To both points, you can say the same about chiropractors, LPNs, some coaches, personal trainers, etc etc. Anyone who
Stands to profit from you using their services.
In my world, I've found telling a mom her kid doesn't need his grill fixed goes a long way. I may not make anything from treating that kid, but you can bet she sends every one of her friends to see me.
Good therapists, in my experience, take the same approach. If there's something that can be helped, they'll tell you. And then they'll leave it up to you to decide if it's something you want to work on. And if there's really not something, they'll also tell you. They are busy enough that they don't need to drum up the extra business.