How do you find a therapist?

January 8, 2005 2:34 PM

Related to this question, what's a good way to find a qualified therapist, especially to look for help with depression? I don't actually have a personal physician (aside from the guy who's name is on my chart at the HMO).
posted by anonymous to health & fitness (12 comments total)

At least for me, it helped to find a good primary care physician first. Once I established that relationship he was able to recommend a therapist.
posted by corpse at 2:41 PM on January 8, 2005

I found one I liked via the search function at 4therapy.com. I am sure they have to pay for inclusion on that site, but I liked being able to read about the education, specialization and interests of the various therapists.

I've also heard of asking friends to ask their therapists for peer recommendations.
posted by xo at 2:47 PM on January 8, 2005

Both corpse and xo offer good suggestions, but ultimately, you're going to need to do a little bit of shopping to find just the right person. If you're under an HMO and have no other insurance, then you might start by finding out what psychiatrists in your area are covered by your HMO (this information can probably be obtained from your HMO's website). Find a doctor convenient to you and make an appointment for an initial consultation. After meeting her or him-- and this is vital-- if you don't feel one hundred percent confident that you are comfortable speaking freely to this person and that he or she has nothing but your health and best interests in mind, find someone else immediately. There's very little room for benefit of the doubt in this game, so don't feel discouraged if you don't feel like any given doctor is right for you. Good luck. With a little legwork, I'm confident you'll be able to get the treatment you need.
posted by Faint of Butt at 3:15 PM on January 8, 2005

Metanoia has an article on this very topic.

There are statistics (which are, unfortunately, vague in my mind at the moment) which suggest it can take a few years to even get a correct diagnosis (especially for bipolar patients). The related statistics also suggest that, on average, people will see at least a few different mental-health professionals before finding a compatible one. I don't mean to make this sound like "It's a long, grueling, miserable journey" -- rather, I mean to say, "Don't worry if it doesn't initially work out quite right!" Try to keep the big-perspective in mind and remember that help is on the way.
posted by oldtimey at 4:47 PM on January 8, 2005

See also this thread on finding a therapist...
posted by daver at 5:45 PM on January 8, 2005

anon -

trying to be cognizant of my own bias, but you would be well served by locating a primary care doc that you click with. The name on your HMO card need not be your doc. Talk to friends at work, etc. that may be on the same plan, find out who they recommend,. and see if they will take you as a patient. If their practice is closed, ask the staff to send a message to the doc, stating that they were recommended highly by your friend, etc. Sometimes the best docs close their practices but will take patients on a case by case basis.

A seasoned doc will know who the good therapists are, which usually means competency combined with common sense and empathy.

Good for you for finally getting some assistance.
posted by docpops at 10:07 PM on January 8, 2005

I disagree with the notion that physicians know who good therapists are. They might have one or two colleagues that they like to refer to, but in my experience, their scope of knowledge about therapists is quite limited. But more important than that, is that someone who is a good therapist for one person might be a terrible fit for another.

You need to get a bunch of names, and interview them - first over the phone, and then in person if possible. When you talk with the therapist, feel free to ask lots of questions about their experience with people who have problems and goals like yours. Then pay very close attention to your instincts about their manner, their answers, and so on. Don't feel like you have to decide in a hurry. Meet several, and try out the one you feel has the most promise to be able to help you with your concerns.

Where do you get the names from? My advice is to gather names from friends, if possible. If not, many communities have local psychological associations: for example, the San Francisco Psychological Association is a local affiliate of the state and national associations. Your community probably has some such referral network, which is a good start, but really, IMO, there's no substitute for meeting with and getting a feel for the therapists before you begin working with them in earnest. Feel free to email me if you'd like - maybe I can track down a local psychological referral network - address is in profile.
posted by jasper411 at 10:37 PM on January 8, 2005

I can't help on the specific issue of what's the best strategy to find a very competent counselor/psychiatrist. The above suggestions are all pretty good. And even to the degree that jasper is right, it won't hurt to start with your GP for some names.

But I do think you should take a step back and use your GP to help decide (or find someone, a psychiatrist perhaps) that you can use as a first-step to finding, the right long-term professional(s) for your needs. Specifically, I've long been of the opinion that given that most psychiatrists today eschew or don't care that much about talk therapy (aside from the analysts, but that's a different story, really) it's best to find and go to a good counseling psychologist for your talk therapy. That is a problem because there's a variety of different schools of thought and finding the right approach for you, even more the right therapist, is complicated. I'd suggest exploring (introspectively or, preferably, with some help) what it is you think you might get from talk therapy and how you might get it (that is, exploring childhood issues, or your habits and lifestyle, or your habits of thought, or a melange of different approaches) and find someone highly qualified and with a good reputation that will help you work through your issues in that manner.

