You made VP. You survived the analyst grind and the associate years. You told yourself it would get better once you had the title, the compensation, the team beneath you.
Instead, it got worse.
You’re no longer just executing—you’re responsible. Responsible for your analysts who are burning out. Responsible for client relationships that can evaporate with one mistake. Responsible for deal flow that determines your group’s relevance. Responsible for managing up to MDs who have impossible expectations and managing down to juniors who resent the hours you’re demanding.
The compensation is real. The prestige matters. But you’re exhausted in a way that sleep doesn’t fix.
And you’re starting to realize: this is the job. There’s no next level where it magically gets easier. This is what you worked toward for years, and it’s destroying you.
You’re not weak. You’re confronting the reality that most investment banking VPs face but rarely discuss: you’ve reached a career stage where the psychological demands exceed what most humans can sustainably manage.
Across California—from San Francisco tech M&A groups to LA entertainment banking to Silicon Valley venture debt teams—VPs are quietly struggling with anxiety, burnout, relationship collapse, and the dawning realization that they may need to choose between their career and their wellbeing.
This is your guide to therapy for investment banking VPs: what makes your level uniquely difficult, how to recognize when you need support, and how to access licensed psychotherapy that protects your confidentiality and actually understands your world.
You made VP and it got worse, not better. You’re not alone—and there’s a way forward.
Confidential therapy from clinicians who understand VP-level banking realities
Why VP Is the Breaking Point
Most people assume investment banking gets easier as you advance. The opposite is true.
As an analyst, the work was brutal but simple: execute what you’re told. As an associate, you managed analysts and developed client skills. But as a VP, you’re caught in the worst position in the entire hierarchy.
The VP Trap
Responsibility Without Authority
You’re accountable for deal outcomes, but you don’t control client decisions, managing director priorities, or junior banker performance. When deals fall apart, you absorb blame. When they succeed, credit flows upward.
Squeezed from Both Directions
Managing directors pressure you for unrealistic deliverables. Your team expects you to protect them from impossible demands. You’re the shock absorber that gets compressed from both sides until you collapse.
The Political Complexity Intensifies
Success at VP level isn’t just about technical excellence—it’s about navigating office politics, managing client relationships independently, and building coalitions for your deals. These skills aren’t taught. You’re expected to develop them while maintaining the execution intensity of your junior years.
The Compensation Trap Tightens
You’re making $400K-$700K depending on group and performance. You’ve upgraded your lifestyle. Your family depends on this income. Walking away now means sacrificing years of brutal work for nothing. But staying means accepting that this is your life indefinitely.
You See the Future Clearly
You watch your managing directors. They’re making $1M-$3M+, but they’re also divorced, alienated from their kids, and tied to their Bloomberg terminals at 9 PM on Saturday. That’s the path you’re on. The rewards keep increasing, but so do the costs.
At CEREVITY, we work with investment banking VPs across California who describe the same revelation: they achieved what they thought they wanted, only to discover it’s not sustainable. The question isn’t whether they can continue—technically they can. The question is whether they should.
The Specific Mental Health Challenges for Banking VPs
VP-level investment bankers face psychological pressures that are distinct from both junior bankers and managing directors.
Performance Anxiety at a New Level
The Credibility Crisis
As an analyst or associate, you could defer to senior bankers. As a VP, you’re expected to be the expert. Clients ask you questions directly. Managing directors expect you to have answers. And you’re terrified of the moment when someone realizes you don’t actually know everything.
This is textbook imposter syndrome, but at VP level it has real consequences. Your credibility determines whether clients trust you, whether junior bankers respect you, and whether managing directors see you as promotion material.
We work with VP clients who describe the same pattern: they’re objectively competent, but they’ve developed catastrophic thinking about their limitations. They mentally rehearse every client call for hours. They triple-check models that are already correct. They can’t sleep before major presentations because they’re anticipating every possible question that could expose their inadequacy.
Decision Paralysis
You’re making recommendations that affect hundreds of millions of dollars and hundreds of jobs. A wrong call on valuation, a missed risk in due diligence, or a bad read on competitive dynamics can destroy deals and damage your reputation. The weight of these decisions creates paralysis. You over-analyze. You seek consensus excessively. You delay making calls because you’re terrified of being wrong.
