Blog No.2 - 7 Reasons Why People Decide Against Therapy

Before I started therapy, I came up with an elaborate cover story as to why I was doing it.

At the time I was studying for a MSc in Sports Psychology and I was able to attach therapy to a ‘personal development’ module. Perfect. No need to tell people the truth (I wasn’t very happy) and I didn’t have to keep it a secret. Looking back, I probably would have tried it a few years earlier if I had not been scared about other people’s perceptions. This may or may not apply to you and there are plenty of other reasons for consigning therapy to the list of things that you will do at some point. Probably.

It’s certainly possible that now might not be the right time for therapy, but this list will hopefully help you evaluate your own reasoning and help you make an informed decision.

1. ‘I don’t think it works’

In short, it does work! The research literature has consistently demonstrated this and talking therapies would not be offered on the NHS unless there was clear evidence of effectiveness.

Although a range of therapies have been shown to work in large high quality research trials, there is no doubt that there can be significant variability in terms of the quality of therapy offered by different therapists, plus some approaches are more or less suited to particular problems or concerns. In short, if you can find the right therapist, offering an approach that suits your needs, it has the potential to make a significant difference to your quality of life.

Talking therapies don’t purport to be miracle cures and you are also going to need to invest in time and energy in the process for it to work. If you start thinking that one or two sessions is going to be transformative experience then you are heading for disappointment.  Lasting change at an emotional level (not just thinking differently, but feeling differently about yourself) doesn’t happen overnight so you need to have realistic expectations of what is achievable in a given timeframe. Up to six sessions, is going to be primarily supportive and focused on your immediate needs and circumstances (a nice injection of compassion and direction during a challenging time). Sixteen or more sessions is likely that therapy is going to focus with underlying patterns or issues (the chance to get under the bonnet and make some lasting changes).

2. ‘My problems aren’t serious enough’

Many of the people I come into contact with through Headroom, don’t feel like their concerns are at the threshold for being suitable for therapy. This view is often connected to the idea that therapy is predominantly for ‘people with mental illnesses’ or a psychiatric diagnosis. These unhelpful categorisations promote an ‘us/them’ view of psychological distress which a growing number of prominent academics are starting to question because psychiatric categorisations lack scientific validity and reliability. I defy any adult human who claims to not have struggled to with a tricky dilemma, or wondered if they could be leading a happier or more fulfilling life, or had difficulties in relationships. Regardless of how you want to label the human experience of ‘depression’, ‘worry’ or ‘distress’, therapy can help you navigate the challenges of life however ‘big’ or ‘small’ you perceive them to be.

I also often hear people say things like ‘there are lots of people in a worse position than me’ which is undoubtedly true for most of us. That doesn’t mean that you are not entitled to explore the possibility that your life could be better. Furthermore, not seeing your own needs as significant is common experience that in many cases, becomes an important theme of therapeutic work.

3. ‘It’s too expensive’

There is no getting away from the fact that it is not cheap and if spending the majority of your disposable income on therapy has a significant impact on other areas of your life then it makes sense to think carefully about the costs and benefits. For some, it may well make sense to wait until they have saved some money or their financial circumstances mean that the cost of therapy is more manageable.

As well as budgeting and thinking about costs, it also worth spending a few minutes considering what you’ll get from therapy: it could lead to meaningful and lasting changes that make your daily experience of the the world, relationships and yourself a whole lot better. Imagine generally feeling pretty good, being relinquished of guilt, anger or shame and more able to use your best qualities to help the people you care about lead better lives themselves. Probably worth spending a few quid on.

When making claims about therapy that might sound a bit grandiose, it is important to say that the process is often not straightforward and you are not passive recipient of words that will magically change your world. It can be hard work breaking down unwanted habits and reforming unhelpful beliefs. A therapist is the facilitator and you, as the active agent of change, get to own and celebrate the results. But it’s not always easy.

4. ‘I’ve had therapy before and it didn’t make any difference’

Unfortunately, this is an all too common experience but this does not mean that therapy isn’t going to be of use to you in the future. One of the main problems with the way the private psychotherapy market is set up, is that people often select a therapist and approach with limited guidance. Differences in the training, experience and aptitude of therapists can be difficult to evaluate and there are 50+ different approaches which are more or less suited to different goals and problem types.

It’s a clumsy analogy, but you wouldn’t take your car into the garage and then buy parts based on what you thought might be wrong. You would ask them to use their expertise to establish what the issue is and make some recommendations for what was likely to lead to the best outcome. The same principle applies to talking therapies. You need a good assessment provided by someone impartial with the right training and experience who can point you in the right direction.

In short, it is not surprising that not many people find themselves sat across from a therapist whose approach and style doesn’t work for them.

5. ‘I’m pretty good at solving problems already so what can a therapist going to add?’

A rationale more frequently, but not exclusively, offered by men. It is an argument that does make sense to a degree. If you are reading this, there is a decent chance you have got this far in life without therapy, and you have probably dealt with some pretty difficult circumstances along the way. You might also be brilliant at troubleshooting at work or helping other people with their problems. Why not just turn the gaze inwards and be your own therapist? To some extent this is what most of us do by learning from the past and using our experience to make better decisions and build a better future. Therapy doesn’t sweep all of that away, but instead offers an opportunity to maximise the learning from what has come before and make best use of  the unique experience we all have.

There is also a big difference between a thinking by ourselves and thinking about ourselves with someone who is listening thoughtfully and responding carefully. Hearing a dilemma subtly reframed or being gently encouraged to focus on a neglected area of your life can be surprisingly powerful, and we all have blind spots or topics we avoid. Throw into to this, the fact that a therapist sits outside of your usual sphere and you have a quality of dialogue that can feel very different to the conversations you have in other contexts (in a good way). When was the last time you had an hour talking to someone where the focus was solely you and your wellbeing?

6. Starting therapy can symbolise a commitment to change. Change can be hard.

It’s not normally a reason that people give for not starting therapy, but with my psychologist’s monocle in, I know that starting therapy is in itself a significant acknowledgement that you want something to be different: before you walk into your first therapy session, on some level you have made a decision to do something, if even if you are not sure whether therapy is going to help or if indeed, change is possible.

Accordingly, people often don’t start therapy because they have mixed feelings about change and the consequences that might come with it, particularly in respect to relationships. After all, if you are starting a process that might lead to shifts in your attitudes and expectations of the people close to you, that can be easily feel a bit overwhelming. No thanks. Lets not rock the boat.

7. ‘Starting therapy feels like I’ve failed.’

Striving for a better life is something we all do, but some of us are more proactive than others. People who try therapy are definitely in the proactive camp. It might feel like an acknowledgement of some kind of shortcoming, but starting therapy is, in my view the exact opposite. It demonstrates a commitment to yourself, the people you care about and to a better life.