The Problem Isn't That We're Over-Therapized. It's That We're Under-Optioned for culture we live in.
A soon to be widely-read opinion piece in the NY Times is making the rounds. It’s written by a clinical psychologist with five decades of practice behind her. Her core claim: therapy has become the default prescription for unhappiness, and in the process we're mistaking loneliness, financial strain, and everyday conflict, otherwise known as Social Determinants of Health (SDOH), for pathology. I 100% agree with her statement that not everyone needs therapy, but I think both the why and the solution are incomplete.
The piece is worth taking seriously. Wait lists stretch for months, clinicians are burning out, there are a lot of people who show up to therapy primarily wanting to be heard, and they’re competing for time slots with people managing intrusive thoughts, trauma, or biopsychological conditions that genuinely require clinical evaluation and skill. As we continue to normalize the connection between our minds and bodies and accept emotional language into our lexicon, more people are turning towards mental health care, read therapy. The share of U.S. adults receiving therapy or counseling rose from roughly one in ten to one in seven between 2019 and 2024, even as the workforce hasn't come close to keeping pace.
My issue is with the piece's proposed alternative, which is essentially, go reconnect with the people in your life. This not only assumes something that isn't equally true for everyone: that community is there, waiting, if only you'd turn back toward it, but it also ignores the many other systemic and cultural issues, the panoply of SDOH that lead to distress.
The quiet assumption underneath "just reach out"
American culture doesn't organize people into relational life the way many other cultures do. In societies with dense extended-family structures, geographic stability across generations, or strong communal and religious institutions, "reconnect with your community" is a real, executable instruction because the infrastructure already exists. In the U.S., this is frequently theoretical. Third places generating incidental connection (union halls, church basements, stable neighborhoods, workplaces with any tenure) are eroding, a trend the U.S. surgeon general's 2023 advisory on loneliness documented in detail. Add in the individualist ethos that treats self-sufficiency as a virtue and needing people as a mild failure, and you get a culture that's very good at telling people to "reach out" and much worse at giving them somewhere to reach.
This isn't evenly distributed. Someone who relocated for a job, a caregiver whose hours don't overlap with anyone else's free time, a rural resident with no provider, or peer within an hour's drive, a person whose family relationships are the source of their distress rather than a refuge from it: for all of them, "rebuild your relational life" is not a next step. It's the goal, not the instruction. Recommending it as though it's simply available is a failure to account for the social determinants of health that shape whether connection is actually accessible; income, housing stability, transportation, work schedule, disability, and geography all determine whether someone can reconnect, independent of whether they want to.
"Therapy" isn't one thing, and treating it like one hides the actual problem
There's a second flattening in the piece worth naming. It treats "therapy" as a single, coherent intervention with a knowable set of tools and a predictable reliability problem. In practice, "therapy" is a label draped over enormous variation: different degrees, different licensing standards by state, wildly different amounts of supervised training, different (or no) treatment modalities, and most critically (as no one who has talked to me for more than 5 minute will be surprised to hear) almost no consistent outcome measurement across providers. Two people who both say they're "in therapy" may be receiving structured, evidence-based treatment, or something closer to well-meaning conversation with no measurement of whether it's working at all. And this is independent of the forced homogeneity the DSM-V pushes us into, irrespective of the SDOH that affects our lives.
I am not critiquing therapy as an idea (full disclosure, I’m a licensed therapist), but let’s be honest that its variance comes from a broken diagnostic and payment system with weak quality control, over-pathologizing taxonomy, and a lack of accountability to measurable outcomes. Even labeling “therapy” as one thing obscures the actual fix, which isn't fewer people in therapy, it's better, highly differentiated care (including building community if possible), with clearer signals about what a given intervention is actually designed to do, and whether it's working.
The missing middle
The real gap isn't between "clinical treatment" and "go make friends." It's the absence of a structured, trained layer of support built specifically for situational distress, loneliness, the work conflict, the financial strain, the life transition, that doesn't require a diagnosis to access and doesn't pretend a diagnosis is what's happening.
This is where a biopsychosocial model of care earns its name. It treats distress as the product of biology, psychology, and circumstance together, rather than defaulting to a purely clinical, deficit-based frame. And this is why I love Coaching. Because Coaching done well is exactly this: a trained, certified person working with someone through a difficult stretch of life, without pathologizing what they're going through. And built-in real measurement of whether someone is actually getting better. Coaching can create space for a more complete infrastructure, where those who really “need” therapy, clinical formulation and specialized intervention can get it, without competing with those who can benefit from less specialized care.
At Wave we hope to replace the false choice between "see a clinician" and "figure it out alone," for the much larger number of people whose distress is real, disabling in its own way, and not a disorder. Wave Coaching also focuses on the specific barriers that are interfering with people living less distressing lives, including those things that are both in and out of their control. Helping support people to navigate their circumstances, making changes where they can, but also accepting when they can’t change the system. Coaching is also half the cost of therapy, making it a more accessible and affordable structure.
The psychologist's instinct that we're routing too much human difficulty through one narrow clinical door is dead on. But the fix is to help enable the skills to help people tolerate their distress by acknowledging the circumstances they’re in. Regardless of if they have a diagnosis or a community waiting for them.