Author Topic: choosing a therapist  (Read 1144 times)

TheGibberingPotato

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choosing a therapist
« on: January 09, 2020, 04:58:50 AM »
Hello All,
I've tried to bold-face the important parts:
I am looking for some help on find a therapist.  I have heard the advice of 'find a good fit, and don't be afraid to switch if the match isn't good'.  However, I don't find that general advice practical.  I'm not looking for a friend or someone who I 'connect' with; I'm looking for someone that can help me figure out my problems.

I spoke to my primary care doctor about, and she gave me a list of places nearby.  In fact, she encouraged me to instead use a free tele-counselor that my work offers it, to save money.  However, I have written that off; I want to seriously commit/investigate this, and when I used a tele-counselor years ago (at the time a workplace requirement to check a box) it was very artificial; the guy was nice enough and maybe reasonably skilled, but I am skeptical of doing this without a face-to-face component, or at least a video option.

I looked at one of the local place's websites, and there are 50+ therapists there.  Some are regular counselors, some PsyDs, 1 or 2 were PhDs, and a few were MDs (e.g. psychiatrists).  I do not think I have clinical depression (though maybe some mild anxiety) so I figured a psychiatrist was not where to start.  But, I do want to look at this rigorously to find out underlying causes/habits/etc... and determine an action oriented plan for me to improve myself.  Therefore, maybe PsyD/PhD is the best match? 

When selecting a therapist, what traits and characteristics might one try to identify to indicate you will have a productive experience with them?


I wont go into much detail, but I can give more if needed:
In short, I am having a 'third' life crisis of sorts (I am 35), and am struggling with finding meaning and purpose, including whether or not to have child (my wife is 35 so we are getting close to too late), as well as whether I want to actually retire early, and if so, what to pursue in 'retirement'.  In fact, these feelings started when I left school and ended up in job I did not find satisfying, and ended up directing me towards the mustachian/FIRE lifestyle.

Happy to give more detail but don't want to make this too complicated.

Thank you!

Smokystache

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Re: choosing a therapist
« Reply #1 on: January 09, 2020, 05:23:38 AM »
I'm a PhD level psychologist (former therapist).

Assuming you're in the US, virtually none of the MD/psychiatrists are providing therapy (and in my opinion, aren't trained for it anyway). They are prescribers - and that's it. Their one tool is the prescription pad - it's a powerful tool - but not when you're describing your problem as more existential/life-purpose. There ain't a pill for that.

If the website provides some description about the therapist, then it literally may be best to simply go with someone who desribes themselves and their theoretical orientation (approach to therapy and helping) in a way that resonates with you. Then follow the advice you already mentioned and give it a try, but don't be afraid to switch.

You're looking for a tricky match. Most therapists who are focused on more existential/life-purpose perspectives don't tend to be therapists who then help you come up with a concrete, 5-step plan to proceed. And many therapists who are great at coming up with clear plans tend to take your existential concerns and break them down so far that it can feel a bit artificial. Speaking generally, of course.

the "find a therapist" feature at Psychologytoday.com gives therapists some space to describe themselves, their theoretical orientation, and who they think they work best with. That may be another place to start if you're not seeing much of a description.

Best wishes on this - great of you to recognize that an outside perspective may be helpful.

TheGibberingPotato

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Re: choosing a therapist
« Reply #2 on: January 09, 2020, 05:39:40 AM »
I'm a PhD level psychologist (former therapist).

Assuming you're in the US, virtually none of the MD/psychiatrists are providing therapy (and in my opinion, aren't trained for it anyway). They are prescribers - and that's it. Their one tool is the prescription pad - it's a powerful tool - but not when you're describing your problem as more existential/life-purpose. There ain't a pill for that.

If the website provides some description about the therapist, then it literally may be best to simply go with someone who desribes themselves and their theoretical orientation (approach to therapy and helping) in a way that resonates with you. Then follow the advice you already mentioned and give it a try, but don't be afraid to switch.

