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Nobody Wants to Go to a Therapist. Here’s What They’re Missing. Dr. Janna Koretz
Azimuth Psychological

About a year ago, a friend of mine started an online matching service for psychotherapists. His team had figured out an algorithm that made exceptionally good matches for their clients, and they had picked up quite a bit of interest from therapists, clients, and companies. But at the end of this month, they are shutting their doors and changing their direction to focus on life coaching. Why? They couldn’t figure out a way to scale their business, because they discovered the truth a lot of us already know: no one wants to go to a therapist. Most people misunderstand the therapy process, avoid it entirely, or look for shortcuts and cheap alternatives.

As a therapist myself, and as someone who has been in therapy a long time, I have always found this curious. Don’t get me wrong, I understand its expensive. But so is my gym membership, my hair stylist, and my husband’s MLB cable package. My friend’s business coach charges twice what I pay my therapist, and he has a six-month waiting list. So for some people, I don’t think it’s just about the money. There’s something more, something cultural, that still prevents people from valuing therapy and using it as a tool to improve their lives.

Therapy is powerful. It can change your life for the better, whether you struggle with a specific psychological issue or not. It can make life transitions easier, provide you useful insights to improve your relationships, teach you communication strategies to connect with your intransigent adolescent daughter. It can teach you how to get what you need, cope with unbearable situations, and help you understand how your mind can play tricks on you. It can help you feel comfortable taking calculated risks, figure out your passions, and to lead a more fulfilling life. It have teach you how to get out of tricky situations, how to manage your boss, and how to trust your gut.

Sadly, the stigma associated with mental health still exists, and the media do a terrible job portraying what therapy is. Therapy is portrayed as an intense experience, better suited for dealing with crisis situations than with the pressures of daily life. On TV, you’ll often see therapists behaving in unethical ways that would cause them to lose their license in real life; think Dr. Melfi approaching and flirting with Tony Soprano in a restaurant, or Madolyn sleeping with Billy in The Departed. While they make for saucy TV, these examples paint an unfortunate and untrue picture of the therapeutic process, and of what kinds of people benefit from going to therapy.

Further, therapy has now been lumped into the medical system, which forces therapists to rely on predefined labels and diagnoses determined by the insurance companies. Therapy is framed as primarily a medical solution, like putting a cast on a broken leg, which propagates an insidious message: “you have to be crazy to go to therapy, and therapy is a crazy place for sick people.” In truth, therapy is just a place where an expert listens to your challenges, then helps you learn new techniques and perspectives so you can relate to yourself and others in a more helpful, healthy way. Sometimes, that doesn’t fit into any one particular ICD-10 billing code.

Today, we’re used to apps providing us instant gratification and shallow interpersonal interactions. Therapy, by contrast, requires lots of time and energy, and includes deeply human (and sometimes painful) conversations that look nothing like our day-to-day experience. And, while there are some companies attempting to make therapy more tech-driven, the success found in real therapy will never be quick and easy.

The desire for some kind of shortcut can be seen in emerging mental health technology companies like Basis, whose co-founders clearly value making therapy easier to access and cheaper. But how have they managed to cut costs? TechCrunch explains:

“Basis works with paraprofessionals — people trained in research-backed approaches but who don’t have the same certifications as a counseling or clinical psychologist.”

You also can save some money on fixing your car by going to your “paramechanic” father-in-law who owns a torque wrench… but should you? Over thousands of hours of clinical practice, one of the most difficult things you learn as a therapist is that your basic instincts for how to “help” people are often wrong. Sometimes, they’re even counterproductive or dangerous.

For example, take someone who is easily distracted, and is having trouble completing tasks at work. An untrained therapist might try to help this person by giving them “executive functioning” tools and strategies, such as writing down to-do lists with clear deadlines. But, if the root cause of the distractibility is severe anxiety rather than executive functioning issues, the to-do lists could overwhelm the person and trigger a full-blown panic attack.

These cases are not an exception. People are complicated, and an understanding of these nuances can save lives. Of course, Basis’s lawyers tell you all this in their Terms of Service:

“BASIS LABS DOES NOT VALIDATE THE INFORMATION OR ADVICE PROVIDED TO YOU BY SPECIALISTS ON THE PLATFORM. BASIS LABS STRONGLY RECOMMENDS THAT A USER SEEKING MEDICAL OR MENTAL HEALTH ADVICE MAKE AN APPOINTMENT FOR AN EXAMINATION IN PERSON WITH A QUALIFIED PROFESSIONAL […] BASIS LABS MAKES NO REPRESENTATION OR WARRANTY WHATSOEVER AS TO WHETHER YOU WILL FIND THE SERVICES RELEVANT, USEFUL, CORRECT, RELEVANT, SATISFACTORY OR SUITABLE TO YOUR NEEDS.”

So if I need to see a professional, I should see a professional? Where do I go to find out if I should see a professional? Apparently not to Basis.

There are no shortcuts. Therapy is not the same as talking with a friend. Therapy is expensive because it is hard to do well. Early in their training, therapists tend to fuck up quite a bit—that’s why they are closely supervised by other therapists who have been working for many decades. Years of research, education, and clinical rotations are required to develop the therapist’s unique domain of knowledge. Yet, again, nobody seems that interested in paying for it.

Between crappy information, a culture of shame, and a need for instant gratification, people don’t want to go to a therapist because they simply don’t get a chance to see how it can help them. All they see is a scary, medicalized process that costs a lot and is pretty inconvenient. People don’t know what they’re missing, which is truly a shame. But once you find a therapist that you feel a connection with, who is an expert in the areas that you’re trying to work on, it’s a powerful tool that is truly worth paying for.