Why do people seek psychotherapy?

There are many reasons that people might seek counseling. Some of the most common presenting problems include:

  • Marriage or relationship problems
  • Phobias (irrational fears)
  • Weight control
  • Alcohol or other drug abuse
  • Problems with children
  • Child abuse
  • Eating disorders
  • Bipolar disorders
  • Sexual orientation concerns
  • Paranoia
  • Anxiety
  • Workplace stress
  • Panic attacks
  • Smoking cessation
  • Problems with parents
  • Spousal abuse
  • Elder abuse
  • Attention deficit disorders
  • Parenting issues
  • Severe thought disorders (hallucinations or delusions)

Sometimes it may seem to others that the person who comes in for psychotherapy doesn’t really need it. “How can John need therapy? He has everything: a great wife and children, he makes a nice enough living, he’s good looking, and he always seems happy…” Or, “Why would Mary ever need to go to a shrink? She’s happily married, she has a good job, has two wonderful children, etc, etc.”

Well, as we all know, outward appearances can be deceiving. Inside the perfect picture window that looks so happy and content often lies a very different story. If you knew John better, you would know that he came from a family where, if you didn’t rise to the very top of the corporate ladder by the time you were forty, you were considered a failure. Making $180,000 a year would be unheard of for most people, but within John’s frame of reference, believe it or not, he feels like a downright failure. And Mary, whose mother had been an abusive alcoholic her whole life until she died two years ago, is still wrestling with demons from her childhood that get in the way of her feeling like she deserves any modicum of happiness.

On the other hand, there are people whose lives appear to be a train wreck even to the most distant observer. Bill has never held a job for more than six months, goes through relationships like there’s no tomorrow, has a temper that can be triggered by the most innocuous of events, yet believes that all of his problems are inevitably caused by bad breaks, and others’ behaviors, never of his own making. It’s always “out there.”

Bill will likely never cross the threshold of a therapist’s office, unless dragged there by a desperately unhappy girlfriend, by a family member or friend, or in some cases because the court has sent him as part of his “rehabilitation”. And when he reluctantly walks in the door, his prognosis for real change is poor unless he can begin to see that he has played a role in his many years of mistakes, disappointments and failures.

The list of psychological problems at the top of this section is of course incomplete. The truth is that there are as many nuances and variations of these types of problems as there are people. We could go on and on with examples of how people develop their individual personality styles and problems in living. The cautious, timid and withdrawn man possibly grew up with an intolerant, volatile parent and even though he has no reason now to be scared, he has not gotten rid of those early paralyzing feelings of fear. And the arrogant, know-it-all irritates the very people he’s trying so hard to impress. Just like his own father did when he was growing up.

Many of these irrational patterns of behavior function on an unconscious level. One of the goals of psychotherapy is to help the client understand where his or her behavior comes from, and to teach them that while there may have been good reasons for developing these patterns as a child, the original causes are no longer there. THE ORIGINAL CAUSES ARE NO LONGER THERE! The behaviors, feelings and thoughts have developed a life of their own. They have continued unabated even though the person (and those around them) might know that they are no longer needed or useful.