What kind of therapy should someone like me go for?

January 3, 2015 5:23 AM

I feel a terrible darkness looming over me that I find scary enough to seek help for. I've never been to a shrink before. Please help me know more about this stuff. I've heard of CBT, TALK, behavioral... I don't know which is good for this.

I'm usually fine. This is not a regular or normal state for me to be in. I did go through a terrible depression about 6 years ago where I had trouble sleeping less than 12 hours a day and spent the waking hours in a daze and physical pain all holed up in my room. Everyone knows that you feel emotions in your body, but I didn't realize how bad it could physically hurt before this happened to me. Sometimes even finding myself thinking I was going to throw up because of the pain in my gut. A few times I woke up to panic attacks (another thing that never happened to me before then). But I was mostly able to snap out of it after I got out of a bad situation at the time....mostly. It took some time. I don't want to go through that again if I can help it.

The past 6 months have had some bad events occur on me, including the death of a loved one that I didn't quite get to say goodbye to. But sadness is sadness and grief is grief and that's life... but what I'm feeling now is not normal or healthy. I don't know how to explain it, but what I'm feeling is ... dangerous. That's all I know. Like I might become incapacitated again. This feeling came down on me pretty suddenly. A few days ago I thought I was doing alright.

I don't know if any of this helps to determine what kind of therapist I should see, but I really want to set up an appointment as soon as Monday morning comes around. Your thoughts and suggestions would be most appreciated.

posted by rancher to Human Relations (15 answers total)

See a medical doctor, if you can get into a psychiatrist for a medical evaluation, that might be best. That way you can rule out any chemical imbalances that may be exacerbating your mental state. The psychiatrist may recommend a psychologist or other therapist for further talk therapy.

No one on the internet can tell you what you need when it comes to your mental health. So get a professional opinion.
posted by Ruthless Bunny at 5:36 AM on January 3, 2015

Thank you bunny- I'm a little confused. I didn't realize psychiatrists ran medical tests. Like brain scans? I might not be able to afford an array of tests like that right now.
posted by rancher at 5:47 AM on January 3, 2015

Not a brain scan, but there may be blood tests, discussion and an evaluation based on affect and responses to questions. Be 100% honest.

If you live in the US, you should have health insurance, and it should cover this visit. Check your policy, you may need a referral from your GP, and in fact, a GP isn't a terrible place to start.
posted by Ruthless Bunny at 5:58 AM on January 3, 2015

What you need depends on what you believe being alive is all about. Terms like "chemical imbalance" sound like science but no one has ever physically seen one. This is not to say that psychiatric meds may not make you feel a way you prefer to how you feel now. (Keep in mind that it is often several weeks before they do what they are supposed to and in the short run may make you feel worse.)

Few will admit it but the different forms of therapy all hide metaphysical assumptions. Choosing among them is not so different than choosing religious (or irreligious) beliefs. One point of view is that our culture pathologizes grief. Here is an article expressing that opinion.

My own belief is that you need to shop for a therapist--that finding a human you feel comfortable working with requires you to try things out and that the "type" of therapy is less important than how you feel in their presence. You need to feel comfortable enough to question how they work and what you can expect. This is something that, as ruthless bunny puts is, no one on the internet can tell you.
posted by Obscure Reference at 7:07 AM on January 3, 2015

For bloodwork, usually the easiest route is via GP (or GYN, if you're a woman, and Planned Parenthood can handle it in most areas if you have access to one). The reason that's important is that this "darkness" could be a malfunctioning thyroid, liver disease, cardiac issue etc - some kind of physical illness - and no amount of talking to a therapist will fix those things.

Psychiatrists are medical doctors who have specialized in medical issues of mental health. Most don't do ongoing talk (that's not a specific form of therapy, that just means two people talking in a room, separate from medical treatment) therapy anymore, they focus on the medical aspects of mental health and prescribe medication and help determine if other kinds of medical intervention would be beneficial to your situation.

Psychologists, Licensed Professional Counselors, Social Workers, [plus your state may have additional kinds of regulated non-medical mental health professionals] do various forms of conversational therapy. CBT (cognitive behavioral therapy) is probably the most common in the US right now, but there are other modalities. Unfortunately, it seems like in most parts of the US right now therapists are running on a 2-3 month lead time, and you may not be able to be seen by anyone for months.

You can get medication for depression and anxiety from a GP or urgent care, and that is probably the fastest route to getting enough relief to be able to articulate what is actually going on, but you still should have a physical exam.

