get thee to a therapist
September 1, 2007 6:00 PM   Subscribe

How do I get me some therapy? How do I talk to a therapist?

Life has thrown me a few curve-balls lately. Like: money, relationship, education, friends, future plans ... all have crashed and burned in the last year. Irredeemably. Mostly due to circumstances beyond my control. Not entirely, but mostly.

And while I've been able to weather these obstacles without any major depression, I've also found that formerly simple tasks [talking to strangers, making phone calls, managing my money, writing (I freelance), getting employed] are becoming more and more difficult. Toward a point of impossibility. Simply, I don't have any skin for rejection, and I avoid situations where I might incur any.

I need to see a therapist. I know this. But I don't, in two senses of the word, know "how."

1) I don't know how to choose / pay for one. As mentioned above, I have no job, little money, and there's not a lot of relief on the visible horizon. I thought that a student getting a degree in counseling would be a good bet, but I don't know to go about finding somebody. And I can't honestly say that I can make more than bare-bones sliding scale payments. For what it's worth, I'm in West Los Angeles.

2) I don't know "how" to talk to a therapist. In high school I visited a guy (mandatory for all students) who ended up reporting on my non-scary conversations ... like that I wanted to quit the soccer team, or that I found my friend K attractive ... to my parents, who were friends of his. Three sessions, and I quit. I think understandably. In college, after my girlfriend left in the middle of the semester to go live with her 18-year-older childhood tennis instructor, I sought another counselor. I met with a woman who responded in the most rote, unhelpful way possible: I ended up loaded to the gills on Zoloft I didn't need. I felt like I was talking into a mirror. I'd read more insight in my psych 101 book. She was nice, sympathetic, and well-intentioned ... but she didn't actually 'do' anything except allow me to whine in her office for an hour a week. She never asked me tough questions or gave me really helpful advice. I really ended up resenting her, feeling the counseling was a waste of time. Finally, in the middle of one meeting she asked if I'd like to tutor her high school daughter in Spanish. I'd been talking about lost friends at the time. I didn't go back the next week.

So how do you 'do' an effective therapy session? What do you say? I need life coaching of some sort, I know. But beyond listing all the bad mojo that's gone down lately, and admitting that, you know, I'm confused and unsure of my future, what can I do? How do I get the real advice I need?
posted by anonymous to Health & Fitness (12 answers total) 13 users marked this as a favorite
As far as talking to a therapist, it will only really be useful for you if you are 100% honest with them, which means above all you must trust them. Then, be 100% honest with them, which includes your feelings about them. For example, I had a therapist who was nice, but sometimes the way he reacted weirded me out a bit. I was a bit nervous about it but I called him out on it and he seemed to respect that.

It sounds like you've had bad luck with therapists. In my experience, a lot of therapists are really lousy, for two reasons:
  1. they think that all they have to do is sit an listen to people, so many people who are in every other way not qualified to be a therapist (i.e. they're not balanced within, they have strong ego issues or even worse boundary issues [I remember one time running into a therapist during a weekend retreat who decided to take on a parental role towards me, which pissed me off])
  2. Listening is actually really hard
If I had to choose just one culprit, I'd choose #2. There's such a big difference between sitting there and looking at a person and hearing what they're saying, versus being active in the listening proces -- which sometimes, to be really effective, means cutting in, either to get clarification or to prevent a train of thought that's not going to be constructive to the session. Listening is usually thought of as a passive activity, but for a therapist it should be active.

I realize this doesn't help you find a good therapist. But at least you know what you' should be looking for.
posted by Deathalicious at 6:15 PM on September 1, 2007

FWIW, every 5-6 weeks, I spend 15 to 30 minutes talking with a psychiatrist, with my schizophrenic brother, about my brother's condition, which includes, by necessity, a regular set of questions to me, as my brother's caregiver. This guy is a board certified psychiatrist, and a licensed lawyer admitted to the Florida bar. Most of his practice is at the interface of the legal system, where seriously disturbed people have run afoul of the law, and he appears, in the mental health wings of big public hospital institutions and courts of various jurisdictions, and takes on their cases.

He knew and spoke with both our mother and father, on similar schedules, in diagnostic and therapeutic sessions for more than 10 years, after becoming my brother's psychiatrist. So he has, far more than any therapist generally ever gets, a complete view of our immediate family. And, he's probably got an I.Q. of about 180, and is incredibly perceptive and committed to his work.

