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” (American Psychiatric Association, 2013). Thus, by the fact that Mary adds she is struggling with sleeplessness for months and her problems are negatively impacting those around her, she is acknowledging that her problems are causing both “clinically significant distress” and “social impairment” in this song. Understanding these points may help you better understand when it may be time for you to at least check-in with a mental health professional to assess your situation.

There’s one other technical point I want to address in this song, and it involves the frequency of therapy as stated in the chorus:

Why would I spend the rest of my days unhappy Why would I spend the rest of this year alone When I can go therapy When I can go therapy When I can go therapy two times a day

Now, I LOVE Mary. Personally, if I could talk to her two times per day, I would be in heaven. Yet in my role as a psychologist, I have never heard of therapy twice per day (outside of specialized, intensive treatment programs). These lyrics surprised me when I first listened to the song. Some psychological modalities call for extended session times (e.g., couples counseling may require 90 minute or longer follow-up visits). Some situations may call for meeting a few times per week (e.g., working through a crisis or if engaging in psychoanalytic psychotherapy). Besides that, I cannot say this frequency is the norm. Now, she is probably using artistic license rather than being literal to emphasize that she feels so overwhelmed and is overwhelming her loved ones so much that she could probably go to therapy twice daily; she just has that much to say. I must highlight this point because it has always stood out to me, and because in this blog, I want to provide a little education. Those who are new to therapy generally end up asking, “how long will this take and how often will we be meeting?” The answer is typically once per week to start. In time that drops to every other week and then monthly until it is time for therapy to end. The time frame from the first to the last session varies per person. Some people address their issues within 3-6 months; others are working through years of pain and may need extended time to process all that they have been through.

In providing therapy to hundreds of people over the years, I cannot count how many times people wonder aloud why they have waited so long to start counseling. They talk about the challenges of even picking up the phone to call, sometimes waiting weeks, months, or even years to finally start the process to get relief. Why? My best answer is that the delay is fear-based; fear of embarrassment, fear of an unknown process, fear of what others will think (which is interesting given the process is confidential), or fear that they will view themselves as having failed in some way. Yet in the meantime, they are suffering and miserable; they are maybe even driving away the ones they love without meaning to. And what do people tell me AFTER they have taken that hard step of initiating therapy? “I wish I had started this sooner.” Poof. Fears are gone and relief is underway. Perhaps time was lost to healing or perhaps that person was not quite ready to start the process and needed more time, or just a little more pain, or a nudge from an outside source to encourage them to get started. If you need a little more information or a nudge and want to read more about this process, particularly as offered through my telehealth practice, I invite you to read my featured article in Authority Magazine, “Telehealth Best Practices: Alicia Rozycki of AROSE eTherapy & Life Design on How to Best Care for Your Patients When They Are Not Physically In Front of You.” https://medium.com/authority-magazine/telehealth-best-practices-alicia-rozycki-of-arose-etherapy-life-design-on-how-to-best-care-for-8a90a310e05

If you can relate to Mary and are tired of sleepless nights, work stress, and wearing your partner out with complaints, consider (tele)therapy. Imagine sleeping soundly through the night, learning skills to keep your work stress from dominating your life (or learning that your constant work stress is an indicator that it may be time for a change), and having pleasant chats with your partner about positive highlights of the day, weekend plans, personal wins, and hopes for the future. There really is no reason to suffer when solutions are available. Take it from Ms. Blige—why spend the rest of your days unhappy when you can go to therapy, but just don’t plan for therapy twice per day!

The author of this blog, Dr. Alicia Rozycki, is a Licensed Psychologist, and founder of AROSE eTherapy & Life Design, a therapeutic space where women can support women. Dr. Rozycki is an Unmute Therapist and licensed to see clients who reside in AZ, CO, DE, FL, GA, IL, MO, NE, NV, NH, NC, OK, PA, TX, UT, and VA.

If you’d like to be matched with Dr. Rozycki for a virtual counseling session, sign up through Unmute and let us know!

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

White, F.A., Smith, S.F., and Blige, M.J. (2014). Therapy. [Recorded by Mary J Blige.] On The London Sessions. London: United Kingdom: Capitol Records and Matriarch Records.