You can also go to nami.org to find mental health resources in your state, or to get your area's hotline numbers if you'd like to speak to someone right away. If you think you're going to hurt yourself, go to the emergency room.
posted by Lyn Never at 7:19 AM on January 3, 2015

I assume you are in the U.S.? Here are the terms to know:

therapist - this is a talk therapist. you go in, tell them your issues and they work with you to achieve your goals.
psychiatrist or nurse practitioner - can prescribe meds and has specialized education in psychiatric meds
your regular doctor - can prescribe meds and can also run tests on physical issues that can bring on the symptoms of depression - like thyroid imbalances.

Your therapist can be your ally in all of this and help you formulate a plan. I've had the best luck going to a practice that has lots of therapists plus a couple people who can prescribe meds. That way your therapist can give feedback to the med person and give you better care. (It's also nice that they have receptionists who can schedule appointments when the therapists is in session - that saves a lot of back and forth).

To find a therapist, you can look here or ask friends for recommendations. (My friend and I go to the same therapist and it's not an issue.)

This article has a good view of what successful therapy looks like. In my opinion, the most important thing is that you need to like your therapist. That will lead to the trust you need to open up to her and let her help you.

Good for you for asking this question and getting help - that can be the hardest part! Don't let yourself get caught up too much in finding the perfect way to do this. Start with any of the people I listed above and let them help guide you through the process.
posted by dawkins_7 at 7:27 AM on January 3, 2015

If I did not try anti-depressants at certain times in my life, there would be no kind of life for me at all. I just wanted to emphasize that sometimes you can do therapy, exercise, meditation and try all sorts of things and still you can get an unbelievable amount of relief from symptoms from medication. Especially for anxiety issues.

Definitely start with your GP. Make some notes and take them into your doctor's office, if you're like me you might freeze up and forget the points you want to communicate with your doctor. Emphasize that this is impacting your quality of life - if you use those words, and impress upon your doctor that your quality of living has degraded due to these issues, it gets their attention and their ears seem to perk up (my own personal experience - anecdotal and take it with a grain of salt).

I like the steps you're initially taking; if it were me I'd do three things to bide my time until I was able to see a professional: - exercise (long daily walks), spend as much time with people or around people as possible (take a book to a coffee shop, visit friends/fam if you can), and do the daily 10-minute pen/paper exercises in David Burns' Feeling Good book (most likely at your local public library, or available through intra-library loan).

Definitely see your doctor - that is step 1 in my opinion, they can run tests to rule out, say, a thyroid problem.
posted by joseph conrad is fully awesome at 7:27 AM on January 3, 2015

The thing that I WISH WISH WISH someone had told me when I sought out therapy years ago was that like any issue you need a professional for, you have to shop around. When I was much sadder and more naive about this stuff, I would see people who didn't make me feel better, and I would think that therapy didn't work because there was something wrong with me. Then I'd give up. CBT was terrible for me because what's the point of logic-ing your way through something when you're already acutely aware your issue is irrational? Eventually I found a great lady who just talked me through stuff in a schema way, and it was a revelation. It took years of stopping and starting for this to happen.

Now something like CBT might be great for you. Medication might be good too (I had a combo of this with talk therapy). It just depends on you and not what a bunch of internet people think without knowing who you are. But whatever you decide, give it three sessions and if you still feel terrible, move on to the next person. Remember that it's not YOU, it's just not the right fit. Be honest and clear about what you want out of therapy, even if you don't know yet. Ask them to take you through what it is they do. Prepare yourself for the possibility that it might take a while to find the right person but keep forging ahead. When I met my great therapist she spent the entire first session just talking with me about how I sat (my body language was inferring that I was submitting to her and expecting to be "cured" and she wanted to put the agency of "getting better" back on me - which was great but something I didn't realise I was doing) and I was confused but intrigued, and once she revealed why she was doing what she was by the end of the session it was kind of a revelation. I saw her for 5 years, and now I feel we've reached a natural end. If I need to see someone again I think I'll find someone new.

It is actually really great that you can step back from your darkness and recognise it for what it is, and know that you need to and are ready to do something about it. Not being able to tell or articulate what is wrong is the worst.
posted by scuza at 7:46 AM on January 3, 2015

As linked above, the Therapist Finder at Psychology Today is a great resource.

