I need an advanced therapist
January 20, 2021 1:59 PM   Subscribe

Are there any tips for finding a therapist who is ready for a more "advanced" patient who doesn't want to talk about the importance of drinking tea when sad? Or do you have any direct recommendations now that geography doesn't seem to matter anymore?

Every 6 months or so I think "Wow I'd really love the benefit of a therapist to help me think about ___" (where ___ represents various things going on I would just love the input & advice of a neutral 3rd party).
Some things I'd like to talk about:
- I'm reading about neurodivergent conditions like autism & ADHD and I think that might be me. I'm seeing the world & my place in it differently & also learning about coping mechanisms/communication approaches that other people have that might help me too. I don't want to hear about whether or not "labels" are a good thing or a bad thing. I want to talk about me and how I can be a better person using all the information and resources available to me now and can I be evaluated for diagnosis and get a yes or no on that.

- I am having a serious relationship conflict with a family member that I don't know what to do with and I need someone's help thinking through what I should do, which I think is out of scope for AskMe. These situations tend to pop up once or twice a year where there's a family thing I don't know what to do about or just want to get off my chest to someone.

When I actually manage to get an appointment, I try to explain how I have moved past "Therapy 101" and I don't want to hear about how to cope when sad. I already know how to operate my brain, how to respect my feelings, how to create self-care rituals and "do something just for me every day that I enjoy", how to parent my inner child, and all that great stuff. I don't have clinical depression or even clinical anxiety at this point anymore after lots of other, effective therapy, reading, meditation, and lived experience. I'm not saying this facetiously, I just already do this stuff and don't need further help with it.

But even after listening to me say all this, if I just mention feeling temporarily down or stressed by something then they hear "Oh you're sad! I know how to help sad people! I tell them to do something that makes them happy!" and when I push back against it they don't understand why I don't want to talk about that, then I feel overwhelmed and can't move the conversation past that so I just quit therapy again. This has played out twice in a row. Another therapist just told me I was "fine" and didn't need therapy at all!

Instead what I would like is someone who can actually hear and understand what I'm saying that I just want to talk about what I want to talk about in an intelligent way and I don't want "tips".

My strategy for finding therapists has been looking for local names on various sites like TherapyToday or whatever, and I also tried an agency near me who purported to specialize in neurodivergence but the therapist didn't actually know anything about it at all. The one time I actually had a therapist who actually heard what I was saying was due to a personal recommendation in someone else's AskMe.

So given that my current strategy has failed 3 or more times what should I be doing differently? Or do you know of someone in particular? I will be paying cash.

Thank you for your help!
posted by bleep to Human Relations (17 answers total) 15 users marked this as a favorite
 
Step #1, no matter who your therapist is, is to talk less about what you don't want to talk about, and talk more about what you do. Otherwise the other stuff will be on their mind and it can derail into a conversation about all that - just part of natural human brain-ing, we take direction better when it's toward rather than away. Basically, you won't be able to *prevent* them from asking about other things, but you can minimize it and redirect when it happens.

I would suggest looking for a marriage and family therapist and saying specifically "I'm looking for someone who can help me work through (family issue) and how best to approach it." that will help you find people who are a little bit less focused on trying to make you personally the happiest you can be, and let them come in with the right mindset.

And if sometimes they get into things you don't really want to talk about, I'd suggest just saying "oh, yeah, I've got that under control and feel good about how I'm handling that. I'd rather get some help sorting out __ at the moment." People (therapists but also others) kind of assume that if you're telling them about something, it's because you want their help with it.
posted by Lady Li at 2:14 PM on January 20 [5 favorites]


To clarify what I meant above about looking for a marriage and family counselor and telling them you want to talk over the specific family issue, I'm referring here to a short-term counseling relationship in order to address a specific issue. You don't have to have an existing therapist relationship in order to set up a few appointments to talk through an issue, and I find it can be really helpful and focusing to have a targeted set of sessions. Whereas when I don't have something specific to talk about for an appointment, it tends to get open-ended and vague and "looking for a problem" in the way you describe.
posted by Lady Li at 2:19 PM on January 20 [2 favorites]


Are you sure it's a therapist you actually want? It sounds as though you're in the sort of place that therapy (as far as most therapists practise it) can't offer a lot of help, which might be why your search has been unsuccessful so far.

My suggestions would be to find other spaces to have these conversations with yourself instead.

