Do I Really Need Therapy?

I sometimes hear people who are considering therapy question whether or not they “really need it”. It’s very valid and very worthwhile to consider carefully whether or not you are ready to add therapy into your life. After all, therapy is a big investment—of both your time and your money, and it’s reasonable to be sure that the investment is necessary and worth it.  I’ve also found over the years, that there is often much more meaning behind this question than is apparent on the surface. 


“Do I Really Deserve Therapy?”

Sometimes, the real question people have is whether or not they deserve therapy.  My clients have sometimes told me that being in therapy seems “selfish” or like “a luxury”—one that is paradoxically permitted for only the very unfortunate.  Surely there are people much more deserving than them—people who have suffered so much more—who really deserve to be in therapy. Of course, it is always possible to identify people who have suffered more than oneself.  After all, life has been extremely hard on certain people and most of us have heard stories of extreme tragedy and suffering.  Rest assured, there are enough therapists go around and you will not be hogging all the therapy resources should you chose to enter therapy yourself. 

Therapy is also not meant for helping only people who have suffered in extreme ways.  You need not have been horrifically abused or traumatized in order to justify entering therapy.  Difficult and enduring emotional experiences such as chronic stress, loneliness, anxiety and depression are, unfortunately, somewhat common and are often caused by circumstances far more subtle than dramatic violence or abuse.  If you're questioning whether or not you’re suffering enough to be in therapy, you’re probably suffering enough to be in therapy. 

Additionally, you do not need to be suffering a great deal right now in order to benefit from therapy. Some of the best work in therapy can occur after periods of acute suffering are over.  

First time therapy clients often arrive in my office awash in emotional overwhelm. They are like shipwreck victims, nearly drowning.  They cling to their weekly session for some sense of safety and stability.  They feel themselves to be struggling just to survive. Over time, with consistent sessions, they find something like land—a feeling of something more solid and a sense that the great danger has past.  They are able to lift themselves up and look around.  With the chaos behind them, they’re able to think more clearly.  They can now consider, how did I get in this situation to begin with?  And what do I need to do to get out of it?  Enormous amounts of work and growth can occur during this time. 

If you feel that you are already in a place of having found some sense of stability--perhaps from having attended a previous therapy or perhaps from your independent efforts—you are likely to be able to approach your therapy with a degree of purpose and thoughtfulness, which can yield great results.

Clients who initially worry about the selfishness of therapy also eventually discover that therapy isn’t selfish at all.  They realize how much people around them are benefitting from the work they’ve done in therapy.  They notice that they are better romantic partners to their partners, better parents to their children, and better friends to their friends.  When they are not dragged down, imprisoned or overwhelmed with difficult feelings, they have more time and energy to give to others.  They start to see therapy not as a selfish luxury, but as a social responsibility to which they wish more people would commit.  They feel proud of the work that they did in therapy. They see that what is good for them is good for everyone around them.   


“Am I Really Crazy?”

This is question is, in some ways, the reverse of “Do I deserve therapy?”.  Rather than fearing that they don’t deserve to be in therapy, these people fear that they definitely deserve to be in therapy. 

People with this worry fear that they are so erratic, so irrational, so out of touch with reality or so irritating to others that everyone but them knows that they need to be in therapy.  These clients are often frightened to look too closely at themselves for fear of what they might find, and in my experience, these clients sometimes leave treatment too soon.  

My experience is also that these clients aren’t generally any more “crazy” than other clients who seek therapy.  Generally, these clients are smart, capable people who have had some difficult life experiences and who have, nonetheless, achieved some pretty phenomenal things. And despite all of their achievements, they aren’t enjoying their lives very much. If they manage to stay in therapy despite their fear of finding out that they are “really crazy” or “really messed up”, they are able to gain much from the process.  They are able to stop running from their fear that they are "broken"and face the concerns that have been haunting them.  They come to view themselves with more compassion, which creates the necessary emotional space to tackle the problems that have been keeping them from more fulfilling lives.  


A Better Question:  "Do I Want Things to Be Better?"

