"A little on me” read the first email I ever sent to my therapist. “I am a 31-year-old male with no serious mental health history. I am looking for help with mild issues relating to anxiety and insomnia.”
I can see now how little of that message was true. Only my age and the fact that, yes, I was looking for help—though I assumed it would take a handful of sessions at most, a few wise words from a bearded, bespectacled savant and I’d be on my way.
I sent it while stood outside a London tube station on a Monday morning with a raging hangover. The night before, I’d lied to my new girlfriend about having an early start so she’d go home. This was so I could walk to the supermarket alone and buy two bottles of wine which, like most other nights of the week, I administered with stoic determination to ensure I would, eventually, fall asleep. The email to Marco had been sitting in my drafts folder for a long time and the realization I’d chosen alcohol over her and then lied about it was the final straw I needed to press send.
A week later I walked up to a tall, grey downtown office tower. The sky seemed unusually full of cranes, pecking at London like thirsty birds. I’m Tony Soprano I told myself, as I pressed the buzzer and walked inside, my chin pinned to my chest in case anyone I knew was walking by. Upstairs, a man in soft black clothes opened the door and smiled in a way I’d come to know well over the better part of the next decade. Warm and sincere, but tightly reined. Touching the eyes but not flooding them. An invitation into an empty space.
More than a year later, once the trust between us was strong enough, Marco shared his impressions of me during those early sessions. I walked in with a slight stoop, he said, even though at 6 foot 1 I should have towered over him. In the chair I squirmed around constantly, something he described as like “physical Tourettes.” I was determined to try and make him laugh, and had a habit of sharing bleak memories flattened and smoothed out into amusing anecdotes, delivered with a hollow chuckle.
One word he used in particular made me wince in recognition. Ingratiating. This alternative reading of what I had always believed to be my natural affability made my stomach flip. It was the first real gift Marco gave me; the second was the instruction to stop asking him how he was at the start of our sessions. You’re not here to worry about me, he said. I’d later learn this was not a rule of therapy per se—for narcissists or psychopaths, taking an interest in their therapist could be a sign of progress. Rather, it was something catered to my specific set of neuroses. The license not to try and please or take care of him, even with bland, automatic pleasantries, felt uncomfortable —until it started to feel completely radical. These were early breadcrumbs on a path towards deconstructing my persona, the public mask we all create in childhood which eventually, Carl Jung believed, reaches the limit of its usefulness during some crisis in adulthood. A kind of guided ego death on which there would be, and still are, many wrong turns.
Today, eight years later, when we meet for our weekly appointment at the same time and place as always, I occasionally feel the old impulse to ask Marco how he is. But I never do. Sometimes I marvel at the fact this man—neither bearded nor bespectacled, as it happens—knows more intimate things about me than anyone; my parents, my partner, my lifelong friends. And yet I could not tell you if he is married, has kids, his sexuality, where he grew up or what kind of music he likes. I have a handful of tiny, often vivid details he has shared, gathered up in my mind like shards of glass in a handkerchief. I feel their weight from time to time, but have no idea what they form together.
And yet somehow, this has not produced a lack of intimacy or an imbalance of power between us. Marco is the master of the discipline we are there to enact—long-term analytical psychotherapy—but an apprentice in the subject we are there to discuss, which is me. Our relationship is not a friendship, a mentor and mentee situation, or even a professional arrangement. It is something else, sometimes called the therapeutic alliance. It hasn’t just solved the problems I went there with, it has enriched and fortified every aspect of my life. And the main reason for this is not his brilliance or my dedication, though I can point to evidence of both. The reason is lots and lots of time.
No one can put an exact figure on how long therapy should last. It is, like the stuff you drag in there, entirely subjective. Many short-term therapies, such as CBT, are proven to be highly effective in helping people manage conditions like anxiety. But in recent years, a quick-fix approach has been on the rise even for styles of therapy that are traditionally carried out over multiple months, if not years.
This first occurred to me when I heard an advertisement for BetterHelp, the app that promises affordable, online access to trained therapists. Given that the barrier to therapy for most people is cost, what it was offering sounded great. Then it went on to list as one of its advantages “the ability to change your therapist at any time.” Although this is technically true in traditional, in-person therapy—there is no contract, and you’re free to stop and start with someone new whenever you wish—the process is emotionally charged and time-consuming enough to make you at least think twice. Here, the app was promising it at the press of a button. I immediately thought about Marco, and how many times, in the early days, I wanted to walk away, either because where we were heading felt too disturbing or the whole thing had started to feel like a drag. Each time something inside told me to stick with it, and each time I discovered I was actually on the precipice of a breakthrough.
