The goal of this post is to describe my experience with psychotherapy in the
past few years, structured as questions and answers. It is written from
the perspective of in-person psychotherapy in France, for problems that are not
too severe (nothing life-threatening), and from someone with the financial
resources to pursue it (more on this below). It is meant as a personal report of
how I see psychotherapy and how I feel about it – it is certainly not
authoritative and I do not have any specific legitimacy to write about this.
The post covers mostly the meta aspect of my experience with the
therapeutic process, and does not really say much about the nature of the problems.
What is this, in factual terms?
In the spring of 2021, I finally managed to act on an idea that I had
considered for years: I took an appointment on the Web to see a psychologist
(chosen at random among those close to where I lived).
Since then, I have been consulting a therapist on a regular basis, once every
2-3 weeks on average with some variation. (In particular, I stopped for 6 months
as I was traveling abroad and used this as an opportunity to see whether
stopping made a difference. That said, eventually I felt that seeing a therapist
again was a good move.)
Over that time, overall, I have been seeing three different therapists, in two
different cities in France. In all cases the modalities were similar: talk
therapy (which I would classify as supportive therapy), for 50-60 min sessions. The cost was 70-75 EUR/session.
Which kind of therapists can you find in France?
There are plenty of resources online to help you navigate the many different
kinds of psychotherapy that exist, but let me just write here what I understand
as a non-expert user.
The broad categories include:
- Psychologue, which are the ones I went to. They are not medical doctors and
cannot prescribe drugs, but they
must have a university diploma (it is a regulated title). They can have different
therapeutic methods, with, e.g.,
cognitive behavioral therapy being one
of them.
- Psychiatre, which I have not tried; the main difference with "psychologues"
seems to be that they are medical doctors and often include drugs in their approach (and in particular
they can prescribe psychiatric drugs). Note that other medical doctors in
France (e.g., médecin généraliste aka
GPs), can also prescribe
such drugs.
- Psychanalyste, which follows the specific practice of psychoanalysis. I have
not tried these either.
I'm assuming that the practitioners listed on established therapy websites have
some form of credentials, though of course I have not checked. Beyond the above,
there are other kinds of neighboring professionals, e.g., life coaches, that
I am not familiar with.
I have only seen psychologists in-person, though you can also see them online.
(Many in-person psychologists also offer online sessions, and there are also
purely online services.) This was a deliberate choice — to me it felt like
interacting with the therapist in person was an important part of the experience
(and it also drew me more out of my comfort zone), but of course online therapy
can also have advantages (it can be more convenient, it can be cheaper, it can
be easier to find available therapists depending where you live, etc.).
Many therapists will have some kind of schedule about when they can see patients
(during the day or at night, online or onsite, etc.): the schedule can also be a
factor when choosing the right therapist.
Did you try psychiatric drugs?
No. I'm scared of them, it is somewhat irrational but at some level I think it's
a reasonable worry. I thought I would rather try talk therapy first, and things
never got dire enough for me to consider trying psychiatric drugs.
That said, I would definitely try them if I felt like there was no other
option. And it is entirely possible that I have been missing out on some
immediate benefits that could have been obtained more easily using drugs.
How different were these therapists?
The three psychologists I have seen were, to me, surprisingly similar in terms of
how they operated. There were of course some small differences:
they were different people, following somewhat different processes (one
practices EMDR which did not convince me, another practices CBT which convinced me more).
Overall, though, I was more struck by the uniformity of the process than by
individual differences. This relates a bit to the
dodo bird verdict, i.e.,
the various psychological theories seem to end up having roughly similar effects
on patients. (Note how much this contrasts with physical health, where the
efficacy of treatments is obviously different depending on what the underlying
illness is — e.g., appendectomy is a very effective treatment for appendicitis
but a very ineffective one for pneumonia.)
Somewhat more subtly, depending on the therapist, the areas of my life that we
would end up talking about most regularly were not the same. However, it is hard
to tell whether how much of this was connected to differences in therapeutic
approach, vs differences in what were the main problems in my life at a given
moment when I was seeing them. I also suspect that the first sessions with a
therapist tend to initiate a dynamic that will tend to be followed for longer
afterwards, but which is reset when changing therapists.
