Story at a glance

  • While more people are being treated for mental health than before, Americans are increasingly turning to medicine without therapy.
  • Online discourse shows that there are still stigma and stereotypes about what therapy is and how it works.
  • Friends and therapists fill similar roles, one expert says, but there are key differences.

A good friend is compassionate, patient and a good listener — which are probably the qualities you also want in a therapist. So why see a therapist?

One Twitter user posited that a therapist is basically a stand in for a good friend, in a now-deleted tweet that had more than 2,500 likes by noon on Jan. 23. And people had plenty to say in the replies. 



Jerome isn’t alone in thinking that a good friend is basically a therapist or that seeing a therapist is only to deal with clinical issues. 

Nearly half of American households have had someone seek mental health treatment this year, but stigma remains. The American Psychological Association said government surveys show that mental health visits increasingly involve only medication and no psychotherapy, arguing that it reflects a misconception of what therapy is all about. 

“I think that people sometimes misconstrue therapy as about problems and about disorders, whereas I think therapy is about the art of teaching you to be more human and more fully yourself,” said Dr. Michael Alcee, a clinical psychologist in New York. “I think people sometimes don’t see how there’s overlap between what’s considered mental illness and just ordinary human suffering.”

But Alcee says people have become more open and aware of mental health and therapy in recent years. As a mental health educator at the Manhattan School of Music, he’s seen demand for college counseling go through the roof with the current generation of students. He sees his role as a mentor. 


“Our work as therapists is meant to relieve problems, but also to show a person to access their own creativity, to process their own process,” he said. “Yes we want to help people to lower their anxiety and help their depression, but it’s even better to help them understand why and how this is happening.”

A good therapist is willing to be there with you through everything, just as a friend is, Alcee says, but with one key difference. 

"They’re different in that they have the luxury of not being a player in your everyday life, and that affords you and them some freedom," he said.

Even the best of friends can’t always detect their own biases, anxieties, challenges or self-interest when speaking with you. But by taking themselves out of an equation, a therapist can. In a perfect world, with perfect friends, there might not be a need for therapists, Alcee says, but today’s reality is limited. 

“This is a product of our culture and generation, whereas if you think about it 100 years ago even 50 years ago, community and extended family were a much more important part of our lives,” he said. “The culture doesn’t have a lot of organic social support built into it. We sort of are alienated from each other.”

While the phenomenon isn’t unique to America, Alcee says that compared to more collectivist cultures, American emphasis on independence can lead to social isolation. So, in some ways, Jerome might be right. 

The reason there's a blurry line between therapy and friendship because as one definition goes, 'psychotherapy is the art and science of healing through social interaction.’” Alcee said. “It's the social interaction part that's the crucial ingredient. So therapy partakes of the same stuff that good friendship is made of, and good friendship, on its best days, gives us what our best therapy sessions give us too.”

Published on Jan 23, 2020