“Doing it yourself is a fad in the United States.” These were the first words in my first book in psychology, which I coauthored more than 40 years ago. Turns out we were wrong. Doing it yourself is not a fad, but a way of life in the U.S. These days we have so many more resources available to help us help ourselves, including self-help blogs like this one. And, of course, YouTube, which is a wonderful resource for training videos. I’ve turned to YouTube to learn the basics of such tasks as caulking a bathroom tub and repairing a hinge on kitchen cabinets. There’s pride in doing things yourself, even if the quality of the work may not match that of a professional. But I would draw the line at developing a winning tennis serve by following a self-instructional tutorial. Sometimes a good coach is needed. There is also a line to be drawn between using the Internet for self-help—even blogs like this—and seeking professional help.
My first book in the field focused on applying principles of behavior therapy to problems in living, from losing excess weight to smoking cessation to overcoming fears and sexual problems. For many of the problems people encounter in their daily lives, behavior therapy offered practical solutions. This blog continues in that tradition, offering tips for changing your thoughts and attitudes to change your life. We have explored how to rethink your responses to life’s twists and turns, and along the way offered tips on a range of troubling emotions, from overcoming worry and guilt to coping with fear and managing anger. We applied the wisdom of ancient Greece to “know thyself” by turning inwardly to examine and evaluate our thoughts and beliefs, especially the negative thoughts that underlie emotional problems like anxiety, depression, and anger. We confronted the two worthless emotions, worry and guilt—worthless because we don’t need to be wracked with guilt to recognize our mistakes and correct them or to be consumed with worry to take steps to protect ourselves from impending threats.
Self-Care Is Self-Help
With all this emphasis on self-help, we can lose sight of the importance of a basic principle of self-care—seeking help from others when help is needed. But how do you know when going it alone is just not cutting it? The benchmark clinicians typically use is whether problems are persistent and cause significant emotional stress or impair daily functioning. If you regularly struggle to get out of bed and get going in the morning because you’re feeling down in the dumps, your state of mind is affecting your ability to function effectively. If you can’t shake off intrusive worrisome or guilt thoughts, or if angry outbursts damage your relationships with others, or if you are continually on edge and can’t sleep at night or relax during the day, then it’s clear your daily functioning is impaired.
Where to Turn for Help
In the forty or so years I’ve been in practice, I’ve witnessed many changes in the field, including the emergence of cognitive behavioral therapy (CBT) as the leading modality of psychotherapy in use today. When I began my practice, psychodynamic therapists schooled in the Freudian and neo-Freudian traditions dominated the field. Today, there are many different forms of therapy and many different types of therapists, from psychologists and psychiatrists to mental health counselors and clinical social workers. Some forms of therapy, like CBT, offer briefer and more problem-focused treatment approaches than traditional therapies, such as psychoanalysis. CBT has become the treatment of choice for a range of psychological problems from phobias to social anxiety to insomnia, and evidence from controlled trials shows that CBT more than holds its own when stacked up against other therapies for treating depression and other emotional disorders and when compared to psychiatric medication.
Over the years, the field of psychiatry has become increasingly medicalized, as psychiatrists (medical doctors with specialized training in psychiatry) largely turned from practicing psychotherapy toward medication management. Though psychiatric drugs have important roles to play in the treatment of mental health disorders, especially so with more severe disorders such as bipolar disorder and schizophrenia, popping a pill does not help people solve problems in their daily lives or learn skills they need to change how they think or improve their relationships with others. Moreover, relapse rates are high when patients stop taking psychiatric meds, and for good reason, as these drugs help manage symptoms but do not address underlying emotional or interpersonal problems. On the other hand, patients can carry the techniques they learn in psychotherapy well beyond the course of treatment and continue to apply them in their daily lives.
Am I Ready to Reach Out? A 10-Item Checklist
If you’re thinking about whether it makes sense to seek help from a professional, you may find the following checklist to be a useful guide. There is no set number of items that determine whether you could benefit from seeking help. But as a general guideline, answering at least a few of these questions in the affirmative suggests it might be helpful to talk to a psychologist or other mental health professional.
Yes or No? (You be the Judge)
1. Are my efforts to change my thinking or attitudes working?
2. Do I continue to struggle with anxiety, depression, or other negative feelings that impact my daily functioning?
3. Am I able to step back and examine my own thoughts, or would it help to have another person’s perspective?
4. Do I give up too easily rather than persevere in changing my thoughts and behaviors?
5. Are other people telling me I would benefit from “talking to somebody”?
6. Are worries making it difficult to sleep or function effectively during the day?
7. Am I avoiding situations out of fear or anxiety?
8. Is my behavior affecting my relationships in negative ways?
9. Do I find it difficult to make changes on my own or to stick with them?
10. Might I work better with a professional than going it alone?
Finding a Therapist
If you do decide to seek help, select a therapist who best fits your needs. Do you want to work with a therapist who uses psychological methods of treatment, such as a psychologist or counselor, or would benefit more from psychiatric medication prescribed by a psychiatrist?
Find a practitioner with the appropriate licensure and credentials—for example, a licensed psychologist, or a licensed psychologist holding advanced credentials (e.g., a Diplomate in Clinical Psychology awarded by the American Board of Professional Psychology, or ABPP), or a board-certified psychiatrist. Find out whether your medical insurance covers mental health services (check it out with your health care provider) and whether are you covered for out-of-network providers. As with other specialists, you may need to pay the therapist’s fee upfront and be reimbursed afterwards if the services are covered by your insurance plan, less any deductibles, co-pays, and so on.
Word of mouth is a good source for finding a therapist but be aware that what works well for one person might not work for another. You might also “google” the practitioner to see if anything untoward turns up or ask your state licensing board if there are any complaints filed against the individual. Be prepared to ask a potential therapist a lot of questions, like whether the therapist is experienced in treating people with similar problems as your own, what specific form of treatment will be used and what evidence supports its effectiveness, how long treatment is expected to last, what adverse experiences might be expected, such as drug side-effects, whether you are responsible for cancellation fees, and so on. Licensed professionals will openly discuss these and other questions with potential clients. If they balk, take that as a sign to look for someone else.
Whether you try going it alone or reaching out for help, the good news is that there is a range of effective therapeutic techniques that can help people live happier and more fulfilling lives.
© 2019 Jeffrey S. Nevid