What is the best way to go about finding a therapist?

February 4, 2013 6:30 AM

I think I have a personality disorder (not an illness or condition) that few therapists ever deal with. How can I find a therapist up to the challenge of helping me with this?

I believe that I probably have avoidant personality disorder as I match each and every component of the DSM criteria for it. I have done a bit of research and it appears most people with this disorder don't seek treatment and not many therapists really know how to treat it. (I have also read that therapy can have limited success because negative thoughts with this disorder are so pervasive, but no matter - willing to try anyway.)

How can I find a therapist who understands this disorder and can deal with it, or who has experience with it? I would also like a therapist who is equipped to diagnose it and evaluate my symptoms to ensure that's really all that's going on here. What I go through isn't simply social anxiety though and it seems it can't be approached like a case of anxiety. I think going to a doctor who knows how to deal with anxiety and not avoidant personality disorder would set me up for failure. I've been trying various searches online and I've found plenty of local therapists who deal with anxiety and depression, rarely ones who mention personality disorders and not a single one that mentions avoidant personality disorder (or anxiety + personality disorders, which might work).

tl;dr How do I find the right therapist for me? Thanks in advance.

posted by anonymous to human relations (15 answers total)

Hmmmm....I would call one of the more well known counseling clinics in your area and ask them who specialized in avoidant personality disorder. Chances are one of the therapists that are well established and connected in the field would know who specializes in what. You may have to make several phone calls to get some leads, but it could be worth it because if the same name keeps popping up you know you're on to something.

You can also use the clinician locator at APA to get an idea of who is in your area. There also may be a state psychological association website that has a clinician locator as well.
posted by MultiFaceted at 6:44 AM on February 4 [2 favorites]

I know quite a few people in therapy for anxiety and avoidant behaviors. I don't think it's as uncommon as your readings mention. In any case it's really best to phone up therapists and ask them; they don't put everything online.

Please don't worry about statistical success numbers, btw. Strong indicators of succesful outcomes are the patient-therapist relationship, and readiness and willingness to make changes (feel free to search for those and see how often they come up in research etc.). Concerning potential outcomes, the diagnosis is only important in that it can affect either of those factors – if you're aware that you're avoidant and in what ways that could manifest as wanting to avoid therapy/change, yet going ahead with it anyway, then you've already done a good lot of work.
posted by fraula at 6:44 AM on February 4 [2 favorites]

Matching the symptoms in the DSM is not useful unless you are well trained. Instead, think about how your thinking and behavior affects your life. Look for a Ph.D. psychologist. This person will be the most highly trained practitioner who does therapy. You should interview potential therapists, asking them what methods of treatment they use. It's also reasonable to ask if they have experience with personality disorders. Be persistent. There are a lot of therapists who are okay at basic listening, and able to assist many people, but not able to deal with complex problems. If your 1st therapist doesn't help, keep trying.
posted by theora55 at 6:47 AM on February 4 [3 favorites]

Also, since this disorder is related to social anxiety, finding a clinician who specializes in social anxiety treatment would be worthwhile. That actually may be what you need to ask for first because avoidant personality disorder isn't as commonly discussed as social anxiety. Be careful that you aren't referred to a psychiatrist for general anxiety disorder...they may just put you on meds (and those may help) but what you are really looking for is therapy, most likely Cognitive Behavioray Therapy or a variant of exposure therapy.
posted by MultiFaceted at 6:52 AM on February 4

This seems like something cognitive behavioral therapy might be great for. Don't get so hung up on the exact diagnosis (which, fun fact--are used primarily for billing codes, outside of forensics), and look for a CBT practitioner who advertises as being experienced with "social anxiety disorder" (lots of crossover, a more layperson friendly term).
posted by availablelight at 6:54 AM on February 4 [3 favorites]

nthing availablelight's CBT recommendations.

I'd start by getting a list of therapists your insurance would pay for. Then call them and ask about their specialties or areas of interest.

Anyone that mentions CBT or DBT (dialectical behavioral therapy) is probably worth going in for an interview/getting-to-know-you session.

And don't overlook the value of medication. Seeing a psychiatrist to discuss if medication might make the first steps in therapy easier might be worth considering.
posted by colin_l at 7:20 AM on February 4

I want to second the idea that the DSM is not meant to assist the layperson in making a self-diagnosis.

I also want to suggest to you that holding off until you find the perfect therapist for your particular issue or disorder is only going to delay you starting to work on whatever it is that you feel you need to work on. The perfect really is the enemy of the good, here.

In non-financial terms I think it's important to think about therapy and self-improvement as though it really is a low-to-no-cost endeavor. You try a therapist. If they help you right away, so much the better. If they don't help you, you say to them, "that didn't help. What's going on?" and you listen to what they have to say. And you listen to yourself as well, especially taking care to support that part of yourself that wants to overcome your social avoidance. And if, after having given it an honest shot, (let's say, three to six months) you find that that part of you -- the part that wants you to overcome your stuff -- doesn't trust or feel right about what this therapist is doing, even after discussion with the therapist about what's not working, you can ask them to recommend somebody else.

You can ask them to recommend somebody else early on, too. You can march in and say, "I've self-diagnosed as having avoidant personality disorder and I need you to recommend somebody who can help me with this rare disorder. I don't think it's you. Who can you recommend?" That is totally a fair question to ask at any stage of the game.

