Dispel Medical Myth #1: I Don’t Need Therapy Because…
As we head back to work and to school, now is the perfect moment to ask ourselves:
What does it mean to be well?
This is the central question of our time as we navigate an unprecedented era of disease, misinformation, and medical vulnerability. We were wired and tired well before COVID. The pandemic laid bare how very unwell we were — and how desperate we are for straight talk and trusted guides to shepherd us through hard times.
If you’re living your best life, congrats! (Please tell me what you’re smoking.)
But let’s face it: The pandemic has taken a toll on each of us. It has affected our routines, relationships, and everyday sense of safety. It has generated anxiety and fear. It has driven more and more people to self-medicate with alcohol, food, and other substances. We have all experienced grief in one way or another.
We are less healthy than ever before. We scroll through social media for wellness memes and quick hits of Dopamine. We are irritable and sleepless and don’t know what’s wrong. Worse, we don’t even know who to talk to and who to trust.
Which is why I’ll spend the next six weeks dispelling six common medical myths and mistaken beliefs that patients bring into my office and that keep them from feeling — and being — actually well.
Some are assumptions that patients make about themselves, like “I can’t [lose weight/quit drinking/leave my unhappy marriage].” (Spoiler alert: with the appropriate structure and support, they can and do!) Others are fixed, firm beliefs pulled from the internet, a cultural construct, or well-meaning friends or family, like “Hormone replacement therapy causes breast cancer, so I know I can’t take it.” (Newsflash: HRT is safe and appropriate for many women.)
This is not to suggest my patients aren’t smart or generally well-informed. In the digital age, it’s normal to crowdsource our problems and seek advice from Dr. Google and our social network. (Ask me about my “self-diagnosis-a-day” during medical school.)
So join me as I dismantle some mythology and help reframe your thinking about common medical issues.
MYTH #1: I don’t need therapy because [I have supportive friends/I’m not that bad off/No one can make this problem go away].”
Psychotherapy is a proven treatment for common conditions like anxiety, depression, substance use disorder, bipolar disorder, and PTSD. It’s also appropriate for people dealing with a variety of other problems like marital distress, grief, and parenting challenges.
In other words, you don’t have to be in crisis or carry a specific diagnosis to benefit from talk therapy. Just like exercising helps prevent heart disease, bolstering our coping kit with a trained mental health professional can help prevent further distress. As I said to a patient last week, “Let’s help you be in control of your emotions instead of your emotions controlling you.”
Most of my patients are glad for the recommendation, relieved to have a place to talk through complex social, emotional, behavioral and/or relationship issues. But there are three common refrains I hear from people when I suggest it.
“So you think I’m that bad off?”
Some patients worry that I even suggested counseling. The idea of needing extra support can generate anxiety and feel threatening in and of itself. This is when I smile and remind the patient that they’re not broken — and that it’s normal to experience a wide array of emotions and to sometimes need help coping with them.
Just like I recommend physical therapy for various skeletal woes, I routinely suggest psychotherapy to patients to work on emotional fitness. I tell patients that therapy is like going to the brain trainer, the cognitive behavioral gym. It’s a place to unlock tight mental muscles and to strengthen the weak ones. It’s a place to fact-check our thoughts and internal narratives; to work on accepting things we cannot control and reclaim agency over the things we can control; and to practice new vocabulary when talking to other people and to ourselves.
Other patients recognize they need help, are loath to take medications (more on that in a future post), and ask me if therapy is really necessary. I get it. Therapy can be expensive. It also takes time and energy to find the right fit with a counselor. Therapy can also be hard. Plumbing the depths of our interior worlds is akin to cleaning out an attic closet: We make a huge mess before we sort through the piles and put things back in order.
“I have supportive family and friends.”
Leaning on loved ones is a healthy way to cope with stress. But it’s often not sufficient. Our friends and family aren’t trained therapists. They can’t always hold our feet to the fire; there’s too much at stake. They’re also inherently biased. They have preconceived notions of how we should think, feel, and behave which can prevent you from gaining new insight into your own problems.
Unlike talking with a friend, therapy isn’t a place to seek approval, sympathy, or a preordained opinion. In addition, leaning on loved ones can over-burden them. Interpersonal relationships are two-way streets. Heavily relying on a friend or partner for emotional support without an appropriate give-and-take can stress the relationship and do more harm than good.
“No one can make this problem go away.”
While it’s true that no therapist can change difficult people or situations in our life, this isn’t the point of therapy in the first place. Therapists cannot cure infertility, bring back a lost loved one, or parent a challenging kid.
The goal of therapy is not to eliminate stress; it’s to better tolerate it. When we fortify our reserves to better cope with life’s inevitable potholes, we are healthier, mentally and physically.
Let’s be clear: Therapy isn’t appropriate for every person. Not everyone is ready or willing to engage in therapy. Sadly, therapy isn’t always affordable or feasible. Nor is therapy a panacea. It can sometimes even do harm. I’ve seen patients spend decades in therapy for issues that would have been more appropriately addressed with medication, behavioral change(s), a different type of therapy, and/or another treatment modality altogether.
For these reasons, I urge patients to engage in therapy only if they are willing and able to invest in the process — financially and emotionally — and to be vulnerable, honest, and open to change. I choose therapists who are empathic yet firm, who understand the medical and social context of the patient’s issues, who recognize the limitations of therapy, and who work in tandem with the patient’s medical and psychiatric team as needed.
How do you know if therapy is working?
Let’s revisit the exercise analogy. You know you’re getting more fit when you’re huffing and puffing on a power walk, jog or bike ride — and/or when you’re a little sore a day after a gym session. You know you’ve pushed yourself too hard, fast, or soon if you’re in pain. Similarly, you’re probably benefiting from therapy if you’re stretching your thinking, challenging unhealthy behaviors and/or feeling more in control of your emotions. If it feels too hard, you might ask yourself: Do I feel safe? Am I communicating my needs, goals, and emotional limitations? Is it time to consider medication to help my underlying [anxiety/depression/complicated grief] in order to get more out of therapy?
And if therapy feels too easy, you might ask yourself: Is this the right therapist? Am I trying too hard to be liked? Am I withholding information and/or being totally honest? Still not sure? Keep a journal to track your progress. Ask your friends and family if they notice. And ask your therapist!
It takes a village to be healthy. If you are lucky enough to afford therapy and to find the right person, be patient with the process. Use it as an opportunity. Lean into discomfort. Dare to make changes.
You’re not crazy, you’re human.
In my village lives Phyllis Fagell, LCPC, a seasoned school counselor, author of
Middle School Matters, and mother of three. Phyllis knows exactly how fraught — and potentially how fabulous — adolescence can be. On this episode of Beyond the Prescription, Phyllis dispenses practical advice and personal anecdotes on tolerating distress and approaching the school year with optimism.
As parents brace for an unpredictable autumn, Phyllis’ wisdom is just what the doctor ordered! As always, my newsletter subscribers get early access to the pod every Monday night before the official Tuesday launch. Give it a listen now on
Apple, Spotify, or wherever you find podcasts.
I will see you next week. Until then, be well.