05/27/2014 11:40 am ET Updated Dec 06, 2017

When Do You Know You Need Therapy and How Do You Pick a Therapist? Dos and Don'ts


Few folks escape the ravaging effects of mental illness when you consider that 46.6 percent of Americans will suffer a mental health disorder in their lifetime (according to the Centers for Disease Control and Prevention), and their struggles invariably strain the other 53.4 percent of their family and friends. With May being Mental Health Awareness Month, it's timely to address when and how to seek out therapy. The below guidelines will, I hope, equip you with the confidence and clarity to know when you're in good hands therapeutically, and when you're decidedly NOT, as displayed in the video at the bottom of this post. (Don't leave this post without seeing it. I promise you you'll wince with pained amusement.)

You know you need therapy when:

1) You've had a thorough physical exam that has ruled out any medical underpinnings of your symptoms of distress. Indeed, physical exams on a routine basis are crucial to mental health. The Mental Health Awareness Theme this year, "Mind your Health," underscores the crucial interdependency of mental and physical health and well-being.

2) In general, you've not been yourself for more than a month, you struggle to carry out your basic functions day-to-day, you feel lonely, alienated from others and from yourself and can't locate the source of your despair.

Specifically you suffer:

3) Plaguing anxiety:
You feel like you're "idling high" with buzzing excess energy, like you've had too much caffeine. You hold expectations of doom, "borrowing trouble," convinced that "everything that can go wrong will go wrong." Your mental wheels of worry are spinning like tires on ice, burning energy but getting you nowhere. Anxiety is a psychic signal that something is awry, needing attention and resolution. Sometimes we worry about petty superficialities in order to distract ourselves from deeper, graver anxieties we're afraid to confront. Yet, avoided problems, like embedded splinters, can grow and spread like infections if not attended to early.

4) Irritability and diffuse anger:
You're an agitated grump with no tolerance for the usual day-to-day nuisances of family and work life. It may appear at first that everyone else is in a foul mood, but on reflection, you can discern that you're the common denominator in all the tensions and conflicts surrounding you -- due to your own ill-temper, spraying like a skunk. Anger, like anxiety, is a signal that something is awry needing attention and correction. Honor your anger by getting help deciphering your underlying grievances, rather than inflicting them on those closest to you who are ultimately "on your team."

5) Sadness:
You feel emotionally tender, reactive and raw. You may be sighing more and trudging around with a vague and heavy-hearted sorrow and don't know why. Pause to reflect on recent hardships, losses and anniversary reactions that are burdening you, but you've not allowed yourself to honor and come to terms with.

6) Shocked disorientation:
Often, indeed usually, people need therapy for help in coping with besieging life losses and hardships that would fracture anyone's sense of well-being. Barrages of ill-fortune leave people stunned, confused, paralyzed, helpless and self-isolating (e.g., grim medical diagnoses, sudden premature deaths, financial losses, profound personal rejections). Stoicism in the face of devastating hardship may feel heroic, but tends to lead to close-hearted estrangement from yourself and those closest to you who are in the best position to lend you crucial support.

7) Sleep disruptions:
Your sleeping patterns are off for unexplainable reasons. You toss and turn fitfully, plagued by worries or distress or you feel like a hibernating bear wanting to sleep all day. Either way, you awaken leaden, unrested and unmotivated as you face the day.

8) Appetite changes:
You don't feel like eating anything and must remind yourself to fuel yourself with nutrition, or you've become Java the Hut; eating anything that's carbon-based, hungry or not. A five- to 10-pound weight change in a month is a tipoff.

If you think you might need therapy, consider following the guidelines below to optimize a good therapeutic fit.

1) List the ways you've not been yourself lately: physically, emotionally, behaviorally, socially, sexually, professionally. Also tally up what losses, disappointments, challenges and changes you've experienced in the past year. Consider whether the most pressing problem lies within you, your marriage, your family or your work.

2) Sketch out treatment goals. The more clear you are about your destination, the more likely you are to get there, and the better your therapeutic roadmap can be. Consider whether working with a male or female is relevant: if your troubles tend to revolve around one gender, it can be in your interest to embark on therapy with a therapist of that gender to maximize opportunities to address those patterns head-on in the therapy relationship.

3) Inform yourself about practical constraints imposed by insurance and finances. Does your policy restrict you to in-network preferred providers? Is there a limit on number of sessions permitted per calendar year? Do you have a health savings account from which you can draw for therapy costs?

4) Do your due diligence: Ask those you respect for names of therapists they highly regard (e.g., friends, physicians, religious leaders). If they don't have leads, ask them who might. Use the "I have a friend with a problem," ploy if you prefer to preserve your own privacy. Before you meet with potential therapists, request a five-minute phone call to clarify fees, insurance and treatment approach. (#1 and 2 above should help you efficiently state your treatment needs.) To inform yourself about treatment approaches mentioned, you can confer with online resources such as the following:

5) Be a good consumer: shop and compare. Any decision to entrust a stranger not only with your money and time, but also with your deepest private troubles deserves great care. In your state of distressed vulnerability, your impulse may be to seize on the first treatment option you encounter, to passively defer to the first "expert" you meet with. You forget that you know better than anyone else what you need and what suits you best. Of course you can't wait to get past your pain, which makes it particularly challenging to force yourself to patiently take the time and effort to search out your best therapeutic match. But I routinely urge people to not just start therapy with the first referral they receive, but rather to arrange two, or better yet, three one-shot "consultations" in which they interview different therapists. Comparison and choice unquestionably clarifies and maximizes your best therapeutic match.

6) Interview your therapist: Be forthright in your therapy consultations about your treatment preferences, goals and questions. What is their treatment approach and orientation? What kind of clinical techniques do they use? How active, directive, educational are they, versus passive and neutral in approach to your life dilemmas? How frequently would you meet and how long would they estimate your treatment would last? How often have they worked with problems like yours? If your therapy issues fall outside their clinical experience bandwidth, to whom might they refer you, who does specialize in your area of need? Note how receptive they are to your frank questions. You want a therapist who welcomes your self-advocacy and agency, a hallmark of mental health itself.

7) Pay close attention to your "gut" impressions. Optimal therapeutic outcomes are forged by a catalyzing chemistry between client and therapist. This has more to do with who the therapist is as a person than what kind of training s/he has had. You can only discern "good chemistry" by tuning into your "gut" feelings being in the therapist's presence. Are you feeling a mutual resonance? Are you feeling accepted, respected, affirmed? Or scrutinized, judged, patronized? Do you feel the therapist beholds you with compassion or scrutinizes you like a specimen? Does this therapist have a good sense of humor? Do you feel this therapist "gets you?" Or is the therapist missing who you really are in the process of conducting the evaluation? Is this a person you feel you could trust and open up to freely?

8) Once underway, err on the side of candor. The more active and forthright you can be in addressing difficult issues, including about the therapy experience itself, the more productive your therapy will be. Your reflex may well be, understandably, to avoid what scares, challenges or distresses you. But your very avoidance is self-sabotaging as it permits problems to grow more entrenched. As is the case in all of life's arenas, the sooner problems are intercepted, the swifter and more easily they're resolved.

The following video demonstrates in agonizing detail what to avoid in a therapist at all costs...