For generations, only children have navigated a world of stereotypes: being labelled as spoiled, lonely, or socially awkward. Yet, as family structures evolve, these portrayals are increasingly disconnected from reality. The single-child family is now the fastest-growing family unit in the United States, with about 20% of households with children having just one, according to Pew Research Center. Despite this shift, a lingering stigma persists, leading many adults who grew up without siblings to seek therapy to process their unique experiences.
"Therapy can be a healthy space ... to learn about themselves and how they interact with the world around them" as only children, explains Altheresa Clark, a licensed therapist and owner of Inspire4Purpose. We spoke with Clark and other mental health professionals to understand the common themes that emerge in these sessions.
Navigating Loneliness and Building Chosen Family
A frequent topic in therapy is the adult longing for sibling-like bonds. Coming from a smaller family can translate to fewer built-in support systems. Rebecca Greene, a mental health therapist and author of "One & Done: The Guide to Raising a Happy & Thriving Only Child," notes that holidays can be particularly isolating without the large gatherings often depicted in media.
The solution, therapists suggest, lies in intentional community building. "There’s a saying [that] if you don’t have family, then make your own family," Clark says. She encourages finding like-minded individuals through friendships, organizations, and community work. Greene adds that inviting close friends to celebrate milestones and helping one's own children form cousin-like friendships can effectively fill that relational void.
The Weight of Solo Responsibility and Perfectionism
Another significant pressure point is the sole responsibility for aging parents' care. As the only child, the burden of medical appointments, financial management, and daily support falls entirely on one person, a situation Greene describes as overwhelming, especially when long-distance is involved. Her advice includes planning ahead with parents and partners and seeking professional help from geriatric care managers or social workers.
Parallel to this is the internal pressure to be perfect. The focused attention from parents, while often fostering close bonds, can make an only child feel constantly observed. Clark points out this can cultivate perfectionism or a type-A personality, driven by a fear of disappointing others. Simply recognizing this dynamic in a therapeutic setting can help individuals be less self-critical.
Independence, Communication, and Combating Stigma
Growing up alone often breeds a strong sense of independence—a trait with dual edges. On one hand, only children are typically self-reliant, innovative, and natural leaders, Greene says. On the other, they may be perceived as bossy or inflexible. To mitigate this, therapists recommend honing collaboration skills. Greene suggests using "I" statements to communicate feelings effectively, while Priya Tahim, a licensed professional counselor and founder of Kaur Counseling, emphasizes asking questions and listening to others' perspectives.
Finally, many only children grapple with feeling misunderstood or judged due to persistent cultural stereotypes, often reinforced by negative media portrayals. Greene advocates for more positive representations that highlight the strengths of single-child families. For support, she recommends Facebook groups for adult only children, which offer community and resources.
Therapy ultimately serves as a valuable tool for anyone to explore how their childhood family position shapes them. "Whether you are an only child, [oldest child], middle child or [youngest] child, there are pros and cons to each," Tahim concludes. "It’s how we choose to grow, learn and adapt ... that truly matters."
