⚠️ Important : The following information does not constitute medical advice – it’s just the information your doctor is supposed to give you.

How Did We Get To This Point?

It’s completely legitimate to criticize psychiatry for its past and present failings, which are well-documented throughout history. But we need to understand that psychiatry emerged to address a real and urgent need: caring for the “mentally ill” in our society.

The reality is that humans are sadly predictable: when faced with difference, they abuse. A person who becomes disruptive due to psychosis, mania, or paranoia had to be controlled so they wouldn’t be a nuisance, and this was often done in terrible ways. Chained, locked up, beaten and tormented, these people suffered the same fate everywhere in the world, often until death – far from the romantic image of the beloved “village fool” cherished by their community.

It’s worth noting that asylums have existed since the Middle Ages, but they were true prisons for the “insane,” like Bedlam in England. The fact that the word “bedlam” still exists in everyday English, shows that the horror of these places hasn’t been completely forgotten. It was only at the end of the 18th century, under the influence of the Enlightenment period, that doctors had the revolutionary idea that these institutions could actually heal rather than simply contain.

The idea was promising, but within a century, the demand had exploded: between 1800 and 1904, the United States went from a few hundred patients to 150,000. This explosion was partly due to a neurosyphilis epidemic (5-20% of the population had syphilis, 6% of whom developed psychiatric disorders), increased alcoholism, and major social changes: where families once took care of their elderly and sick, they now preferred to send them to the asylum. Doctors had to manage 300-400 patients each instead of the originally planned 20-30, and the psychiatric asylum became little more than a human warehouse.

It’s easy to talk about mistreatment, and it’s probably factual. But the reality is that most patients in these places were genuinely ill – many ended up dying there. The others simply couldn’t rejoin society because they had lost all contact with reality. This partly explains the desperation of psychiatrists who were frantically trying to find a solution: hydrotherapy with ice baths, rotation therapy, massive bloodletting, violent purgatives, lobotomies, and electroshock treatments…

And this also explains their immense relief when three discoveries revolutionized psychiatry: lithium in 1949, which effectively calms manic episodes; chlorpromazine in 1952, which makes hallucinations and delusions disappear in psychotic patients; and imipramine in 1957, the first antidepressant capable of lifting patients out of deep melancholy. These medications transformed psychiatric wards overnight: psychiatry finally had effective tools against mental illness, and the most severely affected patients finally had treatment that significantly improved their quality of life.

But this pharmaceutical success had unexpected consequences. Psychiatrists gradually forgot the relational aspect of their work. No need to spend time listening to and reassuring a patient when five minutes is enough to check a prescription and manage dosage. This transformation of the psychiatrist into a simple prescriber, coupled with the enormous power they still hold today (the ability to lock people up against their will and force treatments), triggered a massive revolt against psychiatry in the 1960s.

Ironically, this movement wasn’t completely wrong. Even though it was mistaken in denying the existence of serious mental illnesses and their suffering, it was right about one essential point: the excessive pathologization of human experience. This revolt still exists today in other forms: social media movements, communities advocating alternatives, medication withdrawal support groups. But at least there’s much less tendency now to deny the existence of serious illnesses.

Subsequently, pharmaceutical companies, having discovered an extremely lucrative market, funded the research needed to broaden the definitions of mental disorders. The psychiatrists’ diagnostic manual (DSM) went from 180 disorders in 1968 to 297 in 1994 (a number that continues to grow), often under the influence of lobbying campaigns rather than actual scientific evidence. But is the systematic medicalization of the human experience really the only way forward?

The Problem with Medication

If you go to a psychiatrist, they’ll almost certainly prescribe you one or more of the following medications:

Antidepressants

In cases of severe depression, these medications genuinely do save lives. If you can’t get out of bed in the morning, they help you regain enough energy to function and potentially find other solutions. And even though there’s a significant placebo effect, that doesn’t mean there isn’t real relief.

The problem is that depression is a bit more complicated than “chemical imbalance”, which was mostly marketing. Today we talk about inflammation, trauma, genetics, environment… everything’s connected. And the medication’s side effects are minimized: sexual problems in most people, weight gain, emotional numbing… It’s also a lot harder to stop taking it than they tell you.

Benzodiazepines

Truly effective for panic attacks or severe anxiety, they can provide necessary relief while you find other solutions.

The issue is that finding these “other solutions” often takes months, even years, and with benzodiazepines, dependence sets in within weeks, and withdrawal is often worse than the original problem. Long-term, memory and concentration are damaged, and in seniors, the risk of dementia increases.

Antipsychotics

Essential for psychosis, schizophrenia, and severe manic episodes, antipsychotics (or neuroleptics) allow people with these conditions to regain their lucidity and have a relatively normal life.

The problem is that today, they’re prescribed for anything and everything: “treatment-resistant” depression, “agitated” children, “difficult” elderly people… One in five patients develops permanent involuntary movements called tardive dyskinesia. Newer antipsychotics are described as safer, but in reality they just have different side effects.

Mood stabilizers

Lithium remains one of the few psychiatric medications with solid evidence of effectiveness for bipolar disorder. It can really stabilize manic and depressive episodes.

The problem is its toxicity: you’ll need regular monitoring of your kidneys and thyroid. Other stabilizers are actually anti-seizure medications: we don’t really know why they work, and side effects vary depending on the specific drug.

Sleep medication

If you haven’t slept for a week, you can’t deny their effectiveness: they’re there to make you sleep, and that’s what they do.

So what’s the problem? Tolerance: you often need to increase doses to maintain effectiveness, and they can cause significant dependence without solving the underlying problem. Stopping can also trigger rebound insomnia that’s often worse than the original insomnia.

Systemic Problems with Medical Treatments

Most medications are only tested for a few weeks or months before being approved, even though many patients will take them for years. So we only find out what the long-term effects are after the fact. Plus, many of these drugs are prescribed “off-label” – meaning for conditions they were never actually tested for (like anti-seizure meds for bipolar disorder). This is completely legal, but it basically means you’re a guinea pig.

And to top it off, half of psychiatric patients take at least two medications at once – this is called polypharmacy, and these drug cocktails quickly become unpredictable. The interactions are largely unknown because studies don’t test combinations, and doctors generally ignore or don’t account for these interactions anyway.

⚠️ Important : Psychiatrists readily prescribe psychotropic drugs, but tend to downplay just how difficult it is to stop them or reduce doses. For information on gradual withdrawal, check out Le Manuel de Sevrage des Psychotropes by Psychotropes.Info and SoutienBenzo, available free online.

The Pathologization of Daily Life

Psychiatry is trying to medicalize normal human experiences. There’s obviously a financial motive, but I think it’s also about an interventionist mindset that can’t handle difficult emotions – just like our Western culture, which only knows how to flee, repress, or numb them. For neurodivergence, it’s simply the unapologetic pathologization of difference.

It’s normal to feel sad when you’re grieving, or anxious about the current political, economic, and ecological instability of the world. Don’t let yourself be labeled for every little thing. You’re a human being first and foremost, and a diagnosis is only useful if it helps you or improves your quality of life. Otherwise, it’s just a way to categorize humans, an attempt to manage anxiety and control life’s diversity and unpredictability.

Moreover, we’re just beginning to realize how much the nervous system influences how we act and think when it’s dysregulated following difficult events. This is undoubtedly the future of psychology, because it forces us to look at pathology from a different angle: having a normal nervous system reaction to an abnormal situation isn’t a mental illness.

The Ideal Treatment: A Holistic Approach

First things first: rule out the most common physical causes

Before consulting a psychiatrist, I recommend asking your GP for blood work to check that you don’t have a physical issue that’s mimicking psychiatric symptoms.

Blood tests to request before a psych consultation

• Thyroid panel: TSH, T3, T4 (Warning: doctors often only prescribe TSH. Explicitly ask for T3 and T4 to get a complete picture of your thyroid function)
• Vitamins: B12, B9 (folic acid), D
• Minerals: Magnesium, calcium
• Metabolic panel: Fasting glucose, HOMA index (insulin resistance), kidney and liver function
• Ferritin (anemia)
• Hormones: Cortisol, testosterone/estrogen depending on sex

Other physical causes to rule out: Sleep apnea, autoimmune diseases, chronic infections, medication side effects…

Reading Between the Lines on Lab Results

Pay attention to the results too. Doctors tend to never worry about anything as long as the results are “within normal range.” This lack of nuance in interpretation can miss important weak signals for the patient. A ferritin level that’s technically “normal” isn’t necessarily “optimal,” and can still make you feel tired and depressed. You might need a higher level to feel good. Thank goodness the internet and AI are there to help you double-check things yourself… For a more comprehensive approach, you can also consult a naturopath or nutritionist who will know exactly which tests to ask your doctor for and how to interpret them properly.

Check Your Lifestyle

Get enough sleep, pay attention to how well you’re sleeping, watch what you eat, stay hydrated, exercise regularly, and manage your stress… that’s basically 90% of taking care of yourself. If you’re not sleeping enough, too exhausted to work out, and living off takeout for months while dealing with a tough, stressful job, of course you’re going to feel terrible – and your doctor can prescribe whatever they want, but it’s not going to help much.

Consider Therapy

Our relationships can either support us or tear us down. Same with our past – the experiences that shaped us can become a huge source of pain if they left us with a messed-up way of seeing the world. Getting the right kind of therapy to work through losses, deal with trauma, and figure out how to relate better to others and yourself is the most effective way to tackle psychological problems without necessarily needing medication..

More Than Just Pills

Ideally, we should see medication as just one treatment tool among many equally important ones – a last resort for most situations, after working on your lifestyle, relationships, and environment, and after doing the personal work to understand why you’re not feeling well.

And this goes for people with real mental health conditions too! It seems even more important to combine medical treatment with everything else. Giving people medication and then sending them on their way without any other kind of follow-up seems totally irresponsible to me, and really just a short-sighted quick fix.

When Medication Has Its Place

Conditions That Need Pharmaceutical Treatment

For psychosis – especially schizophrenia – despite the side effects, these medications are essential, because without them, you risk being unable to manage daily life without 24/7 care. For bipolar disorder, lithium is very effective at preventing manic or depressive episodes, and for severe depression, taken short-term, antidepressants can literally save lives.

There are conditions that really do need pharmaceutical treatment. If your problem significantly affects your quality of life, and medication can relieve your suffering, don’t hesitate.

A common fear is the fear of dependence. And it’s a legitimate fear, because it’s not easy to accept that you might need medication long-term. That’s a loss you have to grieve, for starters. But don’t forget: you’re already dependent. You depend on air, water, sleep, food, human connection, society. Dependence is part of life. So one more thing, is it really that big a deal? What matters is feeling better – you didn’t seek help for nothing.

