Therapy Shame: How Feelings Of Shame Affect Mental Health Care-Seeking
If you are struggling with substance use, contact the SAMHSA National Helpline at 1-800-662-HELP (4357) to receive support and resources. Support is available 24/7.
While therapy has become more mainstream in recent years, shame and stigma around mental health care still exist. The fear of judgment from peers and loved ones may prevent people from seeking support—which can be problematic especially for those experiencing depression, anxiety, eating disorders, and other mental health concerns, since a range of therapy interventions can improve mental well-being. Here, we’ll explore the concept of therapy shame, how it impacts mental health, and tips for overcoming shame around therapy in order to seek support.
Understanding therapy shame
For some, therapy shame involves the belief that seeking support means they’ve failed, while others may believe it makes them look weak. According to BetterHelp's 2025 State of Stigma report, 37% of the Gen Z population report believing that those who seek counseling are “mentally weak.” While this means that the majority of individuals in this age group may not have negative feelings toward those who seek therapy, 37% is still a significant portion of this population who may not seek care due to stigma.
Where does therapy shame come from?
There’s a long and complex history of mental health stigma in general in the US and across various cultures. Gaining a deeper understanding of it may help us understand the landscape today.
Key aspects of this past include the historical pathologization of those who are different, practices of forced institutionalization, and many others, intertwined with racism, sexism, and socioeconomic inequality. Certain cultural beliefs (such as a focus on keeping a “stiff upper lip” or prizing individualism above all) and media portrayals often perpetuate this stigma. While advocacy work and an increase in the availability of information have helped decrease mental health stigma in a variety of ways, this deep-rooted prejudice still affects many people today.
What does stigma around therapy look like?
Stigma around mental illness and, by extension, stigma around seeking therapy has been persistent for generations. In addition to and as a result of feeling its effects from peers, media, and other influences, people may also unconsciously experience stigma within themselves. Research suggests that internalized stigma delays people from seeking care. Either way, therapy stigma tends to take a few different forms, such as the following.
Negative thoughts and feelings of shame
Even if nobody else is judging them, some people may experience negative thoughts and feelings of shame inside themselves related to seeking mental health support. Examples of such distorted thoughts may include:
- “I should be able to handle this on my own, without help.”
- “What if someone finds out I’m going to therapy?”
- “Other people have it worse, so help isn’t necessary for someone like me.”
These thoughts often center around comparison with others, fear of what others might think, and the idea that problems should be handled alone. Learning to recognize “shameful” emotions and shame-related thoughts like these and push back on them can be an important component of rejecting stigma in one's own life. It can also be important to remember that anyone can seek therapy for any reason, you don't have to have signs of a serious mental health condition to seek support, and there's no shame in reaching out for help.
How feelings of shame can impact mental health
The American Psychological Association defines shame as “a highly unpleasant self-conscious emotion arising from the sense of there being something dishonorable, immodest, or indecorous in one’s own conduct or circumstances.” It’s typically not just a passing thought or feeling, but rather an internal belief that shapes how individuals think and act in day-to-day life.
Shame itself can cause distress, self-blame, self-criticism, and a sense of worthlessness, which can sometimes contribute to or exacerbate depression, anxiety, or a substance use disorder (formerly referred to as a “substance abuse disorder”). Personal feelings of shame—which can be reinforced by cultural factors like media or peer feedback—can also make a person feel “too flawed” for therapy to help, or too embarrassed to seek support.
The consequences of hiding your feelings because you feel shame
When you feel shame related to mental health, you might feel like hiding your feelings and struggles from others. Since shame thrives in silence, doing this may negatively impact a person’s everyday functioning—especially in terms of mental health and interpersonal relationships. For instance, one study suggests that hiding mental health struggles can lead to loneliness, isolation, and negative relational experiences. Out of fear of being rejected, a person may decide to avoid sharing their negative feelings and mental health symptoms with anyone, even their closest loved ones.
Shame as a barrier to seeking mental health care
One of the major potential consequences of shame is that it often discourages people from seeking therapy when they’re experiencing mental health challenges. It's just one more reason why combating mental health stigma and shame as a society could lead to improvements in outcomes for many.
Common misconceptions about therapy
Misinformation and misconceptions can perpetuate therapy shame and stigma. Some common misconceptions around therapy that may make a person less likely to seek help include:
- “Therapy is only for people with a mental illness.” (False) Virtually anyone has the potential to benefit from mental health therapy, whether they're experiencing signs of a mental health condition or are struggling with grief, low self-esteem, major life transitions, or relationship conflict.
- “All a therapist does is listen.” (False) Therapists are trained in specific, evidence-based methods of talk therapy, which typically involve a back-and-forth dialogue as well as practical strategies for the client to implement.
- “Therapy is only for rare/serious cases.” (False) According to some statistics, almost 22% of US adults received therapy or other mental health treatment in 2021. The source reports that the number would likely be higher if availability of healthcare was improved, particularly for marginalized populations. In other words, millions of people already engage in therapy, as it’s more common than some might think.
Spreading accurate information and pushing back against these untrue and potentially harmful misconceptions may help reduce therapy shame and stigma.
Are views around therapy changing?
