Geries Shaheen • February 16, 2023

Navigating Common Difficulties in Counseling: Strategies and Statistics for Success

As a licensed professional counselor, I have had the opportunity to work with a diverse range of clients who have presented with a variety of difficulties. While each person's experience is unique, there are certain difficulties that are commonly encountered in counseling. In this blog post, I will discuss some of the most common difficulties clients face and provide strategies for addressing them, including statistics that support the prevalence of these difficulties.


1. Difficulty in building trust and rapport with the therapist: Building a therapeutic relationship is the foundation of effective counseling, yet some clients may struggle to trust the therapist or feel comfortable sharing their thoughts and feelings. This can be especially true for those who have had negative experiences in therapy in the past, or those who have difficulty trusting others in general. According to a study published in the Journal of Clinical Psychology, about 15% of clients drop out of therapy within the first three sessions, with lack of trust in the therapist being one of the primary reasons cited. To address this, therapists can work to create a safe and non-judgmental space for clients, actively listen and validate their experiences, and clearly communicate the therapeutic process and boundaries.


2. Difficulty in identifying and expressing emotions: Many clients may struggle to understand and communicate their emotions, which can make it difficult to process and make sense of their experiences. According to a study published in the Journal of Counseling Psychology, emotional expressiveness is positively related to better therapeutic outcomes. To address this, therapists can help clients develop an emotional vocabulary and provide strategies for identifying and expressing emotions in a healthy way.


3. Difficulty in setting and achieving goals: Setting and achieving goals can be challenging for clients who may feel overwhelmed or lack motivation. According to a study published in the Journal of Consulting and Clinical Psychology, goal-setting is positively related to better therapeutic outcomes. To address this, therapists can work with clients to set realistic and achievable goals and provide tools and strategies for overcoming obstacles and staying on track.


4. Difficulty in managing stress and anxiety: Stress and anxiety can be overwhelming for many clients, and can make it difficult for them to function in their daily lives. According to the Anxiety and Depression Association of America, anxiety disorders are the most common mental health concern in the United States, affecting 40 million adults in the U.S age 18 and older, or 18.1% of the population every year. To address this, therapists can teach clients coping strategies such as mindfulness, relaxation techniques, and cognitive-behavioral therapy to help them manage these feelings in a healthy way.


5. Difficulty in overcoming past traumas: Past traumas can have a significant impact on a person's present and future, and can lead to a variety of difficulties such as anxiety, depression, and relationship problems. According to the National Center for PTSD, about 8% of the U.S population will have PTSD at some point in their lives. To address this, therapists can use a variety of evidence-based techniques such as cognitive-behavioral therapy, EMDR, and other trauma-focused therapies to help clients process and heal from their experiences.


While these are some of the most common difficulties clients face in counseling, it is important to note that each person's experience is unique and may require a tailored approach. As a licensed professional counselor, I work collaboratively with clients to identify their specific needs and develop an individualized plan to address them. With the right support and strategies, clients can make meaningful progress in their journey toward healing and growth.


As with any field, you might be new to, there are helpful reads you can pick up! Guides, books, workbooks! Read through the below list for 5 helpful book resources as you enter the counseling field!


"The Counseling Practicum and Internship Manual: A Resource for Graduate Counseling Students" by Shannon Hodges. This is a comprehensive guide for graduate counseling students and new counselors, providing practical information and strategies for successfully navigating the counseling practicum and internship experience. It covers topics such as developing therapeutic relationships, understanding the counseling process, and addressing ethical and legal issues.


"The Handbook of Clinical Techniques in Child and Adolescent Therapy" edited by Thomas Ollendick and Michel Hersen. This book is a comprehensive resource for counselors working with children and adolescents, providing a wide range of evidence-based techniques and strategies for addressing common mental health issues. It covers topics such as anxiety, depression, and behavioral problems, and includes chapters on specific populations such as children with autism and those who have experienced trauma.


"The Skilled Helper" by Gerard Egan. This classic text provides a comprehensive overview of the counseling process, including the skills and strategies needed to be an effective counselor. It covers topics such as building rapport, active listening, and goal-setting, and provides practical examples and exercises for developing these skills.


"Cognitive-Behavioral Therapy: Basics and Beyond" by Judith Beck. This book is a comprehensive guide to cognitive-behavioral therapy (CBT), one of the most widely used and evidence-based therapies in counseling. It covers the basics of CBT and provides strategies for addressing a wide range of mental health issues, including anxiety, depression, and relationship problems.


"Introduction to Addictions and Substance Abuse Counseling" by David Capuzzi and Mark D. Stauffer. This book is a comprehensive introduction to the field of addictions and substance abuse counseling. It covers the basics of substance abuse, the impact of addiction on individuals and families, and the most effective treatment strategies for addressing addiction. It also includes information about the ethical and legal issues involved in the field.


These books can provide a solid foundation of knowledge and practical techniques for licensed professional counselors starting new in the field, helping them navigate the counseling process effectively. It is important to stay up to date with new research and developments in the field. Additionally, it is also important to seek out supervision and mentorship from experienced counselors to gain additional guidance and support.


