Therapy for the Burdened and the Bored

Something subtle has shifted in the mental health field, though few inside the profession seem willing to say it plainly. Therapy, once understood as a clinical intervention for real suffering, now increasingly resembles a consumable, another lifestyle accessory among many, curated to match preference and identity rather than employed to transform a life. The shift did not happen all at once. It has been slow, incremental, and mostly unspoken. But it has changed what therapy is for, who it serves, and what therapists are expected to provide.

I find myself grieving that change, not because I imagine a lost golden era of pristine clinical practice, but because of what the shift reveals about us as a culture. We no longer seem to understand suffering, responsibility, or transformation. We prefer consolation to change, and validation to confrontation. Therapy has followed suit. The market rewards comfort, and comfort is now misinterpreted as care.

When I first entered the field nearly twenty-five years ago, the work was difficult in the way it was supposed to be difficult. Clients arrived burdened by trauma, anxiety, depression, suicidality, and the complicated defenses that accompany such histories. They didn’t come for comfort; they came because life had become untenable, because they were frightened of their own minds, or because their relationships were collapsing under the weight of unexamined pain. Therapy was chosen reluctantly, sometimes desperately. It was work: hard, disorienting, humbling work, and the goal was not catharsis but change.

Or maybe I’m wrong. Maybe it has always been like this, and I simply chose the suffering to work with. That is not grandstanding. It is simply trying to understand.

The contemporary landscape is something else entirely. The majority of therapy now exists under the gravitational pull of consumer psychology. The client becomes the customer, the therapist becomes the service provider, and the session becomes the product. And in a market logic, the customer is always right. Except clinically, the customer is often very wrong, and indulging that wrongness can be disastrous. But the market does not reward what the clinic demands.

Just recently, I encountered a professional announcing what she described as a “new and innovative” model of mental health care: drop-in therapy sessions, thirty minutes at a time. The framing was celebratory. People in the comments praised it as compassionate, accessible, and novel. Some even invoked Yalom, as though brevity and convenience were synonymous with depth and existential orientation.

I asked a different set of questions. How do you assess for acuity in thirty minutes? What happens when clients return for repeated “one-off” encounters? At what point does a drop-in become treatment? And if it does, who holds responsibility for continuity of care, trajectory, and outcome?

What struck me was not the model itself but the logic beneath it. Therapy had been reimagined as a kind of psychological quick-serve: something to be consumed for the sensation of being heard, without the burden of sustained work. I imagine the Tootsie Pop owl taking lick after lick. Consume consume consume. And, the response I received was telling: a reassurance that informed consent and a strict protocol secured the process. The subtext was unmistakable. If the paperwork is clean, the model is justified. In other words, therapy as liability management rather than therapy as transformation.

I felt a kind of quiet revulsion, less at the professional and more at the cultural landscape that made such a model feel inevitable. We no longer ask whether an approach cultivates change, resilience, or responsibility. We ask whether it feels good, scales well, and protects the institution from risk. That is not innovation. It is the commodification of what was once sacred.

Now shift to two kinds of clients that have surfaced repeatedly in modern practice. They are archetypes, not individuals, though many clinicians will recognize them immediately.

The first is the burdened. These are the clients for whom therapy was originally designed. They arrive suffering, sometimes unbearably. Their histories include complex trauma, attachment ruptures, grief, debilitating anxiety, rigid self-structures, suicidality, shame. They are not seeking comfort so much as coherence. They want their minds back. They want to live without dread. They want to stop replaying childhood in their adult lives. They do not need therapy to validate their feelings; their feelings already dominate them. They need therapy to help them think.

They work. They read. They confront distorted beliefs. They take psychoeducation seriously. They engage in exposure. They attempt homework. They relapse and return. They assume responsibility for their part of the struggle, even when it terrifies them. And over time, measured not in emotional highs but in behavioral shifts, they change. They grow more capable and more flexible. It is not glamorous, but it is sacred. It is why the field exists at all.

