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Who Needs Therapy?

There's little doubt that many people could use professional help. Nearly a half-century ago, when epidemiology in this area was somewhat less rigorous than it is today, one study found that 81.5 percent of the population of Manhattan had "signs and symptoms of mental distress."

Using more precise definitions, the 1999 U.S. surgeon general's mental health report suggested that in the course of a year 22 to 23 percent of Americans have a diagnosable mental disorder-that's 44 million troubled people. Most suffer from some form of depression or anxiety severe enough to cause marked distress or interfere with work or personal life. A 1993 study by the National Advisory Mental Health Council found that nearly one American in ten experienced significant functional impairment due to emotional ills-their problems made it truly difficult to go about their daily lives.

"Just as practically no one gets through life without a physical ailment, very few can without significant psychological ailments, conflicts, and stresses," says Jeffrey Binder, Ph.D., director of doctoral and master's clinical training at the Georgia School of Professional Psychology in Atlanta.

An identifiable crisis, loss (of a job, romantic partner, or close relative), or trauma propels many people into therapy. For others it's the culmination of a lengthy process; the problem is long-standing, and now the time seems right. Symptoms, like anxiety or difficulty concentrating, have become severe enough to interfere with your life. Perhaps your work is suffering.

"The key idea is perception," says Sharon Hymer, Ph.D., a clinical psychologist practicing in New York City. A family conflict may have been simmering for years, or a romantic disappointment may be just the latest act of a long-running drama. But on top of that, there's a feeling of demoralization. "People go to therapy when they perceive themselves in a crisis that they can't resolve by themselves and with the help of friends." (The kindling of hope, experts say, is often the first big benefit of effective therapy.)

Feeling you are out of your depth is a key indicator that it's "time to ask for some help," advises the American Psychological Association. Think of therapy when you feel trapped, with nowhere to turn, when it seems that things aren't getting better, when worry becomes chronic and never leads to any answers, or when emotional unease spills over and affects the way you eat or sleep, or takes a toll on your job or personal life.

Psychiatrists often treat those at the more seriously ill end of the spectrum. The American Psychiatric Association lists marked personality change, extreme highs and lows, excessive anxiety, anger, hostility, or violent behavior as indications for a prompt consultation. Thoughts (or talk) of suicide are a warning that immediate help is needed.

The mind and body are closely connected, and some signs that therapy may be helpful are physical. Unexplained, often vague symptoms-fatigue, frequent headaches, backaches, or other troublesome pains, frequent digestive upset, even pesky skin conditions-can reflect depression, anxiety, or a burnout level of stress. Such problems may accompany emotional distress or take their place. When a thorough medical work-up finds nothing, consider a psychological explanation.

On the other hand, a life-threatening illness such as cancer or heart attack, or a painful chronic condition like arthritis, often outstrips one's ability to cope. Psychotherapy doesn't take the place of medical care, but it can supplement it: in fact, substantial data suggests that people with serious illness do better physically if they take effective steps to deal with the emotional turmoil it creates.

While there's little solid data on just who seeks therapy and why, a widely cited 1995 survey by Consumer Reports found that nearly half of four thousand readers who went for professional help were "in considerable pain." Besides mental disorders like anxiety and depression in their various forms, the motivating forces included family or sexual problems, work woes, stress-related symptoms, problems coping with grief, and difficulties with alcohol or drugs.

Most significant emotional problems, however, remain untreated. The surgeon general's report noted that only one third of people with a diagnosable condition were getting any sort of help with it, and just over half of these were in treatment with a specialist such as a psychologist or psychiatrist. You may be in serious distress; you've done what you can to make things better, and it hasn't been enough. Your work, family life, or friendships are somewhat the worse for wear. Yet you hold back. You just can't take the next step toward getting help.

Why does this happen so often? For one thing, there's a persistent notion that we should be able to do it on our own, that it's shameful to need help. Some people fear that they'll give up control of their lives by submitting to the influence of someone with a sophisticated knowledge of human nature, or coerced into taking drugs. Or that they'll be "homogenized" by therapy, lose their individuality, become some sort of processed clone. They think that therapy must be a lengthy process that inevitably requires rehashing all of childhood and opening up a Pandora's box of repressed impulses. Or that nothing will really help-their problems are so hopeless that they are beyond therapy.

Many such attitudes come from images of therapy and therapists promoted in our culture. We laugh at endless analysis à la Woody Allen and set box office records to see movies featuring a Hannibal Lecter-type psychiatrist who is as expertly manipulative as he is malevolent. (Some psychiatrists have described the Lecter portrayal in The Silence of the Lambs as "devastating to the profession," and expressed concern that such images may prevent potential patients from getting the help they need.)

The best way past these obstacles is information. Learning, for example, that an explicit goal of good therapy is to help you become more individual and creative, not less so. That many effective kinds of therapy focus on the present and pay little attention to ancient history. That the "nothing will help" feeling is itself a symptom of emotional trouble (specifically, depression), not a realistic appraisal.

One last barrier to seeking therapy is simply not knowing how. What do you do to find a therapist? How can you ensure that he is competent, qualified . . . right for you? Is there reason to believe his approach is likely to be helpful? The aim of this book is to assist you in this quest.

next: Why Even Try Therapy? and Types of Therapy

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Reviewed: 03/2006