Help me choose a therapist, please.

March 16, 2006 11:22 AM

How does one go about choosing a therapist or counselor?

So I'm pretty sure that I suffer from a certain level of depression and have for far too long, to the point where I'm just used to it, but I know it's there. I also have issues with anger control/management, which definitely affects my personal relationships in a negative way.

I've decided to suck it up (monetarily, mostly), make a move and get some help. I don't want to be a miserable, angry, and lonely old man someday. But hell if I know how to pick someone. Is it a "hit or miss" type thing, where I might have to switch from therapist to therapist until I find someone I'm comfortable with? That's could get old pretty fast.

I don't even know where to begin. I've read some other AskMe threads on the topic (depression), but I guess I'm really just looking for advice on "how to get started"... a practical and efficient approach to finding the right kind of help. Thanks.

posted by Necker to health & fitness (18 comments total)

These might help a bit:

APA: How to choose a therapist

Psychology Today: Choosing a Therapist

I think you can do a lot of weeding out based on initial phone calls or emails. When I was looking for someone, I went through the profiles on Psychology Today, really kind of arbitrarily chose those profiles that appealed to me, emailed about eight different therapists, and just waited to see who responded, and how.

The woman who emailed almost immediately was actually the one who's profile most appealed to me, and after going back and forth with her over email a few times I made an appointment and it turned out very well, I think.
posted by occhiblu at 11:32 AM on March 16, 2006

(And actually, if you want more articles, Google:Choosing a Therapist turns up a lot of good information.)
posted by occhiblu at 11:34 AM on March 16, 2006

Sweet... a good start indeed. Thanks. I did a some googling earlier, but a little first-hand advice from familiar "voices" is always nice.
posted by Necker at 11:38 AM on March 16, 2006

I've decided to suck it up (monetarily, mostly), make a move and get some help.

Good step on your part.

I hit a rocky patch a few years ago and decided to see a therapist. This coming from a New England Yankee who was raised to think that "suck it up and deal" was the way to go -- and therapy was shunned. I'm glad I made the move. After 9-months of talk therapy I got to a point where I (and my therapist) felt that things were going well, etc.

The way I approached it was to talk with friends who were seeing therapists. Fortunately, the first recommendation was a perfect fit for me. Most therapists understand that folks may want to "shop around" and will recommend that you go for one session with them. There's no need to feel guilty or bad, if at any point in your therapy you don't feel a therapist is right for you. Treat the search as seeking a partner to help you sort out your thoughts. The "chemistry" is important.

If you don't have any friends who could recommend therapists to you, check with a local health clinic or hospital. They can provide direction.
posted by ericb at 11:38 AM on March 16, 2006

Where do you live, Necker? You might get some specific recommendations from the AxMe community if we knew.
posted by MrMoonPie at 12:10 PM on March 16, 2006

I'd ask people that you know and trust, unless you don't want anyone to know that you are going to be going to see a therapist, in which case, follow the advice occhiblu lists.

People will probably come into the thread to suggest that you see one type of therapist or another, or one who works from a particular theoretical orientation. The good news is that all modalities of therapy work as well as all other modalities of therapy, provided that they make sense to and are comfortable for you. The research is quite clear on this, as little as 1% of treatment efficacy is related to the type of therapy being practiced. Metaanalysis of many, many studies has shown that therapy works, and that the kind of therapy (among legitimate psychotherapies) is almost irrelevant to improvement.

On the other hand, there are vast differences in effectiveness between therapists practicing the same kinds of therapy (and even between psychiatrists rxing the same drugs), so you really should feel comfortable with your therapist and if you don't you should find another one. This same research shows that therapy works well and relatively quickly for most people (about 80%).If you feel as if it's taking too long to see the results that you want, discuss it with your therapist. Early change is a predictor of later change in therapy, despite the previous paradigm which suggested that it took a long time to see results.

As far as picking a therapist, I'd give some thought to how your mind works and how you think about your unhappiness. Is it an issue of recurrent thoughts? Consider cognitive therapy. Is it a problem of motivation and ambition? Think about someone who is a bit more solution focussed. An issue of past history and unresolved childhood etc conflicts? Consider someone insight oriented. Any will help, the closer the theory fits with yours the easier it will be to get into it.

Good luck. My email is in my profile if you would like to discuss it more.

(Oh, the stats I referred to are available from Bruce Wampold, The Great Psychotherapy Debate)
posted by OmieWise at 12:12 PM on March 16, 2006

I actually asked my doctor, explaining that I wanted to pay for therapy out of pocket and didn't want anything regarding my mental health to appear in my medical records, but that i knew that I wanted someone who has a phD in psychology, and she gave me a list of recommended therapists (and actually the one she recommended to me doesn't even take health insurance, so that worked out just fine for me). Of course, I haven't actually called and made an appointment yet, but I will someday soon. :)
posted by echo0720 at 12:57 PM on March 16, 2006

Wow, such fine responses so far. Some of the points you make OmieWise are certainly a relief, in that, I don't have to worry too much as far as a particular kind of therapy is concerned (at least not right away).

I'll try and expand a bit on how I'm feeling - and honestly, I've felt this way for so long that I've just accepted as the way it is.

Is it an issue of recurrent thoughts?

I may need an example there. I'm not quite sure what that would entail. I mean, the thoughts I have about myself, about what I'm capable of, about my perceived future, about what others think of me, etc., has remained unchanged forever, going on 20 years I guess (I'm 35). To sum it up, it's not very positive.

