Why people used to leading find it so hard to start therapy

“To be honest, I don’t know why I’m here. I don’t have a real problem.”

This sentence often comes in the first few minutes when someone who is used to leading comes to therapy. It is said by a person who runs a team or an organisation, who makes decisions every day that affect other people, and who has spent months thinking it over before making their way to me. They have not slept properly for six months. They have drifted away at home. Sometimes they sit in the car for ten minutes before going into the house. But they do not have a “real problem” — because they still have everything under control.

People who are used to leading often come to therapy late. Not because they do not care about themselves, but because everything that got them to where they are is also what makes the road to help so hard. This piece is about why that is — and what therapy really is once you get there.

Why it is the most capable people

First, something that is not unique to leaders. In a large international mental health survey, the World Health Organization asked people who had difficulties but had not sought help why not. Among those who recognised that they needed help, the most common answer was not money, not waiting lists, and not fear of stigma. It was: I wanted to handle the problem on my own. Almost two thirds of these people gave that answer.

If this wish is so common among everyone, in people in leadership roles it is often stronger still. They reached their position precisely because they solved things themselves. Because they were the ones who did not give up, who could manage a little more, who stayed calm in a crisis. These qualities are not a flaw. They are strengths that have taken them far. It is just that the same quality that works at work turns against them when it comes to their own distress.

Working with people who can manage a great deal, I notice three intertwined layers: the need for control, the relationship with vulnerability, and the fear of losing standing.

Control: when it has always been your answer

People who lead are often very good at managing things. They know how to divide up a task, how to anticipate risks, how to stay calm when others are not. Control gives them a sense of safety, and it has often genuinely been the key to their success.

But control has a history too. When we look back with people who can manage a great deal, it often turns out they learnt it very early. Perhaps in a family where one parent was unpredictable, ill or absent, and someone was needed to “hold it all together”. Perhaps in an environment where love was linked to achievement. A child who learns they are safe when everything is under control becomes an adult who keeps everything under control — even when it would be better to let go for a moment.

Therapy, though, is a place where you are not fully in control. You do not know where the conversation will go. You do not know what will open up. You cannot prepare your answers in advance. For someone used to chairing meetings, this can be extremely uncomfortable. It is no coincidence that panic sometimes appears in exactly the people who hold everything together — I wrote about this in Panic and control: why it strikes the person who holds it all together.

Vulnerability: a word that is not in the job description

We often understand vulnerability as weakness. In the knowledge base I have described it differently — vulnerability as a willingness to show yourself as you are, without any guarantee of how the other person will respond. That is not weakness. It is a risk you take because without it there is no closeness.

People in leadership roles often have few places where they can allow themselves this. At work they are expected to be strong. At home the same is often expected — or they do not allow themselves to be any different, because “the family is already carrying enough”. And so vulnerability becomes something that happens nowhere. And when something happens nowhere, a person forgets it is possible at all.

Beneath this there is often shame. Not guilt — that you have done something wrong — but the deeper feeling that there is something wrong with me if I need help. I have written more about how shame works in Shame: the emotion that whispers “There is something wrong with me”.

For men, this barrier is often even more pronounced. Research on masculinity and help-seeking shows that beliefs such as “men don’t complain” and “you sort out your problems yourself” predict seeking help later and less often. This is not a rule for every man, but it is a pattern worth knowing; it is discussed in more detail in Men and therapy: why they come later and what stops them.

The fear of losing standing

The third layer is the most concrete. People in prominent positions are afraid that someone will find out. That their seeking help will be seen as a sign that they cannot cope. That word will get around the team, among clients, in public. In a small country where people know one another, this fear is not unfounded.

Researchers who reviewed dozens of studies on stigma and help-seeking found that, among the forms of stigma, the one most often mentioned was precisely concern about disclosure — the fear of what others will say if they find out. An important part of this fear, however, is not external but internal. Psychologists call it self-stigma: when a person turns prejudice about seeking help against themselves. “If I go to therapy, it means I’m weak” is not your colleagues’ opinion. It is a sentence you say to yourself.

That is why confidentiality is worth talking about openly right from the start. I described what stays between us and where the limits set by law and the profession lie in Confidentiality in therapy: what stays between us and where the limits are, and the particular questions that arise when people know who you are are the subject of Therapy for people in prominent positions: confidentiality when people know you. There is also a short explanation of the term in the knowledge base under confidentiality.

Therapy is not a repair job

People used to solving problems often come to therapy with the logic of a service garage. Something is not working — sleep, mood, the relationship at home — so the cause has to be found and fixed. Ideally quickly, efficiently and with measurable results. That logic is understandable. But therapy often does not work the way they expect.

The symptom that brings someone to therapy is often more a message than a fault. Insomnia may be saying that the nervous system has gone without rest for a long time. Distance at home may be saying that somewhere along the way the person lost touch with what once connected them to those close to them. If we only “fix” the symptom without hearing what it is saying, it often comes back in another form.

That is why I prefer to describe therapy as a space. A space where you do not have to be anything. Where there is no agenda you have to get through. Where you can say “I don’t know” and it is not a weakness but a beginning. For people who spend all day in the role of the one who knows, this is often the strangest and, at the same time, the most relieving experience.