You're looking for a tricky match. Most therapists who are focused on more existential/life-purpose perspectives don't tend to be therapists who then help you come up with a concrete, 5-step plan to proceed. And many therapists who are great at coming up with clear plans tend to take your existential concerns and break them down so far that it can feel a bit artificial. Speaking generally, of course.

the "find a therapist" feature at Psychologytoday.com gives therapists some space to describe themselves, their theoretical orientation, and who they think they work best with. That may be another place to start if you're not seeing much of a description.

Best wishes on this - great of you to recognize that an outside perspective may be helpful.

Thank you for your advice. 
I am a little surprised to hear not many therapists aren't well positioned to help people work on more generalized life-improvement.  I would think it is one of the most common problems.  Is it because they are more focused on acute problem, specific problems?

So, would you say then, that problems such as mine are more in the realm of self-help?  I more or less arrived at this point after several years of trying to improve my situation on my own but not really making much progress.

Do you have any thoughts on pursuing a PsyD/PhD psychologist versus a conventional therapist (i guess that is BS/MS level with maybe X hours of 'residence')?  My logic was to pursue someone with the more advanced degree, since I wanted to break my problem(s) down into component and figure things out.

Malcat

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Re: choosing a therapist
« Reply #3 on: January 09, 2020, 05:50:17 AM »
"Connecting" with a therapist doesn't mean becoming friends or even liking the person, it means that you find their therapeutic style to be compatible with your issues.

I need my therapist to be incredibly direct, and to drill down immediately. If I'm asked about my life's history, it's not going to work.

My favourite therapist was wildly unpleasant, I actually dreaded seeing him because he never pulled any punches and it was the most uncomfortable experience of my life, and that's saying a lot. However, each session was remarkably productive.

We clicked and we clicked incredibly well, even though I distinctly disliked every second with him, and his approach was exactly what I needed at the time after spending a year and a half with a really gentle, really lovely therapist whom I've referred many many people to, but who was really sub optimal for my personality.

That was my first experience with understanding therapist compatibility, I really liked the nice doctor, but it was the asshole who broke through to me.

My current therapist is also no nonsense. She spent the bulk of her career in a women's prison, so she's not only tough as nails, but she so exquisitely understands severe childhood trauma that our very first session left me dumbfounded by her insights and perspectives.

A few years ago I sought out a psychologist who was an expert on chronic pain, thinking that since that's one of my main issues, she might be a great fit. She wasn't, I really wanted it to work, so I gave it some time, but we got nowhere. She had very little experience and her insights were too superficial. She is a perfect fit for chronic pain patients who have poor coping skills, that's not me. However, I refer a lot of my chronic pain patients to her now and they find her a revelation.

Over the years I've moved a lot, my therapists have retired or died, and I've been in the position to find someone new a number of times. I've tried out dozens of therapists in my time, and I know within max 2 sessions if the therapeutic relationship is going to work.

Malcat

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Re: choosing a therapist
« Reply #4 on: January 09, 2020, 05:53:03 AM »
I'm a PhD level psychologist (former therapist).

Assuming you're in the US, virtually none of the MD/psychiatrists are providing therapy (and in my opinion, aren't trained for it anyway). They are prescribers - and that's it. Their one tool is the prescription pad - it's a powerful tool - but not when you're describing your problem as more existential/life-purpose. There ain't a pill for that.

If the website provides some description about the therapist, then it literally may be best to simply go with someone who desribes themselves and their theoretical orientation (approach to therapy and helping) in a way that resonates with you. Then follow the advice you already mentioned and give it a try, but don't be afraid to switch.

You're looking for a tricky match. Most therapists who are focused on more existential/life-purpose perspectives don't tend to be therapists who then help you come up with a concrete, 5-step plan to proceed. And many therapists who are great at coming up with clear plans tend to take your existential concerns and break them down so far that it can feel a bit artificial. Speaking generally, of course.

the "find a therapist" feature at Psychologytoday.com gives therapists some space to describe themselves, their theoretical orientation, and who they think they work best with. That may be another place to start if you're not seeing much of a description.

Best wishes on this - great of you to recognize that an outside perspective may be helpful.

Thank you for your advice. 
I am a little surprised to hear not many therapists aren't well positioned to help people work on more generalized life-improvement.  I would think it is one of the most common problems.  Is it because they are more focused on acute problem, specific problems?

