Negative Attitudes and Barriers to Seeking Help
There's a familiar saying among helping professionals, "People who try therapy are actually healthier than those who say they wouldn't touch it with a ten foot pole." Or something to that effect.If that statement bears any truth, then why is there such a stigma attached to psychotherapy? When did we become so afraid that someone will find out we're going to counselling? When did asking for help become a sign of weakness rather than a show of personal strength and positive coping?
We've all seen the way mental illness is portrayed in the media. You've got Hannibal Lecter, Tony Soprano, and that kid who sees dead people, all chatting to psychiatrists who seem to have too many problems of their own to give full attention to the psychotic needs of their anti-social patients. These Hollywood depictions are intended to get butts in seats at the cinema, rather than to offer a realistic picture of the average person having difficulty managing who asks for guidance, and the empathic, dedicated professional there to offer it.
I found an excellent literature review about People Seeking Help in California (Morrell & Metzl, 2006). It discusses motivations and barriers to people seeking treatment from psychotherapy services in America:
Avoidance: Barriers to Seeking Treatment
Treatment fearfulness. In their studies about what they term the “service gap,” Kushner and Sher (1991) report that utilization of services may be low primarily because people prefer to receive help from informal sources such as family, friends, and clergy, because of the inaccessibility of services, and because of what they call “treatment fearfulness.” Treatment fearfulness is defined as “a subjective state of apprehension that arises from aversive expectations about the seeking and consumption of mental health services (p.4) Treatement fearfulness can come from a variety of sources, including the six identified by Kushner and Sher (1991): 1) fear of embarrassment, 2) fear of change, 3) fears involving treatment stereotypes, 4) fears associated with past experience of the mental health service system, 5) fears of negative judgement (stigma), and 6) fear of treatment associated with specific problem types.
Self-disclosure. A person may desire to conceal negative personal information (Cepeda-Benito & Short, 1998; Kelly & Achter, 1995) or avoid the increase of painful feelings that can be experienced during therapy (Komiya et al., 2000). An individual’s willingness to disclose personal information may impact not only the outcome of treatment (Kahn, Achter, & Shambaugh, 2001; Kahn & Hessling, 2001), but also initial willingness to seek help from a variety of sources including friends, family, clergy, and mental health professionals (Hinson & Swanson, 1993). Vogel and Wester (2003) studied college students' attitudes toward self-disclosure and the risks and rewards of disclosing within a therapeutic relationship. They found that the students’ comfort with self-disclosing distressing information and the perceived benefit of such self-disclosure had a high association with willingness to seek help. The impact of one’s comfort with self-disclosure is large, accounting for between 35% and 40% of the variance between help seekers and non-seekers.
Gender. Traditionally, studies have found that women are more likely to make use of services than men, without regard to age or sexual orientation (Garland & Zigler,1994; Husaini et al., 1994; Butcher, Rouse, & Perry, 1998; Modcrin & Wyers, 1990). One estimate, in the early literature, states that one in three women will seek professional mental health help in their lifetimes, while only one in seven men will do so (Collier,1982).Kushner and Sher (1991, 1989) report that although women are more likely to engage in therapy, women experience more treatment fears than men. In spite of the prevalence of women as help seekers, the number of men seeking treatment has been on the rise (Betcher & Pollack, 1993; Freiberg & Sleek, 1999). Nevertheless, most of the published research explores barriers that affect menmore than women. For example, Robertson (2001) states that “traditional counseling requires men to set aside much of their masculine socialization simply to get through the door and ask for help” (2001, as quoted in McCarthy & Holliday, 2004, p. 26). A fear ofthe power differential inherent between therapist and client (Blazina & Watkins, 1996; Tracey, 1985) and a confusion caused by the differences between their perceived gender roles and their reality (Blazina, 2001) may create double bind situation for men in which they need help but are resistant to seeking that help (Blazina & Watkins, 1996; Levant,1990). Men in the United States are socialized to be self-reliant and to avoid self-disclosure (Nadler, Maler & Friedman, 1984). They may believe that vulnerability and emotions are signs of femininity, that seeking help shows potential incompetence and that communication of feelings should be avoided (O’Neil, 1982). Levant (1990) reports four gender-role characteristics that can contribute to men’s avoidance of therapy. First, men have difficulty admitting that a problem exists. Second, they have difficulty asking for help. Third, they have trouble distinguishing between the various emotional states. Finally, they may be trained to fear intimacy.
