29 Sep How to psychotherapize yourself

Researchers published a study in 2016 that made the rounds of the blogosphere recently, with one writer describing the conclusion as: “Researchers say you might as well be your own therapist”. It should not come as a surprise that such a sensational description is not an accurate summary of the study. Also not reassuring: when writers rely entirely on the abstract for their analysis.

Whenever reading any scientific research we should be cautious about what conclusions we draw and aware of its limitations. Therefore we should also be skeptical of any science writer who makes strong claims from single studies in isolation. Whenever you can, compare science writing to the source material because researchers are typically cautious in their own conclusions, whereas science writers tend to be less circumspect because “Scientists learn a bit more about a thing” is a less captivating title than “Scientists discover everything you thought you knew is now definitely wrong”.

Psychotherapy, in its modern talk therapy form, can be considered to have started in the 19th century, though some form of treatment for people with arguable mental illness can be found throughout history. Research has demonstrated the effectiveness of psychotherapy to treat many mental health conditions, to varying degrees of success, but the mechanisms and by which psychotherapy accomplishes this are still under investigation.

This study furthers that goal by investigating the relationship between the psychotherapist, the client, and outcomes when treating depression, anxiety, panic attacks, phobias, OCD, and PTSD using Cognitive Behavioural Therapy (CBT). The results are that CBT is effective at treating those conditions and the results are comparable when the techniques are performed by a therapist on a client or a client on him- or herself (though, notably, the benefit is greater when delivered by a therapist).

There are important caveats to consider. 1. The specific therapy used in this study was CBT. There are other forms and techniques that may be more or less effective for a particular issue. 2. CBT is a “manualized” form of therapy, which means that there is a manual with very specific steps to follow to use it. The benefit of manualization is that it is relatively straightforward to learn (by therapists, clients, even AI) and research because one just follows the step. One drawback to manualization is less flexibility for an individual’s particular situation. Other therapies are less manualized and depend on an individual therapist’s skill and the rapport between client and therapist. 3. Participants selected for such studies generally only have one mental health diagnosis and participants with multiple diagnoses are excluded. Researchers look for the independent variable (such as CBT treatment) to have an effect on a dependent variable (such as mental health diagnosis), and multiple diagnoses muddy that relationship. Outside of research settings, multiple diagnoses are common—PTSD may also lead to depression, or someone with a spider phobia may also have generalized anxiety—so therapists must be able to provide treatments that contend with all the presenting problems.

The upshot is that this study illustrates that you can do CBT on yourself if: 1. You understand the cause of your concerns; 2. the cause is something that responds to CBT; and 3. you have a CBT manual you can use to teach yourself.

I am very supportive of people using using CBT or other psychological techniques on themselves. Just like if you learn enough mechanics to perform maintenance on your car but you take it into a mechanic for an engine rebuild, I encourage people to use psychological techniques when they can solve their own problems and come to me for problems that require a specialized expertise in psychology.

Treating diagnoses responsive to CBT are not the only reasons people seek counseling; some are unsatisfied with their lives but not aware of what the specific problem is; others are aware of the issue but seek to learn the skills to address; and yet others do not have a problem to fix but strive to perform at a higher level. My approach to psychotherapy is less about “doing therapy” on my clients, and more about helping them gain self-insight, learn skills to solve problems and improve their functioning.