Where to go for therapy
May 7, 2012 6:57 AM   Subscribe

What kind of therapy do I need?

Gay male, late-20s, recently and belatedly out of the closet to most of the people in my life. But years and years of closeted self-loathing and shame have made sex and relationships difficult, if not impossible. I really want to move toward living an honest, healthy life, but it's been really hard, and I've finally decided that I'm too messed up to work through it on my own, and that I really need to talk to somebody. (I feel that I should get extra credit here for skipping an AskMe step.)

But who should I be looking to talk to? What qualifications should I be looking for, and where should I be looking? I've poked around on the internet and have found an alphabet soup of generalist therapists and counselors who offer to help with common anxieties, relationship problems, etc. I would never belittle anyone's reason for seeking therapy, but my problems seem super-specific and almost clinical, and for some reason it feels like it would be weird to dump them on a random counselor and expect him/her to be able to help. (I acknowledge that this might just be more neurosis.) And I'm pretty sure I'm not depressed, and lead a pretty fulfilling life outside of the sex-and-relationships arena. It's this one part of me that's been miserably dysfunctional.

Should I be looking for a specialist? Someone who offers a particular kind of therapy? I'm pretty deeply skeptical of psychoanalysis, being convinced that much of it is pseudoscience, but I could probably be persuaded to give it a shot. Are there specific alternatives? I know so little about this.

I'm in the Bay Area. Throwaway email in case someone has a specific recommendation they'd rather not post publicly: throwawaymefi2@yahoo.com

posted by anonymous to Human Relations (10 answers total)
It sounds like you are talking about relationship issues as a primary goal for your therapy (how to communicate and live more authentically with others, how to form a romantic relationship, etc.), so having that in mind as you try to find someone to work with is key. You also would probalby benefit from working with someone who has experience working with LGBTQ clients, as that is an important part of your story too.

As far as academic qualifications, that can be a little bit hard to say. A psychologist would have a Ph.D. (did a research-based dissertation in addition to focused study of clinical work as part of their training) or Psy.D. (did graduate work with a focus on clinical training). A social worker would have finished a masters degree rather than doctoral and would have focused on clinical training. The degree/designation doesn't necessarily matter, just so you have an idea of what the alphabet soups after the names mean.

I'm someone who tends to be skeptical of psychodynamic theory as well, but in the right hands it could be what you're looking for. The focus of that kind of therapy is using the relationship (dynamic) between you and your therapist to work out issues in your other relationships. Interpersonal therapy may also be helpful, again focusing on relationships. Cognitive behavioral therapy may also appeal to you. There you have specific goals for therapy that you and your therapist develop together, then work on examining your thoughts and behaviors and how they may be linked (e.g., if you always think "There is something wrong with me, why would anyone be interested in me?" that will affect how you interact in your relationships).

What I generally recommend is contacting a therapist and go to meet with them. See how you feel interacting with them and talk about what you are hoping to get out of therapy. Ask how they would work on that with you. If it feels like a good fit, the degree and the therapeutic approach are not so important.

All the best to you.
posted by goggie at 7:41 AM on May 7, 2012

Since you don't feel like you are depressed then you don't necessarily need anyone who can prescribe medication, which is helpful. Do you have insurance that will cover counseling? If so, then I would choose someone off of their list. If not, then look for more inexpensive options. Some religious organizations offer counseling on a sliding scale. This might be a good fit for you (a gay friendly one, obviously). You might also want to look around for a life coach. A good life coach will act as your cheerleader as well as the person who you hate most in the world for pushing you out of your comfort zone. And that is what it sounds like you need the most- someone to push you out of your comfort zone. If the first person you talk to isn't a good fit, then find another and another until you find the right one for you.
posted by myselfasme at 7:56 AM on May 7, 2012

I'd look for LGBTQ-specialized therapists, and also Marriage and Family Therapists (MFTs), who specialize in working on relationships. Then I would set up a few different appointments with people who seem of interest, and then see what the fit might be like, then choose one or keep looking for someone I felt pretty comfortable with.

