Does Everyone Need Therapy?

I worked with a client in therapy once who just couldn’t seem to make progress on improving her relationship with her husband. She initially thought that their marriage problems were the result of her own anxiety. But after we made significant progress with her anxiety only to find that the relationship conflict remained, it became clear that the problems lay with the relationship itself.

As many of us can attest to, relationship struggles are rarely one-sided. Clearly my client’s difficulties had something to do with her husband as well. Unfortunately, he was adamantly opposed to participating in any type of therapy, either on his own or as a couple. His only explanation for the refusal being, “I don’t need therapy.”

This kind of response to therapy is common and unfortunate because it’s the wrong way of looking at the question.

Ultimately, therapy is about growth and creating opportunities for positive change.

Of course, my client’s husband didn’t need therapy—it wasn’t a life or death situation, and their marriage would probably hold up even if they didn’t make any changes. But the point was, he could have benefited greatly from therapy by learning how to communicate and interact with his wife more helpfully and thus improve the quality of their relationship generally.

But because he framed the problem in terms of needing therapy, that meant (in his mind) that there was something wrong with him and participating in therapy would only strengthen the embarrassment or shame that went along with it. Sadly, this mistaken belief about what therapy is about and what it means kept him from a real opportunity to improve his marriage.

The moral of the story is that by framing therapy in terms of what we need rather than what we could benefit from, many people experience too much shame or embarrassment to try it.

Which is why I always answer the question of “Does everybody need therapy?” with a definitive: No. But… just because you don’t need something doesn’t mean you couldn’t benefit from it.

Very few people need to go to the gym

I think an analogy would be helpful here: Does everybody need to go to the gym and hire a personal trainer to be healthy?

Of course not. Some of us jog around the neighborhood or hike in the woods; some of us play pickup basketball or are a part of a city soccer league; some of us do pushups in the basement while others do yoga at the gym; some of us do epic amounts of research about the perfect weight lifting regimen and implement it with Spartan-like discipline at the gym each morning at 5:00 am, and some of us don’t exercise at all and manage to stay reasonably healthy and content with our physical appearance and fitness level.

On the other hand, some of us truly need the structure and technical knowledge that a trainer provides in order to meet our health and fitness goals. If we have a serious injury or medical condition, for example, there may be certain exercises that could be harmful, so a qualified trainer or coach is essential.

Given these two extremes—those who have absolutely no need for a trainer and those who’s condition necessitates it—I think most of us probably fall somewhere in the middle. That is, there are aspects of having a personal trainer that, while not necessary, would be beneficial:

• Helping to keep us motivated and accountable (it’s harder to blow off a training session if you know your trainer will be disappointed or charge you a cancellation fee).
• Providing valuable technical knowledge for a specific goal (e.g. which supplements to take and lifts to do for maximum muscle growth, interval training or plyometrics for speed, etc.).
• Introducing you to new ideas or activities that you wouldn’t have been exposed to on your own (benefits of free weights compared to weight machines, optimal heart rates for specific fitness goals, what to eat and how much before a training session, etc.)

Therapy isn’t much different. Substitute physical health and wellness for mental and emotional health and wellness, and the analogy holds up almost exactly.

Side Note: Want to learn more about emotional health? Check out my article The 7 Habits of a Peaceful and Productive Mind.

Many people don’t struggle with a major mental health difficulty, and they have resources and support in their lives that help them remain resilient even in the face of difficult stressors or other troubles. On the other hand, some people’s lives are severely impacted by their emotional struggles, and for these people, therapy may be the minimum they need just to keep their lives from falling apart.

But the vast majority of us fall somewhere in the middle of these two extremes. We’d probably be alright if we never saw a therapist, but there are likely several aspects of our lives, work, or relationships that we could improve with some good work in therapy:

• Understanding how the way we tend to think about things affects our moods and emotions
• Clarifying our values and strategizing about the most effective path toward them
• Learning to communicate directly and assertively in relationships or the workplace
• Building self-confidence in social situations
• Acquiring more effective parenting skills and techniques
• Working through complicated grief or loss

What’s more, in addition to improving traditional mental health struggles, therapy can also be a powerful and efficient way to make progress on personal goals or aspirations.

---

5 Personal goals therapy can help us achieve

We usually think about the goals of therapy in terms of traditional mental health issues like depression or anxiety. And while it’s true that many people start therapy primarily with this in mind, the usefulness of therapy isn’t limited to these strictly clinical issues. Therapy can also help you achieve common personal goals like weight loss or better sleep habits by showing you how to identify and overcome the psychological or emotional obstacles that may be getting in the way.

