The conversation around mental health services has certainly changed in recent years, with more people — particularly the Gen Z population — showing an openness to, and actively seeking out, therapy. But there’s still a large percentage of the population with clinical-level mental health problems that do not seek treatment.
So why do people avoid therapy? And as a therapist, what can you do to improve engagement and ensure people get the mental health care they need?
Here are the top 20 reasons why people avoid mental health treatment so you can look for ways to overcome these kinds of objections to seeing a therapist.
1. The Impact of Stigma
According to research, the primary reason people avoid talking to a professional is out of fear they will be judged as somehow inadequate or unstable. In most societies, psychiatric problems are regarded as defects in character rather than as legitimate disorders. Many people who suspect that they would benefit from talking with a therapist cannot shake the fear that admitting they need help means that they belong to a category of people that society has deemed ‘unstable’ or “untrustworthy” for decades. For care providers, the goal is to normalize seeking help by highlighting the fact that mental health is health.
2. My Problems Aren’t Serious Enough
Many people incorrectly assume that mental health issues must be dire before it is appropriate to seek mental health care. When they compare their own problems to extreme cases, it is easy to feel that their problems are not severe enough and that they do not need treatment. For care providers, the task is to create awareness that mental health support is not intended to be a last-ditch effort reserved only for those who are catastrophically impaired.
3. It’s Too Expensive
Many people fear the financial cost of seeking help from a therapist. Of course, that can be a legitimate concern for many. However, potential clients can be unaware of insurance options and payment plans. They also might not see mental health support as a worthy investment given how society tends to devalue mental health wellness.
4. I’m Too Busy
Therapy-avoidant people can use a busy schedule as an excuse for failing to engage with a therapist. They might not consider that they are working harder or more inefficiently because of mental health symptoms. They might also not realize that, with the pandemic, convenient and cost-effective telehealth options have been prevalent.
5. I’d Rather Talk to My Friends
Social support plays a major role in promoting wellness of all sorts. But talking with friends and family might not be enough when a mental health issue has escalated. Most friends, of course, are not trained to deal with psychiatric disorders. Their advice might be unproductive or even dangerous. Relying on friends also does not offer the consistency and intensity of a therapeutic process.
6. I Don’t Want a Therapist to Judge Me
Most clients worry that a therapist will judge them poorly for past actions and current thoughts. People who have been traumatized and/or abused can be too ashamed to relay their experiences. Families seeking help inevitably worry that the clinician is intent on identifying all the ways the parents have damaged their children. Therapists often do well to anticipate these reactions by discussing them with clients at the outset of therapy.
7. Medication Should Be Enough
Talking about problems or learning coping strategies can involve no small amount of effort and discomfort. The idea of solving all one’s problems with a pill or two can seem like an attractive alternative. However, it’s rare that a mental health condition is best treated with medication alone. And even conditions for which pharmacotherapy is the primary intervention require adjunctive treatments. Further, therapy can help patients move away from medications — a worthy goal given that some medications have long-term side effects.
8. I Want Certain Topics Off Limits
Some people stay clear of therapy out of concern they will immediately have to talk about topics they feel are taboo. They might feel especially uncomfortable talking about abuse, trauma, or other personal issues. Therapists can identify and address these fears at the outset, in part by making it clear that the clients can inch their way toward the 'forbidden' topics at their own pace.
9. I Feel Like I Would Betray the People I Love
A prospective client sometimes worries that therapy will lead them down a path of betrayal, because they would talk critically about people they love. A wife may feel she would be betraying her husband if she divulged details about his infidelities and their impact on the marriage. An adult child of an abusive parent might see airing the family’s dirty laundry to a therapist as an indictment of important relationships. It is essential to assure the person that therapy is not gossip. It is learning to cope with one’s experience and those who have caused pain.
10. I Don’t Need Help
People suffering from mental illness are not always aware that they could use help. They might be too confused to know, sadly immune to the pain, or just of the mind that misery is the way of the world. Some deny their own problems by blaming others as the ones who require assistance. And still others have problems identifying how their own behavior can cause harm to one’s self or others.
