“Fear is only as deep as the mind allows.” – Japanese Proverb.

I got a lot of really great feedback about my recent post, I’m Not Saying You’re Crazy – How To Talk About Therapy.  Thank you all for reading and for your insightful comments.  Much of the sparked conversation related to the difficulty people have talking about therapy, not just for others, but also for themselves.  These discussions had me thinking about why people come to therapy.  Of course, they come to help themselves through a hard time or troublesome issue, or to deal with particular symptoms or behaviors.  This assumes that they have gotten to the point of recognizing that these things indicate a need in the first place.  For many people, this recognition is the hard part.  We tend to go through life thinking that when something is wrong, we should be smart enough or strong enough or brave enough to figure it out on our own.  It is the American way after all.  Pull yourself up by your bootstraps, quit complaining and do something about it!  Just work harder, and you will be too tired to worry about “issues.”  But this denies the fundamental nature of many people’s issues, which tend to lie at the core of their being and personality.  In order to reach some of those things, the critical recognition of a need must come first.  Many people never make it that far.

This led me to approach things from a different angle and ask a different but related question – why do people say no to therapy?  As I have previously discussed, there are the issues of stigma and misunderstanding of what therapy actually is.  And then there is there is the associated belief that only crazy people need therapy.   I’ve had this discussion with many people, and those who are most resistant tend to live with a lot of fear.  Their stated fears are about therapy, and being analyzed or judged, or worse, someone finding out.  But again, as we’ve discussed before, these are projected negative self-judgments.  There must be something deeper than worrying about what someone else thinks.  What keeps a lot of people from therapy is the very real possibility that they might find out (and then have to deal with) what they think about themselves.  Isn’t this really just the ultimate form of fear of the unknown?  The people who willingly come for treatment are already aware of why they are there and what they want to work on.  The unknown is largely known for them, and thus the resistance is lowered.  That is not to say that there is no resistance or that certain things may be hidden from them, but that is for the therapy process to uncover, and they are willing participants.

The people who reject therapy as a whole are more likely afraid of what they might learn about themselves.  With that knowledge comes the obligation to do something about it, including changing behaviors, and ultimately changing the way they feel about themselves.  With that knowledge, the excuses and rationalizations they have used to keep them in place, frequently to their detriment, fall away.  With that knowledge, the adaptive defenses, which have provided comfort and governed behaviors for so long must also be acknowledged and change.  The pattern goes something like this:  therapy leads to knowledge, which leads to change, which leads to fear, which leads to resistance to therapy.

Maybe the person does not want to change.  Maybe they think that it is others who need to change, not them.  Therapists see that a lot.  “It’s not me, it’s them.”  In another form, fear of change is stated, “That’s just the way I am.”   These internal structures tend to be rigid and strictly adhered to.  But a rigid structure can be quite fragile as it lacks the flexibility to deal with any amount of change.  The fear actually protects the structure by preventing and avoiding movement.  And when a person is pressed into a potentially changing situation, they become excuses avoid change and keep things the way they are.

So, given that fear is frequently at the base of resistance about therapy, how can we talk to people to allay their fears?

1.             Make the Unknown Known.  When I talk about therapy, I begin with an explanation of what therapy is and what it isn’t.  When I meet with first time clients, I go over the process of therapy, which is basically just talking and listening.  I try to establish that my office is a safe place for the client to say whatever it is they have to say.  I also address some of the misconceptions of therapy, starting with the fact that there is no couch, that I am not going to “shrink” their head (still not sure where that one comes from – readers can fill us in), and that I am not going to judge them as people for what they think, say or do in session.

2.         Put The Client In Control.  Another source of fear is that once the process begins, the client will be sent inexorably down a path from which there is no return.  And while it is true that a client cannot un-ring the bell (something discovered cannot be undiscovered), I assure the client from the outset that this is their therapy and that they are in control of it.  The client has the power to determine what we talk about, as well as what we don’t talk about.  She has the power to determine the direction of the discussion.  And she has the power to stop at any time.

3.         Use Regular Talk.  Lastly, I try to communicate with all clients like a regular person to another regular person.  Just about everyone who comes in does so with a preconceived idea about therapy.  Frequently those ideas come from other experiences in the medical community as well as from the media.  Their medical experiences may have left them feeling helpless as they struggled to understand medical jargon bandied about by blissfully unaware doctors.  And the media tends to inflate and complicate the nature of the therapeutic conversation.  When people come in, we just start talking – like regular people.  We have a nice conversation.  And when we are comfortable enough, we can begin to talk with greater frankness and depth.

To me, its not that scary, but it is hard to know that until you try.  Let me know what you think.  Have you been fearful of therapy?  What helped you overcome that fear?  For clinicians, what techniques have you used to demystify the process?

Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist.  His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts.  Contact him at andy@bostonprofessionalscounseling.com or visit his website at www.bostonprofessionalscounseling.com