How to Select the Right Therapist for You

Author Article
It’s not easy to find a good therapist. Therapy can be incredibly cost-prohibitive, for one thing, depending on insurance coverage. Then, there are scheduling constraints (it’s hard to find a therapist with open hours if you work a traditional 9-to-5), location constraints, general time constraints, and trying to suss out whether or not the person you’re spilling all your shit to is the right one to help you unpack and repack it.

There are also hundreds of different types of therapy, which is daunting when you’re not sure what kind will work best for you, in addition to a slew of different categories of mental health professional, all of which come with different credentials and training. It’s a lot to navigate, especially when you’re a first-time client. Here are some tips for selecting the right kind of help.

What kind of therapy do I need?

There are many, many different types of therapy, and mental health professionals don’t necessarily use a one-type-fits-all approach. If you’re suffering from something like generalized anxiety disorder or depression, for instance, your therapist might use a combination of treatments in your sessions. But let’s take a look at some of the most common options:

Cognitive behavioral therapy (CBT):

CBT is a common treatment that focuses on looking at certain behavioral patterns and coming up with a game plan of sorts to break them. “It’s trying to help you change your behavior through thinking differently about your situation,” Ryan Howes, PhD., a clinical psychologist in Pasadena, California, says. “So, for instance, if you get anxious about confronting your boss at work, or anxiety stops you from making any movement, CBT can help you reframe that. Instead of thinking of all the horrible things that could happen, it’ll help you imagine positive outcomes.”

CBT therapy is usually short-term—your therapist helps you determine a specific goal, and will then work with you to help regulate your emotions and develop new personal coping strategies. It can be especially good for treating anxiety and depression.

Psychodynamic therapies:

Psychodynamic therapies like psychoanalysis and Jungian therapy involve digging into your past to look at the root of whatever problems you’re trying to treat. So, for instance, if you’re anxious about confronting a boss, a psychodynamic approach will try to determine when this particular anxiety first took place, and how early traumas and relationships contributed to your current predicament. “The idea is that being able to uncover early thoughts will free you up to be able to act differently,” Howes says.

Psychoanalysis can take a long time (like, years) and many therapists will use it in tandem with a CBT approach, which is something worth bringing up in a consultation.

Specialized therapies for specific disorders:

Both CBT and psychodynamic therapies (or a combination of the two) can be effective for more general mental health disorders, but f you’re struggling with a particular disorder, like an eating disorder or post-traumatic stress, it may be more beneficial to see a mental health professional who specializes in treatments targeting those issues. For instance, if you’ve suffered from trauma, there’s Eye Movement Desensitization and Reprocessing (EMDR) therapy; if you’re mourning a tragic death, there’s grief therapy.

The thing about therapy, though, is that you might think that CBT will help you the best, or that you want deep psychoanalysis, or that only one specific kind of treatment will help you. The reality is that therapists will often use multiple approaches when treating a patient, and though it’s helpful to find a therapist who specializes in a particular disorder, when you start seeing one, you may discover it’s not just anxiety or grief that’s causing you problems.

“Nobody walks in the door with one problem,” Faith Tanney, a psychologist with a private practice in Washington, D.C., says. “You have to be able to switch around with different modalities.”

More importantly, if you like your therapist and feel comfortable opening up to them, the type of treatment they specialize in might not make a difference. “If you think your therapist is healing you, stay with them,” Tanney says. “If you don’t think your therapist is helping you, I don’t care what kind of therapy they’re doing.”

What kind of mental health professional should I see?

There are a few different kinds of people licensed and qualified to provide therapy. Psychologists have PhDs and PsyDs, and are trained in both psychotherapy and assessment testing. Licensed clinical social workers are also trained in psychotherapy and perform functionally similar mental health services to psychologists, but don’t have doctorates. A licensed mental health counselor is also trained in psychotherapy and will treat patients much in the same way as a social worker. Psychiatrists primarily focus on chemical imbalances. They have medical doctorates, and prescribe medication (in some states psychologists can also prescribe medication).

A psychiatrist is the one to see if you’re in the market for mood-correcting meds, but if you’re looking for talk therapy, you’re better off seeing a psychologist, social worker, or counselor. Psychologists tend to see people with serious mental illness, while social workers and counselors can help patients suffering from more common forms of psychological distress. In the long run, though, as long as you’re seeing someone with a valid state-issued license (states have online license lookups for psychologistscounselors, and clinical social works), if you like your therapist, their specific credentials don’t really make a difference.

What research should I do before having a consultation?