Burnout That’s Different from Junior Years
The Exhaustion Is Existential, Not Just Physical
As a junior banker, you could tell yourself the hours were temporary. You’d make VP and get your life back. But now you are VP, and you’re working harder than ever. The burnout you’re experiencing isn’t just sleep deprivation (though that’s real). It’s the psychological exhaustion of realizing this is permanent. There’s no finish line. No achievement that finally lets you relax. The intensity is the job.
According to the World Health Organization, burnout is characterized by: Energy depletion or exhaustion • Increased mental distance from one’s job, or feelings of negativism or cynicism • Reduced professional efficacy
For investment banking VPs, this manifests as: going through the motions on client calls without genuine engagement, cynicism about deals that should excite you, and the persistent sense that no amount of success will ever be enough.
The Meaning Crisis
You’re helping companies get acquired, go public, or restructure their capital. Intellectually interesting work. But are you actually building anything meaningful? The deals close, the fees get paid, and then you start the next one. What’s the point? This isn’t depression—not yet. It’s the existential questioning that happens when you’ve achieved external success but feel internally empty.
The Team Management Burden
| The Burden | The Reality |
|---|---|
| You’re Destroying People | Your analysts are working 90-hour weeks. They’re missing weddings, canceling vacations, and developing anxiety disorders. You know this because you went through it. And now you’re the person demanding it from them. The guilt is crushing. |
| The Authority You Don’t Have | You’re supposed to manage your team, but you can’t actually protect them from unreasonable demands. When a managing director wants a pitch book by Monday morning, you can’t refuse. You can only distribute the suffering among your analysts and associates. |
We work with VP clients who describe lying awake at night thinking about the analyst who started crying during a modeling session, or the associate who’s getting divorced because of their work schedule. You’re not just managing your own burnout—you’re carrying guilt about causing burnout in others.
Relationship Destruction at the VP Stage
Your Marriage Is Failing
Your spouse initially understood that investment banking was demanding. But you’re VP now, and nothing changed. They’ve reached their limit. The conversation isn’t “I wish you were around more.” It’s “I’m leaving you unless something fundamentally changes.”
Your Kids Don’t Know You
You’re the parent who shows up occasionally and brings gifts to compensate for absence. Your kids have stopped asking when you’ll be at their events—they’ve accepted you won’t be there. The long-term psychological damage is well-documented.
You’ve Lost Your Friend Network
Your college friends stopped inviting you to things because you always cancel. Your non-banking friends don’t understand your world. Your banking friends are too busy to socialize. You’re socially isolated.
The Substance Use Pattern
Alcohol Is How You Transition
You’re not drinking to get drunk—you’re drinking to shut off your brain. One drink at 9 PM became two drinks at 7 PM became three drinks before dinner. Your tolerance has increased. You can’t remember the last night you didn’t drink. But you’re still functional—you’re not missing work or making obvious mistakes. This is what makes it insidious.
The Stimulant Use “Everyone Does”
Adderall to maintain focus during marathon modeling sessions. Modafinil to stay sharp on four hours of sleep. Cocaine at client dinners or team outings. In banking culture, performance-enhancing substance use is normalized. But what starts as “social” or “performance-enhancing” use can become dependence.
How to Recognize You Need Professional Help
Investment banking VPs are exceptionally good at normalizing dysfunction. When your entire peer group is working 80-hour weeks and surviving on anxiety and scotch, it’s hard to recognize when you’ve crossed from intense but manageable to genuine psychological crisis.
Here’s what to actually look for:
Immediate Warning Signs (Require Urgent Intervention)
⚠️ These symptoms require immediate professional intervention
- You’re having thoughts of suicide or self-harm
- You’re experiencing panic attacks—racing heart, chest pain, sense of imminent death
- You’re using alcohol or drugs daily and can’t stop
- You’re making uncharacteristic errors in your work due to inability to focus
- You’ve started having intrusive thoughts about harming yourself or others
- Your substance use has escalated to the point where colleagues are noticing
- You’ve missed work or important meetings because you couldn’t face going in
- You’re having blackouts or memory gaps related to drinking
- Your marriage is actively ending and you can’t function
- You feel completely detached from reality or like you’re watching yourself from outside your body
If you’re having suicidal thoughts, call 988 immediately. This isn’t normal VP stress. This is a psychiatric emergency requiring immediate intervention.
