What therapy is and what it isn’t
Therapy is a science-backed treatment addressing mental health symptoms that cause significant problems in daily functioning. For instance, mindfulness-based stress reduction for anxiety or cognitive processing therapy for post-traumatic stress disorder. Sessions focus on setting goals for change, developing and practicing skills that improve psychological health, and an ongoing evaluation of progress toward goals and continued treatment needs.
Therapy involves developing trust and rapport because the therapist-patient relationship is proven as the most essential predictor of positive change. But building this trust and rapport in therapy is not the same as chatting about a symptom such as stress for an hour.
Therapy skeptics declare, “I’m not paying to talk to a friend.” They are correct.
Therapists are not patients’ friends, in part because it is one-sided sharing. Therapists have specialized training. They have an ethical responsibility to help patients develop insight and build skills.
Therapy is not about venting. It’s about change.
Who needs therapy and who does not
People need therapy when their mental health symptoms are causing serious impairments in their daily functioning — in close relationships, work performance, sleep or social activities. For instance, if a person’s work stress overwhelms them to the point that they miss work and are subsequently at risk of losing their job.
They don’t need therapy when they are able to manage their symptoms well — if they feel stressed about their work but continue to perform well, have a supportive network of family and friends, engage in meaningful activities outside work and do not have significant levels of depression and anxiety.
As Tracy Dennis-Tiwary writes in her book, “Future Tense: Why Anxiety Is Good For You (Even Though It Feels Bad),” we have become a “fragile people” when it comes to feeling uncomfortable. But we don’t need to schedule a therapy appointment when we feel bad. We need to learn how to feel the emotions and cope.
“Most of the time, anxiety is a healthy human emotion,” Dennis-Tiwary wrote in an email. “And the only way to learn to cope is to build skills in experiencing and working through anxiety.” What can become more problematic than the anxiety itself is the “meta-anxiety,” or the anxiety about our feelings of anxiety, she said.
How to build coping skills
Therapy offers tools and support, which can be helpful and make us feel good, but when we are not suffering from “clinical” symptoms — those causing significant impairment in daily functioning — those tools and support are available outside the therapist’s office. Here are some ways to build coping skills:
- Check out workbooks related to your concern. There are many science-backed interventions (the most popular being cognitive behavioral therapy and acceptance and commitment therapy) that experts have packaged into a workbook format for people to do independently.
- Read memoirs of people who have experienced similar challenges. Connecting with another’s experience can reduce feelings of separateness and provide a model for how to cope.
- Use mental health and meditation apps to access many of the basic coping tools that therapists teach, such as meditation (Calm, Insight Timer) and labeling emotions (How We Feel).
- Listen to psychology-focused podcasts such as “The Psychology Podcast” and “All in the Mind,” and search for episode topics or experts in your area of interest, such as anxiety over a relationship or stress about work.
- Consider a coach who specializes in the area where you want to make change, such as your career or parenting. Therapists can coach, but coaches don’t need to be therapists. There are important differences between coaching and therapy.
- Identify community groups. Support from others enduring a similar struggle can, in many cases, have a greater effect than talking in one-on-one therapy. Examples include groups that focus on addiction, grief or meditation.
If you have tried these strategies and do not feel better, or if people close to you have expressed concern about changes in your behaviors such as being more withdrawn or irritable, your symptoms may need professional support. The clearest sign of needing mental health treatment immediately is any safety concern such as considering suicide or engaging in self-harm.
Making changes to improve your life is like gardening — you have to dig into the soil, plant seeds of change, tend to the fragile new plants and flowers to make sure they survive, give them water and nutrients, and remove weeds. A therapist can help when mental health symptoms make it hard to grab the shovel to start, but most people can be their own gardeners.
Emily Edlynn, PhD, is a clinical psychologist and director of pediatric behavioral medicine at Oak Park Behavioral Medicine in Oak Park, Ill. She is the author of “Autonomy-Supportive Parenting: Reduce Parental Burnout and Raise Competent, Confident Children” and the co-host of the “Psychologists Off the Clock” podcast.
We welcome your comments on this column at OnYourMind@washpost.com.
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