“There’s nothing wrong with me. I should be able to deal with this myself.”
It is a thought many people have before considering therapy.
Perhaps you have always been the person who copes. You go to work, look after other people, deal with whatever needs dealing with and carry on. From the outside, everything may look perfectly fine.
But coping and feeling well are not necessarily the same thing.
You do not need to be in crisis, have a mental-health diagnosis or feel that something is fundamentally “wrong” with you before you are allowed to ask for help.
Sometimes therapy is simply about recognising that something has become difficult and deciding that you would like it to be different.
Why can asking for help feel so difficult?
Despite much greater openness about mental health in recent years, seeking psychological help can still feel surprisingly uncomfortable.
Some people worry that needing therapy means they are weak, unable to cope or somehow failing at something that other people seem able to manage.
Research suggests that worrying about what others think about them asking for help can affect whether people seek support.
A large systematic review involving more than 90,000 participants found that mental-health-related stigma was associated with reduced help-seeking. Concerns about disclosure and people’s own beliefs about mental-health treatment were particularly important.
A later meta-analysis involving more than 54,000 people similarly found that self-stigma around seeking help was associated with less positive attitudes towards getting psychological support and lower intentions to seek it.
In other words, sometimes it is not simply the difficulty itself that stops someone seeking help. It is what they think needing help says about them.
“I should be able to sort this out myself”
Self-reliance can be a strength.
Most of us solve countless problems without professional help, and having confidence in our own ability to cope is generally a good thing.
But self-reliance can become less helpful when it turns into a rule:
“I should always be able to cope on my own.”
We rarely apply the same standard to physical health. If you had persistent pain, you probably would not conclude that seeing a physiotherapist demonstrated a lack of character. If your eyesight changed, you would not expect yourself to correct it through willpower.
Psychological difficulties are different in some ways, but the principle is similar.
Sometimes an outside perspective, some specialist knowledge and a structured approach can help us understand something that has become difficult to see clearly from the inside.
Seeking that help is not the opposite of coping. It can be one way of coping effectively.
You don’t have to wait until things become unbearable
Another common belief is:
“I’m not bad enough for therapy.”
People sometimes imagine that psychological therapy is only for severe mental illness or for people who can no longer function.
It isn’t.
The NHS explicitly states that you do not need to have a diagnosed mental-health condition to access talking therapies. Psychological therapies are used for problems including persistent worry, low mood, panic, phobias and difficulties associated with long-term physical conditions.
Someone can also be functioning very effectively in some parts of life while struggling considerably in another.
You might be doing your job, looking after your family and meeting all your responsibilities while also:
- lying awake worrying at night
- avoiding situations because they make you anxious
- experiencing panic attacks
- feeling constantly tense or overwhelmed
- struggling with a habit you cannot seem to change
- becoming increasingly restricted by a fear or phobia
- repeatedly telling yourself that you should be coping better.
You do not have to reach breaking point before any of these things deserve attention.
Why problems don’t always disappear by themselves
Sometimes difficulties do improve naturally.
A stressful period passes. Circumstances change. We adapt. Something that seemed overwhelming becomes manageable again.
So it would be wrong to suggest that every worry or difficult period requires therapy.
But some patterns persist because the things we understandably do to cope with them can accidentally keep them going.
Take anxiety.
You feel anxious about doing something, so you avoid it.
Avoiding it brings immediate relief.
That relief teaches you that avoiding the situation was useful — perhaps even necessary.
The next time the situation arises, it can feel even more threatening.
Or perhaps you are worried about your health. You repeatedly check your body or search online for reassurance. You feel better for a few minutes, but then the uncertainty returns and you check again.
These cycles are not a sign of weakness. They are understandable ways of responding to distress.
The difficulty is that strategies which help in the short term do not always help in the longer term.
Therapy is not about being told what is “wrong” with you
For many people, one of the most intimidating parts of considering therapy is wondering what the therapist will think of them.
Perhaps you worry that your fears will sound ridiculous, that you will be judged, or that talking about something will somehow make it more real.
Good therapy should not feel like someone sitting opposite you deciding what is wrong with you.
It should be collaborative.
Within cognitive behavioural approaches, for example, therapist and client work together to understand the connections between situations, thoughts, emotions, physical responses and behaviour.
The NHS describes talking therapy as an active process in which the therapist and client work as a team to understand difficulties, identify goals and practise useful changes both during and outside sessions.
That is quite different from the idea of simply lying on a couch while somebody analyses you.
Sometimes we simply can’t see our own patterns
All of us have ways of thinking that have developed through experience.
We make assumptions. We predict what other people are thinking. We imagine what might happen next. We develop habits designed to protect ourselves.
Most of the time we do this without consciously analysing it.
That can make certain patterns difficult to recognise.
For example:
“If I don’t do this perfectly, people will think I’m incompetent.”
“If I start feeling anxious, I need to get out of the situation.”
“If I say no, I’ll let everyone down.”
“I must be certain nothing is wrong before I can relax.”
These beliefs may have made sense at some point. They may even have helped you.
Therapy gives you an opportunity to become curious about them.
Where did this idea come from?
Is it still helping me?
What do I do because I believe it?
And what might happen if I tried responding differently?
Where does cognitive behavioural hypnotherapy fit?
My own approach is cognitive behavioural hypnotherapy (CBH).
This combines cognitive and behavioural methods with hypnosis, imagery and focused attention.
Importantly, hypnosis is not used because I think someone needs to be “fixed”, nor is it a way of taking control away from them.
The cognitive behavioural part helps us understand what may be maintaining the difficulty. We can then use hypnosis and imagery to rehearse alternative ways of thinking, feeling and responding.
For example, someone who fears public speaking may already know logically that making one small mistake would not be disastrous.
But knowing that intellectually and feeling able to stand in front of a room while anxious are different things.
Therapy might involve examining the person’s predictions, gradually changing avoidance or safety behaviours and using hypnosis to mentally rehearse coping successfully with the situation.
The client remains an active participant throughout.
Finding the right support
Different problems require different types of support, and hypnotherapy will not be appropriate for every mental-health difficulty.
If you are struggling with anxiety, low mood or another mental-health problem, you can speak to your GP or, in England, self-refer to NHS Talking Therapies for many common difficulties without needing a formal diagnosis.
If you choose private therapy, it is reasonable to ask about the practitioner’s training, professional registration, therapeutic approach and whether they have experience working with the problem you want help with.
And if you are experiencing a mental-health crisis or feel that you may be at risk of harming yourself or someone else, seek urgent help rather than relying on private hypnotherapy. NHS 111 can provide urgent mental-health support, while an immediate emergency requires 999 or A&E.
Sometimes reaching out is the difficult part.
But you do not need to prove that things are bad enough, and you do not need to decide that there is something “wrong” with you first.
Wanting things to feel different is reason enough to start a conversation.
References
Clement, S., Schauman, O., Graham, T. et al. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. DOI: 10.1017/S0033291714000129.
Schnyder, N., Panczak, R., Groth, N. & Schultze-Lutter, F. (2017). Association between mental health-related stigma and active help-seeking: systematic review and meta-analysis. British Journal of Psychiatry, 210(4), 261–268. DOI: 10.1192/bjp.bp.116.189464.
Xu, Z., Huang, F., Kösters, M. et al. (2018). Effectiveness of interventions to promote help-seeking for mental health problems: systematic review and meta-analysis. Psychological Medicine, 48(16), 2658–2667.
NHS. Talking therapies.
NHS England. NHS Talking Therapies for anxiety and depression.