I'm not sure what you mean by "almost clinical"--but I wonder if it might be helpful to just give it a try, and not to overdiagnose/pathologize yourself before you even get started. The things you're talking about are actually very common for people who are coming out or have had difficult coming out processes (because there are reasons it was so difficult, right?), and you might be surprised at how much your own false beliefs (due to your family background, religious background, anxiety, whatever reason/s it may be) are contributing to your thinking about being "almost clinical" when you're actually pretty on par with the normal range of reactions in your situation.
posted by so_gracefully at 8:38 AM on May 7, 2012 [3 favorites]

Why not start here? Look at therapists' self-descriptions (I like the way that site is set up to give them some space to talk about their credentials and approach) and pick someone who seems like someone you'd feel comfortable talking with.

In terms of credentials, given that you're looking for help with sex and relationships, I would think that the best fit would be an MFT (master's of family therapy), MSW (master's of social work), or Ph. D psychologist who emphasizes work with relationships and intimacy.
posted by Sidhedevil at 10:20 AM on May 7, 2012

Try Adam Zimbardo (or any of a billion qualified gay-focused therapists in SF)
posted by zug at 11:28 AM on May 7, 2012 [1 favorite]

You should see a psychiatrist trained in psychotherapy; therapists and psychologists rarely have the amount of training, educational expertise, and knowledge base. The extra $200 per appointment is worth it, pinky promise.
posted by lotusmish at 11:31 AM on May 7, 2012

You should see a psychiatrist trained in psychotherapy; therapists and psychologists rarely have the amount of training, educational expertise, and knowledge base. The extra $200 per appointment is worth it, pinky promise.

Kinda disagree, partly because a) psychiatrists who do therapy practically don't exist anymore and b) if he's not depressed and not getting medication, I don't see the point. More important is someone who gets his issues in particular, which would be any number of Bay Area therapists who specialize in gay issues.
posted by lewedswiver at 11:52 AM on May 7, 2012 [7 favorites]

Wow, I could not disagree with you more, lotusmish. Psychiatrists trained in psychotherapy are incredibly rare in the US, and usually so overbooked in their practices that they aren't taking new patients, and if by some chance he got in to see someone like this they would (if they are like my dear friend Dr. S.) recommend that he see a therapist and give him a bunch of referrals.
posted by Sidhedevil at 11:57 AM on May 7, 2012 [6 favorites]

Agreed, lotusmish, I think you're misunderstanding areas of expertise. Psychiatrists complete very comprehensive medical training with specific training and expertise in the medical management of mental health issues. Their training does not focus on therapy except in very, very rare cases. Psychologists social workers and marriage and family therapists do years of work being specifically trained to do therapy. They do have expertise and intensive training in therapy.
posted by goggie at 1:45 PM on May 7, 2012 [6 favorites]

Congratulations on coming out!

First of all, it sounds like maybe you're being a little hard on yourself, and I just want to say that you're not "messed up." It's often a really hard thing in this culture to come out and start to be comfortable with your sexuality when it's not the norm. And you're clearly on a healthy path if you've identified that you need help freeing yourself from some of the baggage that comes with being (and having to hide being) gay.

I agree that you'd probably do well in talk therapy with an MSW or psychologist -- it's definitely much more a question of your fit with a particular person than of the letters after their name. (There are some psychiatrists who do great therapy, but I don't imagine it would be worth the likely higher cost for you.)

One thing I'd add to the great advice here is that you might want to look for a therapist who's gay himself (or herself). I find that sometimes even incredibly well-meaning, well-informed straight people don't quite get how hard coming out and being out can be. I think it's sometimes because they're so accepting they have trouble understanding that some other people aren't so accepting and sometimes we don't accept ourselves so easily.

The SF gay center most likely has referral lists for therapists. It would probably be worthwhile to give them a call.

I think you might also benefit from a coming out group. I know you've already done a lot of the heavy lifting of coming out, but it sounds like you're still in the general coming out phase, and I think those sorts of groups do a lot of to help folks coming out see how universal their challenges are and realize that they're not personally to blame for the difficulties they face. I did a quick search of coming out groups in SF and found these:

Men’s Coming Out Group
Sponsored by New Leaf, all ages welcome. Wed 6-7:30pm at 103 Hayes St, SF. Info: 626-7000 x471.

Coming Out Over Coffee
Support group for those new to the lesbian and gay community, or dealing with coming out to family or at work. Sat, 12:30-2pm Billy DeFrank Community Center, 938 The Alameda, SJ. Info: 408-293-AGAY.

Good luck! Keep taking good care of yourself. You're clearly on the right path.
posted by zahava at 4:29 PM on May 7, 2012

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