How do I know if I need to go to therapy? (And other Frequently Asked Questions)

How do I know if I need to go to therapy? (And other Frequently Asked Questions)


"A shattered, suppressed I is unable to love. In this case, too, it is true that grace does not supplant nature but presupposes it. We might recall here the words of Saint Paul: 'It is not the spiritual that is first, but the physical, and then the spiritual' (1 Cor 15:46). Supernatural love cannot grow if its human foundation is lacking. Divine love is not the denial or the destruction of human love but its deepening, its radical change into a new dimension." --Joseph Ratzinger

I know that Ratzinger wasn't specifically referring to mental health and the importance of therapy in the passage above, but that was what immediately came to mind when I read it in my book of daily Ratzinger meditations, Co-Workers of the Truth. Sadly, many Catholics/Christians in general are still skeptical about the value of therapy, medication, and other practices that aid mental health. I've met Catholics who think it's sinful to take SSRIs or that all therapy is New Agey self-help nonsense. I can't count the number of times I've heard people of faith claim that spiritual direction should be all a person needs to be happy, healthy, and functioning--or that people with anxiety disorders or depression just need to pray and/or frequent the Sacraments more often, and all of their issues would disappear. 

The reality is that good therapy is necessary for some people, in order to help repair the "shattered, suppressed I" and provide more solid ground on which God's grace can build in a person's life. The legitimate discoveries of contemporary psychology are gifts from God, and should be seen as such. Therapy in no way replaces prayer, the Sacraments, Scripture, community, or spiritual direction. But it is often the case that without therapy, the proper "human foundation" for supernatural love is lacking. At least, that was the case in my life until a couple of years ago

Since I’m so vocal about my love for therapy and belief that it can benefit most people, I get lots of questions from readers and followers about finding the right therapist, paying for therapy, and getting the most out of the actual sessions. I thought it would be helpful to combine all of them into one post as a handy reference for those who are interested.

Disclaimer: I am not a therapist, nor am I an expert on therapy. I am someone who has been in therapy off and on for more than a decade and have experienced the good, bad, and ugly of the counseling world. I share MY LIMITED PERSONAL experiences in order to help my friends, family, and readers who are hesitant to go to therapy or aren’t sure where to begin in looking for a therapist.

Photo by Susan Reue. 

Photo by Susan Reue. 

How do I know I need to go to therapy?

Like so many of these questions, I cannot answer this one definitively because 1) I do not know you personally and 2) I am not God, nor am I a licensed therapist. That said, I do get this question a lot, and along with it, lots of reasons why a reader has put off going to therapy, such as:

“I probably just need to pray more.”

Most of us don’t pray enough, but that doesn’t mean that you can pray your issue away or that therapy wouldn’t be beneficial to you. If you find yourself having difficulty praying--even though you’ve been to confession, have a good spiritual director, and are making time for prayer--then therapy could be a huge help to you. Anxiety and depression can make it nearly impossible to pray with any sort of clarity or peace. I think as Catholics/Christians, we have a tendency to spiritualize all of our problems, which can be dangerous if you have a legitimate psychological issue rooted in your brain chemistry. If you are chronically depressed or anxious, while it may feel like it’s entirely a spiritual problem, the reality is that it is a physiological problem that is affecting you spiritually. 

“Maybe my problem is that I don’t trust God enough/am not holy enough.”

You probably don’t trust God enough; who among us does? But that could be in large part due to psychological and emotional wounds and not (necessarily) spiritual deficiencies. A good therapist can actually help you in your journey toward holiness, by clearing out the obstacles from your past so that you can embrace God’s plan more fully.

“Therapy sounds good, but if I go that means I’m admitting that I’m mentally ill/crazy.”

First of all, there is nothing shameful about having a mental illness. Anxiety and depression (not to mention more serious illnesses like bipolar disorder, obsessive-compulsive disorder, etc) are 1) not your fault and 2) manageable if you receive the proper care and do your work in therapy, take care of yourself physically (nutrition and movement), and maintain a close relationship with the Lord.

Secondly, you don’t have to have a diagnosable mental illness to benefit from therapy! All of us were raised by fallen human beings and have been wounded in one way or another; for some, those wounds affect us more deeply and end up impacting our daily lives and relationships in unhealthy ways. There is nothing wrong with admitting that, or seeking healing for those wounds.

“I’d like to go to therapy, but I’m afraid of what my current/future significant other will think of me.”

