Should I consider going to therapy?
Seeking Therapy for a Specific Symptom or Disorder
When considering whether or not therapy may be beneficial, individuals often fall into one of two categories. The first category consists of those for whom a specific symptom, such as anxiety or depression, is causing some degree of difficulty or discomfort in their lives and ability to function on a day to day basis. While there can be a number of obstacles to seeking therapy, if this applies to you, these barriers tend to be relatively straight forward. Some individuals have received messages that they ought to be able to solve their problems by themselves, while others may have reluctance based on fearing the unknown and the perceived threat of opening up and talking candidly with a stranger. When it comes to these types of barriers I often will compare therapy to other forms of care or service that they might more willingly seek out. For example, most individuals don’t give much thought to going to a physician for a medical concern or even going to a dentist or a mechanic. There tends to be little stigma about seeking these types of services and in the end, the benefits of getting something taken care of and addressed tend to outweigh any perceived risks or associated burdens.
What if I don’t have specific symptoms?
The second category consists of difficulties involving some combination of self/identity and interpersonal relationships. Most if not all individuals struggle in navigating challenges related to these areas at one point or another in their lives. Sometimes these struggles can be due to situational factors such as a change in relationship status, or during times of transition in life, such as the birth of a child, or getting a new job or promotion. While many of these changes are ultimately positive, the growth they often require can none the less be difficult. These types of issues tend to fall into four main elements. In terms of issues related to self, they can be broken down into identity and self-direction. In terms of the interpersonal domain, these issues tend to relate to either intimacy or empathy. Difficulties in any of these areas can range in terms of their severity and impact on an individual’s functioning. In the following sections I will describe in more detail each of these areas as well as the types of problems individuals can sometimes experience related to them.
Issues of Identity
Identity can broadly be thought of as the experience one has of themselves, their degree of confidence, personal strengths and weaknesses, and ability to be aware of and able to regulate their own thoughts, feelings, and behaviors. For individuals with a relatively strong and coherent sense of themselves, they typically are consistent in their ability to regulate positive self-esteem, can accurately appraise their own abilities, can experience and tolerate a full range of emotions and maintain healthy boundaries in relationships. Difficulties in this area can range from things such as diminished confidence at times, or needing to restrict emotional experiences to feeling empty, lacking in a sense of self, and having poor boundaries such that they typically overidentify with the identities of others or overemphasize independence. At this end of the continuum, individuals are often organized around a sense of a perceived threat or some form of external persecution. Self-image can easily be distorted or threatened and predominant emotions tend to be organized around aggression.
Barriers to Self-Direction
When we think of self-direction, we’re talking about the ability to conceive of and pursue meaningful goals in life and to be reflective and accurate in our self-appraisal as we work towards these goals. Individuals that are relatively high functioning in this domain consistently set and meet goals and have aspirations consistent with their own capacities. They are generally fulfilled in most realms of their lives and can reflect and make constructive changes when they perceive disruptions or incongruences between where they are and where they aspire to be. Difficulties on the mild end can take the form of being conflicted about goal setting or struggling with unrealistic goals or expectations. Individuals can also over emphasize a single area or ability while overlooking other areas of potential growth. In more moderate cases goals tend to be more focused on gaining external approval and personal standards may be exceedingly high or low.
Deficits in Empathy
Empathy refers to the ability to be aware of other people’s emotional experiences and motivations. This includes the ability to understand and tolerate other people’s perspectives that may be different than your own as well as the ability to understand the effects your behavior has on other people. Individuals with difficulties with empathy can struggle to understand other people’s experiences and while capable of considering different perspectives, often resist doing so. They can also struggle to reflect on the effect of their own behavior on others. Individuals with more moderate difficulties in this area can be unaware of or unconcerned about the effects of their behavior on others and can feel highly threatened by differences of opinion or alternative points of view.
Difficulties with Intimacy
Being able to connect with others and desiring these connections are the building blocks of intimacy. Individuals competent in this area are able to maintain multiple satisfying relationships and are engaged in close reciprocal relationships. They tend to strive for cooperation and mutual benefit and are generally flexible in how they respond to other’s ideas, emotions, and behaviors. Difficulties in this area take the form of more superficial or limited relationships, often constrained by intense emotions or conflicts. They often have unrealistic or unreasonable standards for others and tend not to see relationships in reciprocal and cooperative ways. In more moderate and extreme cases, intimacy can be hindered by fears of rejection or abandonment or driven by an intense and sometimes even desperate desire to connect. They can also view relationships in terms of what they can provide such as fulfilling basic needs or escaping painful or unpleasant experiences.
Any or all of the difficulties detailed above are completely valid and common reasons for seeking therapy. One does not have to have a clinically diagnosable condition to benefit from participating in therapy. While this is certainly one of the main reasons for individuals to seek out treatment, often those symptoms (i.e. depression, anxiety), are related to or even caused by difficulties in one or more of the other domains (i.e. identity, self-direction, empathy, intimacy). Conversely, difficulties with depression and anxiety, or other psychiatric symptoms can also make it more difficult to function in each of these domains. In either case, good treatment takes into consideration this intersection of symptoms and personality and can be tailored to focus on any one particular domain. If you are considering therapy, whether for acute symptoms, transient difficulties in any of these domains, or even more chronic and longstanding difficulties in these areas, I encourage you to consider these various factors in weighing whether or not therapy may be able to benefit you.