Do we really need therapy?

‘Researchers say you might as well be your own therapist,” the website Quartz proclaimed recently, in light of a new study that found a vanishingly small difference between seeing a cognitive behavioural therapist and just doing various self-help exercises on your own. Naturally, this sort of thing is liable to make therapists angry. (The correct response is to nod compassionately and ask: “Now, why do you think that makes you so angry?”) As Mark Brown noted in this paper, we should be wary of any finding that seems to suggest governments could save money by telling people to sort themselves out. But the self-help route has another limitation worth bearing in mind: what makes you so confident you even know what your problems really are?

Typically, self-help works like this: you’re troubled by some issue – procrastination, commitment-phobia, depression – so you seek a book to fix it, just as you’d seek a spanner or screwdriver if the legs on your kitchen table started wobbling. But minds aren’t like wobbly tables. There’s no reason to assume – actually, there’s much reason to doubt – that we’re in touch with our deepest anxieties and hang-ups. Rather than productivity techniques, maybe you need to face the fact that your job provides no meaning. Maybe accusing yourself of “commitment-phobia” is how you rationalise the subconscious awareness that your partner doesn’t love you. Maybe your depression is best understood not as the result of “automatic thoughts”, but as a sign that you’re living life to serve your parents’ agenda, instead of your own.

Or maybe not: probably, some problems are exactly what they seem. But the question is so personal that the best book in the world can’t help but miss the mark, whereas another human at least stands a chance of hitting it. And if CBT is truly no better than self-help, maybe the right conclusion isn’t that therapists don’t matter, but that CBT isn’t necessarily the apogee of therapy?

Crucially, the point isn’t that therapists are wiser, thus better placed to tell you what your problems are. Rather, a good therapist will throw up roadblocks to your attempts to swiftly define the problem before hurrying on to fix it. This is the kernel of good sense in the cliche of the Freudian shrink who does nothing but rephrase his patient’s comments as questions: he’s refusing them the comfortable option of a one-size-fits-all solution, stubbornly forcing them toward self-understanding. Therapy isn’t the only way to do this: journaling, meditation, even some books are among the others. What they all share is that they throw you back on yourself, blocking the easy but inauthentic alternative of using someone else’s secondhand answer. As Albert Einstein is often quoted as saying, though he didn’t really say it: “If I had only one hour to save the world, I would spend 55 minutes defining the problem.”

Plus, when it comes to psychology, there’s a bonus: half the time, a problem truly understood stops being a problem at all.

oliver.burkeman@theguardian.com