The Building Blocks of Self Therapy 🧠
Why getting good at self-discovery (inner work) is a secret superpower
“Psychotherapy is built on a promise: you bring your suffering to this private place and I work with you to keep you safe and help you heal” — Todd Essig, PhD
Keeping you safe and helping you heal. This quote calls out an important tenet of traditional therapy: bottle up your suffering and release it in a detached universe away from the pains of regular reality. Although there is increasing acceptance and adoption of psychotherapy solutions, many remain skeptical. After all, why invest in a cost- and time-intensive service where the output is largely driven by yourself?
To make matters more complex, the paradigm shift to digital-by-default presents both possibilities and fears for psychotherapists and patients alike. Long gone are the days of sitting on a satin sofa and recounting emotionally charged stories to a trained practitioner nodding and scribbling away. Shared stressors for Zoom-fatigued individuals add tension to intimate connection, especially with the absence of attention, empathy, and physicality from the usual expectation.
The sobering truth is that therapy has departed drastically from its traditional form.
As accessible as therapy has become, you could argue that the telehealth trend undermines the key benefit of an enclosed haven that historically promoted feelings of safety, privacy, and reliability for patients.
But what if this digital health revolution has enabled more creative options for both patients and providers, while maintaining efficacy of traditional therapy?
To test this hypothesis, I committed in early 2020 to plunge headfirst into a new therapy-enabled growth journey. This is a tale about how a year-long exploration of cognitive-behavioural therapy (CBT) completely transformed both my internal perception and external worldview, eventually equipping me with a toolkit to perform on-demand “self-psychotherapy”. This piece will also include a deep dive into designing best-in-class wellness experiences and imagining what a future state therapy landscape could look like. Let’s start our scheduled check-in!
I. Undisturbing Yourself: CBT Tricks of the Trade
Journalist Rosie Spinks suggests in this article that literally everyone can benefit from therapy by framing it as a proactive mechanism to help model correct behaviour and replace missing support.
I was intrigued by her arguments and eager to find the path of least resistance of sourcing a proper therapist, knowing that the vetting process was much like the trial-and-error troubles of online dating. Here were my key considerations:
- Objective: Why do you want to invest time, energy, and money into therapy? I was looking to engage in rigorous exercises in self-development and self-discovery.
- Modality: What type of therapy would make the most sense with my current situation? Literature in CBT describes the method as a collaborative, first-line defence tool, which was compelling and aligned well with my generalized goals.
- Quality: How do you differentiate between therapist quality? The therapist I landed on positioned his offering as “existentially-minded CBT”, which caught my eye in a sea of comparable credentials and indistinguishable hourly rates.
I embraced a feeling of open curiosity going into the first session. I outlined three guiding goals for myself: optimizing for work, relationships, and life purpose. Upon minutes of meeting my therapist, he dropped a mesmerizing line that fully flipped my mindset from cautiously curious to enthusiastically eager for this experience.
“Over our time together, my main intention is to armour you with the systems and frameworks of CBT thinking and unpack your subconscious limiting beliefs. We’ll take this to an extreme boiling point where you ideally unlock the art of self-therapy.”
The core framework that grounded each of my therapy sessions was the “CBT Triangle”: the interplay between thoughts, emotions, and behaviours. The essence of CBT is applying proactive data-driven techniques to disrupt your mind and body in real-time, whenever there is a disturbance within any of the three elements.
This model manifests around feedback loops: negative thoughts spiral into negative emotions, which drive negative behaviours. This cycle starts morphing into a self-feeding living organism over time. Soul-nourishing in the best case, and harmfully parasitic if left unchecked. I call this the mental wellness flywheel:
Sidebar: This visual is the key reason why people are stuck in a vicious vortex of their own self-defeating patterns. The flywheel feeds on your subconscious and overrides your body’s regular programming during stressful periods. These outcomes compound over time and potentially "crowd out" activities normally considered pleasant or enjoyable. Quite a problem especially if you find ways to rationalize these thoughts!
My therapist then introduced the concept of cognitive distortions as my first homework assignment. This was critical to helping diagnose the irrational biases and decision heuristics carried over from our formative years as starry-eyed children. From catastrophizing events, adopting black-and-white thinking, or just overusing the words “Should” and “Must”, these cognitive principles laid the groundwork for deep exploration. The premise: make your inner thoughts visible by targeting the invisible.