I'd bet, however, that 9 out of 10 therapists will, before giving you that recommendation, ask you to talk with them about your self-diagnosis and what you are experiencing, and I'd bet that 100% of them are already treating patients who are experiencing exactly or almost exactly the things that you are experiencing. Whether any of them is right for you is a different question, but it is one that you won't be able to answer without trying some of them on for size.

Good luck.
posted by gauche at 9:36 AM on February 4

I wouldn't worry too much about your self-diagnosis. The main issue is whether your therapist can help you develop specific coping strategies for maladaptive behaviors that negatively impact your life. Since you've self-diagnosed with avoidant personality disorder, I think it's fair to say that you have issues with social anxiety. Any therapist who specializes in helping those who suffer from anxiety will be able to help you--the key is finding one that works for you.

To prepare to interview therapists it's helpful to make a list of your problems and goals ahead of time. Write them down and present your case.

"Right now I'm having problems with a, b, c, and d. The quality of my life suffers because of these problems in the following ways: 1, 2, and 3. Ideally I'd like to be able to do x, y, and z. How would you help me accomplish these goals?"
posted by xyzzy at 9:54 AM on February 4 [1 favorite]

Do you know anyone who is connected to the psych community in your area? I had been to some useless talk therapists in the past (picked from the insurance list, essentially), but when I was in really bad place and needed quality, results-oriented therapy, I had really great luck by asking for personal recommendations from someone who was well-connected in that regard. I called the 3 names given me - naturally, as a top-3 name they were not taking new patients. But one of them took the time to speak to me over the phone about my issue and what I needed, and gave me a couple of other names to call. I basically followed xyzzy's script, and found a great therapist. Unfortunately it did take a few phone calls, but it was completely worth it.

If you don't know anyone personally who can point you in the right direction, I bet AskMe would be a good source for recommendations in your geographic area.
posted by stowaway at 10:27 AM on February 4

Have hope! Half the battle is wanting to get help to help yourself!

Thankfully, there's increasing high-quality evidence that patients with personality disorders can be helped by psychotherapy. For example, in this well-performed randomized controlled trial examining specific formulations of brief psychoanalytic and cognitive therapies for Cluster-C personality disorders (which includes avoidant PD), the authors found that nearly half of all patients had "remission" both symptomatically and in terms of interpersonal & personality functioning. Both therapies performed essentially equally on average (a pretty common finding; if anything the psychoanalytic one effected marginally better outcomes), and it's possible that longer-term therapies of either treatment type may have been further helpful for those who were not treatment responders.

In addition to seeking out individual therapists, I would recommend looking at major research hospitals and their community clinical offerings. Even if an individual is a resident or intern, being in a good psychiatric center (either MD or PHD) provides a therapist in training the proper supervision and training to deal with more complex cases, as yours may be. Community clinical offerings at such programs also are sometimes less expensive than therapists you might find on your own.

If you are in a metropolitan area and are comfortable with PM-ing me your location, I might be able to provide some specific references for centers or therapists who may have specific training or expertise in PD.
posted by Keter at 10:37 AM on February 4

Filtering out potential therapists based on a self-generated story that what's wrong with you is rare and difficult to treat seems like it might be a manifestation of the problem that's leading you to look for help in the first place.

Please don't let this stand in the way of taking some of the good therapist-finding advice above.
posted by ottereroticist at 11:02 AM on February 4 [4 favorites]

Try this website and use the "specialties" button to select a therapist who's familiar with your symptoms. Good luck!
posted by andariel at 4:16 PM on February 4

I think you should try going to therapists who are experienced with treating social anxiety disorder, particularly using CBT. This is for two reasons:

1) I think it will be helpful to you, regardless of whether you have AvPD or social anxiety disorder.

2) These therapists, if they're keeping up with literature and ideas about social anxiety disorder, will very likely have awareness about avoidant personality disorder as well. And someone who does clinical research about SAD told me that there is some belief that they are actually the same thing!

Having watched relatives go through a number of therapists and psychiatrists and having had some experience with that myself, I believe that diagnosis of some mental health stuff is an inexact science. Particularly with these two issues, I think it's a matter of throwing different things at your issues until you find something that works, and I think good therapists who are experienced at treating social anxiety disorder will have enough tools in their toolbox (so to speak) to help you find some things that help.
posted by needs more cowbell at 4:22 PM on February 4

Seconding checking the ACBT website. More than likely counselors can/will tell you over the phone whether they have experience in that area.
posted by Elagabalus at 5:58 PM on February 4

there's a lot that goes into finding a good therapist. think of it like buying a car. :) it's expensive so you need to do your homework and there are lots of variables to consider. it might be good to give yourself a deadline though so you don't overthink it.

one of the things that is really important to consider, in addition to their treatment orientation and experience, is if you feel you have a good fit with the therapist. some therapists you may naturally just feel comfortable with and those are the ones you want to consider seeing. if you don't have a natural sort of fit with a therapist then it may be difficult to open up to them. it's important to feel comfortable and accepted by them so you can do the work. so, trust your gut on that point.

here's an article on finding a therapist. here is a page on how a couple different types of therapy will approach avpd: treatment
posted by wildflower at 5:58 PM on February 4