A Temporary Solution

For other problems, it’s a question of pros and cons. You can take short-term treatment while doing therapy work on the side. Kind of like a crutch. It doesn’t mean you’ll have to walk with it for life.

When There’s No Other Choice

And sometimes, you might just not have any other option. We live in a society that often creates the conditions for psychological distress: economic instability, social isolation, burnout… Sometimes you can’t change your circumstances right away, for financial or other reasons. Maybe you can’t sleep well because you live in a noisy neighborhood and can’t move. Changing jobs isn’t necessarily within everyone’s reach. And even if you know you need to see someone, you might not have the time, energy, or money.

Sometimes the only solution is taking medication to cope. And that’s just how it is – it’s not your fault, you’re not weak, you haven’t “lost” – you’re simply doing your best to survive.

Take Back Control of Your Life

So what should you actually do when faced with a diagnosis and potential medication?

First, remember that you have the right to accept or refuse medical treatment. The decision is yours, and yours alone. Don’t let anyone intimidate you – you’re the only one who has to live with the side effects. And medical coercion is illegal. A doctor is ethically and legally obligated to respect your free and informed consent, so if you feel like they’re trying to pressure you or taking advantage of your vulnerability and exhaustion, find a different doctor.

Your psychiatrist is also supposed to inform you of ALL potential side effects, withdrawal difficulties, treatment success rates… But they’ll probably struggle with that, given that consultations usually last 15 minutes. Fortunately, you can research this yourself thanks to the internet and AI. Pay special attention if you’ve experienced trauma or if you’re neuroatypical, because the treatments are completely different.

Do your own research on your diagnoses, the labels they give you, and the treatments they suggest. You’re the only one who has to live with the consequences of your choices. And trust yourself. Doctors don’t have magical powers, and despite what they think, they don’t know everything and don’t know you better than you know yourself. Respect their medical expertise, but believe in your own human expertise, your feelings and intuition, and be an active participant in your care, even when it’s hard and you’re exhausted. No one’s going to save you except yourself.

Conclusion

The medication approach has become the norm because it’s simple and quick, but it only masks symptoms instead of healing. Even worse, the very existence of these pharmaceutical solutions has created a “miracle cure” mentality: no need to change your lifestyle, do difficult therapy, or question your toxic relationships when you can just get prescribed a pill. Rather than encouraging us to take back control of our lives, it positions us as victims, dependent on a medical system that actively discourages autonomy and questioning, submissive to our great “experts,” the doctors.

Psychotropic drugs do have a place in treatment, but shouldn’t be used systematically and exclusively. Humans are complex neurobiological beings, and we’re nowhere close to understanding everything about the brain and mental health. The truth is that in 50 years, we’ll look back and probably be horrified by the quality of today’s care, just like we are about past treatments. It’s sad, but it’s also wonderful because it simply means we’ll never stop innovating and searching for solutions to treat illness and improve quality of life. In the meantime, we just have to do our best with the information and knowledge we have today.

Sources

History of psychiatry:

• Shorter, E. (1997). A History of Psychiatry: From the Era of the Asylum to the Age of Prozac – Reference book on the history of psychiatry

Antidepressant side effects:

• Montejo et al. (2001) – Spanish multicenter study, 59.1% sexual dysfunction side effect rates Link
• Williams et al. (2010) – European study, side effect rates of 37-61% Link
• Safak et al. (2025) – Recent study, side effect rates of 84-88% Link

Withdrawal difficulties:

• Hengartner et al. (2020) – Prolonged withdrawal syndrome, average duration of 37 months (up to 166 months) Link
• Moncrieff et al. (2024) – 40% of patients have symptoms lasting more than 2 years Link
• Psychotropes.Info and SoutienBenzo – Le Manuel de Sevrage des Psychotropes – Complete guide on gradual withdrawal from psychiatric medications, available free online Link

Benzodiazepine dependence:

• Hood et al. (2012) – Physical dependence can develop in 3-6 weeks even at therapeutic doses, 40% have moderate to severe withdrawal after 6+ months of use Link
• Lader (2011) – Review on benzodiazepine dependence and withdrawal difficulties Link

Cognitive damage from benzodiazepines:

• Barker et al. (2004) – Meta-analysis showing persistent cognitive deficits after withdrawal, no complete recovery in the first 6 months Link
• Crowe & Stranks (2018) – Updated meta-analysis on medium and long-term residual cognitive effects Link
• Zetsen et al. (2022) – 20.7% of long-term users classified as having cognitive impairment, greatest effects on processing speed and sustained attention Link

Dementia risk in seniors:

• He et al. (2019) – Meta-analysis showing increased dementia risk (51% increased risk) in long-term benzodiazepine users Link
• Wu et al. (2023) – Review of 5 meta-analyses, all show correlation (38-78% increased risk) but causal relationship remains uncertain Link

Sleep medications:

• Soldatos et al. (1999) – Meta-analysis showing development of tolerance and rebound insomnia with rapid-elimination hypnotics Link

Trial duration vs real-world use:

• Ward et al. (2025) – Systematic analysis showing median duration of antidepressant use in the United States is approximately 5 years, while median trial duration is 8 weeks; 88.5% of trials last ≤12 weeks and none exceed 52 weeks Link

Polypharmacy:

• Mojtabai & Olfson (2010) – US national study showing visits with 2 or more medications increased from 42.6% in 1996-1997 to 59.8% in 2005-2006, and visits with 3 or more medications from 16.9% to 33.2% Link

Tardive dyskinesia:

• Carbon et al. (2018) – Meta-analysis showing that “20% of subjects on second-generation antipsychotic treatment presented at least mild tardive dyskinesia” and overall prevalence is 25.3% Link

Lithium:

• Shine et al. (2015) – Cohort study of 500,000 individuals showing that “lithium treatment is associated with decline in kidney function, hypothyroidism and hypercalcemia” with increased risk of stage 3 chronic kidney disease (HR 1.93) and hypothyroidism (HR 2.31)) Link

The Shock of Diagnosis

It’s normal to feel very strong emotions following a diagnosis, and it sometimes takes time before you’re able to process this new information. Often, after the initial shock, the first thing you feel is relief – especially if the diagnosis was a long time coming.

But then other, much less pleasant emotions can follow: anger, sadness, bitterness – even fear, particularly if it involves an incurable condition like psychosis.

There’s also a finality to it, a chapter closing: you’re no longer searching, you know. Maybe you’d suspected it for a long time, but now it’s official. And that makes all the difference.

These emotions are normal and healthy. You have every right to be sad or angry, or to be afraid of an uncertain future, of this new reality that changes everything. Don’t carry this burden alone, without support. Many therapists can guide you through this – don’t hesitate to reach out to them.

Redefining Your Identity: Who Am I Now?

Certain diagnoses can completely change our perception of ourselves. Are we still the same person? What future is possible now? In addition to reconsidering our present and future, we might also tend to see our life history differently. Our self-perception changes, and that’s not easy.

Some people will simply want to avoid the question entirely, pretend nothing changes, while they process the information in the background. Others, on the contrary, will think about nothing else, join every support group, and make it almost their entire identity. This is normal – it takes time to cope. Maybe the key is simply accepting that this diagnosis is part of your identity, without completely overshadowing it. A part of you, more or less significant, but not everything. You are more than your diagnosis.

This information also involves socio-professional considerations, since mental disorders are still heavily stigmatized in society. It’s often wiser to remain discreet. This stigmatization can also be deeply internalized, and it can be terribly difficult to accept that you have a mental disorder, or any other diagnosis for that matter. Beyond our perception of ourselves, there’s our perception of our worth as human beings deserving of love and respect that can take a serious hit.

Yet a diagnosis is just a label, even if it represents a psychological reality and implies more or less long-term treatment. You are you, you are more than this piece of paper, than your symptoms and your care. And you deserve to be loved, to be respected, and to have a future.

Having support can really provide relief and help make sense of all this. With time, this diagnosis can become simply one piece of information among others about who you are – important information, but information that doesn’t define you. In the end, you decide your new identity.

The Grief of Late Diagnosis

A very common feeling is grief in the face of a diagnosis that comes late, perhaps much too late, after years of medical wandering, suffering, and treatment errors.

This grief is often accompanied by completely legitimate anger and bitterness at the injustice of all that lost time, money, and energy, those missed opportunities, and perhaps even a profoundly altered life path. It’s normal to feel all of this – you have been wronged. The only way to get through these emotions is to experience them fully and let time do its work, ideally with compassionate professional support. This is legitimate grief – grief for the person you could have been, for the life you could have had with the right diagnosis and the help you needed from the start.

The Impact on Loved Ones

A diagnosis doesn’t just affect you – it also impacts your loved ones. And unfortunately, their reactions aren’t always what you might have hoped for. The reality is that your loved ones will also have to weather their own emotional storms in the face of this new reality.

We can observe phenomena of denial, often linked to guilt about perhaps having minimized your suffering before, or simply fear of the unknown. They question the diagnosis, try to dissuade you from following treatment… These are normal reactions but no less painful. Your loved ones are grieving, especially if your diagnosis involves lifelong care. Additionally, some mental disorders are hereditary, which can be very frightening if there are children… or revealing. You suddenly remember the aunt or grandmother no one ever talks about but who strangely had similar symptoms, which can add another layer of guilt and toxic reactions.

It’s already difficult to manage yourself. It’s not your responsibility to manage others. Be understanding, but prioritize yourself.

Finding Your Community Without Isolating

Faced with loved ones who may struggle to understand, you might turn to online communities of people with the same diagnosis. There are many benefits, because beyond feeling understood, members can be very active and there’s real sharing of information, advice, recent studies… in short: it gives you hope. You’re no longer alone, you have a future! Participating in the community can also give life meaning again, if you felt like you’d lost it.

But don’t isolate yourself from your friends or family: they’re not “other,” they simply don’t have your diagnosis. Offer them the opportunity to be included in your new community, in your new identity: they might surprise you. And try to be tolerant if they’re not particularly interested. You are more than your diagnosis, and you can’t necessarily share everything with everyone. Look for what unites you, not what separates you.

What If It’s Not the Right Diagnosis?

Sometimes what you feel facing your diagnosis isn’t relief, but rather frustration. You thought you finally had answers, but something’s off. The treatment isn’t working, or your symptoms don’t really match what you’ve been told. You feel like you haven’t been heard, especially if you’re a woman or a marginalized person.

The reality is that diagnostic errors are common, with studies showing error rates ranging from 30 to 90% depending on the disorder and context! Between cultural biases, gender biases, symptom complexity, and professionals’ lack of time, the first diagnosis is often not the right one.

A diagnosis is not a prophetic revelation. You have the right to question it. However, be attentive to your feelings. If you find yourself “diagnosis shopping,” you might simply be in denial.