I want to talk about me and how I can be a better person using all the information and resources available to me now and can I be evaluated for diagnosis and get a yes or no on that.

This sounds like something an autism or adult ADHD support group might be able to help with, online or offline. Have you checked those out? People who are going through similar issues might be most helpful for you in terms of charting out the next steps and giving you advice here. Getting evaluated for a diagnosis might depend on your location, but you could start by investigating things with your doctor.

These situations tend to pop up once or twice a year where there's a family thing I don't know what to do about or just want to get off my chest to someone.

I'm not trying to be flippant here, but I think this is actually something AskMe is very well equipped for! If it feels too personal, you could always anonymise it. You could also look at online support groups if you just want to talk to someone and have them listen -- there are a range of places on Reddit, for instance, relating to family conflict, where you can actually get some decent advice (the smaller subs tend to be better for that). You could also look for a space specific to whatever particular issue has come up and get some thoughts from people who have gone through something similar.

I think at the moment you have some very specific needs which you want to have met, whereas therapy is a much more general conversation, so you're unlikely to find that sort of granular help unless you've already got an established relationship with someone (meaning you'd have to go through all of the Therapy 101 stuff with them).

Personally I would try the above first before potentially wasting more money and time on therapists.
posted by fight or flight at 2:24 PM on January 20 [9 favorites]


Both of my most effective therapists (at different points in my life) had significant formal education:

* A therapist who had a PhD, published articles related to the topic I wanted to talk about, taught part-time on that topic area at a local university, and also had relevant lived experience. She had a website that demonstrated her credentials, including some of her writing on the topic. I read some of her materials before meeting with her, and it gave me confidence that she'd know what I was talking about.
* A therapist who also had a PhD, along with having completed multiple professional training programs on one of the key topics I needed to talk about. She also had a website that listed these credentials.

Advanced credentials aren't a guarantee of anything, but you might consider looking for them as a way to narrow your search to more likely candidates.
posted by dreamyshade at 2:44 PM on January 20 [2 favorites]


I wonder if what you need is a coach instead of a therapist? I work with both and these seem to be more coach-y things. I have a recommendation of someone who works online, I'll send it along.
posted by bighappyhairydog at 2:45 PM on January 20 [4 favorites]


I’ve auditioned a lot of therapists and generally—very generally—I have found that Licensed Clinical Social Workers and Doctors of Psychology tend to get into issues more deeply than Marriage and Family Therapists, who, again, generally, tend to lean toward the “gratitude journal!” end of the spectrum. I think they all just have different training and therefore, different approaches. Maybe looking for someone with different credentials might help?
posted by corey flood at 2:46 PM on January 20 [3 favorites]


So ok, here's a question. Do you want a therapist who doesn't try to address your feelings at all? Or do you want to discuss feelings, but therapists keep doing it in ways that seem... inadequate, insulting, infantilizing, irrelevant, something like that? (Your comments about "drinking tea when you're sad" make me think it might be the second.)

If you really don't want to address feelings at all, but are looking for evidence-based tools for getting through life as an autistic person with executive function problems, then I think you'll have to target your therapist search differently. There are occupational therapists and social workers who specialize in helping neurodivergent people with practical daily-life problems. And there are counselors who focus on ADHD and autism rather than mood. But you'll need to seek them out specifically.

If you do want to address feelings, but don't like the way your therapists are doing it, then I think the thing to focus on is
when I push back against it they don't understand why I don't want to talk about that, then I feel overwhelmed and can't move the conversation past that
This is... a thing I can relate to. For me, that overwhelm comes from autism and also trauma. For you, who knows where it comes from. But it's the point where this sounds like it's going from "normal therapy conversation" to "Bad Experience." Having to push back on your therapist is common and healthy and part of the process. You definitely get to have needs and boundaries in therapy, and "don't tell me to drink fucking tea" is a valid boundary. But getting so overwhelmed you have to quit therapy entirely isn't helpful, and having a therapist put you in that position isn't helpful.

