Are all therapists the same?

July 19, 2012 3:15 PM

I need therapy. I have no idea how to start. How does one pick a therapist if all seem the same?

I have searched online for information about therapists in my area and found a network of local psychologists and psychotherapists. They are all listed with their special fields, but those sound very broad and generic to me. There are at least 7 in my immediate area, about the same distance, so just starting with the most (logistically) conventient isn't working either. And all look like nice people on the photos. The only ones I could exclude so far are couple therapists. I know I'm not a couple, but other than that, the special fields aren't very helpful. All of them list "depression, anxiety, stress relief" and one also has "OCD" listed. I'm not an expert, but OCD is likely one of the few things I don't qualify for. Since I don't know what I actually might have, beyond a broad category, I don't know how to decide which of them I want to make an appointment with.

Do I just call all of them and ask "Hello there, do you have experience with (list of approximate self diagnosis)?" I could be wrong about my "diagnosis", they are the experts, after all. So this approach seems like I could easily find the "right" therapist for something I don't really have.

I have a bad history with doctors in general. I was pumped up with sleeping pills in my youth to "cure" my insomnia and really none of them worked. In my late teens, I tried to find a therapist and just went to the first I found in the Yellow Pages. He proceeded to diagnose me with several different personality disorders, most contradicting the previous one (basically jumping from Cluster A to C to B and back on a weekly basis). The next told me in the first session that I had "too many symptoms" and none were his field of expertise, so he wouldn't treat me. Asked for a recommendation who to see about it, I got a shrug. I pretty much lost my faith in doctors due to that.
What I want to treat is the massive problem to focus on anything (I'm hestitant to self-diagnose, but inattentive ADD fits the bill; super-easily distracted, can't focus, can't organize easy tasks, can't ever shut up the inner monologue, occassions of hyperfocus, trouble sleeping; lifelong issues with most of that) and the growing anxiety. Getting full blown panic attacks because of the door bell ringing (and being pretty sure it's just mail) was what made me realize I need therapy, really really bad.
Due to my unemployment being cut to barely anything (not enough for basic needs such as food and electricity) because I missed appointments - because some days I'm too afraid to leave the house - makes things just worse. So the problem is not just "possible ADD and bad case of social anxiety", it's also financial pressure, fear of debt (something I magically managed to avoid so far), making it all rather urgent. I don't want to rush the therapist search (I've seen where that got me in the past), so any advise how to select and approach a potential therapist from my list is welcome.

How do I know a therapist is a good match, if they all look like nice people, are close to my house and list the same fields? They are also all accepted by my health insurance.
What do I ask when I call and what answers would be red flags/don't bother to make an appointment territory?

posted by anonymous to Health & Fitness (13 answers total)

I would go for an initial session and see how you feel about it. I know, it is cumbersome, but in the past trusting my gut feeling when meeting a person has worked for me. Sorry for not being able to help more.
posted by nostrada at 3:22 PM on July 19, 2012

One of the most important things with therapists is getting a good match. The way to tell if you have a good match is just if it feels right. So, if you're up to it, it would be really great if you could just call everyone and talk to them for a couple minutes - introduce yourself, tell them that you're interested in seeking therapy, and ask them to explain a little about themselves and their style.

In the course of the conversation, you'll probably find that you "click" more with some of them than others.

Good signs: The therapist listens to you, seems respectful of you, is not judgmental, is happy to explain their therapeutic style, is happy to spend 10-15 minutes talking to you on the phone.

Bad signs: The therapist is very rushed (it's fine if they don't have time to talk right away, and schedule a later time to talk for 10 minutes, of course); the therapist doesn't seem to listen or hear you, the therapist doesn't seem to take your concerns seriously.

It would be ideal to schedule a first appointment with 2-3 therapists. Some therapists will have you pay for the first (trial) session, some will not. Either is professional, normal, and acceptable. You should ask about whether you will be expected to pay for the first session. The therapist should consider that a reasonable question, and respond accordingly.

The therapist should also be okay with the idea of a trial session - it's an acceptable, frequent practice. It's a red flag if the therapist wants you to commit without a trial session.

After you go to your trial sessions, take some time to think it over, and choose the therapist you like best and feel most comfortable with. It's okay to take cost into the equation too, if your co-pay is different or there is some reason costs will vary.

