My answer is… it depends.
As a wholistic human being, there is an interconnection between the physical and non-physical aspects of your functioning, namely your body, mind (or psyche) and soul (or the essence of who you are). Some emotional distress and/or dis-ease are experienced at the physiological/bodily level. This may be a recurring panic attack that makes you feel like you can’t breathe, or your heart is palpitating like crazy, or a catatonic depression that jams up your brain or body, or you have taken too much drugs or alcohol that your brain is no longer the same as before. You will need to see a physician, preferably an experienced psychiatrist, who can treat you at the bodily level first.
Your body must first clean up, calm down and regulate itself, then only you can do some meaningful psychological work for your mental health. This also means, that if you have not been eating well (eg. anorexia) or sleeping well (eg. insomnia), the lack of nutrition or sleep may affect your mood, judgment, and impulse control. Hence, your first line of intervention is to boost your absorption of nutrition, and seriously, get as much sleep as you need to! Your body has its own natural rhythm and capacity to restore and regenerate, when you listen to what it needs.
If you have already seen a psychiatrist and received diagnosis like “schizophrenia” or “bipolar/manic-depression”, you are most likely on very strong medications. These medications can make you feel sleepy and somewhat cut-off from your feelings. I am not suggesting that you therefore stop your medications, as you may very well need them. But know that given your mental and emotional state, you probably can’t do very much deep psychological work, which is the whole purpose of doing psychotherapy (meaning “healing of the mind”). Furthermore, psychotherapy can aggravate your state of mind, which is already quite fragile given the serious diagnosis. Hence, I do not recommend psychotherapy when someone is still recovering from psychotic or manic episodes. They may benefit more from a structured rehabilitation program, such as the psychiatric daycare programs offered in public hospitals or private mental health centers.
Having said that, if you have a psychiatric diagnosis and would very much like to try psychotherapy, I recommend you experiment with a one-off psychological consultation first. If you find the experience helpful and you don’t experience much negative “side-effects” after, you might be a good candidate for psychotherapy then.
Likewise, when someone has a developmental and neurological disorder, such as autism or dementia, the first line of care is addressing their practical needs. This could boil down to some basic things like can the person pay attention or focus on a conversation? This will require specific skill training, usually provided in special needs educational centers or occupational therapy care. Psychotherapy may not be useful for the identified patients with autism or dementia, but is very helpful as a supportive measure for their caregivers. And a positive side effect when caregivers are feeling calmer and supported, they can create more effective interactions with the identified patients, who then respond with better mood and less anxiety. In that sense, psychotherapy can kill two birds with one stone, whencaregivers seek mental health support for themselves first.
If you are feeling unsure about whether you should start psychotherapy or not, consider signing up for a one-off psychological consultation instead! It may be financially less burdensome, and it also gives you the opportunity to clarify within yourself: what you truly need for your own mental health and recovery. The same applies if you were a parent or caregiver of someone who’s mentally unwell. Get a consultation for yourself first. Often, my clients felt better after they could ventilate all the longstanding stress from caring for an unwell family member. Furthermore, as people slow down to listen to themselves, they usually gain some perspectives about their own roles in the caregiving or parenting interactions. This helps them to be more open to trying something different, so that they can have more success with the person they are caring for.
The nature of a psychological consultation is also more flexible, especially for those who could not get their loved ones to attend any kind of treatments. This is often true for family members who have addiction issues, severe mental illness, or when there is an impasse in the family communication. I typically recommend any ready family members to come and get some support for themselves first. Often, this breaks the cycle of co-dependency where everyone is stuck together and no one gets the help that they need.
All in all, you may see psychological consultation as a starting point, and you can return at any point of time to have more sessions as you see fit. You have the flexibility to decide when you might need more support (eg. during more stressful seasons in your life), and when you might want to phase out your sessions as you are feeling more empowered in navigating your own life. I believe in you as the Expert of your own life; and my role as your consultant is to support you towards becoming the Person you want to see in yourself.