He's the main reason my brother is alive today.

And yet, as he's admitted to me and to my father, he prescribes for my brother based on pharmaceutical recommendations. The mechanisms by which the drugs that control my brother's schizophrenia are not entirely understood. What he does is not voodoo, but it is not science, by anyone's standards. He sticks to a methodology that is medically accepted, and he's in the trenches 5 days, or more, every week. He got my brother on atypical anti-psychotics back in 1996, when they were still "study protocol" items for Medicaid.

I relate this simply to say, that at their very best, the mechanisms of psychotherapy are as much placebo and chance, as science. My brother foundered about, in state hospitals, jails, and various sketchy living situations for over 20 years, with a diagnosed and supposedly treatable mental illness, before meeting this good, dedicated man.

So, what I'm trying to tell you is simple:

1) Psychotherapy is something of a crap shoot, at best. You've got to be willing to roll craps, numerous times, and keep trying, if you do, to get to the people/person who can, in the end, help you. If there are any such people.
2) There's no "right" way to "do" a therapy session, or find a therapist. And so, your chances of finding someone competent, as opposed to the kind of people you've already dealt with in therapeutic roles are only going to be bettered, if you give some attention to their credentials, and trust your own gut. This latter part is especially hard to do for many people who think, perhaps rightly, that their own perceptions of others are problematic.
3) Psychotherapists aren't life coaches. Their expertise, such as it is, at the top of the spectrum, is necessarily limited by the fact that scientific understanding of how the human brain and consciousness "work" is appalling insufficient to the requirements of their work. If you have a problem that can be dealt with by short term therapies like CBT, or by prescription medications, you're lucky. If you don't, "therapy" is pretty much a continuing crapshoot. I say to you "Good Luck!" without any shred of ironic intent, insofar as finding someone who can assuredly help you.

If it hadn't been for a gunman, who pistol whipped my brother while my brother was working a night shift as a grocery stocker in a small Florida town, thus landing my brother again in a mental hospital, in a full-blown paranoid psychotic break, my brother would never would have met his current psychiatrist, who has been taking care of him since 1996. And I would never have had many interesting conversations on the subject of family dynamics and psychotherapy, these last several years, since my brother has become my charge, on the death of our parents.

Without specifics of your locale, I can't make useful suggestions regarding sources of therapeutic help, such as may be available in your area. If you live in the U.S., and want some free place to help you assess local resources in your area, I'd suggest contacting your local NAMI volunteers.
posted by paulsc at 6:50 PM on September 1, 2007 [2 favorites]

Craigslist has a listing in conjunction with psychology today:

you can read up on their specialties and credentials and make an informed decision from there.
posted by drjimmy11 at 7:55 PM on September 1, 2007 [1 favorite]

I'm sorry you've run into some very unhelpful therapists. Unfortunately, there are many out there. If I were to look for one, I would ask any friends I knew that were in counseling (and were getting better!). It sounds like you might know anyone in that situation.

My first suggestion, then, would be to agree that you should find your closest NAMI group on the NAMI website referred to above, and give them a call on Tuesday. They may have the names of therapists that they are aware of that they have had good experiences with. Since finances are a major concern, they would certainly have contact numbers for publicly funded resources, or those that will accept a sliding scale. (I am a NAMI volunteer in my area, and I know that our office has tons of resources that we can send out, tell you about over the phone, email, etc.). I've found that many times Clinical Social Workers will accept a sliding scale payment, and are sometimes just as good, if not better, therapists than psychologists or psychiatrists due to the way they have been trained. (In fact, in my experience, the psychiatrist normally is just involved if there are medication issues, but others may have had a different experience.)

Since you're in LA, there are probably a number of teaching hospitals that are in your area. You could call their departments of psychology or psychiatry and ask if they have a clinic. (Also call any college that offers a Masters in Social Work.) You would probably be getting someone in training, but sometimes it's good to have someone who is being supervised - the person is fresh at it and not jaded, plus you get the advantage of the wisdom of the supervising professor. The clinic might actually be free--I'm not sure exactly how that works. I think the downside might be that if it does work out and you click with one of the training students, they will leave at the end of their residency, so depending on where they are with their schooling, it could be that you would get started with someone and then have to switch to someone else.

