Suicidal thoughts are often treated solely as symptoms to be eliminated or risks to be managed, yet this narrow focus can overlook their deeper meaning. Many people who experience suicidal thoughts are also carrying unresolved trauma, loss, or chronic emotional pain. This article explores what suicidal thoughts may be trying to tell us, reframing the desire for death not as a literal wish to die but as a signal that something in a person’s life, identity, or relationships has become unbearable or unsustainable. When these thoughts are approached with curiosity, compassion, and attention to meaning alongside safety, therapy can become a space where individuals feel understood rather than silenced, and where genuine change can begin.

Suicidal ThoughtsEmotional PainTrauma and LossTherapy Support

In This Blog

• Why suicidal thoughts are so often misunderstood
• Suicidal thoughts as communication
• Trauma, loss, and chronic emotional pain
• How therapy can create space for meaning
• Reclaiming agency and choice
• Frequently asked questions

If safety feels uncertain

If you or someone nearby may act on suicidal thoughts or cannot stay safe, call or text the 988 Suicide & Crisis Lifeline now, use 988 chat, call local emergency services, or go to the nearest emergency room. The National Institute of Mental Health warning signs can also help loved ones recognize when immediate support is needed.

Why Suicidal Thoughts Are So Often Misunderstood

For many people, the moment suicidal thoughts arise, fear takes over. Individuals may feel ashamed, frightened by their own minds, or convinced that something is deeply wrong with them. Friends and loved ones often react with panic, while professionals may quickly move into assessment and crisis management.

While safety is essential, fear-based responses can unintentionally shut down the very conversations people most need to have. When suicidal thoughts are treated only as emergencies or warning signs, individuals may learn that honesty leads to consequences rather than care. As a result, many people hide these thoughts, even as they continue to suffer internally.

This silence can be deeply isolating. Instead of feeling supported, individuals may feel reduced to a problem that needs to be fixed or controlled. Over time, this can reinforce the belief that their pain is unacceptable or too much for others to hear. GoodTherapy’s guide on talking and writing about suicide offers helpful language for approaching the subject with care.

Key insight: Safety matters, but people are often more willing to talk honestly about suicidal thoughts when their pain is met with steadiness instead of panic.

A Different Lens: Suicidal Thoughts as Communication

Many people who experience suicidal thoughts are not expressing a true desire to die. Rather, they are expressing a desire for their pain to end. This distinction matters.

Suicidal thoughts can serve as a form of communication when other ways of expressing distress feel unavailable or unsafe. They may emerge when someone feels trapped, overwhelmed, exhausted, or disconnected from meaning and connection. In this sense, suicidal thoughts are not evidence of weakness or failure but signs that something in a person’s internal or external world is asking for attention.

Seen through this lens, the question shifts from “How do we make these thoughts stop?” to “What are these thoughts trying to tell us?” This reframing does not minimize risk. It makes room for both suicide prevention and a more humane understanding of pain.

PainA desire for pain to stop+

Suicidal thoughts may point to emotional pain that has exceeded a person’s current capacity to carry it alone.

LossA grief that has not been witnessed+

When grief is minimized, delayed, or unsupported, suicidal thoughts can become one way the mind signals that something important still needs care.

TraumaA nervous system stuck in survival+

Trauma can leave the body scanning for danger and the mind searching for escape, even long after the original harm has passed.

SupportA need for agency, connection, and safety+

The presence of suicidal thoughts can be a signal that support needs to become more immediate, collaborative, and compassionate.

A meaning-focused question can sound like

What feels impossible to keep carrying? What has gone unheard for too long? What kind of support would make the next hour safer? What would make life feel one small degree more livable?

The Role of Trauma, Loss, and Chronic Emotional Pain

For many individuals, suicidal thoughts are closely tied to unresolved trauma or loss. Trauma can disrupt a person’s sense of safety, identity, and trust in others. Loss, whether sudden or prolonged, can leave emotional wounds that do not heal easily, especially when grief is minimized or unsupported.

Chronic emotional pain may develop when someone has spent years feeling unseen, unheard, or required to carry more than they are equipped to manage. Over time, this accumulation of pain can overwhelm the nervous system. The body and mind may enter a state of exhaustion, where continuing to endure feels impossible.

In these moments, suicidal thoughts may arise as an imagined escape from relentless suffering. This does not mean the person truly wants life to end. Often, it means they cannot see another way forward. The CDC’s suicide risk and protective factors note that relationship, community, health, and life circumstances can all shape risk and protection.

GoodTherapy’s article on how complex trauma changes a person offers additional context for understanding why long-term pain can affect safety, trust, and identity.

When Survival Takes Precedence Over Living

Some people experiencing suicidal thoughts have spent much of their lives in survival mode. They may appear highly functional, meeting responsibilities, caring for others, and seeming capable. Internally, however, they may feel numb, disconnected, or deeply lonely.

Survival mode can keep someone alive, but it does not necessarily make them feel alive. When life becomes reduced to endurance rather than meaning, suicidal thoughts may surface as a response to this inner deadening. They can reflect a longing for rest, relief, or an end to constant striving.

Understanding this context allows for a more compassionate response, one that recognizes how much strength it has taken to survive up to this point.

A More Helpful Pathway

Unbearable pain

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Honest language

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Safety support

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Meaning and agency

The Limits of Risk-Only Approaches

Traditional approaches to suicidality understandably focus on risk assessment and prevention. These strategies save lives and are often necessary. However, when risk management becomes the sole focus, the deeper emotional story can be overlooked.

Checklists and assessments do not capture the full complexity of human suffering. They cannot fully explain why someone feels trapped, empty, or hopeless. When people sense that only certain answers are acceptable, they may disengage or minimize their experience.

This does not mean safety should be ignored. Rather, it suggests that safety and meaning must be held together. When individuals feel heard and understood, they are often more willing to engage honestly in conversations about safety and support. For loved ones, GoodTherapy’s suicide prevention guide outlines ways to respond with directness and care.

How Therapy Can Create Space for Meaning

Therapy has the potential to offer something many people experiencing suicidal thoughts have never had: a space where their pain is taken seriously rather than feared or dismissed.

In a meaning-oriented therapeutic approach, suicidal thoughts are explored gently and respectfully. Clients are invited to talk about what feels unbearable, what has been lost, and what feels impossible to change. Instead of rushing to solutions, therapy slows the process down, allowing understanding to emerge.

What therapy can explore safely

• What this pain has taken from you
• What feels unspeakable, unresolved, or unseen
• Which parts of yourself have had to be hidden or abandoned
• What would make life feel more livable, even in small ways
• Which support plan would help you stay safer while the deeper work unfolds

These conversations do not encourage harm. They honor the reality of suffering while opening pathways toward agency, connection, and hope. If you are considering therapy, GoodTherapy’s step-by-step guide on how to find the right therapist can help you think through fit, safety, and support.

Looking for support?

You can use GoodTherapy to search for a therapist who can help you talk through suicidal thoughts, trauma, grief, and emotional pain with care.

Rebuilding Trust After Difficult Therapy Experiences

Some individuals experiencing suicidal thoughts have previously sought help and felt misunderstood, dismissed, or even harmed. These experiences can make it difficult to trust therapy again. When someone has learned that vulnerability leads to invalidation or control, they may approach new therapeutic relationships with understandable caution.

Acknowledging this history matters. Therapy can be effective only when trust is built slowly and collaboratively. A respectful therapeutic process emphasizes transparency, choice, and pacing, allowing clients to remain active participants in their own care.

Over time, consistent attunement and honesty can help repair not only the relationship with therapy but also a person’s relationship with themselves.

