Therapy for the Greater Good
By Dr. Kimberly Sogge, C.Psych.
A respected colleague recently argued in The New York Times that therapy has become “the default prescription for all forms of unhappiness” — that people without clinical symptoms, the lonely and the stressed and the grieving, might be better served by community than by the consulting room (Lieberman, July 5, 2026). There is real wisdom in my colleague’s caution. No one should pathologize ordinary sorrow, and no therapist should pretend to be a substitute for friendship, belonging, or a vibrant, functioning society.
Not long after the article appeared, a client asked me — with a tinge of sheepishness — what I thought of it. The question underneath was plain: Do I deserve to be here?
I told them what I believe: that they were not in therapy only for themselves.
Each of us has a responsibility, to ourselves and to our communities, to cultivate our gifts and become a positive influence in the world.
The scarcity argument — that access to therapy should be limited to the most symptomatic — rests on a premise we should question: that therapy’s proper business is the treatment of symptoms, and that a person without prominent symptoms therefore has no business in therapy. As a psychologist who has offered care across the healthcare spectrum, from schools to community clinics to tertiary care hospitals, I believe this understanding of therapy as symptom-reduction technology gets the history of psychotherapy wrong and confines the work to only the most painful range of human experience. It also gets the relationship between therapy and community wrong.
Here is my thesis, plainly: therapy and community are not rivals. Good therapy supports healthy community, and healthy communities support good therapy. Each is the other’s precondition, and a society serious about human flourishing will invest seriously in both.
Therapy was never only about symptoms
First, the history. Psychotherapy has always carried two lineages. One lineage of psychotherapy is biomedical, going back to Bleuler and others: this lineage sought to establish psychotherapy as a science, it focused on illness and the relief of disorder, systematizing patterns of symptoms and applying the Western medical model to suffering that arises from the brain, the nervous system, or the internal conflicts from within rooted early in development. I value this tradition and was trained in it as a scientist practitioner. The other lineage of psychotherapy is far older and far more indigenous; this other lineage runs through contemplative and philosophical traditions in many cultures — the deliberate cultivation of the most noble qualities of human character. Aristotle called the aim of the second lineage “eudaimonia”: a flourishing that is not the absence of pain but the presence of virtue exercised well. The Stoics understood their practices as therapy for the soul. Buddhist traditions built systematic curricula for training the heart — the Four Limitless Qualities, for example: lovingkindness, compassion, joy, and equanimity. East and West alike developed entire technologies for training the best qualities of the human mind, transforming fear into courage and dissolving self-preoccupation into generosity and compassion. As a clinical psychologist and therapist I also value this tradition, and belong to organizations such as the Society for Contemplative Research (link here) that seek to build bridges between Western science and contemplative traditions. The ISCR website states: “We understand contemplative research to be the scholarly and scientific investigation of meditative and other mind-body practices and their clinical and pedagogical applications”.
Can we reconcile the differing aims of the root lineages of psychotherapy?
There are many reputable researchers seeking to build bridges between the two healing traditions i describe here. A significant swath of modern psychology has quietly rejoined that older more indigenous lineage, carrying contemplative technologies out of the temples and into Western research laboratories, coupling thousands of years of experience in mind training with rigorous neuroscience. For example, at the Center for Healthy Minds at the University of Wisconsin–Madison, Dr. Richard Davidson and his colleagues have spent more than two decades demonstrating that wellbeing is a set of trainable skills. In one landmark study, just two weeks of compassion training measurably increased altruistic behaviour toward strangers — participants gave up more of their own money to help a victim of unfairness — with corresponding changes in the brain’s circuitry for empathy and emotion regulation (Weng et al., 2013). The Center for Mindful Self-Compassion has translated Dr. Kristin Neff’s research into a structured eight-week program whose randomized trials show durable gains in self-compassion, mindfulness, and life satisfaction (Neff & Germer, 2013). In the United Kingdom, Dr. Paul Gilbert’s Compassionate Mind Foundation has built Compassion Focused Therapy on evolutionary and affective neuroscience, with a growing evidence base for reducing the shame and self-criticism that keep people from connecting with others. Stanford’s Center for Compassion and Altruism Research and Education developed Compassion Cultivation Training, shown in controlled studies to increase compassion for others and reduce the fear of receiving it (Jazaieri et al., 2013). And Harvard’s Human Flourishing Program, under Dr. Tyler VanderWeele, has made flourishing itself — meaning, character, close relationships, not merely the absence of pathology — a measurable scientific outcome, now tracked across more than twenty countries in the Global Flourishing Study.
