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Improving Emotional Health

Strategies and Tips for Good Mental Health

Improving Emotional Health In This Article

People who are emotionally healthy are in control of their emotions and their behavior. They are able to handle life’s challenges, build strong relationships, and recover from setbacks. But just as it requires effort to build or maintain physical health, so it is with mental and emotional health. Improving your emotional health can be a rewarding experience, benefiting all aspects of your life, including boosting your mood, building resilience, and adding to your overall enjoyment of life.

What is mental health or emotional health?

Mental or emotional health refers to your overall psychological well-being. It includes the way you feel about yourself, the quality of your relationships, and your ability to manage your feelings and deal with difficulties.

Good mental health isn't just the absence of mental health problems. Being mentally or emotionally healthy is much more than being free of depression, anxiety, or other psychological issues. Rather than the absence of mental illness, mental and emotional health refers to the presence of positive characteristics. Similarly, not feeling bad is not the same as feeling good. While some people may not have negative feelings, they still need to do things that make them feel positive in order to achieve mental and emotional health.

People who are mentally and emotionally healthy have:

  • A sense of contentment.
  • A zest for living and the ability to laugh and have fun.
  • The ability to deal with stress and bounce back from adversity.
  • A sense of meaning and purpose, in both their activities and their relationships.
  • The flexibility to learn new things and adapt to change.
  • A balance between work and play, rest and activity, etc.
  • The ability to build and maintain fulfilling relationships.
  • Self-confidence and high self-esteem.

These positive characteristics of mental and emotional health allow you to participate in life to the fullest extent possible through productive, meaningful activities and strong relationships. These positive characteristics also help you cope when faced with life's challenges and stresses.

The role of resilience in mental and emotional health

Being emotionally and mentally healthy doesn’t mean never going through bad times or experiencing emotional problems. We all go through disappointments, loss, and change. And while these are normal parts of life, they can still cause sadness, anxiety, and stress.

The difference is that people with good emotional health have an ability to bounce back from adversity, trauma, and stress. This ability is called resilience. People who are emotionally and mentally healthy have the tools for coping with difficult situations and maintaining a positive outlook. They remain focused, flexible, and creative in bad times as well as good.

One of the key factors in resilience is the ability to balance stress and your emotions. The capacity to recognize your emotions and express them appropriately helps you avoid getting stuck in depression, anxiety, or other negative mood states. Another key factor is having a strong support network. Having trusted people you can turn to for encouragement and support will boost your resilience in tough times.

Physical health is connected to mental and emotional health

Ladies working outTaking care of your body is a powerful first step towards mental and emotional health. The mind and the body are linked. When you improve your physical health, you’ll automatically experience greater mental and emotional well-being. For example, exercise not only strengthens our heart and lungs, but also releases endorphins, powerful chemicals that energize us and lift our mood.

The activities you engage in and the daily choices you make affect the way you feel physically and emotionally.

  • Get enough rest. To have good mental and emotional health, it’s important to take care of your body. That includes getting enough sleep. Most people need seven to eight hours of sleep each night in order to function optimally.
  • Learn about good nutrition and practice it. The subject of nutrition is complicated and not always easy to put into practice. But the more you learn about what you eat and how it affects your energy and mood, the better you can feel.
  • Exercise to relieve stress and lift your mood. Exercise is a powerful antidote to stress, anxiety, and depression. Look for small ways to add activity to your day, like taking the stairs instead of the elevator or going on a short walk. To get the most mental health benefits, aim for 30 minutes or more of exercise per day.
  • Get a dose of sunlight every day. Sunlight lifts your mood, so try to get at least 10 to 15 minutes of sun per day. This can be done while exercising, gardening, or socializing.
  • Limit alcohol and avoid cigarettes and other drugs. These are stimulants that may unnaturally make you feel good in the short term, but have long-term negative consequences for mood and emotional health.

Improve mental and emotional health by taking care of yourself

In order to maintain and strengthen your mental and emotional health, it’s important to pay attention to your own needs and feelings. Don’t let stress and negative emotions build up. Try to maintain a balance between your daily responsibilities and the things you enjoy. If you take care of yourself, you’ll be better prepared to deal with challenges if and when they arise.

Taking care of yourself includes pursuing activities that naturally release endorphins and contribute to feeling good. In addition to physical exercise, endorphins are also naturally released when we:

  • Do things that positively impact others. Being useful to others and being valued for what you do can help build self-esteem.
  • Practice self-discipline. Self-control naturally leads to a sense of hopefulness and can help you overcome despair, helplessness, and other negative thoughts.
  • Learn or discover new things. Think of it as “intellectual candy.” Try taking an adult education class, join a book club, visit a museum, learn a new language, or simply travel somewhere new.
  • Enjoy the beauty of nature or art. Studies show that simply walking through a garden can lower blood pressure and reduce stress. The same goes for strolling through a park or an art gallery, hiking, admiring architecture, or sitting on a beach.
  • Manage your stress levels. Stress takes a heavy toll on mental and emotional health, so it’s important to keep it under control. While not all stressors can be avoided, stress management strategies can help you bring things back into balance.
  • Limit unhealthy mental habits like worrying. Try to avoid becoming absorbed by repetitive mental habits—negative thoughts about yourself and the world that suck up time, drain your energy, and trigger feelings of anxiety, fear, and depression.

More tips and strategies for taking care of yourself:

  • Appeal to your senses. Stay calm and energized by appealing to the five senses: sight, sound, touch, smell, and taste. Listen to music that lifts your mood, place flowers where you will see and smell them, massage your hands and feet, or sip a warm drink.
  • Engage in meaningful, creative work. Do things that challenge your creativity and make you feel productive, whether or not you get paid for it—things like gardening, drawing, writing, playing an instrument, or building something in your workshop.
  • Get a pet. Yes, pets are a responsibility, but caring for one makes you feel needed and loved. There is no love quite as unconditional as the love a pet can give. Animals can also get you out of the house for exercise and expose you to new people and places.
  • Make leisure time a priority. Do things for no other reason than that it feels good to do them. Go to a funny movie, take a walk on the beach, listen to music, read a good book, or talk to a friend. Doing things just because they are fun is no indulgence. Play is an emotional and mental health necessity.
  • Make time for contemplation and appreciation. Think about the things you’re grateful for. Mediate, pray, enjoy the sunset, or simply take a moment to pay attention to what is good, positive, and beautiful as you go about your day.

Everyone is different; not all things will be equally beneficial to all people. Some people feel better relaxing and slowing down while others need more activity and more excitement or stimulation to feel better. The important thing is to find activities that you enjoy and that give you a boost.

Supportive relationships: The foundation of emotional health

No matter how much time you devote to improving your mental and emotional health, you will still need the company of others to feel and be your best. Humans are social creatures with an emotional need for relationships and positive connections to others. We’re not meant to survive, let alone thrive, in isolation. Our social brains crave companionship—even when experience has made us shy and distrustful of others.

Social interaction—specifically talking to someone else about your problems—can also help to reduce stress. The key is to find a supportive relationship with someone who is a “good listener”—someone you can talk to regularly, preferably face-to-face, who will listen to you without a pre-existing agenda for how you should think or feel. A good listener will listen to the feelings behind your words, and won’t interrupt or judge or criticize you. The best way to find a good listener? Be a good listener yourself. Develop a friendship with someone you can talk to regularly, and then listen and support each other.