Reclaiming Agency and Choice

One of the most important aspects of healing is the restoration of agency. Suicidal thoughts often arise when people feel powerless, trapped, or unable to influence their circumstances. Therapy can help individuals reconnect with choice, even when options feel limited.

Agency does not mean forcing positivity or making drastic changes overnight. It may begin with small acts of self-understanding, boundary setting, or self-compassion. As people begin to understand what their suicidal thoughts are communicating, they can explore new ways of responding to their needs.

This process often includes learning to recognize emotional and relational patterns, identify values and sources of meaning, develop healthier ways to ask for support, build tolerance for difficult emotions, and imagine change without overwhelming the nervous system.

When depression is part of the picture, it can be especially important to have timely support. GoodTherapy’s article on depression and suicide explains when to seek help and why warning signs should be taken seriously.

When Hope Feels Out of Reach

Hope is often misunderstood as optimism or certainty. For people experiencing suicidal thoughts, hope may feel distant or unrealistic. In therapy, hope does not need to be forced or manufactured.

Sometimes hope begins as a sense of being less alone. Sometimes it shows up as curiosity, or as a willingness to stay present for one more conversation. These small shifts matter.

Healing is rarely linear. There may be moments of progress alongside moments of discouragement. A supportive therapeutic relationship can help individuals stay connected through these fluctuations, offering steadiness rather than pressure.

A Compassionate Closing

If you or someone you love experiences suicidal thoughts, it is important to know that these thoughts are not a personal failure. They often reflect pain that has gone on too long without adequate support. They may be signaling unmet needs, unresolved grief, or a longing for change that feels out of reach.

Understanding what suicidal thoughts may be trying to tell us does not replace the importance of safety. It deepens it. When people feel understood rather than judged, they are more likely to reach out, stay engaged, and explore new ways of living.

Therapy can be a place where these conversations are held with care, respect, and honesty. When meaning and compassion are allowed alongside safety, the possibility of genuine and lasting change becomes more accessible.

If you are struggling or feeling unsafe, reaching out for support can be an important step. Speaking with a trusted person, a mental health professional, or a local crisis resource can help you navigate this moment with care and support. The NIMH 5 action steps can also help loved ones respond when someone is in emotional pain.

Frequently Asked Questions

Direct answers about suicidal thoughts, therapy, trauma, grief, and immediate support.

Q: Are suicidal thoughts always a wish to die? +

A: Not always. For many people, suicidal thoughts can express a wish for unbearable pain to stop. Even when the thoughts are communicating distress rather than intent, they should be taken seriously and paired with safety support.

Q: Can therapy help with suicidal thoughts? +

A: Therapy can help people explore suicidal thoughts with safety, care, and meaning. A therapist may support crisis planning, help identify trauma or loss beneath the pain, and work with the client to rebuild agency and connection.

Q: What should I do if someone tells me they are having suicidal thoughts? +

A: Listen calmly, take the disclosure seriously, ask directly about immediate safety, and do not leave the person alone if they may act on the thoughts. In the United States, call or text 988 for crisis support.

Q: Why might suicidal thoughts show up during trauma or grief? +

A: Trauma and grief can overwhelm a person’s sense of safety, identity, and connection. Suicidal thoughts may appear when emotional pain feels unbearable or when the mind cannot yet see another way to get relief.

Q: Is it safe to talk honestly with a therapist about suicidal thoughts? +

A: Yes. A compassionate therapist can help you talk about suicidal thoughts directly while also paying attention to immediate safety, support, and the deeper pain behind the thoughts.

Q: When should suicidal thoughts be treated as an emergency? +

A: Suicidal thoughts should be treated as an emergency if someone may act on them, has a plan or access to means, cannot commit to staying safe, or feels unable to get through the next moments safely. In the United States, call or text 988 or use emergency services.

Take the Next Step

You do not have to make sense of suicidal thoughts alone. Compassionate support can help hold both immediate safety and the deeper meaning beneath the pain.

Find a Therapist Near You >

About the Author Kristin Robert Associate Marriage and Family Therapist Kristin Robert is an Associate Marriage and Family Therapist in Westlake Village, California. Her work centers on helping individuals and couples navigate intimacy, loss, betrayal trauma, grief, anxiety, relationship patterns, and major life transitions. Her GoodTherapy profile lists her work with teens, adults, and elders, and concerns including grief and loss, anxiety, depression, trauma, relationship pain, life transitions, and suicidal ideation and behavior. Her approach emphasizes compassion, honesty, meaning-making, and support for people navigating painful or uncertain seasons. View Profile >

It May be Time to Seek a Therapist

We all reach moments in life when things feel like too much — when struggles pile up, and even small tasks feel overwhelming. Maybe you’ve noticed it’s harder to get through the day, or that your once-familiar joy just isn’t there anymore. It’s not always easy to tell when a rough patch has become something deeper, but being aware of certain signs can help you decide when to reach out for extra support. When any type of mental health or emotional concern affects daily life and function, therapy may be recommended. Therapy can help you learn about what you’re feeling, why you might be feeling it, and how to cope. Psychotherapy, talk or talking therapy, counseling, or simply therapy — no matter the name it’s known by, mental health counseling can benefit people struggling with emotional difficulties, life challenges, and mental health concerns.

Why You Should Consider Therapy?

Seeking therapy isn’t about needing to be “fixed” or having something “wrong.” Instead, it’s a safe space where you can work through thoughts, emotions, and life’s complexities with someone who understands and has the tools to guide you toward feeling better. Therapy can help improve symptoms of many mental health conditions. In therapy, people can learn to cope with symptoms that may not respond to treatment right away. Research shows the benefits of therapy last longer than medication alone. Medication can reduce some symptoms of mental health conditions, but therapy teaches people skills to address many symptoms on their own. 

Therapy also lets you talk through life’s challenges, such as breakups, grief, parenting difficulties, health impacts, or family struggles. For example, couples counseling can help you and your partner work through relationship troubles and learn new ways of relating to each other. Note that crisis resources, not couples counseling, are typically recommended for abusive relationships.

If you’ve been wondering whether it’s time to ask for help, keep reading to learn about a few common signs that therapy could bring you relief, greater understanding, and the strength to take on life’s challenges with a renewed sense of purpose.

How Common are Mental Health Issues?

Mental health issues are common. Recent statistics from the National Alliance on Mental Health show 1 out of every 5 American adults lives with a mental health condition, while 1 in 20 adults experience a serious mental health condition each year. 1 in 6 U.S. youth age 6-17 experience a mental health disorder.

But only about 40% of people with mental health issues get help. Untreated mental health issues often get worse and may have other negative effects. They could also lead to:

• Inability to work or go to school
• Difficulty in relationships or taking care of children
• Increased risk of health issues
• Hospitalization
• Suicide

Suicide is the second leading cause of death for people in the United States between the ages of 10 and 34. About 90% of people who die by suicide in the U.S. lived with a mental health condition.

The best option for anyone contemplating suicide is to get immediate help is reaching out to a suicide helpline through phone, text message, or online chat. You may be encouraged to call or visit the nearest emergency room. A therapist can help support you going forward, once you are no longer in crisis.

The GoodTherapy registry might be helpful to you. We have thousands of therapists listed with us who would love to walk with you on your journey. Find the support you need today!

Recognizing the Signs You Could Benefit From Therapy

It may take some consideration before you decide you’re ready for therapy. You might want to wait and see if time, lifestyle changes, or the support of friends and family improves whatever you’re struggling with.

