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Sunday, February 03, 2008

Choosing a Therapy Doc, or is that Dodo Bird?

A mom requested this one awhile ago.

How should a person go about finding a good mental health professional?

I think I've sent you all subliminal messages about what to look for when looking for help, but perhaps it is time to get a little more specific.

It's very hard. Just admitting that you want help can feel so uncomfortable, so dependent.

But if you look at it like, Nobody gets into Pre-K without immunization for measles, mumps, and rhubella, yet here I am, working at being a grown-up, and I've never had my emotional temperature taken, not by someone who can really read it. So perhaps it's time.

Oh, man, you think, and this is going to cost me.

That can be bad. But if you have no insurance or no money, that can be good. You're likely to seek services at a community mental health center or a social service agency, and it won't cost much at all.

What will you find? Probably caring, well-intentioned, well-trained professionals, young and old, who have the means to consult with other caring, well-intentioned, well-trained, experienced mental health professionals. These are people who like people, usually. Consultants and supervisors swarm agencies and mental health centers. And the training for interns in MSW, PhD, and PsyD programs is better than ever before.

So using community resources is certainly a good idea for starts. Your family doctor is another good option.

And if you have insurance, most insurance companies have some mental health benefits package, and provide affiliated provider lists that point you to licensed social workers, psychologists, and psychiatrists. Good people.

Eeny, meeny, miny, moe. Catch a tiger by the toe.

How do you pick from that list? It's not easy. You can try finding someone with a nice name and then google to see if the provider has a web site. But the likelihood is that your average Joe or Sally Mental Health Provider doesn't have a website.

Which is ridiculous, of course. Those of you who are going to become therapy docs should, absolutely should, put up a website that describes the type of therapy you do, the types of people you see, your specialties, preferences, fee schedule, etc. You'll probably not want to explain who you are and what you do on the telephone.

But if you have a website, you avoid the following telephone conversation:

New patient (catches me between patients): Uh, Dr. Therapydoc, My name is _____and I got your name from _______ and I was wondering if we could talk awhile about your practice and how you work, and the kinds of problems you treat, and how you treat them, perhaps where you went to school, who mentored you, do you have any certification in . . .

I'm listening as the list goes on, and inside I'm thinking:

This can't be good! I'm TERRIBLE at these interviews! I always fail! There's no summing up these things just to dismiss a patient's anxiety. And no time. There's the scheduling, the billing, the calls to the pri-cares, psychiatrists, teachers, and principals. There are the ex-spouses, divorce lawyers, childrens advocates, all needing a consult, too. And a therapist has her own appointments, her own children, in-laws, parents, friends, and hair-dresser to consider. Where's the time?

Oy, such an attitude. It's not good. There's no heart in it, and I've never actually said these things to anyone but FD, only recited that list to him while describing previously failed interviews, the ones in which I fumbled trying to answer the questions. The ones in which the patient-in-need-of-doctor at the end of the line has said, after listening to me patiently explain what it is that I do,

"Well, thanks very much, but I'll keep looking."

Of course.

But people do need to know what we do. Not every therapist does the same thing. We're a very mixed bunch. How are you supposed to pick one? How do you know if a doc is right or wrong for you if you can't even get an interview on the phone?

It might not matter, truthfully. The outcome research on therapy docs is that a dodo bird is a dodo bird is a dodo bird (except the CBT dodo birds, who are special). If patients like their therapist, if they get a rapport going, if there's a good feeling, good karma, call it what you will. If you get along just fine that first visit, it's likely to become a therapeutic relationship.

We're all Dodo birds.

But you can't tell people that on the telephone.

Me (armed with cybertechnology): No, I don't do interviews anymore on the phone. I suggest you take a look at my website, though. Got a pencil? Okay? Great, write this down. Hope to hear from you. Give me a call back if you still want to see me after reading through the material on the web. Terrific.

But let's say the therapists on your list aren't equipped with that technology, haven't got a kid who is a graphic designer. You can still get at least some information, usually, from the busiest therapy docs if you ask a specific question or two.

Like you can ask, By any chance, do you happen to do a particular therapy, uh, ________therapy?

Some therapies are better than others for certain problems and you can go into treatment knowing something about them.

For example, if you want to see your life and your problems through the lens of learning theory and past relationships, including family, lovers, and friends, and you have the time to sit on the couch awhile, a psychosocial approach might feel good. Almost all social workers learn that style of therapy in foundation courses and it can be extremely powerful.

But if you know that there are serious repairs that need to happen in relationships right now, or you think that someone in the family is truly suffering because of the behavior of someone else in the family, you might ask a therapist if he or she has some post-graduate training in relationship, family, or marital therapy.

If you have an addiction, you might ask if the doc has certification in addictions therapies. Although it's not always necessary, it really helps.

If you like problem solving, and don't feel your problem really warrants an overview of your entire life story down to your toilet training (psychoanalytic therapy) you might ask if the therapist comes from a problem-solving, task-centered, or behavioral background.

Or perhaps you're struggling with depression and/or anxiety and your thoughts tend to go negative and irrational. You should surely ask about cognitive-behavioral expertise.

If you just saw someone murder someone, you might ask for experience in crisis counseling or exposure therapies for post-traumatic stress.

I particularly like acceptance-commitment therapy, an outgrowth of cognitive behavioral therapy. In ACT you accept where you're at and commit to changing, growing, and trying to become a different, more complicated, more lovable human being.

But ACT is so different from bemoaning that past child abuse and blaming the stars, although you can do that, too, in ACT.

And you know I think in terms of family systems.

