Mind If We Talk?: Bonus Episode: Why Are So Few People in Therapy?

Welcome to a Bonus Episode of Mind If We Talk?

Mind If We Talk? is an original podcast created by BetterHelp and Acast Creative Studios. Hosted by licensed therapist Haesue Jo, this 8-episode series takes a grounded, therapeutic approach to some of life’s most relatable mental health challenges. Each episode features candid, two-part conversations exploring topics like imposter syndrome, grief, procrastination, and setting boundaries. With warmth, clarity, and professional insight, Mind If We Talk? creates space for honest reflection and emotional growth. Whether you're deep into your self-growth journey or just starting out, this show offers comfort, connection, and practical tools for healing.

Bonus Episode: Why Are So Few People in Therapy?

In this special bonus episode, Dr. Sreela Roy-Greene talks about something she sees in her work all the time—and maybe you’ve felt it too. You know therapy helps. You believe in mental health care. But when it’s your turn to ask for help? That hesitation creeps in. This isn’t just a personal feeling—it’s a global one. In their first-ever State of Stigma report, BetterHelp surveyed over 16,000 people across 23 countries about mental health. The findings? They’re powerful—and a little heartbreaking—but also hopeful.

SREELA ROY GREENE:

Hi, I'm Sreela Roy-Greene, a licensed therapist on BetterHelp, and I'm here with a special bonus episode of "Mind If we Talk?" Today, I'm stepping in to talk about something I see in my work all the time, and maybe you've felt it too. You know therapy helps, you believe in mental health care, but when it's your turn to ask for help, that hesitation creeps in. This isn't just a personal feeling, it's a global one. In their first-ever State of Stigma Report, BetterHelp surveyed over 16,000 people across 23 countries about mental health. The findings, they're powerful, a little heartbreaking, but also hopeful.

We'll dig into some major trends, like how three out of four people say it's wise to seek help for your mental wellbeing. Yet only 27% in the US are in therapy. That stat is even lower at 16% in the UK.

While stigma can look different around the world, the hesitation to seek help is something many people share, regardless of culture or country. A little later in this episode, we'll be joined by one of our BetterHelp therapists based in the UK to explore how these patterns are playing out locally and what might help more people feel safe and supported in reaching out. So today, let's unpack what's really preventing people asking for the help they deserve.

Let's start with the tension I find both fascinating and deeply familiar. We love to support mental health from the sidelines, right? We tell friends to go to therapy, repost "check on your people" quotes, maybe even have a mug that says "self-care isn't selfish." But when we are the one struggling, suddenly it's, "I'm fine, just mildly spiraling. Thanks for asking." 

Here's what the data says. Nearly three out of every four respondents surveyed worldwide agree that it's wise for people to seek support, to maintain wellbeing. But nearly six in 10 say that societal attitudes discourage people from seeking mental health help.

And only 27% of people in the United States are actually in therapy. That's the heart of stigma. When belief doesn't lead to action because something in the culture still says, "don't go there," I see it in sessions all the time. Clients will say things like, I should be able to handle this. Other people have it worse, or they hold back because they've spent years being told directly or indirectly that their pain should stay quiet.

Now, let's talk about Gen Z for a moment. They're leading the conversation around mental health more than any other generation, sharing, posting and speaking up. But all the same. They're also carrying some of the heaviest emotional contradictions about it. Here's what the report found.

37% of Gen Z believe that those who seek counseling are mentally weak compared to 27% of Millennials, Gen Xers and Baby Boomers combined. And even among those in therapy, 37% say their therapist doesn't understand them, 33% don't trust their therapist, and 34% admit to not being fully forthcoming in sessions.

They're showing up, but they're not sure therapy is showing up for them. And I get it. I've worked with younger clients who are incredibly self-aware, articulate, and emotionally intelligent, and still deeply afraid that they won't truly be seen. So my question is, what is Gen Z asking for that traditional therapy hasn't delivered yet, and how can we meet them in a way that feels safe, validating and real?

