Therapy Isn’t Just for a Crisis: Why You Should Start Before You Break

I am a bit of a personal finance junkie.  Recently, I was listening to a podcast that featured two financial planners who specialize in “crisis debt management”.  They were swapping stories about the most extreme call for help that they have ever received, and one of them recalled a couple who contacted him the day after they received a foreclosure notice, asking what they could do to retain their home.  He gave them a very honest answer, “Nothing”.  If they had called him 12 months, or even six months, before the foreclosure was filed, he may have been able to help them keep their home.  “When you call me the day after you get the foreclosure notice, I can help guide you to an outcome, but I can’t guide you to that outcome.”  I found myself sitting at a red light and nodding my head as he shared this bit of wisdom.  I may have said “preach” out loud.

Sometimes, it can be very hard to determine when to reach out for help and support, and, unlike finances, mental health issues rarely present with a clear indicator of an impending crisis.  Most of us would agree that the best time to reach out for guidance about diverting a foreclosure is the first time you get notice of a missed payment from the bank.  The second-best time would be when you get the follow-up notice of missed payment.  Unfortunately, mental health does not work that way, and many of us delay seeking treatment until there is some type of acute crisis.  As a mental health professional, I would never discourage anyone from seeking therapy in a crisis.  I would rather have someone enter my treatment room in a crisis state than not enter it at all; however, crisis mode can limit the options that are available to any therapist when working with a client who is seeking the outcome, not an outcome. 

Sometimes, avenues that may have been open six or 12 months before the start of therapy may have simply been cut off before the first appointment is even made. At a recent training on safety planning, the moderator, who works at a community mental health center, shared that the number of clients she has referred to inpatient treatment after the first appointment has increased exponentially in the past six years. This is largely due to people delaying treatment out of fear of being “forced” to take psychotropic medication.  Many of her new clients only come to therapy when they reach the point of experiencing active suicidal ideation or intrusive thoughts about harming other people. Once this threshold has been reached, her options are limited, and she has an ethical and legal obligation to pursue inpatient care without their consent, which often involves medication.  Earlier intervention can sometimes divert this higher level of care, or at least give the client more agency in deciding where they go for treatment and which medications they take. 

As someone who works in private practice, I rarely encounter this exact situation, but there is a small segment of my client base who come to their first session experiencing a mental health crisis that does necessitate a higher level of care. These individuals do not meet the standard for involuntary commitment, but their issues and symptoms suggest that they need more support than one or two outpatient sessions a week can provide. Referral to a higher level of treatment is often the outcome they feared, so they avoided seeking help as long as possible, only to learn that inpatient care or an intensive outpatient program is their only immediate option. 

Usually, the consequences of delaying therapy are less serious and less direct, but they can still be disruptive and painful. When I first meet with new clients, many of them express that the issues they have been struggling with “don’t seem serious enough for therapy”. They then proceed to tell me about the death of a parent, a divorce, a fight with their partner that turned physical, a trip to the grocery store that ended with getting robbed at gunpoint in the parking lot, a plane crash that they survived when they were 20, or non-consensual sexual contact that happened on a first date in college.  Sometimes, they have been carrying these experiences for years, even decades, ruminating on them, living with them, and treating them like a defining piece of who they are. When they finally seek therapy, it is often because “nothing else worked”.  When they start to experience relief and healing, they express regret at not getting therapy sooner. These sessions leave me with a deep sense of professional sadness and sometimes a resentment that there is no designated organization that sends out “got to therapy” orders the way banks issue foreclosure notices.  Wouldn’t it be nice? 

Ultimately, the decision of when to seek therapy is deeply personal and dependent on a variety of factors, values, beliefs, and expectations.  The delays in getting help can be financial, ideological, social, or systemic. Sometimes, the barriers are just internal, and they fall when they fall.  Whatever the reason, delays can have significant personal costs and limit a client’s choices.  When is the best time to reach out to a therapist?  Probably the first time you ask yourself, “Should I talk to someone about this?”

Written by: Deanna Diamond, LPC