For many people, the idea of consulting a psychotherapist regarding a personal problem is strange, foreign and oddly threatening. They may believe that counseling is only for people who are seriously mentally ill or for those who have experienced an extremely traumatic life event such as the death of a family member, divorce or loss of employment. Others may have the vague sense that reaching out for professional help indicates a weakness or some kind of moral failing. They may believe that truly strong people are able to face and solve their problems alone and that only weak or deficient people would consider sharing the intimate details of their lives with a total stranger. Others have serious questions about the usefulness of psychotherapy and doubt that counseling would specifically benefit them.

These popular concerns contribute to the governmental statistic that at any given time more than 50 million American adults suffer alone from a mental or addictive disorder and that less than one-third of them gets professional help. This is regrettable. In the November 1995 issue of Consumer Reports, the results of the largest survey of its kind was conducted querying people about the effectiveness of mental health care. The study found that for the vast majority of the 4,000 study participants, therapy resulted in a significant improvement in their ability to function and resolve problems and in their subjective sense of well-being. More than 54 percent reported that psychotherapy "made things a lot better." Irrespective of whether participants had begun psychotherapy feeling "fairly poor" or "very poor," almost everyone got some relief from the problems that brought them to a therapist.

Psychotherapy is a process of self-exploration and discovery that usually happens by way of dialogue between two people. The therapist and client come together to learn more about the client's presenting problems and to mobilize his or her abilities to respond to situations in constructive ways.

Skilled counselors are trained to ask discerning questions to help clients clarify their feelings, thoughts and behaviors. Often through this process, clients make connections between seemingly unrelated elements of their lives and discover their own answers to perplexing life questions.

The essence of psychotherapy is listening. As the therapist listens carefully to the client, the client learns to listen more respectfully and fully to him or herself. Through the process of honoring one's own experience, clients often discover sources of inner guidance and affirmation. Often the counseling relationship models for clients how to relate to themselves in honest and more caring ways.

1. When a life event is having a strong, prolonged negative emotional impact that doesn't improve over time. All of us experience loss and change that can trigger difficult feelings. The ending of a major relationship, a financial setback, a serious accident or illness will usually activate normal responses of fear, sadness, anger or loneliness. While these feelings may be strong and distressing, they usually diminish over time. If you find that your negative feelings are persisting or increasing or that they are having an increasingly negative impact on the quality of your life, it may be useful to sort out the experience with a therapist. A therapist can help you see memories or meanings associated with the event and help you move through complex feeling responses.

2.When you notice yourself repeating negative patterns with work, family, friends or personal pursuits. Do you chronically get into power struggles with your bosses or repeatedly end up with romantic partners who betray or undermine you? Do you have patterns of under achievement in areas of interest or find yourself unable to break out of old family roles and expectations? If, despite repeated attempts to think about and change distressing patterns you find yourself still repeating them, it may be time to discuss them with a therapist.

3.When your work and/or personal life is negatively impacted by your moods or feeling states. Do you "blow up" or lose your temper to the extent that it threatens important projects or relationships? Are you often so "low" that you're unable to motivate yourself to act in your own behalf? Does pervasive anxiety keep you from engaging in activities that would be pleasurable or profitable? Problems with mood have many components: they may be a learned response to unmanageable childhood situations, a reaction to recent trauma or a physiological tendency influenced by brain/body chemistry. A trained counselor can help you discern the sources of negative mood and explore various approaches to managing your feeling states and feeling better.

4.When you suffer from poor self esteem. For many people, the hardest part of life is consistently feeling bad about themselves. They walk around feeling inadequate, defeated and ashamed or "like a fraud," just on the verge of being discovered. They are their own worst enemies, harshly judging themselves, comparing themselves to others or berating themselves for past losses or failures. Psychotherapy has been demonstrated to help people free themselves from chronic self-criticism and attack. Through the trusting relationship with a therapist, many people learn to challenge and change their negative assumptions about themselves and develop a more positive and realistic sense of self.

5. When habits or substances negatively impact your life. Is your drinking interfering with your ability to do your job? Are your credit card bills mounting because you can't stop yourself from buying unnecessary "necessities?" Is your partner complaining that they never see you due to overwork? Do you spend much of the day thinking about food, eating or weight? When habits or substances make you feel out of control, it can be time to seek professional help. Psychotherapy can compliment specific recovery programs or can be useful as the primary means of exploring and changing the ways we use behaviors and substances to soothe, regulate or maintain a sense of self.

6.When you are moving through an important life transition. Have you recently become married or divorced? Have you moved to a new city or completed a major career change? Are you a new parent or a new "empty nester?" Have you recently undergone a major surgery, medical procedure or just found out you have a major illness? Significant life changes challenge our old identities and calls into question assumed roles, rules, responsibilities and relationships. Psychotherapy can be one way to take stock of our lives and to clarify what we want during these new phases of our development.

7.When life has ceased feeling meaningful, joyous or purposeful. Does your life feel dry, flat or routine? Do you find more often than not that you're simply going through the motions, doing the daily tasks that must be done with little pleasure, satisfaction or delight? Have you lost touch with the hopes and dreams that used to motivate and inspire you? These states of spiritual and psychological aridity can signal the need to take a deeper look at ourselves and reevaluate our commitments and priorities. The responsiveness of a therapist can help us acknowledge the deep urgings and longings of our truer selves. Therapy can be a place where we chart a new course for our lives.

8.When an important relationship is in trouble.Close, intimate relationships are the places where we learn the most about ourselves. They have the ability to bring out the very best and worst in us and our partners. If your relationship with your spouse, partner, child or family is a repeated source of pain, consider consulting a therapist. Often an objective third party trained in relationship dynamics can point out problematic patterns in communication, habits of criticism, attack, defensiveness or withdrawal and help a couple reconnect with what they value in each other.

9.When others express concern for you. Have family, friends or co-workers mentioned that they're worried or concerned about you? Have you received feedback that you don't seem yourself lately or that your behavior is alarming to those who care about you? It sometimes takes great courage for the people who love us to let us know that something seems wrong. This can serve as a wake-up call. If others have commented or asked about your well-being, therapy may provide a safe place to take a fuller look at yourself and the challenges you're currently facing.

At the Marina Counseling Center, therapists meet with clients on weekdays, evenings, and weekends. The directors and staff of the Marina are happy to answer question and speak with you about the appropriateness of beginning therapy. "When is it time to consider psychotherapy?" was written by Karen Rogers, MFCC, Former Clinical Director of the Marina Counseling Center and a therapist with over 20 years in private practice in San Francisco.