“Do you think I should go to therapy?”
As a psychologist, I get this question a lot. Like most questions about psychology, my answer is “it depends.”
Do you need therapy? Maybe not.
Would you benefit from therapy? Absolutely.
Some people need therapy to help them work through negative experiences they’ve had in the past or to cope with current issues that make it next-to-impossible to live a good life. You’d be surprised how many people have experienced trauma, especially during childhood. But even without trauma, a lot of people struggle with anxiety, depression, low self-esteem, anger, and a host of other issues related to how we think about ourselves and the world around us.
But the majority of people go about their day, depression and anxiety in tow, without going to therapy. They don’t have control over their issues—they’ve just learned to live with them. So do they need therapy? Maybe not, but if they went to therapy, they’d have the opportunity to learn how to deal with the things holding them back.
Take anxious thoughts, for example. They’re kind of like hyper dogs—they run all over the place, leaving chaos in their wake. Some people resign themselves to the uncontrollable nature of their dogs: “That’s just how they are,” they claim. Therapy gives you the tools to leash the chaos-hounds and put them through obedience training. The dogs still have the potential to act up, but you’ve learned how to reign them back in if they do.
Therapy is about giving you the tools to understand and control the things holding you back.
So why don’t more people take advantage of what therapy can offer them?
What Keeps Most People From Going To Therapy
Here’s the sad reality—therapy can be expensive. It can range anywhere from $100-$250+ per hour, which doesn’t include “high profile” therapists who charge a premium for their time. Most insurances will cover it, but only for certain diagnoses and a certain number of sessions. So you might have depression, but if your depression isn’t “bad enough,” your insurance might not pay for therapy at all or only pay for a few sessions. “Anger issues” isn’t a diagnosis, so unless your therapist can do some fancy diagnostic finagling, your insurance won’t cover it. Want to go to couple’s therapy? Be ready to pay out of pocket, because most insurances give precisely zero shits about you wanting to improve your marriage.
If you don’t have insurance, or can’t afford the copay, look for places that have a “sliding scale.” Sliding scales are based off your income; so depending on how much you earn, you may only pay $10 per session. Some private practices have sliding scales, but your best bet is probably to look at your local FQHC (Federally Qualified Healthcare Center) because their services tend to be more affordable because they receive federal funding.
They Don’t Know How Therapy Can Help
Sometimes you dig yourself so deep into a hole, you don’t know how to get out. You’ve spent so much of your life in the hole, you struggle to even imagine life beyond it. And because you can’t figure out how to get yourself out, you assume other people can’t help you get out either.
“I’ve always been depressed.”
“I’m just an anxious person.”
“I’ve can’t control my anger.”
Just because this is how you have been doesn’t mean it’s how you have to be in the future.
If your car breaks down and you don’t know how to fix it, that doesn’t mean a mechanic can’t. Jocko Willink refers to psychologists as “mind mechanics” because of their ability to diagnose and treat issues of the mind much the same way an auto mechanic operates on vehicles.
Let me give you some permission: You don’t have to know how therapy can help. Therapy is a process—the more you go, the more you learn about yourself, your struggles, and how to overcome them. People routinely come to therapy and say, “I don’t really know how to describe what’s going on, but I haven’t felt good in a long time.” That’s a perfectly fine starting point.
Stumble over your words, struggle to explain what’s going on, be unsure if you’re making any sense—just go, and see where the journey takes you.
This is the main thing that keeps people from going to therapy. You can have the money. You can know what you’re struggling with. But if you’re afraid to go to therapy because you think things like:
- It means you’re crazy
- Only weak-minded people go to therapy
- People will judge you if they find out you go to therapy
- Mental issues aren’t “real” the same way medical and physical issues are
You will never go. Women go to therapy more frequently than men. This doesn’t mean women have more issues than men, it just means women go to therapy more than men. Most of the guys I’ve seen for therapy have a lot of shame because they think going to therapy somehow makes them mentally weak or less of a man.
The other issue with stigma is that it causes most people to wait until they’ve exhausted every other option to deal with their issues—so they’re at their wit’s end by the time they finally break down and go to therapy. They feel helpless, hopeless, and lost for a way out because everything they’ve tried on their own has failed.
Here’s another way to think about therapy: If you have a cavity, how do you handle it? Do you just “walk it off?” Do you try to cover it up with booze? Pretend it isn’t there and hope it goes away? Or do you go to a professional who specializes in treating cavities, aka, a dentist? If you’re a rational human being, you go to the dentist.
Do you blame yourself for developing a cavity? Does this shame prevent you from going to the dentist because you’re afraid you’ll be judged by your peers? Do you beat yourself up for being “weak-toothed?” No. You go to the dentist, get your tooth issues under control, then move on with your life.
Going to a therapist for mental health issues is like going to a dentist for tooth issues.
Keeping with the dentist analogy, you go to the dentist regularly for a checkup. This way you stay on track and, if you start to develop any small cavities, they can be quickly addressed. But if you only go to the dentist when your cavity has grown so large it’s causing you a lot of pain, the procedure is going to take longer and be more extensive. You can go to therapy for a mental health checkup too. A little prevention goes a long way.
What Do You Learn In Therapy?
If you’re angry, you don’t just go 0 to 60, even if that’s how it feels. What actually happens is you have thoughts boiling under the surface and, because you’re already on the edge, one tiny thing will set you off. It wasn’t the tiny thing that caused all that anger, it was everything going on under the surface you weren’t paying attention to.
Depressed people have depressing thoughts. Anxious people have anxious thoughts. Plop anxious thoughts into a “normal” person’s head and guess what? They’ll become anxious. It’s not magic; it’s how we’re wired. Our thoughts color how we see the world.
