Get a therapist: how?

May 19, 2010 1:02 PM

"Get therapy" seems to be a common decree around these parts, but that's usually where the suggestion begins and ends. Okay: but how? Can I get the Baedeker Guide to Seeking Therapy?

Let's say I come to a point in my life where talking myself out of my problems isn't quite cutting it anymore, and I decide I need the help of a mental health professional to un-wedge me (or help me un-wedge myself) from a mental rut. A good first step. Then what do I do?

Assume for the sake of argument there is no clear single hot-button issue or diagnosable problem like depression, anxiety, work trauma, etc., that I'd need a specialist for: let's say I'm just generally interested in receiving help sorting through my problems and developing the tools needed to be successful in taking charge of my life.

• How do I go about choosing a therapist? How do I determine whether I am in need of the services of, or distinguish between, a counselor, career counselor, social worker, psychologist, or psychiatrist? Is it the severity of the issues at hand? Their nature? What I can afford?
• How do I locate a therapist? Do I ask my primary care physician for a suggestion, or do I just whip out the phone book and go from there? If so, how do I determine if the person in question is well-established and well-respected or scammy? Is there such a thing as a "general issue" counselor? Are there therapist referral sources?
• How do you decide on a type of therapy? How is one to know whether she wants psychoanalysis, behavioral therapy, group therapy, CBT, or any other of the vast number of methods and approaches?
• What about seeking out low-cost options? What about determining the applicability of health insurance?

This is suggested so frequently around here without any follow-up for the nitty gritty how-to aspects, and I actually have no idea how you'd go about doing this in real life, so I figured I'd ask.

Just to clarify, this is more of a general purpose inquiry than a personal or situation-specific need. I'm looking for the general thought process, decision tree, and resource guide. Thank you!

posted by gavagai to Health & Fitness (17 answers total)

Where do you live? That will affect the answers.
posted by different at 1:07 PM on May 19, 2010

I me-mailed you.
posted by Zosia Blue at 1:16 PM on May 19, 2010

Many larger workplaces have some sort of assistance program that can help pay for therapy services. You might inquire with your HR rep about the possibilty of these existing.
posted by Big_B at 1:16 PM on May 19, 2010

As for general thought process, if using a similar program to what I mentioned, there is a list of approved providers just like with a doctor or dentist. Calling names on the list will tell you if they are or are not accepting patients, and if they are you can usually (in my experience anyway) chat with them for a bit and get a feel for if they will work for you. Obviously you have to be able to trust the person, and (again, in my experience) it was pretty obvious either over the phone or in person at the first meeting if it was going to work or not.

It's just like going to any other doctor in my mind, but instead of looking at you and running tests there is lots of talking.
posted by Big_B at 1:21 PM on May 19, 2010

Response by poster: I live in the United States. Does it vary greatly state-to-state?

I'd also like to reiterate that I'm not necessarily looking for personal recommendations (I do not need a therapist at this time), but general strategies and approach.
posted by gavagai at 1:23 PM on May 19, 2010

Psychology Today has a nice search tool by zip code, which can help find locals. They have profiles and you can read up on the various therapists there.

Asking friends about what Kinds of therapy they found helpful was part of my search. I also tried one therapist that I got referred to through my GP, and realized he and his mode were not for me. I then scheduled an appointment with the psych specialist in my GP's office, and through a lot of questions and debate he helped me find the kind of therapy that's worked for me.
posted by ldthomps at 1:33 PM on May 19, 2010 [2 favorites]

If you're in MA, this excellent resource is available to you. I have used it before and gotten some good referrals -- a licensed social worker in the network gives you a call, asks you questions about the kind of therapist you would like to see, and then gives you some suggestions based on your location. This makes the "shopping" period much easier.

If you're not in MA, and you can't find a similar service, I'd recommend finding some contact information and meeting in person with more than one therapist. Most will do a lower rate initial meeting so you can each get a sense of whether the relationship will work. You need to see if it "clicks" -- does the therapist's approach sound good? is their voice one that you can listen too? do they seem nice? are they able to understand the way that you communicate? When I first started therapy I just went with whoever was taking patients. Later I realized that it's important to shop around and make sure there is a good fit.
posted by cubby at 1:34 PM on May 19, 2010

oh man, I forgot to link the excellent resource: the Social Work Therapy Referral Service
posted by cubby at 1:35 PM on May 19, 2010 [1 favorite]