Ethnicity. Members of minority populations, who may already suffer from fears of negative judgment and stigma, can “be faced with unique concerns about how they will be received in the predominantly White, middle-class mental health system” (Kushner & Sher, 1991, p. 8; see also Minrath, 1985).
Citation: Morrell, M. & Metzl, E. (2006) Seeking Treatment in California: Motivators, Barriers, and Perceptions, cited on CAMFT website: www.camft.org
To read the full review, visit the California Association of Marriage and Family Therapists Press Room, CAMFT website article >>
georgie
7 Comments
mental health is as important as medical health
ive sought counseling in my life, and i probably will again....its probably one of the more healthier things ive done for myself. sometimes you need counseling when times are difficult in order to stay on track to reach certain goals, sometimes you need help figuring out things that friends and family couldnt help with because they are biased.
i think it is disturbing when people ridicule others for having received counseling. i also believe we should have MUCH BETTER mental health care programs. Theres a reason divorce is at 60% of all marriages in the usa right now.
Every single person has problems and issues, if you say you dont you are a liar. not only do i not see anything wrong with talking to someone about these issues but i think it is healthier to try and work these problems out, rather than ignoring them.
counselors help save marriages, lives, families, and help people reach their potential. my cousin Michelle is a counselor and is currently writing a book about this very topic.
I know of people who have gone through some incredibly life changing ordeals and have not at all been able to cope (or just skim by like i did) , some try and seek help but find it too hard to admit they have either a mental illness (seeing it as shameful or living under the belief that its wrong to feel the way they do ) or are worried that seeing a mental health profesional is a sign of weekness , that it takes away from who they want to see in themselves. or are just ashamed (usually this should not be the case) that they have had something happen to them or that they have or might have a diagnosable mental heath problem.
I know this becuase i have an anxiety disorder , and i suffer from a rather large case of agoraphobia (not sure about the spelling) wich is from what i understand related to that and did not seek help for it for as far back as five years ago .
I had my first panic attack when i was very young (although a doctor confused this with an asthma attack) and there is a family history of it .
They worsened about five years ago when some very bad things all happened around the same time and then started to effect my work and home life to such a degree that it was ruining both (home life wasn't magical around then anyway ) but i would still not seek help despite the severity and length of these terrifying experinces becuase i thought if it was some sort of disorder it would change the way people around me would view me as a person (even though i had no idea of what it was) or i was actually sick with something else i wouldn't want to find out as i had probably had enough bad news . I felt weak, helpless and alone.
I kept it a secret from workmates , friends and family , my girlfriend (who wasn't very understanding on mental heath issues despite having some of her own) , especially my kids who i felt were far too young to understand (they were) or anyone i met in that time.
About a year and a half ago i had a very bad panic after suffering from an increasing level of depression and anxiety and ended up at my local hospital where i was informed of what was wrong and that there was help .
They refered me to the hospitals mental health team and i have been seeing someone for more than a year now .
I still have my disorder but now i know that there is help and that it can be beaten with time and help.
I can't say that everyone i know has been entirely understanding about my disorder and initially that hindered the way i felt about the treatment , i also had a side effect to one of the drugs i had been given but regardless of that i'm improving and i really hope that anyone in a similar condition or even if your just having problems to get yourself into counseling , see you local doctor and get a referal if necesary and try and keep an open mind. Things can and will change and taking that first step is hard but its far easier than waiting and living with it on your own.
To my friends and family that have supported me : thankyou becuase i really needed the and still need your help caring and understanding . You really are priceless to me.
To everyone else :
Please try and be open minded and educated on matters of mental health before you comit to a negative ideal .
Try and seek profesional help for and advice for a friend or family member above telling them that its simply just going to be ok .
Above all else just be there for them becuase to this day there still really arent many people i have left that know what i go through daily and i really wish there were more.
Thanks for the stellar post Georgie.
to be truly healthy people should take care of their mental health and medical health.
opinions are changing and more people are realizing that its HEALTHY to get counseling rather than a sign of some sort of craziness.
Thanks, everyone who responded to this post on why people avoid therapy, with true stories about how therapy has worked for them. It can be very hard work, after all.
I have also had on-off dealings with NHS Mental Health Services since I was 15 (nearly 19 years now!) and I kept this to myself for ages. But in the last couple of years I have actually become very open about it and even done a little campaigning on some Mental Health issues. As you say, randomglenn, we are often terrible at being advocates for ourselves and I feel that, as an intelligent articulate person, I owe it to those who can't.
Anyway, I may well share my story and views some more another time but I have to dash!
Hey you know AdGuy always gets the last word! ;)