I believe being in therapy is more normalized than it has ever been. Even so, the sad fact remains that when researchers ask people what keeps them from seeking help, the answer given most often is concern about how others will see them (Corrigan, 2004). Not cost, and not time. Our efforts to get rid of stigma clearly have a long way to go, and I think therapists have to lead the way. This is what that looks like in my practice, and in my own life.
I ask about the fence
When I begin a new counseling relationship, I make a point of finding out what the person believes about seeking help. Some arrive with a clear idea. Others, especially those who are new to therapy, are at a loss, or come in with assumptions grounded in stereotypes they picked up from family, church, or the group chat: therapy is for broken people, strong people handle it on their own, once you start you never stop.
The point is, I ask. Counseling, therapy, and "treatment" can be a scary concept, let alone a reality, and I would rather bring those assumptions into the open than let them sit unspoken in the room with us. In my experience there are usually two voices on that fence. One is curious about growth. That is the voice that got you reading this. The other is fear-based, and it argues for staying comfortable and unexamined. You get to choose which one to take advice from.
Nothing about you gets decided without you
A good deal of stigma comes from misconceptions about what words like depression, anxiety, and bipolar actually mean, so it makes sense that people are leery of having a label applied to them. In my private-pay practice, no insurance company requires a diagnosis before we are allowed to begin, so nothing gets labeled for billing's sake. When a diagnosis is useful, and sometimes it is, I am transparent about it. I will open the DSM-5 with you and we will cross-check the criteria against what you are actually experiencing. A diagnosis is merely a shared language for a set of symptoms that tend to appear together. I have found that people who participate in that process, rather than having it done to them, often come away feeling more empowered, not less.
The best stigma-buster I know
Most importantly, I engage in my own therapy, and I say so. I disclose it to the people I work with when it is appropriate, to friends and colleagues, and to the occasional stranger in the grocery store checkout line. Every time a therapist talks openly, even proudly, about being in therapy, I can't help but think stigma takes a big hit.
Most clinicians I have met are, after all, quite human. We go through the normal ups and downs of life, and no amount of education or experience makes us immune to the issues we help other people manage. Sitting on the other side of the couch keeps me honest about how difficult it is to share the vulnerable parts of your life with a stranger. It also lets the people I work with see what a person who seeks help looks like. They look like everybody.
Most clinicians I have met are, after all, quite human. We are not immune to the things we help others with.
So if you are on the fence, you do not need a crisis, a diagnosis, or a rock bottom to justify climbing over. And if you are a fellow therapist who has wondered what it is like to be on the other side of the couch, the same invitation applies. As I often say to my new clients, therapy is an experiment. If the status quo is not working for you, give it a shot and see what happens. The first conversation is a free phone call, and the fence looks smaller from this side.
Mandy first explored these ideas in “The Best Way Therapists Can Decrease the Stigma of Being in Therapy,” published on GoodTherapy.org. This piece is a new take, written for life here in Florida. It’s education, not a substitute for care from a licensed clinician.