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Treatment for Depression: Finding a Therapist

11/4/2015

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I know that what I’m about to address does not represent a scientific treatise.  It’s strictly anecdotal, but it begs examination.  Namely, the frequency of people – prospective clients – who seek out a therapist but subsequently bail out after one or two…… or no sessions, often without a word or behind somewhat transparent explanations.  What scares people away from a potentially positive growth experience?  (No, it’s not me.  It happens to my colleagues as well.)  We in the field are well aware that there exist different “stages” of readiness to change, to examine oneself.  The most prominent model describes 6 Stages of Change ranging from Precontemplation to Contemplation to Preparation to Action to Maintenance (Prochaska & DiClementi, 1977).  The decision to change, more specifically, to find a professional to help you pursue change can be daunting.  It often involves a dance – a series of approach / withdraw actions which eventually leads to picking up the phone and making the call.  There is also a burgeoning body of research literature on early termination.  Countless studies look at the whys and wherefores of clients pulling out of an ongoing therapy regimen before goals have been reached.  Reasons abound from ethnic and cultural issues to breaches of the therapeutic alliance to financial issues.  So we, as professionals, are provided reams of research woven into our training which explain how to raise our awareness of the various factors that drive clients away from therapy.

But what about clients who approach enthusiastically, who are inquisitive, open and engaged only to cancel abruptly or to disappear without so much as a returned phone call?  I know that there are countless extenuating circumstances that can arise.  My curiosity stems from my observation – limited as it may be – that there seems to have been a spike in such clients as of late.  I’m going to be looking for some feedback on this in a moment, but first I’d like to offer my own theory.  I propose that people are on some level….. for lack of a better word….. afraid of therapists (synonyms: counselors, social workers, life coaches).  There have been many occasions, after an initial introduction at a social gathering, that a potential new friend being advised of my profession will ask, “So you’re going to be analyzing me all night?”  (The answer will always be “No”)  As mentioned above, the process can be daunting, but whence the fear?  I suggest 3 essential elements:
1.  Stigma.   Despite the relative popularity of the Self Help and Wellness paradigms in our culture, the idea of needing help to maintain or restore mental/emotional wellness still has a stigma attached to it, a remnant of the cultural discourse of “Mental Illness”.  We value mental health, but devalue those for whom it doesn’t come easily.
2.  Perceived Authority.   Therapy, by and large ends up being a collaborative, warm process.  For many who have not experienced it, the expectation is shrouded in the image of the cold, detached Freudian psychoanalyst taking copious notes but not really relating.  There is an assumption that we professionals somehow know the client’s lived experience better than the client and will be all too willing to judge it on that basis.
3.  Fear of Change.  Simply put, we tend to become comfortable in our established “systems”.  That is, we get used to the way things are done even if things are done badly.  It’s often easier to stay in our habits, our compulsions, our addictions, our maladaptive relationships than to beat a new path.  “What if I change but nobody changes with me?”  It’s a valid concern.
So I now put it to my readers.  Have you ever struggled with any of these issues?  Have you shied away from a potential growth experience?  I invite you to share your thoughts and experiences here.  Don’t be afraid.
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    Portrait Health Centers Specializing in Diagnosing and Treating Depression, Attention Deficit Disorders, Nutritional Needs, and Learning Differences in Children, Adults & Seniors

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