Good mental/emotional specialists in Seattle?

July 25, 2012 12:06 PM

Looking for a relatable, compassionate, pill-free mental/emotional/marital health specialist in Seattle, for a spouse who hates doctors. Any recommendations (or advice in general)? Details inside.

My wife needs a new doctor but carries a lot of baggage from her old ones that kept her heavily medicated since she was a child. They steadily upped the ante over the years, increasing her dosages and escalating to more potent pills when the old ones lost their effectiveness (or produced unwanted side effects, which they all did). My wife has decided she wants off this train, and I support her decision fully.

The complication is that she strongly dislikes and mistrusts doctors for a few reasons, which I'll list shortly. Recently we moved to Seattle and she seized the opportunity to cut ties with her old doctor and cease medication (concerta and effexor) cold turkey. I cautioned her that she needed assistance from a professional but she did it anyway, and after a few rough weeks of withdrawal I think she has purged the drugs from her system.

We're both glad she did it regardless of the method she chose. The pills she was taking were overkill for her naturally occurring symptoms. However, it's clear that without treatment she still needs help staying focused and managing her emotions. If she had her way she'd never set foot in a doctor's office again, but I'm urging her to start over with a blank slate and new diagnoses. After a great deal of negotiation she's agreed to try, but she's not fully cooperative and gave me a "three strikes" condition... if we can't find a good doctor after three tries, she's giving up hope permanently. Here are the reasons she's so averse to them:

• She's ashamed of her issues and the stigma attached to them. Despite my protests, she's afraid she might be labeled "crazy" and would rather avoid the matter than tackle it head-on, even if it makes things worse.
• Every doctor she's seen in the past has prescribed pills for her. We definitely don't want to start that cycle again, but she's not convinced a doctor exists anywhere who won't try it as a first resort.
• In her experience, doctors are always in a hurry and won't take the time to listen or care.
• She's extremely trypanophobic. Though it's probably irrelevant in this case, her fear of getting a shot makes it hard for her to enter any medical center.

Additionally, my wife confided to me she's afraid to discuss her problems in detail with a professional. Turns out I'm the only person in the world who has seen the extent of the issues she has; even her old doctors were never clued in properly. She wants to go through the motions without revealing her vulnerable parts. I know full disclosure with the doctor is vital in order to get an accurate diagnosis, but how do I help my wife open up? I think we need a doctor who is friendly and genuine, but who also asks probing questions and knows how to dig beneath the surface.

I've said "we" quite a bit here because I'm doing my best to take an active role. The issues my wife struggles with are not hers alone; they affect our relationship as well, which is why I added "marital" to my original question. If we're eschewing psychiatric medication in favor of therapy or counseling, I want to be there. I want to learn how to better understand what my wife's going through and how to communicate with her and help her through it. I'm doing everything I can to keep our household peaceful and happy, but I don't know much about mental health personally. If I'm to support her, I need assistance of my own.

Since we've ruled out drugs, what other options are there? We are not really naturopaths (I'm actively opposed to some "alternative" medicines like homeopathy). Your suggestions are welcome, particularly if you have names of good people we can talk to in Seattle.

posted by anonymous to health & fitness (9 answers total)

You want a psychologist, not a psychiatrist. Anecdata: Lil' Thumbscrew needed therapy recently. We first took him to a psychiatrist, who immediately suggested a rather potent mood stabilizer (this for a kid he'd met for all of twenty minutes). We declined and chose a psychologist instead, and he's been an enormous help. Like I said, this is totally anecdata, but since psychologists CAN'T prescribe, they're less likely to immediately suggest medication.
posted by julthumbscrew at 12:09 PM on July 25, 2012

It would've hard to find a talk therapist who could prescribe medication, even if you wanted one. Very few M.D. or D.O. psychiatrists provide talk therapy anymore.

So. You want a Ph.D or MSW therapist who provides services in an office setting that isn't part of a medical clinic. Again, this is easy to find.

Do you intend to use health insurance to pay for this? Are you looking for couples therapy, or is she looking for individual therapy, or both? Are there any particular therapeutic modalities you or she is particularly interested in trying (for example, cognitive or dialectical behavior therapy)?
posted by Sidhedevil at 12:12 PM on July 25, 2012

Can you have a mod post an email address for private recommendations?
posted by liketitanic at 12:15 PM on July 25, 2012 [1 favorite]

I can recommend an excellent, non-judgmental cognitive behavioral therapist who practices in south Puget Sound (Tacoma), if you're not opposed to seeing someone outside Seattle proper. Feel free to MeMail me.
posted by trunk muffins at 12:16 PM on July 25, 2012

Nthing that you want talk therapy. I recommend very highly that you do not go hunting for someone who definitely won't suggest pills, because you're cutting out a whole host of people who will do a great job and will respect your boundaries if you say "I am not interested in medication."