The American Psychological Association suggests you consider a time to see a therapist when something causes distress and interferes with some part of life, particularly when:

• Thinking about or coping with the issue takes up at least an hour each day
• The issue causes embarrassment or makes you want to avoid others
• The issue has caused your quality of life to decrease
• The issue has negatively affected school, work, or relationships
• You’ve made changes in your life or developed habits to cope with the issue

If you experience any of the following emotions or feelings to the extent that they interfere with life, therapy may help you reduce their effects. It’s especially important to consider it’s time to see a therapist if you feel controlled by symptoms or if they could cause harm to yourself or others.

1. Feeling Constantly Overwhelmed, Anxious, or Have Intrusive Thoughts. 

• While life is frequently stressful, constant feelings of overwhelm, unease, or anxiety can sometimes linger without relief and become so present that they negatively impact your daily life. When these feelings cause physical symptoms, constant intrusive thoughts, interfere with your ability to work, connect with others, or manage day-to-day responsibilities, it might be time to seek support. Therapy offers tools to manage anxiety and ways to identify its root causes, helping you regain a sense of calm and control.

2. Experiencing Persistent Sadness or Hopelessness.

• Sadness in certain quantities is a normal part of life, but if it persists or intensifies into depression, therapy can offer a safe space to work through your feelings. Losing hope or motivation, or feeling as if you have no future, can indicate depression or another mental health condition. Whether due to loss, major life changes, or something harder to pinpoint, a therapist can help you process dark days, find coping strategies, and regain hope.

3. Struggling with Self-Esteem or Negative Self-Talk.

• Feeling like you’re not enough or constantly doubting your self-worth can be exhausting and isolating. If self-criticism is holding you back from being social, pursuing goals, or feeling proud of yourself, therapy can help you see your inherent value. If you often compare yourself to others or constantly feel unworthy, these patterns could be signs that professional support may be needed.

4. Facing Major Life Transitions.

• Major changes, such as a new job, a move, political events, or a relationship shift, often come with their fair share of tough questions and difficult emotions. If these transitions leave you feeling stuck, unprepared, overly stressed, or totally lost, therapy can help you manage the change. Experiencing an intense fear of failure, regret, or constant second-guessing might be signs that professional support might be needed to make the transition smoother.

5. Difficulty in Relationships.

• Healthy relationships take effort, but if you find yourself facing recurring conflict, isolation, or trust issues, therapy can offer tools to navigate these challenges and strengthen your connection. Signs of recurring resentment, loneliness, or emotional distance are often early indicators that couples therapy or individual therapy might be necessary. Working with a relationship counselor can help you understand unhealthy patterns, improve communication, and build stronger, more fulfilling emotional bonds.

6. Turning to Unhealthy Coping Mechanisms.

• Turning to habit-forming behaviors for comfort can provide a quick fix, but will often lead to lasting issues. If you’re increasingly relying on substances, excessive screen time, unhealthy eating, or other habits to cope, therapy can provide a better alternative. Exploring these patterns in a nonjudgmental space can offer clarity and provide new ways to handle stress in healthier, more sustainable ways. Signs like secrecy, guilt, or relying on substances or habit-forming activities to escape your emotions can indicate a need for support in making changes.

7. Difficulty After Trauma

• Unprocessed trauma can lead to flashbacks, hypervigilance, or a constant sense of unease. If you find yourself avoiding certain places or people, struggling with trust, fighting intrusive emotions, or feeling on edge without explanation, it might be time to consider therapy. Working through the trauma with a professional can help you feel safer, and more grounded, ultimately opening, and ultimately open the door for healing.

8. Feeling “Stuck” or Lacking Motivation.

• When you feel stuck, unmotivated, or disconnected from the things you once enjoyed, therapy can help you reestablish a sense of purpose. Processing these feelings with a therapist can provide fresh perspectives, renewed energy, and the inspiration you need to face life head-on.

9. You’re Interested in Bettering Yourself.

• If you’re asking whether or not you need therapy, you might want to go ahead and try it out. Therapy isn’t just for people with trauma or “something wrong” — professional mental guidance can benefit just about anyone by improving self-understanding, everyday coping strategies, empathy, communication, and so much more. Even the “healthiest” individuals can gain so much from having a protected space to share and reflect. You don’t need to wait for things to get bad before starting therapy, just like you shouldn’t wait for health problems to appear before starting regular checkups with a physician.

Additional Signs: 

Fatigue. 

• This physical symptom often results from or accompanies mental health issues. It can indicate depression. Fatigue can cause you to sleep more than usual or have trouble getting out of bed in the morning.

Disproportionate rage, anger, or resentment. 

• Everyone feels anger at times. Even passing rage isn’t necessarily harmful. Seeking support to deal with these feelings may be a good idea when they don’t pass, are extreme compared to the situation, or if they lead you to take violent or potentially harmful actions.

Agoraphobia. 

• People with agoraphobia fear being in places where they might experience panic attacks or become trapped. Some people may become unable to leave their houses.

Apathy. 

• Losing interest in usual activities, the world around you, or life in general can indicate mental health issues like depression or anxiety.

Social Withdrawal

• Many people feel better when they’re able to spend at least some time alone. Introverted people may need even more time alone than others. But if you feel distressed around others or fear being with other people, therapy can help you understand and deal with these feelings.

What If I’ve Already Tried Therapy and It Didn’t Work?

Sometimes therapy doesn’t “work” right away. Even in an ideal therapy situation, it can take time for symptoms to improve. – months or years. Going to therapy and seeing no change may cause frustration. Perhaps you haven’t found the right therapist, so it’s worth it to continue your search for help. If you’re still experiencing any of the symptoms above, therapy should still be an option. Don’t stop your quest to improve your mental health.

It can help to look for a therapist who treats what you’re experiencing. If you don’t have a diagnosis, you can talk to potential therapists about your symptoms. Most therapists will let you know if they’re able to treat your concern. If they can’t, they may be able to recommend someone who can.

Keep in mind different approaches may be better for different issues. If you didn’t feel heard in your previous therapy, or if your symptoms have changed since your last therapy session, a different therapist might be exactly what you to move forward.

The Benefits to Seeking Therapy

If you’re considering therapy, you may be thinking about the possible drawbacks. Cost might be a concern for you. You might also be aware that therapy is often difficult. Trauma or other painful events from the past can be frightening to remember and discuss with someone. Working through challenges isn’t easy, and therapy isn’t always a quick fix. Make sure that when you’re ready to see a therapist that you can be honest with yourself and with your them.

But if you’re willing to do the work, therapy can be rewarding. It’s a safe, judgment-free space where you can share anything, with a trained professional who is there to help.

Here are a few benefits of therapy:

• You’ll learn more about yourself. Therapists listen to your story and help you make connections. They might offer guidance or recommendations if you feel lost. Therapy can empower you to take action on your own.
• Therapy can help you achieve your goals. If you aren’t sure of what your goals are, therapy can help you clarify them and set realistic steps to meet them.
• Therapy can help you have more fulfilling relationships. Whether you’re single or in a relationship, therapy can help you address difficulties relating to others, such as insecurity in relationships or difficulty trusting your partners.
• You’re more likely to have better health. Research supports a link between mind and body wellness. Untreated mental health issues can impact physical wellness. On the other hand, people in good emotional health may be more able to deal with physical health issues that arise.
• Therapy can lead to improvement in all areas of life. If you feel like something is holding you back from living life as you envision it, therapy can help you address this. When you aren’t sure what’s keeping you from making change, therapy can help you discover the answer.

How Therapy Can Help You Move Forward

If you recognize the signs that a change is needed, starting therapy could provide a gateway to greater well-being. It’s more than just talking about what’s not right — it’s a chance to explore new perspectives, recognize patterns, and build skills that help you manage stress, strengthen relationships, and improve your overall mental state. With the right therapist, you’ll work together to set goals that feel meaningful to you, taking small steps that create lasting change.

