Is It Time to Start (Or Go Back To) Therapy?
Deciding to start therapy, whether you’ve been in therapy before or are brand new to it, is a personal choice
Deciding to start therapy, whether you’ve been in therapy before or are brand new to it, is a personal choice. While the thought of starting therapy can be an easy decision for some of us, for others, it may require a long thought process. There may be moments when we expect to feel fully ready for therapy, and this may be a prerequisite for starting it. Although there will never be a perfect time to start, only we know when the right time is for us. Typically, there are signs, changes, or experiences that we encounter, which may indicate that it is time to begin therapy. Several studies highlighted the role of internal motivators in the decision to start therapy. These internal factors often revolve around the recognition of personal difficulties or distress that individuals feel unable to manage on their own. Nakash et al. (2018) found that emotional distress and other psychiatric symptoms were among the most prevalent reasons for initiating therapy. The studies also highlight the importance of external and social influences in the decision to start therapy. We may observe these experiences in the following areas of our lives, such as Internal signs (emotions, cognitions, or bodily), social/relational factors, occupational factors, and experiences (e.g., traumas, changes).
Internal Signs: Our body can be a significant indicator that we may need extra support from a mental health therapist. Wells et al. (2020) identified “making sense of experience” as a key theme, suggesting that individuals seek therapy to understand and manage their internal signs. These signs can be emotional, cognitive, or physical. Here are examples for each domain:
Emotional: Feeling sad, nervous, angry, irritable, hopeless, or apathetic.
Cognitive: Losing focus, difficulty concentrating, having intrusive thoughts, or being forgetful.
Physical: Feeling drained or exhausted, chronic headaches, stomach problems.
Social/Relational Factors: While we are better equipped to recognize our internalizing symptoms, our peers (e.g., friends, partners, and family) are often better equipped to notice our externalizing symptoms. Kadushin’s research (1958) identified “being told by others” as one of the typical ways individuals recognize they have a problem that may require therapy. Our social relationships can pick up on things like:
Mood swings, outbursts, or lashing out
Substance use
Hygiene
Canceled plans
Self-isolation
Risk taking
Arguments or fights with loved ones
Also, people can seek therapy (e.g., couples therapy and family therapy) for relationship difficulties directly. Doss et al. (2004) found that problematic communication and lack of emotional affection were the most common reasons for seeking couples therapy.
Occupational Factors: Work can be another predictor for our mental health and whether it is time to see a therapist. These cues can include excessive stress, increased workload, burnout, or difficulty concentrating. Like our peers, colleagues, and supervisors, we can also pick up on signs that inform us it may be time to start therapy. Our colleagues may pick up on our:
Tardiness and attendance
Disorganization
Outward manifestation of stress
Completion of tasks
Overall performance
Experiences: Whether we are externalizing or internalizing our symptoms, different life experiences we encompass may be impactful enough for us to consider initiating therapy. This can include events like:
Breakups or divorce
Loss of friends
Death of a loved one or grief
Pregnancies, abortions, miscarriages, and births of children
Changes or clearer understandings of identity
Unprocessed or newly experienced traumas
Loss or changes in employment
Other unexpected life changes or stressful events
Readiness for Change
According to Moore et al.’s study (2013), the decision to begin therapy is influenced by a complex interaction of personal distress levels and external factors. However, even though we show internal signs, social/relational and occupational factors, and different life experiences that deeply affect us, we may still postpone our decision to start therapy or have questions in mind. The key point that affects our decision to begin therapy is “readiness for change.”
According to Procheska (1984), the concept of “readiness for change” refers to an individual's willingness, motivation, and preparedness to make a behavioral change. This readiness depends on the individual's stage of change. The model defines change as a process that progresses over time, rather than as something that occurs all at once.
Precontemplation: In this stage, we are not aware of the need for change, and consequently, we do not take any action for change.
Contemplation: In this stage, we are aware of the signs and consider changing something, but we are still not ready to take any action to change
Preparation: In this stage, we take small steps towards change and are willing to make adjustments.
Action: In this stage, we take concrete and observable steps towards change, which are evident in our behaviors.
Maintenance: In this stage, we aim to maintain change and prevent the relapse of old, non-functional behaviors.
The stage we are in can affect our decision to begin therapy. However, this does not mean that being at a certain stage is a prerequisite for starting therapy. Therapy aims to support us to the next stage with interventions appropriate to the stage we are in. In other words, readiness is not something fixed; it can increase or decrease throughout the process, and therapy itself can support it. “Readiness for change” highlights our willingness, motivation, and readiness to change our behavior. This process is unique for everyone and can be a significant factor to consider when starting therapy. If you have a few questions in mind, here are some quick answers to help you if you're considering starting therapy.
FAQs
Do I need to have my trauma or symptoms figured out before starting therapy?
No, your therapist will work with you to find a starting point and develop a plan to unpack your presenting problems.
Is therapy right for me?
Anyone can benefit from therapy. However, therapy is a commitment, and it’s important that you are ready to make that commitment.
Does therapy work?
Yes, research and client reports have shown that therapy is beneficial and helps people overcome mental health problems. However, commitment, readiness, and a belief that change is possible are necessary for therapy to work.
Take aways
Initiating therapy is a personal choice, and only you know when the time is right for you to start therapy.
Signs it’s time for you to start therapy include changes in mood, loss of joy, excessive stress, or fatigue, engaging in substance use or risky behaviors, changes in productivity, conflict with loved ones, and stressful life experiences
Therapy works, and anyone can benefit from treatment; however, readiness for change is crucial.
References
Nakash O, Cohen M, Nagar M. "Why Come for Treatment?" Clients' and Therapists' Accounts of the Presenting Problems When Seeking Mental Health Care. Qual Health Res. 2018 May;28(6):916-926. doi: 10.1177/1049732318756302. Epub 2018 Feb 7. PMID: 29415635.
Wells, H., Crowe, M., & Inder, M. (2020). Why people choose to participate in psychotherapy for depression: A qualitative study. Journal of Psychiatric and Mental Health Nursing, 27(5), 566–575. https://doi.org/10.1111/jpm.12603
Kadushin, C. (1958). Individual decisions to undertake psychotherapy. Administrative Science Quarterly, 379-411.
Doss, B. D., Simpson, L. E., & Christensen, A. (2004). Why do couples seek marital therapy? Professional Psychology: Research and Practice, 35(6), 608–614. https://doi.org/10.1037/0735-7028.35.6.608
Moore, L. E., Tambling, R. B., & Anderson, S. R. (2013). The Intersection of Therapy Constructs: The Relationship Between Motivation to Change, Distress, Referral Source, and Pressure to Attend. The American Journal of Family Therapy, 41(3), 245–258. https://doi.org/10.1080/01926187.2012.68535
Prochaska, J. O., & DiClemente, C. C. (1984). The Transtheoretical Approach: Crossing Traditional Boundaries of Therapy. Homewood, IL: Dow Jones-Irwin.