Why I Left Psychotherapy
And Why You May Want to Too
I Hate That I Got Here
For years, I was dreaming of the day I would feel brave enough to go back to school to become a therapist. At 32, when I started my master’s in social work, I showed up bright-eyed and optimistic - feeling like the embodied version of myself was just around the corner.
I was quickly disillusioned.
I was drawn into mental health work through my training in meditation and yoga. I was inspired by practitioners like Drs. Tara Brach, Richard Schwartz, and Peter Levine. I was convinced when I entered social work, I would find my tribe - others who were grounded in non-violence, holism, integrated health, and spirituality.
I was wrong.
Those people I held up as heroes were not the norm in the industry. They were on the fringe - subversive, and their modalities were often pushed to the corners.
I was similarly ostracized.
I would not be exaggerating to say I hated every minute of my psychotherapy training. I found the education and industry dangerously performative, anti-science, and bound up in an unchecked hero complex.
At the end, it was rejection that pushed me out of my intertia.
I was training at an LGBT psychotherapy center. While I had a full case load, perfect retention, and clients who loved me - I was being supervised by a classically trained psychoanalyst who despised me. She set up professional traps, ridiculed my focus on somatics and anatomically oriented solutions, and eventually pushed me out.
She was the norm.
As I dealt with the fallout, I heard time and time again the same thing: I’m so sorry this happened, but unfortunately this is common in our industry. Egos are large and fragile - and many are sadistic.
And I asked: Do I want to be a part of this?
It broke my heart to leave psychotherapy - because I had a dream for it, and for myself in it. But I was tired of swimming against the current - of trying to change a system I didn’t agree with. I yearned to work in a way that I didn’t feel compromised - to build something that felt true to me.
In this post, I’ll walk detail why I didn’t feel like I could work with integrity within the structure of psychotherapy.
But First: A Broad Caveat
To be clear, those original heroes do practice psychotherapy. I’ve met many brilliant psychotherapists operating within the system. They’re subversive - taking the parts of the system that they agree with and shedding the parts they don’t.
I sometimes wish I could be like them.
Changing broken systems requires diverse strategies - including those who work within them and those who work outside of them. For years, I wanted to be someone who worked within the system to change it.
I’m more comfortable on the outside.
For every brilliant psychotherapist within the system I met, I’d meet four brilliant healers or educators or coaches operating outside of the system. These were people willing to carve entirely new paths - to not just subvert the system but to build entirely new ones.
At the end, this was where I belonged.
My abandoned path of psychotherapy taught me something valuable about myself: I decay working within systems I don’t agree with. I respect those that can work within them and push for change from the inside. It’s just not something I can do while keeping my own mental health.
And a Definition of What Psychotherapy Is
The most common question I get about my coaching work is: how is that not just psychotherapy?
I would have asked the same question three years ago. The reality, though, is that the defining traits of psychotherapy are (1) diagnosis against the DSM, (2) intervention planning that target symptoms as defined in the DSM (or “maladaptations”), and (3) working under a license that grants the right to do 1 and 2.
Psychotherapy is not defined by the relationship in the room or the work that is done. Rather, it is a legal right to diagnose a client as ill, and to then accept insurance payment because of it. That is structurally what defines psychotherapy.
As long as someone is willing to pay that cost of entry - to diagnose the client and on paper aim to address those defined symptoms - then they can do almost literally whatever they want during session and still call it psychotherapy.
It’s somehow everything and nothing - as long as the client is called ill.
And this function, the one that singularly defines psychotherapy, is the one I most disliked.
The Diagnostic Model is Stigmatizing, Reductive and Anti-Science
I was trained in the DSM (the Diagnostic and Statistic Manual of Mental Disorders). The backbone of psychotherapy is giving a client one of the “F” codes of the book - something like major depression disorder, Bipolar 1, generalized anxiety disorder, or antisocial personality disorder. Here are some things I’d like you to know about DSM diagnoses:
They are descriptive, not etiological. This means that they are lists of symptoms under a broad name - and are not focused on root cause or biological underpinning. For example, the evidence suggests that “personality disorders” are adaptations to complex and developmental trauma. Instead of recognizing this, we literally just lump this population as having unfixable, unlikeable personalities.
This descriptive nature causes massive overlap between “diseases.” A veteran surviving trauma may be struggling with PTSD, which spins into depressive symptoms when it destabilizes their life, and eventually copes through substances. A survivor of sexual violence may miss PTSD screenings because they have a fully dissociative presentation, emerge with challenged eating, and eventually be diagnosed with borderline personality disorder because they struggle in intimate relationships. In each of these, whatever is being diagnosed is what will theoretically be treated. The book is a red herring of symptoms distracting from what is causing a myriad of survival strategies.
Field testing for the DSM shows it’s not a reliable instrument. Even among pre-screened clients, when a client is seen by two therapists, there’s less than a 35% chance those clinicians will agree on the client’s diagnosis for many of the most common diagnoses - depression, anxiety, bipolar, substance use disorder, schizophrenia, borderline personality disorder . .. This would not be accepted as a reliable or valid instrument in pretty much any other rigorous scientific environment.
Clients only qualify for a diagnosis if it impacts their functioning in a negative way. In practice, what this means is that a clearly autistic client is not considered to have autism spectrum disorder (ASD) if they are happy and thriving.
The DSM has a long history of sexism, racism, homonegativity, and transnegativity. “Diseases” like obstinate defiant disorder or conduct disorder (both literally lists of behaviors that we deem challenging) came about during the War on Drugs and have disproportionately been used against Black children and teenagers. Until the 1970’s, homosexuality was considered a disorder. “Diseases” like borderline personality disorder or histrionic personality disorder have historically been used to categorize strong-willed women as diseased. Men are more likely to be diagnosed by coping strategies (alcohol, conduct disorder) rather than the emotions they are numbing to (perhaps, depression). These social factors influence the lack of reliability in the instrument.
