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.
Harvey Lieberman is a clinical psychologist, a mental health services administrator and a writer.
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