What brings people to therapy?
That is an excellent question, and one I work to answer each time I meet a new client.
The first thing I assess is how someone views therapy, as this often reveals how aligned or close they are to change. For many, there is a belief that something must be “wrong” with them, or that they are broken. To face this fear would be to validate every negative thought they have carried about themselves. As Phil Stutz describes, the shadow, the parts of ourselves we try hardest to hide, that we feel we would be judged harshest (or have been in the past) for, continue to confront us.¹
This, however, is not how I, or most mental health providers, view clients. Instead, we see the whole person as greater than the sum of their parts. You are not inherently broken, rather, strategies that once worked for you may no longer serve you, the support you need might be missing, or shifts in your life roles may leave you feeling lost in your sense of self.
Each of us carries a wide range of experiences that shape how we see ourselves. From those experiences, we take in messages and form behaviors, sometimes to protect, sometimes to soothe. These behaviors may help us find significance, maintain comfort, manage relationships, or, at times, simply survive. Yet, a behavior only works until it does not. That breaking point is often what brings people into therapy.
We develop behaviors in response to triggers, which activate physical reactions tied to past memories or events. Trauma responses are our body’s physical reaction to something that pulls us back into the past. The same instincts our ancestors used for survival are still with us, although the threats today are less physical and more emotional or psychological.
Dr. James Doty, a neurosurgeon and founder of Stanford’s Center for Compassion and Altruism Research and Education (CCARE), teaches that disconnection, threat, and isolation keep us in a constant state of fear.² These triggers often stem from past trauma and our brain’s built-in negativity bias, and we create behaviors and elaborate masks that we will utilize to fit in, to somehow feel connected, it is how we attempt to avoid the threat we perceive.
Trauma expert Dr. Gabor Maté explains: *“Trauma is not what happened to you, but what happens inside of you as a result of what happened.”*³ Trauma does not need to be a “big T” event to qualify, it is any internal wound that lingers. What overwhelms one person may not overwhelm another. Our bodies adapt, forming protective behaviors, whether through hypervigilance, dissociation, emotional dysregulation, or even physical symptoms like chronic pain, fatigue, or digestive issues. These once-protective strategies can later pull us back into old wounds, making us respond as if the event is happening all over again. Dr. Doty calls this a “fear narrative,” an ingrained sense of threat that shapes our behaviors and beliefs about ourselves and the world.²
Our broader culture also impacts how we experience connection. For example, when my family and I moved into our home this past year, I realized after living here about 6 months I had not met either of my neighbors. As a child, I knew every kid on my street yet now have to move with greater intention in order to feel connected. Historically, humans lived in tribes or villages with deep communal bonds. Today, we often live disconnected, interacting only through curated images or comparisons rather than authentic connection. This disconnection stirs envy, jealousy, despair, and inferiority. Surrounded by people, yet lacking depth in relationships, many feel insecure or inadequate, and try to fill that emptiness in unhelpful ways.
Isolation often takes root in guilt and shame. Guilt is the remorse for actions or inactions that have harmed another, and it points us toward accountability, it points us to behaviors we can adjust. Shame, on the other hand, tells us I am bad and corrodes our belief that we can change. Brené Brown defines shame as *“the intensely painful feeling or experience of believing we are flawed and therefore unworthy of love, belonging, and connection.”*⁴ Shame pushes us into isolation and convinces us we are a burden.
Brown’s research shows that while guilt can be resolved through accountability, shame cannot survive when it is met with empathy and vulnerability.⁴ Many clients fear that revealing their scars will confirm their unworthiness. Yet, when they share openly with someone trustworthy, they are often met with compassion instead of rejection. That moment of being seen, without the other person looking away, diminishes shame’s power. Sharing does not erase the wound, but it makes it lighter. The weight, it turns out, was not the shame itself but the loneliness of carrying it alone.
Every trigger is the anticipation of a threat. Our negativity bias keeps us scanning for danger, which is why fear-driven media, whether social, news and advertising, is designed holds our attention so tightly. When a trigger pulls us back into a wound, whether powerlessness, humiliation, or abandonment, we relive those feelings repeatedly. To avoid them, we create behaviors to bury or project them and are always taking in negative information to avoid them.
A trigger can be anything, a song, a smell, a phrase, a loud noise, or even silence. We cannot control when we are triggered, but we are responsible for how we respond. Avoidance keeps us stuck. Clinically, we call the process of healing extinction, gradually exposing ourselves to the stressor while using grounding and coping skills to move through it.
It is like entering a cold swimming pool. Being thrown suddenly into the deep end leaves us panicked and desperate never to return. But if we step in gradually, we allow our body to acclimate. At first the water is uncomfortable, but over time we can tolerate it. Eventually, we can swim freely in the same water that once overwhelmed us. The temperature never changes, just as the intensity of an emotion never truly changes. What changes is our capacity to remain present and functional within it. Extinction works the same way, our tolerance increases as we turn toward the emotion instead of avoiding it.
The work of moving through trauma is centered in the messages we internalize from the incident itself. The real question becomes: What does this wound say about me?
In working through my own history, I confronted a phrase that surfaced after I was terminated from a position under deceptive pretenses: “I am not the guy.” That message replayed whenever I encountered similar stressors, carrying with it feelings of failure, humiliation, and powerlessness. To protect myself, I avoided situations that could expose me to the possibility of failure again, becoming stuck, and in many ways numbing the pain that arose whenever a trigger appeared.
Finding and reframing that message became a turning point. It wasn’t that I wasn’t the guy it was that I wasn’t his guy. That shift communicated more about him, his choices, and his character and the unsavory manner he went about removing me, than it did about me. If I could begin (which sounds simple, though it is profoundly difficult) to hold that perspective, his behavior became less a reflection of my worth and more about his his character, his insecurity.
This is the heart of trauma work. We cannot change what has happened, but we can begin to affect the meaning those messages hold. By reframing, we move beyond roles, failures, and the negative narratives we’ve carried from painful experiences, toward a story that we author ourselves.
So, what brings people to therapy? Not because they are broken, but because the behaviors that once protected them now keep them stuck in cycles of isolation, threat, and disconnection. In therapy, we learn to ground ourselves, cope effectively, and build a team of supportive relationships that meet shame with empathy. Over time, we discover that while we cannot control the world around us, we can control how we respond to it.
Healing, then, is not about erasing the past or pretending it did not shape us. It is about reclaiming the meaning of our experiences and allowing ourselves to write a new narrative. The old wounds may remain a part of our story, but they no longer have to dictate the whole story.
Therapy provides the space to practice this new way of engaging with ourselves and others. Little by little, we learn to trust that our worth is not defined by failure or shame, and that connection and compassion can be stronger than fear. In this process, we are not trying to become someone else; we are learning to return to ourselves, with greater clarity and resilience.
That, to me, is the real work of therapy not fixing what is “broken,” but creating room for growth, connection, and the possibility of living more fully aligned with who we truly are.
Footnotes
Stutz, P., & Michels, B. (2012). The Tools: 5 Tools to Help You Find Courage, Creativity, and Willpower—and Inspire You to Live Life in Forward Motion. Random House.
Doty, J. R. (2016). Into the Magic Shop: A Neurosurgeon’s Quest to Discover the Mysteries of the Brain and the Secrets of the Heart. Avery.
Maté, G. (2022). The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture. Avery.
Brown, B. (2012). Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead. Gotham Books.