I am not saying there isn’t a version of the world where a diagnostic manual would be helpful. There are disorders in the manual that seem to have biological underpinnings - depression perhaps a challenge with serotonin, ADHD perhaps a challenge with dopamine, PTSD an overactivation of the sympathetic nervous system. Schizophrenia and bipolar are both hardly understood and seem to have a biological basis. Certainly, looking at patients based on what we know is going on their body would be an improvement over the current version.
While it’d be an improvement, I’d still find it lacking. The presumption even behind categorizing biological mediators is that we assume the client's body is somehow misfiring. In practice, every client I’ve worked with has been having a normative, adaptive response to their lived experience. Their depressive symptoms usually show that they’re not in the life they want to be. Their anxiety usually developed rationally in response to environments they were likely to be isolated, rejected or harmed. Their self-injury, drinking, substance use, or challenging eating patterns create a sense of control - and delay looking at deep pain until the client is actually resourced to do so. Even antisocial behavior usually helps the client stay in predictable environments - maximizing their sense of control.
In each client I’ve worked with, what the DSM called a disease, I found to be body wisdom waiting to be heard.
Even though the DSM is garbage science, it has social clout and real life impact. A diagnosis can follow a client forever. It can come up in court cases, in divorce proceedings, in custody battles, and in private insurance applications. A diagnosis will stay on their medical record and can stigmatize the client with future practitioners. (Therapists notoriously don’t want to work with anyone diagnosed with borderline personality disorder.) A client can take that diagnosis and internalize it as a permanent limitation.
These are astounding real world impacts from something that is essentially meaningless.
This is not the only way to look at a client. There are branches of psychology that view people’s emotions and behavioral responses as adaptations. Positive psychology and strengths-based work shifts the focus to what is good in the client, and how to help them flourish. Person in environment perspectives ask how a person’s response is being co-created within their environment. Ancient wisdom practices often use all body sensations as a way to grow closer to the divine. Indigenous practices sometimes view personal challenges as windows in which we can view how society is failing the population.
This is not the only way. And yet it is literally the singular structure that sets psychotherapy apart.
Consider how a shift in perspective can change a few common diagnoses:
ADHD is often considered a permanent feature, a form of neurodivergence. Research suggests this isn’t true - and that people move into and out of symptoms of ADHD over the course of their life. Those symptoms usually disappear when the person finds an environment that suits them - suggesting that the symptoms were a form of reasonable social resistance all along.
PTSD is treated as an individual disease - the burden of a survivor to re-regulate their nervous system. If we considered these symptoms from an ecological level, that shifts. PTSD symptoms are adaptive for a community because they draw attention to something the community has to address for everyone.
In yoga and Buddhism, dukh is similar to depression. However, in those philosophies, it’s an essential part of the human experience, a fire under which we transform. Dukh arises when we need to change. It’s that period when we’re scared to change because we know it will be painful, but not changing is also painful because our life doesn’t fit us. From a spiritual perspective, this is not a disorder - but something powerful, transformative.
A woman in an abusive marriage may be diagnosed as having generalized anxiety disorder or panic disorder if they are living in constant fear. An alternative diagnosis structure could be environmental - that they’re living in an unsafe environment.
I want to be clear that many psychotherapists understand this. They give every client an adjustment disorder diagnosis and are comfortable with this - and then work from a strengths-based, person-in-environment perspective. They’re subverting the system (often by committing insurance fraud) and are doing brilliant work.
I didn’t want to continue being one of them. I wanted to work with my clients from the clear basis that who they are today is exactly who they needed themselves to be today.
Clinical Psychotherapy Erodes Self-Trust
A common phrase you’ll here in therapy is “feelings aren’t facts, and thoughts aren’t true.” This is essentially the cornerstone of cognitive behavioral therapy. If a client can recognize the ways their body is lying to them, then they can intervene.
The bedrock belief is simple: the client’s feelings and thoughts are misfires, mistakes from the body.
In practice, this relieves symptoms as defined in the DSM for the average client. The client learns to repress the undesired parts of themselves and gets better at complying with a socially acceptable presentation. When I have clients who have had a lot of traditional psychotherapy, they come as experts in this. They can use their meta-cognition to talk themselves into or out of whatever they want.
Yet they have no idea what they really want.
The problem is: feelings and thoughts have purpose, and are goal directed. Suppressing or repressing them ignores whatever message they’re asking you to listen to.
As a result, these clients have lost touch with this inner wisdom.
Let’s compare this to physical pain. When a client is experiencing physical pain, we assume there’s a reason. The body is highlighting the need for medical care, or requesting rest to recover.
Emotions and thoughts are no different than physical pain. They’re just neurological fires. Like with physical pain, we should assume the body is producing emotions and thoughts with reason. They’re goal directed - and drawing attention to something.
Let’s look at how this plays out in a few cases:
Large-bodied clients often come with internalized fatphobia - and at some point the work turns to shame. In classic psychotherapy, we might flag their social anxieties as thought distortions - and try to reprogram the mind with something else (such as people don’t care how I look). The problem is, this is getting the client to gaslight themselves. Shame rises adaptively to help us avoid social ostracization. Shame internalizes fatphobia to tell us the hard truth: our life will be easier thin because the world is unfair. If we listen to that message of concern the shame is presenting us, it will quiet. That doesn’t mean the client needs to obey the shame. They can take time to sit with that body message and decide conforming with social norms is not within their truth. However, instead of fighting with their shame, they move to working with it.