I guess if it were me, I'd first call NAMI and get in touch with the person or resource that they can point me to.

As to "how" you do therapy, give the first person you go to a try for a few sessions. Explain what's been happening, why you've decided you want to try therapy, your past experiences with therapy and what didn't work, etc. Be honest! Then see how they react. They should interact with you, ask questions, clarify, ask you what your goals are, etc. and give you a good idea of the way they work. Give it a couple of sessions. If you feel like you aren't being heard or you just don't think that they are the one for you, don't hesitate to try someone else. It can be a frustrating experience, but it's worth it to find the person who is the right fit.

I hope everything works out for you.
posted by la petite marie at 8:11 PM on September 1, 2007

Go to a local hospital and talk to their finance department. I'm not sure about your state, but in my state you can register for "free care," which is care paid for by the government's uncompensated care pool. If you're unemployed you should qualify.

The paperwork can take a while and it will be a few weeks before you're approved, but after that you can see any clinician at the specific hospital you're registered for "free care" with.

The important thing is not to give up. It's really hard to get good mental health coverage even if you have insurance, and it's harder to get it if you don't have insurance or money, but you can find it somehow. You may also try to get an appointment with a clinician at a hospital or university; if you find the right person and explain your predicament they might have some ideas for you.

Good luck. This is why we need national health care.
posted by mintchip at 8:43 PM on September 1, 2007 [1 favorite]

Good therapy seems to require a certain chemistry. I have a family member who saw two therapists (both recommended and experienced) but neither did much good. The third one clicked on the first meeting and helped through some really tough times.

I think an important test is to be frank with the therapist about how you think things are going (especially if you have concerns or don't like something) and see how he or she responds. A good therapist will listen, take responsibity for their actions and address your concerns.

In addition to Clinical Social Workers, in California, Marriage and Family Therapists are licensed to work with individuals (as well as families). Both are usually more affordable than psychologists or psychiatrists and MFT's are trained specifically to do therapy. You should be able to find clinics which offer sliding scale services. If you don't like the person you are assigned, ask if you can work with someone else.
posted by metahawk at 8:53 PM on September 1, 2007

I agree with metahawk that it's partially chemistry, and finding that chemistry is just a numbers game.

1. Get a list of therapists (hopefully someone here can point you to a source of low-cost therapy).

2. Call maybe five. They'll probably walk you through some "why do you want to see me" questions. See how that felt. Ask them some general question like "what's your approach to therapy" or "how do you try to relate to your clients" or "what do you think your clients find most helpful about seeing you."

3. Set up appointments with the ones you liked best. At minimum, go to a first session with two. There's nothing wrong with this, just let them know that you want to find someone you really relate to. At the first session, talk to them a bit about what's happening in your life and see how they are (the substance), but also have a more "meta," process-oriented discussion. Ask them what they think leads to a successful therapist-client relationship, and tell them a bit about how you think you'd like therapy to work. After the first session, you'll probably have a gut reaction.
posted by salvia at 9:17 PM on September 1, 2007

You can start by searching online around things like free clinics, sliding scale counseling, and the name of your home city. A rudimentary search turns up prospects worth looking around at. Given your financial situation your choices may be pretty limited.

There isn't much you can do except keep trying options looking for the right person and the right relationship. If you can, giving it a fair number of sessions (say 6-10) might be needed to get a feel for whether you are involved in something fruitful. Of course, ultimately you have to look to your own judgment, particularly if you're really objecting to what's going on in session.

Although I know you were talking about a bad experience I would take exception to your characterizing what you were doing in therapy as whining for an hour. It is supposed to be a place where you let things out and belittling it or yourself isn't going to help.

I was lucky, when I did weekly counseling for about 5 years a few years back, to get a good relationship first time out. I did NOT expect to be at it for 5 years. Things I'd characterize from my experience as "good signs" were that although there were a good couple sessions of introductory talking about my situation, we got into goals and expectations very quickly and checked in on these things regularly (i.e., it was important from the start that therapy was actually accomplishing something). My decisions about whether or not to include drugs in treatment were respected. Pigeonholing me into a diagnosis wasn't a priority (obviously diagnosing major disorders requiring medication is a different issue).

