How to know if you need therapy

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“I don’t know (or I’m not sure) if I need therapy”…  I hear this a lot- and understandably, when I speak with someone for the first time, it could be the first time they have talked to a therapist.  In fact, many people think about it for quite some time before they take the leap.

Why wouldn’t we know when we need help, or why would we be reluctant, you ask?  Well, first of all, stigma.  Historically it’s been “weak” to ask for help, much less to call a therapist (especially if you’re a guy).  Many of us were brought up to believe that we should be able to handle everything by ourselves, which of course we can’t always do.

But… it’s not weakness at all.  We all have our limits of what we can handle, and sometimes life throws more at us than even the strongest can manage.  Is it weak that you can’t fix your heart or kidneys by yourself?  Is it weak that you can’t heal a broken leg?  Then why the double standard when it comes to the brain?  I have never gotten that!

Another thing to think about is that we’re not all trained mental health professionals– so how could we possibly know all about mental health and how to manage certain issues or treat a potentially serious problem?  I have learned a bit about carpentry, electrical work, and auto mechanics over the years, but I have no problem admitting I don’t know it all, or calling in a professional for some assistance.  I can pretend I know all about cars, computers, or plumbing- but that’s not always going to turn out well.

A second reason, and the focus of this post, is that we don’t always know when we need help- or when something has crossed the threshold into a problem too big for us to handle alone.  Where exactly is the line? For some people this means a crisis, requiring immediate action.  For others, it might be a chronic issue they have either ignored or have not had success in handling (and they’re tired of spinning their wheels trying to do it their own way- or tired of other people suggesting they get help!).  While for others, it might just be something bothering them enough that they want to discuss it with someone else- a professional who specializes in these things, or just an unbiased person they don’t know who isn’t going to gossip all over town about it.

So how do you know if you need therapy?  Well, “need”, is a somewhat of a subjective term.  Let me start by defining what a disorder is (in the context of behavioral health).  Something becomes a disorder when it is distressing to the person, and/or it is impacting his or her functioning in important areas.  Common disorders include anxiety, depression, ADHD, or alcohol abuse.  We know when something is distressing to us, or bothering us so much that we have difficulty not thinking about it, and we know what things make us feel bad about ourselves of our lives.  In terms of impact, I’m referring to things like our relationships; our ability to go to work or school and do what we need to do there; our ability to function in the community without issues; or even our ability to take care of ourselves.  We don’t always see these things right away, and it might be difficult to admit, but most of us reach a point where we feel like one thing or another is too much.

It’s worth mentioning that all problems or issues exist on a continuum or a spectrum (as in the Autism “Spectrum”)- not only whether or not something qualifies as a disorder, but when it is a disorder, how severe is it (i.e. how much is it impacting the person’s life).  If a person has a more severe disorder, such as bipolar disorder, schizophrenia, or major depression, we might say the person has a serious mental illness (SMI).  And I will say that someone with a SMI or with another disorder that seriously impacts their life- for example, with symptoms like suicidal or homicidal thoughts; hallucinations; or that otherwise put themselves or others at any kind of risk, treatment is crucial.  And the best treatment may involve medication in addition to therapy.  Consulting with a professional would be very important.  But, there are plenty of less severe issues too.

As a professional, I will tell you that anyone with a diagnosable disorder, especially a severe one, could benefit from therapy.  As someone who values insight and having a variety of tools to cope with life’s challenges, I’ll tell you that anyone can benefit from therapy.  When it comes to insurance reimbursement; however, some diagnosable disorder is important in order to support “medical necessity” of therapy.  That can be a problem in today’s health care system, because there are plenty of life issues we could benefit from counseling for, but the good thing is that there are many recognized disorders, many not requiring the degree of difficulty or impairment that others might.  For example, an individual grieving from a death or loss might have a diagnosable mental health condition, or similarly, someone having difficulty adjusting to a life change, such as marriage, a new baby, a move, or even retirement.

The important thing, when deciding if you need or could benefit from therapy, is whether or not there is some issue that is bothering you to the extent that you might like to consult with a professional about it.  You could benefit from understanding the problem better, or learning new ways to cope with or manage it.  If so, it couldn’t hurt to find the right kind of professional, contact him or her, and seek their professional opinion.  He or she might provide a phone consultation, or perhaps you could schedule an initial appointment.  This gives you the chance to speak to someone who doesn’t know you, but has experience working with individuals with similar situations; and he or she should be able to give you some direction on what to do next.  This may or may not mean therapy, and if you do end up participating in therapy, it could be in a short or a long-term context.  This, of course, is dependent on the issue, as well as what you are looking for and the particular therapist’s approach.

So to recap, here are 3 things to think about if you are considering talking with a therapist:

  1. Is there a problem in your life that is bothering you that you have been unable to put out of your mind or resolve yourself?
  2. Is this problem impacting your functioning in some way?
  3. And, would it benefit me to understand the problem better or to learn some new ways of dealing with it?

If your answer to any of these is yes, get in touch with a therapist.  For more information on this, check out some of my other posts.  And if you want to find a referral, you can look here.  Take care!

– Dr. Matthews


Published by Dr. Jesse Matthews

I'm a practicing psychologist and director of Matthews Counseling & Coaching, a private practice in Chester Springs, PA. I work with clients 18 and older, and my specialties include: depression; addiction/substance abuse; relationships; anxiety; ADHD and behavioral issues; and Autism/Asperger's. Our group works with individuals from tween through older adult, helping them with a variety of life issues. Check out the practice website for information on other clinicians and their services: .

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