A client with severe developmental trauma is likely to see the world as unsafe. In classic psychotherapy, we might flag that as a a thought distortion - and try to reprogram them to see the world as safe. Again, this would be gaslighting themselves. The client was raised in a harsh environment and became more alert to potential risks. That doesn’t make them irrational - and in fact, in many contexts, can be a superpower. Like with the shame, the client can learn to listen to their anxiety - to understand what risks are being flagged. Again, that doesn’t mean the client needs to obey the anxiety. However, by listening, they can discern when the wisdom is suggesting the risk is more than they can handle, and gently create space in their body for new experiences when the risk is acceptable.
LGBT clients often come with internalized homonegativity - with a negative core belief like “who I am is fundamentally unacceptable.” Shame has internalized the message that their mere existence positions them for abandonment. In classic psychotherapy, this might be called a thought distortion, and the client might be pushed towards a more “rational” belief. Again, the problem is that their body was picking up on something real: who they are poses a social threat, which is a safety threat. If they work with that shame instead of against it, they can then use their own discernment to decide when to subvert or fight against that reality, and when they may want to respect it for their own social comfort.
Like with everything in this post, I know many psychotherapists who understand this and subvert the system. In fact, I’ve been to dozens of trainings on how to avoid these problems in psychotherapy: how to adapt standard protocol to “abnormal” cases. The problem with this is simple: Psychotherapy refuses to honestly reflect on how damaging its principles are. Instead of confronting that, it tries to handle all the many ways it fails clients as exceptions.
This is why my work is called body wisdom coaching. The bedrock of psychotherapy is that there’s something misfiring in your body - and we need to shut it down. The core of my work is that your body is asking to be listened to.
Clinical Psychotherapy is Structurally Built to Sustain Capitalism
A fair question would be: why use this DSM, and assume the client is irrational?
The answer, sadly, is that psychotherapy is built to uphold social structures.
It’s a finger-pointing exercise. Psychologists wrote a book that says it’s a disorder to either (1) engage in behaviors that society says are undesirable, or (2) to be unhappy with your life in the current structures.
Because it would threaten the system if the people weren’t the problem.
Imagine a world where instead of depression, a therapist could diagnose the root cause as “capitalism,” “localized patriarchy,” or “religious trauma?” What might change in how we treat the condition?
Instead, psychotherapy labels societal challenges as individual diseases.
From there, the implicit message is that anyone can be happy under colonialism, under capitalism, under racism, under patriarchy. As long as they do the work.
We aren’t meant to be happy and compliant in broken systems. That’s bullshit.
Social norms and expectations infiltrate every aspect of psychotherapy diagnosis and treatment. Concepts of maturity and development are rife with cultural baggage. We’re taught it’s immature or a personality disorder to voice anger, to act on outrage, or to push back. We’re taught there’s something wrong with us that we can’t be happy in a bad job, a bad marriage, or while living in poverty or under oppression.
The ultimate devil’s bargain of psychotherapy is that we get paid to get the client well enough to function as expected in a deeply broken system.
The Clinical Bubble Reinforces Social Isolation
In making social problems individual problems, psychotherapy pushes clients toward individual instead of collective solutions.
This is made worse because it medicalizes healthy relationships.
Anyone trained in psychotherapy will have been told that it’s the relationship that heals the client. It’s that the client is given positive regard, compassion, and space for acceptance.
Yet psychotherapy is explicitly not a relationship.
The nature of clinical work is that the therapist-client relationship is entirely bifurcated. It’s a “safe” place to play because there aren’t real stakes, because there is no real relationship to maintain.
It implicitly says what is good in therapy is medical, not a part of normal relationships.
That’s bullshit, and that’s bleak. People do heal in relationships -and everyday relationships can be infused with unconditional positive regard, compassion, acceptance, and active attention.
What makes good therapists make good friends, mothers, managers, and strangers.
There are times therapists offer specialized knowledge and support. Much of the time, though, they’re profiting off of the paucity of social connection in a client’s life. They’re play-acting a good friend for 50 minutes, offering a salve for loneliness.
All while implicitly saying this thing that feels good, social connection, is medical treatment.
The Default Model is Predatory Marketing
A fair question would be: why are so many people comfortable with pathologizing the client. I think the honest answer is cynical: it’s great marketing. It’s easier to get a client to pay if they think they’re sick and only psychotherapy is available to help.
The reality is psychotherapy doesn’t really understand how it’s helping.
There’re a lot of studies that psychotherapy on average helps. However, what’s amazing in that research is how much doesn’t help. Modality (what intervention is done) doesn’t seem to matter. Therapist experience (years on the job) doesn’t seem to matter. Whether it’s 1-1 or in a group doesn’t seem to matter. Supervision (talking about a case with a senior) doesn’t seem to matter.
The things that define psychotherapy don’t seem to be what help.
And yet, that is what is advertised as necessary. From the positioning of “you’re sick and I can fix you,” the industry can convince clients they need weekly, years-long support. They can collude with the pharmaceutical industry to create mass demand for daily, long-term medication.
We need to be asking what’s helping and what’s harming.
Therapist Value is Narcissistic and Defensive
I’m making quite a cynical case that psychotherapy structurally is selling snake oil. I’m not saying I think that psychotherapy doesn’t add value - and in fact, I think many psychotherapists do brilliant work. What I’m saying is that psychotherapy has greatly inflated its value.
Psychotherapy is a new practice.
While healing through words is an ancient practice, psychotherapy as it exists today dates back to the 19th century when it began being practiced by Freud and his contemporaries. I’ll suggest this as the defining trait: the founders believed understanding ourselves intellectually healed us.