Aaron Balick is a psychologist and author whose work tries to understand the way technology is reshaping our relationships. He is the last person in his profession to resist change. But he too has reservations about the rise of instant online therapy. “Traditional psychotherapy has been really slow to innovate and make itself more approachable and accessible to a wide variety of people,” he says. “And in that breach, these tech innovators have stepped in. They're looking for the pain points: you know, ‘What can we solve? How can we make it all easier?’ Which are questions we do need to be asking ourselves. But their [solutions] are not actually grounded in psychological nous.”
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Another of BetterHelp’s innovations is the ability to contact your therapist at any time, making them effectively a mental health concierge service. “How much time do [clients] give that relationship, before they just switch to somebody else?” Balick wonders. “[And] is it OK that somebody with an anxiety disorder chooses a therapist who makes themselves available to them 24/7, when actually, those gaps between sessions are really important periods for people?” He sees BetterHelp as part of a wider cultural trend for taking the interpersonal complexity out of life—we are, gradually, smoothing away the difficult parts about how we interact with each other. “The switching [between therapists] makes me think of Tinder. It's kind of like: Okay, they've broken my idealization now, so I'm going to swipe left and move on to someone else who is gonna magically fix my feelings! Probably the most important thing [in therapy] is what happens when the relationship takes a turn that's unexpected.”
Last year I attended a talk in London alongside 3,000 other people. It was by Gabor Maté, the 80-year-old author of bestselling books about how the mind and body processes emotional distress. It had the genial atmosphere of a soft rock concert—Bon Jovi, with chairs. And yet Maté opened his talk on a bitter note, responding to an attack written in The Spectator accusing him of leading a "cult of trauma." The charge was that physicians like Maté are encouraging people to self-pathologize. It’s part of a wider, culture war-adjacent pushback against “therapy speak,” the idea that mental health awareness has tipped into mental health indulgence.
Rather than prove we are "over-therapized" as a culture, endless TikTok videos about concepts like trauma, or shadow projection, or insecure attachment strike me as a sign we are not yet therapized enough. That we’ve become snagged at the stage of intellectual understanding—the part of the process Freud called interpretation. At the interpretive stage, we learn the language and theories of therapy and how to apply them to ourselves. And there is great power and value to that. But as Freud and many psychotherapists who came after him discovered, it is rarely enough on its own to create any meaningful, long-term change.
About three years in, I was lying in the bath one evening reading an essay by Carl Rogers called "Becoming A Person." Rogers was a hugely influential American pioneer of what he called person-centric psychotherapy. He believed in giving clients unconditional positive regard so they could explore hidden or undeveloped parts of themselves in safety.
I was deep into my own interpretation stage at that point, and desperately reading all I could about psychology in my spare time to try and wrestle back a sense of control. I’d come to dread my sessions with Marco, where we were nudging our way towards memories and feelings I’d done my best to ignore my whole life.
I came across a passage I’ve read probably 100 times since, where Rogers describes a person reaching the conclusion of a successful period of therapy:
Most PopularHe feels less fear of the emotional reactions which he has. There is a gradual growth of trust in, and even affection for the complex, rich, varied assortment of feelings and tendencies which exist in him at the organic level. Consciousness, instead of being the watchman over a dangerous and unpredictable lot of impulses[...] becomes the comfortable inhabitant of a society of impulses and feelings and thoughts.
Suddenly I was crying in the tepid water. It sounded so beautiful, and yet so far from what I was experiencing. My inner world was still tense, unforgiving and a lot of the time, afraid. My watchman was still on the clock, dragging a baton across the prison bars inside of me.
Before this period of understanding without feeling, I had been mostly stuck in resistance, spending months arguing with Marco that I did not need or deserve the help I was paying him to give me. I vehemently insisted I had been the beneficiary of that most common of mirages, the happy, normal childhood. That this happy, normal childhood had led to a series of rigid beliefs—"I will never know what it means to be relaxed"; “I am incapable of a good night’s sleep”; “I am pretty sure I’d struggle to love a son"—was, I insisted, entirely unrelated.
Therapy is not linear. Each stage is fluid and overlaps, like tides sloshing in a rock pool. But what finally broke me free of this push and pull between denial and intellectualization was simply time—time and repetition. The boring truth about therapy is that rather than a stream of profound epiphanies, it is mostly a case of revisiting the same analysis—rising from the same undesirable thoughts and patterns of behavior—over and over again. But each time, the truth of it penetrates a fraction deeper and starts to catalyze changes in how you react to things and feel about them.
