Mental Health and Therapy: Who Needs Therapy and Questions to Ask them

A few weeks ago, a fellow therapist on a WhatsApp group I’m a part of posted the following: ‘43-year-old female looking for a therapist. She’s very particular that she doesn’t want to do any worksheets or relaxation exercises. Looking for someone to help her through a work-related issue.’ I found this request for a therapist quite intriguing. Two key things about mental health and therapy can be drawn from this message: 

• Therapists have different ‘styles’, or what we call in psychology language, ‘theoretical orientations’. While some therapists may focus on childhood experiences, others may focus more on core beliefs and thoughts. Some therapists may focus more on coping mechanisms and strategies, while others may focus on insight and awareness. Different orientations may have different ways, but the goal of therapy remains the same - to help you become more self-aware and learn to navigate life’s ups and downs in a healthy way.  
• One can seek therapy for a variety of concerns, and not just when they suspect having a clinical mental “illness”. There are many situations in life which can make us feel distressed, stressed, anxious or overwhelmed. Psychotherapy helps us cope with emotional distress, learn strategies to deal with challenging times, and become more self-aware so that we’re better equipped for the future.   

Who Needs Therapy? 

I grew up at a time when seeing a mental health professional was a recourse only for those who had debilitating mental illness. It was only when someone would be unable to manage their day-to-day life and responsibilities that you’d consider getting professional help. There was extreme stigma and taboo around mental health, and this kept many people from reaping the benefits of therapy. 

As the message above illustrates, one can benefit from therapy for a variety of concerns. These include: 

• relationship issues 
• workplace stress 
• lack of motivation
• low self-esteem or low self-confidence
• perfectionist tendencies that impact one’s work or relationships
• life transitions such as divorce or childbirth
• sickness, or loss of a loved one 
• moving to a new city or country 

These are all good reasons to get therapy. They are psychosocial issues - challenging life events that can take us off course, and exceed our capacity to cope. There are many events that can make us feel overwhelmed. These issues may be related to work, our family or culture we’re born in, life stage, and even physical health issues. Some of these things - like entering adulthood and going through physical changes associated with age - happen to everyone. Some psychosocial issues may be unique to the individual. Nonetheless, everyone goes through some challenges that come from the social setting we are a part of, that therapy can help navigate. 

Sometimes, we may have clear symptoms that call for professional mental health help. Some common symptoms of poor mental health are: 

• sleeping too much or too little, or more or less than usual 
• not enjoying things you enjoyed previously 
• compulsive habits or obsessive thoughts. For example, washing hands excessively, checking the door lock multiple times, fearing something bad will happen if you don’t follow a daily ritual 
• having trouble focusing on tasks. For example, getting easily distracted, having trouble starting a task, or not being able to concentrate and feeling restless once you start 
• feeling irritable, angry, or sad more than usual 
• eating too much or too little, or being overly concerned with one’s diet or health 
• social withdrawal, or not wanting to hang out with friends and family anymore 

Different mental health professionals can help with different types of concerns you may have. For example, 

• a counselling psychologist can help you navigate life transitions by providing you with a space to understand your feelings and thoughts and learn effective coping mechanisms. 
• A clinical psychologist can conduct diagnostic evaluations and offer a treatment plan that will help you with strategies to manage your symptoms, as well as track progress. 
• A psychiatrist steps in when medication may be needed. You can read more about the different types of mental health professionals and their scope of work, here. 

What Kind of Therapy Do You Need?

Let’s go back to the referral request above: “She’s very particular that she doesn’t want to do any worksheets or relaxation exercises.” Some people prefer conversation over paperwork in therapy, and perhaps she wanted someone who would talk her through the issue. While some people find worksheets and relaxation exercises helpful, others may not be in a place to follow through with the activities. And that’s okay!  

