I am standing outside a building in Shoreditch, east London, admiring its elegantly distressed paintwork. It could be an artisanal cheese shop but for the name, Self Space, and the blurb on the window that reads: “A good conversation with a qualified person.” Let’s hope. I have a session booked: 30 minutes of therapy for £44.
I have many questions, and not just about my mental health. Can a one-off therapy session make a difference? And is Self Space at risk of being swamped by a stream of neurotic people like me?
There is only one way to find out. A young, welcoming therapist – who asks not to be named – shows me into Room 1. I had selected her from an online roster on Self Space’s website of 11 therapists and life coaches, all of whom are registered with the Health and Care Professions Council. I chose her because she has a kind face in her website photo and – most importantly of all – because she was free at 10am on Tuesday morning.
We sit facing one another, her on a yellow chair, me on a blue one. At the outset, she identifies that I’m conflicted: I am reporting on consumer-friendly therapy as well as being a troubled fiftysomething hoping to sort himself out before his dotage (my words, not hers). I blurt out my worries: why do I neglect myself? Why do I feel stuck existentially? Is it too late for me to fulfil my potential? Shouldn’t I stop whining and get on with life?
Of all the therapists’ rooms I have visited to air my woes or do interviews, this one is by far the smallest – there is no space for a couch, still less for me to pace up and down. But Self Space’s approach to therapy is far from traditional in many ways.
Over coffee at a nearby cafe after my session, the founder, Jodie Cariss, tells me that Self Space wants to revolutionise therapy, helping it to become as accepted a means of achieving and maintaining wellbeing as visiting the gym. “We feel that if it becomes more accessible and less stigmatised and is associated with mental health as opposed to mental ill health, we’ll begin to culturally aspire to good mental health, as opposed to waiting until crisis point, which is often what happens now.”
Isn’t that just bringing the principles of consumer choice to therapy, I suggest? “I’d like it to be acceptable that you work on your mental health in the same way that you work on your physical health – we need to give it attention,” she says. “At Self Space, we really advocate the concept that everyday mental maintenance is an essential part of surviving.”
Self Space is one of several enterprises changing therapy in a way that would doubtless make Freud turn in his grave. They include Happy, a US app set up by Princeton graduates and billed as “the Uber of emotional support”, connecting lonely and distressed people to “ordinary folks with extraordinary listening skills”.
These so-called “happy givers” are not trained, but rely on crowdsourcing and reviews for quality control. Jeremy Fischbach, the founder, said the idea came to him when he was going through a rough patch and found his best friends couldn’t help.
“Wouldn’t it be nice if you could tap a button and hear a voice,” he thought, “and for that person to give me as much time as I needed? For it to be a regular person with extraordinary abilities, who understood what I was going through? And for all of that to be anonymous, affordable?” Fischbach says his app is not a substitute for therapy but – at 40 cents (31p) a minute – it can be a bridge to it.
Another consumer-focused therapeutic service is offered at Alain de Botton’s School of Life, which believes “getting therapeutic help should – ideally – be an ordinary and wholly unsurprising process”, akin to going for a dental checkup or getting a haircut. “Therapy isn’t for the select or distressed few; we believe that therapy is for everybody,” proclaims the website. Self Space is similar in its bid to revolutionise how we think of our mental health – but what strikes me about it is not so much the short sessions, but the transfer of responsibility to the person seeking help.
With Self Space, clients book and choose time slots via an app, they pay online and can choose the regularity of their visits. The app is big on bundles: I could buy four 30-minute sessions for £176, or 16 50-minute sessions for £979. You can start and stop treatment, cancel sessions, and even change therapists. When I have had therapy in the past, this sort of freedom was inimical to the process: the shrink was someone to defer to because she had all the answers, rather than someone I might drop if I felt they were unsympathetic.
Does short-term therapy work? “It depends what it is we’re working on – we’re not just short term, we’re across the scale,” says Cariss. “I find I develop a relationship with a client over some months and then I won’t see them for a few months. Then something happens and they come back and the history [of our previous work together] is there and so is the trust to develop a relationship.”