But sometimes it's good to have a therapist who knows how to play well with kids. Children won't necessarily talk to you unless you know how to play. A deck of cards, a box of dominoes, a few dolls. A therapist who treats kids and doesn't do just a little play therapy might not cut it for your particular little angel. On the other hand, a child's therapist who ONLY does play therapy is potentially stealing your money.

If you have terrible post-traumatic stress from a violent or cataclismic episode or three, then you might benefit from an exposure therapy.

Hypnosis
sometimes works for eating and smoking. Not always.

Feminist and empowerment therapies are really good for issues that have roots in oppression or social inequality.

So you see, it's handy to have an eclectic therapist. Use whatever model works with a particular patient, I say.

Bottom line? If you don't feel a connection with your therapist after the second visit, if you don't feel you can relate, then you probably should discuss it to see why you may not make a good team. There isn't a therapist on earth who relates to everyone, and that's as it should be.

Now. Armed with that very limited treatment overview, that first phone call should go as follow:

Patient: Hi, I got your name from ________ and wondered if you were taking new patients.

Therapist: Sure, but first, very briefly, tell me what you're looking for.

Then the patient provides a brief summary of the problem, i.e., I want to save my marriage, or I lost my mother, or My wife if cheating on me, or My kid is thirty and won't leave home, that sort of thing. Whatever it is. Brief.

The therapist then hopefully responds with an empathetic remark, like, Oh, dear. That must not feel so good. Let me see what I have for you, see if our schedules match up, if I can get you in. When did you want to come in? What day/time is best for you?

IT DOESN'T HAVE TO BE ANY MORE COMPLICATED THAN THAT.

Then, at the set appointment time, the patient discusses the problem and the goals and objectives of the therapy, assuming that these are actually important to him. Sometimes they're not. Sometimes people really do just want to talk, and talk, for weeks and months, indefinitely, and that's fine, too.

But if a patient has something in mind, certain goals to accomplish, the therapist should somehow communicate that these can be accomplish. The therapist should have a clue as to how. Because face it, the patient doesn't.

It's like a first and second date. You really don't have to see a person a second or third time if you know, deep down, that it's not a good fit. Therapy is a good place to work on NOT being co-dependent. It's a good place to put yourself and your family first.

Okay. Go get 'em.

Copyright 2008, therapydoc

14 comments:

Untreatable said...

Unfortunately when it comes to some disorders your choices very quickly diminish. Where I am there is one person qualified to treat PTSD and the majority of therapists will not take on Borderline Personality clients so your search turns from finding the perfect therapist to finding any therapist. Good post

Leora said...

Well expressed post. I'll save for my next: "how do I pick a therapist" person.

On a related topic, how would you respond to Rivka:
http://wingslikeadove.blogspot.com/2008/02/lost.html?

mother in israel said...

Do you think it's any different when you are looking for therapists for children?

Cham said...

I think this is such an important post. I feel like so many peoplehave fears about making a phone call to a therapist because they really have no idea what the process is like. Very good post, especially as a reference to others who are feeling scared of this process.

Jack said...

I have grown accustomed to being able to use the net for virtually everything I do.

It has gotten to the point that I really prefer not to work with a business that doesn't have a website that I can use to research the company.

SF Money Musings said...

None of the mental health physicians my insurance covers had websites. So I just called everyone that was within a mile radius of home, checked if they took new patients and only two people returned my call and only one had a flexible schedule in the evenings so I chose her just by process of elimination.

I did ask her some questions however such as how she treats people and the process for therapy. After the first meeting I was sold on her ability to help me understand my problems. It was also the butterflies in her office which made it easy to relax and unwind for an hour.

Simply Curious said...

I found this blog through the little Rock and Roll Cafe recipe blog, and after reading a little bit, I'm glad I stopped by. I'll be sure to bookmark you so I can come back.

therapydoc said...

SF's experience is probably very common, likewise UNTREATABLE. I think, as I indicated on a post ages ago explaining why I thought it was OKAY to tell patients about my blog (now I don't), that we're in an age where everything is changing about how people seek help. The internet community, for example, has a wealth of mental health resources that was unimaginable even a year ago!

And yet, because of legal and professional ethics, at this point I could not feel comfortable going over to the post that LEORA suggested, and offering consolation or help.

All I could say is that certain symptoms point very well to serious illness and that when an individual is very sick, either physically or emotionally, he or she needs to be seen by a doctor right away.

Not Fainthearted said...

Wow! You mean I did all that? It sounds so complicated!!

I think the last couple of paragraphs are the most important!

The people I know (myself included) who have needed to find a therapist, tend to do it in crisis mode and think that they need to work with the first person the insurance will cover who has an opening.

My consistent advice (from my own experience) is to keep looking until you find someone with whom you "click."

Not very technical but hopefully permission giving enough.

Barbara K. said...

Excellent advice. I've sent the link to a few friends who wanted to know how to find a good therapist.

stress said...

That is a very interesting post on post traumatic stress! In fact, to find out more about post traumatic stress, check out http://www.howtorelievestress.org
, they have many great articles and tips to guide you.

Shauna said...

Great advice. Might I add, asking your family doc for a referral to a mental health professional?
And some workplaces have an Employee Assistance Program in place to, well, assist you in finding professionals for various problems.
By the way, I came here from Carnival of MS Bloggers.
Shauna

therapydoc said...

Thanks. I can not believe I forgot the family docs (and the EAPs, for that matter).

One of the reasons they know the quality of the therapists in the neighborhood is that a big part of what we do (some of us) is communicate with them.

so when your therapist says, Can I speak with your primary care doc? (sign here). Say YES. It's nice when one hand knows what the other hand is doing.

Dr. Deb said...

I find every phone conversation "a meet and greet". A way to match my skills to the presenting problems and to refer out, etc. It IS so hard to find a good therapist out there!