How to Know If You Need Therapy

The signs you should call for backup aren't always easy to spot.

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Dec 14 2016, 7:00pm

Chest pain or trouble breathing should send you straight to the ER, but the red flags that signal that you need to see a mental health professional often exist in more of a gray area, says Chicago-based therapist Rachel Kazez, founder of mental health consulting service All Along. When life deals you a tough blow—you get canned, you have a death in the family, your relationship fizzles or combusts—it's not abnormal to struggle and feel sad. Loss and change are part of the normal human experience and might not require professional intervention. "You don't always need to fix or diagnose or make grief clinical," she says. Regular coping strategies—supportive friends, exercise, travel—plus the passage of time often suffice.

In other words, don't assume you should go to therapy just because you've hit a rough patch. But when the challenges you face exceed your ability to cope, it makes sense to call in the pros. Here are a few ways to recognize that you're stretched too thin.

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The situation: A divorce or bad breakup
In one study, University of Denver researchers found that 43 percent of 18 to 35-year-olds saw a drop in life satisfaction and a rise in distress when a relationship ended. That doesn't necessarily mean they needed therapy to bounce back, however. Even if you subtly suspect the link between tubs of ice cream and romantic splits to be the work of a Haagen-Dazs marketing mastermind, the cliché exists for a reason: Sometimes, you need to wallow for a while before you move on. Crying, indulging in comfort foods, ranting about your ex, and feeling sorry for yourself can all be a part of the process, as long as it doesn't go on for too long or negatively impact your health and other relationships, Kazez says.
When to get help: If your partner was your sole source of social support and you feel overwhelmed and alone. In some cases, relationships blur the boundaries and leave you wondering who you are without the other person. A good therapist can help you find your strengths and reestablish your identity, says Carl Sheperis, vice chairman of the board of directors for the National Board of Certified Counselors. If your other life circumstances mean you can't afford to flounder—say, you have sole custody of children or serve as a caregiver for a sick parent—professional help might restore you to full functioning more quickly, Kazez says. Another red flag: You're coping in unhealthy ways, such as getting blackout drunk, withdrawing from the world, or having lots of impulsive sex, says Ben Rutt, a licensed psychologist in Baltimore.

The situation: A close relative died
Grief doesn't always proceed in a straightforward fashion; most people alternate between hope and despair, Kazez says. Typical reactions to losing someone you love include sadness, messed-up sleep, and trouble eating. According to a recent research review, about half of people start to feel some relief from these symptoms within 18 months. There's no sign therapy alters this trajectory—talking with a professional isn't harmful, but it's not necessary if you don't want to do it, Rutt says. For some people, grief can cause temporary forgetfulness, and keeping therapy appointments might only add to the burden, Kazez says. Talking with another loved one (especially one who's also feeling the loss), using a therapy app or online program like Talkspace, or finding a convenient drop-in support group might work better if you crave connection.
When to get help: After a few weeks, if you never feel even a glimmer of brightness—or if you start to feel worse instead of better. You might be on the verge of something experts call complex bereavement-related disorder or complicated grief. Other signs include bitterness and anger, feeling emotionally numb, or completely withdrawing from others. Treatment can help in these cases, Rutt says. Also, you might want to consider getting help processing deaths that occurred in a particularly violent way, or touch on issues involving race, gender, or another sociocultural vulnerability, Kazez says.

The situation: You lost your job
In many ways, the employer-employee bond is a relationship like any other. When one side breaks it off, it's normal to feel sad, rejected, and worthless for a little while. In the best-case scenario, you can come to view a firing or layoff as an opportunity to learn new skills and refocus your career, Kazez says. If you can frame things that way, you might cruise through fine, or even end up better off in the long run.
When to get help: If getting canned triggers unhealthy thought patterns or symptoms of a previously treated disorder—for instance, the types of hopelessness and loss of interest in life that accompany depression. One recent Gallup poll found about one in five Americans who have been off the job for a year or more seek treatment for the condition. In those cases, even a few sessions of therapy could reboot your defenses and get you back up on your feet, Kazez says. Also, depending on the circumstances of your termination, you might not have the luxury of time to get your shit together. If financial pressures mean you need to work again before you feel psychologically ready to job-hunt, investing a little cash in therapy up-front could pay off in a swifter return to a steady paycheck.

The situation: You're hurt or sick
Unless you have a lot of other terrible things happening in your life, you can probably cope with a sprained ankle or a bout of the flu. But when injuries are severe or diagnoses turn terminal, your resilience can be tested, especially if they alter the course of your life in a significant way (think cancer or an accident that leaves you disabled).
When to get help: This is one instance in which individual therapy often isn't the best choice, Kazez says—instead, consider group therapy or a support group that includes others in the same situation. "It's definitely more useful to see somebody else who has whatever the disorder or injury is and hear them say, 'I'm thriving, I'm coping,'" Kazez says. But if you need help hooking up with a group—or coming to terms with your new reality in a way that allows you to talk about it with others—one-on-one counseling can serve as a bridge, she notes.

The situation: You want to quit smoking or drinking
Unlike events that happen to you, changing your habits involves a conscious choice, Kazez says. While that does give you a little more control, it doesn't mean the process is easy. Sometimes, ditching booze or cigarettes disrupts your daily habits and social circle just as much as a breakup, and physical or psychological dependence can make the picture even more complex.
When to get help: As noted above, other life stresses can drive you to substance abuse. Signs include problems in your job, relationships, or home life—if you spot them, consult a mental health professional, Sheperis recommends. Also remember that your regular doc can sometimes help in these situations too, since treatments like medication and nicotine replacement therapy have also proven effective in reducing dependence on alcohol and cigarettes.