Therapy vs society questions

August 10, 2006 7:22 PM

TherapyFilter: How does one get out of work to see a therapist, how do you find one, and how can you overcome being closed?

I have reviewed the many postings here on therapy, but could not find anything dealing with this.

How does one who has not had health insurance in years, but suddenly finds themselves with corporate america decent insurance, find a therapist. I have various issues, and one of them is an extreme feat of people judging me, or confronting my issues. I prefer to avoid them. I find it an almost impossible task to reach out for help (hence the anonymous post).

After that; When you have a 9-5 job, how do you schedule a weekly (or otherwise) therapy session, and not make it scream "MENTAL HEALTH CASE, OFFICE 7". I am scared that addressing issues may lead to people in my company thinking "we shouldnt burden him with more, he will be depressed", or that it will somehow limit my professional development.

Finally, I have mentioned it a few times, but I have major issues with letting my issues go, and putting them on the table. I have seen 2-3 therapists before and they asked why I was there, and insunuated I had no problems, mostly my own fault. I don't know how to get around this. I know that most therapists have probably seen everything I have to say (and worse), but this is ME. I am scared to let people see who I am.

Thanks Meta.

posted by anonymous to health & fitness (20 comments total)

When I was using the Employee Assistance Program at my employer, I said I was going in for a series of tests that was related to my sleep problems, which I had told my employer about so that he would excuse my regular late mornings. That was a half-mistruth, as the counseling sessions helped resolve the anxiety that was causing the sleep problems. However, it didn't cause any suspicions when I had a mid-afternoon meeting once a week with my therapist for several weeks.

After that, she and I randomized them and scheduled them in the morning, as I could go further between appointments.
posted by SpecialK at 7:40 PM on August 10, 2006

Some therapists have evening hours. When making your choice among therapists, factor their hours into your decision.
posted by amro at 7:46 PM on August 10, 2006

You don't have to say what your appointment is for. Just request sick leave for a doctor's appointment. It's not the company's business what it's about. I know in my job with the Federal Government, the manager's can't even disclose whether you are on vacation leave or sick leave. It's protected by the privacy act. I am not sure if the same rules apply to the private sector. You may also be able to schedule after your working hours, or during lunch, if you are afraid of a "pattern" emerging.

I am no expert, but maybe you need someone who specializes in cognative therapy. This is a method of gradually being made to face your fears, until the associated anxiety goes away. Kind of like realizing afterwards "well that wasn't so bad..." Does that make sense?
posted by The Deej at 7:50 PM on August 10, 2006

It's a doctor's appointment. Beyond that, it's not their business unless you want it to be.

In an ideal world, all employers would realize that happy, healthy employees are productive employees and encourage them to do what is necessary to be happy and healthy.

In the meantime, you'll have doctor's appointments and if anyone asks, learn the art of deflection. For example, laugh lightly and say, "oh you couldn't possibly be interested in that!" or simply, "I'm not comfortable saying." followed by a change of subject.

As for finding, I am a strong proponent of word of mouth. Find someone who's done well who trusts you and ask if they know someone.
posted by plinth at 7:56 PM on August 10, 2006

I got a therapist by calling the number on the back of my health card. They referred me to a clinic near where I live, and I met with somebody there. If I didn't get along with her, there were others available there that I also could have seen. But we got along just fine and she helped me a great deal. As for what to say it is about, just tell them it is a doctor's appointment. They have no right to inquire beyond that.
posted by Roger Dodger at 7:57 PM on August 10, 2006

Scheduling: lunch hour? Come in early and leave early? Evening appointments?

"We shouldn't burden him more ...": I seriously doubt your coworkers will think this. Their real goal is to shift as much of their work as possible onto you, so they can do less.

Limit professional development: one goal of therapy is improve your coping and social skills. Both of these factor into professional development, so you may find your career actually benefits from succesful therapy.

Putting issues on the table: you did it quite well here. Why not tell your therapist the exact same thing, or even print out your post?
posted by Quietgal at 7:58 PM on August 10, 2006

Just tell people you are going to a chiropractor.

Chiropractors also have regular weekly appointments, but without the stigma.
posted by peabody at 8:15 PM on August 10, 2006

When I was working full-time, I chose a therapist close to work and scheduled my appointments for lunch time. I only told one close friend at work (she happened to be the person who recommended the therapist I saw). I did not tell my manager(s). I did usually try to make up the time if my appointment ran late, but I didn't always.

