Do I need therapy?

In the United States, we are experiencing an unprecedented time of acceptance and validation of mental health services, especially during the COVID-19 pandemic. Naturally, not every community or family is comfortable with or “believes in” therapy, however, there is less stigma now to treatment than there has ever been. It can often be difficult for one to know if therapy is right for them though. Hopefully this post can help you answer the question, "Do I need therapy?"

I am going begin by highlighting the obvious - If you are experiencing symptoms that are contributing to major problems in your daily functioning (e.g., hygiene, sleep, diet, ability to get to work/school or complete basic tasks), you would probably benefit from therapy. If you are experiencing thoughts of suicide or engaging in self injurious behaviors, you would probably benefit from therapy. If you are experiencing depression, manic episodes, or panic attacks, you would probably benefit from therapy.

Notice that I do not say “need” therapy. That is because I am not deluded enough to believe that therapy can help all the people all the time with all the things. Therapy is great. I believe in it, and I have been a consumer of it. But sometimes the message of “go to therapy” as a panacea to your problems is not helpful. There are many ways people can get the help and support they need to make important changes in life that does not involve therapy. So, we can debate how much people “need” therapy, versus if they “would probably benefit from therapy.” For now, let us just establish that some people fit more clearly in the “yes” or “probably” category, as outlined above.

So, what about those who do not quite fit in the above categories? Well, let me explain what mental health treatment tends to look like. It might mean weekly, bi-weekly, or monthly individual therapy meetings. It might coincide with periodic meetings with a psychiatrist for medication management. It might mean weekly group therapy meetings. It might involve an inpatient, partial hospitalization, or intensive outpatient program. These processes can range from a few weeks, to months, to several years, depending on a variety of factors. The question becomes, how does one know what they might need, and if they need any mental health treatment at all?

An easy way to answer those questions starts with an assessment by a mental health professional. A first meeting typically involves completing basic questionnaires ahead of time (including consent forms) and providing information about current symptoms and functioning. The provider follows-up with more questions, might use a standardized assessment tool or two, and makes a recommendation for treatment. Depending on the experience and specialization of the provider, they may refer you to a different or higher level of care. For example, I often work with individuals struggling with addiction issues, however, if a client is finding it difficult to get through a typical weekday without consuming alcohol, once a week individual therapy might not be sufficient to address their concerns. I would consider referring such a client to a substance use clinic offering a wide range of therapy options, including detox, intensive outpatient, and group therapies.

But what if a person is not experiencing any of the “obvious” reasons to seek treatment (e.g., suicidal thoughts, panic attacks, significant substance use, etc.)? How do they know if mental health treatment is right for them? I start with the foundational question – What change would you like to make in your life? Do you want to have better interpersonal relationships? Do you want to feel better about yourself? Do you want to be better at school or work? Do you want to overcome fears, anxieties, or traumas? Any of these questions (and others) can be addressed in mental health treatment.

Therapy is a change process. It is about understanding your patterns and learning new ones. These patterns are typically conditioned over the course of many years (and decades), and frequently operate on a semi-conscious level. That can make it difficult to recognize that you are even experiencing something that therapeutic intervention can help change. For example, you recognize that you have many acquaintances, but no very close friends. That could be the thing you want to change in your life, and therapy can help identify the patterns that contribute to that dynamic repeating itself.

Usually there is a disorienting experience that helps folx realize they are unhappy with one or more aspects of their life. An example here might be starting to question your career after learning that a friend changed theirs to pursue a dream job. Other life circumstances can create disorienting moments, such as births, deaths or other losses, major relationship changes, transitions, etc. Really anything that results in serious self-reflection can lead us to insight about ourselves and our lives. Therapy facilitates that reflection and deeper exploration to clear out the “noise” of daily life, to focus intensely on you for that one hour, and help you see things that are typically just out of sight.

Here is the thing – most people would probably benefit from therapy. Some form of modern-day therapy has existed throughout the course of human history (think religious counseling, or consulting with elders). There is robust scientific literature detailing how therapy is helpful. If you need it or not, is better determined by answering a couple questions for yourself, “Do I need to make a serious change in my life right now? Am I able to make that change with the resources I have?” I like to tell people that therapy is not an easy process, just as any change is not easy. And the likelihood is that if you are in therapy, you have already tried to make change, but have not been successful. Coming to therapy is an acknowledgement that you have not quite figured it out yet. Then again, let's face it, none of us really have.