Is Signing Up For Therapy An Overwhelming Decision?: A Collective Conversation

Matt: Just about every Psychology Today profile and half the therapists’ websites I come across open with some version of the phrase: “signing up for therapy is an overwhelming decision.” I don’t see it that way at all. Which is to say, I think it certainly can be overwhelming, especially if someone has had some bad therapy experiences or particularly struggles with trust. However, we don’t say the same about going to the dentist. The assumption is that people that seek therapy need to be handled with kid gloves or taken care of around this.

I’m concerned about both the universal application of this idea and leading with this type of, what I find to be, pitying posture right out of the gate. I think therapy is seriously hard work and certainly part of our job is to be sensitive to that, but I also relate to prospective or new patients as being capable of handling that tough work. What do you think?

Kelly: There’s a fine line between validating and patronizing. While some people may genuinely find therapy to be scary or intimidating, I relate to this as part of the work–knowing you have a need to confront tough realities in your life in partnership with a good guide (a therapist), taking action to start the process, and then, remaining committed for as long as it takes. It reminds me of Steven Reisner’s article. Just like he says that the reality is that trauma happens and it can’t be undone, therapy can be scary and there’s no way around that. The way forward is in integrating and digesting, learning and doing. I like that sort of matter-of-fact approach. There are no babies here, just adults-in-training.

Rachael: I’m struck by the phrase “overwhelming decision” since it seems like an easy way to view the patient as a mess and not savvy. I think patients are the opposite–they are incredibly savvy people. I think going to therapy is a savvy way of taking on your pain rather than letting it take over. Savvy also means the ability to choose a therapist. It’s empowering to say, “I am going to work on this.” In a sense, by describing the overwhelming decision, these therapists are trying to tell patients that they can handle overwhelmed, but by doing so, they’re not saying they can handle savvy, smart, hurt, in pain folks.

Kelly, I like your description of the partnership and the matter-of-fact approach. I think patients can handle a lot and already have handled a lot themselves. When you start therapy, patients realize they don’t have to take it all on solo–there is a co-leader and a co-collaborator who can help mess with the mess, so to speak.

Liz: I agree that sometimes language found on websites that perhaps was intended to protect the patient from feeling shame, instead resonates as pity or being patronized. Maybe it’s a result of patients being so harsh or critical with themselves that we sometimes feel compelled to soften, normalize or validate their experiences in a way that tries to protect them from the experience itself.

Kelly, I also like normalizing the potential anxiety-provoking aspect of moving toward change, but agree that the “overwhelming decision” language doesn’t quite fit the bill. I think new patients are often afraid to lose parts of themselves that they have been clinging to for a long time. I like to frame change as giving those parts a new job, rather than losing them altogether.

Heather: Gosh, everything Liz, Rachael and Kelly have said all certainly rings true. It is a perhaps well-intentioned attempt to empathize, create space for these feelings, and decrease shame and stigma about seeking or needing help.

At the end of the day, I also think its laziness on therapists’ part. It’s really, really hard to put into words what we do when we are in the room with people, and why it's so helpful to them. Talking about how hard it is to get help is a cheap way to bypass this work. We, as a practice, are always grappling with and finding new ways to articulate what good therapy is. This helps us translate our work better to future patients, and I’d have to guess it is helpful to our current ones as well.

Nora: I think part of the problem with that language is that it’s a set-up. If it’s that hard to get in the door, then how can someone do the harder work of therapy? It also sets up the patient as somewhat of a victim rather than an agent in the process of therapy, like somehow the process is stacked against them before they even start. I think it’s an empowering and exciting idea to choose to get help, and it’s not special to need or seek help. The part that’s special is what you then build and work toward with your therapist.

Karen: I think that describing the decision to sign up for therapy as an overwhelming decision is fraught with the wrong kind of assumptions about folks looking for therapy. I want to relate to patients as the people that they want to become rather than assume they are overwhelmed by coming into therapy. If they are, that’s fine, and we can work with that. But, the assumption here feels like, as Heather says, sort of a lazy attempt to connect with potential patients. Therapy is definitely hard work, and I think it’s important the patients are up for that. It’s not a passive activity.

Matt: When people criticize therapy, they tend to say it’s about feeling sorry for yourself and is cast in opposition of taking responsibility. This way of speaking feeds into that. In contrast, though, going to therapy is the height of taking responsibility.

Rachael: I think we should, instead, relate to new and prospective patients with an invitation and an excitement to get to work, as well as an acknowledgement and an acceptance that they did this. They reached out for help. I’m glad the patient is looking to work, so let’s get to work.

Heather: Yes to what you said, Rachael. I like the idea that it is an invitation and an active one. Let’s get to work, let’s do it, let’s get moving!