Therapy for People Who Hate Therapy

How I debugged my own brain.

Why should I read this?

You should read this if you’re going through some sort of distressing thoughts: depressive, obsessive, repetitive, intrusive, etc. and you’ve failed to find much benefit from traditional therapy, or you have some reason you don’t want to deal with it.

You may further benefit if you just have a bad mental model for dealing with this, entirely. A lot of mental anguish is actually rooted in bad metaphysics, philosophy of mind, or ethics; and while I can’t Complete the System of Psychotherapeutic Realism in less than thirty-five hundred words, I hope I can at least provide some useful scaffolding.

Versioning & disclaimer

A version of this post has actually existed for over a year as a Google Doc. I found that I was giving a lot of the same advice over and over to friends since I did this to myself, and eventually a friend of mine encouraged me to just write it up so it could be shared more easily.

Since I made it a Google Doc, about twenty other people have tried it in the last sixteen months or so. Some of them were friends, but a lot of them were friends-of-friends who my friends asked if they could send it to someone else. Again, every person who tried it got some relief, and a few got dramatic relief.

This is a pretty thorough revision, but it remains almost the same as the original Google Doc. It’s out of beta now, this is a more polished product.

Importantly, I am not a professional psychologist or licensed counselor. This is strictly about the roll-your-own stuff, here. I’m the moral equivalent of an internet peptides dealer, except I’m maybe worse because I’m not putting the NOT FOR HUMAN USE label on the bottle for you. You’re probably also going to need some tools I can’t provide in a Substack piece.

Preface

There are some good reasons to be skeptical about therapy, and quality varies wildly if you even do it. I’ve had four different therapists, and I’d say two of them were completely useless. One of the useful ones was only marginally so, too: You know how people joke about how what if there’s a guy so good at sex the prostitute will turn down the money? I was that guy with therapy; the therapist felt he was getting so much out of our conversations he kept refusing to charge me for over a year (and I needed more friends then, anyhow).

So, if you’re a therapy skeptic, it’s ok, because I’m one, too. (Though, maybe, it’s more appropriate to say I’m very skeptical of the usefulness of the median therapist.)

However, by far the most useful thing I’ve done for my mental health (besides getting enough sleep) was learning to practice therapy on myself.

This involved stripping down cognitive behavioral therapy (CBT) to a useful, minimal core, while also having a model of how emotions work, and what they mean. I think CBT is, in general, very useful, but most CBT promoters I see have a flawed model of emotions, and that bad model can turn people off from a powerful, simple method that can deliver real results.

I used the method I’m outlining here to achieve drastic – and sustained – improvements in my well-being in a few weeks. Further, as I mentioned above, the people who’ve actually implemented this method after I explained it to them have also achieved good results. I’m not saying this will work for you, but the method is non-intrusive, not particularly hard, and can be done without a lot of support. (If you can find a partner for accountability, whether that is a professional therapist or not, you may have an easier time.)

I know a lot of people struggling with negative self-narratives, destructive self-talk, and otherwise unregulated emotions who also struggle with implementing therapeutic methods because they, frankly, seem dumb to them. CBT seemed pretty dumb to me when I started looking into it (part of this is because of how it discusses emotions and thought), but the clinical evidence was quite strong. Parts of CBT also seemed hokey, but I thought there was a core to the techniques that could work without it being so cringe.

Turns out, there was.

The situation

So, why did I have to come up with this method in the first place?

One thing I need to make clear is that I wasn’t just a little unhappy, or a little anxious when I started this process. I was close to nonfunctioning. I was sleeping irregularly, depressed, anxious, and had been struggling with all this for some time… all while I was constantly besieged by negative self-talk and distressing intrusive thoughts of being mutilated.¹

Sleeping regularly, and well, is very important to psychological (and physical) well-being, but I actually didn’t fix that for some years after I started this process. (Now that I have fixed it, I protect my sleep.) I also needed a couple other interventions, and still do regular maintenance work on my mental well-being.