It was the scientific revolution applied to our psyche.
It’s an appealing proposition. Many people delight in learning about others, in understanding them. Psychotherapy offered a way for them to make money, good money, while helping others heal.
That value proposition attracts wounded healers.
Psychotherapy as an industry is full of codependent people pleasers. It’s easy to see why. For someone who adapted as a child by helping everyone around them, in appeasing and making life easier for their family - this is a way to make it into a career. It offers an off-ramp to their own honest introspection - a way to see their own ways of manipulating and controlling others as “good.” It allows us to dress social control in the cloak of a “healer.”
It’s an ego threat to everyone in the industry to question if we’re actually helping.
I was an antagonistic student when I studied social work - but nothing inflamed a classroom more than calling an intervention a manipulation. We would learn strategies to push clients toward a desired outcome, and I would call these manipulative if we weren’t choosing to engage in that strategy collaboratively with the client. It was astounding how virulent the pushback was against that idea.
I heard time and time again - we’re not manipulating them if we’re helping them.
And this is a problem. In an industry where the concept of healing is actually social compliance, where we have frameworks for maturity that are meant to fit all people - therapists easily become a strongarm of the system to bend the will of the individuals into accepting what is expected of them.
In many ways, the value of psychotherapy is actually that the therapist gets to feel self-important.
This is what sustains the hype talk of psychotherapy - preserving its singular space in the world of healing. The industry can conveniently ignore that healing clearly existed before the creation of psychotherapy. It can ignore that the cornerstones of their work don’t seem to add value. They can ignore all the ways the industry wounds at least as much as it heals.
This is why we have so few studies on differential impact.
There are a lot of studies that psychotherapy on average has a benefit. What you won’t find is much asking questions like: how does weekly psychotherapy compare to a personal trainer, a weekly manicure, a yoga class, massage, spirituality, mindfulness education, group fitness classes or a change in diet.
Therapy is scared to ask what it adds over alternatives.
And frankly, it should be. A recent meta-study on treatments for depression found that dancing was the most effective treatment, far more effective than psychotherapy. Fitness like yoga or walking were about as effective as psychotherapy.
Really, why would someone pay for psychotherapy if they can just go for a walk?
Psychotherapy is scared to clearly articulate their value because it threatens their ability to make so much money off of it - and it also threatens the egos of the many practitioners.
What matters seems to be the quality of the relationship and therapist presence in the room.
And perhaps a placebo affect.
The actual value of psychotherapy is available in any context, from any person.
Licensing is About the Monopoly
Anyone advertising or offering psychotherapy in the United States needs to be licensed to do so. I’m an LMSW (Licensed Master Social Worker), which means I’ve completed my education and have psychotherapy experience. I’m permitted to practice psychotherapy under supervision - and if I were to do so for three years then I could practice without supervision.
Remember, experience and supervision don’t add client value.
The research on this is clear: an intern is as good as a 40-year experienced practitioner. Most supervision doesn’t support client outcomes. Yet, the licensure path is built on the back of these two methods as assuring quality.
There are essentially no safeguards.
Hours of experience and supervision are the two signals of quality - and neither have any evidence base that they protect the client. There are ways to file complaints against therapists for ethical violations, but for the most part that system is weak.
You kiss the ring, then you do whatever you want.
I heard it time and time again: the system is structurally unfair and miserable - but if you finish it then you can open your own practice and do whatever you want. If the process is widely considered painful and unhelpful, though, then why does it exist?
This keeps the supply limited.
The licensure path is financially burdensome. You have to complete a master’s degree or a doctorate - offering unpaid work (north of 1,000 work hours) before you graduate. Then, after your graduate, you work under someone and typically make around 40% of what a client pays (often resulting in every graduate being a fee-for-service contractor being reimbursed $40-$60 a session).
This systematically keeps only the most privileged practicing.
Not everyone can afford this path, which is the point. Widespread recognition of psychotherapy as a value-add and insurance reimbursement were hard fought wins. Like all honeypots under capitalism, gatekeeping came up around it.
It’s Smoke and Mirrors.
Licensure creates the appearance that there’s something substantial behind the term psychotherapy. There’s not. All it means was that the person made it through all the steps, which were never designed to protect the client or assure outcomes in the first place.
It’s about the money.
The state profits off of the licensure fees. Schools profit as essential gatekeepers into the profession. People who are already licensed profit off of an exploitative licensure path. Insurance companies reap large administrative fees off of the medicalization of the work.
And clients are left to fend for themselves.
Clients are led to believe that these credentials are designed to mean something - to assure quality. Clients aren’t trained to understand what high quality care looks like - and the power dynamics of a positioned expert make the industry rife for malfeasance.
It’s the Wild West - plus diagnosis.
Once someone has their license, they can do almost literally whatever they want with clients (minus some clear ethical restrictions). The only unifying principle is that they each got through this meaningless path, and for the most part they diagnose clients according to the DSM.
This doesn’t mean there aren’t good psychotherapists.
As I’ve said many times, there are many brilliant psychotherapists. I believe firmly that these people do great work despite of the system, often actively subverting the system.
It means the existence of a license guarantees nothing about quality.
Education and Training Ignore the Science
I love being a student. I have four degrees and am in my final year of a fifth, and have enough credentials that I’ve lost track of them.
My Master’s in Social Services (MSS) was the most pointless education I have completed.
Social work curriculum is largely governed by an accrediting body, the CSWE, and aligns closely with what will be on the licensure exam. Pretty much anywhere you go, you’ll study the same things: human development theory, diagnosis, clinical intervention, power and oppression, social policy, and research foundations.
In a large part, you learn outdated theory.
