How can therapy actually transform my life?

Co-creating transformative goals

Nothing in this essay constitutes medical or mental health advice. This is a story about what worked for me, not a protocol you should copy instead of working with a licensed clinician. I hope it creates value for you, but I'm not qualified to offer medical or mental health advice. If you're in immediate danger, or might hurt yourself or someone else, call emergency services (e.g. 911) or go to an emergency room. If you're in the US and need crisis support, call 1-800-784-2433 (1-800-SUICIDE.)

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By the time I started therapy, I’d been thoroughly “succeeding” via all external metrics, but my internal life was a shitshow. I’d been a co-first author of a Nature paper, gotten multiple promotions inside Google Brain and reached financial security.

The dismal state of my apartment was a reflection of my psychological state. Dishes were often stacked up, laundry scattered across the floor, and the garbage not yet emptied out. Blackout curtains covered the windows, all in a failed attempt to help me sleep despite my racing thoughts. I was addicted to weaponizing my stress as a dirty fuel to increase productivity at work. I’d power through the workday, come home drained, eat unhealthy food and pass out. I’d continue this pattern until I crashed. I’d then hermit for a bit, recover, overcommit again, and the cycle would repeat.

This bottomed out in 2019 when I conclusively burned out. By this point, I’d tried all sorts of “fixes” to bring my life under control like sleep alarms, inbox zero, Pomodoro, etc. I’d run out of other options, and turned to therapy as a last resort.

My first attempt at therapy failed because I wanted my therapist to validate my escapist fantasies of moving from SF to NYC. Looking back, there were some reasonable motivations underneath this fantasy. However, most of them were distorted by fear, judgement, etc. Like an addict seeking his next high, I wanted my therapist to rubber-stamp my goal of racing towards NYC. So I interpreted it as an obstruction when he, very reasonably, slowed me down. Looking back, this was clearly a responsible and measured response. At the time though, I concluded that maybe therapy wasn’t for me.

My second attempt at therapy came on the heels of a close friend getting diagnosed with a potentially fatal cancer. This therapist specialized in supporting the family and friends of cancer patients. I’m deeply grateful for her help in holding space to process my grief. Yet her explorations just didn’t land for me when we attempted to “fix” the deeper structural issues in my life. She was very compassionate, but I felt she just couldn’t connect with my experience outside the grief. Honestly, I wasn’t ready for broader transformation at that time. Moreover, this was neither the right therapist nor the right therapeutic container for this broader structural transformation.

I stopped seeing her once I got over my grief. But the pandemic had taken its toll, and I fell into another depression at the start of 2021.

I was in survival mode and wanted to feel alive again. I wanted peace, love, joy and flow in my life in addition to the sort of external success I’d already achieved. I didn’t want to get burned out by work again. I especially didn’t want to let my external achievements be the only way that I felt “enough”.

I knew I’d eventually try therapy again, but was quietly dreading it. While emotionally processing my grief was helpful, it didn’t structurally change my life. I was scared of therapy becoming an emotional circlejerk without any results. On the other hand, I’d felt like I’d utterly failed the last time I’d tried to consciously direct my therapy towards a specific goal. I didn’t want to feel unheard in that way again.

Essentially, I’d been approaching therapy with an all-or-nothing mindset that made it difficult for me to slow down to unpack not just what I wanted to achieve, but why I wanted to achieve it. It was this same all-or-nothing thinking that defined my relationship to work, and led to my burnout. Either I was anxiously full throttle on the cusp of burning out, or hermiting in an almost catatonic state.

This pattern of all-or-nothing ran really deep. It shaped the way I participated in the world at a fundamental level. There wasn’t some local “fix” or some new “framework” that would let me address this. Rather than fixing the problems I had, therapy needed to change who I was, by changing the fundamental patterns limiting my life.

Specifically, my identity, and therefore my participation in the world, was too organized around external validation. I’d been running my life through a broad range of “shoulds”, rather than examining and self-authoring what I actually wanted. If I was really so keen to move to NYC, why did I keep making excuses to stay in SF? If I was really so committed to my “career” in SF, why did I keep fueling this NYC fantasy?

