Can Someone Be Too Unstable for Therapy?

Most people with mental illness benefit from different forms of psychotherapy, also known as counseling, or talk therapy. There are times, however, when a person is in the midst of a mental health crisis or a psychotic episode and may to be too unstable to benefit from therapy until the crisis has passed. When that happens, the individual needs to be stabilized before progress can be made.

What is a Mental Health Crisis?

A mental health crisis can be triggered by external events such as the sudden death of a loved one or job loss, or it can be triggered by undiagnosed mental illness. A person who is approaching a mental health crisis may display a wide variety of symptoms including:

• Increasing agitation and irritability
• Inability to perform normal daily tasks such as bathing or changing clothes
• Abusive behavior toward self and others
• Violent, out-of-control behavior
• Self-harm such as cutting
• Rapid, unpredictable mood swings
• Restlessness and pacing
• Racing thoughts and talking fast
• Suicidal or homicidal thoughts
• Hallucinations such as hearing voices or seeing things that aren’t there

If someone you love is in a mental health crisis, they may be too unstable for therapy. You will need to assess the immediacy of the situation and determine if you have time to call a mental health professional for guidance. If your loved one is in immediate danger of harming themselves, others or property, don’t hesitate to call 911.

Signs of Suicidal Tendencies

When a person threatens suicide, this statement should never be dismissed or ignored. A person in danger of harming themselves may require hospitalization before therapy can help. Signs that a person may be considering suicide include:

• Giving away or throwing away many of their personal possessions
• Preoccupation with death and dying
• Isolation and withdrawal from friends and family
• Appearing very despondent and hopeless
• Making statements like, “Everyone will be better off without me”
• Dramatic changes in mood, personality or behavior
• Previous suicide attempts
• Increased drug or alcohol abuse

Psychotic Episode

Psychosis involves believing, seeing, hearing or feeling things that are not real. There are usually warning signs before a person reaches a point of crisis. Warning signs include:

• A sudden decline in personal care
• Trouble thinking clearly or concentrating
• Withdrawing from family and friends
• Strong, inappropriate emotions, or lack of any emotional reactions

Psychotic episodes may include either hallucinations or delusions. Hallucinations include hearing voices that are not there and may also include seeing, smelling or feeling things that aren’t there as well. Delusions involve believing things that aren’t true, such as believing one is being followed or surveyed by others.

A person in crisis who is having a psychotic episode may be extremely frightened and withdrawn. They may be paranoid that others mean to harm them, and they may be at risk of self-harm.

Inpatient Treatment for Mental Health Instability

When an individual is extremely unstable mentally, they may require hospitalization. Spending time in a residential treatment facility may be the best option in order to stabilize severe symptoms. An individual who is struggling with treatment-resistant depression may be unable to function without more intense forms of treatment. An individual who is experiencing an extreme episode of mania in bipolar disorder won’t respond to therapy until his or her moods are stabilized.

If a person is completely unable to function because of major depression, or if they are suffering from psychosis and having a great deal of difficulty distinguishing what’s real from what isn’t, being in an inpatient setting allows doctors to find a mental health treatment plan that works in a safe environment.

While therapy is an important tool in psychiatric treatment, a person in crisis may not respond to therapy until the appropriate medication is found to stabilize symptoms. It may also be necessary to remove a person from their regular environment to be able to evaluate what’s going on and find the best course of treatment. In this case, inpatient hospitalization may be the best option.