Finding a Therapist
moodcheckin.com
moodcheckin.com
I've seen more therapists in my lifetime than I care to admit. But something like this would have helped a lot when I was starting out.
The casual approach does a really nice job at breaking things down and explaining parts of the process, without feeling like it's being dumbed down at all. It makes it feel very approachable, which is very welcome, given how daunting it felt (at least for me) starting out.
I cracked up at "My therapist is dull and doesn’t laugh at my cat memes. Should I keep seeing them for therapy?".
1. What therapy is
2. How therapy fits inside a broader context of other kinds of practice - counseling, psychiatry
3. Some common misconceptions
4. How to go about a search process
Bookmarked to send to friends who are hovering in the general vicinity of finding a therapist in the future.
Pedantic alert: I know it isn't you, but your wife... but MFT degrees don't "specifically on couples and family therapy." The degree is just named that because the license is named that. The programs cover individual, couples, and family therapy but since the license isn't named that the programs aren't named that.
Also, don't be impressed by credentials (PhD, MD, etc).
After some false starts with other therapists, I was lucky to stumble on to one who focuses on short-term intensive treatment for anxiety—he specifically avoids long-term talk therapy. His belief is that two-thirds of patients who seek treatment for anxiety are ill-served by long-term treatment or medication.
I'll say this: he managed to get me stable in a fairly short amount of time. The sessions were so mentally taxing I often just went home instead of going back to work for the rest of the day, which is probably a sign they were working.
Who made you the expert to make this determination? The people it doesn't help are the people who put no effort into the process.
I’ve heard this repeated a lot. I have no doubt this is true for some people (maybe even the majority of people for which therapy doesn’t work, I don’t know). However, I wouldn’t want to claim this is the only reason. Especially since it’s a great effort for many people to even make it to therapy in the first place. They are making an effort. And it’s disheartening to then turn around and tell them they’re the problem if it doesn’t work.
I was one of those you speak of, that merely getting there was a great effort. Therapy did me immense amounts of good, where I can thankfully live a reasonably normal, content life today. But, starting out, you better believe it took everything I had just to get up the will to drive there, and even sit there, and nothing more.
I don't think you understand how much of a breakthrough it is for some people to even get to this point, and how _fragile_ things can be at that point, either. Just even getting someone to agree to sit down with a therapist can be a massive step for them - to finally start working to confront things.
Psychiatric medication does not provide a magic pill that restores your will and motivation. If only it did! Things would be so much easier, and I could have saved a lot of time on therapy.
Does the US culture there produce more stress and broken people, or us Europeans just more ashamed of admitting to this sort of thing or is it something else?
The thing is that therapy can be bought, and Americans love spending money on things. You can't buy relationships. This is my -- admittedly completely unfounded -- explanation.
I can't imagine asking my high-school friends (who were largely potheads with no career ambitions beyond working retail) for advice about getting over my fears about starting a company, for example. Or, later in life, wondering why I didn't have a girlfriend when many of my friends were nerdy workaholic commitment-phobic males. It took a perspective beyond the folks I normally hung out with to break out of my old habits. These are different from acute crises like grief, which can usually be handled through sympathetic relationships.
A therapist's incentives are strictly financial (well, mostly - many of them do also want to help in general) and their time with you is bounded by 50-minute hours, and so they're oftentimes willing to take on clients that they would not be willing to have as friends.
That being said, I think that calls into importance the civil organizations I mentioned before. How many young people are in any kind of community organization? I'd venture not many. The advantage of these kinds of community organizations is that they contain many kinds of people, united by being in the same place, rather than any common interest. The advent of social media has kind of decimated these organizations, but they're hugely important.
As a point of fact, my wife and I have met many friends through simply being in our local diocesan youth group. While we are both software engineers, most of the people we meet through the group are not. We know plumbers, teachers, entrepreneurs, video techs, etc. If we want perspective outside those of people just like us, we would just go here. If I wanted to start a business, for example, I'd just go to my men's club, and ask one of the older guys who own a business, instead of my parents or my friends. Why hire a therapist, when these guys are perfectly happy to help? All I have to do to get their advice and pick their brains is to take one evening off every month to have snacks, drink beer, and be their friend. I can not tell you how many old people in these organizations are happy to have some young blood show up and participate.
Don't get me wrong... if you don't have any of these in your life, then it makes sense for some situations to pay for it. But I do think it's sad we have all but eliminated these groups.
