Finding the Right Therapist

January 23, 2005 5:15 PM

ShrinkFilter: I've been increasingly stressed, self-loathing and distracted for years, and (since my spouse and I are having a baby in a few months) have decided I need to Get Professional Help--mostly to figure out what's wrong with me and deal with it, so I don't pass it on to our kid. But "professional help" is a very big category, and I need to narrow it down. I want to find somebody whose perspective is "let's figure out the big problems and how you can fix them, as efficiently as possible," rather than "there's nothing wrong with you that years of expensive chatting can't prolong." I'd also like to avoid medication. How do I find the right... therapist? counselor? I don't even know what the right word is.
posted by anonymous to health & fitness (26 comments total)

I will say that the two therapists I've seen through my HMO were so unsatisfactory that I will never see another therapist, unless I someday hit the lottery and can afford real, professional help. Be that as it may, my advice is to get the best help you can pay for.
posted by AlexReynolds at 5:27 PM on January 23, 2005

It's taken me 10 psychiatrists and 8 psychologists to find someone who works for me, isn't a moron, and is serious about getting me the right medications.

My best advice is to hang in there.
posted by Ryvar at 5:33 PM on January 23, 2005

Therapy did a lot for me, but I think you need to keep an open mind, anonymous, about the way it works. It sounds like you want someone to identify your big problems, and tell you how to solve them quickly and easily- well, if you want that, go on Dr. Phil. "Expensive chatting", if you're doing it with someone who you click with, is what will really help you get better. Take the time to find someone you really like that really understands you- don't be afraid to try a lot of different people. If you are religious, check to see if your house of worship recommends someone- that might help find someone who understands your personal frame of mind.
posted by ThePinkSuperhero at 5:34 PM on January 23, 2005 [1 favorite has favorites]

Not everyone has a negative experience. But if you aren't happy with whomever you find, do seek out someone else.

I would say that you should seek a therapist (psychologist or counselor) first. There are some disorders that only a psychiatrist can diagnose, but a therapist should steer you in the right direction and tell you if you need to go that route. I don't know if you have a disorder (depression, etc) or just need some general help, but a therapist can tell you that too.

I know you don't want medication, but if they find that you have a disorder that requires medication, it really can be the best thing for you. I feel ten thousand times better now that I am medicated than how I felt before. It's just like taking meds for any other illness.
posted by veronitron at 5:38 PM on January 23, 2005

It's not easy to find the right person. You want someone who you feel comfortable with and can trust. You want someone with the right professional preparation and experience. And you want someone who can "get" you on a basic level, too. I called around looking for someone once, and found that you have to pay to sit down and have an initial talk with a shrink. Like it's your first appointment or something. I still think that's a bit lame, but it seems to be common practice.

There are 2 things you can do to improve your chances. Learn as much as you can about the various treatment strategies that are out there. You may find you like the sound of one of them better than the others, and you will be able to find someone with training in that approach. At that point, the other thing you can do is network. Way more people than you think have had experience with therapists. Ask people you trust and respect if they can recommend anyone. Also check and see if there are any free counselling services in your city or a nearby university. While they might not be able to meet your needs, they might very well have referrals to offer you. Otherwise, you're stuck shopping around at $100+ per attempt.

Good luck! Your decision represents sound judgement and a responsible, loving gesture toward your child. Follow it through.
posted by scarabic at 5:42 PM on January 23, 2005

Look for a cognitive-behavioral therapist if you want proven results.

Most people go to therapists who operate on various theories based on talking about you and exploring how you feel about things and why you feel that way. Although many people vouch for this type of therapy through anecdotes, it has never been proven scientifically to work.

Cognitive-behavioral therapy has been proven to work. Instead of looking at why you feel a certain way or have a certain problem, it looks for ways to change your situation.

So instead of looking at why I was having panic attacks and anxiety problems, through cognitive-behavioral therapy was able to teach me new ways to approach situations. I almost never suffer from those problems any more, because I have learned how to avoide them. And when they do come back, I have tools that help me deal with them. It's all based on choices you make, and you don't have to blame your problems on your mother to get better.
posted by croutonsupafreak at 6:09 PM on January 23, 2005

All (all) of my personal and secondhand knowledge of therapy says that progress just does not come quickly... certainly not in less than 6 months, and usually significantly longer. Also, don't put too much stock in referrals from friends; I tried a guy who a friend had a great experience with, and it turned out terrible. A therapist that's good for someone you know won't necessarily be helpful to you.

