Friendship Therapy

My phone rings. There’s a pause when I answer, and a nervous cough crackles through the line. Hesitantly, a female voice says, “Hello, is this Catalyst Counseling? My name is Sarah, and I hope this isn’t a ridiculous question, but like, can I come in to see you with someone else? We’re not a couple. I’m not looking for couples therapy. We’re friends but our relationship needs help. I guess I’m looking for friendship therapy. Can you do that?”

“Absolutely,” I say.  

She lets out a relieved sigh, which was quickly followed by more uncertainty. “Because I’ve called like four other therapists. And they all sound somewhat confused when I asked about it. Or they say, ‘Oh, we can certainly address relationship dynamics in individual therapy.’ But this is not about my marriage … or my parents. This is about my best friend, my most important friendship. And it feels like it’s dying. And I feel lost. And frankly, I’m a little ashamed that I’m even calling a therapist about a friendship. Is that even a thing? Friendship therapy?”

“Sarah,” I say, “let me be very clear. You shouldn’t feel an ounce of shame for calling me. You’ve identified a pain point that makes perfect sense. Friendships are critical in our lives, and friendship therapy is a completely legitimate thing to ask for.”

What’s a “Significant” Relationship?

After I listed friendship therapy as one of my specialties, I began getting a trickle of requests like Sarah’s, though always with the same sense of hesitancy. Over time, that trickle has grown to a steady stream. How did I start down this rather unusual path of friendship therapy?

A long time ago, when I was a school-based therapist at a high school, a student came into my office and told me how angry she was at her best friend and how confused she was by her behavior. I said, “Would you like to invite her here to chat with you?  We can create a space for the two of you to communicate, if you and she would like that.”

Even though opening up our therapy space to friends felt a bit odd—looking back, I realize I thought I wasn’t “allowed” to—the conversation went well. The tension between them was palpable when they walked into the room, but their shoulders relaxed, and their faces softened when they realized this was a safe space. Instead of the usual defensive postures they assumed with one another out in the world, or the abrupt conversations that happened over text, they could sit facing each other. They could take turns speaking without the fear of being overheard or judged, and they could receive gentle guidance to help them hear what the other was trying to say beneath the hurt and confusion.

Unfortunately, as a therapeutic community, most of us have tacitly agreed to a narrow definition of what constitutes a “significant relationship” worthy of dedicated intervention. We’ve built entire empires around romantic partnerships, elaborate models for family systems, and profound avenues for individual exploration. Yet, when it comes to the intricate, often messy, deeply formative bonds of friendship, we’ve largely offered a therapeutic shrug.

We might say things like, “Oh, of course friendships are important, and we can explore the impact of those relationships in individual sessions.” But how many of us have truly created a dedicated space specifically designed to navigate the complexities of a faltering friendship, the pain of a betrayal between friends, the silent erosion of intimacy that turns a ride-or-die into a casual acquaintance?

It’s time we acknowledge that friendship is not merely a social convenience or a pastime; it’s a foundational element of life as deserving of care as our romantic relationships. And it’s time more therapists, meticulously trained in the art of rupture and repair, use their skills to help more friendships thrive.

After all, there are no rules, societal expectations, or legal frameworks for friendships, like there are for marriages. Friends can drift apart with an unsettling ease, leaving a gaping wound that not many people know how to suture.

When a long-term friendship crumbles, you’re often dealing not just with the loss of a special person, but the loss of a shared past and a witness to your evolution. This kind of rupture can be as devastating as a romantic breakup, sometimes even more so, because it lacks the readily available language of grief and recovery. No one sends casseroles for a friendship breakup. There are no support groups specifically for the pain of losing your best friend over a disagreement or even over the course of a subtle drifting. (I run a therapy group for this, but I digress.)

What if our therapeutic reluctance to embrace friendship therapy stems from our own biases about love and attachment? We prioritize romantic love as the ultimate fulfillment, the pinnacle of human connection. Anything less is often viewed as secondary, a nice-to-have, but not a need-to-have. This hierarchy, subtle yet pervasive, bleeds into our therapeutic frameworks. But true intimacy isn’t solely defined by sexual expression or cohabitation. It’s defined by vulnerability, shared meaning, witnessing and being witnessed, the courage to show up imperfectly and be loved anyway. And in this definition, friendships often stand shoulder to shoulder, and sometimes even surpass, romantic relationships in their depth and resilience.

