Choosing a Therapist

January 5, 2004 1:41 PM

I'm curious how one selects a psychotherapist. Do you go by instinct alone, after a couple of visits? How many times do you have to tell your life story to a complete stranger before something clicks? At $150 a pop, these can get to be expensive auditions. How do you wall off the question of whether he/she is "the right person" from the issues you're there for in the first place? Any experiences out there?

And p.s. to the proprietor: this is the kind of issue that could really benefit from an anonymity option.
posted by luser to health & fitness (11 comments total)

I hate to say it, but there's no way to get around the expense unless you're with an HMO like Kaiser.

Because the need isn't pressing, but I want someone available, I've started a leisurely process of an occasional session. So far, no luck.

What's important is to first decide how you feel about certain subjects, so you can bring them up with the therapist and see what they think. How do you feel about group therapy? Natural remedies? Drug therapy? Hynpotherapy? Oftentimes therapists only seem to have a hammer, and if you're not a nail, it's not a good match.

Finally, don't go for just the "click". Someone you like can still steer you wrongly (this has happened to me, resulting in a minor disaster and a lot of resentment). Go for someone who has the same ideas about your treatment that you do, and who isn't unwilling to answer your questions and educate you where necessary.
posted by frykitty at 2:02 PM on January 5, 2004

Personal referrals can work well. But then again, not always.

I had a wonderful experience with someone in the DC area, recommended by a disinterested party. We clicked right away. I went in feeling crazy. I came out of the first session feeling like maybe I wasn't. She saw how all the various, seemingly incongruous parts fit together. It then took 2 1/2 years for me to see it. I then more-or-less told her I was more-or-less done, and she agreed. Let me know if you're in the DC area, and I'll give you a name.

I also had a really bad experience, also based on a personal referral, but, well, there were extenuating circumstances. I went to the therapist of the woman I was dating. Bad move. He was, basically, the man my girlfriend wanted me to be, and he tried to make me the man he wanted my grilfriend to date. Or something like that. It ended badly, with yelling and tears and whatnot. And I broke up with the girlfriend, too.

The "good" therapist was gentle and calm, lots of back and forth, just sort of a conversation, guidance. The "bad" guy was like a football coach, forcefully telling me what I should do and be and think. My ex liked that, but I didn't. The guy had a very successful practice, so I guess other people liked it, too.
posted by MrMoonPie at 2:14 PM on January 5, 2004

A couple of thoughts:

I've had a fairly brief series of visits with a psychotherapist some five years ago. In my case the first 'point of contact' was a woman I met on holiday - she was a psychotherapist, I liked her, when I decided I wanted to see a psychotherapist I contacted her and she referred me to someone else within the same practice.

The practice had a booklet explaining their tariffs, their working methods and principles. I wouldn't be surprised if many therapists had websites and / or websites explaining their approach.

Also, the question of whether you or the therapist are right for eachother is a valid one, and one that needs to be answered at an early stage. If I recall my first visit to my psychotherapist had the purpose of figuring out whether the two of us felt things would work out. I'd expect any psychotherapist to do some kind of 'intake': not only because you may not be right for eachother, but also because your expectations of psychotherapy might be unrealistic.

A couple of additional suggestions:

You might want to gain some familiarity with the major 'schools' within psychotherapy (like Freudian or Jungian) to get an idea of what approach appeals to you;

If you want to see a psychotherapist for a specific complaint (like anorexia) there may be organisations of people in the same situation who can recommend therapist who have experience with that specific complaint.

Anyway, best of luck.

