Need help in choosing a psychologist.

November 2, 2005 1:17 PM

Need help in choosing a psychologist.

I need to find a psychologist or social worker. Here's my deal -

Male. Late 20's. Was physically, emotionally, and sexually abused as a child and adolescent by my mother. Difficulty being intimate and forming relationships with women, despite being heterosexual. Self esteem/self hatred issues. Lots of problems.

Here are my questions -

1. Should I choose a Psychologist or Social Worker? Psychologists seem to me like a better option since they have to go through more schooling, but this could just be a bias on my part. (Psychiatrists are not an option since I oppose medication)

2. Should I choose a male or female therapist? Common sense would dictate "male," since I am male and have problems with women. However, it is possible that a woman could be more helpful and offer insight that a male therapist couldn't.

3. What questions should I ask when interviewing possible therapists over the phone, to help determine whether they can help me or not? I'm new in town, and a referral isn't really possible.

4. I have the World's Worst Insurance (tm), and the psychologists that I have called seem offended that I got their number from my insurance database. Why is this? Should I avoid telling them where I got their number? Right now, my only option is to choose a random name from this big list of providers that my insurance gives me. (And yes, I do need to see someone in-network, even though the people most likely to help me don't even take insurance)

I hope this isn't too heavy of a subject. I normally am not a fan of "therapyfilter," however, I don't really have anyplace else to turn on this. I can't very well ask a psychologist!

posted by anonymous to health & fitness (13 comments total)

P-S-Y-C-H-I-A-T-R-I-S-T
posted by Pretty_Generic at 1:19 PM on November 2, 2005

Psychiatry is not solely about medication.
posted by Pretty_Generic at 1:20 PM on November 2, 2005

I would suggest that you find a psychologist who is affiliated with an educational institution. For instance, a postdoctoral fellow in psychology working in the teaching clinic at a school - they are far enough along in their career to be of use to you, and they are heavily supervised, so if it's not working out, the situation has some potential to be fixed painlessly.

I know that you said you are against medication, but sometimes it helps. The other benefit to university psychological services is that they often have a psychiatrist on staff if that becomes an option.

Most psychological clinics don't require that you be affiliated with the school, and do take many different kinds of insurance. Good luck!
posted by dirtmonster at 1:25 PM on November 2, 2005

Psychologist, start with a male. further along you may switch if you feel you are ready to do so. Interview in person. Ask about treatment methods they use/are trained in. Group therapy may be of some benefit to you. If they act all weird over you having gotten their name from the insurance list consider moving on. Professionally they should not let this matter. Scope out their office.

This is a potentially LTR so you need someone who you feel comfortable enough spending time with and whom you can trust.

If you are not ready for meds, don't sweat it now. They can make some things easier, but effective therapy works well over time, and it may be a topic you can discus with your psychologist at some point.
posted by edgeways at 1:53 PM on November 2, 2005

Formal training is almost irrelevant. Psychiatrists, psychologists and social workers are all in the same boat when it comes to verbal therapy. Some pointers:

1) Figure out what you expect from therapy. The have the pain go away. To have a successful relationship. To feel comfortable in your own skin.. etc
Realize that none of these can be alleviated by drugs, so forget about them.

2) Trust your gut about who you connect with. Notice who seems credible, competent and that you feel you could trust.

3) I don't believe in therapy taking forever stuff. Find a therapist that has had actual successes. Have them tell you about those successes, how long they took, and what they entailed. Gauge for yourself whether you believe them.

4) I personally would look for a therapist that has some short term techniques knowledge, including things like hypnosis, behavioral therapy , NLP , etc.. That kind of knowledge is not that common, and makes a huge difference in efficacy, meaning how long it will take for your pain to go away or for you to work things out for yourself.

5) The insurance thing is slightly ticky, but also realize that many therapists have sliding scales as well. So some might be willing to take you w/o insurance at a reduced rate.
posted by blueyellow at 2:25 PM on November 2, 2005

You might also consider what kind of therapy a psychologist practices. For example, Psychotherapy or Cognitive-Behavioral Therapy (CBT). My therapist is trained in CBT as well as Hypnosis and Art Therapy, and I find it very helpful. CBT is a lot more active than psychotherapy, as in addition to talking about stuff, you have "homework" where you have to go out and practice certain behaviors. My therapist is actually licensed as a Marriage and Family Therapist, so that is another route you might want to look at.

I will also second dirtmonster's suggestion of looking for educational institutions with affiliated clinics. If they're not helpful in actually treating you, they should at least be helpful in recommending someone on the outside community to help you. Does your work have anything like a counseling center, or possibly even an ombudsperson that you might be able to get a recommendation from? I work at a large University, and we have a Counseling Center (not open to public, just university students and staff) that is free for 12 visits or something. Totally private.