The only clear advice I can offer is to notice how long your initial session is. To shrinks, an hour is never longer than 55 minutes, but for some, its 40.
posted by gsteff at 6:14 PM on January 23, 2005

A lot of people in the recent past claim to have benefitted from reading Feeling Good by Dr. David Burns. Probably the most well-regarded (non-academic) book on cognitive therapy and might be worth reading before you see anyone.
posted by billsaysthis at 6:19 PM on January 23, 2005

I had a friend who was in a similar situation. His Dad drank a lot and beat him. He was afraid he would do the same thing with his kid. He talked it over with a counselor for a while and says it really helped him.

Just go in and meet counselors until one clicks with you. By meeting counselors, they also can put you in touch with other counselors that might be better for your situation.

I found a great counselor once by simply choosing at random from the yellow pages. Find someone that takes your insurance and try calling them. Say you are interested in meeting with them, but not sure if your type of problem is what they specialize in.
posted by xammerboy at 7:31 PM on January 23, 2005

"Therapist" is a generic term that refers to any of the different kind of health care professionals who do work around mood, behaviors, and psychological issues in general. There are specific groupings based on professional training, but there's lots of variability between states, and licensure is a state function.

Typically there are psychiatrists, who are MD physicians who've had specialized training in emotional/behavioral issues. Sometimes this training is quite abbreviated, which gives other practioners fits. Be that as it may be, psychiatrists are the only mental health specialists who can prescribe, EXCEPT in New Mexico, which just granted psychologists the right to prescribe (and Louisiana is apparently coming down the pike). Many psychiatrists (not all) spend most of their professional time around medication issues. If you specifically don't want meds, you probably don't want to start your search with a psychiatrist.

Next are psycholgists, which are typically doctoral level people, though in some states I believe master's level clinicians can call themselves psychologists. Then there are the master's level practitioners, typically social workers, and, out here in California, MFTs (marriage & family therapists). Generally "counselor" refers to a bachelor level training, and "counseling" is seen as different than "therapy."

This is probably heretical for my discipline (psychologist), but I do not see a lot of compelling reasons why someone would set out to choose only a member of one or the other disciplines - there are some reasons, like psychiatrists can do meds, psychologists can do assessment, etc. But I know really good therapists who are members of each discipline, and I know really bad therapists who are members of each discipline.

Cognitive behavioral therapy is good for some things and for some people. So, even though there is specific research evidence about the efficacy of CBT under some conditions, I wouldn't limit my search to someone who only does that particular mode of work. Psychotherapy research is very complicated as there are lots of factors to balance out. In general, my feeling is that as therapists gain more experience they tend to become less doctrinaire and more eclectic, and borrow techniques from lots of different strands of therapy.

You should find out if the therapist has experience/training in any area that might be relevant in your situation. For example, if drinking/substance use is an important part of your situation, you would do well to find someone who has experience in that area. That said, in my view a major determinant of whether a therapist is going to be helpful is the "fit" between you and the therapist. If you feel comfortable and trust that someone is going to be helpful, my sense is that that relationship has a higher chance of working than if you don't. Unfortunately, I think this means that you've got to become a health care consumer and get out there, making calls and meeting people. Tell the therapists that you're shopping around, set up a meeting and ask all the questions you'd like about how they would work with you. If you don't like the answers, or feel that it's not exactly what you want, move on. If you decide you want to stay with someone, continually evaluate whether you are reaching your goals, or whether the therapist's plan makes sense to you. Remember, the therapist is *your employee* - you are paying their salary, and you're entitled to interview them to see if they're a good fit for the job.

Where do you get the names to start off with? I think friends and colleagues are a really good place to start. If you choose to use insurance, your insurance plan probably has a list of providers. Also, many areas have referral services that are either outgrowths of professional organizations, like this. Other referral services represent a group of practitioners who pool their resources together.
posted by jasper411 at 7:37 PM on January 23, 2005 [1 favorite has favorites]

Here's another vote for cognitive-behavioural therapy. By learning to notice your behaviours, you gain a deep understanding of where your problems are. The hardest aspect of recovery is identifying that which ails you. You can feel malaise for years and not understand why, or think it's purely physiological. CBT with a good therapist can expose some plainly obvious habits that you never thought to acknowledge, and the methods are surprisingly effective. By challenging the implicit assumptions behind your actions you can learn to phase out those habits through repetition, and you will learn a lot about yourself in the process. It can be tough to stick with it, but even going through a basic CBT program will yield some kind of positive result for almost everyone. It is expensive but worth it.
posted by Succa at 8:40 PM on January 23, 2005

If your work (or your spouse's) offers an employee assistance program, that can be a good way to find a therapist. I found mine through my mom's EAP. I called the number, went for three sessions with one of the EAP's counselors (they were free) and then after the third session, the EAP counselor referred me to my psychiatrist, whom I still see. He's definitely helped.

