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Malka Ceh, PhD, MSc, cNPA

Tag: Therapy culture

When Your Therapist Thinks Being Childfree Is the Problem

Imagine booking an appointment because you’re starting to feel like shit after almost every conversation with your partner. They make jokes at your expense and accuse you of being oversensitive when you object; lately, you’ve caught yourself rehearsing perfectly ordinary sentences before saying them. Somewhere in the first session, your therapist asks about children, and when you explain that you’re childfree, and a new possibility suddenly interests them: perhaps your relationship has lacked the shared purpose that a family would provide. By the end of the hour, you’re defending your decision against parenthood while your partner’s behavior has disappeared from the discussion. Quite a result for someone who didn’t even attend.

You might entertain this suggestion for longer than you otherwise would. The person offering it has qualifications, presumably knows something you don’t, and has met you at a moment when your confidence in your own judgment is hardly magnificent. Perhaps there really is something you’ve overlooked. Asking about children is ordinary enough, after all, although the route from “I don’t want any” to “that explains why your relationship is miserable” deserves a few questions of its own. The fact that you need help doesn’t make every theory offered about you worth considering.

When an assumption becomes an interpretation

The assumption underneath the leap is that a complete adult life eventually includes parenthood, and anyone who declines must have misunderstood the assignment. You’ve probably met the person who assures you that you’ll understand real love once you have children, apparently writing off every attachment you’ve managed so far. The term for this is pronatalism and can enter the consulting room through theories that treat parenthood as a developmental achievement. As psychotherapist Emma Palmer discusses, some older accounts of women’s development gave motherhood a central place in psychological maturity. A therapist working from those assumptions may start wondering what went wrong before asking what went right.

You can see how judgments about a proper life become judgments about happiness in an experiment by psychologist Leslie Ashburn-Nardo. In the study, 197 university students evaluated a fictional married adult who had chosen to have either no children or two. The childfree adults were judged less psychologically fulfilled and elicited greater moral outrage. Nobody had measured these fictional people’s happiness, obviously; what the experiment captured was how observers imagined it. When someone confidently predicts that you’re unfulfilled, then, it’s worth asking how much they know about your experience and how much they’re supplying from their expectations.

What happens when you ask childfree people?

Researchers who ask childfree people about their lives have rather more relevant information. In a 2021 study of 981 Michigan adults, Jennifer Watling Neal and Zachary Neal found no statistically significant differences in life satisfaction between childfree adults and the other parental-status groups after accounting for demographic differences. Their study also did something that sounds elementary but matters enormously: it distinguished people who didn’t want children from people who had wanted them but couldn’t have them. Counting everybody with zero children together obscures whether that situation represents a disappointment, a temporary arrangement, or exactly the life someone wants.

Of course, you’re entitled to be childfree and unhappy. You can make a reproductive decision that suits you beautifully and still have a dreadful relationship, which is why arriving at therapy shouldn’t require a preliminary demonstration that your life choices have produced uninterrupted contentment. If having no children feels like a loss, there’s something to explore; if it doesn’t, an assumption of reproductive grief supplies you with an imaginary disappointment while the actual difficulty waits. The therapist still needs to establish what is troubling you and why their proposed explanation fits. You shouldn’t have to bring a happiness study to get back to your partner’s habit of humiliating you over dinner.

Whose wishes is the treatment serving?

There is another distinction worth keeping clear: being unhappy about your life and being worn down by other people’s objections to it. Suppose your parent keeps calling you selfish for refusing to give them grandchildren. You love them, so their disapproval hurts, even though your decision is settled. You may dread visiting because you know the subject will return before you’ve finished your coffee. By the time you bring this to therapy, there’s plenty to discuss about the relationship and what happens to you in it. A suppressed wish for parenthood would need evidence beyond the fact that these encounters upset you.

If the therapist responds by encouraging you to reconsider having children, your parent’s campaign has acquired a professional ally. You came looking for help with a painful demand and find yourself discussing whether you should satisfy it, perhaps because the therapist finds your parent’s wish so understandable that your refusal begins to seem like the problem. Understanding another person’s expectations doesn’t require fulfilling them, and being upset by criticism doesn’t mean the criticism has uncovered a truth you were avoiding. Producing another person is a fairly substantial concession to make for a calmerThanksgiving.