So, would you say then, that problems such as mine are more in the realm of self-help?  I more or less arrived at this point after several years of trying to improve my situation on my own but not really making much progress.

Do you have any thoughts on pursuing a PsyD/PhD psychologist versus a conventional therapist (i guess that is BS/MS level with maybe X hours of 'residence')?  My logic was to pursue someone with the more advanced degree, since I wanted to break my problem(s) down into component and figure things out.

^spot on

Also to add, you may not find a one-stop-shop with a therapist. You may find an amazing therapist who helps you drill down into your issues, but then benefit from a coach to help you process and implement goals and plans.

Smokystache

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Re: choosing a therapist
« Reply #5 on: January 09, 2020, 08:51:49 AM »
I'm a PhD level psychologist (former therapist).

Assuming you're in the US, virtually none of the MD/psychiatrists are providing therapy (and in my opinion, aren't trained for it anyway). They are prescribers - and that's it. Their one tool is the prescription pad - it's a powerful tool - but not when you're describing your problem as more existential/life-purpose. There ain't a pill for that.

If the website provides some description about the therapist, then it literally may be best to simply go with someone who desribes themselves and their theoretical orientation (approach to therapy and helping) in a way that resonates with you. Then follow the advice you already mentioned and give it a try, but don't be afraid to switch.

You're looking for a tricky match. Most therapists who are focused on more existential/life-purpose perspectives don't tend to be therapists who then help you come up with a concrete, 5-step plan to proceed. And many therapists who are great at coming up with clear plans tend to take your existential concerns and break them down so far that it can feel a bit artificial. Speaking generally, of course.

the "find a therapist" feature at Psychologytoday.com gives therapists some space to describe themselves, their theoretical orientation, and who they think they work best with. That may be another place to start if you're not seeing much of a description.

Best wishes on this - great of you to recognize that an outside perspective may be helpful.

Thank you for your advice. 
I am a little surprised to hear not many therapists aren't well positioned to help people work on more generalized life-improvement.  I would think it is one of the most common problems.  Is it because they are more focused on acute problem, specific problems?

So, would you say then, that problems such as mine are more in the realm of self-help?  I more or less arrived at this point after several years of trying to improve my situation on my own but not really making much progress.

Do you have any thoughts on pursuing a PsyD/PhD psychologist versus a conventional therapist (i guess that is BS/MS level with maybe X hours of 'residence')?  My logic was to pursue someone with the more advanced degree, since I wanted to break my problem(s) down into component and figure things out.

I would definitely seek someone with an advanced degree - but there is no evidence that Phd/PsyD-level professionals would be more likely to be helpful. In the US, I would focus on finding any of these: clinical or counseling psychology (my background is "counseling psychology" and I'm biased and think it's the best, licensed professional counselor (LPC or similar acronym), LCSW (licensed clinical social worker) - but then also a written philosophy that seems to resonate with you. 

In regards to focusing on general problems, some therapists think that way. But unfortunately insurance companies don't think that way. Oversimplifying, insurance companies think in terms of Symptoms A, B, C - tell me therapist, what are your interventions for symptom A. What are your interventions for symptom B. In our chart in a binder it says that a person with Symptom A should have that problem taken care of in 4 weeks .... and if it isn't then you must be providing poor treatment ... and we're not going to pay for longer than 4 weeks. ...All of that to say that therapists being paid by insurance are trying to work within a system that is very focused on clear, simplistic diagnoses and simple treatments that supposedly help that diagnosis. .... which is pretty much the opposite of what you seem to say you're looking for. Some therapist can give the insurance company what they want and still provide a more general treatment, some focus more on playing the insurance game so they can get paid. And I should say that it is much more likley these days that people come in with a self-diagnosis and they want specific help for that: "I'm having panic attacks. I'm bipolar, I'm ...."
 

Lady SA

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Re: choosing a therapist
« Reply #6 on: January 09, 2020, 09:38:19 AM »
I chose my therapist by 1) finding reputable counseling offices that were reasonably close to my home and also within network with my insurance and then 2) reading blurbs of all the therapists at those offices, looking specifically for someone who understood/had experience with treating trauma because that's what was affecting me.

