Do I need therapy?

Is therapy only for people with mental illness?

Are there other options for improving my life?

How do I know what the best path is for me?

These are valid questions and we want to help you think through your options and choose your best next step.

Please note: If you are dealing with mental health symptoms that are significantly impairing your ability to function, then visiting a psychiatrist or mental health provider (mental health counselor or psychologist) is your best bet.  In most cases, you’ll work with both to address the soul and physical components of the issue so if you have a good referral for one, they can connect you with the other.  Of course, if you are having thoughts of harming yourself, please go straight to your nearest emergency room or behavioral health hospital.  Keep in mind they function just like the emergency department for other medical issues – they don’t treat chronic issues and often will not be able to fully unpack the problem.  They exist to stabilize and refer, so keep your expectations in line with that.  Like any ER experience, it is about saving your life and stabilizing you enough to embark on the comprehensive journey to healing that begins with discharge.  

This post is most helpful for the one who is functioning OK, but is identifying areas of life that are either not working or simply not to your liking.  That grey space between optimal functioning and serious breakdown is where most of us find ourselves, making it difficult to determine what to do.

Before we get into the options, it is important to address the issue of context.  Therapy (and other mental/emotional health interventions) are being sold as a panacea for situations that are often created and fed by structural problems in our society.  Problem is, no amount of therapy, self care, mindfulness or self help books will fix the anxiety, worry or depression that comes with food insecurity, lack of housing, limited access to healthcare or unemployment.  In those situations, reaching out for practical assistance makes the most sense:

• In Florida, you can call 211 to access not just emotional support but a comprehensive database of every organization existing for the full spectrum of human need.
• Access the Orlando database here – https://www.navigateresources.net/211CommunityResources/
• For resources nationally, try this database – https://findhelp.org/
• Social workers are excellent providers in these situations.  Not only are they the best at understanding systemic factors, but they are also trained to connect you to the right systems of support and can therapeutically address your internal barriers to connection.

Once food, shelter, income and healthcare is stable, then it’s time to move on to the next level of care which is where this post comes in.  Let’s consider the options:

