Is Therapy The Best We've Got?

In my twenties, living in London, I spent two and a half years in psychoanalysis. I lay on a couch twice a week. My analyst, Nigel, almost never spoke. I talked and he listened, and he said essentially nothing, until our very last session, when I walked in wearing a suit for a job interview, and he said, in his clipped British accent: “You look very smart in that suit.” I said thank you. That was it.

I would never do analysis today. Who has the time or the money? These days, I’m likely to look for an easier solution (Maybe Ketamine? It’s only a couple sessions!). And of course I’m not alone.

I wasn’t in analysis because I was in a crisis. I had experienced anxiety and depression off and on for years, yes, but what I was really doing was exploring my story — my parents, my neuroses, the person I was becoming. Perhaps it was the secular equivalent of something people used to do in other ways: on a pilgrimage, in confession, in prayer, through hard life experiences that leave you changed. Psychotherapy, starting with Freud, stepped into that space and in my world, it was just what you did. My mom used to say that in life you needed “A mother, a father, and a therapist.”

Megan Cornish is a therapist, a Substack writer, and one of the most provocative thinkers I’ve encountered on the collision of mental health, loneliness, and modern life. She is also, importantly, not anti-therapy. She is a therapist. But Megan argues we expect too much out of a single 50 minute session a week. We need to start looking beyond therapy for solutions to the angst of being human.

Her provocation: We have outsourced meaning-making to therapists. And that’s a problem.

Megan isn’t saying therapy doesn’t work. She’ll be the first to tell you it does, for what it was designed to do. Therapy was built to treat mental illness. It is a highly effective clinical intervention. But somewhere along the way, we expanded its mandate to include everything that makes us human: relationship confusion, existential searching, loneliness, the basic ache of a life that feels hard. Popular podcast ads for therapy services will tell you that therapy is simply “having someone to talk to.” That’s a very different thing.

“Mental health has become the catch-all drawer,” Megan told me, “for anything that we need to be human that may be inconvenient to our workplace productivity.”

There’s a structural dimension to this that doesn’t get talked about enough. The mental health field has flipped dramatically — it’s now roughly 70% female in terms of psychologists, licensed social workers, and therapists. That’s a profound shift with real implications: for how much practitioners get paid, for how men get served, and for how we culturally think about the whole enterprise. Emotions are already coded female in our culture. Mental health content skews that way too. And the self-improvement content that dominates platforms like LinkedIn demands frictionless solutions, which is the literal opposite of what good mental health work actually is.

Cornish argues the things that used to be handled in community — in kitchens and churches and front stoops and bowling leagues — now get routed to a fifty-minute hour with a professional. We arrive at therapy vitamin-deficient, she says, but instead of examining our diet, we take a vitamin and keep going. We treat the symptom. We don’t ask whether the life we’re living was designed for human beings in the first place.

There’s a specific word Megan uses: efficient. Therapy is not efficient. There are a limited number of therapists. They can only hold so many relationships at once. The more people they see, the less effective they become — because the magic of therapy, the research is clear on this, is not the modality or the years of training. It’s the relationship. And a relationship can’t be scaled.

This connects to something I’ve been watching closely in my own work on AI and the workplace. The first major study on AI at work that really broke through, from Boston Consulting Group, found that AI was making people dramatically more productive and burning them out at the same time. That’s such an American formulation. More output, more exhaustion, more need for a fifty-minute hour to process it all. Megan put it plainly: workplace mental health benefits exist to make you more productive, not to make you happier or healthier.

And nobody, she points out, has the luxury of opting out. There’s no safety net. You have to keep working not just for today but for tomorrow, which is why Megan keeps coming back to the idea of universal basic income — not as a utopian fantasy but as a practical question about what changes when people aren’t in constant survival mode. The basic income experiments we’ve seen, including one recently in New Bedford, Massachusetts, found that recipients reported something surprising above all else: more time to engage in their communities and less constant worry. Not luxury. Just enough breathing room to be a neighbor.

This is why the AI therapy conversation makes her uneasy. CBT, she notes, can actually be self-administered — read the book, do the exercises, get roughly the same result. But the eclectic or psychodynamic modalities that work largely through relationships? You can’t replicate that with a bot or a book that will always tell you what you want to hear. A colleague of Megan’s, a cyber psychologist who studies AI’s impact on human relationships, calls real relationships a social skills gym: sometimes fun, sometimes not, but you walk away stronger. Removing the friction, she says, is not actually good for us, even when it feels better in the moment. I have found therapy over the years a great place to practice having friction when I would choose to avoid it in my personal relationships. I also don’t think therapy is a replacement for a real, messy, high stakes, essential relationship. Therapy can help us do better with those, but it’s not that.

Megan grew up moving across ten states. Her grandmother grew up in Caddo Mills, Texas, and could name everyone on her block and in the local cemetery. That kind of place-based community — the loose-tie network that Robert Putnam wrote about so memorably in Bowling Alone — has largely dissolved. And in its absence, we’ve built a therapeutic infrastructure to absorb the loss.

But therapy can’t give you what community can give you. It’s structurally different. In therapy, the relationship is organized entirely around your needs. Your therapist doesn’t call you when they’re having a hard day; there’s not much give and take or generalized reciprocity. And when we start expecting all our meaning-making relationships to work that way, we lose something essential: the experience of being needed, of being woven into something larger than ourselves.

Megan told me about her book club. She’s an introvert in a new state, trying to put down roots, showing up to a stranger’s living room not knowing whether to take off her shoes. It was excruciating. She went back. She’s on meeting number four now. “Building community is one of my values,” she said. “So, though it is excruciating, I am going to put myself out there.”

You know I love ACT therapy, and in ACT, this would be the committed action.

Megan isn’t nostalgic. She knows that some of those tight-knit communities were welcoming only to certain people — the right color, the right sexuality, the right religion. She doesn’t want to go back into nostalgia. She wants us to go forward with our eyes open about what we’ve lost and what we’re compensating for.

And she wants us to stop pathologizing the ordinary. Sadness is not a disorder. Loneliness is not a diagnosis. The struggle to make new friends in your late thirties is not a clinical problem. These are the textures of a human life. We have, in her words, “metabolized a version of life that says the point of life is not to have discomfort,” when actually, discomfort for a purpose is pretty much the whole project.

With Feeling,
Morra

P.S. My friend Sanyin Siang wrote a wonderful piece, looking from an organizational lens, called “In Defense of Inefficiency” that I recommend.

P.P.S: Subscribe to Megan’s Substack. It’s awesome.