When patients first sit down with clinical psychologist Natalie Dattilo, one of her opening questions is deceptively simple: How much do you believe psychotherapy will help you?
Talk therapy — a central treatment for mental health conditions — aims to unpack patterns of thought, behavior, and emotion while building healthier coping strategies. Many of Dattilo’s patients say they believe in its effectiveness. Yet paradoxically, many also doubt it will work for them.
“A lot of people are on the fence,” says Dattilo, an instructor of psychology at Harvard Medical School. “That may be the biggest barrier to care. Some think therapy is just like talking to a friend — a paid friendship. That misconception keeps people away.”
Millions Struggle Without Help
According to the National Institute of Mental Health, nearly one in four American adults — more than 59 million people — live with conditions such as anxiety, depression, PTSD, or obsessive-compulsive disorder. Yet data from the American Psychiatric Association show that more than half never seek treatment.
The reasons, Dattilo notes, fall into two broad categories: internal and external barriers.
Internal Barriers: Stigma and Self-Doubt
Internal barriers stem from personal beliefs and emotions. Shame, guilt, or denial often prevent people from seeking therapy even when they recognize a need.
“Internal stigma says, ‘It’s okay for others to need help, but not for me,’” Dattilo explains. “People think they should just tough it out.”
External Barriers: Cost and Social Stigma
Other obstacles are structural. Access to qualified providers remains a challenge, particularly in areas where mental health professionals are scarce. Cost is another hurdle, especially when many therapists do not accept insurance.
“Most people want to use their insurance, but if providers don’t accept it, affordability becomes the gatekeeper,” Dattilo says.
Lingering social stigma compounds the problem. While public conversations about depression and anxiety are more open today, treatment itself is often viewed as shameful.
“We’ve made progress in reducing stigma, but there’s still judgment around taking medication or seeing a therapist,” Dattilo says.
Overcoming the Hurdles
Dattilo encourages people to explore alternatives, such as online or self-directed therapy programs, which research shows can be highly effective.
She also recommends reframing self-critical thoughts. Instead of telling yourself, “I shouldn’t need help,” she advises replacing it with, “It would be nice if I didn’t need support, but right now I do — and I’m committing to it.”
Acknowledging the need for care, she says, is far healthier than denying it. “Guilt about taking care of your mental health can easily undermine your recovery.”
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