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 definitively 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 took 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.¹ 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.² 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 someones 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 definitively 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.