What are the common misconceptions about going to therapy? When do you need counselling?

Many misconceptions about therapy exist. Like, isn’t it just talking about your problems, except you’re paying someone to listen to you and agree with you? How is it different from spilling the tea with your bestie? And for the introverts among us, how is revealing our deepest, darkest secrets to a total stranger helpful at all?

“Therapy helps to guide you to live your life according to your values, provide hope and reduce suffering,” said Nicole Wong, a senior psychologist with Department of Psychological Medicine at National University Hospital (NUH).

And it’s not a passive process where you lie on the couch and talk about your day to your therapist. “It’s a collaborative approach between the client and therapist, with the client as the expert in their own life, thoughts and feelings, and the therapist as the expert in psychological theories and interventions,” said Wong.

“It’s a safe space to share and explore your thoughts and feelings without judgement, and help you break difficult patterns in your life and make the meaningful changes that you want.”

A safe space to discuss anxiety, stress and depression may be what we need, at least according to the latest National Population Health Survey 2022 by the Ministry of Health: Poor mental health increased from 13.4 per cent in 2020 to 17 per cent in 2022. Nearly one in every four Singapore residents (or about 25 per cent) between 18 and 29 years old suffer from poor mental health – an uptick from 2017’s 16.5 per cent and the largest age group to be affected.

“The pandemic could have been a contributing factor to this decline,” said Andrea Chan, the head of TOUCH Mental Wellness, TOUCH Community Services, of the survey results. “It could also be that people now have a better understanding about mental health issues. With that, they can better define what constitutes poor mental health and are more willing to admit that they have poor mental health.”

But even without the impact of COVID-19, the “competitive, fast-paced, and often stressful” society we live in is often stressful for all ages, said Dr Cecilia Chu, a consultant and specialist in clinical psychology at Raffles Counselling Centre. “Amidst the busyness, we also miss out on social connections and other pursuits that could give deeper meaning that mitigates the relentless pace or stress.”

MORE OPEN TO SEEKING HELP

The upside to the national mental health situation is that we’ve become more open to talking about our problems, according to the survey: 56.6 per cent were willing to seek help from health professionals in 2022 compared to 47.8 per cent in 2019. Close to 80 per cent were willing to seek help from informal support networks in 2022 compared to 74.5 per cent in 2019.

The openness appears to cut across the ages as well. “With the increased efforts to improve accessibility to mental health services, we are seeing a wide range of ages from as young as seven years old to the older adult population," said Wong.

Chan agreed that the increased accessibility to help plays a part in more people seeking help. “People know where to find these resources and many of them are now closer to home and in the communities that they live in.”

THERE’S STILL PUSHBACK

Still, taking that first step to seek out a therapist can be a big one. It “requires a readiness to face one’s emotions, thoughts and behaviour and also be open to change”, said Dr Chu. “This takes time and energy – and may not be everyone’s inclinations.”

For others, the mental health stigma persists. “People may worry about being judged negatively or discriminated against by others,” said Eugenia Yee, a senior psychologist at NUH’s Department of Psychological Medicine. “Others may worry about losing opportunities (such as jobs and scholarships) if they have a mental health diagnosis on record.”

“Some don’t want to receive counselling because of negative past experiences with counselling,” said Chan. “The reality is that every counselling experience is different. Just because you had a negative experience does not mean that counselling automatically is not for you. Give it a try again with a different counsellor and you might see the benefits of speaking to someone.”

Cost is another big one, continued Chan. “A very common reason we hear is the lack of knowledge as to where individuals can get professional help and the costs associated.”

But there are ways to get around that. For instance, some therapy services are free of charge, including TOUCH Community Services’ Youth Integrated Team, Singapore Association for Mental Health and Aware. You can also get “a referral from a polyclinic to access therapy in the polyclinic or at government restructured hospitals at a subsidised rate”, said Yee.

MORE THAN JUST TALKING

Still uncertain if you need therapy? If you have doubts or questions, here's a look at some common misconceptions about therapy that may be stopping you from seeking the help you need:

Misconception 1: I don’t need therapy; I just go to the gym or have a good cry

You’re not wrong in seeking refuge in the gym or having a cry if these methods help you to feel better. “There are many ways of coping and therapy is one of them. But it’s actually a myth that it’s the way,” said Dr Chu. In fact, counting reps in the gym or laps on the track can temporarily increase endorphin levels, which evoke happiness and euphoria, said Chan. Crying has the same effect, too.

