Is Friendship Therapy the Next Big Thing in Mental Health?

Years ago, Aminatou Sow and Ann Friedman hit a rocky patch in their friendship. For reasons they couldn’t fully articulate, they weren’t communicating or clicking like they once did. Things just felt off.

Sow and Friedman are serious about friendship—they co-wrote the book Big Friendship: How We Keep Each Other Close—so they tried something a bit unconventional: friendship therapy. Just like in traditional couples counseling, a therapist helped them understand their relationship dynamics, where they’d gone wrong, and how they could move forward together.

“The structure was everything, because in a less-structured way, all you’re doing is talking about surface-level stuff. You’re not seeing the patterns,” Sow says. “It was really nice to have someone who doesn’t know us ask us these questions.” 

When Sow and Friedman sought friendship therapy in 2016, the concept was somewhat fringe. They struggled to find a therapist who worked with friends, rather than business or romantic partners, and had to fire one clinician who got hung up on the idea that they actually were romantically attracted to each other. But now, the idea of friendship therapy is becoming more popular, as people wake up to the reality that friendship is intimately connected to well-being and happiness—and that, particularly post-pandemic, many people don’t have as many strong connections as they’d like.

“The way that we view friendship in society—that is changing,” says Miriam Kirmayer, a clinical psychologist and friendship expert based in Canada.

Read More: What to Do When Health Insurance Denies Care You Really Need

Barbie Atkinson, who offers friendship therapy at Catalyst Counseling in Houston, is seeing the effect of that shift in her practice. Years ago, she says, she’d get calls from people who wanted to go to therapy with a friend but weren’t sure if that was “allowed.” Today, about 25% of her clients are pairs, or even groups, of friends in therapy together.

Friends come to Atkinson for all sorts of reasons, like reconciling political differences, processing shared grief, or working through tricky life transitions—like one friend having a baby or moving away for a new job. “It’s normal human stuff,” she says.

The process isn’t so different from what a romantic couple would do in therapy, except that friend sessions typically don’t revolve around discussions of sex, romance, or co-parenting, Atkinson says. Just as she would with spouses, she helps her friendship-therapy clients understand their attachment styles, define how they relate to and communicate with one another (and where those dynamics could be improved), and set goals for their relationship. “You’re just seeing two people that want to reconnect—who are sad at the way their relationship has gone and are so actively trying to fix it,” Atkinson says.

Unless a friendship has turned truly toxic or abusive, to the point that friends no longer feel physically or psychologically safe together, most conflicts or impasses can be worked out collaboratively, says Victoria Kress, a professor of psychological sciences and counseling at Youngstown State University in Ohio. She used to work with friends all the time when she was a college counselor, mediating everything from roommate struggles to the aftermath of fights between close friends. There’s no reason full-grown adults can’t seek therapy for their own problems, she says.

“I spend most of my career working with people who have been hurt in relationships, trying to help them be healthy in relationships,” Kress says. “Friendship counseling is such a great way to promote growth and healing that will transfer into all relationships across a person’s life.”

Read More: How to Know if Your Friendship Is Toxic—and What to Do About It

Improving friendships can be transformative. Research increasingly suggests that close friendships, perhaps even more so than familial bonds, are important for well-being, and Americans seem to be getting the message. As of 2023, 61% of U.S. adults said having close friendships is vital to living a fulfilling life, whereas only around a quarter said the same for being married or having children. And as more people forgo those traditional milestones, some are leaning more heavily on platonic partnerships for support, companionship, and care—which sometimes means nurturing those bonds with the help of a therapist.

There’s little official data on the popularity of friendship therapy, perhaps because it is not technically a specialty; there’s not a separate certification process or degree required to offer it. At its core, friendship therapy is just “systemic therapy”—which examines how an individual’s relationships affect their well-being, and which often forms the backbone of couples therapy—applied to a platonic pair, says Paul Hokemeyer, a Colorado-based marriage and family therapist.

Hokemeyer says he’s not aware of many clinicians who focus on friendship therapy, but he has noticed rising patient demand for the service. He’s even worked with friends himself, including one duo struggling to navigate the college-to-adulthood transition while keeping their relationship intact.

Hokemeyer says friendship therapy seems to be particularly popular among millennials, who tend to be comfortable turning to therapy and who place a high value on friendship. “There’s a real hunger for human connection and human relationships,” he says. “Millennials, in particular, value connections, they value experiences, and they value their mental health.”

Kirmayer says she’s noticed a clear uptick in interest, too. In recent years, in fact, she started getting so many requests for friendship therapy from all over the place—which, because of licensing requirements, she wasn’t able to provide to people outside her province—that she decided to pivot to creating friendship-focused workshops for people who live anywhere. “This is something that so many of us are facing,” she says.