Counseling

Approved by the Cancer.Net Editorial Board, 04/2018

Counseling helps people manage and respond to their mixed emotions about life’s challenges. Counselors cannot always solve problems, but they provide a safe place for people with cancer to talk about their concerns. Because counselors are separate from a person’s life, they provide a helpful, outside viewpoint.

When to seek counseling

It is normal to feel distressed while living with cancer. But it is important to seek help when the distress is long lasting. Seeking help is also important when your feelings affect your ability to cope with your daily life. You may find counseling helpful even if your level of distress is not severe. Living with cancer is a huge challenge for everyone. Even a few counseling sessions will likely help you.

How counseling helps

Counseling may help you:

  • Learn ways to cope with a cancer diagnosis and feel less overwhelmed and more in control.

  • Explore what your cancer experience means to you.

  • Manage 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 with family and friends.

  • Discuss financial concerns and identify helpful resources.

  • Explore options and get feedback about important decisions.

  • Consider workplace issues and strategies to manage them.

  • Discuss your concerns about what comes after finishing treatment.

  • Learn how to help your family understand and adjust to changes in routine.

  • Explore concerns around intimacy and sexuality.

Types of counseling

The type of counseling you choose may depend on your needs, preferences, and finances. Options include:

  • Individual counseling. This provides a 1-on-1 exchange with a counselor to talk about troubling events, thoughts, and feelings. The counselor will listen closely, 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 fairly to every person in the session. The counselor helps to find how certain thoughts and actions may be adding to conflict. Family members learn new ways to support one another during stressful times.

  • Group counseling. A group of people with similar concerns may meet together. A counselor leads the discussion and provides support and guidance. Group members learn from the counselor and other members.

Types of counselors

Usually, mental health workers must complete expert training and pass a state exam before becoming a licensed counselor. The following professionals are trained to provide counseling services:

  • Psychiatrists. These are medical doctors who specialize in detecting and treating mental disorders. They can provide counseling and also prescribe drugs.

  • Psychologists. These specialists have a doctoral degree and advanced training in detecting and treating mental disorders. They perform psychotherapy and research, but they cannot prescribe drugs.

  • Licensed clinical social workers. These specialists are also called psychiatric social workers. They have a master's degree in social work and advanced training in counseling. They also provide practical assistance, such as help managing health insurance issues. In addition, social workers can connect patients with local resources.

  • Oncology social workers. These specialists have a master’s degree and focus on the effects of cancer on people and their loved ones. They provide services such as counseling, education, and referrals to local resources. They also often act as a link between people with cancer and the medical team. In addition, they help people navigate the health care system. Oncology social workers often have the letters “OSW-C” as part of their title. Learn more about how an oncology social worker can help.

  • Psychiatric clinical nurse specialists. These specialists, also called psychiatric nurse practitioners, are registered nurses who have a master's degree in mental health nursing. They treat mental disorders and provide counseling.

  • Licensed counselors. These specialists, also called licensed mental health counselors, have a master's degree in counseling.

  • Licensed pastoral counselors. These specialists have a master's degree in ministry or divinity. They 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 health care team to help you find options. You may have mental distress, such as depression and anxiety, that does not improve over time. In this case, you may need to see a psychiatrist, clinical psychologist, or oncology social worker. Or you may be looking for practical advice or general mental health support. In this case, you may need a clinical social worker or a support group guided by a counselor.

Here are some tips for finding a counselor:

  • Ask about counseling services at your hospital or cancer treatment center. Many hospitals and clinics offer such services to their patients.

  • Ask members of your health care team for referrals to counselors in your area.

  • Ask your health insurance company for a list of counselors covered under your plan.

  • If your chosen counselor does not accept your insurance and finances are a worry, ask if a discount program is available.

  • 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 who work with people with cancer.

  • Ask the staff at your local library to help you find mental health services in your area. You may also check with your local health department about these types of services.

  • 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.

The following groups offer referral services to help you locate counselors:

  • American Association of Marriage and Family Therapy. This group has a searchable database that lists marriage and family therapists in the United States and abroad.

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

  • National Register of Health Service Providers in Psychology. This group’s searchable database helps people locate psychologists in the United States and Canada.

Choosing the right counselor

Once you have a list of potential counselors, briefly interview each one over the telephone before choosing. Ask the counselor if there will be a cost for the first 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. Ask for more details if there is something 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 about personal issues, even when that person is a professional counselor. The success of counseling often depends on how well you interact with the counselor. Also, not every counselor will be a good match for you. If you do not feel at ease after several sessions or think the counselor’s suggestions are not helping you, then consider finding a new one. And find out whether the type of therapy and the topics of discussion have been the right match for your needs. This 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 based on his or her degree of training and the setting. For example, psychiatrists and clinical psychologists often charge more than licensed social workers or licensed counselors. And counseling done at a private practice setting often costs more than at a clinic setting. Group counseling is often less expensive than 1-on-1 counseling. Most cancer support groups are offered as a free, civic service.

Contact your health insurance provider to learn what services your insurance plan covers. Most plans cover some of the cost of counseling. Many will pay for a limited number of sessions with a licensed specialist. You may have to pay a co-payment, which is a portion of the cost of each session. Some insurance providers may only pay for sessions with certain types of counselors. Or, they may just pay for 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 overall services.

  • Local health departments or social service agencies may offer free or low-cost counseling services for people who qualify.

  • Some local mental health clinics and private counselors offer services on a sliding fee scale. This means that it will cost what you can afford to pay.

  • Medical schools with mental health clinics may offer lower-fee counseling sessions. Clients often receive counseling from students doing advanced training who are managed by a senior professional.

Learn more about managing the costs of cancer care.

Related Resources

Managing Emotions

How to Recognize Cancer Distress — and Cope with It

More Information

LIVESTRONG: Finding a Counselor

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