Ask people what keeps them from trying therapy and the honest answer usually isn't money or scheduling. Research has said it plainly for years: the most-cited barrier is concern about how others will see them. Not the couch — the optics. Which means stigma isn't a side issue in mental health care. It's the front door, and for a lot of people it's stuck.

I think therapists must lead the way on unsticking it. Here's what that looks like in my practice — and in my life.

I ask about the fence

At the start of every counseling relationship, I ask what the person believes about seeking help. Some arrive clear-eyed. Others carry assumptions absorbed from family, church, locker rooms, group chats: therapy is for broken people, strong people handle it themselves, once you start you never stop. I ask because those beliefs, unexamined, sit in the room with us — and because therapy can feel like a scary concept, let alone a reality. Naming the fear is the first thing that shrinks it.

In my experience there are usually two voices on that fence. One is genuinely curious about growth — it's the voice that got you reading this. The other is fear-based, and it argues for staying comfortable and unexamined. You get to choose which one to take advice from.

Nothing about you gets decided without you

Part of stigma is the fantasy of the therapist as a silent evaluator, privately concluding what's "wrong with you." In my office, nothing runs that way. One quiet advantage of a private-pay practice: no insurance company requires a diagnosis before we're allowed to work together, so nothing gets labeled for billing's sake. And when a diagnosis genuinely is useful — because naming a pattern can be clarifying, even freeing — we look at it together, openly. A diagnosis is a shared language for symptoms that travel together. It's a map label, not a verdict, and you're holding the map too.

The best stigma-buster I know

Here it is: I go to therapy, and I say so. To clients when it's helpful, to friends and colleagues, occasionally to a stranger in the checkout line at the beach Publix who got me talking. Every time a therapist talks openly — even proudly — about being in therapy, stigma takes a direct hit.

Because most clinicians I've met are, after all, quite human. We are not immune to the things we treat. Sitting on the other side of the couch keeps me honest about how hard it is to hand your vulnerable parts to a relative stranger — and it shows, better than any brochure, what a person who seeks help looks like. They look like everybody.

Stigma survives on silence. It has no defense against ordinary people saying "yes, I go."

So if you're on the fence: you don't need a crisis, a diagnosis, or a rock bottom to justify the climb. As I tell my new clients — therapy is an experiment. If the status quo isn't working for you, give it a shot and see what happens. The first conversation is a free phone call, and the fence looks smaller from the other side.

Mandy first explored these ideas in “The Best Way Therapists Can Decrease the Stigma of Being in Therapy,” published on GoodTherapy.org. This piece is a new take, written for life here in Florida. It’s education, not a substitute for care from a licensed clinician.