I used to worry about this too, but the more healing I experienced, the more confident I became that the right man would not only accept that I was going to therapy and was on medication for anxiety--he would admire me for it. And I was right! Kristian told me that he was impressed by my willingness to do my work in therapy and get the help that I needed. I was impressed that he was going to therapy too. There’s nothing more attractive than someone who is humble enough to admit that they cannot do everything on their own. If your significant other is weirded out by the idea of you going to therapy or being on medication, then either he or she is not the right person for you, or they have their own wounds that haven’t been healed, or they're just unfamiliar with therapy and don't understand how beneficial it can be. If you explain your situation to your significant other and they are simply not open to your experience, that's a red flag. On the other hand, you never know how opening up about your healing journey could help another person feel free to explore their own need for healing.

NB: Did you know that depression and anxiety can be caused by thyroid problems? If you want to cover all of your bases while searching for healing, consider getting a thyroid panel done at your doctor's office. You can find more information about the connection between hypothyroidism and depression here

Do I need to go to a Catholic therapist?

Not necessarily, but you do need a therapist who shares your most fundamental values and has at least a Judeo-Christian anthropology, i.e. someone who believes that human beings are body AND soul, and that religious faith is an essential element of a rich human life and not a crutch or coping mechanism. I’ve only had one Catholic therapist in the past decade, and have had only positive experiences with non-Catholic Christian therapists who were respectful of my Catholic faith. The only negative experience I had was with a “spiritual but not religious” therapist who (while never saying it out loud) gave me the impression that she thought my Catholicism was a quirk that was holding me back.

How do I find a good Catholic/Christian therapist in my area?

Google: I found one of my favorite therapists this way! It can be as simple as searching for “Christian/Catholic therapist in my area.” : My current therapist told me about this website and it’s definitely a game changer!

Call your parish/diocese : Not all parishes and dioceses are equally helpful in this regard, but it doesn’t hurt to ask if they have a list of local Catholic therapists.

Ask around: I found my current therapist through word of mouth. If you live in Central Texas, Phoenix, or the DC area, feel free to email me for a list of recommendations.

How do I find a therapist who specializes in my particular needs?

If you know that you need help with an eating disorder, anxiety, depression, attachment, addiction, trauma, or what have you, that can narrow your search quite a bit and make it easier to find someone who can zero in on your particular struggles. I literally Googled “Christian therapist specializing in attachment issues” when I decided to go back to therapy in Phoenix, and that’s how I found my therapist.

I also recommend doing some research on different types of therapy: talk therapy, Cognitive Behavioral Therapy, EMDR, couples therapy--therapy is not one-size-fits-all! I spent many years doing talk therapy before I discovered EMDR (which I may do a separate post on at some point), and I think both were valuable at different points in my life.

 What should I be looking for in my first session?

A sense of comfort and trust, but also challenge. There’s no point in going to a therapist who doesn’t make you a bit uncomfortable sometimes (not in a creepy way, of course, but in an asking-the-tough-questions kind of way). It will also be clear whether or not you and your therapist share similar world views, which is important for the trust factor.

Keep in mind that you probably won’t feel totally comfortable with your therapist in the first session, and that’s normal! It takes awhile to build up a rapport. But if you’re completely uncomfortable, then they’re probably not the best fit and you should keep looking. I've heard from several readers that they gave up on therapy after one unpleasant experience, and I always encourage them to keep looking--and pray that the Lord will guide you to the right fit. 

How do I get the most out of each session?

1) Go in with something specific to talk about/process--even if that “specific” thing is that you’re generally anxious. If you just show up and expect the therapist to do all of the work, you will be frustrated. This is your life and your healing journey, not your therapist's. 

2) Do your best to be completely honest with your therapist. Otherwise, you’re really just throwing your money (and time) away. I spent too many therapy sessions dancing around tough issues because of shame and fear, and I wish I hadn’t. Therapy (like prayer) is only life-changing when you lay all of your cards on the table. It may take you awhile to get to the point where you’re able to do this, and it will NOT be fun (but is worth it because it opens the door to true healing), but it should be a goal.

How often should I go to therapy? How long will it be before I see “results”?

It depends on your particular situation. There have been times in my life when I’ve gone weekly, and times when I’ve gone once every few months. Typically, you’ll start out going weekly to lay the foundation, and then discuss with your therapist how often you feel like you need to meet.

