What’s Stopping You from Going to Therapy?

One could almost say people require therapy in order to decide to go to therapy. Many needful of the help don’t make it. What is the way there and why do some go and others stay away?

Here are a few of the obstacles:

  1. Sensitive souls want to be seen, but are terrified of being seen. History tells them disclosure is dangerous.
  2. Psychological defenses were created before the counseling profession existed. Our ancestors needed emotional armor to survive. Those who were defenseless in the face of crushing reversals of fortune (poverty, disease, loss of loved ones) were less likely to endure. We are therefore the descendants of creatures equipped with instinctive fortifications. Many are still useful under the right conditions. Hesitation before a psychotherapeutic project designed by Freud to dismantle you should not be a surprise. A good therapist, however, will be aware of the dangers of tearing these down before providing a better alternative.
  3. Those emotional barriers include over reliance on the following: avoidance, denial, rationalization, distraction, emotional constriction, dissociation, fantasizing, compartmentalization, intellectualization/over-thinking, alcohol, food, drugs, and sex. Once ingrained, the defense tends to choose us more than be chosen by us. Reflection on one’s default tendencies is uncommon. Were we to inventory the mental habits and behaviors working for and against us, psychotherapy might appeal more. Successful defenses established in your formative years are not always the best ones to use as an adult, when your life situation is different.
  4. Many who don’t avail themselves of psychotherapy’s benefits are lost, like “a man who knows the price of everything and the value of nothing” (Oscar Wilde). They believe their vision of the world is complete. A need for treatment goes unrecognized. Their sense of relative emotional health is part of their problem.
  5. Most people think they understand themselves. Few therapy virgins, however, try to systematically look for repetitive patterns of behavior in their past. George Santayana famously said,”Those who cannot learn from history are doomed to repeat it.” Others remind us that history rarely repeats itself literally, but often rhymes.
  6. Depending on ethnic, religious, economic, or national origins, treatment faces social prohibitions. For example, fundamentalist religions sometimes point to significant depression as evidence of a failure of the suffer’s faith. Reliance on God and a reorientation of one’s relationship to God is believed to be the solution. Psychotherapy is judged a misunderstanding of what the believer identifies as the problem.
  7. The most troubled doubt counseling will help.
  8. A preference for a passive, rapid solution: medication. The individual ignores (or may not know) that some disorders are better treated by talking than a trip to the pharmacy.

Nine more:

  1. Social and economic obstacles to therapy include the stigma of being “weak” or “crazy,” fear that self-disclosure will lead to betrayal (including the sharing of sensitive medical information with their employer), the expense of treatment, guilt at the idea of talking negatively about one’s parents, and the time in session and traveling to sessions. “Real men” comment that one should be able to solve problems without the emotional crutch of expert help. Your mom might even agree. If you fear what she thinks about your decision, you need the fix more than you need her judgement.
  2. More than a few of us persist in trying to change others. Rather than look inside, we try to alter the peopled world. While in vigorous and hopeful pursuit of this goal, the turn inward is hard to come by. Some will never realize the material for change is at hand within themselves, the only being they control. You might recall the mythic figure of Sisyphus, whose punishment for eternity was to roll a ball up an incline, watching the inevitable and dismaying roll back down each time. Those who take on the comparable job of changing another adult will first need a long period of frustration before they recognize they must begin to work on themselves. Here, then, is a hint to the kind of painful experience required to get us into the counselor’s office.
  3. Many people cannot imagine a new way of living — something substantially different from their normal existence. They lack not only the will to transcend themselves, but the imagination of what transcendence might look like. Such people are similar to the residents of Plato’s imaginary cave, who believe their shadowy cavern is the entire world.
  4. Counseling takes many forms. The potential client often has no idea how to choose from the array of options and helping professionals. This difficulty is exacerbated if the treatment candidate lacks even minimal understanding of his own psychology and well-targeted therapeutic goals.
  5. Horror stories of therapy-gone-wrong abound.
  6. The internet allows a virtual life for those who would otherwise live in seclusion. While it can serve as a stepping stone to richer human contact, the brightly lit screen may instead just prevent them from reaching for more satisfaction in the face-to-face world.
  7. Simple alternatives to therapy are appealing: move to California, get a different job, dump your mate, have an affair to remedy a mid-life crisis, etc.
  8. Self-help books can prove a waste of time or a method of avoidance.
  9. The slave in the magic mirror used by the Evil Queen in Snow White and the Seven Dwarfs is unwelcome when she says Snow White is fairer than the Queen. Such a mirror also tells us when bad luck and betrayal are no longer sufficient to explain our unhappiness. Until you are willing to accept the glass’s truth and take responsibility for your life, psychotherapy will not be in your immediate future.

