Can you be your own therapist?
I've been thinking a lot about mental health lately. Here are some of the findings from my research so far:
More than half of U.S. adults with a mental illness do not receive treatment.
Medication and psychotherapy are the most common treatments for mental illness.
There are reasons to prefer psychotherapy over medication.
Demand for therapy has been increasing recently.
Basically, therapy is an effective treatment for mental illness, but not everybody has access to therapy (it's expensive and hard to find, among other reasons).
In order to make sure that everyone with a mental illness who wants to get effective treatment is able to, how can we expand access to therapy?
In a previous post, we proposed solutions to the barriers that are preventing people from accessing traditional in-office therapy.
In this post, we'll explore how individuals can be their own therapists. This would solve for therapy being expensive and hard to find. And it substitutes personal empowerment in place of reliance on corporations and the healthcare system.
What does a professional therapist do for you?
Based on research and my own experience with therapy, this is mainly what a professional therapist will do for you:
Listen
Remember, remind, repeat
Analyze
Teach
Of course, therapy is a large, complex, and continually developing field of healthcare and it would be an oversimplification to say that the offerings of all forms of therapy and all therapists are confined to those four bullet points above.
Here is a longer list of the services provided by therapists.
However, those four bullet points do seem to account for the main offerings of the majority of therapists and it would be difficult to consider every facet of every therapist's practice, so we will use those four to compare self-guided therapy to therapy with a professional therapist.
Can you provide these services for yourself?
Do the services included in therapy necessarily have to be provided by someone else? Or, is it possible to do these things for yourself, effectively becoming your own therapist?
Let's review each of the four main services offered by professional therapists to determine whether an individual can administer each service to themselves.
Can you listen to yourself?
Yes, there are many ways to do this:
You can "listen" to the voice inside your head (internal dialogue).
You can observe your thoughts in meditation.
You can write down your thoughts and read them.
You can speak aloud and listen to yourself in real time.
You can speak to a recorder and play back the recording.
You can speak to a transcriber and read what you said.
From a purely mechanical perspective, yes, it is possible to listen to yourself. However, one of the often-mentioned benefits of therapy is "feeling heard."
There's the problem-solution aspect of identifying the mental health issue, getting to the root of it, and then implementing a solution. But then there's also just this universal human need to feel heard. The methods of listening to yourself seem like they could be effective for the problem-solution aspect, but will you feel heard if you're the one listening to yourself?
Some interesting questions that we won't be able to answer fully here, lest we digress: How many people seek therapy because they want a solution to their mental health issue? And how many people seek therapy because they just want to feel heard? Also, how do these two relate? In some cases, does feeling heard solve the mental health issue?
If just feeling heard without any other solution is an effective solution for some mental health issues, what solutions other than therapy can help people to feel heard? Why do we not feel heard in our daily lives? Is it because nobody wants to listen to us? And if so, why is that? Is it because we have poor social skills? Because we have nothing interesting to say? Because society has gotten to a point where we just don't listen to each other anymore? Was there a time when we listened to each other more than we do now?
Here are some things to try if you want to feel heard:
Share your personal writing publicly
Express yourself through art
Go to Authentic Relating events
Ask a friend to listen to you
In terms of feeling heard when you're listening to yourself, one form of therapy called Internal Family Systems suggests that each person has sub-personalities called "parts" as well as a core Self. We won't go into any more detail on IFS, but it's possible that one might feel more heard when their compassionate and curious Self is listening to any of their parts.
It's an open question whether you can feel heard by listening to yourself in the same way that you feel heard when someone else is listening to you, but it does seem that you can at least listen to yourself from the purely mechanical perspective in order to progress with being your own therapist for the problem-solution aspect of therapy.
Can you remember and remind yourself of what you said before?
Of the ways to listen to yourself, some of them are more conducive to being able to remember what you said.
If you're just listening to your internal dialogue or observing your thoughts in meditation, it might be difficult to remember what you said.
When you're meditating, it's counter to the point of the practice if you're trying to remember what you're thinking. The whole point of meditation is to observe your thoughts without engaging them, letting them float through your mind like clouds through the sky.