The interpretation you’re not allowed to disagree with

The conversation becomes especially difficult when every attempt to clarify your position confirms the therapist’s interpretation. You explain that you’ve considered parenthood carefully and don’t want it, which is described as rigidity; when you object, the objection becomes resistance. You could spend the hour examining yourself with almost indecent thoroughness and still fail to qualify as reflective, because the only acceptable discovery is that the therapist was right. Under those conditions, you have very little room and even the possibility that you know something about yourself becomes suspicious.

I’m a psychoanalyst, so I’m interested in the possibility that people misunderstand their own motives. That includes the person offering the interpretation. A claim about your unconscious needs support. Sometimes an interpretation hurts because you recognize something you’ve been avoiding. But other times it hurts because a person you hoped would understand you is insisting on an account that feels alien. The discomfort itself settles nothing. You should be able to ask how the therapist reached their conclusion and receive an explanation grounded in what you’ve said or done, with room to consider what might make that explanation mistaken.

Eventually, you may begin editing what you say. You don’t mention that lonely evening because you can already imagine where that will lead, and you become careful about admitting doubts in your relationship lest they reappear as evidence of your inability to commit. You may even catch yourself presenting a suspiciously cheerful account of being childfree, despite having booked the appointment precisely because you wanted somewhere to speak honestly. Now you’re managing the therapist’s impression of you as well as whatever brought you into treatment. It’s exhausting enough doing this with relatives; paying someone for the opportunity adds a particular insult.

A basic requirement of the job

A therapist’s understanding of a healthy adult life should accommodate parenthood and childfreedom on equal terms, without awarding extra points for reproduction. They can ask whether you want children, since having none doesn’t tell them whether that is a choice; once you’ve explained that you’re childfree, however, they have their answer. You owe no explanation of how you arrived at that decision, and you shouldn’t have to request that it stop being treated as unfinished business. Unless you choose to discuss it, the subject is closed. You have already supplied the information; persuading your therapist to accept it should never become part of your treatment.

If a therapist makes a pronatalist assumption, the mistake has already happened; you don’t have to object repeatedly before it qualifies as one. They should acknowledge it and correct it immediately. Examining the bias that produced it is their professional responsibility, and you have no obligation to spend your sessions helping them develop a less provincial understanding of adulthood, or to give them further chances to get this right. You came for help with a relationship in which you’re being belittled. That already provides plenty to discuss, and your therapist should be able to get on with the work without adding a baby to the mess.

September 4, 2026
Ceremoniousness in Therapy Culture

Lately, I’ve been seeing more therapy memes and more therapists making funny reels about their work. They share ridiculous moments from our working lives, speak without arranging their faces into expressions of profound concern, and occasionally admit that they, too, can be petty, mistaken, tired, or absurd. More therapists are beginning to sound like people you might actually know. It caught my attention because for a long time, the public image of my profession gave the impression that becoming a therapist required acquiring a new personality, complete with a superbly soft voice, an inexhaustible supply of sympathy, and a face permanently prepared for a difficult disclosure.

The professional face

You probably know the performance I mean. The therapist tilts their head, lowers their voice, and receives an ordinary sentence as if it has arrived from a remote and tragic civilization. Every feeling gets a solemn acknowledgment; every account of a disagreement seems to require a grave expression and a lesson about boundaries. Of course, people need to be heard, and some experiences deserve great care. What makes this particular manner questionable is its constancy. A person cannot be equally moved by everything. When concern becomes the default facial setting, it stops telling you what the therapist actually thinks or feels. You begin to wonder who’s behind it and at what point in their working day they switch on the professional mode.

I encountered this manner as a client and later, during my training, among clinicians. And I tell you, the backstage version could be even worse. In discussions with colleagues, the voice of compassionate authority sometimes to often gets dialed even higher as the competition is tougher. People speak as though their professional knowledge has carried them beyond the ordinary human tendencies to judge, compete, get irritated, or talk nonsense. That implied elevation is hard to bear when you only want to learn how people work and discover that you’re apparently also expected to join a priesthood. It leaves you wondering how much the pose gets between the clinician and what they’re supposed to be examining.

The client gets a part, too

The etiquette can recruit the client, too. If the expected therapist is an endlessly sympathetic witness, the expected client may become someone who arrives with an inventory of injuries, armed with the correct vocabulary for naming every slight. Others may feel pressure to display enough distress to justify the attention they receive. Someone can have been badly hurt and still find this script embarrassing; someone can genuinely lose control without performing anything at all. The point is that a room has its customs, and people learn them. When every account of being wronged receives the same reverent response, it becomes harder to ask a less comfortable question: what else was happening there, including in me?

