You Can Self-Administer Therapy

protocols like CBT are not that complicated

At times perusing through nooks-within-crannies of the web designated for complaining and validation, I might encounter a grievance. Someone will avow they have mental health concerns, express interest in pursuing therapy after some back-and-forth with other users exchanging experiences, but explain that pursuing this may not be possible. Either they can’t afford it, or it’s too inaccessible and inconvenient, or the hoop-jumping is cumbersome or infeasible. Or, they’re skeptical of efficacy and can’t be arsed.

If you are a self-motivated individual, there’s an other option: do it yourself.

ABCs of CBT

At their core, popular therapy approaches are simple. That may be why this treatment has been “app-ified” and shoved into online platform solutions behind dark-patterns and paywalls, for some time. The astute may infer how CBT, for example, is applied just by reading about what it is. Of course, the work is not complete as easily as reading a few words off a page. The mind needs time to adapt and transform, just as it does for learning any new skill, through repetition. Doing-the-work is where you may find that an in-person therapist, or an app, may not be redundant. Both can provide reinforcement, a therapist more deftly so with guidance, and with the benefit of talking-it-out. As I will lay out, self-directed learning the low-tech way may work for you and perhaps even be more to your liking.

There are a myriad of therapy approaches, but for simplicity I will merely highlight CBT (Cognitive Behavioral Therapy) and MCT (Metacognitive Therapy). The latter is considered part of third-wave CBT. Up front, there is some ideological squabbling between proponents, particularly from the third-wave, but ultimately these approaches are not mutually exclusive. I would argue they are complimentary.

I would frame the approaches thusly: CBT is about recognizing and correcting distorted negative thinking, while MCT is about letting intrusive (unwanted) thoughts pass-by without judgement, and redirecting one’s focus elsewhere. That is, as I understand it, the heart of it. Simple, right? If I were to to employ these in parallel, in defiance of the purists, my approach would be to exercise CBT until such a point that recognition of distortion is internalized, then pivot to MCT.

Crack open the books

A therapist gives you homework. Usually, at any rate. If you’re going solo, you’ll want to grab some. More, you ought to find practical streamlined guides for therapy (I mean, more detailed than *this* one), and explanations of how it all works.

Enter therapist handbooks and workbooks (also called worksheets). These are not particularly thick tomes. They can vary between booklet and textbook in size. In the main, the material is easily digestible. Best of all, you can usually find some at the public library, or else, there are some PDFs floating online from reputable sources (and less reputable I would bet).

I have no strong recommendation here for a particular source, as in my experience they are more alike than different. What may help refine your search is that some are books geared towards specific disorders, such as anxiety or insomnia. I had picked up Edinger and Carney’s Overcoming Insomnia from the local library, which is a short read. I can currently spot, buried in a stack of books in my office, The Cognitive Behavioral Workbook for Anxiety by Knaus. The core principles don’t change (CBT-i has some extra approaches specifically to deal with insomnia such as Sleep Restriction Therapy, but the CBT component itself is just CBT).

The exercises for their part offer common examples that you may see reflected in your own thinking. It is one thing to concede that distorted perspective can be a problem, and another to recognize exactly what that is in yourself.

We are creatures of habit. It’s not sufficient to tell yourself once that you are catastrophizing, or believe things about yourself that are ungrounded and may cause harm. It’s not enough to tell yourself once to let things go. You have to practice. Effectively, you will supplant a bad habit with a good one.

Efficacy

I did not scour the web for much data, but some research suggests that self-directed CBT may be effective through the use of technologies. I can’t imagine that an approach leveraging books rather than apps would be much different.

One objection might be “wouldn’t this approach be more time-consuming?” No, I put it to you that it is more efficient. Seeing a therapist is a commitment spread out typically over many weeks. In these typically hour-long sessions you have ample opportunity to vent, but receive piecemeal relevant information each time, in whichever way that particular therapist decides. It’s such that acquiring a firm grasp of principles for applying any specific form of therapy may take a rather long time, if it happens at all. Conversely, by absorbing therapist handbooks directly, you cut out the middle-man and focus on the task. There is more up-front time investment, with ultimately less time wasted.

Final words

I want to be clear, I am not arguing that therapy is a silver-bullet that will solve all your problems. I do believe that it can help bolster mental foundation in non-trivial fashion, and should be considered to that end. My own approach for dealing chronic malignant issues like insomnia has been to throw the kitchen sink at it — in good faith. Transformation takes time. This is not a eureka-mind-virus that cures you upon exposure.

Whether self-directed learning is right for you depends on whether you can be honest with yourself and do the work without external feedback. If that does not suit you, that’s ok. Through my own anecdotal experience, I believe many readers are capable. I am not endowed with any extraordinary capability (including ambition and drive), yet succeeded, by my own measure anyway.

I encourage you to explore what your local library has on offer. You can walk out with a giant stack of books at no cost. That can help you grok what you need to in a short period.

Thanks for reading, be well.