With all these obstacles and more, what gets a person beyond the contemplation of treatment to a voluntarily meeting with a counselor? This list of factors is shorter than the previous one:

  • Advice from a trusted friend, relative, cleric, physician, or former patient.
  • Research to discover what therapy entails.
  • Pain is almost always the key. If every other alternative has been tried and the suffering remains great enough, even the hesitant will sometimes take the leap.

Two jokes apply to the question of change through psychotherapy. The first is the better known:

How many therapists does it take to change a light bulb?

One, but the light bulb has to want to be changed.

The second emphasizes the hesitation of an introvert who is offered group therapy:

How many introverts does it take to change a light bulb?

Why does it have to be a group activity?*

———————–

*Thanks to Life in a Bind for the introvert joke. The top image is a screen capture from the public domain film Carnival of Souls. The second is called Modern Stress by outcast104. Finally, a picture depicting the Shyness of Tamil ANGEL by Sureshbmani. All three are sourced from Wikimedia Commons.

Why Loved Ones Refuse Therapy and What to Do About It

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You’ve tried — with your friend, your spouse, your adult child. You made the case for counseling. Some hem, some haw, some say they will, but don’t. Others just refuse.

Why?

A few reasons to consider and what you might do about it:

  • Stranger danger. Suspicion of strangers is deeply rooted in the human race, derived from our primitive beginnings and ever-present con-artists. Your friend’s personal experience of betrayal may be a key factor.
  • Saving face. Much in life depends on reputation. How many of our parents admonished us to hide the family secrets and “be sure you don’t tell the neighbors!” Men, in particular, want to project strength, the better to succeed in the world of work and win a desirable spouse.
  • The doctor doesn’t care. He is only in it for the money and measures his patients’ value by the size of their bankroll. Should counselors then give treatment away and make their living after hours by standing on street corners with hat in hand?
  • I’m afraid my employer will find out. I can’t risk it. If you use insurance, the insurer will know your diagnosis, as will every such company in the linked system. They are not supposed to reveal anything to your employer. However, if you work for someone with few employees and his premiums go up the next year … ?
  • Therapy is for the weak, a crutch for the spineless. A therapist argues instead that facing your demons and working to change are signs of strength, not evidence of frailty: an indication of courage, not its absence.
  • I don’t believe in the value of looking back. Sometimes therapy doesn’t require it, but a historical evaluation can remove the bolder from your backpack and allow you to move ahead with pace. On the other hand, baseball’s Satchel Paige said, “Don’t look back, something might be gaining on you!”
  • Emotional pain. Whatever reasons are given, the prospective client can be unconsciously timorous at opening painful issues — digging up a grave bursting with undead horrors of the heart and memory.
  • I’m a logical person, not into feelings. I can solve this logically. Such statements are uttered most often by those who aren’t as logical as they think.
  • A real man does things, he doesn’t talk about them. But what if he doesn’t know what to do after trying everything?
  • Fear of change. Most of us find discomfort in new challenges, in or out of treatment. Yet change can’t be avoided unless you want to wear the same clothes in the same size and color the rest of your life; and continue to travel to the same job site even after your employer bars the door.
  • Fear of the mystery. The counseling office is a bit like the inner sanctum of a haunted house — a place of strange rites and secrets, incense and shadow play, frequented by the ghost of Sigmund Freud. The person who wants control will find few guideposts. Will a wizard cast a magic spell on him?
  • Fear of medication or hospitalization. Though you can’t be forced to take meds as a rule, some are terrified they might hear the doctor recommend it — or worse, a hospital stay.

What’s to be done? I received calls from spouses who wanted to make an appointment for their mate. This is rarely useful. If the individual lacks the courage or motivation to seek treatment himself, the likelihood of his appearance at the appointment is a coin flip at best.

Begging and pleading have their limits, too. The more you push, the more therapy becomes your agenda, not the person you care about. You own it, he doesn’t want to buy it. The more you pester or threaten, the faster he runs. If he does attend a session, his motive is to placate you, not heal himself.

