When to start getting therapy
In the last few years of talking about my journey with mental illness, the question I get most often is “How do I know if I should get therapy?” implying that a certain minimum level of severity is required in order to start. My default answer has always been to say that everyone can benefit from therapy and if you can afford it, you should go.
But today I came across a thread on twitter that answered the question of when to start very clearly. I’ve reposted his thread (with permission and minor formatting edits) as a post here:
“Let’s talk about when it is time to go to therapy and the threshold needed for that to happen. It is a question I get very often. Let’s divide these into 4 categories: prevention, mitigation, treatment and intensive treatment.
These categories play a different role in terms of what they can achieve. Prevention is when there are no visible symptoms or presence of mental health issues but someone knows that there are many stressors out there and fear that this may lead to symptoms appearing soon.
Prevention forms of treatment are the least that I have encountered in my career. Most of us won’t think about an issue before it appears, but learning some skills and ways to manage our mental health is one of the best things we can do and requires less sessions to do so.
Mitigation is when something is just appearing, and we want to stop it from getting worse. Let’s say someone has panic attacks once every 2 months and still wants to make sure they don’t come back, we would do mitigation treatment, to see what can be done.
Generally, these would be sessions that we have once every 2 weeks or once a month because they are not in need of treatment right away but it helps to have coping mechanisms and learning the root causes before it gets worse.
Mitigation is a great form of treatment, similar to prevention because we are making sure the issues are dealt with before they impact quality of life all the time. They also don’t require as many sessions to be able to recover, because they started treatment very early.
Treatment is when someone’s mental health is already affecting their quality of life, they tend to have less productivity, many symptoms already present, and need treatment in order to get better. This is our standard treatment for depression, anxiety or something else.
These are sessions that generally happen once a week or once every two weeks. These are individuals whose personal and professional life are suffering. It is where most people fit when it comes to therapy.
The last one is intensive treatment. This is for when the presenting issue has gotten to a point that it is very severe. There is generally self-harm tendencies or an immediate need to keep them safe and work quickly in order to help them feel better.
While it doesn’t happen too often, it is not rare either. These are generally individuals that would need more than 1 session a week, and check-ins everyday to ensure their safety. If it continues getting worse, this is when hospitalization is necessary to stabilize everything.
I hope that separating treatment into these 4 categories helps in seeing what types of treatment we give depending on circumstances. The easiest is prevention and mitigation because the work can happen quickly, but sometimes things get worse quickly and we move into treatment.
Finally, if you are hesitating about whether to go to therapy or not, the answer is probably yes. That means you are realizing something is not going well. Trust your instinct and start therapy. The worst that can happen is your therapist will say there is nothing to worry about!
Omar Bazza is a therapist based in Canada whose twitter threads and Q&As have helped me answer a lot of questions that people come to me with. I’m not a therapist myself so I often link to existing literature or information about mental health and Omar has become one of those great resources. You can find him on Twitter and Instagram.
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