Confession takes various forms depending on the circumstances and your relationship with your confessor. At a minimum, it involves standing before the icon of Christ, saying a short prayer, confessing your sin to God in the priest's presence, getting whatever counsel the priest may have, and kneeling to receive absolution.
However, sometimes confession takes the form of sitting and talking--or at least begins that way, especially if your confessor is more of a spiritual father to you. Sometimes the two roles of confessor and spiritual father are conflated, but a confessor is any priest (with the episcopal authority to do so) who hears confession and absolves sin. A spiritual father may or may not be a priest, but is someone who guides you spiritually. In North America, there are so few monks and priests, that usually your parish priest fulfills both rolls. God is faithful, and usually a parish priest is sufficient for both roles. Occasionally, someone just doesn't mesh well with his or her parish priest, and he or she has to seek a spiritual father elsewhere—although they can still confess and receive absolution from their parish priest, even though it may be awkward (confessions are often awkward, regardless of your relationship with your confessor--it's just something you have to work through).
Some people have the misconception that a monk is a better confessor than a parish priest. Monks and nuns are people struggling for salvation just like you and me. Only a few monks become spiritual fathers (or mothers). One needs to be very careful when seeking and receiving spiritual advice. On the one hand, we all need to be guided; but on the other hand, inappropriate advice can be very destructive (both in your own life and in the lives of those around you). The best course is to begin with your parish priest and stay with him as a spiritual father and confessor for at least a few years. If you are unable to get along with your parish priest, then that too must be a matter of confession. As you meet others whom you suspect may have wisdom for you, you may also talk to them (but not to compare advice or to complain about your parish priest). If you find someone's advice helpful, and this person is not a priest who has authority to hear confession and absolve sins, then you may continue to get advice and counsel from this person, but you should tell your parish priest, who will still be confessing you that you are getting spiritual advice from someone else (tell your priest who this person is--honesty is essential). If your spiritual father is a priest who hears confession, then you must tell your parish priest that you want to go to this other priest for confession. It is essential that your parish priest know that you are confessing regularly because your parish priest is responsible for giving you Holy Communion.
There is a kind of subtle pride that I have experienced myself and that I suspect may be common. It is the a pride that thinks that only an Elder or Starets, someone who is clairvoyant and very advanced spiritually, can help me overcome my sins and passions. This prideful attitude assumes that if I could only hear the correct advice I would certainly follow it and so be saved from my sins and passions. This is a delusion. In my experience I have found that if I cannot accept and follow the advice that I receive from my parish priest, then I certainly will not be able to follow the advice of a God-bearing Elder. We must humble ourselves and believe that God has given us the confessor/spiritual father we need, and that God will bring along someone else at the proper time if that is truly needed.
This is not to say that every counsel of our confessor/spiritual father is always right for us. Priests are not magicians. Your relationship with your priest is just that: a relationship. You have to communicate. You must say what is working well for you and what isn't. You have to try to follow his counsel, but you also must be honest about your weaknesses. Humility is key.
Confession and spiritual fatherhood are gifts from God to help us along the path of Salvation. This is a path that involves struggle. There are no shortcuts or secret passages. There is only repentance, confession and forgiveness producing meekness, humility and self control. These are the tools God has given us for our salvation: to make us like Him.
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