How to Navigate the Medical System

Some diagnoses are harder to obtain than others, and it’s common to lose confidence in the medical system, or even to be deeply disgusted or traumatized by it. How do you continue receiving care when the patient-doctor trust relationship has been destroyed?

If you’ve experienced medical violence and developed a phobia because of it, you’re not alone. Iatrophobia (fear of doctors) affects about 3% of the population, and mistrust of the medical system is increasingly documented. Having professional support to overcome this can help, but doesn’t change the objective reality of medical mistreatment, healthcare providers’ lack of empathy, and doctors’ well-known oversized egos.

It’s important to be an actor in your illness, to be responsible for yourself, and to have done the necessary work on yourself to be able to face and dare to say no to a person in a position of authority. A doctor is a human being. They make mistakes. And they have a legal obligation to respect you.

The Right to Choose

You have the right to refuse any medical treatment, whatever it is, even if your doctor disagrees. The doctor doesn’t have the right to refuse to treat you; at most, after having their little tantrum, they must redirect you to someone else. Demand respect: you’re sick, you are not a piece of shit.

You also have the right to be fully informed before making any decision – about side effects, alternatives, and risks. And the doctor must not try to impose anything on you, threaten you, or intimidate you, because that’s called medical coercion, and it’s illegal. The doctor must respect their patient’s free and informed consent.

Just as you have the right to say no to treatment, you also have the right to accept it, regardless of what your loved ones think. Often, the idea of side effects and prejudices we might have about these treatments deeply worry the family, who are afraid of losing you, of losing the person they know and love. And in some toxic situations, they may be afraid of losing the control they have over you. Try to remember that you have the right to treat yourself because you’re the one living with your symptoms and suffering, not others.

And finally, you also have the right to be wrong. Maybe taking the treatment was the right thing to do. Or on the contrary, the side effects were unbearable and your family was right. You have the right to change treatments, stop them, or initially refuse and then accept them later. You can also give yourself time to think. This isn’t a lobotomy. Treatment can be stopped at any time, even if you sometimes need medical guidance to avoid severe withdrawal effects. Give yourself the right to make mistakes, and relax.

Conclusion

Your diagnosis is just information, not a condemnation: you’re not branded with a hot iron. Your doctor can guide you, but they don’t live your life: you’re responsible for your life and your treatment. So it’s time to become your own expert and stop waiting for someone to tell you what to do. You are much more than your diagnosis, so don’t be afraid of it and above all, don’t let it define you!

Beyond the therapeutic alliance and individual competence of each practitioner, certain conditions have well-established reference treatments, while others require a more personalized approach, since two people can have the same problem but for completely different reasons.

This article offers clear guidance to help you find the right professional for your situation.

Work with a specialist whenever possible

Generally speaking, the best thing you can do – by far – is to find someone who has the specific skills to help you. First, for their experience, since this person will be used to working with your condition. But also for efficiency. Someone who is specialized in your particular issue should know it inside and out. They know which techniques work, and they probably stay up-to-date on new developments in the field.

Even for very common conditions like depression or anxiety, a specialist is still more effective than a generalist. The problem is that specialists are often hard to find because they have longer waiting lists, are potentially more expensive, and there might not be any in your area. But if you can find one and they’re accessible to you, I really recommend working with them.

For neurodivergence, you absolutely must choose someone trained in this area, because it’s not a pathology but a difference. Your brain works differently and you need someone who understands this and helps you navigate a world that wasn’t built for you. Most of the problems that neuroatypical people suffer from come from over-adapting to a neurotypical world. A specialist understands this distinction well and will help you develop strategies that are adapted to you and your brain.

The same goes for people who are part of the LGBTQ+ community: make sure your therapist is LGBTQ+ friendly and understands the specific difficulties of navigating a world that is often hostile towards you.

Certain conditions have established treatments

After all this time trying to find concrete and effective solutions to our psychological problems, we’ve actually been able to work out that certain conditions have treatments that are particularly well-suited to them.

Trauma

We started seriously studying trauma since World War I, faced with the terrible psychological damage it left on surviving soldiers. Today, thanks to advances in neuroscience, we know that trauma is a major nervous system dysregulation, and that’s why talk-based therapies are often ineffective in treating it.

The most “simple” version of a traumatic state is PTSD (the famous post-traumatic stress disorder). This occurs following a single traumatic event, unlike complex PTSD and dissociative disorders, which are due to repeated and/or prolonged trauma that damages or even completely fractures the self.

You absolutely must choose a “trauma-informed” therapist, meaning someone who knows the effect of trauma on the nervous system. To treat PTSD, we now know that certain approaches are much more effective than others, notably:

• Brainspotting
• EMDR
• Neurofeedback

Brainspotting is currently THE cutting-edge therapy for trauma-related problems. It’s more effective than EMDR and less protocol-based, however, it’s harder to find a therapist who practices Brainspotting because there are far fewer of us. EMDR remains the best known, and even though it’s less suited for people with dissociative disorders, it’s a very effective therapy, just like Neurofeedback. These approaches work directly with the nervous system. In cases of complex PTSD or dissociative disorders, you need a multidisciplinary approach or a specialist because the healing process is longer.

⚠️ Important: CBT and traditional psychoanalysis are not effective for treating PTSD.

Grief

There are many types of grief, but the ones we’re interested in here are so-called “normal” grief and those that are “complicated” or “traumatic.” Although these last two were long considered different, complicated grief is now considered similar to traumatic grief, and thus the best approach takes the nervous system dimension into account.

If you’ve experienced a loss and need support, a psychoanalyst will know how to create a space where you can simply express yourself and be heard in your suffering. If you realize you can’t move forward, and/or you have traumatic symptoms like flashbacks or nightmares, you need to treat the problem at the nervous system level, with EMDR, Brainspotting, or Neurofeedback. Nothing stops you from combining both approaches, by the way, to benefit from both.

Borderline personality disorder

Borderline personality disorder is a complex disorder that requires an approach tailored to it. Today, the most effective therapy that exists for this condition is dialectical behavior therapy (DBT), which was designed specifically for it.

It’s an approach that combines:

• cognitive-behavioral techniques
• acceptance and mindfulness approaches
• interpersonal effectiveness strategies
• emotional regulation strategies for dealing with distress

It is currently the only empirically validated treatment for borderline disorder, and unlike other approaches, it integrates both a non-stigmatizing approach where the intense emotions of borderline individuals are recognized as adaptive responses (no “manipulation” or “attention-seeking”), but also teaches positive behavioral changes to manage intense emotions and build healthy relationships.

You should also know that comorbidity between ADHD and borderline disorder is common (up to 34% of adults with ADHD have both diagnoses), which complicates diagnosis and treatment. Given that 70% of borderline people have experienced childhood trauma, it’s crucial that your treatment takes this into account and that your therapist is trauma-informed, and if possible, trained in EMDR, brainspotting, or neurofeedback.

The problem with “symptom-conditions”

Depression, anxiety disorders, and eating disorders are “symptom-conditions,” meaning they are very often symptomatic of something else, and to be able to treat them effectively, you need to know what that something else is.

Let’s examine the following cases:

Severine: She consults because she’s felt very anxious since her car accident and has panic attacks whenever she gets behind the wheel. She jumps at the slightest noise and sleeps poorly. She was diagnosed with an anxiety disorder, but in reality it’s trauma manifesting this way because her nervous system has been hyperactivated since that event. So she needs trauma-informed therapy, not CBT.

Marc: He’s always been a boy who “worried about everything,” but it got worse when he started believing he had to be perfect or he couldn’t be loved. He can no longer undertake the slightest project because the possibility of failure is too risky. Here, he needs to change his beliefs and thoughts, and structural therapy like NLP would be the ideal approach. CBT could also help him.

Elise: After having a very difficult childhood where she suffered significant emotional violence, she’s hypervigilant in her relationships and constantly watches for the moment when she’ll be rejected. She can’t trust her own perceptions of reality and feels anxious all the time. Here, she needs therapy that takes attachment bonds into account, like psychoanalysis. She could also benefit from NLP to change her limiting beliefs, or brainspotting or EMDR to potentially treat difficult emotions or trauma.

So these are three anxious people, but who are anxious for completely different reasons, and who therefore need approaches that differ as well. Treating Severine’s anxiety with CBT would be as ineffective as treating Marc’s with EMDR. And the same goes for depression and eating disorders, although the latter requires a specialized and probably multidisciplinary approach because they often involve additional medical and nutritional aspects.

When you need a multidisciplinary approach

Certain conditions require combining the expertise of several professionals, like psychosis, for example, or bipolar disorder. For example, working with a psychiatrist to have appropriate pharmaceutical treatments, but also with other therapists for support and listening, or to resolve trauma-related or relational problems.

Burnout and eating disorders also need this multidisciplinary approach, although consulting a specialist in the matter remains ideal. And the same goes if you’re unlucky enough to have several problems to treat, like PTSD coupled with depression, or ADHD accompanied by an anxiety disorder.

Finally, in cases of severe trauma, complex PTSD, significant dissociative disorders, and failing to find a specialist to work with, combining a trauma-informed approach (EMDR, Brainspotting, etc.) and supportive therapy (psychoanalysis or other) is ideal for regaining a regulated nervous system and quality of life.

Conclusion

Choosing a therapist is complicated, but I hope that with this article you’ll have an easier time making a decision and getting the help or support you need.

Remember, finding the therapist who’s right for you can take time, and that’s normal. A specialist remains your best option when possible, but someone competent and attentive can also work wonders if they know what they’re doing. The important thing is that this person understands what you’re going through and knows how to accompany you with kindness and humility.

Finally, keep in mind that your needs can evolve over time. It’s perfectly normal to need to change approaches along the way, test other therapies, or even completely change therapists depending on your evolution. Healing is not a linear thing – sometimes we think we’ve resolved something, but it comes back because we need to work on it more deeply. At other times, treating one problem brings others to the surface. This can be terribly frustrating, and we can feel like we’re not moving forward (or even going backward), but it’s normal, and it means quite the opposite!

Mental health is more of a journey than a destination, and you deserve to find the right support. So take charge of it: don’t be afraid to do your research and trust yourself, because even if you make a mistake, at worst it’ll just be a detour.

So let me help you self-diagnose correctly. If we’re going to do this, let’s do it right: even though it won’t replace an “official” diagnosis, it’s a good start, and it might just save you years of bouncing between therapists and getting nowhere.

First Off – What’s a Diagnosis, Really?

Psychiatrists and psychologists would love to be the only ones capable of making diagnoses. And technically, they are: at least for the “official” ones. But… how do I put this. A diagnosis isn’t magic. They went to university, not Hogwarts. What they do is memorize a bunch of symptoms and pathologies from the DSM-5 (the big book of psych disorders), listen to you talk about what’s wrong, while checking boxes in their heads.

