How do I get counseling?
November 3, 2004 11:53 PM   Subscribe

Due to a few recent events in my life, as well as a number of incredibly stupid and hurtful things I now realize I've done, I've decided to seek counseling. My problem is I have no idea where to start, i.e., what kind of psychiatrists and psychologists there are, what types of questions to ask when looking to find someone to meet with, what the generally accepted approaches to counseling are, etc. I've spent a lot of time talking to friends about this, but am still feeling quite lost about the entire process.

There are a lot of sites with counseling information and advice, of course, and I've read many of them, but I keep getting the feeling I'm just dealing with professional organizations that are trying to feed their members or somewhat suspicious groups that aren't all that qualified to be doing what they say they are. So, what advice do any of you have for finding a good counselor? What good or bad experiences have you had in finding help, and what do you think are the best approaches to finding counselors?

posted by anonymous to Health & Fitness (11 answers total)
First off, I commend you for seeking help -- I've taken part in counseling in short-term bursts as well as for extended periods (depression, with a side of anxiety disorder), and it's been invaluable to me. There was an earlier discussion here, which may help get you get started. In general, I think it's helpful to consider what you're seeking help for (e.g., clinical depression, anger issues, addictive behavior, relationship problems, etc.), which can narrow the field a little bit in terms of which types of counselors may be of more or less help.

Then it's worth asking around (if you feel comfortable doing so) among trusted friends and/or family members for any references to a good counselor -- you might be surprised at who else in your circle has sought help. Also try asking your primary care physician, if you'd feel comfortable with that. (Of course, your insurance situation may also play some role in determining what kind of counselor you might be able to see and for how long, at least off the bat.)

And please feel free to email me, if you like -- I'd certainly respect your privacy and not reveal your identity to other users. Good luck!
posted by scody at 12:17 AM on November 4, 2004

One place to start: Psychology Today has a therapist referral service. You input your location and how far you're willing to travel to see someone, what your primary area of concern is, and if you have had any kind of diagnosis in the past (that's optional) and it brings up a list of professionals in your area with links to profiles where they explain their treatment ideals.

Mind you, professionals choose to list themselves with this service, so it's not comprehensive, but it could point you toward someone whose profile clicks with you, and start a connection. It can't possibly be any worse than getting "assigned" to a therapist by your insurance company or a mental health conglomerate that aligns people based on whomever has the time in their schedule in the location you've chosen, and that's how many people connect with counselors with whom they have very productive and helpful relationships.

You might also consider asking your medical doctor who will almost assuredly have referrals -- to either individuals or an umbrella mental health organization -- that can help. You might also see if you can get a referral from the employee assistance program at your place of work, if you have one.

If cost is a consideration, or if you need to be sure that your insurance will cover the cost of therapy, definitely get the list of in-plan counselors on hand, you could do worse than to start there. If you don't have insurance, many mental health organizations have sliding-scale fee schedules or arrangements for subsidized sessions and you should absolutely feel no qualms about asking. They'd rather you get the help you need than go without because of financial worries.

Once you do find someone of interest and have the money matters in hand, any professional counselor should be willing to set an appointment with you to explain their philosophies and approaches, explain what they'll want from you (and if they don't, you should ask) and what their "rules" are (also something you should ask). If someone is unwilling to spend a session hour (which is usually 45-50 minutes, actually) in an "interview" session of this sort, don't waste another moment with them, no matter how promising they otherwise seem.

If you're working through an umbrella agency, ask questions of whomever you're dealing with there as well. Make sure you're entirely satisfied with their policies and how much control they might exert over the therapeutic process. If it doesn't work for you, look elsewhere.

In short, ask a lot of questions. Ask everything you can imagine you'd want to know before you begin to share initimate details of your life with this person. If you don't feel rapport and comfort (emotionally and physically) keep looking.
posted by Dreama at 12:39 AM on November 4, 2004

FWIW: when I was a student, I went to see the people the university employed. They were complete washouts, and I could not engage with them beyond one session. In retrospect, I was severely depressed, majorly stressed, and they should have picked up on that instead of asking me to draw pictures on brown paper with marker pen. In time I got over my problems on my own. No thanks to them.