Tips and strategies for connecting to others:

  • Get out from behind your TV or computer screen. Screens have their place but they will never have the same effect as an expression of interest or a reassuring touch. Communication is a largely nonverbal experience that requires you to be in direct contact with other people, so don’t neglect your real-world relationships in favor of virtual interaction. 
  • Spend time daily, face-to-face, with people you like. Make spending time with people you enjoy a priority. Choose friends, neighbors, colleagues, and family members who are upbeat, positive, and interested in you. Take time to inquire about people you meet during the day that you like.
  • Volunteer. Doing something that helps others has a beneficial effect on how you feel about yourself. The meaning and purpose you find in helping others will enrich and expand your life. There is no limit to the individual and group volunteer opportunities you can explore. Schools, churches, nonprofits, and charitable organization of all sorts depend on volunteers for their survival.
  • Be a joiner. Join networking, social action, conservation, and special interest groups that meet on a regular basis. These groups offer wonderful opportunities for finding people with common interests—people you like being with who are potential friends.

Risk factors for mental and emotional problems

Your mental and emotional health has been and will continue to be shaped by your experiences. Early childhood experiences are especially significant. Genetic and biological factors can also play a role, but these too can be changed by experience.  

Risk factors that can compromise mental and emotional health:

  • Poor connection or attachment to your primary caretaker early in life. Feeling lonely, isolated, unsafe, confused, or abused as an infant or young child.
  • Traumas or serious losses, especially early in life. Death of a parent or other traumatic experiences such as war or hospitalization.
  • Learned helplessness. Negative experiences that lead to a belief that you’re helpless and that you have little control over the situations in your life.
  • Illness, especially when it’s chronic, disabling, or isolates you from others.
  • Side effects of medications, especially in older people who may be taking a variety of medications.
  • Substance abuse. Alcohol and drug abuse can both cause mental health problems and make preexisting mental or emotional problems worse.

Whatever internal or external factors have shaped your mental and emotional health, it’s never too late to make changes that will improve your psychological well-being. Risk factors can be counteracted with protective factors, like strong relationships, a healthy lifestyle, and coping strategies for managing stress and negative emotions.

When to seek professional help for emotional problems

If you’ve made consistent efforts to improve your mental and emotional health and you still don’t feel good—then it’s time to seek professional help. Because we are so socially attuned, input from a knowledgeable, caring professional can motivate us to do things for ourselves that we were not able to do on our own.

Red flag feelings and behaviors that may require immediate attention

  • Inability to sleep
  • Feeling down, hopeless, or helpless most of the time
  • Concentration problems that are interfering with your work or home life
  • Using nicotine, food, drugs, or alcohol to cope with difficult emotions
  • Negative or self-destructive thoughts or fears that you can’t control
  • Thoughts of death or suicide

If you identify with any of these red flag symptoms, consider making an appointment with a mental health professional.

More help for emotional health

Resources and references

The Road to Resilience – Guide to resilience, including ten ways to build your resilience, how to learn from your past, and how to stay flexible. (American Psychological Association)

Mind/Body Connection: How Your Emotions Affect Your Health – Learn how emotions affect your health and what you can do to improve your emotional health. (American Academy of Family Physicians)

Mental Health: Keeping Your Emotional Health – Defines good emotional health, describes how stress affects emotions, and offers tips for avoiding problems. (American Academy of Family Physicians)

Making and Keeping Friends: A Self-Help Guide – Offers practical advice and tips on developing supportive friendships. (U.S. Department of Health and Human Services)

What Every Child Needs for Good Mental Health – Parenting advice on how to provide the love, security, and boundaries every child needs for mental and emotional health. (Mental Health America)

Download Meditations – Download or stream a dozen free meditation recordings to help you cope with life's inevitable hurdles. Comes with handouts. (Sitting Together)

Emotional Health – Written for college students, with special sections on adjusting to college life, how relationships factor in, and why it’s important to reduce stress. (Princeton University)

Authors: Melinda Smith, M.A., Robert Segal, M.A., and Jeanne Segal, Ph.D. Last updated: April 2015.


Finding a Therapist To Help You Heal

Getting the Most out of Therapy and Counseling

Finding a Therapist Who Can Help You Heal In This Article

Therapy can be an effective treatment for mental and emotional problems. But in order to reap its benefits, it’s important to choose the right therapist—someone you trust who makes you feel cared for and has the experience to help you make changes for the better in your life. A good therapist helps you to become stronger and more self-aware. But your therapist cannot do the work for you. In order to make the most of your sessions, you must be an active participant.

How therapy and counseling can help

Talking about your thoughts and feelings with a supportive person makes you feel better. It can be very healing, in and of itself, to voice your worries or talk about something that’s weighing on your mind. And it feels good to be listened to—to know that someone else cares about you and wants to help.

It can be very helpful to talk about your problems to close friends and family members. But sometimes, we need help that the people around us aren’t able to provide. When you need extra support, an outside perspective, or some expert guidance, talking to a therapist or counselor can help. While the support of friends and family is important, therapy is different. Therapists are professionally-trained listeners who can help you get to the root of your problems, overcome emotional challenges, and make positive changes in your life.

You don’t have to be diagnosed with a mental health problem to benefit from therapy. Many people in therapy seek help for everyday concerns: relationship problems, job stress, or self-doubt, for example. Others turn to therapy during difficult times, such as a divorce.

Why therapy and not medication?

The thought of being able to solve your problems with taking a pill each day can sound appealing. If only it was that easy! Mental and emotional problems have multiple causes, and medication is not a one-stop cure.

Medication may help ease certain symptoms, but it comes with side effects. Furthermore, it cannot solve the “big picture” problems. Medication won’t fix your relationships, help you figure out what to do with your life, or give you insight into why you continue to do things you know are bad for you.

Therapy can be time consuming and challenging, as uncomfortable emotions and thoughts often arise as part of the treatment process. However, therapy provides long-lasting benefits that go beyond symptom relief. Therapy gives you the tools for transforming your life—for relating better to others, building the life you want for yourself, and coping with whatever curveballs come your way.

Myths about therapy

  • I don't need a therapist. I'm smart enough to solve my own problems. We all have our blind spots. Intelligence has nothing to do with it. A good therapist doesn’t tell you what to do or how to live your life. He or she will give you an experienced outside perspective and help you gain insight into yourself so you can make better choices.
  • Therapy is for crazy people. Therapy is for people who have enough self-awareness to realize they need a helping hand, and want to learn tools and techniques to become more self-confident and emotionally balanced.
  • All therapists want to talk about is my parents. While exploring family relationships can sometimes clarify thoughts and behaviors later in life, that is not the sole focus of therapy. The primary focus is what you need to change unhealthy patterns and symptoms in your life. Therapy is not about blaming your parents or dwelling on the past.
  • Therapy is self-indulgent. It’s for whiners and complainers. Therapy is hard work. Complaining won’t get you very far. Improvement in therapy comes from taking a hard look at yourself and your life, and taking responsibility for your own actions. Your therapist will help you, but ultimately you’re the one who must do the work.

Finding the right therapist for you

Finding the right therapist will probably take some time and work, but it’s worth the effort. The connection you have with your therapist is essential. You need someone who you can trust—someone you feel comfortable talking to about difficult subjects and intimate secrets, someone who will be a partner in your recovery.
Therapy won’t be effective unless you have this bond, so take some time at the beginning to find the right person. It’s okay to shop around and to ask questions when interviewing potential therapists.

  • Experience matters. One of the main reasons for seeing a therapist, rather than simply talking to a friend, is experience. Look for a therapist who is experienced in treating the problems that you have. Often, therapists have special areas of focus, such as depression or eating disorders. Experienced therapists have seen the problems you’re facing again and again, which broadens their view and gives them more insight. And for some problems, such as trauma or PTSD, seeing a specialist is absolutely essential.
  • Learn about different treatment orientations. Many therapists do a blend of orientations. However, it’s a good idea to learn about the different treatment types, because that can affect your therapist’s way of relating and suggested length of treatment.
  • Check licensing. Credentials aren’t everything, but if you’re paying for a licensed professional, make sure the therapist holds a current license and is in good standing with the state regulatory board. Regulatory boards vary by state and by profession. Also check for complaints against the therapist.
  • Trust your gut. Even if your therapist looks great on paper, if the connection doesn’t feel right—if you don’t trust the person or feel like they truly care—go with another choice. A good therapist will respect this choice and should never pressure you or make you feel guilty.

