Member Contributor — Adam A. Neal, M.A., AMFT/APCC

Help as a Hindrance: Exploring Barriers to Seeking Therapy

As a newly hired clinician, about to serve a community counseling center through a grant to support wildfire relief, I had a fully formed vision of my work to come. I anticipated meeting with a full caseload of new clients within a few weeks, foresaw the need to refer out overflow clients, envisioned waiting lists of individuals trying to meet with me, and imagined having to wrangle fellow clinicians to co-facilitate group therapy sessions maxed out with participants. Within a few months, there were more crickets heard than clients, and I found myself wondering if the universe was trying to tell me something.

While I cannot speak for the universe, I feel that I can speak for my own experience as an “outsider” clinician within a community devastated by tragedy. In coming to work for a well-established community counseling center, the idea of having to “seek out” clients in need was surprising to me. The grant funding my work was a recent boon for the center (which I will keep anonymous), which has provided affordable sliding-scale mental health services to anyone in the community for over 30 years, but has not frequently forayed into grant-based disaster relief work. The local community, overwhelmed by recent wildfires such as the Thomas Fire (December 2017) in Ventura County and the Woolsey Fire (November 2018) in LA county, was also touched by the Borderline Bar & Grill Tragedy, which occurred the evening before the latter wildfire ignited. In response to these tragedies, causing hundreds of thousands of people to be evacuated, lose homes, lose businesses, and, for several, lose loved ones or their own lives, funding agencies allocated grants to various social service organizations with missions of aiding the recovery efforts.

Herman’s (1992, as cited in Zaleski, Johnson, & Klein, 2016) tri-phasic model of trauma recovery includes (1) Safety & Stabilization, (2) Remembrance & Mourning, and (3) Reconnection & Integration, and most of the community members I have been seeking to serve have found themselves stuck in a recurring cycle of destabilization-stabilization. Some have lost part of their home, and their focus has been on renovation; some have lost their home completely, and the focus has been on rebuilding or facing the inability to rebuild. Moving into a phase of remembrance, for many, means having already established a steady foundation of safety. And, I’ve come to learn, people around here still don’t feel safe, and they aren’t necessarily ready to remember.

As a result, my efforts have included far more community outreach and education than direct clinical services, which has been a transformative experience for me. In fact, this unlikely confluence of factors has fulfilled a previously untenable calling I have felt to be an educator, and I have now learned of an important niche to be filled: why seek mental health services at all? What is it about psychotherapy that keeps many people in need away, rather than drawing them close? I expected tremendous clinical efforts, but instead I have expended tremendous educational efforts. Time and time again, I have heard from case managers, even those specifically trained as disaster case managers — “They don’t want therapy. They just want to be less stressed.” Slowly removing my ‘therapy-defender’ hat as an educationally-privileged clinician with a master’s degree, I have spent more time assessing people’s perception of therapy than engaging in clinical assessments. As Michael White, pioneer of Narrative Therapy, might put it, here are three basic problems I’ve begun to externalize:

• Commitment — People still perceive therapy as a long-term process, involving a weekly commitment that might continue for years. Rather than consider the possibility of a short-term therapeutic relationship, the idea of a long therapeutic commitment causes many to minimize their stress and decide that their time is best served elsewhere. If short-term or brief therapy were further promoted as a beneficial possibility, those whose perception is linked to stereotypes of decade-long psychoanalysis might reconsider.


• Brokenness — Whether or not we name it explicitly, the stigma around mental health continues to exist. Even case managers trained to help people locate resources are continually offering mental health services as a response to a problematic statement or series of statements a client has made. Because of this, prospective clients become defensive and feel that they are being provided mental health referrals because they sound “crazy” or “disturbed.” As part of my educational efforts, I have been encouraging providers to offer community mental health services, especially those provided at a reduced cost or free, in a way that sounds universal and inclusive. I have explained that a productive way to provide a mental health referral is as a tag at the end of a resource conversation. By saying, “We’re encouraging everyone to take advantage of affordable counseling being offered in our community, for any reason,” we build a sense of unity and normalize the idea of mental health services as a way to continue growing, learning, and processing our experiences.


• Need — While many prospective clients do not feel a potential stigma in seeking services, they will continually minimize or invalidate their own need to spend time in therapy. Since many mental health services are offered following a disaster or tragedy, people decide that they will allow those who “really need it” to receive the benefit. The perception that seems to predominate throughout the community: “Unless I’m unable to function, I don’t deserve therapy.”

As we continue to map the effects of these problems throughout our communities, we will hopefully guide prospective clients toward alternative discourses that begin supporting unique outcomes. I remain optimistic that the community narrative about therapy will soon shift to accommodate everyone. Until then, I’ll humbly continue to educate.


References
Zaleski, K. L., Johnson, D. K., & Klein, J.T. (2016). Grounding Judith Herman’s Trauma Theory within interpersonal neuroscience and evidence-based practice modalities for trauma treatment. Smith College Studies in Social Work, 86(4), 377-393. doi:10.1080/00377317.2016.1222110

Adam A. Neal, M.A., AMFT/APCC, has worked in the community agency setting, educational setting, and private practice setting. Adam completed his master's in counseling psychology at Sofia University in Palo Alto, CA, with a certificate in Creative Expression. He now serves as adjunct faculty, teaching courses such as Human Sexuality and Systems Theory and Application. Adam has contributed writing to CAMFT’s magazine, The Therapist (July/August 2019), the AAMFT-CA newsletter, and Psychology Tomorrow Magazine.