Do I Need Therapy?

This is a question I often hear, not only from prospective clients, but also from friends and acquaintances.

So first of all, I’m not one of those people who sees therapy as part of a healthy lifestyle like exercise should be. I see therapy as something you only do when you need to. You do the work, get it over with, and go back to normal life, with the new normal hopefully being better than prior to therapy.

So when do you need to? In three circumstances:

1. You’re experiencing symptoms that are disrupting or interfering with your life.

What kind of symptoms? Could be just about anything. Intrusive images or thoughts from an upsetting experience such as a trauma or loss. Anxiety, depression, trouble sleeping, short temper, addictive behaviors… Just about anything that you find distressing or disruptive, or that interferes with your functioning, in one or more realms such as self-care, work/school, behaviors, or relationships. For example:

A married man told me in our first meeting, “My wife says I have to get my temper under control, or she’s walking out. She’s had enough.”

A teenager was anxious and depressed, having trouble staying focused in school, and their grades had gone from As/Bs to Cs/Ds, in the months following a romantic break-up and some bullying.

2. You’re not experiencing symptoms, but only because you’ve restricted your life in some way.

Some people manage to keep things smooth, but in a way that’s less than satisfying, because they’ve restricted their lives to avoid problem areas. For example:

A young woman who had been molested as a child became overweight and wore baggy clothing. This enabled her to feel safer, in that (she imagined) by being less attractive she would be of less interest to sexual predators. But by keeping herself “safe” she was also avoiding any possibility of an intimate relationship, which made her lonely.

A young man sustained a traumatic head injury and became somewhat disabled due to neurological limitations. He went back to his previous demanding full-time job, but could not concentrate on it for enough hours in a row, and had to quit. He soon tried a different job with the same results. After that, he refused to try even a part time job for fear of further failure. So he got Disability benefits, holed up in a low-rent apartment, and got high every day. He did not have to face further failure, but instead he lived a life of disappointment.

3. You have an unprocessed emotional wound.

Okay, this is not necessarily a need for therapy so much as a good idea. Because unprocessed emotional wounds can put you at risk for later difficulties. For example, the early research on children of divorce found that divorce messed kids up. But subsequent research found that after an initial adjustment period of perhaps a couple of years, children of divorce functioned just as well as other children. So then the conventional wisdom was that divorce did not, after all, harm children. That view prevailed for some years, until those children got older and started attempting intimate relationships of their own. Then those kids were impaired again (Wallerstein, Corbin, & Lewis, 1988).

So why would a child of divorce seem fine and normal for many years, and then wind up impaired when attempting an intimate relationship of their own? Because an unprocessed emotional wound can be like a sore spot. As long as nothing hits the sore spot, everything seems fine. But the sore spot remains. Then when a related challenge comes along, and hits the sore spot, it becomes much more challenging than it otherwise would be (Greenwald, 2005).

This is why I often recommend a brief course of therapy (featuring EMDR or PC) following a significant trauma or loss, even when no symptoms or restrictions are apparent. Just to clean up any possible sore spot, to give you the best chance of handling related future challenges.

And by the way: In each of these circumstances, therapy can help!

References

Greenwald, R. (2005). Child Trauma Handbook. NY: Haworth

Wallerstein, J., Corbin, S. B., & Lewis, J. M. (1988). Children of divorce: A ten-year study. In E. M. Heatherington and J. Arasteh (Eds.), Impact of divorce, single-parenting, and stepparenting on children (pp. 198-214). Hillsdale, NJ: Earlbaum.