And sure, when you have years of experience, maybe it’s easier to recognize patterns – I’m not saying otherwise. But an official diagnosis is nothing more than glorified box-checking. And if the Rosenhan study and research on diagnostic reliability have proven anything, it’s that these professionals get it wrong constantly: you’ll rarely get the right diagnosis on the first try.

This being said, if you’re reading this article, you probably have at least some self-awareness, and that’s all you need to self-diagnose. And remember: it’s just a label. Even if you make it official, by the way. It’s just information. It’s not the end: it’s the beginning.

First Things First – Let’s Assess How Urgent This Is

If you’re experiencing physical or sexual violence:

Violence typically follows a predictable cycle: tension, explosion, reconciliation, tension. The abuser controls their victim by isolating them, threatening them, controlling their finances, or using emotional manipulation (suicide threats, playing victim, put-downs). Recognizing these tactics can help you understand that it’s not your fault and that the situation won’t improve on its own. If you feel confused and don’t dare talk to a human about it, explain the situation to ChatGPT or Claude AI by saying something like “I think I’m being abused, but I’m not sure – can you help me?” It will ask for more information, and AI does an excellent job at spotting and explaining different types of violence. Don’t forget to delete the conversation afterward to avoid potential retaliation.

Keep your important documents accessible and if possible at a trusted person’s place, and prepare an emergency bag just in case. Memorize important phone numbers and plan where to go in an emergency. If you leave, do it when the abuser isn’t there.

Hotlines and Immediate Help:

• 3919 – Violences Femmes Info (free, 24h/24)
• 119 – Allô Enfance en Danger
• 17 – Police/Gendarmerie (emergency)
• 15 – SAMU (medical emergency)
• Online chat at violences-femmes-info.gouv.fr

If You’re Having Thoughts about Hurting Yourself

Many people have suicidal thoughts without acting on them: the problem is when you have a plan. If you have a detailed plan and the means to carry it out, if you feel like you can’t control yourself anymore and you’re in distress, this is a medical emergency.

⚠️ Important: Healthcare professionals have a legal obligation to ensure your safety and that of those around you. Expressing suicidal or violent thoughts frequently triggers hospitalization and involuntary treatment.

How to ask for help if you don’t want to be hospitalized:

Focus on functional symptoms:

• “I can’t get out of bed in the morning anymore”
• “I’m having trouble concentrating at work”
• “I’m not sleeping / I’m sleeping all the time”
• “I have no appetite”
• “I feel very sad”

Avoid trigger words:

• Don’t mention suicide or violence
• Avoid phrases like “I can’t go on like this”

Emphasize your desire to get better:

• “I’d like to get my motivation back”
• “I want to be able to function normally”
• “I need help feeling better”

If you simply describe depressive symptoms and functional difficulties, you have a good chance of getting outpatient treatment (antidepressants, therapy) rather than hospitalization. And if they ask whether you have suicidal thoughts, you can say that it happens but it’s very rare, and not right now.

Hotlines where you can speak freely:

• Suicide Écoute : 01 45 39 40 00 (24h/24, free)
• SOS Amitié : 09 72 39 40 50

The volunteers on these lines are not healthcare professionals and don’t have the same legal obligations.

Another option: requesting voluntary hospitalization

If you’d still like to be hospitalized because you feel you need intensive, immediate support, but want to keep your human rights, it’s possible to request voluntary hospitalization. It’s generally recommended to first see your primary care doctor who can write a medical certificate. With this certificate, you can go to the psychiatric hospital. You can also go directly to the psychiatric emergency room – a doctor there can do the necessary evaluation. About 80-90% of psychiatric hospitalizations in France are voluntary.

In voluntary hospitalization you keep the right to leave, even against medical advice (by signing a waiver), and you can refuse treatment without being restrained and forcibly injected by multiple people. This can be an option if you feel a crisis coming on or if you need a secure environment to stabilize. However, if the medical team determines during your stay that you pose a danger to yourself or others, they can convert your voluntary admission to involuntary hospitalization. So be careful – studies show that 12-13% of patients develop post-traumatic stress disorder from forced treatments, and that 69-82% of patients consider psychiatric hospitalization traumatic. You don’t need that on top of everything else.

⚠️ IMPORTANT – Note to Healthcare Professionals:

If you’re a healthcare professional and you’re grinding your teeth reading all this, know that I’m not hiding my pro-human rights stance in psychiatry. No one should have the power to legally override other people’s human rights “supposedly” for their own good. If you’re not capable of building trust with your patients to the point where they refuse help when they’re in distress, you’re the problem.

The facts are clear: current research shows that forced psychiatric treatment is counterproductive for suicide prevention. It destroys trust, increases traumatic symptoms, and the highest risk period is immediately after discharge, when people have been traumatized by a system that was supposed to help them. Patients complain of abuse, coercive practices, and dehumanizing procedures. What the hell are you doing?

Finally, the fact that you have the power to forcibly commit people isn’t exactly a secret and prevents some people from seeking help because they would literally rather die than ask for your help.

The whole situation is terrible. Do better.

If Everything Feels Weird and You’re Scared

Use your phone’s camera to check what you’re seeing – if it’s only in your head, it won’t show up on screen. You can also call someone you trust and show them live what you’re seeing, or explain what’s happening if you’re hearing strange things or feel like someone wants to hurt you. If this person is worried about you and advises you to see a doctor or go to the hospital right away, listen to them, and ask them to come with you if possible.

If you’re really unwell, call 15 (SAMU) directly.

Simply describe what you’re feeling and what’s scaring you. The professionals will be able to assess you and guide you properly.

Remember: what you’re experiencing can be treated. Even if everything is terrifying, with the right treatment you’ll be okay. These episodes respond well to medication today: trust the healthcare professionals even if you’re scared – they’re there to help you reconnect with reality and get better.

You’re not crazy, your brain is just sick, and it can be treated.

Self-Diagnosis: The Three Questions You Need to Ask Yourself

What?

The first thing to do to self-diagnose properly is to try to put words to what’s wrong. Let’s try to categorize our feelings for more clarity:

It’s My Internal State

• I feel BAD (sad, depressed, hopeless)
• I feel ANXIOUS (worried, scared, panicked, stressed)
• I feel NOTHING/I feel DISCONNECTED (numb, detached, empty, cold)
• I feel ACTIVATED (angry, frustrated, explosive, on edge, wound up)
• I feel WEIRD (like nothing is real, I see myself from the outside, I feel like I’m floating)
• I’m being PERSECUTED (they’re spying on me, they want to hurt me)
• I’m in a state of ALERT (I startle easily, I’m always on guard, I don’t feel safe, my body reacts like there’s danger)
• I feel GUILTY/I’m ASHAMED (I did something wrong, I disgust myself, I’m ashamed of who I am, I feel dirty, I’m worthless)
• I’m OVERWHELMED (everything is too much, I can’t handle it anymore)
• It’s PHYSICAL (tired, tense, pain, sleep problems)

It’s My Situation

• It’s RELATIONAL (alone, rejected, relationships that fail)
• It’s my WORK or my PRODUCTIVITY (burn-out, procrastination, perfectionism)
• I have ADDICTIONS/COMPULSIONS (I can’t stop myself from doing something)
• It’s my FUNCTIONING (I can’t concentrate, make decisions, get things done)
• I AVOID things (I avoid people, places, or situations)
• I HURT myself (I injure myself, I sabotage myself, I have destructive behaviors)
• My THOUGHTS haunt me (racing thoughts, intrusive memories, I can’t turn my brain off)
• My MEMORY is messed up (I forget everything, or I can’t forget certain things)
• My life has no MEANING or PURPOSE (what’s the point?)
• My life has FLIPPED (everything changed, I’m lost, I don’t recognize my life anymore, I don’t know where I stand)

I’m the Problem

• I have an IDENTITY problem (I don’t know who I am, I feel like an impostor, I can’t be myself, I’m different, I’m weird)
• I have a MOTIVATION problem (I have no goals in life, nothing motivates me)
• I have a SELF-ESTEEM problem (I’m worthless, I’m broken, I don’t deserve to be loved/respected, I’m useless)
• I hate my BODY/APPEARANCE (obsessions with food, weight, or exercise)

You can feel several of these things at once. You need to write everything down – it’s important for the next part!

If you have no idea what you’re feeling, you can try writing in a journal every evening, talking about your day, etc. When you reread it, something might stand out.

Since When?

Once you have an idea of what you’re feeling (or not feeling), it’s time to clarify the timeline – meaning trying to “date” your symptoms. It’s a bit like an archaeologist trying to date the objects they dig up, but here, it’s your personal history you’re trying to decode.

Something Happened

• Grief (death of a loved one, loss of a pet)
• Trauma (accident, assault, abuse, natural disaster)
• Breakup (divorce, end of relationship, loss of important friendship)
• Major change (moving, job loss, serious illness)
• Major failure (studies, work, personal project)
• Birth (postpartum depression, parental stress)

It’s Always Been Like This/For a Long Time/As Long as I Remember

• I had a difficult childhood (violence, neglect, absent/sick parents)
• I’ve always been like this (anxious, sad, different from others)
• Chronic family problems (alcoholism, mental illness, poverty)
• Bullying/harassment at school
• Always felt “weird” or “different from others” since I was little

I’m Not Sure

• There were several things (stress accumulation, small traumas)
• It started when I was little and got worse
• Hormonal changes (puberty, menopause, pregnancy)
• Chronic stress (overwork, persistent financial problems)
• It fluctuates depending on periods in my life

How Bad Is It?

You know what you’re feeling and you know more or less since when: the last thing is to try to assess how intense it is, because it’s important to know when you need to ask for help.

“I often feel sad” is not the same as “I want to die every day.” “I feel anxious right now” is not the same as “I can’t stop thinking about what happened and I haven’t slept in a month.” How often do you have these feelings? How much does what you’re feeling interfere with your daily life? Does the intensity fluctuate depending on the day, time of day, or situations? Next to each symptom, add its intensity on a scale of 1 to 10, and if possible its frequency.

It’s important not to pathologize normal human feelings like we tend to do today (we’re not supposed to feel super happy 24/7, and it’s normal to feel bad when life gets complicated), but it’s also important to know when to ask for help.

Apart from the emergency situations I mentioned earlier, basically, if your quality of life is severely impacted, and/or you can’t function normally anymore, it’s time to get help.

BONUS QUESTION 

Do you have any family history of mental health issues? Meaning: are there people in your immediate circle (parents, siblings, grandparents) who have had a mental health diagnosis?