I was just on the blurb pages and ctrl+F finding in the page for key words like "trauma" or various treatments that were similar to what I thought I needed. I got hits for a few therapists, then read each of those blurbs. I picked the one I liked most, and she actually turned out not to be a great fit for me and I didn't make any progress for months. She referred me to another therapist (who I had written off originally) in the practice, who is incredible and turned me around in a single session lol

So for you, I might spend some time googling around to come up with a few key words that fit what you are experiencing and try to narrow down your list of potential therapists by searching for therapists who explicitly mention what is affecting you in their bios. If you choose a reputable counseling practice/office, it's also pretty seamless to switch therapists if you want, after the previous therapist gets a feel for what you need and has knowledge of what all the other various therapists at the practice specialize in.

Also, if you don't want to do a ton of research up front, if you just find a reputable practice with multiple therapists, you can call the office to set up an appointment and the person answering the phone should ask you for an overview of your problem and would help determine which therapist has experience/is a good fit.

SunnyDays

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Re: choosing a therapist
« Reply #7 on: January 09, 2020, 11:25:39 AM »
Maybe you don't need a therapist, but a life-coach?  It sounds more like a "what do I want to do with my life?" issue than "I'm having problems functioning" issue.  I know that's somewhat simplifying things, but it might be a place to start and see where it gets you.

TheGibberingPotato

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Re: choosing a therapist
« Reply #8 on: January 09, 2020, 11:33:27 AM »
Maybe you don't need a therapist, but a life-coach?  It sounds more like a "what do I want to do with my life?" issue than "I'm having problems functioning" issue.  I know that's somewhat simplifying things, but it might be a place to start and see where it gets you.

Thanks for the comment; yes, that could be a possibility.  To be honest, I had no idea it was a thing.  Actually, I vaguely recall a Seinfeld episode about something like this... I think I had assumed it wasn't actually real, heh.

I would say I have some of each, but the former might be contributing to the latter.  Part of what I want to address with a therapist is anxiety, and techniques to productively deal with it.

LifeHappens

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Re: choosing a therapist
« Reply #9 on: January 09, 2020, 11:43:10 AM »
Last year I needed to work through a couple challenges, but didn't fall into the level of needing full-blown therapy (which I've used in the past). Basically, I needed someone to talk with on a really deep level and for various reasons didn't want to do so with my spouse or any of my friends.

I ended up using an online counseling service and selected someone with more of a coaching orientation. It wasn't expensive, maybe $250 per month for one session a week. There are several online sites and I don't know that one is any better than another, but the one I used is called BetterHelp.

mozar

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Re: choosing a therapist
« Reply #10 on: January 09, 2020, 03:01:14 PM »
There are anxiety workbooks and cognitive behavioral therapy workbooks to try. Also tons of self help books on the topic. Jon Acuff is a good place to start. You can also search "what do I do with my life" in your favorite search engine.

kittykat

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Re: choosing a therapist
« Reply #11 on: January 09, 2020, 05:09:19 PM »
If you're dealing with any level of trauma, especially childhood trauma...however mundane it may seem, I would recommend finding a consultant level EMDR therapist.

Also, I like a therapist that listens but then helps to evaluate my situation and what I am going through, and gives me an eye opening interpretation. This is as opposed to a more novice therapist I once had that just listened, but never provided much feedback or thoughts about what is going on and what i should do. I wanted someone with experience who just tells me what they think I should do, and I eventually found someone like that.

TheGibberingPotato

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Re: choosing a therapist
« Reply #12 on: January 10, 2020, 07:08:34 AM »
If you're dealing with any level of trauma, especially childhood trauma...however mundane it may seem, I would recommend finding a consultant level EMDR therapist.

Also, I like a therapist that listens but then helps to evaluate my situation and what I am going through, and gives me an eye opening interpretation. This is as opposed to a more novice therapist I once had that just listened, but never provided much feedback or thoughts about what is going on and what i should do. I wanted someone with experience who just tells me what they think I should do, and I eventually found someone like that.

