When Therapy Makes Sense

By Joe Nelson | December 20, 2006 10:23 am

Those of us who chose to make our livings as mental health professionals probably didn’t do so because we had so much good mental health that we wanted to share it. Most of us likely started the process as seekers of mental health services and, somewhere along the way, discovered that we had something to offer as well.

The fact that most therapists have experienced therapy is a positive sign. This should indicate that they have a better self-awareness, understand what it is like to be in the other chair, and truly appreciate the difficulty of the work. They can also better understand the overall process of how people change and how painful this process can be. Facing the fact that we are often our own worst enemies can be frustrating, but it also allows us the opportunity to step up and make decisions that are empowering. There are few things in life that are as empowering as the notion that we can do something to alter our feelings and ultimately our behavior and health outcomes.


The most challenging aspects of seeking therapy are deciding when and with whom.

When to seek therapy depends on your tolerance of discomfort and your personal resources. Discomfort is in the eye of the beholder, and some of us don’t believe that our pain is intolerable so we are less likely to be proactive about seeking help. These are often the folks who feel that they must have severe depression before they will see a therapist. Others may choose to have a regular therapist as a trusted resource to work with as life changes take place. There really isn’t a right way to be, but as someone who likes to coach mental health, I prefer to see someone before a crisis.

In the case of diabetes, I like to meet with the families of people who have been recently diagnosed so I can get to know how they work and understand what kind of support the person who has diabetes can get. This also gives me a chance to discuss the most helpful things a family can do, so that we can keep cheering on what the person with diabetes is doing right and help head off some of the problems. This meeting also gives the family members a resource for future reference.

Years ago, I worked with the Diabetes Control and Complications Trial, or DCCT (the landmark study that proved that intensive control of blood glucose levels can prevent diabetes complications). We screened all potential participants and really looked for those who were mentally healthy and had good support. During the nine years of the study, over 50% of our participants sought out counseling sessions with me, and many had regular sessions. This clearly indicates that a large percentage of people will have a need for occasional sessions to help them deal with problems in their lives. Not only people with diabetes, but almost everyone can use some time when our privacy is guaranteed and we can sit and talk with someone who cares and listens.

The other issue is who. This is often determined by insurance coverage. You may have designated mental health care providers in your insurance network. If so, you may want to find out if they understand and work with people who have diabetes. Professionally, I believe that this is useful—although many mental health issues are not diabetes-related, it is important that the provider understand how diabetes plays a part in your life.

If the provider allows it, have an “interview” time with him to ask questions about how he practices, what his expectations are, and what you can expect of him during a session. If nothing else, this will give you an initial impression of how the provider works.

Lastly, starting therapy doesn’t mean you have to stay forever. Set a limit on the initial number of sessions and then check in about how therapy is going and if it needs to continue. I usually set an initial limit of four sessions and then, if it is appropriate and we agree, we will set up more sessions. I hope that if you have pain in your life you don’t wait until it is unbearable before you seek help; get it before you are desperate and you’ll find that it is much more useful.

For more information on beginning therapy, please see my article Navigating Mental Health Care.

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Joe Nelson: oe is a psychotherapist in private practice in Minnesota, where he specializes in the psychology of chronic disease and sexual problems and works with couples, families, children, and teens. He has been a Licensed Psychologist since 1985 and has earned a master’s degree from St. Mary’s College Winona, a bachelor’s degree in social work from the University of Minnesota, and an associate’s degree in human services from the College of DuPage in Glen Ellyn, Illinois.

Joe has worked with troubled youth in Chicago and Minnesota and on a special project on Turtle Mountain Reservation in North Dakota. He was the first social worker hired by an affiliate of the American Diabetes Association. He worked at the International Diabetes Center for 20 years, directing psychological services there for 12 years. A Certified Sex Therapist, Joe co-developed the Sexual Health Center at Park Nicollet Clinic.

Having practiced meditation for over 30 years, Joe offers instruction in mindfulness-based meditation to patients in groups and as individuals. Joe is married, has a 23-year-old daughter, and enjoys scuba diving, motorcycling, golf, and being outdoors doing almost anything.

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