Marisa G. Franco is familiar with the art of secure attachment. She’s spent years studying it: that coveted quality that makes some people so trusting, so quick to accept that they are, in fact, loved. She wrote the 2022 best seller Platonic: How the Science of Attachment Can Help You Make—And Keep—Friends. She knows how to make connections without being clingy, how to be self-sufficient without pushing people away, how to avoid taking things personally.

Well—she knows how all of that should look in theory. In reality, Franco told me, she can be sensitive. She can get hurt by someone who’s not doing anything remotely wrong. At some point, she realized that she was striving so hard to be secure that she was performing well-adjustedness for her own therapist. “There’s this way that I can lean on the very real parts of myself that feel proud and feel happy and impressive and glittery,” she said. “But there were these other parts of myself that felt ashamed or felt needy, and I would try to not talk about them.” The truth, of course, was that her therapist needed her not to be composed or even coping, but to be honest. And if she wasn’t being honest, she was arguably wasting time.

That lesson is at the core of her latest book, Worth: The New Science of Self-Esteem and Secure Attachment. Nominally, Worth is about how to become more self-assured. But as soon as Franco presents that possibility, she upends it by suggesting that it may be impossible. Maybe most people are just a bunch of insecurities in a trench coat, one stiff wind away from toppling over. Perhaps, she suggests, they should accept their weak or tender spots, all of their little ways of being defensive or touchy—and settle, if anything, for “secure-ish.” This might seem like a defeatist argument for a self-help book, but it’s an apt one at a time when the literary-self-help industry is thriving. Many of Franco’s readers may already be fluent in therapy-speak, ready to chat about attachment theory, and keenly interested, as she was, in presenting themselves as mended and enlightened. She’s not convinced it’s helping.

In the past decade or so, the self-improvement industry has grown colossal. According to Gitnux, a market-research firm, U.S. self-help books earned a collective $813 million in 2023 alone. And the behemoth has sprouted new arms: With the mega reach of platforms such as TikTok, Instagram, and Spotify, people can consume a constant drip of life advice. One hungry customer might listen to the audio book of James Clear’s Atomic Habits on the way to work, use a meditation app on their lunch break, and scroll through some therapist-influencer posts in the evening. Then, while getting ready for bed, they could turn on The Mel Robbins Podcast—the most followed show on Apple Podcasts last year, from the author of The Let Them Theory, the best-selling book about tuning out other people’s judgments. Gitnux reported that 52 percent of the industry’s patrons were “repeat buyers”—and some analyses have found that the literary-self-help category specifically caters to a pool that’s 80 percent repeat customers. If you’re looking to publish something new in the genre, you have an enormous potential audience of people who take self-optimization very seriously.

That opportunity is also a challenge for authors like Franco. They have to set themselves apart—and maybe even help readers unlearn guidance they’ve already hoovered up. Some writers have started speaking explicitly to this task (which allows them to signal a bit of knowingness about their company in the self-improvement aisle). In his 2021 best seller, Four Thousand Weeks: Time Management for Mortals, for instance, Oliver Burkeman argues against the idea that any one trick will get you on top of your to-do list; your best hope, he says, is to accept that a human life is terribly brief, far too brief to accomplish all of your goals. In Amir Levine’s 2026 book, Secure, the Columbia University neuroscientist questions the feasibility of mining security within yourself—and instead suggests seeking out people who make you feel valued from the start.

[Read: The psychiatrist’s case for downsizing a friendship]

Franco’s approach, too, is a little meta. Before she started this book, she looked around and saw a “group of people that was just trying so hard to heal,” she told me. They could resolve conflict with “I” statements, speaking about their own feelings rather than jumping to blame others. They could set boundaries. They were hoping to become the perfect partner, or break cycles of generational trauma. And yet, she said, “it just didn’t seem like it was working.” She recognized herself in their show of composure. (I pictured the “this is fine” dog grinning vacant-eyed through the flames.) So she didn’t want to give people more ways to go through the motions. She wanted to know: “What does it mean to feel secure in the marrow of your bones?”

A conventional idea of self-worth might involve embracing what Franco called “glittery” attributes: reminding yourself of your strengths, accepting compliments, spending time with people who see your best sides. But she calls on evidence that shows that, much of the time, positive feedback can backfire. Psychology studies have shown that participants with low self-esteem felt worse after receiving compliments or after repeating aloud “I’m a lovable person.” When people received praise for giving a speech, researchers observed actual spikes in their blood pressure. One explanation can be found in “self-verification theory”: the uncomfortable tension one feels between their own self-image (bad and stupid) and how others see them (not perfect, but perfectly valuable). “At the neural level,” Franco writes, “the brains of people who feel unworthy are sticky for criticism and slick for love.” (All of the screenshots of nice messages I’ve saved to my computer, I concede, haven’t fixed me yet.)