It took me a while to find the therapist that was right for me. When I called my insurance company, they gave me several names. I called all of those people, and not a single one was taking new patients. So I called the insurance company back. This time they arranged the appointment themselves. The woman they sent me to was *definitely* not for me (I think she was trained in psychotherapy, which was pretty useless as I am an introvert and don't really talk to people until I trust them and I am prompted to talk.) Then my ex-boyfriend gave me a recommendation. A friend of his had given him this therapist's name, on the condition that the friend remain anonymous. This therapist was not in my insurance, however my insurance would reimburse me 60% up to a certain amount per year. I went to see her and immediately knew she was the one. She listened to me, and immediately acknowledged the fact that I was smart and had a mind oriented towards CBT. I paid the therapist's full price for a while, but couldn't really afford it, so I am paying 50% of that now. And it's worth every penny.

Regarding your insurance, I think my therapist mentioned to me once that there is one particular insurance company that pays very little per session, and is a pain to work with in general, so people don't like taking clients with that insurance. This might be the one you have (can't remember which one specifically).
posted by sarahnade at 3:09 PM on November 2, 2005

1. Psychologist v Social Worker: I know nothing about Social Workers... but a psychologist could be able to help you with some insight into what's driving your problem - family, early experiences that have created unhelpful patterns - and help you learn practical strategies to address those problems in the present - cognitive behavioural therapy, for example.

2. Male or Female: go with who you instinctively trust. It's really important that you feel comfortable and safe if you're going to address issues like abuse. So, if you feel you'd most likely be able to place some trust a male therapist... think about going with a guy to start with.

3. Questions to ask: "Hi, I'm anonymous. I'm looking for a therapist to help me with (your issues). Can you tell me a little bit about your approach to (issues)?" Try and get an idea of what a session with them would involve and don’t be afraid to ask for clarification. See how they respond. Are they open about what they do? Are they able to explain their practice clearly? (Good signs.) Or is the explanation confusing? Do they seem evasive? Patronising and dismissive? (Bad, bad signs.)

Then, of course "What's your background?" How long they've been in practice, where they've worked, who they've worked with (both clients and institutions or organisations e.g. universities, hospitals etc). Did that doctorate come from an internet school of divinity, huh? You want someone reputably qualified and with experience helping people with the same sort of problems you're having.

And... "What's your scale of charges?" Some therapists will offer a discount to long term clients. Some charge more for the first one or two consultations (often spent taking a history and getting an idea of the problem), then a bit less after this. And if you're going for a long time - more than six months - you might be able to negotiate a slightly reduced rate, especially if you're a student or otherwise in straitened financial circumstances. So: it's worth flagging the charges thing up front.

Check when they're available for appointments too - no good finding someone awesome who only consults when you're at work, or otherwise unable to visit them.

After this... what's your gut feeling? Do you think you'd feel comfortable meeting them? Do they sound OK? Or do they sound like a prat? Proceed accordingly.

4. Insurance: Who knows why they're snotty - perhaps admin problems with your provider? - maybe you could just say something like "Oh and I'd be paying with XYZ provider", in the "How much?" part of the conversation? As for choosing a random name from your insurer, could you contact a support group in your area and ask if they have a list of therapists who specialise in what you're dealing with? You could see if any of their recommendations are on the insurance list.

Support groups sometimes run group therapy sessions which can be a cheaper (free, sometimes) way of getting therapy – or of adding extra sessions to supplement the therapy you’re getting through your psychiatrist.

Congrats on taking first steps to dealing with some scary stuff. Hope it all goes well.
posted by t0astie at 3:14 PM on November 2, 2005

Oops, typo. I meant 'through your psychologist'.
posted by t0astie at 3:16 PM on November 2, 2005

However, it is possible that a woman could be more helpful and offer insight that a male therapist couldn't.

It's possible -- but assuming competence and professionalism, it shouldn't be significant.

You said a referral wasn't possible. Try. Crack the Yellow Pages and cold-call physicians asking for referrals. A few may decline to refer a non-patient, but most have one or two regulars they send their patients to. You're looking for overlap, obviously: If three doctors are recommending the same psychologist, that's a good sign.

Visit your local hospital. Try to speak with someone in charge -- if necessary, leave a voicemail, or drop off a SASE. Ask for their recommendations. Again: You're looking for something that strikes a chord ("Oh, his specialty is...") or overlap.

Barring that, you might consider emailing Matt or Jessamyn to request amending your question to include your hometown (or one nearby, if you're paranoid about anonymity). MetaFilter has a lot of members, and you might get an answer from someone who can offer a personal recommendation near you.