Questions to ask yourself when choosing a therapist

What’s most important in a therapist or counselor is a sense of connection, safety, and support. Ask yourself the following questions:

  • Does it seem like the therapist truly cares about you and your problems?
  • Do you feel as if the therapist understands you?
  • Does the therapist accept you for who you are?
  • Would you feel comfortable revealing personal information to this individual?
  • Do you feel as if you can be honest and open with this therapist? That you don’t have to hide or pretend you’re someone that you’re not?
  • Is the therapist a good listener? Does he or she listen without interrupting, criticizing, or judging? Pick up on your feelings and what you’re really saying? Make you feel heard?

Types of therapy and therapists

There are so many types of therapies and therapists; it might feel a little overwhelming to get started. Just remember that no one type of therapy is best, any more than any style of car is best. It all depends on your individual preferences and needs.

It is true that certain techniques are more useful than others in dealing with specific types of problems (phobias, for example). But in general, research about the "best" type of therapy always reaches the same conclusion: the philosophy behind the therapy is much less important than the relationship between you and your therapist.

If you feel comfortable and trusting in that relationship, the model of therapy, like your car, is just the vehicle that will help you move ahead to lead a more fulfilling life, regardless of the circumstances that brought you to therapy.

Common types of therapy

Most therapists don’t limit themselves to one specific type of therapy, instead blending different types in order to best fit the situation at hand. This can offer many powerful tools for the therapist to use. However, therapists often have a general orientation that guides them.

  • Individual therapy. Individual therapy explores negative thoughts and feelings, as well as the harmful or self-destructive behaviors that might accompany them. Individual therapy may delve into the underlying causes of current problems (such as unhealthy relationship patterns or a traumatic experience from your past), but the primary focus is on making positive changes in the here and now.
  • Family therapy. Family therapy involves treating more than one member of the family at the same time to help the family resolve conflicts and improve interaction. It is often based on the premise that families are a system. If one role in the family changes all are affected and need to change their behaviors as well.
  • Group therapy. Group therapy is facilitated by a professional therapist, and involves a group of peers working on the same problem, such as anxiety, depression or substance abuse, for example. Group therapy can be a valuable place to practice social dynamics in a safe environment and get inspiration and ideas from peers who are struggling with the same issues.
  • Couples therapy (marriage counseling). Couples therapy involves the two people in a committed relationship. People go to couples therapy to learn how to work through their differences, communicate better and problem-solve challenges in the relationship.

Types of therapists and counselors

The following types of mental health professionals have advanced training in therapy and are certified by their respective boards. Many professional organizations provide online searches for qualified professionals. You may also want to double check with your state regulatory board to make sure the therapist’s license is up to date and there are no ethical violations listed.

However, keep in mind that lay counselors—members of the clergy, life coaches, etc.—may be able to provide you with a supportive, listening ear. It’s not always the credentials that determine the quality of the therapy.

Common types of mental health professionals

Psychologist

Psychologists have a doctoral degree in psychology (Ph.D. or Psy.D.) and are licensed in clinical psychology.

Social worker

Licensed Clinical Social Workers (LCSW) have a Master's degree in social work (MSW) along with additional clinical training.

Marriage and family therapist

Marriage and Family Therapists (MFT) have a Master's degree and clinical experience in marriage and family therapy.

Psychiatrist

A psychiatrist is a physician (M.D. or D.O.) who specializes in mental health. Because they are medical doctors, psychiatrists can prescribe medication.

What to expect in therapy or counseling

Every therapist is different, but there are usually some similarities to how therapy is structured. Normally, sessions will last about an hour, and often be about once a week, although for more intensive therapy they maybe more often. Therapy is normally conducted in the therapist’s office, but therapists also work in hospitals and nursing homes, and in some cases will do home visits.

  • Expect a good fit between you and your therapist. Don't settle for bad fit. You may need to see one or more therapists until you experience feeling understood and accepted.
  • Therapy is a partnership. Both you and your therapist contribute to the healing process. You're not expected to do the work of recovery all by yourself, but your therapist can’t do it for you either. Therapy should feel like a collaboration.
  • Therapy will not always feel pleasant. Painful memories, frustrations or feelings might surface. This is a normal part of therapy and your therapist will guide you through this process. Be sure to communicate with your therapist about how you are feeling.
  • Therapy should be a safe place. While there will be times when you’ll feel challenged or when you’re facing unpleasant feelings, you should always feel safe. If you’re starting to feel overwhelmed or you’re dreading your therapy sessions, talk to your therapist.

Your first therapy sessions

The first session or two of therapy is a time for mutual connection, a time for the therapist to learn about you and your issues. The therapist may ask for a mental and physical health history.

It’s also a good idea to talk to the therapist about what you hope to achieve in therapy. Together, you can set goals and benchmarks that you can use to measure your progress along the way.

This is also an important time for you to be evaluating your connection with your therapist. Do you feel like your therapist cares about your situation, and is invested in your recovery? Do you feel comfortable asking questions and sharing sensitive information? Remember, your feelings as well as your thoughts are important, so if you are feeling uncomfortable, don’t hesitate to consider another therapist.

How long does therapy last?

Everyone’s treatment is different. How long therapy lasts depends on many factors. You may have complicated issues, or a relatively straightforward problem that you want to address. Some therapy treatment types are short term, while others may be longer. Practically, you might also be limited by your insurance coverage.

However, discussing the length of therapy is important to bring up with your therapist at the beginning. This will give you an idea of starting goals to work towards and what you want to accomplish. Don’t be afraid to revisit this issue at any time as therapy progresses, as goals often are modified or changed during treatment.

Making the most of therapy and counseling

To make the most of therapy, you need to put what you’re learning in your sessions into practice in your real life. 50 minutes in therapy each week isn’t going to fix you; it’s how you use what you’ve learned with the rest of your time. Here are some tips for getting the most out of your therapy:

  • Make healthy lifestyle changes. There are many things you can do in your daily life to support your mood and improve your emotional health. Reach out to others for support. Get plenty of exercise and sleep. Eat well. Make time for relaxation and play. The list goes on…
  • Don’t expect the therapist to tell you what to do. You and your therapists are partners in your recovery. Your therapist can help guide you and make suggestions for treatment, but only you can make the changes you need to move forward.
  • Make a commitment to your treatment. Don’t skip sessions unless you absolutely have to. If your therapist gives you homework in between sessions, be sure to do it. If you find yourself skipping sessions or are reluctant to go, ask yourself why. Are you avoiding painful discussion? Did last session touch a nerve? Talk about your reluctance with your therapist.
  • Share what you are feeling. You will get the most out of therapy if you are open and honest with your therapist about your feelings. If you feel embarrassed or ashamed, or something is too painful to talk about, don’t be afraid to tell your therapist. Slowly, you can work together to get at the issues.

Is therapy working?

You should be able to tell within a session or two whether you and your therapist are a good fit. But sometimes, you may like your therapist but feel like you aren’t making progress. It’s important to evaluate your progress to make sure you’re getting what you need from therapy.

A word of caution: There is no smooth, fast road to recovery. It’s a process that’s full of twists, turns, and the occasional backtrack. Sometimes, what originally seemed like a straightforward problem turns into a more complicated issue. Be patient and don’t get discouraged over temporary setbacks. It’s not easy to break old, entrenched patterns.