Another common point between these therapists is that they all adhered to the
basic framework: the sessions started on time, ended on time,
the therapist listened actively, focused on what I was telling them, were
welcoming towards what I disclosed, reacted appropriately, etc. And there was no
interaction with the therapist outside the sessions. This being said, I have heard of people who
experienced wildly inappropriate behavior from their therapist — so I know this
also exists and unfortunately one needs to consider the possibility that things
may not go well.
Does it help?
I would say it does... probably. That said, after all these years, I'm still not
sure how much. Part of the problem is that there are lots of confounding
factors: some problems got better but it's unclear how much this was thanks to
therapy (vs thanks to my own efforts, or thanks to changes in circumstances).
I would say there was an immediate improvement in the first few months (though
I only say this in hindsight, and it wasn't so clear in the moment).
Again, though, it's unclear whether things improved thanks to the therapy, or whether me
starting the therapy was a sign that I was ready to take action and get better.
I think there are clear benefits immediately after sessions: I tend to feel
relieved, and feel like I have more clarity about the problems discussed. I get
some "fresh start effect" giving me confidence that I'll manage to make progress
on these problems in the following weeks. I also get a self-esteem boost, simply
because someone gave me (against payment) the feeling that my problems were
important enough to deserve some attention.
In the longer term, I think there are other changes. Here are the main ones I
can think of:
- More clarity about where you and your worldview come from. It is a bit
cliché that the therapist wants you to talk about your mother, but in fact
talking about family relationships turned out to be far more enlightening
than I would have expected. Here is how I would summarize it:
when you grow up as a child, you take a lot of
things for granted about the environment in which you live, your family,
your caretakers, etc; and this affects a lot how you see the world later. It
requires some deliberate effort to reexamine things and see your life from an adult
angle. (E.g., "what's happening in the lives of my adult friends right now is
what happened earlier when I was a kid and now it makes more sense"; or
"This thing that happened to me as a child was a pretty big deal, even
though I couldn't tell at the time and hadn't taken the time to reflect on it
since")
So I got the opportunity to realize that many points in my behavior and my
problems could be better understood in the familial and sociological context
that I come from. (The problem with this kind of epiphanies is that it's hard
to notice when you have them - your perspective shifts on things that were
"hidden in plain sight", and afterwards it feels like you always knew about
them at some level.)
- Getting an outside perspective about things. You may be going in circles
stressing over problems and then you realize that these problems sound very
different when you explain them to a neutral third party. Maybe this exercise
helps you to remember why the problems matter to you. Maybe you realize that
they don't matter so much in the end. Often you will realize that your way of
seeing the situation is not universal: it's not necessarily invalid, but it's
more personal than you thought. On the other hand, sometimes you will get
outside confirmation from the therapist that your situation is objectively
difficult and that your feelings are a healthy and understandable reaction to
the situation. This turned out to help: in some cases in real life, I could use
my mental model of the therapist to estimate how they would react to what
happens and do an outside view visualization exercise. It also helps me to
make some distinction between who I am as a person in the long term, vs how I
am feeling in the present time about the problems of the moment.
- Emotional literacy. Trying to get the habit of mentally checking on myself
how I am doing at an emotional level: accepting that I have emotions,
noticing them, understanding them. You may benefit more or less from this
depending on how connected you are to your emotions: I had a long way to go,
so there were some "noob gains" that were easy to unlock.
- Being more open. I think it is easier for me now to talk about life
stuff to others (e.g., to friends, or on my blog ;)) without fear of
judgement. At some level this is just about trusting other people; and opening
up to the therapist was a (very scary) first step. In fact, the extent to which
it scared me was (with hindsight) pretty good evidence that I needed to make
progress on that front. So I think it was useful training for me to say deeply
weird and inappropriate things to a stranger and have them react
in a welcoming and non-judgemental way. (Also, given that people overall are
weirder than it looks, talking to a therapist can help you realize that your
seemingly very unusual personal problems are rather mundane when seen in the
very wide space of all the things that people may need to talk about.)
- Useful pointers, concepts, and theories. Sometimes the therapist will
point out that what you are saying/thinking sounds like [problem category X],
and will explain to you briefly what this is about. These labels can be good
pointers to read more about the topic yourself if you didn't know about it.