Where did we get these customs? I suspect part of the answer lies in psychotherapy’s inheritance of medical authority and the expectation that a professional should possess a special composure. The profession also developed a language of attentive concern that can be useful in one conversation and stifling when applied to every conversation. Then there’s the older cultural habit of looking to an expert in human troubles for something like moral guidance. Few therapists, I imagine, set out to imitate priests, but the posture is recognizable: one person speaks as though they occupy higher ground while the other offers a confession. In a culture where psychological difficulties can also become conspicuous parts of an identity, both people have a remarkably elaborate set of roles available to them.

The people who never book

Some of the cost remains invisible because the people paying it never enter the consulting room. They take one look at the charades and imagine having to discuss their lives with someone who will call them brave for making a phone call, search their childhood for the meaning of a joke, or nod earnestly through an account of a perfectly ordinary bad day. They may have something serious they want to understand, perhaps a difficulty that keeps returning despite their efforts to change it. But that kind of gaze is simply to cringe to be a part of it. Others do book, spend the hour sitting in uncomfortable pomposity, and never return. They leave having been listened to, perhaps even kindly, while much of what they received had a funny aftertaste.

I understand that recoil. I’ve felt it as a client and as a clinician. I am one of those who need a conversation in which we can examine something painful without adopting a reverent tone. Concern can be expressed without every movement of the face being recruited to demonstrate exceptional compassion. The conversation itself should be the object of attention. Psychoanalysis gives us ways to listen for what a person doesn’t yet know about themselves and to question what initially appears obvious. That work asks us to acknowledge our participation in the human mess. If you ask me, pretending to float serenely above it makes the conversation rather difficult, as does expecting you to deliver your life in the approved vocabulary of wounds.

We can dispense with the priestly face

This is why the silly voices make me hopeful. A meme won’t reform psychotherapy, and a television character tells us little about what happens in actual consulting rooms. Still, when clinicians speak plainly and laugh at their professional habits, people can more easily imagine what talking to them might be like. As more of us work and speak across borders, those who find the old atmosphere intolerable have a better chance of finding someone with whom they can think out loud. I hope this irreverent corner of the profession keeps growing. Serious work requires skill and close attention, including the willingness to notice when you’re wrong. The priestly face contributes remarkably little to any of it.

August 19, 2026
Mental Difficulties as a Ready-Made Identities

Before TikTok began explaining your personality to you, Tumblr had helped make being unwell into an aesthetic. In parts of its 2010s culture, depression, anxiety, and eating disorders acquired a recognizable vocabulary, a visual style, and communities organized around them. You could find people who understood your unhappiness, then gradually come to understand yourself through the unhappiness you shared. A label became an identity signifier. In their account of this history, Gayathiri Rajkumar and J. D. Haltigan describe a “pseudo-normalization” in which mental illness acquired social appeal and recovery could recede from view. Being troubled had become a way of being somebody.

The vocabulary has since become more adventurous. Today, you can join a “BPD Baddie Club,” giving borderline personality disorder the branding of an exclusive social circle. You can discover that you are a “dark empath,” a research-derived personality label that has acquired an online life considerably more glamorous than its scientific beginnings. The name alone suggests that your relationship difficulties deserve a film adaptation. Then there are videos treating sleeping with “T-rex arms” as evidence of ADHD. Apparently, even your wrists have something to confess. Psychiatric disorders, neurodevelopmental conditions, and nonclinical personality labels end up displayed together, each offering another way to reveal what sort of person you are.

A sound diagnosis can explain difficulties that have troubled you for years, help you obtain appropriate care, and relieve considerable shame. Finding people with similar experiences can also make life less lonely. Those benefits help explain why the labels carry such force. The glamorization of mental illness as a social identity takes that appeal further: a condition becomes a recognizable persona, complete with a manner of speaking, an account of your past, and a community prepared to recognize you on sight.

You can see the attraction, especially if your answer to “who are you” has become a little uncertain. A ready-made identity supplies an explanation for your feelings, a vocabulary for your difficulties, and people who share your experience and offer additional insight about it. You can introduce yourself with a few letters and feel that something substantial has been communicated. Much of the interpretive work appears to have been done for you. You belong somewhere, your experience makes sense, and your peculiarities have acquired the reassurance of a category. That is quite a lot to get from a label.

