How do you choose a shrink?
February 26, 2017 12:18 AM   Subscribe

So I'm finally at the point where all my usual coping and handling strategies for depression and anxiety don't work. I'm surprised I got all the way to 45 before that happened but there you go. Anyway I need to talk to someone. Maybe get medicated. And there's a crapload of life experience I'm gonna have to throw that shrink's way including childhood trauma. But having NO experience in mental health, I'm not exactly sure what I'm supposed to be looking for here. A psychiatrist? A psychologist? Specific talents or skills? I don't know what I don't know here. Is there some kind of decision tree someone's made up for this sort of thing?
posted by anonymous to Health & Fitness (9 answers total) 8 users marked this as a favorite
I've been seeing mental health professional for 30 years and invariably I've found psychologists to be far more help than psychiatrists, unless I needed specialised medication that my GP couldn't prescribe. This is Australia - ymmv. Also, from my pov, you need 2 things - a brain dump & CBT. The first is not a technical term, and i have found that psychologists tend to go for one or the other.
posted by b33j at 12:39 AM on February 26, 2017

Psychologists can't prescribe medicine, so you will need both a psychologist and psychiatrist if you are considering both medicine and therapy. But there are those with other degrees who can do these things: a licensed clinical social worker can provide therapy and an advanced nurse practitioner can prescribe medication, for example. It will really depend on the resources of your community.
posted by kerf at 1:27 AM on February 26, 2017 [1 favorite]

If you have insurance, their "Find a Provider" should list various options for counselors: psychology Ph.D.s, social workers, Psy.D.s, etc. There's not much difference between them, to be honest. My wife has a M.A. in clinical psych and a M.S.W., and her coursework was largely redundant.

The key distinction is between counselors/therapists and psychiatrists. The latter attended medical school and, as a result, is usually more interested in the medical aspects of mental health, i.e. psychopharmacology. While a good psychiatrist won't just write you a prescription without talking to you first, in general, psychiatrists are rarely interested in what they call "talk therapy". That's the job of a therapist. Psychiatrists also generally require s referral (you can't just walk in off the street and be like "hey pal hit me with the Ritalin"), sometimes from your general practitioner but more commonly from a counselor.

A counselor's job is to help you work through your issues, to indentify root causes and develop coping strategies. Although they're not opposed to medication, they generally see it as a complement to therapy. Medication can get you through life, but therapy is where the real work is done.

The typical process would be to see a counselor for therapy a couple of times, and if they think you need medication in addition to therapy, they'll refer you to a psychiatrist. If you don't have insurance, or your insurance doesn't provide a list of providers for some reason, you can get recommendations from your county mental health board, or, if you're in school, your college's counseling center. Look at the counselors' backgrounds and philosophies to find one that fits with what you need. In my opinion (which is widely shared on here), you should be looking for someone with a background in CBT, which is also sometimes grouped under the rubric of "evidence-based" therapy (so called because it's been proven to work).

Best of luck to you. Mental health problems, like physical ones, are largely solvable, but you have to take the first step. Congratulations to you for doing so!
posted by kevinbelt at 4:31 AM on February 26, 2017 [5 favorites]

an advanced nurse practitioner can prescribe medication, for example.

Exactly. This will partly depend on what sort of issues you are working on. I manage anxiety. I see a licensed clinical social worker (I think? all I know is she is not a psychiatrist) and when she suggested I try anti-anxiety medication, I was able to get it from my doctor. However, if you have something that may be more complicated and that might involve trying a lot of different medications, you might benefit from working with a psychiatrist. Really the best thing is to get started: find someone your insurance covers who seems to work in the area that covers your loose estimations of your issues.The ThereIsHelp wiki has links to a few places where you can look. The Psychology Today therapist finder is one I know a lot of people have used.
posted by jessamyn at 7:28 AM on February 26, 2017

It sounds like you're coming to a sort of reflection on how you've arrived at this point in your life and how to proceed, so to add to the options above: you may want to consider the option of psychotherapy as well. Some psychologists sometimes focus mainly on disease, complaint and the treating of it towards getting better from depression or anxiety for instance, that is one option. People who do psychotherapy (in my country North Europe they are psychologists with years more training and registration: they can be psychologist, psychotherapist or psychiatrist doing psychotherapy) usually can offer a bit longer, a bit more broadly-focused treatments that can be based on CBT techniques or psycho-dynamic/analytic, schematherapy, client-centered therapy etc (these are some of the classic schools of psychotherapy, if you're interested you could read about those and see which you would like). Maybe you could ask your GP, sometimes they've got good referring and working relationships (experiences) with therapists in the area.

