Why your friend who needs therapy refuses to get it

I often get asked some version of the question of “I have this friend that needs therapy, and won’t get it. What’s going on?” In a previous post, I discussed one particular reason that keeps some people from seeking the help that they need (“Too expensive!”). I want to tell you about 3 other reasons that may cause people who need therapy not to seek it.

1. Fears of entering a relationship
I would estimate that fear of intimacy, or relatedly, fear of vulnerability, is the number one reason why people who need therapy actually avoid it. Many other reasons, such as money and time, are often disguises for worries about what it means to be vulnerable with another person. We have all been hurt, and to the extent that we have been hurt, we tend to want to protect ourselves, in conscious and unconscious ways. Often this protection comes in the form of keeping an emotional distance from others. Therefore, to the extent that someone has been hurt, they are understandably very nervous about the prospect of entering into a relationship with another person. “But it’s just a professional relationship,” some people say. While it’s true that the therapist is a professional, feelings that come up in therapy are very much like relationships in “real-life.” In actuality, these feelings form the very basis for what makes therapy powerful, and helpful, but they also make it scary. After all, would you really expect that you would share all of your innermost thoughts with someone and not feel anything towards them? The very patterns that are causing you problems in your own life are the ones that need to be addressed in therapy, and in the context of the therapeutic relationship. We have learned over the past 50 years of research and thinking in the field of psychotherapy, that the relationship between the therapist and the client or patient is the single most predictive factor of whether therapy will be helpful. A skilled therapist is one who understands this idea and is able to navigate this relationship through their understanding of both their client and themselves, in a way that leaves the patient with a great deal of knowledge about themselves, and a renewed sense of safety and freedom within the context of their relationships.
Important note: We can even be scared and not know we are scared. Our minds have a way of avoiding what we are afraid of, without even letting our conscious minds know what’s going on. All of our defenses fill this purpose: Denial, humor, intellectualism, escapism, and many others. ALL of us all of these defenses on a daily basis to get through life. The defenses are not the problem. We need them. It is when these defenses become too rigidified that we run into problems. More on this in another post.

2. Trust issues
Trust issues can lead to a person not wanting therapy since a certain amount of trust is required to walk in the door of a therapist’s office. If someone has been hurt often or deeply enough, their trust in others, especially an authority figure like a therapist, may be too low to even take the plunge of going to a first session. Some may make the first session, but then get nervous about how much they revealed, and not come back.
Parents are our original authority figures. To the extent that our parents violated our trust, hurt us, took advantage of us, didn’t listen well, or left us, we will have a distrust of people who are supposed to be caring for us. We might not want to admit it, and think of ourselves as “over” what our parents did to us, but that’s just how it works. Kids are innocent creatures, absorbing much of what our parents are putting out, and very sensitive to their reactions and treatment of us. If you think about it, this makes sense from an evolutionary perspective, because children in many cases benefit from their parents’ experience: what to avoid, how the world works, how to have relationships with others. Some of this is pre-programmed, but we are often “programmed” to learn from our parents, for better or for worse, and often unconsciously. We just absorb it without even knowing it.

3. Bad experiences with therapy
Another major reason people are anxious or worried about beginning therapy is that they, or someone they know, have had a bad experience with therapy. This is usually either because the therapist was not very good, or because it brought up painful feelings, or both. How do you know which it is? This is a tricky question, but the basic answer is that if the feelings that came up in therapy are also feelings that you have had in other relationships, then it may be because therapy brought up important feelings, not necessarily that the therapy or therapist was low quality. If the feelings that you had weren’t at all similar to feelings you have in other relationships, then it may have been the therapy. If you bring up your feelings about the therapy with the therapist, they should not be defensive, but rather should be able to be curious with you about what those feelings mean, and what may have happened between the two of you that you can learn from. Again, this is a normal and necessary part of a good therapy. If you feel that you are learning things and covering new ground, not just intellectually, but emotionally, even if the emotions are painful, these are signs that the therapy is likely productive.

These are a few of the many reasons that people needs therapy don’t get it, all having to do with worries about having a painful or negative experience. Starting therapy is scary for everyone on a certain level, but given that it can change your life, it’s so worth it!

I should note that there are other factors involved in the decision not to go to therapy, even though one is suffering. A person may not believe that it is helpful, or they may have cultural beliefs that would point them in other directions for their relief. It is important to note that I am just discussing some of the factors that may be out of people’s awareness, and I have a belief that most people can use therapy at one time or another, but not everyone shares this belief.

For my next post, I’ll answer the question of how to get help for a friend who needs it. That is: “Okay, I understand why they aren’t going, but how do I get them to go?”

Please comment, share, email me with questions, and stay tuned for more posts! Also, if you have ideas for what you’d like to hear more about in future posts, I would be glad to hear and consider them!