Strong Signals You Should Seek Support Now
- You dread Monday mornings with genuine despair, not just normal work reluctance
- You’re snapping at your team, clients, or family over minor issues
- You check work email compulsively, including during family events or vacation
- You’ve gained or lost 15+ pounds without intentional diet changes
- You can’t fall asleep or stay asleep even when you’re exhausted
- Your alcohol consumption has doubled over the past year
- You fantasize about getting sick or injured just to have a legitimate reason to take time off
- You’re avoiding client calls or deal work because you can’t handle more stress
- You feel emotionally numb—nothing excites you, nothing matters
- You’re questioning whether you can sustain this career for another year, let alone 5-10 years
- You’ve thought seriously about quitting without a plan for what’s next
- Your primary relationship is deteriorating and you feel powerless to stop it
If you checked four or more items, you’re not experiencing normal investment banking stress. You’re likely dealing with clinical anxiety, depression, or burnout—conditions that respond to therapy but rarely improve without professional intervention.
Why Most Therapy Doesn’t Work for Banking VPs
Many investment banking VPs have tried therapy before and found it useless. The problem isn’t therapy itself—it’s that most therapists fundamentally misunderstand your professional reality.
The Therapist Who Doesn’t Get It
| The Problem | Why It Fails |
|---|---|
| Naive Work-Life Balance Advice | When a therapist suggests “setting boundaries with your managing directors” or “learning to say no,” they reveal they have no idea how investment banking works. You can’t set boundaries when your career depends on responsiveness. |
| No Comprehension of Financial Stakes | A therapist earning $120K annually can’t fully grasp why you don’t “just quit” when you’re making $500K-$700K. They don’t understand the golden handcuffs, the lifestyle adjustments, the family expectations, or what walking away means. |
| Can’t Work Within Confidentiality Constraints | You can’t discuss specific deals, company names, or strategic plans without violating NDAs and potentially insider trading regulations. Most therapists don’t understand these constraints or how to provide effective therapy within them. |
| Misunderstanding the VP Position | Do they understand the specific psychological burden of the VP role? The squeeze between managing directors and junior bankers? The responsibility without authority? The political complexity? If they don’t, they provide generic stress management advice that doesn’t apply. |
What Effective Therapy for Banking VPs Actually Looks Like
Therapy that works for investment banking VPs addresses both immediate crisis management and the deeper patterns that make you vulnerable to breakdown.
Evidence-Based Clinical Approaches
Cognitive Behavioral Therapy (CBT)
For anxiety and catastrophic thinking. CBT helps you identify and challenge thought patterns that amplify stress: catastrophizing about mistakes, all-or-nothing thinking, mind-reading, and discounting positives.
We work with VP clients to distinguish between healthy diligence and anxiety-driven rumination.
Acceptance and Commitment Therapy (ACT)
For values and career decisions. Many VPs reach a crisis point where they need to make fundamental decisions about career trajectory. ACT helps you clarify what actually matters to you beyond external markers of success.
This clarity gives you a framework for making choices that align with your actual values.
Dialectical Behavior Therapy (DBT)
For emotional regulation. DBT teaches practical skills for managing intense emotions and navigating interpersonal dynamics: distress tolerance during high-pressure meetings, emotional regulation with difficult team dynamics, interpersonal effectiveness for office politics, and mindfulness practices that work within your schedule.
Solution-Focused Therapy
For practical, rapid change. You don’t have bandwidth for 18 months of exploratory therapy. You need concrete strategies for managing your current crisis, improving sleep, reducing substance dependence, repairing your marriage, deciding whether to stay in banking, and building sustainable patterns.
The Critical Importance of Confidentiality
For investment banking VPs, therapy confidentiality isn’t just about privacy—it’s about protecting your career and your compensation.
⚠️ The Insurance Problem
When you use insurance for mental health services, diagnostic codes enter databases that can surface during background checks for new positions, security clearances if you move to certain roles, internal HR reviews in some firms, and future employment verification. You’re not being paranoid—you’re being strategic. In high-stakes finance, perception matters.
