Get Therapy. Yeah, I'm going to need a little more help than that...
June 21, 2013 4:49 PM   Subscribe

I think I might be a little depressed. Sometimes more than a little, but usually at least a little. And I know I have issues with anxiety. So, I've decided to get therapy. And I've called my insurance to figure out how to go about doing that. So my question is: now what? I don't know if I need a psychiatrist or a psycologist. I know that a psychiatrist perscribes medication, but I don't know if I need that. Knowing that seems like their job.

So, how do I know which one to go see? After I've figured that out, how do I pick one? My health insurance gives me a list of people who are covered, but all it tells you about them is if they are male/female, where they are located, and a list of things they "specialize" in. Obviously I'll be looking for one who does the depression and anxiety but that's pretty much all of them. How do I pick one? My friends don't go, so asking for recommendations is out, and even if y'all gave me some (I'm in Phoenix, if you know of someone...) they might not be on that list of covered people. Do I just pick one at random and hope for the best? I've been procrastinating doing this for a long time (mostly out of fear and convincing myself I was fine), and it seems like I just have one more hurdle to make it happen. Please help!
posted by Weeping_angel to Health & Fitness (14 answers total) 7 users marked this as a favorite
 
This only covers a small part of your question, but: I suggest starting with a psychologist. If your psychologist thinks medication might be helpful for you, they can easily refer you to a psychiatrist for a prescription (most psychologists I know have a doc they work with regularly for this purpose).

If you have another doctor you trust (GP, OBGYN, whatever) you can try asking him or her to recommend a psychologist. But, honestly? Just pick one. You can always, always switch. The important thing, I think, is to get started.
posted by Mender at 4:54 PM on June 21, 2013 [1 favorite]


Best answer: Just a few things to think about:

Think about whether you have a strong preference to be very trusting and open with a man or a woman.

Think about whether, given your ongoing depression, you might need to focus on finding someone who is super convenient to you so that you never have any excuse for cancelling an appointment.

Ask yourself if you have any biases about education. I have had really good therapists who were MSWs (Masters in Social Work) or MFCCs (Marriage, Family, and Child Counselors), but the one who did me the most good had a PhD (i.e., he was a psychologist) and that was partly due to the intellectual rigor he brought to the table.

Think about your coverage -- can you see your therapist more than once a week? If not, I would avoid psychiatrists, as they are more likely than others to want to see you 3 to 5 times a week (depending on other factors as well).

Also, depending on your jurisdiction and your health insurance, your copayment may vary widely. Some insurers in some states will pay, say, $35 per visit and you pay the rest. With a psychologist, that might be another $35. With a psychiatrist, that might be another $150. And if you have anxiety, don't add to it by having money worries too. Some states require that the insurer put each kind of therapist on an equal footing monetarily so that you can make a judgement about what you need without having to count pennies.

A therapist is a service provider. Dive in, pick one, see them once. If you feel like you could benefit from this person's help, commit to four to six sessions with them, and then if you don't feel like you're being heard or helped, try someone else. Don't give up too soon unless you're sure that it's not your tricky mind tricking you into thinking you're not getting enough from this therapist, when what's really going on is that your tricky mind is trying to avoid focusing on stuff that's uncomfortable.

Therapy stirs up a lot of muck that is currently below the surface. It can be very uncomfortable and challenging. And it can be time consuming and sometimes exhausting. But it is one of the best things you can possibly do for yourself. Imagine, if nothing else, the ability to talk about everything that is troubling you without having to worry about whether you're boring your friends/family, or whether you will have to reciprocate in the future. :-) Good job in taking the right steps to feel well and come fully alive.
posted by janey47 at 5:06 PM on June 21, 2013 [2 favorites]


Response by poster: Sorry to threadsit, but janey47 said something that I hadn't thought of. Is it expected that I'll see this person weekly/multiple times per week?!? My insurance only covers 20 visits a year (though I just pay one set co-pay no matter what kind of person I see, so I don't have to worry about that.)
posted by Weeping_angel at 5:13 PM on June 21, 2013


Best answer: Picking one at random and hoping for the best isn't a terrible idea. You can call them up on the phone first and sort of "interview" them a bit. It doesn't matter really what you ask, just that the conversation lasts a couple of minutes so that you get a sense of whether you like them or not. A gut feeling is fine there.