The Uniqueness of Platonic Bonds

So how does one do friendship therapy? It requires a therapist to step outside the familiar narratives of romance and family, and instead, cultivate a deep curiosity about the unique dynamics of platonic bonds.

Unlike romantic relationships, friendships rarely begin with a clear discussion of expectations, boundaries, or even the dreaded “where is this going?” conversation. Friendship therapy often starts by unearthing these implicit contracts, bringing to light the unspoken rules, the assumed roles, the subtle shifts in power dynamics that have gone unaddressed. What does “best friend” actually mean to each person? What are the boundaries around money, time, and other relationships?

Friendships thrive on reciprocity, a delicate balance of giving and receiving. When this balance shifts, resentment brews. Is one friend consistently the listener, the problem-solver, the emotional anchor, while the other is perpetually taking? Friendship therapy creates a brave space to confront these imbalances, articulate needs that have been swallowed, and renegotiate the terms of engagement.

When shifting life circumstances—like marriage or divorce, children, career changes, geographical relocation, illness, and unexpected pivots in belief systems or political views—place strain on a bond, friendship therapy can help people understand how these external shifts impact the internal world of the friendship, allowing for proactive adaptation rather than reactive rupture. When envy, competition, and passive aggression occur, instead of cutting off the friendship or letting resentment brew, therapy can provide a space for these difficult emotions to be aired, understood, and ultimately transcended.

And when a betrayal happens between friends, therapy can be a place to work on the F word—forgiveness—because friendship repair requires a deep, intentional commitment to emotional labor. It’s about rebuilding trust, acknowledging hurt, and cultivating a willingness to rewrite the narrative of shared history, without the benefit of sexual passion to paper over the cracks.

Of course, not all friendships are meant to last forever. And sometimes, the most loving act is to acknowledge that a friendship has run its course. But therapy can facilitate a conscious uncoupling between friends, allowing individuals to honor the past, grieve the loss, and release each other with compassion, rather than allowing the friendship to simply wither, leaving a lingering sense of bitterness or unresolved hurt.

Ghosts and Different Planets

When Sarah and Meg came to see me for our first session, I invited them into my office and gestured toward a small couch and two chairs. “Welcome, Sarah, Meg. Thank you both for being here today.” Sarah, I noticed, sat on one end of the couch, leaving room for Meghan to sit beside her. But Meg took a chair opposite my chair. “I know these conversations can be challenging,” I began. “But they’re also incredibly brave. So, let’s start broadly. What brought you both to friendship therapy? Who wants to begin?”

“I guess I can,” Sarah says, jumping in first. Meg stiffens. I wonder if she can sense, as I do, that Sarah has been rehearsing this moment for weeks. “For me, I just feel like we’re on different planets now, Meg. We used to be so in sync, and now it feels like I’m constantly chasing a ghost of what we had.”

The metaphors people choose always tell me so much about their internal landscape. I’ve heard variations of this “ghost” metaphor used to describe the experience of a flagging friendship countless times. There’s something so haunting about mourning a relationship with someone who’s still sitting right in front of you. “Different planets” suggests not just distance, but entirely different atmospheres, different gravitational pulls.

“I know what you mean, Sarah,” Meg says. Her response is tentative. “It’s hard. I feel the distance, too. But for me, I feel like I’m constantly letting you down. Like whatever I do is never quite enough.”

“Are you aware of what that feels like?” I ask gently.

Here’s the other side of the coin, the crushing weight of not being able to show up the way you used to, even when your heart is still invested.

“I feel guilty and inadequate.” Meg’s shoulders curve inward as she speaks, like she’s trying to make herself smaller. I lean forward, genuinely curious.