Worth, then, is about setting down all of the tools you have for demolishing your flaws—and instead looking at your insecurities plainly, asking where they come from. Franco believes they’re rooted in the past: Even if you had amazing parents and a great childhood, you might still have some formative memories of times when someone made you feel less than, whether intentionally or not. Psychologists use the phrase open memories for the ones you haven’t come to terms with. You push them away, or you fixate on them unhelpfully, or you burst into tears when you talk about them. They’re too painful to bear. They’re also associated, in some studies, with low self-esteem. Securely attached people, according to the classic theory, can describe their own traumas without getting overwhelmed by or denying feeling; their memories still sting, but they’re “closed.” But Franco is speaking to people who might be in such a rush to move forward that they haven’t effectively processed what they’ve gone through.

Thus, Franco walks the reader through some ways to gently fold those memories shut. One is the act of “memory reconsolidation”—which involves recalling a painful event but then changing it in some way, perhaps by imagining a different outcome or picturing what the present version of yourself would tell the version of you from that time. This is different from rumination, she says, which is when you revisit a memory obsessively but superficially. Instead, you really feel what a recollection brings up for you, and then you inject the memory with some new, more positive meaning.

Franco mentions a memory-reconsolidation study in which one participant, for instance, recalled how a partner had lied to her about committing a crime (which he was ultimately arrested for); she then pictured reassuring her younger self that she wasn’t at fault for believing him. A week after this exercise, participants rated their chosen memories as less upsetting and reported higher self-esteem overall. Other studies have shown that similar processes alter activity in the hippocampus, the hub of memory storage. “We become emotional archaeologists, digging out the grounds of our psyche,” Franco writes, “and then we build over them with a new psychological home.”

[Read: How ‘somatics’ became the solution to modern life]

There’s no way around it: That kind of excavation is painful work. Franco doesn’t believe that you can heal with a sense of urgency—what she calls “dragging the dog across the street on its hind legs”—or bypass vulnerability by using therapy terms, branding your ex as a gaslighter or your parents as narcissists and moving on.

Perhaps devoting so much attention to your own wounds sounds a little navel-gazey; I myself wondered, at times, whether Franco might be preaching self-reflection to a whole lot of people who already monitor their own happiness and growth so much that it makes them miserable. But she argues that the point is ultimately to avoid that kind of endlessly self-involved intellectualizing by having an actual emotional experience. In one study, she says in Worth, the depth of a client’s emotion—how much they expressed feelings such as sorrow and fury—was the best predictor of whether therapy would raise their self-esteem. “I don’t get to change,” she said on our call, “without going through grief.”

And even grieving won’t make you perfectly secure on the other end. The goal, instead, is “integration”: welcoming the hurt and ugly parts of yourself into your self-image along with the shiny parts, and feeling that you deserve kindness anyhow. That message might be especially crucial for the self-help heads—the ones trying so hard to fix themselves that they’re re-creating all the shame that may have made them feel unworthy in the first place.

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Less than 50 years ago, the first child conceived by in vitro fertilization was delivered in Oldham, England. Louise Brown was heralded as a medical marvel—not only for her parents, who had struggled to conceive for a decade, but also for the world. “At 11:47 pm, on July 25th 1978,” the British paper The Observer declared, “hope was born.”

Thirteen million “test-tube babies” later, Brown is still too young to qualify for social-security benefits, and IVF has gone from science fiction to a household acronym. It accounts for almost one in 36 births in the United States, according to some estimates. In the meantime, another fertility treatment has become much more common: From 2014 to 2024, the number of egg-freezing procedures per year went from 6,000 to 39,000, a sixfold increase. By most obvious standards, the assisted-reproduction industry is thriving. It has allowed countless single people, same-sex partners, and couples dealing with infertility to become parents. It also happens to be worth tens of billions of dollars.

So I was particularly struck by a couple of statistics from this year’s “Singles in America” study, an annual survey of roughly 5,000 people conducted by the Kinsey Institute, in partnership with the dating company Match: From 2017 to this year, the share of respondents who said they would be willing to consider IVF fell by more than half, from 44 to 18 percent. Openness to egg freezing dropped from 33 to 17 percent. Those are steep declines, especially in a time when more people are choosing to become single parents, celebrities have shared their own IVF or egg-freezing stories, and use among the general public keeps increasing. (Singles’ interest in adoption also plummeted, the Kinsey researchers found—but actual adoption rates, too, have declined.)

The reasons are impossible to name with certainty. But while thousands of Americans are relying on fertility treatments, it may be that millions of others simply want to believe that they’ll never have to.