And I'd start with a therapist. They should be able to give you objective input on whether they think you would benefit from medication. If they think so, then you can make an appointment with a psychiatrist too. Most people I know who see a psychiatrist also see a therapist as well.
posted by lollusc at 5:16 PM on June 21, 2013


Oh and as for your follow-up question, I think most therapists expect you would see them weekly at first, but you might only need to see them for a couple of months, and then maybe the occasional visit later to follow up on things you are still struggling with. It depends on what your problems are and how they improve. I saw a therapist twice a week for a month while I waited for my antidepressants to start working, and then I felt a lot better, so we switched to once a week for three more weeks, and then I felt like I didn't need it at all. I've seen her twice in the two year period since then, both to talk through specific things in my life that came up. But those were one-off appointments, and she was cool with that.
posted by lollusc at 5:19 PM on June 21, 2013


If you're just starting out, you would do best to go at least once a week. There's a lot to cover and trying to do it one hour every other week isn't going to cut it. I've had therapists that wanted to see me as often as 3 times a week, and I ONLY ever did that when I was deep in despair and really needed the structure and constant checking in. Generally, a once per week commitment is sufficient, but try not to do less. You can get a lot done in 20 weeks, and then you can take a winter hiatus and restart in January.
posted by janey47 at 5:19 PM on June 21, 2013


Best answer: It has not been my experience that a psychiatrist will require 3-5 visits per week for anxiety and/or depression. I wouldn't get too hung up wrt where to start. Psychiatrists can refer you to psychotherapists and vice versa, and yes, a psychiatrist can and will assess whether you will benefit from meds before starting them. Don't let the uncertainly about where to start keep you from starting.
posted by Wordwoman at 5:21 PM on June 21, 2013


To give an anecdote: I had moderate depression and anxiety, and saw my therapist maybe 3 times a week for a couple of months. That tapered off to once a week, then biweekly, then once a month, before both of us were confident I don't need any more sessions. This was coupled with antidepressants from a psychiatrist.

You should pick a few people from the list of approved therapists that meet your criteria; there's a chance that the therapist you call can't take new patients, so having some choices help. You can also ask the therapist for recommendations (maybe they have colleagues). Even if the recommendations aren't within your insurance network, you can default to them, should the in-network therapists all be unavailable.
posted by curagea at 5:36 PM on June 21, 2013


Make a list of 10 that seem reasonable to you and your schedule (e.g how far rom work, etc.). Call thm. Most likely you'll have to leave a message because they are busy seeing people. When they call you back, talk with them and see if they are accepting new patients, accept your health insurance and give them a little information on by you are seeking therapy and your goals. You have to do a little interviewing.
posted by floweredfish at 6:22 PM on June 21, 2013


Best answer: Pick the 5 you like best, leave them messages, talk to them when they call back, set up appointments with the 2-3 you like best, then just go with your gut. Don't get all analysis-paralysis, but yeah, you're right! You have no idea who you will click with. And research has shown that the relationship with the person does partially predict the outcome (... according to my old therapist. i haven't pulled up the study myself). Relationship was something like "liking and respecting" them. It doesn't have to be perfect or anything.
posted by salvia at 7:15 PM on June 21, 2013


People respond to therapy in many different ways, and you may find that you need to try a few different people and places before you find something that feels right for you. (By the way, there's also group therapy for people who are more comfortable with social situations than one-on-one contact.)

Speaking personally (so grain of salt and all that), I find that talk therapy isn't very effective if it's less than once a week. It works best when you can talk spontaneously and freely about whatever enters your mind, and that's harder to do when you have to recall how some event or situation made you feel weeks ago. But again, everyone is different and you may find that bi-weekly or monthly appointments are fine for you.

Psychiatric appointments can be spaced out over longer intervals than talk therapy if they're mainly about monitoring the effects of prescription medication.
posted by Kevin Street at 7:46 PM on June 21, 2013


You can go to your general practitioner and ask them to recommend a therapist in your network to you. Most likely you will go to a psychologist first. If the psychologist recommends that you try medication as part of your therapy, they will recommend a psychiatrist for you.
posted by deathpanels at 9:18 PM on June 21, 2013


You probably won't see a psychiatrist for therapy, but might see one for medications, if you go that route. I encourage you to get referrals from your insurance company or primary care physician and call them to do phone interviews. Ask about education, experience, type of therapy. I asked a wild card question to get a better sense of them. (I asked "Do you consider yourself a feminist?" It certainly sparked discussion.)
posted by theora55 at 9:55 PM on June 21, 2013


For someone seeking out therapy for the first time, I would suggest not limiting yourself to psychologists or psychiatrists. People with social work degrees or certification (MSWs, DSWs, LCSWs, etc.) can be just as good or better. Academic research suggests that one of the most important predictors of success in therapy is the relationship you have with the therapist - so talk to some, maybe even asking them wild card questions (about something that is important to you), as theora55 suggests. And if you feel that you're not connecting with the therapist during the first contact, move on.

Also keep in mind that costs vary a great deal depending on the degrees that the person has; for example, psychiatrists can cost as much as $200/session, while you could see an MSW for $80. Some of this is to do with price setting by insurance companies - not how good the therapist is. Even if you have insurance, if your co-pay is a percentage of their fee, you'll be stuck with a huge co-pay with most psychiatrists.
posted by ashworth at 6:13 AM on June 22, 2013 [1 favorite]


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