Seeking advice on finding an appropriate therapist
January 4, 2022 3:09 AM Subscribe
I’m interested in going to therapy, but I’m not sure how to find an appropriate therapist. My past experiences with therapy haven’t been great. I’m looking for a therapist who will do more than just listen. Instead, I'm looking for someone who will offer guidance and concrete suggestions. I’m also not interested in antidepressants or other psych drugs.
My main reason for seeking therapy is to figure out how to be less stressed about my unhappy marriage (fixing the marriage would be nice but is probably not feasible). My wife and I are a cis-het couple in our mid-50s. We’ve been together for 15 years, but we’re not a good match. There’s nothing horrible going on – no abuse, infidelity, overt mental illness, or drug addiction/alcoholism. The problem is that we’re two very different people with different priorities and interests – and my feeling is that I’ve largely had to give up my own goals to help my wife achieve hers. At my initiative, we did try couples counseling a few years ago, and it didn’t go well. My wife was very reluctant to go, though she ultimately agreed. She never fully engaged with the process, and we stopped after four sessions (also, in a rare instance of complete agreement, we both felt that the therapist was inept). The counseling didn’t lead to any substantial improvements (in fact, the sessions led to arguments on the way home), and things have only gotten worse since then.
Divorce is not an option. My wife can’t work full-time, and I wouldn't be able to afford alimony (we’re living paycheck-to-paycheck). More importantly, my wife has two chronic health conditions that are causing only mild disability currently but are going to get worse over time and will likely require expensive treatment in the future. I simply can’t leave her to live on her own.
My second major reason for going to therapy is to address a long-standing problem with procrastination, distractibility, indecisiveness, and disorganization. These issues have really hurt me in both my personal and professional lives.
My third reason is to get help with a constant stream of negative thoughts and memories. My brain has a vast library of embarrassing or painful memories, and those recollections are on endless auto-play in my head.
A few other things to note:
I doubt that I can persuade my wife to go back to counseling. She seems happier with the marriage than I am, and she doesn’t really believe in counseling, in general.
I’m not depressed currently – just garden-variety unhappy. I did have a period of depression a couple of decades ago when I was still single. I tried a number of different meds, alone and in combination. None of them helped, and a few had very unpleasant side effects. I’m not going down that road again.
Also during my period of depression, I was treated by several psychiatrists. They were all nice, well-meaning people, but they didn’t offer anything in the way of insights, practical advice, or guidance. All I did was vent about my problems during 50-minute sessions – and the venting didn’t lead to any improvements or changes. Thankfully, I recovered from the depression anyway and have not had any relapses since then.
So, in summary, I’m looking for suggestions on how to find a therapist who can offer something more than sympathetic listening – and who won’t push meds on me. I’m fine with doing reading and homework assignments. In fact, I want them.
I’m hoping the hive mind can give me some pointers here. I’m not in any crisis situation, so I have some time to research options.
My main reason for seeking therapy is to figure out how to be less stressed about my unhappy marriage (fixing the marriage would be nice but is probably not feasible). My wife and I are a cis-het couple in our mid-50s. We’ve been together for 15 years, but we’re not a good match. There’s nothing horrible going on – no abuse, infidelity, overt mental illness, or drug addiction/alcoholism. The problem is that we’re two very different people with different priorities and interests – and my feeling is that I’ve largely had to give up my own goals to help my wife achieve hers. At my initiative, we did try couples counseling a few years ago, and it didn’t go well. My wife was very reluctant to go, though she ultimately agreed. She never fully engaged with the process, and we stopped after four sessions (also, in a rare instance of complete agreement, we both felt that the therapist was inept). The counseling didn’t lead to any substantial improvements (in fact, the sessions led to arguments on the way home), and things have only gotten worse since then.
Divorce is not an option. My wife can’t work full-time, and I wouldn't be able to afford alimony (we’re living paycheck-to-paycheck). More importantly, my wife has two chronic health conditions that are causing only mild disability currently but are going to get worse over time and will likely require expensive treatment in the future. I simply can’t leave her to live on her own.
My second major reason for going to therapy is to address a long-standing problem with procrastination, distractibility, indecisiveness, and disorganization. These issues have really hurt me in both my personal and professional lives.
My third reason is to get help with a constant stream of negative thoughts and memories. My brain has a vast library of embarrassing or painful memories, and those recollections are on endless auto-play in my head.
A few other things to note:
I doubt that I can persuade my wife to go back to counseling. She seems happier with the marriage than I am, and she doesn’t really believe in counseling, in general.