Notice what these integrative research programs have in common. None are purely in the business of DSM-5-TR categories or symptom reduction alone. Most are building research-based methods for cultivating the noble qualities of humanity: compassion, courage, wisdom, purpose, connection. Decades of converging research — on psychological flexibility, values-based living, post-traumatic growth, the trainability of compassion — tell us something a purely symptom-focused model cannot: human beings do not merely return to baseline with treatment. Given the right conditions, they grow. Rather than being crushed by suffering, they become more courageous, more honest, more generous, wiser.
I would gently suggest that psychotherapy for those without diagnoses is not indulgence for the “worried well.” It is a practice ground for human transformation. Where else in our present moment contemporary culture is a person invited — required, even — to turn toward what they most want to avoid, to tell the truth about themselves, to take responsibility for their patterns, to clarify what they stand for, and then to act on it, for their own good and for the good of their community? That is not a clinical procedure for removing illness. It is a continuation of the oldest human disciplines, and it builds the oldest human virtues. Unfortunately, in a time of polarization and online nurture funnels, communities have become forces for polarization and division, a devolution that needs to be addressed by individuals with the courage to break out of the darker tendencies of human empathy to cling to one’s in-group and other those who differ from oneself. This kind of individuation and courage is nurtured in psychotherapy that is focused on aims beyond pure symptom reduction.
What are symptoms, anyway?
Every physician knows that symptoms exist on a continuum, and that the absence of symptoms is not the same as the absence of risk. Hypertension is the textbook case: silent, symptomless, and treated aggressively precisely because waiting for symptoms means waiting too long. Medicine long ago concluded that prevention is both more humane and less expensive than rescue.
The same logic applies to mental health. Limiting therapy to those with observable symptoms does not necessarily serve individuals or communities. Early intervention and prevention cost less than managing established illness, and they create the conditions for positive ripple effects: healthier individuals create more health in their communities. If we accept preventive care for the heart, why ration it for the mind?
Effective therapy serves the greater good
If we lived in stable times, the question of whether the symptom-free deserve deep attention to their inner lives might be a simple debate about where to spend limited resources. We do not live in stable times.
The structures that once held human communities — durable institutions, close kinship networks, a predictable future — are dissolving in real time. As I write this, smoke from out-of-control wildfires in the boreal forest covers much of North America; over each daily errand hangs a haze that is tangible — and breathable — evidence of the unfolding climate crisis, which is not only an ecological emergency but a psychological, communal, and moral one. The people arriving in offices like mine without diagnosable conditions are not confused about where they are. They carry grief for a changing world, moral distress about their own complicity and helplessness, dread on behalf of their children, and questions about how to contribute to a more beautiful world. None of this is pathology. All of it is a sane response to reality — and it is precisely the material from which either despair or moral courage gets made. The courage they find as they turn toward their suffering in therapy, they carry back out into their communities.
A society facing cascading crises needs citizens who can hear alarming information without numbing, or splitting against the vulnerable; who can act with clarity and determination without any guarantee of success; who can hold their own fear and still remain openhearted and useful to others. Scientists call this “adaptive capacity.” The contemplative traditions on which some contemporary psychotherapies are based might call it nobility of heart. Whatever we call it, it does not appear out of a vacuum. As my frontline paramedic and firefighter clients like to paraphrase from Archilochus: “We don’t rise to the level of our expectations; we fall to the level of our training.”
So here is my disagreement with a “community first, therapy second” prescription: communities benefit when individuals do the inner work of transforming suffering into wisdom, and individuals depend on healthy, equitable, inclusive communities to maintain their wellbeing over a lifetime. Individual and community healing inter-are, to borrow Thich Nhat Hanh’s term — each arises with and through the other. Communities do not assemble themselves out of exhausted, avoidant, reactive people. They are built and held by individuals with particular capacities: to tolerate discomfort without shutting down, to stay in conflict without dehumanizing the other side, to grieve without closing the heart to loving again, to keep alignment with values when authorities have no plan and the outcome is uncertain. Community helps maintain these capacities; therapy is one of the few remaining training grounds in our society that builds them.
My colleague points to Britain and Japan, which address loneliness through social programs rather than clinicians. Excellent. We need those programs. But people cannot benefit from social programs while caught in the internal vortices of trauma; they must first be capable of showing up for the nurturance a program offers — capable of taking initiative, recovering from rejection, repairing the first rupture with the attunement and communication skills therapy teaches. When therapy helps a lonely person, it rarely does so by treating loneliness as a disorder. It does so by developing the very skills that make connection possible.
The noblest human qualities do not emerge by accident
It can be tempting to assume that courage, compassion, integrity, and wisdom are traits some blessed people happen to have — as though character were a fixed property of persons or the luck of the genetic draw rather than a capacity that both community and therapy can cultivate. Psychology has a long literature on this fixed-trait fallacy, from the classic person-versus-situation debates to Dr. Carol Dweck’s research showing that believing a quality is fixed is itself one of the surest ways to keep it from growing. Ironically, by sorting people into the “well,” who need only community, and the “unwell,” who alone merit therapy, the Times essay commits exactly this error: it treats wellbeing as something people are, rather than something people and communities manifest under the right conditions.
