Therapy 101: What kind of therapist does my husband need?
February 7, 2014 7:00 PM   Subscribe

My wonderful, kind, funny, awesome husband needs some help. I think he may have some mild depression issues. It manifests itself mostly as roadblocks in his brain that stall him on major work projects, grad school, etc. He just shuts down on certain big projects and can’t finish them, and I’m worried about him.

He seems to have episodes like this where he gets really dragged down maybe once a year (this time of year, generally—I’m guessing the season may have something to do with it). He is willing to talk with a therapist and I’d like to help him find someone. Neither of us has ever been in therapy so I’m a little overwhelmed by all the different styles and don’t know what to look for.

So, what kind of therapy would you recommend for someone who needs help overcoming mental obstacles and self-defeating behaviors? CBT? DBT? Life coach? “Talk” therapy? I’m also confused by all the different titles (this is in the U.S. if that helps); I’m looking at a website that lists local therapists and I see counselors, psychologists, licensed professional counselors, clinical social workers, limited licensed professional counselors, etc. etc.

Any help steering us in the right direction, and/or advice on how I can best support him through this would be most appreciated. Many, many thanks.
posted by anonymous to Health & Fitness (12 answers total) 8 users marked this as a favorite
I think the person and the way you "click" is more important than the modality. I believe studies back that up. Most professionals blend all the different types together in their toolkit and use whatever is appropriate at that moment for that person.

Have a look at Psychology Today's therapist listing. You most likely do not want a psychiatrist but the rest of the various titles are often different based on jurisdiction (ie, some states/provinces require an MSW to be a social worker, some don't), some titles like "life coach" are not regulated at all (but there are some good life coaches out there too). If possible, personal recommendations are best. If either of you are employed you might want to check with your HR department to see if there is an EAP that gives you. A few free appointments to check out a few different people. Your doctor/GP is also another good source of recommendations.
posted by saucysault at 7:38 PM on February 7, 2014 [2 favorites]

"Talk therapy" just means someone who talks one-on-one with clients in a therapeutic way. CBT and DBT are both talk therapies.

The academic degree and the orientation (e.g., CBT, DBT, psychodynamic, etc.) have been shown not to matter except that it's important the therapist believes in their own orientation, and the client buys into (not in a manipulative way) the therapist's orientation.

If your husband is VERY RATIONAL, some sort of *BT therapy might be a good starting place. If he's more interested in how families affect people's adult lives, a counselor listed as "psychodynamic" might be a good fit. If he's very abstract and talks a lot about how "the world" works, a therapist listed as "humanistic" or "existential" or "existential-humanistic" might be a good fit.

Really, though, he should read through the profiles and just pay attention to who "clicks" for him. As others have said, the relationship between the therapist and client is the most important aspect of healing (studies say 80% of the effectiveness of therapy is just the client-therapist relationship). You, or he, don't need to pick the "perfectly qualified" therapist; just look for the "this is a good fit" therapist.
posted by jaguar at 8:16 PM on February 7, 2014 [2 favorites]

When I was in college, I constantly struggled with large tasks—specifically, long research papers—and I was probably depressed. The one really good piece of advice I received was to try to break big tasks up into smaller ones, so that they don't feel so overwhelming and so that you can feel a sense of accomplishment when you meet one of your goals. So a 15-page paper? That always felt like kind of a beast to me. But three 5-page papers? I could do that.

So at the same time your husband seeks out therapy (which is a very good idea), I might also try encouraging him to break big tasks up, even if it's only a mental exercise.
posted by Conrad Cornelius o'Donald o'Dell at 9:10 PM on February 7, 2014

It manifests itself mostly as roadblocks in his brain that stall him on major work projects, grad school, etc. He just shuts down on certain big projects and can’t finish them, and I’m worried about him.

The school may have a psychologist that specializes in procrastination.

The Now Habit is a good self-help book on the subject.

He seems to have episodes like this where he gets really dragged down maybe once a year (this time of year, generally—I’m guessing the season may have something to do with it).

A friend of mine swears by his "human grow lamp" for his mild case of Seasonal Affective Disorder.

Exercise may help too.
posted by sebastienbailard at 9:18 PM on February 7, 2014

Is it possible that he actually in over his head? In my past I have had similar issues arise with work and school. It manifested in bouts of anxiety and depression. However, really the root cause was that I didn't know what I was doing, or deep down I knew that it would take two or three times the amount of time I had.
posted by BabeTheBlueOX at 10:20 PM on February 7, 2014 [4 favorites]

Sounds more like biochemical issues could be behind some this. There are several labs that do complete workups these days, and the tests they have today are more accurate then ever before. I know Dr. Phil praises the non-profit lab he uses out of Houston, or Dallas as the best in the country. Sorry don't recall the name of it but its posted on his web site if you want to look into it more. They may be able to locate same types of services in your area. Men are not always so open to "therapy" as most women are. Still has a lot of stigma around it. If it is a bio-chemical imbalance a simple change in his dietary habits could bring your husband's spark back in a very short time. Best to rule out other common causes of these symptoms before paying lots of $'s for therapy that wouldn't help at all if it was chemical based and not corrected along with therapy sessions. Best luck to you both.
posted by dragonflyher at 10:34 PM on February 7, 2014

Most places, licensed counsellors and social workers have two years' training, mostly of an applied nature (though there is some research in there, it's not the focus), plus a certain number of supervised hours after that. There are differences in the emphasis placed on different aspects of their training, but they will be working from models that have a reasonable evidence base behind them. I think after a few years of working with people, it more or less will come down to the individual.

