A Sense of Doubt blog post #4281 - Not Everyone Should be in Therapy? - I DISAGREE
Long before I decided to become a clinical mental health counselor and long before I was in therapy myself, I always said that EVERYONE should be in therapy.
- Personal Use & Seeking Care: About 45% of U.S. adults say they have sought mental health care in the past, and 17% say they want to seek care in the future, according to data from the American Psychological Association. [1]
- Recent Treatment Rates: According to the Centers for Disease Control and Prevention, roughly 14.0% of U.S. adults received counseling or therapy in 2024, while 19.3% took medication for mental health. [1]
- Stigma and Hesitation: Cultural views remain mixed. For example, a widely cited survey reported that 47% of Americans viewed seeking therapy as a sign of weakness, while others avoided it because they felt they could handle problems alone or that their issues were not "big enough". [1, 2]
- Demographic Differences: Acceptance and usage are much higher among younger generations—such as Gen Z, where 53% have sought professional mental health services and 87% report feeling comfortable discussing mental health. [1]
Okay, so not as many.
- Higher Overall Numbers: The percentage of U.S. adults receiving outpatient psychotherapy increased from about 6.5% in 2018 to roughly 8.5%–10.5% in subsequent years following the rapid adoption of teletherapy during and after the COVID-19 pandemic. [1]
- Current Distribution of Care: According to research published in JAMA Psychiatry, outpatient mental health care is now split across modalities:
- 50.6% of patients use in-person care alone.
- 27.8% use telehealth (video or phone) alone.
- 21.5% use a hybrid approach (combining in-person and telehealth visits). [1]
- Dominance in Behavioral Health: Telehealth visits remain heavily concentrated in mental health. Behavioral health appointments consistently account for a majority (over 50%) of all telehealth claims across many health systems and insurance networks. [1]
- Convenience and Reduced Barriers: Telehealth removes travel time, cuts down on transportation hurdles (which are linked to a 2.4x higher likelihood of telehealth use among those with transit issues), and lowers social stigma. [1, 2]
- Demographic and Socioeconomic Gaps: While total numbers are up, access via telehealth has grown faster among specific groups. Studies show that teletherapy use is higher among:
- Mild-to-Moderate vs. Severe Conditions: People dealing with mild-to-moderate psychological distress or receiving psychotherapy from counselors and social workers use telehealth at higher rates than those with severe, chronic psychiatric conditions, who often require more intensive, in-person clinical management. [1, 2]
Given that seeing a therapist is met with stigma, the majority of the population is NOT seeking therapy, so the solution to convince some people that they do not need therapy for loneliness, struggles at work, or social isolation is incorrect and actually counter to the mandate of mental health counselors who are supposed to ADVOCATE for mental health.
Lieberman makes a case for the dearth of counselors, but his conclusion for what to do about it is wrong. He writes the opinion article below in weird lunge and fade weave in which he makes claims about the importance of therapy and how everyone can get something out of therapy while at the same time suggesting that therapy is really for people who have persistent and intrusive thoughts that they cannot control and other similar issues.
Thanks for tuning in.
Guest Essay
I’m a Therapist. Not Everyone Should Be in Therapy.
Dr. Lieberman is a psychologist and a founder of the Institute for Community Living, a social services organization.
As a clinical psychologist with over 50 years of experience,
I know that therapy can be essential. A person with persistent intrusive
thoughts can learn ways to reduce their intensity. Someone in an acute crisis
can hear a perspective that helps steady his or her thinking.
But I hear from former patients and colleagues that people
are often turning to therapy not because of disordered thoughts, but because of
difficult circumstances: loneliness, conflicts at work, financial strain.
Therapy seems to have become the default prescription for all forms of
unhappiness.
Anyone who simply needs a listener may get something out of
therapy. But when every struggle is routed toward a professional, we risk
mistaking mental health issues that require treatment for problems of isolation
or circumstance.