This isn’t about inevitability, it’s about understanding certain tendencies. If your father tried to commit suicide in the past, it doesn’t mean you have depression, but it’s useful information. Sometimes family members never got an official diagnosis, but they had symptoms – the “eccentric” cousin, the “dramatic” grandmother, the alcoholic parent…

Detective Work: Following Promising Leads

You now have enough information to start your investigation. Like a detective following clues, here are some leads that might match what you’re feeling. But keep an open mind – it’s possible that several things fit, or that nothing speaks to you: it happens, and that’s why we’re here.

You might be TRAUMATIZED:

If you’ve been through something difficult, like an accident or an assault, if you were bullied at school or work, or if you had a difficult childhood, you might have a trauma-related issue.

You might feel anxious, on high alert, stressed, or scared, you might see disturbing images or memories on repeat, or think about the event constantly. It’s also possible that you feel weird or disconnected, or that you don’t feel anything at all. This is dissociation, which is often the result of trauma. It’s even possible to alternate between these two states.

⚠️ Warning: A persistent feeling of shame, guilt, or anger can signal present or past abuse, and trauma. It’s possible that someone hurt you, tried to control you or manipulate you. This includes emotional abuse (put-downs or other forms), which are often harder to recognize but do just as much damage.

Google searches to do: PTSD, C-PTSD, post-traumatic stress disorder, trauma reactions, nervous system trauma

Online questionnaires: the PCL-5 (for PTSD), the ITQ – International Trauma Questionnaire (for C-PTSD)

You might be GRIEVING::

If you’ve lost someone or something important (death of a loved one, breakup, job loss, moving, end of a life stage), it’s normal to feel sad or angry. Grief isn’t an illness, it’s a natural human reaction to loss.

But if your grief is preventing you from functioning after several months, if you feel “stuck” in sadness, if you’re isolating yourself from others, or if this loss has deeply changed how you see yourself or the world, you might have “complicated grief.”

This isn’t the same as depression (though you can have both). Complicated grief is when the normal grieving process doesn’t happen – you stay stuck in the pain of the loss and can’t move forward.

Google searches to do: complicated grief, pathological grief, grief therapy

Online questionnaires: the Inventory of Complicated Grief (ICG)

You might be DEPRESSED:

If you feel sad or hopeless all the time, if everything seems dull and uninteresting, if you feel tired, have trouble concentrating, sleep too much, or can’t fall asleep anymore, you might have depression.

This isn’t just feeling down. Real depression lasts over time. Some people manage to function in ‘survival mode’ but will suffer from the constant effort it requires and the deep distress they feel.

If you frequently have suicidal thoughts, it’s time to ask for help. Sometimes just finding someone to talk to, to unload some of your suffering, is enough initially to calm the distress. If you’re planning to end your life, writing goodbye letters, and you know when and how you’re going to do it, you’re in danger, and it’s urgent to get psychiatric help. Don’t do something irreversible: there are treatments that really work and can help you.

Google searches to do: major depression, dysthymia, chronic depression

Online questionnaires: PHQ-9 (Patient Health Questionnaire), Beck Depression Inventory (BDI-II)

Immediate help lines:

• Suicide Écoute: 01 45 39 40 00 (24/7, free)
• SOS Amitié: 09 72 39 40 50 (24/7)
• 15 – SAMU (medical emergency)

You might be ANXIOUS:

If you feel worried and stressed all the time, if you feel like something terrible is going to happen, if you have unexplained physical reactions (fast heartbeat, sweating, shaking), you might have an anxiety disorder. It’s your brain making you believe there’s danger when there isn’t, and the more you avoid what scares you, the worse it gets.

There are different forms of anxiety, from generalized anxiety (you worry about everything), to panic attacks (intense and sudden fear), to social anxiety (fear of being judged by others), specific phobias (which can also result from trauma), or OCD (obsessive thoughts + compulsive rituals to calm the anxiety).

Google searches to do: generalized anxiety, panic disorder, social anxiety

Online questionnaires: GAD-7 (Generalized Anxiety Disorder-7)

You might be NEURODIVERGENT:

If you’ve always felt different, if you struggle with social codes, or if you’ve had trouble concentrating since childhood, you might be neurodivergent.

This includes autism (social difficulties, need for routine, intense interests), ADHD (attention difficulties, hyperactivity, impulsivity), giftedness (high IQ, hypersensitivity), or other neurological differences.

⚠️ Warning: If you suspect neurodivergence, only consult professionals who specialize in or are trained on the topic. General practitioners usually miss the diagnosis (especially if you’re a woman), and risk pathologizing typical neurodivergent behaviors.

Google searches to do: adult autism, adult ADHD, autism masking, late diagnosis neurodivergence, gifted symptoms, high potential symptoms

Online questionnaires: AQ (Autism Quotient), ASRS for ADHD, online giftedness questionnaires

You might be PSYCHOTIC:

If you’re hearing voices that others don’t hear, if you’re seeing things that aren’t there, if you feel like you’re being spied on or that someone wants to hurt you, if you feel confused and have trouble thinking clearly, you’re probably not reading this article… but just in case, you might be having a psychotic break.

It’s scary, but medication can really help you. The sooner you get help, the sooner you’ll feel better. Don’t try to self-diagnose yourself because your perception of reality is altered: ask someone you trust to go with you to your primary care doctor or to the emergency room.

And if you’re really unwell, call 15 (SAMU) directly.

You might be BIPOLAR:

If you alternate between “high” periods (full of energy, less need for sleep, tons of ideas flying around, impulsive spending) and periods of deep depression where nothing interests you and you don’t want to do anything, you might have bipolar disorder.

It’s often only during depressive phases that someone will seek help, so the doctor only sees half the picture. It’s important to mention these high phases if you have them.

Google searches to do: bipolar disorder, manic episode, hypomania, cyclothymia

Online questionnaires: MDQ (Mood Disorder Questionnaire), HCL-32 (hypomania checklist)

You Might be BORDERLINE:

If you have impulsive behaviors with very intense emotional reactions (especially when stressed), if you feel a constant inner emptiness or have identity issues, if you’re terrified of being abandoned, and you realize your relationships are intense but chaotic and you tend to see everything in black and white, you might have borderline personality disorder.

If that’s the case, you probably have a history of trauma, and it’s also possible you have ADHD. It’s a complex disorder but responds really well to therapies designed for it.

Google searches to do: borderline personality disorder, BPD

Online questionnaires: McLean Screening Instrument (MSI-BPD)

You might Have an EATING DISORDER:

If you have a complicated relationship with food, if you’re obsessed with your weight or appearance, if you restrict what you eat or you’re always dieting, if you make yourself throw up, if you lose control and consume large amounts of food without being able to stop, you might have an eating disorder.

The main disorders are anorexia (food restriction), bulimia (binge episodes and compensatory behaviors), binge eating disorder, and orthorexia (obsession with “healthy” food).

These disorders mess with your body and wear you out mentally. You need to see a specialist as soon as possible.

Google searches to do: anorexia nervosa, bulimia, binge eating disorder, orthorexia

Online questionnaires: EAT-26, SCOFF questionnaire, BES (Binge Eating Scale) for binge eating disorder, ORTO-15 for orthorexia.

It might be BURNOUT :

If you’re emotionally and physically exhausted, if you feel like you’re no longer effective, if everything feels like too much and is overwhelming, you might be experiencing burnout.

This isn’t just being tired. It’s psychological and nervous exhaustion that doesn’t go away just by taking a vacation. You might develop physical symptoms (headaches, digestive issues), feel constantly on edge, and have sleep problems. Anyone can experience burnout after chronic stress over a long period.

It’s a complex problem that requires specialized help, often multidisciplinary. The sooner it’s treated, the better, and remember that it’s not a personal failure but a normal reaction to abnormal stress conditions.

Google searches to do: burnout, occupational exhaustion syndrome, parental burnout, emotional exhaustion

Online questionnaires: Maslach Burnout Inventory, Copenhagen Burnout Inventory

Maybe your life just SUCKS:

Sometimes you’re not the problem – your situation is. If you’re living in poverty, if you’re facing discrimination, sexual harassment, if you’re in a toxic relationship, if you work in an unhealthy environment, if you’re caring for a sick or difficult loved one, it’s NORMAL to not be doing well. Often, the solution is to quit, get divorced, move, or change jobs. A therapist or social worker could help you find concrete solutions to change your situation.

It’s also possible that you simply need to learn to communicate, say no, set boundaries, manage conflicts, so your life can be easier and more fulfilling. You might be going through a rough patch, and that’s where supportive therapy can help you develop strategies to cope, and simply give you a place to vent your emotions by complaining in sessions. Sometimes there’s nothing to “fix” – you just need to talk, to have a safe space to discuss what’s happening to you.

⚠️ IMPORTANT: If you’re using “substances”:

Alcohol and drugs (even “soft” ones like cannabis) completely alter brain chemistry and can mimic or mask practically all psychiatric symptoms. You might think you have depression when it’s just your brain trying to compensate for your consumption. Or conversely, you might be using alcohol to “manage” an anxiety disorder or trauma without realizing it since you’re masking the symptoms.

If you use regularly (even “just” on weekends), you need to stop for at least a month first to be able to make a real assessment of your actual mental state. If you can’t stop, it means you have an addiction – and that can also be treated with the right support. If you think you have a problem, talk to your primary care doctor – they can advise you.

Resources: Alcoholics Anonymous, CSAPA (Addiction Care, Support and Prevention Centers), primary care physician.

Why the Questionnaires?

The questionnaires were developed by psychiatrists and psychologists to be able to diagnose their patients more systematically and efficiently. They’re very good tools, but that’s all they are: tools, a starting point, and nothing more. What’s great is that they’re available online for free.

Understanding How These Questionnaires Work:

Sensitivity and Specificity

Each test has a sensitivity and specificity score evaluated as percentages:

• Sensitivity measures the test’s ability to detect people who actually have the condition. A sensitivity of 85% means that out of 100 people, the test detects 85 of the people who have the condition but misses 15 (false negatives).
• Specificity measures the test’s ability to correctly identify people who don’t have the condition. A specificity of 90% means that out of 100 people, 10 without the condition will still get a high score (false positives).

These tests work on general trends, not individual cases – and that’s why they never have a 100% score.

Core Symptoms and Associated Symptoms

• Each condition has its own core symptoms, for example chronic sadness for depression and excessive worry for anxiety disorders. These are the symptoms that define the condition.
• Associated symptoms are optional – they may be present – or not!
• Multiple conditions can have the same associated symptoms
• If you’re missing the core symptoms, it’s probably not what you have.