In principle, I could see a different therapist on each occasion, as long as I agreed for my records to be shared within the practice. “It isn’t encouraged for the client to move around. However, it is good for there to be an option,” says Cariss.
Like so much of life, therapy is changing to accommodate the preferences of new demographics, those whom sociologist Zygmunt Bauman called “liquid moderns”, who create provisional bonds loose enough to stop suffocation. Enabling you to change your shrink mid-treatment is part of that shift, an application of consumer choice to mental health – but therapy isn’t supposed to be like shopping, is it? Shouldn’t it involve commitment to your designated mental health provider?
Cariss disagrees. “This might be seen as a bit unconventional, but we have found it works and is more reflective of real life, where people work unsociable hours and hold jobs that can be unpredictable and where holding regular slots can be impossible or limiting.”
Revolutionary, too, I suspect, is Self Space’s desire to bust down the shrink from God-like authority figure. Classic Freudians, for example, may well sit out of sight as you monologue on the couch. You know nothing about your therapist’s life and any questions about it are met with the disempowering: “Why do you want to know?”
But, says Cariss: “Therapists don’t have all the answers. It’s not our job to fix the client. We didn’t break it; we can’t fix it. All we can do is shine a light where the client may not have been looking.”
Cariss has been a therapist for 15 years, having trained at the Tavistock Institute in London (part of the Tavistock and Portman NHS foundation trust). She is also a member of the British Association of Drama Therapists, which uses healing aspects of drama and theatre as the therapeutic process.
She describes therapy as a “place of deprivation”, meaning that the shrink is often encouraged to be a blank slate so that the client can redirect on to them emotions originally felt in childhood. That blank slate is deemed necessary for this process of transference. But Cariss says that happens even in short-form therapy: “It doesn’t depend on the length of the relationship.”
Nor does she automatically make herself distant or conceal her life outside the therapy room. “I’ve had clients ask if I have children. If I think it’s useful to the client and the work, I will in some cases answer.”
What would Freud make of Self Space? “I think there is a lot that Freud would have an opinion on. But there’s quite a lot of what he did that we have an opinion on. We keep conventional boundaries – time and confidentiality, ethics, payment. These are what keep the work safe for all.”
A decade ago, one in six people had depression or chronic anxiety, but only a quarter of them were receiving treatment – mostly drugs. The government’s then happiness tsar, the economist Richard Layard, suggested that cognitive behavioural therapy (CBT) was as effective as drugs and was preferred by most patients. Layard’s plan to scale up CBT for people with depression and anxiety was ditched by David Cameron’s 2010 government, but the problem remains. The government has estimated that about half of days taken off work in 2017/18 were due to stress, depression or anxiety.
Cariss says it is no wonder that half of Self Space’s clients are referred through HR departments and corporate companies offering sessions to their employees. But she denies that what she is offering is 2019’s answer to CBT, a quick fix that risks papering over the cracks.
“CBT is solution-focused, forward-looking,” she says. “We’re about trying to get to the core.”
Self Space, which celebrated its first birthday in February, reached 77% capacity within its first three months, which Cariss thinks indicates the need for support in the mental health sector. Already, she is looking for larger premises to cope with demand and dreams of expanding the brand globally.
“It feels like it’s the right time for what we are doing,” she says. “People are much more open to talking. British companies are much more open to the idea that employers need to support people to reach their potential and thrive, not just survive.”
I am not sure I did much effective work in my 30-minute session. The blurb on Self Space’s website says: “The probability is you’ll leave feeling better than when you came in.” And although I do feel better, it is not because I have sorted out any problems, but because I have given them a preliminary airing. I feel I have something I didn’t have half an hour earlier: namely a sense that I could do one-to-one work with this woman that would help me improve my health.
That said, she may never hear from me again, or hear from me only after I have road-tested other candidates, including, possibly, the shrink I could hear treating another client in the next room. The choice is mine, and that in itself feels liberating.