I am a therapist and I've been in therapy. When I have looked for a therapist in the past, I've entered my location information on the Therapist Finder website, then picked a few therapists who sounded interesting in some way. There does not need to be any logic to why they sound interesting, just that it seems like the way they're presenting themselves would mesh with my personality and needs.

I will generally then google their names to see if any reviews come up. With therapists, very few reviews do come up, because clients don't really like admitting that they've gone to a therapist, so no or few reviews is not a bad sign. A lot of bad reviews would be a bad sign.

Because I'm more comfortable with email than the phone, I then email the therapists I'm interested in and see if they have appointments available, and if they do, I go in and start therapy.

I've had good luck with this in the past and have not had to "fire" a therapist, but I think that if I wasn't clicking with the therapist or feeling at least a little better or more hopeful within three or four sessions, I'd start over with someone new. (Therapy often requires us to feel a little worse before we start feeling better, but it should also instill or nourish more hope than we had before starting therapy.)

CBT is actually a type of talk therapy, as are most of the common forms of therapy "modalities," so don't get too caught up in the marketing distinctions. Look for licensed therapists (psychologists, social workers, marriage and family therapists, professional counselors) with master's or Ph.D.s and some years of experience in the field. Given the bit of background you shared, you might also want to look for someone who does list grief as a specialty -- there are certain ways in which treating grief and treating depression often differ, and most therapists have training in treating depression but not always in treating grief, so someone who's had experience with both might be helpful for you.

It's a great idea to also get a medical check-up. I would get the therapist in place first, though, just because you're more likely to get in to see them first. Your therapist can also help set you up to see a psychiatrist if it seems like an evaluation for psychiatric medication would be appropriate.

If you are worried you are going to hurt or kill yourself in the meantime, or you feel like you're in crisis and need immediate attention, you can call the National Suicide Prevention Hotline in the U.S. at 1-800-273-TALK. (Their website says, "If you feel you are in a crisis, whether or not you are thinking about killing yourself, please call the Lifeline. People have called us for help with substance abuse, economic worries, relationship and family problems, sexual orientation, illness, getting over abuse, depression, mental and physical illness, and even loneliness.") It looks like they also have an option to chat with a volunteer through their website. (International hotlines are listed here and here.)

Good for you for seeking help.
posted by jaguar at 8:32 AM on January 3, 2015

Some U.S. cities and states also have referral programs that might help. New York City has LifeNet, for example, where trained mental-health professionals can do a bit of an assessment and refer callers to appropriate resources. Googling your city, county, or state name and "mental health" or "behavioral health" and looking for .gov addresses might turn up some helpful resources like that.
posted by jaguar at 8:44 AM on January 3, 2015

Somebody once told me the statistics on how many of us are depressed for how many times in our lifetimes (major depression), and how many of us are actually experiencing one of these major bouts of depression at any one time - suffice to say - I was stunned at how large those numbers were. The take away for me was that no matter how abnormal you feel - you are still human and on the scale of what normal humans do occasionally. Most just don't talk about it.

This community helped me immensely.
wingofmadness.com

One of the things I found extremely helpful about this community is that it is INTERNATIONAL. Different docs do things differently all around the world. you may find a solution to your problem in another country.

Also - individuals talk very honestly about symptoms and what drugs, or other treatments are working for them. You can find people similar to you all around the word and see what has worked for them.

Good luck!
posted by About Animals at 9:08 AM on January 3, 2015

Apprehension aka "sense of impending doom" are actual chemical things sometimes. For instance, it is a known side effect of some medications. (Just FYI)
posted by small_ruminant at 1:42 PM on January 3, 2015

(which is another plug for going to your medical doctor.)
posted by small_ruminant at 1:45 PM on January 3, 2015

Just chiming in to say: try a therapist, and if it doesn't feel helpful, try another.

Good luck - you are not alone.
posted by MrBobinski at 6:29 PM on January 3, 2015

Nthing starting with your GP and asking for a full blood panel. Psychiatrists don't always do that, because often, by the time you see them (through a referral or through the ER), your symptoms will have been framed as a psychiatric issue; it's possible something else could be at play. Therapists you pay for out-of-pocket also don't often push the medical side of things, they're not situated to, other than recommending you do it yourself.

(I would also the GP for a Vitamin D screen, which they don't always do - severe Vit D deficiency can mimic depression. Thyroid dysfunction and low iron can also contribute to depressive symptoms.)
posted by cotton dress sock at 7:20 PM on January 3, 2015