A few years ago, when I was separating from my ex-wife, and very distressed, we were recommended to see someone by a mutual friend who was in the psychiatric biz, and I later went on to see this guy on my own. He was absolutely good. I liked to think of him as my "paid uncle". In other words, an older, wiser man who I could unburden myself to without incurring the shame that would have accrued in talking to my father.

Funnily enough, at one stage Mr "paid uncle" suggested I talk to another guy he thought highly of. Other guy was a useless psychodrama twat (yes, you may think highly of it, I don't, let's not go there). So while personal recommendation is the best I can come up with, it's not failsafe either.

One thing I figured out is that I am very practically-oriented when it comes to messing with my own psyche. I want to see empirical research backing your approach. I hate touchy-feely stuff. I want to maintain my autonomy, and I don't like being poked at. If you don't work like that, you can't help me. And that's all right, because there are plenty of alternatives out there. (equally, you, dear anonymous, may be completely unlike me. hooray! the point I'm trying to make is that people differ enough mentally to respond totally differently to counselling approaches just as they differ metabolically enough to respond differently to medication, even with the same apparent symptoms).

My advice: don't be afraid to walk if you don't feel helped. Also, don't be afraid to help yourself. Be your own best friend. Also also: I am really suspicious of people who think only they can help you. There are lots of people who can help you, and neither you nor they should believe any different. Also also also: I am even more suspicious of people who want to sign you up for a lot of painful work. You're looking to feel better, not join Mr/Ms Therapist's personal cult. SHOP AROUND.

PS: if my description resonates with you, look out for the phrase "solution-based therapy". CBT, aka cognitive-behavioural therapy, is also in this line.

"If you want to dredge up your past and spend several years being miserable, see a psychotherapist" -- Kathy the Wise.
posted by i_am_joe's_spleen at 1:18 AM on November 4, 2004

As others have said there are different approaches to therapy, and you need to find someone who you click with. And don't be afraid to leave and try again (the hardest part).

I'd recommend looking for someone who is flexible in their approach as different problems you're having have different "needs" (in my opinion). So someone who thinks medication is the only answer, or only psychotherapy, is probably not the best thing you need, unless you agree with that approach.

And see a psychiatrist if you think you need medication (I did, and forever will, and is the best thing that ever happened to me for my depression).

Congrats on finally seeking help, and good luck.
posted by evening at 4:47 AM on November 4, 2004

Trying not to repeat any of the excellent advice you've already received, but wanted that add that if you work for a large company, they may have an Employee Assistance Plan. The people who run that should be able to offer you some referrals.
posted by jacquilynne at 5:40 AM on November 4, 2004

I'm an employee of a University and use their therapists in residence with a psychiatrist overseer. I've had good luck. Just a different perspective than i_am_joe's_spleen offered.
posted by pissfactory at 6:25 AM on November 4, 2004

Just be ready to shop around like others have said. Some people just try to blame it all on your childhood or find some huge traumatic event in your past, when you know it's not that. If you don't like them, don't feel comfortable with them, go somewhere else. It can take a long time.
Good luck.

I suggest you ask others if you feel comfortable about it.
posted by aacheson at 7:35 AM on November 4, 2004

In my opinion, the best source of recommendations is from friends - word of mouth, if you feel comfortable asking people you trust if they can recommend anyone. You don't say what kinds of problems you are looking for help with, but if there's a self help group around that issue, you can check it out, and ask people who go to the group for any recommendations. For example, for people with mood problems, I often refer people to check out the depression bipolar support alliance self help groups (click on "find a support group in your area" link).