The Private-Pay Solution
At CEREVITY, we operate exclusively on a private-pay model. This means:
- No insurance claims filed
- No diagnostic codes in any database
- No paper trail beyond the therapeutic relationship
- No risk of your firm’s HR department receiving information
- No possibility of disclosure during background checks
Additional Privacy Protections We Provide:
- HIPAA-compliant video platforms for remote sessions
- No confirmation of client status to anyone without explicit written consent
- Discrete payment processing (no obvious mental health provider names on statements)
- Flexible scheduling through secure systems, not shared calendars
- The ability to use a different name if you prefer additional anonymity
Your managing directors won’t find out. Your HR department won’t receive records. Your next employer won’t discover you were in therapy. You get the support you need without professional risk.
Common Issues We Address with Banking VP Clients
Beyond general stress management, here are the specific challenges investment banking VPs bring to therapy:
The Politics You’re Not Prepared For
Managing Up to Difficult MDs
Your managing director is brilliant technically but terrible interpersonally. They email you at midnight with vague instructions. They contradict themselves. They take credit for your work and blame you for their mistakes. How do you maintain the relationship without sacrificing your sanity or career prospects?
Office Politics That Determine Your Future
The path to managing director isn’t just about deal execution—it’s about building alliances, managing perceptions, and navigating group dynamics. Who do you align with? How do you build support for promotion without appearing threatening? How do you position yourself when your group is struggling?
Team Management Under Impossible Constraints
| The Challenge | What We Help With |
|---|---|
| The Analyst Who’s Burning Out | One of your analysts is struggling—making mistakes, missing deadlines, clearly exhausted. You remember being in their position. We work with you to support team members within your constraints, have difficult conversations about performance, know when to escalate concerns, and manage your guilt. |
| The Promotion Decision | You need to decide which associate to promote or which analyst to offer a return offer. The candidates are all competent. But you have one slot. We help you develop decision-making frameworks, manage the emotional weight of the choice, and cope with the aftermath. |
The Marriage That’s Ending
Your Spouse Has Given You an Ultimatum
They can’t do this anymore. They need you present—not just physically in the house, but actually available and engaged. If something doesn’t change, they’re leaving. The problem: you don’t know what to change. You can’t work substantially less without destroying your career trajectory. But you can’t lose your marriage either.
We work with couples (sometimes individually first, then together) to:
- Identify specific changes that would make a real difference
- Distinguish between reasonable requests and impossible demands
- Improve communication about your constraints
- Find ways to demonstrate commitment within your actual availability
- Make difficult decisions if the relationship truly isn’t compatible with your career
Sometimes marriage counseling saves the relationship. Sometimes it helps you separate more deliberately and less destructively. Either way, you need professional support to navigate this crisis.
Career Trajectory Decisions
Stay for MD or Exit Now?
You’re at the inflection point. Do you grind it out for 3-5 more years trying to make managing director? Or do you exit now to private equity, corporate development, or something entirely different? The financial calculation isn’t simple. The emotional calculation is even more complex.
The Entrepreneur Fantasy
You’ve thought about leaving banking to start something. Maybe joining a startup. Maybe launching your own fund. Maybe consulting. Is this a genuine calling or an escape fantasy? We help you distinguish between strategic career moves and desperation-driven decisions that create new problems.
When Banking VPs Need Therapy Intensives
Standard 50-minute weekly sessions work for many investment banking VPs. But sometimes you need concentrated intervention—especially during crisis periods or when you have rare availability.
The 3-Hour Intensive Format
The therapy intensive format provides 3 hours of focused work without the fragmentation of weekly sessions.
This is particularly useful when: You’re between major deals with a window of availability • You’re in acute crisis • You’re making a major career decision • You need processing after a traumatic experience
What to Expect from Therapy at CEREVITY
When investment banking VPs begin working with us, here’s the typical progression:
Initial Phase: Assessment
The first 2-4 sessions focus on understanding your specific situation and providing immediate crisis management. We gather information about your role, work schedule, stressors, relationships, substance use, and goals.
Middle Phase: Skill Building
This is where substantial therapeutic work happens. We focus on building cognitive flexibility, developing emotional regulation, improving political navigation, creating sustainable work boundaries, and addressing relationship repair.