(On preview: money might be a consideration as well. Here in the Netherlands health insurance usually doesn't cover therapy by a psychotherapist, unless the therapist is a psychologist or a psychiatrist.)
posted by rjs at 2:16 PM on January 5, 2004

(Sorry about the grammar and spelling errors. It's been a long day and it's getting late.)
posted by rjs at 2:18 PM on January 5, 2004

When I was in college (12 yrs ago, in Rhode Island), I used a therapy referral service, which was great - you paid a one-time fee which was only slightly higher than any other therapist's one hour fee, and you discussed your issues and preferences with the referral therapist, who would then come back to you with three recommendations based on your requirements. That same fee covered your initial consult with any or all of the recommended therapists, and allowed you to see if there was a fit. I thought it was a great model.
posted by judith at 2:46 PM on January 5, 2004

Here's an overview of the different types of mental health professionals that are available. Unless you're looking for Psychoanalysis (as in, here's how I grew up, what's wrong with me), you may be able to find what you need from a counselor who might charge a bit less than a limb per visit. frankly, it seems a bit biased towards psychotherapist, in my opinion... I've had better luck with folks with a Masters of Social Work than I have had with some PhDs.

Ask about a sliding scale. Some therapists offer them based on economic need. You could also asking them to be flexible about about initial fees (3 sessions half price, the remainder at full...).

Be clear about what you want. Is there a specific issue you want to work on? If not, it's going to be a long, expensive ride.

Figure out what genre of therapy seems most comfortable to you -- you'll need to trust your therapist, which is more difficult if you don't trust their methods. Ask any potential candidates to explain their approach and see how it feels. (on preview... What rjs said)

Don't expect immediate results. If the problem were simple, you'd have figured it out by now probably. I'd expect to spend 6 weeks to or (possibly much much) more just bringing your therapist up to speed and figuring out how to address the issue. Again, much more if you don't have a particular issue...
posted by daver at 2:46 PM on January 5, 2004

To continue on daver's note, it is definitely helpful to consider what you want to get out of therapy as well as what you're willing to put in (time, money, effort, etc.). Counselors with Masters in Social Work are often good (in my experience) for short- to medium-term crisis management (wanting to find the confidence/means/etc. to make a career shift, for example, or dealing with specific relationship issues); psychologists are better (again, in my experience) with longer-term issues (chronic depression, more fundamental family issues, etc.); some psychiatrists will also take the long-term "talk" approach (while also medicating, if necessary), while other psychiatrists will barely converse (which always drove me even more nuts!).

Per the cost of "shopping around," I've found therapists are often sympathetic to the whole issue of being hamstrug by insurance limitations, and so may at least be willing to do a free (or reduced) initial consultation session if cost/insurance is an issue, as well as work on a sliding scale if you do decide you want to move ahead.

Good luck!
posted by scody at 2:54 PM on January 5, 2004

Does your company have an Employee Assistance Program? If so, you may be able to get some advice, a referral, or a few free sessions.

You might find this article Choose a Competent Counselor helpful - it's not written as a marketing piece as so many are, but as a consumer guide: "...this article will show you how to evaluate the true competence and effectiveness of a therapist or counselor based on very simple evidence YOU can gather with your own eyes and ears."

It seems pretty comprehensive and worth a read. The author also lists a variety of other articles and resources on the last page.

Definitely, you want to try to credential or vet the therapist in some way - this article discusses some red flags and credentialing issues.
posted by madamjujujive at 3:49 PM on January 5, 2004

Good for you for posting anyway, luser. Stigma around mental health is decreasing, but not as fast as anyone would like.
posted by gramcracker at 8:56 PM on January 5, 2004

I agree with what everyone else has said. In addition, once you know what kind of therapy you want, you can always ask questions about that person's methods before making an appointment with them (on the phone, of course). If you are talking with someone you know won't work, that saves you from the expense of the visit. Of course, you're really not going to know until you go (or even after a few visits), but at least you can, hopefully, narrow down your choices.

Good luck!
posted by evening at 6:09 AM on January 6, 2004

Good point, daver. My good experience was with a Masters of Social Work counselor, bad one with the PhD psychotherapist. A good counselor will refer a patient to a psychotherapist if need be, I suppose. Me, I'd just gotten divorced after 10 years, and had a lot of confidence issues to work out, but no serious psychoses, no real depression.
posted by MrMoonPie at 7:15 AM on January 6, 2004