If I’m depressed or anxious because of my situation, what can therapy do for me?

You might think therapy is for people who just need to be less depressed or anxious. In other words, their lives are fine—they just need to work through their feelings. But what can therapy do when your problem is situational? What if you're depressed or anxious because your life circumstances are genuinely depressing or anxiety-inducing?

If the people and circumstances around you are causing sadness and distress, your thought process might be something like, “My job/my family/the state of the world/[insert big existential problem] is making me miserable. I have to change my personal circumstances/the entire world in order to feel better. So, I should focus on changing the external rather than the internal.”

That's logical, right? If you're depressed or anxious because of what's happening around you or to you—whatever that looks like—how could talking to someone possibly help? 

It turns out therapy can actually help a lot. While therapy won't make your terrible boss quit or reverse climate change, it can help you decide what to do about your circumstances. Importantly, therapy can also help you figure out where you’re spinning your wheels—in other words, where your anxious rumination or self-loathing spirals are making the problem worse, or at best, wasting your time. It can teach you skills that help you understand and accept your emotions, and, over time, improve your anxiety and depression. 

“Unhappiness isn’t always simple,” explains Andrew Triska, director of Triska Psychotherapy. “If you’re unhappy in your relationship and you’re also convinced it’s all your fault, you’re going to be much more unhappy than someone with a balanced idea of what they can and can’t do, and you might stay in the situation longer.” Triska adds that extreme beliefs, like hyper-responsibility or an unrealistic sense of helplessness can worsen situations: “Therapy can help you find a balance between rigid beliefs like ‘I can’t do anything about this’ and ‘I should be able to make things right all the time.’”

Here's more about how therapy can help when the problem feels situational. 

Better Understand the Situation, Including What Is and Isn't Possible

A therapist can help you understand the situation that's making you depressed or anxious, and what you actually can change about it.

Here’s what that might look like. Let's say you're caring for your aging mom. You have three siblings, but only one of them is willing to help. You're paying for all the pricey medications and dialysis appointments, too. You might have other options, but they don't seem great—like getting in-home care by borrowing against your mother's house. Or putting your mom in an adult care facility when she's always said things like, "I'd rather die than go to those Turtle Apartments." (It’s Turtledove. The complex is called Turtledove Villages. Get it together, Mom.)

The whole situation is physically and emotionally draining. You've paused your master's program to take care of her. It's all taking a toll on your mental health, but you've decided you just need to keep going. The only hope, as you see it now, is to persuade your siblings to help a little more to relieve some of the burden. 

A therapist can help you understand not only what is technically possible, but what is realistic. You might, for example, not be able to guilt your sister into leaving her children and sleeping in the spare bedroom three times a week to help you. Your brother might not want to write a check for in-home care, even if he has the money. It may not be possible for your mom, with her evolving needs and house with way too many flights of stairs, to continue living in her own home. 

Making a change always comes with costs and benefits. Not making a decision or delaying a decision does, too.  A therapist can help you concretely understand what those are. In this example, you can continue as things are, letting your mom age in place, but sacrificing your own goals. A therapist can also help you understand who or what is actually contributing to the problem. (Spoiler: It may not be what you think.) Is it really your sister's refusal to help? How much responsibility do you actually have for your mom’s life? Yes, she's your mother, and she wants to stay in her home, but is fulfilling that wish 100% on you? At what point can you say that you did your best and you can let your mom make her own choices? 

“A therapist won’t say, ‘Your mom’s going to be fine in assisted living,’” Triska says. “They won’t make the choice for you. Instead, they’re going to help you think more clearly about the choices you’ve already made and the ones you’re currently making.” Triska adds that clients often feel caught between two unacceptable choices, which leads to paralyzing indecision and feelings of helplessness. According to Triska, therapy can help you develop a sense of agency and accept the inevitability of bad outcomes rather than engaging in wishful thinking: “Your therapist might say, ‘You’re making a decision right now. You’re deciding not to make a change. Would it hurt more to keep making that decision, or would it hurt more to make a different one?”

You might not even realize that your worldview comes into play, too, and a therapist can help you understand that. For example, do you think you "deserve" bad things or "should" help because she’s your mom and gave birth to you?

“These are beliefs you might not even know you have,” Triska says. “You might not even truly believe them, even if you live by them! Sometimes, just saying them out loud can be helpful. I see a lot of clients stop in their tracks in therapy and say something like, ‘Wait, did I really just say, “I’m the only one who can save this family”?’”

Learn Acceptance Skills

So, maybe you understand that you have (realistic) options, but do you actually want to take action? A therapist can help you work out what you're okay with and what you're not.

