Sunday, September 22, 2019

Why Would Anyone Get Therapy?

Her decision was a quiet one. But the family fallout when my mother, suffering from stress and a mild depression, announced to those close to her that she had decided to go to therapy was far from quiet. There was a cacophony of unsolicited opinions.

"You're kidding, right?" said her old friend Jackie, peering over her rhinestone-trimmed sunglasses with a mixture of incredulity and ill-disguised disgust. "Look, we all have our problems. I have my three divorces and my grown kids driving me crazy with their antics and demands for money. But at least I've never felt the need to see a shrink."

My father, the major source of my mother's stress, weighed in with "That's just crazy... You got a problem? Talk to me. It's a lot cheaper than going to some stranger."

But Mother went to see a therapist anyway and found considerable comfort in what turned out to be the last year of her life.

Even though it has been nearly 40 years since her fatal heart attack, I still remember her quiet determination to get counseling and the peace she said it brought her to share her feelings with someone who would listen and care.

The bond she built with her young therapist -- Dr. Jim Alsdurf -- was warm and enduring. She was still seeing him for therapy when she died. When her heart stopped, she had just finished wrapping a gift for Hannah, the baby girl Jim and his wife Phyllis had recently welcomed. And, not really understanding the boundaries of the therapeutic alliance back then, we asked Dr. Alsdurf to give the eulogy at Mother's funeral. How very California of us to have her therapist give the eulogy! And how gracious he was to go along with our request, speaking eloquently about the emotional legacy she was leaving us.

Through the years, my own perceptions of therapy have changed from skeptical to embracing the process, first as a patient suffering from grief after the sudden heart attack and stroke deaths of both parents and my grandmother within a devastating five month period when I was 35. And then, in my forties, after years of writing articles and books in the areas of health and psychology, I decided to go back to school to become a psychotherapist myself.

In my work as a therapist, especially at a clinic for those with medical problems who saw me for depression and anxiety secondary to their injuries or illnesses, I initially saw a lot of the suspicions and attitudes that had attended my mother's announcement.

One patient in particular stands out in my memory for her resistance. Marianna was a Romanian immigrant and was so angry when her cardiologist referred her to me that she refused to speak English during our initial session. Her young adult daughter had come along to act as an interpreter and mom-wrangler. Every time I would ask one of our standard intake questions, Marianna would stand up and shout in English: "Stupid question! You're stupid!!" Her daughter would tug at her sleeve and say "Mama! Sit down! Listen to the doctor!" This process was repeated many times in our interminable 50 minutes together.

"Well," one of my fellow therapists who had overheard our exchange through our thin office walls, said, leaning into my office after the mother and daughter departed. "You probably won't see HER again...."

But they surprised us all by coming back the next week. And, free of the intake protocol, I asked Marianna what meant the most to her in life besides her wonderful daughter. She stopped scowling at me. Her face brightened. "My doggie," she said.

I smiled. "Tell me about your dog."

And that was the beginning of a lovely and memorable therapeutic experience. We bonded initially over our shared love of animals and I was able to help her in the months and years ahead to deal with the fear and anger she was feeling over the precarious medical condition that eventually led to her death. Her daughter still keeps in touch more than a decade later.

Times have changed considerably since my mother decided to go into therapy or since I faced initially resistant clients like Mariana. But the stigma still exists in some societies. That was what Princes William and Harry addressed not long ago in a video made to promote mental health in the UK. They talked about the ways that grief over the loss of their mother, Princess Diana, had lingered through the years, prompting Harry's wild risk-taking behavior in young adulthood. Prince Harry said that he finally sought therapy after some urging from his brother and sister-in-law and that it had made a real difference in his life.

Many who have never had therapy think that seeking professional help is a sign of weakness. But it isn't. As Fred Rogers once remarked: "It takes strength to talk about our feelings and to reach out for help and comfort when we need it."

Yes. I know that on a personal level and as a mental health professional.

But many are still skeptical and ask a perfectly reasonable question: Why would someone choose to seek therapy rather than simply talking with family and friends?

Why indeed:

A therapist will be listening to you with a different perspective. While a family member or a close friend may have a great understanding of your situation, it's possible that he or she may share your frustration in not knowing what to do or may be suffering from battle fatigue, having been through this crisis with you before. There are many times when someone dear to you is the best person to help you resolve a crisis. But sometimes he or she wants to help but doesn't know how. That's when a therapist comes in. The therapist, who is new to your situation, who is not being affected personally by your situation and who, as an outsider, may be able to see certain things with greater clarity, can be a great help in this instance.