The goals I claimed I wanted to achieve were too unexamined, and consequently hopelessly tangled up together. “Should I live here?”, “Should I work here?”, “Should I have these friends and hobbies?” and “Is this who I’d like to be?” had gotten all muddled up. No wonder my first therapist tried to slow me down from charging towards NYC!

Crucially, I’d confused what I needed (i.e. co-creation of coherent therapeutic goals) with what I felt comfortable with in the moment (i.e. controlling and dictating my therapeutic goals). I’d tried to totally control my relationship with the first therapist to execute on a goal whose underlying motivation I didn’t really understand. I was in so much acute grief during my second attempt at therapy that I unconsciously optimized for a therapeutic container that’d help with the grief and nothing else.

In contrast, co-creating coherent therapeutic goals involved taking the time to slow down with my therapist to build a shared map for improving my life. This co-creative approach meant that even a few hours of venting felt like forward progress because it brought us closer to clarity. I already had some vague orientations like becoming less anxious, having a girlfriend and finding meaning at work. However, clarity around these goals themselves was often obscured by fear, judgement, etc. that my therapist needed to help me unwind. Building out this shared map over many sessions was incredibly trust-building. It was the missing link from my previous attempts at therapy.

The idea of moving to NYC started off as an escapist fantasy. But there were some reasonable goals underneath that fantasy. For example, moving closer to family, prioritizing dating to enter a serious relationship, and moving away from a life organized around “productivity”. Our co-creative process brought all of these authentic goals up to consciousness. Making progress on them was often walled off by a bunch of fears, judgements and memories of past pain, and my therapist helped with that too.

Ironically, I did in fact eventually move to NYC, but with far more clarity and integrity. I found a fulfilling long-term romantic relationship, found meaning in my work, and felt surrounded by the love of my family and friends. I felt a peace and security in my body that pre-therapy Varun couldn’t have imagined.

These days, when I’m looking for a new therapist, I take the time to find one that I can co-create coherent therapeutic goals with. My commitment to the therapeutic process seems to be the most important variable for increasing the probability of success, relative to other factors like the modality they practice, their individual vibe, etc. Don’t get me wrong, they’re not unimportant. However, my commitment to the process and to changing has consistently been the most important. Therefore, I work hard to find a therapist who’s a good fit to merit that level of trust and commitment. I’ll usually try working with a new therapist for 4-5 sessions before ruling them out. I won’t overthink it if a single therapist doesn’t seem like a fit. However, I’ll assume there’s a structural problem on my end if I haven’t found a fit after 4-5 therapists.

Although modality doesn’t seem to matter as much as my commitment to the process, I’ve found the most luck with therapists who take a psychodynamic approach. I’m not claiming that CBT is “bad”. In fact, it’s been very helpful for my OCD. However, I generally appreciate the “deeper” perspective of psychodynamic approaches.

I’ve found good therapists most reliably by asking people for referrals. Specifically, people I know that have invested a lot of time on inner work. As of 2026, that means I typically ask my smartest female friends for recommendations. Most women I know are in therapy, and most men I know aren’t. Broader social commentary around this observation is well outside the scope of this essay.

If all else fails, I try going upmarket to increase the level of choice available to me. I’m not claiming that higher fees always lead to better care. However, I’ve found that for my specific needs and cognitive stack, I’ve tended to get better help from out-of-network therapists who bill directly and offer an invoice for reimbursement.

Once I’ve started meeting a therapist, I’ll give them broad access to my inner experience so they can form a more accurate clinical picture of me. Imagine debugging a production system without production logs or access to the source code. Or if each bit of access had to be carefully negotiated. It’d take forever! Assuming I find someone I vibe with, I prefer to give them expansive “read” access to the production system that’s my mind. I don’t lie to my doctor, my lawyer, or my therapist.

