How do I know if I need a therapist or psychiatrist?

Therapists provide talk therapy (psychologists, licensed counselors, social workers). Psychiatrists are medical doctors who primarily manage medication. Many people benefit from both. If you think you might need medication (for depression, anxiety, bipolar, etc.), a psychiatrist is appropriate. For therapy, any licensed mental health professional with relevant training works.

Is it normal to feel worse after starting therapy?

Sometimes, briefly. Therapy involves confronting difficult thoughts, memories, and patterns — which can increase distress temporarily before it improves. This is particularly true in trauma therapy and grief work. If you feel consistently worse after several sessions, discuss it with your therapist — the approach may need adjustment.

How long does therapy take?

It depends on the condition and goals. Brief, structured therapies (CBT for anxiety or depression) typically run 12-20 sessions. Trauma processing may take 8-15 sessions. Complex issues (personality patterns, relational difficulties, C-PTSD) may benefit from longer-term work. Some people do periodic 'tune-up' courses throughout their lives.

Can I do therapy online?

Yes. Telehealth therapy is well-studied and produces outcomes comparable to in-person therapy for most conditions. It's particularly convenient for people in rural areas, those with mobility issues, or those with busy schedules. Some conditions (severe dissociative disorders, active psychosis) may be better suited to in-person care.

When to See a Therapist: 7 Signs It's Time to Get Help

You don't need to reach rock bottom before therapy makes sense. The persistent belief that therapy is only for crisis — for people who "really" need it — delays help for millions. A survey by the APA found that the average person waits 11 years between first experiencing symptoms and seeking treatment. Eleven years of unnecessary difficulty. If you're wondering whether you need therapy, that question itself suggests it might help. Here are seven specific signs.

1. Your Feelings Are Affecting Your Daily Life

Sadness, anxiety, anger, or numbness that persists for more than two weeks and interferes with work, relationships, or basic functioning (sleeping, eating, hygiene) warrants professional evaluation. The two-week threshold isn't arbitrary — it's the clinical guideline for distinguishing normal emotional responses from conditions like depression that benefit from treatment.

2. You're Using Substances to Cope

Drinking more to quiet your mind. Using cannabis to sleep. Relying on anything external to manage internal states that feel unmanageable. Substance use as coping is a neon sign that something underneath needs attention. Therapy addresses the root; substances address the symptom — poorly, and with compounding side effects.

3. Your Relationships Are Suffering

Withdrawing from people you care about. Conflict that escalates beyond what situations warrant. Difficulty trusting. Inability to maintain closeness. Relationships are often the first place mental health problems become visible, because they require the emotional bandwidth that psychological distress consumes.

4. You've Experienced Trauma

Whether recent or decades old, trauma that hasn't been processed continues to affect the present. If you're having nightmares, flashbacks, or avoidance behavior related to past events — or if you suspect that early experiences are shaping your current patterns — trauma-focused therapy (PTSD treatment) can help.

5. You're Constantly Overwhelmed

Everyone has stressful periods. But chronic overwhelm — the sense that you can't keep up, that everything is too much, that you're barely holding it together — suggests your coping capacity has been exceeded. Therapy doesn't remove stressors, but it builds capacity, clarifies priorities, and teaches regulation skills that make the same load feel more manageable.

6. Physical Symptoms Without Medical Cause

Headaches, stomach problems, chest tightness, fatigue, muscle tension — when medical workups come back clean, psychological factors deserve exploration. The mind-body connection isn't metaphorical; chronic stress and unprocessed emotions produce genuine physical symptoms through HPA axis dysregulation, autonomic nervous system activation, and inflammatory pathways.

7. You Feel Stuck

Maybe it's not crisis-level. Maybe you're functioning fine by external measures but internally feel flat, directionless, unfulfilled, or like you're going through the motions. Therapy isn't only for pathology — it's also for growth, clarity, and understanding patterns that keep you repeating the same cycles.

How to Find a Therapist

Know What You're Looking For

Different conditions benefit from different modalities. OCD needs ERP. PTSD needs trauma-focused therapy. Depression and anxiety respond to CBT, ACT, or psychodynamic therapy depending on presentation and preference. A therapist who's excellent for general anxiety may be wrong for OCD.

Where to Search

Psychology Today's directory allows filtering by specialty, insurance, and location. The IOCDF directory (for OCD), EMDRIA (for EMDR), and ABCT (for CBT) offer specialized searches. Your insurance company's provider list is a starting point but often outdated. Ask your primary care doctor for referrals.

The First Session

The first session is an assessment — the therapist gathers history and you assess whether you feel comfortable. Chemistry matters. Research consistently shows that the therapeutic alliance (the relationship between you and your therapist) is one of the strongest predictors of outcome, regardless of modality. If the fit doesn't feel right after 2-3 sessions, try someone else. This isn't failure — it's smart shopping.

Cost and Access

Insurance increasingly covers therapy (mental health parity laws require it). Community mental health centers offer sliding-scale fees. Training clinics at universities provide therapy by supervised graduate students at reduced cost. Online platforms (BetterHelp, Talkspace) offer convenience, though quality is variable. Some therapists offer reduced rates for financial hardship — ask.

What If Someone You Love Needs Help?

Express concern without ultimatums. "I've noticed you seem really stressed lately, and I care about you. Would you consider talking to someone?" Offer to help with logistics (finding a therapist, scheduling). Don't take it personally if they're not ready — but don't stop gently raising it if the need is clear.