Life Challenges, Mental Illness, or Both? Treatment Considerations

As therapists, we often have the honor of being invited into a window into the darkest moments of our clients’ lives, and of course, we are human beings who experience pain in our own lives. One of the more challenging aspects of therapy is diagnosis.

For health insurance to cover psychotherapy, you typically need a diagnosis of a mental illness, such as generalized anxiety disorder or major depression. However, often it’s challenges in life, not a mental illness, that prompt people to seek psychotherapy. Difficulties such as grief, relationship difficulties, abandonment, a diagnosis of a physical illness, or caring for a sick loved one are common reasons for seeking psychotherapy.

of Diagnostic and Statistical Manual of Mental Disorders Although the diagnostic code “adjustment disorder” is permitted for individuals struggling with life changes, criteria state that the reaction to the change must be “disproportionate” to the stressor (American Psychiatric Association, 2013). Who gets to decide what is disproportionate? It can be difficult to draw the line between recognizing a need and pathologizing normality.

Sometimes both

To make matters even more complicated, when a person with a mental illness experiences a significant life event, it can trigger natural reactions and symptoms of the mental illness. For example, a person with depression may feel the pain of heartbreak that everyone feels after a breakup. A breakup can also trigger or worsen a depressive episode.

To make things even murkier, the stress-diathesis model of mental illness suggests that individuals who are at risk for mental illness, for example through genetic factors, may be at increased risk of developing the illness if exposed to sufficient stress. Studies of psychosis and schizophrenia suggest that interactions between stress and associated pituitary, inflammatory, and neurobiological responses may influence the early onset of psychosis (Pruessner et al., 2017).

Similar findings have been found with regard to depression, where studies have found an interaction between polygenic risk scores (an individual’s known genetic vulnerability to depression based on genetic markers) and life events in whether a person develops depression ( Colodro-Conde et al., 2018 ).

There is evidence to support the model that mental illness is a complex disease with biological, psychological and social dimensions. Furthermore, it is crucial that the mental health field does not discount the emotions felt by people with mental illness over the course of their lives, even when it is difficult to determine how the illness contributes to the sufferer’s suffering.

How do we address this?

Interpersonal therapy

Most psychotherapies take an individual-based approach, focusing on an individual’s beliefs, thoughts, and feelings. However, individuals exist within systems, with relationships at the core. Feeling connected is an important part of mental health for almost everyone.

Interpersonal therapy takes an approach that openly acknowledges the ways in which mental health and social health impact one another. Interpersonal therapy provides a space to explore grief, role transitions, and conflicts that may impact mental health. If you lack social systems or struggle to address specific social challenges such as making friends or asserting yourself, interpersonal therapy can also help with skill development.

Interpersonal therapy usually takes place in a personal setting, with people’s relationships being the central area of ​​exploration.

Family therapy

Family interventions can directly target the relationship between patients in the therapy room, with the family members as clients. A person living with a mental illness can affect the entire family, and family stress can affect both the individual diagnosed with the illness and the course of their illness.

While schizophrenia is believed to be at least partially neurological in nature, research has found that overexpressing emotions can have a detrimental effect on the illness and family therapy often makes a big difference in outcomes (Girhar et al., 2024). Research has also shown that family therapy has positive results in treating many other illnesses, including adolescent depression (Jiuju et al., 2022).

Yet family therapy is not routinely offered in mental health care.

Conclusion

It can be difficult to disentangle the connections between our inner experiences and the changes that have been made by our lives and relationships. A diagnosis of mental illness further complicates this situation. Interpersonal and family therapy, which focuses on relationships and mental health, may be an underutilized intervention to improve these areas of well-being.

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