I have been in the mental health field for several years, and have worked in a variety of settings with a diverse array of people. One reasonably consistent variable, however, has been the average person’s resistance or hesitance to seek therapeutic support independently. Now, I should confess that my clinical experiences likely skew my perspective in the low-motivation direction of the engagement spectrum. To clarify, I spent my early career providing both therapy and assessment services to people in forensic settings (e.g., prisons, forensic units in hospitals) and my most recent experience was as the Clinical Director of a private outpatient practice providing therapeutic services to emerging adult men ages 17-30 struggling with a myriad of academic, wellness, and mental health challenges. While it is common for people to feel trepidatious about reaching out for therapeutic support, the people belonging to the populations mentioned above are recognized as having markedly low motivation to engage in such services. Given my experiences, I thought it appropriate to provide visitors to my website, some information about the process of seeking therapeutic support. I hope that the information validates the feelings associated with seeking help, increases the likelihood of contacting a mental health professional, instills hope about the prospect of experiencing a positive therapeutic outcome, and provides some clarity about when may be the time to seek therapeutic support.
According to the National Alliance on Mental Illness (NAMI), the average delay between the onset of symptoms and treatment is 11 years. Age at onset, access to quality treatment, and stigmatization of mental illness all play a role in the delay. Additionally, the idea of reaching out to a stranger, albeit a licensed professional, to engage in incredibly intimate work, is an idea that would fill even the most stoic amongst us with discomfort. Despite mental health professionals’ educational efforts to destigmatize mental illness, there remains considerable hesitance to pursue therapeutic services for fear of being labeled as “weird,” “defective,” or some other synonym to “not normal.” I have found this to be particularly true for men (because of the societal pressure to deny or minimize emotional experience) and those people in highly competitive communities, although the fear and resulting hesitance are common to many. According to the National Institute of Mental Health (NIMH), the prevalence rate of mental illness in the United States in 2017 was 18.9% or 46.6 million people. That rate was higher (25.8%) for those in the emerging adult population (ages 18-25). In other words, at any one time in 2017, one in four people ages 18-25 in the United States met diagnostic criteria for a mental illness. One of the messages I communicate early in the therapeutic process is that just because he/she is struggling with anxiety, depression, grief, etc. does not mean that he/she is “weird,” “broken,” or “not normal.” Quite the contrary, these issues are common and treatable.
Seeking a therapeutic process first requires that the person recognizes that on some level, there is a need for the service. For many, obtaining that recognition is incredibly difficult as it requires the person to nimbly sidestep their internal defenses and open themselves up to honest and sometimes painful feedback. Some people that I have worked with do not come to that recognition on their own. It is sometimes a friend or family member that communicates their concern and encourages them to engage in therapy.
What To Look For
So, now that we have determined that mental health issues are relatively common and that the process of seeking therapy can be challenging, I would like to identify signs that may indicate that it is time to seek therapy. As a preface, the following list is not intended to be exhaustive.
No one knows you better than you…
I view the people I work with as experts of their own experiences, which is to say that “no one knows you better than you.” If someone is noticing that they do not recognize the person they see reflected in the metaphorical mirror, where they are sadder, angrier, or otherwise engaging in uncharacteristic behaviors, and if this experience persists for a significant period of time, then it may be appropriate to seek help. A common question I hear is, “Well, exactly how sad or angry is too sad or too angry?” and “What do you mean by significant?” The response I usually provide is if the issue impacts the person’s ability to satisfy the standard requirements associated with school, work, relationships, and other significant life domains, then that is likely an issue needing therapeutic attention.
…And listen to loved ones
Ellipses connect the last heading with this heading for a reason. I briefly spoke to how difficult it can be for someone to recognize that something is awry. Sometimes, family, friends, and significant others are the people who tell others (hopefully in a digestible manner) that they may need to seek therapy. These people are not as influenced by the internal defenses that prevent the identified person from recognizing that help may be warranted, and they often know the person well. In many cases, I implore people to heed what those close to them are telling them, especially if more than one person is communicating the same or similar message.