Let's try another example. You hate your job as a marketing executive and wish you'd become a marine biologist. You might have this conversation with yourself all the time, and it might make you feel stuck, thinking about all the perceived wrong turns you took or how long it would take you to get on track. You might say things like "by the time I change careers I'll be too old," or, "All those twenty-somethings who knew what they wanted will be swimming with the dolphins and I'll be creaky. I'll probably die at sea due to muscle badness." There would be trade-offs, too: Being a graduate student would mean not contributing as much to your 401(k) or taking as many vacations. You’d have to uproot your life to somewhere with an ocean, and you've just made a one-year membership commitment to your local gym.

In this case, you're looking at a big life transition, potentially with a big payoff (dolphins), and big tradeoffs (money). A therapist might help you develop the skill of accepting the costs of changing and not changing so you can decide whether to take this leap. Along the way, you’d unlearn habits that have made it tough to make decisions, uncovering beliefs like I can’t accept either solution or I must be sure I’m making the right decision or else I can’t make a decision. Your therapist will also help you explore the costs of not deciding. What do you lose every day, week, or month you don’t make the decision? What are you deciding to do right now?

“A therapist is never going to ask you to be happy about your decisions,” Triska says. “That’s not what acceptance is about. Accepting a decision just means making a decision with all the bad feelings it involves—even when your brain is screaming at you that you’re being stupid. Acceptance is the process of letting yourself feel whatever you’re feeling, but not letting that get in the way of your decision.”

Develop Important Emotional Skills

How about one last example? Let's talk about (gasp) life circumstances that affect other people. The problems with your spouse have become unbearable. His drinking is out of control and it's affecting how he acts toward you and your two children. No matter how many times you try to bring it up gently, he won't admit he has a problem. Outside of that, you feel like the two of you haven't been able to connect meaningfully for years. You've talked about leaving and he didn't take it well. The whole situation has left you anxious about what to do next, and stuck. How are you going to share custody this way? Don't you "owe it to him" to try and make it work?

Anxiety is what happens when you avoid an emotion. It’s not just a problem for people with anxiety disorders, but for anyone who feels stuck or indecisive. If you’ve put off decisions or can’t shake the nagging feeling of tension that comes with keeping away bad feelings, you might be avoiding. Maybe you're sad that the person you married is behaving this way or ashamed that you didn't see it sooner. You're angry at your spouse for acting like this and fearful of what a divorce might look like.

These are all normal emotions. But your anxious brain might come up with unhelpful “solutions” to these emotions. If you’re feeling fear, you might try to soothe it by saying, “I’ll make him go to couples' therapy again,” even if that solution has never worked To “resolve” your anger, you may try to analyze his behavior or make yourself believe things aren't so bad ("He's a good man," "He loves those kids," or "It’s my responsibility to help him realize he’s hurting me.")

Triska explains that these “strategies” may not look like emotional avoidance on the surface. “Most people don’t think of themselves as avoidant,” he says. “But emotional avoidance is baked into our brains from the time we can walk and talk. Adults say things like, ‘Don’t be sad, it’s not a big deal’ or ‘You can’t be afraid.’ A lot of people grow up thinking that ‘real’ adults never doubt their decisions, which might make you think it’s not normal to let yourself feel things like fear or regret.” Emotional avoidance, he explains, may make you feel like you have no other options but to endlessly keep the fear or doubt away. It can also alienate you from the reality of the situation, which makes it more challenging to move forward. A therapist may be able to help you stop the back-and-forth, and realize that you can feel angry and have compassion. Or that sadness doesn’t always have to be fixed.

Therapists can teach the skill of interoception, or figuring out how you actually feel in the moment. You can get past questions like What kind of person would feel something like... or What would my family or his family or our friends think? and understand what you want independent of other people. They can also help you clarify values--what is important to you? Is it career success? Family? Art? A safe environment? This can help you separate your core values from fleeting thoughts, confusing emotions, or other people’s needs.

Benefits of Therapy

You might have noticed that all these situations are very different. That’s because the skills you learn in therapy don’t just apply to one thing. They can help you navigate future decisions without feeling paralyzed or helpless. The tools you develop in therapy can help you be more at peace in general, even in bad times. Regardless of circumstances and uncertainty, therapy can help you achieve clarity and become better able to move toward the things you want in life.

“What I emphasize in therapy is that happiness is a long-term endeavor,” Triska concludes. “And sometimes, what you do in the moment to make yourself temporarily happier makes you feel worse in the future. So what we promise people in therapy isn’t momentary happiness, but the skills to quiet your brain that you can use even when you’re temporarily unhappy.”