Typically, a different name is used to schedule the appointment, or a personal email address is used instead of the one that passes through the assistant. A private card is used for the billing. The location is chosen with the same consideration that goes into every other professional decision this person makes, whether it’s a telehealth session conducted from a hotel room or a parked car, or it’s a discreet private practice tucked into a building with multiple tenants. The therapy is genuine. The confidentiality is regarded as non-negotiable.
This arrangement is not uncommon. The decision to seek mental health support and to keep it completely private has become more common among CEOs, senior partners at law firms, surgeons, and others whose identities are professionally linked to their competence than the public narrative surrounding mental health stigma might suggest.
Ninety percent of American top executives said they had experienced fear of failure in the previous year, according to data cited by Inc. Twenty-two percent have seen a psychotherapist, and about thirty-two percent have sought advice from an executive counselor. Even those figures have significance. Even in an anonymous survey, they fail to account for the portion of the remaining population that is also looking for assistance but refusing to acknowledge it.
The reasons for the secrecy are complex and, upon closer inspection, more comprehensible than they might first seem. In some industries, visible vulnerability carries real professional risk. A CEO whose board is already closely examining the quarterly results, a managing partner at a law firm, or a doctor whose patients demand unwavering authority are not individuals for whom the admission of difficulty carries neutral consequences. The fear is not unreasonable.
The perception of weakness can have tangible consequences in high-stakes, high-performance settings, such as lost clients, missed promotions, and changed professional relationships. In many situations, the secrecy serves as a kind of risk control.
However, there is something more intimate and harder to identify beneath that pragmatic calculation. Professional success for many high achievers is more than just what they do; it’s the foundation of their self-concept. The title on the office door, the law degree, and the company’s valuation are not distinct from the self; for many, they serve as the main indicators of one’s value.
When that wiring is in place, asking for assistance doesn’t seem like a wise choice made by a self-assured individual. It seems to acknowledge that the structure as a whole may not be as sturdy as it seems. Researchers and therapists have started referring to this emotion as “work-identity fusion,” and it causes a specific type of internal resistance to seeking help.
This is greatly exacerbated by imposter syndrome. The experience is genuine and well-documented among high achievers, despite the term’s informality as a diagnostic term. C-suites, operating rooms, and courtrooms are more likely than their exteriors to convey the persistent, quietly draining feeling of not quite deserving the level one has reached—of being, at some level, a fraud who has managed to fool everyone so far.
Psychotherapist and author Amy Morin has written about seeing clients come to therapy with a single presenting issue, only to have imposter syndrome show up as the real motivator after multiple sessions. One of the reasons it persists so much is the unwillingness to identify it, even to a therapist.
According to research published in 2019 by Curran and Hill, professional populations have been experiencing an increase in reported perfectionism for decades. The relationship between perfectionism and mental health is complex. Adaptive perfectionism, in which real accomplishment and high standards coexist, can be a useful characteristic.
Chronic stress, low self-esteem, and an emotional climate where burnout becomes inevitable rather than a risk are all associated with maladaptive perfectionism, where the main goal is to avoid failure rather than achieve excellence. Professionals who are most likely to appear invulnerable are frequently the ones who fall into this second pattern the most.
In this group, burnout often goes unnoticed for longer than it should. By definition, high achievers are adept at carrying out tasks under duress. They persevere. They fulfill orders.
The symptoms of a problem, such as irritability that spills over into evenings at home or a lack of engagement that coworkers may notice for a short while before it is redirected into productivity, are absorbed into the workplace and reclassified as transient stress. The accumulation is frequently substantial by the time the private therapy session is scheduled.
The way therapy is framed in these professional communities is changing, albeit slowly and somewhat unevenly. In contrast to the language of vulnerability and healing, the language of strategic investment—therapy as performance optimization, emotional regulation as a leadership skill—has created an entry point.
This reframing may be somewhat pragmatic in that it avoids the identity threat that would have arisen from a more direct conversation while still enabling people to obtain something they needed. Regardless of the mechanism, therapists who work with this population report a shift in who shows up and, in certain cases, a cautious but sincere willingness to eventually be less secretive about it.
Observing this change gives one the impression that secrecy is the final obstacle rather than the initial one. The appointment has already been scheduled. The work has already begun. The gap between receiving care in private and being able to acknowledge—even in limited ways—that receiving care is something capable people do still exists.