Remember that growth is difficult, and you won’t be a new person overnight. But you should notice positive changes in your life. Your overall mood might be improving, for example. You may feel more connected to family and friends. Or a crisis that might have overwhelmed you in the past doesn’t throw you as much this time.

Tips for evaluating your progress in therapy

  • Is your life changing for the better? Look at different parts of your life: work, home, your social life.
  • Are you meeting the goals you and your therapist have set?
  • Is therapy challenging you? Is it stretching you beyond your comfort zone?
  • Do you feel like you’re starting to understand yourself better?
  • Do you feel more confident and empowered?
  • Are your relationships improving?

Your therapist should work with you, reevaluating your goals and progress as necessary. However, remember that therapy isn’t a competition. You are not a failure if you don’t meet your goals in the number of sessions you originally planned. Focus instead on overall progress and what you’ve learned along the way.

When to stop therapy or counseling

When to stop therapy depends on you and your individual situation. Ideally, you will stop therapy when you and your therapist have decided that you have met your goals. However, you may feel at some point that you have got what you need out of therapy, even if your therapist feels differently.

Leaving therapy can be difficult. Remember that the therapeutic relationship is a strong bond, and ending this relationship is a loss – even if treatment has been successful. Talk about this with your therapist. These feelings are normal. It's not uncommon for people to go back briefly to a therapist from time to time as needs arise.

As long as you continue to progress in therapy, it's an option

Some people continue to go to therapy on an ongoing basis. That’s okay, especially if you don’t have other people to turn to for support in your life. Ideally, your therapist will be able to help you develop outside sources of support, but that’s not always possible. If therapy meets an important need in your life and the expense is not an issue, continuing indefinitely is a legitimate choice.

Signs that you may need to change therapists

  • You don’t feel comfortable talking about something.
  • Your therapist is dismissive of your problems or concerns.
  • Your therapist seems to have a personal agenda.
  • Your therapist does more talking than listening.
  • Your therapist tells you what to do and how to live your life.

Paying for therapy and counseling

In the U.S., for example, many insurance companies provide limited coverage for psychotherapy—often as few as 6-12 sessions. Read through your plan carefully to see what benefits you have. Some types of mental health professionals might not be covered. You may need a referral through your primary care physician.

Also keep in mind that some therapists do not accept insurance, only payment directly from the patient. Sometimes these therapists will accept sliding scale payments, where you pay what you can afford for each session. Don’t be afraid to ask what arrangements can be made if you feel the therapist could be a good fit for you.

In other countries, insurance and eligibility requirements vary. See Resources & References below for links on finding therapy in your country.

Affordable therapy and counseling options

Take a look around your community for service agencies or organizations that may offer psychotherapy at discounted rates. Senior centers, family service agencies, and mental health clinics are good places to start. Many offer affordable options, including sliding payment scales.

Agencies that involve interns in training also can be an option for quality therapy. An intern may be a good choice for you if the intern is enthusiastic, empathetic, and has quality supervisory training. However, an intern’s time at the agency is limited, so when the training is finished, you either need to stop the therapy or find another therapist.

Another possible way to obtain affordable therapy is to try bartering with a therapist or mental health clinic. A few clinics and health centers across the U.S. already encourage bartering services, swapping health care for carpentry, plumbing, or hairdressing services, for example. If you have a useful skill or are willing to volunteer your time, it may be worth trying to strike a deal.

More help for mental health treatment

Resources and references

Therapy and counseling

Psychotherapy – Learn about psychotherapy, what conditions it treats, and what to expect. (Mayo Clinic)

Finding a therapist in the U.S.

Mental Health Professionals: Who They Are and How to Find One – Offers an overview of different types of mental health professionals, and practical resources for finding them. (NAMI)

Mental Health Providers: Find One to Suit Your Needs – Discusses how to find a therapist, insurance considerations and what to expect during therapy. (Mayo Clinic)

Finding Help: How to Choose a Psychotherapist – Fact sheet on how to find a therapist and evaluate how therapy is working for you. (American Psychological Association)

You can also search by category: Search for a Psychologist; Search for a Social Worker; or call the American Psychiatric Association: 1-888-35-PSYCH

Finding a therapist internationally

Search for a Marriage or Family Therapist in your country by clicking on “Search Overseas”.

In Canada, Search for a Psychologist or Search for a Marriage or Family Therapist by clicking on “Search Canada”.

In the UK, Relate offers relationship and family counseling; you can Learn about Psychotherapy, including where to find a therapist, or Find Psychological Therapy Services in your local area.

In Australia, Lifeline's Service Finder (1300 13 11 14) offers a directory of low-cost mental health services; or you can Find a Psychologist or Find a Mental Health Practitioner.

Licensed mental health professionals in the U.S.

National Association of Social Workers (NASW) provides information and services provided by social workers. There is also a national searchable database of licensed clinical social workers.

American Association for Marriage and Family Therapy (AAMFT) provides information about Marriage and Family Therapists, as well as a Therapist Locator national database of qualified therapists.

American Psychiatric Nurses Association (APNA) webpage provides more information on this profession.

American Psychological Association (APA) provides a Psychologist Locator to find a psychologist in your area.

Healthy Minds, Healthy Lives – provides information on the practice of psychiatry, including how to choose a psychiatrist (American Psychiatric Association)

American Psychoanalytic Association (APsaA) provides a member directory for finding an analyst, by city and state.

Melinda Smith, M.A., and Jeanne Segal, Ph.D., contributed to this article. Last updated: April 2015.


Finding a Therapist For You

How therapy and counseling can help

Talking about your thoughts and feelings with a supportive person makes you feel better. It can be very healing, in and of itself, to voice your worries or talk about something that’s weighing on your mind. And it feels good to be listened to—to know that someone else cares about you and wants to help.

It can be very helpful to talk about your problems to close friends and family members. But sometimes, we need help that the people around us aren’t able to provide. When you need extra support, an outside perspective, or some expert guidance, talking to a therapist or counselor can help. While the support of friends and family is important, therapy is different. Therapists are professionally-trained listeners who can help you get to the root of your problems, overcome emotional challenges, and make positive changes in your life.

You don’t have to be diagnosed with a mental health problem to benefit from therapy. Many people in therapy seek help for everyday concerns: relationship problems, job stress, or self-doubt, for example. Others turn to therapy during difficult times, such as a divorce.

Why therapy and not medication?

The thought of being able to solve your problems with taking a pill each day can sound appealing. If only it was that easy! Mental and emotional problems have multiple causes, and medication is not a one-stop cure.

Medication may help ease certain symptoms, but it comes with side effects. Furthermore, it cannot solve the “big picture” problems. Medication won’t fix your relationships, help you figure out what to do with your life, or give you insight into why you continue to do things you know are bad for you.

Therapy can be time consuming and challenging, as uncomfortable emotions and thoughts often arise as part of the treatment process. However, therapy provides long-lasting benefits that go beyond symptom relief. Therapy gives you the tools for transforming your life—for relating better to others, building the life you want for yourself, and coping with whatever curveballs come your way.

Myths about therapy

  • I don't need a therapist. I'm smart enough to solve my own problems.We all have our blind spots. Intelligence has nothing to do with it. A good therapist doesn’t tell you what to do or how to live your life. He or she will give you an experienced outside perspective and help you gain insight into yourself so you can make better choices.
  • Therapy is for crazy people. Therapy is for people who have enough self-awareness to realize they need a helping hand, and want to learn tools and techniques to become more self-confident and emotionally balanced.
  • All therapists want to talk about is my parents. While exploring family relationships can sometimes clarify thoughts and behaviors later in life, that is not the sole focus of therapy. The primary focus is what you need to change unhealthy patterns and symptoms in your life. Therapy is not about blaming your parents or dwelling on the past.
  • Therapy is self-indulgent. It’s for whiners and complainers. Therapy is hard work. Complaining won’t get you very far. Improvement in therapy comes from taking a hard look at yourself and your life, and taking responsibility for your own actions. Your therapist will help you, but ultimately you’re the one who must do the work.

