Explain it Like I'm 5: Therapy
May 12, 2020 9:07 PM   Subscribe

I have a lot of personal mental health work that I need to do, and I've finally admitted to myself that I need professional assistance to get there. But I have absolutely, positively, no idea what I'm doing. And that's an understatement. How do I go from knowing almost literally nothing about the subject to actually talking to a therapist? Anxiety inside.

I've been stuck with an "I have to do it myself and I can't ask for help" mentality throughout most of my life, which means I have very underdeveloped tools when it comes to seeking help. I'm also avoidant and have some medical anxiety, so I've avoided doctors as much as possible over the years. That means I'm also clueless about how to even really use insurance or contact doctors' offices and feel overwhelmed when trying to look up the most basic of information. I'm also ashamed of how ignorant I am on the subject, so I've avoided asking friends or family out of embarrassment, even if they have a history with mental health services. These all feel like things I should have figured out a long time ago but have actively avoided learning about consciously and subconsciously.

So, here I am asking for help. I know that I could probably call up my insurance company, but I've never called an insurance company in my life and I don't even know what I'd be asking whoever picks up—and it doesn't feel like it's the operator's job to help me understand this stuff. I have absolutely no understanding of what to do next in this process and am truly overwhelmed by Googling and trying to navigate my insurance company's website. Using their "Find Care & Pricing" tool I found listings for "Licensed Professional Counselor" and "Clinical Psychology" but I don't understand the difference, or even if either are what I'm looking for. I also put my insurance into ZocDoc and typed "Therapy" and am overwhelmed by the results (I live in NYC) and don't know who I'd click on or why I'd choose them over someone else.

I tried starting this path a few years ago during a personal crisis but got overwhelmed when I ended up talking to a couple of private practice places (which I found through PsychologyToday's Therapist Finder after stumbling in the dark for far too long) who ended up not accepting my insurance and estimated $300 per session which I couldn't afford at the time (and would, of course, prefer not to pay out of pocket now). But then the crisis-of-the-moment passed so I continued to avoid seeking help.

But now I'm determined to figure out my long-term health, outside of any given crisis (or as much as one can be not in crisis during a global pandemic). So right now I'd like as much basic information as possible in order to not hit that wall and give up again. How do I figure out my insurance to understand what my mental health coverage is? I look at the documentation they gives me and it all turns to Greek. How do I actually find the doctors who take my insurance and how do I find out what I'd pay? How do I pick the right doctor? How do I pick the right specialty? What's the right way to book? Should I get a consultation before booking an appointment? What does a consultation even consist of? Is that a phone call or is it a proper appointment? How do I figure out how to explain to them when I'm looking for help with when I've had no experience articulating it?

Also, if you have any tips of going through this process specifically during quarantine, that would be great, too. I'm open to telehealth services as a stopgap but don't know where to start there, either. Waiting 6 months until I can start in-person sessions doesn't sound ideal. If possible I'd love to find someone who I could transition to seeing in person once businesses in New York safely open back up.

Also, apologies if this sounds a bit panicked or confused, but even asking about the subject is hitting my anxiety in a bad way and I'm having trouble keeping my thoughts together. And believe it or not anxiety isn't even the main thing I want to talk to a therapist about—what I'm really interested in is solving some of my emotional issues. But perhaps it's all wrapped up together.
posted by gregoryg to Health & Fitness (20 answers total) 8 users marked this as a favorite
Lots of providers have online lists, so you may not even need to call, in terms of providers both the categories you mentioned are fine. One haa a doctorate the other has a masters degree, both are capible of doing what you want and both can practice independently . A psychologist is able to do some assessments that an licensed practitioner can't, but that likely doesn't matter in your case. Really it is going to come down to the individuals personality and how they work with you. In general rates are slightly cheaper for the masters level therapists, but that's on the insurance side and not on the providers side. The actual self pay billing rates can vary.

Many many people have problems navigating these issues to find a therapist. Most just call around find somebody taking new patients with their insurance and start there. It's okay many therapists if you call will tell you if they take your insurance or not and explain things pretty clearly, it's just a part of running the business. Some have a flat rate for the session where this stuff is covered, some make the first session free.

All will want an intake season where you learn a little about them and they alittle about you to figure out if it will be a good for it not, not everyone will be! People are very different from eachother and there are things about since people that you won't like for any variety of reasons .it's okay to just move on. It'

Your insurance may have a behavioral health line to explain these things. It is litterally their job to be and to explain your benefits to you, don't stress about it.

