How do you go about finding your first therapist?
May 19, 2011 10:12 PM   Subscribe

Looking for some help for my friend who's decided to go into therapy for her depression, family issues and other BS in her life. What can she expect from these sessions? What should she ask in deciding the right therapist?

Because it's her first time in a new city, she'll have to basically go with her instincts on deciding a therapist. Are there questions to ask when it comes to determining if a therapist is a right fit? Is CBT practiced by most therapists? For depression, if a therapist doesn't offer CBT, should she look for someone who does? I understand that the answer varies depending on many factors, but I'd appreciate any help.

Another concern is in choosing a counselor or a psychologist. There tend to be counselors at local health centers, but she thinks she'll be more comfortable with a psychologist...but what's the difference in what they can offer? (aside from their educational background)

In general, what can she expect from a therapist at these sessions? Will she be on her back on a couch, sobbing, just talking while the therapist asks 'how does that make you feel'?(our experience is only based on the movies we've seen) or is each session geared towards addressing an issue/emotional at the time?

Because she'll be paying for these sessions out of her pocket, how willing are therapists(psychologists with private practices) willing to work with her on the cost? Or will they just refer her to local university students looking for experience and experimentation? Thank you in advance!
posted by anonymous to Human Relations (6 answers total) 2 users marked this as a favorite
She can call and ask what techniques they use and what methods they like to use with clients who are depressed or have her particular issues.

She can also ask if they work "on a sliding scale" meaning they are willing to accept less money from poorer clients.

She can also shop around, schedule a few first meetings with different people, have initial meetings and see if she likes the person and their approach. Some therapists are useless, some are great, and sometimes you do or don't have a good personal "click" - so it's normal to shop around a bit to find a good fit. Appointments will often be several weeks from the time you call, so it makes sense to call now, schedule several appointments with candidate therapists for a one or two week time period, and then decide which one you want to stick with.

Mefi wiki page on "There is help" collects some good posts about how to search for a therapist. (skim down the page to the "therapy" section).

What happens in therapy:
In a therapy session, normally you'd come in, there might be a little waiting area with chairs and magazines where you'd wait until it's your turn, then you'd go into their office. Their office usually has a normal chair for you and for them (might have a couch too). You can sit in the chair, and often the therapist would begin by asking you to explain why you've come in. What is bothering you, or what do you feel is a problem, and what would you like to get out of the appointments. You can ask them to explain their professional background, what techniques they use, what their philosophy of treatment is, or just how they normally like a session to run. You can say what you're looking for -- maybe you want someone who is very practical and has little exercises for you to do (CBT would be an example of this) or maybe you want mainly to just talk and have an attentive listener, or if you want to try psych meds, or whatever. What you talk about varies -- sometimes you might talk about things that are upsetting or scary, or Big Things in the past, but often you'd just talk about things that are more mundane. If you feel like the sessions are not focusing on what you think is important, you can raise that with the therapist.

The therapy session is usually around 50 minutes, and at the end of the time, the therapist will draw things to a close. That's normal, because they might have another person waiting, and they will need to write up some notes about your session (eg, what goals you have set for the next session) before the next person comes in. It can be a little surprising, because you might be discussing something emotional and then the therapist gently begins to wrap up, but it's just a fact of life that the sessions are a set time. It's good to prepare yourself so you're not startled by the time limit.
posted by LobsterMitten at 10:33 PM on May 19, 2011 [4 favorites]

She should find someone she feels comfortable with and respects. Therapy is fundamentally a one-sided relationship with a helpful person.

I recommend she call up a few people, ask their prices and whether they offer a sliding scale, share 30 seconds of background (like you did here), ask their approach ("what's your approach to therapy in situations like this?"), and then if she likes them, set up a time. If she gets a bad feeling, just thank them. She could even call, like, six people, take notes, and set up appointments with the three she liked best. After one meeting with each, then decide.

The meeting will probably start with small talk, then move to her explaining why she's looking for therapy (e.g., a question like "so tell me a little about what's going on"). That back and forth should give her a sense of what dialogue will be like with this person. I'd look for her to feel a sense of comfort and relief that such a professional and kind person is there to help her. She could have a range of feelings, but I'd discourage going with the person who annoys her, who seems insensitive to something important, or who she feels uncomfortable with (e.g., with me one older gentleman jumped straight to "and how's your sex life?" in a way that rang subtle alarms).

She might start crying, I don't know. Therapists aren't magic emotion surgeons; they're just really good listeners who have seen a lot, and who can also share their insights in a clear fashion. Some talk more, some less. Some assign homework. They have different focuses, styles, and assumptions, but they will usually modify it based also on what she's looking for.

Best of luck!
posted by salvia at 10:46 PM on May 19, 2011 [1 favorite]

CBT can be (but isn't always) very systematic, even manualized (in other words, the therapist follows the procedure in the manual) This makes it very easy to use in scientific experiments because of the consistency across subjects. So, there is a lot of scientific evidence that CBT works on depression.

However, what I've read suggests that the general process of therapy seems to be more important than the specific technique. Furthermore, the relationship between therapist and the clients seems to account for as much as half of the effectiveness of therapy. So, trying out a couple of therapist makes a lot of sense - go for the one that you feel the best chemistry with. It can take a couple of tries to find someone that works for you.

My daughter had just lukewarm experiences with her first two therapists (both recommended by others who had success with them) and then clicked her third on the first meeting. (Usually takes longer than that but after a few session you should feel some trust in therapist and some sense of potential that this might help.)
posted by metahawk at 10:54 PM on May 19, 2011 [1 favorite]

And don't rule out an intern. A good intern can be just as effective as a licensed professional. In California you can find interns with 2-3-4 years of experience who are more affordable because they are not fully licensed. I would however suggest that she find someone who has at least a year of experience. Again, in California that would be an intern who had completed their counseling degree and was working towards their hours of supervised experience, rather than a trainee (still in school)
posted by metahawk at 11:00 PM on May 19, 2011

Unfortunately, I can't respond to your questions about cost because I'm not from the US, but I can comment on the process. I second what Metahawk said about shopping around. It does take time to find a therapist who 'clicks' with you, and this is partly because you just don't know how you'll respond in your session. I first went into therapy (years ago!) thinking I'd want a warm, 'earth mother' type of person to talk to, but found that more 'nurturing' therapists tweaked my anxiety. I eventually found a therapist who was very calm and almost distant, and for some reason that made me feel much more comfortable.

I also suggest that your friend write down some of the issues she wants to discuss ahead of her first appointment. This will help with identifying the best strategy to work through her problems.

CBT is an enormously useful approach, but it's also an approach, not an homogenous category. There are many different 'flavours' of CBT (for instance, my therapist uses an acceptance and commitment therapy approach [ACT]). Its worthwhile having a frank discussion with your future therapist about the approach they use, and what they see as an ideal outcome.

As for the difference between a counsellor and a psychologist, psychologists have more extensive training than counsellors, but the approaches they use are similar. She may really 'click' with a certain counsellor, or she may really 'click' with a psychologist. What matters here is the relationship. She will need to feel safe with whoever she ends up seeing.

And best of luck to your friend!
posted by nerdfish at 4:52 AM on May 20, 2011

In response to a previous question like this, I wrote out some advice about how to get the most out of therapy. The research suggests that most people get better with therapy. The post goes a bit into how to put what we know works about therapy into one's decision making process.
posted by OmieWise at 5:27 AM on May 20, 2011 [1 favorite]

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