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The confusion evidenced by this question is the view of psychotherapy itself. The assumption is that therapy is for crazy people, or at a minimum people who are not well. This fits well with the medical model of therapy that has been dictated by insurance companies.

Medical Model Applied To Psychotherapy Due to Insurance Companies

Insurance companies require that clients have a mental health diagnosis to be eligible for coverage or a percentage of reimbursement.The therapist must define what is “wrong” with “the patient”. And what is wrong needs to be a mental health disturbance that lasts over months or even years of the client’s life. These can cover mood disorders like depressions and anxieties, behavioral issues, like active addiction or obsessive compulsive disorder, or character disorders like narcissism or borderline personality disorder.

Most of us have some feelings or behaviors or symptoms that fit in the general range of at least couple of these diagnoses. But that isn’t how diagnoses work. Each has criterion that are far down the line on the continuum of each of these issues. For instance a lot of folks get depressed or anxious sometimes, but most are unlikely to meet the criterion for Major Depressive Disorder or Generalized Anxiety Disorder which require a particular level of consistency and severity. But for clients seeking coverage by an insurance company, the therapist will need provide them with the diagnosis in the wheelhouse of the client’s symptoms even though they are unlikely to meet the actual critereon.

Why Do People Go To Therapy?

Certainly lots of folks start therapy because of issues that fit neatly into a diagnosis. But tons of clients come because they are looking for a place to contemplate a situation in their lives, or to get support for something they are going through. People come to therapy when they have suffered a loss, through death, divorce, retirement, moving, leaving or getting fired from a job. They come to therapy because of relationship conflict, with partners, parents, kids, bosses, friends and community. They start therapy because there are aspects of their personality that trouble them, or that they seek to strengthen. Folks seek out therapy to help them craft a life they hope to build and become the people they want to be.

You don’t have to be crazy, or seriously messed up, or even have an actively problematic issue happening in your life to go to therapy. Psychotherapy is a tool for radical self-improvement. Not all people who exercise are fat. Not all people who go to church are sinners. Not all people who do yoga are balls of anxiety.

Good Psychotherapists Do, and Should, Go To Therapy

Many therapists go to therapy, as a standard practice, or at different junctures in their life. I would never refer a client to a therapist who had never been in extensive therapy. Here are some of the reasons.

  • If a therapist thinks psychotherapy is a good tool, then surely they would use it, unless they only think it is good for a certain type of person. I would hate to be in a consulting room with someone who thought they didn’t need therapy but their clients did.
  • While a therapist can not, nor do they need, to have had every experience their client has had, being a client in a therapy session can feel vulnerable.  It is the role that holds less power in the room and I can’t imagine being safe in a room with a therapist who had never embodied the less powerful role.
  • Good psychotherapists aren’t advise-givers who sit and dispense wisdom. What they are supposed to do is be a guide on the client’s exploration of their unconscious. The unconscious can be a disorienting, murky, and frightening place. It is great to have someone who is familiar with similar terrain, inside themselves…who have traversed their own dark places and learned something about how and when to rest, explore deeper, find clues, stay safe, notice pitfalls, and when and how to leave.
  • Two key characteristics of a good therapist is a hunger for truth and a boat load of courage. A good therapist has faced the kind of hard truths we access about ourselves in psychotherapy. Remember, therapists can’t help us much with the external world…the task is figuring out our patterned role in events/perspectives/interactions that we can shift for more emotional and psychological safety and freedom. It takes courage to unlock truths about ourselves we would rather not see. We want a therapist who wasn’t too afraid to see their own darkness.
  • Because of our job, it is actually quite imperative the a psychotherapist go to therapy. Working with clients activates a lot inside the therapist. In all relationships, exchanges stir stuff up inside both people, but in the case of therapy, the therapist has to be highly tuned in to what is getting mobilized inside of them. Our job is to feel the pull from the interaction, but to refrain from responding prior to analyzing what has been activated in us. We have to tease apart our impulses from our thoughts on what the client is needing from us and how they are going about trying to get that. While authenticity is key, the motivation behind each and every one of our responses has to be towards the end of helping our client. In order to do the work of analyzing each moment to moment experience, we have to be highly attuned to our own issues/blind spots/Achilles heels/triggers/transference. Client’s psychic material can get lodged in us in disorienting ways, so knowing ourselves and the shape of our issues is imperative.

Both Sides of The Couch

Psychotherapy is a defining experience of my life, from both sides of the couch. Like many therapists, I had someone in my family I was desperate to save/heal/help. Since you can’t help someone who isn’t trying to save themselves, that repeatedly failed. I eventually realized saving myself from the relentlessness of my mother’s trauma would bring me at least some of the relief I longed for. When my journey freed me enough to stop repeating her mistakes and build a life of my own, a good life, I knew I could help others find the keys to unlock their own suffering.

In my mid-fifties now, I am still devoted to my own psychotherapy. I use it to find the stuck places in me that make certain change hard, to hear the critical voice I still use sometimes to diminish my truths, to tease apart the the way the shadow of my mother occasionally cast darkness and confusion on my own parenting, or in my friendships, and when I was partnered, for sure reared its ugly head. And I use it, along with clinical supervision, to keep myself a good vessel/instrument for this rich, nuanced work, which often requires use of my own unconscious to decipher the messages from my client’s inner world.

Therapy Is As Rich, Deep and Rewarding As You And Your Therapist Make It

If you and your therapist arent uncovering a complex internal, unconscious world, think about which of you is preventing/avoiding depth. Ask your therapist to think about it with you. There are many forms of therapy available to help us navigate our lives, but psychotherapy traverses the world of the unconscious.


Smith is an analytically oriented psychotherapist with 25 years in practice. She is additionally the Founder/Director of Full Living: A Psychotherapy Practice, which specializes in matching clients with seasoned clinicians in the Greater Philadelphia Area.

If you are interested in therapy and live in Philadelphia or the Greater Philadelphia Area, please let Full Living: A Psychotherapy Practice match you with a skilled, experienced psychotherapist based on your needs and issues as well as your and own therapists’ personalities and styles. All of our therapists are available for telehealth conferencing by phone or video in response to our current need for social distancing.


Here are some other posts about similar topics:

Psychotherapists are like Dance Archeologists

Attending to the Unconscious in a Psychotherapy Session

Myths about Psychotherapy (a video blog)

Author Karen L. Smith MSS LCSW Karen is the founder and director of Full Living: A Psychotherapy Practice, which provides thoughtful matches for clients seeking therapists in the Philadelphia Area. She provides analytically oriented psychotherapy, and offers education for other therapists seeking to deepen and enriching their work with object relation concepts.

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