I’m not depressed currently – just garden-variety unhappy. I did have a period of depression a couple of decades ago when I was still single. I tried a number of different meds, alone and in combination. None of them helped, and a few had very unpleasant side effects. I’m not going down that road again.
Also during my period of depression, I was treated by several psychiatrists. They were all nice, well-meaning people, but they didn’t offer anything in the way of insights, practical advice, or guidance. All I did was vent about my problems during 50-minute sessions – and the venting didn’t lead to any improvements or changes. Thankfully, I recovered from the depression anyway and have not had any relapses since then.
So, in summary, I’m looking for suggestions on how to find a therapist who can offer something more than sympathetic listening – and who won’t push meds on me. I’m fine with doing reading and homework assignments. In fact, I want them.
I’m hoping the hive mind can give me some pointers here. I’m not in any crisis situation, so I have some time to research options.
Something you might not know about therapy is that you're supposed to be allowed to question your therapist's plan. They're not supposed to be like a teacher with a fixed syllabus to follow, or a religious leader who you need to believe without questioning. You're supposed to have room to say "This isn't what I need" or "It upsets me when you X and Y" or "I want something different."
Not all therapists are going to give you that room. But it's supposed to be there. Even when they can't actually give you what you want, you deserve a conversation about why you want it and what it means to you. If a therapist won't even give you that, they're not a good match.
I've had pretty good luck just flat-out telling therapists "I want advice about this situation" or "I want a plan for making progress on this issue." Sometimes I've had a therapist ask "What do you want?" and said "You're the expert! I want to know what I should be doing to get better!" Good therapists have responded well to that—even if their reaction was "I don't know what you should do this time" or "Well, I've got some questions first," it's helped steer the conversation in a useful direction.
(Also: demanding what you need from your therapist might be hard for you. It might feel weird or shitty or impossible even when you know it's allowed. You can also talk about that in therapy, or at least think about it if you aren't ready to talk about it out loud. And that might help you understand how you feel about discussing your needs with other people—like your wife. "I'm going to practice this skill with my therapist, learn from my reaction, and then use what I learn with other people" is a really useful way to work.)
posted by nebulawindphone at 5:30 AM on January 4, 2022 [6 favorites]
Not all therapists are going to give you that room. But it's supposed to be there. Even when they can't actually give you what you want, you deserve a conversation about why you want it and what it means to you. If a therapist won't even give you that, they're not a good match.
I've had pretty good luck just flat-out telling therapists "I want advice about this situation" or "I want a plan for making progress on this issue." Sometimes I've had a therapist ask "What do you want?" and said "You're the expert! I want to know what I should be doing to get better!" Good therapists have responded well to that—even if their reaction was "I don't know what you should do this time" or "Well, I've got some questions first," it's helped steer the conversation in a useful direction.
(Also: demanding what you need from your therapist might be hard for you. It might feel weird or shitty or impossible even when you know it's allowed. You can also talk about that in therapy, or at least think about it if you aren't ready to talk about it out loud. And that might help you understand how you feel about discussing your needs with other people—like your wife. "I'm going to practice this skill with my therapist, learn from my reaction, and then use what I learn with other people" is a really useful way to work.)
posted by nebulawindphone at 5:30 AM on January 4, 2022 [6 favorites]
Oh, also also: You might get more practical real-world advice from a therapist with a social work or counseling background. "LCSW" or "licensed clinical social worker" is a good qualification to look for. So are ones with "counselor" in them. It's not an absolute thing, but I think people with those backgrounds are more likely to think in terms of empowering a client and less likely to think in terms of figuring out what's wrong with a patient.
posted by nebulawindphone at 5:33 AM on January 4, 2022 [7 favorites]
posted by nebulawindphone at 5:33 AM on January 4, 2022 [7 favorites]
Hey! We're relationship twins! We've been a bit more fortunate in the health and finance department but the unhappy marriage with the wife who won't go to counseling... I've been considering an AskMeFi on the topic so your post certainly grabbed my attention.
I can't help with the therapist but something that's helped me a lot in the last 5 years has been meditation and Buddhist philosophy. Meditation is brain training. It trains your brain to pay attention to the present so that when it wanders off down some dark alley you can notice that and remind it that the alley is mostly imaginary and that's not what's happening right now anyway. That's a shitty description but it takes a lot more time/words to give a real description. If you're interested let me know. The Buddhist philosophy puts context around the things you learn from the meditation, gives you a framework for looking at life so that it doesn't make you miserable, and gives you some pro-tips to make the meditation more effective. I sincerely believe that will improve anyone's life, but also that it's not a quick fix. It's learning new skills and that always takes time.
