Do You Need Therapy?
Dr. Elias Barghash, PsyD
The decision to start therapy often begins with a question like this. You might ask yourself the question after an intense argument with a friend or loved one, or in the middle of a stressful day at work or school. Whether you’re alone in your car, in the middle of a crowded party, or trying to fall asleep, the question of whether or not you need therapy might bounce around in your mind. Although it seems like a simple question, as is the case with our mental health, the answer is multifaceted. Since “Do you need therapy?” is only four words, let’s break it down into four parts.
Do You Need Therapy?
“Do, or do not. There is no try.” — Yoda
When thinking about what you should do, you may be thinking of it as a simple yes-or-no question. Either I do need therapy, or I do not. Either something is wrong, or something is not.
Whether it’s finding a therapist with a certain type of training or cultural background, fitting therapy into your schedule, or wrapping your mind around how therapy works, therapy has a lot of moving parts before you even set foot in a therapist’s office. While yes-or-no, “black-or-white” thinking can be problematic at times, it may be a helpful place to begin if you’re feeling overwhelmed. We tend to put things into black-or-white, all-or-nothing terms when we’re anxious, angry, sad, or overwhelmed.
While “Do I or Don’t I?” sounds simple enough, it’s important to remember the emotions at the core of this question. You may have many different reasons or reservations for starting therapy, but asking this question suggests that something feels “off,” and that you’re wanting to implement a change.
This desire for change is usually prompted by emerging symptoms that diminish your overall quality of life. Perhaps your sleep is suffering, your thoughts won’t stop racing, or you get tongue-tied whenever you try speaking your mind to a colleague or loved one. To that end, you may have already tried some solutions; maybe you’ve improved your sleeping habits, added hobbies back into your life, or changed your diet. These are all important, measurable parts of your health, but they may not be directly addressing the sources of your underlying distress.
Your health is essential to your happiness and quality of life. When your efforts at self-care (link Taryn’s article?) and stress relief haven’t been completely effective at resolving your symptoms, there’s a good chance you’re avoiding important work you may need. Much like tending to an infection or broken bone, tending to your emotional distress is just as crucial to do
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Do You Need Therapy?
“If you run into [a jerk] in the morning, you ran into [a jerk]. If you’re running into [jerks] all day, you’re the [jerk].” — Raylan Givens
In wondering whether or not you need therapy, you may be thinking: Is something wrong with me? Am I the problem, or are they? They’re the ones who need to go to therapy, not me.
Sometimes it’s clear to you what’s wrong. You may have identified a behavior you’d like to change, or perhaps you’ve pinpointed the exact factors that feed into your stress. Alternatively, your life may have felt so complicated and overwhelming for so long that you’re not sure where one problem ends and the next one begins.
Even if you’re curious about seeking help, uncertainty is a normal part of that process. Much like the black-and-white thinking mentioned earlier, heightened distress can lead you to think of “Do you need therapy?” as a barometer for who’s to blame. You may have been told you need therapy as though it’s an accusation or evidence that you’re “crazy.” Someone you care about might even refuse the very idea of therapy.
As a result, you can spend a lot of time in the weeds, retracing your steps about what you might change in your life or the people around you. This type of self-detective work is important, and can lead you to make connections between your symptoms and your situation. The downside of this is that it can indirectly isolate you with your own thoughts and feelings, making you less effective at resolving your distress.
Where you can benefit from therapy is having regular access to a private environment that helps you gain perspective on your life with someone who is separate from your life. Even with a map, navigating a maze can be overwhelming and confusing. Your therapist will help you process and make sense of your distress in a way that is not always possible on your own.
What’s important to remember is your overall quality of life, and the degree to which it’s being negatively impacted. Are you more irritable? Are you more withdrawn or depressed? Do you keep saying “next week” when it comes to your self-care?
Although therapy is one ingredient in a larger healing recipe, you are the main ingredient when it comes to your life. Much like no one else is going to go to the gym on your behalf, your healing requires your acknowledgement and participation to proceed. Therapy is one way to focus on you.
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Do You Need Therapy?
“I need a vacation.” — The Terminator
This is the most subjective part of the question, and need is a loaded word. My problems aren’t as bad as other people’s. I’d rather handle this on my own. I need things like food and water, so I shouldn’t spend money on something like therapy.
Picture yourself as a coin. On the “heads” side are your desires: the things you want most, and the principles that will guide you there. On the “tails” side are your fears. These aren’t just things you dislike, but go against the very principles and desires you live your life by. While desires and fears sound like opposites, they give shape to your individual and interpersonal needs. From the water you drink to the quality time you seek, your needs are worth investing in.
Everyone’s needs are unique. Yours are specific to your development and life circumstances — a blend of nature and nurture. The hardships of a single parent diagnosed with cancer are different from the struggles of a teenage student with body dysmorphia (link Andrea’s article). The stress of a CEO making organizational decisions is different from wondering if you can afford your next meal. Everyone’s challenges are differently valid, and how you navigate those challenges is informed by your needs.
It’s common to not know what your needs are until you stop and reflect on them. For example, maybe you don’t want to be perceived as overbearing in your relationships, and as such, might hesitate to express your feelings. While this can come from a desire to be independent or well-liked, it can also compete with a fear of being burdensome. Perhaps you have a desire to make it on your own, but fear failure. As such, seeking help might go against your social, cultural, or spiritual beliefs.