There are a lot of different factors that go into finding a therapist. Therapy is expensive, so if your health insurance will cover it, it’s a good idea to search for one through your provider, though some therapists will offer counseling on a sliding scale. Location is also a big factor—if you think it’ll be difficult for you to get to your therapist, you’ll probably be less likely to make your appointments, especially when you’re still in the “feeling it out” stage.

If you’re looking to treat a certain problem, you do want to know your therapist has some experience in that realm. If you struggle with anxiety, your therapist should know how to treat anxiety. If you have bulimia, your therapist should have experience with patients with eating disorders. Websites like therapy.organd Psychology Today will tell you a little about your prospective therapist’s areas of expertise, so you can get an idea of what you’re working with.

Then, you have to take into account your personal preferences. “Some people feel like they want someone who fits in a certain age bracket. Some want someone a little older and wiser, some people feel more comfortable talking to someone around the same age,” Howes says. “Gender is a big part of it, too. I tell people to try to make a list of three therapists that on paper seem to fit their criteria, that are the right age and specialize in that area, and go on a test drive with these therapists.”

What questions should I ask in my first session?

When you’ve selected your three therapists, you should set up a consultation, either by phone or in person. Sometimes therapists won’t charge for consultations, and sometimes they will, so it’s a good idea to suss that out beforehand.

Once you’re at the consultation, though, the most important thing is to get a feel for your therapist. “This is like a first date,” Tanney says. She recommends skipping over the “where did you go to school” part of the standard dating questionnaire—“They’re already licensed, so you can sue them,” she jokes—and getting right into your particular goals and how they might go about helping you achieve them.

“You got my name from someone. You’ve read up on me, and see that I have the skills, I have the techniques, I have the training, I have the experience. Now we’ll see if that works for you,” Tanney says. “We set goals for therapy, I’ll tell you what I think we’re going to work on first, and you say whether or not they make sense to you.”

It’s also a good idea to ask your therapist for their specific policies—some require advance notice if you’re canceling a session, for instance, or will only allow you to take a couple weeks off without being charged. Some will ask that you give them a few weeks’ heads up before you decide to end therapy. “If you feel the time has come to leave, I would ask that you let me know, so we have a couple weeks to discuss that,” Tanney, who has her patients sign a contract, says.

Ultimately, go with your gut

The real key to finding a therapist is exactly like trying to find a romantic partner—there has to be a “click.” After a couple of sessions, if you don’t feel like your therapist is someone you can open up to, then they are not the therapist for you.

“It’s about trusting your gut,” Howes says. “The therapist can be the most highly trained person in the world with years of experience and mountains of books, but if you can’t open up to them, the therapist is worthless. Or they can be a brand new trainee, but if you feel safe and comfortable talking to them, the therapy will be more beneficial.”

So if you’ve test-driven a few therapists, pick the one you felt the most comfortable talking with. And if, after a few sessions, or a few months, or a few years, you decide you’ve lost that connection, it’s okay to leave. “You have the power. This person is in your employ,” Tanney says. Don’t ghost, and do bring up your specific concerns about your therapist to them, since it’s always a good idea to give someone an explanation as to why you think things aren’t working. But you’re the boss. After all, as Tanney says, “This is not your friend, this is your worker bee.”

When Therapy Makes Things Worse

Author Article

Therapy is often touted as a ‘safe place’, when, in fact, it is anything but that. It is a place where we surface our demons, dig deep into our neuroses, explore our habit patterns and challenge belief systems that often do more harm than good. Therapy is a place where we learn to be uncomfortable with ourselves, so we can, ultimately, become more comfortable with who we are and our place in the world.

We Don’t ‘Get Better’

The spiritual teacher Ram Dass is often quoted as saying that, after 40 years of psychotherapy and meditation (for those unfamiliar, Richard Alpert (Ram Dass) is himself a clinical psychologist and former Harvard professor), he is no less neurotic than he’s ever been—now, he simply invites his neuroses over for tea. This statement is a bellwether for those of us doing ‘the work’, in that it intones exactly what happens through the process of self-examination. We don’t ‘get better’. We diminish the charge of our struggle, reframe it and use what we’ve learned to make less destructive—and, in some cases, more productive—choices.

Before that happens, however, we need to sit in our sh*t—surfacing our demons, digging in the dirt and deconstructing those repeated patterns of thought and behavior that seemingly and inexhaustibly dog our relationships, careers, family interactions and, often, every other aspect of our lives from finances to self-care. There is nothing to predict what prompts us to make this choice. It might be a bad breakup, the loss of a jobgriefaround a loved one or the simple existential realization that something just isn’t quite right with our world. No matter what the motivation, the call to self-examination is a powerful one and, more often than not, heeding that call can, at least for a time, make matters worse.