The second archetype is the bored. This is the quiet catastrophe of modern therapy, though the industry pretends otherwise. These clients often present without diagnosable symptoms, without impairment, and without any real desire for transformation. Their distress is existential, but not in the deep sense. There is no confrontation with meaning, mortality, or responsibility. It is boredom disguised as suffering. Therapy becomes a weekly ritual of complaint, attention, and self-justification. Nothing is learned because nothing is risked.

The bored do not read. They do not complete homework. They do not engage in cognitive or behavioral change. They want listening, validation, and sympathy, and when a therapist introduces responsibility or confrontation, they often respond not with curiosity but grievance. Therapy, for them, is not a path but a performance. The goal is not to change the conditions of the self, but to be seen suffering without having to earn the dignity of struggle.

It is this second clientele that has grown alarmingly prominent in the therapy marketplace. They require far less clinically, but demand far more interpersonally and rhetorically. They are the ones most likely to treat therapy as a subscription service, something consumed rather than endured. They extend the logic of customer satisfaction into the domain of the psyche. And when satisfaction is not achieved, they escalate, sometimes passively through withdrawal, sometimes actively through increased attention seeking.

There are therapists who will counter that all clients deserve unconditional regard, that boredom is merely a cover for deeper wounds, and that every human being must be met with a nonjudgmental stance. I do not disagree with the value of compassion. What I dispute is the collapsing of compassion into indulgence, and the assumption that validation will eventually lead to transformation. It rarely does. In fact, endless validation often becomes a defense against change. It keeps the self intact by shielding it from self-implication.

Therapy, at its best, is a structured confrontation with the self. Not confrontation in the adversarial sense, but in the sober recognition that one’s thoughts, beliefs, patterns, and behaviors must be examined if life is to become more bearable. The work requires humility, curiosity, and responsibility. It demands that a person participate in their own restoration. The burdened understand this instinctively because their suffering leaves them no alternative. The bored avoid it because it threatens the comfort of grievance and the pleasure of being aggrieved.

I am not infuriated by this shift so much as I am grieved by it. Therapy is being cheapened, not by malice, but by consumer logic. The commodification of mental health has made it palatable, marketable, and endlessly accessible. But in the process, we have made it unserious. The field increasingly resembles a spa for the psyche, a place to unwind rather than a place to confront. It is no wonder that the bored find it appealing. Transformation is too demanding; consolation is easier, and far more fun to discuss publicly.

But consolation is not a therapeutic value; it is a cultural one. We have become a society that treats discomfort as pathology and suffering as injustice. We do not ask what pain is for, only how quickly it can be relieved or reframed. It is no surprise that therapy has absorbed this reflex. The bored thrive in such an environment because boredom is the absence of necessity. Without necessity, suffering becomes aesthetic.

Transformation has a cost, and that cost is out of fashion.

To change is to relinquish grievance, to take responsibility for one’s part in the story, to confront the gap between who one is and who one could become. Consolation requires none of this. It flatters the self. It preserves identity. It allows the bored to experience the sensation of depth without the labor of excavation. That is why the bored prefer indulgence over integrity: indulgence asks nothing of them.

When therapy abandons seriousness, it loses integrity. I do not mean ethical integrity, though that too suffers. I mean existential integrity, the alignment between purpose and practice. Therapy that cannot bear weight cannot bear suffering. And suffering, unlike boredom, demands something of us. It demands work, humility, and responsibility. It demands that we leave the session with a task, not a performance.

This is the part no one wants to say out loud: the field is unlikely to return to seriousness. The incentives are misaligned. The culture rewards visibility, identity, grievance, and novelty. The marketplace rewards accessibility and ease. None of these forces reward transformation, or at least few. This is not nihilistic, it’s reading the current culture through a realistic lens.

When an entire field organizes around consolation, it cannot help but drift toward a form of simulated intimacy. And simulated intimacy is easy to sell. Look to the world’s oldest profession. Yes, that one.

It is frictionless. It scales. It attracts the bored and reassures the institutions that regulate it. But simulated intimacy has no weight. It cannot hold a suicidal mind. It cannot help a traumatized indivdiual stop reenacting their childhood. It cannot interrupt the physiology of panic or the rigidity of shame. It cannot reorient a person toward reality.

