I have a lot of questions about therapy.

April 9, 2011 8:23 PM

I need to find a therapist, and I have a lot of questions.

I apologize in advance - I know a lot of questions in this vein get asked, but finding the right search terms was just too hard and the multitudes of questions make it hard to find answers. And I also apologize for the rather verbose question, it's really hard for me to boil it down.

I'm 17, about to go to college in the fall, and I'm sick of being miserable. I could go into detail about how I've known since, like, 5th grade that I needed said help but I'm waiting til now, but that's not really relevant. The issues I'm experiencing are mostly in the anxiety/depression-ish (not trying to diagnose myself, just the symptoms line up a little too closely for comfort)/possible unresolved ADD vein (which I realize is a little different, but related, at least for me.) So, therapy, right? But I don't know anything about it.

I was able to find the directory of therapists for my insurance online, and a few in the area. I think I would prefer a man (I'm a girl), knowing that my uncomfortability around school-based therapists and women doctors and people has been this total irrational sense of being judged and whatever and I've felt much more comfortable, oddly enough, with male doctors (of all types) in the past. My options, though, are pretty limited, and most people that come up seem to be LICSW (social worker, right?), with some MA, LMHC. What sort of degree should I be looking for? Social worker sounds wrong to me (I thought they removed abused children from their houses or something, but wikipedia tells me that it seems to be a lot more than that.) Other than meeting in person, is there any way to tell online if you would mesh with them?

My second question is parents. I guess they'll probably be supportive, but they'll probably be all "why?" and I don't want to be like "because I cry myself to sleep twice a week". Do you guys have any suggestion on how to approach it without going into detail about why I know I need it? About how much might it cost them if I use someone listed in the insurance directory (I know this totally depends on the insurance, but if it helps I think it's pretty good insurance, provided by my dad's job at a huge corporation, and has pretty good coverage. I know, for instance, that my pretty damn cosmetic anti-acne topical meds go from $50 to $4 with the insurance.)?

This is totally subjective, but if I was going in 100% ready to open up, how much progress could I really make in the 4ish months before I go to the opposite coast for college? What might happen then? How often do people usually meet? What is therapy...like?

I'm obviously new to all of this, and I'm terrified, but it's kind of come to a head and I know it's something I have to do, if for no other reason than I just wanted a good friend have a rapid breakdown (school, parents, grandparent with cancer, secret abortion...yeah.) and I feel too close to that myself.

Basically, my questions are: How do I find a therapist? How do I ask my parents? How does it work once you're there?

Any other information that you feel is relevant is also welcomed! Thank you!

Throwaway: [e-mail]. I'm sorry, I couldn't think of a good one. I don't even like gum drops.

posted by anonymous to health & fitness (17 answers total)

There is really no way to know if you will "click" with a therapist without going and trying, unfortunately. You *can* research different approaches (CBT, etc) and try to find one that agrees with you beforehand, but still, it'll always be trial and error. I found mine through an online directory, Psychology Today I think.

Do *not* be put off by someone being "only" a social worker though. My therapist is a social worker and she is absolutely great. My first therapist was a "real" psychologist and it didn't work out at all. She was far less professional than my current one and we just didn't click. I know what you mean about what "social worker" sounds like, but there are social workers who do regular therapy too- it just means they haven't gotten (or don't want to get) a psychology PhD. For me this works out great because my current therapist is a) cheaper than the old one and b) easier to relate to because she is much closer to my age. Getting a phD takes forever, so people who have them tend to be older.

I go every two weeks. Some people go less often, some people go every week. It's really hard to say how much "progress" you will make in any certain period of time, but it *will* help. There's probably never going to be a day where you walk out going "all fixed now!" but I can almost guarantee your life will improve.

I can't speak to dealing with parents because I was over 30 and living 3000 miles away before I ever considered therapy. But I think it's really really great that you are starting to deal with this now. (I grew up in an era where mental health issues were either completely taboo, or people were simply unaware of them- I had no idea what clinical depression even *was* until college I think, despite both my parents being on anti-depressants and the condition (obviously) running the the family.)
posted by drjimmy11 at 8:41 PM on April 9, 2011

One approach to take with your parents is to say that you're anxious about your upcoming transition to college and want to get all your ducks in a row before you go. That should be understandable, and I'm sure they want you to succeed in college, so that approach might work and keep you from saying more than you want to. If they press for more info, tell them you're worried about managing academic stuff and making friends at the same time (that would cover the ADD and depression/anxiety angles without actually using those terms). Those are common fears, so saying something like that will make you look proactive, so they probably won't object then.

