• John Snyder, Psy.D.

When To Seek Psychotherapy

Thinking about psychotherapy

When to seek therapy?- is a maddeningly case-specific question.

Stress, anxiety and even depressive feelings are a part of a rich emotional life and there is nothing pathological about experiencing them from time to time.

Mental health is not a static state. Instead, mental health is dynamic, fluctuating, and ever-changing. It depends upon your external and your internal environment, and the current psychological resources you can bring to bear in relation to these two environments.

One of the best indicators that it is time to seek therapy is when a person's emotional life has become static, that is, when it one is experiencing a dramatically reduced capacity for emotional change. This can be experience as a sense of being stuck or trapped. Of course extreme fluctuations in emotional states such as those experienced in people with bipolar disorder also warrant professional help.

Growth Approach versus Deficits Approach

Broadly speaking, the purpose and goals of psychotherapy can be divided into two levels. The first is a “growth oriented” approach in which the individual and the therapist seek to expand and maximize the patient’s functioning in the world. There may not be any“specific problem." This "growth oriented" or "personal growth" approach can be very effective and rewarding in the long-term for the individual, as it can help her or him to identify and move more efficiently towards her or his goals in life.

The second approach is a “deficits approach" wherein the patient and the therapist seek to address a serious problem or problems in the patient’s life. The goal is to alleviate problematic symptoms, cognitions, and behaviors that are seriously impacting an individual's ability to function. The idea is that there is a current deficit in functioning and the patient must be brought back to previous levels of functioning. Once a return to previous levels of functioning is achieved, a patient may elect to remain in psychotherapy in order to prevent future deficits, or to pursue previously unrealized goals, thereby transitioning to the “growth approach” to psychotherapy.

More frequently, in my experience as a psychotherapist, people tend to wait until they are in this second “deficits-state” before they enter psychotherapy. At this point, the person's life may have been dramatically impacted by his or her psychological difficulties. The person is in danger of losing important aspects of his life such as a romantic relationship, her job, his freedom (DUI, arrest, etc), or her life (suicide).

Everyone has problems that differ in degree at different times in their life. The key is to catch oneself before one’s circumstances overwhelm one’s capacity to cope. This can be tricky because this requires emotional awareness. Those with less emotional awareness are less likely to enter psychotherapy until things have gotten “really bad.” Men tend to be less emotionally aware than women, not because this is a man's natural state, but instead because men are trained to be that way by society and cultural expectations. That being said, many women lack emotional awareness, and can struggle to identify how and why they are feeling and reacting in a certain way.

In either case, behavioral markers can indicate that it is time to seek professional help. Here are a few (the list is by no means an exhaustive list):

  1. Friends, colleagues, family are expressing concern.

  2. Your social interactions have decreased significantly (isolation).

  3. You no longer care about your personal appearance (poor personal hygiene)

  4. You feel sad and down most of the day

  5. You feel irritable and even angry most of the day

  6. You have thoughts that you might be better off dead

  7. You have thought about killing yourself or have attempted to do so.

  8. You are engaging in self-harm (cutting, burning yourself).

  9. You are engaging ins unsafe sex (many anonymous partners, not using condoms)

  10. You are sabotaging your career, or your romantic relationship

  11. You are sick often with no medical explanation

  12. You are increasingly relying on alcohol, pot, or other drugs (including prescription) to “relax” or “unwind.

  13. You feel hopeless and/or lost”

  14. You are isolated.

  15. You are in danger of losing or have already lost a romantic relationship

  16. You’ve been fired for poor performance or behavior at work.

If the answer is "yes" to any of these questions, you may benefit from psychotherapy.

*In particular, if you are experiencing suicidal thoughts, it is important that you seek professional help immediately. If you feel that you may actually carry though with killing yourself, you should immediately call the suicide hotline at 1-800-273-8255 or simply dial 911.

Dr. Snyder is a Licensed Clinical Psychologist practicing in San Francisco.

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