For licensing, you need to understand theorists like Freud and his successors, as well as early developmentalists like Erikson. This would be helpful if we were learning it because it provided a historical foundation. Rather, you learn Freud as if he still represents a meaningful, modern picture of our understanding of the human psyche. You’re tested on Erikson as if that model isn’t now widely critiqued.
We do this because the industry is stuck on outdated theory.
The DSM and its many flaws exist because the industry refuses to move past these early theorists. It’s an analytical posturing - an effort to categorize, name, and describe various human presentations. It’s alluring because it centralizes the psychotherapist - an omniscient, self-important analyst who can finally explain the mystery of a client.
You don’t learn the new theories. (At least by default)
Science as a whole has evolved to more complex understandings about how our body rewires itself. Much of the old theories can now be explained with which parts of the nervous system or which areas of the brain are being activated - and how they’ve been made more or less important when adapting to the environment. We have a lot of research on how to change nervous system states, leverage neuroplasticity to rewire the brain, and how to disrupt entrenched patterns.
For example, I once learned non-suicidal self-injury (cutting) was a symbolic self-castration.
Modern science helps us to understand self-injury releases the body’s natural opiates - and that helps to cope with pain. More modern theory also suggests self-injury creates a sense of control over when and how much pain they receive in their life. This strangeness - this centralizing of old hypotheses when science has evolved into more specific, nuanced understandings - pervades social work education and psychotherapy.
The focus is on describing the client, not helping them.
The nature of psychotherapy is case conceptualization - essentially describing why the client is who they are today. I never learned what it meant to use that analytical style to actually move a client forward. We’d study critical race theory - but not how to help a client overcome internalized oppression. When my cohort mates and I began writing treatment plans, we’d joke that the treatment plan was “to talk to them.”
I often reviewed treatment plans that literally said “help client understand the source of their anxiety”
Frankly, I still don’t understand how this is a plan.
Mostly, I felt like I was in a circular, self-reinforcing bubble of woke performance.
That honestly pains me because I’m very liberal. I felt like I was learning to engage in virtue signaling - what words to say to help others understand that I understand racism, oppression, and am sensitive to diverse cultures. In some ways, I felt like I finally understood the criticisms of the right.
I was at a loss because I had great professors and my school was respected.
To be fair, I actually think many of my professors were too. My clinical professor often pushed us away from over thinking intervention because the research shows modality doesn’t matter. My diagnosis professor told us she believes all of her clients were having normative, adaptive responses - not suffering from disorders. My research professor talked at length about the limitations of research - how we focus on the mean, and that we only understand what they’re choosing to measure.
We were questioning a system while at the same time reinforcing it.
We were being shepherded through a process that no one seemed to agree with. We would talk about how psychotherapy and social work were entrenched in racism, in capitalism, and colonialism. But we were simultaneously so entrenched in the system that we were a part of the problem.
It fed into an unconfronted savior complex.
Because we never directly confronted the moral ambiguity of working in a profession we were so actively critiquing, it created a narrative that we were somehow not really a part of it. We were subverting it, changing it, breaking it. We were the exception - which is, to me, a dangerous mindset to have.
In a way, I actually think it will help make many of my classmates great psychotherapists.
Many of my classmates were brilliant - and I expect they do exceptional work. I’m glad they had an education where we moved through the process discussing how broken it is. They’re well positioned to navigate their career - to do meaningful work while confined to structures that aren’t serving clients.
But what a waste of time.
I feel like I wasted two years proving competence at a set of skills and knowledge that everyone agreed was bullshit. It was like a wink wink devil’s bargain: we’re doing this but we’re not really doing this.
The problem is that time could have been spent usefully.
The research consistently shows that it’s the nature of the therapist and the quality of the relationship that drive outcomes. Those skills - presence, nervous system regulation, attuned listening, compassion, equanimity - can all be actively developed. With time and active practice, we can foster the abilities that actually seem to make a difference in client’s lives.
I read three articles stating empathy helps clients. I did no skills development on empathy.
This was the problem. I could have spent those two years working actively developing my ability to sit with another person and relate to them. Instead, I spent that time performatively checking through boxes that everyone seemed to be in agreement weren’t actually helpful to the work.
Everything that I practice I learned outside of my social work training.
I came to social work school with a deep background in meditation and yoga - and a personal interest in body-mind connection and nervous system development. I’ve done a lot of training in bodywork, breathwork, using mindfulness to develop human traits like compassion, and understanding how those all can help a client to rewire a body. That background is what I use with clients.
Mostly, my social work education helped me to understand why social work was not a good home.
Psychotherapy Panders to Western Self-Importance and Individualism
I’ve always hated case conceptualization - a psychotherapy process by which you write a paper or give a presentation on why a person is the way they are. Then, other psychotherapists give other perspectives and opinions. This is the core of psychotherapy work - understanding the client.
I find this extremely self-important.
I have never once felt like I understood a client - and I’ve never believed that with a client we actually came to understand how they got where they were. This would be omniscient, impossible. Memory is too fickle, too unreliable to draw clean lines. There are too many variables. The client also co-created their experience the whole time, so who is to say what happened to them and what they invoked. Hell, I’m only observing the version of them that comes into existence across from me.
I also find it reductive.
Once a client thinks they understand themselves, they start to internalize it. They make it a part of who they think they are, and it becomes a limiting belief. If they believe they’re a person with anxiety, they will live in a way that self-reinforces the anxiety. If they believe they’re a highly sensitive person, they will live in a way that avoids growing a different skillset. Understanding ourselves is a modern cage - and its a cage our ego understands well how to use.
I think this stems from a desire for it to be someone else’s fault.