>our priest, our deacon, and our deacon's wife
How much do you tithe per week? Don't kid us by implying they'd give you that support if you weren't a paying customer.
Of course, as somewhat active members of the parish, we help out a lot. We volunteer for the marriage prep ministry, and I often help the men's club out with various improvement projects, by contributing brute strength or woodworking skills. Not all 'tithing' is monetary.
FWIW, it helps if you find a parish that is associated with a religious order, where the members are vowed to poverty. Diocesan priests tend to be the ones with the most monetary ambition.
Growing up in a church ministry household, the only time I ever heard my father talking about specific individuals and their financial support for the church was in situations such as when someone died and left a bequest they had to sort out. I imagine he probably did get some idea about the generosity or otherwise of some of our parishioners just through knowing them sufficiently well, but I don't think he'd ever let it show.
Of course, if my dad wanted money, he'd have stayed in accounting. As a software engineer, I was earning more only one year out of uni, even with only Australian-level engineer salaries, than he's ever earned at any point in his whole career.
It may be that the involvement strengthens resilience or strengthens the support network, or an inverted cause and effect, etc.
But to echo other commenters, it's not exactly something people are very open about in the US either, you wouldn't usually tell anyone but your very closest friends, and sometimes not even them.
But I think there's more widespread acceptance in the US that therapy has value for many people and isn't quack science, while many Europeans are quicker to reflexively dismiss it or stigmatize it as for people who are "broken". Therapy doesn't have anything to do with being broken.
Again, just anecdotal from the people I know and attitudes I've heard... zero data to back it up.
I never considered therapy as an option within reach at any point in my life, but I think it could have and can in the future help me, and 90% of people.
If you’re opposed to it, you can actually think of it as better understanding your brain and leveling up your life and career. PhD students go through 5-8 years of training on understanding the brain and human behavior. Even if one doesn’t have serious problems, it’s likely a huge help.
I have a minor ADHD that could easily be ignored or worked around. But to stay competitive as a programmer I felt that I needed to to have Adderall to keep up with my colleges. So I went to the therapist.
When I got promoted into a position where I was required to present to rooms of 50 people... I sucked. I'm terrible at public speaking. Is that an anxiety disorder, or just a personal weakness? I don't know but either way a trip to the doctor and a prescription of Xanax later and I'm great at talking to a big group.
I've been married for 5 years and the wife noticed we don't have the same type of relations that we used to. Saw a marriage counselor for a few visits and she suggested I see a different kind of therapist who could load me up with a little blue pill. Now marriage problems are gone too.
Is that gross to you? Do you think we shouldn't take a pill for everything? Because a part of me in the back of my head, is like "WHAT ARE YOU DOING?". But the bigger part of brain is happy to go with flow. See a doctor for everything, and if I have doubts about the amount of medication I'm taking.... well, there is a pill to help with that too.
I think it’s disingenuous to link people going to therapists in order to talk through their problems with your medication-centered problem-solving approach, or with drug-seeking behavior.
My father traveled all over the world sharing evidence based research with other international researchers in India, Japan, Korea, Russia, Germany, Spain, etc. Now he focuses on research oversight in the US but trust me, its very common, just not talked about due to stigmas surrounding mental health.
I think marriage counseling being so big is also affected by the heterogeneity of culture; it's very likely that you and your spouse have quite different backgrounds and expectations across a gamut of things.
Talking about problems and issues with someone is important. If it's not friends, or a community leader (priest/rabbi, etc), a therapist is a great option.
Do Europeans talk about their problems with their friends more openly? Perhaps this is the cause of the difference?
Therapists make sense to me given that in the western world, the role of our elders / guiding parental voices has been greatly diminished.
Edit: looking at the other comments I am not the only one assuming this :
"That is a significant amount of work to engage in for someone who is already in a compromised mental state :'( "
I personally think almost everyone would benefit from a good therapist, though stigma, cost and the view you're expressing are all probably huge obstacles.
There's a vicious cycle at work here: People don't want to talk about going to a therapist since they are worried about being seen as "broken", so people who could benefit from therapy don't seek it out because they don't know anyone else who does, so it becomes more unusual, which creates more of a stigma against it
Edit: I also think that perceptions are changing around, what, specifically, is broken. Your post mentions "broken people", but if a person had cancer, or a fractured bone, or an infection, we wouldn't say that the person is broken. Similarly, I think we need to realize that people with mental health issues have issues with brain chemistry, rather than being broken people.