So, the story here is not as simple as “I fixed everything at once.” Instead, I made significant, dramatic improvements over the course of a few weeks that enabled me to do other things that helped me down the road. This isn’t a One Weird Trick to end all psychological distress. Also, some psychological distress isn’t even always bad.

One thing that helped lay the ground for accepting some form of CBT for me is I already had a model of cognition and emotions that I could slot (something very-like) CBT into. Having a model isn’t necessary. You can brute force the method (some people have); there’s a magic to the observation inherent to it that works all on its own. However: (1) I wouldn’t have used the method if I didn’t have a framework in which I could accept it; (2) Having a good philosophical model of mental states will likely improve the method’s effectiveness and bring about better psychological health.

So, here’s how I think about things:

The logismoi

You have a different types of mental phenomena and while distinguishing and categorizing them is fuzzy, I generally use three broad groups²:

1. Discursive thought: Your internal monologue, thoughts that arise in your head with grammatical content, self-talk about your other mental phenomena, etc.

2. Emotions: How you feel at a base level, whether or not you are articulating it in a discursive mode.

3. Sensation: The feeling of your breath or your body, the impressions of the external world on your senses.

So, we’re all very familiar with the fact that sensation isn’t really under our control, and maybe that emotions aren’t, but many people (especially very smart ones, perhaps) fall into the trap of thinking our discursive thoughts all arise from something real and substantial: that they’re the result of a process.

One great thing about meditation is it teaches you how untrue this is. With a bit of detachment and observation of yourself, you notice how many discursive thoughts arise out of nowhere. Perhaps those are all rooted in unconscious processes. It doesn’t matter. Many are unconnected to any substantial reality, and are simply habits, noise, or worse. (Speaking of noise: A side-effect of this method is that I can now dismiss a song that starts getting stuck in my head by just telling it to stop now.) Even today, I can analyze my thoughts and find a lot of babble, but since most of it is harmless, I usually just let it go. The point is not to be distressed by these unrooted thoughts.

Borrowing a word from ancient Christian mystics, these are examples of logismoi. In my usage, the logismoi are all those mental states which are maladaptive. They are rooted in false premises; they are intrusive; they are meaningless and repetitive; they tempt you to harm yourself or others. You don’t really need to have a model of where these come from, but you do need to accept that they exist and you’re beset by them. The logismoi aren’t rooted in rational appraisal; they aren’t proportionate emotional responses; they are exaggerated or grotesque; they jump to conclusions without support.

The logismoi don’t just include negative self-talk like my life is over, they also can include false emotion and false sensation. False sensation doesn’t have to rise to hallucination or anything like that; most false sensations are simply imagined pain or exaggerated discomfort.

False emotion is a bit trickier:

One problem with therapeutic culture is it often seems to slip into a mode where it seems as if the goal is to free yourself from all negative emotion. If you’re attempting to do this, I believe you will harm yourself. You don’t have to give up any realism about your condition; you can retain your pride. The goal is to let negative emotion have its proper space, and not let it become a precious friend – another one of the logismoi. (You likely already know when your negative emotions are getting out of proportion.)

If you let it, a negative emotion will carry you away with it. Your rational grief at a deep loss will become a conviction that happiness has left the world; your anger at a real injustice will become a habit that lashes out at mere blows to your self-importance. The logismoi are always lurking, waiting to hijack your inner life.

If you don’t find any of this convincing, I can only encourage you to learn to meditate. Learning to meditate is too involved a topic to go into here, but I believe that simple awareness of the breath is the foundation of meditation, and sufficient to unlock a lot of observational power and a reserve of detachment you can draw upon when needed. Meditation was very important for the method working for me, but people have used what I outline here without it, so feel free to try it without it. You don’t need a framework for why meditation works, and some of the frameworks out there might harm you (more on that, below); so just try it. Think of it as a breathing exercise.