I suggest you look over some descriptions of therapeutic modalities and pick out the stuff you think will be easier to accept to start. Try to find someone who has experience with PTSD, by the way. Your wife will have to work through her doctor/therapy/trust issues on top of whatever is underneath it all.

You may want to attend a NAMI Family To Family course, or attend a support group, to get more local suggestions.

Also, for things she has a hard time saying out loud, I highly, highly, highly recommend writing it down instead. You can even mail it in if you're too embarrassed to hand it over in person.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 12:24 PM on July 25, 2012 [1 favorite]

You are so lucky to live in Seattle, because it means you have access to this referral service. I've recommended it before, here.

I think particularly in your case — where is it going to be very important to find someone your wife clicks with — you will be very well served by meeting with a few different therapists before starting a therapeutic relationship rather than throwing a dart at the wall and hoping the first one you pick works out. Please feel free to MeMail if you have any questions about it.
posted by adiabat at 12:26 PM on July 25, 2012

Oh, shoot, I didn't notice that this was an anonymous question.

One place to start, if none of the recommendations given here fit, is the Psychology Today directory. It's better organized than most, and the therapists list prices and which insurance providers they accept, as well as their credentials and a personal statement.

Again, would encourage you to look for a therapist with either a Ph. D/PsyD credential or an MSW credential. Though there are many fine counselors with an MA or MS and LMHC credential, it's a less reliable filter than the former in my experience. On the other hand, if you get recommendations for LMHC therapists, pursue those!
posted by Sidhedevil at 12:27 PM on July 25, 2012

[This is a followup from the asker.]

Thank you for the helpful answers so far! At liketitanic's suggestion, anyone who would like to make private recommendations or speak personally can email me at [e-mail].

posted by cortex at 12:30 PM on July 25, 2012

Additionally, my wife confided to me she's afraid to discuss her problems in detail with a professional. Turns out I'm the only person in the world who has seen the extent of the issues she has; even her old doctors were never clued in properly. She wants to go through the motions without revealing her vulnerable parts. I know full disclosure with the doctor is vital in order to get an accurate diagnosis, but how do I help my wife open up? I think we need a doctor who is friendly and genuine, but who also asks probing questions and knows how to dig beneath the surface.

Oh goodness. This all sounds familiar. My wife and I have both dealt with all the components of this at one point or another: med-phobia, trouble trusting a new doc or shrink, trouble admitting how bad things have gotten, etc. A bunch of kind of disorganized thoughts, from our experience with it:

• It's okay to start seeing a therapist and be like "Hey, so you know, I really have a hard time opening up about how bad my symptoms are, and this is one thing I want to work on." That's definitely part of the job description for therapists, and they're used to it and will appreciate the heads-up.
• Some therapists "push" harder than others. Some prefer to let the patient steer everything, some are willing to hammer you with hard questions, some will do either depending on what the you prefer or need. This is something you can talk about prior to setting up an appointment. "I have trouble opening up, and I'd prefer to see someone who can push back against that. How do you feel about taking that sort of role?" Some therapeutic modalities are also "pushier" than others.
• If she really doesn't even want her therapist to mention pills, she should say that up-front. "I'm not willing to consider medication, and I'll be very upset and probably quit therapy if you try to make me take it. Unless it's a life-or-death emergency, please don't go there."
• One sort of standard trick for patients who have trouble opening up is to write stuff down ahead of time, and bring that written description in to a therapy appointment. It's easier to work up the nerve to hand over a piece of paper than it is to open your mouth and discuss this stuff spontaneously. And there's a reassuring sense of control that comes from being able to take your time finding the right description for your symptoms instead of just trying to wing it.
• It might be helpful for you to be in therapy yourself. Supporting a mentally ill partner is hard and brings up a lot of intense scary feelings and you'll want to find ways of dealing with that. Couples therapy might also be helpful. But for either one, you're going to have to open up about your own issues to a therapist, and not just talk about hers. Would you be okay with that? (If yes: awesome. If no: that's okay too, but hopefully you can use that reluctance to have some empathy for the hard work your wife is doing in trying to talk about this stuff. And don't bother with couples therapy if you don't want to put your own feelings on the table; it will be a waste of everyone's time.)
• Basic good nutrition and exercise are empirically proven to help with depression. I'm not talking homeopathy or weird-ass herbal or chemical supplements or anything. Just, you know, eat protein, eat fresh veggies, stay hydrated, walk a lot, stretch, break a sweat now and then. It's not a cure, but it's a step in the right direction.

posted by nebulawindphone at 2:35 PM on July 25, 2012