Q: I am a 30 year old health care professional. I’ve been considering therapy for several years. I think I probably have a low grade, chronic depression and some issues with anxiety. About 7 years ago, when I started grad school, I had some difficulty adjusting. I had difficulty meeting friends, and with the stresses of work and school, started cutting myself. While this isn’t as much of an issue anymore, I do still cut occasionally. I moved again about 4 years ago to start my present job, and again had some difficulty adjusting and meeting people. I’m single and really have never been in a relationship. My life goal, since childhood, was to marry and have children. I’m starting to address the idea that this may never happen for me, and thinking about how my life could possibly be worthwhile without those things. I have days when I feel fine, and days when I am extremely depressed. It doesn’t seem consistent enough to truly “qualify” as a diagnosis of depression. I’m still able to function. My anxiety regarding starting therapy far outweighs any anxiety I experience in my life. In fact, the idea of therapy triggers my cutting more than anything else. I guess my question is about drawing the line between pathology and personality. What’s a normal variant vs a mental illness. Sometimes I think that the cutting alone is a decent enough reason to seek help, but how is my cutting any different than the person who smokes or overeats as a reaction to stress. Those people aren’t in therapy. How can I get over the anxiety of actually making the phone call to set up an appointment with someone? My previous attempts have literally made me physically sick. I can’t decide if therapy is something I need or if I just need to try to get over it all. Thanks.

A: The bottom line is that you need to find a way to get into therapy. Prior to that you may want to spend some time thinkng about and do some journaling about why exactly you are so afraid to take that step. Unlike what you said, many people are in therapy for the issues you mentioned such as reactions to stress, smoking, eating, and poor coping skills. As a health professional you should know that you don’t have to have a serious mental illness to seek help. Early intervention and prevention are powerful tools. I personally do believe that the “coping skill” of cutting is a very good reason to enter therapy. It is a very unhealthy and harmful means of coping with stress and pain. You can also then address the fact that you have not achieved your life goals at this point. I would suggest that you start asking around to get a good referral as it may reduce your anxiety. Ask friends, family, coworkers, or even patients who they see and just make the appointment. It is far less threatening once you start the process than the fear and anxiety it creates by not doing what you know you need to do. Take the plunge and “just do it.”