Finding the right therapist for you

Finding the right therapist will probably take some time and work, but it’s worth the effort. The connection you have with your therapist is essential. You need someone who you can trust—someone you feel comfortable talking to about difficult subjects and intimate secrets, someone who will be a partner in your recovery. 
Therapy won’t be effective unless you have this bond, so take some time at the beginning to find the right person. It’s okay to shop around and to ask questions when interviewing potential therapists.

  • Experience matters. One of the main reasons for seeing a therapist, rather than simply talking to a friend, is experience. Look for a therapist who is experienced in treating the problems that you have. Often, therapists have special areas of focus, such as depression or eating disorders. Experienced therapists have seen the problems you’re facing again and again, which broadens their view and gives them more insight. And for some problems, such as trauma or PTSD, seeing a specialist is absolutely essential.
  • Learn about different treatment orientations. Many therapists do a blend of orientations. However, it’s a good idea to learn about the different treatment types, because that can affect your therapist’s way of relating and suggested length of treatment.
  • Check licensing. Credentials aren’t everything, but if you’re paying for a licensed professional, make sure the therapist holds a current license and is in good standing with the state regulatory board. Regulatory boards vary by state and by profession. Also check for complaints against the therapist.
  • Trust your gut. Even if your therapist looks great on paper, if the connection doesn’t feel right—if you don’t trust the person or feel like they truly care—go with another choice. A good therapist will respect this choice and should never pressure you or make you feel guilty.

Questions to ask yourself when choosing a therapist

What’s most important in a therapist or counselor is a sense of connection, safety, and support. Ask yourself the following questions:

  • Does it seem like the therapist truly cares about you and your problems?
  • Do you feel as if the therapist understands you?
  • Does the therapist accept you for who you are?
  • Would you feel comfortable revealing personal information to this individual?
  • Do you feel as if you can be honest and open with this therapist? That you don’t have to hide or pretend you’re someone that you’re not?
  • Is the therapist a good listener? Does he or she listen without interrupting, criticizing, or judging? Pick up on your feelings and what you’re really saying? Make you feel heard?

Types of therapy and therapists

There are so many types of therapies and therapists; it might feel a little overwhelming to get started. Just remember that no one type of therapy is best, any more than any style of car is best. It all depends on your individual preferences and needs.

It is true that certain techniques are more useful than others in dealing with specific types of problems (phobias, for example). But in general, research about the "best" type of therapy always reaches the same conclusion: the philosophy behind the therapy is much less important than the relationship between you and your therapist.

If you feel comfortable and trusting in that relationship, the model of therapy, like your car, is just the vehicle that will help you move ahead to lead a more fulfilling life, regardless of the circumstances that brought you to therapy.

Common types of therapy

Most therapists don’t limit themselves to one specific type of therapy, instead blending different types in order to best fit the situation at hand. This can offer many powerful tools for the therapist to use. However, therapists often have a general orientation that guides them.

  • Individual therapy. Individual therapy explores negative thoughts and feelings, as well as the harmful or self-destructive behaviors that might accompany them. Individual therapy may delve into the underlying causes of current problems (such as unhealthy relationship patterns or a traumatic experience from your past), but the primary focus is on making positive changes in the here and now.
  • Family therapy. Family therapy involves treating more than one member of the family at the same time to help the family resolve conflicts and improve interaction. It is often based on the premise that families are a system. If one role in the family changes all are affected and need to change their behaviors as well.
  • Group therapy. Group therapy is facilitated by a professional therapist, and involves a group of peers working on the same problem, such as anxiety, depression or substance abuse, for example. Group therapy can be a valuable place to practice social dynamics in a safe environment and get inspiration and ideas from peers who are struggling with the same issues.
  • Couples therapy (marriage counseling).Couples therapy involves the two people in a committed relationship. People go to couples therapy to learn how to work through their differences, communicate better and problem-solve challenges in the relationship.

Types of therapists and counselors

The following types of mental health professionals have advanced training in therapy and are certified by their respective boards. Many professional organizations provide online searches for qualified professionals. You may also want to double check with your state regulatory board to make sure the therapist’s license is up to date and there are no ethical violations listed.

However, keep in mind that lay counselors—members of the clergy, life coaches, etc.—may be able to provide you with a supportive, listening ear. It’s not always the credentials that determine the quality of the therapy.

What to expect in therapy or counseling

Every therapist is different, but there are usually some similarities to how therapy is structured. Normally, sessions will last about an hour, and often be about once a week, although for more intensive therapy they maybe more often. Therapy is normally conducted in the therapist’s office, but therapists also work in hospitals and nursing homes, and in some cases will do home visits.

  • Expect a good fit between you and your therapist. Don't settle for bad fit. You may need to see one or more therapists until you experience feeling understood and accepted.
  • Therapy is a partnership. Both you and your therapist contribute to the healing process. You're not expected to do the work of recovery all by yourself, but your therapist can’t do it for you either. Therapy should feel like a collaboration.
  • Therapy will not always feel pleasant.Painful memories, frustrations or feelings might surface. This is a normal part of therapy and your therapist will guide you through this process. Be sure to communicate with your therapist about how you are feeling.
  • Therapy should be a safe place. While there will be times when you’ll feel challenged or when you’re facing unpleasant feelings, you should always feel safe. If you’re starting to feel overwhelmed or you’re dreading your therapy sessions, talk to your therapist.

Your first therapy sessions

The first session or two of therapy is a time for mutual connection, a time for the therapist to learn about you and your issues. The therapist may ask for a mental and physical health history.

It’s also a good idea to talk to the therapist about what you hope to achieve in therapy. Together, you can set goals and benchmarks that you can use to measure your progress along the way.

This is also an important time for you to be evaluating your connection with your therapist. Do you feel like your therapist cares about your situation, and is invested in your recovery? Do you feel comfortable asking questions and sharing sensitive information? Remember, your feelings as well as your thoughts are important, so if you are feeling uncomfortable, don’t hesitate to consider another therapist.

How long does therapy last?

Everyone’s treatment is different. How long therapy lasts depends on many factors. You may have complicated issues, or a relatively straightforward problem that you want to address. Some therapy treatment types are short term, while others may be longer. Practically, you might also be limited by your insurance coverage.

However, discussing the length of therapy is important to bring up with your therapist at the beginning. This will give you an idea of starting goals to work towards and what you want to accomplish. Don’t be afraid to revisit this issue at any time as therapy progresses, as goals often are modified or changed during treatment.

Making the most of therapy and counseling

To make the most of therapy, you need to put what you’re learning in your sessions into practice in your real life. 50 minutes in therapy each week isn’t going to fix you; it’s how you use what you’ve learned with the rest of your time. Here are some tips for getting the most out of your therapy:

  • Make healthy lifestyle changes. There are many things you can do in your daily life to support your mood and improve your emotional health. Reach out to others for support. Get plenty of exercise and sleep. Eat well. Make time for relaxation and play. The list goes on…
  • Don’t expect the therapist to tell you what to do. You and your therapists are partners in your recovery. Your therapist can help guide you and make suggestions for treatment, but only you can make the changes you need to move forward.
  • Make a commitment to your treatment.Don’t skip sessions unless you absolutely have to. If your therapist gives you homework in between sessions, be sure to do it. If you find yourself skipping sessions or are reluctant to go, ask yourself why. Are you avoiding painful discussion? Did last session touch a nerve? Talk about your reluctance with your therapist.
  • Share what you are feeling. You will get the most out of therapy if you are open and honest with your therapist about your feelings. If you feel embarrassed or ashamed, or something is too painful to talk about, don’t be afraid to tell your therapist. Slowly, you can work together to get at the issues.