Like everyone says though, it is a matter of finding someone you are comfortable with. If the one doesn't click with you, keep trying others til you find someone who does.
posted by SisterHavana at 8:52 PM on January 23, 2005

I'm about to try my own form of therapy: I'm going to go volunteer. I figure working with people, and especially disadvantaged (homeless, handicapped, mental health) patients will clue my brain into just how fucking lucky it is to have all the advantages it does.

And, anyway, helping people always feels good.
posted by five fresh fish at 9:38 PM on January 23, 2005

ditto what veronitron said.

i've had years of therapy, but always avoided medication and would endure cyclical bouts of depression. last year was a bitch and i finally decided that i really had no good reason not to try. i feel a gazillion times better. it's a huge step to take, but well worth the long term benefits.
posted by heather at 10:38 PM on January 23, 2005

There's no substitute for a good recommendation from someone you trust, and for your own sense of rapport (or not) after the first session. Like lawyers, many therapists offer a first session for free. Also, when I started therapy I asked a counselor friend to recommend a few folks, and was surprised by her first question: "Do you want a male therapist or a female therapist?" Thinking about the answer to that one helped get the process going, so it might be worth considering.

Having a nonjudgmental person I could bounce observations off of and a place where I could feel safe letting some long-buried crap rise to the surface worked pretty well to cut through some bullshit I'd been telling myself about myself. It wasn't a cure, but it definitely helped me cope at a higher level.
posted by mediareport at 11:18 PM on January 23, 2005

It took me going thru all kinds of meds and non mental health type doctors (mostly internal medicine) and therapists until I finally was able to see a real psychiatrist and get on the right track. Within one session he was able to figure out a med that worked for me based on discussion of my family history and the history of the meds that didn't work. I'd say go see the real deal to begin with and don't bother with people who don't have both the medical and therapeutic training. Stick with a psychiatrist, hopefully one that someone else had a good experience with. Another note, from your description of your issues I don't think Cognitive-behavioral therapy may be your best choice. IANAD
posted by white_devil at 5:21 AM on January 24, 2005

I agree with what's been said about finding the right person... it's like any relationship. If you don't feel some kind of rapport with the person, it can be useless or even make you feel worse to talk to them (yet another person who doesn't understand me...).

Meds should never be the first line of defense, IMO; they're prescribed way too easily these days and very often will just be treating the symptoms and not the underlying cause. They're like pain meds - in some cases, there is no reason for pain; it just happens, and should just be treated. This is rare; it would be a nerve disorder. The same is true of depression. Here and there, it is probably just a 'chemical imbalance', an analog of nerve disorder of some sort. Most of the time, it is a response to or symptom of other elements in your life. You can certainly take pain meds while treating a disease, but generally you shouldn't think of the pain meds as the treatment itself.

Sometimes just talking about problems is pretty unhelpful, though - it seems to me that it can even exacerbate issues to focus on them too much. I've never tried CBT, but it has always sounded sensible to me, and I might give it a go if I found myself in a bad patch again.

I have to say, though, that for me it was honest reassessment and some pretty big goal changes (breaking off a relationship, quitting my job, going back to school) that have made me happier the last few years than I was for the years before that. Remember that you only live once and you'll be continually, albeit often quite subtly, frustrated, if you are living a life that differs significantly from the one you know somewhere you actually want. Try to figure out what it is you actually want and see what you can do to get there.
posted by mdn at 5:41 AM on January 24, 2005

I'm a social work therapist who works in what is broadly called a "common factors" approach.

What we know about psychotherapy: it works for many many people, that it can bring results fairly quickly, that early change in therapy is indicative of the possibility for later change, that no technique or theory is really any better than any other (in other words, CBT does not work better than other kinds of therapy), that some therapists are better than others for some patients, that extra-therapuetic change accounts for over 40% of the positive mood change people experience during therapy (getting a job, having a kid, starting to exercise, volunteering), and that relationship with your therapist, hope that change is possible, and a plan for the future account for the vast majority of the rest of the positive change. The theory that a practicioner uses accounts for between 1-9% of the change.