“Before, we’d talk every day,” Sarah’s words tumble out in a rush. “We’d go out, have spontaneous adventures. Now, I’ll text about a new opportunity at work, something I’m really excited about, and I get a one-word reply, or nothing for hours.” I can practically see Sarah’s inner child throwing a tantrum. What about me? What about my exciting news? It’s not pretty, but it’s so deeply human. She’s grieving the loss of being someone’s priority. “And when we do talk,” Sarah says, “it’s always about motherhood and Leo. I love Leo, don’t get me wrong! But it feels like my career, my struggles, my joy is secondary to you.”

Meg’s eyes, I notice, are already glossing over.

“How do you hear that, and what’s your perspective on Sarah’s experience?” I ask Meg, hoping to keep her engaged. “I know this must be hard to hear.”

Meg shrugs, which I see not as evidence of her indifference but as a defense against the pain of hearing the way she’s hurting Sarah.

“I get it. I really do,” Meg says. “You know how much I love you, Sarah. You’ve been my rock for years. But when Leo came along, my life just completely inverted.” Meg exhales. “There’s no spontaneous anything. My brain is mush from lack of sleep, and when I do have a spare second, it’s spent trying to catch up on laundry, or staring blankly at a wall, not crafting a thoughtful response to your exciting career news. I want to be there for you, but physically and mentally, I can’t be. When you say it feels like you’re chasing a ghost, it makes me feel like I’m failing you as a friend.”

Here it is, I think. The breakdown. This is the moment when someone finally names the impossible situation they’ve been trying to navigate. It’s a critical first step to either rebuilding the friendship on new terms or acknowledging that it might not survive this season of their lives. The truth is, Meg isn’t choosing to neglect Sarah—she’s drowning in the relentless demands of new motherhood, and Sarah’s texts feel like additional weights tied to her ankles. And what makes their situation even more complex is the fact that Sarah’s needs are legitimate, too.

Her longing to be celebrated for a career milestone, her desire for connection, her need for clarity about where she stands in Meg’s world—what she craves is valid and reasonable. Two people can both be right at the same time while their different needs can make them incompatible. Sarah and Meg’s friendship isn’t failing because someone is doing something wrong; it’s growing strained because life has fundamentally altered the conditions under which it was built.

“Meg, becoming a new mother fundamentally alters your entire existence.” I’m walking a bit of a tightrope here. I need to validate Sarah’s pain without villainizing Meg’s experience or her needs. “Sarah, do you recognize the impact of that on Meg, and how it might manifest in your friendship?”

“Intellectually, yes,” Sarah responds, picking at one of her cuticles. It can’t be easy to expose her needs like this, and I sense it’s making her anxious. “Of course, I know Meg’s busy, and tired,” she continues. “I try to be understanding. But emotionally it still feels like I’ve been demoted. Like our friendship isn’t a priority anymore.”

“How does that resonate with you?” I ask Meg, though I know the answer even before she opens her mouth. The guilt is written all over her face.

“You’re right, Sarah. What you’re saying is true. And it makes me feel terrible. I’m just trying to survive some days. I want to be the friend who’s always there, who has great advice, who can meet for drinks at a moment’s notice. But that’s not me right now. And I guess I’ve just been hoping you’d understand.”

We’d made tremendous progress in this single session. I’d helped Meg and Sarah explicitly communicate their limitations and needs, recognize assumptions about what it means to be a “good” friend, and engage in real conversations that connected the dots between their feelings, wants, and diverging realities (rather than stewing in resentment, guilt and inadequacy).

We’d made room for the grief that festers underneath so many of the friendship challenges I see—about time passing, responsibilities accruing, new relationships encroaching on limited emotional resources, and missing the special shorthand of jokes, words, and interactions that give friends that precious sense of “getting” each other. I was also able to address a key misconception both Sarah and Meg held: that they needed to “get back to the way things were,” rather than negotiate a new relationship that honored who and where they are now.

My hope is that more therapists will be willing to think outside the well-worn boxes of our field, challenge their assumptions about what constitutes a “primary relationship,” and get curious about what friendship therapy can offer.

This isn’t about replacing what we already do with something completely different and new; it’s about expanding our compassion, broadening our scope, and ultimately, reflecting the true complexity of human connection. It’s about recognizing that friendship isn’t just a pleasant diversion; it’s a foundational pillar of humanness.