Be your own therapist? Fine – if you’re up to the job

Feeling that you are not coping is horrible, like trying to untangle shackles around you that instead pull tighter with every movement. We are supposed to be able to look after ourselves. Our culture lionises fighters; decision takers; people who know their own mind. We are comfortable in the hands of specialists such as hairdressers or driving instructors, yet many of us find the idea of using a therapist, a specialist in distress, to be strange and uncomfortable – an admission that we can’t sort out our own problems. People experiencing mental distress are often desperate for some kind of talking therapy, yet we still maintain a deep cultural ambivalence toward the concept.

 

This ambivalence is often reflected in research. Does therapy work? Do other cheaper things work better? The website Quartz recently published an article headlined “Researchers say you might as well be your own therapist”, summarising a paper that contrasts self-help therapy with therapist-delivered therapy. The paper, a meta-analysis of 15 studies, contrasted cognitive behavioural therapy (CBT) delivered by a therapist with CBT delivered through self-help activities, such as activities and exercises. CBT is defined by NHS Choices as “a talking therapy that can help you manage your problems by changing the way you think and behave”. It is provided as part of England’s Improving Access to Psychological Therapies programme, which began in 2007 and was recently written up with besotted love by the New York Times. The authors of the paper “found no difference in treatment completion rate and broad equivalence of treatment outcomes for participants treated through self-help and participants treated through a therapist”.

So, is it time to say goodbye to sitting in a consulting room feeling uncomfortable with a box of tissues on the table? Not quite. The paper found variability for both CBT approaches provided by therapists and self-help, suggesting that what someone brings to the therapy is very important to the end result. If it’s not right for you, it’s not right. Therapy isn’t a magic bullet.

The study found greater variability of outcome when people were using self-help interventions. The authors suggest this is “most likely … because therapists are able to ameliorate negative therapeutic reactions through use of the therapeutic relationship, and perhaps adaptation of the intervention, to better address the needs of the client”. They go on to say: “Self-help has more limited interactivity and typically has weak capacity to detect negative therapeutic reactions, let alone respond to them effectively.”

Self-help can be brilliant, but only if you are at least part of the way to being sorted. You can learn, but learning isn’t doing. In reality, self-help is more like the seven habits of highly effective people. The advice to rise early and never quit is great advice for people who like getting up at the crack of dawn and who already have a remarkable levels of tenacity. The gap between where you are and where you might be is often a chasm across which self-help may help you to construct a bridge, if your inner Isambard Kingdom Brunel hasn’t abdicated his post to sit numbly eating dry cereal while staring at rain on a window pane.

For many years, learning stuff from a book is the way that we have culturally sorted out our problems. Self-help is a massive industry covering everything from magic crystals to apps to psychologically approved therapeutic programmes. Our current government is very keen on self-help therapies rather than therapeutic relationships.

Therapists have the benefit of being able to respond to people. You can change; the self-help text or workbook doesn’t. And if the self-help therapy doesn’t work the way it’s supposed to, well, maybe you just didn’t try hard enough.

There is space for better self-help, and better support for those engaging in it, but we must always be wary of this debate being represented as an either/or proposition. Everyone tries self-help before they admit the things that trouble them are beyond their resources to resolve. By all means be your own therapist, until you can’t be any more and need someone else. We must be careful as a country that self-help is never the only help on offer.