Here are five common personal goals that can be worked through in therapy:

1. Stop procrastinating and get stuff done. Still stuck on Chapter 1 of your novel? Still imaging how great that new back porch will look? Keeping your bedroom spotless but still no progress on your dissertation? Anxiety and shame are two common contributors to chronic procrastination. By working with a therapist to illuminate the causes and maintainers of these negative emotional states, and then developing strategies for reducing them, you may find that those seemingly impossible tasks are much more doable when you’re not walking uphill against your own negative emotions.
2. Get to sleep. A great night’s sleep makes everything remarkably better—worries roll right off us, we have energy to get stuff done, and our mood stays brighter and more buoyant. But more than a few nights in a row of bad sleep can wreak havoc on almost all aspects of our lives. Many people suffer from consistently poor sleep because the habits that lead to good sleep are often counterintuitive and difficult to establish initially. A good therapist—especially one who’s trained in CBT-I (Cognitive Behavioral Therapy for Insomnia)—can help you get back on track with your sleep, which is a crucial foundation for building improvements in all other aspects of our lives.
3. Lose weight. We’ve all heard the term ‘emotional eating,’ so it probably doesn’t come as a surprise that our emotions and moods play an important role in our eating habits. A good therapist can help you get clear about the real reasons and motivations that go into unhealthy eating patterns, and consequently, help you develop healthier substitutes in order to both lose weight and get your emotional needs met.
4. Save money. Have you ever bought an expensive sweater only to see it hang unworn in the closet for months or even years? Or impulsively bought that new iPhone, knowing that you didn’t have the money and that putting it on a credit card was probably a bad idea? Decisions about money and finances are some of the most important in our lives, but they’re also especially sensitive to emotional swings and negative core beliefs. Therapy can help you see how your old patterns of thought and behavior might be getting in the way of good financial decisions today that will have a significant effect on your future.
5. Find your passion. Whether we’re in our last semester of college, or eyeing a Porsche leading up to our 50th birthday, we all experience what psychologists call ‘crises of meaning.’ We ask ourselves, what do I really want to do with my life? While a few people seem to have a calling since before they could talk, most of us don’t. And trying to discover one can be daunting. Part of effective therapy involves a technique called values clarification, which helps you to better understand what it is you truly value and carve our practical strategies for moving towards it.

Even outside of the many benefits to trying therapy—clinical, personal, or otherwise—it’s also important to think of what we’re potentially missing out on by not trying therapy.

---

The Cost of NOT trying therapy

One of the most powerful ideas in economics is opportunity cost, the deceptively simple notion that for every decision we make, there’s an infinite number of alternative decisions we give up.

When you decide to buy a house in the suburbs, you’re also giving up the possibility of buying a condo downtown, buying a quaint little farmhouse in the country, or living out of your van and being able to move anywhere on a whim. Similarly, that $270,000 you just spent on a house now cannot be spent on a new Ferrari, traveling the world, investing in your buddy Dave’s artisanal Tupperware startup, or any number of other things or experiences you could buy with $270,000.

While the basic idea of opportunity cost is not too difficult to grasp intellectually, cultivating the habit of thinking in terms of opportunity cost is actually pretty challenging. Partly because it’s uncomfortable to always be thinking about what we’re giving up; it feels much better to simply focus on what we’re getting and give-in to the comfort of an ignorance-is-bliss mindset.

The problem is, the merits of any decision can’t be judged simply in terms of their benefits. You always have to consider the cost as well. Suppose our buddy Dave told you that his startup was making 5 million dollars per quarter in revenue and projected to double that in two years. Sounds impressive, right? Should you invest based on that information alone? Probably not. If you were smart, you’d want to see what his expenses were too. If he was spending 6 million a quarter with plans to borrow even more, you might think twice about the true value of the business.

So, what does all this have to do with therapy?

Therapy and Opportunity Cost

When it comes to therapy, I think most of us are actually pretty good at thinking about opportunity cost. That hour and a half we spend each week getting to and from and being in therapy could be spent going to the gym, hanging out with our kids, or binge-watching the hottest show on Netflix. Similarly, over the course of, say, six months of weekly therapy sessions, that $40 co-pay adds up to almost a thousand dollars. Wouldn’t it be better to put that money into paying off student loans or buying that sweet looking new iPad they just released?

Maybe. Depending on your particular situation and values, the benefit of therapy may not be worth the opportunity cost. But, it’s also useful to think through the opportunity cost of not trying therapy. In other words, what are you potentially giving up by not giving therapy a shot?

