Okay, okay. I'm getting therapy. ...How do I do this?

October 10, 2014 12:47 PM

After struggling with a few largely non-crisis issues for the last eight years or so, I've decided to go see a therapist. I've seen a counselor before, and she's lovely, but I feel like I need more cognitive insight now. I found my current counselor by calling the local Pride Center and getting a list of names, then going with the first one who answered their phone. I want to make a more informed decision this time.

I have a history of depression, and a more recent history of what I guess I would call high stress (not sure whether my problem is that I'm slightly depressed and dealing with current stresses poorly or whether it's an outright anxiety problem). I have had a breakdown in the last few months, but by the time my counselor was able to see me I was feeling much better, so we mutually pretty much brushed it off as a one-time thing. Now I'm feeling many of the same symptoms of high-stress that I felt immediately prior to that breakdown, and I'm concerned.

I recently (at the rather pointed suggestion of a family friend who is a psychologist) read a book on ADD, and I read so many things about myself in that book it was kind of sad - forgetful, sense of underachievement, chronic lateness, easily bored, hyper-focused when a task is engaging, etcetera. So I might want to talk about that too. I also want to discuss my stresses about my current job (which I'm trying to leave, but can't yet), trying to find a new job (which is not going well), and relationships (I'm in a pretty new one for the first time in about five years and I feel like I'm not as good a boyfriend as I should be).

Oh, and I'm transsexual. FtM; have been on testosterone for about... Five years now, I think. Recently I switched delivery methods, and there is evidence to suggest that my testosterone levels are very low compared to where they were in, say, 2011. I have approached my endocrinologist with my concerns and have had blood work done recently; results should come back soon, and we can begin working on a solution then.

To clarify: I do not need to talk about gender dysphoria. I do want someone who is at least passably familiar with the FtM population so that they understand potential changes due to hormone fluctuations, but I don't have any problem with my body and don't need or want to talk about my perception of my gender/sex/sexuality/whatever.

So... What kind of practitioner should I be looking for? Psychologist? Psychiatrist? Should I be looking for a certain kind of therapy, like CBT, or something else? I don't especially want to go to the Pride Center again, because the folks on record are mostly there to specifically discuss gender and sexuality issues, and I feel that I've quite thoroughly left those hurdles well behind me. What sort of questions do I ask, besides making sure they participate in my health insurance plan? Is it reasonable to conduct a phone interview instead of scheduling a bunch of "let's meet" appointments, each of which I will need to leave work for and pay a co-pay? ...Halp.

Thanks very much for any and all advice.

tl;dr: FtM wants someone who is aware of the GLBTQ community but doesn't necessarily specialize in it to talk about stress, depression, anxiety, and maybe ADD. Advice for finding the right one?

I'll hang around for another ~hour to answer any follow-up questions, and can be reached after that via the following throwaway email: [e-mail]

posted by anonymous to Health & Fitness (5 answers total)

I would go with a psychologist. You can a psychiatrist later if you the medication route. On the phone you can ask a few questions: What is your experience with x,y,z?
Friends or your previous counselor are pretty reliable sources for good therapists. Then google them and see what you think.
In the end though it all comes down to sitting in person with them and seeing how it feels.
posted by SyraCarol at 1:12 PM on October 10, 2014

It is reasonable to speak with people on the phone, and tell them what you're looking for, and ask them what kind of therapy they do, how they tend to approach issues like this, and whether or not they think you're a good fit-- and if they don't, ask if they know anyone else they can recommend. I would say call no more than five or six at first, just to talk to them over the phone, and then the one that you feel the best about, you should schedule an in-person first visit with.

Do not be afraid to see someone for a few sessions, decide you don't like it, and see someone else. I had to go through two really not-for-me therapists before I found an amazing one in my new town. (And then I just lucked into my current one, she just happened to have an opening and she's perfect.)

You should also think about telling your current counselor that this is what you're looking for, and ask her if she can recommend some therapeutic modalities that she thinks might be good for you-- tell her what kinds of things she did that really worked for you, too. Basically, you're asking her for some leads on what kind of therapist to look for to begin working through some different issues that you're ready to address with someone who has a different take. It *could* feel awkward to do this, but it doesn't have to; this is a perfectly reasonable thing to be doing.
posted by Made of Star Stuff at 1:24 PM on October 10, 2014

Does your current job provide health insurance? Does that health insurance have mental health coverage? Get the list of providers who are in-network for your current job's health insurance and within a reasonable distance from home/work. Rather than going with the first person who answers the phone, ask each therapist some questions. Examples, and you may vary these and/or come up with others:

* What form of therapy do you practice? (Do your own research on CBT and other methods of therapy and try to decide which one will work best for you -- the therapist's answer to this question will let you quickly rule out those who practice therapy methods you don't think will work.)
* What is your approach to treatment for stress management in patients with a history of depression?
* What is your approach to treatment for potential ADD?
* How familiar are you with common medical issues in post-transition FtM transpeople?
* How long have you been practicing?
(Qualifications such as degrees should be readily apparent from the insurance listing, so you don't need to ask that. Psychologists have had more training than LICSWs or MCSWs, and are consequently more expensive and less available.)

The American Psychological Association also has a guide online on How to Choose a Therapist.

Keep in mind that you could have someone make you feel comfortable with their answers to your questions and then not work out after a few sessions. Finding a therapist is a long process.
posted by tckma at 1:30 PM on October 10, 2014

Finding the right therapist is more like dating than like research. You need to shop around and find someone who works for you. Asking questions is good but how you feel around them is more important.
posted by Obscure Reference at 2:21 PM on October 10, 2014

I started by calling my insurance company to get a list of psychologists (my personal preference, I'm sure MFTs and social workers are fine) covered by my insurance. Then I looked them up on Psychology Today's website to see what they said about themselves. I picked one that dealt with trauma issues and called her. It worked out wonderfully.
posted by kathrynm at 9:20 AM on October 11, 2014