Barriers to therapy

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Barriers to Seeking Therapy

 One of my passions as a therapist is destigmatizing therapy and helping more people access mental health services. Growing up and        throughout my career, I have heard a range of thoughts and opinions about therapy. But study after study shows that mental health services are way underutilized. In the wake of national tragedies such as Sandy Hook or Aurora, we often ask why wasn’t more done or why the people didn’t seek out help. While there are many answers to these questions, which over time I hope to examine at some point, I think the answers first start by examining our own attitudes and reasons for or for not seeking out our own therapy. I am struck by how many people don’t believe in therapy or may believe in the importance of therapy on a broad level but not on an individual level. I am of the opinion that everyone could benefit from counseling – I haven’t met any perfect or completely content people!

So, I did some informal polling to ask people what prevents them, or people they know, to seek out therapy. I got a lot of responses and boiled them down to five categories: finances, time, stigma, pride, and hopelessness. So for the next two posts, I will address these issues. At the end of the month, I want to look a little deeper to see if there is a common denominator underlying these five categories. Today, I will address finances and time since they both seem more like external constraints.

 

1)            Finances: After being a student for many years, I completely understand trying to live within a budget, especially in our current economic climate! For many people, the idea of spending money on therapy seems like a luxury. While this is a little uncommon for me, let me throw some data and research at ya! The National Institute of Mental Health (http://www.nimh.nih.gov/statistics/4TOT_MC9606.shtml) reported that in 2006 mental health issues tied for third (tying with cancer) as the most expensive medical conditions averaging 57.5 BILLION dollars in expenditures! Those with mental health problems are at higher risk for physical health conditions, needing sick leave, unemployment, and other indirect costs. One study (Wang, et. al, 2005 http://www.ncbi.nlm.nih.gov/pubmed/15939840) found that only 41.5% of people with diagnosable mental health disorder received treatment within the past year. What that tells me is that many people are not seeking treatment for mental health problems and that is actually costing them and our country a ton of money!

I do understand that on a day-to-day basis therapy can seem expensive when bills are piling up. Depending on using insurance or not, level of education and experience of the therapist, geography, severity of problems, reason for referral, and a whole lot of other reasons, therapy can range from $0-$500+ a session. In many major cities, there are community mental health agencies or other low cost agencies, and often therapists often low cost or sliding scale fees.  Universities are also a great resource as most have counseling centers for students and many have community clinics. So therapy might not be as expensive as you might think!

However, it is important to note that in some cases you might get what you pay for. Obviously, there are wonderful therapists out there working at community agencies, but many are training sites. Now, I have worked many years as a trainee in university counseling centers, residential facilities, and community mental health centers and fully support training. Depending on level of severity of your issues, this is probably a good option for you. However, if you are struggling with more severe issues such as suicidal thoughts, transitioning from in-patient care, heavy substance abuse, etc. it might be a good idea to do some more research to determine the appropriate setting. Some places have session limits or may not have therapists that would match your needs. Also, insurances require some information about your diagnoses and progress thus limiting your confidentiality. You should determine what things are important for your therapy and your therapist to possess. Do you want someone with a lot of experience or a certain degree? Do you want someone with a certain philosophy towards therapy? Do you want to use your insurance? And finally, how much am I comfortable paying? When meeting with a new therapist, it is important to talk to the therapist about these issues to make sure that the therapist is a good fit for your needs. I raise these issues so that you are aware and don’t just make a decision based on cost. Overall, cost may seem like a huge barrier, but there are resources out there – it just may take a little more effort to find something that matches your financial and personal needs.

 

2)            Time: Many people complain about not having enough time, myself included! Let’s do a little math together… Say you sleep 8 hours a day (good for you if you are able to do this!) and work 9 hours a day. That leaves you 7 hours of time to fill with your life, which is 35 hours a week, not including weekends. Therapy requires just 1 hour of that time. When I do that with clients, many are amazed to think that they have 7 hours a day because it sure doesn’t feel like it. Then, it becomes figuring out what you are spending your time on. I often have clients keep a pretty detailed schedule of a typical week and write out all their activities, including sleeping, eating, driving, working, playing with kids, watching TV, etc. Then, we look at it to see what is a priority and how to best maximize your time to include a balance between productivity and rest. So, I would argue that it is more about priorities than time. Is your mental health a priority to you? Furthermore, do you value yourself enough to give an hour of your time to yourself? We give so much of ourselves for our friends, family, work, etc. that we often forget ourselves, or worse we feel selfish if we take time for ourselves. I often think of ourselves as cups giving parts of ourselves to others. However, if give so much without replenishing ourselves than we run ourselves dry and have nothing to give. If you don’t take care of yourselves, then you can’t take care of others or other important aspects of your life. Therapy is that opportunity to fill your cup!

 

Overall, money and time are what I would characterize external demands because they are pressures that are outside of ourselves. However, they can often dictate what we do or don’t do. I’ve always been taught that where you spend your money and time shows where your heart and priorities are. So take a minute and look at your time and finances and see where your heart and priorities lie. Next week, we will look at more internal reasons people don’t seek therapy – stigma, pride, and hopelessness. Today, I want to leave you with a little quote about self-care, which I would say therapy falls into, that a friend of mine shared.

Self-care is not selfish or indulgent. Self-care is essential for healthy relationships with the people we care about most – we cannot nurture others from a place of exhaustion or one of resentment. When we nurture others from a place of fullness, we feel renewed instead of taken advantage of, and our loved ones also feel renewed instead of feeling guilty. We are able to offer gifts to others when we empower and care for ourselves.” ~Angie Gooding