How to pick a therapist to help my anxiety (before pregnancy/parenting)

November 24, 2014 12:09 PM

How do I pick the right therapist to help with my anxiety, stress, indecisiveness, and perfectionist tendencies? What kinds of therapy/techniques/approaches might be most helpful? How do I quickly assess whether to stick with someone or look elsewhere? What are reasonable expectations of how much I can improve in therapy and how quickly? I'm terrible at making decisions-- I need help! (Especially since we want to start trying for kids in a few months so I feel real urgency to make progress quickly to feel comfortable going ahead, for both my and the kid's sake.) DC-area, FYI.

Skip the details if you want, but here's more about me:

I have general anxiety disorder, usually decently manageable in low-stress times but which can flare up and make me pretty miserable under even medium-stress conditions (like home-buying and making big decisions after the inspection, which I imagine is far easier than pregnancy and parenting.) And even day to day, while I can certainly function, I have a hard time really relaxing and enjoying myself, and I just spend a lot of time worried and stressed about what's not getting done on my to-do list, or whether that weird symptom is actually life-threatening, or what other people are thinking about me. It's kind of exhausting being me and I'm increasingly realizing how much this stuff interferes with me feeling truly happy and satisfied about my life. And it seems likely it will get worse in pregnancy/postpartum/as a parent (worrying about miscarriage/something happening to the kid/how the choices I make are going to screw up the kid) unless I address it in advance, right?

I also have a terrible time making decisions... even easy ones like what to have for dinner or what birthday card to buy (although I've gotten better at being able to kick myself out of that loop once I catch myself.) But if something seems Really Important to me-- such as anything that could have any health consequences or significant financial consequences or whatever-- it's incredibly hard for me to stop short of feeling almost positive that I'm making the absolute best choice. (It took me 7 years of dating my husband to decide to get engaged.) And what's more Really Important than things that affect the health and well-being of your kids? I know there will be SO many decisions ahead (it's already started with choices around prenatal vitamins, which I've researched and agonized over) and it seems like it could get really paralyzing and miserable.

I've toyed with the idea of anti-anxiety meds and actually got a prescription once but never took it because I was too anxious about side effects. After reading and thinking more about meds and about my issues, I think if I wasn't looking to get pregnant soon I'd want to give meds a try. But while I know SSRIs aren't super high risk in pregnancy, there do seem to be risks. But then again apparently stress and anxiety in pregnancy is pretty bad for the baby, and leads to higher rates of postpartum depression and anxiety which are obviously bad for the baby and for me. So I'd really like to make some progress in getting less anxious and stressed without meds.

I've been in therapy in the past, and it's helped modestly but not all that dramatically. (Most of the therapists I've worked with have had CBT as part of a mix of techniques they use, but the therapy wasn't super-focused CBT work.) There were a couple folks I only did one or a few sessions with, and a couple others I stayed with for months/years making slow progress when I probably should have looked for someone better sooner (but I stayed because I was trying to fight my tendency to hunt for the perfect therapist-- and because I knew that between my ADHD and my indecisiveness (and my busy schedule) it ends up being months between therapists even when I intend to find a new one immediately.) As I said, my problems with being indecisive mean I get really anxious and uncomfortable if I feel like that I haven't done enough to find the best possible outcome, so it's really hard to figure out how much of my "this therapist doesn't seem good enough" feelings to trust, and sometime I end up going the total opposite direction to try to counter-balance it.

Maybe slow progress is all I can really expect? I hope not, I hope there are ways to improve things more deeply and more quickly, but I don't know, and that's part of what's made it hard in the past to know who to pick and whether to stay, when I'm wondering whether my expectations are too high or too low or what. What are reasonable expectations for how much I can improve in therapy and how quickly?

Anyway, I'm ready to find another therapist again, and I'm hoping I can find a really good one. But I need help figuring out what I should be looking for, who I should contact (i.e. folks who use technique X or have experience with Y), what kinds of questions I should ask them/what kinds of things I should discuss with them in initial consultations/first visits, and how I should decide relatively early on whether to stay or go.

TL;DR-- I am bad at decisions, y'all. Can you help me figure out how to pick a good therapist to help me with my anxiety and other issues?