Rather than asking yourself if you really need therapy, ask yourself if you really want your emotional life to improve. Do you want to feel happier or more content?  Do you want to feel more motivated? Do you want to feel more confident? Do you want to feel less overwhelmed?  Do you want to stop behaving in self-defeating ways? Do you want to be a better romantic partner? Or want to stop dating people who are unkind to you? Do you want to stop fighting with your relatives?  Do you want to stop feeling stuck?

And, also, do you want help in making these things happen?  Working with a therapist means having support in reaching the emotional and relational goals you have for yourself.  It means joining forces with someone to help move your life in the direction you’d like it to go.  It means no longer having to figure out how to make this thing happen all on your own. It means having someone listen deeply to your concerns and having someone helping you to understand yourself and your life better.  

And whether or not you think you need that, you may very well want it. 

Carly Earnshaw, MFT is a San Francisco therapist who provides psychotherapy to people struggling with depressionand problems in relationships. She also helps people recover from difficult childhood experiences. She has offices located in the Sunset Districtand Hayes Valleyin San Francisco.  To schedule an appointment, call her San Francisco office at (415) 261-2989.  You can also email.





Starting therapy, again…


Frequently, I meet with new clients who have already been to see another therapist.  Often, people worked with someone several years ago, felt greatly helped by therapy, and are ready to address some other issues that they’ve been thinking about addressing for a while.  I also sometimes meet with people who tried working with a previous therapist, were disappointed with how it went and dropped out because they weren’t seeing results and couldn’t justify the expense.  This second group of people have decided to give therapy another chance—often because they are desperate for help and they aren’t sure where else to turn.  

Regardless of whether your last last therapy went great or awful, you have an advantage over the first time you tried therapy.  Here’s why.

Paying For Therapy Might Be Easier Than You Think

Paying for Therapy in San Francisco   

You’ve may have heard that it’s hard to get decent mental health care.  You may have also heard that it’s expensive and that insurance doesn’t cover it.  This isn’t entirely true.

Although we still have a long way to go in terms of providing adequate mental health care to everyone who needs it, things have improved in the last several years and more people are able to access therapy than ever before.  Following the implementation of the Affordable Care Act (a.k.a. Obamacare) the majority of my clients now use insurance to cover most of the cost of their therapy.  Amongst my clients, I’ve found that insurance usually covers 65-75% of the session fee (after the deductible has been met).


What you need to know:

Do you have an HMO or a PPO?  This information might be listed on your insurance card or in the materials that came with your policy.  If you can’t find the information on the documentation you have at home, you can call the 1-800 number listed on your insurance card and ask them whether you’re on an HMO or PPO policy.  

If you have an HMO, there’s good news and bad news.  The good news is that your insurance probably covers therapy and you’ll likely only pay a small co-pay for each session. 

The bad news is that you’ll have to pick a therapist who is on their list of providers, and it can sometimes be a challenge to find someone “in network” who is also accepting new clients.  

This process can obviously be difficult and frustrating when you’re already not feeling great.  Keep trying, though!  Getting the help you need will be worth it.  

If you have a PPO, awesome!  You’ll have your choice of going to any therapist you’d like to see. This is how the majority of my clients pay for their therapy.  At the end of each month, I provide my clients with a form to submit to their insurance companies, and their insurance companies then send them a check, reimbursing them for the majority of their session fee.  On average, clients with PPOs seem to be getting reimbursed for 65-75% of their sessions after the deductible is met.  

If you’re looking for therapy in San Francisco and aren’t sure whether your insurance company will cover it, feel free to give me a call at 415-261-2989.  I’ll be happy to check your benefits for you and will point you in the right direction once we determine what type of insurance you have. 


Carly Earnshaw, MFT is a San Francisco therapist who provides psychotherapy to people struggling with depression and problems in relationships. She also helps people recover from childhood trauma and abuse. She has offices located in the Sunset District and Hayes Valley in San Francisco.  To schedule an appointment, call her San Francisco office at (415) 261-2989.  You can also email or send a text.