How to know if you need therapy (and stop waiting)
There is no single threshold for seeking help. How to tell distress that already weighs and how to take the first step today.
Ricardo De Castro KingPsychologist · Meet the author 
The threshold nobody gave you
There is a figure almost nobody says out loud: most people who could benefit from therapy do not seek it, and not because they are not suffering, but because they do not know when they have the “right” to.
Clement et al. (2014) reviewed dozens of studies on what stops people from seeking psychological help. DOI: 10.1017/S0033291714000129 The barrier was not only money or lack of supply: it was something quieter, the stigma — internal and external — the conviction that asking for help signals weakness and that the problem is not “enough” to justify it. People do not stay still for lack of pain. They stay still for lack of permission.
That permission is not written down anywhere. There is no official threshold from which you have the right to therapy, and that is why this page will not give you a number. It will give you something more useful: the right question.
1. What is happening to you (the diagnosis of “it is not that bad”)
Let us start with what actually brought you here, because it is almost never “I feel bad” and that is it.
What is happening is this: there is a distance between how you live and how you would like to live, and that distance became normal. You get up tired, hold down the job, answer the messages, deliver. And at some point in the day, almost always at night, the question appears that you do not let yourself finish: is this all there is? There is no tragedy. There is no clear reason. And precisely for that reason you tell yourself you have no right to anything.
That is the knot. The absence of catastrophe becomes the reason not to move, and the phrase that always closes it is the same: “somebody has it harder”. You say it as if it were compassion, and it is something else: it is a way of setting yourself aside without guilt.
It is worth saying something almost nobody says: suffering has no comparative scale. Someone else being worse off does not take a gram off what you carry. You can be deeply unwell without meeting any severity requirement, and you can function at a ten on the outside while inside you have been asking for a pause for months.
2. Why it happens: the waiting cycle
There is a cycle that explains why people hold on for years before seeking help, and it is worth seeing in full because once seen it is hard to switch off.
| Phase | What you think | What you do | What happens next |
|---|---|---|---|
| Alarm | ”Something is not right” | You set it aside: you have things to do | The distress does not leave, it builds |
| Normalisation | ”Everyone is like this” | You compare with others and minimise | You lose the reference of your own state |
| Justification | ”It is not that bad” | You look for the ideal moment to deal with it | The ideal moment never comes |
| Hidden cost | ”It will pass” | You stop doing things, without naming it | Your life shrinks a little more |
| Threshold | ”After this, yes” | It is no longer a choice, it is urgency | You arrive late and with more damage done |
The cycle is not broken by an accumulation of pain. It breaks when someone — sometimes an article, sometimes a sentence — changes the question for you. Instead of “is it that bad?”, the question becomes “how much is it costing me already?”. Notice the second one does not need to compare your pain with anyone’s. It only asks you to look at your own list of what you stopped doing.
3. The signals that do weigh (and the ones that do not)
Not all signals carry the same weight, and treating them as equivalent is what keeps people stuck. There are signals that barely mean anything and signals that weigh a lot.
| Signal | Does it weigh? | Why |
|---|---|---|
| ”I cry every now and then” | Little | Crying is a normal response, not a symptom |
| ”I have bad days” | Little | Everyone has bad days; the proportion matters |
| ”I have been sleeping badly for six weeks” | A lot | Sustained time is the indicator, not intensity |
| ”I stopped seeing my friends” | A lot | Isolation is one of the clearest signals |
| ”I enjoy nothing I used to enjoy” | A lot | Sustained anhedonia is a classic marker |
| ”I am irritable with the people I love” | A lot | If it damages your relationships, it is already costing something real |
| ”I can only relax with a drink” | A lot | Changing your state to get through the day is a flag |
Notice the pattern. The signals that weigh share two things: they last and they have a cost. The ones that do not weigh are single moments. The criterion is not “I feel very bad for a while”: it is “I have been like this for a while and it has already changed my life”.
People who wait more than a year from when they notice the first symptom to when they seek help. It is not for lack of suffering: it is for lack of a clear criterion about when to do it.
People who give “it is not that serious” as the main reason for not starting therapy. It is barrier number one, ahead of money and time: the sense of not having the right.
People who hold up work, home and responsibilities on the outside while at the limit inside. Functioning is not being well, and confusing the two delays help for years.
4. Which one you are (the four who reach this page)
You do not arrive here the same as everyone else. Recognising where you arrive from helps you see what is stopping you, specifically.
The one who functions. Holds everything, fails at nothing, and therefore believes they have no right. Their brake is the demand: if they can, then they do not need it. They usually arrive late, when the body has already sent the bill.
