Tired of Crazy

February 18, 2009 10:51 AM

I've been very depressed for my entire life and have decided that it's time for another ride on the therapy train. My previous trips were rather unpleasant, so I'm hoping for recommendations for a doctor in NYC and some general advice.

My life has been at a standstill (meaning I mostly stand still) for the past 12 years and it's time to put all of the angst aside and start living a little. I've seen two psychiatrists, one psychologist phd and some sort of a counselor in the past and never felt the slightest change or improvement. Mostly I just rolled my eyes, wrote a check and went home to sit on the couch.

I can't remember a time when I wasn't depressed so I have no idea what I'm "supposed" to feel like. When I was younger I would have manic periods where I would stay up for days and do lots of dangerous things, and I lived for those times because it was amazing to feel so alive. But now I care so little about everything that even the mania hasn't come to play in years. I'm not and I've never been suicidal but my profound apathy startles even me. Plus, it's getting boring. If you meet me on the outside I'm happy, confidant, friendly, outgoing, and often the life of the party. Seriously!


So,
1. I need a therapist. Preferably not a psychiatrist because I won't take any drugs, but I would like them to have a PhD. Know anyone good in Manhattan?

2. In general, what type of therapist should I look for? What type of therapy have you found to be successful?

3. How should I screen therapists to find someone I click with?

Thanks for your help!

posted by wrinkle to health & fitness (7 answers total)

I think you need a wholistic approach to this. Mind, body and soul. And I'm also thinking nutrition could be a huge factor in your overall outlook and mood. Memory and emotions are stored in the body's cells and they need to move out or else you *get stuck* and you feel the way you described being for 12 years. There is stagnancy - and this can only be aleviated by getting up and going - however that happens - sports, yoga, massage, running etc. The other aspects of this - nutritional - you have to understand that a low-grade nutritional diet with processed foods and vitamin/mineral deficiencies can't produce a sense of well-being at all - in fact can actually bring about the opposite - manic depression, anxiety and more.

Your best bet is to find an integrative holistic therapist that can address these issues in a professional, healing way and work with you in breaking through the habits, belief systems and lifestyle into a new life-sustaining and positive one. The spiritual part is very important to your sense of well-being as well - and this isn't about religion - but of faith that you will get through this and that you will find the strength - and this is through a support group such as 12 Steps or Al Anon that will allow you to vocalize your fears, hear others and gain insight from one another. It's crucial that you find others like yourself who are on some kind of path who understand where you're coming from and how it is. There is much comfort there. Here too, an integrative holistic therapist could provide names of such support groups - which in most if not all cases are free.

Take care.
posted by watercarrier at 11:12 AM on February 18, 2009

That all sounds very familiar. I'm sorry things aren't going well for you.

1. Seeing a psychiatrist doesn't necessarily mean you'll be cowed into taking medication. So I'd suggest keeping an open mind with regard to the letters that appear after the doctor's last name. Unfortunately, I don't know any good ones in Manhattan.

2. Focus on someone who specializes in issues that are relevant to you. Are you suffering from PTSD and/or childhood trauma? Sexual abuse? Chemical dependency? Also think about the type of person to whom you'd be most comfortable speaking: a man, a woman, an older person, a younger person, a person from a particular cultural/racial/religious background. This is one of the few times in your life when it's really ok to be biased about people's backgrounds.

I'm a big one-on-one talk therapy person. Yet some of my friends are more of the "go out in the woods with a therapy group" type people. To each their own. Group therapy weirds me out because I find I edit what I say. I've found cognitive behavioral therapy works for me because I see patterns in my behavior and have learned to react differently to them; I'm a logical person so CBT is nice and binary for me.

3. First off, bear in mind that finding a good therapist is unfortunately much like dating. You likely won't fall in love with the first (or second or third) one you meet. So I'd suggest not getting too disappointed or discouraged when the first few aren't workin' for you. Again, much like dating, you'll click with the right person. You'll feel a comfort level that you just don't feel with the others. So please be patient with yourself during this process and don't set your expectations too high at this point; that'll only leaving you feeling more depressed.

I know it's really hard to muster the energy during a depressive phase to go through this amount of work. But, really, it's worth it. Take it step by step, along the lines of, alright today I'm going to see Applicant Number One. Next week I'm meeting with Applicant Number Two. Don't set the bar at "today I'm going to find a therapist that work with me forever." That's just too much pressure on yourself. Think of it as a job interview. You're interviewing potential employees to help you feel better.

Don't be badgered into seeing someone you don't like. This is all about YOU and you get to choose who you want. You shouldn't feel like you're writing a check that goes into a vortex of non-help. Take your time, shop around, ask friends/colleagues - if you're comfortable - for suggestions and recommendations.

At some point, you'll find one that rises above the rest. There aren't any specific criteria, you just kinda know when you get there. It just feels right, albeit somewhat awkward at first to be talking about your problems to a perfect stranger.

Best of luck to you.
posted by December at 11:50 AM on February 18, 2009 [2 favorites]

1) There are some new medications out that may be of use to you. For some people, depression is an organic problem and these medications may be required for the long term. For others, they can be helpful while other measures are taken.

2) Consider cognitive behavioral therapy. (Perhaps this is just personal bias, but... I like the solutions orientation and the emphasis on results.)

3) Always consider your first meeting with a therapist to be a job interview on their part. Some therapists will do a "get to know me and my approach" meeting at no charge if you ask about introductory sessions or the like. It won't be therapy, but it will be a chance for you to see if you are comfortable and the fit is right. A good therapist will understand that in addition to education and approach, there are innumerable intangibles that make for a successful relationship and will be supportive of you as you seek the best therapy available for yourself.

4) Best of luck.
posted by driley at 12:39 PM on February 18, 2009

Do you have an awesome regular doctor? Ask him or her for a recommendation -- good doctors of one kind know good doctors of other kinds too. If not . . . do you have acquaintances who are high-powered professionals or whatever? Ask for recommendations! (Say it's for 'a friend,' if you need to.) Even . . . OK . . say you call up a therapist that comes well-recommended, and they tell you they aren't accepting new patients at the time. Ask "Do you know of anyone else I might call? Who would you recommend?" and repeat as necessary.

Seconding a few of December's points above, also. Take a little bit of time to condense your aims/goals into a letter or 1-page summary or whatever, so you can get through the initial meetings quickly and easily (and you won't waste time). Do you want straight blah-blah talk about your childhood? New-agey feelgood stuff? No-nonsense practical suggestions about behavior? Identify your communication style and the direction you want therapy to take. If you can't really define that, write down what you DON'T want, or what things seemed unsuccessful about your previous efforts. Also: take the time to summarize your mental health history on a page or two. It will save time . . if you have to meet with several therapists, it will REALLY be handy . . . and, once it's written down, it might be sort of interesting/helpful just for yourself.

Good for you for making some positive changes in your life!
posted by oldtimey at 6:10 PM on February 18, 2009

I've said this before, but having just been through all this I found the Psychology Today website's Therapist Finder really helpful. You can search by zip code and specialty. This makes it much easier to shop around. My friend's therapist wasnt helpful and my doctor wasn't helpful.

You can email them with the 1 page summary/letter like Old Timey recommends, and then they'll call you to ask questions, give you a free phone consultation, or set up a meeting. This way you don't have to call people coldly and talk about everything, they have some history. This helped me so much and I was in no position to "shop around," or so I thought, but I ended up talking to a lot of people, much like an interview, and found someone I really like. I'm not sure exactly what his style is, probably CBT with some other stuff thrown in, but I feel like it's very collaborative. He challenges me and asks interesting questions. I like it, well as much as anyone can.

He doesn't have a PhD, but if you'd like the info mefimail me. Good luck!
posted by sweetkid at 6:46 PM on February 18, 2009

I'm so sorry that you've been depressed for years, and I'm glad you want to take some action. You deserve a better life, one free of depression.

A good first step would be to visit a psychiatrist to review your history and get a proper diagnosis. (This is entirely analogous to visiting an MD when you feel sick, describing your symptoms, and getting a diagnosis). From that you could discuss what options are available to treat you, from medications to various types of therapy.

As science investigates the human mind, it increasingly discovers the chemical basis for our brain's operation. Mental illness, and especially depression, is now largely seen as a chemical imbalance in the brain. New medications act in new ways to help restore the brain's proper functioning. Please don't dismiss medications from the get-go. Keep an open mind about them, because they *might* be the key to a healthier you.

Best of luck.
posted by exphysicist345 at 6:48 PM on February 18, 2009

One thing I forgot to mention above: there's a financial aspect to this, too, which is important to address before you get started. Think about how this is going to impact you financially and take appropriate steps to prevent financial difficulties (but of course, don't avoid going to a therapist simply because it's gonna cost you some bank - this is your health and it's worth more than anything). But think about your insurance situation (or lack thereof) and work within that framework. That is, use the above ideas in conjunction with what your insurance will/won't accept (in network, out of network, etc.).

If you don't have insurance, seek out options that perhaps offer sliding scale payments, for example. Since you're in NY, I'd venture to guess there's a whole smorgasbord of options available to you. In my universe (DC), there is a whole host of options available that cater to different income levels and abilities (universities, non-profs, etc.).

It might be too late for you to do this considering the new year just started, but for next year, think about whether employing a flex spending plan through your job is possible, if you're working. That can be a nice financial cushion for you. Alternatively, I know you're down and probably don't feel like doing this, but if you can work an extra hour or two of overtime and put that money in a savings account for rainy days, that'd be helpful too.

The key here is not to let the financial aspect of taking care of yourself get you down. The last thing you need right now is more stuff to depress you and tight finances can certainly do that.

Take good care.
posted by December at 10:12 AM on February 19, 2009