Perhaps you are a private practice in the mental health industry, or maybe a large agency trying to get your clinicians on the same page regarding Trauma Informed Care. Consider the Pioneer Counseling Trauma Informed Care Psychotherapy Tx Planner. It really is more than a tx planner, it is a guide and a point of reference.



https://www.amazon.com/dp/B0BQ9FWFMT?ref_=cm_sw_r_cp_ud_dp_0MKBDBQ5PRD8G8NBEJ0B




Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally. Geries is EMDR trained and DBT Certified, practicing from a TIC lens.The body content of your post goes here. To edit this text, click on it and delete this default text and start typing your own or paste your own from a different source.

Pioneer Counseling Blog

DSM-6: What We Know, What’s Being Discussed, and What Licensed Professional Counselors Should Understand

By Geries Shaheen • August 11, 2026
Conversations about DSM-6 are growing louder in professional spaces . Industry leaders, researchers, and clinicians are sharing insights about what the next revision of the Diagnostic and Statistical Manual of Mental Disorders may look like. Some projections suggest a potential release window around 2029 to 2030 , though the American Psychiatric Association has not formally confirmed a publication date. For Licensed Professional Counselors, it is important to distinguish between confirmed information and thoughtful speculation. What follows is a grounded overview of both.  What Is Officially Confirmed There has been talks of the next DSM potentially being names something totally different, as well as potentially being a living breathing document housed online rather than a printed material. This has led to thoughts that it will include a full structural overhaul as it aims to find a balance between psychiatric insight as well as lived experience data. At the moment, there has been no official announcement of: A finalized DSM-6 release date A confirmed structural overhaul A change in name Adoption of biomarkers as diagnostic requirements The APA has historically used multi-year committee processes for revision, as documented during the development of DSM-5 (Regier et al., 2013, American Journal of Psychiatry). Any specific timeline, including projections of 2029 to 2030, remains speculative unless formally announced by the APA. Documented Criticisms of the DSM Many of the concerns you listed are well documented in peer-reviewed literature, including in the American Journal of Psychiatry. Historically cited critiques include: • The DSM uses a categorical model, which may not fully capture dimensional or nuanced symptom presentations. • Emphasis on diagnostic reliability has sometimes been prioritized over diagnostic validity. • Limited integration of biological markers despite advances in neuroscience. • Heavy reliance on expert consensus panels. • Concerns about Western cultural bias in diagnostic framing. These critiques have appeared in academic discussions surrounding DSM-5 and broader psychiatric nosology debates (Hyman, 2010; Regier et al., 2013). What is important to note is that these criticisms are part of ongoing scholarly dialogue. They do not automatically predict specific DSM-6 changes. Themes Being Discussed in Professional Circles While not formally confirmed, several themes are widely discussed among researchers and leaders: 1. Greater Dimensional Integration DSM-5 already introduced cross-cutting symptom measures and severity scales. Continued movement toward dimensional models is supported in academic literature (Krueger & Markon, 2014). A future DSM may further integrate dimensional frameworks alongside categorical diagnoses. 2. Stronger Alignment with ICD There has been ongoing effort to harmonize DSM diagnostic codes with the International Classification of Diseases, maintained by the World Health Organization. Future revisions may continue this integration to improve global diagnostic consistency. 3. Inclusion of Biomarkers Despite significant neuroscience research, no current psychiatric diagnosis relies on validated biomarkers. The National Institute of Mental Health developed the Research Domain Criteria (RDoC) framework to explore biologically informed models. However, RDoC remains a research framework and is not a diagnostic manual. Any integration of biomarkers into DSM-6 would require strong empirical validation, and no official confirmation currently exists that biomarkers will be required for diagnosis. 4. Cultural and Social Determinants DSM-5-TR expanded cultural formulation tools and updated language related to gender and diversity. Ongoing discourse suggests future editions may further incorporate cultural, socioeconomic, and environmental determinants of mental health. 5. Lived Experience Input There is broader movement in healthcare toward incorporating lived experience perspectives. While stakeholder feedback has been part of past revisions, there has been no formal announcement detailing the extent of lived experience integration for DSM-6. The direction of greater inclusivity aligns with contemporary healthcare standards but remains under development. Autism and Potential Diagnostic Shifts Speculation regarding updates to Autism Spectrum Disorder criteria reflects ongoing research around gender differences, masking, and underdiagnosis in women and people of color. Research literature supports the idea that autism presentations may differ across populations. However, there is currently no official confirmation that DSM-6 criteria changes will create a diagnostic surge. Any future criteria updates would require field trials and empirical validation before implementation. Committee Structures The APA historically forms workgroups and task forces organized by diagnostic categories and thematic areas. Planned improvement committees include the "Structure and Dimensions committee", "Functioning and Quality of life committee" "Biomarkers and Biological factors committee" " Socioeconomic, cultural, and environmental determinants of mental health committee". What LPCs Should Do Now Continue practicing under DSM-5-TR standards. Strengthen dimensional assessment skills and measurement-based care. Stay informed through official APA channels and peer-reviewed publications. Approach social media claims with professional caution. :) It is reasonable to expect that DSM-6 will aim to reflect scientific advances, cultural responsiveness, and improved diagnostic validity. However, until the American Psychiatric Association releases formal statements, timelines, or draft criteria, any detailed structural predictions remain speculative. For Licensed Professional Counselors, preparation is less about anticipating dramatic changes and more about maintaining strong assessment practices, cultural competence, and evidence-based treatment planning. Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally. Geries is EMDR trained and DBT Certified, practicing from a TIC lens.