I was having this casual conversation the other day. Somebody said, “isn't your job to tell people what to do?” My response, “no.” My job is to help the other person understand themselves and figure out what they want, not the other way around. I listen and give them grace. That's not something many of us have in this life. I think that is very much the root of the issue. I think that traditional therapists, especially the ones who are “seasoned,” need to remember that what they already know or understand may not be applicable to Gen Z. The tools can still be used, but it's important to change the language, get on the same level as much as you can. While the human experience remains the same, the challenges that Gen Z are experiencing feel different for them. So I think it's important to remember that therapies are for the client, not for the therapist. I think the other piece to this is understanding that Gen Z is more self-aware and informed. So treating therapy as a safe, open, and here's the key word, authentic experience is the most important thing we can do, keeping it real rather than rehearsed or scripted. And lastly, remembering that therapy doesn't quote, fix everything, but it's a way to learn how to fix things for yourself. I thinkx that's a key misconception that needs to be addressed.

Let's take a minute to talk about something that's reshaping how we view mental health around the world, social media. According to the State of Stigma Report, one in five people globally spend over four hours a day on social media. And for many, these platforms have become informal spaces to talk about mental health. They offer visibility, community and connection, especially for younger generations. But here's the paradox, the more time people spend online, the more conflicted they often feel about getting real support. People who heavily use social media are almost twice as likely to feel judged for seeking therapy, 45% more likely to believe therapy rarely solves personal problems, and are more likely to share about mental health online than to speak to a therapist about it compared to those spending less time on social media. In fact, one in four people say they feel more comfortable discussing their mental health on social media than in therapy.

And I get it, posting a story, sharing a meme, or liking a video can feel like a release, like you're saying, "I feel that too." But sometimes that relief is a bandaid, not a breakthrough. It covers the pain, but it doesn't always help us understand or heal it. Another thing we have to be careful with: diagnosis by algorithm. It's easy to scroll through content and suddenly start wondering, "Wait, do I have that?" And while that curiosity can be a powerful first step, it's not a substitute for real evaluation, care or support. Here's what I remind my clients of: being seen isn't the same as being supported, and venting online isn't the same as working through it. Social media might start the conversation, but therapy helps you explore the full story. Because healing doesn't happen in comments or captions, it happens in the quiet intentional work of being heard.

Now let's talk about the environment we're in, because that plays a big role in how safe it feels for us to get help. In the US, nearly half of people say they have a space for therapy, but that drops to 40% for people living with roommates and 36% for those living with older generations.

If you are living in a small, shared space and don't feel like you can even speak freely, you're probably not gonna open up about your deepest struggles. That's not avoidance, that's lack of access. And access isn't just about having a phone or wifi, it's about having the right conditions to make therapy feel doable. That's where socioeconomic barriers come in, because let's be real, solitude is a privilege, time is a privilege, and emotional bandwidth is a privilege, especially when you're in survival mode. If you're a single parent juggling two jobs, childcare, and everything else, carving out 45 minutes to talk about your feelings, it can feel impossible. Among parents of young kids, 63% believe in therapy even when nothing's wrong. But, 34% still think people who go to therapy are different in a negative way, and 47% question whether it even works. So even when people believe in the idea of therapy, there's a wall between that belief and the follow through. And that wall is built from things like housing, money, exhaustion, and fear. Stigma doesn't live in isolation. It's braided into people's realities. If we wanna break it down, we can't just say "get help." Do they have the space to? The time to? Resources to? Emotional safety to?

We've looked at stigma from a few different angles, generational, cultural, emotional, even logistical. So where does that leave us? If you ever hesitated to reach out or worried what someone might think if they knew you were struggling, I want you to know you're not alone. And that hesitation, it's not weakness, it's not failure. It's often the result of living in a society that hasn't made support feel safe or accessible or fully human. But here's the thing, every time we talk about this stuff, we shift the culture just a little. When someone hears you say, "yeah, I've been to therapy," or "I actually wasn't okay for a while," you give them permission to be human too. And that's what this is really about. So maybe today just ask yourself, do I feel supported? And if not, what kind of support would actually help? If you're interested in reading the full State of Stigma Report, you can find it at betterhelp.com.

Earlier, we mentioned that only 16% of people in the UK are currently in therapy, even though the level of emotional need is just as high as it is in the US. In fact, the data shows that Brits report similar rates of anxiety and depression, but are nearly twice as likely as Americans to avoid therapy due to stigma. To help us understand this better, I'm joined by Victoria Wren, a qualified therapist on BetterHelp based in the UK. Thanks so much for being here.

