I was a newly minted freshman in college, with mounting anxiety over essays and tests and the lingering effects of some adolescent mental-health concerns, when I realized I could stand to benefit from therapy. But knowing and doing something about it are two different things, and it took me until the fall of junior year to actually seek out a therapist — and even then, I attended only a few sessions before giving up. Why? Simply put, I was too anxious. I was too busy and too freaked out. Every time I imagined going to therapy, I thought about all the work I could be doing instead, and all the money I couldn’t afford to spend on regular sessions.
Several years later, I’ve picked it back up again. In hindsight, I wish someone had nudged me back into therapy sooner — and I try now to be that nudge for other people. I’m not the only one whose road to therapy was potholed with excuses: According to numerous psychoanalysts, many people in need of counseling delay actively seeking treatment. Insidiously, their excuses often stem from the same issues they’d seek treatment for: I’m too depressed to leave bed, let alone haul myself to a clinic, or How can I trust someone enough to discuss my trust issues? Maybe you want to talk to someone about work anxiety, but you’re too busy with work to make it to therapy. Or you have money problems and would like to work through them with a therapist, but your insurance won’t foot the bill.
Many of these barriers are legitimate, notes Stephen Seligman, a clinical psychiatry professor at the University of California, San Francisco. The price of private therapy sessions can be prohibitive, for instance. Still, low-cost options do exist, from therapy collectives such as Open Path to therapists offering sliding-scale rates. If you need it badly enough, chances are you can find something in your price range.
Erik Gann, a psychiatrist and psychoanalyst based in San Francisco, notes that many people use practical concerns to conceal the true reasons they won’t go. “If somebody … has a physical injury or illness that’s impeding their functioning, they will somehow find a way to get it taken care of,” he says. But with therapy, the true barriers are often internal, and they don’t make that same effort to overcome them: “Either there’s some sort of anxiety about … coming to terms with something in themselves that’s [not] compatible with who they’d like to be, or their problems are so complex they don’t believe they can change.”
If you know someone who might need help, this can be extremely frustrating to watch. It’s also a great way to feel powerless, since ultimately, the only person who can overcome these internal barriers is — you guessed it — the person who’s putting them up. But still, if you’re close to that person, you might be able to get them a step closer to getting them into therapy. Here’s some therapist-approved advice about how to do this effectively.
Don’t try to force them.
“You can’t pressure someone to get into treatment,” says Suzanne Klein, a psychologist based in the Bay Area. “All you can do is try to encourage them.”
One way to do this is by bringing the conversation back to you and your own experience. If you’ve gone to therapy, Klein says, talking about it can help a person who’s considering it. “If you’ve done it, you can say, ‘Hey, I’ve done this thing, it’s really helpful for me,’” she says. “‘I see you’re struggling and I think it could help you.’”
Making it personal also has the added benefit of reducing embarrassment about going to therapy. Klein notes that despite advancements in the cultural conversation around therapy, stigma around the practice still looms. Which is a shame, because nearly everyone has some kind of issue that therapy could help. Talking about your own experience with therapy can help normalize the experience, and make someone feel less isolated in their issues. It’s the rare case in which peer pressure can actually be a force for good.
When encouraging someone to try therapy, “There’s a tendency to be cautious, euphemistic, and so on,” Seligman says, noting many of us tend to “buy into our [loved ones’] shame” around the idea of going to therapy. Rather than indulge such shame by dancing around the subject, he suggests, “try to make the optimistic assumption that if you could speak directly, though tactfully, and with care, then that might bring relief.”
This is particularly true for acute mental illnesses, he adds. If someone is going through something immediate and urgent, such as a suicidal urge, they can feel that nobody is treating it seriously if nobody confronts them directly. This will increase their isolation and likely their symptoms. Being direct, Seligman says, can “be a step, albeit a small step, towards interrupting that mind-set.”
It’s a strategy to use carefully, though. Gann cautions to be sensitive in your application of direct language, and to mediate it depending on your relationship with the individual and their issues. “With a delusional psychotic individual, I might not come on very forcefully,” he said. “Whereas with a family member whom I love, I’d say, ‘There’s no fucking way you’re going to continue like that — you need some help.’” Ultimately, the decision to suggest therapy to someone requires a pretty high level of emotional intelligence — the best you can do, Gann says, is to “tune in as well as you can to where they’re at and the difficulty they’re having.”
Frame it with care.
According to Seligman, it helps to start the conversation by letting the other person know how much you care about them, even (or maybe especially) if they’re doing something that’s causing you stress. This sounds almost trite — but too often, he says, our raw feelings of anger and hurt may cloud how we talk to them: We may shame or blame them, or simply phrase our statements without much compassion.
To do this, it helps to distance yourself from the other person for a second, and remember that they are not their mental-health issues. Picture the things you like about them in your head. Then take a few minutes and write down how you’d like to approach the conversation. Starting it off with something like, “X, I love you so much, and here are all the things I like about you” can be an effective segue.
If you want to take it to the next level, Seligman says, you can also show them you care through pragmatic acts of service, which has the added benefit of reducing the logistical hurdles. You can drive them to therapy for the first few sessions, or offer to sit with them while looking for lower-cost options. You might even suggest the two of you start therapy at the same time. After all, it can’t hurt you to go too.
Stress that they’ll have their privacy.
Many people believe that if they tell a therapist something, it’s going to get out. But if you want to keep your issues on the DL, it’s actually far safer to talk to a therapist than a friend — and it can be far more clarifying. In fact, one of the best things about therapy is that it’s the best way to be totally forward and open about what’s going on in your life without any consequences.
“With your best friend or your love or your spouse or your parent, you’re risking hurting someone, or breaking something in the relationship, if you spoke the absolute truth about everything.” Gann says. “Whereas with the therapist, the idea is that you have a boundary.” As a therapist, he explains, his clinical distance allows patients to say anything and everything to him without fear of damaging others. “I invite them to go places they cannot go in any other relationship,” he says.
If you can’t get them to go, prioritize yourself.
A while ago, I was in a relationship with a guy whose immature behavior indicated deeper emotional issues. Following one of our conversations about the damage he’d done to me, he told me he knew he needed to seek therapy and was “definitely gonna do that soon.” Then, I made my fatal mistake: I believed him.
Even after we ended things, I kept spending time him, confident he would seek help, and trusting he would reform the way he acted toward me. I even sent him the contact information of a therapist in town. After a few more weeks, I realized that he was still engaging in the exact same behaviors that he’d called out in himself — and that he’d made no progress toward seeking help. The last time we hung out, he reiterated that he needed a therapist. “I hope you get one,” I said, leaving his car without a backward glance. The next day, I deleted his contact information from my phone, unfriended him on Facebook, and unfollowed him on Twitter. We still interact sometimes, but emotionally, I keep my distance.
“At some point, you have to protect yourself,” Klein says. “You cannot force somebody else to get help.” Counterintuitively, often trying to get someone help when they are unwilling to do it for themselves just makes things much worse: Ultimately, it’s their decision,.
In fact, sometimes, breaking off contact can shock the person into seeking therapy, whether that’s to repair their relationship with you or with themselves. “Sometimes that’s the wake-up call they need,” she says.
But just remember: It’s not up to you. At the very least, setting boundaries with someone will give you peace of mind. After all, you’re the only person you can control.