You can say whatever you need to and know it will go no further. Confidentiality is a key component of the therapeutic relationship, as it is in certain religious settings. With the exception of certain well-defined circumstances (to be discussed fully later), the therapist is bound by ethics, and by law, to reveal nothing that transpires during your sessions. The communication, in fact, is privileged, which means that the therapist cannot be required (again, with exceptions) to reveal what you've said, except under court order.

Part of the safety zone in which therapy takes place is its reliability. It generally happens at the same place and at the same time, and follows a predictable format. It isn't contingent on your performance-the therapist won't get up and leave if you fail to keep her entertained or to live up to her expectations. Even intimate relationships can be jeopardized when one of the partners goes through personal changes ("You don't seem like yourself"), but in therapy, change is the whole point.

In addition to everything else, therapy is an educational experience. Some therapists actually describe what happens as a kind of learning, and compare their role to that of a teacher or coach. But even when this isn't explicit, any kind of effective therapy leads you to step back and reconsider what you may have always taken for granted, to try out new ways of looking at yourself, your emotions, and your world.

Who Needs Therapy?

There's little doubt that many people could use professional help. Nearly a half-century ago, when epidemiology in this area was somewhat less rigorous than it is today, one study found that 81.5 percent of the population of Manhattan had "signs and symptoms of mental distress."

Using more precise definitions, the 1999 U.S. surgeon general's mental health report suggested that in the course of a year 22 to 23 percent of Americans have a diagnosable mental disorder-that's 44 million troubled people. Most suffer from some form of depression or anxiety severe enough to cause marked distress or interfere with work or personal life. A 1993 study by the National Advisory Mental Health Council found that nearly one American in ten experienced significant functional impairment due to emotional ills-their problems made it truly difficult to go about their daily lives.

"Just as practically no one gets through life without a physical ailment, very few can without significant psychological ailments, conflicts, and stresses," says Jeffrey Binder, Ph.D., director of doctoral and master's clinical training at the Georgia School of Professional Psychology in Atlanta.

An identifiable crisis, loss (of a job, romantic partner, or close relative), or trauma propels many people into therapy. For others it's the culmination of a lengthy process; the problem is long-standing, and now the time seems right. Symptoms, like anxiety or difficulty concentrating, have become severe enough to interfere with your life. Perhaps your work is suffering.

"The key idea is perception," says Sharon Hymer, Ph.D., a clinical psychologist practicing in New York City. A family conflict may have been simmering for years, or a romantic disappointment may be just the latest act of a long-running drama. But on top of that, there's a feeling of demoralization. "People go to therapy when they perceive themselves in a crisis that they can't resolve by themselves and with the help of friends." (The kindling of hope, experts say, is often the first big benefit of effective therapy.)

Feeling you are out of your depth is a key indicator that it's "time to ask for some help," advises the American Psychological Association. Think of therapy when you feel trapped, with nowhere to turn, when it seems that things aren't getting better, when worry becomes chronic and never leads to any answers, or when emotional unease spills over and affects the way you eat or sleep, or takes a toll on your job or personal life.

Psychiatrists often treat those at the more seriously ill end of the spectrum. The American Psychiatric Association lists marked personality change, extreme highs and lows, excessive anxiety, anger, hostility, or violent behavior as indications for a prompt consultation. Thoughts (or talk) of suicide are a warning that immediate help is needed.

The mind and body are closely connected, and some signs that therapy may be helpful are physical. Unexplained, often vague symptoms-fatigue, frequent headaches, backaches, or other troublesome pains, frequent digestive upset, even pesky skin conditions-can reflect depression, anxiety, or a burnout level of stress. Such problems may accompany emotional distress or take their place. When a thorough medical work-up finds nothing, consider a psychological explanation.

On the other hand, a life-threatening illness such as cancer or heart attack, or a painful chronic condition like arthritis, often outstrips one's ability to cope. Psychotherapy doesn't take the place of medical care, but it can supplement it: in fact, substantial data suggests that people with serious illness do better physically if they take effective steps to deal with the emotional turmoil it creates.

While there's little solid data on just who seeks therapy and why, a widely cited 1995 survey by Consumer Reports found that nearly half of four thousand readers who went for professional help were "in considerable pain." Besides mental disorders like anxiety and depression in their various forms, the motivating forces included family or sexual problems, work woes, stress-related symptoms, problems coping with grief, and difficulties with alcohol or drugs.