Good luck! It takes time and effort to find a good fit.
posted by AlexiaSky at 9:25 PM on May 12, 2020

I won't touch on all of these but will address some.

Psychiatrist: typically for prescriptions, most don't do "therapy" beyond supportive listening during your 20 minute follow up. Some DO so you'll need to ask.

Psychologist: PsyD, PhD, LMHC (Master's level). Some do therapy, some doctoral level providers do testing or legal aspects.

Clinical Social Worker: psychotherapy, often trained to pay extra attention to environmental influences on presenting problems versus the medical model (broken parts to replace or repair)

Marriage and Family Therapist: trained some for individual treatment but primarily for couples and families

Many therapists will have a listing on Psychology Today as you have seen. You can filter by the type of insurance you have, and get a feel for the person by how they describe their work. Many therapists will verify insurance benefits as a courtesy to you. One thing you will want to ask is whether they will return to in-person work when the pandemic is over. Many of the therapists I know have fallen in love with teleworking.

For some reason I don't understand, many therapists are not great at responding when a potential client contacts them. So, don't take that personally if it happens to you - especially right now when so many are off their routine.
posted by crunchy potato at 9:37 PM on May 12, 2020

A licensed professional counselor (LPC) is a masters or bachelors degree level credential. A clinical psychologist is a doctoral level (PsyD or PhD) in most states. Someone with a PsyD has a doctorate that focuses on training for practice; PsyD programs are much less selective than PhD programs, which in psychology focus more on research in addition to practice.

As for how to find someone: your approach of using the find a provider tool in your insurance website or checking out Psychology Today are both fine. Try interviewing a few (say three) therapists by phone. Ask about their training and how they work with clients. Tell them you're never gone to therapy before and feel anxious. Pay attention to your gut feelings -- research suggests that how you feel about your therapist does predict how much therapy will help, so those feelings of good or poor fit are your best guide.

Most therapists are doing teletherapy because of COVID now, and most will transition to in person when its safe. You can ask about this when you call, and it won't be weird, I promise.

Congrats on doing this good thing for youraelf!
posted by shadygrove at 9:38 PM on May 12, 2020

Particularly for someone going into therapy for the first time, the first person that you talk to will probably not be the right match. However, part of a therapist’s job is to help people find the right place so you can expect them to help you with either a direct reference or at least the right keywords that you should be looking for. Basically, don’t worry that you’re leading anyone on or wasting their time by having a single session with them — everyone understands the importance of a good match.

I don’t think there is any standard for the difference between an appointment and a consultation. You’ll need to ask.

Most of the therapists I’m aware of are doing remote sessions right now. Virtually all of them are looking forward to getting back to being in the same room with people when it’s safe to do so. I don’t think you’ll have a problem finding someone who wants to transition to in-person sessions.

The questions about figuring out coverage and finding therapists who take your insurance I will leave to more experienced/intrepid people. Frankly that part gives me the heebie jeebies.
posted by Tell Me No Lies at 9:58 PM on May 12, 2020

If you got to search via psychology today: honestly googling "therapists [enter your location here]" it'll probably be your first hit, then you refine your search by your insurance provider (filter by blue cross blue shield, for example) and your specific issues, and bam, you've got a short list of people you can call who accept your insurance.

It is worth tracking down the info you have in an email, a giant file in your "important papers re: insurance" folder, or giving a call.

One thing to note: if you call the your insurance you will be talking to an absolute stranger who doesn't give a damn if you're asking for help.
posted by Grandysaur at 10:39 PM on May 12, 2020

The MeFi Wiki ThereIsHelp page has a section for Help with Finding a Therapist, including AskMe threads about finding a therapist, and The National Alliance on Mental Illness (NAMI) offers a free HelpLine at 1-800-950-NAMI (6264) for information, resource referrals and support for people living with a mental health condition, and the NAMI online directory can be searched for local NAMI organizations.
posted by katra at 1:05 AM on May 13, 2020 [2 favorites]

Advice from another person who has very little experience with therapy - prepare yourself for an internal mutiny after your first session. I've tried therapy a few times over the years and never get beyond the first appointment because all my defenses suddenly rise up and I find myself thinking "I don't deserve to be in therapy, other people have way worse problems" and "I should be able to fix these problems myself, it's indulgent to want therapy" and "Oh dear this therapist must think I'm a real loser to have such pathetic problems and still not be able to cope" etc etc. Prepare yourself for your self sabotage volume to go way up. Hopefully this won't happen with you. Good luck!
posted by Zumbador at 3:48 AM on May 13, 2020

First: good for you. It's great that you're trying to do this.
Second: Agreed that you might have internal mutiny. I wish I'd started therapy the first time I tried (what a difference that might've made in my life!).
Third: For me, when I finally got into it, I felt this great sense of relief, like I finally had an expert who could help me sort these things out. So this process will be a little hassle but will also hopefully quickly begin to feel worth it.