This proved useful to me, despite all the Wikipedia-backed
self-diagnosis I'm capable of. Indeed, it's one thing to know that an abstract
concept exists, and another one to have someone point out to you how that
concept can relate to a very specific thing that you just lived or said or did.
- Better self-knowledge and more clarity about your life problems. You're
probably already aware of the fact that some things in your life are not how
you would like them to be. However, I have the impression that in many cases
you become accustomed to your problems and you no longer realize that you have
them. Or, more viciously, you had never realized that you had these problems
in the first place, but they were still taking their toll. Indeed, therapy was
for me the occasion to notice many obvious problems that I wasn't noticing
(e.g., a fish not having the concept of water), and that these problems were
not universal and maybe even fixable! Further, the immediate problems that I
would complain about would often be a consequence of these larger problems,
and I hadn't connected the dots. (Of course, awareness of a problem doesn't
mean you can immediately fix it, but it's an important prerequisite.)
Why can't you take care of yourself on your own?
I sympathize with the hope that one should always be able to fix all personal
problems on one's own. Self-sufficiency certainly looks like something
desirable! Further, psychological problems look like they should obviously be
self-fixable, simply by introspection and willpower. (This is not like material
problems, e.g., it feels less like a failure to ask friends for help if you need
to carry something that's physically too heavy for you to carry alone.)
You can also get the impression that therapy isn't necessary for you if you
already have some reflexivity about your life (as opposed, e.g., to people who
aren't interested at all in their own psychology) and already have some of the
theoretical concepts (as opposed, e.g., to people who don't know how to find
documentation about human psychology). If you already do things like journaling,
and if you're already able to find information online by yourself, then why
would you need help?
I have been this person for a long time — but I have changed my mind about this.
I now think that it's OK to ask for help. And I think it's acceptable even in
cases where it's not an absolute life-or-death necessity, e.g., something that
you could possibly do on your own but which will be far easier to handle with
some help. I think that the myth of self-sufficiency can sometimes come from the
fact that asking for help is scary.
I also think that the inability to ask for help, and the years of procrastination
before finally seeing a psychologist, have a lot to do with me having been raised as a
man. The statistics I've heard seem to suggest that men in France are much less likely to
see a therapist, even when corrected for gender differences in the prevalence of some psychological
problems. In fact, hearing about this masculine stereotype and recognizing
myself in it was part of what encouraged me to try psychotherapy in order to
escape it.
There are other bad reasons not to see a therapist (which I suspect can also have
some connection to gender), including:
- Imagining therapy as a battle of wits where the therapist would
lose.
If you have a high opinion of your intellectual abilities, you may think that
seeing a therapist is a waste of time: how could they possibly find something
clever to say about you that you wouldn't have been able to deduce on your own? In
particular, if you are trained as a scientist, it's easy to want to take a
scientific view on everything, and be contemptuous towards people who study
inferior topics such as psychology. In any case, part of the therapeutic
process is to accept that someone may be able to help you with things that you
are not managing well on your own. I think you can be both highly intelligent
and find yourself unaware of your problems or unable to make progress on them.
- Imagining that the therapist can't possibly understand you.
A variation of the above argument, based not on the lack of intellect but the
lack of familiarity. How could a stranger find something relevant
to say about your life when you see them one hour every two weeks, compared to
you living your own life 24/7 for decades, or compared to friends or family
who have known you for years? The counter-argument is that therapists actually
understand and remember very little factual detail about what you are telling
them — but your general approach and feelings can be pretty obvious to spot
for a trained professional. It's disconcertingly easy for them to tell you
something about the situation that was not thinkable from your perspective
- Imagining that the therapist can't solve your problems. Maybe you have it
all figured out: the problems in your life are XYZ (something something job,
something something relationship), and these problems are hard to fix, indeed
you're already working at fixing them. How can a psychologist help? Well, not
by solving your problems directly — but it's important to realize that active
listening (as opposed to problem solving) can already help a lot. Of course
sometimes part of the road in getting better is indeed to fix some
already-identified problems that don't depend on you, e.g., being stuck in a
bad financial situation, in a harmful job, in a toxic relationship, etc. But
you may need help in order to actually get it done, and you may also need help
in figuring out what the real problem is.
