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On the whole, we Britons are not disposed to the idea of “therapy” – it still feels American and somewhat self-indulgent. And yet, an increasing number of us find ourselves in need of emotional direction as we battle the challenges of work, redundancy, relationship breakdown, bereavement, or just the unpredictable ups and downs of midlife and beyond.
“Most people simply crash-land into adulthood,” says Owen O’Kane, psychotherapist and the author of How to Be Your Own Therapist. “Unless we’ve been lucky in our parents, psychological wellness has not been part of our upbringing: we haven’t been taught the key skills of managing difficult thoughts and emotional regulation,” he says. Moreover, post-pandemic, he has been witnessing the highest level of emotional distress in 30 years of practising. “The sheer level of the struggle is astonishing,” he says.
O’Kane, 54, who was born in Belfast, worked in palliative care before becoming a psychotherapist, NHS clinical lead, and is now a private practitioner. “There’s a misconception about therapy,” he says. “I’m not a fan of it all being nodding heads and long silences. You can’t hand over responsibility to your therapist, nor can you expect them to simply ‘fix’ you. Mere reassurance can be counterintuitive.
“But a therapist can be helpful when a person can’t see the wood for the trees,” he adds, “to stand alongside them and help them understand themselves and why they continue to repeat certain patterns of behaviour.”
Every person could benefit from therapy, he believes. “We’d all love a personal fitness trainer if we could afford one – this is no different. But NHS waiting lists are longer than ever, and many people can’t afford a private therapist.” In the absence of a therapist, he believes, doing nothing is not an option. “The idea of self-therapy is to get you on the road: a crash course in getting to know yourself and understand yourself.”
O’Kane’s approach mixes the disciplines of cognitive behavioural therapy (CBT), trauma therapy and mindfulness. His insightful book is both thought-provoking and practical, with written exercises and simple tasks for the reader to engage with. “It doesn’t help anyone in distress just to ruminate on their problems,” says O’Kane, who advises BBC drama writers on the verisimilitude of their scripts. “The ‘knowing’ has to be matched by the ‘doing’, with the aim that we change our behaviours and deal with our future problems more easily.”
Here, in O’Kane’s words, are seven key skills that could help you become your own therapist.
1. Get to know your own ‘story’
The story of your life will contain many treasures that help you understand who you are, and how you can live a fuller future. Start off by literally jotting down a timeline of the key events of your life – just the highlights, like the trailer to a movie. Go through the highs and lows: what are your thoughts and emotions around these? Most people go through their lives and simply don’t stop to ask.
For example, can you see there were periods when you found it hard to trust people, and that this could be affecting you now? Most of the stuff that creates big emotions in your current life is less about the here and now, and more about issues you haven’t dealt with in the past. By beginning to understand these, you can turn them into something useful. When you find the courage to tell your own story without edits or revisions, you are saying you are no longer ashamed of it, and that’s life-changing.
2. Your response to an event is the most important thing, not the event itself
We have high expectations that our life should go to plan, but this is never guaranteed. We will all meet periods of difficulty or pain. And in moments of distress – the loss of a job, the end of a marriage – people tend to attribute their upset to the event that’s just happened. And of course there will be an initial surge of negative emotion. But once this has passed, instead of thinking: “This isn’t fair!”. Ask yourself: “Is there another way of looking at this?”. You have two choices: to see this as a moment to lie down and admit defeat, or a moment of opportunity.
For example, a person who has been made redundant may only see failure, and blame themselves. They may be thinking: “This is a disaster” and “How am I going to pay the bills?”. Step out of the catastrophising and think about similar times in the past that you have coped. Your negative feelings are strong at the moment, but feelings are never permanent: they pass. Every possibility will provide new opportunities for growth and resilience. “I can’t manage” becomes “I have survived tougher moments”.
3. Keep a sense of perspective
For 10 years, I worked in palliative care: the tough area of death, and the dying. This really played a huge part in my understanding of what makes a better life: working with people having to face up to their mortality was grounding, gave me perspective and forced me to look at things differently.
I learned lots of lessons during the period, but chiefly, I came to understand that how we use our time is vital. Relationships are by far the most important thing: you never see someone’s career achievements on their gravestone.
4. Psychological flexibility is key
Most people have rigid beliefs about how their life “should” be: “I must please people”; “I must not disappoint”. But repeated research shows that if you operate from the ground zero of how you think life should be, you’ll end up being inflexible. By this token, if something goes wrong, it proves you are rubbish.
Learn to negotiate with your own rules. Instead of the above, try: “I don’t have to be perfect”; “Sometimes I get it wrong”, or “I can’t always be at my best”. This takes practice, but if you catch yourself being rigid in your thought process, stop yourself, and ask whether there’s an alternative way of looking at it.
I liken this to the suspension on a car: if it’s rigid, you will feel every bump in the road, but if you are flexible, the journey will feel more smooth and comfortable.
5. Don’t categorise feelings as ‘good’ or ‘bad’, but ‘interesting’
Emotions are signposts, they are there for a reason. And people cling onto the positive emotions – they want to be happy, successful, in love – and push down the negative feelings such as fear or anxiety. This is entirely understandable. But we need to be curious about these “negative” emotions, and what they are teaching us. No emotion is wasted.
For example, that anxiety about a big work project might be telling you to slow down. That sadness after a break-up is hard, but it is healing. Telling yourself – or another person – to “look on the bright side” is counterproductive as it invalidates your feelings and slows down your recovery.
6. Always examine the evidence
Your inner critic is there to stop you getting hurt, and your anxiety is driven by “what ifs”. You might think you won’t be able to cope with being single, or losing your job, but what is the evidence that this thought is true?
I tell my clients to imagine themselves in a court of law. Would their evidence about how they feel stand up in court? Is this evidence biased, or personal? Deal with your inner critic by becoming a lawyer in your own life.
I also advise people to write things down – keeping a journal, for example, can be very useful. If you find yourself in difficulty, challenge the negative thoughts you are having by writing down 10 key evidence points against yourself. You may surprise yourself that you can’t think of anything.
7. Show up unapologetically as who you are
Of course life has uniforms and rules: we have to present ourselves in a particular way and act appropriately in a work situation, for example. But we spend a lot of time in our lives trying to show up as something different to how we are: it’s not the route to a happy life. I grew up as a gay man in Northern Ireland during the Troubles, and lived my early life with Catholic shame and guilt. I had to move away to realise the impact, and only came out in my early 20s.
Ultimately, being comfortable with ourselves and holding true to our internal values is a human freedom. This means sometimes speaking up, even though it isn’t popular, and pushing through boundaries. If you see someone being bullied, and no-one else is standing up for them, be the person who does. You might create discomfort and upset people, but this doesn’t mean that it was the wrong decision.
Other people’s opinions don’t matter in the long run. If what you are doing pleases everyone, you are doing something wrong. If we spend our lives waiting for approval, we’ll be dissatisfied. Trust yourself and your judgment. And always ask yourself this: what are my actions going to be?
How To Be Your Own Therapist by Owen O’Kane (HarperCollins, £9.99)