advanced training in diagnosing and treating mental disorders. They are qualified to do psychotherapy and research, but they cannot prescribe medication.

Licensed clinical social workers. These professionals, also called psychiatric social workers, have at least a master's degree in social work and advanced training in counseling. In addition to providing counseling, social workers specialize in connecting patients with community resources and providing practical assistance, such as help managing health insurance issues.

Oncology social workers. These professionals have at least a master’s degree, with a special emphasis on the effects of a cancer diagnosis on people and their family and friends. Oncology social workers provide services such as counseling, education, information, and referrals to community resources. In addition, they often act as a liaison between people with cancer and the medical team and help people navigate the health care system. Qualified oncology social workers generally have the letters “OSW-C” as part of their formal title. Learn more about how an oncology social worker can help.

Psychiatric clinical nurse specialists. These professionals, also called psychiatric nurse practitioners, are registered nurses who have at least a master's degree in psychiatric mental health nursing. They specialize in treating mental disorders, and they are trained to conduct counseling.

Licensed professional counselors. These professionals, also called licensed mental health counselors, have at least a master's degree in counseling.

Licensed marriage and family therapists. These professionals have at least a master's degree and specialized training in conducting counseling with couples and families.

Licensed pastoral counselors. These professionals have at least a master's degree in ministry or divinity and specialized training in counseling. Licensed pastoral counselors conduct counseling within the context of religion and spirituality.

Finding a counselor

Before looking for a counselor, consider the type of counseling you need. Ask your oncologist, nurse, or social worker for help evaluating the options. If you are experiencing emotional problems (such as depression and anxiety) that do not improve over time, you may need to see a psychiatrist, clinical psychologist, or oncology social worker. If you are looking for practical advice or general emotional support, you might consider a clinical social worker or a support group facilitated by a counselor.

Keep in mind that finding a comfortable connection between you and the counselor is just as important as learning about the counselor’s education and skills. You may need to talk with several potential counselors before finding the one that is best for you. When you first speak with a counselor, be sure to ask about his or her experience in working with people coping with cancer.

Here are some tips for finding a counselor:

  • Ask about counseling services available at your hospital or cancer treatment center. Many hospitals and clinics offer such services to their patients.
  • Ask your oncologist or other members of your health care team for referrals to counselors and counseling services in your community.
  • Ask your health insurance company for a list of counselors covered under your plan.
  • Ask whether your employer has an employee assistance program (EAP) that provides counseling services.
  • Ask members of a cancer support group for recommendations of counselors experienced in treating people with cancer.
  • Check your telephone directory or ask your local librarian to help you find information on services available in your community, including those available from your local health department.
  • Use the Internet to search for mental health and cancer service organizations. Many of these organizations have free referral services, and some offer limited, free counseling services over the telephone. Find a list of organizations that offer support and services for people with your type of cancer.

In addition, the following organizations offer referral services to help you locate counselors: 

American Association of Marriage and Family Therapy. This organization has a searchable database (therapistlocator.net) that lists marriage and family therapists in the United States and abroad.

Association of Oncology Social Work. This organization provides a list of qualified oncology social workers in your area.

American Psychological Association. This organization offers an online psychologist locator service.

American Psychosocial Oncology Society. This organization has a toll-free helpline (866-276-7443) for people with cancer and their caregivers to find counseling services in their local communities.

CancerCare. This organization provides counseling performed by oncology social workers, available by telephone or in person at locations in New York City, Long Island, New Jersey, and Connecticut.

Mental Health America. This organization provides a directory of local mental health associations that connect clients with mental health services.

National Register of Health Service Providers in Psychology. This organization’s searchable database (findapsychologist.org) helps people locate doctoral-level psychologists in the United States and Canada.

Choosing the right counselor

Once you have a list of potential counselors, briefly interview each over the telephone before choosing one. Ask the counselor if there will be a cost associated with the initial phone call. Often, a brief initial phone call is free of charge.

The following suggestions will help guide your conversation:

  • Describe your situation briefly, and explain your reasons for seeking counseling.
  • Ask the counselor whether he or she has experience treating people with cancer or people with other serious medical conditions. This is very important. You do not want to waste your valuable time and money with someone who does not have this background.
  • Ask the counselor to describe the approach he or she would use to help you, and ask for an explanation of any terms you do not understand.
  • Ask the counselor to explain his or her professional degrees, training, and licensure. You can double-check a counselor's credentials by contacting your state licensing board.
  • Ask about office hours, fees, billing arrangements, and insurance plans the counselor accepts.

Many people feel nervous when talking to a new person—such as a new counselor—about personal issues. The success of counseling often depends on how well the counselor and client interact, and not every counselor will be a good match for you. If after several sessions you do not feel comfortable talking with your counselor or you don't think that your counselor's suggestions are helpful, consider finding a new one. And assess whether the type of therapy and the topics of discussion have been an appropriate match for your needs, which will help guide your search for a new counselor.

Paying for counseling

Counseling can be expensive, so it is important to address payment issues before beginning. In general, the cost of counseling is influenced by the counselor's degree of training and by the setting in which the counseling occurs. For example, psychiatrists and clinical psychologists typically charge more than licensed social workers or licensed professional counselors. And counseling delivered in a private practice setting typically costs more than counseling delivered in a clinic or community setting. Group counseling is often less expensive than individual counseling. Most cancer support groups are provided as a community service and are free to its members.

Contact your health insurance provider to learn what services your health insurance plan covers. Most plans cover some of the cost of counseling. Many will pay for a limited number of sessions with a licensed professional. You may be required to pay a copayment (a portion of the cost of each session). Meanwhile, some insurance providers will only pay for sessions with certain types of counselors or specific counselors from a network of providers.

If the financial cost of counseling is a burden for you, consider the following options:

  • Some hospitals and cancer centers offer free counseling services to patients as part of their comprehensive services.
  • Local health departments or social service agencies may offer free or low-cost counseling services for people with limited financial resources.
  • Some community mental health clinics and private counselors offer services on a sliding fee scale, meaning that the cost is based on what you can afford.
  • Medical schools and universities with psychiatric or mental health clinics may offer lower-fee counseling sessions. Clients typically receive counseling from students undergoing advanced training who are supervised by a senior professional.

Learn more about managing the cost of cancer care.

More Information

Caring for the Whole Patient

Emotional and Physical Matters

Additional Resources

LIVESTRONG: Finding a Counselor

Mental Health America: Finding the Right Mental Health Care for You