DM if interested, or if you just want someone to commiserate with. I'm an introvert so "where do I find someone to talk to" has been a similar AskMeFi question that I've considered.
Best of luck.
posted by Awfki at 5:51 AM on January 4, 2022 [3 favorites]
I can't help with the therapist but something that's helped me a lot in the last 5 years has been meditation and Buddhist philosophy. Meditation is brain training. It trains your brain to pay attention to the present so that when it wanders off down some dark alley you can notice that and remind it that the alley is mostly imaginary and that's not what's happening right now anyway. That's a shitty description but it takes a lot more time/words to give a real description. If you're interested let me know. The Buddhist philosophy puts context around the things you learn from the meditation, gives you a framework for looking at life so that it doesn't make you miserable, and gives you some pro-tips to make the meditation more effective. I sincerely believe that will improve anyone's life, but also that it's not a quick fix. It's learning new skills and that always takes time.
DM if interested, or if you just want someone to commiserate with. I'm an introvert so "where do I find someone to talk to" has been a similar AskMeFi question that I've considered.
Best of luck.
posted by Awfki at 5:51 AM on January 4, 2022 [3 favorites]
My second major reason for going to therapy is to address a long-standing problem with procrastination, distractibility, indecisiveness, and disorganization. These issues have really hurt me in both my personal and professional lives.
Have you been tested or evaluated for some flavor of ADHD? I was in my 40s when I got my life-changing evaluation. If you already have a diagnosis, never mind. But if you do not have a diagnosis and it turns out you do have ADHD, going to therapy to deal with your procrastination, disorganization, indecisiveness, etc. will not be as helpful as one might hope. At least based on my own experience. I spent years of therapy that was very helpful except for the thing that actually took me to therapy in the first place, which turned out to be ADHD.
I am not a doctor, I cannot diagnose anyone, your mileage may vary, etc.
(Also, let me just briefly note that I find your decision about staying in your marriage bc of your spouse’s health admirable. I had a friend who made a similar decision in similar circumstances, although many people do not. I’m not convinced I could make that decision and I salute you.)
posted by Bella Donna at 6:12 AM on January 4, 2022 [2 favorites]
Have you been tested or evaluated for some flavor of ADHD? I was in my 40s when I got my life-changing evaluation. If you already have a diagnosis, never mind. But if you do not have a diagnosis and it turns out you do have ADHD, going to therapy to deal with your procrastination, disorganization, indecisiveness, etc. will not be as helpful as one might hope. At least based on my own experience. I spent years of therapy that was very helpful except for the thing that actually took me to therapy in the first place, which turned out to be ADHD.
I am not a doctor, I cannot diagnose anyone, your mileage may vary, etc.
(Also, let me just briefly note that I find your decision about staying in your marriage bc of your spouse’s health admirable. I had a friend who made a similar decision in similar circumstances, although many people do not. I’m not convinced I could make that decision and I salute you.)
posted by Bella Donna at 6:12 AM on January 4, 2022 [2 favorites]
I'm trained as a therapist, but don't currently practice. I've also sought therapy for myself and I was recently disappointed with therapy I received, because I was looking for something more directive.
You can be as specific as you've been here, with a therapist, about what you're looking for. In fact, you could print your post out and hand it to them. You can say on the phone - "I'm looking for someone who can be directive and suggest strategies to try."
A good therapist will want to know what you're looking for, and won't be dissuaded by the fact that you've had mismatches with therapists in the past. In fact, it's good information for them, in terms of meeting your needs.
I know that your number one reason for wanting therapy is your unhappiness in your marriage, but the second and third reasons scream out for a therapist that can provide ADHD coaching - which includes more guidance and concrete suggestions. You may not have ADHD, but they are the people who specialize in helping with "procrastination, distractibility, indecisiveness, and disorganization". And they may suggest meditation - as suggested by Awfki.
Your number one reason for seeking therapy - figuring out how to be less stressed by your unhappy marriage - I recommend looking for a narrative therapist. Narrative therapy is a type of cognitive therapy that can help you re-story/create new perspectives on your situation so that you can feel more yourself, more of the time.