On the other hand, I’ll slow down before letting a therapist’s explanation reorganize my beliefs or decisions. This guards against misunderstandings and other failure modes. Essentially, I err on the side of providing expansive “read” access to my mind, while carefully negotiating “write” access to how I understand myself and what I actually do.

Here’s the sort of thing I’ll say to new therapists in our first session. Such an invitation does a few things. It provides a grounded context of a real problem in my life (e.g. quitting my job), provides read access to the therapist, and explicitly invites the co-creation of authentic goals without sacrificing my self-determination.

I’m here because I’m torn between staying at my current job or leaving. I realize that this decision is probably hard because my emotions are distorting my thinking, but I don’t know exactly how.

Zooming out, I’d like to live a life where I’ve achieved money and meaning simultaneously, where I have fulfilling relationships with myself, my family, my friends and my romantic partner. I don’t yet know what that means in terms of tractable and measurable goals.

I’d like to spend the first few sessions working with you on goal-setting. I’m inviting you to ask probing questions across the domains of my life where you think it’s clinically relevant and within your professional scope. I’d like your help noticing where fear, judgement or the pain of old wounds might be distorting my ability to create tractable goals in the direction of what’s most authentic to me.

I’d like to perhaps start with the immediate problem of helping me gain clarity on why I’m finding it difficult to quit my job, and on the goals I’m actually looking for underneath my fears of quitting.

A co-created goal is most useful when it pairs a broad orientation with something that can be tractably measured. An orientation goal is abstract and broad, but provides an overarching orientation for goal-setting. A tractable goal is contextual and specific, but its specificity makes measuring progress tractable.

Orientation goals without tractable goals can feel aimless and wishy-washy. Tractable goals without orientation goals can feel empty, meaningless and hollow.

Here are some examples of orientation goals paired with tractable goals.

• Anxiety

  • Orientation goal - I’d like to live my life free of anxiety.

  • Tractable goal - I currently anxiously check and re-check that I’ve locked my door every day. I’d like to do this half as often in the next few weeks.

• Money and meaning

  • Orientation goal - I’d like to find money and meaning simultaneously.

  • Tractable goal - I’ve looked at my calendar, and 40% of it is currently occupied by meetings that I find very draining. They don’t seem to be useful for immediately helping my career, nor do I find them very meaningful. I’d like to understand how to bring this down to 20% in the next quarter, and what emotions are holding me back from doing so.

• Relationships

  • Orientation goal - I’d like to have a healthy relationship with myself, my family, my friends and my romantic partner.

  • Tractable goal - I’m single and would like a romantic partner. I haven’t been on a date in the last two months due to work. I’d like to get to one date a week in the next two months.

A good tractable goal is typically one that intuitively and rationally makes sense, but feels a bit scary and uncomfortable in my body. I then ask my therapist to help unpack my fears, change my relationship to them, and we’re off to the races.

Sometimes pursuing a goal shows me that I don’t want it after all, and that’s okay. This additional clarity then becomes a springboard towards co-creating more aligned goals.

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This process eventually becomes a flywheel for transformation. Co-created goals give me clarity on a direction and a tractable way to measure progress. This clarity builds trust, which makes it easier to commit to the goal even when it’s hard. This increases the odds of successfully achieving the goal. Success begets more ambitious goals, and the cycle continues with each iteration beautifully compounding over the last.

The co-creation of coherent therapeutic goals, rather than controlling the therapeutic relationship, is the key ingredient for setting up this flywheel that actually transforms my life with therapy.

I hope you find peace, love, joy and flow, or whatever you’re looking for. If you have questions, I’m happy to chat at varun@doubleascent.com.

Acknowledgements

• All my therapists - you’ve changed my life.

• Brian Whetten - Thank you for being an incredible coach, and giving me the frameworks for understanding my experience.

• Charlie Awbery for teaching me Opening Awareness and for helping me understand how the different pieces of my practice life fit together.

• Professor John Vervaeke for everything he’s taught me over the years.