I’ve grown a particular distaste for mental health social media - its creation of villains, finger-pointing, and its sharp push for boundaries and comfort. I think it’s a natural outgrowth of psychotherapy, though, because psychotherapy fundamentally is about looking for reasons for the parts of yourself you don’t like. You avoid commitment - because of your parents. You don’t want to go to a party - because you have a social anxiety disorder. You don’t connect to your wisdom - because of a cycle of narcissistic abuse.
These are all half-truths.
Certainly, our environment impacts us - and it can be helpful to understand the meaning we have made from our experiences. However, it’s an abdication of personal responsibility to remove ourselves from that equation. Modern research shows much of our temperament is genetic - meaning we may have been like this no matter what happened to us. Our temperament in many ways invokes our environment - and it certainly colors the perception and meaning we make of our experiences. If we spend our time seeking a why without being able to accept the reality that it just is who we are today, all we are doing is using the language of psychotherapy to avoid seeing ourselves.
And these half-truths create social friction.
When other people are the problem, the solution is obvious: avoid other people. I think this blunt force treatment is creating social division today - all while not actually making many people happier. It’s certainly true that sometimes no contact or firm boundaries are in a client’s interest. However, many times, to develop and move forward, the actual work is understanding and working with our own perception and meaning making of social encounters.
I also think it stems from our addiction to control and knowing.
In the west, we’re indoctrinated in the idea that we can control everything. I think this is most visible in how we treat the earth - in our steadfast belief that we don’t have to work with local conditions, but can heavyhand our desire anywhere onto anything. When it comes to our self-image, I think we are no different. People in the west want to know themselves because it creates a sense of control - of permanence.
I worry that just strengthens our egos.
In theory, psychotherapy is meant to create cognitive space to step back and look at ourselves with neutrality. In practice, I worry sometimes it just moves clients from a subconscious ego identification into an active one. Now, they’re not just entrenched in patterns - but they have new words and descriptions to describe it all. Now, they can use the skillsets of rationalization and intellectualism to stay entrenched in patterns, instead of just doing is subconsciously.
I also worry it erodes mutuality and compromise.
As egos strengthen, I’ve noticed many people begin to believe the world should more fully accommodate how they see themselves. There seems to be an implicit curriculum in western mental health that we have a right to not just expression and lifestyle - but acceptance and support. This to me is individualism and avoidance at its worst. Certainly, I welcome growth in reasonable accommodations for people with disabilities, inclusion of diverse genders, and a reduction in oppression. But this is also earth - and humans are imperfect and some of our resources are finite. Living in community comes with friction and compromise - and the deepest growth often comes in facing this reality. I think a subtle violence of truth is brewing: that if I understand myself, I can force my truths onto others.
There are alternatives
I’m drawn to the Buddhist concept of non-self. One definition I liked a lot is that the idea that we are anything permanent, describable is extremely limiting. We can seek to relate to ourselves better, which parts of ourselves to nourish and encourage - but at the end, there is no permanent us. We are a part of something larger than us that is constantly being co-created and is always in flux.
My Philosophy
I fundamentally belief that nothing I find with a client is actually truth. I work with clients to try to describe and understand their current body sensations, and to make meanings of their experiences. I truly have no idea if anything we talk about is actually real, no matter how real it feels or how rational it sounds. Instead, I look at the work we’re doing and the meanings we’re making and ask more generally - is this nourishing the parts of you that you’d like to nourish, is it moving you in a direction that feels aligned?
Clinical Psychotherapy is Highly Colonial
My work is grounded in yoga, Buddhism, subtle anatomy, and western anatomy. I’ve sought to find ancient wisdom practices that predated psychotherapy - to understand how humans healed for thousands of years.
I’ve yet to find anything psychotherapy added to existing knowledge.
I like the language of modern theory - but I’ve yet to find something truly new. I enjoy Dr. Bruce Perry’s work - but I think much of what he writes about regulation is a simple re-summarization of the first three chakras (root, sacral, solar plexus). I really like Abraham Maslow - but his pyramid of human development is essentially the chakra system. I think the concepts of negative core beliefs, shame core, introjections, or burdens are powerful - but they existed as words in sanskrit thousands of years ago. Even ego - the cornerstone origin of psychotherapy - is at least thousands of years old.
We’ve repackaged old understandings while erasing their origins.
I think Jung is having a moment right now - and people are being drawn to many of his powerful writings. I also think Jung largely plagiarized ancient wisdom and found a way to make it palatable to a then modern audience, without crediting any of it. I think in large part modern research profits off of this: the discovery of wisdom isn’t the person thousands of years ago who first felt it, but the first person who can write about it in a peer-reviewed journal.
We keep finding old wisdom aligns to modern science, but we also keep deriding it.
I’m always amazed how things that sound peculiar in yoga end up correct. For example, yoga has long held our breath has a natural rhythm between the right and the left nostril - and that those create a natural rhythm in the nervous system. That’s been found true - that the erectile tissue in our external nares has a daily cycle and that creates a cycle in our nervous system. Things like these make me think: we will probably find modern descriptions for the chakra system, the energy body, and the nature of spirits in all things. In my experience, though, most people don’t see it that way. The ancient wisdom practices are still widely derided woo-woo, out-there, or anti-science. And when those understandings do get pulled into modern language, we pretend that our version is somehow different. It’s not the chakra system, it’s neuroscience.
Licensure swallows ancient wisdom and indigenous practices.
The latest APA statement on discrimination offered a wish to respect more indigenous healing practices. It also offered the intent to pull them under the umbrella of licensure. We see this already with the medicalization of plant medicine - and I expect we will see dance and music pulled more thoroughly under licensure with time. This will make only make it illegal for people with traditional knowledge to practice.
The problem is we often have a shallow understanding of old practices.