At GoodTherapy, we make it easy to find the perfect therapist for your individual personality and needs, cutting the guesswork and difficulty out of finding empowering support. Whatever challenges you face, remember you’re not alone — help is here when you’re ready.

Even if you aren’t sure you want to commit to therapy, many therapists offer a free first session or phone consultation to talk through what you’re dealing with. Based on your symptoms, they might encourage you to get help. Begin your search for a therapist today!

If you believe you may need help beyond or in addition to a therapist, GoodTherapy Recovery Treatment Centers provide additional options to help beat addictions.

If you’ve never gone to therapy, you might not have much idea what happens in a therapy session. This is fairly common, since much of what people know about therapy comes from (often inaccurate) media portrayals.

In the past decade, awareness around mental health issues has increased significantly. Greater awareness has helped reduce mental health stigma by supporting therapy as a beneficial, normal method of getting help. Accordingly, the shroud of secrecy around therapy has started to fall away. Your friends, family members, even your coworkers may be perfectly willing to open up about their experience in therapy and how talking to a mental health professional has helped them.

But if you’re still unsure about therapy, or don’t know anyone who’s gone to therapy, you might hesitate before booking your first session. Maybe you feel nervous about what a therapist will do, or you don’t think your distress actually merits therapy.

You don’t need to experience any significant mental health issues or emotional distress for therapy to work.

Before exploring how therapy works to help people who are struggling, let’s bust that myth right now. You don’t need to experience any significant mental health issues or emotional distress for therapy to work. If you’re struggling, confused, feel like you want to sort out a problem or your life and don’t know where to start—therapy can help.

Therapy Is Personalized

The process of therapy can differ somewhat based on what you’re experiencing.

For one, the length of therapy can vary based on the issue you want help with. If you’re struggling with depression after a breakup or job loss, for example, therapy often helps you work through the problem within a few months. You might not be completely “cured,” but you’ll generally be able to resolve lingering distress on your own. That’s a key goal of therapy.

Serious or longer-lasting concerns, like trauma from abuse or chronic depression, may require more therapy sessions and a more intensive approach.

In most cases, you’ll spend just an hour each week in therapy. But your therapist might also recommend specialized types of therapy to meet your needs. Dialectical behavior therapy, for example, generally involves an hour of therapy, an hour of skills training, and an additional hour of group therapy each week.

Therapy doesn’t operate as a blanket remedy or one-size-fits-all approach. Therapy for intrusive thoughts (a component of OCD) will likely look much different than therapy for a phobia of dogs.

But even two people with generalized anxiety might see treatment proceed in different ways, based on the type of treatment the therapist specializes in and their individual needs.

If you’ve tried various coping strategies and still struggle with severe anxiety, for example, you might want to try medication, a perfectly valid (and helpful) treatment option. Your therapist should support your decision and work with you to find the right drug.

If you know you don’t want to take medication at all, unless absolutely necessary, you might look for a therapist who specializes in alternative treatments, like yoga or nature therapy.

Therapy Helps People Reach Goals

You might consider going to therapy (or want to avoid therapy entirely) with the idea that your therapist will give you advice, tell you what to do, or ask how every little thing makes you feel.

But therapy doesn’t work like that. Rather, therapy offers a safe, nonjudgmental space for you to talk about problems and anything that’s overwhelming you or even just making life a little tough. Your therapist listens to what you have to say and then works with you to develop a plan to confront challenges and achieve an improved quality of life.

You can also go to therapy if you aren’t experiencing significant distress. Therapy can be beneficial in the pursuit of any goal, no matter what that goal is.

Maybe you want to date but feel you lack the skills to approach someone or make a relationship work. Perhaps you want to work on being closer with your teenage children. Or maybe you just want to break a lifelong nail-biting habit.

Whatever your goal, your therapist will help you explore potential changes you can make to arrive at the outcome you desire. But you come to therapy with your goals (or spend time identifying them in session). You also have an opportunity to share solutions that don’t work, which can help you and your therapist work together to find something that will have benefit.

Say you’ve been feeling low because you no longer have time to create art. Your therapist asks what a typical day looks like for you. After you explain your schedule, they point out you’re spending all your time doing things for others, something you never stopped to consider.

In short, therapy can help you work to identify and break concerning patterns or habits on your own. Therapists don’t give you all the answers. They help you find the right tools to help yourself.

In therapy, you drive the car. Your therapist can help you navigate when you get lost or help dig you out if you get stuck in the mud.

Therapy Puts You in Control

In therapy, you drive the car. Your therapist can help you navigate when you get lost or help dig you out if you get stuck in the mud. But your therapist doesn’t decide where you go or how you get there. You do that work yourself.

That’s why finding a therapist you can work well with is so important. You can often help personalize your own therapy experience by choosing your own therapist, so look for someone you feel comfortable with.

Therapists aren’t machines. Their unique personalities, mannerisms, and styles of interaction will likely show through in the therapy process. Their personality can help attract you to the work you’re doing together, or put you off it.

Finding a therapist who will encourage you to keep pushing through difficulties, even when it’s unpleasant, is also essential. Therapy often feels uncomfortable, even unpleasant. That’s a normal part of the process. But when you and your therapist have a strong working relationship, you trust them to support you through the discomfort and arrive at a place where you feel ready to make change.

If you don’t believe your therapist will continue offering compassion and support, regardless of the thoughts you share or challenges you face, you’ll have a harder time opening up and sharing your vulnerabilities. As a result, therapy may have less effect.

You pay for therapy. It’s your space to create change. Your therapist offers guidance during the process, but you work toward what you need.

Conclusion

If you go into therapy looking for a quick, easy solution, or with the hope your therapist will solve all your problems, you won’t get much out of the process.

Therapy can be hard work, and going into therapy with this in mind can help prepare you for the occasional tough session. But when you work with the right therapist, therapy can be productive and healing, and most of your sessions will probably feel rewarding, even when they’re a little difficult.

Ready to find a compassionate therapist? GoodTherapy is the best place to start. Start your search here.

References:

1. Frey, E. (2017, April 27). How therapy actually works and 5 myths about therapy debunked. Retrieved from https://medium.com/kip-blog/5-myths-about-therapy-debunked-17e7fdd8b8a5
2. Going to a therapist. (2018). TeensHealth. Retrieved from https://kidshealth.org/en/teens/therapist.html
3. Understanding psychotherapy and how it works. (n.d.). American Psychological Association. https://www.apa.org/helpcenter/understanding-psychotherapy
4. What is psychotherapy? (2019). American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/psychotherapy

In day-to-day life, we often spend a lot of time holding in the feelings and thoughts we have about others. These thoughts may be about people we love, someone we’re in relationship with, those we work with, or even just people we dislike but need to interact with regularly.

Life is about relationships; the quality of those relationships can contribute to how fully alive and happy we get to be. The authenticity and honesty in our closest relationships are strong markers for a healthy life—but we still hold back.

Why Do We Hold Back?

Part of the reason for this is maturity. Many of us know what it’s like to be with a child who doesn’t have a filter. They might tell a stranger that they’re ugly or let Great-Aunt Abigail know that her birthday gift was the same as last year’s—and it wasn’t appreciated then! This child hasn’t yet learned that little white lies can be okay and that there are times we aren’t blatantly honest in order to protect the feelings of others.

Another contributing factor is that we can get so used to holding in our thoughts and feelings that we lose awareness of them. And when they do make it awareness, we often say, “Bah! It’s not that big of a deal. Forget it.”

There goes another repressed feeling.

When Repressed Thoughts and Feelings Surface

Maybe we unload into a journal or speak with a friend or partner (not about them, but about each other.) Perhaps those feelings get displaced onto others, or even somatized into physical symptoms. Suddenly, all the little things we didn’t think were important are coming out in unexpected, unhelpful, and unhealthy ways.