So find someone that you like, someone that is focussed on change rather than on insight, someone who can help you make a plan for how you will feel better. If you do not see results quickly, think about finding someone else. If you are geeky and want to read about the ways that therapy works for people, including good meta-anlyses of studies of therapy and medicine, consider the following books:

The Great Pschotherapy Debate (technical and not very interesting, but a lot of good data)

The Heroic Client
The Heart and Soul of Change

The last two books are very accessible and might really help you to decide what you need in a therapist.
posted by OmieWise at 7:07 AM on January 24, 2005

MeTa
posted by dame at 7:16 AM on January 24, 2005

I would caution against seeking out a specific kind of therapy. That kind of decision is best made between you and your therapist, no one here has enough information to provide anything close to a diagnosis or make an informed recommendation regarding what therapies would be most beneficial to you.

All of the advice about finding someone you trust is right on. The best therapists in the world will not be able to do anything for you unless you trust them and follow their advice. Therapists will not get upset if you decide to shop around. Anyone who has done clinical work will be aware of the concept of finding a "match" and the best of them will encourage your searching and recommend people you might like.

Feel free to email if you want to talk about any of this stuff, it will of course remain confidential.
posted by spaghetti at 8:27 AM on January 24, 2005

Plagiarizing from myself from this thread:

Just wanted to make one point that I haven't really seen mentioned in this thread, 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. I assume you are seeing someone related to your pregnancy. That might be a good place to start. What is vital, though, is that there are potentially serious medical conditions that sometimes present as (or complicate) chronic and/or clinical depression. Also, pregnancy itself may be contributing to this condition, and pre-existing conditions may make you especially susceptible to post partum depression after the baby is born. Therefore, it is important that your current doctors be made aware of potential complicating factors.

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, both for you and your baby.

###

As for those urging Anonymous not to rule out medications, please keep in mind that she is pregnant.


Best wishes, Anonymous!
posted by Man O' Straw at 9:04 AM on January 24, 2005

As for those urging Anonymous not to rule out medications, please keep in mind that she is pregnant.

or the partner of someone pregnant, no?

I had actually assumed the poster was a husband because of "my partner and I" rather than just "I"... but the q doesn't specify anyone's gender or pregnancy status, so could be male or female partner of a pregnant woman, or a pregnant woman with male or female partner.
posted by mdn at 9:40 AM on January 24, 2005

[The poster said avoid, not rule out.

Having said that, there are certain physical symptoms that one has when one has a biochemical mood problem. If he or she doesn't have those, it is probably a matter of "changing stinking thinking."

My recommendation is to ask your primary care physician for a referral. You need to find someone who you click with as far as personality, someone you will enjoy talking to. You also might want to see if any group therapy is out there and available-sometimes watching other people work thru things gives you insights into your own situation.


And finally, I can heartily recommend regular vigorous exercise as a mood elevator and a stress reliever. It doesn't fix my bipolar disorder but it makes me a lot easier to live with. Oh, and a good B complex vitamin once a day helps too.
posted by konolia at 9:58 AM on January 24, 2005

Hmm, mdn... You have a good point. I took "so I don't pass it on to our kid" literally in combination with the "my spouse and I are having a baby," and the reluctance to take medication. But it may not have been intended that way.

Either way, having a doctor rule out potential medical problems prior to determining a course of therapy is always a good idea.
posted by Man O' Straw at 10:34 AM on January 24, 2005

It seems like the crux of this arguement is that with both meds and therapists it is a process of trial and error. A course of different meds or visiting different shrinks is the only way to find what works for you.

It really took me 7 years to find a shrink who has given me the right diagnosis. I have never found a therapist who has worked for me, so I prefer meds. However all this talk of CBT is very interesting.

If you are in NYC, NY-P has a referral directory where you can look up doctors. That is where I found the only shrink who could put two and two together.
posted by scazza at 10:52 AM on January 24, 2005

I also second what veronitron said above--

Therapy really helped me and I went for about 4 years but eventually I realized that everything I was doing right (therapy, exercising everyday, eating right, etc.) just wasn't working. Taking medication has really made all of the difference and I was very opposed for many many years.

I do know that CBT is proven to work really well, and is actually the first line of treatment recommended by the APA now for some disorders (I know for panic disorder, for sure).

My one suggestion in terms of finding someone good--is there anyone you know (friends, family, etc.) who could recommend someone? My mom happened to work as clerical help in a mental health office. One of the therapists there recommended the person I saw for four years. I had a friend go to her with much success as well.

Good luck!!
posted by fabesfaves at 4:10 PM on January 24, 2005