It's a recent development, and is definitely not true of everyone. My father will probably never see a therapist, even though he most definitely could use one.
You aren't "broken" because you go to a therapist.
As I say it seems somewhat strange to me. (I hope this doesn't come across as offensive) but why would you go to a therapist of you aren't "broken" to some extent? (Maybe broken isn't the best choice of words, but I think you understand what I mean by it). It's not cheap to go to a therapist is it? It's not something we do over here. If it is more common than I realize then its not something we talk about.
Life is full of trauma and catastrophe. I think therapy is something most people would benefit from at at least some point in their life.
They might (They do, this has happened to me, and the end result was not getting care I needed, but anyway) suggest you not inform them of your insurance, then it's your fraud, not theirs.
My wife is a therapist and tries to prevent this by being as transparent as possible. She posts her rates, her calendar, and makes it very clear that she is private pay only on her website. By the time someone reaches out to her, they usually know that it is going to work because they have had the opportunity to see all of that information.
- Gender. Consider what gender you might be more comfortable with. Many of my male friends prefered female therapists, I personally felt like I was talking to a maternal figure and found I was better off with a guy. No shame in either choice.
- Trial period/multiple options. When I first moved to my current city I made appointments with multiple therapists, even seeing two simultaneously for a few weeks. You want to be comfortable with them and it can be very hard to tell from one session. This is obviously very insurance dependant though.
The other thing I'd include is that it's helpful to realize you're not trying to find a best friend. You're looking for a therapist, and how they can help you is a lot different from other relationships you might have had with people in the past. Once I realized that, it made it easier for me to adjust and find someone that fit me best, rather than someone I had to like, or enjoy my time with, or other "normal" benchmarks you tend to look for otherwise.
1: Estimating variability in outcomes attributable to therapists: A naturalistic study of outcomes in managed care - Wampold, Bruce E.,Brown, George S. (Jeb) Journal of Consulting and Clinical Psychology, Vol 73(5), Oct 2005, 914-923
2: Huppert, J. D., Bufka, L. F., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2001). Therapists, therapist variables, and cognitive-behavioral therapy outcome in a multicenter trial for panic disorder. Journal of Consulting and Clinical Psychology, 69(5), 747-755.
Its a mixed bag on age. Younger, I think, is better due to both learning more recent research and also continuous education. Relatableness is a factor. Again, all anecdotal.
When using age as the predictor I'd imagine time spent practicing is the latent metric actually being measured. You can't have 10 years of experience at age 25. That said it seems silly to use age when time spent practicing is a readily observable value.
Broad agreement among whom? As with MDs, I would expect several complex trade-offs. Particularly between the value of medical (and life) experience against the value of being trained with the current science and treatment methods. For therapists I would also expect more significant trade-offs due to the difficulty of building strong therapeutic relationships across large age differences for some patients. Are you aware of any studies on the issue?
This, combined with the fact that there is enough disposable income floating around to pay good therapists out-of-pocket means good therapists will just not take insurance (though you may have some success getting reimbursed). If you can't afford, many of those good therapists will find ways to help you pay, and perhaps even offer you a bit of a break in their rates[1]
1: One psychologist I know personally quit a non-profit to start a private practice after determining that they could do better work and make more money by charging a high rate, and doing pro-bono work for poor people who really needed help.
Licensed Marriage and Family Therapist (LMFT): In CA they have at least 3,000 hours of experience. Similar to LCSW except they have a Masters in Marriage and Family Therapy and not in Social Work.
Licensed professional counselor (LPC): Same as above but in more states than CA.
Also, Psychologists and Psychiatrists do not necessarily have more experience since they can practice the day they graduate. What is important is the amount of time they have been practicing.
http://apps.bostonglobe.com/spotlight/the-desperate-and-the-...
> Take the Restoration Center, a big, boxy building on the edge of downtown. It’s a point of entry for people in psychiatric or substance abuse crises, mostly for those who lack health insurance. In the past, they went straight to emergency rooms or jail. Now many come through here — some 2,400 people a month.
> Open 24 hours a day, seven days a week, the center has a locked psychiatric ward for short-term stays, detox units, a medical clinic, and other services. Some patients walk in on their own. Others are brought by police or referred by hospitals. Anyone reporting suicidal or homicidal thoughts is seen within 15 minutes, day or night.
> In Massachusetts, there is no equivalent. Here, hospital emergency rooms function as crisis centers, and often ineffectively: Many people with severe mental illness end up being discharged without any promise of meaningful treatment.