We must learn to bring into consciousness the small cuts that build up in our lives and hold us back from more intimate relationships.

We think, “Okay. Let’s head to therapy! That will help with my anger, anxiety, or depression.”

In a counseling session, we may talk about Great-Aunt Abigail’s cheapness and how it seems to show how little she’s cared for us all along. Maybe we talk about a demeaning boss with whom we can never express our full frustration. Perhaps we get to share about all our friends who willingly take and take but never seem to return all we do for them.

Realizing Your Therapist Is Human

We should talk about all of these issues with our counselor. But over time, something else often becomes apparent: we discover our therapist is also a human being. We begin holding back the same kinds of thoughts and feelings from them.

A few examples of these thoughts include:

• “They looked at the clock a few more times than they usually do, but maybe they’re just hungry and looking forward to lunch. Never mind that it made me feel expendable.”
• “Okay, they stumbled when remembering my child’s name—I’ve only been talking about the little brat for 8 months now. But they must have so many clients, right?”
• “That was definitely a yawn. A yawn! How dare they. Oh, come on, it’s 8 p.m. It’s not a big deal. Stop thinking about it.”

Why Should I Share These Thoughts With My Therapist?

We often censor feelings and thoughts about our therapists because we know that’s the mature thing to do. We certainly won’t make too many friends if we’re constantly telling the people in our lives how they’ve let us down. But we’re not in our “daily lives” in therapy. We’re in therapy. We’re in this experimental petri dish to get to know ourselves better, something we can only do in relationship to someone else. We must learn to bring into consciousness the small cuts that build up in our lives and hold us back from more intimate relationships.

Talking with your therapist about any of the thoughts listed above may not get them to change or apologize, although that may happen. The main purpose of verbalizing these feelings is to give you the experience of exploring how these slights, which are most likely replicated in real life and often in bigger ways, affect you and your relationships with others. Discussing these thoughts in a trusting therapeutic relationship can help you work toward spending less energy holding them in on a regular basis. It can help to find a trusted therapist near you with whom you can explore these feelings.

Over time, you may find you are not holding grudges for as long as you used to or that your expressions of anger are not as strong as they’ve been in the past. This may mean you’ve begun to release yourself from the grasp of those slights and the repressed thoughts that often accompany them.

The decision to initiate any interpersonal relationship is anxiety-provoking, and the decision to talk with a therapist might be uniquely so. When we decide to meet with a therapist, we are faced with numerous challenges: allowing ourselves to depend on someone else for help and support; revealing our problems; risking trust in a stranger; facing what we have avoided; and relinquishing long-held, sometimes beloved habits, to name a few.

When we refer someone to therapy, it is important to keep this in mind. Though the statement “I recommend you talk to a therapist” sounds simple and benevolent enough, we cannot lose sight of the fact our caring act is simultaneously an anxiety-provoking challenge to the would-be person in therapy. So how can we go about this in a way that doesn’t provoke any additional, unnecessary worries or fears?

The following is a list of principles one can consider when making a referral to a therapist. While these ideas do not guarantee a certain outcome, they may reduce the chances of triggering anxiety that could promote avoidance.

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1. Make it about their needs and goals.

Therapy is much more likely to succeed if the person is there of their own free will, motivated by their own goals, trying to meet their own needs. External pressures to be there and pressures to work on problems that other people see, but that we do not see, can lead therapies to get stuck. The last thing we want to do is refer someone to therapy because we want them to change or conform to some goal that we have for them. That’s usually a recipe for someone either avoiding therapy or showing up but hating it.

Good therapy involves difficult, anxiety-provoking work, so most people will want to do that only if it is their only option for reaching specific goals. That is why it can be important for your referral proposal to include a reference to those goals, and to the way their emotional difficulties hold them back. An example could be: “Seems like the headaches you are getting are really hassling you at work, and it seems like they get worse with stress. Therapy can help with that and it might make you less miserable at work and home.” In this example, it is clear the referral is in the service of the person’s feelings and interests, done out of care and concern for them and not out of some demand or expectation by the referral source.

2. Make it optional.

I encourage you to make your recommendation optional, with liberal use of comments such as, “It’s really up to you,” “I’m not sure if I’m right, but it’s something you can decide for yourself,” and, “It’s not a requirement, just a thought.” I encourage you to phrase your referral as optional because going to therapy is optional. Therapy is anxiety-provoking enough to begin with, and we only add anxiety if we make the person feel like it’s an expectation, a demand, or a requirement.

When we approach therapy as a demand or requirement instead of an option, we can trigger a few responses that decrease the effectiveness of our referral. If the person we are hoping to refer has submissive tendencies, they may comply with our wish that they be in therapy. That will get them as far as a therapist’s office, but because they are not there of their own free will, they may not get the full benefits of the therapy. Other people may respond to our demand that they seek therapy with defiance or stubbornness. Rather than consider the option, they may say no just to spite you and to stymie your efforts to control them, even if they feel therapy could help.

Therapy has the highest likelihood of helping if the person is there of their own volition, not out of compliance, so be sure to remind yourself and the person you want to refer that the referral is optional.

If we’re clear about the reality of therapy—that the length of treatment and the level of commitment is up to them—they may find it less threatening and be more likely to try it.

3. Make it conditional.

What do we commit to when we commit to meeting with a therapist? Many people fear that by meeting with a therapist, they are committing to a long-term relationship. They sometimes also fear the therapist will decide how long the therapy lasts. These are anxiety-provoking preconceptions, and they are incorrect. When we try to refer people to therapy, it is important that we remind them of the truth—they are agreeing to one session at a time, and the length of the treatment is their choice, based on their goals and preferences.

It may help to be frank about what an initial therapy session is: a test drive. You can say, “You can meet with Maury and decide if you’d like to meet with him again. The first session or sessions can help you decide if you think he might help. You may know right away you’d like to meet with him more, but sometimes it can take a few sessions to decide if it’s worth continuing to invest in the therapy. Either way, it’s up to you how many sessions you go for. A therapist is an employee whom you can hire and fire.”

When we present the idea of therapy as a test drive, something the person can continue for as long as it meets certain conditions for them, we take away anxieties that therapy will be more of a commitment than the person may want. If we’re clear about the reality of therapy—that the length of treatment and the level of commitment is up to them—they may find it less threatening and be more likely to try it.

4. Do not make promises.

Ethically speaking, even a therapist cannot make promises, predictions, or guarantees about what they can do. We do not have a crystal ball with which to see the future. Often, my initial phone call with a new referral includes a difficult conversation along these lines:

Person: “So, do you think you can help me?”

Me: “Well, for better or worse I can’t know that just yet. We’d have to meet for you to form an opinion about that.”

Even if it’s a bit disillusioning, this is the truth. Like physicians or personal trainers, therapists can’t know whether their efforts will turn out to be helpful—only time and a careful, continuous, collaborative assessment will tell. We find out if our treatment plan is helpful once it helps.

There is great danger when a referral source makes promises about therapy or a therapist. Any expectations you give to the person you’re trying to refer can give them false hope or make them unnecessarily anxious and avoidant.

Every therapy session is, like every day of life, an experiment—we assess the problem that’s going on, pick an intervention or style of intervention we think might help, try it out, see what result we get, and adjust our treatment plan according to what works and what doesn’t. There is no magic to it, just a workaday process of trial and error, where we work hard to tailor a unique therapy to the unique person and their unique goals. In that sense, any preconceived expectations about therapy, just like in any other relationship, will be false.

For these reasons, there is great danger when a referral source makes promises about therapy or a therapist. Any expectations you give to the person you’re trying to refer can give them false hope or make them unnecessarily anxious and avoidant.

