How Do I Know It's Time To Get Help or, Is This Normal Or...Something Else?

Often, after we've worked together awhile, my clients will confide, "You know, I almost didn't come in that first time.  I was second-guessing myself asking, Why can't you just suck it up and handle this on your own?"  When I ask what tipped the balance in favor of therapy, the answers, in retrospect, range from "I was out of control," to "It was too scary to do this on my own," to "I'd tried everything and nothing was working."

Virtually everyone referred to the one commonality that separates the everyday from the debilitating: severe, prolonged distress.  In almost every case, clients reported that the distress had become too much, for too long, affecting one or more important areas of their lives: relationships, work, health, finances, and legal difficulty. What becomes evident over time is that intense and prolonged distress cannot only cause somatic (in the body) difficulties, but also significant impairment in carrying out the activities of daily living.

So, the symptoms. How do I know this just isn't a rough patch, like everybody goes through from time to time?

Most people don't seek therapy at the first sign of that "rough patch." In fact, I believe that, as a species, most human a beings are remarkably resilient. We tend to endure hardship and bounce back, often many times in a lifetime.  

When you begin to feel like you're not bouncing back and decide to seek clinical help, your clinician (psychiatrist, psychologist, licensed marriage and family therapist, social worker, etc.) is likely to rely on a 900-page publication called the Diagnostic And Statistical Manual of Mental Disorders (DSM-IV) to guide his/her assessment and diagnosis of your condition.  Published by the American Psychiatric Association with contributions from some 1,000 mental health professionals, this manual categorizes, defines and provides specific guidelines for diagnosis. 

While everyone is unique and not everyone experiences mental distress in precisely the same ways, there are two criteria which, in general, surface in the diagnoses, which help clinicians discern what's going on with their clients: intensity and duration of distress.

Intensity or depth of distress refers to "How bad is it?" For example, if you're concerned about depression,  your therapist will likely start out asking you questions about your daily routine. Are you able to get out of bed in the morning? Can you make it to work, or are you missing lots of days? Are you sleeping? How much  or how little? Are you isolating from people you love? What's the degree of isolation?  (Remember from above: relationships, work, health, finances, and legal difficulty?)

For anxiety, a similar discussion might go along the lines of: How does your anxiety show up in your body (what does it feel like)? How is it affecting your relationships? Does it limit your enjoyment of your life (have you stopped doing things your might otherwise enjoy) ? Is it affecting your work or your ability to go to work? Has your anxiety led you to do things that have gotten you into legal or financial trouble?  

Duration simply means "How long has this been going on?"  Many of life's disappointments, difficulties and setbacks resolve themselves in a reasonable amount of time.  But, when your distress has been interfering with your life, work, relationships or daily functioning for longer than the norm (as outlined in the DSM-IV, referenced above), you may benefit from therapeutic intervention.

A few things to pay attention to when considering whether to seek therapy. 

Pay attention to how you feel. If you're not "yourself" for an extended period of time or if you have intrusive thoughts that are disturbing to you, you may need to talk with someone.  If you're having persistent thoughts of hurting yourself or someone else, I would recommend talking with a professional right away. Most communities have crisis or suicide hotlines that can provide immediate help, often round the clock. Remember, you won't be shamed--just helped.

Pay attention to your routine. Are you sleeping more or less than usual? Has your appetite changed? How about school or work attendance?  Are you engaging in unusually risky behaviors or behaviors that  are a bit bizarre for you?

Pay attention to your relationships. Are your relationships at home or work deteriorating or becoming progressively more difficult, with no end in sight?

Pay attention to your body. Are you experiencing new, chronic pains or aches? Stomach or digestive difficulties? First thing, consult your physician to rule out any organic difficulties. If he/she finds nothing organically wrong, your next step might be to consult about your mental health.

Pay attention to your moods. Do your moods swing from euphoric to profoundly sad? Are you more angry now, more often and with more intense behaviors? Are you more sad, worried, easily frustrated, disinterested, confused than usual?  

And finally, pay attention to feedback from those you usually trust. Have friends or loved ones expressed concern about your behaviors, moods, or thoughts? Are you hearing the same concerns from several sources? 

Despite our resiliency, intelligence, and support from others, sometimes it doesn't feel like "toughing it out" is productive or even possible.  If your distress has become so intense that it's affecting many areas of your life, and it's been going on longer than you're used to, you may want to talk with someone. Someone trained to help you determine if this distress you're going through is "normal"--or something else.

Thanks for listening.