Shedding Light in the Dark

We all have skeletons. Life sometimes opens the door on that closet, amplifying the power those pesky little fellows have over us. For instance, a reflexive tendency to people please might, in the context of new relationships, turn the corner into unhealthy co-dependence, or unmet needs may, over time, build resentments that express themselves, if not as misplaced temper tantrums, at least in uncharacteristic acting out.

This leaves us with a choice—we can stay stuck in our struggle, or we can turn inward and explore our own inner darkness—our shadow self. Should we choose the latter, we will find that, just like a child who learns without a nightlight there’s nothing to be afraid of in the dark, entering the tomb of our inner landscape can, ultimately, only shed light on our darkness. In making the choice to turn inward and enter the tomb, we also choose to first recognize, and then embrace, our vulnerabilities, imperfections and, sometimes, flat out forays into Crazy Town. That’s when things get interesting and, more often than not, more than a bit messy. It’s also where ‘the work’ happens.

Becoming a Witness

One of the most important tools in this process is developing something called ‘witness consciousness’. This is a state of natural presence—operative word here being presence—where we objectively observe our thoughts and actions. It is not a state of disaffectation or emotional absence—quite the opposite. Witness consciousness is a relaxing back into an awareness of what is happening for us—in our bodies, with our thoughts and with our emotions. It is the lever that prods us into our discomfort and prompts us to see what it is we’re actually up to, and a window into our rapprochement—the way we are in the world. That window overlooks a landscape that leads to myriad paths tracking back to everything from our attachment issues to the shaping of our worldview. With the revelation of that perspective, we quickly discover we aren’t in Kansas anymore.

WikiMedia Commons
Source: WikiMedia Commons

This revelation is very much a reflection of what, in literature, folklore and narratology (the study of narrative and narrative structure) has come to be called ‘The Hero’s Journey’. It is the bridge between our challenges and transformation, and the light we shed in the tomb of our inner landscape. In that abyss, we have the opportunity to discover our true nature; what in post-modern spiritual practice has come to be called our ‘authentic self’, and, in Buddhist psychology, our ‘awakened heart’.

Embracing Change

Truth be told, we’re going to fight it. Whether we’re talking about a story arc or real life, the revelation of the authentic self means change, and change is hard, to say the least. We’re going to push back—and hard. Shedding the mortal coil of our daily burdens, and coming to terms with our true nature, is probably one of the most significant, dangerous and enlightening choices we can make, but it does not come easily. Shedding that mortal coil is, in some ways, like a shedding, not of a skin, but the armor of what we feel is our humanity, which, in truth, is our isolating sensibility of separateness.

In the space between our challenges and our transformation, we encounter, not only the ego-self—the separate self we believe ourselves to be—and the authentic or awakened self, but the shadow-self. Engaging the shadow-self, and the energies it brings to our lives, we are presented with an opportunity for an integration of these disparate elements of self. The tomb becomes a womb—a sacred space where we experience the death of the former and the birth of new, entering into the light of our transformed, whole and integrated self.

The Hero’s Journey is not for the faint of heart, and many turn back on their path. For those willing to stay the course, braving the perils of our own inner the landscape and embracing the change we so fear, there dawns not only a new day, but a new way of being in the world.

© 2019 Michael J. Formica, All Rights Reserved

5 Things to Know Before Attending Your First Psychiatry Appointment

See Healthline Article Here
By Vania Manipod

As a psychiatrist, I often hear from my patients during their initial visit about how long they’ve been putting off seeing a psychiatrist out of fear. They also talk about how nervous they were leading up to the appointment.

First, if you’ve taken that major step to set an appointment, I commend you because I know it’s not an easy thing to do. Second, if the thought of attending your first psychiatry appointment has you stressing, one way to help tackle this is knowing what to expect ahead of time.

This can be anything from coming prepared with your full medical and psychiatric history to being open to the fact that your first session may evoke certain emotions — and knowing that this is totally OK.

So, if you’ve made your first appointment with a psychiatrist, read below to find out what you can expect from your first visit, in addition to tips to help you prep and feel more at ease.

