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I think this is a general problem with the health care system. Finding somebody that's worth a shit is basically impossible to do in any sensible way, even for something as straightforward as orthopedics -- my journey towards shoulder surgery has been ridiculous to the point of farce.

If it's this bad for ortho it must be unimaginably awful for anything touching mental health. What does one do? Get personal recommendations from trusted friends who've done their own searches? Are online communities any use?

I can testify to the mental health search difficulty. A close family member is searching for a therapist for emotional help dealing with an occasionally debilitating physical health issue. The first group we found through online searches ended up being a front for a multi-level-marketing group schilling essential oils. The second group, recommended by the overseeing physician at one of the most prestigious hospitals in the United States, was actually a "new age" center, whose main advise was to try homeopathic remedies. The third group, recommended glowingly on its web page, and organized by the hospital itself for sufferers of my family member's very condition, seemed to have vanished without a trace. No one had heard of it. Turns out it went defunct years ago, but no one bothered to update or remove its associated page.

That's where we stand. Infuriating. This is not quality befitting a first world nation.

I've begun to wonder if the US is really and second and a half world nation. We have so much potential, and we keep it from ourselves. Maddening.

If you can, I suggest finding a Psychotherapy institute (this is not the "institute" of "institutionalized"). They have many therapists on "staff", and you begin your treatment with an interview that's designed to match you to a therapist that works well for you. The interview asks about why you're seeking therapy and if you have any preferences for your therapist (male, female, young, old, religious, non-religious, etc.). And if you wind up not liking the therapist they recommend, you can ask for another without any fuss.

There are a number of these offices in NYC and I'm sure there are some in other cities as well. I hope you find somebody that works for you.

Oh wow. That's even worse than the therapist I tried to see after getting out of undergrad and finding myself depressed with adulthood. I said that I was depressed with the thought that life after graduation consisted exclusively of work and materialism. He said I was being immature and should grow up.

Psychotherapists and psychiatrists often seem to be utter shit at serving patients as normatively neutral medical professionals, ie: not treating their own lifestyle preferences or ideological frameworks as the One True Way to Live.

Interesting, I'm not sure it's worse than your experience. I was pretty well equipped to discount the advice of a therapist pushing prayer and weird conspiracy theories. On the other hand, your therapist was an authority on mental health who was actually confirming some of the negative thoughts that depressed people often have. That would be a lot harder to defend against.

Totally speculative, but I think this might have something to do with a high demand for good therapists. For instance, I spoke recently with a friend who was studying to practice psychoanalysis and when I asked him if he was looking for clients, he turned me down in such a way as to suggest 'you're not on the level of my clientele' or at least 'I have all the clients I need.' This was in New York where I'm sure there's a huge base of wealthy potential clients willing to pay a premium.

If therapists have no problem finding clients, word of mouth may actually be the best system for them.

Please correct me if I'm off-base here.

Or maybe he didn't want a friend as a patient. You're not supposed to bond with your therapist but if you're already a friend it's too late.

So his rejection may have been ethical and not about your worth as a patient.

I know as someone who was a caretaker[0] for a partner, it's incredibly hard to separate making responsible choices for someone who can't always make them from your regular actual friendship or relationship with them.

If you were already friends with the person, I really don't see them ever wanting to treat you formally. In the worst case they might have to make the almost impossible decision between involuntarily committing you (if they think you are a danger to yourself/others) and losing a valued friendship, or not committing you against their better instincts to preserve their friendship and risking you harming yourself/others. (Not that you are necessarily in that category ever, but if you're making a decision like "Can I ethically provide treatment for this person?" you really have to think about worst cases.)

[0] I don't have any medical/therapy training, but I wound up spending a few months taking care of someone I was dating who was having a pretty severe manic episode. Very irresponsible of her doctor, in retrospect, who later said the reason he hadn't hospitalized her was because she had me to help take care of her/watch her--and we were both college students and he had met me once, briefly.