Finding a therapist usually starts with your insurance company's website where they will have a list of local clinicians in their coverage network. You can choose from the therapists listed on your insurance company's website by either Googling them and reading whatever there is out there about them (in my experience therapists are waaaaaaay behind the curve in terms of providing the kind of information online a prospective client would be interested in, though), seeing which are near you geographically and would be convenient to your schedule, or whatever other criteria you might place on making that kind of determination. You call the therapist and schedule an intake appointment. They may ask you some general questions over the phone, then at the initial appointment they will do an assessment and have you fill some paperwork out for your insurance company. If you have a gut feeling that you don't like the therapist on this first contact, you can simply make an intake appointment to see another one. If you aren't sure about the fit at the intake appointment, you should schedule a follow up appointment and take it on a visit-by-visit basis. If after five or so sessions (give it a chance) you are still feeling like this isn't the right fit, you should explain to your therapist (leaving a message is fine, you're not breaking up with them) that you're going to explore your options and meet with another therapist. Don't expect immediate results with talk therapy, 90 days is considered the typical "dosage unit" after which the effects of therapy can be measured. You should expect to change therapists at least once, possibly many times, before you meet a clinician who is both the right fit for you in terms of treatment methodology and personality. Having a targeted referral from a trusted source will reduce the chance of having to change therapists over and over. Do you know someone who had a good experience? Do you think their therapist would be a similarly good fit for you? Is that therapist in your network? Etc.

If you do not have insurance, you can search for a list of sliding scale clinics in your city or county that provide low cost services on a fee-for-service basis. If you happen to live in Philadelphia, I can provide you with this list. You will likely have to wait a considerable amount of time in order to complete the initial intake and schedule your first appointment, as there is a tremendous demand for low cost services. Don't wait until you are in a crisis, if you have an issue you think you need help with make the appointment now before things get worse and you are in a crisis and unable to get the help you need.

If you are uninsured, unemployed and have little by way of resources to pay for sliding scale treatment, you are going to need to access the predominantly Medicaid funded community mental health system. These resources vary wildly in terms of availability and quality depending on your city, and may not exist at all if you are in a rural area. You can fill out an application for Medicaid at your local county assistance office. Google your local department of welfare and search for assistance office locations on the site. You may be able to start an application online. If you aren't sure if you will qualify, fill the application out rather than not; many states say on their welfare department websites that qualifying criteria are often complicated and malleable and instruct prospective applications to submit the paperwork and then attend your appointment with your welfare caseworker once it is scheduled. Explain to the caseworker that you need mental health treatment and are uninsured and broke. They will provide you with a list of resources. Conversely, if you know a community mental health treatment site, contact them and schedule an intake and they'll start your Medicaid application at the intake appointment.

Best of luck.
posted by The Straightener at 1:37 PM on May 19, 2010 [7 favorites]

Psychology Today has a nice search tool by zip code

I used this and found it quite effective.

For me, the bottom line is: Do I click with this person and are they helping me? What degree or title they have isn't really relevant at the end of the day. The woman I go to now is a social worker, not a psychologist, but I like her far better then the "real" psychologist I used to see. And she charges less.

(I could be wrong, having never been to one, but I don't think people usually see a psychiatrist exclusively. You usually see a psychologist, and they may refer you to a psychiatrist when they think medication would be helpful.)
posted by drjimmy11 at 1:39 PM on May 19, 2010

What about determining the applicability of health insurance?

I have always taken the approach of paying out of pocket, even though I have insurance. I've heard too many horror stories of how hard it can be to get insurance in the future once you have "MENTAL HEALTH" stamped on your permanent record. As far as I know, they don't make much of a distinction based on how serious the condition is: they still consider things like minor depression and anxiety as red flags on the same level as bipolar or schizophrenia.

Of course, health care reform may be changing some of this, but I'm not prepared to take the risk yet.
posted by drjimmy11 at 1:44 PM on May 19, 2010 [1 favorite]

I could be wrong, having never been to one, but I don't think people usually see a psychiatrist exclusively.

Many people with chronic and severe mental health disorders see psychiatrists exclusively to maintain the medication they need to manage their symptoms. Some may have previously sought outpatient mental health treatment that engaged them in other types of therapies and upon completing those programs continued on with only regular psychiatrist visits.
posted by The Straightener at 1:48 PM on May 19, 2010

I used the Psychology Today therapist finder referenced by others above. I also decided what credentials I wanted my therapist to have before hand. Then I combined those therapists with a PhD who were located near me, and cross-checked it with who my insurance would cover. I now have a therapist that I've been seeing for over a year and am incredibly satisfied with. Additionally, photos sometimes accompany the Psychology Today listings, and I found this helpful because the therapist I ultimately wound up had really kind eyes in her picture, and knowing that ahead of time made me feel more comfortable. Obviously I wouldn't use the photo as a sole criterion, but I had an instinctual reaction to her picture that turned out to be accurate in person.
posted by lagreen at 2:14 PM on May 19, 2010

I haven't had a problem getting health insurance despite having MENTAL HEALTH stamped on my permanent record (?) I think the important thing is not having gaps in coverage, because then you fall into the issue of pre-existing conditions. MMV but I think a lot of people can be scared by this.

