When Should I See a Therapist?

by Cyndi Williams, MSW, LCSW

Grief can feel like depression, raise anxiety, and have some similar symptoms to post traumatic stress disorder. It can cause social anxiety and agoraphobia (fear of leaving the house). It can have extreme highs and extreme lows. Anhedonia, which is the inability to feel pleasure or have interest in things you normally enjoy, is almost universal among grievers. Psychomotor retardation, which is the slowing down of cognitive function and physical movements, is common, as is psychomotor agitation, the “antsy” feeling that you should be doing something at all times.

A clinical diagnosis of depression usually includes physical symptoms of sleep disturbance, changes in appetite or weight, poor concentration, and fatigue. Other considerations for a therapist are feelings of being worthless, hopelessness, and suicidal thoughts. The reality for most wisters is that they have likely experienced some or all of these symptoms and likely do not have a serious mental health disorder.

As a therapist, when I meet with someone who has recently had a loss, it can sometimes be challenging trying to sort through all of the symptoms that can come with grief to determine the right diagnosis. The most common diagnosis I give to someone I am initially meeting with for grief is “adjustment disorder,” or difficulty coping with a recent change along with anxiety, depression, or both.

Adjustment disorder is typically a short-term diagnosis most of us wisters would qualify for after the death of a spouse, requiring mental health support. Most people begin to see improvement in symptoms over several months, even without the support of a counselor or therapist. But I am often asked how to know when more help is needed, or the right timing after a loss to seek professional support.

There is no cookie cutter answer to this because although we all may have experienced some or all of the symptoms listed above, each and every grief journey is unique to the person experiencing the loss. You may have a great support community of friends, family, and helpful church or work colleagues. You may have a strong faith or inherent resilience and coping skills to draw on. You may have been very close to your spouse, with every aspect of your day-to-day life intertwined with theirs, or you may have had a more distant or independent relationship with them. Their death may have been sudden and unexpected, even traumatic, or it could have come after years of battling illness. You may have taken on the role of caregiver, or you may not have been with them when they passed away. All of these factors play into your own grief and healing experience in a positive or negative way, and may not always have the impact you’d have predicted.

I personally believe therapy can be effective even after just a few visits to help normalize the feelings and experience of grief, to validate the feelings (anger, relief, etc.) you may not be comfortable sharing with your close circle, to help you learn new ways of coping with anxiety and depression symptoms, and to encouraging self-care. I would never discourage therapy in any circumstance, but I also would not say it is always necessary for healing. However, you should seek professional mental health support if you are feeling some or all of the following symptoms:

Suicidal thoughts. As a Christian whose faith has always been a strong source of coping, I found myself often praying “Okay, God, I’d be okay if you’re ready to sound those trumpets soon,” but I never had any thought of taking my own life. Have you had thoughts that life is just too hard? Have you thought about how you would end your life, or begun to plan a timeframe, or convinced yourself the world would be better without you? These are not healthy or normal thoughts, and you should seek help immediately. Call 9-1-1 or the National Suicide Prevention Lifeline at 800-273-8255 for help. You are loved, your life is precious, and you won’t always feel as terrible as you do right now.

Poor functioning in one or more areas of your life. Are you having difficulty completing tasks on time, making a lot of errors, or having trouble showing up at the time expected? Are you having difficulty parenting due to your own emotional struggles, getting kids to school, housekeeping, meal prep, etc.? Are you isolating from everyone? Are you forgetting to pay bills? All of these can be normal to some extent, but multiple areas of difficulty, or difficulty over a long period of time, may indicate a need for professional support.

Sleep difficulty. According to a Harvard research study, sleep deprivation affects 50-80% of patients in psychiatric care, compared with 10-18% of the general population. There are clear connections between sleep and mental health. Even a week or two of less than 6 hours of good sleep per night can impact your cognition, response times, and executive function. In addition to contacting a counselor or therapist, a call to your doctor to discuss the possibility of a medication for anxiety or depression may be warranted.

Health problems. The Holmes-Rahe Stress and Social Readjustment Scale, which lists 43 life-changing events, is referenced often at Modern Widows Club to emphasize the importance of taking care of yourself in grief. Loss of a spouse is 100 points on this scale — the most stressful life event — and the secondary losses calculated by this test put nearly every widow at increased risk of developing a serious health diagnosis in the two years following the loss. If your physical health has been impacted, in addition to following up with your medical professionals, enlist the help of a mental health professional to help you beat these odds.

Symptoms don’t lessen over time. If you are in the same mental state 3 to 6 months after your loss as you were the day you lost your partner, this can be a sign that you will benefit from learning new coping skills and/or beginning to process your grief in a safe environment with the support of a counselor.

Wishing you hope and healing.

Cyndi Williams is a mental health advisor and contributor for Modern Widows Club, currently working as a mental health therapist at Sandhill Counseling and Consultation in St. Louis, Missouri.