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Comment by charleyramm | Hacker News Reader

Do you think it was necessary to go through this process with a therapist, or could a less expensive alternative have had the same effect?

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A therapist can be a useful tool. I spent a total of about 3.5 years of my life in therapy.

I also briefly was in couple's counseling and my husband was seeing a therapist as well during that time. He was extremely introverted and he truly hated discussing private matters with a therapist.

One day I told him "I don't care if you see a therapist. I just want our marriage to get better. Therapy is just a means to an end. That's it."

He happily quit therapy and couple's counseling promptly. He also promptly was a better husband to me and never fell down on the implied promise that he would rise to the occasion somehow.

I continued with therapy because I had a lot to sort out and I saw it as a useful tool.

In the long run, learning how to live well was the best therapy for me, so to speak. But I didn't personally know how to get there without first talking to someone about bad things that had happened to me and how they shaped me. My husband didn't want to go through that step and he was somehow able to just behave different towards me once I made it clear "I just want a better marriage. That's it. I don't actually care if you go to therapy."

I think a therapist is necessary, at least to bootstrap the process. You can listen to podcasts and read books by therapists. You can think and try to reason about it yourself. You can expose yourself to the ideas. You can learn about cognitive behavioral therapy and try out worksheets etc... But that takes time and you may not cover everything or know what will be effective for you. A therapist can keep you accountable but mostly it takes a long time. Plus it's hard to do that when you are depressed. Even with a therapist you will be reading a lot on your own anyway.

This. It's similar to a personal trainer. People don't hire personal trainers because they can't figure out how to exercise, they hire personal trainers so they have someone guiding them, supporting them, keeping them on track.

In my personal battle with depression, a big part of it has been self-distrust. So I could reason about it all day but I struggled to make any actual changes because I was always questioning. Having someone there actively giving me permission to reshape my thought patterns and giving me confidence that I'm on the right track has been absolutely essential.

Totally agreed. When I pay a therapist, it's not really for facts, which I can get from books. It's for their long experience with a lot of different people. That gives them the ability to immediately spot patterns in my life that might take me years to recognize. And also the skill to point out my self-fooling BS in a way that I can listen to and understand the point.

The evidence is fairly clear - reading self-help books or using an internet-based CBT programme is similarly effective to in-person psychotherapy. That doesn't mean that these approaches will be effective for you, but they're viable treatment options that are vastly more accessible. I'd still suggest trying in-person therapy if it's available to you, but don't be disheartened if that isn't an option - there's no evidence to suggest that self-help is significantly inferior to therapy.

https://doi.org/10.1016/j.janxdis.2018.01.001

https://doi.org/10.1016/j.cpr.2017.09.006

> reading self-help books…is similarly effective to in-person psychotherapy

That was not the outcome of the CPR paper, and even the authors' statement in the abstract is considerably more hedged than you imply here.

iCBT and bibliotherapy have both demonstrated the greatest efficact in subclinical or extremely high functioning populations; their utility in more severe cases or those where there are comorbid psychiatric or bio-social issues is less clear.

I absolutely believe in using telehealth to broaden access to behavioural health services and think they're an excellent first line treatment, but stating there's nothing to suggest that they're a fungible good with equivalent value to human-delivered psychotherapy risks dissuading people who're already struggling and fail to improve with self-guided resources from seeking out more comprehensive services.

As with many things, a therapist offers one to exchange money for time spent figuring out things on your own

I've found success without therapy through minimal exercise over no exercise & framing things as neutral

Framing things as neutral: I'm Canadian, so during Winter I've made a point to perceive the statement "I'm cold" as a neutral statement. A sensory experience as opposed to an affliction of pain. Also focussed on relaxing my muscles in the cold, which made it less uncomfortable. Shivering & clenching up are unnecessary until the temperature has dropped to a point that you really are in pain & should either get inside or get better atire

I started taking cold showers in the morning about two months ago to practice this exact thing.

After about a week, you sort of learn to neutralize the feeling of being cold as just that, a feeling. And a temporary one.

It’s a good reminder for other “negative” feelings, and something I can point my brain to with other emotions I don’t like, anger, anxiety, etc. They all pass fairly quick the less I dwell on them.

This is an approach that worked for you. You have employed your own CBT technique it sounds like, and that's great! Bit I think it's unfair to imply that you can just work harder and come to the same conclusions without a professional. A physiotherapist is often highly educated in psychology and has had, usually, years of experience dealing with a range of people, issues and scenarios. Some people, due to what ever is going on in their head (myself included) can't see the wood for the tree's and a therapists job is to help bring that clarity. Mental health is complex and unique to the individual, there isn't a thing that works for everyone, even therapy.

For sure. When I say "time is money" that might involve more time than you'll ever have available. & a friend once reflected on seeing a therapist: "It's not the job of my friends to be my therapist" ie there's value in bouncing ideas off someone who you don't have to worry about stressing a casual friendship over

No, a (good) therapist helps you find things that would be difficult or impossible to find on your own, it's literally an outside perspective. If what you did works for you, you either didn't have any serious mental health issues to begin with, or you figured out a hack to avoid thinking about the things which trouble you, which isn't much different from people avoiding problems by losing themselves in work, alcohol, religion, whatever. It's essential to have techniques to help yourself stay on an even keel, but it's damaging to other people who actually have problems to encourage them to dismiss their problems as insufficient detachment.

I think you've misunderstood me; I'm not suggesting people avoid therapists. I agree with what you're saying

Part of many personal issues is that you "cheat yourself", or simply avoid tough topics (psychoanalysts call that resistance). A good therapist uncovers these topics, helps you to face them, and supports you in finding ways to deal with them. It is hard for me to imagine how one could do that without a human counterpart.

To piggy-back on the personal trainer analogies earlier, alternatives like CBT tools, podcasts, books, etc. are good augmentations once you’ve learned “good form” on how to work with your depression through a therapist.

The alternatives aren’t going to really push you to unpack thoughts that might be holding you back or know to switch things up if your situation becomes very dire.

I’ve heard plenty of writers describe their writing as therapy. “Free-writes” where I write exactly what I’m thinking with no filter have helped me. At some point I just get tired of retelling whatever story is affecting me and move on. Work outs have helped before (mostly cardio), etc.

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