Do you need help? And what kind?

“You need help.” People often say this as an insult. It’s a somewhat milder version of “You’re out of your mind.”

But there are times when you really do need help of the counseling variety.
Or someone close to you does—including employees. But when? And what kind of help?

To start with the when, David Seck, MD, writing in Psychology Today, gives some signs that you might need psychotherapy:

• Feeling sad or angry, or otherwise not yourself. Uncontrollable sadness, anger, or hopelessness.

• Abusing drugs, alcohol, sex, or engaging in other addictive substances or behaviors—including overeating.

• You’ve lost someone or something important to you, such as a family member or a job.

• Trauma. This could include abuse or neglect from childhood, being the victim of a crime or accident, or the aftereffects of military combat.

• Unable to do activities you enjoy. You no longer take pleasure from hobbies or pastimes, or you avoid socializing more than usual.

• Suicidal thoughts. The Centers for Disease Control report that the suicide rate for youths from 10 to 24 has risen 56 percent over the last decade. (The fact that there is a suicide rate for ten-year-olds is chilling in itself.)

Other possible symptoms are chronic lack of energy or physical pain. Donna Aldridge, a counselor based in South Dakota, observes, “Physical pain is not something you would normally associate with anxiety or depression, but it is a good place to put your feelings if you don’t want to talk about them.”

Then there’s the question of what kind of counseling you need. As for the countless schools of psychotherapy—Freudian, Jungian, cognitive therapy, gestalt—from a practical point of view it may not matter very much which one you choose.

Actually, there is no agreed-upon model of the mind, how it works, or its connection with brain function. Most studies have shown that it is the individual counselor or therapist, not the type of therapy practiced, that makes the most difference.

This means that the best approach is word-of-mouth referrals (although for many people this is a delicate subject to bring up). You can also do web searches for practitioners in your area. Make sure you understand their basic outlooks. Some practitioners operate from premises (such as religious beliefs) that you may or may not feel comfortable with. You don’t want a counselor whose worldview clashes with your own.

There is another kind of counseling too: life coaching. It is not psychotherapy. In fact, it isn’t even licensed. Although there are training programs for life coaches, they are not accredited and carry no institutional authority.

Life coaching can be useful, but for a different set of problems. A life coach usually doesn’t have the training to deal with deep-seated cognitive or emotional issues but may be better for guidance in areas such as finances, career, or life goals.

Gary S. Goodman, MBA, PhD, author of How to Get Paid Far More than You’re Worth and other books, offers these thoughts:

“As I see it, therapists and life coaches generally focus on different things. Therapists ask and try to get clients to answer the question, ‘What’s wrong?’ The goal is to identify causes of distress while operating under the presumption that an understanding of causes will provide relief.

“A life coach asks, ‘What’s next?’ That’s an action-producing inquiry. It says the past is the past. Who-did-what-when-and-why are interesting as history and personal biography, but where do we go from here? What’s the action plan, and especially, what’s the next step you need to take?”

Payment is another issue. Because life coaching is not therapy, it is almost never covered by health insurance. Life coaches may also charge flat fees for longer-term relationships rather than billing by the hour.

A bonus: because life coaches aren’t bound by the same confidentiality agreements as therapists, you can ask for referrals.

Finally, if you’re approaching someone else who may need help, you can start with this basic premise: nobody likes unsolicited advice. If you bring up the issue, do so tactfully. Especially for employees or subordinates, it’s best to broach the subject with care. Avoid harshness, even when it’s a matter of disciplinary action.

Richard Smoley, editor for Blue Book Services, Inc., has more than 40 years of experience in magazine writing and editing, and is the former managing editor of California Farmer magazine. A graduate of Harvard and Oxford universities, he has published eleven books.