For Balick, this is the power and beauty of being in it for the long haul. “Though you keep coming back to a lot of those same repetitions, you get to them quicker, you move through them faster and you take greater risks,” he says. “Your therapist knows you and what your limits are. If it's good, trust continues to grow, deeper things continue to be said. And it's a real exploration—for the therapist, too.”
Today the symptoms that led me to Marco’s inbox in the first place—the drinking, the insomnia, the OCD, the unbearable daily thrum of dread—have vanished, or become so rare that when they do flare-up, I know they will pass and feel full of gratitude that they no longer dominate my life. I still have periods of crisis, of course. But the trust in myself that Rogers described has grown. My watchman only works part time. I can imagine him retiring one day—handing him a gold watch to thank him for keeping me safe all those years and then sending him, finally, on his way.
There is a six-to-18-week waiting list for therapy from the NHS, the U.K.'s national public healthcare provider. If, then, you are deemed to need what I do—psychodynamic psychotherapy, which digs into your past to help you resolve issues in your present—you might be lucky enough to get 16 sessions, or four months’ worth. When I think about where I was after that long with Marco—still completely lost, barely scratching the surface of my denials—this strikes me as a burning injustice, a sign we are still in the dark ages of treating mental health. I do not know how we get to a place where people without the means to pay for long-term private psychotherapy are able to access it through public healthcare, only that it seems a goal we should aspire to. Once, the idea of education for everyone seemed radical—now in Britain it is a basic human right.
Most PopularIt is difficult to calculate, though easy to imagine, the uplift it could have on society if more people had a chance to work seriously on their mental wellbeing. “Reject racism, try therapy,” read a placard at the recent anti-fascism marches across the UK, a clunky sentiment with more than a grain of truth. Someone once described therapy as a second chance at childhood; how much pain is inflicted on the world by people who are alone with the legacy of their first? Often I start to feel guilty about the fact I have benefitted from something many people, including my friends and family, do not have access to. But that also makes me more determined to stick it out.
People often dismiss therapy as self-indulgent, and this is somewhat true in the beginning. You go because there’s something you have to change, something making you miserable or anxious. Many people feel the immediate relief of catharsis—I’ve said it out loud! Finally!—and stop. Sticking with it over the long term, I’ve come to understand I’m not just there to invest in myself but other people, how I interact with the world. It's a space to practise saying things that used to terrify me in real life—“I am angry with you”, “I feel insecure about this”—and learn the world does not fall in as a result. The long grind of therapy has enabled me to have conversations—with my parents, with strangers, with all sorts of people in between—that would have been unthinkable before.
“Long-term therapy has the capacity to deepen and improve all your relationships in life,” says Balick. “You can hold space. You can listen better. You can understand your own defensive reactions and be less reactive to them. That’s a very different thing from feeling less anxious about giving a presentation at work, which is a totally valid reason to seek a short-term therapy. It's just a different offer.”
As the years have gone by, it has slowly improved my capacity not just to like myself but other people. You start to see individuals as icebergs rather than obstacles frustrating your path (or, even worse in some cases, idealized figures). It’s not that you know, exactly, the depths they are concealing, just that you sense it is there. There is a beat of empathy before making up your mind about who people are. You learn to protect your boundaries from others—the part that makes for good TikTok videos. But also, the quieter skill of asking yourself, always, ‘what bullshit am I bringing to this situation? Where might I be going wrong?’ Emotions don’t stop raging inside of you, they just stop dictating your actions so often, and start to become sources of useful information.
When I read that first email to Marco back now, one phrase in particular moves me and makes me laugh in equal measure. A little on me. Why would it be a little on me? It was me I was writing about, me I was trying to help! The fear in those four words, the shame about putting myself forward for serious consideration in the world, feels like a snapshot of where I was then, and where I could have easily got stuck forever. The girlfriend I fobbed off to buy wine and drink alone is still with me, eight years later. I’m not sure that would have happened without therapy, either.
“People have traditionally come for psychoanalytic conversation,” wrote Adam Phillips, the great British psychotherapist and essayist, “because the stories they are telling themselves about their lives have stopped, or become too painful, or both. The aim is to restore the loose ends, and the looser beginnings, to the story.” In the end, I think this is what therapy—when you take it beyond the crisis that drove you there into deeper, stiller waters—is for. The chance, not just to understand your story more clearly, but write what is left of it on your own terms.
This story was originally published on British GQ.
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