Some examples of the opportunity cost of NOT trying therapy:

• What’s the cost of your marriage continuing to deteriorate because you can’t seem to communicate with your spouse in a genuine way?
• What’s the cost at work of not challenging and confronting your fears of public speaking? How many interesting business opportunities are you giving up on because it’s easier to keep your head down and avoid those anxiety-producing situations?
• What’s the cost of your child being so anxious leaving you that they can’t focus at school or make new friends?
• How much future enjoyment and fulfillment are you giving up because you’re unwilling to ask for professional help with your procrastination on that plan for writing a novel or restoring that old Chevy that’s been sitting in the garage for a decade?
• How much extra time are you spending each month by avoiding driving on the freeways and taking only side streets to and from work each day because you’re worried about getting in another accident on the freeway? What could you do with an extra 20 hours per month?
• What kinds of romantic experiences are you giving up on because you’re avoiding working through trauma from an abusive prior relationship?

By cultivating the habit of considering opportunity cost, you can improve your decision-making process by always considering both the benefits and costs of a particular decision. If you’ve historically made the decision to not try therapy, it might be worthwhile to reconsider that decision in light of the potentially major opportunities you’re giving up.

---

10 Surprising (and totally valid) reasons to start therapy

As a final argument in favor of at least considering giving therapy a try, I thought it might be useful to describe some surprising yet extremely common (and completely legitimate) reasons that people begin therapy.

1. Head off a crisis

Many people start therapy because they’re in the middle of some kind of crisis and things have reached a breaking point:

• My panic attacks are getting worse again and it’s taking me three times as long to get to work because I’m avoiding driving on the freeways.
  
• My spouse has issued an ultimatum and is threatening divorce if I don’t get my anger under control.
  
• The two glasses of wine at dinner have steadily turned into a couple of bottles per night resulting in frequent blackouts.
  

While situations like these are obviously appropriate reasons to start therapy, many people start therapy in earlier stages of distress because they don’t want to end up in crisis in the future.

• I’ve started noticing my anxiety about driving getting worse since the accident last month.
  
• I can see that my anger causes my spouse to shut down, but I just don’t see how else to get them to understand…
  
• I only have a few drinks at night, but I know that I do it to reduce stress and there’s probably a healthier way to do it.
  

It’s counterintuitive, but you can start therapy even if you feel fine. In fact, it’s often a really good idea. Getting into therapy and learning some new skills could be a lot easier (and probably cheaper) than dealing with a crisis after it hits. Don’t procrastinate on getting help just because things don’t seem “serious enough.”

2. Strengthen a marriage or relationship

Your marriage doesn’t have to be falling apart for marriage counseling or couples therapy to be a good idea. Even if your marriage or relationship is going well, it may be beneficial to do some couples therapy to strengthen a particular aspect of your relationship such as assertive communication, intimacy/sexual concerns, parenting issues, etc.

In addition to couples therapy, simply doing your own individual therapy to work on issues related to your relationship can also be helpful. A common concern I see is new parents worrying that they will “repeat their parents’ mistakes” with their own children. As a result, they use therapy as a way come to terms with their own childhood so that they can be as present and available with their own children as possible.

3. Navigate a difficult transition

Being in therapy in anticipation of or during a difficult transition can often make the transition more manageable. Some common examples are divorce, retirement, death of a loved one, onset of chronic illness or disability, birth of a child, and a new job or career. Retirement, in particular, is something I see a lot of people struggle with, partly because the difficulty of being retired often comes as a complete surprise. People who are most vulnerable are the ones who have poured so much into their careers that they may not have many interests or sources of enjoyment/excitement outside of work. Gaining insight into this and making a plan for building in new sources of satisfaction are very common tasks in therapy.

4. For the curious

One of the ways therapy can help people work through a difficulty is by increasing their insight into themselves. But learning more about yourself and your own psychology doesn’t have to be in response a problem or crisis. If you’ve ever been curious about details of your personality, wondered about small foibles in your behavior, or questioned why you tend to act just like your parents, seeing a therapist might help you answer some of those questions.

5. Build a specific psychological or emotional skill

I had a client once who came to therapy primarily because a colleague had pointed out that he didn’t seem to be very good at “relating to his clients on an emotional level.” He was an attorney and was specifically having a hard time connecting with and encouraging witnesses before trials. He would lay out the facts systematically and plainly but was continually surprised when his clients didn’t perform as well as he expected.