Also, I highly recommend the Psychology Today site -- they also have a feature for some where you can email the therapist and they call you, having read your summary of issues from the email. So it's not a cold call, like 'um, hi, I need help with crazie?" because they've already had their brief intro. I found that helped me a lot.
posted by sweetkid at 2:32 PM on May 19, 2010

The only note of caution I would sound on the Psychology Today site is that it is totally not comprehensive and there will be a lot of qualified, perhaps superlatively qualified, clinicians in your area not on their site. In fact, if having a PhD and a lot of practice experience is a big deal for you, you'll find that clinicians who provide a lot of information about themselves online tend to be a bit younger, whereas older clinicians who have decades of practice experience might not even use the Internet, or consider it not necessary to build their practice because they typically have more referrals than they can handle to begin with.
posted by The Straightener at 2:38 PM on May 19, 2010 [1 favorite]

It sounds like you've started the process already. You know more than you think about the options available. The next step is sorting out what you need with what's available. Based on your general description, you probably don't need a psychiatrist. They tend to evaluate for meds and they will cost the most.

You might benefit from a psychologist, but many focus on testing. You would probably be best served by a LCSW, or clinical psychologist, or LCPC. They are probably most equipped to listen to your initial presentation and then guide you from there. If a medication or testing is required, they should be able to make a referral. If you are able to, find a professional who has had at least 5 years of clinical supervision in their training.

If you use insurance, you will need to consider whether you want to use their providers because it will be cheaper; or simply find someone you like and have the insurance pay its out of network rates, with you paying the balance. If you have access to an EAP, you are probably entitled to a few sessions for free. This may be all you need, or they can help you find someone to continue working with you.

If you have limited income to spend on therapy, there are still options.Social service agencies and universities often offer sliding scale fees. They also usually have graduate students who are learning to be therapists, who will see anyone assigned to them. While they are inexperienced, more than likely their work is carefully supervised, so you will probably get more attention on your case than you might in other settings. Also you can usually find private therapists that will consider a lower fee if you can meet at less demanding times. The important factor with private therapists is remembering you can ask if they have a sliding scale.

I would suggest you focus on keeping this process simple. You can get names from the EAP, your doctor, or people you trust. Once you do, call the therapists and see how it feels to you to talk to them. Do they seem interested in you and your concerns? Do they seem like they want to rush you off the phone? Are they too quick to offer a solution over the phone? Do they sound like someone you might feel comfortable to sit with for about an hour of your time and talk. If so, then schedule an appointment with them and see how that goes.

Most research has shown that if there is a positive relationship between therapist and the patient, the patient will most likely leave feeling satisfied; regardless of the therapist's credentials. Good luck.
posted by ChicagoTherapyConnection at 3:05 PM on May 19, 2010

ChicagoTherapy...

"You might benefit from a psychologist, but many focus on testing. You would probably be best served by a LCSW, or clinical psychologist"

Huh? A clinical psychologist focuses on clinical work, which is defined as the assessment (including diagnosis) AND treatment of mental disorders. Testing is one part of clinical psychology (the assessment part).

I don't understand the differentiation you are making between a "psychologist" (most of whom focus on testing (?)(what?) and a "clinical psychologist" -- Psychologists who do testing ARE clinical psychologists.

Some clinical psychologists focus on testing, some focus on therapy, some do both. PLUS -- at least in New York State, there is only one license -- Psychologist (generic).

Anyway -- back to where to get a therapist -- personally I think the best way to get a therapist is to ask people you trust for personal referrals -- as I would for any professional, including doctors, lawyers, accountants, mortgage brokers, etc.

If you must use in-network insurance (which plenty of people don't have for outpatient mental health, and, even if you do, they often cover something like 30 sessions a year which is generally not enough), then I'd print your list and ask people I knew in the area if they knew anybody good on the list. If not, you have to do the random thing, sadly.

Third choice would be to pick names from Psychology Today or other *advertisements*.
Not that there is anything wrong with ads - and the Psych.Today ones are nice because you can usually see if you like the person's face, which, if you get into therapy with them, you are probably going to have to look at for a long time.
posted by DMelanogaster at 6:35 AM on June 14, 2010