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Excerpt from Self Magazine         October 2021         copyright

13 Signs It’s Time to Consider Therapy

We all really do need it.

By Jessica A. Gold, M.D., M.S.

“You need therapy.”

This is a phrase used far too often as an insult, a punishment, or even a bad joke. We say it to the partner we are mad at (or dumping), to the politician or anonymous person on Twitter we disagree with, or to the friend we feel is in the wrong yet doesn't understand why.

As a psychiatrist, I cringe when I hear therapy discussed like this. Not only is this the wrong way to think about when we should be going to therapy, but it's also a deeply stigmatizing view. Instead, we should be thinking of therapy’s many potential benefits to, well, really any of our lives.

Because we so often talk like this, I've noticed that many people don't actually know the various reasons you might consider going to therapy in the first place. They may be skeptical of it, see it as self-indulgent, or not think they need it at all because they have loved ones to talk to or believe it's reserved for only extreme circumstances.

To help clear up these misconceptions, I asked therapists what signs they think about when they recommend therapy to people and why. Here are 13 very good reasons you might consider going to therapy—none of which are an indictment of you as a person.

1. You’re having trouble processing something in your life.

Have you ever felt like you can't quite articulate what you're feeling or struggling with? Chase T. M. Anderson, M.D., M.S., child and adolescent fellow in the UCSF Department of Psychiatry, says one of his first cues someone might benefit from therapy is that they continue to say, “I wish I had the words for this,” or “I need to talk this out more.” Therapy can help with both. It does this by being a place for a patient to work through feelings, thoughts, and challenging situations, according to Marcia McCabe, Ph.D., clinical psychologist and professor of psychiatry at Washington University School of Medicine. In doing so, “sometimes something truly valuable comes from this process—becoming a more aware and better version of ourselves,” Dr. McCabe tells SELF.  Brit Barkholtz, MSW, LICSW, a clinical therapist in St. Paul, agrees, adding, “Therapy can be a mirror to hold up to help you see yourself a little more accurately through the eyes of someone trained to see you comprehensively.” This can be particularly helpful for breaking through our limited, tunnel-vision perspective of who we are and what we're going through.


2. You seem to have a shorter fuse than usual, and it’s affecting your mood, relationships, or other areas of your life.

Are you more easily annoyed with your friends or family over the “little things”? Are you becoming more enraged by your inbox with every passing day? Paying attention to how you're reacting to everyday stressors—and how that's changed over time—can be helpful when considering whether therapy might be right for you, explains Maia Wise, LICSW, founder of Wise Therapeutic Solutions LLC in Washington, D.C.

This includes taking note of any major changes in your mood, behaviors, sleep, relationships, and decision making, as well as your relationship with food, alcohol, or drugs, among other things. Some of these may be symptoms of actual mental health disorders like anxiety or depression, but they don’t have to reach that level of severity for therapy to be helpful. Therapy can help sort out some of the root causes of these reactions by getting at the thoughts or feelings behind them, as well as the patterns causing them. You may also learn to incorporate more adaptive coping skills so that you're not always turning to a drink at the end of a stressful workday, for instance.


3. You don’t feel like you’re functioning at 100%...or anywhere close to it.

All of us can feel sad or angry or tired, but it doesn't always interfere with our life, relationships, or goals. According to psychologist Riana Elyse Anderson, Ph.D., assistant professor at the University of Michigan School of Public Health, a change in our optimal functioning is a red flag that we need help. “If it typically is a breeze for you to get up in the mornings or complete your to-dos throughout the day, but now it feels like a ton of bricks are lying on you when getting out of bed, or you're agitated at everybody while you're completing your errands, it means you're functioning differently than your baseline,” she tells SELF. “That's data right there. It helps you to say, ‘Hmmm, I'm not feeling the same way I used to or doing the things I used to love with joy or ease.’”

These changes in our mood or anxiety can affect our concentration, decision making, and even our memory, adds Wise, which can then affect our ability to get things done. Therapy helps you figure out why these changes have occurred and how to get back to functioning more optimally. For example, if you're having trouble getting out of bed, you might purposefully schedule activities that are pleasurable throughout your day to get you going, using a technique known as behavioral activation.


