A lot of clients don’t come in asking about loneliness directly. They ask about energy, anxiety, a feeling they can’t name. They talk about being tired all the time, about feeling numb or hollow. They ask, quietly, like it might be a character flaw: Is it weird I don’t have close friends anymore?

We talk a lot in this field about trauma, attachment, identity, and neurobiology. We talk less often (at least explicitly) about connection as a baseline need. Not in the Maslow’s hierarchy sense, but in the physiological, nervous-system-regulating, life-extending sense. Social connection is a public health issue. The absence of it is a crisis.

But what do we mean when we say “connection”? What kinds of relationships actually protect mental health? How many are enough? And what does that question even mean for clients – and for ourselves as clinicians – who are living in a dominant culture that rewards self-reliance and punishes need? Let’s get into it.

What the Research Actually Says

At our core, human beings are not designed for independence. We are wired for co-regulation. That’s not new. But what has shifted quietly and dangerously is how our lives are structured to cut us off from one another. We move more. We live alone more. We work longer. We parent in isolation. We spend more time online, which gives the illusion of contact while often deepening the ache for something real.

According to the above 2023 Surgeon General’s report, lack of social connection and feelings of isolation increase the risk of premature death by 29% – a risk comparable to smoking 15 cigarettes a day. And yet, the dominant cultural narrative still insists that needing people is a personal weakness, and especially so if you’re a man, or a therapist, or anyone taught to be the strong one.

So what’s the alternative? What actually supports wellbeing?

The 5-15-50-150 Model

British anthropologist Robin Dunbar found that humans consistently organize their relationships in concentric layers based on emotional closeness. According to his research, most of us can cognitively manage about 150 social ties before we in essence max out on memory. But when it comes to real emotional support – who we call in crisis, who knows the truth of our lives – it narrows dramatically.

According to Dunbar’s 5-15-50-150 model, most people tend to have about five close, emotionally supportive relationships (what he refers to as a “support clique”). These aren’t casual friends or friendly coworkers, but the people you can truly rely on in times of need. While the exact number varies, five has historically served as a common average to maintain emotional and psychological health. Fewer than that may leave us more vulnerable during times of stress or crisis, while significantly more may dilute the time and emotional energy we can invest in each connection.

These are the people who will help you move, or listen to you fall apart. The ones you can text when you’re spiraling and who you know won’t judge you. People with whom you feel emotionally safe, and who feel the same way about you. There’s a kind of earned mutuality to these relationships – they’ve seen you over time, and they’re still there.

The number is small on purpose. Emotional intimacy has a cost: time, presence, and attention. We’re not meant to do that with everyone. But we are meant to do it with someone.

What “Authentic” Actually Means for Relationships

“Authentic relationship” can be one of those jargon-y terms that gets thrown around without much clarification, so let’s be precise. It doesn’t mean constant vulnerability or total transparency. It means:

• Emotional safety
• Mutual responsiveness
• Consistency over time
• No one person doing all the work

These relationships don’t have to be dramatic or intense. In fact, the strongest ones often feel ordinary. It’s the friend who checks in without prompting. The sibling who remembers a hard anniversary. The neighbor who brings soup and doesn’t ask questions. In a culture obsessed with spectacle and performance, real connection can feel surprisingly quiet.

As therapists, one consideration to help lonely clients is re-attunement to that kind of quiet. A lot of people are looking for peak intimacy and missing the steady, durable relationships already in their lives.

Who’s Most at Risk for Not Having Enough?

Here’s where it gets harder. The people most likely to lack about 5 close relationships are often the ones who’ve had to survive without them. You may see this in:

• LGBTQ+ clients estranged from family
• Neurodivergent folks navigating social exhaustion
• Men in midlife with fading peer networks, often shaped by social norms that discourage emotional vulnerability and close male friendships
• Clients who’ve moved cities repeatedly for work or safety
• People of color in predominantly white professional spaces
• Trauma survivors who expect abandonment and rejection as a given

And then there are your clients who are caregivers. The parents of small children, the adult children of aging parents, the clinicians. The ones doing the emotional labor for everyone else. Often surrounded by people, often deeply alone.

Structural factors matter here. You can’t talk about connection without naming the ways racism, poverty, ableism, and capitalism erode it. Not everyone has equal access to safety in a community.

How This Shows Up in Therapy

When someone doesn’t have enough authentic connections, it can look like:

• Idealizing the therapist relationship
• Internalized shame about needing support
• Despair that doesn’t respond to insight-oriented work
• Rigid independence masking deep unmet need
• Flat affect or emotional numbness
• Going against their own values or comfort to maintain relationships, even unhealthy ones, out of fear of being alone

Clients may say, “I’m just tired.” Or “I don’t want to bother anyone.” Or “I don’t really have people like that.” They may also override their own boundaries, tolerate mistreatment, or cling to relationships that feel one-sided — not because they don’t know better, but because the alternative feels like social starvation. 

They often think it’s their fault. That they’re awkward, broken, too much, or too boring. That everyone else got a manual for connection that they missed. This is where our work begins – not just helping them feel less ashamed of wanting closeness and healthy, authentic relationships, but helping them imagine what that might look like in real life.

Talking About “Enough”

Even despite Dunbar’s prolific publications, there’s no magic number. About 5 close relationships is a guideline, not a prescription. Some people thrive with one deeply bonded person. Others need a wider net. The goal is functional, mutual connection, not hitting a quota. Ask clients:

• Who do you feel emotionally safe with?
• Who knows the parts of you that feel hardest to share?
• Who shows up when you ask – and when you don’t?

Help them map their networks in layers: intimate, close, casual. Sometimes the work is about deepening existing ties. Sometimes it’s about grieving what’s missing. Sometimes it’s about building something new from scratch, which is harder but possible.

What Therapists Need to Ask Ourselves

Let’s not pretend we’re exempt. Many therapists are also chronically relationally depleted. We give attention, attunement, and responsiveness all day. We listen with care. Then we go home and find ourselves unable to pick up the phone or engage meaningfully with those we love.

It’s not just compassion fatigue. It’s social fatigue, emotional flattening, and sometimes real loneliness. Supervision doesn’t always touch this. Peer consults may help clinically, but they’re not substitutes for personal connection. So ask yourself:

• Who in your life really knows how you’re doing?
• Who can you fall apart with, and know that you’re still loved and admired?
• When’s the last time you connected with someone without an agenda?

If your answer is unclear, that’s not a personal failure. It’s a signal. You may need to prioritize low-demand connections. Friendship without caretaking. Intimacy without fixing. Peers who don’t need you to be insightful or regulated.

Therapist isolation is a real thing. And it doesn’t just affect you – it shapes the energy you bring into the room. If we want clients to risk closeness, we have to remember what that feels like in our own lives. Connection isn’t soft. It’s not decorative. It’s essential. And it’s not just the client’s job to build it, as therapists it’s our job to make it part of the clinical conversation. To treat it as worthy of time, attention, and intervention.

We can help clients build toward relationships that are steady, mutual, and real. We can help name what’s missing, not as a flaw, but as a gap created by culture, context, or circumstance. And maybe, in the process, you’ll ask the same of yourself.