I have been working with low-income black, brown, and white young adults my whole career. Many of them do not want to go to therapy. In fact, I remember talking to a mentor who was a licensed counselor and when I told him I wanted to become a counselor and work with young adults like those I mentioned, his answer was “they won’t come see you in therapy.”
He was right. In my career, I made referrals often (and got better at doing it) but many would not show up and those that did would not have the experience they expected.
I will often see folks imploring people to “GO TO THERAPY” making equivalencies like “You wouldn’t go to your friend or pastor if your leg was broke, would you?”, all but ensuring a non-successful referral.
My research, among other correlates, focuses on wellbeing in young adults. My work has mostly been front lines, non-clinical work in educational settings. As a non-clinical professional who has been providing mental health support (not treatment) to adults of all ages for years, I know this is doable.
I have referred adults who were experiencing issues that impacted their day-to-day life. People trained to spot it would tell you that these young adults need help. But the options for them are often too clinical, too high-risk in the mind of the prospective patient.
One of the unintended consequences of providing a high standard of care for mental health issues is that many think of the clinician’s office as something they would consider only in crisis.
Think back to middle and high school. Teachers, coaches, ministers, and in some cases, counselors, helped bridge the gap between the clinical and actual. That gap still presents a need as these traditional roles fall out of the support system for young adults as they age.
Quality therapy is an on-going need for young adults—but the costs (money/trust/commitment/homework/access/cultural competency) are too high for many.
Many standard therapies (CBT/ACT/Mindfulness) can be done DIY with $20 books (David Burns so good) from Amazon—but intuition tells me that dropout rates are high, room for confusion abounds, and, most importantly, there’s no one to talk to unless you seek out communities with intention.
Perhaps a solution is to train people to do what counselors do so those folks can go where access is limited or unlikely to be used. Can you teach a person to provide mental health counseling? Psychiatrist Dixon Chibanda has been doing just that in Zimbabwe. He thinks one month of training can prepare someone to help provide mental health support.
Maybe someone reading this is thinking: sure but that’s Zimbabwe. But the need here is not different—people who want someone to talk to, where they live/work, and they get help on the spot.
A college student once called me in the middle of a panic attack, their first. Through tears and distress, they apologized for finding and using my personal number, but they were afraid they might be dying, because they felt they could not breathe.
I left the restaurant table I was at with friends and walked outside to the alleyway. “I understand. That feeling is terrible and I’m sorry you’re having it. But I know you can breathe because you’re talking to me. You’re going to be ok. I will stay with you on the line.”
The sympathetic nervous system subsided as it does, leaving a sense of confusion, some embarrassment, some relief. I made a referral for clinical follow-up.
Let’s face it. Most therapeutic work is done outside the office. If your counselor doesn’t give you homework, get a different counselor. And, of course, there are some issues, perhaps many at some point, that are best left to professionals. But the role of non-professionals has been overlooked for too long. It’s time to consider training regular people to help regular people in supporting positive wellbeing.
Idea: If Psychiatry and Deep Therapy is senior management, then counseling is middle management, and the troubled youth are the workers. Those that sully with counseling (the troubled talent) are a different breed than the nutters who abuses counseling and desire to mess with therapist and psychiatry (the smart ambitious). The former needs it to touch grass through therapy, the latter might not and should just "eat a**" with social aid.