4. You could use an unbiased, confidential person to talk to.

People often say that talking to a therapist is the same as talking to a friend, but it isn’t. A therapist is unbiased and neutral, does not get exhausted or burdened by your coming to them, and is someone you can absolutely trust to keep what you say confidential. “We have no hidden agenda or biased desires; we just want the best for you,” says the University of Michigan’s Dr. Anderson. “We help you, the expert in all things you, dig into the hows and whys that are within and try to iron out those wrinkles in your body, mind, or spirit. We often do not give advice or explain what to do; rather, we help to summarize, repeat, or string together some of the things you are sharing with us.”

This is very different from the type of conversation you would have with a friend. Or maybe you want to talk through these things with a friend but you feel a lack of support from your loved ones—or you've tried to discuss this with them and they weren't helpful. All of these are signs that you could benefit from talking through your situation with a therapist, says clinical and forensic psychologist Angela Lawson, Ph.D., associate professor of psychiatry at Northwestern University's Feinberg School of Medicine.


5. You feel stuck.

Many of the therapists interviewed pointed to therapy as a way to help when part of your life feels unfilled, stagnant, or stuck. Psychologist Alfiee M. Breland-Noble, Ph.D., founder of the mental health nonprofit the AAKOMA Project, describes that feeling as: “You do not feel better even though you have a strong desire to feel better emotionally, or you might even be trying out new behaviors to help yourself feel better, but nothing seems to be working.”

Therapists can help you get unstuck by helping you figure out your goals as well as any anxieties and fears that may be holding you back. “A therapist can help you to identify your values and activities that connect you to those values,” licensed psychologist Kathryn H. Gordon, Ph.D., author of The Suicidal Thoughts Workbook, tells SELF. “Therapy is [also] useful for naming obstacles to joy and getting guidance for overcoming those obstacles.”


6. You seem to be repeating patterns in your life.

This is a bit different than feeling stuck, as it relates to a specific behavior that you can't seem to quit. “One sign I hear often is repeatedly engaging in a behavior that the person can intellectually or rationally recognize isn't helpful or healthy, but they find themselves doing it anyway to their own detriment, whether that be professional, personally, or relationally,” explains Emilie B. Joseph, Ph.D., licensed psychologist and founder of Empowered Insights LLC. “Another related sign is feeling a lack of control in their life generally or over their behaviors.” This lack of control could show up in various areas of your life—from substance use to relationships to general impulsivity.

Barkholtz believes that having external objective support, like a therapist, is essential to breaking these patterns and establishing new ones. “Often there are roots and contributing factors and triggers underlying patterns that we don't even realize until someone else helps us do a little digging to figure it out, which is something a therapist is trained to do.”


7. You feel overwhelmed.

Overwhelm is a big and broad sign that therapy could be helpful for you, says Barkholtz, because overwhelm itself can be caused by so many things—from relationships and external circumstances to your own emotions. When we feel overwhelmed, we often can't process and cope with things, whereas a therapist can help us do both, she says.

Therapy can help you learn to name, identify, and understand all those feelings you're having. For instance, maybe you're overwhelmed with anger and irritability lately—which is certainly not uncommon these days. “Mental health professionals help to identify the external and internal factors that are contributing to the irritability,” Dr. Gordon explains. “For example, is anxiety or stress driving it? Is there a need for better communication? Do you need to take more self-care breaks so that you don't feel as on edge? Therapy is a process that provides skills for working through difficult feelings and situations to improve your well-being and relationships.”


8. You’re struggling with expectations—like the pressure to be constantly productive.

Yes, even high-functioning high achievers who can go about their day-to-day responsibilities without disruptions can still benefit from therapy, points out Dr. McCabe. “Often these people have learned very well the importance of self-control and being responsible, but there can be too much of a good thing,” she says. “People who have unrelenting self-expectations often feel that they can never relax and that there is too little pleasure in life. They may even feel lonely from believing they can only show the achieving and responsible side of themselves to others.”

