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by throwatherapy 855 days ago
Although the OP may indeed be well advised to consider whether there is an underlying psychological issue, "just trying therapy" is bad advice.

Therapists are not trained in diagnosis. Just trying therapy is like finding that your house is damp, and picking randomly from the list of tradesmen that might fix a damp issue: roofers, renderers, heating engineer, plumber, ventilation installer, etc etc. If you pay a roofer, they will probably do something to your roof. But that might not be the problem.

Before getting therapy you should consult either a clinical psychologist or a psychiatrist. Psychiatrists do diagnosis. Clinical psychologists do something similar which they call "formulation".

Without this you can spend years of your life in effect trying to get roofers to fix your rising damp issue. That's not an exaggeration, it happened to me: I felt bad, was in therapy for depression. For years. My problem was actually an anxiety disorder. TBH I think tradesmen are more honest: if you call a roofer and it's not a roof problem, I'd say that you have >50% chance that the roofer will tell you they can't fix the issue. All of the therapists I tried were happy to try fixing my "depression issue" for as long as I cared to pay them.

Now, the situations are not quite the same as therapists don't specialise much. IMO this is a big problem, but not one you can solve as an individual.

There are actually two reasons to get your problem diagnosed first: one, to actually figure out what it is, and two, to have another professional to hold whoever does the actual treatment (whether that's therapy or something else) to account. Otherwise a therapist can "mark their own homework" and keep convincing you that it's worth continuing to pay them, especially if you are too demoralised to put energy into finding an alternative. (Also happened to me). Clinical Psychologists also do treatment, so could suggest that they do the treatment as well, but IMO it's better to have separate person with oversight.

I do think that changing your personal circumstances can be hugely powerful, and therapists often overlook this in favour of internal work. But if you don't really know what the problem is then who knows what changes will help.

2 comments

Not everyone who struggles in life has a clinical diagnosis.

"Just trying therapy" is akin to taking some OTC painkiller before going to the doctor. You try that first before going to the ER for a headache. Likewise, therapy is a really solid first move when something is wrong. For many people, and for many things, it will work and is the right answer. Many people go to therapy a few times, get some perspective, learn some new coping skills, and then move on with life in a better place.

Now, if they try that and it doesn't work, by all means, go farther and talk to a psych professional who can diagnose them.

Agree with the first point.

I would argue that "just trying therapy" is very much not like taking an OTC painkiller. It's more like getting in a business consultant. Especially when, as in this case, you don't know what you want. Ok, not as expensive as a business consultant, since you are paying for a fraction of their time. But the incentives are similar.

It may work for some people to try it out, but I would strongly suggest deciding on advance some time limit (many therapists will resist that, which should be a red flag). It's difficult to hold to that, which is why it's good to be referred to them by another professional who can monitor progress.

FWIW, in most areas 'therapist' is a catch-all term for a practitioner that performs therapeutic interventions, be they Psychiatrists, Clin Psychs, General Psychs or Counsellors.

I just say this as the first half of your post had me concerned as it seemed you were rubbishing all mental health clinicians, and it wasn't until I realised you were using the term to delineate counsellors from Psychologists/Psychiatrists that I coined on.

Glad that you saw the value in seeing appropriately trained clinicians and echo your sentiments regarding ill trained therapists.

Perhaps it would have been better if I warned against just trying out "therapy" before figuring out the problem ("diagnosing")

Indeed, the terms may not have the same definitions everywhere. Readers should find out what definitions apply in their area, including what qualifications apply

I'm not saying that any of these therapists are necessarily useless, indeed a psychiatrist or psychologist might refer you to one, but after figuring out the problem.