The method

Many CBT manuals take you through extensive mood inventories, writing exercises, and other homework. The method I used did none of that.

The core of CBT is actually just observation. It’s what every method has in common. It treats you to start observing the mind instead of being carried away with it. The writing exercises seem to matter for people because they teach some people to argue against their negative thoughts. Dr. David Burns, the author of Feeling Good, has an extensive list of cognitive distortions he warns users to be on the lookout for. (I did not find the Burns approach useful – though I did try it before arriving at this method – but you might.) If you can simply learn to reject the logismoi as you recognize them for what they are, all the better.

The method uses two tools: A thumb tally counter, and a text file on your phone. (You could also just keep a record in a journal, or even just a cramped index card. There are also counter apps for your phone, but I think not having to switch apps around on a smartphone or nearly-constantly having it in hand is good. Just get the tally counter.)

All I did was this: When I had a false thought, unhelpful self-talk, an anxious ideation, or a distressing intrusive thought, I hit the counter. At the end of the day, I recorded the number on the counter with the date. I did this for three weeks.

The method feels absurd at first. If you’re as bad as I was, the logismoi tend to come on like a torrent, and just noticing one leads you to notice dozens of others. Sometimes, I’d be hammering away at the counter. Worse, you get better at noticing. That means the number keeps crawling upwards over the first few days. But, as you keep going, and just keep noticing and recognizing the logismoi for what they are, the number declines. Within a couple weeks, the number looked completely manageable, and I was no longer constantly being carried away by uncontrolled distress.

And all I had done was observe, recognize, and record. This got me to a point where I could observe, recognize, and reject.

Reject? That’s the whole problem! That’s true! That’s why I think you will benefit from some model of what distinguishes real, rooted cognitive phenomena from the logismoi. You need a sense of what your end is as a human being, what is good, and what is real³. Without that, all cognitive phenomena are on equal footing: why reject some and embrace others?

Sometimes, I engaged in argumentation against my self-talk in a way like traditional CBT recommends: “Just because my life is in a bad state right now, it doesn’t mean I cannot improve it.” But, mostly, I just rejected the logismoi with a firm dismissal: “That’s not real.” When things got really bad during the counter phase, I would force myself to meditate and just observe the logismoi without judgment (I stopped hammering the counter when I did this); this usually helped calm things down. I still use this technique on occasion today.

You should use the counter as long as it takes you to see meaningful improvement. Some people seem to enough benefit after a week that they just set it down. Others have used the method for a few months. I don’t have the resources to do a study on this, so I can’t give recommendations. You’re just going to have to find out.

The real trick comes once you get rid of the counter. Hopefully, the counter has helped you get the number of logismoi down to a manageable number, but you’re still going to have them, and you’re still going to get carried away sometimes. Now it’s time to use the pattern you learned with the counter: Observe, recognize, reject. Maybe your time with the counter led you to discover some other coping strategies, so you can employ those, too.

Can it really be this stupid?

The problem with the method is that it sounds very trite if you just start from the end-point of observe, recognize, reject. If it was that simple I could already do it. Well, you obviously either aren’t doing it or you can’t yet, so maybe it’s not that simple. The counter gives you physical feedback for the first step in the process, which I think is part of why it works.

The counter is a ladder to get you to the point where you can employ the method seamlessly in everyday life. There’s an actual magic to the ruthless, empirical recording of your inner turmoil that the counter imposes; going through that stupid process makes all the difference. It isn’t that different from how some people report their overall mood improving over time with a mood check-in app. It helps you treat the mind like an environment, rather than something that intrinsically belongs to you in every sense. However, there’s a danger here, too.

In my experience, therapists working with CBT, CBT guides online, and some major psychologists who work with CBT have a tendency to embrace a pop-Buddhist conception of the no-self doctrine that amounts to abolishing self-identity (even when the psychologists claim otherwise, that’s where a philosophical view of their claims often leads).

