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Friend or Therapist?

Updated: Feb 18


Should I Go to Therapy?

Three important points before you read the rest: (1) Therapy helps people. It can probably help you. I am pro-therapy. Some readers may interpret this article as a message to "toughen up" or to stop going to therapy—I promise that if you read carefully, that is not what I am saying. (2) If you are currently in therapy, take a deep breath. Your therapist does not secretly wish you out the door. Effective therapists have conversations about ending therapy if, in their professional opinion, you should see someone else or stop therapy altogether. (3) If you have serious intentions to hurt yourself or others, if mental or emotional problems interfere with your functioning at work or at school, or your distress has been chronic, please seek professional help.


People are surprised when I tell them that only some people need therapy. Part of their surprise, I think, is due to my occupation. I am a therapist. In fact, not only does not everyone need a therapist, but I will go a step further. For some people, staying in therapy actually does harm. Let me explain why:


Therapists are therapists.


Therapists are not friends. Therapists are not family members, or mentors, or colleagues, or ministers. This may seem obvious. Everyone knows that therapists are therapists, and not their priest or their quirky aunt Mel. However, it seems like some people forget that their therapist is not a good replacement for those people.


Sometimes you do not need a therapist. Sometimes you need a friend. Or a mother. Or a pastor. Or a mentor. Or a quirky aunt Mel. So, how can you tell when you need one or the other?


Friend


Friendship has existed as long as humans have. We gravitate towards other people. Friends are well suited for the pains and strains and insanes of everyday life. Social connectedness is highly correlated with well-being and health.[1] In contrast, social isolation is highly correlated with mortality.[2] Social support is so important that it protects us against death, either through disease or suicide! Building friendships is crucial to your wellbeing. Friends are important and they have taken us pretty far.


Which is why seeking therapy can do harm. If you are feeling sad or anxious about something that would make any healthy person sad or anxious—you do not need therapy (at least, not for that particular issue). If you do seek a therapist instead of a friend, you are missing the opportunity to build intimate social connections. Importantly, your friends will be around longer than your therapist, and will help keep you healthy long after your therapist is gone.


Of course, therapists can provide empathy and support during those times. If you are already in

therapy, it makes sense to talk about those events. However, if your sadness lessens with time,

or your anxiety resolves after the stressful event, you don’t necessarily need therapy for that.


So…when do you need therapy?


Therapist


We can contrast therapy with the role of friends. Whereas friends last forever (as the song goes) and are well suited for discrete, tolerable levels of distress, therapists exist for a distinct season and are well suited for chronic, debilitating levels of distress. An example may help.


Sally (this is not a real person but a fictional conglomerate of many people) was born and raised in the Midwest. Unfortunately, she lost her mother to cancer a couple of years ago. She still finds it difficult to go to work, stopped exercising regularly, and does not enjoy going to concerts, which is something she used to enjoy quite a bit. Sally has not gone on a date for several months, although she used to value having a family and enjoyed casual dating for the interesting (and sometimes disastrous) stories she could share with friends. It feels to her like something shifted. Something inside her changed course.


Sally could use a therapist. She experienced a loss and experienced deep sadness. This is healthy and normal. However, her grief continues to affect her daily functioning (e.g., hard to go to work) and interferes with her long-term values (e.g., pursuing a family) longer than expected, given what is expected in her culture.


What if things were different for Sally? If she lost her mother and felt very sad, but was able to function in her daily life, find support from friends, and enjoy what she used to enjoy, she would not need a therapist. She might still feel sad at anniversaries, the holidays, or when something reminds her of her mother—those are common and expected (though unpredictable). If she did not know whether her reactions were common, she could talk with friends, mentors, or other trusted people to figure this out.


Hospital


This does not make for much of a title (i.e., “Friends, Therapist, or Hospital?”), but it is necessary to include. Just like a therapist is not a friend (and vice versa), so too is a therapist not a hospital. Hospitals can assess for risk in the middle of the night, attend to medical needs (e.g., if pills or bleeding are involved), and keep watch until the emergency has passed.


If you or someone you know is in serious risk for harming themselves, call 911 or go to the nearest Emergency Department at a hospital. Do something to stay safe. "Serious risk" may include making a suicide attempt, writing a suicide note, gathering the means (e.g., pills, gun) to end one’s life, or comments about intending to attempt suicide made while intoxicated. This is not a comprehensive list of indicators of an emergency—these are just examples of situations in which you should definitely call someone for help.


Not everyone needs therapy, but some do. Thoughts and feelings can interfere with our lives and therapy can often help. Contact my office if you think therapy would be helpful. I can also help you decide if therapy is right for you. If you are unsure what to do, the best thing is usually to contact a professional.[1]

Take good care of yourself. Sometimes this means going to therapy. Sometimes it means talking with a friend. Hopefully, this helps you decide.



[1] Though some people care so much about relationships that anxiety about others' judgments becomes a presenting issue in therapy (i.e., social anxiety).

[2] http://science.sciencemag.org/content/241/4865/540

[3] Please note: I am not available for emergency consults and nothing in this article qualifies as my professional opinion about your specific situation. Always seek an available, appropriate professional when needed.


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