Okay, on to the How To.

How to make that call to your insurance company.
- Find your insurance card. It should have a number on it. Or, look up the phone number. It might even be on the back of your card. This doesn't have to be stressful -- all you're doing is finding a phone number. Now write it on your To Do list or create a calendar appointment for yourself at a specific time that includes the phone number.
- Next, all you have to do is dial that number. Pretty easy. You'll get put on hold. Then someone will answer and you'll say "can you please tell me if my coverage includes therapy?" and they'll answer, and then you'll ask "do I have to choose from a list of providers?" and they'll tell you. There's no emotional information exchanged.

How to find a therapist.
- First, make a list of maybe six therapists. You could get names from any number of places including the ideas above.
- Then, write down a little script for yourself (or wing it) and then dial the numbers. Nobody will answer; you'll be leaving six voice mails. "Hi, my name is ___ at [number]. I'm looking to start therapy for the first time. I've been dealing with some medical anxiety and would like to sort through some emotional issues. I have [XYZ Insurance]. Could you please call me back at [number again]? Thank you."
- Here's the tricky part: As the return calls start coming back (usually later that day or the next day), answer the phone and have conversations with people. Find out: Do they have availability at a time you could attend? Do they take your insurance? What's their education and experience? Then ask them to tell you a little about their approach. You could even tell them a little bit about what you're dealing with and see how they respond. Then rule out the people whose approach sounds terrible. You think now, how will I know which approaches I like and don't like, but a few will jump out as "no way." Narrow it down to 2-3 people. Set up meetings with them.
- Meet with them and see how it goes. At this point, trust your gut. Who inspires trust and confidence in you? Do you feel like they would be an ally in helping you work through these issues? "Decades of research indicate that the provision of therapy is an interpersonal process in which a main curative component is the nature of the therapeutic relationship." So you can't choose the wrong person.

Good luck!
posted by salvia at 4:15 AM on May 13, 2020 [9 favorites]

Response by poster: Thanks so far everyone, this is wildly helpful and soothes my anxiety about it all a great deal. I feel like I was pretty close with many steps in the process but your advice has helped my confidence with that last 10% in each area that I've been freaking out about. The mutiny is something I definitely anticipate, but I've also been down this road so many times and, honestly, there are a couple of areas in my life that are far-gone enough that I feel like it should be somewhat simple for me to get over that hump. But I am a generally happy person outside of a few issues that I tend to avoid and ignore and are disasters, so I can see my subconscious attempt that self-sabotage on that fact alone.

The next big unknown that I'm curious about is: when I'm actually talking with someone... where do I start? I have years of built up thoughts and assumptions and angles and self-diagnoses and red herrings and walls and compartmentalizations built up in my head I'm worried that I'll freeze up and not be able to articulate what I'm actually going through when faced with summing it all up concisely. I do think I have more clarity around it all than ever, but I tend to keep these things inside/hidden in my life so I don't have much if any practice communicating them. Is it a good idea to organize my thoughts on paper and come in prepared, or would that end up being overly restrictive and harmful if I'm way off the mark about root causes or have put too much importance on one area or another or lack self-awareness about some of my issues?

posted by gregoryg at 6:02 AM on May 13, 2020 [3 favorites]

Most visits with a new therapist will start with them taking your history and asking you a lot of questions about your life, family, friends, work, etc., so don't worry too much about knowing where to start. It may take a couple of sessions to do that before you get deeper into your goals or your worries. I think it's a great idea to write your questions for your therapist on one piece of paper, your fears/concerns on another, and your goals/wishes for therapy on another. You can ask your therapist if they want to see them first or wait until they've gotten to know you in the first session.

It's okay to be anxious about this- many people are! Don't worry if you don't get to everything right away either. Therapy is a journey!
posted by Mouse Army at 6:24 AM on May 13, 2020 [3 favorites]

On your followup question about where to start, and as someone else who's looked at their pile of baggage before starting therapy and wondered how to communicate it in a way that could possibly make sense to another person: it doesn't really matter. Or, rather, there's no specifically wrong approach here.

