Is It Time to Think About Therapy?

The idea of mental health counseling may make you nervous, but it can help you deal with a wide range of issues.

You may notice that you feel blue more often than you did when you were younger. Maybe you find yourself feeling more anxious. Perhaps you never really got over your divorce, or you’re uncomfortable in retirement. There could be a relationship in your life that you’d like to patch up or you simply have thoughts and feelings that need sorting out.

A mental health professional can help with all of these issues and many more. But if you’ve never had any kind of therapy, you may have a lot of questions. How do I begin? Can talking with a stranger can really help? Shouldn’t I be able to handle my problems on my own, without any help? What will others will think if I start seeing a therapist.

Sarah Gray, PsyD, a clinical psychologist with Massachusetts General Hospital, says those feelings are quite common, but there are ways to help you get past that reluctance. “Starting therapy can feel difficult for many, as it’s often a decision to explore more fully aspects of one’s life to facilitate growth and change,” she says. “It’s normal to feel a bit uncertain about this. It may be helpful to make a list of the reasons you are seeking out a professional’s guidance and the ways you think it might help you to live a more rich and meaningful life.”

Clearing up Misconceptions

There are many reasons why people hesitate to pursue therapy. There may be financial concerns or feelings of embarrassment when it comes to discussing very personal issues. “But often people have some misconceptions about therapy—for example, that it might involve lying on a couch for years and years,” Dr. Gray says. “That can lead to inaccurate conclusions or avoiding trying it out.”


  • Consider referrals from friends or family when choosing a therapist, but also look for mental health professionals with an interest in your particular area of concern, such as couples counseling, addiction therapy, grief counseling, etc.
  • Ask for a free phone consultation prior to scheduling an in-office appointment. This can help you decide if the therapist might be a good fit.
  • Bring notes of issues you’d like to discuss, and be ready to take notes to help you remember points your therapist makes during your session. You may also have sessions in which you don’t have any major issues to discuss.
  • Expect to feel uncomfortable, sad, or upset once in a while. There may be times when you don’t feel like going to therapy. You should also have moments in which your outlook improves and you gain a better understanding of yourself or a particular relationship or situation.
  • Remember that you can disagree or challenge your therapist’s conclusions. Just do so in the spirit of working together for a common goal.
  • Understand the goal of therapy and what your progression should look like. This should be discussed early in therapy.

She recommends doing a little investigating on your own. Research the various types of therapy that are available, for example. “You may also find it helpful to read up on the many ways that therapy has been shown to be helpful for people, or talk to others who have benefited from therapy,” Dr. Gray advises. “Often therapists will offer a phone consultation as a way to see if they might be a good fit, which can help you answer questions you may have about the experience of therapy and what the therapist’s style is like.”

But how do you know what type of therapist would be the best fit? Would you benefit most from a licensed clinical social worker, a psychologist, a psychiatrist or some other type of mental health professional? The nature of your concerns may help guide you. A couples and family counselor may be best for domestic issues, while a psychiatrist capable of prescribing medications may be the right choice if you have depressive symptoms that include intense feelings of hopelessness or suicidal thoughts (see sidebar).

Just as important as the therapist’s areas of interest and experience is the comfort level you feel with the therapist. Being able to talk freely with a therapist and receiving helpful guidance and perspective that makes sense to you are critical ingredients to successful therapy.

“Research has indicated that an important factor in benefiting from therapy is that a good alliance, or therapeutic ‘fit’ is formed,” Dr. Gray says. “This may take a few sessions to determine, but often in reading a profile of the therapist, or having an initial phone conversation, you can get a feel for their style and approach, which may help determine if setting up an initial meeting makes sense. This ability to form a connection and feel comfortable with the clinician is more important than their degree in most cases.”

Getting Started

If you don’t have a specific issue that you want to work through in therapy, that’s okay. You don’t need an easily expressed concern, such as grieving the loss of a loved one or a fear of flying in order to see a therapist. Dr. Gray explains that a both a major change in your life, such as “empty nest syndrome” or caring for an elderly parent, can trigger the need to deal with new feelings. Likewise, an awareness that you’re in a rut and in need of change can be the impetus for therapy.

“Many times, a major transition or a sense of being ‘stuck’ in life will spark an openness to giving therapy a try, especially if you have had others share their experiences of therapy or if you’ve read about the benefits,” she says.

Even if you can’t articulate your feelings at the beginning of therapy, an experienced mental health professional will be able to help you find the words to identify clearly what’s bothering you. “Most therapists will conduct a thorough assessment in the first session or two to help determine areas to focus on in the therapy, and will check in and/or formally assess progress towards goals along the way,” Dr. Gray says.

She adds that each person’s experience with therapy is unique, because of the individual’s needs and concerns, as well as the type of therapy he or she is receiving. The key is to understand that therapy is a process. You may leave your first session with a lot of strong feelings. You may feel sadder or more upset than when you went in, but you may also walk out with some strategies to help you cope. While a typical session may last an hour, the number of sessions you have will depend on many factors.

“For example, more behaviorally based therapies may be shorter-term and focus in a structured, active way on a few specific goals for change, while other therapies may seek to cultivate deeper insight into long-held patterns and may work over a longer amount of time to help you better understand and shift these patterns,” Dr. Gray explains. “In order to be successful, all types of therapy will involve some degree of examining difficult emotions and will often require some efforts, both in session and outside of session, to reflect and take action in order to produce change. Overall, though, one can expect therapy to be a powerful tool for deeper insight, support, understanding and shifts in patterns, with outcomes often leading to an enriched quality of life and often the reduction of specific symptoms.”

Charting Your Progress

So once you have started therapy, how do you know if it’s working? Mental health doesn’t have measurable numbers, such as weight and blood pressure, but there are targets that you and your therapist can and should develop early in the process.

“Many therapists will work with their patients/clients at the outset to determine the goals of therapy and will check in regularly, sometimes with formal assessment tools, to determine if the work is progressing in ways that feel beneficial,” Dr. Gray says. “You should never be afraid to bring up any concerns about the therapy with your therapist, as most therapists will be happy to discuss their approach and make sure you both are on the same page. In general, people often notice that therapy can bring up strong emotions, and the therapist can be a good guide in helping to process these emotions and/or introduce new skills and tools to help cope. As the sessions progress, you may notice changes in how you perceive, experience, and/or act on situations that may have been difficult or problematic before, and that is often an indication, along with any other measurable shifts that you and your therapist may be tracking, that therapy is beneficial. If not, a discussion with your therapist or even a change to a different therapist may be warranted.”

If you feel that therapy could be helpful, go in with an open mind and be ready to share your thoughts and feelings honestly with your therapist… and with yourself. You will get more out of the process if you have a goal in mind and are willing to put in the time and effort to reach it. Therapy has helped millions of people around the world, so there’s no reason you should suffer without at least trying to work through the challenges keeping you from feeling better. And if you don’t find a good fit with the first therapist, know that you can change therapists if necessary. You should also speak up if a particular approach isn’t working. The goal is to boost your mental health.


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