So what if you make working on that overwhelm one of your goals in therapy? You could even start out with a new therapist by saying "Look, I've had bad experiences with this before. Sometimes when someone seems like they're fixating on cheering me up instead of listening to what I need, I get so overwhelmed I can't handle it and I just quit. What are we going to do instead when that happens?"
posted by nebulawindphone at 3:14 PM on January 20 [13 favorites]


You’re not wrong, per se, but most therapists aren’t there (they claim) to give you advice and when you’re seeking it from them will redirect you toward yourself. There is a fuzzy boundary and therapists are human and make mistakes and try to influence you when they should be listening etc., but I’m guessing your therapists are perceiving that you’re the sort of person that is looking for external validation to the extent that you’re willing to pay them for it, which to them might look like a person who needs practice depending on their own judgment and intuition, relaxing into their own feelings, accepting ambiguity, etc. Sure, tea can be part of that.

I’m similar to you, want someone else’s point of view, input, etc. to the extent that I’d pay a life coach and often it’s because 1) I don’t trust myself and 2) because I don’t trust myself, I don’t spend time with likeminded people or trust who I gravitate toward, and then feel the need for a lot of external validation & feedback on my perceptions and choices. You may have autism or something related (I’ve suspected I do as well) but the same advice will apply either way, which is to learn to trust yourself when things feel right and when they don’t.

It seems trite but it’s true, therapists aren’t specially qualified Existential Life Understanders, they’re just trained in techniques to get you to a place of healthy narcissism and emotional regulation so you can make your own judgments without overwhelm.

Try reading David Foster Wallace, if you haven’t. He’s not on my top 10 list but the wisdom of the tea stuff will “solve” a lot of other problems firmly lodged in the thinky brain.
posted by stoneandstar at 3:30 PM on January 20 [3 favorites]


I am pretty similar to you in many ways (same neurodivergent conditions, also needed help talking through relationship stuff, though I also had other things to work through as well). I found a great therapist by just trying to find the smartest person I could. Now, "smart" doesn't always mean "highly educated" but having a good education from a reputable institution was one of the things I looked at. More important than that was seeing what they'd written, looking for someone with a range of experience in a lot of things, and then just talking to them. In the first conversations the main thing I was looking for was seeing if he listened to what I actually said, whether he had to have things spelled out for him or could extrapolate on his own, and whether had a good combo of pushing back when he needed to and going where I led when I needed him to.

A lot of it is luck, truly. But it's possible to find. I love my therapist.

(It's also possible that "Therapy 101" has more to offer than you think, at least in the hands of the right person. I too had read all the books -- I'm an academic psychologist -- and yet my therapist has offered some insights to me at key times that really pretty much were basic therapy 101 but I hadn't had the distance or perspective to realise how they applied to me in that particular situation).
posted by forza at 3:38 PM on January 20 [9 favorites]


David Foster Wallace cannot help you with this. He's a documented abuser.

Most therapists in the US, in my experience, use CBT or CBT inspired methods, which locate problems in the individual and their cognition patterns. I would encourage you to think about looking into trauma based therapy, emotion-focused therapy, or family systems therapy instead.
posted by k8lin at 4:00 PM on January 20 [10 favorites]


I have a suggestions of a very experienced therapist that works via zoom and does longer (three hour sessions) for deep dives that one hour sessions don't cover. Their philosophy is also that therapy should not me an on-going maintenance cash-grab. They operate on a sliding scale. They also focus specifically on very dysfunctional family dynamics. I can send it via DM if you are interested.
posted by saucysault at 4:03 PM on January 20 [7 favorites]


Just my two cents on reading what you wrote.

Perhaps, with regard to the neurodivergence diagnosis, looking specifically for a neuropsychiatrist.

With regards to the family member conflict, I would personally consider that more of a psychologist/therapist issue, but I would say personally that it's perfectly okay to tell a new therapist early on that you have expectations, and that they need to be honest with you if they feel that their process won't work with those expectations, and for you to go 'hey whoa' if they seem to have ignored those or be overriding your intents nonetheless with their usual approach to treatment. In other words, approaching it more as a partner in the process than always subordinating to the therapist's guidance.

To avoid that sort of a situation to begin with, I would also see if there are psychological keywords that help describe the emotional issues you have with the family member(s), and then see if there are those that specialize in those. Are they narcissistic? Are they borderline? Are they geriatric? Are they schizophrenic? Etc.

I will note that brains are (at least in my understanding) associated networks. Picking at one string - including one emotional string - that doesn't seem related can end up pulling out a connected string of relevant associations and beliefs that can be relevant to the problem you're trying to solve. So the paragraph where you write about how they want you to talk about certain feelings -- those feelings can be symptoms, signs your psyche is signaling a particular topic. I know that firsthand myself. So I would certainly give them some leeway on that. As much as we like to think we are self-mastered, our minds also quite purposefully blind us to some symptoms and mannerisms that a third party can see.