The problem with this is what Buddhist theologians meant by no-self, and what a modern Westerner would mean by no-self are very different. The latter means a nihilistic elimination of identity, whereas what the Buddhists meant by no-self is that there is no intrinsically existing self, but few educated, modern Westerners actually believe in such a self anyhow. The Buddhist doctrine has to be taken in context of existing in a centuries-long conflict with other doctrines that exalted the self as an eternal principle: one that was, if not being itself, a fragment thereof.

Sometimes, usually because of influence from New Age thought, you’ll encounter someone who believes their inner self is eternal, pure, and good. That person could benefit from the Buddhist corrective, which challenges you to analyze and find in yourself any self that is not a result of dependent arising. But such an analysis does not negate self-identity in any absolute way, and what some Buddhists would call a “conventional self” remains.⁴ I could have a lot more to say about the proper conception of the self, but this is a practical piece, and I’m trying to avoid being exhaustive about philosophy.

Then, why am I bothering to go into this? Well, I’ve already recommended meditation, and I’ve recommended a (modified CBT), and I’ve mentioned David Burns, so I’ve potentially led a reader to go down any number of paths at which the bad version of the no-self doctrine is waiting at the end. Most stories of meditation gone wrong seem to be from people embracing this bad no-self doctrine and going a bit insane from it. I also think that you’re likely to do damage to yourself by practicing this method, or a more standard version of CBT, and having the underlying idea that it works because there’s no such thing as self-identity. Self-identity as such is not what is harming you, it’s excessive porousness to the logismoi: identification with too much.

Ten years later

So, when I implemented the method I was in this terrible state. Did anything about my life really improve? Yes.

Many things improved immediately, but in other ways I needed the method as a foundation to get further help. (I didn’t even get my sleep under control until after I graduated from law school, four years later.) I’ve weathered a lot, and the basic observe, recognize, reject loop the counter helped me implement has always served me well since.

If this simple twist on CBT doesn’t work for you, I encourage you to try the standard methods. They probably that they have more validity than mine; the point of this method is that it’s very easy to implement and doesn’t have the same therapy-talk vibe as most CBT manuals. I encourage you to focus on methods over philosophy in approaching these techniques if it’s what helps you implement them.

Also, in no way am I encouraging people to not seek professional therapeutic help if they need it. I called this therapy for people who hate therapy – and that’s true – but maybe this method gives you the resources to benefit from therapeutic (or psychiatric) help, as well.

I’m writing about this not just because it worked for me, but because it is such a low cost, low effort method for attempting to relieve distress that I wanted to make a public record of it. I hope it works for you if you try it; if not, please try something else.

If you use this, let me know how it goes. You can leave a comment or send me a DM on Twitter.

1. Full disclosure: I score quite low (bottom quintile) in neuroticism on valid Big Five inventories. I’ve had two administered to me, both after I implemented the method. I almost certainly would have scored much higher in neuroticism when under the distress I’m talking about.

There are two possibilities: (1) I have a natural low set-point for neuroticism, and the method got me back to it and that’s why the method was so dramatic for me, or (2) the method is actually effective at changing your personality in such a way that you can reduce neuroticism.

2. Many mental states are mixed states. However, I think most mixed states don’t need to be analyzed as a single entity and thus can usually be split into their component parts. There is a feedback loop here too: Improving your discursive thought environment improves emotions and sensations; easing your sensations (via meditation, relaxation techniques, or exercise) improves emotions and discursive thoughts; controlling emotions improves discursive thoughts and sensations. For example, I like periodic deep tissue massage as a way to engage with sensation and start the positive feedback loop from that point.

3. This is is why I think philosophical counseling is under-explored, and I suspect it would be especially useful for intelligent people who have succeeded in competitive areas like tech startups or the professions, but now feel adrift.

4. The most well-known Buddhist way of squaring this, the “two-truths doctrine,” is also something I would dispute, but it remains outside the boundaries of this text.