Help me help my brain.

August 27, 2014 10:17 AM

I am seeking mental health services. I've called my insurance and they've emailed me a list of 400+ covered providers - psychiatrists, psychologists, counselors, LSWs, etc - currently accepting patients. That step has already made me feel a bit better. Could you please help me narrow it down a bit?

My problems are depression and social anxiety - see previous one two .

I moved 5 months ago and still feel very isolated and sad. I'm very embarrassed as I live with my sister who is being great but I feel guilty and weird for not having met people to hang out with yet. It was my birthday a couple of days ago and my sister put the effort into making the whole weekend very special by taking me out to do several things with her friends. I just felt guilty and losery for not having my own friends, and I hid it because I can't stand the idea of her feeling bad for me. I do have some possibly related abuse-ish history with my mom I would like to talk to a counselor about. /sob story

I'm currently on wellbutrin for depression, I've been on it for 2+ years and I felt okay for awhile but I don't know if it's working anymore. It was prescribed by my previous PCP who is now out of state. I won't be seeing my new PCP until October for a check-up.

I don't understand the differences between mental health providers. I know NPs and psychiatrists can prescribe meds, but I don't know if they do talk therapy as well. If I want someone to evaluate if my antidepressant is working, do I need to see one of them and possibly another type of therapist for talk therapy? I've heard cognitive behavioral therapy is helpful for some people?

Goals - I really just want to have the confidence to go out and meet people, and stop feeling so guilty and embarrassed all the time. I want to get more happiness out of my life and I have been unhappy for too long.

My only past experience with mental health services - I saw a LSW, once, for one session a couple of years ago for a specific issue. The one session did help me.

posted by pintapicasso to Human Relations (10 answers total)

First do a sort on your provider finder website so you can narrow these 400 people down to find those who will be easy for you to visit, location-wise. You want someone you can get to quickly/easily so that therapy will just be a thing you do and not a chore requiring a special trip.

Then, once you have a much smaller list, start looking those people up online. Most of them will have websites and/or a profile on the Psychology Today therapist finder site. Read their blurbs and look at their specialties until you find several people who specialize in social anxiety and whose philosophy you like.

Then look those people up and see if they have a Yelp page. Everyone's experience of therapy is different, so that's less useful, but it'll be good to find any red flags like if someone is really shit at scheduling appointments or is impossible to reach or fucks up billing.

Then from that much, much smaller list make phone calls to see if anyone is available to see you in the next few days.

Go to an appointment. If your first appointment doesn't click (i.e. you feel uncomfortable or get a bad vibe from the therapist), go to the next person down on your list.

Give yourself a deadline on the narrowing down process so you don't spend days/weeks on it. The most important thing is for you to actually get into therapy!
posted by phunniemee at 10:27 AM on August 27, 2014 [3 favorites]

Psychiatrists will not do talk therapy. On your first visit, they will ask you questions about why you're there, and this evaluation might take 30 minutes or more, but subsequent visits will be very short, maybe 15-20 minutes. Basically it consists or "are you having any side effects from your current medication? is it working? do you want to try something else?" and that's about it.

Depending on where you are, it might be difficult to find a psychiatrist who is taking new patients, and when you do, the first available appointment might be two or three months away. So I'd deal with that first and then look for therapists. There are lots of practices that have both so you might want to see one in the same office for convenience. (They will share notes between themselves.)

I would think about some questions to ask a potential therapist. Do you have a preference for the therapist's gender? If you are gay or trans, I would ask your local LGBT organization for references. Would you be interested in a spiritual approach? Or do you specifically not want that? (I've had some therapists ask to pray with me and I wish I'd filtered those out ahead of time.) I'd ask for someone who specializes in abuse or anxiety, though both are really common.
posted by desjardins at 10:31 AM on August 27, 2014

Oh - and even though your insurance emailed you a list, when you talk to the provider, verify with them that they are still on that insurance's plan. I've gotten massively burned by this.
posted by desjardins at 10:33 AM on August 27, 2014 [2 favorites]

In my experience having a good psychiatrist and a good counselor can be extremely helpful for the issues you're describing. There can be overlap between the two (a psychiatrist CAN BE a good counselor), but they aren't necessarily the same thing, and my personal feeling is that it's two separate skill sets that require two separate providers. Ideally your psychiatrist and counselor would communicate about your care, which has the added bonus of giving you two people on your "team" instead of just one.

