“Do I have to?”

If I had to choose one word that drives many of the mental health challenges that we experience, it would be “avoidance.”  Understandably, we all want to avoid difficult thoughts, emotions, or experiences, and all of us at some point do things so that we can get out of those psychologically tough situations.  I think it is this tendency toward avoidance that leads to a common question I receive in the context of therapy, which is some variation of “do I really have to talk about the bad stuff? I really don’t want to talk about it.” 

Of course, no client should ever feel that he has to think or speak about something.  But is it necessary to do so in order to see improvement? 

Sometimes the answer to the question is “no.” In these instances, building coping skills or mindfulness skills can be sufficient for the client to see a decline in distress or impairment, such that he is pleased with his functioning without directly addressing the difficult thoughts or emotions.  Many times, however, not addressing the difficult experiences is another expression of the avoidance that is driving the distress or impairment. In such a situation, it may be more difficult for the client to see improvement without talking about “the bad stuff.” 

It is exactly for this reason that the process of therapy can be very difficult, as people may have spent years avoiding the exact things that the therapist will ask them to think about.  But in many cases, if a client can break this pattern in therapy, it can be a liberating experience and have a profound impact on many aspects of his life.