Alice Turing
Individual therapy can help when you live with a chronic illness or disability. Your medical team treats the condition, but therapy can assist with mood, sleep, and relationships.
A good therapist referral recognizes the load you carry. It should never be a verdict on whether your symptoms are real. This guide covers what therapy can and cannot do, how to find a therapist who takes your body seriously, and how to make sessions work on low-energy days.
Why Chronic Illness and Mental Health Are Linked
Living in a body that needs constant management is stressful, and the link between physical and mental health runs both ways. According to the National Institute of Mental Health (NIMH), people with a chronic disease face a higher risk of depression, and depression raises the risk of some chronic diseases. People who have both tend to have more severe symptoms of each.
Disability data shows the same pattern. In a CDC analysis of 2018 survey data, 32.9% of adults with disabilities reported frequent mental distress, defined as 14 or more mentally unhealthy days in the past 30 days, compared with 7.2% of adults without disabilities. That is 4.6 times the rate.
Medical events can leave their own mark. A meta-analysis of 24 studies found that about one in eight people who had a heart attack or a similar cardiac event developed clinically significant symptoms of post-traumatic stress disorder (PTSD) afterward. The same kinds of reactions can follow a stay in intensive care: nightmares, dread before appointments, a racing heart in waiting rooms, or putting off care you need.
Does a Therapy Referral Mean It’s All In Your Head?
In a Cochrane blog post on psychological therapies for chronic pain, Amanda Williams (who led the 2020 Cochrane review on the topic) writes that people with chronic pain often feel misunderstood and offended when a clinician suggests psychological treatment. She describes the treatment as work on the problems that come with pain, such as fear that it will get worse and disappointment after treatments that did not help, and she is clear that it has nothing to do with “thinking positive”.
Your symptoms are real, and so is the strain of managing them every day. Therapy works on the strain. It also gives you one place where you can set down the pressure to stay positive and say how hard this is. If a referral to therapy shows up in place of a medical workup, ask for both.
What Individual Therapy Can Help With
Therapy works on the load that comes with a condition. In practice, that includes:
- Depression and anxiety: Low mood or constant worry that started or got worse after a diagnosis. Depression is treatable even when you have a chronic disease, and treatment usually means psychotherapy, medication, or both.
- Medical trauma: Intrusive memories or avoidance tied to emergency care or a hospital stay. The World Health Organization lists cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) among the treatments to consider for people with PTSD.
- Grief and identity: Some people grieve the plans or the body they had before. Others never frame their disability as a loss. A good therapist follows your framing instead of handing you one.
- Pacing and guilt: Planning your energy and saying no without a 10-minute apology.
- Relationships and roles: Shifts in who does what at home, and how to ask for help without feeling like a burden.
- System stress: The phone trees and denials that come with insurance and disability benefits.
What Individual Therapy Cannot Do
Therapy cannot treat the disease, and it cannot make an inaccessible world accessible. The 2020 Cochrane review analyzed 59 studies of CBT for chronic pain, with more than 5,000 participants, and found average benefits for pain, disability, and distress that were small at best. Treat therapy as one tool alongside medical care, and be wary of anyone who promises it will erase your pain.
Therapy also cannot fix a building with no ramp or a boss who refuses accommodations. Those are structural problems, and naming them as structural in therapy can keep you from blaming yourself for them.
How to Find a Therapist Who Understands Chronic Illness
Ask five questions before you book an appointment, and pay attention to how the therapist answers.
- Have you worked with chronic illness or disability? Ask for examples, and listen for whether they treat your symptoms as real.
- Do you offer video sessions? Video saves the energy a commute costs, and NIMH notes that psychotherapy can be effective in person or by telehealth. Therapists must be licensed or legally permitted to practice in the state where you are located, so check before booking someone out of state.
- What happens if I cancel during a flare? Ask how late cancellations work, since flare-ups rarely give 24 hours’ notice.
- Is the office accessible? Ask about step-free entry, parking distance, restrooms, and seating. If you have sensory needs, ask about lighting and noise too.
- Which approach would you use with me, and why? Approaches such as CBT and EMDR fit different goals, and a good therapist can explain the choice in plain words.
Look for flexible formats as well as credentials. In our practice, for example, individual therapy in Palm Beach County runs in 50-minute sessions, in person at our Jupiter office or by secure video anywhere in Florida, and clients can switch between the two as their energy changes.
How to Make Therapy Work On Low-Energy Days
Ask for accommodations in therapy the same way you would at work or school.
- Join from bed or a recliner: On video, this is a reasonable request. Tell your therapist ahead of time, and agree on a plan for ending early if symptoms spike.
- Ask about audio-only sessions if screens trigger migraines or eye strain.
- Request a short written recap: Brain fog makes it hard to remember what you agreed to try, and a three-line summary in your patient portal helps.
- Book your best hours: If mornings are rough, ask for afternoon slots.
- Budget the session: If you use spoon theory, count therapy as a spoon and plan a low-demand hour after it.
Where to Start
Pick one concern to bring to a first session, such as sleep or dread before appointments, and write it down with your access needs before you call. Individual therapy for chronic illness and disability does its best work when the therapist starts from your body as it is today. Listen for that in the first call. If you are thinking about suicide or are in crisis, call or text the 988 Suicide and Crisis Lifeline at 988. In a life-threatening emergency, call 911.
Frequently Asked Questions
Can therapy cure a chronic illness?
Therapy treats the depression and anxiety that can come with a chronic illness, and your medical team treats the illness. Treating the mental health side still matters, because people who have both a chronic disease and depression tend to have more severe symptoms of both.
How do I know if I need therapy or if this is a normal adjustment?
Watch the calendar. NIMH says a depression diagnosis requires symptoms most of the day, nearly every day, for at least two weeks. Low mood or loss of interest on that schedule is a reason to talk to a professional, and so is skipping medical care because of fear.
Does my therapist need to specialize in chronic illness?
It helps, but it is optional. At minimum, look for a therapist who believes your symptoms and will adapt sessions to your energy, then ask the five questions above.
What if a therapist doubts my symptoms?
Say it directly first: “I need you to treat my symptoms as real.” A therapist worth keeping will adjust. If they do not, find another one. Therapy for chronic illness starts with believing what you report.
Follow me down the rabbit hole!
I'm Alice and I live with a dizzying assortment of invisible disabilities, including ADHD and fibromyalgia. I write to raise awareness and end the stigma surrounding mental and chronic illnesses of all kinds.