I can’t tell you how long it will be before you see “results.” The most likely scenario is that you’ll feel a lot better after the first session, but not every session will be life-changing. Depending on the issue you’re struggling with, the time frame will vary. In 2015, when I went back into therapy after a several year hiatus, it took about six months for me to feel as though I could come up for air, emotionally speaking. For awhile, I was just hurting a lot because I was facing demons I had never really faced before. But the pain was healing, and didn’t last forever.

How do you balance acknowledging a need for therapy and maintaining a sense of responsibility/culpability for your actions?

This is a big one for Catholics. We don’t want to give ourselves a get-out-of-sin-free card by blaming all of our weaknesses and mistakes on our emotional/psychological wounds, but we also have to be realistic about how those wounds have affected our choices. The best way to handle this, in my experience, is to let the Lord be the judge of your heart, your motives, and your culpability. Confess the sins you commit, and let Him deal with the rest. I’m working on making St. Therese’s attitude toward her sins my own: “How happy I am to see myself imperfect and to have such need of God's mercy.”  

What’s the difference between a spiritual director, therapist, and life coach?

A spiritual director’s primary mission, as I understand it, is to help you move deeper into relationship with the Lord, whether it’s by helping you find a prayer rhythm, giving you guidance on overcoming sinful habits, or creating a plan to cultivate virtue in your daily life. Since human beings are body AND soul, there will always be some overlap between good spiritual direction and good therapy. If your spiritual director is wise and well-trained, he or she will be able to tell if what you need is outside of their expertise and will refer you to a competent therapist.

In my mind, therapy and spiritual direction go hand-in-hand, and complement each other when done well. When I was in the throes of my anxiety disorder (pre-medication, pre-regular therapy), spiritual direction was only marginally beneficial. Once I started on medication and went back to therapy weekly, my spiritual direction sessions became fruitful, because I had the clarity of mind to distinguish between spiritual issues and psychological issues, as well as the ability to actually pray without obsessive or intrusive thoughts interrupting me constantly.

A life coach is someone who helps you look at your daily life and take stock of what needs to change so that you can reach your goals, whatever they may be. They will help you formulate a plan for every facet of your life, including your spiritual and emotional growth, and will often refer you to a therapist if they recognize that your psychological state is impeding your growth in other areas of your life.

What if I can’t afford it?

Most people who ask this fall into one of two categories: those who could afford therapy but would have to sacrifice some non-essentials to do so, and those who truly can't afford it. I'll address the first group first:

If you're struggling to justify the cost of therapy, even though you technically could afford it if you wanted to, it might be helpful to shift your mindset. Think of therapy as an essential health care expense, instead of a luxury or an “extra”. Especially if you’re single, this is an investment that is worth making, even if it means giving up [insert non-essential thing here]. I would encourage you to prayerfully consider where you can make room in your budget for your psychological and emotional health; your friends, family, and future/current spouse and children will thank you.

That said, I know that there are lots of people--especially moms and dads with kiddos--who legitimately cannot afford therapy, in which case, I encourage you to:

Check with your insurance. You may be surprised at how much they will cover. Not all therapists take insurance, of course, but some insurance companies will reimburse you for a certain percentage of your sessions if you send them an invoice.

Ask about sliding scale fees. Many Catholic therapists will let you pay on a sliding scale, based on your income. This is my current situation and it’s a huge blessing.

Contact your local Catholic Charities office. I recently found out through a couple of my readers that Catholic Charities offers free counseling at some of its local branches. Definitely something to consider if money is really tight.

Invest in some good books/workbooks that you can work through on your own until you’re able to afford therapy. While these won’t take the place of a therapist, they can definitely help you in your journey toward healing. My top recommendations are:

(Disclosure: This post contains Amazon affiliate links. If you purchase a title linked in this post from Amazon, at no additional cost to you, a portion of the sale goes back to me.)

Facing Codependence (+ the Workbook) by Pia Mellody 

Getting Past Your Past by Dr. Francine Shapiro (all about EMDR, with instructions on how to start practicing EMDR techniques on your own) 

Attachments: Why You Love, Feel, and Act the Way You Do by Dr. Tim Clinton and Gary Sibcy 

Boundaries (+ the Workbook) by Drs. Cloud and Townsend 

Growing Yourself Back Up by John Lee 

Attached: The New Science of Adult Relationships and How It Can Help You Find--and Keep--Love.  by Rachel Heller

Be Healed by Bob Schuchts 

That's all she wrote (for now anyway)! Please feel free to email me with any other questions you may have, and may the Lord bless you on your road to healing and wholeness. 

Where I've Been, Where I Am Now

Where I've Been, Where I Am Now