It's fine to go in saying that you have a lot you want to talk about but you don't know where to start; a half-decent therapist will be able to work with that. It's also fine to bring a list of topics or areas you know you want to cover - when I first started seeing my most recent therapist, I brought a set of index cards with a topic on each which she held onto, and we periodically looked through them to check that we hadn't missed something (although, unsurprisingly, the majority of what I wanted to cover came up naturally during the process through a tangent or a discussion about a different related topic).

The best way to approach it for you is likely to depend on the kind of person you. Are you someone who sees a gordian knot and feels overwhelmed by not knowing where to begin, or someone who spots a thread in the unholy tangle and starts working at it? If you're the former, coming to the therapist with an "I don't know where to begin" approach might be helpful, as well as being a gentle way of easing yourself into getting used to asking others for help. If you're the latter, you might get more value out of some pre-work, like prioritising the things you're finding most distressing/you most want help with now and making a list of other topics that you know you want to visit at some point but they're less pressing than the top-priority items and then bringing those lists to therapy.

It's not your job to have figured out perfectly in advance how, specifically, you need the therapy to work or to help you. That's part of the job that the therapy itself can do.

Also I'm in the UK rather than the US, so I don't know if this is possible, but salvia's list above would be a huge phone anxiety trigger for me. I have only ever sought out new therapists via email, rather than phone. It can be a lot easier to write an email that says "I am struggling with x y z specific things and I know I'm going to find them difficult to bring up in a session so I'd appreciate it if you could bear those things in mind and encourage me to talk about them" than to have that conversation in person during a session for the first time. Therapy has gone better for me when I've given the therapist some prompts in writing beforehand about what I'm looking for, compared to when I've approached it with both me and the therapist as blank slates to one another until we begin the work.
posted by terretu at 7:03 AM on May 13, 2020

Let your therapist guide you. They’re the expert. They get new clients all the time, and many (most?) know even less than you do. It’s not that different than a job interview or a first date: they’ll start by asking basic questions, and when one of your responses seems like there’s more to say, they’ll dig deeper on that. Pretty soon, you’ll be engrossed in conversation.

Personally, I keep an outline of things on my mind in my Notes app, but it has been pretty common in the past that I end up talking about something completely different in a session. I still keep the outline just to stop storing everything in my head.
posted by kevinbelt at 7:09 AM on May 13, 2020 [1 favorite]

On your 'where to start?' question - bear in mind that this might be a long process. You have plenty of time to 'get to the point' - you don't have to do it all perfectly on day one by walking in and providing a perfectly eloquent, itemised list of exactly what your issues are, in order of importance. Starting out by describing them inadequately, awkwardly, insufficiently, vaguely, on your first visit, is kind of par for the course.

Having therapy over time is not only about talking your issues through, it's also about learning how to be in therapy, how to talk to your therapist, how to gradually build up some trust and some common knowledge about you. That takes time. Your therapist will know that, especially if you tell them you've never been in therapy before.

And honestly, the things that you think are the big issues on day one are just one subset of the things you'll probably end up having useful conversations about. The wiring underneath, the gnarly stuff that's hard to deal with, can really only emerge gradually, over time, in the context of a whole range of conversations with your therapist. As you get used to therapy, as you start to dump your thoughts and feelings gradually on the floor between you and your therapist, they will know how to look for threads to pull out and help you unravel. You don't have to do it all perfectly on day one.
posted by penguin pie at 8:30 AM on May 13, 2020 [1 favorite]

Here is a very TL;DR version of some of the types of therapy you could receive (it's been 10 years since I took a psychology course so my info may be out of date / wrong). I have experience with basically 2 types:

Psychodynamic / family /talk therapy (Freudian school): You will go in and basically just talk and talk and talk while the therapist makes notes and asks you questions. They will ask about your parents, childhood, how you feel towards authority figures. Very internally focused and helping you realize how childhood trauma (which this framework posits we all experience - not talking about extreme forms of abuse, just normal growing up processes) may affect your experiences today. All about excavating old memories and emotions you may have buried. May bring emotional catharsis but doesn't give real-world coping strategies.