• Support Groups – There is no substitute for immersing in a group of people who understand your particular struggle.  The validation you receive for experiences and feelings others have dismissed is life changing.  Many groups have an educational component that will also help you understand the unique dynamics of your situation.  If you already know the steps you need to take for change and are simply looking for camaraderie, insight and peer accountability, this may be the path for you.  Limitations to consider: some groups can be simply a space for complaining with little education, agency or accountability.  Individual group leaders are the key to quality with this option!
• Spiritual Direction – Faith is a wonderful resource for facing the difficulties of life, establishing self worth, as well as finding purpose and meaning.  However, just because we align with a particular spirituality, that does not mean we automatically understand how to grasp these benefits.  A spiritual director who has wrestled with the tenets of your shared faith and who has developed an intimate relationship with your Higher Power can be an effective guide if you are looking to establish anchors of self worth, purpose, meaning or other existential foundations for moving forward.  Limitations to consider: spiritual directors have varying levels of understanding when it comes to how trauma histories and neurodivergence interact with theology and relationships.  If you have worked through significant trauma or suspect you might be on the Autism spectrum or have some form of ADHD, ask potential directors about how they incorporate the unique needs of those issues into their work.
• Somatic Practices – Ever since Bessel van der Kolk released The Body Keeps the Score (written more for clinicians than lay persons), pop culture has become more and more aware of how our bodies carry the emotional consequences of our experiences.  Polyvagal Theory has helped us to further understand the specific impacts on our nervous systems.  If you realize your greatest need is to develop safety in your body and learn how to move through various nervous system states instead of getting stuck, then this is a great path to consider.  There is no end to the choices in this category: meditation, breathwork, yoga, joyful movement, nature, or complementary medicine with a variety of apps, practitioners, courses, classes, and clubs to consider.  It is important to do your research to find the tool that will work best for you: fits into your lifestyle and time availability, is created by or run by someone with an appropriate level of training/certification and has a proven track record of effectiveness.  Limitations to consider: Working with the body can bring up unprocessed trauma so have a backup plan at the ready for soul care, should you find yourself dealing with thoughts and feelings you find overwhelming or disturbing.
• Self Help  – If you live in the US, then you are swimming in the waters of individuality as supreme.  There is the famous, “pull yourself up by your bootstraps” mentality that is baked into our ethos.  Never mind that phrase is a scientific impossibility – we are conditioned to give it a go, gosh darn it!  That said, solitude in harmony with community has healing properties, so practices like journaling or bibliotherapy (reading self help books) can be tremendously useful.  If you are seeking to understand what may be causing distress in your life or you have good insight but need to figure out what specific skills or knowledge you need to do things differently, self help can be a great path.  Check out our bookshop for great recommendations.  Whether you take notes on what you’re reading or just want to process your thoughts, this is a great excuse to get a new journal.  We have an abundance of scientific proof that writing helps process overwhelming emotions, clarify your thoughts and manage stress.  Keep in mind that writing by hand has far greater benefits than typing.  Limitations to consider: This category requires us to know what we do not know.  We may consume excellent books or develop consistency in journaling but still miss tackling what really needs to be addressed.  If you’re not seeing progress after three months on this path, consider trying a different one.
• Mentoring – We are designed to learn within relationships.  Ideally, our families of origin should model the skills, habits and perspectives that help us build a healthy life but many of us did not get that.  Identifying someone who has conquered what you want to conquer or who lives life in the way to which you aspire and who has demonstrated a willingness to share vulnerably, is the first step to filling the gap.  Next would be clarifying what you specifically want to learn from them and then approaching them to see if they would be willing to meet with you on a regular basis.  For this path to work, it is important to clarify at the start – the importance of vulnerability on both sides, a specific learning plan, what constitutes constructive feedback for you, how to hold you accountable and opportunities to observe your mentor in action.  Limitations to consider: It may take a few tries to find a mentor that will help you get where you want to go.  Not only does there need to be good chemistry between you but they have to be willing to share their mistakes and have the skills to teach and encourage well.  Mentors may also be unable to address underlying issues that are keeping you stuck in old patterns.
• Coaching – Life coaching showed up in the 1980s, on the heels of the strong self help movement of the 60s and 70s.  As mentioned in that section, self help often reaches a point where an individual’s blind spots get in the way and external assistance is needed.  Again, we are wired to learn in relationships so the elements of sports coaching and organizational psychology offered a new path to success.  This field has evolved with several certification programs available but no licensure to establish consistent standards or oversight so like many other services, it’s a gamble but can be an excellent choice if you have already identified specific goals you want to accomplish, have a decent level of motivation and simply need help with planning, skill building and accountability.  Limitations to consider: most coaches have a specialty, whether they advertise it or not.  Check into your coach’s background to see what lived success and/or training they have had to ensure it aligns with where you need help.   While coaches may be able to call out underlying issues that keep you stuck, they are typically not trained to address such things as trauma effects, mental health conditions or spiritual barriers.
• Therapy – This is a protected term across most of the United States, meaning you cannot offer this particular service without completing specific graduate-level education and training, registering with your state and submitting to the legal and ethical guidelines of your profession.  This is a major point of protection for the consumer as providers are regulated and accountable to their licensure board, just like doctors, nurses and other medical providers.  Therapy is a great option in a number of cases:
  • When there is any level of uncertainty about what is causing distress or negative patterns of thoughts and behaviors in your life.   
  • When there is insight and awareness into why you think or act the way you do but you feel stuck in changing it.  
  • When you are looking for a comprehensive guide to the healing process that incorporates knowledge, emotion regulation, processing, skills and developing new habits.  Someone who can coordinate all the pieces for you and break the process down into manageable steps.   
  • When you know that your success depends on sensitive incorporation of factors like trauma history, neurodivergence or mental health diagnosis.  
• Therapy, like many of the other paths – comes with a multitude of options so it is important to put some time and effort into determining what will work best for you.  The primary providers of therapy are Marriage and Family Therapists who are trained to see and guide you within the context of your family systems and Mental Health Therapists/Licensed Counselors who are trained to assess and treat you as an individual.  Once practitioners graduate however, they are free to pursue any perspective through supervision or continuing education so title is not necessarily useful in choosing your practitioner.  There are four initial dynamics I would suggest you consider:
  • Chemistry – this is completely subjective.  You need to feel comfortable and open with your therapist so if you’re not feeling it after three sessions, give another one a try.  Look for counselors who offer a free initial consultation so that you can assess these dynamics.
  • Specialty – Therapists are trained as generalists but your best option is typically going to be someone who has a specific interest, training and experience with the issues you face.  Check their website or social media platforms to see what they talk about most.
  • Orientation – Every therapist has an idea in their mind about what makes people tick.  Is it thoughts, needs, subconscious dynamics or relationships that drive people?  Wherever they have landed, that is their “orientation” – the lens they use to understand human behavior, despite the variety of interventions they have learned to use.  It is a good sign when your therapist is able to explain their orientation clearly.  However, research consistently tells us that the therapist’s ability to form a healthy working alliance with you is the greatest determining factor (not orientation), for client change so keep that in mind.
  • Depth – Therapy can range anywhere from solution focused which looks to solve current problems with little concern for cause, all the way to forms of psychoanalysis which seek to identify root causes – processing and releasing what no longer serves.  Every form of therapy has its place depending on what the client needs in that season of their life.
  • Finally, there is the matter of access: To use insurance or not.  Ideally, insurance coverage increases access.  Many of us cannot afford healthcare costs without this support.  Unfortunately, it is well understood that the goal of insurance companies is to pay as little as possible for care which has created a health system of underpaid/overburdened providers, denials of needed care and intrusive interference in patient processes.  Another factor many are unaware of is the fact that insurance does not pay for ‘life circumstances’ therapy.  If you’ve had a breakup, hate your job, don’t like the relational patterns you see in your life, etc. – your therapist must diagnose you with a mental health disorder to get your sessions paid for by insurance.  For those with privacy concerns (such as federal employees), this can feel uncomfortable.  To receive care from a practitioner who is not hindered by insurance limitations, many seek private pay care or work with nonprofits who provide counseling.
  • Hot tip: Group therapy combines the benefits of support groups and therapy while minimizing the limitations of support groups! 
  • Limitations to consider: With so many dynamics to consider, finding a therapist who will meet your needs may feel like finding a needle in a haystack.  It can be easy to give up on the process if it isn’t working out as you had hoped.  The context of healthcare industry problems can compromise a therapist’s opportunity to provide the level of care they are qualified to offer.  This process requires patience and self advocacy just as with any other healthcare provider.

There you have it.  Many paths to consider.  We don’t claim to capture every single option out there for improving your mental and emotional health but we hope this provides a comprehensive summary that helps you make a good decision for your next step.  For specific recommendations in many of the above categories – visit our recommended resources page.

There is a foundational principle to remember as you choose your path: human existence will always include a measure of suffering so getting comfortable with that reality by developing the tools to move through suffering is a major factor in optimal living.  Constant happiness and perfect regulation is not a realistic goal, despite what social media tells us so take that pressure off.  As we’ve discussed before, realistic expectations is key to contentment, no matter which path you choose!