Therapy, Medication or Both?
After years of sitting across from clients in the therapy room, I've watched people transform — not through willpower alone, but through the courage to do work outside of the session accept support. Today I want to speak honestly about two of the most powerful tools in that journey: therapy and medication.
The Foundation: Why I Believe in Both?
“You don’t need to pay someone to listen to you. You have family or friends.”
“Therapy is expensive.” or “I can’t find a therapist. Everyone has waitlists.”
“I don’t want medication and that’s what a therapist will make me do. “
“Do I have to journal?”
The above comments or questions are ones I have heard throughout my career in mental health. Over my twenty year career, I witnessed significant changes and there is still a stigma around seeking out therapy, taking medication or using both resources. There is still a stubborn myth in our culture that seeking help is a sign of weakness, and needing medication means something is fundamentally broken in you. I have spent my career watching that myth cause unnecessary suffering. The truth, from where I sit, is almost the opposite: choosing to pursue therapy and, when appropriate, medication is one of the most honest and courageous acts a person can take.
These two approaches are not rivals. They are not a hierarchy with one superior to the other. They are, in many cases, profoundly complementary — two different doors into the same room where healing lives.
Therapy: What Actually Happens in The Room?
Therapy is often misunderstood as simply "talking about your feelings." While emotional expression is part of it, what skilled therapy actually offers is far more structured and transformative. The benefits I witness most often include:
Learning to identify and interrupt unhelpful thought patterns before they spiral
Developing a language for emotions that many clients never had growing up
Processing grief, trauma, and loss in a container that is safe and boundaried
Building genuine insight into relational patterns — why we keep choosing what we choose
Practicing new behaviors in a low-stakes, supported environment
Reclaiming a sense of agency and authorship over one's own story
Setting boundaries in our lives
One of the things I find most remarkable about therapy is its longevity. Often, therapy is not meant to be long -term. The work doesn't evaporate when sessions end — it becomes part of how a person moves through the world.
Medication: When the Brain Needs a Different Kind of Help?
I am not a prescriber, and I always encourage clients to work closely with a psychiatrist or their physician on medication decisions. But as a therapist, I have watched medication — approached thoughtfully — change the trajectory of people's lives in ways that still move me.
The brain is a physical organ. When someone has a broken leg, we don't tell them to think harder about walking. Yet we routinely tell people with clinical depression or anxiety disorders that they should simply try harder, sleep better, exercise more. Sometimes those things help. And sometimes the neurochemistry needs direct support before any of them become possible.
What medication most often does, in my observation, is lower the floor. It doesn't remove the work of healing — it makes the work accessible. Clients who previously couldn't get out of bed find they can come to sessions. Clients who were so anxious they couldn't process anything in the room discover, once anxiety is regulated, that therapy suddenly feels possible. Another way to view medication is it turns the volume down. Finding the right medication for you often involves a dance. It is important for you to share what you’ve noticed since starting the medication and communicate any concerns with the provider.
Together: The Case for a Combined Approach
Research consistently shows that for many conditions — particularly moderate to severe depression, panic disorder, OCD, and PTSD — the combination of therapy and medication outperforms either treatment alone. But beyond the data, I've seen it happen in the therapy room, one person at a time.
When a client's nervous system is sufficiently regulated through medication, therapy becomes deeper and more durable. And when therapy provides coping skills and insight, medication often needs to do less heavy lifting over time. They create a virtuous cycle — each one making the other more effective.
Some clients need medication for a defined period, then gradually taper off as their coping skills solidify. Others manage a chronic condition and benefit from ongoing support. Both paths are valid. There is no single right answer — only the answer that fits this particular person, at this particular moment in their life.
Stigma: The Thing We Need to Name
I would be remiss not to address the elephant in the room: stigma. Many people who would benefit enormously from therapy or medication avoid both because of what they fear it says about them. I've heard every version of this over the years — "I don't want to be dependent on a pill," "I should be able to handle this on my own," or "therapy is for people who are really broken."
These are understandable fears rooted in cultural messages that have done real harm. But I want to offer a reframe: seeking support is not an announcement of failure. It is an act of self-knowledge. It requires you to look honestly at what is happening and to choose your own wellbeing over the comfort of denial.
In my years of practice, the bravest thing I've watched people do isn't white-knuckling through pain alone. It's asking for help when they needed it.
A Final Word: You Don't Have to Choose
If you are considering therapy, I encourage you to reach out to a licensed provider. If you're wondering whether medication might help, have an open conversation with your doctor, or a psychiatrist — without shame, without preconceptions. And if the idea of combining both has crossed your mind, know that this is not indulgence. It is good medicine.
The goal, always, is not to simply survive your mental health — it is to build a life that feels livable, meaningful, and yours. Both therapy and medication can be part of how you get there.