I have been in therapy many years with a couple different therapists (due to moving cities). Please feel free to memail or email me (email in profile) with any follow up questions!
posted by insectosaurus at 3:26 PM on July 19, 2012 [2 favorites]

This isn't specifically about choosing a therapist, but it gets at that idea too: A previous comment I wrote about how to get the most out of therapy.
posted by OmieWise at 3:37 PM on July 19, 2012 [1 favorite]

Honestly, finding a therapist relies a great deal upon trial & error. You may luck out & click with the first one you see or you may need to see a couple before you find the person who is right for you. One thing I would recommend is seeing a LICSW rather than an MFT. They have slightly different training/experience and, from what you've described, an LICSW could probably address your specific issues more effectively. On the other hand, you may find an MFT that rocks, but I'd start with an LICSW and go from there.
posted by katemcd at 3:54 PM on July 19, 2012 [1 favorite]

Ask people you know (or metafilter!) for recommendations. But everyone above is right, a lot of it is chemistry and trust, and you may want to just plan on trying a couple out to find a good fit.
posted by mchorn at 3:58 PM on July 19, 2012

The first meeting you have with them is you auditioning them. If they don't pass the audition, you don't continue with them. It sounds laborious, but it's the only way to do it. Whilst hopefully you find someone who works for you early on, the more therapists you're exposed to, the better idea you have about what works for you and what doesn't.
posted by heyjude at 4:03 PM on July 19, 2012

Ask if you can spend 5-10 minutes with them on the phone.
Ring at least 4 of them. Pick the one you get along with best for the initial appointment, but don't be afraid to reschedule for the next therapist.

I could suggest questions, but really, I wasn't feeling good about the ineffective therapists I've had at the end of the first session (even if I kept going, not realising that was a bad sign), and it was a lot clearer who the competent and good therapists were just a little way into the first session.
A therapist who makes it easy for you to explain what the issue is, draws out particular issues, displays insight and has ideas for useful strategies, tools and directions you could go in, becomes quite obvious, very quickly.
A bored, confused, distant therapist, is also pretty clear.

For the panic attacks and ADHD, the therapist probably won't be able to prescribe you meds.
Ask each of them on the phone if they diagnose these things, because if they don't, getting set up with someone who can diagnose, like a psychiatrist/Dr first, then settling in with the therapist for the actual support may be more effective.
posted by Elysum at 4:41 PM on July 19, 2012 [1 favorite]

I actually asked a therapist about this last week, and this is what she told me:

1. First, find some therapists online (psychologytoday.com has a good resource; there was another website but the name escapes me).

2. Call the therapists you're interested in and interview them. She specifically said to ask what their approach is, (and then ask other details such as insurance options, etc if applicable) and ask them if they have a website with more information. Usually most therapists have some sore of website or internet presence where they outline their philosophy and approach to therapy.

During this call you're ONLY asking for information and finding out more about the therapist, do not feel pressured to make an appointment!

3. If you find one you like, make an appointment. You don't have to make another appointment if you're undecided about continuing with them, or if you plain just don't like them. If you ever feel pressured at all to stick with them even though you don't like them, please don't stay with them. No decent therapist should ever do this. (I know someone who's therapist left them an angry voicemail about not making an appointment with them. The heck? That's definitely a red flag.)

---

That's pretty much how I ended up with my therapist. I found her on psychologytoday.com, read her website and really liked her message (it was a lot about mindfulness, yoga and nutrition). I was too nervous to call her so I sent her an email telling her how I found her and that I liked her philosophy, and if I could make an appointment. She emailed me back some times she had open and that's how I made my first appointment.

My first session was mostly me filling out paperwork (depression scale test, other "quiz" type papers so she could get a good idea of where I was psychologically, insurance/payment, some other normal legal documents), and she went through my papers and discussed some things I wrote, asked me about my background and started me on some mindfulness exercises to practice until I saw her again.

She never specifically asked me what was wrong, as it would be counter-intuitive to diagnose myself before she could get a clearer picture of where I was and why I was there.

