Cancer is a disease that affects a person’s physical and emotional health, and distress and anxiety are common for people coping with cancer and those who care about them. Fortunately, counseling can help reduce stress, improve coping and decision-making skills, and improve overall quality of life.

In counseling, the clients (patients) talk about their problems and receive guidance and advice from a trained mental health professional. Although the terms counseling and therapy (or psychotherapy) are often used interchangeably, counseling aims to find solutions to specific, immediate problems (such as coping with the side effects of cancer treatment). Learn more about the benefits of counseling. Therapy usually involves a longer, more intensive exploration of life issues or treatment of more serious conditions, such as clinical depression.

The types of counseling include individual counseling, family counseling, couples or marriage counseling, and group counseling (where individuals with similar problems meet in a group led by a counselor). Counseling services are found at a hospital, in a community or clinic setting, or in a private practice setting (at the counselor's office or home). The type of counseling you choose depends on the goal of therapy, cost, and whether you prefer a group or individual setting.

Types of counselors

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

Psychiatrists are medical doctors (MDs) who specialize in the diagnosis and treatment of mental disorders. Psychiatrists can prescribe medications to help treat mental disorders and emotional problems, such as anxiety and depression, in addition to providing counseling.

Psychologists have a doctoral degree (PhD, PsyD, EdD) and advanced training in diagnosing and treating mental disorders. Psychologists who conduct counseling or therapy usually have a doctoral degree in clinical or counseling psychology.

Licensed clinical social workers (LCSW), or 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 managing health insurance issues.

Oncology social workers have specialized training in how a diagnosis of cancer affects a person and his or her family and friends. An oncology social worker provides services, such as counseling, education, and information and referrals to community resources, including support groups. An oncology social worker often acts as a liaison between people with cancer and the medical team, and helps people find ways to navigate the health care system. Learn more about how an oncology social worker can help.

Psychiatric clinical nurse specialists (or 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 are trained to conduct counseling.

Licensed professional counselors have at least a master's degree in counseling.

Licensed marriage and family therapists have at least a master's degree in marriage or family therapy or a related field of psychology and specialized training in conducting counseling with couples or families.

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

Finding a counselor

Before looking for a counselor, consider the type of counseling you need. Talk with your oncologist, nurse, or social worker about the types of problems you have to decide what type of counseling might be best. If you are experiencing emotional problems such as depression and anxiety that do not improve over time, you may need to see a psychiatrist or clinical psychologist. If you are looking for more practical advice or general emotional support, you might consider a clinical social worker or a support group facilitated by a counselor.

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 social work and counseling services to their patients.
  
  
• Ask your oncologist or other members of your health care team for recommendations. Hospital discharge planning or home care departments can usually give you names of counselors and counseling services in your community.
  
  
• Ask your health insurance company for a list of recommended counselors.
  
  
• If you have an employee assistance program (EAP) at work, ask about services provided by the EAP or for a list of recommended counselors.
  
  
• Cancer support groups are a good place to get referrals for 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 services 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. Get a list of patient information resources.

Choosing the right counselor

Once you have a list of potential counselors, it is a good idea to briefly interview each counselor on the telephone before choosing one. There may be a cost to do the phone interview.

• Call the counselor on the phone and briefly describe your situation and reasons for seeking counseling.
  
  
• Ask the counselor to describe the approach he or she will use to help you, and ask the counselor to explain 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 the counselor whether he or she has experience treating people with cancer or people with other serious medical conditions.
  
  
• Ask about office hours, fees, billing arrangements, and which insurance plans they accept.

Many people feel nervous when talking to a new person about personal issues, including a new counselor. The success of counseling often depends on how well the counselor and client fit together as people, 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, you may want to consider finding a new one.

Paying for counseling

Counseling is expensive, so it is important to address payment issues before beginning. In general, the cost of counseling is determined by the counselor's degree of training and by the setting. Psychiatrists and clinical psychologists usually charge more than licensed social workers or licensed professional counselors. Counseling delivered in a private-practice setting usually costs more than counseling delivered in a clinic or community setting. Group counseling is often less expensive than individual counseling.

• Call your health insurance provider. Most insurance plans cover some of the cost of counseling. Many insurance plans will pay for a limited number of counseling sessions with a licensed professional. You may be required to pay a co-payment (a portion of the cost of each session).
  
  
• Some insurance providers will only pay for you to see certain types of counselors or specific counselors from a list or network of providers.
  
  
• Some hospitals and cancer centers offer free counseling services to patients receiving treatment at the hospital or center as part of their comprehensive services.
  
  
• Local health departments or social service agencies may offer free or low-cost counseling services for clients with limited financial resources.
  
  
• Some community mental health clinics and private counselors offer services on a "sliding fee" scale, meaning 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 are often seen by students in advanced training who are supervised by a senior professional.

Locating a counselor

The following organizations offer referral services to help people with cancer and those who care about them locate counselors:

CancerCare provides counseling performed by oncology social workers (by telephone nationwide or face-to-face at locations in the New York City area).

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

The American Psychological Association's (APA) Help Center offers an online Psychologist Locator Service.

Findapsychologist.org is a searchable database by the National Register of Health Service Providers in Psychology for locating doctoral-level psychologists in the United States and Canada.

Mental Health America provides a directory of local mental health associations (listed by state and county) that connect clients with local mental health services.

TherapistLocator.net, a service of The American Association of Marriage and Family Therapy, is a searchable database of marriage and family therapists in the United States and abroad.

More Information

The Benefits of Counseling

Caring for the Whole Patient

Coping

Additional Resources

Lance Armstrong Foundation: Finding a Counselor

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

Comments? Got an idea for an article? Send an e-mail to contactus@cancer.net.

Last Updated: June 09, 2010