Differential Diagnosis

• The same symptoms can have completely different causes – this is called differential diagnosis – and that’s why it’s important not to stop at the first diagnosis that seems to fit.
• If the diagnosis isn’t right, you risk looking for inappropriate solutions, like doing CBT for anxiety when you actually have trauma.
• For example: concentration problems are found in depression, ADHD, anxiety, trauma, chronic stress…

How to Use These Tests Correctly

• You need MOST of symptoms, not just a few. If a depression test describes 9 symptoms and you only have 2, there’s little chance you have depression.
• Check first that you have the core symptoms – because if you don’t, that’s suspicious.
• Consider the duration and frequency of your symptoms, because to have a psychiatric diagnosis, symptoms need to persist for weeks or months.
• Don’t forget to get comprehensive blood work done to verify that you actually have a psychological issue and not a physical problem.
• It’s also possible to end up with multiple conditions: for example, trauma + depression, ADHD + anxiety disorders, or depression + anxiety.

Special Note for Neurodivergent People

If you think you’re neurodivergent or if it’s already been confirmed, be very careful because in my experience, we don’t present symptoms the same way neurotypical people do. For example, someone who has psychosis might just “ignore” auditory hallucinations, or someone with severe depression will learn to function with it. I can’t stress enough the importance of only seeing professionals who specialize in neurodivergence, and/or who are neurodivergent themselves.

What Now? What Do I Do With My Self-Diagnosis?

You have several options:

• Do nothing (and that’s okay)
• Find a therapist to talk to about it (a psychoanalyst for example)
• Take steps to get an “official” diagnosis and potential pharmaceutical treatment (psychologist/psychiatrist)
• Find the right therapist to address your problem

Remember: a diagnosis is just a label. It’s information, a tool, not a sentence. It’s the beginning of something: it can potentially help you understand yourself better, find a community around that diagnosis, and also help you better communicate what’s happening to you to competent professionals and guide you toward effective treatments.

You’re not broken. At most, your brain is just acting up. It’s not your whole story, it’s just part of it.

If you want to present your findings to a doctor or psychologist, you can simply be honest. You read an article, you have certain symptoms, you took certain tests: a good therapist should normally be delighted to meet an informed patient who’s active in their care. Bring notes with you if you’re afraid of forgetting something.

A bad therapist will feel threatened in their position as the “expert,” get defensive or mock your work, and won’t listen to you. Don’t forget that you’re paying them, and they have legal and ethical obligations to you: respect, listening, and care. It’s supposed to be collaborative work: so if they insult you, refuse to answer your questions, or threaten you, you have the right to leave and find someone else.

The road to hell is paved with good intentions. Trust yourself – they’re not in your head.

Conclusion

I wrote this guide for the person I was 25 years ago, who wanted answers and had to wait decades to get them. I wrote it for my ex, who was schizophrenic, and who wouldn’t have waited 7 years for his diagnosis if he had read this. And I’m writing it for you, because even though you’re not a mental health expert, you are an expert of yourself, and that still counts for something.

This is psychoeducation. In middle school, we learned some basics about the human body, and here, I’m teaching you about diagnoses and mental disorders. I hope that with all this, you understand yourself a little better. Moreover, this knowledge isn’t just there to help you – it could also help your family, your children, or your friends.

We may have made technological leaps this past century, but psychologically we’re the same traumatized primates who have been killing each other since the dawn of time. Except now, we have the technology to wipe ourselves out entirely, taking the whole planet out with us. Understanding how we function and learning to regulate ourselves is no longer a luxury – the survival of our world depends on it

Sources

Voluntary hospitalization rates in France:

• “Involuntary hospitalization” (2008) – Academic article from Cairn.info confirming that involuntary hospitalizations represent only “13% of psychiatric hospitalizations” Link

Diagnostic reliability in psychiatry:

• Rosenhan, D.L. (1973) – Famous study “On Being Sane in Insane Places” demonstrating that “we cannot distinguish the sane from the insane in psychiatric hospitals” and revealing diagnostic reliability problems Link

On ChatGPT and general AI for recognizing patterns of violence:

• Zhang, et al. (2025) – Study published in Family Relations (Wiley) examining “the effectiveness and consistency of ChatGPT in identifying domestic violence” and demonstrating ChatGPT’s ability to provide emotional and informational support to victims Link

On the harm of forced commitment:

• Berry, K. et al. (2013) – Meta-analysis showing that “PTSD prevalence rates following trauma symptoms and/or hospitalization range from 11% to 67%”  Link
  
• Frueh et al. (2003) – Study “Trauma Within the Psychiatric Setting” showing that “82% of patients reported that institutional events and procedures caused trauma and harm” Link
  
• Martinaki, S. et al. (2021) – Study showing that “PTSD after mechanical restraint or involuntary medication was 12.6%”  Link
  
• Jordan, J.T. & McNiel, D.E. (2020) – Study showing that people who were forcibly hospitalized had a significantly higher risk of suicide attempts than those who did not report coercion, demonstrating that forced psychiatric treatment is counterproductive for suicide prevention Link

 The risk of commitment prevents some people from seeking help:

• Jina-Pettersen, N. (2022) – Study showing that “hospitalization was found to induce significant fear, which ultimately acted as a deterrent to seeking future mental health services” and that “increased trauma and traumatic stress from hospital stays coupled with subsequent avoidance of mental health services may contribute to a significant public health problem” Link

When I put it that way, it seems obvious that therapists have an emotionally demanding job that could potentially lead to burnout. The solution? Supervision.

In this article, we’ll explore what supervision is and why it’s essential for every responsible therapist.

The responsibility that comes with the privilege of being a therapist

The honor of being a healer

Being in a position of trust with clients or patients is both a privilege and an honor. But this privilege comes with great responsibility, because we owe them significant psychological availability, an unwavering therapeutic frame, and a strong emotional holding capacity.

Moreover, when working with vulnerable people, we’re in a position of power because we have knowledge, skills, and emotional stability that they don’t. This imbalance only reinforces our ethical duty to respect their dignity and trust.

The lake metaphor

A good therapist is like a lake, with calm waters that reflect the other person. Therapeutic work cannot happen if those waters are infested with the emotional sharks of an unregulated therapist.

You can’t give what you don’t have. And you can’t pour from an empty cup: a therapist’s psychological state directly impacts the quality of care they provide.

Why All Therapists Should Have Supervision

The profession’s inevitable challenges

Supervision with a more experienced therapist ensures professional rigor. It provides:

• An outside perspective on complex cases (under anonymity protection)
• Relevant guidance when patients trigger the therapist’s own wounds
• Monitoring to prevent emotional burnout and potential errors

This is essential for delivering quality work.

Personal work included in supervision

Supervision isn’t limited to the technical aspects of the profession. Beyond professional supervision, having done and continuing to do personal work allows therapists to:

• Process their own traumas
• Manage potential countertransference (when our own emotions and reactions interfere with treatment)
• Maintain healthy boundaries with patients

Who Gets Supervision?

A unique case: the psychoanalyst

In France, psychoanalysts are the only professionals required to have ongoing mandatory supervision and to have completed their own training analysis. This profession has integrated these requirements into its basic training, recognizing the importance of personal work and continuous professional support.

Everyone else – psychiatrists, psychologists, psychotherapists, psychopractitioners – practices without supervision, without professional support, and generally without being required to do their own therapeutic work.

The reality of supervision

Ideally, you’d want access to a clinician who benefits from regular supervision, but outside of psychoanalysis, that’s not today’s reality.

However, many excellent practitioners don’t have formal supervision but have done significant personal work – in fact, it’s often because of their own healing journey that they chose this professional path!

Others get support in different ways:

• Peer consultation groups
• Personal therapy
• Continuing education

So the absence of supervision doesn’t necessarily mean the therapist is inadequate.

Conclusion

I hope that one day supervision and personal work will become standard for all therapists, not just a psychoanalytic requirement. It’s a difficult profession, and the burden would be considerably lightened with better support.

But ultimately, it’s the quality of the therapeutic alliance between you, and having the right therapist for your specific issues that will make all the difference – with or without supervision.

Yet we often think we should stick with the first therapist we find, even when things don’t feel right and we’re struggling to build that crucial therapeutic alliance.

This misplaced loyalty is harmful, because that alliance is exactly what makes therapy work.

What is the therapeutic alliance?

The therapeutic alliance is the connection that makes you feel safe enough to really open up. It’s not about liking your therapist as a friend – it’s about trusting them enough to do the deep work. Any therapeutic relationship needs vulnerability to succeed.

This therapeutic alliance actually predicts therapy success rates better than any degree or technique.

How to recognize the therapeutic alliance

• You feel heard without judgment
• You can share anything with them, even things that embarrass or upset you
• Your therapist adapts to your needs and respects your boundaries
• You trust them and believe in their ability to help you
• You look forward to your next session

Transference vs. Alliance problems

It’s completely normal to feel angry, frustrated, or sometimes even hate your therapist. These feelings are echoes from the past – emotions you’ve felt (or feel) toward other people that get projected onto your therapist. A skilled clinician understands this phenomenon and will help you explore it, since it’s valuable therapeutic material.

There’s a crucial difference between the temporary discomfort of effective therapy and a real alliance problem. Red flags include feeling judged or looked down on, sensing that your boundaries aren’t respected or your needs aren’t heard. If you consistently leave sessions feeling genuinely bad – not just stirred up by the work, but actually dreading your next appointment – that’s concerning. If you feel fundamentally unsafe or completely misunderstood session after session, it might be time to reconsider the relationship.

Transference can be intense, but you’ll still trust your therapist. A problematic therapeutic alliance means you’re probably incompatible.

How to build and maintain the therapeutic alliance

The therapeutic alliance rarely clicks immediately, especially if you’re dealing with trauma or have trust issues in general. If you’re uncertain, give it at least 2-3 sessions before deciding.

If you have specific needs or requests, speak up early. You have every right to advocate for yourself, and good therapists will accommodate you when possible. Remember that feeling uncomfortable in early sessions doesn’t mean the alliance isn’t forming. Relax, your therapist is human too. We don’t bite.

When it doesn’t work out

Sometimes, despite everyone’s best efforts, it just doesn’t click. The therapeutic alliance never forms – you’re not a good match.

You can leave by saying you don’t feel like continuing, or that you think you need a different approach – no need to elaborate. Your therapist might even refer you to a colleague if you’re looking for something specific. If you can’t bring yourself to have that conversation, at least don’t just ghost your therapist. It’s unfair to them and to other clients who could use that appointment slot. You can always claim an emergency and say you’ll reschedule later. We’re used to it – we know we’re not right for everyone, no matter how good we are at what we do.

Most importantly, don’t let this experience stop you from going to therapy altogether. That would be like swearing off dating after a single terrible date. You deserve to find a therapist who’s right for you and who can help you take care of your mental health.

Conclusion

The therapeutic alliance is like a marriage – you need to find someone you feel able to weather storms with. This human connection matters more than all the credentials in the world. Without it, even the most skilled therapist with the best techniques can’t help you.

So take your time. The right therapist is out there waiting for you – you just need to find them.

This article will cut through the noise and help you evaluate a therapist beyond their credentials.