Is it a problem of motivation and ambition?

God, yes. I suppose I'm not unlike a lot of people there. But it's really annoying to look around my family and close friends and wonder, "what the hell happen to me along the way that basically caused me to stop growing/progressing" while everyone else is comfortably grown up and happy. I don't feel like an adult, a lot of the time, if that makes any sense. I lack passion for anything in particular and I definitely can't stay focussed on anything long enough to see it through. I drive myself crazy in that regard. Don't get me wrong, it's not as if I need to be them or just like them or as successful as them and so forth... I'm not trying to compete with them. But I feel totally disconnected from the closest people I have in my life because I "dropped out" somewhere along the line and no longer have "life's little stages" in common with them anymore.

To further the problem with ambition/motivation... I basically don't feel like anything is good for me is even possible anymore, that my life ideas aren't an option at this point. Scrap the whole mess and start over... that I'm doomed to be an average Joe nobody who never quite got on track... but makes a great Uncle. :)

An issue of past history and unresolved childhood etc conflicts?

I think so. While I'm hesitant to focus too much or even go so far as to blame my relationship with my father for any of my deficiencies today, I DO think about him, things about him and certain aspects of my growing up with him... I think about those things a lot, probably more than I should. So it's a problem from that standpoint.

The anger part of my overall mental health problem is more temper oriented. I'm not an angry person per se. I don't deal with "bad days" and things not going my way by showing anger. I'm not just a dick to people for no reason. But when "I'm provoked, especially when I feel like I've made it clear that the provocation needs to stop, I explode. I get enraged and tense up, lash out, break stuff occassionally. I need some new weapons (hehe) to fight this tendancy.

Good luck. My email is in my profile if you would like to discuss it more.

Thank you.

MrMoonPie, I live in northern Virginia.
posted by Necker at 1:08 PM on March 16, 2006 [1 favorite has favorites]

Whoa... that may "too much information". Forgive me if I've skewed the direction of the thread.
posted by Necker at 1:16 PM on March 16, 2006

Oh, bless you for addressing this now, instead of living a long bitter life of hurting other people. If only more people (my father, ahem) would take stock of things and accept responsibility for what's going on-- after all, hurt people hurt people, and until you address what is hurting you, you'll continue to hurt others. So a rousing bravo from me.

If you're on the north side of Chicago I have a few therapists I can heartily recommend. Otherwise, are you near any universities with masters in counseling programs? You might ask there for recent grads or suggestions of highly regarded therapists in your area. I found mine that way.
posted by orangemiles at 1:26 PM on March 16, 2006

(oops) -- just read that Virginia part...
posted by orangemiles at 1:28 PM on March 16, 2006

Nothing against therapists, but you might try reading Psycho Cybernetics first (the maxwell maltz original, not the dan kennedy revised version that came out later).

The book really helps you shake off your old self-image, the one left over from your youth. Remember that kid who couldn't tie his (her) shoes or ride a bike? You're NOT that kid any more. The book helped me wake up to that. It helps put you in the present and see the future from the perspective of who you are NOW, not who you used to be.

Looking back (solo or in therapy) may be interesting and even insightful, but I'm more interested in where I'm going, not where I've been. Just my $.02 worth.
posted by wordwhiz at 1:39 PM on March 16, 2006

hey necker, the list i mentioned that i received from my doctor is for psychologists for the greater dc area. my email's in my profile if you want to check out some of the names.
posted by echo0720 at 1:54 PM on March 16, 2006

echo0720, you have mail.

Also, OmieWise, I know your "questions" were merely suggestive and/or rhetorical, but I felt compelled to describe my little dealio in more detail. So, yea...
posted by Necker at 2:25 PM on March 16, 2006

Wow. Necker, your reasons for looking into therapy sound a lot like my own. It's been two and a half years since I sat down and really started working all of this stuff out (I'm 30), and the difference has been phenomenal. That's not to say things are absolutely peachy now, but I feel a lot less skewed in the way I look at my life/the world/whatever. It might take a while to find someone you're comfortable working with, but when you do, you'll thank yourself.

I lack passion for anything in particular and I definitely can't stay focussed on anything long enough to see it through

Taking care of yourself should be your top priority right now. Treat yourself kindly, and try to make a distinction between things you need to do (eat, sleep, pay the rent), and things you feel you should do (suffer fools gladly, write the Great American Novel). The rest of it will fall into place in its own time. Hang in there.
posted by Vervain at 3:52 PM on March 16, 2006

Craigs List has a new therapist directory that I found really useful - I found my therapist there.
posted by The_Partridge_Family at 7:14 PM on March 16, 2006

Its not like buying a car. If you find that after one visit or two you have any misgivings, try someone else.
posted by sswiller at 7:22 PM on March 16, 2006

Necker, you can shoot me an email, too, if you'd like a specific referral. After the break up of my 10-year marriage, I saw a counselor in McLean for 2 1/2 years, and she helped me tremendously. She may or may not be right for you, but she'd definitely be able to refer you to someone.

The thing she did for me, more than anything else, is make me feel like I wasn't crazy, that all the various parts and oddities and quirks of my personality actually made some sense. Then we set to work on smoothing some of them out. After 2 1/2 years, I wasn't all fixed, but we both felt like I had the tools to deal with my issues on my own.
posted by MrMoonPie at 8:53 AM on March 17, 2006