When psychedelics was used traditionally, it was much more revered and more ingrained in long term spiritual practices. When we westernize, medicalize it, sterilize it - we risk losing subtle knowledge that was developed over thousands of years. I was once in a training with Dr. Bessel van der Kolk where he talked about how something ephemeral and powerful in psychedelics isn’t described in the research - love. It’s just considered too fluffy for western science. Imagine what power in healing we lose by removing that.
We take community practices and monetize them as 1-1 services.
Across modalities, in ancient wisdom practices, community was central to healing. As we take these practices increasingly under the psychotherapy umbrella, we often strip away the centrality of community - and then cage them in 1-1 clinical environments.
The Implicit is Clear: We believe modern, western practitioners can do it better.
To me, this is just hubris. And I think it will do great harm.
The Ban on Dual Relationships Makes No Sense
I’m an LMSW, a licensed social worker. This is the most common credential for psychotherapists in the United States, though not the only one. I can’t speak for the licensing rules for other paths.
My code of ethics strictly prohibits any kind of dual relationship with clients, ever.
There is no time constraint on this. If a social worker engages with a client under that license, they can never have any other kind of relationship with that client. I had a professor who sometimes had former clients attend the university. He couldn’t teach them.
In theory, this is to create a pure working space.
It’s my understanding that the idea behind this rule is that it preserves the relationship between psychotherapist and client as purely about the work. At no point, does the messiness of the real world infiltrate the working relationship. It also makes ensuring confidentiality easier.
Some clients need that.
Not everyone is ready to be seen in the context of a real life relationship. For them, having a psychotherapist who is a true stranger creates safety - a container for them to look at themselves in ways they would be incapable of in the real world.
Some clients don’t.
It’s true that people heal in relationships. I believe there’s a hard cap on how much someone can heal in an entirely fictitious one. At a certain point, they have to translate the work into real-life relationships - to play with their truth and authenticity in a world with consequences. That’s the true test of growth.
I firmly believe a client and a therapist or coach can decide together if a dual relationship would help or harm the work.
There’s something deeply patronizing and infantilizing baked into psychotherapy. We’re trained to withhold information, to test the waters, and to direct the clients - because they may not be able to handle directness or honesty. I firmly disagree. I believe everyone is capable of looking at their best interests in a direct, honest conversation when it is infused with compassion and non-judgment.
I have a dual relationship with my therapist.
To be clear, my therapist identifies as a therapist but isn’t one in the United States sense. She’s not licensed and doesn’t diagnose. She lives abroad and has more freedom in her branding. Here, she’d be considered a coach like me and does similar work. I see her every week - but we’re also friends and sometimes work together. I can go to her yoga classes and we can dance together at ecstatic dances.
Being seen by someone who actually knows me has been immensely therapeutic.
It means something different every time I share something dark or vulnerable about myself. This isn’t a relationship that I can just cut off with an email and run away from. There’s a real world consequence in my sharing - and an actual relationship that I have to navigate. Every time I share something and we co-create space to look at it, I heal. I heal because this is a real person seeing me, a real person continuing to love me.
The bubble is bigger but more honest in a dual relationship.
My therapist has insight into my real life, and sometimes she uses it. I was in a bad business month when I got no new clients, and I expressed dismay that I was doing the work but nothing was coming. She said directly “Let’s be honest, you haven’t been doing the work the last two months.” It was compassionate but firm - and she was right. I had a story my ego needed to tell myself - that my circumstances weren’t tied to my work - and she cut through it immediately. This would have been impossible without our dual relationship.
The clinical bubble can be entirely detached from reality.
In a clinical space, a psychotherapist is always unsure if the client is being honest with them. The work is defined entirely by what they choose to share. The client is putting up the walls and is choosing what’s hidden in closets. The psychotherapist has little ability to check against collateral information if their work is reasonably tied to the client’s reality.
This is how psychotherapists become enablers.
Let’s be honest, the worst person you know is probably in therapy. And they probably use the fact that they’re in therapy to justify all their shitty behavior. Having an invisible third party signing off on their growth or behavior becomes a cudgel, a self-righteous sign of superiority often used to gaslight others in their life.
Their therapist may have no idea.
This is by design. The dual relationship ban creates a very particular bubble - one in which the therapist enters the world that the client brings to them. The growth happens from that starting place, no matter how detached from reality it is.
This is why psychotherapy is often contraindicated for narcissism.
Not everyone should be in psychotherapy. For people who are antisocial or highly manipulative, psychotherapy easily becomes one more tool for them to rely on. There are bad actor populations who only become worse in psychotherapy.
For me, the breaking point with social work was what this means for dual licensure.
I’m a licensed social worker, but I’m also a registered yoga teacher, a certified personal trainer, a cranial sacral therapist, and I’m soon to be a licensed massage therapist. I went to law school and if I chose to take the bar then I’d be a lawyer as well.
A psychotherapy client of mine couldn’t even attend a yoga class if I was teaching.
With the way I see health as integrated and holistic, I can’t work with this constraint. I want to be able to invite clients to yoga classes or to join retreats. I want to be able to build an ecosystem of healing, one in which the clients can engage with me across my skillset.
I refuse to compromise on the ability to integrate bodywork into talk work.
I believe healing through talk becomes immensely more powerful when intentional touch is added. As a social worker, I cannot put a client on the massage table - even as someone with two licenses. It would violate the dual relationship ban.
And I reserve the right for something more expansive than just a coach-client relationship.
I work with a lot of fellow healers. One day, we might want to work together to build a course, write a book, run a retreat, or open a wellness center. We might find ourselves wanting to be friends.
I believe we can make those decisions together, and that navigating those gray spaces is the actual work of growth and healing.