- Worrying about confidentiality. Part of my self-sufficiency fantasy was
worrying too much about secrecy, e.g., I was uncomfortable with the risk and
vulnerability involved in disclosing my feelings or private details about my
life. In this light, deliberate disclosures to an untrusted stranger sounded
like the worst breach of security imaginable. Of course, therapists are
supposed to observe strict confidentiality about the contents of sessions —
but in my view this was not a strong security guarantee (especially judging
from the standards of computer science, e.g., compared to a cryptographic
protocol). So part of the process of
seeing a therapist, for me, was accepting that my problems were not so
terribly confidential that I couldn't tell them to someone else — and that I
wasn't such an important person and so it didn't matter so much if someone
else knew.
- The therapist doesn't really care about you. I admit that this is true —
for all three therapists, I got the impression that they were doing the job
seriously during the session, but I wouldn't imagine that they would "care"
beyond the boundaries of the session. Which is
normal — it's just their job. Still, like all professionals, it doesn't mean
that they cannot do their job well.
In contrast with the above, there are of course some good reasons not to see a
therapist, e.g., if you can't afford it, or if you legitimately don't need it.
OK, why can't you get help from friends then?
I sympathize with the view that professional psychotherapy is not an ideal
system because it's based on a financial transaction: it leaves out those who
can't afford it, and appears to compete with the non-commercial help you can
receive from friends (or other people you may have various kinds of social
relationships with, in particular romantic partners — I could quip that this is
especially true for men in heterosexual relationships, as we tend to
disproportionately benefit from free emotional labor by women).
I sympathize because I think it's important to cultivate friendships where you
can be open and vulnerable and receive the same kind of benevolent help that you
get from professional therapy. With loneliness becoming more prevalent,
and social ties getting weaker, it certainly sounds like therapy is
the wrong solution — and being closer to your fellow humans without a
mercantile crutch is a better answer.
However, this argument isn't so convincing when you look at other areas
of life. Cooking for instance: you can cook with friends and share meals, or you
can use money to buy a sandwich or go to the restaurant; it sounds like it's OK
that the two approaches would coexist and may be more or less appropriate
depending on circumstances. Further, while there can be some common points
between a therapy session and emotional support from a friend, there are also
some important differences:
- There is no expectation of reciprocity. You're not supposed to "use" friends
to vent about your problems, or for one-sided emotional support. Of course,
doing it at some level is normal, but it's also normal for friendly conversation to
stray away from your problems towards other topics (in particular towards
the problems of the other person). Asking for friends for help too often feels
(to me) like I am burning some social capital and could eventually degrade the
friendship. Not so with therapy: it's all about you, and the social obligation
to care about the other person is replaced by financial payment. The therapist
is officially here to help you for some set period of time — which your friend
didn't sign up for.
- The goal of therapy is explicitly for you to get better. This is in
contrast with many friendly interactions with people, which pursue other goals
(e.g., having uncomplicated fun). Of course, friends can support each other
and help each other to improve their lives, but not all friendships are like
that (and not all friends are interested in this kind of topics, and they are
not interested all the time).
- The therapist is completely exterior to the rest of your life. There are
some things that it's difficult to say to friends. Say you want to talk
about a mutual acquaintance: it can be difficult for them to keep a secret.
Or say you want to talk about your relationship with the friend themself...
These can be mitigated if you have a diverse enough set of friends to ask for
advice from people that are sufficiently far away in the social graph, but
this is not always possible. Or say you want to say something embarrassing,
which the friend may find inappropriate, or which could worsen their image of
you if you told them... In brief, saying something to a friend can have some
irreversible side effects. By contrast, the therapist doesn't know anyone else
about your life, you don't have a strong duty to them and you can stop seeing
them if you want: so in a way you don't have to strategize about what you tell
them and what you don't.
- The therapist has psychological training. Unlike your average friend, the
therapist is a professional who is trained in helping people with their
psychological needs. You may have some friends who also happen to have such
qualifications, or to be naturally good at this; but most of your friends
probably are not.