Degrees and Training

Being credentialed, trained, or certified simply means that your therapist has completed some more or less official training and scored high enough to receive that piece of paper.

A doctor, psychologist, or psychotherapist will have a “state degree,” which means the state has put its seal of approval on that particular diploma. Just like it did, for example, in the 70s when psychiatrists were doing lobotomies. Basically, take it with a grain of salt.

It’s an appeal to authority. It sounds serious, and sometimes it is.

Plus, someone who scored 11/20 on their exams has the same diploma as someone who scored 18/20. The paper doesn’t tell you which one you’ll be seeing. So it’s not a guarantee of competence.

Licensed to Practice

Some therapists are “licensed to practice” or “in training.” This means they need to complete hours (sometimes hundreds of hours) of practical work to gain experience before obtaining their final certification. And it doesn’t mean they don’t know the theory, since they generally have to pass their exams before getting licensed.

Competence

A competent therapist has mastered the field: they use their techniques correctly, understand the nuances of their work, recognize their limits and gaps in knowledge… in short, they’re a good practitioner who does their job well.

Furthermore, a competent therapist isn’t necessarily experienced. Someone who recently completed their training might be more competent than someone who studied 20 years ago and hasn’t kept up with recent developments in their field.

Continuing Education and Supervision

In France, there’s no continuing education requirement except for psychiatrists, who must complete CPD (Continuing Professional Development) every 3 years since 2009. Similarly, only psychoanalysts are required to have ongoing supervision. Yet a therapist working alone, without professional support, can easily drift off course, burn out, or make mistakes without realizing it.

Ideally, you’d want a therapist who does both. But unfortunately, since it’s not mandatory, few will have this level of rigor, which is a real shame.

Effectiveness

Effectiveness in a practitioner means you get the results you’re looking for. The reality is that if you see a highly certified and competent podiatrist for a toothache, they’ll be completely ineffective and unable to help you.

This effectiveness will largely depend on the match between your issues and the practitioner’s competence/specialization, but also on their flexibility in adapting to you as well as your active collaboration in the therapeutic process.

The Most Important Thing: The Therapeutic Alliance

You could find someone who’s super credentialed, ultra-competent, and perfectly suited to your issues… but you just don’t click with them. It’s nobody’s fault: you’re simply not compatible.

The right therapist for you, beyond everything else, will be the person you feel comfortable with. This is called the therapeutic alliance – that human connection that makes therapy work, and it’s the key to healing.

Conclusion

Ideally, you’d find a therapist you feel good with, who is credentialed, pursuing continuing education, competent, experienced, effective, in regular supervision, has done their own personal work, takes cultural differences into account, has humility, humanity, empathy, and knows their limits well…

Then you wake up and realize that in reality, it’ll probably be very difficult to find all of that in one person, and fortunately, that won’t prevent you from getting better. But for that to happen, you need to be an active participant in your mental health and remember that practitioners, from psychiatrists to coaches, are first and foremost humans – imperfect, fallible, limited… just like you.

You have the right to be demanding, but don’t put us on a pedestal: you’ll inevitably be disappointed. We’re not gurus. We don’t have all the answers, and even though we do our best, we can make mistakes.

A healthy therapeutic relationship recognizes the therapist’s expertise but also your own expertise about your own life. Treatment is fundamentally teamwork.

And don’t hesitate to interview several therapists before making a choice, and take your time asking all your questions. Your well-being is worth it.

The Big Three

There are three main types of therapy that are officially recognized, though they definitely don’t cover everything out there. These are psychodynamic, cognitive-behavioral, and humanistic therapies.

Psychodynamic Therapies

Psychodynamic therapy assumes your current problems stem from past experiences and unconscious patterns you keep repeating without realizing it. It’s all about exploring and talking – not necessarily trying to fix things right away, but really understanding what’s going on, often through your relationship with the therapist.

Main types:

• Classical psychoanalysis – with the couch and everything
• Psychodynamic psychotherapy – basically psychoanalysis but sitting face-to-face
• Analytically-inspired therapy – same thing as psychodynamic psychotherapy but with a different name

Cognitive Behavioral Therapy (CBT)

CBT works on the idea that your thoughts, feelings, and actions are all connected. Change how you think or behave, and you’ll change how you feel. It’s very hands-on with homework between sessions. You’ll identify unhelpful thought patterns (called “automatic thoughts”), challenge them, and try out new ways of doing things.

Main types:

• Standard CBT – the original, very structured approach
• ACT (Acceptance and Commitment Therapy) – learning to accept difficult thoughts instead of fighting them
• DBT (Dialectical Behavior Therapy) – CBT plus emotional regulation skills (especially helpful for borderline personality disorder)
• Behavioral therapy – focuses purely on changing behaviors

Humanistic Therapies

Humanistic approaches believe you already have what it takes to get better – you just need the right environment for it to happen. It’s very supportive and trusts your natural ability to grow and heal. The therapist walks alongside you as you explore, being genuine, empathetic, and non-judgmental. It focuses on personal growth, finding meaning, and big life questions. It’s about the here and now, not digging into the past.

Main types:

• Gestalt therapy – works with body awareness and what’s happening right now
• Person-centered therapy (Rogerian) – the therapist follows your lead without directing or interpreting
• Transactional analysis – looks at psychological games and relationship patterns
• Logotherapy – helps you find meaning and purpose
• Existential therapy – tackles the big questions about life and death

Other Approaches

These approaches are less official but they’re becoming increasingly popular and well-respected. This includes trauma-focused therapies, structural approaches, family and relationship work… and many others.

Trauma-Focused Therapies

These therapies understand that trauma and chronic stress mess up your nervous system, not just your psychology. They work directly with your body to help your nervous system settle down and increase your ability to handle stress. The idea is that some problems can’t be solved just by talking – you need to work through the body. This is especially helpful when you feel stuck or have overwhelming emotional reactions.

Main types:

• EMDR – uses eye movements to process trauma
• Brainspotting – uses specific eye positions to access and heal trauma
• Somatic Experiencing – helps your body complete stuck stress responses
• Neurofeedback – trains your brain to regulate better using real-time feedback
• Mindfulness-based therapy – brings meditation into traditional therapy

Structural Therapies

These look at how your thoughts and beliefs are actually organized in your mind. Instead of asking “why” you have problems, they ask “how” your mind processes things. Rather than just talking about issues, they directly change how you experience things – how you store memories, what beliefs drive your behavior, how different parts of your personality interact. They can be very effective and relatively quick.

Main types:

• NLP (Neuro-Linguistic Programming) – changes how you internally represent experiences
• Schema Therapy – identifies and changes deep-rooted patterns from childhood
• IFS (Internal Family Systems) – works with different “parts” of yourself
• Solution-focused brief therapy – concentrates on what’s working rather than what’s wrong

Relationship and Family Therapies

These recognize that we’re social creatures and our relationships massively impact our mental health. They look at the systems you’re part of – family, relationships, work. The idea is that changing how you relate to others can solve a lot of personal problems. Even in individual therapy, you’ll explore how your relationships affect your wellbeing.

Main types:

• Family therapy – works with the whole family to improve dynamics
• Couples therapy – helps partners communicate better and resolve conflicts
• Systemic therapy – applies family systems thinking to individual work
• Attachment therapy – heals relationship wounds and builds secure connections

Creative and Body Therapies

There’s also a whole bunch of complementary therapies that people often use alongside other treatments to help them express themselves or just relax.

• Hypnotherapy – accesses and changes unconscious patterns
• Art therapy – uses creativity for expression and healing
• Music therapy – healing through music
• Sophrology – combines relaxation, breathing, and visualization
• Movement therapy – uses body movement to release emotions

So what should I choose?

You’re probably thinking: “This is great, but which one do I actually need?” It’s totally normal to feel lost with all these options. Ideally, you’d know what’s wrong before picking a therapy – but if you don’t, that’s actually useful information too!

If you’re not sure what the problem is, you have a few options. You could see a clinical psychologist for a proper assessment (though diagnostic mistakes do happen). If that feels too clinical, you can try self-diagnosis – it’s not rocket science, and let’s be honest, you’ve probably already spent hours Googling symptoms at 2am. You could also start with psychoanalysis or a humanistic approach since just talking about your life can be incredibly healing. Or simply go with whatever approach feels right to you.

If you do know what’s wrong, pick the therapy that matches your problem – like trauma therapy for trauma, or existential therapy for grief. The key is being an active participant in your own mental health.

You might also need a combination of approaches. More therapists these days train in multiple methods so they have a bigger toolkit to help you. These “integrative” therapists adapt to what you need. Others prefer to specialize and work with colleagues who have different skills. Both approaches work fine.

Conclusion

Don’t be shy about asking questions in your first session – good therapists love explaining their approach and checking if it’s right for you. Most importantly, find someone you feel comfortable with. If you don’t feel safe with your therapist, nothing else matters. This connection is called the therapeutic alliance, and without it, real change can’t happen.

Don’t be afraid to shop around. If your first choice doesn’t work out, that’s completely fine. You have every right to keep looking until you find the right fit. That person is out there, waiting for you.

Yet understanding these differences is essential: it’s hard enough to ask for help when you’re not doing well, there’s no point in prolonging the process by seeing the wrong professional.

This article aims to clarify all of this, explain the differences between them, and give you a complete explanation of what they do… and what they don’t do.

The Psychiatrist

The psychiatrist is a doctor, so they have 6 years of general medicine + 4 years of specialization in psychiatry. They’re trained to make diagnoses and prescribe medications like antidepressants, anxiolytics, antipsychotics, sleeping pills, and can treat severe psychiatric conditions, even hospitalize you against your will if you’re a danger to yourself or others. Additionally, their diagnosis will be part of your medical record and will be visible to other doctors, and psychiatric diagnoses can potentially create biases that will negatively affect your future medical care.

If they haven’t done other training like psychotherapy or psychoanalysis, they’re not trained to treat you using specific therapeutic techniques. Their approach is therefore exclusively medication-based.

Reimbursement:

• Sector 1: 70% by Social Security (with referring physician), 30% outside care pathway
• Sector 2: partial reimbursement based on €39, excess charges at your expense
• You can consult directly, without referring physician approval

Average price:

• Sector 1: €55 (since December 2024), then €57 starting July 2025
• Sector 2: €60-120+ (free excess charges)

Session duration:

Between 10 and 30 minutes. They’re in high demand, often with very long waiting lists.

My opinion:

For me, the psychiatrist is a healthcare professional you should only consult if you need medical treatment: from experience, it’s better to leave diagnosis to psychologists whose sessions are longer and who are specially trained to do very comprehensive psychological assessments. In fact, they often work in tandem with psychiatrists for this reason.

Note: a psychological assessment is not a medical diagnosis that only a doctor can make.