If you do get some diagnoses, you might want to consider meeting with/contacting your college's disability office to see whether you can get any accommodations (things like a quiet place to take tests, for instance) that will help you do well your first year. Having that documentation from a therapist in place before you leave for school could be really helpful.
posted by BlooPen at 9:01 PM on April 9, 2011 [1 favorite]

Hmmm...not knowing your relationship with your parents, it's a little hard to advise. My own parents refused to get me therapy from when I first started asking (I was around 12) through college, though in my senior year I was able to start seeing a therapist through my college.

I know that my parents refused in part because my mother thought therapists tended to make you hate your mother by blaming her for your problems, and in part because they thought I was being hysterical and over-reacting to things. If I had it to do over again, and were a more mature 17-year-old than I was at the time, I'd have approached them not so much as "OMG I'm going crazy!" but as something more like, "I need some help sorting out a few things." In your shoes, with college coming up soon, I might say something like, "There are some things that have been bothering me, and stuff I feel like I didn't handle as well as I could have, and I'd like talk to someone about how to improve in these areas before I leave for college, so I don't make the same mistakes there." Or some version of that.

I was eventually helped with anxiety very much through a combination of meds (which I no longer take routinely, but which helped me tremendously at various times) and cognitive-behavioral therapy. I have read in many places that CBT is the most effective form of therapy for anxiety. If you can get started soon, it would not be a waste to go for four months.

What is therapy like? Well, I did generic talk therapy for a long time, and it was kind of about sorting out childhood stuff and thinking about how that had influenced me, and talking generally about what was going on in my life and how I was handling it. You can be in that kind of therapy for years. CBT, as I've experienced it, is much less likely to deal with all of that kind of mushy stuff and much more likely to focus on what you're thinking and doing right now. I remember my therapist sending me home with a list of things to try after my very first session. I spent more time in CBT sessions talking about ways to identify and counter habitual negative thoughts, for instance, than in talking about that thing that happened in 10th grade. I think in general people tend to spend less time in CBT. I know I did, but I also always felt like CBT for me was like the last piece of a puzzle I'd been working on for a long time; if I hadn't had the background of working through a lot of stuff in general talk therapy already, I'm not sure how long it would have taken to progress with CBT.

I have seen several therapists in my adult like (I'm 45 now, so this has been at various periods over about 25 years), and the two that helped me the most were a Licensed Clinical Social Worker and a Ph.D. So do judge your therapist more on your experiences with him than on those kind of credentials.

Good luck.
posted by not that girl at 9:03 PM on April 9, 2011 [1 favorite]

LCSW is fine.

Two main points I would emphasize:

1) Unless you are lucky, you will likely have to try out several therapists before you personally "click" with one. "Clicking" with a therapist is crucial. If you go to a therapist, and you feel you don't click after the first session or two, find another one and try them out. Liking the therapist as a person is good. Even more important may be the feeling that the therapist is a happy, stable person. If the therapist doesn't come across as content and seems to be bringing weird vibes from their own problems into the session, find someone else as this is unprofessional of them! (this problem happened to me with two different therapists and wasted a lot of my time...). The therapist shouldn't be too cold and distant either.