Is therapy working?

You should be able to tell within a session or two whether you and your therapist are a good fit. But sometimes, you may like your therapist but feel like you aren’t making progress. It’s important to evaluate your progress to make sure you’re getting what you need from therapy.

A word of caution: There is no smooth, fast road to recovery. It’s a process that’s full of twists, turns, and the occasional backtrack. Sometimes, what originally seemed like a straightforward problem turns into a more complicated issue. Be patient and don’t get discouraged over temporary setbacks. It’s not easy to break old, entrenched patterns.

Remember that growth is difficult, and you won’t be a new person overnight. But you should notice positive changes in your life.Your overall mood might be improving, for example. You may feel more connected to family and friends. Or a crisis that might have overwhelmed you in the past doesn’t throw you as much this time.

Tips for evaluating your progress in therapy

  • Is your life changing for the better? Look at different parts of your life: work, home, your social life.
  • Are you meeting the goals you and your therapist have set?
  • Is therapy challenging you? Is it stretching you beyond your comfort zone?
  • Do you feel like you’re starting to understand yourself better?
  • Do you feel more confident and empowered?
  • Are your relationships improving?

Your therapist should work with you, reevaluating your goals and progress as necessary. However, remember that therapy isn’t a competition. You are not a failure if you don’t meet your goals in the number of sessions you originally planned. Focus instead on overall progress and what you’ve learned along the way.

When to stop therapy or counseling

When to stop therapy depends on you and your individual situation. Ideally, you will stop therapy when you and your therapist have decided that you have met your goals. However, you may feel at some point that you have got what you need out of therapy, even if your therapist feels differently.

Leaving therapy can be difficult. Remember that the therapeutic relationship is a strong bond, and ending this relationship is a loss – even if treatment has been successful. Talk about this with your therapist. These feelings are normal. It's not uncommon for people to go back briefly to a therapist from time to time as needs arise.

As long as you continue to progress in therapy, it's an option

Some people continue to go to therapy on an ongoing basis. That’s okay, especially if you don’t have other people to turn to for support in your life. Ideally, your therapist will be able to help you develop outside sources of support, but that’s not always possible. If therapy meets an important need in your life and the expense is not an issue, continuing indefinitely is a legitimate choice.

Signs that you may need to change therapists

  • You don’t feel comfortable talking about something.
  • Your therapist is dismissive of your problems or concerns.
  • Your therapist seems to have a personal agenda.
  • Your therapist does more talking than listening.
  • Your therapist tells you what to do and how to live your life.

Paying for therapy and counseling

In the U.S., for example, many insurance companies provide limited coverage for psychotherapy—often as few as 6-12 sessions. Read through your plan carefully to see what benefits you have. Some types of mental health professionals might not be covered. You may need a referral through your primary care physician.

Also keep in mind that some therapists do not accept insurance, only payment directly from the patient. Sometimes these therapists will accept sliding scale payments, where you pay what you can afford for each session. Don’t be afraid to ask what arrangements can be made if you feel the therapist could be a good fit for you.

In other countries, insurance and eligibility requirements vary. See Resources & References below for links on finding therapy in your country.

Affordable therapy and counseling options

Take a look around your community for service agencies or organizations that may offer psychotherapy at discounted rates. Senior centers, family service agencies, and mental health clinics are good places to start. Many offer affordable options, including sliding payment scales.

Agencies that involve interns in training also can be an option for quality therapy. An intern may be a good choice for you if the intern is enthusiastic, empathetic, and has quality supervisory training. However, an intern’s time at the agency is limited, so when the training is finished, you either need to stop the therapy or find another therapist.

Another possible way to obtain affordable therapy is to try bartering with a therapist or mental health clinic. A few clinics and health centers across the U.S. already encourage bartering services, swapping health care for carpentry, plumbing, or hairdressing services, for example. If you have a useful skill or are willing to volunteer your time, it may be worth trying to strike a deal.

More help for mental health treatment

Resources and references

Therapy and counseling

Psychotherapy – Learn about psychotherapy, what conditions it treats, and what to expect. (Mayo Clinic)

Finding a therapist in the U.S.

Mental Health Professionals: Who They Are and How to Find One – Offers an overview of different types of mental health professionals, and practical resources for finding them. (NAMI)

Mental Health Providers: Find One to Suit Your Needs – Discusses how to find a therapist, insurance considerations and what to expect during therapy. (Mayo Clinic)

Finding Help: How to Choose a Psychotherapist– Fact sheet on how to find a therapist and evaluate how therapy is working for you. (American Psychological Association)

You can also search by category: Search for a PsychologistSearch for a Social Worker; or call the American Psychiatric Association: 1-888-35-PSYCH

Finding a therapist internationally

Search for a Marriage or Family Therapist in your country by clicking on “Search Overseas”.

In Canada, Search for a Psychologist or Search for a Marriage or Family Therapist by clicking on “Search Canada”.

In the UK, Relate offers relationship and family counseling; you can Learn about Psychotherapy, including where to find a therapist, or Find Psychological Therapy Services in your local area.

In Australia, Lifeline's Service Finder (1300 13 11 14) offers a directory of low-cost mental health services; or you can Find a Psychologistor Find a Mental Health Practitioner.

Licensed mental health professionals in the U.S.

National Association of Social Workers (NASW) provides information and services provided by social workers. There is also a national searchable database of licensed clinical social workers.

American Association for Marriage and Family Therapy (AAMFT) provides information about Marriage and Family Therapists, as well as a Therapist Locator national database of qualified therapists.

American Psychiatric Nurses Association (APNA) webpage provides more information on this profession.

American Psychological Association (APA) provides a Psychologist Locator to find a psychologist in your area.

Healthy Minds, Healthy Lives – provides information on the practice of psychiatry, including how to choose a psychiatrist (American Psychiatric Association)

American Psychoanalytic Association (APsaA) provides a member directory for finding an analyst, by city and state.

Melinda Smith, M.A., and Jeanne Segal, Ph.D., contributed to this article. Last updated: 


What You Need to Know About Borderline Personality Disorder

Personality Disorders – articles and other resources

By understanding personality disorders, you can identify the best ways to regain control and lead a full and meaningful life.

Man Drinking at Bar

Having a personality disorder doesn’t mean that your personality is somehow flawed or there is something fundamentally wrong with who you are. Rather, someone with a personality disorder has rigid patterns of thought and behavior which makes it difficult to relate to people and situations. This has a negative effect on interpersonal relationships. Most people with a personality disorder are unable to sustain meaningful and fulfilling relationships at home or at work, and experience other problems functioning in social and occupational situations. 

But you’re not powerless. Personality disorders are one of the most commonly diagnosed psychiatric conditions. There are effective treatments and coping skills that can help you feel better, take back control of your thoughts, feelings, and actions, and build fulfilling relationships.

What is a personality disorder?

A personality disorder is a condition that creates an unhealthy pattern of thinking, feeling, and behaving. Most people with a personality disorder experience chronic instability, especially in their relationships, moods, and behavior. You may feel like you’re unable to relate to the world around you or that your thoughts and impulses are out of control.

Since your way of thinking and behaving seems natural to you, you may not even realize that you have a problem. Instead, you may blame others for the difficulties you face, which can cause even more problems in your interpersonal relationships. With the right treatment and coping skills, though, you can regain control of your life. 

