Therapy has a branding problem.

And high performers are paying for it.

A few months ago, a client of mine sat across from me at the end of our first session, a senior leader running a team of about 60 people, and said something I was not expecting. He looked at me and told me that nobody knew he was there. When I asked why, he gave me this look as though I was the one who was confused, as though I did not understand something obvious about how the world works.

What he meant was simple. If this had been coaching, he would have mentioned it to his team, his partner, his board. Coaching is acceptable. Coaching signals ambition and investment in growth. Therapy signals that something is broken. Even if it is the same room, the same conversation, the same work being done, one word makes it fine and the other makes you feel like something is wrong with you.

This was not a one-off. I hear versions of this regularly, from founders, executives, senior ICs, and increasingly from younger professionals building their careers in tech. Smart, functional, educated, high-performing people who are dealing with real things, self-doubt, burnout, decisions keeping them up at night, and who will call what they need by any name except therapy. Advisory. Mentoring. A strategy session. Anything that sounds like performance and forward motion rather than sitting with what hurts.

The packaging problem nobody wants to name

The reason these people avoid the word is not that they are uninformed or emotionally illiterate. The reason is that therapy as a category has a branding problem, and almost nobody in the industry wants to talk about it honestly.

Therapy was historically built for a specific population and a specific model of communication. About 60 to 70 percent of therapy patients are women, and roughly the same percentage of therapists are women. The dominant model is talk therapy, which means articulating what is happening inside you, naming the emotion, translating internal experience into language. That works for a lot of people and I am not going to pretend otherwise. But for a certain type of person, and I see this especially in men though it is not exclusive to men, that model feels foreign in a way that is hard to describe if you have not experienced it.

There is a clinical term for this, normative male alexithymia, which is a fancy way of saying that a lot of men are functionally disconnected from their own emotional vocabulary. The emotions are there, fully present, but the words for them are not. And when you walk into a therapy room and someone asks you how you feel, the honest answer in many cases is: I do not know. Not because you are avoiding the question. Not because you are resisting the process. You genuinely do not know.

If this feels familiar, you’re probably the kind of person I write for and work with. Learn more about my work and set a 60’ free consultation.

When not knowing gets misread

Here is where the design flaw shows up. The therapeutic model tends to interpret “I don’t know” as avoidance or resistance, as a wall to break through rather than a literal description of the person’s experience. So the client walks out thinking therapy does not work for them, or worse, that they are bad at it. And what do high performers do when they feel bad at something? They do not come back. They find an alternative, and the alternative is called coaching, advisory, or consulting, all of which sound like they are about performance and forward motion and none of which make you feel like you are broken.

The distinction between therapy and coaching, by the way, is wildly overstated. The work overlaps far more than either industry wants to admit. But those overstated distinctions serve an important function: they give people permission to do the work without stigma. And I want to stay with that for a moment, because it matters.

I need to be clear about something. I am a therapist. I trained in this. I believe the process works, and there is plenty of evidence it works for men and women when the fit is right. What I am against is the industry pretending the packaging does not matter, and the quiet elitism underneath that pretence, the idea that if people avoid therapy it is their resistance, their failure to be vulnerable enough.

That is lazy thinking. If someone genuinely needs help and avoids it because the branding of therapy gives them a specific impression, that is not on them. That is on us. We have wrapped psychological work in a specific aesthetic, a soft-focus, feelings-first language that signals to a lot of competent, action-oriented people that this is not for them. And then we act surprised when they do not show up.

The performance paradox

There is a deeper structural issue at play here. High performers are, by definition, people who solve problems through action. You feel ashamed, you achieve more. You feel inadequate, you get more results. You feel anxious about your career, you work harder. The entire operating system is: if something is wrong inside, fix it by fixing the outside.

Therapy asks you to do the exact opposite. It asks you to stop doing and start feeling. For someone whose entire identity is built around competence and output, that is not a pleasant invitation. It sounds more like a threat, because you are asking them to sit in a room where the thing they are best at, performing, is useless.

I had a client once, a woman running her own firm, accomplished by any measure, who told me she had tried therapy three times before working with me. Each time she left feeling worse. Not because the therapist was bad, but because the format asked her to do something she had no practice doing, which was sitting with discomfort without solving it. She described the experience as showing up to a basketball court without knowing how to dribble, while everyone assumes you know the rules. That is not a personal failing. That is a design flaw in how the work is presented.

What I have been doing about it

I am still figuring this out, and I want to be transparent about that. I have been building a set of structured self-examination tools, video-led diagnostic experiences that cover the most common things people bring to my practice: repressed emotions, burnout, procrastination, purpose-seeking, shame, and the question of whether you are stuck or protecting yourself from something you do not want to face.

They are not therapy and they are not coaching. They are designed so you start working through the material on your own, at your own pace, without sitting across from anyone, without having to call it anything. If you get something from the process and want to go deeper with a therapist or a coach, you walk in with better questions and a clearer picture of what is going on. If you are already in therapy or coaching, the material gives your sessions a sharper starting point.

I got tired of the gap between how many people need this kind of work and how many will ever walk into a room and call it therapy. The category is creating a barrier, so I stopped fighting the category and started asking a different question: what if the work could begin before you decide what to call it, before you have to identify as someone who needs help? I am far less interested in what you call it than in whether you do it.

If this feels familiar, you’re probably the kind of person I write for and work with. Learn more about my work and set a 60’ free consultation.