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Therapy without the therapist: what role should self-help play?

Rachel Temple

The Top 10 questions generated by the Right People, Right Questions project are a to-do list for researchers working on treatments and services for young people’s mental health. They are the most important, unanswered questions identified by children and young people, parents, teachers, mental health and social work professionals, and researchers. In other words, they are the questions that matter most to those most affected by a lack of treatment solutions and poor service delivery.

This blog post is part of a series responding to the questions. It focuses on Question 9: 

“What are the most effective self-help and self-management resources, approaches or techniques available for children and young people with mental health issues?”

 

Imagine having a broken leg. Imagine being expected to fix your broken leg because the hospital doesn’t have the time or space to treat you. No medical attention for at least six months. And that’s if you’re lucky! You’d be left with a high chance of getting a serious infection and most likely a permanently deformed leg.

If this began happening, there would be national outrage. And rightly so, being expected to just “get on with it” in any medical emergency is unacceptable… isn’t it? And yet, young people with mental health problems are told this every single day. In the last year, at least 21 per cent – or 55,800 young people – of those referred to CAMHS (Children and Adolescent Health Services) were turned away.

This isn’t good enough but it is the reality. So where do we go from here?

In the Right People, Right Questions workshop, where the 25 questions rated most important by the public were prioritised by young people and those that support them, the squeeze on mental health services was at the forefront of everyone’s minds. The room was divided about what, if any, role self-help and self-management techniques should play to ease the strain. Some people argued that putting too much emphasis on these approaches reduces the responsibility on services to support children and young people, unfairly shifting that burden onto the young people themselves.

I understand the controversy. But I’ve learned that recovery comes from the individual. You really do have to want to help yourself in order to get better. You have to take responsibility. So then the question becomes: When things are tough and we feel like we’re on fire, how do we help ourselves?

A few self-management activities come to mind – mindfulness and meditation is the obvious one, but there is also diet and exercise. I’ve blogged about exercise before and how we shouldn’t underestimate its impact on our mental health. This self-management technique has certainly been one of the most effective for me. In terms of diet, what we feed ourselves is what we feed our brains. Some research findings suggest that a diet high in particular vitamins and minerals can enable our brains to function better and as a result, improve wellbeing.

But these approaches can only do so much. For most people, the real “ground-breaking” stuff is achieved during therapy. The trouble is that mental health services that provide the therapy are in crisis themselves. They simply aren’t meeting the demand. It feels like a sinking ship: no matter how much government money is put into the pot, it seems like services won’t catch up with the number of young people that desperately require support.

Stretched to the limit

A recent BBC Panorama highlighted that CAMHS are so stretched that young people are unlikely to be seen by them at all – unless one expresses suicidal tendencies. Allowing things to get this bad can result in lengthy inpatient stays, which due to high demand, can sometimes mean young people are placed in a hospital miles from their homes. Even then there is no guarantee of therapy: I have witnessed children being told that they are “too unsettled” to receive any therapy at all during these stays.

We need alternatives to this broken system.

Self-management won’t work for everyone but it might help some people who have not yet reached crisis point and who are receptive to it. In my view, one overlooked tool is self-help books. The name itself is pretty off-putting and I can understand that not everyone wants to browse the self-help section of the library. Personally, I’ve gained most of my tools from books. There are some books that talk about the author’s experiences of a mental health condition, while others specialise in therapy itself. Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy… it’s essentially therapy without the therapist. The idea is that you teach yourself the therapeutic tools and then apply them to everyday situations. You become your own therapist.

In my view, turning to self-help books has got to be better than being placed on a waiting list for… however long. When left to themselves, problems only become worse and more complicated. When I had a particularly rough period of social anxiety and obsessive compulsive disorder (OCD), I was told that my therapy sessions could only address one of the two. I’d already waited two years for social anxiety treatment but OCD had decided to make a reappearance during that time. They were both at their peak. How could I possibly choose between them? I’m not going to lie… I was a bit of a mess.

Luckily for me, I had an exceptionally good therapist. She recommended a CBT-based book for OCD while she supported me with the social anxiety. Better that, than to just ignore the OCD side of things. It’s difficult to compare two conditions which manifest so differently but I can honestly say that the tools I’ve acquired for OCD have been life-changing. And all from a book. Yet, I can’t say the same for social anxiety because it still interferes with my life a lot. This may be because I waited so long to be treated for the latter, but dealt immediately with the former. Self-help is readily available. Mental health services often aren’t.

I’m not saying that self-help books will be beneficial for everyone. However, they are a practical means of managing some mental health problems. Certainly for OCD, books can quickly teach you about the dangers of compulsions and working yourself up into a vicious web of worry. They can teach you about the importance of accepting your anxious feelings for what they are: just feelings. Not a sign of genuine danger.

Future research could compare the outcomes of immediate self-help therapy to that of therapy with a therapist but after enduring a long wait. Books could be tailored so that they are child-friendly. I hope that this particular question gets addressed quickly. It is beyond clear that we are stuck for options right now. And yes, I do think that asking people to help themselves (especially if they’re in a particularly bad place) is controversial. It is dismissive. That said, I do believe that self-help in some form should be part of the process for some people. And since the Top 10 questions were generated from an initial list submitted by the public, this question’s inclusion suggests that a lot of other people think so too.

For more information about Right People, Right Questions, including how we generated the Top 10, visit mcpin.org/RPRQ and click on the reports.