How to know when it’s time for counseling

We all have good days and bad days. When the bad days outnumber the good or when one bad day makes it harder for you to get back in balance, consider reaching out for help.

Starting therapy can feel daunting, especially if it’s your first time seeing a professional. It's no wonder people put off seeing a counselor until a situation becomes completely unmanageable, according to Ryan Wesneski, LCSW, a licensed clinical social worker with PeaceHealth in Eugene, Oregon.

“Oftentimes people wait too long to get help,” says Ryan, “Their job might already be in jeopardy or their relationships could be falling apart. It’s common for people to use unhealthy coping skills such as watching TV, eating too much or too little or drug use. And all of those things end up creating more complications.”

If this sounds familiar, it might be a good time to get an outsider’s perspective on the issues you’re grappling with. Here are some signs that you could benefit from a brief counseling assessment session:

1. Things don’t feel as good as they used to

Anhedonia (the loss of enjoyment for activities that were once enjoyable) is a major warning sign for depression. It doesn’t just extend to watching TV, playing guitar, or reading the paper.

“When we are depressed, even our closest relationships are affected,” says Ryan. The partner we never got into fights with before might now somehow cause us irritation. In our moments of clarity, we might sense that we are being overreactive, so we scold ourselves and recommit to being kinder, but the same frustrations keep coming up.

“The reasons behind this loss of enjoyment may not be clear to you and that’s where a therapist can help,” he notes.

2. Physical symptoms appear

For some people, the term “psychosomatic” (meaning “physical pain begins in the mind”) has an unpleasant stigma attached to it. But the same neurotransmitters that help regulate mood, serotonin and norepinephrine, also work on regulating pain so it’s not a surprise that as mood becomes more impaired, the body responds with physical changes, Ryan explains.

Physical symptoms can appear as we try to beat back uncomfortable thoughts and feelings with ineffective techniques.  Symptoms such as the following can sometimes indicate the need for mental health treatment:

• Fatigue
• Headaches
• Sleeping too much/too little
• Racing heartbeat
• Weight change
• Joint pain
• Back pain
• Gastrointestinal problems

You might consider getting a general health screening for any or all the above symptoms to rule out a possible physical illness.

3. You can’t stop thinking about a traumatic event

Re-experiencing (or replaying in your head) stressful events, hyper alertness, avoidance habits, and nightmares related to a specific event or events are all signs that you may be experiencing PTSD (Post Traumatic Stress Disorder).

It is unlikely that these symptoms will clear up on their own, but the good news is that there are several effective therapies for helping to recover from traumatic experiences, says Ryan.

A counselor can help guide you through the process while providing the extra support you may need when the painful thoughts and feelings are being wrangled.

4. You are going through a major change

Sometimes the field is cleared, and all the rules suddenly change. We lose our job, a loved one contracts a serious illness, we start or graduate from college. All of these scenarios require you to master new skills and explore unfamiliar territory, says Ryan.

During these times, it can be useful to have someone in your corner who is an “outsider” that you can confide in and bounce ideas off. “Friends and family can sometimes be helpful, but they can also be biased,” he notes. You can benefit in many different ways from spending time with a trained professional who can offer confidential assistance from a non-judgmental attitude.

How to seek help

If you feel ready to speak with someone, your options will vary depending on your financial situation, insurance, employment status and other factors.

A good place to start is to talk with your primary care doctor who may be able to refer you to a licensed clinician that works with your insurance.

Some people prefer to pick their own therapist. You can go online to trusted websites for help to find a counselor near you. You'll find profiles of clinicians in your area along with the types of insurance they take and what they charge out of pocket.

Some employers also offer employee assistance programs that cover a brief course of treatment (generally around six sessions).

If you are without insurance, you can reach out to a community mental health center in your area to receive information on low-cost options. They may also be able to help you sign up for Medicaid or an Affordable Care Act plan to help cover all or part of the cost of treatment.

Free support groups for your specific issue may also be an option; many of these can be found with a quick search online.

When you shouldn't wait

Following are times that nearly ALWAYS require urgent professional help. In these situations, seek help IMMEDIATELY:

• Suicidal or homicidal thoughts, particularly if the thoughts involve planning or steps already taken.
• Substance use has gotten out of control and threatens your health, safety, relationships, or other material aspects of life.
• Hallucinations, delusions, paranoid thoughts, or other signs that you may be disconnecting from the reality around you.
• Behavioral issues requiring medical intervention.
• You are involved in an abusive relationship where your physical safety is threatened and feel unable to escape.

Sources:
Madhukar H. Trivedi, M. (2004). The Link Between Depression and Physical Symptoms. Retrieved from National Institute of Mental Health: https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/index.shtml#pub2
U.S. Department of Health and Human Services (2015). Depression. Retrieved from National Institute of Mental Health: https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/index.shtml#pub8
U.S. Department of Health and Human Services (2016). Generalized Anxiety Disorder: When Worry Gets Out of Control. Retrieved from National Institute of Mental Health: https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml
U.S. Department of Health and Human Services (2016, Feburary). Post-Traumatic Stress Disorder. Retrieved from National Institute of Mental Health: https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml