You've told me I need therapy; what type?

May 13, 2009 8:48 AM

Help me determine how best to go out seeking therapy so I can improve my life. For example, what type of therapist should I get (psychologist? life coach? psychiatrist? other?) and how should I approach it to get maximum benefit?

Well it was bound to happen..."go to therapy" is a common enough answer on Ask MeFi so now here is someone taking that advice.

A short summary of why I think I need therapy at this point: I am finding it hard to reconcile what I want my life to be (fame, fortune, scores of scantily clad women wanting to be with me) with what my life is (standard married boring almost 40 office drone). I am trying to adjust to Tyler Durden's sage advice "You are not a beautiful snowflake", but it's hard...

I feel I have to come to terms with this fairly quickly. Up until a year ago I was feeling on top of the world, but in the past year things seem to have fallen apart.

Current Job: my career came crashing down around me only partially due to the economy. Previously I thought I was on a path to a CEO position; I now find myself stuck in a dead-end job and no prospects for future advancement. Worse, I have an advanced degree in my field and at this age I can't afford (financially) a "career reboot" and start a new career at the bottom again "paying my dues"

Hopes and Dreams: My efforts at breaking into a dream vocation have been met with some harsh realities. I never wanted to be an office worker, I wanted to be an entertainer. I wanted to spend my time on this Earth making others' forget about their lives for a bit and simply enjoy something. I worked in college at writing and producing and tried to cultivate those skills in my off-hours post-college, but was always too afraid to make the big leap and move to L.A. leaving everything behind. I have had some serious talks recently with people who are in the business and I think perhaps it's time for me to give up that dream. But it's a depressing reality, to finally tell yourself "I'm too old for my dreams. I will never accomplish what I want."

Marriage: My marriage is not as fulfilling as I would like. We have been fighting a lot lately, and only partially because of my disappointment in my real and desired careers. We've been married 11 years and while I don't see the marriage ending, I find myself bored in it. We are in too many ruts and seem unable to break out of them.

In the end, in the span of 6 to 12 months I've gone from an energetic, excited person who felt he was on the verge of greatness, to a person who feels his life is no more significant than an ant carrying dirt back to make an anthill. I don't see anything good in my future, just more of the same. I feel that the best moments of my life are behind me, and that I have nothing else to look forward to.

But I think at 40 I'm too young to really be that old.

I don't think I'm clinically depressed, I don't think a chemical imbalance is at work. It's circumstance and coming to grips with reality, and I'm having problems figuring out how to do that. My entire life is now a question of "Why should I bother?" I don't think pills are the answer, and I don't really want to be on medications with all their side effects. Or perhaps I just fall into whatever this is called.

But I don't want to feel like my life is over, I want to be happy again. I want to be motivated again. So to try and find this I am going to therapy. But I don't even know where to start.

I feel like I need someone to tell me what I need to do, to point out to me something I'm missing, some way to get back what I've lost (my dreams, my ambition), but in talking to a good friend who has been in therapy for over a year he tells me that isn't what therapists do. He says a good therapist never tells you what to do, they just listen to you talk. Well...that's not quite what I need. I feel fairly self-actualized (which perhaps this post shows). I don't need someone to tell me I had a shitty father and a bad mother, I know those things and I can see the resonance of those facts in my daily life. I know all the root causes of what's wrong with me...I just don't know how to fix them.

Another friend had visited a life-coach for a period and that seemed to help him get his priorities straight and help him achieve many of his life goals. That said, he went in with specific goals and the coach helped him get there. I am pretty much goalless.

So...where do I go from here? I'm thinking psychologist (partially for insurance reasons; they'll cover psychologists but not life coaches), but from people who have been I'd like to know what you think I should seek, and how I should approach it, what my expectations should be, to achieve maximum benefit.

If follow-up info is needed I set up the anon email [e-mail] which I will check for the next few days.

Thanks in advance.

posted by anonymous to Health & Fitness (15 answers total)

The only advice I have, is that when you feel that you don't want to discuss root causes, but rather change the way you deal with things now, looking for a psychologist that specializes cognitive-behavioral therapy can be more satisfying.

They tend to be more action-oriented, than "tell me about your past." In your insurance has a directory of participating docs CBT is sometimes a listed specialty, of when you call to make an appointment, you can just say you're interested in CBT and ask if that is an approach they focus on.