VICTORIA WREN:

You're very welcome, Sreela. It's lovely to be here. 

SREELA ROY GREENE:

So Victoria, I wanted to talk to you a little bit about what's really striking in the report, that 74% of people in the UK believe mental health should be treated just like physical health. And 67% say they're comfortable sharing personal feelings with a therapist that's significantly higher than the 56% across continental Europe.

 That's real cultural progress. The report highlights that the UK is leading a cultural shift in how people talk about mental health, but we're still seeing low therapy participation. What do you think is keeping that gap in place?

VICTORIA WREN:

Hmm. It's very interesting. I think that there definitely has been a cultural shift over maybe the last five years in the UK. There's been a great deal of focus on mental health in the workplace and also in education. So in schools and colleges there's a focus on mental health awareness. So I think that filters through from children and young people to adults or parents. I think that what can prevent people stepping towards therapy can kind of boil down to the fear of the unknown. If you've never done therapy before, you don't know what it's gonna be like, then you are listening to others and what they perceive their experience of therapy has been, and also in the media. And I think what's been amazing with BetterHelp as a platform is that people can access therapy from their own home. They don't need to tell anybody about their journey of therapy unless they want to. So I think that's been a real opening of possibility for lots of people.

SREELA ROY GREENE:

I agree a hundred percent. I think that that's the best part about what we do on BetterHelp, right? It gives people that access. And, you know, there's this idea that asking for help is admirable in theory, but in practice it still feels taboo.

The data shows that UK residents are over 50% more likely than Americans to fear judgment from others for seeking therapy. 

What does that fear of judgment tend to sound like in the therapy room?

VICTORIA WREN:

My feeling is that when I first meet a client, I am aware in those initial stages of maybe fears and anxieties of coming into therapy, so maybe the person has an intuition that therapy can help them in various ways, but then fear of friends and family knowing that they're in therapy or workplace knowing that they're in therapy, or feeling that they may be perceived as ill, or weak, or in some kind of way that isn't positive in their cultural circumstances. But then it's interesting, because people are very supportive of others generally who are seeking help for their mental wellbeing. And so maybe it's just a thing personally.

SREELA ROY GREENE:

I love that you just brought that up because I know even over here in the US, same thing. What's good for you isn't necessarily good for me. I think it's great that you are getting help, but I don't know if that's for me. I hear that quite a bit often in casual conversations that I happen to be overhearing, or social media posts, or whatever the case is. Have you talked to anyone about that? Have you seen anybody about that? Are you asking for help for that? If that questioning got reversed, it's almost like, “oh, I don't need help. I'm okay, I'm good. I already figured it out for myself and I think I already know what I need.” There's almost this resistance, right? And you know, we talk about resistance and therapy and we talk about that I think in a very different way when we have somebody sitting in the room with us. But when that resistance starts even before the person walks in or logs on, in our case, right? It can be really difficult to work through that.

VICTORIA WREN:

Most definitely. And I think the first step is often the hardest. So recognizing the courage that it takes for a person to step towards therapy, it's a real personal choice towards being kind to oneself. So, often we find it easier to be kind to others than kind to [ourselves] to give time to others, but not to [ourselves] to appreciate what others need, but not what we need. And I think therapy is an invitation to turn the spotlight back on the self. And the interesting thing in doing so is that the self-awareness and self-leadership capacities that are generated through working on the self in that way benefit everybody else around. And also in a longer-term sense, [it] often lead[s] towards people stepping into their strengths more and more and more, whether it's career-wise or relationship-wise or community-wise. And so that real courage that's needed to turn the focus back to the self is a first step in creating cultural change as well as personal change, which I am pretty certain most people would see as a positive step.

SREELA ROY GREENE:

I love that you just said that. The courage first off, that it is courageous, you know, asking for help is a sign of courage. You know, we're not good at it because it exposes our vulnerability, right? And the one thing we hate being is vulnerable. And I feel like that's a big part of it, is by admitting I need help taking that first step. But the other side of that, to your point, is it's also showing strength and compassion towards yourself.