Your needs can indeed pull you in different directions, making you feel like a coin perpetually spinning on its side. The “spin” can lead you to be avoidant of necessary conflict, or convinced that “this is just the way life is.” When this happens, a strained status quo can develop, keeping you “fine” or “okay” in the short-term while maintaining your suffering in the long run. Your therapist can help you uncover how you are perpetuating unhelpful patterns, and challenge you towards meaningful, lasting change.
Whether you regularly self-reflect or keep your nose to the grindstone, therapy is an avenue for you to identify and better understand your needs.
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Do You Need Therapy?
“I don’t think navel-gazing is gonna get me where I need to be.” — Saul Goodman
Psychotherapy is one of the most misunderstood aspects of healthcare. I don’t think this is something I can talk my way out of. Talking about it only seems to make me feel worse — isn’t there just a pill I can take? Maybe my problems are just sleep and diet related.
Whether through movies, books, podcasts, or social media, you likely have ideas about how therapy looks and feels. If you’ve had therapy before, you might even have memories from your past experiences. In wondering if therapy is what you need, it’s important to understand how therapy facilitates change, and the ingredients that make it effective. It’s also helpful to dispel common misconceptions about therapy.
The therapeutic alliance — the relationship between you and your therapist — is the cornerstone of therapy. Regardless of what brings you to treatment, the largest predictor of successful therapy is the strength of this alliance. You may be highly motivated for therapy, and your therapist may be extremely competent, but if trust struggles to form, therapy will have limited effectiveness. If therapy is like building a house, the alliance is as important as pouring a solid concrete foundation. A trusting therapeutic relationship will pave the way for you to build higher towards lasting change.
Now, the importance of trusting your therapist might seem obvious, but it warrants a closer look to understand why this matters.
Let’s say you’ve experienced criticism your whole life. Or maybe you’re just not a “touchy feely” person; trusting others might not come easily for you. Building that trust within a private, confidential environment is what will allow you to feel safe enough for therapy to begin, let alone flourish. While it is important and healthy to express yourself to the people in your life, confiding in a professional has different benefits. Not only will they have the benefit of rigorous training and licensure, they also bring a unique perspective that may not come from the people in your life. An effective therapeutic relationship can be a corrective experience for you, which can help you identify and gradually resolve the missing ingredients in your other relationships.
Even with the therapeutic relationship at the center, misconceptions still exist about what therapy is. A prominent misunderstanding is that therapy is venting—a canyon into which you cry and complain while a stranger occasionally interjects, “But how does that make you feel?” Related to this is the idea that therapy is “navel-gazing,” a place for you to ruminate or wallow without taking meaningful steps toward progress. This, in turn, highlights another misconception: therapy is advice – a recipe for controlling emotions, changing thoughts, or squashing impulses. A final misconception is that therapy can be done “as needed,” reserved for moments of crisis or convenience.
To dispel these misconceptions, let’s highlight some key factors that enhance the therapeutic alliance.
While many different formats of psychotherapy exist, “talk therapy” is the most common. By communicating and “unpacking” your thoughts and feelings, you and your therapist will begin the process towards resolving them. But whereas other disciplines like medicine are prescriptive—a set of interventions prescribed for you to do—psychotherapy blends feedback with a longer-term process that is supportive and exploratory.
Therapy is a hybrid approach, one that props you up when needed (supportive) and at other times probes for deeper understanding and context (exploratory). This approach helps you feel understood, improving your self-awareness over time. And as stated in the previous section, your needs should be front and center in therapy: the wishes and fears that contribute to your conflicts, as well as the defense mechanisms that shield you from fully confronting your emotional pain and resolving those conflicts.
Much like the animals that camouflage for protection, your defense mechanisms protect you from internal distress. Do crowds make you uncomfortable ever since that sexual assault you experienced? In today’s world, grocery stores and restaurants are incredibly easy to avoid. You might even deny that what you experienced wasn’t that bad, or rationalize that other people have it much worse. These are some common examples of defense mechanisms that, while sometimes necessary, are problematic if they become the norm.
When camouflaging becomes automatic, we actually lose the ability to self-regulate and cope. We are then more likely to maintain harmful patterns and develop secondary physiological symptoms in response to distress.
This is where psychotherapy shines. You may get the gist of a landscape if you zoom by at seventy miles per hour, but unless you reduce your speed, you won’t absorb the same amount of depth or detail. Throughout therapy, you are consistently taking the time to slow down rather than speed up. This allows you and your therapist to hold painful and complicated emotions, which in turn improves your tolerance of those emotions without the need to camouflage. And much like with physical therapy or exercising, consistent frequency is required for progress. When combined with a strong therapeutic alliance, therapy will gradually strengthen and “inoculate” you over time, improving your self-awareness and overall distress tolerance.
Even with a better understanding of therapy, you may find that talking or thinking about your emotional pain leads you to feel worse in the short-term. And as strange as it sounds, this is to be expected. By lowering your defenses, you are going to be working muscles that have been dormant for some time. It might seem more appealing to seek relief through a “quick fix,” or by staying busy. You might also choose to consult with other physicians to try and pinpoint or rule out other problems. While these are important, exhausting other options at the expense of therapy can be a form of avoidance.
Any process of change involves leaving your comfort zone. The same is true, and necessary, in therapy.
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In determining whether or not you need therapy, remember to pay attention to the underlying thoughts and emotions steering the question in the first place. Even if they’re difficult to make sense of, they’re telling you something important about your emotional needs and overall quality of life. It’s also important to bear in mind any biases and reservations you have about therapy.
Oftentimes when we’re in distress, we want a fast solution that follows the path of least resistance. While the process of therapy isn’t quick, it has the power of bringing healing that goes beyond mere symptom relief. Remember that you have the power to decide if that is a path worth traveling.