Therapy helps you examine your thoughts and develop a deeper understanding of the assumptions you make about the world and why you react the way you do.
“All men are assholes.” No, all the men you’ve dated are assholes. Therapy can help you identify toxic patterns in your life that keep you miserable and pessimistic about the world.
If you only have a hammer, you treat everything like a nail. If you only have one way to cope with things—making jokes, distracting yourself, pretending it isn’t there, drinking, punching things—then you’ll deal with everything the same way. Having only one way to cope eventually stops working and leads to more problems–rigidity leads to pathology.
Therapy gives you more tools to put in your toolbox, this cognitive flexibility allows you to find the right “tool” for the job. In therapy you can learn things like cognitive restructuring, behavioral activation, distraction, mindfulness, deep breathing, progressive muscle relaxation, gradual exposure, and a bunch of other techniques to deal with everything life throws your way.
Things You Didn’t Know You Could Go To Therapy For
Therapy isn’t just for mood and emotional issues. Many therapists, especially those who work in medical settings, offer a wide range of services. These can include helping you with issues like:
- Diabetes management
- Heart disease
- Chronic pain
- Communication skills
- Setting boundaries with others
- Parenting skills
But how do you choose the right therapist?
What Kind Of Therapist Is The Best?
“Therapist” is a generic term for several different kinds of mental health providers. The three main types are licensed clinical social workers (LCSWs), licensed professional counselors (LPCs), and licensed clinical psychologists. But what’s the difference?
Basically, the way they’re trained. In the olden days, there used to be more of a distinction between the three types, but that distinction continues to dwindle as interdisciplinary training and evidence-based research inform best practices. As a clinical psychologist, I’m obviously partial to my discipline.
At the doctoral level (most LPCs and LCSWs are masters’ level practitioners), psychologists are trained in a greater depth and breadth of issues—including the nuances of addiction, geriatric populations, advanced psychotherapy techniques, sexual minorities, and other special populations. But many LPCs and LCSWs go on to seek specialty training after licensure. I’ve met psychologists who are terrible clinicians. I’ve met LPCs and LCSWs who are great clinicians. So a therapist’s degree doesn’t give you much information on how good they are.
Cognitive Behavioral Therapy (CBT) is currently the most prominent form of therapy. It focuses on identifying maladaptive thought and behavior patterns and developing healthier ones. Most modern therapists, regardless of degree, have training in CBT because it’s considered the gold standard.
If you go on a therapist’s website, they’ll have a section about their theoretical orientation. You’ll find terms beyond CBT like “DBT” (Dialectical Behavioral Therapy), “ACT” (Acceptance and Commitment Therapy), and a host of other newfangled terms. These ultimately don’t mean much, as they’re considered “3rd Wave CBT.” All this means is they have the same goal as regular CBT, they just use different strategies to get there.
DBT tends to focus more on helping you learn how to regulate your emotions, while ACT tends to focus on helping you come to terms with the things in your life that are beyond your control.
Don’t get bogged down by these distinctions either.
What Actually Matters
Your therapist’s degree doesn’t matter. Their theoretical orientation doesn’t matter. So what the hell does matter?
How they make you feel.
- Do they make you feel safe, comfortable, at ease?
- Are they easy to talk to, or do they seem judgmental?
- Do they listen to you, or do they preach at you?
- Are they warm and welcoming, or cold and aloof?
Rapport—the relationship you develop with your therapist—is the single most important aspect of therapy. If your therapist is a graduate student working out of the free university clinic but you really click with them, you’ll make way more progress than if you worked with Dr.-Ivy-League-Douche-Canoe. If you don’t get along with your therapist, move on.
But what else should you expect from therapy, and how do you know when to switch to another therapist?
How Does Therapy Work?
Most sessions last between 30 and 60 minutes, depending on the setting and specific therapist (private practice sessions are generally 60 minutes, while primary care settings tend to be 30 minutes). Your first session is called an intake. It’s where the therapist gets background information about you—how was growing up, how do you get along with friends and family, what brings you in today—things like that. Some therapists won’t start actual therapy until the next session, but good therapists will go ahead and help you get some relief on day 1 (you can ask if they do this when you schedule an appointment).
Follow up sessions are where you get into the meat of what’s going on. You’re typically in control of where the session goes, what you talk about, and how much you talk about it. But the therapist’s job is to both support and challenge you.
They support you by making you feel safe and comfortable talking about sensitive topics (or whatever brought you in). But they also challenge you by asking questions that force you to look at your problems from angles you might not’ve considered before, and to call you on it if you try to bullshit yourself—you can make excuses or changes, but not both.
Therapy is a collaborative relationship, meaning you put in 50% of the effort and they put in the other 50%. Don’t expect them to work miracles if you aren’t giving it your full effort.
Therapy is hard. Not because of what you do in session (although this can be difficult too), but because of what happens outside of it. The session may only be an hour, but the real work happens between sessions, the other 167 hours that week—when you’re practicing what you’ve learned. No practice = no results.
Be honest and communicate your needs. If you’re not ready to talk about something, or if you didn’t do the work outside of session, tell them. Process why you’re holding back—you’d be surprised what insight you’ll gain by shining a light on the things you try to avoid.
With all this in mind, I usually recommend people give their therapist 2-3 sessions. If you don’t feel you’re clicking with them by the end of session 3, move on. Find a different therapist. Wash, rinse, repeat until you find a good fit.
No matter what you’re going through, therapy will probably help you get to where you want to go faster. Just like with exercise, you might be able to get in shape on your own, but having a personal trainer will get you better results in a shorter period of time.
Connection trumps credentials. Focus on the relationship you have with your therapist—how well you two click—instead of what kind of degree or training they have. Give it 2-3 sessions. If you’re still not feeling it, try another therapist until you find the right one.