Dear Therapist:

People have told me in the past that I need to go to therapy. However, I am an extremely practical and logic-based person and I am skeptical that therapy actually helps people. If I had statistics that 70/80% of people had significant improvement through therapy that would make me much more likely to spend the money. As of now I am not convinced. Does the panel agree that until proven otherwise my position is the correct one in the risk/reward cost/benefit analysis of the situation?



Your question is rather generic, and you appear to be avoiding the main point. Essentially, you are asking whether you should seek therapy, but you frame the question as one of statistical analysis. I don’t know what the reason is that people have suggested therapy. Sometimes when this occurs, the “problem” lies at least partially with the person making the suggestion. (This becomes less likely as the number of people increases.) Often, however, it is much easier for others to observe and recognize a problem from an objective viewpoint. Additionally, you don’t appear to be contesting the fact that you could use help. Rather, you are looking for proof that therapy could help.

There are many varied types of mental health issues that typically respond differently to many therapy modalities. There have been many excellent studies and meta-analyses that shed light on particular disorders and the efficacy of specific treatments. Within many studies, specific disorders are carefully studied, and particular treatment protocols assessed. Of course, there can be correlating factors, like comorbid conditions (more than one disorder), family support, and the skill of the therapist.

However, it is important to note that there are many causes for emotional difficulties, ranging from personality to childhood trauma, to coping skills. Basically, each individual is just that—individual. Even with a full understanding of your symptoms, a major component would be missing; we wouldn’t know why, how, when, where, and based on what your symptoms developed and continue to thrive. Without a full evaluation, it would be in inappropriate for any therapist to offer a clear sense as to treatment process, expectations, or even proper goals.

I don’t know the reason that you did not include any specifics in your question. Perhaps you have the sense that therapy for all mental health issues is similar. This is not at all true. A skilled therapist will either tailor each treatment to the individual based on their particular needs, or will refer the case to someone with the required skill set.

Perhaps you didn’t mention your issues because you are somewhat in denial. If this is the case, your first step should be to challenge this denial and ask yourself whether there is something that is preventing you from doing so. For instance, do you have trouble admitting (even to yourself) that you are less than perfect? Or does your reluctance to discuss particular issues point to a general pattern of avoidance? 

Denial is a common defense mechanism that we all use to some degree. Another typical defense mechanism is intellectualization. As with denial, we all intellectualize at times. It can become problematic, however, when intellectualization becomes prevalent and prevents us from acknowledging (and therefore working on) our problems. Since I don’t know you, I can respond based solely on your brief words. These seem to be overly intellectualized.

In your question, you refer to “significant improvement.” What constitutes “significant?” For that matter, what constitutes “improvement?” Once again, only after a full assessment would a therapist be able to help you to determine treatment process, expectations, and goals. Furthermore, what makes “significant improvement” the deciding factor? If someone has diabetes or heart disease, should they seek treatment only if they were guaranteed a significant improvement? Or should they obtain the tools necessary to combat the disease, then consistently work on improvement?

I don’t know what your issues are, or what might be necessary to help you better deal with them. It is important, however, that you acknowledge these. In order for you to identify possible goals and expectations, try to view things from the perspective of someone else. Or you can imagine yourself counseling a friend with similar problems.

I can understand your reluctance to spend money on therapy that may not help in the way that you think it should. At this point, however, you may have little to no understanding as to what it is that you hope to achieve. Recognize that some improvement is better than none. Also, sometimes just a few sessions can help someone to begin working on themselves with minimal help from the therapist. Very often, one or two sessions will be enough to give you a sense as to whether there would be an advantage to continuing the therapy process.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer / 516-218-4200