- The therapist has a neutral relationship towards you. Your conversations
with a friend are part of an ongoing relationship with the friend. Depending
on that relationship, there can be some emotional intensity going on which
could blur the psychological help that you receive. E.g., maybe what you are
saying resonates with another shared experience, maybe your friend is mad
at you for some unrelated reason... The therapeutic relationship is different
because it has some level of distance, and the therapist will work to maintain
that distance and stay in their role without letting their own emotions
interfere.
So, broadly speaking, therapy sessions have a clear agreed-upon framework, which
your interactions with friends generally don't. Your mileage may vary here: some
people do not have trouble with the ongoing negotiation of giving and receiving help
from friends; but personally I'm much more comfortable when the framework is
clear and I don't need to second-guess.
This leads to the obvious question of whether you could get your friends (or
strangers) to agree to such an explicit framework in order to exchange mutual
support. This is the idea of
co-counselling as I understand
it, and it sounds promising but I have never practiced it.
But what makes psychotherapy work?
I'm not sure, really:
- What I say during sessions sounds a lot like introspective self-monologue, but
the difference is that I'm putting it out loud in front of someone who
listens, which forces me to articulate it more.
- Having someone else involved in the process makes me accountable (e.g.,
genuinely trying to make progress), like getting classes from a teacher to
learn how to play an instrument vs trying to learn on your own.
- The therapist's outside perspective seems to make it easy to say things that
must look obvious from the outside but are not obvious to me from the inside.
In any case, it's not because the therapist would have some magical
solutions to fix the specific problems that you have. They will often just state
the obvious, e.g., remark "this problem seems to be bothering you a lot"
(perhaps with the implication "other people could have the exact same problem
but it wouldn't be an important topic to them"). Such observations seem trite,
but somehow they can help me realize, e.g., that
I had been spiralling non-stop about the problem but that this was
neither proportionate nor
necessary. Alternatively, it can force me to articulate the problem more and understand what's really
bothering me.
Astral Codex Ten has an interesting
article
with a subjective take on why some people seem to benefit from therapy more than
others. (The author, Scott Alexander, is a psychologist — and he is also a central
TESCREAL figure, so you should
probably take the blog with a grain of salt.) Of the reasons mentioned, I
identify a bit with the "external reassurance" part: having someone else telling
me something never has quite the same weight as when I say something to
myself.
Why didn't you start psychotherapy earlier?
For most of my adult life my #1 reason for not doing psychotherapy is that I
felt like I didn't need it. Further, I didn't even see it as an option — I
thought this was only for people with major problems, or for rich people, or
generally not for me. In retrospect, I think it could have helped me a lot to
get started sooner. Probably some of my friends would agree — at the
time I think I did not have many friends who knew me closely (mostly by lack of
self-disclosure from my part), but even then some probably suspected that
something was amiss. I think I just didn't have enough perspective to ask myself
how I was doing, whether things could be better, or whether some outside help could
be useful.
I'm not sure when is the first time I started imagining that seeing a therapist
was something I could actually try. From a personal diary I know that I had the idea at
least in summer 2018, and the idea regularly recurred from then on, but it took
me around 3 years at least to act based on this idea. (This kind of negligence
in following my goals and taking care of myself is of course part of the issue
as you might have guessed.)
Starting therapy was also easier because some of my friends were doing it, and
because broadly speaking it had progressively become more culturally acceptable.
(To the extent that people now talk about therapy
speak and therapy culture to
criticize how much the approach of therapy has percolated in everyday life.)
Overall, more sarcastically, one could say that I had now transformed into the
kind of person for whom therapy was a good fit sociologically speaking.
In any case, I think a large part of what blocked me was fear: psychotherapy,
and the vulnerability it entails, were really outside my comfort zone. Doing
frightening things is hard — and I'm still not very good at it.
What do you talk about during sessions?
It's very unstructured. Usually I will spend a few minutes just before the
session to remind myself of what happened since last time, and whether some
particular things stick out. (It would probably be a good idea for me to do this
more consistently, but I haven't managed to form the habit yet.) Depending on
the session, sometimes there will be obvious problems that I'm struggling with,
and sometimes it's less clear. When there isn't too much pressure from bigger
crises, the session will sometimes explore some longer-term issues, or more
conceptual territory about broader topics.
