Self-help is effective

I have a guilty confession to make. For many years I made most of my living as a psychotherapist. (That’s not the guilty confession yet.)

But having been trained in a number of therapy styles, and in particular having for a long time been immersed in the world of classical psychoanalysis (I read all 20-something volumes of Freud’s writings, for instance, as well as attending three different psychoanalytic training institutes for a spell), I came to believe deeply that “real” mental health treatment nearly always required extensive immersion in therapy or analysis. In fact, there was and still is a belief in the psychoanalytic field (a fading specialty, nowadays) that for every patient, the “gold standard” for treatment was psychoanalysis — several years (or more — I logged about thirteen!) lying on an analyst’s couch for four days every week, going through an extensive review of your every thought, your childhood, your fantasies and desires and dreams, your “transference” relationship to your analyst, and so on.

Back in those years, one of the things that I’d sometimes be very defensive about (you would think that after all those years of analysis, defensiveness would have been pretty much beat out of me!) was the notion that people can get very, very effective results from a quicker form of psychotherapy, such as cognitive therapy. In fact, the idea that someone could get “cured” after just one session with a therapist, or perhaps by working on their own with some self-help ideas from a book or that they thunk up themselves, was something I’d probably dismissed as naive.

Fortunately, a few things helped me grow beyond this set of beliefs. And the biggest one was the early training I’d had  to respect the findings of psychological research. Sometimes, it’s important to let the “nasty facts” spoil our unexamined (or more important, our examined) beliefs. And there were a few “nasty facts” that had nagged at me.

First was the finding in some surveys that showed that many people who went in to see a therapist would come for just one visit. This bothers traditional therapists a great deal, as they are generally taught that the first session or even the first few sessions are mainly “intake” appointments, when they should be getting some background and trying to develop a “treatment plan” for the client. So of course they feel frustrated and confused and even personally hurt if the patient comes in for that session and then vanishes.  But when people who did this were followed up by researchers, it was found that the clients often felt that it had been a great session, and that they even felt “cured” by it! Very often, they weren’t coming back because that one session did the trick!

I had an experience like that in talking to a client: one time I met with a client for some reason who happened to remember that he’d seen me for a single visit some years before. He told me that our single visit proved very important to him in helping him to get better. I had no idea why, and he told me that a single thing I said, seemed to make a huge difference. (It was something along the lines of hearing his many problems at the time — how his life was in fact pretty much collapsed in many ways — and then saying  “Wow, the only good thing might be that it can’t possibly get any worse, so maybe things will start getting better for you.” He said that made a lot of sense and he managed to feel more optimistic after that, as he started to realize that yes, things should start to gradually get better!)

The second thing I realized from research was the fast treatment approaches often did help people, a lot. The research on this is pretty huge, actually.

It also turns out that self-help books can be very effective (some more than others). A number of studies have shown that the “effect size” (it’s a statistical term, but basically it means “how much impact does a treatment have compared to other treatments?”) for self-help books is, at least in some cases, nearly as good as the effect size for traditional psychotherapy.

Of course, your mileage may vary, as they say. Certainly, some folks need more one-to-one help with an actual person, while others may prefer learning toe skills to “DIY” (do it yourself). But many people get a lot out of particularly well-designed self-help approaches.

(Note: This is an excerpt from my forthcoming book on the self-treatment of depression)

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