Come prepared with your medical history

You’ll be asked about your medical and psychiatric history — personal and family — so be prepared by bringing the following:

  • a complete list of medications, in addition to psychiatric medications
  • a list of any and all psychiatric medications you might have tried in the past, including how long you took them for
  • your medical concerns and any diagnoses
  • family history of psychiatric issues, if there are any

Also, if you’ve seen a psychiatrist in the past, it’s very helpful to bring a copy of those records, or have your records sent from the previous office to the new psychiatrist you’ll be seeing.

Be prepared for the psychiatrist to ask you questions

Once you’re in your session, you can expect that the psychiatrist will ask you the reason you’re coming in to see them. They might ask in a variety of different ways, including:

  • “So, what brings you in today?”
  • “Tell me what you’re here for.”
  • “How’re you doing?”
  • “How can I help you?”

Being asked an open-ended question might make you nervous, especially if you don’t know where to begin or how to start. Take heed in knowing that there’s truly no wrong way to answer and a good psychiatrist will guide you through the interview.

If, however, you want to come prepared, be sure to communicate what you’ve been experiencing and also, if you feel comfortable, share the goals you’d like to achieve from being in treatment.

It’s OK to experience different emotions

You may cry, feel awkward, or experience various kinds of emotions while discussing your concerns, but know that it’s completely normal and fine.

Being open and sharing your story takes a lot of strength and courage, which can feel emotionally exhausting, especially if you’ve suppressed your emotions for quite a long time. Any standard psychiatry office will have a box of tissues, so don’t hesitate to use them. After all, that’s what they’re there for.

Some of the questions asked about your history may bring up sensitive issues, such as history of trauma or abuse. If you don’t feel comfortable or ready to share, please know that it’s OK to let the psychiatrist know that it’s a sensitive topic and that you’re not ready to discuss the issue in further detail.

You’ll work towards creating a plan for the future

Since most psychiatrists generally provide medication management, options for treatment will be discussed at the end of your session. A treatment plan may consist of:

  • medication options
  • referrals for psychotherapy
  • level of care needed, for example, if more intensive care is needed to appropriately address your symptoms, options to find an appropriate treatment program will be discussed
  • any recommended labs or procedures such as baseline tests prior to starting medications or tests to rule out any possible medical conditions that may contribute to symptoms

If you have any questions about your diagnosis, treatment, or wish to share any concerns you have, be sure to communicate them at this point before the end of the session.

Your first psychiatrist might not be the one for you

Even though the psychiatrist leads the session, go in with the mentality that you’re meeting your psychiatrist to see if they’re the right fit for you as well. Keep in mind that the best predictor of successful treatment depends on the quality of the therapeutic relationship.

So, if the connection doesn’t evolve over time and you don’t feel your issues are being addressed, at that point you can search for another psychiatrist and get a second opinion.

What to do after your first session

  • Often after the first visit, things will pop up in your mind that you wished you had asked. Take note of these things and be sure to write them down so you won’t forget to mention them next visit.
  • If you left your first visit feeling badly, know that building the therapeutic relationship may take more than one visit. So, unless your appointment turned out horrible and unredeemable, see how things go during the next few visits.

The bottom line

Feeling anxious about seeing a psychiatrist is a common feeling, but don’t let those fears interfere with you getting the help and treatment that you deserve and need. Having a general understanding of what kinds of questions will be asked and topics that will be discussed can definitely alleviate some of your concerns and make you feel more comfortable at your first appointment.

And remember, sometimes the first psychiatrist you see may not necessarily turn out to be the best fit for you. After all, this is your care and treatment — you deserve a psychiatrist who you feel comfortable with, who’s willing to answer your questions, and who will collaborate with you to achieve your treatment goals.

Helping Others Get The Psychological Support They Need

See Psychology Today Article Here
By George S. Everly

According to many authorities, currently there is a mental healthcrisis. School shootings, workplace violence, random acts of violent rage, even some acts of terrorism have been associated with, and even blamed on, acute psychological distress, depression, or more frank mental illness. Data from the National Institute of Mental Health suggests that roughly 10 million individuals in the US suffer from some form of severe mental illness characterized by severe impairments to their daily lives. But it has been further estimated that up to another 30 million people may have to deal with psychological conditions that serve to mildly or moderately interfere with their ability to most effectively function socially or at the workplace. How does society begin to address such a problem when traditional approaches are sometimes disappointing?

