Are You in Your Therapist’s Dunbar Number?

One common reason people seek therapy is that their anxiety, depression, attachment disruptions, or trauma reactions interfere with their ability to develop and maintain meaningful relationships. If you already have a lot of meaningful relationships, these psychological ills are often easier to bear, and you’re less likely to seek therapy. But it’s also because we don’t usually think upsetting emotional states are serious enough to warrant professional help unless they interfere with work, sleep, play, or, especially, our relationships.

Psychotherapy can help best by engaging you in a meaningful relationship and resolving the personality patterns that interfere with it. This approach allows the dyad to work on these interfering patterns in real-time rather than just consulting about them, much as a good physical therapist doesn’t just give you handouts describing exercises to do at home.

Dunbar’s (2021) number of around 150 represents how many meaningful relationships most people can maintain. Setting aside the biological and evolutionary arguments and counterarguments, I think most people recognize themselves in a system that suggests we can sustain a small number of intimate connections, somewhat larger numbers of good friends and real friends, and about 150 meaningful relationships.

For psychotherapy to work of the sort that is more than a consultation about your life, I argue that you would have to be one of your therapist’s meaningful relationships. Otherwise, you’d be learning how to be in a pretend relationship, a relationship that claims to be meaningful but isn’t. That may sound like social media and it should; social media can make us pretend that acquaintances are friends. Pseudo-therapy, like social media, tends to the false self but does not feed the real self or what Freud called “the soul.”

I like my doctor. He seems smart, trustworthy, and invested in my health. His website says he treats patients like family, but it must be a very extended sort of family, because I was surprised to learn from an internet search that most general practitioners maintain 1,000 to 2,000 patients. No wonder he takes such careful notes! He has to refresh his memory of me every time he sees me. I have responded by repeating pertinent information at the start of every contact, like stating your name when saying hello to a professional acquaintance you hope remembers you but suspect does not.

Given the relevance of the Dunbar number to the practice of psychotherapy, there is a limit to the number of patients a therapist can treat at one time without turning into a source of information and homework exercises that you can easily get off the internet. For a time, I saw 30 people in therapy, and in that period I didn’t have much interest in making new friends. When I stopped seeing patients and started teaching, suddenly my dance card was relatively empty and I filled it with new people: colleagues and students.

In my department, we’re supposed to pretend we have meaningful relationships with all 50 faculty and staff and all 30 to 40 students in each classroom. This prepares students for an HMO or community mental health practice where they will juggle hundreds of patients by teaching them to pretend to be in meaningful relationships. I’d prefer it if we all wore nametags and stopped the pretense that memorizing people’s names makes relationships meaningful. I do have meaningful relationships with perhaps half my colleagues and all the students whose clinical work I supervise (about 15 each year).

One measure of the emptiness of relationships is whether you behave differently with your closest 5, with your friendliest 15, with your meaningful 150, and with the general public. Some of my colleagues and I get criticized for behaving differently with the people we supervise and collaborate with in meaningful connections (where we tend to be empathic and argumentative in the service of getting on the same page) compared to the people we teach in classrooms or merely work alongside (where we tend to be polite unless the topic is clinical psychology or civil rights, and where we tend to be argumentative to promote beneficial policies). People who treat everyone the same make me suspect that none of those relationships are meaningful, not that all of them are.

One thing I’ve noticed is that when you are not in your therapist’s network of meaningful relationships, they try to make you think that you are. They nod and offer sympathy; they try to help you feel better. They also take notes and put a lot of information in your clinical record so they can review it before sessions. When you actually are in a meaningful relationship with your therapist, they don’t take up so much space trying to prove you are; they listen intently and try to help you get better. They don’t have to read notes before they see you.

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I argue that if you’re not in your therapist’s Dunbar number, you are not getting real therapy. Your gnawing angst, vague ennui, background fears, and sense of disconnection are not improving because all you are getting is what you can get online—information and ideas and affirmations, which are a poor substitute for meaningful connection.