Feeling Friendless

Lonely Walk Home

by Michael Pickett

Living in a large, popular city, I see quite a few people coping with transition. One of the common requests for an initial appointment will go something like, "I'm new in town," or "I've lived here about a year now," followed by their complaint, typically something to do with depression or anxiety.

Many clients, particularly those beyond their mid-20's, are shocked, at a loss, or somewhat ashamed when they realize they are struggling in the friendship department.

Maybe they were used to making friends easily. Or they remember that reaching out to make friends never was easy but they somehow stumbled into a group of chums.

And now they find themselves feeling friendless. They start to feel the panic rise. How do I do this? Where do I start? What's wrong with me that I haven't found friends yet?

At some point in therapy, it becomes apparent to me that they are struggling to establish friends. It might take us awhile to reach the stage where we decide the client needs to target socializing. It's seldom a problem area people feel comfortable bringing up. People feel awkward admitting their lack of affiliation. The worry about the stigma of appearing friendless. The fear of being judged as a social dud.  

In therapy we explore the client's friendship history. How did they make friends in the past? Did it feel easy or was it a struggle? What types of friendships did they enjoy? Close confidantes or more distant acquaintances? Feel a part of a close knit group or often like an outsider looking in?

We often talk about the ease of making friends in high school and college, in particular. Life surrounded by hundreds or thousands of same-age, similarly situated peers. Mostly single, working part-time jobs, flexible schedules, with a variety of clubs and avenues available to study, exercise and socialize. To make friends. Dorm life is a friendship building tool at the ready. Close to campus apartment living is another. Potential friends all around, within arms reach, even.

Sometimes friends come in a bundle. A sports team. A choir group. A work team. Or we start to date someone and they have a big group of friends. Gradually they become our friends, too. Though not always easily. This wriggling into and feeling accepted by a pre-existing set of friends can feel awkward for many. Especially when those friendships go back to their days in the nursery. It's a situation ripe for feeling odd-person-out.

Which brings me to relationship break-ups and divorce. These are transitions where friendships are often lost. Partners exit and take their friends with them. You see this in a large group of couples. After the break up, maintaining friendships with those remaining in the couples club is a logistical nightmare. Seeing and hearing about The Ex can be too painful. Too close a reminder of what is lost. Learning about their new dating interests. Ouch.

Sometimes the friends appear to take sides. Or they don't know what to do and in their uncertainty, fail to reach out. This can really hurt the person left behind. Loss on top of loss can leave someone with profound self doubt, feeling sad and lonely.

It is well documented in the research literature that socializing on a regular basis is associated with positive physical health and emotional wellbeing. Feeling connected and cared about, laughing and going places together, keeping busy, exercising together, having someone to confide in: These are all benefits of friendships. It is no wonder, then, that finding oneself in a suddenly-friendless situation is associated with the onset or exacerbation of depression, anxiety, or a number of psychological conditions.

So how does one go about finding friends, exactly? Stay tuned. In my next post we'll talk about the goal of meeting new people and making friends.

Sandy Andrews, PhD  is a Clinical Psychologist / Therapist who provides CBT in Austin, Texas  

first session: what to expect

Clinician's differ to some degree, of course, but the first session is generally part "getting to know you" and "getting you to sign paperwork."

After the initial forms are signed, very often therapy begins with me explaining a little bit about my practice, my theoretical orientation, as it's called, which means the type of therapy I use in treating patients. I suggest my clients Google "Cognitive Behavioral Therapy" or CBT to learn more about my approach. A well informed client often has a head start in healing. I encourage questions throughout our meetings.

Then I move on to asking for a brief description of the "presenting complaint." What problem area brings the client into therapy?

The moment we've all been waiting for.

Sometimes I get pieces on the phone but will want to hear about the therapy issues in greater detail. This is where the box of tissues might come in handy.

From there I begin an evaluation that could take one to three full sessions.

I like to get the following, give or take:

- a history of previous therapy, counseling and psychiatric visits; what felt helpful; what didn't

- medical history including prescription medications, over the counter, nutritional supplements

- family of origin including history of mental illness

- education and work history

- relationship history: who have been the most significant romantic relationships and friendships

- trauma history

- current symptoms

- expectations and preferences for treatment; for example, individual (one on one), couples or family therapy; this could also include specific therapy expectations, such as a request for dream analysis or stress management skills

Not all mental health clinicians will begin this way. I cannot speak for all therapists, but most psychologists (who must have a Ph.D. in a psychology field as well as a list of other requirements) have been instructed (or should have been) to be thorough in assessment, diagnosis and treatment planning.

If you are contemplating starting therapy and wonder what you can do to help move things along, thinking about your family history can be a plus. Many people prefer to keep their therapy quest private and that's understandable. But filling in the blank spots of the "who's who" in your family of origin can help the therapist in the diagnostic process. Any parents, grandparents, aunts, uncles, siblings, cousins who have been diagnosed with a mental health condition? Someone who has been prescribed psychiatric medications? Antidepressants? "Nerve pills?" Has anyone had a "nervous breakdown," an unofficial term that can range from a depressive episode to a psychotic break? Blank spots are not uncommon and can be worked around.

The important thing is showing up, being yourself, asking questions, thinking about goals, being willing to consider recommendations, and trusting that this can work, that you can find a caring, listening, non-judgemental ear, and ultimately you can feel better.

begin at the beginning

Greetings. This is my first post at "blogging behavioral." I hope this is the start of a long and satisfying ... oh, forget all that. I'd like to get right to it.

So are you ready for something truly original? I shall begin ... at the beginning.





Which is the first session.


Many people express nervousness and uncertainty at the thought of their first therapy session. They do not know what to expect and are understandably wary.


Some people have never sat in a room and disclosed private details to a stranger, professional or otherwise. It can feel daunting, at the least. What will I say, exactly? How will I start? How do I ease into potentially embarrassing details? Do I just spill my guts or do I start with the healthier aspects of my functioning?


People worry, in other words, about forming a good impression in the midst of sharing the troubled chaos that has become their life. It's not easy walking into a situation where the emphasis in on our low-lights.


Some are worried about intense emotions expressed during the initial session. It is not uncommon, for example, for clients to shed tears very early on. I often hear something dismissive, like, "I don't usually cry like this." Or, "I'm sorry. I don't know why I'm crying."


But I do. I understand. I expect it. And for this I am prepared. With the most critical tool in my therapeutic arsenal: a box of tissues. I consider this emotional outpouring a normal part of the therapy process.

Most people enter therapy because they have an overwhelming amount of emotional distress. Predictably, and typically out of necessity, they want to unburden. As a professional, I welcome this. There is no judgement.

Next post, I will talk about what a patient can typically expect from me as part of an initial evaluation.


Image source, here.