Why the People Who Need Therapy Most Avoid It the Hardest

Often the people who are suffering the most are the least likely to walk into a therapy room.

From a psychoanalytic perspective, this isn’t a paradox or a character flaw. It’s actually a sign of how much they need their defences just to get through the day.

Here are some of the deeper reasons why the people who would benefit most from therapy often stay far away from it.

From a psychoanalytic perspective, avoiding therapy is rarely a simple matter of “not wanting help.” It’s usually the visible tip of an unconscious conflict: parts of the mind are desperate for relief, while other parts are equally desperate to keep painful feelings, memories, and needs out of awareness. Defences like denial, minimisation, intellectualisation, and projection are not just bad habits – they are deeply rooted survival strategies, developed in response to early relationships and internalised voices. In this sense, the people who “refuse” therapy are often those whose internal world is most fragile, and who unconsciously experience the very idea of being seen and understood as a threat to the psychic structures that have kept them going.

1. “If I let myself feel this, I’ll fall apart”

For some people, emotional pain isn’t just painful – it feels dangerous.

Early experiences of neglect, trauma or chronic misattunement can create a kind of inner rule:

“Do not feel. Do not look. If you open this up, you won’t survive.”

On the surface this can look like:

• “I’m fine, it wasn’t that bad.”

• “Other people have it worse.”

• “I don’t see the point of talking about the past.”

Underneath is a fear of psychological collapse. Therapy, with its invitation to reflect and feel, is unconsciously experienced as a threat: You want me to look at the very thing that’s holding me together by not looking at it.

So they avoid therapy not because they don’t need it, but because they fear they need it too much.

2. Defences that are “working too well”

Psychoanalysis takes defences seriously. They’re not bad habits; they are creative solutions the psyche invented to manage pain.

Some examples:

• Denial: “It wasn’t that big a deal.”

• Minimisation: “Yeah, my childhood was weird, but everyone’s is.”

• Intellectualisation: “I’ve read a lot of psychology books; I understand myself.”

• Humour or sarcasm: turning everything into a joke.

When these defences are rigid but effective, life may be very restricted but just about bearable. Therapy threatens to loosen these defences, and that can feel like being asked to walk around without skin.

So the people who are the most defended – the ones who can’t allow themselves to know how bad it feels – are often the ones who stay away.

3. “Needing help = being weak, bad or shameful”

For many, the idea of seeking therapy collides with a harsh internal voice (the superego):

• “You should be able to cope on your own.”

• “Stop being dramatic.”

• “You’re too sensitive.”

• “Only crazy people need therapy.”

Often that voice was originally someone else’s – a parent, culture, religious environment, or peer group – but over time it becomes internal.

Psychoanalytically, we could say: the person has identified with a critical other. They now police themselves from the inside.

The more vulnerable and fragile they feel, the more vicious this internal critic can become. So just at the point where they most need care, they’re also most convinced they don’t deserve it or will be judged for wanting it.

4. “If I trust you, you’ll hurt me”

Therapy is a relationship. That means it activates all our templates for what relationships feel like.

If early caregivers were:

• unsafe,

• emotionally absent,

• intrusive,

• humiliating,

• or unpredictably loving and rejecting,

then the unconscious expectation becomes:

“Anyone I depend on will eventually hurt, control, abandon or shame me.”

So when a therapist offers curiosity, warmth, or reliability, the person may feel:

• Suspicious (“What’s their agenda?”)

• Contemptuous (“They’re just doing it for money.”)

• Dismissive (“They don’t really care.”)

• Panicky (“If I open up, they’ll have power over me.”)

Avoiding therapy then becomes a form of self-protection: If I never rely on you, you can’t let me down.

Tragically, the very history that makes therapy so important also makes it feel too dangerous to try.

5. “I’m not the problem – everyone else is”

When someone is deeply defended against self-reflection, it can feel safer to locate all problems outside themselves.

Psychoanalytically, this often involves projection:

• Unacknowledged rage becomes “Everyone’s always attacking me.”

• Disowned vulnerability becomes “Everyone else is so needy.”

• Unconscious shame becomes “People are stupid, therapists included.”

If I’m certain that:

• my partners are always toxic,

• my bosses are always unreasonable,

• my family are all narcissists,

then there is no incentive to examine my own patterns. Therapy, which starts from “Let’s be curious about your part too,” can be experienced as a threat to a fragile self that depends on being the innocent one.

So the people who most rigidly externalise blame – who feel constantly wronged by the world – are often the least likely to seek help that would ask them to look inward.

6. The paradox of low self-worth

You might think that someone who feels terrible about themselves would be eager for help. But low self-worth often carries an unconscious belief:

“I am beyond help.”

Or:

• “If you really got to know me, you’d be disgusted.”

• “My problems are too much; I’ll overwhelm you.”

• “I don’t want to burden anyone.”

Here, what keeps the person away isn’t arrogance, but despair. Therapy stirs hope – and for some, hope itself is painful because it sets up the possibility of disappointment.

Better, unconsciously, to avoid hoping at all.

7. Repeating the pattern: not asking, not receiving

From a psychoanalytic angle, many of us are caught in repetition compulsion – an unconscious drive to repeat old patterns, hoping unconsciously for a different outcome.

If, as a child, your needs were:

• mocked,

• ignored,

• or used against you,

you might have learned: “Asking doesn’t help.”

As an adult, this can become:

• never asking for support,

• making yourself “the strong one,”

• or only choosing environments where vulnerability is discouraged.

Not seeking therapy can be another repetition of this pattern: “I don’t ask because no one ever truly comes through for me.”

Paradoxically, the refusal to seek help is a loyal repetition of how they survived in the past.

8. It’s not just individual – there are real-world obstacles

Psychoanalysis focuses on the inner world, but it doesn’t ignore reality.

People who most need therapy may also face:

• Financial barriers

• Lack of time, childcare, or privacy

• Living in cultures or communities where therapy is heavily stigmatized

• Having had bad or even retraumatizing experiences with help in the past (including with professionals)

When you already feel fragile, even one invalidating encounter with a therapist, GP, or school counsellor can confirm: “See? I was right not to open up.”

So what helps people finally come?

Often, it’s not a clever argument but a felt experience that shifts things:

• A relationship where someone is consistently kind and non-judgemental.

• A crisis that makes old defences crack just enough for curiosity to slip in.

• Encountering language (a book, post, podcast, therapist’s content) that makes them feel deeply understood, maybe for the first time.

Psychoanalytically, you could say: something in the internal world warms up enough that the person can risk turning toward, rather than away from, their own mind.

When they do come, they often bring powerful fears, mistrust, and defences into the room. A psychoanalytic approach doesn’t try to smash those defences; it respects them as survival tools and slowly, carefully, offers another way.