For example, a referral source could say, “He specializes in depression—he gets great outcomes.” Even if that is true, no two depressions are the same because no two people are the same. Likewise, no two treatments are the same because no two therapy teams are the same. Making promises or suggestions regarding a particular outcome can promote misleading or false hope. It may also distract from the fact it’s the work of the person in therapy, not the work of the so-called “expert in depression,” that makes or breaks the therapy.

Referral sources sometimes also make claims about a therapist’s technique when making a referral. For example: “He’s a very confrontative therapist—he’ll bust right through your defenses!” While it may be true that a therapist is capable of being confrontative, and while that kind of therapy may be appropriate for some people’s needs, presenting a referral in this way can be problematic. Good therapists base their technique on a careful assessment of the unique needs of the person in therapy, not based on what the therapist is good at or known for. Because of that, there is no guarantee the person you’re referring will ever have their defenses “confronted”—it all depends on the therapist’s assessment of what might help in the moment. Making such claims about a therapist can set up false expectations or give a person something to fear. Imagine already being nervous about letting go of certain defense mechanisms and then hearing a therapist is going to “bust right through” them.

For these reasons, when I refer someone to a therapist, I say something like, “There’s no way of knowing how it will go in advance, so the best way to find out whether the therapist can help is to go and check them out, assess how you feel with them, and make the best decision you can about whether to keep investing in the therapy. Hopefully they’ll be flexible and you two can make a therapy together that meets your needs.”

5. Let go of your desires!

If you haven’t caught it yet, my main thesis here is that while we can suggest that someone goes to therapy, or reveal our desire that they go, it is up to them. Pressuring people into doing something that is anxiety-provoking will usually lead to avoidance, submissive compliance, or stubborn defiance.

It is hard, but we must accept that we all have the right to avoid therapy and the anxieties that are built into it. No matter how badly we want to see a friend, loved one, or other person get help, our wanting it cannot make them want it. Only their inner desires can do that. So, while we can feel free to make suggestions to people about going to therapy, we must remember that they can do it only for them, not for us. Our desires for them can play only a very limited role in someone else’s therapy journey.

Example of Referring Someone to Therapy

Here is an example, based on the principles above, of what I might say to refer someone to a therapist:

“You seem to be suffering a lot and you’ve been clear that you’re not liking that, so I’ve been thinking that therapy might be useful to you. Obviously, it’s up to you if you want to go, but I do have the name of a person who I think might be able to help. Of course, that’s no guarantee, and you may have to shop around a bit to find someone who is a good fit. Either way, if you want to check this person out, they could be helpful. Do you want me to pass their contact info along?”

You can phrase this any way you like, but I think the key points for any referral are here:

1. Seems like you’re hurting, so therapy might be worth a shot.
2. It’s up to you.
3. You’re not committing to a lifetime on the couch, just one initial session.
4. There’s no guarantee it’ll be worthwhile, but the only way to find out is by trying.

Of course, this approach does not guarantee a specific outcome, but I believe it gives the best possible chance that the person will feel cared about by you, make the decision for themselves, and have the most realistic expectations possible going into therapy. Let me know if this helps!

It’s one of the most important questions in therapy. It’s stereotypical. Sometimes, it’s disruptive. It can lead to anxiety and self-examination.

And it’s not going away.

Your therapist asking you what you’re feeling is a staple of most forms of counseling, and for good reason.

What you do with the question can begin to free you.

Yes, we all know therapy is about feelings. Before any of us stepped into a therapist’s office, we probably saw a cartoon, TV show, or movie in which a therapist asked the person sitting across from them: “How does that make you feel?”

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The thing is, people come to therapy for a million different reasons. It could be to deal with depressive or anxious symptoms, trauma, or unhealthy expressions of anger. The list could go on and on.

Few people come to therapy with the stated goal: “I want to better understand and connect with my feelings.” For everyone else, it may not seem productive to be asked each week about what they’re feeling. All they know is they want to feel better!

A common response to the feelings question is frustration and annoyance. Especially if it occurs during a the telling of an event or a story from the past. If you’re focused on something from the weekend or from work, the feelings question may disrupt your flow.

Well-timed, the question can lead to breakthroughs regarding unhelpful patterns, difficult feelings, and negative interpersonal relationships.

Of course, it could be an ill-timed question by the therapist. Maybe it would be more helpful if they waited a bit longer to move you toward reflection. Maybe not, though. Perhaps the question is coming from the therapist’s sense that there are feelings you may be unaware of.

Well-timed, the question can lead to breakthroughs regarding unhelpful patterns, difficult feelings, and negative interpersonal relationships. It can reconnect you with any feelings you may be trying to avoid by overthinking the situation.

So, yes, the question may be an attempt to interrupt and go deeper. But if it’s making you angry, tell your counselor. That’s important information too.

This Is Not a Test

A common response to the feelings question is anxiety or, worse, a sense you’re doing something wrong if you’re not sure what the feeling is. Suddenly, it may feel like you’re being “quizzed” or tested.

This, too, is important information to bring up. The intention is (hopefully!) not to make you feel like a failure. You’re in therapy to learn about yourself and how to better understand your feelings. You’re not expected to know all the answers, let alone anticipate questions. Speak up if you sense pressure to perform or expectation from your counselor.

Remember that “I don’t know” is an acceptable answer. You may not be aware you’re having a feeling because you don’t tend to stop and check in with yourself. If the feelings question comes up, it’s a chance to do that.

And maybe you’re having zero feelings in that moment. Again, good information.

The Feelings Layer Isn’t the Only Layer

Becoming more aware of how you’re feeling at any given moment is not the only aspect of emotional well-being, but it’s an important layer to explore. Knowing your feelings may help you understand your actions better. It can inform your future choices.

Becoming aware of your feelings may help you feel less helpless. It may help you feel more in control.

Perhaps best of all, knowing your feelings gives them less control over you.

Dear new client: Welcome to the wonderful world of therapy! I know it can be hard to come in for your first appointment—really hard. You are here to meet me, a stranger who will hear about parts of your life that no one else hears about, and entrust I will do everything I can to help you. To make things easier, here are 10 crucial things I want you to know.

1. Honesty is the best policy.

If you’re not honest in the therapy space, you’re missing out! This is a rare opportunity to be 100% honest without the prospect of being judged. You’re paying for therapy, so lying is counterproductive. Are you using drugs? Tell me. It helps me better understand and work with you on everything from coping skills to medication use and interactions, to social skills, to behaviors that may or may not be attributed to substance use, to relationships, to even finances. Cutting? Tell me.

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2. Therapy is an investment in both the present and the future.

The skills you learn here, and the support and insight you receive, will not only help you with the situation you’re in, but will become part of the “toolbox” on your lifelong journey. You’ll gain knowledge that improves your ability to cope with stress and mood swings, helps your understanding of why and how you do things, and facilitates communication between you and others in your life including loved ones, friends, and business connections.

3. Keeping appointments and being on time is critical.

Part of therapy is consistency. If you’re late, we not only have less time together, we also have to think about the reasons you’re not arriving on time. Making therapy a priority is important. And yes, you may be charged a fee if you don’t show up or you cancel late. The time you’ve reserved is yours and yours alone. When you don’t show up, two things happen: other people needing help who would love to have your time slot are not able to, and I don’t get paid for my time. I rely on this in planning my family and work finances.

4. If you have any concerns, tell me.

I can’t fix or address what is wrong unless I know about it. I won’t get angry or offended or lose my cool. Therapy is all about the therapeutic relationship between the therapist and the person in therapy. If you’re offended about something I said or how you feel treated or mistreated, give me a chance to help you understand or change things. Some things that may seem trivial, such as the fear of being overheard by others in the waiting area, can be addressed and/or explored. If you’re worried because I seem angry, let’s talk about that. My thinking face can look like a grumpy face at times. Knowing your concerns and allowing me to address them is a way to work on empowerment.

