That Boy Needs Therapy

August 13, 2009 4:06 AM

I'm a male in my early twenties who has washed out of college and is looking for a mental health professional of some sort in Northern Virginia. Issues I feel are likely to come up are my (long-ago diagnosed) attention deficit disorder, depression, and some form of OCD - I have a deep and (likely irrational) fear of psychosis and other impairments of cognition. I am deeply wary of psychiatric drugs, and want to work with someone who shares my attitude toward them, but would recommend them as a last resort. So what I'm after is some sort of talk therapy, preferably with a medical doctor (as oppose to "just" a PhD).

I think would prefer CBT over other modalities. Freud, Jung, Lacan and their ilk aren't for me, but anything else is fine.

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posted by anonymous to health & fitness (11 comments total)

There is a joke among therapists that people come to them seeking help, and then resist your attempts to do so. Boy, do you sound like that!


You talk about "Issues" that might come up, and then list only diagnoses. It's good that you have some insight into this, and I wonder about if there is some deeper seeded stuff than, you know, self-labeling, going on for you. It can be scary, and feel like opening the floodgates, to go into some of the vulnerable stuff. Talk therapy is not fun and games, and it often involves kleenex. CBT will be more goal-oriented, and that might be appealing to you-- it doesn't sound like you really want someone digging around in your backyard too much given the length and content of your post.

"So what I'm after is some sort of talk therapy, preferably with a medical doctor (as oppose to "just" a PhD)." This is an interesting conclusion that you draw. Psychiatrists, or the MDs to whom you're presumably referring, tend to do less of the talk therapy, and more of the prescribing. Medical Doctor--medicine--prescription. Given your deep wariness of "psychiatric drugs," that's even, yeah, more minutia. (Could you be self-sabotaging this attempt to get help from the outset? Too pithy! F that!) If you're looking for talk therapy, someone with a PhD in Psychology might be "just" the thing.

As far as drugs go though, no one is going to force you to take them. Are they for you? Who knows. If you do start with one, and its not right, guess what? You just stop taking it and work with the psychiatrist to find another one. It's a lot less scary when you realize that you and the professional with whom you're working are on the same page, and just trying to deal with what's in front of you. If you're worried about drug pushers, the PhD is probably going to be less into that than a Psychiatrist.

I've had a bit of a field day with this, and I am genuinely sorry for what you are dealing with. From what you've said, and in the way that you seem to have really nailed down the specific (and maybe dubious) way about getting yourself some help, I can't help but think that you're going about getting therapy in a very narrow sort of way. That's not good. My general advice is to be a little more open to finding a professional to work with and open to working with the professionals you find. That willingness might take you further than some of the conclusions you've already drawn for yourself.
posted by No New Diamonds Please at 6:49 AM on August 13

So what I'm after is some sort of talk therapy, preferably with a medical doctor (as oppose to "just" a PhD).

I'm sorry but as someone who will be a psychologist in a little over a year I take offense to this statement. I really hope that you didn't mean that the way it came across. You claim that you don't want to take the meds, but that is what you would see a psychatrist for. At least, I'm assuming you mean psychiatrist when you say MD. I think you're going to have a really hard time finding a psychiatrist who will be willing to do talk therapy and not prescribe anything. In my experience, many (NOT all) psychiatrists will only prescribe meds. On the other hand, you'll find a lot of psychologists who would be willing to work with you without pressuring you to get medication. You do realize that psychologists with "just" a PhD/PsyD have gone through years of training to help people with problems such as yours through therapy, right? Its not like we just woke up one day and said, "you know, I think I'll go get my PhD today".
posted by Nolechick11 at 6:59 AM on August 13

You're also ruling out licensed social workers or professional counselors, who only do talk therapy since they can't prescribe. I agree with the other commenters; going with an MD is highly unlikely to get you someone who "shares my attitude toward [psychotropic drugs], but would recommend them as a last resort".

Disclaimer: I have a PhD in another field and am training to become a licensed professional counselor.
posted by catlet at 7:32 AM on August 13

There is free and low-cost mental health counseling available at the Foggy Bottom campus of the George Washington University (accessible on the orange and blue lines from Northern Virginia). It is called the Community Counseling Center and their phone number is 202-994-8645. There is also a center in Alexandria (near King Street Metro) and that number is 703-299-9148.
posted by parmanparman at 7:32 AM on August 13

Psychiatrists aren't any more qualified to give talk therapy than a PhD psychologist. What differentiates their training is their ability to prescribe. Also, it will be difficult for you to find a psychiatrist that will use talk therapy over medications - unfortunately, psychiatry today is more about what drugs to prescribe than spending quality time with patients. You are far more likely to find the treatment you are seeking with a psychologist or social worker. These kinds of professionals will use talk therapy exclusively until they feel that medication is warranted, at which point they will refer you to a psychiatrist. In addition, they will likely be much more cost-effective than a psychiatrist.
posted by sid at 7:39 AM on August 13

So when did you become an expert on psychology, to the extent that you know more than a psychologist or a psychiatrist about the kind of treatment and medication which is appropriate for you? They have degrees and training in their field. You do not.

Why not let them decide how best to treat you? If you enter into the process with the attitude you appear to have, you aren't going to find any kind of relief.
posted by twblalock at 8:16 AM on August 13

Well, I understand your reluctance to be medicated. I think that a PhD might be the right way to go. They usually have a relationship with a psychiatrist who can medicate you if you need it. That way you will have 2 opinions about it.

Of course, there are psychiatrists who are excellent at therapy. PhDs just tend to be more therapy focused. They can also be cheaper...woo!

The Psychology Today therapist finder is good.

Studies show that the number one factor in successful therapy is your rapport/relationship with your therapist, so try to focus on that as your number one priority. If you're not into Freud and the like, the keyword to avoid is "psychodynamic".
posted by kathrineg at 10:29 AM on August 13

So when did you become an expert on psychology, to the extent that you know more than a psychologist or a psychiatrist about the kind of treatment and medication which is appropriate for you?

You know, being proactive about what you do and don't want out of therapy is important. The poster is open to medication as a last resort and, in fact, wants to be seen by someone who can prescribe. I think that he is being reasonable and has a right to choose what he wants. It is his body and mind and I do not think it is helpful to diminish his role as his own caretaker.
posted by kathrineg at 10:32 AM on August 13 [1 favorite]

But if he has strong biases from a position of ignorance or disinformation then he may be setting himself up for failure. He should really take the advice of his doctor(s) not what Oprah or Kevin Trudeau are saying about medications.
posted by damn dirty ape at 10:53 AM on August 13

"The poster is open to medication as a last resort and, in fact, wants to be seen by someone who can prescribe. "
posted by kathrineg at 11:30 AM on August 13

If you're looking for a qualified CBT therapist in your area, I would definitely look up one on The Academy of Cognitive Therapists. It's a useful association that requires therapists to be fully vetted before they obtain certification; so all the therapists on the list are fairly competant. There seem to be a decent number in Northern Virginia.

I think some of the above posts are excessively harsh: like Kathrineg said, it's great that you know what type of therapy you are looking for and what you can get out of it.
posted by HabeasCorpus at 7:34 PM on August 13