Question: I have always managed to cope with various difficulties in my life (which have been no more, no less than other people I know), but recently I have been overwhelmed by a few things that happened all at once.  I have friends who I talk to, and my mother helps me out when I need her. Everyone keeps telling me I should see a therapist but I'm not quite sure how and why a therapist can help me more than my family and friends.                                                                    

Answer: What you are describing is quite common. As therapists, we see many people who have been functioning fine all their life when something—or a combination of things—seem to tip all that functioning into a feeling of being overwhelmed. Don't forget, we live in a fast-paced society in which we are required to be and do many things at once: parent, spouse, employer, friend, community volunteer, and maybe even more. So it's not surprising that somewhere down the line, especially when a “few things happen all at once”; we can get seemingly derailed from the outwardly smooth course of our lives.

You have not identified ways in which you are not “coping” but I would assume that “not coping” would mean feeling anxious, and perhaps feeling unhappy or dissatisfied. I would also hazard a guess that if “everyone” is telling you to see a therapist, then you are acting in ways that others feel are detrimental to both yourself and loved ones such as being snappy with others, or unable to do or accomplish things you have done in the past that is adversely affecting those around you. Perhaps those affected are your children or spouse; perhaps the roles affected are those as a student or daughter/son; employer or friend.

The miracle is that we function as well as we do for the most part, so give yourself a huge pat on the back for all these years that you have always coped and then we can turn our attention to what a therapist can do for you that sometimes your friends and family cannot.

Family and friends can provide physical and emotional support when the situation warrants it (financial help, babysitting, a hot meal, work or parenting-related advice, a hug or reassuring words), and if that help is useful to alleviate the symptoms of anxiety and depression, then you are right; there is no need for therapy. However, it is when the interventions of family and friends are not helpful in alleviating symptoms and improving functioning, then the therapist offers a very special type of help. In your case it appears that everyone agrees that despite the fact that your mother is there to help you and your friends are available for support, you are not getting relief.

The field of therapeutic work is wide and varied, beyond the scope of this article, consisting of many evidence-based therapeutic theories, orientations, and interventions. The two most common reasons for people entering therapy at any stage of their life is usually related to feelings of anxiety or depression. For the purpose of this article, we will not address trauma that necessitates therapy, but more the everyday stressors that can wear a person down over a period of time; or even a single stressor that can be so difficult that it can tip a functioning person into a non-functioning mode. Everyday stressors can  be things like financial or work-related problems, parenting issues, or caring for ill family members. Single stressors can be a sudden death or illness, losing one's job, or even seemingly happen occasions like getting married, having a baby, or moving to a new home.

Therapy is governed by the boundaries of the therapeutic alliance. These boundaries are manifest by the time constraints of the therapy hour, agreed upon payment, professional boundaries of the therapist, and the therapist's commitment to ethical practice as determined by the governing licensing boards of various fields of mental health (social workers, mental health professionals, psychologists, and psychiatrists). The therapist and client enter into a relationship in which these boundaries are the framework of the therapeutic work and alliance; with the expectation that the therapist is licensed, has a strong grasp of a theoretical framework of therapy from which she or he practices, and will use her knowledge to assess the problem and apply the necessary interventions.

As a therapist, and also a member of the community, I am aware how many people think that anyone can do the therapist's job, which seems like just a bunch of talk. But a therapist who can help her client effect change can also explain very clearly how therapy actually works. It may not be the exact science as treating an ear infection; but neither is treating cancer an exact science; there are so many variables to consider when applying treatment. But the therapist's strong theoretical knowledge of theory and application exists; as well as as her responsibility to her profession's inviolable legal and ethical standards.

There are two types of therapy that would helpful in your case: cognitive behavioral therapy (CBT) or psychodynamic therapy. Although there are many more, these two are the broad categories into which many therapies fall. CBT addresses a person's faulty thinking and assigns specific homework assignments (yep, homework assignments, for all those of you who loved school!) to effect change in behavior. Psychodynamic is commonly referred to as “talk therapy” and it believes that there are unresolved conflicts in a person's unconscious that impacts present behavior. The work of therapy is to develop awareness of these conflicts, resolve them, and thereby effect changes in behavior. Research has shown that both of these types of therapy are equally effective; but the nature of the therapeutic alliance and relationship will be more indicative of success than the actual method used. Meaning, putting aside all the therapist's education and theoretical tools, you have to like your therapist for any work or change to occur.

If you listen to those everybodies who are encouraging you to see a therapist, you will be pleasantly surprised how you will be feeling more like your old self in a rather short time. And as we therapists like to say, “Thank you for sharing!”

FIRST PUBLISHED IN ADVICE COLUMN OF JEWISH ECHO MAGAZINE

My book, Therapy, Shmerapy, can be found in bookstores or online