Help! Three Women, Three Problems, Three Therapies

Go behind the closed doors!
Olivia: "The light had just seemed to go out of me."
Nicki: "We'd started to grow apart."
Lauren: "I felt as though my life was standing still."

In my first year of training as a psychiatric resident, a friend called to ask whether I thought she needed to be on an antidepressant. She'd been dating the same man for several years, and despite the fact that nothing in the relationship had recently changed, she was feeling mounting anxiety about its future. "Some days I have this impulse to just end things with him," she said, "and other times I wonder if I just want out because I'm afraid he's going to leave me ." I could hear the stress and emotion in her voice, which suddenly got uncharacteristically quiet. "I've been pretty miserable lately.

I was quiet for a second too. Then I asked if she'd thought of talking her problems over with a therapist. And just like that, her voice was back to its full decibel range, and fully indignant. "What, you think I'm crazy?"

I laughed. I assured her I didn't. But it wasn't the first time I'd heard this response to what seemed to me to be a most logical suggestion.

Maybe people genuinely believe that therapy is helpful only to those who are severely mentally ill. In fact, the opposite tends to be true. The decision to go into therapy is often an emblem of sanity, a marker that a person is wise enough to know when she needs some help and support, and responsible enough to get it.

There is no set list of issues that require therapy, but there is a common reason to begin: A problem looms large, and there are no good solutions in sight. For the millions of women who suffer from depression or anxiety, the central issue may be the sometimes-crippling impact of those illnesses. Women with depression may lose interest in activities that once brought them pleasure. They may sleep too much, or not enough. They might feel hopeless or helpless. In the most extreme cases, they may have thoughts of killing themselves. Women with anxiety may be plagued by excessive or unrealistic worry that can cause shortness of breath, diarrhea, sweating, or panic attacks.

For others who seek therapy, the trigger is not the debilitating symptoms of mental illness but rather ordinary life—the quotidian problems that make us feel sad or helpless or interfere with our ability to be happy and productive. We are each, of course, differently equipped to handle challenges. The same woman who confidently navigates a career change might find herself unexpectedly devastated by her mother's death, while a woman whose marriage has always been a solid source of comfort and strength may find her partnership unmoored when she is unable to conceive a child.

By its very nature, the therapy relationship is targeted toward just this individuality. And by this I mean that when you enter into therapy, those sessions are a time and place wholly for you . Therapy is focused on helping you understand your feelings and, if need be, changing your behavior. The issues you face may involve others in your life—a difficult boss, an aging parent, a distant spouse—but you and your therapist will focus on how to steady your own life, regardless of the storms that rage around you. In other words, therapy is focused on helping you understand who you are.

At first blush, this kind of goal may seem abstract and ethereal, even flighty and aimless—calling to mind the teenager who drops out of school to "find herself" while hitchhiking to California. And who has the time or money for such self-indulgence?