No trauma here; just a regular 1st world problem:  third-life crisis.  Aside from the 'what am I doing with my life???' stuff, I have mild anxiety related to things work.  This is partially caused (I guess) by my own tendencies to freak out too much, and also my work-life has really tossed me around recently; multiple geographical locations, multiple job changes, all due company reorganizations and such.  This coinciding with not meeting my personal goals of having certain accomplishments at work (often contributed to by being forcibly moved around too much) as well as my trouble with making large decisions (especially whether or not to have children), has more or less overwhelmed me and left me with uncertainty on how to take control of my life and put it in a positive direction.

But none of my problems are trauma or any sort of serious medical condition.

TheGibberingPotato

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Re: choosing a therapist
« Reply #13 on: January 10, 2020, 07:10:55 AM »
Last year I needed to work through a couple challenges, but didn't fall into the level of needing full-blown therapy (which I've used in the past). Basically, I needed someone to talk with on a really deep level and for various reasons didn't want to do so with my spouse or any of my friends.

I ended up using an online counseling service and selected someone with more of a coaching orientation. It wasn't expensive, maybe $250 per month for one session a week. There are several online sites and I don't know that one is any better than another, but the one I used is called BetterHelp.

I think I need more than a listener.  The coach idea I will consider... perhaps I'll think about that.

TheGibberingPotato

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Re: choosing a therapist
« Reply #14 on: January 10, 2020, 07:18:28 AM »
"Connecting" with a therapist doesn't mean becoming friends or even liking the person, it means that you find their therapeutic style to be compatible with your issues.

I need my therapist to be incredibly direct, and to drill down immediately. If I'm asked about my life's history, it's not going to work.

My favourite therapist was wildly unpleasant, I actually dreaded seeing him because he never pulled any punches and it was the most uncomfortable experience of my life, and that's saying a lot. However, each session was remarkably productive.

We clicked and we clicked incredibly well, even though I distinctly disliked every second with him, and his approach was exactly what I needed at the time after spending a year and a half with a really gentle, really lovely therapist whom I've referred many many people to, but who was really sub optimal for my personality.

That was my first experience with understanding therapist compatibility, I really liked the nice doctor, but it was the asshole who broke through to me.

My current therapist is also no nonsense. She spent the bulk of her career in a women's prison, so she's not only tough as nails, but she so exquisitely understands severe childhood trauma that our very first session left me dumbfounded by her insights and perspectives.

A few years ago I sought out a psychologist who was an expert on chronic pain, thinking that since that's one of my main issues, she might be a great fit. She wasn't, I really wanted it to work, so I gave it some time, but we got nowhere. She had very little experience and her insights were too superficial. She is a perfect fit for chronic pain patients who have poor coping skills, that's not me. However, I refer a lot of my chronic pain patients to her now and they find her a revelation.

Over the years I've moved a lot, my therapists have retired or died, and I've been in the position to find someone new a number of times. I've tried out dozens of therapists in my time, and I know within max 2 sessions if the therapeutic relationship is going to work.

I suspect that I would need the same style of therapist, or perhaps a coach as some have suggested.  I probably need help developing confidence.  I respond well to being pushed/challenged, typically... but I definitely need to respect the therapist.

I don't really need a listener, as some people do.  I am more the opposite kind of person.  Some people like for you to listen to them, but not really give them advice.  Over the years, I have learned that with these sorts of people, I need to suppress my own tendency to responsively give advice... when I hear a problem, I want to fix it (if I know how).  As such, I would be looking for someone I have respect for (or maybe trust in their ability to guide me) to help guide me on making my own decisions.  Not sure if that makes sense...

Thankfully I don't have chronic pain issues as you have.  That really sucks; I hope that the therapy helps you there.

SunnyDays

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Re: choosing a therapist
« Reply #15 on: January 10, 2020, 10:15:13 AM »
You might also consider a Behavioural Psychologist (which I was for many years, but trying not to be biased!)  Our approach is to define the problem (eg, what exact behaviours make up "lack of confidence?" - not being able to talk to strangers, not putting your ideas forth, etc.) and then identifying steps you can take to overcome this (eg, ask 5 people per day for the time, state your opinion once every work meeting, etc.).  It's very goal oriented and defines everything clearly so you know if you're making progress or not.  Your feelings are largely left out of it - it's about what you do.  Over time, as you see yourself doing things you didn't do before, your beliefs about yourself will change.