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.