On the medication side, I've come to believe that since most psychiatrists are essentially psychopharmacologists in practice, that's the expertise you should be looking for in a psychiatrist. Look for someone who really knows their medicine and science with regard to the drugs they are prescribing.

Finally, I think you really want the pair, along with your regular physician, to cooperate...at least minimally. But ideally, much more closely.
posted by Ethereal Bligh at 1:47 AM on January 9, 2005

jasper, at the risk of sounding defensive, how in the living fuck would a general community psychological association be of more value than someone that just spent a half an hour talking to you? I know therapists that are superb with certain types of people and horrible with others. Some people want a therapist that is more clinical. Maybe you have religious preferences, maybe you are more of a holistic, maybe you are an incredible skeptic, maybe you are a young, anorexic new mother.

I do agree that a good therapist should give you a few minutes of their time over the phone - any that I recommend will do that. I also don't refer to anyone that doesn't dictate thorough consult notes, or who won't collaborate freely with the persons doctor.

As far as recs from friends, great idea, except that most people won't really go to their friends with that kind of query, from what I have found. In fact, it's one of the things I tell people the first time we meet, that their friends will tell them about their gall bladders, their erections, their aunt with cancer, but not their own struggles with depression or anxiety, in most cases.

Trust me, we don't make money off of a forty minute visit with a patient who is depressed or anxious. But it is one of the more gratifying aspects of being a family physician.
posted by docpops at 9:37 PM on January 9, 2005

"jasper, at the risk of sounding defensive, how in the living fuck would a general community psychological association be of more value than someone that just spent a half an hour talking to you?"

You do sound defensive, and I think there's good reason to think that you might be wrong, too. Taken together, that seems irresponsible to me. Just because it's very rewarding to you to do such work, doesn't mean you should.

As a GP, your knowledge and experience of various counselors is going to be greatly limited relative to that of a bunch of people who have pooled their extensive experience of different counselors. Further, you don't have any special expertise in this matter. Exactly in what way are you more qualified to evaluate someone's psychological counseling needs than anyone else?

The reason that a "community psychological association" might be much more helpful is because the people there would have a more comprehensive knowledge of the counselors in the area and, more importantly, the types of treatment each specialized in; and, also, actual experience with those counselors.

You are being defensive. I say this as someone who's a strong and outspoken advocate for the central importance of a GP in an individual's medical care. Aside from this particular disagreement between us, I do think that one's primary care physician should be involved in these decisions and involved in the treatment (at least in the sense of being "in the loop").
posted by Ethereal Bligh at 10:23 AM on January 10, 2005

Point taken. As a response, though, consider the average sized community's likelihood of having an association such as you mentioned. Perhaps so in a fairly progressive city, exurb, or more progressive community. Here where I practice, and where I was in residency, there was nothing of the sort. You got a secretary on the phone. Maybe she had personal knowledge of a certain practicioners style, maybe she just liked their phone manners.

In truth, most people will probably be OK with any number of therapists, as long as they are reasonably professional, non-judgemental, and have more common sense than their patient. But other people approach counseling with great trepidation. I wouldn't send a young male patient who's wife is divorcing him because of his internet porn interests to some therapists because I know full well that they are born again fundies. Likewise, if a patient swears that her afflictions are the work of food additives and lunar cycles, well, I know just the lady for her.

As far as special expertise, I would disagree strongly. People become proficient not at what they are taught, but what they do day after day and by seeing the effects of their interventions and also from their errors. Most FP's see more mental illness than any other general condition, save for uncomplicated respiratory illness.

Jasper stated outright that it was his contention that doctors do not know who the right therapists are, and beyond that, refer based on habit, or something equally vacuous. So the strength of my response wasn't defensiveness as much as it was a call-out to an opinion that made no sense to this practicioner. And I don't think I'm particularly unique.

And yes, I tend to drop the F-bomb a little too easily. It's such a satisfying thing, for some reason. Maybe due to the kids and the limits they bring to the realm of audible profanity.
posted by docpops at 7:16 PM on January 10, 2005

Just wanted to make one point that I haven't really seen mentioned in either of these threads, yet, re: therapists:

It is very important that you start your search with a licensed medical doctor; whether that's a GP or a Psychiatrist will depend somewhat on your individual circumstances. What is vital, though, is that there are potentially serious medical conditions that sometimes present as (or complicate) chronic and/or clinical depression. Unless you are at serious risk of hurting yourself, your first order of business needs to be obtaining a thorough physical checkup from a doctor with whom you must be totally forthcoming and honest. A GP will set this up at your request. A Psychiatrist will initiate this preliminary to initial diagnostics.

As has been stated, an accurate diagnosis is key to effective treatment. It may also have other health implications. An appropriate therapy course – whether psychological, pharmacological, or both – must start with a complete medical history.

Best wishes!
posted by Man O' Straw at 4:08 PM on January 11, 2005