2) I think for most people, deep-rooted issues take years to sort out satisfactorily (or may often may never be sorted completely...just managed). However, just going to a therapist and opening up can be helpful in the short term - you will feel better from addressing your issues and feeling that you are doing something to get more control over your life. The therapist should also be able to help you with useful practical advice about your feelings and social relations when going to college for the first time (I so wish I had a therapist when I first went to college!! ), which is a disorientating experience for many people. If you find a therapist that you like before you go to college, you can ask them if you can do skype (online video chat) sessions with them when you are away at college. It's not widespread yet but more and more therapists are doing skype therapy now (though mostly younger, digitally savvy types). Alternatively, you can also do it over the phone of course.

p.s. anti-depressants are a crapshoot. works more or less for some people, not for others, depending on context and drugs mix... and noone really knows how/why.
posted by Bwithh at 9:04 PM on April 9, 2011 [1 favorite]

Also, you may find this anecdote about a young person's experience with a LCSW inspiring:
http://www.prx.org/pieces/47405
It's the third story on the show - you will have to register and login to hear it (it's free).
posted by Bwithh at 9:15 PM on April 9, 2011

The issues I'm experiencing are mostly in the anxiety/depression-ish (not trying to diagnose myself, just the symptoms line up a little too closely for comfort)/possible unresolved ADD vein... most people that come up seem to be LICSW (social worker, right?), with some MA, LMHC. What sort of degree should I be looking for? Social worker sounds wrong to me...

It's totally fine to see a LCSW if that is what is available to you at this point. If your therapist thinks you would benefit from a medical diagnosis and referral to an MD for purposes of prescribing medication, then he would see to that.

A lot of therapy isn't necessarily about being mentally ill.
posted by Sara C. at 9:31 PM on April 9, 2011 [1 favorite]

That you know that you'd prefer a male therapist is actually a good thing. I'm a guy, and when asked, I said I would prefer a female, for whatever reason.

Those upthread who say that you'll have to see how you click, and that specific degrees are not relevant are correct. Feel free to interview your potential therapists via telephone before deciding on one. Ask them how they approach problems.

Cognitive behavioral therapy is what's worked best for me, but ymmv.

Finally, even four months of therapy can make worlds of difference. As the saying goes, though, it works if you work it. It's your shot at feeling better, so take advantage of it. It's your time, and you're paying, so make the most of it.

As for your parents; tell them you have stress or whatever: it's really not their business.

I sincerely wish you the best.
posted by Gilbert at 9:39 PM on April 9, 2011

Re the time factor.

I've been seeing a therapist for about 7 months now and will be concluding things next month. (Or possibly taking "a summer break"? Not entirely sure at this point.) My therapist doesn't think it's odd at all that I'm either going to move on or have a long break in therapy - in fact she's the one who offered me those options in the first place.

A good therapist (in my experience) will work with you to do whatever is possible in the time that you have. Let go of any ideas you have about therapy that come from Woody Allen movies.
posted by Sara C. at 9:43 PM on April 9, 2011 [2 favorites]

(Answering one question I missed)

What is therapy...like?

It's pretty cool, actually. You get to vent to someone and know that you're not going to hear about it next weekend from a friend or have an ex throw it in your face. Most importantly, you get an entire hour once a week that is entirely devoted to you. I always feel better after having gotten out of my session.
posted by Gilbert at 9:48 PM on April 9, 2011 [1 favorite]

Just answering you bit about what can happen in four months:

in my case, I saw a therapist for the first time in January last year. At the end of the first session she said she thought I was very despressed, and suggested I see a doctor to talk about medication. I saw the doctor the following week, and he agreed and prescribed me an anti-depressant. I was lucky that the first one I tried worked (although not until I had been taking it for a month, and then it was like a lightbulb suddenly came on: I woke up one morning and I wasn't sad anymore).

I kept on with the therapy sessions for a while, but all in all, I went from depressed to normal within about six weeks. If you are lucky, this COULD happen to you too.

My husband had a similar experience, but he had to try two different types of anti-depressant and then increase the dosage a lot before it worked, so it took about five months to get his medication right. Meanwhile, the therapy held him together.

Another friend never found that medication worked for her (well, until she got the correct diagnosis of ADHD instead of depression, but that's another matter), so talk therapy was all she had for her depression symptoms. Within about three months the therapy had given her some alternative coping skills to cutting herself and not eating, and she had improved on those symptoms a lot. So while the underlying problem didn't get fixed quickly, some of the everyday problems did, and I think she felt quite a lot better just because of that.

So yeah, I think expecting some sort of progress within four months is quite reasonable.
posted by lollusc at 10:48 PM on April 9, 2011

In no particular order.

how much progress could I really make in the 4ish months before I go to the opposite coast for college?