The one who cannot go on. Has been holding on for months and one day breaks over something small. Their brake was “it will pass”, and they arrive with urgency, not calm.
The one who compares. Looks around, sees others worse off, and convinces themselves that complaining is a privilege. Their brake is guilt, and they do not recognise that pain is not a competition.
The one who wants to understand. Not in crisis, but something keeps repeating — in love, at work, in relationships — and they want to look at it with help. Their brake is the doubt about whether that “counts” as a reason. It counts.
With that you already know what your block is. And so it does not stay in theory, below there is an exercise that confirms it with your own data.
5. The four myths that keep you still
Before seeing which of the four you are, it is worth dismantling the myths that sustain the wait. Almost all of them come from a bad comparison.
| What you tell yourself | Why it fails | What is true |
|---|---|---|
| ”It is not serious enough to go” | Severity is not the criterion | The criterion is time and cost |
| ”Others have it worse” | Pain is not a competition | Someone being worse off does not take off what you carry |
| ”If I can function, I do not need it” | Functioning is not being well | Hanging on by a thread is the typical reason people ask for help too late |
| ”It will pass on its own” | What is put off grows | Months of distress do not resolve by waiting |
Notice the last row. It is the one most people let through, and the one that costs the most time. “It will pass” sounds like prudence and works like a bet: you bet the distress will resolve without you doing anything. And sometimes it resolves. But when you have had the same pattern for months, the bet has already lost several times and you keep putting down the same chip.
People who say they waited because they believed it would resolve on its own. It is not naivety: it is that nobody told them time, by itself, does not move this kind of distress.
People who confuse being able to function with being well. As long as the body holds, the head has permission to postpone. And the body holds longer than it should.
6. What to do (this piece’s exercise)
The exercise is called the list of what I dropped, and it takes ten minutes. It is the direct answer to the question “is it that bad?”, because it makes that question unnecessary.
- Draw a column on paper or on your phone. At the top write: “Things I did a year ago and no longer do”.
- Fill the list with facts, not feelings. “Seeing my friends on Fridays” is a fact. “Being sad” is a feeling. Both matter, but here go the facts: what stopped happening.
- Next to each one, write roughly when you stopped doing it. The approximate date. This is what reveals the time: it was almost never all at once, it was in slow motion.
- Mark the ones you dropped without deciding. Not the ones you chose, but the ones that fell away on their own. Those are the ones the distress took with it.
- Count how many there are. If the list has few things and all of them are your choices, maybe you are fine. If it has several that fell away without you choosing them, you already have your answer without having measured a single level of pain.
That last step is what breaks the cycle. Because the question of the right — “is it that bad?” — has no answer. But the list does, and it is written with your life, not with your anguish.
Suppose the list comes out short — does that mean I do not need therapy?
Not exactly. There is another reason to go, beyond repair: self-understanding, life changes, a relationship that repeats. The list measures the cost of what already happened to you; some people come for what they want to not happen. That your list is short only says you are not in deficit: it does not say you have nothing to look at.
7. The case: the promotion that became insomnia
A composite sketch; names, dates and concrete details were altered to protect privacy. Any recognisable resemblance is a product of the assembly.
She is a woman of thirty-six, mid-career. Two years ago she was promoted to head of team. What she wanted. What she had worked toward.
A year later she started sleeping badly. At first she thought it was the job: more responsibility, more people under her, more decisions. Then she started waking at three in the morning and not getting back to sleep. Then the irritability with her partner, over small things. Then whole Sundays in bed, doing nothing, with the sense of being exhausted from having done nothing.
When something like this happens, the first explanation you give yourself is the most superficial one: it is tiredness. And tiredness is endured. She endured it for two years, held the team, met the targets, and her reviews were good. On the outside, spotless.
What led her to seek help was not the insomnia. It was the list. One night, without looking for it, she did the inventory: she no longer read, she had stopped running, she had not spoken to her sister in months, she no longer invited anyone over, and she could not recall the last time something had made her laugh out loud. The list was long, and none of those things had fallen away by choice. They had fallen on their own, while she held up the rest.
That is what the waiting cycle makes invisible. She had no tragedy to justify it. She had a promotion, a good relationship, a job going well. And for that very reason she felt she could not complain. The list showed her the opposite: that the cost was not in the severity of the problem, but in everything that had disappeared without her noticing.
Suppose I'm in this state but cannot find a clear "why"?
It is more common than it seems, and it does not mean there is nothing to work on. Sometimes the “why” appears precisely through the therapeutic work: what has no name today is something you see better when you look at it with company, alongside someone trained to bring up the questions you tend to avoid. You do not need to arrive with a diagnosis under your arm to start.