That being said, I think a reaction along the lines of, I talk and talk and talk and talk, what is the point of this and is it going anywhere? is just inevitably going to come out repeatedly in therapy. In my experience it was always interspersed with 1) identifying things going on in my brain that I wasn't aware of or had a really questionable understanding of and 2) developing genuine working strategies for doing things different in my life that addressed real problems. These benefits kept me going and I'm glad I did.

As far as how to do therapy, I honestly think it's something you have to learn in the process. I agree with comments above that honesty is critical. You're always in counterproductive territory when you are bending the truth in service of getting a particular reaction or convincing a therapist you're doing better than you are. If you're getting uncomfortable chances are you're headed in the right direction: it is an often uncomfortable process. Be proactive about not just using therapy to vent your feelings and mull over your history and recent experiences, but also identifying what specifically you want to change in your life, what your goals are to achieve by getting therapy, and what the real-world steps are to achieve those goals
posted by nanojath at 9:31 PM on September 1, 2007

i've found my past therapists through referrals from my friend's therapist (they wouldn't see me due to being too close to my friend thus possibly compromising their relationship). a lot of ones will work with a sliding pay scale, too, i've found. in ny i've noticed that if you call as a referral from another therapist/psychiatrist, they are more willing to call you back/work with you. (versus just cold calling from a list.) it definitely takes a few sessions to get a proper vibe since i've noticed everyone sort of has their own methods of how they work. ultimately though, it comes down to if you feel comfortable with them, (so that you can be 100% honest, and get the most from the session). therapy is definitely a slow process, but in the long run definitely worth it (i've found anyways).
...hopes this adds to the already existing good advice...
posted by fuzzypantalones at 11:32 PM on September 1, 2007

If I were in your shoes, I'd first do a little research about the type of therapy, not the therapist. Then I'd select a therapist who offers that type of therapy.

In particular, I think you may benefit from cognitive behavioural therapy. The goal of this therapy is to change the way that you think. Are you afraid of math, for example? This therapist would work with you to devise a list of reasons that you are not and help change that mindset. Additionally, you would be provided with steps to try math problems. This program is only supposed to last a few weeks. Finally, efficacy has been shown in treating patients with depression (although this depends on the severity). You have listed several tasks that you need help with so this therapy may help.

Finally, I am going to suggest something else but I do think from your description therapy is essential.

I've had problems at times with making phone calls, talking to strangers, etc. Over the last few years I've found I can overcome these obstacles on my own via desensitization.

I'm going to suggest that you try to interact with other people more doing an activity that you enjoy/and where it is acceptable to reach out to strangers.

For myself that was cycling, I ran a craigslist to meet other cyclists, and went from there. Chit chat with a stranger - and over time you become friends with some of the people. At minimum, you interact/chat and have a pleasant interaction. Observe how the other person interacts with other people who are complete strangers.

Or you may try to find a group that you think may be supportive - Meet up group? Church? Pleasant interactions that reinforce that the average person does not need to be avoided.

Along the way you may find a friend who can help you wiht some of your challenges (phone call, looking for a job).

Wait - craigslist - look for or create a support group for others looking for a job.

Best of luck.
posted by Wolfster at 6:55 AM on September 2, 2007

How to do therapy?

Well, there's an interesting book about that - Focusing. The psychologist who wrote it noticed that certain people did better in therapy than others and that it wasn't necessarily dependent on the therapist, their philosophy, or technique offered. He boiled down the idea of what works - what the client can do - in this book. I really recommend it.

And, yes, find someone you can trust. That's key.

Best of luck to you in your quest for healing.
posted by pammo at 1:37 PM on September 2, 2007

Psychotherapy is safe and very effective. 79% of people who enter therapy do better than similar people who want therapy but do not obtain it. The most important predictor of success in therapy is your fit with your therapist. Their theoretical orientation matters almost not at all (CBT is no better than other kinds of therapy). I wrote an extensive answer about how to enter therapy in order to get the most out of it, largely from my understanding of the extensive outcome research, here.

I would not call NAMI about advice relating to therapy. NAMI is significantly funded, and significantly influenced by, pharmaceutical companies. If you're interested in taking medications to address your issues, then by all means give them a call, but if your interest is in therapy you would be better served to ask friends for suggestions or to call one of the local social work or psychology grad programs.

Let me reiterate that 79% of folks are helped when they enter therapy, so your chances of doing better are quite good.
posted by OmieWise at 4:13 PM on September 3, 2007

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