Of the many people with mental health problems who would likely benefit from psychological help, only a fraction actually find themselves face to face with a clinical psychologist or other kind of psychotherapist. There are of course practical reasons for this, including demand outstripping supply, but in many cases it also has to do with the perspective of the person who has the psychological difficulties. For example, a European survey published in 2009 found that of nearly 9000 people who showed evidence of clinically significant depression or anxiety, only a third thought that mental health services could help them.
A new study published in Clinical Psychology & Psychotherapy has lifted the lid on the psychological processes people go through in deciding that psychotherapy could be beneficial and arranging to begin treatment. Katherine Elliott and her colleagues assessed 155 people who’d made initial contact with psychological services at a university training clinic, including asking them how long they’d had their current mental health problems, how long it took them to decide that psychotherapy could help, how long they took to decide to seek therapy, and how long to arrange therapy. The participants were also followed up after their third therapy session and then again after they’d finished treatment.
The participants had had their current problems – mostly anxiety- or depression-related, but also including things like anger management and sexual problems – for an average of 10.5 years. They described the most difficult step towards starting treatment as deciding that psychotherapy might be beneficial. Once they realised they had a problem, it took the participants an average of four months to decide that psychotherapy might help (though this includes over 40 per cent who said it took a year or more to come to this realisation and 16 per cent who decided right away).
Once the potential benefits of psychotherapy were realised, each subsequent step became progressively quicker and easier. Deciding to actually go ahead and seek help took an average of a further month, and after that most participants said they took just a few weeks to make an appointment. However, it’s striking that a quarter of the sample then failed to attend their first appointment.
Of the participants who did begin therapy, those who found deciding and arranging to start therapy more difficult also tended to expect the therapeutic process itself to be more difficult. Given that past research has shown people’s expectations about therapy tend to correlate with the success of therapy, this sounds worrying. But actually this study found that expectations were not related to the participants’ levels of commitment – a key factor in successful psychotherapy – once they had started their treatment (unfortunately there is no data on the actual outcomes of therapy).
This is a tricky topic to study: after all, we only have data here on people who made initial contact with psychological services so we’ve learned nothing about people with mental health difficulties who don’t seek help. And we also don’t know why a sizeable minority of the participants failed to begin therapy. That said, there are some useful insights here. In particular, the researchers said their results showed the most challenging and time-consuming aspects in seeking psychological help are often realising that one has a problem, and recognising that psychotherapy could be beneficial. Of course psychotherapy isn’t for everyone. But spreading accessible information about mental health symptoms, and what psychotherapy entails and its potential benefits, could help a greater proportion of distressed people get the help they need.
Elliott, K., Westmacott, R., Hunsley, J., Rumstein-McKean, O., & Best, M. (2015). The Process of Seeking Psychotherapy and Its Impact on Therapy Expectations and Experiences Clinical Psychology & Psychotherapy, 22 (5), 399-408 DOI: 10.1002/cpp.1900
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