I come from a generation that does not believe in therapy. Not because we do not believe it is effective, but because we believe we can handle things on our own. If things are hard, we push through. If we need help, we figure it out independently. By the time I became a physician, self-reliance was not just a value, it was my tried-and-true survival strategy. I remember years ago, during a medical malpractice deposition, the plaintiff’s attorney asked me pointedly whether I had ever been in therapy. I remember resolutely responding, “Never.” At the time, it felt like a retort and a marker of strength.

I grew up in the Islamic Republic of Iran, an era that inspired Margaret Atwood’s dystopian novel “The Handmaid’s Tale.” My family immigrated to the United States in the mid-1980s, at a time that public animosity towards Iranians was high due to the ongoing hostage crisis. At home, my father’s alcoholism brought relentless chaos and unpredictability into our daily life. Survival mode was my default state. I learned early how to shrug off whatever came my way, trusting that I would somehow manage.

And it worked. It carried me through medical school, emergency medicine residency, and through the constant upheaval of life. Like many physicians, I internalized the idea that my hyper-independence and ability to sidestep emotionality were twin superpowers, and that I could invariably keep up with the metronome of life without faltering.

A fracture in the family system

When I became a parent, I was intentional about creating a different kind of family environment than what I had grown up with. I aimed for stability, predictability, warmth, and consistency. My sons grew up in one home, attended the same schools year after year, and formed lasting friendships. They were surrounded by cousins, family traditions, and joyful rituals, annual ski trips, shared meals, and ordinary happiness. So when, during adolescence, they would ask for “mental health days,” I was bewildered and confused. It made no sense. What was so hard, and why were they so soft? How were they going to manage life’s vicissitudes?

The first real fracture emerged during my eldest son’s middle school years. Bright, intelligent, and deeply curious, the gap between his academic performance and natural abilities began to widen. As his grades slipped down to C’s and D’s, alarm bells began ringing. For his father and me, both children of immigrants and both physicians, this was deeply unsettling. I practiced emergency medicine; my husband pursued an academic physician-scientist path focused on curing childhood cancers. Achievement and perseverance had been etched into us by shared life experiences of our parents’ sacrifices. It was during the in-home coronavirus disease 2019 (COVID-19) year that the pressures converging on our teenage son pushed him to a breaking point that forced us to consider therapy for him.

Transitioning from surviving to thriving

That decision changed far more than we anticipated. Through that process, we began to understand his neurodivergence. I also began to recognize how my own survival-based stance profoundly shaped our family culture. The way I moved through the world, emotionally constricted and hyper-independent, the very posture that had helped me survive, was eroding our family’s connections and contributing to distance and pain. I intuitively understood that what was needed was not simply a new parenting strategy, but a fundamentally different way of relating to my child, to my family, and to myself.

I decided to try therapy. My experience was transformative. I began to see that there is another way to move through life, one that is grounded, relationally sound, and wholehearted, completely different than my tried-and-true survival mode. For the first time I experienced living life in a centered manner, with authenticity and connection to the people closest to me. I began to experience a shift from surviving towards thriving. These shifts have reshaped my personal life, my family life, and my professional life in ways that have remained enduring and transformative.

Becoming a marriage and family therapist

Therapy offered me tools and perspectives that meaningfully changed my life, and I came to believe that anyone who is willing and motivated can grow with the right guidance and support. From that place, I took another step. After 28 years as an emergency room (ER) physician, unwilling to remain beholden to the legal, insurance, or pharmaceutical industries, I chose work that feels meaningful and aligned with my values. In May 2025, I graduated from the University of Southern California (USC) marriage and family therapy program and began transitioning from emergency medicine to becoming a therapist.

I like to think of our mental health in the same way we view our physical health. We do not stigmatize working with a personal trainer for physical fitness. Why should psychological health be any different? Therapy does not have to take years. Some seek short-term, solution-focused work for specific issues; others pursue deeper exploration to untangle long-standing patterns. The scope and boundaries of therapy are defined by the unique relationship between therapist and client.

I have completed a generational journey from “I do not believe in therapy” to becoming a therapist myself. This does not mean my problems have disappeared or that life has stopped throwing curveballs. But I find myself moving through the world with greater ease and steadiness, without scorching those closest to me, and with a sense of centeredness I once could not have imagined possible. Given how relatively short our lives are, why not live as fully and wholly as possible?

Shahrzad Rafiee is an emergency physician and therapist.