FWIW, this is not a blanket endorsement of what's the best type of therapy, but I think that CBT can be more accessible.
posted by mercredi at 8:57 AM on May 13, 2009

I would go to the most convenient, affordable therapy available via your insurance as soon as possible, and start building out these questions one-on-one with that person then. Make a phone call, see someone, evaluate if it feels like a good start, and then either continue with that person or make another phone call. It sounds like you know you need to go and you have already done so much great introspection to get this far. Now you just need to... go. Pick up the phone.

Starting therapy is hard. Sometimes the desire to plan things out as much as possible before you actually begin them is a method of stalling, even if there's no good reason to. I mean this kindly, and without judgment, but are you sure you are not doing that?
posted by juliplease at 9:10 AM on May 13, 2009

To me, it sounds like you're right on schedule for your age-40 mid-life transition, what used to be known as the mid-life crisis. You've pushed yourself, you've made choices/sacrifices and you've gotten far, but now you're not satisfied with where you've gotten to, and you're struggling with the rest of you're life - will it be stagnant or filled with growth? Do you have to settle for what you've got or can you move on? Should you try to reclaim your adolescence or figure out a new way to be excited in the world?

It's a precious, dangerous, and difficult time - opportunities abound for introspection, learning, despair and bitterness. You can read about this time by looking at books on adult development - Levinson and Erikson are the two giants in this field. If you're looking for self-help type input, Barbara Sher is an author who speaks to your issues (though she does so in a cheesily enthusiastic way at times.)

As far as your question goes, good for you for thinking about getting help. You may well be depressed, and it may be that medication would be helpful, but I'd be wary of anyone who thinks that medication is going the be-all and end-all of your problems. It's worthwhile keeping an eye on the depression aspects, but I'd want to make sure that your therapist/coach's orientation is toward growth - that he or she understands the challenges of adulthood and midlife and can support you in this part of your journey. I'd certainly advise you to avoid rash decisions - in particular, don't throw yourself into an affair to add some drama to your life. I know you're feeling unhappy with your marriage - it may or may not be sustainable, but an affair is not a real solution, just distraction.
posted by jasper411 at 9:26 AM on May 13, 2009 [1 favorite]

I saw a therapist who specialized in educational and vocational issues because I was confused about professional stuff, but she was also a PhD counseling psychologist who was capable of working with couples, emotional issues, etc. She was also a faculty member at UPenn's Grad School of Education. That's what you want, she was totally awesome, if you live in the area drop me a line and I'll give you her info.
posted by The Straightener at 9:29 AM on May 13, 2009

Whatever you do, don't delay while you try to find the Exact Right Kind of Therapist. There's research (I can't recall sufficient details to Google it) to show that the type of therapy is much less important than a) getting yourself to therapy at all and b) finding someone who's a good competent professional with whom you can connect.
posted by game warden to the events rhino at 9:32 AM on May 13, 2009 [1 favorite]

A therapist won't tell you what to do, but he/she will help you figure out what you want to do - so don't rule that out.

I found Barbara Sher's book - "I Could Do Anything I Want If Only I Knew What It Was" very helpful. One of the best insights is that even if it doesn't work for you to drop everything and move to LA, there is still ways to make entertaining a part of your life. Don't give up on your dream, just take a different but still rewarding path to get to what you really want. It may look different than you originally thought but if it satisfies your real dreams then it will make you happy.
posted by metahawk at 9:46 AM on May 13, 2009

Also, chemistry is more important than title or training. Pick three that sound promising, make an appointment for a first session with each one and see who seems to fit you best. Then work with him or her for 2 months and see if you feel like things are changing. If not, find someone new.
posted by metahawk at 9:49 AM on May 13, 2009

I encourage you to research what the actual differences are between psychiatrists, psychologists, marriage and family therapists, and life coaches. There are vast areas of difference in what each field is geared toward.
Psychiatrists: are MDs, and specialize in diagnosis and medication for anything from depression to more serious psychotic disorders--some will do talk therapy, but it is fairly rare to find that.
Psychologists: individual talk therapy, sometimes family therapy--each one has their own specialization (older adults, education, children, depression and anxiety, family and parenting, and the like).
MFT/MFCCs (Marriage & Family Therapists): individual/family/couple talk therapy for relationship and life cycle types of issues (specialties will vary beyond that, but all have training in those basic areas).
Life Coaches: I encourage anyone to research what type of education and training background a particular life coach has before seeing him/her.

