To Be, Or Not To Be… (in therapy).

Beyond Routine Stress

There are other times when routine stress becomes overwhelming: times when problems seem insurmountable; instances when we can’t find solutions; when our sadness and anger don’t go away and instead become preoccupations.  For any number of reasons, we now find it difficult to cope with the very same stressors that we did in the past — so much so that it is interfering with our enjoyment of life. People seek psychotherapy when they are experiencing these higher levels of distress.

Typical Signs and Symptoms

There are several signs and symptoms that are generally good indicators that therapy should be considered.  The most obvious is distress:

• Are you frequently sad, angry, pessimistic or hopeless?
• Do you feel lonely, alone or empty?
• Are you irritable, nervous, or jumpy?
• Are you offended more easily than usual?
• Do you feel misunderstood?
• Have you noticed it is difficult to enjoy things that you used to?
• Has your appetite for food or sex changed (significant decrease or increase in these appetites)?
• Has your need for sleep changed (either not being able to sleep or sleeping too much)?
• Are you irritable, nervous or jumpy?
• Are you offended more easily than usual?

Similarly, does it seem like you are withdrawing from other people, social situations, or from activities? Are you more emotional than usual (crying easily, quick to anger)?  All of these are signs of distress. In its most extreme form, self-destructive or suicidal feelings or thoughts may appear. Violent impulses toward others may come into consciousness. These signal that something is going on that may be more than you can handle by yourself.  This is especially true if the symptoms have been present for more than just hours or days.

Subtle Symptoms of Distress

Most of the symptoms described above are relatively obvious.  You know something isn’t right. However, there are symptoms that you may not recognize as signs of distress.  These include difficulty concentrating, not having much motivation, a decrease in the quality of your work, or receiving feedback from others that you “don’t seem like yourself.”  Even changes in physical well-being can be signs that you are struggling with psychological or emotional distress.  People tend to get sick with colds, minor infections or other ailments when they are overly stressed and not coping adequately. Since these symptoms are a bit more difficult to identify as “emotional well-being,” they are more likely to be dismissed and therefore, therapy is not pursued.

Troublesome Triggers and Events

The changes and/or challenges that are encountered in the course of life can be triggers for the need for therapy, as well:

• Illness or death of family member or friend
• Relationship problems, separation, or divorce
• Employment termination or demotion
• Anxiety associated with starting a new job or promotion to a new position
• Moving to a new location — locally or long distance
• Change of school or starting college
• A motor vehicle accident
• Seasonal reminders of traumatic events such as the loss of a loved one

Happy Events Can Also Trigger Depression And/Or Anxiety:

• The birth of a new baby may present challenges for parents and siblings
• Holidays and social events can be a source of stress and tension
• Events that mark the passage of time such as milestone birthdays, anniversaries and retirement

While you may not need therapy as a result of these events, they may trigger a link to past depressive or anxious states of mind.  Frequently, the connection isn’t made between the events and the way we feel.  It is often that only through discussion do we understand that we are feeling the way we are because of our reactions to events around us.

Psychiatric Conditions

There are conditions that require treatment that do not have obvious connections to stress.  Some psychiatric conditions; for example, depression, anxiety disorders, bipolar disorder,  and certain phobias, may be caused largely by biochemical imbalances in the body.  In such cases one can feel depressed, anxious or fearful, or have impaired functioning at work, school or in social situations, even in the absence of perceived stress. It is not unlike someone with diabetes having an imbalance in the amount of insulin they produce. In cases like this, a life stressor may not even be present.  But the chemical imbalance exists and causes changes in the ways we feel and behave.

Brain chemistry is complicated and delicate. In many instances, there is too much or too little of brain chemicals that are found in everyone. The result can be a disturbance in mood or behavior without an obvious cause. In these cases, medication, combined with psychotherapy, can be very valuable, and have a powerful and beneficial impact on one’s sense of well-being.

Substance Abuse

A related area is substance abuse or dependency. Some people choose alcohol or recreational drugs for pleasure or relaxation. For many, this is not a significant problem if they can continue to function responsibly. But for others, alcohol or drugs can become a real problem. Dependency, where you cannot live without that substance, is always problematic. This can also be true of prescribed medications that are addictive.

Auto accidents, trouble with the law, or difficulty functioning as a result of drug or alcohol can be indicators that substance use has progressed to abuse and/or dependency.  These changes can surface suddenly or over time, and are indicators that a problem exists. There are three good rules of thumb that differentiate between substance use vs. substance abuse or dependency:

• Are you receiving feedback from others that your use of substances has become a problem?
• Are you wondering if you have a substance abuse problem?
• Have you decided you need to reduce the use of substances and have not been able to follow through on your decision?

One thing that makes substance abuse or dependency especially complicated is that often the person with the problem is the last one to become aware of it. People have a tendency to minimize or deny its seriousness.  They often reject or dismiss feedback from others. Sometimes it takes a real crisis, (an overdose, a DUI, a motor vehicle accident) before an individual is able to accept that they have a problem. Sometimes, it takes intervention from close friends and relatives confronting the issue that drug or alcohol abuse has been hurtful to them personally. Regardless of how one finds out, treatment of one kind or another is almost always necessary. People with substance problems typically require a combination of different forms of treatment.

The Difference Between a Need and a Choice for Therapy

I have described above a variety of situations that suggest the need for therapy. But there are other reasons as well. Sometimes, people choose therapy simply to learn more about themselves or their relationships. Sometimes people would like to understand why and how their patterns have developed, and how to change them; for example repeatedly choosing partners that are unsuitable or unavailable. Others choose therapy to enhance the quality of their lives – to become more productive, creative or organized. These examples reflect a wish, rather than a need. They are optional, and sometimes considered a luxury. But, they are legitimate reasons for seeking assistance just the same.

There are many different types of therapy available today. It is often difficult to know where to turn to find the treatment and clinician that will work best. It is a complicated process, one that should be taken seriously.

In my next article, “Choosing The Right Therapist,” I will share various types of treatment, along with suggestions about choosing the right clinician for you. In the meantime, spend some time with yourself! Ask if any of the signs or symptoms I’ve described in this article ring true for you. You may find that they do not; that you are coping adequately and getting the most out of your life. However, if they do apply, be kind to yourself and acknowledge the need for some type of treatment that will enhance your life. It may be the best gift you can give yourself.

“Self-knowledge is the great power by which we comprehend and control our lives.”

– Vernon Howard