In short, plenty. There are whole schools of therapy devoted to 'brief therapy' in particular solution focused approaches. Even outside of people who make it a specialty it is a common approach. You are young, this is not the time to go digging in to the depths of your psyche, it's a time to focus on the problems immediately in front of you, your life will change too fast for most other things to make much sense.

How do I find a therapist?

Make a list of likely candidates and phone them one by one. You will likely get a series of answering machines. Leave a message with your details telling them you are interested in exploring short term therapy. When you get to speak to them briefly describe the issues you want to tackle and ask them how they would approach this.

From this you should get a list of possible candidates. As much as therapy is about finding a therapist who you click with it's also about the therapist working with clients who will respond to their approach and a good therapist will want to figure this out. Avoid anybody who seems willing to take you on regardless. Once you have talked to a few pick the person you liked the best and ask to make an initial appointment. This will be a chance to sit down, explain things in more depth, and figure out if you can work together. The best people I have come across have always been upfront about this.

Other than meeting in person, is there any way to tell online if you would mesh with them?

Once you have some experience I think its possible to get some sense of somebody, and how they work by how they describe themselves. Regardless your initial contact by phone will be a chance to figure this out. Anybody worthwhile will be prepared to spend a decent amount of time on the phone figuring this out. Its a good sign if they will and/or suggest this.

The first appointment will be longer than subsequent ones.

How does it work once you're there?

You walk into a room, there will likely be a few pieces pieces of vaguely abstract art or sculpture around. You sit on the couch with strategically places tissues (mine has chocolate too). You talk. They listen, take notes and try not to make it too obvious when they try to catch surreptitious glances of the clock place conveniently over your shoulder*.

Traditional therapists are kind of notorious for not saying anything and deliberately letting pregnant pauses hand in the air. These days they tend to be a little more talkative. Regardless its all about you finding a solution to your problem, at least with talk therapies so don't expect them to offer you advice or tell you what to do, though if they prescribe, in my one experience of this, they treat that differently, though the rest is similar. Make the best use of it you can and don't be afraid to ask questions or seeking prompts, they can always say no. Don't be afraid of saying anything, confidentially is sacred, they won't say anything to anything else, unless there is immediate, serious danger to you or anyone else, and they don't do that likely.**

*By tradition a therapist hour lasts 50 minutes not a hour. This is so they can usher people in and out with out any potentially embarrassing crossover. They are also likely too bring things to an abrupt close if it looks like you might go over, regardless of whats happening. Don't be alarmed by either of these two things, it's just the way things are.

**They might have a (therapeutic) supervisor but the rules of confidentiality are just as strict so it amounts to the same thing.
posted by tallus at 12:07 AM on April 10, 2011

My therapist is a female LCSW who is GOLD. I had to try a few different ones until I found her and let me tell you, that woman has literally saved my life. She's got a minor in pharmacology and does all her CEU (continuing education credits) in psychotropics, so she's up on her stuff and can recommend what she thinks would work for me, knowing my particular issues and how I react to certain meds. She used to work with my primary care doc, emailing him her reccommendations, but when something recently went very sideways for me, she got me in to see a psychiatrist within 3 days that usually has a 6 week waiting list.

I see her every other week, but she's always available to me if I have some sort of crisis. She's called me at home after hours when I left a message about something that had happened to my son at school-a few weeks ago, she moved things around in her schedule so she could see me 3 times that week because of something going on that was overwhelming me at the time. She.is.amazing

For me, therapy is more cognitively based now and while she's very empathetic and supportive, she's also able to call me out on my shit when I'm not really working on getting better. (I can tend to wallow in my misery sometimes). Even when I feel like I'm wasting my time that week because I have "nothing really to talk about" it seems like those are the sessions where I actually have some sort of epiphany about something. I have been VERY committed to getting well and have seen (and she and my family/friends) have seen some hugely dramatic changes in me.

If you find one you really like-you can always see if they are open to using Skype after you go to college. My friend has a therapist that she sees via Skype and she's really happy with it-it works out pretty well according to her. Please memail me if you like-I was undiagnosed at your age and it pretty well sucked-so I think it's fantastic that you're mature and self aware so much and are so willing to do what it takes to feel better.