Taking psychotropic drugs isn’t something to take lightly, and your diagnosis will be noted in your medical files that any doctor can consult, which can be very stigmatizing and potentially complicate your care for other issues.

That said, there are circumstances where certain psychotropic drugs can be necessary, even life-saving, like antipsychotics in cases of psychosis, mood stabilizers for severe bipolar disorders, antidepressants for very severe depression, or anxiolytics for acute anxiety attacks over very short periods.

If you think you need them, don’t hesitate to ask.

⚠️ Warning: If you tell a psychiatrist you feel suicidal, there’s a good chance they’ll hospitalize you against your will – with or without your consent. They have this power, and it’s perfectly legal. Medical trauma and psychiatric abuse are unfortunately studied phenomena that can severely worsen your condition.

The Psychologist

The psychologist holds a level 2 master’s degree in psychology, obtained after 5 years of university studies. This university training focuses on research, statistics, diagnostic evaluation, and psychological theories, but doesn’t include specific therapeutic training. Specializations are rather based on patient age (child, elderly) or on a particular field of activity (occupational psychologist, school psychologist).

This university training is excellent for understanding human functioning and making precise psychological assessments (which are not medical diagnoses), and that’s why these professionals often work in tandem with psychiatrists.

Reimbursement:

• “Mon soutien psy” contracted psychologist: 12 sessions per year reimbursed at 60% by Social Security (€30 reimbursed out of €50), plus 40% by your insurance. Since 2025, no prior approval from a referring physician is needed.
• Non-contracted psychologist: no Social Security reimbursement
• Psychologist at CMP (Medical-Psychological Center): 100% covered

Average price:

• “Mon soutien psy” contracted psychologist: €50 per session (€0 out-of-pocket with good insurance)
• Non-contracted private psychologist: €60-100+
• CMP: free (but very long waiting lists)

Session duration:

45-60 minutes generally

My Opinion

The psychologist, spending more than 10 minutes with their patient, is much better at making diagnoses than the psychiatrist. From experience, if they’re up to date on evidence-based care, they’re quite effective when it comes to understanding what’s wrong, and that’s why if you’re looking for medical care, I advise you to find a psychologist who works with a psychiatrist, and combine these two professionals. This will avoid wasting months, even years with a psychiatrist who only has 10 minutes to spare and basically plays darts with the DSM-5.

Additionally, many psychologists (but not all!) have completed their training with other specializations like CBT, EMDR, etc., so they’ll have real treatment skills that can help you, although it’s important to have care adapted to your unique case. A practitioner can be perfectly competent in their specialty but ineffective if that specialty isn’t suited to you: it’s like seeing a podiatrist for a toothache. Make sure your psychologist has the therapeutic training you need, because not all of them do.

⚠️ Warning: even though a psychologist can’t hospitalize you against your will, they can alert a psychiatrist or authorities if they believe you’re a danger to yourself or others.

The Psychotherapist

The title of psychotherapist is “protected” in France since 2010. To get it, you need a master’s in psychology (bac+5), plus 400 hours of training in clinical psychopathology, plus a 5-month internship.

Basically, it’s a psychologist with 400 additional hours of… psychology. The same thing they already studied for 5 years, but with even more theoretical psychopathology, diagnosis, clinical cases, and supervision. It’s a premium psychologist, basically. Just like the psychologist, they don’t learn specific therapeutic techniques unless they do additional training. They have knowledge about these different methods but aren’t trained to use them.

Reimbursement:

Same as psychologists

Average price:

€60-100

Session duration:

45-60 minutes

My opinion:

The psychotherapist is a psychologist who did one more year to… be a psychologist with an additional title. It’s French bureaucracy in all its glory: creating an extra degree to try to control people that changes nothing in practice but gives the illusion of specialization. In reality, you’ll get exactly the same thing as with a psychologist, just with a nice extra title. Of course, some then train in specific techniques, but that’s not guaranteed.

Note: You’ll also find “Psychotherapy Practitioners” (unprotected title) out there who do similar training but without the 5 years of university studies. The goal is to be able to circumvent the rules to use the word psychotherapy (because people know it and it sounds serious) without going through university.

The Psychoanalyst

Psychoanalysis is an old but very controversial discipline that requires several years of training (between 3 and 5 years), and having undergone your own psychoanalysis. It’s the only discipline that requires the practitioner to have done some self-reflection (which doesn’t guarantee quality but at least they made the effort). Additionally, a serious psychoanalyst has the obligation to be under continuous supervision: they must consult a training analyst (a shrink’s shrink) several times a year to discuss clinical cases, continue their personal work, etc.

A psychoanalyst can also be a psychologist or psychiatrist, but they’re not necessarily so. Several schools offer this training, and it’s not particularly regulated outside the requirements specific to each organization.

Why is it controversial? Because of its androcentric (even misogynistic) theories, its position on autism which is outdated and very harmful to concerned patients (autism is not psychosis!), and its omnipresence in medico-legal settings which has no place given that the approach is absolutely not scientific nor based on evidence-based care.

There are two main psychoanalytic schools in France: Freudians and Lacanians. The approach differs in theory but especially in session duration: a Freudian psychoanalyst does 45 to 50-minute sessions, while Lacanians don’t set session duration in advance, leaving it up to the analyst to end the session at any moment for greater impact. Thus, the duration is totally random, possibly even just 10 minutes, while the price, however, is not random at all, which obviously opens the door to all kinds of abuse.

Psychoanalytic therapy is known for its length: you need to count on 2 years minimum. It can happen face-to-face, and we talk about analysis when the patient is lying on a couch. This technique isn’t suitable for all profiles, notably for those with post-traumatic stress disorder, but normally the psychoanalyst will know if you’re a candidate for this and doesn’t impose anything anyway.

Reimbursement:

None

Average price:

€40-80

Session duration:

5-30 minutes (Lacanians); 50 minutes (Freudians)

My opinion

I became a psychoanalyst after training in many different approaches because, in my personal and clinical experience, psychoanalysts listen better than any other specialist. We’re specifically trained for this – to consider the patient as a whole person, beyond pathologizing diagnoses. That said, this doesn’t erase the damage that’s been done to the autistic community and continues to be done, since there hasn’t been any official position change yet.

Psychoanalysts aren’t necessarily trauma-informed and don’t have knowledge about neurodiversity unless they’ve specifically studied it or made it their specialty. They also lack specific training or protocols for domestic violence, psychological manipulation, eating disorders, addiction, and similar issues. If you’re seeking help for any of these problems, you absolutely need to ask about your psychoanalyst’s competence in these areas during your initial consultation. Don’t hesitate to find someone else if their experience doesn’t match your needs.

What psychoanalysis does exceptionally well is listening. A good psychoanalyst won’t judge you and will approach you with genuine respect and humanity. They should be open-minded and intellectually curious. If you want to talk things through, reflect on your life, and do some real introspection with skilled support, this is your person.

The Psychopractitioner/Therapist

These two terms are interchangeable, with psychopractitioner being used more and more because it’s classy and in France, the word therapist has been dragged through the mud by numerous criticisms of this unregulated field.

Because what defines the field is indeed this wild side: training and schools differ in seriousness and quality, and don’t have the appearance of seriousness of other titles.

And yet. Depending on the therapy in question and the therapist’s quality, they are by far the most effective. Technically, CBT and EMDR are therapies. They’re known and recognized worldwide for their efficiency. When this happens, the medical world does everything to appropriate them and monopolize access to them, thus, practicing EMDR in France is only possible for psychiatrists and psychologists, depriving many people of access to this care under the pretext of quality. Doctors tried to do the same for psychoanalysis, but Freud himself told them to get lost quite virulently in his book The Question of Lay Analysis (even though he was a doctor himself), explaining that doctors are the least qualified to practice psychoanalysis because they already think they know everything. Anyway, it’s always the same: when a therapy is truly effective and becomes famous, if access to its practice is restricted by doctors, it will be taught under other names, circumventing the problem.

Reimbursement:

None

Average price:

Generally between €50 and €100, but there’s a new trend of selling multi-session “programs” which can quickly reach thousands of euros in investment.

Session duration:

50 minutes to 1.5 hours for most practices, but impossible to generalize due to the multitude of approaches.

My opinion

I’m a psychopractitioner in NLP, Brainspotting, CBT, and I’ve done numerous trainings in various therapies. Personally, I don’t want to work in the medical world, but I think this war between different healers is ridiculous. We should be working together because we have the same goal: helping others.

The problem with non-regulation is non-regulation, meaning you have no quality guarantee. This doesn’t mean that quality isn’t there, nor that you’ll necessarily find it with psychiatrists or psychologists.

But the beauty of non-regulation is this freedom of exploration that’s responsible for all the therapeutic advances that exist today. All therapies without exception, including medicine and psychiatry, were once unregulated. Don’t forget that. And in regulation, there’s bureaucracy, protocol complications that are only there to give the illusion of authority. Regulation is not a guarantee of quality or effectiveness. It’s just an illusion to reassure you.

There are good and bad practitioners in all disciplines. The key is finding the method and therapist that suit you and help YOU.

Coach and personal development

Personal development is a field focused on self-improvement and life optimization, but it doesn’t treat clinical conditions or specific psychological problems. It’s meant to help with everyday challenges like productivity, goal-setting, or interpersonal skills – basically life coaching rather than therapy. Coaches are the main practitioners in this space.

Sessions aren’t reimbursed of course, and the price varies, from a hundred euros to thousands, even tens or hundreds of thousands for the most famous coaches. Just like the price, session duration depends on the coach and their particular method.

⚠️ Warning: Anyone can call themselves a coach – there’s no regulation. Some have followed serious and recognized training in specialized schools, others became self-proclaimed coaches after reading a few books. The best coaches have recognised degrees in the field and solid training, but this isn’t guaranteed by the title. There’s a wide variety of coaches: life coach, work coach, relationship coach, sports coach, nutrition coach, etc. It’s up to you to verify their training and experience before committing.

My opinion

Coaches can be really valuable if you want support in improving your life. It’s a modern approach that I think makes a lot of sense. They’re there to motivate you, encourage you, and help you become more effective and comfortable with yourself.

The only downside is when coaches try to play therapist without the proper training – there’s an important difference in approach. But if you don’t have specific issues to work through and just want to enhance your quality of life, a coach could be a great fit.

Conclusion

And there you have it! So we have the psychiatrist (maximum regulation, exclusively medication-based approach), the psychologist (regulated but with limited tools without additional training), the psychotherapist (a glorified psychologist), the psychoanalyst (controversial but humanistic), the psychopractitioner or therapist (unregulated but potentially excellent), and finally the coach (non-therapeutic approach).

I hope this article will help you find some clarity in this therapeutic swamp, and allow you to find the practitioner who’s right for you.