Psychotherapy, often referred to as talk therapy, is immensly helpful to people every day. However, despite its potential benefits, many individuals feel a sense of resistance when considering or trying in psychotherapy. Not to mention, that if you struggle with anxiety, you’ll almost certainly have anxiety about starting therapy! That is completely NORMAL! Therapy resistance comes from a variety of things, including real and perceived stigma(s), a variety of common misconceptions, and personal discomfort that comes in many shapes and sizes. Part of therapy is being able to look at all sides of an issue rather than engaging in toxic positivity and "powering through" the hard. In that vein, let's take some time hold some space to address some common barriers to psychotherapy. I’ll even throw in some research that is fairly recent to address some of them directly.
Barriers to Psychotherapy:
Stigma and Social Perception: As a psychotherapist, I naturally find the lingering stigma surrounding mental health treatment frustrating. I know of its potential, of the science behind it, and of its efficacy from my own relationship with it. It is an answer that is easily accessible to many people who can’t bring themselves to engage with it even though I know it can be life changingly helpful! I think one of the felt senses that society still imposes on way too many people is one of instability – meaning “if you need therapy, you must be unstable”. Or unreliable. Or difficult. Or whatever the thing may be…. People fear judgment from friends, family, or colleagues if they are known to do therapy. As such, it can and often does discourage them from asking for or getting help. This fear of being leveled and perceived “badly” may lead to avoidance of psychotherapy despite its potential benefits (Corrigan & Watson, 2020).
Misconceptions about Psychotherapy / Who Really Needs It? Misunderstanding these things about psychotherapy can also contribute to resistance. Often, people believe that therapy is only for the severely ill and aren’t aware of its usefulness for managing the multitudes of everyday stresses that are a part of our lives: relationship issues, life stage transition, professional issues, parenting issues, and the desire for personal growth. Others may hold the caustic idea that to do therapy is to acknowledge that something is “wrong”, which in turn may come with a felt sense of “getting it wrong” – yet another potential barrier to seeking help (Swift & Greenberg, 2019).
Personal Discomfort and Vulnerability: Engaging in psychotherapy usually requires individuals to turn inward and mindfully engage with their thoughts, emotions, and experiences, which can absolutely be anxiety provoking. Fear of finally facing the “things” that may be a part of their story is often something that comes into my work with clients. Another common occurrence is the fear of letting parts of us, or our respective stories, be known by someone else. It’s terrifying and that is normal. The clients’ relationship to their work and the space that they hold with their therapist is often the key to be able to address these things safely. Let’s face it - vulnerability feels terrifying to a great many of us and often is the very thing to hinder the therapeutic process and perpetuate resistance (Kashdan & Rottenberg, 2020).
Time and Personal Commitment: Committing to psychotherapy does require time, energy, and effort – it’s true. And so many of us, with a particular nod to the single working parents, see time as a precious commodity! No doubt, I am one of them! But therapy often doesn’t take even a small portion of the time we take to watch tv or “doom scroll” in a week! The next time you’re thinking of trying psychotherapy and the idea that you “don’t have time for that!!!” Pops into your head, ask yourself: Do I really NOT have an hour to invest in myself each week? It’s most common for individuals to do one session a week, especially when just starting out.
Cost: Yep. This one is real for just about everyone. And, it is not insurmountable for a great many people. Not everyone has insurance at all, let alone a policy that provides in network benefits for psychotherapy. This is why a great many clinicians, myself included, offer a sliding scale rate. Regarding insurance, if you have a policy that does not pay for in network benefits, call your provider and ask if they pay out of network benefits. These can then be submitted for reimbursement which often pays the majority of the paid fee back to you. The truth is, it is more difficult for some than others to be able to pay for service, and, there are many who can who are unaware that they actually have the resources to facilitate treatment. **If a clinician at our practice cannot help you, please ask us for help in finding someone who can!
Efficacy of Psychotherapy: Regarding the effectiveness of psychotherapy – some of the literal mountains of research analyses conducted over decades have shown that psychotherapy is associated with significant reductions in symptoms of more common conditions such as depression, anxiety, and post-traumatic stress disorder (Cuijpers et al., 2016). Yes, you can learn to live with “it” and have a good life. And you can learn to process “it” differently with help and have an even better one!
Conclusion: A multitude of factors inform and influence how we see our world and ourself as a part of it. Needing and seeking help is so often mistaken for a deficiency and associated with feelings of being “less than” – less stable, less intelligent, less reliable, less desirable…. And if you need help, less autonomous. I invite you to be curious about therapy and what it might mean for you. If you’re one of those people who believes they can benefit and have encountered these barriers, try it as an experiment. Live the questions to get the answers for yourself as an ultimate act of autonomy! Some things you might keep in mind as someone autonomous who is trying therapy for the first time are:
You are hiring the therapist and this is ALL ABOUT YOU! If the therapeutic relationship doesn’t work for you, there is nothing stopping you from finding another therapist.
It is SO NORMAL for you to feel the way you feel about therapy - anxiety about going somewhere new, doing something different, and interacting with someone strange are normal, everyday reasons to feel that way. It would make the most sense to bring your anxiety about therapy to your first session!
You don’t have to open up and “bear your soul” the first day. Or even the second. It’s up to you to decide when it feels right! The therapist needs to earn the right to hear your story.
Best of luck on your journey, no matter where it takes you. I, or one of my colleagues would be more than happy to consult with you about our practice and how it all works. Please reach out to connect and we look forward to supporting you!
Corrigan, P. W., & Watson, A. C. (2020). Understanding the Impact of Stigma on People with Mental Illness. World Psychiatry, 19(1), 116-117.
Swift, J. K., & Greenberg, R. P. (2019). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 87(11), 971-983.
Kashdan, T. B., & Rottenberg, J. (2020). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 82, 101934.
Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., van Straten, A. (2016). The effects of psychotherapies for major depression in adults on remission, recovery, and improvement: a meta-analysis. Journal of Affective Disorders, 210, 29-42.