Unhappiness is often not a disorder, but a structural
condition. In 2023, the U.S. surgeon general identified loneliness and social
isolation as urgent public health concerns. He pointed to an erosion of
everyday social connection as a central cause, yet much of the response has
focused on expanding clinical access rather than rebuilding relational life. In
2019, about one in 10 American adults reported receiving counseling or therapy.
By 2024, that figure had risen to roughly one in seven.
The cracks in the clinical system are beginning to show. In many regions, therapy wait lists
stretch for months, and clinicians report burnout. Patients with the most
disabling conditions are left competing for the limited time, and those who are
primarily seeking friendship and connection may leave feeling disappointed.
Part of the confusion lies in what therapy reliably
provides. When it is effective, it often helps with persistent problems that
come from within: obsessive thoughts that return no matter how often you try to
dismiss them, fears that repeatedly damage relationships, periods of despair
that continue even when life circumstances improve. Therapy can be especially
useful when people’s habits deepen their suffering, or when painful experiences
remain difficult to make sense of alone. But when distress is shaped primarily
by situational difficulties or the absence of community, therapy may not be the
best fit.
Consider a few situational difficulties: child care
frustrations, anxiety after relocating to a new place, a family dispute.
Sometimes, these problems can affect thinking in ways that therapy can help
resolve. But on their own, these issues do not necessarily require clinical
intervention. They can be painful without reflecting a disorder.
Some people would say that a therapist’s consistent, neutral
perspective would help anyone. It’s true that many people benefit from having a
place to think and to be heard, and from a therapist’s disciplined attention.
But therapy’s tools are limited.
In my own practice, I helped patients understand their
problems in a new light — but those insights could go only so far if their
circumstances remained unchanged. Some who came in after a life crisis told me
that after a few sessions, they began reconnecting with friends and family,
seeking support they had not known how to ask for during the crisis. Looking
back, I suspect that restoring those connections often mattered as much as
anything we discussed in my office.
All around us, more of what was once understood as part of
life has come to be seen as something requiring treatment. Psychiatrists
including Allen Frances, who led the task force that developed an earlier
version of psychiatry’s diagnostic manual, have warned of “diagnostic
inflation.” Prolonged grief now has its own diagnostic category. Newer
diagnoses that were intended, in part, to reduce the overdiagnosis of childhood
bipolar disorder may also place more childhood behavior, such as tantrums, on
the spectrum of mood disorders.
As the boundary blurs between a disabling disorder and
ordinary distress, people may start to view their suffering through a clinical
lens. But often, distress functions less as a symptom than as a signal. Feeling
anxious does not mean you have an anxiety disorder. It could point to
circumstances that are worth changing.
Before turning to therapy, consider reaching out to someone
you trust, volunteering, joining a community activity or reconnecting with a
group that once mattered to you. Meaningful relationships rarely develop
overnight, but those are all small steps toward deep connections. Sometimes
hope arrives before companionship does. If your distress continues to interfere
with daily life and relationships, therapy may be the right next step.
Rebuilding relationships should not fall entirely on
individuals, but also on schools, workplaces and governments. Britain has
treated loneliness through a national strategy that includes a “social prescribing” program, a model designed to provide
patients with personalized care plans that connect them to community groups and
volunteer opportunities. Japan established an Office for Policy on Loneliness
and Isolation that has supported community-based efforts to address social
disconnection.
In the United States, states or counties could adopt a
similar approach; many of the institutions that shape social connection —
libraries, schools, recreation programs — are organized and supported locally.
Government agencies could help communities measure loneliness, identify groups
at greater risk and support outreach efforts that connect residents to existing
resources. The challenge is often not creating new opportunities for
connection, but helping isolated people discover and participate in the ones
that already exist.
The psychologist William Schofield once described
psychotherapy as “the purchase of friendship.” More than 60 years later, his
words ring true: Modern societies have formalized the practice of receiving
someone’s sustained attention. For some people, therapy can help in ways
nothing else can. But many will find that the best forms of understanding and
emotional support flow from informal networks of relatives, neighbors and
friends, not the health care system.
FROM THE AUTHOR -
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- Days ago: MOM = 4145 days ago & DAD = 799 days ago
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