Frequently Asked Questions

Depth-oriented therapy (also called psychodynamic therapy) is longer-term therapy that's meant to address where symptoms and distress come from, rather than simply how to manage them. One of the most useful ways to describe how we work is to start with the opposite.

There's a wide range of approaches out there in the therapy world. On one end of the spectrum are the short-term, structured models: you set an agenda at the start of each session, there may be worksheets or homework between sessions, the focus is on concrete coping strategies for managing symptoms, and the goal is that within a few weeks or months, you're done and on your way. For some people and some situations, that's exactly right.

We are very much the other end of the spectrum, and here's why that matters for the people we work with. Physicians, executives, founders, attorneys, high achievers broadly—these are people who tend to be doers and fixers by nature and by training. Problem-solving is the default setting, and it's a skill that has built entire careers.

But the things that bring someone into therapy usually aren't problems that can easily be "solved." So in psychodynamic therapy at Helm Psychology, instead of just managing symptoms with surface-level coping strategies, we aim to go after—and get underneath—where the symptoms come from in the first place. Patterns like these form over years, usually starting in your earliest relationships. They don't tend to change just because you've spotted them.

Therapy here looks different from more structured therapies. We don't set an agenda at the top of the hour. There are no worksheets. You won't get homework. We start with what's on your mind, and we gently follow things together—sometimes that leads us into your history, sometimes into something that happened on Tuesday, sometimes into what's happening right there in the session.

Most of our clients run their whole lives on output. Rounds, filings, board meetings, payroll. Everything is a deliverable, including, often, how they show up for other people. Therapy with us has no performance baked into it. For a lot of the people we see, that alone is unfamiliar. But that discomfort is usually where things start to move over time. ‍

Learn more about how we work, and why, here.

Many of our clients have worked with a coach at some point—executive coaches, physician coaches, business coaches. Coaching works on goals, performance, and strategy: it takes your objectives as given and helps you hit them more effectively. Within that frame, it can be genuinely useful.

But that frame is also its limit. Coaching runs on the same operating system our clients already live in: targets, metrics, action items, optimization. If part of what's wearing on you is that operating system (e.g., the relentless self-pressure, the sense that you're a project or a product to be managed), then more optimization isn't the answer.

Therapy with us works underneath those layers: not how to get you to perform better, but where the ambition and drive to excel came from, and what it's likely costing you (even alongside everything it's helped you achieve). Coaching also isn't clinical work, and it isn't confidential the way therapy is. There's no legal privilege protecting what you tell a coach.

If you've done therapy before and it helped for a while, then faded—or it gave you language for your patterns, but the patterns didn't change—that can be common with shorter-term, skills-based therapy. But it doesn't mean therapy failed you or that you're beyond help. Instead, it usually just means the work reached a ceiling: coping with things rather than getting at the roots of them. Depth-oriented therapy is built to go further down, and that's often exactly what makes the difference the second time around.

We won't pretend to know on day one, and we'd be wary of anyone who says they do.

What we can tell you is how it tends to go. This is longer-term depth work. Realistically, that means most of our clients are with us for at least a year, many considerably longer. This is not because therapy is meant to be endless. Instead, it's because the patterns we're working on took decades to form, and they aren't simply going to be understood, much less reorganized, in a few short weeks or months.

That said, this isn't open-ended drift. We'll be paying attention the whole way to whether the work is working. We won't be grading each session as it happens, though. And if you notice the urge to do that—to optimize every session, to squeeze maximum value out of every minute together—then that's worth processing in our work, rather than treating as an indictment of therapy itself. And in fact, it may be part of the very patterns we're working with together. But over the broad arc, you'll feel when therapy is working and helping.

And when things reach a natural conclusion, ending well is itself a phase of therapy, not an afterthought. Some clients also return for a season when something new arises, be it months or years later. That's not a failure of the first round; it's simply how depth work tends to function across a lifespan.

Almost nobody who calls us is in crisis. In fact, quite the opposite: they're running departments, practices, companies, caseloads—and by every external measure, they're doing quite well.

But what they usually say is some version of this: I don't know if things are bad enough to be in therapy. Therapy is for people who are really struggling, and I'm doing okay enough. Other people have real problems. Therapy is for the weak, and I'm definitely not weak. In fact, I'm the only one holding it all together.

That logic can hold for years, because for someone capable, it almost always works—you absorb things, you keep going, the bar for "bad enough" keeps moving up alongside your capacity to handle things.

But feeling flat inside a successful life, or like you're watching it from a slight distance, doesn't have to reach an emergency to be worth taking seriously. There's no threshold of suffering you need to clear first. If something in you keeps raising the question, that's enough.