And when listening to your internal dialogue, it's difficult to continue with your internal dialogue if you're trying to remember what you said before. Especially if you're trying to achieve a therapeutic effect, it's best if you can get into an uninhibited stream of consciousness, just letting your thoughts flow. The stream is inhibited if you're too conscious of what you're saying as you're trying to remember.
Speaking aloud and listening to yourself in real time is also not the best way to be able to remember what you said because you aren't writing or recording your thoughts.
The other ways of listening to yourself are better for remembering because there's an element of writing, recording, or otherwise capturing your thoughts in a form that you can access later.
For me, speaking to a transcriber is the best. I use a software called Otter that both records and transcribes audio. They have an app for your phone and you can use the microphone on your phone to record. Amelia Broughton, a connection coach who I really admire, does this too.
When I'm recording myself with Otter, I can more easily get into an uninhibited stream of consciousness. I turn on the recording, close my eyes, and start to talk. I'm not trying to remember what I said. I'm not looking at the words that are automatically typing on the screen. I'm just continuing to talk in a free-flowing and natural way, actively thinking and feeling whatever comes up for me and trying to get deeper to the root of the experience.
After I'm done talking, I stop the recording and then I'll often go and do something else. I prefer to give myself some space and time so that I can transition from the role of the speaker to the role of the listener. Later, I'll come back to the transcription and read it. Sometimes I'll listen to the recording, but more often I'll just read the transcription because I tend to process words better than I process audio. This is when I start to analyze what I've said.
Can you analyze what you said?
This may be the point where an individual is not well-equipped to administer therapy to themselves.
There are ways to listen to yourself and to remember what you said, but when it comes to analyzing what you said, there are a few reasons why you might not be the best person to do the analysis, especially if the goal is to achieve a therapeutic effect:
It's hard to be objective.
If you're the one creating the problem, how can you have the solution?
It's exhausting.
Professional therapists have more education, experience, and skill.
According to the APA, a therapist is "objective, neutral, and nonjudgmental." If you're the subject of the therapy, it's difficult to be objective and neutral as you're also playing the role of therapist for yourself. You already have preconceived ideas about who you are and why you do the things that you do, so your analysis may tend to default to your existing thought patterns and old feelings.
"We can't solve problems by using the same kind of thinking we used when we created them."
— Albert Einstein
It already requires a lot of focus and energy to be vulnerable and talk about your traumas and insecurities. If you're responsible for the analysis as well, that can feel like a lot of work on your shoulders.
Humans are not all that different from each other. Although the specific circumstances of our individual lives are different, there are general issues that are common, e.g., drug and alcohol addiction, loss of a loved one, financial hardship, self-esteem issues, childhood trauma, divorce and breakups.
Not only do professional therapists go to school to learn researched methods for analyzing these common issues, they also have experience from treating hundreds of patients. Therapists are like experienced chess players. They have seen many different possible configurations of the game with pieces in various spots on the boards, so they are more prepared to make the right moves.
The combination of education and experience gives professional therapists skills for analyzing mental health issues, skills that the average person doesn't have.
Can you teach yourself to resolve your issues?
This is another aspect of therapy that may need to be administered by a professional, rather than an individual trying to teach themselves to resolve their own issues.
It's one thing to perform the analysis, and then it's a couple of steps further to make the right recommendation and teach someone how to implement the recommendation.
Again, professional therapists have more education, experience, and skill. There are hundreds of solutions for mental health issues and there are studies on their relative effectiveness. Therapists are aware of all these different solutions and the latest studies. They've also developed skills from experience to present the solutions to their clients in a way that makes the client more likely to implement the solution successfully for themselves.
Conclusion
Of the four main services provided in therapy listed above, there are methods for an individual to listen to themselves and to remember what they said.
However, it may be difficult for an individual to analyze what they've said and to teach themselves to resolve their own issues, at least to the extent that they would achieve similar effectiveness as professional psychotherapy in treating their mental health issues.
Resources
There are some existing solutions that can offer assistance to anyone who wants to try self-guided therapy:
A list of self-help books recommended by the Association for Behavioral and Cognitive Therapies
A workbook written by Seth J. Gillihan
Various resources from the UK National Health Service
Startups are building apps, websites, and AI chatbots
And research that proves the effectiveness of self-guided therapy:
For anxiety
For depression
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