At this point you might be saying: “Okay learning these concepts is fantastic, but how do I actually take control of my own flywheel?” This model can be stacked with the House of Cards metaphor — each card represents a different limiting belief distorted in your mind. The exercise here is to observe each layer of the card structure and toss out the ones that are not serving your wellness needs.
One of my constraining philosophies was a tendency to obsess over future-proofing my life and over-valuing potential options and outcomes that don’t even exist yet, instead of fully immersing myself in the present.
On paper, the corporate world typically sees this mentality as being ambitious, having keen foresight, and embracing a bias for action. Productivity hacking reigns supreme. Optionality is the end-game. So on and so forth. You can see how easy it is to justify the merits of any belief, especially when combined with societal norms. Some common violators include: acting solely for outward affirmations or self-absorbing over the final product instead of learning from the end-to-end process.
Reshuffling your inner house of cards and starting with a new refreshed hand can be viewed as the ultimate goal of the CBT game, as there are direct impacts on how you perceive yourself and the world (self-talk + automatic thoughts). We can make this metaphor more practical by viewing it as a bottom-up pyramid of reflective actions:
Structuring the practice in a four-part sequence allows for a common dialogue both in-session and between sessions as part of an overall mental fitness workout routine. If “Old Sam” were too fixated with the future and this belief was driving unhealthy thoughts, behaviours, or feelings, here is the systematic CBT flow in action:
- Limiting beliefs (Identify): Stretch the analysis of deeply-rooted beliefs to its extreme end. Think: the distortions at play are polarized thinking and should-ing/must-ing. I value external stimulus through achieving. I am afraid of falling behind. I am not enough as I am.
- Double-sided evidence (Challenge): Dig deeper into your subconscious by assessing the costs and benefits of keeping this belief. Ask: if this belief is true, what does it say about me? In this case, my internal prosecution team posits that prioritizing the future is a never-ending unhealthy cycle, while my inner defence sides with the long-term utility of always optimizing for new opportunities.
- Mindset shift (Update): Remove the distortions and inject nuance back into the belief for a balanced view. Frame: “Even when [x would be preferred], evidence suggests that [y still occurs or z is still true]”. Even when it would be preferable that I’m set up well for future success, evidence suggests that living the present is also equally fulfilling, nutritious, and enjoyable, and can also lead to serendipity.
- Recurring practice (Rewire): Remind yourself constantly of the new updates to ingrain them into your subconscious and displace the old. This can be achieved through a codified mantra, mindfulness meditation, or scheduled check-ins.
Despite only showing you the abridged version of my one-year therapy experience, I hope this provides greater clarity into the value of CBT. By merely having a mindful collaborator listen to the substance and delivery of my stories, I uprooted several unkempt weeds in my mental forest of beliefs. A self-driven mindfulness masterclass!
II. Designing CBT Experiences: A WellTech MVP
These CBT frameworks look powerful in practice, but we’ve made one simplifying assumption that these outcomes are representative of any inbound patient’s journey. We also have not addressed people who are seeking direct remedies for stress, anxiety, depression, or burnout, and those suffering from more chronic conditions.
The affinity, availability, and affordability of classic therapy solutions do not align with characteristics of a broader population, especially underrepresented groups.
With a vested interest to tackle this wicked problem after 6 months of CBT exposure, I kickstarted the development of a makeshift wellness web application. My goal was to apply therapy principles and address a core pain point relevant to my own immediate surroundings: burnout risk for early-career professionals. Success would manifest as a greater self-service capability for the less mentally savvy, with the platform acting as a complement to traditional CBT through tailored DIY wellness routines.
Oranga was then birthed as my self-therapy brainchild, collaborating with a full-stack developer passionate about holistic health and a product designer leading the charge at a mental health startup. The name derives from the Māori word for [health, wellbeing, and life], which definitely resonated with me during my time spent in New Zealand.