5. Nothing is off limits.

Don’t be embarrassed to bring up things, even uncomfortable ones such as sexual experiences or feelings, anger or rage, dreams or fantasies. Believe me, I’ve heard and dealt with nearly everything. I’m not easily embarrassed or fazed. You can also say something such as, “There is something I really want to bring up, but I’m embarrassed.” I’ll help you work through your feelings, and even if you don’t talk about it right away, we can work toward creating a space where you feel okay sharing it.

6. Don’t worry about me.

I have support systems in place if I need help. I seek supervision from peers or others who have more expertise in a given area than I do. Therapists don’t operate in a vacuum, nor should they. I can handle your anger, sadness, and grief. I also know my limits. This is why some therapists refer people to other therapists for some issues. If, for example, I am uncomfortable working with someone who is struggling with a terminal illness because it’s outside my expertise, I will help you find someone who can better assist you.

In the case of therapy, if I were to have an outside relationship with you, I couldn’t be a productive or helpful (or ethical) therapist. Unlike a friendship where both people support each other, my only focus when we meet is you.

7. There’s a good reason I can’t have a friendship with you.

It’s the same reason I can’t be my friend’s therapist. It’s called a dual relationship, which basically means being two things at once to someone. In the case of therapy, if I were to have an outside relationship with you, I couldn’t be a productive or helpful (or ethical) therapist. Unlike a friendship where both people support each other, my only focus when we meet is you. My years of training, supervision, and experience are all focused on helping you.

8. I’m not perfect by any means.

I run late sometimes. I may miss an email or forget to return a phone call. This doesn’t happen often, but if it does, please let me know. In the case of running late, I will make up the time either at the current session or at a later time. If it bothers you, let’s talk about it. Again, nothing is off limits.

9. What you say to me stays with me, with two exceptions.

The exceptions are if I feel you are going to kill yourself or hurt someone else, or if I suspect there is child or elder abuse or neglect. This doesn’t mean if you say you wish you were dead I’ll call the police. But if you mention a plan or I feel like you are on the edge of suicide, I have to take action to ensure the safety of you and others.

10. When you’re ready to leave therapy, that’s great!

It’s something you might be thinking of or I may bring up. Please don’t just stop coming in. Let’s talk about it. If you abruptly leave without letting me know, I am likely to be both confused and concerned for your well-being. The preferred method of ending therapy is to have at least one session where we talk about what we’ve achieved and where to go from here. Closure is important for both of us. You are always welcome back—be it in a month, a year, or five years.

Again, welcome to therapy. I’m glad you’re here. Let’s start this journey together.

Do you have strong interpersonal skills and a passion for helping students navigate the world of education? If so, you could excel as a school counselor. School counselors provide resources for students who want to learn how to pursue their academic and professional futures, and they also work with students who have learning difficulties or mood issues that interfere with their success in school. Whether providing K-12 education support, helping undergraduates navigate the world of higher education, or getting students to the next step in graduate school, thousands of opportunities for school counselors exist.

Like many health-related fields, specific requirements for becoming a school counselor can vary from state to state, so check with the American School Counseling Association for details. Otherwise, read on to find out how you can get started.

1. Lay the Foundation with Undergraduate Studies

As with similar fields of study, people intending to become school counselors will need a substantial academic background. Your first step is to decide where you want to go to college and apply. Depending on your current level of education, this could mean applying for an undergraduate or graduate program. While your undergraduate degree is not typically required to be in education or counseling, it is often helpful to choose a major that reflects knowledge and understanding of the theories and practices required for counseling. Students who major in subjects such as psychology, sociology, or counseling may find they have acquired a feel for the work involved with becoming a school counselor, and as an extension, are well prepared for their graduate studies. [fat_widget_right]

2. Get Your Master’s Degree in School Counseling

Depending on your program, receiving a master’s degree means learning counseling and guidance techniques for multiple age groups and ability levels. During this process, which may take 1-2 years, you can explore areas of specialization, such as K-12 education, behavior issues, or education for children with developmental delays. According to US News & World Report, some of the top-rated counseling programs in the country are at University of Maryland, College Park, and University of North Carolina, Greensboro. However, there are many worthwhile programs across the country depending on your preferred home base.
Infographic by Hannah Johnson

3. Work Under Supervision After Graduation

During or after your study program, you can intern or complete a practicum as part of your course requirements. Many programs set a certain number of these hours for you to complete, either as a graduation requirement or part of your future doctorate studies, if you decide to pursue that course. For example, one school counselor program might require 100 practicum hours, 40 of which are in direct contact with K-12 students. Additionally, to take the licensing exam to become a school counselor, you must have completed hundreds of hours of practicum or internship work.

Get familiar with the day-to-day workings of your site and don’t be afraid to ask your supervisor for any tips or important things to know while working there—it is better to ask more questions than less, especially when you are still in a learning environment.

During your school counseling internship or practicum, you will get hands-on experience in the field, generally at a school site you have chosen. You will perform most of the duties associated with your field under the direct supervision of both an on-site supervisor and your instructor or supervisor on campus. Get familiar with the day-to-day workings of your site, and don’t be afraid to ask your supervisor for any tips or important things to know while working there—it is better to ask more questions than not enough, especially when you are still in a learning environment.

4. Get Licensed as a School Counselor

After completing your educational and working hour requirements, it is time to become a board certified school counselor. First, you will need to know your state’s requirements, as they vary. The National Counselor Examination (NCE) is a 200-item exam you might sit for, as it is required to become licensed in most states. It may also be required for a national license or any potential military work you are interested in doing. The NCE website lists all the requirements for the exam and provides information on where to take it in your state. It’s a good idea to study and prepare for this exam like you would for other important, long-term tests. Find example questions from past exams and consider borrowing or ordering an NCE test prep book, which will contain helpful strategies and tips for passing your NCE successfully.

5. Optional Credentials for School Counselors

Before hiring you, most schools will prefer that you have one to two years of hands-on classroom experience. You may also need to get a teaching certificate or license. Research your state’s teaching certificate requirements, as these can differ depending on the education system. Additionally, you can pursue specializations such as career counseling or an emphasis in students experiencing addiction.

6. Get Hired as a School Counselor

The field of school counseling has many opportunities and benefits: more than 200,000 school counselors are employed every year as of 2014, and the profession has a median salary of $50,000 a year. Most educational institutions, whether K-12 schools or colleges, need counselors. Openings for these positions are generally posted through school districts or university careers sites for internal positions. You might begin your job search by researching where you would like to work and begin looking for school counseling postings in that location or ask your own college counselor for help finding a placement. Sometimes the connections you make during your internship or practicum hours can lead to future employment opportunities.

References:

1. Danzinger, P. & Newman, H. (2011). School counseling concentration practicum/internship handbook. William Patterson University College of Education. Retrieved from https://www.wpunj.edu/dotAsset/315254.pdf
2. National counselor examination for licensure and certification. (n.d.). National Board for Certified Counselors. Retrieved from http://www.nbcc.org/Exams/NCE
3. School and career counselors: Summary. (2017, October 24). Bureau of Labor Statistics. Retrieved from http://www.bls.gov/ooh/community-and-social-service/school-and-career-counselors.htm#tab-1
4. School counseling degree programs & schools. (n.d.). Retrieved from http://careersinpsychology.org/degree/school-counseling
5. State certification requirements. (n.d.). American School Counselor Association. Retrieved from https://www.schoolcounselor.org/school-counselors-members/careers-roles/state-certification-requirements

Structured self-help programs, which allow participants to give themselves therapy, may work just as well as psychotherapy with a therapist, according to a study published in the journal Administration and Policy in Mental Health and Mental Health Services Research.