Also, at my first session, my therapist recommended that I not use my health insurance to pay for therapy sessions. Her reasoning was that it would be better not to create a paper trail of having a history of therapy. YMMV. I don't think it really matters anymore, unless you are in a very sensitive profession like politics.

One benefit of paying for therapy out of my own pocket was that when I felt myself holding back and being afraid or just reluctant to speak the truth with my therapist, I would remind myself of how much money this process was costing me, and that I was wasting my own money and time by not laying it all out there.
posted by SuperSquirrel at 8:20 PM on August 10, 2006

One thing you could do to overcome your nerves is write out a list of things you want to talk about. That way you don't clam up and forget what to say, you can write it out beforehand.
posted by radioamy at 8:23 PM on August 10, 2006

Be sure to seek out a therapist w/an open mind themself -- also one that is open to medical intervention if it's needed. That said, if you see an unscrupulous psychiatrist, they may be inclined to too eagerly suggest medication to address your needs w/out giving talk therapy a chance. Point is you want the best of both worlds -- someone that will earnestly try to do what's best for you -- even if that means referring you to someone else more suited to your needs.

In the U.S. you're likely to see a marriage and family counselor (MFCC or another acronym), a clinical social worker (MSW), a psychologist Ph.D, or a psychiatrist MD. There are *great* MFCC's and terrible psychiatrists. Unfort. the degrees and resume have little to do w/suitability for your partic. needs.

Try to define exactly what your core issues are: depression, anxiety, anger, sexuality, etc. -- and then research, talk to trusted friends, etc. to find someone w/special experience in that area. Also think bout who you're most comfortable with -- men, women, young, old, ethnicity, etc. Find someone you're comfortable with and qualified, and your issue w/revealing deep issues should not be a huge problem.

Keep at it. Don't dabble in therapy, but don't make it your life. Consider group therapy as surrogate or adjunct. Lots of benefits to be had there.

As for leaving work for appts., I agree w/prior post advice. Ultimately it's nobody's business but yours. Treat it as a medical issue requiring lots of follow up visits. That's all anyone needs to know.
posted by pallen123 at 8:27 PM on August 10, 2006

I appreciate all the feedback, and as such feel that I need to expand upon reponses...

Everyone so far has avoided the how do you go about finding someone, especially in a semi-rural community in New England.

Secondly, I have an issue really 'connecting' and trusting people. Not evident (and somewhat purposely avoided in the orignal post) I had abusive (not sexually) parents, and find it EXTREMELY hard to trust people. As a result, I could never discuss such things with any coworkers.

Quietgal: I didnt mention even 99% of what my issues are :~)
posted by SirStan at 8:32 PM on August 10, 2006

The Find a Therapist search on the Psychology Today website might be helpful. I know that there were also at least a few threads about people's experience with finding a therapist in the past; they may be worth rereading.
posted by occhiblu at 9:56 PM on August 10, 2006

The Help Me Find a Therapist, Please thread, in particular.
posted by occhiblu at 9:59 PM on August 10, 2006

You've raised a bunch of questions that I think present a barrier to a lot of people considering therapy, which I say just to assure you that they'r e normal issues that can be overcome.

Finding a therapist: Many therapists have evening and even weekend hours. You can ask about that when you call around. Your health insurance would be a good resource, as well as trusted friends. You should interview therapists to make sure your fit with them is right, and that they work the way you are interested in working. This is especially true since all forms of therapy work generally as well as all other forms. You should be comfortable with the method of working.

Scheduling: You don't have to tell work what's up. You can just refer to it as a different type of appt each week. Until you can get set up with a time that works outside of work hours. The research suggests that people enter therapy when in distress and leave it with significant relief after a period of a few months. That's most patients. So you aren't necessarily talking about something that you're going to have to explain forever.

Being honest: This is a tough one, and one which can be at the heart of successful therapy. The basic question that you should ask yourself is "Do I want to change?" Therapy is very good with helping people to change and therefore feel better. If you don't want to change, you should ask yourself why you want to go to therapy, and if you can get yourself to the point of wanting to change or if you need a therapist to help you with that. I'm not suggesting any value judgements here, but the fact is that a lot of people aren't distressed enough to actually want to change, and therapy in those circumstances is not very effective.