Also, if there has been a book or magazine article (or website) that you feel has been helpful to you, feel free to contact the author and ask for recommendations. Lots of times therapists give talks at community organizations, sometimes it's worth while to check them out and see if you can connect with them.

These, as well as insurance company lists and professional association referral lists are an ok starting point, but they are just that - starting points. The absolute most important thing is to meet with someone once or twice and just get a feel as to whether or not they might be helpful to you. During these meetings, let the therapist know that you're shopping, and feel free to ask all the questions you want about your needs and about the therapist's understanding of them and how he or she might be helpful to you. Check out how you feel about the way your concerns are answered.

There's a lot of controversy in the mental health field about evidence-based practices, and so on, but I still think the main element in success of mental health treatment is the connection between the therapist and the patient.

Good luck to you in your search! - and feel free to email me (address on profile) if I can answer any questions for you.
posted by jasper411 at 9:04 AM on November 4, 2004

Please take the following comments with a large grain of salt, since I have not been through counseling myself. I'm basing my opinions on a) an academic background in psychology, b) observing experiences of several close friends & family members in therapy and c) the experience of making some significant changes in myself (without the benefit of counselling), such as some people would have sought counselling to help with.

With those caveats, here's my opinion. Any significant inner change/growth/healing you may accomplish is something you do for yourself. A therapist will in the best case be a guide who points you towards some helpful tools that you can use to do the work with. Imagine you're having to remodel your home, and you're the only person who can go inside the house. A good therapist may be the helpful experienced guy at the hardware store with some advice on what tools to use on the drywall and how best to track down the wiring. A bad therapist may be the guy who read a book on how to remodel a totally different type of house, and now thinks he's the expert on your situation. Either way, you're the one who's going to be doing all the hard work.

With that said, I'll echo the advice of everyone above - shop around. You need someone whose approach seems to fit with what you're striving for and how your personality works. Also, sometimes regular therapy sessions may be useful just for keeping you focused on doing your own inner homework. If you don't personally click with your therapist, you're more likely to skip sessions and therefore more likely to start slacking off on your efforts for change.

Good luck!
posted by tdismukes at 9:35 AM on November 4, 2004

Do you have issues you want to work out or moods/behaviors you want to change?

For issues, I recommend psychoanalysis. This is the kind of therapy you have probably seen on TV, where the patient sits with a therapist and talks about what is concerning him/or.

For moods/behaviors, I suggest you look for a cognitive-behavioural therapist. Cognitive-behavioral therapy is about looking at the moods and behaviours and trying to change them, without necessarily digging up a root cause. And it's been proven to have a higher rate of success than old-school therapy in scientific studies.

When I was depressed and suffering anxiety attacks, I tried psychoanalysis and the experience really offended me. I didn't want to blame my problems on my mother or find out if they were rooted in this experience or that, I just wanted to solve them. Cognitive-behavioral therapy allowed me to take concrete actions that challenged my negative moods and behaviors. Repeated enough, I was able to overcome them.

Either kind of therapist may recommend drugs. Although there are a lot of taboos and good reasons to think seriously about any prescription, I hope you don't dismiss them offhand. Most people that I know who have used prescription drugs to help treat psychological problems do not stay on medication for ever and are not altered by the pills.

Sometimes prescriptions get you to the point where you can actually face what's bothering you. Once you face it, you can ease off the drugs. I have found this to be true both for psychoanalysis and cognitive-behavioral therapy.

For more serious problems, of course, medication is sometimes more permanent.
posted by croutonsupafreak at 10:53 PM on November 4, 2004

I can't add much more to the thread, other than to say that if all of those ways to find a therapist fail, you can always look into your public mental health system. They do the sliding scale fees if mental health is not covered on your insurance/you're uninsured.

The most important thing to do is to shop around. If you would like to know more about the many different kinds of therapy/theories out there, pick up an abnormal psychology textbook. There's pretty much something for everyone, though your choices may be limited to your location.

Best of luck!
posted by somethingotherthan at 10:54 PM on November 4, 2004

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