Sometimes it helps to enlist the persuasive talents of one who is respected by the prospective patient: a clergyman, best friend, or close relative. The danger here, however, is an unauthorized revelation to a third-party interpreted as a breach of trust. A similar risk occurs when you plan an “intervention:” getting several friends and family members together to encourage and explain their concern to the doubtful potential client. This technique is more often used with alcohol and drug abuse problems, and is easier to rationalize when the person’s life is out of control and in danger.

I am not speaking here of people who are at risk of harming themselves or others. Thus, legal remedies to force the issue are not available. If your steady expression of loving concern cannot turn the tide, waiting might be the only alternative. The accumulation of pain perhaps will do what you can’t.

You are left in a difficult situation: straining your patience when everything in you wants to scream.

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Most of us spend a good part of our lives wishing others were different: more loving, kinder, attentive to us in a way rarely offered; with an intensity and compassion that finally permits the auditor to “get us.” We want the love of this one, the respect of that one, and wish another would take our words to heart. We think and plot about attracting the dark stranger, selling the human product (ourselves), and winning the vote of the crowd.

The good news here is the presence of one person we tend to ignore. While we work on others to change, he remains in the shadows. We don’t need to run after him, persuade him, make an appointment to meet six weeks in advance, and cause his face to turn in our direction. His visage greets us in the mirror every morning.

When others resist our efforts to influence them we are left to change what we can about ourselves — what we may and what we must: our attitude, emotions, and reactions to the one who refuses treatment — and to the rest of life as well.  The transformation begins whenever we want. The process of self-modification can persist as long as we live. Unlike changing the loved one, however, the necessary alterations are in our hands.

The most important opportunities in life sometimes have been there all along. We wait for the other to wake up while what is changeable in ourselves awaits its own awakening. Imagine standing at a crossroads: one path leads to a darkling state of perpetual hope or desperate preoccupation with a person you can’t control. You pass the time alternately gnashing your teeth or imagining what life might be like if only he changes. The other road directs you to a house of natural light and mirrors revealing all sides of the one human you do control. This workshop evokes the hard work of the master sculptor in everyone, the painstaking job of reshaping our basic stuff.

Become your own work of art.

050613102055--Bristol RWA gallery starting point for Festival of Stone Sculpture Trail

The second image is a Ladies Watch Case photographed by Zeigerpaar and sourced from Wikimedia Commons. The bottom photo comes from the Bristol RA Gallery Festival of Stone Sculpture.

 

What I Learned About Therapy From Frankie Avalon

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Now, you might not think about Frankie Avalon in connection with psychotherapy. But, in a peculiar way, he taught me a bit about treatment many years ago.

Frankie Avalon was performing in Chicago and appeared on a late night local program on Chicago’s ABC affiliate TV station; as did I and two other mental health professionals. Avalon was talking about his career as a singer and one-time pop-idol of the 1960s. The rest of us were speaking about hypnosis. Frankie Avalon was to appear on the first half of the program, while the mental health section was scheduled second.

The program was taped on Thursday for broadcast the next day. And, as things worked out, both the legendary singer and the shrinks all spent a few minutes together in “the Green Room” before the taping began. Avalon asked us a bit about ourselves.  When he discovered that we would be talking about hypnosis, he posed the following question: “Hey, can you guys stop me from smoking?”

One of my fellow-therapists responded, “Do you want to stop?”

“No,” Avalon replied.

We all laughed, but in truth, the singer had demonstrated something very important about therapy. To wit, not everyone who comes to therapy wants to change. Or, at least, they might not want to change the particular thing about themselves that is causing their unhappiness, or suffer the pain of making that change, or explore the unsettling emotions that sometimes surface in treatment.

This often happens in marital therapy too, when one member of the couple doesn’t think he or she is doing anything that bad, and so has no reason to adjust.

Therapists often can help those who recognize that their problems are severe enough to require “whatever it takes” to change. But, we are not much good when working with someone who, like Frankie Avalon, really doesn’t want to do anything different.

Those adults who are forced into therapy, pressured into treatment, or who go because they think that they ought to, are usually setting themselves up for failure. A wise therapist will usually identify this quickly and ask those individuals if they really want to be there — or point out that they don’t seem ready, and that premature therapy would be a waste of their time and money.

As the old joke goes, “How many therapists does it take to change a light bulb?”

One, but the light bulb has to want to be changed.

The above image is an Electric Light Bulb From Neolux in Studio by KMJ, sourced from Wikimedia Commons.