The study was a meta-analysis that analyzed data from previous studies of cognitive behavioral therapy (CBT). CBT is a semi-structured approach to therapy that encourages participants to recognize, understand, and correct automatic thoughts that lead to painful feelings and self-defeating habits. Because CBT focuses on addressing and correcting specific thought patterns, it is possible to distill its principles into a self-help program.

The study points to the value of self-help programs for those reluctant to share their experience with a therapist, those who can’t afford therapy, or those who can’t access a local therapist.

Is Do-it-Yourself CBT Just as Good as Therapy?

The analysis gathered data from 15 previous studies of 910 participants. Each study randomized participants to receive either self-help CBT or traditional CBT through a therapist. A total of 723 participants completed the treatment program. Participants used CBT for a variety of mental health issues, including depression, anxiety, and posttraumatic stress (PTSD).

[fat_widget_right]Researchers found no differences in completion rate between self-help and therapist-delivered CBT. Treatment outcomes were also broadly similar. This suggests both self-help and therapist-based programs can offer symptom relief.

Could Self-Help Programs Replace Therapy?

The study’s authors say self-help programs could be a good first line of defense against mental health issues. They don’t advocate an end to therapy. The analysis only examined self-help CBT, so the findings don’t extend to other types of therapy. A therapist can be helpful for exploring different types of treatment options, and some people in therapy may not have the motivation to keep up with a self-help program on their own.

Outcomes varied in both groups. In the self-help group, there was greater variability. The study did not directly assess why this might be, but its authors suggest the therapist may play a key role in standardizing outcomes. The therapeutic relationship could be a valuable tool for counteracting negative emotions in therapy, and this might ensure more standardized outcomes in people seeking therapy from a therapist.

This supports past research that suggests the therapeutic relationship is a key to therapy’s success. However, the study did not find significant differences between therapists. This may mean the competence of an individual therapist is secondary to the therapist’s ability to follow a standardized treatment program and respond to negative emotions.

In terms of access to mental health treatment, the study shows self-help programs may be an effective interim treatment until an appointment with a therapist can be made.

References:

1. Brown, M. (2017, August 23). Be your own therapist? Fine – if you’re up to the job. Retrieved from https://www.theguardian.com/commentisfree/2017/aug/23/therapist-self-help-therapy
2. King, R. J., Orr, J. A., Poulsen, B., Giacomantonio, S. G., & Haden, C. (2017). Understanding the therapist contribution to psychotherapy outcome: A meta-analytic study. Administration and Policy in Mental Health and Mental Health Services Research.

People enter psychotherapy with the desire to feel better, but they are often unsure how therapy will help them accomplish this goal. A common refrain from people hesitant to enter therapy is, “How is talking going to help?” People are used to talking to other people to get practical solutions to problems, and while problem-solving does have a place in therapy, change also occurs on a much deeper and unconscious level. This process has to do with the way the human brain is programmed and cannot easily be mimicked outside of a relationship with a psychotherapist.

Our brains are always evolving unconsciously through our relationships. People who experienced painful relationships growing up have been trained to expect hurtful experiences with others. It takes a new type of relationship—in particular, a therapeutic relationship—to retrain the brain to expect more positive experiences, which is a big part of ultimately feeling better.

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Why Can’t a Therapist Just Tell Me What to Do?

To understand why the therapeutic relationship can be so valuable and cannot be mimicked by, for example, advice in a self-help book, it is instructive to look at how the human brain has evolved. Broadly, there are three parts of the human brain that represent different phases of evolution: There is the reptilian brain, which evolved first and is responsible for the automatic control of vital bodily functions such as breathing; the limbic brain, which evolved second and is responsible for the regulation of emotion and behavior; and the neocortex, which evolved last and is responsible for higher-order functions such as symbolic thought, language, and reasoning.

When a person asks their therapist or a friend what they should do about something, they are essentially asking for a neocorticol solution—something that is rational and can be consciously implemented. Often, however, their problems are a result of hurtful experiences in their earlier relationships that have caused changes in their limbic brain, and only a new type of relationship can alter their limbic brain to produce fewer negative emotions and more positive ones.

Brain Wiring in Our Youth: How Emotional Issues Begin

Our emotions are meant to help us survive in a world in which we need the help of others. Over time, our limbic brains evolved to automatically create emotions, such as anger and sadness, that are meant to help us navigate the social world. When someone mistreats us, evolution has programmed us to become angry to try and change their behavior. When someone rejects us, we feel sad so we can mourn the loss of what we wanted with them and move forward with our lives.

However, when we are young and particularly dependent on others for survival, whether our emotions actually help us navigate the world has a lot to do with how other people—our parents in particular—respond to them. A child who responds to unfair or disappointing experiences with anger and is further punished for doing so may, over time, come to unconsciously pair the expression of anger with pain. As this occurs, rather than directly experiencing anger at times of unfair treatment or disappointment, they may instead experience anxiety about having anger because their brain has been trained by their social environment to expect that anger will hurt rather than help. Their limbic system is in effect attempting to prevent further emotional pain in the form of being punished, but the cost is another type of emotional pain in the form of persistent anxiety. This can be particularly problematic when people enter into new relationships (friendships, romantic relationships) where there would not be the same costs associated with the open expression of an emotion like anger, but earlier experiences still create anxiety and inhibit its expression.

Retraining the Brain with Psychotherapy

A psychotherapy relationship allows a person to essentially retrain their limbic system to no longer expect negative reactions to the expression of certain emotional experiences, and in doing so can alleviate the anxiety and unconscious emotional suppression their earlier experiences programmed into them. The therapeutic relationship does this in part because the parameters of psychotherapy recreate the type of relationship in which a person was first forced to suppress their emotions: one where they are dependent on another person to meet their needs.

A successful course of therapy helps restore a person’s emotional flexibility and empowerment so they can have greater agency in their relationships.

Just as a parent has a daunting task in meeting all of a child’s needs, so too does a psychotherapist, especially since many people arrive to therapy wanting a conscious, rational solution to their problems when such a solution often does not exist. Therapy presents a unique opportunity to heal and feel better by the way the therapist solicits and responds to feelings such as disappointment, anger, and sadness that emerge over the course of treatment. Rather than punishing a person for having these emotional experiences in the same way that may have occurred when they were younger, a therapist can actively solicit, explore, and normalize their feelings. This helps to retrain a person’s limbic system to no longer pair the expression of those emotions with punishment. As this de-coupling unconsciously occurs, the person becomes more easily able to tolerate the experience and expression of emotions.

Thriving in Adulthood

This shift in tolerance for emotions naturally causes a person’s anxiety level to diminish because their mind is no longer fighting to ward off their innate emotional impulses. In addition to symptom relief, the beautiful part of this process is it restores a person’s ability to constructively access their emotions for their original purpose—as a way of helping to navigate the social world. It is hard to thrive in relationships when we have been programmed to believe we must accept the mistreatment of others or that we cannot show others when we are hurting and in need of care. As adults, this is often no longer the case, but our early experiences may make such underlying beliefs unconsciously feel true.

A successful course of therapy helps restore a person’s emotional flexibility and empowerment so they can have greater agency in their relationships. The result can be genuinely transformative, and studies suggest people who have been through therapy show less activity in the areas of the brain responsible for creating negative emotions. Talking, it turns out, can help quite a bit when the person you are talking to is a skilled and compassionate therapist.

If you’re struggling, reach out to a therapist in your area for help.

References:

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