I guess it's a bit taboo to discuss these issues on a public forum, but to me it was a first step that I'd been unnecessarily hesitating on for several years. I didn't know a single person who had a good experience with therapists so I was very nervous about it even being beneficial, or if they'd just tell me things I already knew and pump me full of drugs (none of these things happened!).

I've worked through a lot of my problems with my therapist; she's always positive and my maintenance sessions now are almost like having a conversation with a non-judgmental and wise friend. I only cried during my first session haha, so every session isn't like "omg spill my soul and tell her every horrible detail of my life."

I hope you find a therapist to suit your needs. I hope everyone does, if they need the help. Feel free to message me if you have any questions. Remember; if something doesn't seem right, ask them to clarify. If their reason doesn't resonate with you, it's probably a sign to leave. That's how all healthy relationships work. Good luck.
posted by french films about trains at 5:37 PM on July 19, 2012 [4 favorites]

I found it hard. I saw psychologists (CBT too dry for me) and psychotherapists and after wandering about aimlessly for years thinking it was me just not "getting it" and still barely understanding the difference between all the various types on offer and therapists handing me photocopies of work/life balance venn diagrams or telling me it was my father in the first ten minutes...I found my awesome therapist by accident. This is what was different about her.

Before I met her, she sent me a comprehensive history about herself, covering her education, specialisations, work history. She told me how she worked each session. She had statistical data. She collected data about me each session and got me to grade her each session. She told me what sort of supervision she was in. She basically answered all the questions I had about therapy without me needing to ask them, because I didn't know what questions to ask. She also shared enough of her personal life to help me understand where she might be coming from - eg, over time I've learned she has her own mother issues, so I weigh this knowledge in with the times I am talking about my own mother. Before I went into my first session with her, I felt like I was given all the information I needed to understand the type of therapy she offered and her approach.

If you haven't done therapy before it's really hard to know which therapy is right for you. If I could do it over again I would have listened to my gut more when I felt it didn't work and not blame myself for assume I couldn't take the time to find the right person and asked more questions (although I never knew what to ask!). So I think it's great when therapists anticipate this with new patients and basically hand them a dossier about themselves.

Good luck.
posted by scuza at 6:47 PM on July 19, 2012

Here's my story. I went to my first therapist through my Employee Assistance Program. There was a limit to the number of sessions that EAP would cover. On the last session, I asked him for a referral. After our few sessions, he understood my issues and could make an intelligent recommendation. And it worked out really well.

Maybe that's it: you need a therapist to help you find a therapist. That might sounds silly, but the mind is a "wicked problem": you need a partial solution just to understand what you need to do.
posted by SPrintF at 6:51 PM on July 19, 2012

IAAT, but IANYT. Here's how I would choose. First, unless I had an odd specific problem, like anorexia, I wouldn't pay that much attention to what people said they had experience with or what they claim they specialize in. My personal point of view (feel free to disagree) is I don't like those who over medicalize the treatment process with diagnoses and the like.

I'd want to know what they charge and their policies (do they charge if you cancel a session two days before? What about a week before?) . Do they take your insurance (if you have insurance--call the company and check and find out the limits of coverage.) Ask their "approach" and see if it makes sense to you. After that, it's a lot like dating, in that you want a relationship in which you feel comfortable and safe and open, or as much of those as you can expect with someone you've just met. I'd want them to care about me, but not be more intrusive than I was comfortable with. And take your emotional response seriously. If you feel uncomfortable with them, don't decide it's your own problem. I'd also want to feel they were smart enough to understand me and clear enough that I could understand them.
posted by Obscure Reference at 6:54 PM on July 19, 2012

You might want to think of any marginalized identities you might be coming from. Like, you might want a therapist with experience working with
(or who is) a POC, or LGBTQA, or whatever.

That is something I'd aask about, myself.
posted by spunweb at 7:18 PM on July 19, 2012

Here's my story. I went to my first therapist through my Employee Assistance Program. There was a limit to the number of sessions that EAP would cover. On the last session, I asked him for a referral. After our few sessions, he understood my issues and could make an intelligent recommendation. And it worked out really well.

This is exactly how I found my therapist. The way it worked was that I had 3 sessions with the EAP therapist. After the third, she referred me to my current therapist. It's worked very well for me too.
posted by SisterHavana at 9:09 PM on July 19, 2012