I do not believe the field was corrupted by bad people or bad intentions. At least that is what I hold out hope for. It was softened by comfort. It was lulled by consumerism. It was seduced by the applause that comes from being relatable rather than the silence that comes from doing difficult work with those who are suffering.

Every generation inherits the assumptions of its culture. We happen to live in a culture that avoids suffering, worships convenience, and treats responsibility as either oppressive or optional. Under such conditions, the bored will always outnumber the burdened. The bored will always have louder voices and larger platforms. And the industries that serve them will always become unserious.

To hope that therapy alone could resist such forces is to misunderstand culture. Fields do not exist outside of their era. They are shaped by it, rewarded by it, and eventually absorbed into it. In that sense, the field as it once existed: serious, weight-bearing, transformative, is already gone. Its remnants persist in pockets, in individual rooms, in quiet corners of private practice or the rare inpatient unit. But as a cultural institution, it has surrendered its integrity. What a dire picture I’ve just written.

I do not write this to mourn the field. I am not interested in nostalgia. I do not believe the past was pristine or that elders were wiser. I am simply acknowledging that therapy has become something different than what it was for me, and for the clients I was trained to serve. The burdened still exist. They always will. But they are no longer the imagined beneficiaries of the industry. They are the outliers.

This realization has forced me to make a decision about my own work. If the field is unserious, then seriousness can no longer be assumed. It must be chosen. If integrity is not rewarded, then integrity must be practiced without expectation of reward. If transformation is no longer the telos of therapy, then it must become the telos of my therapy, quietly, without applause, without argument, and without any illusion that the culture will care. And often a decision made with an enormous bullseye on my back.

I do not harbor fantasies of reform. Or that is exactly what this piece is about-fantasizing about some sort of total reform where the burdened are the focus. I do not believe a manifesto will restore the field or that legislative interventions will resurrect complete existential integrity. One can hope. Culture does not move backward, and the market does not repent. The bored are not going anywhere. They will continue to consume therapy for the experience of being heard, and the field will continue to congratulate itself for its accessibility.

I cannot control that. I cannot save the field. I cannot make the world take suffering seriously. But I can take seriousness seriously. I can choose to work with the burdened, even if they are fewer. I can choose to teach responsibility instead of grievance, even if grievance is more fashionable. I can choose to labor in the direction of transformation, even if transformation is out of season.

There is a particular dignity in doing work that no longer interests the wider culture. It is not martyrdom and it is not moral superiority. It is simply fidelity to what is real. The burdened do not care whether therapy is accessible or novel or relatable. They care whether it helps them remain alive. They care whether it restores agency, coherence, and sanity. They care whether it teaches them how to suffer in a way that does not collapse their lives.

Those are the clients I choose. Not because they validate me or make me feel useful, but because their suffering demands seriousness. They remind me why therapy existed in the first place, not as a place to perform one’s story, but as a place to confront it.

The field may be unserious, and the culture may be allergic to burden, but the burdened remain. They do not advertise their work on social media. They do not congratulate therapists for being innovative. They do not quote Yalom in the comments section of marketing posts. They walk through the door quietly and ask a version of the only question that ever mattered in this work: 

“Can you help me think clearly enough to live?”

I do not know what will become of the field. I suspect it will continue to soften, to console, and to curate. I suspect it will become more visible and less useful. I suspect it will become a form of paid companionship for the bored and a kind of self-care accessory for those who enjoy the performance of depth without the cost of change. That is the culture’s prerogative.

My task is smaller. I will continue to practice as though therapy still has integrity. I will continue to believe that suffering is not an aesthetic, that transformation is not optional, and that responsibility is not cruelty. I will continue to work with the burdened because they remind me that seriousness is not dead; it is simply out of fashion.

Perhaps the field will rediscover integrity someday. Perhaps it will not. Either way, I will remain where the work is, even if the world is elsewhere. I do not need the field to be serious for me to be serious. I only need the suffering to keep showing up. And they do.

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Author’s Note

This essay began after a client sent a text that made me tear up. Not from praise, but from recognition: the work still matters for those who are working. At the same time, I found myself angry at others who treated therapy as a consumable and me as a product. I contributed to that dynamic by softening when I should have remained clinical. The field told me compassion was enough. It wasn’t.