Long-Term: Optimization
Therapy shifts from crisis management to optimization. You’re maintaining wellbeing while performing at a high level. Many VPs continue on a maintenance basis (biweekly or monthly) as consistent support.
Progress isn’t linear. During live deals, you might regress. Between deals, you make substantial gains. This is normal and expected.
The Practical Questions About Starting Therapy
If you’ve read this far, you’re likely past wondering whether you need support. The question is how to actually start.
“Can I Afford This?”
Our sessions are $175 for 50 minutes or $525 for a 3-hour intensive. This is a significant investment, but consider the alternative costs: impaired decision-making on major deals, health consequences of chronic stress, divorce (far more expensive than therapy), substance dependence requiring intensive treatment, career moves made from desperation, and the opportunity cost of underperforming due to burnout.
“How Do I Find Time?”
We offer early morning sessions (starting at 8 AM), evening appointments (until 8 PM), weekend availability, and flexible rescheduling during intense deal periods. Many VP clients schedule therapy during time they’d otherwise use for email or administrative work.
“What If Someone Finds Out?”
Complete confidentiality is our foundation: exclusively private-pay (no insurance trail), HIPAA-compliant secure platforms, no confirmation of client status, discrete payment processing, and secure scheduling. Your firm won’t find out. Your managing directors won’t know. Your background check won’t flag treatment.
“Will This Actually Help?”
Therapy isn’t magic. But research consistently demonstrates that evidence-based approaches effectively reduce anxiety, prevent burnout, improve relationships, and support strategic decision-making. Success requires a therapist who understands banking VP dynamics, consistent engagement, and implementation between sessions.
We can’t make investment banking less demanding. But we can help you navigate those demands without sacrificing your health, relationships, or long-term career satisfaction.
Most investment banking VPs we work with say their biggest regret is waiting so long to get support. The problems don’t improve spontaneously—they compound until crisis forces change.
You’ve built your career on making difficult decisions under pressure. Here’s another one: invest in support that allows you to sustain performance without destroying everything else that matters.
You Made VP. Now Get the Support You Need to Sustain It.
Therapy for investment banking VPs who need more than stress management—you need help navigating performance anxiety, team management burdens, relationship crises, career trajectory decisions, and the question of whether this path is sustainable.
What You Get:
• Evidence-based therapy from clinicians who understand VP-level realities
• Complete confidentiality with no insurance trail or professional risk
• Flexible scheduling including early morning, evening, and weekend sessions
• Support for anxiety, burnout, substance use, relationship crises, and career decisions
• Help making strategic decisions from clarity rather than crisis
Or visit: cerevity.com
When you call, you’ll speak directly with a licensed clinician who will assess your needs and match you with the most appropriate therapist for your specific situation.
✓ Private-Pay Only (No Insurance Trail) • ✓ Complete Discretion • ✓ VP-Level Understanding
Related Resources for Investment Banking Professionals
These resources explore similar dynamics for finance professionals at different stages:
About the Author
Brett Abrams, PhD, is a therapist at CEREVITY, a boutique concierge psychotherapy practice serving high-achieving professionals across California. With extensive clinical experience treating investment banking professionals at all levels—from analysts through managing directors—Dr. Abrams specializes in helping VPs navigate the unique psychological demands of mid-career banking while maintaining their wellbeing, relationships, and career trajectory.
Dr. Abrams uses evidence-based approaches including Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Solution-Focused Therapy to help banking VPs develop sustainable stress management strategies, address substance use patterns, repair relationships, navigate office politics, and make strategic career decisions from clarity rather than crisis.
CEREVITY operates exclusively on a private-pay model, ensuring complete confidentiality and discretion for clients who require absolute privacy in their mental health care. The practice serves investment banking professionals throughout California, including San Francisco, Los Angeles, Silicon Valley, San Diego, and Orange County.
Disclaimer: This article is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. If you are experiencing a mental health emergency or having thoughts of suicide, call 988 (National Suicide Prevention Lifeline) immediately or go to your nearest emergency room. The information provided is based on clinical experience and research but should not replace consultation with qualified mental health professionals. CEREVITY provides licensed psychotherapy services exclusively in California to clients physically located in California at the time of services.