Many narrative therapists also work with clients with ADHD, so that's the center of the Venn diagram I'm suggesting - find a narrative therapist who works with clients with ADHD. (Narrative therapists also tend to not need you to have a formal diagnosis, in order to work on the problems that are bothering you. I've put the term ADHD on this - it may not be appropriate - but you can stick with "procrastination, distractibility, indecisiveness, and disorganization". )
posted by vitabellosi at 6:19 AM on January 4, 2022 [7 favorites]
You can be as specific as you've been here, with a therapist, about what you're looking for. In fact, you could print your post out and hand it to them. You can say on the phone - "I'm looking for someone who can be directive and suggest strategies to try."
A good therapist will want to know what you're looking for, and won't be dissuaded by the fact that you've had mismatches with therapists in the past. In fact, it's good information for them, in terms of meeting your needs.
I know that your number one reason for wanting therapy is your unhappiness in your marriage, but the second and third reasons scream out for a therapist that can provide ADHD coaching - which includes more guidance and concrete suggestions. You may not have ADHD, but they are the people who specialize in helping with "procrastination, distractibility, indecisiveness, and disorganization". And they may suggest meditation - as suggested by Awfki.
Your number one reason for seeking therapy - figuring out how to be less stressed by your unhappy marriage - I recommend looking for a narrative therapist. Narrative therapy is a type of cognitive therapy that can help you re-story/create new perspectives on your situation so that you can feel more yourself, more of the time.
Many narrative therapists also work with clients with ADHD, so that's the center of the Venn diagram I'm suggesting - find a narrative therapist who works with clients with ADHD. (Narrative therapists also tend to not need you to have a formal diagnosis, in order to work on the problems that are bothering you. I've put the term ADHD on this - it may not be appropriate - but you can stick with "procrastination, distractibility, indecisiveness, and disorganization". )
posted by vitabellosi at 6:19 AM on January 4, 2022 [7 favorites]
To be clear: what I am saying is that therapy is super helpful for people with ADHD if everyone knows that they have ADHD, therapist and patient alike. Otherwise, at least in my case, therapy was helpful for lots of other things (such as dealing with my asshole dad ) but in the absence of a valid ADHD diagnosis, therapy was no help at all with my procrastination and other symptoms.
My understanding is that it’s a super challenging time to try to find a therapist these days. So I wish you best of luck and do not be afraid to interview several therapists if possible and to ask them how they work after you explain what you were looking for. I had one therapist who never talked, and he was useless. While I enjoy talking, I need a therapist who can help me explore my goals and then how to reach them while keeping me on track during our sessions.
Because of my distractibility, I would often go to therapy sessions and end up talking about 1 billion things that were important to me but did not actually contribute to changing my behavior. So when I found a different therapist a few years later, I explained that I needed help staying on topic. And then at the beginning of every session I would have a list of things and we would agree on what we had time to discuss and which things could wait or did not fit in with my therapeutic goals.
That particular person, who specialized in a kind of more human DBT (Which is to say personalized, and also they had a recovery background which was useful for me as a codependent type) was the best therapist I have ever had, and I’ve been through a few.
I will also note that as a human person, they fucked up on occasion. This is likely to happen and when it happens, bringing it to the attention of your therapist is incredibly useful as an exercise for both of you. I learn to be truly honest with that particular therapist in a way that I was not with any others because it felt safe to be truly honest. I also want to note that there is no one perfect therapist out there. Lots of different people with lots of different approaches may be able to help you if you feel comfortable with them and their approach. Good luck!
posted by Bella Donna at 6:27 AM on January 4, 2022 [5 favorites]
My understanding is that it’s a super challenging time to try to find a therapist these days. So I wish you best of luck and do not be afraid to interview several therapists if possible and to ask them how they work after you explain what you were looking for. I had one therapist who never talked, and he was useless. While I enjoy talking, I need a therapist who can help me explore my goals and then how to reach them while keeping me on track during our sessions.
Because of my distractibility, I would often go to therapy sessions and end up talking about 1 billion things that were important to me but did not actually contribute to changing my behavior. So when I found a different therapist a few years later, I explained that I needed help staying on topic. And then at the beginning of every session I would have a list of things and we would agree on what we had time to discuss and which things could wait or did not fit in with my therapeutic goals.
That particular person, who specialized in a kind of more human DBT (Which is to say personalized, and also they had a recovery background which was useful for me as a codependent type) was the best therapist I have ever had, and I’ve been through a few.