Perhaps this solution is not as “revolutionary” as I tried to pitch (just a glorified online survey?!), but the four-week sprint was geared more towards validating and learning rather than shipping a full-fledged platform. From my POV as the product manager, I gained three takeaways for building best-in-class WellTech experiences:
- Setting a bold product vision can be clouded by intricacies in the wellness space. While the therapy industry is definitely ripe for disruption, it is easy to get caught up in trying to reinvent the therapeutic wheel instead of remixing on top of existing market alternatives. My initial customer discovery efforts revealed that each target user’s self-care routines and perceptions of therapy varied wildly, but also strengthened the case of focusing on early-stage career burnout.
- Accounting for conflicting user feedback can influence the design-dev handoff. The added complexity of individual wellness preferences pushed me to prioritize usability testing, starting with low-fidelity designs. As a result, running a typical agile process with stage-gated sprints had limited effectiveness given so many variables. Giving piecemeal insights to your software engineer constrains the ability to commit to code, especially with differing opinions on critical features!
- Spreading awareness to a small group of power users can still have a profound impact. Even with a light backdrop of 15 alpha users, the anecdotal follow-up conversations revealed a surprising, clear-cut interest in seeing further iterations of the prototype. There is inherent value in hosting lengthier “show-and-click” sessions if merely to spark collaborative consultations on an underserved topic.
III. Overcoming Barriers: The Future of Therapy
My attempt at driving an app-based approach shows the difficulty of triaging the pains of burnout with therapy modalities. This last section aims to greatly expand our discussion past the traditional and into future-forward trends. I created a positioning matrix to differentiate and plot high-growth companies in the market, based on stakeholder focus (patient vs. practitioner) and service mode (proactive vs. reactive):
While the following trends present attractive opportunities to reach patients at scale, my final caveat is that productizing therapy may never fully replicate and replace the quality of a human-centered intervention. But there is also cause to be optimistic!
Trend 1: Increasing therapy-related complements and substitutes
The broad theme around these companies is integrating the community aspect to create cohort-driven options that either work with or work around classic therapy.
- Octave’s added combination of well-being coaching and support groups: In addition to their standard therapy matching platform, Octave addresses a wide range of pain points through their breadth of support services.
- Pace’s facilitator-led wellness groups around shared interests: Pace’s model reduces the formality from therapists and replaces it with facilitators who lead personalized, handpicked small groups based on any topic or comfort level.
- Marigold Health’s community behavioural health mechanism: Peer support forms the crux of Marigold’s model, providing a closed circle of on-demand individualized support. Marigold also integrates with existing health providers.
Trend 2: Democratizing therapy modalities for everyday access
These solutions unbundle the components of therapy and repackage them into new channels of consumption with a focus on reactive diagnosis.
- Talkspace’s free 10-day healing curriculum: While an established player, Talkspace continues to innovate by curating clinically-backed lessons and practices geared towards self-restoration. Full therapist sign-off included.
- Quilt’s distributed model of talk therapy: While not branded as a direct therapy product, Quilt builds on a Clubhouse-esque audio approach to normalize authentic conversations around self-care. A natural extension: mini therapy pods!
- Woebot’s AI-powered CBT chatbot: Going one level of abstraction higher than the popular text messaging approach, Woebot leverages natural language processing (NLP) to build meaningful bonds with users asynchronously.
Trend 3: Building proactive routines for mental and emotional wellness
This group of early-stage ventures can be considered as “wellbeing-as-a-service”, touching on other important elements to proactively optimize your mental health.
- Coa’s emotional fitness gym concept: With a unique model of group-based classes, Coa is pioneering a movement to shift the narrative around therapy — from being a tool only when you’re unwell to a core building block of wellness.
- Chorus’ social layer to meditation: Injecting fun and liveliness into a conventionally low-energy, high-barrier to entry practice, Chorus is creating a group meditation experience to promote proactive inclusion into daily life.
- Intellect’s app-driven psychological training regimen: Being one of the prime CBT-oriented apps to raise seed capital, Intellect’s value proposition focuses on self-guided exercises to improve personal behaviours, relationships, and habits.
As a parting reflection, I recognize that this essay only scratches the surface when it comes to exploring and understanding the broad-based, multivariate nature of therapy. The silver lining is that incentivizing consistent coverage and empathizing ruthlessly with therapy-goers are lightweight methods to help move the needle on a crucial topic.
I envision a world where conversations about mental health are completely normalized and people are empowered to develop the skill of self-therapy.
After all, the best work of your life is the work you do on yourself.