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For weeks you haven't felt like yourself. Maybe you're a little blue and out of sorts, you're anxious about everything from the kids to the economy, or you're worried because you and your husband have fallen into the habit of using that tone with each other too often. But you can handle it, right?
Well, maybe. There are plenty of common emotional issues you can deal with on your own, experts say, by talking it out with friends and family or by taking better care of yourself. But sometimes you need extra support from a therapist. About a quarter of adults in the United States have a diagnosable mental disorder, according to the National Institute of Mental Health. Even those who have less serious troubles will often find comfort and help in talking to an unbiased professional. The trick lies in recognizing the difference between a DIY situation and one that requires skilled guidance.
"There are lots of women who could benefit from seeing a therapist but don't ever do it," says Jennifer Yashari, MD, a clinical instructor of psychiatry at UCLA and a member of the LHJ Medical Advisory Board. "Going to therapy doesn't mean you're weak or crazy or don't know how to take care of yourself. It just means you're having a hard time right now. And much of the therapy offered these days is designed to help people work through their problems in a fairly short amount of time." Just as it's better to catch most health problems early, it's easier to tackle an emotional issue, whether it's depression, anxiety, grief, or a relationship conflict, before it becomes firmly entrenched. Here's how to tell when your emotional life needs a tune-up and who to go to for help.
The problem: Your marriage has hit a rough patch. Your best efforts at reconnecting aren't working, whether it's through talking, going on dates, or taking a vacation. "The average couple waits seven years before seeing a therapist, which is seven years too long," says Diane Gehart, PhD, a professor of marriage and family therapy at California State University in Northridge.
When you may need help: If your partner is abusive, has had an affair, or is struggling with addiction, you're going to benefit from seeking help -- period. But if you're not dealing with a dramatic problem it can be tougher to tell when to send out an SOS. One major warning sign is when a tone of contempt has crept into your conversations. "Things that seem fairly innocuous can indicate a deep sense of dissatisfaction with the relationship," says John Gottman, PhD, cofounder of the Gottman Institute, a marital counseling center in Seattle. "That can include such things as using a superior tone or saying things like 'you always' or 'you never.'"
More red flags: Eye-rolling, sneering, or frequent criticism. "It's important to nip those kinds of things in the bud because they can erode your emotional bond with your partner," says Dr. Gottman, author of The Seven Principles for Making Marriage Work. Other signs of trouble include feeling lonely even when you're with him, having go-nowhere arguments that leave you feeling more resentful than before, and a dwindling sex life. There's no "right" number of times to have sex, but lack of physical intimacy can indicate that you're drifting apart emotionally, too.
Basics of marriage counseling: Don't expect a counselor to fix your problems. Marital therapy requires active engagement from both you and your spouse. Through joint sessions, marriage counselors help you understand the root of your conflicts and resolve them by giving you tools to communicate, negotiate differences, and talk about problems (or even argue) in a healthy, productive manner. Most couples go every week for at least 12 sessions, but if you're in a crisis you might want to go more often. If your spouse is reluctant to see a therapist, he may be more comfortable trying online counseling with you. A directory of marriage therapists and counselors, including online and telephone options, is available at family-marriage-counseling.com.
Worry and Anxiety
The problem: The bills are piling up but your income isn't. Your son is struggling in school. Your aging mom is starting to show signs of dementia. Whatever the problem, your brain is stuck in an endless loop of worry and anxiety. It's normal to feel anxious when you're in a stressful situation, but not to the point where it's making you miserable for months or affecting your ability to function at work or at home, says Dianne Chambless, PhD, professor of psychology at the University of Pennsylvania. Ongoing anxiety can be a sign of trouble and affects up to 18 percent of U.S. adults.
When you may need help: If you've become so obsessed with your dwindling bank account (or other trouble) that it's interfering with your ability to concentrate, sleep, or do the things you need to do during the day, that's a concern. "If you're expending so much energy on the worry that you can't function the way you should, and it lasts more than a month or so, it's time to see someone," says Dr. Yashari. Another clue to over-the-top anxiety is the onset of panic attacks, when out of the blue you feel shortness of breath, heart palpitations, and/or a sense of doom or dread.
Basics of anxiety therapy: Treatment for anxiety goes to the core of the problem, according to Una McCann, MD, a professor of psychiatry and director of the Johns Hopkins University School of Medicine's Anxiety Disorders Clinic. "We teach people to breathe properly to help their bodies relax and have patients take concrete steps toward facing their fears, whether it's speaking in front of a crowd or getting on an airplane," she says. Therapy also targets unhelpful thoughts, like the what-ifs that typically plague anxiety sufferers. Many patients begin to notice improvement in eight to 10 sessions and most go for fewer than 20.