Counselling or clinical psychologists have a 4-5 year doctorate, which involves producing a big piece of original research, along with applied training. They also have a certain number of supervised hours after that before they can be licensed.

Totally agree with the point about fit. It's supported by research (sorry I can't think of it atm; there's anthropological research favourably comparing outcomes after treatments by non-Western spiritual counsellors and Western psychiatrists [I think]). My personal experience, as a client, with people of all those stripes, was that specific background mattered a lot less than chemistry. (When I was younger, I thought the background was more important, but I got the most out of a practitioner with a two-year professional education who had more common sense in her pinky than others whose walls were papered with qualifications. I like no-bull, get-to-business straight talk, ymmv)

I do think there's something to be said for evidence backing specific treatments, though -- you won't see classic psychoanalysis anywhere, for good reason. I think DBT and CBT have more in common than not. And I definitely think a commitment to a grounding in professional ethics and values and oversight is worthwhile. Which is why I would only consider seeing a life coach if I had a very specific problem or goal that didn't involve a lot of emotional upset and I just needed help organizing my time (on recommendation).

But if your husband's in grad school and is also employed in a serious position that demands time and energy for 'big projects', I bet part of it is just that he's maybe understandably overwhelmed. (This time of year is right after exams, or course work might be due.) Practical thinking around that might include making decisions about course load, taking a break for a semester, or finding a less demanding job. Maybe it'd be worth talking to an advisor somewhere in the academic world, or even other students?

You could probably help him by lessening any non-essential burdens from his non-school / non-work life.
posted by cotton dress sock at 11:20 PM on February 7, 2014

If it were me, I'd go to a life coach. I've been in therapy before, and I didn't find it to be helpful. The therapists never really gave much concrete advice, and the therapy sessions were just opportunities for me to complain about everything without actually coming up with a specific plan of action.

Looking back on it now, I think what I really needed was someone to help me get a handle on all my projects and responsibilities, how to prioritize them, and how to manage my time effectively. I also could have used help in getting my finances in order, planning ahead for a career change, sticking to a sleeping schedule (I had a tendency to watch TV late into the night), getting into a regular exercise routine, and improving my diet.

I like to think of myself as kind of a practical, down-to-earth guy, and the therapy really didn't do it for me.
posted by alex1965 at 4:54 AM on February 8, 2014

I feel like getting so many different suggestions may be making this harder for you, rather than easier, but one thing you may want to keep your eye out for as you read listings is phrasings like "solutions oriented," "solutions focused," and/or "brief therapy." If your husband has a fairly specific area of difficulty that he needs help with, that may be a good place to start. I'm working with a therapist who describes herself as solution-focused, and our work so far has focused on strategizing to tackle specific immediate challenges in my life in a collaborative dialogue that includes her pointing out potential trouble spots, making concrete suggestions, and me becoming more mindful of when I stumble onto an approach or solution that seems to work for me and trying to generalize it to other contexts.
posted by drlith at 5:35 AM on February 8, 2014

Start with a check-up by his physician. What looks like a mood disorder to laypeople may be a physical problem. If therapy is advised, the doctor can make a referral.
posted by Carol Anne at 5:46 AM on February 8, 2014

As a therapist I'm always wanting to answer these questions in a helpful way, but struggle to do so in text. So I hope this is useful.

A basic answer would be: seek out a therapist who does Cognitive Behavioral Therapy. It is a broad based technique applicable to a lot of problems. Research shows that the techniques work, so that is always good. If a person has training in this they should also have training in more specific behavioral techniques as well as the cognitive side of things. Dialectical Behavior Therapy is a type of therapy that was designed for individuals with suicidal and self harm behavior, though it has been shown to be helpful for a variety of other groups. He probably doesn't need a DBT trained therapist.

I can understand how it feels like a big decision to pick the "right" therapist. However, part of being a therapist is knowing when you aren't the right clinician for your client. So in the very unlikely event that your husband ends up with somebody who cannot help him, they are ethically obligated to let him know and transfer him. And if he does not feel comfortable with the person he meets, he has every right to request to meet with somebody else, even within the practice, with no feeling of weirdness. Feeling comfortable with the person you are working with is one of the most important predictors of getting better. If you don't feel comfortable, how can you open up and trust them? Therapists know this and there are no hard feelings if the "fit" isn't right. When contacting people to schedule a first appointment, you can ask them things about what kind of people they usually treat (what disorders, men or women, for how long generally) and any other questions you might have.

If you feel like you'd like to ask more specific questions, feel free to memail me and we can chat somehow online.
posted by gilsonal at 6:57 AM on February 8, 2014

Especially if you live in a northern latitude where the light levels vary greatly from season to season, a "SAD light" (seasonal affective disorder) might be a good thing to try. If mild depression is due to a lack of natural daylight, it really helps - both my spouse and I sit in front of one occasionally in the winter when we're feeling sluggish. You can sit in front of it and read or work, so it doesn't take any extra time out of your day. Google "SAD light therapy" for recommendations of how much light is recommended. Good luck!
posted by summerstorm at 10:15 AM on February 8, 2014

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