Featured articles

Borderline Personality Disorder: For people with BPD, almost everything is unstable: their relationships, their moods, their thinking, their behavior, and even their identity. But this guide to symptoms, treatment, and recovery can help.MORE »

Helping Someone with Borderline Personality Disorder: BPD not only affects those with the diagnosis, it affects everyone who cares about them. These tips can help you take care of a loved one with BPD while also taking care of yourself. MORE »

Finding a Therapist Who Can Help You Heal: In order to reap the benefits of therapy, it’s important to choose the right therapist. These tips can help you make the right choice and get the most out of therapy and counseling. MORE »

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Borderline personality disorder

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Borderline personality disorder (BPD) is rarely diagnosed on its own but often co-occurring with disorders such as anxiety. When worries, fears, or panic attacks start to get in the way of your life, it may be the sign of an anxiety disorder. 

But peace of mind may not be as far away as you think. There are many things you can do to get your anxiety in check and regain control of your life. MORE »

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If you have borderline personality disorder, you’ve probably struggled with maintaining stable, satisfying relationships, including those with lovers, co-workers, and friends. While all successful relationships require an investment in time and energy, there are also social and interpersonal skills that you can learn. 

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Understanding Schizophrenia

Symptoms, Types, Causes, and Early Warning Signs

Schizophrenia: Signs, Types & CausesIn This Article

Schizophrenia is a challenging disorder that makes it difficult to distinguish between what is real and unreal, think clearly, manage emotions, relate to others, and function normally. But that doesn't mean there isn't hope. Schizophrenia can be successfully managed. The first step is to identify the signs and symptoms. The second step is to seek help without delay and the third is to stick with the treatment. With the right treatment and support, a person with schizophrenia can lead a happy, fulfilling life.

What is schizophrenia?

Schizophrenia is a brain disorder that affects the way a person acts, thinks, and sees the world. People with schizophrenia have an altered perception of reality, often a significant loss of contact with reality. They may see or hear things that don’t exist, speak in strange or confusing ways, believe that others are trying to harm them, or feel like they’re being constantly watched. With such a blurred line between the real and the imaginary, schizophrenia makes it difficult—even frightening—to negotiate the activities of daily life. In response, people with schizophrenia may withdraw from the outside world or act out in confusion and fear.

Most cases of schizophrenia appear in the late teens or early adulthood. However, schizophrenia can appear for the first time in middle age or even later. In rare cases, schizophrenia can even affect young children and adolescents, although the symptoms are slightly different. In general, the earlier schizophrenia develops, the more severe it is. Schizophrenia also tends to be more severe in men than in women.

Although schizophrenia is a chronic disorder, there is help available. With support, medication, and therapy, many people with schizophrenia are able to function independently and live satisfying lives. However, the outlook is best when schizophrenia is diagnosed and treated right away. If you spot the signs and symptoms of schizophrenia and seek help without delay, you or your loved one can take advantage of the many treatments available and improve the chances of recovery.

Common misconceptions about schizophrenia

MYTH: Schizophrenia refers to a "split personality" or multiple personalities.

FACT: Multiple personality disorder is a different and much less common disorder than schizophrenia. People with schizophrenia do not have split personalities. Rather, they are “split off” from reality.

MYTH: Schizophrenia is a rare condition.

FACT: Schizophrenia is not rare; the lifetime risk of developing schizophrenia is widely accepted to be around 1 in 100.

MYTH: People with schizophrenia are dangerous.

FACT: Although the delusional thoughts and hallucinations of schizophrenia sometimes lead to violent behavior, most people with schizophrenia are neither violent nor a danger to others.

MYTH: People with schizophrenia can’t be helped.

FACT: While long-term treatment may be required, the outlook for schizophrenia is not hopeless. When treated properly, many people with schizophrenia are able to enjoy life and function within their families and communities.

Early warning signs of schizophrenia

In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Many friends and family members of people with schizophrenia report knowing early on that something was wrong with their loved one, they just didn’t know what.

In this early phase, people with schizophrenia often seem eccentric, unmotivated, emotionless, and reclusive. They isolate themselves, start neglecting their appearance, say peculiar things, and show a general indifference to life. They may abandon hobbies and activities, and their performance at work or school deteriorates.

The most common early warning signs of schizophrenia include:

  • Social withdrawal
  • Hostility or suspiciousness
  • Deterioration of personal hygiene
  • Flat, expressionless gaze
  • Inability to cry or express joy
  • Inappropriate laughter or crying
  • Depression
  • Oversleeping or insomnia
  • Odd or irrational statements
  • Forgetful; unable to concentrate
  • Extreme reaction to criticism
  • Strange use of words or way of speaking

While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, treatment will help.

Daniel’s story

Daniel is 21 years old. Six months ago, he was doing well in college and holding down a part-time job in the stockroom of a local electronics store. But then he began to change, becoming increasingly paranoid and acting out in bizarre ways. First, he became convinced that his professors were “out to get him” since they didn’t appreciate his confusing, off-topic classroom rants. Then he told his roommate that the other students were “in on the conspiracy.” Soon after, he dropped out of school.

From there, things just got worse. Daniel stopped bathing, shaving, and washing his clothes. At work, he became convinced that his boss was watching him through surveillance bugs planted in the store’s television sets. Then he started hearing voices telling him to find the bugs and deactivate them. Things came to a head when he acted on the voices, smashing several TVs and screaming that he wasn’t going to put up with the “illegal spying” any more. His frightened boss called the police, and Daniel was hospitalized.

Signs and symptoms of schizophrenia

There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the signs and symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all symptoms, and the symptoms of schizophrenia may also change over time.

Delusions

A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include:

  • Delusions of persecution – Belief that others, often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”).
  • Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them.
  • Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly).
  • Delusions of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).

Hallucinations

Hallucinations are sounds or other sensations experienced as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.

Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.

Disorganized speech

Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.

Common signs of disorganized speech in schizophrenia include:

  • Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next.
  • Neologisms – Made-up words or phrases that only have meaning to the patient.
  • Perseveration – Repetition of words and statements; saying the same thing over and over.
  • Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").

Disorganized behavior

Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as:

  • A decline in overall daily functioning
  • Unpredictable or inappropriate emotional responses
  • Behaviors that appear bizarre and have no purpose
  • Lack of inhibition and impulse control

Negative symptoms (absence of normal behaviors)

The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals. Common negative symptoms of schizophrenia include:

  • Lack of emotional expression – Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions.
  • Lack of interest or enthusiasm – Problems with motivation; lack of self-care.
  • Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal.
  • Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in monotone.

Causes of schizophrenia

The causes of schizophrenia are not fully known. However, it appears that schizophrenia usually results from a complex interaction between genetic and environmental factors.

Genetic causes of schizophrenia

Schizophrenia has a strong hereditary component. Individuals with a first-degree relative (parent or sibling) who has schizophrenia have a 10 percent chance of developing the disorder, as opposed to the 1 percent chance of the general population.

But schizophrenia is only influenced by genetics, not determined by it. While schizophrenia runs in families, about 60% of schizophrenics have no family members with the disorder. Furthermore, individuals who are genetically predisposed to schizophrenia don’t always develop the disease, which shows that biology is not destiny.

Environmental causes of schizophrenia

Twin and adoption studies suggest that inherited genes make a person vulnerable to schizophrenia and then environmental factors act on this vulnerability to trigger the disorder.

As for the environmental factors involved, more and more research is pointing to stress, either during pregnancy or at a later stage of development. High levels of stress are believed to trigger schizophrenia by increasing the body’s production of the hormone cortisol.

