Therapist for chronic condition

November 7, 2023 4:43 AM

A buddy on the East Coast of the US has just received a devastating health diagnosis. They are interested in finding a therapist to help them think through issues around different potential futures, depression, etc. Is there a particular school of therapy or a particular type of therapist they should be looking for? Any advice is appreciated, especially if you or loved ones have faced a similar situation.
posted by Bella Donna to Health & Fitness (13 answers total)

Best answer: You can search providers on psychology today by issue. There are therapists who specialize in chronic illness, but to expand your search anyone who specializes in grief and coping strategies will have a ton of overlap. A chronic illness diagnosis can be, as you said, devastating. You have to grieve for yourself first.
posted by phunniemee at 4:52 AM on November 7, 2023 [1 favorite]

Response by poster: Apologies for thread sitting, will stay out of it after this: CW for self-harm.



One of the thing they want to discuss is the possibility of ending their life. I have never been in this situation myself, so it's unclear to me if therapists who specialise in chronic illness have experience with such discussions. But probably? If you know, please share. Thanks again!
posted by Bella Donna at 5:26 AM on November 7, 2023

Best answer: I usually tell people that any therapist will generally do, but you're right that this has some nuances I would certainly want in a therapist if it was me.

They may need some guidance/referrals from their diagnosing doctor, but I think it's worth trying to get referrals from local palliative/hospice care to social workers and psychologists with legitimate experience in serious/chronic illness. I don't know if they'll even do that without your friend being enrolled in one of their programs, but it's worth asking if they maintain a resource list.

Another route might be to find a local Psychiatric Nurse Practitioner or Mental Health Nurse Practitioner (PNP/MHNP). I use online pill mills for my antidepressants and adhd meds, but all my randomly-assigned prescribers have been some flavor of NP and even our 15-minute refill calls are some of the best doctor/therapist visits I've ever had. There would be a significant advantage to working with a trained medical professional as a therapist in this situation.
posted by Lyn Never at 6:54 AM on November 7, 2023 [3 favorites]

Best answer: Hi Bella Donna. So, depending on the illness and where they're being treated, they might have access to a social worker through a hospital or clinic. Good social workers can help patients articulate their needs at a very difficult time and point them to resources and options for coping. Often there's a network of resources.

For example, with end stage renal, I had a social worker who did regular depression screenings, talked with us about options for therapy or religious support, shared online resources, recommended support groups, advised us on community assistance, housing, transportation, public assistance like getting on disability -- that kind of thing. Things that make it easier. No topic was ever taboo.

phunniemee's suggestion of finding someone who focuses on grief & coping is a great idea.

Your friend should also know that considering an early exit is a pretty common thing for people to feel in this position. This would not come to a surprise to any trained mental health professional working with someone with a chronic illness, and it's often one of the first things they ask about. They're not alone, and it's not a shameful way to feel. It's good to talk to someone.
posted by mochapickle at 7:01 AM on November 7, 2023 [5 favorites]

Best answer: There is a form of Therapy focused on accepting a big change, and was mentioned to me when my spouse had a drastic injury resulting in total vision loss in one eye. ACT, maybe?

It was also helpful for him to google around and find blogs by people who were further along on the journey. For some health conditions there are existing groups that help people acclimate because they have navigated those moments, whether someone claims a new tribe is up to that person.
posted by childofTethys at 7:33 AM on November 7, 2023 [2 favorites]

Best answer: Existential may be the right school to look into, though it's not super common. Irvin Yalom, one of the most prominent practitioners, writes a lot about people facing the worst outcomes, and the whole ideology/methodology/whatever is based on the idea that we are all eventually facing death and the thing that can make this bearable is, in Viktor Frankl's phrase, the search for meaning.
posted by less-of-course at 8:45 AM on November 7, 2023 [1 favorite]

Best answer: I'm so sorry that you and your friend are having to deal with this situation! I agree that finding a therapist with experience in chronic illness would be ideal. When my husband was facing a terminal illness we met together with a therapist to talk through things, and it was helpful to have someone who really focussed on that area, as it was very specific. We found our therapist through a referral from a friend of a friend, but asking a hospital social worker or palliative care doctor could be a good route as well.

And also just want to 2nd that a therapist who specializes in this will not be at all shocked about discussing end of life choices.

Sending you lots of love and strength.
posted by bobafet at 9:32 AM on November 7, 2023 [1 favorite]

Best answer: As Lyn Never mentioned above, when I had a heart procedure, my cardiologist insisted I see a therapist and he gave me the name of three from which to choose. The diagnosing doctor might have a great recommendation.
posted by JohnnyGunn at 11:06 AM on November 7, 2023 [2 favorites]

Response by poster: The hive mind is the best, thank you so much. I found several potential therapists for my buddy based on the advice I have been offered here. And I also just let them know that they might be able to get referrals as well from their diagnosing neurologist. That would never have occurred to me so thank you so much for that advice as well. Apologies for not calling out individual contributors. I am dealing with an unwieldy tablet plus I am sad and it is late. But I am less sad than I was because I have eaten a lot of chocolate and I have gotten a lot of good advice. Thanks again!
posted by Bella Donna at 1:34 PM on November 7, 2023 [3 favorites]

Bella Donna,
If your buddy is actively considering suicide, this is an emergency situation, not a wait-for-an-appointment situation. Can you research what appropriate emergency mental health resources might be available to them, or yourself, if your friend discloses active suicidal ideation - they have a plan and a method at hand.


This could be held in reserve if your friend is not currently suicidal, but it would be good for your friend, and their wider group of friends to know there are resources beyond a therapist.
posted by citygirl at 2:34 PM on November 7, 2023 [1 favorite]

When I was looking for "major health change" therapy I found Mettle Health online. I did an info appointment with them etc. and they seemed really great. I did not end up pursuing therapy there for either me (caregiver) or my loved one (patient), but I still consider them to be in my back pocket if the need arises.

The specifically include End of Life Assistance in one of their service packages, too.
posted by gideonfrog at 2:34 PM on November 7, 2023 [3 favorites]

As mentioned above, many major, e.g., cancer centers have palliative care groups that specialize in this. It sounds like that would be something to look at in addition to standard therapy options.
posted by pjenks at 6:13 AM on November 8, 2023 [1 favorite]

Just jumping in here to say that not ALL individual choices to die are a dire emergency. Sometimes, when faced with no option other than prolonged suffering and pain it's a perfectly reasonable choice. But one that should clearly be made with the help of a neutral therapist, which is exactly what OP is asking for.

OP, sounds like you have some good recommendations, but licensing tends to vary state by state. Feel free to DM me if you happen to be in VT.
posted by nixxon at 1:45 PM on November 8, 2023 [3 favorites]