Every tradition that has studied human character seriously — and now the science emerging from places like the Center for Healthy Minds and the Human Flourishing Program — points to the same conclusion: the most valuable human qualities are grown under specific conditions. Sustained attention. Opportunities for mastery with honest feedback. Belonging and connection in relationship. Repeated practice at the edge of what one can tolerate — the boundary of what Dr. Daniel Siegel has named the window of tolerance. Our society needs small islands of coherence and stability where individuals can meet challenge without being overwhelmed. Those islands can be found both in therapy and in community.
So when a person without symptoms sits down in my office and says, in effect, I want to become someone capable of meeting this moment — I do not believe they are misusing a scarce clinical resource. I believe they are doing something ancient, responsible, and eminently practical, for themselves and for society. The public ripple effects of private transformations in therapy are tangible and pragmatic. A first responder who can integrate information calmly under pressure saves lives. A person who learns to regulate their own reactivity changes every meeting they attend. A parent who faces their own inherited fear raises children less burdened by it. A neighbour who has practiced tending profound grief becomes the one others can turn to when the flood or the fire comes.
It is not a choice between therapy and community
The forced choice between therapy and community rests, finally, on an economic argument: therapist hours are scarce and expensive, community is abundant and scalable, and every hour spent on the unsymptomatic is an hour taken from someone in crisis. Fair enough — if human suffering were only what the Diagnostic and Statistical Manual measures, and if therapy only came packaged in a fifty-minute hour. But the flourishing science has already answered this. Mindful Self-Compassion, Compassion Cultivation Training, and the compassion-focused group work described by the Compassionate Mind Foundation are all delivered in group formats, at a fraction of the cost of individual treatment, by a workforce that can be trained at scale. And a group learning compassion together is not merely an efficient delivery mechanism. It is community — community with a curriculum. The line between “therapy” and “community” that the scarcity argument depends on dissolves exactly where the science is most promising.
Beyond that, I will happily concede everything that deserves concession. Yes, access matters, and those in acute crisis must never be crowded out by those with more privilege — but that is a triage problem, solvable by funding mental health on par with physical health, not by narrowing the purpose of the work. Yes, there is bad therapy: therapy that drifts for years without goals or direction serves neither the individual nor the community. Yes, a culture that outsources all meaning-making to licensed professionals is impoverished — not one I, as a therapist, would enjoy living in. And yes, there are bad therapists: a therapist who lets the therapeutic relationship substitute for a thriving life — the client’s or their own — does harm to themselves, to the people they have taken an oath to serve, and to the web of community connections they both inhabit.
But the answer to therapy done poorly is not less therapy for the unsymptomatic. It is good, science-driven therapy with a larger aim: not the mere subtraction of suffering from human experience, but the deliberate cultivation of what is best in us. That larger aim is no longer aspirational rhetoric; it is an active research agenda at Wisconsin, Stanford, Harvard, and beyond. We have the science for good therapy at scale. We should use it — and think bigger, not smaller, in response to the mental health crisis around us — rather than confine therapy to a form of palliative care.
Surprise! Good therapy is not about you
The traditions that shape my own practice hold that the point of working on oneself is never just peace and healing for oneself. The point of what we do in therapy is to expand what we are capable of embracing and transforming in the world. Individual therapy should not supplant community, and community is not a cheap, scalable substitute for patient, dedicated inner work. Each breathes life into the other. We should want more people doing both — symptoms or no symptoms — because the qualities we grow together, in therapy and in community, are the ones the world is calling for from all of us.
Dr. Kimberly Sogge, C.Psych. is a registered clinical psychologist and founder of an Executive Mental Health group practice, Ottawa River Integrative Mental Health, with locations in both Ottawa and Toronto, Canada
References
Jazaieri, H., Jinpa, G. T., McGonigal, K., Rosenberg, E. L., Finkelstein, J., Simon-Thomas, E., Cullen, M., Doty, J. R., Gross, J. J., & Goldin, P. R. (2013). Enhancing compassion: A randomized controlled trial of a Compassion Cultivation Training program. Journal of Happiness Studies, 14(4), 1113–1126.
Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the Mindful Self-Compassion program. Journal of Clinical Psychology, 69(1), 28–44.
Weng, H. Y., Fox, A. S., Shackman, A. J., Stodola, D. E., Caldwell, J. Z. K., Olson, M. C., Rogers, G. M., & Davidson, R. J. (2013). Compassion training alters altruism and neural responses to suffering. Psychological Science, 24(7), 1171–1180.