Barriers to Therapy

It’s normal not to want an appointment with a therapist.  When we don’t need an appointment life is good, we are happy and have fulfilling life.  The same could be said of lots of professions eg, doctors, dentists, opticians, life coaches, solicitors, mechanics etc,  yet we think nothing of making an appointment with these people.  The truth is we all need help and assistance from someone at some time. 

When life has turned upside down or has been cruel it’s often shame, denial and fear of therapy that stops us from seeking help.

Shame

Shame lets us believe we are bad, it’s inbuilt and we would do anything not to feel it. 

Shame may be expressed as:

• ‘I am incompetent / weak / stupid / inept / lazy / vulnerable / needy / horrible.’
• ‘My feelings / thoughts / wishes / needs are shameful and disgusting.’
• ‘The only way I can cope is to attack myself or others; isolate or inflate myself; freeze or shut down; submit or avoid.’
• ‘I am ashamed of who I am.’

We like to fit in, to be just like others, there is a fear of rejection if we are found out as being different.  A fear of being told to shut up, be quiet, don’t tell us about your problems / abuse / mental health / fears etc. 

The direct and indirect message received during your upbringing may have told you, you were bad, unworthy or stupid.  These messages come from a variety of sources  - home, family, peers or the media - and can be interpreted to mean, ‘I deserved the treatment I received’; ‘I must have wanted or asked for it in some way’; ‘I don’t matter’.

There may be a shame in asking for help.  How often have you heard the words ‘stand on your own two feet’; ‘stick up for yourself’; ‘pull yourself together’; so if you ask for help you are seeming to do none of these. 

Actually asking for help is a sign of strength and self respect.

Denial

Denial can be as simple as ‘it doesn’t hurt enough’.  Everyone experiences feeling uneasy or unwell and on those days think, ‘I really should make an appointment to sort that out’.  Then, life gets busy, the symptoms or unhelpful behaviour is forgotten; until a new situation triggers the uncomfortable, unhelpful and potentially debilitating symptoms.  And even then we can talk our self out of seeking help, ‘I don’t have enough time/money’; ‘I’m nervous of asking for help’; it’s not bad enough to need help’.  It’s normal for this cycle to repeat its self several times or for years before clients make an appointment.    

Denial is a natural reaction to bad experiences; ‘it didn’t happen!’  ‘It’s not so bad!’  ‘Other people are worse than me!’ ‘I’m OK, really I am!’  Denial is a wonderful way of coping, if we don’t acknowledge what’s happening we can pretend it never did.  Problems can be glaringly obvious, but with a sprinkling of denial they may go away, but that leaves an uncomfortable inner knowledge; a truth that won’t go away.  It’s not long before the original episodes affect all aspects of our life. 

Sooner or later you might notice evidence of denial through:

• Emotional difficulties (anger, frustration, submission, anxiety, panic, depression; flashbacks; nightmares; easily startled; trouble concentrating...).
• Somatic symptoms (feeling sick; emotionless; poor appetite; disturbed sleep; illness or aches and pains that GPs can’t diagnose...).
• Fear and phobic reactions (triggered by sights, sounds, smells, tastes, body positions, touching something unrelated to the original event...).
• Avoiding doing or talking about things connected with the terrible event.

The purpose of denial is to place some psychological and emotional distance between you and the trauma, so you can carry on with everyday life, to continue some sort of relationship with perpetrators or to allow society to cope with uncomfortable realities. 

You might think you can’t afford the time or money for therapy, but can you not afford not to?

Fear of Therapy

The most frightening part of therapy can be the therapy itself!  If I make an appointment:

• ‘I am going to have to talk about myself, what I have experienced, thought and done’.
• ‘My shame has prevented me from seeking help and until now I have been able to deny and pretend I’m OK, what will she think of me?’
• ‘I might become dependent on my therapist and never be able to cope on my own’.
• ‘What if I feel worse before I feel better?’

Therapy might seem scary; there is often a fear of adding to the shame or feeling stupid.  It can seem crazy to expect people to attend therapy sessions and disclose what has been denied for a very long time.  It might feel shameful to admit to hiding the truth, for not putting an end to issues and problems before now. 

You may feel uncomfortable about contacting a counsellor or psychotherapist fearing that you don’t know what to do in therapy, after all the therapist has been to ‘therapist school’ and has learned how to be with clients; there is no such school for clients, how could they know what to do. 

If you could have put an end to the discomfort you would have done it before now. 

Good therapists are aware you may feel anxious about seeking help.  It’s our responsibility to make sure you feel safe and understood.  I appreciate you may need time between making contact and starting therapy; you might have lots of questions about therapy before you feel safe to make an appointment; you may need to talk about your fears before doing any therapeutic work.  And, that’s OK. 

Extracts from clients comments about attending counselling or psychotherapy:

'What makes a good therapist, she held my hope for me when I was hopeless’.

‘For most of my life, I was terrified to go to counselling.  But I thought I probably should at some point. My childhood was, pretty dramatic at times and maybe I needed to work through some of that.  Then I got married and things started to get rough.  A friend suggested I seek counselling, and frankly, my biggest regret is I didn’t go sooner, it would have helped me so much.’

‘Yes, it was scary at first, I was nervous about what to expect but after the first session it got easier. I realised counselling was designed to help, not to make me look or feel bad.  I had become so overwhelmed by the event in my life, and therapy helped me to put my past behind me and not be afraid anymore.’

‘I was nervous at first, but that lasted all of one session. Maybe two. By the third session I was talking her ears off. Yes, I have friends I can talk to and get support from. I talk to them all the time about what’s going on and how I’m feeling. But, there’s a big difference between that and learning how to overcome the darkest moments of my life.’

‘Counselling is totally one way, and meant to be that way. The focus was on me. This is obviously different from a friendship where you listen and support each other. That may sound strange but the fact is I don’t have to worry about her and if I’m overwhelming her or spending too much time talking about myself, because that’s the point of being there.’

‘I can be 100% honest. There is no need for a filter. With a friend, I would not share the difficult times I’ve had. In counselling, I can say anything. And it helps to say those things!’

‘I decide the topics and how we spend our time, I am never pushed to talk about anything I don’t want to discuss.’

‘Being strong doesn’t mean I have to work through everything on my own. Talking to a therapist has definitely made me a stronger person.’