Best of luck-you sound like a truly intelligent and insightful person and I think you're going to be an amazing adult :)
posted by hollygoheavy at 4:41 AM on April 10, 2011

"I guess they'll probably be supportive, but they'll probably be all "why?" and I don't want to be like "because I cry myself to sleep twice a week"."

Not to second-guess you -- if you don't want to tell them the reason, use the excellent suggestions above -- but if they'll probably be supportive, consider just telling them, "I cry myself to sleep twice a week." "I'm miserable." Etc. It may be hard for them to understand what you're going through at first, but if they're generally supportive, they will probably be your strongest supports while you're in therapy and your biggest cheerleaders for getting healthy.

Having a support network in dealing with depression is important.

When you go to college, you'll be able to use the campus mental health services, which are typically pretty cheap or free, if that's what you choose to do. You can research what's available at your school -- don't be afraid to call and get specifics -- and you and your therapist for the next four months can discuss what would be best. Maybe you keep in touch with Home Therapist by phone, maybe you use what's available at school. Maybe you find a local therapist not affiliated with your school, that your insurance covers because you're in school out of state. Lots of options depending on what you (plural) decide your (singular) needs are.
posted by Eyebrows McGee at 4:55 AM on April 10, 2011

This is a comment I wrote in response to another AskMe regarding how to approach therapy and how to get the most out of it.
posted by OmieWise at 8:34 AM on April 10, 2011 [1 favorite]

In fact, you should check out that whole thread.
posted by OmieWise at 8:41 AM on April 10, 2011

A link to a collection of AskMe threads on finding a therapist, touching on such topics as:
What's the best way to find a good one?
How do I even start to located the kind of therapist who would be right for me amid so many options?
How can I see a therapist on my parents' insurance without my parents finding out?

And this article, which I found via AskMe,* is a consumer's guide to finding a good counselor and avoiding an incompetent one.

I like it because the writer -- who leads online support groups -- is not trying to promote her own practice (she's not a therapist) or a particular professional association. She brings up and answers questions that can be a barrier to seeking help, such as: "How do I know if my counselor is competent?" "What is supposed to happen in therapy?" "Can a therapist be incompetent without me realizing it?" Considering some of my early experiences with counseling, I wish I'd had this article to guide me.

* Courtesy of madamjujujive, I do believe.
posted by virago at 4:11 PM on April 10, 2011

I can't give you seasoned advice, but I can give you fellow starter perspectives:

First, goddamn. How together are you at that age, that you're this in tune? I wish to Christ I had your head, even ten years ago (my 36th birthday is this week). Your future is bright, with self-knowledge like that at your age.

Secondly, if you want to get tested for ADD, you need to see a psychiatrist, not a therapist. A doctor is needed for that part. A therapist can handle the rest. How do I know this? I'm going to be tested for ADD next month.

Here's what I went through (in the US, which I'm assuming you are too): two weeks and about a dozen phone calls before I found a provider with a staff that promptly returned my calls and took my insurance, only to tell me that there would be a two-week wait to schedule an appointment 4-6 weeks after that. Insane, right? But all the good shrinks here are booked or don't take my insurance or whatever.

None of which is to dissuade you. It is only to tell you that you may have to work for this and fight through disappointment. Do it. Fight through that crap, if it comes.

If you're looking to keep this from your parents, you can't, if you file it on their insurance. If you pay out of pocket, the provider is legally obligated under the HITECH act to keep it from the insurance company and so from your parents, if you tell the provider to keep it confidential.

If you want to address it with your parents, well, I don't know your dynamic with them. I know that I would want to know if my children were crying themselves to sleep. I know that I could tell my parents about it if I were in your shoes, but I would have been scared to do so at your age, so I understand your reluctance. If you have a healthy relationship with them, I'd nudge you in the direction of telling them bluntly. If not, or if they're panicky, I think a general "I'm very unhappy and think I need some help" may ease them in well enough.

Seriously, if you have open and healthy communications with them, your parents may surprise you.
posted by middleclasstool at 7:40 PM on April 10, 2011