Psychotherapy is Part of Rising Healthcare Costs
I increasingly see psychotherapy, especially 1-1 work, as an indulgence - a luxury. There is too limited research on how it compares to more affordable, accessible, and community based alternatives.
Psychotherapy is expensive.
I live in NYC, and the insurance reimbursement rate here is usually $150 or higher. If a client sees a psychotherapist 48 weeks of the year, that’s at least a $7,000 cost for that one person. (That’d be before considering administrative costs on the insurance side).
That’s not scalable.
In the United States, healthcare costs keep going up every year - and are increasingly unaffordable for the average American. Every medical institution seems to be extracting as much money as possible, creating a vicious cycle.
Psychotherapy is contributing to that greed cycle.
The research on psychotherapy is that group work is as effective as individual work - yet most psychotherapists prefer individual work. It’s easier for them to fill their client list that way because it requires fewer clients - and it’s more manageable on the self-care side.
That doesn’t mean insurance should cover it.
In a world where dance is more effective than psychotherapy at helping depression, I don’t believe this is a sensible use of our resources. Mental health is important - so I think it’s important we take care and really consider how our resources can help everyone.
I used to tell myself insurance made mental health care more accessible.
I now believe it’s more nuanced than that - and I worry the modern appetite for 1-1 clinical mental health work will only make all healthcare more inaccessible.
My cash-pay policy is no perfect alternative.
Having left psychotherapy, I now only take cash. My default fee is high, and I offer essentially a pay-by-your-means sliding scale. The reality is that makes my services inaccessible to some people - and even those that can afford it, it comes with a sacrifice.
I welcome my clients weighing the cost of my services.
I’m not always the best use of money for a client, even if I’m helpful. I’d like for them to consider the alternatives. Would they benefit more from seeing me, or from going to three fitness classes that week? At this period, am I what’s needed or is a massage? Do they need private 1-1 support, or would a support group or a weekly meeting with peers be just as good?
These are the questions I think the industry as a whole should be asking.
I Worry About Documentation Under Fascism
Psychotherapists traditionally take a lot of notes. At intake, they usually document everything they can about you. This includes things like a trauma background, details about your family, your current lifestyle, your sexual history, and your drug use. They even usually document how they’d rate your intelligence and how you’re dressed. Typically, they assign a diagnosis, and at the end of every session they summarize what happened.
I worry about the power of this information in the wrong hands.
It’s idyllic to believe that this is truly private. I also think it’s naive. Much of this information is stored digitally - which means it could be accessed through hacking (which is only becoming more common and widespread). More concerning for me right now, though, is how accessible it could become under a fascist regime. Psychotherapists have to disclose their notes when required by the law. Laws can and are changing to make it easier to target political opponents. So much of what is said in the clinical world could be easily weaponized. It’d be a treasure trove for bad actors.
I’m not the first person to worry about this.
I trained in LGBT-affirmative psychotherapy. Some early LGBTQ+ mental health centers kept gasoline by their client files - so that they could burn the notes quickly if it ever became necessary.
Now, I rarely take notes.
In most sessions, I write nothing down - and instead focus on being entirely present for what is unfolding. The only times I keep documentation are when my lawyer brain kicks in and I think I need to document my reasoning and work in case of a lawsuit. This is largely limited to suicidal or homicidal ideation - and whether I’ve talked about the implications of working with me instead of a medical practitioner. Even in those cases, I write down the absolute minimum that I think is necessary.
Given Everything Else, The Regional Limitation was Too Much for Me
My licensure is state specific, and it wouldn’t translate to many countries. It allows me to do a very specific thing - practice psychotherapy - in a very specific place - New York or Pennsylvania.
My ambitions aren’t so localized.
I want to be able to take clients from anywhere, to host workshops and retreats anywhere. I envision a global life for myself, one that spans borders. Psychotherapy as its defined in the United States would not allow that.
I wanted work that could move with me.
Living in the United States right now, I’m not sure for how much longer I will call this country home. I know I will leave if fascism becomes entrenched. If I invested all of my energy into US psychotherapy licensure and practice, I’d have to start entirely from scratch if i immigrate someplace new.
This calculus may have been different if I believed licensure protected clients.
I would feel uncomfortable with this decision if I believed psychotherapy licensure meant much or protected clients. If I was a doctor, it would unsettle me if I offered “off-brand” surgery outside of the medical system. But with psychotherapy versus coaching, I actually believe there are equally non-existent safe guards for clients. In each, the work depends entirely on the practitioner.
At least with my work now, clients come skeptical.
I believe that skepticism, that uncertainty of what I do or the value of what I offer, is actually far more protective of the client than the psychotherapy licensure. As I build out my services, my brand, I will have to prove their worth every day. My guarantee is the quality of what I offer, not the letters after my name.
I actually believe coaching as healing through talk offers something unique, valuable, global, and customizable.
And that is a place I can finally feel like home in.
Curious About My Work?
When I left psychotherapy, I left behind the need to justify the existence of psychotherapy. It created so much space for me to ask what I want to do, why, and what I think adds meaning.
I still do 1-1 client work (though I keep a firm cap at 15 client hours a week). I offer body wisdom coaching and psychological bodywork. I enjoy both - but I don’t feel obligated to justify them as essential for any client. I work to help clients create a sense of spaciousness in their self-experience, to tune into body wisdom, and to honor their truth in a lived way. While I think the work is meaningful, it’s also a luxury service.
For the most part, my life force has moved toward ways I can democratize everything I know about health. You can expect more courses, writing, meditations and retreats - as well as community psychology (how the skills I’ve learned can come to be infused in daily life, making healing a natural part of living).