Stress, stress, and more stress
Importantly, stress is a common experience in life and can even be healthy. An experience that tells us that we need to exert energy to overcome an obstacle or accomplish a goal. It would be unrealistic (and unhealthy) to establish the therapeutic goal of NEVER experiencing stress again. It is, however, advantageous to seek therapy if a person feels that stress is omnipresent and inescapable. Experiencing prolonged, heightened levels of stress results in high cortisol levels, which can lead to a myriad of issues to include: weight gain, severe fatigue, irritability, high blood pressure, difficulty concentrating, and headaches. It can also impact other bodily systems and rhythms, which can alter eating, sleeping, and sexual behaviors. The experience of stress itself is not a reason to seek therapy, but if a person is experiencing stress at higher-than-tolerable levels of intensity, frequency, and duration, then I would recommend trying therapy.
Turning to addictions and distractions
It is common and often times understandable for a person to want to avoid or distract themselves from experiencing a distressing emotion. This is especially true when the person feels that they are unable to exert control over the factors that impact the experience or emotion. People are not meant to endure internal turmoil indefinitely. I have worked with many people who have communicated that they lived with *insert distressing experience here* for an extended period of time before engaging in a pattern of behaviors that would eventually become an addiction. Those behaviors can be related to substance use, video games and technology, sex, gambling, food, or some other behavior that floods the brain with reward-related neurotransmitters. Often, addiction co-occurs with another mental health issue. It is essential to find a professional who can appropriately understand the relationship between the two processes and identify how best to treat them.
Grief and trauma
Grief itself is normal and healthy, and there is no ONE right way to grieve. That said, sometimes, people need help processing the loss. It can be helpful to identify a healthy and effective way to process losses so that the person can replicate if and when necessary.
Trauma comes in many forms. Many people think about the more prominent examples, such as war/combat, natural disasters, car accidents, and physical and sexual assaults. Traumas can also include unsuccessful transitions (e.g., from high school to college, college into the workforce), interpersonal conflicts, bullying, and financial challenges. All of these examples become increasingly problematic if they occur multiple times. Importantly, however, several evidence-based treatments help. These include interventions such as prolonged-exposure, cognitive processing therapy, and eye movement desensitization and reprocessing (EMDR). If someone has experienced trauma(s) and they are enduring intrusive trauma-related symptoms (e.g., nightmares), avoiding reminders of the event, displaying changes in thoughts and mood, and appearing more prone to startle or engage in self-destructive behavior then I recommend a therapeutic process.
Thousands of studies have determined that there are consistent and positive effects of therapy. Further, the average person receiving therapy is better than nearly 80% of people who do not seek treatment. That said, there are many forms of evidence-based treatment and many more mental health professionals, all of whom do not (or should not) treat every kind and type of mental illness. Therefore, I strongly recommend that if a person does decide to seek therapeutic support, that he/she asks the mental health professional questions to help determine if there is a fit between what the person is needing and what the professional can offer in terms of treatment.
Motivation is Dynamic
Ambivalence is a frequent experience in therapy. It is inaccurate to think that motivation is static and unchanging, wherever a person falls in the spectrum, high, low, or somewhere in the middle. It is equally inaccurate to think that a person is equally motivated to change all behaviors that were collaboratively targeted at the beginning of the work. I implore anyone who may be reading this and thinking that they may want to engage in therapy but want to wait until they are motivated to make the commitment to therapy, to entertain the idea that motivation to begin therapy is not critical to positive therapeutic outcomes. Sure, it may be helpful, but it is far from necessary.
If you believe that you or someone you love may benefit from therapy, then I encourage you to do research, identify a therapist who has experience treating people struggling with the very thing that you are struggling with and make the call. Quality, evidence-based treatment can change and even save a person’s life.