As for your strategy, I see from the public location in your profile where you live, but I don't know if you want that in plain text on this thread. I'd ask people in a separate question (either public or anonymous) for referrals or suggestions, after doing the keyword step above. "I'm looking for neuropsychiatrists in _________" or "therapists in ______________ that have a specialty in ___________".

Good luck; hope this helps.
posted by metabaroque at 4:33 PM on January 20 [2 favorites]


All of these answers are great, I marked the ones that made me say "Oofa doofa, yes" but thank you to everyone so far.
posted by bleep at 5:29 PM on January 20 [2 favorites]


Or do you have any direct recommendations now that geography doesn't seem to matter anymore?
Just FYI, in the many states in the US, a therapist must be licensed in that state to practice, even over video, so you may be more limited than you think. I don't know the exact rules in each state, but it's worth looking around and figuring it out, if it is a therapist you want.
posted by wesleyac at 7:32 PM on January 20 [4 favorites]


So the paragraph where you write about how they want you to talk about certain feelings -- those feelings can be symptoms, signs your psyche is signaling a particular topic.

If it helps to clarify it's not that I don't want to talk about feelings, I super do, but I don't need to be lectured at that I should be self-soothing when I'm sad (etc.) as if it was the first I was hearing about this, because I already do that. I already know feelings are a symptom. Basic therapy stuff.
posted by bleep at 9:50 PM on January 20


I'm reading about neurodivergent conditions like autism & ADHD and I think that might be me. I'm seeing the world & my place in it differently & also learning about coping mechanisms/communication approaches that other people have that might help me too. I don't want to hear about whether or not "labels" are a good thing or a bad thing. I want to talk about me and how I can be a better person using all the information and resources available to me now and can I be evaluated for diagnosis and get a yes or no on that.

This is basically an ADHD coaching problem, not a therapist problem. I've tried an ADHD coach, I don't know if there are also autism coaches but there is a lot of overlap there.

I tried an ADHD coach recently and was pretty happy with them, they very much focused the sessions on what I specifically wanted to work on and didn't get into "feelings" stuff. When I did want to explain very briefly some family of origin stuff for some context, we went right back to practical matters in the present rather than having to take a loooong detour through all that.

Also in the US there are some laws about state licensing that limit therapists, but these don't apply to coaching.
posted by yohko at 11:39 PM on January 20 [2 favorites]


I have experienced similar frustrations as you have when trying to find a therapist. I started vetting them pretty severely and I no longer feel guilty or second-guess myself when I move on to try someone else. I approach the first few sessions as test sessions, and I evaluate the following things (apologies, this is long):

- Does this person believe in woo? Do they try to force that on me? "Woo" for me = naturopaths, crystals, religion, karma, etc.
- Does this person try to twist my idea of reality and downplay what I'm going through? For example, telling me that I should be kind to an abusive relative because they're family, or telling me that something "isn't that bad." I have found this to be extremely and unfortunately common.
- Does this person seem to have a limited or privileged life experience and is unable to understand or imagine how horrific life can be for others, especially people belonging to marginalized groups?
- Does this person keep up to date on research in their field(s)? Do they understand neurodivergency? Trauma?
- Does this person try to force their opinions and views on me? For example, authoritatively telling me I'm attractive when I say that I don't feel attractive.
- Does this person try to force me to do anything *at all*? Do they respect my boundaries? For example, if I say I don't want to talk about something that should be the end of that topic. No arguing.
- Does this person react well if I talk to them about an issue I have with them personally?
- Does this person seem to understand the brain and how it works?
- Does this person simplify issues and say things like, "If you just did x, then you'd achieve y"? I can go to MeFi for that, thanks.
- Does this person seem way too interested in the fine details of my abuse? There are some people who have treated me like a fascinating specimen with salacious, shocking stories, rather than as a human being who needs help.
- Does this person seem intelligent? Introspective? Well-read? Well-rounded? Do they actually listen to me or are they waiting for me to stop talking so they impress me with their profound thoughts?
- Does this person take notes? Do they seem to have reviewed their notes before our session?

It often takes just one 30 min introductory session for me to get evaluate most of the above, but sometimes it can take a couple sessions before I get a good idea of how well we'll mesh.
posted by Stoof at 9:13 AM on January 21 [5 favorites]


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