The problem: You're feeling blah and out of it and are worried that you might be depressed. It's a legitimate concern: Depression strikes an estimated one in four women at some point in life, and although treatment can alleviate symptoms in many people, most don't get the help they need. "Too many people suffer needlessly," says Michelle Riba, MD, a professor of psychiatry at the University of Michigan Depression Center.
When you may need help: If you've been feeling helpless or hopeless for at least two weeks and it seems as if your problems have no solution, it's a warning signal. Sure, the blues are normal if you're going through a trauma, such as a job loss or divorce. "Everyone goes through bad times," says clinical psychologist Jaine Darwin, PsyD, an instructor at Harvard Medical School. "But if you feel like your situation is never going to get better and you're starting to withdraw from life -- nothing can make you smile and you have little interest in things that you used to enjoy -- that's a sign of depression." Physical symptoms can be a clue, too, such as eating or sleeping more or less than usual or having unexplained stomachaches, backaches, or headaches. "How we think and feel emotionally affects our physical well-being," says Dr. Darwin.
Basics of depression therapy: Distorted thoughts like "this will never get better" or "no one cares about me" are often a key symptom of depression. A therapist will try to help you shift your thinking in a more positive direction by helping you see that your thoughts aren't realistic or well-founded. If the depression is driven by a difficult life situation, a therapist will help you understand which aspects of those problems you can change. She'll also suggest concrete tools for coping, such as spending time with friends, exercising, and doing things you love, to help you regain a sense of joy.
The problem: Someone close to you died -- your mother, spouse, or best friend -- and you haven't felt the same since. "It's normal to feel sad after a loss as you're figuring out where you fit in without this person," says Holly Prigerson, PhD, associate professor of psychiatry at Harvard Medical School. "But if grief becomes chronic it can take a toll, leading to missed work, excessive smoking or drinking, and increased risk of developing high blood pressure, a heart attack, or even becoming suicidal."
When you may need help: If it has been six months or more since your loved one died and you feel every bit as sad, angry, and upset as you did on day one and spend much of your day thinking about him or her, then you're not coping. "After most deaths, it's normal to start feeling slightly better after about six months, although extremely traumatic experiences, like a violent or unexpected death or the loss of a child, can take much longer to work through," says Dr. Prigerson. If you have the feeling that there's no way you can be happy or healthy again without this person in your life or you're turning to unhealthy activities such as sleeping all the time, drinking too much, or avoiding contact with family and friends, it's time to think about some counseling.
Basics of grief therapy: The goal is to reestablish healthy habits, learn to cope with and accept your feelings of loss, and make efforts to reconnect with people, says Dr. Prigerson. "A therapist will try to identify problems that stand in the way of reengaging with life," she says. Therapy often focuses on behavior and forming new attachments; your therapist will encourage you to do things you've quit doing, whether it's seeing friends, gardening, or working. He can also help you break any self-destructive habits you've picked up during the grieving process.
A therapist will not try to make you forget about the person you lost. Instead, he'll help you to find a way to maintain your love for that person while adjusting to life ahead and finding rewards in new or renewed relationships and activities.
Bottom Line: What Does Therapy Cost?
The price a therapist charges is based largely on four things: her level of training, years of experience, reputation, and location. "More highly trained, experienced therapists in urban areas are going to be at the high end: from $90 to $350 or more for a 45- to 60-minute session," says Susan Heitler, PhD, a marriage therapist in Denver and author of The Power of Two: Secrets to a Strong and Loving Marriage. In some areas you might be able to seek help at a mental-health center or see a therapist for as little as $40 per hour, and some offer a sliding scale based on your income. Many therapists accept certain types of insurance, but that varies across the country. Insurance companies and policies vary widely in their coverage. You may be more likely to get coverage if you have a diagnosable disorder, like depression or anxiety, than if you have marital problems or are suffering from grief, but always ask.
How to Get Started
The relationship between you and your therapist is the most important element in determining how effective your sessions will be, so it's crucial to find someone you click with. Counselors and social workers usually have a master's degree. Psychologists have a PhD or PsyD, and psychiatrists have an MD and can legally prescribe medication. Ask family members, friends, your doctor, or your local university's psychology department for referrals, then meet with potential candidates for informational sessions. Or try these resources:
And forget about the couch. Most therapy these days is very interactive, where you sit face-to-face with the counselor. More and more therapists are using cognitive behavioral therapy to treat a wide range of problems, including depression and anxiety. CBT is based on the idea that our thoughts cause our feelings and behaviors, so the goal of therapy isn't to delve into the past. It's to help you see things in the here and now from a different perspective and to recognize and change unhealthy thoughts and actions. As a result, therapy sessions begin with setting goals and are like talking to a smart, interested, compassionate friend. A therapist will ask questions about the problem and help you come up with alternative perspectives to reframe your thinking. He might also give you homework assignments, such as books to read or activities to try, to push your thinking in new directions.
Originally published in Ladies' Home Journal, May 2011.