Clker-Free-Vector-Images/Pixabay
Source: Clker-Free-Vector-Images/Pixabay

Using psychological first aid (PFA) to foster resilience may be one nontraditional approach. This is the third in a series of three discussions of PFA. PFA may be defined as a supportive presence designed to achieve three goals: 1) stabilize (prevent acute stress from worsening) 2) mitigate (de-escalate and dampen acute distress) 3) advocate for and facilitate access to professional assistance, if necessary. Two previous discussions in this series have addressed the first and second goals. This discussion addresses the third goal, facilitating access to supportive psychological care, if needed.

EXPANDING THE REACH OF MENTAL HEALTH SUPPORT

Getting friends, family, and others for whom you care the psychological assistance they might need is not always easy.  The first step is recognition. Family members, friends, co-workers, healthcare providers, and educators all have the potential to reduce the stigma associated with seeking mental health care. Furthermore, they have the potential to help others seek professional guidance when needed. This is achieved by serving as compassionate frontline advocates for the pursuit of such professional mental health support.

Kahll/Pixabay
Source: Kahll/Pixabay

EARLY RECOGNITION

As noted, the first step to removing the stigma associated with seeking mental health support as well as expanding the reach of mental health services is recognition of the  problem. Listed below is a sampling of psychological or behavioral patterns of concern. Recognition of signs and symptoms such as these is a foundation of PFA.

1. Depression: Everyone gets sad, but depression is another matter.  The warning signs of a significant depressive episode may be a persistent sad mood for a couple of weeks combined with a loss of appetite, chronic fatigue, awakening early in the morning (often around 3am) with difficulty falling back to sleep, and a loss of libido. We become especially concerned when there is a questioning of the value of life, and the loss of hope or a future orientation as these may herald suicidal ideation and even self-injurious or suicidal acts. Professional care in such cases is imperative.

2. Debilitating Fear: Fear may be thought of as apprehension and stress arousal in response to a specific threat or challenge. Most people have fears of one kind or another. We become concerned when those fears become debilitating interfering with one’s personal or occupational lives. Persistent phobic (irrational fear) avoidance can be crippling. For example the fear and avoidance of crossing bridges or of flying can be quite debilitating.

3. Anxiety: Anxiety may be defined as apprehension and stress arousal in response to an ambiguous threat or challenge. Anxiety can be especially challenging because of its ill-defined nature. It too can be crippling. When it becomes so, it is time to seek a professional opinion.

4. Posttraumatic Stress and Posttraumatic Stress Disorder (PTSD):These are perhaps more correctly envisioned as posttraumatic stress injuries (PTSI): Stress following the exposure to a trauma, usually thought of as either direct or vicarious exposure to a life threatening experience, can be intense and disorienting, but that stress reaction usually diminishes within weeks and resolves within months. When one becomes acutely disabled or continues to vividly re-imagine the experience, becomes psychologically numb or depressed, and experiences irritability, anger, or impulsiveness which interferes with one’s personal or professional life for more than a few weeks, it is then important to seek professional assistance.

5. Strange, erratic, or self-debilitating behavior of any kind, including self-medication: In the final analysis, whether it is crippling depression, anxiety, phobic avoidance, posttraumatic stress reactions, or self-debilitating behavior of any kind that interferes with one’s happiness or personal and professional life, the guidance of a mental healthcare provider should be sought.

Ricinator/Pixabay
Source: Ricinator/Pixabay

COMPASSIONATE ADVOCACY

Beyond recognition, what else can be done? If you recognize a perceived need for professional mental health guidance or support in someone you care for, work with, supervise, or mentor, compassionate advocacy may be useful in facilitating access to such care.  Listed below are some simple steps to assist.

1. Stressful life experiences can make one feel alone and overwhelmed. Make it clear there is no reason for anyone to endure distress alone.

2. Anticipate barriers to seeking professional support and be prepared to address them.  Barriers include such things as stigma, a perception of weakness, or a misunderstanding about what mental health providers actually do. Help the person reinterpret getting help as a sign of personal strength, not a weakness. Reframe seeking professional guidance more as a means of fostering resilience, less as seeking treatment. Create a positive and hopeful expectation of improvement or recovery. Point out that delaying intervention can lead to a needlessly  prolonged period of distress or inability to function effectively. Lastly, suggest that getting professional support is a sign of respect and concern for others, such as family, friends, and co-workers, as well as well, as themselves.

3. Be prepared to address practical and logistical concerns such as where and how to seek professional services. Be prepared to offer specific options about trusted providers, pastoral counseling options, telephone hotlines, financial counseling services, community-based mental health services, employee assistance programs, or other employer-based services.

4. Use encouragement in a compassionate and supportive manner, but be persistent in your encouragement.

© George S. Everly, Jr., PhD, 2019.

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