(P.S. I would also be delighted to get specific recommendations of particular therapists-- I'm in the DC area. Especially great if you know they take insurance/Cigna.)

posted by SockHop to Human Relations (4 answers total)

I only have advice on one small part: you've laid out some of the risks and benefits of taking an SSRI during pregnancy. But have you actually asked for a doctor's perspective on this? Your Ob/Gyn shares your goals with regards to you potentially using medication to control your anxiety (healthy mom/healthy baby) but probably has more information to work off of.
posted by i_am_a_fiesta at 1:45 PM on November 24, 2014

I'm in a DBT therapy program (client, I mean, I am not in any way any kind of trained therapist) and it's like CBT only more so. I've already noticed changes in my behaviour, and it's only been 8 weeks. One of the things we use as a tool is a diary card for tracking general emotions, specific things we want to track (and change), actions (as in e.g. tracking urges to self-harm and whether or not the action was taken on that urge), and which if any skills we used on a particular day and whether they were effective. Just being aware of behaviour in a really concrete way helps to address it. So I kind of suggest trying that out as a tool for now while you work on finding a therapist. Along with that, engaging in a daily mindfulness practice really helps, especially with anxiety; grounding and centring yourself (moving into what is called 'Wise Mind' in DBT) helps address anxiety head on.

As to your specific questions:

Nobody is ever going to find The Perfect Therapist. But you can find one who's pretty close. I think about 3-5 sessions is probably enough to get an idea of whether to continue with them or seek out someone else--but if you want to do the latter, best to discuss with your current therapist what you feel are barriers to therapy with them, and whether they are truly incompatibility issues or related to your decision/commitment anxiety.

One of the primary things to look for is a therapist who asks you what your goals are, and helps you really drill down to concrete and achievable aims that are well-defined. A good therapist will work with you.

Maybe slow progress is all I can really expect? ... What are reasonable expectations for how much I can improve in therapy and how quickly?

It may be beneficial to think of psychotherapy as more akin to physiotherapy than anything else. Recovering from trauma takes a long time, physically; there are days you don't want to, there's frustration at progress, and sometimes it can feel like two steps forward one step back. Mental therapy is basically no different in this regard.

As for what amount of change can be reasonably expected and how quickly, that really depends on your personal situation--there isn't, as far as I know, any hard or fast rule about these things.

When it comes to 'should I stay or should I go,' do you have anyone close to you with experience with therapists? Someone you're comfortable discussing these details with? That person, if there is one, may be a very useful resource for you when it comes to making that decision.
posted by feckless fecal fear mongering at 2:02 PM on November 24, 2014

I really identify with this question because I entered therapy with this exact same issue -- an inability to make decisions and feeling compelled to make the "right" decision, which resulted in delaying decisions forever and researching things to death and never feeling good about any decision I made. It sucked and was having a negative impact on my life as I let opportunities pass me by.

One of the first things my therapist told me in our very first session is that she's not the "right" therapist for me, just sort of challenging my whole underlying assumption that there's a perfect fit for me out there somewhere. It made me uncomfortable to hear her say that, but perversely, also made me think she got me and my issue pretty quickly. I still struggle with the question of whether she is the "right" therapist, but I am more comfortable with the uncertainty of it.

That said, I did the normal things that people recommend: I shopped around a bit, asked for recommendations, went to a session with a different therapist, asked them about their approach, looked at therapists who took my insurance and were in a reasonable transportation distance from me, etc.

So we've worked on this issue slowly, laboriously. She has a humanistic background and throws some things in like CBT. I think one of the things we discovered is that I don't always learn from my experiences -- say I went on a vacation, and had a really goddamn hard time with all the decisions involved, but overall the vacation was a good one. Well, the next time I have to make decisions related to a vacation I don't always remember "hey, I've done this before, I am capable of doing this, I know from past experiences I'll make some good decisions and some not-so-good decisions but in the end, it will likely be a good trip in the aggregate" and instead fall right back into the whole indecision/perfectionism cycle. But this slow pace is mostly because of me, I think, and my huge resistance to change. I don't think it's easy to generalize how fast or slow things need to progress, but I do feel like within a few sessions you should know if someone's style is good for you. It would probably be a good idea to go into therapy with a few key decisions you are trying to resolve.

All I can say is that going through all these decisions with her (big and small -- we once spent several sessions talking about my difficulty settling on a pair of shoes, and she talked me into buying a pair I was on the fence about and I hated them. The world did not end. It is now slightly easier for me to make shopping choices. I can laugh about it even) has relaxed somewhat the grip that perfectionism has on my brain. At the very least, I understand how it works in my life much, much more clearly.

In general, a therapist who can talk to you about things like thought distortions and black/white thinking and maximizing/satisficing is going to be useful. There is no magic bullet in choosing a therapist; you just have to start making the calls.
posted by megancita at 2:16 PM on November 24, 2014 [1 favorite]

The thing that sucks about anxiety is that it can actually hinder you finding a therapist to help with your anxiety! Honestly the best thing (after reading this thread) is to just *go for it.* You may not like the first person you try, but whatever, you try again. Trust your gut - I have had two therapists that I didn't click with, and I knew after the first session (although for some reason I went a second time).
posted by radioamy at 4:45 PM on November 24, 2014