It’s helpful to know what type of therapy would be most appropriate for you and the kind of concern you have at the moment. While there are many evidence-based treatments therapists offer, theoretical orientations can broadly be divided into the following:   

• Cognitive Behavioural Therapy or CBT

CBT is a common therapy modality based on the premise that our thoughts impact how we behave and how we feel. A CBT therapist, then, will be very interested in the way you think about yourself and the world around you. They’ll be looking for negative statements you tend to repeat to yourself, like, ‘I’m not a good judge of people’, and help you reframe these statements so that you can cultivate a more positive relationship with yourself. A CBT therapist will also help you identify biases or ‘thinking traps’ that might be impacting your mental wellbeing. The goal of CBT is to help you identify the core beliefs that may be behind these negative thoughts, understand where and how these beliefs originated, and help you change these beliefs to more healthy ones. CBT therapy tends to involve worksheets and homework. 

• Psychoanalytic & Psychodynamic Therapy 

Psychoanalytic and psychodynamic therapies are based on the premise that we have an unconscious which impacts our behaviour. This unconscious is impacted by our childhood experiences. Our experiences with our caregivers shape the way we look at ourselves, others, our relationships, and the world at large. We may not always be aware of these lessons that become a part of our personality. Sometimes, these lessons may make it difficult for us to navigate situations as adults. Psychoanalytic and psychodynamic therapy helps us become aware of these, and through insight, we can learn better ways of relating to ourselves and others.    

• Humanistic or Person-Centered Therapy 

Humanistic or person-centered therapy is based on the idea that every individual is naturally inclined to fulfill their potential. It is believed that we all instinctively know what’s best for us, and under ideal circumstances, we will organically make choices that are healthy for us. We develop unhealthy behaviours or thoughts because we haven’t had or don’t have the right conditions that can allow us to live in a way that’s true to us. An example of this is learning methods followed in schools. Some children struggle academically because of the rigid and rote environment seen in schools. Humanistic thinkers lean towards more flexible and playful ways of learning and teaching because this will allow the child to tap into their inner creativity.  The goal of humanistic or person-centered therapy is to identify and remove the obstacles that prevent us from listening to our own inner voice. The therapist trusts the person seeking therapy to be the expert of their own life. 

• Some therapists may use an eclectic approach where they draw from different orientations. For example, they may help you identify patterns you’re carrying from your childhood, and they may also draw from CBT to help you reframe your thoughts and beliefs. They may draw from person-centered thinking and help you think creatively about what’s best for you, while also offering you some relaxation techniques.  

When you reach out to a therapist, use this as your guide to understand their style. It’s important to have some clarity about the process and expectations right at the start. When reaching out to a mental health provider, do ask the following questions: 

1. What school of thought or orientation do you follow?
2. How can your approach to therapy help me with my current concern? 
3. How often do you recommend meeting?
4. How long is each session? 
5. Do you offer brief therapy or long-term work? 
6. What’s your cancellation and rescheduling policy? 
7. What if I’m not happy with the sessions? 

Do keep in mind that your rapport and the quality of the relationship you have with your therapist is of utmost importance. A good therapeautic relationship has three elements:

• It is collaborative, and both you and your therapist work together 
• You share an emotional bond and feel safe with your therapist
• You agree on the goals and method of therapy 

Your therapist will be someone you’ll share your deepest secrets and fears with. It’s crucial that you feel comfortable and safe with them. Whichever theoretical orientation your therapist may bring to the table is more effective when you share a strong relationship. Sometimes, it takes a bit of hopping around to find the right fit. So, if the first therapist you reach out to doesn’t work out, try out a few more therapists. Ask them the questions we discussed above, and give it a few sessions to see if you’re able to build a good rapport. One last thing to keep in mind: Sometimes, it helps to give your therapist feedback and tell them what you need. For example, if you want them to ask you more questions in the beginning, it’s okay to tell them that! 

References: 

American Psychological Association. (2009). Different approaches to psychotherapy. Apa.org; American Psychological Association. https://www.apa.org/topics/psychotherapy/approaches

American Psychological Association. (2017). What is cognitive behavioral therapy? American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

Chu, S.-Y., Lin, C.-W., Lin, M.-J., & Wen, C.-C. (2018). Psychosocial issues discovered through reflective group dialogue between medical students. BMC Medical Education, 18(1). https://doi.org/10.1186/s12909-017-1114-x

Stubbe, D. E. (2018). The Therapeutic Alliance: the Fundamental Element of Psychotherapy. FOCUS, 16(4), 402–403. https://doi.org/10.1176/appi.focus.20180022 

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