When Danny, a 37-year-old marketing executive in L.A., went to therapy to manage his stress and anxiety about his wedding two years ago, he had a positive experience. In fact, it was so helpful, he didn’t feel like he needed it anymore once he settled into married life. Until, that is, last fall, when he started bringing more work stress home with him. He’d vent to his wife, who would gently suggest that he “should talk to an expert about that.” But instead of taking her advice, he’d become furious, regretting that he told her about his problems in the first place.
“At the time, I perceived that as a betrayal,” he tells me. “Before, I felt like she was on my team, but in that moment, I felt like she had left my team.”
These smaller arguments came to a head when he lashed out at his conservative in-laws over a debate about politics. Once again, his wife told him he needed to speak to a professional about his temper. After he still wouldn’t listen, she broke down crying and told him she was scared that if he didn’t get control of his anger, he was going to die of a heart attack. “The comment about me dying and leaving her on her own — mad at me — was what turned me in the other direction,” Danny recalls. “I said, ‘I will find a therapist today.’”
Despite benefiting from therapy in the past, his wife had to frame it as a life-or-death issue for him to snap out of his defensiveness. It turns out, that’s how many of us feel about therapy, too: It’s perfectly fine during a crisis or circumstantial stress, but outside of that, it’s mostly for other people.
A review of more than 50 peer-reviewed studies on the topic revealed that psychotherapy is largely an effective form of treatment, but also largely under-utilized. More specifically, 75 percent of the people who suffer from anxiety don’t get the help they need, on top of another 40 to 50 percent of those with bipolar disorder or schizophrenia who go untreated every year. And while a majority of people cited a lack of insurance and cost as the reason for not seeking help, the stigma associated with therapy is another common barrier to entry, per the American Psychological Association.
“Despite all of our progress, there’s still a lot of stigma about receiving professional mental health care,” explains Judy Ho, a clinical and forensic neuropsychologist and author of Stop Self-Sabotage. “We still use words like ‘crazy’ to describe people with mental illness, and people believe that there’s no reason to seek therapy if you aren’t struggling with some severe mental problem. Of course, that’s not the case.”
This stigma isn’t always obvious either. For Danny, who always regarded himself as pro-therapy, it showed up in the form of pride that he took in being able to get by without it. When his wife pointed out that he was failing to do exactly that, it threatened the way he perceived himself. “I thought I was fine for a year and change, but my biggest mistake was stopping therapy after our wedding,” he says. “It really takes someone who sees you every day to point those things out to you.”
Still, if you want to tell someone to see a therapist, you don’t necessarily have to be married to them or see them every day to make the suggestion. You just have to neutralize their defensiveness by answering the question: What’s in it for them?
One way to do so might be by connecting mental health to physical health, the way Danny’s wife did when she expressed fears about him having a heart attack. “Most people readily recognize the importance of seeking medical care for physical discomfort,” says Dean McKay, a professor of psychology at Fordham University. “Emotional discomfort and the behaviors to alleviate it are often harmful, and so, suggest to a friend or loved one that addressing it will improve their lives.”
“Connecting this to something meaningful for them helps, too,” he continues. “If they’re business-oriented, suggest that their metaphorical ‘stock price’ could be higher; or if they exercise regularly, suggest that their fitness could be enhanced.”
It also helps to note any personal experiences with therapy as well. “Let them know that you went to therapy at a time when things were tough, and that it was very helpful. Or mention that you’ve been considering it yourself — if that’s true,” Ho explains. “This will make them feel like they aren’t being judged by you because you went through the same process yourself and found it helpful.”
That said, Ho recommends refraining from giving any other advice. Rather, she endorses simply asking subtle questions and listening, a concept in psychology known as motivational interviewing. “You try to elicit cognitive dissonance where they notice that there’s an unaddressed problem in their life and that they don’t like the way it’s going,” Ho says. “From there, you ask for their permission to offer some suggestions. People don’t like feeling forced, and they like believing that decisions are theirs to make. So this method is extremely effective.”
In the end, Danny’s wife didn’t force him into therapy by threatening divorce or some other ultimatum, but by helping him raise important questions about the person he wants to be — and it wasn’t the kind of guy who screams his way into an early grave. Today, he tells me, “For the first time in my full adult life, I feel totally normal.”
The difference is that now he knows this isn’t a reason to stop, but to keep showing up.