Research on what works in therapy supports this. A meta-analysis by Christoph Flückiger and colleagues, covering almost three hundred studies, showed that the quality of the relationship between client and therapist is one of the most reliable predictors of how therapy turns out — regardless of approach. What matters is not only what the therapist does, but also whether you feel safe, heard and understood in the relationship. The term the therapeutic relationship in the knowledge base is about exactly this.

A short dialogue

This is how part of a first conversation with someone used to leading might sound (composite, not a real person):

“Tell me how this works. How many sessions, what’s the plan, what’s the goal?”
“I can tell you how we’ll begin. Where we’ll end up, I don’t know yet — and neither do you.”
“I’m not sure I like that.”
“I believe you. What is it you don’t like about it?”
“Not knowing what’s going to happen.”
“When did you last feel like that?”
“…Actually, six months ago, the first time I ended up sitting in the kitchen in the middle of the night without knowing why.”

Discomfort with uncertainty is not an obstacle that has to be removed before we can start working. Often it is already part of the reason the person came.

What happens in the first sessions

Because the unknown is one of the biggest sources of resistance, it helps to know roughly what to expect. The first sessions are mainly about getting to know each other. We will talk about what has brought you here now, what you would like to change, and what you have already tried. I will also ask about your life outside work — relationships, family, your body, sleep — because these parts are often more connected than they seem.

In the first sessions you can ask questions too. How I work, what it means that I am a therapist in training under supervision in marriage and family therapy, what happens with confidentiality. That is not rude but important: a good relationship starts with knowing who you are dealing with. You can read more about what the beginning looks like in What a first session with a psychotherapist is like — no mysteries, and some practical tips are gathered in the knowledge base under preparing for a first session.

One more thing matters: you do not have to arrive with a prepared story. People who are used to presenting often prepare for a first session as if for a presentation — with a neat overview of problems and possible solutions. You can bring it. But it is just as fine to leave it at home and start with what is true: “I don’t know where to begin.”

In relational family therapy, in which I am training, we pay particular attention to what happens in the relationship between us. Christian Gostečnik describes how people unconsciously bring patterns from their earliest relationships into the therapeutic relationship. Someone who has always looked after others may look after me too — checking whether I am tired, apologising for taking up my time. When this shows up in the room, we can observe it together, up close. This is not a side road in therapy. It is often the main one.

Where this explanation does not apply

I want to be honest about the limits of what I have written.

Not every leader is closed to vulnerability. Many people in prominent positions talk very openly about their struggles and seek help early. What I have described is a common pattern, not a profile of everyone.

It is not always resistance that holds people back. Sometimes a person does not come to therapy because they genuinely do not have the time, because they do not know where to go, or because they had a bad experience with a therapist. Then it is not about their relationship with vulnerability, but about concrete obstacles that need to be taken seriously. And “resistance” is not the enemy either — why it is part of the journey is the subject of Resistance in therapy: when part of you doesn’t want change, and why that’s normal.

Therapy is not always the first step. If severe physical symptoms have appeared, if deep low mood has lasted for weeks, or if you can no longer work, the first step is often a doctor or psychiatrist. Therapy can run alongside, but it does not replace a medical check-up.

When thoughts of not wanting to live appear, there is no time to wait. In Slovenia, call the crisis line Klic v duševni stiski on 01 520 99 00 (every day from 7 pm to 7 am), the Samaritans helpline on 116 123 (24 hours a day) or, in an emergency, 112. Position, standing and the fear of what others will say do not matter in that moment.

An exercise: a conversation you are not leading

This exercise is not a substitute for therapy. It is a small test of what it is like to let go, for a moment, of the role of the one who knows. You can do it today.

1. Choose one person. Someone you trust who is neither your subordinate nor your superior. Your partner, an old friend, a sibling.
2. Tell them one thing you do not know. Not a plan or a solution, but something that has been weighing on you lately and that you have no answer to. For example: “I haven’t been sleeping well lately and I don’t know why.”
3. Do not take over the conversation. When the other person starts asking questions or giving advice, do not steer it. Notice what it is like when the conversation does not follow your plan.
4. Notice your body. Where in your body do you feel discomfort? In your jaw, chest, stomach? Just notice it, do not fix it.
5. Write down one sentence. When the conversation is over, write down what was hardest about it — and whether anything was also a relief.

If the exercise shows that there is nobody you could tell something like this to, that in itself is important information. This is also the subject of Loneliness at the top: why leaders have no one to talk to.

How to take the first step

People who are used to leading often put off the first step until the perfect moment. When things calm down at work, after the project ends, after the summer. But there is no perfect moment — and often the first step only comes when the body or a crisis at home forces it.

If you are thinking about it, it helps to know that fear of starting is not a sign that therapy is not for you. It is a normal part of the journey that almost everyone has; what worries people most before they begin is the subject of Fear of therapy: what if I cry, what if I don’t know what to say?

And one more thing: you do not need to know what you want to achieve. It is enough to know that something is no longer the way you would like it to be. We can find the rest together. I see clients in person in Ljubljana and also work in English.

What to remember

• The most common reason people do not seek help is wanting to handle the problem on their own — and in people used to leading, this is often even stronger.
• Control, your relationship with vulnerability and the fear of losing standing are not character flaws. All of them once had a good reason.
• Therapy is not a repair job but a space where you are allowed not to know, and where vulnerability is part of the work, not an obstacle.
• The quality of the relationship with your therapist is one of the most reliable predictors of whether therapy will help.
• You do not need to arrive at a first session with a prepared story. It is enough to know that something is no longer the way you would like it to be.