Cognitive Behavioural Therapy: Helps you identify processes occurring between your Experiences, Thoughts and Behaviour. Sometimes, experiences, thoughts and behaviour become wrapped up in a vicious cycle, as with anxiety. By isolating each one of these processes and identifying how one affects another, it's possible to break these cycles and develop new ways of behaving and coping. This framework was amazing for helping me with depression and social anxiety.

Apologies to all the psychologists out there if I butchered my descriptions of your discipline. OP, I would recommend starting out with a group therapy session to get your feet wet. You'll see that many people have similar problems and that the solutions developed over centuries of academic study do in fact have proven results.
posted by winterportage at 8:40 AM on May 13, 2020

Someone with a PsyD has a doctorate that focuses on training for practice; PsyD programs are much less selective than PhD programs, which in psychology focus more on research in addition to practice.

This is true. DrMsEld is a practicing, licensed clinical psychologist (PhD) and her opinion of PsyD programs is, while obviously liable to bias, not wonderful. The idea that PhD recipients have more focus on research, both during school/training and as a hypothetical career goal afterwards, is accurate but, in practice, what it does is it gives them a much better and more up to date grasp of what treatment modalities are research backed and how to better apply them. For what it's worth it's certainly harder to get into and through a PhD program than a PsyD program from what my research and experience, via her, has shown.
posted by RolandOfEld at 8:44 AM on May 13, 2020

Hey! It's OK. All these people, it's their job to help you figure out what your insurance will pay for, and then it's your therapist's job to get you to talk about what you need to. You don't have to know what to do, I promise.

Salvia's guide is really good. Honestly, this is the hardest part, at least for me -- actually finding a therapist and setting up an appointment. After that, you just go. And you do the work, sure, but I'm so anxious about phone calls, etc. that that was the hardest part.

Also remember that if you go see someone and you don't like them, you're not obligated to keep seeing them. It's a relationship. And that they aren't expecting you to "know what to do" when you get there. It's their job to walk you through it.

Cheers to you for getting started. I'm excited for you. Therapy has really helped me in my life.
posted by fiercecupcake at 9:47 AM on May 13, 2020

The next big unknown that I'm curious about is: when I'm actually talking with someone... where do I start?

My general rule, which has served me very well over the years, is that whatever I’m talking about in therapy is what I’m supposed to be talking about in therapy. Understanding why in this time I’ve set aside to work on myself I’ve decided to update my therapist on Astronomy news* can start the process nicely.

That said, at this point in history virtually every patient in the world is talking to their therapist about the effects of the coronavirus on their life. If you’re at a loss for something to start with, that’s a good one.

(*) The reason is that when I’m feeling insecure I fall back on to provable scientific facts. Then the question is why am I feeling insecure right now, and we’re off to the races.
posted by Tell Me No Lies at 10:49 AM on May 13, 2020 [1 favorite]

If you have a friend you trust, saying “I feel a ton of anxiety about medical stuff, is there any chance you could look up which therapists in my area take my insurance and are seeing patients?” is help that you could ask for. I have friends who find this kind of thing easy—pleasant, even, to be able to help a friend in a tangible way.
posted by tchemgrrl at 10:54 AM on May 13, 2020 [1 favorite]

when I'm actually talking with someone... where do I start?

Your therapist will help you but it can be a good idea to think in advance... what are your goals? Like they can be basic, not like "Get my shit together" more like "Be able to go to the grocery store without getting incredibly angry at everyone"

Usually the first visit is an "intake" visit with a lot of questions just to get an idea of what your life is like, what your support structures are, who you are as a person. They'll probably ask about what you'd like to work on and you guys can work on that together. I'll second what everyone is saying, early visits can be really cathartic and can feel weird and to someone anxious that feeling can sometimes feel like "Aaaaaaaa" so it's worth making a plan to stick it out for like 3-4 visits to let your amygdala settle.
posted by jessamyn at 6:21 PM on May 13, 2020 [1 favorite]

I wouldn't worry so much about your therapist's level of education, degree or license type as its been found to be only a weak predictor in terms of client outcomes. Of course PhDs are gonna think they offer more than a PsyD or a masters level clinician, but honestly from the perspective of whether or not therapy is working for you, its really one of the last things to consider imo. Its the relationship between the client and therapist or the "therapeutic alliance" which is a much stronger predictor of positive client outcomes. Its all about (or at least A LOT about) fit so really listen to yourself on this and don't be afraid to end treatment with a provider if after 3 sessions it's not feeling right.
posted by flamk at 1:16 AM on May 14, 2020 [1 favorite]

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