In-depth interviews with 100+ therapists reveal the real reasons founders don’t get help

Monika Holod, founder of the OMA Mind platform, shares the real reasons founders don't open up

May 29, 2024

In-depth interviews with 100+ therapists reveal the real reasons founders don’t get help

The entrepreneurial journey is filled with challenges that extend beyond the boardroom and into the personal well-being of founders. Data from OMA Mind and Startup Snapshot paint a comprehensive picture: an overwhelming 92% of founders acknowledge the direct impact of own mental health on their business performance and 72% of entrepreneurs report that steering their companies takes a significant toll on their mental well-being, manifesting in increased stress, anxiety, depression, burnout, and panic attacks.

This stark reality underscores a paradox. Given the high stakes and intense pressure, one might expect founders to prioritize mental health support as rigorously as professional athletes do, incorporating regular therapy into their routines to maintain peak performance.

We couldn’t be more wrong: only 23% of founders actually get professional help. This disparity raises a crucial question: Why are so many founders reluctant to seek the help they need? 

Based on in-depth  interviews with over 100 therapists and entrepreneurs conducted by OMA, we highlight the top 3 reasons founders struggle to reach for help.

1. Simply can’t afford it.

Mental health support is expensive. Regular sessions with therapists to resolve specific issues, or for ongoing support are affordable when you are on decent salary, but the truth is that in the first years founders operate on a ‘survival budget’ and it’s often their only source of income. There is also resistance to spending the investors money on self-improvement, even though the founder’s excellence is one of the most powerful assets of every early stage business.

One of the founders we asked said “I would rather find a way to pay out of pocket, but if I don’t provide it to my team, I can’t imagine paying for my own support. It wouldn’t be fair.”.

The problem is, that the impact of founders’ performance on the business is significantly higher than any other employee. High resilience to stress is part of the job, and at the early stage – it takes some training to achieve the maximum resilience.  

“I’d love to see the research about how many more companies would succeed, if the founder had high quality resilience training, mental health advisory and coaching available to them.” says one Angel investor we spoke to, who supports founders in their mental health journey.

That’s where the investors can play the role – if not fund the support, then at least encourage founders to prioritize it and make it legitimate business expense. The annual cost of mental health support and coaching is often unproportionally lower than the price we pay for slower growth and the ‘lows’ when founders figure out their own psychology.

That’s where the organizations like Founders Mental Health Pledge come into picture – they recently announced a proposal to add a clause in the Term Sheets where the investors encourage founders to spend a portion of capital on mental health. It’s a great start!

2. Hard to find the right therapist

Once the financing issue is solved, there’s a whole different difficulty in finding the right support.

The journey to find a therapist who can navigate the specific challenges of the entrepreneurial world is often long and filled with missteps. More than half of the founders who have engaged in therapy reported that it took a few years before they found the right therapist and then started working with them.

Therapeutic alliance is the main reason why the therapy works in the long term, but trusting that the therapist can understand the founder’s mindset seems to be a fundamental challenge.

In the interviews conducted by OMA, one successful serial founder described, “I needed therapy on several occasions with my first company. I was referred to someone and stayed with her, but their lack of understanding of what’s at stake when the company grows with a lot of attention from the public is frustrating. I stay with her because she already knows my story, but it would be easier to work with someone familiar with the entrepreneur’s journey.”

Entrepreneurs operate in high-stakes environments that demand a unique blend of resilience, innovation, and speed. Therapists who understand these dynamics are supposed to be better positioned to build rapport with their entrepreneurial clients. This understanding can come from previous business experience, strong experience working with entrepreneurs or work with professional athletes whose mentality is similar to Founders.

Another successful founder, who had raised over $100M for his startup, described his journey to finding the right support professional. “During the rough time just before announcing our highly scrutinized down round, my stress and anxiety went through the roof, something I’d never dealt with before. My wife pushed me to see a therapist, and after a long search, we thought we’d found the perfect one. He claimed that he had experience working with founders. But after a few sessions, it became clear he didn’t get the real picture of what startup life throws at you. He seemed more accustomed to dealing with corporate clients and middle managers and thought it would be similar.
It felt like he was  out of his depth, like getting tips for climbing Everest from someone who’s only ever hiked in a local park. A very time-expensive mismatch that was both disappointing and felt like a betrayal especially after I had spent so much time sharing and specifically asked, because I needed help.”

This sort of negative experience presents a serious issue, because there is only one thing Entrepreneurs lack more than finances to support therapy – time. Spending hours in research of the right person to talk to, reviewing their credentials and finally spending an hour or a few to open up requires hours which Founders don’t have.
If the experience is negative or disappointing, they will often not repeat the journey but leave it unless it’s extremely bad.

3. Mismatch of expectations

We asked therapists and founders the same question – what makes a good therapist? Both groups list ‘no judgment’ as top quality of good therapists. However the second answer couldn’t be more different: founders list the therapist’s ability to provide actual advice as their main expectation to whom they will consider great, while the majority of therapists consider providing advice as one of the main things they are trained not to do.  

I see the therapist as any other expert I interact with. I have to have some knowledge and brief them but then expect to hear their opinion based on the information shared.” says one of the founders we spoke to. It’s definitely not the only way how Founders want to experience therapy but an interesting one to consider when creating protocol for founders. 

The issue of therapeutic alliance extends beyond initial trust. Many founders express frustration over therapists’ lack of flexibility and understanding of the entrepreneurial lifestyle, which often requires prioritizing business needs over personal care, including therapy.

A founder that raised £25m total prior to a successful acquisition described, “I really needed therapy when we were selling the business.(..) I put a significant amount of time to shortlist therapists on the insurance page, called maybe 20 and finally found one who could be a fit, matched my schedule and I had a good feeling about. I saw them a few times but gave up because they struggled to understand that therapy is not my priority at any moment. The therapist must understand that as a founder my life is not my own.”

The therapist’s normal approach to any client who wants to start therapy would be to assume they can prioritize self work, carefully unpack past experiences, and take the time to reflect, explain and discover their own issues. 

Founders’ frustration with this approach cannot be ‘blamed’ on therapists -”The structure of traditional therapy is rooted in structures that were put in place over 100 years ago and not much has changed. I think that being able to take control of both how you find a therapist but then also interact therapeutically (..)  doesn’t really exist for people to manage their mental needs outside of that traditional structure” says one of the therapists we spoke to.

This mismatch in expectations and understanding underscores the need for a tailored approach to mental health support for Entrepreneurs. Changing the process and adapting to the reality of people who push the world forward requires a bigger shift in what the therapy for Founders actually means.

If the experience of therapy is shaped by such a big mismatch of expectations, difficulty in finding and financing the therapy it seems no surprise that 77% of Founders don’t use professional help. It doesn’t however mean it needs to stay this way – there are more and more solutions and platforms which address Founders mental health and we are hopefully at the peak of all sides involved, Founders, Therapists and the Investors, seeing the need to build mental resilience for maximum performance as everyone can win if that’s done.

Monika Holod

Monika Holod

Founder OMA Mind


Monika is the Founder of OMA Mind, a platform for therapy made for founders to achieve greatness.

Monika Holod

Founder OMA Mind


Monika is the Founder of OMA Mind, a platform for therapy made for founders to achieve greatness.

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