There is some variance between sessions: sometimes I feel like I understand
things in a new light, sometimes I'm disappointed because I feel we didn't
really connect all that well. I guess that this is inevitable. It's also
interesting to see how sometimes the main topic ends up being something
completely different from what I would have anticipated; or to see what are the
topics that we apparently managed to conspicuously avoid.
I have heard from friends that it sometimes happened that they would run out of
things to say during a session, and I think it is a common worry about therapy
sessions. So far this has never happened to me: I don't seem to ever run out of
things that I need to talk about. (This may be a good or a bad thing.)
I have seen therapists giving some "home assignments", e.g., asking me to make
progress on one concrete objective by the next session. That said, I
didn't get the feeling that they were enforcing this very closely — they would
not necessarily bring it up the next time.
When does it end?
I'm not sure. Of course one can ask whether it's a normal thing for therapy to
go on indefinitely — isn't this a sign of its ineffectiveness?
After about 5 years I'm not sure how much I still "need" therapy, but I still
feel that there are things holding me back, and I don't feel confident enough
yet about being able to address them on my own — which is why I haven't
stopped yet. The 6-month break I took in 2023 also gave me the impression that,
in the long run, it made sense for me to start again — though I used this as an
occasion to switch to a different therapist.
I do not know, from the therapist's side, how much they optimize for patients
that "need" them more, and whether they can "sack" you if you're managing well
enough or if you don't seem to benefit a lot from therapy. (I know that some
therapists have a clearer protocol about how many sessions the therapy will last
and what is the expected trajectory, but I have not encountered this yet.)
Is therapy a good use of money?
First, the answer to this question depends of course on how much money you have.
I have enough money that paying for therapy sessions is not a financial problem,
but I realize that this is definitely not true for everyone.
It is of course awful that people who need care (psychological or otherwise) are
prioritized depending how much they can afford to pay for help, rather than how
much they would benefit from it.
For this reason, I have wondered
whether it was acceptable for me to ask for this care, given that there were
certainly other people who needed it more (e.g., people with real issues that
were genuinely putting them in trouble!), and also that the money I was spending
could have been used in different ways (e.g., donating to a good cause).
In fact, this question was the occasion for me to go on a spiral of doubt: is
it OK to spend a significant amount of money towards the specific goal of
improving my life? I think that, to some
extent, this kind of doubts were connected to the issues that caused me to
seek therapy in the first place. This may be related to another reason why
therapy can be effective: paying money to get help is a way to prove to yourself
that your well-being has some value (at least financially), and that it is worth
the "investment". (Still, this can't be all that there is to it: I would expect
that paying for therapy works better than indulging in other expensive things
with no long-term benefits.) In fact I can think of situations afterwards where
psychotherapy loosened a bit my relationship to money: I felt OK paying for
something that might make me happier, because I was "already" paying significant
money for psychotherapy so it wasn't a huge investment in comparison.
On the negative side, however, psychotherapy is branded as "healthcare", which I
think can make it easier for people to accept whatever it costs. At least,
personally, I find it hard to be rational about money when help is involved. So
I don't really put the 70 EUR I pay per session in balance with other ways in
which I could have benefited from spending this money. There is also a question
of habit: it's easier to continue once you've started.
Anyway, looking at the bigger picture: I have paid a few thousand euros in total
(and also invested time, around 100 hours overall over the course of five
years), with the outcome that it probably helped me feel better and improve in
the problems that I had. When phrased in this light, I don't regret the
investment.
Why are you writing about this?
The idea to write this post came from discussions with friends about my
experience with psychotherapy. Despite the normalization of therapy (at least in
the social circles around me), these conversations gave me the impression that
it could still be useful to share my personal experience with therapy —
especially coming from someone who doesn't typically write about
this kind of topics, or who might radiate (at least in some contexts) the
impression that I'm not the kind of person who "needs" it. Indeed, I hope that
this can help readers of this blog to think about whether they may benefit from
therapy, e.g., some people who might be in the same situation where I was a few
years ago.
Anyway, let me reiterate that this is just personal experience: the point
isn't that you should absolutely do therapy, or that I endorse it
wholeheartedly. (As you can see, despite the overall positive impression, I also
have mixed feelings.) The point is to share my perspective in the hope that it
can be useful, and of course in the process to help myself to understand better
how I feel about therapy.