I think there are a lot of emotional and environmental factors that would contribute to whether someone would see a therapist or can work it out on their own.
For me personally, I was a born-in, elders kid. I could recite the dogma mostly and defend it if needed, but I never "took it to heart". As I woke, I didn't have the emotions or withdrawal that many do experience; I just started living for me instead of the organization. My best friend who faded had a much harder time and did talk to a counselor; there was a stronger emotional attachment to the org than I ever had. Technically, I'm still PIMO for family (SO is not one though) until I can fade out. I consider myself a diest at this point.
The hardest part for me was not feeling guilt during holidays/birthdays. It's not the guilt associated with the celebration, but that being PIMO means I have to be careful, so I would avoid certain things with my kids that were more public or always scanning a store before buying supplies/decor. I think that will fade with time, so no therapist needed.