Cadence Matters: Matching Rhythm to Need

By Geries Shaheen • August 11, 2026
In behavioral health, we spend a significant amount of time discussing medical necessity. We complete assessments, symptom inventories, risk scales, progress reviews, treatment plans, and utilization documentation designed to justify levels of care to payors, agencies, and federal grant programs. Those systems are important. Accountability matters. Evidence-based care is crucial. But there is another clinical variable that often determines outcomes more than any assessment score alone: Cadence. The frequency and consistency of therapy can profoundly impact stabilization, insight development, emotional regulation, therapeutic alliance, and long-term outcomes. Yet cadence is often treated as an operational scheduling issue instead of a clinical intervention in itself. The reality is that not all clients need the same rhythm of care. Some clients benefit from: Daily therapy for intense instances. Twice-weekly sessions during periods of crisis stabilization or acute symptom escalation Weekly therapy for active trauma processing, emotional regulation development, or skill acquisition Biweekly sessions during maintenance phases Monthly sessions for relapse prevention, accountability, and long-term support after sustained improvement Research increasingly supports what many clinicians already observe in practice: matching cadence to client need improves outcomes. A 2024 meta-analysis published in the Journal of Affective Disorders found that increasing psychotherapy frequency from one session per week to two sessions per week was associated with significantly stronger treatment outcomes for depression, particularly during the acute phase of treatment. Researchers noted that session frequency appeared to matter more than total treatment duration alone. ( https://www.sciencedirect.com/science/article/pii/S0165032724008061? ) Additional longitudinal research comparing weekly and biweekly therapy found that clients receiving weekly therapy demonstrated higher rates of early improvement and shorter durations of suffering compared to biweekly treatment schedules. The study also emphasized that therapy frequency should be individualized because client response trajectories vary considerably. ( https://pubmed.ncbi.nlm.nih.gov/37870790/ ) This aligns with what clinicians see every day: Clients in early trauma work often need tighter therapeutic containment Clients learning emotional regulation benefit from repetition and proximity Clients with attachment disruptions frequently require consistency before depth Clients in relapse recovery may need increased contact before symptom escalation becomes visible in formal assessments Therapy does not occur only during the 53-minute session. It unfolds between sessions , in how quickly a client can reconnect after dysregulation, revisit a cognitive distortion before it hardens into avoidance, process a triggering event while it remains emotionally accessible, or practice a coping strategy before disengagement returns. The interval between sessions can either sustain therapeutic momentum or unintentionally interrupt it. This is where the tension between clinical reality and administrative structure often emerges. Many large agencies rely heavily on standardized assessments and federally guided documentation frameworks to determine treatment frequency and level of care recommendations. These tools create accountability, consistency, and measurable outcomes across systems. As they should, but Measurement-based care has become increasingly important in behavioral health. Some recent findings suggest that structured measurement-informed care can improve patient outcomes by as much as 24%, while psychiatric treatment incorporating routine symptom monitoring has shown remission rates up to 75% higher than treatment without ongoing measurement practices. (https://www.twochairs.com/blog/two-chairs-publishes-first-of-its-kind-study-showing-measurement-based-care-training-improves-outcomes-by-24-at-scale) Thus, assessments are snapshots. Cadence is relational. An assessment may capture symptom severity at a single point in time. Cadence captures the pace of support a client clinically requires to sustain progress between those moments. Two clients can present with similar PHQ-9 or GAD-7 scores yet require entirely different treatment frequencies based on: emotional regulation capacity environmental stressors trauma acuity relapse history attachment dynamics coping skill generalization safety concerns psychosocial support systems Strong clinical work requires balancing measurable data with clinical judgment . (and often, clinical judgment comes from building clinician autonomy).( https://www.psychiatrictimes.com/view/measurement-based-care-in-psychiatry-clinical-outcomes-and-practical-applications ) Sometimes the most important question is not: “Can we justify this frequency to insurance?” Sometimes the more important question is: “What cadence gives this client the best opportunity to succeed?” Approximately 50% of clients discontinue therapy prematurely, with poor therapeutic fit, inconsistent engagement, and treatment structure often contributing factors. ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600065/ ) As mental health systems continue evolving toward outcome-driven care, there is an opportunity to broaden how we define treatment effectiveness. Frequency of contact, continuity, relational consistency, and therapeutic pacing deserve greater recognition as active components of care. Otherwise they will be thrown to the wayside as mere operational details. In our industry, timing truly matters. And cadence is part of the treatment itself.  Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally. Geries is EMDR trained and DBT Certified, practicing from a TIC lens.
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