That participants have cooled on alternative ways to have children could reflect that Americans have, in fact, cooled on having children in general. In the 2017 “Singles in America” poll, 80 percent of respondents younger than 40 said they felt it was important to find a partner who wanted to have kids; this year, only about 38 percent of singles ages 18 to 49 reported wanting children. Half of all participants said financial stability (or lack thereof) is a major factor in that decision. If you’re unsure about parenthood—whether you desire it or whether you can afford it—arduous and expensive fertility treatments might not seem worthwhile. In the United States, a single cycle of egg freezing typically costs about $10,000 to $20,000, including necessary medications; the average cost of IVF is commonly more than $20,000 per cycle. Both processes require the patient to inject hormones, which can cause bloating, bruising, and mood swings, and then to undergo sedation for egg retrieval. They require a life-disrupting amount of time, with no guarantee that they’ll work.

Recent revelations about the fertility industry might be discouraging even to people who do feel sure they want kids. When I spoke with Justin Garcia, the Kinsey Institute’s executive director and the author of the book The Intimate Animal, he mentioned some high-profile cases of “fertility fraud”—including a doctor in Indiana, the home state of the Kinsey Institute, who secretly used his own sperm to father more than 90 kids. “People locally are just totally, totally freaked out by the idea,” he said. And more routine risks and limitations can spook potential customers too. One buzzy 2025 UCLA study found that less than 6 percent of women who froze their eggs from 2014 to 2016 had used them five to seven years later. (“That’s not a reason to not do it,” Garcia said. “It’s an insurance policy.”)

Stark figures have also been reported for IVF and intrauterine insemination, or IUI, a similar procedure; according to a 2022 CDC report, only about 40 percent of embryo transfers result in live births for women ages 35 to 37, and the chances drop precipitously at older ages. My Instagram feed is filled with women posting about their harrowing fertility sagas: years of doctor’s appointments, needles, aches, getting excited about embryos only to grieve when yet another ceases to develop. For viewers muddling through similar experiences, I’m sure, those videos could be comforting. For people like me, imagining someday being in that position, they’re terrifying.

[Read: America’s IVF failure]

Skepticism toward fertility treatments is creeping in at a time when many Americans, on the left and the right, are already suspicious of medicine and science—and particularly wary about taking hormones. The New York Times reported last year that some of Robert F. Kennedy Jr.’s MAHA adherents in the White House are exploring ways to fund “fertility awareness” education: a strategy that involves abstinence from sex during fertile windows, rather than using hormonal methods such as the pill or an IUD, both of which they claim (without solid evidence) can harm one’s health and alter their personality. Alex Clark, who hosts the popular show Culture Apothecary (what she calls a “wellness podcast for cuteservatives”), has referred to hormonal birth control as “poison.” The 2021 documentary The Business of Birth Control, produced by Ricki Lake and Abby Epstein, “traces the feminist movement to investigate and expose the pill’s risks alongside the racist legacy of hormonal contraception,” according to its website. (Critics accused it of making dubious claims, including one talking head’s plea to “kill the pill before it kills you.” Lake and Epstein told Rolling Stone that they’re simply trying to “empower people to make informed decisions.”) In 2025, when La Trobe University public-health researchers analyzed 100 TikTok videos about contraception, they found that more than half rejected hormonal methods outright. The videos were riddled with misinformation.

Part of what makes such content alluring can be the idea of returning to what’s “natural”—and fertility treatments clash with that value in every possible way. They’re technologies that allow people to extend childbearing years, or to have biological children when they wouldn’t otherwise be able to. But perhaps just as important: They can lead to nontraditional families, which aren’t exactly romanticized by young people at the moment.

On the contrary, Gen Z survey respondents report relatively high levels of support for strict gender roles and old conventions: women staying home and caregiving, for instance, while men work. Garcia has observed this “nostalgia trap,” as he called it, among students where he teaches at Indiana University. Many of them are planning to find a straight relationship and marry young. They tell him that they want to have kids while they’re “still fertile,” he said, “the quote-unquote natural way.” He doesn’t think they realize how impossible a life course is to control. Maybe they’ll marry their college sweetheart and try for kids right after graduating, only to find that they can’t get pregnant. Or maybe they’ll find themselves single at 35, afraid they’ll miss the chance to become a parent. IVF and egg freezing might seem worth considering after all.

[Read: America’s biggest dating company is betting on trad values]

I wondered whether this attitude shift might foreshadow a dramatic drop in assisted-reproduction rates—but Garcia said that would surprise him. Prominent Republican leaders have criticized both IVF and egg freezing, and IVF in particular has been targeted by anti-abortion activists who oppose the discarding of embryos (which they argue are living beings). And yet, most Americans seem to support those procedures in theory. In a 2024 Pew Research Center poll, only 8 percent of participants said they were against IVF. The popular sentiment is less wrong for you and more not right for me. But ultimately, “you don’t know until you know,” Garcia said. “Until you’re in a situation where you’re in a doctor’s office and saying, We’ve been trying for a year. And what’s the next step?”

Perhaps the “Singles in America” result never showed a true rejection of any treatment or type of family. More than anything, it might just reveal a failure of imagination.

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