That said, the most important thing in finding a mental health provider is finding someone you're comfortable sharing your fears and vulnerabilities with, and someone who really connects with you. It's good to have someone who specializes in your issues, but most psychiatrists and counselors are experienced in dealing with depression, anxiety and trauma, so it's worth the effort to keep looking for someone you really feel comfortable with.

If you google "how to find a therapist" you can find some tips on weeding people out, but again, your comfort and ability to share openly with this person (and feel safe doing so) is the most important thing.
posted by odayoday at 10:34 AM on August 27, 2014

One of the big problems with that provider list is that probably 75% of them will be incorrect or not accepting new patients. Some of them are probably only nominally "in your area" as phunniemee says.

But you do the rest of the process stated above, and just don't even worry about fit or functionality until you have a small pool of providers that actually exist as possibilities. Then you do the reputation search to figure out which ones are Not For You for whatever reason.

And you will probably end up, eventually, with one provider for talk therapy (they will be psychologists, social workers, professional counselors) and another provider for prescriptions (they will have a medical or advanced nursing degree). You can start with one or the other, there is no right or wrong here, it's just a common one-two punch that seems to work for most people.

It sounds nightmarish, and it is a bit tedious, but you can do at least half of your initial sweep online and then just make yourself a script for the phone calls. Use a spreadsheet to keep track:

Hi, I got your name from INSURANCECO and wanted to check that you are still accepting new patients from INSURANCECO?
[if accepting a) new patients b) from INSURANCECO]
And are you still at ADDRESS?
Do you have a website?
Just generally, what's the wait time for a new patient appointment?
Great, thank you so much!

So if they are accepting new patients this year from your insurance company and are within a reasonable distance and are polite and responsive on the phone, then you can look at their website and Yelp and decide if they are worth calling back for an appointment.
posted by Lyn Never at 10:42 AM on August 27, 2014 [4 favorites]

Psychiatrists will not do talk therapy.

This is often the case, but it is not universally true.
posted by Jahaza at 10:46 AM on August 27, 2014 [1 favorite]

Does your employer offer an EAP? If so, that might be an option for getting a quick referral to somebody who is guaranteed to take your insurance, so you can get in and see a therapist as soon as possible. It sounds like you really need this, and doing it that way might be a little less of a pain than sorting through a massive pile of contacts in your insurance's directory.
posted by Kosh at 10:57 AM on August 27, 2014 [1 favorite]

It sounds like you would benefit from both a psychiatrist to handle meds and a therapist (LCSW, MS, or PhD) to talk to for counseling/therapy. Psychiatrists sometimes do both but I agree that usually you'll want two separate providers. Often if you find one provider that you like you can get recommendations for the other.

Do you have a primary doctor, internist, gynecologist or other doctor who you could ask for a recommendation?

I find that it's helpful for me to have questions written down before I call, as LynNever suggested. If you have specific concerns/constraints, write those down. For example I was only interested in therapists who had appointments at 8am, 6pm, or 7pm on weekdays due to my work schedule so I asked that.
posted by radioamy at 11:34 AM on August 27, 2014

You can try asking the question "how many years has Dr. ___ been practicing?" or look for that info on their website, your insurer's website, or Psychology Today. Definitely filter out anyone fresh out of school with less than two years experience, and possibly also filter out anyone with more than 30 years experience because they might not be in line with cutting edge/currently accepted best practice or they may be close to retiring and less likely to be taking someone new.
posted by slow graffiti at 11:45 AM on August 27, 2014

I was surprised to find, in my smallish town, a psychiatrist who DID do talk therapy as well as medication. When I had to stop seeing him, I found an NP who did the same. So, if you're like me and feel it would be beneficial to have the same person doing both, it's worth asking the providers.

N.B. - I DID run into a couple of psychiatrists in my search who got a bit hostile and defensive when I asked the question. But it was worth it in the end.
posted by The Underpants Monster at 11:50 AM on August 27, 2014 [1 favorite]