January 27, 2023

By Max E. Guttman, LCSW

Person talking with a therapist
As a mental health professional and someone who lives with mental illness, my best advice to others is to address your mental health concerns early — before they snowball or escalate. The ideal conditions for seeking treatment are on your terms and before your symptoms outweigh your capacity to cope.

Moreover, taking a preventative approach to your mental health care allows the time to find quality care that is the right fit for you. Your success will hinge on finding a therapist with whom you connect and finding a treatment method and plan that best serves your needs. For some folks, brief or short-term therapy is sufficient for learning new coping skills and techniques to self-manage their mental health challenges. For others, therapy might be part of a long-term treatment plan.

In my work as a licensed clinical social worker (and in my lived experience with mental illness), I have found that most people have "stuff." For some, this means diagnosed illnesses and disorders, and for others, unresolved emotional scars that are distressing but do not rise to the level of a DSM-5 diagnosis.

Regardless of our "stuff," we can all be proactive in getting the right help. Indeed, one or two seemingly minor symptoms that do not accompany an official diagnosis can evolve and worsen, becoming a more long-term challenge. The people who experience one or two (initially) minor symptoms comprise the vast pool of untreated people who could benefit from therapy.

For those who fall into that category and are new to the treatment process, how can they be proactive in evaluating whether a therapist or approach is the right fit? Once they secure care, how do they decide if it is effective?

When beginning treatment, consider the following points:

You Should Be an Active Participant in Your Care

A good therapist will guide and support you on your mental health journey, but your progress will also depend on your investment in the process. Evidence-based practices (EBP) show that effective treatment comes from an equal energy investment between provider and client.

If you are complacent or unwilling to have a conversation, you can expect to experience a limited level of gains. Giving "lip service" or avoiding sessions can cause severe setbacks. Ideally, if your therapist observes any therapy-interfering behavior, they will flag the issue and try to get a general sense of your mental status from session to session.

Distress Tolerance Is a Part of the Process

It is ok (and normal!) for treatment to be uncomfortable. But how much distress is acceptable? A good therapist will help you to understand this threshold better. When a topic causes discomfort, your therapist should engage you intentionally and gently to determine your limits, insights and awareness. Pay attention to how your therapist navigates distress in the session and to what response feels most productive. Do you benefit from gentle, positive reframing that allows a healthier view of a situation? Or having your feelings and experiences validated?

Once you have established these boundaries, your therapist can help you expand your insight, awareness and distress tolerance.

The Energy in the Room Matters

When done correctly, the work involved in therapy can bring energy and trust to the room. Pay attention to how you feel during your sessions. Do you feel safe being vulnerable? Can you be your authentic self in the therapy room? A therapist can best tend to your needs when you are comfortable showing up and center your true self (identity, history, trauma, your daily lived experience).

Good therapy requires this foundation of trust and understanding to gain the skills needed to make informed choices about how you live and what you want from life.

I have lived with a chronic mental health disorder for two decades, and it has been quite a journey and learning experience. I would not be around today to share my insights if I hadn’t found the proper treatment fit. Getting the right kind of therapy (and sticking with it) can make all the difference in your mental health.

After all these years, I am still independent because I know when to ask for help when I need it. Ultimately, people that self-manage and thrive know how and when to connect to the right care. Finding the proper treatment is essential to walking the path of recovery.


Max E. Guttman is a Licensed Clinical Social Worker, mental health therapist and disability rights advocate. He has worked in various systems of care in New York State, both as a clinician and as a peer. Max is also the editor-in-chief of Mental Health Affairs, a website for the mental health prosumer.

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