Should have mentioned he was more of a friend-of-a-friend and he also mentioned to me that he does see acquaintances.

It's a classic NY/Jewish joke that the only doctor worth seeing is a doctor whose schedule is fully booked.

I highly recommend the book "Feeling Good" (by David Burns) as an alternative to talk therapy. I (and several of my friends) have found it instrumental in overcoming depression. More importantly, it has been clinically studied and IIRC evidence suggests that it's on par with talk therapy or medication for mild to moderate depression.

I've felt the same way. I randomly found a therapist who has been very helpful to me and who I think is quite talented, but I only found her long after I'd given up on searching (many years later). It was essentially random happenstance. Though it also required me to become more open minded about the value someone could provide despite what I consider a less than ideal scientific literacy (in this case Myers-Briggs).

Was your second session your last because the prayer suggestion made you not want to go again?

It was a little more than that - he was talking about the HAARP conspiracy theory as well. It just became clear he didn't approach the world rationally. I'm sure for some people he would be a great therapist, but not a good match for me.

So I'm a sucker for conspiracy theories, and this one's a new one on me:

http://en.wikipedia.org/wiki/High_Frequency_Active_Auroral_R...

Yeah, I hadn't heard of it either. He started talking about it and I said, "that sounds like a conspiracy theory," and then ended up looking it up in the session because he wouldn't let it go.

Wow, that's and extremely weird thing to come up from the therapist in a therapy session.

That, and the bit about prayer, sounds like the therapist was focusing on his own needs rather than the needs of the client.

Being told to pray is pretty much the antithesis of good therapy.

Not necessarily. I haven't researched it beyond what my doctor told me, but "studies have shown" that for people who have prayer as part of their life to begin with, prayer can be very helpful. Not for the GP commenter, so that suggestion wasn't helpful, but certainly for people already open to it.

And doesn't that make sense? We're not merely bodies and brains, a biological machine built to specification, arriving at a particular day exactly like each other and exactly like we were born. Besides differences in brain mechanics and chemistry from each other and from our birth, we are also each the various experiences of our history. We have as much in difference as in common with each other.

Quite apart from the question of whether prayer and what's prayed to is reality or not, people do believe in prayer and what's prayed to. If that's an effective part of their therapy, I see no reason to question it. If it lifts them out of the horror of depression and keeps them alive, I'm very happy for them, and for me if they're in my life.

-- Signed: a non-partisan, small "a" atheist.

I see (religious) prayer as simply a form of deliberate enunciation or vocalisation of hope. One would likely only pray if there was even the smallest glimmer of hope to begin with! Doesn't matter if it's a call for a miracle, there's still some dopamine activity there.

The idea of encouraging the hopeless to pray as a method of bootstrapping themselves out of depression may simply be an appeal to a more cognitive self-realisation process. This simply by the act of vocalising what the individual hopes for.

Depends why the therapist is suggesting it.

If he thinks that praying in and of itself will be valuable, eg, because the patient is religious and a calm, focussed mental state would be valuable, then it is good therapy.

If the therapist is suggesting that the patient ask God to cure him... well, that's not good therapy.

I am not religious but I can see the value of prayer.

In this case, the therapist could have understood that prayer was not a helpful suggestion - but in general, it's a valuable tool.

When used with caution, perhaps. Separation from a god-belief coincided with the start of my depression, so prayer would be super-not-helpful.

This is why prayer is better as a preventive measure, not a treatment.

Keeping faith feels healthier than trying yo regain it.

How so? Seriously praying is an involved, focused mental state. It's not flippantly wishing.

Being asked to pray is not the right way to go. But, gaining a spiritul practice of some sort and learning/practicing mindfulness can be a tremendous help to someone suffering from major depressive disorder, such as myself. It has helped me quite a bit. Though I am still depressed, as I have been my entire life. It's a good tool in my toolbox of things that I have to help myself.