If you do want to change, to feel better, if you've answered that question, then you've got to be pretty tough with yourself. You sound like a quiet person and so you should probably go slow anyway revealing yourself to a new therapist, but were it me, I'd write down on a piece of paper at least a set of bullet points of the things that were bringing me to therapy, and after I'd acheived a modicum of rapport with my therapist, I'd hand them the note. They should be able to help you to talk about those things if they know what they are.

I'm sorry, in particular, that there isn't an easier answer to this. It can be really hard to talk about difficult subjects, but that's also why, I've got to point out, you're considering going to a therapist. At some point you've got to just reveal the issues if you want to work through them.

My email is in my profile if you have any other questions.
posted by OmieWise at 4:47 AM on August 11, 2006

A lot of therapists also have early morning hours, or will work with you to change the time every week (my appointments are sometimes wednesdays, sometimes thursdays, sometimes in the morning, sometimes during the lunch hour -- she works around my schedule and my co-workers just think I'm a hypochondriac or always sick because i have so many doctor's appointments. It helps that I also really AM always sick.).

As for how to find one...I asked my doctor, actually, and she gave me a list. I was lucky, the first person I talked to was someone I really liked, but I have heard that most people have to "shop around" until they find someone they like and feel comfortable with.
posted by echo0720 at 7:27 AM on August 11, 2006

Going a bit off what OmieWise said: I'm also pretty reticent, and I've noticed that throughout my life, it's such a relief to actually admit all the horrible awful things in my head out loud to a person, to bring them into the light and see how really not dangerous they are (or at least, that they have much more power to do bad bottled up in my head, and they lose so much sting when forced into the open). What's wonderful about going through this process with a therapist is that he or she won't judge those things; admitting something bad does not in any way poison your relationship with your therapist. As I, at least, kept doing it, I started to realize that admitting these faults/weaknesses/bad things shouldn't have to poison my relationship with anyone, because the therapist showed me that people would actually accept the things I thought were completely abnormal and inhuman in myself.

Which I think is the greatest benefit of therapy. You can use therapy to learn to be open. You do, as OmieWise said, have to make some leaps to trust your therapist, but think about it: This is a person who has no interest in changing you (other than helping you), who will not be hurt by the things you tell them, who you can walk away from without repercussions, and who will not judge you. It's pretty much the equivalent of anonymous posting on a message board, in many ways, except the pay-off is phenomenally greater.
posted by occhiblu at 8:41 AM on August 11, 2006

SirStan,

First off, please know that you are not alone, you are not a freak, and that there are a lot of poeple out there who understand and are sympathetic to what you are going through. As a matter of fact, you might be surprised how many people at your workplace would respect you for taking actions to address this issue (not that I'm suggesting you get up on the desk and proudly proclaim it).

Second, your health insurance company will be the best resource for you to find a doctor within your network.

As for how to find the right one... well just like any relationship it takes trial and error. Shrinks are people too, and you will find that you get along better with some and not with other. Just because someone has a degree on the wall doesn't mean that they know how to talk to you. Don't be afraid to set up a couple of initial consultations with different doctors, it's the only way to find right doctor for you.

And one last thing, please remember to be patient with yourself. The issues at work here are deep ones, and the healing process will take longer than you expect. But rest assured the payoff is well worth the effort.

Good Luck. If I can be of any further help, please email me.
posted by perelman at 9:13 AM on August 11, 2006

Also, if you use Outlook, be sure make the appt. private so no one sees the subject line if they try to schedule a meeting with you.
posted by surferboy at 10:00 AM on August 11, 2006

Some ideas on opening up: It sounds like you want to learn to open up. Couldn't you just remind yourself of that in the therapy sessions? Also, take baby steps. Could you come up with one disclosure to make every week between sessions? Also, tell your therapist that you feel closed off right away, and that this is what you want to work on, and that it's been a barrier to successful therapy in the past. Then s/he can gently shine a light on that issue and help you with your goal of opening up with him/her.

I agree with the vague appointment. I think you could either make up some mysterious ailment (shoulder pain? headaches?) for which you are seeing various people (chiropractors, acupuncture, neurologists). Or, you could pick something you'd feel comfortable saying -- that you are doing long-range financial planning in a series of meetings with an accountant, that you have a weekly check-in with your gym trainer, that you have some dental issue that requires you to have regular cleanings for several months... Or, could you ask to work 9 hour days and then leave at noon on Fridays? I like having time to myself after therapy.