Good luck.
posted by cribcage at 3:18 PM on November 2, 2005

From my experience working in the mental health field, there's not a huge difference between psychologists and social workers, except that social workers generally charge less than psychologists and psychiatrists tend to charge more.
At least in the state where I live (PA), social workers have to be licensed and that requires further supervision beyond grad school.
Everyone above who has said that it really depends on the person is right, because you need to be comfortable with your therapist and you need to have some kind of bond so that you'll return and get something out of therapy.
Since you do have issues with women, perhaps it's not advisable for you to work with a woman therapist initially, as that might not allow you to fully connect with your therapist, but that is really your call.
I'm not sure why the therapists you've contacted so far have had a problem with you mentioning you were referred by your insurance; it would seem like they should be thankful for a new client! In any case, it is completely fair to ask them about their costs, hours, their background/specialty, and what you are looking to work on emotionally (depending on how much you feel comfortable sharing).
In any case, best of luck to you...I hope you're able to get everything you need out of therapy!
posted by robynal at 3:33 PM on November 2, 2005

I found Cognitive Behavioral Therapy worked for me. I like the approach. I'd go with psychologist, but I have had no experience with a social worker, so I can't really speak to that. I'd talk with at least 5 over the phone and if they make you feel uncomfortable at all, by say acting upset that you got their number from the insurance company, I would move on. Therapy only works when you feel comfortable enough with the person. You can't force it. Also, ask them how many people they've dealt with that have similar problems to you. Experience really helps. And then ask them the types of techniques they've used to treat those patients. You'll quickly get an idea of what techniques you think might work for you and which ones don't (like medication, you said).

Then, once you have the 5 or so, make a half-hour appointment with each and just go and do a brief session and see how you connect. Questions over the phone are helpful, but you have to know how the two of you interact in person during therapy to really discover who would be the most helpful.

In talking with people, I've found it's personality issues that make or break therapy. That's the biggest factor.

Good luck.
posted by Moral Animal at 4:20 PM on November 2, 2005

Either a social worker or a psychologist is going to be able to do the same things for you. Therapy works, and both disciplines are well trained. The training can be different, or it can be very similar, but the bulk of training comes in the internships, which are quite similar in that they are working with patients.

I'd call the local rape crisis center. If you live in a city of any size they may well have a hotline. They may offer you free therapy, although they might generally reserve it for women. I would go ahead and ask anyway, and they will certainly be able to refer you.

As far as what to look for: you should like the person, they should be optimistic about helping you and about your chances for getting the help you want relatively quickly. They should solicit your opinions, be very interested in what you think is going on, and even solicit your opinions about what you think will help you out. You should feel, at the end of the interview, as if they can help you.

There's a lot of good research that says that mode of therapy does not significantly affect outcome. This is great because it means that you should feel free to choose whatever means of therapy seems most comfortable for you. If that's CBT, great, but if not, then all reputable therapy works about equally well.

There is also research that shows that therapy works well and quickly, and that early change predicts later change. What this means is that therapy doesn't take forever (you should certainly be seeing relief from the symptoms that brought you to therapy in the first couple of months), and if you don't see early change, talk to your therapist about making changes in what you both are doing. Don't just wait around for things to change later.

Good luck. (Email in profile if you have any questions.)
posted by OmieWise at 6:07 PM on November 2, 2005 [1 favorite has favorites]

Dear Anon: 1) I don't think it makes any difference what degree the person has. It is most important to find someone you feel ok with in opening up re these important central concerns. 2) gender: whoever you feel most comfortable with, as issues with your mother obviously do not mean that all females are like her. quite the contrary, and that may be helpful to you for that alone. 3) most therapists are not dismissive and welcome to work with you. 4) your willingness to ask here for help indicates a capacity for insight and new life. a good prognosis. 4) when a young child is abused often they feel self-hatred, their fault, depressed, etc. you are talking about a posttraumatic stress situation that has taken deep root in your self. emdr therapy can be very helpful for such problems. you could go to the emdr website to find people skilled in your area. Many insurance companies will reimburse for emdr therapy. I guess you would need to find someone on your approved insurance list who is trained in emdr and who you like. That is doable. 5) Complicated traumatic experiences as you describe are not forever fixed and hopeless of moving past. medication can be helpful depending your symptoms, but often your PCP can prescribe an antidepressant or other class of medications that do not require a psychiatrist to prescribe. 6) There are all sorts of therapists and approaches- cbt, emdr, etc. The most important thing is to find someone you feel comfortable with and who you feel can be helpful to you, who understands you and your situation past and present. You can meet with different therapists until you find someone who you feel fits your bill. 7) I would also emphasize that you find someone who you feel can bear your pain, and who does not focus necessarily on the pathological aspects of the situation, but sees your capacities and helps you move toward your liberated self, and not focused on your traumatized self. 8) re: emdr- you can find some books on emdr at your local bookstore or on amazon and see if that speaks to you. It can be very helpful re the trauma you have had to endure. Get the book Trauma and Recovery by Judith Hermann and see what you think. 9) Good luck my friend.
posted by madstop1 at 6:56 PM on November 2, 2005