8. What changes when you start earlier
There is a practical reason not to wait for a crisis, and almost nobody names it: what you bring to therapy changes depending on when you arrive.
If you arrive before a crisis, you arrive with resources. You have energy to work, relationships that hold you up, and room to look at what is happening without everything depending on solving it now. If you arrive in crisis, you arrive with the minimum: the therapeutic work starts by putting out the fire, and that leaves less space to understand what is underneath.
| When you arrive | What you bring | What can be worked on |
|---|---|---|
| Before the crisis | Resources, time, clarity | Patterns, history, prevention |
| In crisis | Urgency, exhaustion | Stabilise first; the deeper work, later |
| Years later | Accumulated damage, distrust | Rebuild, and sometimes undo old habits |
Notice the first row. It is not that waiting is a moral error: it is that the same work costs more and yields less. Arriving earlier is not overreacting; it is arriving with your resources intact.
People who say the therapeutic work was harder for having arrived late, when damage had already accumulated. It is not a sentence: it is a cost that could have been avoided.
9. When it is worth not waiting
This text does not end with “and now book an appointment”. That would be false, because there are situations that do not allow the calm of an exercise.
There are signals that ask for help today, not next week: thoughts of harming yourself or that nothing is worth it; being unable to sleep or eat normally for days; shutting yourself off completely; feeling you cannot cope with life. If any of those appear, it is not the moment to assess calmly whether “it is that bad”. The lines are below, available 24/7, and using them is not overreacting: it is exactly what they exist for.
And if what you have is less urgent but sustained — months of distress, relationships that repeat, a grief that does not close — that too deserves time and help. The difference between the two cases is not the right to ask for it: it is the urgency.
10. What is not a signal
Just as there are signals that weigh, there are things people use as an excuse not to go that mean nothing. It is worth naming them, because dismantling them removes a brake.
It is not a signal that you have not had a tragedy. Most people who go to therapy have not been through anything catastrophic. They have been through life: changes, tiredness, a relationship that cooled, a stage that does not close. That is enough, and it always was.
It is not a signal that others are worse off. Pain is not measured on a comparative scale. Someone being worse off does not take a gram off what you carry, and using it as an argument is a way of setting yourself aside without feeling guilt.
It is not a signal that you can function. We saw it: functioning on the outside is compatible with being at the limit inside. In fact, it is the leading reason people ask for help too late.
It is not a signal that you cannot explain what is happening. “I cannot really put into words what’s going on” is enough of a starting point. Therapeutic work exists precisely to put a name to what feels like background noise.
People who believe they need a “serious” reason to justify therapy. Severity was never the criterion, and holding that it is delays help for years.
11. The threshold that does exist
Back to the beginning, to the threshold nobody gave you. Now you can see that the threshold is not in severity. It is in cost and in time.
Corrigan (2004) showed how stigma — including the kind you apply to yourself — blocks the road to care. DOI: 10.1037/0003-066X.59.7.614 It is not that people do not know therapy exists: it is that they tell themselves that asking for it makes them weak, or that their problem does not reach the minimum. That stigma has a measurable consequence: people arrive later, with more damage done, when it is harder to recover. And it did not need to be that way.
Because the finding that is sometimes missing is this: therapy works. Smith and Glass (1977), in the meta-analysis that opened this field, found that those receiving psychotherapy fared clearly better, on average, than those who did not. DOI: 10.1037/0003-066X.32.9.752 Five decades later, that finding has not been disproven: it has been refined. It is not magic or a promise: it is a real, measured effect, and it is available.
So the honest question is no longer “is it that bad?”. It is how much longer you will hold up a list of things that fell away without you choosing them. That is the threshold: not the one someone gave you, but the one your own life is already giving you.
If you want to keep going, the piece on the fear of starting therapy works on what stops you, and the one on what to expect from the first session shows you the next step. And if you have decided yes, therapy at rdkterapia is one possible door.
People who, after their first session, say they should have started earlier. It is the most honest sign that the threshold was never where they thought: they waited too long.
Caja de crisis. If you are in an acute crisis right now — thoughts of harming yourself, or that nothing is worth it — do not keep reading. Call right now. Colombia: 123 (emergencies) and 106 (psychological crisis line). If you are in the US: 988 (Suicide and Crisis Lifeline). If you are in the UK: 116 123 (Samaritans). If you can, stay with someone while you call.
One last one: what if I go and it turns out I am fine?
It is a possible outcome and it is not a failure. Sometimes therapy serves exactly for that: to confirm that what you are going through has a name and can be worked on, or to discover that the distress you were carrying was not as serious as you feared. Coming out with an “I am better than I thought” is as valid an outcome as any other. What is not valid is staying without knowing, out of fear of finding out.
