July 3, 2014 at 9:35 pm

Recently I’ve been kind of fixated on trying to figure out what motivates people (including myself) to get help. A relative of mine has been suffering for years from undiagnosed anxiety/depression related to childhood trauma, and dabbled with psychotherapy and medication briefly in the past. Recently, he was ready to really delve into treatment more seriously, and the results have been astounding. Which, of course, makes one wonder whether seeking out help sooner would have yielded similar results or if he really wasn’t ready until now. Prior to entering therapy, I asked him why he decided to try therapy again, and he repeatedly replied: “I just can’t go on like this”. Would love to hear what your experiences either personally or with clients has been!

September 19, 2014 at 10:49 am

This is such an interesting question to think about, Lara.  After reflecting on this, from both personal and professional experience, it seems that the right balance of Awareness-Hope-Fear contributes to readiness for help (this is at least how I’ve encapsulated it).

1.) Awareness: not being in denial – recognizing that a change is needed

2.) Hope: awareness of and hope about how one might be helped (e.g., a realistic idea of what therapy is, how the process works, having access to providers that are a good fit, etc.)  “Help” may be in the form of therapy or some other type of intervention for change/healing.  But, people need to have some knowledge about what’s available as well as some hope that they can be helped and/or can help themselves with the proper support.  Sadly, some people can feel hopeless about changing, especially if it’s a really long-term problem.  But, that hopelessness is just an ingrained feeling; there’s always hope!

3.) Fear: not too much fear about seeking help (as this leads to avoidance), yet enough fear/anxiety/angst that’s serving as an indicator that change is needed.  Fear of seeking help, as you know, can come from many sources, mostly cultural: stigma / being seen as weak for seeking help / expectations of rugged individualism.  Generally speaking, change is very scary — even if it’s going to lead to something good.  That’s just how we wired as human beings.  So, again, if the fear level is too high, then one won’t feel “ready.”  Another contributor here recently wrote a great post on the Stigma of Psychotherapy that looks at more of these pieces.

Hitting rock bottom:  this speaks to the fear and denial piece as well.  Like your family member who said “I just can’t go on like this.”  Sometimes, things need to get really bad before people feel moved to seek help.   As I’m sure you’ve heard as a clinician (something I hear all the time) is how people often take a very long time before seeking help.

I’ll finish with a summary of the “Stages of Change Model” (aka, Transtheoretical Model of Change originally developed in the 1970’s for use with problems of addiction, but now is applied in a variety of contexts).  I’ve found this model helpful to think about when working with clients, and many have found it helpful as well when thinking about “readiness for change.”

1.) Pre-contemplation = Not Ready
You see the cons of change more than the pros and may not even be aware of the need for change.

2.) Contemplation = Getting Ready
You’re seriously considering making a change, but you feel ambivalent about it. The benefits of change seem about equal to not changing at this stage.

3.) Preparation = Ready to Change
You’re clear that you want to make a change, but you fear that you may not be up to the task.

4.) Action = Productive Activity
You are starting to make the changes you wish to see, but the behavior hasn’t become established yet.

5.) Maintenance: Keeping on Track
You have made the changes you wish to see and now are working at maintaining this positive growth.