One idea is to check out one of the many "therapist finder" directories and look for someone in your area who specializes in the problems you are experiencing. Then see how well you feel you can connect with that person. Those are going to be the keys here--finding someone who knows a lot about how to help with YOUR problems, and the relationship you can build.
posted by so_gracefully at 9:57 AM on May 13, 2009

From reading your question, it seems you struggling with reconciling your life expectations with reality. (As someone who recently turned 40 myself, believe me, I can identify with this struggle). You might find some useful information in this previous AskMe on CBT and Mindfulness.

(I would also recommend The Mindful Way through Depression).
posted by Otis at 10:07 AM on May 13, 2009

I would go to the most convenient, affordable therapy available via your insurance as soon as possible, and start building out these questions one-on-one with that person then.

Do this. You can discuss treatment options and referrals with THAT person.

Trying to pick out what you think you need ahead of time is natural and can save you and your therapist some time, but you also need to careful here. This can also turn into something like showing up at your GP's office and telling him what to prescribe you. In the end, therapy is about trusting someone else to be able to look at your life and problems as objectively as possible and offer whatever help they see fit. Just as you might get second opinions from other GP's, so should you plan on seeing multiple therapists before committing to one path of treatment.

I wanted to spend my time on this Earth making others' forget about their lives for a bit and simply enjoy something.

There are so, SO many ways to do this, in all areas of your life. Start at home, and work outward from there. You might be surprised how much you can scratch that itch in your daily life.
posted by hermitosis at 10:09 AM on May 13, 2009

I would suggest calling a few local practices, describing what you're experiencing, and asking if there's someone available who fits your needs. You should feel free to interview your therapists over the phone or in person.

I might also suggest marriage counseling. You can go to someone who specializes in marriage counseling alone, or talk your partner into coming with you.

I personally think that just about everyone can benefit from therapy, regardless of whether they have a chemical imbalance or disorder or what have you. It is a great experience to have an unbiased professional with whom you can talk through your issues.
posted by emilyd22222 at 10:22 AM on May 13, 2009

You're casting a wide net, which is good. One thing to keep in pursuing therapy is that the rapport you have with the therapist has more to do with the efficacy of the treatment than the modality that the therapist is using.

So, like where Mercredi talked about your maybe not wanting to talk about root causes, CBT corresponds to that and sounds like a fit. Although, a good therapist of any modality should be able to conceptualize your situation and intervene based on the needs of your situation. I'm no cheerleader for CBT, but I respect what works for people.

Find the therapist/professional with whom you mesh well. That's the person who you'll feel 100% comfortable talking about and exploring some of the things that you might not want to or might not yet be able to explore.
posted by No New Diamonds Please at 10:34 AM on May 13, 2009

I'm a bit younger, but a lot of what you have said resonates, I don't think you are in any way alone in this. I would agree on the CBT, although to a cynical realist a lot of it parses like religion.

I would suggest that you try to involve your partner in the therapy at some stage.

Good luck, and if you find an answer, let me know.
posted by fistynuts at 11:23 AM on May 13, 2009

Highest priority: make a list of experiences you will have if you both (a) get help and (b) that help is not effective. If you wanted to weigh less and (a) got help but (b) gained pounds then you would know that particular form of help wasn't working. You have to have that in place first. Then you can seek help. Then you can judge if it's not working. If it's not working, do something else. If it's working, keep doing it and keep re-calibrating if it's a bridge to the next level of working or if it's a dead end and you need a new level of help or you're where you want to be.
posted by eccnineten at 5:05 PM on May 13, 2009 [1 favorite]

Okay, as others stated above: Psychiatrists prescribe medications - that is all that they do in my experience. I mean they follow up with you with maintenance appointments to see if the drug is working, etc. This is not where you would typically start.

A therapist is a good place to start. Psychologists, MSWs, etc. I think a good lesson here is that if you don't think your therapy sessions are working for you - you can find a new therapist and give it another try.

Lastly, in my experience: therapy works for some folks (you find the right therapist or maybe that is what you need, whatever)....medication also works for some folks (chemical imbalance or whatever)....healthy life changes work for some....and a combination of the three or two of the three work for many.

Best of luck. congrats for taking this on..
posted by fieldtrip at 10:08 PM on May 13, 2009