For some individuals, the decision to see a therapist may bring a sense of relief; for others, the decision may bring feelings of fear or dread. The act of going to therapy can require courage for a number of reasons. The stigma surrounding mental health issues may lead to fear of being ridiculed or discriminated against if others discover that the individual attends therapy. Individuals with anxiety disorders may fear the unknowns associated with therapy. In addition, a mistrust of the healthcare system by some marginalized groups may produce fear and uncertainty regarding mental health services.
It takes courage to overcome a stigma and individuals with mental health issues face stigmatization both from within and without. Self-stigma refers to negatively held views about oneself regarding mental health concerns. This type of stigma can lead to reduced self-esteem and self-efficacy, the latter of which refers to the perceived ability to cope successfully with mental health conditions. In fact, self-stigma can exacerbate mental health problems when the individual denies the existence of problems or the need for help. A second type of stigma, public stigma, refers to overt and covert prejudices in society regarding help-seeking behaviors for those with mental health issues. Both types of stigma are associated with reduced use of mental health services. It takes courage to overcome the internal struggle against self-stigma and to seek help even when society holds negative views about such actions.
For some individuals, the need for courage to seek therapy may be related to the type of disorder for which they seek help. Anxiety disorders are fairly prevalent in the United States, affecting about 18% of the population. Social anxiety disorder and specific phobias are the most prevalent types of anxiety disorders, affecting 6.8% and 8.7% of the population respectively, followed by post traumatic stress disorder and generalized anxiety disorder at 3.5% and 3.1% of the population, respectively. A common thread among some anxiety disorders is an intolerance of uncertainty. This characteristic refers to the inability to cope with negative responses triggered by perceived uncertainty. Intolerance to uncertainty is strongly correlated to worry and the severity of suffering among individuals with generalized anxiety disorder and social anxiety disorder.
Therapy sessions may be associated with a degree of uncertainty. For an individual who has never seen a therapist before, uncertainty may exist over whether or not the therapist will be kind and effective, whether counseling will help, the cost associated with therapy, how to physically get to the therapist’s office and whether or not one will be on time, and the types of issues that the individual will discuss during counseling. This uncertainty could trigger a strong sense of worry in anxious individuals. Thus, for these clients, a great deal of courage may be needed to step into the unknown, particularly when they may lack adequate coping skills to deal with the uncertainty.
In addition to stigma and intolerance of uncertainty, a third reason why courage may be required to attend therapy is cultural mistrust of healthcare providers. For example, African Americans are less likely than Whites to use mental healthcare services due to mistrust of White people, systems that are dominated by Whites, and a lack of African American counselors. For members of this cultural group, a great deal of courage may be needed to seek help despite a complete lack of trust in the healthcare system.
For many individuals, courage is needed in order to seek help for mental health problems. Some individuals may face self- or public stigma or may have difficulty coping with the uncertainty surrounding the experience of making life changes. Others, who have had trouble navigating the healthcare system in the past, may lack trust in mental health services. Therapists must be aware and sensitive to these issues in order to develop an effective therapeutic alliance with their patients.