Working out who you are through the particulars of your own life is a painfully slower business. You have to examine what you want, what you value, which loyalties you inherited, what you resent, and why you keep making certain choices. The answers interfere with one another. You may value independence and arrange your life around being needed; enjoy solitude and feel wounded when people leave you alone; pursue an ambition whose achievement would oblige you to abandon something else you love. A useful understanding of yourself has to accommodate all of this. A tidy description is considerably easier to manage.

Social media is exceptionally good at providing these tidy descriptions. A creator lists a handful of familiar experiences, gives them a clinical name, and invites you to recognize yourself. The distinction between describing one person’s experience and making a claim about everyone with a condition can disappear in seconds. A 2025 study of popular ADHD TikToks collected in 2023 found that fewer than half of the symptom claims matched DSM criteria; acknowledgments that the experiences could occur in people without ADHD were rare. Most creators who stated a credential cited lived experience, and half of the creators were selling something or otherwise seeking financial support. Expertise was optional. An audience offered rather more tangible advantages.

The invitation is seductive because recognition feels like understanding. You see a description that resembles you and experience the pleasure of being explained. Yet a resemblance leaves plenty to investigate: how often something happens, under what circumstances, how much it affects your life, and what else might account for it. A video can offer a useful starting point. The trouble begins when the starting point becomes your finished account of yourself, and every subsequent experience is recruited to confirm it.

Once other people recognize you through that account, the attachment can become social as well as personal. Clinicians Jane Harness and Hayley Getzen called attention to a “sick-role subculture” on TikTok. The phrase captures an uncomfortable possibility: illness can become a role through which you gain membership, attention, and social capital. A disorder identity can make you distinctive enough to be interesting and familiar enough to belong. That combination has always had a market.

Such performative mental illness carries many risks. An audience can shape sincere distress. If certain accounts of your experience receive recognition, you may learn to emphasize them, repeat them, and notice more of the experiences. Rajkumar and Haltigan propose that these incentives can also encourage exaggerated symptom presentations. Social rewards shape behavior. Being recognizable to your community can start to govern how you describe yourself, until the performance helps decide which parts of you receive attention, including your own. You can become quite practiced at being the person everyone has agreed you are.

My concern is the narrowing that can follow. If you organize your identity around a disorder, the features that fit it can become disproportionately important, while your other interests, capacities, conflicts, and possibilities receive less consideration. You may begin to treat a difficulty as a permanent statement about what you can do. An improvement can even become socially awkward if your friendships and your place in a community depend heavily on a shared account of being unwell. You have acquired an explanation, and now you have reasons to preserve it.

What you lose in this arrangement is your individuality. You set out to explain what makes you particular and end up describing yourself in language shared by thousands of strangers. Even an accurate diagnosis leaves most of your personhood unexplained. It says little about why a particular compliment embarrasses you, why success sometimes disappoints you, what you hope another person will notice, or which desires you can admit to yourself. These details matter because they concern the way you actually live. They are also considerably harder to put in a bio.

Developing an identity of your own requires sustained acquaintance with those details. You begin with plenty of material: your temperament, history, relationships, culture, and the roles you have already learned to occupy. The work involves understanding what you have inherited, discovering what you have overlooked, and deciding what you want to continue. Your account of yourself changes as you learn. You can become clearer about what matters to you while remaining capable of surprise, contradiction, and revision. That flexibility gives your identity room to develop with your life.

This is the kind of exploration we undertake in psychoanalytic conversations. We begin with your experience and follow its particularities: a reaction that puzzles you, a recurring wish, an association, an incident you keep returning to. I bring psychological knowledge, questions, and interpretations; together, we examine how the details connect and what those connections might mean. If you describe yourself as someone who always avoids conflict, for instance, we can look at the conflicts you avoid, the people involved, what you expect would happen if you spoke, and the occasions when you are quite capable of arguing. The familiar description starts to acquire some useful complications.

I use psychoanalysis outside the clinical framework for this work of self-knowledge; clinical care has its own place whenever it is needed. In our conversations, you have time to develop an understanding of yourself that can hold more of your experience, including the parts that make your preferred explanation inconvenient. You participate in forming an identity you can understand, question, and revise. It takes longer than recognizing yourself in a video. You do, however, get to have a say in who you become.

June 18, 2026