That said, the people who practice these psychotherapeutic treatments can be a psychiatrist themselves (but usually are not) or will work together with (be able to refer you to) a psychiatrist in the area for when their patients might need medication as well. The duration can range (weekly) from -I think- at least half a year to a couple of years.
And you could consider grouptherapy (led by the abovementioned registered professions) as well, if you want to share and reflect with others. But you could talk about that with whomever you start to consult with.

If you feel you would like to reflect on recurring patterns (of depression/anxiety), lifelong copingstrategies in relation to childhood experiences, psychotherapy could be a way to go too. Whatever discipline or institute or private practice you choose to try out, IME: pay mind to how you feel, if you feel interested, stimulated, if you feel a good kind of connection to the therapist. It is very important for starting to build on the trust and embark on the quest. It's not uncommon to not settle with the first therapist you meet.
posted by Litehouse at 8:14 AM on February 26, 2017

In addition to what people have said above, if I were you, I'd look for a therapist with experience working with trauma. It's a specialized skill set, though one that's generally widely available among therapists.

How To Choose a Counselor or Therapist from is more about the interpersonal aspects than the nitty-gritty aspects, but might be helpful. That site also has a therapist finder that might be a good starting point, as does Psychology Today, though if you'll be using insurance, you may need to cross-reference with your insurance provider. (It's a giant pain, I know.)

For me, I looked up therapists in my area on both sites, cross-checked with my insurance list, and then emailed a couple of therapists whose descriptions appealed to me to see if they were accepting new clients and still accepting my insurance. One had a waiting list so I started seeing my second-choice, and stopped after two sessions because she was extremely unhelpful and had some weird boundary-crossing stuff going on. I contacted my first choice again and was able to eventually get in to see her. Taking the time to shop around a bit, like that, can be helpful, or at least knowing that you can leave if it's not feeling right can be helpful.
posted by lazuli at 9:24 AM on February 26, 2017 [1 favorite]

@lazuli has a great point about Psychology Today -- that's how I've found a couple of my therapists. The cool thing is that they now have a way to filter based on insurance, so if you have any of the Big Companies you can filter down to those that are listed to take it. You still want to cross-check with your insurance company, of course.
posted by gloraelin at 1:14 PM on February 26, 2017

Chiming in to nth Psychology Today; I found 2 therapists I loved that way!
posted by fiercecupcake at 2:07 PM on February 26, 2017

Yeah, I don't know about the online stuff.

Look, I'm going to sound like an asshole here, but - find someone like yourself.

You're anonymous, so I don't know - are you black? Find a black shrink. Irish? Find an Irish guy.
Are you a vet? Get another vet.

It sounds trite, but one of the things I've learned from experience, you want to find someone whos been down at least a piece of the same road you've been down.

Since you're anon - my bit of road here. One of the things it's hard to deal with, the whole violent life thing. Having guns around. You get depressed and you've got a shitload of firearms around the house, that could be a thing.
Not a lot of shrinks know how to deal with that. Given the givens. Their backgrounds and whatnot.
You know, a lot of people with the whole compassion and caring thing don't put in a lot of time at the range.
So, in my experience, a lot of guys, vets in my case, have some issues dealing.
So they turn to buddies, etc. Who know guns, and are willing to box them up for a few days, but aren't, you know, shrinks.
Similarly, shrinks aren't comfortable with a box o' guns.

What I'm saying here is, whatever your issues, you're going to need someone with the same experiences. Maybe not exactly the same ethnicity or socialization, but someone who knows the same shorthand, gets the same references.
You're 45, there's no way a 26 or 27 year old is going to get where you're grounded. Although that might be an advantage.

I guess you need to find someone who listens. But again, it seems easier without a cultural barrier.
posted by Smedleyman at 11:28 PM on February 26, 2017 [3 favorites]

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