I will also note that as a human person, they fucked up on occasion. This is likely to happen and when it happens, bringing it to the attention of your therapist is incredibly useful as an exercise for both of you. I learn to be truly honest with that particular therapist in a way that I was not with any others because it felt safe to be truly honest. I also want to note that there is no one perfect therapist out there. Lots of different people with lots of different approaches may be able to help you if you feel comfortable with them and their approach. Good luck!
posted by Bella Donna at 6:27 AM on January 4, 2022 [5 favorites]
I accidentally got one therapist a few years ago who was pretty confrontational, in a way that probably isn’t great for lots of patients but worked awesome for me! I’d say something that happened and say, “well, I guess that’s just the way the world works,” and she’d say “No! I disagree with that. It seems like you’re assuming ______ but it’s not necessarily true. ” It seemed unconventional but I grew a lot out of that therapeutic relationship.
When I was looking for a new therapist because I’d moved, I told potential therapists in our initial “fit” phone calls that this style of more directed, opinionated therapy really worked for me. One said she’d be happy to try it even though it’s different from how she normally works, and it’s been working great!
Just wanted to share my story that it’s possible! They weren’t even some obscure modality/type of therapist - I think just general, maybe CBT or other common types if I had to guess. I’m sure you can find someone who can help you very effectively - good luck!
posted by estlin at 11:06 AM on January 4, 2022 [1 favorite]
When I was looking for a new therapist because I’d moved, I told potential therapists in our initial “fit” phone calls that this style of more directed, opinionated therapy really worked for me. One said she’d be happy to try it even though it’s different from how she normally works, and it’s been working great!
Just wanted to share my story that it’s possible! They weren’t even some obscure modality/type of therapist - I think just general, maybe CBT or other common types if I had to guess. I’m sure you can find someone who can help you very effectively - good luck!
posted by estlin at 11:06 AM on January 4, 2022 [1 favorite]
My off-and-on therapist seems like she would be a good fit for you. Please DM for contact info if interested.
posted by troywestfield at 8:39 AM on January 5, 2022
posted by troywestfield at 8:39 AM on January 5, 2022
This thread is closed to new comments.
1. A good therapist is very worth it (mine has, no exaggeration, probably saved my sanity), but there is some trial-and-error involved in finding one because it's all about fit, which ultimately depends on the kinds of intangibles that underlie chemistry between people (a different kind of chemistry than when dating, but still chemistry). Some of the rules of thumb below can help but you will probably still need to just try a few. Give someone a session or two, and if you don't have a good feeling about them, try another one. You might have to kiss a few frogs to find a prince. Don't give up after the first one, and don't sink a lot of time into somebody you feel blah about.
2. If you're not looking for medication, you don't need to restrict yourself to psychiatrists. In my experience, people with psychology degrees (but not the MD) are not only far more numerous and cheaper, but they are also trained to do more than sympathetic listening. Look for people who call themselves counsellors or therapists or clinical psychologists.
3. Do your homework. You've already got a good start here in thinking about what you want, but it's worth taking the time to really see what options you have available and think about what they mean for you. In my case, I googled extensively for anybody near me, including reading reviews I could find of them as well as anything they'd written on their webpage. Different things matter to different people -- therapists vary widely in what approach they are trained in (e.g., CBT, DBT, EMDR, inner child, etc), what problem areas they tend to focus on (anxiety, relationships, etc), and what their training and background is in (their degrees, what kinds of practices they have worked in, etc). Learn what those things are and have a good think about which of them you care about. In my case, I knew I wanted somebody with certain knowledge (about gender/queer issues, relationships, as well as non-neurotypicality) as well as somebody who was just smart and flexible and not overtly wedded to a specific methodology. I chose my therapist in part because I loved how he wrote about what he does on his webpage, and because his background was varied and interesting enough that I thought he would have those traits. It took me a while to find him but it was well worth the time.
4. At the same time, don't let the perfect be the enemy of the good. I was hesitant about my guy because he was far enough away that we would either have to do telehealth sometimes or I'd spend more time in transit than I wanted. But he ticked enough other boxes that I thought it was worth at least checking out. I'm very glad I did, in part because with covid it's ended up mainly telehealth for everyone anyway, but also because he is so great and the telehealth thing has bothered me much less than I thought it would. Point is, you're probably not going to find someone who is exactly perfect, so be willing to relax some things to see if they end up mattering to you as much as you think they will.
Hope this helps! As I said, it can sometimes take a while but it really is worth it.
posted by contrapositive at 3:27 AM on January 4, 2022 [4 favorites]