VICTORIA WREN:

Most definitely. I completely agree, Sreela. So, that first step of courage towards stepping towards therapy, it's interesting because in therapy, the therapist is told in the space, offering resources, listening carefully and feeding back and mirroring back. But, the client is the one that does the work ultimately. And so, with a therapist, the person is held in a space where they feel safe to be able to do the work they want to do. And so there's complete freedom within that process, which is why I love working on the BetterHelp platform, because I meet so many people from lots of different parts of the world, different generations, different backgrounds, different challenges. But there is, I would say, a few common themes that arise, and self-worth and allowing time and space for ourselves and healing for ourselves are common themes that I work with regularly.

SREELA ROY GREENE:

You know, and I think that, as you were speaking that really stood out to me is that it's funny, you know, the State of Stigma Report showed that these are the areas where we still struggle and this and that. But it's funny, you and I are across the pond from one another, right? And yet we're seeing the same universal themes when it comes to what brings people to therapy across generations, the struggles with, stigma and the impact that has on them, and the importance of self-compassion and carrying and delivering that for yourself. You know, I don't know if you've had this experience, but I've certainly had it where I've had clients sit in front of me and say, this feels so selfish.

VICTORIA WREN:

It's an interesting word, the selfish word. So as if there's something negative about turning the attention towards the self in some way, and the conditioning, it takes a little while to loosen up and change, not necessarily the word, but the perception around the word. And, also what I found very interesting as a therapist is that role modeling is important and whether I can do the work, whether I can give myself time and space and support my own wellbeing.

And so there's an interesting dynamic there, in having the courage to take my own health and wellbeing as a focus, as well as the work that I'm doing with clients. And it seems the more that I do that in balance, the more effective I am at working with young people, children, adults, families, whoever.

SREELA ROY GREENE:

It's very much a part of the, I think, you know, again, we speak of the human condition, right? And so we've become so accustomed to putting our needs last and focusing on the needs of others [that] we forget that if we don't take care of ourselves first, we can't be a resource for other people either.

VICTORIA WREN:

Wise words.

SREELA ROY GREENE:

Whether you're a therapist or a client, it doesn't matter. You're human. And as human beings, it's so important to remember you've gotta take care of you first. There's no other you there is in the world. So, let me ask you this as we wrap up. If someone in the UK is listening right now and thinking, maybe I could try therapy, but I'm still not sure, what would you want them to know?

VICTORIA WREN:

Hmm. That there are ways of stepping towards therapy that can be supportive and gentle and in their way of doing things. So if that way is going in person to an office, that's one way, or if that way is doing it online with an individual therapist, that's another way. My feeling is that with BetterHelp, what's great about BetterHelp is that it's all online and there are so many therapists to choose from. So the client's particular profile is matched with a particular therapist. And if the client isn't happy with a therapist and they can always switch, and that's completely okay. So I feel that the freedom to choose is very strong with therapy. That's what it's all about. So I would say, if you feel ready, take that step. Why not? What is there to lose? Really, you can always say no as well as yes.

SREELA ROY GREENE:

The word that came to mind is, it's empowering, right? You have the empowerment to choose your path, and I think that's a really incredible way of putting it. So thank you so much for joining us today, Victoria, and for sharing your perspectives on "Mind If We Talk?"

VICTORIA WREN:

Aw thank you so much, Sreela. I've loved being here.

SREELA ROY GREENE:

What's clear, whether you're in the US, the US or elsewhere, is that stigma doesn't always shout. Sometimes it's quiet, subtle, dressed up as self-reliance or not wanting to be a burden, but across the globe the need for support is universal, and so is the courage it takes to ask for it. Thank you so much for joining us and for making space during Mental Health Awareness Month to reflect on what still gets in the way of people getting the help they deserve. If this episode resonated with you, consider sharing it with someone else, because when we talk about stigma out loud, we loosen its grip, not just for ourselves, but for our communities too. And don't forget to explore the rest of our series, where we hear from people navigating real life challenges like grief, anger, and family tension, followed by insights from therapists that can help us all feel a little more seen, supported, and understood. Until next time, take good care of yourself and we'll talk again soon.