Despite persistent stigma, it is true that views around therapy seem to be changing. Especially since the pandemic began, the number of people seeking therapy has been on the rise. Advancements in technology that allows for virtual therapy have made it easier to seek care. An increase in the availability of mental health information thanks to the internet and social media have encouraged more open conversations about mental health. As a result, more people are beginning to advocate and raise critical awareness for therapeutic care, which may help the general population view therapy more positively over time.
Seeking therapy for mental health conditions, from anxiety to eating disorders
As well as supporting people who are facing challenges at work, at home, or in their relationships, therapy can be a valuable tool for treating specific mental health conditions like anxiety, eating disorders, depression, and others. In fact, such conditions often will not resolve without professional support. A therapist can create a safe and nonjudgmental environment for treating various concerns, which may help reduce the impact of shame and support self-compassion, self-forgiveness, self-esteem, and personal healing.
Therapeutic tools for addressing shame in eating disorders, depression, and other conditions
Researchers have identified the fact that shame often plays a role in the development of certain mental illnesses. For those who feel ashamed often, a therapist might use a specific approach to address it as part of a broader treatment plan.
One example is shame resilience therapy, which is based on shame resilience theory. This approach may help clients identify and process feelings of shame, potentially leading to improved mental health, nervous system functioning, and emotional balance. Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) are examples of other methods that may also be helpful.
Online therapy for those who feel shame around seeking mental health care
Again, there should be no shame in seeking mental health support like therapy, and it can actually be a sign of self-awareness and strength. That said, feelings of shame and other effects of stigma related to mental health can be very real for those who experience them. In such cases, meeting with a mental health care provider online may feel more approachable than meeting with a provider in person.
With online therapy, an individual can connect with a licensed therapist virtually, through audio, video, and/or in-app messaging. For those struggling with therapy shame, attending therapy sessions virtually from the comfort of home may be more comfortable than traveling to in-person appointments in one's own community.
With an online therapy platform like BetterHelp, a person can get matched with one of over 30,000 licensed therapists, each offering different forms of compassionate care. Clients are also allowed to switch therapists at any time for no additional cost if needed until they find someone they can feel comfortable with.
The research on online therapy
In recent years, there have been many different studies on whether online therapy can be effective, and the majority of the evidence indicates that it can. For example, consider the findings of a 2021 study which suggest that online therapy is “no less efficacious” than traditional in-person care in many cases.
Takeaway
Is going to therapy shameful?
No; there's no shame in attending therapy. Doing so is simply a way of reaching out for help, which can be a sign of strength, self-awareness, and dedication to finding ways to manage your own well-being.
How do you get rid of shame in therapy?
Reducing stigma-related shame around attending therapy can be a gradual process. It might help to read statistics about therapy, such as how many millions of people already attend and benefit from it. You could also try speaking to people or reading stories about people who have overcome stigma and found valuable support through therapy. If a husband, friend, colleague, or family member is making you feel ashamed for wanting to seek professional support, setting a boundary around this topic may be necessary.
Why do I feel shame after therapy?
Stigma around seeking mental health support is deep-rooted in today's society, according to a wealth of grounded theory study papers. This may affect individuals by making them feel shame for reaching out for help. Or, if a mental health care provider is the one making you feel ashamed, they may not be a quality professional and it could be beneficial to accept this and switch providers as soon as possible.
Can you talk too much in therapy?
Therapy is your time, so you can spend it in whatever way will be most beneficial to you. That said, it could be helpful to generally aim for a sense of dialogue between you and your therapist so that they can offer guidance. If you're concerned about the structure of your therapy sessions, you might bring this concern to your provider.
Why am I embarrassed to cry in therapy?
We live in a world where expressing emotion is often stigmatized, which can cause a sense of shame. In many cases, shame brings difficulties in a therapy setting and beyond. For this reason, it can be normal to feel embarrassed when crying in therapy, even though there's no shame in showing emotion. If you're concerned about these feelings, it might be helpful to share them with your therapist so you can work through them together.
How do therapists deal with shame?
Many therapists who work in contemporary social services today have training or expertise in how to help their clients address shame. It's often a gradual process of unlearning cultural messages about various topics.
What does shame look like in therapy?
Shame in therapy can take many different forms. Some common examples include self-censoring due to stigma around being vulnerable and showing emotion as well as self-punishment and resulting suffering for mistakes or shortcomings. A therapist or clinical psychology provider will typically be trained in noticing these signs and helping a client feel safe enough to cultivate a sense of personal power in order to work through them.
How to get rid of shame in therapy?
Finding a connection with a qualified therapist can be an effective way of addressing shame. The approaches they use may vary, but it often involves a gradual process of unlearning and practicing self-compassion.
Can therapy make you feel worse before you feel better?
It often takes a bit of time for therapy to start helping a person feel better. This can be especially true for those who are resistant to treatment or feel shame around seeking help, as the process of strengthening one’s ability to reduce these barriers could feel challenging at first.
What are the symptoms of shame in therapy?
Shame can take many different forms in a therapy client. For example, a person might censor themselves, feeling unable to express the truth and reality of their feelings due to shame for showing signs of strong emotions. Or, they might do harm by being harsh with themselves for shortcomings around their own human imperfections, feeling unworthy of grace and experiencing a sense of guilt for their automatic thoughts or capacity to make a mistake.
- Previous Article
- Next Article