How to know when it's time to go to therapy?

How do you know when it's time to go to therapy? It is a tough question with many possible answers. With therapy there are no concrete rules about time frames (outside of clinical emergencies such as suicidality or homicidality which indicate immediate treatment). With medical problems it seems like it is easier to know the answer to when to seek help. Pick up any box of over-the-counter medication, and it will tell you exactly when you should go to the doctor—"if symptoms persist beyond x days or if you experience symptoms X, Y, and Z, consult your doctor.” With life stressors, troublesome symptoms, and frustrations, it is hard to say when a person should schedule an appointment with a therapist. Why is it so hard to know when?

I often use the anecdote of the frog in the pot of boiling water to explain why it is hard to appreciate just how high stress levels may be. You have probably heard the anecdote before. Put a frog in a pot of water, and it may just sit there. Put the pot on a stove and slowly start turning up the heat. The temperature of the water will begin to boil, and despite the increasing heat, the frog will stay in the water until it is completely cooked. But if you take a pot of piping hot boiling water and toss a frog in there, you will quickly see the frog use those jumping legs to pop right out of that pot. We are just like the frogs in this anecdote. Put us in the face of a significant, sudden and shocking trauma, and we will probably realize we need help right away. Yet, gradually add stress after stress over an extended period and many people won't realize just how overwhelmed they are. They may not even realize they are stressed, worried, or anxious. They begin to believe having constant muscle tensions, sleepless nights, headaches, upset stomachs, worries, and irritabilities are a normal part of functioning. For additional guidance on when to seek out therapy, let's turn to a song (the first line of which is the title of this blog) that is co-written and performed by one of my absolute favorite recording artists, Ms. Mary J Blige.

First of all, if you are not familiar with Ms. Blige, know that she has openly spoken about her engagement in therapy. I appreciate her taking that transparency to the next level by making song about therapy. In my humble opinion, Therapy, is one of the best songs on The London Sessions album, from song writing, to lyrics, and of course Ms. Blige’s amazing vocals. What impresses me most is that a song could be produced about therapy that isn’t cheesy and speaks from the heart. The queen of hip hop and R & B gets to the core of what drives someone to seek out therapy: life stress, overtaxing loved ones with complaints, and desiring relief through therapy to end the suffering.

Here are some lyrical excerpts:

Why would I spend the rest of my days unhappy…

Why would I spend the rest of this week so bitter And all that listening is making you bitter too…

I don't wanna be around me…

Most nights I lie awake between you and Fall Work stressing me out…

I'm stressing you out And at the way is going you need it more than me

She highlights the main reasons someone would go to therapy: feeling unhappy, bitter, stressed, and sleepless for months—feeling so miserable to the point where someone does not even like being around themself. We may identify with some or all of this at times. We may have a bad day or couple of days. That is a part of being human. There is greater concern when problems and symptoms cause distress, persist over several weeks or months, and impact functioning. Notice she adds the points about not only being dissatisfied with herself and her functioning but recognizes her struggles are impacting those around her. Having struggles for an extended period that cause distress, impact functioning, and /or impact social relationships is what shifts concerns from being “life” to being problems that might warrant professional help.

All mental health providers in the U.S. use a diagnostic manual called the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders Fifth Edition). For every mental health condition that is diagnosable in the DSM-5 a stipulation is noted that the symptoms alone are not enough to classify a problem or diagnose a disorder. This makes sense because, again, anyone can experience symptoms of, for example, anxiety (e.g., worry, sleeplessness, tension) or depression (e.g., sadness, low energy, guilt) from time to time. This does not mean a person is dealing with a clinical diagnosis of these conditions. To warrant a clinical diagnosis, the conglomeration of symptoms also must create “clinically significant distress” or “impairment in social, occupational, or other important areas of functioning” (America