About others' perspectives. I respect people more (at least not less) when I know they go to therapy, because to me it means they are proactively trying to be the best person they can be. Sometimes I'll find out and think, "oh, that's why he's so well-adjusted!" (Other times: "oh good, maybe he'll stop being such an asshole.") Anyway, people go to therapy for many things. You could pretend it's to help you work through your grandmother's death, a fear of the dark you want to get over, help losing weight...
posted by beatrice at 10:30 AM on August 11, 2006

New England. Also sounds like in addition to trusting ppl, you have a bunch of other issues you want to address. Unless one or more of those issues is a blockbuster from which the others sort of emanate (chronic illness, phobia, extreme anxiety or depression, etc.), sounds like a generalist practitioner would be appropriate. That's not to say a specialist wouldn't be helpful, but for the sake of troubleshooting, I'll assume you've got a bunch of 'garden variety' issues impacting way you feel bout yourself and others, and way you interact w/world. I'd guess that parental physical abuse is more of a blockbuster than garden variety. Sexual abuse ditto. Standard brand of emotional abuse is probably garden variety, but there are exceptions.

Anyhoo, if you're close enough to a bigger city: Hartford, New Haven, Boston, Bangor, etc. -- go there for anonymity and larger selection of therapists. Also, universities often cluster generalist therapists catering to neurotic students and professors -- so they've 'seen it all' and get tons of practice.

If you think you may have an issue that could benefit from medication, read: obsessive thoughts, rumination, anxiety, depression, deep insecurity, I suggest starting w/a psychiatrist. Partic. in larger cities there are organizations on campuses -- student centers and student services centers at hospitals -- that will make strong referrals. Typically, therapists/psychiatrists that practice w/in a hospital or clinic affiliate w/a university, also have a private practice. If a university is making referrals, or has on staff a psychiatrist/therapist, odds are pretty good they're qualified to meet your needs. If you fit the psychiatrist path, and you identify a core issue to be addressed, you might also find a local chapter of a national organization that will make frequent referrals to qualified therapists. For example, if you google Boston and 'anxiety workshop' you'll probably find several support groups led by psychiatrists, or links to organizations that can make good referrals.

There's advice I've heard about eating fish: Go to BUSY restaurants not too far from the ocean/lake. Same holds true w/therapists. You don't want to be the fifth client of a 25 yr. old therapist that just finished a correspondence course in family counseling.

If you don't need a psychiatrist (don't think medication may help), and you feel your issues are garden variety, use the same strategy to find someone, but focus on LCSW's (MSW's) or MFCC's. Typically LCSW's have slightly more stringent licensing requirements, but in some states I think they're the same requirements. You can also look for a Ph.D (psychologist) but you have to be careful. There are many, many therapists, but especially a lot of Ph.D's that complete less than spectacular educational/training programs.

Ultimately, whether it's a psychiatrist (able to prescribe meds) or one of the other types of therapists, their value to you will be a function of your determination to feel better, willingness to engage, and their abilities as a therapist. I feel strongly that clients should interview therapists in the first visit. Get a feel for them. Understand their treatment approaches. How many years have they been practicing? Do they specialize? Etc. If they're not a fit, tryout another. And another. Til it feels right.

Some other ideas:

- If you're 50 yrs. old, it may be less effective to work with a 30 yr. therapist -- especially if that individual has limited life experience and you've 'traveled the world'.

- If your native language is other than English and you're more comfortable speaking whatever, find a therapist that speaks your language.

- Trust men/women more?

- Explore treatment types on wikipedia.org so you understand the basic schools of thought: psychoanalysis, RET, cognitive-behavioral, eclectic, etc. Some therapists are real devotees of one approach versus another and believe their approach to be the best for their clients. An eclectic approach is most often best, but depending on your personality, you may find that knowing a bit about psychoanalysis helps you organize your thinking about certain topics/issues -- whether or not you believe lock, stock, and barrel in psychoanalysis. Also, if you understand a bit of the theory behind diff. approaches such as psychanalysis, you will recognize when your therapist is employing a technique or observation related to it, and knowing what they're doing can help reinforce your learning, or give you insights you need to decide whether the approach is appropriate.

Good luck.
posted by pallen123 at 10:46 AM on August 11, 2006