A therapist is legally bound to keep what you say confidential -- with a few exceptions. In general, by law, what is said in the therapy room stays in the therapy room. What you tell a therapist will never hit the gossip circuit. A therapist won't rat you out to your loved ones -- with two major exceptions. If you are feeling suicidal and demonstrate a likeliness to act on these feelings, the therapist is bound by law to report this to your loved ones and to make sure you have a way to be safe, perhaps by hospitalization for a time. The other instance where a therapist has to break confidentiality: if you pose an imminent threat to someone else. You might express a lot of angry feelings about an ex-lover or ex-spouse without triggering any alarms, but if you appear to have a violent plan of action, the therapist has a duty to warn that person. Otherwise, anything you say in the room with a therapist will be between the two of you.

A therapist has skills to see you through a crisis. A therapist can provide you with the safety you need to vent painful feelings and to hear your thoughts without judging or criticizing you. He or she can sit with you in your pain, help calm you through a panic attack or period of anxiety and give you the support you need as you work through overwhelming grief.

Ideally. Some therapists are more skilled and empathetic than others. Some have their limitations and preferences. For example, some therapists work best with children and adolescents while others feel more comfortable working with adults. Some do well with depressed patients, but not with agitated, angry patients.

There is a matter of fit when you're choosing a therapist. It's okay to hold out for just the right therapist for you.

Therapists have different personalities and strengths. My brother Mike, a medical doctor, and I were comparing notes not long ago on the early days of our professional lives, when, as interns, we were assigned patients. Reflecting back, we found that our respective supervisors, at widely separated facilities, had matched us both with a lot of really angry patients. We looked at each other and laughed. We grew up with an angry, volatile father and, as a result, we both developed a certain comfort around angry people. We learned not to fear anger. We could stay calm and help patients to sort out the myriad of feelings behind their surface volatility.

There are times, though, when a therapist proves to be the wrong fit for a client before a word is spoken.

When I was working at the medical clinic, a young woman came into my office, stopped and stared at  me and then sat down at the edge of her seat, decidedly uneasy. I asked her what was making her so uncomfortable.

She looked down at her hands and her voice was a near whisper. "You," she said. "You look remind me of someone...I'm sorry...I can't work with you."

I quickly assured her that that was okay, that the most important thing was that she feel comfortable enough with a therapist for a session to be helpful. I praised her for her honesty and courage in speaking up and asked if she would like me to refer her to another therapist. She nodded. She worked wonderfully with my colleague Linda for some months after that.

You owe it to yourself to speak up if something doesn't feel right with a therapist. Psychotherapists are a varied lot. Some are warmer than others, some more cerebral. Some spend a lot of time in listening mode, interjecting occasional questions or comments. Others, who utilize more behavioral based therapies like Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT) may be more directive, focusing on skill-building interventions. Others may tailor their therapy very specifically to your needs whether you need guidance in one session or a listening ear in the next.
There are times in therapy when it's uncomfortable to talk about certain things or when you may leave feeling a little worse than when you did coming in. But if you always feel worse or feel that you can't be honest with your therapist, it may be time to move on.

How do you know that you might benefit from therapy?

  • When you have been feeling depressed for awhile and even loving reassurance from your friends and family doesn't seem to be helping.
  • When your anxiety is interfering with your life
  • When you feel overwhelmed with grief, even some time after a major loss. Friends may have sympathized but now say you just need to get over it. Family members may be locked in their own grief experiences and unable to help you. Or you may be grieving a beloved companion animal who was very much a family member to you -- but no one else seems to understand the magnitude of your loss.
  • When you're trying to deal with an issue or make a decision that you're reluctant or embarrassed to share with anyone you know and want to talk it over with someone who will not pass judgement or spread the news to the universe.
  • When you and your husband are at odds and need someone to be there for your relationship and not take sides.
In such instances, therapy can be a blessing --whether you choose to go for a few sessions or for months or even years.

How do you find a therapist? A good place to start might be to ask your primary doctor for a referral or a friend you know who has been in therapy. Another good place to look: Psychology Today Therapist Finder. This online tool lists therapists in your area and gives full page reports not only on their education and licensure, but also information about how they approach therapy, what kinds of therapy they offer, the insurance companies they work with and contact information.  Reading through that, you can get a fairly good idea what to expect going in.

The decision to get therapy or not is a very personal, sometimes painful one. But if you make the quiet decision to try it, perhaps despite some disapproval from those around you, you will find that it can make a wonderful difference in your life.


  1. Thanks for this intro to therapy. Up until now all I knew about it was what I saw on The Sopranos. Tony was skeptical, but not weak, so it can't be a sign of weakness to go to therapy.

  2. This is an excellent piece and spot on. I've been in therapy -- it is enormously helpful. Sometimes it is just the questions the therapists asks that makes us realize we might have some answers deep inside ourselves. And that if someone else will take the time to listen to us, perhaps we should honor that and take a little time to listen to ourselves. Lovely, Kathy.

  3. Dear Kathy, thank you for posting this. It will, I feel sure, help others who might hesitate to see a therapist. Peace.