Research points to several stress-inducing environmental factors that may be involved in schizophrenia, including:

  • Prenatal exposure to a viral infection
  • Low oxygen levels during birth (from prolonged labor or premature birth)
  • Exposure to a virus during infancy
  • Early parental loss or separation
  • Physical or sexual abuse in childhood

Abnormal brain structure

In addition to abnormal brain chemistry, abnormalities in brain structure may also play a role in schizophrenia. Enlarged brain ventricles are seen in some schizophrenics, indicating a deficit in the volume of brain tissue. There is also evidence of abnormally low activity in the frontal lobe, the area of the brain responsible for planning, reasoning, and decision-making.

Some studies also suggest that abnormalities in the temporal lobes, hippocampus, and amygdala are connected to schizophrenia’s positive symptoms. But despite the evidence of brain abnormalities, it is highly unlikely that schizophrenia is the result of any one problem in any one region of the brain.

Effects of schizophrenia

When the signs and symptoms of schizophrenia are ignored or improperly treated, the effects can be devastating both to the individual with the disorder and those around him or her.  Some of the possible effects of schizophrenia are:

  • Relationship problems. Relationships suffer because people with schizophrenia often withdraw and isolate themselves. Paranoia can also cause a person with schizophrenia to be suspicious of friends and family.
  • Disruption to normal daily activities.Schizophrenia causes significant disruptions to daily functioning, both because of social difficulties and because everyday tasks become hard, if not impossible to do. A schizophrenic person’s delusions, hallucinations, and disorganized thoughts typically prevent him or her from doing normal things like bathing, eating, or running errands.
  • Alcohol and drug abuse. People with schizophrenia frequently develop problems with alcohol or drugs, which are often used in an attempt to self-medicate, or relieve symptoms. In addition, they may also be heavy smokers, a complicating situation as cigarette smoke can interfere with the effectiveness of medications prescribed for the disorder.
  • Increased suicide risk. People with schizophrenia have a high risk of attempting suicide. Any suicidal talk, threats, or gestures should be taken very seriously. People with schizophrenia are especially likely to commit suicide during psychotic episodes, during periods of depression, and in the first six months after they’ve started treatment.

Diagnosing schizophrenia

A diagnosis of schizophrenia is made based on a full psychiatric evaluation, medical history, physical exam, and lab tests.

  • Psychiatric evaluation – The doctor or psychiatrist will ask a series of questions about you or your loved one's symptoms, psychiatric history, and family history of mental health problems.
  • Medical history and exam – Your doctor will ask about your personal and family health history. He or she will also perform a complete physical examination to check for medical issues that could be causing or contributing to the problem.
  • Laboratory tests – While there are no laboratory tests that can diagnose schizophrenia, simple blood and urine tests can rule out other medical causes of symptoms. The doctor may also order brain-imaging studies, such as an MRI or a CT scan, in order to look for brain abnormalities associated with schizophrenia.

Mental health professionals use the following criteria to diagnose schizophrenia:

  • The presence of two or more of the following symptoms for at least 30 days:
    1. Hallucinations
    2. Delusions
    3. Disorganized speech
    4. Disorganized or catatonic behavior
    5. Negative symptoms (emotional flatness, apathy, lack of speech)
  • Significant problems functioning at work or school, relating to other people, and taking care of oneself.
  • Continuous signs of schizophrenia for at least 6 months, with active symptoms (hallucinations, delusions, etc.) for at least 1 month.
  • No other mental health disorder, medical issue, or substance abuse problem is causing the symptoms.

Conditions that can look like schizophrenia

The medical and psychological conditions the doctor must rule out before diagnosing schizophrenia include:

  • Other psychotic disorders – Schizophrenia is a type of psychotic disorder, meaning it involves a significant loss of contact with reality. But there are other psychotic disorders that cause similar symptoms of psychosis, including schizoaffective disorder, schizophreniform disorder, and brief psychotic disorder. Because of the difficulty in differentiating between the psychotic disorders, it may take six months or longer to arrive at a correct diagnosis.
  • Substance abuse – Psychotic symptoms can be triggered by many drugs, including alcohol, PCP, heroin, amphetamines, and cocaine. Some over-the-counter and prescription drugs can also trigger psychotic reactions. A toxicology screen can rule out drug-induced psychosis. If substance abuse is involved, the physician will determine whether the drug is the source of the symptoms or merely an aggravating factor.
  • Medical conditions – Schizophrenia-like symptoms can also result from certain neurological disorders (such as epilepsy, brain tumors, and encephalitis), endocrine and metabolic disturbances, and autoimmune conditions involving the central nervous system.
  • Mood disorders – Schizophrenia often involves changes in mood, including mania and depression. While these mood changes are typically less severe than those seen in bipolar disorder and major depressive disorder, they can make diagnosis tricky. Schizophrenia is particularly difficult to distinguish from bipolar disorder. The positive symptoms of schizophrenia (delusions, hallucinations, and disorganized speech) can look like a manic episode of bipolar disorder, while the negative symptoms of schizophrenia (apathy, social withdrawal, and low energy) can look like a depressive episode.
  • Post-traumatic stress disorder (PTSD) – PTSD is an anxiety disorder that can develop after exposure to a traumatic event, such as military combat, an accident, or a violent assault. People with PTSD experience symptoms that are similar to schizophrenia. The images, sounds, and smells of PTSD flashbacks can look like psychotic hallucinations. The PTSD symptoms of emotional numbness and avoidance can look like the negative symptoms of schizophrenia.

Hope for schizophrenia

Treatment options for schizophrenia are good, and the outlook for the disorder continues to improve. With medication, therapy, and a strong support network, many people with schizophrenia are able to control their symptoms, gain greater independence, and lead fulfilling lives.

If you think that someone close to you has schizophrenia, you can make a difference by showing your love and support and helping that person get properly evaluated and treated. To learn more, see the related articles below.

More help for schizophrenia

Resources and references

Understanding schizophrenia

Schizophrenia – Provides a comprehensive overview discussing causes, symptoms, diagnosis, treatment and current research on schizophrenia. (National Institute of Mental Health) 

Learn More About Schizophrenia – A guide to the symptoms, causes, diagnosis, and treatment of schizophrenia. (Schizophrenia Society of Canada) 

Basic Facts About Schizophrenia (PDF) – This 40-page booklet covers the most frequently asked questions about schizophrenia, including what it’s like and how families can help. (British Columbia Schizophrenia Society)

Understanding Schizophrenia and Recovery(PDF) – Covers what people with schizophrenia and their families need to know about schizophrenia and its treatment. (National Alliance on Mental Illness)

Symptoms and early warning signs of schizophrenia

Schizophrenia in Children – Describes symptoms in children, which may be different from those in adults. (American Academy of Child and Adolescent Psychiatry)

The First Signs of Schizophrenia – Read through personal stories, offered by both people with schizophrenia and their loved ones, describing the early signs and symptoms they observed. (Schizophrenia.com)

Types of schizophrenia

Paranoid Schizophrenia – Learn about the most common subtype of schizophrenia, including typical signs and symptoms such as paranoid delusions. (PsychCentral)

Catatonic Schizophrenia – Overview of the signs and symptoms of catatonic schizophrenia, as well as its causes and effects. (PsychCentral)

Disorganized Schizophrenia – Guide to disorganized schizophrenia’s signs and symptoms, such as disorganized thinking, disorganized behavior, and flat affect. (MedlinePluse)

Causes of schizophrenia

Possible Causes of Schizophrenia – Reviews the possible causes of schizophrenia, including biological, psychological, and social factors. (Schizophrenia Fellowship of NSW)

What Causes Schizophrenia? – Covers the combination of causes involved in schizophrenia, including genes, brain chemistry, and brain structure. (National Institute of Mental Health)

Authors: Melinda Smith, M.A., and Jeanne Segal, Ph.D.  Last updated: April 2015.


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