Another plus from exercise is reduced stress levels, she said. “Increasing your heart rate can reverse stress-induced brain damage by stimulating the production of neuro-hormones such as norepinephrine. These neuro-hormones not only improve your mood but also cognition, which could be clouded by stressful events. So, doing moderate exercise throughout the week and occasionally crying can improve depression and anxiety,” said Chan.

However, if your daily life is affected for a prolonged period, you may need more than exercise and a cathartic teary session, said Justyne Ho, a counsellor with Singapore Association for Mental Health. “These methods cease to work when we continue to feel emotional and negative and our daily life is affected.”

“We would suggest that you see if professional help works for you. Seeking help does not mean that the professionals are going to take over your life; it is actually an opportunity to share and gain new insights,” said Ho.

Misconception 2: I can analyse and solve the problem myself

The solutions from talking about your problems with a mental health expert can be quite different from those in your mind. “When you speak with someone, it is a dialogue and it can open more perspectives for you. It can also be helpful for you to ‘hear’ what you have been saying to yourself,” said Ho.

Indeed, being able to talk to a professional can help you to dissect your problems and put in place healthy coping mechanisms to better process your negative emotions and thus, improve your mental health, said Chan.

Moreover, these are professionals who are equipped with the skills and resources to facilitate conversations in a productive manner and help counsel you, said Chan. “The trained professional is able to take on an objective lens as compared to a friend or family member, who may feel more invested in your personal life.

“By talking about the difficulties you face, coupled with the therapeutic questioning from a trained counsellor, you allow your brain and your whole being to digest what is happening and how to cope moving forward”.

Misconception 3: I don’t feel comfortable sharing intimate details of my life with a stranger

It is natural to feel this way. “Like any other relationship, it takes time to warm up and trust your therapist,” said Yee. Give yourself time and try not to be too quick to draw conclusions about your therapist and the process. “It is strongly encouraged that you be open and honest with your therapist,” said Yee, which could include bringing up concerns you may have about therapy.

“While your therapist can help you to better understand yourself as well as provide you with guidance and alternate perspectives to consider, a huge part of your progress is dependent on what you do with the insight you gain from therapy,” said Yee. In essence, you determine your therapy’s effectiveness by applying what you learn in the therapy room to your life out there, she said.

Misconception 4: My problems need to be serious enough to warrant therapy

Chan has this analogy: If you had a cold, wouldn’t you see your family doctor at the onset of a blocked nose or sore throat? You aren’t likely to wait for the symptoms to worsen before making your way to the clinic because by then, the recovery is going to take longer and the treatment may be more intensive.

The same goes for mental health issues, said Chan. “Mental health issues can be managed and are treatable, especially when addressed early. So, we encourage anyone who is struggling with their mental health to seek help early. Do not wait till you have full-blown symptoms before seeking professional help.”

Some people may not seek professional help early on if they have friends, relatives or religious organisations that can provide the support they need, said Ho. “However, if you still feel a sense of mental distress after talking to your friends and family, it is a sign that you need to consider seeking professional help.”

Misconception 5: I thought I only needed one session

“Therapy is not a one-off magic pill”, said Chan. “It would require multiple sessions before we see results. A good estimate for a low-risk case (that is, non-complex and help was sought early) would be four to six sessions.”

Ho also reminded that counselling need not be for good. “While we do have clients who are in therapy for the long term, they usually do not require intensive counselling and may attend sessions once a month.” Nevertheless, “there are clients who come back for counselling after some time because of new stressors or the recurrence of previous issues,” said Ho.

Misconception 6: I just have to talk, right?

Exploring and talking about your deepest vulnerabilities is an intimate process that can be emotionally draining, said Yee.

“Before attending each therapy session, make time to ground yourself, gather your thoughts and think about what you would like to bring into the session,” said Yee. To gain the most out of therapy, she suggested considering the following before meeting with your therapist:

• What are the key difficulties that I am facing right now?
• What are my goals for therapy? What do I hope to get out from therapy?
• Am I ready to talk about the hard stuff and actively make changes to improve my situation/life? If I don’t feel ready, what are some steps I need to take before commencing therapy?

After each session, allow yourself to wind down and engage in activities that are self-soothing before returning to your usual responsibilities and duties, said Yee.

Find a qualified psychologist here, which is maintained and regularly updated by the Singapore Psychological Society.