11. I Don’t Want to Prove That People Were Right to See Me as Struggling
In some cases, a person is reluctant to seek help because they have been told for years that they were ‘bad’ or ‘wrong.’ In their mind, going to therapy would simply validate that viewpoint. Shining a positive light on therapy as a ‘tool’ to support good mental health instead of a ‘punishment’ is essential.
12. I Deserve My Unhappiness and Pain
Even when people know that they need mental health support, they can feel too ashamed or belittled to believe they deserve a good life. A person might think that they warrant or deserve the pain they feel. In a way, they think that they are not good enough to justify the time and expense of therapy.
13. Getting Help Is Too Complicated
Avoiding seeing a therapist sometimes comes down to resources and logistics. For some, the lack of transportation makes it impossible to book appointments. Others are not sure how to find therapists that can work with them. Additionally, language and cultural barriers can cause people to go without the help they need because they do not know where to get it. In these cases, outreach from therapists is important — everything from telehealth appointments to bilingual services within a therapy practice. In many cases, advertising these flexible resources can help a practice attract new clients.
14. I Am Not Depressed, So I am Fine
Some people think that therapy is only for people who are feeling ‘down.’ They assume that their anxiety, compulsive behaviors, or relationship issues cannot be helped by therapy because they do not have the classic signs of depression. Messaging that emphasizes how therapy can tackle many issues that create many different emotional experiences is vital for helping these people realize they can benefit from treatment.
15. The Idea of Getting Into Therapy Makes Me Nervous
The fear of trying something new can hold many people back from seeking help, especially those who are anxious by nature. From the outside, therapy might seem like it is a secret club with its own customs and rules. The way movies and other media portray therapy can also make it seem like an odd and stressful enterprise. In reality, therapy is about developing a calm and safe interchange of ideas and emotions.
16. I Am Too Old to Start Now
Individuals who are middle-aged or older can feel like they are like old dogs who will not be able to learn new tricks. They assume that the time to work on yourself is when you start a new life, new relationship, or new career. Therapists have the task of reminding potential patients that it is never too late to resolve life’s problems and improve one’s functioning.
17. Therapists Just Want My Money
A shocking number of people distrust therapists. They can believe that mental health providers are only interested in the income they generate from seeing patients (an ironic stance given the average income of most therapists and counselors). They also can be suspicious of a therapist’s adherence to rules around confidentiality. Much of the initial process of engaging a new patient is hearing them out around these kinds of concerns.
18. Been There, Done That, No Thanks.
Unfortunately, one negative experience with a therapist or counselor can sour a person on the idea of talking with someone again, especially for people who were “forced” to attend therapy during their adolescent years. By providing a positive and nurturing environment, a therapist can help undo some of the negative scripts that a person has built up based on a single experience. Emphasizing the empowerment that comes from deciding to seek help can be especially beneficial for a patient who has previously been forced or coerced into seeking therapy.
19. Change Scares Me
People struggling with substance abuse or unhealthy romantic relationships might avoid treatment because they have become so accustomed to the dysfunction. When someone is trapped in these behavior patterns, the idea of getting better can be terrifying. Many people incorrectly think that a therapist cannot work with them if they are ambivalent about getting help. They believe they have to be completely ready to make a change before they receive mental health care. Therapists often have to assure potential patients that therapy is not about pushing someone to make a life decision in one direction or another. It is about talking through those decisions in an atmosphere that supports healthy change.
20. How Can Talking Help?
Laying down on a couch and talking about one’s problems has become the iconic portrayal of psychotherapy in the movies. Many clients believe therapy simply involves endless chatter. They do not understand how laying on a couch and talking about one’s problems can help — especially when they believe the problem is insurmountable. They may see each therapy session as a waste of time.
It is vital to assure patients that talking about the problem helps the therapist understand the problem. It also helps the patient manage negative emotions and develop coping skills to deal with the issue. Emphasis should also be placed on the fact that there often is not a quick fix. Mental health therapy is a process that takes time.
Final Thoughts
You can engage more patients at your practice by keeping in mind the reasons why people avoid seeing a therapist in the first place. Identifying and relieving those concerns go a long way toward keeping patients engaged and improving outcomes..
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