Even though my client wasn’t experiencing any particular distress in his life, he realized that better “emotional fluency” would help him in his job. So we worked on that, and relatively quickly, he started building a new skill set that improved his performance as a trial attorney. Other types of psychological skills that clients commonly want to build include assertive communication skills, emotional regulation, cognitive flexibility, perspective taking, anger management, and mindfulness.

6. Appease a spouse or partner

As a therapist, it’s wonderful when a client comes charging into your office full of energy and internal positive motivation to make important changes in their life: “I’ve had it with this fear of public speaking! I want to be able to give a speech at my son’s wedding, so let’s do this!”

However, that’s rarely the case. Much more commonly, people enter therapy with many different motivations, some positive and internal like the above, but some external and negative: “My wife is threatening to divorce me if I don’t kick my addiction to painkillers. I’m terrified of how I’ll going to feel coming off of them, and honestly, I’m not sure I can do it. But I just can’t stand the thought of losing my family, so here I am.”

Thankfully, having a big messy set of motivations for coming into therapy doesn’t mean you can’t do it or are less worthy of therapy. I’ve had many clients who began therapy primarily as a way to appease a spouse, parent, or significant other but ended up finding it incredibly helpful for themselves in addition to appeasing someone else in their life. Some even chose to stay in therapy after the initial issue was resolved to work on more issues.

In other words, don’t feel bad if you have mixed motivations for beginning therapy. This is common and completely okay.

7. Emotional support

Everybody needs a shoulder to cry on or a patient ear to vent to from time to time. But for many people, it can be hard to find sources of emotional support among friends or family members. In fact, one of the most common reasons people tell me that they’re starting therapy is because they feel like they’re burdening family members or friends with their emotional difficulties.

In any case, most therapists are happy to do what’s called supportive therapy. In supportive therapy, there may not be any one particular problem or crisis that needs to be addressed. Instead, the therapist simply provides emotional support in a structured, consistent, and professional way.

8. Achieve a personal goal

I mentioned this earlier, but it’s worth re-stating: If there’s something in your life that you’ve been trying hard to accomplish but just can’t quite seem to make happen, it may be that there are subtle psychological or emotional factors causing friction and preventing you from succeeding. A common one I see is people wanting to work on procrastination in order to be more efficient at work or complete a major academic project like a dissertation.

Some other personal goals that people come to therapy to get helping working on include weight loss and better eating habits, starting a new business or side project, and improving the mental side of their performance in a sport or competitive activity.

9. Encourage someone else to start therapy

Maybe it’s not the primary reason for starting therapy, but one positive benefit of being in therapy yourself is that it may encourage someone else you care about to try therapy. I’ve seen this most commonly with spouses.

Similar to the client I described at the beginning, I saw a woman in therapy once who initially came in with mild anxiety. As we worked on the anxiety, she eventually opened up to me and explained that part of her motivation for beginning therapy was to encourage her husband to do the same. He needed help with depression but felt too ashamed to see a therapist. Consequently, part of our work became figuring out the best way for her to talk to her husband about his depression and show how therapy had been helpful for her without being pushy or preachy about it. Eventually, after many conversations with his wife about her therapy and what it was like, the husband did begin his own therapy.

If you’re comfortable talking with other people about being in therapy or specific aspects of what it’s like, that can be a wonderful act of service to others.

10. Stress management

Sometimes life is just difficult and stressful—a huge project at work, caring for a sick or elderly family member, helping a loved one through a difficult crisis. These are all potential sources of significant psychological and emotional stress. And even if your stress isn’t resulting in any major emotional or psychological difficulties, it may be that a therapist could help you manage your stress more effectively.

I see this a lot with folks who are acting as primary or significant caregivers for elderly parents. Often there are strategies we can implement that help the caregiver to ease disproportionately high stress levels. As a result, they often feel better themselves and are actually able to provide better care to their parent.

---

Summary and Final Thoughts

So, does everyone need therapy? Of course not.

But whether we need therapy is usually the wrong way to look at things. The better way to approach the question of trying therapy is whether or not we could benefit from it.

Fundamentally, therapy is about mental health, and health means a lot more than feeling less badly. It means growth, resilience, understanding, and strength.

Unfortunately, many people who may not need therapy but could benefit from it tremendously never even consider it because of misguided beliefs about what therapy is.

Most people think therapy is, at best, like going to see a doctor to get an illness cured. Some even think of therapy as some sort of moral re-education process. But therapists don’t have magic pills or special wisdom about how to live your life “the right way.”

Both of these perspectives miss the truth of what good therapy really is: A structured and systematic opportunity for personal growth, all done in the context of a supportive and non-judgmental relationship.

Who couldn’t benefit from that?