Therapy can be a place to work on boundaries, establish a better work-life balance, and learn to connect with others. Perhaps most important, it can make you more understanding of the imperfections of being human. Therapy can also teach skills to help deal with self-criticism and asserting your needs, adds Dr. Gordon.


9. You’re anticipating—or currently going through—a major life transition.

We often get anxious about change—like moving, starting school, or starting a new job. Right now many of us may be anxious about returning to work if we haven't already or adjusting to whatever this “new normal” looks like. Therapy can be a great tool for easing you through these big changes, so that you don't have to try to power through them solo.

“Therapy offers an objective, outside view of your thoughts, feelings, and emotions to help you feel less anxious and overwhelmed about change or transition," therapist Jessica Gaddy Brown, LICSW, CEO of Nia Noire Therapy + Wellness, tells SELF. It helps you prepare for what to expect and make it a softer landing when the change does occur. Plus, challenges and changes will always happen, and learning how to approach them will be helpful when they come unexpectedly in the future.

“Life will always throw a curveball at you, and society has normalized functioning in dysfunction due to the stigma of mental health,” says Wise. “How do you position yourself to stay balanced despite the curveballs?” Self-awareness and coping skills learned through therapy are definitely one answer.


10. You experienced a trauma.

Many of us have experienced tragedy beyond our control—especially recently—including death, accidents, assault, and bullying, among others. Trauma is something that can interfere with functioning in our interpersonal relationships, be triggered on an unexpected timeline (including years later), and even manifest itself physically. According to Brown, therapy can “assist with exploring and processing the emotional impact, helping you understand your emotional and/or psychosomatic response to triggers, [and offer] opportunities for clarity and behavior/thought modification.”

This includes processing racial trauma and microaggressions, ideally with a culturally sensitive therapist who makes you feel safe, seen, and heard. “Having someone who is trained to talk out such issues, to listen, to help, is essential for a minoritized person to survive in this world that is too often intentionally fracturing to the psyche of minoritized people,” says UCSF’s Dr. Anderson.


11. You’d like help working through difficult family or relationship dynamics.

Current and former family challenges make for excellent exploration in therapy—whether that's in an individual or group setting. For example, you might discuss your relationships in individual therapy to better understand the root causes for some of your own behavioral patterns and to learn to navigate those relationships in a healthy way with boundaries and improved communication skills.

Or, if you're dealing with a specific issue that's causing fighting or strain in your relationship, it might make sense to go to family or couples counseling for an objective mediator. “A skilled family/couples therapist can facilitate productive conversation and problem-solving among family members to enhance interpersonal communication and behavioral patterns,” says Brown. “Many people find family/couples therapy beneficial in healing parent-child or sibling relationships, guiding new parents through postpartum challenges, or helping couples enrich the love they share, creating healthier, more loving environments.”


12. You have a physical health condition.

Far too often we separate the mind and body, viewing mental illness as entirely different from physical illness. It isn’t. “Injury and illness affect us in many ways—practical, emotional, and social,” Dr. McCabe explains. “We may need to make significant adaptations to our usual lifestyle, learn new ways to cope, and deal with significant uncertainties.”

Plus, in the case of some physical illnesses, stress can actually exacerbate your symptoms, which makes it even more necessary to learn stress-reduction techniques and coping skills. Therapy for physical health problems can help in many ways, says Dr. McCabe, from directly helping with pain management to learning to manage the thoughts, behaviors, and emotions that come with a chronic illness, and even helping with overall quality of life.


13. You are living in a pandemic.

There really is no better time to prioritize self-improvement and stress reduction through therapy. As you can see from this list, you don't need a diagnosable disorder to see a therapist and benefit from that support. Therapy is there to help you navigate through difficult times, says Dr. McCabe—“and so many people have experienced difficult times in the past two years.”

Adds Wise, “2020 was a walking cesspool of trauma. We all had very different individual experiences. We are here to normalize your experience and help you verbalize what you might need, and help you get on the right path. What's better than spilling your deepest, darkest secrets to someone who won't tell you your business or judge you?”

“To be honest, I think that every single person on the planet would benefit from and needs a therapist,” says Dr. Anderson with UCSF.

I couldn't agree more.

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